• No sensation of a let down
• No longer leaking milk
• Mom’s breast do not feel full (or engorged) anymore
• Unable to produce milk with a pump
• Baby does not stay at the breast as long as mom would like

Though some of these things may cause reason to look further, none are indicative of a poor milk supply.

The best way to gauge adequate supply is growth.

In the first few months of life, we expect babies to gain close to an ounce per day, and double their birth weight by 5 months.

Since you may not always have a scale handy, ask yourself questions like:

• Do you hear swallows during the feed?
• Does your baby seem content after the feed?
• Is your baby pooping 4 or more times per day? (this number falls around 3 months)
• Is your baby having 6 or more pale wet diapers per day?

If you answered these questions “yes”, then it is likely the baby’s weight is climbing as well. If some or many of the answers were “no”, then you should follow up with your child’s pediatrician for a weight check and/or evaluation.

Despite repeated calls from experts to lifeguard your child, 19 children have been rushed to Cook Children's for drownings and four children have died since May 1.

Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s, said parents and caregivers should take important steps to save their children from drowning, including taking CPR lessons.

"Seconds really do matter," Dr. Warmink said. "Quick, efficient CPR performed before EMS arrives has been shown to improve outcomes. Learning CPR should be an important part of any family's safety plan. You want to be prepared in critical situations."

Studies show CPR doubles the victim’s chance of survival. Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers. Please watch the following video from Steve Muyskens, M.D., medical director of the Cardiac MRI at Cook Children's.

Dr. Warmink describes drowning as the inability to breathe, normally due to submersion in a liquid, usually water. The outcome, including death, of the person who drowned depends on how long she or she is under water.

"Everything is based on getting oxygen to vital organs,” Dr. Warmink said. “The outcomes of drowning and the adverse effects are based on the lack of oxygen. The most effected parts of a drowning victim are the brain, lungs and the kidneys. The one that is most catastrophic and the one that will kill you is the brain.”

The amount of time children spend under the water while drowning usually determines their outcome. The lack of oxygen destroys brain cells and that causes damage to the brain, ranging from short term (forgetful, clumsy …) to severe (can’t walk to vegetative).

Dr. Warmink says there are several variables that shape how severe the brain damage will be, including how long the child was submerged in the water and how quickly he or she received CPR.

Once a child arrives at Cook Children’s Emergency Department, treatment begins that may include oxygen, X-rays, intubation or medication.

“But a lot of what we do is supportive care for the children that come in here,” Dr. Warmink said. “We may have to support their lungs because they have been damaged and they have difficulty breathing. Their kidneys could be damaged, so we will do lab work to see what’s going on there. But our biggest concern is the brain and honestly, there’s not a whole lot we can do. The vast majority of treatment for drowning is supportive. We see what we can do to keep that child alive. That said, the earlier you can intervene, the better. One of the things that helps outcomes is early, good CPR. By the time they get to us, it may be too late.”

Lifeguard Your Child 

It's time to make Texas #1 in drowning prevention. Drowning is the leading cause of accidental death for children ages 1 to 4, and the second leading cause for kids 1-14 in Texas. But with your help, we can change that. Please join us in our drowning prevention effort. Together, we can Lifeguard Your Child around water.

Want to know how you can get involved or create an awareness campaign in your community? Contact Dana Walraven, Safe Kids Tarrant County coordinator at 682-885-1619 or email safe.kids@cookchildrens.org.

More resources for you:

• Cook Children's Upcoming CPR Classes
• Project Adam
• Red Cross CPR Training
• Fort Worth Red Cross Safety Class, Including CPR
• American Heart Association
• Texas Heart CPR Training 
• DFW CPR Training Center
• Texas OnSite CPR
• CPR Training in Fort Worth, Texas
• CPR Training in Denton, Texas
• Drowning prevention page at Cook Children's
• Is your baby ready for swim lessons?

As a pediatrician, I've never been in favor of these medications as a treatment for your child's stomach virus and diarrhea. Studies have shown that use of antidiarrheal medications may prolong the course of the illness. 

Stomach viruses are the most common cause of diarrhea. Diarrhea, after a stomach bug, can last a while, even up to 1 week. A close second is diarrhea associated with antibiotics which can last as long as the child is on antibiotics and even a few days later.

