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Daily Dose

Are Parents Too Connected?

1.30 to read

Has your spouse, babysitter or other child care provider ever called you to come home “because the baby is crying”?  It seems that technology, which is readily at our finger tips 24/7, has created yet another dilemma - what to do if a baby is crying? 

Pre-cell phone days, there really was not much to do if you the parent left home and your baby/child started crying.  Outside of calling the restaurant, store, movie theater (directly), and asking them to page a parent, most of us just muddled through a crying child.  I also think that in most cases, said child eventually stopped crying (unless there was an obvious reason that could be “fixed”) and by the time you the parent returned home, all was typically well.  

But now, with a cell phone in every hand, it only takes one call to summon the parent of a crying child.  I think this is a good news/bad news dilemma.  The good news is: parents may feel more comfortable leaving their child with a babysitter, knowing that they may be reached in the event of an emergency.  The bad news is:  is a baby or child who is only crying, typically an emergency?  Depends on your definition. 

The reason I bring this up is that I often hear young parents, and especially mothers, tell me that during the first several months of their infant’s life, they cannot leave the house for more than minutes, before being called home....because the baby is crying.  Some of these mothers are really “stressed out and exhausted” and need a bit of a get-away to “re-boot”. I am not talking about a trip to the day spa. I am simply talking about an hour or 2 to go to the store or meet a friend for lunch or just sit alone in the park and read a book.  Just a bit of quiet after being home with a baby day in and day out for the first 4 weeks of their newborn’s life.  If you have been there you understand. 

But, now that they have a cell phone, there is CONSTANT communication.  The minute the baby cries, the cell phone rings....”the baby is CRYING, come home.”  My husband would tell you that his best parenting started the first time I left him alone with our first son and I actually went away for the weekend.  (I believe the baby was 6 or 7 weeks old and off I went breast pump in hand to a reunion.)  No cell phones then, and guess what, he did a great job!!!!  He told me how after the first 24 hours he figured out that he really didn’t have to have the baby in the bathroom with him in order to take a shower. He later told me that the first shower he took, not only was our son in the room in his “bouncy” chair, but he left the shower door open as the door got steamy and he couldn’t see the baby!! How cute is that. 

Technology, as wonderful as it is, may also enable us to “cop out” when things get a bit difficult.  That goes for parenting as well. 

Turnoff your phone off sometime and let the “other parent” or babysitter handle it for awhile. Being disconnected is NOT always a bad thing!

Daily Dose

Bathing Your Baby

The end of summer baby “boom” is still going on and new parents are coming in with all sorts of questions…including how do I bathe my baby?  As many mothers and their babies are being discharged from the hospital after 24 hours, they really don’t have the opportunity to “practice” new parent skills, including giving their baby a bath.

Bathing your baby is really fun and is a good bonding experience for parent and child.  The bath also keeps your baby clean and smelling “sweet”.  I was convinced that it would also help them to relax and to sleep longer (not scientific at all - but it works for us right?).  At any rate, you can bathe your baby every day or every 2-3 days, or even once a week. It is really personal preference…but that wonderful “after bath smell” makes me smile.

Many people buy infant bath tubs and there are tons to choose from. I like the the “Puj Tub” or the “Tummy Tub” as you can easily put them in the kitchen sink (grandparent friendly), but you want to make sure that there are no sharp edges or places where a baby might get bumped or injured when you put the tub in the sink.  Some people use a folding tub (be careful not to pinch the baby) or inflatable tub  these may collapse), because they are easier to store if you have limited space.

The number one rule for a bath - NEVER leave your baby alone in the tub, not even when they can start sitting up. A baby may drown in an inch or two of water…so never even turn around to check your phone or check an email.  You should also make sure that the water temperature is correct and every new parent should check the hot water heater and lower the temperature to 120 degrees F, so prevent burns. Regardless, always check the water temperature before you put the baby into the tub.

