“Newborn Feeding” – with Dr. Jay Begun

Dr. Nathan: Welcome to today’s episode of Healthful Woman, a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At Healthful Woman, I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Dr. Jay Begun. Jay, thank you for coming on the podcast. How are you doing today?

Dr. Jay: I’m doing great this morning. How are you?

Dr. Nathan: I’m terrific. Thank you for asking. So, we’ve been circling this for a while, trying to find a time that worked for the both of us. But I mean, we go way back. I was thinking, I’ve known you a long, long time in a good way.

Dr. Jay: Yeah, medical school days.

Dr. Nathan: Back from medical school. Yeah, you were, I guess, if I’m correct, you were a fourth year when I was a first year. You graduated right after I started.

Dr. Jay: Correct, 98.

Dr. Nathan: Yeah. You were with some of the legends of Mount Sinai. Shlomo Drapkin?

Dr. Jay: Yes, yes, yes. That’s for sure. We’re still in touch.

Dr. Nathan: Yeah. Aaron Gottlieb.

Dr. Jay: Yeah, some of your colleagues, 100%. Aaron Gottlieb, 100%.

Dr. Nathan: Yeah, amazing. So, and then when I come back to Mount Sinai after my training, my fellowship, and I joined this practice and they’re like, yeah, there’s this pediatrician we work with all the time. His name is Jay Begun. I’m like, Jay, I’ve known that guy.

Dr. Jay: Yeah.

Dr. Nathan: Amazing.

Dr. Jay: Old friends, old friends. And I appreciate all the referrals over the years. So much so that I left Mount Sinai East to follow you to Sinai West.

Dr. Nathan: We’re recruiting. We’re trying to get all of our good people to come over with us. But no, it’s great for us. It’s great for our patients. We’re really happy about that, obviously. So, thanks for doing that. How are you enjoying the West Side so far? It’s all right?

Dr. Jay: Very much so. It’s great. Really enjoy it. And it’s a little bit of a commute now, but we’re leaving a little early. So, good.

Dr. Nathan: It’s all good. So, Jay, just for our listeners, give us just a brief recap on who you are, where you’re from, how you got into medicine and pediatrics.

Dr. Jay: I’m from Whitestone, Queens. I grew up Whitestone Bayside area, local high school. Then I ended up at University of Pennsylvania, went off to Israel to study for a few years, came back, did a post-bac program at Columbia, trained at Mount Sinai Medical School, graduated in ’98. Then I did my pediatric training at North Shore before it became North Shore LIJ. And my father was a pediatrician for many years. He was on the Upper East Side, also at Mount Sinai. A legendary pediatrician who actually, I don’t know if he was in practice when you first came to the group, but we actually worked together. He had an office on the Upper East Side for many years.

Then I went into pediatrics and he retired. As I finished my residency, I opened an office in Williamsburg, Brooklyn, and he was so bored in retirement, he actually joined me. And we worked together for like seven years in Williamsburg. And he also mutually covered my newborns. I took over his sort of newborn practice idea. He came up with it. He was doing that at Mount Sinai East for 50 years.

And then we worked together for about six, seven years in the office setting and also in the hospital setting. And I owe everything to him. I learned everything I know from him. He passed away about six years ago, but I still remember his teachings on a daily basis. And he was the biggest influence for me going into pediatrics. And it’s been an amazing career so far. One of my daughters is a PA. She also went into pediatrics, Esther. She’s working at Mount Sinai East in the nursery. We have three generations of Beguns working in pediatrics at Mount Sinai. So we’re very grateful and we enjoy that position.

Dr. Nathan: Did you know from when you started medical school that you wanted to do pediatrics because of your father?

Dr. Jay: Yes, 100%. I really love kids and I love working with kids. And between me and you, I can’t stand and have so much patience to listen to adults complain. So I listen to babies cry and I listen to parents complain, which I’m much more able to deal with.

Dr. Nathan: Well, what a blessing it must have been to work with your father, your role model to work together. Some people, they sort of dread the idea of working with family. But I think with medicine, it’s different. I just think that it’s such a wonderful thing to do. Because obviously, I’m sure even when you weren’t working together, you’re talking about patients, about medical conditions and back and forth and to get to actually do that. I mean, really, what a blessing.

