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Daily Dose

MMR Vaccine Update

vaccine, virus, health, parenting

Although there is more and more data to confirm that childhood vaccines are safe, and DO NOT cause autism….there  continues to be some parental concern surrounding the timing of a child’s vaccines.  The majority (read as all of my patients) receive their vaccines according to the CDC guidelines…and for the most part my patients realize the importance of vaccines and how many lives have been saved as more vaccines are given to children today than 25 years ago.  

But, when it comes time for the MMR (measles, mumps, rubella) vaccine, there are still a few parents who express concerns and some who would “like” to defer the vaccine to a later date when their child is “older”….typically after their child reaches the age of 18-24 months. Concerns are not only about safety, but also about efficacy of the vaccine at a younger age.   There have been several recent studies that should help to allay fears and actually reassure parents that giving the vaccine at 12 months of age is preferable and may have even have fewer side effects, if any, than when given when the child is older.

A study from Finland (which uses the same MMR vaccine)  looked at whether the antibody response (protection) from the MMR vaccine was any different when given at 12 months vs 18 months of age.  This study showed that the antibody response and protection from the MMR vaccine was similar when given at 12 months vs 18 months. Good news for giving it younger and protecting the child earlier.

Another study looked at the risk of febrile seizures after the MMR vaccine. This study reported that the risk of a seizure was more than 6 times higher during the 7 - 10 day interval after the MMR vaccine among children who were 16-23 months, as compared to those who were 12 -15 months.  So..in fact, delaying the vaccine actually put a child at more risk for a seizure than if given earlier.

These studies point to the win-win in giving the MMR vaccine to children at their 1 year old well child visit.  Not only does it provide earlier protection against measles, mumps and rubella ( a new outbreak of measles in the Amish community in Ohio was just reported), the chance of your child having any adverse effects are actually even lower. 

But remember, while this study showed “twice the risk” for delaying the vaccine…it is still a VERY LOW number, out of 10,000 kids there may be 4 extra febrile seizures.  While that number may seem insignificant,  when your child is one of the 4 to have a seizure it is significant. This is coming from a mother whose child had a febrile seizure (unrelated to vaccines) and who is a pediatrician.  It was even frightening for me to watch my child have a febrile seizure and I knew what was happening. While most febrile seizures only last 1-2 minutes he of course decided to have a prolonged seizure, (always doctor's kids). I am happy to report that he is of course totally fine and never had another febrile seizure…as most children “outgrow” febrile seizures during the pre-school years. 

Bottom line,  with these studies in hand…you should feel reassured that immunizing at 12 months is  preferable, safe and prevents serious illnesses.  

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

Your Baby

Choosing the Safest Fish to Eat During Pregnancy

2:00

As a parent or an expectant mom, you may have travelled down the same path as many others- searching for the healthiest diet for your family or soon-to-be newborn.

Fish is one of the foods that rank high on the healthy food chart. It’s frequently referred to as a “brain food” because of its brain-boosting nutrients, particularly omega-3 fatty acid. Certain fish are an excellent choice while others may contain high levels of mercury; a known toxin than can harm a developing child.

Mercury is a common seafood pollutant. This neurotoxic chemical can harm a baby’s developing brain in utero, even at very low levels of exposure.

Seas are increasingly polluted by toxic chemicals from 2 major sources: small gold mines and coal fired power plants, according to a recent report by Healthy Babies Bright Futures (HBBF.)

Mercury in a mother’s body can be transferred to her fetus during pregnancy, exposing the developing fetus to the potent neurotoxin.

The report states that millions of women of childbearing age who eat mercury -contaminated fish have enough of the toxic chemicals in their bodies to harm a developing child. “55% of the global sample of women measured more than 0.58ppm of mercury, a level associated with the onset of fetal neurological damage.” This is the finding of a new, first of its kind report on mercury levels in women of childbearing age in 25 countries by HBBF partner, IPEN: the International POPs Elimination Network

While these findings may make you wonder if any fish are safe to eat, many health experts recommend that women who are pregnant should not give up eating fish out of fear of mercury toxins, but should focus on eating fish found to be very low in mercury. These include: wild Alaska salmon, sardines from the Pacific, farmed mussels, farmed rainbow trout, and Atlantic mackerel (not trawled).  

