Pearls of Wisdom: Overcoming Bedwetting

Although it’s a common issue that millions of families face, the stigma and shame attached to bedwetting or  nocturnal enuresis” is very real, especially to your child. Bedwetting is rarely caused by a serious medical condition and often resolves on its own, but the recurring matter can cause anxiety and embarrassment, not to mention precious time and money spent on doing laundry or buying new sheets.

The involuntary passing of urine after the age when bladder control should have been established is a common but perplexing problem that parents discuss during their doctor visits. The prevalence of this problem at 10 years old is 3% for boys and 2% for girls. The condition is divided between two forms; primary enuresis, when the child has never been dry at night and secondary enuresis, where the child has been confident for at least a year and then starts to wet the bed again. Around 75% of all enuretic children have primary enuresis and 50% of late school aged children have secondary enuresis.

Persistent bedwetting is usually secondary to inadequate and inappropriate toilet training. Parents who forcefully demand that their child use the potty when they’re not ready often elicits an angry reaction as the child unconsciously defy them by wetting the bed. In contrast, parents who are not sensitive to toilet train their child can sabotage the child’s attempt to successfully be potty trained. Certain psychological stress unrelated to toilet training such as moving to a new home, arrival of a new baby, divorce or death in the family can also affect bladder mastery. These types of bedwetting problems have a better prognosis, are self-limiting and easier to manage. Thankfully, very few cases are related to organic pathological conditions such as a urinary tract infection or bladder pathology.

Even during the most frustrating incidents, parents must keep in mind that bedwetting isn’t always caused by ineffective potty training, or your child; rather, it’s a result of miscommunication between your child’s brain and her bladder during sleep. It can also be a factor of genetics. Most children who wet the bed have at least one parent who had the same issue during their own childhood.  It’s important to be understanding, and to utilize a motivational/praise system like stickers for dry nights. In case of an accident, have your child help in changing the sheets and explain to him that this is not a punishment.

Sometimes the use of a bedwetting alarm which has a sensor that detects moisture can help by training the child’s brain to be more sensitive to full bladder signals. Have your child empty her bladder before retiring to bed, and limit fluid intake after dinner. Occasionally, your pediatrician may prescribe a drug called Desmopressin that signals the brain to produce less urine at night.  The downside to this remedy is it only lasts for a short period of time and a child can relapse when he discontinues the drug. It can be reserved for sleepovers, vacations, camps or other social over-night events.

Every year, a significant number of children ages 5 and up that used to wet the bed stay dry with no intervention. Still, parents should be proactive and should not feel embarrassed to approach the subject with their pediatrician. There is reason to remain positive as the prognosis for this condition is excellent for dry nights ahead. I always remind parents that during your child’s infant and toddler years, every day can seem like a year but in retrospect, years pass like a day. Bedwetting is almost always a temporary challenge and won’t last forever, any more than diapers will!

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Colic

COLIC – a word that instantly triggers feelings of fear and despair all too familiar to new and experienced parents everywhere. “Colic,” as a defined term, pertains to a symptom complex characterized by bouts of abdominal pain and severe crying. It is a common phenomenon in infants under 3 months of age. Attacks, which could last for hours, come out of nowhere. During a bout of colic, some or all of the following will occur: a baby will cry loudly and continuously;  his face turns red, the abdomen is hard and distended; legs may be drawn up on the abdomen; feet feel cold, and the hands are clenched. Episodes may last until the baby is completely exhausted; usually there’s no relief even after passing gas or stool. During this time, babies are often inconsolable, so this can be agonizing for parents who also attend to so much more: other children; work; studies; aging parents; housework, and other long lists of things to do.

Recurrent attacks usually occur between 6 pm and midnight, suggesting that events in the household routine may contribute to occurrence. Certain infants appear to be more prone to colic. The cause is oftentimes not obvious, although hunger and swallowed air that passes into the intestines could trigger colic. Certain foods, such as those with a high carbohydrate content, can lead to excessive fermentation in the gut. There is no single factor that consistently causes colic, nor does any specific treatment consistently give relief.

