Teething

Teething Chart (http://www.orajel.com/Products/TeethingChart.aspx)

Well, it has begun.  Teething.  And by the looks of the infant teething chart above (provided by Orajel), looks like we’re in a for a few years of fun.

True to the diagram, my son’s right central incisor is the first to erupt.  Right now it looks like a pearly white dot in his mouth; at first glance it would be mistaken for a drop of milk or formula.  But upon closer inspection, it’s clear that it’s the top of a tooth, peeking out amongst hills of red and swollen gums.  Poor little guy is gumming onto anything — bibs, toys, his own hands — any chance he gets for some relief.

Allow me to share what I have experienced:

• DROOL:  It’s coming in gallons.  Soaking through several bibs a day.  Dripping all over his clothes, the floors, and Mommy or Daddy when holding him.  Turns out this is a classic sign of teething, especially if excessive and after 4 months of age.  I read somewhere that the drool actually helps the baby with discomfort by cooling and lubricating the gums.  Maybe so, maybe not… But it’s definitely everywhere.

• Coughing:  All the drool has nowhere to go, especially if the baby is reclined, except into the throat.  This leads to some coughing and gagging.  At first it freaked me out until I realized what was causing it.  There’s not much I can do but encourage him to “cough it out.”

• GUMMING:  I don’t know the official term for it, but by this I mean grabbing anything and everything he can to shove it into his mouth for some chewing relief.  His bib is usually an easy first grab, followed by his toys or even his own fists.  He loves Sophie the Giraffe and is finally getting some use out of his teethers.

• Reduced Appetite:  Feedings have become, at times, extraordinarily fussy.  He tries to eat, realizes he is still in pain, cries/screams, tries some more, realizes it still hurts, cries some more, etc.  Frustrating for all of us.  I’ve found that alternating bottle and solids as part of the same feeding helps somewhat.  I think it’s just because of the distraction aspect – something different to keep his mind off the pain.  Whatever it takes.

• Kidsme Food Feeder:  Baby and I both love this little contraption!  It’s BPA free (yay) and holds little pieces of fruit or veggies for the baby to taste/eat without the risk of choking.  I use it for teething relief by filling it with frozen mango chunks  – the organic ones from Whole Foods are the perfect size.   He gums it to his heart’s delight and gets to try new fruit while the cold takes the edge off.  I also use it during flight takeoffs and descents; the sucking helps with his ears.

• Camilia Teething Drops:  After complaining to my hubby’s cousin about trying to find a good teething relief agent that didn’t contain benzocaine, she recommended these drops.  They are wonderful!  A homeopathic remedy, they are single-dosage (read: sterile) drops that finally help provide relief for my little one.  I’ve tasted them myself and they’re mildly sweet – not offensive like some other remedies.  They guarantee both us and baby a period of calm whenever used.  Also – since they are single dosages – they are easy to drop into your purse, baby bag, whatever.  I get mine at Whole Foods although I know they’re available online as well.

Other than that, we just provide a lot of love and comfort.  Our son’s been a little trooper so far; a bit fussy and uncomfortable, but handling it overall.  Would love to hear about other relief tips if any of you have them!

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3 Favorite Infant Supplements

Given all the time and energy I have spent on finding the appropriate nourishment for my infant son (see previous posts: Judgments-Breastfeeding vs. Formula Feeding and Infant Formula Roulette), you know I did my research when it comes to additional nutritional supplementation.  After a fair bit of trial and error, I’ve found the supplement cocktail that has been working best for our little one.

Vitamin D:  This fat-soluble vitamin can be ingested via food (think fatty dairy products or oily fish) or synthesized via sunlight exposure.  It aids with calcium absorption and regulates calcium and phosphate in the blood to encourage normal bone growth.  Vitamin D deficiency can result in rickets, a childhood bone deformity disease.  Breastmilk unfortunately does not contain a high amount of Vitamin D – as such, the American Academy of Pediatrics (AAP) recommended in 2008 that breastfeeding women supplement their infants with 400 IU of Vitamin D per day.  Formula-fed infants typically receive a higher amount of Vitamin D through their formula; however it may still not reach the recommended daily amount of 400 IU/day.  What I did was simply figure out how much my son was ingesting via his formula based on volume, and then supplemented the rest using Enfamil V-Di-Sol (I found it at most of my local drugstores).  One dropper of Enfamil’s product is about 400 IU of Vitamin D, so I would measure out a portion of that accordingly and add it to one of his bottles.  He tolerated it well, and I continued with it until he was ingesting enough formula (about 28-32 oz/day) to reach the recommended amount using that alone.  One note, however, is that there appears to be some dispute as to what amount of Vitamin D is the “right” amount for an infant.  Potential toxicity is a valid concern as the amount reaches 1,000 IU per day, so stay well below that amount and always consult with your doctor before adding any supplements to your baby’s diet.

Vitamin C.  We all know about Vitamin C… In fact, I loaded up just this morning to hopefully nip the scratchy throat coming on in the bud.  Found in many common fruits and vegetables (oranges, broccoli, strawberries, tomatoes, etc), the vitamin helps with immunity.  The good news is that both breast milk and formula should easily provide the adequate amount needed for infants.  So why supplement?  In truth, you don’t need to.  I choose to supplement before and after vaccinations only, to help with my son’s immune response.  So, about 3-5 days before and 3-5 days after each set of vaccinations, I supplement him with 1/2 teaspoon (50 mg) or less of Country Life Maxi Baby C Liquid in one of his bottles.  Just enough to hopefully give him that boost to get him over the vaccine hump.  The recommended daily amount of Vitamin C is 40 mg/day for infants up to 6 months, and while an upper tolerable limit is not established for infants, it is established for children ages 1-3 years at 400 mg/day.  Of course, as his daily formula intake increases, his Vitamin C supplement before/after vaccinations decreases; although the vitamin is typically well tolerated up to daily limits.

Probiotics.  LOVE.  THIS.  STUFF.  I was so worried about my son’s immunity due to him not being breastfed that I looked into all kinds of supplements to potentially help in this area:  bovine colostrum, raw milk, probiotics, etc.  It was an easy decision to go with probiotics.  Proven and safe, even my conservative pediatrician agreed that they “can’t hurt, and might help.”  I will say, since using them, that our son has had no more colds, has a better appetite, and has the wonderful regular bowel movements that all new parents pray for.  So what are probiotics?  Basically, strains of good bacteria to help maintain beneficial gut flora; in other words, to help with the proliferation of good immune-strengthening bacteria in the gut.  I tried a few different formulations before finally finding one that stuck.  I knew there were several bifidobactera (B) and Lactobacillus (L) strains that I wanted included: B. infantis,  B. breve, B. longum, L. acidophilus,  and L. rhamnosus.  I also wanted Fructooligosaccharides (FOS) included, which is actually a prebiotic that supports the growth of bifidobacteria in the gut.  The hardest part was finding a product that included both the bacterial strains I wanted AND FOS, but I finally found it in Nature’s Way Primadophilus Children (and btw, I could only find it at Sprouts).  It comes in a powdered form that needs to remain refrigerated, and I add 1/2 teaspoon to one bottle daily.  As I said, it’s worked wonders for our son and I only wish we started him on it sooner.

So there you have it – the three supplements that have worked best for our baby.  I would love to hear about what is working well for others… Any other recommendations?

Picking a Pediatrician

Earlier this week, a friend of mine who is expecting her first child emailed me with a quick question about who our pediatrician is and whether or not we would recommend that person.  Of course, being the long-winded person I am, I could not give her a simple answer – and ended up responding with all the pros, cons, and other tidbits I could think of regarding our experience with our particular pediatrician. 

Although we had completed our due diligence during pregnancy (interviewing various pediatricians, asking what we thought were the “right” questions, etc), we have the benefit of hindsight now that we’re on the other side of the fence.  We’re reasonably happy with our pediatrician so I suppose got lucky; but if I could go back in time, this would be my new and improved selection process:

• Ask for Referrals.  Duh.  I didn’t even ask my OB-GYN.  I should have.  I did ask a couple friends, but their pediatricians were out of network for me, so I let it go there.  I admit I ended up resorting to Yelp for my top candidates.
• “Scope Out” Referrals.  Once I had a list of referrals from trusted sources, NOW would be the time for me to scope them out.  Check their websites.  Go to Health Grades and search for reviews.  And yes, now would be the time to even go to Yelp.
• Check Scheduling.  Sure, it seems trivial now, but when you’re a new mom wanting to take your baby in with issues…  Or having to take your baby in as often as every month or two for vaccinations… You’re going to want a pediatrician who has a schedule in synch with yours.  I found many that were only open a few hours a day, Monday through Friday.  And only a handful (if that) who were open any Saturdays at all (which was important for us).  Are you going to want to schedule appointments for weekends?  After work?  Then make sure your potential candidates can accommodate that.
• Confirm In Network.  Ah, the joys of medical insurance.  Before moving any further, I would now contact my insurance company to make sure my top candidates are “in network.”  ‘Nuff said.
• Request Consultation.  At this point I would call each office and request a consultation with the pediatrician.  I felt a bit awkward doing this at first (after all, I’ve never contacted any other type of doctor for a consultation), but apparently it is pretty common.  All candidates I called except for 1 had special hours for these consultations.  That 1 was scratched off the list.
• Ask the Right Questions.  Here is where I semi-failed.  I didn’t have the baby yet, so I didn’t have the right questions.  You don’t know what you don’t know.  If I could do it over, these are the areas I would focus on:

– Confirm hours of operation and urgent visit policies.
– How can the doctor be contacted after-hours?  What is the response time?
– What hospital affiliations does the doctor have?
– Can I email you with non-urgent questions?  What is your response time?  (I would have never thought to ask this.  Fortunately, my pediatrician offers it.  This has been a lifesaver for me – I am able to email him questions, pictures, and even videos of non-urgent issues so he can take a look and respond.  Has saved me a LOT of trips to the doctors’ office)
– Will you always see the same doctor?  (A family practice was important to me; others have a group of doctors and it is only guaranteed that you will see one of them)
– When will you come to the hospital post-birth?  How many times?  (I think once is standard; however, mine came every day I was in the hospital which was appreciated)
– IF APPLICABLE, What are your views on modified vaccination schedules?  (I ran into an issue where my pediatrician and I had differing view on this – led to several tense conversations and emails, and I wish I had simply asked upfront)
– What are your views on breastfeeding vs. formula feeding?  (Even if you plan to breastfeed, it doesn’t always work out.  You want a doctor who will support you in whatever you choose instead of adding even more guilt and pressure)
– Who covers in the event that you are unavailable, on vacation, etc?
– Any other questions about their medical views on nutrition, antibiotics, disease, as well as probing to get a feel as to how they interact with the kids.

• Talk to Parents in the Office.  How long have they been using this pediatrician?  What do they like/dislike?  How long do they have to wait to see the doctor each time they come in?  etc.
• Hire.  By this, I mean that you simply let your birthing hospital know who your pediatrician is, and let the pediatrician know that you’ve decided to go with them.

Now that I’m a parent, the things I most appreciate about my pediatrician is that I never have to wait (once we arrive, we are seen right away), they are great at handling urgent issues (since they don’t overbook, I’m able to come in at any time and be seen almost immediately), I’m able to contact him via email, he knows me and my family personally (e.g. we’re not just a number), he is open one Saturday a month, and he has accommodated some of my requests despite disagreeing (e.g. a modified vaccination schedule).  These are not all things I thought would matter to me before the baby had arrived.

I continue to learn how important the mother/pediatrician relationship is, so do pick someone you trust, can talk to openly, and who will not downplay your concerns.  Pick someone who you would be comfortable discussing poop patterns with.  Someone who you would be comfortable sending pictures of dirty diapers to (yes, we have done this).  And someone who will care for your child’s health almost as much as you do.