I am also a fan of using mild soaps..including Cetaphil, Cerave, Aveeno, and Aquaphor  baby wash. If your child tends to have sensitive skin it is best to avoid fragrances and harsh chemicals.  I also like to moisturize the infant after a bath with baby lotions from these same companies. New data is showing that frequent moisturizing (twice a day) may also be important in preventing allergies later in life…. so why not enjoy some baby massage…and keep watching for more information on this issue.

 

 

Daily Dose

OTC Medicine Dosing Changes

Are you confused about just how much OTC medicine to give your baby? You're not alone. Are you confused about over the counter liquid medication dosages? No need to worry; you are not alone.  The good news is changes are coming!  The FDA has just released new guidelines in an effort to reduce the risk of overdoses when giving children liquid OTC medications.

In previous studies, numerous medication errors had been reported as many liquid OTC products did not come with appropriate dosing devices, or even with consistent dosing directions. This led to a lot of confusion among parents, caregivers, even doctors and nurses.  There have been numerous medication errors which at times had serious consequences. The FDA now recommends the following:

  • OTC products taken by mouth should come with dosing dispensing devices. The devices should be marked with calibrated units of measurement that will match the units of measurement on the medication label (teaspoon, tablespoon, milliliters).
  • The dispensing devices should be only used with the specified product (I would tape the device to the appropriate bottle if necessary to prevent confusion).
  • The measured markings should be clearly visible when the liquid medication is added, and there should not be any other marking on the device

At about the same time, the Consumer Healthcare Products Association announced plans to change liquid acetaminophen products to one concentration. In other words, the infant’s acetaminophen concentrated drops will be eliminated in favor of a single strength acetaminophen suspension. The current single ingredient acetaminophen (Tylenol name brand), which is 160mg/5ml, will become the only liquid concentration for children under the age of 12. These products will also come with age-appropriate dosing devices including syringes and dosing cups for different aged children. So, the picture should be a little clearer with these guidelines and there should be fewer errors with dosing, especially for blurry-eyed parents in the middle of the night. That’s your daily dose for today. We’ll chat again tomorrow.

Your Baby

Teething May Make Your Baby Fussy, But Not Sick

2:00

Parents sometimes have trouble distinguishing between whether their cranky baby is actually ill or is just getting his or her first teeth. Because a baby’s gums may be tender and swollen as their teeth come in, a slight rise in temperature can occur.  Other changes may happen as well such as fussiness and increased drooling. All- in –all, babies can be pretty miserable till those first teeth break through.

That said, teething does not cause a full-fledged fever above 100.4 degrees Fahrenheit or any other signs of illness according to a new review led by Dr. Michele Bolan, of the Federal University of Santa Catarina, Brazil.

Certain symptoms can be confusing for parents says Dr. Minu George, interim chief of general pediatrics at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"I get questions about this on a daily basis," said George, who was not involved in the study.

When a baby’s temperature reaches 100.4 degrees F or higher, it becomes an actual fever, not just a slight increase in temperature.

"Fevers are not a bad thing," she pointed out. "They're part of the body's response to infection." But, George added, parents should be aware that a fever is likely related to an illness.

Of course, new parents are going to be somewhat edgy when it comes to caring for their infant. It’s a new world of responsibility that can seem overwhelming at times. 

Pediatricians and family doctors regularly answer questions about this topic with an explanation of how a typical teething experience presents.

Over the ages, other symptoms have been linked to teething that should never apply. They include sores or blisters around the mouth, appetite loss and diarrhea that does not go away quickly. Any of these symptoms warrant a call to your pediatrician.

Babies differ in age as to when their teeth begin to come in.  Typically, the fist tooth begins to erupt around 6 months of age. It can also be as early as 3 months and as late as 1 year of age. There really isn’t a set age for teething to begin, just an average.

