Category Archives: Newborns

Why does my baby’s eye constantly have tearing and goopy drainage?

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Suzanne Berman, M.D.

Many healthy young infants can have watery or ”mattery” eyes. Parents often wonder if their baby has pinkeye or an eye infection. Actually, the usual cause is a small, blocked tear duct. It is not a bacterial infection and doesn’t need antibiotic drops. Fortunately, it is harmless and won’t affect the baby’s eyes. It will resolve on its own with home treatment.

Why are tear ducts important?

The tear gland (above the eye) produces tears to bathe and protect the eye. The tear duct (below the eye) drains away tears and debris. If the tear duct gets blocked or stopped up, there is no place for the tears and debris. The tears will start to run out over the eye, and the debris and mucus will begin to accumulate in the inside corner of the eye, forming mattery material.

Why do babies’ tear ducts get blocked?

Babies, because they’re small in general, have very small tear ducts. Also, anything that makes a baby’s nose swell up–like lots of crying or a cold–will swell a tear duct closed.

How can I unblock my baby’s tear ducts?

Fortunately, nothing has to be done, because leaving the eye alone isn’t harmful. However, if the drainage bothers you, try the following. Applying warm, moist compresses over the eye and massaging the tear ducts can help open the tear duct. This has to be done several times a day until the baby grows big enough that his or her tear ducts enlarge on their own. If it is still a problem when the infant is over 9 months old, an opthalmologist can surgically open the blocked duct, but this is very rarely needed.

How can I tell if it is pinkeye?

Pinkeye, also called conjunctivitis, is an infection of the lining of the eye. There is thick pus in the eye and eyelashes, and the white part of the eye will be red.

Why does my baby spit up so much?

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Suzanne Berman, M.D.

Nearly all babies spit up to some degree. Occasionally, though, a baby seems to vomit so much that parents wonder if something is wrong.

Persistent spitting up in babies is called reflux (also called gastroesophageal reflux or GER.) Reflux is never concerning in an otherwise normal baby who is growing and developing normally. It will sometimes seem that a baby vomits more than he eats, and may seem amazing that he grows or gains weight at all! These “happy spitters” do quite well, and are chubby more often than scrawny. Most show significant improvement by 6 months of age, and almost all are better by their first birthday.

In our experience, most “spitty babies” are formula fed. This is because formula flows much faster from a bottle than does human milk from the breast. It’s a lot easier to “overeat” when the baby doesn’t have to work to get the milk. Babies also don’t “know when to say when.” An infant’s stomach is not much bigger than his two fists together, babies will try to eat more, resulting in vomiting. The baby will then be hungry again, causing a second rapid feeding (and often more vomiting.)

Reflux can be very smelly. Many parents are concerned when they see nasty-smelling curdled milk in their child’s vomit. However, this is what milk mixed with stomach acid looks like; it’s not a sign of something strange. Reflux can indeed be messy, but it’s not harmful to an otherwise normal baby. If reflux bothers you, here are some things you can do to help it:

  • Feed your baby in the upright position.
  • Offer your baby smaller feedings that are more frequent. This is the single biggest change you can make to help reduce spitting up. For example, most one month olds spit up if they take 4 oz at a time every four hours. The same baby will probably be much less “spitty” with 2 oz every two hours – which is still the same total amount of milk in a 24 hour period. Most newborns can only take an ounce or two at a time; most four-month-olds get “spitty” beyond 4 ounces at a time.
  • Elevate the head of your baby’s bassinet or crib at an angle of about 15 degrees. This gets gravity on your side. (Let your baby lie flat or stand up; a seated position such as in a car seat can actually cause more reflux.)
  • Burp your baby well in the middle of and after feedings. “Barracuda babies” who ravenously take a complete feeding in 10 minutes swallow lots of air with their milk.
  • Try a different type of bottle. There are new “airless” bottles that reduce the amount of air babies swallow with feedings, available at some of our local pharmacies. These bottles also result in slower milk flow, helping infants to feed slower overall.
  • Add a teaspoon of rice cereal to a bottle to thicken the feedings.
What if these things don’t work?

