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Daily Dose

Taking Your Child to the Doctor

1:15 to read

I imagine that you have heard the saying, “motherhood is the necessity of invention”?  It seems I must use this saying often as I can overhear my nurses quoting me and using the phrase as well.

 

There are many times I find myself in an exam room with a young patient and their mother when the mother says, “I forgot the……”. Sometimes it is a diaper (easily available in any pediatrician’s office), maybe a bottle (we have those too), a child’s favorite “lovie” (dire), and in many cases a pacifier.  Getting through the office visit without some of these necessities may make not only the child miserable, but also their parent.

 

Just the other day an adorable 5 month old baby and her cute mother came in because the baby had a cold and some eye drainage. Her mother was concerned that she might have an ear infection.  The first part of my exam was easy and the baby had a clear chest and no respiratory distress. She let me look at her nose and throat as well. Then it was time for the ear exam and of course the ear canals were waxy and I could not see her ear drum.  This means I have to use an instrument to remove the wax from the ear canal before I can get a good look at her ear drum.  The first ear was cleaned out and her ear drum was clear!!  But the second ear was more difficult to clean and the baby started to WAIL during this. Her mother looked frantically for something to soothe her..but she had forgotten her diaper bag with all of her stuff. So, once the ear canal was cleaned …she was pronounced ear infection free. While this was great news for the mother, the baby just continued to cry, loudly and angrily. 

 

I was trying to discuss the cold with the mother, but it was difficult for either of us to hear with the baby screaming. What to do…..? The only thing I had in the exam room was the basket of lollipops and stickers that we offer to children at the end of their exam.  I tried making a “sticker pop” on a tongue depressor to entertain and distract the baby…no such luck. The mother then looked at the lollipops, took out a grape one and unwrapped it and put in the baby’s mouth…INSTANT calm and smile on her face!!  Hysterical laughter from both of us as we took a picture to send to the father with the caption…Baby’s first food!!  Priceless. 

 

Love a mother like that…motherhood IS the necessity of invention!!

Daily Dose

Your Baby's 1st Cold

1.30 to read

Has your baby had their first cold yet?  It is just the beginning of cold season and there are many more colds ahead during the next 5 months of upper respiratory season.  

I remember as a mom/pediatrician that the first cold a baby has is the hardest. Like so many things in life, once you have some on the job training, you can look back and realize that you can manage many issues, including the common cold. 

A baby with a cold looks like we all do, they have red rimmed eyes, a runny nose, a cough and they act like they don’t feel well. A baby may also run a bit of a fever on the first day of a cold, so remember, “fever is your friend” (another post). 

The best way to treat a cold is the same for baby/child/adult, you just have to treat your symptoms. Unfortunately, there is still not a cure for the common cold, and when there is one day, the cure will win the Nobel Prize in Medicine! 

For an infant, one of the biggest problems is the congestion and runny nose and the fact that cannot yet blow (or even pick) their own nose.  But, at the same time they are snotty and have a hard time breast feeding or taking a bottle and worst of all they don’t sleep well. Us older parents were used to using the bulb syringe, but now the parents of babies are swearing by the “Nosefrida”. 

I must admit I was totally skeptical and thought they were inserting this contraption way into their baby’s nostril!  We doctors used to use a “deLee” catheter somewhat like this in the delivery room to clear a baby’s nose but this little device is placed at the edge of the nostril, rather than into the nose itself.  

A small tube extends from this and the parent then uses their mouth to suck on the tube (like a straw) and the mucous is sucked into this little tube with a filter to keep the mucous from going up the tube. (no buggies in the mouth). Does that all make sense?  You can use just the right amount of suction with your mouth and then you can see the mucous come out of the nose and throw away the tube and filter. 

 I remember that gross bulb syringe I used long ago had disgusting stuff inside of it once I cut it open to investigate, so this little “Nosefrida” seems to make sense. It also doesn’t upset the baby like putting a bulb syringe inside the nostril. 

Suctioning out the nose may make it easier for your baby to take their bottle and to sleep! This may mean you get a bit more sleep yourself, which is always at the top of the list for new parents. Regardless, remember it will take 7 - 10 days for your baby to get over their cold. 

Lastly, wash your hands and cross your fingers that you don’t catch it!

