Some mothers produce so much milk that their baby can’t drink it all.  Have you ever wondered how to give it away?  Perhaps there’s a baby who could really use it.

Now, there’s a way to donate it.  “MilkShare” is an organization dedicated to uniting babies in need with a breastmilk donor.  One of my patients alerted me to this resource; she has donated milk for two families, and she’s found it to be a rewarding experience.

Donors are not expected to be reimbursed for the milk itself, but you can be reimbursed for equipment and shipping costs.  (Selling the milk itself is forbidden by the site.)  The recipient is also responsible for any costs for testing the milk.

Click HERE to see the MilkShare website, and find out more.

– David Epstein, MD

The safety issue relates to the way that the safety belts themselves restrain the child.  In order for the belt to restrain the child without causing injury, the belt must nestle against the child’s bones, rather than soft tissue.

Delaware law (click here for interesting info) requires kids to be in their car seats while travelling until the 8th birthday, or 65 pounds, whichever comes first.  But following this rule does not guarantee safety, especially for smaller kids, because of the geometry of safety belts.

To convince yourself (and your child, if she is agitating to get rid of the booster seat), you can try this test:

Let your child (over 8 years old and 65 pounds) sit in the back seat of your car, with just a seat belt on.  Drive around the block once or twice, then park in your driveway.  BEFORE the kids get out of the car, go to the back seat and check the position of the seat belts on the child’s body.

The lap belt should strike the child’s lower hip bones.  And the shoulder belt should be laying across the hard clavicle (collar bone).  If the lap belt has slipped up across the soft tissues of the belly, or if the shoulder belt lays across the soft tissues of the neck, then it is not safe for the child to be transported this way: in an accident, the safety belts themselves could cause soft tissue damage.  The purpose of the booster seat is to raise the child, so that the safety restraints are in the proper position.

Frankly, I think the only reason that a child would want to get rid of a booster seat is to think of themselves as more “adult”.   But the booster seats let the kids see out the car window better!  My daughter, who was rather petite, needed to use a car booster seat until she was almost 10.  When she complained, I performed the demonstration above, and she quickly understood the need.

(For information about car seats for younger kids, click here.)

–  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 most babies who cry a lot don’t have colic.  I haven’t made this diagnosis more than 2 or 3 times in my 20+ year career.  There is usually some other explanation for a baby’s fussiness.

For starters, true “colic” refers to a baby who cries all day and all night.  If your baby cries only at night, for example, and seems fine during the day, she probably doesn’t have colic, and may not have any medical problem at all.

A persistently crying baby with no other symptoms should be examined, to rule out an ear infection or other medical illness.  But most commonly, the medical exam is normal.

Here are some of the possible causes for fussiness in babies.

Overstimulation:  When my daughter was born, our friends and relatives were as excited as we were.  We had many visitors.  She slept all day, but then screamed all night.  Once we finally figured out that we needed to limit visitors during the day, she was more alert in the day, we all slept better at night.  TV is another important cause of overstimulation; I recommend that the TV be limited to an hour a day within the baby’s hearing.

The “fussy period”:  At a few weeks of age, many infants will start crying every evening.  The infant may start to get wound up just after supper, then wail on and off until he exhausts himself before midnight.  These infants sleep fine the rest of the night, and they seem fine in the daytime.  This “Fussy Period” is well known.  It is frustrating but not serious, and most babies grow out of it by about 6 weeks of age.  This is another manifestation of overstimulation.  During the day, do what you can to limit the noise, and handle the baby gently; when the baby is wailing, certainly offer feedings, holding, and other comforts; and get through it as best as you can.

Parental excitement: The noise that a screaming newborn makes is close to intolerable.  Exhausted, frightened parents can be desperate to calm the baby.  But please be assured that if the baby is gaining weight, is feeding well, and has no other sign of illness, then it is very unlikely that the screaming represents a medical emergency.  In fact, parents can inadvertently overstimulate a screaming baby.  Vigorous bouncing, loud “shh”‘ing, and patting the baby may inflame his mood, causing a vicious cycle.  Instead, the most effective action is to role-model the calm behavior that you would like the baby to perform.  You can hold the baby close, move slowly if at all, and speak quietly if at all.  The louder the infant becomes, the more quiet and soothing you can try to be.  It may take an hour, or much longer!  But, through your role modelling, your infant will learn self-soothing; he will learn to manage his own emotional state, which is a very useful skill for anyone to learn early.

Teething: probably not a cause of infant colic.  Infants may start chewing and drooling for months before the first tooth breaks through.  But infants under 2 months old are unlikely to have behavior changes due to teething.

Formula “allergy”:  Most infants can handle any commercially available formula.  But some will have a formula intolerance, manifested as persistent vomiting, diarrhea, or constipation.  Simple crying without other symptoms is rarely due to formula intolerance; but a change in formula might be worth a try.  Try switching to a soy formula, or Nutramigen (or their generic substitutes).  Don’t bother with low-iron formula; there is not enough iron in formula to cause intestinal problems, although the iron is needed to prevent anemia.  Don’t switch to another formula in less than 5-7 days; rapid formula changes will leave you unsure which one helped the most.

Gastroesophageal reflux:  In my experience, “silent reflux” is the most common medical cause of persistent crying in infants.  Stomach contents may not reflux all the way into the mouth, but the discomfort of having stomach acid refluxing into the esophagus can cause crying and arching.  Keeping the baby upright during and after feeds can help.  If not, a visit to the office might be useful; the baby should be examined, then we might try thickening the milk with cereal, or medication.  Sometimes XRays are needed.

A persistently crying newborn can be frustrating, or even frightening.  But there’s usually a treatable cause.  So don’t give up hope – and try to get some sleep!

–  David Epstein, MD

This is certainly not a “new” vaccine;  the H1N1 vaccines are just like the regular seasonal vaccine, made by the same manufacturers, who use the same egg-culture process.  There’s a different flu virus inside, but that’s little different than the “new” seasonal flu vaccine that comes out each autumn.

Side effects?  I’ve heard of no reactions from my patients so far, other than occasional 1-2 days of fever.  So there’s no reason to be more fearful of the Swine Flu vaccine than any other routine immunization.  (Click here to visit my post last month about the safety of flu vaccines.)

It’s unfortunate that there’s so much noise and misinformation about flu vaccines.  Much of it stems from recent political activity from groups who oppose universal vaccination.  (Click here to see my thoughts about that issue.)

But the facts are plain.  Thousands of people die each year from influenza.  The CDC reports that 324 Americans have died from Flu since April (as of 2/10/10), including 260 children.  (Click here to see the data.) Thousands more have been hospitalized.

But I’m not aware that anyone ever died from a flu shot.  The balance of safety is certainly convincing: we’re all better off getting vaccinated!

–  David Epstein, MD

But what about little babies under 6 months?

For decades, doctors advised against sunscreen for babies under 6 months.  However, there seems to be nothing in the sunscreen itself that’s actually bad for little babies.  (I’ve even spoken to the engineers at Johnson & Johnson; they can’t explain the recommendation!)  I suspect that the recommendation to avoid sunscreen under 6 months of age came about because somebody was afraid that parents might get too relaxed.  Might a parent apply sunscreen to a little infant’s skin, then take him out on the boat all day?  I hope not!  Common sense will help guide us.

I think it’s perfectly safe to apply sunscreen to the skin of little infants, even under 6 months.  (Avoid the eyes; it stings!!)  But I wouldn’t take the baby out in direct sun for very long (use your judgement), and certainly avoid direct sun between 11 am and 3 pm.  Re-apply the sunscreen every 2 hours or so, just as with the older kids.  If you’re on the beach or by the pool, or if it’s really hot, pay attention to the baby’s hydration status and give extra fluids (water or the baby’s usual feeds).

I’ve heard dermatologists say that 85% of a person’s lifetime risk of skin cancer comes from the sun exposure accumulated before 15 years of age.  So slather on the sunscreen, especially on an infant!

–  David M. Epstein, MD

A new program to improve the nutritional quality of food, and to further promote breastfeeding, has been put in place this year.  Delaware’s Department of Health and Human Services is one of the first states to implement the new program.

Are you interested in the program? or do you think your family might qualify?  Click HERE to see Delaware’s WIC program website.  For information about the federal funding, click here.

–  David M. Epstein, MD

Some pediatricians have recommended against having the ears pierced until the child is old enough to take care of them herself.  Usually this meant waiting until the child is school age.  However, I have rarely seen complications from infant ear jewelry, and my impression is that problems are no more common in infants than in older children, if care is taken.

There are potential complications.  Here are some of the more common ones.

Dangling jewelry may get hooked on something and get ripped out of the earlobe; or the infant’s fingers may clutch and remove jewelry, leading to a choking hazard.  I recommend screw-back earrings for infants and toddlers.  (Clip-on jewelry should not be used until the child is old enough to avoid a choking hazard, usually by school age.)

Infection can set in, especially in the first 6 months after piercing; I recommend removing the posts, cleaning and coating them with antibiotic ointment, and replacing them in the earlobe twice a day for at least 6 months, until the channel has epithelialized.

A metal allergy can develop, giving an inflamed appearance or a nasty discharge.  (Sometimes a doctor’s examination is needed to distinguish this from infection.)  For the first year, you should avoid 14 carat gold, silver, nickle, inexpensive “white metal,” or any plated metal.  18 carat gold, surgical steel, or titanium posts are better, although they are more expensive.

Occasionally, the earring or the back will get pulled too deep into the tissue of the earlobe.  This can be painful, especially if it becomes infected, and usually requires medical attention to remove.

Who performs ear piercings?  Gone are the days when it would be done at home with a hot sewing needle and a slice of raw potato!  In the past, I have recommended consulting a plastic surgeon; a plastic surgeon pierced my own daughter’s earlobes when she was two months old.  However, it appears that our local plastic surgeons in the Delaware area will no longer perform this procedure.  So you might be reduced to having it done in the local shopping mall, an alternative I don’t find appetizing.  I suggest that you size up carefully the skill and experience of anyone whom you contemplate piercing your daughter’s ears, and ensure that sterile (preferably disposable) equipment is used.

David Epstein, MD

You can run a quiet fan, or buy “noise machines” from a baby store.  Or, for a buck or two, you can download an hour-long “white noise” track, burn it to a CD or mp3 player, and play on “repeat” to help soothe your baby (or yourself for that matter!) to sleep.  Click on the links below:

Try this one for simple, monotonous white noise.
Or check out one of these for something slightly less monotonous.
Finally, here is a website with several free white-noise downloads.

–  David Epstein, MD

A:  Many babies spit up occasionally with feeds.  I don’t get concerned if weight gain is good, the baby eats eagerly and seems satisfied after feeding, and the baby is cheerful and sleeping well.

If the baby’s vomiting is excessive, the baby is unhappy, or if other symptoms of illness are present, the child should examined.  If the child is not suffering from another illness, I may diagnose Gastroesophageal Reflux (GE Reflux).

If your baby suffers from GE Reflux, I suggest keeping the baby upright as much as possible, so that gravity can minimize the spitting.  Sometimes, thickening the formula with rice cereal may be advised.  (Obviously this is not practical for the nursing baby.)  Occasionally, switching brands of formula might reduce symptoms; if you try changing formula, give it 5-7 days to see if the symptoms improve.  If more severe symptoms persist, medications or Xray studies might be indicated.

GE Reflux often runs in families; several siblings may all suffer with it.  Typically, infants grow out of GE Reflux by 9-12 months of age.  But in about 15% of cases, it may persist beyond 12 months; in these cases, the child may require treatment for a few years until he grows out of it.

One of my biggest concerns about long-term consequences of GE Reflux is the potential for a “feeding aversion.”  If the esophagus is inflamed from acid reflux, the baby may learn that it hurts to eat.  If he avoids eating for months or years because of the fear of pain, nutritional problems might result.  Usually, this can be avoided by early recognition and treatment of the reflux.

–  David Epstein, MD