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Mix And Match: Goldilocks Formula

Often new parents are nervous about mixing and matching infant formula they offer their babies. They worry if they switch from one formula brand to another, they may cause their baby fussiness, stool changes, upset or worse–that they could put their baby at risk.

It’s safe to mix and match infant formulas if you are following standard mixing instructions. Really.

Although spitting up or gassiness is usually not due to the protein in formula (cow’s milk versus soy versus hypoallergenic), sometimes changing formula helps new babies and their parents who worry. Switching them up can even help clarify worries in some scenarios when a parent worries about excessive gassiness, intolerance, or significant urping or spitting up.

Experimentation with formula brands in an otherwise healthy newborn is okay. But it’s not necessary at all, either.

It’s fine to make a bottle that is ½ formula from the blue can and ½ formula from the yellow one. Fine to serve Simulac one week, Enfamil the next, Earth’s Best or Goodstart followed by Soy formula the following day. Fine to buy one brand that’s on sale only to buy the other brand next week. Read more »

All Children Need A Flu Shot

This is part deux to an earlier video/post describing the global effort to reduce flu & reasons why we need one every year. Infants and children under age 5 are at higher risk for serious complications from influenza infection. Influenza (“the flu”) is an illness that strikes during the late fall and early winter annually in our country. Great thing is, there is a global effort to coordinate knowledge to reduce the consequences of severe infections. Each year a new flu shot is released to protect us. All children need a flu shot. The reason? It’s estimated that somewhere between 10-40% of all children, each year, get influenza. Sometimes it’s a mild upper respiratory infection, but sometimes it can cause severe lung infections and even death. Each year hundreds of children die in our country from flu even though it is a vaccine-preventable illness. I hear lots of myths and rumors about the flu shot in clinic (more than any other vaccine). Check out my friend Dr Claire McCarthy’s post on de-bunking the myths.

Of those children who are seriously ill and hospitalized, somewhere between 1/3 to 1/2 can be children with no underlying medical issues. Healthy children get the flu, too. If your child has underlying neurologic problems, wheezing or asthma, or diabetes they are also considered higher risk for severe infection.

It takes a well-immunized community to reduce the spread of influenza. And our children, swapping spit and snot at school, are one of our most precious groups to protect.

Which Flu Vaccine And How Many to Get?

Infants 6 months of age and up can get flu shot. Most infants will need two doses, separated by 1 month, while all children over age 9 years need only one dose. If you have a young child (<9 years) and they have never had the flu shot before, they will need two doses. Ask your child’s doctor how many doses your baby, toddler, or child needs this year.  What you need to know about flu.

There are two types of vaccine, the flu shot & the nasal spray. Both protect against the same virus strains. Check out www.flu.gov. Here’s a quick explanation: Read more »

New Data On Infant Sleep You’ll Want To Know

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.

There are many things that go into the equation of how we get our babies to sleep thought the night. And those of us who struggled after our babies after 6 months of age are in good company. Research shows that about 45% of mothers say they struggle with their 6-12 month-old’s sleep.

Solving the sleep solution requires a diverse mix of instinct, patience with personal and baby temperament, timing, mood, advice we get, and good luck.

The reality is that there isn’t one perfect way to help support an infant who’s learning to sleep through the night. But there are few pearls I believe in: Read more »

Father’s Day: Two Wheels Of Their Own

We had a marvelous Father’s Day weekend. On Saturday we started a Dad-coached soccer team with some friends which was surprisingly successful. And then on Sunday, we completed our first-ever family bike ride on the Burke-Gillman trail. Everyone had two wheels of their own, including Grandma. Although O ended up in the ditch at one point after steering off-course, it was an injury-free ride and we proclaimed it a success. I think we all felt really grown up. We gave my husband a mixture of homemade gifts (paintings) and then a trite, expected one (a necktie). We played ball in the yard, pulled weeds from the grass, and Jonathan got a bit of time to himself for a run. When we went out for Italian food and ordered Shirley Temples we formally celebrated the fortune of having a father parenting so actively in our lives. The boys began the day with exclamations and closed it with a final, “Happy Father’s Day” after the lights went out. It was then that I realized it’s prime time for this holiday in our home.

I get that Father’s Day isn’t this Hallmark in everyone’s home and I certainly understand it won’t always be like this. These manufactured holidays bring up thoughts of the tension and distance many of us feel from our own fathers. I also think about my friends and patients who have lost their fathers and those children who are separated from their fathers due to work, military commitments, or unique family circumstances. Last week one of my colleagues pointed out that children had eras in their lives where Father’s Day was on the map; young children adore and celebrate but then retreat as we’d expect during the late school-age years. “They tend to check back in during young adulthood,” he said.

And it got me thinking: is there a way to keep the intimacy of preschool-parenthood alive? Read more »

TIME Magazine And The Mommy Middle Road

You saw the TIME magazine cover in the last 24 hours, right? Me, too. In the midst of 25 patients yesterday, moms and dads weren’t really talking about it in the office. It was in my inbox. But I hear and feel and witness the anxiety/angst we all swim around in every day as we compare parenting styles and essentially swap (pacifier) spit about how best to do this. The monogram of this parenting era is the quest for perfection. The epic win that’s constructed for us is built on prevailing over the rest. It’s not about juggling it all anymore, it’s about being tough enough to do it better than your peers. TIME magazine wants us to contemplate if we’re really “Mom Enough?”

Before you know it, you’ll be 13 decisions down the road wondering why you worried so much about what you did. You’ll care even less about what you called it. Of anything I hear over and over again from parents ahead of me on the road it’s this: “I simply wish I worried less about my choices.”

It’s a mom-eat-mom world right now and the media wants us perpetually navel-staring. Doubt sells magazines, pageviews, and books. I saw moms post opinions on Facebook this morning only to quickly take them down as they got too controversial. We’ll keep questioning ourselves and our decisions as TIME takes a supermodel, airbrushes her body and paints the cover the magazine with a provocative image for Mother’s Day. This article, this cover, this timing–this is the engineering of our age. The dinosaurs once ruled the planet—now it’s the voices online.

Your motherhood, your parenthood, your decisions. You know what? Of course, they’re Mom Enough

The cover really isn’t really about breast feeding but I’ll bite. Read more »

Baby’s First Shots: Swaddling And Shushing

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 more »

Pacifiers: A Love Affair Worth Having?

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:

  1. 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.
  2. 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.
  3. 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.

Additional Safety Tips on Using Pacifiers:

Mayo Clinic’s Do’s & Don’ts on Pacifiers

Review article about dental problems caused by pacifiers after age 3.

Satisfying your baby’s needs: Pacifiers

7 Truths About The “Stomach Flu”

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”:

  1.  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.
  2. 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.
  3. Disgusting & Terrifying It’s creepy-eepy to take care of a child with vomiting. Read more »

Live A Long Life: Avoiding Heart Disease

Late last week, The American Academy of Pediatrics (AAP) published a 43 page expert panel report addressing ways to reduce risk from cardiovascular (heart) disease beginning with interventions in childhood. The panel report is based on a huge review of current medical evidence, yet the press focused mostly on 1 sentence from the thick report:

All children should be screened for high cholesterol (via a blood test) at age 9-11 years and then again between 17 -21 years of age.

And although the recommendation for cholesterol screening is a huge one and represents a major shift in pediatric screening, the other 42 plus pages were loaded with additional wisdom founded in science. I’m doing my best to make sense of all the recommendations but as I get more overwhelmed by the sheer quantity of information in the report, I’m taking the advice of my husband, “Effective communication [about this report] lies somewhere between a tweet and those other 42 pages.”

Most primary care docs simply won’t have time to read the entire report but will likely incorporate the recommended changes into practice. And because heart disease kills more men and women than any other medical problem in our country, learning how to protect our children/prevent heart disease remains an essential part of my job description. Yours, too. Read more »

First Movie With My 4 Year Old


I’ve had media on my mind lately. And Finn McMissile, I’ve got my eye on you.

We took F (age 4 1/2 years) to his first movie about a month ago. It is something we’ve been talking about for over a year. He’d built up a sense of anticipation that we could have bottled. F is a focused boy. The only movie he has chosen to watch from start to finish his entire life is the original Cars. So with the news of Cars 2 coming to the big screen, we plotted our first big family trip to the cinema. F lost sleep with anticipation. He studied (and slept with) the New York Times synopsis. The NYT review, we didn’t share with him…

What age did you first take your child to a movie? Did you go because of a certain film or because the timing was right?

I’m asking because I think although there is no perfect answer (3, 4, 5, or 6), I wish our first movie had gone better. All in all, our experience was a great success in the eyes of my son, but Pixar let me down. As did Finn McMissile.

McMissile, why the unnecessary ammo? Read more »