Daily Dose

Starting Baby on Solid Food

1.30 to read

Did you read the latest study from the CDC about the number of infants who are starting solid foods too soon?  One of the only things that I think has stayed pretty constant since I began practicing medicine (and what I did with my own children), was waiting until they were around 6 months of age to begin solid food.  

Beginning a baby on solid foods is not really “momentous”, in that it does not “make a baby sleep through the night”, it does not “make them less fussy”, or “gain weight faster”, but it certainly is a little more work.  A baby really does just fine on breast milk or formula for the first 6 months of life.  It is wonderful to watch a newborn grow and thrive, and it all happens with milk alone. 

While many new parents are anxious to start solids, there is no rush. Actually, once you are starting baby foods you soon figure out that it is really more work, and you get to “fix” meals for the next 18 years! Formula or breast milk seems like a great meal when you are too tired to cook one night when they are older.  Milk for dinner just doesn’t work for a 10 year old. 

Early introduction of solid foods may be linked to obesity, diabetes, eczema and celiac disease. While the studies on these issues continue, why risk any of these problems when your baby is doing well on breast milk or formula alone for 6 months?  

When beginning solid foods your baby should be able to sit up in their high chair and open their mouths when the spoon is introduced.  There is no “magic” as to how much a baby will even eat when you start baby foods. For some babies, eating solid foods is “cosmic” and they may love it and continue to eat more and more.  

For others, the spoon and baby food just doesn’t hold the same excitement, and they push the spoon out of their mouth and are less than thrilled.  Experiment with pureed foods for your 6 month old, but don’t be worried if it takes some time...let your baby “lead this dance.” 

I typically have parents puree as many different foods as they can, and introduce a different one every 2 to 3 days.  The more different foods the better.  At this age your baby will like all sorts of things that might surprise you.....broccoli, asparagus, black eyed peas,kale, beets.  Same thing for fruits...try kiwi, melon, avocado, papaya, grapefruit and mango.   

Even as your child is beginning “solid” food they are still getting the majority of their calories from breast milk or formula.  It will be several months before they are eating enough solid food to change their milk intake. 

No rush....solid foods have nothing to do with sleeping through the night either. That too comes with time.

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

Daily Dose

Colic

1:30 to read

I just read an interesting article in the journal Pediatrics on the subject of infant colic. It was a review of over 5600 articles that looked at the “mean duration of fussing and crying an the presence of colic in infants in the first 3 months of life”. If you have had or currently have a “colicky baby” this is quite interesting, as it looked at the incidence of “colic” in numerous countries as well.

 

The study evaluated the” mean total fuss/cry duration during 24 hours at ages 1-2 weeks (11 samples), 3-4 weeks (6 samples), 5-6 weeks (28 samples), 8-9 weeks (9 samples), and 10-12 weeks (12 samples).Interestingly the peak fussy crying period was highest in the first 6 weeks of life (17-25% of infants) and dropped by 8-9 weeks of age (11%)  and by 10 -12 weeks less than 1% of infants were reported to be “colicky”.  On average, babies around the world cry for around 2 hours per day in first two weeks, peak at 2 hours 15 mins at six weeks - and crying reduces to 1 hour 10 minutes by week twelve. (My son was not in this study…as he was colicky far longer than this study reported!!)

 

The study also found that infants in Denmark, Germany and Japan had less fuss/cry duration than infants in Canada, Italy and the United Kingdom.  What is that about?  It could be any number of variables including genetics, climate, socioeconomics and cultural factors….but I can remember feeling so helpless with an infant with colic (yes, even as a pediatrician…may have been worse knowing that there was not an answer) that I might have considered buying a plane ticket to Denmark!! Desperate times require desperate measures.

 

This study did not solve the mystery of colic nor did it give any answers to how to “treat” the fussy/irritable/colicky baby….but it did help to reassure parents around the world that this phenomena is universal…and that these babies do improve with time. You only wish that your baby could verbalize and explain to you what was going on in those first few months….but that may happen one day in the future…for now it is just an unknown, stressful situation for a parent…and the baby seems to outgrow it and has no memory of this experience.  (I have asked my own son who just looks at me with a puzzled expression?).

 

In the meantime parents with colicky fussy babies do require extra support and reassurance that their baby will be fine,  and ask their pediatrician if  their baby is growing and developing normally. But with all of that information …are there any “bargain fares” to Denmark and Japan???

 

 

 

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Daily Dose

All About Naps

1.00 to read

Just how many naps should your baby be taking and how long? When you are an adult, there is nothing better than taking a nap. Shouldn’t it be the same for children?  I get lots of questions from parents who ask when their children should take naps; how many times a day they should be napping and when do children stop napping?

Many new parents expect their newborn infants to take regular naps throughout the day (and then to sleep all night) even when they are only 4-10 weeks old. Unfortunately, a newborn’s sleep cycle is not ready for 2 hour naps in both the morning and afternoon followed by a 10 -12 hour extended sleep at night. But, by the time your child is 6-9 months of age (and sooner for some great sleepers); they should be on a good schedule with a morning and afternoon nap.  Naps are usually anywhere from 45 min – 2.5 hours.  I think naps serve a dual purpose, as they provide rest and rejuvenation for both child and parent. Nap time, just like bedtime should be scheduled, typically mid morning and mid afternoon and a child should be able to put themselves to sleep after a book or a story. Naptime routines can be bit shorter than the bedtime routine. You will be able to tell when your child is ready for a nap as they may rub their eyes, or get fussy, or some may just lay their heads down or point to bed as they know they are tired. By the time a toddler is somewhere between 12months – 2 years of age they will usually drop a morning nap and continue to have their midafternoon nap. This is usually right after lunch. Transitioning from 2 naps to 1 nap a day is a little “dicey” at first, as your child may get quite cranky in the morning as you drop that nap, while at the same time their afternoon nap may become longer. This adjustment period usually only lasts several days to a week and then you will find that they are back on a good nap/nighttime schedule. I get asked about stopping a child’s nap. I think naps are important (and as we adults know a privilege) for children until they are in elementary school. Most kindergartens continue to have “rest” time after lunch and many children will fall asleep for 20-30 min while the teacher reads them a book or music is played and the children lay on their mats. Even if your 4 – 5 year old child doesn’t “want” to nap in the afternoon, they need to have quiet time.  This may be for an hour or so in the afternoon, and is time for them to lay in their bed and read, color, play with dolls etc.  I do not think is the time for video games, or computer time etc. Many a child will fall asleep once they are in bed reading and will continue to take a good nap, they just didn’t know that they needed it! Moms, Dads, babysitters etc all need this quiet time too, to get much needed work done around the house, or dinner started etc. It was just a rule at our house that naps didn’t stop until you were in “big boy” school.  A quiet house for an hour each afternoon seemed to make the rest of the day and evening a happier time for everyone! That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

When Your Child Has RSV

Dr. Sue discusses what a parent can do if their baby has RSV, pneumonia and a double ear infection.I received a question from Brooke (via our new iPhone App). Her six month old has RSV, pneumonia and a double ear infection.

As we discussed yesterday, it is RSV season and children under one year of age seem to have the greatest problem handling the virus. It is not uncommon for a young child to develop an ear infection after developing RSV, and secondary pneumonias are also a problem . Unfortunately, there is not a vaccine to prevent RSV infection and only high risk infants are eligible to receive Synagis (a monoclonal antibody against RSV) to help prevent serious infection. The treatment for RSV is also supportive, with IV fluids and supplemental oxygen used for hospitalized infants. The use of bronchodilators and steroids has been controversial, and does not seem to be therapeutic. Antibiotics are used for secondary ear infections. Younger children have a higher incidence of secondary problems. There is not a “perfect” way to prevent RSV, but limiting your baby’s exposure to other children (daycare, public places) and to make sure that no one smokes around your child is helpful. The older your child is when they develop RSV (about 80% of children by 1 year of age) typically makes it easier for them to handle the virus.  Unfortunately, you can get  RSV more than once during RSV season. The season usually ends about April, so we are getting closer! That's your daily dose for today. We'll chat again tomorrow!

