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Why do we give books out at your child’s well visits? We partner with Reach Out and Read (ROR), Ready for School, and the Ottawa Area Intermediate School District (OAISD) to provide this program that we believe in for your family! At each well visit from age 3 weeks to 5 years your child will get a new book to bring home with them to enjoy. Did you know that more than 80% of a child’s brain is formed before the age of 3? Their experiences during the first 3 years affect their development for the rest of their lives. Attention and nurturing from a loving parent or caregiver supports healthy brain development—and one of the best ways to engage young children is to read books together. Studies show that families that participate with Reach out and Read program are 2.5 times more likely to read with their children. Children have better language development when they are read to which is important to help them thrive. Reading together also helps children develop strong bonds with family members and helps develop a love of reading. Many of us have fond memories of snuggling up alongside those who love us and enjoying a favorite book. Even the youngest babies love to be held close and hear the voice of a loved one as they read a book aloud. This experience helps your child be more resilient to stressors in life and is calming routine. When we share a book with your child and family we also use this as an opportunity to evaluate some of their fine motor development and social emotional development. Can they hold a book, can they turn a page? Do they point at pictures as they get older? Are they excited to show you their book or look at with sibling? This helps us, along with other tools, to make sure they are track to reach their full potential. We encourage you to read with your children anytime you get a chance. Bedtime can be a great time to read together to develop a healthy bedtime routine. Read these tips from the American Academy of Pediatrics on the recommended Brush, Book, Bed routine. Reading together can be difficult if you don’t feel confident in your own reading ability. Even looking at pictures together helps develop a love for reading. Check out READ Ottawa for adults if you or someone you know wants to improve their reading. We can’t wait to share a book at your child’s next well visit!
In a perfect world, the amount of time you spend waiting in our office would be minimal. We recognize your time is important and we want to be efficient during your visit. However, sometimes things don’t go exactly like we planned, and you end up waiting at some point during your visit. We removed the tubs of books from our exam rooms during COVID, and we do not plan to return them now. Over the past year or so, I often observe young children watching a screen when I enter the room. Screens such as cell phones or tablets are highly entertaining to your children and keep them quiet while waiting for us. However, as a healthcare professional who works with children, the amount of time young children spend on screens is concerning. I am not the only child healthcare provider concerned about this. We know that as the amount of time a child spends on a screen increases, so does the likelihood of developmental delays, obesity, sleep difficulties, and mental health diagnoses over time. When it comes to screen time, less is more. The 2023 updated American Academy of Pediatrics screen time recommendations can be found here: https://www.healthychildren.org/English/family-life/Media/Pages/Where-We-Stand-TV-Viewing-Time.aspx . So, what are alternatives to screen time when you find yourself waiting in our office? As the parent, model good screen time habits for your children. If you are waiting for us, look at the information on our walls, bring something from home to read, or show your child that sitting quietly for a time without a screen is okay. As you enter our office, there is a “Little Free Library” in our lobby. Grab a book that is new to your child and look at it if needed. If your child is less than 5, they will receive a “Reach Out and Read” book at their well child exam. Look at that with your child. When parents model how fun it is to read, the children are likely to follow. Play “I Spy”. Our rooms are painted and decorated in bright colors for a reason. You can play “I Spy” with colors, shapes, and textures and each room should have a variety of different opportunities for this. Last, put a few things in your bag that your children only get to see and play with when they are in our office. This will make these items new and fun while they are here. Examples of something that fits in your bag might be a couple matchbox cars, the “Spot It” game, special book, or action figure. These are easy to follow tips that may come in handy when waiting at other places too! Just like you, we want to see your child grow and develop to the best of their potential. Thanks for partnering with us in their care.
