Second Opinion: Co-sleeping

Co-Sleeping

I remember the tidal wave of emotions I felt after the birth of our first child. The fear and sense of responsibility driving home from the hospital. The sense of wonder watching him gaze at his surroundings. The joy in my heart seeing him coo or smile. Except for the times he had projectile vomiting, I wanted to be around this little guy all the time, awake or asleep. And so I was first confronted with the issue of co-sleeping.

Let’s first define what co-sleeping is in regards to this article.  Co-sleeping is when a parent sleeps next to his/her infant in the same bed. (Incidentally, my least favorite form of co-sleeping is in a motel room with family — usually because there is little sleep.)

What are some of the potential benefits of co-sleeping? Moms may not need to get out of bed to breastfeed. It may deepen the relationship between mother and child. And some may sleep better in this arrangement.

But studies indicate there are pitfalls to co-sleeping as well. The most important potential danger is SIDS (Sudden Infant Death Syndrome). Co-sleeping becomes more dangerous when parents use tobacco or alcohol or when a parent is overly tired or sleeps on a couch. The United Kingdom Department of Health advises that the safest place for an infant to sleep is in a crib in the parents’ room for the first six months of life. Similarly, the American Academy of Pediatrics, in a November 2011 report, recommends that baby can sleep in the same room as parents, but not in the same bed. Sharing a room is OK, but sharing a bed is not.

Let’s re-examine some of those purported benefits. If co-sleeping works while baby is small, fast-forward a year to when that toddler needs to graduate to his or her own bed — that could be a more difficult task. There are other ways to bond, as well: taking a walk, reading a book or playing games.

And on a related note, please place your baby on his or her back to sleep, and avoid blankets and toys in the crib (please see healthychildren.org for more information). The above AAP report also notes that immunizations and breastfeeding are associated with a lower incidence of SIDS.

Many mothers go the extra mile in pregnancy, avoiding over-the-counter medications, caffeine, soft cheeses and fish. Parents fill their homes with safety latches, gates and CO2 detectors. I would challenge parents to think of co-sleeping as a similar safety issue, where good choices can potentially save lives.

David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He co-sleeps with his pager, and he is happily married with three children.

Second Opinion: Antibiotics

“But antibiotics taste so good”

It is a hassle to see the doctor.

The first battle typically involves the phone system. With carefully orchestrated options designed to keep you from reaching an actual person, it can be a minor miracle to reach the scheduler. Then, does your schedule match an opening for your doctor, if she or he has one?

Next up: the waiting room.

If your child wasn’t truly sick before arriving there, licking the waiting room toys might cinch the deal. When you are finally called back to the exam room, there is some momentary excitement, until you surmise that this is actually another smaller waiting room.

And don’t get me started on the redundancies of disclaimers and insurance paperwork.

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I know what you’ve been through to get to see me. And I want to try to redeem the experience and make it as positive as possible. That doesn’t necessarily mean I’ll prescribe an antibiotic, however. Sometimes an antibiotic may be harmful rather than helpful.

Let’s take sore throats for example.

What percentage of sore throats are caused by strep bacteria and will benefit from an antibiotic? Only about 20 percent. The remaining are caused by viruses, and an antibiotic will not help.

And what about the color of mucous — is this important? I don’t like that green nasal drainage running down your child’s face either, but it turns out that whether it’s clear or colored does not matter. The color is caused by inflammatory cells, called neutrophils, that are present in both bacterial and viral infections.

Many bacterial infections are going to be self-limited. If a child is found to have an incidental ear infection, but is feeding well and not lethargic, he or she can probably get away with observation. A sinus infection should not be treated with antibiotics unless the patient has severe pain or symptoms have progressed past one week.

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A study that affected how I prescribe was published in The Journal of Family Practice in 2000. It evaluated using a “backup” prescription, instructing families not to fill this unless the patient’s condition deteriorated or failed to improve. I may use this when an ear infection is mild, or if a sinus infection has not progressed beyond a week.

Sometimes people will request another antibiotic because the first one didn’t cure their infection, but it may be that the patient simply has a viral infection that just needs to run its course.

Why are physicians passionate about this topic? Possibly because contrary to the goal of the Hippocratic oath, they have done harm at times with antibiotics. Little Johnny may have had the sniffles before, but now with the help of antibiotics, he’s really got diarrhea and a diaper rash to boot. Antibiotic resistance (think MRSA) has proliferated with overprescribing. If you have a strong stomach, Google “Stevens-Johnson Syndrome” and you can see some of the dangerous rashes (and accompanying trial attorneys) that can rarely result from an antibiotic.

Now don’t get me wrong. I love the great taste of pink amoxicillin suspension as much as the next guy. But these medicines are a double-edged sword that need to be used at the right time in the right situation. So please don’t demand them.

And maybe I’ll see you in the waiting room with my own children, hoping to graduate to the next, smaller waiting room. We’ll try not to lick the toys.

 –David Pommer, M.D. is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

2nd Opinion: “Screen Time”

 

 

 

 

 

 

 

 

 

 

 

 

By Dr. David Pommer for Playdate magazine

OK, I confess. I have not been a perfect role model about “screen time” with my patients and my family. But I think this is important to discuss as summer comes to a close and many of us retreat indoors.

What is screen time? The American Academy of Family Physicians defines this term as “watching television or DVDs, playing video or computer games and surfing the Internet.” A few years ago with patients, I would primarily ask about TV and video games, but now I need to inquire about cellphone screen time as well. As I will detail below, more screen time correlates with worse health.

Let’s take a quick self-assessment to see if this may be an issue with your family.

1) Do you use television as a baby sitter so you can get other things done at home?

2) Have you misplaced your library card months ago? … Or do you first check out the video section at your local library?

3) Do your children feel that happiness comes at Redbox?

4) Have you heard your child repeat a phrase in conversation that they likely heard from TV (for example, when I heard my son state “it’s fun for the whole family” when he wanted my wife and I to buy something, I knew he had been sitting too long in front of the boob tube).

If you answered “yes” to any of the above, keep reading.

According to a 2010 Kaiser Family Foundation study, the average child spends 7 1/2 hours per day in front of a screen. Another study broke this amount into about four or more hours of TV, videos and/or DVDs, more than one hour of computer time, and almost one hour of video games. Two out of three children ages 8-18 have a TV in their bedroom. And those kids who have a TV in their room watch almost 1½ hours more television per day than those who do not.

The consequences of this excessive screen time are more sobering.

The more time kids spend in front of a screen, the higher their risk of obesity. Obesity rates are lowest in children who have less than one hour of screen time per day, while they are highest in kids with greater than four hours per day. Screen time may also negatively affect body image and school performance and may correlate with increased violent behavior.

What is our remedy?

The American Academy of Pediatrics recommends limiting screen time to no more than one to two hours of “quality programming” per day. If there is a TV in a child’s room, I would recommend removing it. Use parental controls on your computer so a child has a set limit before he or she is logged off. Establish a “token economy” where kids need to earn their 1-2 hours by chores or reading earlier in the day. Though your children will not thank you now, hopefully their brains and waistlines will thank you in years to come.

David Pommer, M.D., is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

Is my baby’s head normal?

By Laura Reed

Physical therapists at Children’s Village see up to six new babies every month who are sent by their doctor because they have flat heads. It is estimated that one out of every 50 babies will experience this condition, called plagiocephaly.

Although there are many reasons why a baby’s head may become flat, many cases are preventable. In all cases, it’s important to seek treatment because plagiocephaly can negatively affect your baby’s developing vision, hearing and movement.

Why is my baby’s head flat?
There are many reasons why a baby’s head becomes flat. Twins or triplets are more at risk due to the limited space they have to change position in utero. Premature birth, low muscle tone or birth complications may place a baby at higher risk. Sometimes babies have medical or skeletal issues that have caused this.

Unfortunately, some of the things that give us convenience are also to blame for many cases of plagiocephaly. Babies now spend much of their time in infant carriers, baby swings and bouncy seats. You can imagine how a baby rests the back or side of his head when sitting in one of these devices. Prolonged pressure quickly causes a baby’s head shape to change; skull bones not yet fused together actually shift, causing his head to become flat.

What are the symptoms of this condition?
By the time a baby begins physical therapy at 6 to 12 weeks of age, the flatness often is very noticeable and the baby also has uneven eyes, ears, nose cheeks, forehead and jaw.

Muscles in the baby’s neck may also become tight, making it hard for her to turn her head one way, a condition called torticollis. The combination of these conditions makes it difficult for your baby to look to both directions, reach with both arms, and roll to both directions. It makes it difficult for your baby to raise his or her head when on his or her tummy.

If untreated, a baby could experience a “head tilt” posture that does not go away. Alignment of the eyes, ears and jaw may be affected as well as the shape of the skull. Vision and hearing also may be impacted, as well as motor coordination and balance.

How can I keep my baby from getting a flat head?
Prevention is the easiest treatment. It’s really pretty simple!

First, to decrease the risk of SIDS, always, always have your baby sleep on his back. And, always have your baby secure in his car seat when riding in a vehicle. However, when the baby is not sleeping or riding in a vehicle, here’s what you can do:

• Give your baby lots of time on her tummy when you can closely supervise her. Place your baby on her tummy, helping her to prop on her elbows several times a day, for short periods of time.
• Use a front pack or baby sling for baby-wearing, versus a bouncy seat, swing or infant carrier. Limit time spent in car seats to only those times when your baby is riding in a vehicle.
• Change the way your baby’s head is positioned when sleeping. For one nap, turn his head toward the left. For the next nap, position his head in the middle. For the next nap, to the right.
• Encourage your baby to look to the right and the left by giving her lots of things to watch with her eyes.

What should I do if my baby’s head seems flat?
You should talk to your doctor immediately if you notice that your baby’s head is flat, or if she prefers to turn her head one way more than the other.

Your baby will be evaluated for any tightness of neck muscles, limitations of movement and abnormalities of the skull.  The therapist will provide you with stretching and positioning exercises to perform several times each day.

Depending on the severity of your baby’s torticollis and plagiocephaly, weekly therapy may be recommended. In addition, some babies will need to wear a helmet to re-shape their head.

Laura Reed is a pediatric physical therapist at Children’s Village in Yakima.

What are the benefits of probiotics during pregnancy?

What are the benefits of probiotics during pregnancy?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

Dr. Robel says: Probiotics, or friendly bacteria that reside in our gut, may increase fertility and reduce early miscarriage as well as help prevent eczema and allergies in infants, according to several recent studies.

Probiotics are found in yogurt and other fermented foods. They serve to protect us from infection and help prevent a wide range of health problems including constipation, diarrhea, colitis, irritable bowel syndrome, allergies and various skin problems.

New research is finding that probiotics may also be beneficial to women trying to conceive. In a study done in Belgium, supplementing with a probiotic while women underwent in vitro fertilization increased the rate of conception compared to women not taking the supplement. Likewise, several studies have found that women given a probiotic at the onset of pregnancy have lower rates of spontaneous miscarriage in the first trimester.

Besides the benefits to mom, there are benefits to your infant. Taking a probiotic supplement for the last three to four weeks of pregnancy may reduce rates of eczema and allergies by as much as 50 percent, according to a study published in The Journal of Allergy and Clinical Immunology.

Probiotics can be obtained by eating yogurt labeled as containing “live and active cultures.” Also, there are various supplements that can be taken.

Always speak with your health care provider before taking any supplements, including a probiotic, to decide if it is right for you. Also, not all supplements are created equal so it’s important to get a recommendation to ensure you are getting what your body needs.

— Heidi Robel, ND, is a naturopathic physician and acupuncturist in private practice in Yakima.
She’s expecting her first little one in August.

Will thumb-sucking harm my child’s teeth?

SECOND OPINION
by Ashley Tercero, DDS

Will thumb-sucking harm my child’s teeth?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

Dr. Tercero says: Non-nutritive sucking habits (finger or pacifier sucking) are normal in infants and toddlers. These habits help address a child’s need to feel secure.

