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Daily Dose

SIDS Risks

1.30 to read

Sudden Infant Death Syndrome (SIDS) is every parent’s worst nightmare. From the time a family has their new baby until that child is 1 year of age, SIDS is of a concern. 

Most new parents in 2012 know about the Back to Sleep campaign (BTS), which was recommended by the AAP in 1994. After  the recommendation for newborn’s sleep position was changed from prone (tummy) to supine (back) the incidence of SIDS in the U.S. showed a sharp decline (more than 50%) over the first 10 year period. Unfortunately, the overall SIDS rate has plateaued since that time, and SIDS is still the leading cause of infant mortality in the U.S. 

A study in the April 2012 issue of the journal Pediatrics looked at risk factors for SIDS. Parents need to know that greatest risk for SIDS is during the first 12 months of life (the so named “Critical” development period). There are also both intrinsic and extrinsic risk factors for SIDS as well. All of these factors contribute to the vulnerability for SIDS. 

The peak incidence for SIDS is still between 2-4 months of a baby’s life. (postnatal age). The intrinsic risk factors for SIDS include, male gender, prematurity, genetic differences (now being found called polymorphisms) and a child’s prenatal exposure to cigarettes and/or alcohol. Extrinsic risk factors include tummy or side sleep position, bed sharing, over bundling, soft bedding and a child’s face being covered.  In this study 99% of SIDS infants had at least 1 risk factor, and 57% had at least 2 extrinsic and 1 intrinsic risk factors. Only 5% of the SIDS victims studied had no extrinsic risk. I think this is important for all parents to know! 

So what can parent’s do to lower the risk of SIDS for their baby?  Well, while you cannot change the peak incidence of SIDS between 2-4 months of a baby’s life there is a lot you can do! 

Looking at intrinsic factors:  gender is a 50-50 deal and seeing that I have 3 sons, I don’t know a lot about gender selection, so will not even touch that topic. But, you can prevent prenatal cigarette and alcohol exposure, and every pregnant mother (and father due to second had smoke issues) should eliminate smoking. That sounds easy enough. 

Prematurity may be lessened when a mother is healthy prior to her pregnancy and continues to do as much as possible during her pregnancy to ensure a full term birth. Basically maintaining a healthy diet, getting good prenatal care and listening to your doctor will help to prevent many pre-term births. 

Extrinsic factors are the easiest to change. While prone sleep positioning is a large risk factor for SIDS, there is now evidence that some other risks may appear in conjunction with sleep position.  Putting a baby on their side where they may roll to their tummies may be one issue.  Leaving soft objects or blanket in the crib may be another. Bed sharing is also not advised. 

So, the so-called “triple risk factors” for SIDS may be important information in providing risk reduction strategies for parents and caregivers. Any change that may lessen the risk of SIDS is meaningful and beneficial and will help new parents sleep a bit better as well!  I also did not see any mention of video cameras in the room as a reduction in risk, just saying..... 

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

Daily Dose

Why You Should Not Co-Sleep With Your Infant

There has been another newsworthy article that may support changes in the parental perception of risks associated with co-sleeping with their babies.

The British Medical Journal reported this month that more than half of the SIDS (sudden infant deaths) in 80 infants in southwestern England between 2003 and 2006 occurred while the baby had been co-sleeping with a parent. There have been many studies and developments in previous years relating to the prevention of SIDS, with ongoing research to hopefully one day solve the puzzle surrounding sudden infant death. The public awareness of risk factors for SIDS, which include tummy sleeping, have reduced the incidence of SIDS from one in 800 live births 20 years ago, to one in 2,000 today. Other risk factors for SIDS include maternal smoking, having soft objects in the infant’s crib (such as pillows and blankets), and pre-term birth. Protective factors such as the use of a pacifier and ceiling fans has also recently been encouraged. The “back to sleep” campaign has probably had the greatest effect in reducing SIDS. With this study of the SIDS infants, 54 percent died while co-sleeping, compared with 20 percent among the control groups. The infants who were co-sleeping had been sharing a bed or sofa with a parent or child at the time of their death. There was also an association with alcohol or drug use among the parents who had been co-sleeping with their infants. Once again parents need to be reminded that co-sleeping with infants is dangerous. This study re-iterates previous studies which have also shown infant deaths after co-sleeping with parents. Having a baby in a bassinet with a firm mattress, next to the parental bed, is the preferred recommendation for the first four to eight weeks after birth.  BACK TO SLEEP is always to be remembered. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

When Your Baby Loses Weight

WHen your baby is losing weight, could it be pyloric stenosis?Strep throat is still lingering this time of year and I saw one of my cute patients who told me “my froat is on fire.”  I had just seen this family earlier in the week when they brought in their one month old for a check up.

