Posted tagged ‘baby’

Peanuts, when?

October 25, 2008

Gretchen asked, “When is it ok to feed a child peanut butter? I have heard that you should wait until 4 years old because if you try sooner then the child could become allergic. I have been feeding my 14 month old peanut butter since his first birthday and he has shown no signs of allergy, but can he develop one if I give him peanut butter too often (another rumor I have heard)? He eats it about 3 – 4 times a week.”

There is no consensus among allergists or pediatricians about when kids can safely start peanut butter. There is no “official” recommendation from either the American Academy of Pediatrics (AAP) nor the American Academy of Allergy Asthma and Immunology (AAAAI). Since there’s really no evidence that delaying introducing peanuts prevents allergies, there’s no good reason to delay peanuts as long as many people suggest.

For a long time, a strategy proposed to prevent allergy was to delay introducing certain foods. You’ll find all sort of tables with specific “recommendations”—strawberries at 12 months, or peanuts at 3 years, or whatever. But until recently there really was very little research to help guide these sorts of suggestions. The tables were arrived at by a process of “expert consensus,” a fancy term for “making things up.”

The best recent studies, summarized here, do not support delaying food introduction. In fact, some studies have found that by delaying certain foods, you might increase your child’s risk of allergy.

Keep in mind that your child’s risk of food allergy depends very much on the parent’s history. If neither parent has food allergies, a child has a very low chance of food allergy, less than 2%. If one parent has a food allergy, it’s up to 8%; if both parents have food allergies, their child has about a 50% chance. You could also consider siblings—the more siblings with allergy, the higher the chance. And once a child has one food allergy, the risk of having others is fairly high. So if there is no family history of allergy, and a child hasn’t shown signs of any other food allergies, the chance of a peanut allergy is very small.

Since your child is tolerating peanuts fine, there is no reason to restrict them. It is not true that frequent peanut ingestion can lead to allergy. Your child can continue to eat peanut products safely as often as he’d like.

I routinely suggest that children who don’t have a strong family history of allergy can start having peanut products at twelve months of age. It’s important for all families to keep Benadryl in the house, and know their child’s dose (ask your pediatrician.) If a rash develops after peanut (or any other food) is ingested, give Benadryl. If there are any signs of trouble breathing, tongue swelling, or decreased consciousness, call 911. If you’re not sure what to do, contact your child’s pediatrician immediately.

Pillows, cribs, and the Great Escape

October 21, 2008

A post from Holly: “This may be a less serious question compared to other topics on this board, but it’s something I’ve wondered about but not found much written about — when and how do you introduce a pillow for sleeping? So far, my 26-month-old twins have shown no interest in climbing out of their cribs (and we aren’t going to move them to beds until they do), but I’m wondering if a pillow should be an initial step in learning how to sleep in a bed? And if so, what kind of pillow should I look for? Smaller than standard I’m assuming, but how small? And should it be more firm than soft for suffocation concerns?”

The safest thing to do is leave all pillows out of the crib. Leave out any sort of toy or stuffed animal or anything else that Junior can use to climb out.

It’s kind of a logic or problem-solving puzzle: picture yourself as a little person, 2 feet tall, locked up in a cell with no ceiling. The walls are vertical rails three feet high. You have in your cell only a mobile with little stuffed bears, a flat thin blanket, a surprisingly absorbent diaper, and a pillow. How do you get out? Imagine that you spend a lot of time in there, about 12 hours of each day. Sooner or later, many toddlers will figure out that you can fold up the pillow to make it taller, or wedge it in between the rails. Free at last! (As a bonus, if you’ve figured out how to get the diaper off, you can get out naked. Believe me, it has happened.)

So: safety first. Toddlers are resourceful, and you don’t want to make their escape easier. No pillows should be put in cribs, and nothing else that can be stacked or wedged to use as a ladder should be within your child’s reach.

If you’ve got a really clever kid, put some duct tape on the tabs of the diaper, too!

Outgrowing milk allergy

October 19, 2008

Kelly posted: “My daughter just turned one year old and has started the switch from breastmilk to cow’s milk. She has broken out in a rash each of the three times she has had cow’s milk, so we are switching back to breastmilk temporarily. If she does turn out to have a milk allergy, what’s the likelihood that she will grow out of it? And, does the milk allergy extend to milk-based products like cheese, yogurt and cottage cheese?”

True milk allergy (sometimes called “milk protein allergy” or “IgE mediated allergy” or “type 1 hypersensitivity”) causes either hives, wheezing, severe vomiting, or a drop in blood pressure that can cause unconsciousness. Of these reactions, hives are by far the most common and the most benign. The rash is raised pink blobs, occurring anywhere on the body. For some reason, they sometimes seem to prefer the armpits or just around the belly button. Hives itch, and each individual raised area resolves on its own within twelve hours. More hives can follow, but no single spot stays in the exact same place for very long.

Children who have hives triggered by milk will usually outgrow their allergy. It may take a few years, but by kindergarten age over 90% of these children will be able to tolerate milk. (more…)

Nursing multiple siblings

September 27, 2008

Nancy posted a question about nursing two siblings at once: “I am not sure if this is more of a question but for OB or a pediatrician but I thought I might ask anyways ) I am pregnant and still breastfeeding my now 13 month old. If I was to continue to breastfed once her younger sister was born would my newborn get all the nutrients she needs? My daughter only nurses twice a day so of course the newborn would nurse a lot more but I am very concerned my body wouldn’t make enough nutrients for a vulnerable newborn. Please any information you can give me would be wonderful. I am less concerned about my older child’s nutrients because he takes vitamins and eats tons of regular food. Thank you!”

At The Pediatric Insider, we’re happy to tackle the occasional OB question! Nursing multiple siblings is called “tandem nursing.” Here is an article from an experienced mom addressing some ways to address some of the challenges that may arise. The bottom line is that you can successfully and safely nurse both of your children. Your body will be able to make enough milk for both of them, and both kids will do fine. Usually the quality of the milk will change to match the needs of the newborn, and in fact sometimes the older child weans shortly after baby is born, perhaps because the milk begins to taste different.

Tandem nursing may be a little harder on mom. Make sure you’re getting plenty of fluids and enough calories, as well as enough calcium, vitamin D, and iron. Your newborn should take a vitamin D supplement as well.

Organic infant formula? One brand is a bad idea

August 10, 2008

As reported by the New York Times, parents thinking that Similac Organic Infant Formula is healthier than conventional formulas are in for a surprise. The company that makes it, Ross, decided to use cane sugar as a sweetener. This makes Similac Organic taste sweeter than other infant formulas, and much sweeter than human milk. It’s riskier for a baby’s teeth, and is very likely to lead to over-eating. Worse still, it may help imprint a desire for sweeter foods starting at a very young age.

As discussed in this post, I’m not a proponent of organic foods. They’re more expensive, and I’m not convinced that they’re healthier or better for children. In the case of this particular infant formula, parents are paying about 30% more for a product that’s very likely to be less healthful than non-organic alternatives. You can’t assume that organic = more healthful.

Baby disinterested at mealtimes

July 25, 2008

“My daughter who is one does not seem interested in feeding herself. Whenever I sit down and eat with her – I try to guide her fingers into her mouth while she is holding a piece of food. She starts crying hysterically. After 30 min of sitting there and playing with her food, I end up feeding her jarred baby food. She has even gone as far as handing the finger foods back to me and then opening her mouth to show me that she wants me to put it in her mouth. The same goes for sippy cup vs. bottle.”

You’ve got some ingrained habits that may not be quickly fixable, but I’ll answer the question in a general way that should help you and other families. You should talk with your pediatrician for more specific advice, and consider asking for a referral to a “feeding center” which works with children to establish better eating and feeding routines. I don’t know if your child is unable to feed herself, or unwilling. You didn’t mention any sort of motor delay or oral-motor problem, so I suspect it is more a matter of habit. However, you two are certainly locked in a battle of wills at this point, and you may need more hands-on expertise to work your way out of it.


Taking a newborn outside

May 23, 2008

A post from Steve: “I have a newborn baby girl and I was wondering how long after birth does she need to stay in the house. I have heard everything from 1 month to three. If we do take her out what places should we avoid?”

If your daughter is healthy– born at or near term, with no problems—she can go outside any time the weather is nice.


Sunscreen for babies

April 12, 2008

KM writes, “I have recently read that it is ok to apply sunscreen to infants under 6 months. Is this true? Can it be applied to the face? Is there a certain product that is better for their sensitive skin? Also, any suggestions for skin protection this summer for an under 6 month infant besides minimal sun exposure and a hat ? Thanks.”

Sunscreen can safely be used at any age, but parents need to know that that young babies may be at special risk from too much sun exposure. (more…)

How much formula needed at 10 mos?

April 12, 2008

Katie posted: “My daughter’s 10 months old. She takes 4 bottles a day, about 20oz. I want to ease into the 1 year – weaning – thing. What is the minimum amount of formula I should give her? Can I go ahead and supplement with milk, or is it best to wait until she is 1 year old?”

By 10 months, your daughter should be eating solids at least three times a day, and solid meals should include a good variety of ordinary table foods that you share with her at family meals together. This can include almost any sorts of foods, except nuts, peanuts, and raw honey. All of these foods ought to be soft enough for her to “gum them.” Good examples are noodles, well-cooked veggies, beans, crumbly meat, cottage cheese—almost anything can be ripped apart so it’s soft enough for a 10 month old.

Why won’t she stay asleep?

April 7, 2008

DM posted on the suggestions thread: “I have a 21 month old that is still waking up several times a night. She cries in her sleep, and 75% of the time, she puts herself back to sleep with no intervention. She will do this anywhere from 1 – 8 times a night. Some of these episodes last just a minute or two, but some of them are getting to be much longer. If she is teething (currently 2 yr molars are breaking through early) or sick, I intervene as briefly as I can after about 20 minutes of crying. Currently, the episodes are lasting up to an hour or hour and a half. She has a consistent night time routine, and goes to bed at the same time each night. Is it normal for her to be crying in her sleep throughout the night? Am exacerbating the issue by ever intervening? Thank you for any insight you can provide. I am getting worried (and tired!).”

The post was made at 4:30 am!