Let us know if the above suggestions don’t work. Sometimes we can recommend other changes if reflux persists, like prescription medication. Vomiting is rarely caused by formula intolerance, and so we don’t usually recommend changing formulas simply for persistent spitting up.

When is spitting up worrisome?
  • Extremely forceful (“projectile”) vomiting. Although seen in many normal children, it can be the sign of severe blockage if it happens more than once.
  • Dehydration, as seen by decreased saliva, tears, and urine (see our information sheet on dehydration.)
  • Weight loss or minimal weight gain in a child under the age of 1. Ask us if you are concerned about your baby’s weight gain.
  • Peculiar vomit, containing bile (bright green) or blood (red or brown.)
  • Associated with other symptoms which are themselves concerning, like severe belly pain or distension, wheezing, profuse diarrhea, and/or severe skin rashes. These should be reported to your doctor immediately.

Why do newborns get jaundiced, and when is it bad?

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Suzanne Berman, M.D.
Why do newborn infants get jaundice?

Jaundice, a golden yellow discoloration of the skin and eyes, is very common in newborns. About 60% of healthy, full term infants have some degree of jaundice in the first week of life. (It is even more common in premature babies.) The yellow color is due to a pigment called bilirubin, a by-product of the breakdown of red blood cells. In many newborns, the bilirubin level is high enough for the pigment to accumulate in the baby’s skin, causing the golden color. Usually, the yellow color starts on a baby’s cheeks and face, then spreads downward to the chest and abdomen.

Where does bilirubin come from?

Bilirubin comes from hemoglobin (the oxygen carrying protein) in old red blood cells. As red cells are broken down in the body, the hemoglobin inside gets converted by enzymes to become bilirubin. The bilirubin is then transported in the blood to the liver. The liver processes it further (called conjugation) and then sends it to the gall bladder. The gallbladder then excretes the bilirubin into the intestine, where it goes into the baby’s stool and is eliminated from the body.

Why do babies have such high bilirubin levels compared to older children?

The high bilirubin is caused by several differences between newborns and older children and adults:

  • Healthy babies break down about 30% of their red blood cells in the first month of life, which tends to make a lot of leftover bilirubin. Babies with bruising or birth trauma (hematomas) can break down even more red blood cells.
  • Slow livers. Right after a baby is born and cries for the first time, his or her lungs have to start to work harder. A baby’s liver has to do the same, and is usually a little slow getting started.
  • Delayed stooling. If a baby is “slow to poop,” he or she may not get rid of the bilirubin in the intestines very quickly. The bilirubin can even get re-absorbed from the gut if the baby doesn’t have many stools in the first few days of life.
  • Breastfeeding. For a number of reasons too complex to describe here, breast feeding can cause elevations in bilirubin. (Note: this is a mild elevation and isn’t a reason to stop breast feeding.)
When is jaundice concerning?
  • Jaundice that develops in the first 24 hours of life. This is one reason why we don’t like to send babies home right after delivery; we want to follow their color for the first few days. “Early” jaundice suggests that there might be a different problem going on.
  • Very severe jaundice. Bilirubin levels above 20 warrant treatment (see below). In small or premature babies, we might institute treatment sooner.
  • Other concerning symptoms. If the baby has any other signs of illness or infection, like fever, lethargy, poor feeding, dehydration, etc., obviously those other symptoms would need to be checked out.
How is jaundice treated?

