Becoming a new mom is a wonderful, life-changing experience. But it can also be a stressful time, as we learn what’s best when it comes to the care of our new baby.
We asked three of the newest pediatricians at St. Mary’s Hospital in Jefferson City to answer a few questions new moms may have as we head into these cold winter months.
Answering our questions today are Dr. Katherine Blount, DO; Dr. Bethany Crawford, MD; and Dr. Olga Brea, MD.
Q. We’re heading right into flu and RSV season. What should new parents know about vaccinations and preventative care?
Blount: “Vaccinations are safe, effective, and vaccines saves lives. They are one of the best ways we have to protect children from illnesses that can be devastating and even life threatening. The most common side effects are redness, swelling or a bump at the injection site, but these usually resolve within a day or two and it is worth the long-term protection!”
Crawford: “Vaccinating your baby is one of the most important things you can do to protect their health. Newborn babies can get a hepatitis B vaccine in the hospital before they go home. They can receive several other vaccines at their two-month well child check, including vaccinations for pertussis, tetanus, diphtheria, haemophilus influenzae, rotavirus, polio and pneumococcal bacteria. Babies can receive their first influenza vaccine at six months of age.
If your baby is younger than this, you can protect them by making sure all their close contacts are vaccinated, particularly against influenza and pertussis. This provides a ‘cocoon’ of protection for your baby. Good hand-washing practices and limiting your baby’s contact with sick people are other helpful precautions.”
Q. With RSV, how should a parent monitor an infant’s breathing at home?
Blount: “We talk about watching for fast breathing or retractions. Fast breathing looks like they are taking a breath every second. It is normal for a baby to alternate between a series of fast breaths and then a pause, but if they get ‘stuck in the fast lane’ for several minutes, this can be an indication they are having trouble breathing. In addition, if you see deep sucking in underneath their ribs with each breathing, there are retractions and can also be a sign of difficulty breathing.”
Crawford: “RSV is a common respiratory virus that is most active in the winter months. In adults and older children, RSV infection looks like the common cold. However, in infants and very young children, symptoms can be more severe, making it difficult for them to breath.
Common symptoms of RSV include fever, cough, runny nose, fussiness and decreased feeding. When babies work hard to breath, they use their abdominal muscles to help them move air in and out of their lungs. If you see your baby’s belly or chest suck inward under or between their ribs with each breath, they are using those abdominal muscles and are working hard to breath. Other signs a baby is working too hard to breath include faster breathing, shallow breathing, head-bobbing and nostril flaring with each breath.
If you think your baby is working hard to breath, you should take them to see their doctor, or to the emergency room, immediately. If you’re not sure, try calling your doctor’s office and speaking to a nurse. At our office, even at night, there is a nurse available to talk to you about your baby’s breathing, help you figure out if your baby is breathing too fast, and give advice on the best next step.”
Q. What are some safe, at-home methods of caring for an infant with a cold?
Blount: “Almost all the issues an infant has with a cold comes down to the mucous. If you are able to help them out by suctioning their nose often, this can be very supportive. Sometimes a few drops of saline in the nose before suctioning can help. If they are having difficulty eating during the illness, try timing the suctioning to be right before a feeding.”
Crawford: “Nasal suction to clear mucus from the nose is one of the most important things to do for your baby when they have a cold. Clearing the mucus can help your baby both breath, feed and sleep more comfortably. First, place saline drops in your baby’s nose. This will thin out the mucus and make it easier to remove. Next, suction both nostrils with a bulb syringe or Nose Frida. The most important times to perform nasal suction include before feeds and bed, but you can perform nasal suctioning at other times as well, throughout the day.”
Q. When it comes to feeding, what should parents know about breastfeeding versus formula?
Blount: ”Ultimately both give your baby everything they need to grow and stay healthy. There are many healthy benefits to both the baby and the mom with breastfeeding including helping them to build their immune system in the first couple of months when they are most vulnerable. If they are solely breastfeeding, they will need a supplemental vitamin D dose daily as this is the only thing not provided in mom’s milk.”
Crawford: “Coming from a currently breastfeeding mom – breastfeeding can be hard, but is very much worth the effort. Breast milk allows you to share your antibodies with your baby, which will help protect them from infection. Plus, breast milk is free! While there are important benefits to breastfeeding, there are many reasons why families cannot or decide not to, including low milk supply, certain infections in mom or just personal preference. For these families, formula is a safe alternative to nourish your baby.”
Q. If breastfeeding, how can a mother know if her infant is getting enough food?
Blount: “You should feel a difference after a feed, like they have ’emptied.’ The infant should seem satisfied following a feed. We keep a close eye on their weight in the first few weeks and ultimately, if they are growing well, we know they are getting enough food. If you are able to also pump additional milk, if you pump when you are full and then completely empty, this can give you an idea of how much the infant is getting when they feed.”
Crawford: “Parents of breast-fed babies are often uncomfortable with not knowing exactly how much milk their baby is eating. However, if you know the signs, you can be confident that your baby is getting enough to eat. While breastfeeding, moms should listen for sucks and swallows. After latching, babies will first suck quickly to trigger let-down of the milk. After let down occurs, babies suck more slowly and deeply, and this is when you should start hearing those swallows. Counting wet diapers is another way to reassure yourself of your baby’s intake. Well-hydrated babies over 5 days old have five or more wet diapers per day. If you’re concerned your baby isn’t getting enough to eat, talk to their pediatrician. They may make some changes to your feeding regimen, or refer you to a lactation consultant to work on any breastfeeding problems.”
Q. When it comes to sleeping arrangements, what are the advantages of a crib versus co-sleeping? Or room-sharing versus a separate room for the infant?
