A Child Grows has a monthly column by Dr. Hugh Gilgoff at Long Island College Hospital. I am thrilled to have his expertise on this blog. To read his previous articles, please check them out at the end of this post.

Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a westerntraining at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans. To see his listing information, check the blog here under “Recommended Pediatricians”.

Vaccines:  Efficacy and Safety

Why do we need vaccines anyway?
There are tons of germs out there, and unless we make our baby the “boy in the bubble” we are going to have exposure to a lot of dangerous bacteria.  Indeed, our natural immunity can fight off many viruses and even certain bacteria, but there are some very serious illnesses that we just can’t fight off without help.
When pediatricians are evaluating a seriously ill child with a high fever, we conduct tests – blood, urine and even spinal fluid exams.  After a few days, we get back our results, and we have clear statistics on the rates of the bacterial illnesses we see each year.  Luckily, many of these diseases are not very common – but they are still very real and pose a significant risk to a young child.  One of the benefits of a cleaner society has been fewer epidemics and fewer deaths attributable to infectious diseases.  But if we relax, and fail to protect our children, we will definitely see an increase in some horrible infections.
We need to take a look to our not so distant past to realize just how far we have come in preventing some of the most dreaded infectious diseases.  Back in the 1940’s and 50’s, people lined up around the block for their polio vaccines. Polio was one of the most dreaded childhood diseases of the 20Th century in the U.S.  Polio epidemics crippled thousands of people, mostly young children each year.  Most of us don’t remember how terrified parents were that polio would leave their children unable to walk or force them to spend the rest of their lives in an iron lung.  Since the polio vaccine became available, the disease has more or less disappeared from the US.  But it still is rampant in many parts of the world, and we have travelers come to New York all the time!  If our immunity as a society waned, surely there could be another outbreak here.
Then there is the HIB germ – which was so rampant in the 1980’s, but because of a successful vaccination program has plummeted in its incidence.  It was a leading cause of meningitis and pneumonia in children and thousands of deaths have been prevented.  The pneumococcus germ (a form of strep) remains one of the most common causes of meningitis and pneumonia (as well as ear infections).  Since the creation of the prevnar pneumococcus vaccine, the rates of children admitted to the hospital with this germ have gone down significantly.  This germ specifically affects younger children – so that once a child is over 2 years old, the risk goes down.  But the risk is highest among those 6 to 24 months old – thus the reason that delaying vaccines puts a baby at risk!
Measles is also a very serious disease.  Measles is a leading cause of death among young children even though a safe and cost-effective vaccine is available to prevent the disease. In 2007, there were 197,000 measles deaths globally – nearly 540 deaths every day or 22 deaths every hour. More than 95% of measles deaths occur in low-income countries with weak health infrastructure. Measles vaccination efforts have reaped major public health gains, resulting in a 74% drop in measles deaths between 2000 and 2007 worldwide – a drop of about 90% in the eastern Mediterranean and Africa regions.  If we fail to vaccinate against measles, the disease burden seen abroad will surely return to the U.S.

But why so many?
Surely, there are more vaccines now than before.  But the body’s immune system reacts to the antigens in each vaccine and that number has actually decreased.  Indeed, the smallpox vaccine was a strong vaccine – it had so many antigens, and there were many local skin reactions.  But it worked – and now smallpox is eliminated!  Nowadays, the vaccines are better targeted and therefore do not overwhelm a baby’s immune system.  We conduct specific studies to make sure we give small doses, and slowly boost the immune system with “booster shots”.
Gone are the days where doctors say medicines and vaccines are without any potential side effects, but when you weigh the risks and benefits, vaccines have significantly improved the well being of our children.

Why the scare?
There has been a media frenzy for almost 10 years now which has led to a real cynicism regarding vaccine safety, and specifically their relationship to autism.  This started in 1998 when Dr. Wakefield, a gastroenterologist from England published a study postulating a link between the MMR vaccine and autism.  The problem was his study was very flawed.  He used a self-selected group of patients – those already referred to him with problems (not a random placebo controlled double blinded study with neutral unbiased observers) and his numbers were very small – not enough to have the power needed to prove anything.
Nonetheless, when word got out that there was even a possibility of a link to autism, fear spread like wildfire.  Indeed, autism diagnosis continued and still continues to go up.  Moreover, the timing of the diagnosis of autism was often right around the failure to say the first words – around 12 or 13 months.  The MMR is given at 12 months, so the timing seemed to support the link as well.
Since 1998, there have been numerous large randomized clinical studies that have clearly shown that there is no link between MMR and autism.  Dr. Wakefield has actually retracted his results, and the Lancet journal that published the article has issued an apology for the flawed study.  The studies are pretty straight forward: take a large group (in Denmark over 250,000 patients) who did not get the MMR vaccine, and have neutral blinded experts compare the rates of autism.  It is clear that in kids who have NOT received the MMR vaccine, the rate of autism is the same.

Why is autism on the rise?
Nowadays, we are able to screen for and identify signs of autism much earlier than before.  Therefore, before a child reaches their first birthday, we can usually tell whether the child has developmental delays and any signs of autism.  Clearly, there has been an alarming increase in the incidence of autism.  A major factor for this is observer bias – the fact that we are all looking for, and therefore seeing more autism.  It was not too long ago, that children with autism were underdiagnosed – they were labeled as mentally retarded, or speech delayed, or just missed altogether.  Nowadays, everyone from teachers, to parents, to doctors are vigilant in their search for autism, or any pervasive developmental disorder (PDD) and this contributes to an increase in cases officially diagnosed.
There definitely is a genetic basis and researchers are locating a gene that predisposes someone to autism.  However, there may indeed be something in the environment that is causing more autism.  That may actually be something that mom was exposed to while pregnant, as the most common forms of autism are probably with a child since birth.  The case we all have heard of a child developing normally, and talking well, only to spontaneously regress is actually quite rare, and NOT your typical autistic child.  The usual presentation of autism includes the inability to form interactions, connections, or communication skills that are appropriate all along – and not a loss of skills that were already acquired.

What about thimerosal?
Thimerosal is a preservative for vaccines that was used for a long time.  It is broken down to a mercury compound.  The toxic effects of mercury have been known for a long time.  Indeed, the mad hatter in Alice in Wonderland, like many hatters of the old days, handled mercury in their trade and suffered the consequences.  But there is a big difference between methyl mercury (toxic, and can get into the central nervous system) and the thimerosal compound, which is ethyl mercury (less potent and can’t get into the nervous system).  Nevertheless, after a fear developed, the American Academy of Pediatrics demanded that all vaccines were made without this preservative, and since 2001 all vaccines (with the exception of some adult flu vaccines) are not preserved with any mercury component.  Nonetheless, in these 8 years autism cases continue to increase, so it was not the thimerosal.
The causes of, and potential cures for autism will take a large effort from scientists, politicians and activists, and pediatricians are 100% behind those efforts.  But it now seems clear that vaccines are not the root of the problem.

Splitting or altering the vaccine schedule:
Nowadays, people worry that there are too many vaccines, and the immune system will be overwhelmed.  This question has been thoroughly studied by scientists and that is how the present recommendations have been created.  Before a vaccine is added to the schedule, there are huge studies conducted where they measure the success of the immunity based on blood tests (titers) and any side effects.   The most common side effects are fever (less than 10%) and muscle aches or soreness.  The vast majority of babies and children have absolutely no reaction to any vaccines.
We have already determined that giving a vaccine to a child before they are 6 weeks old is NOT as effective – so we don’t recommend that!  But after 6-8 weeks, a child’s immune system can and does accept and incorporate the passive immunity afforded by the vaccines.  The vaccine schedule allows a child to develop enough immunity to have the best chance to fight off the germ by the time the child is most likely to see that germ.  Any delay in giving the vaccines is obviously increasing the chances that you will not be able to fight off that germ at that time.  Nonetheless, if a caretaker feels more comfortable splitting the first few rounds of vaccines into two – in other words getting some shots 6 different months (month 2-7) instead of  3 different months (2,4,6), the delay of one month is not a big risk to the child.  I think the child would rather get it all over with in three different days, rather than face six days of pain, but I insist on trying to make my parents feel comfortable.
Dr. Sears is a good pediatrician who promotes an alternative, delayed schedule.  He raises many good theoretical questions – like can an aluminum preservative cause harm, but he offers little answers, and I fear he just adds fuel to the fire.  I wish that he offered the schedule without making people pay to see it, and I wish he didn’t have car commercials or coupons for vitamins on his website.  There is a recent article in the Pediatrics journal about the harm some babies have encountered after delaying their shots and getting the illnesses that were preventable.  I don’t want that to happen to any of my patients.

