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  • Selective Babies Alzheimer: When someone forgets that they were babies too

    Selective Babies Alzheimer: When someone forgets that they were babies too
    After a long “baby winter” (my definition of the first months, when any fever is an automatic “go to the hospital card”), we have started to enjoy the amazing summer. We have been blessed with company from great grandparents to my daughter’s 20 month old cousin. Sharing stories about how we were in the past. It’s amazing how certain things and behaviors our daughter started to do that other family members (including, Uncle, Dad, Mom, etc), gestures, positions and even the way the she sooths herself to sleep; for example, she plays with her hair to relax herself to sleep, just like her uncle does. Is it a coincidence or genetics having fun? I really don’t have a straight answer, but I’m just impressed and wonder what other surprises she will have for us in the future.

    It’s human nature to act upon a crying baby. Mom will know specifically their babies cry and it is interesting when other people, for example, in a restaurant, would react (of course I’m not describing the crying baby in a movie or opera concert). They have this look and wired silence, expressing in a non verbal way, that “someone” needs to mute the baby, and the more adventures ones, just moves to another table. It seems that they are having “Babies Alzheimer” defined as: NOT REMEMBERING THAT THEY WERE BABIES ONE TIME, AND PROBABLY, THEY CRIED TOO. Well, that’s life right? Until we find the mute button or my baby (that usually cries for a couple of seconds) talks fluently in one language (including sign language), will have those moments, that at the beginning were more uncomfortable for us, but now, we see it as a learning process to have a social life, starting to be experts on how and what to bring to “social events” so everyone will have a great experience

  • Un par de ideas sobre el Affordable Healthcare Act

    Un par de ideas sobre el Affordable Health Care Act

    Llego un poco tarde a la discusión… El Affordable Health Care Act  (ACA) va a cambiar al futuro de los Estados Unidos. Comienzo con la premisa que la ley no es perfecta, pero definitivamente se puede mejorar con nuestras iniciativas. Para los hispanos es una gran oportunidad de poder tener seguro, hoy en dia aproximadamente 40% no cuenta con ningún servicio de salud, NO ESTOY INCLUYENDO INDOCUMENTADOS EN ESA CIFRA (http://www.healthcare.gov/news/brochures/latinos-top5.pdf), siendo propensos a utilizar los servicios de urgencias como único contacto para obtener servicios de salud.

    Dentro de nuestro entrenamiento y practica medica, si un paciente llega a urgencias con una emergencia médica, pongamos el ejemplo de un politraumatisado, stroke o infarto; cuando entra al hospital, teniendo minutos para salvar la vida de esta persona, NO SE PREGUNTA SI TIENE SEGURO O NO… En caso de que no tenga seguro (como es un gran porcentaje de personas de entre los 20 a 40 años por que piensan que a ellos no les puede pasar…), nosotros terminamos pagando por ellos. Realmente abogo por la igualdad de derechos para todos los pacientes, y sobre todo por lo que es justo. Gracias al ACA, ellos van a poder tener un seguro, disminuyendo el costo de los servicios. Es muy sencillo, entre más personas entren el “pool” más barato va a ser. En los personal, NUNCA en mi vida pregunte a una persona si tenía seguro o no antes de tratarlo en una emergencia médica.

    Muchas personas han incluido la idea falsa “las primas” van a subir, lo cual a sido reprochado por nuestra actualidad habiendo una baja en primas en lo general. Además, antes que pasara o no el ACA, las aseguradoras y muchos del Estado Republicanos ya habían prometido no cambiar algunas de las propuestas como la inclusión de los jóvenes menores de 26 años al seguro de los padres,  no limitar las pólizas entre otras.

    Y tomando en cuenta la ley 80/20, donde las aseguradoras tienen que invertir el 80% de sus costos en SALUD en lugar de “COSTOS ADMINISTRATIVOS”, y en dado caso que tuvieran un excedente, pagar la diferencia entre sus miembros, LO CUAL YA SUCEDIÓ.