It only takes a walk from our front door to our car to frigidly realize that it is winter in Michigan. And, as we drive a few feet on the road- we also realize that a safe car ride cannot be taken for granted. Now, even if you’re a great driver (or not so great like some of us…😊), there is one measure you can take to keep our little ones safe on the roads, even in not-so-safe driving conditions: car seats. The National Highway Traffic Safety Administration “reports that nationally the lives of 325 children under the age of 5 were saved by a car seat in 2017”- wow! That is one encouraging (and warming) thought. So, okay, we can all agree car seats are a great idea- however, many times we find ourselves wondering if we have truly picked the correct car safety restraint for our precious cargo…the following are a few helpful tips: Michigan Child Passenger Safety Laws require that all children younger than age 4 ride in a car seat in the rear seat if the vehicle has a rear seat: If all back seats are occupied by children under 4, then a child under 4 may ride in a car seat in the front seat. A child in a rear-facing car seat may only ride in the front seat if the air bag is turned off. Children must be properly buckled in a car seat or booster seat until they are 8 years old or 4’9” tall. All passengers under 16 years old must use a seat belt in any seating position. All front seat occupants must use a seat belt regardless of age. Children should never ride on a lap, in a portable crib, or in any other device not approved for use in the vehicle. Thank you, Michigan, for providing protective laws for our children! Now, let’s get a little more specific on what guidelines provide the most safety: A car seat is the best way to keep a child safe in the car. If there is a car crash, a seat belt is not enough- so…what are the car seat options? So glad you asked! Rear-facing car seats – These have a 5-point harness. They include infant seats that are rear facing only. There are also “convertible” seats that can be rear facing then switched to forward-facing later. Forward-facing car seats – These have a 5-point harness. Some car seats are designed to be forward-facing only. Others are “convertible” seats that can be used rear-facing or forward-facing. Booster seats – These are used after a child has outgrown their forward-facing car seat. Some boosters have a high back to support the head and neck. Others are backless. Backless boosters are best for use in a car that has head rests. Some car seats are “all in one.” They can be used rear-facing at first, then forward-facing, then converted into a booster. And which type is best for my little one? Well…it depends; recommendations are based on age, height, weight, and your car. All babies under one year should ride in a rear-facing car seat. Many people choose an infant “bucket” seat that clicks into a base that stays in the car. The other option is a “convertible” car seat. These can be installed rear-facing, then switched to forward-facing when the child is older. Keep your baby or toddler in a rear-facing car seat for as long as possible, but at least until they are two years old and reach the height and weight limit for the seat. This is the safest position for them. Once your child reaches the rear-facing height or weight allowed by their seat, switch them to a forward-facing car seat with a harness. When your child outgrows the forward-facing seat, use a booster seat with a lap and shoulder belt. This should be based on the child’s height, not their age. They should be tall enough for the shoulder belt to lie across their shoulder and chest, not their face or neck. Keep using a booster until your child is at least 4 feet 9 inches (145 cm) tall. For most children, this is between about 8 and 12 years old. Make sure that the lap and shoulder belt fit properly. Children should not sit in the front seat of a car until they are at least 13 years old. Now that we know which car seat we should use, let’s focus on making sure our little ones are safe in their car seat: If you are using an infant seat with a handle for carrying, check the instructions to make sure that the handle is in the right position. The harness straps should be flat and not twisted. The straps should be threaded through the seat at or just below your child’s shoulders for rear-facing seats and at or just above your child’s shoulders for a forward-facing seat. The chest clip should be even with their armpits. The harness should be snug against the child’s body. Do not dress your child in bulky clothing or a coat while they are in their car seat. This can make it hard to buckle them in safely. If it is cold, tuck a blanket over the harness once it is buckled snugly. In a booster seat, the shoulder belt should lie across the child’s shoulder and chest, not their face or neck and the lap belt should lie across their upper thighs, not their belly. Phew! That was a lot of information- but very likely, just a review of what we already know, and may simply need a reminder on how important it is to follow these safety precautions. Most of the information we covered today can be found on the websites for: National Highway Traffic Safety Administration, Michigan’s Office of Highway Safety Planning, and American Academy of Pediatrics Healthy Children, along with the physician reference website UpToDate. Thank you for reading! And stay warm and safe 😊.
