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Your Baby

Important! New Guidelines for Cleaning Breast Pumps

2:00

When possible, breastfeeding is one of the best ways to give your newborn a healthy start in life. There are many reasons when breastfeeding may not be possible or simply inconvenient; that’s where a breast pump comes in handy.

Just about every mom knows how important it is to clean baby’s bottles, however, not everyone is aware that the same cleaning thoroughness should be applied to the breast pump.

After a baby developed severe complications last year from a rare infection she contracted from improperly cleaned breast pump parts, the Centers for Disease Control and Prevention (CDC) has issued new guidelines to help moms care for their breast pumps.

In April 2016, a premature baby in Canada developed a rare but life-threatening infection from a bacteria contaminated breast pump. The results were devastating to the infant and family.

Health experts tracked down the cause of the baby’s illness. The infant’s mother cleaned her breast pump after using, but not properly. After each time the mom pumped, she soaked her equipment in warm water for about five hours without scrubbing or otherwise sanitizing it. She then rinsed it, air-dried it and stored it in a plastic zip-top bag.

Health experts found that the mom’s pump and her breast milk samples had been infected with C. sakazakii, a rare type of bacteria that can cause sepsis and meningitis in infants. 

The particular infection this baby developed is quite rare, but other types of bacterial infections can and do occur when breast pumps aren’t cleaned correctly.

The CDCs new guidelines for preparing and cleaning breast pumps are:

Before every use

  • Wash your hands with soap and water.
  • Inspect your pump as you assemble it; if you see any mold in the tubing, throw it away immediately and replace.
  • Use disinfectant wipes to clean your countertop along with the pump’s dials and power switch.
  • Store milk safely in a sealed container labeled with the date, and store it right away in the refrigerator or a cooler with ice packs.
  • Take apart the pump, including tubing and any separate parts that come into contact with your milk.
  • Rinse all parts under running water. Hold the parts in your hands — don’t place them in the sink, where they could come into contact with other bacteria. Then clean as soon as possible by hand or in a dishwasher.

After every use- If you’re cleaning by hand:

  • Place parts in a basin that’s specifically for cleaning your pump and baby’s bottles — never place gear in the sink! — and fill it with soapy hot water.
  • Scrub the parts using a brush designated for your baby’s feeding gear.
  • Rinse under running water.
  • Rinse the basin and scrub brush after each use and clean every few days in the dishwasher or by hand using hot water and soap.
  • Allow to air dry completely, placing the washbasin, brush and all feeding parts on a clean dry towel. Definitely do not use the towel you use with your family’s dishes, since it can be infected with bacteria.

If you’re using a dishwasher:

  • Check that your pump is dishwasher safe, then place pump parts inside, with small parts in a closed-top basket or mesh laundry bag.
  • Run the dishwasher on hot water/dry cycle or sanitize mode.
  • Wash your hands before removing the parts from the dishwasher.
  • If any parts are not dry, place on a clean dry towel (never your dish towel!) and allow to air dry.

Sanitizing and storing your breast pump:

At least once a week, sanitize the pump parts, wash basin and bottle brush using boiling water, steam or a dishwasher’s sanitize setting — especially if your baby is under 3 months old, was born prematurely or otherwise has a weakened immune system.

Once all of the pumping parts are dry, store in a dry, clean box. Remember the dry part. Any moisture allows bacteria to multiply!

While it might seem like a lot of work, it’s definitely worth the effort to help protect your baby from potentially dangerous infections.

Story source: Colleen de Bellefonds, https://www.whattoexpect.com/news/first-year/cdc-new-guidelines-cleaning-breast-pumps/

 

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.  

 

 

Your Baby

Breast Milk Beneficial for Baby’s Gut

1:45

Breast milk provides infants with the ideal nutrition. It also contains antibodies that help babies fight off viruses and harmful bacteria. New research also shows that nature’s marvelous elixir delivers good bacteria to an infant’s digestive system, providing a healthier immune system.

