Search for tag: "babies"

Dr. Jones: The epidemic of substance abuse in the U.S. includes moms and the babies they carry. Can a baby be born addicted? And how can we find out so we can provide better care for the newborns? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Whatever you breathe, eat, smoke, inject or put on your skin when you're pregnant goes to your baby. Knowing this, most moms-to-be are very careful about what they put in their bodies. But some moms just don't know the risks to the baby of the drugs they are taking. And some moms can't help themselves and put dangerous substances into themselves and their fetuses.

When a baby is born, the baby is separated physically from the mom, the cord is cut, and the umbilical cord, which is baby tissue, is discarded. If we obstetricians or pediatricians are worried about what the baby might have been exposed to, what can we do? Sometimes moms will tell us, sometimes they won't, and sometimes they don't know.

Today in The Scope studio we're talking to Dr. Gwen McMillin. She's a professor of pathology and the medical director of toxicology at ARUP, which is our big national testing lab. She'll tell us how we can use umbilical cords to help us take better care of newborns at risk.

Welcome, Dr. McMillin. When it comes to babies being exposed to drugs of abuse during pregnancy, what's the scope of the problem? Big? Little? One in a million?

Dr. McMillin: Unfortunately, the problem is actually growing, and some of that is the recognition of how harmful both drugs of abuse and prescription drugs can be to a mother and the unborn baby. I think the incidence is estimated at about 10% right now, so about 10% of babies are thought to have been exposed to dangerous compounds in utero, and I would say that that problem is growing in parallel with the national opioid epidemic that most people are aware of.

Dr. Jones: Wow, one in 10. One in 10.

Dr. McMillin: Yes.

Dr. Jones: We do 4,000 births at the University Hospital here a year. One in 10 makes a lot of babies exposed to drugs. Well, so how do we figure out if babies have been exposed? What kind of samples are used?

Dr. McMillin: So the traditional specimens that have been evaluated to identify drug exposed infants have been hair, which not every baby has.

Dr. Jones: I got a baldy for sure.

Dr. McMillin: And the meconium which is the first stool of the newborn, or baby poop maybe, that most of us are familiar with. And the challenge with meconium is that it may take several days to pass. We have to be very aware of those passages and scrape the meconium out of the diapers. That can require sometimes several days, several passages and lots of people involved. So there can be lots of problems or errors associated with that. It also will take more time to get results from the laboratory about what might be inside that meconium or hair.

So, a few years ago, we recognized that problem and investigated the possibility of using the umbilical cord tissue itself, which as you pointed out is typically discarded but is a lifeline to the baby. So we found that if we actually grind up that tissue we can detect drugs and drug metabolites or breakdown products in that cord to identify those drug exposed infants. And of course, that's logistically the best specimen possible because every child has a cord and it's available right at birth.

Dr. Jones: Right. And taking it, it's not like having to stick the baby for blood or wait around for the baby to poop. It's right there as soon as the baby is separated from the mom and we can send it to you. So, how do doctors access this? Can you ask for it? Or is it just a research plan? Or how is this happening right now?

Dr. McMillin: Well, ARUP laboratories has been offering this test clinically for about three and half years. There are now two other laboratories in the US that also offer this type of testing.

Dr. Jones: Were you first?

Dr. McMillin: We were actually second. But that's a tough race.

Dr. Jones: To be the best.

Dr. McMillin: To be the very best, yes.

Dr. Jones: Yes, to be fastest.

Dr. McMillin: Yes, yes, yes. And so we offered it as a clinical test to our clients, which are primarily hospitals, and we found that more and more hospitals are now making this a routine part of their practice so that they go ahead and collect cords for every baby and then store it to find out whether or not the baby starts to exhibit signs and symptoms of drug withdrawal or whether there are other risk factors that would suggest drug testing would make sense.

Dr. Jones: Right. But at sometimes we use it for moms who came in addicted to drugs, but changed their behaviors for themselves and for their babies and were completely clean for their pregnancy and it makes a big deal for them and the way the social services look at their mom if the moms cord is clean, the baby's cord is clean.

Dr. McMillin: Absolutely, absolutely. A cord that is negative for drugs or drug metabolites does not definitively say that mom abstained from drugs during pregnancy because, of course, no drug test is perfect and no drug test can pick up everything. But for the most part, yes, it's a way for moms to help validate that they did change their behavior and did what they thought was best for their child.

Dr. Jones: Right. So, in terms of the sample, does it reflect what happened in the last 12 hours or 72 hours? How long does the toxin, does the opioid, or whatever drug might be stay in the cord that you might be testing?

Dr. McMillin: The actual detection limits vary a little bit based on the stability of the drug at physiological temperatures.

Dr. Jones: Well, that sounds like lab speak but I get it.

Dr. McMillin: Okay. So, yes. At physiological temperatures, which are warm. . .

Dr. Jones: Well, thank you.

Dr. McMillin: Some drugs don't stick around very long and breakdown, and so some drugs are hard to detect after a period of time when they're incubated, basically, by the mom and the baby. But research has been done thus far suggests that the umbilical cord tissue can detect drugs that are used during approximately the last trimester of a full-term birth. We can also pick up drugs that are administered during labor and delivery sometimes and that's because of contamination of the cord with mom's blood, but sometimes that's informative as well.

Dr. Jones: Right, and unless we have records of that?

Dr. McMillin: Yes.

Dr. Jones: So you know or you can ask the record . . .

Dr. McMillin: That's correct.

Dr. Jones: That the mom got during labor. Well, this is all important for us to take care of babies and to take care of moms. I think when babies are born and suffering symptoms that look like drug withdrawal, we need to have the tools to provide the best specific care for the newborn, and ARUP laboratories have given us new tools to help the babies and we'll try to create a better world for moms. And thanks for joining us and thank you, Gwen, for joining us on The Scope.

Dr. McMillin: Thank you for the opportunity.

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Dr. Gellner: As pediatricians, we often hear old wives' tales about cranky babies with feeding issues. What's behind these myths and what is sound advice? I'll tackle those on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do when raising your kids? Find out if it's true or not. This is "Debunking Old Wives' Tales" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: "Babies who are cranky and don't sleep usually have gas, and the only way to get some relief is to change the formula." No! That can cause more issues. See, gas gets a bad rep. Many people think it's an evil condition that causes pain and misery, but the truth is, everyone produces gas in their large intestine because that's how bacteria processes what we eat. It's part of the digestive process, and if your baby is healthy, gaining weight, and pooping well, don't worry. It can cause some pain, but it shouldn't interfere with sleep issues.

Crying babies increase the air they swallow, and so they have more gas, and crying increases the passage of gas by forcefully contracting the abdominal muscles. So, unless your baby has a true allergy or intolerance to a component of the formula and needs a special formula, don't play the formula-changing game. Changing formulas too often can actually cause more digestive issues than they can help with.

Number two, "Colicky babies are very hungry and you've got to feed them more." Actually, feeding them more can make the problem worse. Overfeeding is not good. Many parents think that every time a baby cries, it must be from hunger, and that's just not true.

Feeding your baby may reduce the crying, but only for a short time before the whole colic cycle begins again. Then, these hungry babies are too full, and then they end up spitting up, and gaining weight too fast, and they may be fussy because they're overeating and bloated. Remember how you felt the last time you ate more than you should have? Full, overstuffed, uncomfortable and miserable.

Feeding a colicky baby less, like every three to four hours, rather than every one to two, will give them time for their stomachs to empty and their feedings to be digested. Everyone will feel much better.

So, if your baby is otherwise growing well, you really don't need to worry about their crying or their gas. If there are other feeding concerns, be sure to talk to your child's pediatrician about them and see if further investigation into these digestive issues is warranted.

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Dr. Miller: Ultrasound guided procedures in orthopedics. We're going to talk about that next on The Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here with Dr. Daniel Cushman and he's a nonoperative sports medicine physician using ultrasound guided techniques to deliver therapy to patients. Daniel, can you tell me a little bit about how ultrasound made its way into sports medicine? I mean, I think most people are aware that ultrasound is used to look at little babies in utero and to diagnose other things, but this is kind of new in sports medicine, kind of interesting and cool.

Dr. Cushman: Definitely.

Dr. Miller: Tell me a little bit about that.

Dr. Cushman: The most common joke I hear when I'm ultrasounding a patient is they say, "Is that a boy?" And I think that's what everybody knows ultrasound from is it's from babies.

