Everything You've Always Wanted to Ask A Pediatrician, with Dr. Mary Martin

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0:32Are you not talking or am I just never stopping talking? What fresh hell laughing in the face of motherhood? How else will we spread a little tomato sauce on a tiny pizza? With Margaret Ables and Amy Wilson. They don't understand what happened to Corduroy's button, Mary. A podcast that solves today's parenting dilemmas so you don't have to. Talk to your pediatrician about your hatred of classical music.

1:01Hello, everyone, and welcome to What Fresh Hell? Laughing in the Face of Motherhood. Today is all about everything you want to ask your pediatrician. And I am so lucky to be joined by my world's most favorite pediatrician, who is also my niece, Dr. Mary Martin. Welcome, Mary. Thank you so much for having me. You will remember that, and we will link to in the show notes, Mary's mother, Christy Martin, who is my sister-in-law, my brother's wife, was on the podcast talking about education and kids because she is a progressive education expert. I believe this is the first, I think we had a mother-daughter combo who spoke at the same time, but I believe this is the first mother-daughter, two separate fields interview that we're doing.

1:52And it's an honor to be a trailblazer. So Mary, as I mentioned, is, although it's shocking to me because I still believe in my heart that she is two years old, is a practicing pediatrician. So we are going to go through today kind of your questions, all the things, everything you wanted to know if you had an hour with your pediatrician. We're going to try to hit the questions you might want to ask. And we'll start, as humans often do, as babies, with babies. And we'll talk about all things babies first. So, Mary, what is the one thing, if you had to name one thing, that has the biggest impact on baby's health?

2:34There's things that impact sort of like day-to-day health, and then there's things that prevent the biggest and scariest things that are nonetheless fairly rare. In the second category is vaccines. Vaccine preventable illness kills children and getting your child fully vaccinated and protected against those illnesses is, I would say, the easiest, biggest thing you can do to prevent from big, scary issues. Let me double click on that because certainly in our day and age with social media and lots of other things, people are hearing scary things about vaccines. Vaccines cause autism. Vaccines are unnatural.

3:09Babies don't have a blood brain barrier developed enough to handle the vaccines. Our vaccine schedule is run by Big Pharma, who is just after money and doesn't care about the health of our children. and just coming into the conversation a little bit more, the vitamin K shot, which is, I believe, given to, is it newborns? Is it the day they're born? Yeah, like hours after birth, which seems scary, right? People have a baby and they're like, wait, what are you shooting into my baby, my tiny little baby that 12 hours ago didn't need this shot and now you're telling me you need. So how do you talk to parents who are vaccine hesitant?

3:48Because I want to underscore that as a podcast, we also are extremely supportive of vaccines, but I want to put in front of people who might have heard scary things about vaccines, the reality. Yeah, there's a lot of information out there. I think this is true with a lot of things in medicine and kind of in the world. And it's difficult because it is really hard for parents who are trying their best to make the best possible decisions and the safest possible decisions for their children to sort between what information is reliable and true and science fact and what isn't. And I think that there is a lot of mistrust in the medical system, some of which is founded on real harms that the medical institution has done historically and currently.

4:29Vaccines are something we have so much good data about. The breadth of data that we have that says that vaccines are safe, that they work, that they prevent serious illness that kills children, Outpace is almost everything else we have, especially in pediatrics where it's hard to have randomized clinical trials, which are the gold standard of data. We know that vaccines work. We know that they're safe. We have seen extremely rare side effects from vaccines. And in most cases, it's hard to even link those side effects to the actual vaccine. Getting vaccinations for your child is always an individual choice.

5:03As a pediatrician, I am never trying to overrule parents. I want to be on your team. I am not trying to tell you what to do. or overrule the autonomy you have and the care you have for your child. But it is my duty. I signed up for this job because I love kids and I want kids to be safe. And I want to help children and their families navigate health and disease as best I can. And so it's my duty to say that vaccines are an incredible tool that prevents truly horrific and devastating outcomes. And we're sure that they're safe. The studies that linked vaccines to autism were actually just made up.

5:39That guy who did those studies was later prosecuted for just actually making up his data. And there have been no replicable studies that credibly link vaccines to autism. Vitamin K is different. It's not a vaccine. It is a shot that we give to newborns because when a baby is born, their liver isn't able to make clotting factors that help blood clot rather than continuing to bleed. It takes a couple of weeks for those clotting factors to kind of kick in. And so we give vitamin K to give a boost right at the beginning. to prevent newborns from having dangerous, potentially fatal brain bleeds, especially.

