Category: Ages & Stages

Don’t Skip Your Baby’s Vitamin K Shot

Most parents understand and expect that their baby will get a vitamin K shot when they are born and before they leave the hospital.

It helps prevent bleeding from vitamin K deficiency.

Vitamin K for Babies

Leave the formula samples at the hospital, but don't leave without your baby's vitamin K shot.
Leave the formula samples at the hospital, but don’t leave without your baby’s vitamin K shot.

Newborns have been routinely getting vitamin K shots since at least since 1961.

While it was well known that newborns could suffer from hemorrhagic disease of the newborn (the old name for vitamin K deficiency bleeding) since 1894 (thanks to Dr. Charles Townsend), it wasn’t until later that it was connected to a temporary lack of vitamin K in newborns and younger infants. This occurs because:

  • vitamin K doesn’t pass through the placenta well, so your baby doesn’t build up a good supply during pregnancy
  • breast milk is a poor source of vitamin K, even if the breastfeeding mother eats well and takes supplements, so your baby isn’t able to quickly build up a good supply after she is born
  • babies have a mostly sterile gut and are not born with the bacteria in their intestines that can make vitamin K
  • some clotting factors need vitamin K to work

Although vitamin K deficiency bleeding was never very common, before newborns began it get vitamin K shots, it did affect from 1.7% (classic onset disease) to 7 in 100,000 newborns (late onset disease).

Since many of these bleeds were fatal, even though they were rare, no one thought that there was a benefit to being low in vitamin K and getting a vitamin K shot wasn’t controversial. At least not until a 1992 paper suggested that vitamin K shots could be associated with childhood cancer. That soon led some parents to refuse their babies vitamin K shots for a short time, at least until the link was refuted.

In 1996, a student called for the ‘End of the Vitamin K Brouhaha:’

“Because hemorrhagic disease of the newborn can be life-threatening but preventable, the studies by von Kries et al and Ansell et al should allay our fears and doubts about the dangers of administering intramuscular vitamin K immediately after birth. It seems that hemorrhagic disease of the newborn can be completely eradicated without the threat of leukemia and childhood cancer as a side effect.”

And the vitamin K brouhaha did seem to end.

The Vitamin K Controversy

It came back though.

In addition to holistic and natural parenting groups, there are some who are against vaccines who are also against vitamin K shots.

This is surprising to many people, as those who oppose giving babies vitamin K are often the same folks who push many other types of vitamins, including megadoses of vitamin C, vitamin B12 shots, and extra vitamin D.

Vitamin K Misinformation

So why do some parents skip giving their new baby a vitamin K shot?

It is possible that in doing their research, they have been mislead by some of the misinformation about vitamin K that you commonly find on the internet.

This includes claims that:

  • there is mercury and other toxic ingredients in the vitamin K shots (the truth is that neither mercury or thimerosal nor any other heavy metals are used as a preservative in vitamin K shots and all of the other ingredients are safe too)
  • vitamin K shots cause cancer (the truth is that they don’t and an early study that suggested they did was later refuted many times)
  • babies don’t need extra vitamin K (the truth is that some do though and it is typically impossible to identify them, except maybe for babies born to mothers taking certain medications, mostly seizure medicines, that put them at extra risk of early vitamin K deficiency bleeding)
  • babies start making enough vitamin K when they are 8 days old (the truth is that some babies don’t, especially those with liver disease and other disorders that might interfere with the absorption of fat soluble vitamins)
  • babies did fine before we started giving them vitamin K shots (the truth is that some died, which is why we started giving vitamin K in the first place)
  • you can just give babies oral vitamin K instead of a vitamin K shot (the truth is that oral vitamin K doesn’t work to prevent all cases of late onset vitamin K deficiency, which is also deadly)
  • only boys who get a circumcision need vitamin K (the truth is that we don’t know why some infants with vitamin K deficiency bleeding develop bleeding in their brains, as it isn’t usually any kind of big trauma, so it doesn’t have to be something like a circumcision or a fall or whether you delivered vaginally or by C-section, etc. In fact, late onset bleeding can occur up to 12 weeks, and sometimes as long as 6 months, after a baby is born!)
  • there must be a benefit to having low vitamin K levels when we are born, otherwise God wouldn’t have made us this way (even if this were somehow true, it doesn’t negate the fact that some babies die from their low vitamin K levels…)

Just as with vaccine preventable diseases, since vitamin K deficiency is now rare (because most parents make sure their babies get a vitamin K shot), it is easy for parents to be misled by this type of misinformation.

