Transitioning to Solid Foods

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Trust your intuition and always error on the side of moderation. A go slow approach is generally best while always maintaining a relaxed environment during feeding times. Choosing a small initial portion and only adding one new food per week is best.

After age 1 year try to keep milk intake under 24ozs per day. This allows your child to have “room” for other foods. A good approach is to aim for 3 or 4 food groups at every meal. Variety is the spice of life. I would consider yogurt to be part of the milk products administered and would decrease the amount of milk given. Solids should be given prior to or in conjunction with milk or water and avoiding sweetened drinks is always best. Milk and water are the best choices. Eat the fruit not drink the juice. This is also a great time to transition to “sippy” cups and eliminate most of the bottles.

When adding new foods always look for GI symptoms such a diarrhea, gas and vomiting or skin rashes. A reaction may take hours or longer to be evident. You know your child best so you are the best person to challenge your child to a new food exposure. Always wait a few days between new food exposures. Most parents wait until 6 months to add fish, peanuts and egg to a child’s diet. New guidelines suggest exposure between 4 and 6 months is safe and may help prevent dangerous food allergies. Always start with a taste and advance slowly. Be cautious about home prepared spinach, green beans, beets, squash and carrots during the first year of life since these vegetables can contain large amounts of nitrates that can lead to anemia. Peas, corn and sweet potatoes are safe choices for home prepared vegetables. Commercially prepared baby foods test for nitrates and are safe. Although the egg yolk is less allergenic than an egg white there is cross contamination so I generally suggest a small amount of scrambled egg being reasonable rather than straining off and discarding the egg white. I also feel a taste of chocolate is reasonable but remember infants have very sensitive taste and new tastes may need to be acquired slowly.

A well balance breakfast should include carbohydrates, healthy fats and protein. A 60/20/20 ratio is reasonable as is frequent small meals since an infant’s stomach is quite small. Rather than counting calories allow your child to tell you how hungry he or she is. When your child slows down allow the meal to end rather than encouraging all prepared food to be eaten. You know your child has been drinking enough when your child’s urine is clear and copious. Remember that vegetables and fruit contain a large amount of water. Do not fear if your child does not seem to be as thirsty as you would expect.

Bon Appetit!

Breastfeeding is Best

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Breastfeeding is best for both mom and baby. Everyone knows breast milk is the best nourishment for a newborn infant. It protects your infant from infection, is easily digested, makes your baby smarter and lowers your child’s future risk of developing asthma, allergies, diabetes, obesity and Sudden Infant Death Syndrome. Benefits are not just for the infant.  There are also clear benefits for the mother who breast feeds. It decreases a mother’s risk of heart disease, high blood pressure and diabetes as well as lowering your future risk for developing breast, uterine and ovarian cancer.

Besides these physical benefits there are cognitive and developmental benefits for both mother and baby.  Mothers who breast feed experience a physical and emotional union with their child. This fosters secure attachment, supports self-regulation and healthy eating patterns and enhances maternal fulfillment and emotional satisfaction. Babies who are breastfed have a developmental advantage over formula fed infants.

Another benefit that is easily overlooked is the benefit to the father. Fathers who learn about breastfeeding and become a true partner with their spouse strengthen their relationships with both mother and baby and improve the success of breastfeeding.

The more you know and learn about breastfeeding prior to delivery the more successful the breastfeeding experience will be for both you and your child. Including your spouse in this discovery and learning process is also beneficial.  Breastfeeding is natural but it is also a learned behavior.  Support from family, friends, workplace and your social and healthcare networks are vital but the most important advice is to always expect the best.  Guidance and advice can help you eliminate fears which often lead to anxiety and breastfeeding difficulty. Taking a breastfeeding class, joining a breastfeeding support group and seeking consultation with a lactation consultant or your pediatrician all are helpful. Tailoring your support to your individual needs prepares you best.

During the first hour after delivery it is important to initiate breastfeeding. The nursing staff will be there to guide and support you. Skin to skin contact with your infant is important as is body and head position.  In the days following delivery your milk will come in and your nipples will become less tender.  You and your infant will discover one another. You will become comfortable with making sure your infant rests her chin and nose on your breast and opens her mouth wide with lips turned out. You will learn how to recognize a good latch and watch and listen for rhythmic and deep sucks with interspersed bursts and pauses. Listen for deep swallows rather than sharp clicks and make sure her cheeks are not sucked in. Patience and support are the best therapy.