Dr. Jay: Yeah, he was very influential in us. My partner and I being successful in Williamsburg, he gave us that level of experience, which two young guys opening a practice in Williamsburg, he had that level of experience. People trusted him and he really was a teacher to us and he really jumpstarted our practice and gave it such incredible credibility and relevance. And we’re just really grateful for him and everything he did.

Dr. Nathan: Tell us about where’s KinderCare now? Like what are you guys doing now? It’s big.

Dr. Jay: We sort of came full circle. We opened up in 2001 in Williamsburg on Ross Street. Then after a year or two, we realized we needed bigger space. We moved around the corner from Lee Avenue. And then as we got full at Lee Avenue, we realized there was a whole new area in Williamsburg that was starting to be developed several blocks down around Skillman-Flushing area. And I was at a wedding once, the Rose Castle, and I saw all these apartment buildings going up and it was in a sort of deserted area of Williamsburg.

So I said to some of my friends in the community, what’s going on here? He goes, oh, these are all going to be apartment buildings in five years. This is going to be the new center of Williamsburg. So I said, better idea. Let’s open a second location here. So, we opened the second location on Skillman Street, 8th Skillman, and we hired another doctor and we each worked a little part time in that office and we built that up. So at one point we had two very bustling offices in Williamsburg.

Then right before COVID hit, we decided to consolidate as we saw most of the young people are moving towards the new area of Williamsburg, we’re in our Skillman Street location. So we decided to focus all our energies into that location while simultaneously looking for even bigger space. And we found the new commercial real estate building on Spencer Street. It’s called 18 Spencer or Tower 18. And it’s a beautiful building. We were the first tenants to sign and we have an entire floor where we have two workspaces, one for two pediatricians and we have occasional specialists. We have an ENT coming in, we had podiatry and we’re always looking to expand our services for the community. And over the past 22, 23 years of inter-practice, we’ve had offices in Burr Park, we had for a while in the summer in the Catskills, we had an office. So we’re very entrenched in the community, providing services locally and afar, and we really enjoy it and we’re looking to the future.

Dr. Nathan: And you spend a couple of weeks each year up at Camp Simcha, right?

Dr. Jay: Yes, correct.

Dr. Nathan: We have that in common. My daughter did that for several summers, which is, you know, unbelievable, just unbelievable.

Dr. Jay: Yeah, I think I met her there. My wife originally was among the first counselors in Camp Simcha 30 years ago with Rabbi Scholar when it was a much smaller operation and she kept involved. And then after I was in practice, she sort of encouraged me, like, you know, they always need help, why don’t you come work there? And, finally, I did and for the last 15 years, we’ve been going pretty much every summer working in the boys and girls special sessions and really enjoying.

Dr. Nathan: Yeah, and for our listeners who don’t know, Camp Simcha is essentially a summer camp for children either some of the sessions are for children with cancer and some of the sessions are for children with sort of more chronic illnesses. And this is like their respite in the camp is just unbelievable. It’s like a regular camp for them. And no matter what their challenges or medical situation is, they get to go to camp. I mean, they have like basically like an intensive care unit there as needed.

Dr. Jay: We have a very large infirmary with at least three doctors and 10 nurses working. And it’s a pretty incredible situation and it really makes the kids feel normal, like they’re not alone in their struggles and their difficulties.

Dr. Nathan: It’s amazing. So, when when you and I were bouncing ideas back and forth about dates for the podcast and topics, you mentioned pretty emphatically that newborn feeding was something you wanted to talk about. So, why newborn feeding? Like, why is that a topic that you think is really critical to get the word out about?

Dr. Jay: Well, first of all, on a personal level, that’s one of…most days I start my day in the newborn nursery. So I’m dealing with this almost on a daily basis. And really after someone deliver a baby, the main challenge, the main issue, the main work that needs to be done is to feed the baby. That’s the most important thing. So there’s a lot of issues surrounding it, you know, in terms of breastfeeding, bottle feeding, reflux issues, you know, things that could interfere with the breastfeeding and feeding, like tongue ties and lip ties, a lot of issues circulating, a lot to deal with right away. And so, it is a topic of very great importance and something that mothers have to deal with.

Dr. Nathan: Do you find that amongst, you know, your your patients, or I guess your patient’s parents, that there’s a lot of stress over this or is it just sort of like, you know, work that needs to be done? I mean, what’s your experience with new parents?

