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Holiday Hours

Christmas Week

12/23 —– Open all day for sick visits ONLY,

Christmas Eve —– Open from 8am to 12pm for sick visits ONLY,

Christmas Day ——– All offices are closed,

12/26 —— Open all day for sick visits ONLY,

12/27 —— Open all day for sick visits ONLY,

New Year’s Week

12/30 —– Open all day for sick visits ONLY,

New Year’s Eve —– Open from 8am to 12pm for sick visits ONLY,

New Year’s Day —– Open at Lorton for sick visits BY APPOINTMENT ONLY,

1/2 —– Open all day for sick visits ONLY,

1/3 —– Open all day for sick visits ONLY,

When our offices are closed, you may still reach our on call nurse service by calling 703 436 1200, press option 2

We wish you and your family a happy and safe holiday season!

Feeding through the ages Part 1 & 2

Part one – newborns

I will start the discussion with infants.  Breast feeding is clearly best for numerous reasons, and we are strong advocates.  That having been said, if breast feeding is not for you, for whatever reason, in America today you will not be harming your child if you use formula. If you are unsure whether you want to breast feed or not, start off doing it, as you can always switch to a bottle later, while it is hard to do this the other way around.

To establish breast feeding, frequency is probably the most important factor.  Feeding for shorter periods every 2 hours is more helpful at getting milk flowing than marathon feeds every 4.  We recommend trying to feed 10-12 times per day (every 2-2.5 hours), 10 minutes per breast, and then ‘topping off’ for a few more minutes if the baby is still hungry.

Breast milk does not come in for a few days, during which time your baby will lose weight, up to 10 % or so in many cases.  This is normal, and not a cause for concern.  Well-meaning family and friends may suggest giving a bottle to the baby ‘just in case’. This is not necessary, and can interfere with breast feeding.  There are some medical indications for supplementing, but let us help decide that.

If you choose formula, there are a wide variety from which to choose, for gas/fussy/spit up and so forth.  All of the formulae nowadays are nutritionally complete (low-iron ones are no longer out there), and I am not convinced that there is much more than marketing, rather than science, that goes into these.   I therefore do not recommend any particular brand.  Along those lines, I have no problem with generic formula, which is often made by the company that produces brand names, and can be the same, except for the label.

Lastly, a word about gas and spitting up.  Just about all babies spit up some.   We may suggest changing formula, or the maternal diet, to see if that helps, as this is simple enough, and safe to do.  However, it will usually not work.  Most spitting up is due to the baby themselves, not the diet, and one waits for it to be outgrown.  As long as the baby is comfortable and gaining weight (a ‘happy spitter’), this is a laundry problem and not a medical one.

Part two- starting solids (4 months to one year)

When to start solids has varied over the years, but current thinking is as follows.  First, a healthy breastfed baby can be exclusively breast fed until six months of age, and a bottle-fed baby does not need solids until they are consistently taking 32 ounces of formula a day.  Second, however, a baby is developmentally ready for solids at around four months of age, in that they have the tongue and lip movement skills and co-ordination to safely take pureed foods.  Therefore, you may start solids at this age, if you wish.

Traditionally, rice cereal was the first food given to babies in this country. However, it is perfectly okay to start with whole grains, fruits, or vegetables.  We actually prefer not to begin with rice cereal nowadays, as there have been reports of arsenic in baby rice cereal; there is no evidence that this causes harm, but with other options out there, it seems prudent to start elsewhere (barley and oatmeal are other cereal options).

Whether to begin with fruits or vegetables first is not a question for which science has an answer.  Either is fine in my opinion, just be sensible – creamed spinach is not a good starting choice.  With a new food, it should be introduced in pure form, not mixed with other foods (you want the baby to learn that bananas taste like bananas, and not like oatmeal).  Your baby will let you know how thick to make it (they will spit it out or sputter if it is too thick), and how much they want; when they are full, they will get bored and stop eating.  Do not make them finish a meal.  Introduce only one new food at a time, for two reasons:  one, if they are allergic, I only want to have to worry about one possible food, and two, they do not always like a food right away.  If a food is rejected, offer it for several days in a row (but do not force it), and they will usually come around.

The most important point about early feeding is that it be fun:  it is for the experience, not the nutrition. Feed the baby in a relaxed manner, at a time when you are not rushed, and when you can fully engage with them – no TV in the background, no texting, etc.