    Sobre los pagos a los médicos, hay un gran problema en este país, es una realidad que se necesita el influjo de International Medical Graduates para mantener el sistema, además de que va a ver una falta de alrededor de 90,000 medicos en los siguientes 15 años. Por lo cual el ACA provee subir los salarios a los “Primary Health Providers” (Pediatras, Family Practitioners, etc), para poder dar los servicios básicos de prevención y tratamiento a la población.

    Definitivamente estamos creciendo y aprendiendo de nuestro sistema, cambiando los factores de volumen por calidad. La ley no es perfecta, pero es perfeccionable, Y ESO DEPENDE DE NOSTROS COMO MÉDICOS Y EDUCARNOS PARA PODER HACER MEJORES DECISIONES, TRANSMITIENDO LA INFORMACIÓN A NUESTROS PACIENTES, con el único objetivo real: Mejorar la vida.

  • STARTING SOLIDS FOR MY BABY…

    Dear Friends:

    As a Pediatrician, I can tell you that it has been an open search of knowledge improving for sure the quality of care thanks to my daughter. We have been starting solids, and I need it HELP from one of my best teacher that I had in Chicago for Nutrition. Heather thank you for your help!!!!

    Heather, MS, RD, LDN
    Dietitian
    Dietitian.Heather@gmail.com

    Starting complimentary foods in infants at 6 months:

    A wonderful book is: Blender Baby Food: Over 175 Recipes for Healthy Homemade Meals by Nicole Young and Nadine Day (2nd edition) available on Amazon.  A Registered Dietitian helped to write it and that each month there was a table at the start of the chapter with a guide of types of foods, frequency, and portion sizes.  The recipes were pretty good and they had a lot of information on how to make the items tasty for other family members. The yogurt at 9 months is a newer trend, but with the numbers of kiddos with constipation the probiotics are helpful. If you are breastfeeding/expressed breast milk, your kiddo may not suffer from constipation and may not need this food early – one good brand is the Yo baby and Yo toddler whole milk organic yogurts by Stonyfield.

    Some big things to remember:
    Your kiddo will eat each day until they are 100 years or older, there is no need to rush at 6 months – 12 months.
    The first food is to help with iron intake – can be pureed meat or can be infant cereal (currently debatable which is better) the point is iron intake and getting used to the first semi-solid in the mouth and by spoon. Infant cereal is easier to control and transport. Typically rice is the first due to the lack of allergy problems.

    It is not uncommon to work on just the first food for the first 30 days, simply working toward thicker consistencies. An adult may get bored with this, but an infant is learning more than just taste.

    When you start the next foods, remember to work on that food for about 3 days then it goes on the approved list. Each new food on the approved list can be consumed in a rotation with other approved foods.  i.e. rice cereal 2 tbsp bid, puree apple 1 tbsp 1x/d, puree sweet potato 1x/d; then next day rice cereal, puree green beans, puree pear etc.

    Homemade baby food is typically better received and can be adjusted to your flavors. Don’t make it spicy/hot, but it does not need to be bland. Some kiddos LOVE garlic, cumin, coriander, black pepper, cinnamon, nutmeg, vanilla, etc.  Kiddos can have added fat, go easy on added salt and added sugar.

    One of the best early foods: puree sweet potato – microwave sweet potato until soft, remove peel, put in food processor with pumpkin pie spice (or nutmeg and cinnamon) and butter – they all seem to love sweet potato

    Now is the time to go to the store and buy some extra ice cube trays. When you make a puree batch of food say on Sunday night, you put the remainder in the ice cube trays and freeze. Typical size is 1-1.5 Tbsp each cube (a kiddo portion size) and then you can put them in a container with you when you leave home, they will slowly defrost and then you have a good portion of healthy food you know your kiddo loves with you.  (Your fridge will have funny ice cubes in baggies – just warn your guests!) If you choose to buy infant foods from the store, remember that the open container contains much more than one portion of food, it must be thrown away in 3 days once opened and within hours if you double dip (i.e. spoon to baby and back into packaging).

    NO KID NEEDS JUICE – feel free to skip it altogether, fruit is better in so many ways

    Making kiddo food does not need to be stressful, if you are having a vegetable with dinner – corn, put the left-overs (spices you ate with it and all) in the blender/food processor, thin with chicken broth to the consistency you like and freeze – if they only eat 1-2 cubes each day this will last you for a while.