Although normal and harmless for young children, non-nutritive sucking can result in long-term problems if persistent. Prolonged finger or pacifier sucking can lead to a permanent open bite and other dental and jaw deformities.

In order to prevent these problems, the habit must stop by age 5. However, the difficulty of ceasing this habit increases with age, so it’s best to stop the habit before age 3. If the habit persists beyond the age of 3, it’s recommended to see a dentist for professional evaluation.

— Ashley Tercero, DDS, is a children’s dentist at Yakima Pediatric Dentistry.
Her 7-month-old daughter, Kya, doesn’t have any teeth.

What is postpartum depression?

SECOND OPINION
by Ryan Moultray, D.O.

What is postpartum depression?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

You’ve just had a baby. You’re not sleeping, your hormones are completely confused, your body hurts and there is this constant crying noise in your ear. Who wouldn’t be a little depressed?

The “baby blues” are common, and usually develop within the first few days after birth. You might experience mood swings, anxiety, sadness and insomnia. This is a transient phenomenon and usually resolves without treatment within two weeks.

Postpartum depression is also common, developing in up to 10 percent of mothers, but often goes unrecognized. The symptoms can be nonspecific, including fatigue, sadness and crying, insomnia, feeling guilty or inadequate, being overwhelmed, poor concentration, decreased libido, anxiety and not wanting to do usually enjoyable activities. In rare and extreme cases, a woman can develop psychosis (a loss of contact with reality).

Treatment usually involves a combination of counseling, medication, exercise and spiritual or emotional support. Some women are more prone to developing PPD, so if you have a previous history of depression or other mental health issues, you may want to talk to your doctor before the baby arrives. Usually, a mother doesn’t have a follow up appointment with her doctor until six weeks after delivery. It’s important to seek help sooner if there are any concerns for PPD.

— Ryan Moultray, DO, is an osteopath at Selah Family Medicine. Will and Owen call him Dad.

Do children need to take vitamins?

SECOND OPINION
by Ryan Moultray, D.O.
and Heidi Robel, N.D.

Do children need to take vitamins? Read more

Do you recommend any vaccines for teenagers?

SECOND OPINION
by Ryan Moultray, D.O.
and Heidi Robel, N.D.

Do you recommend any vaccines for teenagers? Read more

What’s the difference between medical degrees?

SECOND OPINION
by Ryan Moultray, D.O.
and Heidi Robel, N.D.

I need to find a new family doctor. What’s the difference between an M.D., a D.O. and an N.D.? Read more

Are there any programs for overweight kids?

SECOND OPINION
by Ryan Moultray, D.O.
and Heidi Robel, N.D.

I am the parent of an overweight child (age 10). We have been actively looking for some type of class for children with this problem. I have called doctors’ offices, the YMCA and various gyms. I have been turned away at all places. With obesity beginning to be out of control for our youth, Yakima needs to start offering things. I know I am not alone. Children do much better when interacting with children their own age and who have the same problem. I am beginning to see her self-esteem go down. Is there any help you can offer? Or maybe you know of somewhere I haven’t looked. Read more

What’s the deal with peanut allergies?

SECOND OPINION
by Ryan Moultray, D.O.
and Heidi Robel, N.D.

A few weeks ago, I heard that you shouldn’t give peanut products to young children because of allergies. I’d never heard about this before and I give my kids peanut butter sandwiches all the time! What other foods should I know about? Read more

Should I give my child cold medicine?

SECOND OPINION
by Ryan Moultray, D.O.
and Judy Harvey, M.D.

I’m confused about the news regarding cold medicine for children. I have two preschoolers who have already had several colds this season. Is it OK to give them cold medicine? What else can I do to help them feel better? Thanks. Read more

What’s the difference between the flu and a stomach bug?

SECOND OPINION
by Ryan Moultray, D.O.
and Judy Harvey, M.D.

I often hear people saying they’ve had “the flu,” but I’ve always thought influenza was fairly rare — and very serious. What’s the difference between the flu and a stomach bug? Also, should my kids get a flu shot? Read more