The other day something unexpected happened that completely changed the pace of the day. Normally, it would have created stress and frustration. Instead, it led to something surprisingly meaningful.
It reminded me why connection matters so much in pediatrics… and why sometimes the slower days leave the biggest impact.
Fever 101 Tips – Mommy BasicsHow to Find a Pediatrician for Your Baby: Top 5 Questions!Mindful Moms 101 – Mommy Basics30 Fun Family Activities When You’re Bored at HomePediatrician Fever FixRestore Baby Sleep
Fever 101 Tips – Mommy BasicsHow to Find a Pediatrician for Your Baby: Top 5 Questions!Mindful Moms 101 – Mommy Basics30 Fun Family Activities When You’re Bored at HomePediatrician Fever FixRestore Baby Sleep
How Much Caffeine You Can Have Depends On Your Baby
Babies may be sensitive to caffeine and breastfeeding or whatever their breastfeeding mothers drink or eat. Drinking a low to moderate amount of caffeine shouldn’t affect your baby. But every baby is different. And some can’t handle any caffeine at all. In this post, you’ll discover the average amount of caffeine your baby might be able to handle. But first, let’s review some details about caffeine.
Yes it can. Caffeine is a natural diuretic; it increases urine production. This can cause dehydration which decreases breast milk production. Make sure to drink lots of water if you consume caffeine.
How Long Does Caffeine Stay in Our Bodies?
When you ingest caffeine, it gets processed in your stomach, then into your blood. Next, the liver processes it and breaks it down. In a healthy adult, caffeine stays in the body for 3-7 hours.
Will My Baby Clear Caffeine as Quickly as I Do?
No; not at all. Although 1% may seem like a tiny amount gets passed onto your baby through breastmilk. But babies process caffeine differently because their liver and kidneys are immature. Babies can hold onto it for 65–130 hours! Preterm and newborn babies take even longer to break down caffeine. Mothers of these infants might consider having even less caffeine or no caffeine. Ask your doctor for specific advice regarding your baby.
Some Signs of Your Baby’s Negative Reaction to Caffeine:
Irritability
Fussy
Jittery
Increased crying
Poor sleeping patterns
Feeding problems, including feeding refusal
Reflux/Hartburn that doesn’t go away or that worsens
My Baby Has a Negative Reaction, But I Didn’t Have a Lot of Caffeine!
These reactions have typically been reported in infants of breastfeeding mothers with high intake of caffeine. However, some babies might have these symptoms with a breastfeeding mother who has only one (1) cup of caffeine. If your baby appears to have one of these symptoms after you’ve breastfed and you’ve had caffeine, then consider decreasing your caffeine intake or stopping it altogether.
Want to Know More?
Breastfeeding & Alcohol | Pump & Dump – Truths & Myths? Read more about it here.
What’s Next?
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Alcohol & Breastfeeding: You Might Not Need to Pump & Dump
While breastfeeding & alcohol are generally not recommended, there are some workarounds. If you would like to have a drink and not affect your baby, it involves limiting how much you drink. It also involves waiting about 3 hours before you can breastfeed, if you’ve only had one (1) drink. This means if you decide to drink, you’ll need to think carefully about your baby’s feedings. But first, let’s review a few facts about alcohol in general.
Drinking While Pregnant is a NO!
When a pregnant mother drinks, alcohol is directly passed on to the unborn baby through the placenta. Basically, if mom drinks, baby drinks. And with a developing body, this is dangerous for baby. Fetal alcohol syndrome is caused by a mother drinking while pregnant. It leads to physical, behavioral, and cognitive problems to varying degrees depending upon the amount of alcohol the mother consumed while pregnant. Basically, don’t do it. It’s not worth the risk.
Once you drink alcohol, it gets broken down in your stomach, then it is quickly absorbed into your bloodstream. Next, alcohol spreads from your blood into your brain, lungs, and liver. The liver acts as the greatest filter to remove alcohol from your body. Your body also removes alcohol through urination and breathing.
What is Blood Alcohol Content (BAC)?
BAC is the measurement of alcohol in your body.
