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Daily Dose

New Test for Baby

1.30 to read

If you recently had a baby (or are getting ready to) you may have noticed another “test” being performed on your newborn before they leave the hospital. Earlier this year the American Academy of Pediatrics endorsed the routine use of pulse oximetry to enhance detection of critical congenital heart disease.  

Critical congenital heart defects (CCHD) are serious structural heart defects that are often associated with decreased oxygen levels in infants in the newborn period. These heart defects account for about 17-31% of all congenital heart disease (or about 4,800 babies born each year in the U.S.)  

While some of these defects are found on pre-natal ultrasounds, and some may be evident immediately after birth when the pediatrician hears a murmur or the baby has difference in their pulses, others may not present until a baby is several hours - days of age.  Using pulse oximetry to measure a baby’s oxygen levels before they are discharged is just another method of screening a child, and if there are abnormalities a baby would undergo further evaluation with an echocardiogram and would see a pediatric cardiologist. 

Pulse oximetry is routinely used in all aspects of medicine these days and requires a simple non-invasive device that is placed on a babies finger or toe to measure the level of oxygen in the blood. (looks a little like ET device to light up a finger). It works by comparing the differences in red light, which is absorbed by oxygenated blood, and infrared light, which is absorbed by deoxygenated blood.  

In a large study just published in the journal Lancet (looking at over 230,000 newborns), simple pulse oximetry detected 76% of congenital heart defects, with only a rate of 0.14% false positive results. The risk of false positives was even lower than that when pulse ox was performed when the baby was over 24 hours of age. Pretty impressive! 

It has been estimated that about 280 infants with unrecognized CCHD are discharged from newborn nurseries each year. Congenital heart disease also accounts for somewhere between 3-  % of infant deaths. With early intervention and surgery the chance of survival from CCHD is greatly improved. 

So ask your pediatrician or obstetrician if they are doing routine pulse oximetry in your hospital nursery.

 

 

Daily Dose

Monitoring Your Baby

1.30 to read

I have recently received several emails from patients which included attachments.  The attachments were videos of a baby in their crib with questions from parents about whether the baby was “breathing okay”, was “crying enough to be picked up”, or whether I thought “the baby was dreaming”. I had to laugh, as the first thing I thought of while watching all of these videos was: we are really just “too smart for our own britches”, which was a line often used by my dear deceased grandmother who died at the ripe age of 104!  In this case, she would be right as we have so much technology available to us but I’m not sure if it is really that helpful when we are talking about caring for a baby. 

Every parent wants to make sure that they are “watching” their newborn, infant or toddler as closely as possible. That is good parenting.  But, even a newborn does not need to have constant video monitoring with rewind and playback ability.  Just having your baby in the bassinet by your bed or in the nursery next door to your room is really sufficient.  

The idea is that you can hear your baby if they are crying.  You do not need to hear hiccups, and know that they latest for 18 minutes. If your baby is stretching and making normal “new baby” grunting and groaning sounds, you do not need to hear every noise. You do need to hear your baby crying because they are hungry, wet or uncomfortable.  That is when a parent is supposed to get up and go to their baby’s bed.  Watching them just making a few noises to get settled is not a call for intervention.  

I am the first doctor/mom to totally believe that a new baby needs to be held when fussy or irritable. I am not the “cry it out” doctor (let them cry for the first 5-6 months of life).  But, a baby can ooch and scooch and not need to be picked up and if you do not have a video monitor, you probably would not know they were ooching and scooching.  With video monitors on day and night a baby cannot even burp without the parent watching and wondering and “worrying” if that burp was significant.   

While we talk about our teens being “too connected”, maybe we parents need to think about that too.  Are “we” parents (and grandparents) being too connected to the baby?  Are we part of the problem of “instant” intervention, when many a baby might calm themselves if given the chance (and the parent never knew).  

Many generations of newborns and young babies were raised, successfully, without a video camera. Parents ears are a pretty good monitor too , for both babies and even teens.  Eavesdropping is still allowed! 

Daily Dose

Feeding Baby Solid Foods

1.15 to read

I still get a lot of questions about starting solid foods in a baby.  The recommendation from the American Academy of Pediatrics is somewhat confusing as the latest recommendation is that mother’s should exclusively breast feed for the first 6 months of life...which means you do not start solid foods until 6 months.  But, the recommendation for formula fed infants is to begin introduction of solid foods between 4-6 months of age.

I recommend that parents routinely wait until their baby (whether breast or bottle fed) is about 5 1/2 months old to begin solid foods.. For a first baby, parents are really anxious to start cereal as they think it will, “make them sleep all night”, or want to try out all of those spoons people gave them as gifts. Those cute grand parents perpetuate the idea that cereal=sleep. Again, a myth, the majority of children are sleeping by 4 months of age whether breast or bottle fed, and no cereal.  Cereal is less calorie dense than milk! If we all drank breast milk or formula all day long we would definitely have weight problems, but for the first 4-6 months of life milk is all the baby needs.  

Whether you start your baby on solid foods at 4 or 6 months, it is important that you do give your child infant cereal. Whether you want to use rice cereal, oatmeal or mixed grains, baby cereal is iron and zinc fortified. The amount of iron and zinc in fruits, vegetables and even baby food meats is actually very low.  Baby cereals also provide vitamin B and other vitamins that are important for a baby’s nutrition. 

So, for parents who want to make their own baby food fruits, vegies and meats I am all for that. Did you know that there is more iron in pureed cooked meats than in infant prepared jar meats? But not all parents cook and some are uncomfortable in pureeing food at home. 

 At the same time, I encourage families to continue baby cereals for as long as they can.  For first children that may be until they are even 15-18 months of age. They don’t “know” that there are other cereals out there.   Mixing in some fruit will make that baby cereal just taste great as well as increase the absorption of iron.  Those toddlers will learn that we have Cheerios and Corn Flakes, and if it is your 2nd, 3 rd or even 4th child, they know about Cocoa Puffs and Fruit Loops by the age of one and are reaching for their siblings Captain Crunch. 

Birth order does play a role in foods introduction!

Daily Dose

SIDS Risks

1.30 to read

Sudden Infant Death Syndrome (SIDS) is every parent’s worst nightmare. From the time a family has their new baby until that child is 1 year of age, SIDS is of a concern. 

Most new parents in 2012 know about the Back to Sleep campaign (BTS), which was recommended by the AAP in 1994. After  the recommendation for newborn’s sleep position was changed from prone (tummy) to supine (back) the incidence of SIDS in the U.S. showed a sharp decline (more than 50%) over the first 10 year period. Unfortunately, the overall SIDS rate has plateaued since that time, and SIDS is still the leading cause of infant mortality in the U.S. 

A study in the April 2012 issue of the journal Pediatrics looked at risk factors for SIDS. Parents need to know that greatest risk for SIDS is during the first 12 months of life (the so named “Critical” development period). There are also both intrinsic and extrinsic risk factors for SIDS as well. All of these factors contribute to the vulnerability for SIDS. 

The peak incidence for SIDS is still between 2-4 months of a baby’s life. (postnatal age). The intrinsic risk factors for SIDS include, male gender, prematurity, genetic differences (now being found called polymorphisms) and a child’s prenatal exposure to cigarettes and/or alcohol. Extrinsic risk factors include tummy or side sleep position, bed sharing, over bundling, soft bedding and a child’s face being covered.  In this study 99% of SIDS infants had at least 1 risk factor, and 57% had at least 2 extrinsic and 1 intrinsic risk factors. Only 5% of the SIDS victims studied had no extrinsic risk. I think this is important for all parents to know! 

So what can parent’s do to lower the risk of SIDS for their baby?  Well, while you cannot change the peak incidence of SIDS between 2-4 months of a baby’s life there is a lot you can do! 

Looking at intrinsic factors:  gender is a 50-50 deal and seeing that I have 3 sons, I don’t know a lot about gender selection, so will not even touch that topic. But, you can prevent prenatal cigarette and alcohol exposure, and every pregnant mother (and father due to second had smoke issues) should eliminate smoking. That sounds easy enough. 

Prematurity may be lessened when a mother is healthy prior to her pregnancy and continues to do as much as possible during her pregnancy to ensure a full term birth. Basically maintaining a healthy diet, getting good prenatal care and listening to your doctor will help to prevent many pre-term births. 

Extrinsic factors are the easiest to change. While prone sleep positioning is a large risk factor for SIDS, there is now evidence that some other risks may appear in conjunction with sleep position.  Putting a baby on their side where they may roll to their tummies may be one issue.  Leaving soft objects or blanket in the crib may be another. Bed sharing is also not advised. 

So, the so-called “triple risk factors” for SIDS may be important information in providing risk reduction strategies for parents and caregivers. Any change that may lessen the risk of SIDS is meaningful and beneficial and will help new parents sleep a bit better as well!  I also did not see any mention of video cameras in the room as a reduction in risk, just saying..... 

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

Daily Dose

Your Baby's Toenails

1:15 to read

I have noticed over the years, that babies are born with the weirdest toenails.  I get a lot of phone calls, pictures and questions during those first few visits about these little toenails.  Just like everything else, they are just “immature” and often are totally flimsy or at times appear to be “ingrown” as they grow and push a bit of skin away.

In most cases I tell patients to just leave them alone, even is they are a bit irritated and red on the edge. That is unless the toe is warm to the touch, or tender or has an obvious infection with drainage. Typically when you push on the toe the even though it may appear a bit irritated and bothersome to you, it should not bother your child or seem to cause them pain.  They should NEVER have a fever due to the toenail issue and if your infant has a temperature above 100.4 you do need to call your doctor.

While a baby’s fingernails seem to grow overnight (and are really sharp), newborns toenails grow at a snails pace. It sometimes seems babies don’t really even have all of their toenails until they are over 1 year and in most cases by then you have stopped paying attention as your child is walking, falling and has a lot of bumps and bruises so the toenails are no longer an issue.

If your baby’s toenails look irritated, clean them with a little soap and warm water and leave them alone!

 

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

Babies & Bow-Legs

1.15 to read

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

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

Your Baby

Fisher-Price Recalls Infant Cradle Swings

1:30

Fisher-Price is recalling three models of their cradle swings: CHM84 Soothing Savanna Cradle 'n Swing, CMR40 Sweet Surroundings Cradle 'n Swing, and CMR43 Sweet Surroundings Butterfly Friends Cradle 'n Swing.

The swings have two different swinging motions - rocking side-to-side, or swinging head-to-toe, and six different swing speeds from low to high. The product number is located on the seat under the pad. 

When the seat peg is not fully engaged the seat can fall unexpectedly, posing a risk of injury to the child.

Fisher-Price has received two reports of a seat peg coming out from the seat, causing the seat to fall. No injuries have been reported.

Consumers should immediately stop using the recalled cradle swing and contact Fisher-Price for revised assembly instructions.

The infant cradle swings were sold at buybuyBaby, Target and other stores nationwide and online at Amazon.com and other websites from November 2015 through March 2016 for about $170.

Consumers can contact Fisher-Price at 800-432-5437 from 9 a.m. to 6 p.m. ET Monday through Friday, or online at www.service.mattel.com and click on Recalls & Safety Alerts for more information. 

Source: http://www.cpsc.gov/en/Recalls/2016/Fisher-Price-Recalls-Infant-Cradle-Swings/#remedy

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!

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