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Melanie Cole (Host): Taking an infant to get their vaccinations can be just as hard for the parents watching. However, vaccines are a vital part of an infant health and sleep needs for those infants that are just coming home from the hospital, again, for parents is one of the more confusing and scary parts when you’re bringing home a new baby. My guest today is Dr. Beth Summers. She’s a pediatric hospitalist at Hendricks Regional Health. Welcome to the show, Dr. Summers. So, let’s start with vaccinations. What are the vaccinations that newborns get while still in the hospital?

Dr. Beth Summers (Guest): So, babies that are newly born only actually get one after birth and that is the Hepatitis B vaccine. It’s against the Hepatitis B virus which can cause severe liver disease in babies. Babies that contract the Hepatitis B virus during pregnancy or during the laboring process, 90% of infants who get the Hepatitis B virus can become chronically ill and there’s a one out of four chance of them actually dying from the liver disease. So, the vaccine, the Hepatitis B vaccine, is very important to give to your newborn right after birth to prevent further liver damage down the road. That’s preventable with this vaccine. Obstetricians, they test to see if mom has the virus while they’re pregnant and try to prevent the baby getting the virus if mom is Hepatitis B positive. If mom is Hepatitis B positive while she’s pregnant, we can give the vaccine right after birth and we can give another medicine to prevent the baby from getting liver disease. So, this is the only vaccine that babies get right after birth. A lot of times we give them either Too Sweet which is basically a sugar water on a pacifier when we’re doing the injection or for moms that are breastfeeding, you know, they can soothe their baby by breastfeeding right after an injection if they have any concerns with pain. Most babies do fine right after the vaccine and don’t need any pain medicine afterwards.

Melanie: So, mom is tested for Hepatitis B while she’s pregnant or when she’s in labor and delivery?

Dr. Summers: Yes, she’s tested while she’s pregnant and during the pregnancy, if she is found to be positive from this virus, then as a pediatrician, we are notified and we would give the vaccine right after the birth and then we would give something called immunoglobulin, which is basically a medicine that will prevent the virus from affecting the baby. It decreases the risk by a lot and prevents them from getting this liver disease and contracting this virus.

Melanie: And, Dr. Summers, what do you tell new parents when they say, “Oh, I’ve heard about the vaccination schedule for the first year. And this first week I have to come back,” and what do you tell them to soothe their fears about vaccinations and their importance?

Dr. Summers: Well, I can tell you I treat a lot of patients that aren’t vaccinated and things that are preventable like pneumonia, meningitis, different diarrheal diseases, things that we take very for granted, I see those patients in the hospital all the time. So, although it seems like children and babies are getting a lot of vaccines, they do save lives. This is a point, in fact, with the measles outbreak we had a couple of years ago in California. Those were unvaccinated patients that got measles and spread the disease. So, if we vaccinate, we can prevent these horrible diseases that you know they had back in the ‘20s or ‘30s when vaccines weren’t around. A lot of our grandparents and great grandparents remember children that died of either diphtheria or meningitis or pneumonia that was preventable were afflicted by polio. So, vaccines are very important and I think in our culture, in our society now, we tend to forget about how fortunate we are that we don’t see those diseases anymore but they are starting to come back because parents are refusing some vaccines. But, they do save lives and the patients that aren’t vaccinated; those are the most likely patients I see in the hospital. You know, for example, if a parent refuses the Rotavirus vaccine, which prevents a horrible viral diarrheal illness, all the patients that I have treated for severe dehydration and illness from a diarrheal illness have been unvaccinated. I haven’t treated one patient that had a diarrheal illness that was not vaccinated. So, vaccines really do save lives and it saves the cost for the parents in the long-term not only for their child’s health but you know hospital bills down the road.

Melanie: So, now, the new parents have had their children vaccinated for Hepatitis B and they’re on their way home from the hospital and those first few weeks are pretty confusing and a little bit scary for parents. Maybe a baby sleeps two hours a night, maybe not, and they cry and then they sleep, and parents just do not know if they can get a newborn on a sleep schedule, when they can get that newborn on a sleep schedule, and how to do that. So, speak about the importance of good quality sleep and getting your baby on a sleep schedule.

