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Your Baby

Should You Let Your Baby Cry Itself to Sleep?

1:30

As any parent of an infant will tell you- sleep is a precious thing. So, what’s the best way to get your baby to sleep through the night? There are many ways to help baby drop off to dreamland, but two of the most common had researchers wondering if there might be long-term harm resulting from these techniques.

Turns out, they was nothing to worry about.

The study tested two methods; graduated extinction and bedtime fading.

Graduated extinction is more commonly known as controlled-crying or letting baby cry his or herself to sleep while learning how to self-soothe without parental involvement

Bedtime fading is keeping baby awake longer to help them drop of more quickly.

Researchers discovered that both techniques work and neither had any long-term negative effects.

The graduated extinction approach also showed babies waking up fewer times during the night.

Parents worry about the controlled-crying method, in particular, according to study leader Michael Gradisar, a clinical psychologist at Flinders University, in Adelaide, Australia.

With that technique, parents resist the urge to immediately respond to their baby’s nighttime cries, so he or she can learn to self-soothe. Some parents worry that will damage their baby emotionally, and possibly cause "attachment" problems or other issues in the long run, Gradisar explained.

But, he said, his team found no evidence that was the case.

For the study, the researchers randomly assigned parents of 43 babies to one of three groups: one that started practicing controlled crying; one that took up bedtime fading; and a third, "control" group that was just given information on healthy sleep.

The babies ranged in age from 6 months to 16 months. All had a "sleep problem," according to their parents.

Parents in the controlled-crying group were given a basic plan: When their baby woke up crying during the night, they had to wait a couple of minutes before responding. They could then go comfort, but not pick up, the baby.

Over time, parents gradually let their baby cry for longer periods before responding.

Bedtime fading is a "gentler" approach, according to Gradisar: The aim is to help babies fall asleep more quickly by putting them down later.

Parents in that study group were told to delay their baby's bedtime for a few nights -- to 7:15 p.m. instead of 7 p.m., for instance. If the baby was still having trouble falling asleep, bedtime could be pushed back another 15 minutes.

After three months, the researchers found, babies in both sleep-training groups were falling asleep faster when their parents put them down -- between 10 and 13 minutes faster, on average. On the other hand, there was little change in the control group.

A year after the study's start, children in the three groups had similar rates of behavioral and emotional issues. They were also similar in their "attachment" to their parents -- which was gauged during standard tests at the research center.

Experts say that infants are usually able to sleep longer through the night, as they get a little older. By the age of 6 months, 80 percent of infants sleep all night. By 9 months, about 90 percent do.

If your baby doesn’t seem to be able to sleep through the night by those ages, contact your pediatrician to see if your little one may have a problem that needs checking out.

Story source: Amy Norton, http://www.webmd.com/parenting/baby/news/20160524/what-really-works-to-help-baby-sleep

 

Your Baby

Updated Safety Guidelines for Infant Sleeping

2:00

Elaborate beddings and plush accessories may look stylish and cute in a newborn nursery however, pediatricians know that these things should never be part of a baby’s sleeping environment. Getting new parents to understand why this type of bedding can be dangerous for babies is one of the reasons that the American Academy of Pediatrics (AAP) has updated and issued new safety guidelines.

Nineteen evidence-based recommendations aimed at protecting infants up to 1 year of age are featured in SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, an AAP policy statement and technical report from the Task Force on Sudden Infant Death Syndrome.

Safe sleep recommendations include placing infants on their backs to sleep; using a firm sleep surface; room sharing without bed sharing; avoiding exposure to smoke, alcohol and illicit drugs; breastfeeding; routine immunization; and using a pacifier.

Every year, about 3,500 infants die from sleep-related deaths. Soon after the “Back to Sleep” campaign debuted in 1994, the SIDS rate declined, but it has leveled off in recent years. Ninety percent of cases occur before an infant turns 6 months of age, with peak incidence between 1 and 4 months.

Most parents know the importance of placing babies on their backs to sleep; the focus now is on the total sleep environment.

“I think the back-to-sleep message has gotten out loud and clear,” said Rachel Y. Moon, M.D., FAAP, lead author of the statements and chair of the task force. “When you ask parents, almost every parent knows — whether they are doing it or not is a different thing. We have been less successful at getting people to not sleep with their babies … and much less successful in getting the soft bedding away from babies.”

