We often get emails, phone calls, and “oh by the ways” from our patients and their families asking about common problems that affect many of us: stress, sleep problems, nutrition, exercise, constipation, difficulty in school, and so on. Here in our FAQ section, we’re compilng some of our favorite questions and answers in the hopes they will help other patients.
Please note, the advice here does not constitute medical diagnosis or treatment recommendations and is not a substitute for in-person care from a physician.
Our office handles a wide range of urgent care issues. Here is a guide to help you understand when a problem can be dealt with in our office and when you need to go to the emergency room. If you have a chronic condition, make sure to discuss in advance with your doctor when you should go to the emergency room.
Urgent care problems are conditions that require immediate care but are not life- or limb-threatening.
For example:
When you need to go to the Emergency Room:
Do not take a chance with anything life-threatening. The Emergency Room is the best place for these and other critical conditions, including:
Remember that you can always call us at (310) 315-8900 for a same-day appointment if you feel you have an urgent care health issue!
We also offer walk-in urgent care appointments 365 days a year:
Monday to Friday, 5:00 pm to 9:00 pm
Weekends and holidays 9:00 am to 5:00 pm
If you have a serious condition including stroke, heart attack, severe bleeding, head injury or other major trauma, don’t fight traffic, call 911! Important to note! Visits to the Emergency Room generally cost more than a visit to our clinic or another urgent care center.
Q: Hi Dr, K
I was wondering if you could give us some info on starting solids. My baby is 5 months old now so we are thinking of starting sometime between now and her next appointment. She’s scheduled to see you a week after she turns 6 months. She isn’t able to totally sit up on her own yet but seems to have good head control when supported and seems interested in food. I’ve been reading up on how to introduce solids but am a little unsure of what to do since she is in daycare. Should we start new foods on the weekends to make sure they are okay before sending any to daycare?Anyway, we aren’t in any rush but any advice would be appreciated.
A: Starting solids is always an exciting time, so congratulations! I think it’s fine to start on the weekends so you can monitor any reactions/responses. It’s not usually dangerous if she has a reaction, but you can give the food in the morning if that would make you feel better. As a rule, I generally say to go slow with introducing solids; we went too fast with my first son and he got constipated for 3 weeks! One new food each week is a good rule of thumb because it makes it easier to remember when to introduce a new food. Starting with fruits and vegetables and skipping rice cereal is fine. Common fruits to start with are apples and pears, and with vegetables, babies tend to do better with the “yellow” vegetables like squash, sweet potatoes and carrots before trying out “green” vegetables like green beans, peas and spinach. I like to put in a plug for making your own food — you can control the ingredients and it’s actually pretty easy to do with a blender. Nowadays you can get fancier baby-food making systems like the Beaba, but I don’t think it’s necessary. Frozen peas and corn are so easy to boil or steam and then blend and they taste so much better than the jarred stuff. Things like banana or avocado you can just feed them with a spoon if it’s ripe enough. Anyway, have fun and good luck! Let me know how it goes.
Q: Hi Dr. K,
My little one has been at daycare for a week now and has been having difficulty taking the bottle. I will nurse her right before we part at 7:30am. Then she will stay at daycare from about 8:30am-2pm but while she is there she only drinks around an ounce at a time or will refuse it altogether. I know she’s hungry though because when she comes home she will nurse right away and is up around every 2.5-3 hours at night to feed.
Should I practice bottle feeding more at home or will she take it when she is “hungry enough”? I typically don’t do bottles at home since nursing is more convenient and for bonding reasons. Do you have any suggestions? Thank you for your help!
A: Hi, J. This is a common problem that breastfed babies have when transitioning to a new caregiving environment. The day care should be experienced in this and hopefully will be persistent in trying to offer her the bottle. You don’t necessarily need to give bottles at home, although once a day wouldn’t hurt to help your little one accept using the bottle. Maybe dad could do one feed a day? Some strategies are for you to sleep on a blanket so it has your scent on it and for the day care to wrap that around her when they feed her so she smells you.
How much she ends up taking in day care depends on how stubborn she is. Because she’s only there for half a day, it could be that she’s allowing herself to get hungry knowing that you’re going to be able to feed her. Once she’s there for the whole day, she’ll probably give in and take the bottle once she’s hungry enough. In rare cases, babies are really stubborn and take only enough not to be hungry (i.e., 1-2 ounces at time, very reluctantly) because they are so tied to the breast. I think once you go to full-time work, she’ll hopefully give in to taking the bottle after a week or so. I don’t think you need to worry about it too much over the holidays.
Hope this helps, and please let me know if you have any additional questions!
Q: Dr. K,
I totally forgot to talk to you about sleep training at our 2 month appointment. Is that something that should start with our daughter before she’s 4 months old? Or is that a topic that can wait until our 4 month appointment? Thanks as always!
