Posted tagged ‘baby’

Generic baby formula

July 1, 2009

Sylvia wants to know: “Can I use generic baby formula?  I use generics for myself all the time, but get nervous about the idea with my baby.  (He only eats one thing – I want it to be good for him!)  Are generic formulas ok?  Do I just need to make sure it has the same nutrition info as the well-known brand?”

Generic formulas adhere to the same industry standards as the name brands, and are essentially the same. When you buy the name-brand products, you’re paying more for a label, and you’re paying more for their extensive promotional efforts and giveaways.

I almost always buy generics—including medications, when they’re available. (Except for JIF peanut butter. Mmmmm, Jif!) It’s a myth that brand-name products are superior, a myth allegedly maintained by false or misleading advertising campaigns. There have been times in the past when new developments in baby formula first appeared in the name-brand products, most recently the addition of the essential fatty acids ARA and DHA. At this time, however, the generics have entirely caught up, and you don’t need to spend extra to get the second best product available.

(I forgot Coca-Cola. OK, for the record, all other brands of cola are nasty, especially icky store brands. Mmmmm real Coke!)

Almost all formulas fall into one of these groups, with very little variation within the group:

  1. Standard cow’s milk based formulas, like Enfamil Lipil or Similac Advance or almost any store brand. These are fine, the standard second best thing to feed your baby.
  2. Partially hydrolyzed cow’s milk formulas. A few brands partially “digest” their milk proteins, supposedly making the formulas easier on the tummy. There’s very little data to support their use, but they’re fine if you want to try one, like Gentlease or Carnation Good Start.
  3. Soy formulas, including many generics, Isomil, and Prosobee. There are very few, rare medical reasons to use these; many babies with genuine cow’s milk allergies can’t tolerate soy, and have to use a genuinely hypoallergenic formula. Still, if you’d like to avoid cow’s milk, go for it. These are probably fine.
  4. Reduced-lactose formulas (Similac Sensitive, Lactofree). These are just silly—there is no such thing as lactose intolerance in babies, and these formulas are only there to pander to fears and misinformation. If your child is genuinely allergic to milk, these won’t help.
  5. Hypoallergic formulas, like Alimentum or Nutramigen, are for babies with genuine milk allergies. This isn’t common, but for those babies these products are essential. There are no generics of these formulas, which are very expensive.
  6. Spittin’ formulas, like Enfamil AR or Similac RS, add modified rice starch that thickens somewhat in the stomach, preventing spitting. They seem to help some, but keep in mind that almost all babies spit up sometimes, and most don’t need any medicine or special formula. There are no generics of these moderately-priced formulas.

(I like genuine Ivory soap, too. Smells nice.)

tl;dr summary: If you’re looking to save a few dollars, generic baby formula is fine.

Fever part 3: Dispelling fever phobia

June 21, 2009

Worry about fevers is the most common reason for an urgent call or visit to a pediatrician. Parents worry about fevers because it makes their child look and feel ill, but also because they’re concerned that the fever means there is a serious medical problem going on, or that the fever is going to harm their child.

Historically, fever did once mean that something terrible could be going on. One of the most common causes of fever world-wide, malaria, is no longer seen in the developed world thanks to improved mosquito control. Likewise, many other serious fever illnesses have become rarities thanks to improved sanitation (like typhoid fever, plague, and dysentery.) Vaccinations now protect against most of the more serious bacterial infections (including meningitis and blood poisoning), as well as many viral infections that had been so devastating in the past (like polio and measles.) Other potentially serious infections have now become easy to identify and treat (scarlet fever, pneumonia, kidney infections.) Compared to a century ago, we are far more able to access reliable health care that can accurately diagnose and treat almost any illness. So while it made sense for parents 100 years ago to worry that a fever could mean the death of their child, this fear is not justified today.

If your child does have a fever, how can you tell if it’s caused by something serious?

In the past, a general rule was that the height of the fever predicted how serious the underlying problem was—so a fever of 105 was far more of a worry than 101. But in a fully vaccinated, otherwise healthy child, this “rule” doesn’t hold true. Even a 105 fever in a healthy child is quite unlikely to be from any serious condition. The best way to determine how likely it is for a child to have a serious medical issue causing a fever isn’t to look at the number on the thermometer, it’s to see how the child acts when the fever goes back towards normal. Give a dose a fever-reducer, wait 30 minutes, then see how Junior feels. If he’s doing much better, it’s very unlikely that you have a serious infection to worry about. We’ll cover this in more detail in the next (and last) installment of my fever series.

