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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

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

Plane Travel With Your Child

The best way to travel with a baby on a planeI had a question from a parent via our iPhone App about traveling overseas with a 4 month old.  I think it is actually quite an easy time to travel with an infant. 

By this age a baby not only is having a more regular sleep and wake schedule, they are also at the cutest age and are typically fairly easily entertained. They are so sweet and happy that it is also an good time for others to help you.  What person doesn’t want to come to your aid when you have a fussy infant.  You will see as your child gets older, there are less “helpers” for a crying toddler.

I also think that this is a good time to travel as your child has presumably already received their 2 and 4 month immunization series and have mounted and antibody response to some serious illnesses.  With that being said, an infant is not immune to viruses like RSV and flu, so if possible I would schedule travel in early fall, spring and summer and avoid the winter.  I realize that that may not be do-able, but for a vacation I like travelling with babies during “non-sick” season. It is also easier to fly long distances with an infant (lap child) when the flights might be less crowded and you can get a bulk-head seat which has “bassinets” or maybe an extra seat next to you that your infant car seat will fit in for traveling.  It can be expensive to buy a seat for an infant, and holding a baby while you are trying to sleep too just doesn’t work.  Hopefully you will be traveling with two parents to share the duty during an overnight flight. Lastly, I get a lot of questions about needing to have a baby “sucking” for take-off and landing.  I really don’t think that is necessary, especially if your infant is sleeping.  When I am travelling I often see parents awakening a sleeping baby once the pilot announces  “we are preparing to land”.  The baby wakes up, and starts to scream,  and then the parents are convinced that the baby’s ears hurt.  I really think the baby is tired and unhappy due to  being awakened. If they are awake and want to nurse , take a bottle or a pacifier that is fine but remember, “never wake a sleeping baby”.  I realized with my own children,  If I was “lucky” while they were all infants, we could fly  for 3 -4 hours while they slept and never peeped, either  for take-off or landing. On other trips we were not quite as fortunate and had a fussy baby mid flight, with presumably no ear problems. I think the “ear issue” is highly overrated. Their ears are no different than ours! Best time to fly with babies is really between 4 months and 12 months of age.  Once they are walkers it gets a lot harder!!  I would not attempt an overseas flight with a 1–2 year old, but that is me. I would wait till they were 3! That's your daily dose.  We'll chat again tomorrow! Send Dr. Sue your question!

Daily Dose

Prevent SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito…rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

New Baby Advice for the Royals!

1.30 to read

Welcome your Royal Highness Prince (name to come) and congratulations to new parents Prince William and Duchess Kate.  I imagine (like all new parents) you are over the moon in love with your new baby boy!

There really is no way to account for that instant unconditional love that a parent feels for their child.  It truly happens the minute your newborn baby takes their first breath....God opens a parent’s heart and fills it with love!

The first few days after the baby’s birth are adrenalin filled and most of the time is spent just holding and gazing in awe at your new baby.  At the same time, the reality of having a newborn has not yet really settled in.  The days spent in the hospital go by quickly and then suddenly you, (new parents), are “discharged to home” with a few instructions and “good wishes” for your new life together.

Even in a palace (and with plenty of help I assume) the reality of parenthood begins to hit with the knowledge that this baby requires attention 24/7, and many times that means sleepless nights.  For some reason a newborn does not “understand” circadian rhythm, at least for several months, and those night time feedings lead to tired parents.   Even with nurses and nannies, a mother is breast feeding mom needs to get up every 2-4 hours to feed her precious bundle.  

Remember as a new parent you need to sleep when the baby sleeps! This means you may need a nap from 2-4 in the afternoon as that darling baby may be up from 2-4 in the middle of the night, which means you are too! All new parents feel exhausted at times; it is all part of parenting.

Newborns are also quite unpredictable and even though you may have changed, fed and burped your baby, you should know that they sometimes cry and it is hard to figure out what to do next. 

I believe in picking up your newborn baby if they are crying, as sometimes they just need to be held and cuddled (even if they keep on crying).  You can’t spoil an infant. Try swaddling and swaying with the baby as you make a “shushing” sound.  

I also recommend using a pacifier (dummy in England) because a new baby may need some non-nutritive sucking which is yet another means of self calming.

Make sure your baby sleeps on their back (lowers the risk of SIDS) but tummy time is important as well so that their heads don’t get flat. 

If your baby ever falls asleep during tummy time they must be turned over to sleep on their back - even if you are standing there watching them. NO TUMMY SLEEPING!

The first 6-8 weeks are the hardest and it is really just about “survival”. Sleep when you can, make sure you are eating (especially for breast feeding moms) and know that all new parents feel overwhelmed at first.  You really don’t need to worry about “messing up” and in about 8 weeks that precious new baby will give you a beautiful smile, and that makes those memories of long sleepless nights (and some days) fade away fairly quickly.  

Congratulations and good luck!

Daily Dose

FDA Warning for Simply Thick

Does Simply Thick work for reflux? Dr. Sue weighs in. I have been receiving many questions regarding Simply Thick, a thickening agent that is used in formula to aid in swallowing and gastro-esophageal reflux.  The FDA has issued a warning against the products use after a recent investigation.

