If you are planning to breastfeed, the first few weeks of your baby’s life can be the most challenging.

Even if this is your first child, you’ve probably heard stories from other moms discussing the trials, tribulations and triumphs of breastfeeding. At Carolina Kids Pediatrics in Raleigh, NC, our pediatricians and our lactation consultant are here for you every step of the way to make breastfeeding more successful for you and your baby.

Latching Takes Time 

The chances of a successful latch increase if you are able to attempt nursing in the first hour or so after a baby is born. Babies tend to be alert and readier to breastfeed during this first hour – afterward, they (and their exhausted parents) often fall asleep for the better part of the next 8-12 hours. Although it’s still important to wake babies to breastfeed during this time, it tends to be more challenging than during that first hour.

Remember that your milk does not come in for about 3 to 4 days after your baby is born – so when they are breastfeeding, they are getting only small amounts of colostrum (early milk) for those first few days. 

During this time, it’s less important how much a baby gets, and more important that they develop a deep latch – with the baby’s mouth wide open, their lips flanged apart, and the nipple in the back of their mouth – not between their gums. Support your baby’s head close to the breast – I often tell new moms that if you aren’t worried that the breast will suffocate your baby (no worries, it won’t!),  then your baby probably is not close enough to your breast. If they back up, they will slip off and bite down on your nipple with their gums. Not only is this painful, it’s just not an effective way for your baby to express milk. 

Breastfeeding Happens Around the Clock 

Babies should be breastfeeding about every 2 to 2 ½ hours – or more often if they are asking for it – for the first few weeks. That time is measured from the beginning of one feeding to the beginning of the next – so, unfortunately, your break between feedings is usually even shorter than this. 

At first, they may only nurse for 5 or 10 minutes. That’s fine on the first day, but your baby should start to feed longer on the second and third day. Eventually, they may latch for 20-30 minutes on the first side, and a few minutes on the second. Once your milk comes in, your breast should soften with the feeding – and it’s always a good idea to empty the first side before switching. The last part of the milk feeding (the hindmilk) is higher in fat and calories, so it’s important to empty the first breast before offering a baby the second side. 

Babies can lose up to 7 to 10% of their birth weight before your milk comes in. Once your milk comes in, your baby should gain close to an ounce a day. They should also be more content after nursing; their stools should change from dark to light yellow and loose - sometimes 8 to 12 stools a day or more (you’ll never look at mustard the same way again!). 

Remember that at Carolina Kids we have a lactation consultant, Jerrianne Webb, working in our office. She is happy to meet with patients for in-depth lactation consults – or just answer your questions by phone.  If you are having trouble breastfeeding at any point don’t hesitate to talk to our pediatricians or our lactation consultant at Carolina Kids in Raleigh. Remember, successful breastfeeding takes all kinds of support - roadblocks can and do happen but we are here to help.

If you are looking for resources online, check out www.kellymom.com. You’ll find a wide range of information on breastfeeding, from the basics to more unique topics (like how to get through surgery or jury duty while breast feeding). 

Do you have questions about breastfeeding? Whatever you need, Carolina Kids Pediatrics in Raleigh, NC, is here to help. Call us today at (919) 881-9009 to schedule an appointment or to address your breastfeeding concerns with us.

Have your kids struggled with asthma symptoms? Do you wonder if your child’s respiratory symptoms are reasons to be concerned about chronic asthma?

Asthma is one of the most common chronic conditions of childhood – according to the American Lung Association, there are over 6 million kids affected in the U.S. 

How can you recognize if your child has asthma? Symptoms can include:

• Frequent dry cough, particularly at night
• Cough that seems chronic, and is not limited to times when your child has a cold or during a peak allergy season
• Shortness of breath
• A wheezing sound when exhaling
• Cough or wheezing with exercise 
• Chest tightness

Kids with asthma are more likely to have a history of other allergic conditions, including eczema, food allergies or allergic runny nose or eyes (allergic rhinoconjunctivitis), or to have a family history of allergic conditions. 

