Nina Sebastiane: Well it’s that time again when our resident Dr. Su Laurent joins us to answer your baby and toddler questions. Now some of the problems we will be tackling today include an eight week old who won’t goes to loo and a tongue tied baby. Welcome Su, I’ve got my mailbag questions here ready for you. First one off, I can’t seem to wean my two year-old baby off his dummy, I am sure this is constellation fit for many people out there including myself. Everytime I take it out, he screams, what can I do?
Su Laurent: Well first of all I think what you do is to decide do you really want to get him off the dummy or not. And if it’s a big issue then you can do it quite easily and the way to do it is to decide, today is the day and actually show the baby that you are throwing the dummy away, or show you toddler you are throwing it away and you haven’t got spares anywhere around, they are gone. The thing about children is that if they know there is no other option, there is nothing hidden away and you’re not going to give in and go and get another one, then very quickly they move onto something else. And I’ll give you a very good example. My little one who used to suck his thumb all the time and I was thinking to myself, when am I going to have to try and wean him off sucking the thumb.
Nina Sebastiane: How did you do it?
Su Laurent: Well, I didn’t. I had this awful thing all at work, which as my nanny saying, he has fallen over and he is on this horrible injury to his thumb and he’d skinned it completely and he might allow us to a clinic, and he just ripped off the skin from his thumb. So I said, get in the taxi, whizz off – you know get one of my nurses to have a look. He done this horrible thing, and we had it bandaged up and we had to keep sort of a checking it and eventually it healed. But he never -- he knew he couldn’t put his thumb in his mouth.
Nina Sebastiane: So you saw --
Su Laurent: He just didn’t ask for it. He didn’t ever once say. Oh, I need my thumb or anything and then we took off the bandages and it – they’re gone, his needs to suck his thumb.
Nina Sebastiane: Now this baby, the mum whose mailbag does sent this baby is two years-old. Is there a minimum age, I mean for example, with a baby who is 12 months old, you’re not going to able to communicate that they won’t do.
Su Laurent: No. And you also need to think about time of day, I mean for some parents, having a dummy at night is fine and it pacifies them and it’s fine but they don’t want a dummy during the day. I think what -- you just have to be sure, if that’s what you really want to happen as a parent you just make sure you don’t do it anymore, it’s the -- giving the mixed messages thing that for difficult thing.
Nina Sebastiane: And I suppose planning the right time, because if you are about to go to the supermarket and you said, no more dummy, that’s it, then be prepared for it, you know, hellish two hours?
Su Laurent: Exactly, exactly. And if you’ve decided you are definitely going to stop, then you have to then stop.
Nina Sebastiane: Well, I’ve considered bribery.
Su Laurent: Have you?
Nina Sebastiane: Well, I am thinking that may be what we’ll do is, with my daughter say, well, Santa is coming to give you some presents for Christmas but in exchange he is taking all your dummies away. And that’s it, no more dummies because Santa is going swap them for some new toys.
Su Laurent: Well, bribery is a very, very good way forward to everything with children. It’s always best to bribe, and I bribe all the time. It’s much better the carrot than the stick, generally with children.
Nina Sebastiane: Yeah, okay, well that’s good, bribery works, then fine. Next one, what are the Heal Prick Tests?
Su Laurent: All new born babies I think in the world and certainly in the UK will have a Heal Prick Test at about four or five days old. It’s when they are well established on milk feeds, breast or bottle feeds. And they are looking for several rare congenital abnormalities, which if found can be and treated right away can prevent long-term problems in babies.
Nina Sebastiane: So what kind of example?
Su Laurent: For example, there is a condition called Hypothyroidism, Congenital Hypothyroidism, where the thyroid gland which lives here in the neck is underactive or is not there at all in some babies. If you start them on a little dose of thyroid medicine from when you discover they’ve got an underactive thyroid gland, they can live a full active normal life but if you don’t pick that up until they’ve got significant signs and symptoms of hypothyroidism, then they may have long-term problems.
Nina Sebastiane: Now does this happen to all children just a few days after they are born, how does it work?
Su Laurent: All of them and the midwife does it.
Nina Sebastiane: Right, okay.
Su Laurent: So it’s often done at home when the baby has gone home.
Nina Sebastiane: And not very painful, I mean it’s just --
Su Laurent: No, they will cry.
Nina Sebastiane: Right.
Su Laurent: Because it’s a little -- you have to get some blood out off their heals.
Nina Sebastiane: Yes.
Su Laurent: So it’s a quick job and then they get some little bit of blood, little spots on the piece of paper. And there are other things like for something called phenylketonuria similarly, if you diagnose it early, you can treat it early.
