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Daily Dose

Sleep & Your Baby

1.30 to read

How many books, manuals and even blogs are there out there on “getting your baby to sleep”.  There are even “coaches” for new parents who will help them “get their baby to sleep through the night.” 

The longer I practice the more I realize that every baby is different and it really doesn’t matter which book/blog you read....it takes some time to get a newborn to sleep through the night.  If you told expectant parents that it is “tough” in the beginning and sleepless nights are “normal”, most of us would have thought, “not me and my baby”.  Like many things you have to live it to learn.

Getting a baby to sleep through the night is not really an intellectual endeavor, which parenting is later in life. You can read books, talk to a coach, buy all sorts of gizmos and “sleep equipment”, but it also just takes time.  Some of you may just stop reading right now and go, NOT MY BABY!

A newborn baby does not enter this world knowing about circadian rhythms, or lengthy periods of sleep without eating.  A baby really only wants to eat and sleep.... and in the beginning, on their own schedule! Learning to sleep is like a lab in college, lots of hours in class with little credit.  

Of course I believe in things like, “Try to put your baby down to sleep when they are tired but not asleep and they will learn to quiet themselves”. “Try to keep your baby up a bit after their feeding during the day, rather than letting them go right back to sleep”. “Try to only feed your baby every 2-3 hours during the day which will help get them on a schedule”. There are a million other suggestions as well. The only one that I know I always adhere to is “Your new baby must only sleep on their back”, other than that, the first few weeks and even months learning to sleep is just practice, practice, practice. 

Yes, some babies are better sleepers than others, just like you will see some children are better readers while other are better athletes or artists. Some parents will have a baby that is sleeping 6-8 hours by 6-8 weeks and other parents will have to keep “practicing” with their baby for 3-4 months, everyone is different. 

But, do not start off feeling like a failure as a parent if your baby is not sleeping while your friend or co-worker’s child is. Parenting is not a competition and realizing this early on will make some parental struggles a bit easier to handle over the next 21 years. Your baby will learn to sleep...but like so many things, it takes time and practice. 

If I had the potion...trust me I would be selling it by now, there is not a new parent out there that would not buy it....just don’t think the FDA will approve the patent.

Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

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

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

Daily Dose

Your Baby's Umbilical Cord

1.15 to read

I get a lot of phone calls several days after parents head home with their newborn regarding their baby’s umbilical cord.  The umbilical cord really is the lifeline for the baby for 9 months, but once the baby is delivered, and the cord is clamped, it becomes a nuisance and “grosses” many parents out.  So often parents don’t even want to touch the cord and one of my patients told me....”why can’t it just dry up and fall off immediately?”. My only answer to that is, “God did not make it that way?”.

So, in a nutshell the umbilical cord is made up of 3 blood vessels, actually 2 arteries and one vein.  When the cord is cut and clamped the vessels begin to clot and eventually the cord detaches, typically in 7-14 days and then falls off.  

In the interim the cord is developing a scab so it may “ooze” a bit and there may even be dried blood on the baby’s diaper or around the edge of the cord.  A tiny bit of blood is to be expected, and parents don’t need to be worried that the baby is bleeding!!!  I like to explain that it is the first time as a parent that you might need to clean off a little blood, the same way that you will again when this sweet newborn becomes a toddler and falls down and skins their knee.

On occasion the hospital forgets to take the cord clamp off before the baby is discharged and the family comes in with the baby for their first visit with the cord clamp still on.  Poor parents have no idea that this is typically removed before discharge...somewhat like leaving the store with the magnetic tag on the outfit....just no alarm to let you know it is still there. In that case they are amazed when we pop off that yellow or blue plastic attached to their baby!

Lastly, the newborn baby can have some time on their tummy, if they are awake, even with the remnant of the cord still on. It will not hurt the baby at all and early tummy time is important...just NOT when a baby is sleeping!

I have to admit that I opened the baby book 30 years later and that dried umbilical stump was in there..Yes, I too was a first time mother.....don’t save it!

Daily Dose

Kidney Reflux in Children

1.30 to read

Have you ever heard of vesico-ureteral reflux (VUR)? This is a problem that I have be seeing lately which occurs in the urinary tract.

In the normal scenario urine is produced in the kidneys and then travels through the ureters (which are like a straw) from the kidneys to the bladder. The urine is supposed to only proceed in one direction, and only down and into the bladder and then out the urethra when you urinate. But in some children, the kidneys are fine and doing their work of making urine but the ureters (the straws) allow the urine to go in a retrograde fashion (both up and down, or back and forth or whatever terminology you want) from bladder to kidney,  and this is termed vesico ureteral reflux (not to be confused with gastro-esophageal reflux).

Vesico-ureteral reflux is often diagnosed in infants and young children who present with prolonged fever which may be an indicator of a urinary tract infection.

When a child under the age of 2 has persistent fever (usually over 72 hours), without any other focus of infection, a urinalysis and culture is often performed to rule out a urinary tract infection. It is also more prevalent to see this occur in little girls rather than in boys.

If a urinary tract infection is confirmed it was previously the “standard of care” to perform a VCUG (voiding cystourethrogram) which is a radiographic study where dye is injected via a catheter into the bladder to look for retrograde flow of urine (the back and forth, up and down) to rule out VUR. In the past several months there have been changes in the management of VUR especially as it relates to first urinary tract infections.

The new recommendations state that, “children of any age, regardless of gender, with a first febrile UTI should undergo a renal/bladder ultrasound, rather than a VCUG.”  In other words, no more radiation and dye (not to mention the associated trauma) that went along with the voiding study.

Years ago a VCUG was performed without any sedation, but over time it became standard to sedate the children before this procedure, and with that there were other issues about safety etc.  It was also recommended that a VCUG be done yearly to watch the regression or progression of reflux. That yearly VCUG just sent some kids and parents over the edge (including me!).

The concern with VUR is that over the years this retrograde flow of urine could cause damage and scarring to the kidneys. This scarring could cause numerous problems (high blood pressure, kidney disease etc) for a child later in their life. The problem was figuring out who might go on to scar and need surgery etc.   The new guidelines recommend using a different type of scan in management of reflux.

If your child has a urinary tract infection in association with a fever you might want to discuss whether they should see a pediatric urologist, and/or have an ultrasound. But if someone mentions a VCUG consider the newest guidelines. And, if you have a child with VUR, talk to your doctor about the changes in management and don’t stress about a VCUG this year!

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

Daily Dose

Teething Pain & Recalled OTC Products

Do OTC teething products really work? Which ones have been recalled? WHat parents need to know.I am getting a lot of questions from patients related to teething, pain, and the recall of over the counter teething products that contain benzocaine.

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. 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. 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 teething in the first place. 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 and can throw out when used), or rub their gums with a cold washcloth if you think your child has discomfort. 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 the FDA even agrees! What do you think? I look forward to your feedback.

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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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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