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Dr. Gellner: There are a lot of old wives' tales out there when it comes to babies and feeding. I'll let you know which ones are true and which ones need to be updated myths 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: It's hard to keep up with changing feeding recommendation sometimes, even for pediatricians. One common myth is that baby should be given rice cereal to help them sleep through the night. Truth is there is no great data to support early introduction of solids before four months old. In fact, studies have found that babies who were started on solids prior to four months old were actually worse sleepers because their stomachs weren't ready to digest food.

The American Academy of Pediatrics recommends delaying introduction of solids to at least four to six months of age, depending on the child. The World Health Organization recommends not starting solids until six months of age if that baby is exclusively breastfeeding. One big reason for this is that babies who are fed solids prior to four months old tend to be more obese by three.

Another myth is that babies need water when it's hot outside. While many parents are concerned that their baby will be dehydrated without water, they often forget that most of the baby's diet is straight liquids or pureed foods. A baby doesn't have fully functioning kidneys, and so extra water can actually cause those electrolytes to become out of balance. This is especially true of sodium. And if a baby's sodium gets too low, it can trigger seizures. Babies can start occasionally sipping water around six months old, but really shouldn't drink water regularly until after age one.

Parents often want to put ice on their baby's gums, too, when the babies are teething. Despite some providers still recommending it, there are better ways to help. There are teething toys that are meant to go in the fridge or the freezer to be cold, and you can put an ice cube in a washcloth and briefly rub it on the baby's gum. Giving babies ice or popsicles can cause something called cold panniculitis, which happens up to three days after they've been sucking on frozen items. It causes redness and swelling in the deep layers of the skin due to inflammation from the cold. Luckily, this clears up on its own in a few weeks.

Another old wives' tale that is even perpetuated by some pediatricians is to start your baby on solids with veggies first to keep them from having a sweet tooth. In 2011, the American Academy of Pediatrics published an update saying there is no evidence that a baby will develop a dislike for veggies if fruits are given first. This is because babies are born with a preference for sweets, and what order you introduce foods to them does not change this.

What about spicy versus bland foods for babies? Americans traditionally start babies off with bland foods and then introduce spicy flavors a bit at a time. But that's not really necessary. Many cultures give their babies spicy foods as soon as they start eating solids. Go with what your family eats. Just be careful about giving too much added sugars or salt.

Finally, is it okay for a mom to nurse a baby if she's tired? Well, let me just say that all new moms are tired. It's exhausting to take care of a new little person, and it's exhausting to make their food. However, if a mom is so tired that she's afraid she will fall asleep and drop the baby or roll over on to the baby if she brings the baby to bed, then that's a concern. If a baby is breastfed, it's best if a mom does something extra to help wake her up so she can safely nurse, or even, if possible, pump extra breast milk so dad can feed the baby and mom can get some extra sleep.

If you have more questions on what is true and what is false about feeding your baby, ask your pediatrician who can help you sort out the facts.

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Dr. Gellner: Puberty is one of those awkward times for teens and parents. So how does one talk to their daughter about a certain monthly change that's going to start around now? I've got some advice for that. I'm Dr. Cindy Gellner 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: Many parents of girls get very apprehensive around the time of puberty. They start pulling out books like "Are you there, God? It's me, Margaret" and secretly stashing feminine protection products for that big day when a girl has their first period.

It can be a challenge to talk to girls about the changes in their body. But if you are honest and open about what is going on, they will be more comfortable with this milestone. Let them know that puberty is the time when a girl's body grows into a woman's body. The physical changes are necessary for a girl to have babies. Puberty may begin as early eight years old or as late as 14 years old. For girls, the start of puberty is officially marked by the first period, which usually happens anywhere from two to two and half years after breast development occurs. The average for a girl's first period to start is 12 years old. Some girls start to get their periods as early as eight or as late as 16. If your child gets their period before age eight or after age 16, you need to talk to your child's pediatrician about that.

Once puberty has begun, the hormones from the brain signal the ovaries to start developing numerous eggs that have been present since birth. After puberty, an egg fully develops and is released from the ovary about once a month. After the period stops, the monthly cycle starts again. And the entire menstrual cycle takes 22 to 35 days. Periods come at the end of this monthly hormonal menstrual cycle and lasts about three to seven days.