Dr. Miller: You haven't found any head?

Dr. Cushman: No, fortunately not yet.

Dr. Miller: Okay, they haven't asked you just check out the probe over the area where the baby might be.

Dr. Cushman: I had a pregnant woman do that and it's kind of fun actually. But originally, the thought was you do an x-ray, you get radiation. You do a CT scan, you get radiation. But a lot of the time with ultrasound, we get the same amount of information without having to do radiation.

The other advantage that we found nowadays is that you can actually have somebody move while you're doing it. So if you're doing an x-ray, the person is standing still. If you're doing an ultrasound, you could have them move their shoulder and actually see if something is pinching up on something else or something like that. So that's kind of where it came from and it's really developed a lot over the last ten years especially.

Dr. Miller: So expand on that a little bit. The great news is that when you use ultrasound, when does the patient doesn't receive radiation nor does anyone else using the probe, what is ultrasound? Is it a sound wave?

Dr. Cushman: Yeah, good question. That's it exactly, it's a sound wave. I think about it like putting a speaker on your hand. If you think about doing that you can kind of feel those vibrations and those vibrations are what you get with an ultrasound but they're so small you don't feel them. So the machine can send out sound waves and then pick them back up. Based off of that, it can tell how tissues are looking like underneath the skin.

Dr. Miller: How long ago did the ultrasound make an appearance in the use of musculoskeletal?

Dr. Cushman: Yeah, I think it was originally in the '50s is when ultrasound was originally made and that was one of the original thoughts is that you could use it for something like this, but it never really caught on until probably the last 20 years or so is when it's really caught on.

Dr. Miller: How many doctors now are able to do this?

Dr. Cushman: So it's getting more and more common. There are two areas that it's used probably the most commonly. The rheumatologist use it a lot looking at joints and then additionally, the orthopedics specialist like myself tend to use it a lot for these sorts of things.

Dr. Miller: Now for this little podcast, I wanted to talk a bit about how you use ultrasound to deliver medication or therapy into areas that you're interested in treating.

Dr. Cushman: We do that very commonly and there are a couple of advantages we find. Number one is kind of the way we're taught in medical school is to take a needle and put it into the area based off of landmarks on the body.

Dr. Miller: That's what I used to do in injecting the shoulders, and I don't do that anymore because people like you have an ultrasound probe and do it probably a lot better than I ever did.

Dr. Cushman: Yeah, and there's been a lot of studies on this and in some places, it honestly doesn't matter. You can do for example, the knee, somewhere around 93% accurate if you just do it by landmarks. If you do it with the ultrasound, it's closer to 100%. So most of the time, you really don't need to. But in some places like the hip where only about 40% accurate, if we just put a needle down to the hip, while it's 100% accurate with an ultrasound machine.

Dr. Miller: How about shoulders?

Dr. Cushman: Shoulders, so if we're talking about the shoulder joint, it's probably in somewhere in the range of 80% accuracy without it. So a lot of the times, we'll have doctors who have done the injection and they're just not 100% sure it was in the right spot and the person didn't get better. So they will do an injection with ultrasound to make sure it's in the right spot and see if that's really helping.

Dr. Miller: How about spine? I know that some people with back pain ultimately get injections to try to get by the need for surgery. Do you use ultrasound in delivering injections into the spine?

Dr. Cushman: So for the spine, that's still what I would call in the experimental phase. So there are some people who do it, but for the most part, we still rely on x-rays to do those.

Dr. Miller: So for folks who might need some type of injection and I guess typically, you're injecting medications to reduce pain or inflammation, what would be the reason for them to seek out someone with your skills?

Dr. Cushman: I find that a lot of the times, it's more of the doctors they work with are the ones who kind of send them over to us to help out with that. But a lot of the times, I find that just from my own patients, when I see them I use these a lot of the times to help diagnose the problem. So a good example would be if somebody's shoulder hurt. Sometimes that pain is coming from their neck, not from their shoulder. So when we do an injection and it doesn't help, we know we were in the right spot so it really could be coming from somewhere else.

Dr. Miller: So it helps with diagnoses as well?

Dr. Cushman: Yeah, exactly.

