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Daily Dose

When Your Baby Loses Weight

WHen your baby is losing weight, could it be pyloric stenosis?Strep throat is still lingering this time of year and I saw one of my cute patients who told me “my froat is on fire.”  I had just seen this family earlier in the week when they brought in their one month old for a check up.

During their visit, their mom commented that the baby had been vomiting and spitting up a lot more in the last several weeks.  The baby was all bundled up and in his car seat, so I  said, “oh well, let’s weigh him and see how he is doing while we do a throat culture on his brother”. Well, guess what? The baby had lost 1 lb in two weeks!!  So, when I went back in to the exam room, I told the mom that this baby was indeed the sicker of the children and he had just “come along for the ride”.  Thank goodness for small miracles. I then examined this little boy and he looked thin, wasted and a bit dehydrated. But, he was one of those “easy” babies and did not fuss and cry even though he was vomiting so much that he was losing weight. The first thing that popped into my mind was that he might have pyloric stenosis.  Pyloric stenosis is due to the fact that the muscle surrounding the outlet from the stomach to the intestine (the pylorus) is thickened and thereby blocks the movement of food (milk in this case) from the stomach to the intestine. Pyloric stenosis usually occurs in infants between 3 – 6 weeks of age, and is more common in males than females and is seen in about 1/500 newborns.  It also runs in families. The typical baby with pyloric stenosis develops projectile, forceful vomiting that begins at several weeks of age (different than spitting up, and reflux etc), and becomes more frequent over time. Almost, every baby will have an episode or two of projectile vomiting but with pyloric stenosis you notice that the baby vomits within 30 – 60 minutes of a feeding and it happens every time. The milk comes out with such force that it literally may spew a foot or two.  When you see the vomiting it is pretty impressive, such force coming out of such a small body. I must say that there have been several times in my practice when I have tried to feed a baby thinking, “this baby just is a spitter and these parent’s need reassurance”, only to swallow those words as the vomit sprays from one side of the exam room to the other. Time for an ultrasound!! Pediatricians are taught to feel the baby’s abdomen for the hypertrophied pyloric muscle which can feel like an olive, but often it takes an ultrasound or an upper GI to make a definitive diagnosis. Once the diagnosis is made, a pediatric surgeon will be consulted to do a pyloromyotomy (where they will clip the muscle) which is a fairly easy procedure. Many children will require some IV hydration prior to surgery and can often go home within 24 hours after the surgery and have a full recovery. The scar is barely noticeable. So…the moral of the story is thank goodness for bringing both children to the pediatrician.   This little boy has already been seen by the surgeon and will be operated on in the morning. That’s your daily dose for today.  We’ll chat again tomorrow.

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

HELP! My Child Does Not Like Milk!

A mom's dilemma: my child will not drink milk.Dear Dr. Sue: my 13 month old baby boy doesn’t like milk! With my other two children, I stopped bottles/formula cold turkey. But my baby boy loves his formula.  What should I do?”

Rhonda, I think you have answered your own question. You said that you stopped formula and bottle with your other two children.  Provide your son with healthy meals and if you stop the bottle and formula and ONLY give him milk in his cup, he will eventually drink his milk. Not only does he have good role models in his older siblings, if you don’t “cave” and give him his formula or even juice or water he will drink his milk, as he is thirsty. Not only does he no longer need formula after he is 1 year, he needs to get the majority of his calories from food rather than from formula. You also know that this is the easiest time to get rid of the bottle before he becomes “attached’ to it. He may be your “strong willed” third child (all children seem to have this title at some time) on this issue. I also agree with you that he needs to be a milk drinker and this is the time to establish this. I have found that if you don’t get children to start drinking milk at this age, then for the majority of children, they will not drink milk later on in their childhood and adolescent years.  Although you can give him other dairy products to help him meet his calcium and vitamin D needs, it is hard to meet those daily requirements without drinking some milk. So, I would just go with your previous habit and stop the formula and give it some time. He will drink his milk; he just has to get thirsty enough (that means that his sibs cannot give him other fluids either!) Anyone else go “cold turkey”? How did it go? Love to hear from you.

Daily Dose

Late Teether?

1:30 to read

Time for another of those moments in my office when I just turn my head and say “what?”.  The latest...during a 9 month old check up the child’s mother expressed concern that her daughter did not yet have any teeth.  