There is a whole host of products out there specifically designed for teens to help with protection. A variety of pads and tampons to help absorb the blood that comes out. And though it seems like a lot of blood, it's usually only about two to five tablespoons over the entire period for most girls. Some girls can have heavy periods. Some can have lighter. For the first year or two, a girl's periods are usually irregular. That means they can happen anywhere from twice a month to three times a year. During this time, the body's hormones are not yet fine-tuned so the ovaries may not release an egg once every month.

Periods start coming on a regular schedule once the body starts releasing eggs. Ovulation usually begins one to two years after your daughter's periods start, but it can happen with the first period. Most girl's menstrual cycles become fairly regular as their hormone levels mature and synchronize. If your child has been having periods for less than two years and their physical exam is normal, irregular periods may be part of their normal development. Some women will continue to have irregular cycles as their normal pattern. It's always good for girls to carry an extra tampon or pad in case her period starts unexpectedly.

Some girls have lower abdominal pain and cramping during ovulation or during their period. The pain can be mild or severe. If this happens before a period starts, usually in the middle of the menstrual cycle, the pain is caused by ovulation and usually lasts a short time. It is called mittelschmerz and it feels like a stabbing pain on one side. It's nothing to worry about. Cramps most often happen during a period. They are caused by the hormones that cause the shedding of the lining of the uterus. Some girls have pain for only a day or others, it may last your entire period. Taking ibuprofen or naproxen usually helps.

Remember, your child needs you during this time of transition. Don't make her feel more awkward than she already does. Remind her of the beautiful woman she is becoming.

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Dr. Gellner: Your child's speech development is something your pediatrician checks at toddler and preschool well visits, so how do you know if you should be concerned or not about your late talker? I'm Dr. Cindy Gellner and today we are talking about delayed speech and language development on The Scope.

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

Dr. Gellner: Some kids are early walkers and some are early talkers. Some are late walkers and some are late talkers. Unless a parent observes other areas of slowness during early development, they may be hesitant to seek advice. Knowing what's normal and what's not in speech and language development can help you figure out if you should be concerned or if your child is right on schedule.

So what are developmental normals for speech and language development? Before age 12 months, kids should be watched to see if they are using their voice to relate to their environment. Cooing and babbling are the early stages of speech development. As babies get older, usually around 9 months, they begin to string sounds together, incorporate different tones of speech, and say words like "Momma" and "Dadda" even though, until they are about 12-15 months old, they sometimes don't realize what “Momma" and "Dadda" really are. Before 12 months old, babies should also be attentive to sound and begin to recognize names of common objects like bottle, binky, and especially their name, by 9 months old. Babies who watch intently, but don't react to sound, may be showing signs of hearing loss.

By 12-15 months, kids should have a wide range of speech sounds in their babbling, like the p, b, m, d, or n sounds. They should begin to imitate sounds and words modeled by family members, and typically say one or more words other than just "Momma" and "Dadda." Nouns usually come first, like "baby" and "ball." Other things would be things like "uh-oh" or "wow" or "no," which is a very popular first word.

From 18-24 months, there's a lot of variability. This is when we talk about the language explosion. Most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn two. By age two, kids are starting to combine words together to make two word sentences such as "baby crying" or "come help." A two year old should be able to identify common objects as well. If you point to a picture in a book of an object that they know, like a baby, they should be able to tell you that. They should also be able to point to their facial features when asked, and follow two step commands like "please pick up the toy and give it to me."

From ages two to three, parents also see a huge gain in their speech. Your toddler's vocabulary should increase to too many words to count, and he or she should routinely combine three or more words like "please come here" or "mommy I want." Comprehension should also increase. By three years old, a child should begin to understand what it means to put something on the table or put it under the bed and they should start to be able to identify simple colors and comprehend descriptive concepts such as big versus little.

What is the difference between speech and language? They're often confused but there is a distinction between the two. Speech is the verbal expression of language and it includes articulation, which is the way sounds and words are formed. Language refers to the entire system of expressing and receiving information in a way that's meaningful. That's why sometimes your child may have receptive language skills that are good, they understand what you're saying, but they have expressive language problems, meaning they cannot get the words out that they are trying to say. A child with a language problem may be able to pronounce words well, but unable to put more than two words together. A child's speech may be difficult to understand, but he or she may still use words and phrases to express ideas.

