Pediatrician on potty training, the measles outbreak & cold and flu season (ft. Dr. Ari Brown)

23:44Dr. Ari Brown:So it's not too early to get that protection on board. And again, for babies, the important thing to know is if you want to do the flu vaccine, it's given as young as six months of age. But babies and young children who are getting flu vaccine for the first time, it's actually two doses given a month apart. And so you really want to get in and get that first dose because they need the second dose before they really have an adequate immune response before flu season shows up. Do you have a percent that the vaccine protects you against on the flu? It varies from year to year. It's, you know, it's probably 50, 60 percent.

24:23Dr. Ari Brown:And then people go, well, it's only 50 or 60 percent. And I'm like, that's a lot more than zero. Yeah. No protection is zero. So and it does protect against getting serious infections. So that's the other piece is I think it's a win-win. And the way I view it is either you don't get the disease or you get a milder version of the disease, which is a lot easier to manage. And you get, well, faster and you go back to school and you go back to work. So, you know, I view that as a win. and you can decide what you want to do. But I get my flu shot every year. And how, and so babies as young as any can get it, you're saying - Six months.

25:04Six months. Okay, six months. They just have to do it a back-to-back month. Right. Okay.

25:08Dr. Ari Brown:Okay. Yeah. So, and then the other things that come up that are important and helpful for your audience to hear is RSV because this is a relatively new option. So moms can get RSV vaccine during pregnancy, 32 to 36 weeks if they deliver between September and March. And if you're an off-season mom, then the baby can actually get RSV monoclonal antibody shot. So that's actually kind of delivering passive antibody protection to the baby without them mounting an immune response, which is really cool. And that's not a new product. That's something that we've had for decades for premature babies, but it's only new in the past few years to be able to offer it to all babies.

25:58Dr. Ari Brown:And it's a long acting antibody shot. So it lasts for five or six months through our species. And we're going to start that October 1st. Okay. Okay. And then what are other ways besides being vaccinated that we can do anything? Okay. So this is like super low hanging fruit, things that you can do, things that I do, because people always say, how do you not get sick all the time? How do you not get sick all the time? It's like I was thinking it. Yeah. So here are the secrets. First thing, good hand washing. Your mom was right. It's really important to wash your hands. But the other thing, this is my secret, is don't touch your face.

26:37Dr. Ari Brown:We like instinctively all day long, we rub our noses, we rub our eyes. Kids notoriously put their hands in their mouths. I touch nothing. I touch nothing near my face when I'm in the office all day long. And I do think that that is what keeps me from getting sick from all these kids. But you just introduce these germs into your body by doing that. So if you can teach your kids not to touch their face. Oh, boy. That's a big one. I know. I know. I'm going to have better luck potty training. I'm going to be like, don't eat your hand. I know. But we can try. Right. So simple so important but i know a little hard to do in reality um and then the final thing is for older kids um is teaching them not to share drinks or food with their friends oh that's such a big one so that's probably how it spreads all the time i mean we water bottles share like crazy so i mean this is just real easy stuff you know real easy but it really does help reduce the spread of illness.

27:43Dr. Ari Brown:And when one person's sick in the house, if you can just try to get behind them and wipe things off so that, you know, doorknobs and hand towels and keeping things separate can help the spread in your household. I'm not ready for it. And why do you, just curious if you know the answer to this, I'm sure you do. Why is the flu season, if it's cold and flu season is October to, I think you said April, why is the summer off? So it's kind of barometric and atmospheric pressure. Like the germs just like a certain season. And so interestingly, the Southern Hemisphere has their flu season during our summer, their winter.

28:23Dr. Ari Brown:And so, you know, Australia has already had their flu season. And what a lot of people actually don't know is we decide which flu strains we're going to use in our vaccine based on the Southern Hemisphere. So we see the flu, what's circulating, and then try to, so every year that vaccine is modified depending on what the circulating strains are. But we then cross our fingers and hope that the virus doesn't mutate enough when it travels up to the Northern Hemisphere. And so that's why sometimes it's not an exact match. I've always heard you're not sure if it's the right strain that they're vaccinating against.

29:04So the Southern Hemisphere is where we get it.

29:06Dr. Ari Brown:Yeah. We say they've got this, we're gonna do it. Yes, exactly. So hopefully there will be a universal flu vaccine sometime that we don't have to rely on those things. I love it. But that's currently what it is. And so that's why there's a seasonality to it. Okay. Okay. That makes sense. And maybe because people aren't in school and that just spread like wildfire. Yeah. So that's the time of year when people are in close contact. They're indoors because it's cooler. Oh. And then it just runs rampant. But okay, we're going to get your take on a few things that we've covered on the podcast lately.

29:42Okay. The first one was when it comes to ear piercing, you know, what's the ideal time to pierce your toddler or baby's ears? And we did not know that pediatricians' offices offered ear piercing. Yeah. So how often are you piercing ears? And what's like, what's your protocol?

29:59Dr. Ari Brown:It's pretty common. It's pretty common. I can't give you a number, but it's common. We are happy to do it. What's your common age? Like, is it usually a baby or is it a toddler? It depends. Okay. So culturally, some families really like to pierce their baby's ears, like almost like out of the womb. They want to pierce their baby's ears. And we don't actually do it until the baby is four months of age just because, you know, God forbid they have some fever or some infection. We don't want to deal with a zero to three month old with a fever infection. So we wait until they're four months of age.

