Baby Hints & Tips

Paediatrician Tips: Q&A with Dr Howard Chilton

Responses from Dr Howard Chilton from a question and answer session on Baby Hints and Tips Facebook page.

Recently, we invited members of our Facebook page to submit questions for Dr Chilton to answer during a timed Q&A sessions. Questions ranged from sleeping issues to cysts on gums. Read on to see Dr Chilton’s response to each of the questions.Q&A with Dr Howard Chilton

Chauntelle asks: Hi Dr Chilton. My 3 year old has been waking at night screaming and we are unable to settle her no matter what we try. She seems to be awake but no matter what we say to her we just can’t calm her down. These episodes can last up to 30 minutes, and it’s quite upsetting as she won’t talk to us and we don’t know what is wrong with her. Could it be “night terrors” and what can we do about this as we have a 3 month old baby who wakes with the noise. Thank you.

Response from Dr Chilton: Night terrors are like nightmares and children who have them need to be comforted. There is no other way and neither does there appear to be a way of preventing them. Generally children grow out of them relatively quickly. Luckily they don’t seem to remember the events.

Amber asks: hi Dr Chilton. My 12 week old son has little whit lumps on his gums…his paediatrition said they are cysts…we found them when he was 5 weeks and at the time he also had oral thrush. the doc put him on nilstat to clear it up. im just wondering if that should have cleared up the ‘cysts’ as well because he still has them and are they detrimental to his overall and oral health? thanks 🙂

Response from Dr Chilton: Mucous cysts in the gums are a normal variant. The gums are full of mucus glands, and these cysts are just glands that are blocked. They will unblock by themselves eventually and do no harm. Ignore them.

Melissa asks: Dr chilton, what are your thoughts on amber teething necklaces? Can they work? Thanks for your time!

Response Dr Chilton: I hate to get into this discussion but there is no way Amber teething necklaces can do anything useful in teething. Sorry if you are a believer!

Prue asks: Hi Dr Chilton, our 19 week old bed shares with us wakes 4+ times a night a to feed. Do u think bed-sharing causes him to wake this frequently? Also, he catnaps for about half an hour, almost to the minute! Is it realistic to think he’ll grow out of this?

Response from Dr Chilton: Hi Prue. there is no doubt that bed sharing babies feed and wake more often than babies in their own beds. Prof McKenna studied many mothers and babies in a co-bedding situation and found the babies fed between 3 and 12 times a night. It’s okay and is part of the deal. if you can cope, your baby certainly can and it is only doing him good and making him more emotionally stable. As you can see I’m a fan.

As for short naps there are some babies who are more lively than others and don’t wish to miss anything during the day. They tend to nap one sleep cycle only and it’s hard to prolong it, unless you make his environment much more calm and boring. This will not necessarily be to his liking! Remember babies change month by month at this age so have hope!

Prue: thanks Dr Chilton, I’ve done quite a bit of reading from Dr McKenna, he has a website with some great articles. Good to know my baby is normal! Certainly with a 2 year old it’s becoming increasingly difficult to keep home calm & boring, (Will is a bit big for the sling now!), I think Will is getting use to it! Thanks again, time to accept the broken sleep & take what I can when I can!

Melissa:hi prue, do you have a link to share from McKenna?

Prue: Sure Melissa, here it is http://cosleeping.nd.edu/or try to google mother-baby behavioral sleep laboratory. Hope you find it.

DR asks: Question how can i get 7month old to sleep alnight in his own cot without needing me he has wheezing breathing issues has been in hospital on and off since born also getting my near 3 year old to play nice and understand no is no not winge more thank u DR

Response from Dr Chilton: 3-year-olds do not understand ‘no’ very well at all. A better way of modifying unacceptable behaviour in that age group would be to withdraw your attention. When toddlers do something they know will annoy their parents they do it in order to gain attention. Even angry attention is better than none. So by ‘switching off’ and withdrawing attention when they are behaving badly is more likely to change their behaviour ban giving them so much intense focal attention at that time.

Shannon asks: Hello. I have a question about my 5 month old. Ever since she was born she does nothing but scream. It’s a terrible high pitched scream that continues for hours on end and usually accompanied by lots of distressed leg kicking and arching her back. She is currently on zantac syrup for reflux and has been since 4 weeks, but has made no difference. The last few weeks she has also had a constant tempreture of around 38.6 that baby panadol or nurofen does nothing to help, and is sleeping less than normal, which generally is not great at the best of times. I just dont know what else I can try to help her.

