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Q&A: Erika Beard-Irvine, MD, IBCLC 

Pediatrics and Breastfeeding Medicine

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Q:
Here's your chance to get important questions answered by the experts! This issue Erika Beard-Irvine a doctor of Pediatrics and Breastfeeding Medicine gives advice on everything from formula to wetting the bed. Send us your questions for next issue to angela@bendnest.com


I will be going back to work in a couple weeks, and my three-month-old will be staying with my mother. I want to switch her to formula, but so far have had no luck with her taking a bottle. Are there certain types you would recommend and what is the best way to introduce the formula?

A: Any of the standard baby formulas are fine. The best way to introduce a bottle of formula or expressed breastmilk to a breastfed baby is to have someone other than Mom give baby the bottle. Babies who learn to breastfeed from Mom will often not want to take a bottle from her. It can be a good opportunity for you to give Baby and Grandma some practice time together. If Baby still will not take a bottle, try feeding when Baby is still somewhat asleep. And, finally, because some babies are picky about the feel of the nipple in their mouth, try different bottles and different nipples. If you are planning on continuing to breastfeed, a slow-flow nipple will help baby go back and forth between the bottle and the breast. If you are switching entirely to bottle feeds, any nipple should be fine.

Q: My 8-year-old son occasionally still wets the bed. He would like to have a sleep-over at his best friend's house, but he is worried about this issue. Any advice you have would be appreciated.


A:
Wetting the bed is more common than you think. Up to 15 percent of kids are not dry at night at age 5 and 3 percent are not dry at night by age 12. Your child is not alone, and there are things you can do to help. The lower part of the GI tract and the urinary tract are close together, so constipation can contribute to problems staying dry at night. I recommend parents treat for constipation, even if their child seems to be having a bowel movement every day. 

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You might be surprised how much this helps! You can give an over-the-counter medication, like MiraLAX, to increase dietary fiber. If you aren't sure, talk to your child's doctor.Staying dry at night is a developmental milestone that can run in families. If a parent or sibling wet the bed until they were a bit older, a child will likely wet the bed until around the same age.

In motivated kids, hypnosis can sometimes be helpful in achieving nighttime dryness sooner. For sleepovers, vacations, and other special events, disposable underpants with a plastic bag for discretely taking them home can work well. There are some medications available that may offer dry nights but will not address the underlying cause. Talk to your child's doctor if you are interested in trying medication (and give the medication a try ahead of time to know how your child will react).

Q: I keep hearing about vitamin D. How do I know if my kids need it, and how much do you recommend?

A: Vitamin D is a fat-soluble vitamin that regulates the amount of calcium and phosphorus in the blood and bones and is important for bone health. It's also important in immune function and the regulation of inflammation. It's found naturally in a few foods (like fatty fish, egg yolks, and beef liver), added to some foods (like milk and orange juice), and available as a supplement. It's also made in the body through a process that's triggered when sunlight strikes the skin.

Because of the shallow angle of the sun in northern latitudes, we receive less sunlight here in Oregon to be able to make as much vitamin D naturally. People with darker skin also make less vitamin D. Vitamin D is measured in international units or "IU." Infants who take in less than 1 quart per day of vitamin D-fortified formula should receive 400 IU of vitamin D per day. Kids over 12 months should get 400 IU of vitamin D per day, including vitamin D from any food sources. If your child drinks more than 1 quart of vitamin D-fortified milk per day, he or she is getting 400 IU already.

There is some evidence that people benefit from more vitamin D (600 IU per day for kids) between the months of October and April this far north. Higher doses of vitamin D supplements are not necessarily better and have been found in studies to be associated with some health issues. Evidence about vitamin D increasing lifespan or helping with a variety of other medical conditions has had mixed results and still is not completely clear at this point.

Send us your questions to:

angela@bendnest.com


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