Pediatric Pulmonlogist and Pediatrician Leila Yoonessi, M.D. answers your most commonly asked questions about early allergen introduction and discusses why she recommends Ready, Set, Food! to parents and her patients. Ready, Set, Food! is proud to have the support of 1,000+ doctors who recommend our evidence-based approach to early allergen introduction.
Childhood food allergies seem to have increased dramatically since my childhood, why is that?
I’ve seen the rise in food allergies firsthand in my practice with many of my pediatric patients suffering from one or multiple food allergies. There are many theories as to why 1 in 12 children suffer from a food allergy today, including:
Hygiene Hypothesis - The lack of microbial exposure or in other words, lack of exposure to germs and/or allergens in childhood can weaken the immune system towards the development of allergy, with many studies supporting this theory. Therefore, by exposing your child to germs and/or allergens, that exposure can strengthen your child’s immune system and in turn, can help fight off the development of illnesses and food allergies.
Vitamin D Deficiency - There is research that suggests that infants with low vitamin D levels may be more likely to have egg or peanut allergy compared to infants with normal vitamin D levels.
Delayed Exposure - The landmark LEAP study not only demonstrated that introducing allergens early is vital but also that delaying exposure to allergenic foods can put your baby at a greater risk for developing allergies to those foods.
What do you tell parents of babies with eczema?
All babies are at risk for developing food allergies, as over 50% of children who suffer from one or multiple food allergies have no family history of food allergies. However, there are some important risk factors that can put your child at a greater risk for developing food allergies, including eczema.
Eczema: Where there are other risk factors for developing a food allergy, eczema is the most important risk factor to consider. Up to 67% of infants with severe eczema and 25% of infants with mild eczema will develop a food allergy. That’s why new guidelines from the AAP and NIH on early allergen introduction are specifically focused on infants with eczema as these infants need early allergen introduction the most.
Family history: Research suggests that if you have a sibling with a food allergy, your risk of developing one is 13%, compared to 8% in the general population (or 1 in 12 children).
Delayed Exposure: Delaying the introduction of allergenic foods into an infant’s diet can increase their risk of food allergies. Research has shown that introducing allergenic foods like egg and peanut into an infant’s diet around 4 months of age can significantly decrease their risk of developing food allergy.
If my baby or toddler is allergic to something, what type of reaction should I be looking for?
It’s important to note that in the three landmark clinical trials (LEAP, EAT, PETIT) on early allergen introduction with over 2,000 infants who participated in those studies, there were zero cases of severe allergic reactions. This underscores the inherent safety of early allergen introduction. In addition, there is new research that indicates that if you introduce allergens to your infant (under a year of age), there is no risk for anaphylaxis based on survey data collected from all the oral food challenges that took place at the Children’s Hospital of Philadelphia and Vanderbilt University between September 2016 and February 2019.
However, parents should be still aware of the signs of an allergic reaction, which in most babies will appear as hives and/or vomiting. Other mild to moderate symptoms include swelling of the face, lips, and eyes.
Learn more about the signs of an allergic reaction from the American Academy of Pediatrics: https://youtu.be/QpnJQayDaj0
Why do you recommend Ready, Set, Food!?
There are new USDA Guidelines for Infants and Children that recommend introducing allergens such as peanut and egg starting at 4 months of age. Since many 4 month old babies are not developmentally ready for solid foods at 4 months of age, Ready, Set, Food! allows families to follow the new research and guidelines on food allergies by introducing allergenic foods in a bottle so that all babies can benefit from early allergen introduction. It’s important that parents follow these new guidelines because if every parent introduced allergens early and often, there would be 200,000 fewer cases of food allergies in children. That’s a significant difference in the quality of life and health for thousands of children and that’s one of the reasons I recommend Ready, Set, Food! at every 4 month well visit.
