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.
If you spend time outdoors with children, you’ll need to keep them safe from mosquitos, biting flies and ticks. For young infants, the best approach is to protect them with clothing or nets that cover their strollers. For older children, you’ll need an insect repellent to get the job done. DEET can be used with infants as young as 2 months, but the American Academy of Pediatrics (AAP) recommends not using products with more than 30% DEET: http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx. Lower concentrations of DEET work well, but last for shorter periods of time. A 10% concentration lasts for about two hours. I prefer an ingredient called picaridin because it works almost as well as DEET, but feels nicer on the skin. If you want a natural product, the soy-based repellent in Bite Blocker lasts about 90 minutes.
If you use a product containing DEET or picaridin, a lotion or pump spray is safer than an aerosol. Don’t apply it to your child’s hands and be careful to avoid the eyes, nose and mouth. It’s also a good idea to wash it off when you come inside.
You should not use products containing insect repellent and sunscreen. Instead, apply the sunscreen first, wait until it’s absorbed, and then apply the insect repellent. Keep in mind that sunscreen should be used liberally and reapplied every two hours. Bug sprays are applied sparingly and many should not be reapplied. Always read the instructions that come with the product you’re using.
It’s common for people to use baby powder after showering to keep dry, especially during the warmer months. Similarly, parents often use baby powder on their baby’s bottoms after diaper changes. I disagree with the latter use for two reasons. First, I’m not convinced it does any good. Although baby powder may absorb perspiration on an adult, it’s hard for powder to contend with the volume of urine a baby produces in between diaper changes. More importantly, baby powder can be dangerous. A number of reports have been published in medical journals where an older infant had grabbed a container of baby powder while he was lying on his back during a diaper change. Because baby powder containers look like bottles, these infants held the bottles up to their mouths and inadvertently aspirated the powder into their tracheas.
Many years ago, I took my 3-year-old son to the Montgomery County Fair. We were having a grand time until I lost sight of Ryan for a second. When I turned around to find him, he was lost in a sea of parents, babies and screaming children. As my heart raced, I vainly tried to find Ryan’s face the crowd. What I noticed instead is that when you’re panicking, all toddlers look alike. Luckily for me, he hadn’t wandered off, but just went to throw a pizza crust in a nearby trashcan.
When I bent down to pick Ryan up, I noticed that he was wearing blue shorts and a bright orange T-shirt. In my three seconds of panic, it would have been easier to look for an orange shirt and blue shorts than my son’s face. From that point on, whenever I was out with one of my kids, I always kept a mental image of what they were wearing in case we got separated.
Car seats are designed to keep babies safe in the event of a motor vehicle accident. They are not meant to be a substitute crib. However, everyone knows that babies commonly fall asleep during car rides. This happens because the vibrations and sounds inside a motor vehicle often lull the baby to sleep. The same thing happens when parents rock and shush their babies to help them relax.
Because babies commonly fall asleep in the car, parents may let them finish napping in the car seat once they have arrived home. Although most doctors would not argue with the adage, “Never wake a sleeping baby,” it is important for parents to be aware of the dangers associated with sleeping in car seats.
There are three reasons why most doctors discourage sleeping in car seats.
- It can make stomach reflux worse. If a baby refluxes while he is in a car seat, he is more likely to choke because he cannot extend his neck to clear the refluxed material.
- A baby can fall out of a car seat if he is not strapped in correctly. Also, an older sibling might accidentally push the car seat off a table or other raised surface.
- When a baby is strapped into a car seat, his head can fall forward onto his chest. If this happens, the baby’s airway may become compromised making it harder for him to breathe. A 2005 study showed that oxygen levels dropped in 18% of newborns who were strapped in car seats.
Interestingly, parents worry about different things than doctors. Although no one has researched this question, my own patients worry about the following:
- Sleeping in a car seat for a long period of time may hurt the baby’s back or neck. This is an unnecessary concern. Babies are so flexible they do not get aches and pains after being in a car seat.
- A baby can become conditioned to sleep in a car seat. As a result, he may be unable to sleep in a crib when he gets older. There is an element of truth to this concern, especially when you consider that parents typically let babies sleep in car seats because they don’t like their crib.
If your baby does not like sleeping in his crib, try the following techniques before putting him in a car seat to sleep:
- Keep your baby next to your bed so you can comfort him if he stirs during the night.
- Swaddle your baby.
- Give your baby a pacifier.
- Turn on a ceiling fan or a sound machine to help soothe your baby.
It is well known that young children are more likely to choke on food than older people. There are two things you can do to reduce the risk of choking in your children. First, avoid foods such as hot dogs and peanuts that are associated with choking. Second, make sure your children are sitting down when they eat. In my office, I remind parents that young children are easily distracted and that sitting at the table helps them stay focused on their eating. I also show parents how hard it is to swallow when a person is looking up. I do this by asking them to swallow saliva while they are looking at the ceiling (this is very difficult to do). I then point out that toddlers frequently look up at people. If children are walking around with food in their mouths and try to swallow while they are looking up, they may gasp and aspirate by accident. Finally, because children may have choking episodes despite your best efforts, you should take a CPR class so you know how to do a Heimlich maneuver should the need arise.
Up until a few years ago, poison control numbers were regional and people had to call 411 to get the local poison control number if they needed help when they were out of town. Because this made the system inefficient, the poison control network now has a national number: 1-800-222-1222. This means that regardless of where you are in the country, if you call this number, you will automatically be connected to the closest poison control facility. Not only does this number belong on every phone in your house, but you should also program it into your cell phone. The reason for this extra precaution is that children sometime ingest poisons while they are outside of the home, and you may not be thinking clearly in this situation.
Older brothers and sisters learn quickly that babies only drink breast milk or formula. Once you start feeding your baby jarred foods at six months of age, an older sibling may think it is okay to share his food with the baby. Therefore, make sure to tell your older child that even though the baby is now eating from a spoon, he is still too little to eat “big-boy” food. If your older child is interested in feeding the baby, you can supervise spoon-feeding once the baby has demonstrated that he is a competent eater. Make sure that you stay alert for sharing even though you have warned your older child to keep his “macaroni and cheese” to himself.
In most doctors’ offices, children get blood counts and lead tests at nine months and two years of age. After the finger poke is done, a lab technician will put a bandage on the child’s finger to stop the bleeding. Young children do not like finger pokes. Consequently, they often try to pull the bandage off shortly after it has been applied. What is worse, they typically do this with their teeth and may choke in the process. In my practice, we deal with this safety hazard by telling parents to wait in the office for five minutes (that is when the bleeding stops) and to remove the bandage before they put their child in his car seat.