We Asked a Pediatrician About Your Most Common Questions and Concerns

There's a fear of breast-feeding, and unfortunately it seems to be potentiated through other moms. Complete strangers will come up to you and tell you how hard it is to breast-feed, or unfortunately, through previous generations, where everyone was formula-fed. I find there's a lack of support from a lot of grandparents about breast-feeding. The sixties and seventies were the formula age, and unfortunately it was a confusing time. Even pediatricians were recommending formula then. So sometimes there is a real lack of support for it. Parents come in when they're finally faced with this little creature and actually getting them to nurse, and they aren't really sure there's anything in there. It creates a lot of problems.

Nurses in the hospital are trained to try to get the baby on to the breast every two to three hours, and sometimes the message that comes across to the parents is that the baby has to eat every two to three hours, and that's not the case. So on that first day I can usually fend off some anxiety by saying to them, "I expect him or her to sleep for the next 23 hours after birth." And often they say, "Phew, I thought she had to feed every two hours," and right there breast-feeding is set up to fail on that first day.

If you can get in there early and tell parents what's normal, what to expect, then you can take away that anxiety. I think a lot of [breast-feeding difficulties] have to do with anxiety, and if you can reduce that anxiety it just works out so well, which is evident by the second and third child, when everyone knows what they're doing and the breast-feeding goes so much better. The more anxious a mom is, the longer time it takes for the milk to come in. There's a whole mental side to breast-feeding. If you're very anxious, you're not going to have an adequate let-down. If you don't feel like you're providing this nutrient to your child, it's probably not going to happen. Reassuring new breast-feeding mothers is a huge part of what I do.

Some parents come in having read everything. I call them "over-read." They come in and say, "I'm going to breast-feed for the first year because that's what everybody says." But if you start off on Day One saying you're going to breast-feed for a year, that's kind of daunting. Whereas if you just set little goals, saying "OK, I'm going to make it through the first week," then "I'm going to make it through the second week," then "OK, let's shoot for two months," then it's easier.

We know that babies do, in fact, grow in spurts, and the first one happens around Day 10 of life. And if you're warned about it then you know what it is, but if you're not warned about it you think your milk has dried up or that you ate something that disagrees with the baby. [During a growth spurt] all of a sudden they cluster-feed. After having established a nice pattern of feeding every two to three hours, they suddenly hit this growth spurt and grow up to a centimeter in one day, which is like you or I growing a foot. And they feed every hour for seven hours and you don't even have time to refill. Even when you know what's happening it can be overwhelming. And then, like teenagers going through a growth spurt, they sleep. So the next day you get a bit of a break. Just some basic knowledge can help parents get through and allay some of their anxieties.

So many things bother the parents, but the baby isn't bothered one bit. I follow the same rule for pediatric dermatology, because skin concerns are a huge subject during well-baby visits. Usually the parents are bothered, but the baby is fine with it.

Lots of infants are different, and many of them don't like their baths too much. Really the only reason to bathe an infant is to get rid of the buildup of sebaceous secretions that occur in the skin folds in the neck and the arms. So really there's no absolute requirement for doing it. If parents feel the need to do it on a daily basis it's OK, but if the baby's skin is drying out, because bathing really does dry out the skin, then I usually ask them to back off. My general statement is to do it maybe once a week. It's almost as if I'm giving them permission to bathe them less often. If their child likes it and it's an enjoyable thing, great, but so often it's a struggle and I think a lot of parents would be happy to find they only had to bathe the baby once a week.

As soon as you're a parent, the marketing world descends on your fears and knows exactly what they are and capitalizes on them. Special detergents for babies are a good example. You don't need a special detergent. The Tide or Cheer you've been using are just fine. The same thing is true of soaps and lotions for babies. Johnson & Johnson Baby Magic is fine, but so is plain old Dove unscented soap. And it is unfortunate because they charge an arm and a leg for something that's "baby approved." My advice is to stay away from soaps and lotions for about the first week. Babies come out and their skin dries and they actually, for lack of a better analogy, kind of "molt" around their arms and legs. The top layer of their epidermis comes off and that can be quite concerning. Parents want to do something about it. There are lotions that you can use, but 15 minutes later the skin looks the same way. The umbilical cord can also be a source of anxiety in the first week. We actually don't do anything with it anymore. It used to be that we put alcohol on it, but it turns out that just makes the cord stay on longer. You try to keep it dry until it falls off.

This is something where we get some interference from the grandparents, who say, "Everyone was put to sleep on their tummy and you all survived." Obviously not all of SIDS is caused by this, and those other causes are being investigated. Two to 4 months used to be the peak age for SIDS. After 4 months, a lot of it is suffocation with inanimate objects, those kinds of things. We don't recommend bumper pads in the crib anymore. There is no reason for a bumper pad in a crib. Unfortunately there have been some very active young babies who have gotten their heads in between the bumper pad and the crib and basically strangulated on it, or the straps that are used to tie them on have become wrapped around little fingers or toes.

Somewhere around 6 weeks or so you can try to fit yourself into a schedule. There's something called the five-minute rule. It's used with breast-fed babies, and it starts around 6 weeks. That's about when babies can start to spread out their sleep at night. In a study published in Pediatrics in 1993, two researchers asked a group of moms to give their babies a really good "focal feeding" between 10 and midnight — a full 20 minutes on one breast, or 10 minutes on each breast, and then put the baby down. Then, when their babies woke up for that 1 or 2 a.m. feeding, they asked them to try a "five-minute rule." The parents could do anything except feed the baby. So this isn't the "let them cry" rule that people talk about later on, but the parents would go into the room, pick them up, hold them, rock them, change the diaper, do whatever they could to calm them for five minutes. If they weren't crying lustily afterward, they put them down in the crib to see if they could go back to sleep without a feeding. What they were doing was training [the babies] to not take a feeding, because for his entire life — 4 to 6 weeks — he's been fed every two to three hours. Now his liver is mature enough to store up sugar and make it through the night, but he just doesn't know it. So this five-minute rule helps them to know that.

In the study they compared the group doing this to a control group, and all the babies in the five-minute group were sleeping through the night (which they defined as six hours) at 2 months of age, whereas only 40 percent of the control group were sleeping through the night at 2 months. Some babies just fall into this pattern on their own, of course, but this can be very effective for many nursing babies.

Children start this usually in the evening, somewhere between dinner and bedtime, between 6 and 9 at night. So breast-feeding moms will invariably blame what they ate for dinner, and they'll be making all sorts of dietary changes. The children are pulling up their legs and doing all sorts of "gassy" things. Every culture has a cure for this. I had some parents from Britain who brought me in a bottle of what they call "gripe water," which is the British cure for colic, and we have Mylicon. The Chinese use a couple of herbal extracts, and my Indian patients have chamomile tea and chamomile drops. Every one of these has been studied and shown not to do a thing compared to a control group. But sometimes when children are colicky like that you feel like you just have to do something. So if you want to spend the 12 bucks on the Mylicon so you can do something, it's OK with me. It doesn't have any side effects, and it really doesn't have any proven benefit. When they gave a group of parents who had what were defined as colicky babies sugar-water and Mylicon, and they didn't know which they were giving, 33 percent of the babies in each group got better.

Every pediatric specialty thinks they might have the cause for colic. Gastroenterologists will look at the intestinal motility of infants and say "OK, the intestinal motility and peristalsis, which is the ability to move food smoothly through the intestines, are markedly different between about 2 weeks and 3 months, which correlates with colic."

We also know that if you look at a child's growth chart, it's really steep between about 2 weeks and 3 months. If you've ever had an older child experience growing pains, when do they have those pains? Between 6 and 9 o'clock at night. So there is some theory that some of colic may actually be bone pain. So in terms of the causes of colic, if anyone tells you they know, they don't know. It's one of those things where we just look and try to find it out. We do know that it's self-limiting. It goes away by 3 months.

As a pediatrician, you have to make sure that that's all you're dealing with. There are all kinds of things you have to worry about, from child abuse, shaken baby syndrome, to a hair tourniquet, where a piece of hair got wrapped around a finger, but these are all things that you get through the history. If you bring a baby in who's gaining weight and is fine the rest of the day, then you know what you're dealing with, and you just have to reassure the parents that this will go away. Because it starts at 6 p.m, I've had dads who start spending more time at work. It can affect relationships and marriages. I've had moms tell dads to change colognes, because it happens right when they get home. It's a difficult time. As long as parents know it's not their fault, it provides a lot of reassurance because there's a lot of anxiety that goes through parents' minds.

For first-time parents, there isn't a lot of gear that they really need. We don't even have a list that we give out. We recommend having a really good thermometer and some Vaseline. I don't recommend the ear thermometers because the infant ear canal is so small and curvy that you can't get an accurate reading from the ear thermometers. I recommend a digital rectal thermometer. We have to make some pretty big decisions based on temperature. A child who gets a fever under 6 weeks is automatically back in the hospital. And so for me to make that decision, I really want a rectal temperature. We show how to do that in the office or even in the nursery. The babies are fine about it. It's really the parents who are cringing.