Let’s really go back to the very beginning and review some basics of baby formula preparation. Of course, we pediatricians still advise that the best infant nutrition is breastfeeding, but at some point most babies’ diets will likely include some formula. The AAP recommends the following:
- Prepare the formula according to the manufacturer’s directions ONLY. DO NOT dilute the formula (to save money) or concentrate it (to increase calorie concentration). Both can cause diarrhea at least and sometimes disruption of blood electrolyte levels like sodium and potassium which can lead to severe problems with normal nerve or heart function.
- Make sure the water source is safe. If your home has well water, it’s best to boil the water for 1 minute (“rolling boil”) and then allow 30 minutes to cool before mixing your formula.
- Be careful to maintain proper formula temperature. Use a bottle warmer or place the bottle in a container of hot water for 5-10 minutes. It is best not to microwave the bottle. Microwaving can heat the insides of any container in an uneven fashion which can cause burns, and also it can disrupt the nutritional value of some formula ingredients. At any rate, its best to always check the formula temperature on yourself prior to giving it to the baby.
- “Cleanliness is next to Gdliness.” Always wash your hands prior to preparing or feeding your baby. Wash all countertops and surfaces carefully. A dishwasher will not clean the inside of a long, thin bottle very well, so wash by hand using a bottle brush for the inside. Bottles and nipples should all be cleaned with hot, soapy water and be sure to rinse all soap off thoroughly. By the way, best to boil nipples for approximately 10 minutes prior to using for the first time. This is not for cleanliness as much as to boil off residue of chemicals used to soften the rubber.
- Be aware of proper storage times. All leftover formula should be discarded 1 hour after feeding to the baby. Powder based preparations can be refrigerated for 24 hours; bottles of unused concentrate can be refrigerated for 48 hours prior to usage.
As stated initially, breastfeeding is still best and what I and all pediatricians recommend as the first line nutritional source for your baby’s best health. This seems like a good place for me to give a shout out to Dr. Rose St. Fleur and my colleagues at the Center for Breastfeeding at Jersey Shore Medical Center. They can be reached at 732-776-3329 and are an excellent resource/clearinghouse for questions from nursing mothers. Tell them Dr. G sent you (they won’t care).
Even though you try as hard as possible to keep your child safe while they are playing sports, accidents still happen. At these moments, it’s important that you know whether these are injuries that can easily be treated from the comfort of your own home or whether you need to turn to a pediatrician for proper medical attention.
Pediatricians have seen a lot of sports-related injuries over the years and while we also focus as much of our attention on prevention, we know the importance of being able to get immediate and comprehensive care when your child does sustain an injury.
Common sports-related injuries include:
- Dislocations (particularly in the shoulder)
- Traumatic injuries (this includes cuts, sprains and strains, and broken bones)
- Stress fractures
- Tendinitis (often in the hand or wrist)
When a dislocation happens many times it is accompanied by an audible popping sound at the moment that the injury occurred. This unnerving sound is often followed by sudden and intense pain. It’s important that you turn to a pediatrician who can put the shoulder or any other area of the body back in place. The joints of a child’s body are looser than adults, so it makes shoulders and other areas more prone to dislocations.
Minor cuts, sprains, and strains can often be handled with at-home care. In most cases, the RICE method is a great way to ensure that your child gets the rest they need to heal properly and to stay off of the injury until it fully heals. Icing and elevating the injured area can also reduce pain and swelling. Of course, if you suspect that your child has a broken bone, this will need to be evaluated by a medical professional right away.
Children who are serious or long-term athletes are more likely to experience overuse injuries. These injuries occur over time rather than suddenly and they are often the result of performing repetitive movements. Overuse injuries include stress fractures and tendinitis. If your child feels pain whenever they move a certain area of the body or if they notice pain or swelling in a certain area it’s important that they get checked out.
Wearing a helmet is crucial for protecting your child’s head while playing sports. Of course, if your child has received a blow to the head and is experiencing dizziness, fatigue, frequent or severe headaches or just seems out of sorts it’s crucial that you bring them in right away to see if they’ve incurred a concussion.
When in doubt, pick up the phone and talk to a pediatrician about your child’s injuries and symptoms. They will be able to determine whether or not they should come in for proper care.
Your child is eager to start the school year so they can participate in sports. That’s great news! Keeping your child active is an important part of a healthy lifestyle and sports can be a great experience for many children; however, it’s also important that your child’s pediatrician performs a yearly sports physical to make sure that they are ready for physical activity.
A sports physical is necessary for every child regardless of their current health. In fact, some schools make it mandatory for children to get an annual sports physical before they participate in any school sports. Regardless of whether this physical is mandatory or not, it’s highly advised that all children get a sports physical once a year.
Your child’s sports physical will involve going through their medical history and conducting a physical examination. The physical examination is pretty self-explanatory. We will check their vitals, as well as their height and weight. We will perform a vision test and evaluate everything from their heart and respiratory system to their musculoskeletal system. The goal of a physical exam is to make sure that your child hasn’t incurred any past injuries or developed any health problems that could be exacerbated by physical activity.
