Parenting 101: Baby Basics – PediaCast 241

Join Dr Mike Patrick and Dr Sarah Denny for a special edition of PediaCast! This week, we cover 25 topics every new mom and dad needs to know inside and out. Voluminous baby care books abound, but this practical get-started guide will have you up and running with your newborn infant in no time flat.

Guest

Topics

  • Breast Feeding
  • Formula Feeding
  • Solid Food
  • Vitamins and Minerals
  • Fluoride
  • Spit-Ups
  • Newborn Growth
  • Growth Charts
  • Developmental Milestones
  • Developmental Delay
  • Early Intervention
  • Urine
  • Baby Poop
  • Concerning Stool
  • Blood in Stool
  • Constipation
  • Infant Sleep
  • Cry It Out
  • Colic
  • Immunizations
  • Home Safety
  • Car Safety
  • Bath Safety
  • Sleep Safety
  • Child Abuse Prevention

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, it is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children’s Hospital in Columbus, Ohio. It is episode 241 and we’re calling this one Parenting 101 – Baby Basics.

This is a special edition of PediaCast. We’re really going to cover baby care from A to Z. Now I know voluminous books abound on baby care and this podcast is not meant to replace them. Here is what we hope to accomplish today – think of this as a get started guide. So this is the pamphlet that they pack on top of the thick user manual that you likely never open.

We’re going to have over 20 topics that every new mom and dad need to know inside and out. So this episode will be a good lesson as you head to the hospital with contractions or on your home with your new baby. And of course, be sure to tell your family and friends about this episode.

If there’s a baby in the house or one on the way, they won’t want to miss this one. And if you don’t have a baby at home, no grand kids, you’re not a babysitter, really you have no interest in baby care whatsoever, and maybe that’s because you’ve been there and done that and even if you didn’t do it perfectly your kiddo turned out fine, so you just don’t care anymore.

OK, fine. Those of you fitting that description you are excused, go find another episode to listen to. Maybe one that concentrates on teenage topics like our previous episode 240, we’d covered teenage stuff in that one quite extensively so go back and listen to that one, but please this one on to someone you know who would benefit with a baby get started guide of sorts.

02:18

All right, those of you left, those with babies at home or on the way or those that have another reason to care about babies, get ready for the time of your lives and I don’t mean the show, I mean with your babies because it’s going to be quite the ride with every sort of emotion that is humanly possible.

Joy and excitement, yes. But there’s going to be a lot of fear and worry, too, and lots of concern like maybe you don’t feel quite up to the task. Well stop worrying, you are up to the task. Of course, our baby basics podcast will help you get started.

But more important than this and this is extremely important, make sure that you find a primary care doctor that you trust. So find a pediatrician or a family-practiced doctor in your community. Someone who is trustworthy, well-trained, available and approachable.

It’s really important because while we’re going to offer a lot of information we’re going to be going fast through many topics and so it is important that you have someone that you can connect with at the moment that you have a need. So just make sure you have a physician in your community who is caring and knowledgeable.

All right, and I also want to apologize if my voice may crack a little bit. I’m getting over a little cold and so I’m going to apologize right up front, you just have to kind of put up with that. All right. So let’s move on to some specifics of our lineup today. We have lots to cover, over 20 topics in all, but it is going to be a rapid fire approach because you could wrap an entire show around each of these topics.

Here’s a little sampling of what you’ll find – breastfeeding, formula feeding, solid foods, vitamins and minerals, fluoride, spitups, growth and development including milestones and delays, infant pee and poop, sleep, colic, immunizations and if that weren’t enough our resident safety expert, Dr. Sarah Denny, MD, will swing by the studio to talk about baby safety in the home, in your car, in the bath, in the crib. So we have a jam-packed show for you today and we’ll get started in just a moment.

First, a quick reminder if there is a topic that you’d like us to talk about on PediaCast or you have a question for me, it’s easy to get in touch, you just go to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That’s 347-404-K-I-D-S.

Also the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for a specific individual. So if you do have a concern about your child’s health, again be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find over at pediacast.org.

All right, let’s take a quick break and I’ll be back with Parenting 101 – Baby Basics, right after this.

[Music]

05:35

All right, we are back. So babies have very few jobs that they have to do. They have to eat, they have to grow, they have to pee and poop and they have to sleep. And as I mentioned, they don’t come with user manuals and of course, moms and dads out there you’re going to find information, but not all information that you find is evidence-based.

And it’s the job of us, doctors, to provide the best information and to keep it practical and understandable. So we’re going to embark on a broad survey of baby topics, kind of survivor guide style. It’s going to be low-tech and I make no apologies for that. We’re not going to cover research studies or back anything up even though you just have to trust me that I really did research this and know what I’m talking about.

So it’s low-tech but it’s high impact. This is the stuff that you moms and dads want to know and of course we have lots of clinicians in the audience as well and this is the stuff that you want to communicate with your moms and dads. And it’s the stuff that they don’t teach in medical school. So hopefully, you’ll find this beneficial.

All right, so all of you know, you’ve heard this before, breast milk is best, but why? Why is breast milk best? Well, it is recommended as the exclusive nutrient source for babies for the first six months of their life and you really should breastfeed at least until age 12 months, but you can go longer than that. And how long do you go it’s really until you and the baby feel comfortable with stopping.

I always kind of made the joke that when the kid’s old enough to ask for it then it’s probably time to stop. But it really is just you go as long as you want. There’s no real hard and fast rules on that. It is free. It’s convenient. Antibodies transfer immunity through the breast milk, you don’t get that with infant formula.

It has easy to digest proteins. The lipid or fat mix provides optimal absorption. And this is interesting, the minerals and the trace elements are bound to digestible proteins, so they kind of ride in on the protein so you actually get better absorption. And that’s why breast milk actually has fewer minerals in it, but it’s because they actually get absorbed better than just the free minerals that are in formula.

07:41

Some breastfeeding tips, expect challenges and get help early. There’s lot of different resources for you on that, the La Leche League has a lot of great information at their website. Your local doctor should know breastfeeding consultants that they can refer you to. So don’t be prideful here, just expect the challenges, admit that you have them and get help and that’s going to be your best bet for success.

More stimulation equals more production. So it is OK to pump even sometimes between feedings if your babies go on a little bit longer between them and store the milk. You can store them in meal-sized increments just to make it easier to break them out and use them. And breast milk should be stored in glass or plastic that’s made for breast milk that way the nutrients don’t stick to the plastic and there’s no toxic chemicals in the plastic and a strong plastic that’s not going to leak.

In terms of breast milk storage times, this might surprise you a little bit. Breast milk is fine at room temperature for six hours. In an insulated cooler with ice packs it’s good for an entire day. In the refrigerator it’s good for a week. In the freezer it’s good for six months and if you’re going to freeze it then you just want to thaw in a fridge or warm water. Don’t stick it in the microwave because you might get it too hot in the microwave.

If you want to know more about breastfeeding, we did an entire breastfeeding extravaganza with a neonatologist and a breastfeeding consultant here. It was PediaCast episode #195 and we’ll put a link in the Show Notes for you for that if you’re more interested in breastfeeding.

09:14

All right. Infant formula. Infant formula starts with a cow milk-based, now this is just sort of your standard formulas and then they tweak the cow’s milk to make it more like breast milk. And if you look at just sort of your basic one, just some examples of just standard, regular cow milk-based formula, you have Similac Advance, Enfamil (made by a different company) and Carnation Good Start. Those are all cow milk-based formulas.

And then we also have organic versions of some of those where basically they get the cow’s milk from an organic farm, which you may or may not think is beneficial and that goes beyond what we’re talking about here. And then there are also soy-based options for kids who have cow’s milk protein intolerance, then the soy milk options may be better. And those are brand names like Isomil or ProSobee. I think two or some of them now are coming out that just says Similac Soy and Isomil and little letters where it used to be plastered Isomil, so they’re kind of going with the name brand and putting which different formula it is underneath that main Similac brand if you’re looking at that particular company.

Then there’s also a sensitive line, which basically they take the lactose out, it’s still a cow milk-based but they take the lactose out and they call it ‘sensitive’. The soy-based ones are also lactose-free. And then for kids who have a little bit more trouble with the proteins they have infant formulas that have hydrolyzed proteins, which makes them hypoallergenic, and some examples of those are Alimentum and Nutramigen. And then there are other specialty formulas for kids with certain metabolic disorders and things that are just prescribed basically by the physician, especially a metabolic or GI specialist, and you won’t find those particular formulas out at a grocery store shelf.

Then there are also some that are thickened with rice starch and those are helpful for kids with reflux. And then there’s also a formula out there with added soy fiber that they kind of market for kids with diarrhea just to help kind of firm up their watery stool a little bit. And those kinds of ones you really shouldn’t use on your own. It just should be under the advice of a physician even though they are available over-the-counter at the grocery store.

11:23

All right, so if you’re formula feeding how much do you give? An easy convenient way to remember to start is your hours and ounces should match up. So one to two ounces every one to two hours in the very beginning and then two to three ounces every two to three hours and then onward from there. So four ounces every four hours.

Now obviously, that’s just the starting point and you can titrate up or down depending on growth, if you’re not seeing enough growth titrate up a little bit; same thing if there’s too much growth go down a little. We also look at hydration status. Is your kid dehydrated then they need more fluid. And also spit-ups, if you’re filling the tank too full your kid’s going to spit-up so that then you got to titrate down a little bit.

Also I want to make a mention of animal milk. Babies in the first year of life should not have cow’s milk or goat milk. It has very poor iron absorption. A lot of kids have protein sensitivities and those milks, by themselves, will cause gut wall inflammation and GI bleeding. Little bits of it is common, but that happens over a long period of time and severe anemia can result. So cow and goat milk is made for baby cows and baby goats and not for baby humans.

12:32

All right, let’s talk about baby food. Parents and grandparents are always antsy to start but there are some really good reasons to wait including food allergies, although there are studies that kind of go both ways with that that show if you wait a little while you’re less likely to have food allergies, but then there are also ones that show earlier introduction of certain foods may make it less likely you have food allergies.

So the verdict is kind of out on the food allergy issue with it. But suffice it to say that consensus right now is waiting a little longer is probably best overall when you’re talking about food allergies. Another food has high calories and so the earlier you start the more likely that your child will be obese. And then also young babies, they don’t maintain their airway quite as well, and so there are choking hazards with starting solid foods too early.

So when do you start? Well the American Academy of Pediatrics currently recommends starting at age six months. So babies should not have any solid foods now until six months of age and they also point out that your child should be developmentally ready. So they should be able to sit up, have control of their neck and their head, be able to swallow, be able to protect their airway before you get started.

Now we’ve all heard the likes of stage 1 baby food, stage 2, stage 3. What’s all about these stages? Stage 1 are basically very thin texture, they’re cereals, fruits and vegetables and meats. Stage 2 are basically combination products. There are some companies that are making stage 2 1/2, which basically there are still combinations but they make them thicker and there are some texture involved. Stage 3 baby foods are basically have chunks in them.

And then stage 4 and 5 are basically for toddlers. The baby food manufacturers don’t want to lose customers when kids get old and so they market some foods for the older kids and call them stage 4 or stage 5 foods.

So when do you progress? There are no rules on this. So you start with stage 1, you introduce one thing at a time in case they are going to have an allergic reaction or something and it’ll be easier to figure out what it was. But then when they’ve been doing that well for a while then you go to stage 2 and you do that. You progress up the stages just that your child’s or whatever seems natural on however you want to do it. So that’s one of those ways where parents can have some leeway there.

What about juice? No juice until six months of age, only breast milk, preferably, or formula until six months. And then you really want to limit the amount of juice that you give to four ounces per day. And juice also is high in calories and will cause obesity if you do too much of it. And then your kids also would just want more and more of that because it tastes good and they like the taste. So you just really have to limit them right from the beginning in order to keep at that four ounces a day.

What about water? Kids don’t really have to have water, but if your child does want to drink something more and they’re already kind of on that, they’re getting obese on their growth chart, then offering them water may be a way to pacify them without adding extra calories.

15:23

Vitamins and minerals. Formula contains all necessary nutrients so no supplements are needed for healthy babies. Nursing moms should maintain good nutrition. If they have poor diets then they can take a multivitamin and the vitamins will get into the breast milk. Breast milk is deficient only in vitamin D.

And if you look from a nature’s standpoint the reason for that is our skin does make vitamin D when it’s exposed to sunlight. But unfortunately, since we humans wear clothes now and slap sunscreen all over ourselves we still really are kind of deficient in vitamin D.

So the American Academy of Pediatrics recommends that all babies, regardless of their skin color, who are breastfed should get vitamin D supplements 400 international units (IU) per day and there are tons of products that are available over the counter that basically one dropperful is 400 units. And so if you’re breastfeeding, right from the get-go start some vitamin D drops for your baby.

I want to point out that vegan diets also lack vitamin B12, which can result in anemia and also central nervous system developmental type problems. And so for vegan moms it is important to supplement mom or baby with vitamin B12. Also, it’s easy for vegan folks to be iron deficient as well if they’re not eating lots of green leafy vegetables, although lots of them are. So you may want to talk to your doctor about iron supplements, too.

Also premature babies have fewer iron stores and so they’re going to have some special supplement needs with regard to iron.

16:49

OK. What about fluoride? Fluoride is not necessary during the first six months of life. It is present in breast milk as long as mom is ingesting fluoride. And so you do want to make sure that your local water supply has at least 0.3% parts per million (ppm) of fluoride.

Some well water, by the way, has far more than that. In fact, well water can have dangerous amounts of fluoride and so if you do have well water make sure you get it tested. It should also be tested if you have a baby at home to make sure there are no microbes living in the well water.

And one safe thing that you could do is just substitute out your tap water if you have a baby at home with some fluoridated water. And it’s really not too expensive to buy this nursery water that’s available. You can also have it delivered in big jugs to your home so that if you substitute your tap water with the fluoridated water even if you’re breastfeeding no supplements are needed.

Fluoride drops are an option but they’re not ideal because it is easy to kind of overdose with the fluoride and again, too much fluoride is also a concern. It can cause something called fluorosis.

Let’s talk about spit ups, kind of the natural progression of eating. It is common. Lots of kids spit up. The valve on top of the stomach gets a little bit loose, so when the stomach squeezes some of the food comes back up. Warning signs with spit ups would be if it’s projectile and by projectile doctors mean across the room, not out like a fountain.

Also if it has blood in it or green or yellow bile, we worry about that. Sometimes like a light yellow can be normal. Stomach just sort of the mucus has a little bit of a light yellow color to it, but if it is a dark yellow or green we worry about bile which can be a problem.

If your child is spitting up and they have poor growth; if they’re choking or they’re wheezing or have any other airway problems then we have to deal with that. But if your child is a happy spitter, they’re spitting up but they’re happy and they’re growing fine then this is a laundry problem, not a baby problem.

18:38

Treatment for reflux begins with just smaller more frequent feedings. So instead of doing three ounces every three hours you may want to back that down to two ounces every two hours. So overall they’re getting the same amount but they’re getting smaller amounts more frequently and often times that’ll help you not fill the tank too full.

Also you can consider thicker feedings, but you do have to watch their weight with that. Kids can become obese pretty fast with all that added starch from thickening the feeds with rice. You’d really want to keep that down because maybe they are having choking or they’re having wheezing problems, so that’s something that you can consider.

And then if they are having airway problems a lot of times it’s not really the formula, it’s the stomach acid and so you can consider H2 blockers, things like Zantac or PPIs (proton-pump inhibitors) if babies are having airway irritation or if they’re really fussy with their reflux and you really think it’s not colic which we’re going to get to and you it is the stomach acid that’s making them fussy then you can try those kinds of medicines.

Surgical treatment for reflux is rarely necessary.

OK. What about growth? So babies are born with extra fluid on board. And the reason for that is it leaves a little bit of wiggle room for feeding delays – babies may have some latching problems, mom may have some milk production problems in the very beginning as her milk is “coming in”.

And so babies are born with extra fluid so that they don’t get dehydrated. An acceptable loss is 10% of their birth weight and that’s just a guide. Really you do want to monitor their hydration status and we’ll get to how you do that in a few minutes. And then you’d like to see them back to their birth weight by the time that they are two weeks old.

And then during the rest of the first month of life the average weight gain is going to be kind two-thirds of an ounce per day. Their average length gain is one and a half to two inches and their average head circumference gain is three centimeters. Again, these are averages.

Now, we monitor a child’s growth with a growth chart and what this does is it compares a child’s growth to a known population. The standard chart that we use today is basically a multi-ethnic Americans. And so we’re going to measure weight, height or length, head circumference and as they get older you can also measure their BMI.

And then on the chart it’s reported in percentile with normal being between the 5th percentile and the 95th percentile. So under the 5th we would say they’re underweight or their length is a problem and over the 95th then that could be a problem.

And this really allows for snapshots and time. What’s more important really is baby maintaining an appropriate percentile. So are they growing along their curve? And we do have to consider family growth and what ethnic group them belong in because if you have an Asian child who is at the 10th percentile that may very well be normal for them and you a have a Swedish kid at the 95th percentile and that may be normal for them.

Really it’s not like everyone is trying to strive for 50th percentile. You just want to make sure that they are maintaining their curve. There are some special well-standardized growth charts out there for premature babies that just look at them, Trisomy 21 or Down syndrome, Turner syndrome also has one.

21:50

But you do want to beware of some of the other special growth charts that you can find online, particularly the ethnic growth charts. So they do have like a Japanese growth chart that’s out there, but a lot of those are out of date and have very limited sample sizes and so it’s not advised that you use those.

In terms of development, we talk about developmental milestones and it’s recommended that pediatricians use a standardized validated tool to screen baby’s development and that’s an important part of every well-child encounter. A commonly used tool is the Denver Developmental Screening Test (DDST). It measures growth and fine motor development, receptive and expressive language, personal and social skills.

And basically, it boils your kid down into a risk category — Is their development normal? Is it questionable? Or is it abnormal? And so the questionable ones you kind of watch for a couple of well-visits before you get concerned. The abnormal ones you do start to worry that they could have a developmental issue.

I’m going to extend this part of the talk out a little bit further than 12 months and I think it’s important to point this out. The American Academy of Pediatrics and the CDC recommend specific autism screening at 18 months of age and 24 months of age with the different tool than the Denver.

There are many of them available, the Ages and Stages Questionnaire (ASQ), Communication and Symbolic Behavior Scales (CSBS), Parents’ Evaluation of Developmental Status (PEDS), Modified Checklist for Autism in Toddlers (M-CHAT) and the Screening Tool for Autism in Toddlers and Young Children (STAT).

It doesn’t matter so much which one you use, just that you are using one of those and using it consistently. Parents, if you are interested in seeing what they look like and physicians out there if you want to find them at the AAP’s website and also the CDC’s website has links to those tools.

A lot of them you have to pay for. Someone spent a lot of money standardizing it and coming up with a good tool to use and so they want to make a little profit out of it and so they are copyrighted and you do need to pay for this, including the Denver, too.

23:45

OK. So what do you do if a child does have developmental delay, whether using the Denver or one of these autism tools? Well first, you have to realize like growth development does occur with some variety. So some potential causes of what we would consider a developmental delay include looking at family pattern, especially if the delay is not global. So if a child has a delay just in one area but everything else looks good, we kind of look at the family pattern. You may say oh yeah, cousins they all talk a little bit later and that may be OK if that’s sort of what you see in your family.

Sometimes, developmental delay may just be poor stimulation, especially if they are young parents or depressed mother, really just not interacting and stimulating your baby can cause a developmental delay. And then it could be a disease state. They could have autism. They could have a genetic syndrome or something that really needs more intervention.

Speaking of intervention, we do know that outcomes improve with early identification and early intervention of developmental problems. Speaking of early intervention, every single state has a federally funded early intervention program. Here in Ohio it’s maintained by the Ohio Department of Health, it’s called Help Me Grow. It’s a multidisciplinary program. Any physician can refer children to early intervention and actually parents can self-refer. So you can go online at the Ohio Department of Health and refer yourself if you like.

It’s multidisciplinary, there are social workers, physical therapists, occupational therapists, speech therapists, dietitians. And really early intervention is most often effective when stimulation issues are the cause of delay. When really parents just need a little guidance and a little help in stimulating their kids and really getting their development on track.

Persistent delay requires more than early intervention. It really requires a developmental specialist. Your local children’s hospital would have a developmental specialist. Here at Nationwide Children’s Hospital, we have a Child Development Center that physicians can refer to. We have the Center for Autism Spectrum Disorders. These are multidisciplinary clinics with the full support of all pediatric specialties that they can then refer to.

We also have a Genetics Clinic here, which looks at the diagnosis and management of genetic disorders and provides genetic counseling and pregnancy planning as well. And we’ll put links to those in the Show Notes for you today.

26:05

All right, moving on fast, peeing and pooping. Urine production is one indicator of infant hydration. There are others – weight loss, tachycardia or fast heart rate, if kids aren’t making tears, they have a dry mouth or cracked lips, sunken fontanelle, sunken eyes, poor skin turgor, delayed capillary refill – these are all things that your doctors out there know what I’m talking about.

So when parents say my kid’s not peeing that much that’s just one item. You have to look at other items as well. Normal urine outputs is going to be six or more wet diapers in 24 hours. And the diapers today are so absorbent, even a little bit of urine counts. So when kids are sort of the on the verge of getting dry because they have a little vomiting and diarrhea, sometimes they only pee a really small amount but it counts in those six or more wet diapers in 24 hours.

And absorbent diapers can make that determination difficult. If they have diarrhea sometimes it’s to tell whether they peed in there or not. You can put like a cotton ball or some toilet paper in the front of the diaper and then check and see if that got wet. There are little tricks like that that you can use to see if your kid really is peeing or not.

Also I wanted to mention concentrated urine because a lot of times parents will come in and say their pee smells funny. That can be from metabolic disorders but more likely it’s concentrated urine that just means your baby does need more fluid, so a smaller volume has the same amount of waste products in it which makes it smell a little stronger.

Also there is something in little babies called “brick dust” where we see pink, red or orange powdery stain in the diaper. Those are caused by uric acid crystals. They can be normal in the first few days of life but after that they usually indicate the baby’s dry and needs some more fluid.

27:41

What about poop? Well there’s a wide range of normal consistency. It ranges from thin yellow and seedy to mustard-like to formed clay, those are all normal. There’s also a wide range of normal frequency from several stools per day to just one or two stools a week and that’s all normal.

Volume, consistency, frequency, color and smell of poop all depend on diet, gut absorption, transit time (how fast things move through) and the mix of bacteria in the intestine. All of those things together dictate volume, consistency, frequency, color and smell.

So what’s concerning with stool?

Well red stool is concerning because it could be blood. We like to confirm with a stool guaiac test and the reason we want to confirm that is because other possibilities of red in the stool include something in the diet, medications; purple dyes can sometimes break down into individual components and can cause red in the stool.

And then there are also some medications that cause iron precipitation, so iron in the breast milk and in the formula can precipitate out and that can have a red color. One example of that is Cefdinir or Omnicef can cause like a maroon color stool because of iron precipitation, it’s not really blood.

Black tarry stools can be a concern. In the first few days of life that’s caused by meconium or ingestion of amniotic fluid will cause a black tarry stool. So in babies you do see that in the first few days of life. Also iron supplements, especially if it’s a lot of iron can cause black tarry stools. But we do worry about bleeding, especially higher up in the GI tract if they have black tarry stools.

White or light gray stool can be cause by antacid ingestion. For reflux a lot of kids’ moms will try Mylanta and so antacid ingestion can cause white or light gray stool. It can also be caused by biliary obstruction and especially if a kid also have jaundice with white or light gray stool will make you really worry about their liver.

Really greasy stools can be a sign of cystic fibrosis and then diarrhea with just watery increased volume can be caused by viral or bacterial infections, juice intake, lactose intolerance or milk or other food allergies.

29:49

OK. So let’s say you test red and it is blood, possible causes anal fissure, babies can get a little nick or cut around the anus that can bleed. Swallowed maternal blood can do it. Something called necrotizing enterocolitis where there’s a bowel wall infection and that can cause a very serious condition.

Food allergies, in particular, cow milk protein allergies; bacterial infections like salmonella, shigella and E. coli O157:H7. GI bleeds can be caused by malrotation with midgut volvulus, intussusception, meckel’s diverticulum, inflammatory bowel disease. It could be coagulation disorders. So really red in the stool you got to see your doctor, see if it’s blood and then the workup kind of goes from there.

What your doctor will do is consider the degree and duration of the bleeding. If there are other symptoms along with it like bilious vomiting, fever, fussiness the physical exam is important. Is there anal fissure or is your child having weight loss? Is there a tender distended abdomen?

And the workup is really going to depend on their symptoms, the history, the physical. It may just be yeah, there’s an anal fissure there and we’re going to watch this for a day or two. It could be a formula change. It could be that you’re going get blood work like a CBC and coags or you’re going to get a stool culture, you’re going to do imaging, playing films up your GI or ultrasound. All those are possibilities.

31:05

All right, let’s move on to constipation. This is unlikely to be constipation – one or two bowel movements a week as the usual pattern and struggling or straining to have a bowel movement even though you’re only having one or two a week – that’s normal. That is within the range of normal.

So what would be constipation? Well dramatically fewer bowel movements than before. So if your child was having a couple a day and then they go to having one a week and they’re restraining then that may be an issue. Also very large hard stool which may or may not have a little bit of traced blood on the surface that would be constipation.

Frequently straining for more than 10 minutes without success, it is normal. You try to have a bowel movement lying on your back, it’s difficult and so babies do strain a little bit. But if it’s more than 10 minutes without success then you may want to help loosen it up a little bit for him. And also if those things are happening and they’re fussy and maybe spitting up more than usual that could be a sign of constipation.

So if we determine that it’s constipation what do we do? If they’re really little just some rectal stimulation, little Q-tip with some Vaseline on it in the bottom kind of like you’re taking a rectal temperature sometimes that’ll be enough to help them go.

You can use glycerin suppositories. You can also use juice as a medication. So basically, we would use apple juice, pear juice or the big daddy, prune juice. These juices have undigested sugar, sorbitol, which get down into large intestine and increase the osmotic loads that draws water in to loosen up the stool.

You do want to use full strength adult juice and make sure it’s processed, just the pasteurized kind of thing, not fresh juice from a farm market. But you want to use full strength adult juice because the baby juice is they dilute and so you don’t get as many of those undigested sugars to help you out.

What’s the dose? One ounce per month of age and you can either do it once or twice a day with kind of a maximum dose of about four ounces per serving on that. And it does a really nice job of loosening the stools. Even for little babies who are constipated who are very young you can do it. You’re not using that for nutrition, you’re using it as a medication.

Severe and stubborn constipation, you may want to see a GI specialist for that. There are many causes of it – Hirschsprung’s disease, spinal cord abnormalities, hypothyroidism and other metabolic disorders. So severe or stubborn constipation does need a longer look at those kids with a GI specialist.

33:21

Let’s move on to sleep. Prior to six months anything goes. By six months of age, here’s kind of the average 2/3 of babies wake or cry only one time per week, so that’s great. By age six months 2/3 of babies are only waking up once a week. That’s fabulous.

But what about the folks out there who have the other 1/3 of babies? Well those kids tend to cry or wake up six or seven nights a week, so these are the difficult babies, but it’s still normal at age six months. You kind of do your regular thing, you pick them up, you soothe them, you put them back down. The natural progression of it is by 15 months these babies wake up and cry about two nights per week; by age 24 months they’re finally doing the one night per week thing.

Now, as it turns out most infants wake up every night. The difference is those who self-soothe back to sleep and those who cry out and want you to come get them. And here’s a thing, self-soothing is an important skill and it can be learned. And this is where the “cry it out method” comes into play. And this is really controversial in the parent world, some swear by it, some equate it with child abuse.

Basically, what you do is you start at six months of age. At that point you put your child to bed awake, you develop a plan for your response to their crying and you stick with the plan. So one that always worked in our house, you put them to bed, they cry, five minutes later you come in, you don’t pick them up but you just say hey, I’m here and they stop crying and you leave. If they start crying again then you do 10 minutes then you weigh, then you do 15 minutes and you do 20, then you do 25, you get it out a little longer.

Next night instead of starting at five you start at 10 minutes. The third night you start at 15 minutes and same response for overnight wakings, too. And eventually, a lot of these kids will convert from wake and cry to wake and self-soothe.

And studies have shown that this will convert criers to self-soothers and there’s also been studies that show there’s no adverse effect on long-term mental health if you do that.

35:17

Colic. It usually begins by age two to three weeks. So these are young kids, there’s a lot of colicky babies that get diagnosed with reflux who just have normal spitting up that don’t really have heartburn, they just have colic. It usually resolves by four months of age.

It affects 25% of all infants. It usually occurs around the same time each day, most common in the late afternoon or evening. And kind of a description of colic – infant seem angry, they’re difficult to console, they tense up their belly, they drop their legs, they clinch their fists and they cry to the tune of more than three hours a day.

What causes it? We really don’t know. I think the cause that really makes the most sense to me is some central nervous system immaturity. So the cry center of their brain fires and we don’t really understand why. The fact that it’s late afternoon or early evening it may have something to do with stimulation overload.

They just all day long their senses are being stimulated with noise and movement and action and TVs and conversations and older siblings arguing and by crying they just block it all out and go back to being inside the womb again. So that’s kind of my favorite theory, but it’s just a theory.

Some thought about GI sensitivity and there was a recent study that showed questionable improvement with probiotics, but data is still out on that. And for some kids it could be central nervous system and for other kids it is a little GI sensitivity. We just don’t know because they can’t tell us what’s going on.

The take home for moms and dads, colic is common; three hours of crying each day is frustrating; frustration and anger are normal responses, but you got to be smart about this and put your baby in a safe place when they’re crying like this and walk away. Parents need respite care.

In the end get a babysitter, go out, have a date night once a week, it’s really important. The other thing, too, is the end is in sight, most cases of colic do resolve by four months of age.

37:08

In the introduction I mentioned I was going talk about immunizations. Here’s my advice on immunizations – GET THEM!

OK. So in conclusion, infants don’t come with instruction manuals; bad advice is readily available; and your primary doctor has got to be your most trusted source of information. So go out there and get one.

So I hope this is helpful to folks, especially with brand new babies at home. Some other resources, of course here on PediaCast, we do a weekly podcast and I mentioned this, I know you’re listening to it you know what it is, but I have a feeling there’s going to be a lot of people who are introduced to this program with this very episode.

So I just want to mention it’s a weekly podcast, radio-talk show style format. We cover news parents can use, answer listener questions and have interviews with pediatric experts. And you can find us at pediacast.org. Also, the American Academy of Pediatrics has a great site called healthychildren.org., it’s a comprehensive site with up-to-date well-child and disease information. It’s really geared toward parents, so check that out.

All right, I went way over. We’re actually giving a presentation on this to some physicians and I’ve got 22 minutes to talk about what I just talked about, so I think I’m going to have to remove some material. But anyway, you guys got the full force talk and I hope you found it helpful.

We are going to take a quick break and then we’re going to get our resident safety expert, Dr. Sarah Denny, MD, settled into the studio and see what she has for us with regard to keeping your baby safe. So she will be here, right after this.

[Music]

39:13

All right, welcome back to the show. Dr. Sarah Denny, MD, is a physician with the section of Emergency Medicine at Nationwide Children’s Hospital and she’s an Assistant Professor of Pediatrics at the Ohio State University College of Medicine. She is also an affiliated faculty member with the Center for Injury Research and Policy at the Research Institute here at Nationwide Children’s.

Dr. Denny joined us last summer to talk about summer safety topics like bikes and helmets and swimmings and playgrounds and trampolines. Good stuff really. If you missed that one be sure to check out PediaCast 210 and we’ll put a link in the Show Notes so you can find it easily because that information will be relevant for many summers to come.

So now that I’ve gone off on that tangent, a warm PediaCast welcome to Dr. Denny, thanks for coming back.

Dr. Sarah Denny: Thank you, Dr. Mike. I’m happy to be here. So you may wonder why I’m talking about injury prevention in a newborn talk because they just lay there and look cute and don’t get in much trouble around the house. But it’s really important to start safe injury prevention from the hospital and continue that on as you go home.

Unintentional injury is the leading cause of death in children and adolescents in the United States with one child dying from an injury every hour and every four seconds a child is treated for an injury in the emergency department. So I’m hoping as we cover these topics it changes a little bit how you think about injury and how you manage your child at home to try and prevent these injuries and really we can all work together to reduce these numbers.

The leading causes of unintentional injury death for children under a year in order are: (1) suffocation and we will get into all of these in more depth in just a couple of minutes; (2) motor vehicle traffic, which is both pedestrian as well as car accidents and we’ll talk a bit about child passenger safety seats and whatnot in that section; (3) drowning; (4) and burns and fires, they are the next two most common causes of unintentional injury in children under a year.

41:09

So infant suffocation death, this is a complex topic and it’s got a lot of subcategories that can be a little bit confusing. So I’m going to try and put them in an order that I think is a little bit easy to understand and kind of explain what I mean by infant suffocation deaths.

According to the CDC, unintentional suffocation causes 1,000 infant deaths annually in the United States. So I’m primarily going to be talking about suffocation and SIDS related to sleep because the AAP has recently released some new guidelines related to safe sleep. But it is important to talk about the other suffocation mechanisms as well.

So within suffocation we have sleep-related suffocation, choking, strangulation and other. So choking, Dr. Mike talked a lot about feeding your baby and when to start food. It’s really important that you’re using small bite-sized pieces and I would really recommend all new parents to take a basic CPR and first aid class, so you if your child starts choking you know what to do and you know how to respond.

I’m not going to spend a lot of time on choking but it’s just as important to realize that that’s a significant cause of mortality in infants.

Strangulation. We’re going to cover some of this in regards to crib safety, but as your baby starts becoming more mobile it’s important to just look around the house and look for hazards such as electrical cords, the cords on blinds and just try and make it as safe as possible.

OK. So within sleep-related death there are three categories – asphyxiation, which we’re going to talk a bit more about; SIDS and then undetermined. So the definition of SIDS is a sudden death of an infant less than one year that cannot be explained after a thorough investigation is conducted and that includes an autopsy as well as a death scene examination and a clinical history.

What they do now is the medical examiner goes out and actually do a recreation of the scene with a doll and try and figure out exactly what the conditions were when the child died. And this helps them categorize them by what mechanism the child died from.

Undetermined is kind of a vague gray area and that makes the data a little bit difficult to interpret. Undetermined is listed as the cause of death when the exact cause cannot be found, but something at the scene investigation indicates that there were dangers in the baby sleep areas. They can’t completely rule that it was asphyxiation but they can’t rule it out either.

43:39

So when I’m talking about sleep-related asphyxiation what exactly do I mean? There are four different ways that a baby can die of asphyxiation. The first is by suffocation by a soft bedding. This is a pillow, a water bed mattress, the bumpers, the comforter that comes in a cute little bedding pack. Any of those things can cause suffocation.

Overlay is a term that describes when another person, usually an adult, either rolls on top of or rolls up against the infant and causes them to not be able to breathe. Wedging or entrapment is common. It’s when the baby becomes wedged between two objects, either they get wedged between the mattress and the headboard or mattress and the wall.

Another area where we see this, actually in increasing frequency is the baby gets wedged between the adult and the couch or an arm chair.

Strangulation is when the infant’s head and neck become caught in between the crib railings and we’ll talk a bit more about crib safety in just a minute. According to the Ohio Department of Health, data from 2008-2010 showed that 68% of infant as suffocation deaths were sleep-related. So this is a really big area that we can improve upon and I’m hoping some that some of the pointers I give you today can help you create a safe sleep environment for your child.

CDC states there’s been a four-fold increase in the rates of accidental suffocation-strangulation since 1984. Does this mean that more kids are actually dying of suffocation or does it mean we’re recognizing it better? That’s a little bit unclear. We are getting better with these death scene investigations and so the thought is that maybe some of the deaths that were categorized as SIDS are now being relooked at and we’re realizing that they’re actually due to suffocation.

Just a bit about risks, males are slight increase risk and the rate of suffocation deaths in African-American babies are 165 times out of Caucasian babies.

45:38

So what can we do to prevent suffocation deaths in infants? It’s actually pretty easy if you follow the American Academy of Pediatrics’ safe sleep recommendations. The first one is to put the baby on their back to sleep. And in the 1990s the AAP started the Back to Sleep Campaign and there was more than 50% decrease in the rate of SIDS.

But that rate of decline has plateaued in the recent years and we continue doing studies and trying to figure out why that is. The studies continue to indicate that sleeping on the back is much safer than sleeping on the abdomen. And when I’m talking to moms I sometimes ask if they do put their baby on their belly why. And the most common answer I always hear is I’m afraid the baby is going to throw up and choke.

If you look at the anatomy of a child that is not the case. The baby is not at any increased risk of choking laying on their back. So it’s really important to keep the baby on their back.

Next, just put the baby on a firm surface or put them in a safe crib. Cribs should meet the acceptable safety standards including slats no more than 2 3/8 inches apart and these are all available on the Consumer Product Safety Commission website if you are needing more clarification.

Hardware should be tightened up. There should not be any rough edges or sharp points exposed. And the mattress should be firm. It should snuggly fit in the crib. You don’t want to have any gap between the edge of the mattress and the side of the crib that the baby could slide down into.

As probably most of you know by now drop-side cribs have been recalled and are not considered safe because of the risk of strangulation, so you want to make sure that you’re not using a drop-side crib. And then on the mattress, you want to make sure you’re using a tight fitting sheet. You don’t want a sheet that can get balled up or get over the baby’s mouth or nose.

47:25

OK. Room sharing without bed sharing. This is the hot topic in safe sleep. Really what’s important here is the definitions. Co-sleeping is a term that was previously used, but this term means different things to different people. It means that the baby is in close proximity to the parent and that may mean that they’re sleeping on the safe surface or it may mean that they’re sleeping on different surfaces.

So what we prefer to do is call it room sharing or bed sharing. Bed sharing as it sounds like is when the adult and the child are sleeping on the same sleep surface. Whereas room sharing is when the baby is in close proximity to the parent but on a separate sleep surface.

Study showed that the room sharing decreases the risk of SIDS by as much as 50%. And the Ohio Child Fatality Review data indicates that 66% of sleep-related infant deaths where the infant was sharing a safe sleep surface with another person.

I know it’s hard when you’re tired and you’re up and you’re breastfeeding to get them back in bed, but it’s really, really important just to get them into their own bed. It can be right next to you but it’s really the safest place for them. The other thing is keeping soft objects and loose bedding out of the crib.

And I know it’s hard when every single advertisement you see has got these bedding packages with cute comforters and bumper pads and little stuffed animals. It’s important to know that although it looks really cute these things are really hazardous to your child and it’s very important that the babies have nothing else in their crib besides the child, OK?

49:00

I’m going to go through the rest of the recommendations a little bit more quickly. Prenatal care. There’s significant evidence that regular prenatal care decreases the risk of SIDS. Behind sleep positions, smoke exposure is one of the biggest risk factors for SIDS and the reasons are multiple.

One is smoking during pregnancy can cause low birth weight as well as preterm delivery, both of which are risk factors for SIDS. And in postnatally smoke exposure affects the arousal in infants and so they are not as able to wake themselves up if they need to.

The American Academy of Pediatrics estimates at least 1/3 of all SIDS deaths could be prevented if maternal smoking were eliminated. OK. Avoid drugs and alcohol during pregnancy that kind of speaks for itself.

Breastfeeding. Multiple studies demonstrate that breastfed babies have significantly lower rate of SIDS than formula babies. We don’t exactly know why this is but we do know that babies who are breastfed arouse from sleep more easily. And we also know that breast milk has a lot of antibodies from the mother that help the baby’s immune system. So by keeping the baby healthier you’re also reducing the risk of SIDS.

Pacifier at nap time and bedtime is another one. It was just added to these new recommendations and we don’t exactly know why that the pacifiers shown to decrease the risk of SIDS, but it does by 50% to 60%. Now we know that the American Academy of Pediatrics recommends waiting until breastfeeding has been established before introducing the pacifier, but it can be helpful to reduce the risk of SIDS.

Avoid overheating. We always see these little tiny babies all bundled up in the emergency department and one good rule of thumb when you’re trying to figure out what your baby should be dressed in is just put the baby in one layer more than what you’re wearing and that should be sufficient.

A lot of the birth hospitals now are distributing these Halo SleepSacks and those are great because you can the baby in their onesie and then in their sleeper and then you can put in their cozy little sleepsack and you know that they’re warm and they’re safe.

And the last recommendation is to immunize. Dr. Mike talked about immunizations. There are so many great benefits of immunizations and reducing SIDS is just another one to add to the list. So get your immunizations and get them on the recommended schedule.

OK. Part of the new campaign for safe sleep is called the ABC’s of Sleep. It’s nice and simple. A for alone, baby should sleep alone; B for back, put them on their back; and C in a crib. In Ohio, more than three infant deaths each week are sleep-related, which is the equivalent of seven kindergarten classes not going to school each Fall.

It’s a really preventable mechanism of death in kids and so we really want to try and get the word out there and get kids sleeping in a safe environment.

51:55

OK. So moving on to child passenger safety. Babies as you know require a lot of gear and you will not be able to leave the hospital without your child passenger safety seat. So there have been some changes in the American Academy of Pediatrics recommendation for car seats. I’m just going to go through each one of them and give you a little bit advice about car safety.

The first one is all infants and toddlers should ride in a rear-facing car seat until they’re two or until they grow the rear-facing recommendations by the manufacturer. This is a tough one to convince parents and I will say in my own family, my husband and I have argued with this on each of our three kids.

My husband thinks the kids are bored. He thinks they’re uncomfortable. He wants to see them in the rear-view mirror and he doesn’t understand why I want to keep kids rear-facing. But when you look at the crash data it shows that forward-facing children less than two years of age are much more likely to be significantly injured than rear-facing children no matter what kind of crash it is.

And the other thing that I hear from parents is well, I’m afraid that if they’re rear-facing and we’re in an accident they’re going to break their legs. This, again, has not really been shown to be the case. The risk of a lower extremity injury in a rear-facing child is about one in a thousand.

So it’s very unlikely and really we would rather see a broken lower extremity than a broken neck or some serious abdominal trauma. So try and keep those kids rear-facing for as long as possible. Some European countries have laws that you keep them rear-facing till four. So we’re not the only country that’s kind of trending this way.

53:30

OK. Children two years or older or those who have outgrown the rear-facing height or weight requirements should use a forward-facing car seat with a harness. So each manufacturer has different height and weight limits for the different positions of the car seat and it’s important that you review your owner’s manual and check out and see when you need to be turning your car seat around.

Forward-facing car seats reduce the risk of death by 71% compared to unrestrained children, so it’s really important. We have a rule in our house the car does not move till everyone is fastened in properly. We are having this argument today about the harness strap and where it’s appropriately placed with my son in the booster seat and we’ll go through kind of the process of how do you know that the child is properly restrained in their car seat.

OK. Once they have moved out of the regulations of the car seat, they move in to a booster seat. So the next recommendation is children who have reached the weight and height requirement of the forward-facing car seat should use the belt positioning booster seat.

And these come in all different varieties. You can get the high-back ones, the low-back ones with the 5-point harness. And the recommendation is that typically they stay in the booster seat until they’re 4’9″, which is usually between eight and twelve years of age.

Forty-eight states have booster seat laws, so you really need to look into what your state’s specific laws. Some have primary enforcements, some have secondary enforcements, but you need to know what your specific state requires.

The children who are wearing poorly-fitting seat belts or if they’re just in a regular seat belt in a backseat of the car are at significantly increased risk for spinal cord and abdominal injuries. The booster seat lifts up the child so that the shoulder strap fits them properly. So it goes across the middle of the chest as opposed to going across their neck or face and then lap belt fits low on the hips in the pelvis as opposed to going across the abdomen.

55:27

And once the children are old enough to move out of the booster seat then they need to go in to a car seat. And a lot of parents have questions, how do I know my child’s ready to go in to car seat. And a couple kind of pointers on how you can tell is when the child can sit still in their seat belt with their back against the seat; when they are sitting with their back against the seat you want to make sure that the lap belt is going low across the hips and the shoulder belt fits across the middle of the chest and the shoulder. And their knee should bend naturally at the edge of the seat with their feet touching the floor. If their legs are still sticking straight out they’re not ready to be in a regular car seat.

It is really important that when they’re wearing a seat belt that they always use the shoulder belt. Shoulder belts reduce the risk of injury by up to 81% and it really reduces the amount of abdominal injuries that you see in lap belt only seat belts.

And then the last recommendation that I’m going to pass on to you is that kids less than 13 should always be in the backseat. I often times will see kids who look seven or eight riding around the front seat and it’s really not safe. They can get injured by the airbag and it’s just best to keep them in the backseat.

So that’s a lot of information. Car seats can be very confusing. NHTSA has a big campaign on it and they’ve got a lot of commercials on the TV, Is Your Child in The Right Car Seat? And we will put the link on to Dr. Mike’s PediaCast webpage for you to access that information.

The American Academy of Pediatrics also has a downloadable car seat app as well as Nationwide Children’s, I believe, is coming up with one shortly to help you figure out what is the right car seat for your child.

57:11

A couple of quick pointers about installation because if you have not yet installed your car seat you will find out it is not an easy task. According to the National Highway Traffic Safety Administration, three out of four child passenger safety seats are installed incorrectly.

And what really shocked me when I was doing some of this research was that 20% of all drivers of child passengers do not read any instructions on how to install a car seat. And once you see the manual you will realize it is confusing enough with reading the instruction, I can imagine trying to do it without.

A lot of places nearby including local fire stations offer car seat inspections, which is a great idea once you get your car seat and to take it somewhere and make sure it’s done properly.

I’m going to just quickly go over the five most common installation mistakes. The first one is the wrong harness slot is used. The harness straps are what hold the child in the car seat and are often positioned either too high or too low. When you’re adjusting the harness strap you want to make sure that the harness straps go through is either just at or just below the infant shoulders.

Then you have the harness chest clip and people commonly put it too low. They put it down across the abdomen. Really it should be up at the nipple line. Loose car seat installations, so how the car seat is actually installed in the car. You can install a car seat either with a seat belt or a lot of the cars now have a latch system, which is really convenient, but you want to make sure that the car seat doesn’t wiggle more than two inches from side to side or one inch front to back.

Loose harnesses I see these all the time in the emergency department. Parents get their kids all ready to go out the door and they look down at the infant carrier and the kid got the harness on and it’s really, really loose. There should not be any slack in the harness straps and most car seats have straps that you pull towards the bottom to tighten up those harness straps.

And then the older kids’ seat belt placement was wrong. So this is where the lap belt is over the stomach or the shoulder belt is over the kid’s neck or face. One note, especially in the winter time, is you don’t want to over bundle your kid before you put them in the car seat.

The more layers you have between the baby’s body and the harness strap the less effective it is. So you want to put them in just their regular clothes, buckle them in, get everything tightened up the way it should be and then you can put on blankets or whatever else you’re going to put over them. But if you’d bundled them up in a big snow suit, in 13 layers of clothing it’s not going to be as effective of a restraint system.

59:48

OK. I’m just going to say a couple of words about drowning. The majority of infants drowned in the home, either in the bathtub or in large buckets and a lack of supervision is the most common factor in drowning deaths. If you have your child in the bathtub there is nothing more important at going on than staying with your kiddo.

The someone on the door can come back, someone calling you on telephone can call again or leave a voicemail. Kids fighting, if you need to leave the bathroom pick your baby up out of the bathtub and take them with you. One note about bathtub seats or bathing seats these are not a safety device.

Some people use them. I, personally, have not used them but people I think sometimes make the mistake thinking that this is some kind restraint device to keep them safe. Children should never be left unattended in these bath seats.

OK. Fire and burn safety I am just going to touch on because I think a lot of it is probably common sense. But there are a couple of things that you need to think about and changes you can make in your home to reduce the risk of burns.

The majority of infant burns are due to scalding burns, so you should adjust your hot water heater to 120 degrees and then always check the bath water temperature before putting your baby in the tub. The third thing I would recommend is keeping hot liquids away from the baby, never holding a hot drink and the baby at the same time.

I can’t tell you how many times in the morning moms bringing her baby in and moms really tearful and she’s accidentally spilled coffee on the baby while she was putting them in the car seat or doing something as she was rushing out the door.

This is a really preventable injury and just keeping those drinks away from the baby. Keeping hot liquids and foods away from the edge of the table, this is more as the child gets a little bit older and starts pulling up on things. We don’t want them to pull a table cloth and pull things down on top of them.

And good habits to get into right off the bat is when you’re cooking at the stove turning the pot handles backwards so little hands can’t reach up there and pull something down. Just going through some other kind of household safety things related to fires and burns, always use outlet covers; there should be a working smoke detector on every level of the house; using fireplace screens and if you’re using a space heater you want to keep that space heater at least three feet from curtains and other objects.

And one thing that firemen always tell us when we go every year to the fire station is that everyone should sleep with the bedroom doors closed. OK. So that covers the top main causes of unintentional injury.

01:02:29

I’m going to just very briefly speak about child abuse in infancy. This could be multiple hours long of discussion and so I’m just going to let you know that abuse in children less than a year makes up 47% of all fatalities due to child abuse and neglect.

The kids less than one are at the most risk of child abuse. Specifically, I want to speak about shaking baby syndrome. It’s difficult to asses but some estimates show that three to four children a day suffer severe or fatal head trauma from child abuse in the United States.

Most common perpetrators are usually dad, mom’s boyfriend or stepdad. Dr. Mike already talked about colic. Being a newborn parent is hard. You’re tired, your baby is up a lot, you’re often overwhelmed, not to mention if there’s any other stressors going on with housing or finances or work.

It’s a lot to take on and it’s a lot to manage. If you have a baby who cries a lot has colic that can be really challenging and parents don’t always recognize that crying is a normal part of development. As Dr. Mike says it starts at two to three weeks of age and peaks around six to eight weeks and usually resolves by four months.

And it’s really important to recognize this is a normal behavior and it’s no reflection of your parenting or baby needing something that you’re not providing. It is totally normal. It is OK to put that baby down in a safe place and take a time out to regroup, go take a walk around the block or whatever you need to do.

It’s important to ask for help. It’s OK to say, I can’t do this right now, I just need 15 minutes and get some help. And recognize that crying is normal, it is not a problem.

01:04:18

Some soothing techniques, walking the baby around, rocking the baby, offering a pacifier. Just to kind of re-emphasize what Dr. Mike said about overfeeding, you don’t want to overfeed because then they are at increased risk of reflux. Speaking or singing in a rhythmic voice, running the vacuum, driving the baby in the car, having white noise or a fan can sometimes help.

Swaddling is a great one, this always work with my kids. Swaddling is really helpful. It just kind of cuddles them back up into that almost fetal position and makes them feel safer, they don’t have their arms out flailing around startling themselves and then rubbing the baby’s back.

The other thing is this post-partum depression and baby blues are a normal part of the post-partum time period and just be aware if you’re feeling more sad or more overwhelmed than you think might be normal. Talk to your doctor. It’s important to recognize these symptoms early so you can address them and get them treated.

So I know it’s not the most uplifting topic when we’re talking about newborns, but it’s really important and a lot of these things are preventable. So I hope that you’re able to get some helpful information for how to keep your baby safe when you get them home. Thank you.

01:05:34

Dr. Mike Patrick: All right. Well thank you for stopping by the studio and talking to us about baby safety stuff. It’s just a goldmine of information there and I think parents are going to need to back it up and maybe listen a couple of times to get all the information out of it. But we really appreciate you stopping by.

Dr. Sarah Denny: Thank you. Thank you. I know it’s a lot of information and I went through it quickly so I’m happy to provide any links or any additional information as needed.

Dr. Mike Patrick: Yeah. And we’ll get those links from you and put them in the Show Notes, people can find those. So this is episode 241 of PediaCast and you can find all those links in the Show Notes at pediacast.org. All right. Well again, thanks to Dr. Denny for stopping by. That does wrap up our presentation of baby basics and I’ll be back with the final word, right after this.

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01:06:49

All right, so I have a feeling this episode is going to go around the block a few times and I anticipate lots of new listeners for this show with a first time exposure to PediaCast. And so I wanted to tell as my final word this week just a little bit more about the program and give you just a touch of history and background so you’ll be up to speed and feel like family.

So we are a weekly podcast produced by Nationwide Children’s Hospital. We cover news parents can use, we answer listener questions, we interview pediatric experts. Our primary audience is parents but we have plenty of clinicians who are in the audience as well and we try to get a new show out every week. Usually they come out on Wednesdays.

In terms of where we’ve been, the show started back in 2006 and I was in a private practice at the time and sort of podcasting was a new thing and the vision was with a busy practice and you really don’t have a ton of time to spend in the examination room, but parents have a lot of questions and you don’t want to leave them hanging.

So if I could give the five-minute version of why your kid keeps getting ear infections in the exam room but I could say, hey, if you’re really interested in the pathophysiology of ear infections, of exactly what it is that’s happening and why your kid keeps getting them, check out PediaCast number whatever and I could give them a link and tell them you could listen to the half-hour version of ear infections instead of the quick five-minute version.

So that’s kind of how I got started the initial vision and it’s kind of morphed in to what it is today into this weekly program. So that’s where we’ve been and where we’re heading. Part of the effort here really though is to get your questions answered.

And so it’s easy to get a hold of me, just head over to pediacast.org and you can click on the Contact link and ask a question or suggest a show topic or point us in the direction of a news story that you think other parents will be interested in.

You can also email pediacast@gmail.com. And we also have a voice line at 347-404-KIDS that you can call in and leave a message for us that way. Again, that’s 347-404- K-I-D-S.

We’re also on Facebook, we’re on Twitter, we’re on Google+, we’re also on Pinterest. We have an Episodes board so you can repin your favorite episodes and share them that way. We also have a News Parents Can Use board where we have new stories that we don’t include in the podcast.

So we have a lot of like product recalls and really just interesting stories that I think you’d find but we just don’t have time to cover all of them in the weekly show. So you’ll find that all over at Pinterest.

All right. Well that’s a bit about the program, where we are, where we’re going.

Until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody!

[Music]

Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.

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