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Daily Dose

Breastfeeding

1:30 to read

August is National Breastfeeding Awareness Month as well as World Breastfeeding week. The theme this year is “Sustaining Together”  which means getting a mother’s “community” around her to help her with her breast feeding.  In my mind this means getting the father involved in being there for his wife, followed by the hospital nurses in the nursery, the lactation nurse if your hospital has one, your pediatrician and then any close family members who may be involved in helping a new mother.  

 

Although breast feeding is “a natural process” it sometimes takes one baby or mother or both a bit longer to “figure out” the latch, how to hold the baby comfortably for a feeding and how to be successful with breastfeeding. One of the first hurdles is assuring a new mother that she is “not doing it wrong”. While there may be some tips…there is not ONE WAY to breastfeed.  At times too much pressure from outside influences may actually cause more anxiety and I often find myself telling a new mommy that it just takes “practice, practice, practice…you cannot mess this up on day #1!!”. 

 

But, for some new mothers, breast feeding causes a great deal of  anxiety and they may need a bit more reassurance and support to hang in there and see how it goes… reminding them that a baby does not always nurse for the same amount of time, that they may eat in 2 hours one time and not want to eat for 3 hours the next. They are newborns and not robots…and  we all eat a bit more or less at different times of the day. It is hard to “schedule” a new baby’s feedings and the best advice is to try and watch your baby’s cues and cries.  While one baby may be a bit sleepier in the first few weeks,  another may wake on its own..but either way it is important to try and feed the baby every 2 -3 hours to get breast milk and breast feeding established. Lots of poops and wet diapers is also very reassuring that something is working!

 

This is where the baby’s father may be extremely helpful. He can make sure that the mother is getting “fed” as well.  She needs plenty of healthy meals and lots of fluids to ensure breast milk production.  He may also get up with the baby and change the baby before the feeding and then bring the baby to the mother to nurse.  Encouraging his wife is equally important. There are times when some of those hormonal changes in the new mother makes her feel weepy, sad or inadequate as a new parent….and he can reassure her as well. (even if he is unsure of himself - fake it a bit).  Partnering from the beginning of parenthood is important for both a father and a mother.

 

In some cases if a baby is not feeding well or the baby is premature a mother will need to pump breastmilk and offer the baby a bottle. This is tiring for a new mother and so the grandparents may also help both new mother and father and offer to help feed the baby so the parents may get some rest (which is also important for milk production) or even wash the bottle and breast pump. Every little bit will help.

 

In my experience a new mother who has a lot of support and encouragement is more successful with breastfeeding.  After the first few weeks of breast feeding the “newness” wears off and breast feeding usually seems to get easier and easier. Once parents see that the baby is gaining weight and the mother’s milk supply is equilibrating to her baby’s needs and breast and nipple tenderness is going away, many a new mother tells me how happy she is that she continued to “work on breast feeding her baby”. 

 

Lastly, there are some situations where a mother may not be able to breast feed her baby and she should not be “mommy judged” or shamed for this.  Not everyone knows a new mother’s medical history, or the reason she chose not to breast feed.  

 

 

Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Breastfeeding Anxiety

1:30 to read

I am a huge proponent of breastfeeding and having breast fed 3 babies of my own I do remember several things about “learning to breast feed”.  Now that my children are grown and I am taking care of my 2nd” generation of babies, I have decided that “we” (doctors, hospitals, lactation consultants etc.) are making breast feeding more and more stressful rather than just letting it happen “organically”, the way it has been done for hundreds if not thousands of years.

 

I make newborn nursery rounds and see new mothers within 24 hours of their baby’s birth, and then everyday until discharge. I am noticing more and more tearful, anxious mothers who are completely “stressed out” about breastfeeding and their milk is typically not even “in” yet.  So, how is it that they already feel as if they have failed, or “can’t do this”??  We have so many different people coming into their room telling them to cluster feed, not to use a pacifier or that their baby is tongue tied, and they are overwhelmed - and the baby is one day old!

 

Sometimes too much information is detrimental rather than helpful. Being a bit “clueless” and having no expectations did not make breast feeding seem stressful. A foreign sensation yes, awkward at times absolutely!!  A mother’s milk will “come in” on day 2, 3 or 4 even if you don’t cluster feed for hours at a time and even if you decide to use a pacifier. Nature has a plan….whether we do or not.

 

Just like many things in life….it is easier for some mother’s and harder for others.  Some babies just seem to latch on immediately, while others take a while to figure it out.  But, practice is the name of the game, and you cannot practice breast feeding. It is postpartum on the job training..and some mothers may need extra help and some “tutoring”. No new mother needs to hear discouraging words…encouragement and reassurance is the name of the game in the first few days after giving birth.

 

Babies are expected to lose weight after birth…but parents are now told how much weight their baby has lost and what will happen i”f they lose more than 10%”of their birth weight”. They are also told the transcutaneous bilirubin level every morning even though they “are not sure what that means”, but it is another number thrown out there to add to their worry list.  Maybe I am old school, but I tell my patients that my job is to “tell you if there is a concern”…and not have you worry about 7% weight loss on day 3 of life or a bilirubin of 10 mg/dl, so that parents can “Google” hyperbirubinemia and worry about kernicterus and brain damage. 

