Tag Archives: Infant Care

Potty Training: A Guide for Parents

By Shilpa Vernekar, M.D.
Potty Training Child First Steps

If you are a parent, you can most likely relate to the unparalleled feeling of elation and excitement that comes when your child reaches a big milestone. In the early years, those major accomplishments may seem minor to the outside world, such as baby’s first words, baby’s first steps, and baby’s first poopy in the potty, but as a parent you alone are enchanted and just so proud of your little one. As both a pediatrician and a mother, I get it. I will never forget the first time my child said “mama,” and I celebrate with countless other parents every day over their children’s achievements.

However, it is important to first understand that potty training – like most processes with children—may or may not be easy or come naturally for you and your child. Although a bowel movement on the potty sounds so simple to you as an adult, it is important to understand that it may take time, understanding and patience on your end. Please know that you are not alone! As your child’s pediatrician, I am here to help if needed at any point along your journey of potty training. And one day, I assure you, that child who is still using his/her diaper, will be independently using the toilet thanks to your hard work and dedication!

So, let’s start at the beginning, and I will answer the most common potty training questions that parents ask in my office.

When is the right time to start potty training?Potty Training 2

Potty training can start anywhere as early as 6 months to when the child is 2-3 years of age. Each child is different, and you know your child better than anyone else.

He will show signs of being ready like informing you every time he has to do stools or pass urine. Parents can also identify that it may be time to begin potty training based upon the child’s body language. When children are about to pass stools or urine, they often change facial expressions, squirm, and/or cross their legs.

Also, prior to removing the diaper, it helps to know if your child can understand instructions or be able to rush himself to the potty if needed.

 

My child is ready for potty training. So, how do I start?

First, invest in a potty training device which can be purchased from any store for as low as $15-20. Next, allow your child to become familiar with the potty and ensure that the child is comfortable when he sits on the potty with his feet resting firmly on the floor. Let the child know that every time the child needs to use the potty, he needs to sit on the potty chair. The child can wear a diaper to pass stools or urine while sitting on the potty, but it is best done without the diaper. Therefore, the child can help undress and remove the pull ups before he sits on the potty.

Another strategy is to allow the child to sit on the potty every 2-3 hours to help void urine. If there is a specific time during the day that the child passes stools, then allowing the child to be on the potty at that time will help reinforce the behavior. Stickers and reward charts help older children to become potty trained.Potty Training 3

Additionally, wiping from front to back is important, especially for girls, to prevent urinary tract infection. This is something that seems natural, so parents may forget to teach, but it is vitally important.

Finally, hand hygiene is important after using the potty. Parents should make it a habit that the child washes his hands each and every time after he uses the potty.

The parent should be patient with the whole process and understand that it may take 2 weeks to 2 months depending upon the child’s level of maturity. If you have tried for 1-2 weeks and feel your child is not ready, do not force the child. It will make the situation worse and make potty training even more difficult. Let the child grow, and try again few weeks or few months later.

While day time training and stool training happens in the first three months, bed wetting or being dry by night might take longer. Sometimes the child might continue to bed wet until five years of age or longer if there is family history of bed wetting. For further information of nocturnal enuresis or bedwetting, refer to this article.

When should I ask my child’s pediatrician to help with potty training?

If you child is unable to potty train by 3-4 years of age during the day or a previously potty trained child is now reverting back to passing stools/urine in the underwear on a routine basis, then it is time to visit your pediatrician.

But, remember it is normal to have some accidents at times, especially if the child is in an unfamiliar setting or with different care giver. Do not worry about it unless it happens on a daily basis.

For additional questions, please consult your child’s pediatrician. And remember: Stay calm and keep persevering: potty training will occur eventually.

Potty Training 1

Dr. Vernekar, M.D., F.A.A.P. is a board-certified pediatrician who works at Preferred Medical Group, which has locations at Phenix City Children’s, Fort Mitchell Clinic and Opelika Pediatrics and Family Clinic. Her special areas of interest include weight management and nutrition. Follow Dr. V. on Twitter at: www.twitter.com/shilpavernekar.

 

Avoiding New Sibling Jealousy

By Michelle DeRamus, Ph.D.

