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Daily Dose

Talking to Your Baby

1:30 to read

An interesting study on how mothers and fathers converse with their infants was recently published online in the journal Pediatrics. I found it fascinating since I am once again “oohing and gooing” with a baby: my precious granddaughter. I was just feeding her yesterday and remembered talking to my own children years ago and gazing into that baby’s eyes in amazement.

The study entitled, “Gender Differences in Adult-Infant Communication in the First Months of Life”, looked at 33 babies and audio recordings which were made from birth to 7 months of age.  They found that infants were exposed to more speech from mothers than fathers (are you surprised, we do have more words, right?). Interestingly they also found that infants preferred mother’s speech and language over fathers. Do you think it is the timbre of the voice or the number of words that we mothers use when talking and soothing an infant? I am not sure that it is purposeful, but men do use less words than women.....at least in my house which was full of boys...who turned into men of few words as well.

The study also showed that mothers responded more frequently to girls and there were trends for fathers to respond to boys at birth and during the first month of life.  Do you think it may be that new mothers and fathers are not yet sure what they should be discussing with these new babies that may be of the opposite gender? It takes a while to figure out that a baby boy is just as happy hearing his mother discuss how to bake cookies, as a baby girl may be to hear her father discuss the latest sports scores.

Interestingly, overall language exposure increased over time for all of the infants as they matured. 

Bottom line? Start talking to your baby the minute they are born....about anything.  Babies just love hearing their mothers’ and fathers’ voices and parent talk is always beneficial for a child’s language development.

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

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.

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!

Daily Dose

A Baby's Neck Issue

1:30 to read

Torticollis is becoming more and more common and it may be related to several different things. Torticollis is defined as a “twisted neck”, or as my grandmother used to say, a “wry neck”.  Most of us have experienced a tight neck after a bad night’s sleep, and you can hardly turn your head to back out of the garage it is so painful, but be reassured your baby does not have any discomfort, but will just hold their head somewhat “tilted”.

A baby’s 40 weeks spent in utero may cause some positional deformities of the head and neck.  Due to the intrauterine positioning a baby may “favor” turning their head to one side rather than another. At the same time back sleeping which is recommended for all babies, may also contribute to torticollis.  

In order to help the baby resolve the tightness in the neck which is actually due to the sternocleidomastoid muscle being tight, your doctor may have you do several things early on to help stretch the neck muscle.  

If your baby prefers to look to the right they have left sided torticollis. In this case turn your baby in the crib so they have to turn to the left to look out (they don’t want to face a boring wall). When you are feeding them have the bottle on your right arm. When changing diapers, place the baby so that they have to tur left to see you.  Hold the baby on your left hip as well and burp them on your right shoulder. All of these strategies will help to stretch the muscle.  On top of this the baby needs to have tummy time, when awake, and work of having them turn to the left during this time too. Lastly, do gentle neck stretches 3-4 times a day and massage the tight muscle.  

If your baby prefers to look to the left also called right sided torticollis, reverse the above.

Your baby should continue to work on stretching so that their head will also not get flattened on one side or another, which is called plagiocephaly.  By continuing to have tummy time and neck stretches, most cases of torticollis will resolve. In severe cases or when you don’t feel that the baby is improving,  ask you doctor about the possibility of physical therapy.

Daily Dose

Monitoring Your Baby

1.30 to read

I have recently received several emails from patients which included attachments.  The attachments were videos of a baby in their crib with questions from parents about whether the baby was “breathing okay”, was “crying enough to be picked up”, or whether I thought “the baby was dreaming”. I had to laugh, as the first thing I thought of while watching all of these videos was: we are really just “too smart for our own britches”, which was a line often used by my dear deceased grandmother who died at the ripe age of 104!  In this case, she would be right as we have so much technology available to us but I’m not sure if it is really that helpful when we are talking about caring for a baby. 

Every parent wants to make sure that they are “watching” their newborn, infant or toddler as closely as possible. That is good parenting.  But, even a newborn does not need to have constant video monitoring with rewind and playback ability.  Just having your baby in the bassinet by your bed or in the nursery next door to your room is really sufficient.  

