Cradle Cap or Seborrheic Dermatitis

What is it?
Seborrhea is scaling skin problem (yellow crusty scales).

Where is it found?
It is most often found in the scalp, eyebrows, beside the nose, behind the ears, in the arm pits and in the diaper area.

What is the cause?
The exact cause is unknown. It is often worse in the cold weather.

Is it contagious?
No.

What is the treatment?
Most often your doctor will prescribe or suggest a shampoo and a cream or lotion that will clear the condition. Hydrocortisone cream may be helpful for short periods of time. Usually 2-3 times a day for 3-5 days. Applying baby oil to your infant scalp, usually 1-2 hours prior to shampooing, may be helpful.

Does it come back?
Yes, it may come back even after it has been treated. If it returns, resume the treatment as previously recommended and notify your child’s pediatrician. If the rash is severe or appears infected, notify your child’s physician immediately.

Umbilical Hernia

Why does my baby’s belly button stick out?

This is called an umbilical hernia and is more common in some ethic groups than in others. An umbilical hernia is caused by a split in the abdominal (stomach) muscles. These muscles will normally come together by school age, and the hernia will normally go away thereafter. However, a large umbilical hernia, those bigger than one to two inches, may need surgical repair by first grade.

The bulge or hernia will get larger when your baby cries or is trying to have a bowel movement. This is normal. On rare occasions, especially with larger umbilical hernias, a piece of bowel may get caught inside the hernia. If you suspect this, call your pediatrician.

Can I do anything to help it go away?

No. Many remedies such as placing tape or a coin over the belly button may actually do more harm than good. Patience, observation and knowing when to call your pediatrician is the best treatment.

When should I call my pediatrician?

  • If the hernia is not closed by school age.
  • If the hernia is hard and is not easily pushed back into the belly button
  • If your child or infant is vomiting and irritable and you notice the umbilical hernia is large than usual, a part of the bowel may have become caught in the hernia and this requires immediate treatment. Please call your pediatrician immediately.

Questions from New Parents

Why isn’t my baby gaining weight?

In the first week after birth, it is normal for your baby to initially lose weight because he/;she was born with extra water.  This extra water helps your baby while waiting for your milk to “come in” or to get use to bottle feeding.  It is common for your baby to lose 5% to 10% of her birth weight during the first seven to ten days of life.  For a 7 lb. baby this would be about 10 oz. 

Why isn’t my baby feeding well and why is he spitting up? 

Some babies take to the bottle or breast very well at the first feeding.  Your baby is born with water and calories to last for several days and may not be interested in feeding for the first 24 hours.  When she does feed, she may gag and “spit up” the mucous and fluid swallowed before and during birth.

Do babies hiccough?

Yes, many babies hiccough frequently.  It sometimes helps to burp your infant at the middle and end of feedings, and to feed him slowly.

Why is my baby sneezing and breathing so noisily?

Sneezing is a baby’s way of cleaning his nose.  His stuffy nose may come from too much use of nasal suction or a dry, dusty or smoky environment.  Noisy breathing may be caused by air turbulence in narrow nasal passages.  Most babies breathe almost entirely through their nose until 4 or 5 months of age.  This will cause some babies to become cranky and feed poorly if nasal congestion is present.  It is sometimes helpful to use a nasal bulb and a few drops of dilute warm salt water to clean out the nose (1/4 tsp. baking soda in 1 cup of water).  Nasal decongestants, or antihistamines and oral decongestants should not be used unless prescribed by your doctor.

When can I take my baby outside? 

Usually after 7 – 10 days, weather permitting, your child may go outside.  The infants should be kept away from large crowds and should not be kissed or handled by people who have cold or flu symptoms.  Remember, handwashing is the best way to prevent the spread of “colds.”

How can I help my baby not to catch “colds”? 

Frequent handwashing is essential, as well as limiting handling of your baby by people with cold symptoms.  Children of preschool age and children who attend day care centers may be sources of “colds.”  They are around many children with colds and they share many toys which are covered with these “germs.”

What kind of soap should I use on my baby? 

Any of the various brands of “baby soap” are acceptable.  A mild white soap without additives is best.  Many soaps may dry your baby’s skin, so bathing with soap should be done only when necessary and the soap can usually be limited to the diaper area if your baby has dry skin.  Only “sponge baths” should be given until about age 2 months.

What should I do for the umbilical stalk (“belly button”)? 

The umbilical stump should be kept dry and clean.  The use of alcohol at the changing of every diaper will help keep it clean and hasten it “coming off.”  Give daily “sponge baths” until this happens.  If there is a sign of infection (redness/swelling/pus), your child’s doctor should be contacted.  Occasional small stains of blood are seen when the cord falls off.  Do not be afraid to touch the cord or to have your baby lie on his stomach.  Do not force the cord off.  Let it come off by itself.

How do I care for my baby’s circumcision? 

The area should be cleansed with mild soap and water and petroleum jelly applied to the tip of the penis to lessen irritation from rubbing against the diaper.  If there is not a “good” stream when he urinates, your child’s doctor should be notified.  If your child has not been circumcised, there is no need to pull back the foreskin.

Why is my baby’s skin peeling? 

Most mothers expect their baby’s skin to be soft and smooth.  Many babies have skin which peels.  Babies have been “floating in water” for many months and now when they are exposed to a dry environment, their skin will often become dry and cracked.  Perfumed baby lotions, talcum powders, and oils should be avoided.  A small amount of non-perfumed lotion may be used, but avoid the face.  If a rash occurs, stop the lotion and notify your physician.

Why does my baby have a rash? 

Newborns frequently have a rash called erythema toxicum (“newborn rash”).  It is normal and tends to come and go for a few days or weeks.  Your infant may have red pimple-like dots on the face and cheek area.  This rash usually will resolve by itself without treatment.  Avoid soap and oils on the face.

What are the bruises on my baby’s forehead, eyelids or neck? 

These flat marks are called “stork bites or angel kisses” by many parents and medically each is called a nevus flammeus.  When your baby is crying or upset, they become bright red.  Usually these birthmarks fade over a period of 1 to 2 years.  A different skin marking frequently seen at birth is called a capillary hemangioma (“strawberry birthmark”).  These commonly appear between 1 and 2 months of life and look like small red “flecks.”  In the majority of cases they also fade with time. 

What are the bumps on my baby’s head? 

Your infant may have a swollen, raised area of the scalp (called a caput succedaneum).  This usually disappears after several days.  There are other types of swelling which an infant may have.  One of these (cephalhematoma) is a swelling due to blood collecting under the top surface of the skull.  This type of swelling may take months to subside.

Why does my little girl have a whitish discharge from her vagina?

This whitish vaginal discharge is normal.  It is caused by maternal hormones which came across the placenta to the baby or are in the breastmilk.  It will gradually go away over a period of several weeks.  This same transfer of hormones is also the cause of breast tissue in some infants. 

What are most baby’s bowel movements like? 

Stooling patterns vary from baby to baby and depend upon whether your baby is breast or bottle fed.  Breast fed infants have bowel movements varying from many a day (up to 6 or more) to several per week.  Breast fed infants usually have more bowel movements than bottle fed infants.  Breast milk stools are typically “wet mustard” in color and consistency and have little odor.  Bottle fed infants generally have less frequent and slightly firmer stools.  Infants on soy formulas frequently have the firmest stools.  Most babies strain and draw up their legs and even grunt or cry when they have a bowel movement.  The first few days, babies pass dark, greenish, brown-black stools.  After this the stools change to many colors including mustard yellow, light brown or even green in color with small curds and/or seed like particles.

Will my baby’s eyes change color?

An infant’s eye color develops over a period of six months during which time the color may change from blue to darker colors.

Is it harmful for my baby to be around smoke from cigarettes?

Yes, cigarette smoke is harmful to your baby and can cause lung and breathing problems, ear problems and more frequent “colds.”

Prenatal Visit Information

When do I schedule a prenatal visit (before the birth of my baby) and what is it for?

The visit is usually scheduled in the last part of your pregnancy. Both parents, if possible, should be present. The visit is your opportunity to meet your child’s physician and ask questions about any concerns, anxieties or expectations. It also provides you the opportunity to see the office and meet the office staff.

What types of questions should I ask?

Possible questions include those about routine nursery care, physician notification at the time of your baby’s birth, when your child will be examined and whether she will stay in the mother’s room (“rooming in”) or in the nursery. Routine feeding, infant safety and home-care questions are reviewed as well as the timing of scheduled office visits, office hours, telephone hours, emergency numbers and fees.

What kind of questions might we be asked by the baby’s physician?

Topics include questions about some of the following: household composition; parental marital status; parental occupations and backgrounds; family medical history; previous pregnancy outcomes; family member’s health status; parenting philosophy; parental work status; family support status; circumcision; breast feeding and formula choices. The most important reason for the visit, however, is not for you to be asked questions, but rather for you to ask questions and obtain information about your child’s safety, development and medical care.

Bedsharing

The American Academy of Pediatrics (AAP) has raised concerns about bed sharing. The AAP Task Force on Sudden Infant Death Syndrome suggests newborns and infants sleep in a crib placed alongside the parent’s bed. The biggest threat to safety for bed sharing was for infants under 12 weeks of age who were exposed to secondhand smoke. Some people believe this advisory is too broad and believe steps can be taken to minimize or eliminate any risks that bed sharing poses while supporting potential bed sharing benefits.

Bed sharing benefits include the potential to improve breastfeeding patterns by decreasing disruptions caused by the close proximity of the infant to the mother. Enhanced infant-parent bonding and comforting especially for sensitive or “fussy” babies are often discussed as is the potential to decrease so called SIDS or Life Threatening Events. Mothers and babies who sleep together often sleep in synchrony allowing their arousals to overlap and enhance sleep.

There is no absolute answer to this question. Most pediatricians seek to avoid risk. It is much easier to focus on a safe crib environment than a safe bed environment. Western beds include many forms of soft bedding that can be hazardous and cause suffocation. Most beds are elevated and a pose a risk of injury from a fall off the bed. Some beds have not met safety standards for bed rail positioning to prevent strangulation. Most people sleep with sheets and blankets that can cover an infant’s face and lead to breathing pattern changes that lead to Acute Life Threatening Events (SIDS). Finally there is a risk of a bed sharing parent rolling over and obstructing the breathing of their child. This is especially important for exhausted parents or parents with underlying medical conditions who are more prone to sleep through arousals that a non-sleep deprived parent would not.

What should you do?

If you pursue bed sharing then choose your bed and bed surface carefully. Make sure the mother is the only co-sleeper and neither the mother or baby should wear or use anything that could cover the infants face. There should be no headboard, footboard or railing on the bed and there should be no bed coverings, toys or dangerous bedding including pillows. Make sure there are no draperies, blinds or cords nearby and the mattress should be close to the ground and added protection placed on the ground to soften any fall. Keep the room cool and prevent overheating since most babies sleep in warm clothes.

Due to this long list of precautions most parents prefer to use an approved crib or bassinet that is placed next to the bed. This allows the mother to be within arm’s reach of her infant and provides most of the benefits of bed sharing without the risks. It also allows for the infant to sleep in the same room as the parent and then to be transitioned away from the parent’s bed as age, caretaking and parental preferences allow.

Remember, there are risks to bed sharing and infants sleeping in adult beds. Make your choice wisely.

Circumsion and Diaper Area Care

Your decision to circumcise or not is usually based on family preference. This does not need to be a scientific decision. Your personal preference is a reasonable way to make a decision. There is a very small potential risk of medical problems if your son is not circumcised. Most issues are related to the risk of infection due to the foreskin being in place and cleaning of the glans of the penis being more difficult. Most parents decide on circumcision.

If he is not circumcised then leave the foreskin alone. Do not retract it and it will retract naturally as he enters his early school age years. You may notice a small amount of white putty like discharge from the tip of the foreskin. This is a natural lubricant. It does not signal an infection. If he is circumcised you need to lubricate the glans of the penis with Vaseline every time he is changed. This will help protect the unprotected glans from adhering to the diaper and also makes cleaning the area much easier. Vaseline should be applied by
squeezing it out of a tube as you move the tube around the shaft of the penis. Do this every time the diaper is changed. After about 1 week the skin will change from a shiny red to a dull grey and the healing is complete. If a bell system is used the guard will fall off the penis after about 1 week. It can be discarded.

If you child is circumcised the foreskin usually reattaches to the glans. You may also see some small white natural lubricant along the edge of the foreskin. This is natural. In the past many people would retract the foreskin daily to prevent adhesions from forming. This can be done but is not necessary. The foreskin will release from the glans by early school age years. If you do retract it then you will need to clean under it daily. This is extra work so leave it alone.

To prevent diaper rashes the best treatment is prevention. Use Vaseline on the entire diaper area every time you change your child. This makes cleaning easier and prevents diaper rash. Make the diaper area look like your child is about to swim the English Channel. You can never use too much Vaseline. By using Vaseline there is a barrier between the skin and the urine and stool which can irritate the skin. It also serves as a lubricant to prevent friction and irritation from the paper diapers.

Don’t Forget the Father

Most people think of the mother and not the father when asked about the attachment between a parent and a newborn. Attachment, however, also occurs with the father and with other non-parental caregivers whom the new infant relies on for safety and security. A father’s involvement is extremely variable. It ranges from little parental care to that of a sole or co-caregiver. To view a father as biologically and genetically engineered to provide mostly economic support is outdated. Mothers and fathers often share in home and economic responsibilities. The old model of a mother staying at home with the children and the father working is being replaced by two working parents. In addition, up to 40-50 % of all new mothers are unmarried or divorced. In these single parent households frequent non-traditional duty sharing is seen with variable involvement of the biological father and other adults including grandparents.

Today most fathers want to support their children in non-financial ways. In fact, men who show an affinity for infants are more attractive to women than those who do not. In nature, certain groups of mammals show prominent “helpful father” patterns. Close primate relatives of ours, however, show limited paternal involvement. It is unclear why this is so, but, it appears a father responds to what is expected of him when it comes to the needs of his infant and child. If there is strong physical or emotional motivation then a heightened and extensive paternal involvement is seen. If limited expectations are placed on the other than providing financial support are placed on the father then less involvement is seen. This is why it is vital for a father to be engaged in meeting the minute to minute needs of his new infant. Once a pattern of limited support is established it is hard to change. Similarly once an extended caregiving pattern is established there appears to be internal physical chemical and hormonal reinforcement that encourages this behavior to continue.

Fathers, like mothers, can also suffer from postpartum depression. This is especially prominent when the mother shows signs of depression. Involved fathers experience changes in their chemical and hormonal make-up. In addition to these physical changes there are major emotional changes. Engaged and involved mothers and fathers both change.

When a father responds to the physical and emotional signals from his new infant he will rebalance his own needs. When this change occurs it can be strenuous and demanding. A new network of responsibilities and obligations can lead to internal stress and external stress including the relationship with a spouse. Fear of this stress, however, does not justify limiting or minimizing paternal involvement. Rather, it supports the establishment of a parenting budget where both parents working together meet the emotional and physical needs of their child. Such a tag team approach allows both parents the space and time they need to recover from the ongoing stressors of childrearing. Even if one parent stays home and the other parent works there should be joint participation in most parenting tasks. This can be accomplished by the parent who is home performing other non-work tasks that the working parent was responsible for prior to the birth of their child. The key is nonjudgmental, open communication and the honest sharing of feelings.

It is important for both parents to take the time to discuss their parenting roles before the delivery. The expectations you set will affect your parenting and the type of caretaking each of you provide.

After delivery everything moves so fast. Demands must be met and problems must be solved. New issues arise daily and time is difficult to find when both parents are rested and ready to tackle difficult discussions. No matter how you divide up the responsibilities the key is to be fair. Roles should change day to day based on who has the time and energy to meet the demand. Shared responsibility is the goal and each parent should have the opportunity to meeting every type of need. Anything less than this leads to concerns that one parent is working harder than the other. If one parent, due to emotional or physical issues, is unable to share in the responsibilities then that is fine as long as the issue is talked about from the heart and the responsibility is readjusted when a partners health allows.

What is Colic?

No two babies are alike and no two parents are alike. One of our greatest gifts is diversity. There is no one right or wrong way to parent your child. As a parent you try to do what is best for your child on that day and in that moment. On another day and at another time you may respond differently and that is the gift of diversity.

Babies respond to social stimuli including eye and body contact, gentle touching, feeding and soothing speech. All of these stimuli are the precursors to communication and future language development. Infants who are raised in environments where constant contact and frequent feeding are the norm have the least amount of crying. Yet, some infants no matter what their level of physical contact is cry excessively without any apparent medical or physical need. No matter what contact and feeding choice you make there will always be some infants who cry excessively. These infants are described as having colic.

With any infant the first response to crying should be to make sure there is no underlying physical reason. The most common issues include hunger, pain, fatigue and separation. Numerous articles and books have been written about these causes. A good approach is to use a checklist system to run through all the common causes. When in doubt about a physical cause including infection, breast milk or formula intolerance you must call your Pediatrician. Remember that something as simple as cow’s milk protein intolerance can be the cause of excessive and inconsolable crying. You should also discuss genetic patterns and tendencies that run in families. At all times, however, remember infants less than 6 months of age cannot be spoiled or over indulged. Hold your child, feed your child, caress your child, dance with your child, swaddle your child, sing to your child, talk to your child and quite simply be with your child.

What should you do if there is no clear physical reason for your infant to cry? Many pediatricians call these infants sensitive babies. Your first step is to look within at your own support system. Parental support and self-care are often the last needs to be met. Mothers may have heightened anxiety and depression as well as isolation from their social support system.

This can be a stressor to your infant. Some stress is acceptable but toxic stress causes emotional and physical reactions in both parent and infant. These reactions are sensed by all members of the family, including the infant. Your infant may become excessively fussy or seem distant and withdrawn. She may have difficulty feeding, sleeping or self-soothing. Look at your diet, sleep and activity patterns. Is there exposure to smoking, alcohol or caffeine? Are you getting the sleep you need and deserve? Are you having time for your own physical needs including movement and exercise? Have you been able to get out into nature or experience the beauty of the arts? Do you have someone to call who will listen to you without judgment? Have you limited your time commitments and responsibilities?

Parents must remind themselves about the importance of relationships. Relationships buffer stress. Following delivery many parents feel alone and isolated. In addition, the decisions and responsibilities that accompany giving birth and beginning to make caretaking decisions are stress inducers. Every parent needs to include in their daily activity ways to lessen their stress burden and increase their access to mature and loving reciprocal relationships. By learning to recognize and respond to your new demands and stressors in a healthy, productive fashion you will be teaching your child how to recognize and deal with emotions. By watching you he will learn by example how to live, cope and thrive in an unsettled world.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) is the leading cause of death in healthy infants under age 1 year. It is the terms used to describe the sudden death of an infant under one year of age when a cause cannot be found when a thorough postmortem examination is performed. 20% of all episodes of SIDS occur when a child is being cared for by someone other than the parent. This is the time when protective strategies such as the “Back to Sleep” position is not used and the infant is placed on their tummy to fall asleep. Infants is accustomed to sleeping on their backs are 18 times more likely to die from SIDS if they are placed to sleep on their tummies. SIDS is not caused by immunizations, vomiting or choking and the risk can be limited by maintaining safe sleep practices and a safe sleep environment.

