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Daily Dose

The Reality of Bringing Home A Newborn

What it's really like to bring home your newborn baby.I am so blessed to have the opportunity to continue to see newborn babies in my practice.  Now that I have “been around for awhile” I am also getting a chance to see some 2nd generation babies, in other words, newborns whose parents were my patients!!  It is just the best!!!

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You’ve heard me say, “your baby doesn’t come with a manual” and despite reading a lot about a new baby, many new parents are feeling totally “overwhelmed” with in just a few days after the birth of their child. Every new parent needs to know that feeling overwhelmed is a normal and realistic emotion in the first weeks after an infant is born.   I just had a discussion about this very topic with a cute couple who had their baby last week. The father had been patient of mine and I have been excitedly awaiting the baby’s birth.  They welcomed a new little boy to their family last week and I saw them several days later. They were beaming with pride and joy, but expressed to me that despite all of their preparation they still felt “unprepared”.  I must say, I don’t think there is a book, blog, CD, manual or anything else that can totally prepare you to be a parent. It is “on the job training” and just like any job, the first days to weeks are sometimes some of the most challenging. I have decided that early parenting is really more of a physical job than an intellectual one.  For the first month or so, certainly the first 2 weeks, the main goal for a parent is to sleep whenever you can. Forget the books about having a “schedule” for a newborn. Intellectually that makes a great deal of sense, but practically it does not. I do not mean to say that you should not “try” to feed your baby every 2-3 hours and “try” to get them to stay awake for a bit after a feeding, and “try” to put them down when they are awake. But, if you go into those early weeks with expectations that you can make it all happen like clockwork, then you are going to set yourself up for failure and feeling inadequate.  I really believe that those first weeks are about SURVIVAL, and that means you sleep when you can (even if that is the middle of the day), as you never know what time of day your baby will decide that they want to have some awake time. Often that awake time is not at all related to a parent’s normal circadian rhythm. If you think too much about making it happen on your terms, again, you should have spent that time sleeping when you could have. The same thing goes for feeding a newborn.  They are human after all, and they too will eat differently from one meal to another. That does not mean there is a problem, every feeding is not going to be the same.  You would love for them to eat their “biggest” meal right before you put them to bed at night, but a newborn may decide that they prefer to eat in the morning or in the middle of the night, again, you have to go “with the flow”. Stressing over the fact that your baby only fed for 10 minutes on one breast and then 5 rather than 10 on the other, or that they only took 2 ounces of formula rather than 4 will only drive you crazy and contribute to sleeplessness if you try to analyze it.  Again, intellect doesn’t work at this stage of the game.  In the beginning, every day is different; some are better than others. Just be assured you have many more days and years to “perfect” this parenting thing. But what I do know is that for most of us, parenting while extremely challenging at times (like the first 2 -4 weeks), is the most rewarding job you will ever have.  So, jump in with few expectations except to know that your baby is changing every day.  The rhythm will come, the days and nights will straighten themselves out and you will eat and sleep again on a regular schedule. It just takes time! That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue!

Parenting

Breast Feeding

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 

 

Daily Dose

Jaundice in Newborns

1:30 to read

It is not at all uncommon for a healthy newborn to develop jaundice in the first several days of life. Bilirubin is produced when red blood cells are broken down. It is a yellow pigment that we all metabolize in the liver and then it is excreted in urine and stools. In an newborn, the body produces almost 2-3 times the bilirubin that an adult does. Because newborns are also “immature” their liver cannot keep up with the bilirubin production and therefore bilirubin levels rise. In some cases the bilirubin is high enough to cause a yellowing of the skin (jaundice), and this is termed physiologic jaundice of the newborn. 

 

Your infant will have their bilirubin level checked while they are in the hospital and your pediatrician will follow any bilirubin levels that seem to be rising. In most hospitals the bilirubin is tested transcutaneously (through the skin), and you may never know that you baby has been tested. If bilirubin levels seem to be high, a blood test will be performed to more accurately assess the bilirubin level. If bilirubin levels continue to rise a baby may then be put under phototherapy (special blue lights that breaks down bilirubin in the skin and help it to be eliminated). Phototherapy prevents extremely high levels of bilirubin which may get into the brain and could be toxic to the baby and cause brain damage.

 

When a baby is put under phototherapy they may be in a basinette or wrapped in a “bili-blanket”  and they will wear sunglasses to prevent any damage to their eyes from light. They are usually naked or only in a diaper so that as much skin is exposed as possible. In most cases the bilirubin levels have peaked by day of life 3 or 4 and the baby will no longer need phototherapy. While the baby is under the “bili-lights” they will continue to have blood tests (from their heels) to follow the bilirubin levels.

