Yes, its flu season.  But its also RSV season.  Respriatory syncytial virus is a very common respiratory pathogen in humans of all ages.  Most infections occur in the first year of life but virtually all children have had at least one RSV infection by age 2. It is highly contagious, especially for children in day care or nursery schools.  LIke influenza, its “season” is October-April and peaks in January-February.  In healthy older children and adults RSV usually causes no more than mild to moderate URI symptoms–low fevers, sore throat and headache, congested/stuffy nose, uncomfortable cough; mild supportive measures ar best for these cases.  But it can occasionally cause severe illness.   

Populations at greater risk include:

  • infants under 6 months
  • adults over age 65 years
  • premature infants under 1 year
  • infants with congenital heart or lung diseases
  • people with asthma or chronic lung diseases
  • immunocompromised people (e.g. cancer therapy or HIV)

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Starting Solids

I want to offer some guidelines for introducing solids to your older infant. Note there’s no exactly “right” way to do this. Some improvisation is ok.

1. When-Generally no earlier than 4 months; recent data suggests closer to 6 months. Doubling of birth weight. Starting earlier does not help your baby sleep through the night, and can increase the risk of immune disorders including asthma and eczema(starting after 6 months does not provide any benefits). Starting earlier can cause constipation and may be associated with increased risk of obesity. Other milestones indicating readiness are better head control, sitting stable with assistance, and ability to hold food in the mouth.

2. What do you need-High back chair on a stable surface, plastic bibs, unbreakable plastic plates and bowls.

3. How-Start feeding once daily (generally in the evening, but this isn’t essential). Feed small amounts first-a teaspoon or two to start, increase as she finishes what’s offered. Generally we now recommend vegetables, meat, cereals , then fruit (nutritionally rich before more calorically dense). In fact there is no evidence that the order of food introduction has any direct influence on later dietary preferences.

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common colds

I am not a medicine guy.  In the 1980’s, Nancy Reagan promoted “just say no”to drugs, and certainly with respect to medications for upper respiratory infections (“URI’s” “the common cold”) I firmly agree.  The large majority of URI’s are caused by viruses for which there is no effective treatment to kill that infection.  Young toddlers routinely experience 6-12 colds each year–that’s one every month or 2.  Fever is a common although not universal symptom.  The cough and congestion typically runs from 3-7 days but it is not rare for it to linger for up to 2 weeks. Headache, sore throat, body aches also occur typically.   It is common for nasal secretions to progress from clear to thick and dark–this is not any specific indication for a bacterial infection that requires antibiotics.

So what does work?

  • Drink extra fluids, particularly hot fluids like tea or soup–the steam eases nasal stuffiness and soothes sore throats
  • Vaporizer or humidifier in the child’s room
  • Nasal saline drops (you can make them at home–boil water for 10 minutes, let it cool, add 1/4 tsp salt for 8 oz of water and you have “normal” saliine) also relieve the stuffed nose.

The object of the above is to loosen respiratory secretions so they don’t settle in the lower respiratory tract and cause progression to bronchitis or pneumonia.  As such, coughing is good as it keeps the lungs clear.  So suppressing the cough is actually counterproductive and, except for sleep or pain relief, should mostly be avoided.

Honey is a mild but effective cough suppressant that can be used with the above in mind.  According to the American College of Chest Physicians, several “old style” anti-histamines can be useful for cough relief to aid the child’s sleep as well.   Acetaminophen (tylenol) or ibuprofen (advil, motrin) is useful for body aches and fever.  Please note that not only are most “cold medicines” ineffective, but they can actually be quite harmful.

What about sinus infections and antibiotics?  The CDC offers some specific guidelines here.

For prolonged higher fever (above 102.2 in children under age 3), coughing with rapid breathing(more than 1 breath/second for an hour), children unable to hold fluids and not passing urine, or a child who appears to be in great pain, it’s always best to call.

Thanks for following; please contact me for comments or questions.

