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Your Baby

Should Newborns Sleep in Yours or Their Own Room?

2:00

It’s an age-old question, should your newborn sleep in his or her own bed in the parents’ bedroom for a while or start their sleeping habits in their own room?

A new study suggests infants benefit from sleeping in their own room, but the American Academy of Pediatrics (AAP) says the dangers may offset the benefit.

Recent research from a hospital in Philadelphia says babies go to sleep earlier, take less time to fall asleep, get more total sleep over the course of 24 hours, and spend more time asleep at night when they don’t share a bedroom with their parents. Parents also report that they get more rest as well.

“There are a number of possible reasons that babies sleep better in their own room,” said lead study author Jodi Mindell, associate director of the Sleep Center at the Children’s Hospital of Philadelphia. 

“One main reason is that they are more likely to self-soothe to sleep,” Mindell said by email.

During the study, researchers found that parents who put babies to sleep in a separate room were less likely to feed infants to help them fall asleep at bedtime or when they awoke during the night.

When babies had their own rooms, parents also perceived bedtime to be less difficult.

The study focused on infants 6 to 12 months old. Researchers examined data from a questionnaire completed by parents of 6,236 infants in the U.S. and 3,798 babies in an international sample from Australia, Brazil, Canada, Great Britain and New Zealand. All participants were users of a publicly available smartphone app for baby sleep. The researchers noted that because of the use of the smartphone app, results might not be the same for a larger population of households.

The AAP recommends that newborns sleep in their own bed in their parents’ bedroom till the infant is at least 6 months of age to minimize the risk of sleep-related death. Ideally, babies should stay in their parents’ rooms at night for a full year, AAP advised 

The reason for the AAP recommendation is because babies sleeping in the same room as parents, but not the same bed, may have a lower risk of sudden infant death syndrome (SIDS).

The safest spot for infant sleep is on a firm surface such as a crib or bassinet without any soft bedding, bumpers or pillows, the guidelines stressed. 

“Pediatric providers have been struggling with what to tell parents since the release of the AAP recommendations,” Mindell said. “Once a baby is past the risk of SIDS, by 6 months of age, parents need to decide what works best for them and their family, which enables everyone in the family to get the sleep they need.”

SIDS deaths occur most often from birth to six months but can also happen in older babies that were the focus on the study, said Dr. Lori Feldman-Winter, a coauthor of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey. 

“If the only goal is to increase sleep, then the results may be compelling,” Feldman-Winter said in an email to Reuters Health. “However, since we don’t know the causes of SIDS and evidence supports room sharing as a method to decrease SIDS, giving up some sleep may be worth it.”

The study was published online in the journal Sleep Medicine.

Story source: https://www.reuters.com/article/us-sleep-infants-location/parents-find-older-babies-sleep-better-in-their-own-room-idUSKCN1BC5QI

 

Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

Daily Dose

Research Supports "Back to Sleep"

2.00 to read

This month’s issue of The Archives of Pediatrics and Adolescent Medicine has an interesting article on sleep position in infants. I wa going through several journals (piled high on my desk) and found an intersting article in The Archives of Pediatrics and Adolescent Medicine about sleep position in infants. You may recall, I have discussed previously, the safest position for an infant’s sleep is on their backs.

Placing a baby “back to sleep” became a routine recommendation beginning in 1994 after evidence showed that babies who slept on their backs had a much lower risk for sudden infant death syndrome. SIDS is the leading cause of death for children under the age of one year. In this study out of Yale University, researchers found that the number of babies who were put on their backs to sleep increased from 25 percent to 70 percent since the recommendations changed in 1994. But in this study, the number of caregivers heading this advice has not changed since 2001. The researchers looked at how different caregivers positioned their babies for sleep to see if there were any factors affecting a caregiver’s choice of an infant’s sleeping position. Interestingly, one of the factors was whether or not the caregiver was ever told to place the baby on their back to sleep. One-third of those surveyed said that their doctor did recommend that their child sleep on their backs, but many did not receive any recommendation. How is a parent to know how to position their baby for sleep if their doctor does not discuss sleep positioning? Another factor, which influenced a caregiver’s choice of infant sleep position, was comfort. Again, more than one-third of those surveyed felt like the baby was more comfortable on their tummy. Another 10 percent were worried that an infant might choke if they were lying on their back. It is imperative that physicians discuss infant sleep position with parents and the need to reiterate this is evident in my own practice. Just today I saw a two-month-old baby with her mother and babysitter. The mother and I had discussed “back to sleep” (this is her third child), but the babysitter happened to mention that she “puts the baby on her tummy to sleep if she is in the room watching her”. It doesn’t matter if you are in the room, sleeping next to the baby, or watching on one of those new video monitors. Placing babies on their backs to sleep remains the most effective means to reduce the risk of SIDS, and there are few exceptions. The risk of a baby sleeping on their tummy “because they seem more comfortable” is just too great. The evidence is compelling. So…. until your child is old enough to role all over their crib, put them “back to sleep” and know that you are doing the very best thing to protect your baby. Tummy time is only for awake time. Don’t cheat! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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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

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

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

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

Daily Dose

Your Baby's 1st Cold

1.30 to read

Has your baby had their first cold yet?  It is just the beginning of cold season and there are many more colds ahead during the next 5 months of upper respiratory season.  

I remember as a mom/pediatrician that the first cold a baby has is the hardest. Like so many things in life, once you have some on the job training, you can look back and realize that you can manage many issues, including the common cold. 

A baby with a cold looks like we all do, they have red rimmed eyes, a runny nose, a cough and they act like they don’t feel well. A baby may also run a bit of a fever on the first day of a cold, so remember, “fever is your friend” (another post). 

The best way to treat a cold is the same for baby/child/adult, you just have to treat your symptoms. Unfortunately, there is still not a cure for the common cold, and when there is one day, the cure will win the Nobel Prize in Medicine! 

For an infant, one of the biggest problems is the congestion and runny nose and the fact that cannot yet blow (or even pick) their own nose.  But, at the same time they are snotty and have a hard time breast feeding or taking a bottle and worst of all they don’t sleep well. Us older parents were used to using the bulb syringe, but now the parents of babies are swearing by the “Nosefrida”. 

I must admit I was totally skeptical and thought they were inserting this contraption way into their baby’s nostril!  We doctors used to use a “deLee” catheter somewhat like this in the delivery room to clear a baby’s nose but this little device is placed at the edge of the nostril, rather than into the nose itself.  

A small tube extends from this and the parent then uses their mouth to suck on the tube (like a straw) and the mucous is sucked into this little tube with a filter to keep the mucous from going up the tube. (no buggies in the mouth). Does that all make sense?  You can use just the right amount of suction with your mouth and then you can see the mucous come out of the nose and throw away the tube and filter. 

 I remember that gross bulb syringe I used long ago had disgusting stuff inside of it once I cut it open to investigate, so this little “Nosefrida” seems to make sense. It also doesn’t upset the baby like putting a bulb syringe inside the nostril. 

Suctioning out the nose may make it easier for your baby to take their bottle and to sleep! This may mean you get a bit more sleep yourself, which is always at the top of the list for new parents. Regardless, remember it will take 7 - 10 days for your baby to get over their cold. 

Lastly, wash your hands and cross your fingers that you don’t catch it!

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