Infant

All Articles in the Category ‘Infant’

What To Know About Baby Teeth

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Things have changed over the past couple of years regarding how to care for baby teeth. Official recommendations for fluoridated toothpaste begin with the very first sighting of the very first tooth. This is news to many.

What we do early in our child’s life can have lasting consequences. Some quick reminders for new parents, grandparents and anyone out there lucky enough to be hanging out with an infant. Keep their mouth delicious!

5 Things Every Parent Needs To Know About Baby Teeth

  1. Use fluoridated toothpaste at tooth eruption. The minute those baby teeth come in consider it the start of the lifelong brushing habit for your baby. Brushing and rinsing the teeth after breastfeeding or formula, solid meals or snacks will always be recommended.  In minimum, build brushing into everyday, ideally morning and night, with a tiny amount of fluoridated child toothpaste (see image above). This may be most important after the last evening feeding.
  2. Tap water! Brush with tap water twice a day and provide tap water for your infants and children when serving water. After you brush teeth DON’T RINSE with water. Let the tiny amount of fluoride from the brushing sit on the teeth as long as possible to prevent decay.
  3. Use the right amount of toothpaste (image above). This provides protection from bacteria and acid but also avoids concern for too much toothpaste.
    1. < 3 years of age – rice sized smear of toothpaste on the brush.
    2. > 3 years (including adults) pea sized amount of toothpaste is all you need on your brush once you know how to spit.
    3. Don’t rinse after brushing.
  4. Timing: Most infants and toddlers, preschoolers and young children can brush their teeth and tongue in about 1 minute — goal really is to brush at the gumline on all sides of each tooth, paying special attention to back teeth, molars, and lower teeth where bacteria love to reside. For older children, teens and adults the rule of thumb is typically 2 minutes of brush time to brush teeth, tongue and rid mouth of dragon breath!
  5. Bacteria: Baby teeth enamel is thinner than adult (secondary) teeth so the mix of sugar and bacteria in the mouth must be deterred. We unfortunately transfer oral bacteria to babies when we share utensils, kiss them, clean their pacifiers with our mouths (don’t do it!), and drink from shared cups. If you have a history of lots of cavities the American Academy of Pediatrics’ new policy says, “Parents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.” I’m all for smooching babies so I say this: get to the dentist yourself to make sure your mouth is in tip-top shape to avoid some bad transfers…

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Power Of A Kiss And Family Oral Health

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Oral health doesn’t start and end with the dentist. Times are changing as the Washington Dental Service Foundation has trained 1,600 pediatricians and family physicians throughout the state on the importance of oral hygiene in young children. Pediatricians are now applying fluoride during well-child check-ups and counseling families more comprehensively on how to prevent dental decay while also referring to dentists for prevention and acute dental problems. Just last month I attended the 1-1/2 hour oral health training with a pediatric dentist. That learning coupled with a new policy statement from The American Academy of Pediatrics highlighting the importance of oral health inspired me to get the word out. I suspect we can all do a bit better protecting our children’s mouths. Recommendations for fluoridated toothpaste have recently changed (use it with the very first baby tooth!) as has knowledge and reminders about how we share our bacteria with our children. What we do for our mouth may have direct effects on our children’s.

The Most Common Chronic Childhood Disease

  • The facts about oral health in children are a little surprising. By their first birthday 8% of toddlers have cavities in their mouth and the Pediatrics policy detailed 24% 2-4 year-olds, 53% 6-8 year-olds and 56% 15 year-olds also have dental disease. Since oral health (even in babies and toddlers) is an integral part of overall health of children this is problematic. Dental disease has strong links between diabetes, respiratory infections and heart disease. The numbers for children with dental disease are high (!!) which makes dental disease the most common infection of childhood.
  • Good news is much of this disease can be prevented (or corrected) and because infants and young children see the pediatrician more frequently than the dentist, it’s becoming clear that pediatricians need to hone skills on oral health, the disease process, prevention and dentist interventions when necessary.