A: The earliest that an infant can sleep through the night is usually 4 months, and the average is 6-7 months. I’ve had parents who were lucky and their 6 week old was sleeping 5 hour stretches, but that’s rare.
I would say that the optimal window for sleep training is about 6 months of age. For parents who are interested, I direct them to the Sleepy Planet website and materials — it’s a gentle way to sleep train that most parents seem to be okay with. In the end, all sleep training involves some level of “crying it out” so it mainly depends on how much parents are able to endure.
Q: Hi Dr. K,
When we came in for our son’s 1 month visit, his belly button was slightly ballooning out. We were told that he had an umbilical hernia and the doctor wasn’t concerned. Since then, our son’s belly button has totally ballooned out, and it hasn’t receded at all. Is that change concerning?
A: In general, umbilical hernias are not dangerous. Some babies have weak stomach muscles, so a loop of intestine can protrude out of the belly button. As the babies get older, the stomach muscles tighten up and the abdominal wall is more formed, not allowing the loop to protrude. In most babies, these types of hernia will resolve on their own. We can continue to monitor until he’s about 2-3 years old. As long as it continues to get smaller over time, he will probably not need surgery. If by age 3 years the hernia is still the same size or bigger, we can refer to you to a pediatric surgeon and it is a minor outpatient procedure to sew up the weakness in the muscles. It does require general anesthesia, however, which is why we wait until the children are a little older because it is primarily a cosmetic issue.
In some cultures, parents wrap cloth belts or tape coins to the try to keep the hernia in—none of these strategies work, so I would not advise using them. I get asked whether this means the baby will have an “innie” or “outie” belly button — I don’t think there’s a correlation between having a hernia and what the belly button will ultimately look like. I don’t think you need to come in earlier to have this evaluated, although if you have other questions and want to be seen, of course we’re happy to see you!
Q: Hi Dr. K,
Our newborn daughter is peeing and pooping like she should but last night her pee color was mixed with a little redness. I was wondering if this is something to be worried about. I wanted to check with you to see if we should take her soiled diaper with us. Thanks!
A: Not to worry — newborns often have “urate crystals” in their urine which can make it look pink or orange. Also, because of mom’s estrogens, sometimes girl babies have a little blood from their vaginas like their having a mini-period from estrogen withdrawal in the first week after birth. Both are normal and should resolve on their own in a few weeks.
True constipation in the first 6 months of life is actually quite rare, but then becomes more common once solid foods are introduced around six months. The number of dirty diapers that babies have each day however is very, very variable. Breast fed babies do tend to have slightly more stools per day compared to formula fed babies but the number can range anywhere from twelve stools per day to only one stool every week, all of which can be normal.
Figuring out when you baby is constipated can be tricky. All babies strain somewhat when passing stool due to having weaker abdominal muscles, not knowing relax the appropriate pelvic muscles when stooling, and being in a lying position. If the stool that comes out is soft, your baby probably isn’t constipated and is instead just going through a normal developmental process. Interfering with this by using suppositories or rectal stimulation with a thermometer can actually be counterproductive and make the child dependent on these interventions. Signs of true constipation would be fully formed or pellet like stools, blood streaks on the stool, or pain that lasts even after a bowel movement.
Especially once solids are introduced, stools can become quite hard from time to time. When this happens, you have several options. If your baby does well with solids, fruit purees of prunes, apples, or pears may be effective. Prune juice also usually does the trick (make sure it’s 100% fruit juice) and starting with 2-4 ounces per day is reasonable. If your baby does not like prune juice, you can try diluting it with equal parts water to lessen the intense taste, or try using pear, apple, or apricot juice. If you are using a soy based formula, know that they tend to be more constipating than the others, so if this becomes a frequent problem, a change in formula might be helpful.
If this isn’t working consult with your pediatrician for additional advice. We might recommend a one time glycerin suppository to help clear out any impacted stool, although you wouldn’t want to do this too often. Stool softeners such as MiraLax are also safe and effective but you would want to discuss with your pediatrician about the proper dosing and make sure it’s necessary before starting. Your doctor will also probably want to examine the baby to make sure there are no unusual medical causes of the constipation before continuing along this route.
As always, if you have any concerns about your baby’s health, consult your pediatrician for individualized advice. by DrCurcio
As your pediatricians, we are always here to assist you with any difficulties that arise with breastfeeding. Breast feeding can be a wonderful experience for you and your baby with proven health benefits. It also provides an excellent bonding experience for mother and baby. Breast feeding in the first 6 months promotes a healthy immune system to help fight infections, can prevent allergies, and is associated with lower rates of obesity. It’s also healthy for moms and has been associated with lower rates of osteoporosis, certain types of cancer, and maybe even heart disease. Also, if you haven’t noticed, formula gets really expensive.
