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Baby Formula Shortages

From the American Academy of Pediatrics:

Updated 5/19:

Since the outbreak of COVID-19, there have been significant shortages of infant formulas in stores. Current shortages have been largely caused by supply chain issues and the recent recall of several baby formula products over concerns about contamination.

Here are some tips on finding formula your baby needs during the shortage, and what you may safely consider if you absolutely can’t find any.

Keep in mind, this advice is strictly during this current URGENT formula shortage. If you have any concerns about your baby’s nutrition, please talk with your pediatrician.

What if baby formula is out of stock everywhere I look?

  • Check smaller stores and drug stores, which may not be out of supply when the bigger stores are.
  • If you can afford it, buy formula online until store shortages ease. Purchase from well-recognized distributors, grocers, and pharmacies rather than individually sold or auction sites.
  • Check social media groups. There are groups dedicated to infant feeding and formula, and members may have ideas for where to find formula. Make sure to check any advice with your pediatrician.
  • If you find it in stock, it can be tempting to buy as much formula as possible right now, but the American Academy of Pediatrics (AAP) advises buying no more than a 10-day to 2-week supply of formula to ease shortages.
  • Call your pediatrician if you cannot access the formula you need for your baby. They may have samples in stock, connections to other local organizations, or ideas of other places to call, such as your local WIC clinic.

I found small amounts several different formulas. What is the best way to switch among the brands?

For most babies, it is OK to switch to any available formula, including store brands, unless your baby is on a specific extensively hydrolyzed or amino acid-based formula such as Elecare (no store brand exists). Ask your pediatrician about recommended specialty formula alternatives available for your baby.

It is very likely that your baby will do just fine with different formulas as long as they are the same type. If your baby does not like the taste or has a hard time tolerating a different formula, you may want to try gradually introducing small amounts of the new formula mixed with the usual formula. Slowly increase the amount of the new formula.

My infant needs a specialty baby formula, but I can’t find any. What should I do?

Abbott is releasing limited quantities of Similac PM 60/40 and other metabolic formulas for babies in urgent need. Your pediatrician’s office can fill out a request and if it is approved, the formula can be shipped to your home. Talk to your pediatrician about safe comparable specialty formulas for your baby.

Only one brand of baby formula is covered under the WIC program, but I can’t find any. What should I do?

Most states are allowing parents who use WIC benefits to buy other brands of formula or different sizes and forms like ready-to-feed formula. (To find out what your state is allowing, you can check here.)

I have a 3-month-old infant and can’t find my usual baby formula. What should I do?

This is a very difficult problem. If you can find another similar formula, it’s okay to make the switch. If not, your pediatrician’s office can work with you to access all community resources.

Can I add extra water to formula and give my baby a multivitamin to make up the nutrients?

This should never be done. Watering down formula to stretch it out can cause nutritional imbalances in your baby and lead to serious health problems that require hospitalization. Always follow label instructions or those given to you by your pediatrician. Always mix formula as directed by the manufacturer.

Can I make my own baby formula? I’ve seen a recipe online that people say was used safely in the 1940s.

Homemade formula is not recommended. Although used in the distant past, online recipes have significant safety concerns regarding contamination and nutrient concentration. Even if recipes for homemade formulas circulating on the internet may seem healthy or less expensive, they are not safe and do not meet your baby’s health needs. Infants have been hospitalized from reported use of some homemade formulas.

What is the earliest age I can start giving my baby solid food to stretch my formula supply?

Solid foods should not be used to stretch formula supply. Formula contains many nutrients young babies need. Infants generally are ready to eat solid food when they are 6 months old, but it depends on their rate of development. You can introduce solid foods as early as 4 months of age, but infants 4-6 months of age will continue to need breastmilk or formula to supply the majority of their nutrition.

Is it safe to get breast milk from a friend or online group?

We can’t know for sure whether breastmilk from a friend or online group is safe. It is better to check with a local milk bank that is accredited through the Human Milk Banking Association of North America. To find an accredited milk bank, check here.

I heard the government will be importing baby formula from other countries. Is that safe?

The U.S. Food & Drug Administration (FDA) is considering accelerated approval of certain imported formulas. The FDA is working to assure procedures are in place to verify production standards, labeling and shipping of brands that have not been sold in the U.S. previously. European formulas are regulated by the European Food Safety Agency similar to how the FDA regulates formula in the U.S. and are highly reliable. But while they may contain adequate nutrients, they must be imported in a way that maintains temperature and other safety issues. That’s why FDA oversight is critical.

Can toddler “formula” substitute for regular formula?

Toddler drinks, often found in the formula isles, are not recommended for infants. However, if you absolutely have no other choice, these products can be safe for a few days for babies who are close to a year of age.

Can I give my full-term baby premature formula?

Formulas designed for babies who were born premature (and have “catch-up” growth to do) can safely be used for a few weeks to feed full-term babies if nothing else is available.

Is cow’s milk a safe alternative to baby formula?

If your child is older than 6 months of age and is usually on regular formula (not a specialty product for allergies or other special health needs), this may be an option. In a pinch, you could feed them whole cow’s milk for a brief period of time (no more than a week).This is not ideal and should not be done for more than one week. However, it is a better option than diluting formula or making homemade formula.

