Daily Dose

Head Flattening on the Rise!

1.15 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Daily Dose

Babies & Bow-Legs

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Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Have Your Child's Blood Pressure Checked

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When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Your Baby Will Always Be Your Baby

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I feel like a new parent who is sleep deprived, but in actuality I am a sleep deprived parent of a 21 year old who had surgery this week. The interesting thing is that the feeling of utter exhaustion, coupled with parental love, really does not change from the time your baby is born; it just matures.  The parents of the four week old baby I saw this morning were also tired and wondered when their baby would sleep 4 -6 hours at a stretch. I just couldn’t bear to tell them; it really never ends.

I am happy to report that “baby” son is just fine after his surgery and is now home recovering while I am playing mommy/nurse (no doctor here).  That feeling when they wheel your child into the OR is the same whether your child is one year or 21 years.

This is not the first time that one of my children has had to have surgery, but each time I “know” that this feeling in the pit of my stomach will come as they wheel him through those double doors to the OR. The feeling only goes away once I know that the surgery is finished (thank God for good surgeons) and my child is safely in the recovery room.

Once in the recovery room, your child appears helpless and miserable but I have to remind myself that this too shall pass. This is when they need you the most, as they wake up dazed and confused.  Even a 21 year old is happy to have his mother there.

Thank goodness for medicine to help the pain and wonderful nurses who know just the right way to judge when and how to give medications.  I am amazed that my 6’3” son who is in pain and has IV narcotics going can still answer any questions and make sense! In fact, he is really so lucid that when I ask if he wants anything else for Christmas he manages to tell me the name of a video game and provides me instructions on how to order it right from the recovery room!  Technology progress on all fronts as Wi-Fi is available even at his bedside and the Amazon delivery will arrive about the time we get home from the hospital. That is also amazing!

He is now home recovering and after two sleepless nights I think that the worst is over and hopefully we will all get a bit more sleep. Why is it that sleep also seems to be the greatest healer?  He is hopeful to get a full night’s sleep and needs sleep to get well. We all need sleep to be able to take care of him so we can continue our “other” jobs.

The circle of parenting is really never ending, the difference is that the child is a bit taller and can talk.

Here’s to more sleep for all parents, especially for those with babies of all ages.  

Daily Dose

Colds & Suctioning Your Child's Nose

1:30 to read

I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

Daily Dose

Medical Decisions at Age 18


It suddenly seems that I have been in a time warp and so many of my patients who “should still be little” are coming in for a visit while home frm college.  It was hard enough for me to realize that my own children had “grown-up”, but I am now realizing that my own patients are “growing up” as well. With many of them now being 18 years old, they are now also “in charge” of their own health care decisions. This became apparent the other day as I was seeing a long time patient for her 18 year old check up, and I was filling out her college health form as well. 

When I got to her immunizations I realized that she had not had the HPV vaccine series, and I then remembered that her parents had decided not to give her this vaccine. (I had discussed the importance of the HPV vaccine with her mother and father every year for the last 4-5 years). As I started to say, “Oh I forgot you did not get the HPV vaccine”, she chimed in with “now that I am 18 years old I want to get that vaccine.” 

I paused for a few seconds and then she said, “I always thought I should get that vaccine and I listened to you every year, but my Dad just didn’t think I was old enough to get it.”  “Now that I can make that decision, I think it is a good vaccine and something that I want to have.” “Can I get it today, and can I come back at the end of the summer and get the second one before heading off to school?” 

Now I am thrilled that she had been listening to our discussions about HPV and the need to vaccinate, but it also felt a bit weird that she suddenly could make her own decisions about vaccines.  In reality, she could make all sorts of decisions now, even though her parents were actually still the holders of her health insurance benefits and would be until at least she was out of college. 

I thought about asking her to call her parents one last time to see what they thought she should do, but then decided that she wanted the vaccine and at her age needed the vaccine, so she had the legal right to sign off on it herself---lets get the vaccine. 

