Preparing Your Child for a Sibling

Expanding your family is an exciting time but preparing your children for the addition of a baby can be tricky.  Dr. Jessica Long gives her professional, as well as personal, advice on how to prepare your child for a sibling.

When I was pregnant with my second child, I was concerned about how an additional baby would transform the dynamic in our household.  I was most worried about how it would change, for better or worse, life for my oldest. Would she resent her baby sister? Would it affect her relationship with me?  Is it even possible to love multiple children equally (spoiler alert: it is!)?

I spent a lot of sleepless nights brainstorming how to make the transition from only child to big sister as smooth as possible.  While there were certainly hiccups along the way (and, to be honest, there continue to be 3 years later), having a sibling has been the best thing to happen to my sweet firstborn.  So much so that we gave her another!

When preparing your child for the arrival of a baby, get them involved as much as is developmentally possible.  Have your oldest help pick out or make artwork for the nursery, choose some books for the bookshelf, and put clothes in the drawers with you.  Talk about the baby and reminisce about when your oldest was a newborn by looking at pictures together.  There are lots of good books, for kids of all ages, that talk about having a sibling in language they will understand.  Communicating with your child and getting them involved in preparing for the baby’s arrival will make your big kid feel part of the excitement.

Make sure you prepare your oldest for what it will be like when you go to have the baby.  Let them know you’ll be gone for a few days but that some fun special things will happen (Grandma is going to have a sleep over with you or Daddy is going to take you to the Zoo that day).  If you decide to have your child visit you at the hospital, have the baby snuggled in the bassinet and not in your arms so you are 100% available for big kid hugs and cuddles before the sibling introduction occurs. Having a small present “from the baby” to the big sibling also works magic – nothing like a little bribery to get the relationship off to a good start.

Once you are home, expect some unusual behavior.  Sometimes children regress and your toilet trained three-year old-may start having accidents, or your eighteen-month-old who sleeps through the night suddenly starts a sleep protest.  Give it time – everything will get back to normal soon.  Though your newborn needs most of your time and attention, try to block off some alone time for just you and your oldest each day.  You’ll appreciate the one-on-one time as much as she will.

Try to keep the sixty days before and after the birth of a sibling as laid back for your older child as possible.  That is not the time to transition from a crib to a toddler bed, start potty training, or throw out the pacifier.  As things settle down, your child will get back to her old routine.

My only other advice is to think long and hard about when you tell your child you are expecting.  Be prepared that they will ask you every single day thereafter if today is the day the baby is coming.  So learn from my mistakes and consider keeping that a secret and save your sanity for a bit longer.

Winter Car Seat Safety

How do you keep your child bundled up and warm in the car?  Dr. Jessica Long is here to help!

Safely strapped into her carseat with multiple thin layers for warmth.

Tuck a blanket around your child after she is buckled in to add extra warmth without interfering with the safety straps.

One of my favorite things about being a pediatrician is getting to work with new parents as they embark on this wild, crazy, amazing journey of raising a little human.  They often apologize for having so many questions but how could they not? There’s no all-inclusive manual on parenting and, even if there were, no parent would have the free time to read it.  Thankfully my schedule allows me to spend the time parents need to walk themthrough their questions and concerns,andtoassurethem that even as a pediatrician I had many of the same quandaries when I first became a parent.

This time of year one of the big things we talk about is how to keep kids safe and warm in the car. Multiple times a day a baby adorably bundled up in a snowsuit comes into our office looking like the Stay PuftMarshmallowMan. She’s clearly warm and toasty buckled in her car seat, but she’s not safe.  The parents are unaware that there is a better way to keep their baby snug and safe this time of year.

Due to the fluffiness of snowsuits and puffy jackets, it is impossible to get car seat straps tight enough to appropriately buckle your child.  Even when you have tightened the straps as snug as they can go, there is typically still four (!!!) inches of slack.  Though our muscles cannot squish down that extra air in the puffy clothes, the force of a car crash certainly can,and those four inches of slack can be enough to let your child slip out of the harness all together.

The puffy snow suit may be adorable but it leaves too much slack in the car seat straps.

Yikes! Look how loose the car seat straps were with the puffy layer.

Save the snowsuits and puffy jackets for playtime outside or walks in the stroller. When you are buckling your child into the car, multiple thin layers are the way to go.  A long-sleeved shirt with a tight fitting fleece over it, a snug hat, and fleece leggings with pants on top is plenty warm in the car.  You can always add a blanket tucked in all around your little one.  There are also many products on the market that go around your baby or car seat for additional warmth without additional bulkiness.

What about when you’re putting your child in the car for a trip to go play in the snow? I know it’s a pain, but bring the snowsuit with you and put it on your child when you get there. If you dress your child as just described above, she’ll be warm enough for those few minutes. And the inconvenience is worth it to keep your child safe.

While most of these tips address infants, the same applies to bigger kids as well.  A bulky jacket will hinder the tightness and effectiveness of all car seat straps,so plan ahead with tight layers and add a jacket worn backwards (so that the fluffiness does not interfere with the straps) after your child’s buckled in.

Teething

Is your little one preparing for the arrival of some adorable teeth?  Dr. Jessica Long has tips to get both of you through this trying time!

I always love seeing babies for their four month well checks – they are smiley and interactive but not yet scared of coming to see the pediatrician. They are also drool monsters with a continuous thread of saliva running down their chin and many are sporting adorable bibs to catch the never ending flow of spit.  This excessive drooling is a normal sign of the sweet little teeth that will pop up in the next few months.  Now that my youngest has hit this phase as well I am reminded of all the tricks of the trade to help your baby deal with the discomfort of teething.

Around 4-6 months of age it is normal for your little one to put everything in her mouth to gnaw on and sometimes be a bit cranky.  These are signs of teething and, while they can’t be entirely prevented, there are certainly things you can do to help ease the discomfort.  Thankfully a handy tool is always available – your finger!  With a clean finger you can massage your baby’s gums or just let her chomp on your finger with her gums (keep away from any teeth that have already popped through!).

Cold temperature is also comforting so offer a cool washcloth or chilled (not frozen) teething ring. If your child has started solids, you can put a piece of frozen fruit in a mesh or silicone food feeder, which lets him enjoy the coolness and firmness of the fruit on his gums without worrying about choking.

When all else fails, it is safe to use pain medicine to help alleviate the achiness.  Babies under 6 months of age can be given acetaminophen (Tylenol) and those over 6 months old can also try ibuprofen (Motrin).  These medications can be especially helpful if your baby is having a hard time falling or staying asleep due to teething discomfort.  Though there are a variety of other medications available over the counter for teething, avoid any with benzocaine or lidocaine which can be harmful – even fatal – to your baby.

Now what to do about the constant drool?  Keep a clean dry cloth handy for frequent face wiping.  Since all of that saliva can be irritating to your child’s skin, he might enjoy having a moisturizer rubbed onto his cheeks and chin to protect from the onslaught of drool.  Hacks for magically cleaning all this drool laundry without taking up your entire day are outside of my scope of expertise and I would in fact appreciate help in that department!

Big Kids and Sleep

Sleep (or lack thereof) is one of the biggest frustrations we deal with as parents. Here are Dr. Jessica Long’s tips on how many hours of sleep children need at each age and how to create a nighttime routine to achieve these sleep goals.

September is always a busy month in our household. School, homework, extracurriculars – there’s a lot to incorporate back into the daily routine, which is fun but also exhausting. By the end of the day our whole family is spent and everyone is exhausted. I know more sleep is the answer, but how exactly do we successfully get our children to sleep earlier, sounder and longer?

How much sleep your child needs depends a lot on her age. The American Academy of Sleep Medicine (AASM) recommends that preschoolers (3-5 years) get 10-13 hours of sleep, grade-schoolers (6-12 years) get 9-12 hours and teens (13-18 years) get 8-10 hours. Parents, as we know, routinely survive on 5 hours without problems (just kidding!).

So how do we meet these lofty sleep goals? Bedtime rituals are incredibly helpful in getting your child’s mind and body ready for sleep. A bath, brushing teeth, and a book may be the perfect routine for your 5 year old. Your middle-schooler might find it helpful to journal a bit before lights out. Whatever works for your family, make sure you plan for a sufficient amount of time to complete the bedtime ritual. Start the process 30-60 minutes prior to bedtime so that your child is sound asleep at an appropriate time.

Prepare your child’s room for sleep success as well. Keeping the temperature cool, the windows dark, and the bed free of too many toys/books/stuffed animals helps to set the scene for a good night’s sleep. My eldest daughter hoards dozens of books in her top bunk. We routinely have to declutter her bed to encourage her to close her books at an appropriate time to maximize her rest.

Probably the least popular advice I give to patients and their parents about improving sleep hygiene involves screen time. There is no wrath like a teenager who has been told she can’t charge her phone in her room overnight. Ideally, all screens should be turned off at least one hour prior to bedtime and all electronics should be charged outside of the bedroom. We are all guilty of checking our phones right before bedtime so make this a family goal to help improve everyone’s rest.

Sleep is a very important aspect of your child’s overall health. Poor sleep can affect mood, concentration and grades at school, behavior and more. If you are worried about your child’s sleep, discuss it with her pediatrician.

Happy zzzzz’s!

 

Ear Piercing Safety

You know the day is coming when your tween is asking to have her ears pierced. Do it the safe way with these tips from Dr. Jessica Long.

Getting your ears pierced can be a momentous occasion.  For some kids, it happens when they are babies and they have no memory of it.  For others, it’s a birthday promise they’ve been counting down towards for years. My three year old is already begging for earrings but has to wait until the arbitrary age of seven (I’m such a mean mom).  Regardless of when the big moment happens, you want to make sure it’s done right.

Be sure to choose a clean and reputable place.  Your pediatrician might even offer it as we do at Spring Valley Pediatrics.  You’ll want to make sure the person poking a hole in your child’s ears is well trained, wears new disposable gloves, and uses equipment that is sterilized to decrease the chance of infection.

Be sure to choose the right earrings.  Since nickel is a main culprit of allergic reactions, stick to hypoallergenic materials like sterling silver or 14-, 18- or 24-karat gold.  At Spring Valley Pediatrics, our patients choose from a variety of earrings all made of 14-carat gold or surgical stainless steel.

Be sure to be up to date with vaccines.  Most pediatricians recommend your little one have received her third tetanus shot, typically given at the six-month-old well-visit, before any ear piercing.  We want to make sure this elective procedure carries as little risk to your child as possible.

Be sure to follow proper care of your piercing.  For the first six weeks after your ears are pierced, it is important to wash the ear lobe (while keeping the earring in) twice a day with soap and water.  We provide our patients with another cleaning solution to use in addition to soap and water twice a day. Turn the earrings, like winding a watch, twice a day as well.   After 6 weeks of keeping the original earrings in, you can replace them for other light stud earrings but avoid any heavy or dangling earrings for 4-6 months.  Also don’t leave your earrings out for more than 24 hours until your piercing is at least six months old – you don’t want those holes closing up!

Be sure to call your doctor if your new ear piercing is red, painful, or has discharge.  No matter how careful you are, infections can happen so be sure to be seen by your physician if things don’t seem right.

Happy piercing!

Fever 101 – When to call the pediatrician

As parents we often see it coming – crankiness, sleepiness and loss of appetite followed by a fever. Here Dr. Jessica Long gives advice on when to call the pediatrician.

If there is one complaint or concern that pediatricians get called about the most, it’s fever.  They’re rough – kids are miserable with them, parents are worried about them, and there’s a lot of misinformation on the internet about them.  However, I’m here to calm your fever phobia and hopefully allow you and your child to sleep a little more soundly, even if her temperature isn’t 98.6 degrees Fahrenheit.

What is a fever?

Doctors consider a fever to be a temperature of 100.4 or higher., A fever is not an illness but instead a sign that your child’s body is fighting an infection – whether a virus or a bacteria – and is actually an important part of your child’s defense against these invaders. How high a fever is does not provide any clues as to what your child is fighting.  A common cold can cause a child to have a temperature of 104 while strep throat might raise it to only 100.8.  Don’t let a high number alarm you if your child is otherwise doing ok and likewise don’t ignore a slight fever in a child who looks ill.

What to do?

You actually don’t have to do anything.  If your child is comfortable, playful, and eating and drinking well despite his 101 temperature, it’s ok to just watch and wait.  However, if your child is miserable, then acetaminophen or ibuprofen (in children older than 6 months) is the way to go.  Some stubborn fevers may require that you use both of those medications and it is safe to alternate them if needed.  Be sure to reference a weight based dosing chart, like the one we have here at Spring Valley Pediatrics, to ensure your child is getting the correct amount of medicine.   Giving too small a dose will not reduce the fever as effectively.

When your child has a fever, he will lose fluids more quickly.  Be sure to encourage lots of drinking to avoid dehydration and call your doctor if he is crying without making tears, has a dry mouth or lips, or is not urinating frequently.

When to call your pediatrician

If your baby is under 3 months old and has a rectal temperature of 100.4 or higher, call your pediatrician right away.  Fever and illness can be more serious and progress faster in younger infants so do not hesitate to wake your physician in the middle of the night if your baby has a fever.

If your older child has fever as well as other symptoms – a stiff neck, severe headache or sore throat, rash, repeated vomiting or diarrhea, signs of dehydration – or is unusually drowsy or fussy, give your pediatrician a call.  If your child’s fever continues for 3 days, it’s worth chatting with your doctor about whether or not your child should be brought in for a visit.

The other time to call is when you’re worried, even if your child is not experiencing any of the symptoms above. We are always happy to talk our families through any concerns.  That’s what we are here for.

How to Handle Separation Anxiety

It is heartbreaking to leave your child when he is upset. Read on for tips from Dr. Jessica Long on how to ease your child’s separation anxiety.

Nothing pulls at your heart strings like your child crying when you need to leave.  It makes you feel awful and, even if your little one recovers as soon as you are out of sight, makes you feel horribly guilty the entire time you are away.  Separation anxiety is a normal part of your child’s development but that does not make it any easier to endure.

Babies start to experience separation anxiety around the age of 4-7 months once they realize that you exist even when you are not right in front of them (this is known as “object permanence”).  They want you when you’re not there and are sad when you leave, even if it’s just to walk to the other room.  As our babies grow into toddlers, episodes of separation anxiety become less frequent but can be more intense (think crying, yelling, tantrums).  School-age children can even exhibit separation anxiety, especially with big changes like starting school or a new sibling in the house.  Thankfully though, it’s unusual for daily separation anxiety to continue in your school-age child. If it does, you should discuss it with your pediatrician.

So what’s a parent to do when you have to leave the house – now! – but you have a sobbing child clinging to your leg?  First off, no matter how tempting it is, don’t sneak out.  Your child needs to trust you and suddenly disappearing will only make her more fearful of your absences.  Instead, let her know that you are leaving and when you’ll be back in terms she’ll understand (“after you wake up from your nap” or “right before lunch”).  Just as importantly, keep that promise and be home when you say you will.  Develop a goodbye ritual that you use each time, to provide consistency, but keep it short.  Longer rituals may lead your child to fixate on the idea of you leaving.

Remember that practice makes perfect.  Being separated from a parent is important for your little one’s development, and it’s healthy for him to spend some time away from you.  Even having a friend, family member, or nanny provide child care for a few hours gives you the chance to practice your goodbye ritual and allows your child to experience special time with other trusted adults in his life.

Most importantly, separation anxiety is temporary.  Our children continue to grow, mature, and get used to new situations.  Stay loving and consistent in your goodbye routine and it will become easier and easier.

WHAT TO CONSIDER WHEN CHOOSING A PEDIATRICIAN

Calling all moms-to-be! One of the most important decisions you can make leading up to your baby’s debut is selecting a pediatrician that is a good fit for your family. Read on for tips from Dr. Jessica Long  on what to look and questions to ask when interviewing potential pediatricians.

Finding out you’re pregnant is such an exciting time!   After the initial thrill and announcing the news to friends and families, you suddenly realize there is so much you need to accomplish before this little one makes his or her debut. If you’re like me, you suddenly have a to-do list a mile long that includes practical things like buying a car seat as well as slightly neurotic endeavors like deep cleaning the floor boards of the entire house (it’s called “nesting” for a reason). One thing you definitely want to cover before your due date is choosing a pediatrician.

As both a mom and a pediatrician, I naturally have some insight into what you should look for in choosing a practice and a doctor for your baby. This is someone you will be spending a lot of time with, especially in the first year of your baby’s life, and who will get to know you and your family for decades to come. She will support you through challenging times and illnesses as well as celebrate your child’s growth and milestones. She will provide sound medical and practical advice when the internet tells you to panic, or to cure your baby’s runny nose by burning toadstools under her crib, or to put your sniffly infant on a three-week juice cleanse. The relationship between a pediatrician and her families is filled with trust, respect and caring – how do you pick someone who can provide this for you?

First off, ask around. Friends, family, and coworkers can be a great place to start before you do your own research. Make sure the physician is certified by the American Board of Pediatrics, which is in charge of training and board-certifying pediatricians across the country. You likely want a practice that is relatively close – like I said, you’ll be spending plenty of time with your pediatrician. Next, schedule a meet and greet to check out the practice and get to know the physicians there.

When you visit the office, make sure there are separate waiting areas for well children and sick children (an additional space designated for infants only is even better!). Especially for your baby’s routine first-year visits, it’s a big comfort to know that there’s an extra layer of protection between you and the teenager who got mono at soccer camp.

Besides just seeing if you “vibe” with the physician you meet, there are some important questions you’ll want to get the answers to as well. Be sure to ask what happens if your child gets sick or hurt outside of normal office hours and you need to ask a question. Is there a physician you can reach by phone or a nurse triage line? What are weekend and holiday hours? How easy is it to talk directly to your pediatrician? As a mom I can promise you your child will become ill at the least convenient time (vomiting as you get on an airplane, ear infection on Christmas morning) but knowing what aid your pediatrician can offer during those moments can be a big relief. Be sure to ask how quickly you can be scheduled for a sick visit and what wait times typically are once you’ve checked in. You already likely know what a pain it can be to wait to see a doctor – now imagine doing that with a sick child.

You probably have already thought about things such as breastfeeding and immunizations, and you want to make sure you have a supportive physician. Is lactation support available? Does she advocate for the immunization schedule recommended by the American Academy of Pediatrics and Centers for Disease Control? You don’t want any unvaccinated children in the waiting room who could expose your little one to an illness he is too young to be vaccinated against.

While you are pregnant it may seem silly to think ahead to “big kid” needs but now is the time to ask. What is the turn around time for school and camp forms and is there an additional charge? What happens if your child has to be admitted to a hospital or see a specialist – what role will your pediatrician play in those situations? How long can your child continue to see the pediatrician before graduating to an adult physician?

Perhaps most importantly, is this a physician you feel you can talk to and trust? You will, after all, be calling him in the middle of the night the first time your baby has a fever or seeking his guidance when your little one goes through a frustrating sleep strike. As a pediatrician, I greatly value the relationship I get to make with my patients and their families (it’s the best part of my job) and want to make sure they feel the same way. Doing your research before your due date allows you to find the right fit for you.

Choosing a pediatrician is ultimately a personal decision. It doesn’t matter if you have the world’s most brilliant doctor on speed dial if you don’t feel comfortable asking for and following her advice. But I hope it comes as no surprise that I think Spring Valley Pediatrics does all the big and little things right.

Whether you are newly pregnant, new to the area, or just looking for a change, we love meeting new families at Spring Valley. We are open 365 days a year so if your little one wakes up with a fever on a weekend morning or Thanksgiving Day, he can be seen. We try to be incredibly accessible to our families, offering a call in time each weekday morning where you can talk to your physician directly. After hours one of our physicians is on call 24/7 and happy to answer your urgent questions. We find that our patients and families are most comfortable when they can see the same pediatrician for all visits and strive to ensure you always see your doctor for well and sick visits. If you want to learn more and check out our office and physicians, call our office for a complimentary new patient consultation at 202-966-5000. We look forward to meeting you and your family!

 

Babies and Spit Up – When to See the Pediatrician

For many first-time parents, baby spit up can be a bit terrifying. There is a very fine line between what is “normal” and when you should seek help from your pediatrician.  Dr. Jessica Long helps to clear up some common spit up misconceptions…

When I found out I was pregnant with my first daughter, I daydreamed about lazy mornings cuddling with her, taking long walks together through our neighborhood, introducing her to all of my favorite childhood spots in DC, and of course all of the adorable clothes. What did not play a starring role in my motherhood fantasy was the amount of spit up that would end up on her, me, my husband, the dog, and really anything within a four foot diameter after she ate. Her spitting caused her no distress and certainly did not slow down her impressive weight gain but wow did it lead to a lot of laundry.

