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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

New Baby Advice for the Royals!

1.30 to read

Welcome your Royal Highness Prince (name to come) and congratulations to new parents Prince William and Duchess Kate.  I imagine (like all new parents) you are over the moon in love with your new baby boy!

There really is no way to account for that instant unconditional love that a parent feels for their child.  It truly happens the minute your newborn baby takes their first breath....God opens a parent’s heart and fills it with love!

The first few days after the baby’s birth are adrenalin filled and most of the time is spent just holding and gazing in awe at your new baby.  At the same time, the reality of having a newborn has not yet really settled in.  The days spent in the hospital go by quickly and then suddenly you, (new parents), are “discharged to home” with a few instructions and “good wishes” for your new life together.

Even in a palace (and with plenty of help I assume) the reality of parenthood begins to hit with the knowledge that this baby requires attention 24/7, and many times that means sleepless nights.  For some reason a newborn does not “understand” circadian rhythm, at least for several months, and those night time feedings lead to tired parents.   Even with nurses and nannies, a mother is breast feeding mom needs to get up every 2-4 hours to feed her precious bundle.  

Remember as a new parent you need to sleep when the baby sleeps! This means you may need a nap from 2-4 in the afternoon as that darling baby may be up from 2-4 in the middle of the night, which means you are too! All new parents feel exhausted at times; it is all part of parenting.

Newborns are also quite unpredictable and even though you may have changed, fed and burped your baby, you should know that they sometimes cry and it is hard to figure out what to do next. 

I believe in picking up your newborn baby if they are crying, as sometimes they just need to be held and cuddled (even if they keep on crying).  You can’t spoil an infant. Try swaddling and swaying with the baby as you make a “shushing” sound.  

I also recommend using a pacifier (dummy in England) because a new baby may need some non-nutritive sucking which is yet another means of self calming.

Make sure your baby sleeps on their back (lowers the risk of SIDS) but tummy time is important as well so that their heads don’t get flat. 

If your baby ever falls asleep during tummy time they must be turned over to sleep on their back - even if you are standing there watching them. NO TUMMY SLEEPING!

The first 6-8 weeks are the hardest and it is really just about “survival”. Sleep when you can, make sure you are eating (especially for breast feeding moms) and know that all new parents feel overwhelmed at first.  You really don’t need to worry about “messing up” and in about 8 weeks that precious new baby will give you a beautiful smile, and that makes those memories of long sleepless nights (and some days) fade away fairly quickly.  

Congratulations and good luck!

Daily Dose

Does Your Baby Need Water?

2.00 to read

Since most of the country is sweltering with summer heat and temperatures well into the upper 90’s and even over 100 degrees, I guess I can understand parents’ concerns about giving their babies water. It seemed like a strange question to me when I first started hearing, “Dr. Sue, how much water does my baby need to drink every day?”  I know I am continuing to talk about staying hydrated during the heat wave, but we are really talking about those children and adults who are spending time outdoors, especially when involved in physical activity.

I have actually been telling parents with newborns that there is really no reason to take that sweet new baby outside for any length of time. I think it is too hot to enjoy being outside, and an infant doesn’t miss going to the playground like a 2 or 3 year old would.

But, when you have young children you have to get out (or go crazy inside everyday), so everyone just suffers through the heat. Remember to take your sunscreen and fluids and head out for an hour or two, in the morning or later afternoon if at all possible. These children need lots of water breaks, as do their parents and caregivers.

So, back to the water and baby question. Infants in the first 6 months are getting fed breast milk or formula which is made up of free water, so therefore a baby is staying hydrated by eating every  2 -3 hours. A baby doesn’t “need” water every day for any particular reason.

With that being said, it does not mean that your baby cannot have a bottle of water. This is especially true for a breast fed infant whose mother may have run out for an hour but is coming back to breast feed.  But what if the baby awakens or gets hungry 30 min or so prior to mother getting home.  This might be a good time to “stall” by giving the baby a bottle of water, rather than formula. In this case it is fine to use tap water (yes bottled water is not necessary, unless you have a well or something) in a bottle and see if the baby will even take it. Most babies don’t just gulp down 8 ounces of water!

If you are out in the heat with an infant, just remember to feed them every 2 – 3 hours and make sure they have nice drool in their mouths and wet diapers. If you are concerned about hydration take along a bottle of water for both you and your baby. You will probably need it more than your baby!

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

Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

Breathing & Your Baby

1:30 to read

The first few weeks of a newborn’s life is usually a bit “cra-cra”, for both parents and the baby.  Once you leave the hospital with your newborn reality sets in pretty quickly, and you realize that your baby not only doesn’t sleep when you want them to but that at times they may seem to be noisy breathers when they are awake and/or asleep.  

