Cough, Development, and Teething – PediaCast 023

 

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Topics

  • Cough
  • Development
  • Hypothyroid
  • Teething

Announcer: This is PediaCast.

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[Music]

Announcer: Hello moms, dads, grand moms, grandpas, aunts and uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, the pediatric podcast for parents. And now, direct from Bird House Studios here's your host, Dr. Mike Patrick Jr.

00:00:43

Dr. Mike Patrick: Hello everyone and welcome to this week's edition of PediaCast, the pediatric podcast for parents. This is Dr. Mike coming to you from Bird's House Studio. And I'd like to welcome everyone to the program this week. Don't forget if you have a topic that you would like to address on PediaCast, it's really easy to get a hold of this, just go to pediacast.org and click on the contact link. You can also email me at mike@pediacast.org or call our phone in line at 347404KIDS that's 347404KIDS.

00:01:14

Alright, on the program this week we're going to discuss infants coughing at night time. Also we have a discussion on brain development and there were also throwing in a little talk about hypothyroid mothers and then some information on baby teething. That's all on this week's episode. Before we get started though, I just want to say I know it's been a little bit longer than I had wanted in terms of getting a PediaCast out and I apologize for that. I really, I'm going to try to be on a weekly schedule for you. I have to tell you in the office, it's been really busy. The last couple of weeks, not just with colds and flu but also when kids are on a break for the holidays a lot of parents get their well check-up scheduled.

00:01:56

So we sort of have a rush of well check-ups plus the colds and flu and ear infections and strep throat and things that all go along with this time of the year. So it's been really busy in the office plus then with the holidays that made it tough and I have a new toy that I'm making this podcast on. Actually making the switch from PC to Mac and I have to tell you so far I've been really pleased as punch with the Macintosh computer. I have a Mac book pro that was sort of a Christmas present. I got some the gift certificates from the Apple Store then I had to throw in a little cash on my own. But I'm really happy with it so far. In fact, this is the first time that I have used garage band to do a podcast.

00:02:34

But it has to take me a little walk; I've been spending some time getting all the ins and outs of the Apple rather than the PC. Alright, don't forget the information presented in PediaCast just for educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange for 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 at pediacast.org.

00:03:06

Okay, let's go ahead and move in to our first topic. This comes from Michelle in Athens, Illinois. And Michelle says, is there anything I can do to help relieve night time coughing? My 4-month old has an almost choking cough at night. He has a runny nose too so I imagined it's a post nasal drip. I used a cool mist humidifier in his room. He's not eating as much now either. Can I give him a bit of water to help him keep him hydrated? Love this podcast by the way, very informative.

00:03:35

Well thanks Michelle for your question. First I would say, any 4-month old with a persistent cough on are used to be seen by their doctors. So I would definitely give your doctor a phone call if you have a 4-month old who has a persistent cough. Now what can cause night time coughing in a 4-month old? Probably the most common thing is going to be viruses. You know the viruses cause a lot of mucus production. They typically last 7-10 days and you could have it last longer than that because if you had a virus that would just go and away and then your baby caught another virus, then you can have you know you can have 3 or 4 weeks of illness if you have 2 viruses sort of back to back like that. So that's definitely something to keep in mind.

00:04:20

Now in addition to viruses, even 4-months old can have allergies. And it's more likely to be whatever mom is allergic to at 4 months because you have to remember allergies are caused by antibodies. Your body is reacting to something in your system that it perceives as foreign and the antibodies are going to attack it and then that's what causes the allergic type symptoms.

00:04:43

So if you have a mom who's allergic to cat dander or molds or dust mites, those kinds of things in the house particularly this time of the year with a 4-month old and she passes those antibodies on to the baby they can have some allergic type reactions. Now if you have an infant who's a little bit older than 4 months but not quite, you know 9-12 months old, allergies on those kids are going to be a little bit less common because moms' immune system is sort of where and out and they have an early developed antibodies on their own yet.

00:05:18

So you don't see as quite as many allergic type reactions in kids but you know, sort of in middle infancy period compared to early infancy and then a little bit later on. You can also have allergies to food products and if you could go back to archives, we talked about that before so that can be allergic reactions to the milk, the gluttons because it's a 4-month old you started some cereals. So we eat glutton proteins, so those kind of going to cause some allergy type symptoms as well which could include the night time cough with that.

00:05:51

Certainly cigarette exposure could cause a night time cough so you want to make sure there is no cigarette smoke that your babies exposed to and we also have to talk about that in the previous episode. Keep in mind that if you spend your time smoking in one room, and Michelle I'm not saying you're a smoker remember that we are trying to give everybody information out there based on Michelle's question. So if you do smoke in one room of your house, keep in mind that the cigarette smoke is a gas and so gases are going to have a tendency to seek under cracks, you know under doors.

00:06:26

They basically spread themselves around out around the house even if you just started smoking on one room. And if you have a forced air vent you know the intake is certainly going to take some of that cigarette smoke and then spread it through the rest of the house through the heating duct. So you do have to be careful about that.

00:06:43

Also gastroesophageal reflux, now whether babies are actually spitting up or not. If you have a spitty baby then some stomach acid is likely to be coming up with the spit up. But even if you have a baby who doesn't actually vomit with their reflux they can still have some stomach acid that's sipping up, up the esophagus and then up into the upper ways especially when they're lying down flat at night and that acid can irritate the mucous membranes and the upper airway and can cause mucous production. So we do see a lot of kids with a chronic night time cough that if you treat their acid reflux with a medicine like Zantac, that kind of thing, there's other options available too.

00:07:23

But then you decrease the stomach acid that's coming up and they don't have quite so much of a problem with a runny nose and cough at night time. Heart disease can actually cause a night time cough, if you have any kind of heart disorder that can cause congestive heart failure even in babies and that causes some fluid build-up in the lungs and that could cause a night time cough as well.

00:07:43

And then upper airway abnormalities, sometimes you can get a baby that is born with a little connection between the trachea which is the breathing tube and the esophagus which is the swallow tube. And if you have a little fish chiller or a connection between those two, that's another place where some reflux can occur. Also food can actually come up from the stomach and they don't even spit up. But then the food can go through that little connection and into the airway and that can cause chronic cough as well.

00:08:11

So again, there are lot of different things that can cause a chronic cough especially a night time cough in a 4-month old infant. You really should see your doctor for that so that they can do a complete history and physical examination to try to figure it out. Now Michelle mentioned that the baby was also fussy and if you have a fussy baby with a runny nose and a cough you certainly think ear infections because chronic, not chronic but runny nose and cough that's been lasting for a little while, you know a few days, then you can get some mouth bacteria that go up the Eustachian tube, get trapped in the middle ear space because of the mucus from the virus and then they can end up with an ear infection. And often then they're going to have a fever and fussiness although they don't have to have the fever with it they do tend to usually be fussy though because ear infections hurt.