There’s a lot to think about when preparing for a new baby. For families who already have at least one child, that prep work should include making sure older siblings are ready for the new baby. A little preparation before the baby arrives and following a few guidelines after the baby is born can minimize new sibling jealousy and maximize helpful behavior from older children.

Jealous over new baby

When considering how to prepare siblings for a new baby, it is important to consider the developmental stage of the siblings. Toddlers and preschoolers are very sensitive to changes in their routines, so it can be helpful to make any big adjustments to daily routines (e.g., moving to a new bed/room, starting preschool, potty training) either several weeks before baby arrives or after baby is a few months old. Adjusting to baby will be a big change, and keeping all other routines as familiar as possible will help toddlers and preschoolers feel safe and comforted.

Older children may be less sensitive to minor changes in routine because they can better understand how and why the family is changing. However, older children are often faced with greater responsibilities and an expectation to act more “grown up” when a new baby is born. Be sure to keep expectations reasonable and age-appropriate. There are many websites available that provide suggestions for chores and responsibilities that are appropriate for different age groups. And, just like with younger children, adding responsibilities for older children gradually in the weeks before and after baby arrives can help the transition go smoothly.

Newborns require a great deal of time and attention. It can be a big adjustment for older siblings to have less of their parents’ attention. Many siblings go through a phase of new sibling jealousy. To minimize siblings’ jealousy, help big brother or sister get ready for baby by allowing them to be a part of some of the decisions and preparations before baby arrives, such as choosing a special toy for baby, decorations for baby’s room, or where to put some of baby’s belongingSibling Jealousys.

Siblings might want to “hand down” a special stuffed animal or toy from their own collection to share with baby, although it is OK for siblings to keep some toys as their own and away from baby’s reach. When baby arrives, be sure to praise siblings for all the helpful things they do, from little things like handing you a diaper to bigger responsibilities such as cleaning up their toys. Giving lots of praise is a good way to help siblings feel like they are still getting attention from you even though your hands may be occupied with caring for baby. Finally, even though babies need lots of time from you, it is important to carve out some one-on-one time with siblings on a regular basis. Even 10 minutes a day of special play time where you can give your undivided attention to siblings will go a long way for helping them feel valued and loved, which will cut down on new sibling jealousy of baby.

Additionally, it is important to acknowledge and validate the older child’s feelings. I would advise parents to problem solve with the child by saying things like, “I understand that you feel sad that you will have to share Mommy’s attention now; what can we do to help you feel that you are still just as important?” or “I understand that it upsets you when the baby cries and it’s really loud; how can we help you to feel better about this?” On the other hand, I would tell parents not to tell a child “Don’t feel that way.” It is OK for the older child to feel mad, sad or confused, which are all perfectly normal emotions, as long as those feelings are expressed in an appropriate way. For example, it would not be OK for the older child to act aggressively by hitting the baby, breaking baby’s toys, or hitting mommy’s stomach. If those things are occurring, discipline may need to be used, just as it would be used in similar situations when children are not following the rules.

Positive redirection can also be useful; for example, if a child was to say, “I hate the baby and wish he was never born,” parents could interpret why the child is feeling that way in this particular moment and respond by saying, “I understand that you really don’t like how the baby sleeps all the time, and we have to be quiet. What if we went to play outside later, just you and I, and let Daddy watch the baby? Then, you can yell and scream and get all of your energy out.” You are replacing strong words like “hate” and the idea that the baby is the problem and replacing it with the idea that the older child simply does not like a particular behavior and the effect that the particular behavior has in his/her own life. By offering a solution, such as a louder playtime outdoors later that day, the child will hopefully see that his/her life can continue even with baby in the house, and new sibling jealousy will gradually decrease.

After the birth of the baby,Sibling excited about new baby life will never be the same for your older kids, so advance preparation and a few steps taken by the parent can go a long way in easing a family through this major time of transition. Positive redirection and scheduling reserved one on one time for the older child to spend with a parent can go a long way in helping older siblings love and accept the baby. It takes kids different amounts of time to adjust; some love baby from Day 1, and other kids continue to be jealous of their younger sibling throughout their life.

If your child continues to express extreme negative emotions including aggression, extreme sadness, or excessive worrying about the family or even the baby itself, and you as the parent begin to feel that this issue is affecting the child’s quality of life or the overall family dynamic, you may seek assistance from a counselor or therapist.