For most cases of diarrhea, you probably don’t need to see the doctor. Here are some things you can do at home to help:

1. Get back to a regular diet as soon as possible. Continuing the Gatorade or Pedialyte only makes it last longer.

2. Do not use antidiarrheal medicines (even Pepto-Bismol). They don’t work and can have severe side effects. 

3. Talk with your doctor about using probiotics. Some studies have shown that they might be helpful.

Here are some reasons it might be time to go ahead and give the doctor a call:

1. Stool with blood or mucous

2. High fever

3. Signs of dehydration (dry lips, not urinating for 6-8 hours)

4. Diarrhea that lasts more than 1 week

Diarrhea will never be fun because it can ruin your life for a few days. But, if your child’s diarrhea lasts more than a week, trot (sorry) on over to your friendly pediatrician. They might need to do some tests to help you figure out what is going on.

“Is it GERD?”

Or, as I frequently see it spelled, “Is it gurd?”

Every baby spits up ... there is definitely a spectrum from the babies that spit up once in their whole life all the way to the babies that spit up every single time they eat.

It can be hard to understand what a doctor or patient means when they use the terms spitting up, reflux or GERD because people use them in different ways.

I try to keep it simple and only use the terms reflux and GERD when I think that the spitting up might be causing a problem:

So, if every baby spits up, how do I decide what is normal? When is it spitting up vs. reflux vs. gastro-esophageal reflux disease (GERD)?

The answer to this is tricky but I’m hopeful that I can help you decide.

Studies have been done where they watch how many times a baby regurgitates milk and stomach acid by placing a probe down his or her esophagus (this is reflux). The answer ... on average, 30 times per day. Most, but not all, of these episodes were associated with milk at least making it into the mouth.

Why does this happen?

There's a muscle that sits on top of the stomach that is meant to properly relax and squeeze to allow milk into, but not out of the stomach. Unfortunately, in most young infants, this muscle is both weak and dumb. It's not strong enough to override the pressure of the stomach pressing on it and it frequently relaxes when it is supposed to be contracting, letting stomach acid run back up into the esophagus.

So, reflux is, for the most part, a mechanical problem that's based on the pressure of the stomach and the strength of the muscle that sits on top of it. That is why, I think, that the most common cause of spitting up is overfeeding.

Often a family of a 2 month old will come in for their checkup and have questions about why their baby (who eats 6 ounces per feed) is spitting up. The issue is that the stomach is only a few ounces big at this age and everything else that you try to squeeze into it just raises the pressure and causes the baby to spit up.

So, if it’s so common what makes it abnormal?

There’s really only 2 reasons why I will treat babies for reflux: poor weight gain or associated pain/fussiness. So, the most common thing I will do to treat reflux is check the baby’s weight and if weight gain is good, reassure the family that they have a “happy spitter.”

I also see babies who are consistently fussy with their spitting up or that have fussiness predictably during feeds or in the 30 minutes following each feed with or without spitting up. Some people have termed this “silent reflux,” but I don’t really like that term because the screaming associated with it is anything but “silent.” Babies can also arch their backs which is sometimes confused for seizures but is, in fact, reflux.

What do we do about it?

Many babies can be helped by just cutting back on the amount of milk they are ingesting ... most babies need about 2-3 ounces per feed at 2 months and this goes up about 1 ounce per month of age after (6 ounces at 6 months).

I still commonly discuss with families that they can slightly elevate the head of the crib although it looks like review of the literature questions whether this is actually helpful,  so I may have to rethink this.

Studies have shown varying percentages about babies with reflux who have an allergy or sensitivity to cow’s milk protein (some studies show it as high as 40 percent). Thus it might be reasonable to try a short trial of a hypo-allergenic formula (Neutramigen or Alimentum). Many babies who are sensitive to cow’s milk will also be sensitive to soy. Many publications don't recommend a trial of soy, but because of the expense of the hypo-allergenic formulas I will sometimes have families do a trial of soy formula first.

Finally, in those babies who aren't gaining weight well or who are fussy with their GERD or following feeds, a short trial of an antacid medicine can be attempted to help with symptoms. There are two types of medicines that can be used: H2-blockers (ex Zantac) and PPI (ex Prevacid). I try to remind families that neither of these medicines are meant to help keep milk in the stomach. They only change the acidity of the contents that are coming up. So, it's likely that the baby will continue to spit.

Summary

1. Most babies with reflux have a laundry problem and not a medical problem (think happy spitter).

2. Limiting overfeeding is the major non-medical treatment for spit up.

3. Medicines for reflux can be used in babies with poor weight gain or fussiness but should be used sparingly and with appropriate expectations.

