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Daily Dose

What is Thrush?

1.15 to read

I get a lot of phone calls and questions from worried mothers who have noticed that their baby’s tongue has a bit of white coating and is this thrush?  Thrush is fungal infection of the mouth that is seen in babies (about 2-5% of babies), but thrush typically affects the sides of the inside of the baby’s mouth or under the lips and along the gum line. A white tongue alone is most likely residual milk. 

There are many cases of thrush that are mild enough that they may resolve on their own. On the other hand, a severe case of thrush may be painful and may make it difficult for a baby to feed, which then leads to a fussy, irritable baby. 

Thrush is caused by the fungus candida and despite everyone’s best efforts at cleanliness, candida like bread mold, can just happen.  Candida may be acquired at the time of delivery as the baby passes through the birth canal that is colonized with candida, or during nursing from the skin of the breast, or from a pacifier or the nipple of a bottle.  

Thrush is typically treated by wiping the inside of the mouth with a soft washcloth followed by an antifungal medication given as drops in the baby’s mouth after the baby has eaten. In a breast fed infant I treat the mother’s breast with a topical antifungal cream as well. 

Best way to look for thrush may be when you baby yawns and you get a good look at the inside of their mouths (bucal mucosa).  You don’t need to be a detective to find thrush, it is usually fairly evident and the biggest clue that it is not milk as it will not wipe off with a soft washcloth.

Daily Dose

Babies Do Not Need Water?

1.00 to read

With the temperatures sizzling across the country, I have started to get the question, “how much water does my baby need to drink during the hotter months?” 

I have to admit, I am still confused as to where this medical myth was started?  Babies, even in warm to hot weather can stay hydrated just by their breast milk or formula intake. An infant does not “need/require” extra water in order to stay hydrated during spring and summer months. Many young moms tell me that the grandparents are asking about more water. 

An infant can get all of the hydration they need from their mom’s breast milk or formula intake as there is free water in the milk.  The best source of hydration for a healthy baby is via their milk intake. This is true for babies who are eating baby foods but are still taking a bottle or getting breast fed as well.  

I know that when the weather warms up we may drink more water with exercise or when out in the heat. But a baby is not an athlete (yet) and they are not really losing more water via sweating etc like our older children do. 

It is okay to offer a baby a bottle of water, but they don’t “need” extra water. In many cases an infant won’t even drink plain water as they prefer their mother’s milk or formula and the water just dribbles out of their mouth as you try to get them to drink it. Don’t think that they “need” 8 12 ounces of extra water a day. Someone started this little rumor. 

The bottom line? If you think you need to change your baby’s fluid intake for the warmer weather you can cross that one off your worry list! But, if you have children who are going outside and playing, or adolescents who are participating in outdoor sports, it will soon be time to start thinking about keeping them hydrated during the heat.  More on hydrating your active kids and athletes to come.  Stay tuned! 

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

Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

Colic & Your Baby

1.15 to read

I had a chance to visit with my middle son (he lives out of town) and the discussion about who was the most “difficult” baby in our family came up once again. I still cringe thinking back about the first 6 months of my now 25 year olds life. He struggled with COLIC!

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 a physician, 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 and just 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….

Your Baby

Weight Gain During Pregnancy

2.00 to read

Every pregnant woman wonders how much weight she could gain during pregnancy. For some women, being pregnant is an open invitation to eat whatever and whenever they like, while other woman worry what the weight gain will do to their figure. There is no absolute law about weight gain during pregnancy, but there are set of guidelines that can help you.

Weight gain should be based on your pre-pregnancy body mass index (BMI.) Your health and your baby’s health also play a role in how much weight you should gain.

Here’s a list of suggested pregnancy weigh gain related to a healthy woman’s BMI.

  • Underweight (BMI less than 18.5) – 28 to 40 pounds
  • Normal weight (BMI 18.5 to 24.9) – 25 to 35 pounds
  • Overweight (BMI 25 to 29.9) – 15 to 25 pounds
  • Obese (BMI 30 or more) – 11 to 20 pounds

Multiples are a different story. If you are carrying twins or other multiples you’re likely going to need to gain more than average weight. Your health care provider can help you determine what is right for you. Here are the recommended weight gain options.

