Infant plagiocephaly: everything new is well forgotten old.

There was a time when absolutely all babies used to sleep on their backs. Placing babies on their backs started most likely when people did not know how to write. It was a tradition. Why do traditions exist? Supposedly, only for one reason: to change them. Placing babies to sleep on the back did not escape the challenge of time, and several decades ago, someone brilliant decided that the best position for babies to sleep was on their bellies. That was a change, revolutionary in its courage and boldness. It was not as revolutionary as the polio vaccine, but something new challenged a tradition. Two generations of pediatricians knew only one infant sleeping position - on the belly. 

It turned out that our grandparents and great grandparents, and before them, Moses, Sarah, and Abraham were correct in placing their babies for sleep on the backs. Maybe they have known something we discovered only in the 1990s - belly sleeping was often responsible for sudden infant death. Thousands of infants died because the "progressive" doctors changed the old habit by placing babies to sleep on their bellies. However, following the discovery that sleeping on the backs was much safer, pediatricians started the "back to sleep" campaign, and in a mere decade, it almost succeeded. Nowadays, most nurses and doctors do their best to change the habits of their patient's parents, who inherited them from their parents. This change led to the rediscovery of a disease called "infant plagiocephaly."

Plagiocephaly is the flattening of the baby's naturally soft skull caused by the pressure of sleeping in one position combined with a low amount of vitamin D in the mother's diet during her pregnancy, making babies skull even more pliable. When babies slept on their bellies, their heads were randomly turned to one side, avoiding constant pressure on one side and an asymmetrical flattening of the face. Since the "back to sleep" campaign required placing babies on their backs, many babies developed flattened backs of their heads. 

This disease epidemic caused enormous alarm among pediatricians. A new industry arose to deal with it when companies began manufacturing infant helmets. Hundreds of scientific articles discussed the origin of this new disease and ways to treat it. Many doctors earned their professorship publishing them. Pediatric neurosurgeons developed surgical procedures for correcting anesthetically molded infant's skulls shapes. 

We could have avoided all of this if the same pediatricians had asked their grandmothers about plagiocephaly or read seemingly ancient textbooks of pediatrics written when their grandparents were young. They would have made an astonishing discovery that infant plagiocephaly is as old as the world. They would have learned that plagiocephaly was very common and did not alarm pediatricians back then because they knew that the head deformity would disappear once babies began to roll and sit. The pressure of the rapidly growing brain on still moldable skull bones would gradually make the head round again. And that using helmets is a waste of money because helmets work no better than time itself.

Sergey Shushunov, MD

The new coronavirus is not going to end mankind

Forget about global warming, international terrorism, SARS virus, or being kidnapped on your way to work. 

We have a new scarecrow: previously unknown coronavirus from China. The real question is: how bad is it?

According to the data from China as of February 9, 2020, there were about 800 deaths among 38,000 people diagnosed with coronavirus or a 2% mortality rate. 2% is scary, but the keyword in a previous sentence is "diagnosed". The illness with coronavirus starts just like the common cold and in the majority of people, it ends like a common cold. Runny nose, mild fever, cough, and this is it. The number of people whose disease does not progress to a severe form is tens of times larger than the number of people who feel bad enough to be tested. In reality, the mortality rate from this virus is probably only a small fraction of one percent. A fraction of 1% is also bad, but it is not much worse than a mortality rate of the influenza epidemic, which claimed around 60,000 lives during winter 2017-2018 in the US alone. 

What makes this virus so scary is the fear of the unknown on one hand and the media, which blows it out of proportion, on the other. It is not unlike the fear of Martians. We don't know Martians, but we, just in case are afraid of them. However, I would rather be afraid of reporters.

Sergey Shushunov, MD

Selecting baby cereals

Baby cereal is one of the first foods introduced to babies. Cereals are nearly ideal infant transitional foods. Cereals are very convenient. Cereals can be prepared to have a consistency close to the thickness of milk or formula, which can be thickened as the baby gets older, add another source of nutrition, have fiber, which is an essential component of gut health. One of the most common cereals is rice.

What makes rice cereal so attractive? Nothing, for the babies. However, rice is technologically easier than other grains for manufacturers to turn into cereals, making them very popular.