1. Make sure your house is safe while you are away. Alert the neighbors that you will be out of town. Stop the mail and newspaper from delivering or make sure a neighbor can pick it up for you. Now there’s even technology available to set a timer on the lights in your house. The timer lets you keep your lights on and turn them off the same as you would if you were actually at home, making any potential bad guy think you are there.
2. Don’t let everyone know your plans. Remember it’s not only old high school friends and co-workers following your every move. Crooks are definitely Facebook and Twitter savvy. Don’t announce to everyone that you are taking off soon or that you are trying to get packed tomorrow. Do things the old fashioned way and call the people who need to know you will be out.
3. Get your rest. A report released by the AAA Foundation for Traffic Safety states that drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more. Crash rates increase with every hour of lost sleep.
4. Make sure your child is secure in their car seat or booster before you travel. You can’t be too careful on the road, both in the U.S. and out of the country. Motor vehicle crashes are the No. 1 killer of kids 14 years and under in the United States.
5. And secure on the plane too. Buy the extra ticket for your baby and make sure your child is properly protected in an approved safety seat. The No. 1 way children are injured in planes is due to turbulence. For safety, children need to be either restrained in their safety seat or in the lap belt in the plane seat.
6. Bring a current picture of your child with you on your trip. Have a very specific description of what your child is wearing in case your son or daughter gets lost. In this day and age of cameras on your phone, it’s easy to take a picture of your child that morning.
7. This is an uncomfortable one, but so important. Let your child know it’s OK to scream and fight if someone tries to grab them. However, just throwing a fit may not work. We’ve all seen kids screaming and crying as parents carry them out of the store. If the child is old enough they need to know to scream “this isn’t my Mommy or Daddy, help me” instead of just screaming like they are upset because they were told “no.”
8. Traveling with asthma. Be sure to pack your child’s quick-relief medicine and long-term control medicine. Keep them where you can reach them and not packed away. Pack your peak flow meter, health insurance cards and your asthma action plan. Consider purchasing a portable nebulizer. Call ahead to where you are traveling and discuss your child’s triggers. Bring your child’s pillow and blanket from home.
9. Childproof your grandparents’ home. Make sure they know about any nut allergies or any other allergy they should know about during your stay. Check all the rooms for any electrical cords, cleaning supplies and loose pills on the floor. Grandparents usually leave them out so they can remember to take them. Don’t let this happen. Put the pills away. Often times they aren’t child proofed and kids can easily mistake them for candy. Also remember to unpack and put away any medications that you bring with you.
10. Avoiding food allergies takes extra prep work. Research local hospitals and medical care wherever you are traveling. Also call ahead or go online to find out about area grocery stores, restaurants and any other place you may stop along the way. Make your family aware. Yes grandma makes the best pecan pie, but make sure everyone knows your child has allergies and one bite can mean horrible consequences. Pack your own food if necessary. Stay alert and be prepared with your child’s medications
11. Be aware of the new surroundings for your kiddo. If they have a family pool without a fence, talk to your children about them. Make them aware of the dangers of stairs and banisters, and go outside with them to point out dangers, such as rakes, power tools, spots where there may be snakes and other critters.
12. Be safe. Cook Children's Trauma team sees lots of ATV/4-wheeler injuries during the holiday break. If your child is on an ATV, please make sure it's built for a child. No child under 5 should be on one at all, let alone driving it. If your child is on a bike, hover board or skateboard, please be sure your kids have on the proper safety equipment (helmets please) and establish the rule of safety first. With family over, it can be easy to think someone else is watching your kids. Mom and dad, make sure you are the ones responsible for supervision.

Hope this list helps during this busy time of year. Happy holidays from Cook Children’s.

So I got home the other day from a LOOOOOOONGday at work. You know what I’m talking about …It was a Monday (few things go right on a Monday), the beginning of the work week. And my son was off his schedule from a long three-day weekend because his grandparents spoil him.

All my wife and I want to do is get home and lay on the couch. WAIT! I can’t because we have a 2 year old who just wants a little attention. All he wants to do is … eat a snack, wrestle, play the tickle game, go outside, go on a bike-ride, kick the ball, throw the ball, go see the ducks, eat another snack, watch a movie, run up and down the stairs, go on another bike-ride, play hide-n-go seek and wrestle some more. No big deal, we can do this. To think, it’s only MONDAY!! Oh, and someone has to make dinner.

