Dr Shap's

Tag: american academy of pediatrics

  • 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!

  • 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?

  • Summary of week 6: Tips, tricks, scheduling and life

    This week I had the pleasure of having family over the weekend, and for sure, like many of us that don’t live in the same zip code as our family, it’s a blessing to have them here (someone told us that Florida attracts more family… Nobody took into account our new baby to be a better tourist magnet!). Our daughter is starting to form her routine, we already know about her “crappy hour”, and we have established a nice ballet of feeding, burping (I’m becoming an expert), diaper change, activity and happy times. We have gone to the maximum time allowed at night (amazing and extravagant 5 hours between feedings), meaning that we actually get to sleep a 4 hour cycle (GO BABY GO!).

    My wife has given me the opportunity to do the last feeding of the day (no, I don’t use the props from “meet the Fockers”), enjoying a couple of minutes with my baby. The entire philosophy of bonding/feeding time really makes sense, whatever feeding method you use (bottle/breast milk/formula), being there and interacting is just amazing (PLUS YOU GET AT LEAST 10 MINUTES OF SILENCE!). Completely recommended if you have not done so.

    The bath routine is working, she actually, contrary to popular beliefs, she loved the water, probably a genetic trait from my family. She is joyful and having fun (maybe some memories of mommy’s tummy?), making it clear to us that she does not want to leave the bathtub.

    From the water to the earth, we have started her on “tummy time” now that she has more neck control, using our “mini GYM”, she starts on the top and slowly works her way down to the bottom of it to lay her face in the cushion and we start again. A part of stimulating your baby, it has a couple of more advantages, using the wake time for a positive activity. It comes to my mind one thing that is happening a lot with the new recommendations to prevent Sudden Infant Death Syndrome, it decreases and prevents unnecessary deaths, but if we are not moving the position of the head of our babies, they start having a “flat head”, that’s way one of the reasons to do tummy time and observe the shape of your baby’s head, if you think it is flat, talk to your pediatrician about it.

    My amazing wife noticed this week that our Baby started to find her hands, it was amazing to see it, how we take for granted, and we forget the little things of our body, I encourage you to take a moment and observe your hands, probably you won’t remember when you saw them for the first time (at least I don’t) J.

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

    1)    Tummy time is amazing and fun for the entire family, changing the routine of poop, eat, sleep moments of the day

    2)    Baths are amazing, even for babies!

    3)    Feeding your baby as a father/partner at least once a day creates a special bond for a couple of minutes that will give peace to you and your baby.

     

    PS This is going to be an historic week for the US, whatever decision the Court makes regarding the Affordable Healthcare Act will have an impact on all of us.

  • Summary of week 5: Colic’s, crying and the miracle

    It has been an amazing week. Energy started coming back, our regular “not grumpy” soul is starting to sleep a little better. But the week did not start that way… On her birthday, she decided to cry and complain all day and all night (our dog, Nikki, decided to have a muscle spasm on her back, having two patients at home!), she was grumpy, moving, fuzzy and for sure not happy! As a pediatrician, I finished with my mental check list of differential diagnosis, no fever, no crazy cough, no sneezing, not coughing, breathing well… And of course, LACK OF SLEEP for the entire family. We were really frustrated; usually on the 2nd to the 4th week it’s expected to have crying spells (“it’s normal to expected up to 2 hours of crying”, translation: BREATH IN, BREATH OUT, RELAX… IT WILL STOP…). As a textbook girl, she started with everything… Colic in pediatrics is a combination of gas, tummy issues and just plain old “fuzziness”, and she was having everything. We started to notice for a couple of nights that she loved sleeping in her nap nanny (cushion with a nice >45 angle), and each time that she was laying on her back she was uncomfortable, moving, doing funny noises and NOT SLEEPING AT ALL. On the second day, It was enough, consulting with the pediatrician (for objectivity: I’M NOT HER PEDIATRIC-DAD), and we started a trail of antiacids: THAT WAS THE CURE TO HER PROBLEM. Probably she was having some reflux (all little ones will have reflux and spit ups, it’s  a normal process until the Gastrointestinal Track [the tummy and guts] is mature enough), after a couple of doses, our little one started to be happy (Mommy and Daddy were happier!). With reflux the content of the stomach moves up to the mouth and potentially can be painful.

    Moving on to the week, she started to have a social smile, it is a delightful scene, the pooping/sleeping machine is interacting with us more and more each day… For sure, you have shared this feeling before, it’s just pure happiness, at her 1 month of age she is already spinning my world.

    There are different recommendation at the beginning of life to see your pediatrician, usually at birth, 2-5 days after, 1, 2, 4, 6, 9 and 12 months (just to make the list small… also 15, 18, 24months and after that every year), we had our 1 month preventive visit, I’M A PROUD FATHER, she gained her weight, her height and head size, without forgetting how beautiful she is becoming every day. I did assumed, wrongfully, many things in my mind, that thanks G-d my wife asked the pediatrician, it’s a wired interaction, Imagine being a lawyer, and your business partner is now defending your family in a trail, you can give input, but the one running the show is your partner… Plus, going to the other side, your partner has “extra pressure” to perform and do his best. The first time that we were there, she felt like in an exam at the hospital, I smiled and told her: you Aced the exam (plus she is an amazing human being, active, happy, truthful and smart). Then my professional partner and my wife did have a session of questions and answers, at the same time that I ran out of the room to parade my daughter.

