Month: January 2020

This is intended to be educational. This should not be used to substitute medical advice. If you have concerns about your child’s health, see your child’s doctor.

There are various causes for respiratory illness in babies, including having a cold, croup, bronchiolitis, or more severe infections. Some signs and symptoms include:

fever, cough, sneezing, runny nose, stuffy nose, breathing difficulty, noisy breathing, fast breathing, sucking in of areas in the neck, between the ribs and below the ribs, turning blue in the mouth, wheezing, lethargy, reduced appetite, not peeing as much or as frequently

If you have concerns that your baby has a respiratory illness, please see your baby’s doctor.

This is intended to be educational and should not be substituted for medical advice. If you have any concerns, please see your child’s doctor.

One key feature to keep in mind about the baby’s airway, which is different from the older child and adult is this:

babies are obligate nose breathers, which basically means they breathe exclusively from their noses. We can also breathe from our mouths as we get older and therefore this advice really is intended for babies.

That being said, you can imagine, when a baby gets an illness like cold, and their noses become blocked, they can have a hard time with feeds and even sleep. Try to imagine eating/drinking or sleeping if your nose is blocked and you could not breathe from your mouth.

Here are 5 tips to get your baby through a respiratory illness:

1. Saline drops in the nose with aspiration of mucus – the ideal time to do this is before feeds/naps.
2. Ensure your baby is drinking well and making good number/volume of wet diapers. Fluids in smaller volume, more frequently will help also. You should speak to your doctor about whether pedialyte is an option for your baby (usually depends on age).
3. Ensure your baby gets plenty of rest. But, if they are not waking to feed, this could signify lethargy and your baby should be taken in to see their doctor immediately.
4. Control fever with tylenol/advil as long as your doctor has cleared your baby to use these.
5. Make sure your baby is fully immunized, they are not in contact with other sick people, and everyone practices good hand hygiene. Keep in mind that having one respiratory illness doesn’t mean your baby cannot catch another illness.

*For some respiratory illnesses, your doctor may have prescribed puffers, in which case, be sure to use them as directed.

In short, influenza is far more of a concern to the Canadian population than the coronavirus. Across Canada, from August 2019 to January 18, 2020, there have been 12,165 cases of Influenza A and 8,423 cases of Influenza B isolated https://www.canada.ca/content/dam/phac-aspc/documents/services/surveillance/respiratory-virus-detections-canada/2020-2021/week-3-ending-january-18-2020/pub1-eng.pdf.

Why is influenza a concern?

Influenza is a virus that has the potential to cause significant illness, hospitalization and even death. Children under the age of 5 years old are at highest risk of severe illness.

When is flu season?

Cases of the flu start to rise as early as October to as late as May and peak between December to February.

How can we protect our children?

I will only be discussing the flu shot and not the nasal spray. The flu shot is not effective in babies under 6 months of age, but here are some things you can do:

• Pregnant women get your flu shot: immunity can be passed to your baby through the placenta

• Breastfeeding women: immunity can be transferred through breastmilk
• When your baby turns 6 months old, get them their flu shot. If a child is younger than 9 years of age when they get their first flu shot, they will need to get a second one a month later. After this, it should be once a year.
• The flu shot should be given once every year, as the flu virus changes, and there are highly educated people working very hard to make sure the vaccine also changes to keep up!

You cannot get the flu from the flu vaccine

The flu shot is not live and therefore you cannot get the flu from it.

Other general tips:

1. Handwashing is very important. The virus can stay alive on surfaces for hours. If you are sick, make sure you wash your hands to prevent spread also.
2. Avoid sick contacts.
3. If you are sick, try to minimize spreading the infection, i.e., cover your mouth when you cough, don’t go to school/work

Sunshine! When the sunlight hits our skin, vitamin D is converted to an active form that can be used by the body!

Vitamin D is important for your baby to build strong bones and teeth. When vitamin D levels are low (deficiency), this can have a negative impact and in its most severe form, vitamin D deficiency can lead to a condition called rickets.

The daily dose recommended for primarily breastfed babies is 400IU daily.

Babies are at risk of vitamin D deficiency when they are exclusively breastfed because only a small amount of vitamin D is transferred in breastmilk. Therefore, breastfed babies should get 400IU of vitamin D a day. Formula is fortified with vitamin D, so exclusively formula fed babies do not need supplementation with vitamin D (unless they have other risk factors). Discuss this with your doctor.