Dr. Jay: First time parents, it is, I think, the mothers feel the most stress when it comes to feeding. Because especially for nursing mothers, you know, they don’t know how much the baby is actually getting. They’re not so experienced in terms of, you know, a lot of parents, it’s the first time they’ve seen a newborn. And maybe they have one, you know, cousin here, but a lot of them, it’s their first experience with a newborn baby. Depends on which community you’re from, but where you’re from. But so and people are nervous, you know, as I tell them, babies don’t come with instructions. Now there’s a lot available online and in books, but, you know.

And a lot of a lot of mothers are very well read and prepared, but there’s nothing like, you know, actually dealing with a baby that’s there. You know, you can read as much as you want until practically you have to handle a baby, a newborn, and there’s nothing that can compare to it. So it is definitely a topic that mothers are very concerned about. It does engender a lot of anxiety. But, you know, my job is to get them to relax, be the baby, either breastfeeding or bottle feeding. You know, some mothers are just so tense, they have to switch to bottle, but I try to encourage nursing very much.

Dr. Nathan: Yeah, I wanted to start there because that’s obviously a hot topic all over the place. And, you know, you’re in the thick of it. Right. So you’re there with the mom first day, second day. And a lot of people, obviously, have plans for how they’re going to feed the baby. But I’m sure a lot of people ask you like right away, like, well, do I need to nurse? You know, is it okay if I bottle feed, or is it better to bottle feed because I can get the amounts? Or whatever it might be. How do you talk to new parents about, you know, the relative benefits of breastfeeding versus bottle feeding and how to help them go through with that decision?

Dr. Jay: So, I would say most mothers have in mind to breastfeed their babies. I think that’s like the fallback position. Now, we discuss the benefits of the mother-baby connection and how the mothers feel much closer to babies when they’re nursing the babies. I mean, I always press as if I see that the mothers, you know, don’t feel they’re going to be successful, I try to encourage them that they can be successful breastfeeding. But I always telling them, you know, I was bottle fed, I didn’t turn out so bad.

Dr. Nathan: Well, I mean, we’ll be the judge of that after this podcast. We’ll find out what people think.

Dr. Jay: It’s not the end of the world. Like you have to do what’s best for the mother-baby combo. And most mothers do take to it very well and are able to successfully nurse their babies. They do need support. There’s always a lactation consultant available in the hospitals. And there are many lactation services available, even outpatient. They’ll come to your house, they’ll work with the mothers. And, in general, can mothers relax and focus on the nursing is generally very successful.

Dr. Nathan: No, I think that’s pretty… I mean, I think that’s wise and I think people appreciate because you see so many new moms and, you know, just the idea that many of them or most of them or whatever percent end up breastfeeding, it works out well. And some don’t and you’re able to give people some perspective. They’re like, listen, you know, if it’s something you want to do and you work at it, it’ll likely work out. But if it doesn’t, like you said, it’s not the end of the world. Like it’s okay, you know. But bottle fed babies are going to do okay and they’re going to make this way in the world just fine. And it’s not like a life or death decision that sometimes people feel that it is like that weight is put upon them for whatever reason, internally or from outside pressures or whatever it might be that they feel like this is the most important decision they’re ever going to make in the well-being of this child. And it’s just not true.

Dr. Jay: Right. That’s right. I mean, the formulas out there, they simulate breast milk to an incredible degree. I mean, they talk about the initial, you know, cholesterol and certain IGAs and all the different nutrients that may not be exactly replicated in the formula, but it’s pretty close and babies do extraordinarily well with formula also.

Dr. Nathan: Right. I mean, as all new parents know the most important decision you’re going to make is where they go to kindergarten, of course.

Dr. Jay: Right.

Dr. Nathan: That’s the critical.

Dr. Jay: You have to apply before you deliver the baby.

Dr. Nathan: So, when you’re going over the parents, however they’re feeding, what what is sort of the standard feeding schedule for a newborn, like the first month or so of life or however you divide it. How do you go over what they should be doing or what to expect the baby to need over that time period?

Dr. Jay: So, for breastfeeding mothers, we’ll divide into breast [inaudible 00:15:04] a little slight difference from breastfeeding. Generally, they’ll feed every two to three hours or we’ll try and get them, you know, not before two hours to be feeding. Sometimes if mothers say, you know, they did their research, they want on-demand feedings. So I’ll tell them every one and a half to three hours. But, in general, breastfeeding is every two to three hours. And for the most part, I’ve found out in the first month of life, the babies are waking up pretty frequently to feed. So, it’s not a question of having to wake the baby, unless there’s something medically wrong, obviously, for the baby sleeping too much. That’s a concern you have to raise with your pediatrician immediately.