Response from Dr Chilton: That sounds really hard. If the diagnosis is reflux then she should be on another agent than Zantac. Losec is more effective after 3 months of age. I wonder who made the diagnosis on her however, and wonder whether it is correct especially as she has had a fever for quite awhile now. She really does need to see a doctor to have a diagnosis made. See your GP and maybe go to your local paediatrician to try and unravel this mystery.

Shannon: I have taken her to my GP a few times with the same problem and have been pretty much told to tough it out. The last time I went (last week) I was given a prescription for polaramine just to try and make her go to sleep…. which makes me feel bad like I’m drugging my baby. Plus it doesn’t work. She still screams

Response from Dr Chilton: Did they say why she was having fevers? Is she having a series of viral infections? Perhaps there a toddler in the house who goes to daycare that’s bringing them home?

Shannon: no. they checked her over and said they couldnt find a cause. and there’s no other toddlers. just her and i, and she does not go to daycare

Taryn asks: Hi my 3 year old son wakes up every night around mid night he has always been a good sleeper and slept through the night he goes to bed around 8 and wakes around six thirty seven when he wakes he screams and i cant get him to settle in his own bed he comes to our room on the floor what can be causing this and is there any way i can stop him waking altogether or a way to try and re settle him in his own bed thanks

Response from Dr Chilton: Characteristically children sleep well for the 1st 4-5 hours and then go into light / dream sleep more frequently so his pattern is a common one. With a 3-year-old I suspect he’s doing whatever is efficient for him i.e. actions for which he… is rewarded. I guess the important question is, when he wakes is he angry or is he anxious? if he is anxious then generally ‘camping out’ in his room is a better option than letting him cry for increasing intervals which you might do for ‘angry’. You really should see your paediatrician to develop a management plan and with a 3-year-old it should be easy to achieve. I can’t be more specific online. is rewarded. I guess the important question is, when he wakes is he angry or is he anxious? if he is anxious then generally ‘camping out’ in his room is a better option than letting him cry for increasing intervals which you might do for ‘angry’. You really should see your paediatrician to develop a management plan and with a 3-year-old it should be easy to achieve. I can’t be more specific online.

Taryn: Thanks he just wakes up crying he has a security sheet so im not sure if he loses it in his sleep how do you differ angry to anxious

Howard Chilton: If you can’t tell it’s probably neither, as it’s obvious. So it’s not separation anxiety (anxious), so sleep training would be worth a go. See your paediatrician for a plan

Alex asks: Dr Chilton,Is it ok that Mahalia eats sushi(not the raw sashimi type of course)????

Response from Howard Chilton: Hi Alex. Mahalia should be eating what you are eating at this stage. actually we should be feeding our infants especially up to the age of one year whatever foods we normally eat in the family, but pureed of course. We know that babies taste preferences are put in place under the age of one year and after that they are more resistant to new foods. So they should eat foods from 5 continents between 6 months and one year!

Paula asks:

Dr Chilton, My 12 month old is breastfed and is co-sleeping. She is waking up about 4 times a night. I am exhausted, any tips to improve her sleep without letting her cry it out. Thanks 🙂

Dr Chilton’s response:

There are two styles of parenting, so called ‘contact parenting’ and ‘control parenting’.  Bed-sharers are, of course, in the former group.  There is no doubt that this group parents get less sleep than the latter group, it’s just part of the territory (but for my money you get more secure kids).  When a baby is in bed with us she may feed frequently, even hourly, and there is little you can do to control this without fairly radical management. For instance, you can move her out of your bed into hers, or sleep with a utilitarian bra and refuse the breast!  The only other (quite successful) way would be for YOU to move into another bed when she demands a feed and leave her in the big bed (with or without Dad), or some combination of these suggestions.  We know that babies don’t actually NEED food at night from about 6 months of age, so she’s doing this because is loves it (and you) rather than she’s hungry. It is reasonable at this age to start imposing a sleeping routine on her which is suitable for everyone. If that’s co-bedding and feeding, no problem. But if you’re desperate for sleep, make a change. It will take about 4 nights of determination to succeed. She will not come to harm as long as you’re gentle,  firm and reassuring. She’ll object, but that OK.