Choosing day care for your child

Let’s acknowledge that the days of the “bread winner father and stay at home mother” are mostly gone.   Whether the reason is professional fulfillment or economic necessity, it is far less common for young children to stay at home all day in today’s world compared to even when I was a young parent.  So choosing proper day care is a very common need, and certainly important and confusing for families today.  What issues should be considered?

1) Note the types of facilities–

  • family home day care–are there enough adult care givers?  Is there proper supervisioin for different ages of children in one area?  Are the premises child proofed for toddlers?
  • Day care centers–Is it licensed?  Is it part of a for profit entity or a religious institution (and if so, what type of religious liturgy might be followed and is that appropriate for your child?)
  • In home day care–hiring a nanny–most expensive
  • Some facilities are available for children with special needs

What are some other considerations?

  • Are caregivers experienced?  Of course check references
  • What does the facility look like–go check it out! Is it clean, is it secure?  Do the children in attendance seem to be enjoying themselves? How are they interacting with the staff?
  • Is the facility licensed?  There are major accrediting agencies for these facilities like the National Association for the Education of Young Children and the National Association for Family Child Care.
  • Is there proper supervision?  Pay close attentionto the caregiver/child ratio–0-12 mo:1/3; 13-30 mo:1/4; 31-35 mo:1/5; 3yrs 1/7; 4-5 yrs 1/8; 6-8 yrs:1/10; 9-12 yrs 1/12(according to Nelson’s Instructions for Pediatric Patients).

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Every new parent’s worst nightmare is SIDS–Sudden Infant Death Syndrome.  Its such an unpleasant topic to discuss but let’s try and go over a few things which can help to ease parents’ understandable anxiety about this nightmarish situation.  SIDS, also called “crib death,”  occurs when an apparently healthy infant dies suddenly in his or her sleep without some other identifiable cause.  It is uncommon but not rare.  Each year, about 4,000 infants die unexpectedly during sleep time, from SIDS, accidental suffocation, or unknown causes, the leading cause of death in babies 1 month to 1 year of age.  Its peak incidence is from 1-4 months and it is no longer a risk after the first birthday.  There is no known cause and, in fact, there may be multiple factors that lead to SIDS-type deaths.

Some risk factors along with preventive measures:

  • Don’t smoke!! Especially if your infant sleeps in your bed.  Note that bedsharing with your infant may be a risk in and of itself.   Also, smoking during pregnancy increases the risk as well.
  • Babies who sleep on their stomachs are at greater risk.  Each day give your baby some “tummy time” which may promote more mature breathing patterns.  You can get lots of information on the “Back to Sleep” program at
  • Overheating–dress the baby in pajamas appropriate to the room’s temperature.  You can “overbundle’ the baby despite what your grandma says!
  • Prematurity.  So, expectant mothers: please keep your OB appointments and try and follow your obstetrician’s advise as much as possible.
  • Chronically ill infants
  • Sibling of SIDS sufferers or infants that have an “apparent life threatening event (ALTE)” may be at risk
  • Boys are at greater risk than girls. African Americans have a greater risk than white babies who have a greater risk than Latinos or Asians.
  • Avoid having your baby sleep on a soft mattress, pad or sheepskin; avoid heavy blankets, thick pillows and bumper pads.  All of these things increase the risk of SIDS.  Current theory is that these soft, fluffy materials may cause the child to re-breath exhaled carbon dioxide leading to low blood oxygen levels and disruption of the infant’s normal breathing pattern.  Have your child sleep on a firm, flat mattress.  A recent study demonstrated that many parents remain unaware of this important safety measure.  We pediatricians must be much more attentive to educating young parents about this (that’s the point of this blog post!!)

There is no evidence that so called SIDS-prevention devices like monitors or “positioners” that hold a baby in a particular position are of any benfit and they are not recommended by the AAP.  They may be harmful.  There is no evidence that immunizations are associated with any increased risk of SIDS.

Being a parent means always living with some anxiety about your child’s safety and well being.  It never leaves (my mom is 84 and still worries about me!)–its part and parcel with the joy and pride that comes with having your precious child.  Following the above, hopefully, can help young parents keep at least this part of that experience in some perspective.  Please contact me with any questions or comments, and thanks for reading