But in terms of your regular healthy baby, they’re waking up every two, three hours to feed. And when they’re crying or they’re uncomfortable, I tell them they’re either hungry, dirty or they’re tired. For the most part, they’re hungry. So, you know, check the diaper and open them up and make sure everything’s okay. And then just try and get them on every two to three hours. For formula, you know, and of course, with breastfeeding, you don’t know how much they’re getting, but they generally stay on for 20 to 30 minutes-a-side. So, you know, it’s an hour process and then burping the baby afterwards. And a lot of times they have a dirty diaper, so you have to change the diaper in between.

So it’s really a process and, you know, it’s not easy, but, you know, as I tell the mothers, very doable and it’s great for the baby. For formula fed babies, generally, you know, two to three ounces every three to four hours. Generally, you could span them a little longer, like they won’t be…the formula is much thicker and heavier. So, generally satisfy the baby for a little longer. So that’s in the first month or so.

And for breastfeeding babies from month one to two is basically the same. But in terms of the formula, they may go up to four, you know, three to four ounces a day. But again, every day it’s different. I tell mothers that, oh, how do I know how much to feed the baby? Not just in the first month, the first year. I said, you know, it’s sort of like filling up a cup with your eyes closed. Like you take it, you fill it up and you see it’s overflowing. Then, you know, you scale back a little next time and you can go forward with that amount. So, basically getting back to the 0 to 1-month period. And basically, you know, it could be feeding the baby eight times a day, you know. Yeah. Eight to ten times a day.

Dr. Nathan: It’s a lot.

Dr. Jay: Yeah, it’s a lot. It’s work.

Dr. Nathan: And a lot of work.

Dr. Jay: And it needs your support. You know, yeah, it has to be supported. And, you know, it’s a good thing.

Dr. Nathan: And then so there is that question you mentioned it before. Should you wake a baby to feed or is that more later than the first month or two?

Dr. Jay: So I say in the first month or so, during the day, once they have hit past three to close to four hours, I recommend waking the baby. And at night after like four hours, I recommend waking the baby. This in the first few weeks of life, but afterwards, I generally say if they’re sleeping at night, generally they’re happy and you don’t need to wake them. But most babies are waking up for the first couple of months in the middle of the night for feeding.

Dr. Nathan: Right. I mean, again, it’s very different the first month or two versus three to six months active.

Dr. Jay: Correct. Right. Usually around, you know, we try and get them on some sort of schedule. But in the first few weeks, you really can’t make a schedule. You sort of want to create that day-night time situation. So, I tell mothers that when they’re feeding the babies at night or middle of the night, they shouldn’t have all the lights on in the room. You know, we try and, you know, stimulate the circadian rhythms and give the babies a sense of day and night. And that way, that’ll transition them more to sleeping through the night.

Usually, you know, by about four months, I strongly encourage, you know, mothers to employ the fervor method, which is an old time method of just letting them cry through the night if they wake up. You know, feed them at like, you know, 11, 12 and before you go to sleep. And if they wake up at two, three in the morning, after four months, you don’t really need to feed them in the middle of the night. And so I say, let them cry for 20 minutes. I know it’s hard for mothers, but you let them cry. Then after 15, 20 minutes, if they’re still crying, you go in, you soothe them. You don’t take them out. And try and replicate that process a couple of times. And my experience with even my own kids is within a few nights you’re sleeping through the night.

Dr. Nathan: Yeah. And through the night, again, when you have a newborn and you’re used to every two to three hours, “through the night” could be from midnight to 5:30 in the morning. Like it’s not like a 12-hour stint, but you’re like, if you can fall asleep at midnight and wake up at 5:30, you almost feel like a normal human.

Dr. Jay: That’s amazing. That’s amazing. Especially for new time mothers not used to, you know, over the first few months of life and they’re up after every three hours. So it’s unbelievable.

Dr. Nathan: Right.

Dr. Jay: Life changing.

Dr. Nathan: Yeah. That’s a bit… And then, you know, once they go from 12:00 to 5:30, then it becomes, you know, 10:00 to 6:00. And then eventually you get like a proper night.