 

Letting a new mother get some rest while encouraging her to feed her baby every 2-3 hours while practicing different positions for latching seems to be a much more natural and relaxing method to promote breast feeding and not anxiety provoking “rules”. 

 

I do not encourage a new mother to  cluster feed for hours at a time so that her nipples are already blistered, bleeding and painful,  before even leaving the hospital. I also let her know that it is not abnormal for breast feeding to be a bit “painful” , and for her breasts to feel engorged as the milk “comes in”. There are lots of new “feelings” going on in the initial postpartum days, including all of those raging hormones!

 

So…try to relax, enjoy your baby and not et overly anxious about “breastfeeding” correctly…as one way does not fit everyone. 

 

 

 

 

 

 

 

 

Daily Dose

Fussy Babies

1:30 to read

I have written a lot about fussy infants, spitting up and gastro-esophageal reflux (GERD). The diagnosis of GERD in infants in the past 10 - 15 years has soared….especially in irritable infants some of whom arch their backs and act as if they are uncomfortable while feeding (both breast and bottle fed babies) and spit up frequently,  to those who are diagnosed with “silent reflux”. 

 

When new drugs came to the market for adults with GERD, initially H-2 blockers like Zantac (ranitidine), Pepcid (famotidine) and Axid (nizatidine) they were soon prescribed for children as well. These drugs were followed by the introduction of proton pump inhibitors (PPI) which also inhibit gastric acid production, and include Prevacid (lasoprazole), Nexium (esomeprazole), and Prilosec (omeprazole).  Suddenly, younger and younger children were being placed on either H-2 blockers or PPI’s and many of these prescriptions were being written for infants under 6 months of age.

 

Being a pediatrician who had practiced for a long time and also had a incredibly fussy, irritable and colicky baby myself….I could never really decide if these drugs worked well or if “we” wanted them to work. There were some cases where it was quickly evident that the baby’s symptoms improved, while in many others the parents “were not sure”.  But, the use of these drugs has soared.

 

I have more and more young parents who want to start medication within their baby’s first month of life…”just because they are fussy”.  But there are new studies showing that the use of these medications in young children, especially those under one year, may have lasting side effects including an increased risk of fractures. In a retrospective study looking at over 850,000 children born between 2001-2013, those prescribed PPI’s had a 23% increased risk of fractures and those prescribed H2 blockers had a 13% increased risk while those prescribed combination therapy had a 32% increased risk of fractures. The risk also increased if children took these medications before 6 months of age, and there was also increased risk for those who used medications for longer periods of time.

 

Take home message for both doctors and parents….if these drugs need to be used it is preferable to limit it to one type, preferably H2 blockers and for the shortest amount of time possible. The use of other remedies including herbal remedies, thickening of feeds and probiotics should be first line treatment. When symptoms persist or are worsening and GERD is suspected, a 2 week trial of medication may be considered with ongoing discussion as to improvement in symptoms. Use the lowest dose for the shortest period of time as well.

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Your Baby

First U.S. Baby Born After Uterus Transplant!

2:30

An amazing event that could give hope to women who have been told they could never have a child because their uterus is nonfunctioning, unfolded recently in Dallas, Texas.

For the first time in the United States, a woman who was born without a uterus gave birth to a baby. The landmark birth took place at Baylor University Medical Center at Dallas, a part of Baylor Scott & White.

In an exclusive report by TIME, the details and background of this major undertaking are revealed.

The birth took place at Baylor — the first birth in the hospital’s ongoing uterus transplant clinical trial. Women who participate in the trial have what’s called absolute uterine factor infertility (AUI), which means their uterus is nonfunctioning or nonexistent. Most of the women in the trial have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome — and have lived their entire lives under the assumption that they would never be able to be pregnant or give birth to a baby. The procedure could also work for women with other medical issues, such as certain cancers.

The women in the clinical trial are transplanted with a uterus from either a living or deceased donor. The woman who gave birth received her transplant from Taylor Siler, a registered nurse in the Dallas area, who was a so-called “altruistic” living donor: a stranger who volunteered to donate her uterus to a woman without one. So far, Baylor says they’ve had over 70 women express interest in donating their uterus.

Baylor will complete a total of 10 uterus transplants as part of its first trial. So far the hospital has completed eight. At least three have failed. The hospital has confirmed to TIME that there is another woman in the trial who is pregnant, using a living donor uterus.

Baylor’s uterus transplant program is one of a handful to launch in the United States in recent years, and it’s the first to use both living and deceased donors. Successful uterus transplants from live donors have taken place in Sweden — a medical team at Sahlgrenska University Hospital in Gothenburg pioneered the first uterus transplant trial that resulted in eight births. This birth at Baylor is the first to replicate that success.

