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Daily Dose

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

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

Talking to Your Baby

1:30 to read

An interesting study on how mothers and fathers converse with their infants was recently published online in the journal Pediatrics. I found it fascinating since I am once again “oohing and gooing” with a baby: my precious granddaughter. I was just feeding her yesterday and remembered talking to my own children years ago and gazing into that baby’s eyes in amazement.

The study entitled, “Gender Differences in Adult-Infant Communication in the First Months of Life”, looked at 33 babies and audio recordings which were made from birth to 7 months of age.  They found that infants were exposed to more speech from mothers than fathers (are you surprised, we do have more words, right?). Interestingly they also found that infants preferred mother’s speech and language over fathers. Do you think it is the timbre of the voice or the number of words that we mothers use when talking and soothing an infant? I am not sure that it is purposeful, but men do use less words than women.....at least in my house which was full of boys...who turned into men of few words as well.

The study also showed that mothers responded more frequently to girls and there were trends for fathers to respond to boys at birth and during the first month of life.  Do you think it may be that new mothers and fathers are not yet sure what they should be discussing with these new babies that may be of the opposite gender? It takes a while to figure out that a baby boy is just as happy hearing his mother discuss how to bake cookies, as a baby girl may be to hear her father discuss the latest sports scores.

Interestingly, overall language exposure increased over time for all of the infants as they matured. 

Bottom line? Start talking to your baby the minute they are born....about anything.  Babies just love hearing their mothers’ and fathers’ voices and parent talk is always beneficial for a child’s language development.

Daily Dose

A Baby's Neck Issue

1:30 to read

Torticollis is becoming more and more common and it may be related to several different things. Torticollis is defined as a “twisted neck”, or as my grandmother used to say, a “wry neck”.  Most of us have experienced a tight neck after a bad night’s sleep, and you can hardly turn your head to back out of the garage it is so painful, but be reassured your baby does not have any discomfort, but will just hold their head somewhat “tilted”.

A baby’s 40 weeks spent in utero may cause some positional deformities of the head and neck.  Due to the intrauterine positioning a baby may “favor” turning their head to one side rather than another. At the same time back sleeping which is recommended for all babies, may also contribute to torticollis.  

In order to help the baby resolve the tightness in the neck which is actually due to the sternocleidomastoid muscle being tight, your doctor may have you do several things early on to help stretch the neck muscle.  

If your baby prefers to look to the right they have left sided torticollis. In this case turn your baby in the crib so they have to turn to the left to look out (they don’t want to face a boring wall). When you are feeding them have the bottle on your right arm. When changing diapers, place the baby so that they have to tur left to see you.  Hold the baby on your left hip as well and burp them on your right shoulder. All of these strategies will help to stretch the muscle.  On top of this the baby needs to have tummy time, when awake, and work of having them turn to the left during this time too. Lastly, do gentle neck stretches 3-4 times a day and massage the tight muscle.  

If your baby prefers to look to the left also called right sided torticollis, reverse the above.

Your baby should continue to work on stretching so that their head will also not get flattened on one side or another, which is called plagiocephaly.  By continuing to have tummy time and neck stretches, most cases of torticollis will resolve. In severe cases or when you don’t feel that the baby is improving,  ask you doctor about the possibility of physical therapy.

Daily Dose

The Dangers of Using Baby Aspirin

1.15 to read

During a recent office visit, I saw a 4 year old child who is not one of my routine patients.  He had a fever and runny nose. His mother was giving me the child’s medical history during the time I was beginning to examine the little boy.  I had my back slightly turned from her. 

The mother was explained to me that her son had had a fever the previous evening and said, “I gave him some ASPIRIN before putting him to bed.”  I immediately turned around and with a stunned voice said, “you mean you gave him Tylenol or Motrin or Advil,” right? She really looked at me like I was crazy or that I had not been listening to her and she said, “No I said baby aspirin.”  “He likes the chewable ones.”  

I was shocked, as I had not heard of anyone giving aspirin to their children for a fever in over 20 years!! This very nice, young, concerned mother could not figure out why I was so worried about the aspirin.  I then had to explain to her about the risk of Reye’s Syndrome. She had never heard of Reye’s Syndrome and said that her mother had kept baby aspirin in the house for her, so that is what she bought to use for her own child.  

I know that they sell enteric coated baby aspirin for adults to take to help prevent a stroke. I guess I didn’t even realize that regular old baby aspirin was even around. There was so much publicity in the 1980’s about the link between aspirin or any salicylate containing medication and the development of Reye’s Syndrome, as well as warning labels about not giving aspirin to children that had a fever or chicken pox that I had not heard of anyone using aspirin for years! 

I explained to her that Reye’s syndrome affects the brain and liver and is a very serious disease, which may lead to death.  It occurs in children between the ages of 4-18 and causes recurrent vomiting, lethargy and coma and was often seen after a child had the flu or chickenpox. 

I saw several patients with Reye’s during my training, but have not seen a case since that time. This mother had never even heard of it, but was quite concerned that she had already given her son the aspirin the previous evening. 

This was a great lesson in the necessity of telling every new parent about the use of appropriate medicine to treat a fever. I typically have this discussion at the time of the first vaccines as I tell parents that prior to that time I don’t even want them to have fever reducing medications available. 

Many pediatricians, including me, had been in the habit of using “Tylenol” as the name for acetaminophen, in the same way as you say Kleenex. Since Tylenol was withdrawn from the market last year, we are now correctly saying that you should treat a child’s fever, which is usually due to a viral illness, with acetaminophen, and NEVER aspirin or aspirin containing products!! 