Dr. Jay: Yeah. Exactly.

Dr. Nathan: Over time.

Dr. Jay: Exactly. Exactly. But you have to do it the right way. I mean, you have to…you can’t wait till 9, 10, a year to start doing the process. It’s much more difficult. You start when they’re very young, actually much more successful in getting them to sleep through the night probably young.

Dr. Nathan: Right. Now, what about, you know, for parents who are interested in sort of tracking the feeding, you know, volume going in, you know, dirty diapers this and, you know. Is there a point that’s too much? Is that like, you know?

Dr. Jay: Yeah. Good question. You know, there are a lot of apps available and there’s like books you could fill in the feeding. I find it causes more anxiety than it’s productive because the mothers are so obsessed sometimes with, you know, we have a wet diaper at 8:22:32. We have one. It’s already, you know, six hours later. I fed him the bottle two and a half ounces and, you know, and they’re busy, you know, documenting. I think you have to take a general like gestalt of the baby. And if they’re doing well, they’re waking up for feeding. Can’t get bogged down with so many of the details in the documenting thing. I think it causes more anxiety than good, honestly.

So I’m not a big fan of of these apps and these books to fill in the feeding and the peeing and the pooping. And, you know, some some people hire nurses and baby nurses for the first couple of weeks, the first couple of months, whatever it is. You know, a lot of time they do that, they will like to do that, you know, to prove that they’re actually doing something. But for your standard mother, I don’t think it’s productive. I think it causes more anxiety than any good that can come out of it.

Dr. Nathan: Then if they’re not doing it in sort of that rigorous type of fashion, then what kind of advice do you tell them in terms of like, here are things that, you know, if they’re going on, you should let us know to make sure everything’s okay. Like, you know, in terms of like diapers or feeds or whatever.

Dr. Jay: Yeah. So, initially I tell them, you know, 5 to 10 wet or dirty diapers a day is in the normal range. As they get a little older, it peels off. And in terms of the feeding, I said the baby should be waking up every two to four hours if they’re sleeping five, six hours. And there’s, you know, you need to address it. You need to and if it’s concerning. If they’re not having wet diapers for extended periods of time. If a baby wakes up with a dry diaper, that’s very concerning. The baby is not, you know, having a dirty diaper consistently, especially for breastfeeding babies where they could be having, as I said, part 10 a day, that’s also concerning.

That’s why it’s very important to be in close contact with your pediatrician. You know, any of these signs are coming up. Also, fever, obviously, any fever in the newborn is very concerning. We have different parameters of what we do with fever, but, in general, any fever of 100.4 or over should be brought to the attention of the pediatrician in the first month or two of life.

Dr. Nathan: And then you’re seeing these moms and these babies. And not always the mom, obviously, but you’re seeing these babies pretty frequently in the first couple of months. How often are you seeing them in the office, like in person?

Dr. Jay: So, right. So after the discharge from the hospital, the recommendation is, you know, anywhere between two and four days to be seen in the pediatrician’s office, especially new, you know, first time mothers who want to make sure the baby’s weight is okay, not losing too much. You generally don’t get back to birth weight to two weeks, 10 to 14 days. So losing weight isn’t necessarily a concern. But if they’re close to the 10% weight loss upon discharge of the hospital, then we need to keep an eye on it very carefully.

Jaundice comes into play also. Babies sometimes become yellow, jaundice, and that could also impact our baby’s feeding and it makes a baby a little more sleepy. So, a lot of factors, you know, come into play. So, when they discharge from the hospital, they come at two to three days after discharge. Then probably do another appointment when the baby is two weeks old and then like between four and six weeks and just past two months. And then and if everything is going well, some parents are very, you know, aggressive about coming to the pediatrician. They want to come every month for the first six months.

At two months, if they’re doing great and two month visit, four month visit, six month visit, these are all for well visits. And then nine month visit and a one year. Those are the minimum in the first year. But they end up coming much more frequently. Because I’m concerned about how the baby’s gaining weight. So they’re coming for a weight check. The baby looks a little yellow, they are coming for that, or the baby is sleeping up a little or he feels a little warmer, congested. So they end up coming in, you know, many more times the first six months of their first year of life. So those are things to look for, like poor feeding, not waking up for feeding, any fever, of course, is an emergency.