Bad Advice about Vitamin K

According to the American Academy of Pediatrics, vitamin K deficiency bleeding “is most effectively prevented by parenteral administration of vitamin K.”

That’s the vitamin K shot.

While early (birth to 2 weeks) vitamin K deficiency bleeding can be prevented with either oral vitamin K or a vitamin K shot, late onset (2 to 12 weeks) vitamin K deficiency bleeding is best prevented with a vitamin K shot.

Some people didn’t get the message though, advising parents to skip the vitamin K shot against all standard medical advice:

  • Dr. Mercola still warns parents about the ‘jab with a syringe full of vitamin K.’
  • Sarah Pope at the Health Home Economist tells parents to ‘Skip that Newborn Vitamin K Shot’
  • 28 percent of parents who delivered at local private birthing centers in Tennessee had recently declined the vitamin K shot

So what are the consequences of this kind of non-standard, non-evidence based advice?

They are much as you would expect when dealing with a potentially life-threatening condition – a rise in vitamin K deficiency bleeding in newborns and infants.

Among the recent cases of early and late vitamin K deficiency bleeding include:

  • seven babies over eight months in  2013 at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, including three who required surgery to remove clots “out of their head” and who may “have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”
  • a 5-week-old in Florida with late onset vitamin K dependent bleeding. The youngest of 6 children, none of whom had been given vitamin K, the baby had a seizure and stopped breathing after developing two brain hemorrhages.
  • a 3-week-old in Indiana with late onset vitamin K dependent bleeding who was born in a birthing center and whose “parents signed a waiver to forego vaccination and prophylactic therapies,” and required an emergency craniotomy to evacuate braining bleeding, prolonged intubation, and difficult to control seizures
  • a 6-week-old in Illinois with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and developed brain bleeding and swelling, seizures, a DVT, and who was hospitalized for 10 days
  • a 6-week-old in South Texas with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and died after developing brain bleeding and seizures
  • an infant in Australia who had not been given a vitamin K shot as per her mother’s birth plan and  died of late vitamin K deficiency bleeding (at 33 days of life)
  • another infant in Australia who is in critical condition after his parents refused a vitamin K shot
  • infants in Germany, Switzerland, Denmark, and the Netherlands who have suffered from vitamin K deficiency bleeding while receiving oral vitamin K, often because their parents refused a vitamin K shot

Tragically, most parents who refuse vitamin K shots also refuse other potentially life-saving medical interventions, including getting a hepatitis B vaccine and even getting erythromycin eye ointment. And many go on to refuse all childhood vaccines.

On the bright side, the great majority of parents do allow their newborn babies to receive vitamin K when they are born. One study found that only 0.3% of parents refused vitamin K.

What To Know About Vitamin K Shots for Babies

The bottom line is that vitamin K shots are a safe way to prevent vitamin K deficiency bleeding. This is no good reason to skip this shot for your baby.

More Information About Vitamin K Shots for Babies

Save

How to Clean Your Baby’s Umbilical Cord

It is very important that a baby’s umbilical cord is well cared for, as infections of the umbilical cord stump have historically been a major cause of disease and death in newborn babies.

These infections can include funisitis (foul smelling, purulent discharge from the umbilical cord stump), omphalitis (infection of the umbilical cord stump), omphalitis with necrotizing fasciitis (more severe infection with sepsis and shock), and neonatal tetanus.

History of Umbilical Cord Care

Over the years, many things have been used to try and keep a newborn baby’s umbilical cord free of bacterial colonization until it falls off.

“To achieve the goal of preventing omphalitis worldwide, deliveries must be clean and umbilical cord care must be hygienic.”

AAP Umbilical Cord Care in the Newborn Infant – 2016

These substances include:

  • triple dye
  • isopropyl alcohol  or rubbing alcohol
  • povidone-iodine or iodopovidone (Betadine)
  • chlorhexidine
  • hexachlorophane
  • antimicrobial ointments, such as neomycin and bacitracin

Remember when your baby came home from the nursery with his or her cord covered in purple dye? That was triple dye. It is rarely used anymore.

Umbilical Cord Care Recommendations

So what is used now that we don’t use triple dye?

Although many parents are still tempted to use alcohol, the main advice is now to ‘do nothing’ and just let the cord fall off.

That is not a universal recommendation though.

“Ensuring optimal cord care at birth and during the first week of life, including use of chlorhexidine, especially in settings having poor hygiene, is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.”

Chlorhexidine Working Group

Why the different recommendations?

Because, in some countries, 10 to 20% of live births are still complicated by umbilical cord infections.

But if antiseptics can help keep the umbilical cord stump free of infections, why not just use them?

It is thought that using these antiseptics when they aren’t necessary, like when a baby is born in a hospital under hygienic conditions in a “high-resource country,” then they may:

  • lead to the development of resistance and selection of “more virulent bacterial strains”
  • cause the cord to take longer to fall off – especially if you applied alcohol to the stump at each diaper change
  • waste money and resources

That’s why, when appropriate, it is now recommended that we practice dry cord care. And that’s great news, as it still seems like most parents don’t want to ever touch their baby’s umbilical cord stump!

Dry Cord Care

Give your baby sponge baths until the umbilical cord comes off to help it stay dry.
Give your baby sponge baths until the umbilical cord comes off to help it stay dry.

With dry cord care, you simply:

  • keep the umbilical cord stump clean and dry (sponge baths only until the cord comes off)
  • leave the umbilical cord stump exposed to air or loosely covered by a clean cloth (fold your baby’s diaper down, which will also help prevent the cord from getting soaked with urine)
  • clean the umbilical cord stump with soap and sterile water if it does get soiled
  • watch for signs and symptoms of omphalitis, including a foul smelling discharge, red skin around the umbilical cord, or if the cord or skin around it becomes tender

Keep in mind that dry cord care is likely not appropriate if your baby was born at home, was born in a “resource limited country” or community, or if you are putting any non-sterile products on the cord to ‘help’ it come off more quickly.

These natural products to avoid include clay, cord care powders, dried herbs, honey, and oils.

When should your baby’s cord come off? While the average time is about two weeks, it is usually not considered delayed unless it hasn’t fallen off by the time your baby is three or four weeks old.

What To Know About Umbilical Cord Care

Taking care of your baby’s umbilical cord stump is now easier than ever for most parents. Just keep it clean and dry and watch for signs of infection until it falls off.

More Information on Umbilical Cord Care

Understanding and Treating Teen Sleep Problems

Do your kids have to get up too early because school starts too early?
Do your kids have to get up too early because school starts too early?

Parents often ask for help getting their kids to fall sleep and then stay asleep all night.

At least they do when they are little.

Teens often have trouble sleeping too though, but parents often don’t recognize these sleep problems and might not think to ask for help. They do likely see some of the issues that can be caused by a poor night’s sleep though, which can include irritability, sadness, a poor attention span, and hyperactivity, etc.

Why Teens Don’t Sleep Well

From being over-scheduled and having to get up early for school to staying up late on a screen, there are many reasons why your teen might not be sleeping well.

There are also many different types of sleep problems.

To understand what is causing your child’s sleep problems, ask yourself these questions and share the answers with your pediatrician:

  • Does your teen sleep at least 8 1/2 to 9 1/2 hours each night?
  • Does your teen have trouble falling asleep or does he just wake up a lot in the middle of the night? Or does your teen seem to sleep enough, but is still always tired?
  • Does your teen snore loudly at night – a sign of obstructive sleep apnea?
  • Is your teen taking any medications that could cause insomnia, such as for ADHD (stimulant) or allergies (decongestant)?
  • Does your teen have poorly controlled allergies, asthma (late night coughing), eczema (frequent itching keeping him awake), or reflux?
  • Is your teen drinking any caffeine in the afternoon or evening?
  • Do you think that your teen is depressed or has anxiety, either of which could cause problems sleeping?
  • Have you noticed any symptoms of restless leg syndrome, including a strong urge to move his legs when he is sitting or lying down?
  • Does your teen have too much homework and is staying up late trying to get it all done?
  • What does your teen do just before going to sleep?
  • Does your teen fall asleep easier when he goes to bed much later than his typical bedtime or does he still have trouble falling asleep?
  • Are your teen’s sleep problems new?

And perhaps most importantly, what is your teen’s daily sleep schedule like? What time does he go to sleep and wake up, including weekends, and does he typically take a nap?

Treatments for Teen Sleep Problems

In addition to treating any underlining medical issues that might be causing your teen to have trouble sleeping, it will likely help if your teen learns about sleep hygiene and:

  • goes to bed and wakes up at about the same time each day, instead of trying to catch up on “lost sleep” on the weekends
  • keeps his room bright in the morning (let in the sunshine) and dark at night
  • avoids taking naps, or at least naps that are longer than about 30 to 45 minutes
  • avoids caffeine
  • is physically active for at least one hour each day
  • doesn’t eat a lot just before going to bed
  • turns off all screens (phone, TV, computer, video games, etc.) about 30 minutes before going to sleep
  • doesn’t get in bed until he is actually ready to go to sleep, which means not watching TV, reading, or doing anything else on his bed
  • gets out of bed if he doesn’t fall asleep after 10 to 15 minutes and reads a few pages of a book, before trying to go to sleep again

Did that work?

If you teen is still having sleep problems, encourage them to try some basic relaxation techniques, such as progressive muscle relaxation, guided imagery, and deep breathing or abdominal breathing. You do them at bedtime and again if you wake up in the middle of the night.

I especially like the idea of guided imagery for teens, as they can focus on something they like to do, whether it is building a sandcastle on the beach, or going horseback riding, surfing, hiking, or playing baseball, etc. They should focus on the details of the story they make up, coming back to it if their mind wanders, and hopefully they fall asleep as they get caught up in it.

With the deep breathing technique, they slowly breath in through their nose and out through their mouth. They can hold their breath for a few seconds or breath into their abdomen too (abdominal breathing).

Progressive muscle relaxation is another technique that might help your child relax at bedtime. They simply tense and then relax each muscle group of their body, one at a time, starting with their toes and working their way up. If they make it up to their forehead and aren’t asleep, then they should work their way down, perhaps doing 3 to 5 repetitions for each muscle group,  or try another technique.

And be sure to talk to your pediatrician if your teen continues to struggle with sleep problems.

What To Know About Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

For More Information on Teen Sleep Problems

How To Avoid Peanut Allergies

Infants with eczema are at high risk for developing peanut allergies.
Infants with eczema are at high risk for developing peanut allergies. Photo courtesy of the NIAID.

The worst part of having a severe allergy to peanuts isn’t the high price of EpiPens.

It is that peanut allergies can be deadly, even when you have access to an EpiPen.

And since there is no 100% fool proof way to avoid peanuts and peanut containing foods, doctors have been trying to come up with ways to prevent kids from ever developing peanut allergies.

The first efforts, to avoid peanuts and other high risk foods during pregnancy and early infancy, likely backfired, leading to even more kids with peanut allergies. That’s why recommendations for starting solid foods changed back in 2008, when the American Academy of Pediatrics began to tell parents to no longer delay giving solid foods after age 4 to 6 months and that it wasn’t necessary to delay “the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.”

The latest guidelines are the next evolution of that older advice.

Now, in addition to simply not delaying introducing allergy type foods, as part of a new strategy to prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually give their infants peanut-containing foods!

Prevention of Peanut Allergies

Developed by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with 25 professional organizations, federal agencies, and patient advocacy groups, these clinical practice guidelines recommend that parents:

  1. introduce peanut-containing foods into your infant’s diet as early as 4 to 6 months of age if they have severe eczema, egg allergy, or both (strongly consider allergy testing first)
  2. introduce peanut-containing foods into your infant’s diet around 6 months of age if they have mild to moderate eczema
  3. introduce peanut-containing foods into your infant’s diet in an age-appropriate manner with other solid foods if your infant has no eczema or any food allergy

Keep in mind that it is possible that your baby already has a peanut allergy, so discuss your plan to introduce peanut-containing foods with your pediatrician first. But don’t be in such a rush that you make peanut-containing foods your baby’s first food. Offer a cereal, veggie, fruit, or meat first. If tolerated, and you know that your baby is ready for solid food, and with your pediatricians okay, then consider moving to peanut-containing foods.

And although not always necessary, it is possible to do allergy testing even on younger infants. Testing is an especially good idea if your infant has severe eczema or an egg allergy. For these higher risk kids, referral to an allergy specialist might even be a good idea, where infants can start peanut containing foods in their office (supervised feeding) or as part of a graded oral challenge. Your pediatrician might also consider supervised feeding for your higher risk child who is not allergic to peanuts.

Peanut-Containing Baby Food Recipes

So how do you give a 4 or 6 month old peanut-containing foods?

It’s not like Gerber has any 1st or 2nd foods with peanuts – at least not yet…

So for now, you can:

  • add 2 to 3 tablespoons of hot water to 2 teaspoons of thinned, smooth peanut butter. Stir until the peanut butter dissolves and is well blended. You can feed it to your baby after it has cooled.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of thinned, smooth peanut butter.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of peanut flour or peanut butter powder.

Each of these recipes will provide your baby with about 2g of peanut protein. Since the goal is to give your child about 6 to 7g a week, you should offer them three separate times.

During the first feeding, it is important to only “offer your infant a small part of the peanut serving on the tip of the spoon,” and then wait for at least 10 minutes to make sure there are no signs of an allergic reaction, such as hives, face swelling, trouble breathing, or vomiting, etc.

Of course, because of the risk of choking, you should not give infants or toddlers whole peanuts or chunks of peanut butter.

More Information on Preventing Peanut Allergies

Breastfeeding Recommendations

Parents often have a lot of questions about breastfeeding.

One thing that they shouldn’t question is that breastfeeding provides a number of “short- and long-term medical and neurodevelopmental advantages” for their baby.

That’s why the American Academy of Pediatrics, in their 2012 policy statement on Breastfeeding and the Use of Human Milk recommended:

“Exclusive breastfeeding for about six months…”

And for breastfeeding “to continue for at least the first year and beyond for as long as mutually desired by mother and child…”

Since the AAP has concluded that “breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development,” be sure you get all the help you need to effectively breastfeed your child.

And remember, if breastfeeding was easy, we wouldn’t need lactation consultants. So don’t be afraid to ask for help.

For more information:

Circumcision

The American Academy of Pediatrics policy statement has shifted over the years.

They still don’t recommend that boys routinely get circumcised though.

Instead, the latest recommendation, which was published in a 2012 policy statement, states that:

…the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.

While the health benefits of getting circumcised, including prevention of UTIs, penile cancer, and transmitting some STIs, outweigh the small risks of the procedure, the AAP states that parents still need to decide if circumcision is in the best interest of their male child, thinking about their own “religious, ethical, and cultural beliefs and practices.”

Don’t get your child circumcised because you think it will be too hard to clean his intact penis and don’t get your child circumcised because you think everyone else is doing it and he will have problems in the locker room. Those aren’t good reasons.

It is also important to keep in mind that if your child is circumcised, the AAP also states that babies should be given “adaquate analgesia,” (that’s pain control) including:

  • penile nerve block techniques
  • nonpharmacologic techniques, like positioning and sucrose pacifier, can be used as an adjunct to a penile nerve block

And of course, the AAP came out with a policy statement in 2010 against the “traditional custom of ritual cutting and alteration of the genitalia of female infants, children, and adolescents, referred to as female genital mutilation or female genital cutting (FGC).”

For more information: