New guidelines issued yesterday by experts from the US National Institutes of Health (NIH) recommend introducing peanut-containing foods to babies as early as possible as a way to lower their risk of developing a peanut allergy.
The recommendations reverse previous advice to add peanuts later, but are driven by new scientific research that showed early introduction of peanuts could cut allergy development by 81%. The guidelines are tailored for a child’s risk for peanut allergy, as follows:
- Infants at HIGH risk for peanut allergy (have severe eczema, egg allergy or both)
- Add peanut-containing foods as early as 4 to 6 months
- Consult with health care provider prior to adding peanuts – specialized testing may be needed
- Infants with mild or moderate eczema
- Add peanut-containing foods around 6 months
- Infants without eczema or any food allergy
- Add peanuts to infant diet as appropriate/desired
- IN ALL CASES, start babies on other solids before adding peanut-containing foods
If you have specific questions or concerns about introducing your child to peanuts, speak to your pediatrician or family doctor.
The American Academy of Pediatrics (AAP) held their annual conference this week in San Francisco, and has used this event as a platform for announcing new or updated policy guidelines in a number of areas. One we reported on earlier this week was about New Guidelines on Children’s Exposure to Digital Media.
We report here on another set of updated guidelines – this time focused on safe sleep environments for infants.
More than 3500 infants die each year in the US from sleep-related deaths. This number includes cases of SIDS (Sudden Infant Death Syndrome), plus other sleep-related deaths like accidental strangulation in bed. The rate of infant sleep-related deaths had been dropping up to the 1990s – but little change has been seen in recent years. The issues behind these deaths can all be addressed by similar improvements to enhance the safety of a baby’s sleep environment.
Overview of the Guidelines
Several of the elements outlined in the updated policy are not new, though nonetheless very important. The AAP has long been recommending that babies be put to sleep on their backs (supine position) – and that soft bedding be avoided. They also emphasize the importance of breastfeeding and avoiding smoking and drug use while pregnant – and exposure to smoke/drug use after birth. While most people are likely aware of the risks to babies from exposure to these toxins, not all may know that smoking and drug-use environments are associated with increased infant sleep-death risk, including SIDS. Details of all the guidelines are listed in the box at the end of this article.
What is particularly new and notable in these guidelines is the recommendation for babies to sleep in their parents’ room for up to the first year after birth – especially for the first 6 months when 90% of SIDS cases occur. Research suggests that infant sleep-related deaths could be reduced by 50% through “room-sharing” – as long as the baby is sleeping in their own safety-approved crib or bassinet and not in the parental bed.
“Couches and armchairs are extremely dangerous places for infants.” – AAP Guidelines
The authors of the new guidelines note that “bed-sharing” greatly increases risk for SIDS and other sleep-related infant deaths – and are “especially dangerous” in the following cases:
- When one or both parents are smokers, even if they are not smoking in bed
- When the mother smoked during pregnancy
- When the infant is younger than 4 months of age
- When the infant is born preterm and/or with low birth weight
- When the infant is bed-sharing on excessively soft or small surfaces, such as waterbeds, sofas, and armchairs
- When soft bedding accessories such as pillows or blankets are used
- When there are multiple bed-sharers
- When the parent has consumed alcohol and/or illicit or sedating drugs
- When the infant is bed-sharing with someone who is not a parent
“Skin-to-skin care is recommended for all mothers and newborns immediately following birth” – AAP Guidelines
The updated guidelines FOR PARENTS from the AMERICAN ACADEMY OF PEDIATRICS on safe sleep environments for infants are:
- Back to sleep for every sleep. Babies should be put to sleep on their backs on a surface that meets the Consumer Product Safety Commision (CPSC) should be used. These include cribs, bassinets, portable cribs or play yards. Once babies are able to roll into different positions they can be allowed to sleep in those positions.
- Use a firm sleep surface with NO soft objects or loose bedding. Infant beds should have firm mattresses and tight fitting sheets – and nothing else – including no crib bumpers.
- Breastfeeding is recommended. Breastfeeding reduces the risk of SIDS and the more that a mother exclusively breastfeeds, the greater the reduction in risk. But the authors note that “any breastfeeding is more protective against SIDS than no breastfeeding”.
- Room-sharing with the infant on a separate sleep surface is recommended. Having the baby sleep in its own crib or bassinet is best, but bedside sleepers that are CPSC-approved can be used. No safety guidelines have been developed for in-bed sleepers and there is currently no evidence regarding their ability to reduce SIDS risk – so these are not recommended.
