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Daily Dose

Bathing Your Baby

The end of summer baby “boom” is still going on and new parents are coming in with all sorts of questions…including how do I bathe my baby?  As many mothers and their babies are being discharged from the hospital after 24 hours, they really don’t have the opportunity to “practice” new parent skills, including giving their baby a bath.

Bathing your baby is really fun and is a good bonding experience for parent and child.  The bath also keeps your baby clean and smelling “sweet”.  I was convinced that it would also help them to relax and to sleep longer (not scientific at all - but it works for us right?).  At any rate, you can bathe your baby every day or every 2-3 days, or even once a week. It is really personal preference…but that wonderful “after bath smell” makes me smile.

Many people buy infant bath tubs and there are tons to choose from. I like the the “Puj Tub” or the “Tummy Tub” as you can easily put them in the kitchen sink (grandparent friendly), but you want to make sure that there are no sharp edges or places where a baby might get bumped or injured when you put the tub in the sink.  Some people use a folding tub (be careful not to pinch the baby) or inflatable tub  these may collapse), because they are easier to store if you have limited space.

The number one rule for a bath - NEVER leave your baby alone in the tub, not even when they can start sitting up. A baby may drown in an inch or two of water…so never even turn around to check your phone or check an email.  You should also make sure that the water temperature is correct and every new parent should check the hot water heater and lower the temperature to 120 degrees F, so prevent burns. Regardless, always check the water temperature before you put the baby into the tub.

I am also a fan of using mild soaps..including Cetaphil, Cerave, Aveeno, and Aquaphor  baby wash. If your child tends to have sensitive skin it is best to avoid fragrances and harsh chemicals.  I also like to moisturize the infant after a bath with baby lotions from these same companies. New data is showing that frequent moisturizing (twice a day) may also be important in preventing allergies later in life…. so why not enjoy some baby massage…and keep watching for more information on this issue.

 

 

Daily Dose

Hurricanes & Your Health

1:30 to read

The last week has been a tough one for Texans, and especially for those who live in Houston and along the Texas Gulf Coast.  Having my son, brother and mother all with houses in Houston, I have been watching the “Harvey” situation quite closely. Fortunately, my family is lucky enough not to have flood damage and they have not had to leave Houston.  But, too many other families have suffered flooding and have been forced to evacuate their homes and seek refuge in shelters not only in Houston, but in Dallas where I live as well. 

 

There are many families who are now living in very close quarters where they may be for sometime…as it will take weeks and months if not years to recover from this disaster and to rebuild the homes, schools, churches and businesses that have been either damaged or destroyed. 

 

The necessary relocation of families and children into shelters is also “a perfect storm” for the possibility of the spread of infectious disease. This is an important time in which managing the spread of illness and infection is paramount. What this means is that EVERYONE needs to be up to date on their immunizations to prevent the spread of vaccine preventable diseases. 

 

If you have ever “skipped” a vaccine by choice or missed a vaccine, now is the time to get your child’s vaccines updated. This is not only for those who have had to evacuate, but for everyone, as infectious diseases are spread outside of the shelters and as well.  We pediatricians are working in the shelters to try and make sure that everyone is vaccinated as they arrive, but there are those who are too young to be vaccinated and others who do not have their medical records to ensure accuracy of their vaccines. It is an arduous process.

 

But, for the public health system which will be stretched even more so during the flood recovery, vaccines are one of the most important ways to protect people. It only takes one person who might get mumps, measles or whooping cough to spread it to hundreds of others….all living in close proximity. These people will then also leave their shelter to go to school, church the store or even a temporary job where they may put others at risk, you never know if you might be exposed.

 

Lastly, it is really time to get those flu shots!!! The last thing we need is an early flu season with a large group of un-immunized people…and most doctors have already received shipments of flu vaccine.

 

Please please pray for these families who have lost so much and protect everyone by immunizing your children (and yourself).  

 

 

Your Baby

Moms Getting Poor Advice on Baby’s Health Care

2:00

Moms are getting conflicting advice on infant and child care from family members, online searchers and even their family doctors a recent study found.

Oftentimes, that advice goes against the American Academy of Pediatrics (AAP) recommendations for topics such as breast-feeding, vaccines, pacifier use and infant-sleep, researchers say.

