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Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

Daily Dose

Babies & Bow-Legs

1.15 to read

Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

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.  

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.

Daily Dose

Crooked & Toes Fingers?

1:15 to read

 I get a lot of questions from parents during their child’s first months of life about fingers. ( and sometimes toes as well).  Because, if you look closely you may see that your child’s finger  seems to be a bit “crooked”.

The term used for bending or curvature of the finger is clinodactyly, which describes a bending  or curvature of the finger in the plain of the palm.  It is a fairly common and occurs in about 10% of people. Upon close inspection i actually think that I may have a bit of it myself . It is more common in males and typically affects the small “pinky” finger.  It is unusual to have it on both hands, but possible ( Would be a great show and tell!)

It seems that clinodactyly run in families and may be inherited. When parents are concerned about a bit of bending of the 5th finger, I usually say, “ go to your family reunion and have everyone hold out their hands”. You may find that your favorite aunt or uncle has the same thing!

The very mild curving of the finger that often concerns parents ( especially in the first few months when “we” examine everything), rarely causes any problems. There is no associated pain and you will see that your child uses their fingers without a problem. Often by the time your child is older you have forgotten about it altogether, and are now more concerned that they don’t break those fingers getting it slammed in a door.

For severe curvature of the finger make sure you talk to your doctor and watch the growth of the finger as abnormalities of the growth plate may contribute to clinodactyly. In severe cases where curvature progresses and interferes with hand function a hand surgeon may be consulted to correct the deformity.   

Your Baby

Britax Recalls Car Seat Chest Clips Due to Infant Choking Hazard

1:30

Faulty chest clips on more than 100 models of Britax Care Safety car seats are being voluntarily recalled because the clips could break off and create a choking hazard for infants.

The company says that no injuries have been reported, but it has received complaints of chest clips breaking.

The recall will affect more than 200,000 car seats. However, Britax stresses that the car seats are still safe to use until a replacement kit is obtained. 

The chest clip is on the Britax B-Safe 35, B-Safe 35 Elite, and BOB B-Safe 35 infant seats.

The products were manufactured between Nov. 1, 2015, and May 31, 2017. To see the model numbers that are included in the voluntary recall, or to check the serial number of your seat, visit the company’s website set up for this recall at www.bsafe35clip.com. You can find the serial numbers on the "Date of Manufacture" label on the lower frame of the seat.

Britax is offering to replace the chest clip with a free kit that contains a new clip made from a different material. The kit comes with step-by-step instructions for replacement. Consumers are advised to routinely check their current chest clip until a replacement arrives.

Story sources: Alexandria McIntire, http://www.webmd.com/children/news/20170623/recall-britax-car-seat-chest-clip

Ashlee Kieler, https://consumerist.com/2017/06/21/britax-recalls-207000-carseats-over-chest-clips-that-can-break/

Daily Dose

Cord Blood Banking

1.15 to read

As a practicing pediatrician, I regularly participate in “grand rounds”.  This is doctor lingo for a weekly teaching conference, and grand rounds occur on a regular basis in teaching hospitals all around the country.   Recently, I attended the most interesting and informative “grand rounds” on cord blood banking. 

The topic this week was “umbilical cord blood banking: a safeguard for the future?”  I was really intrigued with the title as I have so many young couples who ask about cord blood banking and many of these couples choose to use private cord blood banks despite the American Academy of Pediatrics recommendations to use public cord blood banks.  But private cord blood banks are really just great advertisers. They play to the emotions of soon to be parents as there is not a parent out there who would not do almost anything (even if expensive) to ensure the long term health of their soon to be born child! 

There are more than 150 private cord blood banks, and 40 public banks. Only 27 states have cord blood banking laws which essentially means that private cord blood banks are not regulated well.  In general, it has been found that private cord blood banks specimens have lower cell counts, the cells may not be of good quality and also have a greater risk of infection. They are often inadequate for use. There are really not that many situations in which these cells would be used at all. In fact there is about a 99.9% chance your child will never need a stem cell transplant, and typically 50% of cord blood specimens which have been stored in private banks are not usable. 

With that being said ,why would you even need a stem cell transplant? The one disease process in which autologous  (meaning your own cord blood) stem cells would be used is if your child developed acquired aplastic anemia.  The incidence of this blood disease is 3/1,000,000 per year.   The chance of being struck by lightening is 1/576,000.  