If you're concerned about your child's speech and language development, there are some things to watch for. An infant who isn't responding to a sound or who isn't vocalizing by six to nine months of age is a particular concern. Between 12 and 24 months, other reasons for concern include children who are not using gestures, such as pointing or waving "bye, bye," by 12 months, prefers gestures over making words and vocalization to communicate by 18 months, has trouble imitating sounds by 18 months, and has difficulty understanding simple verbal requests.

If your child is over two years old, you should have your pediatrician evaluate them and refer them for speech therapy and a hearing exam if they can only imitate speech or actions but don't produce words or phrases by themselves, they say only certain words and only those words repeatedly, they cannot follow simple directions, they have an unusual tone to their voice such as sounding very nasally, they're more difficult to understand than expected for their age. And here's an easy way to understand how a child's speech should be understood. At two they should understand half of what their child is saying. At three, they should understand three quarters of what they're saying, and by four they should understand 100% of what a child is saying.

So what can you do to help with your child's speech development and also try to help them if you notice that they have a speech problem? First you can spend a lot of time communicating with child, even during infancy. Talking, singing, and encouraging imitation of sounds and gestures with your child goes a long way.

One of the most researched ways of improving speech and language skills is reading. You should start reading to your child as early as six months old. Start with an age appropriate soft or board books or picture books that you can point out what the pictures are and have your child feel the pictures. You can use books with textures that they can touch and learn the difference between soft or fuzzy or rough. Later let your child point to recognizable pictures and try to name them.

Finally, you can progress to books that are more age appropriate for toddlers, like the Hungry Caterpillar, where kids can actually predict what's going to happen. Dr. Seuss is also wonderful for children to learn speech patterns because of the rhyming that's in there. So your child is also able to start predicting what types of words come next. As your child gets older they will love reading on their own and will have their own favorite stories as well.

You can also use everyday situations to reinforce your child's speech and language. In other words, talk your way through the day. Point out objects around the house. If you're driving, point out the things you see along the road. Keep things simple, but never use baby talk. Always use good pronunciation so your child learns that as well. Whatever your child's age, recognizing and treating problems early is the best approach to help with any speech and language delay.

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Dr. Jones: When should a baby be born? It's sort of a Goldilocks problem isn't it? When is too early? When is too late? And when is just right? This is Dr Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care. Today we are talking about when should babies be born, on The Scope.

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Dr. Jones: So how do you know when an apple is ripe? Just right. By color? By size? By season? Do you pull it off the tree? But if you're wrong you can't put it back. Do you wait till it falls until the tree thinks it's ripe? Well then it might get bruised. So is it the number of days? How do you calculate them? When is too early? When is too late? What about babies? When do we know that the baby is ripe?

Today we're talking with Dr. Erin Clark a perintologist, that's someone who specializes in high risk pregnancy, about when is the baby just right. Welcome to The Scope Dr. Clark.

Dr. Clark: Thanks for having me.

Dr. Jones: So how do we know when a baby is ripe? Is it 40 weeks? Is it nine months exactly? Is it certain amount of days? And how do we get that number?

Dr. Clark: The formal definition of when a woman is due is 40 weeks from the first day of her last menstrual period. We know generally that that's the date because that's around the time when most people spontaneously go into labor. We have great respect for when Mother Nature does it right. Certainly Mother Nature doesn't always get it right and outcomes for moms and babies are not always good. Ten percent of babies in the United States are born too early, but most of the time delivery occurs about that 40 week mark.

Dr. Jones: So when is it too late?

Dr. Clark: It's a complicated question but if we look at outcomes for moms and outcomes for babies, a variety of outcomes. Stillbirth, c-section rate, the ability of a baby to breath and do well after delivery. If we look at all of those outcomes, the lowest risk time, the sweet spot, so to speak, that perfectly right apple seems to happen at 39 weeks give or take a week or so. So between 39 and 40 weeks appears to be the lowest risk time.

