How does a circumcision heal?

circumcision healingWhen a newborn’s penis is circumcised, the head of the penis (glans) will be red and wet looking for 3 to 5 days. During the healing process, it’s common for the glans to develop small yellow patches. These areas are part of the healing process and do not mean the baby has an infected circumcision. (If you’ve ever had a cut inside your mouth, you’ll recall that it heals with a whitish or yellow patch rather than a tradition scab. The same thing happens to a circumcised penis.)

I’ve been practicing pediatrics for over 30 years, and I have never seen an infected circumcision. If this were to occur, the redness would extend from the glans to the shaft and then towards the baby’s body. If you see this, call your doctor right away.

What to do if your baby has lazy eye

Lazy Eye in ChildrenIn my last blog, I mentioned that 6 muscles control the movement of each eye. This is a lot for a newborn’s brain to coordinate. As a result, it’s common for a newborn’s eyes to “wander” in the first few months of life. In most cases, the eyes move inward instead of outward. They are also more likely to wander when a baby is tired.

If the family history is positive for strabismus (lazy eye), the baby’s eyes are constantly out of balance or the baby’s eyes wander after 6 months of age, she should see a pediatric ophthalmologist. Keep in mind that eyes are supposed to converge (come together) if someone is looking at an object close up.

Like all referrals, it’s best not to schedule the appointment during the baby’s nap time because she’s more likely to cooperate with the exam is she isn’t tired.

Getting your newborn to track an object

Getting Newborn to FollowNewborn babies will look at their parents right after birth, but their eyes can’t do more than “fix” on objects for a few weeks. Between 1 and 2 months of age, babies will begin to follow objects during quiet, alert periods. It’s important to realize that this is still a difficult task. There are six muscles that control each eye, and they must work in unison for a baby to follow an object through space.

The best way to get your baby to follow is to put your smiling face 12 to 18 inches in front of her face. Then, move your head slowly in one direction or the other. Most babies will be able to follow you for an arc of about 30 to 45 degrees. After that, their eyes may stop or wander a bit.

Understanding referred pain in children

Kids-Referred-PainHave you ever watched a TV show where someone who’s having a heart attack grabs his left arm or shoulder? Have you ever had a stabbing pain in your forehead or the bridge of your nose after eating ice cream too quickly? With a heart attack, the source of the pain is in the person’s chest. With a brain freeze, the source of the pain is in the roof of your mouth.

Referred pain occurs because the body’s sensory nerves occasionally send signals in the wrong direction. The following examples commonly occur in children:

  • When children complain of mouth, cheek or tooth pain, they sometimes have an ear infection.
  • When children complain of ear pain, they sometimes have a throat or lymph node infection in their neck.
  • When children complain of knee pain, they sometimes have a problem in their hip or testicle.
  • When children complain of low back pain, they sometimes have constipation.
  • When children complain of stomach pain in the middle of the night, they sometimes have a pinworm infection.

What to do if an infant rolls over in sleep

Infant Rolling OverFor over 20 years, pediatricians in the United States have recommended that infants sleep on their backs. One of the questions that parents frequently ask is what they should do if their baby starts rolling over before 6 months of age.

Although babies occasionally roll over in the first few months, determined rolling isn’t learned until 4 months or later. If a baby rolls over at night, most doctors (this one included) don’t recommend putting the baby on her back again. This reason for this is simple. If you turn the baby on her back, she will invariably roll to her stomach again. If you do this repeatedly throughout the night, no one will get a good night’s sleep, which could lead to other dangers, i.e., car accidents.

So while I would still recommend putting your baby to sleep on her back, I would leave her alone if she rolls to her stomach.

Five early childhood developmental milestones you probably haven’t heard of

Child-DevelopmentWhen parents think about developmental stages in their children, the ones that come to mind are major milestones like smiling, crawling and talking, etc. Despite the obvious importance of these landmarks, I am queried on a regular basis about a handful of “lesser” behaviors children exhibit.

  1. Hand regard. Babies usually discover their hands by two months of age. This can happen in three ways. First, the baby purposefully sticks his hands or fingers in his mouth to suck on them. Second, the baby starts swatting at things. Third, the baby stares at a fisted hand held in front of his face. The last behavior is called hand regard. Parents may mistake hand regard for a seizure. If your child’s hand jerks rhythmically with this behavior, call your doctor. Otherwise relax and enjoy your baby’s new discovery.
  2. Developmental drooling. Humans have two types of salivary glands. There are tiny ones in the cheeks and floor of the mouth that function from the time of birth. The parotid glands, which produce large amounts of saliva required for swallowing solid foods, don’t mature until a baby is about 3 to 4 months of age. This corresponds to the baby’s ability to chew and stick his hands in his mouth with ease. Parents often conclude that a drooling 4-month-old is teething. In reality, it’s due to the maturation of the parotid glands.
  3. The fencing reflex. If you have a 2 to 3 month old, you may have noticed that he sometimes looks like he’s “fencing” when he’s lying on his back with his head turned to one side. The reflex consists of one arm extended and the other flexed as though the baby was getting ready to lunge at his opponent. The medical term for this posture is the asymmetric tonic neck reflex. It disappears by 6 months of age.
  4. The 6-month cough. Around six months of age, babies get more control over their vocalizations. In addition to babbling and guttural sounds, they often cough on purpose. You can recognize this cough because it is “throaty” rather than coming from deep within the chest. In addition, the child won’t have a runny nose or fever, and she will be acting completely normally except for the cough. The behavior lasts for a month or so, and then the baby moves on to other interests.
  5. Ear grabbing. I often joke with parents that when babies are first born, they consist of a stomach and a mouth. The stomach demands to be fed and the mouth is equipped with a sucking reflex to make this happen. This is an exaggeration, of course, because babies hear, see and respond to touch. They can even distinguish their mom from other women in the first few days of life. Despite these amazing skills, a newborn has little to no control over her arms and legs and doesn’t have a clue that she has a nose or other body parts. By 6 months, babies are very good at exploring their bodies. Hands and feet go to their mouths, and they often play with their bellybuttons. At 8 or 9 months, babies discover that they have ears. As a result, parents will often see their babies pulling and poking at their ears. This often makes parents wonder if the child has an ear infection. If your child doesn’t have a cold and isn’t fussy, there’s a very good chance that her ear tugging is body exploration rather than a sign of an ear infection.

Parent’s Cheat Sheet: Describing coughs (and other noises) to the doctor

Describing Cough to DoctorWhen children come down with respiratory illnesses, they make lots of noises. The words parents use to describe these noises don’t always agree with how the doctors use the terms. Here’s the lowdown on the noises kids make when they have a cold or the flu.

  1. Congestion. This occurs with a stuffy nose and sinuses. When a child is congested, he will sound nasal because less air is passing through his nostrils when he talks. Which nostril is clogged varies throughout the day.
  2. Postnasal drip. If a child has a cold, mucus not only drips out of his nose, but some will also drip down the back of his throat. This can make his voice hoarse or raspy.
  3. Garbled voice. If a child has enlarged tonsils, he will often sound like he has “marbles” in the back of his throat.
  4. Chest rattle. Babies and young children don’t do a good job clearing mucus from their nose and throats when they have a cold. As a result, they often produce a rattle-like sound when they breathe. Parents not only hear this noise coming from the baby’s throat, but they may also feel it in the baby’s chest when he’s being held. A chest rattle is not usually a sign of pneumonia.
  5. Dry cough. This refers to a cough that has a rough, staccato quality.
  6. Wet cough. This refers to a cough that has a moist quality. It usually happens if a child has postnasal drip or bronchitis. Contrary to what many people believe, bronchitis in children is usually a viral disease and does not require antibiotics.
  7. Croupy cough. If a child has croup, his trachea becomes swollen below the vocal cords. This creates a hoarse voice and a barky, seal-like cough.
  8. Stridor. This sound is made during inspiration. It’s a brassy sound associated with a sense of difficulty getting air into the lungs. This is most commonly heard in children with croup: they “bark” when they cough and have stridor when they breathe in.
  9. Whoop. A classic whoop is heard with pertussis (whooping cough). The whoop is dramatic and occurs after a child has had a prolonged coughing fit. Nowadays, pertussis is more likely to be seen in older children or adolescents rather than babies or toddlers. An older child is more likely to “gasp” than whoop when he takes a breath after a prolonged coughing spell.
  10. Wheezing. This sound is made primarily during expiration. It’s a medium to high-pitched noise that sounds like the word. It is produced when a child’s bronchial tubes are tight (asthma) or narrowed with mucus (bronchitis, asthma). If a wheezing child is having respiratory distress (difficulty breathing), you may notice certain things when he breathes in: (1) his nostrils flare and (2) the spaces between his ribs pull in (“retract”).