Pearls of Wisdom: Infant Nutrition

Infant FeedingWhen it comes to infants and children, basic nutrition choices have a lifetime impact on overall health and are key for satisfactory growth and avoidance of deficiency states. Adequate nutrition helps in the prevention of acute and chronic illnesses; maximizes physical and mental potential and provides reserves for stress. During infancy, it’s all about milk, whether breast milk, formula or a combination of the two. Breast milk and formulas contain enough nutrients needed by babies in the first year of life. Around 4 -6 months of age, most babies can start consuming solid foods like iron-fortified cereal, mashed fruits and vegetables, and pureed meats. As you introduce more foods, keep in mind that a healthy amount of fat is important for the babies’ brain and nerve developments – unless advised by your doctor for particular health reasons, low-fat options can be avoided.

The feeling of ease between infant and mother is essential to successful infant feeding. When mom can establish a comfortable, satisfying feeding practice, the result is usually emotional well-being of both the mother and infant. Remember that mom’s feelings are readily transmitted to the baby and greatly influence the emotional setting in which feeding takes place. Hence, a tense, anxious, and emotionally labile mother is more likely to develop a difficult feeding relationship with her baby. It’s helpful if she receives appropriate guidance and support from an empathetic family member, friend or physician.

Infant FeedingImmediately after birth, the infant can safely tolerate feedings to ensure a smooth transition from fetal to extrauterine life, to promote maternal- infant bonding and prevent hypoglycemia and electrolyte imbalances. It is critical that your infant receives enough fluids so he will not develop dehydration. Moms who wish to initiate breastfeeding in the delivery room are definitely encouraged to do so. Subsequent feedings either by breastfeeding or bottle feeding are given every 3-4 hours a day and at night. That’s a lot of eating! This is based on the time it takes for the infant’s stomach to empty and varies from 1-4 hours. Do not expect your baby’s feeding schedule to be consistent immediately after birth.  However, by the end of the first month, 90% of babies will establish a more regular feeding schedule. Majority of healthy formula-fed infants will want 6-9 feedings per day by the end of the first week of life. Some babies are satisfied with every four hour feedings, while others who have a faster gastric emptying time will want to eat every 2-3 hours. Interestingly, most breast-fed babies get hungry quicker and require more frequent feedings with shorter intervals. This just reinforces the fact that individual feeding needs vary and one infants’ feeding would not be expected to fit the pattern of another. The best parameter of successful infant feeding is weight gain by the time the baby reaches the second week of life.

Infants cry for various reasons and babies do not need to be fed every time they cry. Usually, sick babies are not interested in feeding and if an infant refuses food, this should act as a red flag to see your pediatrician. If your baby is constantly waking up every 1-2 hours, he may not be receiving enough milk at each feeding or be suffering from infantile colic. This can be addressed during your doctor’s visit and may involve discussions about formula choice and feeding practices. It is important to know that babies cry for reasons other than hunger. Some may just need to be picked up and held, others may continue to cry even after feeding so it’s important to carefully evaluate your infant’s health and behavior for other potential causes of distress. Try to discourage the habit of frequent small feedings, holding and feeding to pacify crying as he may become too reliant on you to calm him.

Infant FeedingThe post-partum period is oftentimes a period of much anxiety and insecurity for first-time parents who may be overwhelmed by the responsibilities that comes with having a new baby. The questions are endless: Am I feeding her enough?  Is she having diarrhea? Should I switch formulas? The list goes on and on. This is why anticipatory guidance sessions should be scheduled between you and your pediatrician. During each office visit, your doctor is already tracking your baby’s weight gain and monitoring whether her weight is steadily increasing. Normally, babies in the first four months of life gain 1 ½ lbs-2 lbs per month and grow 1-1 ½ inches. By the time he is a year old, he would have tripled his birth weight.  Breastfed babies also tend to be chubbier than formula-fed babies in the early months of life however they become leaner by nine months to one year of age.

Parents need to understand the goal of infant’s “self- regulation.” Once the infant establishes a regular feeding schedule, other family members are able to resume their normal daily routine with minimal disruptions. It doesn’t take long to achieve the confidence and calm of an experienced parent. Your baby will give you enough signals and clues as to how she likes to be treated, talked to, held and comforted.  This very special bond, once established will guide you through this challenging stage and the next.

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.

Pearls of Wisdom: Emotional Bonding- Part 1: Birth to 12 Months

We hear the term “bonding” so often in modern culture that it’s easy to minimize its importance and impact. But the bond between parents and children is so critical that immediately after delivering a baby, barring complications, a mother will be given some time to spend holding, stroking and looking at her baby. During this sensitive period when the newborn is very alert and responsive, the very first exchanges of touch, eye contact and sounds between a mother will occur; these first interactions are all part of the bonding process.

Many of the basic core emotions you feel for your child will begin during the period right after birth. Watching your baby look back at you, mirroring your facial expressions and following your movements, you will feel a wonderful surge of awe, protectiveness, and limitless love. This initiates what is called the attachment process. Moms who are sedated or who have babies requiring immediate medical attention may not be able to spend this time but should not worry. This will have no long-term repercussions on their relationship since bonding has no time limit. Once your baby is stable and you have recovered from the stress of labor, you will have this opportunity and achieve the same heightened connection.

shutterstock_78150679Parents have an active role in the infant’s state regulation, by alternately offering stimulation or soothing to lengthen the social interaction. Likewise, the parents are regulated by the baby’s signals, responding, for instance with a bottle or breast to answer cries of hunger. These interactions comprise a system directed toward developing the infant’s normal physiologic homeostasis and physical growth. This also forms the foundation for the budding relationship between parent and child. Your baby learns that you as the primary caregiver can alleviate her stress or tension by feeding and shows this preference by calming down quicker for the mom or dad than for a stranger. In turn, this gives Mom a sense of validation and strong connection with her infant. Breastfeeding is a wonderful means by which mothers feel fulfillment and joy from the physical and emotional connection they experience while nursing. These warm feelings are augmented by the release of the hormone prolactin, producing relaxation and the hormone oxytocin, which promotes the sense of love and attachment between mother and infant.

Babies learn basic trust when they realize that their urgent needs are met. The presence of an adult who provides consistency creates the scenario for a secure attachment. Studies show that infants who are consistently picked up and held in response to distress cry less at 1 year and show less aggressive behavior at 2 years.

shutterstock_130586048By the age of 2 months, infants have their first voluntary social smiles and their amount of eye contact increases, marking a change in the parent-child bonding and also giving the parents a sense of being loved back. The baby interacts with increasing sophistication and range, expressing varied emotions of joy, anger, fear, interest and surprise by different facial expressions. When interacting with a trusted adult, the infant and the caregiver have matching expressions about 30% of the time; the eye-widening, laughing and lip-puckering rises and falls together. If the parent turns away, the baby leans forward and reaches out to get the adult involved again. Infants of depressed parents have a different pattern and spend noticeably less time in coordinated movement with their parents, and make less effort to re-engage. They show sadness, apathy and a loss of energy when the parents are not available. This face- to- face behavior demonstrates a baby’s ability to share emotion and expectation from the relationships, which is the initial step in communication.

Babies 6-12 months old show advances in cognitive understanding and communication ability, with new tensions around themes of attachment and separation. Babies look back and forth between a stranger and a parent, as if to contrast a familiar versus an unfamiliar, and may cling or cry. At the same time, there is an emergence of asserting independence; hence, they attempt self-feeding and refuse to take the spoon from the caregiver. This is when temper tantrums arise as the desire for autonomy comes into conflict with parental control.

The unique emotional relationship that forms between you and your baby is key to him feeling safe, and also influences your child’s social, emotional, intellectual and physical development. A secure bond ensures that your baby will have a firm foundation for life, which includes a healthy sense of self-awareness, eagerness to explore and learn, and trust and respect for others. When babies develop a secure attachment bond, they are better able to enjoy interacting with others, develop confidence, handle disappointment, loss or stress, form mature intimate relationships and maintain emotional balance.

How do you bond with your children? Share your stories in the comments or on our Facebook page!

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: Naptime

Over the years, countless parents have asked me how to get babies to sleep through regular intervals on a daily basis. Naptime is an essential part of a baby’s development and health, but it’s also good for parents, who use those hours to give more attention to other children, catch up on chores, cook, or even to nap themselves!  Here are some of my thoughts on successful snoozing.

Regardless of your child’s age, sticking to a regular routine is essential to get your baby off to a sound sleep. Very young babies will sleep through all kinds of noises and don’t necessarily need absolute quiet…think of how many times your baby has fallen asleep in his car seat while horns are honking!  If a baby grows accustomed to sleeping only when there is silence, parents can set themselves and their child up for problems later on, when siblings are noisy, the telephone rings or the television is on.

When is the best time to lay baby down in her crib for a nap?  You, and not necessarily the clock, will be the best judge of that! It’s vital that you watch for signs of fatigue such as fussiness, crying for no reason, or refusing to play, as these are clear signs that it’s time for a nap.

The average newborn may spend at least 16 hours a day sleeping!  As they mature, babies’ sleep requirements gradually decrease, averaging about 14 hours by the time they are six months old and a little less than 14 hours by the age of one.  The duration of newborns’ naps are variable, often random, and quite unpredictable depending on circumstances (noise level, distractions, discomfort, etc.)  Ideally, newborns settle into a three-nap–per-day schedule by the age of 2-3 months: an hour in the morning, two hours in early afternoon and another short nap in the evening. Moms and dads who bring their babies to a daycare or a nursery may expect their babies’ sleep patterns to be slightly different but eventually, babies adapt and will stick with a pattern that’s in synch with parents’ sleep cycles.

After two years of age, toddlers do not require that much sleep; usually, 1-2 hours in the afternoon is sufficient. This isn’t true for every child but more important is that he or she is active, playful and energetic.  Here’s something that should be kept in mind: it’s not necessary to stop daytime naps with the intention of making babies sleep better at night. Many new parents assume that eliminating naps will result in better nighttime sleep for their child, or greater willingness to go off to sleep.  Oftentimes the opposite can be true! Keep in mind that lack of sleep during the day may lead to behavioral problems and hyperactivity at night.  An overly exhausted child will be agitated, irritable and less likely to wind down for bed… same as an overly exhausted adult!

By four year of age, naptime is usually eliminated, for better or for worse. Before entering school, I suggest limiting naps to weekends only, in order to prepare your child for this big transition. Though daycare centers often include naptime in toddlers’ schedules, many preschools do not and by kindergarten, it’s virtually eliminated.

There are a few strategies that parents can practice to develop a healthy naptime routine:

1. Mom and dad can observe baby’s behavior to see when he or she exhibits signs of fatigue; making naptimes regular and based on when the baby is tired.

2. Engage your baby in active play when awake.

3. Schedule feeding times before naptime so baby will not get hungry and cut short his naps

4. Again, develop a routine around naptime like using a favorite blanket or stuffed toy to calm her down. Then move her to her crib once she’s sleepy.

5. Other effective strategies include: swaddling baby in a blanket; rocking baby in your arms or in a rocking/gliding chair; using white noise or music (singing quietly to baby or playing lullabies) to drown out jarring daytime noise; changing the baby’s diaper before his nap; taking a short walk with baby in a stroller, or even just turning down the toddler bed and telling a story.

These suggestions, combined with patience and experimentation, should provide a plan for good sleep patterns. After all, it’s a parent’s responsibility to satisfy baby’s needs and helping him or her adjust to family life. This will take time and many tears – maybe even fits and tantrums —  but with effort, you will be rewarded with a child who literally ”sleeps like a baby.”

How do you encourage naptime?  Post in the comments below, or go over to BabyLegs’ Facebook page and look for today’s post on naptime. Share your own pearls of wisdom with other BabyLeggers who might need help with this important part of baby’s daily routine.

Warm Regards,

Dr. Pearl

 

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.