Let me start with the question: How many times have you thought about something but didn’t listen or follow through? Most of us should be able to respond with, “Many times!” In fact, you probably had more than one example of this already today. Maybe this morning you wondered about the type of cereal you were going to eat or the outfit you were going to wear. Maybe you had the thought, “I should pack my own lunch for work,” but then you decided getting take out was the better choice—again. Our days are full of thoughts that we may or may not decide to follow through on, and typically we have no problem with our lack of follow through. So why is it different with anxiety? Anxiety demands two things: certainty and comfort. Anxiety tells us that we need to know what’s going to happen next so that we can control it, and that we have to feel safe and comfortable, otherwise we should want out. Anxiety sends the message, “This is bad, and you can’t handle it,” and we often listen. Worry begins in our prefrontal cortex where thoughts, plans, and imagination are created. What’s 8+8? What day is it? That’s your prefrontal cortex. Inventing ideas, hypothesizing, “what if” thoughts – those also live in your prefrontal cortex. “What if mom doesn’t pick me up from school today?” Bingo! You have an anxious thought. Then, that thought activates the amygdala. Your amygdala is the danger/fear center of your brain. Its job is to remember past danger, anticipate future danger, and alert you to current danger. It’s wired to do good, and we need it to activate in actual dangerous situations, but the problem is, it can be glitchy. It’s small—about the size of an almond—and it’s powerful. It has one response: my human is in trouble. When the amygdala is activated, it drops three chemicals down into your body—serotonin, cortisol, and adrenaline–getting it ready to fight back, run away, or freeze. This is when physical symptoms are experienced, such as an upset stomach, increased heart rate, difficulty breathing, shaking, headache, and more. This happens because the chemicals are shutting down non-essential body functions, so that it can give more energy to the bigger organs that will assist in your escape. It does this powerfully, and quickly, leaving us feeling uncomfortable. Now that your body is uncomfortable, it sends more worried thoughts back to your prefrontal cortex asking if it should be worried about the response—aka worried about the worry. If your prefrontal cortex agrees that something seems bad, it sends a message back to the amygdala saying, “Good job! You got it right and kept us safe!” Thus, the chemicals go again, intensifying the physical reactions, and the cycle repeats. The good news is, you can learn to interrupt this cycle and retrain your amygdala! Anxiety demands that we go on the defensive position – run away, avoid, shut down, give up. So, if we want to change the pattern, we have to learn to react and respond to the worried thoughts differently. Rather than give in and go on defense, we have to take an offensive stance. An offensive stance often looks like doing exactly the opposite of what the worry wants. Worry says, “STOP!” It doesn’t like to move forward. But we have to learn to take action when we are worried. Taking an offensive stance towards our anxiety gives our amygdala a chance to relearn how to respond to that situation/trigger. Offense is a choice. The goal is to lean into situations that make you uncomfortable and unsure or nervous because that’s when we’re on the right track. How can you start challenging your anxiety? Look for those uncomfortable, uncertain situations. (The thing that just popped into your head – yes, that.) When you find yourself avoiding something, or feeling anxious, that’s your cue to call out the anxiety, welcome it, and push forward, doing the opposite of what it wants you to do. Have social anxiety? A challenging exercise might be to go inside the coffee shop to order from the barista instead of ordering ahead on your phone. For your child, maybe it’s ordering their own food at a restaurant, asking a friend over for a play date, or saying hi to a classmate in the hall at school. Just because you think it, doesn’t make it so, but anxiety lies and says different. Here’s your invitation to shift your language to, “Bring it on!” “More please!” “I am willing to feel uncomfortable/unsure!” and watch as your tolerance for anxiety grows, and those unhelpful responses decrease.
Hello HPA families! Dare I say it… school is just around the corner. I hope you’ve been soaking in the sunshine, quality family time, and made it out with minimal mosquito bites. As the “s” word continues to loom closer, you may start to observe some nervousness in your child as they sense change coming. Maybe you’re feeling a little on edge yourself. Below are some tips to help ease your child’s back-to-school anxiety, as well as some quick calm-down strategies to instill confidence when those worries show up. 1) Routine: 2-3 weeks before school starts, begin transitioning to what will be your child’s school bedtime and nightly routine. Do they pick out their clothes the night before? Start doing that! Does bedtime change from 10:00pm to 8:00pm? Start going to bed a little earlier each day. 2) Friends: Schedule play dates or family outings that involve social interactions. Bonus if they’re playdates with past classmates. This can help eliminate social anxieties and allow for opportunities to practice play in a familiar environment. 3) Validate the worry your child may express, but don’t spend too much time on it. By showing confidence in them, you’re sending the message that they’ve got this and that there’s nothing to worry about. If parents hesitate or return to the worry, it leaves the wonder, ‘Maybe there is something to be afraid of if mom/dad seem worried.’ Struggling to contain the worry? Schedule a “worry time” – 15 minutes where your child gets to ask any questions they want about their worry/discuss it with you. Kindly remind them that they have to wait until their “worry time” if they try to engage in discussion throughout the day. Perhaps ask them to write it down, so they don’t forget. 4) Roleplay: If your child is younger, practicing saying goodbye and having them walk into a room alone can be helpful. Make it quick, give a positive affirmation, and show confidence in them. There are many other school aspects to practice, such as saying hi to friends, raising their hand, asking to go to the bathroom. Make it a game and have fun with it! 5) Read some books about starting school or anxiety in general. A quick Google or Amazon search will provide you with various options. Here are a few: Don’t Feed The Worry Bug by Andi Green What to Do When You Worry Too Much by Dawn Huebner The Relaxation and Stress Reduction Workbook for Kids by Lawrence E. Shapiro The Anxiety Workbook for Teens by Lisa M. Schab LCSW An option for parents: Anxiety Relief for Kids: On-the-Spot Strategies to Help Your Child by Bridget Flynn Walker PhD Helping Your Anxious Child: A Step-By-Step Guide for Parents by Ronald Rapee PhD, Ann Wignall DPsych, Susan Spence PhD, Heidi Lyneham PhD, Vanessa Cobham PhD 6) Quick calm down strategies: Count heartbeats Press and release palms together 54321 calming technique (list 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste) Squeeze something (can be imaginary lemons in your hand) Run in place Get a drink of water Starfish breathing (trace fingers up and down while breathing in and out) Smell the flowers and blow out the candles Give yourself a hug or ask for a hug Hum a favorite song Think of a happy place Just as any skill takes practice, so do coping skills/calm-down strategies. Practice the strategies above when your child is calm, so that when they find themselves in a worry moment, they–and their bodies–are confident in what they’re trying to do. Calm down! Schooltime can bring many emotions; give yourself extra grace as you help your children adjust. You’ve got this parents! Resource: Lee, K., & Morin, A. (2021, October 12). How can you ease back-to-school anxiety and stress?. In VeryWell Family. Retrieved from https://www.verywellfamily.com/tips-to-ease-back-to-school-anxiety-620832
Hello Holland Pediatric families! This blog will help you discuss internet safety with your family and friends. Plus, help you become more sensitive to methods people use to exploit children on the internet. A few questions to focus the facts: 1.) Who should care about internet safety? -Anyone with a device that connects with the internet -Anyone with a child that uses a phone, tablet or desktop computer 2.) Why should we care about internet safety? – When a device is connected to the internet our personal information may be used or seen by others. – With children they are easily exposed to inappropriate information or images 3.) How can personal information be used? – Steal our financial information -Identity theft -Pictures of themselves -Personal information that should only be shared with close family -Grooming children by developing initially innocent relationships with them 4.) How can we become more safe and aware of internet safety problems? – Talk more -Start with family – what do you consider personal information * Names *Address *Social security number *photos *cell number – Learn more -Some nice resources: https://beinternetawesome.withgoogle.com/en_us/families https://protectyoungeyes.com 5 unhealthy ways Digital Ads may be targeting your child Tips for parents in the Digital Age Please feel free to discuss with your provider at HPA NOTE TO PARENTS – Texting within a chat room, website or game may come from an unknown person. These unknown people often may be the same age as your child but can also be older adult men and women. These texts can start with small talk and may lead to unhealthy, inappropriate and unwanted online relationships.
Today on the blog we will be discussing one of the most challenging parts of having a newborn – colic. It can be very confusing to diagnose colic and often during the diagnostic process parents make many unnecessary changes thinking that these changes will help with their child’s fussiness. What is colic? Colic comes in all shapes and sizes but the key feature among them all is increased fussiness. Colic is more broadly defined as crying for no apparent reason (i.e. NOT hunger, soiled diaper, etc) that lasts for ≥3 hours/day and occurs on ≥3 days per week in an otherwise healthy infant <3 months of age. The “rule of 3’s” so to speak. Stricter definitions include criteria for minimum duration (i.e. three weeks). Other terms that are interchangeable with colic include “cry-fuss behavior,” “excessive crying,” “unsettled infant behavior,” and “period of PURPLE crying.” Clinical features that can distinguish colic from regular crying are: louder and more high pitched cry, facial flushing and clenched fists, and difficulty consoling the baby. Colic often occurs in the evening hours. Colic will resolve with time. Colic resolves in 90% of infants by 8-9 weeks of age and, in almost all babies, colic is gone by 3 months of age. The cause of colic is largely unknown, although it is likely that there are several contributing factors. Gastrointestinal (gassiness), biologic, and pyschosocial etiologies have all been proposed. It is important to remember that even though colic can be extremely trying on the parents, babies with colic have normal growth and development. How do we treat colic? For the most part – there is no pharmacologic therapy for colic. Offering the breast or bottle to make sure the infant is not hungry would be the first step and then we recommend different soothing techniques including: Using a pacifier. Taking the infant for a ride in the car or a walk in the stroller/buggy. Holding the infant or placing him/her in a front carrier. Rocking the infant or standing and gently bouncing the infant. Changing the scenery (or minimizing visual stimuli – dark quiet room). Placing the child in an infant swing. Providing a warm bath. Rubbing the infant’s abdomen. Providing white noise (white noise machine, fan, vacuum cleaner, etc.) can sometimes be helpful as well. Of note, it is NOT suggested to change a mother’s diet or to switch formulas, as there is ZERO evidence to support that this helps and often can lead to worsening symptoms because of the change. However, there are certain cases where a patient could have a milk protein allergy (suggested with blood in the stool among other findings). If you think your child could have this, please make an appointment with your doctor to discuss this. Common over the counter products such as Simethicone (gas drops) or other herbal remedies are not shown to be any better than a placebo medicine. However, since they are often harmless they may be tried on a case-by-case basis after a discussion of potential risks and benefits with your child’s PCP. Probiotic drops can also be used but there is again a lack of any convincing evidence that they help. To summarize, colic can be extremely frustrating for new parents and can certainly affect the pleasure involved with raising a newborn baby. Severe colic can also lead to postpartum depression. It is important, if your child has colic, to try and maximize support from other family members and friends around you so that you are able to rest occasionally during the day. If both parents are home, pass the child back and forth to give each parent a well deserved break. If you are feeling frustrated and nothing is able to soothe your baby it is fine to put the baby in a crib or bassinet and take a 10 -15 minute break in another room or outside. We always recommend a visit with your PCP if you are concerned that your baby is crying excessively and inconsolable. The good news is – colic always resolves! Perhaps if you know that it WILL eventually get better it will be easier to handle the loud cries and continue to provide love and affection to your precious little one.
Introduction of Allergenic Foods to your Baby A big thanks to Dr. Poel for the excellent overview on introducing solid food to our babies! As Dr. Poel mentioned “waiting to introduce highly allergenic foods has shown no benefit in reducing the chance of your child developing a food allergy…”, so how can these foods be safely introduced to your little one’s diet? First, let’s discuss food allergies in a little more detail: “To be or not to be” allergic? Adverse reactions to foods are common, and as a parent, it can be scary to continue to give these foods to your baby, however, removing foods that are not truly allergenic from our children’s diet can in fact promote the development of food allergies. Although true allergy to food is rarer than intolerance to food, it can result in life-threatening symptoms- so we must carefully differentiate food intolerance vs. food allergy. Food allergy is defined as “a reaction in our immune system that occurs shortly after eating a certain food.” If you believe your baby has had an adverse reaction to a certain food or a food allergy, discuss it with his/her pediatrician who can guide you on safe ways to continue food introduction. “Part of the secret of a success in life is to eat what you like and let the food fight it out inside” Mark Twain Well said Mr. Twain! So let’s help our children be successful eaters, by avoiding food allergies. There is a time in our babies’ life in which they are more prone to develop allergies to food, which is why- as we learned in last month’s blog- we should consider introducing solid food between 4 and 6 months of age. Research about peanut allergy has been ongoing for many years and its related findings can help us to follow certain recommendations about other foods as well. Although any food has potential to cause an allergic reaction, these foods are known to be highly allergenic: Peanuts Tree nuts Milk Eggs Fish Shellfish Soy Wheat And some Allergists include: Sesame seed The research mentioned above continues, and researchers are currently working on establishing formal guidelines on the introduction of highly allergenic foods, however an interim guideline was released in 2017: Baby should be at least 4 months old AND show solid food readiness (see Dr. Poel’s November blog) Baby should have tried and tolerated some starter foods (Pureed cereals, veggies, and fruits) When you are considering introducing highly allergenic foods, please make sure to: Feed your baby only when healthy Give first serving of allergenic food at home Ensure one on one adult supervision (primary care giver), without distractions Adult supervising feeding (primary care giver) must be able to spend at least 2 hours with baby after the feeding, and closely monitor for the next 24 hours 4. Introduce highly allergenic foods to baby if no history of eczema or food allergy (if your baby has eczema or known food allergy, please discuss with his/her pediatrician before proceeding): Prepare full portion of allergenic food (ie. 2 teaspoons of peanut butter prepared in a SAFE way , since peanut butter is a choking hazard for babies- please talk to your baby’s pediatrician on how to safely incorporate peanut butter into baby’s food) Offer your baby a small part of the peanut protein containing food on the tip of a soft tip spoon Wait 10 minutes If no allergic reaction noted- give remaining serving of food as per your baby’s usual eating habits Monitor very closely for the next 2 hours (when most allergenic reactions occur) and closely for the next 24 hours (for delayed reactions) If no reaction noted in 24 hours, you may continue to introduce the next highly allergenic food from the list above. For more helpful information on food allergies, please check out the American Academy of Allergy, Asthma and Immunology website: https://www.aaaai.org/conditions-and-treatments/allergies/food-allergies …And most importantly: Have fun feeding your baby. Eating should always be enjoyable and promote lifelong healthy habits. Stay warm, have a Merry Christmas, and enjoy this Holiday Season with your beautiful families! Dr. Egelmeer
When can I start giving my baby solid foods? What type of food should I start giving? How much solid food should I offer every day? These are common questions for new parents and something that we are happy to discuss with you at your child’s visits. All children develop at different rates but in general most babies are ready for complementary foods sometime between 4-6 months of age. Signs that your baby may be ready to try complementary foods include: Good head and neck control- can your baby sit up straight in his/her high chair without support? Loss of tongue thrust reflex- when you offer your baby a spoonful of food, does he/she push it right back out with their tongue and let it dribble down his/her chin? Or is he/she able to move the food to the back of their mouth and swallow it? Interest in solid foods- does your baby watch you eagerly while you eat, grab for your food if it is within reach, or open their mouth if it comes their way? What first foods should I offer? When you first begin offering solid foods to your baby, the main purpose is to provide an extra dietary source of iron. During the last couple months of pregnancy, iron is transferred to the baby from mom through the placenta. Around 4-6 months of age, baby’s iron stores that they received from mom begin to run low and they need additional iron from their diet. For this reason, when you first offer solid foods, it is recommended to start with an iron rich food such as iron-fortified baby cereal (oatmeal, rice, barley) or a meat-containing puree. If offering rice cereal, it should be offered along with a variety of other cereals. The FDA recommends against offering infants only rice cereal because there is a risk of arsenic exposure. Dry baby cereals can be mixed with breastmilk, formula, or water. Single ingredient foods are preferred for first foods. How should I go about offering it? The first time you offer solid foods, start with a small amount (about half a spoonful). It may take several attempts before your baby figures out how to move the food from the spoon into their mouth and swallow. Follow your baby’s lead and if they close their mouth, turn their head away, or begin to cry, those may be signs that they are not interested. Never force the food into your baby’s mouth as this has the potential to create a negative association with eating and set the stage for long-term problems with feeding. If your baby refuses solids the first time you try, just continue to breastfeed or bottlefeed and try solids again in a few days. How do I introduce more variety? What about highly allergenic foods? Once your baby is taking their first food well, you may add in pureed vegetables and fruits. In general, it is a good idea to wait 3 to 5 days in between each new food you introduce to make sure your child can tolerate each food. The foods that tend to cause more food allergies are eggs, fish, peanut butter, and tree nut butters. These can be introduced after your baby tolerates their first foods well. Waiting to introduce these highly allergenic foods has shown no benefit in reducing the chance of your child developing a food allergy. As your baby tolerates individual food purees well, you can introduce combinations of the foods they have tolerated (fruit and cereal, meat and vegetable). If there is a family history of food allergy discuss when to introduce allergenic foods with your health care provider. Are there any foods I should not give my baby? There are certain foods you should avoid giving to your baby. Specifically, you should not give your baby whole cow’s milk before 1 year of age because their gastrointestinal tract and kidneys are not mature enough yet. It is also recommended to avoid honey before 1 year of age due to the association between the consumption of raw honey and the development of infant botulism (a severe paralysis syndrome). Foods that can be choking hazards should also be avoided (i.e. hard, round foods such as nuts, grapes, round carrots). How much should I offer? When you first start solids, the main purpose is to teach your baby how to eat off a spoon and to introduce new flavors and textures. You may offer solids 1-3 times a day. Initially it might just be a couple of spoonfuls in one sitting. As your baby gets closer to 7-9 months of age they might eat an entire jar of baby food in one sitting. The majority of their nutrition should still come from breast milk or formula until they are getting closer to 12 months of age. To encourage this, always offer breast milk or formula first and solids second. Around 12 months of age most babies are getting about half of their daily calories from solids. When can I offer finger foods? Once they are eating thin purees well, you can advance to thicker purees and soft, easily mashed foods. Around 8-10 months of age most babies have developed the ability to pick up finger foods and feed themselves. Self-feeding should be encouraged although they may need a combination of self-feeding and spoon-feeding to ensure they get enough calories until they are proficient at self-feeding. Other excellent resources for feeding solid foods to your child include the following: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to-introduce-solid-foods.html For questions about arsenic in rice cereal, please visit the FDA’s website which has answers to most common questions about this topic: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm493677.htm
