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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!

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

Your Baby

Britax Recalls Car Seat Chest Clips Due to Infant Choking Hazard

1:30

Faulty chest clips on more than 100 models of Britax Care Safety car seats are being voluntarily recalled because the clips could break off and create a choking hazard for infants.

The company says that no injuries have been reported, but it has received complaints of chest clips breaking.

The recall will affect more than 200,000 car seats. However, Britax stresses that the car seats are still safe to use until a replacement kit is obtained. 

The chest clip is on the Britax B-Safe 35, B-Safe 35 Elite, and BOB B-Safe 35 infant seats.

The products were manufactured between Nov. 1, 2015, and May 31, 2017. To see the model numbers that are included in the voluntary recall, or to check the serial number of your seat, visit the company’s website set up for this recall at www.bsafe35clip.com. You can find the serial numbers on the "Date of Manufacture" label on the lower frame of the seat.

Britax is offering to replace the chest clip with a free kit that contains a new clip made from a different material. The kit comes with step-by-step instructions for replacement. Consumers are advised to routinely check their current chest clip until a replacement arrives.

Story sources: Alexandria McIntire, http://www.webmd.com/children/news/20170623/recall-britax-car-seat-chest-clip

Ashlee Kieler, https://consumerist.com/2017/06/21/britax-recalls-207000-carseats-over-chest-clips-that-can-break/

Your Baby

Is Your Baby Safer Sleeping in a Box?

2:00

Is your baby safer sleeping in a box instead of a crib? Some parents think so and are ditching the traditional infant crib for a specially made cardboard box.

The Baby Box Co., is a Los-Angeles based business that is partnering with hospitals across the U.S. to give away free “baby boxes” to new parents.

The parents also receive a 15- minute educational video about safe sleeping habits for infants. Also included in the box are infant clothing, a mattress, a fitted sheet plus $150 worth of baby necessities.

While relatively novel in the U.S., the baby-box isn’t a new idea.  It’s modeled after a program in Finland that began more than 70 years ago. Baby boxes are aimed at curbing infant mortality rates by promoting safe sleeping practices for newborns.

New Jersey adopted the first statewide baby box program; distributing a total of 105,000 boxes. And now, Ohio has joined up, along with hospitals in Philadelphia and San Antonio, Texas.

Proponents of baby boxes say the combination of educational tools and free resources will bring America's infant mortality rate closer to those found in wealthy Nordic countries.

The goal of the Baby Box program is to bring the rate of children dying from Sudden Infant Death syndrome (SIDS) down. SIDS is usually attributed to sleep-related accidents such as strangulation, suffocation or entrapment. In 2015, the Center for Disease Control (CDC) reported about 3,700 infants died from SIDS.

The U.S. saw a drastic decline in its infant mortality rate since 1994, when the CDC launched its "Back to Sleep" campaign urging parents to have their infants sleep on their backs rather than stomachs, but disadvantaged groups still tend to be affected by SIDS more than others.

In Finland, Baby Boxes have had a dramatic impact on infant mortality since the program was launched in 1949. In the 1930s, the country's infant mortality rate was 65 deaths per 1,000 infants. Beginning in 1949, that number has shrunk to 3.5 deaths per 1,000 births— a decrease that's credited in part to baby boxes. Comparatively, the United States had an infant mortality rate of about 5.8 deaths per 1,000 births in 2016.

One University of Chicago study found that primarily lower socioeconomic groups drive the higher infant mortality rate in the U.S. after the mother and child leave the hospital. Contributing factors may include health coverage insurance and the mother’s amount of education.

What else can be done to curb infant mortality rates?

Some experts argue that policies geared toward enhanced post neonatal care for mothers of low socioeconomic status would be most effective in combating the U.S. infant mortality rate.

Universal home nurse visits, available in a number of European countries such as Finland and Austria, are one option. A provision of the Affordable Care Act offers money for a number of similar programs, such as the Nurse Family Partnership founded in 1977 in New York.

The program, which sought to rein in infant deaths in the U.S., provides low-income, first-time mothers with registered nurses who visit their homes to provide assistance and child health education for mothers.

According to the Baby Box Co. website, Baby Boxes are not only available through some hospitals, but also direct to consumer.

Story source: Avalon Zoppo, http://www.nbcnews.com/news/us-news/hospitals-u-s-give-away-free-baby-boxes-curb-infant-n732421

http://www.babyboxco.com

Your Baby

Special Baby Formulas Don’t Prevent Asthma, Allergies

2:00

Parents that have a baby at risk or allergies, asthma or type-1 Diabetes sometimes turn to hydrolyzed milk formulas in hopes of lowering their infant’s risk of developing these problems.

