Category Archives: Safety

13 Things You Should Do When Your Baby Starts Crawling

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Baby Crawling

Photo by Douglas LeMoine, Flickr Creative Commons

I must admit I am a completely neurotic mom when it comes to safety. If my girls are sick, I am actually pretty relaxed. A sick child usually takes a while to get to the point of hospitalization, and I am very well versed on every red flag for a sick child; but injuries happen in a fraction of a second. They are preventable, but in the real world no one can predict every move of a very unpredictable baby or toddler. There are moments when you will gasp or scream as you realize that your baby is in danger, and you can’t stop it. These moments happen to all of us, and we never forget them even when the outcome was just a few tears. The safety things I have listed below are the most common causes of serious injuries, causing hospitalizations or death, in crawling infants and toddlers. If your baby is crawling or even scooting across the room then you need to read this.

1- Put up baby gates at the top AND the bottom of any stairs. About 100,000 kids under 5 visit an Emergency Room in the U.S. each year after falling down stairs. More than a third of these are babies under a year old.

2- Crawl yourself! Everyday you should get down on the floor and make sure there are no hazards within his reach. Look for hidden items under the couch that he can (and will) stick in his mouth, or electric cords that he may pull (along with the lamp attached to it), or an outlet that is unprotected. If your baby were to swallow a button battery, magnets, or a push pin, he could be dead in a few hours. Remote controls, key fobs, calculators, hearing aids, thermometers, and holiday ornaments often have button batteries in them. Be sure to always keep these out of reach.

3- Drain any ditches, ponds or fountains that she could get into, or cover them with a heavy grate. If your baby is going to have access to a bathroom while you are out of the room or even showering, you should also consider a toilet lock. Over 100 children drown in the U.S. each year in bathtubs, buckets, toilets, spas, hot tubs and other containers of water.

4- Strap down large furniture, TVs and appliances that your crawler-soon-to-be-climber can pull onto  himself. Every 3 seconds a child in the U.S. will have one of these items topple on them, and every 2 weeks one is killed. Even the most stable dresser becomes very unstable once your child figures out how to pull the drawers out and use them to climb to the top.

5- Make sure any medications, cleaning agents, or chemicals are placed in a cabinet out of your child’s reach and locked. I have cared for countless numbers of little ones who got hold of grandma’s pills and ended up on my pediatric unit or ICU to monitor or resuscitate. Little boys seem to be the most common offenders- something about that Y chromosome!

6- Remove any furniture that has sharp edges and cover any sharp corners like the hearth on a fireplace. Crawling will soon become cruising, and babies have very large heads that usually make contact with the floor before any of their limbs. A sharp corner can turn that little fall into a lot of tears, hours in the ER, stitches and a not-so-small bill from the hospital.

7- Don’t use a baby walker. These walkers can actually delay when a baby starts to walk and they are ridiculously dangerous. The AAP (American Academy of Pediatrics) has tried to have these banned for sale for over a decade now. Babies can move 3 feet in 1 second in a walker. They can fall down stairs (in a way that will almost guarantee a severe head or neck injury), flip on the edge of a carpet, and even reach hot stoves or table tops that would normally be out of reach.

8- Tie up any cords that may be in reach. Cords from things like window shades or baby monitors can entangle and strangle an infant or young child.

9- Be careful when placing your infant in a shopping cart. It is safest to wear your infant in a carrier if you are shopping. If you do put her in a cart be sure that you strap her in correctly, never step away from the cart, never let another child push or climb on the cart, and never use an infant carrier or car seat in a shopping cart. I can tell you first hand, a toppling shopping cart with your child in it is one of the most terrifying moments a parent can witness.

10- Your baby is no longer safe in his bassinet or bouncy seat once he can sit up on his own (or exceeds the weight limit). He may also be too big for his baby swing now. Most crawling infants are too big and too strong to safely remain in these momma-really-needs-a-shower gadgets.

