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Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Your Baby

Recall: Oball Baby Rattles Due to Choking Hazard

1:30

About 680,000 Kids ll Inc. Oball baby rattles have been recalled due to choking hazards.

This recall involves Oball Rattles in pink, blue, green and orange with model number 81031 printed on the inner surface of one of the plastic discs and on the packaging. The balls have 28 finger holes and measure four inches in diameter.

Embedded in the rattles are a clear plastic disc with all orange beads and two clear plastic discs with beads of varying colors on the perimeter.

Only rattles with date codes T0486, T1456, T2316, T2856 and T3065 located on a small triangle on the inner surface of the rattle are included in the recall.

The first three numbers represent the day of the year and the last digit represents the year of production.      

The firm has received 42 reports of the plastic disc breaking releasing small beads including two reports of beads found in children’s mouths and three reports of gagging.

Consumers should immediately take these recalled rattles away from young children and contact the firm to receive a full refund.

The rattles were sold at Target, Walgreens, Walmart and other retailers nationwide and online at Amazon.com, Babyhaven.com, Diapers.com, ToysRUs.com, Walgreens.com and other online retailers from January 2016 through February 2017 for between $5 and $7.  

Consumers can contact Kids II toll-free at 877-243-7314 from 8 a.m. to 5 p.m.  ET Monday through Friday or visit www.kidsii.com and click on “Recalls” at the bottom of the page for more information.

Story source: https://www.cpsc.gov/Recalls/2017/Kids-II-Recalls-Oball-Rattles

Your Baby

Is Your Baby Safer Sleeping in a Box?

2:00

Is your baby safer sleeping in a box instead of a crib? Some parents think so and are ditching the traditional infant crib for a specially made cardboard box.

The Baby Box Co., is a Los-Angeles based business that is partnering with hospitals across the U.S. to give away free “baby boxes” to new parents.

The parents also receive a 15- minute educational video about safe sleeping habits for infants. Also included in the box are infant clothing, a mattress, a fitted sheet plus $150 worth of baby necessities.

While relatively novel in the U.S., the baby-box isn’t a new idea.  It’s modeled after a program in Finland that began more than 70 years ago. Baby boxes are aimed at curbing infant mortality rates by promoting safe sleeping practices for newborns.

New Jersey adopted the first statewide baby box program; distributing a total of 105,000 boxes. And now, Ohio has joined up, along with hospitals in Philadelphia and San Antonio, Texas.

Proponents of baby boxes say the combination of educational tools and free resources will bring America's infant mortality rate closer to those found in wealthy Nordic countries.

The goal of the Baby Box program is to bring the rate of children dying from Sudden Infant Death syndrome (SIDS) down. SIDS is usually attributed to sleep-related accidents such as strangulation, suffocation or entrapment. In 2015, the Center for Disease Control (CDC) reported about 3,700 infants died from SIDS.

The U.S. saw a drastic decline in its infant mortality rate since 1994, when the CDC launched its "Back to Sleep" campaign urging parents to have their infants sleep on their backs rather than stomachs, but disadvantaged groups still tend to be affected by SIDS more than others.

In Finland, Baby Boxes have had a dramatic impact on infant mortality since the program was launched in 1949. In the 1930s, the country's infant mortality rate was 65 deaths per 1,000 infants. Beginning in 1949, that number has shrunk to 3.5 deaths per 1,000 births— a decrease that's credited in part to baby boxes. Comparatively, the United States had an infant mortality rate of about 5.8 deaths per 1,000 births in 2016.

One University of Chicago study found that primarily lower socioeconomic groups drive the higher infant mortality rate in the U.S. after the mother and child leave the hospital. Contributing factors may include health coverage insurance and the mother’s amount of education.

What else can be done to curb infant mortality rates?

Some experts argue that policies geared toward enhanced post neonatal care for mothers of low socioeconomic status would be most effective in combating the U.S. infant mortality rate.

Universal home nurse visits, available in a number of European countries such as Finland and Austria, are one option. A provision of the Affordable Care Act offers money for a number of similar programs, such as the Nurse Family Partnership founded in 1977 in New York.

The program, which sought to rein in infant deaths in the U.S., provides low-income, first-time mothers with registered nurses who visit their homes to provide assistance and child health education for mothers.