Breastfeeding does not come completely naturally at first. There’s a steep learning curve for both you and your baby. If you are having difficulty, please bring it up at your next appointment, or schedule and extra visit to come see us.
Try to initiate breastfeeding when your baby shows early signs of hunger (smacking lips, sticking out tongue, etc.) Thing will go much smoother when you’re baby is interested, but not ravenously hungry. Experiment with different positions and techniques – there’s really no right answer on how to do this. If a good latch is not accomplished, take the baby off the breast and try again.
Located in Santa Monica, The Pump Station is a great resource for mom’s who need a little extra help with breast feeding. They offer one-on-one consultations with terrific lactation specialists, mommy and me support groups, and a variety of equipment, breast pimps, etc. Keep in mind they are a business – and by no means do you need most of the things they sell. Their website also has a lot of helpful tips on specific issues that may arise with breastfeeding.
Another option for breast feeding support is La Leche League. This non-profit organization offers free support groups and phone consultations to any interested mothers who need a little help breastfeeding.
Always keep in mind that many of the benefits of breast feeding are due to the positive experience this can be for mother and baby. Stress is the enemy of breastmilk production and interferes with the bonding process as well. Bottom line: At the end of the day, your baby will grow and thrive. Although we strive for exclusive breast feeding, a short course of formula supplementation at times may be necessary – and that’s ok. This shouldn’t be a cause for worry or feelings of guilt. Know that your doctors are here and committed to helping you get the hang of breastfeeding and that we have the luxury of a tremendous amount of local support for breastfeeding. Before you know it, breastfeeding will become second nature, it’s just going to take a little practice to get there.
by DrCurcio
Breast milk is rich in nearly every vitamin and nutrient – with one exception: Vitamin D. For that reason we recommend giving exclusively breast fed babies 400 units of Vitamin D daily. Many brands of baby Vitamin D drops are available over the counter, and any will do. Remember, breast milk is rich in all other vitamins so MultiVitamins are typically not necessary for healthy, full term babies.
All commercially available formulas in the United States are supplemented with Vitamin D, so if your baby is taking all or mostly formula, additional vitamin D isn’t necessary.
If your baby is doing some breast feeding and some formula, discuss with your pediatrician whether they think Vitamin D would be helpful. by DrCurcio
Q: My baby has colic? What can I do to make him/her more comfortable?
A: Colic can be one of the most frustrating things a new parent has to deal with. Typically starting around 2-4 weeks of age, colic is characterized by persistent, excessive crying which can be very difficult to stop. Although colic disappears on it’s own by a few months of age, getting through that time can be challenging.
Although colic probably has many causes, it is thought to largely be an immaturity of the intestinal tract and the nerves which help coordinate its function. It occurs in breast fed and formula fed babies at fairly equal rates so it probably has less to do with what you or your baby are eating that most parents suspect. Although many parents worry that it is something they are eating and passing into the breast milk, or something specific to the formula they are using, it’s not usually the case. Think of it more as a developmental stage that your child is going through.
Your doctor will want to keep a close eye on your child’s growth and development. Assuming everything is coming along nicely, there are several things you can try to help get you through these first few months.
You might try feeding the baby in a more vertical position, and burp more often to minimize gas. Pacifiers can also be helpful here. Try to give your baby a calm quiet environment to avoid overstimulation, although quiet singing or “shhh” sounds can have a soothing effect. Gentle rocking or bouncing may help (some parents report that care rides for instance might have a calming effect.) Lightly massaging your baby’s stomach, or applying a warm cloth have also been reported to ease colic at times. Over the counter Baby Mylicon or GasX drops (the active ingredient is simethicone) occasionally will help although are far from being wonder drugs. Colic Calm/Gripe water is a homeopathic remedy that also appears safe and might occasionally have some benefit and can be purchased in pharmacies or at the Pump Station.
If your baby is breast fed, colic is no reason to stop. If your baby is formula fed you can try switching to a specialized formula for colicky babies. Occasionally your doctor might recommend other dietary changes for moms or other specialized formulas for the baby, but don’t make any major changes before speaking with them.
The last thing that has been shown to increase rates and severity of colic is parental stress. This can easily turn into a vicious cycle however with parents getting more exhausted from lack of sleep and feelings of guilt over their uncomfortable newborn, thus in turn worsening the colic. Remember, this is nothing that you’re doing wrong and this developmental stage will pass by quickly. Reassure your baby, and be there to support them, but remember to take care of yourself as well – staying hydrated, eating healthy, taking advantage of power naps and maximizing sleep, and trying to get out of the house each day.
If you have any more questions, or want more information, don’t hesitate to let your doctor know.