 

Dr. DeRamus is a child psychologist with Preferred Medical Group and works at the Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems, ADHD, and behavior problems. She also helps children from infancy through 18 work through anger, anxiety, depression, family problems and peer relationship issues.

Jaundice in Newborns

By Shilpa Vernekar, M.D.

 What is hyperbilirubinemia or  jaundice?

Hyperbilirubin or increased levels of bilirubin/jaundice – is the yellow discoloration noted on the skin and the conjunctiva (the white part of the eye). Jaundice in newborns is fairly common.

 When does it happen?Newborn

Most healthy newborns have jaundice during the first few days of life which disappears on its own without any specific intervention.

What causes jaundice?

Common causes of jaundice in newborns can be blood group or Rh incompatibility, trauma and scalp bleeding during delivery, infection, poor feeding, enzyme defects, RBC structural defects, biliary or liver conditions, metabolic conditions like hypothyroid, infants of diabetic mother and so on…

Why does it happen?

Newborns have relatively larger number of red blood cells (RBC ) with a short life span of these red blood cells. When RBC break down, bilirubin is formed as a byproduct. It is this bilirubin which imparts the yellow color to the skin and the eyes, or jaundice in neworns.

Jaundice may be categorized into two types:

  1. Physiological jaundice in newborns – This type of jaundice happens in most newborns. Start after the first day of life, reaches peak in 3-5 days in term babies and 5-7 days in preterm babies and resolves in 7-10 days.

a.) Breast feeding jaundice in newborns is another form of physiological jaundice. Decreased milk intake can exacerbate or worsen the jaundice. Breast feeding jaundice generally improves by increased and more frequent feeding of the baby.

b.) Breast milk jaundice in newborns is another type of physiological jaundice, where certain substances in the breast milk inhibit enzymes that are responsible for the breakdown of the bilirubin in the liver.

This jaundice generally happens by the second to third week of life and may sometimes stay for a month.

No treatment or intervention is necessary for physiologic jaundice in newborns.

  1. Pathological Jaundice- This type of jaundice in newborns can pose a problem. Jaundice that happens in the first 24 hours of life or jaundice that is higher than expected for a baby that age (in hours) needs to get medical attention.

How is jaundice diagnosed and treated?Bilirubin test jaundice

Jaundice levels can be checked by a device on the skin which is a quick screening method. The definitive way is to take blood sample/heel stick from the baby and have it analyzed for bilirubin levels. In most cases of physiological jaundice, improved feeding helps flush the bilirubin out.

For breast milk jaundice, it is recommended to discontinue breast feeding for 48 hours, supplementing with formula in the meanwhile (pumping the breast milk to maintain supply). This method helps decrease the jaundice, after which breast feeding can be re-started without worrying about jaundice coming back.

Another treatment is photo therapy, where blue fluorescent light is used to break the bilirubin, which is then excreted to the urine.

In severe cases, an exchange transfusion may be necessary. This involves taking a small quantity of baby’s blood and replacing with a similar matched donor blood to decrease the bilirubin levels.

Why should I look out for jaundice?

If high jaundice numbers remain untreated, a condition called Kernicterus may develop.

This leads to long term irreversible brain damage. Hence physicians treat newborn jaundice aggressively.

It is important to ensure once you are discharged home from the hospital to keep the newborn follow up appointment within 3-5 days as jaundice levels peak in term babies by 3-4 days.

Also if you start to notice the skin color appear increasing yellow or jaundiced that lasts more than one week, it is important to have the baby checked out by the physician.

Finally, it is important to continue feeding the baby (through breast milk or supplemental formula depending upon your physician’s instructions,) and do not attempt to keep the baby in direct sunlight as this can result in dehydration, sun burn and more severe complications to the baby. Please do not worry, as with proper evaluation and treatment, jaundice in newborns is often easily resolved.

For more information, please consult your child’s pediatrician. This article is meant to serve as a guide about jaundice in newborns and is in no means is a comprehensive treatment plan for your baby.

Shilpa Vernekar, M.D., F.A.A.P. is a board-certified pediatrician who works at Preferred Medical Group, which has locations at Phenix City Children’s and Fort Mitchell Clinic. Her special areas of interest include weight management and nutrition. Follow Dr. V. on Twitter at http://twitter.com/shilpavernekar.

