I am currently pregnant. Can I visit your office and meet with a pediatrician before my baby is born?
Yes! We would be happy to schedule a courtesy meeting to visit our office and meet with one of our providers. You will be able to tour the office, meet some of the providers and see our staff in action. Learn more about Get Acquainted Visits ›
I notice when there is a loud or unusual noise my newborn will have a brief episode of stiffening her body as she straightens out her arms. Is this normal?
Yes, what you are seeing is called the startle or Moro reflex. This reflex may follow after your infant hears a noise or in association with an abrupt movement or other stimulation. It is noticed frequently at birth then gradually resolves by four months of age.
It is normal also for newborns to randomly hiccup, sneeze, and startle. They also exhibit Newborn Periodic breathing. This consists of short periods where they breathe rapidly for a few seconds, pause for less than 20 seconds, then restart breathing. We expect to see this for the first 2 months of life.
When a newborn starts sucking on his fingers or fists, does this mean he is hungry and I should feed him?
The sucking reflex is a normal reflex that you may see even if your baby has just been fed. This is a survival reflex and will start to diminish between six and twelve months of age. Babies will suck on anything that is put in their mouth. Many newborns can be soothed with extra sucking using a pacifier or their fingers.
Why does my newborn turn red in the face when she is trying to have a bowel movement? Does this mean she is constipated?
Infants do not have the benefit of gravity to assist them in passing a bowel movement and may bear down and pass gas prior to passing a stool. As long as their stools are soft and not formed it is not constipation.
I sometimes notice that my infant’s nose makes noises when he is breathing. Does this mean he has a cold?
Nasal noises in newborns are usually caused by dried mucus in the nasal passages, not a cold. Newborns are nose-breathers, especially during feeding. If your newborn is having difficulty feeding due to a blocked or stuffy nose, you can try a drop or two of warm sterile water or over-the-counter nasal saline drops. Instill one or two drops one side at a time. This will loosen up the mucus so it can be cleared by sneezing, swallowing, or you can use a bulb syringe if necessary.
You may also hear gurgling noises from her throat. Babies do not know how to clear their throats and this noise is usually from air passing through normal saliva or milk. This is especially true while they are sleeping. This will resolve on its own as your infant gets older and learns to swallow more frequently.
Avoiding tobacco smoke, dust and strong odors will help minimize nasal congestion. You should call the office if the nasal washes are not working or if breathing becomes difficult.
When should I start to feed my baby peanut butter? (And other food concerns)
For many years, experts believed the best way to fight peanut allergy was to avoid peanut products in the first few years of life. However, more recent guidelines from the American Academy of Pediatrics (AAP) and the National Institute of Allergy and Infectious Diseases show that there is no benefit to delaying the introduction of allergenic foods. Below is a guideline from the AAP to starting peanut products in your child:
At 4-6 months of age, start with a few foods that are of low allergy risk like infant cereal, pureed bananas or pureed prunes. Give your baby one new food at a time and wait at least 2-3 days before starting another. If your baby develops a rash, diarrhea or vomiting, stop using the new food and call our office.
If there is no special reason to be concerned that your baby is at increased risk for food allergies, after a few first foods have been tolerated, you can start to introduce the more highly allergenic foods (milk, egg, soy, wheat, peanut, tree nuts, fish, and shellfish). It is important that these—and all foods—are in forms and textures appropriate for infants. For instance, while whole cow’s milk is not recommended before 1 year of age, you may introduce processed dairy products such as whole milk yogurt or Greek yogurt mixed with a fruit that your baby has already had in his or her diet.
If your baby has or had severe, persistent eczema or an immediate allergic reaction to any food— especially if it is a highly allergenic food such as egg—he or she is considered “high risk for peanut allergy.” You should talk to your child’s pediatrician first to best determine how and when to introduce the highly allergenic complementary foods. Ideally peanut-containing products should be introduced to these babies as early as 4 to 6 months. It is strongly advised that these babies have an allergy evaluation or allergy testing prior to trying any peanut-containing product. Your doctor may also require the introduction of peanuts be in a supervised setting (e.g., in the doctor’s office).
