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Baby Q&As

  1. Expert: Dr. Jennifer Shu
    January 26th, 2009
    Is it better to give my one-year-old cow’s milk or toddler formula if she doesn’t eat many solids?

    For babies growing and developing normally, it's perfectly fine to switch to whole cow's milk at 12 months of age, although toddler formulas are also acceptable. Toddler formulas (aimed at children nine to 24 months) have the same amount of calories, fat, vitamin D and calcium as cow's milk, but also contain iron and vitamins C and E, which may benefit children who are not eating much in the way of solids.

    Plus, formulas fortified with DHA and ARA (omega fatty acids) may help with brain and eye development. If you choose to use cow's milk at this point, your pediatrician may recommend a multi-vitamin supplement to make sure your baby gets all the nutrients she needs.

    Keep in mind that when babies are taking in more than about 24 ounces of any liquid, they may have little room left for solid foods. If you think this might be the case, here are a few things you can try:

    • offer foods first and limit bottles or sippy cups to three or four times a day
    • offer her smaller bottles or cups (four ounces for example)
    • give her a small amount of milk or formula at mealtime to take the edge off her hunger, followed by as much solid food as she'll take. You could then finish off with a little milk or formula if she's still hungry.

    Finally, remember that a serving size for a 12-month-old is very small–about the size of her palm–so don't be surprised if she doesn't eat large amounts of solids. In rare cases babies who don't take well to solids may have a problem with their swallowing and may need an evaluation by a feeding specialist. Be sure to consult with your pediatrician for the best approach to your individual situation.

     Dr. Jennifer Shu is a board-certified pediatrician in Atlanta and editor-in-chief of the American Academy of Pediatrics' Baby & Child Health: The Essential Guide from Birth to 11 Years and co-author of the award-winning book Heading Home with Your Newborn and Food Fights, both published by the AAP. www.jennifershu.com

     

  2. Expert: Dr. Marjorie Greenfield
    December 29th, 2008
    What is an Apgar score and does it affect my baby's development?
    An Apgar score is used to assess a newborn's wellbeing and is usually done twice–at one and five minutes after birth. The baby's heart rate, breathing, color, muscle tone and response to stimuli are assessed to determine whether she needs extra help, such as oxygen.

    Any score over seven (out of a possible 10) means a baby is doing just fine on her own, while lower scores may mean she'll need a little extra help at first. The one-minute score has no correlation with future development and most babies with a low score at five minutes also do really well–it's normal for newborns to need some assistance initially.

    If a baby still needs a lot of help at five minutes, a third Apgar score may be done at 10 minutes. Although some babies with low scores at 10 or 15 minutes may show signs of neurological problems later on, most babies are alert and breathing on their own by 10 minutes after birth.

    Dr. Marjorie Greenfield is a practicing board-certified obstetrician-gynecologist and fellow of the American College  of Obstetrics and Gynecology (ACOG). She is currently associate professor at Case Western Reserve University School of Medicine and author of the new book, The Working Woman's Pregnancy Book. www.marjoriegreenfield.com

  3. Expert: Dr. Jennifer Shu
    December 15th, 2008
    I think my baby is constipated, what should I do?

    Constipation is defined as a decrease in the frequency of stools, or having pain with bowel movements. It may occur when there is a change in the diet, such as when babies transition from breast milk to formula or cow's milk, or when they first begin solid foods.

    Children under one year typically have one to four bowel movements per day, although if a child usually goes a few days between normal bowel movements, it is not considered constipation unless there is a change in the pattern.

    There are many signs that an infant may be constipated, including: 

    •  She often skips days in between bowel movements.
    • Her poops are hard and small and difficult to pass, or may be large and painful.
    • She may have more fussiness than usual, stomach pains, a poor appetite, or small amounts of bleeding from the anus.

    Constipation may be treated by increasing fluids (such as water or 100 percent fruit juice) and fiber (from fruit, bran and other foods) in the diet. Talk to your baby's doctor about the best ways to change her diet.

    If changing her diet does not treat the condition, your pediatrician may recommend a suppository, stool softener, or laxative until the constipation improves. Babies with severe constipation may need to see a pediatric gastroenterologist, who specializes in intestinal problems in children.

    Dr. Jennifer Shu is a board-certified pediatrician in Atlanta. Her passion is educating parents on all topics relating to children. Dr. Shu is editor-in-chief of the American Academy of Pediatrics' Baby & Child Health: The Essential Guide from Birth to 11 Years and co-author of the award-winning book Heading Home with Your Newborn and Food Fights.
    web site: www.jennifershu.com
    blog: www.parentingsense.com
     
     

  4. Expert: Dr. Jeremy Friedman
    November 17th, 2008
    When can I introduce milk to my baby?
    You can begin introducing homogenized milk at around 10 to 12 months, which is when your baby's digestive system is mature enough to tolerate cows' milk protein. (This is also when an infant's nutritional needs are beginning to be met by solid foods, so he will likely be drinking less breast milk or formula.)

    The most common issue I see is when toddlers drink much more milk than they need. Because cows' milk is not a complete source of nutrition, your baby only needs 16 to 20 ounces (475 to 600 mL), which is about the equivalent of three bottles a day. More than that puts children at risk for iron deficiency and may also affect their intake of nutritious solid food because they fill up on milk instead, which is why it's a good idea to offer milk during or after mealtime as opposed to before. Another tip to help children cut their milk intake down is to switch from a bottle to a cup.


    Dr. Jeremy Friedman is chief of Paediatric Medicine at the Hospital for Sick Children in Toronto. He is an associate professor in the department of Paediatrics at the University of Toronto and is the associate editor of the Canadian Paediatric Society's journal, Paediatrics and Child Health. Dr. Friendman has co-edited three bestselling books for parents, including the most recent The Baby Care Book (Robert Rose 2007). The Toddler Book will be released in spring 2009. He lives in Toronto with his wife and two young children.

  5. Expert: Dr. Jennifer Shu
    October 20th, 2008
    What should I do if I suspect my child has an ear infection?

    Most children will have at least one ear infection before they reach three years old. The only way to confirm an ear infection is for a doctor to look at it with an otoscope, but there are several signs that can also point to the diagnosis. 

    1. Ear infections often start out with cold symptoms, such as a runny nose.
    2. There may be a fever over 101 F.
    3. The child may be fussy or crying more than usual, especially when lying down.
    4. There may be signs of ear discomfort or pain, such as the child repeatedly rubbing or pulling at the ear.
    5. There may be discharge (such as pus or even blood) coming from the ear canal, which can signal a ruptured eardrum. This happens occasionally with ear infections and will usually heal on its own within a few weeks.

    If you suspect an ear infection, your doctor can check your child’s ears and make the diagnosis. Children under two years who have an ear infection are typically treated with antibiotics; those over two may be observed to see if they can fight off the infection without antibiotics.

    It may take a few days for the antibiotics to start working. In the meantime, giving a pain reliever such as acetaminophen (Tylenol), or ibuprofen (Advil or Motrin) if the child is older than six months, can help with the pain. Applying a warm compress to the infected ear may also be soothing.

    Your doctor may also prescribe numbing drops to put in the ear. Always check with your doctor before using ear drops because some can be harmful if used when the eardrum has burst.

    Dr. Jennifer Shu is a board-certified pediatrician in Atlanta. Her passion is educating parents on all topics relating to children. Dr. Shu is editor-in-chief of the American Academy of Pediatrics' Baby & Child Health: The Essential Guide from Birth to 11 Years and co-author of the award-winning book Heading Home with Your Newborn and Food Fights.
    web site: www.jennifershu.com
    blog: www.parentingsense.com

  6. Expert: Elizabeth Pantley
    June 30th, 2008
    What is the best way to potty train my child?

    Potty training your child can appear to be a complicated, difficult undertaking, but I have good news: As a parent educator and four-time veteran of the toilet training process, I know that potty training can be simple and, yes, even fun. The first step is to know the facts:

    • Most children become physically capable of independent toileting between ages two-and-a-half and four.
    • It takes three to 12 months from the start of training to daytime toilet independence.
    • Nighttime dryness is achieved only when a child's physiology supports this–you can't rush it.
    • The age your child masters toileting has absolutely no correlation to future abilities or intelligence.
    • There isn't one right way to potty train–any approach you use can work if you are pleasant, positive and patient.
    • A parent's readiness to train is just as important as a child's readiness to learn.
     
    Here are a few tips to help make the process work for you:
     
    1. Create a potty routine–have your child sit on the potty when he first wakes up, after meals, before getting in the car and before bed.
    2. If your child looks like he needs to go–tell, don't ask! Say, "Let's go to the potty."
    3. Your child must be relaxed to go: try reading a book, telling a story, singing, or talking about the day.
    4. Make hand washing a fun part of their routine. Keep a step stool by the sink and have colorful, child-friendly soap available.
    5. Expect accidents and clean them up calmly.
    6. Matter-of-factly use diapers or pull-ups for naps and bedtime.
    7. Either cover the car seat or use pull-ups or diapers for car trips.
    8. Visit new bathrooms frequently when away from home.
    9. Praise him when he goes!

    Elizabeth Pantley
    Elizabeth Pantley a mother of four and the best-selling author of eight parenting books, including: The No-Cry Sleep Solution and The No-Cry Discipline Solution. She is also a contributing author to The Successful Child with Dr. William Sears. Based in Washington, Pantley is the president of Better Beginnings Inc. (a family resource and education company) and a parenting expert for a variety of publications including: Parents, Parenting and Redbook. (www.pantley.com) www.pantley.com/elizabeth


     
  7. Expert: Dr. Jennifer Shu
    June 15th, 2008
    My newborn falls asleep during feeding and then wakes up hungry after a short nap–how can I get her to eat more so she’ll have more rest?

    Newborn infants typically feed around eight to 12 times per day and will be able to go longer in between meals as they grow. By 10 weeks, most babies will take four to six ounces of breast milk or formula at a time–sometimes even more. Remember, however, that a baby's stomach is about the size of her fist, so she shouldn't be expected to eat too much at each feeding. By about four months, many babies do the majority of their feeding in the day and the bulk of their sleeping at night, so short daytime naps are not unusual. 

    For infants who seem to eat small amounts very frequently through the day, here are some things to consider:

    1. Could there be a problem with the baby's digestive tract? Talk to your pediatrician and make sure your baby is growing normally. Let your doctor know if your baby vomits or has problems with urinating or bowel movements.
    2. Are you feeding the baby at times when she's not truly hungry? A fussy baby who wants to sleep more may still take a bottle if offered. This could interrupt longer naps and might make her less hungry when it's time for a real feeding. Avoid the temptation to feed your baby just because she is crying. A pacifier or clean finger (yours or the baby's) might do the trick.
    3. Some babies (usually newborns) fall asleep easily at the breast or bottle and need a little encouragement to continue. Techniques to keep baby awake include gently stroking her feet, changing her clothes or diaper, and (if drastic measures are needed) giving her a bath before finishing off the meal.
    4. Patterns of short feeds and naps can be normal in many babies who are transitioning from the newborn period to a more "grown-up" routine. Keep following your baby's cues: feed her when she's hungry and allow her to sleep when she's not and eventually she will settle into a better pattern.


    Jennifer Shu, M.D., F.A.A.P. is a board-certified pediatrician in Atlanta. Her passion is educating parents on all topics relating to children. Dr. Shu is editor-in-chief of the American Academy of Pediatrics' Baby & Child Health: The Essential Guide from Birth to 11 Years and co-author of the award-winning book Heading Home with Your Newborn and Food Fights, both published by the AAP. www.jennifershu.com

  8. Expert: Dr. Jennifer Shu
    June 2nd, 2008
    My five-month-old brings up his milk every time he has a bottle. Why does this happen and what should I do?

    Many babies have a condition called gastroesophageal reflux, which can cause them to spit up anything they eat or drink. This reflux is caused when the muscle at the top of the stomach hasn't fully matured and can't keep down all the contents of a baby's digestive tract.

    Most babies will outgrow this condition by their first birthday. In the meantime, there are some things parents can do to help:
     
    1. Avoid over-feeding your baby. Consult with your doctor to make sure he is getting the right amount of breast milk or formula.
    2. Feed your baby upright, not while he's lying down.
    3. Keep your baby upright for about 30 minutes after each feeding.
    4. Burp your baby halfway through a feeding if he needs it.
    5. Avoid tight diapers.
    6. Avoid putting your baby in a car seat inside the house.
    7. If your baby takes formula, ask your pediatrician if switching to a hypoallergenic formula might help.
    8. If your baby isn't growing well, refuses to eat, or seems very uncomfortable, talk to your pediatrician to see if any medication or special tests might be needed.