The dangers of bed-sharing and soft bedding are two problems that Moon says are often misunderstood.

“For the soft bedding, everybody thinks if it’s soft, then it can’t hurt the baby. But soft bedding is actually really a problem because it’s so soft they sink into it. People will often use pillows to ‘cushion’ the babies, and babies sink into them. …That’s very dangerous.”

It’s similar with bed-sharing, she said. “Some parents also think if baby is right next to them, they can tell if there is a problem … and protect the baby,” Moon noted.

A simple ABC formula can help remind new parents and caregivers of safe sleeping actions.

Michael H. Goldstein, M.D., FAAP, a neonatologist and task force member, lays out the “ABCs”:

 A for the baby sleeping alone

for back sleeping

C for sleeping in an uncluttered crib (or play-yard or bassinet)

“Outside of these, one of the biggest things I would really like to see people take away from the updated recommendations is that no matter what, babies should never sleep on a couch, especially with another person,” Dr. Goldstein said. Babies can get wedged between the adult and the cushions.

Other messages in the guidelines deal with sleeping with an infant, swaddling, breastfeeding and pacifiers.

Breastfeeding, along with the use of a pacifier after breastfeeding is established, also is a key recommendation. “We don’t know if people realize that (by breastfeeding) you reduce the risk of SIDS about 50%,” Dr. Goldstein said.

Parents also are advised to be vigilant about environments out of the home. A study in the November issue of Pediatrics found out-of-home settings are more likely to have certain risk factors for sleep-related deaths, including level placement for sleep and location in a stroller or car seat instead of a crib or bassinet

One of the most important milestones for parents and caregivers is when baby sleeps through the night However, it’s normal and appropriate for newborns to wake up a couple of times during the night, especially if breastfeeding, said Dr. Goldstein. Babies will eventually sleep through the night, but not till their little bodies are ready.

Below are the 2016 infant sleep recommendations for parents, caregivers, researchers, pediatricians and media outlets:

1. Place infants on their back to sleep for every sleep period until they are 1 year old. This position does not increase the risk of choking and aspiration.

2. Use a firm sleep surface.

3. Breastfeeding is recommended.

4. Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for the first year, but at least for the first six months.

5. Keep soft objects and loose bedding out of the infant’s sleep area.

6. Consider offering a pacifier at naptime and bedtime.

7. Avoid smoke exposures during pregnancy and after birth.

8. Avoid alcohol and illicit drug use during pregnancy and after birth.

9. Avoid overheating and head covering in infants.

10. Pregnant women should obtain regular prenatal care.

11. Infants should be immunized according to the recommended schedule.

12. Avoid using commercial devices that are inconsistent with safe sleep recommendations, such as wedges and positioners.

13. Don’t use home cardiorespiratory monitors as a strategy to reduce SIDS risk. 

14. Supervised tummy time while the infant is awake can help development and minimize positional Plagiocephal (flat head syndrome).

15. There is no evidence to recommend swaddling to reduce the risk of SIDS.

16. Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child-care providers should endorse and model recommendations to reduce SIDS risk.

17. Media and manufacturers should follow safe sleep guidelines in messaging and advertising.

18. Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths.

19. Research and surveillance should continue on all risk factors.

Parents and caregivers can find more information about the “Safe to Sleep” program at: http://www.healthychildcare.org/pdf/sidsparentsafesleep.pdf

Story source: Alyson Sulaski Wyckoff, http://www.aappublications.org/news/2016/10/24/SIDS102416

Your Baby

Recall: Otteroo Baby Floats Due to Drowning Risks

1:00

Babies and young children can drown in less than 2 inches of water.  That’s why it is  vital that parents and caregivers never leave a baby or young child unattended while they are near or in water.

When bathing their infant, parents will sometimes attach a bath float to their child to help keep his or her head above water. While the float may offer some assistance, critics warn that the device can give parents a false sense of security that their child is protected from drowning.

Otteroo Corporation makes inflatable baby floats that are specifically designed for babies 8 weeks and up.

The company is recalling about 3000 units of their inflatable Baby Floats after receiving 54 reports of broken seems on the product. No injuries have been reported.

