Infant Walkers, Swings or Bouncy Seats

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Are there any potential dangers in using infant walkers?

A potential danger of infant walkers is that developmentally, infants are not able to properly control them.  Infants are unaccustomed to the speed to which they can be propelled. They are also unable to protect themselves if the walker is tipped over.

Potential hazards include:

  • Entrapment of arms, legs, hands, or feet.
  • Head and other injuries from tipping over the walker, running into objects, or falling down stairwells.
  • Damage to feet and/or ankles from the walker running over the infant feet.

Are there any benefits in using an infant walker?

Children do not learn to walk any faster by using infant walkers.  It may actually delay walking by interfering with your child’s own motivation to walk.  Although your child may be more stimulated by being positioned upright and able to “bounce,” infant walkers should never be used unless under close supervision.

Other infants propelled toys may expose your child to similar dangers. They should also be used only with strict supervision.

Are bouncy seats and swings safe?

Yes they can be. Use them in moderation and make sure there are no safety issues. Use them when your child is developmentally ready to use them safely. They need to be assembled correctly and must have adequate support. Make sure there is not risk for an arm or leg being entrapped and as always be cautious about choking risk.

 

Poisoning

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What should I do if my child ingests a poison substance?

Prevention is the best treatment, but be prepared in case an ingestion occurs.  The best preparation is to have a Poison Control Center telephone number and your doctor’s telephone number written down close to your telephone.

Who should I call first in case of poisoning?

You should always call you Poison Control Center immediately without delay.  Do not call your physician or the hospital emergency room until after you have contacted the Poison Control Center.

What information should I have available when I call?

  • An accurate description of the product swallows (read the label).
  • An estimate of how much of the poison was ingested or how many pills were swallowed
  • Your child’s age or size in pounds or kilograms.
  • An estimate of how long it has been since the ingestion.
  • Current medicines your child had taken in the past 48 hours.
  • Current illness or chronic medical problems present.
  • Describe any reactions or symptoms suffered from the ingestion (i. e., choking, gagging, vomiting, sleepiness, seizures, unconscious, etc.)

Remember: If any poison is spilled on the skin or in the eyes, rinse thoroughly with luke warm water. Call your Poison Control Center immediately thereafter.

TV Toppling Injuries

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Between 2000 and 2010 169 children died from injuries sustained from television sets tipping over on them. Front heavy televisions can topple over on children and cause severe injuries. Children frequently are around television sets either reaching for a toy or a remote controller on top of the set or watching the television. They also can become tangled in or tug at TV or cable cords causing the TV to topple. These deaths are caused by severe trauma to the head or body or by suffocation. They do not need to happen and can be easily prevented.

An estimated 13,700 children were treated in emergency departments between 2008 and 2010 after being struck by a television. Younger children suffered greater injuries and were injured more frequently. The most common injuries were head injuries. Since this is the time of greatest neurodevelopmental change head injuries at a young age have dramatic and lasting effects.

To protect your child from such injuries follow these tips from the American Academy of Pediatrics:

  • Place your television on allow stand or base and push the television as far back from furniture as possible.
  • Make sure the stand is sturdy and can handle the weight of your TV.
  • Do not place your television on a piece of furniture that is not designed for this use.
  • Secure your TV and its stand to a wall stud with anchoring devices.
  • Check packaging to make sure the anchoring device can support the weight of your TV and the piece of furniture. Make sure the anchoring device is designed for the kind of TV you own. Older TV sets that are not flat screen are especially heavy and can injure your child severely.
  • Always follow manufacturer’s instructions on anchoring your TV.
  • Do not place toys, remote controls or other items that might attract your child’s attention on top of the stand or the TV.
  • Keep TV and cable cords out of sight and out of your child’s reach.
  • Be especially careful when you are at another person’s house with your child. Make sure their TV is anchored properly and all the safety issues discussed above have been dealt with. If there are concerns then do not allow your child near the TV.

Sun Damage

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When your skin is exposed to sunlight that contains ultraviolet or visible light photosensitivity reactions can occur. The one you see most often is sunburn. Sunburn is seen on sun exposed skin surfaces with red areas and if severe swelling and blistering can also be seen. Pain and itching are also common. During the healing process skin peeling is often seen. The best treatment for mild injury is patience and cool compresses.

Acetaminophen can help with the pain. If there are more severe symptoms including blisters with associated fever, chills, headache and feeling sick then call your pediatrician. Severe sunburn needs to be treated like any other burn to the skin. Hydration is very important.

Other reactions include sun poisoning or sun allergy where a variety of skin changes can be seen. Skin changes begin within hours to days of exposure and can vary from redness and swelling to raise red areas with blistering. Another name is PMLE (polymorphous light eruption).

Skin rashes are also associated with the ingestion of various photosensitizing substances in combination with sun exposure. These are commonly due to drugs that induce photosensitivity reactions. These include antibiotics (sulfa/ tetracycline/ doxycycline), phenothiazines, griseofulvin (used for ringworm), thiazide diuretics and acne medication (retinoids).

Topical agents applied directly to the skin can also cause skin reactions with sun exposure. These include various fragrances, non-steroidal anti-inflammatory medication and various antimicrobial agents including hexachlorophene.