When I explained to her that this was totally within the range of normal, and in fact, I myself loved babies without hair or teeth in the first year of life!!! Why? They are “low maintenance”.  Don’t have to worry about washing dirty hair or brushing those first teeth...plenty of time to deal with that later on right?

But her concern was real...she was very worried about her daughter’s lack of teeth.  I reassured her that it was not uncommon, there are a lot of babies that will not get a tooth until around 1 year of age and late teething often runs in families.  I wondered if she knew when she or her husband had gotten their first tooth?

Upon further questioning her real concern was that she had been “told”  “if your child is a late teether they will also be a late reader?”  Was this something her friends told her on Facebook or on their Instagram post? I thought I had heard all sorts of concerns about teeth erupting...things like my child is fussy, doesn’t sleep well, drools a lot, chews on everything, has runny poop.....but won’t be able to read?  There is just too much information or rather “mis-information” out there.

So, it was such a relief for me to be able to tell her that I was not aware that there was any relationship between teething and reading. In fact...one of my own children had his first tooth erupt at 6 months (which is about average) and he ending up being dyslexic (which is another blog on successful ways to help children with learning differences).   My middle son did not get a tooth until about 18 months (which did worry my mother, she was ready to put money into savings for baby dentures), and he was reading before kindergarten ( which had nothing to do with us...we were focused on trying to teach his older brother how to read).

See why I love my job....something new everyday.... thankfully some of the concerns have no basis in fact....and I get to reassure parents.  

Daily Dose

Colic & Your Baby

1.30 to read

While my middle son was home for a long weekend, the discussion about who was the most “difficult” baby in our family came up once again. Whew, COLIC!!!  I still cringe thinking back about the first 6 months of my now 26-year-old's life.

No one really knows what causes colic and there are many different definitions of colic. The word is derived from the ancient Greek word Kolikos, which means “pertaining to the intestines”. (vague enough)

Colic typically begins somewhere between the 3rd and 6th week of a newborn’s life. Doctors have looked “up and down” for medical problems with these babies and I can attest to the fact that the most frustrating (although reassuring) thing is that they are HEALTHY.

Colicky babies cry and they cry much more than the average baby. While most newborns cry somewhere around 3 -4 hours/ day, a colicky baby will cry for hours on end. While doing so they typically draw their legs up, get stiff and arch their backs and turn bright red and I remember our son even seemed to get hoarse from crying so much. Colic typically occurs throughout the day and night which is different than that evening fussy spell that most babies experience. The crying makes parents feel anxious, frustrated, exhausted, concerned and everyone just wants an ANSWER! If you can solve the mystery of colic you will win the Nobel Prize in medicine as well as the hearts of every parent.

As physicians I tell parents that colic is “short lived” and “self-limited”, but those terms are relative when you are living through what we affectionately termed, “baby hell”. After listening to incessant crying short lived means less than 10 minutes! Colicky babies have very intense cries, whether they are wet, startled, need to burp or are just uncomfortable. They tend to be tense andjust never seem to relax.

A colicky baby is difficult for any parent, whether you are a first time parent or “seasoned”. It is difficult to not blame yourself for your babies crying and the fantasy of that “perfect baby” is shattered. These babies are not “like babies on TV”. A colicky baby provokes exhaustion and can lead to things like breast feeding failures, marital discord, post partum depression and even child abuse.

 So what do you do and what are the current theories?  More to come….

Your Baby

Special Baby Formulas Don’t Prevent Asthma, Allergies

2:00

Parents that have a baby at risk or allergies, asthma or type-1 Diabetes sometimes turn to hydrolyzed milk formulas in hopes of lowering their infant’s risk of developing these problems.

A new review of the data on hydrolyzed formulas finds that there is no evidence that they actually protect children from these types of autoimmune disorders.

"We found no consistent evidence to support a protective role for partially or extensively hydrolyzed formula," concluded a team led by Robert Boyle of Imperial College London in England.

"Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease," the study authors added.

In the study, Boyle's team looked at data from 37 studies that together included more than 19,000 participants and were conducted between 1946 and 2015.

The investigators found that infants who received hydrolyzed cow's milk formula did not have a lower risk of asthma, allergies (such as eczema, hay fever, food allergies) or type 1 diabetes compared to those who received human breast milk or a standard cow's milk formula.

