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Your Baby

Mom and Baby Benefit by Skin-to-Skin Contact Right After Birth

1:30

Over the years, modern birth methods have changed how newborns and mothers interact with each other. Typically, the baby is cleaned up and wrapped in a blanket then given to the mother to hold. A new scientific review suggests that skin-to-skin contact is better for the mother and gives her infant a better start in life.

The review noted that women who had skin-to-skin contact with their naked babies soon after delivery were more likely to breastfeed longer and be breastfeeding months later than women who didn't have their babies placed on their skin right away.

"The more you can do to place the mother and baby together and disturb them as little possible during that first hour, the better off they’ll be," said lead author Elizabeth Moore, of the School of Nursing at Vanderbilt University in Nashville, Tennessee.

Researchers looked through medical literature and found 46 randomized controlled trials to include in their review. The trials included 3,850 women and their newborns from 21 countries. All babies were healthy and most were born at term.

"We compared those trials to usual care, and usual care was very different depending on the trial," said Moore. Trials from the 1970s may have separated mothers from their babies for hours. In more modern trials, babies might be swaddled in a blanket before being handed to the mother.

Moore and her team found evidence that babies who had received skin-to-skin contact were more likely to breastfeed successfully during their very first breastfeeding session, and they also tended to have higher blood glucose levels and stronger heart and lung function.

 “It’s just something that if at all possible should happen," Moore told Reuters Health.

Skin-to-skin contact should begin as soon as possible and last for at least 60 minutes, she said. The hour will give babies time to recover from the birthing experience, find the mother's nipple and latch on.

"It’s not something you can do in just 15 minutes," Moore said.

Not all physicians and hospitals are on board when it comes to immediate skin-to-skin contact after birth.

“I would recommend that a woman make sure she adds skin-to-skin to her birth plan," Moore said. "I think it’s a really good thing for a woman to put together a birth plan before she heads to the hospital and show it to her physicians or midwife."

What if your baby is premature or is delivered by cesarean? The researchers didn't find any benefits to initiating skin-to-skin contact immediately after birth versus after the baby had been examined and washed. They also failed to find any clear benefits to skin-to-skin contact that lasted longer than an hour.

"The evidence supports that early [skin-to-skin contact] should be normal practice for healthy newborns," the researchers wrote, "including those born by cesarean and babies born early at 35 weeks or more."

The review was published in the Cochrane Library in November. 

Story sources: Andrew M. Seaman, http://www.reuters.com/article/us-health-birth-skin-idUSKBN13V2UZ

Kenza Moller, https://www.romper.com/p/why-skin-to-skin-contact-after-birth-could-be-beneficial-for-mothers-babies-alike-24423

 

Daily Dose

Prevent SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito…rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Parenting

Breast Feeding

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 

 

Your Baby

Moms-to-be Need Folic Acid

1.45 to read

One of the best ways to have a healthy baby is to take good care of your own health.  Folic acid has been shown to help prevent certain birth defects, but now a new study suggests when a woman takes it in the first two months of pregnancy; her child may be less likely to have severe language delays.

Folic acid is a B vitamin (B9) found mostly in leafy green vegetables like kale and spinach, orange juice, and enriched grains.  It’s also available as a supplement.

American companies often add folic acid to their grains to help make sure that pregnant women are getting enough of the B vitamin.

“We don’t think people should change their behavior based on these findings,” said Dr. Ezra Susser from Columbia University’s Mailman School of Public Health in New York, who worked on the study.

“But it does add weight to the public health recommendation to take folic acid early in pregnancy,” he told Reuters Health.

And, he added, it shows that “what you do during pregnancy… is not only important for birth but also for subsequent development".

The study took place in Norway, where 40,000 women – a few months into their pregnancy- were surveyed on what supplements they were taking in the four weeks before they got pregnant and eight weeks after conception.

When their children were three years old, Susser and his colleagues asked the same women about their kids’ language skills, including how many words they could string together in a phrase.

Toddlers who could only say one word at a time or who had “unintelligible utterances” were considered to have severe language delay. In total, about one in 200 kids fit into that category.

Four out of 1,000 kids born to women who took folic acid alone or combined with other vitamins had severe language delays. That compared to nine out of 1,000 kids whose moms didn’t take folic acid before and during early pregnancy.