After discharge make sure you have a breastfeeding toolkit nearby when you nurse. It should be packed with all the important items you might need including water, burp cloths, clean baby clothes, cleansing wipes, nursing pads, fresh diapers, petroleum jelly, plastic disposal bags, hand sanitizer, a soft blanket and pillow, healthy snacks, a music player and lanolin. Drink plenty of fluids and eat healthy.  Nurse on demand and do not watch the clock.  Learn to recognize your infant’s cry, movements and facial expressions. Exercise, adequate sleep and stress reduction techniques all help. Exclusive breastfeeding is best but if due to medical concerns you are unable to breastfeed then remember formulas are nutritious, safe and healthy and you should never feel shame or guilt for not nursing due to medical or personal considerations.

Exclusive breast feeding through 6 months of age is best. At 6 months complementary feeding can start. Most parents begin with infant cereal mixed with breast milk and then progress to vegetables, fruits and pureed meats. Complementary foods are not meant to substitute for breast milk. Continuing breastfeeding through age one to two years and beyond is best.  Providing breast milk for your child is one of the greatest gifts parents can provide.

Keeping Your New Baby Safe

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A new infant in the family brings added responsibility to a parent.  The delivery is tiring for both parents and fatigue is often accompanied by poor decision making. Take time before you leave the hospital to rest and catch up on your sleep.  Consider allowing your infant to stay in the nursery while you take a nap and send dad home for a shower and a nap. Post-delivery time is also a good time for parents to discuss a parenting budget and develop a plan to share responsibilities and caretaking so both parents are able to rest. Tired parents are also prone to illness and this is a risk to a newborn.

Breastfeeding is the best way to keep your infant safe. Breast milk is the best nutrient for your infant and breastfeeding is also good for the mother.  By providing support and advice to parents breastfeeding success and duration can be increased.  Make sure you ask for lactation advice both before and after delivery. Avoiding pacifiers and supplemental formula is best. Both of these can be considered after the mother’s milk is in and the infant has become accustomed to breastfeeding.

Babies need to be placed on their backs for sleeping. This “back to sleep” position has been shown to decrease the risk of sudden infant death. Begin this immediately after delivery and continue this positioning after discharge.  Clothing should be in layers and only one thin layer more than you need. A hat should be used if the temperature is below 60 degrees.

Car safety is always important. The infant car seat should be rear facing and a LATCH system should be used. An infant should never be placed in the front seat. Middle rear seat is safest but many cars require back side positioning to use the LATCH system. An appointment should be made with a Child Passenger Safety (CPS) approved technician to inspect your installation if you have concerns. Make sure your car seat straps are at or slightly below shoulder level and the fit is snug. Check the seat angle to make sure your infant’s head and chin do not roll forwards and cause breathing obstruction. Clothing layers should be thin so the straps can fit correctly. Place a blanket over your infant after she is strapped in if the temperature warrants.

Make sure your crib meets the 2011 crib safety guidelines and the mattress is firm and fits properly. There should be no loose objects in the crib and any bumper pads or positioners.

The changing table should be sturdy with guardrails on all four sides. The base should be concave to decrease the risk for your infant rolling off and a safety strap should be used.  Never leave your infant unattended and keep all cleaning materials within easy reach but out of reach of the infant.  Hand washing hygiene is important as is diaper disposal. Baby wipes can save a great deal of time but should be tested on a small area of your infant’s leg first to see if any allergic reaction occurs. Often, wipes do not need to be used for every changing if your child has only urinated. Apply a generous amount of Vaseline to the entire diaper area with every diaper change. This prevents diaper rashes and keeps your infant more comfortable as well as making diaper changing easier.  Bathing time can be challenging. A flat area near the floor is best and be careful about slipping on water. Bathing is often only needed every other day.

When walking around the house with you infant consider using an infant body carrier. With small infants make sure head and neck position do not interfere with breathing. Tripping over pets and other unexpected obstacles that often accompany the arrival of a new baby should also be avoided. Steps are risky and handrails do help. In the kitchen be careful about fumes and hot liquids that could injure your infant.  Proper food preparation and handling and hand washing are always important. Make sure your smoke and carbon monoxide alarms work and are in the right places. Have a practice fire alarm drill so you know who goes where and who gets whom.

For friends and family ask anyone with an illness to stay away. Contact with young should only be with adult supervision and hand washing and hand sanitizer use is essential to prevent the spread of respiratory and gastrointestinal infections.

A new baby in the house is a time for joy.  A safe home and car environment protects both you and your new infant.