- Avoid overheating and head covering in infants. AAP does not provide specific room temperature guidance, but states that babies should wear only one more layer than an adult would to be comfortable in the room.
- Consider offering a pacifier at nap time and bedtime. Although experts do not yet know why, use of pacifiers has been shown in multiple studies to guard against SIDS. The pacifier should be used when laying the baby down to sleep. It does not need to be put back in the mouth if it falls out while the child is asleep.
- Avoid smoke exposure and alcohol/illicit drug use during pregnancy and after birth. Prenatal and environmental smoking exposure are major risk factors for SIDS.
- Prenatal care and immunization of infants is important. Both prenatal care and infant immunization have been shown to have a protective effect against SIDS.
- Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. There is no evidence these reduce risk of sleep-related death.
The Academy has also recommended against use of products marketed to reduce risk of SIDS – such as wedges and positioning devices. These are not CPSC-approved and do not have scientific evidence to support their claims, and may actually pose hazards. They also caution against swaddling. However, the authors do support daily tummy time for babies to promote development.
Finally, AAP has also provided guidelines for health care providers (including in NICUs, nurseries, and childcare centers), public health officials, and manufacturers. These can be found on the AAP website.
The story comes from a study looking at whether a baby’s “pain behaviours” (such as crying and tensing their limbs) during their first immunisation is affected by their mother’s mental health or if she is a first-time mother.
Despite The Telegraph’s headline, the study did not show any direct association between maternal anxiety (at least, long-term pre-existing anxiety disorder) and infant distress.
It did show that the babies of first-time mothers expressed more “pain behaviours” both before and during the first vaccination than the babies of mothers who have other children.
The researchers speculated that a first-time mother’s unfamiliarity with the vaccination process may be picked up by the baby in some way and this causes short-term psychological distress, making them more vulnerable to pain.
The good news for worried mums is that the study also found that all mothers consistently overestimated their baby’s pain levels during vaccination – in other words, it did not hurt their baby as much as they thought it did.
Based on these findings, the researchers have advised that first-time parents be better prepared for infant vaccinations and given more information about the procedure.
Read NHS Choices’ Six practical vaccination tips for parents.
Where did the story come from?
The study was carried out by researchers from the University of Durham. There is no information about external funding.
The study was published in the peer-reviewed Journal of Reproductive and Infant Psychology.
The Telegraph’s headline claiming that babies with anxious mothers feel more pain during jabs was misleading, depending on how you want to define the term “anxious mother”.
The study found that babies of first-time mothers expressed more distress before vaccination, and the authors suggest this may be caused by heightened levels of maternal anxiety immediately before and during the vaccination process.
But no link was found between increased levels of distress and whether the mother had mental health issues, such as anxiety disorder, depression or problems coping with stress.
The research was covered fairly, although uncritically, by the Daily Mail and The Telegraph.
However, again it is probably misleading to talk about the babies “feeling more pain”, as both papers did.
The study looked at behavioural signs of distress in the babies and not directly at their pain levels.
Any increase in signs of distress could mainly have been related to psychological, not physical, discomfort.
What kind of research was this?
This was a prospective observational study looking at whether a mother’s mental health and if she was a first-time mother had any association with how much distress babies express during their first routine vaccinations at two months of age.
The study also looked at whether the baby’s distress was associated with how often they were touched by the mother.
This type of study can only show an association – it cannot show, for example, that a mother’s anxiety levels cause her baby to feel more pain.
In this type of study there may be many other factors (called confounders) that affect a baby’s expression of distress during vaccination.
The authors point out that vaccinations are a common cause of pain and distress in babies and that early experiences of pain shape an infant’s response to later painful events. Maternal levels of stress and depression have previously been found to have a link with infant expression of pain, and research has also indicated that being a first-time mother may be linked to this, but the evidence is still limited.
What did the research involve?
The authors initially recruited 66 mothers and their babies who were attending baby clinics.
All the babies had been assessed as healthy by health visitors, who saw them before the vaccination procedure. Sixteen of the mothers were excluded from the final analysis for various reasons – for example, 13 babies were held during the vaccination by another relative or friend rather than the mother.
Nineteen of the remaining women were first-time mothers.
The mothers and babies were all videotaped during the first routine immunisation at two months of age, which involves two vaccinations.
The researchers measured infant pain levels during the vaccination procedure using a behavioural assessment which looked at levels of crying, facial expression and pain movements (for example, tensing, clenching limbs and flailing).