Again, jaundice to some degree is normal in all babies, and treatment is usually not needed. Bilirubin levels of 10-15 are very common in term infants 2-4 days old and don’t usually require any special treatment. On most babies who are jaundiced, we can check a bilirubin level in our office and have the results in a few hours. If it is reassuring, the baby can be followed outside of the hospital. There are a few things you can do at home to help keep the bilirubin level down:

  • Make sure the baby is feeding well. The more stools the baby has, the better his or her bilirubin excretion will be. If you are having trouble breastfeeding, let us know and we can make some suggestions.
  • Let the baby get some sunlight on his or her skin. Light in the “blue” range converts bilirubin in the skin to a form that is more easily eliminated. Also, bright natural sunlight helps you keep track of the baby’s color better than artificial light. You can take the baby outside on a warm day or put him or her in a sunlit window in the winter.

If the bilirubin level gets very high (usually above 20), we recommend putting the baby in the hospital for a few days to get intensive phototherapy (bright light treatment) and checking bilirubin levels several times a day until it comes down.

If intensive phototherapy in the hospital doesn’t bring the bilirubin level down quickly enough, the baby may need a special blood transfusion in a newborn intensive care unit. Fortunately, this is very rare.

What should I know about my new baby?

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Suzanne Berman, M.D.

Congratulations on your new son or daughter. The following information is a guideline about what to expect in your first few weeks home.

Bathing and skin care

Give a brand-new baby sponge baths until the umbilical cord stump has fallen off and the penis is well healed (if your baby was circumcised.) Then you can begin regular baths. Bathing should take place in a warm room, free of drafts. The water should be warm, not hot — test it before putting your baby in.

Never leave your baby alone in the bath — not even to answer the phone or get a towel. Babies can easily lose their balance and drown in just a few inches of water. Never use a cotton swab to clean your baby’s ears and nose; instead, a washcloth placed over your fingertips is sufficient. After drying the baby well, you can apply a non-perfumed, mild moisturizing lotion to areas of dry skin. Don’t use oils except on the scalp — they can cause rashes.

Cord care

The umbilical cord usually falls off when your baby is 7-14 days old. (Sometimes it takes as long as 3-4 weeks and this is normal. If not, we can remove it in the office.) Until it falls off, clean the base of the cord with alcohol twice a day. A little bit of mild bleeding or clear drainage from the base of the cord is normal. However, let us know if there is heavy bleeding, pus or foul-smelling drainage, or if the skin around the cord becomes red.

Feeding your baby

Your baby should be burped to release air that is swallowed during feeding and crying. Try to burp your baby halfway through a feeding and then again at the end. To burp your baby, hold him or her against your chest facing over your shoulder, or sit the baby in your lap with his or her chin supported in your hand. Rub or pat the baby’s back gently. If the baby doesn’t burp, try again before the next feeding.

It’s normal when…

Most infants have a number of surprising habits which are very normal.

