Chad Perlyn, MD (Host): Welcome to the For Peds Sake podcast, a Nicklaus Children's Hospital podcast that is all about putting children at the heart of healthcare. I'm your host, Dr. Chad Perlyn, a pediatric plastic surgeon here at Nicklaus Children's and a father of two boys. And today, we are back with Dr. Melanie Suaris. Dr. Suaris is a pediatrician here at Nicklaus Children's for part two of our pediatric frequently asked questions episode. Dr. Suaris, thank you again for joining us on the podcast.

Melanie Suaris, MD: Thanks for having me again. Thank you.

Chad Perlyn, MD (Host): Of course. And for those listeners who missed the introduction last week, Dr. Suaris is not only a pediatrician here at Nicklaus Children's, but is a mom of a young son and has another soon on the way. So, sharing lots of expertise, both from her experience professionally and as a parent herself. So, thank you.

One of the things that's really important to us about this podcast is how we approach this both as physicians and parents. So, great to have you back. Okay. As you remember, last time we did something really fun, and we had a series of questions that had been proposed by our listeners, by the audience, through Instagram, about what they wanted to know regarding pediatrics. And we had a lot of questions brought forth, and we split them into the two episodes, last week's and this week's. So, if you haven't already listened to part one, we encourage you to go back and do so because there's some great advice there and we really look forward to jumping right back into it again. So without further ado, are you ready?

Melanie Suaris, MD: Ready.

Host: Let's do it. Question one. When is it safe for a baby to start drinking water?

Melanie Suaris, MD: All right. So generally water, I like to say six months of age is a good time to start. But this is just when we're just starting to introduce it. I don't want parents getting too bogged down of, "Oh my gosh, they're not drinking this amount of ounces, you know, on this day. It's not enough, they're dehydrated." This is just kind of a little taste test. And it's a great way for us to start exposing our babies to something other than a bottle as well. You could try sippy cups, maybe even a straw cup, when they get a little bit older, even an open face cup, if the parents dare to do so. Generally, when you start at six months, I like to say no more than maybe four or eight ounces throughout the day. So, really small amounts.

Host: Question two, ca ommon one. Why does my baby have acne?

Melanie Suaris, MD: Acne, of course, no parent wants to see acne on their little kid. And, you know, I get this a lot actually in the office. And there is actually two different stages for acne. It really just depends on when it comes about. You have what we call neonatal acne, which usually comes about, you know, when they're only a couple of weeks old, two or three weeks old. And then, there's also infantile acne, which comes about when they're a little bit older, three or six months.

So, the neonatal acne, which is the one that we're going to be seeing first, this is mainly due to clogged pores. And it usually goes away by the time they're about one month old. And then, the infantile acne, a little bit different. This may be due to clogged pores secondary to hormones. A lot of things are going on when, you know, our babies are very young. So sometimes, especially for boys, they have a lot of what we call androgens. And these are things that can increase the sebaceous glands, they can increase our chances of getting acne.

Either way, a lot of these things do self-resolve on its own. And what I like to tell parents is think about a teenager. When you're giving them a bath, you try to encourage them to use soap on their face, right? And a lot of parents, especially for young kids, they're afraid to use baby soap. They just use a little bit of water on the face. I say, "Look, use a little bit of that soap." Don't be very aggressive, but make sure you're washing their face. It's just like a teenager, but it will go away.

Host: It will go away, most important. So, this is a how-do-I-know question, the next one. And I really liked this because I think it's so important to parents. So, the question was, how do I know if my baby has RSV or just a cold and does it matter?

Melanie Suaris, MD: This is a really wonderful question, because the frustrating answer is that you don't know whether or not it's RSV versus a cold. Whether or not we have a name to a virus, what matters is how the child looks. But, classically RSV, these come with fevers, it comes with maybe even wheezing, difficulty breathing, and usually lots of nasal discharge. That's definitely a telltale sign that makes me think, "Ooh, maybe this kid maybe has RSV." But the things that I want parents to remember, like I'd mentioned before, is just how your baby looks. Look for those signs of respiratory distress.

And the main three things for me is looking at the belly breathing. You know, you look at their throat, you see if they're just like breathing so deep that you see a little bit of a hole that comes in their throat or if their nostrils are flaring. Those are all three great signs, you know, for these babies who essentially can't speak for themselves that parents can see at home whether or not their child is having respiratory distress. And RSV or not, if you see these signs, these are reasons to definitely go see either your pediatrician during the day or going to the urgent care or emergency department.

Host: Got it. Thank you. We talked a little bit on the first episode about sore throats and tonsils and when a child should get their tonsils out. And you mentioned strep throat then. So, one of the questions put forth by our listeners was why does my child keep getting strep throat? Talk about that.

Melanie Suaris, MD: And I tell you, it's not easy to have a kid that always gets these infections, that always gets strep throat infections. I will say that strep is very highly contagious, and especially once one kid in the class has it, classically, several kids, you know, end up having it in the classroom. Even if you just seemingly recovered from one infection, if you get exposed to someone else with maybe a different strand of strep or just a new exposure, 100% you could get re-exposed and get sick all over again.

Sometimes it's something that we call carriers as well, that if you come in contact with someone who maybe isn't symptomatic, but they have strep growing in their throat, which is kind of weird to think about, but it does happen. That's also a risk factor that would, you know, indicate why someone keeps getting sick.