11- Make sure he is always strapped properly in his high chair. There are almost 10,000 Emergency Room visits each year from high chair injuries.

12- Take an infant CPR class, and make sure anyone caring for your child is CPR certified too.

13- Keep the number for Poison Control on your fridge and telephone. 1-800-222-1222

 

You can click on the links below to access more information:

Button batteries

Magnets

Shopping cart safety

Bouncer seats

Infant swings

High chairs

CPR classes

Baby Safety: The 2 Leading Causes of Death and How You Can Prevent Them

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Safe to Sleep® campaign, baby safety, SIDS

Image courtesy of the Safe to Sleep® campaign

Recently I was asked to speak at a childbirth education class at my local hospital. I love talking to expecting parents as it brings back my own memories of that time: the excitement, hopes, fears…My topic tonight was baby safety.  I want to share this information with you as well.

1- SIDS (Sudden Infant Death Syndrome) and accidental suffocation is the leading cause of death in infants in the U.S. from 1 month to 1 year old.  Your child’s sleep environment is the most important thing you can control to keep your baby safe.  It is important that your baby always sleeps on her back on a firm surface with no crib bumpers, pillows (or breastfeeding pillows), sleep positioners or soft bedding. The safest place for your baby is in a crib that is in your room for the first 6 months. Breastfeeding is also associated with a lower risk of SIDS. If you choose to have your baby sleep in bed with you it is really important to keep in mind the risks and what makes a sleep surface safe.

Our first child was a really fussy baby and we did end up sleeping with her occasionally during her fussiest months (1-3 months). It is not something I recommend to others, but it was a decision we made out of desperation and with all of the risks in mind. We have a firm mattress (pillowtop removed), we slept with no pillows or blankets, and we placed her in the middle of a king size bed. This would have been especially dangerous if there were any other risk factors for SIDS (secondhand smoke, obesity, alcohol or drug use, or pain medications). We never let her sleep on her stomach and we never slept on a couch or chair with her. Sanity trumped absolute safety in our house, but we did our best.

For more information on SIDS prevention and safe sleeping please go to Safe to Sleep.

2- The leading cause of death in infants 1 month to 1 year worldwide is respiratory infections, including pneumonia and influenza. Thankfully in the U.S. we have free access to vaccinations. Unfortunately our vaccination rates in many areas of the country are below 90% and we can’t protect our infants unless everyone they are surrounded by is fully vaccinated. We also have access to clean water. Good hand washing can be very effective in reducing the spread of disease. Unfortunately not everyone (especially young children) does a great job of washing their hands after coughing, sneezing, wiping their noses, or using the restroom.

So what can you do to keep your baby safe from infection?

  • Remind people to wash their hands or use hand sanitizer before touching your baby.
  • Ask people who are sick to visit another time. The first sign of many illnesses that can be dangerous to your baby is just a clear runny nose (whooping cough, measles, RSV…).
  • Make sure anyone who is around your baby is fully vaccinated. This should include a yearly influenza shot and whooping cough (pertussis) booster.
  • Avoid crowded places for the first few months. If you have to go somewhere crowded try to keep your baby in an infant carrier or stroller with a blanket thrown over the top. Carry hand sanitizer and avoid anyone that looks like a grandma! She will want to touch your baby 🙂

For more information go to the AAP (American Academy of Pediatrics)

So I am curious (and maybe neurotically overprotective based on my career choice): Do you ask your friends and family to stay away if they are sick? Do you ask them if they are vaccinated before they come visit your newborn? How do they react?

 

Dr.Raja Live on the Dave Congalton Show

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Natasha Raja, MD on the Dave Congalton ShowIn case you missed the live broadcast, my interview on the Dave Congalton Show is now available as a podcast. You can listen here (my interview starts 37 minutes into the broadcast).

