Medfusion



Common Questions in the First 6 MonthsEye DischargeOne of the most common problems with newborns is a blocked tear duct, also called the nasolacrimal duct. ?The duct is a small opening on the inside of the eye which drains tears into the inner nasal area. ?When it is narrowed or blocked, tears build up forming a yellow, crusty discharge. ?Typically, this discharge is intermittent, lasting days to weeks at a time, usually accumulating during sleep.? It is usually controlled with a warm washcloth to wipe away the tear build-up. ?You can also massage the duct by gently rubbing your finger down the bridge of the nose. ?The natural course is that as your baby grows, the duct grows too and opens up usually by 6- 9 months.? Rarely, the tears get superinfected and form a thicker, green, stringy discharge which does not resolve within 2-3 days and is often associated with conjunctivitis.? This condition requires treatment with antibiotics. ?Recurrent infection occasionally warrants ophthalmology consultation for mechanical opening of the tear duct.?Nasal congestionIn addition to narrow tear ducts, many babies also have narrow nasal passageways at birth causing nasal congestion. ?Babies are obligate nasal breathers which means that they preferentially breathe through their noses. ?Small nasal canals can make a lot of noise but usually pose no threat to your baby. ?As long as your baby is feeding well and has no increased work of breathing, no treatment other than nasal bulb syringe aspiration is necessary. ?This usually resolves by 3-6 months. ?Irregular BreathingInfants can have an irregular breathing pattern during sleep called periodic breathing where rapid breathing for 10-20 seconds is followed by a pause. ?This is considered normal and resolves as the breathing center in the brain matures. ?If you notice color changes (blue color around the lips) or pauses lasting longer than 10 seconds, this is not normal and needs further evaluation to investigate other causes. ?Spitting Up or Gastroesophageal Reflux Disease (GERD)All babies spit up, some more than others.? Typically this is not painful and is more noticeable after large volume feeds, feeding fast or laying down immediately after a feeding. ?GERD usually resolves by 6-9 months.For some infants, GERD can be painful and cause symptoms of persistent crying and back arching during or after feeds. ?If severe, this can lead to feeding aversion and poor weight gain. ?First-line treatments involve slowing down the volume or speed of the feeds, keeping the baby upright for 20 minutes following the feed and elevating the head of the bed to 30 degrees. ?If your baby has persistent symptoms despite these reflux precautions or is not gaining weight, adding prescription antacids is the next step and often can provide huge relief.?Red Crystals in the UrineThis is a common finding more common with breastfeeding and represents urate crystals in the urine.? These resolve spontaneously and do not require treatment.?Flat HeadsSince the guidelines for putting babies to sleep on their backs have come out, an increasing number of infants have presented with a condition known as positional plagiocehpaly (where the back of the head becomes flat and distorted). ?The best way to treat this condition is to prevent it. ?As long as you are aware of this problem and rotate your baby’s head to different positions, this probably will not become an issue. Babies who often get this condition are ones who seem to prefer to always look in one direction. ?This can result from a neck muscle strain often suffered in utero from small bleeding into the anterior neck muscle (known as the sternocleidomastoid muscle) with resultant scar tissue which contracts the muscle.? Typically, a small knot can be felt in the muscle. ?As it tightens, it turns the head to the opposite side. ?We call this condition torticollis. ?The treatment involves massaging the neck muscle opposite the side the head is turned, hanging things on your car seat or mobile to stimulate your baby to turn his head to the other side, and laying him to sleep on the opposite side of the head.? This condition usually resolves by 2-3 months.?Curved Legs and FeetMost babies normally have feet that are intoed at birth and shin bones which have a bowed shape inward. ?This is from uterine positioning and will gradually resolve as your baby grows.?SkinDry skin: Newborn skin can develop diffuse peeling in the first two weeks. ?This is the outer skin layer that sloughs off as the new skin grows in. ?This does require any specific treatment as it will resolve with time, usually by 2-3 weeks. ?For skin moisturization, we recommend Aquaphor, Vaseline or Johnson & Johnson’s hypoallergenic lavender lotion. Eczema: Dry skin occurring in patches and often with an itchy, thickened red component is called eczema. ?This is seen later in infancy, usually first noticeable in the cheeks and then later on the extremities and in the skin folds in the elbow and behind the knees. ?It is extremely common and is more common with babies who have other allergies (history of wheezing or allergic rhinitis) or who have parents with allergies. ?The cornerstone of treatment is moisturizers (Aquaphor or Vaseline) often 3-4 times per day.? Over-the-counter hydrocortisone for up to one week can be used on the body for flare ups. ?Another natural moisturizer we have used is called Emily moisturizer and can be found at . ?CeraVe cream or lotion is another excellent moisturizer which can be purchased at Rite-Aid or CVS pharmacies or through the internet at .Red Bumps on the Neck and Face (Papules): Babies have very sensitive skin and often react to anything from heat to any contact with small red bumps on the face and neck.? Some refer to this as the common “heat rash.”? This usually is intermittent and mild in nature and requires no treatment other than Aquaphor or Vaseline to the area to act as a barrier. ?Lesions which do not blanch (turn white after pressing on them with your finger) are not normal and need evaluation.Stork Bites: Also known as salmon patches, angle’s kisses or nevus simplex, these birthmarks are small blood vessels visible through the skin and are present in 30-50% of normal newborns. ?They are most commonly found on the eyelids, nose, in between the eyebrows and on the nape of the neck. ?On the face these uniformly resolve with time whereas the patches on the nape of the neck always fade but sometimes persist into adulthood. ?(A large number of parents actually have this and do not realize it).Strawberrry Hemangiomas:? This is a different type of birthmark with a raised, red bumpy appearance. ?It is typically not seen or very small at birth and enlarges until around 9 months, after which time it starts to shrink in size and usually disappears by age 5-9 years.Mongolian Spots: These look like dark bruises usually on the sacrum and usually resolve on their own by 3-5 years of age.Neonatal Acne: This condition is marked by scattered fluid-filled spots and red break-outs on the face and neck, usually appearing by several weeks of age and lasting until 2-3 months of age. ?NO treatment is required and the natural history is for complete resolution. This is a response to the high estrogen levels inside the womb.Diaper Rash: There are two kinds of diaper rashes: fungal rash and contact diaper rash. Fungal rash is a beefy red rash found in the creases of the inguinal and buttock region from excess moisture. ?It is easily treated with Lotrimin cream over-the-counter. ?Regular diaper rash is a contact dermatitis from skin contact with the stool and urine. ?It is seen on the mounds of the buttock, usually around the anus. ?These are treated with any of the zinc oxide emollient creams (Desitin, A+D ointment, Boudreaux’s Butt Paste, Aquaphor, Balmex) and avoiding stringent wipes (just rinse and pat dry for diaper changes). ?I also have had success with Calmoseptine ointment (available over-the-counter but often needs to be ordered by the pharmacy). ?The best way to treat a diaper rash is to prevent it by using prophylactic Aquaphor or Vaseline if your baby has soiled diapers more than 3-5 times per day. ??????????? ?Umbilical Cord CareOur recommendations are to just leave the cord as it is until it falls off on its own which typically happens around two weeks of life. ?Oftentimes, after the cord has fallen off, a small yellow discharge is present or bits of dried blood. ?This can be safely cleaned with an alcohol swab. ?Occasionally, some red, beefy tissue called granulation tissue is noted at the base of the umbilicus. ?This usually resolves spontaneously but if it is growing, it should be treated in the office with a topical sealant called silver nitrate.Umbilical hernias are quite common and often look more dangerous than they are. ?As many as 20% of newborns have umbilical hernias, which occur because of failure of the umbilical ring to fully close.? Most pediatric umbilical hernias close spontaneously by 4 years of age if the fascial defect is less than 1.5 cm.? Those hernias that persist beyond this age, as well as large or complicated hernias, may require surgery.?Bumps Behind the EarBehind the ear is a lymph node chain called the posterior auricular chain. ?Often small pea-sized lumps are felt behind the ear which are non-painful and freely mobile. ?These are more common in babies with any scalp dermatitis such as cradle cap as the lymph nodes can swell as bacteria found on the scalp is destroyed and broken down in the lymph system. As long as the lymph node is getting bigger, or red or painful (signs of infection), we recommend to follow it conservatively with time. There is also a normal prominence of the bone in this area. If a lump feels “fixed to the bone”, asymmetric, or is growing in size, this needs evaluation.?Breast LumpsBabies (boys or girls) can sometimes develop breast buds as infants from exposure to high levels of estrogen in utero. ?This causes a small non-painful nodular swelling behind the nipple. ?These uniformly resolve by 3-6 months of age.?BathingAfter the umbilical cord has fallen off, you may submerge your baby in water and start giving baths. ?Babies do not have the same sweat glands as adults and do not need baths every day. ?Every 2-3 days is usually sufficient for infants.?SunscreenSunscreen is not FDA-approved for children under 6 months of age. ?However, in San Diego, we have seen many babies with 1st degree sun burns from sun exposure (even when parents thought they were covered with a hat or umbrella). ?Avoid direct sun exposure in the first 6 months; however, if sun exposure cannot be avoided, we do think the benefits of sunscreen outweigh the risks.?Vitamin DNew recommendations have come out for all babies to receive at least 200 IU of vitamin D each day. ?Vitamin D deficiency can cause a condition known as rickets where the bones do not grow properly. ?Vitamin D, in addition to that found in food, can also be made by the skin through sun exposure.? Rickets historically has been prevalent in underdeveloped countries but after cases of rickets started showing up in the US, the AAP recently changed its recommendations for supplementation. Formula (at least 16 ounces per day) is fortified with vitamin D and meets the daily requirements. ?If your baby is breastfeeding exclusively, he should receive supplemental vitamin D. ?This can be obtained with a liquid multi-vitamin called PolyVi-Sol (1 dropper per day), available at all pharmacies, given alone or mixed with breast milk in a bottle.?SwimmingWe recommend infants start swim classes only after 2 months or after their first set of immunizations.?Airplanes The major risk with flying has to do with exposure to crowded places and sick people.? We do not recommend taking your baby on a crowded plane before 2 months. ?Anytime after that, we would consider it safe. ?Just remember to feed your baby on the way up and on the way down to keep the eustachian tubes open. ?Benadryl can be used safely after 6 months to assist in sleep.? (Please see Benadryl dosing.)?Ear PiercingWe recommend ear piercing only after 3 months of age and we do not perform this in the office. ?Pacifiers We have no objection to pacifiers as they usually cause no feeding issues and can be a source of comfort for those infants with a strong oral fixation. ?The earlier you can wean off the pacifier the better and you should have your baby completely weaned off by 18 months. ?NailsLong nails in infants can be a source of scratches on the face. ?It is safe to cut a newborn’s nails but you need to take extra precaution to trim just those edges which overhang and cause scratches. ?Sometimes, to avoid cutting the skin behind the nail, it is easiest to just file the nails. ?Some babies are born with long nails; others do not need to have their nails cut for 6 months.?Hiccups/SneezingBoth hiccups and sneezing are common normal newborn reflexes and both resolve with time. ?No treatment is required.?TemperatureWe do not recommend taking your baby’s temperature regularly unless he has fever symptoms such as feeling hot, crying without a clear cause, or irritability. ?We recommend buying a standard digital thermometer (same as for adults).? In the first 6 weeks, the temperature should be taken rectally and a fever is anything equal to or greater than 100.4? F. ?This requires evaluation in the hospital for a possible bacterial infection. ?A rectal temperature is mandatory because this is the gold standard and greatly affects management. ?After 3 months of age, an underarm or ear measurement is adequate. ?Crying/ColicAs parents, you will learn your baby’s patterns. ?Crying usually indicates hunger, being cold, being soiled, or just wanting to be held. ?Gas and milk intolerance can cause excessive crying. ?Crying for greater than 3 hours per day with no other cause (as outlined above) is a condition called colic. ?Colic, contrary to popular belief, is not due to gastrointestinal upset or food intolerance. ?New research shows it is a neurodevelopmental problem where babies are unable to self-sooth. ?Typically, crying can last from 3 weeks of age up to 3 months, after which time it spontaneously resolves.? Treatment involves using outside factors to assist in soothing your infant such as rocking, swinging, cradling, white noise (running water), any kind of motion and soft music. ? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download