The idea is that you can hear your baby if they are crying.  You do not need to hear hiccups, and know that they latest for 18 minutes. If your baby is stretching and making normal “new baby” grunting and groaning sounds, you do not need to hear every noise. You do need to hear your baby crying because they are hungry, wet or uncomfortable.  That is when a parent is supposed to get up and go to their baby’s bed.  Watching them just making a few noises to get settled is not a call for intervention.  

I am the first doctor/mom to totally believe that a new baby needs to be held when fussy or irritable. I am not the “cry it out” doctor (let them cry for the first 5-6 months of life).  But, a baby can ooch and scooch and not need to be picked up and if you do not have a video monitor, you probably would not know they were ooching and scooching.  With video monitors on day and night a baby cannot even burp without the parent watching and wondering and “worrying” if that burp was significant.   

While we talk about our teens being “too connected”, maybe we parents need to think about that too.  Are “we” parents (and grandparents) being too connected to the baby?  Are we part of the problem of “instant” intervention, when many a baby might calm themselves if given the chance (and the parent never knew).  

Many generations of newborns and young babies were raised, successfully, without a video camera. Parents ears are a pretty good monitor too , for both babies and even teens.  Eavesdropping is still allowed! 

Daily Dose

Safe Sleep & Tummy Time

1.30 to read

I keep getting so many questions about “tummy time”   Ever since the American Academy of Pediatrics recommended that all infants sleep only on their backs (to reduce the chance of SIDS), parents forget or are afraid to put their baby’s on their tummies. Tummy time is important to help reduce the incidence of head flattening as well as to give your baby time to develop different muscle groups.   

Tummy time is encouraged from the first days after a baby’s birth, but so many parents ask, “just how much time?”  Tummy time does not mean “timed” in the sense that you do it for a certain amount of time or minutes a day.  Tummy time, is not rigid.....it is flexible.  Off and on throughout the day when your baby is awake, you let them experience tummy time.   

Just like so many activities with a newborn, sometimes tummy time is for only a minute or two before the baby starts to fuss or cry.  Other times an infant may enjoy their tummies for 10- 20 minutes before they are ready for a change.  

At other times you put the baby on their tummy, they settle down and then decide to fall asleep.  Keep in mind, you MUST turn them over, even if you are watching them. Remember, NO TUMMY sleeping until your child rolls over on their own. 

So, many parents come in during the first days to weeks after their baby’s birth with not only feeding charts, but “pee and poop” charts and graphs of tummy time down to the minutes.  It is really not necessary to graph the amount of tummy time your baby gets, just make sure you remember to do it.  

As your baby gets older, they typically enjoy their tummies for longer periods of time and are soon lifting their heads, supporting themselves with their shoulders and around 4 months will likely begin to roll from tummy to back. After that milestone it is not long before they start sitting alone and tummy time is old hat by then.  Your baby should also have a beautiful rounded head from getting tummy time from the start. 

Daily Dose

The Dangers of Using Baby Aspirin

1.15 to read

During a recent office visit, I saw a 4 year old child who is not one of my routine patients.  He had a fever and runny nose. His mother was giving me the child’s medical history during the time I was beginning to examine the little boy.  I had my back slightly turned from her. 

The mother was explained to me that her son had had a fever the previous evening and said, “I gave him some ASPIRIN before putting him to bed.”  I immediately turned around and with a stunned voice said, “you mean you gave him Tylenol or Motrin or Advil,” right? She really looked at me like I was crazy or that I had not been listening to her and she said, “No I said baby aspirin.”  “He likes the chewable ones.”  

I was shocked, as I had not heard of anyone giving aspirin to their children for a fever in over 20 years!! This very nice, young, concerned mother could not figure out why I was so worried about the aspirin.  I then had to explain to her about the risk of Reye’s Syndrome. She had never heard of Reye’s Syndrome and said that her mother had kept baby aspirin in the house for her, so that is what she bought to use for her own child.  