Researchers discovered that 27.7% of beneficial bacteria in a baby's intestinal tract come directly from the mother's milk, and 10.3% comes from the mother’s nipple.  They also found that babies who breastfeed even after they begin eating solid food continue reaping the benefits of a breast milk diet — a growing population of beneficial bacteria associated with better health.

The mother’s positive bacterium assists the baby’s intestine to digest food and trains the infant’s immune system to recognize bacterial allies and enemies.

“Breast milk is this amazing liquid that, through millions of years of evolution, has evolved to make babies healthy, particularly their immune systems,” said Dr. Grace Aldrovandi, the study’s senior author and a professor of pediatrics and chief of infectious diseases at UCLA Mattel Children’s Hospital. “Our research identifies a new mechanism that contributes to building stronger, healthier babies.”

The study, which looked at 107 mother-infant pairs, is the largest to date showing the transfer of bacteria in the milk into the baby’s gut, Aldrovandi said.

Earlier research has shown that a balanced bacterial community in the intestine is a key factor in people’s susceptibility to immune diseases. For example, children who develop type 1 diabetes have abnormalities in their gut microbiomes; what’s more, a healthy gut appears to protect against allergies, asthma and inflammatory bowel disease throughout life.

“We’re appreciating more and more how these bacterial communities, particularly in the intestine, help guard against the bad guys,” Aldrovandi said. “We know from animal model systems that if you get good bacteria in your gut early in life, you’re more likely to be healthy.”

During the babies’ first year of life, researchers collected samples of breast milk and infant stool, and swabs from the skin around the nipple. They analyzed the samples to assess which bacteria were shared between mothers and infants, and calculated the relative abundance of the bacteria.

The research team wants to want to expand the research to evaluate more samples in late infancy to better understand the transition to an adult microbiome. They would like to test in the lab how bacteria that are provided through breastfeeding are critical in infants’ immune responses, and determine which beneficial bacteria are missing in people who have certain diseases.

The findings were published online in JAMA Pediatrics.

Story sources: Robert Preidt, https://consumer.healthday.com/women-s-health-information-34/breast-feeding-news-82/another-reason-to-breast-feed-it-s-good-for-baby-s-belly-722463.html

Leigh Hopper, https://www.universityofcalifornia.edu/news/breastfeeding-plays-important-role-seeding-infant-microbiome-beneficial-bacteria

 

Your Baby

Breastfeeding May Improve Infant’s Dental Development.

2:00

Infants that breastfeed exclusively or predominately for their first three to six months of life are less likely to develop any kind of dental misalignment later on according to a new study.

The researchers, led by Karen Peres at the University of Adelaide in Australia, tracked just over 1,300 children for five years, including how much they breast-fed at 3 months, 1 year and 2 years old.

The children were also monitored for pacifier use.  About forty percent used a pacifier daily for four years.

When the children were 5, the researchers determined which of them had various types of misaligned teeth or jaw conditions, including open bite, cross bite, overbite or a moderate to severe misalignment.

The risk of overbite was one-third lower for those who exclusively breast-fed for three to six months compared to those who didn't, the findings showed. If they breast-fed at least six months or more, the risk of overbite dropped by 44 percent.

Similarly, children who exclusively breast-fed for three months to six months were 41 percent less likely to have moderate to severe misalignment of the teeth. Breast-feeding six months or longer reduced their risk by 72 percent.

The reason breastfeeding might offer protection from dental misalignments is the way it works an infant’s jaws. Breastfeeding involves coordinated tongue and jaw movements that support the normal development of teeth and facial muscles.

Dr. Danelle Fisher, vice chair of pediatrics at Providence Saint John's Health Center in Santa Monica, California, agrees that it’s the jaw movement.

"Breast-feeding requires the use of jaw muscles more so than bottle-feeding, so the mechanics of breast-feeding stimulate muscle tone in the jaw," Fisher said.

Open bite, overbite and moderate to severe misalignment were generally less common overall among the children who mostly or exclusively breast-fed. Children who mostly breast-fed but also used pacifiers, however, were slightly more likely to have one of these misalignment issues, the study found.