The Otteroo Inflatable Baby Float is an inflatable round ring made of clear and blue plastic material. It has two air chambers that fasten around a baby’s neck with a white buckle. The floats have a chin rest, two handles and two circular openings on the back of the ring to allow the device to expand as the child grows with age. There are three colorful balls that move freely around inside the ring.  The name “Otteroo” is imprinted on the top of the float in large, orange letters with an Otter logo.

Consumers should immediately stop using the recalled inflatable baby floats and contact the firm to receive a free replacement.

The floats were sold online at Otteroo.com and Amazon.com and Zulily.com from January 2014 through July 2014 for about $35.

Consumers can contact Otteroo Corporation at (415) 236-5388 from 9 a.m. to 5 p.m. PT Monday through Friday or online www.otteroo.com and click on “Safety” at the bottom of the page for more information.

According to their website, Otteroo is offering a free replacement for those who purchased the product manufactured in 2014 (NO: 002013001).

Sources: http://www.cpsc.gov/en/Recalls/Recall-Alerts/2015/Otteroo-Corp-Recalls-Inflatable-Baby-Floats/

http://otteroo.com/pages/safety-info

Your Baby

AAP: No Fruit Juice for Children Under 1 Years-Old

1:45

Kids under the age of 1 should avoid fruit juice, older kids should drink it only sparingly and all children should focus, instead, on eating whole fruit, according to the American Academy of Pediatrics.

A 2006 AAP policy recommended no juice for children younger than 6 months of age, 4-6 ounces daily for children ages 1-6 years and 8-12 ounces for children 7 and older. Since then, however, considerable concern has been expressed about increasing obesity rates and risks for dental decay.

The new policy advices against giving children under the age of 1 any fruit juice at all unless there is a strong clinical basis for it in the management of constipation. For older children, maximum daily intakes of 100% juice products should be 4 ounces for children ages 1-3 years, 4-6 ounces for children ages 4-6 years and 8 ounces for those 7 and older.

When juice is served to older toddlers, it is important that it not be sipped throughout the day or used to calm an upset child. 

Instead of juices, the AAP recommends fresh fruit in children’s diets. Fruit generally contains additional fiber compared to juices. Consistent with recent AAP recommendations, water and cow’s milk are preferred as primary fluid sources after breastfeeding or formula ceases.

The policy clarifies that there is no reason to give juice during the first year of life and that expensive juice products marketed specifically for infants have no value.

The guidelines also strongly discourage unpasteurized juice products, which can carry pathogens such as E. coli.

As far as which juice is better for kids, the AAP does not favor one juice over the other, but does recommend 100 % fruit juice and not fruit drinks – which contain less than 100 % juice and have added sweeteners.

"Some juices naturally have certain vitamins or minerals in them," Abrams said, noting that orange juice has lots of vitamin C. "But that doesn't mean that apple juice doesn't provide vitamin C, because it's usually fortified."

Story sources: Steven A. Abrams, M.D., FAAP, http://www.aappublications.org/news/2017/05/22/FruitJuice052217

Katherine Hobson, http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1

Parenting

Does Time Spent With Dad Make Babies Smarter?

1:30

A new study suggests that not only do dads play an important role in a baby’s social development; time spent with dad may actually increase baby’s I.Q.

In a small British study, researchers looked at how 128 fathers interacted with their infants at 3 months of age. When the kids turned 2, the researchers measured their mental development.

They found that infants whose fathers were engaged and active during play time, within the first few months of the baby’s life, did better on thinking skills tests at age 2 than other infants.

Many factors have a major influence a child's development, and this study wasn't designed to prove a cause-and-effect relationship. But these findings suggest that father-child interactions at a young age are an influencing factor, the researchers said.

Researchers noted that dad’s interactions had a positive influence on thinking skills for both boys and girls.

"Even as early as 3 months, these father-child interactions can positively predict cognitive development almost two years later, so there's something probably quite meaningful for later development, and that really hasn't been shown much before," study leader Paul Ramchandani said in an Imperial College London news release. He is a professor at the school's department of medicine.

Study co-author Vaheshta Sethna said, "We also found that children interacting with sensitive, calm and less anxious fathers during a book session at the age of 2 showed better cognitive development, including attention, problem-solving, language and social skills." She's with the Institute of Psychiatry, Psychology & Neuroscience at King's College London.

"Our findings highlight the importance of supporting fathers to interact more positively with their children in early infancy," Sethna said.

While dads may not always garner the attention moms and babies do, the positive impact that devoted and engaged fathers have, is immeasurable on their little one’s life.

The study was published recently in Infant Mental Health Journal.

Story source: Robert Preidt, https://consumer.healthday.com/kids-health-information-23/child-development-news-124/does-dad-time-with-infants-boost-babies-iq-723168.html

Your Baby

Good News! More Infants Placed in Car Seats Correctly

2:00

More parents and caregivers are getting the message and placing their infants and toddlers in car safety seats correctly, according to new research.

For years, the American Academy of Pediatrics (AAP) has aggressively urged parents and caregivers to put their children in rear-facing car seats until they are at least two years old. The AAP’s education policy seems to be paying off.

The study found that infants placed in rear-facing car seats increased from 84% in 2009 to 91% in 2015. The percentage of toddlers aged 12-17 months being placed in rear-facing car seats also increased dramatically from 12% to 61% during the same time period.

"This study shows that child passenger safety education has been a success in making sure young children are positioned correctly in the car, but there is still room for improvement," Dr. Joseph O'Neil, medical director of the Automotive Safety Program at Riley Hospital for Children, Indiana University Health, said in a press release.

The researchers also found that the use of booster-seat use decreased from 72% to 65% for older kids from 4 to 7 years old during that time.

The study findings suggest educational programs to improve child passenger safety could focus on the gaps identified by the study, including the recommendation to keep children rear-facing in safety seats through age 24 months, to use booster seats through age 8, and the recommendation that children sit in the back seat through age 13.

Safercar.org has a video and step-by-step instructions on how to properly install a rear-facing car seat for baby’s safety.

AAP also offers “Tips for Parents,” in video and written media, for shopping for car seats.

The study will be presented today at the AAP’s National Conference & Exhibition in Chicago.

This research is good news for children! Proper use of rear –facing car seats and booster seats are the first line of defense in keeping children safer when they’re riding in your car.

Story source: Amy Wallace, https://www.upi.com/Health_News/2017/09/14/Study-shows-more-infants-toddlers-placed-in-car-seats-correctly/9381505417976/

Daily Dose

Mandatory Newborn Screenings

Newborn screenings vary state to state, however, this is currently under review by the federal governement.As you know, if you have had a baby, all babies undergo routine newborn screening for multiple metabolic disorders. The initial newborn screening test is performed on a heelstick blood sample in the first 24-48 hours after a baby’s birth and then the baby is typically re-screened after about 1-2 weeks as some of the metabolic  disorders are only detected after a baby has been on milk (breast or formula) for a while.

The use of newborn screening tests is not federally mandated, but varies from state to state.  In most cases states screen for somewhere between 25 – 30 tests routinely.  There is a push for these newborn screening tests to become universally  mandated  so that all states would be screening for the same diseases.  For instance, the state of Texas now screens for 29 diseases with the addition of screening for cystic fibrosis in December of 2009. There is an committee, the Secretary’s Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) that reviews requests from individuals or organizations to nominate a heritable disorder to be considered by the ACHDNC for inclusion in the recommended uniform screening panel.  The advisory committee adopted a list of 29 recommended conditions for inclusion to the uniform screening panel in September of 2005. At the end of January of this year the panel recommended to add severe combined immunodeficiency (SCID) to the uniform newborn screening panel. This is the first addition since 2005. While the newborn screen looks at diseases  that you may know more about such as thyroid disease, adrenal insufficiency, sickle cell disease and PKU (the initial screening test developed in the 1960’s) there are other less known diseases that may be screened for.  There were several diseases that the committee considered for inclusion, but SCID was the only disease that was recommended for inclusion.  SCID affects somewhere  between 1 in 100,000 to 1 in 40,000 newborns. This group of disorders is characterized by the absence of an immune system which results in recurrent infections which may be life threatening if not treated in the first months of life. So, when you have a new baby, check to see which metabolic diseases your state is screening for.  It does seem incongruous to me that a baby born in Florida may not be screened for the same diseases as a baby born in New York or Nebraska. A universal test seems to make sense so that ALL babies are treated equally and parents are not confused as to which disease process their baby has been screened for.  A baby’s possible life threatening disease should not be screened differently based upon the state they live in! That's your daily dose for today.  We'll chat again soon.

