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Tips of the Week for July, 2014

Burping, Hiccups, and Spitting Up


Young babies naturally fuss and get cranky when they swallow air during feedings. Although this occurs in both breastfed and bottle-fed infants, it’s seen more often with the bottle. When it happens, it may be helpful to stop the feeding rather than letting your infant fuss and nurse at the same time. This continued fussing will cause her to swallow even more air, which will only increase her discomfort and may make her spit up.

A much better strategy is to burp her frequently, even if she shows no discomfort. The pause and the change of position alone will slow her gulping and reduce the amount of air she takes in. If she’s bottle-feeding, burp her after every 2 to 3 ounces (60–90 ml). If she’s nursing, burp her when she switches breasts. Some breastfed babies don’t swallow very much air, and therefore they may not need to burp frequently.


Most babies hiccup from time to time. Usually this bothers parents more than the infant, but if hiccups occur during a feeding, change his position, try to get him to burp, or help him relax. Wait until the hiccups are gone to resume feeding. If they don’t disappear on their own in five to ten minutes, try to resume feeding for a few minutes. Doing this usually stops them. If your baby gets hiccups often, try to feed him when he’s calm and before he’s extremely hungry. This will usually reduce the likelihood of hiccups occurring during the feeding.

Spitting Up

Spitting up is another common occurrence during infancy. Sometimes spitting up means the baby has eaten more than her stomach can hold; sometimes she spits up while burping or drooling. Although it may be a bit messy, it’s usually no cause for concern. It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while she’s sleeping.

Some babies spit up more than others, but most are out of this phase by the time they are sitting. A few “heavy spitters” will continue until they start to walk or are weaned to a cup. Some may continue throughout their first year.

It is important to know the difference between normal spitting up and true vomiting. Unlike spitting up, which most babies don’t even seem to notice, vomiting is forceful and usually causes great distress and discomfort for your child. It generally occurs soon after a meal and produces a much greater volume than spitting up. If your baby vomits on a regular basis (one or more times a day) or if you notice blood or a bright green color in your baby’s vomit, consult your pediatrician.

While it is practically impossible to prevent all spitting up, the following steps will help you decrease the frequency of these episodes and the amount spit up.

  1. Make each feeding calm, quiet, and leisurely.
  2. Avoid interruptions, sudden noises, bright lights, and other distractions during feedings.
  3. Burp your bottle-fed baby at least every three to five minutes during feedings.
  4. Avoid feeding while your infant is lying down.
  5. Hold the baby in an upright position for 20 to 30 minutes after each feeding.
  6. Do not jostle or play vigorously with the baby immediately after feeding.
  7. Try to feed her before she gets frantically hungry.
  8. If bottle-feeding, make sure the hole in the nipple is neither too big (which lets the formula flow too fast) nor too small (which frustrates your baby and causes her to gulp air). If the hole is the proper size, a few drops should come out when you invert the bottle, and then stop.
  9. Elevate the head of the entire crib with blocks (don’t use a pillow) and put her to sleep on her back. This keeps her head higher than her stomach and prevents her from choking in case she spits up while sleeping.

Feeding your baby is one of the most important and, at times, confusing challenges you’ll face as a parent. The recommendations apply to infants in general. Please remember that your child is unique and may have special needs. If you have questions, ask your pediatrician to help you find the answers that apply specifically to you and your infant.

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Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Group B Streptococcal Infections

Group B streptococcus (GBS) is bacteria that can cause serious illness, particularly in newborns. It is responsible for many cases of meningitis, an inflammation of the membranes surrounding the brain and spinal cord, in infants, as well as some cases of blood infections (sepsis) and pneumonia. These infections often occur very soon after birth. Infections that take place in the first week of life are called early onset disease. These babies typically contract GBS from their mothers before or during birth. Premature newborns are more likely to develop GBS infections than full-term infants. Infections that occur a bit later, after a week of age and through the first 3 months of life, are called late onset disease. In late onset disease, bacteria can be contracted from the mother, other children, family members, and other caregivers.

Signs and Symptoms:

A baby infected with GBS may have symptoms such as: 

  • Fever
  • Feeding difficulties
  • Irritability
  • Lethargy

Most pregnant women who are carriers of GBS will not have symptoms. Sometimes, however, these women may have urinary tract or blood infections while pregnant.

When to Call Your Pediatrician:

If your newborn has any of these symptoms, contact your pediatrician at once.

How is the Diagnosis Made:

If your doctor thinks that your baby could have a GBS infection, the pediatrician will take a culture from the infant’s blood or spinal fluid and send it to the laboratory for testing and diagnosis.


Newborns with GBS infections should be treated with intravenous antibacterials such as ampicillin, gentamicin, penicillin, or another antibiotic such as a cephalosporin.


Early onset GBS infections in newborns can often be prevented if infected pregnant women take intravenous (never by mouth) antibacterials when they are giving birth, typically when labor begins. For this reason, the Centers for Disease Control and Prevention recommends that pregnant women be tested for GBS organisms in the vagina and rectum late in their pregnancy (during the 35th to 37th week). Unfortunately, treating the mother does not prevent late onset infections. Click here to learn more about how to protect your newborn from Group B Strep!​

There are currently no vaccines against GBS infections, although several are being studied.


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Immunizations Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


ADHD and Substance Abuse: The Link Parents Need to Know

Children and teens with attention deficit/hyperactivity disorder (ADHD) are more likely ​than other kids to smoke, drink, or use drugs. They are also at a greater risk for developing a substance use disorder.

However, just because a child has ADHD does not guarantee he or she will have alcohol or drug issues as a teen. The key for parents is to be aware of the link between the two, step-up prevention efforts at home, and seek professional help if a drug problem is suspected.

Why Are People With ADHD More Likely to Abuse Drugs and Alcohol?

There are several theories as to why ADHD increases the risk for substance use:

  • Impulsivity, poor judgment and school troubles that can go along with ADHD may increase the risk for initiating substance use.
  • There could be a genetic link between ADHD and the vulnerability for developing a substance use disorder.
  • Individuals with ADHD may try to use psychoactive drugs to self-medicate. 

Early Treatment of ADHD May Decrease the Risk of Substance Abuse

The timing of treatment matters. Children treated at a younger age for ADHD may be less likely to develop substance use disorders compared to those who begin treatment later. Treating mental health disorders that often co-exist with ADHD, such as anxiety and depression, is also important.  

Are Stimulant Drugs for ADHD Addictive?

Stimulant mediations are considered "first line" treatment for ADHD. No study has ever found that stimulant treatment increases rates of substance use disorders, however stimulant medications can be misused, abused, or given to others. Close monitoring is recommended to prevent misuse.   

Some types of ADHD medication are more likely to be misused compared to others. For example, short acting stimulant medications are abused more often than longer acting or non-stimulant medications. Talk to your child's doctor for more information about the risks and benefits of different types of medication used to treat ADHD.

Does Your Teen Have ADHD, a Drug Problem, or Both?

Alcohol and drug use can cause symptoms that are similar to ADHD, including:

  • Attention problems
  • Difficulty completing tasks
  • Disorganization
  • Trouble sleeping
  • Poor appetite
  • Reluctance to socialize with others
  • Loss of interest in school

Discuss any new symptoms or a sudden change in ADHD symptoms during adolescence with your child's doctor.

What Parents Can Do:

  • Pay close attention to any change in behavior, even if you think it could be attributed to your child's ADHD.
  • Communicate with your teen about safe and acceptable behavior.
  • Pay attention to your child's friends. If your child is hanging out with someone who is into drugs, it is very highly likely that your child may be exposed to drugs as well.
  • Talk with your child about the importance of using all medications, including stimulants, exactly as prescribed. Discuss side effects and other concerns with your child's doctor.
  • Sharing, selling, or distributing prescription stimulants is always illegal and is dangerous. Keep a close eye on your teens' ADHD medication, as prescription drug abuse among teens is on the rise. Make sure your child understands that he should never give his medication to anyone.
  • Do not keep the medication in a public place such as in the bathroom or the kitchen or anywhere else people can see it. Make sure it's locked up or put away and monitored. Teach your kids to be responsible for their medication, too. Help her learn to manage her ADHD and to own her condition, and be aware that she is at higher risk for certain problems.

Additional Information:

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AAP Committee on Substance Abuse (Copyright © American Academy of Pediatrics 2014)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Stay Safe this 4th of July

Some city and local fireworks displays conducted by professionals are being eliminated or cut back this year due to economic or weather conditions. The American Academy of Pediatrics (AAP) continues to urge families NOT to buy fireworks for their own or their children's use.

Each July 4th, thousands of people, most often children and teens, are injured while using consumer fireworks. Despite the dangers of fireworks, few people understand the associated risks -- devastating burns, other injuries, fires and even death. The AAP is part of the Alliance to Stop Consumer Fireworks, a group of health and safety organizations that urges the public to avoid the use of consumer fireworks and to only enjoy displays of fireworks conducted by trained professionals.

Fireworks Safety Tips for Families

  • Fireworks can result in severe burns​, scars and disfigurement that can last a lifetime.
  • Fireworks that are often thought to be safe, such as sparklers, can reach temperatures above 1000 degrees Fahrenheit, and can burn users and bystanders.
  • Families should attend community fireworks displays run by professionals rather than using fireworks at home.
  • The AAP recommends prohibiting public sale of all fireworks, including those by mail or the Internet.​​

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