Baby 411 & Toddler 411 Blog

FDA Recalls Hyland's Teething Tablets!

 

Most of my readers and patients know that I have never recommended Hyland's Teething Tablets, so it is no surprise to me that the FDA has declared a recall on this product.

Because the tablets are homeopathic, the FDA has not been required to assess them for safety or therapeutic benefit. (A convenient loop hole in the lucrative alternative medicine industry.)

The teething tablets contain a small amount of belladonna, which is a known toxin to the nervous system. So, how the heck it is sitting on grocery store shelves has always been a mystery to me!!!

The FDA has stepped in now though, because they have received reports of children having adverse reactions, which are what you would see from belladonna toxicity. The FDA laboratory tested the teething tablets and found that there are inconsistent amounts of belladonna in the product. They (appropriately!) feel that the amount of belladonna should be more tightly regulated—considering what effect it can have in larger doses (like seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation). Furthermore, the tablets are not contained in childproof packaging, making it easier for a young child to take as many tablets as he wants. And yes, the FDA has also received reports of adverse reactions in kids from that exact scenario.

So, what should you do if you have Hyland's Teething Tablets in your medicine cabinet? Toss 'em.

Yes, the teething tablets are "100% natural"—but so is cocaine, and you've never give that to a baby, right? Be an informed consumer. Just because it's natural, doesn't mean it is safe.

And, while we are on this subject, teething gets blamed on fussy moods, disrupted sleep, runny noses, and diarrhea. RARELY is teething the cause of any of these maladies! If you want a natural teething remedy, try freezing a mini bagel or banana, and let your little one gnaw on that!

Baby 411 series now available as Nook ebook!

Got a Nook, the e-reader from Barnes & Noble? Good news! Now, the entire Baby 411 series is available as ebooks on the Nook!

For Baby 411, click here.

For Toddler 411, click here.

For Expecting 411, click here.

Now the Baby 411 series is available in three ebook flavors: Amazon's Kindle, Apple's iBook and B&N's Nook. Or, if you want to go old school, you can still pick up a print copy at your favorite bookstore!

Whooping cough again: Baby #10 dies

Whooping cough made the news again today as it took the life of another baby in California. The state has had nearly 6000 confirmed cases (and probably many more unconfirmed). Tragically, 10 infants have now died in the state. All of the babies were under 3 months of age, and 9 of the 10 babies were under eight weeks of age—which means they were too young to be vaccinated to protect against the infection.

But California is not the only state seeing a rise in whooping cough. It's all over the country. My hometown of Austin has several recently reported cases across the city. Believe me, I am seeing plenty of kids in my office who have received notes from their daycare or school that they have been exposed to a child with confirmed whooping cough. Parents, with good reason, are concerned and want their child to be checked out.

So, why are we seeing such a rise in whooping cough right now? Isn't it a vaccine preventable disease? Is it simply because some parents are choosing not to vaccinate their kids? Well, it would be terrific if 100% of children were vaccinated but it's not that simple of a solution. Infectious diseases are much more complex.

1. Whooping cough epidemics occur in cycles about every 3-5 years. The last major epidemic was in 2005, so we were destined to see an uptick in infections this year.

2. Immunity to whooping cough does not last forever — whether you are vaccinated for protection or even if you have had the disease. Immunity wears off over time (listen up teens and adults!) That’s why it is so important to get the whooping cough booster shot (called Tdap).

3. Babies cannot receive their first vaccination for whooping cough until they are two months of age. And evn then, they do not have adequate immunity until they have received at least three doses of whooping cough vaccine (at six months of age). So, babies rely on those around them to be protected by vaccination and not spread the infection to them. Up to 80 percent of babies get whooping cough from a loved one in their household (most often, it’s spread from their mom).

4. Adults often don’t know they have the illness. It may look like a common cold at the beginning of the infection and then it becomes a cough that just lingers on forever (whooping cough is also known as the “100 Day Cough”). People are contagious for the first four weeks of the illness.

So, what can you do? Make sure your child is up to date on his shots and make sure you are, too. If you can’t remember the last time you got your tetanus shot (or the last time you got one was from your own pediatrician!), you need to roll up your sleeve and get the Tdap (tetanus, diphtheria, and pertussis). You can get the Tdap vaccine—you just have to ask for it. I know that many adult medical practices do not stock the Tdap vaccine (but I won't get on my soapbox here about why they don't and why they should). If you cannot get it from your doctor, call around to your local pharmacy or grocery store.

In an effort to protect our little patients, my own pediatric practice is now offering Tdap shots for adults. Heck, if Walgreen's can offer it, so can we! I hope other pediatric practices around the country will adopt this practice as well. 

Because of the major outbreak, the state of California has expanded its vaccine recommendations beyond the standard vaccination schedule. Californians who are ages 7 and up, those over age 64, and pregnant women should receive a booster shot for whooping cough.

Let's all do what we can to make this the last fatality from whooping cough.

