Ask the pediatrician! Dr. Diana Blythe answers your questions about kids’ health

Ask the pediatrician!

Dr. Diana Blythe answers YOUR questions. To submit your question, fill out the form here.

Oct. 27, 2010

My grandson is four-months-old and is breastfed solely. At his four month check up his pediatrician said he was concerned about his weight gain and wanted him to be supplemented with formula. My daughter had just started to give him a little stage 1 baby food and rice cereal a couple of days before his appointment. He also said to go ahead and give him more baby food. The baby was in the 25th percentile in height and between the 5th and 10th percentile in weight. He is alert, active, grasping toys, almost rolling over and quite frankly just an all around pleasant baby. He does not look skinny, but he is not a “Gerber” looking baby. My daughter is very distressed and does not want to give him formula. The pediatrician set up an appointment for 1 week after his four month appointment and advised my daughter that if he did not show signs of weight gain they were going to run tests on him. My daughter has not given him any formula but instead is trying to nurse him to the point he is just stuffed. He loves the baby food and she has increased that as well. I almost feel like we are going to create an unhealthy baby by overfeeding him. What do you think? – K., Dania Beach

First thing to do is congratulate your daughter on having breastfed solely for the first four months. As for the discrepancy between the height and weight, his pediatrician could be worried for multiple reasons. If the pediatrician wants to see him back in one week, they are very concerned. It is rare for pediatricians to recommend supplementing with formula, especially with a mother who has obviously shown she has the skills to breastfeed successfully for four months.

Now, I can only hypothesize (make an educated guess) as I don’t have your grandson’s growth chart. What would make sense is that he is starting to fall off the growth curve. In other words, it is probably not that moment of his height/weight but rather that his “rate of growth” is not adequate.

For instance, if he had been at the 3rd percentile for weight/ 25th percentile for height at the two month visit and increased to the 10th percentile for weight/25th for height, that would be considered a good “rate of growth. While a goal is to be in matched percentiles, the “rate of growth” is even more important. Maybe there is something changing about the milk supply. Between the two and four month visits, moms will usually go back to work. If a mother does not have a place she feels comfortable pumping at work, this can leave 8 or more hours without any stimulation. Being a working mom who breastfeeds can itself have a toll on stress hormones. Also, it may be as simple as dehydration. Milk supply can decrease for any of these reasons. As for overfeeding him, that is very hard to do by nursing whereas with bottle feeding it is easy.

As I do not have all the information, please have your daughter bring her questions to her pediatrician. The pediatrician will want to talk about calorie input, calorie absorption and calorie usage. There are many reasons why a child may not be growing well. Most often, the problem is with calorie input (not enough calories going in). If this is not the problem, the tests the pediatrician runs have to do with calorie absorption and calorie usage.

Hope this helps!

My 11-month-old girl has had a cold for about a week. Her nose is congested very badly. So I have to use saline drops and then bulb syringe to clear the mucus at least 5-6 times a day. My questions if the high frequency of suction will irritate or even harm the baby’s sensitive nose lining? – J., Plantation

The snotty nose… One of the best ways to get called to pick up your child early from daycare. It really is amazing how much mucus can come out of tiny noses. And yes, if you suction your child’s nose too frequently or too energetically, you can irritate the nasal mucosa (nose lining). Here is something to think about.

Ask yourself why you are cleaning out the nose. At eleven months, a child will be better at breathing out of the mouth than at a younger age. A congested nose may look ugly, but not necessarily need to be cleaned out. However, if your child is having trouble eating or breathing, you will need to suction.

After adding the saline drops to the nose, gently massage the soft part of the nose. This will help mix the saline and the mucus, thereby softening the mucus and allowing it to be removed more easily. Suctioning after gently massaging the nose will be more effective and you will suction less often.

Hope this helps!

Oct. 20, 2010

My son was circumcised at birth. He is 14 months old now. How do I know if he has penile adhesions? — M.W., Pompano Beach

This certainly can be confusing as there are many different versions of normal after a circumcision. Start by gently pulling back what is left of the foreskin. There should be a distinct line between the head of the penis and the foreskin without any overlapping skin. If you see a distinct line most of the way around except where the leftover foreskin seems to be sticking to the head of the penis, this might be a penile adhesion. By cleaning the area, you can slowly (over weeks to months) get rid of minor adhesions that are already there and lower the chances of getting new ones.The foreskin of a circumcised penis should be gently pulled back(never forced) and the area cleaned of any buildup. This white buildup is called smegma and is comprised mainly of dead skin cells.

Also, please take into account that this advice is only for parents of circumcised boys. In boys who are not circumcised, it can be normal for the foreskin to not completely retract until puberty. It should not be forced. If you are still worried, ask your son’s doctor. It is our job as pediatricians and family doctors to not just care for your child, but to answer your questions as well.

Hope this helps!