30:35Dr. Ari Brown:So we do offer it as young as that age. But then we have some, you know, young preteens and teens who want to get their ears pierced. We don't do cartilage. I love that. Yeah, you only do lobe. I know. Like I watched that. I was like, oh, this is a thing. And Jules has some strong feelings about it too. So you're going to have to show me all the piercings. Yeah, I got half of them are out right now even. But anyway, yeah. So we do it in the office. And I think families really appreciate it because it's a medical setting. It's, you know, we're using disposable medical grade equipment. And we make sure that we're using, you know, titanium and nickel and like all the things.

31:20Dr. Ari Brown:Who taught you guys how to pierce ears? Do you do it? No, no, no. I have a nurse who actually really enjoys doing it. And she's been doing it for a long time. So shout out to Valinda. Now she's going to be like, thanks. Now we're getting all the Austinites. Belinda's like, I have a line. I have a line of ear piercing. Yeah, but she's awesome. So she's the one that does it in your office. Does she mark the dot? Oh, yes. And so sometimes she'll actually ask, you know, if it's an older child, if they would like to do it or the mom wants to do it. But yeah. Mark the dot, not pierce the ear. No, not the – Okay.

31:54Okay. All right. So this one. We were discussing gaming. Yes. And we were like, because somebody had written in and they said, you know, what, how do you got, how would you handle if your husband was always wanting to game and, you know, you were upstairs being a mom? I don't remember the exact question. Like, I think just what, I think it was, what are the rules around video games for dads? And I think a big piece of feedback that we got in the comments was like, I just game with my kid next to me. So we were curious about like the screen time. aspect of it all. If you're playing, and you helped write, or you consulted on the AAP's screen time guidelines.

32:38So, like, who better to ask than you? Because we were thinking, you know, below two, there's the threshold of when you should be on, you know, have a certain amount of screen time versus not. But then when you add in gaming into the equation, depending on, you know, if you're playing FIFA, that's one thing. But if you're playing Grand Theft Auto, that's going to be, I would assume, do something different to a child's brain? Is that accurate or not?

33:02Dr. Ari Brown:So many questions. Yes, just talk to us about. Okay, so there's gaming for the parent, and then there's gaming for the child. So let's talk about the gaming for the parent. So I would view that as background screen time. And when the screen is there for the parent, the parent's going to be distracted. So I would not view you playing a video game while your kid's sitting there as, you know, a proud parenting moment, probably, because you're probably, let's be honest, not going to be paying attention to your child. So we probably don't want that to be happening. And you can game on your own time when your child goes to bed.

33:44Dr. Ari Brown:That's probably a better time. That would be the first recommendation. And whatever it is that you want to game as a parent is really your call. But then there's gaming with a child. and making that a family experience. And there actually can be really positive benefits depending on what you're playing. But part of it is the co-viewing and the co-participation because you're doing something together. And there are some really good games that can help with problem-solving skills and analytical reasoning. So there's some value depending on what you choose. But what I would recommend for a child, and by the way, this is not a policy statement.

34:25This is just, you know, based on our experience on what are the negative consequences of gaming for kids.

34:34Dr. Ari Brown:One is you want to be careful about games that are really aggressive because it does then have, you know, short-term impact on how a child behaves after they play an aggressive video game, you know, violence. The other is having them play in the room. So sharing the space. So we don't want them, you know, gaming in the basement by themselves. We want it to be in the room with you. And then setting a time limit because it becomes a time suck. And, you know, we get immersed in these experiences. So, you know, there's a time for gaming and there's a time for other things to do in your life. Hopefully things that are less sedentary.

35:15Dr. Ari Brown:Also, don't eat while you're playing games because people tend to snack and eat more when they're doing that. I love that you said like it, because a lot of times too, I've heard you say, if you're not, if you are watching a movie, make it interactive. So maybe we talk about what does the lion say? Right. And I think in gaming, that can be a really fun thing because you are doing interactive where the harm, maybe the harm's not the right word, but where it becomes a little less enticing would be you're upstairs, shut your door, don't talk to anybody. And you're just in there gaming, like, oh, he's in there gaming.

35:48But if we're downstairs and we're talking about what we're doing, that is more. But it would be weird to be playing Grand Theft Auto like in the middle of the living room. That would be like I would be overstimulated, you know. Maybe that's not a good game in general. So, okay. So those are some healthy things to think about. So you're not saying don't game with your kids by any means. Right.

36:07Dr. Ari Brown:And the other thing about gaming is your kids can teach you. Yeah, that's cool. Which is super fun. That's really fun. Okay, so some points for the gaming. Okay. All right. So we talked about cold and flu season. Oh, there are no, this is a big one. If your child does get a cold or the flu, are there any medications that they can take? Not really. Yeah, it just is what it is. At that point, they have it. The only way out is through, I assume. Right. So if your child has a fever, which all fever is not bad, by the way, but if your child is miserable and has a fever, you can use fever reducing medications, which also double as pain relievers.

36:53Dr. Ari Brown:So ibuprofen or Motrin, Advil is approved for kids six months and up. Tylenol or acetaminophen is under six months of age. If you have a child under three months of age, please don't give any medication without consulting your doctor because there's certain things, babies under three months, particularly under a month of age, we wanna hear from you if your child has a fever. But fever reducing medicine is on the table for young children. Saline is your friend, which is just salt water. You can make it yourself or you can buy saline nose drops, but they're really effective at loosening the mucus.

37:33Dr. Ari Brown:And loosening the mucus makes them sneeze or swallow it. So there's less coughing also because you're getting rid of some of that drainage. But medications, we don't really have any medications for kids under age four. We used to have cough and cold medicines. They didn't work very well, but there were more side effects than benefits. And so that's why those have kind of left the table. There are some natural products. Some people like to use agave nectar for kids under a year of age. You can't take honey for a kid under a year of age. There are some honey-based cough remedies over a year of age.

38:08Dr. Ari Brown:Do they work? I mean, you can do it. It's something to do. Right, right. It makes you feel better like you're doing something. But really, as far as cough and cold meds, we don't really have much to offer. So I gave Tate some child Zyrtec. Mm-hmm. And I gave it to her. I think at 2 p.m. When bedtime rolled around, I mean, this child was running rampant. Like it was unlike anything I had seen before and I could not figure out what I had done. My neighbor was like, did you give her Zyrtec today? And I was like, yes, because she went to bed at I think midnight, which is very abnormal for her. So, and I gave it to her because she was like very, very, very congested.

38:49What do you think about that? Our pediatrician had said to give it to her.

38:52Dr. Ari Brown:It's fine. Okay. It's fine. It's an antihistamine. Right. Okay. So if you've got allergies, Zyrtex, the right choice. If you have a cold, I mean, again, it's something to try. Will it help dry it up? Maybe a little bit. Again, it's fine to try it, but it's probably not going to be super effective. Now, do you want me to answer the question about not falling asleep? Yes. Okay. So there are different generations of antihistamines. The oldest, first generation, the OG, is Benadryl. Benadryl is super sedating in general, and it has to be dosed every six hours. It's fallen out of favor for both of those reasons.

39:45Dr. Ari Brown:Super sedating, and you have to dose it all the time. Zyrtec is a second generation. Claritin is a third generation. With each subsequent generation, you get less sedation. So Zyrtec, for some people who are really sensitive, it tends to be a little sedating, actually. You can get some paradoxical responses in kids. Even with Benadryl, right? Yes, especially young kids. Okay. So that may be what you saw with that. But sometimes kids are sensitive. I don't know if your Zyrtec had a color or not, but some kids are sensitive to the colored medication. So was it clear? It was clear. Okay, good. Okay.

40:29Dr. Ari Brown:Sometimes I've seen that as well as a reaction to the dye. But anyway, but Zyrtec and Claritin are dosed once a day. Okay. And so that's universally what we use now for, you know, my child has hives. Oh, you would use Zyrtec for that too? I would use, yeah. So Benadryl and Zyrtec are the same thing. So they're all antihistamines. But the beauty of Zyrtec and Claritin is they're once a day for a kid, you know, like getting a kid to take medicine. I mean, the struggle is real. So, yeah. So once a day is great. And also it's not sedating in general. Okay. Good to know. Now, you mentioned allergies.

41:09And I do have a question. If your kid's going to have allergies, I have some friends with really bad allergies, right? And if your kid's going to have allergies, at what age are you going to start to learn that they have allergies?

41:21Dr. Ari Brown:Are we talking about seasonal allergies? Yeah. Seasonal allergies, yes. Because if they're allergic to bees and they get stung by a bee, that's when we're going to learn it, right? Yeah. Okay. Maybe Dr. Ari can dispel this, but my mom sent me a text message after the bee episode that apparently you don't know if you're allergic the first time you're stung by a bee. You actually know you're allergic the second time you get stung by a bee? Right. So there is some truth to that, that your body now recognizes it and then says, I don't like it. And that happens, I'll tell you where this happens from a very practical standpoint is antibiotics.

41:59So I'll have a kid who's been on amoxicillin twice, three times, and then suddenly they

42:05Dr. Ari Brown:have an allergic reaction. And the parent will be, but we're day three into this antibiotic or we're on, this is the third time this kid has had amoxicillin. And it's not the first time. There's a point where your body just says, I do not like this. So it can happen. It's not just one and done and, oh, I don't have a reaction. Also, the dose makes the poison sometimes. So you can have a really significant reaction if you have multiple bee stings or multiple ant bites. Sometimes those things can be related to you. Interesting. she was just wondering if you maybe were allergic to bees maybe I am yeah because it was the second time I had been stung and it did like swell up and it's itching like crazy so I could be so okay so sometimes it's the second time but and it's good to know that with antibiotics too or medicine too that it could develop after day three even though you think you wouldn't think that but if they have seasonal allergies when are we going to start to see the seasonal allergies come into fruition or do you grow into it Okay, so let's talk about allergies and kids.

43:15Dr. Ari Brown:So there are different allergic disorders, and at different ages, you see them manifest. So early in life, you might see eczema, which is basically allergic disorder of the skin. You might see food allergies in infancy, but you don't really start to see seasonal allergies until they start to approach school age. So, you know, three to five years of age for a really allergic kid, seasonal allergies, you might start to see it. But it's really a school age, you know, and up. And so whenever I have kids who come into the office who are like two and under and the kid has a snotty nose and the parents are like, oh, yeah, I think it's just allergies.

43:58And I'm like, well, let me tell you something.

44:01Dr. Ari Brown:If I was in Vegas, I'm putting all my chips on some virus. I am not voting on allergies for a kid under age two with snotty nose. Never. Okay. So it's not, people love to say that. I was just allergies were not contagious. Yeah. Yeah. Don't buy it. That's everyone's favorite. Oh, it's just allergies. Like on an airplane. I'm like, it better be, better be those allergies. Okay. So it's not likely happening. And then the older they get, the more. Yes. Yes. And, you know, Austin is kind of the allergy capital. We don't like to tell people that. I didn't even know that. Maybe we should start telling people that, then they'll stop moving here.

44:36Dr. Ari Brown:Yeah, we have bad allergies here. You don't want to be here if you have allergies. It is true. It is true. But yeah, so it's kind of hard to avoid because some of our pollens are pretty robust. Okay. And there's nothing, when you have allergies, there's really nothing you can do besides take a... Well, you know, the greatest thing that I think has hit the allergy world is this, you know, oral allergy drops. Like they do this oral immune therapy. They used to do allergy shots. And now there's a trend, depending on, you know, not everybody qualifies for this, for doing these little drops where you desensitize them to some of these pollens.

45:13Dr. Ari Brown:So that's pretty cool. And so some people are candidates. This is more older kids and adults. This is not a, you know, young kid thing. And we always start with kind of over-the-counter remedies first before people become a candidate for that. That's the truly miserable category. Okay. That have to, they get to start with it. Okay. So let's move to, we'll go, we're going to organize this now into baby and then we're going to do some toddler. Okay. So we're going to do listener questions. But I'm going to start with a Rocky listener question. Okay. Because, okay. So the latest with Rocky is he's got a bit of a sleep regression, but I feel like we call everything a regression.

45:56Like I didn't know there was a four-month so-called regression. And he was sleeping. We had him sleeping, you know, seven hours. And then there were some nights where we were waking up every hour. And now the past two nights, though, we've got about a five-and-a-half-hour stretch, which is nice. But I felt like I knew what to expect up until four months. And I'm just like, so anything can happen every night.

46:18Dr. Ari Brown:Okay. So when did he start sleeping seven or eight hours? That was when we were in Vancouver. and maybe that was random that he just did. I mean, that was really kind of the only place he did it. So four months. Okay. Three months. Okay. And he's growing. He's hitting his growth milestones. Yep. Okay. And are you still doing night feedings? Does he have night feedings in there? Does he eat in the middle of the night? Yeah. Oh, chugs, yes. How many night feedings do you have? Well, depending on how many times he wakes up. So, okay, so what I'm trying to do when he wakes up is leave him for five to ten minutes if it's an abnormal wake-up time.

47:04So if he went to bed at 11 and he wakes up at 12, I'll give him his pacifier. If that doesn't work, then I'll give him ten minutes, and then I'll see what's going on. I'll try a diaper, and then I'll give him a bottle. And he's like – sometimes he's chugging the bottle. Okay.

47:22Dr. Ari Brown:Tell me what happens on the front end of the night. Like what is your routine for wind down for him to go to sleep at night and also at nap time? Okay. So I think this is probably going to be where our problem is. He takes a pretty long nap and it's my favorite because I let him take it on me. And so I don't want to give it up. Yeah. But around last night it was from 9 to 10. Oh, wow. Yeah. It was really late. But usually he takes his nap at 8 to 9. 8 to 8, 45. So he takes a little, we call it a snoozer doodle. He takes a little snoozer doodle. It's my favorite thing ever. He takes it, right? It's like the best.

48:04And then he's up for like two and a half, three more hours, and then he goes to bed. At what time? Like 11. Wow. Yeah. He's a night owl. I was going to say, Alex missed the sleep episode that we did with you, Dr. R. She did. Well, Harrison could relay it to me. I was just going to say, Dr. Ari said that middle of the night wake ups were based on what you did before they go to bed. That's exactly right.

48:27Dr. Ari Brown:Okay, so you need to watch our sleep episode that Harrison and I did. I thought that I did watch it. But I don't remember anything from those days. No, I'll get. Okay. It's all black for me. Okay. So can we do the snoozer doodle like in the afternoon? Yeah. Do that. But like, well, but, but then do I still, do I try to keep him awake through that? No, no. Okay. Okay. Okay. So he's, I know he's capable of sleep. He's shown you he can, he can, he can sleep at least seven hours. He can do it at least five. Probably. And, and I'm guessing because he's growing, I'm not looking at his growth chart people, but you know, if he's growing appropriately, he's a full term baby.

49:15Dr. Ari Brown:he should be able to sleep nine hours, nine hours on the front end of the night without a night feeding for a five-month-old. Six months, I would say 10 to 12 hours. But we know he can sleep at least seven or eight because he's done it. So I personally would probably shift his bedtime time to something a little bit more, you know, kid friendly, like seven day 30, you know, and get it done. And then you and Harrison maybe get to spend some time together before you go to bed. Like that'd be nice. You can play Grand Theft Auto together. I don't know. I don't know. But you know, like, so there's some benefits to shifting that and you can still do, you know, that cuddle nap, contact nap that you want to do, just maybe do it at a different time.

50:08Dr. Ari Brown:Because what happens is I don't think he's got the signal that it's time for my long stretch. Okay. And that first stretch of the night is the long stretch. So if you shift his bedtime and then, you know, now you may not be super excited about waking up at three or four, you know, maybe that's when I would do his feeding if he still needs it. And then in the next month or so, he's probably going to wake up at like 6, 8, you know, like then you're going to be a 6 a.m. start. So going to bed 7, 8, 30, waking up around 6 is a goal in the next month. But the way to get to that is to kind of start a little earlier so you're catching him before he's kind of overtired.

50:54Dr. Ari Brown:And he knows this is his wind down routine. And then what you do, this is the key, what you do on the front end and consistently at nap time is create a routine that makes him aware, this is my wind down to sleep. Okay. And now it's time to go to sleep. Okay. And just be really consistent about it. Be short and sweet. Do your feeding, but then he's not feeding to fall asleep. Separate that. Okay. He feeds, but then you have a little cuddle time, read a few books, sing a few songs. And then he goes to sleep. And then if he wakes up before kind of – I would maybe start with seven hours, but you can shift up to nine hours over the coming days.

51:38Dr. Ari Brown:If he wakes up before that, I would try to do anything else but feeding. Okay. So that he shifts his calories to the daytime. Okay. Okay, I like this. Yeah. I understand this. So we're going to make a routine. Yeah. Which I've just been dragging my feet on because I've been doing a bit of like clinging to him being such a baby still. Yeah. But it's like, no, he is five months old. So we'll create the routine. And then we will officially put in to play the bedtime routine because I knew – I mean, the writing has been on the wall. Right? So, okay. So we've got to move it up. And then we're going to separate the feed.

52:14Then we'll do a little nighttime routine so he knows that the bedtime is coming. And then if he wakes up in the middle of the night, we're not going to feed him.

52:20Dr. Ari Brown:Right. And what's happened, the reason why this has happened is that he's progressing. He's maturing. Every day is a new day. And so you can't treat him like a two-month-old or a four-month-old. And that's why you're seeing this change because he's a great baby. He's a really good baby. He's now a five-month-old baby. Yeah. You're right. You're right. So I do like that you don't call it regression. You call it progression. Yeah. Okay. So we're just, we're making some progress. I also think, okay, so you're familiar with the snoo. Oh yes. I don't think he, I think he wants to sleep on his stomach.

52:56Dr. Ari Brown:Oh, he needs to be out. Okay. He needs to be out of this. Oh, I'm sorry. I should have asked. Okay. I, I love this new full disclosure, bought one for my granddaughter. Like awesome. Yeah. Okay. But it's awesome really for the first three months. I mean, it's clutch for the first, It's the best thing ever. Yes. I fully agree. Super expensive, but really, really, I think valuable because they do sleep a little bit longer. But there's a time to move them out. And he shouldn't be – he needs to move around. We put his arms out. No. He needs to move. Get him out. He's too big. He's too big. Get banned.

53:33Dr. Ari Brown:He needs to be able to move. Get rid of the snoo. Yeah. I mean it's – For Taylor, it's six months, but you're saying for him – but that's what the thing said. I know. I know. And I'm actually, I mean, full disclosure, I am actually friends with the pediatrician who created this. And we have these banter conversations. Totally. I interviewed him. Dr. Harvey. He's awesome. Yeah, he's great. But there is a time to stop. The time was last month. And you can save it for your next kid. Totally. I do save it. You will get the value out of it. I already have, I feel like. Yeah. Yeah. Too big, you know.

54:06Yeah. Okay. So, oh my gosh, I'm going to be so busy. I'm going to transition out of the SNU. Yeah.

54:11Dr. Ari Brown:Okay. But this is like, if you're going to do all the things, I would just do them all and say, this is our new normal. Yeah, yeah. We're going to rip the Band-Aid off. And he's, I mean, you'll be amazed at how resilient he is. Can he sleep on his stomach? Yeah, if he can roll over. He loves his stomach. Sure. Okay. So he can do that. If he can get there, he can do it. Okay. And he can get there. Because he can lift his head. So, all right. Let's stay on the newborn. They're not even newborn. On the infant. Is he an infant? Yeah. Under a year. Okay. Mm-hmm. We'll stay on infant sleep. Okay. So I hear so much conflicting info on developing independent sleep habits early, but the AAP recommends room sharing for six months to a year.

54:55When is the best time to move a baby to a separate room? I want to do what's safest, but I don't want to make it harder on ourselves later.

55:03Dr. Ari Brown:Okay. Real talk about the SIDS recommendations from the AAP. Yes. These are guidelines that are very important, so I do not discount them at all. But I want you to hear the background of the evidence to support the recommendation. Okay. The reason why the SIDS task force recommends keeping a baby in the same room, so room sharing, for the first six months but up to 12 months is because that promotes breastfeeding. Having the baby in the same room with you makes it easier to breastfeed. Yes. Hands down. Entirely. Right? No question. Okay. But once you stop breastfeeding, or if you're not breastfeeding, if you're formula feeding, that variable is not protective against SIDS.

55:59Dr. Ari Brown:Just having the kid, I mean, people, I mean, this is a very legit question. What is the protection of having the kid in the same room with you? Do you sleep with one eye open? I mean, like, what is it, right? And what it is is the breastfeeding. And so if your baby is sleeping through the night and they don't have a night feeding anymore or you're not breastfeeding anymore, it really becomes a personal choice. So if you want your baby in your room, which a lot of families like that. I mean, they just feel better having the baby in the room with them. That's great. but if you want to move your child to the nursery and you've got one of those cool baby monitors which everybody has like that's fine that you don't have to feel guilty that your child is somehow not being protected you want to do all the other things which are you know have a naked crib always put your baby on their back if they can roll over that's great but you put them on their back.

56:56Dr. Ari Brown:And that solo sleep, you know, is important, but in the same room, not a requirement. Okay. So removing breastfeeding from the equation, having your baby in your room versus their room makes no difference in terms of SIDS. Correct. It's a personal decision at that point. Right. Okay. Okay. That's very digestible. All right. Bottle refusal for an exclusively nursing baby. Our first couldn't latch and only took a bottle, so I exclusively pumped for 14 months. My now four-month-old has taken a bottle of pumped milk once a week since a few weeks old and suddenly refuses no matter what we try. We tried SLP's lactation consultants, and she just won't take a bottle.

57:39Dr. Ari Brown:Yeah, she has a preference. So, okay, if I had met this mom back at day one, what I would have said is once your baby's four weeks old, feel free. And in fact, I encourage you to pump and do one express breast milk bottle a day because you want to keep it in the rotation and have your baby learn that milk comes in different packages. And that's fine. And then you get a break and someone else gets to, you know, your partner gets to feed the baby. Like it's a win all the way around. Okay. But that's not where we are. Now we have a four-month-old who's been getting a bottle once a week and they're like, I just want the breast.

58:21Dr. Ari Brown:Right. So, you know, that's their preference. Babies do form preferences. So I have two words for this mom. Spa day. And what does she do? She goes. She goes. She pumps the milk. Okay. Now, this leaves a lot of responsibility. I'm sorry for her partner. But if the baby is hungry and the food is there and mom is not there, the baby will eat. Now, they may hold out for some. I mean, I've had some holdouts, like some kids who will really, really wait. But eventually, they will take a bottle. It's not fun. It's not fun. The other option is you could do it gradually where you could just do a bottle a day and you just keep doing it.

59:03Dr. Ari Brown:And you could try something creative. Sometimes I'll have families actually start to introduce solid food with a bottle. Yes. Okay. So that's kind of fun because then they're thirsty because they have a spoonful or a bite of something and then they want something to drink. So that might be a way to kind of get over that little mental game that the baby's having with the bottle. But they will take the bottle. Yes. Babies have a hunger drive and a thirst drive. and if they don't have an option, they will take it. But they can smell you. Of course. I mean, even if you're like, I'm just going to go in the bedroom, they can smell you.

59:40Dr. Ari Brown:They know you are around and they will wait. So you have to leave. Yeah, like literally. It is very liberating. Oh, I'm sure. But I had a friend text me and she was like, listen, I went to a wedding and I left my baby who only wanted a boob, right, with my sister and she ended up taking a bottle. But it did, you know, my sister had to go through it. But she did finally take the bottle. And I thought, I didn't know that was even an option. So it is an option. It is. Okay. But you got to leave. I do agree. You're going to have to leave or else. It's also would be so hard to like, you'd just be having letdowns.

1:00:13For sure.

1:00:13Dr. Ari Brown:Yeah. So it's not that baby's not capable of doing it. They're choosing not to do it. Okay. Interesting. Did not know that. So that's baby's choice. Okay. This one I found interesting. My 15 week old hates car rides, which I find a lot of babies, I think, hate car rides. Is it possible they have motion sickness? Are patch stickers safe at this age? Okay, no and no. But one thing that I have seen often enough where I think it's worth commenting is that some babies who have acid reflux really don't like the infant car seat. It's just the position that they're in. And they do better if you put them in the convertible car seat.

1:00:53Dr. Ari Brown:So people who only have infants don't know what a convertible car seat is, but that's what you graduate to when your kid is like over 30 pounds and 30 inches. And that's the one that you're going to keep around for a while. But it's convertible because it can be rear facing and then forward facing. And it's like up to like 80 pounds, some of these things. So you are going to have to invest in that car seat at some point. But if you have a kid who really, really hates their car seat or hates being in the car, that might be something they could try. But how does a baby, because like Tate's convertible car seat, she's really upright and like Rocky wouldn't be able to be in it.

1:01:31I don't think. Are you saying you would?

1:01:33Dr. Ari Brown:So people buy infant car seats because they're convenient. Oh, got it. Oh, so you're saying you could just go right to the convertible. Yes. Day one. Did not know that. Okay. And it leans back. It does. So when it's backwards, it's, you know, it's appropriate for a baby, even a young baby. But it is slightly different with their bellies. And so some babies tolerate it better. The other thing is, you know, if that's not what it is, is just being entertaining. You know, you got to find songs that you like to sing and music. And do you see the TikTok with a grocery bag? No, what is that? That made the rounds.

1:02:14Dr. Ari Brown:So people would take plastic shopping bags and attach them to the coat hook in the back seat and open the window a crack and the bag would just be flying and these babies would be crying and then they'd look. And I mean, I'm not sure I love that, especially if it's not secure. Don't love that at all. But the idea is it's just something. Yeah. Yeah. Behind it. I get that. Thought it was clever. Yeah, that's really clever. How long do you recommend? And I know the answer to this, I believe, is as long as possible before we would move Tate forward facing. Like we wait as long as we can. That's a great question.

1:02:52Dr. Ari Brown:So rear facing for sure until age two. But that's tomorrow. I know. Happy birthday. Happy birthday, Tate. So exciting. But if she doesn't mind it, we try to keep them rear facing as long as possible. OK. Because it is a safer position. But you can check on the National Highway Traffic Safety Association, so NHTSA website, and you can get all of that information about car seat safety and when is it time to turn. But people are always worried that the legs are too long, but really we're more concerned about neck injuries than legs. Right, absorbing the – Yes. It's better for her to be facing backwards.

1:03:33Correct. Yeah, because she doesn't hate it by any means anymore. Great. But we do music. I mean, we do the whole thing. All right. How do you treat chemical burns from diapers? Okay. So is this the whole Millie Moon saga? Well, I don't know. And what is the Millie Moon saga? Was it causing – I liked those diapers. Was it causing chemical burns?

1:03:52Dr. Ari Brown:I don't know that this is new, but it was circulating on socials for a bit. People saying that they must have changed their ingredients because now my baby has these blisters and burns. And this is not a judgment. Like, I have no idea what's going on with that particular brand. But I will say that a lot of diaper brands go to new and improved. And also, real talk, like feminine sanitary pads do the same thing. And I'm like, no, no, I didn't want you to improve it. I liked it the way it was. That's why I was buying it. Yeah, right. So some babies are sensitive. And they do notice when there's been some slight change.

1:04:34Dr. Ari Brown:So if you have a baby who has a problem with a diaper, even if it's the same brand you've always been using, you might want to try switching brands. So that's a consideration. But what to do with these kind of blistery burns. Barrier cream is your friend. Thick, thick application. So whether it's zinc oxide or if it's petroleum-based, if you're going to use Aquaphor or Vaseline, as thick as you can because you want to protect the skin from moisture. so urine stool can irritate it and don't don't worry about wiping it off or rubbing it all off as long as the area is clean you just do a diaper change and add some more yeah okay you just bury it on there all right let's move to toddlers okay okay we have done the potty training all right listener questions my toddler a 20 month old boy is eating like a bird he eats little bits at a time but it feels like he's eating all the time.

1:05:31He doesn't want to sit at the table for family meals. Are we doing okay? Is it okay for us to leave his food out for him to pick at? Should we have concerns?

1:05:41Dr. Ari Brown:Wow. Okay, let's unpack that one. So toddlers are really interesting with their eating habits, and that always throws parents for a loop. Toddlers are interesting in general. Yes, I would agree. I would agree. Oh, that's what we're doing. Okay. And my mantra with toddlers is you can't make them eat, sleep, or poop on the potty. It has to be their idea. Love it. So with that in mind, toddlers decide one meal a day is enough. Or once every three days, they're really hungry. And most of the time, they eat what they need to. But I would not have the 24-hour buffet line accessible all the time. And I would definitely not substitute a bottle of milk.

1:06:24Dr. Ari Brown:and I wouldn't even do a bottle anymore either. But that's a popular parent go-to. And that's because every parent worries my child is not eating enough, so thus I must offer food all the time or chase them around the house with a spoon or give them access. You don't need to do that. In general, you just offer healthy foods when meals are being served. So you serve three meals, two snacks a day. That's it. No grazing in between. And if your toddler wants to eat, they're going to eat. I have one caveat about toddlers, and that is relating to milk is that some toddlers actually drink too much milk.

1:07:04Dr. Ari Brown:Okay. Interesting. And believe it or not, yes. And calcium and iron compete for absorption. So if you have kind of a milkaholic, we actually have these kids who are at risk for iron deficiency and then iron deficiency anemia. And so there's actually a new guideline from the AAP about screening kids for iron deficiency. So we used to just screen them at nine months. But we're also screening them now at 15 months of age because that's when the toddler's diet is kind of atrocious. And they're drinking maybe too much milk. And so we're trying to catch those kids now as well. So if your child has a super restrictive diet or they're mostly just drinking milk and not eating, you definitely want to check in with your pediatrician.

1:07:51Okay. So we're not setting the horses out to pasture. Like it's not just constant food. We're doing meals and then two snacks and we're not overloading on milk.

1:08:01Dr. Ari Brown:Correct. Okay. And know that snacks may be the best meal of the day. So make sure the snacks are nutrient dense. So snacks are not, here's some crackers to get you to lunchtime. you know here's peanut butter on a banana or here's some avocado toast you know something that actually has nutrients in it those are big those are big two big snacks for us we pick the right ones yeah well we and but it changes you know always it's so funny always so toddlers this is by the way your child is not alone um every you know month they decide the menu has changed. So they want the same thing prepared the same way for like a month.

1:08:44Dr. Ari Brown:And then they don't want to see it anymore again. And then you got to find what the next thing is. Yeah. You got to find the new obsession. We love peanut butter right now, which is adorable because we're asking to put on everything, but next month it'll be like, I hate it. Exactly. But that's okay.

1:09:00Okay. Oh yeah. I love this question. I haven't heard of this. My 19 month old is not eating any meat. We give her iron drops, but how do we get her to eat more meat? Do we care? Okay, well, let's talk about iron.

1:09:14Dr. Ari Brown:So again, kids do need a source of iron. Meat is a great source of iron. By the way, white meat and red meat are both great sources of iron. White meat is probably a little bit healthier, but whichever you choose is fine if your child is willing to eat it. The reason why it's a great source of iron is it's very bioavailable. So the iron is bioavailable more so than say spinach. Lots of iron and spinach, but less bioavailable. That said, some families do not eat meat. So you can get lots of sources of iron from non-meat sources. So eggs, beans, lentils, tofu, green leafy vegetables are all really good sources of iron, fortified cereals, sources of iron.

1:10:02Dr. Ari Brown:So your kid doesn't have to eat meat. But there are creative ways that I've like shared with families, like chicken salad. Like it's all about texture and color for kids. They go to, right? And so that's why I love chicken salad because it's like white and pasty, you know, like that's usually a win. Or you could do egg salad for the same reason. But anyway, so just kind of mixing it up. Maybe you're going to do meatballs because they're fun or you're going to, you know, create a little pate spread and they don't even know it's meat. So there are different ways. But gravitate towards the color and the texture of the food that your child is most likely to like.

1:10:44Dr. Ari Brown:And that's called bridging. Okay. Oh, okay. So bridge the gap of the food. Did not know that. All right. We've got – I think we've got time for one more because I know we're already over. teeth brushing every night is a battle 20 month old screams and in wrestles non-stop how do i make this better yeah again toddler battlefront classic um it's all about control toddlers want to be in charge they want to be independent um i think y 'all had said on one show that harrison and tate brush their teeth together i don't know if that ritual still exists but that's a great one because then she wants to be like dad and she's trying to do her thing That's awesome.

1:11:24Dr. Ari Brown:But make it fun. That's another strategy. So I love spin brushes. I love the ones that play music that have lights. They take a turn. Then you take a turn. By the way, toddlers don't really brush their teeth that well. So you kind of got to get in there. You eat the toothpaste. Yeah, exactly. Sometimes when they're distracted. So bath time may be a chance to get in there while they're playing with their toys in the bath. But yeah, but it's unfortunately not a negotiable item. So teeth brushing has to happen. At least twice a day. Okay. Okay. That. Can we do the climbing one? I was going to say that's the one I was reading too.

1:12:00Okay. Our 22-month-old is a climber. If she falls, what do we do? No, that's wrong. Our 22-month-old is a climber. If she falls, what do we look for that might be concerning? We watch her constantly, but she's so fast. Said every mom ever, I think. Exactly. So I'm interested to hear this.

1:12:16Dr. Ari Brown:Exactly. Okay. So first of all, if you can try to keep their activity space as safe as possible. So that's the first thing is they don't roam the house freely. But take away anything that they potentially could climb on. But your kid's going to fall down. This is just life, right? So when do we worry? When do, you know, what are the things we want to know about as a pediatrician when I get that phone call is my child just, you know, bonked their head? How far did they fall? What is the distance? So if it's less than their own height, that's less concerning. What did they fall onto? Is it a padded surface, like an area rug?

1:12:55Dr. Ari Brown:Or did they fall onto concrete? That's more concerning. Did they cry immediately or did they black out? Are they vomiting? I usually give kids one vomit, one free vomit, because they start crying and then they puke. But if they puke again, I want to know about it. Are they confused? Are they irritable? Is it sustained? Those are the things that we want to hear from you about. But there will be so many goose eggs in your life. And it just happens. It just is. The big one that was common among my friend group when our kids were really, really, really little was if they cried immediately. And I don't know who started that.

1:13:33But I get, you know, and you're saying it now, too, which is a good thing. If they fall and they're crying, that's great. As opposed to if they're out. Exactly. So crying can be good. Exactly.

1:13:44Dr. Ari Brown:I mean, some kids are pretty tough, so you don't have to cry. You can just move on. But yes, I'm talking about crying versus loss of consciousness. So thank you for clarifying that. Yeah. Okay. Okay. And I didn't know the height of themselves is helpful. Yeah. Okay. Okay, Dr. Brown, you've done it again. Tell us. Yeah, always good. Truly, it's not even fair. Some of my friends are like, how do you know that? And I'm like, well, because of Dr. Brown, I don't even have to read some of the books. Like you helped me skip so many steps. So thank you. Thanks. I get to sit here with you and answer all my questions.

1:14:19Tell people where they can find you.

1:14:20Dr. Ari Brown:So they can find me online at REBrownMD. You can find my books, Baby 411, Toddler 411, Expecting 411, where books are sold. And you can find me here in Austin at 411 Pediatrics. Amazing. Thank you very much, as always. Thanks so much. Super fun. Okay. Woo. We did it. I got to go get rid of all my pull-ups. Thanks for listening to another episode of Two Parents. If you enjoyed the show, don't forget to subscribe, like, comment, rate, and review. Stay connected on Instagram, TikTok, YouTube, and Facebook at Two Parents in a Pod. Welcome to our home. Sorry it's so messy. New episodes every Monday, Wednesday, and Friday.