Search for tag: "infants"

Dr. Gellner: Sign language is an important way you can communicate with your child before they can use their words. I'm Dr. Cindy Gellner and we will discuss sign language with your baby today on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Baby sign language seems to have become a trend that has been picking up momentum over the past 20 years. It is based on simple observation that children can be taught to use their hands to talk long before their mouths can catch up.

There is a gap between what older babies and toddlers want to say and what they're capable of saying. Baby sign language can help babies use their hands to express themselves as early as eight or nine months old. A distinction must be made, though, in that babies are making gestures for their needs and not really learning American Sign Language.

Some studies suggest that babies whose parents communicate with a combination of speech and gesturing may develop larger spoken vocabularies. The most recent research doesn't support that specifically, but what does seem to be more likely is that gestures can improve communication and make parents more sensitive to what their babies are thinking about. That's a pretty big thing, considering when a parent is more tuned in to what their baby's thoughts and feelings are, babies are more likely to develop secure attachment relationships. Parents also provide their babies more opportunities to explore and learn.

There is strong evidence that older children become better learners and problem solvers when they gesture. Some research suggests that early gesturing is linked with vocabulary development, specifically, receptive vocabulary, meaning they understand more of what is being communicated to them. While there have been some claims that baby sign language is associated with higher I.Q. levels, research has yet to support this.
When getting started with baby sign language you can check out books and videos, but most scientific literature suggests that you should pay close attention to your own baby and discover what signs he or she may invent on his or her own. Your baby may be gesturing and signing already.

Be patient. Your baby is observing everything you do and will learn to communicate in his or her own time. Be sure to keep speaking to your baby. That is the best way to help them with future socialization and language development, and be sure to speak words that you are gesturing as well.

Repetition is key. Make signing a daily habit. Use signs to describe routine activities and common objects that make up your baby's world. Don't worry if your baby doesn't get the signs right or doesn't pick them up right away. The goal is to have fun communicating with your baby and lessen frustration of not being able to understand them.
Finally, be sure to share the signs you are using with others that help care for your baby so you can reinforce these signs and they can help communicate with your baby as well.

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Interviewer: You've just had a baby and then you've got to go to your first doctor's appointment for the first checkup. How about if the doctor came to you instead of you needing to go to the doctor? We'll talk about a brand new service at University of Utah Healthcare called "newborn home visits," next on The Scope.

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Interviewer: Dr. Amy Williams is a pediatrician at the South Jordan Clinic for University of Utah Healthcare and the person who came up with this great idea and you're going to love her for it, newborn home visits. Why did you decide that newborn home visits were a good idea?

Amy: I think there's a really difficult time in the beginning of after having a baby that mothers are trying to establish a relationship with this new baby. They're trying to get home from the hospital and recover and so I felt like it was a really good time for us to come in and help patients with just a critical period in their life that they need some help.

Interviewer: Yeah, so otherwise they'd have to come in and visit a doctor. At what point in the newborn's life is that first visit?

Amy: They are usually coming in within the first week so they get home from the hospital, a couple days later, they're supposed to pack up, get back into a clinic again to have that baby reestablished with their primary care provider and we're trying to alleviate that first three to five days or that first week when they're supposed to come and see us.

Interviewer: And what do you feel the benefits are for that other than

Amy: There are lots. Lots.

Interviewer:
of course, you know, it's convenient. But let's talk about all of them.

Amy: Well, one of them is that we're taking that transition period that the mom's trying to have and just taking that stress from her life so that's obviously a great benefit. We come into the home so it's helpful for parents. They get to show us what they're working with at home so sometimes that's even a benefit where we can look at their environment, help them, show breastfeeding right at their place as opposed to coming to some foreign little clinic office and just reducing the risk of that baby coming in and exposing them to all the other stuff again.

Interviewer: Yeah, sure, sure. Sure.

Amy: It's also a benefit to mom if she's had some sort of surgery. Recovering from having a baby is physically hard and it takes a lot of healing and so if mom's able to move less, we're also doing mom a favor, not only the baby.

Interviewer: Give me an example, tell me a story of a time you went in and you were able to take the mother's environment and actually help making caring for her newborn easier because you saw something going on that they didn't realize.

Amy: I had twins that came home from the newborn intensive care unit. They were premature and they were sent home on car beds, so not car seats. And the mom was trying to figure out how to get her kids in these car beds to the clinic. So I said, "Don't worry about it. We're going to come to your house and we will check them and make sure that we can transition them to a car seat at your house."

So we got to the house, we were able to setup oxygen, just monitoring and see if they could do these car seats. And during that time, we were able to see how the mom was moving around the house and how she was functioning with twins, how she was holding them and help her with breastfeeding and all of that. It was great because after that, she's able to take her kids anywhere now in car seats and she doesn't have to try and figure out how to do these car beds, which are quite cumbersome.

Interviewer: Tell me how do you get that home visit? Is there a special code word?

Amy: Well, the University, right now, we're just offering it at South Jordan Health Clinic, but we want to start getting it out to all the other clinics. So anyone who has their baby seen at the University of Utah Healthcare in any of the community clinics, hopefully at some point we'll have it all there. Right now, parents can just call the 801-213-4500 number that they normally would call to get an appointment for their babies at South Jordan Health Clinic. And at that time, the call center offers them either a home visit or the parents can ask for one and we would set them up and then we would come on out.

Interviewer: What are some of the patients saying about this program that have used it?

Amy: I haven't heard one negative thing yet.

Interviewer: Yeah, okay.

Amy: It's been all awesome. I think parents are overwhelmed, they're excited. They feel like this is something that they wished they could have used with their other kids and now they're excited that it's here for their newborns now. I've heard some parents start with a little hesitancy of having somebody come into their house. They're worried about it not being clean and after you have a baby, the last thing anybody is thinking about is having their house clean. We do not have any care as to what the house itself, what its organization is all about and parents feel really reassured once we get in there that we're not there to judge them on what's around the house, but more to just take care of them and their baby.

Interviewer: And it's really just one of the ways the University of Utah Healthcare is trying to make healthcare a lot more accessible to people instead of the old model where they always have to come to us. We go to them and try to make it more convenient. It's kind of the new way.

Amy: I think University has an interest in getting out to the community and being a part of the community. And this is just one way that we can access our neighbors, our friends, our patients. And it establishes a much better rapport and trust with both sides.

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Dr. Miller: What does a neonatologist do? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

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Dr. Miller: Hi, I'm here today with Mariana Baserga. She is a physician, a pediatrician, and she's also a professor of Pediatrics at the University of Utah. Mariana, if you were at a party and somebody asked you what you did and you told you were a neonatologist, what would you tell them? What does a neonatologist do?

Dr. Baserga: Neonatologist is a specialist that will take care of newborn babies that do not . . .

Dr. Miller: Newborns.

Dr. Baserga: Newborn babies.

Dr. Baserga: Little ones.

Dr. Miller: Tiny ones.

Dr. Baserga: The tiny ones or the not-so-tiny ones that can run into trouble after delivery. So most of the babies that come to the ward don't have a problem transitioning from mom's womb to alive, but when they do, that's where we come in to help.

Dr. Miller: So most of the time, healthy babies, healthy births. But, occasionally, a woman might have an issue with a new baby, and that's where you step in.

Dr. Baserga: Correct. There are about half a million deliveries that are pre-term in this country, and that's by definition of a baby born less than 37 weeks or less than 5 pounds. And those babies are the ones that a neonatologist will be taking care of in the NICU.

Dr. Miller: So if they're less than 5 pounds or less than 37 weeks at gestation, that doesn't necessarily mean that they need to go a neonatology unit, but that you would assess them. That would be part of a routine examination that you would perform on this type of a newborn.

Dr. Baserga: Correct. Babies that come out early may need help with breathing, may need help with giving them sugar because they can't feed well. They can have an increase in sense of infections. And in those cases, they cannot be in the regular well-baby nursery and they have to be in the neonatal intensive care unit.

Dr. Miller: So the great thing about this specialty is that you're available in there in case you're needed. So it's almost like every baby that is born could be seen by a neonatologist and evaluated. And then what percent of the time might they end up going to a unit that cares for these little tiny babies?

Dr. Baserga: So premature babies less than 34 weeks gestation all will come to our neonatal intensive care unit. And there is a mid-ground, and those babies that are between 34 and 37 weeks, what we call "late pre-term babies," that can go either way. It depends on how the baby does. So I would say half of those babies may need to be in the intensive care. And depending on the hospital, they can be in a specialized well-baby nursery.

Dr. Miller: So do you think that most expecting mothers, mothers who are near delivery, know that a neonatologist might be involved in the care of their child if needed? Are they aware of your specialty, do you think?

Dr. Baserga: I would say half about, especially in the United States, most people are aware of the possible need that the baby will need help after being born. But we still in Utah, for example, see a lot of deliveries that happen at home, and everything goes well. So the times where we may need to transport babies into the NICU are when those deliveries don't go well.

Dr. Miller: How long do these babies typically spend in the unit?

Dr. Baserga: They can spend from one day to a year. It depends on how sick they are. Babies that are born at 23, 24 weeks gestation. . .

Dr. Miller: These are really tiny babies.

Dr. Baserga: Those babies are about a pound or half a kilo. And those babies may stay with us three, four month sometimes.

Dr. Miller: But usually what would you think, maybe several days for most babies that are not in that weight range?

Dr. Baserga: Yeah. The NICU has one of the longest stays in the hospital because babies need help for a longer period of time because they have to mature, they have to learn to eat. So what we tell families, when they're getting ready to go home and that's a question they like to ask, is, "When can I take my baby home?" Baby has to be able to control their own temperature. That means no need for an isolette.

And particularly when they're about three pounds, not before that, it's rarely to see the baby outside of an isolette. They have to be able to be taking all feedings by mouth without any tubes to help them gain weight. And they have to be breathing on their own without having what we call "prematurity apnea". And in those cases when the babies are still having apnea. . .

Dr. Miller: Apnea is the. . .

Dr. Baserga: Stop of breathing.

Dr. Miller: Stopping breathing.

Dr. Baserga: They kind of, what we say, forget to breathe because their brain is not mature, and those babies need to be in the hospital.

Dr. Miller: So what would be the more common reasons that little babies would end up under your care?

Dr. Baserga: Most cases are prematurity, being born early.

Dr. Miller: And what would follow that? So inability to breathe is one of the things you've said.

Dr. Baserga: Yeah, so secondary would be sepsis or infection. They need to be in the intensive care. And then we have a big group of babies that are born with congenital malformations, and will. . .

Dr. Miller: Usually cardiac or different kinds?

Dr. Baserga: There are different kinds. We have cardiac malformations. We can have brain malformations, what we call "abdominal wall defects," such as gastroschisis. Those babies all will need intensive care in the NICU. And in most case scenarios, we are aware that this is the case, and we have what we call "antenatal consultations" with these families. And by the time the baby is born, they know that the baby will need intensive care.

Dr. Miller: Now, another thing is that you have an entire team of specialists, including nurses and nutritionists. Can you talk a little bit about the team that surrounds the care of the newborn that goes to your unit?

Dr. Baserga: So the NICU is a big family. We have the neonatologists with the doctors, and then we have specialized nurses. We also have nurse practitioners that are specialized in neonatology. We have respiratory therapists that deal with the airway and ventilators and respirators. We have occupational therapists that are the ones that are dedicated to the development of these babies. And these babies are in an isolette. They don't move much around. And they assist them with neurological development, as well as starting feedings, because they are very immature in their skills to eat. So this is a big team that will help them . . .

Dr. Miller: Just like a big village taking care of these little babies, right?

Dr. Baserga: Yes, it is.

Dr. Miller: So for an expecting mother or families of an expecting mother, one thing that they might wonder about is . . . Well, if their baby is in the neonatal intensive care unit, are they able to visit? I think there may be some fears that they won't be able to see the babies or visit the babies.

Dr. Baserga: So our intensive care unit is family-oriented. It's family-centered and we are open 24/7. There are no visitation hours. The summertime, we even allow siblings and little toddlers to come.

Dr. Miller: You have no visitation hours. You don't . . .

Dr. Baserga: No restriction on visitation hours. So we don't have a policy that limits the time the parents can be at the bedside. Having said that, they're even invited to be present during nurses' sign out. We used to not allow families at that time and now we're an open unit so that they can always be at the bedside. They even hear the report nurses are giving to each other.

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Dr. Gellner: What is PKU and why is it so important my child be tested for it? I am Dr. Cindy Gellner and we will discuss that today on The Scope.

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Dr. Gellner: When your child has the newborn screening test before they leave the hospital and at the two-week well visit, one of the things they're checking for is phenylketonuria or PKU. It's a rare birth defect and it pretty much means the body is not able to break down an amino acid called phenylalanine.

You may have seen the warning labels on soda labels that say, "Attention phenylketonurics, contains phenylalanine." Amino acids are the building blocks for protein, but too much of this amino acid can be dangerous for people with PKU.

The cause of PKU is completely genetic. For a child to be born with PKU both parents must have the PKU gene. If only one parent has the gene, the child will not have PKU. A parent can have the PKU gene, but not have the disease and this is called being a carrier. If a pregnant woman with PKU does not follow a PKU diet during pregnancy, the baby may be born with intellectual disabilities, an abnormally small head, or even heard defects. PKU is much more common in Caucasians than any other ethnic population.

Newborns who have PKU do not show symptoms right away, but without treatment babies usually show signs of PKU within a few months. Symptoms can be mild or severe and may include a musty odor to the child's breath, skin or urine, a small head-size and slow growth, vomiting with feeds, not just normal spit-ups, or rocking back and forth and having seizures. Untreated PKU does lead to brain damage within the first few months of life.

So the newborn screening that your child gets before they leave the newborn nursery and again at two weeks after birth, picks this disease up along with numerous other medical conditions. All 50 states test newborns for PKU. If the PKU test is positive, you and your pediatrician will be notified right away by the Health Department. The main treatment for PKU is a strict diet that limits that amino acid, phenylalanine. Because regular infant formula and breast milk contain phenylalanine, babies with PKU are put on a special infant formula. A small amount of breast milk may be okay for some babies.

Children with PKU are followed closely by genetics doctors. These specialists will work with the family to monitor the levels of phenylalanine in the child's blood. Genetics doctors also work closely with dietitians familiar with PKU that can help the families with getting these special formulas and other drinks that they need as they get older.

So how can I help my child if I find out that they do have PKU? The first thing is to monitor what your child eats every day. Milk, eggs, and other common foods contain phenylalanine. Often you'll find that information on a label like you do on the soda cans. Give your child a low-protein diet, including rice, pasta, tortillas, bagels, breads, and egg substitutes and imitation cheeses. Teach your child to also avoid foods and medicine containing aspartame. Aspartame is a sweetener and it's found in NutraSweet and Equal and many other products that are low-sugar. Aspartame releases phenylalanine when it's digested. Again, a safe amount of phenylalanine differs for every child and your genetics doctor and their dietician can help you determine what this level is.

Can you prevent PKU? No, you can not. If either parent has a family history of PKU, the parent can have a blood test before pregnancy or birth that can tell you if you are a PKU carrier. If you have PKU, you can prevent birth defects by sticking to the PKU diet and even if you only have mild PKU, you should follow the diet if you are pregnant.

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