Practical Pacifier Principles

Pacifiers have proven themselves to be yet one more source of parenting controversy. Breastfeeding purists say stick to your guns and keep them out of your newborn’s mouth—even when your baby is not yet able to use his own fingers as an alternative. (We would note that if and when your baby is able to find his own fingers, it’s OK to let him continue using them as natural pacifiers.) Others forewarn that pacifiers are simply a bad habit waiting to happen. Well fear not, as long as you understand a few practical pacifier principles and pitfalls. In fact, pacifiers have, in recent years, earned the status of a valuable ally in the fight against sudden infant death syndrome. Whether you choose to breastfeed or bottle-feed, or a combination of both, here are some tips for if and when you decide to give your baby a pacifier.

• Soothing through sucking. Pacifiers can be invaluable in soothing babies as well as satisfying those who want to suck all the time. You need not worry about your baby developing a lifelong dependency on them. Just be very careful not to offer your newborn a pacifier at times when he really should be fed instead because pacifiers can inappropriately pacify hungry babies as well as those who are looking for comfort.
• Picking out the perfect pacifier. These days, picking the perfect pacifier may seem like a considerable task, given all of the various brands and styles on the market. To the best of our knowledge, there’s no correlation between price or marketing strategy and effectiveness, so we simply recommend trying one out and seeing if your baby likes it.
• If at first you don’t succeed. When you first offer your baby a pacifier, don’t be surprised if he seems uninterested, gets downright angry, or spits it out even when you know
  he’s not hungry and just wants comfort. For breastfed babies, sucking on a pacifier inherently requires a different technique, and one that may take a few tries. For breastfed and bottlefed babies alike, a nipple that does not provide milk may not be quickly welcomed. As you offer your baby a pacifier, try lightly stroking just to the side of his mouth and then gently holding the pacifier in his mouth for a moment as he starts sucking to keep it from popping right back out.
• A practical pacifier substitute. The cheap, easy, and ever-present pacifier substitute: your pinky finger. If you find yourself in the position of wanting to soothe your baby by giving him something to suck on other than your breast, you can always use your (clean) little finger. Simply turn your hand palm-side up and let your
  baby suck on your pinky finger, allowing it to rest gently in the roof of his mouth. As a word of caution for anyone with longer fingernails than ours—you may want to rethink how much you value your long nails, or at least the one on your little finger. You may find that it’s a small sacrifice to make to clip it shorter for the sake of having a contented baby. Some babies will learn to find their own fingers to suck on earlier than others, so do your best to make sure those fingers are clean (and have clipped nails too!)
• Passing on pacifiers. If your baby just isn’t that much of a “sucker,” he may not need to be soothed by sucking on a pacifier at all. Just be thankful that there’s one less thing to keep track of during the day, and just consider offering one as he is falling asleep.

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A Parent’s Guide To Safe Sleep

Did You Know?

• About one in five sudden infant death syndrome (SIDS) deaths occur while an infant is in the care of someone other than a parent. Many of these deaths occur when babies who are used to sleeping on their backs at home are then placed to sleep on their tummies by another caregiver. We call this “unaccustomed tummy sleeping.”
• Unaccustomed tummy sleeping increases the risk of SIDS. Babies who are used to sleeping on their backs and are placed to sleep on their tummies are 18 times more likely to die from SIDS.

You can reduce your baby’s risk of dying of SIDS by talking to those who care for your baby, including child care providers, babysitters, family, and friends, about placing your baby to sleep on his back at night and during naps.

Who Is At Risk For SIDS?

• SIDS is the leading cause of death for infants between 1 month and 12 months of age.
• SIDS is most common among infants that are 2-4 months old. However, babies can die of SIDS until they are 1 year old.

What Can I Do Before My Baby Is Born To Reduce The Risk of SIDS?

Take care of yourself during pregnancy and after the birth of your baby. During pregnancy, before you even give birth, you can reduce the risk of your baby dying from SIDS! Don’t smoke or expose yourself to others’ smoke while you are pregnant and after the baby is born. Be sure to visit a physician for regular prenatal checkups to reduce your risk of having a low birth weight or premature baby. Breastfeed your baby, if possible, at least through the first year of life.

Know The Truth…SIDS Is Not Caused By:

• Immunizations
• Vomiting or choking

What Can I Do To Help Spread The Word About Back To Sleep?

• Be aware of safe sleep practices and how they can be made a part of our everyday lives.
• When shopping in stores with crib displays that show heavy quilts, pillows, and stuffed animals, talk to the manager about safe sleep, and ask them not to display cribs in this way.
• Monitor the media. When you see an ad or a picture in the paper that shows a baby sleeping on her tummy, write a letter to the editor.
• If you know teenagers who take care of babies, talk with them. They may need help with following the proper safe sleep practices.
• Set a good example – realize that you may not have slept on your back as a baby, but we now know that this is the safest way for babies to sleep. When placing babies to sleep,
  be sure to always place them on their backs.

It Is Easy and Free To Make Safe Sleep Practices A Part of Your Daily Life.
This way, you will know that you are doing all that you can to keep your baby healthy and safe. Do your best to follow the guidelines above.

Where Is The Safest Place For My Baby To Sleep?

The safest place for your baby to sleep is in the room where you sleep. Place the baby’s crib or bassinet near your bed (within an arm’s reach). This makes it easier to breastfeed and to bond with
your baby.

The crib or bassinet should be free from toys, soft bedding, blankets, and pillows.

How Can I Reduce My Baby’s Risk?

Follow these guidelines to help you reduce your baby’s risk of dying from SIDS.
Safe Sleep Practices

• Always place babies to sleep on their backs during naps and at nighttime. Because babies sleeping on their sides are more likely to accidentally roll onto their stomach, the side position is not as safe as the back and is not recommended.
• Don’t cover the heads of babies with a blanket or overbundle them in clothing and blankets.
• Avoid letting the baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing. Dress the baby lightly for sleep. Set the room temperature in a range that is comfortable for a lightly clothed adult.

Safe Sleep Environment

• Place your baby in a safety-approved crib with a firm mattress and a well-fitting sheet (cradles and bassinets may be used, but choose those that are JPMA (Juvenile Products
  Manufacturers Association) certified for safety).
• Place the crib in an area that is always smoke free.
• Don’t place babies to sleep on adult beds, chairs, sofas, waterbeds, or cushions.
• Toys and other soft bedding, including fluffy blankets, comforters, pillows, stuffed animals, and wedges should not be placed in the crib with the baby. These items can impair
  the infant’s ability to breathe if they cover his face.
• Breastfeed your baby. Experts recommend that mothers feed their children human milk at least through the first year of life.
• Pediatrics, P.C. does not recommend co-sleeping

Talk About Safe Sleep Practices With Everyone Who Cares For Your Baby!

When looking for someone to take care of your baby, including a child care provider, a family member, or a friend, make sure that you talk with this person about safe sleep practices. Bring this fact
sheet along to help, if needed. If a caregiver does not know the best safe sleep practices, respectfully try to teach the caregiver what you have learned
about safe sleep practices and the importance of following these rules when caring for infants. Before leaving your baby with anyone, be sure that person agrees that the safe sleep practices explained in this article will be followed all of the time.

Is It Ever Safe To Have Babies On Their Tummies?

Yes! You should talk to your child care provider about making tummy time a part of your baby’s daily activities. Your baby needs plenty of tummy time while supervised and awake to help build strong neck and shoulder muscles. Remember to also make sure that your baby is having tummy time at home with you.

Tummy To Play and Back To Sleep

• Place babies to sleep on their backs to reduce the risk of SIDS. Side sleeping is not as safe as back sleeping and is not advised. Babies sleep comfortably on their backs, and no special equipment or extra money is needed.
• “Tummy time” is playtime when infants are awake and placed on their tummies while someone is watching them. Have tummy time to allow babies to develop normally.

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Diaper Rash Solution

What can I do if my baby gets diaper rash?

If your baby gets diaper rash (and to prevent future diaper rashes) it’s important to keep the area as clean and dry as
possible. Change wet or soiled diapers right away. This helps cut down how much moisture is on the skin.

• Gently clean the diaper area with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing.
• Pat dry; do not rub. Allow the area to air-dry fully.
• Apply a thick layer of protective ointment or cream (such as one that contains zinc oxide or petroleum jelly). These ointments are usually thick and pasty and do not have to be
  completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more.
• Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled parts do not rub against the skin as much.
• Use creams with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.
• Check with your pediatrician if the rash
  • Has blisters or pus-filled sores
  • Does not go away within 2 to 3 days
  • Gets worse

Causes of Diaper Rash

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

• Too much moisture
• Chafing or rubbing
• When urine, stools, or both touch the skin for long periods of time
• Yeast infection
• Bacterial infection
• Allergic reaction to diaper material

When skin stays wet for too long, it starts to break down. When wet skin is rubbed, it also damages more easily. Moisture from a soiled diaper can harm your baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop.

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often when

• Babies get older—mostly between 8 to 10 months of age.
• Babies are not kept clean and dry.
• Babies have frequent stools, especially when the stools stay in their diapers overnight.
• Babies have diarrhea.
• Babies begin to eat solid foods.
• Babies are taking antibiotics, or in nursing babies whose mothers are taking antibiotics.

Call the Pediatrician If:

• The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
• The rash includes
  blisters or pus-filled sores.
• Your baby is taking an antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
• Your baby has a fever along with a rash.
• The rash is very painful. Your baby might have a skin condition called cellulitis

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Brushing Up on Oral Health: Never Too Soon

As the AAP and other children’s organizations report, tooth decay (also called early childhood caries, or ECC) is the most common chronic children’s disease in the country. As a result, it is very important that parents work with their pediatrician to establish good oral health care from the first weeks of their baby’s life. Although most of us think of dental care in relation to our own dentists, parents will be working closely with their pediatrician even earlier than with a dentist.

“Traditionally, the assessment and treatment of oral health problems has not been considered to be the domain of pediatricians, but that is changing,” says Eileen M. Ouellette, M.D., past president of the AAP.

“Since pediatricians see young infants and children frequently for preventive health care visits, we are in an excellent position to identify children at risk for dental health problems, coordinate appropriate care and parent education, and refer affected and highrisk children to pediatric dentists.”

The Centers for Disease Control and Prevention (CDC) has stated that dental caries is five times more common than asthma and seven times more common than hay fever in children. More than 40 percent of children have tooth decay by the time they reach kindergarten. Children with dental caries in their baby teeth are at much greater risk for cavities in their adult teeth.

Health care professionals know that tooth decay is a disease that is, by and large, preventable. Because of how it is caused and when it begins, however, steps to prevent it ideally should begin prenatally with pregnant women and continue with the mother and young child, beginning when the infant is approximately 6 months of age. Pediatricians have become increasingly aware that their own proactive efforts to provide education and good oral health screenings can help prevent needless tooth decay in infants.

For parents who wish to establish good dental health for their infants, the following general guidelines may be of help:

• Fluoride and Your Child: Fluoride is a naturally occurring mineral that is found in many foods, and it also is added to the drinking water in some cities and towns. It can benefit dental health by strengthening the tooth enamel, making it more resistant to acid attacks that can cause tooth decay. It also reduces the ability of plaque bacteria to produce acid. Check with your local water utility agency to fi nd out if your water has fluoride in it. If it doesn’t, ask your doctor if you should get a prescription for fluoride drops or chewable tablets for your child.
• Check and Clean Your Baby’s Teeth: Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist. Clean your child’s teeth as soon as they come in, using a clean, soft cloth or a baby’s toothbrush. Clean the teeth at least twice a day. It’s best to clean them right after breakfast and before bedtime. At about age 2, most of your child’s teeth will be in. Once your child can spit and not swallow the toothpaste (usually around ages 2 to 3), begin using fluoride toothpaste. Use a pea-sized amount of
  toothpaste to limit the amount she can accidentally swallow. As your child gets older let her use her own toothbrush. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Until children are 7 or 8 years old, you will need to help them brush. Try brushing their teeth fi rst and then letting them finish. Be sure that you spread the toothpaste into the bristles of the brush and use only a pea-sized amount of toothpaste.
• Feed Your Baby Healthy Food: Choose drinks and foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies. Be careful with dried fruits, such as raisins, since they easily stick to the grooves of the teeth and can cause cavities if not thoroughly brushed off the teeth.
• Prevent Tooth Decay: Do not put your baby to bed with a bottle at night or at nap time. (If you do put your baby to bed
  with a bottle, fill it only with water.) Milk, formula, juices and other sweet drinks, such as soda, all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near his first birthday, you should teach your child to drink from a cup instead of a bottle.
• Talk With Your Pediatrician About Making a Dental Home: Since your pediatrician will be seeing your baby from the first days and weeks of life, plan to discuss when and how you
  should later develop a “dental home”—a dentist who can give consistent, high-quality, professional care—just as you have a “medical home” with your pediatrician. Usually, your dentist will want to see a child by his first birthday or within six months of the first tooth’s emergence. At this first visit, your dentist can easily check your child’s teeth and determine the frequency of future dental checkups.

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Spitting Up and your baby

Definition
The effortless spitting up (reflux) of 1 or 2 mouthfuls of stomach contents

Symptoms

• Smaller amounts often occur with burping (“wet burps”)
• Larger amounts can occur after overfeeding
• Usually seen during or shortly after feedings
• Occurs mainly in children under 1 year of age and begins in the first weeks of life
• Caution: normal reflux does not cause any crying

Complications
These complications occur in less than 1% of infants:

• Choking on spit up milk
• Heartburn from acid on lower esophagus
• Poor weight gain

Cause

• Poor closure of the valve at the upper end of the stomach
• Main trigger: overfeeding of formula or breastmilk
• More than half of all infants have occasional spitting up (“happy spitters”)

Reflux Versus Vomiting: How to Tell

• During the first month of life, newborns with true vomiting need to be seen immediately because the causes can be serious. Therefore, it’s important to distinguish between reflux and true vomiting.
• Reflux: The following suggest reflux (spitting up): infant previously diagnosed with reflux, onset early in life (85% by 7 days of life), present for several days or weeks, no discomfort during reflux, no diarrhea, hungry, looks well and acts happy.
• Vomiting: The following suggest vomiting: uncomfortable during vomiting, new symptom starting today or yesterday, associated diarrhea, projectile or forceful vomiting, looks or acts sick.

When To Call
Call Your Doctor Now (night or day) If:

• Your child looks or acts very sick
• Blood in the spit up
• Choked on milk and turned bluish or became limp
• Age under 1 month old and looks or acts abnormal in any way

Call Your Doctor During Weekday Office Hours If:

• You think your child needs to be seen
• Chokes frequently on milk
• Poor weight gain
• Frequent unexplained fussiness
• Spitting up becoming worse (eg. increased amount)
• Age over 18 months
• Spitting up doesn’t improve with this approach
• You have other questions or concerns

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Getting Started With Solid Foods

When your infant is able to sit independently and grab for things to put in her mouth, it’s time to begin introducing solid foods. This usually is between 5 and 6 months of age. Start with simple, basic foods such as rice cereal. You should add breast milk or warm formula to the cereal, mixing about 1 tablespoon of cereal with every 4 to 5 tablespoons of breast milk.

Look for infant cereals that are fortified with iron, which can provide about 30% to 45% of your infant’s daily iron needs. About midway through the first year, her natural stores of iron will have become depleted, so extra iron is a good idea.

Here are some additional recommendations to keep in mind.

• Introduce your baby to other solid foods gradually. Good initial choices are other simple cereals, such as oatmeal, as well as vegetables and fruits. Most pediatricians recommend offering vegetables before offering fruits.
• Start these new foods one at a time, at intervals of every 2 to 3 days. This approach will allow your infant to become used to the taste and texture of each new food. It can also help you identify any food sensitivities or allergies that may develop as each new food is started. Some pediatricians advise introducing wheat and mixed cereals last because young babies could have allergic reactions to them. Contact your doctor if symptoms (for example, diarrhea, vomiting, rash) develop that seem to be related to particular foods.
• In the beginning, feed your infant small serving sizes—even just 1 to 2 small spoonfuls to start.
• Within about 2 to 3 months after starting solid foods, your infant should be consuming a daily diet that includes not only breast milk or formula, but also cereal, vegetables, fruits, and meats, divided among 3 meals.
• When your infant is about 8 to 9 months old, give her finger foods or table foods that she can pick up and feed to herself. Make sure she’s not putting anything into her mouth that’s large enough to cause choking. Do not give small infants raisins, nuts, popcorn, or small or hard food pieces that can be easily aspirated.

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Milk – Soy Protein Intolerance (MSPI)

Some infants will have difficulty with breastfeeding
or with certain formulas during their life. Many times these are brief problems
that can be improved with simple changes to their feedings. We always encourage
our families to talk with us before changing formulas frequently as sometimes
the problems are more difficult to treat.

Some infants have difficulties tolerating milk and soy proteins. These
infants can be very fussy, gassy, have mucous or even blood in their stools. If
you have concerns please call us and schedule an appointment with one of our
physicians to discuss how we can help get your happy and healthy baby back.

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Tylenol Dosage Chart

Indications: Treatment of fever and pain.

Table Notes:

• AGE LIMIT: Don’t use under 12 weeks of age unless directed by child’s doctor. (Reason: Fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation).
• EXCEPTION: Fever starting within 24 hours of immunization if child is 8 weeks of age or older. Avoid multi-ingredient products in children under 6 years of age (Reason: FDA recommendations 1/2008).
• DOSAGE: Determine by finding child’s weight in the top row of the dosage table
• BRAND NAMES: Tylenol, Feverall (suppositories), generic acetaminophen
• FREQUENCY: Repeat every 4-6 hours as needed. Don’t give more than 5 times a day.
• ADULT DOSAGE: 650 mg
• MELTAWAYS: Dissolvable tabs that come in 80 mg and 160 mg (jr. strength)
• SUPPOSITORIES: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth).
• EXTENDED-RELEASE: Avoid 650 mg oral products in children (Reason: they are every 8-hour extended-release)
• MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medication. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.

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Ibuprofen Dosage Chart

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Pediatrics, P.C. Vaccination Schedule

Pediatrics, P.C. follows the vaccination schedules recognized by the AAP and CDC for newborns:

Birth- Hepatitis B

2 month- Pentacel, Prevnar, Hepatitis B, Rotateq

4 month- Pentacel, Prevnar, Rotateq

6 month- Pentacel, Prevnar, Rotateq

12 months- MMR, Varicella, Hepatitis A, Prevnar

15 months- DTaP, Hib, Hepatitis B

18-24 months- Hepatitis A

Kindergarten – MMR, Varicella, DtaP, IPV

7th Grade Physical – TdaP, Menveo, HPV

Please visit AAP.org, CDC.gov or talk to our staff if you have any questions

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