Parenting Solved

Motrin Feels Twitter's Pain

An ad for the popular pain reliever Motrin has created a Twitter-style tempest among mommy and daddy microbloggers who find the ad patronizing and disrespectful.  The ad from McNeil Consumer Healthcare and their agency (Taxi NYC) starts off by saying that while babywearing is fashionable right now, moms who wear their babies cry more than those who don’t.  It also suggests that women wear their babies because it “makes them look like an official mom.”  If I were a gamblin’ man I’d bet this copy was written by a room full of men after a few beers.

The most remarkable thing to watch has been less the reaction and more the medium by which the reaction traveled among moms and dads.  It’s the Twitter effect and a clear example of the power of microblogging (You can follow the Twitter feed here.)  As important as anything else was the fact that it took close to a day for Motrin to identify the gaffe and react.

While I expect to see this cautionary tale carried on for days to come in the MSM, the lesson for companies such as McNeil Consumer Healthcare is the importance of a defined and actionable social media strategy, especially surrounding provocative ad campaigns.

The ad has been pulled but you can find bits of it here at Small Dots - look at the bottom of the post.  

Here are a couple of good links.

The Real Problem with the Motrin Ads by Peter Shankman

Motrin's Twitter Moment by Pistachio

Whisper to a Scream by WOM MOM

You can follow me on Twitter here

Sleep Feeding - New Problem or Old Sign of Acid Reflux?

Over the past few weeks I’ve had several questions from parents on a problem referred to as sleep feeding.  What is it? Why do babies do it?  What can I do about it?  And (perhaps the most interesting issue) where did this problem come from?  Here’s my take.  And I’ll modify this over time as I learn more. 

What is sleep feeding?  

Quite simply, sleep feeding is a popular term used to describe babies who feed nearly exclusively when asleep.  Better put, these are babies who have such a difficult time feeding when awake that their sleep state appears to relax them to the point that they are more organized and able to feed. Parents are consequently forced to put their baby to sleep in order to help them maintain their intake.  Mention of the problem in our current body of medical literature is scarce, if not absent.  

But while the popular discussion of sleep feeding is new, the problem is not.  I describe the phenomenon of sleep feeding in my 2007 book, Colic Solved – The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby (see page 46).  And over the past 10 years I’ve evaluated and treated many babies with sleep feeding.

Most babies I have seen with sleep feeding represent variants where some feeding can be completed while awake but only with a great deal of effort.

What causes sleep feeding?  

As someone who has made a living evaluating feeding and digestive disorders in babies, I have found that the vast majority of infants with sleep feeding in my practice suffer with symptoms of acid reflux.  Here’s what happens:

1.     Babies with their recumbent posture, poor gastric emptying, loose lower esophageal sphincters and liquid diets are naturally prone to reflux.  Those with significant reflux sustain inflammation or irritation in the swallowing tube (esophagus).

2.     Painful esophageal inflammation leads to painful feeding marked by frequent pulling from the bottle or nipple.

3.     If not treated, babies continue to struggle to feed and potentially develop an aversion to feeding. 

4.     Parents discover that feeding goes better when sleeping and the pattern is facilitated in order to maintain appropriate milk intake.

Another problem that can predispose to a pattern of sleep feeding in babies is milk protein allergy.  Allergy can create inflammation just like that seen with acid reflux.  And while we always have to consider anatomic problems in any baby with feeding issues, those with anatomic issues in the throat or swallowing tube are unlikely to feed any better when asleep.  In other words, the plumbing won’t change with state of arousal. 

It’s important to look beyond the pattern of feeding while asleep in order to identify what’s behind an infant’s feeding issue.  In other words, the nature and pattern of feeding while awake often offers clues to the presence of reflux esophagitis in a baby.  And the same is true for allergic inflammation in the gut.  Other signs and symptoms as detailed in my book will help identify the baby with subtle signs of reflux or painful feeding. 

In theory, any condition that interferes with smooth, comfortable feeding could lead a parent to help a baby develop sleep feeding.  Consequently acid reflux should not be assumed to be the primary problem.  It needs to be diagnosed based on clinical criteria.

What can parents do with a sleep feeding baby?  

It’s important for parents to understand that sleep feeding appears to be a reactive phenomenon rather than a primary problem or condition.  In other words, feeding during sleep is a pattern that develops out of necessity in a child with an issue that prevents effective feeding while awake. What’s the primary issue?  Consequently our attention needs to be on identifying what’s going on to create such problematic feeding.  This is not an issue that you can resolve on the Internet or through the advice of others in a chat room.  While support is critical, a hands-on assessment by a trained expert is critical. 

Here are a few things to keep in mind when getting help for your baby:

·      Look and treat.  Look for and treat conditions that predispose to painful or difficult feeding.  Acid reflux and allergy need to be firmly excluded.

·      Enlist an expert.  If acid reflux has been firmly excluded, consider an assessment by a pediatric speech pathologist or occupational therapist experienced in infant feeding.  Two things are critical here:  pediatric specialization and infant feeding experience.  You want to find a therapist who spends all of their time with children and has extensive clinical experience in infant feeding disorders.  If you live in a small community, seeking the input of a speech pathologist or OT who dabbles in children may be a waste of time.  Beat a path to the nearest city with pediatric services.  If your pediatrician isn’t immediately comfortable assessing your baby look for consultation with a pediatric gastroenterologist. 

·      Simple feeding difficulty or long standing aversion?  Recognize that when a baby’s primary feeding problem is identified and treated early, normal patterns of eating while awake can often be resumed.  The baby older than 5-6 months of age, however, may potentially have aversive behaviors that persist long after the primary problem has been addressed.  This mandates therapy by a professional experienced in infant feeding therapy.

·      Never force feed.  While tempting, force feeding a baby with an underlying feeding issue is likely to compound the stress, fear and anxiety already associated with the bottle or breast. 

Why are parents talking about sleep feeding?  

This is possibly the most interesting question surrounding the sleep feeding phenomenon.  Why wasn’t anyone talking about this last year, for example.  Is this some sort of new issue?  A modern epidemic perhaps?  Hardly.  As I mentioned, sleep feeding has been around as long as reflux has plagued babies.  The current discussion is just one step in the sequence of recognizing the problem of reflux in babies.

It’s interesting to note that “sleep feeding” or “dream feeding” as a concept has become popularized recently due to social networking – Chat rooms and other forms of social media are allowing mothers with sleep feeding babies to share their experiences and recognize that their baby’s unusual behavior may not be that unusual.  This is a clear example of how e-patients empower themselves and actually get answers. 

Should your pediatrician know about sleep feeding?  

I would have to say that as someone who takes referrals from 200-300 well-trained pediatricians, knowledge about sleep feeding and its relationship to acid reflux disease is not standard.  Remember that acid reflux disease in infancy and childhood is still a relatively new concept.  And considering that this phenomenon hasn’t been reported in the medical literature I wouldn’t expect it to be in the minds of primary care physicians.  Keep in mind, however, that there remain physicians in practice who don’t believe that acid reflux disease is much of a concern in children.  This is one more reason to be informed.

Most babies suffering with sleep feeding will typically demonstrate other signs of reflux or allergy.  But bringing these issues to the forefront during a doctor’s visit is more likely to result in intervention and appropriate treatment.

Help me to help you

If your baby is a sleep feeder I would love to hear from you.  While I can’t offer medical advice, our discussion will help me learn about the patterns of sleep feeding encountered by parents.  Email colic1 at mac dot com.

Mylicon Recall and the Question of Gas Drops

12,000 bottles of Mylicon gas drops were pulled off shelves today over concerns that some of the bottles could contain pieces of metal.  The recalled bottles are from lots SMF007 and SMF008.  You can find these numbers printed on the bottom of the box and on the lower-left side of the sticker on each bottle.

For information on how to dispose of the drops and obtain a refund or replacement, call 800-222-9435 or visit Mylicon.

One lesson here is that no matter what we give to our children there are always associated risks.  Even reliable brands like Mylicon fall subject to human (or mechanical) error.  And we shouldn’t be dispensing to our babies what isn’t absolutely necessary.

This raises the question:  Are gas drops necessary?

As a pediatric gastroenterologist who spends most of his waking hours contemplating gas, I can’t say that they are.  Remember that most gas in babies is a consequence of air swallowing.  This can occur during feeding from a poor latch or an inappropriately matched bottle system.  Air swallowing can also result from crying due to the pain of gastroesophageal reflux or allergy.  In these latter cases the amount of air swallowed is significant enough not to be broken down by a few drops of simethicone.  

For 303 pages of equally brilliant analysis, check out my book Colic Solved -The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby.

Tip to Salon (not the part about the air swallowing).  Image from Colicsolved.com

Is High Fructose Corn Syrup Unhealthy for Children?

The Corn Refiners Association, known for bringing us high fructose corn syrup (HFCS), is on the move to buff up the image of this bastard sweetener.  Long felt to be a contributor to our growing obesity problem, HFCS has been referenced as “the crack of sweeteners.”  You can see one of the CRA’s YouTube videos here.  Propaganda?  Look at the video, read on and make your own decision.

So what’s the scoop?  Is HFCS really the evildoer that some would have us believe?  Here’s what you need to know:

Processed sugar 101.  HFCS is a processed sweetener made from corn starch and it contains a high level of fructose (found in fruits and honey) and glucose.  HCFS is made up of about 50 percent fructose and 50 percent glucose, which is about the same composition of table sugar.  While it may be from corn, HFCS’s refined composition results in remarkably quick absorption which can impact a child’s insulin levels quickly and drastically.  And this stuff is everywhere, from ketchup to twinkies.  Manufacturers love it because it’s 75% sweeter than sugar, it blends well into foods and it’s cheap.

HCFS and the obesity link.  The consumption of HFCS has increased 250% over the past 15 years which has lead some to assume that HFCS is the core thread in our obesity problem.  Further, we consume approximately 300 more calories per day than we did in 1985.  According to data cited by Michael Pollan in his book, In Defense of Food, about a quarter of this caloric increase comes from HFCS.  But another quarter come from fat and about half from grains.  So while corn syrup isn’t helping matters, it definitely isn’t operating alone.  Beyond it’s pervasive presence in just about everything our children eat and it’s propensity for quick absorption, there’s nothing specific about a HFCS calorie that puts a child at higher risk for getting fat.

Bottom line.  So while HFCS may not represent an independent threat to our children, it’s the volume of consumption and the context in which our children consume HFCS that represents a problem.  Processed foods high in calories and fat taken in quantity will put any child at risk for overweight.  If you really want to minimize HFCS, read your labels.  But be prepared to find it everywhere.  Your best general move is to minimize processed foods and offer whole foods whenever possible.

For a little fun check out A Life Less Sweet and follow one family's journey to eliminate HFCS from their world.

Photo via Wikipedia.

5 Signs of Infant Reflux You May Overlook

Everybody has reflux.  But not everybody is sick with reflux.  And so it goes for babies.  Spits, urps and wet burps, the sin qua non of reflux, are what we expect in healthy, normal babies.  But are there other signs to suggest that your baby has more than a simple case of the spits?  You bet.  Here are 5 common signs of reflux in babies that parents often witness but don’t associate with reflux:

1.  Irritability.  Tummy contents are quite acidic and create painful irritation when washed over the swallowing tube and throat.  Look for pain after eating and when lying down.  The irritability associated with reflux also causes baby to arch more than crunch.

2.  Congestion.  If refluxed tummy contents reach the throat it creates a slight degree of swelling and irritation.  The result is noisy, congested breathing often mistaken for allergy or cold.  Think of reflux when congestion is persistent and associated with other signs of reflux.

3.  Sleep disturbance.  When it comes to reflux, gravity is king.  And recumbency may make it more apparent.  While a baby may not have dramatic symptoms during waking hours, the horizontal baby may show her true colors.  Look for acute, “pin-in-the-foot” awakening, unsettled sleep.

4.  Difficulty feeding.  Sometimes feeding difficulty is the only sign that a baby is suffering with acid-related pain.  Esophagus (swallowing tube) irritation classically makes babies pull back and fight the breast or bottle resulting in feeding sessions painfully long for mom and baby.  I’ve referred to this pattern as indecisive or chaotic feeding.

5.  Gas.  Yes, gas.  As it turns out, the indecisive feeding described in #4 above frequently leads to big air swallowing.  And what goes down must come out.  I frequently evaluate babies with debilitating gas where the inciting problem is actually chaotic feeding from reflux.  Who knew?

For more colorful details of the above symptoms, pick up a copy of Colic Solved – The Essential Guide to Infant Reflux and the Care of Your Screaming, Difficult-to-Soothe Baby (2007 Ballantine).

Dr. V's Twitter Plunge

Okay.  I was pushed by a compelling argument recently launched in the Wall Street Journal for Twitter.  And after watching from a distance I've decided to take the plunge.  You can follow me here.  Just like when I started Parenting Solved, I'm not sure where this will lead.  I am interested in how social media can influence the dissemination of health information.  Let's see what happens.