Baby’s teeth usually erupt through the gums in a certain order:

·      The two bottom front teeth (central incisors)

·      The four upper front teeth (central and lateral incisors)

·      The two lower lateral incisors

·      The first molars

·      The four canines (located on either side next to the upper and lower lateral incisors)

·      The remaining molars on either side of the existing line of teeth

By age 3, most children have all 20 of their primary teeth.

As for helping babies get through the misery of teething, George advised against medication, including topical gels and products that are labeled "natural" or "homeopathic."

Instead, she said, babies can find relief by chewing on a cooled teething ring or wet washcloth, or eating cool foods.

The analysis was published in the February online edition of the journal Pediatrics.

Sources: Amy Norton, http://www.webmd.com/parenting/baby/news/20160218/teething-makes-babies-cranky-but-not-sick-review

http://www.webmd.com/parenting/baby/tc/teething-topic-overview

Daily Dose

Breastfeeding

1:30 to read

August is National Breastfeeding Awareness Month as well as World Breastfeeding week. The theme this year is “Sustaining Together”  which means getting a mother’s “community” around her to help her with her breast feeding.  In my mind this means getting the father involved in being there for his wife, followed by the hospital nurses in the nursery, the lactation nurse if your hospital has one, your pediatrician and then any close family members who may be involved in helping a new mother.  

 

Although breast feeding is “a natural process” it sometimes takes one baby or mother or both a bit longer to “figure out” the latch, how to hold the baby comfortably for a feeding and how to be successful with breastfeeding. One of the first hurdles is assuring a new mother that she is “not doing it wrong”. While there may be some tips…there is not ONE WAY to breastfeed.  At times too much pressure from outside influences may actually cause more anxiety and I often find myself telling a new mommy that it just takes “practice, practice, practice…you cannot mess this up on day #1!!”. 

 

But, for some new mothers, breast feeding causes a great deal of  anxiety and they may need a bit more reassurance and support to hang in there and see how it goes… reminding them that a baby does not always nurse for the same amount of time, that they may eat in 2 hours one time and not want to eat for 3 hours the next. They are newborns and not robots…and  we all eat a bit more or less at different times of the day. It is hard to “schedule” a new baby’s feedings and the best advice is to try and watch your baby’s cues and cries.  While one baby may be a bit sleepier in the first few weeks,  another may wake on its own..but either way it is important to try and feed the baby every 2 -3 hours to get breast milk and breast feeding established. Lots of poops and wet diapers is also very reassuring that something is working!

 

This is where the baby’s father may be extremely helpful. He can make sure that the mother is getting “fed” as well.  She needs plenty of healthy meals and lots of fluids to ensure breast milk production.  He may also get up with the baby and change the baby before the feeding and then bring the baby to the mother to nurse.  Encouraging his wife is equally important. There are times when some of those hormonal changes in the new mother makes her feel weepy, sad or inadequate as a new parent….and he can reassure her as well. (even if he is unsure of himself - fake it a bit).  Partnering from the beginning of parenthood is important for both a father and a mother.

 

In some cases if a baby is not feeding well or the baby is premature a mother will need to pump breastmilk and offer the baby a bottle. This is tiring for a new mother and so the grandparents may also help both new mother and father and offer to help feed the baby so the parents may get some rest (which is also important for milk production) or even wash the bottle and breast pump. Every little bit will help.

 

In my experience a new mother who has a lot of support and encouragement is more successful with breastfeeding.  After the first few weeks of breast feeding the “newness” wears off and breast feeding usually seems to get easier and easier. Once parents see that the baby is gaining weight and the mother’s milk supply is equilibrating to her baby’s needs and breast and nipple tenderness is going away, many a new mother tells me how happy she is that she continued to “work on breast feeding her baby”. 

 

Lastly, there are some situations where a mother may not be able to breast feed her baby and she should not be “mommy judged” or shamed for this.  Not everyone knows a new mother’s medical history, or the reason she chose not to breast feed.  

 

 

Daily Dose

Caring For An Uncircumcised Penis

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

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

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

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

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

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