It is acceptable to introduce solids to your baby in addition to their breast milk or formula at between 4-6 months of age.  Rice cereal is a good one to start with.  A serving should be only a few tablespoons, and a soft baby spoon should be used to feed your baby.   As your child is getting used to eating  new foods,  introducing yellow and orange vegetables, followed by fruits and lastly green veggies and meats is an acceptable feeding plan.  Usually it is good to introduce one new food per week to observe for allergic reactions like rashes; or intolerances, such as vomiting or diarrhea.  If a baby does not tolerate a particular food, take it out of the diet and discuss it with your pediatrician.

Raymond O’Toole, M.D.

Dr. O’Toole is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

A healthy full term baby with no breathing issues should ride in a rear facing car seat, ideally in the middle of the back seat.  Consider checking with your local police or fire department for their car seat clinic, where they will help you get the seat set up as tight as possible.

Raymond O’Toole, M.D.

Dr. O’Toole is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

Trying to determine the difference between a cold and a sinus infection can be difficult.  Here are some common symptoms of each to help you decide.

COLD

-Usually caused by a virus.  Antibiotics are not effective against viruses.
-Symptoms usually last 7-14 days.
– Typically starts with runny nose that is clear.  It can progress to green, yellow, or white mucous at any point during the cold.
-A fever may be present at the beginning of the cold and can last for 2-3 days.
-Often accompanied by a cough that can be worse at nighttime.

SINUS INFECTION

-Caused by a bacterial infection.
-Cold symptoms (runny nose, cough, congestion) lasting longer than 10-14 days without improvement.
-Thick, excessive yellow/green nasal discharge that is worsening after 7-10 days.
-Fever for more than 3-4 days.
-Severe pain or pressure at the forehead, behind the eyes, or over the cheeks.
-Swelling around the eyes or yellow discharge from the eyes.
-Usually treated with antibiotics

If you are concerned that your child may have a sinus infection, be sure to contact your pediatrician’s office.

Brian Davies, M.D.

Dr. Davies is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

Diarrhea is most commonly caused by a virus and can last 5-7 days.  The most important thing to do is to keep your child well hydrated.  It is important to encourage regular fluid intake, we recommend Pedialyte.  As long as there is no vomiting your child may mostly have whatever they want to eat or drink.  Do not give fruit juices or high sugar drinks as this can cause an increase in the diarrhea.  Foods such as dried cereals, crackers, bananas, applesauce and noodles are well tolerated.  Probiotics, such as yogurt, can also be used to help replace the healthy bacteria in the intestine and improve the diarrhea.

Once your child’s fever is gone and the stools are improving they may return to school.  You should contact your Pediatrician if you notice a decrease in urine output, refusal of fluids, fever lasting longer than 3 days or the diarrhea lasting longer than 2 weeks.

The overall amount of fluids that a healthy 3 year old drinks depends on many things, including how heavy the child is and how active they have been that day.  A larger child will certainly drink more than a smaller one, and a child will drink much more on a day that he/she has been very physically active.  Let thirst be an indicator of how much water your child should be drinking.  Offer water whenever your child indicates he/she is thirsty.  An easy way to make sure your child is staying hydrated is by monitoring how much urine he or she makes.  A typical 3 year old should be urinating at least 3-4 times per day.

Water and milk are the only fluids that a child needs.  For the average 3 year old, about 1-2 large glasses of milk (8-16 ounces) should be plenty for the day.  One easy way to ensure adequate milk consumption is to offer it with breakfast and dinner each day.  Scatter cups of water throughout the day.

Many people often ask about juice- there is no significant benefit that children get from juices.  Most contain excessive amounts of sugar.  If you decide to allow your child to have juice, offer it no more than 1-2 times per day in small amounts.  Watering the juice down (mix ½ juice and ½ water)can add to hydration while decreasing the amount of sugar intake.

Brian Davies, M.D.

Dr. Davies is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

Dental caries are unfortunately a very common problem in children.  Caries are 5 times more prevalent than asthma and occur in more than 1 out of 4 preschoolers  and almost half of all kindergarten age children.  To avoid early caries, some things that can be done include: avoid sipping of dilute juice throughout the day, avoid sticky food like gummis, and eliminate frequent snacking and night time feeds.  Never let your baby sip on a bottle when sleeping that contains milk or juice.  Things that are protective include offering frequent sips of fluoridated tap water.  And contrary to popular belief, fluoride toothpaste can be used from the first tooth as long as you use a pea sized amount and rub it into the bristles to avoid excessive ingestion.  Two minutes of brushing and flossing a day is all that’s needed for your child, a tooth that’s clean everyday will not decay.  Children should see a dentist no later than 3 years old, but discuss your child’s teeth and dental care with your pediatrician from the very first tooth.

Raymond O’Toole, M.D.

Dr. O’Toole is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

The majority of sun damage occurs in the first 18 years of life.  AAP recommends sunscreen with at least SPF 15.  Sunscreen should be applied liberally 30 minutes before going out.  It should be reapplied every 2-3 hours or more often with extreme sweating or water.

Raymond O’Toole, M.D.

Dr. O’Toole is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

Children can be tall or small, but what is fundamental is that they grow at an appropriate rate each year. This rate changes by age, as children grow the fastest in the womb and slow down during childhood. During the first year of life children grow on average about 10 inches. From years one to two they grow about five inches and from years two to three about 3 1/2 inches. After age 3 children grow on average two inches per year. Pediatricians plot growth rate, head circumference and weight. Normal growth is one of the best barometers of good child health.