Before selecting a baby cereal, the most crucial question parents should ask is: What is the nutritional value of rice? Well, it is an excellent source of two "nutrients": starch and arsenic. The amount of protein in rice in comparison to other grains is negligible. 

The nutritional value of starch is well known: it is the most common source of empty calories, meaning that your baby can't grow well when fed rice cereal. 

What about arsenic? This problem of high arsenic content in rice is much more significant than low protein content. Due to rice being grown and cultivated, arsenic accumulates in rice at several times higher concentrations than other foods. Arsenic is a known carcinogen and adversely affects memory, intelligence, the heart, reproductive system, and skin.

There is one advantage of rice over some other cereals - rice does not contain gluten, a protein found in many grains, including wheat. Gluten in the form of wheat has been one of the most important protein sources for humans for about seven thousand years, but only recently has gluten become a source of widespread concern due to the fear of gluten intolerance. The fear of gluten intolerance is based mainly on mass media hysteria propagated by publicity-looking journalists and bloggers, scientifically unfounded articles, and gossip. 

Regardless of whether gluten fear is real or not, living without worry is much healthier than with it. One of the best substitutes for rice in gluten-sensitive or gluten-scared people is buckwheat. Buckwheat has no gluten, is loaded with protein and minerals, which give it this dark color. All protein reach grains have darker colors due to higher mineral content. The minerals in grains are bound to proteins, which means that colored grains are rich in protein.

Try to follow this rule: select grains of other colors than white, such as buckwheat, barley, oats, and quinoa, depending on the absence or presence of the fear of gluten.

Sergey Shushunov, MD

Mosquito bites itch may be more than just an annoyance

Everyone tuned in to the news media already knows about Zika spread by mosquitoes and the risk of fetal complications among pregnant women infected. 

Unfortunately, much more severe diseases such as Chikungunya and Dengue fever are also spread by mosquitoes.

New animal research suggests that itching and swelling at the site of mosquito bites allow the virus to replicate faster, than when no itching and swelling are present. This means that in addition to mosquito repellents, using anti-inflammatory creams and sprays post-exposure may help reduce the risk of acquiring a mosquito-borne viral infection. This finding has not been confirmed in human studies, but when used sparingly, anti-inflammatory creams and sprays have no serious side effects. It may be a good extra measure to start applying them at the sites of bites right away, rather than waiting for swelling and itching to set in.

Sergey Shushunov, MD

Wheezing and antibiotics. Is it connected?

Children of preschool age who develop wheezing during viral respiratory illness are often diagnosed with Reactive Airway Disease and receive treatment with medications, usually inhaled to reduce inflammation and decrease the narrowing of the airways. Some parents demand antibiotics to treat viral illnesses of their children, thinking that it may shorten the duration of the illness or prevent complications and pediatricians sometimes comply, usually prescribing amoxicillin or something similar, just to keep parents happy.

It has been suggested several years ago that wheezing in some young children may, in fact, be associated with a specific bacteria. However, it was not clear what pediatricians should do about it.  Now pediatricians may have some clues. A small study published in December 2015 demonstrated a dramatic decrease in the duration of wheezing episodes in small children treated with antibiotic azithromycin.  

It is important to keep in mind that while both, azithromycin and amoxicillin are antibiotics, their chemical structure and effect on bacteria and the human body are very different, meaning that using any antibiotic to treat wheeze may do more harm than help.

Exclusive breast feeding and food allergies in babies

There is a well-supported notion that exclusive breastfeeding prevents the development of food allergies in infants. 

However, this rule, just like any other has exceptions. Even exclusively breastfed infants can develop food allergies. The most common culprits are peanuts and cow's milk protein. Egg and wheat proteins can also cause a problem.  This happens when nursing mothers use products containing milk, peanuts, egg, and wheat in their diet when large particles of allergy-causing proteins find their way to breast milk. Just like with any food allergy, the most common manifestation is atopic dermatitis. Some infants may develop chronic diarrhea and colic-like abdominal pain. More severe manifestations, including life-threatening, are rare. The issue of indirect infant exposure to a variety of food allergens via breast milk is quite complex. 

There is evidence, that maternal consumption of peanuts during breastfeeding may actually prevent the sensitization of children to peanuts. Why in some mothers peanut consumption can cause allergies in babies while preventing the same in others? There is no good answer. 

Obviously, something is missing in our knowledge about food allergen transmission and sensitization at a very early age.

Sergey Shushunov, MD

Swaddling danger

What can make us feel more comfortable than hugging and snuggling? We all need this simple expression of love and affection. It calms us down. It makes us feel worry-free. All mammals hug and snuggle. Even snakes and birds snuggle. The reason behind it is the way the mammals, birds, and snakes develop after conception – in a confined, space of a uterus or an eggshell. We carry this need through our lives, but it is the strongest in early infancy. I doubt that a crying baby can become “spoiled” by being picked up and held tightly every time. The problem is that we can’t do it every time a baby cries. We decided to cheat on nature and invented swaddling. Swaddling is hugging and snuggling surrogate. It is known forever to work wonders for upset babies. Swaddling a baby is not hard, but it has a few tricks. In older times swaddling was a skill passed down from generation to generation. Now young parents don’t have anyone around to learn it from. The gap was filled by a multitude of companies offering swaddling garments, which require less effort and fewer skills than a blanked.

There is a small but significant difference between a baby blanket used for swaddling and swaddling garments: the fasteners. All baby garments designed to make swaddling easy use some form of fasteners, such as snaps or velcro. This could make them more dangerous with improper use. An article published by the Journal of Pediatrics in January 2014 described 36 serious incidents, including deaths, reported to the Consumer Product Safety Commission, which was attributed to improper swaddling. In two-thirds of incidents a swaddling garment was used. The number of unreported incidents is probably many times higher.

Swaddling is good if done right – parents need to be educated on how to do it. There are risks regardless of what is used, higher with a garment and lower with a blanket. Informed and educated decision on what to use and how to use seems to be the key to safely and happily sleeping babies and parents as well.

Genetically modified food. Is it really that bad?

Almost all living creatures we use for our benefit have been genetically modified. Think of 500 breeds of dogs, some ugly as hell, 7000 varieties of apples, many of which are inedible, and 80,000 of corn. It took 10,000 years or, putting it in perspective, 400 generations of humans to breed and produce this incredible number of genetically butchered plant and animal species until someone only recently realized it could be done much more straightforward and with more precision.

Genetic engineering is a form of breeding. Clean, thoughtful, and precise – just like robotic surgery. Genetically modified organisms have their genes replaced forcefully rather than by chance of selective breeding, without waiting for one generation after another, with full knowledge of what genes should be changed to give us the result we want. Genetic engineering relies on taking a desirable gene from another animal or plant and placing it precisely in the right part of the chromosome - no waiting for several generations to see the results, no unpredictable characteristics in the offspring.

Here is the best thing: DNA is 100% digestible. Once genetically modified food passes our stomachs, the DNA derived from genetically modified foods turns into the same mixture of amino acids and carbs derived from any other food source. It gets absorbed into the bloodstream, just like amino acids and carbs derived from other molecules consumed with food.

Sergey Shushunov, MD

Antibiotics overkill ?

Did you know that American children 10 years and younger are 50% more likely to be treated with oral antibiotics than children of the same age in the United Kingdom? This is a conclusion of the study published by the journal “Pharmacotherapy” in December 2013 following an analysis of 160,000 charts from each country. Another interesting fact discovered was 5 times higher total cost of prescribed antibiotics within the same groups of children in the United States in comparison with the United Kingdom. The study raises a lot of questions. What drives this discrepancy in usage? Parental pressure? Malpractice pressure? Pharmaceutical companies, making exuberant profits in the American market?

The difference is striking.

Sergei Shushunov, MD

Recent research on infant colic

An article published in the NEUROLOGY journal in 2012 points to a link between parental migraine and colic in babies. Parents suffering from migraines were more likely to have babies with colic. Migraine, just like colic is likely triggered by vasoactive substances present in the body in unbalanced quantities. In some adults, migraine manifests in not just a severe headache, but also in abdominal cramping - just what appears to be happening in colic babies. This article indirectly supports the use of vasoactive compounds, such as anethole, a component of fennel seed oil, used to formulate Pediacalm, colic remedy from Lev Laboratories, to treat baby colic.

Sergei Shushunov, MD