So as you prepare for this winter and lots of viruses with fever go stock up on acetaminophen of ibuprofen and leave the BABY ASPIRIN for ADULTS ONLY! 

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

Daily Dose

New Baby Questions!

1:30 to read

Lots of new baby questions this week in my office, so I that I thought I would cover a few of the most frequently asked by parents within days of bringing that precious newborn home from the hospital. So, here we go:

My baby has blue hands and feet…should I go to the ER?  The medical term for this is acrocyanosis.   It is not uncommon for a baby to have a bluish/purple discoloration to their hands and feet. This often occurs if the baby gets chilled or cold, whether that is after a bath or sometimes even after they are unswaddled to wake them up a bit to get them to eat.  If your baby has pink lips and tongue and seems otherwise fine this is the normal adjustment of a baby’s circulation and may last for a few weeks to months.  When parents are concerned about this and make a trip to the ER where they are discharged with the diagnosis of “worried well”.

What temperature do I need to have my thermostat set?  This question always makes me laugh a bit because some of it is truly dependent on the climate where you live. Many parents think they need to “crank up the heat” for a newborn, but actually a cooler room temperature has been shown to correlate with a reduction in sudden infant death (SIDS).  The “ideal” temperature that has been recommended is around 68 - 70 degrees, but for those of us who live in the south during the dead of summer, it is almost impossible to keep your house this cool and very expensive. At the same time, some parents are uncomfortable during the winter with the thermostat at 68 degrees…so I would recommend keeping your house comfortable and on the cooler side rather than too warm. You also do not need to bundle your baby when it is blazing hot outside, less is more if the house is hot.

What about a pacifier?  Mother’s come in and say, “I was told that I shouldn’t use a pacifier because it will cause “nipple confusion”.  While I am a huge proponent of breast feeding I think that a pacifier is also helpful for a breast feeding mother so that she does not use her own breast as a “human pacifier”. Many new moms come in to see me at the 2 week check up crying, exhausted and with bleeding nipples. They are putting their baby on the breast for hours at a time as “it seems the only way my baby is content”.  Although they were told that they could put their finger in their baby’s mouth as a way to help console their baby, that too does not provide much of a distance from the baby…even to go to the bathroom, take a shower or eat!! A baby has the reflex to suck which is termed, “non-nutritive sucking”.  This is one way that your baby will calm themselves.  So, once your baby is getting on the breast, I would buy a pacifier and “teach” your partner how to hold your baby in the position as if they were going to be fed,  but with a pacifier to suck on rather than the breast. Once situated you can try walking around, gentle bouncing or swaying while your baby is happily sucking on their pacifier. Mother gets a bit of a rest between feedings and infant is happy with a pacifier ( rather than a finger). We will discuss taking away a pacifier at another time! 

 

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

Rice Cereal & Childhood Obesity

Does white rice cereal cause childhood obesity? One pediatrician thinks so.I recently saw Dr. Alan Greene on TV discussing infant feeding practices and how that may relate to the problem of childhood obesity. Dr. Greene, like most pediatricians, has long been a proponent of healthy eating. He recently launched his “White Out” campaign to change how babies are introduced to solid foods.

His argument is that an infant’s first food has long been rice cereal.   Rice cereal is typically introduced to a baby between 5 – 6 months of age when they are just beginning to sit up in a high chair, and may be fed with a spoon. Rice cereal  typically comes in a box and breast milk or formula is added to the dried flakes in order to make it the consistency where the  baby may be  offered a few bites from a spoon. Although rice is a “white grain” there are also other infant cereal products available, and there are no “directives” that say that a brown rice or mixed grain cereal may not  be used. As I understand it, the whole idea is really just to get the baby used to spoon feeding and then I begin introducing my infant patients to vegetables and fruits. So, the idea that the baby rice cereal is somehow linked to the entire problem of childhood obesity seems somewhat shortsighted to me. An infant is only fed rice cereal one or two times a day while still receiving either breast milk or a formula. Remember that breast milk and formulas contain carbohydrates too. Infant cereal whether it be brown or white rice should not be the only food a baby is introduced too, nor should they eat cereal all day long. While Dr. Greene is concerned that babies will “get hooked on the taste of highly processed foods”, I'm more concerned that parents will quickly forgo rice and whole grain cereals, fruits, veggies and meats and begin feeding their children frosted or honey nut cheerios (a favorite early finger food),  as wells as goldfish and puffs, pasta and other white foods.  These are the foods I  am most likely to see in my office, not a bowl fruits and vegetables. Babies really get the  majority of their calories from breast milk or formula until about 9 – 12 months of age. Parents should be encouraged to feed their babies a wide array of healthy foods including cereals, vegetables, fruits and meats.  Dr. Greene is right,  a baby doesn’t tell you he won’t eat brown rice, or oatmeal or spinach or prunes. For the most part an infant happily opens their mouths and will take what is fed to them. The problem occurs a little later as babies start to show a preference for foods , whether that is by making a face, or pushing food away, they definitely show preferences. This is when the idea of getting “hooked on foods” really begins. It is not uncommon for me to hear a parent of a one year old say, “my baby doesn’t like…… squash, or cereal, or peaches.”  Soon thereafter you hear, “my toddler will only eat…..fill in the blank”. Those are the words that send shivers down my spine. Trying to get those parents to buy into the fix the meal and they will eat it if they are hungry is quite a difficult concept at times. The issue is not only beginning a baby on rice cereal, the problem is more complex. It is getting parents to understand that our children will always have food preferences, that does not mean that we need to acknowledge them or submit to them. It means that we need to make good healthy meals for our families, white rice or brown rice is only the beginning of the story. That's your daily dose for today. What do you think? Leave your comments below!

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!

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