About Dr. Lelia Yoonessi: Dr. Leila Yoonessi is a pediatric pulmonologist practicing in Long Beach, CA. She practices pediatric pulmonology and general pediatrics. Dr. Yoonessi holds a BA in psychobiology with a minor in religious studies from Occidental College. She graduated cum laude and was awarded a psychobiology departmental award for her academic achievements. She then studied at the University of Southern California where she earned Master’s in Public Health with a concentration in health care promotion. She went on to complete her medical degree at New York Medical College. She relocated to California to rejoin her family where she completed her pediatric residency at Los Angeles County University Southern California. She is currently a board certified pediatrician who has several research interests. Publications include Progression and Prognostic Indicators of Bronchial and Alveolar Disease in Children with Sickle Cell Disease, and Environmental factors contributing to lung function and growth velocity decline in Sickle Cell Disease. Above all, she remains committed to patient advocacy, research, integrative work, medicine, preventive medicine, holistic health, and non-profit work. Dr Yoonessi enjoys horseback riding, hiking with her 2 Shiba Inus and camping for fun.
Understanding Pet Therapy: Pet therapy is any kind of interaction between a person and a trained animal. It is used with the goal of helping a person cope with and recover from health and mental challenges. The therapy goals can be about physical therapy, therapy for seeing eye dogs, and even therapy for elderly that are lonely, depressed and people suffering from anxiety and post traumatic stress disorder.
Dogs and cats are most common, but benefits have been experienced with fish, guinea pigs, horses and other animals. Depending on the type of therapy needed, the type of animal chosen depends on the patient’s goals.
Pet therapy is becoming more and more common due to the benefits experienced by patients. For elderly living at home, having become widowed, depressed or no longer feeling useful, animals provide unconditional love and help patients feel purposeful and may even give them a will to live.
Pet therapy has proven to be more beneficial with more healing properties, both physically and mentally, than many medications. With these benefits and basically no downfalls, pet therapy is growing and becoming more and more common in many long term facilities and in home therapeutic environments. As the owner of a home health care agency, I am and will continue to suggest the use of animal therapy with almost all of our patients…Pets rule!!
Are 4D Ultrasounds Safe?
4D ultrasounds are just as safe as 2D and 3D and scans since there is no form of radiation.
The rise in temperature depends on the duration of the scan and the acoustic power of the ultrasound device. However, research shows that the elevation in temperature is safe and within acceptable range.
So yes, these ultrasounds are safe. The lack of radiation is a major key to this fact.
What’s the difference between 2D, 3D and 4D ultrasound?
2D ultrasounds generate a flat, black-and-white image of the fetus.
With a 3D and 4D ultrasound, you can see the baby in three-dimensional images. The most significant difference between 3D and 4D ultrasound is that 4D provides a “live stream” video of the baby’s images.
When is the best time to get an ultrasound?
We would recommend having the 3D/4D ultrasound performed between the 26th and 34th week of the pregnancy for a single visit. However, excellent images of your baby can be obtained any time after about 24 weeks of pregnancy
How early can you determine a baby’s gender?
Ultrasounds done between 18 and 22 weeks may identify the gender of the baby.
How long does the ultrasound take?
An appointment is usually around 30 minutes.
Does insurance cover the 4D ultrasound?
Unfortunately, most insurance companies do not cover elective ultrasounds. Since this 4D is an elective procedure and is not intended to be a replacement for your doctor ordered ultrasound, it is likely you will need to pay the cost of this ultrasound as an out of pocket expense.
Call us to learn about our 4D ultrasound scan offerings.
Dr. Shari Carroll is a Diplomate of the American Board of Pediatric Dentistry. In addition to owning and operating her own dental practice, Dr. Carroll is also an instructor at the pediatric dental residency at Children’s Hospital of Los Angeles. She has worked for almost 10 years exclusively treating infants, young children, and children with special needs both in the office and in hospital settings.
I spend quite a bit of time discussing teething with parents at my practice. This is one of the reasons the Academy of Pediatric Dentistry recommends bringing your baby to the dentist by 1 year of age. I compiled a list of common questions I usually discuss with parents on their first visit.
When should I expect teeth?
There are so many charts out there showing when baby teeth come in. I usually caution parents that every child is so different and they follow their own schedules! The average age is between 4-6 months for the first tooth to come in.