Sometimes, babies are fed with breastmilk and formula, and in this case, whether to add vitamin D supplement or not depends how much breastmilk the baby is getting. It would be wise to discuss with your baby’s doctor regarding whether you need to supplement your baby with vitamin D.

If you are pregnant or breastfeeding, you should also consider vitamin D supplementation and this can be discussed with your doctor.

Other sources of vitamin D:

• milk has vitamin D added to it, and once your baby is on 500mL/day of whole milk, they would be receiving adequate vitamin D, so supplementation can be discontinued. Remember, not to start cow’s milk until at least 9 months of age and with advice from your doctor.
• fish such as tuna, salmon
• egg yolk
• fortified cereals
• fortified orange juice

Interesting facts:

• Living in countries such as Canada, we may lack adequate sunlight, especially in the winter, and would require supplementation in our diets or in vitamin form.
• The lighter your skin, the more effective this conversion, so those who live north of 55 degrees latitude, and those who have darker skin, would need supplementation, and to consider larger doses (i.e. , 800IU daily) in the winter time.

This is intended for information purposes and should not be substituted for medical advice.

This information is intended solely for education purposes. It is in no way intended to be medical advice. Should you require medical advice, please contact your child’s doctor.

Cow’s Milk Protein Allergy (CMPA) is the commonest food allergy in infants. Not to be confused with lactose intolerance.

Symptoms can include:

Symptoms of severe allergy or anaphylaxis include swelling of face/tongue/lips/throat, hoarse voice, breathing difficulty, dizziness, lightheadedness, fainting, lethargy, loss of consciousness. If there are any of these symptoms, call the local emergency service (i.e., 911)/go to ER.

Under advice and supervision of a doctor, treatment of CMPA includes a 2 week trial of:

Most children grow out of CMPA and milk can be re-introduced at a later date that can be discussed with the child’s doctor.

This information is intended solely for education purposes and is in no way to be substituted medical advice. If you have concerns about reflux in your baby, take your baby to their doctor.

In simple terms, their gut is still immature.

The mouth is connected to the stomach through the esophagus, essentially a tube lined with muscle. In adults, the esophagus is longer and has something called a “lower esophageal sphincter” (LES) at the bottom before it enters the stomach, which prevents food from moving back up.

In babies, the esophagus is shorter, the muscle has not fully matured and the LES has not fully developed yet, so food easily moves in both directions. When food moves up the esophagus, it can cause discomfort. Many babies with reflux are happy and do not have symptoms. In fact, they may even feel relief once they spit up.

For these reasons, keeping your baby upright after meals uses gravity to help keep food moving downward.

If your baby has symptoms of severe reflux, including arching their back, discomfort or crying with feeds or not gaining weight, they may have gastro-esophageal reflux disease and your doctor can help.

Reflux symptoms tend to get better as the gut matures overtime, and also around 6 months, as your baby is sitting more and eating more solids.

5 factors that can contribute to reflux:

1. Overfeeding – consider feeding smaller amounts more frequently
2. Gulping in a lot of air – consider burping at regular intervals
3. Position – lying down too soon after a feed, consider keeping elevated at least 30 min-1h after a feed
4. Age (due to maturity of the gut) – generally resolves with maturity of muscles and sitting upright
5. Fluid vs. solids – The younger they are, they drink mainly fluids. Reflux tends to get better with solid food introduction.

This post is intended to be educational. This is in no way to be used in place of medical advice. Please see your doctor if you require medical advice.

Iron is a mineral found in our bodies, which allows oxygen to be transported to our organs, for optimal functioning. In children, it is also vital for growth and brain development.

A deficiency of iron can lead to problems with weight gain, reduced energy levels, difficulty with concentration and can affect school performance.

Risk factors for iron deficiency include: being preterm, inadequate iron in the diet, excess dairy milk intake, among others.

If you have any concerns about iron deficiency, you should make an appointment to see your child’s paediatrician/doctor, as your child will need to be examined, potentially have blood tests or start supplementation.

If your doctor has recommended iron, have your child take iron with a source of vitamin C as this increases absorption. Avoid iron being taken with dairy milk as it can disrupt absorption.

Breastmilk for the first 6 months, or, alternatively iron-fortified formula from birth to the time dairy milk is started. Other foods that contain iron include meats, lentils, leafy green vegetables and legumes. It is important to limit dairy intake to 500-750mL/day as higher dairy intake can lead to iron deficiency. If starting solids, start with iron-rich foods.

1. Hand-washing! Here is a link to a video of the steps involved in handwashing in song form! https://youtu.be/GAP8HZdV5Qo
2. Avoid having visitors or visiting others who are unwell.
3. Vaccinations:
   1. It would be wise to ensure visitors are also fully up to date on their vaccinations. Here’s a reason why: the reason we get immunized against perstussis (whooping cough) is so that we can protect babies (that is, prevent them from getting it). Pertussis can make babies very unwell.
   2. Flu shot! Ensure all eligible family members are vaccinated with the flu vaccine every year. Babies under 6 months cannot be vaccinated, so they rely on those who surround them being protected (this is called cocooning). Breastfeeding once you have had the flu shot can also transfer immunity. Pregnant women should also get the flu shot during their pregnancy to confer immunity.
4. Tetanus, Diphtheria and Pertussis Booster: Pregnant women should get the booster during their pregnancy.
5. Anyone who has cold sores should not kiss the baby. Cold sores occur due to a virus that has the potential to cause severe disease in babies.

This post is intended to be an opinion piece and should not be used as medical advice. Should you or your child require medical advice, please contact your doctor.

It’s no secret human breastmilk has many benefits for human babies, including the obvious fact that milk that comes from the same species is generally nutritionally ideal for the offspring.

That being said, formula is an excellent source of nutrition for our babies, and mothers should not be made to feel guilty or as if they have failed should they decide to supplement or exclusively formula feed their babies.

For healthy child development, mothers should ideally be happy and healthy. Her partner and family members, friends and community should come together to support her. As they say, “it takes a village”.

This is intended to educate and is in no way a substitute for individualized medical advice. Speak to your child’s doctor for individualized medical advice.

How do I know if my baby is ready to start solids?

The CPS and AAP, as well as WHO recommend exclusive breastfeeding for 6 months, and sometimes there is confusion about when to start solids. This is because the latest research shows starting foods that cause allergy (allergenic foods) earlier (4-6 months), if there is a family history of allergies, is likely to reduce the risk of your child developing food allergies.

Signs of readiness:

1. Showing interest – it’s important your baby is showing signs of interest. Watching you eat, reaching out to try to eat, opening their mouths, grabbing your food/dishes, are all signs they may be interested. This along with being able to turn their heads away or show you they are not interested is also important. The key is, the feeding experience should be nice for both of you, and these two things – showing interest, and being able to turn away (or your being in tune with them not being interested anymore) – can prevent force-feeding that can have longer term implications.
2. Able to sit upright and keep their head up – To protect the airway, you want to ensure your baby is sitting upright and able to keep their head up on their own. We wouldn’t eat food lying down due to risk of choking – a baby shouldn’t either.
3. Opening their mouths when you approach with a spoon  – it’s important your baby opens his/her mouth when approached with a spoon, as a sign of showing interest. If he or she is not doing this, remember, you can try again another time, but what is key is not to press the issue.

What to start with?

Start with iron-fortified food, including infant cereal, leafy green vegetables, lentils, beans, or meats. Fruits can also be introduced at this time. Once you have introduced various foods and they are tolerated, start considering introducing allergenic foods. We started with peanut butter – a small, rice grain sized bit of peanut butter mixed in her organic oatmeal cereal. Monitor for rash and other signs of allergy. I think a good rule of thumb is to introduce one allergen for at least three days before moving onto another allergen, because this way, if there is a reaction, it is easier to discern what could be causing it.

Once an allergenic food is introduced, keep introducing it regularly. We try to do this once or twice a week once we have introduced it, although it sometimes becomes challenging to keep track of and we have often found ourselves doing so once every couple of weeks. A helpful tool is to create a weekly and even monthly schedule.

How do I prepare the food?

If you plan on introducing foods at 4 months, pureed foods would be best. We introduced infant cereal and pureed foods. By 6 months, we started baby led weaning, as babies are able to tolerate various textures at this age. Always check with your child’s doctor. Ideally, you want to introduce as many textures as possible by 9 months so your baby is likely to keep an open mind to a greater repertoire of foods.

What are allergenic foods?

Peanuts, tree nuts (like almonds), fish, shellfish, soy, wheat, dairy, eggs.

How to introduce dairy?

Milk is not recommended before at least 9 months of age. However, given that dairy is a potential allergen, you can introduce yogurt and cheese.

• Another important thing to remember is a mother can eat allergenic foods during pregnancy and if she chooses to/is able to breastfeed. These are thought to help reduce risk of allergy development in those who have a family history of allergy.