Who can we trust?
I was raised by a midwife mom who created a doula company over 20 years ago, and a Dad who was one of the original consumer reporters – always looking out for the scam, or the company not telling the whole truth!  Indeed, I entered western medicine a bit skeptical, and I challenge a lot of what is taught. I agree that the pharmaceutical companies have a huge financial incentive, and I have observed first hand the shortcoming of the FDA.
But that is balanced by a window to a world that others just can’t see.  In my 13 years caring for children, I have seen meningitis take a baby’s life more than once, and I have seen hundreds of children suffer with pneumonia or blood infections.  I think that I have a balanced approach to medicine on the whole, and I am sure the benefits of vaccines clearly outweigh any theoretical risks.  I had to reexamine all of my feelings as I went through the vaccine schedule with my own daughter, and she received them all and did just fine.
Perhaps the best plan is to find a good pediatrician who you can trust.  Someone who was very very well trained, who is extremely intelligent and can analyze the scientific studies.  They must then also possess the bedside manner and compassion to work with a family that has real concerns.  It is our job to synthesize all of the information out there and present our unbiased opinion.  Of course, I believe that my informed parents have the ultimate decision making capacity when it comes to their children, and I don’t turn away any family, even if they refuse all vaccines.  But the question is how informed (even with the great internet) we can be when it’s not our area of specialty.  Indeed, I stand over the plummer when he fixes the sink, and I nod my head a lot when the mechanic fixes the car.  I even try to research the stock market or certain laws.  But I think that sometimes, even with our children’s health at stake, we have to be comfortable following the advice of unbiased experts.  I hope that I can be that person when it comes to infectious diseases, vaccines and the full array of perplexing pediatric issues.
More information for parents and caregivers issued by theabout vaccinations and autism, go to the following link: www.aap.org/healthtopics/Autism.cfm
www.cispimmunize.org/
– the governments center of disease control
www.vaccinateyourbaby.org – a nice site started by an unbiased mom.
– the general American Academy of Pediatrics website.

Look for other columns by Dr. Gilgoff:

Column one: fevers in all ages
Column two: breathing, rashes, spit-up, jaundice and fevers.
Column three: colic and nutrition

A Child Grows has a monthly column by Dr. Hugh Gilgoff at Long Island College Hospital. I am thrilled to have his expertise on this blog. To read his previous articles, please check them out at the end of this post.

Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a westerntraining at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans. To see his listing information, check the blog here under “Recommended Pediatricians”.

Welcome back! If you happened to miss my last blog entry, please check it out! I covered rashes, breathing, spit-up, jaundice and fevers. Today, I’ll go over some other hot topics in the first year of life –colic and nutrition.

Colic – What, Why, and How to Make it Better!

A wise old doctor once told me that if you want to feel like an expert, just read one book. But if you want to realize that we are all NOT experts – read them all! Colic is one of those areas where the theories are many and the cures few. It is not a simple entity, and it’s not merely gases. Colic is a scary stage or phase that a significant amount of babies (and in turn families!) go through.

Depending on how you define it, perhaps up to 20% of babies go through some degree of colic. Colic is perhaps a maturational phase of the intestines. Some babies are born without intestines fully ready to break down their nutrition into its constituents. Clearly it was easier when baby was inside you! She got her nutrition from your veins, and the gut was never asked to digest any nutrition – whether breastmilk or formula – into amino acids, carbohydrates and fats. Colicky babies look uncomfortable, and they twist, and turn and cry…loudly! Parents often come in to the pediatrician asking if something else is wrong, and indeed colic is a diagnosis of exclusion. We can’t miss other conditions, such as infection, milk allergy or more serious conditions when a baby is so irritable. But colicky babies are not irritable ALL the time – it just seems that way. They are often happy and can smile and eat well – only to have a colicky episode that can last for over and hour – and then return to normal.

