Dental caries (cavities) are preventable for most children. To keep those pearly whites pearly it takes being thoughtful about eating habits, brushing habits, drinking habits, and being knowledgeable about your child’s water supply. Although physicians are making robots to perform surgery and putting tiny cameras in our bodies to explore the inside, we may sometimes lose sight of easy, affordable ways to improve the lives of millions. Maybe we simply retreat from those prevention efforts…or maybe it’s something else.
The CDC reported this spring that for the first time in 40 years, preschoolers have more cavities than they did 5 years ago. And many children have so many cavities that they show up at the dentist with double-digit numbers requiring general anesthesia for repair. In one month alone, I’ve done a number of pre-op visits for dental anesthesia for patients in my clinic.
Many national headlines have covered this data over the last few months. And I would suggest there is one thing to stress here. Part of this increase in cavities may be a cultural issue, a parent-culture issue. That is, many parents may not be brushing their children’s teeth because of push-back from their children and a goal to maintain harmony at home. And many parents believe bottled water is safer than that from the tap. When it comes to teeth, that isn’t the case.
Sometimes we really have to act like adults and do the flossing.
I think this bump in cavity numbers is a parenting issue more than anything else. Read full post »
When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.
We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.
When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…
Signs of Autism In Infants & Toddlers:
There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,
You should observe your infant demonstrating curiosity.
You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.
Your child should show you they know their name by 1 year of age.
You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.
Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.
However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.
It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »
Many parents worry about their child’s development at one point in time. With each of my boys, I had worries about their communication and thought their language delays or behaviors signaled something serious. That might just be the “worrier” in me, but it might just be the “mom” in me, too. Competitive parenting makes us all a little nuts…
Here’s a few signs that your child is developing great communication skills on time. However, if at any time you worry that your child isn’t expressing joy, communicating thoughts, or reflecting an understanding of your language, visual cues, and behavior talk with your child’s doctor. If you don’t feel heard or continue to worry, schedule another visit. If you still worry, contact another doctor for a second opinion. Instincts serve us very well when it comes to parenthood. Further, find some peace of mind if your child is doing many of the behaviors listed below!
Reassuring Developmental Milestones For Infants & Children
Responds to her name between 9-12 months of age.
Smiles by 2 months, laughs and giggle around 4-5 months, expresses great joy to your humor around 6 months.
Plays and thinks peek-a-boo is funny around 9 months of age.
Makes eye contact with people during infancy.
Tries to say words you say between 12 and 18 months of age.
Your toddler uses 5 words by 18 months of age.
Copies your gestures like pointing, clapping, or waving.
Imitates you — ie pretends to stir a bowl of pancake mix when you give them a spoon and bowl or pretends to talk on the phone with a play cell phone.
Shakes head “no.”
Waves “bye-bye” by 15 months of age.
Points to show you something interesting or points to get your attention by 18 months of age.
The 2 month-old check up may be harder for parents than it is for babies. Getting the first set of shots is anxiety provoking for we moms and dads; no question that it’s unsettling to allow a medical provider to cause our beautiful, new, healthy baby pain. Research has found that the pain and discomfort associated with shots is one of the primary reasons parents “elect not to perform timely vaccination.”
A study published this week affirms two truths. First, structured soothing may be a great tool for families to control crying after discomfort from shots. A group of pediatricians in Virginia used Dr Harvey Karp’s Happiest Baby on the Block 5S’s technique (shushing, swaddling, side positioning, sucking, and swinging/swaying) as an intervention for crying after the 2 and 4 month shots. The technique has been advertised to parents as a way to soothe and comfort fussy and colicky babies in the first few months of life. The researchers found that compared to a control group with no intervention and a group of babies that received a sugary solution for comfort prior to the shots, the 5S technique helped soothe crying and pain more rapidly. Most babies that were swaddled, shushed, swung, and offered a pacifier for sucking stopped crying within only 45 seconds. Second, the great reality is that most babies stop crying within 1 to 2 minutes of getting injections anyway. The study confirmed that, too! In my experience, only rarely does a baby leave clinic still crying. Some of our anxiety about the discomfort as parents can be relieved–we really need to get the word out this is a short process. It’s rare for a baby to cry for even 3 to 4 minutes after their injections. Read full post »
This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.
In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.
Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.
Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.
You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.
Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.
Write an email to family and friends to explain.
A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »
I think it’s okay to fly with your newborn baby straight away. After 1 week of age the Federal Aviation Association (FAA) says it’s okay, as does the AAP, but always recommends a separate seat for your infant whenever possible.
The biggest risk flying with a healthy newborn is exposure to infection. So, like any decision in life, you have to weigh the risks and benefits of a decision. Because we take fever very seriously in babies under 3 months of age, we want to avoid infections when possible. Take precautions, wash your hands frequently, and wipe down seat backs, tray tables, and seatbelts on board.
All that being said, I flew with O when he was just 6 weeks old. It was important for us to travel to see family in California for the holidays. I took precautions, loaded up on hand sanitzer, and backed extra diapers. It was a wonderful Christmas…
Some of my best friends are about to have a baby, the due date only a few weeks away. I’m teary thinking about it as my excitement for her arrival exceeds the speed limit. They asked my opinion this week for getting their extended family immunized in light of the recent Whooping Cough (pertussis) outbreak in our area. I advised them that all teens and adults (including grandparents) need a Tdap shot before they are with the baby. Even pregnant women are getting immunized after 20 weeks gestation to protect their newborns at and after birth.
Ideally, everyone should have the Tdap shot at least 2 weeks before the baby arrives.
My friends advised their parents. But both grandmas were turned away–one here in the US and one abroad. Each were told by a physician that they didn’t need the Tdap shot because they were over 65 years of age.
That physician was wrong. Whooping Cough (pertussis) knows no age. And immunization recommendations for pertussis protection have changed this past year because of rising rates of infection and infant deaths.
The best way to protect a newborn baby from getting Whooping Cough is to cocoon them with family and friends who are immunized against it.
All grandparents, all adults, and all teens need a Tdap shot before holding a newborn baby.
Ask questions, please. And one more thing, can you suggest girl names? My friend is beside herself that they don’t have one picked out…I’ll buy you coffee if you suggest the name she chooses (hint: use a real email)
18 month-olds are extremely determined, constantly challenging, tenacious, adorable, witty, and ever-aware. By 18 months, most babies have really figured out how to get and hold a parent’s attention! As they explore their widening world, an 18 month-old’s curiosity leads while their judgment lags well behind. Providing your child with a safe and consistent environment is paramount. Development in all areas (gross motor, personal and social, fine motor, etc) is highly variable but the video reviews typical milestones your baby’s clinician will review around 18 months of age.
What Should My Baby Do At 18 Months?
In general by 18 months, your toddler will be very curious. They will be demanding. They will be communicating wants and needs through words, motions, and imitations. They will be pointing out objects in the sky. They will be calling you by a name just as they run the opposite way…
“Mr No” — I found this extensive list of milestones and observations both very entertaining and educational
What Parents Can Do For 18 Month-Olds:
Give your 18 month-old their space. As they crave more and more autonomy, provide them times for a bit of freedom.
Let your child mimic you. Give them toys or safe objects you use in the house so that they can pretend to be an adult.
Let them help. Start finding daily or weekly “chores” for your 18 month-old (ie bringing napkins to the table or moving stuffed animals to a bin). They’ll love their role!
Offer puzzles, matching, and sorting games.
Read to your 18 month-old every single day. Point out objects in the book. Ask your toddler to tell you the names of animals or toys in the book. Get them involved. And get ready to read the same book over and over and over again!
Keep rules to a minimum. Rather, define “right” from “wrong” for your child and remember to praise your 18 month-old for doing things right. Catch them when they are being good!
Parents, pediatricians, and nurses have been using growth charts since the late 1970’s to track growth in their infants and children. The charts were revised back in the year 2000 as the data for the first charts (from a small study in Ohio) that didn’t accurately reflect the cultural and ethnic diversity of our communities.
The hallmark of a well child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, and/or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.
Watch the video to learn more about interpreting growth charts.
If your doc doesn’t have a computer in the room, ask to see the chart (on paper) or on a computer in their office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time they have been seen.
The human body really is a fine-tuned machine and growth is simply astounding if you really stop to think of it.
If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s okay if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask for the doctor or nurse practitioner to explain it.
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.