Pediatric Pearls for Parents

by Warren P. Silberstein, M.D.
updated 09/12/98

As a pediatrician, my philosophy has always been that patients get the best medical care when they understand their medical care. They need to know what their diagnosis is, what the natural course of their illness is, what treatment can and can't accomplish for them, what the risks of their treatment are and what the risks of not following their doctor's advice are, what alternative treatments are available, and what the names and purposes of each of their medications are. When patients receive and understand this information they can become active partners in their care.

Some patients prefer to just be told what to do. The mystery of their doctor's advice makes it seem more like magic and their doctor more like a powerful healer. The problem with this approach is that these patients often make mistakes in following their physician's advice. And they may stop their treatment the minute they feel better because they don't understand.

A pearl is a tidbit of valuable information. Some of these pearls are just interesting or useful information, while others will save you from a major anxiety attack when you find that little scary whatchamacallit on your child. Hopefully these pearls will enhance your understanding of some aspect of pediatric care, at least a little bit.

bullet ?Blood in a Newborn's Diaper
If you see a pink spot in the front of your newborn's diaper, don't become alarmed thinking it's blood in the urine. Uric acid crystals in the urine dry on the diaper to form a salmon pink powder. If you scrape it with your finger nail you can see that it is powdery. It is absolutely harmless and nothing to worry about; however, if you see it in every diaper it could mean that your newborn's urine is very concentrated which could happen if he isn't getting enough fluids.

bullet Vaginal Bleeding in a Newborn Girl
Newborn girls sometimes have a bloody vaginal discharge for a few days. They are actually "menstruating" because exposure to their mother's hormones in the uterus causes the lining of their uteruses to build up. After delivery, they are no longer exposed to their mother's hormones so they shed their uterine linings just like a woman does when she menstruates.

bullet Breast Enlargement in a Newborn
Mom's hormones can also cause enlargement of her newborn's breasts. This is true even if the newborn is a boy. It is perfectly normal and will gradually go away after a few months. The only time you need to worry about newborn breast swelling is if a breast is red and tender. A swollen, red, tender breast in an irritable. feverish newborn is a sign of a serious infection and needs urgent medical attention.

bullet Immunity Passed From Mother to Newborn
Newborns have immunity to certain infections passed to them from their mother before they are born. This immunity is increased even further by nursing. But this immunity doesn't protect newborns against all diseases. If mom isn't immune to a certain disease, she can't provide immunity to her newborn for that disease. If a mother never had chickenpox, her newborn won't be protected against chickenpox. If a mother had chickenpox, her newborn will have some immunity to chickenpox. Since nobody has much immunity to colds, newborns are susceptible to colds.

bullet Fever in a Newborn
Fever in a newborn can be a sign of a serious infection. Any temperature over 100.5F (38C) in a baby younger than 8 weeks requires medical evaluation. Ear thermometers are not accurate in newborns. The best way to take the temperature is rectally with a mercury/glass thermometer. An electronic digital is satisfactory as well. If you are uncomfortable taking a rectal temperature you can hold the thermometer under the arm for 5 minutes with the arm held against the body. You will have to add 2F (1C) to the reading to approximate the rectal temperature.

bullet When Can Newborns See?
Newborns can see when they're born. In fact, they can see before they are born, but not much light gets into the uterus and there is little to see there. Most people think newborns don't see because they don't appear to look at anything, but that's because they haven't learned that there is anything to look at. When you hold a newborn for feeding your face is in focus, but as you move away you become out of focus. Your newborn will make no effort to focus on you or look for you. Newborns are very interested in human faces, but they have to learn that they are seeing another person. They have to learn that when they don't see you, you still exist. As they begin to learn about the world around them they begin to look at things and focus on them.

bullet Dangers of Powder
Never shake powder onto your baby or into your hand near your baby. The dust particles from the powder can get into the baby's lungs and cause problems. I personally advise against using powder in the diaper area if you use disposable diapers. Disposable diapers have absorbent gels in them to collect the moisture. When there is powder on the diaper area, the urine hits the powder before the gel can absorb it and it forms a paste with the powder that sits on the skin.

bullet Nursing Baby Spits Up Blood
If your nursing baby spits or vomits up blood, before you become alarmed, check your nipples to see if they are cracked and bleeding. If the baby swallows blood with his feeding, he is likely to spit some of it up because it is irritating to the stomach.

bullet Bed Wetting
Bed wetting usually occurs while a child is asleep. Since it occurs while the child is asleep, he can't help it. Most children who wet their beds are embarrassed by it even if their parents don't make a fuss. Punishing or belittling the child who wets his bed will only lower his self esteem more, but it won't help solve the problem.

bullet Breast Swelling in Adolescent Boys
Adolescent boys often develop some swelling of one or both breasts as their bodies change during puberty. Sometimes the breast tissue is tender. This is all perfectly normal, and quite embarrassing to the young man. As his body matures, the breast swelling starts to go away.

bullet SIDS and Sleep Position
Studies have shown that there is a higher incidence of Sudden Infant Death Syndrome (SIDS or Crib Death) in infants who sleep on their bellies. That doesn't mean that sleeping face down causes SIDS or even that most babies who sleep face down will die of SIDS, but the risk of SIDS is less in infants who sleep on their backs. Once an infant can roll over, he will sleep however he wants, but to decrease the risk of SIDS the American Academy of Pediatrics recommends putting infants into their cribs on their backs.

bullet Let a Crying Baby Eat More and Burp Him Later

When infants cry they swallow air. If you try to burp your baby and the baby is crying because he is still very hungry, when the baby finally burps he will only burp up the air he swallowed from crying. If you remove an infant from the breast or take the bottle out of an infants mouth to burp him and he starts to scream, resume the feeding for a minute or two and then try again to burp the baby.

bullet Pink Eye and Ear Infections

There is an association between conjunctivitis (pink eye) and ear infections. Many young children who have conjunctivitis have ear infections even though they are not complaining about their ears. Any preschooler with conjunctivitis should have his ears checked.

bullet Bumps on the Tongue

If your child sticks his tongue out far enough, you may see some things you never saw before which may frighten you. There is a double row of large taste buds in a V formation at the back of the tongue. The epiglottis may stick up behind that. It looks like a flap about the size and shape of the tip of the little finger. It's all perfectly normal

bullet Bumps on the Head
Many people think that the head is round because it looks smooth when it is covered with hair. Newborns have ridges in their skull called suture lines. These are places where the skull bones come together. Everyone has a protuberance behind each ear and at the base of the skull, but sometimes parents haven't discovered these until they feel their child's head after a fall, and then they become unnecessarily alarmed.

bullet A Lump in a Newborn's Chest
The xiphoid process, which is the tip of the sternum (breast bone), is very flexible in newborns and sometimes stick straight up creating a hard little bump right in the midline of the belly just below the rib margin. It's perfectly normal but it really frightens parents when they feel it.

bullet The Right Way to Stop a Nosebleed
Most nosebleeds come from low down in the nostril along the septum (the part that divides the nose into two nostrils). Since the septum goes only part way up, nosebleeds from high in the nose come out of both nostrils at the same time. You can recognize the typical low in the nose nosebleed because it comes out of only one nostril, except on the rare occasion that the bleeding is so profuse that blood goes up over the septum and comes out the other nostril as well. The proper way to stop these nosebleeds is to put pressure on the bleeding point just as you would a cut or scrape on any other part of the body. To do this, the entire fleshy part of the bleeding nostril should be pressed firmly closed against the septum for 5 full minutes. This will stop the bleeding and avoid formation of a large clot which can get knocked free easily resulting in more bleeding. Pressing on the upper, bony part of the nose is useless since it can't put any pressure on the bleeding point.

bullet When Does Eye Color Change in an Infant?
They don't teach this in medical school, but my observations have taught me that the darker the eye color is going to be the earlier the color changes. Babies are all born with slate gray eyes. If the eyes are going to be blue or gray, they get lighter. If they're going to be dark brown they are usually brown by 3 or 4 months. But eye color can take much longer to change. My son's eyes turned from gray to green when he was about 15 months. They turned from green to hazel when he was 3 years old.

bullet Cleaning Ears
Did you ever wonder where the expression "Don't put anything in your ear smaller than your elbow" came from? It's not just a rule for children. Parents like to keep their children clean, so it drives many mothers nuts when they see wax in their ears. But you should only clean the wax by washing it away with a wash cloth. Don't worry about what you can't reach with the wash cloth in the ear canal. The natural movement of wax is out. If you put a Q-tip into the ear to clean away wax, even though you will get some of the wax out, the Q-tip will push some wax further in ahead of it. If this is repeated many times, the child will end up with a large amount of hard wax impacted in his ear.

bullet Gas Pains vs. Fussy Period
Most infants have a fussy period. This behavior starts during the first few weeks of life and can persist for a few months. It is usually between 6 PM and 10 PM, but can sometimes be at other hours. The characteristic features of the fussy period are that the infants are difficult to soothe and it occurs around the same time every day. Gas pains follow no particular pattern. If your baby is relatively calm most of the day but fusses every evening, it isn't gas. It's the fussy period. There is one important exception to this statement. Since nursing babies may get gas pains from what their mothers eat, and most people eat more exotic foods for dinner than lunch, nursing mothers whose babies are always fussy in the evening must look at their evening meal to see if any foods might be contributing to the problem.

bullet Gas vs. Gas Pains
Parents often ask about treating their infants for gas because the baby is passing wind. If the baby isn't plagued by gas pains, nothing needs to be done.

bullet Teething
The average age for the first tooth is 8 months, but 4 months isn't early and 1 year isn't late. Drooling and putting things into the mouth is such normal infant behavior that it can't be used to gauge if an infant is teething. Biting is a more reliable sign of teething. Usually the first teeth to come in are the bottom, middle teeth. It is very hard to tell until they are just about ready to pop through. Acetaminophen (Tylenol, Tempra) and teething preparations can be used if an infant is very uncomfortable, but unless your child appears to be in pain, no treatment is necessary for teething.

bullet Car Seats and Air Bags
There has been so much in the news about this that most people know it is unsafe for infants to sit in the front seat of a car that has an air bag, but if you missed those news stories, you need to know that the force of an air bag deploying against a car seat can fatally injure an infant. The safest place for all children in a car is the back seat.

bulletPoison Ivy is NOT Contagious
The idea that poison ivy is contagious probably results from the way it appears to spread. In reality, it is not spreading, but just following its natural course. The rash from poison ivy and similar plants is caused by a reaction to the resin produced by the plants. The rash generally develops over a period of 4 to 5 days with the areas that got the most resin on them breaking out first and the areas which got the least resin breaking out last. The fluid in the blisters is tissue fluid, much like a burn blister, and does not have any "poison" material in them. People often break out in areas which were not exposed because they get the resin on their hands and touch other parts of their bodies. A person may not be aware that he had poison ivy on his hands if his fingers don't break out because the palms of the hands do not develop the rash, but contaminated hands can still spread the resin. This is why boys and men often develop poison ivy on the genitals. The resin is water soluble, and once it is washed off hands, clothing, and other body parts, touching the rash will not cause it to spread or spread it to other people.

Articles by Dr. Warren
Ask Dr. Warren
Read Ask Dr. Warren Column