Nina Sebastiane: Okay, staying with babies of that age, one of the other question come through. After the birth of my child, the baby will be given vitamin K, I am told, I’ve heard that there are possible links to leukemia, is that right?
Su Laurent: And this is a very interesting and very good question. And the answer is categorically no but I’ll tell you why there is links for thought about. A few years ago, probably ten or more years ago now, they were looking at, I mean large study, Epidemiological study, they were looking to see were there any obvious courses to leukemia. So they took a whole lot of children who had leukemia and a whole lot of children who didn’t, we call them controls, and they looked to see what has happened to them in the first few years of their life and that included many, many, many questions to parent about what is happened, what they’ve been given, what treatment, where they lived.
And one funny little thing that came out was that more of the children seem to have been given an intramuscular injection of vitamin K, then being given it by mouth, because obviously some children been given by mouth, some have been given an injection. They then looked around the world to see if they could replicate that anywhere else. And the answer was, no, they couldn’t. But the problem is once information gets out into the public, there is a possible link but we don’t -- we are not sure about it yet. Everyone starts panicking, so everyone says, no, we won’t have this.
Nina Sebastiane: So, did this research happened in one space and was not able to be repeated anywhere else.
Su Laurent: Exactly. It happened in one place, it happened in the UK but it looked around the world and they have – in Scandinavia, they just happened to have amazing statistics because of the smaller population, they keep fantastic statistics as absolutely no evidence to any link.
Nina Sebastiane: And why does newborn babies need vitamin k for example, why can’t the mum take it?
Su Laurent: Well the answer is that, but most newborn baby, the only vitamin K because that stops blood from becoming too liquid. In other words, it helps your blood to clot so that if you have for example a cut and you haven’t had enough vitamin K, you will bleed more. So what the vitamin k is for is to prevent a very rare condition called hemorrhagic disease of the newborn where a baby is born without enough vitamin K, usually due to liver damage. So with most babies, there will be no problem and you’ll get vitamin K enough from the mum and then as the baby gets older, they’ll get vitamin K from various sources, but what we’re trying to do is to make sure that babies don’t get this rare disease.
Nina Sebastiane: Okay, alright. But it will be standard and it will be offered as soon as you had baby.
Su Laurent: It will be offered in standard and all of my babies have had vitamin K.
Nina Sebastiane: Alright, okay. Next question for you then, my nine week old daughter is tongue tied. The Health Visitor says nothing to be done unless she has problems with her speech when she is older. But I want to do something, can anything be done to solve this sooner?
Su Laurent: Tongue tied, what we all have underneath our tongue a little thing called frenulum, which means a little bit of skin, you probably -- if you look at yourself in the mirror, you’ll feel a little bit of skin under there, that’s right, under there. And some babies when they are little, little bit of skin seem to come almost to the tip of the tongue so it looks more obvious. Traditionally, apparently midwives if they saw a tongue tied, will just stick that finger in the baby’s mouth and kind of rip it.
Nina Sebastiane: Oh.
Su Laurent: But you can understand why we don’t do that anymore. There is a little blood vessel which goes through there and you can get a lot of bleeding there, and also you can get scaring.
Nina Sebastiane: Yes.
Su Laurent: So, what we do is now we watch and we wait. And for some children, the tongue carries on growing and the little bit of skin is relatively minus.
Nina Sebastiane: Yeah. It’s been -- back almost.
Su Laurent: That isn’t a big deal. And for a very few children, the bit of skin seems to always be attached to the tip of the tongue so they can’t actually get the tongue out of their mouth or they can’t use their tongue properly to say certain letters.
Nina Sebastiane: So, perhaps the speech impending or something like that might come in the future?
Su Laurent: Yeah. And so looking at the babies and just monitoring what happens, you can see the rare ones who actually need to have something done about that. And the more common ones, where you just watch and wait and very quickly you realize that there is no problem, they can feed properly, they can speak properly and there is no problem.
Nina Sebastiane: Well, might it affect feeding for example?
Su Laurent: Well, very rarely it can affect feeding, but I have to say I’ve never actually come across one of all the children I’ve looked at.
Nina Sebastiane: So and if -- so my guess is to the mum who is concerned about this, if it is bothering you that much, go back?
Su Laurent: Go back and see somebody, ask your GP to have a look.
Nina Sebastiane: Yeah.
Su Laurent: Eventually, it’s quite a simple thing to do but you would have to give a baby an anesthetic.
Nina Sebastiane: Alright.
Su Laurent: And so you never want to give a baby an anesthetic for something that doesn’t actually need to happen.
Nina Sebastiane: Alright, okay. Next question for you in my mailbag. I am worried because my eight week old baby doesn’t poo everyday, is this normal or this a problem?
Su Laurent: Pooing is a huge area, isn’t it?
Nina Sebastiane: With an under two, you become I think, you become a bit poo obsessed actually when you have children?
Su Laurent: I think, you now before I had a lot to say about poos but poo is something I see a lots and lots of children with problems pooing and the real thing is pooing -- if you have any difficulty pooing and is causing straining and crying and upset, that can be a problem. But just doing a poo every other day without any big deal about it all is normal and in fact the normal amount of poos that any child will produce is between three times a day and every three days.
Nina Sebastiane: Alright.
Su Laurent: And for babies, breastfeed babies, they’ll often produce a poo after every single feed. But some babies will produce poo every two, every three, every four days without any difficulty at all, it’s a nice soft poo, it will be a quite a large volume because it isn’t coming out that often.
Nina Sebastiane: Yeah.
Su Laurent: But it isn’t causing them any trouble. So, those babies do not worry about. Having said that, there are some babies who seem to have great difficulty and strain and push and causes a great distress and those babies you can – well, first of all, ensure that you’re not making – if you’re bottle-feeding them and it commonly on the bottle-fed babies that have problems pooing. If you are bottle-feeding, make sure you are not making the feed too concentrated.
Nina Sebastiane: Yes, more water.
Su Laurent: More water. Also you can do things like giving a little bit of -- tiny bit of orange juice in some water.
Nina Sebastiane: Really? Even to a new born?
Su Laurent: Even to a very young baby. I mean usually with a new born, just giving a little bit of extra water is all you need to do. It’s very unusual for new born to have real problems with constipation, a little bit of extra water. Sometimes, you can also give a little bit of sugar and some sugar.
Nina Sebastiane: Even Sugar?
Su Laurent: Even sugar and --
Nina Sebastiane: And that’ll just start things going.
Su Laurent: It’ll soften the poo and gets them going.
Nina Sebastiane: If you would, you wouldn’t use anything for example like prune juice or anything, because prune juice is historically dangerous.
Su Laurent: With the older children, yes a little bit of prune juice you can use as well and what I always say to people is talk to a Health Visitor because Health Visitor has got lots of tricks up their sleeves. Mostly the thing that often parents do, they get obsessed with bottoms, they start sticking things up their children’s bottoms. I am really trying to avoid that if at all possible.
Nina Sebastiane: Yeah.
Su Laurent: They lie the children on their back, they pull it in their legs, they shut their fingers up, I just think that really exasperates the problem.
Nina Sebastiane: I see, talking to your Health Visitor is probably a really good bit of advice because I know that sometimes you can even just rub the tummy.
Su Laurent: Massaging the tummy, exactly, exactly.
Nina Sebastiane: Because I think that’s what they told me.
Su Laurent: yes, it’s fluid, it’s massage and very often the whole thing will just come out and then your baby will be fine.
Nina Sebastiane: Fantastic. Okay, I think we got time for one more quick question for you. What’s the ideal age to start my potty training with my little girl?
Su Laurent: Well, that’s a very interesting one. I think before I had children, I wouldn’t have been able to answer this question, it’s not really a paediatrician’s question at all, it’s a parent thing and I didn’t really know. I just thought that if they tell you these children, you’ll find out one day, they’d say, oh, I want to use a potty but of course lots of children don’t.
Nina Sebastiane: Yeah.
Su Laurent: They’ll just carry on in their nappies until you say one day, let’s try. So I think, that’s the ideal season is quite a good way of starting because sometimes it’s the summer they got minimum amounts of clothes, it’s sort of easier to take off their nappy, to wear sort of light clothes and give them the feel that you got no nappy on so you tell me when you want to wee.
Nina Sebastiane: My grandmother with my little girl is obsessed about getting her on the potty as soon as possible. I think it might be a generation thing.
Su Laurent: The generation thing, and there’s also a sort of a racial thing. There are some -- I’ve got lots of Indian doctors and they will have their babies will be potty trained from very early on. They’ll feed them when they’re even less than a year old. They’ll feed them and they’ll put them on the potty immediately to get them used to the idea that you feed and then you have a wee or a poo. And often it’s their parents who are doing all this.
So, they’ll say to me, oh, my child has been off nappy since they are eighteen months. Traditionally in the UK, it comes about too much people often try. My advice is if you’re trying and your child is not interested, don’t just battle on for months, have them got around two and wait a couple of months and try again.
Nina Sebastiane: So, two or thereabouts but don’t stress about it.
Su Laurent: Do not stress about it.
Nina Sebastiane: Well Su, that’s -- we run out of time already. Thank you so much for coming in and answering our mailbag.
Su Laurent: Pleasure, thank you.
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