Should I use soapy water to clean my child during a diaper change?
Expert Answers
David Geller, pediatrician
How you clean up during a diaper change depends on how messy it is. If the diaper area is clean, without any stool, then you do not have to wipe the baby's bottom and can just put on a new diaper with or without using diaper cream. If the bottom needs cleaning, you can use a moist washcloth or soft towel with or without soap on it. You may also use wet wipes if you want. Most wipes are very hypoallergenic and won't irritate an infant's skin. If you do use wipes, make sure they're unscented and alcohol-free. Wipe gently, since too much wiping can cause irritation. Stop using any wipe or soap that seems to irritate your child's skin and let the skin heal. Then try it again to see whether it causes a repeated problem. If so, avoid that wipe or soap until the child is older.
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Thursday, March 13, 2008
Tuesday, February 21, 2006
Birthmarks
What are birthmarks?
Birthmarks are areas of discolored skin that are on a baby's body at birth or show up within a few weeks after birth. Over 80 percent of babies have a birthmark. Some birthmarks endure for life, while others fade away over time.Birthmarks are usually grouped into one of two categories: vascular or pigmented. Vascular birthmarks result from an abnormal development of blood or lymph vessels below the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the vessels. Pigmented birthmarks — usually brown, gray, bluish, or black — result from an abnormal development of pigment cells. Some birthmarks are also known as nevi ("nevus" is the singular).
What do they look like and which ones are most common?
Birthmarks come in a wide range of shapes, sizes, and colors, and they can show up anywhere on the body. The most common varieties are:
• Café au lait spots: Tan or light brown flat patches that sometimes appear in multiples. Between 20 and 50 percent of newborns have one or two of these pigmented birthmarks. They usually get smaller as a child grows, though they may also darken with sun exposure.
• Moles: Clusters of pigmented skin cells. They vary in size and may be flat or raised, black or brown, hairy or not. Many moles don't show up until a child is a few years old, but those that are present at birth are called congenital nevi, or birthmark moles, and about 1 percent of babies have them. These often start out flat and become slightly larger and more raised.
• Bluish or grayish Mongolian spots: Large, flat areas of extra pigment on the back or buttocks that are most common in babies with dark skin: 95 to 100 percent of Asian, 90 to 95 percent of East African, 85 to 90 percent of Native American, 50 to 70 percent of Hispanic, and 1 to 10 percent of Caucasian babies have them. Mongolian spots usually fade by school age, though they may never disappear altogether.
• "Stork bites," "angel kisses," salmon patches, and macular stains: Blotchy pink or purple flat marks that are dilated capillary veins near the surface of the skin. They're the most common birthmark, with up to 70 percent of babies having one or more. They can become more noticeable when the baby cries or when there's a change in temperature. The ones on the back of the neck, called "stork bites," usually last into adulthood. The ones on the forehead or eyelids, called "angel's kisses," usually go away by age 2.
• Port-wine stains (PWS), or nevus flammeus: Dark, berry-colored stains that are present at birth. These vascular birthmarks range from pale pink to dark purple and can appear anywhere on the body, though they show up most often on the face or head. About .3 percent of infants are born with PWS. Light port-wine stains might fade, but most endure and get bigger as the child grows. Sometimes port-wine stains can thicken and darken (the birthmark on former Russian president Mikhail Gorbachev's head is an example). They can also form cobblestones, or small lumps, on the surface of the skin.
• Hemangioma: A term used to describe a variety of blood vessel growths. These raised, rough lesions can be large and disfiguring or small and not very noticeable, and they affect about 10 percent of babies. Hemangiomas occur mostly on the head and neck, and unlike other birthmarks, they can grow rapidly. They usually show up during the first six weeks of life (only 30 percent are visible at birth), and grow for about a year — usually no bigger than 2 or 3 inches. Then, without treatment, they usually stop growing, turn white, and start shrinking (this is called involution). This reverse process can take three to ten years. Twenty percent of children who have hemangiomas have more than one, and they're more common in girls, preemies, and twins.One type of hemangioma is a strawberry hemangioma, which appears on about 2 to 5 percent of babies. This raised, strawberry-red mark tends to grow and then disappear — half are flat by age 5, and nine out of ten are flat by age 9. A deeper hemangioma appears as lumpy bluish-red mass. It grows quickly in the first six months and is usually gone by the time a child reaches his teen years. Such hemangiomas are bluish in color because the abnormal vessels are deeper than those in the strawberry hemangioma.
Are they ever serious?
According to dermatologist Seth Orlow, director of pediatric dermatology at New York University School of Medicine, most birthmarks are harmless, and many go away on their own in the first few years of life, without treatment. There are a few exceptions, though. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So it's important to have all birthmarks checked out by your child's healthcare provider. Potential problems include:
• Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with seizures and developmental delay. (This is known as Sturge-Weber Syndrome.)
• Large hemangiomas, depending on where they're located, might interfere with eating, seeing, or breathing. Sometimes hemangiomas grow internally, threatening the health of an organ.
• Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow.
• Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatoses (NF). Children with NF usually have the spots at birth or by age 2, though the number may increase in childhood and occasionally later in life. About 50 percent of people with NF also have learning disabilities.
• Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.
• Some birthmarks can be psychologically damaging to a child over time.
Can my child's birthmark be removed?
It depends. Some of the conditions mentioned above (like a hemangioma close to the eye) might require removal. If a birthmark isn't disfiguring or causing physical problems, though, it's usually best to leave it alone. Of course, a large hemangioma on your child's face can be distressing, and it's understandable if you want to do something about it now. But because most of these birthmarks will fade by the time your child's ready for school, it's unlikely your doctor will recommend any special treatment. Some experts have challenged this wait-and-see approach, though, arguing that enough of them never disappear completely, and that early intervention to treat certain birthmarks can be helpful. So you may want to get more than one opinion about treatment.
Treatment options
Treatment options include surgery, laser therapy, and topical, oral, or injected steroids, depending on the birthmark. Orlow says that almost all birthmark-removal treatments can cause some scarring. Port-wine stains are difficult to remove completely, but laser therapy can usually make them lighter.
What are birthmarks?
Birthmarks are areas of discolored skin that are on a baby's body at birth or show up within a few weeks after birth. Over 80 percent of babies have a birthmark. Some birthmarks endure for life, while others fade away over time.Birthmarks are usually grouped into one of two categories: vascular or pigmented. Vascular birthmarks result from an abnormal development of blood or lymph vessels below the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the vessels. Pigmented birthmarks — usually brown, gray, bluish, or black — result from an abnormal development of pigment cells. Some birthmarks are also known as nevi ("nevus" is the singular).
What do they look like and which ones are most common?
Birthmarks come in a wide range of shapes, sizes, and colors, and they can show up anywhere on the body. The most common varieties are:
• Café au lait spots: Tan or light brown flat patches that sometimes appear in multiples. Between 20 and 50 percent of newborns have one or two of these pigmented birthmarks. They usually get smaller as a child grows, though they may also darken with sun exposure.
• Moles: Clusters of pigmented skin cells. They vary in size and may be flat or raised, black or brown, hairy or not. Many moles don't show up until a child is a few years old, but those that are present at birth are called congenital nevi, or birthmark moles, and about 1 percent of babies have them. These often start out flat and become slightly larger and more raised.
• Bluish or grayish Mongolian spots: Large, flat areas of extra pigment on the back or buttocks that are most common in babies with dark skin: 95 to 100 percent of Asian, 90 to 95 percent of East African, 85 to 90 percent of Native American, 50 to 70 percent of Hispanic, and 1 to 10 percent of Caucasian babies have them. Mongolian spots usually fade by school age, though they may never disappear altogether.
• "Stork bites," "angel kisses," salmon patches, and macular stains: Blotchy pink or purple flat marks that are dilated capillary veins near the surface of the skin. They're the most common birthmark, with up to 70 percent of babies having one or more. They can become more noticeable when the baby cries or when there's a change in temperature. The ones on the back of the neck, called "stork bites," usually last into adulthood. The ones on the forehead or eyelids, called "angel's kisses," usually go away by age 2.
• Port-wine stains (PWS), or nevus flammeus: Dark, berry-colored stains that are present at birth. These vascular birthmarks range from pale pink to dark purple and can appear anywhere on the body, though they show up most often on the face or head. About .3 percent of infants are born with PWS. Light port-wine stains might fade, but most endure and get bigger as the child grows. Sometimes port-wine stains can thicken and darken (the birthmark on former Russian president Mikhail Gorbachev's head is an example). They can also form cobblestones, or small lumps, on the surface of the skin.
• Hemangioma: A term used to describe a variety of blood vessel growths. These raised, rough lesions can be large and disfiguring or small and not very noticeable, and they affect about 10 percent of babies. Hemangiomas occur mostly on the head and neck, and unlike other birthmarks, they can grow rapidly. They usually show up during the first six weeks of life (only 30 percent are visible at birth), and grow for about a year — usually no bigger than 2 or 3 inches. Then, without treatment, they usually stop growing, turn white, and start shrinking (this is called involution). This reverse process can take three to ten years. Twenty percent of children who have hemangiomas have more than one, and they're more common in girls, preemies, and twins.One type of hemangioma is a strawberry hemangioma, which appears on about 2 to 5 percent of babies. This raised, strawberry-red mark tends to grow and then disappear — half are flat by age 5, and nine out of ten are flat by age 9. A deeper hemangioma appears as lumpy bluish-red mass. It grows quickly in the first six months and is usually gone by the time a child reaches his teen years. Such hemangiomas are bluish in color because the abnormal vessels are deeper than those in the strawberry hemangioma.
Are they ever serious?
According to dermatologist Seth Orlow, director of pediatric dermatology at New York University School of Medicine, most birthmarks are harmless, and many go away on their own in the first few years of life, without treatment. There are a few exceptions, though. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So it's important to have all birthmarks checked out by your child's healthcare provider. Potential problems include:
• Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with seizures and developmental delay. (This is known as Sturge-Weber Syndrome.)
• Large hemangiomas, depending on where they're located, might interfere with eating, seeing, or breathing. Sometimes hemangiomas grow internally, threatening the health of an organ.
• Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow.
• Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatoses (NF). Children with NF usually have the spots at birth or by age 2, though the number may increase in childhood and occasionally later in life. About 50 percent of people with NF also have learning disabilities.
• Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.
• Some birthmarks can be psychologically damaging to a child over time.
Can my child's birthmark be removed?
It depends. Some of the conditions mentioned above (like a hemangioma close to the eye) might require removal. If a birthmark isn't disfiguring or causing physical problems, though, it's usually best to leave it alone. Of course, a large hemangioma on your child's face can be distressing, and it's understandable if you want to do something about it now. But because most of these birthmarks will fade by the time your child's ready for school, it's unlikely your doctor will recommend any special treatment. Some experts have challenged this wait-and-see approach, though, arguing that enough of them never disappear completely, and that early intervention to treat certain birthmarks can be helpful. So you may want to get more than one opinion about treatment.
Treatment options
Treatment options include surgery, laser therapy, and topical, oral, or injected steroids, depending on the birthmark. Orlow says that almost all birthmark-removal treatments can cause some scarring. Port-wine stains are difficult to remove completely, but laser therapy can usually make them lighter.
Monday, February 20, 2006
Behavior
Question: My 8-month-old screams to get my attention. How can I stop this?
Answer: It's pretty easy to fall into the trap of paying attention to an 8-month-old when she's screaming. Once she starts yelling, you may have no choice but to pick her up and calm her, guaranteeing that she has your attention. Of course, if she really needs something or isn't physically all right, then it's justified. But if that's not the case, to counteract this cycle, try to pay attention to her before she starts screaming. When she's playing quietly, putting toys in her mouth or even sucking on her hand, give her lots of brief, nonverbal physical attention, whether it's a pat on the head, a rub on the back, or a gentle squeeze of her hand
Question: My 8-month-old screams to get my attention. How can I stop this?
Answer: It's pretty easy to fall into the trap of paying attention to an 8-month-old when she's screaming. Once she starts yelling, you may have no choice but to pick her up and calm her, guaranteeing that she has your attention. Of course, if she really needs something or isn't physically all right, then it's justified. But if that's not the case, to counteract this cycle, try to pay attention to her before she starts screaming. When she's playing quietly, putting toys in her mouth or even sucking on her hand, give her lots of brief, nonverbal physical attention, whether it's a pat on the head, a rub on the back, or a gentle squeeze of her hand
Bathing
Question: When can I give my baby a bath?
Answer: You'll want to stick to sponge baths with a lukewarm washcloth for the first week or so, until your baby's umbilical cord stump falls off and the area heals. After that you really need to bathe a newborn only once or twice a week. (Babies just don't get that dirty until they start crawling around.) Use a soft soap and don't fill the tub too much — a few inches is all you need.
Question: When can I give my baby a bath?
Answer: You'll want to stick to sponge baths with a lukewarm washcloth for the first week or so, until your baby's umbilical cord stump falls off and the area heals. After that you really need to bathe a newborn only once or twice a week. (Babies just don't get that dirty until they start crawling around.) Use a soft soap and don't fill the tub too much — a few inches is all you need.
Sunday, February 19, 2006
Formula Feeding
Question: Soy or milk-based formula: Which is better for my baby?
Answer: Soy formula has no nutritional advantage over milk-based formula and vice versa. Both are fortified with the same vitamins and minerals.Usually parents choose soy formula when their baby is sensitive or allergic (or potentially so) to cows' milk protein, or when a baby is having trouble digesting lactose or milk sugar. Babies can be chronically sensitive to cows' milk protein and may have to avoid it for the first several months of life. If your baby cries or is irritable during feedings or immediately afterward, or if he has diarrhea, he may be allergic to his formula. Check with your baby's doctor if you think he's having problems digesting the milk; the doctor may recommend switching to soy milk.That said, remember that soy protein is just as likely to cause food allergies. In fact, most babies who are allergic to cows' milk protein are also allergic to soy protein. If this happens, your child's healthcare provider may ask you to try other brands of formula that don't contain cows' milk protein. Sometimes, you might need to change brands a few times to find what's best for your baby
Question: Soy or milk-based formula: Which is better for my baby?
Answer: Soy formula has no nutritional advantage over milk-based formula and vice versa. Both are fortified with the same vitamins and minerals.Usually parents choose soy formula when their baby is sensitive or allergic (or potentially so) to cows' milk protein, or when a baby is having trouble digesting lactose or milk sugar. Babies can be chronically sensitive to cows' milk protein and may have to avoid it for the first several months of life. If your baby cries or is irritable during feedings or immediately afterward, or if he has diarrhea, he may be allergic to his formula. Check with your baby's doctor if you think he's having problems digesting the milk; the doctor may recommend switching to soy milk.That said, remember that soy protein is just as likely to cause food allergies. In fact, most babies who are allergic to cows' milk protein are also allergic to soy protein. If this happens, your child's healthcare provider may ask you to try other brands of formula that don't contain cows' milk protein. Sometimes, you might need to change brands a few times to find what's best for your baby
Formula Feeding
Question: Is tap water, bottled water, or boiled water best for formula?
Answer: I recommend boiling the water you use for formula (or using ready-to-feed formula) until your baby is at least 6 months old — that is, when his immune system starts to provide more protection against infection and he's crawling around on the floor and getting into all sorts of stuff anyway. The problem with tap water is that while it may be safe today, it can become unsafe at any time. For example, in 1993, the bacteria cryptosporidium got into the municipal water supply in Milwaukee and caused 400,000 people to become ill and several to die before they caught it.
Although that's not likely to happen very often, a newborn is particularly vulnerable to infection, so it's better not to risk it. Plus, it's hard to know for sure what's in our tap water (or well water) at any given time and what kinds of effects certain levels of heavy metals and other contaminates may have on a baby.If you choose to boil the water you use to mix formula, save yourself time by preparing enough for the whole day in the morning — a few quarts should be enough. Follow formula label and American Academy of Pediatrics' recommendations: Bring the water to a rolling boil for one minute, and then turn it off and let it cool either on the stove or in a covered container in the refrigerator. (We don't recommend boiling it for any longer because you may end up concentrating trace amounts of lead in the water as it boils off.)If you're buying bottled water, look for distilled (not spring) water, since the minerals in spring water could disturb the delicate balance of minerals found in formula. Another option is nursery water. Usually found in the water section of the grocery store, nursery water is a specially marked water that's often distilled and fluoride-free (check the label to make sure). But even if you do use bottled water, you'll need to boil it once the bottle has been opened, unless you use it all right away
Question: Is tap water, bottled water, or boiled water best for formula?
Answer: I recommend boiling the water you use for formula (or using ready-to-feed formula) until your baby is at least 6 months old — that is, when his immune system starts to provide more protection against infection and he's crawling around on the floor and getting into all sorts of stuff anyway. The problem with tap water is that while it may be safe today, it can become unsafe at any time. For example, in 1993, the bacteria cryptosporidium got into the municipal water supply in Milwaukee and caused 400,000 people to become ill and several to die before they caught it.
Although that's not likely to happen very often, a newborn is particularly vulnerable to infection, so it's better not to risk it. Plus, it's hard to know for sure what's in our tap water (or well water) at any given time and what kinds of effects certain levels of heavy metals and other contaminates may have on a baby.If you choose to boil the water you use to mix formula, save yourself time by preparing enough for the whole day in the morning — a few quarts should be enough. Follow formula label and American Academy of Pediatrics' recommendations: Bring the water to a rolling boil for one minute, and then turn it off and let it cool either on the stove or in a covered container in the refrigerator. (We don't recommend boiling it for any longer because you may end up concentrating trace amounts of lead in the water as it boils off.)If you're buying bottled water, look for distilled (not spring) water, since the minerals in spring water could disturb the delicate balance of minerals found in formula. Another option is nursery water. Usually found in the water section of the grocery store, nursery water is a specially marked water that's often distilled and fluoride-free (check the label to make sure). But even if you do use bottled water, you'll need to boil it once the bottle has been opened, unless you use it all right away
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