Will Standing Hurt a Baby’s Feet or Legs?

“Will standing hurt my baby’s legs?”

I’m surprised how often I’m asked if having a baby “stand” on a parent’s lap will make them bow-legged or otherwise hurt them. Standing and jumping while being held and supported is a natural thing babies do, so why do so many parents worry if standing will cause bow legs or other problems?

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Bowed legs from allowing babies to stand with support is one of those tales.

If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs, it will not harm the baby.

Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them.

Supported standing can help build strong trunk muscles.

Other ways to build strong muscles in infants:

Tummy time

tummy time, prevent flat heads
Supervise tummy time when Baby’s awake!

This is a simple as it sounds. Place your baby on his or her tummy. Be sure s/he’s on a flat surface that is not too soft.

I think the earlier you start this, the better it’s tolerated. You can even do it before your newborn’s umbilical cord stump falls off!

Initially babies will not lift their head well, so be sure they don’t spend too much time face down. This can cause problems with their breathing. A brief time doing this is safe though as long as they aren’t laying on fluffy stuff. This is a major reason to never leave your baby alone on his stomach.

Use this as a play time.

Move brightly colored or noisy objects in front of your baby’s head to encourage your baby to look up at it. Older siblings love to lay on the floor and play with “their” baby this way!

Many babies will look like they’re taking off trying to fly. Others will put their hands down and look like they’re doing push ups. Around  4 months they can support their upper body weight on their elbows. All of these are good for building muscles.

Parents often avoid tummy time because their babies hate it. It’s hard to hear babies cry, I know. You can progressively make it harder for your baby without being a mean drill sergeant! Increase the time on their tummy as they gain strength. Start with just a minute or two several times a day. If you never do it, they’ll never get better.

Bonus: Tummy time helps to prevent flat heads!

Chest to chest:

From day one babies held upright against a parent’s chest will start to lift their heads briefly. You will most likely go to this position to burp your baby sometimes.

The more babies hold their head up, the stronger the neck muscles get. Chest to chest isn’t as effective as floor tummy time for muscle strength development, but it’s a great cuddle activity!

The more reclined you are, the more they work. Think of yourself doing push ups. If you do push ups against the wall, it’s pretty easy. If you put your hands on a chair, they get a little harder. Then if you put hands and feet on the floor, they’re even harder. Lift your feet onto a higher surface and it’s even harder.

Chest to chest time can be an easy version of tummy time, but I don’t want it to replace tummy time completely. Make time for both each day!

Lifting gently:

When your baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. This can usually start around 6 weeks of age.

Babies will get stronger neck muscles by lifting their head and strong abdominal muscles by tightening their abs even though you’re doing most of the lifting. You could call these baby sit ups!

Be careful to not make sudden jerks and to not allow the baby to fall back too fast.

Kicking:

Place your baby on his back with things to kick near his or her feet.

Things that make a noise or light up when kicked make kicking fun!

You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.

Bicycling:

When you ride a bike, you get exercise, You can help your newborn stretch and strengthen leg muscles by making the bicycle motion with his or her legs.

When babies are first born they are often stiff from being in the womb. They will learn to stretch their legs, but you can help by moving them in a bicycle pattern. They usually find this to be great fun!

I also suggest doing this after they get their first few vaccines to help with muscle soreness, much like you move your arm around after getting shots. Generally by 4 months, babies kick enough that they can do this on their own.

Sitting:

Allow your baby to sit on your lap or on the floor with less and less support from you.

You can start this when your baby has enough head and trunk control to not bop around constantly when you hold him or her upright for burping. Don’t wait until 6 months to start – by this age some babies can already sit for brief periods alone if they were given the opportunity to practice when younger.

A safe easy position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V” – this offers protection from falling right, left, and back.

When your baby is fairly stable, you can put pillows behind him or her and supervise independent sitting. Never leave babies unattended sitting at this stage.

Big benefits

“Will standing hurt my baby’s legs?” is the wrong question.

Parents should ask more about what you can do to help your baby develop strong muscles. Standing with proper support is not only safe, but also beneficial!

What are your favorite activities to help your baby grow and develop strong muscles?
Will standing hurt a baby's feet and legs? What about hips?

Infant Poop: What’s Normal and What’s Not

Who would think they would focus so much on poop as new parents do? Color. Consistency. Frequency. So many things to worry about with infant poop! One of the most common concerns I hear is that a baby who used to poop several times a day stops pooping for days at a time. They might have a bowel movement (poop) just once a week – sometimes less. That worries parents, but constipation isn’t defined by how often babies have a bowel movement.

First stools

During the first few days of life the stool looks black and is thick. This is called meconium. It occurs in both breast fed and formula fed babies.

Meconium DiaperMeconium stool. Photo by Azoreg via Wikimedia Commons

If your baby doesn’t have meconium within 24 hours of birth, an evaluation to decide if there’s a problem should be done. Be sure to talk with your baby’s doctor if he doesn’t poop within 24 hours of birth.

Transitioning stage

After the first few days there is a period of transition stool. The stools become more green and sticky. This is the meconium mixed with breastmilk or formula stools. It happens earlier in formula babies and after mother’s milk comes in for breast fed babies.

2nd week and beyond

After the transitional stools, the stools will vary in color and consistency depending on if the baby gets breastmilk or formula.

Breast milk

If breast milk is the primary food, the stools can vary quite a bit. They often look like yellow cottage cheese, with a lot of liquid and chunks. It often becomes a bit thicker (like pudding) as a baby gets older.

It is not diarrhea just because it is watery. I cannot repeat this enough. Breast milk stools tend to be watery. It is not diarrhea.

Breast fed stools can vary in shades of yellow to brown or green, often changing depending on what the mother ate. Bright green and frothy stools can indicate a low fat diet in a breast fed baby.

The fore milk has less fat than the hind milk, so if the baby consistently has frothy bright green stools we will monitor the baby’s weight closely to ensure adequate growth and evaluate the amount of milk the mother is producing and baby is drinking. Green milk is not necessarily problematic though.

A breastfed baby might have a bowel movement every time he eats (and in between) or he might go less than once a week. (Watch out when it finally comes – it often escapes the diaper!)