- Babies with mild to moderate eczema are also at increased risk of developing peanut allergy. These babies should be introduced to peanut-containing products around 6 months of age; peanut-containing products should be maintained as part of their diet to prevent a peanut allergy from developing. These infants may have peanut introduced at home (after other complementary foods are introduced), although your pediatrician may recommend an allergy evaluation prior to introducing peanut.
- Babies without eczema or other food allergies, who are not at increased risk for developing an allergy, may start having peanut-containing products and other highly allergenic foods freely after a few solid foods have already been introduced and tolerated without any signs of allergy. As with all infant foods, allergenic foods should be given in age- and developmentally-appropriate safe forms and serving sizes.
- Whole peanuts themselves are choking hazards and should not be fed to babies.They can block the air passages, and if whole or partially chewed peanuts are inhaled into the lungs, they can cause a severe and possibly fatal chemical pneumonia. Avoid whole peanuts until your child is old enough to be counted on to chew them well (usually at least 5 years and up).
- A good way to introduce peanut in infancy would be mixing and thinning-out a small amount of peanut butter in cereal or yogurt. Dissolving peanut butter puffs with breast milk or formula and feeding it by spoon is another good option.
When should I start using toothpaste with my child?
The sooner the better! Parents should use a tiny smear of fluoride toothpaste, about the size of a grain of rice, to brush baby teeth twice a day as soon as they erupt until your child is three years old, using a soft, age-appropriate sized toothbrush. Then start using a pea-sized amount of toothpaste thereafter. Before teeth erupt, clean your child’s gums with a soft infant toothbrush or a clean washcloth and water.
When is it time to start toilet training my toddler?
Toilet training is a big step for kids and parents alike. The secret to success? Timing and patience.
Toilet training success hinges on physical, developmental and behavioral milestones, not age. Many children show signs of being ready for potty training between ages 18 and 24 months. However, others might not be ready until they’re 3 years old. There’s no rush. If you start too early, it might take longer to train your child.
Is your child ready? Ask yourself:
- Can your child walk to and sit on a toilet?
- Can your child pull down his or her pants and pull them up again?
- Can your child stay dry for up to two hours?
- Can your child understand and follow basic directions?
- Can your child communicate when he or she needs to go?
- Does your child seem interested in using the toilet?
If you answered mostly yes, your child might be ready. If you answered mostly no, you might want to wait — especially if your child is about to face a major change, such as a move or the arrival of a new sibling.
Your readiness is important, too. Let your child’s motivation, instead of your eagerness, lead the process. Try not to equate toilet training success or difficulty with your child’s intelligence or stubbornness. Also, keep in mind that accidents are inevitable and punishment has no role in the process. Plan toilet training for when you or a caregiver can devote the time and energy to be consistent on a daily basis for a few months.
What steps should we follow to begin toilet training?
When it’s time to begin toilet training, follow these steps:
- Pull out the equipment. Place a potty chair in the bathroom or, initially, wherever your child is spending most of his or her time. Encourage your child to sit on the potty chair in her clothes to start out. Make sure your child’s feet rest on the floor or a stool. Use simple, positive terms to talk about the toilet. You might dump the contents of a dirty diaper into the potty chair and toilet to show its purpose. Have your child flush the toilet.
- Schedule potty breaks. Have your child sit on the potty chair or toilet without a diaper for a few minutes at two-hour intervals, as well as first thing in the morning and right after naps. For boys, it’s often best to master urination sitting down, and then move to standing up after bowel training is complete. Stay with your child and read a book or give your child a toy to play with while he or she sits. Allow your child to get up if he or she wants. Even if your child simply sits there, offer praise for trying — and remind your child that he or she can try again later. To maintain consistency, bring the potty chair with you when you’re away from home with your child.
- Get there—fast! When you notice signs that your child might need to use the toilet—such as squirming, squatting or holding the genital area—respond quickly. Help your child become familiar with these signals, stop what he or she is doing, and head to the toilet. Praise your child for telling you when he or she has to go. Keep your child in loose, easy-to-remove clothing.
- Explain hygiene. Teach girls to spread their legs and wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder. Make sure your child washes his or her hands afterward.
