FAQs

1. Why is my child constantly getting sick?

   One of the unfortunate consequences of having a relatively immature immune system, as young children and infants do, is that they get sick, sometimes repeatedly. Newborns who are breastfed have the advantage of continuously receiving, in their food, a steady flow of macrophages (germ ingesting white cells) and secretory IgA (a host of immune proteins found in all breast milk that stick to the mucosa, or lining of the baby’s GI tract, from mouth down to the intestines). As little as three months of breastfeeding confers up to a year of protection to germs that MOM was exposed to over the course of her life. Even bottle fed babies receive, through the placenta, a wide array of IgG antibodies (another type of blood borne immune proteins) that can protect them for several months’ time. The age of increasing exposure begins at 6-9 months, when infants begin crawling all over the floor, touching everything in sight, and putting their fingers in their…..yes, mouths! From this age through the preschool years, the combination of waning maternal immunity and massive microbial exposure inevitably leads to frequent infections, both respiratory and GI. This as you may have heard me say is that proverbial silver lining. It’s a nuisance to see your pediatrician too many times, and an added expense, but remember that each time your son or daughter gets sick, his own immune system is creating a new antibody, which he or she will have for life! It’s the rare child who has a true immune deficiency. The typical AIR (annual illness rate….I just made that up) is 6-8 for home-kept kids and 10-12 if in school or daycare. See FAQ #6 for some guidance on the need for an office visit vs. phone advice/home care.

2. Should I use anything on my baby’s skin?

   In utero, before an infant is born, she floats in amniotic fluid. This physiological solution is perfectly suited to cushion the baby in the womb, and is absorbed within the fetal skin. After birth, babies are born with this fluid on board, and in a sense are somewhat over- hydrated. But in the ensuing 3-4 days babies excrete this excess fluid through the kidneys, in the form of urine. This is why we expect a drop in weight during these first days of extra uterine life, often of 6 or 8 oz or more. This process, often leaves the skin dry-appearing, particularly the legs and feet. If it’s mild, you can do nothing. If it seems excessive, or there is cracking of the skin at the creases, use a hypoallergenic moisturizer, like Eucerin, Cetaphil or Lubriderm. It’s also not a bad idea to use a coating diaper area product, like Balmex, or A&D. Avoid powders, because of the risk of lung inflammation from inhaling powder particles. Corn starch is an old time tradition that’s OK.

3. How do I know if I should have my child seen in the office?

   The answer to this, if our nurse Alice is not available to help you decide, most often has to come from the parent. I often hear a parent apologizing to me after a child is seen in our office and turns out to “only” have a virus! There is never a need to apologize! I know folks don’t want to come in unnecessarily, but there is a reason we have a same day visit policy at our office. I place much weight on a parent’s, particularly a mother’s intuition (sorry dads...) about her child and his behavior (sorry dads!) Often a child who may seem on the phone to have a cold, ends up on antibiotic treatment for a mild pneumonia or ear infection once actually examined in the office. On the other hand, a very irritable baby with a cold sometimes has just that, a cold! We are trained to ask you the appropriate questions based on the age of the child, and to evaluate your answers and redirect to more questions in order to help you decide if a visit would be a good idea. This is called medical triage. This website is or will be linked to a symptom/illness algorithm that was designed by a wonderful pediatric expert and author, Barton Schmitt, MD. In general, the younger the child the more caution we exercise when making recommendations for home vs. office vs. hospital care. Trust your gut instinct, and if we give you home recommendations, but you are not comfortable without us taking a looksee, you have the right to request a visit anyway. As your confidence in both your own judgement as a parent, and in us as your medical home builds, your anxiety about your child’s illnesses will begin to fade. Ours (parent and doctor) is a shared responsibility; clearly we both want to do what’s right, and we are here to help you.

4. Should I cancel my flight since my infant has an ear infection?

   In general it’s not a good idea for anyone to fly with an active middle ear infection. The key words here are active, and middle ear infection. If I saw your child at 9 this morning, and I used the words “bright red“, or “pus” being behind the eardrum, do yourself and your child a favor and postpone! This indicates that an active, or acute infection is present. On the other hand, if there is clear or “amber” fluid there, and your child is not in a lot of pain, then there’s more flexibility, particularly if your child is a little older. Then you as a parent have to decide if you are willing to live with the slight risk of a perforation of the eardrum, hemotympanum (bleeding into the middle ear space) or severe pain. I can tell you that I have flown with my own child who had a non-acute ear infection and had no problem, but as a pediatrician I can’t very well sue myself, now can I? I did however premedicate with ibuprofen and a decongestant. If you press me I would have to err on the side of caution and advise against it in either case.

5. Why didn’t I get antibiotics from you for my child’s respiratory infection?

   This comes up literally every day I practice pediatrics. You already know the short answer….because she has a VIRUS, and viruses do not respond to antibiotics. There ARE a few antiviral antibiotics which are used to lessen symptoms, not cure the illness, for example influenza, chicken pox and RSV. The vast majority of respiratory (and GI bugs for that matter) are NOT treatable. In certain situations a viral infection can lay the groundwork for a bacterial infection, like sinusitis, otitis (ear infection), or pneumonia. In this situation an antibiotic is usually prescribed. I say usually because more recently, we, as Americans are now following the lead of our Scandinavian colleagues who for years have been deferring antibiotics for ear infections under certain specific circumstances.
   This is done because, statistically, upwards of 60% of ear infections end up clearing on their own, even without antibiotic treatment. If you, like myself, are interested in decreasing the likelihood of inducing a resistant strain of bacteria, and your child is over 2 years old, and has a mild to moderate infection, talk to me about the option of using the “watchful waiting approach”. If this is done you would just use Tylenol for discomfort, and the followup visit will be scheduled for 3-4 days, rather than the usual 2-4 weeks.

6. I’ve noticed that my baby who ate so well before she turned a year old is now hardly eating anything. When do I need to worry about her not eating enough?

   Once the transition is made from the bottle at age 12 months to soft table foods, some parents DO notice a drop in intake of solids. This is normal, and expected. Be patient, offering the good quality foods that you (should!) eat together as a family. This is a good opportunity to fine tune the family’s nutrition as a whole! When we plot your child’s height, weight and BMI on the growth charts in the office, we will be able to tell you with confidence whether or not the growth parameters are of concern. Any time you want a copy of the growth chart to take home, we’re happy to do it. This may help you to worry less if your child is picky, in which case we can suggest a multivitamin or other supplement.

   Include several ounces per day of high quality proteins, like organic beef, chicken, fish, legumes, like beans (serving beans with rice constitutes a complete array of amino acids, the building blocks of protein), lentils and chick peas. Use olive oil liberally and be moderate with salt in your cooking. Try whole wheat pastas and brown rice, whole grain breads (and pizza!) to maximize nutrients. Expect your child to eat what you serve, but allow him to decide on the AMOUNT. Just don’t allow him to hold out for the refined sugars that exist in cookies, cakes and other low nutrient treats afterwards. Keep healthy snacks readily available, like cheese, real yogurt, fruits, dry cereals and crackers. Avoid or minimize fructose-laden snacks like fruit rollups, gummy bears and juices. You will find that your child will get used to good, healthy foods. You will be doing him a lifelong favor by “training” his taste buds to appreciate the simpler and more nutritious food habits of our ancestors, without developing a taste for foods high in fat, sugar, and salt. I don’t have to remind you of the tremendous epidemic of obesity and heart disease that our country is currently facing.