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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!

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. 

Daily Dose

Feeding Your Baby

1:30 to read

Under the heading of “learning new things everyday” comes some information on feeding your infant. Have you heard of “paced bottle feeding?”  If you are a new mother and are breastfeeding and either supplementing your baby with formula or breast milk you may already be doing this……

 

There are many advantages and benefits to breastfeeding your baby, but not everyone is able to breast feed or desires to breast feed. While I am a huge advocate for breast feeding, I am also supportive of “ a mother’s right to choose” and have some patients who just prefer to bottle feed their baby with formula.  The most important issue is really about nutrition and healthy weight gain for a newborn…with either breast or bottle feeding. 

 

So…a new mother was telling me that she was using “paced feeding” for her baby. I admit I looked at her and said “what”?  It seems that this is a feeding method used when a breast fed infant takes a bottle. It is supposed to more closely mimic the sucking and swallowing pattern of an infant when they breast feed.

 

With paced feeding the infant is held in an upright position and the bottle is held horizontally and the baby is  paused after feeding every few minutes…which is what typically occurs during breast feeding.  This method also encourages the  caregiver to turn the baby from one side to the other midway through the feeding….again like a breast fed infant. This will encourage eye contact and changing the head and neck position of the infant during their bottle.

 

Paced feeding is also supposed to help the baby not over-eat. By pausing “you are letting the cues for being full reach the baby’s brain.”  Mothers have also told me “paced feeding will not stretch a baby’s stomach.” I am not sure that there is science supporting this…and I do feel that in general most babies will not overeat ….they pause and turn away from the bottle as they get full…whether you breast or bottle feed you will notice that your baby really “leads the feeding”. When parents try to “fill their baby up before bedtime” they almost seem to try and force feed the baby and typically that only leads to a cranky baby that might spit up as well….watch your baby’s cues.  Amount fed does not necessarily correlate with longer sleep!

 

Try this and see what you think….again, I don’t think there is truly one way to feed every baby as they are individuals too and you will figure out what works best for your own baby. I think most babies are “pacing themselves” even without you realizing it…

 

Daily Dose

Breastfeeding & Bottle Feeding

1:30 to read

As you know, I am a huge advocate for breastfeeding your new baby. But, with that being said I also know that there are different circumstances for each mother and baby and that some new mothers either choose to breast feed for a short period of time or not at all. I always talk to the mothers about making their own choice, and to not feel they are being judged by anyone.

 

But many mothers are concerned about not breastfeeding and the long term implications for their baby.  They feel “guilty” if they choose not to breastfeed or if they in fact want to breast feed and are unable to for some reason.  I assure them that infant formulas continue to be improved upon and now contain DHA, ARA and oligosacharides that are found in breast milk.  Formula has safely been used for many years and that they themselves may have been a formula fed baby (you usually don’t even know!).

 

So… I am always interested in studies related to breastfeeding. There are good studies that continue to the show the many benefits to breastfeeding, including lower the risk of allergies, ear infections and SIDS. It is also known that breast feeding helps build a child’s immune system. Parents often ask “if I breast feed for X number of days or weeks is that enough?”.  I have not seen any data to quantitate a simple answer to that question.

 

Several years ago it was thought that babies who were breastfed had a higher IQ (by several points), and this was later found not to be the case. It seems that a child’s IQ is actually better explained by long term factors such as family background, genetics and education.

 

The impact of breast feeding on cognitive abilities continues to be studied and debated.  A new study just released in the April issue of Pediatrics  looked at 8,000 families and did not show a statistically significant difference in cognitive ability at ages 3 or 5 years between those babies that were breastfed for 6 months and formula fed babies.  They also looked at the relationship between breastfed and formula fed babies and parent rated hyperactivity scores. They found lower parent rated hyperactivity scores for 3 year olds only, but those benefits were not maintained in the long term. Again, much of this behavior may be based on genetics and environment.

 

Bottom line in my opinion…..adequate nutrition for your baby is the most important factor. Whether that is breast or bottle is up to each mother, and maternal well-being and feelings of happiness are so important in the first few months of an infant’s life.  

 

 

 

Daily Dose

Taking Your Child to the Doctor

1:15 to read

I imagine that you have heard the saying, “motherhood is the necessity of invention”?  It seems I must use this saying often as I can overhear my nurses quoting me and using the phrase as well.

 

There are many times I find myself in an exam room with a young patient and their mother when the mother says, “I forgot the……”. Sometimes it is a diaper (easily available in any pediatrician’s office), maybe a bottle (we have those too), a child’s favorite “lovie” (dire), and in many cases a pacifier.  Getting through the office visit without some of these necessities may make not only the child miserable, but also their parent.

 

Just the other day an adorable 5 month old baby and her cute mother came in because the baby had a cold and some eye drainage. Her mother was concerned that she might have an ear infection.  The first part of my exam was easy and the baby had a clear chest and no respiratory distress. She let me look at her nose and throat as well. Then it was time for the ear exam and of course the ear canals were waxy and I could not see her ear drum.  This means I have to use an instrument to remove the wax from the ear canal before I can get a good look at her ear drum.  The first ear was cleaned out and her ear drum was clear!!  But the second ear was more difficult to clean and the baby started to WAIL during this. Her mother looked frantically for something to soothe her..but she had forgotten her diaper bag with all of her stuff. So, once the ear canal was cleaned …she was pronounced ear infection free. While this was great news for the mother, the baby just continued to cry, loudly and angrily. 

 

I was trying to discuss the cold with the mother, but it was difficult for either of us to hear with the baby screaming. What to do…..? The only thing I had in the exam room was the basket of lollipops and stickers that we offer to children at the end of their exam.  I tried making a “sticker pop” on a tongue depressor to entertain and distract the baby…no such luck. The mother then looked at the lollipops, took out a grape one and unwrapped it and put in the baby’s mouth…INSTANT calm and smile on her face!!  Hysterical laughter from both of us as we took a picture to send to the father with the caption…Baby’s first food!!  Priceless. 

 

Love a mother like that…motherhood IS the necessity of invention!!

Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Colic

1:30 to read

I just read an interesting article in the journal Pediatrics on the subject of infant colic. It was a review of over 5600 articles that looked at the “mean duration of fussing and crying an the presence of colic in infants in the first 3 months of life”. If you have had or currently have a “colicky baby” this is quite interesting, as it looked at the incidence of “colic” in numerous countries as well.

 

The study evaluated the” mean total fuss/cry duration during 24 hours at ages 1-2 weeks (11 samples), 3-4 weeks (6 samples), 5-6 weeks (28 samples), 8-9 weeks (9 samples), and 10-12 weeks (12 samples).Interestingly the peak fussy crying period was highest in the first 6 weeks of life (17-25% of infants) and dropped by 8-9 weeks of age (11%)  and by 10 -12 weeks less than 1% of infants were reported to be “colicky”.  On average, babies around the world cry for around 2 hours per day in first two weeks, peak at 2 hours 15 mins at six weeks - and crying reduces to 1 hour 10 minutes by week twelve. (My son was not in this study…as he was colicky far longer than this study reported!!)

 

The study also found that infants in Denmark, Germany and Japan had less fuss/cry duration than infants in Canada, Italy and the United Kingdom.  What is that about?  It could be any number of variables including genetics, climate, socioeconomics and cultural factors….but I can remember feeling so helpless with an infant with colic (yes, even as a pediatrician…may have been worse knowing that there was not an answer) that I might have considered buying a plane ticket to Denmark!! Desperate times require desperate measures.

 

This study did not solve the mystery of colic nor did it give any answers to how to “treat” the fussy/irritable/colicky baby….but it did help to reassure parents around the world that this phenomena is universal…and that these babies do improve with time. You only wish that your baby could verbalize and explain to you what was going on in those first few months….but that may happen one day in the future…for now it is just an unknown, stressful situation for a parent…and the baby seems to outgrow it and has no memory of this experience.  (I have asked my own son who just looks at me with a puzzled expression?).

 

In the meantime parents with colicky fussy babies do require extra support and reassurance that their baby will be fine,  and ask their pediatrician if  their baby is growing and developing normally. But with all of that information …are there any “bargain fares” to Denmark and Japan???

 

 

 

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Daily Dose

Caring For An Uncircumcised Penis

I just received an e-mail from a listener asking about the care of her infant son’s uncircumcised penis. Her baby is four-months-old and she wondered how to wash the penis and if she should pull back the foreskin.

In an uncircumcised infant the foreskin (the skin that covers the head or the glans of the penis) will not really retract, and you do not want to “force” it. You should just clean the tip of the penis with soap and water while bathing the baby and over time, typically by the time a little boy is 5 years old, the foreskin will become fully retractable. Once the foreskin is retractable (as adhesions have broken down on their own) you can retract the foreskin and clean the glans (head) of the penis and teach your son to do the same thing. Seeing that we are already discussing the uncircumcised penis it is a good time to discuss the pros and cons of circumcision. The American Academy of Pediatrics (AAP) does not routinely recommend circumcision of male infants. They state that it is a matter of choice for families to make. Circumcision rates in this country are around 55 to 65 percent and are variable in different geographic areas. Circumcision may also be routinely performed due to cultural or religious preferences, or for the social reason of wanting sons and fathers to “look the same”. There has been some recent literature showing that there is an increased frequency for uncircumcised males to develop a urinary tract infection (up to 10 times more likely).  The incidence for male urinary tract infections is still low, but further studies are being done to determine if circumcision should again be routinely recommended. There is also an increased incidence for irritation, inflammation and infection in uncircumcised males, as the uncircumcised penis may be more difficult to clean. There has also been data to suggest that circumcised males have a lower risk of contracting sexually transmitted infections, including HIV. Lastly, the incidence of penile cancer (although rare) may be higher in uncircumcised males. All of these issues continued to be studied, so ask your pediatrician about ongoing data if you are trying to decide whether to circumcise a newborn boy. Like so many things in medicine, continued studies may bear new recommendations. That’s your daily dose, we’ll chat again tomorrow.

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

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