- Ditch the diapers. After a couple of weeks of successful potty breaks and remaining dry during the day, your child might be ready to trade diapers for training pants or underwear. Celebrate the transition. Let your child return to diapers if he or she is unable to remain dry. Consider using a sticker or star chart for positive reinforcement.
If your child resists using the potty chair or toilet or isn’t getting the hang of it within a few weeks, take a break. Chances are he or she isn’t ready yet. Pushing your child when he or she isn't ready can lead to a frustrating power struggle. Try again in a few months.
Nap and nighttime training typically take longer to achieve. Most children can stay dry at night between ages 5 and 7. In the meantime, use disposable training pants and mattress covers when your child sleeps.
To handle accidents:
- Stay calm. Don’t scold, discipline or shame your child. You might say, “You forgot this time. Next time you’ll get to the bathroom sooner.”
- Be prepared. Keep a change of underwear and clothing handy, especially at school or in child care.
If you have questions about potty training or your child is having difficulties, talk to your child’s doctor. He or she can give you guidance and check to see if there’s an underlying problem.
What should I do if my child gets a fever?
According to the American Academy of Pediatrics, the normal body temperature for a healthy child is between 97.0 and 100.3° Fahrenheit. Thus, a temperature a degree above or below the “normal” 98.6 is not considered a fever, since body temperature changes throughout the day and every individual is different.
If your child has a fever, do not panic. The most important thing is to look at your child. If they are alert, interactive, occasionally playful, etc. they are probably okay. Common guidelines for contacting the office are as follows:
Infants may not have fully developed the ability to regulate the body’s temperature. Their temperature may actually drop instead of rise.
- 0-60 days: Any rectal temperature 100.4° or higher or less than 97.0°, go to Yale New Haven Children’s Hospital immediately. This is considered an emergency and your child requires immediate evaluation. Even when our office is open, you should take your child to the Yale Children’s Hospital Emergency Department. It is not required to contact our office prior. Do not give any fever reducers. The Emergency Department will contact our office when they are done evaluating your child.
- 2-3 months: If your child has a temperature, he should be seen that same day or the following day if the fever develops overnight and the infant is acting well. If your infant is not acting well, please contact our office immediately.
- 4-5 months: Make an appointment if your child has a temperature of 101° or higher for more than 48 hours and is otherwise acting well.
- 6 months or older: Call if your child has had a fever of over 101° for more than 72 hours and is otherwise acting well.
Any child with a fever who is significantly irritable or lethargic despite fever reducers, who is having difficulty eating and drinking, difficulty breathing, or has altered mental status or any other concerning signs should be seen promptly.
Of course, you know your child best and we are always available to evaluate him or her in our office.
Does my child have a cold or the flu?
The flu (or influenza) and the common cold are both respiratory illnesses caused by different viruses. Because these two types of illnesses can have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold and the symptoms are more intense. Colds are usually milder than the flu. Colds generally do not result in serious health problems, such as pneumonia and hospitalization.
Colds usually begin with a sore throat that goes away after a day or two. Nasal symptoms, runny nose and congestion follow along with a cough by the fourth or fifth day. Your child may have a low-grade fever or no fever at all. With cold symptoms, the nose teems with watery nasal secretions for the first few days. Later, these become thicker and darker. Dark mucous is natural and does not mean your child has developed a bacterial infection, such as a sinus infection.
Symptoms of flu can include fever (sometimes high), chills, cough, sore throat, runny or stuffy nose, body aches, headaches and fatigue. Symptoms of flu will usually come on very suddenly, often over a 24-hour period. Children are more likely than adults to have nausea and vomiting with the flu. Please call our office to have your child evaluated if he or she is at high risk for flu-related complications, for example, if your child has asthma, diabetes, or heart disease, or is two years old or younger. Immediate evaluation should take place in our office or Yale Children’s Hospital emergency department if your child is having difficulty breathing, not drinking enough to urinate three times a day, irritable to the point of not wanting to be held or not waking up and interacting with you.
There are medications that can be given to shorten the course of the flu if it is diagnosed within 48 hours of onset. Special attention should be given to the child who has been diagnosed with the flu, is fever-free for 24 hours and improving, only to have the fever return with a worse cough.