Your Baby

Infant Ear Infections Declining

2:00

Ear infections in infants are very common and can be quite unsettling for parents. The good news is that ear infections among U.S. babies are declining according to a new study.

Researchers found that 46 percent of babies followed between 2008 and 2014 had a middle ear infection by the time they were 1 year old. While that percentage may seem high, it was lower when compared against U.S. studies from the 1980s and '90s, the researchers added. Back then, around 60 percent of babies had suffered an ear infection by their first birthday, the study authors said.

The decline is not surprising, according to lead researcher Dr. Tasnee Chonmaitree, a professor of pediatrics at the University of Texas Medical Branch, in Galveston.

"This is what we anticipated," she said.

That's in large part because of a vaccine that's been available in recent years: the pneumococcal conjugate vaccine, Chonmaitree said. The pneumococcal conjugate vaccine protects against several strains of pneumococcal bacteria, which can cause serious diseases like pneumonia, meningitis and bloodstream infections.

Those bacteria are also one of the major causes of children's middle ear infections, Chonmaitree said.

She added that flu shots, which are now recommended for children starting at 6 months, could be helping as well. Many times an ear infection will follow a viral infection such as the flu or a cold.

Vaccinations "could very well be one of the drivers" behind the decline in infant ear infections, agreed Dr. Joseph Bernstein, a pediatric otolaryngologist who wasn't involved in the study.

Other factors could be having a positive impact as well, such as rising rates of breast-feeding and a decrease in babies’ exposure to secondhand smoke.

"The data really do suggest that breast-feeding -- particularly exclusive breast-feeding in the first six months of life -- helps lower the risk of ear infections," said Bernstein, who is director of pediatric otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai, in New York City.

There's also the fact that breast-fed babies are less likely to spend time drinking from a bottle while lying down, Bernstein noted. That position can make some infants more vulnerable to ear infections, he said.

The study findings were based on 367 babies followed during their first year of life. By the age of 3 months, 6 percent had been diagnosed with a middle ear infection; by the age of 12 months, that had risen 46 percent, researchers found.

Breast-fed babies had a lower ear infection risk, however. Those who'd been exclusively breast-fed for at least three months were 60 percent less likely to develop an ear infection in their first six months, the study showed.

But whether babies are breast-fed or not, they will benefit from routine vaccinations, Chonmaitree said. "Parents should make sure they're on schedule with the recommended vaccines," she said.

Parents can have a difficult time recognizing an ear infection in an infant or a child to young to tell them that their ear hurts.

Some symptoms to watch for are:

·      Tugging at the ear

·      Fever

·      Crying more than usual

·      Irritability

·      Child becomes more upset when lying down

·      Difficulty sleeping

·      Diminished appetite

·      Vomiting

·      Diarrhea

·      Pus or fluid draining from ear

Treatment for ear infections rarely requires medication, such as antibiotics, except when an infection is severe or in infants. 

According to the American Academy of Pediatrics (AAP), most children with middle ear infections get better without antibiotics, and doctors often recommend pain relievers -- like acetaminophen -- to start. But with babies, Bernstein said, antibiotics are often used right away.

The AAP recommends antibiotics for infants who are 6 months old or younger, and for older babies and toddlers who have moderate to severe ear pain.

The study was published online in the March edition of the journal Pediatrics.

Story source: Amy Norton, http://www.webmd.com/children/news/20160328/infant-ear-infections-becoming-less-common

Your Baby

Abusive Head Trauma in Babies, Toddlers Can Last a Lifetime

2:30

This is going to be a hard story to read, but don’t let that stop you. It’s difficult because it involves very young children who suffer head trauma because they are abused.   Sometimes, it’s an accident. Sometimes it’s because a parent or guardian loses control and angrily shakes an infant or toddler until brain damage occurs.  While you may never intentionally abuse your own child, you should know how to recognize the symptoms of an infant or toddler that has been shaken. That knowledge could save a child’s life or improve the quality of treatment they receive.

Half of children who experience a severe abusive head trauma before the age of 5 will die before they turn 21, according to a new study.

