Last fall, two studies showed that probiotics may not work as well in kids who have “tummy bugs” as we had previously thought.

I am defining acute gastroenteritis here – that’s the term we docs use to describe a tummy bug – as that all-too-common few days of vomiting and loose stools/diarrhea your kids pick up at school.

In the studies (which were actually pretty good ones), two large groups of children (one study had 971, another had 886) were randomly selected to take five days of mostly Lactobacillus rhamnosus or Lactobacillus helveticus, two common probiotics we recommend for kiddos this age, if they walked into certain U.S. or Canadian ERs with symptoms of gastroenteritis. Another group was assigned a fake/placebo.

The studies seemed pretty fair. Their poops were tested and found to have similar germs (viruses vs bacteria vs no cause found). Similar numbers in each group had gotten antibiotics or vomiting medicines. Neither study was run by a corporation – they were publicly funded.

After 14 days, participants were given a survey to see how their symptoms were doing. I’ll spare you the details – the probiotic group didn’t feel any better than the placebo group in both studies.

What does this mean? Well. Probiotics may not be beneficial to our kids when it comes to tummy bugs. But, let’s remember our critical thinking skills when we read medical studies –

• They only tested two types of probiotics.
• They only tested a five-day course of it.
• These studies were done on one age group only: 3 months to 4 years.

Probiotics have, in other studies, been proven to be beneficial in helping other ailments! Like colic, irritable bowel syndrome, chronic constipation, and even preventing necrotizing enterocolitis in premature babies. So let’s not give up on them yet.

But I do think this is enough evidence to prove that probiotics likely wont help your kids tummy bug. If you have questions, talk to your pediatrician about other ways probiotics can help.

According to the study published this month in the journal Pediatrics, just half of mothers surveyed said they always put their babies to sleep on their backs.

The findings are alarming for physicians who say back-sleeping is a key way to reduce the risk of sudden infant death syndrome (SIDS).

“We see it all the time, and it is tragic,” said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s Medical Center. “SIDS is responsible for more infant deaths in the United States than anything else during the first year of life.”

While experts don’t know exactly why back-sleeping is best for preventing SIDS, it is believed that babies who sleep on their stomach get less oxygen and retain more carbon dioxide because they are “rebreathing” air. It is also possible that tummy-sleeping can lead to upper airway obstruction and choking.

“Infants should always sleep on their backs in a crib with a firm surface and a tight fitting sheet. No bumpers, pillows or soft bedding should be used,” mentioned Dr. Warmink.

Another big reason infants arrive in Cook Children’s Emergency Department is co-sleeping. While many parents find comfort in sharing a room with their baby, bed-sharing is never recommended.

“New parents are understandably exhausted, but even a quick nap with a newborn can turn deadly,” said Dr. Warmink. “It’s horrible to see a parent lose a child because they were accidently smothered in their sleep. Sharing a bedroom with an infant makes sense, but never on the same sleep surface.”

Dr. Warmink also insists infants should never sleep on a couch, sofa or cushioned chair, even when alone, and especially not with another person.

About Safe Sleep

Tarrant County has one of the highest infant mortality rates among Texas counties–exceeding the national average. The Center for Prevention of Child Maltreatment is guiding a safe infant sleep awareness campaign in collaboration with Baylor All Saints, JPS and Texas Health Harris Methodist. Learn more here.

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.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

What is the core?

“Core” is the word we use to describe the muscles in the middle part of your body. It includes muscles in your stomach, back, hips, and around your shoulder blades. They are not your “six-pack” that you might be able to see from the outside. They are deeper in your body. Even though you can’t see them from the outside the same way you might see big biceps, they are just as important, if not more so.

What does the core do?

All of these muscle groups work together to help keep your body stable. They create a good base for your arms and legs to work on. They help you have good posture, which distributes forces evenly throughout your body. They also work to transfer forces to and from your legs and your arms, like when you kick or throw a ball.

Why is it important?

Having a weak core is a lot like having a chain where the middle link is broken. Your body just can’t work very well without it? Or something like that. When your core doesn’t do its job, other muscles, bones, or ligaments have to do the work. The problem is that they were not designed for that job, so they aren’t very good at it. Without your core muscles working to keep your spine stable, you may be more likely to have injuries like back pain. Having a weak core has also been linked to other injuries, such as anterior cruciate ligament (ACL) tears, shoulder injuries and ankle injuries to name just a few.

What if my child doesn’t play any sports? Is the core still important?

It is still very important to have strong core muscles. We use these muscles even when we are resting. They work hard to keep us strong while sitting in school, riding in the car, and playing outside with friends. The core muscles are so important that they should activate before any movement of your arms or your legs in order to keep your spine stable, even if it is just reaching into a cabinet to get a cup.

So what can I do?

• Make sure to talk to your child’s doctor before starting any exercise programs.
• Encourage your children to sit with good posture using their core to align their body. This means their shoulder blades should be pulled down and toward each other. Their heads should be in a line over their shoulders. They should be drawing their belly button in toward their spine, and they should not have a big curve in their lower back.
• Sitting on Swiss/Therapy balls while sitting at a table or while playing video games so it can activate the core muscles while doing homework or having play time.
• Have plank competitions as a family to engage everyone’s core. 
• Get moving … taking family walks, riding bikes, swimming, getting involved in physical activities such as Karate, dance, gymnastics to name just a few.
• Pilates and yoga classes are both good ways to work on core strength once your child has learned the basics.

Hopefully this article helped to explain a little bit more about the core. If you child is having pain, or is having a difficult time with the ideas above, consider talking with your doctor about a referral for physical therapy.

About the author

Jacky Arrow, PT, DPT, SCS, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.

"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.