February 25, 2014

By Dr. Steven Abrams, Neonatologist and Medical Director of Neonatology Nutrition Program

When I first started as a pediatric trainee in 1982, if an infant was going to receive a formula, which, unfortunately was most of them back then, there were only a few choices. Basically three companies marketed cow milk-based or soy-based formulas. Families asked their pediatrician which company they preferred and discussed whether a soy formula might be helpful. Life was simple even if those choices didn’t usually matter very much.

Now, it’s a virtual maze wandering through the formula aisle. There are more companies, more choices, and a complex set of information on the packages that make it very hard for anyone to know what to choose. Do I want my baby to get a “gentle” formula? Is she “sensitive?” Hmmm “organic” must be a good idea? Wait, am I supplementing breast-feeding? Do I need a formula that will “comfort” my baby? What about “spitting” up?

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My children like to laugh and even write that sometimes I go to the store and wander through the infant formula aisle just so I can see what parents must face. It’s not infrequently that I spot a poor mom or dad combing the aisle desperately trying to guess what will make their baby happy (and sleepy!). I consider myself fairly knowledgeable about infant nutrition including formula choices but even I can’t guess sometimes what’s actually in a formula from its name and must read the list of ingredients, or search on the internet, to find the answer.

The basic principles:
So, let’s go through some principles to at least try to help with the formula aisle maze. Unquestionably, breast milk is the best choice for virtually every infant, but it is also true that the majority of infants in the United States will receive some formula during the first year of life. Helping their parents make good choices between formulas and understanding the options for infant formulas is not in conflict with supporting breastfeeding as long as it remains understood that “closest to breastmilk” is a long way away.

First, the good news is that all of the formulas you see that say “infant formula” on the label are safe except for the very few infants with special medical problems which should be identified by your pediatrician.

Second, there is no evidence at all that parents must or should buy the most expensive formula on the shelf or be concerned about the health benefits of lower cost formulas. I would, however, caution against frequent switching of brands based on one coupon or sale as some infants do seem to develop preferences over time and it can be very difficult for parents to determine the differences between an advertised brand of formula and the one their child has been receiving.

Third, parents can usually purchase powder as it is less expensive than pre-mixed liquid formula. A special exception to this is babies who are born prematurely who should only get ready-to-feed liquid for at least a month after their due date. Concentrated liquid formula is another option although parents must be cautious to properly dilute the concentrate with water based on the label instructions.

Fourth, from a nutritional perspective, there is no reason to choose any particular formula brand or type specifically for breast-fed infants who are receiving some supplemental formula. Marketing in this way should not be confused for evidence of a need for a unique formula choice in babies who are partially or primarily breastfed.

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Special conditions:
Now, beyond that, it gets tougher. For the most part, babies will often have colic, spitting (reflux), upset stomachs, or mild allergic symptoms that do not necessarily require violating rule #2 above. Formulas marketed as improving one or more of these symptoms may or may not be successful in an individual baby. In general, I recommend that for most concerns such as spitting, parents try other behavioral and feeding techniques before switching to formulas marketed using vague terms such as “gentle,” “comfort,” or “sensitive.” It is not uncommon for a baby to have been tried on three or more formulas without any real difference in these symptoms. Often a baby grows out of the problem at the same time as yet another formula switch is made leading to uncertainty related to long-term formula selection.

Having said that, there are some babies who improve on specialized formulas, especially the often more expensive formulas designed to deal with severe allergic symptoms or severe reflux that might uncommonly be affecting growth. Formulas with probiotics (beneficial bacteria) may be helpful in some infants with colic although recent studies are not conclusive regarding this issue. I believe that in every such case, a family should carefully consult with their pediatrician before purchasing or using one of these formulas.

The right pediatrician:
Finally, a key message to parents is that just as it is important to find a breast-feeding friendly and knowledgeable pediatrician, it is also important to make sure that your pediatrician can properly guide you through the formula aisle should you choose to provide an infant formula. Ask questions about why a formula choice is being recommended and whether a lower cost one, or a more readily available one, can be tried. If a specialized formula is started for your infant, remind your pediatrician regularly about this and ask if it would be possible to switch to a more routine one after a month or two. Go through the symptoms your baby is having with your pediatrician and see if the formula descriptions I mentioned earlier (e.g. for spit up, for comfort, being gentle, or organic certified) are ones that truly match what is best for your baby.

In summary, I wish you the best of luck traversing the formula aisle. Don’t forget to send occasional notes to the companies that make these formulas if you’re confused by what is being sold. I sure do!

Dr. Steven Abrams is a Texas Children’s Hospital neonatologist and Medical Director of the Neonatology Nutrition Program at Baylor College of Medicine. Like what you read? Check out our expert posts section to hear more from the vast knowledge of our doctors and other experts right here at Texas Children’s.

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February 18, 2014

By Emily Klein

We’re getting ready to celebrate Audrey’s 2nd birthday and what a wonderful ride it has been! We’ve gone from a quiet easygoing baby who just wants to be held, to an energetic, curious and thriving two year-old. Her outdoor slide is often moved inside so she can burn some energy if the weather is bad or if it’s nighttime. She loves to read, and it’s usually the same book over and over. Every Saturday after breakfast she goes to the back door because she knows it is activity day and we have something fun in store. The zoo, aquariums, trains, boats, and eating out in restaurants are her favorite things. There really never is a dull moment, and it’s shown us a whole new side of life.

Having a 2 year old is a wildly different experience from the infant stage, but it has all been a great deal of fun. She started her “terrible twos” a few months early, so we’re more than prepared for her actual birthday.

Choosing a pediatrician

We’re very fortunate that she has been happy and healthy throughout. Choosing a pediatrician was a bit scary, but you couldn’t ask for a better group of people to work with to seek advice. Through a recommendation of a colleague we chose Texas Children’s Pediatrics Houston Pediatric Associates in Bellaire, and the shared practice of Dr. Schlegel and Dr. Lasics.

The interview

We wanted someone we were comfortable with and who we knew would be there to answer our questions. As a new parent you have and ask lots of questions. We interviewed them to see what our gut reaction was, and they were chosen on the spot.

Location, location, location

The location also mattered since our work and her daycare are around the area. We needed to be able to move quickly in case of an emergency.

The Texas Children’s care

Texas Children’s was always going to be our choice because we know we have the finest physicians offering the best care.

Advice to new parents

My advice would be to gather referrals. Knowing our colleagues have used the same pediatrician throughout their children’s lives made us more comfortable. Always interview the candidates with your child so you can see how you feel about them and how they are with your baby.

The office has always been responsive to phone calls and same day appointments. They’ve always walked us through any concerns day or night and are wonderful with understanding new parent worries and questions. The doctors and staff are very good with her, and have even caught her sitting in “timeout” when they are ready to see her. Like we said, terrible twos started early. We’re grateful for the care and attention she receives, and most of all grateful for a wonderful healthy 2 year old.

Relish every minute with your curiously active 2 year old – even if they do act up from time to time. They really do show you how to be young again!

February 11, 2014

Jillian Young shares what it meant to have her child be on the receiving end of donor milk and why she hopes you will consider donating:

When you find yourself and your baby in the NICU like I did, it can be a very scary time. As a parent, you often feel helpless and aren’t really able to do much to help your child except love on him and feed him. When my body did not cooperate with producing enough milk to feed Henry every three hours, I felt so guilty. The one thing I was supposed to be able to do, I could not. Fortunately Henry was in the NICU at Texas Children’s and became a recipient of donor milk from the Texas Children’s Milk Bank. This service was offered to us once our nurse became aware that I was not able to produce enough milk to feed him every 3 hours. I jumped at the chance to have a donor supplement what I was unable to provide. With him being so tiny and every feeding really counting, I felt a great sense of relief once he was receiving donor milk for most of his feedings. I was so thankful to the lady for taking time so that Henry was able to receive such great nutrients. We live in a society right now that promotes breast milk as being the best source for babies. Given Henry’s situation I wanted to take every measure possible to make sure he got all the nutrients he needed to gain weight and strength.

After months of pumping every 3 hours since Henry would only take milk from bottles, I had a new respect for milk donors. Not only are they most likely feeding their own children, a grueling task in itself, but they are taking the time and effort to pump extra milk for complete strangers! I think it is such a selfless act that impacts parents like me who feel helpless when they can’t feed their child.

With baby #2 on the way, I am praying that breastfeeding goes smoothly and she will not end up in the NICU like her big brother. However, if that is the case, I am happy to know she will be able to receive donor milk in order to help her in the beginning stages of her life. I also have every intention to donate milk myself if I am able. If I can ease a mother’s mind and take away any guilt she may be feeling, I feel it is worth the extra time and effort. After hearing Henry was a recipient of donor milk, my friend became a milk donor to Texas Children’s milk bank since she produced too much! I LOVE that she was able to do that and I hope to follow in her footsteps. If you are thinking about donating you should! Being on the receiving side of milk donation, it really is immeasurable how much it helps a family and most importantly how much it helps these tiny babies!

To find out how you can become a donor, visit: texaschildrens.org/milk

February 4, 2014

LATCH vs. seatbelt, which one is safer?

 This is probably the most common question that my fellow Child Passenger Safety Technicians and I get. The answer is they are equally safe, but the installation method that gives your child the best protection should be used.

The caveat to this answer, however, is that the Lower Anchors and Tethers for CHildren (LATCH) system does have a weight limit and seatbelt does not. As many parents who have struggled with car seat and car manuals have discovered, the weight limit max for the LATCH system can sometimes be ambiguous.

Since the early 2000s, all cars produced for sale in the United States are required to have the LATCH system. The purpose of the LATCH system was to create a uniform system to install car seats and reduce installation misuse. Based on National Highway Traffic Safety Administration (NHTSA) data, about 4 in 5 of car seats are still used incorrectly, and the LATCH system can sometimes be a source of confusion.

Beginning this month, NHTSA is proposing new LATCH regulations to reduce the ambiguity between what car manufacturers and car seat manufacturers say are the LATCH limits. Towards the end of the month, lower anchor limits in cars will be a uniform combined weight limit (car seat + child) of 65 lbs. What this means is, if you have a car seat that weighs 20lbs, you can use the car’s LATCH system until the child weighs 45lbs (20lb car seat + 45 lbs child = 65lbs).

As of now this change is a proposal and not guaranteed. However, as of now, 25 car manufacturers already utilize these guidelines and more may begin to adopt it.

If you have any questions about the proposed changes to LATCH or wish to have your car seat inspected by a certified technician, please call Texas ChildrenÕs Center for Childhood InjuryÕs Car Seat Line 832-822-2277.

This blog post was contributed by Center for Childhood Injury Prevention Health Educator John Ansiaux for Bump Watch – the blog that follows the journeys of Texas Children’s families from pregnancy through baby’s first year.