Dr. Summers: Yes, sure. No problem. So babies have a couple of things in their sleep cycle. They have different stages of sleep. The first stage of sleep is kind of when they first start to fall asleep. It’s called drowsiness. They’re kind of drowsy but you can still arouse them. The second stage of sleep is called REM sleep, which is you might see when the baby’s eyes are closed that their eyes appear to be moving underneath the eyelids and during this stage of sleep, the baby might have pauses in their breathing. Their breathing is often described as irregular and may appear to stop for five to ten seconds. This is called “normal periodic breathing of infancy”. The baby’s skin color should never change when they have these pauses of breaths. Usually they outgrow this periodic breathing of the newborn within the first six months of life. After that stage of sleep, they have a more light sleep where they have more regular breathing but they are less active. And then, the last stages of sleep are a very deep sleep and they may be difficult to arouse. Most babies’ average sleep per twenty-four hour period, including naps for the first four to twelve months of life is anywhere between twelve and sixteen hours of sleep. Newly born babies, they should be awoken, if they’re breastfeeding, every three hours because they need that nutrition to grow appropriately. Bottle-fed babies could go a little bit longer in between feedings. Usually, they should be woken up every four hours to get the nutrition necessary for their growth. Babies don’t start sleeping through the night until closer to four to six months of age. Young babies and newly-born babies need that nutrition throughout the night to sustain their growth and make sure they grow their brains in a healthy fashion. Babies that are closer to the sixth month period, they tend to then sleep through the night and they do not require that nighttime feeding.

Melanie: Okay. So, are there some signs that we should be aware of as to infant sleep issues if they’re not sleeping or if they’re extra fussy or are there any signs you want us to look for?

Dr. Summers: So, babies that excessively cry. Babies cry for several reasons. One, they just want to be held, they want to be fed, or they have a dirty diaper. Very rarely do they cry because they’re in pain. But, if you have a baby that’s constantly crying and you know you addressed their feeding and the holding and the wet-diapers issues, you know and then you got to think, “Is my baby having some kind of issue? Is she or he trying to tell me something that they might be in pain?” And, usually colic starts between one and three months of age. And if that’s a baby that’s crying more than two hours and for a two-hour period at a time several times a day and you seem to not settle them down, those are all reasons to call your pediatrician and see if your baby might have colic or something that we call reflux issue. That usually presents around that age time between one and two months of age.

Melanie: So, then, give us some of your best tips in helping your baby to fall asleep and in the last few minutes about reducing the risk for sudden infant death syndrome.

Dr. Summers: Okay. So, the best way to decrease sudden infant death syndrome, we know that sleeping on your back is the safest way to do that; and, also, on a firm mattress with just a sheet on it, nothing else in the crib, bassinet that you have; and the baby should sleep alone. You shouldn’t co-sleep with your baby. There are some new recommendations from the American Academy of Pediatrics that recommend keeping your baby in your bedroom up to the first year of life, possibly at least six months. We don’t know what the association is, but there’s a decreased risk of sudden infant death syndrome by as much as fifty percent if you have your baby’s bassinet or crib in your room in the same room, not in the same bed but in the same room. We don’t know why those babies do better than babies that are put in an isolated room. Also, parents that are uncomfortable with that idea, if it disturbs the parents’ sleep having the baby in the same room and they’re more comfortable watching the baby with a monitor on the room, that is okay. These are things that you can talk to your pediatrician about if you’re concerned. You know, what works best for your family unit is the most important. But, the new studies that just came out in the last couple of months says that if you keep your baby in the same room with you up to six months of life, they tend to decrease sudden infant death syndrome by fifty percent. Also, you know, talking to your baby, holding your baby, playing your baby some music, soothing music, that’s also helpful for getting them to sleep if you’re having trouble, or rocking them, getting them on a more steady schedule for their sleep.

Melanie: Thank you so much for being with us today. You’re listening to Health Talks with HRH Hendricks Regional Health. And, for more information, you can go to www.hendricks.org. That’s www.hendricks.org. This is Melanie Cole. Thanks so much for listening.