Height has a very strong genetic component, with the greatest influence being the height of the child’s parents. The age of the onset of puberty and the duration of puberty also has a lot to do with the height the child will achieve. If puberty is late, they may grow for a longer amount of time, but if it is early they may not have as much time to grow. The size of the child just before the start of puberty represents 85 percent of their adult size. If the child does not grow normally before puberty, they are not likely to make up all the difference with a pubertal growth spurt. In addition, not every child will have a pubertal growth spurt.

Worldwide the most common reason children are too small is malnutrition, which happens in every country and in every economy. Growth hormone is secreted during sleep and play. Illnesses of nearly every system can influence growth. Even emotional issues can have a role to play. A variety of medications can also influence growing in a negative way, but the medicines may be essential for other aspects of their health.

If you have questions about your child’s growth, talk to your child’s pediatrician. The specialty physician that works with growth issues is a pediatric endocrinologist. It is best to evaluate growth issues after the age of three years and prior to puberty. This gives the physician the most amount of time to evaluate growth and help make an intervention if one is needed.

Deborah Rotenstein, M.D.

Dr. Rotenstein is a Board Certified Pediatric Endocrinologist at the Endocrinology Division
Click here to visit the Endocrinology Division Page

Our recommendations are to breastfeed your infant as long as you are both able.  Breast milk is best for your baby but formula can be used if needed.  You do not have to stop breastfeeding completely just because your baby must take some formula during the day.

In order to maintain your supply try to pump as often as you would feed at home for a minimum of 10-15 minutes.  This milk can then be stored and given later to your infant.  When you are home feed the baby as often as you can.  This will help to maintain your supply.  If you find that your supply is diminishing there are ways to help increase your milk and you should contact your pediatrician for advice.

If you need to supplement breastfeeding with formula, we recommend using a milk based formula and not to switch between formulas.  There are a multitude of formulas on the market and you can discuss with your Pediatrician if there is a brand they prefer.

If for some reason your baby does not seem to be tolerating the formula, i.e. irritable, fussy with feeds, vomiting  or diarrhea you should contact your physician prior to changing the formula.

Getting your young infant to sleep well can be quite challenging.  While occasional naps in a swing or car seat are generally fine for a 3-month-old, this can lead to poor sleep habits in the long-run.  The American Academy of Pediatrics recommends putting your baby to sleep on a firm, flat surface to decrease the risk of SIDS.  The crib is the safest place for your baby to sleep.   If your baby is exceptionally fussy or suffers from GER (gastroesophageal reflux) your pediatrician may recommend other sleep techniques that can help.

Brian Davies, M.D.

Dr. Davies is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

There are modified schedules out there, but the non-traditional schedules are based on someone’s best guess about how to maybe get “good enough” protection. The regular schedule is based on the recommendations of the best researchers in the country. The purpose is to have all babies receive optimal protection from the diseases that cause the most death and disability in that particular age group. In my opinion, if it is worth vaccinating babies (and it is), then it is worth vaccinating them right. People who follow a modified schedule are actually diminishing, or diluting, the protection of the population at large.

It is understandable to be nervous when your child gets a shot. No normal parent enjoys having to watch a sharp object being thrust into the thigh of their beautiful baby. It is best to concentrate on the reason behind the trauma – we are preventing many nasty diseases, and optimizing the baby’s health. There is a little pain, but a lot of gain.

Parents should arm themselves with all the facts. Reading about a modified schedule should be balanced with learning about why the regular schedule was devised in the first place. Don’t sell the baby short!

Brian W. Donnelly, M.D.

Dr. Donnelly is a Board Certified Pediatrician at the North Hills Division
Click here to visit the North Hills Division Page

When infants are outside, it is recommended to keep the baby out of direct sunlight as much as possible. Try to stay in the shade, but if they are going to be in the sun for any period of time, clothing is a good barrier from the sun- lightweight long sleeves, pants, and a hat. Put sunscreen on the small amount of skin that is still exposed.  Choose sunscreen that is free of fragrance/dye, has at least SPF 30, is PABA free, and protects against UVB and UVA rays. Speak to your pediatrician about specific sunscreen that they recommend.  Some stores have UV resistant swim clothing available, which are usually light weight and provide good sun protection.

When children, especially babies are out in the heat, it is important to make sure they are well hydrated.  Make sure they are drinking lots of fluids and do not become overheated.

Stephanie Sterrett, M.D.

Dr. Sterrett is a Board Certified Pediatrician at the Greentree Division
Click here to visit the Greentree Division Page

Insect bites can cause problems from hives to illness.  Insect repellant should not be used on children below 2 months of age.  It should only be applied once per day, and not in a combination with sunscreen(which needs frequent reapplications).  Apply to clothes and exposed skin but not under clothes.  DEET concentration should not exceed 10% on children.  Wash your child’s skin off and change clothes when coming back inside.

Raymond O’Toole, M.D.

Dr. O’Toole is a Board Certified Pediatrician at the Chartiers Division
Click here to visit the Chartiers/McMurray Division Page

For the most up-to-date information on the health of your children please visit the American Academy of Pediatrics (AAP):

http://www.healthychildren.org/

There is going to be a change in Tylenol and all pediatric acetaminophen products, starting July 2011.  The transition will take place through 2012.

All infants’ and children’s liquid acetaminophen products soon will be available in stores in a single, uniform concentration – 160 mg/5 mL – for all children under 12 years of age.  Currently the dosing is different for infant and children’s concentrations.  This will no longer be the case over the next year.

It will be more important than ever for parents to read product labels, paying special attention to the concentration in the product, and only use the dispensing device that accompanies the product.

Please call your Pediatric Alliance Office if you have any questions.

http://aapnews.aappublications.org/cgi/content/full/aapnews.20110701-1v1