  • All babies sound congested. Adults and older children with stuffy noses will breathe through their mouths, but infants always breathe through their noses. Therefore, they often have a coarse, snuffly sound because their noses and sinus passages are so small. One tiny fleck of mucus in a small baby’s nose can sound like a tornado! Babies who are around cigarette smoke or wood smoke are usually even more congested. If a baby is producing lots of mucus, he or she may have a mild cold. (Expect about 10 colds in your baby’s first year.) Rather than using over-the-counter decongestants in these small infants, suck the mucus away with a rubber bulb. You can loosen the mucus first with warm saline nose drops. (See our instruction sheet on how to clean out a baby’s nose.) If you can’t see any mucus, using a bulb probably won’t help much. Once kids get bigger and learn how to blow their noses, this problem goes away.
  • All babies have irregular breathing. Babies pant and sigh frequently as part of their normal breathing pattern. Babies can have normal pauses in their breathing that can last up to ten seconds. On the other hand, babies should not gasp, turn blue, or have to tug their chests in and out to breathe.
  • All young babies grunt, draw up their legs, and turn red when trying to pass a stool. Babies sometimes even cry just before stooling as if it is very painful, then pass a normal, formed soft stool. This is because they cannot sit up and bear down like older children or adults. Unless the stool is rock-hard or contains blood or pus, don’t worry about how your baby acts with stooling.
  • A new baby’s stools are nothing like the normal stools of childhood. Right after birth they are sticky and greenish-black (called meconium.) Bottle fed babies’ stools can vary in color and consistency, and can be yellow, green, or brown; they can be firm, mushy, or watery. Breastfed babies can have 2-12 yellow-green runny or mushy stools a day. Most babies, at 2-3 weeks of age, will at some point go 3-4 days without any stools. This is completely normal. Many parents become quite worried and rush for suppositories, laxatives, different formulas, etc. if the baby goes for more than a day without stooling. Resist the urge to do this: not stooling is harmless, but some remedies to induce stooling can be. Remember, stools are waste products left over from what the baby does not digest. If the baby is just very good at absorbing and digesting his or her milk, there may not be much waste product left over! When the baby is ready to have a stool, he or she will have one. Unless the baby goes for more than 5 days without any stool and is otherwise happy and healthy, it is rarely a cause for concern.
  • All babies can have blocked tear ducts. Babies have very small tear ducts (found on the inside bottom corner of the eyes.) If blocked, there can be eye mattering and “goopy” drainage. Unless the white part of the eye is red, the eye isn’t infected. See our information sheet on blocked tear ducts.
  • Babies can get lots of marks, patches, and rashes on their skin in the first few weeks of life. In the first week of life, most infants get at least a little bit jaundiced, but usually this is normal unless the jaundice becomes very severe. In the first week, red “flea bite” splotches are common. For two weeks, hands and feet tend to peel like after being in a bath too long (the baby was in a “bath” for nine months.) They’re not attractive, but they’re harmless and will go away. If you are concerned about a particular rash, let us know.
  • All babies scream and cry – a lot. Some healthy babies, by the time they are 2 months old, can cry for 2 or 3 hours continuously each day. Babies cry to express emotion when anything is wrong: hunger, discomfort, boredom, gas, loneliness, fatigue, and illness. There’s no hard or fast rule as to how long you should let a baby cry. However, crying never hurts a healthy baby.
Keeping your baby healthy

Until a baby is about 3 months old, we take any kind of illness very seriously. If your baby has a temperature of above 100.4 before he or she is 3 months old, let us know right away, day or night. (After a baby is about 3 months old, his or her immune system is developed enough to fight off the usual germs, and a fever itself is not really that concerning. See our information sheet on fever for more information.)

The best way to take the temperature in a baby is rectally (in the bottom.) See our information sheet on taking a child’s temperature.

In order to keep a baby well through this critical time, no one who is sick should be in the same room as the baby. That means:

  • No kisses from older siblings with the sniffles.
  • No visitors with coughs or colds. Do not be afraid of asking visitors to come back at another time when they are well. (Learning to say “no” is one of the hardest parts of being a new parent.)
  • No trips to the mall or store with the baby. Everyone at Wal-Mart will want to see your beautiful new baby. With dozens of well-wishers leaning over her to coo at her, someone is likely to spread germs to her.
  • No daycare or church nursery until 2-3 months old, if you can possibly help it. Again, we assume that in a roomful of toddlers, at least one of them is contagious with something that may be mild for them, but could potentially be much more severe for the baby.
  • No smoking in the house, ever. Infants around cigarette smoke have so many more ear, nose, and lung problems. If you can’t quit smoking (or make Grandma quit), then at least keep the smoke outside. Just smoking in a different room of the house is useless: all the air in a home recirculates eventually.

You will have lots of questions about your baby in the months to come. Let us know how we can help you.

What should I do for my baby’s thrush?

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Thrush is caused by a yeast infection that grows on the lining of the mouth. It can cause bleeding of the mouth and gums if it is severe. It is very common in babies.

Sometimes parents see white material inside the baby’s mouth and wonder if it is thrush or just milk residue. Milk residue is thin and wipes or rinses out of the mouth easily. It is usually just found on the tongue. Thrush, on the other hand, can’t be easily removed from the mouth lining or tongue. The thick, white plaques, when scraped off, usually leave small ulcers or bleeding underneath. Also, thrush usually covers the gums and the inside of the cheeks.