We don’t have a specific amount of cow milk that infants 6-12 months should drink in this situation. Continue to look for alternative sources of baby formula. One concern with giving cow’s milk to a baby who is 6-12 months old on a long-term basis is that it does not contain enough iron like formula does. This can lead to anemia. If you have to use cow’s milk, ideally do so for as short a time as possible and give the baby plenty of iron-containing solid foods, such as baby food made with meat or iron-fortified cereals.

If you need to give your baby cow’s milk for a week, talk with your pediatriican.

What about feeding my baby goat’s milk?

Goat’s milk is not approved for babies in the United States. However, there are goat milk-based baby formulas registered in other countries that may be among those considered for accelerated import approval by the FDA.

Can I use plant-based milk instead of baby formula if needed?

Plant-based milk alternatives generally are not recommended for babies under a year of age. Soy milk may be an option to give babies who are close to a year of age for a few days in an emergency, but always buy the kind that is fortified with calcium and vitamin D. Make sure to change back to formula as soon as some is available. Be especially careful to avoid almond milk or other plant milks as these are often low in protein and minerals. Talk with your pediatrician if you are considering using plant-based milk.

How long can formula be used past a “best by” date?

Generally, formula should not be used past the “best by” date because it may not be safe or have the required levels of nutrients, especially fat-soluble vitamins. Check the “use by” date on infant formula, which is required by FDA regulations to be on each container. Until that declared date, the formula will contain no less than the amount of each nutrient on the product label and will otherwise be of acceptable quality and safety.

Remember

Don’t hesitate to talk with your pediatrician if you have any concerns you have about your baby’s health and nutrition. If your child has special health needs, be sure to check with their doctor about medically appropriate and safe feeding alternatives.

11 Common Conditions in Newborns

From American Academy of Pediatrics:

Some physical conditions are common during the first couple of weeks after birth. If you notice any of the following in your baby, contact your pediatrician.​​

Abdominal distension

Most babies’ bellies normally stick out, especially after a large feeding. Between feedings, however, they should feel soft. If your child’s abdomen feels swollen and hard, and if she has not had a bowel movement for more than one or two days or is vomiting, call your pediatrician. Most likely the problem is due to gas or constipation, but it also could signal a more serious intestinal problem.

Birth injuries

Babies can be injured during birth, especially if labor is long or difficult, or when babies are very large. While newborns recover quickly from some of these injuries, others persist. Occasionally a broken collarbone occurs, which will heal quickly. After a few weeks a small lump may form at the fracture site, but don’t be alarmed; this is a sign that new bone is forming to mend the injury, and it will soon be as good as new.

Muscle weakness is another common birth injury during labor, caused by pressure or stretching of the nerves attached to the muscles. These muscles, usually weakened on one side of the face or one shoulder or arm, generally re­turn to normal after several weeks. In the meantime, ask your pediatrician to show you how to nurse and hold the baby to promote healing.

Blue baby

Babies may have mildly blue or purple hands and feet, which is usually normal. If their hands and feet turn slightly blue from cold, they should return to pink as soon as they are warm. Occasionally the face, tongue, and lips may turn a little blue when the newborn is crying hard, but once she is calm, her color should quickly return to normal. However, persistently blue skin coloring is a sign the heart or lungs are not operating properly. and the baby is not getting enough oxygen in the blood. Immediate medical attention is essential.

Unusual bowel movements

Meconium. After birth, the staff will watch for your baby’s first urination and bowel movement to make sure she has no problem with these important tasks. It may be delayed twenty-four hours or more. The first bowel movement or two will be black or dark green and very slimy. It is meconium, a substance that fills the infant’s intestines before she is born. If your baby does not pass meconium in the first forty-eight hours, further evaluation is required to make sure that no problems exist in the lower bowel.

Blood in stool. On occasion, newborns have a little blood in their bowel movements. If it occurs during the first few days, it usually means the infant has a little crack in the anus from stooling. This is generally harmless, but even so, let your pediatrician know about any signs of blood to confirm the reason, since there are other causes that require further evaluation and treatment.

Coughing

If the baby drinks very fast, she may cough and sputter; but this type of coughing should stop as soon as her feeding routine becomes familiar. This may also be related to how strongly or fast a breastfeeding mom’s milk comes down. If she coughs persistently or routinely gags during feedings, consult the pediatrician. These symptoms could indicate an underlying problem in the lungs or digestive tract.

Excessive crying

All newborns cry, often for no apparent reason. If you’ve made sure that your baby is fed, burped, warm, and dressed in a clean diaper, the best tactic is probably to hold her and talk or sing to her until she stops. You cannot spoil a baby this age by giving her too much attention. If this doesn’t work, wrap her snugly in a blanket or try some other ways that may help calm your baby.

You’ll become accustomed to your baby’s patterns of crying. If it ever sounds peculiar—such as shrieks of pain—or if it persists for an unusual length of time, it could mean a medical problem. Call the pediatrician and ask for advice.

Forceps marks

When forceps are used during delivery, they can leave red marks or even superficial scrapes on a newborn’s face and head. These generally disappear within a few days. Sometimes a firm, flat lump develops in one of these areas because of minor damage to the tissue under the skin, but this, too, will usually go away within two months.

​Jaundice 

Many normal, healthy newborns have a yellowish tinge to their skin, which is known as jaundice. It is caused by a buildup of bilirubin in the child’s blood. Mild jaundice is harmless. However, if the bilirubin level continues to rise and is not treated, it can lead to brain injury. Jaundice tends to be more common in breastfed newborns, most often in those not nursing well; breastfeeding mothers should nurse at least eight to twelve times per day, which will produce enough milk and keep bilirubin levels low.

