Saturday, February 12, 2011

Photographic Potpourri (Part 2)

We are still not sleeping well in the Gonzalez house. Baby Aaron is a grunter. All night long, even when he is sound asleep, he grunts and groans. A few nights ago we moved his bassinet out of our room and that has helped. Such is life with a three week old.

Anyway, here are some more pictures that may be educational for the anxious parents out there.

Brick Dust Urine
Breast feeding infants will often have a red, salmon-color spots in their diapers during the first couple days of life. This is often confused for blood in the urine by parents. When a mother is breast feeding, she is not producing much milk the first few days. This leads to the baby being slightly dehydrated and the baby's urine being concentrated. Concentrated uric acid crystals in the urine react with the diaper to produce the "red" spots. Once the mother's milk comes in (day 3-5 of life), the brick dust urine should go away.

Sebaceous Nevus
This skin finding is rather rare, and, honestly, this is the first time I have ever seen one. It is a type of birthmark that typically is on the head or scalp. The skin is rough and bumpy and usually there is no hair. It may have a velvety appearance and it will typically be in a linear pattern. Sebaceous nevus may get more bumpy and wart-like in response to hormones during puberty. There is also a small chance of developing into a skin cancer as he gets older. Although, this is rare, birthmarks and other unusual skin findings are quite common. Most of the time, your pediatrician is going to recommend watching it over time and not rushing your infant to the plastic surgeons. I like to see what a lesion is going to do before pursuing any definitive treatment. Is it going to fade away? Is it going to grow? Is it going to cause a problem (get scraped and bleed, interfere with vision if around the eye, etc)? With Aaron, we are going to do just that, watch it and see what happens. There may be a point were we go see a dermatologist or elect to have it removed, but right now there is no rush.

Infant Acne
Babies will often develop pimples on the face between 2-4 weeks old. This is due to maternal hormones that the baby was exposed to when inside mom. Babies that are breast feeding are also exposed to mom's hormones through the breast milk. There is no treatment for this and it does not cause any scaring or problems. Unfortunately, it usually shows up right when you want to get some baby pictures made.

Saturday, February 5, 2011

Photographic Potpourri

I have not posted here is quite some time. This is the busy season in pediatrics and my hours are longer, stress is up, and I am pretty worn out at the end of the day. In addition, my family welcomed our third child, Aaron, in January. He is a healthy boy who weighed 6 lbs and 15 ounces.

Because I know you are wondering, yes, he spits up, he is gassy, he cries a lot, and he poops and pees out of his diaper. He always wants to be held and does not like his bassinet. The first few days of breast feeding were stressful for everyone (surprise, surprise). All in all, Aaron is a perfect, normal baby boy.

I figure I should take this opportunity to document some normal baby findings for the anxious-Internet-parenting-world and to give Aaron ammunition to use against me when he is older. I can hear it now: "Dad, I can't believe you put all those embarrassing pictures of me on the Internet." Hopefully, seeing some of this pictures will help parents know what is normal.

Erythema Toxicum:
This is a normal newborn rash that usually shows up when the infant is a few days old. It looks like little flea bites. It is not dangerous or anything to worry about. It goes away after a week or so. We do not know what causes it.

Jaundice and Erythema Toxicum:
You can see some more Erythema Toxicum on his abdomen in this picture. You can also see the yellow tint to his skin. This is jaundice. Jaundice is not uncommon in infants, but it can be dangerous if the bilirubin level (the chemical that causes jaundice) gets too high. It is pretty much standard of care for all infants to be screened for jaundice prior to leaving the hospital and then to have a follow up appointment a few days after leaving the hospital. If you are given an appointment to go see your pediatrician 2 weeks after leaving the hospital, you should question this. Because of this close monitoring, it is uncommon to have jaundice reach a level that can cause problems.

Bilirubin Blanket
When a baby gets jaundice that requires treatment there are two options: 1) a bilirubin blanket to use at home, 2) admission to the hospital for more intensive therapy. Certain wavelengths of light convert bilirubin to a molecule that can be more easily excreted, thus, improving the jaundice. Sunlight can help, but is not strong enough if the jaundice is considered significantly elevated. Regular house lights do not work. In this picture you can see Aaron on a bilirubin blanket. The "blanket" is up against his skin under his clothes. We used this for a few days and his jaundice improved.

Peeling Skin
Baby's skin often becomes very dry and peels after birth. This comes from living in water for 9 months. You do not need to do anything for this. It gets better after a few weeks. Parents often want to put lotion on the baby, but I am a believer that the less that parents put on a baby's skin the better. One exception to this is at the ankles and wrists. Occasionally if will get so dry that the skin will actually crack open. When this happens I recommend putting Vaseline petroleum jelly at that location.

More pictures to come in future posts....