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Daily Dose

How to Treat a Baby With Thrush

I have received some recent e-mails and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.I have received an email via our iPhone App and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.

The yeast infection usually involves the inside of a baby’s cheeks and lips and occasionally the tongue. It appears as white, almost cottage cheese like patches, and is often visible when a baby is yawning or crying. A baby who only has a white tongue typically does not have thrush, but just a milk coated tongue (see if you can wipe some of the milk off of the tongue, as yeast is usually more adherent). Thrush is fairly common as we all have yeast in our digestive tracts, and babies are often colonized with yeast as they travel through the birth canal. For unknown reasons, in some infants there is an overgrowth of yeast and thrush may develop. Many mothers feel guilty that they “gave their baby” a yeast infection. They worry that thrush has something to do with cleanliness (NOT) and somehow that maternal guiles thing is already beginning. (Dads have already cut to the chase and say, how do you treat it?!) Thrush can happen to any infant. In a breast feeding baby it may also cause a mother to have inflamed and tender nipples, and the baby and mother actually pass the yeast back and forth during feeding (no guilt, as breastfeeding is good!) In most babies thrush does not cause a lot of problems and may go away by itself. But if the infection becomes extensive it may become painful and cause an infant to be uncomfortable when nursing or taking a bottle. If you notice that your baby has white plaques in their mouth or under their lips it may be worth a phone call to your pediatrician. (This is not an emergency and can wait till office hours.) There are several prescription preparations that may be used to treat thrush. The most common being Nystatin, which is a liquid medication that is given to the baby after they have been fed, and is squirted into the mouth on the inside of the cheeks, to treat the yeast infection.  It is also beneficial to treat a nursing mother’s nipples with an anti-fungal agent. I usually tell patients to use the medications for at least seven days or until the white patches have been gone for several days before stopping treatment. It is not uncommon to get thrush again, so don’t fret if your baby develops another infection, at least you know what it is and how to treat it. A yeast infection in the mouth may often lead to a yeast infection in the diaper area (candidal diaper dermatitis), because as you know what goes in the mouth comes out in the poop. But that rash is for another day…. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Feeding Baby Solid Foods

1.15 to read

I still get a lot of questions about starting solid foods in a baby.  The recommendation from the American Academy of Pediatrics is somewhat confusing as the latest recommendation is that mother’s should exclusively breast feed for the first 6 months of life...which means you do not start solid foods until 6 months.  But, the recommendation for formula fed infants is to begin introduction of solid foods between 4-6 months of age.

I recommend that parents routinely wait until their baby (whether breast or bottle fed) is about 5 1/2 months old to begin solid foods.. For a first baby, parents are really anxious to start cereal as they think it will, “make them sleep all night”, or want to try out all of those spoons people gave them as gifts. Those cute grand parents perpetuate the idea that cereal=sleep. Again, a myth, the majority of children are sleeping by 4 months of age whether breast or bottle fed, and no cereal.  Cereal is less calorie dense than milk! If we all drank breast milk or formula all day long we would definitely have weight problems, but for the first 4-6 months of life milk is all the baby needs.  

Whether you start your baby on solid foods at 4 or 6 months, it is important that you do give your child infant cereal. Whether you want to use rice cereal, oatmeal or mixed grains, baby cereal is iron and zinc fortified. The amount of iron and zinc in fruits, vegetables and even baby food meats is actually very low.  Baby cereals also provide vitamin B and other vitamins that are important for a baby’s nutrition. 

So, for parents who want to make their own baby food fruits, vegies and meats I am all for that. Did you know that there is more iron in pureed cooked meats than in infant prepared jar meats? But not all parents cook and some are uncomfortable in pureeing food at home. 

 At the same time, I encourage families to continue baby cereals for as long as they can.  For first children that may be until they are even 15-18 months of age. They don’t “know” that there are other cereals out there.   Mixing in some fruit will make that baby cereal just taste great as well as increase the absorption of iron.  Those toddlers will learn that we have Cheerios and Corn Flakes, and if it is your 2nd, 3 rd or even 4th child, they know about Cocoa Puffs and Fruit Loops by the age of one and are reaching for their siblings Captain Crunch. 

Birth order does play a role in foods introduction!