6:14It is often talked about as a big danger because it does carry a black box warning, which means there is a link that the FDA has identified between vitamin K and bad outcomes. But that black box warning is based on a completely different medicine, essentially. It's based on very, very high doses of vitamin K in adults given by a different mechanism, which is just not really applicable to the vitamin K shot we give newborns, which has literally never been linked to a negative outcome. I think these conversations and saying these things super clearly are super useful for parents because I am extremely sympathetic to parents who get very little face time with any doctor they see and very much information from other sources.

7:02And I think the way you explained it is really clear and hopefully really helpful to people. Let's move on to sleep. How are we sleeping these days? I feel like sleep has always been a little bit like, put them on their stomachs. No, put them on their backs. No, swaddle them. Never swaddle them. Put them in bed with you. Never do it. No teddy bears. So where are we right now with safe sleep for babies? And why do safe sleep measures exist at all? So usually what we say for safe sleep is the ABCs. So a baby should be A, alone, B, on their back, and C, in a crib with no blankets or extra stuffed animals around them.

7:41The baby can be swaddled pretty tightly, but should not be with other loose blankets on top of them. All of this is to prevent suffocation. Babies don't have good muscle control, as we all know, if we've met a baby. Listen, babies, some of us don't have good muscle control as adults. We're not here to judge you, babies. Babies, we're on your side. And as a member of Team Baby, I do not want the baby to get a blanket over his head and then not be able to move his head away. This is also true in mattresses that are squishy. There's baby mattresses for cribs that are specifically firm so that a baby can't sort of get stuck in a divot of the mattress.

8:20Cribs are also go through careful regulation process for this. We recommend against crib bumpers that go around the edge of the crib because similarly, it's something that a baby could kind of get their face stuck in and not be able to move away from. I think this is a topic that is also controversial. I see a lot on TikTok, et cetera, about safe sleep and the lies of safe sleep, et cetera, et cetera. I understand why it's a controversial issue. Sleep is obviously at a premium for new parents. And what I want for parents is to be as well-rested as possible with their newborn in the house, but I also really want those newborns to be safe.

8:55What we know about bed sharing, so that's a baby sleeping in a bed with a parent, is that it really raises the risk of a parent accidentally smothering the baby, especially a sleep-deprived parent, but actually really anyone is at risk of just not knowing that a baby is pressed up against them or similar because you're asleep and that's normal. Unfortunately, I think a lot of the dialogue is driven by a sort of people say, well, my parents did it or I did it with my older children and nothing bad happened. And so this is safe. But I unfortunately work in a hospital where I see the unsafe side of it and it is unfortunately just not safe.

9:32A, B, C. Alone? Alone, on your back, in a crib. In a crib. I couldn't remember it. I was like, no covers? Is that the C? No. We'll take it. You can have two C's. A, B, C, C. Double C's. Let's talk about developmental milestones, the bane of all new moms' existences. I actually used the phrase developmental milestones on my shift last night, and then I was like, oh, sorry, never mind. I don't actually care about that. It's a tough term because we understand that on the one hand, there are things you want to look out for. There are things you want to understand about how a typical baby progresses.

10:08is. But my father, your grandfather, famously did not walk until he was 16 months old. And his mother developed a back problem because she was carrying him so often because she was embarrassed that he didn't walk and it possibly carried him so much that he didn't learn to walk. But whatever was going on there. I love that every family has a story on the other side of my family. My mom's side of the family, the story is that they thought my uncle, who's her younger brother, was speech delayed, but actually he just couldn't get a word in edgewise. My mom talked so much. There you go. I definitely had some kids like that.

10:40It's like, are you not talking or am I just never stopping talking? So tell me about the role of developmental milestones. Yeah, I think really this underlies all this advice. The biggest thing is to have a pediatrician that you trust who you're seeing regularly, who can help you judge what might be within the wide, wide range of what is normal and what might be something to follow up on or look more closely at. When I'm seeing kids in the office, things that I'm thinking about are, is this child generally continuing to develop? So are they gaining new skills? Are they gaining skills approximately along the schedule I would expect for their age with a significant space for a child being faster or slower to any given skill?

11:26I definitely get worried if a child seems like they've stopped gaining new skills. And I definitely get worried if a child has gained a skill and then loses that skill. Those are things that I would want a parent to, if they noticed, bring it to their pediatrician's attention right away. We should say overall, I'm glad you said that, that we are talking about a 30 ,000 foot view of pediatrics today. Big issues, big topics. We are not substituting anything we say today as medical advice from your own provider. So we're trying to provide like big picture answers to questions, but don't take medical advice from a comedy podcast.

12:02If you have concerns, and even if you have concerns over something that you've heard today, go see your own pediatrician. Absolutely. But I think big picture milestones are sort of like rough estimates of what kids might be able to do, but they don't describe every child. Lots of kids never crawl. For example, we play like a fun game in clinics sometimes where we try to describe all the ways that an eight or nine month old has figured out to get around that don't look like the way crawling is supposed to look. And it's like an army crawl or they're like inchworm scooting mostly with their butt.

12:33There's a wide range of normal. Talk to your pediatrician if you're worried. Don't compare it to another kid. People come to things at their own times. Your cousin, my nephew, was a one foot butt scooter and it really did. It was a strange looking mode of transportation and extremely hilarious. Yes. But darn if it isn't cute. But darn if it isn't cute and darn if he didn't get where he needed to go. And they do get where they need to go. As soon as they start in the one foot butt school, it's time to baby proof the house. Let's talk a little bit about baby proofing. Again, lots of consumerism has come in into the baby proofing space.

13:08What do we need in baby proofing? And are there things that you're like, you don't actually need that for baby proofing? My best tip that I tell parents is get down at the baby's level. You don't know what they can get into until you're on the ground looking around like, what can I see and what can I reach? Do you have to do the one foot butt scoot while you're walking around? Yes, it's actually unfortunately mandatory. Oh, too bad. Okay. It's a tough reality we all have to face. I don't know all of the baby proofing products and such. Just get at your baby's level and be like, what could they pull down onto themselves that's heavy?

13:40What could they wrap around themselves that could be too tight? What could they eat that is not tasty? And keep your medications and cleaning supplies some are safe. What do you think about the socket covers? I'm always like, does a baby have a fork? Like, what is the baby going to do with this electric socket? You know, I don't have a good answer to that. I mean, someone has hurt themselves for the product to exist. For sure someone has hurt themselves. I just always looked at them like, I'm not sure what the baby, I guess they could lick them. I have not personally seen a baby who hurt themselves with a socket cover, but who am I to say that, or with a, with an uncovered socket?

14:14Just asking questions. Here's another one. So your grandmother is also a pediatrician and I've referenced her maybe 12 ,000 times on the podcast. Something I didn't know until she yelled at me about it after seeing a picture of my child. Baby mittens. She was mad that the baby was in mittens. She did not like the baby mittens at all. Listen, sometimes the baby has to be in mittens. They scratch their little eyes. They pull out their own pacifier. In the hospital, you should see how many devices we have to keep the baby contained. But in general, a baby's brain is making so many connections every day.

14:50And one of the ways that they're learning new things is exploring their environment. And if their hands are in mittens, they can't explore very well. And so we don't like that from a developmental standpoint. But some babies just need mittens. Mittens for sometimes. No baby should be in mittens all the time. There you go. No baby should be in mittens all the time. But when they need their mittens... And you can file their nails if they're scratching themselves. Get a little nail file. Why are we reading to babies who don't understand language? Babies actually do understand language. I mean, they don't understand what happened to Corduroy's butt and Mary.

15:24Come on. Let's be realistic here. You don't know that. That's true, I guess. And actually, in baby research, this is a real thing, smart baby theory, which is that we actually don't know what babies do or don't know because they don't have very many motor tools to show us what they know. So, you know, we talk a lot. people are always joking. Babies don't know object permanence. They think when the object is under a blanket, it's gone completely. This is why we play peek-a-bo. Exactly. But some baby psychologists actually think that isn't true. And the baby just is not able to reach for an object under a blanket.

15:55And so they're not successfully demonstrating that they know that it's still there. I'm slightly regretting my life choices that I did not become a baby psychologist. Why does that sound like the most amazing job? Yeah. And the way they do the research is so fun. They often show baby videos of like a ball doing something that obeys laws of physics and then a ball that does something that doesn't obey laws of physics. And they look at which video the baby stares at longer on the theory that the baby is like surprised by the ball that is not obeying the laws of physics. But anyway, I digress. I mean, digression is kind of what we're about around here.