"In order for parents to make informed decisions about their baby's health and safety, it is important that they get information, and that the information is accurate," said the study's lead author, Dr. Staci Eisenberg, a pediatrician at Boston Medical Center.

"We know from prior studies that advice matters," Eisenberg said. Parents are more likely to follow the recommendations of medical professionals when they "receive appropriate advice from multiple sources, such as family and physicians," she added.

The researchers surveyed more than 1,000 U.S. mothers. Their children were between 2 months and 6 months old. Researchers asked the mothers what advice they had been given on a variety of topics, including vaccines, breastfeeding, pacifiers and infant sleep position and location.

Sources for information included medical professionals, family members, online searches and other media such as television shows. Mothers got the majority of their advice from doctors. However, some of that advice contradicted the recommendations from the AAP on these topics.

For example, as much as 15 percent of the advice mothers received from doctors on breast-feeding and on pacifiers didn't match recommendations. Similarly, 26 percent of advice about sleeping positions contradicted recommendations. And nearly 29 percent of mothers got misinformation on where babies should sleep, the study found.

"I don't think too many people will be shocked to learn that medical advice found online or on an episode of Dr. Oz might be very different from the recommendations of pediatric medical experts or even unsupported by legitimate evidence," said Dr. Clay Jones, a pediatrician specializing in newborn medicine at Newton-Wellesley Hospital in Massachusetts. He said inaccurate advice from some family members might not be surprising, too.

Mothers got advice from family members between 30 percent and 60 percent of the time, depending on the topic. More than 20 percent of the advice about breast-feeding from family members didn't match AAP recommendations.

Similarly, family advice related to pacifiers, where babies sleep and babies' sleep position went against the AAP recommendations two-thirds of the time, the study found.

"Families give inconsistent advice largely because they are not trained medical professionals and are basing their recommendations on personal anecdotal experience," Jones said.

Less than half of the mothers said they used media sources for advice except when it came to breastfeeding. Seventy percent reported their main source of advice on breastfeeding came from media sources; many of these sources were not consistent with AAP recommendations.

In addition, more than a quarter of the mothers who got advice about vaccines from the media received information that was not consistent with AAP recommendations.

"Mothers get inconsistent advice from the media, especially the Internet, because it is the Wild West with no regulation on content at all," Jones said.

The possible consequences of bad advice depend on the topic and the advice, Jones said.

"Not vaccinating your child against potentially life-threatening diseases like measles is an obvious example," he said. "Others may result in less risk of severe illness or injury but may still result in increased stress and anxiety, such as inappropriately demonizing the use of pacifiers while breast-feeding."

Mothers who look for information online should stick to sources such as the AAP, the American Academy of Family Physicians or the U.S. Centers for Disease Control and Prevention, Eisenberg suggested.

Even though some advice from doctors did not follow AAP recommendations entirely, Eisenberg and Jones agreed that doctors are the best source for mothers on the health and care of their children.

"While our findings suggest that there is room for improvement, we did find that health care providers were an important source of information, and the information was generally accurate," Eisenberg said. "But I would encourage parents to ask questions if they don't feel like their provider has been entirely clear, or if they have any questions about the recommendations."

The study was published in the July edition of the journal Pediatrics.

Source: Tara Haelle, http://www.webmd.com/parenting/baby/news/20150727/new-moms-often-get-poor-advice-on-baby-care-study

 

Daily Dose

Are Parents Too Connected?

1.30 to read

Has your spouse, babysitter or other child care provider ever called you to come home “because the baby is crying”?  It seems that technology, which is readily at our finger tips 24/7, has created yet another dilemma - what to do if a baby is crying? 

Pre-cell phone days, there really was not much to do if you the parent left home and your baby/child started crying.  Outside of calling the restaurant, store, movie theater (directly), and asking them to page a parent, most of us just muddled through a crying child.  I also think that in most cases, said child eventually stopped crying (unless there was an obvious reason that could be “fixed”) and by the time you the parent returned home, all was typically well.  

But now, with a cell phone in every hand, it only takes one call to summon the parent of a crying child.  I think this is a good news/bad news dilemma.  The good news is: parents may feel more comfortable leaving their child with a babysitter, knowing that they may be reached in the event of an emergency.  The bad news is:  is a baby or child who is only crying, typically an emergency?  Depends on your definition. 