I know that they sell enteric coated baby aspirin for adults to take to help prevent a stroke. I guess I didn’t even realize that regular old baby aspirin was even around. There was so much publicity in the 1980’s about the link between aspirin or any salicylate containing medication and the development of Reye’s Syndrome, as well as warning labels about not giving aspirin to children that had a fever or chicken pox that I had not heard of anyone using aspirin for years! 

I explained to her that Reye’s syndrome affects the brain and liver and is a very serious disease, which may lead to death.  It occurs in children between the ages of 4-18 and causes recurrent vomiting, lethargy and coma and was often seen after a child had the flu or chickenpox. 

I saw several patients with Reye’s during my training, but have not seen a case since that time. This mother had never even heard of it, but was quite concerned that she had already given her son the aspirin the previous evening. 

This was a great lesson in the necessity of telling every new parent about the use of appropriate medicine to treat a fever. I typically have this discussion at the time of the first vaccines as I tell parents that prior to that time I don’t even want them to have fever reducing medications available. 

Many pediatricians, including me, had been in the habit of using “Tylenol” as the name for acetaminophen, in the same way as you say Kleenex. Since Tylenol was withdrawn from the market last year, we are now correctly saying that you should treat a child’s fever, which is usually due to a viral illness, with acetaminophen, and NEVER aspirin or aspirin containing products!! 

So as you prepare for this winter and lots of viruses with fever go stock up on acetaminophen of ibuprofen and leave the BABY ASPIRIN for ADULTS ONLY! 

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

Daily Dose

The Scoop On Poop

It seems that I get a lot of questions and concerns from parents about their child’s stools (poops). Who would have thought that once we become parents we would be so interested in poop!!

But from the time a baby comes home from the hospital, so begins lengthy discussions about pooping. In the newborn period stools are actually very important. A baby begins pooping shortly after birth and will have those dark, sticky meconium stools. It is important that these stools are passed and this gives both parent and pediatrician the sense that the GI tract is working properly. Soon after a baby begins eating, either breast milk or formula, the stools will quickly “transition” from meconium to lighter more normal appearing poop. Again, the baby’s stools reassure everyone that the baby is getting enough to eat and digesting the milk. For a breast feeding mother, seeing the stools should also be a gauge of breast milk production, as a baby can’t make poop without milk. It is normal for a breast fed baby to poop with almost every feeding. But be assured poop does change as the baby gets older. Once your infant seems to be eating and stooling normally, and gaining weight, it is really not necessary to keep a chart of each wet diaper and stool, as you will soon grown tired of charting, and by then it probably really doesn’t matter. Babies, just like adults, do have different stools. Some babies go more often than others, and there is not a rule as to number of stools your baby needs to have. It is not unusual for a baby to skip a day of pooping, and make it up several times the next day. If your baby is eating well, seems comfortable etc, not to worry about a day (or even two) without poop! Once a baby is out of the newborn period stools may also change in color and consistency. We get many calls about poop color, from yellow, to green, to brown to khaki, poop does come in all colors. Just wait until your baby starts eating baby foods as once again poops will change dramatically depending on what your child is eating. They also tend to stink a lot more than when an infant is only drinking milk. No wonder we parents go from worrying about how many times a baby poops, to discussions about how to get your child potty trained. The fascination with poop seems to diminish as your baby/child gets older and I laugh when our nurses ask parents of toddlers about stool history. As a mother, I could not have told you if my toddler pooped every day or not, I was more concerned that they had a bedtime routine and ate their vegetables (we all have our issues). Rule of thumb for poop is that a stool should be any color except bloody or stark white. If your child has a bloody or chalk white stool, save the diaper to show the doctor. Most stools that a baby/child has should be somewhat mushy, and not uncomfortable to pass. Again, every one will have an occasional harder, firmer stool. But you should not have a child who is always passing hard stools with difficulty. Many times it is easy enough to manipulate stools by changing diet and giving more vegetables, prunes, etc. I guess the best advice is not to perseverate about poop, and just know that this too shall pass. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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