  • Normal weight (BMI 18.5 to 24.9) – 37 to 54 pounds
  • Overweight (BMI 25 to 29.9) – 31 to 50 pounds
  • Obese (BMI 30 or more) – 25 to 42 pounds

If you are overweight when you become pregnant, pregnancy increases the risk of various complications including diabetes and high blood pressure. Of course, a certain amount of weight gain is normal, but too much adds to the possibility of dangerous health risks for the woman and the child.

Remember that if you gain more than the recommended amount during pregnancy and you don't lose the weight after the baby is born, the excess pounds increase your lifelong health risks. Gaining too much weight during pregnancy can also increase your baby's risk of health problems at birth and childhood obesity.

If you're underweight, it's essential to gain a reasonable amount of weight while you're pregnant. Without the extra weight, your baby might be born earlier or smaller than expected.

Calculating your BMI is not difficult; you just need to know your height and weight. There are several online BMI calculators that will do the math for you. Your healthcare provider should also have a BMI chart that can show you your BMI.

So, how is the extra weight used by your body when your pregnant? Here’s a simple list to help you follow a normal weight gain.

  • Baby: 7 to 8 pounds
  • Larger breasts: 2 pounds
  • Larger uterus: 2 pounds
  • Placenta: 1 1/2 pounds
  • Amniotic fluid: 2 pounds
  • Increased blood volume: 3 to 4 pounds
  • Increased fluid volume: 3 to 4 pounds
  •  Fat stores: 6 to 8 pounds

During your first trimester, you probably won’t gain much weight. Steady weight gain is more important in the second and third trimesters, especially if you begin at a normal weight or are underweight.

Exercise is also important during pregnancy. Even a moderate amount of exercise will help keep your body strong as the extra pressure builds while you are carrying.

As your pregnancy develops, more than likely you’re appetite will increase. That’s not a bad thing. Just fill those hunger pains with healthy food choices!

Source: http://www.mayoclinic.org/pregnancy-weight-gain/art-20044360

 

 

Daily Dose

Get Your Baby to Sleep!

1:30 to read

How many times can you discuss newborns and getting them to sleep? It doesn’t matter how many babies you have, the biggest issue for new parents is ”when is my baby going to sleep through the night?”.  This statement is often followed by, “I have read every book and none of it seems to be working”. “What’s the trick?”  

Over the years I have realized that there is “NOT” one way or method that makes that newborn sleep through the night.  While some babies seem to lull themselves to sleep fairly easily and are sleeping in the first 4-6 weeks, most infants still awaken during the night for the first 8-12 weeks. There are also the “difficult” infants who don’t sleep through the night until 4- 6 months. But all in all...it just takes time, patience and a bit of prayer.

So, with all of this knowledge and remembering how I longed for my own babies to sleep 8-10 hours at night, I found a new article in The Archives of Diseases and Children quite interesting and thought provoking.  

Physicians have long known that it takes some time for circadian rhythm (biological sleep patterns distinguishing day and night) to develop in babies and a study done in the UK actually looked at infant’s sleep patterns between 6-18 weeks of age. They analyzed data including the infants’ body temperature throughout the night,  length of sleep a d urine samples collected am and pm to look at cortisol and melatonin levels. They also looked at the babies’ cheek swabs for circadian gene expression.  All in all a lot of data.

The findings were interesting showing that increasing cortisol secretion at night occurred around 8.2 weeks of age, followed in the next week or two by increased melatonin at night....both integral to establishing circadian rhythm.

When they analyzed body temperature, a drop in core temperature at the beginning of sleep (again maturational) they found that this occurred around 10-11 weeks.  Lastly, mature circadian gene expression was found at about 11 weeks.

So, no matter what book you read, or what your pediatrician, best friend or your own mother tells you, it is all about those hormones starting to “wake up” and regulate sleep. 

At least you know your baby is “normal”, even when everyone on Facebook “SWEARS” that their baby slept all night in the first 2 weeks. They probably either have totally forgotten or just made it up...it is all about science after all.

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Your Baby

Could higher cigarette taxes save babies lives?

1:45

A new study says that when the cost of cigarettes increase, fewer babies die.  The study links rising cigarette taxes to a decline in infant deaths.

Specifically, researchers said that each $1 per pack increase in the overall tobacco tax rate over the years 1999-2010 may have contributed to two fewer infant deaths each day.

The dangers of smoking during pregnancy are well documented. Complications include infant nicotine addiction, lower oxygen for the growing baby, increased chances of miscarriage, an increase of a baby developing respiratory problems and sudden infant death syndrome to name just a few.

