Bringing Baby Home

Essential Info about your Baby’s Head Shape (Pedcast)

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Transcript: Essential Info about your Baby’s Head Shape (Pedcast)

-Welcome to another edition of DocSmo.com, your reliable source of information for parents about a wide range of pediatric parenting and health topics ranging from the bassinet to the boardroom.

-Thank you for joining me today.

– I am your host and the founder of DocSmo.com…Dr Paul Smolen, a board certified pediatrician with 30 years of private practice under my belt.

-These “pedcasts” are intended to bring parents useful practical information about important pediatric topics.  A supplement to your child’s regular office  visits with their health-care provider.

-This is the kind of discussion your pediatrician would like to have with you if they had unlimited time during your child’s health supervision visits.

-I want to stress that by making this podcast, I am not intending to give specific medical advice for your child, rather general information on the topic of the day which today is “What parents need to know about head shape in babies.”

 

-Parents often worry about their baby’s head shape…especially in the first year of life.

-First, we have all the consequence of the birth process… and what a process it is.

-Babies usually come head first into the birth canal, first hitting the hard bones of Mom’s pelvis, then squeezing through Mom’s cervix and vagina.

-Bruising and molding of the skull bones are almost inevitable as a consequence of these processes.

-Many parents are startled and frightened by the molding and bruising their infant is born with but rarely are these a serious concern.

-With the rapid brain and skull growth that occur in the first few months of life, the distorted shape of a newborn’s skull rapidly disappears…unless they spend so much time on their backs in monotonous positions that flattening starts to occur in the back of their little heads.

 

– The medical term for this one sided flattening is plagiocephaly and pediatricians definitely started seeing more of this deformity after the back to sleep campaign started in the US…that’s the recommendation to always have babies sleep on their backs on a safe surface whenever they are unattended.

-Not only can plagiocephaly be a cosmetic problem, but some feel that with enough asymmetry of the skull can come along vision problems since, with enough forward shift one side of the face,  one eye may be in a different plane than the other.  A similar process is thought to possibly cause jaw problems since the mandible may not fit properly on the skull if the upper face is not symmetric.

 

-Everyone agrees that flattening of one side of the skull is something that we want to avoid.

-It can persist into adult life if it is severe.

-Here is what you can do to avoid problems with your baby’s head

         -Start doing tummy time, as soon as your little bundle of joy comes home from the hospital.

         -Try and turn your infant’s head to alternating sides when you lay them down for sleep as soon as you get home from the hospital.

         -Try to get Tummy time, supervised of course, for 30-60 minutes a day on a firm, safe sleep surface…for more on that, I remind you to check out my pod cast on “Safe sleep”

         -If your child always wants to lay on the same side of their head, they probably are doing so because of a cramped womb position.  Have your pediatrician check their neck for tightening or stiffness.  Should this be present, have them show you some exercises to help alleviate this tightening or have them send you to a physical therapist for this purpose.

 

-Here are some things you should not do in an attempt to help your infant’s head shape are:

         – Let your infant sit in a car seat or any seat for that matter  for long periods of time in the same position.

         -You should not buy devices to hold your baby in a certain position to lower pressure on his or her head.  These devices are well intentioned and may work, but their safety is always a concern.  Experts recommend that they not be used.

         -When using tummy time, never leave your child unattended even for a second.

 

-It has been my experience that the flattening can be avoided if parents are proactive with Tummy time and be careful not to miss neck stiffness.

-Should the flattening occur despite your efforts, referral to an specialist in head orthotics should be made by 6 months of age.  They will help you decide if your infant needs a skull-molding helmet to reshape their head.

-These helmets are expensive and don’t always work especially if not put on by 6 months so remember the DocSmo pearl…. Prevention trumps treatment almost every time.

 

 

– I hope the new parents in my audience today found this pedcast useful.

– The head shaping helmets I referenced in the pedcast cost between $1500-$4000 in my community and are not always covered by insurance so by listening to DocSmo today, potentially I may have saved your family a significant chunk of change… all in a days work.

