Author: Robyn

Fluoridated toothpaste

Yes, you need to brush your baby’s teeth with toothpaste that has fluoride in it. Fluoride works by attaching itself to the tooth surface and then becoming a part of the enamel. This outer fluoride-rich layer of enamel is much stronger than regular enamel and helps prevent cavities.

How much toothpaste?

Simply use a smear – the size of a grain of rice. Rub the toothpaste into the bristles so you can get it onto the teeth before your baby sucks it off. Your baby will swallow all of this toothpaste. This is OK and will NOT hurt them.

Brushing

Your baby cannot brush on his or her own. Children need help until they can tie their own shoes, around 7-8 years old. You can let your baby play with the brush (without toothpaste and hopefully without them throwing it on the floor). and then when you are ready, get down to it!

Positioning your child for brushing (with help)

Some babies don’t mind parents brushing their teeth, and for others it is a huge struggle.

Ideally there are two adults at home to help. Let’s say mum and dad are both home. Sit on chairs facing each other with your knees touching. Your upper legs have now created a ‘bed’ for your child.

Mum (in this example) picks up her baby and holds him facing her with the baby’s legs wrapped around her waist. Mum then leans her baby down onto Dad’s lap while then keeping the baby’s legs still using her elbows and holding the baby’s hands down with her hands. Now that Mum is controlling the baby’s body and hands, Dad can brush! At the dental office, this is how many pediatric dentists do their exam on young and/or uncooperative children. You may need to use one hand to move the lips aside or place the fingers on the inside of the cheek for better access. If you really cannot get them to open their mouth or they keep biting the toothbrush and don’t let go, sometimes it helps to use something soft, even the handle of another toothbrush, to place on one side between the teeth while this now props the mouth open enough to brush the other side.

Positioning your child for brushing (by yourself)

If you are on your own with your child and do not have another adult to help, it is harder but possible.

One technique is to sit on the floor and position your child’s head in your lap with their legs in the same direction as yours. Then wrap your legs around your child’s arms and legs so they cannot kick you or grab the toothbrush from your hand. You may also ‘wrap’ them in a blanket to limit their mobility and make it easier for you to brush.

A third option is to sit in a chair and have your child sit on your lap, not facing you. Use one arm to keep their hands down and the other hand to brush their teeth. I understand that this is not easy and your child will likely scream and cry, but you are NOT hurting them and are a GOOD parent for taking care of their teeth. Your baby does not know what is best for them, but you do. The good news is that this rarely gets harder as time goes by – they will grow out of struggling over a toothbrush.

Brushing techniques

Depending on what positioning method you chose, brushing certain surfaces of your baby’s teeth will be easier or more difficult. If your baby doesn’t struggle at all, lucky you! The most common areas that are missed are along the gums, especially along the molars. When brushing the sides of the back teeth and the front of the front teeth, try to angle the toothbrush 45 degrees into the gums and use circular motions or small back-and-forth motions. Guidelines state that everyone should brush for two full minutes. Brush your baby’s teeth twice a day – morning and night.

Flossing

You need to floss every day between any of your baby’s teeth that are ‘tight.’ If they have teeth that are touching so that you cannot see between the teeth, these areas need to be flossed. Even with a good diet and daily brushing, very young children can get cavities between their teeth without flossing. You must do the flossing for them.

Rinsing

This is not necessary. Your baby does not need a mouth wash, and they do not need to try to rinse out the toothpaste. It is best for the toothpaste to stay on the surface of their teeth as long as possible. Put them right to bed after brushing at night so that all night long a thin layer of fluoride is strengthening their teeth.

Breastfeeding

Breastfeed as long as you would like. To keep the teeth healthy, you must brush their teeth after you are done breastfeeding. If you let your child go to sleep after breastfeeding without cleaning their teeth, the sugar (lactose) in your breastmilk sits on their teeth throughout the night and can lead to cavities.

Dental professionals also advise against ad libitum “at will” breastfeeding. This is particularly a problem at night when the baby is allowed to breastfeed whenever they like, often leaving milk (lactose) on the teeth for prolonged periods of time and increasing their risk for decay.

Bottles at night

Do not ever let your baby go to sleep at night with a bottle in their mouth or next to them. Unless there is pure water in that bottle, there is sugar present which will lead to cavities. You must clean your baby’s teeth before they go to bed and do not give them anything afterwards with sugar in it, watered down or not.

So many cases were seen of severe decay on infant’s teeth who were put to bed with a bottle, it was given the name of “baby bottle caries.” Please do not let this happen to your child, and break the habit as soon as possible.

Sippy cups

Pediatric dentists never recommend these. The biggest problem is similar to the “bottle at night” problem. Often parents do not put water in these cups, so now the child has access to sugar constantly. Whether it is milk or watered down juice or all-natural fruit juice, there is still sugar present. Sugar in liquid form is much more likely to cause cavities than in solid form because it coats the entire mouth. Try to transition your baby straight from a bottle to a cup. Another benefit of giving your child water, is that it is not such a big deal when they spill!

Water versus juice

Once you are no longer breastfeeding or using formula, your baby needs to drink water more than any other liquid. Ideally, your child would only drink water and would get all their other nutrients from the food they are eating. Realistically, try to limit juice to 4-6 ounces per day and only with meals, never as a snack. For children older than 6 months, fruit juice offers no nutritional benefits over whole fruits. Whole fruits also provide fiber and other nutrients.

Teething

Some babies go through teething around 4-7 months when the first teeth, usually the bottom two front teeth, break through the gums. Signs of teething include discomfort on the gums, irritability, and excessive saliva/drooling. Try cold items first (cooled in the fridge, never frozen). Examples: teething rings, pacifiers, or clean wet washcloths. Do not use topical anaesthetics such as a teething gel – they do not stay in place and your baby may accidentally swallow too much.

If pain medication is needed, use “systemic” pain medication that your child drinks, ie paracetamol. Always determine dose based on your baby’s weight, not age. You must know the weight of your child before giving them any pain medication to be sure you do not accidentally overdose your child. (Editor’s Note: Always read the label of any medicines, follow the instructions and ensure that the correct dosage is administered. Consult a doctor before giving medicines to children under 12 months of age.)

Pacifiers/dummies and finger-sucking

These habits are considered normal in infants and young children. If the habit persists after your child turns 4 years old and the sucking is forceful and frequent, this may result in long-term dental problems. A child’s teeth may become improperly aligned (malocclusion) or pushed outward, sometimes malforming the roof (upper palate) of the mouth. Malocclusion usually corrects itself when the child stops thumb-sucking or the dummy habit. The longer the habit continues, the more likely it is that orthodontic treatment will be needed.

First dental visit

Every baby should receive a dental exam by 12 months of age. This initial visit should include a medical and dental history, a thorough oral exam, an age-appropriate demonstration of brushing technique, a cleaning (prophy) and fluoride treatment if indicated. This is a great opportunity to have your questions answered and to have a discussion with your dentist about what you may be doing right, and what you may be able to improve upon to keep your baby’s teeth healthy.

With regular dental exams every 6 months, problems can be caught and corrected early. You never want to wait until your child has a cavity or pain to bring them to the dentist. Prevention is key!

Mum and Dad’s oral health

Did you know that if Mum and Dad have untreated cavities, your children are more likely to get cavities? If Mum gets her cavities fixed, she can decrease the numbers of cariogenic “bad, decay-causing” bacteria in her mouth. It’s then less likely that these bacteria get transferred to her baby, decreasing the baby’s chance of getting cavities.

Exciting new research of xylitol suggests that the use of xylitol chewing gum at least 2-3 times per day by Mum when pregnant and after delivery also decreases the transfer of bacteria to her baby.

Even experienced parents might have an “Is this normal?” adjustment period to their new baby, and question whether something needs their doctor’s attention or will clear up in a day or so.

