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Daily Dose

Breathing & Your Baby

1:30 to read

The first few weeks of a newborn’s life is usually a bit “cra-cra”, for both parents and the baby.  Once you leave the hospital with your newborn reality sets in pretty quickly, and you realize that your baby not only doesn’t sleep when you want them to but that at times they may seem to be noisy breathers when they are awake and/or asleep.  

 

As parents (and pediatricians) we play close attention to a baby’s breathing pattern and you may realize that they do some “weird” stuff.  For the first several months of life a newborn is an obligate nose breather.  Some of the noisiest breathing you may notice is when your baby is sucking and eating whether at the breast or from a bottle.  It is not always the quiet time you thought it would be. But, while they may be noisy, you need to look at their color and make sure that they are nice and pink.  Look at their lips and tongue if you are worried and both should be pink…never dusky or blue. 

 

Being a noisy breather does not necessarily mean there are problems. But, if a newborn has mucous in their nose or has refluxed some milk into the back of their throat you may hear some “congested” sounds which often cause parental concern. Again, look at the baby, open up their swaddle and lift up their gown and see what their chest looks like as they breathe.  A baby should look comfortable (even if noisy) and their ribs should not show as they breathe (which is called retracting), nor should you see their tummy (which may be full and protuberan) appear to be moving up and down with any effort.  Again, they should be  pink and well oxygenated.  Try to filter out the noise and watch the breathing!

 

Lastly, newborns have some “strange” immature breathing patterns as well. If you are watching closely you may see that they often seem to breathing normally and then pause before taking another breath. This is termed “periodic breathing of the newborn” and is perfectly normal…albeit a bit frightening. Your baby may pause for 5- 0 seconds before taking a breath which is then followed by several rapid shallow breathes. Sometimes this even occurs a few times in a row and then suddenly the normal breathing pattern returns. Again, your baby should not appear to have any change in color and their breathing pattern returns to “normal” without you doing anything at all. If you think that the pauses (apnea) are lasting longer than 10 seconds you need to call your pediatrician. With the advent of cell phone video I get many video clips of babies with periodic breathing.  The frequency of periodic breathing decreases as your baby gets older…and is usually gone by 2-3 months of age.

 

You will quickly get used to some “baby nuances” you never dreamed of and realize that even a tiny baby can be a noisy eater and sleeper!! 

 

 

 

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Daily Dose

Fussy Babies

1:30 to read

I have written a lot about fussy infants, spitting up and gastro-esophageal reflux (GERD). The diagnosis of GERD in infants in the past 10 - 15 years has soared….especially in irritable infants some of whom arch their backs and act as if they are uncomfortable while feeding (both breast and bottle fed babies) and spit up frequently,  to those who are diagnosed with “silent reflux”. 

 

When new drugs came to the market for adults with GERD, initially H-2 blockers like Zantac (ranitidine), Pepcid (famotidine) and Axid (nizatidine) they were soon prescribed for children as well. These drugs were followed by the introduction of proton pump inhibitors (PPI) which also inhibit gastric acid production, and include Prevacid (lasoprazole), Nexium (esomeprazole), and Prilosec (omeprazole).  Suddenly, younger and younger children were being placed on either H-2 blockers or PPI’s and many of these prescriptions were being written for infants under 6 months of age.

 

Being a pediatrician who had practiced for a long time and also had a incredibly fussy, irritable and colicky baby myself….I could never really decide if these drugs worked well or if “we” wanted them to work. There were some cases where it was quickly evident that the baby’s symptoms improved, while in many others the parents “were not sure”.  But, the use of these drugs has soared.

 

I have more and more young parents who want to start medication within their baby’s first month of life…”just because they are fussy”.  But there are new studies showing that the use of these medications in young children, especially those under one year, may have lasting side effects including an increased risk of fractures. In a retrospective study looking at over 850,000 children born between 2001-2013, those prescribed PPI’s had a 23% increased risk of fractures and those prescribed H2 blockers had a 13% increased risk while those prescribed combination therapy had a 32% increased risk of fractures. The risk also increased if children took these medications before 6 months of age, and there was also increased risk for those who used medications for longer periods of time.