00:09:00

So if you have a fussy baby with those runny nose and congestion symptoms, definitely see your doctor because it could be an ear infection. If they are really fussy to the point that they are inconsolable you worry about meningitis and obviously you would want to let your doctor know. Anytime a baby is inconsolable right away. Now Michelle also mentioned, would it be a good idea to give him a bit of water to help keep him hydrated.

00:09:24

Water in babies is not needed. Remember that formula and breast milk are mostly water. So babies are getting plenty of water when they drink their formula and have their breast milk. Especially at 4 months, you really want him to get a lot of calories especially if they're fighting an infection like a virus or an ear infection. You want them to get their fats and their protein in the diet cause that's going to help their immune system function and you definitely want him to have a good nutrition.
00:09:49

So water is just going to fill their stomach up with some empty calories, the exception to that would be if you have a little bit of an older baby who seems to be hungry all the time and they're already overweight and you don't have a reflux issue with their spitting up then some water you know maybe helpful to some sort of time over until their next scheduled meal that wouldn't get them to many calories. But I wouldn't do that without talking to your doctor first because again generally babies don't need water they just need their formula or their breast milk which is mostly water.

00:10:26

Okay, so what do you do if you're 4-month old has a runny nose and congestion or that business? Well I did say already see your doctor but beyond that what's your doctor going to have you to do? Well they examine the baby and they determine issues to virus or even with the allergies. If it's allergies you know they're going to have you try to avoid whatever might be that's causing it. If it's something in the house that's dust mites or molds that may be difficult to do at 4 months. If it's cat dander you may have to get the cat to visit a relative for a little while.

00:10:56

And then the cigarette smoke you know best to smoke outside. But most of the times these are going to be viruses that are causing this so what can you do? Well as Michelle said, a humidifier in the bedroom cool mist is probably the best ones these days because if you have the other kids at home or if your 4-month gets a little bad older and he's moving around there's less of a risk with scolding if you do the cool mist type of humidifier where's the hot ones you don't need to worry about a little more.

00:11:23

So I think the cool mist one is a good thing to have. A humidifier on the bedroom will tend to help babies out who are coughing and having a runny nose at night. Now keep in mind with this cool mist ones that bacteria can grow in him so what you want to do is change the water pretty often and I would even every couple of days put a little bleach of water in there, and switch it around and then rinse it out really good just to keep the bacteria from growing in there.

00:11:47

The next thing you could do for babies is to get some saline nose drops like little noses or infant air AYR. Basically it's just salt water that's saline and made for babies, and just put a couple of drops on each nose and then suck it back out with the bulbs ringed. Keep in mind the bulbs syringe you want to get as deep as you can and to try to suck that mucus out. Basically what you're doing for your baby when you use the bulb syringed is blow their nose for warmth. I mean that's you sucking out the mucus.
00:12:18

So you want to do it fairly often, not so often that you're causing more irritation and swellness which can lead to more difficulty breathing. But you know they may need it to be done every you know, when it's really bad. Maybe every half hour to every hour you have to get a little bit of mucus out but if you notice it's their nose is trying to get a little swollen inside then you know back off a little bit on that.

00:12:38

Also I would say that if they're a little snort but you see that they're smiling, and then they're comfortable, you know, you don't have to suck him out if their congestion is bothering you listening to it more than it seems to be bothering them. Yet it may be best to leave it alone to be honest with you, I think if it seems like you know, they're not really happy and you think the congestion maybe plain or roll then that would be the time to use your salt water nose drops then suck it back out.

00:13:05

Now what about cough and colds medicines for infants? You know babies who are under 6 months of age and then even to a degree, the ones who are 6-12 months of age, cough and colds medicines probably don't help all that much. You know they decrease the amount of mucus production but keep in mind when you think about how small the upper nasal passages are in a baby, it doesn't take much mucus to clog them off. So if you even got rid of half the mucus from a cough and cold medicine, in an older kid, that may make a difference for him. But for a little baby you know even if you get rid of half the mucus their airways are so small that the amount of mucus that's left is probably still going to cause quite a bit of congestion plus then you get all the side effects to worry about.

00:13:47

You know the anti histamines you run the risk of making him so tired that they forget to breathe. They can have some breathing issues if you use antihistamine medicines for some kids who are sensitive to that. And then the pseudo fed and those sort of derivatives of medicines to keep babies up and can make him irritable so they're not stuffy anymore. But now they're right away crying and wanting you to come and pick him up. So they tend to just causes many, they either don't help or cause problems, you know they fix a problem but then create another one.

00:14:21

Now having said that, if you have a 4-month old at home and your doctor says, Hey try XYZ medicine and they have experienced with it and it seems to work and you trust your doctor and you give it to him and it really does seem to help you know, then that's between you and your doctor. So all doctors do a little bit differently for me, you know a baby who is less than a 6 months of age who has a stuffy nose, usually that's stuffy nose is bothering mom or dad more than its bothering the baby and that's probably not worth doing much especially the humidifier and sucking out that's not.

00:14:52

So that's my opinion. Okay let's go ahead and move on to the next question. This one comes from I think its Lisa, maybe it's like L I C A and she is in Corvallis, Oregon. So I'd like to thank you for writing into us. She says, first I'd like to thank you for the wonderful podcast you're producing. I like the podcast because it is very informative and they sound science. I would like to hear more about developing infant brains and intelligence because I've seen a lot of controversy on the subject, also what is your take on the methods promoted by the institute for the development of human potential to enhance baby intelligence then she says, thank you!

00:15:34

Well thank you for your question. First I want to say, the brain development in infants you know, is going to definitely be a complex interaction between genetics and environment. Once the baby is born, you don't know much that you can do about the genetic component right? You get what you got. You have the genetic potential that you're born with depending on who the mom and the dad is.

00:15:58

So really all you have to work with in terms of trying to develop your infant's intelligence. It's going to be their environment. And I think right from the time that the baby is inside of mom you know stimulating the senses as much as you can is going to be important. Now in terms of what you can do when they're inside you know, playing music, because they can hear through the skin, through the amniotic fluid. So exposing them to a wide range of music, reading out loud, you know touch, you know on the belly, you're really just stimulating all of their senses as much as you can.

00:16:33

And then continuing that just as often as you can after they're born you know with sight young babies are most responsive to high contrasting colors and bright, you know like blacks and whites together and then break primary colors. Not so interested it seems in the past though and lighter colors. So you definitely wanted to give him lots of opportunity to see different patterns and colors, sound a wide range of music is a great idea, reading to him as we mentioned with taste. You know at first, when they're really young, they're just going to get their breast milk or their formula.