These behaviours were taped using a HD digital film camera and were studied frame by frame. A composite total pain measure was then calculated. The final infant pain score varied from 0% (no pain behaviours) to 100% (all pain behaviours all of the time).
They also measured and coded maternal touching behaviour such as rubbing, patting, kissing or rocking.
The recordings were studied frame by frame in order to assess the amount of pain babies expressed in the following five phases during the immunisation process:
- 20 seconds before the first vaccination
- During the first vaccination – where the needle entered the skin
- The time between the two vaccinations
- The second vaccination
- 20 seconds after the second needle had been removed
After the vaccination, mothers completed a validated questionnaire which assessed stress immediately after vaccination, and a further questionnaire to assess whether they were depressed.
Researchers used a pain questionnaire to assess how mothers evaluated their babies’ pain on a scale of 0 (no perceived pain) to 10 (maximum perceived pain).
They analysed their results using standard statistical methods.
What were the basic results?
Forty-nine mothers completed the study, with an average age of 29 years:
- 23 were stressed
- 7 were depressed
- 1 was both stressed and depressed
The researchers found that:
- Babies of first-time mothers showed significantly more pain behaviours before the insertion of the first needle and during the first vaccination than the babies of more experienced mothers
- Maternal mental health, stress levels and type of touch had no association with infant pain expression
- All mothers consistently overestimated their babies’ pain levels and their assessments were “poorly correlated” with infant pain behavior
How did the researchers interpret the results?
The researchers say the findings suggest that being a first-time mother may influence infant pain expression before and during the first vaccination, independent of maternal mental health. They suggest that further research, possibly looking at interventions for new parents, is needed.
This is a small study and although it was carefully carried out, its findings should be viewed with caution. As the authors point out, its size means it may not have had the power to detect all differences in infant pain expression. They argue that a larger study incorporating a more balanced sample of mothers and including other racial and ethnic groups is needed. In addition, other factors could have affected how the babies reacted, including their particular mood at the time.
Still, it seems likely that first-time mothers may find their child’s first immunisation more difficult and their feelings may be sensed by their babies. It would seem to be helpful if this group was given full information about what happens during immunisation to prepare them for the event ahead of time.
If you are a first-time parent, NHS Choices articles you may find useful include:
- Childhood vaccines
- 10 questions parents ask about childhood vaccination
- Six practical tips for parents
- Myths and truths about vaccinations
- Appointments checklist
“Babies with anxious mothers ‘feel more pain’ during jabs,” was today’s headline in The Daily Telegraph. The story comes from a study looking at whether a baby’s “pain behaviours”…
Links to Headlines
- Babies with anxious mother’s ‘feel more pain’ during jabs. The Daily Telegraph, January 9 2013
- Babies of first-time mothers ‘feel more pain’ from injections: Study suggests child can sense parent’s anxiety. Daily Mail, January 9 2013
Links to Science
- Reissland N, Harvey H, Mason J. Effects of maternal parity, depression and stress on two-month-old infant expression of pain. Journal of Reproductive and Infant Psychology. Published online October 25 2012
Editor’s Note: *clarification provided for our US readers.
This is a common question that parents discuss with each other and other parents because most of the time there is no change in status of your child and nothing of importance is noted by his/her Doctor. This is the good news we all wish to hear but there is more than the obvious monitoring going on at these visits, just as important as your child’s current good health. At an early age your baby is seen fairly frequently as growth and development is monitored closely. After all, these elements can predict the overall health of your child as he/she gets older. Developmental issues found early can be dealt with to help avoid later problems.
Also important at these early well baby visits is the frequent and regular administration of vaccines, the order of which is constantly studied to determine the best sequence for adequate immunization. There are many vaccines involved and many parents argue that it is too many for a young child. It turns out that no one vaccine will interfere with any other one and many can be given together; neither will the administration of several vaccines at the same time cause a more severe reaction. Most of these vaccines have very little in the way of significant reactions anyway and should not be feared by parents as the benefits of these vaccines far outweighs the chances of getting the illnesses or suffering any significant side effects.
At these visits a trained professional will also observe the interaction of child and parent which can help predict a smooth or difficult child rearing path. These “well child” visits also provide a time for parents to ask questions that can help allay their fears and give your child’s Doctor the opportunity to expand on these questions. There is a lot of information out there about child rearing and such issues as immunizations (previously discussed) – some real and truthful but some may very well be erroneous in nature – and might add to the normal sense of uncertainty that all parents have when raising children.
