For 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.
When 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.
- 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.
- 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.
- 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.
- 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.
- 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.
When 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.
- 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.
- 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.
- Garbled voice. If a child has enlarged tonsils, he will often sound like he has “marbles” in the back of his throat.
- 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.
- Dry cough. This refers to a cough that has a rough, staccato quality.
- 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.
- 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.
- 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.
- 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.
- 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”).
When parents call me about rashes, I often hear that a child has “hives.” In most cases, parents use this term incorrectly. The question is, does that matter?
The factors that cause most rashes in children are environmental (insect bites, heat rash, allergic reactions) or infectious (viruses, bacterial, fungal). Hives are usually caused by viruses, but they can also occur with strep and allergic reactions to foods. (If you suspect that your child has hives because of an allergic reaction to a food, you should give him Benadryl and call the doctor right away. If your child also has coughing or trouble breathing, you should call 911 in case he’s having an anaphylactic reaction.)
The thing that distinguishes hives from other rashes is the margin between the normal skin and the rash. Most of the rashes children get consist of flat areas with or without a scale and small, raised bumps. (Doctors call flat rashes macules, bumps papules and hives wheals.) Papules come in different sizes, but they have one thing in common. The region between normal skin and the lesion rises slowly like a hill. With wheals (hives), the region between normal skin and the lesion rises more sharply, like a plateau. If you’ve ever seen a welt, the raised area at the edge is more characteristic of a wheal than a papule.
Most children contract hand, foot and mouth syndrome before kindergarten. The infection is usually caused by a member of the Coxsackie virus family. It typically presents with fever, sore throat and small blisters on the palms and soles. Some strains of the virus also cause a red bumpy rash on the body. The treatment is the same as it is for most viral infections: rest, fluids and fever control.
When I see kids with hand, foot and mouth syndrome, parents usually ask two questions. (1) How long is the child contagious? (2) When can she go back to daycare or school? The answer to the first question surprises parents. They’re contagious for 2 to 3 weeks after they get sick. The answer to the second question surprises them even more. Kids can return to school as soon as they feel better. What? How can doctors send kids back to school when they’re still contagious? The rationale for this is simple. Up to 20% of children with hand, foot and mouth syndrome are asymptomatic. This means they contracted the virus and are spreading it to others even though they’re not sick themselves. That fact, combined with the long contagious period, means keeping kids home will have no impact on the spread of the disease. That’s why we send them back when they feel better.
Parents often ask if babies need firm, high top shoes once they start to walk. This is especially true if they previously talked to a grandparent or a shoe salesman who recommended a “supportive shoe” so the baby learns to walk properly.
Shoes accomplish four things in babies.
- They keep feet warm on cold days.
- They provide protection from hard or sharp objects.
- They provide traction on slick surfaces.
- They go nice with certain outfits.
What shoes do not do is provide support or teach a baby to walk better. When babies first learn to walk, going barefoot is best. This allows them to feel the floor and makes it easier for them to stand on their toes, which babies love to do. So the best shoe for a baby is a soft, flexible shoe that has good traction on the bottom. The only advantage of a high top shoe is that it’s almost impossible for the baby to pull it off. This may come in handy at church or synagogue.
I often joke with parents that my gynecologic knowledge is limited because most female adolescent patients prefer seeing a woman doctor. However, my daughter suffered with severe cramps, and I learned the following tip from my partner, Promise Ahlstrom, MD.
If your daughter has bad cramps, she should take 400 to 600 mg of ibuprofen as soon as her period starts. Then, she should repeat the dose every 4 hours for the first 24 hours of her period. The goal here is to “stay ahead of the pain.” If a girl takes the first does at 8am, she may be tempted to skip the noon dose if the cramps have subsided. This is a no-no. By missing a dose, the physiology that causes menstrual cramps will worsen. By the second day of her period, she can usually drop the dose to every 6 hours, but she should still take the medicine on schedule. By the third day of her period, she can take the ibuprofen as needed.
Three things can interfere with staying on course with this regimen. First, if a girl is at school, she may need to go to the nurse to get her medication. If the school has a strict policy about leaving class, a note from the doctor can help. Second, some girls forget to take their medicine. This can be overcome by putting reminders in her cell phone or getting a friendly text from mom at the right time. Third, her period may start right before bedtime. In this situation, I would consider waking her up for a dose of ibuprofen unless doing so would disturb her sleep and cause other problems the following day.
If this regimen doesn’t help, your daughter should see her pediatrician or a gynecologist to discuss other options.