 

Take home message for both doctors and parents….if these drugs need to be used it is preferable to limit it to one type, preferably H2 blockers and for the shortest amount of time possible. The use of other remedies including herbal remedies, thickening of feeds and probiotics should be first line treatment. When symptoms persist or are worsening and GERD is suspected, a 2 week trial of medication may be considered with ongoing discussion as to improvement in symptoms. Use the lowest dose for the shortest period of time as well.

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Daily Dose

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Your Baby

Mom and Baby Benefit by Skin-to-Skin Contact Right After Birth

1:30

Over the years, modern birth methods have changed how newborns and mothers interact with each other. Typically, the baby is cleaned up and wrapped in a blanket then given to the mother to hold. A new scientific review suggests that skin-to-skin contact is better for the mother and gives her infant a better start in life.

The review noted that women who had skin-to-skin contact with their naked babies soon after delivery were more likely to breastfeed longer and be breastfeeding months later than women who didn't have their babies placed on their skin right away.

"The more you can do to place the mother and baby together and disturb them as little possible during that first hour, the better off they’ll be," said lead author Elizabeth Moore, of the School of Nursing at Vanderbilt University in Nashville, Tennessee.

Researchers looked through medical literature and found 46 randomized controlled trials to include in their review. The trials included 3,850 women and their newborns from 21 countries. All babies were healthy and most were born at term.

"We compared those trials to usual care, and usual care was very different depending on the trial," said Moore. Trials from the 1970s may have separated mothers from their babies for hours. In more modern trials, babies might be swaddled in a blanket before being handed to the mother.

Moore and her team found evidence that babies who had received skin-to-skin contact were more likely to breastfeed successfully during their very first breastfeeding session, and they also tended to have higher blood glucose levels and stronger heart and lung function.

 “It’s just something that if at all possible should happen," Moore told Reuters Health.

Skin-to-skin contact should begin as soon as possible and last for at least 60 minutes, she said. The hour will give babies time to recover from the birthing experience, find the mother's nipple and latch on.

"It’s not something you can do in just 15 minutes," Moore said.

Not all physicians and hospitals are on board when it comes to immediate skin-to-skin contact after birth.

“I would recommend that a woman make sure she adds skin-to-skin to her birth plan," Moore said. "I think it’s a really good thing for a woman to put together a birth plan before she heads to the hospital and show it to her physicians or midwife."

What if your baby is premature or is delivered by cesarean? The researchers didn't find any benefits to initiating skin-to-skin contact immediately after birth versus after the baby had been examined and washed. They also failed to find any clear benefits to skin-to-skin contact that lasted longer than an hour.

"The evidence supports that early [skin-to-skin contact] should be normal practice for healthy newborns," the researchers wrote, "including those born by cesarean and babies born early at 35 weeks or more."

The review was published in the Cochrane Library in November. 

Story sources: Andrew M. Seaman, http://www.reuters.com/article/us-health-birth-skin-idUSKBN13V2UZ

Kenza Moller, https://www.romper.com/p/why-skin-to-skin-contact-after-birth-could-be-beneficial-for-mothers-babies-alike-24423

 

Daily Dose

Teething Pain

1.15 to read

I am getting a lot of questions from patients related to teething, pain, and the routine use of products to alleviate the pain.  

The FDA recently issued a warning to parents who use OTC products like Oragel and Anbesol on their infant’s gums for relief of teething pain. These products come as both liquids and gels, and benzocaine is the active pain reducing ingredient.

It has now been found that excessive amounts of benzocaine may lead to a very rare condition called methemoglobinemia. (Hemoglobin is the molecule in the red blood cell that carries oxygen) . With methemoglobinemia there is a reduced amount of oxygen that is carried in the bloodstream which may lead to a bluish gray discoloration to the skin, shortness of breath, a rapid heart rate and fatigue and lethargy. Again, key word is rare.

Although the FDA did not withdraw these products from the market, they did recommend that they not be used in children under two, and then should be used “sparingly”. Unfortunately, the benzocaine containing products do not yet contain warning labels and some of my patients are still asking about using them.