In addition, among those who survive severe injuries, quality of life will be cut in half, the study found.

What causes such terrible consequences? According to www.babycenter.com, when a caregiver shakes and injures a child, it's sometimes called shaken baby syndrome. Abusive head trauma (AHT) and shaken baby syndrome usually refer to the same thing.

When a child's head is shaken back and forth, his brain bumps against the skull, causing bruising, swelling, pressure, and bleeding in and around the brain. The impact often causes bleeding in the retina – the light-sensitive portion of the eye that transmits images to the brain.

A child with AHT may also have a damaged spinal cord or neck as well as bone fractures. The extent of the damage depends on how long and hard the child is shaken or how severe the blow to the head is. But in just seconds, a child can suffer severe, permanent damage or even death.

In the United States, "at least 4,500 children a year suffer preventable abusive head trauma," said lead researcher Ted Miller, of the Pacific Institute for Research and Evaluation, in Calverton, Md.

Among children with any abusive head trauma, including minor cases, one in three "will not survive to adulthood, and even the survivors will lose significant quality of life," Miller said.

For the study, the researchers surveyed parents, caregivers or pediatricians of 170 youngsters who survived an abusive head trauma to determine the victims' quality of life. The head traumas all occurred before the children were 5 years old. But, most -- about eight in 10 -- experienced the head trauma before they were 1 year old.

The majority  (71%) of the cases fell into the severe impact category. Moderate impact cases accounted for 13.5 percent and there were 16 percent that were listed as minor cases. 

Injuries caused by shaking a baby or toddler can be shocking. Almost one-quarter of children required a feeding tube, and 57 percent were blind or legally blind. Among the severe cases, 86 percent of the children lost their sight or needed corrective eye surgery, the report indicated.

"This article is a devastating reminder of how serious shaken baby syndrome is and how fragile these little ones are," said Linda Spears, vice president of policy and programs at Child Welfare League of America. She said children under 5 are much more likely to die due to abuse and neglect for several reasons.

"One is fragility of their little bodies, and another is that they have less ability to protect themselves," she said. "They're also less visible in the community because they rely on the people who abuse them. They're not in school yet and not seen in the community as much as older children."

Frustration is often the cause for shaking a baby. Parents can feel overwhelmed when their infant or toddler doesn’t stop crying. Potty training time is another trigger for some parents or guardians the study notes.

Parents of small children need a support system to help them through the rough times. Without one, things can get out of hand quickly.

"Shaken baby is one of the more devastating things that happen when people don't have what they need in terms of knowledge, skills, emotional maturity, concrete services and emotional support." Spears said.

She explained that "people feel incredibly inadequate in those moments, and if you have little support and little mentoring, frustration levels can get pretty high pretty quickly because parents feel upset and angry and need to feel like they can manage the situation."

The most common signs of abusive head trauma in an infant or young child are:

•       The child is not eating or is having difficulty feeding 

•       The child’s body is rigid; stiff, not flexible or feels firmly fixed.

•       The child’s eyes are glassy looking. They show no expression.

•       The child is unable to lift their head.

•       The child’s eyes are unable to focus on an object.

•       Vomiting

•       The child is lethargic.

•       The child seems constantly irritated.

In a second study, researchers tested the accuracy of a new screening method to identify which children's injuries were most likely caused by abuse.

By assessing four specific types of injuries to almost 300 children under 3 years old, the researchers determined that the method was approximately 96 percent accurate at identifying cases that were definitely caused by abusive head trauma.

Spears said providing education and support to parents, especially younger parents, is effective at preventing abusive head trauma and other forms of abuse, but it is a matter of identifying those families and getting them the support they need.

What should you do if you suspect a baby has been shaken in this way? Miller said you should report it to law enforcement or child protective services. Parents of children who may have been shaken, he said, should take their children to the emergency room, where immediate treatment may improve their long-term outcomes.

Both studies have been published in the journal Pediatrics. The newest study is in the online November issue.

Sources: Tara Haelle, http://consumer.healthday.com/head-and-neck-information-17/head-injury-news-344/abusive-head-trauma-in-babies-toddlers-can-have-lifelong-impact-693746.html

Karen Miles, http://www.babycenter.com/0_abusive-head-trauma-shaken-baby-syndrome_1501729.bc

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