Teething

Teething is a process by which the first set of teeth pushes through the gum line. Some babies do not seem to mind this at all but other babies can be very fussy every time a tooth comes through. They refuse to eat and sometimes may just take the bottle or nurse. They will be waking-up several times at night because of discomfort.They can also be grabbing at their ears because of referred pain, same nerve fibers innervate the gum and the ears.This may be associated with low grade fever but once the temperature is more than 101.5F this is most likely not secondary to teething. Teething is not associated with diarrhea or congestion. Most mother's believe that it is the case. Studies have not shown a correlation between this two symptoms. Teething happens from 3 months to 3 years of age. They should have their first set of teeth, 20 in all, by 3 years of age. What to do if your baby is teething? You will notice some swelling in the gum line with the white teeth coming through, this process can occur for several weeks.

• you can use your clean fingers to massage the area of the gum that is swollen
• give your baby something to chew on, a wet washcloth that has been put in the freezer for 30 minutes should soothe him, teething rings are good too, just make sure it is not hard as ice because this can cause bruising in the gums
• acetaminophen is good to help at night when they go to sleep and should last for 4 hours
• sometimes we can try some baby Oragel or Anbesol only if the baby is very irritable this does not usually last long and I rarely recommend it because it is a topical anesthetic
• lots of hugs and kisses should work great

I always tell my parents that this is a "rite of passage" and this too shall pass before you know it (after a few sleepless nights).

What is the scaly lesion on my child's scalp?

Patient is a 2 year old female who was noticed to have a scaly round patch on the left side of her scalp. She was prescribed several shampoos and was given steroid creams to put on the area but mother noticed that this seem to be persistent for 1 year now and not getting any better. She was then prescribed some Nizoral shampoo which she can buy over the counter and told to follow-up in 1 month. On follow-up apparently the lesion seem to have gotten a lot better but still persistent. Otherwise, she has been a healthy young girl with no other problems. She was them prescribed some Griseofulvin to follow-up in 2 months.

She has "ringworm of the scalp" known as tinea capitis. This is from a group of fungi which invades the layer of the skin, hair and nails. This can be transmitted from animals such as cats or dogs directly or indirectly. This can also be transferred from person to person. The treatment takes a long time because this is a slow growing microorganism. The first line of treatment is Griseofulvin by mouth with Nizoral shampoo twice a week. If we encounter resistance Ketoconazole is another alternative for treatment. Most patients respond well to the medications.
We usually tell parents to make sure child does not share combs, towels with any one, because this can be contagious.

Is it a common cold or allergies?

The most common infection in children in the common cold but the significance of this is attributed to the possible complications that it can cause. Children usually have 5-8 infections a year and this is more common in children younger than 2 years of age. 1/3 of the common colds is caused by the rhinovirus but there are 200 different strains of viruses that can also cause this infection. Colds is usually more severe in younger children because it can result is some fever. They can have ear infections with this and if the discharge is more purulent they can have a sinus infection with this. This is very contagious so it is really hard to quarantine children with this illness. Period of infectivity starts a few hours prior to the appearance of symptoms to 1-2 days after the illness appeared.

Babies younger than 3 months of age start with fever, irritability, restlessness and sneezing. Nasal discharge start which can lead to nasal obstuction. They will then have a hard time breathing or eating so it is very important that we help clear their airway by applying some normal saline to the area with some suctioning. In older children, they feel dryness in their throat some nasal discharge with coughing and some fever. They may complain of some muscle aches too. In most cases, the acute phase lasts for 2-4 days.

Allergic rhinitis can be differentiated from the common cold because it is not usually accompanied by a fever and the nasal discharge is usually clear. They have persistent sneezing and itchy eyes.

How your Baby Develops? (3 years old)

3 year old

They are pretty much ready for pre-school. They should be talking in sentences and can start to tell stories. They can draw a line and pretty much a circle. They know some of their numbers and letters and they can identify 2-3 colors. The temper tantrums still might persist but has markedly gotten better at this age. They can climb, kick a ball, remove their clothes and most toddlers are pretty much toilet trained at this age.

To Vaccinate or Not to Vaccinate your Child with the H1N1

The H1N1 is a new mutation that emerged last August 2009 and the flu vaccine was already in production when the new mutation occurred so they have to make it separately from the rest of the flu vaccine , hopefully next year they would incorporate this in the seasonal flu vaccine. Many parents are worried because this is something new. Remember the H1N1 vaccine is produced exactly the way the regular flu vaccine is produced. Exactly the same manufacturing steps and the same companies who produce the flu vaccine produce the H1N1 vaccine. Since this is a new strain most the young population do not have any antibody to the virus. We do not really know the full extent of what this new virus can do but preliminary results show that this can cause significant morbidity especially to the pediatric population. I urge all the parents to have their children vaccinated. I had all my 4 boys vaccinated too and of course myself and so far everyone is fine.