Daily Dose

Foods You Can Eat When Breast Feeding

1.30 to read

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

baby, breast feeding, Daily Dose, mom
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

Diaper Dermatitis

1:30 to read

Newborn babies have the softest little bottoms and they also have a lot of poop! The combination often leads to a raw red bottom and a diaper rash. A newborn often poops every time they eat and sometimes in between....and you don’t even realize they have pooped again.

Even with the constant diaper changing (would you have believed you would use 8-12 diapers a day) it is very common for that newborn to develop their first diaper rash.  Not only will the skin be red and raw....it may even sometimes be so chapped that it may bleed a bit.  This diaper rash is causes a lot of parental concern and will often result in the new parent’s first of many calls to their pediatrician.

A new baby is supposed to poop a lot, so you can’t change that fact,  but you can try all sorts of things to protect that precious bottom and treat the diaper rash.  After using a diaper wipe ( non perfumed, hypo-allergenic) I sometimes bring out the blow dryer and turn it to cool and dry the baby’s bottom a bit. Then I apply a mixture of a zinc based diaper cream (examples:  Desitin, Dr. Smith’s, Triple Paste cream), which I mix in the palm of my hand with a tiny bit of liquid over the counter antacid.  (I don’t measure it:  just a lot of diaper cream and small amount of antacid so it won’t be runny).  I put a really heavy layer of this on the baby’s bottom.

If after several days rash is still not improving it may have become secondarily infected with yeast so I add a yeast cream (Lotrimin AF, Triple Paste AF) to the concoction. If it has yeast this should do the trick to treat all of the problems.

I will also sometimes alternate using Aquaphor on the bottom with the above diaper cream concoction.  It will take some time for it to totally go away but you are trying to get a barrier between the poop and the skin on the baby’s bottom. She keep something on there after each diaper change.

After a few weeks of constant pooping the number of stools do slow down and bit and that will help heal that new baby’s bottom as well. 

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Daily Dose

Babies Do Not Need Water?

1.00 to read

With the temperatures sizzling across the country, I have started to get the question, “how much water does my baby need to drink during the hotter months?” 

I have to admit, I am still confused as to where this medical myth was started?  Babies, even in warm to hot weather can stay hydrated just by their breast milk or formula intake. An infant does not “need/require” extra water in order to stay hydrated during spring and summer months. Many young moms tell me that the grandparents are asking about more water. 

An infant can get all of the hydration they need from their mom’s breast milk or formula intake as there is free water in the milk.  The best source of hydration for a healthy baby is via their milk intake. This is true for babies who are eating baby foods but are still taking a bottle or getting breast fed as well.  

I know that when the weather warms up we may drink more water with exercise or when out in the heat. But a baby is not an athlete (yet) and they are not really losing more water via sweating etc like our older children do. 

It is okay to offer a baby a bottle of water, but they don’t “need” extra water. In many cases an infant won’t even drink plain water as they prefer their mother’s milk or formula and the water just dribbles out of their mouth as you try to get them to drink it. Don’t think that they “need” 8 12 ounces of extra water a day. Someone started this little rumor. 

The bottom line? If you think you need to change your baby’s fluid intake for the warmer weather you can cross that one off your worry list! But, if you have children who are going outside and playing, or adolescents who are participating in outdoor sports, it will soon be time to start thinking about keeping them hydrated during the heat.  More on hydrating your active kids and athletes to come.  Stay tuned! 

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

Daily Dose

Babies Do Not Need Water?

1.00 to read

With the temperatures sizzling across the country, I have started to get the question, “how much water does my baby need to drink during the hotter months?” 

I have to admit, I am still confused as to where this medical myth was started?  Babies, even in warm to hot weather can stay hydrated just by their breast milk or formula intake. An infant does not “need/require” extra water in order to stay hydrated during spring and summer months. Many young moms tell me that the grandparents are asking about more water. 

An infant can get all of the hydration they need from their mom’s breast milk or formula intake as there is free water in the milk.  The best source of hydration for a healthy baby is via their milk intake. This is true for babies who are eating baby foods but are still taking a bottle or getting breast fed as well.  

I know that when the weather warms up we may drink more water with exercise or when out in the heat. But a baby is not an athlete (yet) and they are not really losing more water via sweating etc like our older children do. 

It is okay to offer a baby a bottle of water, but they don’t “need” extra water. In many cases an infant won’t even drink plain water as they prefer their mother’s milk or formula and the water just dribbles out of their mouth as you try to get them to drink it. Don’t think that they “need” 8 12 ounces of extra water a day. Someone started this little rumor. 

The bottom line? If you think you need to change your baby’s fluid intake for the warmer weather you can cross that one off your worry list! But, if you have children who are going outside and playing, or adolescents who are participating in outdoor sports, it will soon be time to start thinking about keeping them hydrated during the heat.  More on hydrating your active kids and athletes to come.  Stay tuned! 

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

Daily Dose

Are Parents Too Connected?

1.30

Has your spouse, babysitter or other child care provider ever called you to come home “because the baby is crying”?  It seems that technology, which is readily at our finger tips 24/7, has created yet another dilemma - what to do if a baby is crying? 

Pre-cell phone days, there really was not much to do if you the parent left home and your baby/child started crying.  Outside of calling the restaurant, store, movie theater (directly), and asking them to page a parent, most of us just muddled through a crying child.  I also think that in most cases, said child eventually stopped crying (unless there was an obvious reason that could be “fixed”) and by the time you the parent returned home, all was typically well.  

But now, with a cell phone in every hand, it only takes one call to summon the parent of a crying child.  I think this is a good news/bad news dilemma.  The good news is: parents may feel more comfortable leaving their child with a babysitter, knowing that they may be reached in the event of an emergency.  The bad news is:  is a baby or child who is only crying, typically an emergency?  Depends on your definition. 

The reason I bring this up is that I often hear young parents, and especially mothers, tell me that during the first several months of their infant’s life, they cannot leave the house for more than minutes, before being called home....because the baby is crying.  Some of these mothers are really “stressed out and exhausted” and need a bit of a get-away to “re-boot”. I am not talking about a trip to the day spa. I am simply talking about an hour or 2 to go to the store or meet a friend for lunch or just sit alone in the park and read a book.  Just a bit of quiet after being home with a baby day in and day out for the first 4 weeks of their newborn’s life.  If you have been there you understand. 

But, now that they have a cell phone, there is CONSTANT communication.  The minute the baby cries, the cell phone rings....”the baby is CRYING, come home.”  My husband would tell you that his best parenting started the first time I left him alone with our first son and I actually went away for the weekend.  (I believe the baby was 6 or 7 weeks old and off I went breast pump in hand to a reunion.)  No cell phones then, and guess what, he did a great job!!!!  He told me how after the first 24 hours he figured out that he really didn’t have to have the baby in the bathroom with him in order to take a shower. He later told me that the first shower he took, not only was our son in the room in his “bouncy” chair, but he left the shower door open as the door got steamy and he couldn’t see the baby!! How cute is that. 

Technology, as wonderful as it is, may also enable us to “cop out” when things get a bit difficult.  That goes for parenting as well. 

Turnoff your phone off sometime and let the “other parent” or babysitter handle it for awhile. Being disconnected is NOT always a bad thing!

Daily Dose

Baby's 1st Tooth

Dr. Sue answers an email whwn will my baby cur her first tooth?I received an iPhone App email from Lilli who was concerned that her son was almost one year of age, and had not cut a tooth yet.  I remember having the same feeling when our middle son had not cut a tooth at 15 months of age and my mother kept reminding me of “toothless” children.

Of course, our first son cut his first tooth at about 7 months of age, so despite trying NOT to compare them, of course I was.  Upon reviewing the literature I was thrilled to find out that there is a wide variation in dental eruption among babies and very few cases of children who never developed teeth! The first teeth to erupt are typically the lower central (middle) incisors, usually somewhere around 6 months of age, although just like many things in child development there may be those who have teeth earlier and those who will not cut a tooth until after their first birthday.  Girls typically cut their teeth before boys (just like pubertal development). Teeth usually erupt in pairs with the two lower central incisors being the first to erupt, then followed by the upper two central incisors and then the upper lateral incisors. Most children will have their full set of “baby teeth” by the age of three years. Personally, I would not worry about it, and not having teeth should not prevent your child from eating finger foods either.  It is wonderful to have a few extra months of that sweet baby breath (teeth make for bad breath) and you don’t have to worry about tooth brushing. It is still a good idea to give your child a toothbrush that they can begin experimenting with if only to brush the gums! That's your daily dose.  We'll chat again tomorrow

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