Is my baby teething or is it something else?
Just because we can’t see a tooth popping in, doesn’t mean your baby isn’t teething. Babies can feel the teeth move in the jaw bone way before we see it. I usually recommend to just treat teething symptoms and see if it makes your baby feel more comfortable.
What are typical teething symptoms?
Drooling, chewing on fingers, low-grade fever, diarrhea, night waking, and a decrease in appetite.
What is the best teething tip?
Most baby’s don’t love frozen teething toys. I recommend using any toy your baby does like to put in their mouth and place in the refrigerator for 10 minutes for instant relief. I also love a cold washcloth for a baby to chew on.
When will be done with teething?
Most children will get all of their baby teeth by 2-3 years old.
To find out more about Dr. Shari Carroll, visit her website at www.redondobeachkidsdentist.com/ and follow her on instagram @drsharicarroll.
When should you start sleep training?
Good sleep practices can start as soon as your baby is home from the hospital. This can include optimal sleep environment, using light and dark to teach day and night, using safe sleep practices to reduce the risks of SIDS, and more. I help with all of this in my services, no matter which package you chose. As for formal sleep training, it can start any time after 4 months old as this is when a baby is cognitively ready to learn independent sleep. I always like to start at this age because you can get ahead of a lot of bad habits. That being said, I work with kids up to 5 years old, so it’s not too late if you have a toddler who needs help. I simply adjust the methods we use to suit the appropriate age and specific sleep struggles that child is facing.
How long does sleep training take on average?
When I start with a new family, I always ask them to carve out 2 solid weeks to stick to the plan I provide as closely as possible. This means for those 2 weeks, no travel or house guests that might throw off the plan I am providing. Those first 2 weeks are very important for being as consistent as possible to get your baby used to the changes and to settle into the new structure we are providing. After those 2 weeks, if we have achieved the desired results, parents can start to make slight adjustments as they see fit. Some methods take longer than others, and some kids are more resistant than others, but I have yet to meet a family that I couldn’t get significant results in 2 weeks with the parents being fully on board and consistent. (**knock on wood!!**) Also something to note, nights fall into place much faster than naps. So it’s normal to see great progress in nights first, and for naps to linger a bit longer before falling into place.
Should you let your baby “cry it out”?
A lot of people assume that the term “sleep training” automatically means letting your baby cry it out. This is absolutely not the case. Cry it out can be a very effective method when it is used properly. However, there is a lot more to this technique then just leaving your baby in a crib all night no matter how much they cry. In order for this method to work, you have to set the baby up for nighttime success by having the day structured in the correct way. This means the baby has to have enough feeds at the optimal times, the age appropriate number of naps, proper nutrition, optimal sleep environment, age appropriate bed time, a strong wind down routine, etc. I never recommend letting a baby cry it out unless you have done your research and know what you are doing, or are working with a certified sleep consultant who can help you. I also only ever use this method if the parents are fully on board with it, I never want the parents to feel uncomfortable with anything we are doing while working together.
How do the different sleep training methods differ?
There are a handful of different methods when it comes to sleep training. I like to explain sleep training as sort of a spectrum of methods. On one end of the spectrum you have cry it out, which is a hands-off technique that produces quick results but can be emotionally hard on parents depending on their personalities and parenting styles. On the other end of the spectrum we have the very hands-on methods that involve staying in the room and tending to each cry with either touch, voice, or picking up. And there are a few techniques in the middle of the spectrum that are a little more to one side or the other. It’s also possible to combine different techniques, or even to start with one and then progress to another if needed. No one method works for every baby or every parent, but that’s why working with a certified sleep consultant is so amazing, because I can match the method to you based off the intake questionnaire that you fill out for me. If you want to try a different method then what I suggest, that’s fine. I’m here to get you the desired results you ask for, no matter which method you are most comfortable with.
How can I prepare for sleep training before we start?
In the information I provide my clients, I give them everything they need to know before getting started. The most important thing we work on before starting is making sure that the sleep environment is optimal for good sleep. This means we review things like white noise, temperature, sleep attire, light and dark, sleep props, and more. We want to set your baby up for success, so having the most conducive sleep environment is crucial. If baby has their own room, or if they share a room with a sibling, or if they are in a crib/bassinette in mom and dad’s room, we can make it work. Also, I always like my parents to talk to their pediatrician first to get their blessings to start sleep training. I feel like this is a little extra comfort for the parents to know that what they are doing is beneficial and their child is ready.
Because I write about maternal and children health for a living, friends around me like to consult me on this topic: “Can I eat fish during pregnancy?” “What women from Szechuan eat when they’re breastfeeding since you can’t have spicy food when nursing?” “What can I give my baby for constipation?”
Well, guess what, many times I don’t have the best answer. I’m a mother myself, and I often fail to persuade my own 6-year-old to eat mushroom. Sounds ironic, but it’s true.
Recently I had an interesting conversation with Dr. Leila Yoonessi, the pediatrician at MY Pediatrics. She is expecting a baby in one month (congratulations, Dr. Leila!) and she told me that she sometimes consults Internet on what not to eat during pregnancy.
I laughed because I could totally relate to her experience! The information is much needed for every mom, even if you’re a medical professional or a seasoned health journalist. In light of National Breastfeeding Month—which is August every year—we decided to write down the most common myths and truths around what to avoid while breastfeeding for reference of all the moms who wish to nurse, or just anyone who cares about breastfeeding moms.
A friend once told me she chose formula over breastmilk because she “just can’t help having coffee, tea and chocolate.”
That is one of those myths that many mothers believe are true—if the mother drink coffee or tea, her milk does more harm to the babies than formula.
The truth is, it is safe to have caffeine while breastfeeding as long as the mother doesn’t over do it. When caffeine enters the mother’s bloodstream, a small amount of it, usually less than one percent, ends up in her breast milk. The caffeine amount in her milk peaks a couple of hours after she consume it.
Since a newborn’s body can’t easily break down and get rid of the caffeine, it may accumulate in his system. At about three months, the baby will begin to process caffeine more efficiently, and over time it will become easier and easier for him to excrete it.
Experts agree that a moderate amount of caffeine, which means no more than 300 milligrams per day, or the amount in about 16 ounces of brewed coffee, is fine for nursing moms and should cause no changes in most babies’ behavior.
Yes, there are certain herbs and natural remedies that nursing moms should avoid for they might decrease milk supply: sage, sage tea, peppermint candies, menthol cough drops and other foods/teas with large amounts of sage, peppermint or menthol. Sage and peppermint are sometimes used by nursing mothers to treat oversupply, or when weaning.
The amounts of these herbs used in cooking are unlikely to be of concern; it’s mainly the larger amounts that might be used therapeutically that could pose a problem. However, it is reported that some moms have noticed a decrease in supply after eating things that contain sage and peppermint, so it is recommended nursing that moms use these herbs with caution.
While some herb might decrease milk supply, there are several herbs that help milk supply. Although there is no efficient lactogenic study that approves the efficacy of using herbs to increase supply, thousands of years of experience suggest it’s safe and helpful.
Some of the herbs that most commonly used to help enhance breast milk production are alfalfa, blessed thistle, fenugreek, fennel and goats rue. Mothers can use them by adding to food, taking capsules or sipping teas.
There is no reason that breastfeeding moms should avoid dairy products unless there is an allergic issue. However, nursing moms should keep in mind that food protein induced allergy can happen to exclusively breastfed infants.
Many confuse allergy with tolerance. There is a difference. A true food allergy causes an immune system reaction that affects numerous organ in the body. It can cause a range of symptoms. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems.
The most common foods implicated in food allergies in breastfed infants include cow’s milk, egg, soy, wheat, peanuts, tree nuts, fish, shellfish and sesame seeds. While cow’s milk protein (CMP) is the most common food allergens in young children, only two percent of children four years old are allergic to CMP. The severity of a food reaction is generally related to the degree of a baby’s sensitivity. Most children will gradually grow out of it: less than 0.5 percent of adults are allergic to CMP.
