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	ask the experts bob sears

Bob Sears
Pediatrics, Autism, DAN (Defeat Autism Now) Doctor, Vaccines, Nutrition, Sleep, Breastfeeding

• Are well baby visits necessary?
• Vitamin K, Hep B necessary for newborns?
• Long-term breastfeeding
• Rectal prolapse and surgery
• Peanut allergy and breastfeeding
• Seventeen-month-old wakes up too early
• Prep meds and sedatives
• Bottle drinking and cavities
• Does the DTAP vaccine have a connection with autism like the MMR?
• Booster shot while breastfeeding
• Tandem nursing and colostrum
• Tooth decay and sedation
• MMR vaccine as separate shots
• Extremely clumsy three year old

I am not going to be vaccinating my newborn at all. Are there any other health reasons, besides vaccinations, to attend the so-called well baby visits—especially if my baby seems healthy, happy, and growing fine, according to the charts?

Yes, there are. A good physical exam every few months is important—there are a variety of health and physical problems that can come up that a parent wouldn't always notice. Since these problems aren't common, you could argue that checkups are a waste of time and money for everyone who has a normal checkup. But for those who end up having a problem that can be treated or addressed with a better outcome because it was found early, they're well worth it. So, in my mind, it's worth doing. In my practice, I do every other checkup with babies who aren't vaccinated.

I am very concerned about the common procedures done to a baby immediately after birth here in Florida (neonatal eye care, Vitamin K, and Hepatitis B). Can you recommend an alternative to the eye prophylaxis and to the Vitamin K injection? I have heard that there is a liquid Vitamin K. How much would the dosage be for my baby and me since I will breastfeed, and where can I buy it? I have been searching everywhere. Any thoughts on the Hepatitis B vaccine?

I agree we do too much to brand-new babies too soon. I like to first do nothing for an hour or two so parents and baby can bond. In fact, the American Academy of Pediatrics' official policy says that nothing should be done until after the first feeding. I don't like doing Hepatitis B shots in newborns. I do think Vitamin K shots are a good idea. I've had three patients suffer bleeding complications (with severe consequences) due to Vitamin K deficiency. I'm not sure whether or not oral Vitamin K is as effective. But if you want to try it, it's the same dose as the shot. I don't know where to tell you to get it, though. In regard to eye ointment, I say only if mom has gonorrhea.

My question relates to breastfeeding, sleep, and weaning. My son is now two-years-old and is still an extremely enthusiastic breastmilk drinker, nursing about ten times a day, sometimes for up to 20 minutes at a time. At this point, he shows no signs of losing interest in nursing, while I have very mixed feelings. On the one hand, I really like and respect the idea of child-led weaning. I can clearly see how much my son seems to need that time with me, and I don't want to deprive him of that if it might be traumatic for him. But at the same time, I feel personally ready to wean.

There are several reasons. One is that we cosleep, and he still wakes up at least two or three times a night to nurse, sometimes more. In addition, he rarely naps without waking up at least once, often after 35 minutes or so, wanting to nurse again. As I am a stay-at-home mom, this leaves me feeling exhausted much of the time, or at least not well-rested, especially as it has been going on for over two years. Also, I am facing some pressure from my husband, who feels that it's time to wean him, and that it's OK to push him a bit in order for him to learn how to self-comfort, etc. And, finally, nursing a busy toddler as often as I do of course takes time, and of course has consequences when we are not at home, but he needs to nurse (it's very difficult for him to fall asleep without nursing, for example). What should I do? Is it OK to push him a bit, as my husband suggests, or is it important to let him choose the time to wean?

I totally support long-term breastfeeding. My wife nursed our kids for two years, three years, and three years. Having said that, I do think it's OK to push a kid a little bit. Start off with the "Don't offer, don't refuse" approach.

But you are probably already doing that. If you are, you can move on to the "OK, but just a second" approach where whenever he asks to nurse, you say "OK, but mommy's going to go get a drink of water first, or go get the mail, or go outside for a minute, or make a sandwich..." or whatever you want to do to briefly distract him. Then, you don't go back to sitting down after you are done with whatever you are doing. You walk around and stay busy. Engage him in whatever you are doing. If he gets very persistent, then sit down and nurse. But often he'll forget and become interested in what you are doing. So, you haven't said no; you just distracted him. Then when he remembers later and asks, you nurse. You alternate between saying yes and distracting. That may cut down on the nursing some and become a first step toward eventually cutting back to only nursing at naptime and bedtime (and during the night). But this is a start.

