True story: a few weeks ago, I was going through a box of items that had been in my parents’ home. In addition to numerous photos, letters and newspaper clippings—yes, my parents were savers of stuff—there was a surprise: a sheet of paper with newborn discharge instructions for…me!
I read the document with much amusement. Some pieces of advice were identical or similar to what most pediatricians would say today: call for fever, burp the baby. But some things were quite different, not the least of which was the one option for infant feeding: evaporated milk mixed with formula, plus an additive I couldn’t even find online (the closest match was actually a brand of whiskey!). Nothing about ready-to-feed formula nor about breastfeeding.
Although I was certainly born more than one generation ago, and I obviously can’t speak about personal experiences regarding my care at that time, this discovery got me thinking about some of the changes in infant care recommendations in the 30 years that I have been practicing pediatrics. Let’s explore a few of these, starting with the one that probably gets the most press.
Immunizations Then and Now
When I started in practice in 1988, routine vaccinations covered eight diseases. Influenza (flu) vaccine was only recommended for high risk groups, and if a child was not high risk, she was done after the kindergarten set. (The next vaccine was a booster ten years later.) An infant got three injections and three “polio drinks” to cover a total of four diseases (the other three being tetanus, diphtheria, and pertussis (whooping cough)).
The total number of diseases against which we vaccinate has now doubled, and many more are given earlier to protect our youngest patients. Hepatitis B vaccine is now started in the newborn period, and influenza vaccine is now a universal recommendation at six months of age. Finally, vaccines against two bacteria—pneumococcus and hemophilus—have been added to the schedule. While these names are not necessarily household words, those of us who cared for children before the addition of these vaccines remember treating very ill patients with blood infections and/or meningitis due to these germs—some with lasting complications.
Although some parents continue to be concerned regarding the number of immunizations, pediatricians appreciate the role they have in preventing illness, death and future disability in children. And infants are particularly susceptible to vaccine-preventable infections, making delaying vaccines problematic. Pediatric providers are concerned that you know as much as possible about immunizations and the diseases they prevent—most of us in practice for a while have seen nearly all the diseases at one time or another—and they stand ready and waiting to address any concerns you may have!
Newer Thoughts on Baby Meds
As the number of immunizations to prevent disease has increased, the number of over-the-counter medications to treat minor illness has undergone an equally dramatic decrease. Cold medicines containing a mild antihistamine and/or decongestant were formerly available down to the age of one month. Now, products containing these or similar medicines are no-nos at least through age 4, and there are others—codeine cough syrup, for example—that are no longer used at all in the pediatric population.
More recently, teething medicines meant to be used on the gums have come under fire and are disappearing from store shelves. And although not really in the same situation because they’re prescription medicines, there’s a tendency to recommend less often oral medicines for mild degrees of baby reflux.
Although the details are different for each of these situations, the general themes are the same:
- The problems that these medicines were designed to treat are self-limited; they will go away regardless of treatment.
- The treatments (particularly for the cold medicines) have not been found to be effective.
- Overdoses have happened with the medicines, causing death in a few cases.
- Some of these medicines may have long-term bad effects on the baby. Most recently, some reflux medicines have been thought to inhibit proper bone development.
For these reasons, providers now usually recommend using treatments for these illness that don’t involve medication. Parents can treat a cold by suctioning out mucus with a nose bulb, using a humidifier, and elevating the head of the bed. Raising the head can also help mild reflux, as can feeding upright. Rubbing the gums with a cold cloth and putting a pacifier or teething ring in the refrigerator may help relieve gum discomfort.
Everyone wants a happy baby with few or no bothersome symptoms. Certainly check with your provider regarding her recommended treatments, but realize that in many cases they won’t involve medications!
Technology: Less Is Better
In my first office 30 years ago, we had paper charts, a handwritten appointment book, and rotary-dial phones where only the last five numbers were needed to dial within the community. We’ve come a long way since then, and it would be unusual to find a pediatric office without a good number of technological helps.
As much as we like to use technology for patient care, the pediatric community has in recent years taken a much closer look at the effects of all those home devices on babies. The main emphasis has been on examining screen time, particularly television.
Although it seems that there have been TV programs aimed at young children as long as there’s been TV, concerns about infants and toddlers’ exposure have been brewing for a while. In 1999, the American Academy of Pediatrics came out with its first statement on the subject, and recommended that this age group be relatively screen-free. The Academy has looked at this issue again and again, reaffirming these recommendations which have been bolstered by additional research.
Thus, despite the presence of so-called “educational” programming aimed at our youngest, exposure to media—TV, internet, basically anything with an electronic screen—should be minimal. The many reasons for this include:
- Too much TV is thought to limit the time for parents and infants/toddlers to play together.
- There appears to be an effect on future development of language and attention span.
- Excessive television appears to negatively affect a child’s sleep quality.
- Too much screen time is linked to childhood obesity. While there don’t yet appear to be any good studies on infant screen time and later obesity, it’s just too easy to get into the habit of putting the little one in front of a screen, which might continue to the time of real risk.
So much has changed in the last three decades. Some topics, such as the evolving recommendations on food allergies, are worth a separate article. And it almost goes without saying that health care itself has changed immensely. One of the most positive changes is that an office visit with your provider is more likely to be a two-way dialogue about what’s best for your baby, rather than just a set of instructions from your provider. Parents should know that there are choices in their baby’s care, but by all means, look at the risks and benefits of all decisions to be made for your young one!