FAQs

1. Who sees my newborn in the hospital?

   I will see your child within 24 hours of birth, and daily afterwards, either in the nursery or in your hospital room. If the baby has been seen at least twice in the hospital, the first office well visit is at 1 week of age. However, if mom is discharged early, and I only see the baby once in the hospital, then I will need to see the child in the office within 2-3 days. I am on staff at Boca Regional and West Boca hospitals.

2. What's new with sun protection?

   I thought it might be a good time to revisit sun protection.  As Floridians, we all need to be up on the latest information on protection of our skin and eyes, from the damaging effect of the sun’s rays, while also sensibly enjoying our great outdoors.


   There are newly revised FDA regulations on sunscreen labeling when you purchase products now. You may notice the term “Broad Spectrum” on the bottle or tube. This indicates good protection against sunburn, skin cancer, and premature skin aging. This is the labeling you want to look for. In addition, the terms “sweatproof,” and “waterproof” are not allowed. Sunscreens MUST be reapplied periodically, and especially after getting wet.

   The American Academy of Pediatrics suggests avoiding using products containing oxybenzone, an active ingredient in many sun protection products, until we have more information on its potential long-term effects in children. Instead, use products containing titanium dioxide or zinc oxide.  Although generally zinc oxide is considered safe, can have a healing effect on the skin, and boost immunity, there are some questions about its safety in children when used as a formulation of nanoparticles (very, very miniscule particles of the compound.) This relatively new technology allows it to go on the skin less thick and pasty, more creamy and easy to apply.

   As my grandfather always said (who, despite surviving skin cancer in his 90’s died of natural causes at age 104!), “in all things, moderation.”  The bottom line is, too much sun we know can be very bad. Too little sun can also be bad (we need the sun to help our skin produce vitamin D.) It is also possible that overdoing certain sunscreens may be bad in children, we just don’t know for sure yet.

   So, what to do? Get your children outside, but use common sense! If your child is going to be out in the sun for more than 20-30 minutes, use a recommended sunscreen, and get the kids used to sunglasses from an early age, as well. Try to apply it 15-20 minutes before going outside. You can use it on a baby under 6 months, but only on the uncovered parts of the body, and test the skin first by applying to a small area. For more information go to:

   http://kidshealth.org/parent/firstaid_safe/outdoor/sun_safety.html

3. 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 #7 for some guidance on the need for an office visit vs. phone advice/home care.

4. My 14 month old daughter seems to want to eat whatever we’re eating. Are there any foods I shouldn’t give her? I am so afraid of choking.

   You can give her any foods you eat, so long as they are mushed or diced up so she won’t choke. Certain things like crackers and Cheerios dissolve in the mouth fairly quickly. Start with little bits at a time and see how she handles it with you close by. Don’t give hard fresh fruits, veggies, popcorn, or nuts, as they can easily break up and catch in her airway. Introduce new foods slowly if there is a family history of severe specific food allergies such as milk, egg, shellfish, wheat or nuts. If you’re concerned about choking it might be wise to take an infant first aid/CPR course; they can be found at your community hospital’s Education Department, fire stations or online.

5. 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.

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

   The answer to this has to come from the parent, but in collaboration with our office. 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 a lot of weight on a parent’s intuition. 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 hosts symptom/illness algorithms and medication/dosage schedules developed by a wonderful pediatric expert and author, Barton Schmitt, MD. This is located on the lower left-hand corner of the homepage.

   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 can certainly request a visit anyways. As your confidence builds in your own judgement as a parent, and in us as your medical home, 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.

7. 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.

8. 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.

9. 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.

10. Is it ok for my family to eat fish? I am worried about the mercury.

    There are tremendous benefits to including fish in your families diet. These include decreasing lifetime risk of high blood pressure and stroke. The FDA recommends at at least 8 ounces of seafood per week based on a 2000 calorie diet. For an adult, one serving is 4 ounces (about the size and thickness of an adult’s palm). Adults should eat two to three servings a week from the “Best Choices” list (or one serving from the “Good Choices” list). For children though, one serving is only 1 ounce at age 2 and increases with age to 4 ounces by age 11. Women who are pregnant or breastfeeding should consume between 8 and 12 ounces of a variety of seafood per week from choices that are lower in mercury.

    The 36 types of seafood on the best choices list include salmon, shrimp, pollock, canned light tuna, tilapia, catfish and cod, flounder, haddock, crab, clams, and sole. Nineteen varieties make the good choices list and include bluefish, halibut, mahi mahi, grouper, monkfish, rockfish, snapper, and striped bass (ocean).

    The FDA recommends that everyone avoid seven fish that may be high in mercury: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), and bigeye tuna. The recently updated advisory cautions that some fish caught by family and friends, such as larger carp, catfish, trout, and perch, may contain unknown amounts of mercury or other contaminants. It advises checking local advisories for information on how often it’s safe to eat those fish. If there is no advisory, the FDA advises eating only one serving and no other fish that week.