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Your Baby

Should Newborns Sleep in Yours or Their Own Room?

2:00

It’s an age-old question, should your newborn sleep in his or her own bed in the parents’ bedroom for a while or start their sleeping habits in their own room?

A new study suggests infants benefit from sleeping in their own room, but the American Academy of Pediatrics (AAP) says the dangers may offset the benefit.

Recent research from a hospital in Philadelphia says babies go to sleep earlier, take less time to fall asleep, get more total sleep over the course of 24 hours, and spend more time asleep at night when they don’t share a bedroom with their parents. Parents also report that they get more rest as well.

“There are a number of possible reasons that babies sleep better in their own room,” said lead study author Jodi Mindell, associate director of the Sleep Center at the Children’s Hospital of Philadelphia. 

“One main reason is that they are more likely to self-soothe to sleep,” Mindell said by email.

During the study, researchers found that parents who put babies to sleep in a separate room were less likely to feed infants to help them fall asleep at bedtime or when they awoke during the night.

When babies had their own rooms, parents also perceived bedtime to be less difficult.

The study focused on infants 6 to 12 months old. Researchers examined data from a questionnaire completed by parents of 6,236 infants in the U.S. and 3,798 babies in an international sample from Australia, Brazil, Canada, Great Britain and New Zealand. All participants were users of a publicly available smartphone app for baby sleep. The researchers noted that because of the use of the smartphone app, results might not be the same for a larger population of households.

The AAP recommends that newborns sleep in their own bed in their parents’ bedroom till the infant is at least 6 months of age to minimize the risk of sleep-related death. Ideally, babies should stay in their parents’ rooms at night for a full year, AAP advised 

The reason for the AAP recommendation is because babies sleeping in the same room as parents, but not the same bed, may have a lower risk of sudden infant death syndrome (SIDS).

The safest spot for infant sleep is on a firm surface such as a crib or bassinet without any soft bedding, bumpers or pillows, the guidelines stressed. 

“Pediatric providers have been struggling with what to tell parents since the release of the AAP recommendations,” Mindell said. “Once a baby is past the risk of SIDS, by 6 months of age, parents need to decide what works best for them and their family, which enables everyone in the family to get the sleep they need.”

SIDS deaths occur most often from birth to six months but can also happen in older babies that were the focus on the study, said Dr. Lori Feldman-Winter, a coauthor of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey. 

“If the only goal is to increase sleep, then the results may be compelling,” Feldman-Winter said in an email to Reuters Health. “However, since we don’t know the causes of SIDS and evidence supports room sharing as a method to decrease SIDS, giving up some sleep may be worth it.”

The study was published online in the journal Sleep Medicine.

Story source: https://www.reuters.com/article/us-sleep-infants-location/parents-find-older-babies-sleep-better-in-their-own-room-idUSKCN1BC5QI

 

Your Baby

Tdap Vaccine Protects Mother and Newborn

1:45

A new study shows that the Tdap vaccine, (tetanus, diphtheria and pertussis), is safe for pregnant women and their unborn child.

The vaccine does not appear to cause birth defects or any other major health problems for a developing fetus, according to a review of more than 324,000 live births between 2007 and 2013.

"We basically showed there is no association between receiving the Tdap vaccine during pregnancy and these congenital [birth] defects, including microcephaly," said lead researcher Dr. Malini DeSilva. She is a clinical investigator for HealthPartners Institute in Minneapolis.

Controversy over vaccines has caused some pregnant women to worry about possible side effects. The study is part of ongoing efforts to monitor the safety of vaccines, DeSilva said. Her center is part of the Vaccine Safety Datalink, a collaborative project led by the U.S. Centers for Disease Control and Prevention that includes health care organizations across the nation.

Whooping cough (also known as pertussis) is a bacterial infection that gets into your nose and throat. Whooping cough is dangerous in babies, especially ones younger than 6 months old. In severe cases, they may need to go to an ER. Babies with whooping cough may not make the typical whooping sound or even cough, but might gasp for air instead.

Babies can't receive the vaccine that protects against these diseases until they are 2 months old, DeSilva said. Until they do, they have a high risk of contracting whooping cough.

"In between the time they're born and their 2 months' visit, they don't really have any protective antibodies other than what has passed through the placenta," DeSilva said. "There have been some studies that show there is an increased chance of passing these antibodies when the mother gets this vaccine."

The researchers found that maternal Tdap inoculation wasn't significantly associated with increased risk for any major birth defects in vaccinations occurring at less than 14 weeks' gestation, between 27 and 36 weeks' gestation, or during any week of pregnancy.

Dr. Amesh Adalja is a senior associate with the University of Pittsburgh's UPMC Center for Health Security. He said, "This study illustrates the safety of maternal Tdap vaccination and the lack of an association with any birth defects." Adalja was not involved with the new report.

"Vaccination of pregnant women with this vaccine is an important aspect of protecting neonates from pertussis, a potentially fatal condition," Adalja added. "This study should reassure physicians and patients and hopefully increase vaccination rates in pregnancy."

The Tdap vaccine has been recommended for unvaccinated pregnant women since 2010 in California, and since 2011 across the United States, researchers said in background information.

The study was published Nov. 1 in the Journal of the American Medical Association.

Pertussis is very contagious and is particularly dangerous for infants. With the cold season underway, the Tdap vaccine is highly recommended for pregnant women as well as the general public.

Story sources: Dennis Thompson, https://consumer.healthday.com/public-health-information-30/vaccine-news-689/common-vaccine-is-safe-for-mother-baby-in-pregnancy-716379.html

Renee A. Alli, MD, http://www.webmd.com/children/guide/whooping-cough-symptoms-treatment#1

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!

 

 

 

 

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Daily Dose

New Test for Your Baby

1.00 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 3-7 % 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. 

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

Daily Dose

Fever & Your New Baby

Summer is here and many families are heading on vacation. I often get asked "can you trvael with a baby?"I have recently seen many babies coming in to the office for their first post hospital newborn check. The lovely thing about summer is that the office is not quite as busy as there just aren’t as many sick children.

Despite the decrease in sickness throughout the country during the summer, I still explain to new parents that it is important to try and limit their newborn’s exposure to illness. This is best accomplished by avoiding crowds.  This is especially important for the first 6–8 weeks of a baby’s life. We pediatricians get especially concerned if a newborn develops a fever during these first weeks. One of the first precepts of pediatrics is,” an infant under 8 weeks of age with a fever, is admitted to the hospital for a presumed bacterial infection until proven otherwise”.  This means a spinal tap, urine culture, and blood culture are performed and IV antibiotics are routinely started. In most cases the fever is secondary to a viral infection, but until all tests are negative, the baby spends 2-3 days in the hospital. Traumatic for everyone. But with the summer months here, many families are planning on travelling to the beach or mountains, or to go visit the grandparents etc. The travel issue came up as I had a patient that just had her 3rd baby (via C-section no less), and she came in with her precious newborn. While I was examining the baby, the mother casually mentioned that she was planning on going to Washington, DC in the next few weeks (baby would be about 3 ½ weeks old), for a family trip and sightseeing.  Her husband wanted the older children to see DC and they then planned to drive up to the battlefields in PA. UGH! I grew up in DC and there really is not a better place to take children for a combination of fun and learning.  But, the thought of travelling with a newborn, standing in lines to get through security at the airport (another post), and flying for over 3 hours only to stand in more lines to enjoy the sights of Washington with the older children, made me cringe.  Not just for the huge undertaking of travel, but because of this newborn’s possible exposure to infection.  Think of all of the germs that this newborn might come in contact with!! Now, you know I am not a “germaphobe” but I am wary of a newborn being exposed to this many people. Every time you stand next to someone who coughs or sneezes, they may unknowingly pass a virus on to you.  Many of the viral infections we so often discuss are airborne and enter our own eyes or noses via aerosolized droplets. Mother’s and father’s hands also touch many surfaces, and even with hand sanitizers there is no way to be sure that those travelling hands have not come into contact with germs that then may be spread to the newborn. No one wants to get a tiny baby sick, but there are a gazillion people out at airport check in counters, or in security lines, or sitting next to you on a plane that may be ill.  You don’t get to pick who you are with. Same thing goes for standing in a museum or shopping mall or hotel lobby.  So, that precious newborn may develop a fever from all of this exposure and they will end up in the hospital, wherever you are. So, if possible (I realize there are emergencies) stick close to home and plan that trip with your baby after they are 8 weeks of age. It will make it much easier on parent, infant and the pediatrician who hates to have to hospitalize a newborn. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Developmental Milestones & Your Baby

Dr. Sue takes you through milestones during a baby's first year.There are always a lot of questions about your child’s development beginning in infancy and it continues until they are grown. I must say, the longer I practice, the more “variations” on normal I see.

With that being said, an infant’s developmental milestones are very important and typically occur in the following order.  A baby will begin turning their heads from side to side at about one month of age. By two months a baby will be exhibiting a reciprocal smile and will make good eye contact.  Shortly after this, typically around four months a baby will reach out at a toy, grab it and put it in their mouths. They may also start rolling at about 4 -5 months of age.  Around 6 months a baby will start to sit when propped, and then will begin what is called “prop sitting”. In other words, they put their hands down to support themselves while sitting and then over days to weeks you notice that they no longer need their hands for support and they are sitting alone. After sitting the next milestone, somewhere around 8 – 10 months comes “schooching” and then true crawling.  The last milestone of infancy is walking, which is typically around 12 -15 months of age. With all of these milestones every baby is a little different. You should see that your baby accomplishes one of the milestones and progresses to the next, but it may not be exactly at the 4 month or 6 month age. Most importantly, progress is important and you do not want to see your baby “get stuck” and seem to lack interest in achieving the next milestone. Lastly, practice helps, so spend time with your infant on the floor, sitting between your legs, and practicing the “prop sit”. Also make this a fun time together to not only achieve the milestone of sitting, but to just enjoy playtime. If you do not think that your child is making progress in their development, or have ongoing concerns,  it is worth a visit and a discussion with your pediatrician. That's your daily dose for today. We'll chat again tomorrow. Send your question of comment to Dr. Sue!

Daily Dose

What is Thrush?

1.15 to read

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

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

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

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

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

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

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. 

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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