The reason I bring this up is that I often hear young parents, and especially mothers, tell me that during the first several months of their infant’s life, they cannot leave the house for more than minutes, before being called home....because the baby is crying.  Some of these mothers are really “stressed out and exhausted” and need a bit of a get-away to “re-boot”. I am not talking about a trip to the day spa. I am simply talking about an hour or 2 to go to the store or meet a friend for lunch or just sit alone in the park and read a book.  Just a bit of quiet after being home with a baby day in and day out for the first 4 weeks of their newborn’s life.  If you have been there you understand. 

But, now that they have a cell phone, there is CONSTANT communication.  The minute the baby cries, the cell phone rings....”the baby is CRYING, come home.”  My husband would tell you that his best parenting started the first time I left him alone with our first son and I actually went away for the weekend.  (I believe the baby was 6 or 7 weeks old and off I went breast pump in hand to a reunion.)  No cell phones then, and guess what, he did a great job!!!!  He told me how after the first 24 hours he figured out that he really didn’t have to have the baby in the bathroom with him in order to take a shower. He later told me that the first shower he took, not only was our son in the room in his “bouncy” chair, but he left the shower door open as the door got steamy and he couldn’t see the baby!! How cute is that. 

Technology, as wonderful as it is, may also enable us to “cop out” when things get a bit difficult.  That goes for parenting as well. 

Turnoff your phone off sometime and let the “other parent” or babysitter handle it for awhile. Being disconnected is NOT always a bad thing!

Parenting

Labor Day Safety Tips!

2:30

Traditionally, Labor Day is the fond farewell to summer and a welcomed hello to autumn. Lots of people will be on the roads, having backyard or park reunions, grilling, swimming and basically enjoying family and friends get-togethers.

To make this Labor Day a safe one, here are some tips that can help keep you from having to make a trip to the ER on this special weekend:

Road Safety.

-       Before you start out on a trip, make sure that your vehicle is in good condition, and see that any necessary maintenance is performed.

-       Just as adults and kids should always wear a seat belt, infants should always be properly secured in car seats.  

-       Be sure to follow all traffic laws while on the road, and use extra caution while driving in construction zones.

-       Be vigilant about paying attention to the road, and avoid distractions such as cell phones. Even just a momentary look away from the road can drastically increase your chances of a crash.

-       Be mindful of other vehicles on the road and remember to keep a safe distance between your vehicle and others. Keep in mind that semi-trucks, for example, require more time to come to a stop than cars do, and have large blind spots.

-       Keep an eye out for motorcyclists. Motorcycles are more difficult to see because they are smaller and can swiftly move in and out of traffic.

-       Even though you may have GPS, keep a map in the car and road flares in the trunk.

Food Safety. Picnics, barbeques, and neighborhood potlucks are plentiful and that means so is the chance of food-borne illness. To minimize the chance of cross-contamination:

-       Wash your hands before and after you touch raw meat.

-       Dry your hands on paper towels instead of cloth towels, and discard immediately. Refrigerate meat that’s waiting to hit the grill.

-       Never leave food that requires refrigeration (think potato salad, coleslaw or chicken salad) out in the sun. Instead, set the item the bowl is in on top of a pan filled with ice, and serve from a shaded area.

-       Return the item to the refrigerator as soon as guests have been served.

Boat Safety. Lots of folks will be heading to the lake for a family and/or friends boating adventure over the Labor Day weekend. Make it a safe one with these suggestions:

-       Have your boat in good mechanical condition and have all safety equipment on board such as personal flotation devices, an emergency kit and a first aid kit.

-       Stay away from restricted areas.

-       Make sure someone on land knows when you leave, about what time you’re expecting to return, where you’re headed and who all is on board.

-       Take a fully charged cell phone with you.

-       Everyone should have a life-vest on, including infants.

-       Maintain safe speeds and keep a lookout for hidden objects below the waterline

-       Maintain a 50-foot distance from other boats, swimmers, docks and the shore unless operating at an idle speed.

-       Install a marine-grade CO detector in your boat

-       Keep a flashlight and fresh batteries available.

