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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

Feeding Your Baby

1:30 to read

Under the heading of “learning new things everyday” comes some information on feeding your infant. Have you heard of “paced bottle feeding?”  If you are a new mother and are breastfeeding and either supplementing your baby with formula or breast milk you may already be doing this……

 

There are many advantages and benefits to breastfeeding your baby, but not everyone is able to breast feed or desires to breast feed. While I am a huge advocate for breast feeding, I am also supportive of “ a mother’s right to choose” and have some patients who just prefer to bottle feed their baby with formula.  The most important issue is really about nutrition and healthy weight gain for a newborn…with either breast or bottle feeding. 

 

So…a new mother was telling me that she was using “paced feeding” for her baby. I admit I looked at her and said “what”?  It seems that this is a feeding method used when a breast fed infant takes a bottle. It is supposed to more closely mimic the sucking and swallowing pattern of an infant when they breast feed.

 

With paced feeding the infant is held in an upright position and the bottle is held horizontally and the baby is  paused after feeding every few minutes…which is what typically occurs during breast feeding.  This method also encourages the  caregiver to turn the baby from one side to the other midway through the feeding….again like a breast fed infant. This will encourage eye contact and changing the head and neck position of the infant during their bottle.

 

Paced feeding is also supposed to help the baby not over-eat. By pausing “you are letting the cues for being full reach the baby’s brain.”  Mothers have also told me “paced feeding will not stretch a baby’s stomach.” I am not sure that there is science supporting this…and I do feel that in general most babies will not overeat ….they pause and turn away from the bottle as they get full…whether you breast or bottle feed you will notice that your baby really “leads the feeding”. When parents try to “fill their baby up before bedtime” they almost seem to try and force feed the baby and typically that only leads to a cranky baby that might spit up as well….watch your baby’s cues.  Amount fed does not necessarily correlate with longer sleep!

 

Try this and see what you think….again, I don’t think there is truly one way to feed every baby as they are individuals too and you will figure out what works best for your own baby. I think most babies are “pacing themselves” even without you realizing it…

 

Daily Dose

Does Your Baby Need Water?

2.00 to read

Since most of the country is sweltering with summer heat and temperatures well into the upper 90’s and even over 100 degrees, I guess I can understand parents’ concerns about giving their babies water. It seemed like a strange question to me when I first started hearing, “Dr. Sue, how much water does my baby need to drink every day?”  I know I am continuing to talk about staying hydrated during the heat wave, but we are really talking about those children and adults who are spending time outdoors, especially when involved in physical activity.

I have actually been telling parents with newborns that there is really no reason to take that sweet new baby outside for any length of time. I think it is too hot to enjoy being outside, and an infant doesn’t miss going to the playground like a 2 or 3 year old would.

But, when you have young children you have to get out (or go crazy inside everyday), so everyone just suffers through the heat. Remember to take your sunscreen and fluids and head out for an hour or two, in the morning or later afternoon if at all possible. These children need lots of water breaks, as do their parents and caregivers.

So, back to the water and baby question. Infants in the first 6 months are getting fed breast milk or formula which is made up of free water, so therefore a baby is staying hydrated by eating every  2 -3 hours. A baby doesn’t “need” water every day for any particular reason.

With that being said, it does not mean that your baby cannot have a bottle of water. This is especially true for a breast fed infant whose mother may have run out for an hour but is coming back to breast feed.  But what if the baby awakens or gets hungry 30 min or so prior to mother getting home.  This might be a good time to “stall” by giving the baby a bottle of water, rather than formula. In this case it is fine to use tap water (yes bottled water is not necessary, unless you have a well or something) in a bottle and see if the baby will even take it. Most babies don’t just gulp down 8 ounces of water!

If you are out in the heat with an infant, just remember to feed them every 2 – 3 hours and make sure they have nice drool in their mouths and wet diapers. If you are concerned about hydration take along a bottle of water for both you and your baby. You will probably need it more than your baby!

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

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

Sleep & Your Baby

1.30 to read

How many books, manuals and even blogs are there out there on “getting your baby to sleep”.  There are even “coaches” for new parents who will help them “get their baby to sleep through the night.” 