 

As parents (and pediatricians) we play close attention to a baby’s breathing pattern and you may realize that they do some “weird” stuff.  For the first several months of life a newborn is an obligate nose breather.  Some of the noisiest breathing you may notice is when your baby is sucking and eating whether at the breast or from a bottle.  It is not always the quiet time you thought it would be. But, while they may be noisy, you need to look at their color and make sure that they are nice and pink.  Look at their lips and tongue if you are worried and both should be pink…never dusky or blue. 

 

Being a noisy breather does not necessarily mean there are problems. But, if a newborn has mucous in their nose or has refluxed some milk into the back of their throat you may hear some “congested” sounds which often cause parental concern. Again, look at the baby, open up their swaddle and lift up their gown and see what their chest looks like as they breathe.  A baby should look comfortable (even if noisy) and their ribs should not show as they breathe (which is called retracting), nor should you see their tummy (which may be full and protuberan) appear to be moving up and down with any effort.  Again, they should be  pink and well oxygenated.  Try to filter out the noise and watch the breathing!

 

Lastly, newborns have some “strange” immature breathing patterns as well. If you are watching closely you may see that they often seem to breathing normally and then pause before taking another breath. This is termed “periodic breathing of the newborn” and is perfectly normal…albeit a bit frightening. Your baby may pause for 5- 0 seconds before taking a breath which is then followed by several rapid shallow breathes. Sometimes this even occurs a few times in a row and then suddenly the normal breathing pattern returns. Again, your baby should not appear to have any change in color and their breathing pattern returns to “normal” without you doing anything at all. If you think that the pauses (apnea) are lasting longer than 10 seconds you need to call your pediatrician. With the advent of cell phone video I get many video clips of babies with periodic breathing.  The frequency of periodic breathing decreases as your baby gets older…and is usually gone by 2-3 months of age.

 

You will quickly get used to some “baby nuances” you never dreamed of and realize that even a tiny baby can be a noisy eater and sleeper!! 

 

 

 

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Daily Dose

What is Thrush?

1.15 to read

I get a lot of phone calls and questions from worried mothers who have noticed that their baby’s tongue has a bit of white coating and is this thrush?  Thrush is fungal infection of the mouth that is seen in babies (about 2-5% of babies), but thrush typically affects the sides of the inside of the baby’s mouth or under the lips and along the gum line. A white tongue alone is most likely residual milk. 

There are many cases of thrush that are mild enough that they may resolve on their own. On the other hand, a severe case of thrush may be painful and may make it difficult for a baby to feed, which then leads to a fussy, irritable baby. 

Thrush is caused by the fungus candida and despite everyone’s best efforts at cleanliness, candida like bread mold, can just happen.  Candida may be acquired at the time of delivery as the baby passes through the birth canal that is colonized with candida, or during nursing from the skin of the breast, or from a pacifier or the nipple of a bottle.  

Thrush is typically treated by wiping the inside of the mouth with a soft washcloth followed by an antifungal medication given as drops in the baby’s mouth after the baby has eaten. In a breast fed infant I treat the mother’s breast with a topical antifungal cream as well. 

Best way to look for thrush may be when you baby yawns and you get a good look at the inside of their mouths (bucal mucosa).  You don’t need to be a detective to find thrush, it is usually fairly evident and the biggest clue that it is not milk as it will not wipe off with a soft washcloth.

Daily Dose

Smiling & Your Baby

1.00 to read

If you are a new parent or even if you have older children, you can probably remember your baby’s first smile, almost vividly I bet!!  

When a parent first brings their new baby home from the hospital it is such a time of great joy, but parents quickly learn how demanding a newborn baby really is.  The first 6-8 weeks of a baby’s life is all about eating, peeing, pooping and maybe a little sleep, although not on any sleep schedule an adult can remember. The little sleep a parent and the newborn gets comes in 2-3 hour increments and after about 6 weeks of sleep deprivation a new parent can understand why sleep deprivation is used on POWs.  It sometimes does feel like torture.  

But just when you think you “can’t take it ANYMORE”, and wonder why you thought you wanted a baby, (and you are actually telling your baby this), you suddenly realize that your baby is making eye contact and REALLY SMILING!  It is such a wonderful and amazing moment!   One little smile can erase weeks of no sleep and pure exhaustion.  At that moment you begin to understand why you wanted to be a parent, and the pure joy a small smile can bring. 

Parenting, like so many things in life, is about give and take.  With a newborn it is all take, take, take, and then suddenly that tiny little baby learns to smile and they are giving!! The smiles, which are soon followed by sweet coos and goos, become ever more frequent, and the give and take becomes a bit more equal.  

