Is it Time to Start Feeding Baby Solid Foods?

There comes a time in every baby’s life when the food on your plate starts to look better than what she’s been eating. Is it time to start feeding your baby solid foods?

Here are a few questions to consider when coming up with an answer:

• Is your baby around 6 months old?
• Can she sit up with support and hold her head up on her own?
• Does she show interest in solid foods, say, by watching you when you eat and opening her mouth or moving it as if chewing along?
• When you offer her a spoonful, does she take it into her mouth and move her jaw instead of pushing it out with her tongue?
• Has she doubled her birth weight (to about 13 pounds or more)?
• Is she still hungry after eating a full meal of breast milk or formula?

If the answer to these questions is yes, your baby may be ready for her foray into solid foods.

First foods

In the past, parents were advised to start with a single-grain cereal and introduce solid foods in a specific order: rice cereal, vegetables, fruit, and then meat. We now know there’s no scientific evidence showing that introducing foods in a specific order is necessary. Of course, it’s fine if you want to introduce foods in the traditional order, but if you think your baby is interested in trying a different food first, that’s OK, too.

The following guidelines do still apply:

• Introduce new foods one by one, waiting two to three days between each new food to watch for an allergic reaction, such as diarrhea, rash, or vomiting.
• While they’re called solid food, your baby’s first foods won’t actually be solid. Instead, the foods will be soft or pureed – what we generally think of as baby food and find in baby food jars at the store. If you like, you can also puree food in a blender or food processor. Just make sure everything is reduced to the point that it no longer requires chewing. You can also mix in a little breast milk or formula to make your baby’s first solid foods more familiar.
• Offer small bites – half a spoonful or a smidgen on the end of your fingertip is enough. And don’t expect your little one to start feeding himself yet. That will come a little later when he’s ready for finger foods.
• If your baby balks, don’t force it. Back off and return to breast milk or formula for a while. There’s plenty of time for your baby to learn to enjoy solid foods.
• Don’t forget breast milk or formula. Just because your baby has started solid foods doesn’t mean he’s ready to be weaned. On the contrary, breast milk and/or formula will continue to be an important part of your baby’s diet until he’s at least 12 months old.

As you begin feeding your baby solid foods, remember that mealtime is not only for eating – it’s an important social activity as well. So as your little one takes his first tastes, make it a family affair and enjoy your meal together. Bon appetit!

DistrACTION Cards: Because Kids Already Know Shots Hurt

As a pediatrician, I have a confession to make. I’m ashamed to admit that in residency I was amused when kids ramped up the drama getting shots. I’m not talking about a sadistic pleasure watching a 4 year old get poked repeatedly, I’m talking about an artistic appreciation of the wailing, screaming, and ninja-like thrashing performance when the nurse brought in the tray and….cleaned the child’s arm. With cotton. Gently. Yep, it was hard not to restrain a snicker when you alerted the child that, far from being near death from pain, the procedure hadn’t started yet. See? Cotton.

As a pain researcher, I now know that fear dramatically increases pain perception. Not only that, but focusing on the site where you expect pain naturally enhances your body’s perception of pain. Just like focusing on bite of gourmet food enhances your perception of nuances of the flavor (“Oh, cilantro!”) focusing on a painful procedure enhances that pain to occupy your entire consciousness. Not great if you don’t want pain.

Pain relief has become a major focus of medical professionals and children’s hospitals in recent years. While topical anesthetics have been around for decades, only 7% of pediatricians use methods to decrease the pain of needles. Recent innovations to address pediatric pain have been introduced, in part due to the realization that needle fear has jumped from 25% to 63% of children. This 252% increase is theorized to result in part because there are five times more live-saving vaccines that are now routine, and the realization that some vaccines need to be given at older ages to work well. Older age means kids remember the event, have greater cognitive powers to focus on the event, and thus can develop ongoing issues with needles when they experience vaccines as traumatic..

One physiologic way to deal with pain has been spotlighted here before, putting the cold and vibration unit Buzzy “between the brain and the pain”. The body feels sensations of cold and massage, and has less bandwidth to perceive pain. The sensation can even be disrupted, just like cold running water eliminated the pain of a burned finger. What I realized soon after developing Buzzy, however, was that a kid who is bound and determined to let you know how much they hate shots can feel pain from an alcohol swab. For a highly anxious kid who hasn’t seen Buzzy before, the explanation of “how this is going to make it better” might even focus them more on the procedure. I realized I needed something to help the child who is already afraid…something to decrease the fear AND take the focus off the poke.

