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Daily Dose

The Dangers of Co-Sleeping With Your Baby

New parents are sleep deprived and even when being very careful, may roll over in their sleep or push a your-baby up against the wall or side of bed and cause accidental suffocation.With new data just published in this month's Pediatrics on the increase in deaths in infants related to accidental suffocation and strangulation in bed, it points out once again the dangers of co-sleeping. The "back to sleep" campaign that began in the mid-1990s after studies showed that children who slept in the supine position had a decreased incidence of SIDS. Since that time we have seen such a significant decrease in infant deaths related to SIDS.

It is seldom that I even have to re-iterate supine sleeping, as most parents seem to realize the risks associated with tummy sleeping. There is an occasional parent that thinks their child "sleeps better on their tummy" but the inherent risks far outweigh the risks of prone sleeping. This latest article and analysis of data shows that a new group of sudden unexpected infant deaths is now on the rise, and seems to be related to suffocation often secondary to an adult rolling on top of an infant or due to an infant who becomes entrapped between the bed and mattress or wall. These infants have all been co-sleeping with an adult on a mattress, couch, or even a waterbed. The American Academy of Pediatrics recommends that newborns sleep in their parents rooms, but in a bassinet or port-a-crib, and not in the parent's bed. New parents are sleep deprived and even when being very careful, may roll over in their sleep or push a your-baby up against the wall or side of bed and cause accidental suffocation. The rates of accidental suffocation have quadrupled in the last 10 years. We all want to be the best parent possible. If you have a newborn you know that there is nothing better than snuggling with your your-baby. But once cuddled, put your your-baby down to sleep on a firm mattress, in their own bed, without other pillows or blankets in their bed. The new tag line should be "back to sleep in their own bed!" That's your daily dose, we'll chat again tomorrow. More Information: Rise in Infant Suffocations Tied to Bed-Sharing

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Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Daily Dose

Crib Deaths

1:15 to read

Crib bumpers may cause deaths and should never be used!  A recent study in The Journal Pediatrics looked at the incidence of crib bumper related deaths from 1985- 2012.  The authors reviewed data from the U.S. Consumer Product Safety Commission (CPSC) and found that there were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods that had been reviewed. Bumper pads caused 48 suffocations of which “ 67% were due to the bumper alone and not clutter in the crib, and 33% of the deaths were due to wedgings between a bumper and another object in the crib”.  An additional 146 infants had sustained injuries from the bumpers, which included choking on the bumper ties or near suffocation.  

The study also looked at the number of CPSC reported deaths compared with those from the National Center for the Review and Prevention of Child Deaths, 2008- 2011. When using that data the total number of deaths increased to 77. 

While bumpers had been marketed to prevent a baby from falling out of a crib or to keep a baby’s arms or legs from getting stuck between the crib rails, in reality they cause injury and death.  In 2012 a national standard was revised which required that crib bumpers must be 2 inches in thickness or less.  At that time the thought was that “thinner bumpers” would be less likely to cause suffocation. But the recent study found that 3 of the deaths occurred in cribs that had thinner bumpers.   

According to Dr. N.J. Scheers, the lead author in the study, “these deaths are entirely preventable” if bumpers were not used and were not widely available.  But when flipping through a baby store catalog, or even shopping for cribs, parents  and grandparents) see beautiful cribs that are adorned with bumper pads!!  So, if they cause death why are they being sold?  Mixed messages are very hard for parents to understand. Concrete recommendations and guidelines save lives.  

Several cities and states have already banned the sale of crib bumpers and the CPSC is currently in the process of publishing new recommendations on how crib bumpers should be regulated. 

I don’t see the need for any more studies to show that bumper pads may cause deaths and injuries.  Clear guidelines from the AAP state, “bare cribs are the best”  and “all infants should be put to sleep on their backs”.  Save your money and your baby’s life…no bumpers.

Daily Dose

Babies Rolling Around in Their Crib

Many babies roll around in their crib, but should parents worry they will spend too much time on their tummy and not be able to roll on their back?I received an email from the parents of a 3½ month old daughter who has recently learned how to roll from her back to her tummy.  Their “conundrum”, as they put it, was twofold.  They were concerned about her sleeping on her tummy, as well as the fact that she would get upset after she rolled from her back to tummy and would then “scream loudly” So,what to do?