In one word: unless there is an allergic situation, nursing moms don’t have to avoid dairy products. And the allergic situation is rare: only happens on one in every fifty infants.
by Lindsay Pettit
I recently had the pleasure of talking with Dr. Leila Yoonessi on the topic of creating fun, intellectually stimulating crafts with children. The information I received is wonderful because you can apply it to any craft idea you have! I asked her a few questions I had come up with, and here is what she had to say! Keep reading on after to find a little mini unit I did with my girls that implemented the strategies Dr. Yoonessi taught me!
The first question I asked was what types of things make a craft intellectually stimulating. Some of the things she had mentioned was to include problem solving skills and reinforcing confidence in the child. Something as simple as, "That's so cool how you came up with that!" can be such a confidence and self-esteem booster. She also said to let their creative juices flow! Let them be creative. Personally, I feel there is a time and a place for structured play and art time, but I also LOVE having unstructured time, too, where their creativity can really soar! One final thing she mentioned to stimulate the brain is actually AFTER the craft is done, and it's in helping to clean up! Dr. Yoonessi states that having the child help sort and put things back where they belong afterwards is a very important component!
Next, I asked what sorts of outside stimuli can help to create a more intellectually stimulating environment. This first thing Dr. Yoonessi said was that you really want to engage the five senses. This is also important because it develops mindfulness in children and helps them to focus their mind and energy. You can include things like aromatherapy and music to stimulate their brains. She did say to be careful of allergies when including scents and that for music, classical is a great option! Taking them on a walk and opening them up to their surroundings is another example she gave as a great way to engage multiple senses at once in preparing them for craft time.
One really interesting topic we discussed was a child's space and the effect of color on their brains. I brought up the fact that I see a lot of playrooms that are very color neutral, with lots of blacks, whites, and greys. I asked if she felt that this hindered creativity in children. She did mention that a child's space should be bright and colorful, because that is what children are drawn to and that we shouldn't project our color preferences on children. They are naturally drawn to bright and colorful objects and spaces. It was a question I had been very curious about, myself, so I was glad to hear her opinion on the matter. I love the idea of a neutral color space (my house is pretty much all black, white, and greys, but we made our playroom bright and colorful! Children need that burst of color for creativity!). I love that their whole play environment is intellectually stimulating!
Here is how I implemented what I learned!
After hearing from Dr. Yoonessi, I quickly got to work coming up with some ideas that involved the strategies she taught me, and I especially was excited to incorporate some outside stimuli. With the current buzz of the Superbloom all around us, I decided to create a craft around that. I focused on all five senses and built my idea around the topic.
First, I started with touch. I created some "petals" out of different colored felt so that the girls could engage their sense of touch with the softness of the petals. If I had more differing types of material on hand (such as silk), I would have included that, as well!
Next, I focused on sound. Dr. Yoonessi reminded me that classical music is great for stimulating the brain. I used to listen to classical music all the time when I was studying for finals in college! So I played a little classical music to introduce it to the girls, and then I also incorporated "Golden Afternoon" from Alice in Wonderland (the song where the whole garden of flowers sings), because I'm a Disney mama!
In turning to smell, I decided to diffuse some energizing, floral scents in my diffuser. I loved having a floral smelling environment as we worked on our floral crafts!
Sight was catered to simply in the diverse colors of the felt petals and in the color selection for coloring the flower stems and remainder of the paper.
Lastly was taste. I tried hard to get creative using this sense, but I didn't want to do anything TOO crazy or fancy, as I wanted to make this easy and accessible for all. So, I decided to keep with the whole plant theme and served them up some fruit flavored water. I just simply added orange slices to a pitcher of water!
For me, the biggest takeaway I got from Dr. Yoonessi was engaging the senses when doing a craft (or really, anything!) with a child. Engaging all the senses creates a really memorable experience for the child. This is definitely something I will be incorporating more into our play and art time!
