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.

MEMBER QUESTION:
My 10-month-old has had a runny nose for going on three weeks now. She coughs some, which seems to be just from the gunk draining down her throat. I'm reluctant to medicate her for this, since she doesn't seem uncomfortable, but this has been going on for so long now ... Do colds last this long? If it's allergies, how do you test for that?

PANGBURN:
Most upper respiratory infections or colds will last seven to 10 days. The difficulty for parents, as well as pediatricians, is that young children get frequent colds and they may overlap. Children are also susceptible to allergies. Children also, like adults, get sinus infections. So seeing your own pediatrician and having your child examined can help sort out which of those might be the cause. Usually it doesn't require extensive allergy testing, especially in very young children, and most causes can be found by the pediatrician doing a thorough examination.

One of the problems only seen in small children is a foreign body in the nose, which happens more commonly than most of us parents would like to believe. So I suggest any child with a cold for more than two weeks make an appointment with your doctor and have it checked out.

MEMBER QUESTION:
My daughter is 3.5 months old and has very dry skin patches on her wrists, elbows, and knees and I'm not sure what to do about it. The doctor gave me a prescription for cortisone cream but I heard not to use it unless it gets really bad because they can build up a tolerance to it and then nothing helps, but isn't it better to nip it in the bud? Also I don't want to put the cortisone on her wrists because she rubs her eyes and puts her hands in her mouth all the time. I've tried bathing her less frequently and using Aveeno products and Lubriderm cream, but that is not working all that well. Could it be a reaction to the formula? I breastfeed, but she gets about 2 ounces of formula a day just before bedtime. Would cutting that out maybe help to clear it up?

PANGBURN:
It sounds as if your doctor has diagnosed your child with eczema. Eczema is usually an inherited skin condition that is related to allergies and asthma. There's no known cause of those conditions, other than our inheritance. But certainly allergies are known to make eczema worse.

Before changing your diet or the formula you supplement with, I would have further discussion with your pediatrician about your concerns for the prescribed steroids. If the creams are used sparingly over only the reddened areas that may appear itchy, and used for short periods of time, these medications are quite safe.

"Ask questions. There isn't any question you should hold back and worry about. If this is your first baby, you're not expected to be an expert. Don't hold back the worries."

MEMBER QUESTION:
With a fever, how do I know when to call the doctor? For a very young infant, at what temperature do I call?

PANGBURN:
This is one of the most common questions that pediatricians receive, often at 2 a.m., often from a very worried parent. Fever is a warning symptom that there is infection. Most infections in children, infants as well, are viruses that are not serious but rarely may be serious infections. A general rule about fever is that it is the body's response to infection. It implies a healthy immune response.

The definition of a fever is a rectal temperature greater than 100.5 degrees Fahrenheit. There are many types of thermometers available now, including ear thermometers, digital thermometers, and the newest called the temporal artery thermography thermometer, so you may want to talk to your doctor's office about what would be considered an abnormal temperature with the thermometer you use.

A few general rules:
  • If an infant is under 3 months of age with any fever, please call your doctor.
  • If your child is older than 3 months but the fever has lasted more than three days, call your doctor.
  • If your child appears sicker than you expect, regardless of the temperature.
  • An infant or toddler who has a fever of 103 degrees Fahrenheit but is acting normally and is playful and smiling is much less worrisome than the child whose temperature is 101 degrees Fahrenheit and has lost interest in playing or appears excessively sleepy or irritable.
  • When you call your pediatrician, it's very important to describe how your child is acting. That helps us figure out how ill the child may be.

MEMBER QUESTION:
How concerned should we be if our baby doesn't hit a developmental milestone according to the books? My husband is upset that she isn't rolling over yet. I say all babies are different and she's fine. She'll do it when she's ready. Who is right?

PANGBURN:
There are a couple of pieces of information missing from this question, such as how old your baby is. But let me assume that your baby is 4 months of age and is not rolling over yet. That would be quite common, well within the normal range of development. If your baby is 9 months of age and is not rolling over yet that is concerning. Most babies are rolling over in both directions by 6 months of age.

It's important to take a look at the whole baby and not look at one specific milestone. When we try to answer developmental questions or concerns we want to understand how the baby is doing in all areas, including how well they are feeding, how well they're waking, how alert they are, what sounds they're making, how they're using their hands, etc. Many times what you read puts the average age that a child reaches a milestone, and since not all babies are average, many will not have met the milestone by the average time but are still developing quite normally.

So I guess the big answer is, if you're worried ask your pediatrician, and perhaps have both mom and dad at the appointment to both ask questions. You're both probably right.

MODERATOR:
We are almost out of time. Dr. Pangburn, do you have any final words for us?

PANGBURN:
Yes: Ask questions. There isn't any question you should hold back and worry about. If this is your first baby, you're not expected to be an expert. Don't hold back the worries. Ask your questions. And most of all, keep your sense of humor.

MODERATOR:
Especially at 2 a.m. when they barf on you!

Unfortunately, we are out of time. Thanks for joining us, members, and thanks to David Pangburn, MD, for sharing his expertise and experience with us.



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Last Editorial Review: 12/28/2004