Category Archives: Healthy Babies

Reflux & Your Baby

Reflux & Your Baby

For brand-new and veteran parents alike, being spit on, peed on, and yes, even pooped on is an accepted and expected parental rite of passage. Parents are consumed by what to put in their babies bodies—and how it comes out.

Spit Up or Reflux?

One reason experts believe babies experience reflux is that their lower esophageal sphincter (LES)—the valve that connects the bottom of the esophagus to the stomach—is either not squeezing tightly closed enough or it’s relaxing too often when it shouldn’t. Babies born premature need even more time for their LES to grow stronger.

Terms like “spitting up” and “regurgitation” are all descriptions of reflux. About half of all infants up to age 3 months spit up daily, and as their LES grows stronger, it subsides without needing treatment by their first birthday, or a little thereafter.

How Much Spit Up is Normal?

As babies nurse at the breast or feed on formula, they swallow air. Gas bubbles build up, and we burp baby, often forcing up some breastmilk or formula with the air. Spitting up after feeding is normal, and you’ll probably notice it doesn’t seem to bother baby. In fact, it’s even normal if spit up comes out of your baby’s nose.

What isn’t normal—and needs evaluation by baby’s healthcare provider—is frequent vomiting along with breathing problems like a stuffy nose or noisy breathing, vomiting in the night or projectile vomiting.

Sometimes a baby’s digestive tract doesn’t develop normally, resulting in reflux. If your newborn baby has projectile vomiting after each feeding, see their healthcare provider right away to rule out a problem called pyloric stenosis, which requires surgery to correct.

Could it Be Allergies?

Babies are obligate nose breathers—they have to breathe through their noses for the first 4 months of life. That’s what being an obligate nasal breather means; infants literally need to breathe in that manner. Their lack of ability to compensate by breathing through their mouth is why nasal congestion can pose a serious breathing problem for infants.

Parents of babies with chronically stuffy noses tend to see physicians wondering if their child has allergies. We see many children younger than 2 years old with nasal symptoms attributed to “allergies,” but despite allergy medications, their symptoms stubbornly persist. In actuality, the development of environmental allergies to allergens such as trees, grasses, pollen, dust mites, and mold takes many years. Parents often believe that the underlying problem is allergy simply because their pediatricians mistakenly put their baby on allergy medication in the first place.

Infants and toddlers with chronic nasal symptoms are often given too much milk, juice and sugary beverages, while many have inappropriate bedtime snacks, such as milk and cookies. Their “allergies” are among the most common misdiagnoses in the children who see us for second or third opinions. Reflux induced by unhealthy beverages is often the only correct diagnosis.

If your infant or toddler is always congested and full of snot, think respiratory reflux, and closely examine your baby’s diet for acidic or other reflux-causing foods and beverages.

What Reflux May Look Like in Babies

In addition to projectile vomiting, the many aliases of reflux in infants include:

  • Runny nose
  • Nasal congestion
  • Noisy breathing
  • Ongoing cough
  • Allergies
  • Constipation
  • Abnormal bowl movements
  • Choking while feeding
  • Fever with wheezing
  • Not gaining or losing weight
  • Pauses in breathing while asleep (sleep apnea)
  • Reoccurring pneumonia
  • Significant eczema
  • Swollen or tense stomach

Common Reflux-Causing Foods in Infants & Toddlers

The more servings per day that your young child has these foods, the more likely your child may have a diet that puts them at greater risk for reflux:

  • Milk, such as cow’s milk, but not breastmilk
  • Juices, soda or punch
  • Pouched drinks
  • Ice cream
  • Candy
  • Cookies
  • Yogurt

Constipation & Reflux

According to the American Academy of Pediatrics, most children have 1 to 2 bowl movements each day, but others may have only 1 every 3 days. As long as an infant appears comfortable passing the stools and is not in pain, having a bowl movement every 3 days may be normal for them. Breastfed babies usually have mustard-looking watery poop. Formula-fed babies have a pastier stool, usually earth-toned colors from yellow to green to brown. In babies who are more than 1 month old and non-breastfed, constipation is considered when there is no bowel movement in 3 or more days, or if there is significant straining to get the stool out.