During their visit, their mom commented that the baby had been vomiting and spitting up a lot more in the last several weeks.  The baby was all bundled up and in his car seat, so I  said, “oh well, let’s weigh him and see how he is doing while we do a throat culture on his brother”. Well, guess what? The baby had lost 1 lb in two weeks!!  So, when I went back in to the exam room, I told the mom that this baby was indeed the sicker of the children and he had just “come along for the ride”.  Thank goodness for small miracles. I then examined this little boy and he looked thin, wasted and a bit dehydrated. But, he was one of those “easy” babies and did not fuss and cry even though he was vomiting so much that he was losing weight. The first thing that popped into my mind was that he might have pyloric stenosis.  Pyloric stenosis is due to the fact that the muscle surrounding the outlet from the stomach to the intestine (the pylorus) is thickened and thereby blocks the movement of food (milk in this case) from the stomach to the intestine. Pyloric stenosis usually occurs in infants between 3 – 6 weeks of age, and is more common in males than females and is seen in about 1/500 newborns.  It also runs in families. The typical baby with pyloric stenosis develops projectile, forceful vomiting that begins at several weeks of age (different than spitting up, and reflux etc), and becomes more frequent over time. Almost, every baby will have an episode or two of projectile vomiting but with pyloric stenosis you notice that the baby vomits within 30 – 60 minutes of a feeding and it happens every time. The milk comes out with such force that it literally may spew a foot or two.  When you see the vomiting it is pretty impressive, such force coming out of such a small body. I must say that there have been several times in my practice when I have tried to feed a baby thinking, “this baby just is a spitter and these parent’s need reassurance”, only to swallow those words as the vomit sprays from one side of the exam room to the other. Time for an ultrasound!! Pediatricians are taught to feel the baby’s abdomen for the hypertrophied pyloric muscle which can feel like an olive, but often it takes an ultrasound or an upper GI to make a definitive diagnosis. Once the diagnosis is made, a pediatric surgeon will be consulted to do a pyloromyotomy (where they will clip the muscle) which is a fairly easy procedure. Many children will require some IV hydration prior to surgery and can often go home within 24 hours after the surgery and have a full recovery. The scar is barely noticeable. So…the moral of the story is thank goodness for bringing both children to the pediatrician.   This little boy has already been seen by the surgeon and will be operated on in the morning. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Your Baby's Toenails

1:15 to read

I have noticed over the years, that babies are born with the weirdest toenails.  I get a lot of phone calls, pictures and questions during those first few visits about these little toenails.  Just like everything else, they are just “immature” and often are totally flimsy or at times appear to be “ingrown” as they grow and push a bit of skin away.

In most cases I tell patients to just leave them alone, even is they are a bit irritated and red on the edge. That is unless the toe is warm to the touch, or tender or has an obvious infection with drainage. Typically when you push on the toe the even though it may appear a bit irritated and bothersome to you, it should not bother your child or seem to cause them pain.  They should NEVER have a fever due to the toenail issue and if your infant has a temperature above 100.4 you do need to call your doctor.

While a baby’s fingernails seem to grow overnight (and are really sharp), newborns toenails grow at a snails pace. It sometimes seems babies don’t really even have all of their toenails until they are over 1 year and in most cases by then you have stopped paying attention as your child is walking, falling and has a lot of bumps and bruises so the toenails are no longer an issue.

If your baby’s toenails look irritated, clean them with a little soap and warm water and leave them alone!

 

Daily Dose

The Perfect Baby Age

Im often asked what is my favorite baby age? I love 4-5 month olds for a number of reasons.I am in love with 4–5 month old babies!!  I have decided that that age is “the perfect baby” and I want to clone them.  I think I would call it a “Chia Baby” and market it as the baby that is the PERFECT companion and only needs to be watered!

For anyone who is reading this and has a newborn, hang in there as this happy baby will be here before you know it and for the rest of us, we know looking back, that this age baby is the one that we long to hold again. I am fortunate that I get to hug, hold and snuggle with babies every day.  I must tell you that not every age baby is my “favorite”.  But give me a 4 month old and I am in heaven. The 4-5 month old baby does all of the following things:  typically sleeps all night, or at least 6-8 hours, smiles all of the time, coos (record those sweet noises as they don’t last), laughs at everything you say, even if it is not funny, and lastly, doesn’t move when put down, doesn’t talk back, and requires only a liquid diet. I mean is this God’s perfect child or what!! I do think this age baby gets photographed the most often, as they are just so happy and cute. These precious pictures are an important photo memory too, as there were many other nights during my parenting that I looked at those precious pictures and longed for that sweet baby (especially when your teen is arguing about a curfew etc). These are the pictures that are adorning my bedside wall that make me smile right before I fall to sleep. While I cherish all of my children’s photos, the 4 month old photos of each of them hold a special place in my heart. When I see a 2 month old infant and the parents are still tired and wondering when/if their baby will sleep and get happier and on a schedule etc, I tell them just hang in there, only 2 more months and you will have the baby you dreamed of taking home from the hospital. The problem is, you have to go through the newborn stage to get to this precious age.  Why do you think all of the babies on TV are so cute, cuddly and happy? It is usually because they are 4–5 month olds “posing” as an infant.  I am sure the Gerber baby on the box is a 4 month old. I want to “check this age baby out” like a library book, and return it in a month, and get another one. Do you think I am on to something?! I am ready to start the “Chia Baby” so let me know if you want one. I am sure they will sell out quickly! What baby age is your favorite? Let me know!