A fussy newborn

March 19, 2009

Amanda wrote, “My son is 9 weeks old and he cries all the time! He cries throughout the day and night. The Dr. keeps saying that it is colic but I thought that was normally at the same time everyday. This is all day everyday. I have tried gas medicine, Zantac because they said he could have acid reflux and now I have changed his formula that is specifically for colic but there have been no changes. Please help!!! I feel like tests are something should be ran what can you recommend?”

Although some people use the word “colic” to refer to any sort of excessive crying in babies, to most pediatricians colic refers to a very specific pattern of crying. Babies with colic cry at a set interval each day, almost always in the evenings. Many parents will say they can set their clocks by the crying, it’s so regular. The crying peaks at about 4-6 weeks, and goes away by the time the baby is three months old. Although colic can be exhausting, in a way it can be reassuring if your baby only cries excessively during a set time each evening. After all, there is no medical problem that only occurs in the evening. This is sort of crying is not caused by any medical issue, and the main way to treat it is to learn good soothing techniques and provide a way for parents to get some rest and take a break once in a while.

It sounds like your baby, who is fussy all of the time, doesn’t have what I would call “colic.” Excessive fussiness can be caused by many different things, some related to the baby, and some related to the family:

  • Reflux, which you mentioned, can lead to pain and heartburn. There are no simple and easy tests for reflux, but if it seems clear from the history that reflux is occurring many physicians will try to treat it.
  • Food allergy—either formula intolerance or a problem with something in mom’s breast milk—can cause frequent fussiness at all times of day.
  • Temperamental fussiness refers to babies who have a hard time settling down, are anxious, and cry a lot. These babies need extra reassurance, and their parents need extra support.
  • Constipation is not common in little babies, but if your child is having firm and painful stools that needs to be addressed.
  • Maternal health problems, including post-partum depression, can cause or be caused by excessive baby crying.
  • Unusual medical problems in a baby can include urinary tract infections, glaucoma, a broken bone from birth trauma, or really almost anything else. There is no way to “test for everything,” but a careful history and physical exam will reveal almost any sort of problem like these. Rarely, specific directed tests like a urinalysis or an x-ray might be needed.

Your first step is to get yourself some respite care. If you’ve got a very fussy baby, you especially need time to unwind and get some rest. If you don’t have family in town, you may need to rely on a neighbor, close friend, or a hired nursery helper. Do it! No matter what the underlying cause of the fussing, you’ll be able to deal with it better if you have a chance to catch your breath once in a while.

Then, make sure that your pediatrician gets the whole story and a good complete physical exam. Bring notes with a log of the fussiness—when is it? How does it relate to meals and bowel movements? What have you tried that has helped? In my experience the answer to the mystery of a fussy baby is much more likely to be found in clues the parents provide than in any sort of medical tests.

Best of luck, and I hope you get some rest soon!

Got (raw) milk?

February 20, 2009

Jill said, “My pediatrician recently had a bit of a fit when she learned we were feeding our 4 year old raw unpasteurized milk. I don’t understand why this is such a big deal. Can you explain? We get our milk from my father in law who raises cattle so this is the only milk my four year old has ever drank.”

I had a hard time with this question—most of the information I could find was either from very pro-raw milk advocacy groups, or from rather bland statements from health authorities urging people to “just say no” to unpasteurized milk. I’d like to say I’ve found some good science and statistics comparing the risk of straight-from-the-farm, unpasteurized milk to commercial milk. But I haven’t.

Pasteurization itself is a fabulous way to disinfect natural foods like milk and juice. It usually involves heating milk to 165 degrees for 15 minutes (there are other protocols), which dramatically reduces the bacterial content of the milk. And there are some nasty bacteria that can thrive in milk, including forms of tuberculosis, listeria (a potential cause of miscarriages), and diarrhea-causing campylobacter, to name a few. Pasteurization reduces, but does not eliminate, the risk of infection from consuming milk. The terms “unpasteurized” and “raw” milk are pretty much used interchangeably.

