Baby 411 & Toddler 411 Blog

Ode to Oak Pollen: How to find relief!

This is a picture of my patio table. It’s usually brown. But my patio table, like my entire town, is covered in a lovely blanket of yellow as the oak trees have turned their reproductive instincts into high gear. Those oak trees will be happily making lots of acorns. Meanwhile, we humans are suffering the consequences!

About 40% of kids (usually age five and up) and 10-30% of adults (usually young adults) suffer from seasonal allergies. A person’s body is irritated by the pollen, resulting in an itchy nose/eyes/throat, watery eye drainage, watery runny nose, a drip down the back of the throat, a hacking cough, and a feeling of being tired or fatigued. People who are extremely sensitive can have significant eyelid swelling, a flare up of eczema, or wheezing from it. In short: misery!

While every community’s pollen season varies a bit, it takes several weeks for a particular pollen to blow through once it arrives. So my town, unfortunately, will be enduring this “yellow haze” for a couple more weeks.

Here are some things you can do if you or your child has an oak pollen allergy (or any other seasonal pollen issue):

 

1. Stay indoors and keep your windows closed! If your school-aged child suffers significantly from seasonal allergies, get a note from her doctor to excuse her from recess or other outdoor activities.
2. Clean yourself and your pet after being outside. The pollen will come right in with you on your shoes, clothes, and in your hair. And, your dog will be covered in it-especially if he likes to roll around in the grass.
3. Try an over the counter antihistamine for relief. There are various products on the market (examples of brand names: Benadryl, Claritin, Zyrtec, Allegra). I usually recommend the non-sedating antihistamines (i.e. Claritin, Zyrtec) to my patients because they won’t make a child sleepy or zoned out and only need to be dosed once a day.
4. Get a prescription. If the over the counter stuff isn’t providing enough relief, there are a variety of other medications your child’s doctor can prescribe. These include eye drops (if your child is that miserable, he will probably let you put them in), nose sprays, and other medications taken by mouth.

 

Happy Spring!

Colic: The Unhappy Hour(s)

It's the “C word” in new parent circles. While many parents are forewarned about colic and worry that their baby might have it, many don’t even know what colic is. So, this post explains what colic is, and what (if anything) you can do about it.

Q. What is colic, anyway?

It is known as the Rule of Three’s. It starts around three weeks of age. The baby cries for about three hours straight (beginning right around “happy hour” —ironic, right?). And, it lasts until the baby is three months old. About 15% of all babies are afflicted with this malady.

Q. What causes colic?

Although scientists have been studying colic for years, no one knows exactly what causes it. Many experts think the problem is due to immaturity of the gastrointestinal or digestive system. So over the years, doctors have tried treating it with medications to reduce gas, relax the intestinal muscles, or cause sedation. None of these medications really help. The best treatment for colic is time….all babies eventually outgrow colic.

Some babies who seem “colicky” actually have a medical diagnosis. So, it is important to check in with your baby’s doctor if you've got a chronically fussy baby on your hands. Some babies have heartburn (gastroesophageal reflux disease or GERD). Those babies are usually miserable all day and night or around feedings—not just for a three hour period everyday. Other babies may have a cow’s milk protein allergy and don’t start to show signs of discomfort until several weeks of being exposed to the milk protein going through mom’s breast milk or in standard cow’s milk-based formula.

Q. What can I do to help my baby with colic?

What’s a parent to do? (Because, of course, we are all compelled to do something to help our babies feel better even when the doc tells you there is no treatment but time.) After browsing the net, you’ll no doubt find many colic treatments that make miraculous (and unregulated) claims.

My advice before starting any treatment is to ask yourself this question: Am I treating my child to make myself feel better (because I feel I am doing something), or does the therapy really work?

Q. Are there any new studies on treating colic?

A study published today in the journal, Pediatrics examines the scientific evidence supporting the most popular complementary and alternative therapies for colic. So, there isn't any breakthrough research here...it just puts this issue into perspective. Here’s what they found: Of 1764 studies done between 1991-2008, 15 were considered reasonable enough to review. Of those, only 8 of them were well designed. And here’s a key point: most of the purported treatments and effectiveness reported in a study have not been independently verified by other studies. Good science is like a good recipe—it can be repeated with the same results.

That said, let’s take a look at the therapies:

 

1. Spinal manipulation—Four studies were reviewed. Some parents reported improvement in the studies, but all the studies had methodical weaknesses. One study on chiropractic treatment showed no improvement in the number of hours a baby cried.
2. Herbal remedies—Herbs included chamomile/fennel/licorice/vervain/balm mint tea or fennel seed oil*. Three studies were reviewed. The small number of children enrolled in the studies limited the strength of the findings. But, parents noted a significant reduction in colic symptoms compared to the untreated group. Fennel is thought to work by having a relaxing (antispasmodic) effect on the gut and increasing the gut’s motility.
3. Sugar remedies—Babies were given either a glucose or sucrose* solution. Five studies were reviewed. Both sugary supplements seemed to help reduce colic symptoms.
4. Probiotics—Two studies were reviewed. In one study, one group of babies received a probiotic (L reuteri) and the other group received anti-gas drops (simethicone). 95% of parents reported improvement with the probiotic, compared to just 7% with the anti-gas drops.
5. Massage therapy—One study showed conflicting results. 93% of parents reported improvement in symptoms, yet 21% said there was no effect after the treatment itself. This calls into question if symptoms just improved with time.
6. Reflexology—There was no difference between targeted and nontargeted therapies which suggests that there is just some healing power of touch!