Thrush is treated by removing sources of yeast from the baby and with medications, such as Nystatin.

How to apply Nystatin

Nystatin is a topical medicine – it works only on the surfaces it can touch. Therefore, it is very important that the nystatin gets applied directly to the areas with thrush. Sometimes parents just splash the medicine in the baby’s mouth, which mostly dribbles out or gets swallowed before it has a chance to work.

The best way to apply nystatin is with a Q-tip. Measure out the dose into a small cup. Dip a cotton swab into the medicine, then rub the swab gently against the white areas in the baby’s mouth. Repeat with an additional dose inside the other cheek.

Use the nystatin every day until the baby’s mouth looks clear, then continue the medication for two more days after that. If it’s still not getting better after a week of treatment, let us know.

Other things you must do

As with most other illnesses in pediatrics, prescription medicine is only half of the treatment. Sources of yeast must be eliminated. Otherwise, the baby will keep getting re-infected and the nystatin won’t do any good.

For breastfed babies, mothers need to treat their breasts with Nystatin cream. Mothers may have yeast on their nipples that keeps re-infecting the baby. Usually mothers will have red, cracked nipples, but this is not always the case.

For bottle-fed babies, boil all the nipples. This will kill any yeast lurking in the nipples.

Throw away the pacifiers.It is very hard to get rid of the yeast completely as long as the infant uses a pacifier.

What can I do for my baby’s constipation?

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Suzanne Berman, MD

Almost all formula-fed babies, at some time between the ages of 2 weeks and 4 months, will go for 2-4 days without a bowel movement. (Breast-fed babies may do this as well but it is much less common.)

Why does this happen?

Most of a baby’s milk gets absorbed by his body, leaving very little waste product. Babies have an incredible growth spurt at this time in their lives, sometimes putting on as much as a pound in a week or two. All the calories, protein, fat, and other nutrients in the baby’s milk provide the necessary nutrition to do this. The baby’s intestines are designed to absorb as much of these nutrients as possible, and not much will be left over. Also, there is not much in infant formula that is “indigestible” (unlike an adult diet, which includes things like cellulose from salads, which are just expelled in the stool.)

If this happens to my baby, what should I do?

Nothing. It’s normal and doesn’t require any treatment.

When should I worry if my baby doesn’t have any bowel movements?

A baby who isn’t stooling because of something bad will have other symptoms, such as:

  • forceful vomiting (not just spitting up)
  • inconsolable crying
  • fever
  • decreased appetite
  • decrease in wet diapers
  • a hugely bloated, distended belly
So what counts as constipation in a baby?

Constipation in babies means hard stools – not infrequent stools. That is, a baby who has no bowel movements for 2-3 days and then has a soft stool does not have constipation. But a baby who has hard, pebble-like bowel movements – even he has several a day – is constipated.

What can I do if my baby is truly constipated?

Some helpful, safe remedies that soften the stool include:

  • a teaspoon of dark Karo syrup in the bottle
  • a tablespoon of the heavy syrup found in a can of peaches or pears
  • an ounce of the “p” juices: prune, pear, peach, or pineapple

We do NOT recommend:

  • honey in the bottle (this can cause botulism!)
  • glycerin suppositories (these stimulate a bowel movement to occur, but don’t make the stool any softer)
  • putting other things in the baby’s rectum, like soap or pencils
Could the iron in her formula be making her constipated?

No. (Iron only constipates children if it is taken in huge amounts – much more than is found in any formula.) Do not switch your baby to the low iron formulas. These formulas should only be used when babies are getting additional iron drops. (In fact, the formula labels say this.) Putting a baby on a low-iron formula can cause anemia, which is much worse than constipation.

What if these changes don’t help?

If Karo syrup or fruit juice isn’t helping, we should check the baby in the office to possibly recommend a different treatment.