    As you approach 9 months, and teeth are appearing, you start to adjust consistency with these home-cooked flavors, less puree closer to ground – here they are adjusting to your textures. – When you get to ground meats write to me again – perfect the meatball!

    HUGE tip – have them sit at the table when you sit at the table, eat when they eat, let them see that you are eating the same stuff, let them hold a spoon (baby spoon) to get used to what is going on. When you all eat together they are learning what this eating thing is about.  **Know that if they watch ANYONE at the table openly object to a food you are teaching them to be a picky eater.  There is always something a person doesn’t like to eat, be an adult about it, don’t put it on your plate or quietly choose not to eat it.

    Liquids after solids – let them try the solids first, then fill the belly second

    Have meals offered at predictable times – if you only have time at 6 pm each day then start there

    Have all day-time care/family care people on board with your plan

    WHO is wonderful: http://www.who.int/nutrition/topics/complementary_feeding/en/index.html

    You can for convenience purchase foods from groups like plum and happy baby for organic – the dissolvable puffs are a good training food.
    Use them more like treats though – the main food being from home

    Don’t forget about refried beans (kids like the spices, adults can like the fiber, iron, etc.) – best if made at home than from a can to reduce some of the salt content.
    The nice things about doing the nutrition this way: you have a kiddo that loves to eat, transitions to home foods faster and easier, and you don’ have to fight at meal time, the disadvantage is: you will argue with all the other adults you meet.

    Ideas from the work of Ellyn Satter, author of books such as: Child of Mine  and How to feed your child, but not too much
    It is the kiddo’s job to eat,  it is your job to buy, prepare, and offer good foods at regular times
    As long as you like the weight gain, the amount of food consumed in any one meal is not a big deal
    It can take up to 20 exposures to a new food for a child to accept them (they are learning about so many things at once)
    Don’t be a short-order cook, they can eat what you made in a given meal or wait until the next regularly scheduled snack/meal

  • Summary of week 8: Vaccines and vaccines…

    For all parents: when it gets time to start the vaccines of your baby, it’s always harder for the parents for than the baby… Nobody can disagree that vaccines has been one of medicines top 3 inventions that has saved and prevented horrible diseases for human kind.

    Our daughter for the first time (actually, the second time, the first was the hepatitis b vaccine at birth) got her 2 month old vaccines, and of course, we were happy to get to the milestone. I have said a couple of hundred times (at least) the short list of common side effects that the baby can have, it is my version of the “Miranda rights” that cops know by heart, but this time was a little bit different, knowing that my flesh and blood was going to be immunized (and my wife is not a fan of any needles!). She did perfectly great on her weight, height, meeting all her developmental millstones; waiting for the big moment finally, we were prepared. It’s amazing how important it is to have calm parents at the moment of vaccination, even a small infant can tell if mammy and daddy are nervous. Everything was done in seconds, and with a smile at the exit of the pediatrician’s office.

    There is always a small probability that the patient (aka: daughter), can have fever, crying spells, sleeping more than usual, redness on the site and even a bump, everything controllable with general comfort measures. But, my daughter read with me all the side effects, choosing to have on that evening fever and sleepiness. You can imagine the 7 missed calls that I had in my cell phone before I left the office. If you have in your mind the question “you knew the side effects”, the quick answer is: YES, YES and YES! You needed to see this infant, bundled up, having her first fever smiling at her parents: I’m fine; it’s just a little fever. I tried 3 different thermometers, having the same answer: your daughter DOES have a fever. She continued to eat, laugh and play, having extended periods of sleep during the day, but by morning, thank G-d she was back to her old self: laughing, moving and doing her own tummy time. Every day, I learn something new, to be humble and reaffirming that when a parent tells me the fears and myths  that have heard about vaccines, I will share my personal story and the peer review information regarding why it’s important, side effects and the probability of having a severe bad reaction the vaccines, my conclusion always is: I’M HERE TO HELP YOU UNDERSTAND THE INFORMATION, I can’t guarantee 100% that everything will be perfect, but for sure this is a great choice (PLEASE PLEASE go to http://www.vaccines.com/why-vaccinate-fact-01.cfm).

