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Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Your Baby

Britax Recalls Car Seat Chest Clips Due to Infant Choking Hazard

1:30

Faulty chest clips on more than 100 models of Britax Care Safety car seats are being voluntarily recalled because the clips could break off and create a choking hazard for infants.

The company says that no injuries have been reported, but it has received complaints of chest clips breaking.

The recall will affect more than 200,000 car seats. However, Britax stresses that the car seats are still safe to use until a replacement kit is obtained. 

The chest clip is on the Britax B-Safe 35, B-Safe 35 Elite, and BOB B-Safe 35 infant seats.

The products were manufactured between Nov. 1, 2015, and May 31, 2017. To see the model numbers that are included in the voluntary recall, or to check the serial number of your seat, visit the company’s website set up for this recall at www.bsafe35clip.com. You can find the serial numbers on the "Date of Manufacture" label on the lower frame of the seat.

Britax is offering to replace the chest clip with a free kit that contains a new clip made from a different material. The kit comes with step-by-step instructions for replacement. Consumers are advised to routinely check their current chest clip until a replacement arrives.

Story sources: Alexandria McIntire, http://www.webmd.com/children/news/20170623/recall-britax-car-seat-chest-clip

Ashlee Kieler, https://consumerist.com/2017/06/21/britax-recalls-207000-carseats-over-chest-clips-that-can-break/

Daily Dose

Diaper Dermatitis

1:30 to read

Newborn babies have the softest little bottoms and they also have a lot of poop! The combination often leads to a raw red bottom and a diaper rash. A newborn often poops every time they eat and sometimes in between....and you don’t even realize they have pooped again.

Even with the constant diaper changing (would you have believed you would use 8-12 diapers a day) it is very common for that newborn to develop their first diaper rash.  Not only will the skin be red and raw....it may even sometimes be so chapped that it may bleed a bit.  This diaper rash is causes a lot of parental concern and will often result in the new parent’s first of many calls to their pediatrician.

A new baby is supposed to poop a lot, so you can’t change that fact,  but you can try all sorts of things to protect that precious bottom and treat the diaper rash.  After using a diaper wipe (non-perfumed, hypo-allergenic) I sometimes bring out the blow dryer and turn it to cool and dry the baby’s bottom a bit. Then I apply a mixture of a zinc based diaper cream (examples:  Desitin, Dr. Smith’s, Triple Paste cream), which I mix in the palm of my hand with a tiny bit of liquid over the counter antacid.  (I don’t measure it:  just a lot of diaper cream and small amount of antacid so it won’t be runny).  I put a really heavy layer of this on the baby’s bottom.

If after several days rash is still not improving it may have become secondarily infected with yeast so I add a yeast cream (Lotrimin AF, Triple Paste AF) to the concoction. If it has yeast this should do the trick to treat all of the problems.

I will also sometimes alternate using Aquaphor on the bottom with the above diaper cream concoction.  It will take some time for it to totally go away but you are trying to get a barrier between the poop and the skin on the baby’s bottom. She keep something on there after each diaper change.

After a few weeks of constant pooping the number of stools do slow down and bit and that will help heal that new baby’s bottom as well. 

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Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

New parents often come in concerned about their baby spitting up.  They typically  ask, “does my baby have gastroesophageal reflux (GER)?”.  I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants.  Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time. 

GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”.  GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.  

For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.  

The best treatment for benign GER is lifestyle management.  Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas.  Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies.  It is always worth trying.

While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!

Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed.  Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.

For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary.  Talk to your doctor about options if lifestyle management does not seem to help. 

Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

Your Baby

Fisher-Price Recalls Infant Cradle Swings

1:30

Fisher-Price is recalling three models of their cradle swings: CHM84 Soothing Savanna Cradle 'n Swing, CMR40 Sweet Surroundings Cradle 'n Swing, and CMR43 Sweet Surroundings Butterfly Friends Cradle 'n Swing.

The swings have two different swinging motions - rocking side-to-side, or swinging head-to-toe, and six different swing speeds from low to high. The product number is located on the seat under the pad. 

When the seat peg is not fully engaged the seat can fall unexpectedly, posing a risk of injury to the child.

Fisher-Price has received two reports of a seat peg coming out from the seat, causing the seat to fall. No injuries have been reported.

Consumers should immediately stop using the recalled cradle swing and contact Fisher-Price for revised assembly instructions.

The infant cradle swings were sold at buybuyBaby, Target and other stores nationwide and online at Amazon.com and other websites from November 2015 through March 2016 for about $170.

Consumers can contact Fisher-Price at 800-432-5437 from 9 a.m. to 6 p.m. ET Monday through Friday, or online at www.service.mattel.com and click on Recalls & Safety Alerts for more information. 

Source: http://www.cpsc.gov/en/Recalls/2016/Fisher-Price-Recalls-Infant-Cradle-Swings/#remedy

Daily Dose

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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If your child snores, is this a sign of something more serious?

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