Thank you, Dr. Yoonessi, for giving me your time to speak with you on such a fun topic! I know your work will have a positive impact by all who work with you!
For more information on Lindsay Pettit and her tips as a mommy of two, follow her blog: Keeping Mommy Life Simple, or follow her on social media @lindsaypettit15.
By: Penny, On The Go OC
Talking with Dr. Yoonessi I felt that My Pediatric & Respiratory Care Clinic has the priority of families and children at the top of their list.
Health and wellness within daily lifestyle is important to my family and Dr. Yoonessi was so energetic and passionate when speaking to me about how important health care and honesty to her patients is to her.
Health care honesty seemed to come up often in our conversation. Dr. Yoonessi made it clear that she desires, strives and works daily to be a trusted resource in and to the community.
Since she specializes in respiratory care but has a passion for all pediatrics Dr. Yoonessi has some major cute plans!
With bigger dreams to bring an all inclusive integrated treatment center with many facets and resources under one roof it is easy to be excited for the next level of care she wants to provide.
Dr. Yoonessi and I talked about special needs and Autism specifically. I shared with her that my son is on the Autism spectrum and very high functioning. I also let her know of a few concerns, questions and uncertainty I had but that I wanted help with.
She was more than willing to share her own thoughts and expert experiences as well as point me in the direction of more resources and go to materials to extend my knowledge on what I needed for what I was asking.
Interviewing Dr. Yoonessi (I do this with any Dr. or medical professional I may send my kids to) made me feel like I have known her for a while.
An instant connection with a medical professional who was listening to me, hearing my concerns, helping me with what my children may need and offering extended resources.
Dr. Yoonessi has a great knowledge on sensory and special needs and expressed to me how early intervention for any delay is key. I couldn't agree more as a mother of a child with Aspergers.
Dr. Yoonessi completed her master's in Public Health and is very community driven. Community is key to her. She provides community outreach programs monthly and to support not only the children with healthy diets and such but with families as well providing health educational classes too.
I really appreciate that Dr. Yoonessi is inspired to continue her dedication to community health and wellness.
Dr. Yoonessi continues to research topics in children's healthcare important to her as well as studying certain things that affect pediatrics.
It was a pleasure chatting with Dr. Yoonessi and I love that she is an animal lover too. Horses and dogs have come to share her heart with her love of children.
Compassion and empathy are important to her and it shows in all aspects of her life.
If you didn’t make it by our Grand Opening this weekend, here’s a little bit of what you missed! High quality video and lots of stills to come!
We were overjoyed to share the benefits and restorative power of yoga with my patients on Wednesday July 12, 2017. We all want to provide our youth with the tools and guidance to find their path in addition to dealing with obstacles and challenges. Moments like this help me find higher meaning and purpose in the work I do. America's video is so inspiring and I am thankful to be a part of this inspiring journey!
Community baby shower sponsored by Health Net and Dr. Leila Yoonessi provides new parents with educational presentations, surprises, gifts and resources to pregnant mothers. Dream Big Baby Shower strives to promote awareness of eco-friendly, baby friendly and breast friendly resources. Mother’s possess the capacity to create, nurture and transform the community. The baby shower was inspired by the vast need for honest, reliable, and trustworthy sources of information. Dr. Leila Yoonessi a local pediatrician and pediatric pulmonologist who wants to inspire and motivate community members to connect in a meaningful way.
Community partners include: April from Cover My Heart, Space 853, Rhythm Superfoods, Breastfeed LA, Space 853, Neil Med, Twin Z Pillows, His Resting Place, Claris Health, Black Infant Health, Yogalution and Fit 4 Mom.
The event will be on Thursday, July 13, 2017 from 10 AM to 2 PM. The location is the swank, stylish and modern Space 853 located at 853 Pine Avenue Long Beach CA 90813.
Contact:
Leila Yoonessi, MD MPH. FAAP
1040 Elm Avenue Suite 301
Long Beach, CA 90813
lyoonessi@gmail.com
Fit and Fun Support Group with Nike!
Had a blast playing soccer with our group!