4 Things I Learned About Oral Health

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Boring, Bare, Basic: Keep The Crib Safe

bare, boring,  basicWe’ve known for several years that a crowded bed and a decorated crib (pillows, quilts, stuffed animals, bumpers) can put babies at risk for sudden infant death syndrome (SIDS) and unintentional sleep-related suffocation. Boring, bare and basic beds are still best for babies. Tell every mother, father and grandparent to an infant you know. A Pediatrics study out today shows hazardous, soft bedding is still being used by as many as 50% of US parents despite years of public health messages urging the opposite. I see where these numbers come from– we parents love to dote on our babies. We instinctively provide warmth and coziness to our babies all day so images of abundant bedding at nighttime can look divine. Further, our families (mothers or mothers-in-law!), coworkers and neighbors may encourage soft bedding because of old habits; many feel warmer bedding is better. However when it comes to the crib, our instincts may deter us from providing the safest sleep. As friends, parents, relatives and co-workers we have to support new parents in creating a basic, boring, and bare crib. Our responsibility extends from our own home to the workplace and to our neighborhood — what we buy and hand-down for that baby showers matters! The study out today reminds us we have lots of work to do, especially as data finds some groups of parents may be at more risk for using the soft stuff…

Soft Bedding Increases Risk

Several studies around the world dating back to the 1990’s have found SIDS risk increases with soft, loose bedding. This includes blankets, pillows, stuffed animals, quilts and similar materials either covering/on top of or underneath the infant. Read more about risk modes for SIDS, and why I hate sleep positioners. What we know: data in the early 1990’s was so compelling that in 1996 the AAP began recommending that infants sleep in firm, stark bedding environments on their back. The great news is that parents took notice of the “back to sleep” campaign and there was a sharp decline in the use of bedding in the 1990’s. Between 200-2010 the progress slowed. More from the study about moms and babies at risk: Read full post »

Baby Talk: How Moms And Dads May Differ

baby talk photo edited

There may be a stereotype that women talk more than men; the language environment in which we’re raised, starting at day one, may have influence on this. Whether or not women are chattier than men is due largely in part to the context of the conversation. But a new study published in Pediatrics shows when it comes to parents talking to their babies, the term “Chatty Cathy” probably rings truer than “Chatty Carl.” And this has the potential to change the game with your child as they age. It’s well founded that the number of words your baby/child hears in the first few years of life has dramatic impact on their vocabulary, school success and education for a lifetime. Parent-talk has more impact on a child’s IQ and vocabulary than their education or socioeconomic status. Who we are as talkers really changes our babies’ lives.

Gender Differences In “Baby-Talk” And “Parent-Talk”

The Pediatrics study out this week evaluated the intersection of both baby-talk (comparing preterm and term baby boys and girls vocalizations for 16 hours at a time) and parent-talk (comparing Moms’ to Dads’ vocalizations to their infants) at birth, at about a month of age (based on original due date), and at 7 months of age. More than 1500 hours of recordings (derived from little devices worn on babies’ vests) were analyzed to compare family language interactions. Babies in families with a Mom and Dad at home were included (no same-sex couples). About ½ of the babies were late preemies (note: 1/4 of all the babies studied had a stay in the NICU) and 1/3 of families were raising children in a bilingual home. I found three key takeaways: Read full post »

Perhaps Not Intuitive? Car Seat Use From Day One

car seatNew data presented at the recent American Academy of Pediatrics meeting found 93% of parents to newborns incorrectly positioned and buckled their infants into their car seat on their first trip home. A little more proof that perfectly buckling a car seat isn’t an innate early-parenting skill! Even Prince George’s royal family didn’t get it right. I’m certain I didn’t do this perfectly either on our maiden voyage home (I remember using a zip-in blanket in the seat) nearly 8 years ago. As The Car Seat Lady reminds, “products that have a layer that goes under the baby’s body can make the baby unsafe. This is true even if the product is designed with slots for the harness straps to fit through.” Most of us clearly mess this up and although the first trip is just one trip, it may be emblematic of our everyday use.

Car seats and booster seats are important for child safety; our habits for their use begin the moment we leave the hospital or birthing center. Although those “bucket” infant car seats are safest (we’d all be safer in the car facing the rear, and in a bucket) we move away from them when our infants are around 9-12 months of age. But do remember, with every graduation to a new seat, you decrease protection. For example, when you move from a a rear-facing infant seat —> rear-facing carseat—>forward-facing carseat—>booster seat—>seat belt—>front seat at age 13,  each time you advance the child safety seat, you’re decreasing protection you provide. Don’t rush the transition! Keep your child rear-facing until at least age 2 years and in a booster until they are at least 4 foot 9 inches (57 inches) tall.

The No-Duh Importance Of Car Seats

  • Car crashes are the leading cause of death for children in the US. Creating safe habits from day one matters…don’t blow off importance of car seat safety as helicopter parenting. Using the child car seat well every time is an easy way to layer protection and channel your bursting baby love.
  • Infant car seats, rear-facing seats and boosters all hold equal import. Only two states require car or booster seats until age 8 (WA is not one of them) even though children should be in booster seats until they are both 4 foot 9 inches and between age 8 and 12 years.
  •  Car seats reduce risk of death by 71% for infants and 54% for toddlers if used properly: “Results of several studies have indicated that misused child safety seats may increase a child’s risk of serious injury in a crash.” (Page 9)

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Knowing The Benefit Of MMR Shot

A new study out today in Pediatrics reminds us that parents want information about the direct benefits shots have on their baby’s health and wellbeing. Not surprising, of course, but a good reminder for pediatricians, parents, and those who speak out on the value of vaccines to remember that primary motivation for parents in getting immunizations is to protect their child, not just protect the community. As a mom I feel the same way. As vaccination rates have decreased in pockets around the US these past few decades, and as non-medical vaccine exemptions (refusing immunization on philosophical grounds) increase, and as media coverage around the benefits of immunizing “the herd” remain a mainstay, returning to the individual benefit of vaccines makes sense. Parents really want to do what is best for their baby. They want to hear how and why to protect their baby. Vaccines do that.

The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak.   — The message shared with parents in the research study

I like this study for two reasons:

  1. Parents Want To Know Why: In the study researchers went right to parents, mostly moms (80% of participants) between age 18 and 65 years of age, to share messages about MMR shot benefits to their baby and society and then gauged their intention to immunize their baby with MMR at 1 year of age. What I also really liked was the way the benefit was framed around a child’s wellness and their ability to play and be with friends!
  2. It Serves Up a Great Reminder:  We pediatricians, nurse practitioners, family docs, RNs, and MAs need to tell families what shots children are getting and we really need to stress WHY they are getting them in the context of life. We need to make the protection a shot provides relevant every time we order and administer the vaccine!

Pediatrics Study:

In the study, researchers compared about 800 parent responses in 4 groups (each group had about 200 parents). In one group parents got information only from CDC Vaccine Information Statement (VIS) about benefits/risks of MMR vaccine. In another group, parents got information about benefits of MMR shot to their baby and the VIS information. In a third group, parents got information about MMR benefit to baby and to population, along with VIS. And in the last group parents got information only about benefits of the shot for protecting the community along with the VIS.

Results: Parents were more likely to report their intention to get their infants the MMR shot when they heard about the benefit of the shot directly to their baby or when they heard about benefits directly to their baby and the population. When they heard only about risks/benefits of shot and risks/benefit to society, the information presented did not increase their intention to get the shot.

Conclusions: Parents are more likely to want to get their child up to date on immunizations if they know direct benefit on their child’s ability to go to school and play and be with friends.

Let’s focus on what matters to parents to young children when we talk about vaccine benefits — health, wellness, play, friendship, and opportunity.

For more on benefits of MMR shot for children and the diseases it prevents read here. Immunizations do cause optimism…

Summer Reading From Day One

boys readingThe boys and I read two extra books last night — we almost skipped it altogether as it was late and we were beat from a long day and yada, yada, yada…you know the drill. But reviewing this data changed me, yet again. I knew some of the value of reading to young children before I had kids because of my experiences being a teacher and my training in pediatrics but the refreshers provided this week only compound my interest in screaming the value of reading from the rooftops.

It’s NEVER too early to start reading to your baby. Reading aloud before bed is always the right thing to do.

This week The Clinton Foundation with Too Small To Fail, The American Academy of Pediatrics, Reach Out And Read, and Scholastic got serious about ensuring our country takes reading seriously right out of the gate. For the first time ever the groups have come together to proclaim that parents should start reading to children “as early as you can” after birth. The new policy and partnership emphasizes the need for early reading to all infants and children while also emphasizing the necessity that all pediatricians promote this healthy habit at birth and through all preschool doctor visits. Profound health disparities currently exist for US children and book time. I suspect the numbers will surprise you.

It’s a no-brainer to most parents I talk with that reading books enhances development, literacy, and school readiness. What may surprise you is that reading has also been found to enhance the relationship between a child and parent. Reading books (or even the newspaper) to your infant from day one can have profound effects on how they live, how they talk, and how they learn — the impact extends well into adulthood. From the very beginning, though, some children are missing out. Children from low-income families hear fewer words in early childhood and know fewer words by 3 years of age creating the “word gap” early in their lives. The more words a child hears during early, critical times for language development, the more they’ll know. And although reading books can be a great resource to introduce an expansive, enriched vocabulary, less than 1/2 of children are read aloud to in this country every day.

All families face issues of limited time, limited parental understanding of the key role of reading aloud, and competition for the child’s interest and attention from other sources of entertainment ~  The American Academy of Pediatrics Council on Communications And Media ( 2011)

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You Mamas Taking Iodine?

A new policy statement from The American Academy of Pediatrics finds that many women, including up to 1/3 of pregnant women, may have low levels of iodine putting them at risk for iodine deficiency. The reason for the deficiency is the changing food source. Over the last 20-30 years our major source of salt has shifted away from table salt (supplemented with iodine) to salt from processed foods, sea salt or gourmet salts that have no supplemental iodine. This is especially important for breastfeeding and pregnant women as iodine is essential for thyroid function that supports fetal and newborn brain development.

This policy statement was news to me. I had no idea that the salt used to make most processed foods lacked iodine, that the majority of prenatal vitamins didn’t provide iodine, and the number of women who may have a deficiency. I’m not alone; when I polled my Mama Doc Facebook community most moms & many doctors also commented this was a newsflash. Here’s more:

Iodine Deficiencies– Shifting Sources Salt

  • WHY ARE WE DEFICIENT? Most processed foods made are with salt that is not iodized.  Since we get most of our salt from those foods we’re taking in less iodine than we used to.
  • TABLE SALT INTAKE: Table salt is iodized, many gourmet salts are not. Consider ensuring that when cooking in your home (ie putting salt in the pasta water or salting the veggies) you use iodized table salt so your intake of iodine goes back up. REMEMBER: this doesn’t mean you should eat MORE salt, just swap in the table salt for the fancy salts when you can.
  • WHY DO WE NEED IODINE? We need iodine for thyroid hormone synthesis as thyroid is essential in brain development and metabolism. The policy reminds us that even mild iodine deficincy can affect fetal and early childhood neurocognitive development stating, “adequate thyroid hormone production is critical in pregnant women and neonates because thyroid hormone is required for brain development in children.” The recommendations from AAP spelled out:

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Constipation, No Fun For Anyone

Constipation is really no fun for anyone. No fun for baby or child, no fun for the parent who cleans the clogged toilet, no fun for the sister or brother who waits while someone works on solving the problem in the room next door. In general, constipation is a frustrating, sometimes embarrassing, and often chronic problem for young children. Here are a few ideas to get rid of the no-fun part and ways to protect your children, support them positively, and avoid dangers that can rarely come from over-the-counter (OTC) medications.

Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop. I usually break this down for children (and parents) in visual terms. I talk about things you find outside.

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet?

In my experience, parents worry a lot about hard infant or toddler poop in the diaper but constipation sneaks up on many families to school-aged children. After children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl. Long gone are the days of staring at every diaper as parents lose track of the daily poops, how often they poop, and how a child feels when pooping. But first, some definitions: Read full post »

New Recommendations Parents Should Know

New 2014 recommendations are out for improving our prevention efforts for children. Parents can help ensure children get what they deserve at check ups. The updates to recommendations for wellness check-up are written to guide physicians but parents are a key voice in ensuring it all happens!

Updated 2014 Recommendations For Check-Ups

Some relevant changes to prevention/screening for children:

  • Infants: All infants need a pulse oximetry screen at or after 1 day of life to screen for heart defects. The test is non-invasive (just requires a technician, nurse, or doctor put an oxygen probe on their arms and legs). More information on the test here. Ideal time for testing is between 24 and 48 hours of life. If your baby is born at home or outside the hospital, go in to see pediatrician for the screen on day 1 or 2! Toddlers should be screened for iron deficiency risk at 15 and 30 months of age.
  • Children: All children should be screened for depression every single year starting at age 11 years. Don’t ever shy away from discussions about mood with your pediatrician. In addition, all children are recommended to have cholesterol screening at age 9-11. I reviewed ways to prevent heart disease and cholesterol screening policy statement here.
  • Teens: All teens need an annual check-up (a complete check-up will provide some time alone with doctor and nurse; mom or dad will be asked to leave for at least part of the visit). All teens need HIV screening test at age 16-18 (or sooner) and girls get their first pap smear at age 21.

5 Things Parents Need To Know About Check-Ups

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