Here are some information sheets and handouts from our offices that you might find helpful.
Vitamin K for Newborns
Why is Vitamin K given to newborns?
Vitamin K is a critical part of the formation of several clotting factors that prevent bleeding.
Newborns are at risk for vitamin K deficiency because they do not receive enough vitamin K from the placenta during pregnancy, and because they do not yet have a sufficient amount of special bacteria in the gut that helps make vitamin K. Babies receiving breast milk are especially at risk due to the limited amount of vitamin K in the breast milk.
Vitamin K deficiency in the newborn can lead to bleeding within the first week after birth (early Vitamin K deficiency bleeding), as well as bleeding between 2-12 weeks of age (late Vitamin K deficiency bleeding). Babies may bleed from the skin, nose, mouth, umbilicus, gastrointestinal tract or the site of circumcision. Babies may also bleed inside the brain, which may result in permanent brain damage, seizures, and death.
Which is the best way for newborns to receive Vitamin K?
Since 1961 the American Academy of Pediatrics has recommended that Vitamin K be given as a single injection soon after birth. This helps prevent both early and late Vitamin K deficiency bleeding.
Although vitamin K may be given orally (by mouth) and may help reduce the risk of early bleeding, studies have shown that oral vitamin K is not as effective as vitamin K given by injection in reducing the risk of late Vitamin K deficiency bleeding. Even if multiple doses of oral vitamin K are used in the first month, cases of bleeding in the brain due to late vitamin K deficiency have been reported. For this reason, the American Academy of Pediatrics continues to recommend the use of Vitamin K by injection for all newborns after birth and considers the administration of injectable Vitamin K to be safe and effective.
--------------------------------------------------------------------------------------
What you need to know about vitamin D
What is Vitamin D?
Vitamin D, sometimes referred to as, "the sunshine vitamin," has long been known for its importance in helping build strong bones and preventing rickets. New research is suggesting it may have other important roles in heart health, regulating the immune system, and even in cancer prevention. Unfortunately, many Americans, adults and children may have low levels of vitamin D.
What are sources of Vitamin D?
Our skin makes vitamin D when exposed to sunlight. Factors such as the amount of pigment in your baby's skin and skin exposure affect how much vitamin D is produced by your body from sunlight. During winter in the more northern parts of the country (such as the Bay Area), the amount of sunlight is not enough for any baby. Because exposing skin to sunlight has been shown to increase the risk for skin cancer later in life, we now recommend that infants and young children not be in direct sunlight when they are outside, particularly infants younger than 6 months of age. Sunscreen should be used on all children when in sunlight but it prevents vitamin D formation in the skin. Milk is a source of vitamin D in our diets, but we would need to drink 1 quart (32oz) per day to get enough.
Who needs Vitamin D supplements?
The AAP recommends that all babies who are exclusively breastfed, or drink less than 32oz of supplemental formula a day, receive Vitamin D supplements of 400 IU a day. Babies who are exclusively formula fed do not need Vitamin D supplements. Children 1 year of age or older should also receive 400IU of Vitamin D per day.
How do I give Vitamin D supplements to my infant or child?
Tri-vi-sol or Poly-vi-sol are liquid multivitamins that are commonly sold in pharmacies. You may also be able to find liquid drops that contain only Vitamin D. For all three of these products, one dropperful a day given by mouth provides 400 IU of vitamin D.
Carlson's Baby D drops provide 400 IU of vitamin D in only one drop. The drop can be given directly into the baby's mouth, or dropped onto a pacifier or nipple just before feeding. These are available at Whole Foods and some other health food stores.
Most children's multivitamins (gummy or chewable) contain 400 IU of Vitamin D. These can be given to children age 2 or older according to the package instructions.