Although colic episodes usually resolve on their own, there are a few things that could be helpful and worth trying:

  • Hold the baby upright or lay her prone across your lap or over a heating pad and gently rub her back. Putting gentle pressure on her belly may comfort her.
  • If mom is nursing, advise her to avoid milk products, caffeine, onions, cabbage and other gas-forming foods from her diet. For formula fed infants, switching to a protein hydrolysate formula could lessen the colic; this is something your pediatrician can help you decide.
  • Overfeeding could cause discomfort and abdominal distension. Try to wait at least 2 -3 hours between feedings and always remember to burp baby after feedings.
  • A pacifier could be introduced to help calm the baby. Every baby takes to the pacifier differently, and while breastfed babies may refuse it, it can provide relief to others.
  • Steady, rhythmic motion and calming sounds may help them fall asleep. You can try rocking her, running the vacuum or clothes dryer in the next room, a fan, air conditioner or any form of white noise.
  • Try swaddling her in a thin, cotton blanket. This usually makes babies feel secure and warm.
  • Take a break! Ask a family member or a trusted friend to stay with the baby even for a couple hours just so you can keep sane and relieve your tension and anxiety.

Preventing attacks may be achieved by changing feeding techniques, identifying allergenic foods in a nursing mom’s diet, and promoting a stable emotional environment. Know that there is light at the end of the dark tunnel, since most colic rarely persists after 3 months of age.

It’s best to pay your pediatrician a visit so she/he can thoroughly examine your baby to rule out any of the more serious conditions that could mimic colic. These include bowel obstruction, strangulated hernia, and blood or urine infections. If you feel you’ve reached a point of depression and are having a difficult time dealing with stress and emotions, seek help from your own physician. Remember, your baby takes her cue from you; hence, if you are smiling and laughing, he feels good and smiles back at you. Likewise, if you are overly stressed, sad or angry, these feeling are rubbed off on your baby. Whatever you do, please don’t be too hard on yourself. Even Supermoms have their limits!

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Introducing a New Baby

The first two years establish the attachment phase of a child’s life. When they have your undivided attention with every need met, their world is a warm, safe and secure place. They’re comforted in knowing that your focus is entirely on them. As they grow a little older, the arrival of a new baby brother or sister means making certain adjustments such as “delaying  gratification” and “waiting”, concepts  that are all new to him. He has to realize that there is another family member who is as important as he is. Few experiences initiate this rite of passage in the same way as the birth of a new brother or sister. With the arrival of a new sibling, your older child has to understand what it means to wait and share. These social skills will be learned and understood early and will last a lifetime. During your pregnancy your toddler senses that something is different. Change could be upsetting to him, therefore, you as the parent can alleviate his anxiety by explaining to him the physical changes of Mom, the growth of his family and what to expect in the coming months ahead. First of all, keep it simple.  You can tell your child, “When moms and dads love each other they can decide to have a baby.” However, it is best to tell children under two during the last trimester when your belly starts to show to avoid any confusion.

Involve your toddler. Allow her to participate by taking her along to your prenatal checkups so she can hear the baby’s heartbeat and see the sonogram pictures. Let her touch your belly when the baby kicks and take him on trips to stock up on newborn supplies. Find out if your hospital provides classes for expectant siblings so she can learn what a new baby is like. Make your toddler the star. Reminisce and replay his own infancy by going through his baby album. While doing this you can give him scenes to help get a sense of what to expect. For example, “Mommy will carry the baby a lot, just like I carried you” or “Tiny babies eat constantly like you did when you were that small.” Share the happiness.  Remember, while you’re in the hospital your toddler will want to know where she and you will be staying and what he’ll be doing. Prepare him for whoever is your substitute while you are away. For example, tell him, “When mama is in the hospital, Nana will come for a sleepover and you can draw pictures to put in the new nursery.”  Later, have your family members take your toddler along for visits to the hospital so he can experience the joy of his new baby brother or sister’s arrival with the rest of his family. Every child will react differently to the baby’s homecoming, but the following are some suggestions to promote positive sibling interactions. Keep in mind that their early days together set the foundation for a healthy long-term bond. Be nice twice. Before giving birth, wrap a few small gifts for your toddler so she can open them when friends and family lavish gifts on the new baby.  This way, you allow her to share some of the attention the baby is getting.  Encourage her to give the new baby a welcome gift from big brother or sister. She’ll be eager to give a gift like everyone else around her. Give extra praise.  Don’t let your toddler feel neglected. Instead of saying, “what a beautiful baby”, you can say, “Now she has a beautiful big sister or brother.” Toddlers are fascinated with babies so you can use their interest by explaining what you think the baby is thinking. For example, say, “the baby is grabbing your finger so he must really like you.” This will allow him to reciprocate the act in a positive way. Highlight your toddler’s talents and celebrate each child’s individuality. Be generous in encouraging your toddler to be a good role model for the baby by saying something like, “John, this is such a lovely drawing! One day you’ll teach your baby sister how to draw and color.”

