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Daily Dose

Food Myths & Your Baby

1.15 to read

I really enjoy talking to my young parents about feeding their baby and toddler new foods. But what about food allergies they say?   I believe that healthy nutrition and good eating habits begin early on, actually just as a child starts to eat solid foods. The more foods a child is exposed to initially, the better chance a parent has of having a child who eats a variety of foods when they are older.  This means no making yucky faces if you (parent) don’t like spinach - fake it! 

But, with that being said, so many new parents are still under the impression that there is a “list” of forbidden foods. As I talk to them about finger foods and letting their baby explore new foods and textures they are amazed when I say things like, “let them try scrambled eggs” or “what about trying almond butter or peanut butter?”, “try ripping up pancake pieces”. 

I also like to let a 9-15 month old try all sorts of different fruit, veggies and proteins. In fact, “there are really no forbidden fruits” as long as the food you offer is mushy (we adults might say a bit over cooked at times) and broken/or cut into very small pieces. I am most concerned about the size and texture of the piece and protecting the airway than I am about the food itself.  

Over the last 5-10 years studies have shown that restricting foods and delaying introduction of certain food groups did not prevent the development of food allergies.  So, the idea that delaying the introduction of peanut butter until after a child is 2 yrs old, or waiting to give a child fish until they are older, or not letting your 9 month old child taste scrambled eggs, did not prevent food allergies. Some researchers would say it may actually be the converse, earlier introduction may be preventative.  

But the funniest thing to me, it is like old wives’ tales....these ideas have somehow been perpetuated.  The new group of parents that I am now seeing were often still in college and dancing at parties when it was the recommendation to wait to introduce some foods (egg, peanut , fish etc).  How do they hear these old ideas?  Maybe grandparents or friends with older children. Who knows? 

So, for the record, the rates for most common food allergies are still low at 2.5% for milk, 1.3% for eggs and 1% for peanut and less than that for tree nuts.  Don’t limit what you give your child unless you have seen them have a reaction when a food is initially introduced, and if you are concerned, talk to your doctor.  Most people who report having food allergy actually turn out not to have true food allergies after a good history and further testing. 

More about true food allergies to come.  Stay tuned! 

Daily Dose

Get Your Baby to Sleep!

1:30 to read

How many times can you discuss newborns and getting them to sleep? It doesn’t matter how many babies you have, the biggest issue for new parents is ”when is my baby going to sleep through the night?”.  This statement is often followed by, “I have read every book and none of it seems to be working”. “What’s the trick?”  

Over the years I have realized that there is “NOT” one way or method that makes that newborn sleep through the night.  While some babies seem to lull themselves to sleep fairly easily and are sleeping in the first 4-6 weeks, most infants still awaken during the night for the first 8-12 weeks. There are also the “difficult” infants who don’t sleep through the night until 4- 6 months. But all in all...it just takes time, patience and a bit of prayer.

So, with all of this knowledge and remembering how I longed for my own babies to sleep 8-10 hours at night, I found a new article in The Archives of Diseases and Children quite interesting and thought provoking.  

Physicians have long known that it takes some time for circadian rhythm (biological sleep patterns distinguishing day and night) to develop in babies and a study done in the UK actually looked at infant’s sleep patterns between 6-18 weeks of age. They analyzed data including the infants’ body temperature throughout the night,  length of sleep a d urine samples collected am and pm to look at cortisol and melatonin levels. They also looked at the babies’ cheek swabs for circadian gene expression.  All in all a lot of data.

The findings were interesting showing that increasing cortisol secretion at night occurred around 8.2 weeks of age, followed in the next week or two by increased melatonin at night....both integral to establishing circadian rhythm.

When they analyzed body temperature, a drop in core temperature at the beginning of sleep (again maturational) they found that this occurred around 10-11 weeks.  Lastly, mature circadian gene expression was found at about 11 weeks.

So, no matter what book you read, or what your pediatrician, best friend or your own mother tells you, it is all about those hormones starting to “wake up” and regulate sleep. 

At least you know your baby is “normal”, even when everyone on Facebook “SWEARS” that their baby slept all night in the first 2 weeks. They probably either have totally forgotten or just made it up...it is all about science after all.

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Daily Dose

SIDS Risks

1.30 to read

Sudden Infant Death Syndrome (SIDS) is every parent’s worst nightmare. From the time a family has their new baby until that child is 1 year of age, SIDS is of a concern. 

Most new parents in 2012 know about the Back to Sleep campaign (BTS), which was recommended by the AAP in 1994. After  the recommendation for newborn’s sleep position was changed from prone (tummy) to supine (back) the incidence of SIDS in the U.S. showed a sharp decline (more than 50%) over the first 10 year period. Unfortunately, the overall SIDS rate has plateaued since that time, and SIDS is still the leading cause of infant mortality in the U.S. 

A study in the April 2012 issue of the journal Pediatrics looked at risk factors for SIDS. Parents need to know that greatest risk for SIDS is during the first 12 months of life (the so named “Critical” development period). There are also both intrinsic and extrinsic risk factors for SIDS as well. All of these factors contribute to the vulnerability for SIDS. 

The peak incidence for SIDS is still between 2-4 months of a baby’s life. (postnatal age). The intrinsic risk factors for SIDS include, male gender, prematurity, genetic differences (now being found called polymorphisms) and a child’s prenatal exposure to cigarettes and/or alcohol. Extrinsic risk factors include tummy or side sleep position, bed sharing, over bundling, soft bedding and a child’s face being covered.  In this study 99% of SIDS infants had at least 1 risk factor, and 57% had at least 2 extrinsic and 1 intrinsic risk factors. Only 5% of the SIDS victims studied had no extrinsic risk. I think this is important for all parents to know! 

So what can parent’s do to lower the risk of SIDS for their baby?  Well, while you cannot change the peak incidence of SIDS between 2-4 months of a baby’s life there is a lot you can do! 

Looking at intrinsic factors:  gender is a 50-50 deal and seeing that I have 3 sons, I don’t know a lot about gender selection, so will not even touch that topic. But, you can prevent prenatal cigarette and alcohol exposure, and every pregnant mother (and father due to second had smoke issues) should eliminate smoking. That sounds easy enough. 

Prematurity may be lessened when a mother is healthy prior to her pregnancy and continues to do as much as possible during her pregnancy to ensure a full term birth. Basically maintaining a healthy diet, getting good prenatal care and listening to your doctor will help to prevent many pre-term births. 

Extrinsic factors are the easiest to change. While prone sleep positioning is a large risk factor for SIDS, there is now evidence that some other risks may appear in conjunction with sleep position.  Putting a baby on their side where they may roll to their tummies may be one issue.  Leaving soft objects or blanket in the crib may be another. Bed sharing is also not advised. 

So, the so-called “triple risk factors” for SIDS may be important information in providing risk reduction strategies for parents and caregivers. Any change that may lessen the risk of SIDS is meaningful and beneficial and will help new parents sleep a bit better as well!  I also did not see any mention of video cameras in the room as a reduction in risk, just saying..... 

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

Daily Dose

Why You Should Not Co-Sleep With Your Infant

There has been another newsworthy article that may support changes in the parental perception of risks associated with co-sleeping with their babies.

The British Medical Journal reported this month that more than half of the SIDS (sudden infant deaths) in 80 infants in southwestern England between 2003 and 2006 occurred while the baby had been co-sleeping with a parent. There have been many studies and developments in previous years relating to the prevention of SIDS, with ongoing research to hopefully one day solve the puzzle surrounding sudden infant death. The public awareness of risk factors for SIDS, which include tummy sleeping, have reduced the incidence of SIDS from one in 800 live births 20 years ago, to one in 2,000 today. Other risk factors for SIDS include maternal smoking, having soft objects in the infant’s crib (such as pillows and blankets), and pre-term birth. Protective factors such as the use of a pacifier and ceiling fans has also recently been encouraged. The “back to sleep” campaign has probably had the greatest effect in reducing SIDS. With this study of the SIDS infants, 54 percent died while co-sleeping, compared with 20 percent among the control groups. The infants who were co-sleeping had been sharing a bed or sofa with a parent or child at the time of their death. There was also an association with alcohol or drug use among the parents who had been co-sleeping with their infants. Once again parents need to be reminded that co-sleeping with infants is dangerous. This study re-iterates previous studies which have also shown infant deaths after co-sleeping with parents. Having a baby in a bassinet with a firm mattress, next to the parental bed, is the preferred recommendation for the first four to eight weeks after birth.  BACK TO SLEEP is always to be remembered. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

When Your Baby Loses Weight

WHen your baby is losing weight, could it be pyloric stenosis?Strep throat is still lingering this time of year and I saw one of my cute patients who told me “my froat is on fire.”  I had just seen this family earlier in the week when they brought in their one month old for a check up.

During their visit, their mom commented that the baby had been vomiting and spitting up a lot more in the last several weeks.  The baby was all bundled up and in his car seat, so I  said, “oh well, let’s weigh him and see how he is doing while we do a throat culture on his brother”. Well, guess what? The baby had lost 1 lb in two weeks!!  So, when I went back in to the exam room, I told the mom that this baby was indeed the sicker of the children and he had just “come along for the ride”.  Thank goodness for small miracles. I then examined this little boy and he looked thin, wasted and a bit dehydrated. But, he was one of those “easy” babies and did not fuss and cry even though he was vomiting so much that he was losing weight. The first thing that popped into my mind was that he might have pyloric stenosis.  Pyloric stenosis is due to the fact that the muscle surrounding the outlet from the stomach to the intestine (the pylorus) is thickened and thereby blocks the movement of food (milk in this case) from the stomach to the intestine. Pyloric stenosis usually occurs in infants between 3 – 6 weeks of age, and is more common in males than females and is seen in about 1/500 newborns.  It also runs in families. The typical baby with pyloric stenosis develops projectile, forceful vomiting that begins at several weeks of age (different than spitting up, and reflux etc), and becomes more frequent over time. Almost, every baby will have an episode or two of projectile vomiting but with pyloric stenosis you notice that the baby vomits within 30 – 60 minutes of a feeding and it happens every time. The milk comes out with such force that it literally may spew a foot or two.  When you see the vomiting it is pretty impressive, such force coming out of such a small body. I must say that there have been several times in my practice when I have tried to feed a baby thinking, “this baby just is a spitter and these parent’s need reassurance”, only to swallow those words as the vomit sprays from one side of the exam room to the other. Time for an ultrasound!! Pediatricians are taught to feel the baby’s abdomen for the hypertrophied pyloric muscle which can feel like an olive, but often it takes an ultrasound or an upper GI to make a definitive diagnosis. Once the diagnosis is made, a pediatric surgeon will be consulted to do a pyloromyotomy (where they will clip the muscle) which is a fairly easy procedure. Many children will require some IV hydration prior to surgery and can often go home within 24 hours after the surgery and have a full recovery. The scar is barely noticeable. So…the moral of the story is thank goodness for bringing both children to the pediatrician.   This little boy has already been seen by the surgeon and will be operated on in the morning. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Your Baby's Toenails