    Now to other matters… I can spend a lot of time watching my daughter, amazed on how they  start exploring the world, finding their hands, grabbing things, smiling… No she is moving her legs, trialing objects and cooing, our “sleep, eat, move and poop machine” is actually converting into a “little person”, communicating her needs and fears.  I can’t extend how important it is for any parent to be on top of this, you are the one that knows your baby best.

     

    What I’ve learned this week for THE UNOFFICIAL MANUAL ON HOW A PEDIATRICIAN BECOMES A FATHER:

    1)    Vaccines are more painful to watch when you are a parent

    2)    Having a great time learning from my best teacher… MY DAUGHTER!

  • ENTREVISTA UNIVISION / UNIVISION INTERVIEW

    ACCIONHISPANA.TV

  • Coming soon my interview on Univision…

    Coming soon my interview on Univision…
    http://ow.ly/c5l6w

  • Thumb vs Pacifier

    When we are babies, none of us were asked if we wanted to “suck our thumb or use a Pacifier (I LOVE THE NAME!), wondering right now about that decision for my daughter. Many lactation consultants and pediatricians believe that there could be a “nipple” confusion if a newborn is exposed to bottles/pacifiers in the first 3 weeks, for sure it’s a nice a idea but I have not yet seen (until now) some one that has not “exposed” their babies to them. In our debate, someone told us, “you can accidentally loose the paci, but you can’t cut out the thumb”… That got us thinking, we waited 3 weeks, limiting her contact to artificial nipples and we started to have a couple of questions in our heads:

    1)    Having no choice, but for sure influence in the decision, I would encourage the pacifier for my baby instead of the thumb. The entire concept was commodity, easy handling, decrease risk of Sudden Infant Death Syndrome (AKA: SIDS; could be a topic for another day) thinking that one day in the future “Mr Paci” will go on a trip an never come back…

    2)    Choice two: “The Organic Thumb”, you never lose it, they know where it is, but it needs some behavioral interventions (as the pacifier) to finish with it, plus having a finger on the mouth after the child has teeth starts to push  certain areas creating good business for orthodontics.

    And for every one… What was your feeling? Did you choose a method? Any tips? Was it hard to “take” it out?

  • Summary of week 7: Google: your best friend or worst enemy? Child Development, vaccines and translating medical information

    I love the secret smiles of some of the parent’s patients when they ask if I have a son/daughter and my answer is: YES, I do have a daughter! It’s possible to even hear the music in the background mixed with empathy. Now as part of my training, I have continued medical education at home, with my Beautiful wife and daughter.

    This week I fought against a friend called GOOGLE. For sure you have typed so many things in to that white space in order to get “the best possible answer” in the top 10 results, that most of them are “pushed” to the front due to relevance, hits (how many people actually went to that website) and an equation of Money; having all of  this information in milliseconds. I came home, hanging my imaginary white coat outside of my home to embrace my family. I was bombarded with health questions, doubts and fears from the information acquired thru the internet. After a couple of minutes of hearing the case, we had a nice conversation translating the raw medical information to easy to understand facts, at the end of the conversation, all the doubts and fears became security and peace. It’s really easy to find medical information on the internet, probably in million results and in almost all languages, but reading does not mean understanding the big picture. When you get the results of the question you are searching, please have a couple of things in mind (http://safetynet.aap.org/internet.pdf), anybody can create a website with information, instead, go to known sources (American Academy of Pediatrics, Healthychildren.org, CDC.gov, etc) in order to get peer reviewed information. But the process doesn’t end there, if you have questions, doubts or comments (I have read a couple of vaccine related web sites, with old information, that creates fear and doubt…) JUST ASK YOUR MEDICAL PROVIDER; information is one of the biggest tools that we can use, AND I LOVE when parents come with questions/comments about things that they have read or heard because it actually moves the conversation to a higher level, we’ll review the information, do fact checks and after having all the information, we can take action talking about “the white elephant in the room” (I will completely recommend using: aap.org, healthychildren.org, cdc.gov and when in doubt, you can leave me a comment regarding a website, and I’ll look into it).

