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Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Introducing Finger Foods

We had a recent question: how to introduce finger foods?The Kid's Doctor iPhone App is great and we are getting a lot of good questions that I will continue to answer! One mother (Samantha) wrote in asking about beginning finger foods for her 11 month old.  She wasn’t sure what she could offer her daughter.

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Finger feeding is a very important developmental milestone for babies and usually begins around 8–10 months of age, depending on your baby and their interest. You often realize that while you are trying to spoon feed a baby of that age, that they are reaching out to grab the spoon or grabbing at your fork as you put something into your own mouth.  This naturally occurs as you baby explores the environment around them, and they are always putting things into their mouths, so it would seem logical to start finger foods. The easiest way to start finger feeding with your baby is by giving them small pieces of “mushy” food that you are already feeding them, but rather than putting it on a spoon to feed them, put the food on their high chair tray and watch them as they “scoop” it into their hand and then it goes straight to their mouths. Every child is different too. So, some immediately love putting foods with texture into their mouths and will happily feed themselves almost anything. Then there is another group that doesn’t like the “texture” or feeling of having non pureed food in their mouths. This group happily picks up the food, but once it hits their lips, out is comes as if it was some sort of “poison”. As with so many things, every child is different, so don’t push it, but at the same time continue to offer bite sized pieces of mushy table food.  Let your child explore the textures of different foods as this is integral to becoming familiar with different textures.  It is easy to let a child’s natural hunger help drive them to taste things too, so while you are preparing their meal, put a few things on their tray and see how they do with finger feeding. There are really no “rules” as to what you can give to your child for finger foods, as long as the food is well cooked, soft, and is in small bite sized portions. Children (similar to old folks “without their teeth”) don’t chew their food, but gum it, so you need to be aware of offering foods that might pose a choking hazard.  So any fresh vegetable that is well cooked, like carrots, green beans, peas and corn are easy for a baby to pick up and eat. Same thing for fresh fruits, with blueberries and pieces of ripe pineapple, or kiwi, or banana.  It is easy to offer a baby the “over ripe” fruits that you previously threw away as being too mushy. Babies love it all and truly need to experiment with the different textures of foods.  Other good things to try are pieces of pancake, pasta, scrambled eggs and beans and rice.  Do NOT offer peanuts, popcorn, hard candies,  chips, or chunks of meats, as these may cause choking and aspiration risks. By the time your child is around 1, they will really be mostly finger feeding and you will only be spoon  feeding the yogurt, applesauce, cereals that cannot be easily finger fed. By that time too your child will no longer be “scooping” the foods, but they will be using their pincer grasp and are quite agile at getting everything in their mouths.  The next milestone will be as your child begins spoon feeding themselves!! That's your daily dose.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Your Baby

Never Leave a Child Unattended in a Car Seat, Swing or Bouncer

2:00

Placing an infant in a car seat, swing or bouncer as a substitute for a crib can be a fatal decision. These objects work fine when used properly for their intended purpose, but when a child is left unattended – they can quickly turn deadly according to a new study.

Using these devices as directed and not as substitutes for a crib would reduce the risk of death, according to lead author Dr. Erich K. Batra of Penn State College of Medicine in Hershey, Pennsylvania.

“The overarching advice goes back to a more basic message of safe sleep,” Batra told Reuters Health. “In an infant, a safe sleep environment includes the ABCs: they sleep alone, not in bed between parents, on their backs, and in a crib or bassinet without any loose bedding.”

The study reviewed young children’s death in devices like car seats, swings and bouncers and found that most were due to suffocation by improper positioning or strangulation in straps.

The researchers reviewed the reports of 47 deaths of children under two years old that happened in car seats, bouncers, swings, strollers or slings and were recorded by the U.S. Consumer Product Safety Commission between 2004 and 2008.

The study used only reports submitted by consumers or manufacturers, so the number of deaths may actually be higher.

Most of the deaths occurred in car seats (31 of 47). Five happened in slings, four each in swings and bouncers and three in strollers.

About half of deaths in car seats were due to strangulation by the straps, while the other half were caused by suffocation due to positioning, the authors reported in The Journal of Pediatrics.

Strap strangulation usually happens when the restraints are not fastened as directed, Batra said. Whenever a child is in a car seat, the harness should be secured.

“If people leave an older infant or young toddler in a car seat and undo the straps thinking that it makes them more comfortable, that’s a significant hazard,” he said.

“A child properly secured in a car seat is in very little risk of danger,” he said.

However, many times the child falls asleep in the car seat and a parent or caregiver decides to bring the car seat, with baby still attached, into the home.

Dr. Shital N. Parikh, an orthopedic surgeon at Cincinnati Children’s Hospital Medical Center in Ohio, has studied the risk factors for injury in these devices in infants up to age one. He also found car seats to be the most common setting.

“The commonest mechanism of injury was infants falling from car seats when not used in the car, used in the home,” Parikh told Reuters Health. Often parents would bring the car seat in the house while the infant still slept, undo the straps and place it on an elevated surface, he said.

Even four-month-old babies are mobile enough to wiggle out of the top straps and fall, or topple the whole seat from an elevated surface, he said.

“These are very simple things, very basic things,” Parikh said. “The basic idea is that you use (the devices) for their intended purpose only. For infants, you should not use it to make them sleep or carry them around if it’s not intended for that.”

Batra notes that baby in slings need to be “visible and kissable,” as a sling may put baby’s head in a hazardous position.

It only takes four to five minutes for an unattended baby to suffocate in one of these devices.

“That is one of the things we need to draw attention to,” Batra said. Sometimes a few minutes unattended is all it takes.

“If your infant is sleeping and you’re not observing them, then they need to be in a safe sleeping environment,” adhering to the ABCs, he said.

While it may seem safe to leave a baby in a car seat, swing, sling or bouncer for a few minutes unattended, go ahead and place the child in his or her crib. It may wake them up if they are sleeping, but it’s much safer than allowing them to continue to sleep in a device that was never intended for that purpose.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/04/29/us-car-seat-infant-safety-idUSKBN0NK21E20150429

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

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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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Daily Dose

Your Baby's Umbilical Cord

1.15 to read

I get a lot of phone calls several days after parents head home with their newborn regarding their baby’s umbilical cord.  The umbilical cord really is the lifeline for the baby for 9 months, but once the baby is delivered, and the cord is clamped, it becomes a nuisance and “grosses” many parents out.  So often parents don’t even want to touch the cord and one of my patients told me....”why can’t it just dry up and fall off immediately?”. My only answer to that is, “God did not make it that way?”.

So, in a nutshell the umbilical cord is made up of 3 blood vessels, actually 2 arteries and one vein.  When the cord is cut and clamped the vessels begin to clot and eventually the cord detaches, typically in 7-14 days and then falls off.  

In the interim the cord is developing a scab so it may “ooze” a bit and there may even be dried blood on the baby’s diaper or around the edge of the cord.  A tiny bit of blood is to be expected, and parents don’t need to be worried that the baby is bleeding!!!  I like to explain that it is the first time as a parent that you might need to clean off a little blood, the same way that you will again when this sweet newborn becomes a toddler and falls down and skins their knee.

On occasion the hospital forgets to take the cord clamp off before the baby is discharged and the family comes in with the baby for their first visit with the cord clamp still on.  Poor parents have no idea that this is typically removed before discharge...somewhat like leaving the store with the magnetic tag on the outfit....just no alarm to let you know it is still there. In that case they are amazed when we pop off that yellow or blue plastic attached to their baby!

Lastly, the newborn baby can have some time on their tummy, if they are awake, even with the remnant of the cord still on. It will not hurt the baby at all and early tummy time is important...just NOT when a baby is sleeping!

I have to admit that I opened the baby book 30 years later and that dried umbilical stump was in there..Yes, I too was a first time mother.....don’t save it!

Daily Dose

Learning to Crawl

1.15 to read

Back to more funny office stories - they really keep my job interesting and always a little bit of fun. 

Many of my “new” young parents worry (haven’t we all?) and one of the new comments I have started to hear is “why is my baby not crawling?” Well, for one reason, they are only 6 months old!  I know we are expecting children to achieve some milestones at younger and younger ages, an example of this is reading.  But while not all children are ready to read at 4-5 years, MOST children do not crawl until they are around 9 months of age. 

I am suddenly having moms and a few dads ask me how to “teach their baby to crawl”?   What???  This is new to me.  I wish I could remember   each of my own children as they learned to crawl. It is just a foggy memory now, but I do remember that suddenly they were mobile, and that changes everything! 

Babies instinctively want to move and explore their environment. For most babies, if you have been doing “tummy time”, which is followed by your baby learning to sit, they suddenly figure out how to go from the sitting position back to their tummy.   Why?  That maneuver is the precursor to learning to crawl.  They just do it!  You need to put them on the floor and let them figure it out. You DO NOT need to crawl around the house.  

While you will have to help “teach” your child to walk, in a manner of speaking, they WILL just crawl if given the opportunity.  That means putting them down and letting them figure out how to move. I had one mother who asked me if “her baby could sit in the grass?”  She was afraid to even let the child touch the ground. Other parents are worried that it is “too dirty” for their child to sit on the floor and crawl.  The world is full of dirt, grass and who knows what else, but children have to spend some time on the floor to learn to crawl.   

Take home message....no instructions for a baby to crawl, they just figure it out, and we parents figure out that some of the things our wonderful children accomplish are despite us!

Daily Dose

Big Breasts in a Newborn?

Why do some newborn babies have large breasts? Should parents worry?I recently saw a new baby for their 2 week old check up.  During this visit there are many questions about what is “normal” and what is “abnormal”, as new parents are just finding out the nuances of their baby.

While all babies are different, there are many similarities among a newborn. One of the most commonly asked questions is “why does my baby look like they have breasts?”  This is even a more common question when the infant is a baby boy. Many parent’s will notice that their baby seems to have swelling under their nipples, sometimes it is both nipples at other times it may be asymmetrical.  There should not be any redness and the area should not be tender.  If you are feeling the area you may note a small moveable mass beneath the nipple.  All of this is very normal and the benign breast enlargement is due to maternal hormones that influences the baby’s breast tissue. At times parents may even report that they have noticed a milky substance coming from the baby’s nipple.  This is called galactorrhea, and the neonatal milk is also known as witch’s milk.  Galactorrhea is seen in about 5% of newborns and occurs in both sexes. The term “witch’s milk” is derived from ancient folklore where the milk was thought to be nourishment for witches spirits.  (I guess we’ve come a long way in our medical knowledge). Infant’s who seem to have galactorrhea seem to have more breast enlargement, and is also seen more often in babies who are breastfed. In most cases the breast enlargement resolves spontaneously within several months.  No treatment is necessary and I tell parents not to press on the baby’s breast tissue.  If you manipulate the breast tissue it may actually force bacteria into the milk glands. If the breast tissue gets infected an infant may develop mastitis, just like a nursing mother.  I actually saw a baby earlier this year who had developed a breast infection that actually had to be drained and required IV antibiotics and a short hospitalization. I am happy to say that baby is perfectly well, the breast enlargement has resolved and he will never know that he had “baby boobs” in the first month of his life!!!  Some things are better kept as secrets. That’s your daily dose for today. We’ll chat again tomorrow. Send your comment or question to Dr. Sue!

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