The pattern remained after Susser’s team took into account other factors that were linked to both folic acid supplementation and language skills, such as a mom’s weight and education, and whether or not she was married.

The study can’t prove that folic acid, itself, prevents language delay, they wrote in the Journal of the American Medical Association. But Susser said the vitamin is known to affect the growth of neurons and could influence how proteins are made from certain genes.

“The recommendation worldwide is that women should be on folate (folic acid) supplements through all their reproductive years,” Susser said.

The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — consume about 400 micrograms (0.4 milligrams) of folic acid every day. Adequate folic acid intake is very important before conception and at least 3 months afterward to potentially reduce the risk of having a fetus with a neural tube defect.

You can boost your intake by looking for breakfast cereals, breads, pastas, and rice containing 100% of the recommended daily folic acid allowance. But for most women, eating fortified foods isn’t enough. To reach the recommended daily level, you’ll probably need a vitamin supplement.

Daily Dose

Caring For An Uncircumcised Penis

I just received an e-mail from a listener asking about the care of her infant son’s uncircumcised penis. Her baby is four-months-old and she wondered how to wash the penis and if she should pull back the foreskin.

In an uncircumcised infant the foreskin (the skin that covers the head or the glans of the penis) will not really retract, and you do not want to “force” it. You should just clean the tip of the penis with soap and water while bathing the baby and over time, typically by the time a little boy is 5 years old, the foreskin will become fully retractable. Once the foreskin is retractable (as adhesions have broken down on their own) you can retract the foreskin and clean the glans (head) of the penis and teach your son to do the same thing. Seeing that we are already discussing the uncircumcised penis it is a good time to discuss the pros and cons of circumcision. The American Academy of Pediatrics (AAP) does not routinely recommend circumcision of male infants. They state that it is a matter of choice for families to make. Circumcision rates in this country are around 55 to 65 percent and are variable in different geographic areas. Circumcision may also be routinely performed due to cultural or religious preferences, or for the social reason of wanting sons and fathers to “look the same”. There has been some recent literature showing that there is an increased frequency for uncircumcised males to develop a urinary tract infection (up to 10 times more likely).  The incidence for male urinary tract infections is still low, but further studies are being done to determine if circumcision should again be routinely recommended. There is also an increased incidence for irritation, inflammation and infection in uncircumcised males, as the uncircumcised penis may be more difficult to clean. There has also been data to suggest that circumcised males have a lower risk of contracting sexually transmitted infections, including HIV. Lastly, the incidence of penile cancer (although rare) may be higher in uncircumcised males. All of these issues continued to be studied, so ask your pediatrician about ongoing data if you are trying to decide whether to circumcise a newborn boy. Like so many things in medicine, continued studies may bear new recommendations. That’s your daily dose, we’ll chat again tomorrow.

Your Baby

How Much Water Does Your Baby Need?

2.00 to read

Since most of the country is sweltering with summer heat and temperatures well into the upper 90’s and even over 100 degrees, I guess I can understand parents’ concerns about giving their babies water. It seemed like a strange question to me when I first started hearing, “Dr. Sue, how much water does my baby need to drink every day?”  I know I am continuing to talk about staying hydrated during the heat wave, but we are really talking about those children and adults who are spending time outdoors, especially when involved in physical activity.

I have actually been telling parents with newborns that there is really no reason to take that sweet new baby outside for any length of time. I think it is too hot to enjoy being outside, and an infant doesn’t miss going to the playground like a 2 or 3 year old would.

But, when you have young children you have to get out (or go crazy inside everyday), so everyone just suffers through the heat. Remember to take your sunscreen and fluids and head out for an hour or two, in the morning or later afternoon if at all possible. These children need lots of water breaks, as do their parents and caregivers.

So, back to the water and baby question. Infants in the first 6 months are getting fed breast milk or formula which is made up of free water, so therefore a baby is staying hydrated by eating every  2 -3 hours. A baby doesn’t “need” water every day for any particular reason.

With that being said, it does not mean that your baby cannot have a bottle of water. This is especially true for a breast fed infant whose mother may have run out for an hour but is coming back to breast feed.  But what if the baby awakens or gets hungry 30 min or so prior to mother getting home.  This might be a good time to “stall” by giving the baby a bottle of water, rather than formula. In this case it is fine to use tap water (yes bottled water is not necessary, unless you have a well or something) in a bottle and see if the baby will even take it. Most babies don’t just gulp down 8 ounces of water!