To Vaccinate or Not To Vaccinate

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In recent years more and more parents are choosing not to vaccinate their children. In the years from 2003 to 2009 statistics have shown there has been a 4 fold increase in the decision not to administer vaccines. This is an increase from 2.5% to 10%.  The reasons given as to why parents decide on not receiving vaccines range from direct medical contraindications including a direct allergy to an immunization component such as gelatin that is used in chickenpox and nasal spray influenza vaccine to philosophical and religious reasons. If your child has an identified allergy to the vaccine or a component of the vaccine then that vaccine should be avoided unless a decision is made under the direction of a pediatric allergist. The other common reasons for not receiving vaccines are based primarily on fear and personal preferences and not on scientific evidence.

All vaccines are associated with potential risks but the risk of not receiving childhood vaccines is much higher than the risk of receiving vaccines. The rates of serious childhood illness have been dramatically reduced as have the serious potential life-threatening complications that often accompanied these illnesses. Dramatic decreases in common life-damaging illness such as H flu meningitis also support the use of vaccines. There have been tens of thousands of studies that have reviewed the risk benefit ratios concerning vaccine administration risk and efficacy. These studies strongly support the reasons to choose vaccine administration when you are asked whether you want your child to be vaccinated.

Although all states but West Virginia and Mississippi allow religious exemptions it is important to note that freedom of religion is not an adequate explanation if a life-saving transfusion or surgery is required for your child. In those situations the Equal Protection Clause of the 14th Amendment of the Constitution supports that everyone, including children, is equally protected under the law and this protection is independent of a parent’s belief system, whether it be a personal or religious belief.

Receiving vaccines is a very difficult decision for some parents and an easy decision for others. If you are a parent who is hesitant to pursue vaccination and are anxious or fearful of potential side-effects you must remember you are not alone. Many parents have similar concerns. As your pediatrician our job is to communicate with you and explain all the pros and cons of vaccines. As a parent you are never alone. We want to listen to you and encourage you to explore what is best for your child. We promise to be honest and non-judgmental. We will make our explanations simple and direct and throughout the entire decision making process be empathetic to the difficult decisions you as a parent need to make. We want you to know there is no need to rush this decision. By providing you the information and knowledge in an unhurried fashion and by recognizing your emotions we want to be present with you during these difficult decisions.  Through a therapeutic alliance with you and your child we seek communication and the avoidance of misunderstandings that will allow you to make a decision you will trust for many years to come.

Thrush

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What are those white patches on my baby’s tongue and inside part of his cheeks?

Infants will occasionally acquire thrush (a fungal infection of the mouth caused by Candida) that appears as white patches on the tongue and inner cheek areas.  This is normal for infants during the first several months of life, and is usually more common in bottle fed infants.  At times thrush may cause discomfort with feeding, and your baby may become irritable with feeding.

When should I call my physician?

If you observe thrush in the mouth call your pediatrician for medicine to treat it.  Your physician will usually prescribe Nystatin drops.  Apply these drops after feeding. First wipe the formula or breast milk from the infant’s mouth using a clean gauze or wash cloth.  Next apply the Nystatin (usually one dropper full is sufficient) by coating the cheeks and tongue area, three to four times a day for 7 to 10 days.  It may be helpful to apply this medicine to the nipple of the bottle or the breast as well.  The same fungus infection that causes thrush can also cause a diaper rash, so be sure to check for this and notify your physician if observed.  Notify your baby’s pediatrician if the thrush is not improving after several days of treatment.

How can I prevent thrush from occurring?

It is difficult to prevent thrush from occurring early in life.  Your infant will make antibodies after two months of age against the Candida and this will probably help.  You can make sure the bottle nipples are thoroughly cleansed on a daily basis by using the dishwasher or by pouring boiling water over the nipples and through the nipple hole.

Tear Duct Blockage

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Why are my baby’s eyes always watery?

Occasionally, during the first six months of life, an infant’s tear duct (a small tubular connection between the inner aspects of the eye at the nose) gets blocked by mucus or is too small to drain all the tears in the eyes.  Your infant may have watery eye as a result, with tears coming out of the eye instead of running down through the tear duct.  This is common condition during the first six months of age.

What can I do to unblock the tear duct?

Usually warm compresses applied to the eye (not hot) three to four times a day helps to loosen mucus blocking the opening to the tear duct.  Gently massaging the tear duct (the firm little nodule felt in the inner nasal aspect of the eye) with your little finger, three to four times a day after applying the warm compresses, helps to move fluid through the tear duct.  Massage this area with downward motion towards the tip of the nose.  Be careful not to poke your finger into the eye itself and be sure to wash your hands before and after massaging the tear duct.

When should I contact my baby’s pediatrician?

  • If the eyes get red or swollen and are difficult to open.
  • If yellowish or greenish mucus or pus is observed coming from the eyes.
  • If the condition is not improving after six to nine months of age.
  • If the redness or swelling is noted on the area of the nose close to the eye.

Swollen Scrotum or Hydrocele

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What is a hydrocele?

A hydrocele is a scrotal swelling caused by fluid surrounding the testes. It is the most commonly present in infancy after birth. A hydrocele may appear later in childhood but this is uncommon. A hydrocele may vary in size, becoming smaller at night or in the morning after sleep and larger during the day when your child is more upright.
Hydroceles are not tender; they do not cause discomfort to the child, they are not red or bluish in color, and will normally resolve on their own by one to one and a half years of age.

When should I contact my pediatrician?

  • You should contact your physician if your child is crying, irritable, vomiting, and/or the scrotal area is tender to the touch.
  • If you notice reddish or bluish coloration change of the scrotal area, prompt notification is important as soon as possible to your pediatrician. Do not wait to see if it goes away.
  • If any injury has occurred to the scrotal area and you take notice color changes, increased swelling, or your child is in pain, contact your physician immediately.
  • If a hydrocele is present after 1 year of age, surgical intervention may be necessary for it to resolve. Discuss this with your pediatrician.

Uncircumcised Penis Care

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How should I take care of an uncircumcised penis?

The foreskin or extra skin around the head of the penis is normally attached to the head of the penis at birth. If your child was circumcised, the extra skin was cut away to expose the head of the penis. Whether the foreskin is present (uncircumcised) or absent (circumcised) it is important to keep this area as clean as possible.

Because the foreskin is attached early in life and complete retraction normally will not take place for 5-6 years, it is harmful to try to forcefully pull back the foreskin for cleaning purposes. During bathing, using water only, gently wipe the exposed tip of the penis using gentile retraction. You may see whitish discharge called “smegma” during this process. Try to gently wipe this away with water and a wash cloth. It is normal to have smegma, or dead skin, which has come loose from the foreskin attachment to the penis. After cleansing and thorough rinsing with water, gently pat the area dry and pull the foreskin forward over the head of the penis. Cleansing should be done daily, but remember the foreskin, will retract (loosen from the head of the penis) on its own, do not try to force it.

When should I call my pediatrician?

  •  If the foreskin gets caught behind the head of the penis and cannot be pulled forward.
  • Any swelling, blueness, or redness of the penis or foreskin is present.
  • If you believe the area to be infected.
  • If your child’s urine stream is weak or more than one stream is noted during urination.

Diaper Rash

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What is it?

It is a rash in the diaper area that can be caused by irritation or by a germ (i.e., impetigo) or fungus (i.e. yeast infection).

How can I prevent it?

To prevent diaper dermatitis, change the diaper frequently, avoid plastic or rubber pants and rinse out detergents and fabric softeners. Use Vaseline or a lubricant liberally to protect the skin from urine and stool which may act as an irritant.

What is the best treatment?

Keep the diaper area washed with water and leave it open to the air. Zinc oxide or non-antibiotic skin paste (i.e., Desitin) can be used before diapering.

When should I call the baby’s physician?

Call your baby’s physician if the rash is not improved after 2-3 days with the routine treatment. Also, if any of following conditions are noted, call your baby’s pediatrician: the rash is spreading, skin is peeling, blisters are forming, or skin is “beefy” red.

Does it help if I use powder in the diaper area?

It is better to use a lubricant rather than any powders. The powders do not work as well, and powder can inhaled and lead to breathing problems. No single lubricant works better than the rest. Choose one which is available, works for your child and fits your budget. Avoid scented lubricants.

Questions About Colic

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What is colic?
When healthy thriving babies develop a pattern of crying without an apparent reason, they have “colic.”

What causes colic?
No one is certain but usually sensitive, temperamental infants are more prone to have it. Certain symptoms may accompany the excessive crying, such as rashes, diarrhea, congestion, vomiting or frequent spitting. Also, some children may have a milk intolerance.

When does it occur?
In the first 3-4 months of life, but usually within the first month.

How long does it last?
Usually it is gone by 3-4 months of age.

How long do episodes last?
They generally last from 1-2 hours, but may last many hours. The episodes usually occur at night or during evening hours.

What can I do if my baby has colic?
Go through reasons why he may be crying, such as discomfort (wet diaper, being cold, being ill), a desire to be held, being tired, etc. Follow a routine and keep the child warm. Smooth movement for stimulation helps. Avoid over-the-counter medication, formula changes and suppositories, unless your pediatrician has recommended a specific intervention.