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Daily Dose

New Test for Your Baby

1.00 to read

If you recently had a baby (or are getting ready to) you may have noticed another “test” being performed on your newborn before they leave the hospital. Earlier this year the American Academy of Pediatrics endorsed the routine use of pulse oximetry to enhance detection of critical congenital heart disease.   

Critical congenital heart defects (CCHD) are serious structural heart defects that are often associated with decreased oxygen levels in infants in the newborn period. These heart defects account for about 17-31% of all congenital heart disease (or about 4,800 babies born each year in the U.S.)  While some of these defects are found on pre-natal ultrasounds, and some may be evident immediately after birth when the pediatrician hears a murmur or the baby has difference in their pulses, others may not present until a baby is several hours - days of age.  

Using pulse oximetry to measure a baby’s oxygen levels before they are discharged is just another method of screening a child, and if there are abnormalities a baby would undergo further evaluation with an echocardiogram and would see a pediatric cardiologist. 

Pulse oximetry is routinely used in all aspects of medicine these days and requires a simple non-invasive device that is placed on a babies finger or toe to measure the level of oxygen in the blood. (looks a little like ET device to light up a finger). It works by comparing the differences in red light, which is absorbed by oxygenated blood, and infrared light, which is absorbed by deoxygenated blood.  

In a large study just published in the journal Lancet (looking at over 230,000 newborns), simple pulse oximetry detected 76% of congenital heart defects, with only a rate of 0.14% false positive results. The risk of false positives was even lower than that when pulse ox was performed when the baby was over 24 hours of age. Pretty impressive! 

It has been estimated that about 280 infants with unrecognized CCHD are discharged from newborn nurseries each year. Congenital heart disease also accounts for somewhere between 3-7 % of infant deaths. With early intervention and surgery the chance of survival from CCHD is greatly improved. 

So, ask your pediatrician or obstetrician if they are doing routine pulse oximetry in your hospital nursery. 

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

Daily Dose

The Danger in BPA Bottles

2.00 to read

I have been getting plenty of question about BPA in baby bottles.I recently received an email from a parent who’s 4 year old son is a patient of mine, and she is pregnant and due with a baby girl in the next month. On top of all of that she is also a pediatrician. At any rate, her question was regarding BPA (bisphenol A) in bottles, and whether I thought she should throw out bottles that she had used with her son in favor of newer bottles.

I will tell you that her son is a perfectly delightful, bright, inquisitive and developmentally normal little boy and he received breast milk and formula from BPA containing bottles. With that information, and knowing that I am thrifty, I thought long and hard and decided that in my opinion I would toss the old bottles in favor of the newer BPA free bottles. The top manufacturers of baby bottles voluntarily stopped using BPA in their bottles at the end of 2008. These bottles include, Dr. Brown, Avent, Playtex, Evenflo and numerous others. It is easy to find BPA free bottles that are well marked and most large chain stores are no longer selling your-baby bottles containing BPA. The cost involved to replace old bottles seems minimal, and the data regarding the safety of BPA to infants and children continues to be released with more ongoing studies underway. There will be more data available in the coming months and years. The Endocrine Society who held their annual meeting last week presented “worrying” evidence about the effects of BPA , including the statement that “endocrine disruptors (which includes BPA) do have effects on male and female development, prostate cancer, thyroid disease, and cardiovascular disease”. There are concerns that infants and children may be particularly susceptible to BPA and possible long term effects on brain development and behavior. So, with these recent studies and more concern regarding the levels of BPA found in baby bottles as well as comparison data of exposure to BPA between breast and bottle fed infants, it seems prudent to me to purchase newer bottles that are BPA free. Cross this issue off of the mother worry list. The cost of new bottles is minimal as compared to future concerns about BPA. That's your daily dose for today. We'll chat tomorrow!

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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

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

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

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. 

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