September: Fever and Your Child Now that school is back in session, and some of our children are in small rooms with 25 or more other children, there’s no better time to talk about fevers. With the cold and flu season looming around the corner, fevers are likely to make an appearance in your household, because let’s face it, children stink at preventing the spread of germs. Contrary to popular belief, however, fevers aren’t always bad. In fact, a fever can be quite helpful while your child is fighting an infection and shouldn’t be something to fear. Fever Definition Before starting, lets take a minute to define a fever. A fever is a rise in the body temperature above 100.4 degrees F, regardless of whether your child tends to “run cooler” than normal or not. A temperature can be taken several ways, but the most accurate methods of testing are either rectally (in the bottom), or orally (in the mouth) if your child is at least 4 years old. Other methods of taking a temperature are under the arm (axillary), in the ear (tympanic), and on the forehead. These methods may be easier and better tolerated by your child, but the readings may not be reliable and you may be asked to verify the temperature either rectally or orally if you call our office for advice. Causes of Fever Fevers can arise for many reasons, but the most common causes during childhood are viral and bacterial infections. Examples of viral infections that may cause fevers are: the common cold RSV/bronchiolitis influenza croup gastroenteritis (vomiting and diarrhea) And examples of common bacterial infections in children may include: ear infections pneumonia urinary tract infections Vaccinations may also cause the body temperature to rise in some children as well. When to Contact our Office Most of the time fevers can be treated at home with a fever-reducer, fluids and rest, but there are times when a fever may require an evaluation in our office. These include: an infant under 3 months old with a fever of 100.4 or higher, regardless of how they’re acting. children aged 3 months to 36 months with a fever of 100.4 or higher for more than 72 hours, or if they’re acting ill. children aged 3 months to 36 months with a fever of 102 or higher. children at any age with a fever >100.4 for more than 72 hours with no obvious source of infection, or if they have recurrent fevers for more than 7 days if there is a source (like a cold, for example). Call our office right away if your child has a fever and: doesn’t respond to you or is limp has trouble breathing has blue lips, tongue or nails starts to lean forward and drool is an infant and has a bulging or sunken soft spot has a stiff neck has a severe headache has severe belly pain has a rash or purple spots on the skin (red freckles) refuses to drink will not stop crying Treatment of Fever So now that you’re familiar with the most common causes of fevers, and when to call our office, lets take a minute to talk about how and whether or not to treat a fever. I’d like you to think of a fever as the body’s natural defense against an infection, whether it be viral or bacterial. When your child develops an infection, the body temperature may rise to try to kill whatever is causing it, which can be helpful in the disease process and recovery. Unfortunately, a fever can also make your child quite uncomfortable. So when you’re thinking about whether or not to treat your child with a fever-reducer such as acetaminophen (Tylenol) or ibuprofen (Motrin/Advil), I’d like you to consider how your child is feeling. If your daughter has an elevated temperature but is playing, drinking and eating, treatment may not be necessary, but if she’s lying on the couch, crying and clearly doesn’t feel well, using one of those medications may be appropriate. The degree of your child’s temperature is not always a good indicator on when to give a medication, but rather how he or she is acting. You can find proper dosing for acetaminophen and ibuprofen by clicking on this link: https://hollandpediatrics.com/dosage-chart/ . Please be advised that we do NOT recommend alternating acetaminophen and ibuprofen, as this may lead to dosing errors. Instead, choose one medication and stick with the same one unless we advise you to switch. Aspirin should NEVER be used as a fever-reducer in children under 18 years old. One other thing to keep in mind, is that an elevated temperature may cause your child to become dehydrated. Because of this, it is important to make sure that your child is drinking plenty of fluids. Your child may not want to eat as much as usual, and that is fine, but he must drink fluids, so encourage sips frequently. You can offer anything your child would normally drink, but if you’re having trouble getting fluids in, Jello, ice chips and popsicles may be good alternatives. Thank you for reading through and I sure hope this helps to alleviate some anxiety regarding fevers during the upcoming cold and flu season! If you still aren’t sure if your child requires an evaluation, please call our office to speak with the advice line, or send us a message on the patient portal, and we’ll be happy to help you decide. Have a wonderful day, Angela Smith, CPNP
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