Switching your child to low-fat milk

The American Academy of Pediatrics (AAP) recommends breastfeeding for the first year. Most mothers are unable to breastfeed their babies for the entire year because of work or family situations. This is perfectly acceptable.

If breast milk is unavailable, babies should be fed an iron-fortified formula. Babies are transitioned to whole milk at one year of age. In most cases, babies do not need the special formulas that are marketed for the second year of life.

The AAP recommends that children drink whole milk until two years unless there is a reason to switch the baby to low-fat milk sooner. Doctors may make this recommendation for clinical reasons or because there is a family history of obesity, heart disease or a cholesterol problem.

The reason the AAP recommends whole milk until two years has to do with a baby’s growth and development. Infants triple their birth weight by one year of age and quadruple their birth weight by two years. During this period, a baby’s brain and nervous system are making amazing gains in size and complexity. Because the brain and nervous system are largely composed of fat tissue, it is reasoned that the baby should have a higher fat diet during this period of time.

Whole milk contains approximately 4% milk fat. Because children often have difficulty with transitions, it may help to gradually switch your child from whole milk to lower fat milk. Therefore, some doctors recommend that children get reduced fat (2%) milk for a few weeks before switching them to low-fat (1%) or no-fat (skim) milk.


Extra foreskin in circumcised infants

A common finding in male infants is a circumcised penis that has some extra foreskin—it is most noticeable on the underside of the penis. When babies are circumcised, the person doing the procedure has to be careful not to remove too much foreskin. As a result, sometimes a little extra skin will remain behind the head of the penis (glans). It is very important to retract (pull back) this skin in the immediate post-circumcision period so it does not heal to the head of the penis, which could cause problems later. This is one of the things the doctor should check at your first post-hospital visit.

If the circumcision heals properly, the extra skin may develop a thin attachment to the back portion of the glans in early childhood. (Your doctor will be able to tell the difference between a post-circumcision scar and this thin attachment.) It is not necessary to do anything if your child’s penis has a thin attachment because it will resolve over time.

Care of the uncircumcised penis

It is common knowledge that you don’t have to pull back on a baby’s foreskin to get it to detach from the head of the penis (glans). This is a natural process that will occur as the baby grows. Like many aspects of growth and development, a child’s foreskin detaches from the glans gradually. Once the foreskin is fully retractable, it’s important to clean the glans daily with mild soap and water. The purpose of this cleansing is to keep the penis clean and wash away any smegma that accumulated under the foreskin. Smegma is a whitish, greasy substance that is found normally in uncircumcised males.

There is a finding that may occur in uncircumcised children, which can worry parents. Smegma sometimes accumulates under the foreskin before it fully retracts. These accumulations are called “smegma pearls” because they have a round or oval appearance. Most of the time, they are whitish, but on occasion they have a yellowish hue. If this happens, parents may conclude that their child has an infection. There is an easy way to determine if the child has foreskin infection vs. a smegma pearl. The tissue surrounding an infection is red, swollen and tender. If your baby has a white or yellow accumulation under the foreskin that doesn’t look angry and isn’t tender to touch, it’s not likely to be infected. Of course, if you have any questions about this, call your doctor.

Hidden penis in toddlers

It’s very common for the penis of an older infant or toddler to look smaller than it is. Parents (especially dads) worry that the child will have a small penis when he is older. Unless a child had an abnormally small penis at birth, this finding is usually due to something doctors call a “buried” or “hidden” penis.One of the cute things about young children is that they are pudgy. In particular, children often have a prominent fat pad in front of the pubic bone. When this occurs, the penis tends to disappear within the fat pad making it appear small. In some cases, all you may see is the tip of the penis poking out of the fat pad like a tiny turtlehead.The way to assess the true length of the penis is to gently push down on the fat pad. When you do this, you will notice that the penis elongates revealing its true size as the fat is pushed towards the baby. I use this maneuver to reassure parents on a daily basis.