If you see any of the following, give your doctor a call:

• Blue lips. Call 111 immediately
• Blue, yellow or pale skin
• Yellow eyes
• Patches of white in the baby’s mouth (most likely a contagious fungal infection called thrush)
• Redness, pus, or an odour around her umbilical cord stump
• A  temperature of more than 37.5ºC. (Keep in mind that our bodies naturally have higher temperatures in the late evening and night)
• No stool for 48 hours
• Any sign of dehydration, including fewer than six wet nappies a day; dark, concentrated, strong-smelling urine; dry lips; unusual lethargy; sunken eyes and cold, splotch hands and feet (which warrants an immediate trip to casualty)
• Frequent bowel movements, especially with liquid or mucus
• Bloody stools
• Repeated vomiting
• Vomit containing green bile, which could indicate an intestinal blockage
• Several refusals to feed in a row
• Excessive sleepiness or any other drastic behavioural change.
• Any sign that your baby is wheezing or gasping for breath.
• If your baby is distressed and pulling at her ears

Rashes should always be checked out (unless it’s nappy rash and, even then, if it’s severe). Rashes such as Parvovirus B19 (Fifth Disease) can be passed from mother to unborn baby – this is not particularly serious for the baby, but can cause miscarriage in other pregnant women who may be exposed to the baby.

Other rashes, such as meningitis, can have fatal consequences so it’s best to play it safe  – If you’re worried and it’s the middle of the night, a service such as Healthline might be able to help you decide if a trip to Hospital is necessary, or give you advice on what to do at home. Healthline is designed to offer 24-hour access to trained medical assistance. Call 0800 611 116.

What is jaundice?

Around 60 per cent of full-term babies (born after 38 weeks of pregnancy) exhibit signs of jaundice. Jaundice can be more likely in premature or sick babies.

Jaundice comes from high levels of a chemical called bilirubin in your baby’s body. Even before she is born, her body is busy making red blood cells, which then break down into smaller chemicals, including bilirubin (this happens continually throughout our lives).

Before she’s born, the placenta carries the bilirubin out of your baby (and into your own blood). Once she’s with you in the world, however, her liver has to take over the job of getting rid of bilirubin. Often, however, her liver isn’t completely up and running just yet, so the skin has to store the excess bilirubin until her liver can break it down – usually within the first week. The result is that almost-orange hue to her skin.

Jaundice first appears on the face and head. As bilirubin levels increase, it will show on the body and then on the palms of hands and soles of feet. If you think your baby is jaundiced, make sure she is checked by a GP or health care worker. A blood test can work out the level of bilirubin.

Should I worry?

• If your baby has a moderate level of bilirubin, she may be sleepy and may not feed well. Encouraging her to breastfeed more often will often help to keep the bilirubin levels down.
• Doctors will watch your baby’s bilirubin levels carefully because too much (an extremely high level) can damage parts of the brain, including those that affect hearing, vision and control of movement.
• The level of bilirubin that may be harmful depends on the baby’s health and maturity. A large, fullterm baby can have a higher level without problems than can a sick or premature baby. The majority of jaundice newborns will be completely fine sooner rather than later.

How do you treat jaundice?

If your baby is well and only has mild jaundice, treatment is probably not necessary. As the liver matures, it will break up the bilirubin into other chemicals, which are passed out through the gut.

Phototherapy –  or light therapy may be used for babies whose bilirubin levels are increasing. The light energy helps to change the bilirubin into a different chemical, which is more easily excreted. Therapy is simply a matter of exposing the naked baby to light, in a warm, covered cot, with her eyes protected by shields. Your baby may need this therapy for several days.

On rare occasions, the levels of bilirubin are so high that the baby may require exchange transfusion, where her blood is replaced with other blood, sometimes from her mother.

What is botulism

Botulism is a rare but serious illness. A bacterium called Clostridium botulinum – which naturally occurs in soil – creates the toxin that causes botulism.

There are several kinds of botulism:

• Foodborne botulism comes from eating foods contaminated with the toxin.
• Wound botulism happens when a wound infected with the bacteria makes the toxin.
• Infant botulism happens when a baby consumes the spores of the bacteria from soil or honey. [1]
• Adult infectious botulism is similar to infant botulism and may happen after stomach surgery.
• Inadvertent botulism may happen following a botox injection [2]

All forms can be deadly and are medical emergencies.

Symptoms of botulism include blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.

Infant botulism: what parents should know

Infant botulism was only recognised in 1976, [3] though it has probably been in existence for longer. The United States, Argentina, Australia, Canada, Italy, and Japan have reported the largest volume of cases of infant botulism, though researchers suspect the condition may often go undiagnosed and under-reported.