Spit up is an incredibly common baby phenomenon. In fact, more than half of babies younger than 3 months old spit up daily. For most babies, gastroesopahgeal reflux (GER) is a natural occurrence that, while annoying, causes no health problems and improves with time.   However, in some babies it may cause complications – in which case we call it GERD (gastroesophageal reflux disease) – and requires evaluation by your pediatrician.

For all of those parents out there with “happy spitters” who smile while you grab your tenth burp cloth of the morning, there are thankfully some simple things you can do to help reduce the amount of curdled milk you are scrubbing off the sofa.

First off, there’s only so much room in that tiny baby belly and if it gets overfilled with milk there is nowhere for it to go but out. Do your best to not overfeed your baby. Also, try to minimize gas in your baby’s belly so that, as a gas bubble escapes, it doesn’t bring up half the meal as well. Some babies need to take burp breaks in the middle of their feeding as well as at the end in order to not have a wet burp down your back shortly after eating.

While tummy time is important for motor development and can help to relieve gas, it is best to avoid it right after feeding. That extra pressure on the stomach is more likely to send its contents all over the living room rug. Holding your baby upright for 20-30 minutes after eating also helps to keep everything in her stomach right where it belongs.

Still spending more time with the laundry machine than enjoying that sweet social smile of your baby? It is important to have regular follow up with your pediatrician to ensure that gastroesophageal disease is ruled out. Talk with your pediatrician to see if diet changes would be helpful. Some breastfed babies may be sensitive to dairy or egg and having mom avoid these foods could cut down on spit ups. Similarly, a formula fed baby might prefer a hydrolyzed formula. Adding a small amount of oatmeal to bottle feedings has also been shown to help reduce the amount of spit up. However, chat with your baby’s doctor before altering anyone’s diet.

With spit up, time is the best remedy. As your child grows, spitting up will be less of an issue and your little one will be on to new and exciting problems such as desperately wanting to play with electrical outlets and finding every choking hazard accidentally left around your house. Parenthood is a journey and spit ups will soon be a distant memory. The overabundance of laundry in your home will unfortunately be an ongoing problem.

How to Introduce Peanuts to Children

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We all know that peanuts can be dangerous for children with peanut allergies, but when is the best time to begin introducing them to your child’s diet? Dr. Jessica Long gives us the lowdown on this tricky topic…

 

With two girls under the age of five, peanut butter is a staple in our house. It’s easy, delicious, and packs 8 grams of protein in a two tablespoon serving. However, for many families, peanuts are cause for real concern. Peanuts are the leading cause of food allergies in children and can cause serious allergic reactions and even anaphylaxis. For years, the medical community has been trying to figure out how best to prevent peanut allergy. Doctors used to advise parents to not expose their children to peanuts until they were at least two years old but that was not helping to decrease the number of people with allergies. Earlier this year, new recommendations came out in response to research showing that it’s actually early exposure, as opposed to late, that helps prevent peanut allergies.

So who do we now recommend try peanuts? Most healthy infants over the age of 4 months may benefit from early introduction of peanuts. However, some children may require allergy testing before trying peanuts so always discuss with your doctor before introducing new foods. For example, if your child has severe eczema or egg allergy, a peanut allergy test should first be done by 4-6 months old. Also, children with a strong family history of peanut allergy might need to see an allergist before trying peanut protein.

If your doctor gives the thumbs up for introducing peanuts to your baby, you can offer Bamba (a puff peanut product) or make your own thinned smooth peanut protein mixture. Combine two teaspoons of smooth peanut butter with two to three teaspoons of warm water or pureed baby food to make a perfect two gram serving which is the ideal amount for your little one.

The first feeding should be a small amount, just the tip of a teaspoon. Watch your infant for ten minutes to make sure there are no reactions such as hives, vomiting or nasal symptoms. If there are no reactions, continue to offer the rest of the 2 gram serving of peanut protein at your baby’s normal feeding pace.

Once your baby has successfully tried peanut protein, it is recommended that you offer two gram servings three or more times a week. If your infant develops any allergic symptoms within two hours of eating peanut protein, stop and contact your pediatrician. Remember to avoid whole nuts until kids are over 5 years old as well dollops of peanut butter until kids are over 4 years old due to choking concerns.