-If you found this and other pedcasts useful, go ahead and take the plunge.  Subscribe on itunes, like DocSmo on face book or follow us on twitter.

-Currently, all of my content is available for free at my website, www.DocSmo.com.

-And don’t forget to check out my Smo Notes posted at my website where you can find reliable reference material with a simple click of the mouse.

-As always, this is your host, Dr Paul Smolen, broadcasting from studio 1E, that’s the first child’s bedroom on the east side of the house, protecting you from the dread of having a child with a misshapen head.

 

Until next time.

Smo Notes:

Clinical Report: Prevention and Management of Positional Skull Deformities in infants, Pediatrics Volume 128, Number 6, December 2011

 

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Why babies spit up! (Pedcast)

Parents are often concerned about a common infant symptom, “spitting up”. In today’s podcast, Dr Smolen discusses some of the main reasons why babies spit up and older children and adults, don’t.  Take a few minutes to listen to this practical and informative discussion.

Transcript:

Welcome to another edition of DocSmo.com, the home of the pediatric pod cast,
-Where we help parent raise their children all the way from the diapers to the diploma, from the beginning of gestation to after graduation
I am your host, Dr Paul Smolen
-Before we get started with today’s pod cast, I want to remind my listeners that this pod cast is informational in nature, and not intended to give medical advice for any individual child… if you are looking for tailored advice for your child, visit the wonderful person you call your child’s pediatrician.

-After 30 years of practice, I guess I have been asked everything…it certainly seems that way.
-One of the more common questions I get is why babies spit up so much
-For older children and adults, spitting up stomach contents on a regular basis would be abnormal, a sign of disease, … but most of the time this is a normal symptom for infants.
-Actually, many of the digestive symptoms that babies experience on a regular basis would be very abnormal for an adult… spitting up, pooping 8 times a day, having watery stools regularly, and lots of gas… Sounds terrible if that were you or me, but for most babies… all in a day’s digestive work.
-I guess that is why parents are so taken aback by these symptoms in their young children and feel that something must be wrong.
-Lets break down the spit up part in today’s pedcast…shall we

-If you have a baby handy, take a good look at them. What do you notice?
-How are they different from your older children or even yourself?
-Right, they are smaller and they are usually either laying or at best in a semi erect position.
-A babies stomach is only about 2 inches below their mouth…it is practically in their mouth.
-The other thing that you can’t see from the outside is that their stomachs are almost always filled with liquid food and a lot of air.
It takes about 3 hours for most babies to empty their stomachs and as soon as their little stomachs begin to empty, they demand to fill them right up again… hence always full.

-Ok, so we have a baby with only about 2 inches from the top of their stomach to their mouths, who is almost always laying down with a tummy full of milk and gas… Can you see why stomach contents are constantly being regurgitated into their throats or worse, your nice clothes?
– The only thing holding stomach contents in your infant’s stomach is their LES (lower esophageal sphincter) which is constantly opening to vent excess air from our stomachs and allow it to escape. Getting rid of air from their tummies is a good thing but unfortunately, with the air frequently comes liquid stomach contents…milk
-The same process is happening in older children and adults all the time.
The venting process is letting air escape into our throats, but the stomach contents only make it into the lower esophagus …and unless we have an inflamed esophagus, older children and adults are unaware of this process.
-Older children, usually older than a year of age along with adults are therefore actually “silent spitters” since they are unaware of this venting and regurgitation processes going on inside them almost constantly.
-But for babies, it’s a different matter… with only 2 inches to travel from their stomachs to their mouth, liquid not solid food in the tummy, and laying down to boot…the result is spit up, over and over and over.
-Shakespeare talked about the pukng babies so this is certainly not a new thing…it has nothing to do with modern life…its part of the baby experience.

-For most infants, the entire spitting up ordeal is a much bigger deal to their parents than for the baby. Most babies tolerate the stomach contents in their esophagus and throat without much problem. Doctors refer to these healthy babies as “Happy Spitters”
-That’s not to say that spitting can’t cause problems for babies… it certainly can.
-Some babies spit up so much that they get serious heartburn… others fail to gain weight… and some even choke on their stomach contents and aspirate them into their little lungs…that can’t be good.
-Additionally, lots of spitting may be an indication of a serious digestive disorder such as cow’s milk allergy, malformations of the intestines, liver disease etc etc.
-Your child’s doctor is always on the lookout for children where spitting is not the benign symptom it is in most children.
-If you are worried about your child‘s spitting, talk to their pediatrician.

-To minimize spitting, don’t forget to burp your child as often as every ounce of intake and hold them upright for a while after feeding to help their stomach’s empty in the right direction.
-For children with serious spitting issues, thickening feeds with cereal can be very helpful. Thick food doesn’t regurgitate nearly as easily as thin milk.
-But But But…the main thing is if your child is a happy spitter without the serious symptoms I mentioned earlier, just relax and wait for it to go away… which it almost always does by 1 year of age..

-So the next time you ruminate on why babies spit up so much, hopefully you will be able to regurgitate some of the reasons they do.
-Thanks again for joining me today.
-If you enjoy the DocSmo experience and find them useful, please take the time to make a comment on itunes or shoot a comment to the blog.
-I try and answer all relevant comments.
-And while you are at it, send your favorite DocSmo mp3 to a friend or relative. Go ahead, share the experience
-And don’t forget you can follow us on face book or twitter
-This is Dr Paul Smolen, continuing your free pediatric education, hoping you stay smitten even if your little baby keeps on a spittin.

Until next time.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

 

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Safe Sleep Environment for Infants 2011 (Pedcast)

This podcast is part of the Essential Series for parents with newborns and infants.  Knowing the dos and don’ts when it comes to safe sleep environment for infants is something that parents must master.   Sleep associated deaths may, to a large degree, may be preventable.  Listen to what experts feel is the safest environment for babies to sleep.

Transcript:

Intro:
-Welcome
-I created this podast in order to bring parents useful information they can use to help their children from the crib to the country club, from the bassinette to the board room.
-This episode is part of my essential knowledge edition of DocSmo
-Today we are going to talk about the new recommendations, appropriate for most babies, from the Academy of Pediatrics regarding Safe Sleep Practices for infants.
-A task force, working for the AAP, consisting of academic pediatricians. Reviewing available data and making recommendations based on available evidence and some opinion, albeit informed opinion.
-So get ready and sharpen up your pencils if you are a new parents bringing a newborn home from the hospital. I have some detailed recommendations for you hot off the AAP press. Important since deaths during sleep are the most common cause of death in infants during the first year of life!!! Pay close attention and learn what the experts at the AAP think constitutes the safest sleep environment for infants.
-Let me remind my listeners that, I am not your child’s doctor and for specific advice regarding your child, consult the wonderful person you call your child’s doctor.

First some definitions so we are all on the same page;

Our discussion today revolves around deaths that occur in infants during sleep time in the first year of life after they have transitioned from the birth process. These fall into a few categories;
-APNEA is the medical term for lack of breathing that is centrally mediated, that is, your brain forgetting to breath…common in premature infants before they have mature centers in their brain’s to control breathing, especially during sleep. Remember, no need for breathing in the womb so many immature premies just forget to breath…especially if they are asleep.
-SIDS Sudden infant Death Syndrome- Any sleep associated infant death that cannot be explained after a thorough medical investigation that includes an autopsy, toxin screens, metabolic tests…no trauma, no sickness, no suffocation etc. Presumably, the terminal event in a SIDS death is an apneic spell.

-SUID Sudden Unexpected Infant Death- Any sleep associated sudden death of an infant whether explained or unexplained which includes SIDS deaths as well as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac deaths, and trauma whether accidental or non accidental.

-New distinctions about sleep related deaths depend not only on traditional medical information like autopsy and lab tests but also on scene investigation. In recent years, a new tool that can explain many of these sleep associated deaths.

The goal of the new emphasis on safe sleep environments is to eliminate all sleep associated deaths in infants, whether they be SIDS type or SUID type. Here is the consensus of the AAP experts of the do’s and don’ts when it comes to a safe place for your infant to when they are unattended–Hot off the press.

