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Daily Dose

A New Baby

1.15 to read

I must say...being able to have texts and emails from my patients does make it easier to communicate. A quick question or a picture of a cut on the knee can quickly be sent over a handy phone, and I can often reassure a parent that a visit may not be necessary.   

At the same time, messages from my patients make me feel more connected to them and their family. This was the case the other day when I was out of town and missed the birth of one of my newest patients. The good news? The tech savvy, mother kept me in the loop throughout her delivery! 

This mom was having her 4th baby, and 1st girl after 3 boys. (hmmm....wonder if I should have had that 4th baby after all - a bit late to ponder that question?) 

She sent me a quick text that she had gone into labor, but it was 3 weeks early. I had hoped to be at the hospital for her delivery as it is still fun for me to be in the delivery room. There really is nothing better than observing a delivery, as you are always a reminded of the miracle of birth. 

So....out of town, missing the birth..but, she sent me a picture of her in labor, followed by quick text telling me it was almost time and then......a picture of a precious, healthy baby girl, all 7’ 2” of a new life! This picture is of the new proud dad (I think she’s already got him wrapped around her finger).  It was almost like I was there...while still enjoying a few days at the beach.   

So, one of the best parts of my job is being a part of a family and watching that family grow.  Doesn’t get better than that. 

Congratulations to sweet baby girl Roberts. You are perfect!

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

Kidney Reflux in Children

1.30 to read

Have you ever heard of vesico-ureteral reflux (VUR)? This is a problem that I have be seeing lately which occurs in the urinary tract.

In the normal scenario urine is produced in the kidneys and then travels through the ureters (which are like a straw) from the kidneys to the bladder. The urine is supposed to only proceed in one direction, and only down and into the bladder and then out the urethra when you urinate. But in some children, the kidneys are fine and doing their work of making urine but the ureters (the straws) allow the urine to go in a retrograde fashion (both up and down, or back and forth or whatever terminology you want) from bladder to kidney,  and this is termed vesico ureteral reflux (not to be confused with gastro-esophageal reflux).

Vesico-ureteral reflux is often diagnosed in infants and young children who present with prolonged fever which may be an indicator of a urinary tract infection.

When a child under the age of 2 has persistent fever (usually over 72 hours), without any other focus of infection, a urinalysis and culture is often performed to rule out a urinary tract infection. It is also more prevalent to see this occur in little girls rather than in boys.

If a urinary tract infection is confirmed it was previously the “standard of care” to perform a VCUG (voiding cystourethrogram) which is a radiographic study where dye is injected via a catheter into the bladder to look for retrograde flow of urine (the back and forth, up and down) to rule out VUR. In the past several months there have been changes in the management of VUR especially as it relates to first urinary tract infections.

The new recommendations state that, “children of any age, regardless of gender, with a first febrile UTI should undergo a renal/bladder ultrasound, rather than a VCUG.”  In other words, no more radiation and dye (not to mention the associated trauma) that went along with the voiding study.

Years ago a VCUG was performed without any sedation, but over time it became standard to sedate the children before this procedure, and with that there were other issues about safety etc.  It was also recommended that a VCUG be done yearly to watch the regression or progression of reflux. That yearly VCUG just sent some kids and parents over the edge (including me!).

The concern with VUR is that over the years this retrograde flow of urine could cause damage and scarring to the kidneys. This scarring could cause numerous problems (high blood pressure, kidney disease etc) for a child later in their life. The problem was figuring out who might go on to scar and need surgery etc.   The new guidelines recommend using a different type of scan in management of reflux.

If your child has a urinary tract infection in association with a fever you might want to discuss whether they should see a pediatric urologist, and/or have an ultrasound. But if someone mentions a VCUG consider the newest guidelines. And, if you have a child with VUR, talk to your doctor about the changes in management and don’t stress about a VCUG this year!

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

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.

 

 

 

Daily Dose

What is Thrush?

1.15 to read

I get a lot of phone calls and questions from worried mothers who have noticed that their baby’s tongue has a bit of white coating and is this thrush?  Thrush is fungal infection of the mouth that is seen in babies (about 2-5% of babies), but thrush typically affects the sides of the inside of the baby’s mouth or under the lips and along the gum line. A white tongue alone is most likely residual milk. 

There are many cases of thrush that are mild enough that they may resolve on their own. On the other hand, a severe case of thrush may be painful and may make it difficult for a baby to feed, which then leads to a fussy, irritable baby. 

Thrush is caused by the fungus candida and despite everyone’s best efforts at cleanliness, candida like bread mold, can just happen.  Candida may be acquired at the time of delivery as the baby passes through the birth canal that is colonized with candida, or during nursing from the skin of the breast, or from a pacifier or the nipple of a bottle.  

Thrush is typically treated by wiping the inside of the mouth with a soft washcloth followed by an antifungal medication given as drops in the baby’s mouth after the baby has eaten. In a breast fed infant I treat the mother’s breast with a topical antifungal cream as well. 

Best way to look for thrush may be when you baby yawns and you get a good look at the inside of their mouths (bucal mucosa).  You don’t need to be a detective to find thrush, it is usually fairly evident and the biggest clue that it is not milk as it will not wipe off with a soft washcloth.

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!

Your Baby

Recall: Oball Baby Rattles Due to Choking Hazard

1:30

About 680,000 Kids ll Inc. Oball baby rattles have been recalled due to choking hazards.

This recall involves Oball Rattles in pink, blue, green and orange with model number 81031 printed on the inner surface of one of the plastic discs and on the packaging. The balls have 28 finger holes and measure four inches in diameter.

Embedded in the rattles are a clear plastic disc with all orange beads and two clear plastic discs with beads of varying colors on the perimeter.

Only rattles with date codes T0486, T1456, T2316, T2856 and T3065 located on a small triangle on the inner surface of the rattle are included in the recall.

The first three numbers represent the day of the year and the last digit represents the year of production.      

The firm has received 42 reports of the plastic disc breaking releasing small beads including two reports of beads found in children’s mouths and three reports of gagging.

Consumers should immediately take these recalled rattles away from young children and contact the firm to receive a full refund.

The rattles were sold at Target, Walgreens, Walmart and other retailers nationwide and online at Amazon.com, Babyhaven.com, Diapers.com, ToysRUs.com, Walgreens.com and other online retailers from January 2016 through February 2017 for between $5 and $7.  

Consumers can contact Kids II toll-free at 877-243-7314 from 8 a.m. to 5 p.m.  ET Monday through Friday or visit www.kidsii.com and click on “Recalls” at the bottom of the page for more information.

Story source: https://www.cpsc.gov/Recalls/2017/Kids-II-Recalls-Oball-Rattles

Your Baby

Is Your Baby Safer Sleeping in a Box?

2:00

Is your baby safer sleeping in a box instead of a crib? Some parents think so and are ditching the traditional infant crib for a specially made cardboard box.

The Baby Box Co., is a Los-Angeles based business that is partnering with hospitals across the U.S. to give away free “baby boxes” to new parents.

The parents also receive a 15- minute educational video about safe sleeping habits for infants. Also included in the box are infant clothing, a mattress, a fitted sheet plus $150 worth of baby necessities.

While relatively novel in the U.S., the baby-box isn’t a new idea.  It’s modeled after a program in Finland that began more than 70 years ago. Baby boxes are aimed at curbing infant mortality rates by promoting safe sleeping practices for newborns.

New Jersey adopted the first statewide baby box program; distributing a total of 105,000 boxes. And now, Ohio has joined up, along with hospitals in Philadelphia and San Antonio, Texas.

Proponents of baby boxes say the combination of educational tools and free resources will bring America's infant mortality rate closer to those found in wealthy Nordic countries.

The goal of the Baby Box program is to bring the rate of children dying from Sudden Infant Death syndrome (SIDS) down. SIDS is usually attributed to sleep-related accidents such as strangulation, suffocation or entrapment. In 2015, the Center for Disease Control (CDC) reported about 3,700 infants died from SIDS.

The U.S. saw a drastic decline in its infant mortality rate since 1994, when the CDC launched its "Back to Sleep" campaign urging parents to have their infants sleep on their backs rather than stomachs, but disadvantaged groups still tend to be affected by SIDS more than others.

In Finland, Baby Boxes have had a dramatic impact on infant mortality since the program was launched in 1949. In the 1930s, the country's infant mortality rate was 65 deaths per 1,000 infants. Beginning in 1949, that number has shrunk to 3.5 deaths per 1,000 births— a decrease that's credited in part to baby boxes. Comparatively, the United States had an infant mortality rate of about 5.8 deaths per 1,000 births in 2016.

One University of Chicago study found that primarily lower socioeconomic groups drive the higher infant mortality rate in the U.S. after the mother and child leave the hospital. Contributing factors may include health coverage insurance and the mother’s amount of education.

What else can be done to curb infant mortality rates?

Some experts argue that policies geared toward enhanced post neonatal care for mothers of low socioeconomic status would be most effective in combating the U.S. infant mortality rate.

Universal home nurse visits, available in a number of European countries such as Finland and Austria, are one option. A provision of the Affordable Care Act offers money for a number of similar programs, such as the Nurse Family Partnership founded in 1977 in New York.

The program, which sought to rein in infant deaths in the U.S., provides low-income, first-time mothers with registered nurses who visit their homes to provide assistance and child health education for mothers.

According to the Baby Box Co. website, Baby Boxes are not only available through some hospitals, but also direct to consumer.

Story source: Avalon Zoppo, http://www.nbcnews.com/news/us-news/hospitals-u-s-give-away-free-baby-boxes-curb-infant-n732421

http://www.babyboxco.com

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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