Dr. Annie Answers: A Parent’s Intuition

Many of the things that people have said they appreciate about me as a doctor are the direct result of advice from one of my best mentors. One thing – trusting a parent’s intuition – has literally saved the lives of multiple patients of mine, and now hopefully, also that of my nephew. He’s in the womb below, while I was also preggers with baby #2.

As a resident, I remember feeling so lost in the beginning about offering advice on things like breastfeeding or colicky babies or a kid with a weird rash. I had been around lots of kids, sure, but I had never been pregnant, had never tried to breastfed a baby, or to get a fussy toddler to take medicine.

I, for sure, gave some asinine advice in those early days and more than once had patients laugh in my face (sorry pregnant patient who I tried to tell to work on her core strength for third trimester back pain!!). What Dr. Pippitt told me was, “Of course you don’t know their kid better than they do, but you do know medicine better than most of them.” Her advice now seems so obvious – let parents be the experts on their own kids. This applies to people being the expert on their own bodies also, but I’ve found we misinterpret ourselves more than parents do their kids…. so paying attention to what parents think is even more important IMHO.

Since then, I, of course, have become a mom twice over. I know tons more practical advice and can be quite a bit more helpful in treatment strategies. But! I still know that every parent is the expert on their own kid. My bottom line advice for when to have something checked out, followed up on, checked out again is always “if you, as the parent, are still worried or feel something’s not right”.

The validity of this was recently driven home in a tragic way. My sister, back in March, called me on FaceTime to show me a lump on her 3 year old kid’s neck. I took one look at it and thought, “that’s not normal”. My sister and her wife agreed and took him in to their pediatrician right away. The doc told them it was nothing to worry about. But… they were still worried when it didn’t go away. They saw ENT who also said it was nothing. But… they were still worried. Finally at 2 month follow up, it was bigger, not smaller. A few weeks later an MRI and biopsy had confirmed it was Hodgkin Lymphoma, an extremely rare, but very treatable diagnosis in someone his age.

Their intuition was right on, and had they not followed up despite being told it was nothing, it could have been caught at a later and more dangerous stage.

So, the next time you find yourself with that, “something’s not right” feeling, go ahead and get checked. This goes for your own body too, of course. Make sure the provider you see is able to make you feel confident that your fear can be ruled out before you go. This doesn’t mean they will do every test imaginable every time – sometimes we can take a look at something and tell you with high level of certainty, “you don’t need to worry”. We did go to school for a long time to learn that medical side of things, after all. But, if your care provider doesn’t listen to or respect your knowledge about your own kid or your own body, find a new one.

Dr. Annie is a married mother of 2, aunt of dozens of other amazing kids and family doctor in the Sacramento Area.

Ps. If you want to support my sister & her family, you can find them on Caringbridge.com under starlinglynnalesker

Dr. Annie Answers: Kid Vitamin Basics

Mother’s Day is this weekend which has me thinking about all the things moms have to worry about… one of the most common being the nutrition and health of our precious little ones. Almost every day at my clinic, I get some sort of question about vitamins – What’s safe? What’s necessary? Where do I get good ones? The answer, of course, varies by your particular health needs and should be discussed with your own medical provider. A few things are pretty generalizable though and I’ll delve into them here by age. This post is about kiddos – coming up next will be an adult version, so make sure you FOLLOW US to get that update!

Breastfed Babies, Birth through 12 months: 400 units Vitamin DScreen Shot 2018-03-09 at 2.08.17 PM

Vitamin D is needed for all babies who are breastfed half or more of their milk intake. I nearly always recommend Baby Ddrops for those who can afford the $10/month averaged cost. These are concentrated drops so, instead of getting your tiny baby to choke down a whole milliliter of vitamin D like the generic ones at the pharmacy, you only have to put 1 drop on your clean finger and put on baby’s tongue before a feeding. If your baby is formula fed, no vitamins needed, they’re already in there – see below for details.

Breastfed Babies, 4 months through 12 months: Add 6-11mg Iron

Iron is recommended for breast-fed babies after the first 3 months of life. Mom’s iron from the womb keeps them going up until that 4 month mark.

Sidenote…. One of the potential benefits of delayed cord clamping at birth is increasing baby’s iron stores for that first 3-4 month period (great review on this by Dr. Raju et al here.) . This is, of course, an important thing to discuss with your own pregnancy care provider, but worth considering for this and other benefits if there is no reason not to do it.

From ~4 months through the rest of the first year, baby will start eating more and more ‘real’ foods which can supply some iron, but usually not enough. The recommended amount by the American Academy of Pediatrics for babies 7-12 months is 11mg per day. For reference, you’d have to get your baby to eat 2 cups of cooked spinach to get that much – not gonna happen.

Option 1: at this age, stop Vitamin D supplement and change to multivitamin. Poly-vi-sol with iron is the go-to recommendation for most health care providers. However, my daughters both projectile vomited it, so we had to use alternatives. Other options are Zarbees Baby Multivitamin with Iron  and Honest Company makes an easy-to-give vitamin powder: Link herepexels-photo-533360.jpeg

Option 2: continue with Ddrops and give iron-only supplement like this one or give a serving of iron-enriched cereal daily. I personally, along with a growing number of pediatric care providers, recommend the former along with introducing iron-rich foods such as pureed meats, dark leafy vegetables, beets and beans before cereals as part of a healthier early diet. Baby cereals don’t otherwise have much in the way of nutrition or “taste education” for that little one. (References here in AAP News and here from NIH)

Formula-fed Babies up to 1 year

Breast-milk is best for moms and babies that can do it in all aspects except these 2 vitamins. Formula comes conveniently stocked with both Vitamin D and Iron so you don’t have to worry about the supplements. Certainly not a reason to choose it over breastmilk, but a nice side-benefit if it ends up being the right option for you. I usually recommend Baby’s Only Organic Formula or Plum Organics Grow Well Formula. Screen Shot 2018-05-07 at 5.58.09 PMThey are well tolerated (review here), have the right amount of all important nutrients and both come out to roughly $1/ounce (compare to Similac Advance Non-GMO at $1.25/ounce). They are also organic and free of corn syrup solids and chemical additives – which, when you’re talking about the ENTIRE nutrition of your tiny rapidly growing baby is important. AND!! You can get them both on auto-ship from Amazon so no leaving the house – bonus!

After 1 year: Vitamin D 400-1000 Units Daily +/- others…pexels-photo-61129.jpeg

This now depends on how picky of an eater your kid has become. If you have that amazing, adventurous eater who loves a variety of meats, fruits, and vegetables and drinks 2+ cups of milk per day, multivitamins are unnecessary. If your child doesn’t get 400-1000 units Vitamin D from fortified milk and other foods, they will need a vitamin D supplement again. Why? What about kids before the advent of vitamins?? Well, kids were outside ALL DAY without sunscreen back then. We now know better and protect their skin – the downside of which is low vitamin D.

If you do have a picky eater  – even if you’re not sure how picky is picky – a multivitamin can fill in the gaps. Again, the above mentioned Zarbee’s and Honest options are great as is Renzo’s Picky Eater Multi. If they’re getting extra of some of those vitamins, they will pee them out.

Hang on…. I hear a question coming out of the Ether….

“Dr. Annie, are the examples you listed above the only good options?? What about Flintstone’s vitamins or Olli Chewables?” Of course those aren’t the only vitamin brand options. If you want to check out others, just read the fine print on the label on the back and make sure they have the right amounts of the recommended vitamins.

Wait…. another one coming in…. “What about probiotics??” I’m so glad you asked! YES probiotics are so important from infancy through the rest of life – so important I’m going to write a separate post all about it ;^)

94 Dr. Annie is a family physician, wife and mom of 2 picky eaters In the Sacramento Area.

Dr. Annie Answers: Sunscreen Low Down

Anyone else feel utterly overwhelmed by THIS when you hit the stores lately? The choices are ENDLESS!!

Whether you’re still in flurries or the sun is shining, summer is coming! You all know by now that sunscreen is absolutely critical for you and your fam to prevent deadly skin cancer (if not, what rock have you been living under, seriously??). The huge array of options can be super overwhelming.

I’m going to try to simplify things here. There are 3 rules:

  1. Choose physical over chemical sunscreens.
  2. Choose creams/lotions over sprays.
  3. If your choices are limited, still choose some sunscreen over no sunscreen.

In slightly more detail….