Usually, the colicky phase starts between 2 and 6 weeks, and is over by 12 to 14 weeks. That doesn’t seem all that long, but it can seem forever when your baby is wailing for no apparent reason! We have tried many cures – from gripe water, to Humphries (very dangerous!), and nothing seems to work. Mylecon drops can help a little, and are safe, but I prefer to try non medical approaches. I find to have a very nice summary of why a baby might be colicky and how to alleviate their discomfort. The sushing and swaying is helpful for a colicky baby, as are dimming the lights and lowering your voices. Rubbing the intestines from right to left and bicycle kicks are also helpful. I don’t recommend changing a woman’s diet. This is a phase that many babies go through, and food allergy presents in different ways than colic. I have seen too many women eliminate milk, then beans, then citrus, spicy foods and gluten…only to get malnourished and cranky themselves! Then, when the colic passes naturally, we finally feel like we have found that magic offending food – but usually it would have passed anyway without depriving mom her favorite foods!

As if sleep deprivation is not enough, having a colicky baby can be very stressful. Try to hang in there as much as possible and do let your support (including your pediatrician) know if you are feeling overwhelmed. There are support groups specifically for colic here in Brooklyn as well.* This is not an easy issue to suffer through, but as long as it’s really colic – every baby gets through it and the baby will not suffer any long term consequences.

Nutrition – What to Feed Your Newborn.

There have been numerous well done articles supporting the vast benefits of breastfeeding. We have strong evidence that mom’s milk lowers the risk of all types of infections, decreases allergies, improves maternal-infant bonding and clearly saves a lot of time and money! What new moms may not anticipate is just how much anxiety one can feel in those first days! Breastfeeding is a wonderful natural amazing endeavor – but let’s remember that for new moms going through so many other issues including lack of sleep, hormonal changes and the biggest life changing event ever – it can be a stressful undertaking as well.

Since all babies will lose some weight in those first few days, and mom’s milk is the lower volume (but very nutritious) colostrum those first few days, there is a feeling like you are not giving your baby enough. But unless there is severe jaundice and dehydration, you can indeed get through this first week with 100% breast milk and babies will usually regain their birth weight after 7 to 10 days. Nipple soreness, engorgement, and latching issues should all be fair game to discuss with your pediatrician, but we also have compassionate and amazingly skilled lactation consultants that can really make a difference.

When breastfeeding, it is best to feed on demand. Eventually you will find that baby feeds about every 2.5 to 3 hours, but these first few weeks, all bets are off and you should avoid looking at the clock! You may have a baby that falls asleep every time they start feeding, or another baby that stays on the breast grazing for an hour straight! Just hang in there! Soon enough your baby will feed more efficiently and you’ll get a little break, but in the first month always err on the side of offering the breast. Stay well hydrated, eat healthy, and talk to your doctor about any medicines that you are taking, as most do indeed pass to the baby. Alcohol, and even caffeine can affect the baby, so discuss these issues with your doctor.

Do I need supplements?

Breast milk has a slightly lower level of iron than formula, but it is much better absorbed, and so you shouldn’t worry about anemia and don’t need supplemental iron. The one thing that breast milk can lack is sufficient Vitamin D. Although not common, enough breastfed babies have developed Rickets, or weak bowed bones. For this reason, we all recommend starting Vitamin D drops at around a month of age. You can get the right amount in a poly- or tri-visol supplement at any pharmacy. But if you only want to give Vitamin D, just drop by the local health food store and make sure it has 400 IU of Vitamin D. Yes – sun exposure helps, but we don’t recommend too much direct sun for a newborn, and I really don’t see any harm (except for the nasty taste!) in giving one milliliter of Vitamin D. I have seen Rickets, and it’s not a fun disease albeit not common either.

Many moms ask about water. There is just the right amount of water in breast milk and formula, so you never need “straight” water unless the baby gets constipated. We want every ounce of nutrition to help baby grow, and water has no calories. Indeed, there have been cases where the kidneys were overwhelmed and a baby got sick from too much water. And juices of course can wait until 6, or even better 9 months as they have a good deal of simple sugars, even when 100% natural.