Asthma causes air passages to be extra sensitive to certain triggers, including infections, smoke, pollens, animals, and dust. This leads to airway muscle spasm, airway swelling, and decreased lung function. In young kids, asthma is usually triggered by colds and respiratory infections. In older kids, it is commonly triggered by environmental allergies or exercise also.

What are the most important steps your Raleigh, NC, pediatrician can take to help you control your child’s asthma?

First, it’s important to know the severity of your child’s asthma. Is your child’s asthma under good control? One way to answer this question is with the rule of 2’s: If your child has an asthma cough or asthma-related wheezing requiring a fast-acting inhaler or nebulizer more than TWICE A WEEK during the daytime, more than TWICE A MONTH at night time, or if your child has needed oral prednisone more than TWICE A YEAR for a significant asthma flare, then your child’s asthma may be under poor control.

If your child has signs of poor asthma control, we will likely treat your child with a daily controller medication, given by inhaler or nebulizer. Many kids don’t understand why they need to take a daily medication even if they have no symptoms. The reason is simple – their lung function will improve if chronic airway inflammation is controlled. That means they will feel better, sleep better, have better exercise tolerance, and possibly improve their chances of outgrowing asthma completely. Ask your child why they brush their teeth daily even if they do not have a tooth ache. Same idea! Many parents worry that controller medications are usually inhaled steroids. No worries – inhaled steroids are NOT absorbed into your child’s body to any meaningful extent, and will not cause steroid side effects. In fact, your child would have to use an inhaled steroid daily for 5 years do get as much steroid into their body as they would from a couple of days of prednisone.

In kids who are 6 years or older, our pediatricians will also use spirometry (lung function testing) in the office to make sure their asthma is under good control. Your pediatrician may also do allergy testing in our office to clarify potential triggers of your child’s asthma.

If your child takes a daily controller medication for asthma, your pediatrician will also assign our asthma care coordinator to help track your child’s asthma. Michaela Frost is our current asthma care coordinator – she may reach out to you by phone or through the patient portal for several reasons, including:

(1)  To make sure you have an updated written asthma care plan.
(2)  Facilitate an asthma follow up visit (we recommend visits every 3-4 months for all kids with persistent asthma requiring controller medications).
(3)  Check in with you if your child has not received regular refills on their asthma controller medication.
(4)  Check in with you after any unscheduled asthma-related ER visits or hospitalizations.
(5)  Check in with you if your child seems to be requiring albuterol for quick relief more frequently than would be needed during periods of good asthma control.
(6)  Help you with lab follow up, insurance related issues with medication coverage, school medication authorization forms and school asthma plans.

At Carolina Kids Pediatrics, we believe that, in most cases, asthma is a disease that can and should be managed comprehensively by your primary care pediatrician – and that your Raleigh, NC, pediatrician needs to have all the tools and resources to manage your child’s asthma.

Our pediatricians at Carolina Kids Pediatrics in Raleigh, NC always want to be available to you to help provide long-term solutions for managing your child’s asthma.

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC

Is that sports form due again?


Every year, schools and athletic organizations require that you see a Raleigh, NC, pediatrician to complete a sports physical. So, what are the most common sports-related problems we see at Carolina Kids Pediatrics? For many of the conditions listed below, check out my favorite pediatric orthopedic website, www.orthoseek.com, for more information on how to recognize and recover from sports injuries.

(1) Ankle sprains: Ankle sprains are common, and often cause swelling and pain on the outer portion of the ankle. Many can be treated with a simple splint, maybe crutches for a week or so, ice for a day or two, rest, and ibuprofen.  Often a strengthening program is a good idea before a gradual return to sports (for example, tracing the alphabet in the air several times with your toes, using elastic bands with resistance to strengthen ankle muscles, etc.) Growth plate fractures can look like sprains, so if there is pain over bone or your child is limping a lot, please come and see us.
 
(2) Patellofemoral pain: This is typically considered an overuse injury and referred to as “patellofemoral syndrome.” Pain in the front of the knee is due to pressure overload on the kneecap or patella.  In young athletes, this is often due to different degrees of muscle imbalance and high activity levels. It’s important to strengthen, stretch and condition the quadriceps muscle in the thigh if this occurs, in order to stabilize the kneecap. Bicycling and other low-impact activities can help – check out the Orthoseek website above (look under “chondromalacia patellae” under the topics listed) to learn more.

(3) Osgood-Schlatter disease: Osgood-Schlatter disease is an injury at the growth place at the top of the tibia (the bump in your knee under your kneecap). The traction comes from strong and relatively tight muscles (that develop during puberty) and high activity levels. Pain and sometimes swelling can be felt directly over a bump at the bottom of the knee. Treatment includes rest, stretching, ice, ibuprofen, and possibly an over-the-counter knee strap. Although this condition can be painful, it seldom causes serious injury. 

(4) Little League elbow & shoulder: This is why growing kids have “pitch count” limits in baseball! These conditions cause pain at the growth plates either on the inside of the elbow or the shoulder. It’s important not to ignore elbow (or shoulder) pain in growing baseball or softball players. If these growth plates are injured significantly, they can require surgery to repair. Early Little League elbow and shoulder injuries often go away with rest, stretching and attention to proper throwing form.

(5) ACL tears: Unfortunately, this injury occurs far too often in young athletes. The anterior cruciate ligament (ACL) is a stabilizing ligament of the knee that is torn during an uncontrolled twisting motion. It almost always requires surgery in young people.  While there is a high rate of return to sports after this injury, it is safest to wait at least 7-9 months before considering a return to play.
 
(6) Hand or wrist (fractures/sprains/tendonitis): Fractures of the wrist usually occur with a fall on the outstretched hand. If swelling at the wrist and pain with movement occur, there is likely a sprain or fracture. An x-ray is typically needed to tell whether the wrist is broken. Many milder wrist fractures can be treated with a cast or splint for several weeks.
 
(7) Concussion: Concussion usually occurs from a direct blow or rapid turning of the head. Common symptoms and signs include headache, dizziness, nausea, or slowed thinking. The main treatment for a concussion is rest, which means no sports, plenty of sleep and brain rest, including minimal use of electronics and school work. Young athletes may be more susceptible to concussions and may require a longer period of rest for their brains to return to normal function. According to the Gfeller-Waller concussion law, you will need to see a medical provider, such as a Raleigh, NC, children’s doctor at Carolina Kids Pediatrics, or (in more severe cases) a neurologist or sports medicine physician, to complete a return-to-learn and return-to-play plan. Gradual increase in mental and physical activity as symptoms subside is recommended.
 
(8) Dehydration: Most athletes who become dehydrated are simply not drinking enough. A cup for every 15-20 minutes of activity is a good rule of thumb. Other factors that can lead to dehydration include exercising in the heat, drinking too much caffeine or having a viral illness. Extreme thirst, headache, nausea, abdominal pain and muscle cramping are common signs of dehydration. If an athlete suffers from dehydration, they should stop exercising and drink plenty of fluids. Young athletes may be more prone to dehydration because their thirst drive is not as well developed.
 
(9) Shin splints: Pain in the front of the shins with running can indicate an overuse injury, excess pressure in the tissues in the front of the leg, or sometimes a stress fracture of the tibia (shin). Rest, ice, compression sleeves, and elevation are often enough to treat shin splints, but if pain persists, if pain is severe, or if it is localized to one area, ruling out a stress fracture is a good idea. 
 
(10) Heart problems: Although rare in children and teenagers, some of the most serious sports-related health problems are heart-related. If your child every faints during exercise, or experiences significant chest pain, dizziness, or palpitations (sensations of an abnormally rapid heartbeat) with exercise, it’s important to come in to Carolina Kids Pediatrics to evaluate this further with an exam, and sometimes with an EKG or further cardiology evaluation. These can be warning signs of an underlying cardiac problem.

Remember that the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina are here seven days a week to help address any sports-related injuries or problems your child experiences.

