Winter 2016

An update
for parents
Winter 2016
Why does my child get sick so much?
It seems like my child has "Daycare-itis"!
“It seems like my baby (or toddler or preschooler) has been
sick all winter! Should I worry about her immune system?” This is a
common question we are asked in the first several years of life, and
especially common from parents of young children in daycare. We
The fact that
know how frustrating it can be when it seems like your child just
your child bounces
gets over one cold and goes right on to the next, but did you know
back from all
that exposure to viral illnesses when young is actually good for your
these colds,
immune system?
never gets serious
The average healthy child suffers through anywhere from 7 to
12
upper
respiratory infections or “common colds”, during their first
infections,
year of life! The cold count is at least 12 if the child is in daycare,
and is growing
and these colds will be most common in the winter months. Ear
so well means
infections can complicate 30-50% of these colds as well. While
your child has a this is scary and frustrating for parents of young children, exposure
wonderful
to these viruses has to happen at some point, whether it be now in
immune system! daycare or later in elementary school. And research has actually
shown that kids in daycare before age 30 months suffer from fewer
respiratory infections in elementary school than their counterparts.
The numbers eventually even out, usually by age 12, but having
infections earlier in life may prevent your child from missing days of
school later! (If fever does not break within 72 hours, always call.)
The “hygiene hypothesis” says that kids exposed to less sterile
environments (such as daycare) may not only benefit from fewer
infections but also decreases in asthma and allergy, all of which are
related to the immune system.
Despite this, your daycare facility should follow the hygiene
recommendations of the American Academy of Pediatrics to minimize
your child's risk of infections. Visit www.healthychildren.org and
www.healthychildcare.org with trusted advice for your daycare.
When to worry: If you have a family history of immune deficiency, if your child is not growing
well, or if your child has suffered from two or more serious infections such as pneumonia or
hospitalization in a year. Then your pediatrician will recommend evaluating your child's immune
system.
by Monica Hamburgh, MD
and Doug Puder, MD
www.clarkstownpeds.com
• Nanuet (845) 623-7100 • New City 352-5511• Stony Point 786-5776 •
Breastfeeding For Real Women
S
o, everyone has an opinion about it. Some stronger than others.
But truthfully, the only opinion that is important for your baby
PUMP!
is yours. And you are allowed to change your mind at any time…
DON'T
With that said, breastfeeding offers many benefits to your baby.
PUMP
Breast milk contains a great balance of nutrition to help your infant
grow into a strong and healthy toddler. Antibodies passed through
Latch
your breast milk also help protect your infant against some common
This
illnesses and infections. Breastfeeding is “natural”, but natural doesn’t
Way!
mean it always comes naturally. You and your baby will need practice,
DON'T
but for most, it does get easier with time. You two will become a good
LATCH
team if you stay relaxed as possible about it. Most women don’t get
THAT WAY!
in their breastmilk until days 3, 4, 5 or 6 which means you are often
leaving the hospital without being a great team yet. And that’s ok!
Breastfeeding benefits the mom too. It saves time and money on
washing bottles or mixing formula. It helps the uterus contract back
to normal size and delays the return of periods, although not reliably
enough to be a form of birth control. Women who breastfeed also
have lower risks of diabetes, breast and ovarian cancer, high blood
pressure, and heart disease.
However, the best way to have a happy baby is to have a happy
Mom's who formula mom! So if breastfeeding does not go the way you planned, we can
feed are
be thankful that infant formula is a wonderful option.
When your baby is “latched on” the right way, both lips should
Real Women too!
be rolled and cover nearly all of the areola. Instead of smacking
noises, your baby will make swallowing noises. Your baby’s jaw may
move back and forth. If you feel persistant pain while your baby is
nursing, he or she is probably not latched on correctly. The initial
latch can be uncomfortable, but as you breathe and count, the time
it takes to subside should get less and less each week. Most women
feel no pain with the latch by week 3, thankfully! If your baby isn’t
latched on the right way, you’ll need to start over. To take your baby
off your breast, release the suction by putting your finger in the corner
of your baby’s mouth between the gums.
It can be exhausting to feed your baby “on demand” as we
recommend. "On demand" or "as often as he or she wants to be fed"
could mean 8 to 12 times a day. How often your baby wants to feed
will vary as the baby goes in and out of growth spurts. Growth spurts
commonly occur at about 3-4 weeks of age and again at about 3
months and 6 months of age.
Let your baby nurse until he or she is satisfied. This may be
for about 15 minutes to 20 minutes at each breast or longer. Try to
have your baby nurse from both breasts at each feeding, making the
first breast “appetizer and main course” then the second breast as
“dessert”. This allows time for your baby to fully drain at least one
side to get the most satisfying and fatty milk. Then you can start with
by Erica Berg, MD
2
the opposite side for the baby’s next feed.
One hint that your baby is getting enough milk is your baby has
a calm demeanor for a period of 1 ½ to 3 hrs afterwards. Another
hint is 1 wet diaper for every day of life. For example, 3 days old
means to expect 3 wet diapers that day, and by one week of life it
stabilizes at 6-8 wet ones per day. Also, over the first week of life,
the stool color transitions to a yellow seedy loose consistency. It is
normal for all babies to lose weight after birth, but by two weeks old,
they should be back to their birthweight. That’s why it is important
to see your pediatrician during this crucial time and ask for help.