Other childhood cancers including leukemia, lymphoma etc in which a stem cell transplant may be necessary would use stem cells from acquired from peripheral blood (which is the current standard of care).  These cells may be obtained from the public banks and may be obtained by anyone who is in need of a transplant after going through a matching system. You are not limiting their availability like a private banking situation. They may be used for the “greater good” where there is a much greater likelihood that they will be needed, and stored appropriately. 

So, the “gist” of the lecture was that private cord banks are for profit. While they do a great job of advertising, and play to new parents emotions as a “once is a lifetime opportunity” their claims may be falsely inflated.  The private banks have no published data to substantiate their claims. 

Better to give cord blood to a public bank and invest the money you save from not using a private bank in your child’s education (which you will definitely need in some shape form or fashion).  This seems to benefit the most.

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

Daily Dose

Your Baby's Umbilical Cord

1.15 to read

I get a lot of phone calls several days after parents head home with their newborn regarding their baby’s umbilical cord.  The umbilical cord really is the lifeline for the baby for 9 months, but once the baby is delivered, and the cord is clamped, it becomes a nuisance and “grosses” many parents out.  So often parents don’t even want to touch the cord and one of my patients told me....”why can’t it just dry up and fall off immediately?”. My only answer to that is, “God did not make it that way?”.

So, in a nutshell the umbilical cord is made up of 3 blood vessels, actually 2 arteries and one vein.  When the cord is cut and clamped the vessels begin to clot and eventually the cord detaches, typically in 7-14 days and then falls off.  

In the interim the cord is developing a scab so it may “ooze” a bit and there may even be dried blood on the baby’s diaper or around the edge of the cord.  A tiny bit of blood is to be expected, and parents don’t need to be worried that the baby is bleeding!!!  I like to explain that it is the first time as a parent that you might need to clean off a little blood, the same way that you will again when this sweet newborn becomes a toddler and falls down and skins their knee.

On occasion the hospital forgets to take the cord clamp off before the baby is discharged and the family comes in with the baby for their first visit with the cord clamp still on.  Poor parents have no idea that this is typically removed before discharge...somewhat like leaving the store with the magnetic tag on the outfit....just no alarm to let you know it is still there. In that case they are amazed when we pop off that yellow or blue plastic attached to their baby!

Lastly, the newborn baby can have some time on their tummy, if they are awake, even with the remnant of the cord still on. It will not hurt the baby at all and early tummy time is important...just NOT when a baby is sleeping!

I have to admit that I opened the baby book 30 years later and that dried umbilical stump was in there..Yes, I too was a first time mother.....don’t save it!

Daily Dose

Flying With A Baby

1:15 to read

Overheard on the plane this week:  I am in row 15 and there is the cutest most precious 4-5 month old baby girl behind me in row 16.  Key point….she is sleeping as we are making our approach!

 

The mother of the baby is traveling with her mother so there are is a grandmother along to dote on this darling baby. The mother of the baby says to her mother…”we need to wake her up now!!!”  “Mom, please wake her up as we need to feed her NOW!”  At this point the mother takes out a whisk of some sort to put into the breast milk…do you have to mix with a whisk now?

 

So…of course they wake up the baby who starts to cry, but just a bit…and then the grandmother starts to feed the baby the bottle.  The mother is saying, “Mom, just make her eat”.  Now it is really bumpy as we are getting ready to land and I was wishing I had a bottle to calm me too!

 

The baby seems to be quietly eating, but then must have stopped eating as now the mother of the baby takes the baby from the grandmother and starts to try to give her daughter the bottle.  She starts talking to the baby saying, “ please keep eating so your ears will stay clear” followed by “Mommy is going to drink the bottle, so you can see me keeping my ears clear too”.  “If you keep sucking your ears will be pain free”. 

 

Everything seems to be going well…although we still have not landed, when the mother says “I am going to force feed you to keep your ears clear!”  Uh…oh I am thinking, I know where this may be going.  But it seems so far, so good. 

 

Just as we are about to touch down I hear this gurgling noise from behind me and then the mother saying, “Oh dear she is spitting up!!”   Really, are you shocked??

 

But…I must say, the baby was quiet and content…who knows, I would have never awakened that sweet baby girl, but then again, I still believe, “never wake a sleeping baby”, even on an airplane.

 

 

 

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