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Letters to the Editor

Proper Car Seat Buckling

In regards to the April 2007 article "What to tell parents before they leave the hospital," I saw no reference made to the concerning photo on page 55 of the infant in the car seat. This baby should not be swaddled before buckling. The five-point harness is meant to surround the arms and the legs, to secure the baby to the back of the seat. No bedding should be behind the child. The chest buckle should be snug under this baby's chin. As pictured, this "little bundle" could fly through the top of the loose straps in an accident with enough force! I am happy to witness this in the hospital, office, or store-to offer correction for baby's safety!

Sharon McManus, DOTroy, Mich.

I enjoyed the article by Dr. John M. Goldenring. I was about to photocopy his handout, "Facts About Caring for Your Newborn," when a few of his suggestions concerned me.

1 "It is okay to supplement breastfeeding with ... water, or formula." I was trained that additional water in the newborn period is to be discouraged, due to it lacking nutritional value and the decreased ability of the newborn kidneys to process free water. Electrolyte imbalances can occur if too much free water is given.

2 "Give more formula or water if the baby is not having at least one stool daily, or is straining to have a bowel movement." I like to limit this to two ounces of water twice a day for infants. I like to know about straining in the newborn, especially if breastfeeding, to determine proper intake or any concern for anatomical problems.

3 "Diaper rashes may be treated by applying a combination 1% hydrocortisone cream combined with antifungal cream." This combination has fallen out of favor, due to steroids usually worsening a candidal rash. I have families first try barrier creams like Desitin and antifungal creams. If there is no improvement in several days, I will advise a few days of sparing application of hydrocortisone cream.

Pamela Mouser, MDFederal Way, Wash.

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