I have never recommended using these products in the first place. I always wondered if they really helped a baby who was teething, as I am not sure you can tell when a baby is actually teething.  If you watch any infant over the age of 4 months, their hands are always in their mouths, and they are constantly drooling!  Does that mean they are getting teeth? Unlikely, as most babies don’t even cut their first tooth until about 6 months, so they have been drooling and putting anything they can in their mouths for months prior. The drooling and “gnawing” on their hands (and sometimes feet too) is rather a developmental milestone and not always a sign of teething.

My theory is let the baby chew on a teething ring, a frozen piece of a bagel (cut into quarters, good for gnawing but you need to throw it out when getting soft to avoid choking) or rub their gums with a cold washcloth if you think your child has discomfort.

The same thing goes for using acetaminophen or ibuprofen excessively. Some parents are giving a nightly dose during the “teething months/years” and this is too much medicine.  Children go through a lot of sleep changes and awakenings which tend to occur during suspected early teething times and many parents attribute nighttime awakenings to teething pain. They are not synonymous. Remember that temporal events are NOT always causal.

Babies will get teeth for many years to come and once the first several have broken the skin we don’t seem to pay as much attention anyway, right? I mean, who is going to worry about a child cutting their 2 year old molars, there are way too many other issues to deal with (tantrums, climbing, throwing food) than if their molars are erupting.

So, save your money and don’t buy teething products. Now even the FDA agrees!

Daily Dose

Parents Need 'Me' Time

1.15 to read

Do you ever feel TOO connected?  I have been talking with many of my young parents about being a bit too connected to their little ones.  Now don’t get me wrong, good parents are connected to their children, but it cannot and maybe should not be 24/7, day in and out. 

It is important for parents and children to learn independence from one another, and it begins shortly after a baby is born when you realize that as new parents you need a break for an hour or two, maybe to go to dinner, a movie or the book store to pick up the latest parenting book. (so stay tuned from The Kid’s Doctor). 

But while you go out and the baby is either with the other parent,  grandparent or babysitter, you do not need to be in constant communication to check in 15 minutes after you leave. In that case there really is no break.  If you get a phone call, or text 10 minutes after leaving because the baby is crying or spit up or won’t go to sleep, which in turn makes you anxious, so you turn around to come right home, then the whole point of a break is moot. 

This came up again the other day when a young mother told me that she was so exhausted and had a 6 week old baby at home.  Her sweet husband treated her to a mani/pedi which she anxiously looked forward to. She left her husband with a bottle of pumped breast milk and headed out the door for an hour and half break and maybe a nap in the spa chair. But, shortly after she settled in, she kept getting texts about the baby.  The more texts she got the more anxious she got and then wished that I had never even left.  I just “knew I had to be there!” 

When I brought up the fact that life seemed a bit simpler and maybe even more relaxed prior to constant cell phone communication she and her husband both paused for a moment. What? No way! But after realizing that an hour break while their baby was in the care of another responsible adult might be just what the doctor ordered. 

In the olden days a trip to the grocery store ALONE was a treat, and I knew that the baby would still be there when I returned. Daddy could not call to say that our sweet baby boy had cried for 10 minutes, they just muddled through together.  While I was in a sleep deprived stupor at the grocery store, I was also enjoying languishing in the produce department trying to decide whether to buy iceberg or romaine lettuce. It was a break of sorts! 

So, maybe try an hour away from your baby without a phone call or text! Make a pact with your spouse or sitter and take a break. It does wonders for everyone to figure out that baby, mother and father can all survive. 

Try it and let me know how it goes. 

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

Daily Dose

The Reality of Bringing Home A Newborn

What it's really like to bring home your newborn baby.I am so blessed to have the opportunity to continue to see newborn babies in my practice.  Now that I have “been around for awhile” I am also getting a chance to see some 2nd generation babies, in other words, newborns whose parents were my patients!!  It is just the best!!!

{C}

You’ve heard me say, “your baby doesn’t come with a manual” and despite reading a lot about a new baby, many new parents are feeling totally “overwhelmed” with in just a few days after the birth of their child. Every new parent needs to know that feeling overwhelmed is a normal and realistic emotion in the first weeks after an infant is born.   I just had a discussion about this very topic with a cute couple who had their baby last week. The father had been patient of mine and I have been excitedly awaiting the baby’s birth.  They welcomed a new little boy to their family last week and I saw them several days later. They were beaming with pride and joy, but expressed to me that despite all of their preparation they still felt “unprepared”.  I must say, I don’t think there is a book, blog, CD, manual or anything else that can totally prepare you to be a parent. It is “on the job training” and just like any job, the first days to weeks are sometimes some of the most challenging. I have decided that early parenting is really more of a physical job than an intellectual one.  For the first month or so, certainly the first 2 weeks, the main goal for a parent is to sleep whenever you can. Forget the books about having a “schedule” for a newborn. Intellectually that makes a great deal of sense, but practically it does not. I do not mean to say that you should not “try” to feed your baby every 2-3 hours and “try” to get them to stay awake for a bit after a feeding, and “try” to put them down when they are awake. But, if you go into those early weeks with expectations that you can make it all happen like clockwork, then you are going to set yourself up for failure and feeling inadequate.  I really believe that those first weeks are about SURVIVAL, and that means you sleep when you can (even if that is the middle of the day), as you never know what time of day your baby will decide that they want to have some awake time. Often that awake time is not at all related to a parent’s normal circadian rhythm. If you think too much about making it happen on your terms, again, you should have spent that time sleeping when you could have. The same thing goes for feeding a newborn.  They are human after all, and they too will eat differently from one meal to another. That does not mean there is a problem, every feeding is not going to be the same.  You would love for them to eat their “biggest” meal right before you put them to bed at night, but a newborn may decide that they prefer to eat in the morning or in the middle of the night, again, you have to go “with the flow”. Stressing over the fact that your baby only fed for 10 minutes on one breast and then 5 rather than 10 on the other, or that they only took 2 ounces of formula rather than 4 will only drive you crazy and contribute to sleeplessness if you try to analyze it.  Again, intellect doesn’t work at this stage of the game.  In the beginning, every day is different; some are better than others. Just be assured you have many more days and years to “perfect” this parenting thing. But what I do know is that for most of us, parenting while extremely challenging at times (like the first 2 -4 weeks), is the most rewarding job you will ever have.  So, jump in with few expectations except to know that your baby is changing every day.  The rhythm will come, the days and nights will straighten themselves out and you will eat and sleep again on a regular schedule. It just takes time! That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Babies & Sleep

1.15 to read

I am so fortunate that I still get to take care of a lot of newborns, many of whom are friends of mine who are having their first grandchildren! I consider this a perk to be the pediatrician.  

I was at a wedding over the weekend, and a new grandfather came up to me to talk about his first grandbaby who was born a few weeks ago. He was so thrilled and excited to be a grandfather but he was also wise. He told me about talking to his daughter while she was still in the hospital, and reassuring her that the baby was just fine, and that this newborn period was really “as easy as it gets”. I told you he was wise!!  The problem, like many things in life is that you don’t realize how “easy” a newborn is until you look back. 

I saw about 6 new babies in the office yesterday and they were all healthy and beautiful! Now that the parents had had the baby home for 7-12 days and knew that the baby was healthy and thriving, they all asked the same question, “how do we make them sleep?”  

I just have to laugh, as I love my job, but if I had the magic potion I would have bottled it and sold it on the internet, and be retired on the beach! There is not a doctor who can make a baby sleep through the night from the day they come home from the hospital, I don’t care what book you read.  It takes a baby’s brain and sleep cycle to mature and their tummies to grow to extend the amount of time a baby sleeps at night. 

Now, you can start with good sleep habits, even beginning on the first day home from the hospital, but it still takes time. Just like it will take a while for your child to learn to walk, read or ride a bike without training wheels, your child must learn to sleep through the night. 

A newborn does not arrive on the scene knowing about circadian rhythm. In other words having “days and night” mixed up is really not the case.  A baby does not enter the world knowing about days and nights or sun and moon.  But, by beginning to awaken your newborn every 2-3 hours for feedings during the day followed by a little awake time after that before trying to get them back to sleep is the beginning of “teaching” your baby to sleep.  Once a baby is gaining weight and is back to birthweight, I tell parents to “let that baby sleep at night”. Unfortunately, not all babies are listening to the instructions.  Some are up every 1-2 hours at night, and you just have to get up and hope the next day is better. 

Lastly, I wish this was the worst sleep you were going to get, but wait till you have teenagers!  That is a discussion for another day....

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