Dr. Maller’s Blog

So your baby’s a year old or so and doesn’t need formula any more. What are your options?

First of all, let’s talk delivery systems. Since my patients often breast-feed for a long time, they may be unfamiliar with the bottle or even with formula. Taking Baby off the bottle may be a challenge, but the sooner you do it the better, for several reasons. Using a bottle after a 12-15 months is unnecessary, and may cause major problems such as tooth decay and ear infections. “Nursing bottle mouth” is more than a cosmetic issue; it can ruin the permanent teeth and even lead to life-threatening infection. There’s another reason I push for no bottles, despite resistance from grandmothers, babysitters and parents; it’s an opportunity to establish who’s boss. Learning to parent effectively involves a series of confrontations. It’s my job to help you anticipate and deal with them.

A new device just came on the market called a “Tilty Cup” which enables the baby to drink from a training cup without getting into the “chug-a-lug” position. I make a point of introducing a cup early in infancy so as to make the baby’s transition easier.

The nutrition aspect deserves detailed attention. Despite uniform insistence on whole milk for babies one to two by the government and its assorted experts, I have always recommended 2% milk, and here’s why. True, fat is important for a toddler’s brain growth. However, a baby fed whole milk is more likely to reject other foods and to become iron-deficient. It’s time to focus on the “4 basic food groups”, only one of which is dairy. Moreover, there are healthier sources of fat such as olives, nuts, avocado and even eggs. Parents rarely object to this reasoning if it’s explained. We have obesity rampant all over our country, government wringing its hands, lawyers preparing to sue fast-food companies, and yet we know that prevention is the only useful approach. Fat babies may be “cute” (I was one) but I prefer “lean machines”.

Now you may be thinking, “Does this doctor really think he’s smarter than the U.S. government?” I have a 1940 book published by the Childrens Bureau (I’m not making up that name) instructing parents on nutrition, toilet training and other issues. Almost everything in it is wrong! Committees of experts (and they are smart folks) get together regularly to tell doctors what to tell their patients and parents about vaccinations, nutrition, sex, guns, drugs and so on. Trouble is these decisions seem to be made (like most government stuff) in a vacuum devoid of common sense. I’ve worked in such bureaucracies. There is a dangerous combination of arrogance and elitism afoot. Ordinary people are assumed to be irresponsible, ignorant, and worst of all, independent and therefore needing to be told what to do.

I’ve stayed in solo practice almost all my career largely because I love being my own boss. Would I get away with recommending 2% milk if I were in government service or at a clinic? Would I defer certain vaccinations as long as possible so they’d be more effective (as I learned at CDC) and get away with it? No, and thereby hangs a tale. When the chickenpox vaccine came out in 1995, I chose to give it at age two because the research had been done on that age group, and the 12-month recommendation was based on those factors described above and not on sound medical science (let’s nail those babies as early as possible because they won’t show up later). After a dozen years it was found that kids vaccinated at age 12 months had significantly poorer immunity than those immunized when older. Meanwhile I’ve had to lower my age for varicella shots to 18 months because I was getting dinged by the insurance companies and government health plans because my patients were “out of compliance”.

Yep, those brilliant government types who’ve been so successful with Fannie Mae and Freddie Mac, the Dept. of Education, the Post Office and the DMV are slowly but surely taking over the practice of medicine. Don’t you feel better already?

This entry was posted on Sunday, January 4th, 2009 at 7:56 pm and is filed under General. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.