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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!

Your Baby

Mom and Baby Benefit by Skin-to-Skin Contact Right After Birth

1:30

Over the years, modern birth methods have changed how newborns and mothers interact with each other. Typically, the baby is cleaned up and wrapped in a blanket then given to the mother to hold. A new scientific review suggests that skin-to-skin contact is better for the mother and gives her infant a better start in life.

The review noted that women who had skin-to-skin contact with their naked babies soon after delivery were more likely to breastfeed longer and be breastfeeding months later than women who didn't have their babies placed on their skin right away.

"The more you can do to place the mother and baby together and disturb them as little possible during that first hour, the better off they’ll be," said lead author Elizabeth Moore, of the School of Nursing at Vanderbilt University in Nashville, Tennessee.

Researchers looked through medical literature and found 46 randomized controlled trials to include in their review. The trials included 3,850 women and their newborns from 21 countries. All babies were healthy and most were born at term.

"We compared those trials to usual care, and usual care was very different depending on the trial," said Moore. Trials from the 1970s may have separated mothers from their babies for hours. In more modern trials, babies might be swaddled in a blanket before being handed to the mother.

Moore and her team found evidence that babies who had received skin-to-skin contact were more likely to breastfeed successfully during their very first breastfeeding session, and they also tended to have higher blood glucose levels and stronger heart and lung function.

 “It’s just something that if at all possible should happen," Moore told Reuters Health.

Skin-to-skin contact should begin as soon as possible and last for at least 60 minutes, she said. The hour will give babies time to recover from the birthing experience, find the mother's nipple and latch on.

"It’s not something you can do in just 15 minutes," Moore said.

Not all physicians and hospitals are on board when it comes to immediate skin-to-skin contact after birth.

“I would recommend that a woman make sure she adds skin-to-skin to her birth plan," Moore said. "I think it’s a really good thing for a woman to put together a birth plan before she heads to the hospital and show it to her physicians or midwife."

What if your baby is premature or is delivered by cesarean? The researchers didn't find any benefits to initiating skin-to-skin contact immediately after birth versus after the baby had been examined and washed. They also failed to find any clear benefits to skin-to-skin contact that lasted longer than an hour.

"The evidence supports that early [skin-to-skin contact] should be normal practice for healthy newborns," the researchers wrote, "including those born by cesarean and babies born early at 35 weeks or more."

The review was published in the Cochrane Library in November. 

Story sources: Andrew M. Seaman, http://www.reuters.com/article/us-health-birth-skin-idUSKBN13V2UZ

Kenza Moller, https://www.romper.com/p/why-skin-to-skin-contact-after-birth-could-be-beneficial-for-mothers-babies-alike-24423

 

Daily Dose

Hassle-Free Formula?

1:15 to read

I am certainly a big proponent of “hassle free” options for making parenting easier. ( is there such a thing)?   For many of the families I see with new babies, the latest “favorite” gizmo is an automatic baby formula maker. Yes, it is similar to the Keurig and Nespresso coffee machines  but in this case it “mixes the formula powder and water to perfect consistency”…according to one manufacturer label.

 

When I first saw one in use I agreed that it seemed to be “easy”, but at the same time, I was not sure it was any  faster than just putting a scoop of baby formula in a bottle and shaking it up?  It certainly took up more counter space….but whatever right?  I was told…” you don’t have to mix or measure and there are no air bubbles like shaking a bottle”. Old school vs new school - the end product is the same, correct??

 

Well, as with many things, “hassle free” may not always mean better.

 

I recently saw an infant who had been doing well and gaining weight while breastfeeding. Her mother returned to work and decided to start formula feeding and purchased one of the new “instant formula preparation machines”. She was making the baby’s bottles “hassle free” every feeding.  The baby was under 4 months of age, so she was only receiving formula for feedings.

 

When the baby came in for the next check up she had not been gaining weight and had actually fallen off of her growth curve.  When the mother was asked if the baby was eating well, pooping, sleeping etc. all sounded fine. The baby’s physical exam was also normal.  So….why is this baby not gaining weight? The differential diagnosis is fairly long, but includes some serious problems. Pediatricians do not like to see a baby that is not gaining weight - the term used is “failure to thrive”.

 

So, very long story short…the good news is that the baby is fine!!! It turns out that the baby does not have any underlying problems. The problem was the automatic formula maker that the mother was using to prepare the baby’s bottles. For some unknown reason ( technology ) it was not adding the correct amount of formula to mix and make the 6 ounce bottle.  In other words…machine error!  The baby was actually getting diluted formula….and no one knew.

 

Once she started measuring and mixing her bottles the “old fashioned way” - scoop, add water and shake…the baby started to gain weight again.  Mystery solved, healthy baby and no more worried parents…but the “hassle free machine” led to a lot of anxiety. All is well, but I hope they got their money and more counter space back!