The best diet for a breastfeeding woman is well balanced and
has plenty of calcium. And water, water, water! This means you
can eat everything you used to before pregnancy, and anything you
haven’t eaten in a while, it’s best to reintroduce in moderation. And
don’t forget to continue those prenatal vitamins while nursing for a
better guarantee of balanced nutrition. Caffeine and alcohol can get
into your milk, so limit how much you drink. Medicines can also
get into your milk, even those you can buy without a prescription.
Don’t take anything without talking to your doctor first.
When problems with nursing arise, they may interfere with
your milk production or your baby’s ability to get the nutrition they
need. Therefore, it’s important to get help right away if you have any
difficulty. Contact your baby’s pediatrician, keep asking questions,
and ask for help until you get the guidance you need!
Wet diaper chart:
Make sure you give your baby vitaminD drops!
T
he American Academy of Pediatrics has doubled the
recommended daily intake of vitamin D for infants and
children from 200 to 400 international units. This is one dropperful
for most brands, and mom's can squirt it into their babies' mouth
just before nursing. Do this once daily. You can purchase vitamin D
over the counter (D-vi-sol, Tri-vi-sol, Ddrops, other generics).
Sunlight helps our bodies make vitamin D, but we don't
recommend sunbathing for babies, and it's way too cold anyway.
Few breastfed infants are getting enough Vitamin D to meet these
guidelines but fortunately this is the only nutrient which breast milk
lacks. Iron and other vitamins are well provided in mother's milk.
Infant formula has vitamin D added, particularly"newborn"
formulas. Once your baby is taking 32oz per day of formula, they
no longer need supplemental vitamin D.
Legal Rights for Nursing Moms:
N
ew York State law makes sure that employers give nursing moms break
time (at least 20 minutes) throughout their work day "for the purpose
of expressing breast milk". Usually breaks should occur at least every 3 hours.
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©Clarkstown
Pediatrics
©Clarkstown
Pediatrics
Clarkstown Pediatrics' Half Century!
I
sn't it amazing that we will be celebrating the 50th anniversary
of Clarkstown Pediatrics later this year! That means that we have
been diagnosing and treating sick children for about 18,000 days
in a row with the exception of one or two days a year during major
snowstorms. Our office has otherwise been open every day, every
weeknight, every weekend, and every holiday since 1966. And we
have been available for telephone advice every hour of those 18,000
days! We will write more about the emeritus (retired) pediatricians
who founded Clarkstown Pediatrics during our summer celebration.
Right now we would like to focus on two of our newest doctors who
will help us continue our tradition of quality care into the next half
century, Drs. Hamburgh and Berg:
Dr. Monica Hamburgh joined the practice in the winter of 2012
and has already developed a large panel of patients who have come
to trust her warm, thorough, and insightful care. She has become
Quinn, Donovan, Hudson,
Siegal, Yurcisin, D'Angelo, the assistant editor of the Clarkstown Parentletter, and frequently
Medici, Lieberman, Rockower, contributes useful articles for parents.
Karasik, and Puder
Dr. Hamburgh received her medical degree from the University
of Rochester in 2004 and completed her pediatric residency training
at Brown University in 2007. She worked as a full-time pediatrician
for 4 years in Rhode Island. As a member of the National Health
Service Corps, she worked in an underserved community, and helped
develop a pediatric asthma program. She was born in Texas, raised in
Montana, and is now enjoying living in Rockland. She is the mother
of two young girls, and enjoys spending time with her daughters,
husband, and dog.
And please welcome Dr. Erica Berg, who joined our practice in
November 2015. She grew up in Rockland county and graduated from
Nanuet High School. She then graduated from SUNY Binghamton
University and SUNY Upstate Medical University in Syracuse, NY.
While in high school and college, Erica interned with Dr. Puder at
Nyack Hospital helping to complete our research project proving the
importance of bicyle helmets for safety. Then she continued to work
during her summers at the old Nanuet office with referrals and patient
check out. That’s where her love of pediatrics truly became solidified.
After weighing options for her pediatric training, she chose NYU/
Bellevue to follow in the footsteps of Drs Puder, Karasik, and Rockower.
She always hoped to return “home” to Clarkstown Pediatrics.
After completing Chief Residency, she was offered a position with
the faculty NYU group. Since her husband was still completing his
medical training there, it was an opportunity she couldn’t turn down.
Then as her husband, a pulmonologist, joined Rockland Pulmonary
and Medical Assoc., and they began their family with "two great kids",
she was excited to have the opportunity to relocate her practice near
home after ten years in Manhattan.
Welcome home, Dr. Berg!
We hope you find our Parentletter helpful and informative. Please keep in mind that receipt of this newsletter does not create a doctor/patient relationship
and that it is not meant to serve as a substitute for professional medical advice. For particular pediatric medical concerns, including decisions about
diagnoses, medications and other treatments, or if you have any questions after reading this newsletter, speak with your child's pediatrician.