AAP New Safe Sleep Recommendations

Vrinda Kumar, M.D.

Vrinda Kumar, M.D.

Approximately 3,500 infants die each year in the United States from sleep-related infant deaths, including SIDS, deaths without a certain cause, and accidental choking/strangulation.

Just last week, the American Academy of Pediatrics (AAP) released new “safe sleep” recommendations to protect against SIDS (sudden infant death syndrome). These are the first updates to the recommendations since 2011. SIDS is an otherwise unexplained death of a child. The risk and incidence of SIDS is highest at 6 months of age and under, but can be seen in older infants and young toddlers as well.  Even though many SIDS deaths are often unexplainable and have no obvious cause, we do know that unsafe sleeping habits can contribute to SIDS.

The new recommendation still includes some of the older recommendations, including “back to sleep” (putting children to sleep on their backs), no co-sleeping, no soft bedding/bumpers/blankets/or other items in the bed. Babies should sleep on a firm mattress made for infants/toddlers.)

However, the recent recommendations to decrease the risk of SIDS in children also include:

  • Share a bedroom with parents, but not the same sleeping surface, preferably until the child turns 1, but at least for the first 6 months. Room sharing decreased the risk of SIDS by as much as 50 percent.
  • Fully vaccinate child according to CDC guidelines.

The older recommendations have not changed and still apply:

  • Avoid baby’s exposure to smoke, alcohol, and illicit drugs
  • Back to sleep
  • Use a firm sleep surface
  • Breastfeeding is recommended
  • Keep soft bedding and loose bedding away from sleep area
  • Consider offering a pacifier at nap time and bedtime
  • Avoid head covering and overheating
  • Avoid positioners and wedges (and choking hazards like teething necklaces!)
  • Do not use home cardio respiratory monitoring devices as a strategy to prevent SIDS. They have not been shown to decrease risk of SIDS.
  • There is no evidence that swaddling decreased risk of SIDS.

It is important to understand that some deaths are not preventable, even if all the above guidelines are followed. However, following these decreases the chances of a SIDS death and should be followed, despite media and commercial advertisements which may potentially promote other environments which are not consistent with AAP recommendations.

Learn more about safe sleep at http://tinyurl.com/zmf5els.

Flaming Hot No-No’s!

Vrinda Kumar, M.D.

Vrinda Kumar, M.D.

Crunchy junk foods have always been tempting “treats” among young and old alike, and let’s be honest…we all indulge every now and then even though we know that these processed, fried, crunchy snacks are terrible for us. Over the past few years, however, there has been an evolution of this genre of foods that now involves the “Flamin’ Hot” flavors and other “flaming” or “spicy” flavors of cheese puffs, potato chips and even popcorn.

It turns out that these savory snacks may be the WORST of the worst snack foods, especially for our children. These spicy snacks contain cayenne powder in addition to the usual offenders found in crunchy junk foods (sodium, fat, oil, preservatives).

The spicy heat (cayenne) in these snacks release endorphins in the body, which are the same substances released by the body in response to exercise or in response to basically anything that makes the body feel good or makes us feel “warm and fuzzy.” Fatty/greasy foods do the same (which is why “comfort foods” are exactly that, ”comforting” and most of these tend to be unhealthy as well). When something causes the body to release endorphins, the body wants more of that thing. So, in turn, these fatty, fried, salty, spicy foods become ADDICTIVE.

Flamin’ Hot snacks are fried, salty, and spicy, so these tend to be REALLY addictive. The fact that these snacks are mostly fried, they can lead to significant weight gain quickly. The high sodium in these snacks can lead to high blood pressure, especially in children. The spice can cause stomach pain and gut irritation. Not only can this dangerous trifecta of fat, spice, and sodium cause/worsen symptoms of indigestion (acid reflux), but eating enough of these can cause gastritis (inflammation on the lining of the stomach). Severe gastritis can eventually lead to stomach bleeding or even ulcers.

There are a lot of unhealthy snacks surrounding us, and we should probably try to stay away from most, if not all, of them. With the rising popularity of spicy crunchy snacks, it is important to acknowledge that these, in particular, may be causing children significant
health issues and should be avoided completely.

No milk until 1 year of age (no matter what your favorite celebrity says)

Vrinda Kumar, M.D.

Vrinda Kumar, M.D.

I recently read an article about Kristin Cavallari, former reality star, wife of Chicago Bears Jay Cutler, and mother of three adorable kids. She is also anti-vaccine and has written a book with parenting tips (this already is not sounding good to my pediatrician ears). According to her, she chose to put her children on a homemade goat’s milk formula rather than switching to formula, once she depleted her supply of breast milk. (In case you are wondering, it is thought that goat’s milk is slightly most comparable to human milk than cow’s milk). People magazine originally was going to publish her recipe, but then recanted upon the AAP’s (American Academy of Pediatrics) insistence based on the fact that this is potentially harmful advice and that this type of homemade formula is NOT recommended for any child, especially for a child under one year of age. If you are asking yourself “well, why not?”, keep reading…

Current recommendations are to continue your infant on either breastmilk or an iron fortified formula until he/she is one year of age, at which point you can introduce cow’s (or goat’s) milk. I get asked by patients all the time, “why is this?”

Well, the biggest reason is that cow’s milk consumption (or goat’s milk, for that matter) can cause anemia (mostly iron-deficiency anemia, and it can be severe in infants under one year of age!). Children under one year of age need a lot of iron for growth, and cow’s milk can decrease the availability of iron for these tiny growing bodies by the following mechanisms:

1. Cow/goat milk is naturally low in iron, so switching them to this as their main source of milk intake before one year of age deprives them of sufficient iron needed to grow and develop.

2. Small, invisible amounts of blood can be lost through the gut in about 40 percent of children who are introduced to cow’s/goat’s milk before the age of one year. As babies lose blood, they are losing the iron that is in that blood, potentially leading to anemia.

3. Cow/goat milk can inhibit the absorption of iron into the body, specifically by casein and calcium, both of which are present in large quantities in cow/goat milk. The less iron that is absorbed into the body, the less iron there is for the body to use to grow.

I am going to assume the next thought would be, “Why not give cow or goat milk and just supplement with additional iron?” Great thought! But there is still one more danger that has nothing to do with anemia.

The proteins and basic composition of cow/goat milk is very different from human milk and formula. As the waste from the ingestion of milk goes through the body, a lot of it also gets processed through the kidneys to become urine. Cow/goat milk produces a higher solute load going through the kidneys, and the more solute you have in your urine, the more water it is going to draw out of the body with it (remember that from chemistry?). Because of this, your child is at higher risk of dehydration, especially in case of an illness during which he/she will naturally lose more fluid.

There you go! All the reasons to heed the AAP’s advice and not give your infant under one year of age cow/goat milk. Keep in mind that ingesting large amounts of cow’s milk or goat’s milk can potentially lead to anemia, so if you are unsure about safe/recommended amounts of milk for you child (based on their age), please talk to your pediatrician.

Life with a baby and toddler – A personal update

Vrinda Kumar, M.D.

Vrinda Kumar, M.D

Some of you may remember that I posted a blog entry when I was six months pregnant with my second child. I had expressed my anxieties and excitement about having another baby when my older daughter was three years old. Well, now the baby is seven months old, and it’s hard to believe that a year has flown by! I promised to post an update on life with two kids, so here it is.

Well, let me say the transition was hard, but easier than anticipated. My three year old immediately took to “her baby” and wanted to snuggle and kiss her IMMEDIATELY. When we brought the baby home from the hospital, we gave our toddler a “gift from baby sister.” That way, she didn’t feel left out when the baby was receiving gifts. It is natural to be so busy with the baby (especially for me, since I am breastfeeding), so it really does take a solid, conscious effort to make sure we are giving our older daughter the attention she needs. I try to make sure I set aside time when she and I can do things together, just the two of us. My husband does the same. We also allow our toddler to help us take care of the baby. She wants to help and allowing her to do so makes her feel included.

