Breast Feeding for adopted babies?

Attention all future adoptive mom's!!!  Did you know that there is a good chance that you will be able to breast feed your new baby?

Nothing in medicine is 100%, of course.  Assuming that your body reacts normally to horomones and that the ductwork to your breasts is intact (ie, you did not have breast reduction surgery or mastectomy), then there is a good chance that you can breast feed your adopted baby.  This is good for both mom and baby.  It will provide the baby with antibodies and complement, all of which fight off infection.  Breast feeding also hopes to promote bonding between mom and baby and help to limit any sense of loss that the baby might feel.

Here is how we do it.
1.  Start an Herb called Fenugreek.  This herb is available from GNC and Wholefoods Market.  I usually recommend starting at 2 caps 4 times per day then tapering the medication off when the breast milk comes in.  Fenugreek is a safe and effective herb that we all consume to some degree.  It is used as the active ingredient in artifical maple syrup and used extensively in Indian cooking.

2.  Place the baby to breast 10 minutes on each side every two hours.  This will stimulate breast milk production and let down.  If you are doing a directed adoption and the baby is not here yet, you can pump your breasts 10 minutes each side every two hours.  This is not as effective as placing a baby there but given enough time will allow most women to lactate by the time that the baby arives.

3.  While waiting for your breast milk to come in, Feed the baby formula.  While it is true that breast milk is best, it is also true that starvation is WORSE.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

Anemia and Infants

Why worry about a low iron in an infant, you ask???  The answer is somewhat complicated.  Iron is necessary to carry oxygen in the blood.  If your Iron is low, so is your blood's oxygen carrying capacity.  This then results in the brain, which is still growing in an infant, to be starved of oxygen.  When this happens, the child is at increased risk of permenant learning disability and mental retardation.

The body recognizes that it is low in iron, so it attempts to hold on to all dietary iron.  Unfortunately the body does not do such a good job of distinguishing between Iron and its close chemical cousin Lead, a poison.  As a result, iron deficient children are at increased risk of lead poisoning.  Lead intoxication causes lots of problems but the most profound is brain damage (made worse by the low oxygen carrying capacity of the low iron blood).

How to we prevent this?  We check your child's blood for iron and lead at 12 and 24 months.  If the blood is low in iron, we can begin oral iron supplementation and fix the problem before there is damage to the brain.

I hope that this sheds some light on what we do.

Kevin M. Windisch MD, FAAP

Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Stitches

There are a lot of myths about stitches (the medical term for this is sutures) floating around so let me clear a few up.

First, dirty wounds cannot be sutured.  Such wounds will become infected and result in the sutures popping open.  Wounds must be properly cleaned out first.  We try hard not to suture bite wounds because the risk of infection is so high.  To this end, no wound older than 6-8 hours old can be stitched up.  If you think that your child needs stitches, seek immediate medical care.

We place skin sutures only to bring the skin together and to get a nice closure and to try to limit the size of the scar.  Deep or burried sutures provide any strength necessary to keep gaping wounds closed.  skin sutures are under little or no tension.

Sutures don't stop bleeding.  Cautery, direct pressure, ligation of bleeding vessles and vasoconstricting medications stop the bleeding.  If you suture up a seriously bleeding wound the bleeding will place the sutures under tension and they will pop open.

Sutures typically give better cosmetic closure than does superglue.  If it was my son's face we would be doing a running subcuticular suture not glue.  This is the type of suture used by most plastic surgeons for skin stitches for a reason.  You will note that plastic surgeons NEVER glue anything back together.

I hope that this demystifies some things for you.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111
www.facebook.com/sparkspeds.nv

6 month old well child exam

Things start to ge complicated around 6 months of age.
We start as always, answering questions and watching the development of your child.  We are able to perform standardized screens of development at this age and have the parent complete this before we enter the room.  If your child shows delayed development we can address this early, while the child is still young enough to respond quickly.
Next we look at the growth of your child and perform our usual physical.  Special attention is paid to dental development at this time.
Finally we do our usual teaching.  This time we address upcoming mobility and the dangers that come with this.  We also talk about dental hygeine and, here in Nevada where we don't flouridate our water, prescribe vitamins with flouride to help keep the teeth strong.

We finish with vaccination pursuant with the CDC guidelines.

I hope that this helps to dispel many a myth for you.

Kevin M. Windisch MD, FAAP
www.facebook.com/sparkspeds.nv
Sparks pediatric and adolescent medicine
775-359-7111

Why does my child need a flu shot part 1

Why does my child need a seasonal flu shot when he got one at 2, 4 and 6 months with a promise of another one at 12 months? 

I hear this question regularly in my office.  The answer is somewhat complicated.  First you need to understand that the vaccine given at 2, 4, 6 and 12-15 months is not a seasonal flu vaccine.

Seasonal flu or influenza is a virus.  That means that it is a piece or several pieces of protein that surround some genetic material, DNA or RNA.  That viral particle is not capable of eating nor is it capable of breathing.

The vaccine your child received at 2,4, 6 and 12 months is against Haemophilus influenza or HIB.  The unfortunate last name makes people think that theser are the same thing.  HIB is a bacterium.  That means that it is a living, breathing, eating organism.

4 doses of the HIB vaccine protect for life.  The seasonal flu (viral) vaccine however, needs to be repeated yearly because the virus changes its genetic code yearly.

I hope that this clarifies things for you some.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111

4 month well child exam

So what do we do at 4 months you ask?

First we again check height, weight and head size.  Are you seeing a theme here.  These parameters are critical for monitoring your child's health and brain development.

Next we again review developmental milestones.  In my office we now start to use a standardized screening tool for development called the ages and stages questionaire.  This test allows us to check for signs of developmental delay that are very subtle and if present allows us to intervene early.

We then perform the usual physical exam.  Close attention this time is paid to the tone of the muscles throughout.  This is the age when cerebral palsy first becomes easily noticed.

Next we discuss and administer the vaccines

Finally we provide guidance and safety teaching.  This is the age when we first introduce solids so alot of time is spent discussing what foods to introduce and how to introduce them.

I hope that this helps.

kevin m. windisch md, faap
sparks pediatric and adolescent medicine
775-359-7111

2 Month Well Child Exam

So What do we do at 2 months of age? 
Well, we start with checking your child's height and weight and make sure that they are growing okay.  We also check her head size and make sure that her hed is growing okay.  A small or large head could indicate some brain or skull abnormality.

We then check development.  We want to see that your child is starting to look around, lift her head up part way and smile, among other things.

Next, we do a complete head to toe physical.  Special attention is again given to the heart and examining the hips for dislocation.  To see how we do these exams you can go to http://www.youtube.com/watch?v=_5jDjBzXJYA (chest exam) and to http://www.youtube.com/watch?v=uPPkrS8ktp8&feature=related (hip exam).  While maneuvering your child around we also pay close attention to muscular tone (strength) as this could be an early sign of cerebral palsy.

After the exam comes parent teaching.  We will cover things pertinent to 2 month babies including preparation for rolling over, sleep positioning and fever management.

Finally we place the vaccines.  At this age your child will get DTAP, IPV, HIB, PCV-13, Rotavirus and Hepatitis B vaccine.

I hope that this helps to demystify what we are doing