I did find this statistic: between 2002 and 2007, the Centers for Disease Control tracked 1007 illnesses traced to raw milk or cheese, including two deaths. During that same time period, there was an outbreak of listeria from pasteurized milk in Massachusetts that killed three men and probably led to at least one miscarriage.

The FDA recommends avoiding unpasteurized milk, and several states have banned its sale. Some states allow it if an unappetizing gray color additive is added (it can still be used safely to feed animals.)

It’s important that farms that collect milk for consumption without pasteurization practice very clean, hygienic farming. Unfortunately, I doubt most large commercial farms do this; they probably rely on the pasteurization to “make up” for their crowded, factory-like conditions.

If families are going to consume raw milk, I would certainly recommend that they investigate the farm thoroughly, and stick with a small local source. Good hygiene is essential at every step. The milk has a short shelf-life, even when refrigerated. People with immune-compromising conditions, the elderly, pregnant women, and babies would all be at special risk for more severe infections, and should stay away from unpasteurized products.

Diaper rash cure– revealed!

February 17, 2009

A diaper rash question from Kelly: “Dr. Roy – My one year old and I are struggling to get rid of a persistent diaper rash. We’ve tried various creams and antifungal meds (both over the counter and prescription). We’re trying to change diapers every 2 hours. Is it possible that some kids are allergic to diaper creams? If so, do you have any suggestions about what else to do or try? Thank you!”

Any child could be allergic to just about any sort of cream, but I can’t say I’ve run into diaper rash cream allergy. If it seems like that might be going on, switch to plain Vaseline (petroleum jelly.) It has just about nothing in it to be allergic (no protein, just fats.)

As for the best overall approach to diaper rash: every pediatrician has their own secrets. We like to pretend that there’s some super-magical formula for getting rid of diaper rash. In truth, there are really only a few simple techniques that work. You can use any of these in combination:

1. Keep the skin cool and dry. Going naked is by far the best “medicine” for diaper rash, and the cutest too. After a diaper change, let Junior scoot around bare for a little while. Maybe not so good for the carpet, but it’s great for the rash.

2. To further keep skin cool, use a COLD hair dryer after changes (never, never use a hot or warm setting.) Bonus: very young babies love the noise.

3. Bland diaper rash creams protect and soothe. There is no reason to pay more for any kind of fancy-pants (get it?) diaper cream—they’re all going to do the same thing, and none are magic. I like generic zinc oxide paste (anywhere from 20-40%). You can buy store brands in big 1 pound tubs. Good brands of zinc oxide are Balmex and Desitin. Plain Vaseline or generic petroleum jelly works well, too. Use this after the cooling-off naked time. Apply a nice thick layer with a gloved hand (use a glove or it’s hard to get it out from under your nails.)

4. You can add a low-potency steroid, like over-the-counter strength hydrocortisone 1% ointment. Use this twice a day instead of the bland cream if a diaper rash seems like it’s irritating or painful. It will help soothe the skin, though it will not really help it heal faster. There is absolutely no need to use any sort of higher-potency steroid on this area of the body. Some doctors prescribe this stuff, and they’re asking for trouble. Stick with OTC strength and you and your baby will be fine.

5. Yeast sometimes appears in a diaper rash, usually on skin that’s been raw and red for more than three days. Also suspect yeast if your child has been on antibiotics. Though yeast can have a characteristic appearance of little satellite red dots outside of the main rash, it doesn’t always look like this. If you’ve got a diaper rash for more than three days or with dotty satellites, add in an anti-yeast cream twice a day. Over-the-counter generic Lotrimin (clotrimazole 1%) works well. Do this in addition to steps 1-3 above, and add step 4 also if the skin is uncomfortably irritated.

For any diaper rash that doesn’t respond to the above, go see your pediatrician. It’s rare, but sometimes a “diaper rash” can be something different from ordinary. Those cases need additional evaluation.

Melamine is here

November 26, 2008

Melamine in infant formula, here in the USA?