Jaundice first appears on the face, then the chest and abdomen, and finally the arms and legs in some instances. The whites of the eyes may also be yellow. Most hospitals now routinely screen newborns for jaundice twenty-four hours after birth using a painless handheld light meter. If the pediatrician suspects jaundice may be present—based on skin color as well as the baby’s age and other factors—she may order a skin or blood test to definitively diagnose the condition. If jaundice develops before the baby is twenty-four hours old, a bil­irubin test is always needed to make an accurate diagnosis. If you notice a sudden increase in jaundice when your baby is at home, contact your pediatri­cian.

Lethargy & sleepiness

Every newborn spends most of her time sleeping. As long as she wakes every few hours, eats well, seems content, and is alert part of the day, it’s perfectly normal to sleep the rest of the time. But if she’s rarely alert, does not wake up on her own for feedings, or seems too tired or uninterested to eat, you should consult your pediatrician. This lethargy—especially if it’s a sudden change in her usual pattern—may be a symptom of a serious illness.

Respiratory distress

It may take your baby a few hours after birth to form a normal breathing pattern, but then she should have no further difficulties. If she seems to be breathing in an unusual manner, it is most often due to blocked nasal passages. Using saline nasal drops, followed by suctioning the mucus from the nose with a bulb syringe, may fix the problem; both are available over the counter.

However, if your newborn shows any of the following warning signs, no­tify your pediatrician immediately:

  • Fast breathing (more than sixty breaths in one minute), although keep in mind that babies normally breathe more rapidly than adults
  • Retractions (sucking in the muscles between the ribs with each breath, so that her ribs stick out)
  • Flaring of her nose
  • Grunting while breathing
  • Persistent blue skin coloring

Umbilical cord problems

Umbilical stump bleeding. As you’re caring for your baby’s umbilical cord, you may notice a few drops of blood on the diaper around the time the stump falls off. This is normal. But if the cord actively bleeds, call your baby’s doctor immediately. If the stump becomes infected, it will require medical treatment. Although cord infections are uncommon, you should contact your doctor if you notice any of the following:

  • Foul-smelling yellowish discharge from the cord
  • Red skin around the base of the cord
  • Crying when you touch the cord or the skin next to it

Umbilical granuloma. Sometimes instead of completely drying, the cord will form a granuloma or a small, reddened mass of scar tissue that stays on the belly button after the umbilical cord has fallen off. This granuloma will drain a light-yellowish fluid. This condition will usually go away in about a week, but if not, your pediatrician may need to burn off (cauterize) the granulomatous tissue.

Umbilical hernia. If your baby’s umbilical cord area seems to push outward when she cries, she may have an umbilical hernia—a small hole in the muscular part of the abdominal wall that allows the tissue to bulge out when there is increased abdominal pressure (i.e., crying). This is not a serious condition, and it usually heals by itself in the first twelve to eighteen months. (For unknown reasons it often takes longer to heal in African American babies.) In the unlikely event it doesn’t heal by three to five years of age, the hole may need surgery. Don’t put tape or a coin on the navel. It will not help the hernia, and it may cause a skin rash.

Are holiday gatherings OK during the COVID-19 pandemic?

From American Academy of Pediatrics:

For many families, the holidays are about getting together with relatives and friends. But as the COVID-19 pandemic  continues, gatherings with people outside your household continue to be risky this holiday season. Public health experts say that small household gatherings are some of the main ways COVID-19 cases spread so much again this fall.

With some extra planning and lower risk activities, though, your family can create lasting memories while lowering the risk of being exposed to or spreading COVID-19. Here are some tips I’m sharing with families in my practice this year:

  • Celebrate with members of your own household. Limit any in-person celebration to people you live with. Cooking with your children and decorating ​your home are great ways to enjoy each other’s company while protecting your family and others from COVID-19.
  • Find creative ways to share the experience remotely. Prepare a favorite recipe with extended family over video chat. Share what you are grateful for or light candles together virtually at the start of the holiday meal. Set up a group video call to sing songs, play instruments, share stories, open gifts together or count down to the New Year together.
  • Consider a drop-off treat exchange. Another way to share the holiday spirit is to prepare cookies or other special holiday treats for family and neighbors. Instead of exchanging them in person, delight them with a doorstep drop-off.
  • Shop online and help elderly or higher-risk loved ones. Do any grocery or gift shopping online with delivery and curbside pickup options, if possible. Consider holiday food deliveries to elderly relatives. If you need to shop in person, go when stores are not as busy.
Tips for a virtual holiday gathering with grandparentsWith so many families turning to video conferencing platforms for their celebrations this year, the American Speech-Language​-Hearing Association recommends finding different ways to communicate for older adults who may have difficulty hearing. Try using closed captioning or a larger screen, and make sure that they are closer to the computer and speakers to better hear and see facial expressions. Limit side conversations to give everyone a chance to speak and be heard. ​



If you do have an in-person get-together…

Make sure everyone understands that gatherings with people outside your household can be risky. Here are some ways to help make them safer:

