Twitter Facebook RSS Feed Print
Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

Daily Dose

The Difference Between Cradle Cap And Dandruff

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!

Tags: 
Your Baby

Tdap Vaccine Protects Mother and Newborn

1:45

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Daily Dose

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

Foods You Can Eat When Breast Feeding

1.30

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Vaccine Pain

1.00 to read

I am often reminded of the adage, “this is going to hurt me more than it hurts you” before beginning infant vaccinations. I can remember my own parents saying that to me before a spanking (the preferred discipline of my childhood) and that statement never made any sense to me until I too became a parent. 

As I discuss infant vaccinations with new parents, I somehow know that they are wishing they could “take the needles” for their own child. I really do believe that those first vaccines at 2 months of age “hurt the new parent, more than the infant”. It is an early parenting hurdle to get through those first immunizations and realize that your baby handled the vaccines without much ado and somehow the next set of vaccines at 4 and 6 months are a bit easier. Pain is not anything that a parent wants their child to endure, and if there is any way to mitigate the pain associated with immunizations I am all for it. 

Many parents come to my office prepared with sucrose to let their baby suck on during the immunizations.  I recently read an article in Pediatrics that showed the 5 S’s - swaddling, side/stomach positioning, shushing, swinging and sucking on a pacifier significantly reduced the pain associated with vaccines in 2 and 4 month old infants. In fact the 5S’s worked “substantially better to reduce post vaccination pain than sucrose alone”. 

So, if you are concerned about the pain associated with your infant’s vaccines, come ready to swaddle, shush, swing and let your baby have a pacifier as well. A little tummy time after the immunizations might be good medicine too. 

But more importantly, remember that by vaccinating your baby you are protecting them from disease for their entire childhood and into adolescence (when I am not sure the immunizations are any easier). 

The 5S’s seem like an easy solution for parent and baby, and a lollipop or ice cream cone goes a long way for pain relief in the 4-11 year old set as well. Vaccines are a moment of pain for a lifetime of gain for sure!

Daily Dose

Lactose Intolerance

How do you know if your child is lactose intolerant?A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea.  In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental. It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters. All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation) Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products.  It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine.  Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years.  It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve.  In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose.  True milk allergy usually presents in early infancy. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue!

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

Daily Dose

New Test for Your Baby

1.00 to read

If you recently had a baby (or are getting ready to) you may have noticed another “test” being performed on your newborn before they leave the hospital. Earlier this year the American Academy of Pediatrics endorsed the routine use of pulse oximetry to enhance detection of critical congenital heart disease.   

Critical congenital heart defects (CCHD) are serious structural heart defects that are often associated with decreased oxygen levels in infants in the newborn period. These heart defects account for about 17-31% of all congenital heart disease (or about 4,800 babies born each year in the U.S.)  While some of these defects are found on pre-natal ultrasounds, and some may be evident immediately after birth when the pediatrician hears a murmur or the baby has difference in their pulses, others may not present until a baby is several hours - days of age.  

Using pulse oximetry to measure a baby’s oxygen levels before they are discharged is just another method of screening a child, and if there are abnormalities a baby would undergo further evaluation with an echocardiogram and would see a pediatric cardiologist. 

Pulse oximetry is routinely used in all aspects of medicine these days and requires a simple non-invasive device that is placed on a babies finger or toe to measure the level of oxygen in the blood. (looks a little like ET device to light up a finger). It works by comparing the differences in red light, which is absorbed by oxygenated blood, and infrared light, which is absorbed by deoxygenated blood.  

In a large study just published in the journal Lancet (looking at over 230,000 newborns), simple pulse oximetry detected 76% of congenital heart defects, with only a rate of 0.14% false positive results. The risk of false positives was even lower than that when pulse ox was performed when the baby was over 24 hours of age. Pretty impressive! 

It has been estimated that about 280 infants with unrecognized CCHD are discharged from newborn nurseries each year. Congenital heart disease also accounts for somewhere between 3-7 % of infant deaths. With early intervention and surgery the chance of survival from CCHD is greatly improved. 

So, ask your pediatrician or obstetrician if they are doing routine pulse oximetry in your hospital nursery. 

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

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Why you should never use a kitchen spoon to measure medicine.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.