Photo allergic reactions are also seen due to skin contact with various plant substances during sun exposure. Limes and citrus fruits are common culprits. These skin changes are often delayed and appear 24 hours after sun exposure. The areas are not itchy but may be painful and after the redness fades an area of increased pigmentation is seen and can last for a long time.

If your child develops skin changes after sun exposure and it is not typical sunburn call your pediatrician.

Star Trek

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In honor of memories lost and memories gained I want to share a memory with you in honor of Memorial Day.
This weekend while watching the new Star Trek film Star Trek Into Darkness I remembered a big mistake I made during my freshman year in college. It happened in a paper I wrote discussing The Martian Chronicles and the television show Star Trek. I was completing my first semester in college and a term paper was due for my favorite class, English Colloquium. Our grade was determined by class discussions and a term paper. Weeks and months passed and no topic excited me. One morning I awoke and knew the title: “Hopes and Fears as Written and Portrayed by the Author of The Martian Chronicles and Star Trek.”
After finishing my writing, I waited anxiously for a meeting with my teacher to discuss the term paper. I was proud of the paper I had written. When we met, he handed me my paper. I immediately saw there was no grade on the paper. I looked at him with a perplexed look as he began to ask me many questions about my paper. We talked about the hopes and fears of man and the difference between a reader’s and an author’s perception. After almost two hours he wrote an A on the cover page and handed me my paper. He told me he had enjoyed our discussion and looked forward to reading more of my writing in the years to come. He told me to take some time and read his comments. I put the paper in my backpack and headed off to my next class.
That night in the cafeteria I was talking to a friend about my paper when he said to me, “Those stories are not written by the same author.” I ran back to my dorm, grabbed my paper and read my teacher’s comments. At the end of my paper he had written Ray Bradbury – The Martian Chronicles and Gene Roddenberry – Star Trek. Until that very moment I thought Roy Bradbury had written Star Trek. My heart sank. He wrote next to the names, “Joe, mistakes happen. Always follow your dreams.”
Through this mistake my teacher taught me the power of understanding and the importance of fairness. Life for us and for our children is about learning from our mistakes. That day I realized we learn more from a big mistake than a big success, and it is our ability to learn and respond to such failures that define and enable us to achieve our greatest successes. The next time your child makes a mistake remember how being fair, kind and non-judgmental provide your child the greatest opportunity to learn.

Choking

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What foods should I avoid giving my infant or toddler?

Infants and toddlers are unable to chew food as older children or adults.  Foods that are hard to chew should not be given to children until their molars (these are the chewing teeth in the back of the mouth) are in place, usually between the ages 3 to 4 years.  Examples of such foods to avoid are seeds and nuts, hard candy, raw carrots, or celery or popcorn (kernels).

Soft small foods can also be breathed in (stuck in windpipe) if slippery and small enough.  Examples of such foods to avoid include raisins, grapes, hot dogs and sausage until after age 3 to 4.

Foods that are “sticky” and thus difficult to swallow should be avoided.  These foods include caramels, peanut butter, fudge, etc.  Peanut butter can be mixed with jelly.

What other articles can be aspirated (stuck in windpipe)?

Small toy parts, balloons, marbles, styrofoam, plastic bags and pen caps, are some common household items that small children can pick up and put in their mouths.  Be sure to keep all such items out of children’s reach.

What can I do to prevent choking?

  • Do not allow your child to eat and talk at the same time.
  • Cut up foods into small pieces that he is able to chew.
  • Do not allow your child to eat and run or walk around at the same time.
  • Examine all toys for small removable parts and avoid using or purchasing such toys for your child.
  • Teach your child to eat slowly and chew properly.

Are Car Seats for Children Necessary?

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How many children and infants are injured or killed in auto accidents?

Each year between 600-700 child passengers are killed and over 500,000 under the age of 5 are injured.

What is the major cause of death and serious injury threatening children today?

According to the American Academy of Pediatrics it is trauma suffered by children riding unprotected in cars involved in accidents.

Can proper car safety use help?

60-70% of the deaths and injuries children suffer in auto accidents can be prevented with proper car safety.

How much force is exerted on a 10 pound infant in 30 mph crash?

The infant is slammed forward with the force of 300 pounds. This is the same as falling from three story building.

Is it safe to hold an infant instead of using a car seat?

No. This is called the “child crusher” position. At 30 mph a 125 pound adult is thrown forward with the force of almost two tons.

Are there any hints in selecting a car seat?

Select one which is comfortable for your child. Test the seat in your car to make certain it fits correctly and is compatible with your seat belt system. Make certain your seat has passed dynamic “crash” testing and meets applicable Federal Motor Vehicle Safety Standard 213, effective January 1, 1981.

What is an infant seat?

These seats are designed for a baby weighing under 20 pounds. It must be installed so the infant rides facing rear.

What are toddler seats?

These are designed for the child who can sit up unassisted and weighs over 20 pounds but less than 50 pounds. These seats face forward.

Are there any other kinds of seats?

Yes. There are convertible seats which can be used for birth to age 3 or 4 years. They can be inclined and face backwards when the child is an infant and then be turned around and moved upright when the child is older.

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.