Physical vs Chemical

There are 2 ways to block the sun’s damaging rays. One is physical blocking. This includes simple shade or clothing or reflective minerals that you put on your skin. The two primary ones are Zinc Oxide or Titanium Dioxide. The other way to decrease UV radiation is with chemical sunscreens. These are ingredients like Avobenzone, Oxybenzone, Dioxybenzone. Yes, these block UV rays. However, they have not been studied well in humans and in animal models, can be absorbed through the skin – aka, get into the bloodstream and cause problems with endocrine function (thyroid regulation, hormone regulation, blood sugar regulation). Gross.

There is an awesome guide for brand-to-brand ratings here EWG’s Guide to Sunscreens. Our family’s go-to’s are:

Screen Shot 2018-04-10 at 10.10.07 AMBare Republic Mineral Sunscreen

Easy to find at Target and Amazon, goes on nicely, badass bottle (I’m a sucker for good marketing). Sport and Baby versions available. Stick version convenient for little faces.

 

 

Screen Shot 2018-04-10 at 10.12.15 AMCalifornia Baby Super Sensitive Sunscreen

No, I don’t just love this because it says “California Baby” (ok maybe a little), it’s also ultra-sensitive for the rashiest kids. Again, stick version available.

 

 

 

Screen Shot 2018-04-10 at 10.18.57 AM

Blue Lizard Australian Sunscreen because you know the Aussie’s got the sunscreen game DOWN. This goes on easily – not just for babies ;^)

 

Arbonne Baby Care Mineral Sunscreen Screen Shot 2018-04-10 at 10.49.35 AM

 

 

 

 

Arbonne is sold directly through independent providers – I get my goods from my awesome niece (she’s an adult, we have a crazy big family) Megan Fikes

 

 

 

Screen Shot 2018-04-10 at 10.13.57 AM

Elta MD UV Clear Tinted This is the only sunscreen that has EVER not made my face allergic, and with slightly tinted look, is flattering and not white. I wear this every. single. day.

 

 

 

 

 

I can hear you now:  But lotion is so hard to get on a whining, wiggling kiddddd!!! 

Strategy: Before you even get dressed to go wherever fun, sunny place you’re going, apply to your naked child. This way you have a “base layer” in case of wedgies or – if your kids are like mine – unexplained nakedness. Then, just touch up when the clothes come off. Reapply (of course) every 2 hours or when they get out of a body of water and defrost/dry off for a bit.

Spray vs Lotion

When you, as an adult, put on that super-convenient aerosol-spray clear chemical sunscreen, have you ever gotten a *little* of the spray up your nose at the end? And you know how to hold your breath well. Game over for kids – they’re for sure getting it in their nose, eyes, mouth… lungs, stomach. I’m a laid-back parent about dirt, mess, hair dye, the occasional junk-food treat. But chemicals being inhaled and swallowed?? nope.

That being said… there are times and particular children that do require faster application. So IF you must use a spray, top choice is a manual spray bottle with mineral sunscreen, because, the environment. Choice 2 is aerosol mineral sunscreen. Really, just avoid the chemical ones unless it is literally the ONLY way to not have a severely sunburned child.

Kiss My Face SPF 50 SprayAlba Botanical Refreshing Spray Mineral SunscreenBare Republic Spray

Final Rule: Some protection is better than nothing.

Questions come up in clinic all the time about “how old does my baby have to be to wear sunscreen?”. The best, safest sun protection for babies is to keep them in the shade. This goes for all ages, actually.  Avoid the strongest sun, wear hats and loose layers when you can, seek shade.

This is most applicable for babies that are non-mobile. That is the primary reason that the typical recommendation is to start sunscreen when your baby is 6 months old. That is when most babies start to crawl and shade is less reliable. That being said – if you’re gonna be at a sunny farmer’s market with your 4 month old baby in the Ergo, they might pull their perfect sun-protective hat off and yes, you should put a little swipe of safe, mineral sunscreen on their sweet face and hands and toes if they’re exposed.

And if you’re in a pinch, forgot alllll the sunscreen in the bag (maybe because someone left that bag in the entryway when the kids were being loaded into the car…), and the only sunscreen available is some aerosol Coppertone at the gas-station. Yes. Use the sunscreen. Life is all about minimizing risk and doing the best we can.

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Dr. Annie is a married mom of 2, family doctor, amateur blogger and Nerium international independent brand partner. This post is her own opinion, is not sponsored by any products listed and does not replace the personal advice of your own physician.