"Pacifiers are used for non-nutritive sucking but when overused, they can put pressure on the developing jaw and lead to more problems in older children with malocclusion [teeth/jaw misalignment]," Fisher said.

Parents oftentimes depend on the pacifier to help babies relax and self-soothe. The key is moderation of use.

The American Academy of Pediatrics recommends parents consider using a pacifier for an infant's first six months because pacifiers are associated with a reduced risk of sudden infant death syndrome (SIDS).

"Most infants need to suck for comfort or non-nutritive sucking," Fisher said. "Pacifiers can be helpful in the newborn period and even help reduce incidents of SIDS in infants who sleep with them."

Instead, parents should simply limit pacifier use, she said. In addition, pacifiers are not needed past the first six to 12 months, Fisher said, so parents can begin weaning after that time.

Like most studies, the results did not prove cause and effect, but an association.

The findings were published online in the journal Pediatrics.

Source: Tara Haelle, http://www.webmd.com/parenting/baby/news/20150615/breast-feeding-may-have-dental-benefits-study-suggests

Daily Dose

New Baby Questions!

1:30 to read

Lots of new baby questions this week in my office, so I that I thought I would cover a few of the most frequently asked by parents within days of bringing that precious newborn home from the hospital. So, here we go:

My baby has blue hands and feet…should I go to the ER?  The medical term for this is acrocyanosis.   It is not uncommon for a baby to have a bluish/purple discoloration to their hands and feet. This often occurs if the baby gets chilled or cold, whether that is after a bath or sometimes even after they are unswaddled to wake them up a bit to get them to eat.  If your baby has pink lips and tongue and seems otherwise fine this is the normal adjustment of a baby’s circulation and may last for a few weeks to months.  When parents are concerned about this and make a trip to the ER where they are discharged with the diagnosis of “worried well”.

What temperature do I need to have my thermostat set?  This question always makes me laugh a bit because some of it is truly dependent on the climate where you live. Many parents think they need to “crank up the heat” for a newborn, but actually a cooler room temperature has been shown to correlate with a reduction in sudden infant death (SIDS).  The “ideal” temperature that has been recommended is around 68 - 70 degrees, but for those of us who live in the south during the dead of summer, it is almost impossible to keep your house this cool and very expensive. At the same time, some parents are uncomfortable during the winter with the thermostat at 68 degrees…so I would recommend keeping your house comfortable and on the cooler side rather than too warm. You also do not need to bundle your baby when it is blazing hot outside, less is more if the house is hot.

What about a pacifier?  Mother’s come in and say, “I was told that I shouldn’t use a pacifier because it will cause “nipple confusion”.  While I am a huge proponent of breast feeding I think that a pacifier is also helpful for a breast feeding mother so that she does not use her own breast as a “human pacifier”. Many new moms come in to see me at the 2 week check up crying, exhausted and with bleeding nipples. They are putting their baby on the breast for hours at a time as “it seems the only way my baby is content”.  Although they were told that they could put their finger in their baby’s mouth as a way to help console their baby, that too does not provide much of a distance from the baby…even to go to the bathroom, take a shower or eat!! A baby has the reflex to suck which is termed, “non-nutritive sucking”.  This is one way that your baby will calm themselves.  So, once your baby is getting on the breast, I would buy a pacifier and “teach” your partner how to hold your baby in the position as if they were going to be fed,  but with a pacifier to suck on rather than the breast. Once situated you can try walking around, gentle bouncing or swaying while your baby is happily sucking on their pacifier. Mother gets a bit of a rest between feedings and infant is happy with a pacifier ( rather than a finger). We will discuss taking away a pacifier at another time! 

 

Daily Dose

Breastfeeding & Bottle Feeding

1:30 to read

As you know, I am a huge advocate for breastfeeding your new baby. But, with that being said I also know that there are different circumstances for each mother and baby and that some new mothers either choose to breast feed for a short period of time or not at all. I always talk to the mothers about making their own choice, and to not feel they are being judged by anyone.

 

But many mothers are concerned about not breastfeeding and the long term implications for their baby.  They feel “guilty” if they choose not to breastfeed or if they in fact want to breast feed and are unable to for some reason.  I assure them that infant formulas continue to be improved upon and now contain DHA, ARA and oligosacharides that are found in breast milk.  Formula has safely been used for many years and that they themselves may have been a formula fed baby (you usually don’t even know!).

 

So… I am always interested in studies related to breastfeeding. There are good studies that continue to the show the many benefits to breastfeeding, including lower the risk of allergies, ear infections and SIDS. It is also known that breast feeding helps build a child’s immune system. Parents often ask “if I breast feed for X number of days or weeks is that enough?”.  I have not seen any data to quantitate a simple answer to that question.

 

Several years ago it was thought that babies who were breastfed had a higher IQ (by several points), and this was later found not to be the case. It seems that a child’s IQ is actually better explained by long term factors such as family background, genetics and education.

 

The impact of breast feeding on cognitive abilities continues to be studied and debated.  A new study just released in the April issue of Pediatrics  looked at 8,000 families and did not show a statistically significant difference in cognitive ability at ages 3 or 5 years between those babies that were breastfed for 6 months and formula fed babies.  They also looked at the relationship between breastfed and formula fed babies and parent rated hyperactivity scores. They found lower parent rated hyperactivity scores for 3 year olds only, but those benefits were not maintained in the long term. Again, much of this behavior may be based on genetics and environment.

 

Bottom line in my opinion…..adequate nutrition for your baby is the most important factor. Whether that is breast or bottle is up to each mother, and maternal well-being and feelings of happiness are so important in the first few months of an infant’s life.  

 

 

 

Daily Dose

Maternity Leave & Breastfeeding

1:15 to read

When Facebook’s Mark Zuckerberg and Priscilla, his pediatrician wife, had their baby last year he announced that he would be taking off 2 months to be at home with his wife and baby. For those fortunate enough to work for Facebook or Google or another company with a generous maternity/paternity leave policy they too may get anywhere from 2-6 months of paid leave after the birth of their baby. But for most workers, it is more the “norm” that a mother receives anywhere from 4-6 weeks of maternity leave, and in many cases it is not paid.   The first several months of being a new parent are often overwhelming, but knowing that you have 4-6 months of paid leave which allows you time to “become a family” certainly makes the adjustment to parent hood a bit easier.

Unfortunately, physicians (including pediatricians) are faced with returning to their practice often “as quickly as possible”.  I found that going back to work after 12 weeks (which I had to beg for) and trying to juggle a full load of patients, answering phone calls, taking night call and making hospital rounds really did impact my mood as well as my breastfeeding. Although I enjoyed breastfeeding,  I could not figure out how to find any time to pump between patients (talk about running late) to keep my milk supply up. So….I eventually made the decision that in order to keep working I would need to stop breast feeding, which was a bit traumatic for me…..in retrospect I was tougher on myself than I needed to be, but 30 years ago I didn’t realize the numerous other difficult parenting decisions that lay ahead.

Interestingly, a new study just published in Pediatrics is what made me ponder all of this.  Many studies have shown that mothers may have trouble continuing to breast feed after returning to work. This latest study from Australia actually found that the amount of time to return to employment was actually “far less significant than the number of hours a woman worked”.  The study found that working 19 hours or less per week was associated with a higher likelihood to continue breastfeeding.  Those women who returned to a work week of 19 hours or less “experienced no decline in the likelihood that they were breastfeeding regardless of when they returned to work and they were more likely to sustain breastfeeding as well”.  In other words longer breastfeeding, a win win for mother and child. 

As more and more women are employed during their child bearing years, the ongoing debate surrounding the appropriate length of time for maternity leave continues. While there have been many studies to show the importance of family leave after the birth of a baby ( better bonding, less post partum depression) this study is one of the first to show the benefit of a reduction of hours worked upon re-entry to the workplace.  It is my hope that this research may open the door for discussions examining the feasibility of reduced work hours for women who return to work after giving birth.  This new data may be pivotal in improving longer breastfeeding rates in the U.S.  

I am sure many women, although not included in the study,  who have juggled a career and breast feeding would agree.

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