When my son, who is two-and-a-half-years-old, goes to the bathroom, part of his rectum comes out (approximately a half-inch to an inch). It goes back in by relaxing him and pushing gently down on his butt. I am worried the doctor will want to do surgery. Can this be corrected naturally? He was in daycare, and we pulled him out—he didn't like it. Could something have caused this to happen? My other son had a testicular hernia when he was three, and he had surgery. Could this be related or inherited?

This is called rectal prolapse. It isn't too serious, but can require surgery if it doesn't stop happening with stool-softening measures. There probably isn't anything in particular that would have caused it, other than constipation. Add some fiber to his diet; increase the fruits that help you go (prune, plums, peaches); increase water intake. If the stools don't soften up and pass very easily, talk to your doctor about what else to do. If the prolapse continues despite a month of soft stools, see your doctor. I don't think anyone really knows how long we can safely let prolapse go on without needing to be corrected, but you can discuss that with your doctor.

My 14-month-old son recently had a severe reaction to peanut butter (he took a bite of his big brother's sandwich). He was diagnosed with a potentially life-threatening peanut allergy by a pediatric allergist. I am still nursing my son, but feel somewhat responsible for his allergy because I ate peanuts (maybe once each week) prior to his reaction to the peanut butter. I am torn as to whether I should continue nursing him or whether I should stop. Any advice you have for me would be much appreciated.

Breastfeeding is very important up through two years of age, and continues to be beneficial beyond that. There is no evidence that a nursing mom eating peanuts would make a baby allergic. I never tell a nursing mom to avoid peanuts (unless we see a baby having allergic problems). So, this likely would have happened even if you had stayed away from peanuts. I would keep nursing, and give up peanuts for now.

I have a question regarding my 17-month-old son's sleep cycles. For a few months now my son has been waking up between 4 and 5 AM each morning. This is very early for him. He used to wake between 6 and 7 AM. I am still breastfeeding him. When wakes up, he wants to nurse, so I bring him into our bed. After he's done, he becomes really restless, thrashing his legs around and crying some. This lasts for one to two hours until he finally falls into a deep sleep before waking for the day. My husband and I don't know what to do. I really feel bad for him because I know he's still tired, but he can't settle back to sleep. This happens every morning. Any advice on how I can help him sleep in a little longer would be great.

I am a breastfeeding mother of a seven-and-a-half-month-old girl, and today my doctor mentioned that I may need a colonoscopy (I think I have a fissure). I go in on Friday. I am concerned about the prep meds if they?re needed. Please offer me questions for my doctor and any alternatives or advice on the situation.

Colon prep meds and sedatives used for colonoscopy are generally safe for breastfeeding. I can't specify for certain without knowing the exact names of your meds. What most doctors will tell moms is not to breastfeed during the prep and for many, many hours following the procedure (more hours than are necessary). In general, you can nurse up until the time of the procedure, and then nurse again after you feel the sedatives have worn off and you "pump and dump" once. Exact details on this may differ, according to the meds you are given.

My second son recently had his first dental appointment and was diagnosed with multiple cavities. This was not surprising to me, since I had noticed discoloration in his teeth early on. The dentist advised against milk consumption from a bottle, but I am concerned that my son is not getting enough protein now that we have restricted that mode of drinking. He will hardly drink any milk now, but would consume lots as long as he could drink it from the bottle. My oldest son has had milk in the bottle up until this point without any adverse consequences. The dentist thinks genes are involved. My question is whether or not there are any studies that either prove or disprove the theory that tooth decay is linked to bottle drinking.

While I haven't recently looked at the studies, I do believe this has been pretty well documented in research. The thing is, kids don't really need milk anyway. There are plenty of other ways to get calcium and protein, such as yogurt, cheese, poultry, nut butters, eggs, and fish. My kids never drank milk after they were weaned.

Does the DTAP vaccine have a connection with autism like the MMR?

No. There are two main factors with vaccines that are most suspect when it comes to autism. The first is mercury, which is found in some brands of the flu shot, plain tetanus, and diphtheria/tetanus shots, and a very trace amount in one brand of DTaP. The second suspected connection is with the live measles virus component of the MMR vaccine. There is nothing specific about DTaP that has yet been connected or even suspected to be connected with autism.

