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Your Baby

Is Your Baby Safer Sleeping in a Box?

2:00

Is your baby safer sleeping in a box instead of a crib? Some parents think so and are ditching the traditional infant crib for a specially made cardboard box.

The Baby Box Co., is a Los-Angeles based business that is partnering with hospitals across the U.S. to give away free “baby boxes” to new parents.

The parents also receive a 15- minute educational video about safe sleeping habits for infants. Also included in the box are infant clothing, a mattress, a fitted sheet plus $150 worth of baby necessities.

While relatively novel in the U.S., the baby-box isn’t a new idea.  It’s modeled after a program in Finland that began more than 70 years ago. Baby boxes are aimed at curbing infant mortality rates by promoting safe sleeping practices for newborns.

New Jersey adopted the first statewide baby box program; distributing a total of 105,000 boxes. And now, Ohio has joined up, along with hospitals in Philadelphia and San Antonio, Texas.

Proponents of baby boxes say the combination of educational tools and free resources will bring America's infant mortality rate closer to those found in wealthy Nordic countries.

The goal of the Baby Box program is to bring the rate of children dying from Sudden Infant Death syndrome (SIDS) down. SIDS is usually attributed to sleep-related accidents such as strangulation, suffocation or entrapment. In 2015, the Center for Disease Control (CDC) reported about 3,700 infants died from SIDS.

The U.S. saw a drastic decline in its infant mortality rate since 1994, when the CDC launched its "Back to Sleep" campaign urging parents to have their infants sleep on their backs rather than stomachs, but disadvantaged groups still tend to be affected by SIDS more than others.

In Finland, Baby Boxes have had a dramatic impact on infant mortality since the program was launched in 1949. In the 1930s, the country's infant mortality rate was 65 deaths per 1,000 infants. Beginning in 1949, that number has shrunk to 3.5 deaths per 1,000 births— a decrease that's credited in part to baby boxes. Comparatively, the United States had an infant mortality rate of about 5.8 deaths per 1,000 births in 2016.

One University of Chicago study found that primarily lower socioeconomic groups drive the higher infant mortality rate in the U.S. after the mother and child leave the hospital. Contributing factors may include health coverage insurance and the mother’s amount of education.

What else can be done to curb infant mortality rates?

Some experts argue that policies geared toward enhanced post neonatal care for mothers of low socioeconomic status would be most effective in combating the U.S. infant mortality rate.

Universal home nurse visits, available in a number of European countries such as Finland and Austria, are one option. A provision of the Affordable Care Act offers money for a number of similar programs, such as the Nurse Family Partnership founded in 1977 in New York.

The program, which sought to rein in infant deaths in the U.S., provides low-income, first-time mothers with registered nurses who visit their homes to provide assistance and child health education for mothers.

According to the Baby Box Co. website, Baby Boxes are not only available through some hospitals, but also direct to consumer.

Story source: Avalon Zoppo, http://www.nbcnews.com/news/us-news/hospitals-u-s-give-away-free-baby-boxes-curb-infant-n732421

http://www.babyboxco.com

Daily Dose

Flying With A Baby

1:15 to read

Overheard on the plane this week:  I am in row 15 and there is the cutest most precious 4-5 month old baby girl behind me in row 16.  Key point….she is sleeping as we are making our approach!

 

The mother of the baby is traveling with her mother so there are is a grandmother along to dote on this darling baby. The mother of the baby says to her mother…”we need to wake her up now!!!”  “Mom, please wake her up as we need to feed her NOW!”  At this point the mother takes out a whisk of some sort to put into the breast milk…do you have to mix with a whisk now?

 

So…of course they wake up the baby who starts to cry, but just a bit…and then the grandmother starts to feed the baby the bottle.  The mother is saying, “Mom, just make her eat”.  Now it is really bumpy as we are getting ready to land and I was wishing I had a bottle to calm me too!

 

The baby seems to be quietly eating, but then must have stopped eating as now the mother of the baby takes the baby from the grandmother and starts to try to give her daughter the bottle.  She starts talking to the baby saying, “ please keep eating so your ears will stay clear” followed by “Mommy is going to drink the bottle, so you can see me keeping my ears clear too”.  “If you keep sucking your ears will be pain free”. 