Sore throat 411

Strep Throat: See the little red dots on the roof of the mouth? That's a classic sign of it!

Mom, my throat hurts…heard this one recently?

It's that time again for my “Bug O’ the Week” blog. My "busy season" in the office is October to April.  So, I'll be giving you the periodic run-down of the infections I’m seeing in my office over the next several months. Although there is some variability across the country as to when these usual suspects arrive, I guarantee that they will hit your town at some point this winter.

 This week’s bug/bugs: Sore throat infections

There are several viruses that cause a sore throat. Right now, there are two different viruses that my patients are coming down with.

 Bug #1: The common cold (Rhinovirus) This is one we are all familiar with. Here are the typical symptoms: runny nose, cough, and sometimes a sore throat. A child might run a fever at the beginning of the illness for a few days, but not always. Symptoms can last for 10-14 days. Good times. You do not need to be worried if your child still has a runny nose or a cough that lingers for a while. No antibiotics are necessary to treat this illness.

 Bug #2: Adenovirus Never heard of this one? Well, it’s actually a very common viral illness. Adenovirus causes a sore throat, sometimes associated with pink eye (the whites of the eyes will look red). Kids often run a fever with it. In little ones who are too young to say that their throat hurts, fever and a lack of interest in eating may be the only obvious symptoms. But, if you take a look at your child’s throat (if he lets you), you will see that the tonsils are red and swollen. No antibiotics are needed because this is a viral infection, not a bacterial one.

 Bug #3: Strep Throat. To make things even more confusing, Strep Throat is also going around. That is a bacterial infection that DOES need to be treated with antibiotics. It’s more common in kids over two years of age who are old enough to tell you their throat hurts. If your child has a sore throat without a cough, runny nose, or pink eye, he should see his medical provider. (Take a look at the picture in this blog for a nice, but gross, example of what Strep looks like. If your child's throat looks like this, book an appointment!)

So what’s a parent to do for a child who is miserable with a sore throat?

1. Ibuprofen or acetaminophen for kids over six months of age (Be sure your baby sees his doctor to confirm the diagnosis if he is under six months of age to use acetaminophen).
2. Push the fluids. Don’t worry about eating solid food right now.
3. Try popsicles, smoothies, or a milkshake if your child resists drinking.

Lots of TLC from you!

Miley: Goodbye to the girl next door

Miley Cyrus concert, November 2007

Full disclosure: In November 2007, my then 8 year old daughter and I went to see Miley Cyrus in concert and we both loved it. I was impressed with this nearly-14 year old who was so poised and truly entertaining on stage. And, looking around at the other smiling moms and daughters in the crowd, I know I wasn't alone. But, that was almost four years ago and Miley has grown up.

The release of her new music video "Who Owns My Heart" shows that in a big way. There has been much criticism this week regarding the fairly erotic video (although no one seems to be commenting about the lyrics--which are also sexual if you take the time to listen to them!) As a pediatrician and a mom of a tween, I feel compelled to chime in here.

Miley has outgrown her pre-teen and tween fan base and is trying to take her act to a larger and more lucrative audience (since tweens rely on mom and dad to pay for their iTunes purchases!).

It appears that neither she, her parents, her managers or agent care if her good girl image is tarnished in the process. It’s not personal, it’s business.

This “new” Miley really isn’t about promoting clean and healthy values for young girls growing up in America, and as such, I hope that parents are not using her as a role model for their daughters. That Miley has left the building.

The person I am most bothered with in this scenario is Billy Ray Cyrus. It appears he and his wife are more concerned about the revenue than their daughter being exploited. She never got to be a normal kid. I truly hope that this doesn’t adversely affect her life, like so many childhood stars.

And, since I am still the one paying for my now 12 year old daughter's iTunes purchases, you can be certain she won't be buying this song.

Miley Cyrus, 2010

Does newborn jaundice lead to autism?

  

A study published in this month's journal, Pediatrics, has found an association between newborn jaundice and autism. Researchers looked at the Denmark birth registry of all babies born over a period of 10 years (1994-2004), which totaled about 733,000 children.

 The full term babies who were diagnosed with jaundice (yellowing of the skin which I will explain further) had a significantly greater risk of being diagnosed with an autism spectrum disorder (ASD) later in life.  Interestingly, the subset of children whose birthdays fell in the winter months (October through March) had higher odds of having an autism spectrum disorder. And, babies who were NOT the firstborn were also more likely to have an ASD.

The researchers cannot explain this phenomenon by the data. But they speculated that the winter months either put these babies at risk for having more winter viral infections or that there was less sunlight, leading to an increased risk of becoming jaundiced. And, babies whose moms had other kids were more likely to either be discharged home from the hospital sooner (thus increasing the chances of missing early treatment for jaundice) or the moms had more antibodies to a baby's blood which is a set up for jaundice.

What is jaundice, anyway? Well, it is a temporary yellowing of the skin caused by a deposit of pigmented body waste called bilirubin. Newborns frequently experience jaundice in the first few days of life because they aren't too interested in eating so they aren't pooping (which is where that bilirubin body waste is supposed to come out). And, their liver isn't working at full efficiency yet, which helps to break down the bilirubin. For most newborns, a little jaundice isn't considered a big deal- in fact, it's normal. But nurses and doctors watch closely to be sure that bilirubin levels do not shoot up too high and exceed the skin's ability to contain it. Once the skin is saturated, bilirubin can collect in the brain and cause permanent neurologic damage. We've known for a long time that really high bilirubin levels cause intellectual disability and cerebral palsy. Finding an association with autism is new.

So, considering that 60% of babies who are born full term and 80% of premature babies develop jaundice, this study certainly peaked my interest. What is important to note is that the Denmark birth registry data does not specify how severe the jaundice was (which we can easily test for with a simple blood test) and whether or not babies who were diagnosed with jaundice were treated and how soon they were treated. This information is very important in knowing what to make of this data and if healthcare providers need to be more aggressive about treating jaundice.

Bottom line: More research is needed to see if jaundice is truly a risk factor that can cause autism. And if there is an association, do we need to change our current standard of treatment? So what's a new parent to do? Keep a close eye out for jaundice in your newborn and notify your  healthcare provider if you see it.

Baby Iron 411

Iron is the big news coming out of the American Academy of Pediatrics national convention this week. We know that iron is a necessary nutrient for brain development. And iron deficiency in childhood can have lifelong, irreversible effects (kinda scary, huh?)

Thus, the Academy's nutrition committee is recommending iron supplementation for babies who are born prematurely and those who are still breastfed between 4-6 months of age. The policy statement is rather complex, so here is a recap of the major recommendations in plain English!

1. Babies who are born full term and are fed with an iron-containing formula do NOT need iron vitamin supplements. Parents should introduce iron-rich foods into their babies diets, though, when they do start solid foods. (See the list at the end of this post for food ideas!)

2. Babies who are exclusively breastfed or those who get some breastmilk supplemented with formula DO need an iron-supplement starting at 4 months of age until 6 months of age when they start eating solid food, which contains iron. Your child's doc can recommend an iron supplement that is the right dose for your baby.

3. Babies from 6-12 months of age should get about 11 mg per day of iron in their diets. The AAP nutrition committee recommends starting red meat sooner rather than later and high-iron containing vegetables, and iron-fortified cereals to get those dietary needs met.

4. Toddlers from 1-3 years of age need 7 mg per day of iron in their diets.

5. If you have a toddler who definitely does not eat iron-containing foods (and those toddlers can be picky, as we know), then talk to your child's doc about an iron vitamin supplement.

6. Babies who are born prematurely (under 37 weeks) should get an iron supplement (2mg/kg--your doc can give you the dosing) by 1 month of age. Preemies who are breastfed should continue to get that iron supplement until they are weaned to formula or they begin solid foods at 6 months of age.

7. All children should be screened for iron deficiency anemia at 12 months of age.

Bottom line: Many babies get the iron they need, but make a concerted effort to offer iron rich foods once your baby starts eating solid foods. And, if you have a preemie or you are exclusively breastfeeding, be sure to ask your child's doc about iron supplements.

Iron rich foods: (heme iron is easier for the body to absorb). Check out Baby 411 and Toddler 411 Nutrition chapters for a detailed list!

2.5 oz lamb                1.2 mg heme iron

2.5 oz chicken            1.0 mg heme iron

3 oz dk meat turkey     2.0 mg heme iron  

3 oz pork                    0.9 mg heme iron

3 oz clams                    23.8 heme iron 

4 oz cream spinach    0.7 mg nonheme iron

1/2 c instant oatmeal    7 mg nonheme iron

1/2 c seedless raising    1.6 mg nonheme iron

1/2 c cooked lentils        3.3 mg nonheme iron

 

 

Does your child have NDD? That wasn't a typo

NDD stands for Nature Deficit Disorder and it's on the rise in American kids who are glued to screens of all kinds. Remember the good old days when our parents told us to "go play outside" and we didn't see them until dinner was on the table? What happened? Are we so afraid of stranger danger that we keep our kids locked up in our homes? Or, are there so many fun things to do with screens these days that sunshine and exploration of the nearest creek or woods can't compete?

Author and keynote speaker for the American Academy of Pediatrics national meeting, Richard Louv, expressed his concerns of our children's lifestyles yesterday in San Francisco to a packed crowd of pediatricians.

Louv encourages families to look at the real statistics about childhood abductions. The numbers have actually been going DOWN for the past 20 years. And, he says, "the vast majority of abductions are not by strangers, but by somebody the family knows." While media outlets send chills down every parent's spine when they report on these heart-breaking cases, the cases are actually pretty rare.

His advice to pediatricians: "Recommend to parents that kids go outside." Pretty simple stuff, yet incredibly important. I couldn't agree more.

Here's my advice: Maybe parents should go outside, too. And on that note, I am turning off my computer and going for a walk!