Babies start “gumming” and drooling on hard objects, starting at a few months of age.  This might be due to teething, or it might just be oral exploration.  You can try rubbing some teething medicine, such as Baby Anbesol or Baby Oragel, on the gums.  Ribbed teething rings, or a washcloth dipped in ice water, can give some relief.

Sometimes babies wake up fussy in the middle of the night.  If your baby has been fussy and gumming things during the day, then an occasional night waking might be due to teething.  You can try giving some acetaminophen or ibuprofen, in the usual dose for fever.  But if the waking is persistent, it’s probably not due to teething.

Some babies will pull on their ears when they’re teething;  you can try the usual teething remedies.   But if there are cold symptoms also, especially if persistent, an ear infection is also possible; give us a call if you’re concerned.

But I really doubt many of the other symptoms attributed to teething.  How could teething cause a diaper rash?  Or diarrhea?  Or a runny nose?  I can’t figure out what the mechanism would be!

Fever is supposed to be another symptom of teething.  I might believe that a low-grade fever, for an hour or two, might come from teething.  But a baby with a high fever for a day or more needs to be seen by the pediatrician.  It might be something like a virus or an ear infection, but I never find that such babies are simply teething.

Visually inspecting the gums doesn’t help much.  Generally, the white lumps under the mucous membranes lining the gums are just irregularities of the jaw bone, not new teeth.  This is especially true of lumps and irregularities on the sides of the jaw.

You can’t “feel” teeth coming in, unless they’re actually breaking through the mucous membrane.  If you see the actual surface of the tooth on the top of the jaw, then “teething” might explain a baby’s fussiness.  Sometimes there’s a little bleeding; that’s normal.  Occasionally, a dark-colored blood blister will develop over a tooth as it’s coming through; nothing needs to be done about this, since it will “pop” on its own.

But if your baby is sick, please don’t assume that teething is the cause.  It’s best to assume that a baby’s symptoms are due to a virus or other illness.  Please don’t hesitate to call us if you’re concerned.

The bottom line on teething?  I think its bark is worse than its “bite!”

–  David Epstein, MD

But medications can be expensive!  Your insurance plan’s drug benefit should help cover the cost, but sometimes there’s a problem.

If you arrive at your pharmacy and discover that your prescription is much more expensive that you expected, please have the pharmacy call us right away.  Perhaps we’ve prescribed a brand that your insurance company doesn’t cover.  Or perhaps there’s an equivalent medicine that works the same but costs less.   Or maybe the drug manufacturer has a “trial program” that would get you started at minimal cost.

We are quite happy to make a switch if we think it will work as well.  But we don’t know about the cost problem unless you tell us.   Don’t be shy!  Unfortunately, we can’t keep track of all the insurance formularies, because they’re all different.   And we don’t keep drug samples in our office.  But with the help of your pharmacist, we can find out which effective treatment will result in the lowest out-of-pocket expense for your family.

I’m always sad to hear that a family has decided not to purchase medication that I’ve prescribed because they can’t afford the cost, or that the family spent more than necessary.

Whether the medication is for eczema, asthma, ADHD or an infection, there’s almost always a way to make sure that you can afford your medication.   PLEASE call us before deciding that you can’t afford a medication that we’ve prescribed!

–  David Epstein MD

The most important technique is to expose the base of the cord.  If the base is not exposed to air, then bacteria can thrive in the wet, low oxygen environment; this may lead to infection.

Hydrogen peroxide, wetted on a gauze or cotton ball, is perhaps the best choice for cleaning.  Rubbing alcohol was recommended in the past, but it tends to cause rashes.  A little mildly soapy water can also be used.

Grasp the cord with your fingers, and pull up gently.  At the same time, pull the skin away from the cord, all around the cord, to expose the yellow base.  Then you can clean, all around, with the gauze wetted with hydrogen peroxide.  If the cord smells bad or seems infected, you can smear a little antibiotic ointment (such as neosporin) around and on the base of the cord.

You can clean the cord as often as needed, perhaps 3 or 4 times a day.  You may be instructed not to bathe your baby in the tub until the cord falls off; but I don’t feel strongly about this.  If your baby seems dirty or sticky, you may give a quick (warm) tub bath, then dry the infant thoroughly; then open up the base of the cord (as above) to allow drying.

Textbooks say that the umbilical cord usually falls off by two weeks of age.  But my experience is that the cord may stay attached longer, sometimes as long as 4 weeks.  I suspect the reason is that patients take such good care of the umbilical cord that it takes a while to deteriorate!

If you see the skin around the umbilical cord getting red, he should be examined to rule out infection.  But this is unusual.

–  David Epstein, MD

But pressure against these videos has continued to mount.  Disney, who bought Baby Einstein in 2001, calls the bad publicity a “smear campaign.”  But on September 4th, as reported this week on the New York Times front page, the Campaign for a Commercial-Free Childhood convinced Walt Disney Studios to offer a full refund.  The refund applies to any Baby Einstein DVD purchased after mid-2005.  Return your DVD, and get a check for $15.99 – no questions asked!  You don’t even need the original receipt, or even the box.  Just mail in your Baby Einstein DVD before March 4, 2010.

To download the refund form, click here. Or go to the Baby Einstein website, and search for “einstein moneyback;” the link for the refund form will be on the right-hand side of the page.

Remember that the American Academy of Pediatrics still recommends that there’s no reason to turn on the TV at all, for children under 2 years old; and for kids over 2, limit screen time to 10 hours a week.

–  David Epstein, MD

A new feature is my pediatric blog.  From time to time, I’ll post some thoughts about timely topics affecting your children’s health.  Sometime’s I’ll write about seasonal issues; current news reports may also get some attention here.  Post your comments, and check back to see what’s new!  If you have an interest in a special topic that you’d like me to consider for the blog, please call us, speak to one of the staff, or email via the “Contact Us” page.  I’m always looking for interesting topics.  Thanks!

–  David Epstein, MD