The researchers also found no evidence to support an FDA-approved claim that a partially hydrolyzed formula could reduce the risk of the skin disorder eczema, or another conclusion that hydrolyzed formula could prevent an allergy to cow's milk.

Other experts in the United States said that the finding casts doubt on the usefulness of these kinds of specialized products.

"Allergies and autoimmune diseases [such as asthma, and type 1 diabetes] are on the rise and it would be nice if we did have a clear route to preventing them," said Dr. Ron Marino, associate chair of pediatrics at Winthrop-University Hospital in Mineola, N.Y.

"Unfortunately, despite U.S. Food and Drug Administration support [for hydrolyzed formula], the data are not compelling," he said.

Dr. Punita Ponda is assistant chief of allergy and immunology at Northwell Health in Great Neck, N.Y. She stressed that when it comes to infant feeding, breast milk is by far the healthiest option.

However, "current mainstream guidelines for infant formula do recommend that parents consider using hypoallergenic formula if a close family member -- like an older brother or sister -- has a food allergy," she said. That was based on prior studies supporting some kind of protective effect, Ponda said.

Protein hydrolysate formulas were first introduced in the 1940s for babies who could not tolerate the milk protein in cow’s milk.

Protein hydrolyzed formulas are formulas composed of proteins that are partially broken down or “hydrolyzed.” They are also called hydrolysates.

There are two broad categories of protein hydrolysates:

•       Partially hydrolyzed formulas (pHF)

•       Extensively hydrolyzed formulas (eHF)

Both partially and extensively hydrolyzed protein formulas are based on casein or whey, which are proteins found in milk.  

Hydrolyzed formulas have had the protein chains broken down into shorter and more easy-to -digest chains. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain.

Hydrolyzed formulas are also more expensive than regular cow’s milk formulas and often harder to find.

The researchers review was published March 08, 2016 in the BMJ.

Story sources: Robert Preidt, http://www.webmd.com/parenting/baby/news/20160308/special-infant-formulas-dont-shield-against-asthma-allergies-study

Victoria Groce, http://foodallergies.about.com/od/adultfoodallergies/p/hypoallergenic.htm

 

Daily Dose

Are Parents Too Connected?

1.30 to read

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

Vaccine Pain

1.00 to read

I am often reminded of the adage, “this is going to hurt me more than it hurts you” before beginning infant vaccinations. I can remember my own parents saying that to me before a spanking (the preferred discipline of my childhood) and that statement never made any sense to me until I too became a parent. 

As I discuss infant vaccinations with new parents, I somehow know that they are wishing they could “take the needles” for their own child. I really do believe that those first vaccines at 2 months of age “hurt the new parent, more than the infant”. It is an early parenting hurdle to get through those first immunizations and realize that your baby handled the vaccines without much ado and somehow the next set of vaccines at 4 and 6 months are a bit easier. Pain is not anything that a parent wants their child to endure, and if there is any way to mitigate the pain associated with immunizations I am all for it. 

Many parents come to my office prepared with sucrose to let their baby suck on during the immunizations.  I recently read an article in Pediatrics that showed the 5 S’s - swaddling, side/stomach positioning, shushing, swinging and sucking on a pacifier significantly reduced the pain associated with vaccines in 2 and 4 month old infants. In fact the 5S’s worked “substantially better to reduce post vaccination pain than sucrose alone”. 

So, if you are concerned about the pain associated with your infant’s vaccines, come ready to swaddle, shush, swing and let your baby have a pacifier as well. A little tummy time after the immunizations might be good medicine too. 

But more importantly, remember that by vaccinating your baby you are protecting them from disease for their entire childhood and into adolescence (when I am not sure the immunizations are any easier). 

The 5S’s seem like an easy solution for parent and baby, and a lollipop or ice cream cone goes a long way for pain relief in the 4-11 year old set as well. Vaccines are a moment of pain for a lifetime of gain for sure!

Daily Dose

Lactose Intolerance

How do you know if your child is lactose intolerant?A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea.  In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental. It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters. All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation) Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products.  It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine.  Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years.  It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve.  In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose.  True milk allergy usually presents in early infancy. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue!

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Just how much sleep does your child need?

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