I’m glad you haven’t wanted her to ‘cry it out’ The first few months, up to the age of 1 year, is a time that is critical to babies, as it’s during this time they develop their later view of how the world works. If they are dealt with lovingly and consistently during this time, and their cries of distress are dealt with promptly and reliably, they will incorporate into the hardware of their brain that their world is secure, their parents are reliable and loving, and they, the babies, are personally worthy and valuable. They develop a sense of security and good self esteem. This has been shown scientifically both from behaviourist’s studies and lately, from neurobiologist’s studies as well. This means that leaving babies in their early months to ‘cry it out’ may have long term costs, as may avoiding ‘spoiling’ them by not meeting their needs. This is no longer a subject for opinion but is now accepted as the standard model of how babies wire up their brains for later functioning.

Kim asks:

my son had constipation problems for the first 3 months of his life. We went to 5 different doctors before we were taken seriously and he was on stool softener for 2 months which fixed his problem. He is now 16 months old and has in the past week been constipated twice to the point where he cries hysterically while trying to poo. I have since been told that cheese is bad for little once when it comes to this (my son loves cheese and had a fair bit that week) are there any other foods that would make him constipated that I should avoid? Also how can I help him out when he does get constipated? Sorry for the long winded story and questions 🙂

Response from Dr Chilton:

It sounds to me like your boy should remain on his stool softeners to make sure he always has a comfortable stool.  If infants have large, hard stools this can occasionally cause a small break in the skin of the anus. This can be very painful for them during stooling and make the situation worse as they will fight going at all.  Prune juice is an excellent standby to soften stools, however, more formal stool softeners (as you have already been prescribed) such as Duphalac or coloxyl work well, as long as you give enough.  They are not habit forming as they are not laxatives, they merely draw fluid into the stool to keep it soft.  Better that than removing a favourite item of food from his diet (though cheese is not often a culprit); however, avoid bananas.  If he persistently gets constipated, take him back to his doctor as he may need something more effective (such as Parachoc).

Rachel asks:

Dr Chilton: i was just wondering how many ear infections is too many for a 2 year old, my 23 month old has had over 6 diagnosed by gp’s. should i be concerned with this number, should we be discussing other options such as gromets?

Response from Dr Chilton:

I would suggested you go to your GP to get a referral to see a ENT Surgeon for him to check whether there is any “glue” behind his ear drum which would make him more susceptible to repeated middle ear infections. He would be the one to decide about grommets.

Paula asks:

My 7 month old boy has been on Losec for treatment of reflux since he was 3 weeks old. He is now eating 3 solid meals a day, is still breastfed, doesn¹t seem to bring up much anymore however I am unsure of how and when to take him off the Losec. Do we wean him off slowly or stop altogether? We tried halving the dose a month ago and he reverted back with all the signs of reflux trouble when he was little so we are back up to his usual dose of 8mg a day. He is also a terrible sleeper, waking every hour from midnight till 6am and has done this for months now and I wonder if it is the medication adding to the cause of his night wakings. Thanks in advance for your advice.

Response from Dr Chilton:

You did it fine the first time.  The way to stop Losec is to halve the dose for a week or two and see whether the problem returns.  If it does, go back to full dose, if it does not, then stop. It is a harmless medication so don’t worry if you have to continue it.

Unfortunately I don’t have all the information I need regarding this lad. What are ‘his reflux symptoms’? Is he a vomiter? What’s his weight?  It is strange that he has the same symptoms at 3 weeks and at 7 months… He also has been a hourly night waker for months, so I wonder whether there is a behavioural basis for all of this, rather than a physical reason. One thing is for sure, it’s not the Losec.

Regarding the night waking, I assume you breast feed him whenever he wakes. This is fine if you’re happy with it, but does tend to encourage further night waking. From six months of age you do have a choice, as we know babies don’t NEED food at night from then on. Of course it does no harm and if you continue it for as long as you both want. However if you would rather discourage the practice at this age you can start to do so. Get Dad to settle him and space the feeds so it’s not every waking.  Make sure he is put down ‘drowsy but awake’ and doesn’t fall asleep on the breast. Do not abandon him to cry. If necessary sleep near him but don’t offer the breast, just patting, (it’s called ‘camping out’).  This is a large subject though and it’s hard to write specific advice as there is no ‘one size fits all’ approach. See you local paediatrician or if you’re in Sydney come and see me.

