Monthly Archives: June 2016

Breastfeeding for guys. I get it. You don’t have boobs. You can still help.

O.K. Dads here the deal: It’s 2AM, you have your new 2 day old baby at home for the first time, you’ve had 2 hours of sleep in the past 2 days, your kiddo isn’t latching on 2 mom well, tears of frustration are starting to well-up in her eyes and you have 2 seconds to figure out what to do before Mom, baby, and you start to lose it…. what do you do??

Terrifying? Yup. Been there… but don’t panic. If you weren’t trained for this before, I’ll help walk you through it.

Through my own trial and error, and pumping my wife for feedback, I have compiled a couple helpful tips of do’s and don’t that will help you breastfeed.

Tip 1: Consider breastfeeding a team sport with the mentality that you are both breastfeeding.

My wife really found it helpful for me to just be there, as an extension of her. Breastfeeding put an enormous amount of pressure on my wife. After all, breastfeeding is supposed to be natural and the best form of nutrition for your baby… to not succeed gave her feelings of not only failure as a mother, but also that the baby isn’t getting what’s best. Breastfeeding can be a very onerous responsibility, with the pressure of letting the three of you down. The more you make the act of breastfeeding seem like a team sport, the less guilt and burden she will feel when things don’t go so well (which usually is bound to happen). Hopefully you have some paternity time off that first week. I really do suggest waking up for those first few breastfeeds with your wife until things start going smoothly. Now, the question becomes, what to do while she is breastfeeding?

Tip 2: Make like Jeeves and wait.

I’m thinking that origin of ‘waiting on tables’ and thus, a ‘waiter’ probably stems from the responsibility to just stand-by, be patient, and ‘wait’ until given something to do. You don’t have breasts, so you have to find other ways to be a part of this breastfeeding team.

Here’s a couple pearls:

–          Keep a LARGE water glass full of cold water. My wife was ALWAYS thirsty, and really pretty parched for water. (I thought this was curious, so I looked it up. Guess what? Scientific article “Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation.”1 or in other words, baby sucking makes you thirsty). You will find that Mom is so focused on breastfeeding that she really can’t just press pause get things like a glass of water. In fact, with this one, don’t wait for her to ask, just keep a cold glass full by her side. She will notice and thank you.

–          She probably forgot to grab the remote control, lanolin cream, burp cloth, or tons of other little things before she sat down and got things started. Again, interrupting breastfeeding is really tricky for her. Be there to help get these things.

–          Impromptu shoulder rub. Just do it. She won’t mind.

Tip 3: You can over do it.

Yeah, I was feeling a little cocky. I went to the breastfeeding class. I followed around lactation doctors while in residency. I watched the lactation nurses work with my wife in the hospital. I’m IndyPedsDoc for crying out loud! I can be such a bonehead. Your wife does need you to be there emotionally and even physically… but she isn’t a cow that wants to be milked. Its one thing for a lactation nurse to manipulate her breast, but you are her teammate, and doing these things can make her feel as if she isn’t doing it right, and that you could do better. Leave her breasts alone unless she asks.

Tip 4: Reinforce that she is your hero

Especially during those late-night feeds when the latching isn’t going well and she asks, on the verge of tears, ‘What am I doing wrong?” or “Why isn’t he latching?” I found the best thing to do was kiss her on the forehead, maybe hand her a kleenex, and offer words of encouragement (check out my earlier blog with a note from our lacatation nurse for some easy tips that will help). You might have a tip that you remembered during your breastfeeding class, but again, don’t let her think that you could do better, or that she is doing things wrong. If things are really getting strained, it might be best to take a break and have her take a shower or nap, and call the lactation nurse in the morning. Remember: all babies are equipped with extra fluid on board until mom’s milk comes in, which means losing a little weight those first few days is normal. You can remind her that a newborn’s stomach is about the size of a big marble, so as long as the baby is peeing a few times a day, the baby is probably getting everything it needs.

Good luck Team! You are going to be great.

1) James RJ, Irons DW. Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation. , Clin Endocrinol (Oxf). 1995 Sep;43(3):277-82.

Gun Safety? Get real.

8/8/2013: My IndyStar published response to the awful news from Anderson, Indiana:

I can’t write an article every time a child is needlessly killed by a gun. If I did, I would probably have to quit my job due to the time commitment involved. Just in the last six weeks, in central Indiana, three kids have been accidentally killed. The latest fatality, however, emphasizes a point that we just can’t seem to grasp: THERE IS NO 100% SAFE WAY TO STORE A GUN.

The guns were hidden (in a closet).

The guns were locked away.

The bullets were separate from the gun.

The gun was unloaded….almost.

One bullet, unknowingly and accidentally left in the chamber, is what stands between a 13 year old honor student from going back to school today, shot yesterday by his 10 year old brother.

But we still don’t get it.

The Anderson Police department has called the case ‘a perfect storm of unlikely scenarios,’ musing that “had (the bullet) been in another chamber, it would have dry fired. The odds are just really unbelievable.” They are pleading with area residents to please keep your guns safe, even offering free gun locks.

Unbelievable odds? Nope. They are possibilities. Possibilities of your child getting killed. What a stupid game to play.

I am sick for this family. They have been given the delusion by gun advocates, and even the Anderson police department, that there is a safe way to store guns around children. There isn’t. Are there safer ways to store guns? Who cares?

Once again…

1) A gun kept in the home is 43 times more likely to kill someone known to the family than to kill someone in self defense.

2) A gun kept in the home triples the risk of homicide

3) The risk of suicide is 5 times more likely if a gun is kept in the home

Please stop kidding yourself, and each other, that there is a safe way to keep a gun in a home with children.

In case you missed it (I never do), here’s the opening line to Katie Couric’s syndicated talk show last week:

(spooky voice, eerie music) The HPV vaccine is considered a life-saving cancer preventer… but is it a potentially deadly dose for girls?


I used roll my eyes at such irresponsible attempts at sensationalism, but I can’t anymore, not after Jenny McCarthy took to daytime TV to spout her unproven theories blaming autism on vaccines. Like Katie Couric, the TV shows that invited Jenny McCarthy (‘Larry King Live,’ ‘The Doctors’), supported the topic under the innocent banner of a ‘conversation.’

The problem, however, is when in one corner you have two teary eyed mothers (or the pretty, charismatic Jenny McCarthy), and in the other, a scientist giving objective data, science loses EVERY TIME.

The consequences of losing these talk-show ‘conversations,’ unfortunately, are not inconsequential. We are still reeling from the effects of Jenny McCarthy’s media campaign, in which kids unnecessarily got sick, and important dollars were diverted from meaningful autism research.

For the record, we are talking about a medicine that prevents cancer. For all the research, money, and media attention that go towards cancer research and treatment, nothing comes close to the holy grail of medicine, that is prevention.

Here’s the boring objective stuff. HPV isn’t just an unsightly wart. Annually, it is estimate to cause1:

  • 2,100 vulvar cancers,
  • 500 vaginal cancers,
  • 600 penile cancers,
  • 2,800 anal cancers in women,
  • 1,500 anal cancers in men,
  • 1,700 oropharyngeal cancers in women, and
  • 6,700 oropharyngeal cancers in men

And, by the way, its safe:

As a whole, we pediatricians were embarrassingly silent as we watched Jenny McCarthy’s deadly escapade unfold. I don’t think we will let that happen again. Katie Couric, what you did is shameful and dangerous. I hope you use your platform as a respected journalist to refocus the image you created for the HPV vaccine. If not, you may see yourself the recipient of a similar dubious honor, as seen here:



Enough anecdotes. The truth about kids and guns

Media loves social experiments.  It’s the driving theme for a lot of shows, from “Let’s Make a Deal,” to the thought provoking, “What Would You Do?”

Tonight (Friday, 1/31/14) on ABC’s 20/20, hosted by Diane Sawyer, an experiment is conducted in which young children are exposed to “gun safety” programs, then observed via hidden camera to see how they would react to discovering a real gun. Their goal is to dramatically reveal the often unrealistic parental expectations of their child around guns.

Here is the preview:

I always try my best to take the findings from a television show with a heavy grain of salt. After all drama, and often sensationalism, is usually the name of the game. This program, however, is actually a replica of a study published in the respected medical journal Pediatrics back in 2001.

The background was a survey of 400 parents, who were asked if their child (age 4-12) could determine the difference between a toy and real gun, and how they would then behave with the guns. Three-fourths (74%) believed their child could tell the difference between a real gun and a toy. 74% also believed they would leave the gun alone, or tell an adult.

The experiment consisted of watching 2-3 children play for 15 minutes in a room where a real, unloaded gun was placed in one drawer, and toy guns in another (they were not told to look into the drawers). 75% of the kids found the real gun. Of these, 80% handled the gun, and 50% pulled the trigger. 90% of the kids who handled the gun, and 95% that had pulled the trigger, later revealed that they had received some sort of gun-safety training. It didn’t matter whether the child was from a gun-owning family, or whether the child had remarked earlier that he or she was ‘interested’ in guns.

Absolutely, I think it reasonable to consider the results from tonight as “made for TV;” however the results from this study are not. Please remember  to teach your child: STOP! Don’t touch. Leave the area. Tell an adult.



An email from our lactation consultant (a must read for breastfeeding parents)

Dear Sarah and Dr. G,

I am confident with some time both of you will work into breastfeeding success. Don’t give up and Be patient, both of you are learning and he needs some time to forget about his early days in the hospital (the separation from you both, constant NICU stimulation, tests, and bottle feedings).  He needs time to be at home, bonding with you both.  In this (stay at home), quiet,, no testing, atmosphere he will begin to relax and fit into that wonderful baby routine of eat,sleep, poop, pee and best of all being loved and touched gently.   Scheduling is ok right now keeping your breast happy with milk release by pumping or nursing, and making sure Henry  is fed by the 3rd hour.    Remember to time the next feeding from the moment his tummy is full.   It takes about 10 min after a feeding, and gentle burp for babies to slip into that deep sleep so they can be  placed in a crib without waking up.  That’s your goal.  Happy breasts, happy baby, happy Mommy, happy daddy.

> Try natural methods to increase your milk supply.   Diet, fluid intake, eat two servings of oatmeal a day, Pumping on a comfortably high setting with the larger flange 27mm.  Your breasts need a good 2 1/2 hour break between feedings or pumping sessions to replenish milk volumes.

>  Rest:   This is so important to your whole well being.  You can rest with baby skin to skin between feedings, as long as you do not drift into sleep.
Pump before feeding; Give the milk and baby to Daddy for food and bonding,  while you take your meds and go to bed for a good 3 hours.

>  Breastfeeding:  Choose your times to attempt a feeding at the breast, or when doing skin to skin bonding, his little brief latch on moments are good practice   sessions.  Let him explore your breasts and nipples and learn.
If pumping before a feeding: do this 20 min prior to even waking Henry ..  Pump both or one to collect 15 -20 mm per breast.   Wake Henry
Burp him, change his diaper, and bring him to your breast.  Cuddle and bond first, watch for his rooting, and see if he will latch to your bare Wet nipple.  If he
refuses, or fusses,  give him the fresh milk you just pumped,  once he takes that milk.  Then bring him back to your nipple, hopefully to continue his feeding.
You may use the shield as directed.  Apply wet, massage the breast, bringing a puddle of milk into the shield, so he gets instant reward when he sucks.
Massage your breasts as you pump and as you nurse Henry.  This keeps milk moving toward your nipple, for removal.

>  Use the tips provided in the engorgement phase management hand out.  Switch it up to make it work for you.

>  Clean pump parts, bottles, nipples, paci, shield, with hot soapy water, hot rinse and paper towel dry.  Dish washers can harbor bacteria.

Sarah,  Now that you are home with Henry,  Keep visitors to a minimum, stay in your PJ’s, Do a lot of skin to skin bonding with Henry,  Dr. G- this means you too. curl up next to Sarah and Henry in bed for some important gentle bonding time.  When it is time for sleep, Henry goes to his crib.    Both of you Sleep when baby sleeps.  Maternal Fatigue can disrupt milk production, and prompt frustration (tears).  Sarah, You have everything you need to feed your baby.  Working into nursing at the breast needs patients, practice, and confidence.   All of which you have.  You can do it.  You’re both such loving parents.  Keep me posted.  I will check with you tomorrow.

Our lactation consultant and Henry:

Carla and Henry

When it comes to guns and kids, leave your politics at the door

Perusing social media, I strayed upon this blog article posted by a friend, summarizing “something bad could always happen.” Here, a mom left her 12 year old in the car while running in to a bank. Tragically, the mother was then killed by a bank robber, while the 12 year old was unharmed. This, of course, was on the heels of recent arrests for parents that unknowingly left their children in their cars. Her point? Voicing out against laws* that infringe on our autonomy (maximum freedom, minimum government), she argues:

“There is risk in everything in life. Punishing parents who make rational decisions just because something bad couldhappen is not going to change that. Something bad could always happen.”

This popular argument always seems to come up when defending guns in the home with children.

A couple of examples:

pic1 blog

And here (in response to same article):

blog pic2

So we’re missing the point.

‘Que sera, sera’ is certainly a fun Instagram #yolo, but it makes for really lousy parenting. Yep, something bad could always happen, and accidents do happen. We accept this, and do our best to weight and minimize these risks wherever possible. Bike helmets, seatbelts, fences around pools, etc. This is ok. This is parenting. Guns are no exception. Leaving you kid in the car unattended is no exception.

Instead, some seem to suggest it’s fine to ignore risk, because ‘something bad could always happen.’ In reality, though, I think they are ignoring risk because it gets in the way of their politics. This is really selfish, and it’s jeopardizing the safety of children. And for what? The right for an adult to keep a gun in the house with children? An opportunity to decry a state law infringing personal autonomy? When it comes to protecting the lives and safety of children, we need to keep our politics to ourselves. It’s distorting our perception of risk, which isn’t fair to our kids.


*This particular case, by the way, I’m pretty sure isn’t illegal. Most laws, in the states that do have laws, pertain to children under 7, and usually only under certain dangerous situations. See here for your state’s law.

Musings on Measles

For some reason, there are more kids with peanut allergies than beforemeasles.

Peanut allergy, which can cause life-threatening anaphylaxis, is very serious. The community, in response, has adjusted their way of life to protect this minority, knowing the impact even a tiny particle of peanut can have on those that are allergic. We now have peanut free schools, peanut free airplanes, peanut free Halloween. Perhaps begrudgingly, but always understandably, we did this to protect those that can’t always protect themselves.

And now, according to this report in the journal Pediatrics,  we are seeing ‘pockets’ of communities where the decision to not vaccinate is more prevalent than most of the United States. Without vaccination rates somewhere in the 90% range, the community loses the powerful effect of ‘herd’ immunity, where even the unvaccinated are unlikely to get a potentially life threatening disease.

There are kids with cancer and autoimmune diseases that can’t receive vaccines because they are immunosuppressed. There are children under 4 that are incompletely immunized. In the midst of this growing measles outbreak, how does the community respond to protect these kids? Is your right not to vaccinate your child, the same as my right to eat peanuts next to a child with a peanut allergy? I would never do that, by the way.

I’m struggling with this one. Can someone help me out?

Why you (Yes, you) still need the flu shot

Why you (Yes, you) still need the flu shot.

  1. 45% > 0%.

Before every Flu season, a group of scientists, smarter than me and with hard to pronounce titles, meet up to try to figure out which strains of the flu will be rearing its ugly head. I honestly don’t know exactly how they do it, but suffice to say it’s more sophisticated than drawing a name from a hat or throwing darts at a board. Usually they do a good job. So far, this year they didn’t. In particular, they did not predict a “rogue” strain of flu H3N2 which seems to be wreaking the most havoc (about 45% of the H3 strains), and is not included in the vaccine. Rats! The good news: the vaccine does provide protection against some of our most popular, and deadly, strains which can pop up as quickly as this H3N2 strain. Remember “swine flu?” We got you covered.

  1. You can get sick. Real sick.

Last year, the flu caused an estimated 400,000 individuals to get sick. Annually, about 20,000 die. Who can get sick from the flu? Anyone. Yes, the elderly, very young, and those with chronic diseases like asthma, seem to get hit the hardest. But, I’ve also watched healthy teenagers die in the pediatric ICU from the flu. So far 11 children have died this season, the number will certainly climb into 100’s, like every other year.

  1. You can get others sick.

Christmas season is the season of charity and giving. But don’t give the gift of flu. That’s mean, and down-right Grinch-y.  My Pediatric Unit at Hendricks Regional Hospital is currently full of sick children and infants with the flu, some of them too young to receive the vaccine. By protecting yourself, you are protecting your community, which includes the most vulnerable.

  1. You can’t get the flu from the flu shot.

Let’s stop with this nonsense. The flu “shot” only contains part of the virus to help your body develop a natural immunity. This means creating an immune response that sometimes involves soreness around the injection shot, mild body aches, and low-grade fevers. Unlike the flu, these side-effects are well tolerated, and compared to the actual flu, will not hospitalize you or make you miss even a day of work. The nasal spray contains weakened strains that also will not cause true influenza infection, but you may short-lived mild symptoms. Again, ask anyone who has had the flu, this isn’t it. Finally, immunity takes a few weeks to develop, so it is possible to get infected after vaccination, but before immunity develops fully.

  1. It’s not too late!

As mentioned before, several viruses circulate every season, which lasts until spring time. Get vaccinated, protect yourself, your friends, and your community.


Merry Christmas and Happy Holidays!!!

Dr. Tony GiaQuinta, MD FAAP

The Cold Never Bothered Me Anyway

I read somewhere last week that you can get frostbite in as little as 10 minutes with a wind-chill of -60F.

By the way, that’s 10 minutes, not 10 seconds. Yeah, it was cold last week (cold enough to do this awesome trick), but I don’t think we got anywhere near -60F. christmas-story-5

So when dropping off my two-year old at daycare, it’s with curiosity, and a bit of judgment, that I see kids piling out of cars looking like Randy from A Christmas Story.

Are they worried about frostbite in those 10 seconds from the car to the door? Is it a fear that the cold causes the ‘cold?’ Is it plain old southern frigophobia?

Judge me all you want, but when my 2 year-old and I race across the parking lot, he may or may not have his coat on.

He definitely doesn’t have it on in the car.

You see, I feel very good about my son surviving the 10 seconds of cold from the parking lot to the door. I don’t feel very good about him surviving a car accident with his winter coat on in the car. Simple as that.

Here is a great video illustrating why. If you want to bundle your kids up like Randy outside of the car, be my guest, but I’ll tell you, my two-year-old and I have raced inside by then. Sure, expect a few mean looks from folks at the entrance of the supermarket etc. Just do as Taylor Swift does and shake it off. You’re being a good parent. More resources here.

Dr. Tony GiaQuinta, MD



My wife and I are expecting our second baby in a few months. Truthfully, I’ve probably been a little lax in my own mental preparation for taking care of two of these things.  A reality check came in the mail yesterday….

breast supplies

Oh yeah. Breastfeeding. Dear God.

A flood of memories comes pouring in. Countless little breast pump supplies needing scrubbing, breast pads as far as the eye can see, and….  AHH! Something squishy just touched my elbow!  Damn you rogue nipple shield! Really??? How can we be out of lanolin again?!?!

Buckle up, here we go!

I’ve discussed this before in my blog, but I wanted to take a second to remind all the dads, spouses, and significant others out there that breastfeeding is a team sport. I like to think of it as co-breastfeeding.

Relax bro, your nipples are safe. But you can help in other ways.

A new study in Pediatrics this month studied the impact of providing both parents with breastfeeding support information. At 12 weeks postpartum, significantly more moms in the intervention group were still breastfeeding, compared to a control group.1 Dads also felt more knowledgeable and helpful on the subject, and Moms felt more supported.

In our nursery at Hendricks Regional Hospital, I always make sure to make eye contact with both parents when talking and educating about breastfeeding, because I don’t want moms to feel like they are going it alone. It takes teamwork, and success can depend on it!

Again, read my earlier breastfeeding survival guide for dads to find ways you can help your amazing spouse/friend/girlfriend with this important endeavor. Attending a breastfeeding class as a couple, available at most hospitals, is a fantastic idea as well.

Good luck team! You’ll do great.

Dr. Tony GiaQuinta, MD



  1. Abbass-Dick J. Coparenting Breastfeeding Support and Exclusive Breastfeeding: A Randomized Controlled Trial.Pediatrics. Vol 135. January 2015.