Choosing the Best Sunscreen for Babies and Kids

I know, we tell you that kids should get less time in front of screens and need more time outside playing.

And we tell you that they shouldn’t be tanned or get sunburned.

In addition to raising your risk of skin cancer, sunburns are painful.
In addition to raising your risk of skin cancer, sunburns are painful. Photo by Chelsea Marie Hicks (CC BY 2.0)

So what can you do?

Sun Protection

Use sunscreen!

But you are using sunscreen and your kids still get real dark and tanned?

Then make sure to apply it 15 to 30 minutes before your kids go outside, use enough to get good coverage, and reapply it every few hours.

Any other tricks?

Slip on clothes. Slop on sunscreen. Slap on a hat. Seek shade. And Slide on sunglasses to stay safe in the sun.
SLIP on clothes. SLOP on sunscreen. SLAP on a hat. SEEK shade. And SLIDE on sunglasses to stay safe in the sun.

You want to use sunscreen every time they go out, even if it is cloudy, and not just when they are going to be at the pool all day, limit exposure during the hottest parts of the day (10 a.m. to 4 p.m.), use sun protection clothing with a UPF of 15 to 50+, a hat, and sun glasses, and find shade when it is available.

Choosing the Best Sunscreen for Babies and Kids

Are there any tricks to choosing the best sunscreen for your kids?

Although I’m sure you can find a lot of buying guides that try and score or rate sunscreens, it is a lot simpler than that.

The best sunscreen is the one that you are actually going to use and:

  1. provides broad-spectrum UVA and UVB protection
  2. has an SPF of at least 15 to 30 (you can go higher, but get a minimum of 15 to 30)
  3. is water-resistant (even if your child isn’t going to be in the water, they will likely be sweating…)

For infants, or a child with eczema or sensitive skin, also make sure your child’s sunscreen is hypoallergenic and fragrance-free.

What else?

Do you want your child’s sunscreen to be tear-free and non-greasy?

Do you want sunscreen that comes in the form of a stick, gel, foaming lotion, lotion, dry touch lotion, wet skin sprays, spray, or continuous spray?

Do you want a kids’ brand, like Aveeno Baby, Banana Boat Kids, California Baby, Coppertone Kids, Coppertone Waterbabies, Neutrogena Wet Skin Kids, Neutrogena Pure & Free Baby, etc.?

There are plenty of options to help you get a sunscreen that you will actually use regularly. Personally, I like the dry touch lotions. They go on quick and easy, don’t leave a lot of left-over residue if you over apply, and don’t leave you feeling greasy afterwards.

I strongly dislike all of the spray sunscreens. What’s my beef with them? Ever see someone apply a spray sunscreen on their kids outside? If you have, then you have seen that the sunscreen doesn’t just end up on the kid. That’s also easy to see if you ever make the mistake of trying to apply spray sunscreen inside your home. It leaves a big greasy puddle on the floor. What does that mean? You likely aren’t applying as much sunscreen as you think you are when applying a spray sunscreen.

More on Sunscreen and Protecting Kids from the Sun

What else should you know about sunscreen and keeping your kids safe in the sun?

  • It is best to keep younger infants out of the sun, until they are about six months old, when you can start using sunscreen safely.
  • An SPF or Sun Protection Factor of 15 to 30 blocks 93 to 97% of UVB rays. Going up to SPF 50 only increases that to 98%. In theory, that is supposed to mean that it would take you 50 times longer to get a sunburn wearing SPF 50 sunscreen than if you were lying in the sun unprotected. Of course, even with SPF 50, your kids would eventually get a sunburn if you didn’t reapply their sunscreen every few hours.
  • On clothing, a UPF or Ultraviolet Protection Factor rating of 15 is considered good sun protection, but for excellent sun protection, look for a UPF of 50+.
  • The UV index forecast can help you figure out when you should avoid being out in the sun, especially when UV Alerts are issued for your area.
  • Many people only use about 25% of the amount of sunscreen that is needed to provide real protection and keep kids from getting a tan or a sunburn. How much do they need? You can use the teaspoon rule (half a teaspoon for each arm, a full teaspoon for each leg, a full teaspoon for their chest, abdomen, and back, and half a teaspoon for their face, head, and neck) or just use a palmful of sunscreen to cover your child’s body. Of course, that’s your child’s palm, not yours. And for older teens and adults, you should use about 5 to 6 teaspoons of sunscreen at a time to cover your entire body.
  • If you think that your child had a reaction to their sunscreen, try a sunblock with Zinc Oxide and/or Titanium Dioxide, or simply try another sunscreen that uses different ingredients. Apply a small amount to a small area of their body to see if they have a reaction before using it regularly though.
  • Sunscreen expires and becomes less effective after its expiration date. It also needs to be stored properly. Don’t use expired sunscreen or sunscreen that has been left in a hot car.
  • The ideas around “chemical-free” sunscreens, the need to avoid certain sunscreen ingredients, and that some sunscreens are safer than others is the same kind of hype that scares folks into thinking that they have to eat organic food, avoid GMOs, and that their are toxins in vaccines.

And remember that sunscreen is for everyone, not just people with light skin.

What to Know About Sunscreen and Sun Protection

Think about sun protection before your kids go outside, making sure you use a good amount of sunscreen every time they go outside, reapplying it often, and using other methods of sun protection too, including clothing, sun glasses, and shade.

More on Sunscreen and Sun Protection

Common Questions About Baby’s Eye Color

Pediatricians learn a few things about babies eye colors in school.

pexels-photo-1041100.jpeg
Most people have brown eyes.

We learn that they can have eyes with two different colors – heterochromia. And they can have ocular albinism, very light colored eyes caused by having reduced amounts of pigment.

And we learn that eye color is a genetic trait, although lately, we have come to learn that the genetics of eye color is fairly complex. That’s why two parents with blue eyes don’t always have a baby with blue eyes. Or why two parents with brown eyes can have a baby with blue eyes.

Common Questions About Baby’s Eye Color

What questions do parents usually have about their baby’s eye color?

There are a few basic variants that revolve around if and when a baby’s eyes will change color and how they got to be that color:

  1. My baby’s got blue eyes, will they stay blue?
  2. Why does my baby have blue eyes?
  3. How can I turn my baby’s brown eyes blue?

The first question is easy.

Your baby’s eyes can change color until they are about six to nine months old, or sometimes even later.

Well not exactly change color. They usually just get a little darker, sometimes changing from blue to green, hazel, or brown, as they get more pigmented. They don’t usually become less pigmented though, or become lighter, which is why a baby’s brown eyes won’t turn blue.

“Many studies divide eye colors into three categories: blue (or blue and gray); green and hazel; and brown.”

Eye color: The myth

The second question is harder to answer, involving some complicated genetics.

“The inheritance of eye color is more complex than originally suspected because multiple genes are involved. While a child’s eye color can often be predicted by the eye colors of his or her parents and other relatives, genetic variations sometimes produce unexpected results.”

Is eye color determined by genetics?

What makes it complicated?

To begin with, several different genes (at least three and perhaps up to 16) are involved in determining our eye color. There is not a single gene for blue, green, and brown eyes. Instead,  there are multiple genes that interact with each other.

Basically, the original concept of dominant and recessive eye color traits has been found to be too simplistic.

Still, you can try an eye color calculator if you really want to try and predict what eye color your children will have. It’s fun and while not perfect, it will be right most of the time.

What color eyes will your kids have?
What color eyes will your kids have?

What about the last question? How can you make your baby’s brown eyes blue? Tell him that you wish he had blue eyes…

What to Know About Baby’s Eye Color

While your baby’s eye color is determined by genetics, predicting the eye color of your baby  is not as simple as knowing the eye color of each parent.

More on Baby’s Eye Color

News on the Latest Food Recalls and Foodborne Disease Outbreaks

It is not unusual for a food to get recalled.