Chontae-jaeda asks:

My son is 5mths old and has been very sick since he was only a few weeks old and now all of a sudden now his better his super hungry all the time. His having 180ml bottles and baby cereal and yet after 2 maybe 3 hrs his starving again. I’m worried I’m going to overfeed him is it ok to start him on mashed spuds or something that will fill his tummy a little more

Response from Dr Chilton:

Any 5 month old baby who is as hungry as he sounds should be fed to capacity. I am not sure what you mean by being “very sick”, but if he has been unwell and has now recovered, his body may need lots of fuel to recuperate. So feed him. If you mean that he vomited a lot, he may well be underweight and again needs fuel to recover. Overfeeding is very over-diagnosed (and over-rated) these days. It is not possible to give too much food to a baby while he continues to be hungry. You can certainly try other solids, but the best nutrition for a baby under 6 months of age is milk.

Lisa asks:

My daughter is 7 weeks old she is breastfed and seems to be bringing up a lot of her feeds. She is sick after most feeds she is putting on weight and has plenty of wet nappies. She is well settled when awake but doesnt sleep in her cot for day sleeps and has trouble sleeping at night, would it help to put her on reflux medication or is there something else I can do to help her? Thanks so much

Response from Dr Chilton:

The “reflux” you describe is very common. Your baby is a ‘happy puker’, who at the moment doesn’t have an efficient valve between the oesophagus and the stomach, so she vomits a lot. If she is putting on weight it is generally not a problem (just a lot of mess.) Most of these babies are tried on reflux medication, which stops the acid production from the stomach. The acid can potentially cause discomfort, such as heartburn. Very often the medication makes absolutely no difference to the vomiting which continues until the baby’s valve develops more strength (usually by 4 months.) It would be reasonable to give the medication a try in your case.  It is likely that your baby’s sleeping problems have nothing to do with the vomiting. She just needs to be calmed and settled more during her day (check out my “Bore Your Baby To Sleep” article for a plan for this.)

Dr Howard Chilton, based at Prince of Wales Private Hospital and Royal Hospital for Women, is one of Australia’s leading baby doctors, with over 30 years experience as a neonatologist. He was Director of Newborn Care at Sydney’s Women’s Hospital for over 20 years following his training in Oxford, London and the USA. He resigned in 1999 to concentrate on clinical work. As his engagement with high-level Intensive Care diminished so he was able to spend more time with his central passion: parent education and what he terms ’reassurology’. He strongly believes that by enhancing parental attachment by helping parents relax and enjoy their baby so there is significant improvement of baby’s emotional development. He has written a number of books on the subject, ’The New Baby Book’, ‘Babies From Top to Bottom’ and his latest ’Baby on Board’. You can find him on facebook You can see all his articles here.

 

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  1. AvatarEmma says:

    Hi there, I came to your seminar at the Royal Hospital for Women this morning and was appalled by your insensitive, degrading attitude towards women who formula feed their babies.
    I’m sure you are well aware of the fact that not all mothers are able to breastfeed due to medical, physical or inadvertent circumstances? In which case you blatantly humiliated several formula feeding mothers in your presence!
    I urge you to rethink your unnecessary and cruel wording when you describe formula as ‘wall paper paste’, whether that’s your stupid opinion or not!
    Please don’t assume that mothers don’t know how much formula to feed their babies and set their clocks as to when to feed them. It may come as a shock to you but formula fed babies feed on demand and take as much as they need just like breastfed babies.
    It’s another disillusioned perception of yours that mothers of formula fed babies are not ‘intune’ To their babies sensitivities as mothers of breastfed babies are…How absurd! I hate to burst your bubble yet again but Mothers of Formula fed babies can also use their intuition and common sense to read their baby and meet their needs.
    I have a wonderful, happy, playful, contented young baby and guess what…Hes formula fed! On your point about filling the baby up on formula just so he/she sleeps through the night…My baby still wakes up a couple of times a night in his ‘cage’ (as you call it) just for a cuddle and happily goes back to sleep.
    While we’re on the subject of waking in the night, please stop suggesting to sleep deprived Mums to medicate themselves as this in turn will block out the mums capability to comfort their baby and see to their needs during the night.
    Overall I am deeply concerned of the possible effects of your silly misconceived ideas will have on vulnerable, fragile maybe post natal depressed formula fed mothers.
    Please curb your negative enthusiasm which could be detrimental to those you are preaching to!

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