This is really not about HPV, but rather it is about children becoming adults and getting to make decisions about their own health care.  It is also about having a long-standing relationship with patients and hoping that you can help them make good decisions about taking care of themselves and the need for preventative medicine. 

She got the shot, she signed, she was happy, I was glad she was going to be protected (once the series of 3 was completed).  It was a good day, I just wonder what her parents thought? 

Daily Dose

Five Minutes for Mom

1.15 to read

I’m doing a lot of check ups this summer and a lot of questions surrounding behavior.  I have had many a parent lately who keeps asking me, “what is wrong with my 2-3 year old, they used to be so sweet but they are driving me crazy!”  It is a statement that has been uttered by most parents at different times while dealing with toddlers and young children. As I have said before, this is typically NOT an easy stage, but it is so important in terms of child development, behavior modification and early discipline. It requires a great deal of PATIENCE as well. 

For most of the parents it is just a matter of being reassured that: 

  1.  Their child is not “possessed”

B.   They are not the only one going through this

C.   This too shall pass 

One of my fondest memories while dealing with my own children during these years was of a very cute book that I would read to them after a long day! They loved the book, as did I, as it is written for both a parent and child to enjoy. 

The book is entitled “Five Minutes Peace” by Jill Murphy.  I found my hardback copy (I haven’t saved much from my boys early childhood, but did keep a good book collection for future use) and opened it to find that it had an inscription.  It had been given to my oldest son

for his 3rd birthday. The inscription read, “have mommy read this to you and I bet she will enjoy it as much I hope you will”.  The mother who had brought it for a birthday gift had 3 children and her youngest was the same as age my oldest. She was a wonderful mother and she used to give me such sage advice.  This book kept me sane many a day and then I went on and bought several other books about The Large Family. They are all very special books. I recommend you get on Amazon and buy one and see for yourself. 

And guess what?  I am now taking care of this same mother’s 3 most adorable grandchildren and yes, they too have a copy of “Five Minutes Peace” for their mommy to read to them. 

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

Daily Dose

'Twas the Night Before Christmas

1:30 to read

Are you feeling overwhelmed by the night before Christmas? Many parents do including me! Each year I try to plan to have a “calm” holiday with an organized gift list, and everything wrapped early so that our family may spend quiet time together today in anticipation of Christmas. Why is it that I may have struck out again?

If you could see my “office” right now, you would be surprised that I could even write today. The top of my desk is strewn with journal articles, rehearsal dinner seating charts, year end CME (continuing medical education), and lots of ribbons and gift enclosure tags. I am not even sure what goes with what! I am also decorating the mantels with fresh garland, arranging flowers and trying to keep our sweet yellow lab Maggie from eating the Christmas ornaments and the fresh greenery. While I am doing all of that I must tell you that my sons are either asleep, watching TV or working from home and “just want to veg”. It is at this time each year that I feel defeated as a mother.

The visions of family singing carols beside the tree that they helped decorate, are a figment of my imagination. This is when I think it must be different if you have daughters. Do girls rally to help their mothers with the preparation of Christmas? Do they come and ask to help decorate the tree (if they are older than eight), or are they dying to learn to tie a bow on a gift? About this time while I am in a major reflective mood, a patient of mine (now a freshman in college), drops by to deliver a coffee cake and at the same time admires the berries that I am using to decorate. It must be a different world with girls. So, on this Christmas Eve, I wish that I could tell you “all is calm”, but I think I still have a lot to get done before I sleep tonight. I am sure that mothers and fathers everywhere feel the same way, and that is what is wonderful about parenting! We are all in this together.

By Christmas morning, it will somehow all get finished and the family will get to gather together to open gifts, have Christmas breakfast or lunch or dinner and hopefully appreciate how fortunate we are to be a family. For those precious moments it does seem “perfect’ and I am thankful for that. I will take many pictures to remember these times together. I wish each of you a Christmas morning filled with memories after a chaotic week.  Merry Christmas!


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