Fortunately, U.S. smoking rates have declined during the years examined in the study – 1999 to 2010.

The research doesn't directly prove that higher taxes translate into fewer infant deaths. Still, "we found that increases in cigarette taxes and prices were associated with decreases in infant mortality," said study author Dr. Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University in Nashville.

In the new study, researchers tracked infant death rates and tobacco taxes from 1999-2010, when inflation-adjusted tobacco taxes on the state and federal levels rose from 84 cents a pack to $2.37 per pack. During the same time period, the number of infant deaths per 1,000 live births fell from 7.3 to 6.2 overall, and from 14.3 to 11.3 among African-Americans.

Other factors were also considered that might influence infant mortality including family income and education. Researchers still found an association with the rising cigarette taxes.

Patrick acknowledged that it's possible that factors other than cigarette taxes contributed to the decline in the infant death rate. One possibility is that medical care improved over that time, leading to fewer deaths. But Patrick said that prospect is unlikely since such a change would presumably be seen in all states, and the study didn't reveal that kind of trend.

The researchers also examined the effect of tobacco prices, and found that increases appeared to have the same level of impact on infant mortality as tax hikes.

What about the prospect that pregnant women and new mothers might choose to spend money on tobacco -- including higher taxes -- instead of on their children? "That would only occur if smoking is a large share of the household expenditures," Levy said. And, he said, it's important to note that research has shown that higher taxes are especially likely to lead to less smoking among the poor.

While there may be other contributing factors that reduce the number of infant mortality during the research dates, researchers noted that the higher cost of cigarettes means more pregnant women will smoke either not at all or less and that’s a good thing for the babies they deliver.

The study was published online in the journal Pediatrics.

Sources: Randy Dotinga, http://www.kfvs12.com/story/30638397/higher-cigarette-taxes-tied-to-fewer-infant-deaths

http://www.webmd.com/baby/smoking-during-pregnancy

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

Is Cord Blood Banking Worth It?

New parents often ask "is cord blood banking worth it?"During some recent “pre-natal” interviews with couples who are expecting their first baby, I have been asked about cord blood banking.  This question often comes up as prospective parents are given information by either their obstetricians or via the mail regarding private companies that will “bank” a baby’s umbilical cord blood.

In theory, the storage of cord blood is being touted as “biological insurance” in case the child (or possibly another full sibling) may need a stem cell transplant due to a malignancy, bone marrow failure, or certain other metabolic diseases during their lifetime. The chance of this even happening is remote, and at the same time, most conditions that might be helped by cord blood already exist in the infant’s cord blood stem cells and therefore would not be used. (premalignant changes can be found in stem cells). But, when parents are told that the cord blood may someday help their still unborn child, and then look at the financial commitment which may be hundreds to thousands of dollars, they are also caught thinking, “it is only money” and this might one day save my child’s life. Of course, when put that way we would all say, “go for it, money does not matter”. But, in reality the investment is not at all guaranteed and to date there is not much scientific data to support autologous (a baby’s own) stem cell transplantation. (Duke University is currently doing some studies on the use of cord blood stem cells for infant brain injuries and I have a patient who is partaking in these studies.) With this being said, private self-storage programs should be discouraged and umbilical cord blood banking should be encouraged when banked for public use via The National Marrow Donation Program or via state run cord blood banks.  In this way, cord blood stem cells are available to anyone that might need a transplant and could possibly be a match with your child.  The cells may also be used for ongoing research purposes at major medical centers and universities across the country. When using a public donor cord blood bank, the bank pays for the collection and storing of the baby’s cord blood, and there is not an initial or yearly bill for storing the cord blood. The cord blood is also stored in a consistent manner which complies with national accreditation standards. There is not the need to worry about a financial conflict of interest that may occur when using a private company. Lastly, research continues to look at the storage life of cord blood units, and paying a yearly fee for a child until 18, 21 or into perpetuity may not even guarantee the stem cells viability. I would talk to my OB-Gyn about donating an infant’s cord blood to the public bank if that is possible in your area. The cord blood bank will need to be notified 4–6 weeks before the baby is due. Once the cord blood is donated, parents will be notified of any abnormalities found in the cord blood (genetic or infectious etc), so that is a bonus too! Lastly, put the money you would have spent with a private cord blood banking company in your child’s college savings plan and add to it each year, like you were paying for the banking.  You have a much better chance of needing that “bank account”! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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