Your Child

New Studies Look At Childhood Asthma

1.45 to read

2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life.2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life

Antibiotic Use and Childhood Asthma Pediatricians have cautioned parents about taking antibiotics, and giving their children antibiotics, without a true medical need. Now a study appearing online in the journal Pediatrics, suggests that infants who take antibiotics during the first year of life may be at a slightly increased risk of developing asthma by age 18. In a separate analysis, the children of women who took antibiotics during pregnancy were nearly 25% more likely to have asthma compared to mothers who did not take the drug. Asthma can be a life threatening condition. Nine million children under age 18 in the U.S. have asthma, according to the American Academy of Allergy, Asthma & Immunology. Here’s how the study was conducted. Researchers gathered data from 22 previous studies between 1950 and 2010. Two of the 22 studies looked at antibiotic exposure during pregnancy while 19 studies evaluated antibiotic exposure during the first year of life. One study assessed antibiotic exposure during both time periods. Other studies have shown that infants who receive antibiotics are at an increased risk for developing asthma by age 7, and the more courses of the drug given that first year, the greater the risk. This review analyzed the results of studies using over 600,000 participants. It also grouped studies according to design type to see how the results were affected. When all 20 studies were grouped together, researchers found that infants who took antibiotics during their first year of life were about 50% more likely than babies who never received the drugs to be diagnosed with asthma. Researchers also analyzed studies where children who were treated with antibiotics for respiratory infections, were removed.  The respiratory infections skewed the overall results because of the possibility that the infections themselves might be a precursor to asthma. In studies that adjusted for these respiratory infections, a child who took antibiotics was 13% more likely to be diagnosed with asthma than a child who never took the medication. The researchers say they are not suggesting that early antibiotic exposure causes childhood asthma, but that even a slight increase in risk may be a good enough reason to avoid the unnecessary use of antibiotics during pregnancy and the first year of life. Food Allergies and Childhood Asthma Infants and toddlers often have some type of food allergy, while teens and adults are more prone to dust, ragweed and mold allergies according to U.S. researchers. A preliminary release of the Quest Diagnostics Health Trends Report, Allergies Across America, is based on laboratory testing from more than 2 million U.S. patient visits. In this report the findings reveal a pattern of allergen sensitivity consistent with the "allergy march," a medical condition by which allergies to foods in early childhood heighten the risk for the development of additional and more severe allergy-related conditions - including asthma- later in life. "Allergy and asthma often go hand in hand, and the development of asthma is often linked to allergies in childhood via the allergy march," Study investigator Dr. Harvey W. Kaufman says in a statement. "Given the growing incidence of asthma in the United States, our study underscores the need for clinicians to evaluate and treat patients, particularly young children, suspected of having food allergies in order to minimize the prospect that more severe allergic conditions and asthma will develop with age." The most common foods responsible for allergic reactions are eggs, cow's milk, peanuts, soya, fish and shellfish in children and peanuts, tree nuts, shellfish and fish in adults. Substances that are used as food additives and preservatives can also affect individuals. Although a causal link has not been determined, increased awareness of the heightened risks of having both childhood asthma and allergen sensitivity plus good patient-parent education and management of both conditions, can lead to improved health and medical outcomes.

Daily Dose

Your Baby's Cough

1.15 to read

If you’re the parent of a 5-10 month old baby, have you noticed that your baby is coughing, but they don’t seem to be sick?  Does the cough clear your child’s congestion or their throat which is what pediatricians like to call an “effective cough”?  I bet you want to know why your baby only coughs when you’re around.  I have always said parenting starts at a very young age and this is one of the first signs that your child is learning to “manipulate” you a bit…truth! 

This back and forth with you and our baby is called an “attention cough” and occurs when your baby realizes that when they cough you turn your head to look at them. Now, you are probably only turning your head to make sure they are ok, but your baby just sees your face turn to them and that you make good eye contact which is  reward enough for a cough!  Very clever! 

An attention cough is one of the earliest ways that your baby gains your attention.  Later on it may be high-pitched squeals, followed by them throwing a toy your way.  All of these are just a means of early “nonverbal” attention seeking behavior. Just wait, I promise it will continue and it may not always be quite so cute (think teenage years).

 So, if your child gets a little cough, it doesn’t seem like they are sick and you find yourself turning your head, the diagnosis may be “attentional cough”. Save yourself a trip to the doctor and a co-pay as well.  The best thing to do is just smile.

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