What can I do for my baby’s congestion?

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Suzanne Berman, MD

Many parents ask what over-the-counter products they can give their young children for nasal congestion and stuffiness.

In our opinion, most cough and cold preparations for children don’t work very well.  Most studies show they don’t make a difference in most children, and occasionally they can lead to bothersome or serious side effects. We advise you to save your money rather than buying these medications.

Instead, we recommend a different approach: use suction to get the mucus out. Infants and toddlers can’t blow their noses effectively, so you have to get it out another way.

Here’s how to do it, step by step. You may need two people to do it well:

  1. First, clean as much loose mucus out of the nose and face as possible.
  2. Have the child lie down on his or her back.
  3. Put about 1 cc warm nasal saline drops in each nostril. You can buy prepared nasal spray at a pharmacy, or you can make your own at home. Squirt the nose drops in with an eyedropper or splash them in with a soaked cotton ball.
  4. Let the saline soak up into the dried, hard mucus to soften it. Allow at least 30 seconds.
  5. Have the child sit up, so the loose mucus will fall to the front of the nose.
  6. Deflate the nasal bulb by squeezing it out.
  7. Insert the deflated bulb as far up one nostril as possible.
  8. Release the bulb so that it reinflates. This allows the mucus to be sucked into the bulb.
  9. Repeat with the other nostril.

It is very common for babies to cough, gag, gargle, choke, or even pause breathing when doing this. Don’t worry; if you didn’t do this, the baby would choke and gag on the mucus instead!

It’s important to use drops in the nose before trying to suck out the mucus with the bulb. Thick, crusted, dry mucus will stick to the side of the nose like a scab, and suction won’t work.

What can I do for my baby’s colic?

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Suzanne Berman, MD

What is colic?

Colic refers to loud, persistent crying in a young infant without an obvious cause. Typically, infants are between 6 weeks and 3 months old when they first start having these crying fits. Babies will suddenly draw up their legs, turn red in the face, clench their fists, and scream! Sometimes screaming fits will last for hours at a time. Colic typically worsens about 4:00 pm and gets better by about 8:00 pm. Colic in a healthy baby has never harmed a baby, but it is very frustrating and difficult for parents, who themselves may be sleep-deprived!

Note that colic is seen in otherwise healthy infants. Obviously, a hungry infant, an infant with pain, one with a wet cold diaper, etc. will scream inconsolably — but that’s not colic. If your baby is having other symptoms besides just screaming, you’ll want to get him or her checked out.
What causes colic?

By definition, colic doesn’t have an identifiable cause! Physicians used to think it had to do with excessive gassiness in the intestines. However, this is probably a chicken-and-egg issue: persistent crying for ANY cause means babies swallow more air. More swallowed air means being more gassy, which isn’t fun for any baby. But why do babies cry to start with?

More recent information suggests it’s probably a behavioral issue. Some “easy babies” cry but it doesn’t seem very unusual to the parent. Other infants seem to cry a lot more than others. There may also be a relationship between the infant’s personality and the parenting style.

Of note, infants of mothers who smoked during pregnancy have twice the risk of being “colicky” than infants of non-smoking mothers.

How much crying is abnormal?

It may be of some comfort to know that the average 6 week old infant typically cries about 3 hours a day. This means that half of healthy infants cry even more. Considering most infants this age are awake perhaps 8 hours a day, some infants can spend more than half their awake time crying.

You may be also interested in knowing that, by 3 months, the average infant cries about an hour a day. (So it does get better!)
What can I do for colic?

We want you to do something, but we want you do to something that is SAFE and will HELP.

Because colic is so common and frustrating, many physicians have tried a number of things, including medication, to reduce a baby’s crying. Unfortunately, most medications aren’t any difference from sugar water (placebo.) There has been one medication that was very successful, though: In the “olden days,” physicians used to prescribe paregoric drops. This was quite effective to make a baby stop crying: it’s a narcotic, related to opium, that would make the baby go to sleep! Because colic is so common, many studies have been done trying to determine what medications and therapies help.
What doesn’t seem to help?

