I had a great trip to the grocery store today with the boys. Life has been so hectic these past few weeks, we haven’t had weekend time for a leisurely trip to the aisles of fruit and fondue. Today, we had the luxury of time, a list, and a proper plan. They weren’t hungry (and neither was I) so our stomachs didn’t drive the cart and the boys were uniquely engaged. We perused the produce area. We made peanut butter in the machine that crushes raw peanuts. We talked about some of the beginnings of the food we bought (the avocado came from Mexico, the mini-oranges from California). But I thought most about how pleased I am when I end up at checkout with more fresh food in the cart than food stuffed into packages. Today I think I came close.
And that’s the lesson. One thing I say over and over again in clinic is, “If at all possible, for every single meal you offer your child at home, make sure 1/2 the plate is covered in fresh fruit and veggies.”
So if that’s the goal, the cart should always look the very same way.
Pacifiers, a love affair worth having? It’s up to you, of course. Pacifiers are hotly debated among some parents, some pediatricians, some lactation consultants, and some dentists. I say some, as I believe not all clinicians have strong impressions/judgments. That’s because pacifiers don’t cause excessive harm. Yet most parents agree on one thing: they all have an opinion about what to do with one. Some hate them, others adore them. Just like babies. Silicon pacifiers can be all the rage, or none of it…
At our house, we had a love affair with a pacifier. Twice. Without even trying. And it all happened by accident.
Although the American Academy of Pediatrics and National Institute of Child Health and Human Development recommend using a pacifier at night to decrease the risk of SIDS, if your infant doesn’t like one, you certainly DON’T need to force it upon your content baby. Don’t over-think or over-value the pacifier, either.
With F (our first born), I waited, held off, and withheld the pacifier hoping to improve my changes of successful breastfeeding. We had a few sleepless weeks (with the fussing and crying normal for a newborn) until a couple weeks of age when we realize it really was the “plug” he was looking for. F’s crankiness improved, and we had another tool to help support him when holding, rocking, feeding, changing diapers, or swaddling didn’t soothe him entirely. The pacifier was just something he loved.
With O (our second), I didn’t get the choice. While in the NICU, the nurses used the pacifier to “quiet” him down. I asked that they didn’t, but when I returned to feed him, there it was again, in his mouth. And he was in love. So we continued to use it and I didn’t take it from him. As I’ve written before, I loved to see him enjoy and indulge with that pacifier. I mean, he really craved and adored the time he got with it (mostly during sleep or in the car). Weaning him from it was harder on me, it turns out. And I faltered a couple of weeks after the wean during a moment of weakness…
We used pacifiers in our homes until both the boys were just under 2 years of age. And like I said, it really was a love a affair.
The reason is simple, babies soothe by sucking and pacifiers are a perfect tool. My advice on pacifiers: follow your instincts. You’ll be able to find studies both that support use and studies that dissuade use to back up either decision. So don’t over-think this. And stop beating yourself up for using one if you are…
Mama Doc’s Cliff Notes On Pacifiers:
These are things you already know: Wash the pacifier regularly (dishwasher safe are easiest) in warm soapy water, get rid of old pacifiers that show cracking or damage, and use a one-piece silicone design if possible. Don’t dip the pacifier in anything (ie sugar water, honey, etc) ever. And never tie the pacifier around your baby/toddler’s neck.
As your child grows, the pacifier should, too. Don’t let toddlers have infant sized pacifiers due to choking risk. Smaller pacifiers may rest more on their front teeth as well and cause more malocclusion or “bucking” of teeth. Get the correct size pacifier if your older toddler or preschooler still uses one.
When your child approaches 6 months of age, consider weaning. If neither of you are interested in breaking up with pacifier, try again at 2 years of age. By 3 years, get it out of the house or the love affair will cause a most terrible break-up.
Like the makings of a Hollywood movie, I learned this week that there were an estimated 200,000 people in Super Bowl Village this past weekend in Indiana. Amongst them on February 4th, was one (or maybe two) child with infectious measles. Fortunately, the child didn’t attend the game. Yet, measles is highly contagious. The period of infectivity starts before symptoms in some cases and usually 4-5 days before the typical rash, when many think they have just a bad cold. Measles is spread by the respiratory droplets infected people share when breathing, coughing, or sneezing. And the virus can survive for about 2 hours on surfaces or in the air after a person leaves the room. Measles has a wild history and although most children/adults do well after recovering from the illness, measles can result in severe complications like pneumonia or encephalitis. Fortunately, the majority of those in attendance last weekend who may have walked by or been near the infected person were protected by the measles vaccine.