The product is often used in premature infants as they seem to have more difficulty in coordinating suck and swallow and may aspirate breast milk or formula. It also seems to help with spitting up/reflux. Simply Thick has also been used in full term healthy infants who seem to have a problem with frequent spitting, including inability to gain weight due to their reflux, or even excessive irritability thought to be due to their spitting up and esophageal irritation. There have been recent reports from several medical centers around the United States relating necrotizing enterocolitis and the use of Simply Thick. Necrotizing enterocolitis (NEC) is seen more often in premature infants and causes severe inflammatory changes in the intestine, which may lead bowel perforations requiring surgery to remove the affected intestine, as well as overwhelming infection, and at times death. The FDA is now aware of 15 cases of NEC, including two deaths, involving premies who were being fed breast milk or formula with Simply Thick added. Each of these babies had received the mixture for varying amounts of time. While NEC typically occurs early in the course of a premature baby’s life, some of these cases have even occurred after the baby had been discharged from the hospital and were at home receiving thickened feedings. At this time the link between Simply Thick and babies becoming sick is not known. Bottom line? I would recommend to any patient, stop using Simply Thick immediately, even if your baby was not premature. Why take a risk?  We can go back to thickening feedings with rice cereal if necessary, as it was the standard before Simply Thick was introduced. A little bit messier and time consuming, but rice cereal has been used “forever” with no known problems. That’s your daily dose for today.  We’ll chat again tomorrow.

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Daily Dose

Amber Beads for Teething?

1:30 to read

What is the deal with these amber teething beads?? Suddenly so many of “my” babies are wearing these little necklaces, which are “supposed” to help with teething. I worry they are a choking hazard and I have no clue why they would help a baby get their teeth?

I have previously written about teething and the many thoughts and/or “myths” surrounding babies and tooth eruption. A baby typically gets their first tooth around 6 months of age, and they are usually the lower 2 central incisors.  But, some babies will get teeth a bit earlier and some babies will not get a tooth until 15-18 months of age. The latest age that I have seen for a first tooth to come in was 22 months, and yes that child is totally normal and has all of their teeth!

Teething gets a bad rap for causing any fussiness in an infant once the baby reaches 4 months of age.  Whether the baby is fussy day or night, it is often attributed to teeth ( prior to this age it is “gas”). But, while many babies are drooling and putting their hands in their mouth and chewing on toys, it is probably actually due to development of hand to mouth coordination rather than tooth eruption.  A baby becomes really fixated orally around this age...and this stage last until they are about 24 months...you will see, everything goes straight to their mouth!

I am sure I remember my first child’s “teething” but I am also sure I could not begin to tell you when the 3rd son got his first tooth.  My middle son was the “crankiest baby/toddler” on the planet (he is a gem now) and he did not get a tooth until he was about 15 months old, and promptly knocked out his upper middle tooth around 2!   Don’t remember pain with teeth coming in or out?!?

So, back to the amber beads...I think they are a bit like essential oils...not sure what they really do. I also worry that a baby might get tangles up in the necklace and get asphyxiated...even though they are supposed to break apart. I would NOT take the risk. 

Lastly, you don’t see 5-6 year olds wearing amber beads as they lose their teeth and get their first permanent teeth. You also don’t hear a parent make excuses for a cranky/tired elementary school aged child....”she is just behaving like this because she is teething”, sounds a bit crazy right?

We parents like to have reasons for everything...and I don’t care if you blame teeth for making a baby fussy...I am just not sure there really is a correlation and certainly not for month after month...as a child gets 20 teeth in the first 2-3 years of life.   

Daily Dose

Back to Sleep Ads

1:30 to read

I am concerned that I have been seeing on line ads promoting “new” baby products in which an infant is shown sleeping on their tummy. In other words….not following AAP guidelines that all infants are placed on their back to fall asleep.  Their should be a “law” that you cannot shoot a picture for any product being advertised for an infant in which the baby is shown sleeping in the prone position. Seeing this photo may only confuse parents about correct sleep position for their baby, especially when many of the advertisements are for sleep related products. 

 

The “back to sleep” campaign which started in 1994 has served to reduce the incidence of SIDS by over 50%. I have been fortunate in that I have not had a patient of mine die from SIDS since the recommendations for sleep position were changed. Unfortunately, when looking at data, 30% of SIDS cases report that the baby was found in the prone (tummy) position.  

 

So, if a sleep deprived new parent is surfing the net for products related to infant sleep, and then sees a baby on their tummy, they may think “maybe that is the trick “ to get my baby to sleep, never realizing the huge risk they are taking. Many a parent has come in to my office and said “ I think my baby sleeps better on their tummy”, which immediately puts a look of horror on my face!! “WHAT…I thought we had discussed that your baby must sleep on their back until they are rolling over on their own.” Some of the parents do reply, “my ……told me it was okay.” In this case do not listen to anyone about tummy sleeping!!! Discuss car seats, high chairs, pacifier options or whatever else instead….and choose which works for you. Sleep position is non negotiable. 

 

With that being said, I realize that between 4 - 7 months many babies will roll over during sleep even when placed on their backs. It is a developmental milestone for babies to roll and you cannot put a brick on them. I would “guesstimate” that about 25% of the babies I see will ultimately prefer to sleep on their tummies, but they are all out of their swaddle and then roll over after being put down on their back. I also get many videos showing me a baby in their crib who is in the act of rolling over, with a nervous parent running in turning them back over, only to have the child roll right back to their tummy. You could spend the entire night “flipping the baby” over!

 

Remember, back sleeping only, in a crib with just baby and no bumpers or toys….you will have plenty of time for other stuff in the crib when they are bigger.

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!

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