“We do transplants all day long,” says Dr. Giuliano Testa, the leader of the uterus transplant clinical trial at Baylor, and surgical chief of abdominal transplant for Baylor Annette C. and Harold C. Simmons Transplant Institute. “This is not the same thing. I totally underestimated what this type of transplant does for these women. What I’ve learned emotionally, I do not have the words to describe.”

The recipients in the clinical trial are between the ages of 20 to 35, and the donors must be between ages 30 to 60. “When you donate a kidney, you do it to help someone live longer and get off dialysis,” says Dr. Testa. “For these women, they are donating an experience.”

Once the women in the trial are transplanted with the uterus, they wait to recover and achieve menstruation, usually about four weeks from transplant. Women whose transplant is successful can then attempt in vitro fertilization (IVF). (The women in the trial have functioning ovaries that are not attached to their wombs, which is why IVF is required to get pregnant.)

Although the successful transplant and birth may give hope to many women, it comes at a steep cost. Uterus transplants are expensive, with some estimates putting the cost at up to $500,000. Like other infertility treatments, it’s very rare that an insurance company would cover the procedure, which is largely viewed as elective. Baylor covered the cost of the first 10 transplants in the clinical trial, but the medical team is now seeking funding—largely through donations from institutions and private donors—in order to continue. The team says many more transplants need to be done before it could be provided as a standard treatment. “The reality is that it’s going to be very difficult for many women to afford this,” says Testa.

Baylor says they do not view uterus transplants as a replacement for other approaches like adoption or surrogacy, but as another option for women and their partners.

Baylor will continue to follow the health of the baby as part of the study. The goal is for the birth to mark the beginning of a new field of infertility treatment research, rather than be an outlier.

For the complete exclusive TIME story you can click on http://time.com/5044565/exclusive-first-u-s-baby-born-after-a-uterus-transplant/

 

 

Your Baby

Choosing the Safest Fish to Eat During Pregnancy

2:00

As a parent or an expectant mom, you may have travelled down the same path as many others- searching for the healthiest diet for your family or soon-to-be newborn.

Fish is one of the foods that rank high on the healthy food chart. It’s frequently referred to as a “brain food” because of its brain-boosting nutrients, particularly omega-3 fatty acid. Certain fish are an excellent choice while others may contain high levels of mercury; a known toxin than can harm a developing child.

Mercury is a common seafood pollutant. This neurotoxic chemical can harm a baby’s developing brain in utero, even at very low levels of exposure.

Seas are increasingly polluted by toxic chemicals from 2 major sources: small gold mines and coal fired power plants, according to a recent report by Healthy Babies Bright Futures (HBBF.)

Mercury in a mother’s body can be transferred to her fetus during pregnancy, exposing the developing fetus to the potent neurotoxin.

The report states that millions of women of childbearing age who eat mercury -contaminated fish have enough of the toxic chemicals in their bodies to harm a developing child. “55% of the global sample of women measured more than 0.58ppm of mercury, a level associated with the onset of fetal neurological damage.” This is the finding of a new, first of its kind report on mercury levels in women of childbearing age in 25 countries by HBBF partner, IPEN: the International POPs Elimination Network

While these findings may make you wonder if any fish are safe to eat, many health experts recommend that women who are pregnant should not give up eating fish out of fear of mercury toxins, but should focus on eating fish found to be very low in mercury. These include: wild Alaska salmon, sardines from the Pacific, farmed mussels, farmed rainbow trout, and Atlantic mackerel (not trawled).  

High mercury risk fish to avoid include shark, swordfish, orange roughy. bigeye tuna, king mackerel and marlin.

The FDA and the EPA joined forces this year and released new guidelines on fish consumption for pregnant women or those who might become pregnant, breastfeeding mothers and parents of young children. To governmental agencies created a chart to help these consumers more easily understand the types of fish to select. The agencies have an easy-to-use reference chart that sorts 62 types of fish into three categories:

  • “Best choices” (eat two to three servings a week)
  • “Good choices” (eat one serving a week)
  • “Fish to avoid”

Fish in the “best choices” category make up nearly 90 percent of fish eaten in the United States. The chart can be found online at https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

The HBBF report also includes a warning about canned tuna. Limit your intake of canned tuna. While tuna is higher in Omega 3s and nutrients than most fish, the mercury levels can vary in individual tuna. Light canned tuna is recommended over white tuna; however, HBBF notes in their report that scientists found that for both types, the potential harm to a baby’s brain exceeds the fish nutrients’ brain-boosting assets.

One tip to remember is that larger fish tend to absorb more mercury than smaller types of fish. Fish should not be eliminated from any family’s diet; the benefits far outweigh the dangers. However, it’s important to choose fish that are known to be lower in mercury for a healthier outcome.

Story sources:  Charlotte Brody, RN, http://blog.hbbf.org/toxic-mercury-and-your-babys-ability-to-learn/

https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

 

Daily Dose

Head Flattening on the Rise!

1:30 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Daily Dose

Baby Bling Can Be Dangerous!

1:15 to read

I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 

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