Twitter Facebook RSS Feed Print
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

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

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.

Old school and new school…the combo seems to make sense to me. 

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

Daily Dose

Breastfeeding Anxiety

1:30 to read

I am a huge proponent of breastfeeding and having breast fed 3 babies of my own I do remember several things about “learning to breast feed”.  Now that my children are grown and I am taking care of my 2nd” generation of babies, I have decided that “we” (doctors, hospitals, lactation consultants etc.) are making breast feeding more and more stressful rather than just letting it happen “organically”, the way it has been done for hundreds if not thousands of years.

 

I make newborn nursery rounds and see new mothers within 24 hours of their baby’s birth, and then everyday until discharge. I am noticing more and more tearful, anxious mothers who are completely “stressed out” about breastfeeding and their milk is typically not even “in” yet.  So, how is it that they already feel as if they have failed, or “can’t do this”??  We have so many different people coming into their room telling them to cluster feed, not to use a pacifier or that their baby is tongue tied, and they are overwhelmed - and the baby is one day old!

 

Sometimes too much information is detrimental rather than helpful. Being a bit “clueless” and having no expectations did not make breast feeding seem stressful. A foreign sensation yes, awkward at times absolutely!!  A mother’s milk will “come in” on day 2, 3 or 4 even if you don’t cluster feed for hours at a time and even if you decide to use a pacifier. Nature has a plan….whether we do or not.

 

Just like many things in life….it is easier for some mother’s and harder for others.  Some babies just seem to latch on immediately, while others take a while to figure it out.  But, practice is the name of the game, and you cannot practice breast feeding. It is postpartum on the job training..and some mothers may need extra help and some “tutoring”. No new mother needs to hear discouraging words…encouragement and reassurance is the name of the game in the first few days after giving birth.

 

Babies are expected to lose weight after birth…but parents are now told how much weight their baby has lost and what will happen i”f they lose more than 10%”of their birth weight”. They are also told the transcutaneous bilirubin level every morning even though they “are not sure what that means”, but it is another number thrown out there to add to their worry list.  Maybe I am old school, but I tell my patients that my job is to “tell you if there is a concern”…and not have you worry about 7% weight loss on day 3 of life or a bilirubin of 10 mg/dl, so that parents can “Google” hyperbirubinemia and worry about kernicterus and brain damage. 

 

Letting a new mother get some rest while encouraging her to feed her baby every 2-3 hours while practicing different positions for latching seems to be a much more natural and relaxing method to promote breast feeding and not anxiety provoking “rules”. 

 

I do not encourage a new mother to  cluster feed for hours at a time so that her nipples are already blistered, bleeding and painful,  before even leaving the hospital. I also let her know that it is not abnormal for breast feeding to be a bit “painful” , and for her breasts to feel engorged as the milk “comes in”. There are lots of new “feelings” going on in the initial postpartum days, including all of those raging hormones!

 

So…try to relax, enjoy your baby and not et overly anxious about “breastfeeding” correctly…as one way does not fit everyone. 

 

 

 

 

 

 

 

 

Daily Dose

Bathing Your Baby

1.15 to read

Lots of new babies and one frequent question that comes up early on is, “how often do I need to bathe my baby?”.  Good question and I don’t think there is a “right” answer. 

Babies are frequently born with dry and peeling skin, especially on their hands and feet. This is one way that the doctor can tell that the baby is “term”.  Despite being bathed or not bathed, the infant will peel and flake off this little bit of dry skin and then will be left with that beautiful baby skin all over. 

Some people say not to bathe a baby everyday, but I honestly think it is totally up to the parent. I bathed all of my babies everyday, as I loved the way they smelled after a bath, and I was also convinced that a daily bath before bed would make them sleep better!! (not so sure this helped at all). 

Whatever you decide to do about bathing, you want to make sure you are using a mild soap, and I like Aveeno and Cetaphil products, especially if your baby is prone to dry skin.  I always started by washing the baby’s face, then their body and lastly did their hair and scalp.  Babies lose most of their heat through their heads, so I did this last so that I could bundle them up right after the bath.  

After a bath it is a good idea to apply a moisturizer to the skin and again there are a lot of good products out there.  Many of the baby products just smell good as well (what beats the smell of the pink baby lotion), but some are not as good moisturizers as others. If your baby has really dry skin and needs the hydration use one of the newer products that contain ceramides ( Aveeno, Cetaphil, Cerave).  They may not smell as good, but they are hypoallergenic and are better for dry skin and babies who are prone to eczema. 

Bath time is a fun time for both baby and parent! Before you know it your baby will no longer be getting baths in the infant bathtub, but they will be splashing away with toys in your tub. Enjoy these moments as they will go by quickly! 

Daily Dose

Babies & Bow-Legs

1.15 to read

Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

Your Baby

FDA Warns that “Sleep Positioners” Are Dangerous for Infants

2:00

The U.S. Food and Drug Administration (FDA) issued a warning to parents and caregivers of infants about the dangers of using sleep positioners. The products are also known as “nests” or “anti-roll” supports.

The two most common sleep positioners include two raised pillows or "bolsters" attached to a mat. Babies younger than 6 months old are placed on the mat between the pillows to keep them in a specific position while they are sleeping. 

But putting babies to sleep on or near soft objects, such as positioners, toys, pillows and loose bedding, increases the risk for accidental suffocation and Sudden Infant Death Syndrome (SIDS), the American Academy of Pediatrics (AAP) says. 

Some babies have been found in dangerous positions next to a positioner they had been placed in for sleeping. Federal officials also reported that infants have died after being placed in one of these products. In most cases, the infants got out of position, rolled onto their stomachs and suffocated, the FDA explained.

The FDA and infant heath experts say that babies should always be put to sleep on their backs on a firm, empty mattress, preferably in a crib.

Babies should never sleep with a positioner, pillow, blanket, sheets, a comforter or a quilt, the FDA advised. Appropriate clothing keeps babies warm enough while they are sleeping.

Some sleep positioner companies claim that their products prevent SIDS. But the FDA noted it has never cleared an infant sleep positioner that promises to prevent or reduce the risk of SIDS since there is no scientific evidence to back up this claim.

Some of the companies also promote their products as helpful for easing gastroesophageal reflux disease (GERD), a condition that causes stomach acids to back up into the esophagus. Others suggest their positioners help prevent flat head syndrome (plagiocephaly), a deformation caused by pressure on one part of the skull.

While it’s true that the FDA has previously approved some of these products for GERD and flat head syndrome, the government agency has asked these companies to stop marketing these items because it feels that the risks outweigh the benefits.

Every year about 4,000 infants die unexpectedly while sleeping due to suffocation, SIDS or another unknown cause, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The FDA urged parents and caregivers to talk to their child's doctor if they have questions about how to make sure their baby sleeps safely.

Story source: Mary Elizabeth Dallas,  https://consumer.healthday.com/kids-health-information-23/sudden-infant-death-syndrome-sids-news-643/sleep-positioners-a-danger-to-baby-fda-727180.html

 

Daily Dose

Baby Bling Can Be Dangerous!

1:15 to read

I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 

Tags: 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Wishing you a day surrounded by family and friends.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.