Fortunately, kids have amazing imaginations, and — Ooh, look at that! —are pretty easy to distract. An easier, faster, and less expensive way to address pain and even boredom comes from the delightful curiosity kids have about new things, especially when they’re brightly colored. The very trait in kids that can be frustrating in long lines or car trips can actually be a huge advantage in managing pain. In fact, some of the more traditional hospital distractions (blowing up a balloon, etc.) had been proven to decrease children’s distress with medical procedures consistently by about 50%… But for this situation – for the child walking in terrified – we needed something more…but what? And thus, the DistrACTION cards were born….

What we’d learned was that controlling pain wasn’t enough for anyone – Fear, Focus on the procedure, and Pain all contribute to the experience.

To optimally pull a child’s attention away from a painful procedure, Child Life therapists use a variety of techniques, from blowing out (pinwheels, balloons, deep breathing) to visual distractions, both passive (videos) and active (Where’s Waldo??). Pulling from the distraction pain literature, I distilled the elements that seemed to be most helpful. In a stressful situation, too much difficulty (math problems) can be counterproductive. This is why “Where’s Waldo”, while a good active distraction, is actually less effective for most medical situations: he’s just too hard to find. The concept, though, is useful – visual active tasks like finding work well. Adding rote elements like counting can be good, but it depends on how hard it is to find something. “How many of something can you find” can be too easy if they’re right there – you could stop after one. “Find 6 of something”, however, is a concrete task which adds visual input to the cognitive task and gives the comfort of rote familiarity. The trick is distracting effectively for the right situation, giving just the right amount of challenge with the comforting ritual of counting. It’s that simple.

DistrACTION cards have 10 questions on the back of each one, stratified by age groups.

They include questions that require simple finding for younger kids (Where is a purple cow?) with some questions that only adults could get (Can you find all the suits in a deck of cards?) Classic counting, how many cows?, was found to be too easy for older kids, so questions add difficulty by asking “How many cows are wearing a costume?”)

After creating the DistrACTION^® Cards for medical procedures, investigators around the world started testing them.

1. First, Buzzy plus Distraction was tested for IV access in Turkey. Used correctly, Buzzy decreases needle pain 50-80%, and has been highlighted in Phlebotomy Today as a way to help draw blood in anxious patients. When DistrACTION is added, both together reduce pain from IV insertion 88%.
2. Investigators then started evaluating the DistrACTION cards alone. In the first study, pain was reduced 50% with the “Monkeys” set of cards alone; even cooler, 97% of kids said the procedure was better than previous times they’d had blood drawn.
3. Subsequent studies comparing other Child Life techniques found that DistrACTION cards decreased pain more than playing with a kaleidoscope; another study found the cards more effective than blowing a balloon, or playing a singing cartoon game.

The DistrACTION cards have now been clinically proven in three studies to be even better than other distractors in hospitals

Beyond pain management though, we found a terrific secondary benefit. When you can distract a child well enough to reduce pain in an unfamiliar environment, adding DistrACTION cards to a situation that is “merely boring” is extremely effective. From a 2 hour junior high concert recital to (one emergency nurse admitted) sitting through Mass, the cards have been extremely helpful for everyday behavior support. They’re waterproof, so they even work on the beach. No batteries, no screens – who knew?

I think the coolest thing for me has been that now, I get amused when a child seems very anxious, starts to ramp up the drama… and then is told “It’s already done!” As kids learn how distraction helps them deal with their own pain, the lesson sticks, even when there are no cards around. At a recent doctor visit for HPV vaccination, my older son said “Wait! You don’t have DistrACTION cards? Ok, ok, no problem…” he looked around the room and found red, blue and yellow speckles on the tile floor.” “No problem. When I need the shot, I’m counting confetti!” When he didn’t even flinch with the poke he was almost as proud of himself as I was!

HEALTHFUL HINTS

1. Distraction is an extremely effective parenting technique for multiple situations quite apart from pain management. Trouble starts brewing when children get bored, but a child who learns how to entertain themselves will have that skill their whole lives.
   • It’s critical to not depend on a battery powered source for distraction – whether it’s a small book, Distraction cards, or a small pot of play-dough, props help avert a boredom-induced meltdown. Once you learn the level of difficulty that keeps a kid engaged, the world around becomes a perfectly good distraction. “OK, I spy with my little eye…”
   • YOU are the best distraction for your child. While older kids can ask each other questions or read the questions on the back of the cards themselves, human interaction keeps a distraction interesting.
2. For injections and medical procedures, there’s a difference between offering distraction and forcing a kid not to watch. Let the 20% of kids who prefer to view the procedure do so – it may be it’s own distraction for them, or a way for them to feel in control of the situation so they’re less afraid.

We ALL Need To Observe National Child Passenger Safety Week

We struggle in so many ways to keep our children and grandchildren safe from the many dangers we know are out there, both on the streets and in our homes. Yet surprisingly, even those who love them the most, are willing to do everything in their power to protect them from harm, still allow them to be exposed to a dangerous situation, sometimes several times a day. I’m talking about the few minutes required to make sure they are properly restrained in their car.

I’m a grandma. When my own children were young, there were no child restraint safety seats, therefore, no safety regulations regarding their use. Seatbelts were the only safety measures available in cars, and their use was not yet mandatory. Today, with the availability of four types of safety restraints for children based on age, height and weight statistics – and a step-by-step instruction guide to help you figure out which one you need (thank you!) – the watchdogs of child safety have made the use of the proper restraint a no-brainer. Combined with easy-to-follow installation methods (including offering videos as well as live help options) the only part of protection that remains to be taken care of is making sure the restraints are closed properly. That job was never intended to be left for the “kids” to handle themselves. What I think has happened over the last number of years is, with Mom or another caregiver transporting children to school, doctors, play dates, lessons, sports, shopping, etc . . . , everyone is in and out of the car so many times a day, that the easy way out took precedence over what is correct. We let the kids buckle themselves in. But making sure they are safe is an adult responsibility.

It’s time for a reality check. Too many children are killed or maimed each year because an otherwise loving, conscientious caregiver did not realize that the child safety restraint was not the proper one, was not installed correctly, or was not secured the right way. These are senseless and preventable tragedies.

Reaching out to and teaching these loving caregivers that help is available to minimize or eliminate the injuries sustained by children in a car crash has become the mission of the National Highway Traffic Safety Administration. This week, September 21 through September 27, has been designated National Child Passenger Safety Week. Using all the tools at its disposal to spread awareness and make safety checks available to anyone interested in keeping children safe while being transported in a car, NHTSA has gone all-out to spread the word.

We wish everyone concerned in this worthwhile endeavor “good luck”. We’re hoping that every person reading this takes the time to forward the information and the links to all the caregivers they know.

One Decision, Tragic Results: Please Look Before You Lock (Video)

“It could never happen to me.” “I would never leave my child alone in the car – not for a minute.” “No GOOD parent would ever forget their child!”

But it happens every day. According to The National Safety Council on average 37 children die in hot cars each year, about one every 10 days from heat-related deaths after being trapped inside motor vehicles. This year already there have been 3 child vehicular heat-stroke deaths. And this is not counting the life-altering injuries experienced by the children who survive.

It happens…

Children climb into unlocked cars to play. A child is sleeping in the back-seat and a parent “cracks open the window” and runs into the store for “just one thing” (…illegal in some states but in a NHTSA survey, 25% of parents admitted they had done this at least once). A spouse / partner / caregiver carefully buckles the baby into the car seat to drop them off at daycare. Maybe it wasn’t their day to drive…or maybe something distracts them for just one second. It’s just a little departure from the usual morning routine – only this time they forget the baby sleeping in the back seat (…more likely now since the American Academy of Pediatrics changed their guidelines to recommend that children remain rear-facing in car seats until they reach the age of two. A parent looking in the rear-view mirror no longer sees their child’s face – just the back of the car seat – whether their child is in it, or not).

It happens…

…and it doesn’t have to be 100 degrees outside for the consequences to be devastating. According to NHTSA’s Consumer Advosory: “NHTSA Issues an Alert to Prevent Child Heatstroke in Cars“, even cool temperatures in the 60s can cause the temperature to rise well above 110 degrees Fahrenheit inside your car. The inside temperature can rise almost 20 degrees F within the first 10 minutes”. Within an hour the temperature jumps around 50 degrees F. If the outside temperature is in the low 80’s F, the temperature inside the vehicle can reach deadly levels in only 10 minutes. Slightly rolling the window down has almost no impact on these temperature increases.

Take a look at this simulation produced by the SafeKids organization of how fast a car can heat up when exposed to direct sunlight

Children’s bodies – in particular infants and children under 4 years of age – are at greatest risk for heat-related illness. They absorb more heat and are less able to lower their body heat by sweating. Because a child’s thermoregulatory system is not fully developed, their bodies warm at a rate 3 to 5 times faster than an adult’s. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. A core body temperature of 107 degrees F is considered lethal because cells are damaged and internal organs shut down.

It happens…

To the most loving, caring parents…the most responsible caregivers. These are not “those horrible people who should never have been allowed near children”. Take a minute to read Kristie Reeves-Cavaliero’s story about the day her husband Brett took one wrong turn and drove to the office instead of dropping their beloved daughter Sophia (Ray Ray to those who loved her) off at daycare. It wasn’t until they met for lunch later in the day that they realized something was wrong. By that time Ray Ray had been in his truck for 3 hours. An hour and 19 minutes later she was gone.

But this isn’t just Ray Ray’s story. More than 1 in 5 kids who die of heatstroke in a car were supposed to be dropped off at daycare that morning – and no one questioned their whereabouts until it was too late. Other parents have had similar experiences. They share the story of their children’s tragedies here, in interviews, in every public forum possible – in the hopes of saving just one family the pain they have endured.

SO WHAT CAN YOU DO TO PREVENT ANOTHER TRAGEDY??

• Child Vehicle Heatstroke Prevention Tips from NHTSA:
  • Never leave a child unattended in a vehicle. Never leave infants or children in a parked vehicle, even if the windows are partially open.
  • Do not let your children play in an unattended vehicle. Teach them that a vehicle is not a play area.
  • Make a habit of looking in the vehicle – front and back – before locking the door and walking away.
  • If you are dropping your child off at childcare, and normally it’s your spouse or partner who drops them off, have them call you to make sure the drop went according to plan. Ask your childcare provider to call you if your child does not show up.
  • Do things to remind yourself that a child is in the vehicle, such as:
    • Keep a large object such as a stuffed animal in the car seat when it’s empty. Move the stuffed animal to the front seat when you place the child in the seat as a visual reminder.
    • Place your purse, briefcase or something else you need in the back seat so that you will have to check the back seat when you leave the vehicle
  • If you see a child alone in a hot vehicle: call the police. If they are in distress get them out as quickly as possible and cool the child rapidly. Call 911 or your local emergency number immediately
• Download the KidsandCars Safety Checklist and keep it handy
• Friday May 30th is National Heat Awareness Day: Please Help Us Raise Awareness!
  • Post on every social media platform…and use the hashtag #heatstroke to spread the word – child vehicular heatstroke is the leading non-traffic, non-crash cause of death for children.

“If you think it can’t happen to you, then it could and it might… Tell yourself it COULD happen to me, and then do whatever it takes to make sure it doesn’t.”
…kidsandcars.org

And if you ever catch yourself saying…”I’ll only be gone for a moment”… please do two things:

1. Consider the following question: If someone gave you a million dollars – would you leave it sitting there unattended in your car – even for a moment? Isn’t your baby’s life worth more?
2. Consider watching this video…and then maybe even share it:
   Before you do, know that it is very graphic and may be upsetting…so please think twice before you watch it.

Please also know that this was a re-enactment – no one was harmed in the making of this film

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Editor’s Note: This post was originally published in July of 2013. We are republishing it today to commemorate this year’s National Heat Awareness Day.

To Breastfeed for 6 Months or Not To Breastfeed for 6 Months…

Last updated on March 3rd, 2018 at 12:14 pm

…that is the question…

This week a small group of pediatric health experts from the UK published a report in the British Medical Journal questioning the 2001 World Health Organization’s recommendation to provide 6 months of exclusive breast feeding. The WHO and UNICEF recommend:

• Initiation of breastfeeding within the first hour of life
• Exclusive breastfeeding – that is the infant only receives breastmilk without any additional food or drink, not even water
• Breastfeeding on demand – that is as often as the child wants, day and night
• No use of bottles, teats or pacifiers

This is based on significant evidence that breast milk reduces the rate of pneumonia, ear infections, gastroenteritis and other infections.

Given however the much lower incidence rate of these illnesses in “developed countries” some medical professionals have voiced their concern about applying the 6 month restriction universally. They argue that while “exclusive breastfeeding for 6 months is readily defendable in resource-poor countries with high morbidity and mortality from infections, in developed countries, other concerns can take precedence”.

This aligns with the new report which suggests that babies who are breastfed exclusively for six months are at a higher risk for iron deficiency and food allergies including celiac disease, and may also lead to a delay in developing a taste for food products which could have a long term impact on diet. Among the questions asked – “will babies who aren’t introduced to bitter-tasting foods in the first 6 months continue to have an aversion to them for the rest of their lives??” If this does in fact occur, will it make it even more difficult to win the battle against obesity?

All of that being said, the current debate is not one which attempts to answer the question of whether or not a mother should breastfeed. That is a separate conversation with its own proponents for and against. But even for those moms who make the decision to breastfeed, many still struggle to continue for the recommended 6 months – especially if they return to work. (According to the CDC , although 75% of new moms in the U.S. start breastfeeding, only 13% are still breastfeeding exclusively at 6 months).

So what is the right answer? Can solid foods be introduced as early as 4 months? The WHO and UNICEF are continuing to support a 6 month guideline while a number of experts are now recommending the alternative. One area they both seem to agree is that each child is different, and watching for baby’s cues will be the best guideline of all.

So what about you?? How did you know when your little one was ready for solids?

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References:

• In Breastfeeding, What’s Best – Katie Moisse, ABC News Medical Unit – Jan 14, 2011
• Breast may not be best for the first six months of life, some experts say – Karen Kaplan, Los Angeles Times – Jan 14, 2011
• Exclusive breastfeeding – World Health Organization
• No solid answers on baby food – TVNZ – January 16, 2011