Ask the Pediatrician: The First Year

WebMD Live Events Transcript

Babies grow and change so quickly, and so do their health concerns. From the first fever to the first shots, to what to expect at those well-baby checkups, you have questions about your child's growth and well-being. Pediatrician David Pangburn, MD, dropped by WebMD Live with the answers on June 24, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
Does my baby really need all of the shots? I heard that they could cause problems.

PANGBURN:
This is a very big question. Let me sidetrack the controversy, first of all. I think this generation of parents has not experienced what previous generations have. There hasn't been a case of polio in the U.S. since the middle 1950s. Measles, mumps, and rubella have not been seen in years; hemophilus infections have not been seen for almost 15 years, and this is due to the vaccination policies we've had in this country. This generation has many more questions about safety than previous generations. People have had family members or neighbors who have these diseases that are now prevented.

In recent years there have been questions about the MMR vaccine, specifically questioning whether there could be a causal link to autism. There has also been a controversy about a preservative in some vaccines called thimerosal, which contains very small amounts of mercury. There's been a great deal of scientific inquiry into those two questions in the past 10 years. The American Institute of Medicine recently published a study where they concluded there was no scientific evidence that the MMR vaccine or thimerosal could cause harm.

As pediatricians we're all concerned the rate of immunization might fall, given parents' concerns. If that were to happen, outbreaks of diseases that have been not with us for a few decades could come back. But the question parents have about vaccinations are great; it shows they're concerned parents, and as pediatricians we certainly want to ensure any treatments, including vaccinations, are safe for the children we're treating. But overall it seems vaccines have promoted a much higher degree of health in the United States, and the risk of not immunizing is far greater than any known risk of vaccination.

MEMBER QUESTION:
What will my doctor look for at "well-baby" checkups?

PANGBURN:
The well-baby visits are very broad. The main subjects pediatricians are looking into about health maintenance are child safety issues, the child's overall health, their nutrition, their behaviors, and development.

Primarily the well-baby visits are an opportunity to ask questions, have worries laid to rest, or have further investigation done if there are real problems. And they're also the appointments when vaccines are given on most occasions. There are some lab tests, like lead levels and blood counts that are done on an annual basis.

From the broadest perspective they are the time when we can talk about what is of concern to the parents. We also examine the child from head to toe, a complete examination, compared with most sick visits where it's a focus on the problem they came in for.

"The American Institute of Medicine recently published a study where they concluded there was no scientific evidence that the MMR vaccine or thimerosal could cause harm."

MEMBER QUESTION:
My doctor told me my baby has a mild case of thrush and gave us nystatin to treat it. I've boiled the nipples and pacifiers. Will I have to keep doing this until all the medicine is gone?

PANGBURN:
Typically you don't need to do multiple sterilizations of nipples or pacifiers. Once the medication is started, within a few days it is unlikely there would be enough yeast on those (which is the cause of thrush) to be worried about sterilization. Thrush is a very common problem. Infants are more susceptible to these yeast infections, but they tend to clear up quickly.

MEMBER QUESTION:
My daughter who is 2 months old has an umbilical hernia. How long does it take for it to be resolved, and if it does not resolve itself, what does the surgery consist of? Also, what percentage of infants that have this condition needs surgery to correct it?

PANGBURN:
Umbilical hernias probably happen in 5% or 10% of all babies. The vast majority, probably 98%, will close on their own without any treatment. They typically close by 2 or 3 years of age, and rarely do they need surgery. If the opening you feel is about an inch across, which would be a very large umbilical hernia, that size is very unlikely to close by itself. But the vast majority is much smaller.

The hernia is actually what you feel if you push down on the outie belly button and not the outie itself. I've felt a lot of belly buttons in 15 years, and I can only recall one or two who needed surgery. So most of the time I tell parents their child won't always have an outie, that by 3 they'll be just fine.

MEMBER QUESTION:
My insurance plan covers three sick visits and six well visits per year. I am very concerned about this and thinking about purchasing additional insurance. Should I be concerned? How many sick visits are typical for the average baby?

PANGBURN:
Typically, a newborn sees their pediatrician multiple times and typical would be one to two weeks, one month, two months, four months, six months, nine months, and one year. So if I've counted correctly that's already beyond your coverage. My experience tells me that most babies in their first year of life will have more than three visits for problems or illness or questions; they go beyond those well-child visits.

Many health plans are attempting to save costs by reducing the amount of preventive care the member receives. It would certainly make much more sense to cover preventive care as good health maintenance. I believe most pediatricians would advocate for all well-child visits and adequate sick-visit coverage being the standard part of all insurances.