The longer I practice the more I realize that every baby is different and it really doesn’t matter which book/blog you read....it takes some time to get a newborn to sleep through the night.  If you told expectant parents that it is “tough” in the beginning and sleepless nights are “normal”, most of us would have thought, “not me and my baby”.  Like many things you have to live it to learn.

Getting a baby to sleep through the night is not really an intellectual endeavor, which parenting is later in life. You can read books, talk to a coach, buy all sorts of gizmos and “sleep equipment”, but it also just takes time.  Some of you may just stop reading right now and go, NOT MY BABY!

A newborn baby does not enter this world knowing about circadian rhythms, or lengthy periods of sleep without eating.  A baby really only wants to eat and sleep.... and in the beginning, on their own schedule! Learning to sleep is like a lab in college, lots of hours in class with little credit.  

Of course I believe in things like, “Try to put your baby down to sleep when they are tired but not asleep and they will learn to quiet themselves”. “Try to keep your baby up a bit after their feeding during the day, rather than letting them go right back to sleep”. “Try to only feed your baby every 2-3 hours during the day which will help get them on a schedule”. There are a million other suggestions as well. The only one that I know I always adhere to is “Your new baby must only sleep on their back”, other than that, the first few weeks and even months learning to sleep is just practice, practice, practice. 

Yes, some babies are better sleepers than others, just like you will see some children are better readers while other are better athletes or artists. Some parents will have a baby that is sleeping 6-8 hours by 6-8 weeks and other parents will have to keep “practicing” with their baby for 3-4 months, everyone is different. 

But, do not start off feeling like a failure as a parent if your baby is not sleeping while your friend or co-worker’s child is. Parenting is not a competition and realizing this early on will make some parental struggles a bit easier to handle over the next 21 years. Your baby will learn to sleep...but like so many things, it takes time and practice. 

If I had the potion...trust me I would be selling it by now, there is not a new parent out there that would not buy it....just don’t think the FDA will approve the patent.

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

Safe Sleep & Tummy Time

1.30 to read

I keep getting so many questions about “tummy time”   Ever since the American Academy of Pediatrics recommended that all infants sleep only on their backs (to reduce the chance of SIDS), parents forget or are afraid to put their baby’s on their tummies. Tummy time is important to help reduce the incidence of head flattening as well as to give your baby time to develop different muscle groups.   

Tummy time is encouraged from the first days after a baby’s birth, but so many parents ask, “just how much time?”  Tummy time does not mean “timed” in the sense that you do it for a certain amount of time or minutes a day.  Tummy time, is not rigid.....it is flexible.  Off and on throughout the day when your baby is awake, you let them experience tummy time.   

Just like so many activities with a newborn, sometimes tummy time is for only a minute or two before the baby starts to fuss or cry.  Other times an infant may enjoy their tummies for 10- 20 minutes before they are ready for a change.  

At other times you put the baby on their tummy, they settle down and then decide to fall asleep.  Keep in mind, you MUST turn them over, even if you are watching them. Remember, NO TUMMY sleeping until your child rolls over on their own. 

So, many parents come in during the first days to weeks after their baby’s birth with not only feeding charts, but “pee and poop” charts and graphs of tummy time down to the minutes.  It is really not necessary to graph the amount of tummy time your baby gets, just make sure you remember to do it.  

As your baby gets older, they typically enjoy their tummies for longer periods of time and are soon lifting their heads, supporting themselves with their shoulders and around 4 months will likely begin to roll from tummy to back. After that milestone it is not long before they start sitting alone and tummy time is old hat by then.  Your baby should also have a beautiful rounded head from getting tummy time from the start. 

Daily Dose

Teething Pain

1.15 to read

I am getting a lot of questions from patients related to teething, pain, and the routine use of products to alleviate the pain.  

The FDA recently issued a warning to parents who use OTC products like Oragel and Anbesol on their infant’s gums for relief of teething pain. These products come as both liquids and gels, and benzocaine is the active pain reducing ingredient.

It has now been found that excessive amounts of benzocaine may lead to a very rare condition called methemoglobinemia. (Hemoglobin is the molecule in the red blood cell that carries oxygen) . With methemoglobinemia there is a reduced amount of oxygen that is carried in the bloodstream which may lead to a bluish gray discoloration to the skin, shortness of breath, a rapid heart rate and fatigue and lethargy. Again, key word is rare.

Although the FDA did not withdraw these products from the market, they did recommend that they not be used in children under two, and then should be used “sparingly”. Unfortunately, the benzocaine containing products do not yet contain warning labels and some of my patients are still asking about using them.

I have never recommended using these products in the first place. I always wondered if they really helped a baby who was teething, as I am not sure you can tell when a baby is actually teething.  If you watch any infant over the age of 4 months, their hands are always in their mouths, and they are constantly drooling!  Does that mean they are getting teeth? Unlikely, as most babies don’t even cut their first tooth until about 6 months, so they have been drooling and putting anything they can in their mouths for months prior. The drooling and “gnawing” on their hands (and sometimes feet too) is rather a developmental milestone and not always a sign of teething.

My theory is let the baby chew on a teething ring, a frozen piece of a bagel (cut into quarters, good for gnawing but you need to throw it out when getting soft to avoid choking) or rub their gums with a cold washcloth if you think your child has discomfort.

The same thing goes for using acetaminophen or ibuprofen excessively. Some parents are giving a nightly dose during the “teething months/years” and this is too much medicine.  Children go through a lot of sleep changes and awakenings which tend to occur during suspected early teething times and many parents attribute nighttime awakenings to teething pain. They are not synonymous. Remember that temporal events are NOT always causal.

Babies will get teeth for many years to come and once the first several have broken the skin we don’t seem to pay as much attention anyway, right? I mean, who is going to worry about a child cutting their 2 year old molars, there are way too many other issues to deal with (tantrums, climbing, throwing food) than if their molars are erupting.

So, save your money and don’t buy teething products. Now even the FDA agrees!

Daily Dose

Plane Travel With Your Child

The best way to travel with a baby on a planeI had a question from a parent via our iPhone App about traveling overseas with a 4 month old.  I think it is actually quite an easy time to travel with an infant. 

By this age a baby not only is having a more regular sleep and wake schedule, they are also at the cutest age and are typically fairly easily entertained. They are so sweet and happy that it is also an good time for others to help you.  What person doesn’t want to come to your aid when you have a fussy infant.  You will see as your child gets older, there are less “helpers” for a crying toddler.

I also think that this is a good time to travel as your child has presumably already received their 2 and 4 month immunization series and have mounted and antibody response to some serious illnesses.  With that being said, an infant is not immune to viruses like RSV and flu, so if possible I would schedule travel in early fall, spring and summer and avoid the winter.  I realize that that may not be do-able, but for a vacation I like travelling with babies during “non-sick” season. It is also easier to fly long distances with an infant (lap child) when the flights might be less crowded and you can get a bulk-head seat which has “bassinets” or maybe an extra seat next to you that your infant car seat will fit in for traveling.  It can be expensive to buy a seat for an infant, and holding a baby while you are trying to sleep too just doesn’t work.  Hopefully you will be traveling with two parents to share the duty during an overnight flight. Lastly, I get a lot of questions about needing to have a baby “sucking” for take-off and landing.  I really don’t think that is necessary, especially if your infant is sleeping.  When I am travelling I often see parents awakening a sleeping baby once the pilot announces  “we are preparing to land”.  The baby wakes up, and starts to scream,  and then the parents are convinced that the baby’s ears hurt.  I really think the baby is tired and unhappy due to  being awakened. If they are awake and want to nurse , take a bottle or a pacifier that is fine but remember, “never wake a sleeping baby”.  I realized with my own children,  If I was “lucky” while they were all infants, we could fly  for 3 -4 hours while they slept and never peeped, either  for take-off or landing. On other trips we were not quite as fortunate and had a fussy baby mid flight, with presumably no ear problems. I think the “ear issue” is highly overrated. Their ears are no different than ours! Best time to fly with babies is really between 4 months and 12 months of age.  Once they are walkers it gets a lot harder!!  I would not attempt an overseas flight with a 1–2 year old, but that is me. I would wait till they were 3! That's your daily dose.  We'll chat again tomorrow! Send Dr. Sue your question!

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