There's very good data that suggest if we go before 39 weeks electively, sometimes there's a very good medical reason to do that, but before 39 weeks babies have more difficulties after birth. They can have difficulty regulating their temperature, they can difficulty with eating, they can have difficulty with breathing. We know that in a well dated pregnancy at 39 weeks or beyond, babies do really well.

There is a point though at which pregnancies can go too far and it's a gradual increase in risk that happens after the due date which is at 40 weeks. So again that sweet spot appears to be 39 to 40. In general we try to get women delivered about a week past their due date at the latest because those risks start to climb.

Dr. Jones: So what are those risks?

Dr. Clark: For babies there is a risk of stillbirth that climbs over time. That's the biggest and scariest risk because a baby who has a stillbirth does not survive to have any of the other outcomes. But there's also a high rate of c-section because the placenta while it's miraculously marvelous organ, it has a life span. And after the due date it starts to baby and labor is a stressful process for babies and if that organ is not functioning optimally, we see signs in labor by watching the baby's heart rate that the baby is just not getting the oxygen and nutrients that are necessary and so the c-section rate is higher.

There is also some other risks that are higher for moms. The rate of hemorrhaging associated with delivery, the rate of having a baby that doesn't fit because of size. Those things go up over time too. So when we look at those myriad of complications, all of them are at their lowest risk at that 39 to 40 week mark.

Dr. Jones: But it's not always so easy. So if you decide 39 to 40 is a good number, how do we get the baby out then?

Dr. Clark: Maybe this is the apple and the worm analogy.

Dr. Jones: Okay.

Dr. Clark: There's very good data, 39 to 40 weeks baby is ready to come out beyond 39. But the other question that you're getting at is when is mom ready? Sometimes the two are not in sync. But what has been shown is that if you don't induce labor in a timely fashion after the due date has passed, actually the c-section rate goes up and not down. The cervix is like a fist, before labor starts, it's hard, it's somewhat unyielding and as preparations for labor happens it gets softer.

Dr. Jones: Well that's a good thing because we want to get the baby in for those 40 weeks or 39.

Dr. Clark: Correct. It's appropriately unyielding. But as preparations for labor made it gets soft, it get thinner, it starts to open. These are signs that we like to see as women get ready for labor and even in a patient who has a cervix who's not quite ready, if they're going past their due date especially a week or more, we know that their lowest risk are to induce labor rather than wait.

There's the other question though of when is the earliest that's safe to induce labor without a medical indication? And 39 weeks appears to be the earliest based on what we talked about as far as risk for baby go up if we go any sooner than that. In a woman whose had babies before who has a cervix that is soft and ready for labor and who is known solidly to be at least 39 weeks gestation, induction of labor electively is felt to be a very reasonably medically safe practice.

What is less well known and what we need research is what about the woman who has not had babies before? There's many advocates, experts across the nation who say because of this data that suggest that 39 weeks is that lowest risk spot, maybe that should be a policy. Maybe we should induce everybody between 39 and 40 weeks because we know we would see less stillbirths, we would see less pregnancy complications like preeclampsia. Maybe that's the right approach.

Clearly there's a lot of push back saying Mother Nature, Mother Nature. We should let most of these labors go on until there's an indication to intervene. But it's still a big question, and it won't be answered until we take a group of women who have not had a baby before and randomly assign them to either watchful waiting. Seeing if they go into labor on their own and intervening if there's a medical reason. Or another group of women where when they hit 39 weeks and we say it's time to have a baby and regardless of what your cervix says as far as readiness, we're going to give you the medications that will stimulate labor.

Dr. Jones: So this is study that's ongoing?

Dr. Clark: This is a current study. This is a national multi-site study. In Utah we have several participating sites one of which is The University of Utah, one of which is Intermountain Medical Center in Murray, LDS Hospital in Salt Lake City, Utah Valley Regional Hospital in Provo, and McKay-Dee Hospital in Ogden. We are trying to enroll 6,000 women across the nation for participation in the study.

Dr. Jones: Are ladies anxious to sign up? I am assuming randomization is 50/50.

Dr. Clark: It's 50/50.

Dr. Jones: When they randomized and they get not the arm they wanted, are they doing okay?

Dr. Clark: Yeah, we have two camps of women. One is very much wanting spontaneous labor to happen. They want that story of my water broke in bed one cold winter night. They can tell over and over again to this child forever. They want that natural course. And they're not interested in participating and that is totally fine.