How your Baby Develops? ( 2years old)

2 year old

Most people call it the "terrible-twos" , I call it the "awesome twos". They are starting to develop more independence and they tend to say no a lot. They do develop temper tantrums at this age or even a few months earlier. When you as a parent say no make sure it is a real no. 2 year olds are smart and if they know they can get what they want the temper tantrums become longer and more dramatic.

They can definitely walk up and down the stairs, socialize, use a fork and spoon. They usually start to dress themselves, they can stack blocks, scribble with crayons. They can start to talk in 2-word phrases and name body parts. They are the awesome twos.

How your Baby Develops? (18 months)

18 month old

They are starting to be a handful ,but fun. They definitely can walk up the stairs with some help. You see some children beginning to run. They also start to kick a ball and throw a ball overhand. They are starting to be more independent and they can feed themselves with a spoon and they can start to remove their clothes especially the diapers. Most toddlers have 5-10 words and sometimes can combine this into short phrases. They can definitely follow directions and point to body parts and pictures.

How your Baby Develops? (15 months)

15 month old

Most babies will be walking alone at this point. They will be starting to learn how to remove their clothes. Scared or shy of strangers. Their vocabulary will be much more around 5-10 single words. They can follow simple commands. Point to body parts. Start crawling up the stairs. Make sure your baby is off the bottle and the pacifier by this age. Make sure baby is safe around water. Adult supervision is the utmost importance at this age. Remember their heads are bigger than their bodies and they are definitely top heavy. When they fall the head falls first and it will be harder for them to pick it up.

How your Baby Develops? (12 month old)

12 month old

Before you know it 1 year has passed and you are celebrating your baby's first birthday. He will be starting to walk all over the place. So beware, make sure the surroundings are safe for this curious little one. Most babies can pull to a stand and at least stand alone at this time. They start to finger feed themselves and drink from a cup. The are able to grab on to small objects with a precise pincer grasp. They start playing pat-a-cake and peek-a-boo. They point to desired objects. They can say "mama" or "Dada" specifically ,h! how sweet that sounds. They say 1-2 words by this time.

How your Baby Develops? (9 months)

9 month old

9 month old babies can start to pull to a stand and cruise on furniture. The world is a great big playground and they are starting to discover new things. They will try to put everything in their mouths. Some babies will be crawling all over the place at this time. They will be grabbing objects using a pincer grasp. They love to play peek-a-boo. They will start to imitate speech and they understand "no" and "bye". They can say mama and dada randomly. If you build a bond with them they will start to show stranger anxiety. Hopefully by this time your house is fully childproofed.

How your Baby Develops? (6 months)

6 month old

Your baby will be moving a lot more at 6 months. She will start to sit with minimal support. Most babies can now roll from back to front and front to back at the same time. Since they are starting to be mobile at this ]time , I tell parents to start childproofing the house. Make sure they have the POISON CONTROL (1-800-222-1222) number at a visible location. She will start to transfer objects from hand to hand. Turns to sounds and you will hear babbling with somewhat different intonations. At this age, she can definitely communicate if she likes or dislikes something. I usually tell the parents to advance her diet as tolerated. Prevention is the key to avoid a lot of accidents at this age. We do not recommend walkers because the baby is more mobile than they can handle. They tend to grab onto things which falls on them. They can fall onto the staircase. As long as we can prevent this things from happening enjoy your 6 month old.

How your Baby Develops? ( 4 month)

4 month old

4 month old babies really start to be more aware of the world. They start cooing and laughing at you. They sometimes scream when they are happy. They start putting everything in their mouth and they can see you and track you as you walk across the room. Some babies can start rolling over from their backs to their bellies and the other way around. We start to recommend introducing cereals between 4-6 months of age when your baby is ready. Their necks are a little bit more stable. You would not see a lot of tongue thrusting at this point. Parents it is time to start child-proofing your house at this age while you still have time before they become more mobile.

