Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

That's your daily dose for today.  We'll chat again tomorrow. 

Daily Dose

Your Baby's Umbilical Cord

1.15 to read

I get a lot of phone calls several days after parents head home with their newborn regarding their baby’s umbilical cord.  The umbilical cord really is the lifeline for the baby for 9 months, but once the baby is delivered, and the cord is clamped, it becomes a nuisance and “grosses” many parents out.  So often parents don’t even want to touch the cord and one of my patients told me....”why can’t it just dry up and fall off immediately?”. My only answer to that is, “God did not make it that way?”.

So, in a nutshell the umbilical cord is made up of 3 blood vessels, actually 2 arteries and one vein.  When the cord is cut and clamped the vessels begin to clot and eventually the cord detaches, typically in 7-14 days and then falls off.  

In the interim the cord is developing a scab so it may “ooze” a bit and there may even be dried blood on the baby’s diaper or around the edge of the cord.  A tiny bit of blood is to be expected, and parents don’t need to be worried that the baby is bleeding!!!  I like to explain that it is the first time as a parent that you might need to clean off a little blood, the same way that you will again when this sweet newborn becomes a toddler and falls down and skins their knee.

On occasion the hospital forgets to take the cord clamp off before the baby is discharged and the family comes in with the baby for their first visit with the cord clamp still on.  Poor parents have no idea that this is typically removed before discharge...somewhat like leaving the store with the magnetic tag on the outfit....just no alarm to let you know it is still there. In that case they are amazed when we pop off that yellow or blue plastic attached to their baby!

Lastly, the newborn baby can have some time on their tummy, if they are awake, even with the remnant of the cord still on. It will not hurt the baby at all and early tummy time is important...just NOT when a baby is sleeping!

I have to admit that I opened the baby book 30 years later and that dried umbilical stump was in there..Yes, I too was a first time mother.....don’t save it!

Daily Dose

Your Child's Sitter

1.15 to read

Do you ever leave your child with a babysitter or caregiver? Weird question right? But some parents never want to leave their child with someone else....and I am not sure that is healthy for either parent or child.   

I recently had this discussion with parents of a 3 year old child who was having a terrible time with separation anxiety. While many children go through stages of separation anxiety, by the time a child is 3-4 years they are typically past this stage. When I was talking with this family they told me their child had never been left with anyone.  

I guess as a working mother I was incredulous. What? Had the parents never gone out to dinner or to a party, a concert, lecture  or even on a night away for some much needed “couple” time?  They told me that they would occasionally call in grandparents but typically took their child everywhere with them.  (I think there are many places such as movies, adult restaurants, and other venues that might not want the 2 year old in tow).   I suppose some would say the child was fortunate, but I really believe that as a child reaches age 2ish they need to begin learning to separate from their parent. Not for days or weeks, but for either a play group, a pre school program, the gym nursery or something where the child is learning a bit of independence.   

While some parents are quite fortunate that they don’t have to leave their child to go to work every day, the concept of leaving your child for any hour or two with a trusted babysitter should not cause anxiety for the parent and ultimately not the child. Separation is an important milestone, as your child learns that while you may leave for an hour or two, you always return. There is security in that knowledge. They will also learn how to interact with  other adults and children, which is often different than they do with their own parents.  (Ask any teacher about that phenomena). 

Autonomy and independence are typically traits that parents desire for their children.  Parents also need to have some autonomy as well.....I think this makes for a better parent child relationship in the long run.  Little steps in separating become bigger steps as a child grows older....starting with a babysitter or nursery for an hour or two on occasion is often the beginning. 

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

Daily Dose

Ebola in U.S.

1:30

It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.

 

Daily Dose

No More Food Battles

1.30 to read

Seems that I spend several times a day discussing “food battles” with my patients and their families.  I guess the longer I practice the more I don’t think we should even have to discuss how often parents “battle” with their kids about eating.  

From the early days of parenting when a baby is first offered either breast or formula, they are not asked “do you like this?”.  It is taken for granted that an infant will eat and grow and  there you have it.  The easiest days of parenting, correct? (except for a few months of sleep deprivation).  But once that baby begins to eat the discussions start about “he makes a face when he eats spinach”, or “she will only eat chicken tenders from Chik-fil-a”, or “he only likes pasta and won’t eat meat”, or even “I make 3 diferent meals for my 3 kids”.  If you have a child older than 9 months you understand what I am talking about. 

Food is necessary to nutrition, growth and health. But, with that being said, parents have to trust that a child WILL EAT when they are hungry.  Really, hunger drives us all to eat, eventually.  That bowl or cereal, or the steamed vegetables or even the dreaded chicken breast will get eaten if your child gets hungry enough. I remember reading somewhere that , “ a parent’s job is to provide food for their children at appropriate meal times, and child’s job is to decide if they will eat it.”  In other words, make the meal whether for your toddler or teen and “forget about it”.  Meal time needn’t be a battle but more a gathering to enjoy being together eating is just a bonus.  

As an adult, when you go to a dinner party, you don’t ask what they are serving before you accept, nor do you tell the host/hostess, I hate lamb!!  (my example).  You just smile and find something to eat and there is not a battle.  We all need to approach family meals as a dinner party. Our children are our guests, and sometimes they like what we fix and other times they push some food around their plate and choose not to eat.  The good news for most children is that there is another meal to follow. 

So, think about it and don’t let certain food likes and dislikes dictate mealtime. The more foods young children are exposed to the better chance they have of EVENTUALLY becoming a well rounded eater.  Children’s taste buds change with time as well, so you will find some foods that a 3 year old loved is no longer the favorite at 13 years of age.   