Formula

If a baby is taking formula, the stools can look shades of yellow and brown and be the consistency of peanut butter, pudding, or thick oatmeal. Formula fed stools tend to smell more foul than breast milk stools, but even breast fed baby poops can stink.

Most formula fed babies have a bowel movement 1-3 times a day.

Breast milk + formula

Babies who get some breast milk and some formula can have characteristics of each feeding type.

Solids

After 4-6 months your baby can start solid foods.

Once a baby eats solids (or pureed foods) the stools can thicken a bit but should never be hard. They usually become more foul-smelling at this time.

Sometimes chunks of food (especially carrots, corn, and raisins) can be seen in the stool. This is normal.

Iron supplements

If a baby takes an iron supplement the stools might turn dark green or black. This is normal and not a concern.

This does not happen from the amount of iron in baby formula. All formula should have iron. It is an important nutrient for all babies and low iron formula is not recommended.

What’s important?

  • A term baby should gain about 15-30 grams per day after the first week of life until about 4 months of age.
  • Blood in the stool can be from swallowed blood (often from a crack in mother’s nipple), constipation, food allergy (usually cow’s milk protein), or infection and should be evaluated.
  • It is normal to have different shades of yellow, brown, and green stools.
  • A baby with a swollen (distended) abdomen and discomfort or a change in feeding patterns should be examined.
  • A baby should not have formed stools as long as they are on primarily breast milk or formula.
  • Poop should never be a shade of white (liver concerns), red (blood), or black -if not on iron supplements (digested blood).
  • Mucus in stool could be simply swallowed mucus but can be a sign of infection or food allergy.

Bumps, ridges, and soft spots on a baby’s head. When should you worry?

Parents often worry about lumps and bumps on a baby’s head unnecessarily. Babies normally have ridges and soft spots on their head for a while after birth. Many have a type of swollen gland that parents can feel when rubbing the head. All of this is normal.

Skull anatomy

Let’s begin with a brief overview of a baby’s head. We are born with many bones in our skull. This allows the head to be squeezed out of the birth canal as the bony plates move together or even overlap one another.

Infant skull bones
Infant skull bones

Sometimes you don’t really notice much with these bones, but other times they overlap one another noticeably after birth. When a baby has a lot of head distortion due to overlapping of skull bones, we call it molding. It can make the head look pointed – which is often called cone head.  It can also make the head look flat on one side.

The good news? Even really odd looking heads are usually normal. Molding tends to resolve without intervention over the first few days of life.

Soft spots

There are 1-2 “soft spots” at birth. Usually the one on top to the head (the anterior fontanelle) remains open enough to feel for the first 18-24 months of life. The one towards the back of the head (the posterior fontanelle) is unable to be felt by about 2 months of age. It is often so small at birth that it’s not recognized.

Many parents fear that touching a soft spot will somehow damage the baby’s brain. Normal touching won’t hurt, even from a 2 year old sibling. There are several layers of skin and other tissues protecting the brain.

Doctors will feel the soft spots during routine check ups to be sure they are the right size for the growth of the baby’s head. There’s a lot of variation here, so if you question the size of your baby’s soft spot, discuss it at a visit with the doctor. He or she will need to not only feel the soft spot, but also will look at overall head growth, baby’s development, and the shape of the head.

Bruises and bleeding

Coming out of the birth canal can be traumatic for both mother and baby (and often for fathers too). Sometimes babies have a big soft or squishy bump on one side of the head, which usually is essentially a large bruise.

Bruises can cause yellow jaundice.

Any bruise can increase the risk of yellow jaundice in a newborn, so your doctor might watch your baby more carefully for this over the time that the blood is resorbed. This is because yellow jaundice is caused by breakdown of blood cells. Most babies show yellow color in their eyes and face. Even if it progresses to their chest and abdomen it can usually self-resolve with proper hydration, but it should be monitored. If the level gets too high it can be managed. Talk to your doctor if you’re concerned.

Cephalohematoma vs caput saccedaneum.

The two most common types of bruising are cephalohematoma and caput saccedaneum.

A cephalohematoma develops when there is bleeding between the skull and the bone lining called periosteum. Since it is outside the skull, it doesn’t affect the baby’s brain. It covers only one of the bones, and never crosses one of the suture lines.

Caput succedaneum is swelling of the scalp in a newborn. It develops from bleeding one layer above the periosteum in the skin. It can cross the bone areas since it’s not limited by the lining of the bone (periosteum). You will notice a soft, puffy swelling on the baby’s scalp, usually in the area that first came out during birth. Some will show bruising.

Both of these conditions can lead to increased risk of yellow jaundice due to breakdown of the blood collections, but usually self resolve without complications. If baby seems uncomfortable due to this area, discuss with your hospital nurse or doctor.

The picture below attempts to show the layers of bleeding described here and includes more uncommon (and more concerning) types of bleeding. Babies who have deeper bleeds need proper medical management. For information about subgaleal hematoma, see Seattle Children‘s website. Epidural hematomas are very rare in newborns.

Scalp hematomas

 

Flat spots

Flat spots are common, especially if babies prefer to always look to one side. This can cause the forehead to seem to bulge on one side or an ear to appear closer to the face than the other ear. This is usually due to baby laying one direction most of the time, allowing the brain to grow all directions but spot baby is laying on.

Babies always need to sleep on their back until they start to roll on their own, but this can encourage a flat head. It’s important to get baby to lay looking right sometimes, left other times. Supervised tummy time is helpful too. I recommend starting tummy time on day one. The earlier you start tummy time the less they seem to hate it!

When you hold and feed baby, alternate arms because they will look toward you and by simply holding in the right arm sometimes, left arm other times, they will turn their head. If your baby resists turning his head, check out this Torticollis information.

Lymph nodes

One of the most common head worries that brings parents to the office is a pea-sized (or bigger) movable bump on the back of baby’s (or even an older child’s) head. This is usually an occipital lymph node.

Lymph nodes of the head and neck
Lymph nodes of the head and neck

When I say it’s just a lymph node, some parents automatically worry about lymphoma.

Don’t go there.

Most of us remember having a swollen lymph node (AKA swollen gland) under our jaw or in our neck when we are sick. When they develop on the back of the head, it is usually from something irritating the scalp, like a scalp probe during labor, cradle cap, or bug bites in older kids. They can remain large for quite a while (often seeming to come and go when kids have scalp irritations), but unless they hurt to touch, enlarge rapidly, are red and hot, or a child looks sick otherwise, I don’t worry about them.

TL:DR

In short, most lumps and bumps on your baby’s head are normal. If you’re worried, bring your baby in to have your pediatrician look and feel.

Bumps, ridges, and soft spots on a baby's head is often normal - but when should you worry?
Bumps, ridges, and soft spots on a baby’s head is often normal – but when should you worry?

Starting Solids

Many parents are excited yet apprehensive about starting solids with their infants. So many questions… so many fears. Many food introduction guidelines have changed in recent years. What you did with your older kids might not be following current recommendations.

Back in time

I first published a version of this in 2011, and I still hear so much confusion.  It was actually Dr. Phil Boucher’s blog Why Is Introducing Baby Foods So Complicated?? that made me recall my blog and look to see when I wrote it.

Sadly, despite the time lapse of over 5 years, the American Academy of Pediatrics continues to have what I feel is a confusing message. On one line they say a baby may be ready at 4 months, then they say about 6 months. No wonder parents are still confused!

Starting solids
https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Parenting is hard

Yes, there are things about parenting that are hard. Watching kids hurt. Letting kids make mistakes without coming to their rescue and knowing when it’s time to step in. Sleepless nights with crying infants and sick children.

But there are times that parents make it harder than it needs to be. Not only with feeding, but I think parental anxieties bring us to over think too much. (Yes, I’ve been guilty of this over the years too.)

The stay at home moms are made to feel guilty that they aren’t showing their kids an independent female role model. But the working moms have the guilt of missing milestones and other events.

We have the Mommy Wars about breastfeeding and formula. If you don’t breastfeed, you’re made to feel guilty. Unless you breastfeed too long, then you’re made to feel guilty. If you use formula… never mind. This isn’t really about the Mommy Wars.

We need to stop inventing things to be guilty about. Stop trying to perfect parenting and just enjoy the moments. (And for those moments you can’t enjoy yet, like the poop all over the wall… wait for it to become a funny story to embarrass the older version of your toddler.)

Feeding “Rules”

Old Rules for starting solids

The older “rules” for starting solids were so confusing… different sources will vary on these rules.

  • Don’t feed before 6 months
  • Don’t give nuts, eggs, and other “allergy” foods until ___ (2/3/5 years, varying by expert)
  • Don’t start more than one food every 3-5 days
  • Start with rice and other whole grain cereals, then add vegetables, then meat. Save fruit for last.

Variations of this were plenty, depending on the provider’s preferences.

No wonder there is so much confusion!!!!

New Rules for starting solids

New rules are much easier.  I like easier.

  • Start healthy new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy.

Any foods in any order.

Nothing too salted. Try nutritious foods, not junk.

Common sense (and your baby’s response) will hopefully guide types of foods.

Don't make starting solids with your baby too difficult. When they're ready give healthy foods and follow a few rules.

What about food allergies?

Research does not support the thought that starting foods earlier lead to allergies.

In fact, there is research to support that starting foods, specifically peanuts, earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases.

If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. There may be a risk to the person with the allergy if Baby shares saliva laden with the allergen, and Baby might be higher risk of having a reaction. Of course, early introduction might help to prevent your baby from developing an allergy, so it is complicated. Talk with your pediatrician and possibly an allergist if a close family relative is allergic to foods.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. Nuts are hard and round– two no-nos. Peanut butter is thick and sticky– another choking risk. I have a blog devoted to introducing peanuts safely.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food. Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent allergy.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods.

I tend to find that most babies prefer bland foods initially. Vegetables, meats, and whole grains are pretty bland. Babies are not used to strong flavors, so they don’t like fruits or fruit juices. (I don’t recommend juice.)

Saving fruit for last simply doesn’t seem to make a difference for long-term flavor preferences.

Fruits should be added after or along with other foods to give a balance of nutrition.

The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year…

Cow’s milk is not a meal in itself (like breast milk or formula). It’s missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. If they change to regular milk (whole, 2%, skim, organic or regular) they are at risk of nutritional deficiencies.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well-rounded diet as long as they don’t show any allergy risks to milk. If they have allergies to milk products, talk to your pediatrician.

Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so.

There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed.

Pureed meats (preferably from your refrigerator… baby food meats are not very palatable) are a great source of nutrition for baby!

Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we recognize symptoms of allergy?

I know so many parents who worry about allergies that they hesitate to start foods.

First, most kids are not allergic.

Second, introducing foods earlier helps prevent allergies, so when parents wait due to fear, they are increasing risk.

Allergy symptoms can vary and often are not specific
  • dry skin (eczema)
  • runny nose
  • hives
  • swelling of lips
  • difficulty breathing
  • vomiting
  • diarrhea
  • blood in the stool

If your child has one of these reactions we can test to see what the offender was. While testing is possible, it is not always recommended.

For possible food reactions that are mild, such as eczema or runny nose, schedule an appointment to discuss this with your doctor.

Significant reactions of anaphylaxis, such as lip swelling, extensive hives, or difficulty breathing are rare, but deserve immediate evaluation and treatment.

When’s the best time for starting solids?

This question has many variations… Will foods help baby sleep through the night? If we start foods before 6 months will it cause obesity or diabetes? Does starting wheat lead to gluten sensitivity?

It’s also one of the most difficult to answer because the American Academy of Pediatrics isn’t clear in their recommendation (as shown above). The American Academy of Allergy and Immunology is a bit more clear, but is not where pediatricians look for guidance primarily.

Your baby may be ready for starting solids if he/she:
  • is at least 4 months of age (in term babies, later in premature babies)
  • has the ability to sit with minimal support and hold their head up
  • shows interest in food by reaching for it and opening mouth as food approaches

You can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

Starting foods before 4 months is associated with obesity and diabetes. In formula fed babies the risk of obesity increases by 6 times at 3 years of age if foods are started before 4 months of age. That risk is not seen in exclusively breast-fed infants or those who begin foods after 4 months of age.

It is still an old wives’ tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods.

As they eat more food, they will need less breast milk or formula.  In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home-made foods?

This is a common question, but I think it’s the wrong question. Homemade and store-bought foods can be either nutritious or not nutritious. It’s more important that it’s a healthy food. In general healthy foods are fruits, vegetables, legumes, nuts, eggs, meats, and whole grains.

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home-made foods and often contain unhealthy additions, such as sugar.

I didn’t make baby foods when my kids were babies because I thought it would be too hard. As my kids got older, they started limiting vegetable  intake despite loving them when they were younger. I began to puree foods to put into recipes. It really isn’t hard.

Take whatever you’re cooking for your family and put the items in a food processor or blender before adding a lot of salt and spices. Add a little water, breast milk or formula to get it to a texture baby can eat. Voila! Home made food. There are of course many baby food cookbooks and online recipes. You can freeze meal-sized portions so you can make multiple meals at one sitting.

There is help for parents who want to safely prepare baby food at home on How to Make Your Own Baby Food from What to Expect.

Baby led weaning

Common questions about finger foods include:

  • My baby only wants table foods. Is that okay?
  • Don’t they need pureed foods first?
  • He doesn’t have many teeth! How can he eat foods?
What is baby led weaning?

Baby led weaning is a process of starting solids that allows babies to start finger foods and self feed.

There are many benefits to finger feeding. Babies use and develop fine motor skills while finger feeding. They can learn what the foods look like as they associate flavors and textures of various foods. You can also name the foods, so they learn vocabulary as they eat.

Baby needs to be willing and able

Pureed foods are what most babies start with due to the easy texture, but some babies want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

You don’t need to wait for teeth!

Most babies will be able to eat table foods between 6 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Minimize choking risks

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

Don’t overdo spices, sugar, and salt

Avoid giving the exact same foods as the rest of the family. Babies should have limited salt and spices. More on honey below…

Read labels to see how much sugar is in packaged foods. Don’t add extra sugar, honey, or agave to their foods. They don’t need things sweetened!

Let them enjoy the real flavors of foods.

Want more information?

For more on baby led weaning, check out Sarah Remmer, RD’s blog, Baby-Led Weaning: 5 Things You Need to Know Before You Start

How much juice should my baby drink?

I think babies don’t need juice at all. They can practice drinking from a cup with water.

Juice adds little nutritional value and a lot of sugar, even if there’s no added sugar. Eating fruit and drinking water is preferable.

See New Juice Guidelines for the current AAP juice recommendations.

What about organic? 

This is a fantastic question, but you’ll have to wait for the next post to see the answer. I have asked a fellow pediatrician, Dr. Nicole Keller, to help with this common question. Stay tuned. (It’s here!)

Be sure to sign up to receive new blog posts by email so you don’t miss the next post. This is easy to do under the “SUBSCRIBE TO BLOG VIA EMAIL” header. I promise to not overload your inbox or sell your information.

 

Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.

 

I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:

 

Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.



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Introducing Peanuts

For years I’ve been recommending peanut products to infants who are low risk for peanut allergy due to growing evidence that it’s beneficial.

What do studies show?

bamba, peanut
Bamba’s a popular snack in many areas of the world.

Studies have highlighted the benefit of early introduction of peanut product decreasing peanut allergy risk, so more parents are wanting to know exactly how to give a baby peanut products without increasing the choking risk.

The study was done using a product similar to Cheetos, made with peanut butter instead of cheese. Bamba is a snack food that has been sold in Israel for many years is now available in the US.

How can you safely give peanuts?

Parents can of course give a product like this, but what else can you do on a regular basis once your baby’s doctor clears him for peanuts?

Be careful of choking risks!

It’s important that your baby doesn’t get too much peanut butter or a chunk of nut itself because these are choking risks, so a nice thick slab of peanut butter just won’t work.

peanut allergy, feeding infantsSome ideas for introducing peanut products:
  • Look for peanut butter that doesn’t have added sugar – babies don’t need the sugar! I like the peanut powders that are available now, but I don’t think you need to spend the extra cash on the ones made just for babies.
  • Most kids love Cheerios (or other brand oat circle cereal). They do make a peanut butter flavor, made with real peanut butter. Again, look at labels to avoid cereals with high sugar content.
  • Add peanut butter powder or peanut butter to oatmeal – check the texture to be sure it isn’t too thick for your baby, add water, breast milk, or formula to thin it as needed.
  • Mix peanut butter  or peanut butter powder into applesauce (or other pureed fruits).
  • Add peanut butter or peanut butter powder to yogurt.
  • Make a peanut butter smoothie. There are many recipes online, but be sure yours doesn’t have honey if baby is under 12 months! If the recipe calls for milk, use your breast milk or formula for infants. Find one that is made with real foods, such as banana + milk + peanut butter. Babies don’t need chocolate or added sugars. If your baby doesn’t like it cold, use water instead of ice and don’t use frozen fruits.
  • Offer an occasional treat with peanut butter cookies. I like this recipe because it doesn’t have added sugar. You can leave out the raisins if your baby would choke on that texture.
  • Another occasional treat would be peanut butter muffins. Look for one without too much sugar and no honey. I couldn’t find one without any added sugar — if you do, please share below!
  • Put a thin layer of peanut butter on bread, cracker, or even your finger. You can add a little water to the peanut butter to thin it out if needed.
  • Chinese chicken with peanut sauce and other foods made with peanut butter sauces can be a treat for babies who can eat solid foods. The whole family can enjoy these meals!

Once you start peanut products, give the equivalent of 1 teaspoon peanut butter three times a week to help prevent peanut allergy!

Share your favorite recipes that can be adapted for babies and toddlers below.

related blog:

Peanut Allergy Prevention

Flat Heads in Babies

Babies often get misshapen heads from laying on one side or even from being squished while still inside mom. The misshapen head is referred to as plagiocephaly, scaphocephaly, or brachycephaly — depending on the overall shape (see photo under “Diagnosis” below).

 

These head shapes, especially plagiocephaly, are very common. If I knew I’d one day have a blog, I would have taken pictures showing the head shape of my child who had positional plagiocephaly. My baby is now a teen with a normal head shape, so it’s too late for photos.

Positional plagiocephaly

Below is a picture of a baby with positional plagiocephaly. Note the flat left back of the head. In this picture you can’t see the ears, but we look to see if the ear and forehead are pushed forward to help assess the severity of the plagiocephaly.

flat head, plagiocephaly
Flat heads in babies are common from laying on one side too often.

Photosource: By Gzzz via Wikimedia Commons

Below I’ll summarize the guidelines for the diagnosis of as well as treatment options for plagiocephaly with repositioning, physical therapy and helmets from the Joint Section on Pediatric Neurosurgery of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Diagnosis:

Most of the time we can make the diagnosis in the office without any special tests or x-rays. If there is a concern that one of the sutures (growth plates between the bones of the skull) is closed, a skull x-ray or an ultrasound of the area in question can assess if the suture is open or closed. If the diagnosis is still in question after those studies, a CT of the head may be needed. The picture below shows how the skull shape changes if one or more of the sutures is closed (represented by a missing line).

plagiocephalyPhoto source:By Xxjamesxx, via Wikimedia Commons Wikimedia

Treatments:

Reposition

The first treatment used to treat plagiocephaly is repositioning. Repositioning helps with all infants with positional plagiocephaly to some extent.

Repositioning is just what it sounds like: change the position of your baby so the side down alternates when sleeping or laying.

Put fun items to look at on alternating sides when baby is laying on the back when awake.

When feeding, hold baby in alternate arms so when they turn to face you they are looking different directions each feed. (This happens naturally when breastfeeding.)

Use supervised tummy time several times each day and hold baby upright as much as possible to get baby off the back of his head when not sleeping.

The American Academy of Pediatrics has issued a warning against the use of positioning pillows due to risk of suffocation.

Stretching and massage

A stiff neck often is associated with positional plagiocephaly because it limits head movement to one side. The stiff neck is called torticollis.

Torticollis makes it difficult for baby to turn his head to one side, but gentle stretching can help. I show parents how to hold one shoulder down while gently moving the head to stretch the neck – with each ear to the shoulder and then the chin to each shoulder.

It’s important to do a gentle but firm stretch, no jerking or forced movements.

Massaging the neck muscles first can help.

Think of what you do when you have a sore neck and want to stretch it. Working with a Physical Therapist has been shown to be more effective than repositioning alone and as effective as positioning devices (which are not recommended due to safety concerns).
Helmets

Babies with persistent moderate to severe plagiocephaly after repositioning and physical therapy may benefit from a helmet to mold the head to a round shape.

The helmet corrects more rapidly than positioning alone, so is also used if there is significant plagiocephaly in older infants.

I reserve this option for the more severe cases that don’t respond to repositioning and physical therapy since it is expensive and often not covered by insurance.

I don’t know if these recommendations will make it easier for insurance to pay for a helmet when indicated.


prevention is key!

We have significantly decreased the risk of SIDS by placing babies on their backs to sleep, but have seen a rise in flat heads due to their positioning. Prevention of the flatness involves several positioning strategies.

Supervised tummy time

Start supervised tummy time early on – the longer you wait to start, the more Baby might resist it. I see so many parents who are hesitant to put Baby on his or her stomach. Concerns range from the umbilical cord stump still being on and bothering the baby (it won’t) to spitting up will worsen (test it out, for many babies it’s actually better) to “I thought babies should never be on their stomachs” (only when sleeping or not supervised).

Tummy time is an important time for baby to develop muscle strength. It needs to be supervised, but it can be a fun time to interact with Baby. Lay face to face and talk to Baby, encouraging him or her to look up. Grab a brightly colored object and move it around for Baby to watch. Enjoy your play time.

tummy time, prevent flat heads
Supervise tummy time when Baby’s awake!
Back to sleep

It’s important for babies to sleep on their back, but they tend to have their head facing one direction or another. They should alternate which side they face, but many babies have a stiff neck and favor looking to one side. Think of when you wake with a stiff neck – probably from positioning overnight. Many babies are in the same position for quite awhile at the end of pregnancy – of course they’re stiff!

Massage & Stretch

If Baby’s neck is stiff, you can massage his or her neck and shoulder muscles gently. Slowly move the head right and left (chin to each shoulder) and side to side (ear to shoulder). Don’t quickly force the head movement, but think of what you do if you have a stiff and sore neck.

The more frequently you stretch it out, the better it feels, right? I recommend stretching Baby’s neck with each diaper change (before the change or after you wash your hands!) until it isn’t stiff for several days and Baby moves his or her head easily without your help.

For more:

See this American Academy of Pediatrics article on how to prevent flat heads in babies.



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Dry Skin

Dry skin is often called eczema or atopic dermatitis. Whatever you call it, it’s itchy and annoying! We see it year round for various reasons. Managing it can be tricky, but there are things to do to help.

Eczema’s Snowball effect

It’s really important to keep skin well hydrated or it tends to snowball. The dry skin is broken skin, which allows water to escape, which further dries it, which leads to more evaporation…. Broken skin is more likely to become secondarily infected, which leads to more problems….

Itching dry skin also contributes to its worsening by further damaging the skin and allowing more water to evaporate, so try to keep fingers from scratching! (I know this is easier said than done.)

Eczema is not simply dry skin. It can cause significant distress to infants and children. The itch from eczema can impair sleep. It can distract from learning at school. Children with eczema have higher rates of anxiety and depression.

Eczema’s a chronic condition

Eczema doesn’t simply go away with good treatment: it can come and go even with the best treatment. It can therefore be a serious problem for families.

Your goal with dry skin is to hydrate it as much as possible to repair the skin barrier. We don’t always think about skin as an organ (like the heart and liver), but it is. Its functions are to help keep us at a normal temperature, to keep stuff (such as bones, blood, and nerves) inside our bodies, and it helps to keep some things (such as germs) out of our bodies. When skin is excessively dry, there is inflammation and cracking. This keeps the skin from doing its job. We must try to get it back to normal so it can help keep the rest of our body healthy.

causes of eczema

Eczema can be from many factors.

  • There is a genetic component, so if a parent or sibling has eczema, it is common for other family members to have it.
  • It is often worsened by environment, both cold dry air and excessive heat.
  • Clothing can irritate some skin, depending on the fabric and the detergent left in the fibers.
  • Any scented lotions or soaps can also irritate skin. (Don’t be fooled that “baby” soaps and lotions are better for baby. I usually say to avoid any of the baby products because they’re often scented. They make them to sell them, not to be better for baby’s skin!)
  • Allergies can exacerbate eczema.
  • Saliva is very harsh on the skin. Drooling can cause problems around the mouth, chin, and chest. Thumb or finger suckers often have red, thick scaly areas on the preferred finger from the drying effects of saliva.

foods and eczema

Ankles, elbows, and knees are common sites for eczema in babies.

The latest AAP eczema guidelines downplay the need to alter foods to treat the skin. There are some kids who have true food allergies that manifest as atopic dermatitis (dry skin), but the large majority of kids do not. Restricting their diet can lead to nutritional deficiencies without any benefit. Talk to you doctor if you think a food might be exacerbating your child’s dry skin.

My tips for treating dry skin:

Avoid Soaps

Avoid exposures to soaps because they further damage skin. Non-soap cleansers that are fragrance free are much more mild on the skin.

Soaks

Soaking in bath water or in the shower can help hydrate the skin. After bathing the skin should be only briefly dried (remove large water droplets, but allow the skin to still be moist with water) and moisturizers (with or without steroids) must be applied immediately afterwards to prevent water from evaporating out of skin.

Moisturize

Creases of the elbows and knees are common areas affected by eczema.

Moisturizers should be hypoallergenic, fragrance free, and dye free.

A good place to review if a product is good is on the National Eczema Association website.

I really like the moisturizers with ceramide. This has been shown to help heal the skin barrier without steroids.

Use moisturizers at least twice per day, more often as needed on the really dry spots.

Petrolatum Jelly

After the moisturizer soaks into the skin, cover extremely dry spots with petrolatum jelly.

There are studies that show putting petrolatum jelly on infants at risk for eczema daily for the first 6 months of life will decrease their risk of developing eczema. This can save you money since petroleum jelly is pennies compared to the cost of good moisturizers.

steroids

Steroids can be used for flares. They are available in 7 different strength categories. The stronger the steroid, the less often it should be used.

Over the counter hydrocortisone is a very mild steroid and can be used twice a day with mild flares.

Stronger (prescription) steroids should be discussed with your doctor if the eczema is more severe, but they can be safe and effective when used appropriately.

Bleach

Yes, bleach. Like what you use in the laundry or in the swimming pool. The bleach is thought to kill superficial bacteria that contribute to the chronic condition.

Bleach baths have been shown to help in moderate to severe eczema. Add 2 ounces of bleach to the bath water and soak the body (not the face) for 20 minutes a few times a week.

Antihistamines

Oral antihistamines, such as zyrtec, allegra, or claritin (or any of their generics) can help control the itch.

I recommend the long acting antihistamines over the short acting ones, especially overnight, to avoid gaps in dosing leading to the itch/scratch cycle despite the fact that diphenhydramine (Benadryl) works a little better for a few hours. Avoid topical antihistamines due to variable absorption from disrupted skin.

Increase the humidity

Add water to the air during the dry months. If your air conditioner is running you shouldn’t need (or want) to add humidity. If your heat is on, you might have an attached humidifier, which is great. You can also buy a room humidifier or vaporizer to add water to the air. When there’s more water in the air, the skin will have less evaporation.

More water

Use wet water cloths on dry patches. This can help get a child through an itchy time with a cool compress. It also helps hydrate the skin.

Since it might remove the moisturizer, re-apply moisturizer when the wet cloth is removed.

Some kids benefit from wet wraps. This is time intensive, but very effective, so worth trying for more severe eczema patches.

Limit scratching

If your child just can’t stop itching, be sure nails are clipped to help avoid scratching.

Sleeping with socks or mittens helps the inadvertent scratching during sleep. Many kids remove these, so sewing an old pair of socks onto the arms of long sleeve PJs can help. (Don’t forget to put moisturizer on first!)

Remove saliva

If your child drools or sucks a finger, wipe the saliva off regularly and protect the skin with petrolatum jelly.

Oils

Putting oil, such as robathol bath oil, in the bath water can help hydrate the skin.

 

prescription medicines

At times prescription medicines are needed.
These can include steroids, immune modulators, and antibiotics.
If your doctor recommends them, don’t be afraid to use them. Many parents under utilize medical treatments out of fear of side effects.
Yes, there are risks to all medicines, but there are also risks to having eczema untreated.
Discuss fears with your doctor to come up with a good plan that you both agree with. Don’t just not use the prescriptions.

get control!

Get control of your child’s eczema. If you can’t seem to do it alone, schedule an appointment with your pediatrician to see what else can be done.

For more information, see the American Academy of Pediatrics clinical report on eczema management and the American Academy of Dermatology’s Guidelines.

Products that I recommend

I only recommend products that I would recommend regardless of where you purchase, but if you use these links I will get a small fee for the referral. They should all be available at local stores too. They are in no particular order.

 

Help! I’m sick and I have a baby at home.

When we have newborns we don’t want them exposed to germs. We avoid large crowds, especially during the sick season. We won’t let anyone who hasn’t washed their hands hold our precious baby. We might even wash our hands until they crack and bleed.

infection precautionsBut what happens when Mom or Dad gets sick? What about older siblings? How can we prevent Baby from getting sick if there are germs in the house?

In most circumstances it is not possible for the primary caretaker to be completely isolated from a baby, but there are things you can do to help prevent Baby from getting sick.

Wash

Wash hands frequently, especially after touching your face, blowing your nose, eating, using common items (phone, money, etc) and toileting.

Wash Baby’s hands after diaper changes too. Make this a habit even when you’re not sick… you never know when you’re shedding those first germs!

Wipe down surfaces

Viruses that cause the common cold, flu, and vomiting and diarrhea can live on surfaces longer than many expect.

Clean the surfaces of commonly touched things such as doorknobs; handles to drawers, cabinets, and the refrigerator; phones; and money frequently when there is illness in the area.

Avoid touching your face

Avoid touching your eyes, nose and mouth – these are the “doors” germs use to get in and out of your body.

Pay attention to how often you do this. Most people touch their face many times a day. This contributes to getting sick.

Kiss the top of the head

Resist kissing Baby on the face, hands, and feet.

I know they’re cute and you love to give kisses, but putting germs around their eyes, nose, and mouth allows the germs to get in. They put their hands and feet in their mouth, so those need to stay clean too.

Cover your cough

I often recommend that people cover coughs and sneezes with their elbow to avoid getting germs on their hands and reduce the risk of spreading those germs.

When you’re responsible for a baby, the baby’s head is often in your elbow, so I don’t recommend this trick for caretakers of babies. Cover the cough or sneeze with your hands and then wash them with soap and water or use a hand sanitizer if soap and water aren’t available.

Vaccinate

If you’re vaccinated against influenza, whooping cough, and other vaccine preventable diseases, you’re less likely to bring those germs home. Encourage everyone around your baby to be vaccinated.

If you get your recommended Tdap and seasonal flu vaccine while pregnant, Baby benefits from passive immunity.

See Passive Immunity 101: Will Breast Milk Protect My Baby From Getting Sick? by Jody Segrave-Daly, RN, MS, IBCLC to better understand passive immunity.

Breastfeed

Breastfeed or give expressed breast milk if possible.

Mothers frequently fear that breastfeeding while sick isn’t good for Baby. The opposite is true – it’s very helpful to pass on fighter cells against the germs!

Again see Jody Segrave-Daly’s blog for wonderful explanation of how breast milk protects our babies.

Limit contact as much as possible

If possible, keep Baby in a separate area away from sick family members.

Wash hands after leaving the area of sick people.

If the primary caretaker is sick and there is no one available to help, wear a mask and wash hands after touching anything that might be contaminated.

Smoke-free

Insist on a smoke-free home and car.

Even if someone is smoking (or vaping) in another room or at another time, Baby can be exposed to the airborne particles that irritate airways and increase mucus production.

These toxic particles remain in a room or car long after smoking has stopped. If you must smoke or vape, go outdoors.

Change your shirt (or remove a coat) and wash your hands before holding Baby.

Final thoughts to avoid exposing Baby

It’s never easy being sick, and being a parent adds to the level of difficulty because you not only have to care for yourself, but someone else depends on you too.

As with everything, you must take care of yourself before you can help others.

Drink plenty of water and get rest!

Most of the time medicines don’t help us get better, since there aren’t great medicines for the common cold. Talk to your doctor to see if you might need anything.

Don’t be falsely reassured that you aren’t contagious if you’re on an antibiotic for a cough or cold. If you have a virus (which causes most cough and colds) the antibiotic does nothing.

You need to be vigilant against sharing the germs!

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7 Vitamin K Myths Busted

Social media has allowed the sharing of misinformation about many things, especially medically related things. When the specifics of something are unknown to a person, pretty much anything that’s said can sound reasonable, so people believe what they hear. This happens with many things, such as vaccine risks, chelation, and vitamin K. I want to tackle 7 Vitamin K Myths.

Refusing Vitamin K

I am especially frustrated when parents refuse to give their newborns vitamin K after birth. Since 1961, the American Academy of Pediatrics has recommended giving every newborn a single shot of vitamin K given at birth. This is a life saving treatment to prevent bleeding.

Life.

Saving.

Life saving.

Vitamin K works to help our blood clot. Insufficient levels can lead to bleeding in the brain or other vital organs. Vitamin K deficiency bleeding or VKDB, can occur any time in the first 6 months of life. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classical and late. Unfortunately there are usually no warning signs that a baby will have significant bleeding, so when the bleeding happens, it’s too late to do anything about it. Why parents don’t want to give this preventative life saving treatment is usually based on incorrect information.

This is a matter of a fairly low risk of bleeding if you don’t give vitamin K: 250-1700 per 100,000 within the first week, and 4-7 per 100,000 between 2 and 12 weeks. You might notice that the number is variable – it’s hard to study since the large majority of babies have gotten vitamin K over the years and the risk is low even without vitamin K. However, when there is bleeding it has significant consequences: lifelong disability or death. And we also know that there’s very low risk from the vitamin K and it works very well to prevent bleeding. So why take the chance of not giving it?

Conspiracy Theories, Misunderstandings, and Science

This is not a governmental conspiracy to somehow kill children. It’s a world wide attempt to help children survive and thrive.

The World Health Organization (WHO) guidelines:

All newborns should be given 1 mg of vitamin K intramuscularly [IM] after birth [after the first hour during which the infant should be in skin-to-skin contact with the mother and breastfeeding should be initiated]. (Strong recommendation, moderate quality evidence)

Science is hard to understand

Most people look at scientific information and can’t make heads or tails of what it means.

Photo Source: Hemorrhagic Disease of the Newborn

That coupled with the fact that things we read that make us react emotionally (such as fear that something will harm our child) makes us remember and associate with the information that created the emotion, whether it is right or wrong. This can lead parents to make dangerous decisions for their children while trying to do the right thing.

Myth Busting

I’m going to attempt to de-bunk the most common concerns I’ve heard because the best way to combat misinformation is to help explain the facts as we know them.

1. If every baby’s born with too little vitamin K, that’s the way we’re supposed to be.

Babies are born with very little vitamin K in their body. If they don’t get it with a shot, they need to either eat it or make it. Breast milk has very little vitamin K and babies won’t be eating leafy greens for quite awhile. Formula does have it, but it takes several days for vitamin K to rise to protective levels with formula and the highest risk of bleeding is during that first week of life. (Of course if you’re using this argument because you want babies to be all natural, you probably won’t be giving formula at this point.)

Bacteria help us make vitamin K, but babies aren’t colonized at birth with these gut bacteria.

Just because they’re born that way doesn’t mean they’re supposed to stay that way. Inside the mother the baby is in a very different situation. They don’t breathe air. A fetus doesn’t eat. They don’t have gut bacteria. Their heart has a bypass tract to avoid pumping blood to the lungs. This all works well in utero, but must change once they leave the womb. Change takes time, and during this time they are at risk. Why not minimize the risk if we know a safe way to do it?

2. The package insert has a big warning at the top that it can kill.

There are many reasons why we should not use the package insert of a medicine or vaccine to make healthcare decisions. These have been discussed before so I won’t go into all the details but please see these great blogs on how to read and use package inserts:

It is true that there is a black box warning on the top of the vitamin K package insert. This has scared some parents from wanting to get the vitamin K shot for their newborn.

Screen Shot from Package Insert 

Reactions to IV (intravenous) vitamin K are much more common than IM (intramuscular) injections. The difference is anything given by IV goes directly into the bloodstream and back to the heart. But we don’t give vitamin K by IV to newborns.

IM injections go into the muscle, allowing very slow absorption of the medicine. This not only decreases reactions to the injected vitamin, but also helps the level of vitamin K stay elevated for a prolonged time after a single injection.

I only found one report of a newborn with a significant reaction to vitamin K. The authors of the paper did note that IM vitamin K has been given for many years to babies all over the world without significant reactions and could not explain why the one infant had such a significant reaction.

Since we must always look at risk vs benefit, the very, very low risk of a serious reaction from receiving vitamin K IM is preferable to the benefit of the prevention of VKDB.

Another great resource on this topic is Dr. Vincent Iannelli’s That Black Box Warning on Vitamin K Shots. He doesn’t want you to skip the Vitamin K shot either.

3. Vitamin K causes cancer.

Many years ago there was a small study that suggested vitamin K led to childhood cancers. This issue has been extensively studied since then and no link has been found.

Vitamin K does not cause cancer.

Rates of cancer have not increased in the years since vitamin K has been given to the large majority of newborns worldwide. This is reported in the Vitamin K Ad Hoc Task Force of the American Academy of Pediatrics report Controversies Concerning Vitamin K and the Newborn.

4. Bleeding from vitamin K deficiency is rare or mild.

In the US bleeding from vitamin K deficiency is rare because most babies get the vitamin K shot soon after birth. In countries where vitamin K is not used routinely, bleeding is not rare at all. Some communities of the US where vitamin K is being refused by parents are seeing an increase in newborn bleeding.

Early VKDB occurs within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs which inhibit vitamin K. These drugs include anticonvulsants, anti-tuberculosis drugs, some antibiotics (cephalosporins) and blood thinners to prevent clots. Early VKDB is typically severe bleeding in the brain or gut.

Classic VKDB typically occurs during the first week of life. The incidence of classic VKDB ranges from 0.25-1.7 cases per 100 births.

Late onset VKDB occurs between 2 and 12 weeks usually, but is possible up to 6 months after birth. Late VKDB has fallen from 4.4-7.2 cases per 100,000 births to 1.4-6.4 cases per 100,000 births in reports from Asia and Europe after routine prophylaxis was started.

One out of five babies with VKDB dies.

Of the infants who have late VKDB, about half have bleeding into their brains, which can lead to permanent brain damage if they survive. Others bleed in their stomach or intestines, or other vital organs. Many need blood transfusions or surgeries to help correct the problems from the bleeding.

5. It’s just as good to use oral vitamin K.

Early onset VKDB is prevented well with the oral vitamin K in countries that have oral vitamin K available, but late onset VKDB is an issue.

Children with liver or gall bladder problems will not absorb oral vitamin K well. These problems might be undiagnosed early in life, putting these kids at risk for VKDB if they are on an oral vitamin K regimen.

Getting the oral form isn’t easy

There is no liquid form of vitamin K that is proven to be effective for babies in the US.

That is a huge issue.

Some families will order vitamin K online, but it’s not guaranteed to be safe or even what it claims to be. This is an unregulated industry. It is possible to use the vitamin K solution that is typically given intramuscularly by mouth, but this requires a prescription and the taste is questionable, so baby might not take the full dose.

It would be an off-label use so physicians might not feel comfortable writing a prescription. The other issue that might worry physicians is with compliance in remembering to give the oral vitamin K as directed, since most studies include babies with late onset bleeding who had missed doses.

Vitamin K in food

Most of us get vitamin K from gut bacteria and eating leafy green vegetables.

Newborns don’t have the gut bacteria established yet so they won’t make any vitamin K themselves. They may get vitamin K through their diet, but breastmilk is very low in vitamin K. Unless baby is getting formula, they will not get enough vitamin K without a supplement.

It is possible for mothers who breastfeed to increase their vitamin K intake to increase the amount in breast milk, but not to sufficient levels to protect the baby without additional vitamin K.

What do other countries do?

Many countries that have used an oral vitamin K protocol, such as Denmark and Holland, have changed to an intramuscular regimen because the oral vitamin K that was previously used became no longer available.

There are various oral vitamin K dosing strategies that can be reviewed in the linked abstract.

  •  Australia and Germany: 3 oral doses of 1 mg vitamin K are less effective than a single IM vitamin K dose. (In 1994 Australia changed to a single IM dose and their rate went to zero after the change.)
  • Netherlands: A 1mg oral dose after birth followed by a daily oral dose of 25 mcg vitamin K1 may be as effective as parenteral vitamin K prophylaxis.
  • Sweden: (a later study) 2 mg of mixed micellar VK given orally at birth, 4 days, and 1 month has a failure rate of one case of early and four cases of late VKDB out of 458,184 babies. Of the failures, 4 had an undiagnosed liver issue, one baby’s parents forgot the last dose.
Oral Vitamin K vs injectable (IM) Vitamin K

When vitamin K is given IM, the chance of late VKDB is near zero.

Oral vitamin K simply doesn’t prevent both early and late bleeding as well. This is especially true if there is an unknown malabsorption disorder, regardless of which dosing regimen is used.

6. My baby’s birth was not traumatic, so he doesn’t need the vitamin K.

Birth trauma can certainly lead to bleeding, but the absence of trauma does not exclude it.

Late vitamin K deficient bleeding (VKDB) cannot be explained by any birth traumas since they can occur months later.

7. We’re delaying cord clamping to help prevent anemia and bleeding. Isn’t that enough?

Delayed cord clamping can have benefits, but decreasing the risk of bleeding is not one of them.

There is very little vitamin K in the placenta or newborn. Delaying the cord clamping cannot allow more vitamin K into the baby.

Still not convinced?

Read stories about babies whose parents chose to not give vitamin K:

For More Information:

Evidence on: The Vitamin K Shot in Newborns (Evidenced Based Birth)