How your Baby Develops? (2 months)

2 month old

They start being more aware of their surroundings. The best part of this age is starting to smile at you. No accidental or random smiles. Their head control is much stronger but we still see a slight head lag when we are trying to lift them holding their arms from a lying position. On their stomachs they lift their head at a 45 degree angle and move it from side to side. The moro reflex is not as reactive but is still present. They still sleep a lot at this age. Nursing every 2-3 hours and if they are bottle fed 4-6 ounces every 3-4 hours.

How your Baby Develops? (1 month)

1 month old

Your baby is starting to be a little aware of the world. They startle or widen their eyes to sound and seem to quiet down or be calm to voice especially mother's voice. Noticed to start blinking their eyes to sound. You might see a random smile from time to time but this is still not directed to anyone. Everybody finally seem to fit into a schedule around this age. Mother is a little bit rested compared to the prior weeks.. You finally would at least know the kinds of cry your baby have. The hungry cry, the sleepy cry, the wet cry and the fussy cry. They still nurse very often every 2-3 hours and if you are bottle feeding approximately 2-4 ounces every 3-4 hours. Feeding amounts vary also secondary to the size of the baby. They usually gain 1/2 ounce to 1 ounce a day during the first few months.

Limit exposure to crowded areas. When babies get a fever it is hard to say if they are just sick from a cold or from meningitis. We usually work-up the babies when they are younger than 2 months of age to look for any source of infection. Prevention is still the best.

How Your Baby Develops? (Newborn)

Newborn

Once you have your newborn at home, they just seem to stare blankly at you and they sleep all the time. They can move their heads from sided to side but barely can lift it. They just eat, sleep, "poo" and "pee". Sometimes it is frustrating for parents because the baby does not seem to recognize your presence but needs you all the time for its basic needs,

Nursing babies usually feed every 2-3 hours. Formula fed babies anywhere from 2-4 ounces every 3-4 hours. Bigger babies eat more. Bowel movement usually one every diaper change wet diapers are approximately 6-8 times a day.

• moro reflex, both arms and legs will flail symmetrically and sometimes they will cry
  
• they can smile spontaneously but not specifically
  
• they move their head from side to side on prone position

this is the first of a series on discussion of development at different ages of your baby

Getting Ready for the H1N1 Virus Fall 2009

The World Health Organization(WHO) has raised the pandemic alert to Phase 6 in response to the global spread of H1N1. This just means it has spread all over but the severity of the disease remains the same. In order to prevent this from spreading the CDC recommends some of this practical guidelines.

• cover your nose and mouth with a tissue when you cough and sneeze
• instruct children to cough on their sleeves and not on their hands to decrease transfer of the virus
• do not leave used tissue all over the place, instruct minors to throw this in the trash can
• wash hands after coughing or sneezing with soap or water or any available hand sanitizers
• avoid touching your eyes, nose and mouth
• if you are sick try to say home from work or school and limit contact with others. Make sure you stay at home till you are fever free for 24 hours without any fever-reducing .

If you suspect your child has influenza. Call your pediatrician.

Persons diagnosed with swine influenza are contagious for up to 7 days following the onset of the illness and this could be longer if the symptoms are persistent or has not resolved.

Heat Exhaustion and Heat Stroke

In the sweltering heat of Arizona were the temperatures outside have been climbing in the 110-118F it is no surprise that the incidence of heat exhaustion and heat stroke is on the rise. There comes a time when the body will be unable to maintain normal temperature when exposed to excessive heat. We have normal mechanisms that prevent this from happening. We become very thirsty and we start to sweat to help bring our core temperature down. Sometime people do not notice this especially children because they are having so much fun under the sun.

Signs and Symptoms of Heat Exhaustion

• mild dehydration


• core temperature from 100.4 to 104F


• profuse sweating


• thirst, nausea, vomiting


• confusion


• headaches


• feels faint or has collapsed

Signs and Symptoms of Heat Stroke

• usually with severe dehydration


• core temperature greater than 104F


• flushed with hot dry skin


• dizziness, vertigo, fainting, confusion, delirium


• loss of consciousness


• may be in shock

First Aid for Heat Exhaustion and Heat Stroke

• bring child/adult indoors


• undress


• have them lie down and elevate the feet slightly


• put the child is awake place cool bath water or sponge bath the child immediately if outside spray with mist from a garden hose


• if the child is alert give frequent sips of cool, clear fluids


• if child is vomiting turn to side to prevent aspiration


• monitor the child's temperature


• call the doctor if this is not resolving

Prevention is the best medicine

• teach children to drink lots of fluids before and after playing outside even it they are not thirsty


• make sure they wear light-colored loose fitting clothes


• hats , eye wear for protection


• only participate in heavy activity before 10 am in the morning and after 6pm


• tell children to come indoors immediately if they feel overheated

Sunburn

The most common photosensitive reaction in children is acute sunburn and the best treatment for sunburn is prevention.

The sun is one of the most important things that keep our planet alive. We get our vitamin D from the sun from its conversion of cholesterol in our body, this helps absorb calcium for healthier teeth and bones. As we say too much of a good thing is not too good either, it does not take long of sun exposure to cause damage. This can cause skin damage, eye damage, immunosuppression and cancer.

The invisible ultraviolet rays of the sun can cause tanning, burning and other skin damage.

• Ultraviolet A causes skin aging, wrinkling and skin cancer such as melanoma


• Ultraviolet B causes sunburns, cataracts and immune system damage, they contribute to cancer


• Ultraviolet C are most dangerous but fortunately it is totally blocked by the ozone layer

Melanin: Our protection from the Sun

Melanin is our defense from the sun because it absorbs the dangerous UV light before it can cause serious damage resulting in a darker color or a tan but with constant exposure this can still result in a sunburn. Children vary in susceptibility to UV light depending upon their skin tone the lighter they are the less melanin they have.

Sun-reactive Skin Types

Type Demographics Sunburn, Tanning History

I red hair, freckles and Celtic origin Always burns easily with no tanning

II fair skin, fair-haired, blue-eyed and white usually burns with minimal tanning

III darker skinned white sometimes burns, gradual light

brown tan

IV Mediterranean backgrounds minimal to no burning, always tans

V Middle eastern white, Mexican rarely burns, tans profusely dark

Oriental brown

VI Black Never burns, pigmented black

Avoidance is the best Prevention

Avoid the most intense heat of the sun between 10:00am to 4:00pm. Make sure to apply sunscreen if they are exposed to sunlight. Try to avoid exposure of infants to the sun because they burn more easily because of their thinner skins. Make sure you cover-up infants and you may put sunblock on the exposed areas. Make sure you have umbrellas to cover everyone from the sun exposure from time to time.

Sunscreen

Select a sunscreen with at least a SPF(Sun protection factor) of 15 or higher to prevent sunburn and tanning. Select one that is broad-spectrum that protects from UVA and UVB rays. If your child have sensitive skin avoid sunscreens with PABA and instead look for one with titanium dioxide as an active ingredient.

• do not skimp on sunscreen make sure you got good coverage, experts suggest to start of on a lotion as a base and you can use the spray for reapplication every 2-3 hours


• apply sunscreen 30 minutes before sun exposure


• apply a waterproof sunscreen and do not forget the eyelids, back of the neck, lips, hands,ears, feet and shoulders


• need to wear sun-glasses with both UVA and UVB protection

First Aid for Sunburn

• keep away from the sun into a cool shaded area, additional sun exposure will aggravate the burn


• have your child take a cool bath


• apply pure aloe vera gel to any sunburned areas


• pain reliever (acetaminophen or ibuprofen) do not give aspirin to children and teens this can result in liver problems


• apply 1% hydrocortisone to inflammed areas (do not use topical benzocaine, this can cause skin irritation or petroleum-based products, they prevent excess heat and sweat from escaping)

Call your pediatrician if:

• Sunburn is severe resulting in blisters


• child has unexplained fever of higher than 102F


• the skin looks infected


• trouble looking at the light(sunburn in the cornea)


• fever or chills after sunburn


• signs of dehydration (increased thirst or dry eyes and mouth)


• sunburn covering a large area


• facial swelling from sunburn

Newborn Care 101

Feeding and Nutrition
Breastmilk or formula should be your baby's major source of nutrition for the first year of life. We usually introduce solids around 4-6 months of age. There will be a period of time that your baby will undergo growth spurts. They will start to nurse and eat more often than usual and they seem to be hungry all the time. Do not worry this just occurs in spurts and they go back to their normal routine. You know you are overfeeding your baby because they will be spitting-up a whole lot. Make sure you burp them often in between feedings.

You are underfeeding your baby if:

• he has less than 4 wet diapers a day
• not nursing at least 10 minutes at the breast
• appears hungry looking for the breast
• appears more yellow
• does not seem to be gaining weight

(for the first few weeks of like we expect the babies to be gaining at least 1/2 ounce a day)

Bowel Movement

The initial bowel movement of babies are called the meconium stools . They start of as black and tarry then we see the transition stools which are greenish yellow and the normal seedy mustard looking stools that is slightly watery. Formula fed babies have more formed stools. They can move their bowels everytime they eat to once a week there is a wide variation of normal. They are considered constipated if the stools are rock hard and come out as pellets.

