“People are truly choosing to come here,” said Tiffany Pullom, nurse manager for the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).

Pullom and Suzanne Whitbourne, M.D. neonatologist, noted that many admitted infants arrive through the emergency department. Families often share that they chose the Prosper location specifically for its specialized pediatric reputation and its proximity to home.

“We have a long history of taking care of the babies in our NICU (stemming from our flagship medical center in Fort Worth,” said Dr. Whitbourne, “I think a lot of the reassurance comes from that expertise and that experience that we have, and they can see it day by day.”

The NICU typically cares for and admits infants up to 30 days of age. Since its opening, the unit has primarily treated upper respiratory illnesses and babies transferred from surrounding delivery hospitals.

The NICU features:

• 11 beds: 10 private rooms, including a room for twins.
• Family-centered amenities: On-site laundry services and single rooms equipped with bathrooms, breast pumps, milk warmers, and refrigerators.
• Dedicated nutrition lab and formula mixing.
• Virtual connection: A bedside camera system that allows parents to see their babies via an app when they cannot be at the hospital.

Pullom said these amenities reflect Cook Children’s holistic approach to healthcare.

“We have our lactation services; we have speech therapy. We have a multitude of subspeciality specialists here,” said Pullom. “Anywhere from ear, nose, throat (ENT) to pediatric surgeons, pulmonologist and sleep studies can be done here.”

 The care extends beyond the clinical needs of the infants to support the entire family. Case management and social workers assist parents with logistics, such as adding a newborn to an insurance policy.

“This facility supports families,” said Dr. Whitbourne. Having been with Cook Children’s Health Care System for 24 years, she believes established trust in the community is why families continue to choose their care.

 Related Stories:

• Finding Her Voice: How North Texas’ Newest NICU Helped an East Texas Newborn Heal from Vocal Cord Paralysis
• Cook Children’s Medical Center – Prosper Opens Neonatal Intensive Care Unit, Expanding Care for Newborns in One of the Nation’s Fastest Growing Regions
• Cook Children’s Looks to Expand Medical Campus to Keep Up with Unprecedented Growth in Fort Worth

Fluffy pillows, soft blankets and stuffed toys look cozy and cute in a crib. But they can be hazardous for a sleeping infant.

Safety experts say the only bedding to use is a tight fitted sheet around the mattress. Extra objects such as loose sheets, quilts, bumper pads and lovies pose the risk of accidentally suffocating or strangling a baby. Pillows, covers, teddy bears and decorative things don’t belong inside the infant’s sleep space.

Older used items tucked away in your closet might be subject to safety recalls. Certain inclined sleepers and other products have been taken off the market -- including the Fisher-Price Rock ‘n Play and Boppy Newborn Loungers -- due to infant fatalities reported with their use. The Consumer Product Safety Commission (CPSC) in June 2023 repeated its warning about the Boppy loungers after two more infants died since the original 2021 recall.  

Parents can take protective steps when it comes to safety during naps and bedtime. That’s why we at Cook Children’s want to emphasize the message that babies under 1 year of age sleep safest when they’re:

• On their back
• In a separate space like a crib or bassinet or play yard (not sharing a bed with parents or siblings). If co-sleeping occurs, someone might roll over on the baby.
• Atop a sleep surface that’s firm (not squishy or scooped like a hammock). Don’t use couches, waterbeds, memory foam mattresses, air mattresses or sheepskin.  An infant could get wedged between the soft surface and a wall or bedframe. 
• Atop a sleep surface that’s flat (not tilted up). An inclined surface could cause the baby’s body to slide down and their head to slump forward, blocking the airway.
• Zipped into a sleep sack. Sleep sacks provide the warmth of a blanket without the risk of covering the baby’s face.   

Over a 15-month stretch beginning in January 2022, 30 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at their homes. Factors in many of those 30 deaths involved sleeping on an adult bed, a couch or a pallet made from blankets.

Nationwide, more than 3,500 sleep-related infant deaths occur each year in the U.S., according to the Centers for Disease Control and Prevention.

“When babies are really young they’ll get their nose down into the bed or the pillow or the blanket or the stuffed animal, and they don’t have the strength to turn their head side to side,” said Stephanie Eidson, RN. “The carbon dioxide builds up, and then they suffocate.”

Helping New Parents

Eidson prioritizes the topic of safe sleep in her role as clinical education specialist at Texas Health Resources (THR). Eidson educates nurses in the THR system who work with postpartum mothers, newborns and infants in the NICU. Lessons about safe sleep are built into the curriculum Eidson uses for new employees and for continuing education. Opportunities for instruction also come up every day in the nurses’ encounters with patient families. 

“We nurses have to role model safe sleep,” she said. “When we see a parent or a grandparent put something in the bed that’s not safe, we very gently take it out. Then we educate the parents ‘This is why I’m taking this out.’ We have to over and over again be saying the same thing from shift to shift.”

Nurses at THR talk about safe sleep practices with every family on the postpartum floor. Eidson says the standard conversation hits these key points: If you’re feeling tired, put the baby in the crib, on their back, with no blankets or pillows. Booklets given to families of newborns when they’re discharged feature a section on safe sleep information.

Eidson serves on the Safe Baby Sleep Council, which encompasses Tarrant County and a few surrounding locations. Her passion for safe sleep stems from a long career in nursing. But it’s also personal; her relative’s infant, napping on an adult bed, died after becoming trapped between the bed and a wall. It can happen to anyone, she said.  

What gives Eidson hope? Young moms who embrace the recommendations of medical experts. Consistent messaging is encouraging too. Out shopping recently, Eidson spotted a statement about safe sleep posted on the retailer’s display of cribs for sale.

“Being a NICU nurse for 40-plus years now, I want what’s best for our babies and our families. The data’s out there, the research and best practices are out there. It’s part of my job and my mission to educate whoever will listen.”

More About Safe Sleep Spaces

State regulations for child care centers in Texas prohibit anything except for a mattress cover and fitted sheet in an infant’s crib or play yard.

Don’t use car seats, strollers, swings or carrying devices as sleeping spaces. If your baby falls asleep in a car seat or stroller, move them from the seat and into a crib or bassinet one you're home. If the baby falls asleep in a swing, move them to a crib or bassinet.

Make sure the sleep space your baby uses conforms to CPSC safety standards:

• Cribs -- No missing, loose, broken or improperly installed slats, screws, brackets or other hardware. Slats should be spaced no more than 2 3/8 inches apart (about the width of a soda can).  
• Mesh-sided cribs or play yards – No tears, holes or loose threads in the mesh. Side panels should be securely attached to the top rail and the floor plate.

The federal Safe Sleep for Babies Act, signed in 2022, outlaws the manufacture and sale of crib bumper pads and infant sleepers that have an incline of more than 10 degrees. Drop-side cribs have been banned by federal rules since 2011. Don’t sell or give away any item subject to a safety recall.

The Food and Drug Administration (FDA) is warning parents, caregivers and health professionals about the dangers of inflatable neck floats after the death of one baby and the hospitalization of another. The flotation devices are especially dangerous for children with developmental disabilities such as spina bifida, spinal muscular atrophy (SMA) type 1, cerebral palsy and Down syndrome, according to the FDA. 

The floats are much like an innertube but fit around a baby’s neck to keep their head above water while their body and limbs float freely. They have been used in bathtubs, swimming pools and water therapy sessions. 

Like anything inflatable, there is a potential for the float to spring a leak, deflate and put the infant at risk of drowning. One popular infant neck float manufacturer issued a recall of its product in 2015 for this reason. 

The FDA contends the floats may also cause injury from the strain on an infant’s neck, but this claim is disputed by at least one manufacturer. According to a statement on the manufacturer’s website, the company is working with the FDA to “help them properly evaluate the benefits and the risks of neck floats, specifically around the concerns of potential neck strain which have never been reported to us after millions of … sessions.”

Lydia Robey, a Cook Children’s physical therapist, shares the FDA’s concern about neck traction, or pull on the spine, that infant neck floats may put on small children and babies.

“Some developmental disabilities have a higher likelihood of bony neck anomalies that could be compromised, or a condition exacerbated if traction is placed on the neck,” Robey said. 

Children with disabilities do benefit from water therapy, she said. They can move more freely and comfortably in the water thanks to the decrease in gravitational force on their muscles that buoyancy provides.

"I recommend that parents hold their child while they move in the water to be sure they are 100% focused on the child's safety," Robey said.

Sharon Evans, trauma injury prevention coordinator at Cook Children’s Medical Center, worries that if a baby is left unattended in the float and it overturns in the water, it would be difficult, if not impossible, for the baby to turn the float and themselves upright.

Infant neck floats are not approved flotation devices by the United States Coast Guard (USCG). The USCG establishes and oversees marine safety regulations, including the proper fit, function and use of personal flotation devices such as life jackets. Their stamp of approval means the personal flotation device meets certain criteria when put to the test in various water conditions.

“If they're not USCG-approved, then they don't have to pass any kind of USCG guideline or safety test to see if it will actually even keep your kid afloat,” Evans said.

Drowning is the No. 1 cause of death in children under the age of 4. In June, 19 children were treated for drownings at Cook Children’s Medical Center. While not all drownings result in death, they can cause severe brain damage. 

Drownings are preventable. Wearing a USCG-approved life jacket is one way to be safe around water. Keeping your eyes on your child at all times while in or near the water, be it the bathtub, pool or lake, is critical even if they are wearing a life jacket or any flotation device. In both of the neck float cases that prompted the FDA warning, neither infant was being directly monitored by their caregiver, according to the FDA. 

“I think parents just see floats like this and think it helps them in the water, and they put their baby in there and think they’re safe and it takes all the responsibility off,” Evans said. “But there is no replacement for an adult watching a child in the water and being within arm’s reach at all times.”

The recall in February from Abbott Nutrition has placed extra pressure on the supply chain and some stores are limiting the amount a customer can purchase.

Bianka Soria-Olmos, D.O., of Cook Children's Pediatrics Haslet and Alice Phillips, M.D., of Cook Children's Pediatrics Cityview answer top questions for parents and caregivers.

RELATED: Do's and Don'ts of the Formula Shortage (checkupnewsroom.com)

A recall in February from Abbott Nutrition has placed extra pressure on the supply chain and some stores are limiting the amount a customer can purchase.

Here are some tips from the AAP, the U.S. Food and Drug Administration and our doctors.

Never dilute with water

Never dilute breast milk or formula with water. The extra water causes the sodium level in their blood to drop. Low sodium will lead to brain swelling which can cause poor feeding, lethargy, seizure and eventually death.

Do switch to a store brand

For most babies, it's OK to switch to store brands unless your baby is on a specific extensively hydrolyzed or amino acid based formula such as Elecare (no store brand exists), the AAP says. If you're unsure, talk with your pediatrician. Store brand formulas are equally regulated by the FDA, which has requirements for nutrients in infant formulas.

Don't make your own

The AAP and the Food and Drug Administration strongly advise against homemade formula because of serious health and safety concerns. “Although recipes for homemade formulas circulating on the internet may seem healthy or less expensive, they are not safe and do not meet your baby's nutritional needs," the AAP said. "Infant deaths have been reported from use of some homemade formulas.”

The FDA said it has “recently received adverse event reports of hospitalized infants suffering from hypocalcemia (low calcium)” that had been fed homemade infant formula.

In February, batches of three infant powdered formula brands were recalled because of possible bacterial infections. So far, four instances of infant illness have been reported to the Food and Drug Administration.

Do use breast milk

Breast milk is an option. Consider reaching out to a breast milk bank for support.

Don't substitute with alternative milk products

Be careful to avoid milk alternatives, like almond milk, oat milk and other plant-based milks. They are not recommended for infants under a year of age.

Don't buy from third parties

Consumers should also avoid purchasing imported formula or formula that has been diverted from normal distribution channels and relabeled, as it has the potential to be counterfeit, the FDA says. 

For example, if an infant formula is past the "use by" date, a counterfeit label may bear a false "use by" date to obscure the fact that the product may no longer contain the amounts of nutrients listed on the label and may otherwise not be of acceptable quality, the FDA says.

Do check with your trusted medical provider

Pediatricians often have samples or can connect with a formula brand representative for supplies if needed. Check with your local WIC office. They may also be able to help.

At the Neonatal Intensive Care Unit (NICU), patients dressed up and posed with their moms to celebrate their first Mother's Day!

Other patients and their moms celebrated with Mother's Day arts and crafts at the Atrium inside the Cook Children's Medical Center.

I remember scrolling through a Facebook group for physicians a few years ago, and a popular post rolled onto my screen, written by a confused pediatrician.

“What the heck is up with all these moms wanting their baby’s tongues cut?”  It was followed by hundreds of comments of confusion and agreement from other physicians.

I chuckled a little because the tremendous pressure on parents to have their baby’s tongue evaluated is something I literally talk about every day now -- and I hardly talked about it at all when I started my career.

One study showed that from 1997 to 2012 the incidence of tongue-tie diagnosis went from 3,900 to 32,000 – a nearly 10-fold increase -- in a matter of 15 years! This might be because more moms are choosing to breastfeed compared to a few decades ago.

So what’s up with tongue ties? And when should you think about getting your baby’s tongue tie cut (frenotomy)?

Tongue ties are a hard thing to write about, as it is a topic that can be pretty controversial. Depending on whom you talk to, the advice you get will change. That’s because we’re still lacking large, sweeping studies that prove one way or another that the procedure helps more than harms. Also, a gentle reminder that some folks who perform the procedure make very significant income because of it – thus creating biased advice in some ways, I think.

Clipping a tongue tie comes with risks: infection, tongue ulceration, bleeding, tongue damage, and salivary duct damage are all possible.

What is a tongue-tie?

Tongue-tie, or Ankyloglossia, means the tongue has a tight band of tissue underneath it that restricts the tongue’s movement. The tongue typically can’t be stretched upwards very well, beyond the lower teeth or lips.

The existence of a “tongue-tie” and merely HAVING a tongue frenulum (a small fold of tissue that secures the tongue to the floor of the mouth) are not the same thing!

There are different types of tongue ties – some attach to the front of the tongue, some to the middle area, and some to the back.

All tongues have some portion of tissue tethering itself down to the floor of the mouth. Just because you see a thin band of tissue underneath your child’s tongue doesn’t mean it necessarily needs to be cut. But let’s explore when to worry.

When writing this, I decided to phone some trusted friends, because a well-rounded approach is vital. There’s a lot of information here, but I hope it gives you food for thought in making this important decision for your child.

A dentist: Drew Jamison, D.D.S., with Fort Worth Children’s Dentistry (“D”)

A Speech-Language Pathologist: Sara Adams with Cook Children’s (“SLP”)

A lactation consultant (and fellow pediatrician): Andrea Wadley, M.D., with 127 Pediatrics (“LC”)

An Ear-Nose-and-Throat (ENT) physician: Kristen Honsinger, M.D., with Cook Children’s (“ENT”)

What trends are you seeing when it comes to tongue ties?

D: There is certainly an increase in inquiries about tongue-tie in our office. I would estimate at least double the number of inquiries in the past eight to 10 years. Most of these come from new mothers looking for a solution to difficulties nursing. A majority are feeling stressed and feel like they have reached a dead end. Most have also already worked with a lactation specialist and treating the tongue-tie is a "last-ditch effort". We don’t offer this procedure in our office. I have always worked to practice evidence-based dentistry. I'm waiting for more data. I want to make certain that the procedures we provide are in the best interest of our patients. We are certainly open to including these procedures in the future, just not quite yet.

SLP: In our speech therapy and feeding evaluations, parents have questions about if the tongue-tie needs to be clipped or not. They have often received different recommendations or opinions from their different healthcare providers about “to clip or not to clip.” Parents are concerned not only about a baby’s ability to breastfeed or bottle-feed, but they also have questions about if a tongue-tie will cause speech sound differences. For speech sound concerns, the evidence we have says that tongue-tie is not directly related to articulation (speech sound) disorders in most situations.

LC: The trend that I am seeing is that the diagnosis of “tongue-tie” is the explanation for a lot of breastfeeding problems in the community. Tongue, lip and now cheek ties are "en vogue" diagnoses to the point where some will refuse Vitamin K administration, but be upset that I decline to do an elective tongue-tie clipping on their child due to the bleeding risk.

ENT: In the ENT world, we’re seeing more people referred by lactation specialists, speech therapists and other non-physician providers. Previously, most of the referrals came from pediatricians. Another trend we are seeing is referrals for speech issues/concerns related to ties. To date, there have been no good quality research studies linking tongue-tie with any kind of speech delay, speech issues such as articulation problems, or feeding issues besides breastfeeding problems. There is good quality research suggesting that tongue-tie release in babies may improve maternal pain with nursing and may improve latch and therefore breastfeeding outcomes.

Are all tongue ties “bad”?

D: No. We have a large number of patients that could be diagnosed as "tongue-tied" that we simply monitor. Most of these patients thrive. If they ever have concerns that involve speech or other issues, we try and work with speech pathology to discuss diagnosis and treatment.

SLP: Not necessarily, some children have tongue ties and can drink, eat, and talk with no difficulties. This is why it is important to have the child evaluated by a medical professional that is familiar with tongue ties and can help look at those functions.

LC: Not all tongue ties are bad. As the baby grows, often the "tie" or frenulum will stretch and grow over time. Occasionally, ties will need to be corrected later in life, but often kids get by just fine without having them repaired. If the baby has a visible tongue-tie but is transferring milk well from the breast or sucking well from the bottle, I often leave these alone and follow up over time.

ENT: It’s normal to have a frenulum or “tie” under the tongue -- most babies (and adults!) do and it’s a normal part of the anatomy. An evaluation by a qualified specialist is necessary to determine whether or not the frenulum is restricting tongue movement or causing other difficulties, however.

When do you think it’s a good idea for parents to seek out frenotomy (tongue-tie clipping)? Are there any patterns you watch for or anatomical problems you notice in an exam?

D: I can certainly expand on philosophy here, but to remain concise, we typically tell parents: If you feel like you have exhausted all other options, including consultation with lactation consultants, then we promote the procedure. Scientific literature confirming effectiveness and results are scarce. However, we find that about half of our patients report an improvement in nursing.

SLP: If the tongue-tie is impacting the child’s ability to eat or drink – then it is time to consider frenotomy. I look at the overall function of eating or drinking to help determine if the family should talk to their doctor about that procedure. Sometimes, a tongue can look severely tied, but the child still has a great range of motion and no difficulties with eating or drinking. Sometimes a “mild” looking tongue-tie can present with really significant difficulties eating or drinking. You can’t always go by how it looks. For breastfeeding babies, if the mom is experiencing pain with feedings and has tissue damage to her breasts – then I collaborate with physicians about a frenotomy.

LC: I consider clipping tongue ties for babies whose tongues have a "heart shape" when they are extended. If they are unable to lift the tip of the tongue, it is very difficult to breastfeed. If the mom is having a lot of pain with breastfeeding and has lesions/blisters/bruising along the edge of the nipple that is in a "tube of lipstick" distribution this could be due to a tongue-tied baby or if the mom's nipple is shaped like this after every feeding and does not "round out" quickly. I also consider them for breast (or bottle) feeding babies who are taking in a lot of air with feedings, clicking with feeds, or who cannot sustain a latch long enough to transfer milk from the breast. I will also evaluate "posterior" (back of the tongue) or submucosal tongue ties if the baby is not transferring milk well and all of the other factors are accounted for.

ENT: In general, the sooner the better. One of the main goals we have is to help parents who choose to breastfeed to be able to do so- and making sure that we fix a tongue-tie when necessary can be an integral part of this. If there is something that we need to fix, it’s generally best to try to do it as soon as possible so that both the baby and mom can reap the benefits as soon as possible.

Should tongue-tie clipping be done in the newborn period, or do you think there are instances where it should/could be done later in life?

D: I think I answered this in the second question, however, I emphasize limiting any procedure unless necessary.

SLP: Hopefully, if there are concerns noticed with breast or bottle feeding, the procedure is done quickly so that we can support breastfeeding or can help that baby bottle feed. I have seen a few instances where the patient was older, about 12-18 months because the difficulty became more apparent as they were not able to use their tongue appropriately as they began to chew foods.

LC: As a newborn hospitalist, I would clip tongue ties during the newborn period if they were causing very obvious problems or mothers were having significant pain with breastfeeding. Often, I would clip them if the mom was an experienced breastfeeder and had lots of pain or had a previous baby with a tongue-tie that needed to be clipped. Now as an outpatient physician, I will clip tongue ties that have been referred to me by other professionals who have evaluated the mom and baby. These are often done around 1 to 2 months of age. After the parents have exhausted other options.

ENT: It’s easiest if we’re able to do a tongue-tie release procedure before around 3 to 4 months of age because the procedure can be done in the office. When a child gets much older than that, it’s typically recommended to do the procedure in the operating room. Since the research shows that the procedure improves breastfeeding outcomes, it is best performed as soon as possible.

If parents are on the fence about the procedure, who do you think they should reach out to? Do you think they should get advice from more than one profession?

D: I think a team approach is best when diagnosing and treating a tongue-tie. Different specialists’ understanding and communication of specific concerns lead to a well-informed treatment plan. If it is related to nursing, I would follow the advice of a lactation consultant or pediatrician.

SLP: Lactation consultants can help with questions on the latch at the breast. Speech pathology can help with feeding/bottle concerns and speech sound concerns. Dentists and ENTs are also great resources because they can provide insight as well. If you have a concern or are unsure, reach out to qualified health care professionals that are willing to listen to your concerns and that have knowledge on tongue ties – have an open and honest dialogue with them and come prepared with your questions.

LC: If parents are on the fence, I would recommend getting opinions from several trusted physicians. Pediatricians, family doctors, ENT and of course physicians with extra lactation training would be ideal. I would warn families to beware of "professionals" who are pushing the procedure without having done a full evaluation (which includes a feeding assessment).

ENT: I think the child’s pediatrician should always be the first one to evaluate a child and determine if they may benefit from a tongue-tie release. As far as asking other professions what they think/recommend, I would say that it is not uncommon to receive very different advice and recommendations based on who you ask. Each provider likely gives their recommendations based on their own experiences, training and background. ENT physicians also tend to rely heavily on what research papers have shown to help us to determine who will and likely will not benefit from a tongue-tie release.

Some take-home points from me, a pediatrician:

• Tongue-ties are a complex issue that is still being studied, and many factors should be taken into account when trying to figure out whether or not a procedure is needed.
• Not all tissues under the tongue are “tongue ties.” The vast majority of tongue frenula cause absolutely no issues. And many tight tongue ties can stretch out over time.
•  Be careful about what you read on the internet. I can tell you from experience – there is a lot of garbage out there, and I’ve seen many babies fall victim to a painful and unneeded procedure because a parent was so worried about something they read online.
• I’d say that in my personal experience of 12 years as a pediatrician, tongue tie clipping leads to improvement of a feeding or nursing issue maybe 50% of the time. And 50% of the time, it does not help.
• According to our current evidence, tongue ties do not seem to affect speech. Again, this is based on what we know now.
• Some older kids do report having difficulty licking their lips or teeth or licking an ice cream cone. This is one of the rare reasons older kids may need it cut.
• If you’re wondering about getting your baby’s tongue tie cut, consider talking to more than one specialist – the more, the better, especially if you are considering getting a “posterior tie,” or back of the tongue, cut.
• I’d definitely consider getting your baby’s tongue-tie evaluated if he struggles with drawing milk out of the breast or bottle if you are a mother who continues to experience a lot of pain with nursing after more than 2 weeks, and/or if he cannot extend his tongue past his lower teeth or lips (plus struggles with one of the issues above).
• When you read the comments of this post, you’re going to see a lot of “just do it! It helped my baby!”, or “getting the tongue tie cut was the worst decision ever…” – please remember that every child is anatomically and physiologically different, and one person’s experience may not be what you experience.

I hope this post helped give you the slightest bit of clarity on a topic that is not so clear.

For as many tiny studies I found showing that cutting a tongue tie doesn’t help a baby feed, I found an equal number showing that it does in fact help. The truth is, we need more data -- more big studies involving lots of babies -- before our answers will be clearer and more confident when it comes to tongue ties.

The baby in the picture is a sweet patient of mine. He has a normal tongue frenulum that might appear worrisome when you see it, but as a newborn, he was able to transfer milk easily, and he thrived.

Now, for some extra reading!

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012. https://pubmed.ncbi.nlm.nih.gov/28168891/

Breastfeeding: What to do about Ankyloglossia. https://publications.aap.org/aapnews/article-abstract/36/6/11/25079/Breastfeeding-what-to-do-about-ankyloglossia-lip?redirectedFrom=fulltext

A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia. https://pubmed.ncbi.nlm.nih.gov/33501864/

Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941303/

Frenotomy for tongue-tie in newborn infants.  https://pubmed.ncbi.nlm.nih.gov/28284020/

Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941312/

The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review.  https://pubmed.ncbi.nlm.nih.gov/33964037/

Patients in the Neonatal Intensive Care Unit (NICU) dressed up in adorable outfits to celebrate their first Easter.