Dave and I discussed my background and reasons for choosing a career as a pediatrician as well as my book, Parenting MD: Guide to Baby’s First Year. We also talked about why the first year of your baby’s life is so challenging, and we ended with a heated discussion on vaccines. It was a lot of fun and I hope you enjoy listening. Please comment below if you would like to continue the conversation.

Thank you Dave Congalton and KVEC for having me on your show!

5 Things You Need to Know About the New Car Seat Laws

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csl-5step-test-graphic-w-textThere has been a lot of buzz lately about new car seat laws in 2014. This is what you need to know:

1- There is no new law in place right now. There is a proposed law that car manufacturers and car seat makers get on the same page; what we want is consistency. Your child’s car seat may allow your child to be in the car seat until 65 pounds, but your child’s weight plus the weight of his car seat weight may exceed the LATCH system’s weight limit (often 65 pounds or less). In this case, the LATCH may not hold the seat in place if there is an accident.

2- If your child plus his car seat exceeds the safe weight limit for your car’s LATCH you can still secure the car seat with a seat belt. There is no maximum weight limit for the seat belt to secure a car seat.

3- You should always use the top tether on your child’s car seat. There is currently no weight limit for the top tether, and we know they significantly reduce the risk of head injuries if you are in an accident.

4- You should still have your infant or toddler in a rear-facing car seat until she is at least 2  years old or she exceeds the height and weight limit for your particular seat. Rear-facing is so much safer that we just changed our daughter’s car seat to forward-facing at 3 ½ years old!

5- Your child should switch to a booster seat after he exceeds the safe height and weight for your forward-facing seat (typically over 4 years old and over 40 pounds). The AAP still recommends that he remain in a booster until he is 8-12 years old and 4 feet 9 inches tall.

For more information and max weight limits for your vehicle go to Car Seats for the Littles and the Car Seat Lady

Parenting MD: Guide to Baby’s First Year

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This book, written exclusively for e-readers, is filled with straightforward and up to date information to guide you from preparing for your baby’s birth to celebrating her first birthday.

The ebook format includes links to useful resources within the book and online.

Quickly access helpful information about feeding, sleeping, development, and common ailments, as well
as a glossary of terms and conditions.

Every day, research continues to expand our knowledge about keeping our children safe, healthy, and thriving. The information and recommendations contained in this book are based on the most current evidence available. Printed books can take years to get to publication, and medical knowledge and safety recommendations often change before the book even hits the shelves. This electronic format allows the reader to have access to the information within days of the final edit. Dr.Raja will also provide periodic updates to the ebook for free. Subscribe to ParentingMD.com and follow Dr.Raja on Facebook to find out more.

10% of proceeds will be going to St. Jude Children’s Research Hospital

 

Naturopathic cures for the common cold?

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opiumAs a pediatrician I have come to realize that I don’t always get the whole story when I see my patients. Teenagers will often deny that they smoke (because pot smoking is not smoking, right?), and parents will often deny that they are giving their toddlers medications (because over the counter meds or homemade remedies don’t count, right?). I have learned to ask the same question multiple ways if I am concerned. Parents, unlike some of the teens, are not trying to withhold information. It is usually because the vaporub or herbal remedy seems risk-free or unimportant. I hope it is never because they believe I will disapprove of more natural remedies.

The truth is I am a “naturopath”. I believe in our body’s natural ability to fight off infections and heal itself. I believe in the power of good nutrition, exercise and balance. I do not prescribe cold medicines or antibiotics for viruses. But I have also lived and worked in places where modern medicine is not available. I have seen many children die. Thankfully, modern medicine (antibiotics, chemotherapy, vaccines, screening labs) continues to save the lives of millions of children around the world. I also get to see this every day.

My own children are fully vaccinated. My own children have had antibiotics (once each) for bacterial infections that would have otherwise put them at great risk. My children have had Tylenol and Motrin when they had a fever or were in pain. But mostly my children have had salt water (saline) for their snotty baby noses, honey for coughs (over 1 year old) and chicken soup for their colds. I have spent many nights holding my babies in my arms while they ran fevers or coughed incessantly for hours, but I knew nothing but time would cure their viral illnesses. I so desperately want to fix every hurt but most importantly I need to …. DO NO HARM.