Do’s
-Except in rare cases, Back to sleep for EVERY sleep in the first year. Not side, not elevated, not in or on a device such as a wedge.
– Your babies “sleep surface” should be firm and conform to Consumer Product Safety standards for ALL sleeping, day and night.
-Your babies mattress should have no gaps around the edges (suffocation risk) and should only be covered by a fitted sheet…no loose bedding, no toys, no bumpers
-Dress your baby in light, comfortable clothing such as a one-piece sleeper in a room that is between 68-72 with no more than one layer more than that which would make an adult comfortable. No clothing that can get near the babies face.
-Breastfeed your infant
-Consider using a pacifier after breastfeeding is established.
-Put your infant’s crib or sleep surface in the room with the parents for the first 4-6 months?
-Its OK to put your baby down on their tummies for supervised Tummy Time everyday as soon as you get home to prevent flat spot on head however, this time must be supervised and follow the same rules I just outlined except the child is on their tummy rather than back.

Don’ts of sleep;
-NEVER Use pillows, soft bedding, sheep skins, quilts, pajamas with hoods, or blankets that can get near a babies face. If a blanket absolutely has to be used, tuck it firmly under the mattress so it cannot get loose.
-Crib should be free of loose toys or mobiles that can be reached. And nothing should be tied to the baby like jewelry or pacifier tether.
-No co sleeping. Feeding at night…must go back into crib. Infants should not sleep with siblings, parents, strangers, or anyone.
-Do not rely on monitors… cardio respiratory or any other type.
– Do not use a crib that has any broken or mended parts
-NEVER let a baby sleep on an adult who is drowsy or asleep
-NEVER let a infant sleep in a device that covers their face.
– Do not leave your baby to sleep in a car seat or carrier
– NEVER smoke before or after your baby is born
-Never use drugs or alcohol while caring for your baby

Easier said than done. I recently got a note from a Mom with a now 3 month old late preterm infant and you could hear the angst in her note. Let me read a portion of it for you. ” …it can be very frustrating as a parent (trying to preserve one’s own sanity) when doctors make these rulings that are not so easy to execute in the trenches!- Like –Never doze with your baby!! No toys in the bed!! Car seat MUST face back (This mom is particularly distressed when I’m alone with a young baby in the car!) Or—Sleeping in unapproved device may result in DEATH! Never leave baby unattended!!(How do I go to the bathroom, she asks??) She goes onto to say, It’s enough to make anyone lose their marbles. I know doctors just want the best for us, but take pity on us poor sleep deprived parents!”
– Here is hoping that you don’t lose your marbles. We need all the healthy, energetic healthy parents we can get to raise this next generation.

– If you want to read the full Academy of Pediatrics recommendations about safe sleeping environments, check out the references in the Smo Notes.
-Thanks for joining us today.
-Take the plunge and subscribe for your free pediatric education by getting the RSS feed from DocSmo.com or signing up on iTunes, Facebook or twitter.
-Remember this is a blog so your comments are welcome and may possibly be posted for others to ponder and comment on.
-This is your podcast host, Dr Paul Smolen, broadcasting from studio 1E in Charlotte, NC… hoping it is not a great leap for you to provide a safe place for your infant to sleep!

-Until next time

Smo Notes:

1.  Charlotte Observer- safeSleepPoster.pdf (application/pdf Object)-http://www.charlotteobserver.com/images/graphics/post/safeSleepPoster.pdf

2.  http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html

3. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

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Changing Diapers; Hazardous to Your Health? (Pedcast)

Introduction

Just imagine this Norman Rockwell scene– a baby’s room, a changing table, and powder everywhere with a giggling baby kicking and enjoying being liberally powdered. The baby has a nice dry bottom and is enjoying the nice aroma of the powder not to mention the wonderful feel of powder on their skin. What could be more American and traditional?  Grandma’s of yesteryear loved baby powders because they were super absorbent and feel great. Unfortunately, there is a dark side to powders that you should know about! There are things all parents need to know about baby powder, which we are going to discuss today. Before you start sprinkling powder around your baby and yourself, take a listen to this pedcast and learn why the use of baby powders are controversial and potentially harmful to you and your baby! Welcome to another edition of Portable Practical Pediatrics. I’m your host, Dr. Paul Smolen, a board certified pediatrician with a lot of experience and a whole lot to say.