 

Everything seems to be going well…although we still have not landed, when the mother says “I am going to force feed you to keep your ears clear!”  Uh…oh I am thinking, I know where this may be going.  But it seems so far, so good. 

 

Just as we are about to touch down I hear this gurgling noise from behind me and then the mother saying, “Oh dear she is spitting up!!”   Really, are you shocked??

 

But…I must say, the baby was quiet and content…who knows, I would have never awakened that sweet baby girl, but then again, I still believe, “never wake a sleeping baby”, even on an airplane.

 

 

 

Your Baby

Recall: Oball Baby Rattles Due to Choking Hazard

1:30

About 680,000 Kids ll Inc. Oball baby rattles have been recalled due to choking hazards.

This recall involves Oball Rattles in pink, blue, green and orange with model number 81031 printed on the inner surface of one of the plastic discs and on the packaging. The balls have 28 finger holes and measure four inches in diameter.

Embedded in the rattles are a clear plastic disc with all orange beads and two clear plastic discs with beads of varying colors on the perimeter.

Only rattles with date codes T0486, T1456, T2316, T2856 and T3065 located on a small triangle on the inner surface of the rattle are included in the recall.

The first three numbers represent the day of the year and the last digit represents the year of production.      

The firm has received 42 reports of the plastic disc breaking releasing small beads including two reports of beads found in children’s mouths and three reports of gagging.

Consumers should immediately take these recalled rattles away from young children and contact the firm to receive a full refund.

The rattles were sold at Target, Walgreens, Walmart and other retailers nationwide and online at Amazon.com, Babyhaven.com, Diapers.com, ToysRUs.com, Walgreens.com and other online retailers from January 2016 through February 2017 for between $5 and $7.  

Consumers can contact Kids II toll-free at 877-243-7314 from 8 a.m. to 5 p.m.  ET Monday through Friday or visit www.kidsii.com and click on “Recalls” at the bottom of the page for more information.

Story source: https://www.cpsc.gov/Recalls/2017/Kids-II-Recalls-Oball-Rattles

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Daily Dose

New Baby Advice for the Royals!

1.30 to read

Welcome your Royal Highness Prince (name to come) and congratulations to new parents Prince William and Duchess Kate.  I imagine (like all new parents) you are over the moon in love with your new baby boy!

There really is no way to account for that instant unconditional love that a parent feels for their child.  It truly happens the minute your newborn baby takes their first breath....God opens a parent’s heart and fills it with love!

The first few days after the baby’s birth are adrenalin filled and most of the time is spent just holding and gazing in awe at your new baby.  At the same time, the reality of having a newborn has not yet really settled in.  The days spent in the hospital go by quickly and then suddenly you, (new parents), are “discharged to home” with a few instructions and “good wishes” for your new life together.

Even in a palace (and with plenty of help I assume) the reality of parenthood begins to hit with the knowledge that this baby requires attention 24/7, and many times that means sleepless nights.  For some reason a newborn does not “understand” circadian rhythm, at least for several months, and those night time feedings lead to tired parents.   Even with nurses and nannies, a mother is breast feeding mom needs to get up every 2-4 hours to feed her precious bundle.  

Remember as a new parent you need to sleep when the baby sleeps! This means you may need a nap from 2-4 in the afternoon as that darling baby may be up from 2-4 in the middle of the night, which means you are too! All new parents feel exhausted at times; it is all part of parenting.

Newborns are also quite unpredictable and even though you may have changed, fed and burped your baby, you should know that they sometimes cry and it is hard to figure out what to do next. 

I believe in picking up your newborn baby if they are crying, as sometimes they just need to be held and cuddled (even if they keep on crying).  You can’t spoil an infant. Try swaddling and swaying with the baby as you make a “shushing” sound.  

I also recommend using a pacifier (dummy in England) because a new baby may need some non-nutritive sucking which is yet another means of self calming.

Make sure your baby sleeps on their back (lowers the risk of SIDS) but tummy time is important as well so that their heads don’t get flat. 

If your baby ever falls asleep during tummy time they must be turned over to sleep on their back - even if you are standing there watching them. NO TUMMY SLEEPING!

The first 6-8 weeks are the hardest and it is really just about “survival”. Sleep when you can, make sure you are eating (especially for breast feeding moms) and know that all new parents feel overwhelmed at first.  You really don’t need to worry about “messing up” and in about 8 weeks that precious new baby will give you a beautiful smile, and that makes those memories of long sleepless nights (and some days) fade away fairly quickly.  

Congratulations and good luck!

Daily Dose

Breathing & Your Baby

1:30 to read

The first few weeks of a newborn’s life is usually a bit “cra-cra”, for both parents and the baby.  Once you leave the hospital with your newborn reality sets in pretty quickly, and you realize that your baby not only doesn’t sleep when you want them to but that at times they may seem to be noisy breathers when they are awake and/or asleep.  

 

As parents (and pediatricians) we play close attention to a baby’s breathing pattern and you may realize that they do some “weird” stuff.  For the first several months of life a newborn is an obligate nose breather.  Some of the noisiest breathing you may notice is when your baby is sucking and eating whether at the breast or from a bottle.  It is not always the quiet time you thought it would be. But, while they may be noisy, you need to look at their color and make sure that they are nice and pink.  Look at their lips and tongue if you are worried and both should be pink…never dusky or blue. 

 

Being a noisy breather does not necessarily mean there are problems. But, if a newborn has mucous in their nose or has refluxed some milk into the back of their throat you may hear some “congested” sounds which often cause parental concern. Again, look at the baby, open up their swaddle and lift up their gown and see what their chest looks like as they breathe.  A baby should look comfortable (even if noisy) and their ribs should not show as they breathe (which is called retracting), nor should you see their tummy (which may be full and protuberan) appear to be moving up and down with any effort.  Again, they should be  pink and well oxygenated.  Try to filter out the noise and watch the breathing!

 

Lastly, newborns have some “strange” immature breathing patterns as well. If you are watching closely you may see that they often seem to breathing normally and then pause before taking another breath. This is termed “periodic breathing of the newborn” and is perfectly normal…albeit a bit frightening. Your baby may pause for 5- 0 seconds before taking a breath which is then followed by several rapid shallow breathes. Sometimes this even occurs a few times in a row and then suddenly the normal breathing pattern returns. Again, your baby should not appear to have any change in color and their breathing pattern returns to “normal” without you doing anything at all. If you think that the pauses (apnea) are lasting longer than 10 seconds you need to call your pediatrician. With the advent of cell phone video I get many video clips of babies with periodic breathing.  The frequency of periodic breathing decreases as your baby gets older…and is usually gone by 2-3 months of age.

 

You will quickly get used to some “baby nuances” you never dreamed of and realize that even a tiny baby can be a noisy eater and sleeper!! 

 

 

 

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Daily Dose

Research Supports "Back to Sleep"

1.00 to read

This month’s issue of The Archives of Pediatrics and Adolescent Medicine has an interesting article on sleep position in infants. A recent issue of The Archives of Pediatrics and Adolescent Medicine has an interesting article on sleep position in infants. As I have discussed previously, the safest position for an infant’s sleep is on their backs.

Placing a baby “back to sleep” became a routine recommendation beginning in 1994 after evidence showed that babies who slept on their backs had a much lower risk for sudden infant death syndrome. SIDS is the leading cause of death for children under the age of one year. In this study out of Yale University, researchers found that the number of babies who were put on their backs to sleep increased from 25 percent to 70 percent since the recommendations changed in 1994. But in this study, the number of caregivers heading this advice has not changed since 2001. The researchers looked at how different caregivers positioned their babies for sleep to see if there were any factors affecting a caregiver’s choice of an infant’s sleeping position. Interestingly, one of the factors was whether or not the caregiver was ever told to place the baby on their back to sleep. One-third of those surveyed said that their doctor did recommend that their child sleep on their backs, but many did not receive any recommendation. How is a parent to know how to position their baby for sleep if their doctor does not discuss sleep positioning? Another factor, which influenced a caregiver’s choice of infant sleep position, was comfort. Again, more than one-third of those surveyed felt like the baby was more comfortable on their tummy. Another 10 percent were worried that an infant might choke if they were lying on their back. It is imperative that physicians discuss infant sleep position with parents and the need to reiterate this is evident in my own practice. Just today I saw a two-month-old baby with her mother and babysitter. The mother and I had discussed “back to sleep” (this is her third child), but the babysitter happened to mention that she “puts the baby on her tummy to sleep if she is in the room watching her”. It doesn’t matter if you are in the room, sleeping next to the baby, or watching on one of those new video monitors. Placing babies on their backs to sleep remains the most effective means to reduce the risk of SIDS, and there are few exceptions. The risk of a baby sleeping on their tummy “because they seem more comfortable” is just too great. The evidence is compelling. So…. until your child is old enough to role all over their crib, put them “back to sleep” and know that you are doing the very best thing to protect your baby. Tummy time is only for awake time. Don’t cheat! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Back to Sleep Ads

1:30 to read

I am concerned that I have been seeing on line ads promoting “new” baby products for 2017, in which an infant is shown sleeping on their tummy. In other words….not following AAP guidelines that all infants are placed on their back to fall asleep.  Their should be a “law” that you cannot shoot a picture for any product being advertised for an infant in which the baby is shown sleeping in the prone position. Seeing this photo may only confuse parents about correct sleep position for their baby, especially when many of the advertisements are for sleep related products. 

 

The “back to sleep” campaign which started in 1994 has served to reduce the incidence of SIDS by over 50%. I have been fortunate in that I have not had a patient of mine die from SIDS since the recommendations for sleep position were changed. Unfortunately, when looking at data, 30% of SIDS cases report that the baby was found in the prone (tummy) position.  

 

So, if a sleep deprived new parent is surfing the net for products related to infant sleep, and then sees a baby on their tummy, they may think “maybe that is the trick “ to get my baby to sleep, never realizing the huge risk they are taking. Many a parent has come in to my office and said “ I think my baby sleeps better on their tummy”, which immediately puts a look of horror on my face!! “WHAT…I thought we had discussed that your baby must sleep on their back until they are rolling over on their own.” Some of the parents do reply, “my ……told me it was okay.” In this case do not listen to anyone about tummy sleeping!!! Discuss car seats, high chairs, pacifier options or whatever else instead….and choose which works for you. Sleep position is non negotiable. 

 

With that being said, I realize that between 4 - 7 months many babies will roll over during sleep even when placed on their backs. It is a developmental milestone for babies to roll and you cannot put a brick on them. I would “guesstimate” that about 25% of the babies I see will ultimately prefer to sleep on their tummies, but they are all out of their swaddle and then roll over after being put down on their back. I also get many videos showing me a baby in their crib who is in the act of rolling over, with a nervous parent running in turning them back over, only to have the child roll right back to their tummy. You could spend the entire night “flipping the baby” over!

 

Remember, back sleeping only, in a crib with just baby and no bumpers or toys….you will have plenty of time for other stuff in the crib when they are bigger.

Daily Dose

New Trend: Placenta Capsules?

1.30 to read

Okay, have you heard of placental encapsulation?  I recently had a new mother tell me about dissecting her placenta and putting it in capsules - which she swallows. I must say, I was gagging a bit while she explained this to me.  So like everyone else I went on line and looked up any data on this “new” trend. 

There is not much science on this subject, but plenty of sites that advertise people who are “placental encapsulators”. The practice of consuming the placenta is actually called placentaphagy - still sounds gross to me.  I know other species consume their placentas - but rarely is it done by humans.  

According to my patient’s mother (who also happened to be a patient of mine when she was a child), the placenta is supposed to help mother’s breast milk and provide hormonal “balance” post partum and thereby also reduce the incidence of post partum blues and depression.  (As a side note - I saw this young mother on day #4 post partum and she was teary and tired - just like most new mothers, despite the placenta pills).

The father of the new baby explained that he was given the placenta, in a “bio hazard” container after his wife’s delivery. He took it home and kept it in the refrigerator until the local placenta encapsulator person arrived at his house to begin the process. 

She “dried” the placenta in an apparatus (kind of like making your own beef jerky in a dissicator) and then 24 hours later crushed the dried placenta in her “Cuisinart” after which the mixture was placed in capsules.  My patient’s mother is now taking 2 tablets 4x/day and will do this until the capsules are gone. The number of days that you take the placenta depends on how much “dried placenta” is obtained - not a very precise science.

So.....I continue to learn new trends everyday.  This one is a bit tough for me to “swallow”.  I am awaiting science to have data that this is safe and worthwhile.  In the meantime, I have my study of one to gather data from.

 

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