As hectic as that sounds, and believe me it is, it’s worth the time we spend with him. It would be so easy to put an iPad in front of him or even just sit him in front of the TV for a few hours until bedtime. Remember all those activities that my son wants to do? Think about each one and consider the number of vocabulary words and the amount of rich language I would be able to provide him in each of those activities.

It really is endless.

The only way a child will learn words is by hearing words. Wouldn’t it be awesome if we just had a magic wand and anytime we wanted our children to learn a new word, all we had to do was wave it at them, “Abracadaba!” Wave the wand with me two times. My child needs another word, I’m thinking of an animal, so he will say, ‘BIRD”!” There it is, BOOM!! He just improved his vocabulary. That just isn’t the way life works. Believe me, if it was that easy, I wouldn’t have a job as an SLP. The models that my wife and I provide my son Dominic has influenced his language and now he says things like “Where is it?” because we play hide-n-seek. He says “Let’s go!” because he wants to go on a bike-ride.

I recently went to a course where the presenter said that about 90 percent of what young children learn is through play. When you look back, isn’t that what a child’s life should look like? Sleep, play, eat, play, poop and some more play. Their lives revolve around play. At one point, I thought that in order for a child to play, they had to be in a soccer or basketball league, a club or camp, etc. That isn’t true! Play can be anything you make it and you can even play during activities that you are already more than likely doing at home.

1.Bathtime - Get some toys and make them swim, splash, dry them, make them jump.

2. Ball - You can kick, throw, catch, run with it

3. Hide-n-seek- Hide a favorite toy under, on top, in various objects

4. Super Hero Game - use action words(verbs). You can run, jump, roll, throw, etc. Caregivers can even carry their child and make them fly or vice-versa.

These are only a few activities. The best thing to do is go through your day and reflect back on a time or multiple times where you are already interacting with your child doing daily activities. Now think of how you can make the activity into a play activity. Just have FUN!!

Stephen Baker said it best when he said “Of all the toys available, none is better designed than the owner himself. A large multipurpose plaything, its parts can be made to move in almost any direction.It comes completely assembled, and it makes a sound when you jump on it.” We don’t have to buy things to play with our children. All they need is US.

About the author

Jonathan Suarez 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. 

Last year, 24 kids died in the U.S. and from 1998 to present, 676 children have died.

“What’s heartbreaking is that this is a serious public health issue that is totally preventable,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Every mom and dad out there must realize it can happen to you. Texas leads the nation in child heat-related car deaths.”

Parents may mistakenly think they can safely leave a child in a vehicle for a “quick” errand, but that’s simply not true. Temperatures inside the car can be 20 or more degrees hotter than the temperature outside, rising to dangerous levels in minutes. Unfortunately, it only takes a few minutes for tragedy to occur.

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle-related deaths for children.

“Heat is much more dangerous to children than it is to adults,” Walraven said. “When left in a hot vehicle, a young child’s core body temperature may increase 3 to 5 times faster than that of an adult. This could cause permanent injury or death.”

Heatstroke, or hyperthermia, occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

It’s difficult to think that as parents, we could “forget” our children, but it happens each year with no exception to socioeconomic or education level. Often times, a change in routine, a distraction along the way, or the event a child falls quietly asleep, unseen, in the back seat, allows for a parent/caregiver to “forget” and leave a child in the car.

Here are some important tips to help prevent unintentional injury to your child:

1. Dial 911 if you see an unattended child in a car. Sometimes, people don’t want to get involved or just assume the parents are on the way out. But as you read earlier, it doesn’t take long for a child to die in a hot car. If you see a child or children alone in a car without an adult, call 911 immediately.
2. Never leave your child alone in a vehicle, even for 1 minute. Windows left slightly open will not affect rising temperatures in the car.
3. Set safe habits: leave a cell phone, purse, briefcase, etc. in the back seat before driving, forcing you to always check the back seat and see a child is/is not back there.
4. Program your cell phone and/or computer to remind you to drop off your child each day.
5. Have a plan with your daycare provider to contact you within a few minutes of being late or absent. Let your daycare know that you want them to call you if you are late or you have not called in saying your child will not be in that day.
6. Teach children not to play in any vehicle.
7. Lock all car doors, even at home.
8. If a child goes missing, always check the cars and trunks.

Learn more by clicking here. Also, visit noheatstroke.org for the latest on heatstroke deaths of children in vehicles.

For more information

Every year children are rushed to the emergency room to be treated for car related injuries, many don't even involve traffic or another car. Some injuries occur without the car ever leaving the driveway. Click here for some of the top dangers to be aware of and the key things you can do to help make your car safer for your kids.