I feel it’s necessary to point out that formula won’t harm your baby. Sometimes a new mom will confide in me that she feels too guilty here in Brooklyn to admit that she gives her baby formula! Indeed there is no way that a manufacturer will ever duplicate breast milk, but formula fed babies still grow up to be happy healthy people! There is indeed a possibility of nipple confusion if your baby gets too used to the flow of a bottle, as it takes less muscles and is faster. But once your baby has latched well, and is gaining weight, it is not harmful to introduce a pacifier at times, and a bottle (preferable of pumped breast milk, or if not, formula). Many Dads/partners are thrilled at the opportunity to feed the baby, and a flexible baby has its advantages! Indeed, there are many moms in my practice who had to change plans to return to work because their baby absolutely refused to take the bottle, despite all the tricks and twenty different bottles!

Look for other columns by Dr. Gilgoff:

Column one: fevers in all ages
Column two: breathing, rashes, spit-up, jaundice and fevers.

Stay tuned! Coming up in future columns: solids, behavior, siblings, and vaccines!

*Everyday Family Center at the Everyday Athlete has a colic support group.

136 Union street (between Hicks and Columbia.)

The Everyday Family is a new center within the Everyday Athlete Studio in Carroll Gardens that is facilitated by experienced Childbirth Educators, Doulas, Midwives, Nurses, and Lactation specialists and caters to the needs of new and expectant families. They have Childbirth Preparation Classes, Breastfeeding and Newborn Care classes, Breastfeeding Support Groups, Colic Support Groups, Prenatal Yoga, pre and postnatal training (with childcare!) and yoga, nutrition, massage, craniosacral therapy, and more.

A Child Grows has started something new.…..a monthly column by a Brooklyn pediatrician. I asked Dr. Hugh Gilgoff at LICH if he would be interested in being the
columnist. He happily agreed and I am thrilled to have his
expertise on this blog.

This is his second post. His first one was on Fever.

Dr. Gilgoff is a pediatrician relatively new to the Brooklyn
community.  He has a balanced approach to medicine, combining a western
training at top institutions with an alternative outlook shaped by a
mom who is both a midwife and creator of Mother Nurture Inc. – a Doula
company since 1987.  Dr. Gilgoff worked in Manhattan for 11 years, and
now practices with the LICH group on 185 Montague Street. Dr. Gilgoff
is available for free prenatal consults, second opinions, and is
accepts new patients with all types of insurance plans. To see his
listing information, check the blog here under “Recommended Pediatricians”.

Here, Dr. Gilgoff gives us a detailed summary of what to look for in the first few days after the birth of your new baby. He’ll cover breathing, rashes, spit-up, jaundice and fevers in Part I.  Part 2 will be forthcoming.

Before Baby Comes!
You and your pediatrician will usually know a great deal of information about your newborn’s health even before they emerge from the womb.  As a result of some cool technology and a medical system fearing lawsuits, we often check (read over-check) your baby’s health via sonograms, blood tests and a number of health screens on mom.  We check mom for Rubella, HIV, Hepatitis B, and Group B strep to name just a few.  As pediatricians, we also examine the actual birth, counting the hours of ruptured membranes, and seeing whether mom had a fever.  All this will affect how we view your newborns risk of infection and guide our management. While these first few days are filled with endless joy and utter amazement at the miracle of life, it’s our job to keep a keen eye out for danger.  While most of the issues will resolve with minimal intervention (our goal – as well as yours and your babies as well!), these little guys can get sick quickly – so we must review what to look for.

Breathing.
Is she breathing too fast?
Your baby’s respiratory rate is much faster than yours or mine.  We breathe at 16 times a minute and we never show any effort unless we are sick or exercising.  A baby’s normal breathing rate is about 50 times a minute, and to really make our lives difficult, it is normal for it to be abnormal!  In other words, your baby will often breathe a bit faster, and deeper, only to relax and then even hold their breath for a few seconds on end.  You should worry when there is an increased effort or work of breathing.   You should not see the ribs pulling in or the nose flaring, and if you can check the respiratory rate, it shouldn’t stay above 60 times a minute.

But what about the noises?
Many babies are born with upper airway congestion.  It’s not a cold they caught inside you – but rather a shift in the hormones such as progesterone.  And those noses are just so tiny – so any congestion will seem to make your little one suffer and make noises.  Short of some saline drops and bulb suction, there is not much you can, nor need to do.  Just look for the signs of distress, as mentioned above – but don’t stress the snoring!
Some babies also squeak a lot.  This is usually normal, and relates to “floppy cartilage” in the breathing tubes – also called laryngomalacia.   This will resolve as your baby gets older.

Spit up
About 80% of babies have some spit up, and officially this is a type of reflux.  The gastro-esophageal junction is just very loose, and their stomachs are quite small – so a little milk will often return to you as a present.  If your baby spits up often, try to keep them upright after a feed (I know – impossible at that 3am feed!).  Only when there is a failure to gain weight or significant symptoms (such as crying and arching) will treatment be considered.  What we don’t want to see is continuous projectile emesis – a sign of pyloric stenosis, or an upper airway obstruction.  This would mean an urgent trip to your doc.

Rashes
We could talk for days about rashes.  Most are normal, common and benign – although some harmless ones, such as erythema toxicum sound scary for sure.  We are always on the lookout for infectious rashes, such as staph or strep, and unfortunately these are definite emergencies.  So stay on the look out for pus or spreading redness.  But baby acne, cradle cap and atopic dermatitis are all easily managed with mild medicines, or tincture of time.

Jaundice
A wonderful midwife once asked me how I felt about jaundice. Of course, what she meant was how much of an interventionalist I was and how patient I was willing to be. The vast majority of jaundice is normal, or physiologic.  The immature liver and some normal low levels of red blood cell breakdown lead to an increase in bilirubin – and this yellowness of the skin is called Jaundice. While the lower levels of Jaundice (usually anything less than 20) are really harmless, the higher levels (definitely more than 25) can be damaging to the nervous system.  It’s the avoidance of this rare condition called kernicterus that lead to a lot of doctors recommending special lights and rarely the supplementation of formula to a breastfed baby.
The decision making actually involves some complex factors – such as gestational age, blood types of mom and baby, and the rate of rise coupled with the age of the baby down to the hour. As with most issues in your newborn’s health – finding that pediatrician who is an expert in newborn care AND can balance the small but real risk of pathology with the risks of intervention (the bili lights can affect the eyes and interfere with breastfeeding and bonding) is the key.

Fevers
As we mentioned in the last article – fever in an older child by itself is rarely an emergency.  Well that is NOT true with a newborn.  While it is true that most fevers are still caused by viruses that can be contained by the immune system, the risk of a bacteria is just too great.  Bacteria that are normal for a woman to harbor (such as E. Coli and Group B Strep) can be deadly for a baby.  In most scientific studies a dangerous fever is at or above 100.4 Fahrenheit, or 38.0 Celsius.  If your baby is less than 60-90 days old, this means an emergent trip to the ER and not a dose of Tylenol and call us in the morning.
How to avoid fevers?
As mellow as you once were, having a newborn gives you a license to be anal, neurotic (and sleep deprived, but that’s another story!).  The hygiene hypothesis debates the value of exposure to germs, to build our defenses.  That’s an interesting idea – but NOT for a newborn!  Everyone must wash their hands or just refrain from touching and kissing the baby, and that includes your doctor, your partner, and that random stranger on the street who will try to touch your baby!
You CAN go outside with your baby, but not to a one year olds birthday party, and not to the mall.  If mommy gets sick, what should you do?  Breastfeed often and love your baby.  It’s just not realistic to separate mom from baby.  But if your best friend’s two year old has a runny nose, it’s just not worth it to see them this week.  After the third month, your baby’s immune system is much stronger, and specifically able to localize an infection.  But these first two to three months are an intense mix of the most joyous, and nerve-wracking experiences.  Please remember, that your pediatrician is there for you during these times – and there is no such thing as a dumb or bad question.  We have 24 hour on call systems and walk in visits daily exactly for these reasons – to help care for you and your newborn.