-       Choose a designated driver before launching. Passengers that drink alcohol should drink in moderation.

-       Have plenty of water on board to avoid dehydration.

Pool and Water Safety. Pools and lakes are another place you’ll find plenty of people this Labor Day. That means lots of children will be in the water as well. It’s always best if someone knows CPR, if you don’t know it now – make a point of the family taking CPR classes together soon.

-       Appoint a “designated watcher” to monitor children during social gatherings at or near pools or water.

-       Have a fully charged cell phone with you. Call 911 immediately if a child is found unconscious in water.

-       Keep rescue equipment poolside or with you at the lake. Don’t wait for the paramedics to arrive because you will lose valuable life-saving seconds. Four to six minutes without oxygen can cause permanent brain damage or death.

-       Have a first-aid kit close by.

-       Maintain constant visual contact with children in a pool or lake or near a pool or lake. If a child is missing, check the water first; seconds count in preventing death or disability.

-       Never use flotation devices as a substitute for supervision. 

-       Don’t assume you’ll hear a child who’s in trouble in the water; child drowning is a silent death, with no splashing to alert anyone that the child is in trouble.

-       At public pools, use one that has a lifeguard. While not a substitute for parental or caretaker supervision, the more eyes available, the better.

Whether you’re splashing in a pool, enjoying the ultimate picnic or enjoying a ride on a boat, we want you to stay safe this Labor Day weekend. Remember: An accident is never planned. But keeping out safety tips in mind may help prevent one.

Story sources: http://www.cooneyconway.com/blog/road-safety-labor-day-weekend

https://www.safewise.com/blog/7-safety-tips-for-an-injury-free-labor-day/

http://www.nationalwatersafetymonth.org/water-safety-tips

Parenting

Labor Day History for Kids

2:00

For younger Americans, Labor Day signals the end of summer and the beginning of a new school year. Communities, families and friends often celebrate with parades, parties and cookouts.  Many children and young adults don’t know the significance of Labor Day and how it came to be. Here’s a brief history that can help explain this national holiday to youngsters.

Labor Day is also known as the “workingperson’s holiday.” That’s because it was created to celebrate and honor hard working Americans that helped build this great country.

So, how did Labor Day come to be? It began in the 19th century.

During the second “Industrial Revolution” America was experiencing an explosion of new and exciting ideas and inventions. In the late 1800s lots of people from rural areas and farms, as well immigrants from other countries, moved into the cities looking for work. This population explosion completely altered the landscape of the American city.

One of the most historical inventions was the creation of the assembly line – a way for workers to make more products quicker and cheaper.  Another major change was in transportation. The steam engine allowed trains to carry products and passengers faster and farther than ever before. Coal became the primary source of power to move the train engines, heat buildings and generate electricity. With an abundance of people looking for jobs, factory and mine owners had plenty of willing workers to choose from. While this may have been good for the owners, it was not so good for the workers.

During these times, many people labored very long hours, with little pay, in unsafe factories and mines to produce the products needed. Even children as young as six years old worked all day in the same factories and mines and made even less money than the adults. Their jobs were physically and mentally hard as well as dangerous.

As conditions worsened, the workers decided they needed better and safer places to work, higher wages and an age limit on who could be hired. They formed groups known as unions to help make this happen. Sometimes the union workers would hold marches and protests to complain about the bad conditions and low pay. It wasn’t long before unions grew in membership and spread to different trades (or jobs) around the country.

To accomplish the changes the unions wanted, members organized strikes, protests and rallies. Some of the factory, companies and mine owners fought against the unions by firing the members, bringing in new workers and hiring people that would attack the protesters. On several occasions, police officers were involved in breaking up the protests or removing union workers. Sometimes the protests and strikes became very violent and people lost their lives or were severely injured. It was a very difficult time for people standing up for the right to work in a safe place, for a reasonable amount of time and to be paid an honest wage.

On September 5, 1882, almost 10,000 workers marched to Union Square in New York City marking the first unofficial Labor Day parade in U.S history.

Every year after that, this celebration of workers became more popular in other parts of the United States. In 1887, Oregon was the first state to pass a law making Labor Day a holiday. The same year, other states such as Colorado, Massachusetts, New Jersey, and New York also began passing laws recognizing Labor Day as a holiday.