00:17:08

But as they're starting with the cereals in the stage 1 and then into the stage 2 baby foods, you know introduce him to a whole variety of foods you know right from the get go. You know in a slow step wise fashion at once or about 4-6 months of age or so with the salad foods. Also different textures you want him to, on their skin let them feel different, you know smooth, rough, felt, you know just all sorts of experiences. And what about the smell, well you know if you're cooking in the kitchen, put him in their little baby seat, on the floor with you, just be careful you know if your moving hot water from the stove to the sink or something like that.

00:17:46

But certainly exposing them to a wide range of smell is going to be important as well. I think you know the more stimulation the better in terms of the different senses that you're involving as often as you can do it and as long of a period of time as you can do it. I really think that the babies whose parents spend the most time with them are going to have better brain development than babies who are just sort of isolated and by themselves most of the day, or you know not getting any attention or stimulation of their senses.

00:18:17

Now, do I have any research to back that up? No, there are a lot of research studies looking into this but this is one of those cases where it is difficult to judge potential intelligence based on stimulation because there's so many other factors that can be involved with this sort of thing. So for instance if you have a baby you know, who is not being stimulated very often, who are the parents who are less likely to stimulate their kids? I mean which ones, or put them in their crib and then maybe they're watching TV all day, or they're just, they're not interested in their baby which they maybe didn't have a baby to begin with whereas people who are more into their baby typically are going to be that kind of person who is want to give them all that stimulation.

00:19:07

Now the fact that they give him all the stimulation is that what made the baby end up being smarter or are smarter people more in tune with needing to give their baby's stimulation and so really was more of a genetic issue you know, it's so hard to know. I think your best bet is just to give him as much stimulation as you can plus you're going to enjoy yourself and improve the bonding between you and your baby.

00:19:32

Now in terms of the institute for the development of human potential, I'm not quite sure what you're talking about with that. I did a web search and found several places with that sort of name. The one that had that exact name did not seem like it was a sight that had anything to do with research on baby brain development. There was one, that was the institute for the achievement of human potential but that one looked at helping children after traumatic head injuries, improve their quality of life and that one didn't have apparently, there are some controversial methods that they have in terms of helping kids who've had head injuries.

00:20:08

But I didn't find one that was specifically looking at infant so I would just say that if you have a website, you wanted me to look at and give me the actual link so I can take a look and tell you what I think about it. But it wasn't quite sure exactly Lisa which one that you were talking about.

00:20:24

Alright our next question is kind of goes along with the same train of thought. This one comes from Karen in Belleville, Illinois and she says I was recently diagnosed with hypothyroid. I suspect that I probably have while I was pregnant as well. What if any would the effects are of my 4-month old son? Thanks!

00:20:43

Well Karen thanks for your question. It sort of goes along with the intelligence thing because one of the things that maternal hypothyroidism during early pregnancy can result in is fat that that can resolve lower cognitive development or a decrease IQ points. Now let me just say first so Karen, before you get upset about that, if your 4-month old but you know now is growing well seems to be meeting development on milestone, appears to be healthy, you really probably have a little to worry about. I mean the effects of hypothyroidism during pregnancy on the baby, if it's major hypothyroidism I think those are the kids who are more likely to have brain issues and to be honest, a lot of those babies end up in the fetal demise and still birth and spontaneous abortions.

00:21:32

So I mean if there's a major hypothyroidism that's when you have to worry about those things. Now less is known about sort of mild hypothyroidism. And there have been again some studies that show that maternal hypothyroidism during early pregnancy can be associated with lower cognitive development or IQ points or smartness. But you know again, is this studio effect to the thyroid? You know the minor ones or you know are more complex as she's involved because our hypothyroid moms, maybe a mom who's not being treated for their hypothyroidism since they go to the doctor less, they haven't had their hypothyroidism found out about, maybe they had poor prenatal care, perhaps they have poor nutrition.

00:22:18

Are these moms most been less likely to give their kids that the stimulation that they need during infancy. So is it again because you have a hypothyroid mom who was more likely to be hypothyroid because she didn't know about her own lesson and what kind of socioeconomic background does she come from and how does she stimulate her baby is that what caused a decrease in cognitive functioning or is it because of the actual mild hypothyroid illness that was there.

00:22:46

So it's tough, I say, you know, environments kind of play a big role as long as your baby seems to be healthy and developing well and their thyroid is fine which should have been checked with the newborn screen by your state and your doctor knows that you had hypothyroidism during pregnancy. You know there's not a lot you can do about it, other than to continue to give him lots of stimulation, you know watch for developmental problems as you go along but not get to be worried about it.

00:23:11

You know I have a friend, who was a 28-week premature baby back in the 1960's and many of these kids back then died. I mean they didn't have the surfactants that we used today and they didn't have prenatal intensive care units with trained neurologist all over the place. And lots of these babies died, a lot of them have low oxygen to their brain and really they would expect it to have poor cognitive development because of these problems right after the time that they're born. This is again back in the 60's with the 28-week preemie now of course today with the 28-week preemie you know you can expect him do very well but back in the 60's that wasn't the case.

00:23:51

Well my friend who was a 28-week preemie back in the 60's. He went on to medical school and he's now practicing physician. So I mean you can't look at any set of particular circumstances and say, Oh my kids are not going to do so well. I mean you do just everything you can today to stimulate your kids and let nature take its course.

00:24:11

Okay, we're going to move on to our last topic of this week's PediaCast. This has to do with infant teething. This comes from Shana in Winterville, Georgia and she says I have a 4-month old son; this is our 4-month old episode, did it? I just realized that I mean I did the show for you know wrote down these questions and type out my responses I just realized they are all 4-months old.

00:24:34

I mean the bulk doing a side here real quick. The bulk of questions that you folks are sending in which I've gotten so many of them and I'm trying to get the just as many of them as I can but please do be patient with me. Most, the vast majority of them are baby questions, I think that's probably because the younger parents are the ones who are listening to podcast. So if you have teenagers out there and you're listening to podcast and have a question, of course there's also the new mom and dad's syndrome too you just have lot more questions.

00:25:03

So I do want to make this an interesting program for parents who have kids of all ages. So if you have older child or teenager, please feel free to ask questions. Of course if you have baby at home, still ask away and we'll try to get everybody.

00:25:14

So Shana says I have a 4-month old son who is starting to show science of teething. What is the best way to relieve teething pain in babies and thanks for your show? Okay well Shana, let's talk about teething. First, you know what are the signs of teething? You know the traditional thoughts are, my baby's starting to teeth when they're sticking things into their mouth, their drooling, they're fussy, maybe not wanting to sleep as much, or they have a little great fever. But is that really teething?

