A Fussy Four-Week Old

     I’ve written articles on colic, sleep problems and fussy infants before (see Jan and May of this year and refer to the index in Dec 2012 for other listings). A call from the daughter of a friend prompted another article.

   For the first few weeks of his life, Max was a perfect baby. At four weeks, however, he began to get fussy. He would cry and scream, then settle down and even close his eyes when given something to suck on. But even if he fell asleep, he would only sleep a short time and then wake up screaming again.

     Whenever a baby isn’t acting normally, it is always a good idea to have him checked by his caregiver. Max had no fever, no vomiting, normal activity level and seemed to be healthy except for the continuous crying.

     Mom told me two important things: She had been told by a friend to wake him up in the morning and not let him sleep too long during the day so that he didn’t get his days and nights mixed up. She had also been told to never let him cry himself to sleep because he would feel abandoned.

     Some of our basic baby rules are: 1. Never wake up a sleeping baby. 2. Healthy babies cry either because they are hungry, wet or tired. 3.  Babies can need up to 18 hours of sleep a day. 4. Switching a fussy baby from a milk-based to a soy-based formula is always an easy, cheap thing parents can do and is often effective for “colic” because milk allergy is so common. 5. No matter how tired they are, babies (like all humans) don’t go to sleep right away when they lay down. Adults read, watch TV or listen to music to burn off that last bit of energy. Babies cry.

     Max is on a soy-based formula now. When he is crying, mom changes him, tries to feed him and, if he isn’t hungry, she rocks him a little to settle him down and then puts him in his crib and leaves the room. He is allowed to cry until mom can’t take it anymore. However, when mom goes in, she changes him, offers him some formula and, if he is still crabby, puts him right back in the crib. He and mom have had a few rough days getting adjusted but now he’s sleeping longer, he’s happy when he wakes up and mom says she “has her baby back”.

     Whenever someone tells you something that makes you feel guilty as a mother or just sounds silly, feel free to ignore it no matter whom the advice comes from.

Homeopathy

     I recently saw a very famous television doctor who was recommending homeopathy for various aliments and I thought it was time to review what homeopathy is.

     Homeopathy was invented in the 18^th century by a German chemist/physician named Hahneman. He was reading a book that recommended cinchona bark as a cure for malaria. He decided to try taking the cinchona bark and he experienced palpitations, anxiety and joint pain – all of which are symptoms people get when they have malaria. Based on this one experience – no other experimentation or research – he came up with the theory that “like cures like”. He concluded that a chemical that gives people symptoms could cure a disease that causes the same symptoms. If you have vomiting, take a chemical that makes you vomit.

     Many of the most commonly used medications at Hahneman’s time were very toxic – arsenic, mercury and belladonna, for example. It was common for physicians to dilute these medicines with water to diminish their toxicity. Dilution naturally decreases both the effects and the side effects because by adding water, you had less of the drug in the mixture. To keep with his “like cures like” theory, Hahneman developed a second theory of “Potentization”. This theory says that even though the toxic effects of the chemical were lessened by adding water, the healing effects were increased if you shook the mixture in a special way. This, of course, defies basic science and all logic. Homeopathy dilutes a substance with water, then takes a small amount of that mixture and adds a large amount of water to the small sample and then repeats that process 100 or more times. After doing that, the final mixture might have one molecule of the original chemical in it, but, in reality, what you are left with is just water. The amount of actual substance in the liquid has been compared to putting a pinch of the medication into the entire Atlantic Ocean – both North and South.

     There are two factors at work in the practice of homeopathy. One is that most of the aches and ill feelings humans have on a day-to-day basis go away by themselves and don’t need any treatment. So, if you do anything or take anything for them, you’ll feel better because you would have felt better anyway. Second is the power of the placebo effect. In every study of a treatment or medicine, a percentage of people in the study are given a placebo ("sugar pill") rather than the treatment. Many of those who get the placebo improve as if they got the treatment even though there is no scientific reason for it. Every time the effectiveness of homeopathic cures has been subjected to hard scientific studies, they do as well as placebos because they are placebos.

     If someone doesn’t feel well and a massage, aroma therapy or a homeopathic medicine makes them feel better, that’s great because that is the goal of every health care provider. But when a famous television doctor who knows better sells homeopathy as an actual medical cure, that’s dishonest.

Starting Breast Feeding

     My daughter recently told me a horror story about a friend of hers who was trying to initiate breastfeeding with her newborn. She didn’t have milk right away, but her baby cried and acted hungry all the time.  She was told by the hospital staff not to give formula and to keep trying to feed the screaming infant. She was awake for two days getting more frustrated and fatigued all the time. She felt like a failure and finally just gave up and gave the baby formula and swore she would never try to breastfeed again. 

     New moms who want to breast feed need to know some basic facts. On average, most newborns are feeding well at about three days of life. On average, most moms start to feel their breast milk come in on about the third day, too. Nature knows that both mom and baby need some rest after labor and delivery, so babies are born fed – they have excess water and nutrition at birth so that everyone can relax and gradually get breastfeeding started.

     But everything in biology is on a bell-shaped curve which means that some babies will be hungry on the first day and some babies won’t be really hungry until the fourth day. Some moms will have their breast milk come in on the first day and other moms won’t get good milk production until the fourth day. Of course, that means that sometimes the hungry baby will be matched with the late mom and the late baby will be matched with the early mom.

     New moms should always try to breastfeed when their infant gives them the clues that they are hungry. If the small amount of breast milk mom has at first satisfies the baby, there is no problem. The baby will gradually get hungrier with each feeding, mom will gradually make more milk and breastfeeding will move ahead naturally.

     But if it is clear that the baby is still hungry after a reasonable amount of time breastfeeding or if the infant keeps screaming because he isn’t getting enough, it is time to supplement with formula. When the infant eats enough, he will fall asleep for about 3 hours and when he wakes up, he’ll be hungry again and mom can try breastfeeding again.

      New moms are often threatened with horrible outcomes to keep them from supplementing – “He’ll never breast feed well”; “He’ll only want formula”. Thankfully, there was a recent study published in the June, 2013 issue of Pediatrics which dispels these threats. They looked at infants who were given supplemental formula in the first week of life and they found that at 3 months of age, 79% of the infants given formula supplementation were breastfeeding exclusively. Interestingly, only 42% of the moms and infants who were denied supplemental formula were exclusively breastfeeding at 3 months.

     It’s simple: if your infant is hungry, feed him. If you have enough breast milk, fine. If not, give him some formula and try the breastfeeding again the next feeding. You’ll both sleep better.

     

The "Don't" Date

     I’m going to step slightly outside pediatrics for one article and focus of the “due date”. I recently experienced a scenario that I saw many times in practice. A daughter of a friend of mine was having her first child and was induced on her due date, even thought she had manifested no signs of labor. The induction involved stripping the membranes, administration of pitocin and rupturing the membranes.  After a day of artificial, drug-induced, ineffective labor, she was exhausted and underwent a C-section. Because of the risk of infection, the baby had to be delivered within 24 hours of membrane rupture.

     The due date – estimated date of delivery – is a estimate at best. It is figured from adding 280 days to the first day of the last menstrual period or from counting back three months from the last menstrual period and then adding 7 days. Either way it assumes that the woman has a strict 28-day cycle and conceived on the 14^th day of her cycle – neither of which is true for most women. Add to that the fact that a term infant is anywhere from 38 to 42 weeks of gestation and you can see how inaccurate the due date can be.

     The problem comes when either the mother or the doctor takes the due date too seriously. It is especially easy for the mom to do this. The social question that everyone who meets a pregnant woman asks is: “When are you due?” the first 1,000 times a mom answers this question, she says, ”sometime in fall”. The next 1,000 times she says, “in mid-September”. But, the next 1,000 times she says, “September 20^th!” The due date gets larger and larger in her mind and gradually a made-up estimation starts to become a real date. I’ve heard mothers say things like “I’m three days overdue” when it is simply three days past the due date.

     I’ve never been pregnant but I appreciate how difficult it is for moms in that last month. They can’t fine a comfortable position for sleeping, eating, sitting or living in general. They hurt when they walk and they are basically miserable – especially if it happens to be August. So, when that due date comes, it’s time to have that baby – they’ve been counting on it for months! The problem is that Nature doesn’t know the due date and the baby may normally come weeks before or weeks after. And first–time moms can be even further off schedule.

     If the body hasn’t gone into natural labor and isn’t ready to deliver, induction methods are often ineffective and result in an exhausted mom who “has been pushing for 24 hours”, a frustrated hospital staff and a worried physician who then too often resorts to a C-section. Statistics say that induction doesn’t result in any increase in C-sections, but it isn’t right to compare C-section rates from this country and say they don’t increase when our rates are the highest in the world.

     It is important for mom’s caregiver to monitor the baby’s growth, but now ultrasound technique has become so good that it is the best way to both determine the baby’s gestational age and monitor development.

     If a mother has gone beyond her due date, but both she and the baby are doing well, it makes sense to monitor the pregnancy more closely and to do watchful waiting. But the due date should be a “don’t date” when it comes to trying to hurry the natural start of labor.