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'pediatric' Parentelligence posts

Introducing solids to your infant

As your baby grows, you’ve probably started wondering when and how to start feeding your infant solid foods. Here are some general tips to consider:

Is there a safe age to start feeding solid foods to my infant?

Yes, most infants this is between four and six months of age.

Why is there a ‘safe’ age to start feeding solids?

There are a few reasons why this age is safest. The first reason is because prior to four months of age, an infant is not developmentally ready to safely eat from a spoon.

To be able to swallow solids safely, an infant needs good head control; to be able to sit well with support; and to have lost the “extrusion reflex” (the reflex which enables newborns to tightly latch and suck from a nipple, but makes them shove a spoon out of their mouth).

The second reason an infant should be fed solids between four and six months is something many families are not aware of: it is also a strategy to prevent common food allergies. This is one of the strongest reasons I passionately advocate for infants to be exposed to as many foods as possible during this crucial three-month window.

Starting solids and preventing food allergies:

In the past, healthcare providers have advised parents to avoid potential allergens such as peanuts, eggs, and milk. New evidence is now showing that this practice might have played a role in the increased incidence of childhood food allergies in the U.S

Why might this occur? The ...

Hernias: why are some watched while others are repaired?

The most common thing that I see as a pediatric surgeon is a child with a lump that is thought to be a hernia. A hernia is a bulging of tissue through an opening in the muscle layers that isn’t normally present. In children, these openings are usually the result of a developmental process that just didn’t quite reach completion. Some hernias need surgery emergently, while others are observed for years with the expectation that they will close on their own.

Here are some pointers to help understand this wide range of approaches to hernias:

Location is very important in considering how aggressive to be with hernias. Belly button (umbilical) hernias are...

Constipation during infancy

As a pediatric surgeon with a special interest in intestinal issues, I am often contacted by worried parents regarding their baby's infrequent bowel movements. This can be caused by a variety of
problems such as blockages of the intestines or abnormal intestinal function (including a condition called Hirschsprung's disease); but most frequently babies are just efficiently absorbing and thus not needing to poop very often. This is especially true for breastfed babies. So, how can a parent tell the difference?

I would offer the following "red flags" as issues that may indicate a problem needing further medical evaluation:

Fixing Chest Wall Deformities: A Minimally Invasive Option

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

Vomiting in the newborn: when is spit-up something to worry about?

I have never met a baby that didn't on occasion spit-up. Many perfectly healthy babies can even spit-up quite a bit. Reflux is often the label given to babies who vomit, and this rarely amounts to a significant problem.

However, there are a few things that a parent should watch out for:

The most important thing is the color of what a baby is throwing up. Dark yellow and especially green vomit is never normal in a baby and demands immediate medical evaluation as this could represent a dangerous twisting of the intestines (midgut volvulus), which is linked to abnormally positioned intestines (intestinal malrotation).

Another consideration is quantity. If a baby is throwing up...

Sweet Dreams?

Sleep is just as important to child development as a healthy diet and exercise, although it is one of the most commonly overlooked aspects of a child’s life.

As adults, most of us can mutter through on little sleep for a day or so before we get unbearably grumpy, but with kids, their bodies are growing and connecting neurons in the brain all the time. Sleep is absolutely critical for healthy development.

While they sleep their brains are processing and sorting everything they learned that day, and that’s not just the stuff they learned at school; their bodies are honing their fine motor skills and processing the social interactions of the day.

To make sure your child is getting the proper amount of quality sleep, here are some tips:

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