 

  • Simethicone drops. Studies have compared simethicone drops to placebo (Pediatrics 1994;94:29-34) and showed that there was no difference in relief of symptoms or duration of symptoms. In fact, infants on placebo actually did a little better!
  • Dicyclomine drops. This is related to hyoscyamine (Levsin). Dicyclomine is effective at controlling crying. Unfortunately, some infants stopped breathing, or had seizures or coma from the medication. The manufacturer and FDA no longer recommend its use for colic (even though some physicians still use it.)
  • Methylscopolamine drops. Methylscopolamine is comparable to placebo, but 20% of infants getting methylscopolamine actually got much worse with it (Acta Paediatr 1995;44:203-208)
  • Lactase drops. This is based on the assumption that colic is caused by lactose intolerance, but no difference has been found between lactase and placebo in stopping crying.
  • Switching formulas. A small percentage of colicky infants do have a true formula intolerance, and switching formulas sometimes helps. (These children tend to have other symptoms as well.) However, this is pretty rare and usually doesn’t make a difference. See our information page, “Should I change my baby’s formula?” for more information.
  • Chiropractic manipulation. A study in Norway (Arch Dis Child 2001; 84: 138-41) tried to examine this issue. It found that a 10-minute chiropractic adjustment was no more effective than a nurse’s cuddling for 10 minutes.

What does seem to help?

Some safe, natural things you can do for colic:

  • The most important thing to do: Switch caregivers! Let the baby (as well as yourself) get a change of scenery and a new face. A baby actually gets fussier if she senses mom or dad is frazzled, and a frazzled parent isn’t an effective parent anyway. If you don’t have a second caregiver to help out with your baby, you will need one.
  • Swaddle the baby firmly in a soft receiving blanket.
  • Gently massage the baby’s back, arms, and legs.
  • Take the baby for a car ride or stroller ride.
  • Hold the baby prone, one hand on the stomach, one hand on the back, and rock the baby back and forth.
  • Offer a pacifier, the breast, or the baby’s hand for sucking comfort.
  • Burp the baby well.
  • Slow down feeding times. Barracuda “guzzlers” have more gas.
  • Put the baby near of a repetitive noisemaker, like a clothes dryer, dishwasher, or vacuum cleaner. Avoid television, which can be overstimulating.
  • Stop smoking. Babies whose mothers smoke during pregnancy and breastfeeding undergo nicotine withdrawal and cravings later. Passive smoke exposure even after birth may worsen colic as much as threefold.
  • Camomile tea. One study suggests small amounts of camomile tea might be helpful (J Pediatr 1993;122:650-652). However, parents should be careful not to “fill up” the baby on herbal tea, which lacks the protein, fats, etc. of breast milk or formula. Other herbal teas, such as catnip, can be dangerous and we do not recommend them. If you are interested in trying camomile tea, please let us know.
  • Wait a few months! Babies outgrow colic by 3-4 months of age.

If your baby’s colic is driving you nuts, or if you think there may be something else wrong (like an ear infection, diarrhea, etc.) please let us know.

What can I do about my baby’s cradle cap?

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Suzanne Berman, M.D.
What is cradle cap?

Cradle cap is a patch of greasy, yellow-tan scales or flakes on a baby’s scalp. It is not painful for the baby and is completely harmless. Many babies have mild cradle cap. Occasionally a baby will have such severe cradle cap that it covers most of the head, causing “cradle helmet.”

What causes cradle cap?

Cradle cap is a side effect of the mother’s hormones. During a pregnancy, the mother’s body produces high levels of hormones. These cross into the unborn baby’s body as well. After the baby is born, the leftover hormones make the baby’s skin secrete sebum, the oily yellow material which causes cradle cap.

