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Colic: Lactobacillus Reduced Crying by 68%: In a DB PC study of 90 breastfed colicky infants, the probiotic L. reuteri (10(8) live bacteria per day) was compared to simethicone (60 mg/day) for 28 days. The mothers avoided cow's milk in their diet. Daily median crying times in the probiotic and simethicone groups were 159 minutes/day and 177 minutes/day on the seventh day and 51 minutes/day and 145 minutes/day on the 28th day. On day 28, 39 patients (95%) were responders in the probiotic group and 3 patients (7%) were responders in the simethicone group. No adverse effects were reported. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Savino F, et al. University of Turin, Italy. . Pediatrics 2007 Jan;119(1):e124-30. Ed: Complaints of colicky babies occurred in 20% of infants in an Italian study. Yogurt with Lactobacillus acidophilus should work just as well. Colic: Lactobacillus Milk Reduced Colic and Antibiotic Use in Infants: In a 9-month DB PC Johns Hopkins study of 118 infants 3-24 months of age, half were given a milk-based formula with bifidilactobacillus and streptococcus thermophilus similar to the bacteria found in live yogurt. There was a considerably lower level of colic or irritability as well as antibiotic use in the probiotic formula. There was no evidence of ill effects. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Saavedra JM, Abi-Hanna A, Moore N, Yolken RH. Am J Clin Nutr. 2004 Feb;79(2):261-7. Ed: I would think spoon feeding a little yogurt, as in the first study, might be a little better than in the bottle since the heat might kill some of the lactobacilli, but apparently putting it directly into the formula must work, too. Colic: Good Lactobacillus Acidophilus Only in Healthy Babies; Others in Colicky: In a study of intestinal lactobacilli in breast-fed infants with infantile colic (30) and healthy infants (26), lactobacillus brevis (4.34 x 10(8) cfu/g) and L. lactis lactis (2.51 x 10(7) cfu/g) were found only in colicky infants while L. acidophilus (2.41 x 10(7) cfu/g) was found only in healthy infants. Bacterial counts of intestinal Lactobacillus species in infants with colic. Savino F, et al. University of Turin, Italy. . Pediatr Allergy Immunol 2005 Feb;16(1):72-5. Colic: Dr. Brown's Baby Bottles Might Help: In a DB PC 2-week study of 36 colicky infants, infants being fed with placebo bottles significantly spent more time crying (rho=.010) and fussing (rho=.002) on average than infants using Dr. Brown's Natural Flow Baby Bottles. BExamination of the effect of Dr. Brown's Natural Flow Baby Bottles on infant colic. Cirgin Ellett ML, et al. Indiana University, Indianapolis. Gastroenerol Nurs 2006 May-Jun;29(3):226-31. Colic: New Formula Did Better: In a DB PC study of 267 infants comparing a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high beta-palmitic acid content to a standard formula and simethicone (6 mg/kg twice a day), after 1 week the new formula had a much larger decrease in crying (2.47at day 7 vs 5.99 at the study entry) vs. the standard (3.72 at day 7 vs 5.41 at the study entry) (P < 0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76 new formula vs 3.32 standard with simethicone) (P < 0.0001). The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes. Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula. Savino F, et al. University of Turin, Italy. . Eur J Clin Nutr 2006 Nov;60(11):1304-10. Colic: Lactase Helped Some Infants: Two Studies: In a DB PC crossover study of 53 babies with symptoms of colic. Pre-incubation of the feed with lactase resulted in breath hydrogen levels and total crying time which were both at least 45% lower than figures with placebo treatment, in 26% of the full trial group , and in 38% of compliers. The remainder did not respond to the same extent. These findings suggest that infant colic may have a multiple aetiology, and that in a significant number of cases the immediate cause is transient lactose intolerance, in which cases pretreatment of feeds with lactase can result in considerable symptomatic benefits. Improvement of symptoms in infant colic following reduction of lactose load with lactase. Kanabar D, et al. Guy's Hospital, London, UK. J Human Nutr Diet 2001 Oct;14(5):359-63. Also, a second French study reported benefit. Arch Pediatr 2004 Dec;11(12):1546-54. Colic: Star Anise Tea Dangerous: Chinese star anise (Illicium verum Hook f.) is