    Jennifer Shu, M.D., F.A.A.P. is a board-certified pediatrician in Atlanta. Her passion is educating parents on all topics relating to children. Dr. Shu is editor-in-chief of the American Academy of Pediatrics' Baby & Child Health: The Essential Guide from Birth to 11 Years and co-author of the award-winning book Heading Home with Your Newborn and Food Fights, both published by the AAP. www.jennifershu.com
     
  9. Expert: Elizabeth Pantley
    March 10th, 2008
    My baby cries a lot - could he have colic?

    If your baby cries inconsolably for long periods every day, particularly at the same time each day, he may have colic. Researchers are still unsure of colic's exact cause, but some believe it's related to the immaturity of a baby's digestive system.

    Whatever the cause, colic is among the most exasperating conditions that parents of new babies face. Colic occurs only to newborn babies, up to about four to five months of age. Look for patterns in your baby's crying that can provide clues as to which suggestions are most likely to help. Then experiment with some of the ideas in this list:

    1. If breastfeeding, feed on demand (cue feeding), for nutrition as well as comfort, as often as your baby needs a calming influence.
    2. If breastfeeding, try avoiding foods that may cause gas in your baby, such as dairy products, caffeine, cabbage, broccoli and other gassy vegetables.
    3. If bottlefeeding, offer more frequent, but smaller meals; experiment with different formulas with your doctor or health care provider's approval.
    4. Hold your baby in a more upright position for feeding and directly afterwards.
    5. Experiment with when, and how often, you burp your baby.
    6. Invest in a baby sling or carrier and use it during colicky periods.
    7. Give your baby a warm bath.
    8. Hold your baby with her legs curled up toward her belly.
    9. Massage your baby's tummy, or give him a full massage.
    10. Lay your baby tummy down across your lap and massage or pat his back.



    Elizabeth Pantley is a mother of four and the best-selling author of eight parenting books, including: The No-Cry Sleep Solution and The No-Cry Discipline Solution. Based in Washington, Pantley is the president of Better Beginnings Inc. (a family resource and education company). www.pantley.com

  10. Expert: Alan Greene, M.D.
    February 11th, 2008
    How do I find a pediatrician who’s up-to-date on the latest research and best practices when it comes to caring for kids?

    As you did when choosing an ob/gyn, you want to find a pediatrician who is top-notch medically. Here are three questions you can ask to gauge a physician's perspective on some common pediatric concerns:

    1. What is the best way to treat infant eczema?

    A better first approach to using steroids or prescription drugs is often to reduce exposure to eczema triggers (such as soap, bubble baths and synthetic fibres like nylon or polyester), or to gently moisturize the skin with an emollient cream or lotion. Well-informed physicians are more likely to treat the cause rather than just the symptoms and will opt for the gentlest treatment possible.

    2. What advice do you give to parents about introducing solid foods?

    Specifically ask for the pediatrician's advice about introducing whole grains, fresh tastes, or organic foods. Your pediatrician should be conscious of nutrition and care about establishing the healthiest possible eating habits for your child.

    3. How do you recommend treating ear infections?
    If they say that all ear infections should be treated with antibiotics, they may be behind the times. The Academy of Pediatrics now teaches that, in many situations, ear infections will heal better on their own, thus reducing the unnecessary use of antibiotics. (But pain relief should be given for the ear pain.)

    And, from the comfort of your home, you can learn a lot about some physicians and their practices by looking at their websites–many pediatricians have them now–and by talking to other parents.


    Dr. Alan Greene, author of Raising Baby Green, is a graduate of Princeton University and the University of California San Francisco. In addition to being the founder of www.DrGreene.com, he is the Chief Medical Officer of A.D.A.M., and the Pediatric Expert for WebMD. He is the Chair Elect of The Organic Center and on the Advisory Board of Healthy Child Healthy World. Dr. Greene is a practicing pediatrician at Stanford University's Packard Children's Hospital.