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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

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

Daily Dose

Crooked & Toes Fingers?

1:15 to read

 I get a lot of questions from parents during their child’s first months of life about fingers. ( and sometimes toes as well).  Because, if you look closely you may see that your child’s finger  seems to be a bit “crooked”.

The term used for bending or curvature of the finger is clinodactyly, which describes a bending  or curvature of the finger in the plain of the palm.  It is a fairly common and occurs in about 10% of people. Upon close inspection i actually think that I may have a bit of it myself . It is more common in males and typically affects the small “pinky” finger.  It is unusual to have it on both hands, but possible ( Would be a great show and tell!)

It seems that clinodactyly run in families and may be inherited. When parents are concerned about a bit of bending of the 5th finger, I usually say, “ go to your family reunion and have everyone hold out their hands”. You may find that your favorite aunt or uncle has the same thing!

The very mild curving of the finger that often concerns parents ( especially in the first few months when “we” examine everything), rarely causes any problems. There is no associated pain and you will see that your child uses their fingers without a problem. Often by the time your child is older you have forgotten about it altogether, and are now more concerned that they don’t break those fingers getting it slammed in a door.

For severe curvature of the finger make sure you talk to your doctor and watch the growth of the finger as abnormalities of the growth plate may contribute to clinodactyly. In severe cases where curvature progresses and interferes with hand function a hand surgeon may be consulted to correct the deformity.   

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

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

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.   

Your Baby

Britax Recalls Car Seat Chest Clips Due to Infant Choking Hazard

1:30

Faulty chest clips on more than 100 models of Britax Care Safety car seats are being voluntarily recalled because the clips could break off and create a choking hazard for infants.

The company says that no injuries have been reported, but it has received complaints of chest clips breaking.

The recall will affect more than 200,000 car seats. However, Britax stresses that the car seats are still safe to use until a replacement kit is obtained. 

The chest clip is on the Britax B-Safe 35, B-Safe 35 Elite, and BOB B-Safe 35 infant seats.

The products were manufactured between Nov. 1, 2015, and May 31, 2017. To see the model numbers that are included in the voluntary recall, or to check the serial number of your seat, visit the company’s website set up for this recall at www.bsafe35clip.com. You can find the serial numbers on the "Date of Manufacture" label on the lower frame of the seat.

Britax is offering to replace the chest clip with a free kit that contains a new clip made from a different material. The kit comes with step-by-step instructions for replacement. Consumers are advised to routinely check their current chest clip until a replacement arrives.

Story sources: Alexandria McIntire, http://www.webmd.com/children/news/20170623/recall-britax-car-seat-chest-clip

Ashlee Kieler, https://consumerist.com/2017/06/21/britax-recalls-207000-carseats-over-chest-clips-that-can-break/

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.

 

 

 

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