  • Keep the gathering small and short. Keep your guest list as small as possible and reduce the amount of time you would usually visit.
  • Wear cloth face coverings and keep your distance. People who live together can sit together, but arrange for those from different households to stay at least 6 feet apart—especially while eating. Remind everyone to wear cloth face coverings when they’re not eating.
  • Open windows and stay outside when possible. Open windows for better ventilation. If weather permits, gather outdoors. Stay a safe distance apart from others and wear cloth face coverings with multiple layers or medical masks, even outside.
  • Safer serving. Avoid buffet or family-style dinners and choose one person do the serving or get individual meals if ordering out. Remind children to wash hands often, and keep hand sanitizer within reach.
  • Take safety steps beforehand. For two weeks before the gathering, remind guests to follow steps that lower the risk of COVID transmission. This includes wearing cloth face coverings, physical distancing, and limiting outings and social gatherings as much as possible. Consider offering your guests a “self-screening” checklist and ask them to join you virtually if they realize they are at higher risk of exposing the group to COVID-19.
  • Safer travels. Guests traveling for the get-together should drive with family members in a private vehicle, if possible, and wear masks at gas stations and rest stops. Anyone who has to fly should be extra careful around groups clustered near security lines and concourses, wear masks in airports and on planes, and hang back until lines have thinned.

Remember

Do not host or participate in any in-person festivities if you or anyone in your household has been diagnosed with COVID-19 and is still at risk of spreading it to others; has had any symptoms of COVID-19 within 48 hours of the gathering; is waiting for viral test results; could have been exposed to someone in the last 14 days; or is at high risk.

Stay safe this holiday season and your family will be even more grateful for your traditions in the years to come.

Breastfeeding During the COVID-19 Pandemic

From American Academy of Pediatrics:

Breastfeeding can offer many perks, especially during the COVID-19 pandemic. You can even breastfeed if you test positive for COVID-19 or are not fully vaccinated, as long as you take extra safety precautions to protect your baby.

Benefits of breastfeeding during a pandemic

  • Breastfeeding is good for babies. It protects them from many infections. It is not proven that breastmilk protects babies from SARS-CoV-2, the virus that causes COVID-19. However, several studies have found antibodies that target the virus in human milk. In addition, breastfed infants are generally less likely to have severe respiratory symptoms when they get sick.
  • Breastfeeding is good for moms. Hormones released in the mother’s body during breastfeeding promote wellness and can relieve stress ​and anxiety.
  • Breast milk is readily available. No purchase necessary! This can be important during public health emergencies, when it can be more challenging to buy formula and other feeding supplies.

Do I need to take extra precautions while breastfeeding if I’m vaccinated against COVID?

If you’re fully vaccinated against COVID-19, you do not need to take any special precautions when feeding your baby at the breast or expressing milk. However, if you have symptoms of COVID or have had close contact with someone who has the illness, the U.S. Centers for Disease Control and Prevention (CDC) recommends wearing a mask.

Can I get vaccinated while breastfeeding?

COVID-19 vaccines are considered safe for breastfeeding mothers and babies. Many lactating people have received the COVID-19 vaccine. Recent studies demonstrated COVID-19 mRNA vaccine antibodies in the breastmilk of vaccinated lactating mothers, which can potentially pass along protection to the breastfed infant. More studies are needed to determine how these antibodies protect the baby.
What if I am not fully vaccinated and want to breastfeed my baby?

SARS-CoV-2 (the virus that causes COVID-19 disease) spreads during close contact between people when an infected person coughs, sneezes, or talks. People without symptoms of or confirmed COVID-19, who have not been in close contact with someone with COVID, do not need to take special precautions. So far infectious SARS-CoV-2 virus has not been found in breastmilk. Breastfeeding has been shown to be safe when a mom has other viral illnesses like influenza.

How can I keep my baby safe while breastfeeding if I have COVID-19?

Yes, babies can still receive breast milk even if you test positive for COVID-19. The breast milk is safe and important for the baby.

  • Direct breastfeeding. Wash your hands with soap and water before holding the baby and wear a face mask while nursing. Holding your baby skin-to-skin helps the baby latch on and helps trigger milk release.
  • Pumping breast milk. Put on a face mask, wash your hands well, and clean any pump parts, bottles, and artificial nipples. Express milk as often as your baby eats, or at least 6 to 8 times per 24 hours. The expressed milk can be fed to your baby by a healthy caregiver. Remind all caregivers to wash their hands well before touching bottles, feeding, or caring for your baby. Remember to clean your breast pump after each use, following CDC guidelines.

If I have COVID-19, can I stay in the same room with my infant?

If you and your family decide to keep your baby in the same room as you, try to keep a reasonable distance away when possible. Wear a face mask and wash your hands whenever you directly care for your baby.

Continue taking these precautions until you have been fever-free for 24 hours without taking any fever medicines (acetaminophen or ibuprofen); at least 10 days have passed since your COVID-19 symptoms first started; and all your symptoms have improved. If you tested positive but have no symptoms, wait until at least 10 days after the positive test result.

How can I maintain my milk supply if I am sick with COVID-19?

Hand pumping and hand expressing breast milk is especially helpful in the first few days after your baby is born to get the milk supply going. Frequent pumping (or breastfeeding if you have chosen to directly breastfeed and are following the strict precautions noted above) should line up with your infant’s feeding demands, about 8-10 times in a 24-hour period.

Most medications are safe to take while breastfeeding, but always check with your doctor. While this may be a stressful time, try to stay optimistic and practice healthy habits to reduce stress as much as possible. This includes getting enough sleep, eating plenty of healthy foods, and getting regular exercise.