*More than one study found similar results.

Bottom line: None of these treatments are truly supported by the scientific evidence we have to date. More research is in order to help these babies and their parents!

Q. Given the lack of data, what do you recommend to your patients?

If everyone in the house is miserable, I suggest trying “gripe water” (a combination of ginger and fennel) or a daily dose of L. reuteri probiotics. Both products are available in pharmacies and online. I don’t make any promises, but I have seen some scientific evidence of their benefit and safety. I’d certainly like to see more research on colic, though!

Q of the day: 9 months old and still spitting up?

Q. I have a 9 month old who is still spitting up. She sometimes spits up a hour after eating. Is there anything that I can do to help her not spit up? Is this a normal thing? When will it stop?!

A. Although the bell curve for most babies to be done with reflux (spitting up) is around six months, some still have it until the first year of life (and a few beyond that).

If she is spitting up effortlessly, it is not uncomfortable, and she is gaining weight, it is a matter of cleaning up and being patient for it to resolve on its own. Solid foods help since they are heavier and stay down. Thicker formula using pre-thickened products, like Enfamil AR or Similac SR, or adding a thickening agent like Simply Thick to expressed breast milk may also help keep things down for the same reason--you are using gravity to your advantage. It helps to keep your baby upright after feedings for at least 20 minutes also--so the food can leave the stomach and enter the small intestine (so it won't come back up).

If the spitting up is entirely new for your baby at 9 months of age, if she is uncomfortable, avoiding meals, or not gaining weight, then you need to check in with her doctor.

Humidifiers: Will it help your snot-nosed baby?

My pals at Dadlabs and I teamed up again this week to give parents the 411 on humidifiers. Does your baby need one? What's the difference between a vaporizer and a humidifier? Should you purchase a cool mist or warm mist one? Do you actually need to clean the darn thing? All these burning questions and more, in this week's edition of Dadlabs!

Diaper Rash 411

I sat down with my friends at DadLabs and shot a piece on diaper rash. Check out the show and then take a look at our Rash-O-Rama in the bonus material of our website to see what I'm talking about!

Nickie's helmet question

Reader Nickie writes in today:

Wondering if you can clear up the questions over helmeting? Why is helmeting only reccommended for severe plagiocephaly? Does mild or moderate plagiocephaly correct itself as a child approaches adulthood? Please clarify this!! There is such different advice from doctors vs. the internet.

More and more babies have flat heads these days. The official term is plagiocephaly. And the reason, primarily, is that babies are sleeping on their backs to help reduce the risk of SIDS (sudden infant death syndrome). There are also handy infant carriers and seats that allow a baby who can't sit up yet to sit/recline comfortably without mom or dad doing the holding--again this means lots of time resting on the back of the head.

Tummy time is encouraged to reduce the amount of time spent in that one position. It also strengthens the neck and shoulder muscles--key for rolling over and holding the head up.

If you are aggressive about tummy time, and keep your baby off the back of his head during his wakeful hours, you can usually avoid severe plagiocephaly. And the good news is that a child's head shape changes quite a bit in the first year of life...and even up to age 7. So, if even if your child has mild to moderate plagiocephaly, making changes in what you do and waiting it out usually fixes the problem. No helmet required.

Helmets only appear to be useful in cases of severe plagiocephaly. Otherwise, your outcome is about the same, helmet or not.

Alternating Tylenol and Motrin for fever

Many parents ask whether it is okay to alternate Tylenol (acetaminophen) and Motrin (ibuprofen) when their child has a fever. This concern usually stems from a parent who worries that the fever is dangerous. It's not. It's just the body's way of mounting an immune response. We promise your child will not self-destruct if he has a fever.

Is it okay to alternate fever reducing medicine? Yes. Is it helpful? No. A new study from the British Medical Journal looked at this question and found the following results: Giving ibuprofen AND acetaminophen in rotating doses over a 24 hour period only brought the body temperature down for 1.5 hours more than giving just ibuprofen around the clock for 24 hours.

Since it doesn't make a huge difference, we continue to suggest the recommendations in both our Baby 411 and Toddler 411 books: For babies over six months of age, stick with ibuprofen for fever, dosed every 6-8 hours. It works better and lasts longer than acetaminophen. And there is really no need or use to alternate two fever reducing medications.

