Infant Care

While in a doctor's office, parents sometime may not see or understand all the finer aspects of our physical examination. As we talk within the confines of the exam room, parents may easily miss ca a part of our examination of their child. After several years of performing hundreds of exams, physicians and nurse practitioners become quite thorough and efficient. Parents may be unaware that we examined parts of their child as we sequentially perform the exam. For example, an infant came to the office for a well-child checkup. Later that afternoon, the mother called to say, "I was worried that my baby has an ear infection, and forgot to ask the doctor to check her ears." However, we indeed HAD looked in the ears, but we were carrying on a conversation with Mom at the time. We had completed the ear exam before Mom was aware of it. Almost all health care professionals look inside the ear canal of practically every child. After all, middle ear infections are very common, even in so-called "well" children! Looking at the eardrums is "part-and-parcel" of practically every visit! Some physicians talk their way through the physical exam, so the parent knows what we are looking for. For example, "I'm now feeling his neck, looking for lymph nodes or enlarged thyroid gland,...etc. However, some of us find that repetitive and tedious - it's just not our style! Therefore, we want to assure you that we have a "mental check-off list" as we do every physical exam on a child. If you have questions regarding the finer points of our exam, we encourage you to ask - we want you to have all your questions answered.

Now you see it, Now you don’t!

A baby's sleep patterns change as she grows. According to Barry S. Zuckerman, MD, Director of the Division of Behavioral and Developmental Pediatrics at Boston City Hospital, infants need to learn to associate their crib with sleeping. If an infant falls asleep in her mother's arms, she is more likely to have problems falling back asleep when she wakes up in the middle of the night. Infants are more likely to fall back asleep if they awaken in the same place where they fall asleep. Infants typically awaken six to eight times every night. To help them fall back asleep quickly, parents should always put young infants into the crib while they are still partially awake. There has been a lot of interest recently in so called ‘attachment parenting ‘ which goes against the ‘don’t hold or rock the baby to sleep’ philosophy noted above. What we would say is none of these things are set in stone and you may have to find what works best for your baby. One aspect of attachment parenting that we would discourage is ‘Co-sleeping’ which has definitely been found to be dangerous. As the baby's nervous system matures, she is more likely to sleep through the night. Sleeping through has nothing to do with when they are started on solid foods or their weight. By age four months, most infants are sleeping six to eight hours a night. By six months most infants sleep 10 - 12 hours a night. Problems with separation and autonomy begin to affect sleep once babies are one year old. Fixed nighttime routines help older babies fall asleep easier because the routines appeal to the child's need for autonomy. Dr. Zuckerman studied the effectiveness of counseling new mothers to put their babies in the crib while still partially awake. He found that these infants awoke significantly fewer times during the night than infants whose mothers received no counseling on sleep habits and patterns

Getting the Baby to Sleep

Feeding Tips

Breastfeeding- Is It enough?

What determines how much breast milk a baby takes? Why do some infants consume as little as 450 grams of breast milk a day while others consume as much as 1,200 grams?

A four-day study of 73 exclusively breastfed, three-month-old infants concluded that babies themselves determine how much they consume. The amount of milk available was not a factor, as all infants left approximately the same daily amount of milk (about 100 grams) in their mothers' breasts, regardless of how much they fed.

A very good measure of how well your baby is breastfeeding is how often they urinate. A baby who has at least 4–6 wet diapers in a 24-hour period is generally feeding well

Training Breastfed Babies to Sleep Through the Night

A study showed that parents can help train their breastfed babies to sleep longer by following these guidelines:

Feed your infant around the same time each night (for example, between 10:00 and 11:30 p.m.).
Avoid picking your baby up during the night unless they have cried steadily for more than five minutes.
Avoid holding, rocking, or nursing your baby to sleep. Instead, place your baby in bed after the last feeding while still awake.
Help your baby distinguish between day and night by keeping daytime bright and active, while making the baby's room dark and quiet at night.

Breastfeeding & Bowel Movements

Moms who are breastfeeding for the first time, take note: your baby's bowel movement frequency will change.

During the first few weeks of life, breastfed babies often have several loose bowel movements each day. Around 1–2 months of age, some babies begin having bowel movements less frequently—once a day, every other day, or even once a week.

This does not necessarily mean your baby is constipated. Constipation means the stools are hard and dry. As long as the stools remain soft, infrequent bowel movements are common in breastfed infants during the first months of life.

Breastfeeding & Illness

The benefits of breastfeeding compared to formula feeding are well known. To further examine these benefits, doctors in Canada compared rates of pneumonia, ear infections, bloodstream infections, meningitis, gastrointestinal illnesses, and hospitalizations among breastfed and formula-fed infants during their first six months of life.

They found that breastfed babies had fewer illnesses across all categories. Formula-fed infants experienced approximately 50% more illnesses than breastfed infants. The researchers noted that because any baby receiving breast milk was included in the breastfed group—even those also receiving formula—the protective benefits of exclusive breastfeeding may actually be even greater.

While this study did not introduce entirely new findings, it reinforced what breastfeeding advocates have long recognized: breastfed babies tend to experience fewer illnesses during infancy.

Breastfeeding & Intelligence

Children who are breastfed tend to perform better in school than their non-breastfed peers.

Researchers at the National Institutes of Health followed 855 children born between 1978 and 1982 from birth through school age. Evaluations included mental and motor skill testing, interviews with mothers, and report card reviews.

By age two, children who had been breastfed longer demonstrated better coordination and higher cognitive scores. Infants breastfed for less than one month scored similarly to children who were never breastfed. By third grade, children who had been breastfed the longest had moderately higher English scores and slightly higher math scores.

Researchers believe that nutrients in breast milk, particularly lipids essential for central nervous system development, may contribute to these differences.

Diabetes & Milk

Why one person develops diabetes while another does not remains unknown. One theory suggests that introducing cow's milk early in infancy may increase the risk of developing Type 1 diabetes later in life.

More than 60 research articles examining this possible connection were reviewed. When the data were combined and analyzed, researchers found that early exposure to cow's milk may increase the risk of developing Type 1 diabetes by approximately 1.5 times. They also found that the longer a mother breastfeeds, the lower the child's potential risk of developing diabetes later in life.

Formula Advertising

There is no doubt that breastfeeding is the best way to feed infants. There is also no doubt that formula companies actively market their products.

For this reason, we choose not to display formula advertisements or promotional products in our office. However, we do have formula samples available for mothers who are unable to breastfeed or choose not to breastfeed.

Rotten front teeth in a young child are costly, unsightly, and painful. What is more important is that nursing caries is preventable. "Nursing caries" is the term applied to infants and toddlers who develop tooth decay at a young age. In almost every case, it arises, in major part, from poor nutritional habits perpetuated by the parents. In order for tooth decay to develop, at least two ingredients must be present: (a) certain bacteria, called Streptococcus mutans, must be present inside the mouth in large numbers. All of us have some of these strep germs in our mouths, but some children have larger amounts than others. In association with sugar, these bacteria are the culprits that do the actual damage to the teeth. (b) Frequent exposure of the teeth to sugar must occur for nursing caries to develop. For certain parents, it's easier to put a fussy child to bed with a bottle than it is to think about preventing rotten teeth. The same problem occurs when Mom puts Baby into bed with her at night so Baby can breastfeed almost continually. Remember, breast milk has sugar in it, too! Parents who use such techniques to pacify their infant do not realize that they may end up spending around $3,000 to fix these decayed teeth. Baby teeth are extremely important to guarantee proper development of the permanent teeth. Many parents who use the bottle or breast as a pacifier do so because they learned it from other parents or because it is a common habit among their friends or culture. If parents can break this one habit, however, they can save their child the pain, suffering, and embarrassment of having decayed teeth early in life.

Baby Teeth & Proper Feeding Habits

Honey should NOT be given to infants under 12 months of age; it can contain a toxin from a bacteria which can cause extreme weakness, so much so that the baby can't breathe! Evidently, older children and adults are "immune" to this protein. Weird fact: this same toxin is used to make Botox!

Honey

This has become a controversial subject recently. For a long time there was a belief that avoiding ‘allergenic foods’ in early life, i.e avoiding peanuts, eggs etc. for the first year- or even two years -reduced the development of allergies in children. This view has been challenged by some recent studies which have shown that the opposite may actually be true! There is also the ‘hygiene hypothesis’ which goes something like this: our lives have become ‘too clean’ with not too many kids exposed to ‘good ol dirt’ and germs and so, our immune system has nothing to do and starts attacking our own body causing allergic diseases. The jury is still out on this theory too! No one knows why children develop allergies, though many theories abound. Inheritance seems to play a role -Infants with either both parents or one parent and a sibling with allergies are at "high risk" of developing allergies themselves. By the way, these 'high risk babies' are the ones most benefitted by early introduction of these foods.

Hold the Eggs & Nuts???

The Solid Question

Microwaves are great little devices, but please be careful when warming drinks or foods for your children. Mouth burns have occurred, so test the food or drink (and that includes testing the temperature of warmed formula) before giving it to your infant or child!

Microwaves

We usually check a blood count somewhere within the first year of life or so, looking for anemia. Anemia in an infant or toddler is most commonly due to a relative lack of iron; that is, babies tend to "outgrow" their natural supply of iron. Of course, iron is quite important for the body when it manufactories red blood cells. So, it's not unusual for us to prescribe liquid or tablet iron supplements, with such brand names as FeoSol or Fer-in-Sol. If your child needs one of these supplements, there are a few points that you need to remember: a) Iron is poisonous if taken in overdose. If your 3-year-old decides to drink the bottle of iron (or the multi-vitamins with iron that some parents like to use every day), we're in big trouble!! If this sort of event happens, you'll become familiar with the term "stomach-pumping',' not to mention a hospital stay for 1-2 days! b) Iron stains the teeth temporarily black. To avoid this, some recommend that you mix the iron with a clear liquid like Coke or Sprite (not milk, since it decreases the intestine's ability to absorb the iron) and have your child suck the mixture through a straw. c) Iron does funny things to the bowel movements, such as turn them black, or cause constipation (some children have the opposite effect, and have diarrhea). We normally prescribe the extra iron for only 4-6 weeks, and then check another blood count. The benefits of taking the iron are definitely worth the hassles that you may experience. After all, anemic children tend to be more irritable, not as energetic, and may have a few more illnesses than those who aren't anemic.

Supplemental Iron

Immunizations/Vaccines

There are few topics that generate more questions or 'controversy' than vaccines. The word 'controversy' is in quotes for a reason-- from a rational, scientific standpoint, there is no controversy! It is only in popular culture and in the media that vaccines are a 'controversy'. The reality is that they are without a doubt one of the greatest advances of medicine and they have been responsible for eliminating or nearly eliminating a number of diseases that used to be the scourge of humanity for centuries.

We get a lot questions about the supposed 'dangers' of vaccines and we have answers for EACH ONE of those questions. The questions are many and there are literally books that can be written about this but here are some verifiable facts:
Numerous reputable studies in numerous countries involving thousands of children have come to the same conclusion: Vaccines do not cause autism. More and more research is showing that this devastating condition is caused by various factors including genetics, older age of the father, toxins during pregnancy etc--- but NOT vaccines.
The trace amounts of mercury in some vaccines (the polio vaccine) is NOT toxic because it is a miniscule amount and it is in the ethyl mercury form which is not toxic (methyl mercury is toxic). This might seem like a little difference but its the exact chemical difference that makes rubbing alcohol a poison and the alcohol in wine not a poison (methyl alcohol versus ethyl alcohol)! Some amount of mercury is present in all of us. A baby will received more mercury from her mother's milk than she will receive from all the vaccines in the first year of life put together.
The chicken pox is "just the chicken pox" and no bid deal except for the 1-2 children every year who die from severe skin infections of the chicken pox spots.
"I have never had the flu vaccine and neither have my kids and they have been fine." That is the same as saying "I have been driving without a seat belt for years and have been fine, so I am going to continue doing the same".
We are very passionate about ensuring the good health of all 'our kids' and vaccines are a very big part of that effort. So much so that since 2012, we have a policy that if a parent does not want to vaccinate their child at all, we respectfully ask them to find another practice for their child.

When to see the doctor: How can I tell when my baby needs to see a doctor? A study at Yale Medical School identified five symptoms of serious illness that may require immediate medical attention:
1. Your baby cries much more (or much less) than usual, and the crying is louder or more intense.
2. Your baby behaves differently: She is much more cranky and restless and can't be calmed, or she is uncommonly quiet.
3. Your baby's sleeping habits have changed noticeably. Your baby is either very pale or very flushed.
4. Your baby is dehydrated. Dehydration is very dangerous in an infant, and it is important to get a doctor's advice immediately. Tip: If her nostrils, lips and cheeks seem dry to the touch, she may be dehydrated. Also watch for a decrease in urination, or crying without tears.

Illnesses

When to See a Doctor for a Fever

When Should I Bring My Child in for Fever? We have a few "hard and fast" guidelines about seeing your child for evaluation of fever:
(1)Any child under 3 months of age with fever should come in as soon as possible. These infants are at higher risk for having a more serious infection, such as meningitis or bloodstream infection.
(2) Any child who has fever and has other symptoms that you see as serious such as persistent vomiting, serious coughing, etc.

(3) Any child who has had fever for over two or three days for which you are uncertain of the cause.
(4) Any child who has been seen by us for fever in the past 48-72 hours but who still has fever. Remember that fever is simply one sign of illness and is not the "only" reason for which you should seek medical attention. It's the general condition of your child which is the main factor in determining whether you should come to see us. In other words, if your child looks sick, we need to see him in the office for an exam! As is usually the case, very few events in life - including episodes of childhood fever - have straight-forward answers! When deciding whether your febrile child needs to come to our office, you will, many time, have to trust your better judgment. Of course, if you ask us via a phone call, we will almost always say to "Come In" because it is very difficult for us to tell what is happening without examining your child.
Nightime, Fever, & Babies: Infants under 2-3 months of age are susceptible to more serious infections, such as blood stream infection, pneumonia, or menigitis. For this reason, most physicians feel that such a young infant should be seen fairly quickly once the parent has noticed a fever of 101 degrees or over. If you notice in the middle of the night that your infant under 3 months old has a fever, some physicians would even advise a trip to the Emergency Room. Otherwise, an older infant with a fever can usually wait until the next morning to see us in the office. Emergency Room visits for a child with fever are, of course, dependent on how ill the infant looks and the anxiety level of the parent!