What are powders?

Powders are created when solid substances have been crushed, ground, or pulverized into very small particles.  When these dry small particles are collected they are called powders. I guess it is possible to make a powder out of any solid substance and they can have many varied uses; from makeups to lubricants like graphite all the way to cocaine and gunpowder. Powders are amazing things! Today, we are going to limit our discussion to baby powders, the kind that are used on a baby’s bum. Chemically, baby powders are usually made of either talc, a mineral mined in many locations in the U.S. or from cornstarch. When it comes to powders the smaller the particles, the higher the quality of the powder. That’s why talc was so valued as a powder–talc can be pulverized into very small particles. It makes the best powder!  The small size of the particles creates a super-large surface area to absorb lots and lots of moisture. The ultra small particles also give this powder a silky smooth feel that both moms and babies really enjoy.  The powder keeps junior’s bum dry, silky smooth, reduces the friction of the diapers, and absorbs chemical irritants in their urine and poop.  What’s not to love?

If powders work well, what’s the problem?

You know by the title of this pedcast, that there must be a dark side to powders. Well, you are right. Here are some observations that make pediatricians and other health experts worry about people using powders, especially talcum powders around babies.

Workers in talc factories often have lung problems.

Some babies who have inhaled large amounts of powders have had lung problems.

Some naturally occurring Talc has asbestos fibers in it thus creating the long-term concern about lung cancer.

In fact, a jury in 2017 awarded a cancer victim  $100,000,000, finding liability against the Johnson and Johnson Company.

The irony with powders, especially those that contain talc, is that what makes them so useful also makes them more hazardous to use– their small particle size. These very small particles, microns in size, can drift down deep into your and your baby’s lungs and sit there for long periods of time. These particles can provoke allergic reactions, scarring of your baby’s lungs, or possibly even cancers.

 

How do I Keep My Baby’s Bum in Shape?

 

Our friends across the pond, the Brits, call diapers Nappies. So how do you keep your baby’s nappies happy? How can you keep the delicate skin on their bottom from breaking down if you can’t use powders? Here are a few tips that can help keep your baby’s bum in good shape:

 

-Frequent changing of diapers

-Careful cleaning and drying before new diapers put on.

-Avoid chemical wipes

-Remember, babies skin thinner that older people. Be very gentle when cleaning their skin and only use a soft wipe with lots of water.  A soft cotton diaper cut up into squares makes a good cleaning clothe.

-Barrier creams are very helpful keeping irritating poop or pee away from the skin. I love these.

-And of course, avoid using powders. They can be dangerous to your family’s health.

Outro

Well, that wraps up today’s pedcast. If you enjoy learning about child health with pedcasts, please take a minute to write a review on iTunes or subscribe to my blog at www.docsmo.com. You can also spread the DocSmo word by hitting the like and share buttons on my Facebook, Twitter, Google+, or Instagram accounts.

This is Dr. Paul Smolen, broadcasting from studio 1E in Charlotte, NC, hoping you are now more aware, of the dangers of powdery air

Until next time

 

 

 

SmoNotes:

 

  1. “How Can I Make Sure My Baby’s Bedroom Is Safe?” American Academy of Pediatrics : Healthy Children 10 June 2010: 1. Web. 2 Apr. 2011. <http://www.healthychildren.org/English/safety-prevention/at-home/pages/Make-Babys-Room-Safe.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:%20No%20local%20token&nfstatus=401&nftoken=00000000-0000-0000-0000 000000000000&nfstatusdescription=ERROR:%20No%20local%20token>.

 

2. American Cancer Society. 04 Nov. 2010. 02 Apr. 2011 .

<http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/talcum-powder-and-cancer>.

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