Eating honey before the age of 12 months can be a risk factor for infant botulism. [4]

Infant botulism signs and symptoms may include:

• Constipation (first sign)
• Bad temper
• Excessive drooling when feeding
• Eyelids sag
• Facial expression is flat
• Lethargy, listlessness
• Respiratory difficulties
• Slow or improper reflexes
• The baby cries weakly
• The child feels floppy
• The infant does not gag
• Unfocused eyes
• Weak sucking [5]

Prevention strategies of infant botulism include:

• Avoid giving honey to babies under 12 months of age.
• Keep newborn babies away from soil until their umbilical stumps have dropped off and the navel has completely healed.
• Take care when preparing, handling and storing solid foods for babies. [6]

Food safety and botulism

Botulism can be found in soil, water, on plants, and in the intestinal tracts of animals and fish. [7]

Foodborne botulism is most often from home-canned foods with low acid content, such as asparagus, green beans and corn. It is usually due to a failure to follow proper canning methods. Botulism has also been associated with vegetables in oil, chopped garlic in oil, canned cheese sauce, tomatoes, carrot juice, and baked potatoes wrapped in foil. [8] You should throw out all raw or canned food that shows any sign of being spoiled.

When canning or preserving foods at home, pay particular attention to hygiene, cooking time, pressure, temperature, refrigeration and storage. You should use a pressure cooker for preserving foods such as meat, poultry, seafood and most vegetables.

Make sure you use the correct equipment, properly sterilise containers and always follow the manufacturer’s instructions for your equipment. Use only recipes with tested proportions of ingredients and be sure to follow recommendations for time, pressure and safe preserving methods.

Don’t taste food from swollen containers, food that is ‘foamy’ or has a bad odour. Don’t rely on smells or ‘blown’ containers alone – it is not always possible to detect Clostridium botulinum bacterium in this way. When in doubt, throw it out. [9]

Botulism scare in New Zealand

Botulism is extremely rare in New Zealand – the last scare was in 2013. Food giant Fonterra issued a botulism warning when testing revealed that some of its whey powder may have been contaminated with clostridium botulinum. [10]

Fonterra and New Zealand authorities recalled batches of whey product used to form 870 tonnes of products sold in a variety of markets including Australia, China, Malaysia, Saudi Arabia, Thailand and Vietnam. [11]

The inside of the nose is self-cleaning and needs no special care. If your baby has any discharge, wipe it from the outside, but resist using cotton balls or your fingernail to try to remove it from the nostril – you might damage the nasal membranes.

Newborns often have snuffly breathing because their nasal passages are very narrow. Frequent sneezing will help your baby to clear any blockages from his nasal cavity.

Colds and nasal congestion:

• Your baby is naturally inclined to breathe through his nose – even if he can’t because of congestion. Congestion may disrupt feeding, sleeping and our baby’s overall temperament.
• If your baby has nasal congestion, try to keep it cleared so he’ll be as comfortable as he can be.
• While having a cold can be miserable, they usually don’t pose a serious health threat. However, a young child with a cold needs to be watched as his cold could lead to more serious conditions including ear infections, influenza and pneumonia.

Helping my baby with a cold or nasal congestion:

It’s true – there is still no cure for the common cold, but there are some simple steps you can take to make your baby comfortable – and lessen the likelihood that it will become something more serious – while he rides out the storm.

• Make sure that he rests
• Offer him extra fluids (in the form or water or extra breast feeds) to replace the lost fluids
• Use saline drops to help clear his stuffy nose

This article was written by Ella Walsh for Kidspot. Sources include Parenting and Child Health

The first thing to remember when it comes to ear care is ‘less is more’. Don’t go poking around in your child’s ears as you may do serious harm to the ear drum. The ear is naturally self-cleaning, and trying to remove wax by probing may only force it further into the ear. It turns out that the old adage ‘Never put anything smaller than your elbow in your ears’ is true!

For general baby ear care, you should:

• Wipe behind your baby’s ears (which can become quite crusty due to milk that overflows from her mouth which then runs across her cheeks and down towards her ears) and around the outside of each ear.
• Be careful not to stick anything inside her ear, as it’s very easy to do damage.

Ear infections:

Ear infections are among the most common illnesses in babies and young children. And while not serious as a one-off illness, repeated ear infections can cause hearing problems. Ear infections can also make kids absolutely miserable as they can be very painful.

• Most ear infections are middle ear infections (otitis media). Otitis media is caused by a bacterial or viral infection behind the eardrum. Two-thirds of all ear infections are caused by bacteria.
• Young children are more prone to bacterial ear infections because the Eustachian tubes, which connect the throat to the middle ear, are shorter and so allow bacteria easier access to the middle ear.
• Middle ear infections are more likely to occur in winter – they may cause fever and pain but usually respond quickly to treatment. Generally there are no long-term consequences.
• Some children do suffer from recurring ear infections, and these may lead to ‘glue ear’ and possible hearing loss.
• If you suspect that your child has an ear infection, you should have a diagnosis confirmed by your GP.
• ‘Glue ear’ is a condition where there is constantly a thick, glue-like secretion in the middle ear. ‘Glue ear’ often occurs in those who have repeated middle ear infections that are difficult to resolve.
• If you notice any discharge (including blood) coming for the ear, you need to seek medical advice immediately, as this discharge may be the result of a perforated eardrum.

What are the symptoms of an ear infection?

Depending on the age of your child, symptoms may include:

• fever
• irritability
• drowsiness
• loss of appetite
• nausea or vomiting
• diarrhoea
• headache

For some children, ear infections can be ‘silent’, presenting little or no pain until the problem is chronic. For most though, an ear ache is acutely uncomfortable and they will quickly complain of pain or pressure in the ear.

Young children who can’t articulate their discomfort may tug at their ears or try to put their finger inside the ear canal. They may also become difficult to settle at night, as lying down can put more pressure on the middle ear.

Occasionally the eardrum will perforate (rupture) and this will allow the discharge that has been trapped behind the middle ear to run out. This discharge will be thick and may appear bloody. A perforated eardrum will provide instant relief from the pain. The burst eardrum will usually heal naturally, but as it heals you need to take care to protect the ear canal from foreign material.

How can I help an ear infection?

• Give a middle ear infection a chance to get better without help – they often resolve themselves within 24 hours.
• Generally, most GPs will only administer antibiotics for an ear infection if your child is very young or particularly unwell.
• Some people believe that decongestants help relieve an ear infections, although no there is no research to support this.
• Paracetamol, is usually the best medicine for controlling the pain and fever associated with an ear infection.
• Using nasal drops may help your child to feel comfortable – saline drops are the safest for babies and toddlers.
• If your child can blow her nose, get her to do this regularly as the blowing will help equalise the ears and relieve the pressure behind the ear drums.
• Inserting ventilating tubes (grommets) through the ear drum may be required where there are ongoing ear infections or glue ear.

This article was written by Ella Walsh for Kidspot. Sources include Raising Children Network.

Blocked tear duct (sticky eye):

Sticky eye is more likely if your baby’s tear duct is narrower than normal or not fully developed. Tears are unable to drain away through the tear duct into the nose, and built up in the eye. This may cause your baby’s eye to appear constantly wet (hence the term ‘sticky eye’).

• A blocked tear duct will naturally resolve by 12 months old in 90% of babies.
• Occasionally the tear duct can become infected. You will notice a white or yellow discharge for the eye and perhaps swelling or redness around the tear duct. In this case, antibiotics may be advisable.
• You can clean away excess tears and any sticky discharge with a damp cloth.
• Massage of the tear duct does seem to help the tears to drain away, so ask your baby health nurse how to do this.
• If the blocked tear duct hasn’t resolved itself by 12 months, your baby may be required to undergo a simple operation to open it using a fine probe.

Conjunctivitis:

• Conjunctivitis is caused by an infection of the lining of the eyelids and of the outer protective layer of the eye (the conjunctiva). It can be caused by a bacteria or virus or by allergies.
• Conjunctivitis will make your baby’s eyes appear red, and they will feel gritty and usually produce pus.
• If the cause of the infection is bacteria, it’s very likely that the conjunctivitis will appear in both eyes – though, perhaps not at the same time.
• A virus-based conjunctivitis may only appear in one eye and will cause profuse watering and itchiness of the affected eye.
• Allergy-based conjunctivitis usually has other accompanying allergy symptoms – hay fever, itchy eyes, twitchy nose.