Wet Diapers

We need to know the number of wet diapers a baby has to ensure the baby is taking enough breastmilk or formula. This is usually between 6-8 diapers a day.

Crying

Babies can not express themselves very well and they tend to cry for everything. It will take you a few weeks to learn what cry is for what. You can not spoil a baby by carrying and hugging them. Make sure the baby is not hungry or wet. Sometimes they just need cuddling.

According to Dr. Karp think of the 4S

S - swaddle the baby this helps them feel comfortable, remember they were inside the uterus in a tight spot which is a comfort for them

S - Stomach try to lay them across your arms on their stomach they seem to quiet down with this position

S - Shh... silence or darkness can calm them, overstimulated babies are cranky babies

S - swinging not to much just gently, they like monotonous noises like the sound of the blow dryer, the vacuum cleaner

Burping

If you do not burp your baby they will become fussy and inconsolable. Try burping in between feeding. you can burp them over your shoulders, across your lap or sitting-up, make sure you pat their backs gently

Hiccups

This is totally normal in newborns. Try to feed them before they get too hungry when they start gulpin the milk down they tend to swallow a lot of air. make sure the nipple airflow is not too fast.

You can never spoil your baby during the first few months of life. This is the perfect time to attend to their needs closely and you will realize that they can communicate to you what they need and want very effectively.

Starting Solid Foods

Newborns up to 4 months of age are fed on breastmilk and/or formula. They are ready for solids if they manifest the following:

• drinks more than 35-40 ounces of formula a day
• seem to be nursing all the time and does not seem to be satisfied
• when propped up make sure that the baby's neck is stable and not very wobbly
• make sure the baby does not have a lot of tongue-thrusting (tongue reflex that seems to push the food outwards)
• they will be drooling a lot

Once they are ready and able you can start them with 1 tablespoon of rice cereal to 5 tbsp of breastmilk or formula. Make sure you try to sit them up so they do not choke. Give the cereal in a spoon if your baby does not seem to like it try again another time. Try to add less of the milk and more of the cereal until the consistency is thicker. Try a new food for 3-4 days before introducing a new one. Make sure your baby is not allergic to the food. Reactions result in diarrhea, vomiting or a hive like rash all over the body.

• cereals(rice, barley and oats)
• vegetables (yellow/orange veggies before green) the yellow vegetables is more easily digestible than the green
• fruits
• meats (not until 8-9 months of age)
• give eggs around 1 year of age
• stay away from any shellfish(shrimps and crabs) for possible allergic reactions
• do not give baby anything that can choke(nuts, grapes,apple skins...)

Once solid foods has started you will notice that the consistency and odor of the stools will changed. If the food is not strained you will see bits and pieces of food in the stool. Feed the baby solid foods before giving their milk. you will notice that the amount of milk will markedly decrease.

Juice is not needed for infants less than 6 months of age. You can give up to 4 ounces of juice once a day during mealtimes for babies 6 months and older. Juice is not needed.

Introducing new foods should be an enjoyable process. Talk and interact with your child while feeding them.

Fun in the Sun

Summer is here and finally everyone wants to go outside, smell the breath of fresh air and swim in the cool waters of your swimming pool. It is very important to protect yourself from the intense heat of the sun. Here are a few reminders from the American Academy of Pediatrics.

First things first, since we live in Arizona and the temperatures really go up, up and up to 120F. We should not get outside. The less exposure to the sun the better for our skin. If you can not help it, sunglasses, hats and clothes are good to protect yourself. Avoid the intense heat of the sun from 10am in the morning to 4pm in the afternoon.

• Infants less than 6 months should be protected from the sunlight. put them under an umbrella or under a shade. You can apply some sunscreen to small areas of their body such as the hands, face and feet.
• Make sure to put on sunblock on children with sun exposure, hats and sunglasses are a must.
• Get a sunblock which reads "broad-spectrum" this means it is good coverage for ultraviolet A and ultraviolet B with at least an SPF(sun protection factor) of 15.
• Make sure to reapply the sunblock every hour, especially when they swim or they sweat a lot
• Minimize sun exposure by swimming before 10am and after 4pm,
• Cloudy days only reduce the UV rays by only 20%-40% of the time, kids still need to wear sunblock.

Start the kids with good habits and they will grow up to be adults with good habits. enjoy your summer and be safe!