New Cholesterol Screening Guidelines

The American Academy of Pediatrics updated its policy regarding cholesterol screening in kids in the July issue of Pediatrics. Unfortunately, many media outlets chose to highlight only the discussion of using lipid lowering medications for kids and basically missed the boat on what the new policy was really saying. Since we took the time to actually read the report, here is what it boils down to:

1. All children do not need to have cholesterol levels checked. (These tests are also known as a fasting lipid panel, HDL/LDL/triglycerides)

2. More kids are at risk for having high cholesterol levels today because more kids are overweight...which often go hand in hand. Kids who are overweight, with Body Mass Index over 85th percentile should be screened.

3. Kids who have other risk factors for high cholesterol should be screened. These include family members with early heart attacks/disease (men younger than 55, women younger than 65) or high cholesterol levels.

4. Kids with high blood pressure, obesity, or diabetes, and kids who smoke should be screened.

5. Kids should be screened between two and ten years of age, and no one should be screened before age 2.

6. For kids over 8 years of age who have over 190 mg/dL LDL (that's really high folks), especially with other risk factors like obesity, diabetes, or metabolic syndrome, medications may be an option.

Poop 411

WARNING: Those with weak stomachs should not read this post! Or, at least not while they are eating.


Hi everyone,
I was on another Dr. Phil episode recently, but didn't get a chance to give everyone a head's up. The family I worked with on the show had two sons with a medical disorder called encopresis.

Encopresis is a problem that stems from a long history of constipation. Kids who have painful poops due to constipation will often start holding it in (in hopes of avoiding the pain). These kids, who are labelled "withholders", will have a self-fulfilling prophecy. Because they hold the poop in, it gets harder and harder, and ultimately, when the poop comes out--it really does hurt--obviously creating a vicious cycle.

At some point, these children actually lose the sensation to poop because the lower part of the intestine becomes so stretched out. And, new poop that is being formed will actually seep around the old poop that's been sitting there since last Christmas. Kids with this constipation problem may look like they have diarrhea because the poop leaks out and soils their underwear. As you might guess, the smell is overpowering!

Anyway, Dr Phil's message boards lit up regarding this topic with parents who were looking for some tips to help their own kids who suffer with encopresis. So, I thought I would post some comments here since some of you out in blog-land may also be going through this with your kids. We also cover this topic in-depth in Toddler 411.

Top Tips for Encopresis:

1. The Cleanout: With the help of your doc, get your child on a regimen to clean out all the old poop. It took months to get to this point, so it will take months to get it cleaned out. This usually involves taking mild laxatives (Miralax, which is now over the counter is one of my favorites), and a stool softener for several weeks. You may also need to clean out from below with suppositories or enemas depending on the age of the child and the severity of the problem.

2. Maintenance: Once your child is cleaned out, he may still need stool softeners to keep it soft and easy to come out (so he doesn';t go back to withholding).

3. FIBER: The long-term solution to constipation and encopresis is changing a child's dietary lifestyle. This also involves (often) changing the parents' diet too! The whole family has to participate to make this work. The goal for daily fiber intake starting at age 2 is AGE + 5= the number of grams per day. Once you're an adult, that number is about 25-30 grams per day. Fiber is what keeps the poop soft and moving.

4. Toilet sitting: Have your child sit on the toilet for 5-10 minutes after EVERY meal (including lunch at school). That;s the most likely time the bowels will move. Kids often avoid the bathroom at school and end up holding the poop in until they get home. Any time the poop is held and not eliminated, it will be harder in consistency (bad idea!)

For more info, check out Toddler 411 in bookstores nationwide.

Dental dilemmas: Too much or too little fluoride?

Fluoride has been a controversial subject ever since communities began adding fluoride to their water supplies (about 50 years ago). Advocates point to the benefits of fluoride in reducing cavities. Critics have concerns about bone cancer and enamel fluorosis (streaking of the enamel due to excessive fluoride intake).

The latest fuel to the debate is a statement from the American Dental Association. The ADA responded to the National Research Council's assessment that infants being fed formula preparations mixed with water (i.e. powder or liquid concentrate) may be getting too much fluoride.

Here's what the ADA recommendations boil down to:
1) There has never been a recommendation to offer fluoride supplements in babies UNDER six months of age. Babies under six months of age who are fed liquid concentrate or powder formula prepared with tap water that is high in fluoride may be getting too much of a good thing.


2) Each community water supplier assesses naturally occurring fluoride levels, and decides whether or not to add fluoride to its supply. It's important to find out how much is in your own tap water (the ideal, as ADA says is 0.7-1.2 ppm)


3) If your baby is breastfed, this is not an issue. If your baby is eating ready-to-feed formula, it is also not an issue.


4) If your baby is formula fed and you are using powdered or liquid concentrate that needs to be reconstituted, use either bottled water that does NOT add fluoride or use your tap water if the fluoride levels in it are not excessive.


5) And, if you have tap water with little to no fluoride or well water, and your baby is OVER six months of age, you may need to actually give your baby a fluoride supplement. Check with your pediatrician/dentist for their recommendations.

For more information, see the ADA's FAQ page for parents at www.ada.org/public/topics/fluoride/infantsformula_faq.asp