    Now, moving to other “growing” things… When you go to your pediatrician, it’s imperative to talk about the developmental milestones of your kids, this way the parents and the pediatrician can talk about the motor (physical movements), language and social things that are appropriate for your children. This week, we noticed her different reactions to our voices, her face changes and she knows how to communicate, in an interesting way, about hunger and change of diaper. She is tracking objects, reacts to sounds and facial features, having a smile that warms my heart. My pediatric brain (usually turned off when I’m at home) measures all this little things, monitoring the growth of all areas of my daughter. It’s important if you have other children to know that every kid grows at a different pace, and could achieve the developmental milestones faster or slower that other siblings, my point with this is: IF YOU ARE WORRIED,  ASK YOUR PEDIATRICIAN.

    Vaccines are coming our way… My wife hates needles but loves vaccines. In the following week we will have the moment of truth: “the first round of vaccines”. I have been preparing my wife (and my heart too…) for this moment. I will keep you posted… Parents are an essential part of the equation; kids can smell, see and hear fear… Before you step in the room for vaccines, take a deep breath, smile, think about the protection and security that you are giving your kid… Never lie to them, SHOTS hurt, if we say: “it doesn’t hurt”, we are laying to them, then they will be even more scared in the future, not only at the pediatrician office, but every part of your relationship with your child.

    What I’ve learned this week for THE UNOFFICIAL MANUAL ON HOW A PEDIATRICIAN BECOMES A FATHER:

    1)    Internet is a great tool, but sometimes you need a human to translate and filter information from it.

    2)    Follow your instincts, if you are worried about something from your kid, talk to your medical provider.

    3)    It is worth it to take a couple of minutes and have a print out of what developmental milestones to expect from your child, that way you know what to expect and monitor his growth.

  • Nice summary from major polls for the Me

    Nice summary from major polls for the Mexican Presidential Election that is TODAY http://ow.ly/bWoNB

  • Cultural approach to earrings for girls…

    In my home country, when a girl is delivered, they give them 2 shots (standard for the world) one is a vaccine for hepatitis b (to prevent infection of that virus that can lead to liver damage and death) and the other one is vitamin K (to prevent excess bleeding). Also, before going home, the new lady is given to the parents with 2 beautiful punctured earlobes with 2 amazing hypoallergenic earrings: that’s just part of the delivery package.

    You need to understand our cultural “shock” when we asked them when are they going to do the piercings at the hospital, and the answered was “we don’t do that”.

    And I was shocked:

    1) In my mind “the entire world” knew that baby girls will have earrings at the moment that they leave the hospital

    2) We needed to find out what would the process be in order to “normalize” in our cultural standards, her ears

    As per AAP (American Academy of Pediatrics) Guidelines, recommends that anybody that would like a piercing be ready to take care of it, meaning, that the age and maturity of “patient” will differ on that, and having my 1 month old baby, does not even qualify as “potty trained” let alone, be ready to wash her own earrings, and kind of goes against the my cultural expectations. But imagine that I did not read that statement, I can fine the logic to it…

    It’s a fact that our daughter will get her piercings… We went online, we asked friends, doctors and parents regarding what to do… Well practically there is a couple of THINGS TO CONSIDER:

    1. Hygiene: Of course you want to have the safest, cleanest area to do any procedure to your own flesh and blood.
    2. Vaccines: Many people recommend waiting 15 days after the “Tetanus” shot (2 month regular shots for the US) before doing any piercings, that way it minimize risk of contracting a horrible PREVENTABLE disease.
    3. Method
      1. options and choices:
        1. By piercing gun: Usually done in most places, can be self thought to do it, easy, if is in a store, the “gun” per se, in most cases cannot be sterilized, and the blunt trauma (the actual pressure from the earring to the skin
        2. By Needle… Using the same protocol and technique of a piercing professional. Using sterile equipment to perforate the ear lobes, having less tissue damage, but the cost is more and needs to be in a safe place.

    Both of the choices don’t sound attractive…

    What did you do for your baby? What technique did you use? Did you waited, for how long? What was your experience after the fact?