Birth of you Newborn

Once your baby is born the umbilical cord will still be attached to the placenta and the doctor will put a clamp to it. He may cut it or let Dad cut the cord, if he is not too squeamish.The clamp is kept for 24-48 hours till it has dried and upon discharge they take it off. The umbilical stump usually falls off with 1-3 weeks. They will then bring the baby to the warmer to dry and stimulate your baby till he/she cries. Vital signs will be checked to make sure baby is stable. An eye ointment will be applied to the baby to prevent infections that he/she might be exposed in transit through the birth canal. Since babies have low vitamin K level which results in clotting. Your baby will be given a shot of Vitamin K to prevent baby from bleeding. If everything is good and mother is awake they give the baby to mother so she can try to nurse.

Another more important thing they will do is to put some matching bracelets on the baby and the mom. Making sure that it is the right baby for the right mom.They also would get some baby footprints for documentation. They will then call the pediatrician who will then check the baby within 24 hours of birth. They then would check the baby everyday that the mom will still be in the hospital. An alarm will be applied either to the baby's umbilical clamp or the ankles. This is what you call a "baby low-jack". if somebody attempts to get your baby without permission the elevators would not close or the alarms on the doors will be set off. This is a great way of protecting your babies from abductions.

You have the nurses in the hospital for support. Ask a lot of questions because they are very knowledgeable. Get their help as much as you can then you can go home more confident.

What to Prepare for the Birth of Your Newborn?

Things to think about before delivery:

• If you have a boy, Should we circumcise or not? The American Academy of Pediatrics is not recommending this across the board. but parents can decide to have this done. It decreased the incidence of a urinary tract infection and penile carcinoma 1% of the time. It prevents incidence of infection of the foreskin. The most common reason for this is the resemblance to the majority of the males in the United States.


• Breastfeed or Bottle feed? Both methods are safe for the baby but the American Academy of Pediatrics advocates nursing up to 1 year of age.


• Should I store My Newborn's cord blood?Some genetic diseases can be cured by stem cell transplant. The storage of cord blood is not recommended at this point unless there is a member of the family that would need transplant or a hereditary disorder that may warrant transplant.

Preparing your home and family for the baby's arrival:

choosing a layette (baby's clothes)

3 or 4 pajama sets (with feet), 6-8 t-shirts, 3 newborn sacks, 2 sweaters, 2 bonnets/hats, 4 pairs of socks or booties, 4-6 receiving blankets, 1 set of baby washcloths and towels, 3-4 dozen of newborn-size diapers, 3-4 onesies with snaps.

This is just a suggestion for the most basic wardrobe. Make sure to buy big and flame retardant sleepwear. Read washing instructions. Wash clothes before putting them on your baby.

Buying Furniture and Equipment

Crib

• Crib manufactured after 1985 should adhere to new safety standards
• Slats should not be more than 2 1/2 inches apart, so the baby's head can not be trapped inside
• There should be no cutouts in the headboard and the foot board. Baby's head can also be trapped in this areas.
• Corner post on the cribs should be removed because as the baby gets bigger they can start pulling this out and they can choke on this posts.
• The mattress should be snug to the crib so there should be no space for which the baby gets trapped
• Crib bumpers-make sure the strings are not longer than 6 inches. They can get strangulated with this if it is long.
  

Car Seats

• New car seats should meet guidelines. If you are using a hand me down , you can go to the local fire department so they can check it for you. Please do not use a car seat that has been in an accident.

Changing Tables

• It should be on a carpet or in a padded area against a wall and not on a window so there is no danger for a baby to fall
• Put all things away from a baby's reach. It should have shelves underneath for easy access
• Make sure the table is sturdy with handrails.

Diaper Pail with deodorizer

• Need this for disposing the diapers.

Washtub

• You can use a plastic washtub for bathing the baby or you can use the kitchen sink provided you can swing the faucet out of the way and the dishwasher is off.

Everything in the nursery should be clean and well dusted

Mother's preparation for the delivery

• make a list of people for birth announcements
• contact numbers of childcare and housekeeping
• have the name, address and phone number of the hospital
• name,address and phone numbers of the doctors who will be delivering your baby
• know the quickest route to the hospital
• know the entrance to the emergency room
• phone number of the person who will be accompanying you to the hospital
• phone number of the ambulance service (do not drive while having the baby! Some do!)
• pack a bag for essentials, toiletries, clothes, an outfit for the newborn to go home in, phone charger
  
  Resource; Your Baby's First Year by Steven Shelov, M.D.