The peak age range is from 1-4 months and males infants are at greater risk than females. Premature or low birth weight infants and those infants with a history of apnea are at greatest risk. Other risk factors include infants born to mothers who smoke or use drugs, African Americans or those with Native American or Native Alaskan heritage. The fall and winter months are the highest risk periods and siblings of a baby who died from SIDS are at greater risk.

The use of a “Back to Sleep” position and the avoidance of soft bedding will alleviate some of the risk as will the avoidance of an excessively warm room or being over swaddled. Do not let your infant get too hot. If you notice your infant has damp hair, is flushed or has been sweating then dress your infant lighter. Set the room temperature in a range that is comfortable for a lightly clothed adult. Babies do not need warm rooms. Environmental tobacco smoke must also be avoided. The rate of SIDS decreased by more than 50% after the “Back to Sleep” campaign was started. One of the new risk factors, especially for infants under age 2 months, is bed-sharing or sleeping in an adult bed with soft bedding or a soft mattress. Side sleeping is not as safe as back sleeping and should be avoided. Infants can easily roll over to a face down position and the use of special equipment to position your infant on the side is unsafe. Keep all quilts, pillows, and stuffed animals out of cribs.

Tummy time is important for your infant but should be used when your infant is supervised and awake. It should be integrated into your daily activities. Tummy time helps to build strong neck and shoulder muscles. This position allows your infant to develop new skills which will allow a proper progression of developmental milestones.

Parents often raise the question of home apnea monitors to prevent SIDS. Home apnea monitors are not prescribed to prevent SIDS. They are used for infants who are at risk for apnea or bradycardia due to an underlying condition. Apnea is the name given to a pause in breathing and bradycardia is a slowing of the heart rate below a normal level for your infant. Apnea and bradycardia may be associated with cyanosis. Cyanosis is the name given to a bluish hue to your child’s lips or skin. Possible physical causes for apnea include prematurity, anemia, gastroesophageal reflux (GER), bronchospasm, lung disease and seizures. Infants with these conditions may be treated with medication and discharged home on a home apnea monitor. They also may have a a sleep study performed. It is called polysomnography or a pneumogram and it monitors your infant’s breathing and heart rate over a 12 or 24 hour period. If your infant is prescribed a home apnea monitor then you will be instructed in its use. You will want to use it whenever your baby is sleeping and when you are busy and not directly with your infant. During alert periods or when you are with your baby or when you are in an active play activity or bathing your infant the monitor is not needed.

When to Introduce Solid Foods

The introduction of solid food to your infant is one of the most common questions parents ask. The key is to introduce new foods slowly beginning at 6 months of age and avoid mixed foods that have various food allergens. There are certain foods you should be most cautious about. These include egg, peanut, tree nuts, fish and seafood. Introducing solid food prior to 4 months is associated with an increased risk of allergic disease. During the first six months of life exclusive breast feeding is recommended.

At 6 months infant cereal can be added first. Start with rice cereal and then proceed to the other whole grain cereals including oatmeal and barley. At 7 months begin vegetables and start with the green vegetable before the sweeter carrots and sweet potatoes. Generally add only one new food type per week and one food group per month. After vegetables have been introduced begin fruit and then meat. As solid intake increases formula or breast milk intake decreases. Make sure your child’s urine remains clear and urine output is at least 4 times per day. By age 1 year your child should be taking 3 food groups three times per day. The key is moderation and variety. Keep a log of the foods you introduce and look for adverse reactions including mood changes, skin rashes or GI upset.

If your child is at high risk for allergy the following schedule should be followed: supplemental foods 6 months, 12 months dairy products, 24 month’s egg and at least 36 months for peanut, tree nuts, fish and seafood. Certain processed foods including beef and kiwifruit that are less allergenic when cooked should be served cooked and homogenized.

The key is to follow a reasonable schedule that meets your child’s needs and preferences. There is no one right way of introducing food. Listen and watch your child. Respond to her cues and as always remember she is watching and smelling what you eat and how much you enjoy the foods you eat.