Daily Dose

New Autism Study

1.15 to read

A study just released in the journal JAMA Pediatrics revealed that pregnant women who have their labor “induced or augmented” have an increased risk of delivering a child who will develop autism. 

The retrospective study out of Duke University and the University of Michigan (both very well respected medical schools), showed that the percentage of mothers who had their labor either induced or augmented was higher for children who were later found to have “a designation for autism” within the school systems in North Carolina.  The rates of autism were highest for mother’s who had their labors both induced and augmented.  The study found that in this case there was a 23% greater risk of bearing a child who would later be diagnosed with autism than with those who had neither induction or augmentation.  This association was also higher in boys.

So, what does this all mean?

This does not mean that there should never be an induction or augmentation to a woman’s labor. There will continue to be cases in which it is appropriate to induce a woman’s labor when necessary for the health of the mother or her unborn child. One example being when an induction may be appropriate is when a mother’s blood pressure is becoming problematic and puts her and the baby at risk.

Augmented labor is sometimes necessary when a mother’s membranes have ruptured and the baby needs to be delivered to prevent infection Each case needs to be looked at individually by the doctor and discussed with the patient, as to risk and benefit.  

But, “elective” inductions because “the weekend is approaching”, or the “doctor is leaving town” or because the mother is “tired of being pregnant”, (while previously discouraged) may now be looked at with an eye toward this study.    In many cases “elective” inductions often lead to c-section deliveries as well.  Other studies have shown that c-sections in the United Sates have been on the rise and that there are more complications in the newborn period for babies born via c-section.  The JAMA study did not look at the method of delivery.

This study is interesting and may be yet one small part of the puzzle of autism.  More research to come, so I will keep you posted!

Daily Dose

Late Teether?

1:30 to read

Time for another of those moments in my office when I just turn my head and say “what?”.  The latest...during a 9 month old check up the child’s mother expressed concern that her daughter did not yet have any teeth.  

When I explained to her that this was totally within the range of normal, and in fact, I myself loved babies without hair or teeth in the first year of life!!! Why? They are “low maintenance”.  Don’t have to worry about washing dirty hair or brushing those first teeth...plenty of time to deal with that later on right?

But her concern was real...she was very worried about her daughter’s lack of teeth.  I reassured her that it was not uncommon, there are a lot of babies that will not get a tooth until around 1 year of age and late teething often runs in families.  I wondered if she knew when she or her husband had gotten their first tooth?

Upon further questioning her real concern was that she had been “told”  “if your child is a late teether they will also be a late reader?”  Was this something her friends told her on Facebook or on their Instagram post? I thought I had heard all sorts of concerns about teeth erupting...things like my child is fussy, doesn’t sleep well, drools a lot, chews on everything, has runny poop.....but won’t be able to read?  There is just too much information or rather “mis-information” out there.

So, it was such a relief for me to be able to tell her that I was not aware that there was any relationship between teething and reading. In fact...one of my own children had his first tooth erupt at 6 months (which is about average) and he ending up being dyslexic (which is another blog on successful ways to help children with learning differences).   My middle son did not get a tooth until about 18 months (which did worry my mother, she was ready to put money into savings for baby dentures), and he was reading before kindergarten ( which had nothing to do with us...we were focused on trying to teach his older brother how to read).

See why I love my job....something new everyday.... thankfully some of the concerns have no basis in fact....and I get to reassure parents.  

Your Baby

Fisher-Price Recalls Infant Cradle Swings

1:30

Fisher-Price is recalling three models of their cradle swings: CHM84 Soothing Savanna Cradle 'n Swing, CMR40 Sweet Surroundings Cradle 'n Swing, and CMR43 Sweet Surroundings Butterfly Friends Cradle 'n Swing.

The swings have two different swinging motions - rocking side-to-side, or swinging head-to-toe, and six different swing speeds from low to high. The product number is located on the seat under the pad. 

When the seat peg is not fully engaged the seat can fall unexpectedly, posing a risk of injury to the child.

Fisher-Price has received two reports of a seat peg coming out from the seat, causing the seat to fall. No injuries have been reported.

Consumers should immediately stop using the recalled cradle swing and contact Fisher-Price for revised assembly instructions.

The infant cradle swings were sold at buybuyBaby, Target and other stores nationwide and online at Amazon.com and other websites from November 2015 through March 2016 for about $170.

Consumers can contact Fisher-Price at 800-432-5437 from 9 a.m. to 6 p.m. ET Monday through Friday, or online at www.service.mattel.com and click on Recalls & Safety Alerts for more information. 

Source: http://www.cpsc.gov/en/Recalls/2016/Fisher-Price-Recalls-Infant-Cradle-Swings/#remedy

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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