This means I do not use vaporubs (menthol and camphor) or essential oils for my kids. I do not give them alcohol baths for fever. I do not give them herbal remedies or teas. I do not give them antibiotics for viruses, and I do not give them cough or cold medicines. These are the risks:

  • Menthol and essential oil rubs can actually worsen respiratory distress in young children.

  • Alcohol baths can lead to alcohol poisoning, seizures, or death.

  • Herbal supplements are not FDA regulated and up to ⅓ of them don’t contain any of the ingredients listed.

  • Numerous studies have found high levels of lead in tea leaves.

  • Thanks to vaccines, the majority of infections today are viral and antibiotics will not help.

  • Over the counter cold medicines have shown no benefit to kids under 6 years old and they can cause dangerous heart arrythmias in young children.

I have an amazing cousin who is the mother of a very cute one year old. She is a wonderful, very intelligent, and caring mother. Thanks to her great questions and Facebook posts, I continue to learn what she and other parents are trying to help their little ones get through the toughest nights with their sick babies. I continue to research every remedy that it is proposed to find out…. what are the risks? what are the benefits?

In the past, people have tried whiskey, cocaine, and opium (called Svapina in the ad above) to relieve a child’s cough. The truth is, medicine is constantly changing and we can all learn together. Talk to your child’s doctor about what you are using for your kids, or what your friends have tried. Give them the chance to learn from you or to teach you about potential risks. We all want our kids to be safe and healthy. There is no better common goal.

To find out more about complementary medicine practices (both safe and unsafe) please go to the National Center for Complementary and Alternative Medicine.

Would you buy a car without seat belts?

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tvBuy a car without seat belts? Probably not. But this holiday season millions of TVs, appliances and furniture are being purchased without safety straps.

Every 3 seconds a child in the U.S. is injured by a falling TV, appliance, or piece of furniture. Every 2 weeks one of these children dies. Every 2 weeks.

As a pediatrician I once tried (and failed) to save a child who was crushed by a falling TV, and I cared for another child who had permanent brain damage from a falling TV. These two children have been a driving force in my focus on safety education. This holiday season please keep safety in mind in your own home, as well as the homes of family and friends that you may visit.

I live in earthquake country so one of the first things we did in preparation for our new baby was strap everything down (in our house and the grandparent’s). There are earthquake straps available in hardware stores throughout the country because the greatest risk is not an earthquake. The greatest risk is a toddler who climbs everything in her path, a preschooler wrestling with a sibling, or a young child trying to turn on the TV.

You wouldn’t buy a car without seat belts. Why would you buy a TV or dresser without safety straps?

For more information:

TV

 

 

Is Swaddling Risky?

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SwaddleAs new parents we are always looking for ways to get through the toughest first months with our newborns. How can I get my baby to sleep better? How can I get my baby to stop crying? There are a million answers to these questions: gimmicks, gadgets, and folklore that promise to solve all of these normal baby problems. The bottom line always comes back to time. Give it time and your baby will develop the ability to soothe herself. Give it time and she will learn to fall asleep on her own. In the meantime how do we, as sleep deprived parents, manage to get through these months?

When my oldest was 5 weeks old and in the peak of her crying (and mine) and sleepless nights, we watched The Happiest Baby on the Block by Harvey Karp, M.D. His tips on soothing a crying baby gave us hope, and swaddling was the one recommendation that proved to be the most effective for us. It wasn’t that we were able to stop her from crying every time; what he gave us was another tool to put in our new baby survival toolbox. It was something to do. It was a glimmer of hope. It was not a cure for her crying every time, but it was a cure for our sanity. But….. is swaddling safe?

There have been numerous studies looking into the risks of swaddling. This is what we know today:

  • Swaddling does NOT increase the risk of SIDS when a baby is placed on his back to sleep. In fact two studies have shown a decreased risk of SIDS in babies swaddled when sleeping on their backs.1,2  It is important to stop swaddling him when he is able to roll over onto his stomach, because a baby swaddled in the prone position (face down) is at greater risk for suffocation or SIDS. Some babies can roll over on to their stomachs by 2 months of age.

  • Swaddling CAN increase your baby’s risk of hip dislocation or dysplasia IF done incorrectly. If you swaddle your baby correctly her legs should still be able to bend up and out at the hips. Click here for instructions on how to do a “Hip-Healthy Swaddle”.

  • Swaddling CAN comfort a crying baby and DOES help babies sleep. The key to swaddling is to keep his upper body secure. This will prevent his Moro or startle reflex from waking him up. It also mimics the snug and secure environment he had in the womb.

The bottom line: swaddling is a safe and incredibly useful way to comfort a baby and help her sleep. Just make sure you do it correctly and keep your baby’s sleep environment free of loose bedding, crib bumpers, stuffed animals, bags or pillows.

Do you have any tips that helped your baby stop crying or sleep better at night?

References

1  Factors potentiating the risk of sudden infant death syndrome associated with the prone position. Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. N Engl J Med. 1993 Aug 5; 329(6):377-82.

2  Clothing and bedding and its relevance to sudden infant death syndrome: further results from the New Zealand Cot Death Study. Wilson CA, Taylor BJ, Laing RM, Williams SM, Mitchell EA. J Paediatr Child Health. 1994 Dec; 30(6):506-12.

Having “the talk”

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Talking to kids about stranger danger, safety, and sexual abuse

Thankfully my girls are still little enough that “the talk” is not about SEX but rather about SAFETY.  Last week I had a really Bad Mommy moment. Apparently the kindergarteners were getting out of school early and I had missed the memo. Unfortunately my daughter’s teacher released her out into the play yard without noticing that I WAS NOT THERE! She then locked the classroom and left. Although I have played the “what if” game in my head a hundred times since then, it all turned out fine. One of the daddies, a good friend, was out there with his son and noticed her alone. He called me and thankfully grandma was able to rush over immediately and save the day. Yikes. The rest of that day I kept wondering: Was I teaching my daughters enough to protect them from others who may try to harm them?

There are so many safety issues that go through my mind everyday. At the hospital I see babies who have fallen off beds, toddlers who have swallowed grandma’s pills, preschoolers who have been crushed by a falling TV, and helmetless teenagers who have fallen off their skateboards. The list goes on and the memories of these kids have turned me into a neurotic safety freak at home. Thankfully I have not seen or known anyone whose child has been abducted. I would have really fallen apart last week if I did. According to the US Department of Justice “there are about 115 stereotypical kidnappings, defined as abductions perpetrated by a stranger or slight acquaintance and involving a child who was transported 50 or more miles, detained overnight, held for ransom or with the intent to keep the child permanently, or be killed”. More children actually died from  chicken pox in the U.S. each year until the varicella vaccine became available. The news media has not made us fear chicken pox, but watching CNN will give us nightmares about losing our babies to a stranger. The crime numbers that we should probably pay more attention to are the statistics on sexual abuse. Nearly 25% of all girls and 15% of boys in the U.S. will be sexually assaulted or abused. Look around your child’s classroom. That is 1 in 4 of those girls and 1 in 6 of the boys. Depressing stuff.