1:15 to read

I have noticed over the years, that babies are born with the weirdest toenails.  I get a lot of phone calls, pictures and questions during those first few visits about these little toenails.  Just like everything else, they are just “immature” and often are totally flimsy or at times appear to be “ingrown” as they grow and push a bit of skin away.

In most cases I tell patients to just leave them alone, even is they are a bit irritated and red on the edge. That is unless the toe is warm to the touch, or tender or has an obvious infection with drainage. Typically when you push on the toe the even though it may appear a bit irritated and bothersome to you, it should not bother your child or seem to cause them pain.  They should NEVER have a fever due to the toenail issue and if your infant has a temperature above 100.4 you do need to call your doctor.

While a baby’s fingernails seem to grow overnight (and are really sharp), newborns toenails grow at a snails pace. It sometimes seems babies don’t really even have all of their toenails until they are over 1 year and in most cases by then you have stopped paying attention as your child is walking, falling and has a lot of bumps and bruises so the toenails are no longer an issue.

If your baby’s toenails look irritated, clean them with a little soap and warm water and leave them alone!

 

Daily Dose

New Autism Study

1.15 to read

A study just released in the journal JAMA Pediatrics revealed that pregnant women who have their labor “induced or augmented” have an increased risk of delivering a child who will develop autism. 

The retrospective study out of Duke University and the University of Michigan (both very well respected medical schools), showed that the percentage of mothers who had their labor either induced or augmented was higher for children who were later found to have “a designation for autism” within the school systems in North Carolina.  The rates of autism were highest for mother’s who had their labors both induced and augmented.  The study found that in this case there was a 23% greater risk of bearing a child who would later be diagnosed with autism than with those who had neither induction or augmentation.  This association was also higher in boys.

So, what does this all mean?

This does not mean that there should never be an induction or augmentation to a woman’s labor. There will continue to be cases in which it is appropriate to induce a woman’s labor when necessary for the health of the mother or her unborn child. One example being when an induction may be appropriate is when a mother’s blood pressure is becoming problematic and puts her and the baby at risk.

Augmented labor is sometimes necessary when a mother’s membranes have ruptured and the baby needs to be delivered to prevent infection Each case needs to be looked at individually by the doctor and discussed with the patient, as to risk and benefit.  

But, “elective” inductions because “the weekend is approaching”, or the “doctor is leaving town” or because the mother is “tired of being pregnant”, (while previously discouraged) may now be looked at with an eye toward this study.    In many cases “elective” inductions often lead to c-section deliveries as well.  Other studies have shown that c-sections in the United Sates have been on the rise and that there are more complications in the newborn period for babies born via c-section.  The JAMA study did not look at the method of delivery.

This study is interesting and may be yet one small part of the puzzle of autism.  More research to come, so I will keep you posted!

Your Baby

Fisher-Price Recalls Infant Cradle Swings

1:30

Fisher-Price is recalling three models of their cradle swings: CHM84 Soothing Savanna Cradle 'n Swing, CMR40 Sweet Surroundings Cradle 'n Swing, and CMR43 Sweet Surroundings Butterfly Friends Cradle 'n Swing.

The swings have two different swinging motions - rocking side-to-side, or swinging head-to-toe, and six different swing speeds from low to high. The product number is located on the seat under the pad. 

When the seat peg is not fully engaged the seat can fall unexpectedly, posing a risk of injury to the child.

Fisher-Price has received two reports of a seat peg coming out from the seat, causing the seat to fall. No injuries have been reported.

Consumers should immediately stop using the recalled cradle swing and contact Fisher-Price for revised assembly instructions.

The infant cradle swings were sold at buybuyBaby, Target and other stores nationwide and online at Amazon.com and other websites from November 2015 through March 2016 for about $170.

Consumers can contact Fisher-Price at 800-432-5437 from 9 a.m. to 6 p.m. ET Monday through Friday, or online at www.service.mattel.com and click on Recalls & Safety Alerts for more information. 

Source: http://www.cpsc.gov/en/Recalls/2016/Fisher-Price-Recalls-Infant-Cradle-Swings/#remedy

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