ASK DR. MAX
An ongoing list of the most common questions I get from patients and supporters. This is meant to serve as general education not clinical medical advice. Submit your questions at the bottom of the page!
Please note- questions are aggregated and answered on a monthly basis.
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Diaper rash is caused by skin irritation from exposure to urine and stool. It’s similar to the irritation you might feel from wearing wet socks all day. To prevent it, use a good emollient like our Baby Balm to seal out moisture and change diapers when wet or soiled. For longer periods without a change, like overnight or during outings, use a thicker diaper ointment. We love our Diaper Ointment because it lasts through the night. The key is to apply Baby Balm or Diaper Ointment after every change to protect the skin and keep moisture at bay.
Cradle cap is a common condition in newborns caused by rapid skin growth and shedding, sometimes complicated by a harmless fungus. While it’s not painful or itchy, it’s also not cute. To treat it, apply our Baby Balm twice a day to soften the dead skin, then gently exfoliate in the bathtub with warm water and a soft washcloth. With consistency, the cradle cap should clear up in a few days.
Breastfeeding and pumping can be tough on your nipples, causing cracks, chapping, and sometimes even bleeding. Prevention is key. Start applying Nipple Balm a few times a day starting around 35 weeks gestation to build elasticity and skin integrity. Once breastfeeding starts, use a Nipple Balm after every feed to help with recovery and prevent injury. Choose an all-natural, baby-safe balm so you don’t need to constantly clean it off before feeding.
The short answer: rarely, unless necessary. You don’t need to bathe your newborn unless they’re truly dirty—like after a blowout, excessive spit-up, or a milk spill. Bath time can also become a soothing part of your evening routine, signaling the transition to bedtime. By 6 weeks, babies start to associate this routine with sleep.
Otherwise, just wash your baby when needed. Always use a gentle, all-natural moisturizing baby soap to keep their skin soft and avoid harsh chemicals.
There are 5 main reasons infants wake up at night, and hunger isn’t usually the first one. So before reaching for the bottle or breast, take a moment to consider these possibilities –
- Discomfort from stool or urine
Sleeping in a wet or dirty diaper is uncomfortable, and babies may wake up just needing a change. Using a thick diaper ointment helps create a barrier between their sensitive skin and the diaper. Our Diaper Ointment lasts through the night to help your baby stay asleep for longer. - Trouble connecting sleep cycles
Like adults, babies cycle between light and deep sleep but don’t always know how to connect the lighter cycles. Give them a few minutes to settle before rushing in to soothe them. - Startling themselves awake
Babies often hit or scratch their faces while moving, which can startle them awake. A gentle touch can help them fall back to sleep. - Hunger
Of course, sometimes they’re hungry. But often, hunger is the last thing on the list. If your baby is big enough, they might sleep through the night. Constantly offering milk can create a sleep association, leading them to wake up looking for more.
The first step to improving your baby’s sleep is giving them time to figure it out on their own. When they stir, move, or cry slightly at night, pause for a few minutes. They might be connecting sleep cycles or just need time to work through discomfort, like gas or a poop. Allowing them to self-soothe from birth—rather than waiting until they’re 6 months old—can help them develop better sleep habits.
In my experience, babies around 12 pounds should be able to sleep through the night (12 hours). Every baby and family dynamic is different, but a 12-pound baby has enough energy reserves and stomach capacity to go without feeding for a full night stretch.
If your baby has a fever, they may look flushed or sweat, but they might not always "feel warm." Sweating can make their face feel cool due to evaporative cooling, while their core temperature remains high. The most accurate method is a rectal thermometer, though it can be tricky with infants. If that’s not possible, try an oral thermometer while your baby is sleeping, so they keep it in long enough for an accurate reading. Ear or forehead thermometers can also work, but they often show lower temperatures. For example, if an ear thermometer reads 101, your baby definitely has a fever. If it reads 99 but your baby feels hot, they may still have a fever
Infants can poop anywhere from 7 times a day to once every 7 days. Constipation is based on stool consistency, not frequency. As long as the stool is soft, there’s no cause for concern.
Teething signs include drooling and fussiness, but these aren’t always definitive. The best way to tell is by gently feeling their gums. If they have a strong chewing reflex and you can feel teeth coming through, they’re teething. Typically, teeth start appearing around 6 months, with the bottom middle teeth first, followed by the top middle teeth, and eventually the molars by 24 months. While it’s rare for a 3-month-old to teeth, a 9-month-old is much more likely to be
Hiccups are completely normal and common in infants. They occur when the diaphragm is irritated, often because the stomach is close to it. Babies aren’t bothered by them, so there’s no need to worry. However, you can try walking or burping your baby to help relieve the hiccups.
The umbilical stump, which connects the baby to the placenta, typically falls off by day 10. It may smell like rotting flesh, but resist pulling it off—let it fall off naturally. If it hasn't detached by day 21, consult your doctor. Once the stump is gone, give the area a few days to dry before giving your baby their first bath.
Feeding on demand is ideal, so there's no need to stick to scheduled feedings. Trust your intuition—it’s key to understanding your baby’s needs. When your baby cries, try not to rush to feed them immediately. Babies have many needs besides hunger. See “Why does my infant keep waking up at night?” for more on this. While babies will often take milk when offered, it’s best to first try soothing them in other ways. Over time, you’ll recognize the different types of cries and better understand when your baby is hungry versus when they just need comfort.
Here are general guidelines for infant feeding:
- 0-2 weeks: Feed every 1-3 hours, 1-2 ounces at a time.
- 2-4 weeks: Feed every 2-3 hours, 2-3 ounces at a time.
- 4-8 weeks: Feed every 2-4 hours, 3-5 ounces at a time.
- 8-16 weeks: Feed every 3 hours during the day, transitioning to every 6-12 hours (1-2 feedings) at night. Offer 4-7 ounces, depending on your baby’s needs.
Most importantly, track your baby’s growth with your medical provider. As long as they’re following their growth curve, they’re doing great!
I recommend casually introducing solids between 3 and 4 months, then more deliberately between 5 and 6 months. Studies show that introducing foods like peanuts or eggs by 4 months can reduce the risk of allergies. So, around 3 to 4 months, if your baby is reaching for your food, let them try small bites of mashed food like egg, peanut butter, or avocado. While they won't have the skills to swallow, gumming the food can help expose their immune system and prevent allergies.
By 6 months, it’s time to start spoon-feeding and including your baby in family mealtime. It will be messy—food might be spit out or tossed—but it's all part of the learning process.
First, I hear you—this is incredibly tough. The constant crying can feel overwhelming and soul-crushing. If you’re on the verge of losing it, take a moment to collect yourself. If you have a partner, have them step in. If you’re alone, place your baby in a safe spot, step away, and take a few minutes to calm down. It’s crucial to never take your frustration out on your baby, including shaking them. Sleep deprivation and constant crying can test your limits, but your well-being matters too.
When babies are fussy, they often need to feel the comfort of the womb. You can recreate this with the 5 S’s:
- Swaddle – Wrap them tightly to feel secure.
- Side – Hold them on their side while swaddled.
- Shoosh – Create white noise with a loud “shh” or a vacuum/blender.
- Sway – Gently rock them back and forth.
- Suck – Offer a finger, pacifier, bottle, or breast.
When you visit the doctor, a basic cholesterol check is often done, and you’re told you’re "fine." However, this typically misses the preventative side of healthcare. By the time your cholesterol or hemoglobin A1c (diabetes) levels are elevated, damage has often already occurred. Here are some essential labs to request annually for early detection:
- Insulin Levels and Fasting Glucose: These can help measure your HOMA-IR (Homeostatic Model Assessment for Insulin Resistance).
- hsCRP (High-Sensitivity C-Reactive Protein): This is an inflammatory marker linked to cardiac disease and may be elevated before atherosclerosis develops.