The good news is that we can better protect our children from others who may harm them by educating ourselves and educating them. This is what you can do:

  • Talk about it! From the time my girls were toddlers we talked about who should be changing their diapers, and why other people should not touch or look at their “private parts”. I want them to be proud of their bodies. I want them to streak through the house squealing after baths. But I also want them to know that their bodies are their own. No one else has a right to touch them or hurt them. It is important to let your child know that other people should not be asking your child to touch them either.  Using correct anatomical terms will help them explain and understand the concepts better. I talk to every child I see about this in the office before I examine them.
  • Teach your children about good secrets and bad secrets. Good secrets would be something like a surprise party or present. Bad secrets would be anything that makes your child feel sad, guilty, or anxious. These are secrets that have to be shared with a trusted adult.

  • Give them “what if” scenarios. “What would you do if mommy was in the shower and someone knocked at the door?”; “What would you do if someone approached you and said mommy was hurt and they needed to take you to her?”; “What would you do if someone lost his puppy and asked you to help find it?”; “What do you do if an adult you don’t know pulls up in a vehicle to ask you a question?”

  • Read books about stranger danger and safety. We have a Winnie the Pooh book that the girls love. We read it over and over again and talk about what Piglet and Pooh learned from Christopher Robin. If you engage a child’s imagination then she is more likely to remember the lesson you are trying to teach her.

  • More tips: teach your kids your address and phone number, teach them how to call 911, label their clothes with your phone number, do not let your child use a public restroom alone.

Resources

National Children’s Alliance Child Abuse Resources

The National Center for Missing and Exploited Children

Teething Torture

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teethingA friend’s baby had the scariest looking teething experience I have ever seen. He had gums smeared with blood and gore as 4 teeth popped through simultaneously. It made even my steel stomach jump. Thankfully it was short lived and he was a happy baby despite the gore.

In the 1800’s some people actually believed teething could cause death. I suspect it was the treatment of teething (lancing the gums, applying leeches, cauterizing the back of a baby’s head) that was the real cause of death. There were teething powders made with mercury and teething toys made with animal bones (believed to bring the strength of the animal to fight off the pain). Today we continue to have some misconceptions about teething so I wanted to share some facts and myths with you.

Facts:

  • Teething starts between 4 and 12 months and typically ends by 2 years of age.

  • Teething can cause “increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation”.1

  • Teething usually starts with the upper or lower central incisors (middle two teeth). After that the pattern and frequency of new teeth are really variable.

  • Teething does NOT cause significant fever (>102 fahrenheit), congestion, cough, ear infections, vomiting or diarrhea. These symptoms are more likely caused by bacteria or viruses and you should call your baby’s doctor if you are concerned.

Treatments NOT recommended:

  • Homeopathic teething tabs are not regulated by the FDA and therefore have no standardized testing methods to prove that they are produced in a safe manner or contain the ingredients listed on the box. None of these tabs have ever been able to prove any documented benefit in teething babies. In fact many of them contain belladonna, a substance known to have many toxic side effects including constipation, aggitation, and drowsiness. Please read more about the topic in this Q & A section by the FDA.

  • Teething gels have topical anesthetics like benzocaine. Rubbing it on the gums will only numb the area where it is directly applied, but it will do nothing for the tissue underneath that is actually  in direct contact with the budding tooth. These anesthetics are also not risk free and can cause a rare but sometimes deadly condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the bloodstream is greatly reduced. Please read more about this on the FDA’s website.

  • Amber necklaces. These are very reminiscent of the animal bone toys used in the 1800’s. They do not help with teething pain and pose a very real suffocation, strangulation and choking hazard to your infant.

 What can you do:

    Teething, like crying, is a normal developmental process for infants. There are helpful tips to try, but the only cure is time. The safest options are cold clean washcloths for chewing (you can even put them in the freezer for a few minutes for extra soothing), teething rings chilled in the fridge (not freezer), or frozen fruit in a choke free food feeder (once he is over 4 months old).  Massaging his gums and letting him chew on his own hands will also help. We also used acetaminophen for the roughest nights of teething. Just check the dosing with your baby’s doctor.

Sources:

1 Macknin, ML et al. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000 Apr;105(4 Pt 1):747-52.

Do you have any safe teething tips that worked for your baby?