A pediatrician can also answer questions and provide counseling on nutrition, healthy weight loss or gain, and habits that could help your child’s physical health. Remember to bring any questions along with you.
Besides the physical examination, we will also sit down with you and your child and ask questions about their medical history. It’s important to be as detailed as possible. If it’s the first time they are having a sports physical it’s important to bring in a list of any supplements or medications (both over-the-counter or prescription) that they are currently taking.
We will ask a series of questions to find out if there are any serious or chronic health problems that run in the family, if your child has experienced any past injuries, if they’ve ever undergone surgery or been hospitalized, if they have any allergies or if they have any current disorders or illnesses. It’s important to provide as much detailed history as possible so that our pediatric team can perform a thorough and comprehensive physical.
Don’t wait until the last minute to schedule your child’s sports physical. It’s important to get your child on the books before the summer is gone and the doctor’s schedule fills up. You don’t want your child being benched during the season because they didn’t get a sports physical. Call your pediatrician today.
OK, I may make some enemies in our community with what I am about to say, but here goes. There is a growing consensus among health professionals who care for children–including pediatricians like me, neurologists, radiologists, and others–that organized tackle football should be avoided in younger players. Children have larger heads and weaker neck muscles compared to adults, making collisions riskier. Moreover, younger, less experienced players more often utilize poorer tackling technique which also raises the risk threshold. While hard shell helmets do limit skull fractures, the evidence regarding concussion prevention is actually quite poor.
Of course, at these younger ages the brain is still developing. Researchers at Wake Forest Medical School recently followed children 8-13 yrs during football season with MRI scans. None of the boys had developed concussion symptoms during the study period, yet their scans showed subtle but clear disruptions of normal brain metabolism from pre to post season. Related studies done at Boston University Medical School looked at former NFL players and found that those who had started in the sport < 12 years old had a significantly higher incidence of “white matter” brain changes and more frequent difficulties with depression, cognitive impairment and behavioral problems in later life. There are additional studies reporting similar patterns in people playing other contact sports from an early age compared to those who did not.
So where does that leave us? Well, I am certainly NOT “anti-football”(well, maybe anti-NE Patriots, but anyway…). > 1 million boys play high school football. As I spend a good part of my time begging/yelling at my teen patients to get off their darn phones and to be more active, I strongly support this and all high school sports. Presently there are approximately 1.2 million US 9-12 year olds playing youth football (numbers have decreased in the last few years because of these concerns) and those kids sustain approximately 240-585 head hits each season. Note that youth football is a relatively recent phenomenon–when I was growing up in the 1960’s-70’s it hardly existed. Back then, tackle football was something we played on weekends in the park if we could collect enough guys to make 2 teams. There were no non-HS football “leagues”–tackle or otherwise– to speak of.
We need a new paradigm, and I believe this is where flag football comes in. The nonpartisan Aspen Institute recently issued a White Paper advocating for flag only < 14 years. Here in NJ, Assemblywoman Valerie Vainieri-Huttle (D-Bergen) has introduced a bill (A-3760) that would allow flag football but ban tackle statewide < 12 yrs. Given the above, the arguments against–that teaching younger boys proper tackling technique improves safety–are, at best, unconvincing. I believe this bill deserves serious consideration; personally (and professionally) I support it.
Don’t all yell at me at once– but send along questions and comments, and thanks for following.
No two children are ever the same and while you certainly want to let your child discover their unique personality it is important to know when these differences in your little one might mean that it’s time to schedule a behavioral or development consultation with a pediatrician.
Whether you’ve noticed that your child has difficulty making friends, doesn’t have any interests or seems to throw more temper tantrums then other kids their age, it’s important to not only be able to pinpoint these differences but also find out what might be causing them. This is where a behavioral or developmental consultation could benefit both your child and your family.
When you hear the words “behavioral consultation” it sounds pretty disconcerting; however, there are many reasons why parents bring their children in for these visits. Perhaps your preschooler hasn’t started talking yet, or your child has difficulties interacting socially with other children. Maybe their academics are falling behind or they aren’t able to keep up with the challenges of school. When scenarios like this arise a behavioral consultation is the best way to be able to figure out what might be going on and what our pediatric team can do to help get your child back on track.
While some of these situations may be due to behavioral disorders, it is also possible that there are certain developmental delays that could also be responsible for these behaviors. There are developmental milestones that every child must reach physically and mentally. No matter whether your child is displaying signs of an autism spectrum disorder or ADHD, or is having difficulties with social situations, sleep, anxiety, aggression or impulsivity, it is important that they visit a children’s doctor for an evaluation.
Whatever concerns you might have about your little one, it’s important that you turn to a pediatrician that you can trust to perform a thorough behavioral consultation while also providing compassionate care and support. It’s essential that your child has everything they need to be successful in their personal, academic and social life and by assessing, diagnosing and treating any behavioral or developmental disorders early, we can provide your child with the treatment they need to lead a healthy and happy life.
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