Twitter Facebook RSS Feed Print
Daily Dose

Q-tip Injuries

1:30 to read

I know I am asked on a regular basis, “how do I clean my baby’s/child’s ears?  I have replied for years with something that I know I was taught many years ago, maybe even by a grandparent? “Nothing smaller than your elbow should go in your ear”. Who knows where that saying came from but it is a good visual that you should not “stick a Q-tip” or anything into the ear canal.

 

Now an article published in the journal Pediatrics sure makes that adage seem timely, as about 12,500 children younger than 18 are treated in emergency rooms annually, which translates into about 34 children per day.  The study also showed that about two out of three patients were younger than 8 years and children younger than 3 accounted for 40 percent of all injuries. 

 

Cotton swabs are really intended to clean the outer ear and should not be placed into the ear canal…even though most people put a q-tip right into the canal which may cause injury when pushed too far.  The study showed that about 30 percent of injuries caused by the cotton swabs were feeling as if there was a foreign body in the ear, while 25 percent of injuries were a perforated ear drum and 23 percent were soft tissue injuries. WOW…talk about expensive health care costs related to one little cotton tipped swab!

 

Ear nose and throat doctors (otolaryngologists) will tell you that the ear canals are usually self cleaning and using a cotton tipped swab to clean the ear only pushes the wax further down the canal and closer to the ear drum. If in fact the wax becomes impacted by using a q-tip, it is even harder to get the wax out. There are over the counter drops that you can instill in the ear canal to help soften wax and then use a wash cloth to clean the outer ear.

 

So..resist the urge to put a Q-tip into your ear canal and simply use them to take off makeup, paint small places or any of the millions of other uses…just NOT in the ear!

 

 

 

 

Tags: 
Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

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

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

Do You Have a Happy Spitter?

1.15 to read

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

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

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

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

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

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

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

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

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???

 

 

 

Tags: 
Daily Dose

All About Naps

1.00 to read

Just how many naps should your baby be taking and how long? When you are an adult, there is nothing better than taking a nap. Shouldn’t it be the same for children?  I get lots of questions from parents who ask when their children should take naps; how many times a day they should be napping and when do children stop napping?

Many new parents expect their newborn infants to take regular naps throughout the day (and then to sleep all night) even when they are only 4-10 weeks old. Unfortunately, a newborn’s sleep cycle is not ready for 2 hour naps in both the morning and afternoon followed by a 10 -12 hour extended sleep at night. But, by the time your child is 6-9 months of age (and sooner for some great sleepers); they should be on a good schedule with a morning and afternoon nap.  Naps are usually anywhere from 45 min – 2.5 hours.  I think naps serve a dual purpose, as they provide rest and rejuvenation for both child and parent. Nap time, just like bedtime should be scheduled, typically mid morning and mid afternoon and a child should be able to put themselves to sleep after a book or a story. Naptime routines can be bit shorter than the bedtime routine. You will be able to tell when your child is ready for a nap as they may rub their eyes, or get fussy, or some may just lay their heads down or point to bed as they know they are tired. By the time a toddler is somewhere between 12months – 2 years of age they will usually drop a morning nap and continue to have their midafternoon nap. This is usually right after lunch. Transitioning from 2 naps to 1 nap a day is a little “dicey” at first, as your child may get quite cranky in the morning as you drop that nap, while at the same time their afternoon nap may become longer. This adjustment period usually only lasts several days to a week and then you will find that they are back on a good nap/nighttime schedule. I get asked about stopping a child’s nap. I think naps are important (and as we adults know a privilege) for children until they are in elementary school. Most kindergartens continue to have “rest” time after lunch and many children will fall asleep for 20-30 min while the teacher reads them a book or music is played and the children lay on their mats. Even if your 4 – 5 year old child doesn’t “want” to nap in the afternoon, they need to have quiet time.  This may be for an hour or so in the afternoon, and is time for them to lay in their bed and read, color, play with dolls etc.  I do not think is the time for video games, or computer time etc. Many a child will fall asleep once they are in bed reading and will continue to take a good nap, they just didn’t know that they needed it! Moms, Dads, babysitters etc all need this quiet time too, to get much needed work done around the house, or dinner started etc. It was just a rule at our house that naps didn’t stop until you were in “big boy” school.  A quiet house for an hour each afternoon seemed to make the rest of the day and evening a happier time for everyone! That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

The Danger in BPA Bottles

2.00 to read

I have been getting plenty of question about BPA in baby bottles.I recently received an email from a parent who’s 4 year old son is a patient of mine, and she is pregnant and due with a baby girl in the next month. On top of all of that she is also a pediatrician. At any rate, her question was regarding BPA (bisphenol A) in bottles, and whether I thought she should throw out bottles that she had used with her son in favor of newer bottles.

I will tell you that her son is a perfectly delightful, bright, inquisitive and developmentally normal little boy and he received breast milk and formula from BPA containing bottles. With that information, and knowing that I am thrifty, I thought long and hard and decided that in my opinion I would toss the old bottles in favor of the newer BPA free bottles. The top manufacturers of baby bottles voluntarily stopped using BPA in their bottles at the end of 2008. These bottles include, Dr. Brown, Avent, Playtex, Evenflo and numerous others. It is easy to find BPA free bottles that are well marked and most large chain stores are no longer selling your-baby bottles containing BPA. The cost involved to replace old bottles seems minimal, and the data regarding the safety of BPA to infants and children continues to be released with more ongoing studies underway. There will be more data available in the coming months and years. The Endocrine Society who held their annual meeting last week presented “worrying” evidence about the effects of BPA , including the statement that “endocrine disruptors (which includes BPA) do have effects on male and female development, prostate cancer, thyroid disease, and cardiovascular disease”. There are concerns that infants and children may be particularly susceptible to BPA and possible long term effects on brain development and behavior. So, with these recent studies and more concern regarding the levels of BPA found in baby bottles as well as comparison data of exposure to BPA between breast and bottle fed infants, it seems prudent to me to purchase newer bottles that are BPA free. Cross this issue off of the mother worry list. The cost of new bottles is minimal as compared to future concerns about BPA. That's your daily dose for today. We'll chat tomorrow!

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

Baby bling is cute, BUT....

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.