BAC of 0% means there is no alcohol in your body.
BAC of 0.03% is roughly equal to one (1) drink in an hour.
BAC of 0.08% is roughly equal to three (3) drinks in an hour. It is the legal limit for driving. However, no one should drive with any alcohol in their body; it impairs your brain’s ability to function safely while driving.
BAC of 0.35% is roughly equal to ten (10) drinks in an hour. This is the level of alcohol poisoning and dangerous on many levels.
What is a Standard Drink?
A standard drink (commonly known as “a drink”) refers to the same amount of pure alcohol in each type of drink. Each drink has a different Alcohol By Volume (ABV). The stronger the ABV, the smaller the size of a standard drink. For example, drinking 3 ounces of liquor (e.g. rum) is equal to 2 drinks, but drinking 12 ounces of beer is equal to 1 drink.
The Blood Alcohol Content (BAC) in breast milk is equal to the BAC in a mother’s blood. As the mother’s BAC decreases with time, the alcohol content of her breast milk also decreases. Alcohol content is highest in breast milk 30-60 minutes after a woman drinks. The more alcohol a mother consumes, the longer the alcohol can be detected in her blood and her breast milk.
How Long Can Alcohol Be Found in Breast Milk After Drinking?
1 drink – approximately 2-3 hours
2 drinks – approximately 4-5 hours
3 drinks – approximately 6-8 hours
Why You Might Not Need to Pump & Dump
Your breast milk will not have alcohol in it, if you follow the above waiting time guidelines. That means, if you have a drink, you can wait 3 hours to breastfeed your baby again without worrying that your baby will also be drinking alcohol. Why? Because after 3 hours, the alcohol has left your body. And the alcohol has left your breastmilk.
When Should You Pump & Dump
Keep in mind though, that if you had 3 drinks, you would need to pump and dump because if you don’t, your breasts will have extreme pain from all the breastmilk that your breasts have filled in them. That breastmilk is not fit for your baby’s consumption, so you will have to dump it.
Why Would a Mother Drink if Breastfeeding? Don’t Judge!
Personally, I’m not much of a drinker. So, it was easy for me to not drink while breastfeeding. But I also understand that there are many reasons why a mother might want a drink. Maybe a breastfeeding mother wants to socialize with her friends, feel like she’s more than just food for her baby, or other reasons. I’m not here to judge. I’m here to guide you to be the best breastfeeding mother while still being true to yourself.
Guide to Drinking Alcohol While You’re a Breastfeeding Mother:
Drink responsibly. Your baby needs your best clearest mind.
Be aware that a drink may affect you more than it did before, especially as you haven’t been drinking for a while since you’ve been pregnant and are a breastfeeding mother.
Drink plenty of water. Alcohol is a diuretic; it increases urination. You’ll need water to compensate. And to make sure your milk production doesn’t decrease.
Plan your baby’s next feed ahead of time depending upon how much you plan to drink & depending on how long your baby can go between breastfeedings.
If you want one (1) drink, be prepared to breastfeed no sooner than 3 hours after you have finished your drink.
If your baby is old enough to wait 3 hours until the next feeding, you may want to breastfeed at that time. Or have your previously stored breastmilk available for your baby to feed during those 3 hours. Or give your baby formula, if you are comfortable doing that.
If your baby has fed before you could breastfeed again, then consider pumping and storing your breastmilk as long as it has been 3 hours after you finished your one (1) drink.
Get a good night’s sleep. Every mom needs it!
What’s Next?
Stay tuned for my blog post, “Breastfeeding & Caffeine | Will It Hurt My Baby?” Don’t forget to check out the video for more in-depth information on today’s topic! Watch the full video on my YouTube channel!
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Autism and genetic testing is very important. Before I dive in, let’s review what is Autism Spectrum Disorder? Autism is a neurodevelopmental disorder associated with a variety of developmental delays, social and communication delays, and often repetitive behaviors that may first appear during infancy. These delays may include learning delays, speech delays, vocal developmental delays, social skills delays, inability to socialize, non-verbal communication skill delays, and repetitive behavior (also known as self-stimulating behaviors). Autism Spectrum Disorder is a vast spectrum of delays which may be mild and few to severe and numerous. Two other diagnoses considered to be part of the spectrum are Asperger’s Syndrome and Pervasive Developmental Delay.
What Causes Autism?
A specific cause for each case of Autism is unknown. Autism is thought to be due to genetic and environmental effects. However, current data reveals that 70-80% of Autism is due to genetic mutations (deletions, or duplications). Of those, approximately 70-80% are known genetic mutations while 20-30% are unknown.
The answer is complicated. In some cases, it helps. And in some cases, it doesn’t. In some cases, it will help now. And in some cases, it will help in the future. Another possible benefit is that genetic testing may help with family planning.
Can Genetic Testing Diagnose Autism in Pregnancy?
Genetic testing in utero does not reveal a diagnosis of Autism. To date, there is no formal genetic test that can diagnose Autism in utero and otherwise. There are many genetic mutations that have been associated with Autism. And many more are being discovered all the time. And if you had a genetic test of the embryonic fluid, you may discover that your child has one of those mutations. But having one of the genetic mutations associated with Autism doesn’t mean that your child will have Autism. A genetic association is not the same as a diagnosis for Autism.
Why is Genetic Testing Helpful for Autism?
Genetic testing can be helpful if you have a child diagnosed with Autism. Typically, your child’s pediatrician will refer your child to a Geneticist. Genetic testing in the form of Chromosomal Microsomal Analysis (CMA) may reveal a genetic cause for your child’s Autism. It has the highest detection rate among all genetic tests for Autism. Additional testing may include Fragile X testing and G-banded karyotype. A Geneticist may recommend testing for your other children and mother and father. Why? Other children may not have been diagnosed yet. Not all Autism is easily diagnosed as there is a wide range of symptoms on the spectrum. In addition, either parent may be a genetic carrier for Autism.
When is Genetic Testing for Autism Helpful?
Autism and genetic testing is helpful when a specific genetic mutation is known to be associated with specific delays with Autism. A specific treatment plan can occur when this is discovered. And the younger this is discovered, the sooner the therapies can begin. And the more effective they are.
In general Speech Therapy, Physical Therapy, and Occupational Therapy, and Applied Behavioral Analysis therapy are common therapies that children with Autism may need. For example, memory problems are associated with specific genetic mutations while they are not associated with others. If you knew that a specific genetic mutation had memory delays associated with it, you’d be able to tailor that therapy for your child. Tailoring additional therapies and/or increasing the frequency of a specific therapy to help with memory delays would be extremely helpful in this example.
When is Genetic Testing for Autism Not Helpful?
In general, there are over 250 genetic mutations associated with Autism. And more genetic mutations are being discovered. If your child has a genetic mutation that is new or uncommon, unusual, or rare there may not be a known genetic association with Autism yet.
What to do next? The answer is you must wait. As more testing is done and more associations are made, it is possible to eventually have a genetic diagnosis of Autism. As more testing occurs, more data is collected and analyzed. With time, you may learn about specific delays and treatments that apply to your child’s Autism. However, if there are genetic mutations that are found in your child, then it is beneficial to test your other children for the same mutations. It may aid in the diagnosis of Autism. It also may be a benefit as your child becomes an adult with Autism. Future therapeutic options may exist.
How Will You React if Your Child Has a Genetic Mutation?
This is extremely important. Some people need to know. And some don’t want to know. And others just aren’t sure if they should know. Emotions can’t be ignored. Will it bring you peace of mind? Will you be satisfied if you know there is a genetic mutation, and you can get specific tailored therapies for your child? Would you be willing to have your other children tested? What if the genetic mutation is present, but nothing is known about it yet? Will this cause you more anxiety? All this needs to be considered. Knowing yourself and how you might react is helpful to determine your child’s path.
Table 1. Most Significant Terms Enriched Using the GOBP Database (Rodriguez-gomex, et al., 2021
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As of March 7, 2025, per the CDC’s weekly update, there have been 222 cases of measles in the United States with 17% of those with measles hospitalized and one (1) unvaccinated child that died in Texas. That’s approximately 78% of last year’s 285 measles cases in just the first two (2) months of this year. The last child who died of measles in the U.S. was 10 years ago in 2015. This is the worst measles outbreak Texas has had in 30 years. The 12 states that have had measles cases this year include: Alaska, California, Florida, Georgia, Kentucky, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Texas, and Washington.
Measles in Florida
As of March 6, 2025, there is one (1) student at Miami Palmetto Senior High School that was diagnosed with measles. The good news is that the school has a 99.7% vaccination rate. Hence, the chance of it spreading in the school is extremely low. No other cases of measles have occurred at the school.
Measles is a highly contagious viral infectious disease. It spreads when a person breathes, coughs, or sneezes.
How Contagious is Measles?
Very! It spreads when an infected person breathes, coughs, or sneezes. Measles virus can survive in the air for up to two (2) hours! Any exposure can occur up to two (2) hours after a person left the area where they were located. Measles symptoms can begin 7 to 21 days after exposure, so unvaccinated children, adults, and immunocompromised people need to monitor themselves for symptoms. If symptoms occur, get tested.
1,000 developed encephalitis (brain swelling) from measles each year, and
400 to 500 deaths from measles each year.
Why Are There Measles Outbreaks?
In 2000, measles was declared Eliminated in the U.S. The official designation of “Eliminated” is defined as no continuous disease spread for more than 12 months. Herd (community) immunity occurs when vaccination rates are 95% or higher. Unfortunately, the anti-vaccination movement and the COVID-19 pandemic resulted in measles vaccination rates dropping. Illness spreads easily in communities with unvaccinated people, allowing measles outbreaks to occur. Kindergartners Measles, Mumps, Rubella (MMR) vaccination rate across the U.S. decreased to 92.7% in the 2023-2024 school year. This year, Gaines County, Texas has a MMR vaccination rate of 82% in its kindergartners. Hence, the outbreak found a home. As of March 4, 2025, Gaines County reported 107 cases of measles, up 12 from the prior week.
When Do Measles Symptoms Start?
Measles symptoms begin to show between 7-21 days after exposure.
Measles symptom in mouth – Koplik spots
Early Symptoms (First Four Days of Illness)
high fever
cough
runny nose
red, watery eyes
white spots inside the cheeks
Measles Rash
Later Symptoms (3-4 Days After Illness Starts)
rash that starts on the face and neck
rash spreads to lower body (over a period of 3 days)
rash fades (after approximately 5-7 days)
Who’s at Greatest Risk From Measles?
children less than 5 years old
adults older than 20 years old
pregnant women
people with weakened immune systems
Common Measles Complications
Ear infections and diarrhea are common complications with measles.
ear infections – 1 in every 10 children with measles
diarrhea – 1 in every 10 people with measles
Severe Measles Complications
Hospitalization, pneumonia, encephalitis, and death are some of the severe complications that occur with measles disease. Encephalitis is brain swelling that occurs due to the measles infection. It can lead to potential brain damage which may include blindness, deafness, and developmental disabilities. In addition, pregnant women may deliver prematurely, have a miscarriage, a stillbirth, a baby with low birth weight, or a newborn with birth defects including brain damage.
hospitalization – 1 in every 5 unvaccinated people with measles
pneumonia – 1 in every 20 children with measles.
encephalitis (brain swelling) – 1 in every 1,000 children with measles.
death – 1-3 in every 1,000 children with measles die from neurological, pneumonia, or respiratory complications
What is Subacute Sclerosing Panecephalitis (SSPE)?
Make sure you and your children are fully vaccinated. According to the CDC vaccination schedule, full vaccination is defined as measles vaccine should receive two (2) doses of the vaccine. The first vaccine is given between 12-15 months old. The second vaccine is given between 4-6 years old.
It is important to know that it is a live vaccine. As a result, there are certain situations where someone should not be vaccinated with a live vaccine such as the measles vaccine. Pregnant women should not get the vaccine. Children and adults with weakened immune systems due to a condition (HIV, AIDS, etc.) or due to a specific medical treatment (chemotherapy, radiation, high-dose steroids, etc.) should not receive the vaccine. In addition, they need to stay away from those who recently received the vaccine to protect themselves. Discuss with your doctor all the details specific to your child’s or your condition so that you know how long to proceed.
Some real-life examples include a parent who is on high-dose steroids due to a transplant or a grandparent who is undergoing chemotherapy or radiation treatment who has a one (1) year old who is due to be vaccinated.
Is It Safe To Travel with Measles Outbreaks?
For the most part yes. However, if you are traveling to an area or near an area where there has been an outbreak, then check your vaccination status before or after you’ve been to or near the affected outbreak area. Make sure to watch for any signs and symptoms for the following 21 days. Contact your doctor to have a specific plan for you and/or your child’s exposure.
What To Do If Exposed To Measles?
Call your doctor. They will review your/your child’s vaccination status. In most cases, if you and your child have received two (2) doses of the MMR vaccine, you are considered immune from measles.
If you or your child haven’t received two (2) MMR doses, then call your doctor. Your doctor will help guide you as to what to do next. Each case is managed differently. For example, if you have a one (1) year old child who was exposed to measles and had received the MMR vaccine more than 28 days prior to measles exposure, then a repeat MMR vaccine may be given to boost immunity. In another example, you have a seven (7) month old child who was exposed to measles that couldn’t be vaccinated yet because he/she wasn’t yet one (1) year old. Your doctor will likely recommend that your unvaccinated infant receive the measles vaccine early in order to reduce the risk of contracting measles.
Again, if exposed, call your doctor. If you or your child are not vaccinated, you may need to receive a measles vaccine or measles immunoglobulin. And since measles is highly contagious, you will need to be evaluated in a manner that is safe and not around others.
What’s Next?
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Foreskin care is necessary to prevent foreskin infection and/or irritation. The penile foreskin produces a secretion called smegma. Smegma is produced by the sebaceous glands on the inner surface of the foreskin. There is smegma buildup whether or not your son has been circumcised. Smegma acts like glue if left uncleaned. The foreskin always wants to re-adhere to the penile head. This is also true for the uncircumcised penile head. As the foreskin naturally lowers, it’s important to maintain good hygiene. The smegma will slowly be exposed as the foreskin slowly retracts. At that point, if the smegma is not cleaned away, the loosened foreskin will also want to re-adhere to the penile head. It’s good hygiene to clean the penile head daily regardless of circumcision or not.
Many parents believe that since the foreskin has been removed, there’s not much else to do. Even though your son’s foreskin was circumcised, there is some that intentionally remains at the time of the surgery. The purpose behind this is to allow for skin stretching due to growth and erections over time as your son grows. Much of the foreskin is removed during circumcision. However, it can’t all be removed. Otherwise, there would be much pain whenever there is penile growth or an erection. If the foreskin is not gently lowered and cleaned well, smegma will build up and the foreskin will naturally re-adhere to the penile head. This would lead to an increased risk of infection. If the foreskin becomes completely re-adhered, it also leads to a potential need for another circumcision.
It’s important to thoroughly clean the penile head daily. This involves gently lowering the foreskin to beyond the base of the penile head. I often tell parents that when it’s lowered correctly to clean it, this should look like a mushroom cap with a stalk. Notice I’m saying gently lower. Do not force the foreskin down ever. The area should be cleaned once daily with either a wet wipe, plain soap and water, or a washcloth with soap and water. Wyou see smegma, make sure to clean it off.
If the foreskin becomes re-adhered, get an evaluation from your son’s pediatrician. If it is safe to do so, the pediatrician may reduce the adhesions. Then, there will be a discussion regarding follow-up care and prevention. It is important to know that there is a limited age by which your pediatrician can reduce the adhesions. Typically, somewhere between 12-18 months, the adhesions can no longer be manually reduced. At that point, you will need to have a discussion about whether or not your son needs to or can have another circumcision. This is truly a case-by-case basis. Medical decision making and personal choice may be involved.
Foreskin Care for Uncircumcised Boys
It’s important to thoroughly clean the penile head daily. You should lower the foreskin to the point where you feel natural resistance. Notice I’m saying gently lower. Do not force the foreskin down ever.
The important difference from a circumcised penis, is that with the uncircumcised penis, you will most likely barely be able to lower the foreskin. Typically, you may be able to gently lower it by about one millimeter. You will most likely only see the urethral opening. That’s perfectly normal. Over time, as your son’s penis grows and has erections, the opening will continue to expand. And you will be able to lower the foreskin gently more and more. The area should be cleaned once daily with either a wet wipe, plain soap and water, or a washcloth with soap and water. When you see smegma, make sure to clean it off.
You will most likely see the smegma trapped under the foreskin. Again, do not force the foreskin to remove the smegma. While this can be done, there will be a lot of pain and some bleeding. It’s even possible that the foreskin may get stuck at the base of the penile head which would be an emergency. So, just don’t do it. Your pediatrician will let you know if anything needs to be done with trapped smegma.
Teaching Self-Cleaning Takes Time
Boys are well known for taking years until they learn how to clean themselves. I have long heard many parents sharing stories with me about their little boys being fine with poop smears in their underwear and an itchy butt. This also holds true for cleaning their penis. This means you will have to do this for them for many years.
Typically, they are not ready until after they have been fully potty trained. Boys should be potty trained by 4 years old. At that point, I’d recommend starting to teach them by talking to them as you clean their penis. Boys will start showing they are capable of self-cleaning between 5 and 6 years old.
Independent Self-Cleaning Takes More Time
However, in my personal and professional experience, it takes them about until they are 8 years old until they can truly self-clean well. And then, come the teenage years! This is when many boys revert to a lack of self-cleaning. You will need to repeatedly check with them. It’s important to prevent foreskin infection. Common questions to ask your teens are, “Did you wash your hair? Did you scrub your back? Did you clean your penis?” They will get annoyed that you will repeatedly ask this. However, that’s your role as the parent. Rinse and repeat, literally.
What’s Next?
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Handwashing is important as always. As humans, we’re always touching our face, nose, mouth, etc. If we keep our hands clean, this can help minimize catching and spreading the Flu.
Avoid sick people. This may sound simple. However, you’d be amazed at how many people will say they just have a cold. Or they are “over it.” The simplest thing to do is stay away from anyone with the sniffles or a cough. They may indeed have “just a cold.” They may also not be aware that they have a mild case of the Flu. And one person’s mild Flu can be another person’s Flu with a pneumonia or worse.
Get the Flu Vaccine. It’s especially important to get the vaccine when Flu levels are high! These are available at your doctors’ offices, urgent care clinics, and pharmacies everywhere. Babies as young as 6 months old can be vaccinated. Pregnant women can be vaccinated. It protects their baby as well. Anyone caring for your child, including grandparents can be vaccinated. While it is true that the Flu vaccine does not prevent the Flu 100%, it is also true that it prevents severity and hospitalization. In my experience as a Pediatrician, those children and adults who received the Flu vaccine and became ill with the Flu, had milder cases of the Flu. And it prevented severity, hospitalization, and secondary bacterial infections, such as ear infections, sinusitis, hospitalizations, and death.
Treatment
Tamiflu is an anti-viral specifically against the Flu. If you test positive for Flu, treatment with Tamiflu helps, IF taken within the first 48 hours of your illness. Tamiflu also is available in liquid form with weight-based dosage for children as well.
What’s Next?
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During the newborn hospital exam, your Pediatrician ensures your little one is healthy from the start by examining his/her body in detail. Have you ever wondered, “What is the Pediatrician looking for? Is my baby really okay? This is Part 1 of my series, “Newborn Hospital Exam” where I review the examination of the heart, lungs & abdomen after delivery.
During the newborn hospital exam, your Pediatrician ensures your little one is healthy from the start by examining his/her body in detail. Have you ever wondered, “What is the Pediatrician looking for? Is my baby really okay? This is Part 1 of my series, “Newborn Hospital Exam” where I review the examination of the heart, lungs & abdomen after delivery.