How Your Pediatricians in Raleigh, NC, Can Help You 


At Carolina Kids Pediatrics, we do what we can to support families as they navigate all the challenges that come with infant feeding – breast, bottle, or both. The American Academy of Pediatrics policy on breastfeeding recommends:

“Exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” 

We fully support this recommendation, but we also recognize that for many families, it isn’t that easy. There are many challenges to successful breastfeeding, including difficulties with infant latching, flat/inverted nipples, infant tongue tie, breast infections, low milk supply, engorgement, and many other competing demands on a new mom.

Fortunately, it's not a path you have to navigate alone — your pediatricians and our lactation consultant here at Carolina Kids Pediatrics in Raleigh, NC are here to support you every step of the way. We recognize that while breastmilk provides ideal nutrition for babies, breastfeeding is not right for all families – and we are here to help your baby and your family thrive, whether you decide to breastfeed or formula fee. Our lactation consultant, Jerrianne Webb, is in our office weekly to provide extended lactation consultation appointments for families, and she is available to provide free telephone support at other times also.

For most families, I see three phases of learning to breastfeed which I call “learning to latch”, “learning to eat”, and “learning the routine.”

Learning to latch: Newborns are designed to require very little milk – breast or formula – in the first few days of life. In the first 24 hours of life, the focus should usually be on proper latch at the breast, not on how much milk a baby is getting. Your baby’s lips should be flanged wide apart, and the nipple of the breast should be in the back of their mouth, not between their lips. If it hurts or pinches through the feeding, the latch is probably wrong and needs to be corrected. Gently open your baby’s mouth wide and support their head in very close to the breast to achieve a proper latch. During this time, a brief 5 minute feed with a good latch is better than a 20 minute feed with a poor latch. Putting your baby to breast as early as possible after delivery, at least 10-12 times daily, and correcting a narrow, biting latch whenever possible can help increase your chance of success.

Learning to eat: Your milk comes in three or four days after delivery. Now, your breast feels full before the feeding, and hopefully softens after the feeding. Your baby will eat 15-30 minutes per side instead of the brief feedings of the first few days. If your baby has learned how to latch well in the first few days, she should be more content after the feeding, continue to eat every 2-3 hours on average, and start to have more frequent wet diapers and lighter yellow or brown stools. She should stop losing weight and start to gain 1/2 to 1 ounce daily.

Learning the routine: As your baby grows, you may choose to start introducing bottles of pumped breastmilk to get some breaks in your day and to allow family members to feed your baby. Ideally, your baby has learned to latch and nurse well first. A slow-flow bottle, like an Avent bottle, might be less confusing for your breastfeeding baby. Brief pumping after nursing several times daily will provide you the milk you need to supplement. You can freeze breastmilk for months, then thaw it in warm water – don’t microwave breastmilk to warm it. 

The list of advantages from breastfeeding for your baby may include reduction in  the risks of:

1. Infectious diseases such as ear infections, gastroenteritis, and pneumonia
2. Eczema and asthma
3. Obesity
4. Diabetes
5. Sudden infant death syndrome
6. Overall infant mortality
 
Mothers who breastfeed their infants also receive health benefits, significantly reducing their own risk of developing:

1. Type 2 diabetes
2. High blood pressure
3. Ovarian cancer
4. Breast cancer
 
Questions? Give Us a Call

To learn more, call your pediatricians or lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, at (919) 881-9009, or send us a message through the patient portal!

It seems to me that managing physical illness often represents the easy part of being a pediatrician. The real challenges we often face are in the domain of child development, behavioral health, and mental health.

Although there are plenty of excellent child psychologists and psychiatrists in our area, we believe that being a pediatrician in Raleigh, North Carolina means being available to address many childhood behavioral and developmental challenges in our office. In order to facilitate this, we provide extended visits for developmental and behavioral consultations to help you and your family.

During an extended visit and consultation appointment for developmental and behavioral issues, your pediatrician may address a number of concerns. Common challenges we address may include:

• Infancy: Common concerns that in infancy include development of normal gross motor skills, including rolling, sitting, crawling, and walking, as well as challenges involving feeding, including breastfeeding and transitioning to solid foods. We conduct an evaluation at every well visit and perform standardized developmental screening through the Ages & Stages (ASQ) measurement tools in our office. Through these evaluations, we can help you evaluate if your baby’s development is truly behind. If it is, we can gauge how much additional evaluation and intervention is needed. For example, delays in gross motor development may require simply home intervention (for example, a neck stretching program for a baby with mild head flattening which we can teach you in our office). More significant delays may require intervention by a trained therapist. Some of these therapy services can be obtained through private referral. However, if developmental needs are likely to require more in-depth intervention over time, we often refer to the Children’s Developmental Services Agency. This is an arm of the school system which provides a free developmental assessment for kids from birth to age 3 with developmental delays. The CDSA can provide physical therapy, developmental therapy, speech therapy, and occupational therapy if it is warranted. You can contact the CDSA by calling (919) 662-4600, extension 239, if you believe that your child needs an evaluation – or check out the early intervention website at https://beearly.nc.gov/index.php/contact/cdsa .

• Toddler years: Common developmental challenges include delays in communication skills, and sometimes concerns about autistic spectrum disorder, as well as increasing struggles with autonomy surrounding meal choices, potty training, aggression, and defiance. In addition to ASQ screening, we add specific, standardized screening for autism, as well as standardized vision screening in the second year of life. If you have concerns that your toddler has developmental delays that might be due to autism, please take the following steps: First, call us for an appointment. Second, please check out the website http://firstsigns.org – a great resource, with reliable information and screening tools. Third, consider contacting the Children’s Developmental Services Agency (contact information listed in last section) for a complete early learning evaluation through the school system.

• Preschool: The focus during the preschool years often involves early learning skills and school readiness. This can include a more in depth consideration of peer social interactions, fine motor skills and skills needed for early literacy. Your best community resource for evaluating these concerns include Project Enlightenment, a public service offered by the Wake County School system which serves preschool age children and their families. Services include daycare and preschool behavioral consultation, developmental screening, parent behavioral workshops, and individual parent behavioral counseling. Check out their website at https://www.wcpss.net/projectenlightenment . If a preschooler has delays that might affect school readiness and require classroom-based services, you can request an evaluation for these public preschool services through Wake County also – for more information, check out https://www.wcpss.net/Page/4310 .

• Elementary school: Changes in academic performance or behavioral concerns can raise questions about a possible learning disability or attention deficit hyperactivity disorder (ADHD) at this age. Review of school report cards, standardized testing assessments, as well as reports from psychoeducational specialists can be helpful in evaluating these questions. You can also complete standardized questionnaires including the Vanderbilt Teacher and Parent Diagnostic Rating scales – these can provide us with helpful information, and are available at https://www.brightfutures.org/mentalhealth/pdf/professionals/bridges/adhd.pdf . If your child has a medical condition that affects learning (including ADHD, depression, anxiety, etc.) or a learning disability, you have the right to request a Section 504 plan or an Individualized Education Plan (IEP) through your public school. These plans can provide access to specific modifications which might help your child, including behavior plans, extended time on tests or assignments, a modified homework schedule, etc. They can also provide access to special education services – which could be as limited as a once weekly “check-in” with a special education professional, or as extensive as separate classroom placement. When appropriate, we can advocate for you during this process by writing needed letters, providing needed documentation to your school, or making any additional needed referrals. Your best online resource for learning more about ADHD is the organization CHADD (https://chadd.org).

• Adolescence: Although kids can struggle with issues surrounding possible depression and anxiety disorders at younger ages, these challenges can become more prominent during adolescence. We include confidential questionnaires for teens at well visits – these ask age-appropriate questions on mood disorders, substance abuse, and sexuality, which often opens the door to determining if other interventions are needed. These interventions might include cognitive behavioral therapy (changing thought patterns that affect mood), family therapy, and sometimes medication management.

The pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina can provide developmental and behavioral consultations on these and other concerns.

These are in depth conversations and require time and follow up – which is why extended visits for developmental and behavioral consultations are so important. To find out more about how a pediatrician can help with your child’s development and behavior, contact the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina today by calling us at (919) 881-9009 or sending us a message about your concerns through the patient portal.

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC