Wise Words on : A Peacefully Sleeping Baby, Pt. 1

One of the most frequent questions we hear from parents of young babies, is how to handle bedtime in a loving, but quick and efficient manner.  Many parents are reluctant to allow their infant to cry, when it is so much more satisfying (but eminently time-consuming) to rock the baby to sleep.  How to handle sleep training and teaching the infant to separate willingly at bedtime? Fortunately, the journal Pediatrics has published a study in September 2012, which reassures us that sleep training does not cause emotional damage or attachment issues for babies. I myself could have used this reassurance many years ago, when I nursed my baby to sleep for months, well-aware that he was increasingly unwilling and unable to fall asleep without me.  To help others, I thought I would share this excellent article from Dr. Nicholas B. Levy, targeting parents of very young babies, which is the best time to begin this process . . .

Helping Your Two Month Old Develop Wonderful Sleep Habits

It has been said that falling asleep is not like falling off a log. One has to learn how to fall asleep! The question then becomes: How does one learn to fall asleep and what is the best age at which to learn this?

The theory of psychological development indicates that during the first four months or so of life, the infant is developing trust. This allows for psychological integration and the ability to easily transition to the next developmental phase, separation and development of the self as a distinct entity.

During the first few months of a child’s life they develop trust by being attended to whenever they cry. They are, so to speak, impossible to spoil. If they suffer from any condition that causes prolonged crying, like reflux or colic, they should be held or cuddled despite their crying. This is extremely hard on parents but the psychological benefits are enormous and the temptation to “just let them cry it out” should be avoided at all costs.

The other interesting phenomenon that occurs early on in infancy is the internalization of sensation and the development of memory. This appears to happen at about two to three months of life. The first two months are certainly a time when it doesn’t matter where or how infants fall asleep.

It is important, therefore, that parents should ask themselves what it is they want from their child in terms of sleep behaviors. Do they want a family bed, where all of the family members sleep together, and, if so, do they want to go to sleep at the same time as the children every night or would they prefer to join the children later? Would they prefer to have children sleep in their own rooms and again how would they like the children to fall asleep? Do they want to rock them to sleep? Do they want to lie with them while they fall asleep when they are older? Would they prefer to say goodnight to them before they are asleep? Both parents should derive the answers to the above questions because bedtime can become stressful if there is disagreement. This is a time of day for many couples when they should be spending time together.

In many instances it appears that parents want their children to fall asleep on their own and sleep through the night, but they don’t know when to stop nursing or rocking them to sleep. They simply hope that the children will learn how to do it for themselves and get frustrated when it takes five or six years before the children do.

This simple technique will allow your baby to develop good sleep habits without a need for prolonged crying. For the sake of discussion, it will be assumed that parents want an independently sleeping child. If, however, they would prefer a family bed, then the same technique will apply if they want the child to fall asleep alone. Even though it does take some work, the results are well worthwhile.
The best time to start sleep training is soon after your baby is two months old. Most children will sleep their longest stretches during the night hours by this age. They will generally be falling asleep sometime between 8:00 pm and 11:00 pm and most will be waking once or twice during the night to feed. In many instances they are still sleeping in their parents room in a bassinette. Now is the time for the big move!

Set up the babies crib in their own room and envision it the way you think it will be when they are about one year old. Begin to pay careful attention to them at the time that they generally start to fall asleep. As soon as they begin to get drowsy or their eyes get heavy, put them gently into their crib. If they fuss, respond immediately and try to soothe them in the crib. Do this by patting or stroking them or gently shaking the crib, perhaps while singing softly or whispering to them. If they don’t settle down quickly (about 20 to 30 seconds is reasonable) then pick them up again. Walk with them, talk to them and watch closely for them to get drowsy again. As soon as this happens, put them down again. If they again start to fuss, respond as before and try and soothe them in the crib. If this doesn’t work, then pick them up and once again soothe them in your arms until they begin to fall asleep and then just before they do put them down again.

Every baby is different in terms of how many times they will need to be soothed again. If you persist, however, then the end result is that they will fall asleep in their crib even it means that a parent is present to begin with. Each night will be a little easier and fairly soon you will be able to put your baby down, say goodnight, and leave the room. Although the baby may vocalize a bit without really crying, eventually he or she will fall asleep. Ignore the little awakenings during the night but respond to any real crying.

After infants are about four months old, they are quite capable of sleeping for nine to ten hour stretches at night. They don’t need to eat during this time and, in fact, if they are fed, will develop a pattern called “trained night feeding”.

Everybody wakes up during the night and then goes back to sleep. We reassure ourselves that nothing has changed and don’t even remember having woken up the next day. Children that fall asleep in a parents arms and then wake up during the night in a crib, find this very difficult. They tend to need their parents help to fall sleep again.
It is acceptable to allow babies over four months of age to cry a bit. Sometimes a few minutes of crying in the middle of the night is all it takes to teach them to sleep through. Remember to always respond at first, with as little intervention as possible. If you are having trouble with sleep and sleep habits, talk to your pediatrician or arrange to meet with them for a sleep consult.

Parents who have had a good nights sleep are much more tolerant and have loads more energy to deal with the everyday needs of their children.

Bugs and Sun Can't Stop Our Summer Fun!

 Your mom was right: going outside to play is good for children.  Sadly, nearly half of 3 to 5 year old children are not taken outside daily by their caretakers. American children between the ages of 8 and 18 currently spend more than four hours a day interacting with technology.  According to the American Academy of Pediatrics, outdoor play is beneficial for motor development, vision, cognition, vitamin D levels, and mental health. In spite of these manifold benefits, US children today likely spend less time playing outdoors than any previous generation.

Despite the urban environment in which we live, Chicagoans enjoy a “City in a Garden”. It is not difficult for our city children to get back to nature, although bites and sunburn can put a damper on their enjoyment of the outdoors.  Luckily, from the frequent questions we get at this time of year, it appears parents are being proactive in protecting kids from bugs and sun. Here is a rundown on what we advise:

Insect protection:

• DEET is the single most effective ingredient in topical insect repellent (remember, we are protecting against mosquitoes with West Nile Virus and ticks with Lyme disease).

The concentrations of DEET listed on product labels refer to the duration of action, not the effectiveness.  For instance, DEET 10% will last approximately 2 hours, while DEET 30% will last 5 – 6 hours. 

• These products are safe for use in infants over the age of 2 months but should be applied only once daily.
•  DEET is waterproof, so swimming does not mean you need to reapply as you do with sunscreens. (Don’t use combination bug/sun products – the sunscreen should be reapplied, the bug spray should not.)

• Natural alternatives provide significantly worse protection.  The exception is a eucalyptus-derived ingredient, such as that found in Off! Botanicals. However, this product should be reapplied every 30 minutes to protect against ticks.

• Insect Shield clothing is infused with permethrin (has DEET – like bug repellent qualities but is safe enough for pregnant women and infants).  Among the 30 brands of clothing available, toddler-sized leg-warmers can be found ($15, babylegs.com).

• How to provide relief for those itchy bites?  Cool compresses, Benedryl cream, or Hydrocortisone cream 1% (both over the counter) can help.  Scratched and bleeding insect bites can become infected, so should be kept clean with soap and water.

Sunburn protection:

• For babies less than 6 months old, keeping the infant in the shade, covered with light-weight clothing and a broad-brimmed hat, is the best solution. If shade is not available, a minimal amount of sunscreen (SPF 15 to 30) on exposed areas of skin is OK.

• For older babies and children,  waterproof sunscreen  with SPF 30 is fine – it protects against 97% of UVB rays- as long as an adequate amount is applied (about one ounce or one shot-glass-full per child).  

•  Be vigilant about reapplying every 2 hours and after swimming. If this is unrealistic for your active children, a higher SPF can provide incrementally more protection. No sunscreen blocks 100% of UV rays: some UV rays get through and create free radicals, which lead to sun damage.  Look for antioxidants in the sunscreen, which help neutralize the free radicals before they cause damage.

• A white, thick lotion such as Walgreen’s brand, works best and should be thoroughly  applied to dry skin, before going outside.  Those handy sunscreen sprays are not effective. Any sunscreen with zinc oxide is good for the nose and face.   Finally, make sure the sunscreen is broad-spectrum, effective against both UVA (aging rays) and UVB (burning rays).

• If a child does get burned, cool washcloths to the area are soothing, and Ibuprofen (for children over 6 months) works as an anti-inflammatory and relieves the pain. For severe burns with blistering, please call us!

Keeping Kids Healthy

Now that school is well underway, viral infections are making the rounds of the classrooms.  Additionally, infants pick up the viruses, whether from older siblings or at day care, so parents need strategies to keep infections at bay. Preventing the common cold, and possible complications, such as middle ear and sinus infections, requires common sense and some effort, but keeping your family healthy is possible!

First and foremost, boost your family’s immune system by providing plenty of fruits and vegetables, which are rich in antioxidants and vitamins that help little bodies  resist infection. Get ideas from these websites: www.letsmove.gov/eat-healthy and www.choosemyplate.gov. Make sure everyone is getting the recommended amount of sleep.  Finally, children aged 6 months and older should be protected yearly by the influenza vaccine.

The common cold

Children typically have three to six colds per year, but the younger the child, the more severe and worrisome are the symptoms. Prevention techniques that should be used, and  taught to children include:

1)      Frequent hand washing.  Up to 80% of infectious diseases are transmitted by touch; keep those babies and children safe by washing hands.  The simple friction of rubbing hands together while washing with soap or hand sanitizer effectively eliminates most germs.  Washing hands after using the bathroom and before snacks and meals, should be part of the household routine. 

2)      Teach children to sneeze and cough into their elbow

3)      Keep hands away from eyes, nose and mouth

4)      Teach children not to share water bottles or any other drinking or eating utensils.

Preventing complications

Middle ear infections can be a common aftermath of a cold for infants and young children.  Because babies have narrow, horizontal Eustachian tubes, fluid and congestion easily makes its way to the middle ear and gets trapped there, breeding infection.  How to prevent this?

·      Work hard to prevent the common cold, as above. If possible, limit the time your child spends in group child care.  A child care setting with fewer children may help.

·      Avoid second-hand smoke.

·      Breast-feed your baby, for at least 6 months if possible.  Antibodies in breast milk can offer protection from ear infections.

·      If you bottle-feed, hold your baby in an upright position.  Never prop a bottle in your baby’s mouth while he or she is lying down.

·      Make sure your baby receives immunizations, as recommended by the CDC.  Haemophilis Influenzae type b (Hib) and pneumococcal conjugate (PCV)  vaccines may help prevent ear infections by protecting your baby against common bacteria.

Sinus infections

Sinusitis is triggered when sinus drainage is blocked by inflammation from a common cold  or allergies.  The resulting pool of backed-up mucus provides a medium for bacteria to grow out of control. This causes swelling, more mucus build-up, and an influx of white blood cells to fight the bacteria.  Mucus is thickened, and may be tinted yellow or green. Other symptoms may include cough, headache and fever. The risk of developing sinusitis can be reduced by promoting drainage and keeping nasal passages clear.  Here are some helpful tips:

·        First line of defense: Nasal irrigation. One of the simplest, cheapest, and most effective ways to prevent and treat sinus problems is nasal irrigation. Using nothing more than tap water and table salt, you can often relieve sinusitis symptoms, reduce reliance on nasal sprays and antibiotics, and improve your quality of life. At least twice a day, follow these steps:

1.      Stir 1 teaspoon of salt into 2 cups of lukewarm water.

2.      Fill a small bulb syringe with the saltwater solution. (If you prefer, you can use a small pitcher called a neti pot to stream the solution through your child’s nose. Or you can purchase an inexpensive nasal irrigation kit with a squeeze bottle, such as Little Noses Sinus Rinse, at most drugstores.)

3.      Have your child lean over the sink, insert the tip of the syringe just inside one nostril, and gently squeeze the bulb. The water will run back out the nostril (or possibly the opposite nostril) and into the sink. Use at least one full bulb of solution.

4.      Repeat the procedure in the other nostril. (If the salt solution stings, use less salt.)

·        Drink lots of water.  Good hydration helps keep the mucus thin and loose.

·        Inhale steam.  Have your child stand in a hot shower.

·        Avoid dry environments.  Keep a humidifier in your child’s bedroom, making sure it is kept clean and free from mold.

·        Avoid antihistamines unless prescribed.  Antihistamines make mucus thick and hard to drain.

·        Keep your child’s allergies under control, seeking medical advice when necessary.

Being proactive with preventative health care measures can keep children healthy and in school.  By teaching them these good habits, everyone in the family wins!

Sources and further information:

National Institute of Allergy and Infectious Disease: http://www.niaid.nih.gov/topics/sinusitis/Pages/Index.aspx
Healthy Children  http://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/The-Difference-Between-Sinusitis-and-a-Cold.aspx
 http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Ear-Infection-Questions.aspx

Summer Fun - and Safety

I love Chicago in the summer months.  We have world-class beaches, festivals, and outdoor restaurants, many of which can be enjoyed with kids in tow.  But keeping children safe and happy in summer requires some extra planning!  In early summer we get questions and see children in the office about many of the following issues:

 Sun Protection:  As much as we all love to finally feel that warm sun, it is brutal on children’s sensitive skin. EVERYONE needs to use sunscreen, including people of color. Sun exposure is the most preventable risk factor for skin cancer, including melanoma. It is still possible to have fun in the sun, if parents are smart:

For babies less than 6 months old, keeping the infant in the shade, covered with light-weight clothing and a broad-brimmed hat, is the best solution. If shade is not available, a minimal amount of sunscreen (SPF 15 to 30) on exposed areas of skin is OK.

For older babies and children, according to Annette Wagner MD, pediatric dermatologist,   Children’s Memorial Hospital,  waterproof sunscreen  with SPF 30 is fine – it protects against 97% of UVB rays- as long as an adequate amount is applied (about one ounce or one shot-glass-full per child).  Be vigilant about reapplying every 2 hours and after swimming. If this is unrealistic for your active children, a higher SPF can provide incrementally more protection. No sunscreen blocks 100% of UV rays: some UV rays get through and create free radicals, which lead to sun damage.  Look for antioxidants in the sunscreen, which help neutralize the free radicals before they cause damage. A white, thick lotion such as Walgreen’s brand, works best and should be thoroughly  applied to dry skin, before going outside.  Those handy sunscreen sprays are not effective, according to Dr. Wagner. Any sunscreen with zinc oxide is good for the nose and face.   Finally, make sure the sunscreen is broad-spectrum, effective against both UVA (aging rays) and UVB (burning rays). See the end of this article for Dr. Wagner’s sunscreen  recommendations.

If a child does get burned, cool washcloths to the area are soothing, and Ibuprofen (for children over 6 months) works as an anti-inflammatory and relieves the pain. For severe burns with blistering, please call us!

Bug Sprays: We are all too aware of the wet spring, the resulting bumper crop of mosquitoes out there, and the special misery of kids with mosquito bites. What can be done? Common sense approaches include avoiding peak bug times (dusk to dawn), and wearing long sleeves and long pants if outdoors during those times. Insect repellants containing DEET are still the best option for protecting children against mosquitoes carrying the West Nile virus, and the CDC recommends their use. The concentrations of DEET listed on product labels refer to the duration of action, not the effectiveness.  For instance, DEET 10% will last approximately 2 hours, while DEET 30% will last 5 – 6 hours.  These products are safe for use in infants over the age of 2 months but should be applied only once daily.  DEET is waterproof, so swimming does not mean you need to reapply as you do with sunscreens. (Don’t use combination bug/sun products – the sunscreen should be reapplied, the bug spray should not.)

How to provide relief for those itchy bites?  Cool compresses, Benedryl cream, or Hydrocortisone cream 1% (both over the counter) can help.  Scratched and bleeding insect bites can become infected, so should be kept clean with soap and water.

Pool Safety: The July 2011 issue of Pediatrics contains research documenting the danger of small inflatable wading pools; fatal accidents can occur in a few inches of water when toddlers are unsupervised. Swimming lessons for toddlers are not enough to keep them safe and there is no substitute for keeping a close and constant eye on them! For older kids, remind them of the pool rules: no swimming for an hour after eating, no swimming without a partner and no running around the pool.

A few common sense precautions will ensure that you – and your little ones -  have a great summer!

 Recommended sunscreens:

Blue lizard for Sensitive skin SPF 30+

Neutrogena Sensitive skin SPF 30

Neutrogena Pure and Free SPF 60

Presun Sunblock, Sensitive SPF 28

Vanicream Sunscreen for Sensitive skin SPF 60

Walgreens Zinc oxide paste SPF 45+

Sites for sun protective clothing:

http://www.sundayafternoons.com/store/

http://www.sunprecautions.com/

http://stingraybay.com/swimwear/index.html

http://www.coolibar.com/

Source: The American Academy of Dermatology,  http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens