Reader’s Picks

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Why I Hate Sleep Positioners

I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.

When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked at how many parents told me they were using them. We are led to believe (by manufacturers) that positioners confer safety by keeping babies on their back. Since 1994, the Back to Sleep campaign has helped parents become vigilant (yes!) about putting babies to sleep on their backs. But after my sons were born, and while roaming the super-store aisles for bottles, crib sheets, overpriced silicon, and breast pads (oh the glory), I realized why parents get so confused.

In the infant sleep section, I found plenty of products designed for babies I would never recommend. Never. Sleep positioners, head positioners, comforter-like blankets for the crib, bumpers and stuffed animals. Many products went against what I was taught in my pediatric training and what I’ve learned thereafter. Like so many things in life and medicine, less is more. When asked about setting up a safe infant crib I say, “Boring, bare, basic.”

In 2005, the AAP (American Academy of Pediatrics) issued an updated guideline on the prevention of SIDS. Though the message has been effective, sleep positioners have persisted to sell. Two weeks ago, prompted by 12 deaths (over 13 yrs)  due to sleep positioners, the AAP reiterated their position citing the dangers from sleep positioners after the CPSC and FDA (photos seen here) sent out a warning. Even though these positioners go clearly against safety data and medical advice, companies have kept them on the market.

Why? Read full post »

Crack The Code On Pediatric Flu Shot Recommendations

Flu shots have arrived to nearly every neighborhood in the US. Frustratingly, clinics often get the doses after the retail stores (seems silly) and doses for children under age 3 may not arrive at the same time. So if you’re reading all over the planet that shots are available and your pediatrician’s office can’t offer it to you today, have patience. Children under age 3 receive immunization doses without preservative, so if a store or pharmacy advertises that they have “flu shots” it doesn’t mean they offer them to all comers. Pediatric doses are not offered at many retail locations. Often, like so many things in medicine, the same rules don’t always apply to infants and children. But that being said, clinics expect to get all the doses needed for our high-risk (and low-risk) patients in time this year (no expected shortage) and can help you determine when, how, and why to get a flu shot for your child. This year, it is more confusing than ever. Read full post »

Don’t Let The Bed Bugs Bite

A friend called yesterday and asked if I thought her daughter had bed bugs. Her toddler had woken up with welts over her face, chest, back and trunk. She was itchy. Her mom was worried about bed bugs. I tried to reassure her, telling her what I knew about bed bugs &  how young children react to insect bites (not just bed bugs), I asked:

  • Does the bed have copper colored stains on it?
  • Is the mattress new or borrowed?
  • Any other babies or children nap in her crib recently?
  • Any one else at home with bites or itching?
  • Any travel to a hotel recently?

But I got to thinking, what do I know about bed bugs? Not that much, actually. A good friend of mine caught bed bugs from a famous San Francisco hotel about 3 years ago. I’d read up on it at that time to help her; she’d been diagnosed by a SF dermatologist while traveling for work. The hotel apologized, placed all her things (suitcase) in their walk-in freezer overnight and sent her home with some “points” to return to their hotels for free. She left with her frost encrusted “baggage.” She did just fine (easy for me to say), but I’ve certainly remembered the story and I’ll never stay at that hotel. There is something uber-creepy about the thought of bugs chewing on our toes while we sleep.

So I get the overwhelming response to media reports about bed bugs. When my mom mentioned a local NPR interview about bed bugs she heard yesterday, in combination with the phone call, I thought, “Oh no, people are starting to freak out.”  It ‘s all over the media. Then, I opened the NYT this morning and saw the cover article about bed bug infestations in New York City that ends likening bed bugs to the H1N1 scare. Closed movie theaters, infested dressing rooms, you name it.  Bed bugs appear to be teeming around the internet, and as we all start to scratch ourselves and wonder if it’s worth leaving the house (or if we’re surrounded at home), I did a little research: Read full post »

3 Things That Won’t Help Babies Sleep

There is a lot of information (and opinion) about how to get your infant to sleep through the night. Cry it out/don’t cry it out, rocking/no rocking, co-sleeping/crib sleeping, white noise/no noise, breastfeeding or bottle-feeding. Everyone has an idea about what works. Like I said earlier, there is very little data to support one technique over another.

Auspiciously, there is new data that may help us know what NOT to do. Researchers found 3 things to avoid while helping your baby learn to sleep through the night.

A study (summary in Journal Watch) refutes an urban legend: feeding rice cereal keeps babies asleep.

Read full post »

If It Were My Child: No Tylenol Before Shots

Earlier this year there was a massive Tylenol recall. The recall included Infant Tylenol drops, Children’s Tylenol, as well as many other children’s medications. I’m not exaggerating when I say massive, but generic medications (liquid acetaminophen made by Walgreens or CVS, for example) were not included. The recall was a great reminder that generics are just as good as brand-name medications.

The recall also serves as a great reminder that giving medications to children is never risk-free. Recalls like this remind us to use medications only when absolutely necessary. There is always risk when you intervene.

Tylenol (acetaminophen) is a great medication. It has a place in our medicine cabinets and in keeping children comfortable in the face of fever or pain. Teething, viral infections, ear infections, and minor injuries are great times to use Tylenol. But prior to shots is not. Or afterward, as it turns out. After shots, Tylenol will help prevent fever, but may also prevent the desired immune response. There is new data to support this that has changed the way I think and counsel families about Tylenol. Now when parents ask, I say,“If it were my child, no Tylenol before shots.”