High mercury risk fish to avoid include shark, swordfish, orange roughy. bigeye tuna, king mackerel and marlin.

The FDA and the EPA joined forces this year and released new guidelines on fish consumption for pregnant women or those who might become pregnant, breastfeeding mothers and parents of young children. To governmental agencies created a chart to help these consumers more easily understand the types of fish to select. The agencies have an easy-to-use reference chart that sorts 62 types of fish into three categories:

  • “Best choices” (eat two to three servings a week)
  • “Good choices” (eat one serving a week)
  • “Fish to avoid”

Fish in the “best choices” category make up nearly 90 percent of fish eaten in the United States. The chart can be found online at https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

The HBBF report also includes a warning about canned tuna. Limit your intake of canned tuna. While tuna is higher in Omega 3s and nutrients than most fish, the mercury levels can vary in individual tuna. Light canned tuna is recommended over white tuna; however, HBBF notes in their report that scientists found that for both types, the potential harm to a baby’s brain exceeds the fish nutrients’ brain-boosting assets.

One tip to remember is that larger fish tend to absorb more mercury than smaller types of fish. Fish should not be eliminated from any family’s diet; the benefits far outweigh the dangers. However, it’s important to choose fish that are known to be lower in mercury for a healthier outcome.

Story sources:  Charlotte Brody, RN, http://blog.hbbf.org/toxic-mercury-and-your-babys-ability-to-learn/

https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

 

Parenting

Why Moms-To-Be Might Want to Hire a Doula

2:00

Ever heard of a doula?  You’re not alone if the answer is no.  The word “doula” comes from the ancient Greek meaning “ a woman who serves.”

According to DONA International, a doula is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

A recent study found that women with doula care had 22% lower odds of giving birth prematurely, and were less likely to have a C-section. (Among the women with doulas, 20.4% gave birth via cesarean, compared to 34.2% of women without doulas.)

For pregnant women, doulas can offer emotional and physical support throughout the pregnancy and labor; either in a hospital setting or at home.  There are also doulas that are certified to help mothers postpartum.

While many people may not have heard of doulas, they are beginning to gain some recognition.  TIME Magazine recently published an article on the 4 reasons why moms-to-be should consider hiring one.  The author spoke with Jada Shapiro, founder of the doula referral service, Birth Day Presence, in New York City.

1. They provide extra care and support:

Although every doula has a unique approach, their main role is to care for the mom-to-be. 

“Doulas offer continuous support to women both during pregnancy and after childbirth,” Shapiro explains.

“In a way, we are trying to recreate what was typical in old-world communities when women were surrounded by a vast support system of female friends and relatives during pregnancy.”

And while doulas are not medical professionals, they possess a wealth of knowledge about pregnancy and childbirth that can be extremely helpful for expectant moms.

“We work closely with our clients to de-mystify pregnancy terminology and help women interpret their options,” says Shapiro. 

That said, one of the most common misconceptions about doulas is that they interfere with a woman’s obstetrician. Shapiro says it’s important to note that this is not the case. “Doulas complement the care a woman receives from her doctor,” she says. “We don’t get in the way of medical decisions.”

She also adds that while many people believe you can only work with a doula if you want a medicine-free birth, this is also untrue: Women with all kinds of birth plans can find it helpful to consult a doula during their pregnancy.

2. They can assist with pain management:

Moms-to-be are well aware of the stories of pain during labor and delivery as well as the growing physical un-comfortableness that comes with being pregnant.

“Doulas are well-trained in physical comfort and can offer a wide range of pain relief techniques and tools,” says Shapiro, including acupressure, hydrotherapy, birthing balls, massage, and suggesting position changes during labor. Doulas can also help moms relax with soothing imagery, music, and breathing exercises.

This individualized level of care can help moms feel a little calmer during one of the most physically and emotionally challenging days of their lives. “I believe that many mothers just feel generally more cared for and less alone during the experience of childbirth with the help of a doula,” Shapiro says.

 

3.They provide support to both moms and their partners:

“Something I hear from many of my clients is that they can’t believe how intimate their childbirth experience was, even with a doula there,” says Shapiro.

She adds that because childbirth can be such an overwhelming experience for families, having the support of a third party can be just as useful for partners as it is for moms-to-be: 

“Doulas can help recall important information from midwife or doctor appointments, lend a helping hand if mom needs a massage, or just generally absorb some of the stress from the partner,” she says. “In this way, a doula can allow partners to be fully present in the experience.”

4. They’re there for you on the big day:

“Doulas are typically on-call 24/7 during a client’s ‘due window’ of 36 to 42 weeks,” says Shapiro.

When a woman goes into labor, her doula will be available for physical and emotional support both while she’s laboring at home as well as accompanying her to the hospital.

And in addition to the aforementioned relaxation and pain relief techniques, doulas know a lot about childbirth (Shapiro, for example, has attended “more than 350” births in her 13 years as a professional doula).

“During labor, doulas might suggest alternate positions; encourage different non-medical techniques to potentially help speed up dilation, such as walking around; and just generally act as a sounding board for difficult medical decisions,” she says.

If you’re interested in learning more about doulas, you can check out the DONA International website at www.dona.org. It has information on where you can find a certified doula and how the process works.

Sources: Kathleen Mulpeter, http://news.health.com/2016/01/28/what-is-a-doula-4-reasons-pregnant-women-might-want-one/

Your Child

Tips to Keep Your Child’s Room Allergen-Free

2:15

Symptoms such as sneezing, stuffy or runny nose, watery eyes and itchy nose, throat and eyes or roof of the mouth are common in children that suffer from respiratory allergies. If you’re looking for ways to help reduce your child’s exposure to allergens that hide within homes, one place you can start is in his or her bedroom. 

Typical allergens include: dust mites, pet dander, pollen, mold and pests.

Dust Mites- Dr. David Stukus, associate professor of pediatrics in the division of allergy and immunology at Nationwide Children’s Hospital in Columbus, Ohio, offers these suggestions for reducing dust mites:

·      Use zippered, dust mite-proof bed covers. These covers are made of materials with pores that are too small to let dust mites and their waste products through, according to the Asthma and Allergy Foundation of America (AAFA). They should cover the mattress, box spring, and all pillows on the bed.

·      Wash bed linens at least once a week. This should be done using a hot water setting to kill and remove as many dust mites as possible, as well as the skin cells they feed on. The water should be at least 130 degrees Fahrenheit, according to the AAFA.

·      Remove or treat stuffed animals. “Ideally, stuffed animals should be removed from the bed completely,” Stukus says. An alternative solution is to keep one favorite stuffed toy on the bed and put it in the freezer for 24 hours once a week, then put it through a dryer cycle to kill and remove dust mites.

·       Remove carpets. Dust mites can thrive in carpeting. Avoid wall-to-wall carpeting and opt for hardwood floors or throw rugs instead. Just make sure to regularly wash or dry clean throw rugs, notes the American Academy of Allergy Asthma & Immunology. Dust mites can also hide in curtains, blinds, and upholstered furniture, according to the AAFA, so you may also want to avoid having these in your child’s room.

Pet Dander – Some breed may be touted as a “hypoallergenic dog or cat,” but Stukus says there is no such thing. Any animal can bring dander into the house. To keep dander out of your child’s room, try these steps:

·      The first step is to keep pets out of your child’s bedroom. It’s not as easy as it sounds, especially when your child becomes attached to a family pet. “Any access to animals, even for limited periods of time, will increase the dander levels in the room,” Stukus says. Depending on how serious your child’s symptoms are, you may want to consider not having a pet.

·      If you decide that having a pet is ok, Stukus suggests that you bathe your pet once or twice a week. “Families usually laugh when I suggest this,” Stukus says, but it’s an effective way to reduce dander.” Some pets can handle a bath that often, but others will develop skin conditions from excess cleaning. Discuss your pet’s breed and care with a veterinarian before trying this.

·       Vacuum and dust the room at least weekly. This can help remove any dander that makes its way into the bedroom. The American College of Allergy, Asthma & Immunology recommends using a vacuum with a HEPA filter to reduce pet dander, as well as other allergens.

Pollen - One of the worse allergens is pollen. There’s no hiding from it but there are ways to help make the bedroom a “safe zone” when the pollen count is high.

·      Keep the windows closed. It may be tempting to open the window when the weather is cool and the idea of a little breeze to air things out sounds appealing, but even short periods of an open window can let pollen into the room.

·      Use air conditioning.  This can help filter pollen out of the air and provide a comfortable room temperature when days and evenings are warm. When winter sets in, pollen is usually not a problem.

Mold- In the early 2000s, a toxic mold panic swept the nation. Today, a lot more is understood about the various types of mold. While mold can become a problem, it’s a common substance. “Mold is everywhere in our world, but it rarely poses a problem unless you have obvious overgrowth,” Stukus says. This is often visible in the form of large stains or black spots on drywall or other surfaces.

·      If you notice mold in your child’s bedroom, treat the source of the moisture.

·      Excess mold is almost always caused by an errant source of water, such as a leak from the outside or a pipe inside the house. In some cases, you may also need to remove and replace the mold-covered surface in the room.

Pests – Many people aren’t aware of how cockroaches (and even ladybugs) can cause a respiratory illness. If insects or other pests are a problem in your child’s bedroom:

·      Keep food and drinks out of the bedroom. “Cockroaches generally congregate towards areas with water and food,” Stukus says, which is why they’re typically found in kitchens and bathrooms.

·      Fix water leaks. If cockroaches or other pests are found in your child’s bedroom despite the absence of food and beverages, then you may have water leakage that needs to be fixed. This can be a problem in certain public and rental housing, he says.

If you need to contact your landlord about fixing a problem related to your child’s allergies, it’s a good idea to include as much documentation as possible, including a letter from an allergist, Stukus says.

Can children outgrow allergies? Sometimes. Respiratory allergies such as seasonal allergic rhinitis (hay fever) can fade over time or improve.

The first step in helping your child cope with allergies is to have him or her tested for allergens to find out what triggers a reaction. Your pediatrician or allergist will then be able to prescribe medications and or provide more information on other treatments or solutions.

Story source: Quinn Phillips, https://www.everydayhealth.com/hs/managing-respiratory-allergies-children/keep-bedroom-allergy-free/

Your Child

Never Use Q-Tips to Clean Your Child’s Ears

1:45

Parents and caregivers seem compelled to clean their child’s ears with a cotton swab. Despite repeated warnings to not put anything smaller than one’s elbow inside a child’s ear, more than 263,000 U.S. children had to be treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010, according to a new study.

Almost three-quarters of the cases — 73 percent — involved ear cleaning. About two-thirds of the patients in the study were younger than 8.

"There's this misconception that people need to clean their ears in the home setting and that this is the product to do that with," Dr. Kris Jatana, senior author of the study and a pediatric ear, nose and throat specialist at Nationwide Children’s Hospital, told TODAY.

"The ears themselves are typically self-cleaning... It is risky to use cotton-tip applicators in the ear canal across all age groups, and certainly we are seeing way too many injuries as a result of this practice."

The most common incident in the ER was the presence of a foreign body, such as part of the cotton swab and a perforated eardrum, researchers said.

"It's difficult for people to gauge how deep they're putting [the swab]," Jatana said. "Sometimes, it just takes a small movement to puncture the ear drum."

Physicians specializing in ear and throat diseases say that Q-tips and similar products should never be used for cleaning the ears. Not only can they cause ear canal injuries, but can also push ear wax deeper into the canal causing it to become trapped.

Studies have found 90 percent of people believe ears should be cleaned and say they regularly clean their ears or their children’s ears, according to the American Academy of Otolaryngology—Head and Neck Surgery Foundation. Kids also apparently learn to stick Q-tips into their ears by watching their parents: about 77 percent of the injuries in the study happened when the child was handling the swab himself.

If you see earwax on the outer part of your child’s ear, you can clean it with a washcloth or wipe, Jatana suggests. In most cases, earwax is actually beneficial for the ear. It protects, lubricates and cleans the ear canal. Occasionally, children and adults have excessive wax build-up, but a doctor should be consulted about removal.

Hearing loss, a feeling of fullness in the ear or ear pain are symptoms that should be checked out. An ear, nose and throat doctor can remove more stubborn excess wax.

Story source, A. Pawlowski, http://www.today.com/health/cotton-swabs-are-causing-ear-injuries-thousands-kids-t111296

 

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.

 

Your Baby

Weight Gain During Pregnancy

2.00 to read

Every pregnant woman wonders how much weight she could gain during pregnancy. For some women, being pregnant is an open invitation to eat whatever and whenever they like, while other woman worry what the weight gain will do to their figure. There is no absolute law about weight gain during pregnancy, but there are set of guidelines that can help you.

Weight gain should be based on your pre-pregnancy body mass index (BMI.) Your health and your baby’s health also play a role in how much weight you should gain.

Here’s a list of suggested pregnancy weigh gain related to a healthy woman’s BMI.

  • Underweight (BMI less than 18.5) – 28 to 40 pounds
  • Normal weight (BMI 18.5 to 24.9) – 25 to 35 pounds
  • Overweight (BMI 25 to 29.9) – 15 to 25 pounds
  • Obese (BMI 30 or more) – 11 to 20 pounds

Multiples are a different story. If you are carrying twins or other multiples you’re likely going to need to gain more than average weight. Your health care provider can help you determine what is right for you. Here are the recommended weight gain options.

  • Normal weight (BMI 18.5 to 24.9) – 37 to 54 pounds
  • Overweight (BMI 25 to 29.9) – 31 to 50 pounds
  • Obese (BMI 30 or more) – 25 to 42 pounds

If you are overweight when you become pregnant, pregnancy increases the risk of various complications including diabetes and high blood pressure. Of course, a certain amount of weight gain is normal, but too much adds to the possibility of dangerous health risks for the woman and the child.

Remember that if you gain more than the recommended amount during pregnancy and you don't lose the weight after the baby is born, the excess pounds increase your lifelong health risks. Gaining too much weight during pregnancy can also increase your baby's risk of health problems at birth and childhood obesity.

If you're underweight, it's essential to gain a reasonable amount of weight while you're pregnant. Without the extra weight, your baby might be born earlier or smaller than expected.

Calculating your BMI is not difficult; you just need to know your height and weight. There are several online BMI calculators that will do the math for you. Your healthcare provider should also have a BMI chart that can show you your BMI.

So, how is the extra weight used by your body when your pregnant? Here’s a simple list to help you follow a normal weight gain.

  • Baby: 7 to 8 pounds
  • Larger breasts: 2 pounds
  • Larger uterus: 2 pounds
  • Placenta: 1 1/2 pounds
  • Amniotic fluid: 2 pounds
  • Increased blood volume: 3 to 4 pounds
  • Increased fluid volume: 3 to 4 pounds
  •  Fat stores: 6 to 8 pounds

During your first trimester, you probably won’t gain much weight. Steady weight gain is more important in the second and third trimesters, especially if you begin at a normal weight or are underweight.

Exercise is also important during pregnancy. Even a moderate amount of exercise will help keep your body strong as the extra pressure builds while you are carrying.

As your pregnancy develops, more than likely you’re appetite will increase. That’s not a bad thing. Just fill those hunger pains with healthy food choices!

Source: http://www.mayoclinic.org/pregnancy-weight-gain/art-20044360

 

 

Your Baby

Never Leave a Child Unattended in a Car Seat, Swing or Bouncer

2:00

Placing an infant in a car seat, swing or bouncer as a substitute for a crib can be a fatal decision. These objects work fine when used properly for their intended purpose, but when a child is left unattended – they can quickly turn deadly according to a new study.

Using these devices as directed and not as substitutes for a crib would reduce the risk of death, according to lead author Dr. Erich K. Batra of Penn State College of Medicine in Hershey, Pennsylvania.

“The overarching advice goes back to a more basic message of safe sleep,” Batra told Reuters Health. “In an infant, a safe sleep environment includes the ABCs: they sleep alone, not in bed between parents, on their backs, and in a crib or bassinet without any loose bedding.”

The study reviewed young children’s death in devices like car seats, swings and bouncers and found that most were due to suffocation by improper positioning or strangulation in straps.

The researchers reviewed the reports of 47 deaths of children under two years old that happened in car seats, bouncers, swings, strollers or slings and were recorded by the U.S. Consumer Product Safety Commission between 2004 and 2008.

The study used only reports submitted by consumers or manufacturers, so the number of deaths may actually be higher.

Most of the deaths occurred in car seats (31 of 47). Five happened in slings, four each in swings and bouncers and three in strollers.

About half of deaths in car seats were due to strangulation by the straps, while the other half were caused by suffocation due to positioning, the authors reported in The Journal of Pediatrics.

Strap strangulation usually happens when the restraints are not fastened as directed, Batra said. Whenever a child is in a car seat, the harness should be secured.

“If people leave an older infant or young toddler in a car seat and undo the straps thinking that it makes them more comfortable, that’s a significant hazard,” he said.

“A child properly secured in a car seat is in very little risk of danger,” he said.

However, many times the child falls asleep in the car seat and a parent or caregiver decides to bring the car seat, with baby still attached, into the home.

Dr. Shital N. Parikh, an orthopedic surgeon at Cincinnati Children’s Hospital Medical Center in Ohio, has studied the risk factors for injury in these devices in infants up to age one. He also found car seats to be the most common setting.

“The commonest mechanism of injury was infants falling from car seats when not used in the car, used in the home,” Parikh told Reuters Health. Often parents would bring the car seat in the house while the infant still slept, undo the straps and place it on an elevated surface, he said.

Even four-month-old babies are mobile enough to wiggle out of the top straps and fall, or topple the whole seat from an elevated surface, he said.

“These are very simple things, very basic things,” Parikh said. “The basic idea is that you use (the devices) for their intended purpose only. For infants, you should not use it to make them sleep or carry them around if it’s not intended for that.”

Batra notes that baby in slings need to be “visible and kissable,” as a sling may put baby’s head in a hazardous position.

It only takes four to five minutes for an unattended baby to suffocate in one of these devices.

“That is one of the things we need to draw attention to,” Batra said. Sometimes a few minutes unattended is all it takes.

“If your infant is sleeping and you’re not observing them, then they need to be in a safe sleeping environment,” adhering to the ABCs, he said.

While it may seem safe to leave a baby in a car seat, swing, sling or bouncer for a few minutes unattended, go ahead and place the child in his or her crib. It may wake them up if they are sleeping, but it’s much safer than allowing them to continue to sleep in a device that was never intended for that purpose.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/04/29/us-car-seat-infant-safety-idUSKBN0NK21E20150429

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Potty training can be tricky.

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