As your child gets older, the number of visits will become fewer because most of the early immunizations have already been given and that fragile newborn and early childhood period has already been observed and patterned. Of course one of the main reasons for all these visits is to pick up any early signs of illness or disease, process a very unusual situation as your child gets older but, of course, the earlier detection the better for a positive outcome.
The answer to the first question posed in this blog is that it is very important to follow the schedule of office visits set out by your Pediatrician as this schedule has been closely studied and turns out to be the optimal timing for good child care.
One of the many things new parents of an infant struggle with is an inability to communicate with their new little bundle of joy, especially on a verbal level. When they cry, are they hungry, need a diaper change or is there a realistic medical problem happening with their health and welfare that needs our immediate attention … sometimes it’s difficult to tell.
When it comes to their irreplaceable eyesight, monitoring these formidable years are vital when it comes to recognizing possible vision development problems that could affect them in the future. With a myriad of different types of diseases, conditions and terms to deal with when it comes to their valuable vision, it’s almost always difficult for parents to know where to start with this important process.
Early AOA Recommendations
The renowned American Optometric Association (AOA) is all too happy to guide parents on this important pathway. They offer valuable advice on developmental processes and better vision for growing eyes, from birth to the toddler stage. After they’re born, although their environment is full of visual stimulation, infants have not yet developed the ability to recognize two objects at once.
Their primary focus is on something 8 to 10 inches from their face, which is usually mirrored by their parent’s face in front of their own. After a couple of months, they should start tracking objects, but don’t be overly concerned if they have difficulty focusing, their eyes appear crossed or seem to wander since this is completely normal at this stage.
Five, Six, Seven, Eight – Is Everything Going Great?
After three or four months of age, babies should start to track objects and reach for them with their hands. The perception of color should start developing further now and although it’s not as advanced as their older parent’s eyes, there’s still a general consensus that these tots start to disseminate different shades, colors and start to develop better depth perception. To help boost their perception skills, at this age, parents should:
- Give them plenty of toys, blocks and other objects for them to grasp
- Play patty-cake and other games that use eye-hand coordination
- Make sure they have time to explore by letting them crawl around frequently
Nine and Ten – Let’s Do It Again – Getting To Year One
At nine months, babies will start to pull themselves up and while they’re continuing to approach their first birthday, they should be grabbing and grasping objects firmly. Once they’ve reached twelve months of age, they should be walking, but also encouraged to continue to crawl to heighten their depth perception and advance coordination skills. More ways to improve their developing vision during this time is to:
- Play hide-and-seek with their playthings
- Encourage them to continue crawling and entice them to go further distances
- Name toys and objects to begin developing word association with vision
One Or Two – Before We Buckle A Shoe
There are still a few years before we begin teaching advanced techniques like tying shoelaces, but this time is when toddlers should be developing much better eye-hand coordination techniques. Rolling a ball to them and expecting the same in return for example. They’ll probably start throwing things on their own at this point without our help. Look for better aim as they continue to develop and participate with this process. To continue enhancing their visual skills, parents should:
- Roll a ball back and forth to them
- Read to them and show them pictures in the book
- Give them balls, blocks and puzzle games to play with
If you believe your child may have possible or potential vision problems, take them to see an eye care professional as soon as possible. Eye exams are recommended initially at birth, at six months and then not again until they’re three years of age. But these rules aren’t set in stone and the majority of eyesight issues can be corrected, especially when caught early.
In this short video, health visitor Melissa Green talks about the things you can do to deal with burns and scalds.
Editor’s Note: Video Highlights
- Children’s skin is much thinner than adult skin, so it’s very important to treat their burns and scalds quickly for the best chance of healing
- Most important is to run cold water over the burn for no more than 10 minutes
- Water should be cold, but not ice-cold
- The next step is to place something clean over your child’s burn to protect from risk of infection – like cling film or a clean linen tea towel
- If your child has something stuck to their burn, don’t try to remove it – leave it there and go to the hospital for treatment
- Also don’t put anything on the burn, such as creams or lotions
- If your child has a burn larger than a postage stamp, take them to get medical advice from the hospital
- If your child complains of pain after their burn, you can give them something like paracetamol (acetaminophen) or ibuprofen – don’t give them any aspirin
- If the burn has a blister, don’t tamper with it – it should be left to burst naturally
- Blisters that have burst may be raw and need a dressing – you may want to see your doctor or nurse for this