Another reason that someone would keep getting strep throat infections is if, you know, the traditional antibiotic course, if you're using traditional antibiotics such as amoxicillin, it's going to be a 10-day course of antibiotics, which is a long time, and most kids will get better within a couple of days. So, sometimes parents don't necessarily complete the entire 10-day course. So if they don't do that, then you don't really give your body enough tools to completely get rid of it from your body. And that's a perfect opportunity for the infection to start all over again. So, that's why, you know, I always tell parents, even when you feel fantastic, make sure that you're finishing your antibiotic course.

Another reason why it could happen is if that initial antibiotic just didn't work, you know, and if you're not seeing symptom resolution within two or three days, you really should be going back to the doctor and saying, "Hey, I'm still having a sore throat. This is still happening." And then, they're likely going to try maybe a different antibiotic because resistance does happen in the community.

 And then, as we alluded to before in the previous, you know, episode, if this keeps happening, then it's definitely a good reason to see an ENT.

Host: Got it. Number five, an important one and a serious topic. What is SIDS and should I be concerned as a new parent?

Melanie Suaris, MD: So, SIDS is a very scary topic to talk about. And it stands for sudden infant death Syndrome, which it is as scary as it sounds. And it's essentially a term that we use for any sort of sudden death of a baby that's younger than one year of age without any known cause. And despite the amount of research and everything that's really gone into this, this is still very frightening because it still is very much unpredictable. But thankfully, there has been a lot of research and a lot of talk out there that pediatricians will talk to the parents about that could help reduce our risk of SIDS.

One of the best example I could give is the Back to Sleep or the Safe to Sleep campaign, which has definitely significantly reduced our incidence of SIDS. And essentially, what this is parents putting their babies back on a firm mattress to sleep.

Host: Yeah, this is something that as a pediatric plastic surgeon, we know a lot about because of the changes in head shape that can occur from being back to sleep and the importance of turning your baby. And perhaps, one day we'll do a separate podcast on flathead syndrome or plagiocephaly, as we call it, something that we see so many parents have questions about.

On those lines, what are some safe sleep tips for babies besides putting your baby on their back, back to sleep?

Melanie Suaris, MD: Yeah. And I will say that, for the older generation, this may be difficult to hear because there are so many things that have changed over the last decade or two that you know, when I was a kid that maybe my parents were doing that are now considered not safe sleep. So, one of those things around a crib, I definitely do not recommend any sort of bumper pads. We get it all the time. The parents are like, "Oh, but my kid's hands get stuck between the crib. The foot gets stuck. We need to put a little bit of a bumper so that they don't hit their head." But the risk for that is that, you know, a baby can turn to the side. It could ultimately possibly lead to suffocation, things like that. So, no bumper pads.

They say room sharing, but not bed-sharing. And that's very difficult. I know, as we mentioned, we've talked about colic before and, seemingly, the babies will only sleep on your chest or only sleep with you in the bed. But regardless of what you need to do to get the baby to sleep, as long as you put that baby back in the bassinet or back into the crib, that's what's important. One hundred percent, we don't recommend any sort of bed-sharing at any age.

We also want to avoid any sort of overheating. I speak, as a Miami native, for a lot of my Miami community, that we always think our babies are cold. We want to put a hat. We want to put mittens. We want to put like about three different layers before they go to bed. But think about what you need to go to bed, given the temperature of your home. If it's just a simple blanket, then all your baby needs is just a simple onesie and then a swaddle if they're young enough for it, and that's it.

Making sure there's also nothing else in the crib, okay? You know, a cute little animal, blankets, these are all things that are just not necessary and it does increase your risk for SIDS and it's not considered safe sleep.

And then finally, no weighted blankets. This has been actually a pretty common thing that people use because the idea is that maybe it mimics someone's hand on the baby's chest if you're having a weighted blanket. But this is not considered safe sleep and also another risk factor for SIDS.

Host: That is a great tip. I had not thought about the weighted blanket aspect. I see lots of them advertised these days for older kids with ADD or other things. So, families may have these in their home for a different purpose. And great tip, don't use it for your baby. So, I'm going to throw in one more bonus question, of course, like we did in the last episode while we're talking about sleep and things in the cribs. Bottle in the bed at night. Good idea, bad idea?

Melanie Suaris, MD: I will generally say that it's a bad idea. You know, I think that especially as the baby grows, and they get to use the bottle on their own, I think the thing that people forget is that milk is very high in like sugar content. And if they fall asleep even with the bottle in their mouth, this gives us an increased risk for cavities. And so, I say, you know, you feed your baby, you burp, they don't need anything else in the crib. Trust me, they will let you know if they do. So, it's best to just keep everything out. Even when they're older, I like to say don't even keep water in there, or else you're going to get stuck with a kid who basically wakes up in the night requiring milk or requiring water. And so, you're not doing your future self any favors by doing that.

Host: Well, you are amazing once again. look what we've just covered in just this short time from acne to RSV to SIDS and safe sleep. Thank you so much for sharing your expertise in such a concise and realistic and meaningful way for all our listeners. It really was a pleasure having you.

Melanie Suaris, MD: Thanks so much. I had fun.

Host: Of course. And we look forward to having you back. That concludes this episode of the For Peds Sake Podcast. We hope you've learned some helpful tips from Dr. Suaris. Make sure to stay tuned for our next episode. And in the meantime, be sure to follow us on all social media channels. You can find Nicklaus Children's Hospital on Instagram, Facebook, TikTok, and YouTube. See you next time!