Look out for Part II as Dr.Gilgoff explains colic, nutrition, and sleep.

(PHOTO: Willow and I at the Critical Care Unit at NY Presbyterian.  We were next to a bili machine so that is why the light is so blue).

Dr. Hugh Gilgoff is a seasoned pediatrician relatively new to the Brooklyn community.  He has a balanced approach to medicine, combining a rigorous western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987.
Dr. Gilgoff worked in Manhattan for 11 years, and now practices with the LICH group on 185 Montague Street.  He is an expert diagnostician, and is praised for going the extra mile for his patients in need.  Likewise, he is known for his patience, and never makes a family feel rushed or judged.
In a new monthly column, he’ll be presenting his balanced approach to issues such as newborn care, including rashes, reflux and respiratory illnesses.  He’ll discuss fever, its myriad of causes, and when to call the pediatrician.  And finally, he’ll weigh in on sleep, solids and discipline, in an attempt to answer all those questions that you just didn’t have enough time to ask your doc!

Dr. Gilgoff is available for free prenatal consults, second opinions, and is accepting new patients with all types of insurance plans.  We at A Child Grows in Brooklyn have heard numerous positive reports from our families and recommend him without hesitation.  Please call him at to set up an appointment.

In his first column, Dr. Gilgoff discusses fever, and what to look for when your child spikes a high temperature.

FEVER
Fever is a sign – not a disease in of itself.  It’s the body’s reaction to an insult – most often an infection – and some even believe it serves a good purpose.  Why then should we fear a fever – and dread a high fever at that?  Because, as a sign of an infection it could in some cases signal pending danger.

What causes fever?
Except for the rare cases (such as rheumatic diseases or certain cancers), fever indicates an infection.  Infections are usually viral or bacterial (yes, they could be fungal, parasitic, etc. – but let’s stick to the basics here!).  In general, most viruses will run their course and your child’s immune system will eventually deal with and eliminate the germ that caused the fever.  In most cases you’ll see other signs and symptoms that will help you localize where, and therefore what type of virus is causing the illness.

Is there a runny nose, cough, cold and fever?  This is usually an upper respiratory infection.  Is there vomiting and diarrhea, with mild abdominal pain?  In most cases, this signals acute gastroenteritis, or a stomach flu.

When to worry?
If the fever is a natural response of the body, when should we worry?  This often depends on the clinical symptoms and the age of the patient.

A newborn baby just can’t fight off a bacterial infection, and therefore any fever above 100.4, or 38 degrees Celsius is an emergency.  If your baby is less than two or three months, any fever is a serious and urgent concern – so don’t wait for the morning, and don’t just give Tylenol.

If your child complains of localized ear or throat, pain on urination, or right lower abdominal pain (don’t forget about that appendix), this could signal a bacterial infection.  Although we all try to limit our antibiotic use, these are times you may need help to fight off an infection, and you should see your pediatrician within 24 hours.   If there is any fast breathing, or if your child is lethargic, or just not looking right, it’s time to see the doc immediately.  And if there are any mental status changes, or vomiting with neck stiffness, it’s a definite trip to the emergency room, to rule out meningitis.

How do they look?
As your child grows, their immune system matures, and there are more clinical cues to help us assess how sick the child is.  That lack of clinical cues is another reason that we are forced to investigate fevers in newborns with more rigor – they can’t talk, play or even smile when they are first born – so how do we know if they are very sick!

Even an older child can look “out of it” with a high fever, so one of my biggest lessons is that regardless of the number of the fever, the approach is always the same: first bring the fever down and then reassess.   If after Tylenol or Motrin, your child is playful and happy and eating and drinking, it is a great sign, and most likely viral, and can wait a bit more without seeing your pediatrician.  If however, after the fever breaks, your child still just doesn’t look right – they are not interactive and happy – it’s time to get them evaluated.

You know best!
Always remember, that with fever and ALL situations, you know your child best – so if something just doesn’t feel right to you and you are concerned – come see your pediatrician.   That is what we are there for, and there should be a low threshold to making sure your child will be ok!