00:25:40

Because you know we've seen many babies in the office who are doing those same things even if they are not really teething because babies have a need to suck, they're going to put things in their mouth, they're going to put their hands in their mouth, all babies are going to be drooling whether they have a tooth coming or not.

00:25:55

Fussiness you know can be from many things that can be from pain, they can have an ear infection, that could be hunger, could just be boredom, cuddle fashion colic; you know lots of things can cause fussiness in an infant. And as babies get older, they tend to sleep less, and learn how to play the system. You know they're going to cry and then you'll come, you hold him and pick him up and you put him down, they cry again. Is that mean they're teething or is that mean that they're learning if I cry, mom comes to get me and I don't have to be in the room all by myself.

00:26:22

Also keep in mind that fever in babies is really not until it's a 100.5 degrees Fahrenheit rectally so if you have a 99 degree fever and the baby who's drooling and kind of fussy, does that mean that their teething? Maybe not you know a 100 or 99 temperatures maybe normal for your baby. All babies are going to drool and maybe they're fussy because they're hungry or because they want to be picked up.

00:26:50

So it's really hard to know whether a set of symptoms is really going to be whether you can blame it in teething or not. I do want to say one of the thing about the temperature, you know if you, and I say this because one of, when I see kids for well check-up, you can see a kid who's healthy as can be and they can be a 100 degrees even.

00:27:09

So keep in mind in a 100.5 rectally is the definition of a fever in an infant. So 99 is not a little great fever, 99 can be normal of course when your child's sick you take the temperature and you'd see it's 99 but if you took your baby's temperature throughout the day when they're feeling well you'd probably find that they're hitting 99 in a cyclic sort of pattern anyway. So keep in mind 100.5 is fever and teething is not been showing to cause a fevers in babies. If they have a fever of a 100.5 or more you got to look for other causes and not blame it on teething.

00:27:44

So when do kids teeth? Well you know for most kids, their first tooth is going to come when they're about 6 months old. You know the range can be from 3-4 months to over 12 months, so there's a huge range of when it can happen as it turned out both of my pretty little kids late bloomers. My daughter was actually about 13 months old before she had her first tooth. And my son was probably about 10 or 11 months old, somewhere around there. Do I see kids in the office, who are 3 or 4 months who are getting their first tooth?

00:28:12

Yeah it's a little unusual, I mean for most kids it's going to be close to around 6 months of age when they're getting their first one. In terms of what order do they come in. You know the most common first ones are going to be in the middle of the gums on the bottom, so one of those middle incisors on the bottom is the most likely the tooth that's going to pop through first. But you know that is not all kids follow the real books and there can be a great range of normal in terms of what order they come in as well as when they come.

00:28:42

So what do you do let's say you do think that your baby is a little bit fussy because they're teething, what can you do about it? Well of course talk to your doctor and you do want to make sure it is teething. If you have a baby who's persistently fussing or drooling, or what seems for you to be excessive amount, there are certainly other medical things, some of them are even urgent that you really need to see your doctor. So they can make sure that it is just a teething pain and then nothing else.

00:29:05

So let's say you do that and you see your doctor, everything's fine, they think it really is a teething is the issue; you can give infant Talon oil as they needed for pain. And if you're unsure about those, call your doctor. Morton is probably a little bit better for pain control in my opinion. If your baby's over 6 months of age and he's teething and that's just because Morton is an anti inflammatory drug. So if you figure there's a little inflammation involved with the tooth, popping up to the gum, the Morton's going to help with the inflammation that's there causing some of the pain or Tylenol's not going to do quite as good as to the job, Morton would because Tylenol is not in the anti inflammatory medicine.

00:29:46

No aspirins. So we don't use aspirin in babies unless your doctor tells you too. There are some diseases where kids would need some aspirin as prescribed by a physician but in general, no aspirin for kids these days because of the fear of Rye's syndrome with some particular viruses, so you don't want to do that.

00:30:09

Also a gum massage, you know if you wash your hands and just use a finger and massage the gums, that may help. Also something that's cold, you don't want to use direct ice but you know a teething ring that's been cooled briefly in the freezer or in the refrigerator for a little bit may help with the teething issues. You don't want to get anything that can choke on you know a part of parents to putting vegetables, like a carrot in a freezer and freezing it and giving it to their baby, not a good idea. A little piece of the carrot can pop and they could choke on it. So you don't want to give him anything that they could possibly choke on.

00:30:47

And of course anytime that you've been given your baby something because of teething like a cool teething ring you want to make sure you're there and supervising him. What about infant oral gel and Anbesol, you know for some kids they can help, for others it seem to bother them more. You want to use them sparingly because you can overdose on those that can cause some blood issues.

00:31:11

So you want to make sure that you don't use them, you don't want to overdose with oral gel or Anbesol. Again it's a sort of a last resort of the Tylenol that seems to be working or the massage, or the cool teething ring, that kind of thing.

00:31:23

Talk to your doctor about it because you know some people have strong opinions either way on those kinds of products. So again, you know are they really upset because of teething, you know the fussiness is persisting make sure you see your doctor because it could be an ear infection, an acid reflux or just a good old fashioned colic.

00:31:40

Alright Shana I hope that helped with answering your questions about teething. Your 4-month old could be teething you know babies who are having those kinds of symptoms though may not be teething and I think you're going to know when you see the whites of this, the white of the teeth popping out through the gums.

00:31:56

Okay well we've reached our half an hour remark. I'd like to thank everyone for tuning into this week's PediaCast. Once again I apologize that it took a little bit of longer than normal to get the episode out. I do apologize for that. I'll try to be a little more punctual in the future but I did have some folks write in saying, you're still doing this and when is the next ones coming out? So I do appreciate all your support and thanks to all the listeners out there.

00:32:20

Also thanks to my family for putting up with me and allowing me to get a Mac book pro! So thanks for that, it's been a lot of fun. Also thanks vladstudio for allowing us to use his artwork on our website. Don't forget you can submit a question or a comment, view the show notes, take our listeners survey, sign up for our news letter and read our blog at pediacast.org. And if you like PediaCast please spread the word by telling your friends, relatives and neighbors about our program. You can download free promotional materials on the poster page of our website. Reviews in iTunes are most helpful. And actually there's a new thing now to a dig, D I G G digg.com. They have a new podcast directory. So if you'd go to dig and then click on the podcast link and then search for PediaCast, you'll find this and you can dig some of our articles, or some of our episodes I should say. And the more digs we get, the more people will hear about PediaCast, so please go to dig and look there.

00:33:18

Also there's a link to podcast pickle, they just wiped out all of the favorites, and the votes as they do each January and July. So if you go to podcast pickle and search for PediaCast and then put us down as one of your favorites that would be helpful as well, or you can go to pediacast.org and we do have a link to the podcast pickle page from there.

00:33:42

Alright, so enough of this self-plugging, until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids, so on everybody.
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Announcer: This is PediaCast.

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Announcer: Hello moms, dads, grand moms, grandpas, aunts and uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, the pediatric podcast for parents. And now, direct from Bird House Studios here's your host, Dr. Mike Patrick Jr.

00:00:43

Dr. Mike Patrick: Hello everyone and welcome to this week's edition of PediaCast, the pediatric podcast for parents. This is Dr. Mike coming to you from Bird's House Studio. And I'd like to welcome everyone to the program this week. Don't forget if you have a topic that you would like to address on PediaCast, it's really easy to get a hold of this, just go to pediacast.org and click on the contact link. You can also email me at mike@pediacast.org or call our phone in line at 347404KIDS that's 347404KIDS.

00:01:14

Alright, on the program this week we're going to discuss infants coughing at night time. Also we have a discussion on brain development and there were also throwing in a little talk about hypothyroid mothers and then some information on baby teething. That's all on this week's episode. Before we get started though, I just want to say I know it's been a little bit longer than I had wanted in terms of getting a PediaCast out and I apologize for that. I really, I'm going to try to be on a weekly schedule for you. I have to tell you in the office, it's been really busy. The last couple of weeks, not just with colds and flu but also when kids are on a break for the holidays a lot of parents get their well check-up scheduled.

00:01:56

So we sort of have a rush of well check-ups plus the colds and flu and ear infections and strep throat and things that all go along with this time of the year. So it's been really busy in the office plus then with the holidays that made it tough and I have a new toy that I'm making this podcast on. Actually making the switch from PC to Mac and I have to tell you so far I've been really pleased as punch with the Macintosh computer. I have a Mac book pro that was sort of a Christmas present. I got some the gift certificates from the Apple Store then I had to throw in a little cash on my own. But I'm really happy with it so far. In fact, this is the first time that I have used garage band to do a podcast.

00:02:34

But it has to take me a little walk; I've been spending some time getting all the ins and outs of the Apple rather than the PC. Alright, don't forget the information presented in PediaCast just for educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange for 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 at pediacast.org.

00:03:06

Okay, let's go ahead and move in to our first topic. This comes from Michelle in Athens, Illinois. And Michelle says, is there anything I can do to help relieve night time coughing? My 4-month old has an almost choking cough at night. He has a runny nose too so I imagined it's a post nasal drip. I used a cool mist humidifier in his room. He's not eating as much now either. Can I give him a bit of water to help him keep him hydrated? Love this podcast by the way, very informative.

00:03:35

Well thanks Michelle for your question. First I would say, any 4-month old with a persistent cough on are used to be seen by their doctors. So I would definitely give your doctor a phone call if you have a 4-month old who has a persistent cough. Now what can cause night time coughing in a 4-month old? Probably the most common thing is going to be viruses. You know the viruses cause a lot of mucus production. They typically last 7-10 days and you could have it last longer than that because if you had a virus that would just go and away and then your baby caught another virus, then you can have you know you can have 3 or 4 weeks of illness if you have 2 viruses sort of back to back like that. So that's definitely something to keep in mind.

00:04:20

Now in addition to viruses, even 4-months old can have allergies. And it's more likely to be whatever mom is allergic to at 4 months because you have to remember allergies are caused by antibodies. Your body is reacting to something in your system that it perceives as foreign and the antibodies are going to attack it and then that's what causes the allergic type symptoms.

00:04:43

So if you have a mom who's allergic to cat dander or molds or dust mites, those kinds of things in the house particularly this time of the year with a 4-month old and she passes those antibodies on to the baby they can have some allergic type reactions. Now if you have an infant who's a little bit older than 4 months but not quite, you know 9-12 months old, allergies on those kids are going to be a little bit less common because moms' immune system is sort of where and out and they have an early developed antibodies on their own yet.

00:05:18

So you don't see as quite as many allergic type reactions in kids but you know, sort of in middle infancy period compared to early infancy and then a little bit later on. You can also have allergies to food products and if you could go back to archives, we talked about that before so that can be allergic reactions to the milk, the gluttons because it's a 4-month old you started some cereals. So we eat glutton proteins, so those kind of going to cause some allergy type symptoms as well which could include the night time cough with that.

00:05:51

Certainly cigarette exposure could cause a night time cough so you want to make sure there is no cigarette smoke that your babies exposed to and we also have to talk about that in the previous episode. Keep in mind that if you spend your time smoking in one room, and Michelle I'm not saying you're a smoker remember that we are trying to give everybody information out there based on Michelle's question. So if you do smoke in one room of your house, keep in mind that the cigarette smoke is a gas and so gases are going to have a tendency to seek under cracks, you know under doors.

00:06:26

They basically spread themselves around out around the house even if you just started smoking on one room. And if you have a forced air vent you know the intake is certainly going to take some of that cigarette smoke and then spread it through the rest of the house through the heating duct. So you do have to be careful about that.

00:06:43

Also gastroesophageal reflux, now whether babies are actually spitting up or not. If you have a spitty baby then some stomach acid is likely to be coming up with the spit up. But even if you have a baby who doesn't actually vomit with their reflux they can still have some stomach acid that's sipping up, up the esophagus and then up into the upper ways especially when they're lying down flat at night and that acid can irritate the mucous membranes and the upper airway and can cause mucous production. So we do see a lot of kids with a chronic night time cough that if you treat their acid reflux with a medicine like Zantac, that kind of thing, there's other options available too.

00:07:23

But then you decrease the stomach acid that's coming up and they don't have quite so much of a problem with a runny nose and cough at night time. Heart disease can actually cause a night time cough, if you have any kind of heart disorder that can cause congestive heart failure even in babies and that causes some fluid build-up in the lungs and that could cause a night time cough as well.

00:07:43

And then upper airway abnormalities, sometimes you can get a baby that is born with a little connection between the trachea which is the breathing tube and the esophagus which is the swallow tube. And if you have a little fish chiller or a connection between those two, that's another place where some reflux can occur. Also food can actually come up from the stomach and they don't even spit up. But then the food can go through that little connection and into the airway and that can cause chronic cough as well.

00:08:11

So again, there are lot of different things that can cause a chronic cough especially a night time cough in a 4-month old infant. You really should see your doctor for that so that they can do a complete history and physical examination to try to figure it out. Now Michelle mentioned that the baby was also fussy and if you have a fussy baby with a runny nose and a cough you certainly think ear infections because chronic, not chronic but runny nose and cough that's been lasting for a little while, you know a few days, then you can get some mouth bacteria that go up the Eustachian tube, get trapped in the middle ear space because of the mucus from the virus and then they can end up with an ear infection. And often then they're going to have a fever and fussiness although they don't have to have the fever with it they do tend to usually be fussy though because ear infections hurt.

00:09:00

So if you have a fussy baby with those runny nose and congestion symptoms, definitely see your doctor because it could be an ear infection. If they are really fussy to the point that they are inconsolable you worry about meningitis and obviously you would want to let your doctor know. Anytime a baby is inconsolable right away. Now Michelle also mentioned, would it be a good idea to give him a bit of water to help keep him hydrated.

00:09:24

Water in babies is not needed. Remember that formula and breast milk are mostly water. So babies are getting plenty of water when they drink their formula and have their breast milk. Especially at 4 months, you really want him to get a lot of calories especially if they're fighting an infection like a virus or an ear infection. You want them to get their fats and their protein in the diet cause that's going to help their immune system function and you definitely want him to have a good nutrition.
00:09:49

So water is just going to fill their stomach up with some empty calories, the exception to that would be if you have a little bit of an older baby who seems to be hungry all the time and they're already overweight and you don't have a reflux issue with their spitting up then some water you know maybe helpful to some sort of time over until their next scheduled meal that wouldn't get them to many calories. But I wouldn't do that without talking to your doctor first because again generally babies don't need water they just need their formula or their breast milk which is mostly water.

00:10:26

Okay, so what do you do if you're 4-month old has a runny nose and congestion or that business? Well I did say already see your doctor but beyond that what's your doctor going to have you to do? Well they examine the baby and they determine issues to virus or even with the allergies. If it's allergies you know they're going to have you try to avoid whatever might be that's causing it. If it's something in the house that's dust mites or molds that may be difficult to do at 4 months. If it's cat dander you may have to get the cat to visit a relative for a little while.

00:10:56

And then the cigarette smoke you know best to smoke outside. But most of the times these are going to be viruses that are causing this so what can you do? Well as Michelle said, a humidifier in the bedroom cool mist is probably the best ones these days because if you have the other kids at home or if your 4-month gets a little bad older and he's moving around there's less of a risk with scolding if you do the cool mist type of humidifier where's the hot ones you don't need to worry about a little more.

00:11:23

So I think the cool mist one is a good thing to have. A humidifier on the bedroom will tend to help babies out who are coughing and having a runny nose at night. Now keep in mind with this cool mist ones that bacteria can grow in him so what you want to do is change the water pretty often and I would even every couple of days put a little bleach of water in there, and switch it around and then rinse it out really good just to keep the bacteria from growing in there.

00:11:47

The next thing you could do for babies is to get some saline nose drops like little noses or infant air AYR. Basically it's just salt water that's saline and made for babies, and just put a couple of drops on each nose and then suck it back out with the bulbs ringed. Keep in mind the bulbs syringe you want to get as deep as you can and to try to suck that mucus out. Basically what you're doing for your baby when you use the bulb syringed is blow their nose for warmth. I mean that's you sucking out the mucus.
00:12:18

So you want to do it fairly often, not so often that you're causing more irritation and swellness which can lead to more difficulty breathing. But you know they may need it to be done every you know, when it's really bad. Maybe every half hour to every hour you have to get a little bit of mucus out but if you notice it's their nose is trying to get a little swollen inside then you know back off a little bit on that.

00:12:38

Also I would say that if they're a little snort but you see that they're smiling, and then they're comfortable, you know, you don't have to suck him out if their congestion is bothering you listening to it more than it seems to be bothering them. Yet it may be best to leave it alone to be honest with you, I think if it seems like you know, they're not really happy and you think the congestion maybe plain or roll then that would be the time to use your salt water nose drops then suck it back out.

00:13:05

Now what about cough and colds medicines for infants? You know babies who are under 6 months of age and then even to a degree, the ones who are 6-12 months of age, cough and colds medicines probably don't help all that much. You know they decrease the amount of mucus production but keep in mind when you think about how small the upper nasal passages are in a baby, it doesn't take much mucus to clog them off. So if you even got rid of half the mucus from a cough and cold medicine, in an older kid, that may make a difference for him. But for a little baby you know even if you get rid of half the mucus their airways are so small that the amount of mucus that's left is probably still going to cause quite a bit of congestion plus then you get all the side effects to worry about.

00:13:47

You know the anti histamines you run the risk of making him so tired that they forget to breathe. They can have some breathing issues if you use antihistamine medicines for some kids who are sensitive to that. And then the pseudo fed and those sort of derivatives of medicines to keep babies up and can make him irritable so they're not stuffy anymore. But now they're right away crying and wanting you to come and pick him up. So they tend to just causes many, they either don't help or cause problems, you know they fix a problem but then create another one.

00:14:21

Now having said that, if you have a 4-month old at home and your doctor says, Hey try XYZ medicine and they have experienced with it and it seems to work and you trust your doctor and you give it to him and it really does seem to help you know, then that's between you and your doctor. So all doctors do a little bit differently for me, you know a baby who is less than a 6 months of age who has a stuffy nose, usually that's stuffy nose is bothering mom or dad more than its bothering the baby and that's probably not worth doing much especially the humidifier and sucking out that's not.

00:14:52

So that's my opinion. Okay let's go ahead and move on to the next question. This one comes from I think its Lisa, maybe it's like L I C A and she is in Corvallis, Oregon. So I'd like to thank you for writing into us. She says, first I'd like to thank you for the wonderful podcast you're producing. I like the podcast because it is very informative and they sound science. I would like to hear more about developing infant brains and intelligence because I've seen a lot of controversy on the subject, also what is your take on the methods promoted by the institute for the development of human potential to enhance baby intelligence then she says, thank you!

00:15:34

Well thank you for your question. First I want to say, the brain development in infants you know, is going to definitely be a complex interaction between genetics and environment. Once the baby is born, you don't know much that you can do about the genetic component right? You get what you got. You have the genetic potential that you're born with depending on who the mom and the dad is.

00:15:58

So really all you have to work with in terms of trying to develop your infant's intelligence. It's going to be their environment. And I think right from the time that the baby is inside of mom you know stimulating the senses as much as you can is going to be important. Now in terms of what you can do when they're inside you know, playing music, because they can hear through the skin, through the amniotic fluid. So exposing them to a wide range of music, reading out loud, you know touch, you know on the belly, you're really just stimulating all of their senses as much as you can.

00:16:33

And then continuing that just as often as you can after they're born you know with sight young babies are most responsive to high contrasting colors and bright, you know like blacks and whites together and then break primary colors. Not so interested it seems in the past though and lighter colors. So you definitely wanted to give him lots of opportunity to see different patterns and colors, sound a wide range of music is a great idea, reading to him as we mentioned with taste. You know at first, when they're really young, they're just going to get their breast milk or their formula.

