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Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.

 

Old school and new school…the combo seems to make sense to me. 

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

Preschool Nutrition Can Be Challenging

1.30 to read

Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. Preschool children, specifically the two to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a website sponsored by the U.S. Department of Agriculture. This website not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity.

The website encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school!

Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli.

Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s.

The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This website is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that.

That’s your daily dose, we’ll chat again tomorrow.

 
Daily Dose

Homework Help: The REAL Lesson

When you kids have homework to do, how much help do you give them? I can remember the first time a son of mine had homework and how exciting it was for “us” to all sit together and watch him do his homework and let him ask for help when he needed it. I can also remember the last time a child asked me for help with his homework, in Calculus, and I had no idea what he was doing.  So the full circle of homework has been completed in my house.

While I was so anxious to begin the whole homework thing as a first time parent (as we are for so many milestones), I was equally joyful when I no longer even thought about a child’s homework, and also knew I was no longer even competent to help. (Calculus, are you kidding me, it was a lifetime ago).  I think homework has a real purpose when a teacher gives an assignment to reinforce the day’s lesson, and the amount of homework is not unreasonable.  There were times as a parent that I felt that there may have been too much homework, or that the homework was really busy work, but be that as it may, it was an assignment from a teacher and therefore it was completed. I was fortunate that from the beginning we started having a good homework routine where our boys all gathered at the kitchen table to do homework in the afternoon. The routine was pick up carpool, come home and get a snack, have some down time, typically outside to get rid of excess boy energy, and then homework started.  The habit of doing homework at the kitchen table began with our oldest son and his brother’s followed suit. When our oldest son started school, the younger boys would “want” to have homework and we would make up things for them to do. As everyone got older the kitchen table suddenly had 3 boys doing homework and they would often help one another. The other thing about being a working mother was that I was often not at home to “supervise” homework, or to make sure that it was being done. I was fortunate I guess, it was just assumed that “homework is finished before Mom gets home”. By the time our boys were in middle school and high school, they had typically moved to a desk in their own rooms.  The benchmark of getting “your own desk” was somewhat of privilege and a ”right of passage”  in our house, and each child took great pride in the fact that they had a desk in their room and had moved out of the kitchen. Once our children had left the communal homework kitchen table I really never knew if and when they finished their homework.  They were responsible for knowing what they needed to do each night, and for getting it completed. Their father and I did not know when they had tests of what needed to be done, but we were there to support them if needed. What we did do is have dinner ready for them each evening and they had “a bedtime range” which was usually followed. They also had what we called “a homework pass”.  In other words each semester they would get a “ticket” that allowed them to call us from school to bring a forgotten assignment, or take them back to school to pick up a forgotten book. They got one each semester, beyond that, as difficult as it was, they had to figure out how to get that assignment or suffer the consequences. It was probably harder on me than them, but it was a lesson well learned. They did not forget many things at school or home and I think it made them the organized young adults they are today. The hardest thing for a parent is to watch your child struggle, or fail. But sometimes it is THE most important lesson that they will learn. Letting your child suffer the consequences of a paper not turned in on time, or a homework assignment not done, hurts every parent. But more importantly, it will prepare your son or daughter for college and their careers beyond. As much as we “want” to do the work, or bring them the project, that is not our job as parents.  Our job is to prepare them to be responsible, organized and independent adults who will go forward on their own, and not call home to talk to “the boss”. That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Kids Need Vitamin D!

1.15 to read

During all of my check ups I discuss the importance of dairy products in a child’s diet to provide adequate calcium and vitamin D for bone growth and long term bone health.  It doesn’t seem that the little ones are difficult to get  to drink milk, eat string cheese, have a yogurt, but the older kids are definitely more challenging. 

Teenage girls seem to be one of the biggest problems when it comes to calcium intake. When I ask them if they drink milk, a typical response is “Uh, no”, then if I ask about other dairy they may say they drink the milk out of the cereal bowl, or they grab a frozen yogurt at lunch or have a slice of cheese on occasion.  When I ask them if they know how much calcium and viamin D they need during the tween and teen years I also get a blank look  but they do know how many texts they have on their cell phone plan!).  Answer is 1300 mg/day once you hit the teen years. 

With that being said, I am always encouraging more dairy products, milk and then a calcium/vitamin D supplement as well. Interestingly, they usually don’t balk at the idea of a vitamin, but the issue is getting them to stay on the supplement for more than a few days/weeks when they typically start to “forget”. 

So, I was seeing a family with two teenage daughters who had heard my calcium talk before. They were both non milk drinkers, competitive cheerleaders who needed strong bones and who by now could answer my calcium questions. When I asked if they were taking their calcium supplements the mother said, “they have access to calcium and vitamins” everyday......what a great line. Well put by a mom of teens! 

In fact, despite having “access” the girls readily admitted they “rarely” remembered to take them and might be more likely to up their dairy products everyday. 

Calcium and vitamin D metabolism is a hot topic and “banking calcium” during childhood is so important.....even with access to the supplement you have to swallow it to make a deposit. 

Daily Dose

The Dangers of 'Sexting'

If you are a parent of a teen, or even a 'tween, have you heard of "sexting"? If you haven't, you should know about this phenomenon that is happening coast to coast. "Sexting" is a form of text messaging, where racy or explicit sexual images are being sent from cell phone to cell phone. Teens say this is just a form of flirting. Most people would think otherwise.

When you view some of the suggestive and provocative pictures that are being "sexted", it is often embarrassing and some would argue these "sexts" are a form of pornography. A simple picture sent in a suggestive bikini may seem innocent enough until it is sent around an entire school. Unfortunately, many of the pictures are taken without the bikini, showing breasts and nudity. While a young teen may think this picture is only for one set of eyes, many of the pictures are then passed around to classmates, and even beyond that. A recent survey showed that one in five teens have sent or posted provocative photos of themselves. So many teens "sext" before they think and then must face the consequences. The consequences of "sexting" include legal issues about trafficking in child pornography, which most teens haven't even heard of. They are not aware that this is a criminal offense. At the same time, the emotional turmoil that a teen faces after her nude picture has now been passed around her school, may lead to humiliation, depression and even suicide in the case of one teen in Ohio. "Sexting" and cyberbullying are both discussions that every parent needs to have with their child. The dangers of technology can be very real when the technology is not used appropriately. 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

Parenting is Hard Work!

1:30 to read

Being a mom (as well as a dad) is one of the hardest jobs in the world....and as many a person has pointed out, it pays a lot less than minimum wage.  But, it is also the best job in the world.

I have the privilege of seeing a lot of mothers everyday. From the time they come in with their brand new infant until their children have graduated from college....mothers worry about the “job” they are doing.  For a new mother who is already hearing that voice in her head...”am I doing this right?”, 

it is very reassuring for her to hear me say, “you can’t mess this up yet!” Your baby loves you unconditionally, just like you do them.

But as your child gets older it takes a great deal of self-esteem to sometimes feel as if you are “doing it right”.  Children of all ages can sometimes bring us to our knees...how can a small child know just the right thing to say, and that teenager...well, enough said.So, I like to tell them my own stories about raising children and my days of feeling like a failure, or at the least an inadequate mother....especially as your children point this out to you.

When my oldest and very verbal son was about 6, he was riding in the front seat with me (crazy huh) and I stopped the car in front of our neighbor’s house where our 4 year old son was heading to play. I rolled down the window to give the 4 year old some instructions when the eldest son leaned over and started telling his younger brother what to do. So. in my best “mommy voice” I tell the 6 year old that I am the mother and will handle this, to which he doesn’t miss a beat and responds ”if you were doing a better job of being a mommy I wouldn’t have to help you!”  Enough said.

It takes a lot of self esteem and true grit to be a mom. Hang in there.  We all have those days when we know we are doing our best and our kids disagree. 

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