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Your Baby

Infants That “Resettle” Sleep Better and Longer

2:00

Does this sound familiar?

You finally get your baby to fall asleep and shuffle off to bed yourself. Just as you’re drifting into a deep sleep (say about 45 minutes after you’ve laid down), you hear the cries of your little one. She’s awake and letting the world know it.

The dilemma becomes, do you get up and rock her back to sleep or let her “cry it out” and see if she’ll go back to sleep on her own?

According to a new study, infants who know how to “resettle” after waking up are more likely to sleep through the night.

When a baby “resettles” or self-settles, they have learned how to make themselves fall back asleep without the help of a parent or guardian. While many parents just can’t bear to listen to their baby cry, others find that with patience and a few changes to their baby’s sleep routine, resettling takes effect and their infant is able to fall back to sleep quicker and sleep longer without assistance.

For this study, British researchers made overnight infrared video recordings of just over 100 infants when they were 5 weeks and 3 months old.

The videos were analyzed to determine changes in sleep and waking during this age span, a time when parents hope their baby will start sleeping more at night, while crying less.  “Infants are capable of resettling themselves back to sleep by three months of age,” according to the study by Ian St James-Roberts and colleagues of the University of London. “Both autonomous resettling and prolonged sleeping are involved in ‘sleeping through the night’ at an early age.”

The “clearest developmental progression” between video recordings was an increase in length of sleeps: from a little over 2 hours at 5 weeks to 3.5 hours at 3 months. Only about 10% of infants slept continuously for 5 hours or more at 5 weeks, compared to 45% at 3 months.

At both ages, about one-fourth of the infants awoke and resettled themselves at least once during the night. These infants were able to get back to sleep with little to no crying or fussing.

“Self-resettling at 5 weeks predicted prolonged sleeping at 3 months,” the researchers write. Sixty-seven percent of infants who resettled in the first recording slept continuously for at least 5 hours in the second recording, compared to 38% who didn’t resettle.

The 3-month-old babies were more likely to suck on their fingers and hands than the 5 week old infants. Sucking seemed to be a self-regulatory strategy that helped them fall back to or maintain sleep.

When a baby wakes up and cries throughout the night, parents are the ones that end up exhausted. Letting your infant learn how to resettle make take a little extra effort at the beginning, but can reap the reward of more sleep in the long run.

Letting your baby learn how to resettle doesn’t mean they are not attended to when there is a need, such as when they need changing, hungry or are ill.

Babycenter.com has a good article on how to teach your baby to soothe him or herself to sleep. The link is provided below.

The video study was published in the June edition of the Journal of Developmental & Behavioral Pediatrics.

Sources: http://www.sleepreviewmag.com/article/babies-can-resettle-likely-sleep-night/

http://www.babycenter.com/404_how-do-i-teach-my-baby-to-soothe-himself-to-sleep_1272921.bc

 

 

Your Baby

New Guidelines for Newborn Genetic Screenings

2.00 to read

Certain medical conditions can be present at birth but not easily identifiable. Metabolic or inherited disorders can impede a child’s normal physical and or mental development in lots of different ways. Without even knowing that they are carriers, parents can pass on the genes that produce these types of disorders. That’s where genetic screening of newborns comes in. With a simple blood test doctors can tell if the newborn has a condition that may eventually cause the child problems. Some of these disorders, if treated early, can be managed.

The federal government has not set any national standards, but many states have mandatory newborn screening programs. Parents can opt out of genetic testing if they want. Parents should discuss genetic screening with their pediatrician or child’s doctor so they can weigh the pros and cons.

Many states screen for more than 30 disorders and the screenings are often covered in the delivery and hospital charges. If a parent wants expanded testing on their newborn, they may have to pay an extra cost but it may be worth it to their baby.

To help guide states and parents determine what criteria should be used for genetic screening, the American Academy of Pediatrics and the American College of Medical Genetics and Genomics just offered new guidelines.

The new guidelines say that all newborns should be tested for the genetic diseases that are included in their state's newborn screening panel, but anything beyond that is up to parents and the decision must be made in the child's best interest.

The recommendations distinguish between genetic testing for childhood onset conditions versus those for adult onset conditions.

"There is an important role for counseling before and after genetic screening," added policy author Dr. Lainie Friedman Ross, a pediatrician and ethicist at the University of Chicago. "The focus should be on education of families, counseling them and helping them make decisions that focus on the child's best interest."