Bonding with your newborn baby

By Shilpa Vernekar, M.D.

If you are reading this article, you are more than likely expecting a baby or have recently delivered; first and foremost, congratulations! Parenthood is an exciting journey that is unparalleled by any other you will ever take. This baby will certainly change your life in many ways, beginning with the first time that you lay eyes on one another!

If this is your first baby, please take a deep breath and know these two important things:

  1. You are doing (or will do) just fine as a parent! It is all very natural.
  2. You are not alone!

First-time moms are especially prone to worry about various things related to those first few days and weeks of infancy; but, please know your child’s pediatrician is here to help you along the way, from the moment you first hold your new baby in your arms. This is why it is especially important to pick your child’s pediatrician before you actually have the child (if you are adopting,) or during your pregnancy. The third trimester is usually the recommended time to pick the physician who will be your resource and advocate for everything from breastfeeding to soothing a baby with colic.

Once you have your baby, you will likely develop a strong, unique and inseparable bond with your new son or daughter.

What is bonding?Bonding with Newborn Baby

Bonding is a connection or attachment that you will feel towards your newborn. It is the same force that will bring tears to your eyes when you see your baby cry. You may want to take away all of his/her grief and replace it with laughter.

 When does it happen?

TV shows and magazine advertisements often portray bonding as instantaneous, and that it occurs as soon as your bundle of joy lands in your arms. While that may be the case for many, some parents may take few days to weeks to feel the bonding. So, do not worry if you are back from the hospital and do not feel the connection just yet.

How can I make bonding happen?

Spending time with you newborn is one of the easiest ways to initiate bonding. Look into her eyes as you feed her, run your fingers through her hair, gently massage her body with oil, sing to her, rock her, pat her, lay her on you to maximize skin-to-skin contact, and you will start to feel the connection. It will also help if you start bonding with the baby while pregnant.  Thinking about how the baby is growing can be beneficial. Some people choose to photograph their pregnancy each week to keep track of how the baby is expanding in their belly.  Or, like in olden days, knitting sweaters/socks for the baby will also help to train your mind to welcome your bundle of joy and form the bond.

 

When should I worry about bonding?

Bonding with your newborn baby cannot be quantified, so even if one thinks that there is a weak bond or it hasn’t happened yet, maybe it has. You may just not be aware of it. As lo

If you have the feeling of being depressed or unhappy on most days, feel hatred or anger towards the newborn, or you are unable to care for the baby, then it is time to visit the doctor.ng as you are meeting all of the baby’s needs, please be reassured that you will soon start to feel the magic feeling.

However, most of the time, bonding is very natural, so please do not worry too much about the process. And remember, most importantly, you are not alone!

Please call upon your child’s pediatrician as a resource for your family from the day your child is born through age 18. At Preferred Medical Group, for example, we will be there with you as your baby turns into a toddler, a pre-teen, and a young adult. And, we provide continuity of care, so that you and your child can request to see the same doctor each and every time. If you have not found a pediatrician for your baby just yet, please visit our website to see if we might be a good fit for you and your baby: www.preferredmedgroup.com.

 

Colic: A pediatrician’s perspective

By Ritu Chandra, M.D.

Being a new parent is difficult, but being the parent of a fussy infant is infinitely more challenging. An estimated 10% to 26% of infants experience colic, which was defined by Wessel in his classic 1954 article as occurring in an otherwise healthy infant who cries for >3 hours per day, >3 days per week, for >3 weeks in duration. Colic begins during the second week of life, peaks at 6 weeks, and resolves between 12 and 16 weeks. It is equally common in both breast-fed and bottle-fed infants.
Cute little baby crying

If we understood the mechanism of infant colic, life would be so much easier for parents and pediatricians.

Is there a regular fussy period each day when it seems you can do nothing to comfort your baby? This is quite common, particularly between 6:00 p.m. and midnight, and is a characteristic of colic. These periods of crankiness may feel like torture, especially if you have the demands of other children or work to do, but fortunately they don’t last long. The length of this fussing usually peaks at about three hours a day by six weeks and then declines to one or two hours a day by three to four months.

