Infant Care

While in a doctor's office, parents sometime may not see or understand all the finer aspects of our physical examination. As we talk within the confines of the exam room, parents may easily miss ca a part of our examination of their child. After several years of performing hundreds of exams, physicians and nurse practitioners become quite thorough and efficient. Parents may be unaware that we examined parts of their child as we sequentially perform the exam. For example, an infant came to the office for a well-child checkup. Later that afternoon, the mother called to say, "I was worried that my baby has an ear infection, and forgot to ask the doctor to check her ears." However, we indeed HAD looked in the ears, but we were carrying on a conversation with Mom at the time. We had completed the ear exam before Mom was aware of it. Almost all health care professionals look inside the ear canal of practically every child. After all, middle ear infections are very common, even in so-called "well" children! Looking at the eardrums is "part-and-parcel" of practically every visit! Some physicians talk their way through the physical exam, so the parent knows what we are looking for. For example, "I'm now feeling his neck, looking for lymph nodes or enlarged thyroid gland,...etc. However, some of us find that repetitive and tedious - it's just not our style! Therefore, we want to assure you that we have a "mental check-off list" as we do every physical exam on a child. If you have questions regarding the finer points of our exam, we encourage you to ask - we want you to have all your questions answered

A baby's sleep patterns change as she grows. According to Barry S. Zuckerman, MD, Director of the Division of Behavioral and Developmental Pediatrics at Boston City Hospital, infants need to learn to associate their crib with sleeping. If an infant falls asleep in her mother's arms, she is more likely to have problems falling back asleep when she wakes up in the middle of the night. Infants are more likely to fall back asleep if they awaken in the same place where they fall asleep. Infants typically awaken six to eight times every night. To help them fall back asleep quickly, parents should always put young infants into the crib while they are still partially awake. There has been a lot of interest recently in so called ‘attachment parenting ‘ which goes against the ‘don’t hold or rock the baby to sleep’ philosophy noted above. What we would say is none of these things are set in stone and you may have to find what works best for your baby. One aspect of attachment parenting that we would discourage is ‘Co-sleeping’ which has definitely been found to be dangerous. As the baby's nervous system matures, she is more likely to sleep through the night. Sleeping through has nothing to do with when they are started on solid foods or their weight. By age four months, most infants are sleeping six to eight hours a night. By six months most infants sleep 10 - 12 hours a night. Problems with separation and autonomy begin to affect sleep once babies are one year old. Fixed nighttime routines help older babies fall asleep easier because the routines appeal to the child's need for autonomy. Dr. Zuckerman studied the effectiveness of counseling new mothers to put their babies in the crib while still partially awake. He found that these infants awoke significantly fewer times during the night than infants whose mothers received no counseling on sleep habits and patterns

Breast Feeding - Is It Enough? What determines how much breast milk a baby takes? Why do some infants take as little as 450 grams of breast milk a day while other consume 1200 grams a day? A recent four day study of 73 three-month-old infants fed exclusively breast milk concluded that the infants themselves determine how much they consume. The amount of milk available wasn't a factor since, on average, all the infants left about the same daily total milk in their mothers' breasts - 100 grams. This was the same for all infant groups no matter how much they fed. A very good measure of how well the baby is breast feeding is to see how often she pees! A baby who is urinating 4-6 times (minimum) in 24 hours is doing fine.     Training Breastfed Babies to Sleep Through the Night  A recent study showed that parents can actually "train" their breastfed baby to sleep longer. The instructions that parents must follow in order for this to work (according to the research article) were: (1) Feed your infant around the same time each night (e.g., 10 - 11.:30 p.m.), (2) Avoid picking him up in the middle of the night, unless he has cried steadily for over 5 minutes, (3) Avoid holding, rocking, or nursing Baby until he falls asleep, but instead place him down in the bed after the last feeding, (4) Contrast day and night for Baby (that is, during the day, make sure sunlight and surrounding noise is normal for that time of day while, at night, baby's room is relatively dark and quiet).     Breast Feeding & Bowel Movements Moms who are breastfeeding for the first time, please make a note: your "BMs" will change in frequency. Not to worry! Breast-fed babies for the first weeks of life will have several loose BMs each day. Then, about 1-2 months of age, some breast-fed infants change to a less frequent BM habit. They go to once a day, once every other day, or sometimes once a week or so! The infrequent BMs do not mean your baby is constipated. Remember: constipation means that the stools are hard and dry. Frequency has nothing to do with the definition of this term. As long as the stools are soft, these infrequent breastfeeding BMs arc very common during the first months of life.     Breast-Feeding and Illness: The benefits of breast-feeding compared to using formula are well known. Yet there are still skeptics, particularly in industrialized nations. To help settle this once and for all, doctors in Canada compared the incidence of pneumonia, otitis media ("ear infections"), bacteremia (infections of the blood), meningitis, and hospitalizations in breast-fed and formula-fed infants during their first six months of life. Not too surprisingly, they found breast-feeding offered a protective effect against all these illnesses as well as gastrointestinal problems. The babies in the formula-fed group had 50% more illnesses than the babies in the breast-fed group. This result may be distorted because the researchers put any baby in the breast-fed group who received any breast milk, even if they also were supplemented with formula. If they considered only exclusively breast-fed babies as the breast-fed group, the results would be even more significant. This report doesn't present much that's new, but it definitely reinforces what breast-feeding advocates already know breast-fed babies are healthier that those fed formula.     Breast Feeding and Intelligence: Children who are breast fed tend to do better in school than their non-breast fed peers. Researcher at the National Institutes of Health followed 855 children born between 1978 and 1982 from birth through school age. The regular evaluations included testing for mental and motor skills, questioning their mothers, and reviewing report cards. Evaluations at two years old found that the longer the children had been breast fed, the smarter and more coordinated the child. Scores of infants breast fed for less than a month were similar to those of children who were never breast fed. By third grade, children who were breast fed the longest had moderately higher English and slightly higher math scores. Researcher are not sure why breast feeding influences intelligence. They postulate that something in breast milk, perhaps the lipids which are essential for central nervous system development, may have a role.     Diabetes and Milk :Why one person develops diabetes and another doesn't still isn't known. There are many different theories, but none have been proven. One postulates that the early introduction of cows' milk into an infants' diet increases the chances the child will later develop diabetes. To better understand the possible relationship between cows' milk and type I diabetes (formerly known as juvenile onset diabetes and insulin-dependent diabetes), over 60 articles that explored this possible relationship were reviewed. Once all the data was pooled and analyzed, it appears that early exposure to cows' milk may increase the risk of developing type I diabetes by 1.5 times. The longer a woman breastfeeds her baby, the less the chances the baby will develop diabetes later in life.     Formula Ads:There's no doubt that breast-feeding is the best way to feed infants. There is also no doubt that formula companies want to sell a lot of formula with ads. We make it a point to not display any formula products or ads in the office but do have samples available for the mom who cannot or chooses to not breast feed.

Rotten front teeth in a young child are costly, unsightly, and painful. Wha! is more important is that nursing caries is preventable. "Nursing caries" is the term applied to those infants and toddlers who develop tooth decay at a young age. In almost every case it arises, in major part, from poor nutritional th habits perpetrated by the parents. In order for tooth decay to develop, at least two ingredients must be present: (a) Certain bacteria, called Streptococcus mutans must be inside the mouth in large number. All of us have some of these strep germs in our mouth, but some kids have a larger amount than most. In association with sugar, these bacteria are the culprits that do the actual damage to the teeth. (b) Frequent exposure of the teeth to sugar must occur for nursing caries to develop. For certain th parents, it's easier to put a fussy child to bed with a bottle than it is to think about preventing rotten teeth. The same problem occurs when Mom puts Baby into the bed with her at night, so that Baby can breastfeed almost continually. Remember breast milk has sugar in it, too! Parents who use such techniques to pacify their infant do not realize that they may end up spending around $3,000 to fix these decayed teeth! Baby teeth are extremely important to guarantee proper development of the permanent teeth. Many parents who use the bottle or breast as a pacifier do so because they learned it from other parents, or because it is a common habit amongst their friends or culture. If parents can break this one ir habit, however, they can save their child the pain, suffering, and embarrassment of having decayed teeth early in life