Dr. Nathan: So let’s talk a little bit about things that either do get in the way of feeding or perceptions of things that might get in the way of feeding. And let’s start with tongue ties and lip ties. So can you explain what that is and why is that such a big deal?

Dr. Nathan: Okay. So, according to the literature, I think like 4 to 10% of babies have some sort of element of tongue tie. It’s like a little piece of skin that’s under the tongue. Like if you take a stick and you lift up the tongue, you’ll see there’s like a little piece of skin, you know, connecting the base of the tongue to the tongue. And everyone has somewhat of a tongue tie. The question is, is that tongue tie restricting the tongue that would possibly interfere with breastfeeding? Usually with bottle-feeding it doesn’t interfere that much. So, baby could be bottle-feeding very well, but difficulty breastfeeding. And it could be from having this tongue tie. The medical term is called ankyloglossia. That’s a restriction of the tongue in terms of sticking out of the baby’s mouth and getting a good latch on the mother.

So, that’s why it is particularly concerning. It’s interesting that 20 years ago when I first started, it wasn’t such a big deal. Like we check for it, but we sort of said, okay, a little tongue tie. Sometimes you wouldn’t even mention it to the mother. Now, the first question is always, oh, is my baby tongue tied? Because I guess that’s, you know, what’s being discussed on the mother’s WhatsApp groups and different things like that. It’s an area of great concern. So, we try and keep an eye out for that. So, the question is, right, I always wonder, what do we do about it? Like baby is tongue tied. So, I usually tell the mother, let’s see, there’s no rush to… Unless the baby’s so tongue-tied, it’s so anterior where you see like it almost looked like the baby cries or opens his or her mouth, you see the sides of the tongue are like lifting up and the middle is sort of like matted down to the base of the tongue.

So then those I try and get taken care of in the hospital by the ENT. The ear, nose and throat specialist comes in, he takes a little scissor and he just cuts it. My father actually used to leave his thumbnail extra long and he would do it manually. I won’t say whether he had a glove on or not, but he probably did. But that’s how easy the procedure is. So, but nowadays it’s a surgical procedure in the hospital. No anesthesia, but you got to have full consent. Sometimes it bleeds a little. Very rarely does the stitch have to be put in or you have to cauterize it after the procedure.

Actually, one of the ENTs in the hospital taught me how to do it because it’s so common. And now I actually perform the procedure in my office. On a regular basis it’ll probably do two or three a week in the office. And it’s a pretty simple procedure. Just, you know, lift the tongue, take a little pair of scissors, make a snip, push it in a little and you’re done. It bleeds a little. They nurse or give a bottle right away. And it generally heals pretty quickly.

Dr. Nathan: And so how do you decide if it’s not an extreme case? Like you mentioned, whether to do it or not, whether to do the procedure.

Dr. Jay: If the baby’s gaining weight well, and feeding well, and latching on, even though they may have a little tongue tie, there’s no indication to do it. So I would recommend leaving it. I don’t like, you know, do no harm. You don’t want to do any procedure you don’t need to do. So it’s very important, you know, don’t be too aggressive getting it treated. But, you know, a lot of times the mothers come, they say, oh, we’ve been with the lactation consultant and she said the baby’s tongue tied and that’s the problem. Now, very frequently that’s not the problem. It’s a mother baby connection that needs to be worked out. But very frequently, it is a tongue tie. So it needs to be addressed.

Now, I tell the mothers that they always have, oh, is it going to affect speech later on? There’s no studies to indicate that it affects speech. So, if you do it for the idea that maybe one day it’ll affect the baby’s speech, that’s not a reason to do it. The reason to do it is to improve the feeding of the baby in the newborn period. And it’s a simple procedure and very low complication rate. And I find a lot of times I’ll do the procedure and then I’ll say here, now nurse the baby, I’ll come back in 10 minutes and probably about a third of the time they say at this point, it didn’t make a difference. A third of the people say, mothers say, it maybe made a little bit. But occasionally, they’ll say, wow, huge difference in the feeding. Thank you so much. So and after the procedure, I recommend doing massages twice a day on that area for about 10 seconds for two weeks, because sometimes it could reform and, in general, very good outcomes. But if it’s not affecting the feeding, I generally try to convince the mothers to hold off.

Dr. Nathan: Right. Because I was going to say it sounds like what you’re saying is, you know, there are some circumstances where it’s like so blatant that you recommend doing it automatically. But the majority of times it’s a wait and see approach. If the baby’s feeding fine, leave it be. And if not, then you can address it.

Dr. Jay: Right. 100%.

Dr. Nathan: And then I was going to ask how often are you getting sort of pressured from the mom or the dad or the grandparent or something like to do it and where you’re like, you know, baby doesn’t need to like do it, do it, you know, just because they heard it was the right thing.

Dr. Jay: Right. And I won’t be bullied into doing it. I would tell the mother, a lot of times the grandmother has the baby at first. So, I say, you know, it really is not necessary. This type of tongue tie won’t cause any speech difficulty and does not interfere with the breastfeeding. Then they ask me about the upper lip tie. Now, all babies have this little, you know, frenulum on an upper lip. So, I never recommend that being cut in the newborn, period. There are certain specialists that do it. I think it’s a little aggressive. And I don’t find that that really affects their baby’s feeding at all.

You know, sometimes as they get older, that frenulum does throw down their head, causing a separation between the two front teeth. So I say, if that happens, then your orthodontist will deal with it. They could laser it or they could fix it before the child gets orthodontia. But in the newborn period, you don’t need to touch it. Because very frequently in the toddler period, when they’re starting to walk, they fall and they hit their upper lip and it bleeds and the frenulum breaks on its own. So why do a procedure now as a baby when odds are it’s going to break on its own? And if it’s still there as they get older, you can deal with the dentist or doctor.

Dr. Nathan: Interesting. Let’s switch gears and talk about reflux. Right. So this is something that is a lot of parents are dealing with or need to deal with in a sense. So what are we talking about here with reflux? Like what is it and why is it a problem or when is it not a problem?

Dr. Jay: So, as I tell mothers, all babies have reflux. There’s some element of reflux in all newborns. The question is how to deal with it. You know, babies spit up. That’s normal. All babies spit up. As long as they’re not spitting up to the point where they’re not being nourished properly and they’re not gaining weight properly, then it’s a problem. Sometimes babies are so uncomfortable and they’re arching their back and they’re in pain at the end of feedings, after feedings, and they’re not gaining properly. That you could possibly pin on reflux and sometimes anti reflux medications will help.

I find for the most part, anti reflux medication don’t work so well because most babies don’t need to be treated for it. There are different ways you can address spitting up, especially, you know, in the newborn period. Positioning is generally very successful. You keep the baby more upright after feedings, aggressively burp the baby’s, you know, positionally keep them in a bouncer after feeding sometimes if you find they’re spitting up. But if a baby is gaining well, not in too much distress and pain, not arching the back, then I try and convince mother, you know, it’s reflux, I want medication. Relax. You don’t need medication. Let’s see how the baby’s gaining. Babies gaining well up until now. So let’s just try and manage it conservatively without medication.

Dr. Nathan: Is reflux, is it different for babies who are breastfed versus bottle fed? Is it more common in one versus the other? Or is it just sort of baby- specific?

Dr. Jay: Well, yeah, it’s baby-specific.

Dr. Nathan: Because I know there are like formulas that sometimes people switch to if their babies are, you know, I don’t know, having more reflux or more trouble.

Dr. Jay: Yeah. There are certain things that you can do besides the positioning. There’s, you know, gentle, more gentle, these types of formula that maybe babies will tolerate better. But I’m not a big fan of, you know, every time the baby sits up to switch a formula like some other like, oh, he’s not tolerating. Okay, so we’ll switch from similar [inaudible 00:34:26] sort of the same thing. Oh, I want to go on soy. Soy is also, you know, it’s more constipating. But I mean, you know, some people talk about, you know, over the counter, like so like gripe water, right? And you’ve heard of that, right?

Dr. Nathan: Yeah, sure.

Dr. Jay: Gripe water sort of like a home remedy. It decreases supposedly stomach acid with the ARBs and sort of like, calms the baby down. Then there’s these Mylicon drops, which is over the counter, Simethicone, which doesn’t necessarily help with reflux, but could relive back the gas symptoms of reflux? And, you know, they asked me a lot of times, is it bad to put the baby to sleep on the back with this reflux in the base? I generally recommend back or side to sleep. I mean, that’s a recommendation of the American Academy of Pediatrics. I know they’ve flip-flopped on it over the past 20 years, but now they’re back to back to sleep.