In a constipated baby, the stool may look like pellets. This may be a sign of sensitivity to newly introduced food, milk products or an ingredient in the formula. If your baby has multiple diapers with pellets of stool, or the stool has blood in it, let your pediatrician know. It’s also recommended that you contact your pediatrician if your child’s stool is white or red.

Further reading: How to Deal With a New Baby


By Dr. Jamie Koufman

Sun Protection & Your Baby

Sun Protection & Your Baby

If you’ve ever stood in a big box store staring down an abundance of sunscreen products trying to figure out which one to buy, you’re not alone.

What SPF is needed? What is broad-spectrum protection? Are these scientific-sounding ingredients safe? These are the questions that race through your mind as you try to figure out which sunscreen is best for your family, especially for your baby.

The FDA is putting new sunscreen guidelines into place this summer and they’ll help address some of the confusion by adding a star-based rating system to help you choose the sunscreens with the most protection.

Understand these 3 things

As a parent, there are 3 key things to understand when choosing sun protection:

  • All the ways you can protect your skin from sun exposure.
  • Getting protection from both UVA and UVB rays.
  • Buying a protective sunscreen and safely using it.

Start with prevention

Your infant’s skin is 20% thinner than your skin, which means it dries out and sunburns easier. Babies 6 months old and younger don’t yet have protective melanin in their skin and can burn easily. Sunburns in the early part of life are a leading risk factor for skin cancer.

You may be surprised to learn that skin cancer is 5 times more common than breast or prostate cancer, and experts agree that severe sunburns during childhood are the greatest risks for developing melanoma—skin cancer. Protecting baby’s skin and teaching her to use sunscreen as she gets older is one of the most important health habits you can give her.

UVB vs. UVA rays

The sun emits both UVB and UVA radiation. Traditional SPF ratings on sunscreen products only address protecting from the rays that cause sunburn—UVB rays. However, UVA radiation is also dangerous because it contributes to premature aging and the most dangerous forms of skin cancer.

The FDA is requiring sunscreen manufacturers to apply ratings of 1 to 4 stars, with 4 providing the greatest protection, to help you choose a safe sunscreen that has the broadest protection. Sunscreens that protect against both UVA and UVB rays will be labeled as “broad spectrum.”

Use sunscreen safely

Always apply sunscreen at least 15 minutes before sun exposure. Most people don’t apply enough, so cover your skin liberally to prevent sunburn and free radical production that comes from sun exposure, which can prematurely age skin. Reapply sunscreen at least every 2 hours when outdoors; reapply more often if you’re getting in the water or sweating a lot.

Protect Baby’s Skin in the Sun

Most experts agree it’s best to keep babies up to age 6 months out of direct sunlight for prolonged periods of time. When clothing and shade aren’t enough, add a safe sunscreen on small areas of the body, such as the face and backs of the hands, say experts at the AAP. Don’t apply sunscreen near baby’s eyes.

Buy A Good Sunscreen

Lotion or stick? Spray or powder? Sheer or waterproof? There are lots of choices when it comes to sunscreens. Most people buy on SPF factor alone—and the higher the better, they assume. Yet experts agree that anything more than SPF 50 may not actually provide extra protection. Buy wise:

  • Always read the label—not just the advertising language on the package’s front.
  • Choose one with the fewest ingredients possible—mineral-based sunscreens are the safest and are easy to find.
  • Pick a lotion—sprays and powders can be unsafe.
  • Use a minimal SPF from 15 to 50; there’s no evidence that anything higher than SPF 50 adds extra protection.
  • Choose SPF 30 to 50 for beach play, swimming and outdoor activities.
  • Choose “broad spectrum protection” to minimize both UVA and UVB rays.
  • Check the product’s water resistance—no product is really waterproof.
  • Research safer choices online at the Environmental Working Group’s Skin Deep database at or download their free Sunscreen Buyer’s Guide apps.
  • For the broadest protection possible, look for the new UVA “star” rating system on sunscreen labels.The more stars the better.
By AWHONN Editorial Staff

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) promotes the health of women and newborns.