00:17:08

But as they're starting with the cereals in the stage 1 and then into the stage 2 baby foods, you know introduce him to a whole variety of foods you know right from the get go. You know in a slow step wise fashion at once or about 4-6 months of age or so with the salad foods. Also different textures you want him to, on their skin let them feel different, you know smooth, rough, felt, you know just all sorts of experiences. And what about the smell, well you know if you're cooking in the kitchen, put him in their little baby seat, on the floor with you, just be careful you know if your moving hot water from the stove to the sink or something like that.

00:17:46

But certainly exposing them to a wide range of smell is going to be important as well. I think you know the more stimulation the better in terms of the different senses that you're involving as often as you can do it and as long of a period of time as you can do it. I really think that the babies whose parents spend the most time with them are going to have better brain development than babies who are just sort of isolated and by themselves most of the day, or you know not getting any attention or stimulation of their senses.

00:18:17

Now, do I have any research to back that up? No, there are a lot of research studies looking into this but this is one of those cases where it is difficult to judge potential intelligence based on stimulation because there's so many other factors that can be involved with this sort of thing. So for instance if you have a baby you know, who is not being stimulated very often, who are the parents who are less likely to stimulate their kids? I mean which ones, or put them in their crib and then maybe they're watching TV all day, or they're just, they're not interested in their baby which they maybe didn't have a baby to begin with whereas people who are more into their baby typically are going to be that kind of person who is want to give them all that stimulation.

00:19:07

Now the fact that they give him all the stimulation is that what made the baby end up being smarter or are smarter people more in tune with needing to give their baby's stimulation and so really was more of a genetic issue you know, it's so hard to know. I think your best bet is just to give him as much stimulation as you can plus you're going to enjoy yourself and improve the bonding between you and your baby.

00:19:32

Now in terms of the institute for the development of human potential, I'm not quite sure what you're talking about with that. I did a web search and found several places with that sort of name. The one that had that exact name did not seem like it was a sight that had anything to do with research on baby brain development. There was one, that was the institute for the achievement of human potential but that one looked at helping children after traumatic head injuries, improve their quality of life and that one didn't have apparently, there are some controversial methods that they have in terms of helping kids who've had head injuries.

00:20:08

But I didn't find one that was specifically looking at infant so I would just say that if you have a website, you wanted me to look at and give me the actual link so I can take a look and tell you what I think about it. But it wasn't quite sure exactly Lisa which one that you were talking about.

00:20:24

Alright our next question is kind of goes along with the same train of thought. This one comes from Karen in Belleville, Illinois and she says I was recently diagnosed with hypothyroid. I suspect that I probably have while I was pregnant as well. What if any would the effects are of my 4-month old son? Thanks!

00:20:43

Well Karen thanks for your question. It sort of goes along with the intelligence thing because one of the things that maternal hypothyroidism during early pregnancy can result in is fat that that can resolve lower cognitive development or a decrease IQ points. Now let me just say first so Karen, before you get upset about that, if your 4-month old but you know now is growing well seems to be meeting development on milestone, appears to be healthy, you really probably have a little to worry about. I mean the effects of hypothyroidism during pregnancy on the baby, if it's major hypothyroidism I think those are the kids who are more likely to have brain issues and to be honest, a lot of those babies end up in the fetal demise and still birth and spontaneous abortions.

00:21:32

So I mean if there's a major hypothyroidism that's when you have to worry about those things. Now less is known about sort of mild hypothyroidism. And there have been again some studies that show that maternal hypothyroidism during early pregnancy can be associated with lower cognitive development or IQ points or smartness. But you know again, is this studio effect to the thyroid? You know the minor ones or you know are more complex as she's involved because our hypothyroid moms, maybe a mom who's not being treated for their hypothyroidism since they go to the doctor less, they haven't had their hypothyroidism found out about, maybe they had poor prenatal care, perhaps they have poor nutrition.

00:22:18

Are these moms most been less likely to give their kids that the stimulation that they need during infancy. So is it again because you have a hypothyroid mom who was more likely to be hypothyroid because she didn't know about her own lesson and what kind of socioeconomic background does she come from and how does she stimulate her baby is that what caused a decrease in cognitive functioning or is it because of the actual mild hypothyroid illness that was there.

00:22:46

So it's tough, I say, you know, environments kind of play a big role as long as your baby seems to be healthy and developing well and their thyroid is fine which should have been checked with the newborn screen by your state and your doctor knows that you had hypothyroidism during pregnancy. You know there's not a lot you can do about it, other than to continue to give him lots of stimulation, you know watch for developmental problems as you go along but not get to be worried about it.

00:23:11

You know I have a friend, who was a 28-week premature baby back in the 1960's and many of these kids back then died. I mean they didn't have the surfactants that we used today and they didn't have prenatal intensive care units with trained neurologist all over the place. And lots of these babies died, a lot of them have low oxygen to their brain and really they would expect it to have poor cognitive development because of these problems right after the time that they're born. This is again back in the 60's with the 28-week preemie now of course today with the 28-week preemie you know you can expect him do very well but back in the 60's that wasn't the case.

00:23:51

Well my friend who was a 28-week preemie back in the 60's. He went on to medical school and he's now practicing physician. So I mean you can't look at any set of particular circumstances and say, Oh my kids are not going to do so well. I mean you do just everything you can today to stimulate your kids and let nature take its course.

00:24:11

Okay, we're going to move on to our last topic of this week's PediaCast. This has to do with infant teething. This comes from Shana in Winterville, Georgia and she says I have a 4-month old son; this is our 4-month old episode, did it? I just realized that I mean I did the show for you know wrote down these questions and type out my responses I just realized they are all 4-months old.

00:24:34

I mean the bulk doing a side here real quick. The bulk of questions that you folks are sending in which I've gotten so many of them and I'm trying to get the just as many of them as I can but please do be patient with me. Most, the vast majority of them are baby questions, I think that's probably because the younger parents are the ones who are listening to podcast. So if you have teenagers out there and you're listening to podcast and have a question, of course there's also the new mom and dad's syndrome too you just have lot more questions.

00:25:03

So I do want to make this an interesting program for parents who have kids of all ages. So if you have older child or teenager, please feel free to ask questions. Of course if you have baby at home, still ask away and we'll try to get everybody.

00:25:14

So Shana says I have a 4-month old son who is starting to show science of teething. What is the best way to relieve teething pain in babies and thanks for your show? Okay well Shana, let's talk about teething. First, you know what are the signs of teething? You know the traditional thoughts are, my baby's starting to teeth when they're sticking things into their mouth, their drooling, they're fussy, maybe not wanting to sleep as much, or they have a little great fever. But is that really teething?

00:25:40

Because you know we've seen many babies in the office who are doing those same things even if they are not really teething because babies have a need to suck, they're going to put things in their mouth, they're going to put their hands in their mouth, all babies are going to be drooling whether they have a tooth coming or not.

00:25:55

Fussiness you know can be from many things that can be from pain, they can have an ear infection, that could be hunger, could just be boredom, cuddle fashion colic; you know lots of things can cause fussiness in an infant. And as babies get older, they tend to sleep less, and learn how to play the system. You know they're going to cry and then you'll come, you hold him and pick him up and you put him down, they cry again. Is that mean they're teething or is that mean that they're learning if I cry, mom comes to get me and I don't have to be in the room all by myself.

00:26:22

Also keep in mind that fever in babies is really not until it's a 100.5 degrees Fahrenheit rectally so if you have a 99 degree fever and the baby who's drooling and kind of fussy, does that mean that their teething? Maybe not you know a 100 or 99 temperatures maybe normal for your baby. All babies are going to drool and maybe they're fussy because they're hungry or because they want to be picked up.

00:26:50

So it's really hard to know whether a set of symptoms is really going to be whether you can blame it in teething or not. I do want to say one of the thing about the temperature, you know if you, and I say this because one of, when I see kids for well check-up, you can see a kid who's healthy as can be and they can be a 100 degrees even.

00:27:09

So keep in mind in a 100.5 rectally is the definition of a fever in an infant. So 99 is not a little great fever, 99 can be normal of course when your child's sick you take the temperature and you'd see it's 99 but if you took your baby's temperature throughout the day when they're feeling well you'd probably find that they're hitting 99 in a cyclic sort of pattern anyway. So keep in mind 100.5 is fever and teething is not been showing to cause a fevers in babies. If they have a fever of a 100.5 or more you got to look for other causes and not blame it on teething.

00:27:44

So when do kids teeth? Well you know for most kids, their first tooth is going to come when they're about 6 months old. You know the range can be from 3-4 months to over 12 months, so there's a huge range of when it can happen as it turned out both of my pretty little kids late bloomers. My daughter was actually about 13 months old before she had her first tooth. And my son was probably about 10 or 11 months old, somewhere around there. Do I see kids in the office, who are 3 or 4 months who are getting their first tooth?

00:28:12

Yeah it's a little unusual, I mean for most kids it's going to be close to around 6 months of age when they're getting their first one. In terms of what order do they come in. You know the most common first ones are going to be in the middle of the gums on the bottom, so one of those middle incisors on the bottom is the most likely the tooth that's going to pop through first. But you know that is not all kids follow the real books and there can be a great range of normal in terms of what order they come in as well as when they come.

00:28:42

So what do you do let's say you do think that your baby is a little bit fussy because they're teething, what can you do about it? Well of course talk to your doctor and you do want to make sure it is teething. If you have a baby who's persistently fussing or drooling, or what seems for you to be excessive amount, there are certainly other medical things, some of them are even urgent that you really need to see your doctor. So they can make sure that it is just a teething pain and then nothing else.

00:29:05

So let's say you do that and you see your doctor, everything's fine, they think it really is a teething is the issue; you can give infant Talon oil as they needed for pain. And if you're unsure about those, call your doctor. Morton is probably a little bit better for pain control in my opinion. If your baby's over 6 months of age and he's teething and that's just because Morton is an anti inflammatory drug. So if you figure there's a little inflammation involved with the tooth, popping up to the gum, the Morton's going to help with the inflammation that's there causing some of the pain or Tylenol's not going to do quite as good as to the job, Morton would because Tylenol is not in the anti inflammatory medicine.

00:29:46

No aspirins. So we don't use aspirin in babies unless your doctor tells you too. There are some diseases where kids would need some aspirin as prescribed by a physician but in general, no aspirin for kids these days because of the fear of Rye's syndrome with some particular viruses, so you don't want to do that.

00:30:09

Also a gum massage, you know if you wash your hands and just use a finger and massage the gums, that may help. Also something that's cold, you don't want to use direct ice but you know a teething ring that's been cooled briefly in the freezer or in the refrigerator for a little bit may help with the teething issues. You don't want to get anything that can choke on you know a part of parents to putting vegetables, like a carrot in a freezer and freezing it and giving it to their baby, not a good idea. A little piece of the carrot can pop and they could choke on it. So you don't want to give him anything that they could possibly choke on.

00:30:47

And of course anytime that you've been given your baby something because of teething like a cool teething ring you want to make sure you're there and supervising him. What about infant oral gel and Anbesol, you know for some kids they can help, for others it seem to bother them more. You want to use them sparingly because you can overdose on those that can cause some blood issues.

00:31:11

So you want to make sure that you don't use them, you don't want to overdose with oral gel or Anbesol. Again it's a sort of a last resort of the Tylenol that seems to be working or the massage, or the cool teething ring, that kind of thing.

00:31:23

Talk to your doctor about it because you know some people have strong opinions either way on those kinds of products. So again, you know are they really upset because of teething, you know the fussiness is persisting make sure you see your doctor because it could be an ear infection, an acid reflux or just a good old fashioned colic.

00:31:40

Alright Shana I hope that helped with answering your questions about teething. Your 4-month old could be teething you know babies who are having those kinds of symptoms though may not be teething and I think you're going to know when you see the whites of this, the white of the teeth popping out through the gums.

00:31:56

Okay well we've reached our half an hour remark. I'd like to thank everyone for tuning into this week's PediaCast. Once again I apologize that it took a little bit of longer than normal to get the episode out. I do apologize for that. I'll try to be a little more punctual in the future but I did have some folks write in saying, you're still doing this and when is the next ones coming out? So I do appreciate all your support and thanks to all the listeners out there.

00:32:20

Also thanks to my family for putting up with me and allowing me to get a Mac book pro! So thanks for that, it's been a lot of fun. Also thanks vladstudio for allowing us to use his artwork on our website. Don't forget you can submit a question or a comment, view the show notes, take our listeners survey, sign up for our news letter and read our blog at pediacast.org. And if you like PediaCast please spread the word by telling your friends, relatives and neighbors about our program. You can download free promotional materials on the poster page of our website. Reviews in iTunes are most helpful. And actually there's a new thing now to a dig, D I G G digg.com. They have a new podcast directory. So if you'd go to dig and then click on the podcast link and then search for PediaCast, you'll find this and you can dig some of our articles, or some of our episodes I should say. And the more digs we get, the more people will hear about PediaCast, so please go to dig and look there.

00:33:18

Also there's a link to podcast pickle, they just wiped out all of the favorites, and the votes as they do each January and July. So if you go to podcast pickle and search for PediaCast and then put us down as one of your favorites that would be helpful as well, or you can go to pediacast.org and we do have a link to the podcast pickle page from there.

00:33:42

Alright, so enough of this self-plugging, until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids, so on everybody.
 [Music]

The tripod network. What's on?

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