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

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

Daily Dose

Study: Treatment for Colic

A new study looks a treatment for your baby's colic. Having had a baby who suffered with colic, I am always interested in reading any new studies that are related to new findings on treating colic.

Colic, which affects up to 25% of all infants, results in frequent and inconsolable crying throughout the day, and seems to have no "known" etiology. Parent's are at their wits end and are ready to do anything to help console their baby (yet alone get some rest themselves). I am convinced as both a parent and a doctor that the person or persons that discover the cure for colic will not only win the Nobel Prize, but will also win the hearts of every parent who has ever suffered "with" their colicky baby! A study in the March, 2011 issue of Pediatrics from researchers at the Peninsula Medical School in the UK, looked at 15 different studies of over 940 babies and different treatments for colic.  These studies included complimentary and alternative medicines that have been used including supplements, herbs, sugar water, probiotics, massage and reflexology. The review basically showed that none of the "treatments" were found to work consistently and the study design was even often flawed.  There were some "encouraging results" for fennel extract mixed herbal teas and sugar water, but all of these needed further study. So, once again it comes back to the basic tenet for treating colic, "Tincture of Time" and "TLC". I'll keep reading and for those of you looking for a "fix", I assure you I have felt your pain, and the only thing I can add is "this too shall pass".  None of these medicines is easy to swallow! Do you have a favorite treatment for colic? Let me know and we’ll share it.

Daily Dose

Colic & Your Baby

1.30 to read

While my middle son was home for a long weekend, the discussion about who was the most “difficult” baby in our family came up once again. Whew, COLIC!!!  I still cringe thinking back about the first 6 months of my now 26-year-old's life.

No one really knows what causes colic and there are many different definitions of colic. The word is derived from the ancient Greek word Kolikos, which means “pertaining to the intestines”. (vague enough)

Colic typically begins somewhere between the 3rd and 6th week of a newborn’s life. Doctors have looked “up and down” for medical problems with these babies and I can attest to the fact that the most frustrating (although reassuring) thing is that they are HEALTHY.

Colicky babies cry and they cry much more than the average baby. While most newborns cry somewhere around 3 -4 hours/ day, a colicky baby will cry for hours on end. While doing so they typically draw their legs up, get stiff and arch their backs and turn bright red and I remember our son even seemed to get hoarse from crying so much. Colic typically occurs throughout the day and night which is different than that evening fussy spell that most babies experience. The crying makes parents feel anxious, frustrated, exhausted, concerned and everyone just wants an ANSWER! If you can solve the mystery of colic you will win the Nobel Prize in medicine as well as the hearts of every parent.

As physicians I tell parents that colic is “short lived” and “self-limited”, but those terms are relative when you are living through what we affectionately termed, “baby hell”. After listening to incessant crying short lived means less than 10 minutes! Colicky babies have very intense cries, whether they are wet, startled, need to burp or are just uncomfortable. They tend to be tense andjust never seem to relax.

A colicky baby is difficult for any parent, whether you are a first time parent or “seasoned”. It is difficult to not blame yourself for your babies crying and the fantasy of that “perfect baby” is shattered. These babies are not “like babies on TV”. A colicky baby provokes exhaustion and can lead to things like breast feeding failures, marital discord, post partum depression and even child abuse.

 So what do you do and what are the current theories?  More to come….

Daily Dose

How to Treat a Colicky Baby

1.30 to read

We talked a little about colic earlier this week, so now it’s time to talk about some of the theories about what causes colic and some of the different approaches to treating it.

Hypothesis:

#1 Minor GI problems:  gas, cramps and tummy issues. But if that is the case why does colic start at 2 -3 weeks of age as babies have gas beginning at birth and they will pass gas well after they are 3 months old. I do hear parents complain that gas gets worse at about 4 weeks of age?  Babies also swallow a lot of air when they are crying and parents often try OTC simethicone drops, although typically with little help. There may be some placebo effect?

Some parents feel as if they get some relief by changing formula and at times an elemental formula such as Nutramigen nor Alimentum seems to help. For a breast fed baby many recommend eliminating many different foods from a mother’s diet. I too tried eliminating almost everything and would try to only have chicken, rice and bland foods. In my case (not statistically significant) my colicky baby remained colicky and I was miserable giving up so many foods.

I decided to eat what I wanted as it did not seem to make a difference and I was less stressed and also felt better eating again. Baby was still fussy.

#2 Major GI problems:  Gastrointestinal reflux is the buzz word these days. The diagnosis has increased at least 20 fold.  It is estimated that only 2 – 4% of colic is really related to reflux .  Reflux actually peaks at a later age, around 4 months, and resolves around 8 months, long after symptoms of colic have resolved. Regardless, many parents want a trial of anti-reflux medication but the latest studies show that PPI’s (proton pump inhibitors) rarely help the symptoms of reflux and are not routinely recommended.  

#3 Maternal Anxieties: this is counter intuitive as it seems that a colicky baby typically causes the anxiety and not vice a versa.  Colicky babies are not necessarily first born children either and most mothers would admit that they were more anxious with their first child (who might have been a placid baby).  I just don’t see the correlation. It does become a vicious cycle though as everyone ends up stressed, tired and anxious.

#4 Infants have immature neurological systems:  Babies are not yet “hard wired” when they are first born. They have all sorts of immature reflexes including a moro reflex, irregular breathing patterns (called periodic breathing of the newborn), quivers etc. During the first 3 months a baby’s entire neurological system slowly matures and an infant begins to have purposeful movements, starts to smile and just seems to get easier. Some call this period of time the 4th trimester. This makes a lot of sense to me, as colic seems to gradually improve, with TIME.

What is there to do to soothe a colicky baby:  DO WHATEVER HELPS (within reason), I can remember taking advice from total strangers and I was a pediatrician!! Some seemed absurd but I can tell you I bought all sorts of gizmos to see if anything would soothe my unhappy baby.

Babies who are colicky usually like the following:

Swaddling – Whoever invented the “miracle blanket” really was a genius!! It makes swaddling so easy. There are numerous methods to swaddling but with practice it is easy. 

Swaying – whenever you have a baby you learn to “rock” while you are holding them. After about a week of parenting, it almost seems like instinct. Once you have been a parent, any time someone hands you a baby you automatically begin to SWAY. Swings work well too

Shshshing……..  Quietly whispering this sound to a baby seems to be calming as well.  Babies also like to hear soft music or soft lullabies with the same sounds repetitively.  Remember, “Hush Little Baby”, always a good one. When your voice wears out try the hairdryer or vacuum cleaner in the background. Some parents swear by a white noise machine.

Sucking - As I have said many times, I am a huge believer in a pacifier. Infants need to suck to calm themselves. They need to suck to eat but there is also a need for non- nutritive sucking.  The biggest problem is that baby’s have a tongue thrust and often spit out the pacifier just as you get them calmed, but even having to put it back in is often worth it!

Stomach – fussy baby’s often calm when they are on their tummies. But, with that being said NEVER let your baby sleep on their tummy. It is hard to turn that quieted baby over once asleep but you MUST, even if you are watching them!

I wish I knew the reasons for colic or the miracle to end the long days and nights. I do know that the majority of these irritable colicky babies suddenly blossom into happy, joyful 4 month old infants.

Lastly, any help is welcome when you have a newborn, especially a fussy one. Accept offers of help and take a break and get out of the house for an hour to take a walk or grocery shop in solitude. All parents need breaks!

That’s your daily dose for today.  We’ll chat again tomorrow. 

Daily Dose

A Baby's Neck Issue

1:30 to read

Torticollis is becoming more and more common and it may be related to several different things. Torticollis is defined as a “twisted neck”, or as my grandmother used to say, a “wry neck”.  Most of us have experienced a tight neck after a bad night’s sleep, and you can hardly turn your head to back out of the garage it is so painful, but be reassured your baby does not have any discomfort, but will just hold their head somewhat “tilted”.

A baby’s 40 weeks spent in utero may cause some positional deformities of the head and neck.  Due to the intrauterine positioning a baby may “favor” turning their head to one side rather than another. At the same time back sleeping which is recommended for all babies, may also contribute to torticollis.  

In order to help the baby resolve the tightness in the neck which is actually due to the sternocleidomastoid muscle being tight, your doctor may have you do several things early on to help stretch the neck muscle.  

If your baby prefers to look to the right they have left sided torticollis. In this case turn your baby in the crib so they have to turn to the left to look out (they don’t want to face a boring wall). When you are feeding them have the bottle on your right arm. When changing diapers, place the baby so that they have to tur left to see you.  Hold the baby on your left hip as well and burp them on your right shoulder. All of these strategies will help to stretch the muscle.  On top of this the baby needs to have tummy time, when awake, and work of having them turn to the left during this time too. Lastly, do gentle neck stretches 3-4 times a day and massage the tight muscle.  

If your baby prefers to look to the left also called right sided torticollis, reverse the above.

Your baby should continue to work on stretching so that their head will also not get flattened on one side or another, which is called plagiocephaly.  By continuing to have tummy time and neck stretches, most cases of torticollis will resolve. In severe cases or when you don’t feel that the baby is improving,  ask you doctor about the possibility of physical therapy.

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Why you should never use a kitchen spoon to measure medicine.

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