Rear-facing Car seats safer for children until they are 2

Children under the age of 12-23 months riding in a rear-facing car seat are more than 5 times safer than children of the same age on a front-facing car seat. According to the first US data riding rear facing up to 2 years of age is safer for children. (Henary N, Inj Prev 2007;13:398-402). This is in accordance with the American Academy of Pediatrics.

• All infants should ride rear-facing in an infant car seat
• the infant should be switched to a rear-facing convertible car seat once the maximum height(within 1 inch from the head to the top of the seat) and weight(usually 22-32 pounds) have been reached.
• Toddlers should be rear-facing till they reach the maximum height,weight(recommended by the manufacturer), or at least 2 years of age.

In Sweden, children are rear-facing in the car until they are 4 years old. This has been proven to be 90% effective in protecting the children from accidents. However they have seats that are designed to accommodate a 4 year old.

Advise for Pregnant Moms

Pregnancy is one of the most fulling and exciting experience as a woman. For new parents, there is some nagging fear at the back of your mind and you ask the questions "Will I be a good parent?","Will my baby be healthy?" but 9 months of pregnancy will hopefully help you think through the process and be prepared for the birth of your newborn.

• Virtually everything you consume, inhale or expose yourself to can be transmitted to the fetus. You need to be on a well-balanced diet, not smoke including exposure to second hand smoking, do not drink alcohol (this can result in some birth defects) and please inform your physician of any medications prescription or otherwise, so you will know which ones would be safe for the pregnancy.
• Get the best prenatal care. Follow-up regularly with your obstetrician so they can monitor the pregnancy and catch any problems that might start to develop.
• Nutrition - The obstetrician will be prescribing some prenatal vitamins which will contain iron, folic acid and other minerals which can prevent some birth defects prior to the second trimester.
• Eating for Two - You will need to be eating more than 300 calories more than your normal. This is not a time to diet. You will be needing the extra calories to carry your baby and the breastfeeding after delivery.
• Exercise - Is also important during pregnancy. discuss a fitness program with your doctor. Avoid jumping and jarring movements.

Tests during Pregnancy

• fetal ultrasound is the most common test done in pregnancy, it checks for fetal growth and development and can detect abnormalities
• Non-stress test monitors the fetal heart rate. This is usually performed during the last trimester.
• Stress test monitors the fetal heart rate in response to uterine contractions. This occurs when the birth of the baby commences.
• Oral glucose tolerance test is done to check for gestational diabetes towards the latter part or the second trimester and the beginning of the third trimester
• Blood test is obtained to check for the alpha feto protein levels, HCG and estrogen. This triple screen can detect fetal abnormalities early in the pregnancy.

Source: Your Baby's First Year by Steven Shelov

Your Colicky Baby

Colic is the most frustrating thing a baby can have. You know as a parent that you did everything in your power to take care of your baby and still he/she is crying incessantly.
Colic is defined as excessive crying for more than 3 hours a day at least 3 days a week for 3 weeks or more in an otherwise healthy baby. One in 4 infants have colic making this condition of of the most common reasons for visits to their pediatrician. Since no one knows the cause of this condition it is really hard to treat. This usually starts at 2 weeks of age and resolves by 4 months of age.

Treating Colic
There is no single treatment that has been proven to alleviate colic but the following are some suggestions that you can try which works for some babies.

• Make sure the baby is fed, diaper is clean and he/she is not tired.
• Try soothing the baby by walking with him, sitting and rocking, you can not spoil them at this age
• Make sure you burp them often in between feedings and try to feed them a little bit at a time between burps
• Swings might help, anything soothing and vibrating
• You can also try car rides
• Play some music
• Any continuous sound (i.e the sound of the blow dryer, the sound of the vacuum cleaner)
• Try swaddling the baby in a darkened room with decreased stimulation
• Mother needs to have a time-out period without the baby for a few hours a day to de-stress, this helps with stress reduction

Changes in diet is one of the few potential preventive and therapeutic options. Breastfeeding exclusively do not prevent colic but it has been observed that staying aways from certain foods improve the symptoms. Foods to avoid for breastfeeding mothers.

• chocolate
• caffeine (coffee, tea, caffeinated sodas)
• cow's milk (dairy products)
• orange juice
• soy, wheat, eggs, peanuts, tree nuts and fish
• broccoli, cabbages

Hypoallergenic formulas (Nutramigen, Alimentum) has been shown to decrease crying times due to colic. The American Academy of Pediatrics recommend trial of hypoallergenic formula for severe colic.

Some parents and pediatricians result to Complementary Alternative Medicine(CAM) for the relief of colic. An article in the Pediatrics in Review Journal (2007:28:381-385) reviewed the existing studies to see if these are efficacious.

• Fennel Seed Oil - 5ml-20ml of 0.1% fennel seed oil emulsion give up to 4 times a day for 1 week. The study showed significant improvement fewer than 9 hours of crying in 1 week. Patient can have allergic reactions resulting in a rash and difficulty of breathing. Fennel is reported to cause seizures. But long-term safety is unknown.
• Botanical Blend -herbal tea (fennel, chamomile,vervain,licorice and lemon balm) up to 150ml dose of herbal tea for a maximum of three times a day. Study shows that this decreased the crying to 3 hours daily. Long term safety of this herbal combination is unknown.
• Probiotics - Study results in a trial of Lactobacillus reuteri(10 to the 8 bacteria/day) results in 95% were considered to be responders and no adverse reaction was reported.
• Chiropractic manipulation- Studies that were reviewed contradict each other and at this point this is not recommended as an effective treatment for colic.
• Osteopathy-individualized cranial osteopathic manipulation once a week for 4 weeks. No adverse events were reported but this seem to help some infants with colic. Larger clinical trial need to be done before this can be recommended. We do not recommend this at this point.
• Massage-Studies show that there is effectiveness of infant massage in promoting physical and mental health in infants but further studies need to be done before this can be recommended as treatment for colic.

Choosing a Pediatrician

Every pediatrician is trained to take care of your baby. However different individuals have different ways of approaching the problem. It is recommended that you at least interview 2-3 pediatricians so you can see who fits your needs. Conduct the interviews around the second or third trimester of pregnancy so the pediatrician you chose could examine your baby in the hospital when he/she is born. It is recommended that both parents are present during the interview.

Questions to Ask:

• Is the pediatrician accepting new patients, please make sure the pediatrician accepts your insurance plan.
• What are the office hours?
• What is the best time to call for routine questions?
• Does the pediatrician have privileges with the hospital you will be having your baby?
• How often are the well baby exams?
• How long does it take to set-up routine well child care?
• How long does it take to set-up urgent appointments?
• How many pediatricians are in a group? Are there any nurse practitioners or physician's assistant?
• How does the office handle the billing and insurance claims?
• Is payment due at the time of visit?
• How soon after birth will the pediatrician see your baby?

-as long as the pediatrician has been informed of the birth, he/she will see the baby within 24 hours and everyday until discharge

• Is the doctor available by phone?e-mail?
• What hospital does the doctor prefer to use?
• What happens if there is an emergency?
• Who "covers" your doctor when she/he is unavailable?

Hemophilus Influenza Serotype B

There has been an outbreak of Hemophilus Influeza Serotype B infection in Minnesota. This involved 5 underimmunized children younger than 3 years old, including one death. This serious disease has benn uncommon since we started the routine use of the Hib vaccine which began in 1990. There has been a Hib shortage in December 2007 and it was suggested to hold off on the immunization of the Hib for children from 12-15 months of age. The shortage should be expected to last till the mid-2009. We can not but emphasize the importance that vaccines protect our children from these serious diseases.

Invasive Hemophilus disease can cause pneumonia, meningitis, epiglottitis( I graduated in 1998 and I have not seen a single case of epiglottitis), septic arthritis, cellulitis, ear infections and affects other organ systems.Since the vaccine was instituted the rates of disease among children younger than 5 years old has declined by more than 95%. Please make sure your children get the required immunizations at the appropriate time.

Salmonella Outbreak

According to the CDC, there has been an outbreak of Salmonella infection in the 44 states and the infected individuals to date is 600 cases. Illness started from Sept 1, 2008 to January 23, 2009 and there has been 13 cases in Arizona.This has been traced to peanuts contaminated with Salmonella that has been produced by the Peanut Corporation of America. There has been a recall on the products that has been distributed by this company and please refer to http://www.fda.gov/ for a list of products that are recalled or call 1-800-CDC-INFO.





Signs and Symptoms

• diarrhea


• fever


• abdominal cramps 12-72 hours after infection


• bone infection (osteomyelitis) rare


• meningitis rare

Symptoms usually lasts for 4-7 days, most individuals recover without treatment but sometimes severe infections occur especially in the very young, the very old and immunocompromised individuals.

Salmonella is diagnosed by stool cultures. They start treating with antibiotics if the patient is immunocompromised or symptoms are severe.

Please call your doctor if your child is suffering from these symptoms.