If you are out in the heat with an infant, just remember to feed them every 2 – 3 hours and make sure they have nice drool in their mouths and wet diapers. If you are concerned about hydration take along a bottle of water for both you and your baby. You will probably need it more than your baby!

That’s your daily dose for today.  We’ll chat again tomorrow.

 

 

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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

Late Teether?

1:30 to read

Time for another of those moments in my office when I just turn my head and say “what?”.  The latest...during a 9 month old check up the child’s mother expressed concern that her daughter did not yet have any teeth.  

When I explained to her that this was totally within the range of normal, and in fact, I myself loved babies without hair or teeth in the first year of life!!! Why? They are “low maintenance”.  Don’t have to worry about washing dirty hair or brushing those first teeth...plenty of time to deal with that later on right?

But her concern was real...she was very worried about her daughter’s lack of teeth.  I reassured her that it was not uncommon, there are a lot of babies that will not get a tooth until around 1 year of age and late teething often runs in families.  I wondered if she knew when she or her husband had gotten their first tooth?

Upon further questioning her real concern was that she had been “told”  “if your child is a late teether they will also be a late reader?”  Was this something her friends told her on Facebook or on their Instagram post? I thought I had heard all sorts of concerns about teeth erupting...things like my child is fussy, doesn’t sleep well, drools a lot, chews on everything, has runny poop.....but won’t be able to read?  There is just too much information or rather “mis-information” out there.

So, it was such a relief for me to be able to tell her that I was not aware that there was any relationship between teething and reading. In fact...one of my own children had his first tooth erupt at 6 months (which is about average) and he ending up being dyslexic (which is another blog on successful ways to help children with learning differences).   My middle son did not get a tooth until about 18 months (which did worry my mother, she was ready to put money into savings for baby dentures), and he was reading before kindergarten ( which had nothing to do with us...we were focused on trying to teach his older brother how to read).

See why I love my job....something new everyday.... thankfully some of the concerns have no basis in fact....and I get to reassure parents.  

Daily Dose

Monitoring Your Baby

1.30 to read

I have recently received several emails from patients which included attachments.  The attachments were videos of a baby in their crib with questions from parents about whether the baby was “breathing okay”, was “crying enough to be picked up”, or whether I thought “the baby was dreaming”. I had to laugh, as the first thing I thought of while watching all of these videos was: we are really just “too smart for our own britches”, which was a line often used by my dear deceased grandmother who died at the ripe age of 104!  In this case, she would be right as we have so much technology available to us but I’m not sure if it is really that helpful when we are talking about caring for a baby. 

Every parent wants to make sure that they are “watching” their newborn, infant or toddler as closely as possible. That is good parenting.  But, even a newborn does not need to have constant video monitoring with rewind and playback ability.  Just having your baby in the bassinet by your bed or in the nursery next door to your room is really sufficient.  

The idea is that you can hear your baby if they are crying.  You do not need to hear hiccups, and know that they latest for 18 minutes. If your baby is stretching and making normal “new baby” grunting and groaning sounds, you do not need to hear every noise. You do need to hear your baby crying because they are hungry, wet or uncomfortable.  That is when a parent is supposed to get up and go to their baby’s bed.  Watching them just making a few noises to get settled is not a call for intervention.  

I am the first doctor/mom to totally believe that a new baby needs to be held when fussy or irritable. I am not the “cry it out” doctor (let them cry for the first 5-6 months of life).  But, a baby can ooch and scooch and not need to be picked up and if you do not have a video monitor, you probably would not know they were ooching and scooching.  With video monitors on day and night a baby cannot even burp without the parent watching and wondering and “worrying” if that burp was significant.   

While we talk about our teens being “too connected”, maybe we parents need to think about that too.  Are “we” parents (and grandparents) being too connected to the baby?  Are we part of the problem of “instant” intervention, when many a baby might calm themselves if given the chance (and the parent never knew).  

Many generations of newborns and young babies were raised, successfully, without a video camera. Parents ears are a pretty good monitor too , for both babies and even teens.  Eavesdropping is still allowed! 

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