 

As babies are now being discharged in 24-48 hours after delivery some babies will develop jaundice after they have already gone home…so you your doctor will plan on seeing you 1 to 2 days after your are discharged. But, should you notice that your baby seems to be getting more jaundiced you should call you doctor and be seen sooner.  

 

Just this week I saw a baby who continued to become more jaundiced after he went home. At times I see this when a mother is breast feeding and her milk has not yet “come in”.  If a baby is not getting a lot of milk then they cannot poop and pee out bilirubin…somethings just take time to get going with feeding, peeing, pooping and liver maturation. So…this baby boy was started o home phototherapy. Rather than re-admitting him to the hospital, a pediatric home health care company sent out a nurse with a bill blanket who instructed the parents on the use of it. The baby was then able to feed at home every 2-3 hours, and the bili-blanket was used throughout the day and night. The parents lived so close to the office that they would bring the baby in for bilirubin tests, while in other cases the nurse will go to the home to do the testing.  Home phototherapy in an otherwise healthy infant does not disrupt the new family and really helps the mother establish her breast feeding and lets “everyone” sleep in their own beds!

 

This baby only required phototherapy for 24 hours…in some babies it may be longer. Once the bilirubin was back in a “safe range” the lights were discontinued and he will continue to process the bilirubin on his own. His little yellow face and eyes will be the last evidence of his newborn jaundice and “one for the baby books” as it should never be a problem again.

 

Daily Dose

Head Flattening on the Rise!

1.15 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Your Baby

Recall: Oball Baby Rattles Due to Choking Hazard

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About 680,000 Kids ll Inc. Oball baby rattles have been recalled due to choking hazards.

This recall involves Oball Rattles in pink, blue, green and orange with model number 81031 printed on the inner surface of one of the plastic discs and on the packaging. The balls have 28 finger holes and measure four inches in diameter.

Embedded in the rattles are a clear plastic disc with all orange beads and two clear plastic discs with beads of varying colors on the perimeter.

Only rattles with date codes T0486, T1456, T2316, T2856 and T3065 located on a small triangle on the inner surface of the rattle are included in the recall.

The first three numbers represent the day of the year and the last digit represents the year of production.      

The firm has received 42 reports of the plastic disc breaking releasing small beads including two reports of beads found in children’s mouths and three reports of gagging.

Consumers should immediately take these recalled rattles away from young children and contact the firm to receive a full refund.

The rattles were sold at Target, Walgreens, Walmart and other retailers nationwide and online at Amazon.com, Babyhaven.com, Diapers.com, ToysRUs.com, Walgreens.com and other online retailers from January 2016 through February 2017 for between $5 and $7.  

Consumers can contact Kids II toll-free at 877-243-7314 from 8 a.m. to 5 p.m.  ET Monday through Friday or visit www.kidsii.com and click on “Recalls” at the bottom of the page for more information.

Story source: https://www.cpsc.gov/Recalls/2017/Kids-II-Recalls-Oball-Rattles

Daily Dose

Are Parents Too Connected?

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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

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

New Autism Study

1.15 to read

A study just released in the journal JAMA Pediatrics revealed that pregnant women who have their labor “induced or augmented” have an increased risk of delivering a child who will develop autism. 

The retrospective study out of Duke University and the University of Michigan (both very well respected medical schools), showed that the percentage of mothers who had their labor either induced or augmented was higher for children who were later found to have “a designation for autism” within the school systems in North Carolina.  The rates of autism were highest for mother’s who had their labors both induced and augmented.  The study found that in this case there was a 23% greater risk of bearing a child who would later be diagnosed with autism than with those who had neither induction or augmentation.  This association was also higher in boys.

So, what does this all mean?

This does not mean that there should never be an induction or augmentation to a woman’s labor. There will continue to be cases in which it is appropriate to induce a woman’s labor when necessary for the health of the mother or her unborn child. One example being when an induction may be appropriate is when a mother’s blood pressure is becoming problematic and puts her and the baby at risk.

Augmented labor is sometimes necessary when a mother’s membranes have ruptured and the baby needs to be delivered to prevent infection Each case needs to be looked at individually by the doctor and discussed with the patient, as to risk and benefit.  

But, “elective” inductions because “the weekend is approaching”, or the “doctor is leaving town” or because the mother is “tired of being pregnant”, (while previously discouraged) may now be looked at with an eye toward this study.    In many cases “elective” inductions often lead to c-section deliveries as well.  Other studies have shown that c-sections in the United Sates have been on the rise and that there are more complications in the newborn period for babies born via c-section.  The JAMA study did not look at the method of delivery.

This study is interesting and may be yet one small part of the puzzle of autism.  More research to come, so I will keep you posted!

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!

 

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