a well-known spice used in many cultures. Many populations use it as a treatment for infant colic. Japanese star anise (Illicium anisatum L), however, has been documented to have both neurologic and gastrointestinal toxicities. These physicians report 7 cases of adverse neurologic reactions in infants seen with the home administration of star anise tea. In addition, they found evidence that Chinese star anise has been contaminated with Japanese star anise. More strict federal regulation of the import of star anise into the United States is warranted. Star anise tea should no longer be administered to infants because of its potential danger in this population. Neurotoxicities in infants seen with the consumption of star anise tea. Ize-Ludlow D, et al. Miami Children's Hospital, Miami, FL. Pediatrics 2004 Nov;114(5):e653-6. Colic: Herbal Remedy Helped Colicky Infants: In a 1-week DB PC study of 93 breastfed colicky infants, the daily average crying time for the herbal treatment was 201 min/day at the baseline and 77 min/day at the end of the study; for the placebo it was 199 min/day and 170 min/day (p < 0.005). No side effects were reported. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil((R))) in the treatment of breastfed colicky infants. Savino F, et al. Universita di Torino, Italy. Phytother Res. 2005 Apr;19(4):335-40. Colic: Smoking Parents Have More Colicky Infants: In a study on infant crying and smoking in a Dutch national sample of 5845 infants aged 0-3 mo, excessive crying was defined as crying over 3 h a day on more than 3 d of the preceding week. The prevalence rate of excessive crying was 4.0%. Excessive crying occurred 99% more frequently among infants of father's smoking 15 + cigarettes/d and 86% for mothers smoking 10 + cigarettes/d during pregnancy. Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non-smoking parents. Exposure to tobacco smoke and infant crying. Reijneveld SA, et al. Groningen University, The Netherlands. . Acta Pediatr 2005 Feb;94(2):217-21. Co-Sleeping with Your Infant Dangerous: Reported deaths during a four-year period found the risk of suffocation for babies in cribs was 0.63 deaths per 100,000 infants, compared 25.5 deaths per 100,000 infants who suffocate in adult beds. In the U.S., 13% of parents have their youngest child sleep in bed with them. The child can be suffocated by the loose blankets or sheets, caught between the bed and the wall, or even have a parent roll over on top of him during the night. James Kemp, St. Louis Univ., 10/03 Pediatrics. Co-Sleeping with Your Infant Increases SIDS: In New Zealand, 24% of SIDS cases occur with bed sharing especially by smoking mothers (26% vs. 3% of all SIDS cases). Lancet 11/30/96 p1466 Diabetes Type 1 Increased by Gluten Consumption Before Age 3 Months: A German study of 1610 newborns through age 8 found life-table islet autoantibody frequency was 5.8% by age 5 years. Reduced total or exclusive breastfeeding duration did not significantly increase the risk of developing islet autoantibodies. Food supplementation with gluten-containing foods before age 3 months, however, was associated with considerably increased islet autoantibody risk (adjusted hazard ratio, 4.0). Four of 17 children who received gluten foods before age 3 months developed islet autoantibodies (life-table 5-year risk, 24%). All 4 children had the high-risk DRB1*03/04,DQB1*0302 genotype. Early exposure to gluten did not significantly increase the risk of developing celiac disease-associated autoantibodies. Children who first received gluten foods after age 6 months did not have increased risks for islet or celiac disease autoantibodies. Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E. JAMA. 2003 Oct 1;290(13):1721-8 Diarrhea: Glutamine Helps Infant Diarrhea: Glutamine is an important fuel for rapidly dividing cells such as enterocytes and lymphocytes. Exogenous glutamine supplementation in catabolic states preserves intestinal mucosal structure and function, decreases bacterial translocation, and supports normal immunologic responses. In a DB PC study of 6- to 24-month-old children with acute diarrhea using either 0.3 g/kg/day of glutamine (n = 63) or placebo (n = 65) for 7 days, the diarrhea in the glutamine treated group was significantly shorter than that of the placebo group (3.40 days vs. 4.57 days, respectively; P = 0.004). The beneficial impact of glutamine supplementation seems to be through effects on gastrointestinal mucosa. Effect of Glutamine Supplementation on Diarrhea, Interleukin-8 and Secretory Immunoglobulin A in Children With Acute Diarrhea. Yalcin SS, Yurdakok K, Tezcan I, ONer L. Hacettepe University, Ankara, Turkey. J Pediatr Gastroenterol Nutr. 2004 May;38(5):494-501 Fever: Alternate Generic Tylenol with Ibuprofen: In a DB study of 464 children aged 6 to 36 months with fever, children were given either acetaminophen (12.5 mg/kg per dose every 6 hours) or ibuprofen (5 mg/kg per dose every 8 hours) or alternating acetaminophen and ibuprofen (every 4 hours) for 3 days after a loading dose. The group given the alternating regimen had a lower mean temperature, more rapid reduction of fever, receiving less antipyretic medication, less stress, and less absenteeism from day care as compared with the other groups; all of the differences were statistically significant (P< .001). None of the regimens were associated with a significantly higher number of emergency department visits (P = .65) or serious long-term complications (P = .66). The drug used for initial loading had no effect on outcome in any of the groups. Antipyretic treatment in young children with fever: acetaminophen, ibuprofen, or both alternating in a randomized, double-blind study. Sarrell EM, et al. Tel Aviv University, Israel. . Arch Ped Adol Med 2006 Feb;160(2):197-202. Kangaroo Mother Care Helps Underweight Newborns: In Kangaroo Mother Care (KMC), newborns weighing less than 2000 g and unable to regulate their body temperature remain with their mothers as incubators, main source of stimulation, and feeding. They are attached to mothers’ chests in skin to skin contact, wearing only a nappy and a bonnet, and are kept upright 24 hours a day. Fathers can also be carers. The carer should sleep in a semi-sitting position. The KMC often substitutes for neonatal units in poor countries, although intermittent skin to skin contact has been used in ventilated infants who absolutely need the unit. Exclusive breast feeding (plus vitamins) is attempted. Infants will reject permanent contact once they achieve regulation of their body temperature, at roughly 37 weeks after conception. An open randomized trial of 746 low birthweight infants, at the 12 months of age KMC had improved breastfeeding rates and infections were milder. Hospital stay was reduced in "Kangaroo" newborns weighing 1500 g or less. A non-significant reduction in mortality (3.1% v 5.5%; relative risk 0.57) and slight improvements in developmental indices were found. Kangaroo Mother Care, an example to follow from developing countries. Juan Gabriel Ruiz-Peláez et al, Bogota. BMJ 11/13/2004; 329:1179-1181 Massage: Infant Massage Improves Sleep: 30 minutes of bedtime massage therapy to their infant for 14 days, beginning at 10 to 14 days after birth. 20 mothers in random assignment study. The massage involved touching the infant's head with one hand and lightly stroking his or her back in a circular motion with the other. Mother-child sleep patterns became more aligned. Melatonin is higher at night in massaged infants. 12/02 Journal of Developmental and Behavioral Pediatrics. Other studies report enhanced mother-infant interaction for depressed mothers, infant relaxation and decreased crying for colicky infants. Oil on Skin Cuts Premature Infant Infections: Premature babies (497) weighing under 1500 g (3 pounds) and under 33 weeks gestation were either given routine care or twice a day massages with sunflower oil or Aquaphor petroleum-based ointment. In both the treatment groups, infections decreased by 60% for infants treated from the first day. Massaging babies with oil is traditional in many cultures. G. Darmstadt, Johns Hopkins, Lancet 2005. Peanut Oil in Baby Creams Increases Peanut Allergies 7-Fold: Gideon Lack et al. King's College London. 2003. Peanut Allergy Protection: Roasted peanuts are much higher in allergens and are typical in the U.S. diet vs. the boiling or frying in China or boiling in west Africa where peanut allergies are unheard of. Avoiding peanuts entirely during infancy may not work due to trace amounts in food sources and may increase allergy frequency. Theoretically, eating boiled or fried peanuts by nursing mothers and later by the children up to age 2 or 3 should reduce the risk of allergies later. Plastic Diapers Heat Testicles: German study found plastic diapers raise testicular temperatures to 2.1 degrees above body temperature. Researchers think that this may cause an increase in infertility and testicular cancer. USA Today 9D 9/27/00 SIDS: E. Coli Curlin Shock Protein: North Adelaide physician Paul Goldwater has found curlin in all of 68 babies dying for SIDS and none of 60 controls. Curlin causes shock in mice. Serum of SIDS babies toxic to mice. 100% SIDS and 80% controls had E. Coli, but only SIDS had curlin. Curlin may help E. Coli gain some competitive bacteria advantage. Compuserve 4/25/02. SIDS babies have wet and heavy lungs, unlike suffocation. Also, SIDS have unclotted blood, also unlike suffocation. E. Coli from SIDS babies often more toxic than those from normal babies. SIDS: Used Mattresses ? Associated with Increase: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome, multivariate odds ratio 3.07. Use of a used infant mattress for last sleep was also associated with increased risk (6.10). The association was significantly stronger if the mattress was from another home OR=4.78. BMJ 2002;325:1007; Used infant mattresses and sudden infant death syndrome in Scotland: case-control study; David Tappin; However, editorial notes that high parity is strongly associated with SIDS and after controlling for this no impact of used mattresses and that used mattresses not associated with SIDS in low parity families Walkers: Don’t Use Baby Walkers: 190 normal babies about when their children reached the normal childhood milestones and how much time they spent in babywalkers. Babies who didn't use the walkers started to crawl and walk alone about four weeks earlier than the children accustomed to the walkers and walked three weeks earlier. In addition to causing developmental delays, babywalkers have also been shown to increase the risk of injuries in babies. BMJ 6/21/02, Irish study. Vitamin D: Diabetes in Children Reduced by Vitamin D 2000 IU: A Finnish study following 12,055 babies born in 1966 found those who were given the recommended 2000 IU of vitamin D supplement had an 88% reduced risk of developing diabetes (RR for regular vs no supplementation 0.12, and irregular vs no supplementation 0.16). Children who regularly took the recommended dose of vitamin D (2000 IU daily) had a RR of 0.22 compared with those who regularly received less than the recommended amount. Those who had rickets, a disease linked to vitamin D deficiency, in the first year of life had a three-fold risk of developing diabetes. Finland has the highest reported incidence of type 1 diabetes in the world. In north Finland, there are only two hours of sunlight, a key source of vitamin D, each day in December. BBC News 11/2/01 and Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Institute of Child Health, London, UK. Lancet. 2001 Nov 3;358(9292):1500-3.; Vitamin D status increases the expression of Type 1 diabetes in non-obese diabetic mice. Data in the mice, as well as human epidemiological data, point to the importance of preventing vitamin D deficiency in early childhood. Controlling this dietary factor could be an easy and safe way to reduce the incidence of Type 1 diabetes in subjects who are genetically at risk. Belgium. Diabetologia. 2004 Jan 31. Vitamin D Prevents Rickets: 6 cases rickets in England assoc with breast feeding without Vitamin D supplement during pregnancy or after delivery. BMJ 1/16/99 Vitamin D: Give Infants Vitamin D: Healthy, term infants at the highest risk for vitamin D deficiency are those who are breastfeeding and have dark skin or little sun exposure (SOR: B, 2 case series). Infants consuming at least 500 mL of fortified formula each day do not need additional supplementation. A recommendation of vitamin D supplementation of 200 IU/day should be explained to all families. J Fam Prac Dec;54(12):1089-91. Vitamin K Deficiency Can Mimic Child Abuse: Supplemental vitamin K is required for normal hemostasis in infancy. Infants born outside the hospital may not receive prophylactic vitamin K. They may suffer from bleeding into various tissues and are likely to present to the emergency department. This report describes an infant born at home who presented with intracranial bleeding and signs and symptoms consistent with child abuse. Further investigations confirmed the diagnosis of Vitamin K deficiency. Vitamin K deficiency mimicking child abuse. Brousseau TJ, et al. University of Florida Jacksonville, Florida. J Emerg Med 2005 Oct;29(3):283-8.
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