Although crying is normal for all infants, averaging 2.2 hours per day, those with colic cry excessively, are more difficult to console, have disrupted sleep, and are the source of much parental anxiety. Mothers of colicky infants are at higher risk for postpartum depression and are more likely to stop breastfeeding early. Infants who are excessively fussy are also at higher risk for child abuse.

As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there’s no reason for alarm. All newborns cry and show some fussiness.Here is a chart to identify the differences of “just crying” vs. colic in your baby:

 

Just Crying

Colic

Intermittent Crying continuously for 2-3 hours
Occurs any time of day Occurs at the same time each day
Any age Between 2 weeks to 4 months of age

 

***It is important to note that colic usually doesn’t have any medical significance and eventually goes away on its own.

 What causes Colic?

Doctors aren’t sure what causes colic. Intolerance to cow’s milk has been suggested as a possible culprit, but doctors now believe that this is rarely the Mother Holding a Screaming Babycase. Breastfed babies get colic too. Other theories are that colic is due to a baby’s temperament, that some babies just take a little bit longer to get adjusted to the world, and that infants of mothers who smoke are more likely to have colic.

Unfortunately, there is no definite explanation for why this happens. Most often, colic means simply that the child is unusually sensitive to stimulation or cannot “self-console” or regulate his nervous system (also known as an immature nervous system.) As the baby matures, this inability to self-console—marked by constant crying—will improve. Generally this “colicky crying” will stop by three to four months, but it can last until six months of age.

 Treating Colic

No single treatment is proven to make colic go away. But there are ways to make life easier for both you and your colicky baby.

Although you simply may have to wait it out, several things might be worth trying. First, of course, consult your pediatrician to make sure that the crying is not related to any serious medical condition that may require treatment. Then, consider any of the following strategies:

  • If you’re nursing, you can try to eliminate milk products, caffeine, onions, cabbage, and any other potentially irritating foods from your own diet e.g. dairy, soy, egg, wheat. If you’re feeding formula to your baby, talk with your pediatrician about a protein hydrolysate formula. If food sensitivity is causing the discomfort, the colic should decrease within a few days of these changes.
  • Do not overfeed your baby, which could make her uncomfortable. In general, try to wait at least two to two and a half hours from the start of one feeding to the start of the next one.
  • Walk your baby in a baby carrier to soothe her. The motion and body contact will reassure her, even if her discomfort persists.
  • Rock her, run the vacuum in the next room, or place her where she can hear the clothes dryer, a fan or a white- noise machine. Steady rhythmic motion and a calming sound may help her fall asleep. However, be sure to never place your child on top of the washer/dryer.
  • Introduce a pacifier. While some breastfed babies will actively refuse it, it will provide instant relief for others.
  • Lay your baby tummy-down across your knees, and gently rub her back. The pressure against her belly may help comfort her.
  • Swaddle her in a large, thin blanket so that she feels secure and warm.

Colic is a challenging problem for pediatricians to address with parents. Parents come to the pediatrician asking for a remedy for the colic, and our response that the
Colic colicky crying is ‘normal’ and that ‘it will go away’ is sometimes simply not enough for parents. Some parents try a different infant formula every few days, and this may not necessarily be needed. Sometimes, I just let the parents try switching formulas because the parents feel very actively involved in the problem-solving process, even if I am unsure that this will have results.

 In my experience, each baby has his/her own unique/idiosyncratic way of calming down. I have heard moms describe a wide variety of tricks- a baby may calm down only when held a particular way, rocked a certain way or when a particular song is sung to them. When my own baby had colic, the only way to calm her down was to take her outside into the fresh air. What works for one baby, may not work for another baby. Once you figure out what maneuver/action calms your baby, then you can use it to calm down your baby every day.

Caring for a colicky baby can be extremely frustrating. So, be sure to take care of yourself too. Don’t blame yourself or your baby for the constant crying — colic is nobody’s fault. Try to relax, and remember that your baby will eventually outgrow this phase.

In the meantime, if you need a break from your baby’s crying, take one. Friends and relatives are often happy to watch your baby when you need some time to yourself. If no one is immediately available, it’s OK to put the baby down in the crib and take a break before making another attempt at consolation. If at any time you feel like you might hurt yourself or the baby, put the baby down in the crib and call for help immediately.

This blog is our third part in a three-part series on infant care. Please read about breastfeeding and bonding with your newborn baby as well, for more information.

 

Everything Soon-to-be Moms Should Know About: Breastfeeding

By Shilpa Vernekar, M.D.

Along with the excitement of seeing the positive pregnancy test, sharing the news with friends and family, finding out the baby’s gender and decorating the nursery in pink, blue or neutral colors, expectant moms tend to do feel anticipation and nervousness about parenthood. First-time moms-to-be may be especially anxious about the topic of breastfeeding. Many may have preconceived ideas about whether to bottle feed or breast feed stemming from the way that their own parents did things, the thoughts and opinions of friends and coworkers or research on the Internet regarding the pros and cons.

In addition to considering these opinions, it is especially important to select a pediatrician for your baby during the third trimester of pregnancy, according to the American Academy of Pediatrics. A pediatrician is well-equipped to address concerns with expectant parents and to answer any questions related to newborns, including questions regarding breastfeeding. At Preferred Medical Group, we are happy to meet expectant parents before the baby arrives. We arrange a private tour of our office and a one-on-one meeting with one of our pediatricians, who will become an advocate and resource for your family during this exciting journey

.Breastfeeding

 

Here are some of the most common questions, which we are asked during Expectant Parent Meet-and-Greets, as well as our advice for you:

Should I breast feed?

First, relax, and take a deep breath. All mothers for the past thousands of years have done it. Long before formulas became available and mainstream in the U.S. in the 1980’s, breast milk was the only option available. It still is the only option in developing countries.

You have always heard how breast milk is the best milk for your precious little one and not only provides adequate nutrition but also promotes and strengthens the bond between you and your baby.

So should I breast feed? YES, you should.
The exception would be medical contraindications, which are few, and will be brought up by your OBGYN.

Is it best for my baby?
You know the answer already. Yes, it is. Breast milk offers all of the nourishment and nutrients that will benefit your baby. In this instance, natural is certainly the best option.

So what are the benefits for my baby?

  • Breast milk meets the nutrients and water requirements that your baby needs.
  • Breast milk undergoes changes in composition and quantity with your baby’s growing needs.
  • Many studies have shown that colostrum (the milk that is produced during the first few days) and breast milk helps to strengthen the immune system, as all maternal antibodies are transmitted in the breast milk, providing protection to the baby until he/she is able to produce these antibodies independently.
  • Babies who have been breast fed have been noted to have fewer respiratory, and gastrointestinal illnesses.
  • Additionally, babies who are breast fed experience a decreased incidence of allergies and asthma.

Are there benefits for mothers as well? Absolutely.

  • Breastfeeding promotes a sense of wellbeing and satisfaction.
  •  It helps the uterus to return to its pre pregnancy size, and because the body uses calories to produce breast milk, it helps moms to lose baby weight more quickly.
  • Exclusive breast feeding for the first few months may also protect you from pregnancy during those months.
  • With an additional member to the family and an increase in expenses, breast milk will help you save money that would otherwise be spent on formula, bottles and cleaning agents.

So, how long should I breast feed?
The American Academy of Pediatrics recommends breast feeding exclusively for the first 6 months of your baby’s life, and then as desired by baby and mother.

How will I able to do it?
Breastfeeding comes naturally. Your body has been working hard to keep the milk ready as soon as your baby arrives. It is available 24 x 7 on demand and in as much quantity as your baby needs. There is no need to clean bottles, no preparation, no mixing or measuring the right amount of water and formula. Unless there are medical reasons, your body produces breast milk that is sufficient for your baby. Working mothers can pump and store breast milk for future use.

It may seem hard in the beginning, but most good things in life don’t come easily. After all, you want to provide the best for your baby, and there is nothing that will or ever can top the list -other than breast milk.

Please check this website again, as we will be publishing two more parts to this blog series for expectant parents in order to address common questions and concerns, including colic and bonding with your newborn baby. However, we recommend scheduling a discussion with your baby’s pediatrician to discuss your individual circumstances in further detail.

Dr. Vernekar, M.D., F.A.A.P. is a board-certified pediatrician who works at Preferred Medical Group, which has locations at Phenix City Children’s and Fort Mitchell Clinic. Her special areas of interest include weight management and nutrition.

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