And I like to recommend also, especially for the babies that are spitting up more, sometimes they get these little triangular wedges that you could put. And so you have the baby sort of on the back, but on the side. So if the baby’s spit up, it doesn’t go straight down, it could go to the side. And pacifiers are good. I like pacifiers. As long as you know, when to take them away. But pacifiers are also good. You know, good thing to help babies suck.

Dr. Nathan: They’re good for reflux, you mean?

Dr. Jay: Yeah. Sometimes it keeps the baby. It sort of stimulates that like peristaltic, you know, digestive function in babies. So it keeps things moving in the right direction, as opposed to from stomach to the esophagus. If they’re sucking it, it sort of brings things down.

Dr. Nathan: Interesting. And then if babies do need… Actually, I was going to ask you, gripe water, wasn’t it first invented to traditionally have like bourbon in it? And that’s why it would suit the babies?

Dr. Jay: Could be. No one puts bourbon in now.

Dr. Nathan: Yeah, not anymore. But I think Google went all sort of, what? That’s why it worked. That’s good for them. I’ve tasted the gripe water. It’s pretty pepperminty.

Dr. Jay: Yeah, yeah, yeah. But I also tell them sometimes chamomile tea also is good.

Dr. Nathan: If babies do need treatment for reflux, the treatment is what? Just like an antacid and it’s just in like a liquid form you give to them? Or put in the milk or pacifier…

Dr. Jay: I mean, we used to use Zantac a lot, but it was recalled in babies. So in the last several years, we haven’t used that. Generally used Famotidine or Pepcid. Generally the first go-to anti, you know, H2 blocker. And then, you know, if they need something stronger, I like to say, you know what, it’s really not working and you’re really getting frustrated, it’s not been successful and you really are upset. And then I send it to a pediatric GI. And they could either start them on something stronger if they believe it’s necessary, or they could maybe look for certain rare things that could be going. But usually it’s not…it’s just standard reflux. Sometimes I put them on stronger medication and then, you know, we just follow the weight gain. Babies generally outgrow it. So that’s a good thing.

Dr. Nathan: Yeah, I was going to ask…

Dr. Jay: Not like adults.

Dr. Nathan: Yeah, I was going to ask when they [crosstalk 00:37:25.407]

Dr. Jay: Not like adults. Usually by nine to 12 months.

Dr. Nathan: Nine to 12 months.

Dr. Jay: You know, adults, once they get reflux, they’re on medication for life. So but with babies, you know, they generally outgrow it. I tell the mothers when they go into first grade and kindergarten and they’re not popping Pepcid and Zantac. Well, we try to say, you know, don’t worry about it. They’ll be fine.

Dr. Nathan: You know, I was going to ask you sort of like on the back end, as we talked about sort of, the concerns people have when they are either new parents, have a new baby or whatever it might be. When does that for people who are, you know, in the beginning, in the throes of it and they’re having anxiety or dealing with it, what is typical in terms of when parents sort of get it? They sort of figure it out and they know their baby and it just sort of all comes together for them. Is that usually within a week, a month, six months? What on average, like when you have people who are really worried about their kids feeding, when does it sort of go away, those worries?

Dr. Jay: You know, if everything medically is okay with the baby and there are no major feeding issues generally by a month or two, they’re in, you know, good swing and good routine for first time babies. You know, once you get two, three, four, generally depending on the baby, they’re pretty automatic. Right. We say it’s like riding a bike. You get back on, one, two, three and usually it’s fine.

Dr. Nathan: Yeah. Unless the unless the kid throws you for a loop.

Dr. Jay: Right. Right. Unless there’s something, you know, major draw on this issue or major… But, you know, just your regular healthy baby. Everything usually clicks by a month or two.

Dr. Nathan: Awesome. Jay, thanks for coming on and talking about newborn feeding.

Dr. Jay: Great speaking to you.

Dr. Nathan: Yeah, we’re going to do this again. We’re going to find some more reasons to bring you back on so we hang out.

Dr. Jay: You pick the topic and we’ll do some coffee.

Dr. Nathan: All right. Thanks a lot.

Dr. Jay: Okay.

Dr. Nathan: Thank you for listening to the Healthful Woman podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in Healthful Woman is intended for educational uses only and does not replace medical care from your physician. Healthful Woman is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.