Well balanced, nutritious, colorful meals are the family goal and “food battles” can be left out of the vocabulary.   

Daily Dose

Insect Bites are Everywhere!

1.30 to read

We are definitely in the “dog days of summer” and despite temperatures above 100 degrees (not just here in Texas either), it seems that insects thrive in hot weather. The mosquitoes here are just horrible and I see at least 2-3 patients a day that come in because their children have been bitten by “some bug”, most of which I believe are mosquito bites. 

I have been surprised that so many of the parents who are bringing their children in to have their bites checked are not using any insect repellent.  They seem shocked that their child can be bitten just walking into day care, or while on the playground for just 10 minutes, or even while they are in the pool.  It only takes a second for that mosquito to swoop in and bite and you never even know it until you see that swollen bite later that day or even in the next morning. (It’s a mystery why children seem to have bigger reactions to the bite and plenty of of local swelling).  Many parents are convinced that there are bed bug bites, but I truly believe these are just pesky mosquitos.  I even got one the other morning while walking out my front door just to get the morning paper! 

The best way not to “worry” about bites is to prevent them. For infants who are usually in a stroller I would use mosquito netting to start.  It is easy to drape their carseat or stroller as you go outside.  But as a baby gets older and is now outside more, and for those toddlers and older children the most important thing is to pick a mosquito repellent and use it.  

If your children are going to camp or day care, use it in the morning before they are going outside.  Reapply in the evening as well if you are going to spend time outside as well. You do not reapply insect repellent throughout the day like you do sunscreen, so pick the strength of  repellent based on the amount of time you will be outside.  Products with DEET, picardin, and oil of eucalyptus may be used in children (age dependent).  See www.cdc.gov for a listing of insect repellents by brand.  

Fortunately, to date (through the end of July  2013) there have only been a total of 53 cases of West Nile virus disease in people, with 3 deaths in the U.S. (Compare to 2012 with 5,674 cases of disease and 286 deaths).   

While 35 states have reported WNV activity much of the middle of the country is not evening reporting activity (maybe we should all move for a few months). This is all great news. But we still have a lot of summer left, so keep using precautions and drain that standing water around your house as well ...this helps the entire community.

Daily Dose

Babies Do Not Need Water?

1.00 to read

With the temperatures sizzling across the country, I have started to get the question, “how much water does my baby need to drink during the hotter months?” 

I have to admit, I am still confused as to where this medical myth was started?  Babies, even in warm to hot weather can stay hydrated just by their breast milk or formula intake. An infant does not “need/require” extra water in order to stay hydrated during spring and summer months. Many young moms tell me that the grandparents are asking about more water. 

An infant can get all of the hydration they need from their mom’s breast milk or formula intake as there is free water in the milk.  The best source of hydration for a healthy baby is via their milk intake. This is true for babies who are eating baby foods but are still taking a bottle or getting breast fed as well.  

I know that when the weather warms up we may drink more water with exercise or when out in the heat. But a baby is not an athlete (yet) and they are not really losing more water via sweating etc like our older children do. 

It is okay to offer a baby a bottle of water, but they don’t “need” extra water. In many cases an infant won’t even drink plain water as they prefer their mother’s milk or formula and the water just dribbles out of their mouth as you try to get them to drink it. Don’t think that they “need” 8 12 ounces of extra water a day. Someone started this little rumor. 

The bottom line? If you think you need to change your baby’s fluid intake for the warmer weather you can cross that one off your worry list! But, if you have children who are going outside and playing, or adolescents who are participating in outdoor sports, it will soon be time to start thinking about keeping them hydrated during the heat.  More on hydrating your active kids and athletes to come.  Stay tuned! 

That’s your daily dose for today.  We’ll chat again tomorrow. 

Daily Dose

No Power, No Problem

1.30 to read

t has been a really crazy two week around Dallas.  Not only did we have the first Ebola case, we were hit with thunderstorms which resulted in many homes without power, including mine. I quickly learned a lot about living without power, and just how much we depend on technology.

Of course I was on call so I needed to have the cell phones charged and after a night of darkness and sleeping with windows open hoping for cooler temps, (which did occur)I realized that my phones were almost dead, and how do you take all without a cell phone?   So where do you head?  Straight to Starbucks for coffee and power....somehow my nearby Starbucks had power.  After an hour of charging and waiting for the sun to come up I returned home to get ready for a day of rounds and office patients.   I did try to navigate flashlights all over the floor to try and shower in the dark, trust me.....not a good idea.

While over 300,000 households in Dallas didn’t have power one of  the most interesting lessons I learned was how different generations “cope” without power. Both of my sons were also without power and the oldest has the sweet newborn (my first grand baby!) so they too were navigating in the dark. They had to deal with breast pumps, diaper wipe warmers, video cameras and baby monitors that would not work. Somehow they managed to learn about parenting with only the basics and as they said, “you can hear the baby cry without a monitor”.   Back to basics.  After they spent a night without power they encamped to our house as we had our power was restored before theirs.  What a treat to have them and that precious baby with us for 2 days! Pure joy to get to pamper that sweet grand daughter.

The youngest son was also without power and he said he had “nothing to do” when he got home from work as he is so tech reliant. I told him that I had gone to bed in the dark and had read the newspaper by flashlight...and he just laughed!  What newspaper or book? No paper at his house...he gets it all on line. When the power eventually returned he found himself with lights but no internet service so he came over to hang at our house. No, not to see his parents, but to use the internet! Oh well, at least he was home for a few hours.

Tonight, power back on for all and the house is again quiet and I am back “online”. 

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DR SUE'S DAILY DOSE

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