The major change in infant feeding over the last years is when to introduce ‘allergic’ foods.  The recommendation had been to postpone this for years, but evidence shows, that, with peanuts at least, delay actually predisposes to allergies.  There is no reason to think that this will not be true with other foods.  Therefore, starting at six months of age, you can start to introduce your baby to a wide range of foods:  meats, eggs, peanuts, dairy products, etc.   Exceptions would be if there is a child or strong family history of eczema, in which case you should talk with us first about this.  The only foods we do not recommend before one year of age are pure cow’s milk, and pure honey (foods with cooked honey are acceptable).

You can advance the texture as your baby is able to tolerate it.  From experience, I know that most babies go from stage 2 to chewable table foods and often skip stage 3. If a food is soft/crumbly and not a choking hazard, the baby can have it regardless of teeth.  Major chewing is done by molars (front teeth are for ripping), which do not come in until after one year.

Lastly, you can start to introduce a sippy cup at around six months of age, as your baby will need to come off the bottle at around one year.  For breast fed babies, water is a fine choice for the cup.

 

Provider of the month!

Dr. Santhi Nair earned her undergraduate degree from the George Washington University and her medical degree from Ross University School of Medicine. She completed her Pediatric Residency and Chief Residency at Crozer Chester Medical Center in Pennsylvania. She went on to work as a Faculty Physician at The Children’s Hospital of Philadelphia for 2 years before moving to Virginia. She worked at The Community Health Center of the Rappahannock Region in Fredericksburg for over 8 years before joining All Pediatrics in Sept 2018. She works primarily at the Lake Ridge and Lorton offices.

 

Some fun facts:

My  family moved to the United States
 from Kerala, India when I was 5 years old. I am conversant in Malayalam.

I grew up in Alexandria, VA and I went to high school at Thomas Edison High School.

I met my husband while I was in medical school. We now live in Spotsylvania, VA.

We have two sassy daughters who keep us on our toes every moment!

We love hanging out with our large extended family/friends that live in the DC/VA/MD area.

I am one of the founding board members of the Doctor Yum Project, a local non-profit whose mission is to bridge the link between food and your health.

My favorite pastimes are cooking, gardening, traveling and experiencing different cultures with my family.

As far as I can remember I have always wanted to be a pediatrician. I am honored to have the opportunity to care for our future when they are well and sick- it  is very humbling. My passion is promoting preventative care and nutritional counselling for my patients and their families in a supportive and sensitive manner.

I am happily accepting new patients and  look forward to meeting you

Provider of the month!

We are proud of our physicians and nurse practitioners. We want to highlight some fun facts about our providers so that you can get to know them better. Dr. Amisha Armwood is our May provider of the month!

Dr. Amisha Armwood earned her undergraduate degree from the University of Pennsylvania and her medical degree from New York University School of Medicine. She completed her residency at New York Presbyterian-Weill Cornell in New York City and practiced general pediatrics for four years before moving to Virginia. Dr. Armwood practices primarily at our Lorton location.

Some fun facts:

My husband and I met in D.C. years ago, moved to NYC for a while, and are now settled in Virginia.

We have two young children who are full of energy and make me laugh every day.

I have a miniature Australian Shepherd who, if he had it his way, would rather sunbathe by a window than take a walk.

I spend most of my free time with my family — exploring our neighborhood, museums, and parks.

I love practicing pediatrics because I thrive on providing support, encouragement, and evidenced-based care for families when children are both well and sick. I am particularly interested in breastfeeding and healthy eating.

I am happily accepting new patients and can’t wait to meet you!

Welcome to our new Lactation Consultant!

We are excited to announce that we now have a certified lactation consultant on staff! Ashlee Brown will have appointments at our Lorton location on Tuesday, Wednesday and Thursday! To learn a little bit more about Ashlee, keep reading.

“First and foremost, I’m a wife and a mom to two sons. We spend a ton of time outside! I’m also Kentucky native who graduated from Eastern Kentucky University in 2013 with my BS in Biology. Since moving to Virginia in 2017, I have completed 90 hours of breastfeeding education, and I just finished a 500 hour clinical internship program in lactation at Prince William Medical Center in Manassas. There, I worked with four IBCLCs and gained both inpatient and outpatient experience. During my year at the hospital, I also worked as a health educator teaching childbirth, newborn care, breastfeeding, and infant CPR classes. Navigating the early postpartum period can be hard for parents, so I want to do everything I can to make it a little easier for them. That’s why I’m so excited to be a part of the ALL Pediatrics team!”