Equal opportunity is key. Although new babies are generally high maintenance, you can find ways to share with your toddler the time you spend caring for the baby.  As he gets older, encourage him to entertain her like making funny faces, playing peek-a-boo or singing lullabies. Take time to allow your toddler to just cuddle, hug or touch you while your new baby takes naps. Make him feel loved in a special way such as telling him,” You are my favorite first child in the whole wide world.” More Daddy Time.  As mom gets all wrapped up in caring for the little one, daddy can also take advantage of this time and bond more with your toddler.  While the older child feels she has lost some of mom, she actually gets more of dad. Enter dad outings to the zoo, the ice cream parlor, the ballpark or just hanging out in the living room.

A New Friend! Try giving a new doll, a new teddy bear, or some kind of toy to your child just before the baby arrives. You can tell your toddler that he has someone new to add to his family of play friends, and suggest all the ways he can care for his new toy. These can mirror the things you will be doing for the new baby, and you can create some understanding and empathy for the newborn this way. When the infant needs to be changed, suggest that your toddler give their new toy a “diaper change” as well. By empowering your toddler and showing how important it is to welcome a new toy into the home and care for it, he may better understand your new role as well. Patience is a virtue.  Face it, your toddler will show frustration and your job is to help them learn how to manage these negative feelings of anger, jealousy and sadness.  Offer a trade-off, like, “John, now is not a good time but after I feed Timmy we can go bake your favorite cookies.”  Make him feel important by constantly thanking him or her for all their help and for being a good big sister or big brother. No relationship compares to the strong bond formed between siblings. With a little help from mom and dad, siblings can grow up to be each others confidantes, buddies, partners in crime, BFF’s or compadres. They will have many friends as they go through life, but family and siblings are forever.

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Parental Attachment

Bonding between a parent and a healthy baby begins right after birth, but there is a fine distinction between a strong, nourishing connection and unhealthy attachment. It’s a natural instinct for mom to seek ways of comforting her crying and fussy baby by cuddling, caressing, kissing and rocking. Both parents offer security and warmth to this new, but almost instant closeness; especially true with a mother-infant relationship. That bond will eventually have a profound impact on how this tiny human being functions in the world.

A baby communicates by cooing, smiling, gesturing, crying, and moving his body. When his needs are met by his mother and father, he feels safe, wanted and worthy. A stable parental-child relationship sets the foundation for the establishment of healthy circuitry in his brain which can impact his language skills as well as his emotional and social development as he matures.

Unfortunately, attachments between parents and infants are not all perfect. Some parents are apathetic to their baby’s needs to the point where neglect is a very real issue. Whether it’s because they’ve read that newborns must “cry it out,” or because other family members warn that holding a newborn too much is “spoiling” the baby, many new parents avoid consistent responses to a newborn’s cries.  But a lack of nurturing, even in an otherwise stable home environment, will have a negative impact on a baby’s healthy maturation. Even parents who respond inconsistently to baby’s cries reinforce this behavior, sending signals to the baby to scream harder and louder. Parents worry about over-coddling their little one and sometimes ignore their baby’s screaming, but in doing so, fail to understand that babies do not know how to manipulate or test them on purpose.

Many decades of pediatric research have shown that babies develop socially, mentally and emotionally in direct relation to the parents’ responsiveness and sensitivity. Oftentimes, parents who failed to provide a comforting and secure base are linked to insecurity and even aggression in young children. Studies suggest that these aggressive tendencies can affect their social interactions with family and friends as well as their academic performance later in life. Babies whose needs were ignored early on habitually experience delays in speech and emotional maturation.

A securely attached child seeks mom’s reassurance, receives it, and then calmly returns to their activities even in an unfamiliar setting or in the presence of strangers. Children who spend a good deal of time with non-maternal childcare showed little impact on parental attachment as long as the mother’s responsiveness and sensitivity are at a reasonably attentive level. Quality not quantity of time spent with your child is what matters most, which is notably helpful and positive for working moms.

Parenting is never a simple, made to order skill. To complicate things further, moms and dads are saturated with information about parenting fads, they often get pressure from grandparents, and receive a great amount of advice from “experts.” Parents must develop their own bonding and attachment with their child by relying more on their good judgment and intuition. Every family works it out uniquely and differently. The secret to healthy parenting is to give babies a secure foundation so they can venture out in the world, explore their environment, face obstacles and challenges, overcome these tests and then make gratifying developmental breakthroughs on their own.

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Newborn Skin Conditions

shutterstock_28299541We’ve all seen pictures in books and magazines of the perfect newborn, swaddled in a hospital blanket, nestled into her parents welcoming arms. She is as perfect as a rose, with a tiny upturned nose and lovely, clear skin. It’s no wonder that parents are often surprised when their newborns present with a variety of rashes and skin conditions. The Majority of these rashes are harmless and self-limiting, and will resolve on their own or with appropriate treatment.

Normal newborn skin is thin and less hairy than older children and adults. Also, the ratio of skin surface to body volume is high which leads to increased absorption of topical medications.  Frequent manipulation, hot water and harsh soaps are some of the factors that lead to irritation and skin breakdown. Once there are breaks in the skin, these become portals of entry for bacteria, leading to serious skin infections.  Frequent use of moisturizers helps re-hydrate the skin and prevents excessive dryness and skin infections.

There are a number of benign skin changes that are seen in the first few weeks after birth. The more common ones include the following:

* Salmon Patches (also known as “stork bites”) are vascular stains frequently found on the nape of neck as well as the glabella (space between the eyebrows and above the nose) where they are called “angel’s kisses.”  They are found in 70% of white babies and 59% of African American newborns. Although these lesions may fade over time, 25-50% may persist into adulthood.

* Hemangiomas initially appear as flat red patches that darken and spread with time. They may be elevated , bright–red or violet in color, depending on how deep they are. Rapidly growing lesions may require steroids and/or laser therapy, although many will just fade and regress with age.

shutterstock_113526559* Infantile or Neonatal Acne usually appears at 2-4 weeks of age and resolves by 6-8 months. Experts believe that this is an inflammatory response to an organism called Pityrosporum yeasts.  This skin condition usually does not warrant therapy unless very severe in which case, a 2.5% benzoyl peroxide treatment as well as topical antibiotics may be prescribed.

* Atopic Dermatitis (Eczema) is an extremely common itchy scaling disorder that appears between 4-6 weeks of age. It may present on the cheeks, trunk, in bends of elbows and behind knees. Many babies either have a family history of eczema and/or allergies. A good 60% of babies who have eczema or atopic dermatitis outgrow it. Medications can help control flare-ups but does not cure it. I usually recommend avoiding long, hot baths and applying moisturizers daily. Sometimes, we recommend non-steroidal or steroidal creams and antihistamines for itch.

shutterstock_56934568* Seborrheic Dermatitis is the most common scaling skin disorder in infants. It appears immediately after birth, usually affecting the scalp (called “cradle cap”), behind ears, and on the face. It appears like well-demarcated, confluent red patches with greasy scales. This type of dermatitis does not itch and usually resolves by 3-6 months of age. Treatment depends on severity; usually your doctor may prescribe antiseborrheic shampoos that contains zinc and selenium sulfide. Using mineral oil before shampooing may help remove the scales. In the presence of a superimposed fungal infection with Candida, an anti-fungal may be prescribed.

* Diaper Dermatitis is a nonspecific term that pertains to all skin eruptions in the diaper area. Irritant diaper dermatitis is secondary to a variety of factors that include fecal enzymes that erode the skin barrier, prolonged exposure of skin to moisture, and the presence of ammonia in the baby’s urine. Babies with diarrhea and those taking antibiotics also are at risk. Mild cases can be treated with topical zinc oxide paste or a petrolatum emollient which acts as a protective barrier against soiling elements. Frequent changing of diapers is recommended to reduce moisture and time exposed to extrinsic factors. In severe instances, 1% hydrocortisone cream applied after diaper changes may be given.

Plain water with or without a mild soap should be used to gently clean the baby’s skin. Your infant does not require frequent bathing if you wash the diaper area thoroughly during diaper changes. Bathing babies too frequently dries out their skin especially if soap is used. Patting her dry opposed to rubbing hard, followed by application of a fragrance-free, hypoallergenic, moisturizing lotion immediately after bathing can help prevent dryness and eczema. In other words, be gentle with your baby’s skin and avoid substances that have triggered skin rashes or irritations in the past. When in doubt, do not diagnose and treat baby without visiting your pediatrician, who can decide whether the rash is a harmless, benign lesion or something that needs referred to a dermatologist.

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.