Ask your pediatrician for help with getting your baby to latch on​ again once you can restart breastfeeding. Do not hesitate to ask for help if you have trouble with feeding, nipple pain, low milk supply, or with any other concerns.Your pediatrician is here to help

After leaving the hospital, it is important that your baby’s first follow-up visit happen within 1-2 days in person so your baby can be examined, measured, and weighed. Many doctors are scheduling newborn visits during specific times (such as first thing in the morning) to limit exposure to sick patients. Your pediatrician also can help if you need more breastfeeding support, a lactation consultant, or help from local groups and resources.

Remember

The best way to protect your baby is to get the COVID-19 vaccine. If you aren’t fully vaccinated or test positive for COVID, it is still a good idea to breastfeed your baby if you can. Just be sure to take steps to minimize COVID-19 infection. Talk with your pediatrician about how to keep your baby healthy and what resources might be available in your community to help you.

More Information

Food Allergy Reactions

From American Academy of Pediatrics:

How do I know if my child has a food allergy?

A food allergy happens when the body reacts against harmless proteins found in foods. The reaction usually happens shortly after a food is eaten. Food allergy reactions can vary from mild to severe. Because there are many things that can be confused with food allergies, it is important for parents to know the difference.

Symptoms of A Food Allergy

  • Skin problems
    • Hives (red spots that look like mosquito bites)
    • Itchy skin rashes (eczema, also called atopic dermatitis)
    • Swelling
    • Breathing problems
    • Sneezing
    • Wheezing
    • Throat tightness
  • Stomach symptoms
    • Nausea
    • Vomiting
    • Diarrhea
    • Circulation symptoms
    • Pale skin
    • Light-headedness
    • Loss of consciousness

If several areas of the body are affected, the reaction may be severe or even life-threatening. This type of allergic reaction is called anaphylaxis and requires immediate medical attention.

Not A Food Allergy

Food can cause many illnesses that are sometimes confused with food allergies. The following are not food allergies:

  • Food poisoning—Can cause diarrhea or vomiting, but is usually caused by bacteria in spoiled food or undercooked food.
  • Drug effects—Certain ingredients, such as caffeine in soda or candy, can make your child shaky or restless.
  • Skin irritation—Can often be caused by acids found in such foods as orange juice or tomato products.
  • Diarrhea—Can occur in small children from too much sugar, such as from fruit juices.

Some food-related illnesses are called intolerance, or a food sensitivity, rather than an allergy because the immune system is not causing the problem. Lactose intolerance is an example of a food intolerance that is often confused with a food allergy. Lactose intolerance is when a person has trouble digesting milk sugar, called lactose, leading to stomachaches, bloating, and loose stools.

Sometimes reactions to the chemicals added to foods, such as dyes or preservatives, are mistaken for a food allergy. However, while some people may be sensitive to certain food additives, it is rare to be allergic to them.

Foods That Can Cause Food Allergies

Any food could cause a food allergy, but most food allergies are caused by the following:

  • Cow milk
  • Eggs
  • Peanuts
  • Soy
  • Wheat
  • Nuts from trees (such as walnuts, pistachios, pecans, cashews)
  • Fish (such as tuna, salmon, cod)
  • Shellfish (such as shrimp, lobster)
  • Peanuts, nuts, and seafood are the most common causes of severe reactions. Allergies also occur to other foods such as meats, fruits, vegetables, grains, and seeds such as sesame.

The good news is that food allergies are often outgrown during early childhood. It is estimated that 80% to 90% of egg, milk, wheat, and soy allergies go away by age 5 years. Some allergies are more persistent. For example, 1 in 5 young children will outgrow a peanut allergy and fewer will outgrow allergies to nuts or seafood. Your pediatrician or allergist can perform tests to track your child’s food allergies and watch to see if they are going away.

Inclined Sleepers and Other Baby Registry Items to Avoid

From American Academy Pediatrics:

Having a baby is an incredibly exciting time! Many parents set up baby registries for items that they believe their baby will need. However, it’s important to know that some popular products are unnecessary and can actually be dangerous for infants. Examples include inclined sleepers, positioners, and crib bumpers.

Each year, about 3,400 infants in the United States die unexpectedly during sleep. This can happen from accidental suffocation, sudden infant death syndrome (SIDS), or unknown causes.

To help prevent these deaths, the American Academy of Pediatrics recommends that all infants should sleep on flat and firm surfaces. Babies should sleep by themselves, without any bumpers, soft bedding, pillows, or stuffed toys. Crib bumpers and inclined infant sleeper products can cause a baby to suffocate. We also advise against using products that are for infant bedsharing with parents.

New safety standards on the way

A safe sleep environment is so important that the U.S. Consumer Product Safety Commission (CPSC) approved a federal safety standard for infant sleep products in June 2021. Starting in mid-2022, this standard will help get rid of potentially dangerous baby sleep products such as inclined sleepers, in-bed sleepers, loungers, and travel/compact sleepers. These products will have to meet the same CPSC standards that are already in place for cribs, bassinets, play yards, and bedside sleepers.

Here’s why these and other dangerous infant sleep products should stay off your registry and out of your home.

Inclined sleepers and positioners

These are sometimes called baby nests, docks, pods, loungers, rockers, or nappers. Infant positioners and inclined sleepers have been popular items on baby registry lists for years. But until mid-2022, these products are not regulated and have no safety standards.

The CPSC says that sleep products that incline more than 10 degrees are not safe. Soft and plush sleep surfaces are also dangerous. Inclined sleepers allow babies to sleep at a 30-degree angle. Infants placed in these products may fall asleep in a chin-to-chest position, which can restrict their airway. They can also roll out of the devices and become trapped under them. Inclined sleepers have been tied to at least 94 deaths.

With sleep positioners, babies can suffocate after rolling onto their stomachs since they can’t lift their heads. The soft padding can make it difficult to breathe if a baby’s face presses against it.

Crib bumpers

Crib bumpers were long considered staples of nursery décor. They were originally intended to cushion babies from the crib slats. Crib bumpers are dangerous because of the risk of suffocation, entrapment, and strangulation. Plus, older babies may use the bumpers to stand on and climb out of the crib, creating a fall risk. Crib bumpers have been linked to at least 83 infant deaths in the past 30 years.

In addition to traditional padded bumpers, stores now sell mesh bumpers and vertical crib liners. But even these can get loose and become a strangulation risk. Babies can also get trapped between them and the crib mattress.

There is no evidence that crib bumpers—of any kind—prevent injury in young infants.

Cribs today are regulated by the CPSC and have updated safety standards. The slats are closer together to prevent your baby’s head from getting stuck. This means that bumpers are not only dangerous, but unnecessary. Maybe you’re concerned about your child’s leg getting stuck between crib slats. If so, use a wearable blanket or sleeping sack that’s the right size for your baby.

Why are these products still sold?

Unfortunately, the new regulations don’t take effect until mid-2022, meaning that inclined sleepers and positioners will still be available. As for crib bumpers, the CPSC plans to review federal safety standards for them later this year. We continue to urge the CPSC to ban all these dangerous infant sleep-related products.

A bill that would prohibit crib bumpers was introduced in Congress in 2021 too. Known as the Safe Cribs Act, this bill would make it illegal to sell, distribute, manufacture, or import crib bumpers. The bill’s sponsors are concerned that parents will keep buying these products, not realizing that they’re potentially hazardous.

Some stores, online retailers, cities, and states, have already stopped selling or have banned inclined sleepers and crib bumpers. Some companies have also issued voluntary recalls of these products.

Remember

Even in areas where these dangerous products are banned, they can still turn up at secondhand stores or garage sales. It’s important to check the CPSC website to see if products have been recalled before using them. Also, make sure anyone who watches your child knows about recalled and unsafe products.

It’s also important to keep in mind that your baby should only sleep in products that are designed to be safe sleep spaces, like cribs, bassinets, and portable play yards. Other products like swings, reclined seats, bouncers, and other sitting or positioning devices are not safe for sleep. If your baby falls asleep in one of these, move her to a safe sleep space right away.

If you have any questions about safe sleep products for your baby, talk with your pediatrician.

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Colic Relief Tips for Parents

From American Academy Pediatrics:

Does your infant have a regular fussy period each day when it seems you can do nothing to comfort her?

This is quite common, particularly between 6:00 p.m. and midnight—just when you, too, are feeling tired from the day’s trials and tribulations. These periods of crankiness may feel like torture, especially if you have other demanding children or work to do, but fortunately they don’t last long. The length of this fussing usually peaks at about three hours a day by six weeks and then declines to one or two hours a day by three to four months. As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there’s no reason for alarm.

If the crying does not stop, but intensifies and persists throughout the day or night, it may be caused by colic. About one-fifth of all babies develop colic, usually between the second and fourth weeks. They cry inconsolably, often screaming, extending or pulling up their legs, and passing gas. Their stomachs may be enlarged or distended with gas. The crying spells can occur around the clock, although they often become worse in the early evening.

What Causes Colic?

Unfortunately, there is no definite explanation for why this happens. Most often, colic means simply that the child is unusually sensitive to stimulation or cannot “self-console” or regulate his nervous system. (Also known as an immature nervous system.) As she matures, this inability to self-console—marked by constant crying—will improve. Generally this “colicky crying” will stop by three to four months, but it can last until six months of age. Sometimes, in breastfeeding babies, colic is a sign of sensitivity to a food in the mother’s diet. The discomfort is caused only rarely by sensitivity to milk protein in formula. Colicky behavior also may signal a medical problem, such as a hernia or some type of illness.

Although You Simply May Have to Wait It Out, Several Things Might Be Worth Trying:

  • First, of course, consult your pediatrician to make sure that the crying is not related to any serious medical condition that may require treatment.Then ask him which of the following would be most helpful.
  • If you’re nursing, you can try to eliminate milk products, caffeine, onions, cabbage, and any other potentially irritating foods from your own diet.
  • If you’re feeding formula to your baby, talk with your pediatrician about a protein hydrolysate formula. If food sensitivity is causing the discomfort, the colic should decrease within a few days of these changes.
  • Do not overfeed your baby, which could make her uncomfortable. In general, try to wait at least two to two and a half hours from the start of one feeding to the start of the next one.
  • Walk your baby in a baby carrier to soothe her. The motion and body contact will reassure her, even if her discomfort persists.
  • Rock her, run the vacuum in the next room, or place her where she can hear the clothes dryer, a fan or a white-noise machine. Steady rhythmic motion and a calming sound may help her fall asleep. However, be sure to never place your child on top of the washer/dryer.
  • Introduce a pacifier. While some breastfed babies will actively refuse it, it will provide instant relief for others.
  • Lay your baby tummy-down across your knees and gently rub her back. The pressure against her belly may help comfort her.
  • Swaddle her in a large, thin blanket so that she feels secure and warm. 

When you’re feeling tense and anxious, have a family member or a friend look after the baby—and get out of the house. Even an hour or two away will help you maintain a positive attitude. No matter how impatient or angry you become, a baby should never be shaken. Shaking an infant hard can cause blindness, brain damage, or even death. Let your own doctor know if you are depressed or are having trouble dealing with your emotions, as she can recommend ways to help.

Probiotics in Infant Formula

From American Academy Pediatrics:

Probiotics” (meaning “for life”) is a word you may see when shopping for infant formula and supplements. Some formulas are fortified with these probiotics, which are types of live bacteria. Doctors may also recommend probiotic drops or powders for breastfed infants. These are “good” or “friendly” bacteria already present at high levels in the digestive system of breastfed babies.

In formula-fed babies, probiotics in formulas promote a balance of bacteria in your baby’s intestines, and offset the growth of “unfriendly” organisms that could cause infections and inflammation.

Increasingly, parents can find probiotic supplements outside of formula, including for breastfed infants. Research on the benefits of probiotics is ongoing, with some pediatricians embracing their use for infants delivered by C-section or those whose mothers are given antibiotics during labor.

Possible health benefits of probiotics

The most common types of probiotics are strains of bifidobacteria and lactobacilli. Some research has shown these probiotics may prevent or treat disorders such as infectious diarrhea​ and atopic dermatitis (eczema) in children. Other possible health benefits are being studied as well, including the possibility of reduced risk of food-related allergies and asthma, prevention of urinary tract infections, and relief of symptoms of infant colic​.

More research is needed

With many of these health conditions, the evidence confirming any positive effects of probiotic use is limited and more research is needed. At this time, benefits appear to occur only as long as probiotics are being taken. Once your baby stops consuming probiotic-fortified formula, intestinal bacteria levels return to previous levels. This is different from in breastfed infants, where the bacteria in the gut resulting from breastfeeding​ are more resilient and set the stage for healthier outcomes. 

Remember

Before giving your child infant formula fortified with probiotics, discuss the issue with your pediatrician

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Tips for Coping with a New Baby During COVID-19

From American Academy Pediatrics:

All babies cry. Most babies cry a lot from two weeks to two months of age. Some cry more than others, and some cry longer than others. For many new parents, crying is one of the most stressful parts of coping with a newborn.

In some cases, extreme stress and a temporary lapse of emotional control in a caregiver can lead to actions that result in abusive head trauma. In fact, the most common trigger for abusive head trauma is simply a crying baby. As an American Academy of Pediatrics policy statement points out, actions that lead to abusive head trauma often happen when caretakers experience stress and get to the end of their rope.

However, there is a bright side: The key to preventing actions that lead to abusive head trauma is to understand how common feelings of frustration, isolation, and exhaustion are during the first few months of an infant’s life.

Helpful tips

Usually, new parents can seek out social supports and external help—but what happens when we are restricted in our movements and our contacts? What happens when grandparents can’t come over to help out, or when neighbors don’t stop by for a cup of coffee? What happens when families face job loss, childcare challenges, and more lingering fallout from the COVID-19 pandemic? Here are a few suggestions:

  • Try all the soothing tricks. Crying babies want to be soothed. You may need to try a few things, over and over, before they calm. Try holding them, feeding them, swaddling them, gently rocking them, singing to them. If these don’t work, put the baby down and take a break. Be sure your baby is in a safe sleep environment (on their back on a firm sleep surface with a tight-fitting sheet, away from soft blankets, toys, pillows, and other bedding materials). While some babies cry for a long time, many parents are surprised at how rapidly babies will cry themselves to sleep.
  • Pay attention to your own needs. The challenges of new mothers can certainly feel overwhelming sometimes. Rest as much as you can—try sleeping when the baby does. Find time for yourself when your partner or other caring adult watches the baby. Put on your headphones, give a friend or relative a call, have a cup of tea, or just relax.
  • Connect with others. Social distancing during the COVID-19 outbreak can be isolating. Try video chats or social media to stay in touch. If you’re a friend or relative on the receiving end of these calls, listen first before offering suggestions. Imagine you are with the young parent, they are crying on your shoulder, and you are offering reassurance without any words. Keeping this image in mind can help you provide the social support that all new parents need.
  • Use your “helpers.” Engage older siblings as much as you can by encouraging them to be your special helpers, so they can help out in developmentally appropriate ways.
  • Seek help. Depression is the most common mental illness in the United States. If you had a history of depression before your baby was born, you may be at higher risk for postpartum depression. Speak with your provider sooner rather than later to help foresee this potential condition. Many doctors, nurses, and mental health providers are now set up for telehealth visits and may be able to help you by video or phone.
  • Reach out. If you are a friend, relative, or neighbor to a family with a newborn, this is the time to reach out. Think about ways you can help. In addition to social support, can you buy diapers or other baby supplies? Can you drop off food or treats for the siblings or adults? Can you safely supervise older children outdoors? Maybe they could come along with you when you walk your dog!
  • Help a co-worker out. If you are a co-worker of a parent returning to work (especially during social distancing) after parental leave, be kind and supportive. If you see or hear the baby on the call, say Hi!
  • Find a forum. New mothers may find it helpful to discuss their experiences with other new mothers. In addition to seeking help from friends, relatives, neighbors, and medical professionals, look for discussion forums and communities of moms dedicated to sharing problems, stories, and tips with each other online (see the list of resources below).
  • Your pediatrician is here to help. Never hesitate to call for advice. Your pediatricians is an excellent resource for understanding your baby and your own needs, including those related to postpartum depression.
  • Resources. Here are a few key resources that may be helpful to you at home:

Simple Ways to Entertain & Boost Your Baby’s Development at Home

From American Academy Pediatrics:

During social distancing to slow the spread of COVID-19, you may be looking for new ways to entertain and play with your young child. Thankfully, all you need is loving attention and some basic household items.

Try these time-tested activities, suggested by age, and let the fun happen!

Newborn to 3 Months

Puppet Play. Make a hand puppet using a sock. Move it up and down and back and forth where your baby can see it, doing a silly dance and singing silly songs. You can even have the puppet give her kisses!

Footloose. Gently dance with your baby positioned over your shoulder. She will enjoy the movement and at the same time will learn to tolerate the slight pressure against her tummy.

Pat-a-Cake. Hold your baby’s hands and gently clap them together to play a game of pat-a-cake:

Pat-a-cake, pat-a-cake, baker’s man (Take baby’s hands through the motions)

Bake me a cake as fast as you can

Roll it (Roll her hands around each other) and pat it (Clap)

and mark it with a B (Guide her finger to write a B in the air)

And put it in the oven for baby and me (Kiss your baby!)


Can’t Smile Without You.
 Lie down on the floor,tummy down facing your baby. Try to get her to smile by sticking out your tongue, smiling at her, and making other funny faces. You may even hear your infant’s first giggle!

4 to 6 months

Little Piggy Game. Hold your baby’s foot up and wiggle each toe while teaching the classic “This Little Piggy” poem in an animated, singsong way. Don’t forget to give your infant a tickle at the end!

This little piggy went to market (big toe)

This little piggy stayed home (second toe)

This little piggy had roast beef (third toe)

This little piggy had none (fourth toe)

And this little piggy went wee wee wee all the way home (little toe)


Mustang Sally.
 Sit on the floor with your baby sitting on your raised knees. While holding on to her, slowly move your legs side to side and sing “Ride a Little Horsey.” When you say, “don’t fall down,” slide your feet forward!

Ride a little horsey

Down to town

Oops, little horsey

Don’t fall down!


Crocodile Rock. 
Hold your baby securely, tummy down on your chest. Rock your body from side to side and sing a song like “Row, Row, Row Your Boat.”

​Homemade Toy: Stacking Baby BlocksCollect different-sized clean milk cartons, small boxes and toilet paper rolls. Stuff each with newspaper or tissue paper. Fold the ends down to create blocks​and cylinders, then close them with masking or duct tape. Use a variety of fun colors of contact paper or duct tape to cover each block. ​



Free Fallin’. Stack up some blocks and encourage your baby to bat at and reach for them. Most infants absolutely love to see and hear the blocks tumble to the ground!

7 to 9 months

Fly Me to the Moon. Carefully lift your baby up over your head and back down while playing or singing a song like, “Fly me to the moon!” If your child seems fearful, move more slowly and talk in a calm, soothing voice.

See You Later, Alligator. With your baby seated in front of you, hide a rattle under a blanket or behind your back. Shake the rattle while hiding it and see what happens. If your baby loses interest once it’s hidden, reveal part of the rattle and ask, “Where’s the toy?”

If the Hat Fits. Sit just in front of baby, place a colorful hat on your head and say, “Look! The hat is on my head.” Then remove it and say, “Now the hat is off.” Next, put the hat on and off your infant’s head! Encourage your baby to reach for the hat for more play.

The Humpty Dance. Sit your infant on your lap, either sitting up or tummy down, and gently bounce your legs up and down. For more fun, do this while using a rocking chair!

10 to 12 months

Be-Bop Baby. Seat your baby upright on the floor, legs separated just enough to place a medium-sized ball between them. Show your baby how to roll the ball in your direction, then roll the ball back. Continue taking turns.

Marching On. While seated, stand your baby on your thighs. Hold your baby’s hips and slowly make stepping motions by moving your legs up and down, one side at a time. Sing your favorite song.

You Light Up My Life. Shine a flashlight on the wall. Once your baby sees the light, move it slowly from one side of the room to the other and up and down to encourage visual tracking.

Homemade Toy:​Baby Drums​Cover an oatmeal box or coffee can with colorful contact paper and use plastic baby spoons as drumsticks. (Or, simply give your child a saucepan and a short wooden spoon.) ​



Beat It. Show your baby different ways to tap a drum using the palms of your hands, your fingertips, or a baby spoon. See if your baby can imitate you.

12-24 months

The Big Squeeze. Take colorful kitchen sponges and cut them into fun sizes and shapes to fit into your child’s hand at bath time. Show your little one how to sink a sponge underwater, watch it fill up, then hold it up and squeeze the water out.

​Homemade Toy: Toddler TambourineTape two sturdy paper plates securely together halfway around using colorful duct tape. Fill the tambourine half-full of dry cereal, tape the paper plates together the rest of the way, and shake!​​



Mr. Tambourine Man. Show your little one how to shake and tap a tambourine to make noise. Add more ways, like tapping it against your hip, over your head, and in various directions.

Poking Fun. Show your baby how to press numbers on an old phone or peck on an old keyboard. Glue different textures of fabric at the bottom of each section of an egg carton or old ice tray. Let your baby feel the various textures.

Remember

You have the knowledge and tools to make play a fun and stimulating part of your baby’s daily routine. Keep it simple, be flexible, and do what works for you and your child.

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