Testing for disease in the presence of symptoms is another area addressed by the new recommendations. "Clearly, if a child has symptoms, we need a diagnosis to help the family make clinical decisions that are in the child's best interest. This is important even when the disease has no current therapies," Friedman Ross added.

She also said that the results should be explained to the child when they reach the appropriate age.

New technology offers direct-to-consumer genetic screening tests, but the authors caution parents about using these products because of a lack of oversight and results are open to interpretation.

Some experts agree that being forewarned is being forearmed, but are not fans of the direst-to-consumer genetic tests.

"We highly discourage these even on adults, and particularly on children, because there is nobody there to provide counseling and interpretation," says Dr. Joyce Fox, a medical genetics doctor at North Shore University Hospital in Manhasset, N.Y. “These can also be very costly, and are likely not covered by insurance." Fox says.

Parents should educate themselves about genetic screening before the baby is born.  Most babies are born healthy and glide right through the genetic screening. But there are cases when the genetic testing panel reveals serious conditions such as PKU or Sickle Cell Anemia. 

If a baby’s screening results are negative, it means the tests did not show any signs of the conditions in the screening. On the other hand, if there are any positive results, it means there are signs of one or more of the conditions included in the screening,

A positive result does not always mean that the baby has the condition. It does mean though, that further testing is needed to make a final determination.

Early treatment for some of the conditions screened for can prevent serious future complications; so don’t delay if more tests are needed.

Pediatricians and geneticists say they approve of the new guidelines. The guidelines were published online in the journal Pediatrics.

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Sources: Denise Mann, http://consumer.healthday.com/Article.asp?AID=673692

http://kidshealth.org/parent/system/medical/newborn_screening_tests.html#cat150

Your Teen

Young Male Athletes, Parental Pressure and Doping

1:45

When 129 young male athletes, whose average age was 17, were asked what would make them consider “doping” as a way to boost their athletic ability – the majority said parental pressure.

A new study from the University of Kent in England asked the young male athletes about their attitudes on "doping" -- the use of prohibited drugs, such as steroids, hormones or stimulants, to increase athletic competence.

These substances, sometimes called performance-enhancing drugs, can potentially alter the human body and biological functions. However, they can be extremely harmful to a person's health, experts warn.

The study group was also asked about four different aspects of perfectionism. The areas were: parental pressure; self-striving for perfection; concerns about making mistakes; and pressure from coaches.

Only parental pressure was linked to positive feelings about doping among the athletes, the study authors found. Although the study was small, it did point out how important demanding expectations from parents can be to kids. 

Lead author of the study, Daniel Madigan, a Ph.D. student in the university's School of Sport and Exercise Sciences, said the findings suggest that parents need to recognize the consequences of putting too much pressure on young athletes in the family.

"The problem of pressure from parents watching their children play sports is widely known, with referees and sporting bodies highlighting the difficulties and taking steps to prevent it," Madigan said in a university news release.

"With the rise of so-called 'tiger' parenting-- where strict and demanding parents push their children to high levels of achievement -- this study reveals the price young athletes may choose to pay to meet their parents' expectations and dreams," Madigan added.

The researchers only focused on young men for this study but plan to investigate if the same result will occur with young female athletes, and if there are differences between athletes in team versus individual sports.

The study findings are scheduled for publication in the April print issue of the Journal of Sports Sciences.

Story source: Robert Preidt, http://teens.webmd.com/news/20160229/young-athletes-pressured-by-parents-may-resort-to-doping

 

Daily Dose

Parenting is Hard

1.30 to read

Did you read the online article about a mother selling her 4 tickets to the One Direction Concert on eBay? It seems that it may have been a hoax but the gist of the matter was this “fake” mother was selling tickets that she had purchased to take her daughter and friends to the concert. In the online post, the mother (using some very inappropriate language) said that she was selling her tickets to punish her daughter for her inappropriate behavior. 

I applaud parents who do set boundaries and limits which also means having consequences when children break the rules. In many circumstances taking away something often teaches children a lesson.  I disagree with posting it all over the internet. This is a discussion that can and should happen in the home, between parent and child (of any age), rather than sharing the issue and humiliating their child. 

I often relate a similar story with my own children when talking about consequences with parents. When my boys were about 7, 5 and 2 we had tickets to breakfast with Santa and a parade after that. The older boys had been before and really looked forward to this annual event.  They were at the age that they constantly bickered and fought (often) and it just wore me out. 