Dr. Miller: So the bottom line is, if you're interested in having one of your joint pains evaluated, you could have this done under ultrasound guidance. If there's therapy that's needed, it could be injected via an ultrasound guided

Dr. Cushman: Definitely.

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Dr. Gellner: Babies: the reason they cry and how to help manage their crying. I've got the support you need on today's Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: Let's be honest, new babies cry a lot. It's a good thing they're really cute because sometimes they cry to the point you want to cry along with them. There are a few main reasons why they cry. First, their digestive system is still maturing. It wasn't getting used in the womb and now their bodies have to learn how to process breast milk or formula. The muscle where the esophagus and the stomach meet is really weak, and sometimes what they eat doesn't know it's only supposed to go one way. This can be irritating to some babies.

We advise parents to do reflux precautions, which are feeding smaller amounts more frequently, keeping baby propped up for at least 30 minutes after a feeding, and don't feed the baby when they're lying flat. And while this often helps babies, if your child is really uncomfortable during feeds or after feeds, and they're losing weight because they're spitting up so much, or they stop breathing during feeds, you need to talk to your baby's pediatrician about more severe reflux issues.

Next, babies get gas a lot. Parents are always telling me that their baby can clear a room and are way too gassy. Well, the main reason for that is babies swallow air when they cry. They swallow air when they eat. They're trying to coordinate this whole suck, swallow and breathe at the same time thing. Gas drops can only do so much. To help your baby not be so gassy, make sure they take frequent burp breaks while feeding. Make sure they have a good seal on the bottle or breast when they eat. And if they're on formula, they may need to try a formula that has the milk protein broken down for some babies that have gas. If they're nursing, moms need to remember if a certain food gives you gas, it will give your babies gas and adjust your diet accordingly.

Finally, some babies are just naturally more sensitive. They may or may not have true colic. What doesn't bother one baby may turn another into a screaming banshee. Babies are all trying to figure out their new environment. There are new noises and lights and uncomfortable soiled diapers to deal with.

While you can't change your baby's temperament, soothing your baby before they get overwhelmed can help. Figure out what works best for your baby. Some like to be snuggled, some like to be swaddled, some like a swing, some like a pacifier, some like white noise. Every baby is different and it can take a while to figure out what your baby likes.

Trust me, I had a colicky baby and it made me feel frustrated. Here I am, a pediatrician and I can't stop my own baby from crying. He's much older now and completely fine. We've all survived. Regardless of the reason, the most important thing to remember is babies can cry, a lot, and it's usually okay. This is the time when most of the cases of shaken baby occur because it's really hard to deal with a crying baby. So remember put your baby in a safe place and take a time out. Get help when you are overwhelmed and always be sure to talk to your pediatrician if you are at your wit's end.

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Dr. Gellner: What's in your child's diaper? We'll discuss old wives' tales about baby and toddler poop today on The Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: Parents seem to be obsessed with their child's poop from the day their babies are born. Some of the most common concerns we get as pediatricians involve young kids and their bowel habits. The top three old wives' tales that we get questioned about include:

Number one, if my child doesn't poop at least once a day, something is terribly wrong.

Probably not. Babies have to have at least one bowel movement in the first 48 hours of life or they can't get sent home from the nursery. That's when to worry.

Breastfed babies can poop as often as every time they eat, or as little as once a week with a huge blowout, and lots of laundry for you.

Formula fed babies can poop several times a day to once every four days. Number two, my baby is constipated because they scream and turn red whenever they poop.

So there's something called dyschezia that most babies have. It's apparently painful pooping, but your child isn't really in pain, They're pushing, and grunting, and crying to increase pressure in their bellies to squeeze the poop out past the rectal sphincter, that's the muscle that controls poop flow. And unless the poops are rock hard, your child doesn't have true constipation.

Number three, my child's poop is green, or blue, or purple, or orange, is there something wrong with their digestion?

Unlikely. Chances are they ate something with natural or artificial coloring. Red foods can cause reddish or orange poop, purple can cause red or blue poop, green or blue can cause blue poop, iron in the formula can cause greenish poops. Quite honestly, the only colors we really worry about are pure white with the consistency of powdered chalk, very black like tar, and very stinky, and your child is more than a few days old, or if they have actual blood on the surface or mixed into their poops. We need to know about those right away.