Many have to do with undeclared eggs, gluten, peanut, or milk, things that can trigger food allergies, but some are because of potential bacterial contamination.

“When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne disease outbreak.”

CDC on Reports of Selected Salmonella Outbreak Investigations

And some lead to outbreaks that get people sick.

In fact, since 2006, there have been between four and fourteen multistate foodborne outbreaks each year, involving everything from ground beef and cantaloupes to sprouts and peanut butter.

The Latest Foodborne Disease Outbreaks

Do you remember any of these outbreaks?

Unfortunately, many people don’t know about these recalls and outbreaks until it is too late – when they are or someone they know gets sick.

That’s why it’s important to stay up-to-date on the latest food recalls and outbreaks, including:

  • an ongoing Salmonella outbreak that has been linked to recalled shell eggs from Rose Acre Farms’ Hyde County farm of Seymour, Indiana and has gotten at least 35 people sick in 9 states. Over 200 million eggs are being recalled that were sold in restaurants and stores (Target, Food Lion, and Walmart) in Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia.
  • an ongoing E.coi 0157:H7 outbreak that has been linked to romaine lettuce from the Yuma, Arizona growing region and has gotten at least 149 people sick in 29 states, including one death. Although there has been no official recall, we have been warned to not buy or eat romaine lettuce from the Yuma growing region (it is no longer being sold, but some product may still be in homes) or if you don’t know where it is from.
  • an ongoing Salmonella outbreak that has been linked to recalled bulk packages of International Harvest, Inc. brand Go Smiles Dried Coconut Raw that has gotten 13 people sick in 8 states

How can you avoid these outbreaks?

“Since 1996, there have been at least 30 reported outbreaks of foodborne illness associated with different types of raw and lightly cooked sprouts. Most of these outbreaks were caused by Salmonella and E. coli.”

Sprouts: What You Should Know

Although proper cooking and food handling can help keep your family from getting sick in some cases with these recalled foods, it likely won’t with others, such as when fruits and vegetables, that you eat raw, are contaminated with bacteria.

Got Salmonella? You might, if you eat these recalled eggs.
Got Salmonella? You might, if you eat these recalled eggs.

That’s why you have to be aware of food recalls and be sure that you don’t eat foods that have been recalled, especially if anyone in your family is considered to be at high risk to get sick (younger children, anyone with a chronic illness, anyone who is pregnant, etc.). Many experts suggest avoiding those foods that are at high risk of contamination for high risk people, including raw sprouts, uncooked and undercooked beef, pork, and poultry, eggs that aren’t pasteurized, and of course, raw milk.

Also be sure to seek quick medical attention if you have eaten them and get sick (diarrhea, vomiting, abdominal pain, and fever, etc.).

What to Know About Food Recalls and Foodborne Outbreaks

It is important to be aware of food recalls and foodborne disease outbreaks, whether they are caused by Salmonella, E. coli, or Listeria, so that you can take steps to avoid those foods and keep your family from getting sick.

More on Food Recalls and Foodborne Outbreaks

Can You Really Predict or Calculate Your Child’s Future Height?

What’s the most common question most pediatricians get?

No, it is not about eye color, although that’s a common one too.

It’s about how tall a child is going to get when they finish growing.

Can You Really Predict or Calculate Your Child’s Future Height?

Your pediatrician can’t see into the future, so how can they predict how tall your kids will be when they get older?

While it is true that we don’t have a crystal ball to help us see into the future, we do have a lot of science on our side that can help us get a glimpse.

So it’s not a trick, just basic genetics, which tells us that tall parents typically have tall children, and vice versa.

How To Predict Your Child’s Height

How tall will your kids be when they grow up?
How tall will they be?

So how tall will your kids be?

How tall are you and your spouse or partner? In general, you can predict your child’s future height based on their genetic potential, which is based on their biological parents’ average height.

To see how tall your kids will be, you can:

  1. Record mom’s height (in inches).
  2. Record dad’s height (in inches).
  3. Average the two heights together.
  4. Do you have a girl? Subtract 2 1/2 inches from your average heights and that is your daughter’s predicted height as an adult.
  5. Do you have a boy? Add 2 1/2 inches from your average heights and that is your son’s predicted height as an adult.

While not perfect, your kids have a 68 percent chance of being within 2 inches and a 95 percent chance of being within 4 inches of this predicted height.

Want to test it out? See if you reached your own genetic potential by calculating what your own height should have been using your mom and dad’s height. Are you close?

But can’t you just double your child’s height when they are two year’s old? Doesn’t that predict their adult height too? While that is another method, it isn’t clear how accurate the prediction might be.

Another method might be to simply follow your child’s growth curve on a growth chart and see where they end up. Like the two years times two method, following the curve might not be accurate, as the growth curve incorporates an average age for starting puberty. Kids who start puberty on the later side of normal can benefit from a late growth spurt and continue growth in their late teen years that can push them up a few percentiles on the growth chart.

Being a late bloomer can be genetic though, so even if other methods underestimate your child’s height in this case, the genetic potential method might still be accurate.

Does any of this matter? It actually does and monitoring your child’s growth isn’t just something that parents do for fun.

If a child doesn’t seem to be reaching their genetic potential for growth, that could be a sign that something is getting in the way of their growing properly. Do they have uncontrolled asthma? Are they taking a medication that could affect their height, causing short stature? Do they have a thyroid, metabolic, or genetic condition?

Is your child already much taller than everyone in the family? While that is also sometimes a concern, as some conditions lead to excessive growth or a tall thin body type, the most common reason for a child to be taller than their parents is that their are other tall relatives in the family.

Talk to your pediatrician if you are concerned about your child’s growth or have questions about how tall or shot they might become.

What to Know About Predicting Your Child’s Height

While trying to predict your child’s future height is fun to do, it is also an important tool that your pediatrician might use to make sure they are growing properly and meeting their genetic potential for growth.

More on Predicting Your Child’s Height

What to Do If Your Teen Is Talking About Suicide

Suicide is a public health issue that concerns all of us. It is one of the reasons that many pediatricians get involved in pushing for stronger gun safety laws and teach parents to store any guns that they have locked, unloaded, with the ammunition locked elsewhere.

As you will learn, “reducing access to lethal means” is one of the first things you should do if your child is talking about suicide.

Is Your Child Talking About Suicide?

Although there are many warning signs of suicide, one is that a child or teen might simply starts talking about wanting to die.

According to the National Institute of Mental Health (NIMH), they might also:

  • Talk about feeling empty, hopeless, or having no reason to live
  • Talk about great guilt or shame
  • Talk about feeling trapped or feeling that there are no solutions
  • Talk about feeling unbearable pain, both physical or emotional
  • Talk about being a burden to others
  • Talk or think about death often

And it is important to keep in mind that instead of actually ‘talking’ about any of this with you, a parent, your child might instead talk about it with their friends, text someone, or post messages on Facebook, Instagram, Snapchat, or inside a chat room of one of the games they play.

What to Do If Your Child Is Talking About Suicide

So what do you do if your child is talking about suicide?

Get help as soon as possible.

“Asking someone about suicide is not harmful. There is a common myth that asking someone about suicide can put the idea into their head. This is not true. Several studies examining this concern have demonstrated that asking people about suicidal thoughts and behavior does not induce or increase such thoughts and experiences. In fact, asking someone directly, “Are you thinking of killing yourself,” can be the best way to identify someone at risk for suicide.”

Suicide in America: Frequently Asked Questions

While getting help might start with a call to your pediatrician, the National Suicide Prevention Lifeline is always available at 1–800–273–TALK (8255). Call immediately to figure out the best way to help your child, before they have a chance to hurt themselves.

Let your kids know that there are hotlines to call if they ever need to talk to someone when they are feeling anxious or depressed.

And know that help is available.

Most importantly, don’t ignore or dismiss your child’s talk because you don’t believe them.

Talking to Your Kids About Suicide

What would your kids do if a friend texted them and said they were thinking of killing themselves? Would they come tell you?

What if their friend told them to keep it a secret?

What if they were thinking about suicide?

Since we know that talking about suicide is not harmful, is there any good reason to not talk to your kids about what to do in these situations?

Have you?

Your kids should know that they can always come talk to you and:

  • how to call the National Suicide Prevention Lifeline, 1–800–273–TALK (8255), which is available 24 hours a day for anyone who needs help
  • how to contact the crisis text line – text HOME to 741741, and text with a trained Crisis Counselor 24 hours a day
  • what to do when a friend is talking about suicide
  • about the Lean On Me anonymous peer support via text network
  • about the Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth, including a hotline, chat and text help service
  • about the Disaster Distress Helpline for “24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.” Anyone can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
  • how to report suicidal content on Facebook
  • how to report suicidal content on Twitter
  • how to report suicidal content on Instagram (tap “…” below the post and then tap “Report Inappropriate,” select “This Photo Puts People At Risk > Self-Harm”)
  • how to report suicidal content on YouTube (click “More” and then highlight and click “Report” in the drop-down menu. Click “Harmful dangerous acts,” then “Suicide or self-injury” to trigger a review)

Again, talk to your kids so that they know not to ignore any warning signs, as one day, they might be in a position to save one of their friends.

What to Know About Talking to Your Kids About Suicide

Talking and asking about suicide is a good first step in getting someone who might hurt themselves help.

More on Talking to Your Kids About Suicide

5 Rare Syndromes That Parents Should Learn About

I’ve talked about classic and uncommon diseases that parents should learn about before. From acanthosis nigricans to volvulus, they are conditions that are fairly common. Or at least not rare.

There are another group of syndromes that it can be good to be aware of, not necessarily because you will ever know someone that is affected by them, but rather because they are so hard to diagnosis, increased awareness is important.

5 Rare Syndromes That Parents Should Learn About

What are these rare syndromes? They include:

  • Ehlers-Danlos syndromes – now includes thirteen subtypes of connective tissue disorders, at least one of which can cause infants to have repeated, unexplained fractures that can be confused with child abuse
  • Mitochondrial genetic disorders or mito – genetic diseases that can affect multiple organ systems in the body and can cause a variety of signs and symptoms, from developmental delays and muscle weakness to seizures. The type of mutation and whether it is in mitochondrial DNA or nuclear DNA determines the type of mito disorder, of which there are many, including Alpers syndrome, Barth syndrome, Co-enzyme Q10 deficiency, Kearns–Sayre syndrome, Leigh syndrome, MELAS, and Pearson’s syndrome, etc.
  • PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is characterized by OCD and/or tics that appear or suddenly worsen after a strep infection. With the OCD, these young kids might also have anxiety, including separation anxiety, depression, irritability, regression in their behavior, sleep problems, or school problems, etc. Although it has since been renamed PANS, Pediatric Acute-onset Neuropsychiatric Syndrome, you should still have the “temporal association between Group A streptococcal infection and symptom onset/exacerbations” to have PANS.
  • POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other disabling symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia). POTS is actually fairly common. What’s rare is for parents and pediatricians to know about POTS, and to therefore get kids diagnosed.
  • Vocal cord dysfunction – often misdiagnosed as asthma, especially exercise induced asthma, and other things, kids with vocal cord dysfunction often have episodes of repeated shortness of breath, chest tightness, wheezing, and coughing – just like asthma. They don’t improve though, even as more asthma medicines are added, which should be a red flag that these kids don’t have asthma and could have vocal cord dysfunction instead.

Have you ever heard of these disorders? No one would be surprised if you hadn’t.

Although a few are indeed rare, even when children do have them, it often takes years and years and visits to many different doctors before many of these kids finally get a diagnosis. That can mean years and years of unnecessary treatments and more importantly, the missed opportunity to get the proper treatment and hopefully relief for your child’s symptoms.

Why don’t all doctors learn more about these conditions so that they can be sure to recognize them as early as possible?

It’s not that simple. For every teen you every see with POTS, there will likely be dozens with vasovagal syncope or orthostatic hypotension. Same goes with the Ehlers-Danlos syndromes, which can sometimes be confused with the more common hypermobility spectrum disorders, which might just cause kids to have some extra aches and pains.

Tips for Getting a Diagnosis for These Rare Syndromes

How can you get a quick, or relatively quick diagnosis if your child has one of these syndromes? A little luck and a lot of increased awareness. This can also help avoid getting diagnosed when your child probably shouldn’t.

“Vocal cord dysfunction is an asthma mimic. Diagnosis of this condition requires a high index of suspicion if unnecessary treatments are to be avoided.”

Varney et al on The successful treatment of vocal cord dysfunction with low-dose amitriptyline

It can especially help to understand that:

  • Children with EDS often score 6 out of 9 on the Breighton scale.
    Children with EDS have hypermobility and often score 6 out of 9 on the Beighton scale. (Photo by Cattalini et al CC by 4.0)

    you might suspect that your child has one of the Ehlers-Danlos syndromes if they seem to be “double jointed,” often complain of growing pains, have a lot of sport’s injuries, poor wound healing, and/or skin that is hyper-extensible.

  • mitochondrial disorders are rare and children often don’t have classic signs or known genetic defects that make getting a diagnosis easier. There are checklists of signs, symptoms, and physical exam findings to look for, testing that can be done, and family history to look for, that may help if you suspect that your child has a mito disorder. Why would you suspect that your child has a mito disorder? They might have unexplained low muscle tone (hypotonia), muscle weakness, poor growth (failure to thrive), seizures, and lactic acidosis.
  • there aren’t always easy blood tests that help to make these diagnoses. Even when there are, like in the case of PANS/PANDAS, an elevated strep titer, some health care providers will make a diagnosis with a titer that isn’t really elevated or isn’t rising. Or in a child that has had no evidence of a strep infection. You should suspect PANDAS when a younger child (before puberty) suddenly develops (abrupt onset) obsessions, compulsions, and/or tics.
  • since many teens have issues with dizziness and fatigue, to make a diagnosis of POTS, they should have a real tilt test which demonstrates that their heart rate goes up at least 30 to 40 beats per minute within 10 minutes of going from a supine (lying down) to a standing position. The problem is that many health care providers do the tilt testing improperly, getting heart rate and blood pressure measurements at the wrong time. The easiest way to do a tilt test (active stand test) is to have the child lie down for a good 10 minutes, and check their heart rate and blood pressure. Then have them stand up (being careful they don’t faint) and check them again immediately, noting the differences.
  • although vocal cord dysfunction can be triggered by the same things and have the same symptoms as asthma, the treatments are greatly different. Instead of asthma inhalers, kids with vocal cord dysfunction learn breathing techniques and might get voice therapy. Other clues that a child might have vocal cord dysfunction include normal pulmonary function tests, that they have stridor, instead of wheezing, and that episodes come and go more quickly than a typical asthma attack.

With a prevalence of about 1 in 5,000 people, the average pediatrician might never see a child with EDS or a mito disorder.

Pediatricians are much more likely to see kids with PANDAS, POTS, and vocal cord dysfunction. More awareness  of all of these syndromes can help make sure that kids get a quick diagnosis and proper treatments.

A referral to a pediatric specialist or team of specialists can also be helpful if you suspect that your child has any kind of rare or unexplained syndrome.

What to Know About Getting a Diagnosis for These Rare Syndromes

Your pediatrician can help if you suspect that your child has any of these difficult to diagnose conditions.

More on Getting a Diagnosis for These Rare Syndromes

Can You Skip Your Newborn Baby’s Eye Ointment?

A lot of what happens in the delivery room and newborn nursery once your baby is born is routine.

Tragically, skipping some of this routine care, from a RhoGAM shot to the vitamin K shot and hepatitis B vaccine, is becoming standard for some anxious parents.

Some even want to skip getting the antibiotic ointment that is placed on their baby’s eyes that can help prevent ophthalmia neonatorum, which can lead to blindness.

Ophthalmia Neonatorum

Since we don’t usually think of pink eye (conjunctivitis) as a serious disease, it is likely hard to imagine that neonatal conjunctivitis (ophthalmia neonatorum) could lead to blindness. It does though – or did.

Ophthalmia neonatorum due to Gonococcus infection.
Ophthalmia neonatorum due to Gonococcus infection. (Photo by Murray McGavin CC BY 2.0)

The main cause was Neisseria gonorrhoeae, a sexually transmitted infection that could be passed to a baby when they were born. Similarly, Chlamydia trachomatis can cause ophthalmia neonatorum.

That ophthalmia neonatorum could be prevented was first discovered by a German gynecologist in 1881. Dr. Carl Siegmund Franz Credé instilled a drop of silver nitrate into a newborn’s eyes immediately after they were born and this greatly decreased the rates of infections in babies born in his hospital.

Today, erythromycin ophthalmic ointment and povidone-iodine have largely replaced the use of silver nitrate for preventing ophthalmia neonatorum, but it works on the same principle – killing any bacteria that might cause neonatal conjunctivitis, especially those that cause blindness.

Can You Skip Your Newborn Baby’s Eye Ointment?

Why skip a treatment that can prevent your baby from getting an infection that can lead to blindness?

Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection.
Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. (Photo by CDC/ J. Pledger)

Since ophthalmia neonatorum is generally caused by gonorrhoea and chlamydia, most parents who think about skipping their baby’s eye ointment are likely fairly confident that they don’t have one of these sexually transmitted infections. And most of them will likely be right.

In fact, some countries, including Australia, the UK, Norway, Denmark, and Sweden, have stopped routine ophthalmia neonatorum prophylaxis. Some just treat those babies who are at high risk for infections, especially if they didn’t receive prenatal care or have a maternal history of STIs, etc.

In the United States, routine use of erythromycin 0.5% ophthalmic ointment within 24 hours of a baby’s birth for the prevention of ophthalmia neonatorum is still the standard of care. In fact, it is required by law in many states.

What are some of the issues to consider when thinking about skipping your baby’s eye ointment?

  • the incidence of gonorrhoea and chlamydia have been increasing in recent years and it is very possible to have these STDs without obvious symptoms
  • up to 30 to 50% of babies born to a mother with gonorrhoea or chlamydia will get neonatal conjunctivitis, even if they had a cesarean section
  • not all pregnant women are routinely tested for gonorrhoea and chlamydia
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia can very quickly lead to permanent scarring and blindness
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia is not as easy to treat as routine pink eye, often requiring hospitalization and systemic antibiotics
  • gonorrhoea and chlamydia aren’t the only bacteria that can cause severe neonatal conjunctivitis

Most importantly, if you are thinking about skipping your baby’s eye ointment, know that places that routinely stopped using eye ointment to prevent ophthalmia neonatorum often  saw an increased incidence of gonococcal ophthalmia, while rates remain very low in the United States.

“The annual figures for ON reported during the study period, under statutory health protection regulations, underestimated the actual occurrence of this disease by a very substantial amount.”

Dharmasena on Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study

And you are likely to get worried every time your baby has a little eye discharge or redness, just like parents who skip vaccines worry when their child has a fever or cough.

Since the eye ointment that is used is safe (erythromycin doesn’t cause the irritation that silver nitrate used to in the old days), why take the risk of an infection that can lead to blindness?

What to Know About Skipping Your Baby’s Eye Ointment

The use of erythromycin eye ointment after your baby is born can help to prevent a serious infection that can lead to blindness. Don’t skip it.

More on Skipping Your Baby’s Eye Ointment