I do sometimes feel because we are sleep deprived and still in “baby mode,” our fatigues and frustrations sometimes become directed towards our often stubborn three year old during her whiny moments or momentous meltdowns. During these times, I’ve realized I have to stop and take a deep breath so I don’t get short and snappy with her (when you are tired and busy, it’s easy to get that way!) I have to realize that much of her behavior is NORMAL for a three year old, especially for one that is trying to get her parents’ attention when they are focused on a new baby. When she is “misbehaving” or having a tantrum, I either ignore her and walk away from her (as long as she is safe!) because I do not want to perpetuate that kind of behavior by giving it attention, and  I have to remember to be sweet in my words because she is not actually doing anything deserving of punishment but rather just trying to play and interact with her mommy.

The baby LOVES her older sister, and follows her with her gaze everywhere she goes. We let them be physically affectionate as much as possible because it’s good for both of them. Sometimes, we have to remind our daughter than her baby sister is a baby and she needs to be GENTLE (i.e., “don’t pinch her cheeks and squeeze her too hard”) but if that’s our biggest concern, I think we have it pretty good. I’m just enjoying this time before they start bickering with each other!

Little girl is comforting her baby brother. Black and white photo with soft focus on their feet.

The logistics of having a baby and toddler is hard if it’s just one person at home (and that one person is also breastfeeding) but it has been manageable. It’s important to remember that if one child needs something urgently, it’s okay to let the other one cry a little (again, as long as they are in a safe place). Crying never hurt anyone. But when there are two of us at home, it’s basically one on one defense, especially during dinner and bed time.

One thing that I have found to be much harder after having a second baby is finding time to spend with my husband. We rarely spend any quality time during the week (we are both working and tired), but we do make an effort to go on a date night one to two times a month. Sometimes I think we are so focused on being such a great parent, that we sometimes neglect being a great partner to our spouses…marriage and parenthood is hard work! But it’s also the most rewarding and joyous gift in life! Even though life with two small kids is busy and tiring, one thing I think we should all remember is sometimes we have to stop, take a deep breath, look around, and really appreciate the joys in our life…including our beautiful, amazing children.


Amber Teething Necklaces: Risks Versus Benefits

Vrinda Kumar, M.D.

Vrinda Kumar, M.D.

A growing trend for non-medicinal approaches to pain control and teething in children are becoming more popular.

Teething is a fairly long process which can start as early as 3 to 4 months and last as long as two years when children are getting their two-year molars. Some kids do great with teething and exhibit no symptoms. Some kids, however, get fussy, low grade fevers, green slimy stools, eat less, drool excessively, and do not sleep well.

For the parents of the latter group, it can be stressful and distressing to see your child so fussy. There are a lot of teething remedies available, but one remedy that has become more popular in recent years is the Baltic amber teething necklace, which can be found in some stores and on the internet. Baltic amber supposedly has a substance called succinic acid which is a natural pain reliever. The theory is that this substance gets absorbed through the skin and provides pain relief and relieves some of the other symptoms associated with teething. These necklaces are just long enough to fit around a child’s neck but not so long that a child can put it in their mouths.

Some moms I have met swear by these and say that it calms their child down and decreases drooling. So, I started wondering…is there any scientific behind this? The answer is no. There is ANECDOTAL evidence (moms saying it works), but there is no science behind it whatsoever. Dr. Andrew Weil, a world leader in integrative medicine, says the use of these necklaces is not supported by modern science. There is no evidence that the succinic acid actually can absorbed in the skin to a level that can help with pain relief.teething

There are, however, several cases of strangulation and choking from the necklaces. The AAP and AAFP highly discourage the use of these necklaces. Amber is a “soft stone”, meaning it can easily crumble under the weight of a human bite. Putting a string of beads around a child’s neck poses a strangulation hazard, and putting it around an extremity poses the risk of strangulation to the point of cutting the blood supply from that extremity. Some of the necklaces have a magnetic clasp which opens when pulled (in theory to decrease strangulation hazards). But then, you have to think, if the clasp opens, it’s in the child’s reach which means they can put it in their mouths.

Bottom line, the use of these (and the supposed benefits) are not scientifically proven, and they do pose strangulation/choking risk.  I encourage patients to consider alternative forms of pain control for teething (e.g. Orajel Naturals).