I have a newborn son, whom I breastfeed. I plan on pumping when I go back to work part-time so that his dad can give him bottles of breastmilk when I am away. I am also a student starting my clinicals for my nursing degree this fall. My school requires that I have updated booster shots for DTaP. My son is not going to be vaccinated at all. After being given the booster shot, how long must I wait (and pump and dump my breastmilk) until it is safe to feed my son again? Right now I'm pumping milk a little bit at a time to store for when I won't be able to feed him. Will I have to wait for weeks after the booster shot to feed my son? How much extra breastmilk do I have to have ready?

Actually, there is no worry with getting a DTaP shot while breastfeeding.

The chemicals and ingredients in the shot are very minimal, and very little would go through the breastmilk (theoretically). Now, I don't think this has actually been studied thoroughly, but I do believe it is safe.

I am pregnant and have a one-and-a-half-year-old. I would like to tandem nurse, but both the pediatrician and my ob-gyn say I will not produce colostrum for the second baby if I tandem. La Leche League says otherwise. What do you say? And if the colostrum will be produced again while I tandem, are there any medical articles or research that you can point me to?

I have never heard this before. Very interesting. In my experience, you will produce colostrum. It is also very likely your milk will decrease and probably completely go away by the fifth month of pregnancy. Some kids will continue to nurse despite this, some will wean, and some will pick up nursing again once the baby is born. The only reason NOT to nurse during pregnancy, that I know of, is if you have a history of preterm labor or multiple miscarriages. If not, go for it!

My husband and I are going to be adopting a newborn, hopefully sometime this year. I have amenorrhea; we have been dealing with infertility for seven years. I'm extremely worried about nutrition for our baby because I know that breastmilk is so important and there is no substitute equal to it. I've heard of breastmilk banks, but I also know that they pasteurize the milk, and it is very expensive. Do you have any suggestions?

I do agree that breastmilk is best, yet the cost of donated breastmilk is a challenge. If you have the money, I would recommend you do buy it. Pasteurized breastmilk is healthier than formula. Most of the adopting patients in my practice do choose to use formula instead, and I am fully supportive of that decision. Congratulations on the baby!

My three-year-old has tooth decay between his two front teeth. Our dentist recommended getting them filled. If we do so, what relaxants or pain killers for the procedure are best and safest? We're scheduled for a second opinion, but the decay is pretty visible, and it looks like we don't have much choice. I don't want him tied down or traumatized, but I'm also afraid of giving him a dangerous drug. Help, please!

My second child had the exact same situation, and we chose to have them filled. I would recommend composite fillings as the safest choice right now. As for sedation, we gave him a mild sedative called Versed. He was pretty relaxed, but not actually asleep. We also ended up having to add a little Nitro gas. Virtually all kids handle this just fine, just as our child did.

I am trying to find the MMR vaccine in 3 separate shots. I live on McGuire AFB in New Jersey. Do you know how I can get this?

You can find it at the Hopewell Pharmacy in New Jersey. The website is located at http://www.hopewellrx.com/contact/index.shtml.

My son, aged three years and two months, is always tripping and falling. He is extremely clumsy. Others notice. It is beginning to affect his self esteem. I took him to a neurologist, who was not too concerned. Some weeks it is worse than others. He can't sit still, he can't sit up quietly to even put his shoes on: he lays, or leans. He is very active, and challenges himself constantly, daring to jump four steps, for example. He is too big for a stroller, and I make him walk to the playground, seven blocks away. He will fall, trip, cry that his legs hurt—but when he gets there, he's usually fine on the equipment. He sometimes walks into the wall turning a corner. I know this is a lot of info, but I need more opinions on what could be causing this. I am less concerned about my one year old girl stumbling than him. I also have an older son, who had none of these issues. It's like he wants to get everywhere faster than he can get there, or he's looking up when he should be looking ahead. He also can't stand on one leg for more than two seconds. What could be going on? I've been to two pediatricians and no one seems to take this seriously. Please help.

This does sound concerning to me. A couple things could be contributing to this. One, have his vision checked. The walking into walls and stumbling sometimes could be due to a vision problem. Two, all of these complaints sound like he may have low muscle tone and strength. A pediatrician (if you can get one to take you seriously) can do some blood tests to check for a muscle disorder as well as thryoid hormone levels (if they are low this can affect muscle tone).

However, in this type of situation an actual cause of the low muscle tone and strength usually can't be found. But it can be treated with occupational therapy exercise programs. Gymnastic and/or horseback riding based programs are good for muscle tone. Your pediatrician would probably refer you to one. Thanks for asking such a good question and I hope you can find some improvement and answers.