16:28Yeah. The deal with reading is that there is lots of good evidence that reading to your baby is incredible for their development in every way. It's great for their language development. It's great for the bonding between babies and parents or babies and other caregivers or other people in their life who love them. It's great for them to develop skills around like attention, shared attention. So doing a task with somebody else, regulation to kind of stay in one place and read the book. It helps them develop connections between what they're seeing and what they're hearing. It's overall stellar. Every baby should be read to every day.

17:04Love it. Tell me, is there anything I missed about babies that you're like, this is such an important thing about babies that you have to know? I have two like tiny tidbits. Hit me. One is that we don't recommend those walker things that a baby like rolls and walks to learn to walk. They're super dangerous. Babies walk off stuff. Super dangerous, but also so adorable, Mary. So cute. But they have the baby stand in a posture that is not actually really how the baby's going to walk. And so they might not even be that helpful. Okay. And then my other tidbit is your baby in its car seat has to come out of his or her winter coat, because if the car crashed, the coat will compress and the baby will just shimmy right out.

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20:58Mary. Let's start with picky eating. It's a question we get all the time. I had picky eaters, one incredibly picky eater who I think at some time was down to like nine acceptable foods. This is my kid who's on the spectrum. And those two things tend to overlap, picky eating and being on the spectrum. Often linked to like sensory stuff. Sensory stuff. Right. And I mean, I've heard people say we've talked to people who've said like putting something in your mouth is very, you know, invasive, intimate. It's all sorts of things. It's not surprising. And we've also talked about the fact that picky eating, like when you talk to a parent of a 16 month old who's like, they eat anything.

21:38I'm like, talk to me in six months, guys. We got a biological imperative coming down the pike. So picky eating. What are your thoughts? When are we worried about picky eating? And when should we tell everyone else, stop talking about what my kid eats, you're annoying me. I mean, tell everyone else, stop talking about what my kid eats, you're annoying me at any time. That's your right. Why are they talking about what your kid eats? Your pediatrician is going to worry about the picky eating if your child is not growing well. And we follow the growth chart to see if the child is growing on a curve that we sort of like expect and expected growth trajectory.

22:12And then if your child is showing evidence of nutritional deficits, like they're getting really anemic, so low blood counts, which can sometimes be like drinking a lot of milk rather than eating a variety of other foods, or they're having a lot of constipation, that can often happen with picky eating, really like heavy carb-based diets. I think most kids have some degree of pickiness. There's few kids who truly eat anything. Most kids kind of work it out for themselves and figure it out in the long run. My kids really have. We were not great about eating and I've stressed and worried. And now the other day, my kid ordered like an rose con pollo omelet or something.

22:52I was like, who are you? Heck yeah. It just worked out. What a winner. Yeah. I kind of wish I hadn't spent so much time worrying about it, but I also don't want to put in front of people that eating is never an issue because obviously we know kids with ARFID and other things where eating is a pretty severe issue. Absolutely. I think my biggest tips outside of those sort of extreme cases where you really need to be talking to specialists in something like ARFID are to make mealtimes enjoyable shared experiences. So we know that there's a lot of evidence supporting positive effects of eating meals as a family to the extent that it's possible or even just with one parent.

23:32And I generally recommend trying to get away from a position where you're like sitting across from your child being like, you must eat this. The kid's crying, you're crying. It's terrible. I mean, we've all done it, guys. We're not here to judge you, but I'm not going to judge. We're just going to try to get rid of that from the lexicon. I tell parents and kids that you have to try a food 10 times before you really know if you don't like it because kids' taste buds continue to evolve. and also sometimes they've just decided against a food because it looked weird. I thought I didn't like guacamole for a long time because it's green, but I was wrong.

24:06That's my bad. Were you missing out? Wow, was I missing out. And then the other thing I tell parents is that sometimes kids kind of need to get used to the idea of a food. So I say, even if you know they're probably not going to eat the guacamole, put a little bit of it on their plate, let them explore it, let them smell it, touch it. I kind of encourage playing with food. I think it's helpful to have sensory experiences with foods that are neutral to positive. And that can kind of be baby steps that work up towards actually eating the food. I'll link to our picky eater episode because we talk a lot about that.