Most babies learn to roll around 4 months of age and like everything else there is variability in this milestone.  Many babies learn to roll tummy to back first, typically while they are having tummy time. Suddenly you realize that the baby has used their arms to push up and then over onto their back.  Watching them do this is fun, as they will often look up with big startled eyes almost as saying, “Wow, this is like an amusement park ride!”, while other babies will let out a shriek and start to cry as they were scared by the whole event.  Remember we are all different and some of us (me) like roller coasters that go upside down and backwards and others (one of my children) would still rather give up a week’s allowance than get on a ride like that. There are also babies, like the one in question, who learn to roll from their back to tummy first.  This often occurs at night and causes a lot of concern, as all parents hear from the beginning, put your baby “back to sleep”.  But, even when sleep positioners were being used (they are no longer recommended), many an infant would figure out how to roll from their back to get all cozy and sleep on their tummy. Once your baby has achieved this milestone on their own, you cannot keep them from becoming a tummy sleeper. It is important that you still put the baby to bed on their back, but after that your baby will begin to find their own sleep position which many times is at the opposite end of the crib and may be on their tummy. Trying to be a vigilant parent who turns the baby back over is an exercise in futility as they have a mind of their own and will just flip over again, which is not as cute at 3 am. . You do not  need a video monitor or check on your baby every 10 minutes to see if they have rolled during the night.  As an infant has learned to roll it is also assumed that they will turn their head to clear their nose and mouth and the risk of SIDS decreases. Now, in the case of the baby in the email, she loved to flip from back to tummy, but then it would make her upset and she would scream.  Every time the parents went in there and turned her over and settled her again on her back, she would flip over to her tummy again, and the screaming would re-start.  In this case, I think you have to let your baby fuss (scream loudly) for a few minutes to see if they will either roll back over or fall to sleep again. It is so hard to hear your baby so upset, but she got herself in this mess (first of many) and so it is the beginning of figuring out how to handle it. She will either cry or roll, and you can flip a coin to see which comes first. After she has cried for 5 – 10 minutes I would go back in the room, try to soothe her while she is on her tummy (remember she rolled there) and then see if she will calm down and go back to sleep.  This is going to take patience and time and some sleep deprivation (which you had hoped was past I am sure), as she learns to self-console again after rolling over.  The good news is that she has achieved an important developmental milestone with rolling over. Lastly, once your baby is rolling remember never to leave them unattended on the bed, changing table, couch etc.  I call this 4–6 month old a “floor baby” as it is best to leave them on the floor on a blanket while you run to get a diaper or answer the phone etc.  Many a baby, including my own, has rolled right off that bed to the floor, usually without sustaining any injury but causing a lot of parental worry and guilt.  That experience must be like a free fall ride at Six Flags! That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Baby

Sing to Soothe Your Crying Baby

1:30

Have you ever reached the end of your patience trying to soothe a crying baby? Next time, switch to singing instead of talking. You may be surprised at the results.

Researchers at the University of Montreal in Canada, found that infants respond sooner and stop crying longer when listening to a song instead of speech.

The small study involved 30 healthy infants, aged between 6 and 9 months. The purpose of the research study was to investigate how the emotional self-control of the infants would be influenced when they are exposed to music or speech.   

The researchers maintained the objectivity of the study by not using any sounds that could have been recognized by the children.

For their study, researchers at the University of Montreal in Canada, played Turkish music and two types of speech -- ‘baby-talk' and regular adult-directed dialogue to the infants.

Researchers deliberately chose a language and music that would be unfamiliar to the babies.

Mothers were placed behind the children to avoid contact and the environment cleared of any other possible stimuli.

After playing both the music and regular speech to the children, researchers found that singing was twice as effective at calming distressed babies compared to exposure to regular dialogue: Babies remained calm for an average duration of nine minutes before breaking out in tears, while dialogue -- both the ‘baby-talk' and adult speech -- kept them calm for less than half that time.

The findings are significant, authors note, because Western mothers speak more to their babies, than sing.

"Our findings leave little doubt about the efficacy of singing nursery rhymes for maintaining infants' composure for extended periods," said study co-author Isabelle Peretz in a statement.

"These findings speak to the intrinsic importance of music, and of nursery rhymes in particular, which appeal to our desire for simplicity, and repetition."

Next time your baby is cranky, don’t be bashful; break out all the nursery rhymes you know and sing away. It may be the just the sound your baby wants to hear.

The study was published in 2015 in the journal Infancy.

Story source: http://www.ctvnews.ca/health/singing-more-effective-than-talking-to-soothe-babies-study-1.2631472

 

 

Daily Dose

Breathing & Your Baby

1:30 to read

The first few weeks of a newborn’s life is usually a bit “cra-cra”, for both parents and the baby.  Once you leave the hospital with your newborn reality sets in pretty quickly, and you realize that your baby not only doesn’t sleep when you want them to but that at times they may seem to be noisy breathers when they are awake and/or asleep.  