The day before the event I told them that if they did not stop fighting they would not go to breakfast with Santa.  Well, it must not have been an hour later that the older two were fighting and I said, “that’s it, you are not going to see Santa or the parade!”  I picked up the phone and called a friend who had two children and asked if she wanted to join us the following day to see Santa.  The following day the 2 year old and I left the house and the 7 and 5 year old starred out the window crying as I backed out of the driveway.  I will never forget those sad faces. I was equally sad as I too loved taking the kids to this annual, but they had just pushed and pushed. They still say they remember that punishment and my friend still has the picture of her kids on Santa’s lap! 

The moral of this is really two fold. A parent’s job is to be a parent and at times it is hard, really hard. But teaching children about consequences for their choices and behavior is one of the most important jobs a parent has. With that being said, humiliating your child is never appropriate, even when you are pushed to the limits.  Being a parent means you can’t resort to acting like your child.

Daily Dose

Leaving Your Child Home Alone

At what age can you leave your child home alone?

I get asked this question a lot "At what age can I leave my child home alone?"  There is no simple answer but a progressibe one.

I tend to think most children are ready to spend 20-30 minutes alone at home between the ages of 10-11, but every child is different.  It depends on a number of things including how your child feels about being alone, the length of time, and if you and your child have discussed how to handle emergencies and getting a hold of you or a neighbor in case there is an emergency or even just a question that needs to be answered.  

Well, this topic brought up an interesting question, what do you do when you leave your child alone and there is not a home phone?  I have never even given that a thought as I am “old school” and still have that landline in my house. It just gives me a “good feeling” to know that it is there, even if it rarely rings. (although the kids know to call the home number as I typically turn off the cell as soon as I hit the door from work).   

More and more families have given up a home phone and I think this brings up so many different topics for discussion, but for starts how does your child call you when you leave them alone?  Or how do they call the trusty neighbor if they need something.  Do you get them a cell phone? Do you have to have an extra cell phone to have at home?  It seems to me that a home phone is important for just that reason. In case of an emergency, your child can pick up the phone and call for help, assistance or just a friendly voice. I don’t think they need a cell phone!  

Also, landlines are relatively inexpensive. Cell phones for 8,10, 11 year olds?  Sounds inappropriate and expensive.  Wouldn’t it be easier to keep a home phone so children can learn to answer a phone, use good phone manners, and when you are ready to let them stay at home by themselves for a few minutes, there is always a phone available. I don’t know, just seems easy solution to me.    

What do you think? I would love to hear from you!

 
Daily Dose

Mom Judging

1:30 to read

This whole “mommy judging” is really becoming too much!  The latest involves Christy Teigen and her decision to go out to dinner 2 weeks after the birth of her daughter.  Why is she being judged about going out with her husband?  Even a new mother needs to eat!

When I am seeing a newborn for their first visit to the pediatrician I spend a great deal of time talking with the baby’s parents about the stress of having a newborn. While there are so many “highs” after bringing a new baby home, there are also the “lows” of feeling overwhelmed, sleep deprived, and feeling as if you aren’t prepared to be a parent (even after taking every class and reading every book).  For many parents just hearing that they are experiencing “normal” emotions is reassuring.  

During these discussions (while I am usually rocking that sweet newborn) I also inquire as to whether there are family or friends nearby,  or any other help in the home…knowing that “all hands on deck” can be a wonderful feeling when you just need a break, and yes, every parent, especially new parents need to have “a break”.  Whether that is a nap, or a long shower, or a quick trip to the store to pick up that special “sleep sack” you know will help your baby sleep…a break is healthy.  

A new mother also needs to eat and sleep to ensure that she is making milk in order to successfully breastfeed her newborn.  I remember being a new mother, even 30 years ago, and skipping meals because I was either “too tired”  to eat or “too busy” and my husband being wonderful and saying, “your Mom is going to keep the baby for an hour or two while we go out for a quick dinner!”.  While I am sure that I had a bit of trepidation about leaving our son,  and also figuring out how to nurse him just before we darted out the door,  I went!  The good news was that there were no cell phones or social media to interfere with our “new parent” quiet dinner out. i did not have to call home or text every 30 seconds to check on the baby, and my mother was quite capable of babysitting for an hour or two. No one was posting a picture of us leaving our baby, or commenting that I was “ a bad mother” for leaving my home….in fact, the whole event went unnoticed.  What I also remember is the feeling of re-connecting with my husband (who was also a new father), and having a quiet, nutritious dinner which re-energized us for another long day or night….