Seven years later, in 1894, Congress passed an act that made Labor Day a national holiday. From that time till now, the first Monday of September is dedicated to celebrating the bravery and tenacity of American workers.

Happy Labor Day from the KidsDr!

 

Your Child

Young Kids Overdosing on Dietary Supplements

2:00

It’s no surprised that the majority of American adults now take one or more dietary supplement daily. During the last decade, many households have switched from a simple multivitamin to more specific supplements for different dietary needs. It’s become a billion dollar industry even though many scientific studies have shown mixed results on the effectiveness of supplements on a person’s health.

What may surprise you though is the number of children that are accidently overdosing on dietary supplements found in the home. Children under the age of 6 are the most affected.

A typical scenario might play out like this.  A curious toddler opens a bottle of melatonin found on the kitchen counter, and accidentally overdoses on a supplement typically used by adults to help with sleep.

In that case, the doctor who treats the child may only have to deal with a very tired 3-year- old, but it might have been a far more serious scenario if a different dietary supplement, such as the energy product ephedra or the male enhancement herb yohimbe, had been swallowed.

"We see it all the time," said Dr. Barbara Pena, research director of the emergency medicine department at Nicklaus Children's Hospital in Miami.

From 2005 through 2012, the annual rate of accidental exposures to dietary supplements rose in the United States by nearly 50 percent, and 70 percent of those exposures involved young children.

"The biggest increase [in accidental overdoses] was in children under 6. It got our attention," said study author Henry Spiller, director of the Central Ohio Poison Center of Nationwide Children's Hospital in Columbus. Ninety-seven percent of the time, the children swallowed the supplements while at home, the study found.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements, so there is no guarantee that the ingredients listed have been tested or that they are what they claim to be. The FDA can only take action if the supplements are shown to cause harm.

During the 13 years of the study, Spiller's team also found an increase from 2000 to 2002, when the rates of calls to U.S. poison control centers involving supplements rose 46 percent each year. From 2002 to 2005, the researchers found the rates of calls declined. Spiller suspects that is because the FDA banned ephedra in 2004, after supplements containing it had been linked with adverse heart events and deaths.

Overall, only about 4.5 percent of the cases in the study had serious medical outcomes. During the 13-year period tracked, 34 deaths were attributed to supplement exposure, Spiller said.

The supplements most often associated with the greatest toxicity were ephedra (ma huang,) yohimbe (found in male enhancement supplements and other products) and energy drinks and drugs.

Ephedra is now banned, but yohimbe is not. Nearly 30 percent of yohimbe exposure calls in the study resulted in moderate or major harm. Yohimbe can cause heartbeat rhythm changes, kidney failure, seizures, heart attack and death, the researchers noted.

Often, children find the supplements on a kitchen counter, Spiller said. Parents and others may equate dietary supplements with being natural, and therefore safe. Parents usually don't keep track of how many pills are left in a supplement bottle, he said, making it more difficult to tell poison control staff how many pills were taken in an accidental exposure.

Adolescents are also susceptible to overdosing on energy products loaded with caffeine and other ingredients that can cause abnormal heart rhythms or even a heart attack. 

Both Spiller and Pena suggest that parents and caregivers treat supplements the same way they do prescriptions or O-T-C drugs.  Keep all supplements in a locked cabinet or on a high closed shelf if young children are in the house or likely to visit.

Supplements are especially scary, Pena noted, because it's not always possible to know the potency of the product.

The study was published in the Journal of Medical Toxicology.

Story source: Kathleen Doheny, http://www.webmd.com/children/news/20170725/us-kids-overdosing-on-dietary-supplements#1

Daily Dose

Constipation

1:30 to read

Constipation is a topic that every pediatrician discusses….at least weekly and sometimes daily. It is estimated that up to 3% of all visits to the pediatrician may be due to constipation. Constipation is most common in children between the ages of 2 and 6 years. I have been reading an article on updated recommendations for diagnosing and treating common constipation. The most important take home message is “ most children with constipation do not have an underlying organic disorder. Diagnosis should be based on a good history and physical exam for most cases of functional constipation”.