Honey should NOT be given to infants under 12 months of age; it can contain a toxin from a bacteria which can cause extreme weakness, so much so that the baby can't breathe! Evidently, older children and adults are "immune" to this protein. Weird fact: this same toxin is used to make Botox!

This has become a controversial subject recently. For a long time there was a belief that avoiding ‘allergenic foods’ in early life, i.e avoiding peanuts, eggs etc for the first year- or even two years -reduced the develpment of allergies in children. This view has been challenged by some recent studies which have shown that the opposite may actually be true!   There is also the ‘hygeine hypothesis’ which goes something like this: our lives have become ‘too clean’ with not too many kids exposed to ‘good ol dirt’ and germs and so, our immune system has nothing to do and starts attacking our own body causing allergic diseases. The jury is still out on this theory too! No one knows why children develop allergies, though many theories abound. Inheritance seems to play a role -Infants with either both parents or one parent and a sibling with allergies are at "high risk" of developing allergies themselves. By the way, these 'high risk babies' are the ones most benefitted  by eary introduction of these foods.

A friend suggested I give my baby cereal so he'll sleep longer at night, is this good advice? The American Academy of Pediatrics now recommends that no solid foods be given until an infant is four to six months old. Before that, babies' digestive systems aren't ready to handle cereals or other solids. Starting solids too early can also contribute to obesity and allergies. Some babies begin to sleep through the night as early as the second month, while others take quite a bit longer. (Usually the change occurs when the Infant weighs about 11 pounds.) Although it's tiring and frustrating to be awakened every night, it's probably best to let your baby set the schedule for these few months.

Microwaves are great little devices, but please be careful when warming drinks or foods for your children. Mouth burns have occurred, so test the food or drink (and that includes testing the temperature of warmed formula) before giving it to your infant or child!

We usually check a blood count somewhere within the first year of life or so, looking for anemia. Anemia in an infant or toddler is most commonly due to a relative lack of iron; that is, babies tend to "outgrow" their natural supply of iron. Of course, iron is quite important for the body when it manufactories red blood cells. So, it's not unusual for us to prescribe liquid or tablet iron supplements, with such brand names as FeoSol or Fer-in-Sol. If your child needs one of these supplements, there are a few points that you need to remember: a) Iron is poisonous if taken in overdose. If your 3-year-old decides to drink the bottle of iron (or the multi-vitamins with iron that some parents like to use every day), we're in big trouble!! If this sort of event happens, you'll become familiar with the term "stomach-pumping',' not to mention a hospital stay for 1-2 days! b) Iron stains the teeth temporarily black. To avoid this, some recommend that you mix the iron with a clear liquid like Coke or Sprite (not milk, since it decreases the intestine's ability to absorb the iron) and have your child suck the mixture through a straw. c) Iron does funny things to the bowel movements, such as turn them black, or cause constipation (some children have the opposite effect, and have diarrhea). We normally prescribe the extra iron for only 4-6 weeks, and then check another blood count. The benefits of taking the iron are definitely worth the hassles that you may experience. After all, anemic children tend to be more irritable, not as energetic, and may have a few more illnesses than those who aren't anemic

There are few topics that generate more questions or 'controversy' than vaccines. The word 'controversy' is in quotes for a reason-- from a rational, scientific standpoint, there is no controversy! It is only in popular culture and in the media that vaccines are a 'controversy'. The reality is that they are without a doubt one of the greatest advances of medicine and they have been responsible for eliminating or nearly eliminating a number of diseases that used to be the scourge of humanity for centuries.

 We get a lot questions about the supposed 'dangers' of vaccines and we have answers for EACH ONE of those questions. The questions are many and there are literally books that can be written about this but here are some verifiable facts:
Numerous reputable studies in numerous countries involving thousands of children have come to the same conclusion: Vaccines do not cause autism. More and more research is showing that this devastating condition is caused by various factors including genetics, older age of the father, toxins during pregnancy etc--- but NOT vaccines.
The trace amounts of mercury in some vaccines (the polio vaccine) is NOT toxic because it is a miniscule amount and it is in the ethyl mercury form which is not toxic (methyl mercury is toxic). This might seem like a little difference but its the exact chemical difference that makes rubbing alcohol a poison and the alcohol in wine not a poison (methyl alcohol versus ethyl alcohol)! Some amount of mercury is present in all of us. A baby will received more mercury from her mother's milk than she will receive from all the vaccines in the first year of life put together.
The chicken pox is "just the chicken pox" and no bid deal except for the 1-2 children every year who die from severe skin infections of the chicken pox spots.
"I have never had the flu vaccine and neither have my kids and they have been fine." That is the same as saying "I have been driving without a seat belt for years and have been fine, so I am going to continue doing the same".
We are very passionate about ensuring the good health of all 'our kids' and vaccines are a very big part of that effort. So much so that since 2012, we have a policy that if a parent does not want to vaccinate their child at all, we respectfully ask them to find another practice for their child.

When to see the doctor: How can I tell when my baby needs to see a doctor? A. A study at Yale Medical School identified five symptoms of serious illness that may require immediate medical attention:
Your baby cries much more (or much less) than usual, and the crying is louder or more intense.
Your baby behaves differently: She is much more cranky and restless and can't be calmed, or she is uncommonly quiet.
Your baby's sleeping habits have changed noticeably.Your baby is either very pale or very flushed.
Your baby is dehydrated. Dehydration is very dangerous in an infant, and it is important to get a doctor's advice immediately. Tip: If her nostrils, lips and cheeks seem dry to the touch, she may be dehydrated. Also watch for a decrease in urination, or crying without tears.

When Should I Bring My Child in for Fever? We have a few "hard and fast" guidelines about seeing your child for evaluation of fever: 
​(1)Any child under 3 months of age with fever should come in as soon as possible. These infants are at higher risk for having a more serious infection, such as meningitis or bloodstream infection.
(2) Any child who has fever and has other symptoms that you see as serious such as persistent vomiting, serious coughing, etc.(3) Any child who has had fever for over two or three days for which you are uncertain of the cause. 
(4) Any child who has been seen by us for fever in the past 48-72 hours but who still has fever. Remember that fever is simply one sign of illness and is not the "only" reason for which you should seek medical attention. It's the general condition of your child which is the main factor in determining whether you should come to see us. In other words, if your child looks sick, we need to see him in the office for an exam! As is usually the case, very few events in life - including episodes of childhood fever - have straight-forward answers! When deciding whether your febrile child needs to come to our office, you will, many time, have to trust your better judgment. Of course, if you ask us via a phone call, we will almost always say to "Come In" because it is very difficult for us to tell what is happening without examining your child.
Nightime, Fever, & Babies: Infants under 2-3 months of age are susceptible to more serious infections, such as blood stream infection, pneumonia, or menigitis. For this reason, most physicians feel that such a young infant should be seen fairly quickly once the parent has noticed a fever of 101 degrees or over. If you notice in the middle of the night that your infant under 3 months old has a fever, some physicians would even advise a trip to the Emergency Room. Otherwise, an older infant with a fever can usually wait until the next morning to see us in the office. Emergency Room visits for a child with fever are, of course, dependent on how ill the infant looks and the anxiety level of the parent!