A parent has unconditional love for their child, and that never changes.  But to have your child reciprocate that love, with just a first smile, is a moment that will always be remembered. That smile will get a parent through a lot more sleepless nights, and that sweet baby seems to know to smile even more at 2 am! (Foreshadowing for teenage years).   

Daily Dose

Rice Cereal & Childhood Obesity

Does white rice cereal cause childhood obesity? One pediatrician thinks so.I recently saw Dr. Alan Greene on TV discussing infant feeding practices and how that may relate to the problem of childhood obesity. Dr. Greene, like most pediatricians, has long been a proponent of healthy eating. He recently launched his “White Out” campaign to change how babies are introduced to solid foods.

His argument is that an infant’s first food has long been rice cereal.   Rice cereal is typically introduced to a baby between 5 – 6 months of age when they are just beginning to sit up in a high chair, and may be fed with a spoon. Rice cereal  typically comes in a box and breast milk or formula is added to the dried flakes in order to make it the consistency where the  baby may be  offered a few bites from a spoon. Although rice is a “white grain” there are also other infant cereal products available, and there are no “directives” that say that a brown rice or mixed grain cereal may not  be used. As I understand it, the whole idea is really just to get the baby used to spoon feeding and then I begin introducing my infant patients to vegetables and fruits. So, the idea that the baby rice cereal is somehow linked to the entire problem of childhood obesity seems somewhat shortsighted to me. An infant is only fed rice cereal one or two times a day while still receiving either breast milk or a formula. Remember that breast milk and formulas contain carbohydrates too. Infant cereal whether it be brown or white rice should not be the only food a baby is introduced too, nor should they eat cereal all day long. While Dr. Greene is concerned that babies will “get hooked on the taste of highly processed foods”, I'm more concerned that parents will quickly forgo rice and whole grain cereals, fruits, veggies and meats and begin feeding their children frosted or honey nut cheerios (a favorite early finger food),  as wells as goldfish and puffs, pasta and other white foods.  These are the foods I  am most likely to see in my office, not a bowl fruits and vegetables. Babies really get the  majority of their calories from breast milk or formula until about 9 – 12 months of age. Parents should be encouraged to feed their babies a wide array of healthy foods including cereals, vegetables, fruits and meats.  Dr. Greene is right,  a baby doesn’t tell you he won’t eat brown rice, or oatmeal or spinach or prunes. For the most part an infant happily opens their mouths and will take what is fed to them. The problem occurs a little later as babies start to show a preference for foods , whether that is by making a face, or pushing food away, they definitely show preferences. This is when the idea of getting “hooked on foods” really begins. It is not uncommon for me to hear a parent of a one year old say, “my baby doesn’t like…… squash, or cereal, or peaches.”  Soon thereafter you hear, “my toddler will only eat…..fill in the blank”. Those are the words that send shivers down my spine. Trying to get those parents to buy into the fix the meal and they will eat it if they are hungry is quite a difficult concept at times. The issue is not only beginning a baby on rice cereal, the problem is more complex. It is getting parents to understand that our children will always have food preferences, that does not mean that we need to acknowledge them or submit to them. It means that we need to make good healthy meals for our families, white rice or brown rice is only the beginning of the story. That's your daily dose for today. What do you think? Leave your comments below!

Daily Dose

Baby Naming in the Hospital

1:15 to read

An interesting article was published this week in Pediatrics. If you have had a baby or visited the newborn nursery you typically see that a newborn is named “Babygirl or Babyboy Smith” on their crib and chart.  These are the temporary names given until the baby is named and the birth certificate is filled out. Well, it seems that these temporary names can cause quite a bit of confusion and may also contribute to medical errors, especially when there are babies with the same last name.   

These temporary names are even more problematic when a newborn is admitted to the neonatal intensive care unit (NICU), which was the case for my grand daughter last summer. While there may be few orders in the regular newborn nursery which are used for every baby, in the NICU each baby has many different orders and issues.  

A study was done looking at ways to cut down on medical errors in orders written in the NICU by using more distinct temporary names for newborns. In the study they incorporated using a mother’s first name into the newborn’s first name (for example, Susansgirl Smith). By changing the manner in which temporary names were used there was a 36% reduction in orders being placed in the wrong chart and then having to be retracted.

So, the next time you head to the NICU or newborn nursery for a visit you may soon notice a difference in the way temporary names are used. I can see how this would really make a difference as we often have several newborns in the nursery with the same last names and it can be confusing, even when the chart is labelled “name alert”. I like this idea and I would think it would be easy to implement this change without needing a lot of new training or computer programs.  We will all just get used to seeing longer temporary names on those baby cribs!

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