Caregivers & Your Baby’s Safe Sleep

Caregivers & Your Baby’s Safe Sleep

Here’s a story worth repeating: William was six weeks old when Grandma first offered to give us a date night’ away from baby. Dinner and a movie. Since she would spend the night, there was no reason for us to rush. She gently offered again at eight weeks and this time my husband insisted. We had to leave our little newborn sometime, he explained, and I was approaching the end of my 12-week maternity leave. Grandma was a wonderful woman and had raised a wonderful son. We couldn’t have asked for a better babysitter.

We were both first-time parents and had vowed not to be over-protective when it came to raising our son. My husband and I went to all the prenatal classes our hospital offered, and though we were a little nervous, we felt well prepared. I tried to not be tense but there seemed to be a lot to worry about!

Leaving our baby with a caregiver

The movie had just begun and my mind wandered to our house. It was 8pm. Was William taking his bottle of breast milk? Was he getting tired and insisting on being held? Would Grandma rock him to sleep in our comfy recliner?

My next thoughts startled me and took me back to our prenatal class on infant safety and Sudden Infant Death Syndrome (SIDS) prevention. In our class, we had thoroughly reviewed the ABCs of safe infant sleep:

A for baby sleeping alone

B for baby sleeping only on his back

C for baby sleeping in a safe crib

Our instructor had implored us to make sure all of our caregivers knew the ABCs of safe sleep as many, especially grandparents, didn’t. I suddenly envisioned William asleep on his stomach, or in the recliner snuggled against a sleeping Grandma!

I elbowed my husband and whispered too loudly, ‘Does Grandma know the ABCs of safe sleep?’ My husband jumped out of his seat, pulling out his cell phone. I was right behind him.

He tried to sound calm as he talked to his mom. All was fine and Grandma graciously agreed to follow the ABC rules. For now, though, they were still busy playing. We were told to go enjoy our movie.

By Sharon Hitchcock MSN RNC

Bottles, Pacifiers & Your Baby’s Oral Health

Bottles, Pacifiers & Your Baby’s Oral Health

It’s a well-documented fact that babies have a natural tendency to suck. It helps to soothe and comfort them, which is why so many parents allow their small children to suck on baby bottles and pacifiers.

However, if not properly monitored, these items can easily create problems for your baby’s oral health. To protect your baby’s teeth and gums, we’re busting 3 myths about bottles, pacifiers and their safe use.

Myth # 1: Pacifiers Are Harmless

In most instances, and only after breastfeeding is established, pacifiers are fine for infants and toddlers. It’s all a matter of choosing the right product and limiting its use. Choose an orthodontic pacifier with rounded tops and flat bottoms that are designed to allow upper and lower teeth to better align.

Pediatricians are divided as to when the best time is to wean a child from a pacifier. Some say around 12 months, when speech begins to develop. Others suggest they can be used into the toddler years, or up to age four. 

However, the longer your little one continues to suck, the more likely they are to develop problems with their teeth, specifically a misaligned bite or cavities. Be sure to talk to your pediatrician and your pediatric dentist regarding what’s best for your growing child.

Myth # 2: It’s Okay To Spit Clean Pacifiers

Children drop their pacifiers on the ground all the time only to have a parent spit-clean it and shove it back in their little one’s mouth. But cleaning your baby’s pacifier with your mouth can transfer tooth decay causing bacteria through your saliva. Think twice before spit cleaning your little one’s binky.

Myth # 3: Putting A Baby To Sleep With A Bottle Of Milk Or Formula Is Fine

Many parents think putting babies to sleep at night with a bottle of breast milk or formula may help calm them—but the American Academy of Pediatrics warns against this for several reasons. First, an infant should never be left alone with a bottle. Secondly, both breast milk and formula contain some amount of sugar, which means your child’s teeth will be bathing in it all night long, creating tooth decay.

The natural forming bacteria in your child’s mouth changes the sugar into acids that break down the enamel on their teeth. This can cause a devastating situation called ‘milk bottle carries’ where most or all of the teeth in a child’s mouth rot beyond repair. 

Instead, the AAP recommends that if your child needs to suck to soothe while going to sleep, use a pacifier instead of a bottle, as pacifier use is recommended for reducing risks of Sudden Infant Death Syndrome once baby is nursing regularly.

By Dr. Bill Dorfman

Breastfeeding & Postpartum Depression

Breastfeeding & Postpartum Depression

Can breastfeeding actually decrease your risk for postpartum depression (PPD)? Can women with PPD safely take antidepressants while nursing? Between 8%-19% of mothers experience depression in the first year after birth. 

Can you sort myth from fact regarding breastfeeding and PPD? Even well-meaning healthcare providers can struggle with these questions if they don’t know the current research.

Myth # 1: Breastfeeding Causes Postpartum Depression

“I don’t understand, she latched well right after the birth, but she hasn’t latched since. I’m worried that I can’t breastfeed. My girlfriend tried to breastfeed and she said it was a really awful experience. She never had enough milk, her baby lost a lot of weight, and her nipples got really sore and were bleeding! She stopped breastfeeding altogether because the whole experience made her feel depressed.” Cassie

The Evidence

Not all women at risk for or currently experiencing depression will find breastfeeding too stressful to maintain, or that it makes their mood worse. While research suggests that struggling with breastfeeding can increase the risk of depression in some women, establishing good breastfeeding actually protects from depression. , In fact, moms with PPD and who stopped breastfeeding early actually described experiencing more depression and anxiety when asked by researchers about their moods. 

Experts believe that the feel-good hormone, oxytocin, which drives the let-down reflex essential to beginning each breastfeeding session, helps moms feel more relaxed and content. Oxytocin also increases attraction between you and your baby, promoting facial recognition and boosting your caregiving and mothering confidence.

Breastfeeding helps you maintain vitamin A-related compounds at levels that are protective against mood disorders, including depression as any excess amounts of these compounds are passed to baby, who receives and uses these nutrients.

Choosing not to breastfeed stops lactation, and in some cases, a mom may have a rush of depressive feelings similar to what a she might experience after the loss of a child, research shows.

In this way, researchers believe breastfeeding helps bolster and protect your moods. In fact, many moms with PPD describe breastfeeding as giving them a significant—if not the only—sense of connection to their babies while dealing with their depression.

If you’re struggling with early breastfeeding recognize that both you and your baby are going through a lot of changes right now. You’re just getting to know each other and everyone’s breastfeeding experience is unique. Breastfeeding can be uncomfortable in the first weeks when your nipples are stretching and your milk is still coming in. If you are stressed, try some of these ideas to practice a comfortable latch:

Undress your baby and cuddle her against your naked chest

Recline and get as comfortable as possible, maximizing skin-to-skin contact

Allow baby to hear your heartbeat, feel your warmth, and smell your milk

Offer her your breasts when she’s relaxed and alert—don’t wait for her hunger cries as she may be too upset and hungry to latch easily

Try nursing baby within the support of a local breastfeeding group to gain knowledge and help from lactation consultants and other nursing moms

Myth # 2: It’s Not Safe to Take Medications for Depression While Breastfeeding

“I don’t know whether I should breastfeed while taking drugs for depression and anxiety. I don’t want the drugs to hurt my baby; I think I will just stop taking my antidepressants.” Rosario

The Evidence

Newer antidepressants transfer in small amounts only into breastmilk and don’t negatively affect your baby. In fact, research shows:

Moms with anxiety may safely take anti-anxiety drugs, like benzodiazepines, while breastfeeding with only a slight increase of sleepiness in some babies

Moms with bipolar disorder can take mood stabilizing drugs such as valproate, phenobarbital, phenytoin and carbamazepine

Experts caution about the use of antipsychotic medications clozapine and olanzapine in women who are very depressed with psychotic symptoms. Still, they suggest that if a mother has safely taken the drug effectively before lactation, she should continue to use that same medication while breastfeeding

Using any medication while breastfeeding is an individual decision. Make this decision with your healthcare provider based on the risks and benefits of taking or stopping a drug during breastfeeding, including those health risks to moms and babies when mom chooses not to nurse or feed baby breastmilk.

Myth # 3: Breastfeeding women are sleep deprived, making them at greater risk for depression

“I want to breastfeed, but we’re thinking of feeding formula at night so that we all get more sleep. I’ve heard that sleep deprivation is a risk for postpartum depression and I worry that my milk just won’t be enough for her” LaToya

The Evidence

There’s an assumption that moms who feed their babies formula get more sleep or free time than moms who breastfeed—but researchers are finding that this is not the case.

While lack of sleep definitely affects anyone’s mood—especially new moms—feeding formula doesn’t improve sleep or mood, particularly because of how it affects the hormone, prolactin, which helps you make milk and sleep.

Prolactin is the primary hormone responsible for milk supply and it also promotes deep sleep in adults, research shows. Because of this, studies report that exclusive breastfeeding actually improves mother’s sleep. One group of researchers found that parents of breastfed infants slept an average of 40-45 minutes longer each night than parents of babies who were fed formula.

That same finding held true compared to moms who mixed breastfeeding with formula feeding as these “combo moms” as they’re commonly called reported fewer hours of sleep, less energy and higher rates of depression.  While it’s true that formula stays in a baby’s tummy longer, this is because it’s more difficult for babies to digest, which can lead to fussiness and even less sleep for everyone!

Just remember that especially in those first few weeks and months, it’s normal for newborns to have fragmented sleep, to need to be fed often at night and to want to be close to you. Babies are brilliant! They nurse often at night because they instinctively know that your prolactin level is highest then.

Most infants need to eat at night and they get up to 20 percent of their nutrition during this time. Studies have shown that breastfeeding mothers, even if they wake up often, actually fall back to sleep quicker than if they were formula feeding.

Remember, this sleep deficit won’t last forever and eventually you and baby will get into a rhythm with breastfeeding, and one day you both will regularly sleep through the night. Meantime, gain support from your partner or a relative who can help you in the first weeks get comfortable with night-time breastfeeding. They can change baby’s diaper, bring baby to you, burp baby and settle her down after feeding so that you don’t feel so alone and so that you can

By Tonia Olson MN BSN RN IBCLC

Ask a Nurse: How Mindful Diapering Enhances Baby’s Development

Ask a Nurse: How Mindful Diapering Enhances Baby’s Development

Did you know that your baby will need as many as 10,000 diaper changes during their life? Find out how to make each of these moments meaningful with our Nurse, Nancy Travis.

By AWHONN Editorial Staff

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) promotes the health of women and newborns.


iFlora Probiotic Recalled

iFlora Probiotic Recalled

iFlora Kids Multi-Probiotic and iFlora 4-Kids Powder has been recalled due to possible Salmonella contamination. The Sedona Labs announcement was made after its supplier of Galactooligosaccharide (GOS) recalled this ingredient which is an element of the recalled iFlora probiotic.

Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy people infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain.

The recalled iFlora probiotic was distributed between 3/16/2011 and 5/3/2012. Consumers possessing these products should immediately discontinue their use. To date, no illnesses have been reported in connection with the iFlora Kids Multi-Probiotic or iFlora 4-Kids Powder.

Healthcare professionals and patients are encouraged to report side effects related to the use of these recalled probiotic products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program at

By AWHONN Editorial Staff

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) promotes the health of women and newborns.


Your Baby’s Hearing Test

Understanding Newborn Screening

Newborn Screening: Hearing test

Good hearing is so important. From the moment she’s born, your baby is learning and her brain is developing—much of which through hearing. Children who have untreated hearing difficulties can have problems with learning, language and speech development.

Hearing loss also makes it harder to develop social skills, such as playing with others. Catching and correcting hearing problems early allows your child to develop at the same rates as other kids.

Find out more about newborn screening tests

My Baby Flunked the Hearing Test
Newborn hearing screen is only an initial test. You’ll need further testing to learn if your baby has hearing loss. If your baby doesn’t pass the first screening she’ll be referred to a hearing specialist (audiologist) for a full hearing test.
This test should be completed before she is 3 months old, and just like the first screening it’s not painful. An audiologist will ask you lots of questions about your family’s health and any history of hearing loss. After the hearing test, the audiologist will give a report to your healthcare provider and you may be referred to a genetics counselor, an ear, nose and throat doctor (otolaryngologist) or even an eye doctor (ophthalmologist) for follow-up.

Learn what to do if your baby doesn’t pass the newborn hearing test

What If My Baby Has Hearing Loss?
Babies with hearing difficulties should receive help by six months. Interventions can range from learning sign language to wearing a hearing aid or having surgery.
Babies are really smart; signing as you speak is a great way to communicate. Your baby’s brothers and sisters can learn to sign and there may be infant and toddler signing classes in your area. Even if your baby doesn’t have a hearing loss, learning to sign is a lot of fun and gives your baby another way to communicate. Depending on the degree and type of hearing loss, your baby may need a hearing aid or even surgery.
Even if your baby passes the first newborn hearing screen it is important to be aware of signs that your baby may have hearing loss.

newborn screening hearing testNewborn Screening Basics

Understanding Newborn Screening

What If One of My Baby’s Tests has an Abnormal Result? (Video)

Your Baby’s Hearing Test

By Helen Hurst, DNP, RNC, APRN-CNM

Helen Hurst, DNP, RNC, APRN-CNM, is a nurse expert adviser to Healthy Mom&Baby.


What is moro reflex?

What is moro reflex?

Babies are born smart. Almost immediately, your little angel instinctively grasps a finger or roots for a breast. These actions are intuitive and are examples of newborn reflexes. All babies are born with innate reflexes: rooting, sucking, walking and the Moro reflexes, which is why your baby may startle suddenly.


Of these, the one most parents are curious about is the Moro or the “startle” reflex.

Experts think that the Moro reflex evolved to keep babies closer to their caregivers, and to prevent falling.


Why is my baby flailing?

When a baby exhibits the Moro reflex, his body will tighten, his arms will move sideways palms up, and his thumbs will jut out. It looks like flailing, and for a second, baby is flailing! He may cry or not. And then, just as quickly as it happened, baby will relax, and fold his arms back to his body.


What startles baby?

Some babies will startle for no apparent reason. Most babies, however, will startle in response to a loud noise; a change in body position, a sudden movement (anything that feels like falling); a change in environmental temperature; or an unexpected touch. It’s absolutely normal for babies to exhibit the Moro reflex. If your baby cries when startled, keep him more comfortable by swaddling or holding him close.


Babies tend to exhibit the Moro reflex most from birth through age 5 weeks, at which point you may notice baby startles less frequently. This reflex will diminish through time and should completely disappear by 4-6 months of age.


Creating the Moro reflex

During baby’s 1st physical exam, baby’s healthcare provider will seek to create the Moro reflex by placing baby, face up on

a soft, padded surface, such as a crib or bassinet. She will then extend baby’s arms above her torso while holding baby’s hands. She will support baby’s weight just enough to lift baby’s head gently and then suddenly release it, allowing baby to fall backward—just for a split second! Don’t worry; this is perfectly safe with an experienced healthcare provider.


What baby’s healthcare provider wants to see is whether baby exhibits the Moro reflex ononly one side of his body, which could mean baby may have a

broken shoulder (clavicle) bone or an injury to the group of nerves running from the lower neck and upper shoulder areas (brachial nerves). These injuries usually occur during birth, particularly with full-term babies weighing more than 8 pounds.

The lack of a Moro reflex, or an abnormal Moro reflex, is more worrisome than a reflex that occurs on only one side of the baby’s body as it could mean that there could be damage to baby’s brain or spinal cord.


What if I see a change in my baby’s Moro reflex?

If you notice a change in baby’s Moro reflex contact baby’s healthcare provider immediately. She will likely want to perform tests to determine the cause. She may also want to know:

  • If there were any problems or events that happened during labor and birth
  • Detailed family history
  • Any other new or unusual infant behaviors


Life with a new baby is full of surprises. It’s comforting for parents to know that something as odd as the Moro reflex is quite normal and is seen in newborns who have a healthy, intact central nervous system.

By Jennifer Lemoine, DNP, APRN, NNP-BC