 

Like many things in medicine….the evaluation and treatment of constipation has also changed a bit since the last guidelines were published in 2006. It is now appropriate to define constipation with a shorter duration of symptoms (one month vs two) and some of the most common diagnostic criteria (Rome IV Diagnostic Criteria) include the child having less than 2 stools/week, painful or hard bowel movements, history of large diameter stools (parents will tell me their 3 year olds “poops” clog the toilet), and some may have a history of soiling their underpants. 

 

By taking a good history you can avoid unnecessary tests..including X-rays which are not routinely recommended when evaluating a child with possible constipation.  In most cases physical findings on the abdominal exam will confirm the diagnosis in combination with the history. I often can feel hard stool in a child’s left lower quadrant and when asked the last time they “pooped”, no one can really recall. 

 

The preferred treatment is now polyethylene glycol (PEG) therapy. PEG is now used to help “disimpact a child” as well as to maintenance therapy.  Where as enemas were often previously prescribed, PEG therapy has been shown to be equally effective in most cases, is given orally and is much less traumatic (for parent and child!). PEG works by drawing more water into the stool, causing more stool frequency. There are many brands of PEG including Miralax and GoLytely among others. Miralax works well for children as it is tasteless and odorless and can easily be mixed in many liquids without your child knowing it is there. 

 

The guidelines now state that for children with functional constipation maintenance therapy with PEG should continue for as least 2 months with a gradual tapering of treatment only after a full month after the constipation symptoms have been resolved. I usually tell parents that this is equivalent to about how long it takes for them to forget that they have been dealing with constipation….and then begin tapering.

 

Lastly, there is no evidence that adding additional fluid or fiber to a child’s diet is of benefit to alleviate constipation….although it may “just be good for them in general”.

 

 

Parenting

Back-to-School Jitters

2:00

Where did the summer go? Some children will be headed back to school in less than a week and others within the next couple of weeks. It’s not uncommon for kids to be a little anxious as the big day draws near. Your child may be feeling a lot of emotions right now, ranging from high anxiety to  “I can’t wait.” That's understandable. Think back on how you felt when you started a new job or were moving to a new part of the country, it’s quite similar but without the benefit of life experience to help you process the changes.

Besides the unknown of a new school year, there’s the challenge of getting back into an early morning routine and the addition of after-school activities to everyone’s schedule. It’s a hectic time but with a lot of patience and a little smart planning, it can go smoother than you might think.

If your child’s school offers an orientation or back–to-school night, one way to help ease your little one’s fear is to take them and let them see the school, meet their teachers and say hello to some fellow students before classes begin. A familiar face or two can help make the transition go a little smoother during that first week of school.

If your child is able to meet his or her teachers, give them time to talk and get to know each other, if only briefly. Let your child answer any questions the teachers have instead of answering for them. You might even help your child come up with a few questions they can ask the teacher.

You could check with the teacher and see if he or she would mind having a picture taken with your child. As school day approaches, you can show it to your child talk about meeting their teacher. A little thing like that can help your child develop a familiar feeling for the teacher before school starts.

Since it’s always a good idea to read to your youngster, choose books with a back-to-school theme. There are lots of children’s books that tell meaningful stories about kids facing the challenges of moving to a new school, the first year of school, making new friends and lots of other possible scenarios in story form.

Get organized! Easier said than done, I know. If you’re organized and ready for school it not only relieves some of the pressure on you, but for your children too. Chaos or uncertainty about where to go and what to do adds fuel to a child’s concerns about whether everything is going to be OK or not. 

Let your child help create a study area in the home. Being involved in at least some of the decisions can help make this a personal adventure that they have some say in.

All kids need enough sleep and getting into a good sleep routine can help ease them into the changes school is going to require. As you already know from experience, a tired child is more likely to feel overwhelmed, nervous and cranky.  If you haven’t already, start the new bedtime routine now so that you don’t have the arguments and resistance during the first days of school when everyone is trying to find their footing.

The main thing to remember is that your child, whether it’s their first day to attend, or their last year of school, is going to feel a little jittery. Reassure him or her that everything is going to be fine. The new schedule, classmates, studies and activities will be familiar sooner than they think. Let them know that you understand how the unknown can be a little scary, but that this is also a time when good things can happen as they explore all their new opportunities. 

 

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