Reader’s Picks

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Colic, Crying, And The Period of PURPLE Crying

Every infant cries. It’s a part of being a newborn, yet infant crying still puts many of us on edge. As parents, we want to calm our babies and prevent crying; it’s simply instinctive to want to make it go away. The period of time when our babies cry most (between 1-2 months of age) can be entirely exhausting, unsettling, and unnerving. As we transition into parenthood, one of the most difficult challenges can be learning to soothe our crying newborns. One expert, Dr Ron Barr, refers to this period of crying as the PURPLE period. I’ll explain, but first, let’s talk a bit about colic and news today about using alternative “folk” treatments, and ultimately what it may mean when someone, a doctor or not, tells you that you’ve got a “colicky” baby.

This morning I did an interview for Good Morning America Health about a Pediatrics systematic review evaluating 15 large studies (including nearly 1000 babies) to determine if things like infant massage, probiotics, chiropractor’s manipulation, herbal supplements, and sugary/glucose solutions really helped “colicky” babies stop crying. The results proved unfortunate. No, these interventions don’t tend to help infants who are crying/fussy/screaming their heads off. Two things to think about with the new findings: first, when you’re frustrated with a baby’s fussing/crying, don’t reach for these remedies as solutions or as “cure alls.” As we know it now, there’s not a lot of evidence to use any of these remedies. Secondly, don’t confuse the word “natural” with “harmless” or “safe.” Many of these herbal and complementary remedies come with labels that say “natural.” Natural doesn’t confer safety. Some limitations of interpreting data from the 15 studies reviewed was the reality that little time was spent reporting side effects to interventions and therapeutics. It may simply be because there were few, but researchers are unsure. We only want to use medications in infants that prove effective.

The most important thing to do for a fussy infant is to find ways for you to soothe your baby. But know that you won’t always be successful. Read full post »

Japan Tsunami: Reminder For Parents To Prepare

I was up until nearly 1:30am today watching the Tsunami in Japan live online. Terrible for the psyche and hard on the heart, I simply couldn’t stop watching it unfold. It’s utterly terrifying to imagine the devastation and separation that catastrophic events like this cause for people. In the face of this terrible news, there is much we can do as parents. In addition to donating to relief organizations, we can prepare our families. We have incredible strength and insight as the proud providers and nurturers of our children. Now, today, is the time to utilize this reminder for good and harness your concerns into preparedness.

On the news last night, reporters kept repeating that every home in Japan had an emergency kit…that every family had a plan for an earthquake. They detailed how children knew at a very young age what to do when an earthquake began and families had communication plans to re-unite.

Today is a day to begin to create the same for your family. Emulate the universal emergency plans of families in Japan. I trust these kits and plans have saved many lives in the past 12 hours and lessened the worry of the millions of parents reuniting with their children as I type.

Last year, I made a disaster kit and blogged about the experience. Today, in the wake the Japan Tsunami, please consider doing the same. I’m re-posting some of the content here.

I’m gonna be honest, making a disaster kit completely stressed me out. I hope my experience will make it better for you. I guarantee with each step you take, you’ll feel an incredible sense of relief as you ready your family. I’m no expert at this but have learned a lot along the way. And there is no question, I feel so much better with my family prepared and my preparedness tidied.

As The Economist said last year when discussing Iceland’s volcano, “Disasters are about people and planning, not nature’s pomp.”

Prepare.

I believe in the 3 tiered approach you see everywhere:

  • Make a Kit (detailed below and in my video)
  • Make a Plan (how to communicate and find your family)
  • Stay Informed (what disasters are likely to happen, where to find info) Read full post »

If It Were My Child: No Baby Food Before 4 Months

Last week news of a study evaluating the timing of solid food introduction for infants emerged. It got a ton of press because the study evaluated the timing of solids on the likelihood of obesity at 3 years of age. Researchers divided babies into 2 groups, those that received partial or full breast milk until 4 months, and those that were weaned from breast milk and received formula exclusively before 4 months of age. Researchers then determined when babies were given solid food (rice cereal, biscuit, pureed “baby” food, etc) of any kind.

The results proved notable. Babies who received exclusive formula and solid foods before 4 months of age were 6 times more likely to be obese as a 3 year-old (defined as BMI over 95%, sum of triceps and subscapular skinfolds). This however, was not true for the babies that were receiving breast milk of any kind. So this study may not be applicable to many babies; in the US for example, 25% of infants are never breastfed and approximately half are breastfed for less than 4 months. Yet still, this sheds light on what we can do to help. Use this data when Grandma Trudy is urging you to feed your infant cereal at 3 months. Or why it’s best to wait until 4 months when you get excited about starting solids. Those of you who didn’t wait? Before you spin your wheels with worry about that bite of rice cereal you gave your baby at 3 1/2 months, read on. Because although, if it were my child, I wouldn’t give baby food before 4 months, there may be more to consider when it comes to timing. Read full post »

Treating Ear Infections With Antibiotics

New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.