A new study suggests you might want to relax about letting your kids suck their thumbs and bite their nails. The study participants compared children with either or both of these “bad” oral habits with those who did not. The subjects underwent skin allergy testing at age 13 and 32. Those who had one of the habits showed decreased skin sensitivity relative to those who did not (38 percent vs 49 percent). Those who both sucked their thumb and bit their nails showed sensitivity rates of 31 percent. An important note is that the study did not find a difference between the two groups for the development of hay fever or asthma.

This falls in line with similar studies that having a dog early or parents who cleaned your pacifier with their mouth also might have the same effect of decreasing sensitivity on allergy testing.

There are many who believe that exposure to more microbial organisms early on might help children develop tolerance and decrease their risk of allergic diseases later on (this is known as the hygiene hypothesis). This study would support that thought and would suggest that our obsession with sterilizing and purifying everything might be creating problems with allergic diseases later in life.

The lack of association with asthma and hay fever suggests that we should use caution as we consider the results of this study. Further research is necessary to determine if the decreased skin sensitivity will actually produce a better clinical outcome with less allergic disease. For now, let’s just let all our parents with thumb suckers and nail biters have a reason to celebrate for a bit.

The AAP (American Academy of Pediatrics) and the Centers for Disease Control’s ACIP (Advisory Committee on Immunization Practices) stated, “Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-2017 season due to poor effectiveness.”

The first thought that went through my head was this: my kids have to get the injectable flu vaccine next year AND I have to convince them that it’s a good thing. (I may be a pediatrician, but I’m still a dad.)

The committee looked at data from the last three flu seasons showing that the nasal vaccine had limited to no effectiveness for preventing flu.

Here are 4 facts you need to know:

1. Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease. Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.
2. Assuming there’s no new information or guidance, your pediatrician should not offer your child the nasal flu vaccine. Even if we hear something new, I would choose to do the injectable vaccine and I will do so for my kids.
3. The committee is hopeful that this early decision will help prevent any issue with the vaccine supply. However, there are flu vaccine supply issues nearly every year so I recommend getting in to get your shot early.
4. There’s a committee out there who is looking at this data and making the best recommendations possible based on the latest information. Is it frustrating that we were giving a vaccine that didn’t work? Of course. Am I glad that I won’t do it for another year? Definitely.

Stay tuned for more information about flu and flu vaccines as we get closer to September when flu vaccine supplies start arriving at your Cook Children’s pediatrician’s offices.

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.

Trust me, you don’t want to get advice about sex or STDs from teenagers.

Here are some frequently asked questions:

1. Do kids even get STDs?

Yes. About 10 million new cases of STDs are diagnosed each year between the ages of 15 and 24.

2. How will I know if my boyfriend/girlfriend has an STD?

Many STDs don't have obvious symptoms and many teenagers are ashamed to or do not want to talk about it. Because of this, you will never know for sure if your partner has an STD.

3. How serious are STDs?

Identifying and treating STDs is very important. Some like gonorrhea and chlamydia can start with small symptoms but get worse and cause severe, life-threatening infections. Others, like HIV, may not show symptoms at all but can lead to serious health complications later.

4. Are all STDs treatable?

Some STDs go away after treatment but not all. HIV can lead to AIDS which is a life-long condition with severe consequences. Herpes can cause recurrent outbreaks of sores on the genitals which can come back again and again. Human papilloma virus (HPV) causes genital warts which can lead to cervical cancer (in girls) and penile cancer (in boys).

5. Do you just get STDs from sex, or from other stuff too?

You can get an STD from vaginal sex but that’s not the only way.

Oral sex can also transmit most of the infections. A person can get gonorrhea or chlamydia of the throat. HPV and herpes can also be transmitted via oral sex.

HPV and herpes are also contagious via skin to skin contact so even touching another’s genitals can transmit these infections.

If you are a teen reading things, there's a lot more you can learn about STDs. If you have other questions, ask your doctor or talk to a parent. Mom and dad, if you are reading this, please be available to talk to your child.

She is a sweet and happy baby who loves to babble ("mamama"... be still my heart!), pick up small toys and explore them slowly, play peek-a-boo, pick up her tiny foods with two fingers, point, laugh, and clap.

Things she cannot do? Crawl with her belly off the floor. Pull up to stand, or really put much weight on her legs at all. Shift from sitting to crawling to sitting again. Cruise along the furniture while holding onto it. She has delays in what we call “gross motor development” – the development of the “big movements.”

I see patients all the time at our Willow Park office that have gross motor delays, so I know not to worry. Lots of things can contribute to this. Sometimes it's just genetics. Sometimes it’s the baby's weight-to-height ratio. I notice that leaner, smaller kids tend to develop these movements faster, and bigger, longer kids sometimes need more time to build the strength to try these things. As you can see from the pictures, Abby has not missed any meals. There are exceptions to every rule of course, but I think this plays a role.

The baby’s temperament can also lead to delays. Some kids want to go go go...and some are completely fine with sitting still and working with what is in a close vicinity. Abby certainly fits into this latter scenario.

Of course there are numerous medical conditions that can cause motor delays. Always make sure, if your child has delays, to ask your pediatrician for a good neurological exam to check things like muscle tone.

Unfortunately, I believe what has played a big role in Abby’s delay is the amount of time she has spent in her favorite jumpers.

Baby jumpers, bouncers, exersaucers, and activity centers (they’re all basically the same thing) are stationary devices that allow a child to “stand” and bounce prior to developing those skills naturally. Kids love them because they’re fun and stimulating – most have toys and games attached – and they get to see more of the room and things going on around them, along with getting a chance to bounce up and down easily. Parents love them, because, let’s face it – they’re a quick and safe option for a break.

Baby walkers are similar – except they are on wheels so babies can bounce/pull themselves around the house. I have never owned one of these because they come with safety risks – children can fall down stairs, tip over, touch a hot stove, get pushed by siblings, pinch fingers, and slam into walls in these devices, and as fun as they seem, they’re not a good idea.

Around 4-5 months we started putting Abby in a jumper and she was thrilled! Finally she could be propped up and see everyone! She could control her body enough to bounce, and loved it. We were happy too, because we were constantly chasing her 2-year-old brother around, and it was nice to have a safe place to plop her down while that happened. Admittedly, it became a habit. When we’d read books, Abby would be propped up to be able to see the pictures. When we’d sing songs and play music with her big brother…Abby would get to howl and jump along in the bouncer. When we had to deal with the 2-year-old tantrums (and boy are those frequent)…in she went. Emptying groceries? Bouncer. Going to bathroom? Bouncer. Cooking dinner? Boom. Folding laundry? Ker-splat. She was probably in them a total of an hour to an hour and a half a day.

Looking back, she was in the bouncer way too much. Learn from my mistake, friends. Yes, pediatricians make mistakes.

Other doctors may think these things are harmless, but I respectfully disagree. Especially since I suspect my own child has likely been affected. Physical therapists have been warning parents for years about the problems with bouncers. And the more I’ve researched it, the more I’ve realized that too much time in these things can be detrimental to a child’s development.

I spoke with Gail Abaray, a pediatric physical therapist in Weatherford, who told me, "Bouncers don't allow infants to explore and move. They are limited in what they can do, and are stationary. And that pull to explore is so important. When they cruise the furniture, they learn about lateral movement, and how to turn their legs and feet. In a stationary bouncer, all of that coordination can't happen."

Look at the picture of Abby in her favorite bouncer. See how she’s on her tiptoes? This is typical and leads to the majority of the strength being recruited from her calves and thighs. What is not getting a workout is her hip, gluteal, pelvic and core muscles – and these are the ones that help children crawl and eventually walk.

Their hips are spread unnaturally wide by a piece of stiff fabric. They often lock their knees, especially the younger babies.

Babies cannot see their feet or the ground in these devices either – and thus cannot coordinate their body well in them.

Their upper bodies are also thrust forward – taking all the pressure/weight off their gluteal and hip muscles. The very muscles they need to strengthen.

The same things happen in walkers – babies are pulling themselves along while most of their weight is supported, and this works out and coordinates all the wrong muscles. They also can’t see the ground or their feet. “Walkers” are a true oxymoron here – they lead to delays in walking naturally.

So what do I recommend to parents now? Well…go buy a bouncer! They’re great! But – use them in moderation. Don’t put one in every room, like I did – it’ll only lead you to use them more. Use it only for very short periods of time – maybe 15 minutes here and there, once or twice a day – 20 or 30 minutes a day, max! Physical therapist Gail agrees: "I always tell parents not to feel guilty for using them. I did! But moderation is key!"

And avoid walkers in general. I am not convinced they’re safe or worth the money.

Don't feel guilty if you've put your baby in a bouncer - we all need breaks. And it's hard to deny they're so happy in them! But remember the big picture - kids need to learn to explore their environment on their own. It's vital to their development!

As for miss Abby-pants? Well, we got rid of all the bouncers and for the past month have set strict tummy time rules – she must work for toys on the floor for nearly the entire day, and must practice standing several times a day. She yells at me about it all day, but boy has this tough love helped. She has already shown vast improvements. She is now able to stand supporting herself on a piece of furniture, can quickly army crawl (using her arms mostly), and is starting to lift that big belly off the floor! We are also enlisting the help of a local pediatric physical therapist to help with some exercises and strategies. Slowly but surely, she’ll get there!

Hugs,

Dr. Diane

Rice is one of the foods most commonly associated with arsenic. Earlier this year, the Food and Drug Administration (FDA) released a statement expressing their goal to take “steps to reduce inorganic arsenic in infant rice cereal, a leading source of arsenic exposure in infants.” One of those steps is to reduce the allowable amount of arsenic in rice cereal. (Before you ask, brown and organic versions also have arsenic.)

A new study in JAMA Pediatrics released online yesterday shows that intake of rice cereal and rice-based snacks increased the levels of arsenic in the children’s urine. In high levels, it has been shown to cause problems with almost every body system, including poor growth, immune system function and development. It is unclear what health problems smaller increases may cause.

Should you be concerned?

I would not run out to have your child’s arsenic levels checked. Children have been eating rice cereal for ages with no obvious health effects.

We should definitely be aware of the ongoing research about arsenic and the FDA should continue to work with companies to limit the amount of arsenic in rice cereal.

Should you give your baby rice cereal?

There will be different opinions on this debate, but you’ve read this far for my opinion so here goes: I say ... no.

I actually moved on from recommending rice cereal (or cereal at all for that matter) for my patients for over a year now.

There are several reasons why we used to recommend rice cereal as an early first food but each one has fallen by the wayside as a real concern:

1. Iron - Rice cereal is a good source of iron and exclusively breast fed babies were thought to need more iron. But, the reality is, the iron that is in breast milk is absorbed well and there are plenty of other options to get iron.
2. Allergies - We used to think that feeding other foods early could be a cause of food allergies. Turns out, the exact opposite is true. Delaying other foods doesn’t prevent (and might actually be a cause of) food allergies.
3. Safety - Rice cereal can be mixed up into a bunch of different textures for your baby, but so can fruits and vegetables. If you are worried about your child’s safety and what he or she is eating or don’t want to deal with purees or other baby foods, it’s also perfectly OK to wait for solids until 6 months when a baby can handle more “whole” foods.

I recognize that many doctors might give other advice but I tell my patients to skip cereal (for lots of reasons, arsenic being a small one).

Either start with fruits and vegetable puree/baby food at 4 months or wait until 6 months to let babies feed themselves soft items (this is called baby-led weaning). Some great first foods for either puree or baby led weaning are avocados and bananas.

The main thing about early feeding is to have fun! Don’t let worry about arsenic poison your ability to enjoy this exciting developmental milestone.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. 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.

If you make a mistake, it could be harmful.

Myths about fever are common. And, no, you don’t have to go to the ER for fever. Treating a fever at home is often the right thing to do. But, we can’t get so comfortable treating fever that we forget that medicines can be dangerous, even over-the-counter fever reducers.

Here are 7 mistakes parents make when treating their child’s fever:

1. They treat normal temperatures. A child that has a 99 degree temperature does not have a fever. There’s no need to give them medicine. If one of our children has a 101 temperature but is playful, I don’t stop them to give medicine.
2. They wake kids up to give them medicine. If a child is sleeping, it’s OK to let them sleep.
3. They give aspirin. Aspirin should never be given to children with fever. It can cause a rare, but serious condition known as Reye syndrome which leads to confusion, brain swelling and liver damage.
4. They don’t give enough medicine. It is so common for children to be under-dosed by parents. Maybe it’s the psychological barrier to seeing your children grow up, especially when they are sick but giving the same dose to your child at 6 months and 6 years won’t work. Know their weight and dose accordingly.
5. They give too much medicine. Again, know your child’s weight and use a chart. Measure twice, dose once. If you think that you gave too much, you can call poison control to see if you should be worried: 1-800-222-1222.
6. They give too many doses. The old standby of alternating Tylenol and Motrin for fever goes way back but the reality is that overdosing and extra doses occur much more frequently with this strategy. I have quit recommending it for families altogether. Again, if this occurs, call poison control.
7. They leave the fever medicine out and kids get into it. This mistake is common and completely understandable. Often when kids need fever medicine, it’s a high-stress-low-sleep situation; a mental state where we are more prone to let down our safeguards. Don’t do it! Find a place up high to store your medicine and droppers so that they are in a convenient place and put them right back after you pour your dose. If you kid does get into the medicine, any ideas what you can do? 1-800-222-1222.

Here are the two major takeaways for treating fever:

Know your child’s weight and have a chart handy. Use it every time.

Stop right now and store the poison control number into your phone. Here it is again, in case you forgot: 1-800-222-1222.

The troubling trend I have noticed is with a parental mindset that more equates to a “bestie” than a mom or dad. Your child is not an adult. I am not a child psychologist, so I will not wade through those waters. But, from a perspective of someone who performs root cause analysis of incidents, I must say there are dangers associated with a lax parental structure.

I could give a thousand examples of situations where your child should not have total privacy in their lives. Do you keep up with your child’s grades in school or simply leave it up to them to pass or fail? Do you ask them where they are going when they leave the house or do they have complete privacy and freedom to go wherever they want? Would you want to know if they were getting into something dangerous or making a bad life choice?

I do not understand the opposition; but, I do recognize there are those in opposition to using spyware to keep tabs on what their kids are doing online. All I can say to such opposition is I simply do not agree. This does not mean that I am going to read every conversation they have with their friends. This does not mean I am going to keep track of every single detail of every single site they visit. I am keeping eyes on their activity and can be in a position to recognize when I may need to step in and give guidance.

In performing research on the subject and talking to experts regarding child online safety, a few things tend to float to the surface of the sea of information.

1. You tend to get very few physical queues. Picture your child sitting on the couch with their face aglow from the light of their iPad. What are they doing? They could be watching a music video or chatting with a stranger. Switching from one activity to another does not tend to change their outward appearance or mannerisms. I call this the virtually induced poker face.
2. They feel secure in their environment.  They say hindsight is twenty-twenty. This one can be difficult to explain, so let me put it this way: If your child were in a dark alley and was being approached by the silhouette of a large man, they may become apprehensive, keep their guard up, or become standoffish and not be willing to participate in a conversation. However, if your child feels physically secure in the comfort of your home, they may be more than willing to participate in that conversation. That could lead to them being groomed by a predator.
3. A child doesn’t typically recognize the dangers until it is too late. Online predators are not stupid. While they are morally bankrupt, malicious, calloused, brazen and cruel, the successful ones can be rather intelligent. They are master manipulators with a ton of patience and have the tenacity to stick with a target. They find weaknesses and play on them. They weasel their way into a relationship with the child. They comfort them, take their side on issues, and lure them in. By the time your child recognizes they are in danger, it could be too late.

There are real and proven dangers to allowing a child to have complete privacy and freedom in the virtual world.

I don’t like to cite applications in articles because these articles tend to live on when apps die, the name gets changed, or something even better comes along. However, I will make an exception in this case. Currently, my top pick for spyware in regards to monitoring children is PhoneSheriff. PhoneSheriff has the ability to monitor and alert on a large variety of activity, it offers extensive alert and restriction functionality, and is compatible with any major device type.

Another really good spyware product is Mobistealth. While MobiStealth may be prettier, it is also more expensive than PhoneSheriff and, for me, it has one major weakness. MobiStealth does not give you “Geofencing”. Geofencing allows you to set alerts based on the geographical location of the device. An example of this would be setting up a geofence for your child’s school and another geofence for your home. If your child is supposed to leave school at around 4 p.m. and be home at around 4:30 p.m, you would be alerted when your child (device in hand) left the school and when they arrived home. If the times are off, you would know.

As I stated, these recommendations may change over time. Depending on when you read this, you may need to search for “Best Spyware Apps” and do a little research on your own.

Just remember, you are the parent. If your child has a phone or other device, it is because you allowed them to have that device. I do not recommend giving such devices as gifts and I make it crystal clear to my kids that they are borrowing my phone that is on my plan that is paid for by me and I can shut it off anytime I wish. I do not allow them to have passwords I do not know, I do not allow them to lock me out of the phone, I do not allow them to take the phone to the bathroom or their bedroom with the door closed, and I also have a rule that the phone must be charged at night in my bedroom.

I suggest a combination of prevention and monitoring.

Happy parenting and good luck!