Parenting Solved

Parents Driving with One Hand

Here’s irony: Some parents complain about the dangers of vaccines or the rare side effects of medication. However, driving their children one-handed in busy traffic while carrying on a cell phone conversation isn’t seen as a concern. Just something to think about.

While I’m guilty of many indiscretions as a father, I make every effort to use my phone with an earpiece and two hands on the wheel.

Do Parents Want Expensive Infant Formula?

Last week I recommended Carnation Good Start with Natural Cultures to mother who had visited my office. She had considered Good Start but sheepishly confessed that she discounted it when she found it was less expensive than the competitor. It seems some parents believe a high price tag formula holds some advantage for their baby.

Are there cases where it’s a good idea to spend more for formula? Very few. Here are a few situations where you can expect formula to come at a higher cost:

Allergy. Hydrolysed formulas such as Nutramigen and Alimentum are costly to prepare and consequently come at a higher cost. Expect to pay about 350 dollars a month to feed your typical 4-month-old baby with hydrolysed formula. Extensively hydrolysed formulas such as Neocate are more expensive and will cost over 500 dollers per month for the typical 4-month-old baby. In each of these cases there’s no advantage to their use unless your baby is truly suffering with milk protein allergy.

Magic fat. And what about DHA and ARA? These are the long-chained polyunsaturated fatty acids (LCPUFAs) found in breast milk that have been associated improved visual and cognitive function in newborns. While these were once an option for formula shopping parents, most manufacturers produce formula with DHA and ARA. While the argument against LCPUFAs in infant formula is losing steam I recommend a formula with adequate levels of DHA/ARA for those who can’t breastfeed. In this regard I like Good Start Supreme with DHA and ARA and Enfamil Lipil.

Organics. Organic infant formulas come at a higher cost but its unclear whether the degree of ‘contamination’ found in standard infant formula makes the step to organic worth it. Interestingly, Similac markets an organic baby formula and it makes me wonder why would you by the ‘dirty’ Similac when you can have the virginal organic preparation. Gerber faced this issue early on when organic baby foods first hit the shelves. They solved this issue by offering organic baby dinners with names that were entirely different from their standard line of jarred food. Parents never felt the obvious dilemma. Brilliant.

Convenience. Preparations of formula, of course, will vary with ready-to-feed formula being the most expensive. This is pure preference. But despite my insistence that there will be no difference for your baby among powder, concentrate or ready-to-feed, I often encounter parents with stories of intolerance with one form and not the other.

In the case of my patient and her reluctance to use Good Start, the difference in cost reflected differences in marketing, not nutrition. Finally, it’s interesting that I often run into parents looking for ‘permission’ to use the less expensive Parent’s Choice. As an aside, Parent’s Choice represents a fine option for parents seeking a more economical feeding option. While it may lack the live passengers found in Good Start with Natural Cultures, cost in this case shouldn’t otherwise represent a compromise.

My Thanksgiving Patient

Yesterday I saw a patient with short-gut syndrome who underwent a liver transplant about ten years ago. Back then I had identified her impending liver failure and referred her on for transplant. She had previously been under the care of a gastroenterologist who was slow to identify that the situation as dire.

This family makes a point of coming in every year during the week of Thanksgiving. While I thought it was nothing more than a vagary of the schedule, I found out yesterday that their November visit is more than just a coincidence. They credit me with saving their daughter’s life. It’s something of a pilgrimage that makes them remember their sticky situation.

I was moved to learn this. While I sometimes minimize the importance of what I do, it’s moments like these that make me thankful for the capacity to make a difference.

Colic Solved: “An Excellent Resource for Parents of Reflux Preemies”

While I’m not prone to self-aggrandizing behavior, these comments in the Preemie Community Forum made my day. As an author passionate about a subject you hope that you reach an audience, change behavior or views and make a difference. Comments like this make me think I’ve done my job. Thank you AllieKatesMommy wherever you are!

Identity Theft in Children

This gives new meaning to the term, deadbeat dads. The Wall Street Journal this week reported on the rising numbers of childhood identity theft victims. This crime often goes unnoticed until a child reaches their 18th birthday and applies for a license, job or mortgage. Here are a couple of interesting facts

*5-10% of identity-theft cases involve minors.
*In 69% of childhood identity theft cases the thief is one or both parents.

It appears that some people create a new identity when they’ve ruined their own credit and turn to their kids for a new start. Very nice.

How can you prevent this? Keep your kid’s SS# under wraps, check their credit report on a regular basis and keep your eye on Uncle Earnie.

Check out the Identity Theft Resource Center. They’ve even got a teen space laced with hip teen/tween colloquialisms.

Are Doctors Missing Reflux in Children?

According to a study presented at the annual meeting of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition last month, researchers from Loyola University Medical Center found that nearly one third of parents reported visiting three doctors before receiving a correct diagnosis of gastroesophageal reflux for their child.

And among toddlers and preschoolers in the study, more than 50% experienced a 3 month delay from the time of symptom presentation to diagnosis. 22% of children in this age group experienced a delay in diagnosis of greater than 18 months.

While these stats are concerning, they should come as no surprise for some parents who have sought attention for reflux disease. As pediatric GERD awareness remains in its infancy, vigilance is what drove the caregivers in this study to seek care for their kids.

Look for this compelling study to reach peer reviewed publication soon.

The Salt Lake Tribune - Curing The Colic Myth

The myths and realities of colic were recently exposed on the pages of The Salt Lake Tribune. Health reporter Jenn Barrett captured my thoughts on the issue as well as those of my ideological arch nemesis, Barry Lester from Brown. The piece came out very nice and illustrates that there’s more than one way to look at a screaming baby.

Are We Overprescribing Reflux Medications in Infants?

I received a publicist driven email on my iPhone during clinic today that a reporter from the Chicago Tribune wanted to discuss the overuse of reflux medications. I was unfortunately up to my ears treating babies sick with reflux and was unable to help.

His query was no doubt concerning a study published in the journal Pediatrics this month where we learned that babies who spit up are frequently and unnecessarily prescribed reflux medications. As no surprise, the majority of the treated babies in this study weren’t ill and lacked any concerning signs or symptoms of reflux. For those of us who do this for a living, this study tells us nothing new. It should, however, serve as a reminder to pediatricians (especially those in rural Lousiana where the study was conducted) that happy spitters don’t need treatment.

While we may expect over the coming days to hear about the negligent overuse of medication by heartless, pill-happy pediatricians, the public can rest assured that standards for the treatment of acid reflux in children do exist. Such standards were set forth by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition in a 2001 position paper. The results of this most recent study, however, tell us that we have more work to do. Data presented at our national convention two years ago suggested that 75% of American pediatricians were unaware that such guidelines for reflux even existed.

So who are the babies in need of reflux medications? Bottom line: those who are sick. Specifically we treat babies with difficulties feeding, growing and breathing. But of course, no two babies are alike and the decision to treat babies sick with reflux requires attention to the individual under consideration. But as I discuss in Colic Solved, the sick babies and the happy spitters are easy to recognize. It’s the grey-zone babies who create the real dilemma for the busy clinician.

Given the Medco data and this new study, expect to hear lots more about childhood reflux in the coming weeks.

Playtex DROP-INS System - A Better Bottle for the Gassy Baby?

You could say that I’m the kind of pediatrician who believes that a bottle is a bottle. Technology may be changing that.

A study out of Boston Children’s Hospital published late last year in the journal Pediatric Research compared the way babies fed from hard-walled bottles (Avent) and with that of soft-walled bottles (Playtex DROP-INS system). Using sophisticated instruments the researchers were able to simultaneously measure breathing, sucking, swallowing and blood oxygen in babies when feeding from each type of bottle system. They were able to identify differences in the way babies feed and breath with each bottle system and compared that with breastfed babies.

Some of the findings were very interesting:

Breastfeeding. Breast fed babies are able to separate swallowing from breathing.
Soft-walled bottle. Babies fed with the soft-walled bottles, like breast fed babies, coordinate their swallowing and breathing. They swallow less frequently and are less likely to swallow while breathing.
Hard-walled bottle. Babies fed with hard-walled bottles swallowed randomly and tended to swallow more frequently. Levels of blood oxygen in these babies was lower when compared with those babies who were breast fed or fed with soft-walled systems.

So despite popular trends towards certain bottles, it would appear that the Playtex DROP-INS system does a better job of helping a baby coordinate their sucking and breathing. And as the authors describe, this coordination is likely to lead to less air swallowing. As I discuss at length in my book, Colic Solved, air swallowing is the root of all gas in babies and anything we can to minimize it’s access can only help a baby’s cause.

As technology advances, our ability to identify subtle differences in the way babies feed with different bottles will change the way we look at feeding. Once a market driven process, our decisions regarding feeding systems will ultimately be defined by physiologically identifiable differences such as those seen in the Goldfield study.

As always, the breast is best. For those who can’t, the future looks bright.

Gastroesophageal Reflux Disease Escalating in Children

I have occasionally quipped that pediatric gastroesophageal reflux disease (GERD) is evolving as the new epidemic of the early 21st century. Perhaps there’s something to it.

At the 2008 meeting of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition held last week in Salt Lake City noted reflux epidemiologist Dr. Susan Nelson of Northwestern University presented the results of a study which demonstrates that rising numbers of children being diagnosed with reflux. Using an insurance claims database covering over 5 million people, the study looked at the diagnosis and treatment pattern of reflux in kids over a 6 year period.

While there’s lots to the study, I found the following factoids most interesting:

*Infants have experienced a 262% rise in the incidence (the number of new occurrences in the population) of reflux between 2000 and 2005.
*The incidence of reflux in children between the ages of 2 and 17 years of age was found to rise by 30-50% over the same time period.
*Proton pump inhibitors (like Prevacid and Nexium) are progressively overtaking histamine receptor antagonists (like Zantac and Axid) as the preferred method of controlling reflux in children.

And interestingly this rise in new reflux diagnoses isn’t the result of overspecialization of pediatrics … 91% of children appear to be diagnosed by their primary care physician.

While there are limitations to Dr. Nelson’s study, it’s clear that the recognition of GERD in children is on the rise. Is there actually more reflux than years before? It’s unlikely although the study presented by Dr. Nelson doesn’t address this issue.

This fascinating research was presented in abstract form and publication is expected at a later date.