Infant

All Articles in the Category ‘Infant’

New Breast Pump Cleaning Guidelines From CDC

Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.

After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.

In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”

New CDC Breast Pump Cleaning Guidelines:

  • Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
  • Wash your hands before touching your pump parts or pumped milk.
  • Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
  • Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
  • Use running water and soap to clean breast pump parts that come in contact with breast milk.
  • Then let each piece and part air dry.
  • For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.

Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read full post »

Limit The Juice: None for Babies, Only Ounces For Kids

Not news that pediatricians recommend against juice. But the news this week is clearer: no juice for babies, only tiny bits for toddlers, and less than a cup a day for the rest of us. Fruit juice is widely thought of as a healthy and natural source of vitamins and hydration. And although I won’t vilify having juice in the diet of an older child, I can’t endorse it’s ever good for a child. Pediatric recommendations for juice got stricter this week. Juice is never really recommended in an a child’s diet past ounces to a cup a day but now it’s recommended as a NEVER during infancy.

Although whole fruit (i.e. an apple or an entire avocado or apricot) is one of the main focus foods in the Dietary Guidelines of Americans, fruit juice may feel a thoughtful substitute, but it’s not. In fact, even 100% fruit juice offers no real nutritional benefit and it’s never needed. The short list for why?

  • Juice is just a bunch of water and simple sugars (naturally occurring sugar is sugar) and lacks fiber or protein.
  • When you obtain calories from juice you take them in at a faster rate than is ideal. Juice is known to contribute to overweight and excess energy imbalance in children. We don’t need to drink these calories.
  • Whole fruit has the advantage of containing quality fiber that’s good for us.

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Tongue-Tie And Breastfeeding: What To Do For Babies With Tongue-Tie

Image c/o Mayo Clinic

Tongue-tie is a condition in which an unusually short, thick or tight band of tissue (frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. Often it goes unnoticed and causes no problems in life but rarely it can affect how a child eats and how they sound when they speak, and can sometimes interfere with breastfeeding because baby’s tongue may not have enough range of motion to attach to the breast, suck and swallow effectively. Sometimes tongue-tied babies can’t maintain a latch for long enough to take in a full feeding, and others remain attached to the breast for long periods of time without taking in enough milk. Sometimes babies with tight frenulums make it miserable for mom to feed because of the way they attach and latch. When a newborn has a tight frenulum breastfeeding moms may have nipple pain, mom may hear clicking sound while the baby feeds, or mom may feel it’s inefficient. Sometimes a parent will notice a heart shape to the tip of the tongue as the band of tissue pulls on the tongue where it’s attached.

What to do about tongue-tie can be controversial. Not all pediatricians, Ear, Nose and Throat surgeons, lactation consultants and occupational therapists always agree. However, every baby deserves the chance to be evaluated by both a physician and a board certified lactation consultant if there is concern! Awareness about a newborn’s challenges with breastfeeding increases diagnosis in the newborn period but decisions to clip a tongue-tie come about from a variety of factors. The American Academy of Pediatrics states: “surgery, called frenotomy, should be considered if the tongue-tie appears to restrict tongue movement, such as inability to latch on with breastfeeding. It is a simple, safe, and effective procedure—general anesthesia is not required.” It takes only a few seconds and many pediatricians can perform the clip in their office.

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How To Decrease Risk Of A Peanut Allergy

Strong evidence continues for babies getting peanuts before a year of age. Now, more than ever, I believe parents to babies at risk for allergies need to pay close attention during the first 6 months. Although the pendulum has swung about how, when and why to introduce peanuts to babies over the past years, more and more experts agree. There are 3 categories and 3 specific recommendations for babies. Babies at risk for allergies should get peanuts by 4 to 6 months of age, although there are conditions and specific recommendations, based on a baby’s family history and health, so read the 3 tips below carefully.

I’ve noticed with the advice swirling and moving the last decade, parents remain a bit shy about starting peanuts before a year of age. I have a comprehensive blog post, Peanuts During Infancy To Prevent Peanut Allergy, detailing the ground-breaking study (I truly don’t think I’m overstating the ground-breaking part) that came out last year. Basically, researchers found that babies at higher risk for allergies (eczema, family history of allergies, egg allergy) had less peanut allergy in life when given peanuts as babies compared to babies who waited to have peanuts. Since that time more data has unfolded that points the same direction.

Even as the data mounts, I think the shyness to introduce peanuts continues for some families. Simply because we’ve heard the opposite advice for previous years. Read on and please share this. Over the next decade we may turn some of the tide on peanut allergy.

Science shifts its weight a lot so it’s hard to register immediate trust in shifting advice. The shyness makes sense but I hope this post helps combat it. This New York Times article about why advice changes, by pediatrician Dr. Aaron Carroll, is worth your time if you’re curious about the rationale and reason for shifting medical advice. When it comes to peanuts I feel good about early introduction for nearly all children. Here’s why:

An expert panel published new guidelines in the Journal of Allergy and Clinical Immunology this month about when to introduce children to peanut-containing foods to help prevent food allergies. Here’s a summary of the panel’s report written for parents. The science, as detailed in the post I wrote last year was strongly influenced by previous research. The panel says, “recent scientific research has shown that peanut allergy can be prevented by introducing peanut containing foods into the diet early in life. Researchers conducted a clinical trial called Learning Early About Peanut Allergy (LEAP) with more than 600 infants considered to be at high risk of developing peanut allergy because they had severe eczema, egg allergy, or both. The scientists randomly divided the babies into two groups. One group was given peanut-containing foods to eat regularly, and the other group was told to avoid peanut-containing foods. They did this until they reached 5 years of age. By comparing the two groups, researchers found that regular consumption of peanut-containing foods beginning early in life reduced the risk of developing peanut allergy by 81 percent.”

How To Reduce Peanut Allergy Risk For Your Baby:

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New Data And 10 Ways To Reduce SIDS And Suffocation Risk In Babies

Mommy-copy-e1273260009105Any parent to a newborn worries about Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID) and what they can do to prevent it. SIDS deaths are unexplained while SUID deaths in infants are secondary to things like suffocation, entrapment, infections, or trauma. The new recommendations take research on all of these risks into account and are specific to guide parents to reduce risks for SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population.

I’ve been interviewed a lot lately about all the fancy new baby trackers, monitors and even smart cribs available to the public being marketed as SIDS reducers. These are not the answer to safer sleep — no data to prove it. I’m a digital enthusiast but it doesn’t change my concern that these devices are entering the market out of the place of fear, not science for improved safety. I think we have to acknowledge that these trackers might amp and rev up anxiety more than they will decrease it in some parents.

What we CAN do to decrease risk of SIDS is follow new research-based guidelines published this month from the American Academy of Pediatrics (AAP) to reduce the likelihood of SIDS and suffocation. This new set of guidelines are updates to the 2011 recommendations, some being similar, and others a bit different. Big changes from my perspective are the stronger recommendations for pacifier use in infants, the strong recommendation against feeding babies in the nursing chair at night, and the ongoing urging to have your babies in BARE, BORING, BASIC sleeping environments in a parents room. Pillows, blankets, bumpers, and stuffed animals are cute but not safe for infants under 1 year of age. Where we feed our hungry babies in the middle of the night matters, too. The recs out this month help define ways to do this with more confidence you’re reducing risk.

“Parents should never place the baby on a sofa, couch, or cushioned chair, either alone or sleeping with another person. We know that these surfaces are extremely hazardous.” ~Rachel Moon, the lead author of the new guidelines and professor of pediatrics at University of Virginia School of Medicine

10 Ways To Reduce Risk Of SIDS And Suffocation

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How To Dose OTC Medicines In Babies

kyotcs_feverinfographic_weightageAbout 4 million sweet babies are born in the U.S. every year. And since September & October are two of the most popular months in the year for the birth of babies I’m taking a moment to share a couple of reminders for new families and those of you who support them.

1. Nursing Moms & Over The Counter (OTC) Medications: Every new parent feels a sense of overwhelm and exhaustion after welcoming a new baby. It can be especially exhausting when moms are breastfeeding and carry the new concerns about what they’re eating, how they’re both supporting themselves and their baby’s milk and when moms and dads have concerns about passing OTC medications (or Rx ones) through mom’s milk. Here are a few guidelines and reminders:

  • Don’t take aspirin if you’re breastfeeding.
  • It’s always best to avoid extra strength formulas of any medication, as they stay in the blood stream longer.
  • Always ask your doctor if you are worried or have questions about a medicine or supplement you’re taking if you’re breastfeeding. Always makes sense to ask.
  • Read the Drug Facts label as this will sometimes help you understand risks.
  • I like LactMed as a resource/search tool to help find information on medications. LactMed is updated monthly and is a database of over 1,000 drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant. All data are derived from the scientific literature and fully referenced.

2. When Your New Baby Gets A Cold Or Fever: Your baby’s first bout with a cold or fever can leave you feeling scared (and exhausted) as you watch your baby deal with the inconvenience of mucus and snot, coughs and/or sneezes. Infants are more susceptible to infections because they don’t have fully developed immune systems hence why we all work hard to avoid exposures for them early in life. But upper respiratory infections (“colds”) do happen even with the best of protections.

Oral cough and cold medicines (including cough suppressants, cough expectorants and multi-symptom cold medicines) are not safe for infants and young children under the age of 4 or 6 years of age.

However, if your baby has a fever and is OVER the age of 3 months, you can give them acetaminophen to help relieve symptoms. The label on OTC medicines for infants and children only includes dosing for children age 2 and older; so talk to your doctor for dosing for younger children.

Always dose medicine by your infant’s weight, not their age, so at every well child check-up as your baby grows, ask your pediatrician to provide the proper, current dose for OTC medicines.

You can also give your child ibuprofen for mild infections, fever, or teething. Dosing for children 6 months and older is on the label; talk to a doctor for dosing for younger children although it is not typically recommended. Here’s more on dosing acetaminophen and ibuprofen by weight in infants and toddlers.

There are also several non-medicine interventions for colds. If your infant or toddler is too young to be given OTC medications or you’d prefer not to use them, there are other options to help relieve symptoms and keep your baby sleeping and comfortable. Read full post »

Infants Turning Blue And Other Scary Things

EVERY new parent worries about their newborn from how much they are eating, sleeping, peeing and pooping to ensuring they hit developmental milestones. We also worry about how they breathe and how they sound. It’s a stressful time period and most aren’t running on tons of sleep themselves — so we’re more emotional baseline. Occasionally, a terrifying thing happens where your infant turns bright red, or even blue or pauses their breathing. They may arch in a funny way or get stiff in their arms or legs. We may wonder if something serious is going on. If your infant (under 12 months of age) has an episode where they have pauses in breathing for less than 1 minute, they turn blue and then recover to normal…chances are…it’s normal. Normal? Turning pale or blue doesn’t seem normal nor does having your baby get stiff, nor does a second where they pause their breathing, but it can be, and there’s a name for it: Brief Resolved Unexplained Event (BRUE).

No question we have to trust our instincts if we think something isn’t going well for our babies and I always suggest seeing your pediatrician or family physician or nurse practitioner if you worry about your infant’s health, for reassurance. No question! Go in, get reassurance and learn. Don’t ever feel bad if everything checks out — this is why your pediatric team is there for you and your family. However, when you do go in for an evaluation from a nurse practitioner or physician,  even if your baby has unusual breathing at times, or tenses, or even has a change in color, you may not need a lot of testing. Sometimes it’s normal.

Some Information About Breathing Patterns In Infants:

  • Periodic Breathing: Newborns breath less regularly than older infants, children or adults. This is in part because of their immature brain stem (the part our brain that regulates the drive to breathe). The majority of newborns experience some periodic breathing in first couple weeks of life and most infants don’t have periodic breathing after 4 or 5 months of age. The term “periodic breathing” captures behaviors where babies breathe rapidly for a few moments, then pause for a few, then breath rapidly again. Most of the time periodic breathing happens with pauses that last no more than 10 seconds. It can appear really unusual to a new parent or relative. The Academy of Pediatrics defines it this way: “Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern.”
  • Color Change: babies can change color with crying, eating, fatigue or movement. Most of the time parents notice that babies will get bright red or ruddy while other times parents worry their baby looks pale or even a bit blue. It’s true that color change can represent underlying heart or breathing problems so if ever sustained over 1-minute it needs to be evaluated promptly. However, color change in infants over 2 months of age that resolves within 1 minutes may not need any work-up after you check in with a clinician. Sometimes color change can come from things like gastroesophageal reflux, coughing or choking, too. If any concern about your baby’s color it’s worth checking in with the pediatrician for a physical exam. While in the office, a pediatrician will do a full physical exam and ask lots of questions, and they can also check a spot oximetry for oxygen levels (pulse oximetry is standardly obtained in first 24 hours after birth to check blood oxygen levels to screen for underlying heart problems), do a electrocardiogram (EKG), and have observation.
  • Noises: babies make all sorts of terrifying sounds! Gagging sounds, choking, gurgling, sneezing, and coughing. Most of these during infancy fall in the range of typical and normal if they don’t interfere with eating, breathing, and sleep. Sneezing is fairly common in the first couple months, again because of immaturity of reflexes. Some parents worry about babies who spit up and sound like they can’t breathe and want to put babies on their tummies. No evidence that is recommended and to lower risk of SIDS, we always recommend babies are put on their back in bare crib for sleep.

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Cry-It-Out Improves Sleep And Reduces Mom Stress

Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.

6 Take-Aways From The Baby Sleep Study

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Swaddling On Side And Tummy May Increase Risk Of SIDS

SwaddleBoth of my babies loved to be swaddled. It helped them calm down and I always experienced them happier and easier to console while snuggled & bundled. My experience isn’t unusual. Research in the past has found that swaddling rates are increasing and it can help newborns with sleep awakenings while also creating a slight reduction in crying in babies under 2 months, and may help babies have more quiet sleep. So the new study out today in Pediatrics evaluating the relationship between swaddling and Sudden Infant Death Syndrome (SIDS) therefore caught my attention. The study pooled research and data from 4 previously published studies to look at risk for babies who are swaddled. Although the data and findings in this new study don’t prove relationships, it does evaluate risks for babies who are swaddled versus risks for babies who were not.

Pediatrics Study Finds Swaddling On Side And Stomach Increases SIDS Risk 

  • Meta-analysis of 4 studies looking at relationship of swaddling with SIDS risk that spans data from babies in 2 decades and 3 diverse areas of the world: United Kingdom, Australia, and United States (Chicago).
  • Conclusion: Current pediatric advice to avoid tummy and side positions for sleep especially applies to infants who are swaddled.
  • Swaddling risk increased with age in infants. Infants who were swaddled over the age of 6 months had a double increased risk of SIDS.
  • Swaddling risk varied with position of sleeping. The risk was highest for babies swaddled and put on their tummy while also higher for babies put on their side and then those swaddled and put on their back compared with babies not swaddled.

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Tips On Avoiding Arsenic In Baby Rice Cereal

rice cerealWhat we feed our babies matters. No question one delightful and soulful part of raising our babies is introducing the world of solid food. I mean really, it’s hard to describe a competing parenting moment with feeding our children healthy food, at any age. For decades, rice cereal as a first food seemed to make sense but major groups reporting out on only feeding rice with caution. The Food and Drug Administration (FDA) recently proposed new limits for inorganic arsenic in rice cereals (think: potentially cancer causing toxin that is increasingly known to cause harm early in life). Many families start their transition from breastmilk/formula to solid foods by adding in rice cereal. Doing so is convenient, makes for great consistency, but rice cereal is a leading source of exposure to the toxin. Arsenic is an abundant element in the earth’s crust, coming in two forms (organic, inorganic), the inorganic form being tied to bad health outcomes. The reason rice has more arsenic compared with other foods is how rice is grown (in watery fields) and its unique tendency as a crop to absorb the arsenic while growing. Here’s what the World Health Organization (WHO) says about inorganic arsenic:

  • Arsenic is naturally present at high levels in the groundwater of a number of countries.
  • Arsenic is highly toxic in its inorganic form.
  • Contaminated water used for drinking, food preparation and irrigation of food crops poses the greatest threat to public health from arsenic.
  • Long-term exposure to arsenic from drinking-water and food can cause cancer and skin lesions. It has also been associated with developmental effects, cardiovascular disease, neurotoxicity and diabetes.
  • The most important action in affected communities is the prevention of further exposure to arsenic by provision of a safe water supply.

Why are infants particularly vulnerable to arsenic in rice? The FDA says: “relative to body weight, rice intake for infants is about three times greater than for adults.” In their evaluation, they tested 76 different rice cereals and found that 1/2 exceeded the inorganic arsenic limit. Some companies and products are advertising for safety — for example Gerber rice cereal manufacturers announced that their products already meet the FDA’s proposed limits but it will be with time that the food source is changed for good in all products packaged and marketed for babies.

Knowledge about what exactly rice cereal does to babies and their developing bodies continues to unfold but infancy is a time of profound growth and development. Also a time we really want to limit toxins that could change risks. Researchers in JAMA Pediatrics explain: Read full post »