Yup. Trace amounts of this, as well as many other industrial chemicals, are found throughout the food chain. Plasticizers, solvents, cleaners, all sorts of chemicals are used in the processing and packaging of food. And shortly, you’re going to hear all sorts of grandstanding by politicians eager to make a splash in the news. But before you get caught up in the coming hysteria, let’s hear the rest of the story…

Melamine is an industrial product used in cleaning food equipment and packaging. It can also be used deliberately by ruthless food manufacturers to “fool” chemical assays of protein content—that’s probably why it was added in large amounts to several sources of milk used to make infant formula and other foods in China. That story broke in August, 2008, shortly after the Olympics. To date, the Chinese government has acknowledged 3 deaths and 50,000 sickened children from exposure to melamine, though many observers think the totals could be far higher. Melamine causes illness by binding with other chemicals in the urine and forming kidney stones. The tainted products were also exported from China to several neighboring countries, though very little was brought to the United States (only a few candies and novelty foods, mostly sold in Chinese markets, have been shown to be contaminated in high concentrations from the Chinese milk.)

Formulas and other foods in China that made babies ill have been found to have 2,500 parts per million (ppm) of melamine. Keep that number in mind.

In the United States, regulations prohibit the use of melamine as a food additive, but do allow melamine-containing solutions to be used as cleaners of food processing equipment (that regulation was passed over 40 years ago.) The FDA has established a “safe concentration” for most foods of less than 2.5 ppm, 1000x less than the toxic levels seen in China. However, this “safe concentration” does not apply to infant formula—for formulas, no “lower safe limit” has ever been established.

The commercial assays available for manufacturers to test for melamine have a lower detection limit of 0.25 ppm. This includes the published method that the FDA suggests food manufacturers use to test their own products. However, chemical methods continue to improve, and lower limits of detection have become possible with new technology.

The FDA began testing infant formula shortly after the melamine story broke, using the most sensitive assays available. They’ve found that several infant formulas in the US have measurable concentrations of melamine, about 0.14 ppm. It’s not known (or least I couldn’t find) assays of the concentration of melamine in breast milk or drinking water—but my guess is that it will be more than zero.

This concentration in formula is far less than the established safety threshold for most foods, and far far far less than the concentration that has made kids sick in China. Only a few years ago, this concentration wouldn’t even have been detectable; it’s only improved chemistry that has allowed us to know it’s even there.

Paracelsus (1493-1541), a Swiss chemist, is often credited for his statement of the most basic tenet in toxicology: “The dose makes the poison.” In other words, any substance is a poison at a high enough dose (for example, water, salt, and vitamin C will all kill you if you ingest enough of these.) And there is no substance that is poisonous if taken at a low enough dose. Even deadly rattlesnake poison or the most lethal nerve gases have a threshold of toxicity, below which they’re harmless.

Several politicians have already seized on the melamine issue, insisting on a “zero-tolerance” policy. From a science point of view, that’s silly: ordinary foods always contain traces of deadly chemicals, including arsenic (a natural element) and cyanide (which is produced in small amounts in each one of your body’s cells every day.) As chemical assays improve, it becomes possible to detect the most minute amounts of anything—does that mean that the small amounts, which may always have been present, pose a danger? And if all of the infant formula is recalled, what, exactly, are we supposed to feed our babies once they’ve weaned?

The harm of a mass recall of formula—babies being fed some kind of home-brew concoction, or products that are very demonstrably unsafe for infants (like plain whole cow’s milk)—is far, far greater than any harm that might be posed by these infinitesimal amounts of melamine. Besides, there’s an even higher amount of melamine allowed in whatever parents might use as formula substitutes. That couldn’t be an improvement.

The melamine issue requires some clear thinking. Formula manufacturers should work to find the source of the minimal contamination—probably a cleaning solution that could be rinsed more thoroughly—and eliminate that source. Studies to look for possible long-term effects of food-source melamine should be undertaken, and reasonable steps to minimize contamination with melamine and other chemicals should be taken at every step of food processing and preparation. But there is no reason for any sort of formula recall, and no reason for anyone to panic.


White noise at bedtime

November 16, 2008

Lara posted, “My husband and I have always put our son, who is 10 months, to sleep with white noise in the background. It went from the exhaust fan in the bathroom, to a humidifier and now a sound machine. We even take the sound machine with us when we travel for our baby to sleep with. My husband’s family all use fans to sleep with and some have a difficult time sleeping without one. I am concerned that our son will always need white noise in order to sleep if we continue to use the sound machine long into the future. What happens when he goes to sleepovers and there isn’t one there? Should we keep using it or let him learn to sleep without one?”

I’ve written before about the importance of good, fixed sleep associations as an important way to help kids sleep independently through the night. Junior will get used to cues from the environment to know when it’s time to go to sleep and stay asleep. These can be things like being held, a gentle rocking motion, being swaddled, or a dark room. The best sleep associations are those that do not depend on a parent being present. So a white noise machine, running all night, can be an excellent way to help a child learn to sleep solidly and independently.

I’m not too worried about a baby being too dependent on a device like this. They’re easy enough to use every night, and can run on batteries or A/C. They’re cheap, they’re harmless, and I can’t think of any reason not to bring one traveling. In fact, they’re especially good during travel, as the familiar sounds drown out new and foreign sounds that would otherwise keep a baby awake. If a child wants to continue to hear soothing white noise when older, what’s the harm?

If you really want to wean this later, it can be done: just turn down the volume, gradually, so over several weeks Junior will get used to less and less noise, then finally turn it off. But I wouldn’t worry about this kind of habit now. It’s safe, and will help everyone get a good night’s sleep.

Don’t use the car seat as a crib

November 12, 2008

Here’s a sleep question from Kathryn: “Just wondering about the safety of infants sleeping in the car seat (in the crib). My 8 week old sleeps beautifully in the car seat but only naps for 45 minutes at a time in the crib. This is my 3rd child and this is new to me – my others were great sleepers once I “figured them out”. It appears that this one just does better sleeping like that -what are your thoughts? Thank you!”

In the short run, car seat sleeping might save you some trouble, but in the long run it can lead to more serious problems. Best to stop this habit now, before it’s really ingrained.


Ranking the baby names

November 8, 2008

Want to pick a popular, easy-to-pronounce name? Or perhaps you’re looking for something a bit more exotic? The Social Security Administration keeps the statistics, and has created a cool, searchable site at with loads of information and statistics.

Jacob and Emily, once a again, have topped the list of most popular names in the USA in 2007. Roy topped out at number 18 from 1889 to 1894, so it’s due for a comeback!

Other random names, just as examples:

  • Allison peaked in 1994 at #34.
  • Jack hit its top at #14 when Wall Street hit its bottom in 1930. But it’s on the way back up– #38 in 2007.
  • Kimberly made it all the way up to #2 in 1966!
  • Paris peaked in 2004 at #157, but has since dropped to #385.

There’s also a baby names and city names quiz (look on the left) and a list of top twin names. All 10 top twin pair names each start with the same letter.

Interesting stuff, free, and a fun way to waste time!

Subtle developmental clues

November 4, 2008

A post from Day: “Dr Roy, what is considered “normal range” for a one year old’s speaking ability? My 13 month old doesn’t speak yet and this concerns me. He might babble “gagaga” but it has no meaning. I stay at home with him and every day I try to teach him words such as momma, daddy, bye bye, cat etc and he isnt learning to say them. His pediatrician told me this would be something we would address at 15 months(my pediatrician was not worried at all that he wasn’t speaking) but as a mom who sees other 12 month old’s ability I am worried. Also, he 100% understands what I am saying. I can say simple commands such at ‘lets eat’ and he knows to go to his high chair so I know he understands me. Thank you!”

From my point of view, how many words a 13 month old is using really isn’t a useful marker of how well the child is developing. Some normal 13 month olds have 4 words, some fewer; some have no words at all. There’s a lot of variability there, and concentrating on word count at this age can create a lot of unnecessary worry.

A neurologically normal 13 month old should do all or almost all of these things:

  • Follow simple directions.
  • Use gestures like waving or nodding.
  • Point to things he wants, or point to things he wants you to look at.
  • Look at things you point at.
  • Bring things to show you.
  • Show off—that is, do cute things, then look to make sure you’re paying attention.
  • Combine sounds with a melodic quality, similar to speech. Even if words don’t make sense, the overall “sound” of his babbling should sound like a monologue, with pitch and speed changes and pauses.

The easiest “milestones” to talk about and compare between children are things like when they start walking, or how many words they say at a certain age. However, the subtle things like the ones I’ve listed are far more important, and offer far more insight into how a child is developing.