To boost your metabolism, focus on Zone 2 aerobic exercise (getting your heart rate to an aerobic level) for at least 150 minutes a week, combined with weight lifting to build muscle. To calculate your target heart rate for Zone 2:
(220 - your age) * 0.65
Example for a 40-year-old: (220 - 40) * 0.65 = 117 beats per minute.
The key to a healthy diet is eating whole, unprocessed foods. You can follow a vegan, vegetarian, or paleo diet as long as it's based on whole foods. I recommend these principles:
- Opportunistic omnivores: Humans are meant to eat a variety of plants, nuts, and animal proteins.
- Go organic: Choose foods from organic and regenerative farming practices when possible.
- Avoid processed foods: Anything with unrecognizable ingredients or excessive packaging is best avoided.
Adults should aim for at least 7 hours of high-quality sleep each night for optimal health and functioning. This isn’t always possible in the early days of parenting but is a good benchmark to try to work towards.
Our anatomy is prone to back pain, mainly due to having just five lumbar vertebrae to connect the upper and lower body, which puts strain on the bones and discs. This leads to issues like herniated discs and chronic pain.
To prevent this, strengthening the core—especially the psoas muscles—is key. These muscles support and align the lower back. If you have back pain, start with exercises that engage the psoas to improve stability.
The best ways to support your immune system are getting adequate sleep (at least 7 hours), staying hydrated with clean water, and eating a nutritious diet of whole, unprocessed foods. These foundational habits support overall health and immune function.
Headaches can be categorized into three main types, each with its own causes:
Tension headaches
These are often triggered by musculoskeletal strain in the neck muscles. Good posture and proper ergonomics—like how you sit, lift, and carry—are key to preventing them.
Cluster headaches
Insomnia, circadian rhythm disruptions, and abrupt elevation changes are the primary triggers.
Migraine headaches
Diet, hormones, stress, and dehydration are common migraine triggers.
To support gut health, avoid processed foods, as they contain preservatives that can disrupt the microbiome. Incorporate probiotic-rich foods like sauerkraut, miso, and other fermented options. Also, steer clear of added sugars, which promote harmful bacteria like candida.
Start slow to avoid injury. The key is patience—getting to your fitness goals takes time, but pushing too hard early on can cause setbacks. Countless patients have come to me with injuries from going too hard after not exercising for too long, and then are held back from exercise for months while they heal.
If your goal is to eventually run 30 minutes, 4 days a week, here’s a simple progression plan:
- Week 1: 3 days, 10 minutes each day
- Week 2: 3 days, 15 minutes each day
- Week 3: 3 days, 20 minutes each day
- Week 4: 2 days, 20 minutes; 2 days, 25 minutes
- Week 5: 4 days, 25 minutes
- Week 6: 4 days, 30 minutes
This gradual approach helps build endurance without risking injury.
On average, adults should drink 12 cups (about 3 liters) of water daily. This can vary based on exercise, climate, and how much you sweat.
I recommend focusing on how your child looks, not just the fever number. If they’re eating, drinking, and seem okay, it’s usually fine to let the fever run its course. However, if the fever exceeds 103°F, I’d consider treating it, and definitely if it hits 104°F.
On the flip side, if your child has a fever of 101°F but seems miserable and won’t drink or eat, I’d give a low dose of Tylenol to help them feel better and stay hydrated.
You should see a doctor if your child has a fever lasting more than 7 days, appears very sick, or you're simply concerned. If the cough is persistent or worsening, it’s also a good idea to consult a healthcare provider.
Toddlers' pooping patterns can be erratic, often influenced by diet, social changes, or emotional development. The key is to check the consistency of the stool. If it’s soft, a few days without a poop is usually fine. However, if the stool is hard or resembles small pellets, your child is likely constipated. Constipation is common in toddlers, especially during transitions like daycare or potty training. To gauge whether it's a concern, take a look at the stool before wiping or flushing.
I’m sorry to hear this! When your child gets a bug bite that results in a rash, it’s usually a condition called papular urticaria. This is an allergic reaction where the body releases a large amount of histamine, causing swelling, redness, itching, and sometimes even mild hives or a low-grade fever.
The good news is that most kids outgrow this reaction as their immune system matures. In the meantime, be patient. If you know your child will be exposed to bugs and want to prevent a severe reaction, giving them an antihistamine like children’s Zyrtec before exposure can help minimize the reaction.
Hives are different from anaphylaxis, which involves throat or tongue swelling and difficulty breathing—a true emergency. Hives, however, are less severe and usually don’t require a doctor’s visit. You can manage them with antihistamines like Zyrtec or Benadryl. If one isn’t working, try another, as kids may respond differently to each.
Asthma medications fall into two categories: rescue and preventative. Rescue inhalers are for active symptoms, while preventative inhalers are used daily to reduce the need for rescue inhalers.
Asthma often fluctuates, triggered by allergens or illnesses like colds. Certain times of the year, like during pollen season, may cause flare-ups, while other times your child might be symptom-free. If you notice asthma flares after a cold, you can use the preventative inhaler for a few weeks following that illness. It’s important to time preventative inhalers based on when you anticipate asthma will worsen, such as during cold and allergy seasons.
Pediatric visits often focus on developmental milestones, including cognitive, gross motor, and fine motor skills. However, these visits are brief, and you may not have time to discuss concerns, like your baby not rolling over by 6 months. The truth is, babies reach milestones at different times and may have bursts of learning or growth. Some babies develop strong cognitive skills and speak early, while others may take longer.
My advice is to avoid comparing your child to others and trust your child’s unique development. I once had a 3-year-old patient who didn't speak at all until he suddenly began speaking four languages (English, Russian, Spanish, and Armenian) perfectly. Remember, developmental progress isn't always linear.
Contrary to popular belief, soft surfaces like rubber mats aren’t ideal for helping babies learn to walk. They make it harder for kids to maintain balance. A firmer surface, such as compacted grass or dirt, provides the best stability with some cushion for falls.
Encourage "cruising," where your baby holds onto furniture for support while walking. Place objects at their eye level to motivate them to reach and move toward them—this promotes walking rather than reinforcing crawling.
Ultimately, your baby will figure it out on their own. It's all part of natural development!
To boost language development most scientific evidence recommends you speak to your child in full, complete sentences, and narrate daily activities. Encourage them to repeat words, but avoid baby talk or incomplete sentences. Children often understand more than they can say, so treat them as if they fully comprehend what you're saying. This helps expand their vocabulary and communication skills.
Potty training depends on your family’s situation. Toddlers with older siblings or in daycare typically train earlier than those without. Parents also play a big role—potty training requires exposure and teaching long before the actual training begins.
To start, your toddler needs to be able to walk to the toilet, and you’ll need a toilet they can use. Beyond that, it’s up to you and your family. Some toddlers, like 15-month-olds, are fully potty trained (except at night).
I believe parents should create screen-free zones with their kids, which means no screens for either of you. It’s important to practice intentional screen-free time together. Screens themselves aren’t inherently bad, but how we use them, especially with adolescents on social media, can lead to behavioral and developmental issues like ADHD, depression, and anxiety.
For toddlers, boredom is essential. They need to find entertainment in simple things like a stick, a shadow, or a book. Constant entertainment isn’t necessary. That said, intentional, educational screen time can be beneficial. There’s a difference between screen time for entertainment and screen time for learning, and the latter can be great when used purposefully.
This is a common challenge. Ideally, for the first month of your newborn’s life, it’s best to limit exposure to illness by keeping the toddler home from daycare or preschool, especially if your baby was born in the winter. Babies under 4 weeks old with a fever are at risk of requiring hospitalization and IV antibiotics, even for a cold.
If keeping your toddler home isn’t possible, focus on boosting their immune system with good nutrition and supplements like zinc, vitamin C, and elderberry. Encourage frequent handwashing and ensure they shower when they return home.
It’s tough, but with some precautions, you can minimize the risk. Good luck!
Food intolerance differs from allergies in that allergies are easy to test for, while intolerances require more specialized testing. We often recommend keeping a dietary log to track how you feel after eating different foods. By reviewing this log, we can pinpoint potential triggers. While we all wish for a simple test, the variety of foods makes it impossible to test for every possible intolerance. Monitoring your symptoms is the most effective way to identify what may be causing discomfort.
You'll get different answers from doctors, parents, and medical providers, but here’s my take. Ibuprofen (Motrin, Advil) is an NSAID, meaning it reduces inflammation, while Tylenol (Acetaminophen) does not. Both help reduce fever and relieve pain, but ibuprofen is better for treating inflammation—like a knee injury in adults or teething in kids.
For fever, both work well. If you're in significant pain—say, after breaking a wrist—you can take both Tylenol and ibuprofen since they act differently. I usually recommend starting with Tylenol for mild pain or fever, using ibuprofen for musculoskeletal injuries, and combining both if the pain or fever is severe.
Burns from water are generally less severe than those from oil. Water loses heat quickly, while oil retains it, making oil burns more prolonged and often more serious. For example, a burn from boiling water cools quickly, while one from hot oil can cause more lasting damage.
Burns are classified by their depth and severity, which helps determine the appropriate treatment and when to seek medical attention.
1. Superficial Burns (First Degree)
- Characteristics: Affects only the outer skin (epidermis). Skin is red, dry, painful, but no blisters.
- Common Causes: Sunburn, brief contact with hot objects, mild scalds.
- Treatment: Cool with cold water for 5 minutes, then apply a healing salve or emollient. Our Salve-All or Diaper Ointment works great!
- When to See a Doctor: Usually heals within a few days, but seek care if:
- The burn covers a large area (e.g., an entire limb or face).
- Signs of infection (increased redness, swelling, pus, worsening pain).
- Pain is severe or worsening.
2. Partial-Thickness Burns (Second Degree)
- Characteristics: Affects the epidermis and part of the dermis. Skin is red, swollen, blistered, and painful.
- Common Causes: Scalds from hot liquids, prolonged contact with hot objects, chemical burns.
- Treatment: Run cool water or apply a cold, wet washcloth for 15 minutes. Apply Salve-All and cover with a dressing. Don’t break blisters for at least 3 days.
- When to See a Doctor: Seek medical care if:
- The burn is larger than 3 inches.
- It involves the face, hands, feet, groin, major joints, or large areas.
- Signs of infection appear.
Pain is unmanageable with over-the-counter medications.
3. Full-Thickness Burns (Third Degree)
- Characteristics: Affects both the epidermis and dermis, possibly deeper tissues. Skin may appear white, charred, leathery, or waxy. Burns may be painless due to nerve damage.
- Common Causes: Prolonged exposure to flames, electrical burns, scalds from boiling liquids, severe chemical burns.
- Treatment: This is a medical emergency. Do not apply water or home remedies. Cover with a sterile, non-stick bandage and seek immediate medical care.
When to See a Doctor: Always. Third-degree burns require emergency treatment, potentially including skin grafts.
4. Severe Full-Thickness Burns (Fourth Degree)
- Characteristics: Extends beyond the skin, affecting muscles, tendons, and bones. Area may be blackened or charred.
- Common Causes: High-voltage electrical burns, prolonged flame exposure.
- Treatment: Life-threatening emergency. Call 911 immediately.
- When to See a Doctor: Always. Fourth-degree burns require urgent intervention.
Most supplements are safe while breastfeeding. For example, prenatal vitamins are recommended both during pregnancy and postpartum. In general, anything you took during pregnancy is usually fine to continue while breastfeeding.
Yes, you can! Just avoid bringing your baby into the sauna with you. The main concern is dehydration, as it can impact your breastmilk supply.