But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:

  1. Proper inspection
  2. Pain control (Tylenol or Advil, etc). Ear infections hurt!
  3. Observation (waiting for 48-72 hours for relief)
  4. Treatment with high-dose Amoxicillin first and foremost if selected to treat.
  5. Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
  6. Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)

But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read full post »

Greatest “Hits” of 2010

2010 was good to me. See the picture; see my boys? Was it good to you? Life was out of balance, but full, vibrant, meaty, and dynamic. I met amazing people. Work and time with family has been very textured; I feel saturated. Writing and maintaining this blog has ultimately caused me to pause and think about medicine, and my choices, quite a bit more than I used to. I chew on the things people say in comments and in response to what I write over and over again. I’ve learned a lot.

I’m indebted to many. Primarily, to my husband, who has read e-v-e-r-y-s-i-n-g-l-e-p-o-s-t. And for all but about 5 of them, he’s read them prior to them being published. It turns out he is incredibly committed to communicating about pediatric health as well, but goes about things quietly. Clearly, we’re very different (thank goodness). I remain so thankful that someone believes in what I say like he does. My mom also reads nearly every post. She’s been known to scold me about typos and grammatical errors yet ultimately keeps me in check. When an older relative watched a television interview I did recently on obesity, he said, “Well, she speaks too quickly.” My mom apparently responded, “You need to learn to listen more rapidly.” So genuine support abounds at home and at work. I’m entirely indebted to those with whom I work at Children’s, my peers, and my friends in medicine. You’ve all bolstered me this past year. As I said in an interview today, “I am just so lucky to partner with an organization that believes in innovation.” Thank you, all.

So a quick greatest hits. Here’s a breakdown, strictly by the data (pageviews), of the posts that were read most frequently in 2010. Read full post »

Do You Believe in Vaccines? (Part III: Experience)

Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.

This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.

The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.

Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).

Experience:

Dr Kronman, a pediatrician and infectious disease fellow:

We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines. Read full post »

Do You Believe in Vaccines: (Part II: Evidence)

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read full post »

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read full post »

Evidence for Vicks VapoRub?

A Pediatrics study this past week starts out stating that, “Upper respiratory infections (URIs) are the most common acute illness in the world.” Wowza, that seems like a show stopper right there. But it’s true, anyone who works with kids or has kids or knows kids (let’s be honest) also knows that winter brings snot to little noses. And lots of it. I really believe that snot and mucus are a part of being a kid in the wintertime.

Kids typically have 6-10 colds a year, mainly between October and May, so if your child is snot-free today this mid-November, consider yourself lucky. Kids get upper respiratory infections (“a cold”) one after another after another and its often difficult to know when one cold ends and a new one begins. The far majority of these colds are caused by viruses. And because we don’t have treatments to impair the virus or kill the viruses that cause colds, we recommend supporting the machine that does: the body. Support your child as they fight off infections. Immune systems are amazingly efficient. Feed these immune systems the proper fuel: rest, hydration/liquids, energy, and most important, time.

We see many children in clinic with colds when families come in concerned about fever, cough, sore throat, congestion, or possible ear infections. Fortunately we rarely have to use antibiotics or other medication interventions. And although it’s nice not to have to prescribe medications for well children with uncomplicated colds, I hate not having much in my tool box to help a family. After a terrible sleepless night of coughing, hacking, fever, and snottiness, families come in absolutely exhausted. Pediatricians really do get this and we do want to do “something.” But often our advice comes off as “The doctor did nothing.” I look at it this way, we ruled our bacterial infection, provided ideas for improving cough (humidifier in the room, honey before sleep for kids over 1 year of age, nasal suction [love NoseFrida], and upright positioning to let the snot drip the right way) and gave guidance about why or when to return. But I do want more tools in my toolbox. This study may help.

As I mentioned last week, sleep is a major commodity while raising children (duh). The study on Vicks VapoRub surprised me. Read full post »

If It Were My Child: No Teething Tablets

On Saturday, the FDA released a recall of Hyland’s teething tablets. The recall stems from concerns for increased and varying amounts of belladonna, a toxic substance that could cause serious systemic effects to babies. It’s unclear how much belladonna is found in these tablets normally although it is well known it’s in them. Recently, infants have developed symptoms consistent with belladonna toxicity after using the tablets (change in consciousness, constipation, skin flushing, dry mouth). Homeopathic supplements and medications are unregulated and therefore it’s hard to know what is in them, how consistent one bottle is from the next, and how different brands of the same products compare. Local and national poison control previously deemed teething tablets safe even though it is known that they have trace amounts of belladonna (and possible caffeine). The FDA states it is “unaware of any proven clinical benefit from the product.” Because of safety concerns and no known benefit, I’ve always recommended against using teething tablets. If it were my child, I didn’t, and would not use teething tablets. If you have these at home, throw them out. Here’s some FDA tips of safe disposal of unwanted medications. If your child has had these tablets in the past, there is no reason to worry. Ill effects would have been seen soon after using them.

Some Teething Truths: