2 May 2017

Preventing “Flat Head” in Infants

Megan Muscia, D.O.

Megan Muscia, D.O.

Every day I spend a good portion of my day examining babies head shapes and sizes. In recent years, as pediatricians, we have seen an increase in flattened heads. The biggest reason there is an increase in head flattening is due to the recommendation for babies to sleep on their backs. Most of the time the issue is relatively minor, but plagiocephaly (flat heads) can cause some cosmetic issues and be signs of developmental delays, so it is something I pay close attention to.

This head flattening from laying on the back is called positional plagiocephaly. Early in life the skull is very malleable and susceptible to pressures applied to it. Because of this, we see plagiocephaly during the first few months of life when babies spend a lot of time on their backs and that pressure causes a flattening of the infant’s head. There can be a symmetric flattening across the entire skull. Sometimes we may also see it just on one side of the skull, especially when an infant has a preference to look one direction more than another which can be due to a muscle imbalance in the neck called Torticollis. If you think you are noticing a flattening or abnormal shape of your child’s head, it is important to discuss it with your pediatrician. They can decide if they think it is related to positioning of your child’s head, or if it could be related to another process causing abnormal shapes or growth of your child’s head.

How can you prevent this flattening from happening or getting worse? The most important thing you can do is alternate your child’s head position. If you start doing these things early on you will likely be able to prevent the positional flattening that can occur over time.

  • Tummy time – lots of it; early on chest to chest time counts, as your baby gets older tummy time is very important. It gives the skull a break from the pressures put on the back of the head while lying flat.
  • Alternate the arms you hold your baby in during feedings. Breastfeeding naturally does this because the baby feeds from both breasts and you have to alternate arms to feed the baby. When bottle feeding a baby, it is easy to use your dominant arm to hold the baby every feeding. Be sure to alternate arms when feeding.
  • Alternate the end of the crib/bassinet you place your baby’s head. Each time you lay your baby down to sleep (on their back) alternate which end of the bed you put your baby’s head.
  • Hold your baby more – limit time spent in car seats, swings, strollers where your baby’s head is laying on a flat surface. If you are going to be out running errands for several hours, be sure to take your baby out of the car seat to give the head a break from lying flat all day.

While these techniques may not prevent all types of plagiocephaly, it will help diminish the severity. Sometimes infants do need treatments such as physical therapy and occasionally helmets can be used to treat plagiocephaly as well. If you have any concerns about the shape of your baby’s head, please discuss it with your pediatrician at your baby’s next checkup.

1 Feb 2017

Second child…we get it!

Megan Muscia, D.O.

Megan Muscia, D.O.

I had my second child about five months ago and have now returned to my life as a working mom. Once again, being the parent of a newborn is a humbling experience. It reminds me that every baby is different. It reminds me what I thought I had figured out about parenting one child has been turned upside down in trying to parent two kids. So to all the new parents out there, I get it and I agree, it’s really, really hard. You would think as a pediatrician I would have all the answers and my kids would never have tantrums and parenting would be easy. Well, I promise you, I have a lot of pediatrician parent friends and all of us agree, we are not perfect parents and we still have a lot to learn! Sure, I know what to look for to make sure my baby is developing well, and I know when they should start solid foods or remain rear-facing in a car seat, but that doesn’t mean I don’t understand that it’s hard to follow what may seem like impossible recommendations sometimes.

With my second baby I realized how much more tired I was especially for my middle of the night feedings.  How much I would have loved to snuggle up with my baby and not put her in her bassinet to sleep. I get it, you are sleep deprived and sometimes may feel like you are barely hanging on. Despite how much I understand your desire to want to co-sleep with your baby because you both sleep better; I just can’t tell you it’s ok. The thought of potential suffocation from co-sleeping terrifies me. I know you would never forgive yourself if something happened to your baby, and I could never forgive myself if I told you it was ok.

I told my husband I hate being a pediatrician in winter because I feel like I spend a lot of time telling families there is nothing I can do to help their child’s cough or illness. So many illnesses this time of year are viruses and there aren’t any medications that will speed up the healing process or stop their coughing. I too have had a kid with ear infections and nights where my daughter has been up several times a night coughing and puking and there is nothing I can do to help. I am in the trenches with you, I get it. Trust me, if I had a secret weapon I would give it to you!

I think the reason I wanted to write this so badly is that I know it can seem lonely as a parent, like no one is going through what you are going through. I do realize how hard it can be to follow some of the recommendations I discuss at our visits. When I discuss limiting screen time, I get it that its hard. Sometimes you need 30 minutes to take a shower or get dinner on the table or get ready for work. I too struggle with this issue. I know that it seems like your kid’s legs are scrunched up in that rear facing car seat and it’s hard to get them in and out of the car as they get bigger. I too have a hard time squishing my daughter in her car seat. I recommend these things because I truly care about your child. I take it very seriously that I do everything I can to protect your child. To protect them from preventable, potentially life threatening illnesses with vaccines; to protect them from preventable injuries by telling your kids to wear a helmet when riding a bike; to protect them from sexually transmitted diseases by discussing sexuality with them as a teen.

So while I know it may seem like whoever wrote the recommendations I give to you at every visit clearly didn’t have children, I want you to know, I do, and most of them probably do too.  As pediatricians, we know parenting is hard, we know there is no such thing as a perfect parent, and it may not be possible to follow every recommendation perfectly.  We know parenting is a struggle. This is not to say it doesn’t have a lot of amazing times as well, but when you are a sleep deprived parent of a newborn, or sitting through an epic temper tantrum, or dealing with a teenager who is too cool for their parents, just know we get it, and we are with you.

Safe Sleep – Getting babies to bed

Megan Muscia, D.O.

Megan Muscia, D.O.

One of the most common questions I get asked about as a pediatrician is infant sleep. Infant and childhood sleep is a huge topic and there are lots of books about it. I am going to focus on just one aspect of sleep though — getting your baby to sleep in their crib or bassinet. I am by no means a sleep guru, but I hope some of these tips will help many of you and your baby get a better night sleep.

“My two-week old will fall asleep in by arms, but as soon as I put him down in the crib he wakes up!”

First, let me say this is so common in the newborn and infant period. If you are experiencing this, you are not alone! As a pediatrician I know this is hard for any parent, but it is extremely important topic for me. When babies don’t sleep in their own beds, it may lead to unsafe sleep practices such as co-sleeping. Even if only by accident, holding your child to get them to sleep and being a sleep deprived mom or dad can lead to accidents if you fall asleep while holding your child. For all of these reasons, I really encourage you to continue to work on getting your child to sleep in their own crib or bassinet. We know it is the safest place for your baby to sleep.

1) Try “swaddling” him—wrapping him snuggly in a blanket—which can be very soothing. Lots of parents tell me their baby doesn’t like to be swaddled because they want their hands out. You can swaddle with the hands up to allow your baby to be able to get to their hands to suck on them. Being wrapped still gives the baby that warm secure feeling they felt in the womb.

2) Stay with him and rock him, sing, or stroke his face or hand until he settles down. At this age babies can’t soothe themselves, so they still depend on us.baby asian girl

3) Put your baby down drowsy but not fully asleep and then use some of the methods above while keeping your hand on them and “shush” them can help them transition into sleep.

4) Spend time in your baby’s room so they are familiar with their surroundings. Play and read in their room.

5) Start with putting your baby in their crib or bassinet at nap time, then continue to work toward night time. Nighttime sleep is often the more difficult transition. Making these changes in small increments, while making these transitions warm and nurturing experiences, will help your baby learn to connect her room with cozy, safe feelings.

6) If you are transitioning from bassinet to crib, move the bassinet into the bedroom first and try a few nights in with the bassinet in the room before then moving your baby to the crib.

7) Start a nighttime routine. Its never too early to start a nightly routine, bath, dim lights, reading to your baby, snuggle time. This night time routine can calm your baby and prepare them for sleep.

Most of all, it takes time for babies to learn to fall asleep on their own. Helping your child start to soothe themselves during the daytime will help him calm himself at night when you put him down. So, be patient, seek out help when you need it, and remember that these early days and months don’t last forever. I think as with any advice I give parents, consistency is key! Keep working on it, little by little, it will work.

For more information regarding infant and childhood sleep challenges, please see the Zero to Three website.

 

Food Fights – Satisfying Picky Eaters

Megan Muscia, D.O.

Megan Muscia, D.O.

I often have moms tell me their kid is picky or they can’t get them to eat their vegetables. Getting kids to eat healthy is really hard these days.  Picky eaters become the center of the meal.  We start pleading with our children – “just one more carrot,” “are you sure you don’t want more?,” “you can’t have this until you eat your vegetables.”

Most kids start becoming “picky” when they are toddlers.  This is the developmental age where they want to become independent, and one thing they have control over is what they put in their mouth! Also, it is important to know that it takes time for children to develop and acquire tastes for foods.  Research has shown that it can take 10 to 15 offerings of a food before a child will acquire a taste for a new food.  How many people continue to offer foods that many times after their child has refused it?  Thus, it is important to keep offering a wide variety of foods even if your child didn’t eat much of it the first few times you gave it to them.  Can you remember a food you didn’t like as a child but now you do?  I do.  I hated mustard, tomatoes, and quiche, all things I love to eat now.  How did it happen that I now love them?  I kept trying them.  Most foods if you try them enough you start to like them.  Parents, this is the name of the game, keep giving a wide variety of foods to your kids.  Eventually they will become familiar with new foods and even start to like them.

Here are a few other tips and tricks to avoiding mealtime wars:

  • You provide, they decide: Respect that your child knows when he or she is hungry.  If they only eat a little for dinner that day and they say they are done, that is ok.  Respect their ability and NEED to understand their own satiety cues.
  • Routine, routine, routine: Try to eat the same time every day.  Children especially toddlers and young kids need routine and they depend on it.
  • Don’t let your child graze: Almost everywhere I go I see kids with sippy cups and snacks in their hands.  If you are going to provide a cup to your child between meals only offer water.  Filling up on milk, juice or snack foods between meals can make children less hungry for food served at mealtime.
  • Continue to offer a wide variety of foods: Its important to talk with your child about the color and texture of food and show them that we enjoy eating these foods too.picky eater
  • Make it fun: If your child doesn’t try a food or like it the first time, offer it in a new way the next time. Incorporate it into a soup or mash it, or cut it into fun shapes (use cookie cutters). Serve it with a food that your child likes or is familiar with such as mac & cheese, or add veggies to pizza or pasta. Make smoothies with vegetables and fruit.
  • Include your child in the meal planning and cooking: Ask your child which foods they want to eat at the grocery store, have them pick a meal when planning your weekly meals.  Offer age appropriate tasks for helping in the kitchen with cooking.  They can mix or set the table.  Our daughter loves to pretend she’s cooking while we cook, so we give her a bowl and spoon and let her pretend to mix stuff.
  • Lead by example: We can’t expect our children to eat healthy if we don’t do it ourselves!
  • Don’t buy foods you don’t want them to eat: If you don’t want them to eat goldfish or cookies or chips don’t buy them. Out of sight out of mind will work for kids!
  • Make the dinner table technology free time: It’s important to sit down and have dinner as a family if possible, but at minimum no cell phones, tablets, TVs.  Distractions can make it easy for children not to complete the task at hand.
  • Food is for nourishment, not a reward or punishment:Don’t withhold dessert if your child doesn’t finish their meal or as a form of discipline. Consider only offering dessert 1 to 2 times a week and other days don’t eat dessert.
  • Offer veggies/fruits first: Children are most hungry when they first sit down to eat, take advantage of that and offer these foods first.
  • Don’t be a short order cook: Making a meal specifically for your child will only encourage the picky eater behavior.  Try to incorporate something you know your child likes into each meal. It is important your child stay at the table even if they are done eating.

For more information and references about picky eaters, please refer to these sites. If you are concerned that your child’s picky behavior is affecting their growth, please speak to your child’s doctor.

http://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art-20044948

https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Picky-Eaters.aspx

http://www.zerotothree.org/child-development/health-nutrition/how-to-handle-picky-eaters.html?referrer=https://www.google.com/

The Value of Story Time

Megan Muscia, D.O.

Megan Muscia, D.O.

Hi everyone! I want to take a minute to introduce myself and tell you how excited I am to be joining Rush-Copley Medical Group! I am thrilled and honored to care for children in this community.

First, a little bit about myself. I went to college and medical school at Michigan State University (Go Spartans!) I am originally from the Chicago suburbs and I am lucky to have my whole family nearby. I am married and a mom of a very busy 18-month-old little girl.

Being a parent has made more of an impact on me being a pediatrician than being a pediatrician has ever improved my ability to be a mom. It has definitely helped me understand how hard all my patients’ parents are working! I hope you also know that I can empathize with all of you going through the newborn period, sleepless nights, and/or temper tantrums, because I have been there too. I also can say that while I have this experience, I am still trying to figure out parenthood just as much as everyone else! There is no “one size fits all” or perfect parent solution. As parents we can only do our best, and the best we can do for our children is to love them. The advice and recommendations you receive from friends, family and even your pediatrician can feel overwhelming to try and follow. I hope the advice given here can be simple and maybe answer a few questions about why we pediatricians recommend what we do.

In the office sometimes its hard to delve into all they ways you may spend time with your child, but as a parent quality time spent with your child is one of the most important things you can do for your child. It is a way to show your love for them and for them to develop a true sense of security. One of the best ways you can spend quality time with your child each day is reading to them.

In 2014, the American Academy of Pediatrics (AAP) recommended that parents should read to their child every day starting from birth. Recent studies have shown that children, who were read to, especially prior to starting school, have stronger parent-child relationships and have stronger language and literacy skills. Reading aloud with young children is one of the most effective ways to expose them to enriched language and to encourage specific early literacy skills needed to promote school readiness. I know sometimes it can feel silly reading to a 6 week old, but your baby is listening. We live in a world dominated by cell phones, tablets, TVs and computer screens. It is incredibly important to take time each day to “unplug” and read to your child, or as they get older have them read to you.

family with baby read book 2

Here are a few tips from the AAP on ways to help your child learn to love reading:

  • Read to your child every day — even if only for a few minutes. It is your time together.
  • Reading should be fun. You don’t have to finish a story if your child loses interest.
  • Let your child choose the book even if it means reading the same book over and over.
  • Invite your child to “read” to you from a familiar book that he has memorized from having heard it so often read to him.
  • Stop and ask about the illustrations or what your child thinks will happen next. The answers may amaze you.
  • Read from a variety of children’s books, including fairy tales, poetry, and nursery rhymes.
  • Follow your child’s interests in choosing the books. There are many great books on non-fiction subjects such as the ocean or dogs.
  • Join your local library!

I hope this post inspires you to spend some time reading with your child!

Here are some of our favorite books right now, and some websites you can look at if you want more information about reading to your child.

  • Brown Bear, Brown Bear by Bill Martin Jr. and Eric Carle
  • Chicka Chicka Boom Boom by Bill Martin Jr.
  • Hello Ninja by N.D. Wilson
  • The Very Hungry Caterpillar by Eric Carle
  • The Little Blue Truck by Alice Schertie and Jill McElmurry
  • Toot by Leslie Patricelli
  • Any book by Sandra Boyton

Happy Reading!


Resources:

Healthy Children.org

https://healthychildren.org/English/ages-stages/gradeschool/school/Pages/Help-Your-Child-Enjoy-Reading-Aloud-Tips-for-Parents.aspx

AAP Policy Statement:http://pediatrics.aappublications.org/content/134/2/404.full.pdf+html?sid=424738e8-f654-4940-a408-48b03a3687db