There's another group of women who says for logistical reasons this would be a really nice thing to have a time delivery about a week before my due date and there's some enthusiasm there for participation. Remember this is a group of women who are not eligible otherwise to have an elective induction a week early who, yes, are very interested in participating. The ones who are very much often want to be in that induction of labor arm and there are sometimes tears when they randomize the other way but again it gives them a chance at that earlier intervention whereby they wouldn't otherwise. So for some women it is a very nice option.

Dr. Jones: To round up, it sounds like you want your baby just right and somewhere between 39 and 40 weeks is, we think for babies, just right. Up to 41 is kind of practice now but maybe sooner is better. People, if they're having their first baby and want to contribute and they deliver at those places can sign up and hopefully you'll have a perfect little apple for Thanksgiving.

Dr. Clark: Right. That's the goal.

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Interviewer: Why should you get your flu shot earlier than later? We'll examine that next on The Scope.

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

Interviewer: Dr. Susan Terry is the executive medical director for the community clinics at University of Utah Health Care. The flu shot. It actually starts becoming available usually in September, is that correct?

Dr. Terry: Even late August now.

Interviewer: Late August. So is there an advantage to getting your flu shot sooner than later and as early as August?

Dr. Terry: Yes. There is definitely an advantage. Of course, it takes two weeks to become immune so you want to make sure that you get your flu shot as early as possible so you develop immunity before flu becomes really commonly seen in the community. And that usually happens starting in late October and extending through February or March. We know that you have the best protection from flu vaccine during that period of time if you develop immunity prior to flu being seen in the communities.

Interviewer: Yeah, it's a little too late if you're getting it at the height of the season when most people think about it. "Oh, all my coworkers are sick. Now, maybe I should go get the shot."

Dr. Terry: Or if you say, "I don't want to be sick for Thanksgiving or Christmas and two days before you decide to get your flu shot that's not really going to protect you."

Interviewer: Are there other advantages to getting the flu shot sooner than later?

Dr. Terry: The more people who are immune in the community, the less influenza we see in the community. So we help protect others who are maybe not going to have as good an immune response to their vaccination or who fail to get a vaccination.

Interviewer: And generally those are elderly and kids.

Dr. Terry: Yes, particularly babies less than six months old, pregnant women, and the elderly.

Interviewer: And from what I understand, for the average person, flu shots are 70% effective at preventing the flu that you're vaccinated for but if you're elderly it drops quite a bit.

Dr. Terry: It can drop down quite a bit especially if the elderly have a chronic disease.

Interviewer: Is herd immunity something you like to talk about or not really?

Dr. Terry: Well, we do. We love to see herd immunity. We actually know that the more years you get a flu shot the more years you get a flu shot the better your immune response to influenza is going to be. So if you get a flu shot six or eight or ten years in a row you're going to have better immunity and the community will have better immunity.

Interviewer: Yeah, you have less people spreading that virus around.

Dr. Terry: Right.

Interviewer: Are there advantages to getting your flu shot early?

Dr. Terry: Make sure there are flu shots available. This year we have a great supply. We have about 160 million flu vaccines available in the country so there should be plenty. In some years that's not always the case, so you want to make sure you get in there and get yours.

Interviewer: My wife, her excuse is that she feels that she feels that she is healthy and has a healthy immune system and in those years where there is shortage she wants other people to get them. Is that solid logic or not quite solid logic?

Dr. Terry: It's thoughtful.

Interviewer: I'll tell her that.

Dr. Terry: And it's nice but again, we want as many people to be immune as possible so getting herself immune and protecting her family and other people she comes in contact with is really important.

Interviewer: Especially kids, elderly, pregnant women, that sort of thing.

Dr. Terry: Yes.

Interviewer: All right. Do you have any final thoughts on this subject?

Dr. Terry: Get a flu shot. The other thing you need to do is make sure you keep doing all the other things that we do to prevent infection. Wash your hands, stay away from crowds, don't go to work if you're sick, protect your co-workers that way. I know it's hard to take a day off from work but sometimes you can take one or two days off from work and prevent the whole office from having to take weeks off.

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