Having a yearly flu shot in the fall or early winter can prevent flu entirely or lessen the symptoms if your child does get the flu.
Here is a table to help you distinguish between a cold and the flu: Cold Versus Flu (CDC)
What should I do if I find a tick on my child?
First, don't panic – two things are on your side:
- The risk of developing Lyme disease after being bitten by a tick is only about 1 to 3 percent.
- Ticks can’t transmit the bacteria that cause Lyme disease until they attach and begin to feed, which makes them engorged. This can take up to 48 hours, so if you find a tick that isn’t engorged, your child may be less likely to contract Lyme disease.
All you need to do is to remove the tick and watch for symptoms. See these resources for information:
Here’s how to remove the tick:
- Remove the tick using a fine-tipped pair of tweezers. Grasp the body of the tick and pull in an upward motion until the tick comes out. Do not squeeze or twist the tick’s body. Put the tick in a bottle.
- Take note of the size and color of the tick, as well as your estimate of the time it has been attached and whether or not it is engorged.
- It’s not necessary to take your child to a doctor after a tick bite, but if you have questions or want a consult, see your child’s pediatrician.
A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite is common. This generally goes away in 1-2 days and is not a sign of Lyme disease.
My child has head lice! What should I do?
Head lice is an infestation of the human scalp by parasitic insects that occurs worldwide. 6-12 million infections occur in the United States every year, so you are not alone!
Lice are obligate human parasites, meaning they cannot survive off their hosts (humans) for more than two days. They require human blood to survive.
Lice are 1/16-inch long, gray colored, move quickly, and are difficult to see. Nits are white eggs that firmly attach to hair shafts near the skin. Unlike dandruff or sand, nits cannot be shaken off the hair shafts. Nits are easiest to spot at the hair around the ears or at the nape of the neck.
Lice infestations are most often caused by close head-to-head contact. Dogs, cats and other pets do not play a role in the transmission of human lice. Lice move by crawling. They cannot hop or fly. Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes or towels) is uncommon but can occur. It is very unlikely to transmit or catch lice from a swimming pool. Lice can survive for several hours underwater but hold tightly to human hair. The chlorine in swimming pools is not enough to kill lice.
Often the only symptom of a lice infestation is an itchy scalp. The scalp may also have red sores from itching. Head lice do not transmit disease and are not related to personal hygiene or cleanliness of living environment.
There are 2 aspects to lice treatment: killing live insects and preventing re-infestation after eggs hatch.
Treatment is recommended for all people with an active infestation. We recommend monitoring all household contacts of that person by checking for lice and/or nits.
Always start with an over-the-counter lice medication such as Nix. Follow the package directions for usage. Do NOT use a conditioner or crème rinse after shampooing with Nix. It is important to leave Nix on the scalp for 60 minutes (this will help in areas where there is a high level of Nix resistance). People with long hair may need to use two bottles.
Repeat Nix in 7-9 days to kill any nits that survived. The infected person is no longer felt to be contagious after one proper treatment with Nix and should be allowed to return to school.
Nit combs can be used to remove the dead nits from the hair shaft but removal of all nits is not required to return to school.
If you see any live insects less than 24 hours after treatment, don’t worry! It can take up to 24 hours to kill adult lice.
If live lice are seen 48 hours or more after treatment, call our office. Your child may need a prescription medication.
Head lice do not survive long if they fall off a person and cannot feed. You do not have to spend a lot of money or effort on housecleaning activities.
Follow these steps to help avoid re-infestation:
- Machine wash and dry clothing, bed linens, and other items that the infested person wore or used in the two days before treatment using the hot water (130°) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry cleaned or sealed in a plastic bag for 2 weeks, the longest nits can survive.
- Soak combs or brushes in hot water (130°) for at least 10 minutes. Alternative: soak them in a solution containing some anti-lice shampoo for 1 hour.
- Vacuum the floor and furniture especially where that person sat however the chance of getting infected from a louse that has fallen onto a rug or furniture is very small. Head lice survive less than 1-2 days off the human body and nits cannot hatch.
Just remember, lice is very treatable and very common! Call our office if you have any further questions.