The incubation period (the time it takes to get sick after being exposed) is about 10 days with measles. So if unprotected people contracted measles last weekend, they may get sick this weekend or early next week. Hopefully, we’ll hear of no one.
Measles spreads easily. There are reports of measles infecting every single unvaccinated person at a picnic. The public health department, even here in Seattle, sent an advisory email last night with instructions for what we doctors should do if we suspect measles in someone who was in Indiana last weekend.
But this is a global thing not just a US national sport thing. Starting in 2009, the number of cases of measles rose sharply in Europe. In 2010 for example, there were over 30,000 cases of confirmed, reported measles and in 2011 (through October), there were over 25,000 cases, with over 14,000 cases in France alone. Fifty percent of those with reported measles were children, less than 14 years of age. Immunization rates for measles have declined in Europe and public health officials point to waning vaccination as one reason for the surge. Read full post »
Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media and technology to solve many of these problems. It’s time. HPV vaccine? Varicella vaccine? Remember your yearly flu shot? I really think there could an app for that.
Let me explain.
Dr Diekema opens describing a scene very typical in Seattle.
Recently, the mother of a young child confessed to me that she didn’t know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she’d like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.
Yes, the physician obliged her desired schedule for many reasons, I suspect: time restraints/desiring a partnership/a hope for future opportunities to provide education and update immunizations for the child. In a state (Washington) that leads the nation in vaccine exemptions, we encounter patients daily who prefer a delayed or personal schedule. I’ve written about parents and alternative schedules and physicians’ conditional comfort with alternative vaccine schedules. But when Dr Diekema mentions this family, he highlights what many pediatricians and family physicians realize: families may be clustered together in vaccine-hesitancy. Friends of friends instruct each about vaccine schedules and share beliefs about safety. We know that 40% of parents who use an alternative schedule create it themselves.
Family members persuade my patients not to get immunized. Even in the midst of a pertussis outbreak in the county in which I practice, grandparents and relatives of newborns refuse the Tdap vaccine. My patients are bombarded with advice and naysayers. Who we love (friends and family) and who we trust (friends and family) certainly affect what we do. My patients get confused. And most of health (care) conversations happen outside the exam room. Therefore, hesitancy clusters in neighborhoods naturally and poses regional risk. What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that? Read full post »
Survey results published this week found that the majority of parents report carpooling with their 4 to 8 year-old children. About three-quarters (76%) of those carpooling parents reported that their child used a booster seat when riding in the family car. But when carpooling–the seats were used far less often. For example, the survey found 1 out of 5 parents do not always ask other drivers to use a booster seat for their child. And only half of parents always have their child use a booster seat when riding with friends who do not have boosters. So what your friends do really may change what you do.
Getting your baby to sleep through the night is a major milestone for baby and for you. If I had to distill down the best sleep advice I’ve ever heard it would be these 4 things:
Your consistency with the sleep routine is far more important than what method you choose to help get your baby to sleep. The ritual at bedtime (reading, bath, rocking, etc) is one of the most important daily activities you establish for your child from day 1 (or day 30).
Letting your baby learn to fall asleep all on her own at 1 to 2 months of age will serve you and your child again and again. Research shows that infants and children who are allowed to learn to self-soothe and get themselves to sleep will often be far better sleepers, even as adults. Consider letting your baby learn to self-soothe and “cry it out” in the middle of the night after 4 to 6 months of age.
If you’re concerned about your baby’s sleep challenges, talk directly with their doc. Recent research found that 1 in 10 children under age 3 has a sleep challenge, and often sleep trouble persists from infancy to toddlerhood.
Sleep needs to be a priority (for us all). Making sacrifices to support routine bedtimes and sleep routines will always be worth it.
Scald burns are common injuries for young children that arise when our skin or our mouths and mucus membranes have contact with burning hot liquids or steam. Children under age 5 account for nearly 1 in every 5 burn victims each year in the United States. The bathroom and kitchen are the typical danger zones. Many burns come from liquids heated in the microwave but children are also commonly burned from scalding liquids or water heated on the stove or in the shower or tub. The video details ways to protect your children (and family) from a terrible burn. Fortunately, you can improve your child’s safety in a matter of seconds: today, turn your water heater down to 120 degrees Fahrenheit.
Preventing Scald Burns in Children
Be protective of young children around hot liquids from day one. Never carry hot tea or coffee while holding your baby. Insist on the same from anyone who has the privilege of holding your baby. I’ve taken care of infants with severe burns and plenty of older children. Severe burns are not only extremely painful and onerously traumatic, they can lead to serious health complications and lasting disfigurement. Now is the time to protect your child.
Recently while on the plane, O wet his pants. Lovely really. He’d refused to pee prior to getting on the plane. Refused to pee at home. Essentially, O refused to pee “on command.” No surprise for a strong-willed-spirited just turned 3 year-old. And after he wet his pants, he then proceeded to have about 14 accidents (yes, I’m exaggerating) later that same day as we traveled to his grandparents’ home. Instead of being patient, supportive, and perfect, the husband and I realized we were just plain-old disappointed. And full of judgment.
O had mastered his potty-trained world well over the last month or so and the wetting accidents weren’t on our to-do list. He’d been dry all day for a number of weeks. The frequency he was wetting on that particular Wednesday coupled with the inconvenience of it being a travel day just wasn’t my pleasure. Although he’d delayed pooping in the potty for a few months (also totally normal but uber-frustrating, too), that had all resolved some months back. The accidents felt like an inconvenience. And although as a pediatrician, I know how to lend advice in this area, it’s the taking advice part that is more of a challenge.
After age 3, when a child shows resistance to using the potty the “right” thing to do, is to carry on with a smile, stop providing reminders for your child, show that you’re unflappable and continue to praise success. Ignore potty failures, praise potty success.
But it is a seriously difficult task at 35,000 feet when surrounded by pee. Consequently, we spent part of the holiday nudging each other about how terrible we were and how we needed to move from D&J (disappointed and judging) to P&C (patient and compassionate).
As we hit hour 40, heading into day 2 of vomitorium here at our house (O has been sick), I will suggest a couple of things I know as a mom and pediatrician about gastroenteritis or the “stomach flu”:
Hand-washing and keeping things clean is your best defense from getting ill with a stomach bug. Not surprisingly, this is particularly true after touching or supporting your child and when preparing food and/or eating. Some viruses will survive on surfaces for days. And some viruses can even survive hand-sanitizer. But even with ridiculous meticulous detail to hygiene, every parent knows that when the vomit if flying it’s hard to lasso every single errant particle. So simply commit to do you best. Change the sheets and clean up areas of vomit immediately after supporting your child. Soapy warm water is your friend. Wash surfaces immediately, use hot water for the wash, and use high heat in the dryer.
24 Hours (or so) In general most pediatricians will tell you that vomiting doesn’t exceed 24 hours with typical gastroenteritis. But really, it can. Many kids don’t follow the rules. Once a virus that causes gastroenteritis takes hold of a child, vomiting starts. Children tend to vomit more than adults but I’ve never read or learned why this is. With most viruses that cause the “stomach flu,” as the infection moves through the stomach and intestines, vomiting stops after about 24 hours. But not always. If you advance liquids too quickly, or a child eats more solids than they are ready for, even after the first meal 1-2 days into eating again, they may have a vomit encore. If you have one of those, start back where you started (sips of clear liquids) and go very very slow advancing their diet. If vomiting is accelerating at 24 hours, it is time to check in with your child’s doctor.
Disgusting & Terrifying It’s creepy-eepy to take care of a child with vomiting. Read full post »
Caring for your son’s foreskin is pretty much a hands-off job. But knowing what is normal and how your son’s foreskin develops and changes over time is essential for every parent to a boy with an uncircumcised penis.
In the beginning, during infancy, your son’s uncircumcised penis needs no special care. The foreskin is a piece of skin overlying the outside of your son’s penis. You never need to pull the foreskin back or detach it in any way. You clean it just like any other skin surface on his body.
Over the first 5 + years of your son’s life, the foreskin will gradually “retract” or pull away from the head of his penis. This happens without intervention as the connective tissue bonding the foreskin to the head of his penis dissolves on its own. As this happens, you can teach your son to wash the end of his penis with soap and water and rinse it well. Some boys will be able to fully retract or pull back their foreskin by the time they start Kindergarten while others may not fully retract it until puberty. Both are okay. Read full post »
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.