19 January 1998
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physician who knows you and cares about you.
Dr. Warren
-Thankyou,
Theresa
Dear Theresa: Your son may have some sensitivity to dairy, although it may not be allergic in nature since intolerance of some foods may be the result of digestive problems as well as allergy. In any event, as children begin to spend more time upright, the rotation of their stomach changes and the valve between the stomach and esophagus becomes more competent resulting in less spitting.
If your son is doing well, no vomiting, no diarrhea, no gas pains, growing well, then you have to decide how much of a problem the spitting is to decide if it's worth eliminating some foods to see if it will stop. Most likely your son will stop spitting over the next few month just because he is getting older. But if you notice a definite association between certain foods and the spitting, you can try limiting the intake of those foods as long as your son will still be on a nutritious diet.
Sincerely,
Dr. Warren
-Amy
Dear Amy: I have read about co-sleeping. In my article about teaching children good sleep habits at http://www.mindspring.com/~drwarren/sleep.htm I mention the Family Bed and provide links to some pro and con arguments. I am not opposed to the concept if that's what a family wants, but I am not an advocate of co-sleeping, and unless someone asks me for alternatives, I'm not inclined to bring it up and have someone mistake it for my advice. It's fair to say that the people who ask me for advice on how to get their children to sleep in their own beds aren't asking me to advise them otherwise. I'd really have to favor the Family Bed to mention it to them, and, quite honestly, I don't.
I think it's interesting that you liken the process of "weaning" a child from the Family Bed to weaning a child from the breast. The first thing that I should point out to you is that many mothers take an active part in weaning their children from their breasts. Weaning doesn't always just happen because the baby has decided to stop nursing. In fact, I get many requests for help from mothers whose infants refuse to take nourishment from anything except nursing. Some of them are desperate to get their children to at least take something from a cup or bottle so they can cut down or stop nursing.
Most of the parents who write to me for help are having a tough time with their kids. While it may be reasonable to say that some of these children will naturally develop good sleep habits on their own at a later date, it's very likely that most will not without at least a little push. And if the parents really don't want children in their bed, I find that perfectly reasonable. Parents make so many sacrifices for their children, they don't need to feel guilty about wanting their own space. And so we come to the main Dr. Warren rule about developing good sleep habits in children: Don't start anything in an attempt to have a peaceful night unless you are willing to continue it for a long time or even indefinitely. The tough kids that parents write to me for advice about are just as likely to be tough to get into their own beds at 6 years old as 6 months old. And if they've spent 6 years in Mommy's and Daddy's bed, their cries that they want to continue doing it are no less heart rending than those of a 6 month old.
Sure, for some kids the Family Bed might be great, but for the difficult ones, it's just putting off the moment that parents decide they've had enough. For those that want a Family Bed, let them have it. But for those who want the kids in their own beds, I don't see the Family Bed as a stepping stone to independence. Unless a parent is willing to have a child in his bed until 6, 8, or even 10 years old, he'd best not choose the Family Bed with the idea that within a short time the child will be ready for his own bed.
Sincerely,
Dr. Warren
Dear Sir: I would have to respectfully disagree with you about children co-sleeping not being a stepping stone to independence. You see, I have found that when my daughter has her needs met at night, she is quite independent, for a 10 month old. And as she gets older, her independence grows. Most families I know who co-sleep put a toddler bed next to their own bed and the child moves willingly at around 2 years of age. As separation anxiety lessens, it is easier on the parents and baby for the child to gradually move from one sleeping area to the next. As you may have guessed, I am also a breastfeeding advocate. I am wondering why so many parents are writing to you for help with getting their children to sleep alone and take a bottle so they will be "less dependent." Perhaps we, as a culture are forgetting the fact that babies are dependent for a reason! They need our care and protection! Just because our society is so "advanced" as to have cribs, infant seats, and "formula" does not make our babies any more independent! I would argue that perhaps if we allow babies to be dependent as babies and young children, perhaps so many of us would not be dependent on crutches such as drugs, alcohol, food, and smoking!!!
-Respectfully,
Amy
-Thank you sir,
Jeff
Dear Jeff: Aspirin has no sleep inducing properties. What's more, it should not be used in infants and children because it significantly increases the risk of developing Reyes Syndrome. Reyes Syndrome is a rare but serious or even fatal neurological and liver disorder which can develop if children take aspirin when they have virus infections, especially influenza (flu) and chicken pox. Aspirin and Tylenol (Acetaminophen) are not the same. Tylenol is safe when used according to the manufacturer's direction, but it also is not a sleep aid. Aspirin should only be used in children under the direct advice of a physician. I do not recommend using any medications to get children to sleep.
Sincerely,
Dr. Warren
What I would like to know, is the following:
Your advice is greatly appreciated.
Thank You!