Fever is a “normal” immune response to a trigger (medical school and residency taught me this). But being a mom has certainly shown me that fevers in my babies don’t feel “normal.” When we pediatricians say it’s “normal,”we neglect to connect with the experience of parenting a feverish child. I understand why so many parents reach for the Tylenol. I did; after F’s 2 month shots, he developed a low-grade fever and cried his little face off. I gave him Tylenol twice that night. I wouldn’t have, had I known this: Read full post »

The Most Devastating Article: Fatal Distraction By Gene Weingarten

Happy July. In Seattle that usually means that summer is soon to arrive. For the rest of the US, I know, it has already begun. Ever since last week though, I have thought about July differently. I was midway through this post last Friday when I was forced to abandon it. Overwhelmed by the article I read, I wrote about sighing. I’ve now taken a big sigh… But this information has not left me. Today, we enter July, the month out of the year in which more US children die after being left (and trapped) in hot cars, than any other. Windows up and forgotten, these children die of hyperthermia and overheating. They overheat, cry for help, and are left unheard. It’s unthinkable, really. 18 children have already died this year, 8 of them in the first two weeks of June. Unfortunately, now that two weeks has passed, this statistic has likely changed.

This utterly alarming trend has caught the attention of safety experts. And mine. We all need to create systems in our life to prevent this from happening. Make a system to check the back seat of your car every single time you walk away from it. Kids in it or not.

You can read right over this stuff feeling like it’s irrelevant.

You’re thinking, this will never happen to me. No way would I forget my kid in the car. Before you convince yourself, read this 2010 Pultizer Prize winning article by Gene Weingarten published in March, 2009. It has changed my life; It is the most devastating article I’ve read all year. I’m not overstating this. The handful of others that I have had read this say the very same. Share it with anyone who will ever drive a child in a car seat or booster seat, anywhere. Read full post »

O’s Tylenol is Famous: Medication Recall

We woke up today and I read the Tylenol, Motrin, Zyrtec, and Benadryl medication recall from yesterday. It’s a voluntary recall but concerns remain about quality of the medication.  Then I realized the Tylenol I gave O yesterday was still on the counter.

O’s Tylenol is famous, it turns out. It’s part of the recall. Medications on the recall list include: Infant Tylenol, Children’s Tylenol, Motrin, Zyrtec, and Benadryl.

Check the list and check your medicine cabinet.  Maybe you have a bottle of famous medicine, too.

Remember to look just above the medication name for the NDC number as seen in the photo. Then throw it out if you find a match. Call your pediatrician if you have any concerns.

O is fine……

Information for the McNeil product recall here.

If It Were My Child: Infant Swimming Lessons

It turns out, I don’t think you do have to be careful what you wait for when it comes to swimming. A study published a few weeks ago suggested that children under the age of 2 were at higher risk for bronchiolitis, a common pediatric lung infection, if they swam in chlorinated pools when they were babies. I’ve mulled this over and done additional reading. If it were my child, I’d sign up for infant swimming lessons. Believe me, I’m not getting off any swim/pool wait list any time soon! Yet, I do think the study offers a chance to re-frame how we think about protecting our kids around the water.

Although O will be well over 2 years old when he gets off the decade long wait list for the pools in our area, he’ll be swimming in chlorinated pools before then. From how I see it, chlorine exposure is only one side of the story when it comes to infant swimming and safety. It’s okay, maybe even wonderful if I dare say, to swim with an infant. The video we have from F swimming in the first time is hilarious. I am far more ecstatic than any normal human should be in a pool. It’s true; most babies simply love the water. So do plenty of adults (read: me).

Swimming if not only delightful, it is also dangerous. Worldwide, drowning while swimming is the 2nd most common injury that kills children under age of 14. Therefore how our infants and children come to know the water may be as important as how we think about using car seats. Read full post »

Science Of The Soft Spot: The Anterior Fontanelle, Part 1

The soft spot on the top of my baby’s head is one of my favorite places to run my hand.  I don’t know why exactly but it seems one of those places on him that truly represents his baby-hood.  One way I know that his infancy isn’t quite gone and my baby days aren’t over yet. O recently turned a year (so, yes, technically he’s no infant) and I have felt his baby-ness slipping through my fingers. I keep saying that to my patients when they ask about him. I am hoping it will somehow prolong this period and I won’t have to wake up and find myself with two grown boys in the house.

The emotional yo-yo between pure excitement about them growing up, with the simultaneous dread of losing these baby moments, remains real and palpable. The essence of parenthood I suppose is that stew of anxiety-thrill-dread-adoration-excitement as the days unfold and you hope for new things for your little baby while lamenting the loss of precious moments of who your baby is on a Monday in January.  So the soft spot is a good place to go to calm my inner anxiety about my toddlers walking out the door to college.

Lots of new parents ask me about caring for the soft spot. As the first year unfolds, it is the soft spot (aka “fontanelle”) in the front/top portion of a baby’s head that parents ask about, the anterior fontanelle. I think we all conjure up crazy worries about an errant flying pencil landing in it. Read full post »

2 Is The New 1: Rear-Facing Car Seats Until At Least Age 2

rear-facing until age 22 is the new1.

This is kind of like, “brown is the new black.” But different and more important.

Two is the new one. When you’re a toddler. And when you’re at least 20 pounds.

And you’re in the car.

Let me explain. This is important for a number of reasons. One, not a lot of people (even pediatricians) know this yet because new data hasn’t been incorporated into policy statements. And two, it could save lives. Three and four: it could save lives.

Listen up and tell your friends. Scream from the rooftops. Read full post »