Blount: “The ABCs of safe sleep help keep and infant safe and reduces the risk of sudden infant death syndrome. This stands for infant sleeping ALONE (no co-sleeping and nothing else in the crib with them), on their BACK, in a CRIB (or bassinet) and no SMOKE exposure.”
Crawford: “Safe sleep practices are one of the most important ways you can protect your baby. Babies should always sleep on their backs in their own sleeping space, such as a crib or bassinet. The crib or bassinet should have a firm, flat mattress and be free of bumpers and ruffles. Inside the crib or bassinet, there should be no loose blankets or stuffed animals. Swaddling your baby in a swaddle blanket or sleep sack is ok for warmth and comfort. For the first year it’s safest for babies to sleep in the same room as their parents, but babies should never sleep in a bed with another person, and twins should not share a crib either. Other factors that decrease the rate of SIDS include circulating air in the room with a fan, breastfeeding, pacifier use (once breastfeeding is established) and non-smoking families.”
Q. Ear infections can often become an issue for infants. How can a parent recognize when their infant has an ear infection and what are the best treatment options?
Blount: “Ear infections are much more common in children due to the size and shape of their head being a set up for them. Ear infections often follow several days of congestion and may/or may not have a fever. Children with ear infections are often very fussy. The signs can be subtle and it can be hard to tell, so any time you have concerns about the ears, we are happy to take a peek!”
Crawford: “Ear infections are common illnesses in babies and young children. They usually follow a viral upper respiratory infection (common cold) with runny nose and cough. The upper respiratory infection affects how fluid flows through the ear, setting up the opportunity for infection. Common signs of ear infections include fever, fussiness, crying and poor sleep. If your baby’s ear drum has torn, you may see drainage from one or both ear/s. While children with ear infections do pull at their ears, pulling at ears can also be completely normal or a sign of teething, so alone is not a reason to worry. Ear infections in children less than 2 years old need to be treated with antibiotics. Children older than 2 years can be monitored without antibiotics in some cases, and may get better on their own. Babies and young children who have many ear infections may require surgical placement of ear tubes by an ear/nose/throat doctor. If possible, always see your own pediatrician or doctor’s office for ear infections – they’ll be keeping count of the number of infections your child has.”
Brea: “Ear infections tend to be common after days of runny nose. Signs of possible ear infection are: fever (temperature >100.3F), pulling at one of the ears, fussiness, decrease intake of milk or food or decrease latching. If this is presenting in your baby, perhaps a visit with baby’s pediatrician is a good idea for possible antibiotic treatment. It’s important that once the child has a diagnosed ear infection, the baby continues to be followed by his or her provider for follow up and a timely referral to an ENT if needed in the future or if concerns with hearing develop.”
Q. Teething can be a tough time for both infant and parents. What are some tips for at-home care during that period?
Blount: “Hard/rubbery or cold chew toys can be soothing. Just make sure there isn’t anything they can bite off or choke on. Tylenol (and for infants older than 6 months, ibuprofen/Motrin) can be very helpful. It is important to note that baby Orajel is not safe and can actually be very dangerous for babies. In addition, I encourage families to avoid the teething necklaces that the baby wears as there have been some babies strangled by these.”
Crawford: “Teething can be very frustrating for parents and babies. Cold teething toys can help provide comfort, and acetaminophen and/or ibuprofen (for babies greater than 6 months of age) can help as well. As a mother and a pediatrician, I avoid both teething tablets and amber necklaces. Teething tablets are not beneficial and are not closely regulated by the FDA. Amber necklaces are not beneficial and are a significant strangulation hazard.”
Brea: “Teething can be pretty painful. Silicone toys with texture are recommended to relieve gum aching. Those silicone toys that can be placed in the fridge are useful because can sooth the baby’s gum and help in the inflammation process. Remember that teething can take some time! This will eventually pass once the teeth erupts from the gum.”
Q. It’s wonderful when a child starts to walk, but the experience can come with a litany of new falls, bruises and scratches. When is a fall or a bump to the head serious enough for a parent to seek medical treatment for the child?
Blount: “If they are not acting like themselves- extremely fussy, not as active/extremely sleepy, are the most important reasons to bring them in. In addition, if they lost consciousness immediately after the fall, if you see any large area of swelling/bruise or if they have vomited several times, it would be good for them to be seen.”
Crawford: “Most children will fall at some point. When a child hits their head, it can be difficult for parents to know what to do in some cases. Children who lose consciousness or pass out after a fall should always receive immediate medical attention in the emergency room. If your child loses consciousness after a fall, call 911 and do not move them unless their surroundings present a danger (example: a fall into standing water). If your child does not lose consciousness after a fall, but is behaving unusually after a fall (fussiness, poor feeding, sleepiness, difficult to wake, clumsiness and tripping in a child that can usually walk well), they should also be seen in the emergency room. Falls from less than three feet usually do not cause serious injury. If your child falls from greater than three feet, consider having them seen by a doctor.”
Brea: “Walking is an exciting milestone to achieve! But with this skill now comes new falls and scratches and bumps. Any type of trauma to the head that is in the lateral aspect is considered significant, because the head bones from the sides tend to be thinner versus the frontal and back head bone. It is important to closely monitor the child who has suffered from any type of trauma to the head. It is expected for a child to cry after a head trauma, but if the child is inconsolable then that raises suspicion of significant trauma. Other signs of alarm that may mean the child needs to be seen: changes in behavior, lethargy, unusual drowsiness, vomiting, decreased interaction. If those symptoms are present, the child needs to be evaluated by his or her pediatrician.”
Drs. Blount, Crawford and Brea practice at SSM Health Medical Group – Pediatrics located at 3348 American Ave. in Jefferson City. They are all accepting new patients. Appointments can be made online at ssmhealth.com/JeffCityKids or by calling 573-761-7210.