    We also had our first real day out to a restaurant, probably one of my favorites in Ft. Myers: her 1st month day out. I wanted to shelter her, have the crystal bubble around her, and limit the amount of dust, UV rays and cosmic radiation (last one was a joke), it seems that the process to train my mind in order to have a balancing act between being a watchdog and “not reacting to my paternal impulses” is a work in process.

    Every week is counting, time is moving and my family is just growing: I’M JUST ENJOYING IT!

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

    1. Hear and act upon “maternal instinct”, if you think something is wrong: ASK, ASK and ASK!
    2. Read about colic. But the most important is to have a way to “distress” your mind, and most importantly talk to your partner about it.
    3. Pacifier vs thumb… We passed the “3 weeks” of nipple confusion and now we need to decide were to go with this… In the perfect world babies will have a mute button.
    4. The first of everything (first bath, first going out, etc etc) creates new expectations and the lack of familiarity could create some stress… It will get much better with time

  • Summary of week 4: Reconnecting and taking our first bath…

    When your baby is born, you have many things in your mind, and it seems that the world just stops… You forget about work, friends and family… You are trying to figure out (at least it passed trough my mind) how much money will cost in 2032  to do a Wedding and if there are any recalls on the car seat that I just got 2 weeks ago… Such random things. Suddenly, you notice certain changes in the fridge…  You wonder why the milk is “not good” and the limes look old… Would it be the temperature of the fridge? At that moment I smiled to myself… It has been 4 weeks with multiple visits to the supermarket, but none for the real things that we need it…

    Yes, in the beginning life revolves completely around our amazing daughter; she is a baby and needs a new diaper, food, rest, play… And she is the center of our universe, but the real force creating the unity of her atoms are mom and dad. The unity between partners is one of the most important drivers for success for the baby and the couple. This week, was our 4th wedding anniversary, we celebrated at home with sushi, backgammon and a nice glass of wine, and you know what, we started to un-pause life and reconnect. The renewal of energy was priceless!!! And of course the next day we started calling our good friends. Probably I read it somewhere and the quote goes something like this, “the excuse of ‘I have a baby’ to stop doing/calling/living gets old very fast”… Then, take the first step… RECONNECT WITH YOUR PARTNER!

    After a couple of weeks, we waited until the umbilical cord fell down and was completely healed (no oozing/yellowish/sticky stuff coming out of it), to give her a full bath; the idea is that that umbilical cord contains a central pathway to your baby’s body. If you “wash it” and it is still open, there is a possibility that bacteria can go inside of the blood stream causing a serious infection.  You will see a lot of information on the internet and among pediatricians of “how to take care” of the umbilical cord before it falls out. There are two main ideas: Alcohol vs. Water and Soap. It has be noted (you can go to the American Academy of Pediatrics Web site or HEALTHYCHILDREN.ORG) that using alcohol delays the fall and dryness of the umbilical stump. Today, the recommendation is to use water and soap (drying after the area)… If you have any questions I can point you towards nice articles and information… But going back to the bath…

    The umbilical area was clear and we were happy! We took all the cameras we had, 4 live streaming events,  1 I-Pad, 2 cell phones and the webcam streaming a coordinated attempt of the first bath  (and our own camera filming some videos as well)… You will read tons of articles that will tell you “the first bath is chaotic and usually babies don’t like it”; our daughter just LOVED IT… You can imagine a televised event as important as the Super Bowl happening with 8 people giving advice at the same time… But it was just amazing; I can proudly say that my daughter has my SCUBA diving genes! Using soap and washing her was the easiest part… When you see your kid all covered in bubbles and smiling is amazing, and you are in heaven for a couple of seconds, and then, again, NOBODY TOLD ME HOW TO WASH HER AND “CLEAN THE SOAP” out of her… Then we did a couple of tricks, she smelled perfect, was dry, in her pajamas and ready for dinner, and probably mom and dad were even more tiered then her.

    I will write down a couple of links to articles (read them even if you already feel that you are the fastest and best bath expert in the world), they do have nice tips…

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

    1)      The “I have a baby and I’M TIRED” does not excuse the parents to stop calling dear family members and friends… I’m sorry for those friends that I did not call back during these weeks; slowly I’m calling one by one.

    2)      Organize your first bath; you need the correct equipment, the correct utensils and an extra pair of hands if possible to have a successful bath! (By the way, it is not recommended to give a daily bath; the baby’s skin is gentile and delicate, then every 2 to 3 days can be a good average.

    3)      It’s normal for babies to cry around 2 hours a day… It was really easy to explain that to the parents of my patients, but now, after 4 weeks of “normal crying”, I COMPLETELY UNDERSTAND THE FEELING OF FRUSTRATION.

    Please do send me emails, comments or questions…

    Ilan