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Dr. Gellner: Feeding your baby step by step, that's what we'll talk about today on Dr. Cindy Gellner, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists that you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: We talk about feeding your baby at pretty much ever single visit that you come to with your pediatrician. Quite often we'll talk about the different things that you should be feeding your baby depending on their age. For babies who are 0 to 4 months old, breastfeeding on demand or formula feeding if you're not able to or not wanting to breastfeed, is all that your baby needs. Your baby should not have any solid foods before 4 months old. Their digestive system isn't quite ready for it. Make sure that you're not trying to over feed your child. As long as your child is having six wet diapers or more a day, your baby is getting enough fluids.

Most babies who are between 0 and 1 month old will have about 2 to 4 ounces in their bottle. Usually 2 closer to the first two weeks of life and then they can advance to 4 ounces. Between 1 and 4 months your baby could have anywhere between 3 and 6 or 7 ounces. You want to make sure that your baby is letting you know when they've had enough. When they start not showing as much interest in the bottle or the breast or they're sort of pushing it away, then they're done. Babies will let you know when they're done. Don't make them finish the formula bottle if they don't want to. If you're nursing and the baby is done nursing but you still feel full, go ahead and pump that extra breast milk and store so you can have it later on.

For babies that are 4 to 6 months old, we still recommend for babies who are breastfeeding to just have the breast milk until about 6 months old. If they're formula feeding, sometimes we go ahead and say, you can have baby foods. For babies, we usually say to do rice cereal as one of the first foods. Rice cereal will actually add an iron source to the diet of a breast fed baby. It's important for those. Babies who are formula fed and have rice cereal, that's sometimes, since they both have an iron in them, causes a little bit of constipation. You can back off on the rice cereal for formula fed babies if it's a problem.

For babies who are 4 to 6 months old, we recommend one of the Stage 1 baby foods per day. We want to make sure that you know not to put the baby's cereal or foods in the bottles. They need to be fed on the spoon. We don't recommend putting rice cereals in the bottles to make babies sleep more anymore because it actually was shown not to be a big factor. For babies who are 6 to 9 months old, we recommend doing the Stage 2 foods. They can have two jars a day. Continue to give breast milk and formula but you will notice that your child's liquid content will decrease as their solid intake increases.

When babies start to turn 9 months old, then you'll start introducing table foods. You can have the Stage 3 foods as well three times a day, or you can start giving the table foods. The big thing with the table foods is you want to make sure they are not choking hazard size. You want to make sure that the fruits and vegetables are strained or mashed. If they're having meat, then they're tiny, tiny, tiny pieces of meat or that they're strained chicken or beef or beans. Never give hotdogs to a baby under a year old. Actually you should give hotdogs to anyone that is not able to chew their food really well because that is one of the biggest choking hazards.

As far as sippy cups, most people will try to introduce a sippy cup with breast milk or formula in it around 9 months old. Babies also will take water from a sippy cup but you want to make sure not to have them take too much water. They should only have about 4 ounces of water a day. More than that, and they're going to slow down on all the other things that have more nutritive value.

When your baby gets to be about 8 months old, you want to make sure that they're sitting in a highchair as well, because then they're going to get used to sitting at the table with you. As far as little snacks, those are really good for sitters, so 8 months and up. Make sure that they're the dissolvable kinds, like the puffs, things like that, things that babies can learn how to pick up that helps with their fine motor skills and start feeding themselves little finger foods. But they're not choking hazards as much as crackers and things. You also still want to make sure that you're by your baby at all times whenever you're giving any sort of food.

Babies can also start having yogurt and cheese at about 9 months old as well to start advancing their diet. You do not want babies to have whole milk until they are 12 months old. Continue the formula or breast milk until their first birthday. After they turn 1, you'll want whole milk until they're 2, so that they can have the fat content in the milk for brain development.

Things that you should not give to a baby under the age of 1, anything that's really acidic. That's going to hurt their stomachs, so like orange juice, things like that a lot of babies find they can't handle very well, and honey. Honey can cause a serious disease called botulism in children that are less than 1 year old.

As your child comes in for their well visits as a baby, when it's time for a vaccines and seeing how their growing and everything, they are due to adding. Your pediatrician should talk to you about the types of foods you can add to your child's diet at that time. If you have any questions, feel free to ask your pediatrician. We're always there to help.

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