 

As parents (and pediatricians) we play close attention to a baby’s breathing pattern and you may realize that they do some “weird” stuff.  For the first several months of life a newborn is an obligate nose breather.  Some of the noisiest breathing you may notice is when your baby is sucking and eating whether at the breast or from a bottle.  It is not always the quiet time you thought it would be. But, while they may be noisy, you need to look at their color and make sure that they are nice and pink.  Look at their lips and tongue if you are worried and both should be pink…never dusky or blue. 

 

Being a noisy breather does not necessarily mean there are problems. But, if a newborn has mucous in their nose or has refluxed some milk into the back of their throat you may hear some “congested” sounds which often cause parental concern. Again, look at the baby, open up their swaddle and lift up their gown and see what their chest looks like as they breathe.  A baby should look comfortable (even if noisy) and their ribs should not show as they breathe (which is called retracting), nor should you see their tummy (which may be full and protuberan) appear to be moving up and down with any effort.  Again, they should be  pink and well oxygenated.  Try to filter out the noise and watch the breathing!

 

Lastly, newborns have some “strange” immature breathing patterns as well. If you are watching closely you may see that they often seem to breathing normally and then pause before taking another breath. This is termed “periodic breathing of the newborn” and is perfectly normal…albeit a bit frightening. Your baby may pause for 5- 0 seconds before taking a breath which is then followed by several rapid shallow breathes. Sometimes this even occurs a few times in a row and then suddenly the normal breathing pattern returns. Again, your baby should not appear to have any change in color and their breathing pattern returns to “normal” without you doing anything at all. If you think that the pauses (apnea) are lasting longer than 10 seconds you need to call your pediatrician. With the advent of cell phone video I get many video clips of babies with periodic breathing.  The frequency of periodic breathing decreases as your baby gets older…and is usually gone by 2-3 months of age.

 

You will quickly get used to some “baby nuances” you never dreamed of and realize that even a tiny baby can be a noisy eater and sleeper!! 

 

 

 

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Daily Dose

Kids & Bedtimes

1.30 to read

As the summer winds down, my office is bust with back to school check-ups.  During these exams, I find myself asking a lot of questions related to a child’s sleep routines. Over the years I have always asked about sleep, and for so many  parents it is one of their main concerns.  

But what I have noticed is it seems children are going to bed later and later. I know the summer months are less scheduled for many families and children tend to get out of routines, but never the less, when I routinely ask, “during the school year what time does your child go to bed at night?” I am surprised by some of the answers.  And I am not talking about teens either, this is mainly the 5-13 year old set. (I do think teens need bedtime guidelines as well, that is a different discussion). 

As a working parent I totally understand and empathize with how busy the evenings are. I tell new parents that the evening hours between 6-9 pm are often the “witching hours” for newborns but I also see these same “crazy hours”  for most families once their children get to be school aged. (is this why cocktail hour was invented?)  It is the time of day for after school activities, homework to be done, dinners to be cooked and children to be bathed. Add in bedtime stories and/or reading by your child and it is CRAZY....but even so children need to have bedtimes appropriate for their ages.

Hearing that 5 year olds go to bed at 9 pm or that 10 year olds are up until 10 or 11 pm not only makes me tired but worries me as well that these children are not getting enough sleep. And the statement from frazzled parents, “they just won’t go to bed” makes me know just how important early good sleep habits are. Bedtime is a statement not a question!

While some children are just natural sleepers, others can be more difficult, but I am convinced that early good sleep habits help all children to be better and more independent sleepers.  Self soothing begins in infancy, but self calming and sleeping in your own bed is an important milestone as well. A child who awakens every night and ends up sleeping in their parents bed is disrupting both their sleep and their parents, which leads to irritable, unfocused and tired children and adults.

So, this seems to be a good time to re-look at bedtimes and adjust accordingly for your child’s age.  Once you get a good routine going, good habits are easy to continue.  

 

Daily Dose

Afraid Of The Dark?

Dr. Sue has advice on ways to help your child get over their fear of the dark.Just about every child goes through a phase when they become afraid of the dark.  It is interesting to see a toddler who happily goes to bed in their crib in complete darkness, turn into a 2 year old who is afraid of shadows and monsters in a dark room. How does that happen, seemingly overnight?

Actually fear is a normal part of development, and is usually  seen  in children around 2 -3 years of age. Fears develop when a child is old enough to have an imagination, but is not yet old enough to distinguish fantasy from reality.  Try telling your 3 year old “that ghosts aren’t real” and to “just go to sleep”, and I guarantee you will lose that discussion.

Fear of the dark is called “nyctophobia” and is amazingly common.  Even as an adult,  my worries and anxieties seem to be worse in the middle of the night in the darkness, than the same issues are during daylight hours.  A toddler has a very active imagination, which is also influenced by things that they see and hear  throughout the day.  Television shows and videos that they have watched or books that they have read may seem innocent enough during the day but may be a scary memory  at night. When a child goes to bed, even after a lovely, calming bedtime routine, there are few distractions to keep their minds occupied and their young brains go into high gear in a dark room. The shadows are definitely a witch that they saw in a movie, or the noise in the hallway is a “bad guy”.  They are very real and VERY SCARY. The best way to conquer fear is to discuss a child’s fears with them.  Talk about things that seem to make them afraid and turn off the TVs and stimulating videos.  Draw pictures of the scary thoughts and then have a party to throw them away.  By empowering them to talk about their fears will often help children feel better.  Teach them about positive self talk, with phrases such as” I am not afraid, it is just dark” or “I am not alone, Mommy and Daddy are in the other room”. Another strategy that worked in our house was the “bedtime box”.  We decorated a shoe box and filled it with things to help make our boys feel safe and able to handle their fears. In the box was a flashlight, extra batteries ( for the “what if the batteries go out” discussion), a magic wand and monster dust to sprinkle in the room (glitter), and their favorite books.  They knew this box was there every night if they needed it.  Children will also often want a night light and some may even want the lights on for a while, but let them feel like they are in control. Lastly, there are lots of books to read with your children about being afraid of the dark. Take a trip to the library, ask the librarian for suggestions. A few of our favorites were  “The Dark, Dark Night” and “Can’t You Sleep Little Bear”. Children’s fear of the dark usually resolves around 4 -5 years of age as their magical thinking matures. That's your daily dose for today.  We'll chat again soon.

Daily Dose

New Baby Questions!

1:30 to read

Lots of new baby questions this week in my office, so I that I thought I would cover a few of the most frequently asked by parents within days of bringing that precious newborn home from the hospital. So, here we go:

My baby has blue hands and feet…should I go to the ER?  The medical term for this is acrocyanosis.   It is not uncommon for a baby to have a bluish/purple discoloration to their hands and feet. This often occurs if the baby gets chilled or cold, whether that is after a bath or sometimes even after they are unswaddled to wake them up a bit to get them to eat.  If your baby has pink lips and tongue and seems otherwise fine this is the normal adjustment of a baby’s circulation and may last for a few weeks to months.  When parents are concerned about this and make a trip to the ER where they are discharged with the diagnosis of “worried well”.

What temperature do I need to have my thermostat set?  This question always makes me laugh a bit because some of it is truly dependent on the climate where you live. Many parents think they need to “crank up the heat” for a newborn, but actually a cooler room temperature has been shown to correlate with a reduction in sudden infant death (SIDS).  The “ideal” temperature that has been recommended is around 68 - 70 degrees, but for those of us who live in the south during the dead of summer, it is almost impossible to keep your house this cool and very expensive. At the same time, some parents are uncomfortable during the winter with the thermostat at 68 degrees…so I would recommend keeping your house comfortable and on the cooler side rather than too warm. You also do not need to bundle your baby when it is blazing hot outside, less is more if the house is hot.

What about a pacifier?  Mother’s come in and say, “I was told that I shouldn’t use a pacifier because it will cause “nipple confusion”.  While I am a huge proponent of breast feeding I think that a pacifier is also helpful for a breast feeding mother so that she does not use her own breast as a “human pacifier”. Many new moms come in to see me at the 2 week check up crying, exhausted and with bleeding nipples. They are putting their baby on the breast for hours at a time as “it seems the only way my baby is content”.  Although they were told that they could put their finger in their baby’s mouth as a way to help console their baby, that too does not provide much of a distance from the baby…even to go to the bathroom, take a shower or eat!! A baby has the reflex to suck which is termed, “non-nutritive sucking”.  This is one way that your baby will calm themselves.  So, once your baby is getting on the breast, I would buy a pacifier and “teach” your partner how to hold your baby in the position as if they were going to be fed,  but with a pacifier to suck on rather than the breast. Once situated you can try walking around, gentle bouncing or swaying while your baby is happily sucking on their pacifier. Mother gets a bit of a rest between feedings and infant is happy with a pacifier ( rather than a finger). We will discuss taking away a pacifier at another time! 

 

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