According to the Baby Box Co. website, Baby Boxes are not only available through some hospitals, but also direct to consumer.

Story source: Avalon Zoppo, http://www.nbcnews.com/news/us-news/hospitals-u-s-give-away-free-baby-boxes-curb-infant-n732421

http://www.babyboxco.com

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Back to Sleep Ads

1:30 to read

I am concerned that I have been seeing on line ads promoting “new” baby products for 2017, in which an infant is shown sleeping on their tummy. In other words….not following AAP guidelines that all infants are placed on their back to fall asleep.  Their should be a “law” that you cannot shoot a picture for any product being advertised for an infant in which the baby is shown sleeping in the prone position. Seeing this photo may only confuse parents about correct sleep position for their baby, especially when many of the advertisements are for sleep related products. 

 

The “back to sleep” campaign which started in 1994 has served to reduce the incidence of SIDS by over 50%. I have been fortunate in that I have not had a patient of mine die from SIDS since the recommendations for sleep position were changed. Unfortunately, when looking at data, 30% of SIDS cases report that the baby was found in the prone (tummy) position.  

 

So, if a sleep deprived new parent is surfing the net for products related to infant sleep, and then sees a baby on their tummy, they may think “maybe that is the trick “ to get my baby to sleep, never realizing the huge risk they are taking. Many a parent has come in to my office and said “ I think my baby sleeps better on their tummy”, which immediately puts a look of horror on my face!! “WHAT…I thought we had discussed that your baby must sleep on their back until they are rolling over on their own.” Some of the parents do reply, “my ……told me it was okay.” In this case do not listen to anyone about tummy sleeping!!! Discuss car seats, high chairs, pacifier options or whatever else instead….and choose which works for you. Sleep position is non negotiable. 

 

With that being said, I realize that between 4 - 7 months many babies will roll over during sleep even when placed on their backs. It is a developmental milestone for babies to roll and you cannot put a brick on them. I would “guesstimate” that about 25% of the babies I see will ultimately prefer to sleep on their tummies, but they are all out of their swaddle and then roll over after being put down on their back. I also get many videos showing me a baby in their crib who is in the act of rolling over, with a nervous parent running in turning them back over, only to have the child roll right back to their tummy. You could spend the entire night “flipping the baby” over!

 

Remember, back sleeping only, in a crib with just baby and no bumpers or toys….you will have plenty of time for other stuff in the crib when they are bigger.

Daily Dose

Flying With A Baby

1:15 to read

Overheard on the plane this week:  I am in row 15 and there is the cutest most precious 4-5 month old baby girl behind me in row 16.  Key point….she is sleeping as we are making our approach!

 

The mother of the baby is traveling with her mother so there are is a grandmother along to dote on this darling baby. The mother of the baby says to her mother…”we need to wake her up now!!!”  “Mom, please wake her up as we need to feed her NOW!”  At this point the mother takes out a whisk of some sort to put into the breast milk…do you have to mix with a whisk now?

 

So…of course they wake up the baby who starts to cry, but just a bit…and then the grandmother starts to feed the baby the bottle.  The mother is saying, “Mom, just make her eat”.  Now it is really bumpy as we are getting ready to land and I was wishing I had a bottle to calm me too!

 

The baby seems to be quietly eating, but then must have stopped eating as now the mother of the baby takes the baby from the grandmother and starts to try to give her daughter the bottle.  She starts talking to the baby saying, “ please keep eating so your ears will stay clear” followed by “Mommy is going to drink the bottle, so you can see me keeping my ears clear too”.  “If you keep sucking your ears will be pain free”. 

 

Everything seems to be going well…although we still have not landed, when the mother says “I am going to force feed you to keep your ears clear!”  Uh…oh I am thinking, I know where this may be going.  But it seems so far, so good. 

 

Just as we are about to touch down I hear this gurgling noise from behind me and then the mother saying, “Oh dear she is spitting up!!”   Really, are you shocked??

 

But…I must say, the baby was quiet and content…who knows, I would have never awakened that sweet baby girl, but then again, I still believe, “never wake a sleeping baby”, even on an airplane.

 

 

 

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Daily Dose

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

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What can you do if your child stinks?

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