Other patients participated in an egg hunt outside the Cook Children's Medical Center. There was a visit from the Easter Bunny, plus a few little chicks and a rabbit stopped by.

Parker arrived at Cook Children’s Neonatal Intensive Care Unit (NICU) on June 29 for treatment of chronic lung disease and heart defects after being born two-and-a-half months early and weighing 1 pound 10 ounces. A complication with umbilical cord blood flow contributed to his premature birth and development issues.

Since then, Cook Children’s NICU has been home for Parker and his mom, Misty Kent of Brownwood, who stays with him each day and sleeps at the nearby Ronald McDonald House at night. His dad makes the two-and-a-half-hour drive from their family’s home to see him on weekends. But Parker’s grandparents and siblings—two sisters and two brothers, whose ages range from 14 to 21—have seen him only once when his condition worsened to the point that physicians called the family in.

“They got to come up and see him for two hours, but they didn’t get to touch him. He was so little then,” Kent says, glancing at Parker, who now weighs 10 pounds. “It has been a journey, to say the least.”

But a newly installed camera system in the NICU may help ease some of the stress for Parker’s family and others like them—especially with restricted visitation in the pandemic—by giving them a chance to lay eyes on their babies whenever they want. The system, created by AngelEye Health, went live last week, allowing families 24-hour-a-day access to their babies via individual room cameras, says Sheralyn Hartline, RN, and NICU director at Cook Children’s.

Funded by private donors in the community, AngelEye cameras—a total of 106 in the NICU—are set over patients’ beds and turned off only if patients are out of bed or if care is being performed, she says. One access link is given to the NICU patient’s mom, who then can share with other family and friends, Hartline says.

The AngelEye system will benefit the parents and families alike, she says.

“This will allow our parents to go home, get a nice rest and still have the comfort of looking at their baby from home,” she says, adding many of them live out-of-town and face long travel distances. “It’ll allow grandparents and siblings to see the baby, too, because many people haven’t been able to meet the newest family member due to COVID restrictions.”

COVID restrictions limit families to two visitors during an entire NICU stay, Hartline says. An average NICU stay lasts about 20 days, but some patients like Parker remain for months, she says.

“We’re hoping the cameras will help take the place for some of what’s been missing for quite a while now,” Hartline says. “It will allow for some family moments we haven’t been able to have over the past year and a half.”

As soon as the cameras were turned on, it made a difference for Parker’s family, Kent says.

“Our family is over the moon. This morning, as soon as it went live, I sent a link to Parker’s dad and grandma, and they were both on it within two minutes,” she says. “And, of course, grandma cried because she was so excited to be able to see him.”

His siblings also planned seeing him on camera later in the day, she says.

It is unclear how much longer Parker—who needs a tracheostomy tube to breathe and uses a gastrostomy-button for feeding—will remain in the NICU.

“We’re still watching his heart pretty closely,” says Kaitlin Tarver, RN, who works in the NICU.

His heart and lungs might continue to develop on their own in the next couple of weeks, she says, or he may need surgery to repair two holes in his heart before he goes home. In the meantime, they’re placing him on the floor to play on his belly, sitting him up with a support pillow, putting him in a swing or just getting him out of bed to look at the sunshine, Tarver says.

Kent understands the challenges her son faces in the coming weeks.

“He has been here a long time, but we’ve overcome huge obstacles in these six months. We’ll be here for a while longer, but that’s what we need to do to get where we need to be,” she says. “Cook Children’s is one of the biggest blessings we’ve ever had in our lives. If he wasn’t here, he would not be alive.”

And while her son is in NICU, she sees AngelEye cameras as an asset in case she wants to check on him in the middle of the night or if she needed to go home for a school function for one of her children.

 “I think people who aren’t in the NICU or who have never had to face this situation might not understand the gravity of it and how this will help people going through it,” Kent says of having room cameras available for families. “If you’ve never been in this situation, it’s hard to grasp. But I can speak to it because I have other children and have never had to deal with this until now. It’s a life-changing event—like your entire life changes.

“So, if you cannot be here for whatever reason, it may give you peace of mind that your child is OK—you can see it with your own eyes,” she says. “It’s a very, very big deal.”

Well, that’s not really the question. But is there an amount of Vitamin D that a breastfeeding mom can take in order for the breast milk to contain recommended levels of Vitamin D for her baby?

There have been numerous studies confirming the fact that breast milk does not contain enough Vitamin D to meet the nutritional needs of an infant. Even in mothers who are still taking prenatal vitamins; there’s not enough that makes its way into the milk ducts. 

The American Academy of Pediatrics recommends that all babies should be given a daily Vitamin D supplement which provides 400 International Units (IU) of the vitamin. Yes, even formula-fed babies need it (at least until they’re consuming a daily minimum of 32 oz per day of a Vitamin D fortified formula)!

There’s been some new light shed on this topic, however. Some studies have suggested that lactating mothers who take 4000 IU to 6400 IU of daily Vitamin D, will produce an adequate amount of the vitamin present in the breast milk to meet the nutritional requirements of the infant. This is pretty awesome news! Especially if you’re like me and forget to give your little one their daily dose; or better yet, if your little one gives the Vitamin D right back to you (stained clothes or furniture anyone?). 

It’s important to note that the research noted that adequate Vitamin D levels weren’t reached until about 4-5 months AFTER taking the increased dose. 

With that being said, we still recommend that you give your baby a Vitamin D supplement until there is more research done in this area. I would also highly recommend that mothers who are interested in breastfeeding discuss taking an increased dose of Vitamin D with their OB/Gyn as elevated Vitamin D levels in the body can pose some health risks. 

Is this information cause for concern? Yes, but it’s not exactly new and sadly, there’s no easy fix for the problem.

The report is the result of a congressional investigation released on Thursday, Feb. 4. It says four of the nation’s largest manufacturers knowingly sold baby food with “significant levels” of metals that can impact brain development for babies and toddlers. Previous studies (which we have covered in the past) have found similar results but the significance of the increased levels is still not clear.

The latest investigation focuses on seven brands and the four heavy metals listed above: arsenic, lead, cadmium, and mercury. Each brand analyzed showed significantly higher levels of at least one heavy metal than allowed by the Food and Drug Administration (FDA). You may be thinking that organic brands are safer, but even they contained elevated levels.

Where are these metals coming from?

The chemicals in question are naturally occurring elements and are in the soil where crops are grown. This is why they are found in the ingredients of baby food, and are difficult to eliminate, even if you’re feeding your child organic brands or making food yourself.

So, what should we do?

We should:

• Ask government and industry leaders to make every effort to eliminate heavy metals from food where possible. This could mean changes at the production or processing level.
• Ask scientists to research the real effects of these amounts of heavy metals are on our babies as they grow up.

But what can you do as a parent?

• Remember that switching to organic or providing homemade purees probably does not significantly reduce risk. If you weren’t already doing these things, I wouldn’t suggest changing what you’re buying.

• Avoid high-risk foods, especially those without nutritional value. Some of the foods I don’t recommend include: 
  • Rice cereal
  • Teething biscuits
  • Rice-based puffs
  • Apple juice
     
• Provide a variety of foods over time. Sticking with one particular food may contain significant amounts of an individual metal and could cause higher risk for your child.

Stitch-a-Wish, the volunteer sewing, knitting and crocheting group for Cook Children's, generously provided the most fragile babies with original designs, such as a pumpkin, candy corn and Mr. Incredible. 

In the wake a baby is dead and her mom has been charged with her murder. In addition, the baby’s dad has been charged with aggravated battery and cruelty to a child for diluting their baby’s breast milk with water, then refusing to take the child for medical care.

By the time they did take her to the hospital, she was already dead.

Unfortunately, this is not uncommon. I remember a similar case from years ago in which a child’s family was desperate for money and thought they could use extra water to make their formula last longer. In a study from Clinical Pediatrics, up to 25 percent of families considered “food-insecure” admitted to using various methods to make their formula last longer.

The problem is that extra water is not safe for babies. It causes the sodium level in their blood to drop. Low sodium will lead to brain swelling which can cause poor feeding, lethargy, seizure and eventually death.

Giving free water to babies is not just an issue of formula stretching. Families commonly ask during the summer months if their babies need extra water due to the heat. The answer is NO!

Some reasons babies don’t need water:

• Breast milk and formula is mostly water (80-90 percent). Babies don’t get thirsty. Their diet is primarily liquid.
• Water does not have nutrition or electrolytes babies need. If a baby is going to be drinking something, why not make it be something that can help them grow?

Babies can safely start to drink some water after six months but they still don’t need a lot. They can get one to three ounces during their meals if parents want to introduce and practice with a sippy cup.

A phone call at 11:30 a.m. Thursday from Driscoll’s hospital chief to the head of Cook Children’s Hospital in Fort Worth kicked off a frantic, 17-hour race to get the smallest and sickest patients to safety before the massive, Category 4 hurricane slammed into the Lone Star State, Cook Children’s Transport Director Debbie Boudreaux told the Herald yesterday.

Read the full story here.

Debbie Boudreaux, director of the transportation team and a neonatal nurse at Cook Children’s, sprang into action, scrambling to get planes to transport the infants 400 miles north to Fort Worth. (With one exception, their parents would have to drive separately.)

Read the entire story here. 

KERA

Read how Cook Children's Teddy Bear Transport Team answered the call for help and moved the babies out of harm's way.

In the absence of state-led standards, DSHS was tasked with developing criteria for designating levels of neonatal and maternal care. This includes specifying the minimum requirements for each level, one through four. Any NICU in Texas that receives Medicaid reimbursements must undergo this designation process by September 2018 in order to continue collecting Medicaid funds. Cook Children’s NICU was one of the first NICUs in the state to be reviewed.

“While all NICUs help babies who need extra care, Level IV NICUs care for the most critical and vulnerable infants,” said Jonathan Nedrelow, M.D., neonatologist and medical director of the NICU at Cook Children’s Medical Center. “This designation reinforces the fact that Cook Children’s is among the best care centers in Texas for medically-fragile babies.”

• Comprehensive care for infants born at all gestational ages and birth weights with critical illnesses.
• Surgical repair for complex congenital or acquired conditions.
• A full range of pediatric subspecialties and surgical specialists.
• Access to high-risk infant follow-up care through the NEST program once babies are discharged.
• Ability to transport critically-ill babies via aircraft.
• Outreach education to lower-level facilities.
• Single rooms so parents can comfortably stay with their babies.

“Cook Children’s NICU is the only Level IV NICU in Tarrant County,” said Sheralyn Hartline, director of the NICU at Cook Children’s Medical Center. “This recognition is significant because it means families of critically ill babies don’t have to travel far from home to receive the best care available. The physicians and nurses at Cook Children’s NICU provide exceptional care for the some of the sickest babies in Texas and across the United States.”

Find the requirements for a Neonatal Designation Level IV, according to Texas Administrative Code, here. For more information on House Bill 15, please visit the Texas Health and Human Services website.

Learn More About Cook Children's NICU
No one ever wants to think about their newborn being critically ill. But it's good to be as prepared as possible, so if you do have to make such choices, we'll help you be well-informed. Start by asking your doctor about what type of treatment your baby may need. Then ask which NICU has the best equipment and staff to provide that care. You may want to research and learn about the differences between each one. For example, only Cook Children's NICU offers all single rooms, specially designed so that babies can receive the highest level of care and parents can comfortably stay with their babies as much as they like. Your OB/GYN or pediatrician may also be good sources of NICU information. 

ENOUGH MILK ON DAY ONE?

Many parents worry their baby is not getting enough milk. Did you know a baby’s stomach is the size of a cherry when first born? And the drops of milk you are making the first day or two are normal! The milk you make these first days is called “colostrum” and is highly concentrated, yellow, and sticky, full of easy to digest carbohydrates and proteins that help your baby fight off infections.

SUPPLY AND DEMAND:

The more you breastfeed, the more your brain will make hormones that increase your milk supply and switch it over from drops of colostrum to larger volumes of mature milk. The larger the “demand” for milk, the larger the supply you will make. That is why frequent breastfeeding in those first days after birth are crucial! A general goal is 8-12 feeds during a 24 hour period. Watch the baby for hunger cues like opening their mouth, putting their hands to their face, sucking on their hands, or moving their head around as if they are searching for something. Your baby might even begin to cluster feed, where the baby will want to feed seemingly right after you just fed them! This is their way of getting your milk supply to come in. They cannot overfeed at this stage. Sometimes pumping during this stage can be beneficial to the supply/demand effect. The more you stimulate the breasts, by direct breastfeeding with the baby, and by using a pump, the more milk you will produce. To get an idea of what amount is typical, see the chart below for average volumes of milk intake.

MILK COMING IN

Mature milk usually will come in around day 3-4 of life and will be creamy, fatty, and white. Your breasts will likely feel firm, warm, tender, and full. But remember it can take up to four days for this to happen. If your milk has not come in by day 4, see your pediatrician and your OBGYN in addition to optimizing breastfeeding techniques with a lactation consultant.

LOSING WEIGHT (For baby, not mom!)

Some weight loss in the first days of life is normal. Your pediatrician will check the baby every day in the hospital and again a few days after leaving the hospital to make sure the baby’s weight loss is in a safe range. It is normal to lose up to 10 percent of birthweight in the first week, so for a 7 pound baby that means losing up to 11 ounces. Once the milk is in, the weight should start going up, and babies are expected to be back up to original birthweight when they are 2 weeks old. In addition to weighing, a good way to gauge if the baby is hydrated and getting enough from feeds is to check the number of wet diapers. Lots of full wet diapers means your baby is staying hydrated from feeds. If weight loss is beyond the normal range, your pediatrician will guide you through ways to help, which can include supplementing and/or pumping.

IT HURTS!

The most common cause of discomfort with breastfeeding is not having the right latch onto the breast. Try to make sure that the baby is opening up wide to get the entire areola and not just the nipple. You may need to take the baby off the breast and try again if the latch is not right. Both lips should be open wide and curled outwards if the latch is ideal. Lactation consultants in the hospital can help you each day to make sure you and your baby have a good latch. You can also try to use Lanolin creams to help soothe your nipples after feedings. With the proper latch onto the breast, your discomfort should be a temporary issue that gets better with time.

PACIFIER USE

Sleep deprivation combined with a crying infant can make pacifiers a tempting choice in the first days of life. However, studies show that pacifiers are best introduced AFTER breastfeeding is “established” meaning it is going very well, typically at 3 weeks of life, to prevent the baby from being confused between the pacifier and the nipple. Many parents don’t know this, but pacifiers are actually recommended because in the long run they reduce the risk of sudden infant death syndrome. So DO use a pacifier, but try to wait until feedings are going well first.

PRACTICE MAKES PERFECT

I always grew up hearing my dad say “practice makes perfect!” I wonder if that’s why I ended up becoming a doctor. I got used to practicing new things over and over again until it felt like second nature. The same can be said about breastfeeding. It is a skill, and it takes practice and most importantly, patience, but sleep deprivation added into the mix can make this easier said than done! If you are looking for further breastfeeding support from other parents, more resources, lactation consultant recommendations, or free breastfeeding classes, check out the following resources:

• Breastfeeding Tarrant County Coalition website
• Mobile app LatchMe
• Mobile app LactMed - information about safety of medications and their effect on babies through breastmilk

Happy feeding!

Dr. Rachel Hamilton

About the author

Rachel Hamilton, M.D., is a pediatrician at the Henderson Clinic. To make an appointment, call 817-783-4109. Dr. Henderson grew up in the Dallas/Fort Worth area. She obtained her bachelor’s degrees in chemistry and biology and graduated as a president scholar from Southern Methodist University. She completed medical school at the University of Texas – Southwestern Medical Center in Dallas and pediatric residency at the University of Texas at Austin – Dell Medical School. She is a member of the medical honor society Alpha Omega Alpha, and has been recognized for humanism in medicine. She is married to David Hamilton and enjoys traveling, SCUBA diving, bass fishing and other outdoor activities. Her favorite aspects of being a doctor include life-long learning and the joy of helping children live fulfilled, healthy and happy lives.

The FDA's lab found inconsist ammounts of belladona, "a toxic substance, in certain homepathic teething tablets, sometimes far exceeding the amount claimed on the label." The agency warns that homepathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urgests consumers not to use the products. 

The FDA contacted Standard Homeopathic Company, the manufacturer of Hyland's homeopathic teething products, to ask for a recall of its homeopathic teething tablets products labeled as containing belledaonna for protection of the users. So far, the company hasn't agreed to a recall, but the FDA is asking parents to stop using these products. 

Homeopathic teething products have not been evaluated or approved by the FDA for safety or effectiveness. The agency is unaware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children. InSeptember 2016, the FDA warned against the use of these products after receiving adverse event reports.

Last year, Buzzfeed News reported that the agency had examined more than 400 adverse event reports and 10 deaths connected to homeopathic products in the last six years.

Please seek medical care immediately, if your child experiences seizures, difficulity breathing, lethargy, excessive sleepineess, muscle weakness, skin flushing, constipation, difficulty urinating or agitation after using homeopathic teething products.

Homeopathic teething products are labeled to treat the pain or irritability associated with teething, however no study has verified their effectiveness. The FDA has previously recalled teething tabs because they contained an inconsistent amount of belladonna. This is important because even small amounts of belladonna could be toxic, even deadly in a child.

Homeopathic medicines are made by taking a potentially active ingredient, such as belladonna, and diluting it thousands and thousands and thousands of times. For instance, the amount of belladonna in a commercially available teething tab is supposed to be: 0.0000000000002mg of Belladonna alkaloids. If you are thinking, “How could that small amount of anything actually do ANYTHING?” You would be right. Those who prescribe, make or sell homeopathic products claim that despite the dilution, the solution continues to maintain an imprint or memory of the original substance. This statement goes against anything that we know about science (or basic common sense for that matter).

So, why are parents still using them? Because babies get fussy and it’s hard and it causes anxiety and you want to fix it. But, can we be sure that teething actually causes any predictable symptoms? It’s difficult to say. Some studies suggest there might be a day or two of fussiness around the time of tooth eruption, but the idea that babies are fussy for months because of teething has not been found to be true. This is one of many teething myths that are out there.

Treating teething symptoms (even if they are real) probably doesn’t work and many teething treatments can cause dangerous side effects … teething gels with benzocaine can cause your baby to turn blue and amber teething necklaces have no plausible explanation for how they might work and could post a strangulation or choking risk. Even treating with acetaminophen or ibuprofen is not risk free.

If you have given teething tabs and notice any side effects such as those mentioned by the FDA report, call your pediatrician immediately. Watch for seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating or agitation.

If you suspect your baby has teething pain, allow them to chew on their hand or on hard objects for comfort.

No other treatment is required.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

I hear this almost daily as a pediatric physical therapist. However, tummy time is more important than ever these days.

Our babies today tend to have more time on their backs than on their tummies. The Back to Sleep Campaign instructs parents to place children on their backs in their cribs to prevent SIDS (Sudden Infant Death Syndrome). We also have car seats that transport easily into shopping carts and strollers, bouncy seats, swings and rockers. Even when babies are nursing or taking a bottle, they are held in a parent’s arms, essentially on their back. All of this leads to decreased tummy time. But if we have all of these safety precautions and modern conveniences, then why make a baby cry on her tummy?

• Tummy time promotes neck and trunk strengthening for head control. It can be a baby’s first workout.
• Tummy time prevents babies from getting a flat spot on the back of their heads. These flat spots can lead to changes in head shape, facial appearance, and jaw alignment. In more significant cases, children may require the use of a special helmet to reshape their head. In tummy time, babies are taking pressure off the back of their heads and learning to move.
• Tummy time allows a baby to visually explore their surroundings.
• Babies learn to move, roll and reach side to side while on their tummies. These are all the first steps to bigger things like walking, running and climbing.
• In tummy time, babies push up on their hands and arms. They are building strength in their shoulders and hands. This time in weight bearing plays into handwriting, gripping and sensory development.

Tips for Tummy Time

Tummy time is not always easy, but there are definitely ways to help make it a success.

1. Start early. Even newborn babies can play on their tummies. It’s never too soon to let babies learn to explore on their tummies, getting that sensation of weight bearing on their stomachs, pushing with their hands and toes.

2. Build them up! If your baby is having a hard time lifting their head up, you can lay them on your chest while you are reclined on the couch. You can also place a rolled up blanket or towel under their chest to lift them a little and help make it easier for them. As they build their neck strength and head control, you can try laying them flat on their tummies again.

3. Get on the floor with them! Infants of all ages love faces. Especially the faces of those who care for them. A child will follow and respond to a caring face at a younger age than they will a toy. Getting on the floor with them and talking with them will often help them stay on their bellies longer without fussing.

4. Perform tummy time frequently. To start, a few minutes of tummy time after every diaper change is great. Each day, try to add 5 more minutes to their tummy time practice. With these short but frequent times, they will begin to build their strength and tolerance for tummy time.

5. Don’t give up! As tummy time becomes part of a baby’s routine, they will gain strength and learn to move and explore. Once it’s part of a baby’s routine, his strength will build quickly. He will be getting all of the wonderful benefits of moving, exploring, feeling and seeing the world from his tummy. And watch out! You might soon find that your baby actually loves being on his tummy!

About the author

Carrie Carney is a physical therapist at Cook Children's. Physical therapy focuses on large motor and functional skills to enhance development restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's offers Rehabilitation Services in Fort Worth, Hurst and Mansfield.

Here are four reasons I don't recommend putting a breastfed newborn on a feeding schedule:

1. They need comfort and bonding. Imagine being thrown into a brand new, anxiety-provoking environment with no skills for calming yourself and no way of escape. Plus, the person who can give you comfort is right there. Sure, you can cuddle them to help, but sometimes they just need to nurse.
2. They are hungry. I can't wait three hours to eat. I'm pretty sure if I could only eat 1-2 ounces of a liquid meal, I'd be starving before three hours came up again as well.
3. Scheduling can hurt your milk supply. Frequent feeds help your milk come in. I've seen too many babies who've been on a rigid schedule come in at 1 week with lower weight gain. Then we are scrambling to get mom's milk supply up so that they can maintain breastfeeding.
4. They will find their own schedule. Implementing a rigid schedule out of the nursery is not necessary. By paying attention, you can discover an ideal schedule for you and your child and help them keep to that without having a rigid schedule.

The physicians, nurse practitioners, and staff at Cook Children's Willow Park Pediatrics have all fully vaccinated their children. Every single child. Every single vaccine.

August is National Immunization Awareness Month.

Vaccines save lives. It is a thankless accomplishment.. We can't know the good they have done, as they are arguably the greatest preventative invention in the history of modern medicine.

The vaccines you've received may have saved your life. You will never know. Think about that - a shot you got on a random day, in a random year of your life, may be the reason you're still alive.

We've watched children die of vaccine-preventable illness. We've watched parents cope with the horrific loss of a child, knowing that what happened was preventable. We never want you or your children to go through that.

Let's learn about them. Tune in this month as we teach about the diseases we vaccinate against. Sometimes knowing the other side helps us remember why they're so important.

‪#‎savinglivessilently‬

Hugs,Dr. Diane

There, I said it.

Those of you who insist that every child can do so, comment away.

Those of you who tried and started a knock-down-drag-out weekend of fighting in your house, only to quit and come back to it later with a different strategy that was much more successful, you may stand up and applaud.

The three-day potty training method has several different flavors but all of them involve some of the following ingredients:

• Draw a hard line in the sand - no more diapers.
• Let the child go naked for the weekend (or longer).
• Give the child lots of fluids and salty snacks (I’ve seen some recommend soda. I mean, just … NO!)
• Put the child on the potty frequently.
• Celebrate successful pees and poops.

I know that these methods work some of the time, with some kids. The posts about the strategy wouldn’t be so popular if they didn’t. Problem is, I don’t hear much about it when it works. But, I do hear about it when it becomes a disaster. I hear about it when everyone is in tears and tensions are through the roof.

Any of you with more than one child can confirm that kids are different. They do things on their own time and in their own way. Potty training is the same way. To assume that every child can potty train by age 3 and in three days is unfair. Each child may need a different strategy.

Here is my potty training guide:

Readiness

I usually give two signs for potty training readiness:

1.Knowledge of wet and dirty. If a child doesn’t understand what pee and poop is, good luck.

2.Ability to sit still on the toilet. Unless you want to be forcing your child to sit down on the seat every time, they have to be patient enough to wait for the action to happen.

But guess who ultimately decides when your child (and you) are ready to potty train? You and your child! Not grandma, nor your judgy friend or the blog post they shared. So, take your time if you want or go ahead, it’s up to you.

Method

I only have one rule when it comes to your method for potty training. Be patient!

Be patient with your child. Some kids have legitimate fear about the part of their body that they are flushing down the drain. It can be the same to them as flushing an arm. Some kids will get it right away, some won’t. Give them the chance to fail without punishment.

Also, be patient with yourself. You will get frustrated at some point during the process. Pick some fun things to do with your child and alone to recharge. It’s OK if it doesn’t go perfectly.

Pick a method that you think fits well with your child and stick with it for a bit. Don’t change after one day. But, it’s also ok to step back and make a change after a bit if things are going well. It’s even ok to decide that you tried to early and wait to start again in a few months.

Potty training is a necessary step in development. It might not be as fun as the first word or first step but it is just as monumental. So maybe it’s not always a “happy” time but at least it can lead to joy. Don’t let unreasonable expectations steal that.

Leaders from the Who called Zika a “public health emergency of international concern,” earlier in the week, because how fast the virus is spreading and the continued investigation into its link to babies born with abnormally small heads (microcephaly). Experts are also looking into the possible connection between Zika and a neurological condition called Guillain-Barré syndrome, which can cause paralysis.

No vaccine exists to prevent Zika virus. Mosquitoes that spread Zika virus bit mostly during daytime.

Click here for prevention information from the CDC.

Here's what we know from about the Zika virus from the Centers from Disease Control and Prevention:

1. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosqutoes that spread dengue and chikungunya.
2. The mosquitoes are aggressive daytime biters, prefer to bite people and live indoors and outdoors near people. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes then spread the virus to other people through bites.
3. A mother already infected with the Zika virus can pass on the virus to her newborn around the time of birth, but this is rare.
4. The CDC has not found any reports of the Zika virus spread through breastfeeding.
5. The CDC believes the virus could spread through blood transfusion. At this time, there have been no reports of this happening.
6. There has been one case of the virus spread through sexual contact.
7. The most common symptoms of Zika virus disease are fever, rash, joint pain and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week and severe disease requiring hospitalization is uncommon.
8. However, the Zika virus can be dangerous, especially to babies. Doctors are studying the link to the virus and microcephaly, a birth defect that causes abnormally small heads and brains.
9. There is no vaccine to prevent or medicine to treat Zika.
10. The CDC recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”
11. The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

“There is still a lot to learn about Zika virus and the potential risk to cause this particular birth defect,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “However, because it could spread to the United States, it is important that doctors and patients are aware of it. Like other diseases that were once thought to be isolated to tropical areas like chikungunya, many patients and doctors forget to think about them.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Don’t get me wrong, I’m glad he had his baby vaccinated for his baby’s sake, but I don’t want it to affect your decision to vaccinate at all.

I don’t want your vaccine decisions to be based on what a celebrity does, even if that celebrity is one of the most brilliant guys around.

Why?

Because some other really smart person will choose next week to skip vaccines and then where will we be? No better off than getting vaccine information from celebrities like Justin Timberlake or Jenny McCarthy.

If you vaccinate, you are not alone.

Studies show that over 95 percent of you have chosen to vaccinate your children.

Does it feel like that to you?

Does the media portray it that way?

Does your social media stream reflect that vaccination is the overwhelming majority?

The answer, I believe, is no.

But, why?

Maybe it’s not cool or politically correct to vaccinate you child, or at least to say that you do.

Maybe it’s because you are afraid of the comments you will receive if you support vaccines or report that your child just received some.

Maybe you worry what would happen if you question that thousandth share of some 2012 Italian court case. (P.S. That decision, which was made in some really low level court in Italy, was thrown out by a higher court so just stop already with Italian court decision memes.)

I promise you the world wouldn’t end if you do. If you get a comment that is rude, it’s OK to ignore it. If you have an answer, answer. If you don’t know, get advice from someone who might know. Tag me.

So, I don’t care that it was Mark Zuckerberg who chose to vaccinate his child. But, I do appreciate when anyone speaks up to say, “I vaccinate my child because I believe it is what is best for them.”

Let’s start something today:

Share this post that you are reading right now and say, “Thanks for sharing Mark. I #vaccinate too."

In an article published in “Pediatrics,” the AAP says, “no alcohol intake should be considered safe” during pregnancy” and “there is no safe trimester to drink alcohol.”

Key points from the AAP include:

• Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use.
• Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong.
• Early recognition, diagnosis, and therapy for any condition along the Fetal alcohol spectrum disorder( FASD) continuum can result in improved outcomes.

During pregnancy, the AAP says:

• No amount of alcohol intake should be considered safe;
• There is no safe trimester to drink alcohol;
• All forms of alcohol, such as beer, wine, and liquor, pose similar risk.
• Binge drinking poses dose-related risk to the developing fetus.

I am shocked at the number of patients we see where bad posture plays a role in their pain and physical limitations. Whether it be sports injuries, overuse injuries or postural dysfunction, the trend is younger patients are starting to report more injuries. I see technology driving our kids to be more active in an online space than it does in a physical space.

So I would like to take a minute to address how to get our kids active again, but not just any activity. I want to talk about core activity.

What is the core?

The core is a muscular system that works synergistically to provide support and power generation to the body in all positions and with every activity. Think of a soda can to explain the core. The can has a front (deep abdominals), back (multifidi muscles), top (diaphragm muscle) and bottom (pelvic floor muscles). And just like the can, as long as no one pokes a hole in it, it is very strong. As soon as someone creates a weak spot in the can/core, it can easily be crushed.

When do you use your core?

The core should be used during all of life’s daily tasks, but we lose this ability as children when no one teaches us how to use the core during modern-day tasks such as playing on your Ipad or texting your friends.

How do I train the core of a child?

Return to the basics. Too often we see young athletes who have been given formal instruction in how to pitch a ball or perform a round-off back handspring, but little or no training on what it means to use their core functionally. Schools have our kids doing pushups before teaching how to plank. Physical therapy can definitely help patients of all ages with core training, but there are also some things you can do at home. For really young children (3-6yrs) this can mean returning to games that require you to hold positions, such as Twister or Untying the Knot. For slightly older children (7-12yrs), yoga or even just plank holds (3 positions) help build core strength and endurance. For our teens and young adults more formalized training for power generation and power transfer using the core can be very beneficial.

What does a strong core mean?

For your child a strong core means improved performance in their activities whether that is football, dance or band. It can mean no pain when sitting in class or when trying to be active with peers.

For parents, a strong core means fewer complaints from your child, better posture, and less risk of injury while your child is performing their activities.

If you or your child would like help with core training, please contact your physician and seek a referral to Cook Children’s Physical Therapy Department.

More SPORTS resources related to this topic:

• Top 10 questions parents have about sport injuries
• Young athlete's injury prevention guide

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

How do we know that parent-talk builds children’s brains? A study by Betty Hart and Todd Risley, “The Early Catastrophe: The 30 Million Word Gap by Age 3” showed that by age 3, children from lower socioeconomic backgrounds heard 30 million fewer words than children from prosperous backgrounds. This disparity of 30,000,000 words heard had effects on children’s IQ and test scores by the time they were in third grade. Why is this important? All children have the right to full access for learning; to grow their brain; to learn to talk, read and write. What parents and caregivers do and say has a profound impact on a child’s development.

Dr. Dana Suskind, a pediatric cochlear implant surgeon at the University of Chicago recently released her book Thirty Million Words: Building a Child’s Brain. At the center of her program are the “Three T’s.”

• Tune In
  • What does your baby/toddler like to do? Let’s say your little one is super interested in those pots and pans in your cabinet but you would rather baby play with the ball. Think about helping baby explore those pots and pans: making noise, pretending to stir, wearing the pan as a hat, etc. Make it all about baby’s interests.
• Talk More
  • What are you saying to your baby? For example, “Come over here and get this” could have many meanings. A richer language example could be “Walk to sister and get the ball!” By using ‘walk, sister, and ball’ baby hears specific words instead of more non-specific words (‘here’ and ‘this’). By using specific, rich language, baby’s vocabulary increases. We learn to talk based on what we hear. I often encourage parents to ‘be a thesaurus’ – constantly increasing the complexity and richness of their language.
  • Another tip is to teach verbs, verbs, and more verbs. Verbs carry far more meaning in communicating than nouns. For example, the word ‘drink’ will result in more action from parent than ‘milk’. Baby says ‘drink’ parent says, “Oh you want a drink? I have milk, juice, water, ____”. If baby says, ‘milk,’ parent says, “Here’s some milk.” ‘Drink’ can be paired with many other words as children start stringing words together: drink more, drink please, drink milk, drink all gone, drink spill, drink hot, etc.
• Taking Turns
  • From the moment parents meet their new baby, communication begins. Babies coo, giggle, scream, cry, and babble to communicate. Parents then respond with sounds, words, and actions. These early interactions are the beginnings of conversation. As very young children start using words, listen to what they have to say. The more you talk back and forth with them, the more words they learn. The more words they learn, the better readers they will be.

Talking to our babies and toddlers is something we can all do to help babies’ brains.

What can we do as parents and professionals to close that Thirty Million Word gap for all children? How can you use Dr. Suskind’s “Three T’s” strategies to grow your child’s vocabulary?

With so many things to consider how will I know when my baby is ready? Where should my baby sit for feedings? What should I offer my baby to eat first? How do I do this anyway? Should I try the spoon or just go for the squeezy pouches?

As a feeding therapist these are questions we hear a lot. When your baby is ready for the introduction of pureed foods around 4-6 monhts, it's time for the messy fun to begin! If your baby is showing the following signs, it might be time to give it a go:

• Takes a bottle or breast feeds with ease.
• Watches with interest when caregivers eat.
• Brings objects to his mouth.
• Sits comfortably in a bouncy or infant seat.

Here are a few questions you may have when you are ready to take the plunge:

1. Where should my baby sit for the feedings?

• Stable seating is best for your baby. Babies should not be bobbing, leaning or lounging on their back. In the beginning, babies should be in a semi-upright position, like they would sit in a bouncy seat or infant feeding seat. As babies become more stable sitting up, a booster seat or highchair can be used.
• Position baby at caregiver's eye level.
• Remember, as babies grow their seating will need to be adjusted.

2. What should I offer my baby to eat first?

Start with thin baby food cereals. Rice cereal by spoon is a good choice. Gradually increase the thickness of the cereal as your baby tolerates. Alternatively, Stage 1 or homemade single ingredient purees may be offered.

3. How do I offer these foods?

• Show your baby with your expression and tone of voice that this is going to be fun and enjoyable.
• Show the baby the spoon; a small plastic toddler spoon works well.
• Dip the spoon into the puree wiht a small taste on the end of the spoon.
• Offer the spoon slowly. Place small taste on lower lip.
• Caregiver should model smacking lips.
• Continue to give small tastes of puree modeling "Aaahhh" for baby to open mouth and "Mmmm" for baby to close mouth and use lips to clear the spoon.
• Follow the cues of the baby to continue offering more bites and bigger bites. Hint: If he pushes your hand away or turns his head, he's most likely done. However, if he opens his mouth, he's letting you know he's ready for more.
• Keep mealtimes short and sweet. End feeding in a positive way.
• Let baby get messy, messy, messy! While we're at it, don't scrape food off of baby's face during the meal. Save the cleaning up for after all the bites are done and baby is out of the feeding seat. Washing off at the sink works well.

4. Why should I start with the spoon and NOT the pouch?

Here are all of the wonderful things your baby is learning when you offer pureed foods from a spoon:

• Practice getting the tongue and jaw to move in more coordinated and controlled movements getting them ready for harder solids.
• A chance to work on lips clearing the spoon rather than just sealing as they do for breast and bottle.
• A chance for baby to begin working on moving tongue from side to side and biting on a firm object.
• A chance to build a feeding routine that fosters skills and confidence.
• A chance to work on building trust and incidental feeding experiences as they see someone they love and trust offer and explore foods with them.
• A chance to begin working on the co-feeding stage, redefining the parent role and the child role in feeding as babies move toward independence with finger feeding and spoon holding and licking while still needing help from their caregiver.

5. While we are on the subject, how about pureed from pouches?

Pouches are so convenient. They offer parents an easy way to expose their little ones to a variety of flavors, they're easy to transport and easy to offer on the go. For those times when you simply can't pass on the pouch, remember these tips:

• Consider squeezing onto a spoon.
• Remember to get face to face with your baby when using a pouch.
• Offer pouch foods that are more single ingredient or just a few ingredients so that the pouch is an added food, not the whole meal. 
• Offer the pouch when seated in a stable highchair with a tray, offering some of the puree on the tray for the baby to touch and practice licking from the fingers.

About the author

Melissa Smith is a speech pathologist at Cook Children's. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

Then, I was blessed to have a beautiful son...

….who decided that I needed to be re-taught a few things about children.

And by a few things, I mean everything.

Don’t get me wrong – you don’t have to be a parent to be an excellent doctor. I still dish out the same advice. The books and studies are spot-on and I’m going to give it to you straight. Breastfeeding does provide the best nutrition for babies. But I understand the pain you’re going through to meet that goal. And I understand the frustration of having a child who just won’t latch on. And I understand now why you look at me, with a crazy twitch in your eye, when I tell you to try an extra pumping session a day to build up your supply, mama. I hated that thing, too. Can anyone say “dairy cow”? And guess what – formula isn’t poisonous. I wasn’t physically able to meet my full breastfeeding goals with my kid – there’s no judgement here if you grab that can. And it’s okay if it makes your relationship with your child happier, healthier and more fulfilling.

Our car seat remains rear-facing at 18 months. It’s been proven to be five times safer than forward-facing. I’m sorry for my lecture during your little one’s checkup. And oh yes, I too want to rip my hair out when I can’t reach over far enough to give my kid that 400^th toy to keep them quiet on the trip to grandma’s.

“Crying it out” was a tough one for me. Pre-child, it was so easy to coach parents - encourage them to drop the constant rocking, the running into the nursery at all hours of the night, the fear of allowing their child to cry in order to learn put themselves to sleep. Then I went through it with my son. Let’s just say I give the same advice now (it really does work) …and recommend a glass of wine for every 15 minutes of crying. I probably cried more than my kid did. Motherhood helped me give this advice with a much softer tone. I get it, mom and dad. And I feel your pain (and exhaustion).

Pacifiers – I missed that thing so much. So, so much. Oh man I missed that thing when it had to go. I think I needed one myself when the time came to get rid of it.

As for the well-rounded, healthy meals I recommend offering your child throughout the day – I now understand why there are food shortages in some parts of the world. It’s because all that food is currently on the floor of my kitchen. Where my son threw it. I get it. And I’m here to help you find tricks to make things better. Tried and tested in my own home.

In all seriousness, motherhood has been the most exhausting, challenging, humbling thing I’ve ever experienced. But I can say without a doubt that it’s made me a better doctor for your child. Because helping you get through those everyday challenges is a huge part of what being a pediatrician is all about.

I recently polled some physician mom colleagues to get their take on how motherhood changed them:

• “I am that much more in awe of the composure, patience, faith, resolve my patients' families have, especially considering how chronically sick the kids are that I see, and how too not-infrequently, limited the treatments are. I see my son in every patient. Everything is different. Every heartache is my heartache. Each illness, each story seems to hit home that much harder. I am so so appreciative.”
• “I am much more empathetic and practical in some advice. I think that I am much more emotionally available post having kids and can understand a variety of stresses parents who go through NICU may encounter.”
• “You come to understand that "by the book" is not always what is possible in real life!”
• “I feel like when the kids have a tougher diagnosis - cancer- it hits closer to home and I hold my kids a bit tighter. Likewise, little pearls and tricks that I used help make it more of a village caring mentality for the family which has been lost over the last 30-40 years.”
• “My medical advice is not too different, but I understand the unspoken worry so much better now. So I try to address the emotional stuff first in ways that would not have occurred to me pre-kids. Now I'll directly say things like "you are a good mother even if you need to use formula," or "this lymphadenitis/rectal bleeding/etc is NOT cancer," or "they are not dangerous, but constant viral illnesses all winter TOTALLY SUCK.” I think it has made me a much better pediatrician.”
• “One of my favorite attendings in peds residency told me, as I was a mess after coming back from maternity leave with my first, that a little part of your heart will always be on the outside, dangling like a vulnerable little wisp in the wind that is parenting- and that little wisp makes you so much stronger and so much softer- all for the good....it's so true.”

Happy Mother’s Day, everyone!

"We try and try, but he won't burp."

Oh, the magical burp. It's that often elusive sound that would be offensive for you to let loose at the dinner table, but everyone celebrates when it comes from your newborn.

So, what's the point? Easy, to get some of the air that's trapped in the stomach below the milk … out. Some babies are easy to burp. They can suck down eight ounces of milk in five minutes and you barely get them upright before your hear a big, manly burp. There are other babies who, no matter what you do: pat, bounce, dance or turn them upside down … they are not going to burp.

I actually don't think it matters. I think the biggest benefit of the process of burping is simply that you aren't immediately laying them down flat right after they feed. Keeping them upright helps the milk settle lower in their stomach and provides some protection from spitting up, but actually obtaining the precious belch is probably not all that important.

Do you have more questions about newborns? Check out Dr. Smith’s program, Newborn University, including 20 posts about newborn care and classes or consultation at his office in Lewisville.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.