A new review of the data on hydrolyzed formulas finds that there is no evidence that they actually protect children from these types of autoimmune disorders.

"We found no consistent evidence to support a protective role for partially or extensively hydrolyzed formula," concluded a team led by Robert Boyle of Imperial College London in England.

"Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease," the study authors added.

In the study, Boyle's team looked at data from 37 studies that together included more than 19,000 participants and were conducted between 1946 and 2015.

The investigators found that infants who received hydrolyzed cow's milk formula did not have a lower risk of asthma, allergies (such as eczema, hay fever, food allergies) or type 1 diabetes compared to those who received human breast milk or a standard cow's milk formula.

The researchers also found no evidence to support an FDA-approved claim that a partially hydrolyzed formula could reduce the risk of the skin disorder eczema, or another conclusion that hydrolyzed formula could prevent an allergy to cow's milk.

Other experts in the United States said that the finding casts doubt on the usefulness of these kinds of specialized products.

"Allergies and autoimmune diseases [such as asthma, and type 1 diabetes] are on the rise and it would be nice if we did have a clear route to preventing them," said Dr. Ron Marino, associate chair of pediatrics at Winthrop-University Hospital in Mineola, N.Y.

"Unfortunately, despite U.S. Food and Drug Administration support [for hydrolyzed formula], the data are not compelling," he said.

Dr. Punita Ponda is assistant chief of allergy and immunology at Northwell Health in Great Neck, N.Y. She stressed that when it comes to infant feeding, breast milk is by far the healthiest option.

However, "current mainstream guidelines for infant formula do recommend that parents consider using hypoallergenic formula if a close family member -- like an older brother or sister -- has a food allergy," she said. That was based on prior studies supporting some kind of protective effect, Ponda said.

Protein hydrolysate formulas were first introduced in the 1940s for babies who could not tolerate the milk protein in cow’s milk.

Protein hydrolyzed formulas are formulas composed of proteins that are partially broken down or “hydrolyzed.” They are also called hydrolysates.

There are two broad categories of protein hydrolysates:

•       Partially hydrolyzed formulas (pHF)

•       Extensively hydrolyzed formulas (eHF)

Both partially and extensively hydrolyzed protein formulas are based on casein or whey, which are proteins found in milk.  

Hydrolyzed formulas have had the protein chains broken down into shorter and more easy-to -digest chains. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain.

Hydrolyzed formulas are also more expensive than regular cow’s milk formulas and often harder to find.

The researchers review was published March 08, 2016 in the BMJ.

Story sources: Robert Preidt, http://www.webmd.com/parenting/baby/news/20160308/special-infant-formulas-dont-shield-against-asthma-allergies-study

Victoria Groce, http://foodallergies.about.com/od/adultfoodallergies/p/hypoallergenic.htm

 

Daily Dose

Caring For An Uncircumcised Penis

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

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

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

Your Baby

Recall: DaVinci Baby Cribs

1:45

Bexco has expanded a recall of their baby cribs. Bexco recalled an additional 11,600 cribs in July 2015.

The firm has received five additional reports of the mattress support brackets breaking and detaching. No injuries have been reported.

A metal bracket that connects the mattress support to the crib can break, creating an uneven sleeping surface or a gap. If this occurs, a baby can become entrapped in the crib, fall or suffer lacerations from the broken metal bracket.

This recall includes DaVinci brand full-size cribs including the Reagan crib (model #M2801), the Emily crib, (model #M4791), the Jamie crib (model #M7301), and the Jenny Lind crib (model #M7391) manufactured from May 2012 through December 2012.

The model number, serial number and manufacture date are printed on a label affixed to the bottom right hand side panel of the crib. Cribs included in the recall have serial numbers that begin with “N00,” followed by one of the following numbers.  The previous recall included the same model numbers, but had different serial numbers.

The cribs were sold at Target and juvenile products stores nationwide and online at Amazon.com from May 2012 to December 2013 for between $150.00 and $250.00.

Consumers should immediately stop using the recalled cribs and contact Bexco for a free replacement mattress-support that includes replacement brackets.  In the meantime, parents are urged to find an alternate, safe sleeping environment for the child, such as a bassinet, play yard or toddler bed depending on the child’s age.

Consumers can contact DaVinci toll-free at 888-673-6652 from 8:30 a.m. to 5:15 p.m. PT Monday through Friday. Consumers can also visit www.davincibaby.com/safetyrecall3 or www.davincibaby.com and click on “Safety Recall” for more information.

Source: http://www.cpsc.gov/en/Recalls/2016/Bexco-Expands-Recall-of-DaVinci-Brand-Cribs/

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