-AP
Dear AP: If your son is already consuming 16--20 ounces of formula each day, at one month of age it's going to be pretty difficult to get him to nurse more and feed him less formula. If you do start pumping regularly you might increase your supply, but the best way to increase your supply is to get the baby on your breast. Also, pumping so much between taking care of your infant will be exhausting. There is a device, I believe called Lact-Aid, which consists of a bag with tubing that can be worn in such a way that the baby gets formula from the bag while sucking on your breast. This might help to establish your supply and give you the experience you want. Contact your local La Leche League and see if they can give you any further information on this matter.
Your baby has gained a lot of weight in just 5 weeks. He may be overfeeding, and this may give him gas. Do make an effort to see if you can calm him without feeding unless it's almost 3 hours between feedings. If that doesn't help and you can't reestablish your milk supply, you might have to switch his formula to see if the formula is causing his distress.
I doubt that peppermint tea can harm your infant, but I'd need to see the ingredients list since the name does not always tell all. To be honest, I'm not aware of any evidence that peppermint tea helps gas pains or stomach problems. If he's willing to drink the tea, why not try some plain water between feedings. Since I haven't used teas to treat infants, I couldn't advise you on amounts.
Sincerely,
Dr. Warren
Are their any alternatives to blood products?
thanks
-AG
Dear AG: I can understand your distress at the thought of injecting your baby with blood products, but if you've been reading about immunizations I would like to know what source gave you the idea that any of our vaccines are blood products.
DTP and HIB are both killed bacterial antigens. DTP also has part of the tetanus toxin. These work to provoke immunity by injecting a material that has enough of the material we want to protect the baby against so that the baby's immune system can respond better to the real live microbe. Polio vaccine can be given as live or killed virus. Measles, Mumps, Rubella, and Varicella (chicken pox) are all live virus vaccine. The virus has been altered so as to not produce full blown disease and yet provoke an immune response.
None of these vaccines is in any way remotely related to blood.
Sincerely,
Dr. Warren
Is there any way for me to tell whether I need to take him in at the time of the injury?
Thanks in advance....
-RLE
Dear RLE: I hesitate to suggest that there's a foolproof way for parents to judge if their child's injury warrants an x-ray since sometimes it is hard for a doctor to tell. If an x-ray shows no fracture that doesn't mean it was unnecessary. If an injury causes significant swelling, pain, discoloration, especially black and blue discoloration, and localized tenderness, it should be checked by a physician. If the pain and swelling are not extreme, it might be reasonable to apply ice and wait a day before deciding whether medical evaluation is necessary.
Sincerely,
Dr. Warren
Thanks,
-KL
Dear KL: Fifth Disease is caused by parvovirus. It is a relatively symptomless disease except for a rash. Adults, particularly women, may experience joint pain or swelling. By the time children develop the typical rash of bright red cheeks and a lacy rash on the trunk, they have already been contagious. Many adults are immune because they had it during childhood without necessarily developing the rash.
If a woman contracts Fifth Disease during her pregnancy it can cause severe hemolysis (breakdown of red blood cells) similar to what happens with severe Rh incompatibility blood disease. This can be fatal to the fetus resulting in miscarriage. It does not cause birth defects. If the pregnancy carries to term the baby should be fine. The risk of fetal death in the case of a proven infection in a pregnant woman is less than 10% in the first half of the pregnancy and even less in the second half. Some cases have been successfully treated with intrauterine transfusion.
The incubation period is 4 to 21 days but usually 4 to 14 days. Rash and joint pains occur 2 to 3 weeks after infection.
Most of this information was obtained from the 1997 Red Book, Report of the Committee on Infectious Diseases, 24th Edition, from the American Academy of Pediatrics..
Sincerely,
Dr. Warren
-PDH
Dear PDH: There is no question that iron is sometimes constipating. It can also sometimes cause diarrhea. Most infants tolerate it without any difficulty. Infants who are on soy or hypoallergenic formulas have no choice. To the best of my knowledge, only Enfamil and Similac come in a low iron formulation. The American Academy of Pediatrics recommends that all infants be on an iron fortified formula, which is why the other formulas don't come low iron. Many mothers are misled by the term "low iron" on the label. Years ago those formulas were called "without iron" and the FDA demanded a label change because there was a trace amount of iron in the formula. Unfortunately, the "low iron" label is more misleading because parent think they're choosing less iron rather than no iron.
If a mother has switched her child to a low iron formula and her baby is happier and having better bowel movements, it's pretty hard to convince her she's doing something wrong, or that the benefit isn't really coming from eliminating the iron. Since most baby's don't really start to absorb significant amounts of iron until their iron stores are at their lowest level, around three to four months, I try to convince those mothers to give the baby a few months off the iron, and then reintroduce the iron by three to four months. By then, many infants have more regular bowel habits and tolerate the switch back to iron without difficulty.
Sincerely,
Dr. Warren
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