Besides cradle cap, mother’s hormones can cause other harmless skin conditions like newborn acne.

What can I do about my baby’s cradle cap?

Most lotions and creams don’t help cradle cap. We recommend use of a selenium-containing shampoo, such as Selsun Blue. Here’s how we like to do it:

  1. At or after baby’s bath time, dampen his head with a warm washcloth.
  2. Put a little shampoo in a bowl or dish. Add a little water to it and stir up a lather.
  3. Use a soft nail brush to apply the shampoo. Dip the brush bristles in the shampoo mixture, then massage it gently into the baby’s scalp around the scaly parts.
  4. Rinse the shampoo off the baby’s head. Be careful to cover the baby’s face with your free hand so the shampoo doesn’t get in the baby’s eyes.

Do this daily at bath time for about a week. You should see significant improvement. If not, be sure to let us know.

Should I change my baby’s formula?

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Suzanne Berman, M.D.

Most new parents who choose to bottle feed their babies begin with a standard lactose-containing infant formula.

All babies, to some degree or another, are spitty, gassy, and/or have “strange-looking” stools. This is true no matter what formula they get – in fact, breastfed babies have these “problems” too. Nonetheless, many parents ask, “Could it be the formula?”

In most cases, no.

Doesn’t formula make a difference in gassiness?

No. An excellent study published in the medical journal Pediatrics in 1995 (Hyams et al, vol 95, pp. 50-54) investigated this question. Volunteer parents were given one of 4 different formulas to feed their baby, but were not told which formula they had received. Parents were then asked to keep a record of their infant’s stool pattern, spitting up, gassiness, and crying. Although the stool pattern was different (see below), spitting, gassiness, and crying were of equal severity in all formula groups. Unfortunately, infant formula manufacturers aren’t always forthcoming with this information.

If not the formula, then why is my baby so gassy and fussy?

Most babies are gassy due to swallowed air, not the formula. Infants in the first few months of life can spend several hours a the day crying. This forces air into their stomachs, which accumulates in the intestines as gas. This crying behavior is seen in all infants to some degree between 6 weeks and 3 months of life. Gas gets better or goes away when babies start crying less as they get older.

Why does my baby spit up so much?

Most babies spit up regularly. Some babies dribble a little; others vomit whole feedings forcefully. Again, there is no correlation between the severity of the vomiting and the type of formula used. The “spitty” babies tend to be those who eat a large feeding (more than 3 ounces at a time) all at once, who take their feeding too quickly, who don’t burp well, or who eat lying down. All of these things tend to overfill and bloat a baby’s small stomach. This usually results in the baby vomiting. Read more about spitting up (reflux) to help with these problems.

Occasionally persistent, forceful vomiting in an infant can be the sign of a serious problem. Let us know if the baby vomits more than he is able to keep down, if you think he is not gaining weight, if he is getting dehydrated, or if he is acting very sick.

Does formula choice affect the baby’s bowel movements?

Actually, it does. The Hyams study found that there is some correlation between diet and stool. Breast-fed babies and babies taking elemental formulas (like Nutramigen ®) tend to have the most watery stools. These babies also had the most stools. Babies fed soy-based formulas (like Isomil ®) have the firmest stools. Babies taking lactose-containing formulas tend to be somewhere in between.

However, babies are supposed to have this variation in stool. Fortunately, loose stools don’t necessarily mean diarrhea; less frequent or firm stools don’t necessarily mean an infant has constipation. So, babies rarely have true constipation or diarrhea because of the formula. Please don’t switch just to “regulate” your baby’s stools — chances are they are supposed to look the way they do! If you aren’t sure if your baby’s stools are normal, ask us. (See our information about infant constipation and diarrhea.)

When should the formula be changed?
  • Lactose intolerance (very rare in babies)
  • Milk protein allergy.
  • Gluten enteropathy.
  • Metabolic conditions, like galactosemia.

These are all pretty rare conditions. Let us know if you are concerned about one of them.