Tuesday, March 31, 2009

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.

Monday, March 23, 2009

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?

Tuesday, March 10, 2009

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.