----------------------------------------------------------------------------------
Infant Sleep Resources
The Happiest Baby on the Block by Harvey Karp, MD
This book is specifically for parents of newborns with the goal of helping parents find ways to soothe and settle their crying babiesso that they sleep better and longer. There is good information about temperament, colic and newborn sleep. This book is targeted to baby's first three months and getting you off to a good start with sleep habits.
Solve Your Child's Sleep Problems by Richard Ferber, MD
While sometimes maligned as a cruel "cry it out" plan in truth, this book contains an excellent explanation of the science of sleep as well as a careful and detailed plan to help you teach your baby to fall asleep on his own. Ferber advocates a "graduated extinction" method that really works when done correctly and consistently. Usually within a few nights babies are sleeping better. The method involves putting your baby to sleep awake but sleepy and relaxed and then, when your baby protests, you return to the room to reassure baby at increasingly longer intervals. This book also has a comprehensive coverage of problems with naps, sleepwalking and night terrors, and sleep schedule difficulties. It also covers co-sleeping. There are targeted plans for babies waking and wanting to be fed, sleep problems associated with a new sibling, and time changes.
Healthy Sleep Habits, Happy Child by Marc Weissbluth, MD
Billed as a step-by-step program for a good night's sleep, this book is helpful reading right from the time you bring your new baby home as it's goal is both solving and preventing sleep problems. The first part reviews infant and child sleep physiology and discusses how daytime and nighttime sleep are different. The second part is divided into chapters by age and details how babies should be sleeping and how parents can help to establish healthy sleep habits. The third section addresses many other common sleep problems such as sleep walking, daylight savings time, nap refusals and more. Weissbluth also advocates for a method called "extinction" with open-ended crying or "graduated extinction" close to Ferber's method.
Sleeping Through the Night by Jodi Mindell, PhD
The underlying message of this book is the same as Weissbluth's and Ferber's: help your baby learn to fall asleep on her own. However, Mindell allows a more flexible approach for those who are very uncomfortable allowing their baby to cry. She spends a lot of the book discussing relaxation strategies for parents and babies and how to create bedtime routines. She also addresses common sleep problems.
The Sleep Lady's Good Night, Sleep Tight: Gentle Proven Solutions to Help Your Child Sleep Well and Wake Up Happy by Kim West
The Sleep Lady Shuffle approach is a gentle behavior modification technique that helps babies gradually master solo sleeping and self-soothing. She avoids the extinction or "cry it out" approach which may be more comfortable for parents who can not tolerate the other authors' methods. The author covers such general sleep tips as creating a sleep-friendly environment and offers individual chapters addressing various age groups from newborn to five. The book includes information on sleep safety, pacifier use, and breastfeeding, as well as toddler naps, co-sleeping, interpreting newborn cries, and phasing out nighttime feedings.
Internet Resources:
parenting.com, healthychildren.org, kidshealth.org
-------------------------------------------------------------------------------------
Guidelines for Introducing Solid Foods
Most babies are ready for solid foods at 5-6 months of age.
A baby's first solids foods may include infant cereals, pureed fruits, or pureed vegetables.
Add only one new food at a time every 3-5 days to monitor for a reaction to the new food.
If there is a strong family history of food allergy, you may wish to delay introduction of these foods: peanut, shellfish, egg whites
Avoid giving honey before 12 months of age to prevent botulism (a serious illness that can cause paralysis in infants).
Start Water: You may start giving your baby some water in a sippy cup with meals. Give your baby tap water (not bottled) to help prevent cavities. -
A Brita or Pur filter will remove lead and chlorine, but not fluoride
Reactions to food: Rash or hives, vomiting or diarrhea that seems specific to that food.
Symptoms like nasal congestion or fussiness may, less commonly, be signs of a food reaction, but they are harder to distinguish from unrelated events such as colds or a random cranky day. If the behavior is specific to the food, it could be a reaction.
If you think your baby is reacting poorly to a new food, stop giving the food and discuss it with your baby's provider at the next visit.
Initially babies usually eat once a day and slowly increase over the next several months so that by one year of age, most of their calories are from solid food.
---------------------------------------------------------------------------------
What you need to know about Probiotics
What are Probiotics, and when might my child need them?
Probiotics are live microorganisms (in most cases, bacteria) that are naturally found in the human gastrointestinal tract. They are also called "friendly bacteria" or "good bacteria" because they aid in digestion and do not cause disease. The natural balance of these bacteria can be upset when your child gets a stomach virus or is on antibiotics for an infection such as an ear infection. This can result in diarrhea. Replacing the good bacteria with probiotic supplements has been shown to help diarrhea go away sooner.
How do I give Probiotic supplements to my child?
There are many different brands of probiotics available at pharmacies and health food stores. Most often, the bacteria in these supplements come from two groups, Lactobacillus or Bifidobacterium. Some commonly found brands are: Culturelle, BioGaia, FloraStor and Lactinex. Probiotics come in many forms that may easily be given to children or infants such as liquids, chewable tablets, or powder that can be mixed into a small amount of food or drink. When used to treat diarrhea, probiotics should be given twice a day. If your child is on antibiotics, it is important that the probiotics NOT be given at the same time the antibiotics are given. Give the probiotics at least 1 hour before or 1 hour after the antibiotic is given.
Can I just give my child yogurt instead?
Most probiotic supplements contain 10 billion live cells per dose, the amount that has been shown in scientific studies to treat diarrhea. Most yogurts have only about 1 billion live cells of probiotics, so your child would have to eat 10 yogurts to get the same amount as one dose of a supplement! Also, when children have diarrhea from a virus or from an antibiotic, they do not digest milk products well, so yogurt may make the diarrhea worse.
---------------------------------------------------------------------------------
For Parents of Teens
Now that your son or daughter is a teenager, there are some things we would like to share with you that are important to provide them the best of care. Your son or daughter's body is changing and so are his or her feelings. There are many health risks during the teenage years that we try to prevent such as accidents, violence, unprotected sex, alcohol and drug use and stress. Some areas of teen health that we may talk about during an appointment are:
· Diet, exercise and body image
· Working/jobs
· Fighting, danger, and violence
· Depression and stress
· Sexuality and sexual behavior
· Safety and driving
· Dating and relationships
· Smoking, drugs and alcohol
· Family life
· Peer pressure and school
It is good to stay close to your child. It is also important to allow them some time alone to talk about their health and changes in their bodies and their lives. This will help your teenager learn to make good decisions. We encourage teenagers to share information about their health with their parents or guardians. However, there will be some things that your teenager would rather talk about with a doctor, nurse, or counselor. California law allows teenagers to receive some health care services on their own. Health care providers have to keep those services CONFIDENTIAL. "Confidential" means we can share this information with you only if your teen says it's all right. We can also share this information if someone is in danger.
We can contact you about most of the services your child receives. However, if your teenager receives the following services, we cannot give you information about these visits without permission from your son or daughter:
The prevention or treatment of pregnancy or sexually transmitted diseases (STDs) and other contagious diseases. (NOTE: We routinely screen ALL patients age 16 and older for Chlamydia).
The diagnosis and treatment of sexual and physical abuse.
Care and counseling for drug or alcohol problems.
We ask that you support these rules and help your teen learn to care for his or her own health needs. We look forward to providing ongoing medical care for your child. We will be happy to talk with you about questions or concerns you may have about this letter and your child's health.
---------------------------------------------------------------------------------
Guidelines for Colds & Flu
Click here to view our "Guidelines for Cold and Flu"
Breastfeeding
Click here to view our short guide to "Breastfeeding Success"
Helpful websites:
Children's Hospital http://www.childrenshospitaloakland.org/
KidsHealth http://www.kidshealth.org/
American Academy of Pediatrics http://www.aap.org/
American Academy of Pediatrics symptom checker: http://www.healthychildren.org/symptom-checker