True story:  a few weeks ago, I was dealing with a box of things that had been in my parents’ home. In addition to numerous photos, letters and newspaper clippings—yes, my parents were savers of stuff—there is an unexpected: a piece of paper with newborn discharge instructions for…me!

I read the document with much amusement.  Some bits of advice were identical or much like what most pediatricians would say today:  call for fever, burp the baby.  However, many things were quite different, not minimal of which was the one choice for infant feeding:  evaporated milk combined with formula, along with an additive I couldn’t even find online (the closest match was really a brand of whiskey!).  Nothing about ready-to-feed formula nor about breastfeeding.

Although I had been certainly born several generation ago, and I obviously can’t speak about  personal experiences regarding my care at that time, this discovery got me thinking about some of the changes in infant care recommendations in the 3 decades which i have been practicing pediatrics.  Let’s explore some of these, starting with the one which probably gets the most press.

Immunizations Then and Now

When I began in practice in 1988, routine vaccinations covered eight diseases.  Influenza (flu) vaccine was only suitable for high-risk groups, and when a child was not high risk, she was done following the kindergarten set.  (The following vaccine was a booster 10 years later.)  A baby got three injections and three “polio drinks” to pay for a total of four diseases (the other three being tetanus, diphtheria, and pertussis (whooping cough)).

The total number of diseases against which we vaccinate has doubled, and much more are given earlier to safeguard our youngest patients.  Hepatitis B vaccine is now started in the newborn period, and influenza vaccine is now a universal recommendation at six months old.  Finally, vaccines against two bacteria—pneumococcus and hemophilus—have been put into the schedule.  While these names are not necessarily household words, those of us who cared for children prior to the addition of these vaccines remember treating very ill patients with blood infections and/or meningitis because of these germs—some with lasting complications.

Although some parents continue to be concerned concerning the quantity of immunizations, pediatricians understand the role they have in preventing illness, death and future disability in children.  And infants are particularly susceptible to vaccine-preventable infections, making delaying vaccines problematic.  Pediatric providers are worried that you know whenever possible about immunizations and also the diseases they prevent—the majority of us used for a while have seen nearly all the diseases at one time or another—plus they stand available to address any concerns you may have!

Newer Thoughts on Baby Meds

As the amount of immunizations to prevent disease has grown, the amount of over-the-counter medications to deal with minor illness has undergone an equally dramatic decrease.  Cold medicines containing a mild antihistamine and/or decongestant were formerly available right down to the age of one month.  Now, products containing these or similar medicines are no-nos at least through age 4, and there are others—codeine cough syrup, for example—which are no more used whatsoever within the pediatric population.

More recently, teething medicines meant to be utilized on the gums came under fire and are disappearing from store shelves.  And although not really within the same situation because they’re prescription medicines, there’s a tendency to recommend less often oral medicines for mild degrees of baby reflux.

Although the facts are different for each of these situations, the overall themes are the same:

• The problems that these medicines specified for to deal with are self-limited; they will disappear no matter treatment.
• The treatments (particularly for the cold medicines) have not been found to be effective.
• Overdoses have happened using the medicines, causing death in some cases.
• Some of these medicines might have long-term bad effects around the baby. Most recently, some reflux medicines have been considered to inhibit proper bone development.

For these reasons, providers now usually recommend using treatments for these illness that don’t involve medication.  Parents can treat a chilly by suctioning out mucus with a nose bulb, using a humidifier, and elevating the head of the bed.  Raising the head will also help mild reflux, as can feeding upright.  Rubbing the gums having a cold cloth and placing a pacifier or teething ring in the refrigerator may help relieve gum discomfort.

Everyone wants a happy baby with few or no bothersome symptoms.  Certainly seek advice from your provider regarding her recommended treatments, but realize that in many cases they won’t involve medications!

Technology:  Less Is Better

In my first office 30 years ago, we'd paper charts, a handwritten appointment book, and rotary-dial phones where just the last five numbers were needed to dial inside the community.  We’ve come a long way since then, and it could be unusual to find a pediatric office with no significant amount of technological helps.

As almost as much ast we like to make use of technology for patient care, the pediatric community has in recent years taken a significantly closer consider the results of those home devices on babies.  The main emphasis continues to be on examining screen time, particularly television.

Although it would appear that there have been Television programs aimed at young children so long as there’s been TV, concerns about infants and toddlers’ exposure have been brewing for some time.  In 1999, the American Academy of Pediatrics came out with its first statement about them, and recommended this age group be relatively screen-free.  The Academy has checked out this issue over and over, reaffirming these recommendations which have been bolstered by additional research.

Thus, despite the presence of so-called “educational” programming aimed at our youngest, contact with media—TV, internet, basically anything with an electronic screen—ought to be minimal.  The numerous reasons for this include:

• Too much TV is believed to limit the time for moms and dads and infants/toddlers to experience together.
• There seems to be an effect on future development of language and a focus span.
• Excessive television appears to negatively affect a child’s sleep quality.
• Too much screen time is linked to childhood obesity. While there don’t yet appear to be worthwhile studies on infant screen some time and later obesity, it’s just too easy to get into the habit of smoking of putting a child in front of a screen, that might continue to time of real risk.

So much is different within the last three decades.  Some topics, like the evolving tips about food allergies, are worth a separate article.  And it almost is obvious that healthcare itself is different immensely.  Probably the most positive changes is that a workplace visit with your provider is more likely to be a two-way dialogue about what’s best for your baby, rather than just a set of instructions from your provider.  Parents should know that there are choices within their baby’s care, but by all means, consider the risks and advantages of all decisions to be made for your young one!