But now fast forward to 2016 and the CONSTANT connection with the world!!  Add in a celebrity who is being photographed day and night and whose every move is discussed and dissected. In this case being judged as a new mother for going out to dinner.  Christy did not take her new baby out to a crowded restaurant (you know how I feel about that), nor did she leave her baby home unattended.  She did not put her baby at risk at all. What she did do, was go out for dinner with her husband, albeit with lots of paparazzi following her. Going to dinner does not mean she “is an unfit mother”, it has nothing to do “with bonding with her baby” or “neglecting a newborn”.  So, she didn’t get to make a choice on her own, she didn’t put the issue out there for public comment either….she simply went out to dinner. Enough…leave her and other new mothers alone.

 

 

Daily Dose

Sick Child? Have Patience

1:30 to read

I just got off the phone from texting with the mother of a 3 year old patient of mine. It was late in the afternoon and her son had just started crying that his mouth hurt.  I was texting her from the back of a car en route to the airport..the wonders of technology!

She was concerned because the pain had come on so abruptly, but she text me that he did not have a fever, had not had a fall or trauma to hurt his mouth, and that when he opened his mouth she could not see anything that would cause “obvious pain”.  

I asked her a few more questions via text and recommended that she might try giving him a dose of ibuprofen and see if he calmed down and felt better, but I did not hear back from her for awhile.

It was then that I realized that pediatrics and parenting have quite a bit in common…one of the similarities being patience.  

While she was concerned that her child had suddenly started crying due to some sort of pain, much of pediatrics is about watching and waiting.  We parents all want to keep our children pain free, but sometimes things will hurt both physically, and as your child gets older, emotionally (which may be even worse to watch).  A parents first instinct is to find the cause of the pain and “fix it”.  Whether that means a band aid, a kiss on a boo-boo, or medicine.. “just make it better”.

But in many cases in pediatrics and actually all of medicine, it is about watching, following, and waiting, which is not as easy as it may sound. Doctors, parents and patients often have to “be patient” and see what evolves.  Not all tummy aches are cases of appendicitis, not all falls cause a concussion and not all boo-boos result in broken bones (thank goodness!).

But for a parent to hear “let’s see what happens in an hour or so” may sound like a lifetime and waiting just seems crazy when there is a “doc in the box” on every corner.  You may see where I am going with this.

So, by the time I heard back from this concerned mother, she was already at the nearby “doc in the box” waiting for a doctor to see her son, who by now had stopped crying.  She had already put him in the carseat for the drive to the clinic before she read my text, so he had not even had any ibuprofen.

According to the clinic doctor (or nurse), the child “had an ear infection causing his pain” and she was given a prescription for antibiotics.  Once the mother was home and I could talk to her I asked if they had prescribed medication for pain relief, such as ear drops and/or ibuprofen. She said she only had the antibiotic prescription which she had filled, but her child had stopped complaining of pain.

So, I was not there, and did not see her child, but I wonder if ibuprofen might have done the trick and alleviated his pain..and also kept him off of an antibiotic until he could be seen the following day in the office?

But in this age of “quick” medicine and a clinic on every corner,  a patient/parent may not need to wait and see what evolves. I wonder if this “quick” medicine may be one reason we see antibiotic overuse . I’m just saying….  

Your Baby

Prenatal Exposure To Pesticides

1.30 to read

Moms exposed to higher levels of pesticides have lower mental development scores. Children whose mothers had higher levels of exposure to a substance found in a commonly used pesticide were more likely to get lower scores on a mental developmental test at 3 years of age than children whose mothers were exposed to lower levels or not at all, new research says.

Megan Horton, a postdoctoral research fellow at Columbia University's Mailman School of Public Health in New York City, and her colleagues followed 348 mothers from low-income areas of New York City whose prenatal exposure to pyrethroid insecticides -- found in pesticides commonly used around the home -- was tracked. The researchers measured not the common pyrethroid called permethrin but rather piperonyl butoxide (PBO), a chemical added to permethrin that boosts its potency, Horton said. They measured PBO because permethrin is metabolized quickly and difficult to measure, she added. The study authors measured the mothers' prenatal exposure by taking air samples or blood samples. To get the air samples, mothers wore backpacks that collected air from their breathing zone, which was then analyzed. Children were then put into four groups or "quartiles," depending on the level of their mothers' exposures to PBO during pregnancy. At age 3, the children were evaluated using standard scales to assess their cognitive and motor development, according to the study published online Feb. 7 in the journal Pediatrics. "Kids who were in the highest quartile range of exposure to PBO were three times as likely to be in the delayed category, compared to kids with lower exposure," Horton said. Horton's team compensated for factors such as gender, ethnicity, education of the mothers, and toxins such as tobacco smoke in the home. Horton said it's impossible to say what levels of pesticide are safe, partly because many factors come into play, such as the type of pesticide used and the ventilation provided. She did not have data on the frequency of pesticide use. "I don't know whether the mothers used it five times a week or once a week," she added. Pyrethroid insecticides have replaced another class of bug killers, known as organophosphorus (OP) insecticides, Horton said. Increasing pesticide regulations from the U.S. Environmental Protection Agency have resulted in fewer residential exposures to OP insecticides, she said. But, pyrethroid insecticides have not been evaluated for long-term effects on the body after low-level exposure, she said. Jennifer Sass, a senior scientist at the Natural Resources Defense Council, who reviewed the study but was not involved with it, said the findings ''should convince every parent and want-to-be parent to avoid these pesticides." Horton suggests that parents turn to so-called integrated pest management, which includes common-sense measures to control pests such as eating only in home eating areas, not bedrooms; keeping cracks and crevices in the house repaired to keep out pests; using trash cans with a lid and liner to contain garbage; and storing food properly. You can also find piperonyl butoxide (PBO) in medications used for treating scabies (a skin infestation) and lice infestations of the head, body, and pubic area. Some of the products containing piperonyl butoxide (PBO),are listed below. Check with your physician before using these products if you are pregnant. •       A-200 Lice Control® Topical Spray (containing Piperonyl Butoxide, Pyrethrin) •       Lice-X Liquid® Topical Solution (containing Piperonyl Butoxide, Pyrethrin) •       Pronto® (containing Piperonyl Butoxide, Pyrethrin) •       Pyrinyl® (containing Piperonyl Butoxide, Pyrethrin) •       R & C® (containing Piperonyl Butoxide, Pyrethrin) •       RID® Medicated Shampoo (containing Piperonyl Butoxide, Pyrethrin) •       Stop Lice® Maximum Strength Medicated Shampoo (containing Piperonyl Butoxide, Pyrethrin) •       Tegrin-LT® (containing Piperonyl Butoxide, Pyrethrin) Triple X Pediculicide® Medicated Shampoo (containing Piperonyl Butoxide, Pyrethrin)

Daily Dose

Power of Medical Attorney While Away

When you're out of town, make sure you prepare a medical power of attorney for your child's caregiver in case of an emergency.It is the time of year for family vacations and I have noticed many parents are also opting for a little vacation time for themselves too! (I tell my patients it’s important).  I have recently seen a number of grandparents and family babysitters bringing their “charges” into the office for a visit while mom and dad are out of town.

Have you prepared a temporary power of attorney so that in case of am emergency your child can receive medical care when you leave town? In reality, you should always leave a notarized letter that states who legally has the right to seek medical care for your children. Why does it seem like a 2 year old always gets a fever within 2 days of their parent’s departure?  While your long standing pediatrician may not require this document to see your child for an office visit while they are under the care of grandparents, there are times when it might really be needed. If your child needed surgery, stitches or even a trip to the ER to rule out a broken arm, the emergency room will require the letter that states that the caregiver in question has the authority to seek medical care for the under age child. In most cases a parent could be reached by cell phone, even in very remote areas of the world, but on the occasion that the parents cannot be reached this document will be needed. So, why not be prepared? We used to leave the letter on the front of the refrigerator with the names of everyone that might have the need to take our child to the hospital or doctor. The same letter was there for years, and included not only the grandparent’s names, but also friends and neighbors who would be available if necessary.  We had it notarized and updated as necessary, and thankfully I don’t think it was ever used. (My children always seemed to get hurt with me around!) Before leaving for an adult trip, you should leave the numbers of the pediatrician, the dentist, and any other doctors that your child routinely sees. It is also helpful to leave a copy of the medical insurance card! Seems you can’t do anything without it! Lastly, include the phone number for your pharmacy. For the very organized, you might also leave directions on how to get to the doctor, pharmacy or hospital etc. I have drawn many a rudimentary map for a lost grandparent who is now going to have to head from my office to the pharmacy to get the pink medicine filled. In most cases, the child is already well before the parents even return! That's your daily dose for today.  We'll chat again tomorrow.

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DR SUE'S DAILY DOSE

Just how much sleep does your child need?

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