Friday, May 30, 2008
Occasionally I will receive a frantic phone call from a mom who feels compelled to describe in graphic, agonizing detail the contents of her baby's diaper. This of course, invariably happens as I am trying to have a quick lunch at my desk while trying to catch up on paper work. Oh well. Bon appetite.
What was concerning this mother, understandably, was the apparent presence of mucous and blood. (I hope you are not trying to eat while reading this blog). I instructed her to call her pediatrician. Having done that, she begged me to take her through the possible causes and treatments.
The presence of mucous in the stool may indicate that the infant's gut is inflamed due to an allergic reaction to something that the mother is eating. The most common culprit is dairy, with soy as a close second. Other possibilities include eggs, fish, shell fish, corn, wheat, citrus, chocolate, and/or tree nuts. Blood in the stool can be due to breastfeeding on a nipple that is cracked, an allergic reaction to something in the mother’s diet, or the infant could have a small anal fissure.
When blood in the stool is thought to be due to an allergic reaction, the treatment plan varies. Some pediatricians will advise the mom to place herself on a restrictive diet and see if the problem resolves. Other doctors have instructed the mother to stop breastfeeding altogether and place the infant on a hypoallergenic formula. Another plan of action is to refer the baby to a pediatric gastroenterologist.
My experience has been that the problem often resolves itself when the mother is able to eliminate problematic foods from her diet. Occasionally, we have had thriving, healthy infants continue to pass small amounts of blood in their stools. The pediatric gastroenterologist has encouraged the mother to continue to breastfeed. Interesting to note is that despite the small amount of bleeding, these babies have not developed anemia.
Discovering foreign “stuff” in your baby's diaper can be anxiety provoking. Please try to remember that the causes are often correctable and mothers are able to continue to breastfeed without any negative consequences to the baby. Finally, please try not to call me when I am eating!
Tuesday, May 27, 2008
Several weeks ago the LA Times had an article that warned parents against sleeping with their babies. I suppose the newspaper’s job was just to report the statement made by the LA County Officials, but I was so frustrated reading it because the co-sleeping issue has come up repeatedly, with the same recommendation—don’t sleep with your baby. There is so much information available today that disagrees with this statement. Dr Robert Sears was the only authority who was quoted as saying “that some co-sleeping can be unsafe” but, he disagreed with the blanket statement that the practice is unsafe all the time. Dr Sears co-authored The Baby Sleep Book with his father and brother (all 3 are Pediatricians) and his mother an RN/Lactation Consultant. The Sears are strong supporters of sleeping with your child, but only when done in a safe way.
It would have been so helpful to parents if the newspaper had referenced the leading expert in the field of Sudden Infant Death and co-sleeping, Dr James McKenna (Claremont McKenna College is named for him). McKenna is currently a researcher at The University of Notre Dame, and has dedicated his lifework to the subject of infant sleep. He has authored a very important book, Sleeping with Your Baby. Its subtitle says a lot: “Whether you do it occasionally or every night, do it safely.” This book should be required reading for all expectant/new parents and any health care providers who work with parents and babies. It is an easy read that is filled with evidence-based information which allows each family to make correct and safe choices for themselves. It answers all the questions about bedsharing that parents NEED to know, taking the pressure, guilt and angst off their shoulders. In the book Dr McKenna gives his recommendations for every sleeping situation and addresses cultural bias and myth as versus the scientific evidence. In the introduction McKenna states: “This book is designed to describe the present scientific status and medical and social controversies in the field of co-sleeping, and why there is no consensus on the issue of bedsharing. It is intended to educate parents about safe and unsafe sleeping environments according to all lines of scientific evidence, and to let parents of healthy, full-term infants know how to best avoid recognized adverse conditions that can make forms of co-sleeping and bedsharing dangerous.” Dr McKenna goes on to say that the book is not intended to advocate any one form of sleeping arrangement, but to clarify the importance of matching the best sleeping arrangement to each family and inform parents about the potential benefits of sleeping close to the baby when safe conditions can be met.
It would have been beneficial if the newspaper article had said that each parent needs to be well informed and make an educated choice about where their baby will sleep? We have fearful, sleep deprived families who may do dangerous things because they don’t know differently. The article tells of a father sleeping with his baby in a recliner. The baby slipped between dad and the arm of the chair and suffocated. The article also mentions that “some of deaths were connected with parents who were under the influence”. Both these situations are known to be unsafe.
The America Academy of Pediatrics' stand against co-sleeping was brought up in the Newspaper article. It is totally understandable why the AAP needs to make statements like one size fits all. Their recommendation for NO bedsharing could be similar to their recommendation on supplementing all infants with Vitamin D to protect against Rickets. At a recent conference I learned that the AAP didn't want to recommend how much sun exposure is safe for a baby (sun is required to activate Vitamin D in our bodies), so they recommended supplementing all infants with Vitamin D to make sure. The AAP probably doesn't want to take responsibility for saying how to bedshare safely, so they make a statement that it shouldn't be done at all.
We are so grateful to Dr. McKenna for providing his important book. I talk about it to almost every parent I meet. Recently an ER physician with a new baby read the book at my suggestion and reported that it completely changed what he thought and what he says. It changed his family’s life. His working wife had been struggling with her milk supply, but once they allowed the baby to sleep beside mom and nurse as needed during the night, her milk soared and everyone slept better. Please, please read Dr James McKenna’s book and then share it with a friend or two.
Tuesday, May 20, 2008
The controversy swirling over bisphenol A (BPA) has led the Juvenile Products Manufacturers Association (JPMA) to issue not one, but two statements, on BPA and polycarbonate plastic. Both statements contend that polycarbonate plastic is safe to use. So, is it? Is polycarbonate plastic safe to use? Is the BPA debate, in fact, much ado about nothing – just another false scare? Or is BPA harming our children?
It must be awfully frustrating to most parents and caregivers. You are forced to decipher scientific jargon to determine what is safe and what is not. And it must be even more frustrating given that most parents make the decision about which baby bottles to use when they are sleep deprived, responding to the needs of a new baby. I have to admit that I find it frustrating, weeding through the scientific reports and statements, and I actually like the science side of it.
JPMA boldly asserts that polycarbonate plastic is safe. Before responding to the JPMA’s statements, let's catch up any of you new to the BPA issue. BPA is a component of polycarbonate plastic. Polycarbonate plastic is commonly used for baby bottles. However, BPA has been shown to leach out of the polycarbonate plastic and into whatever food or liquid is in the plastic container, including breast milk and formula. Leaching is greater when the food or liquid is heated, although leaching does occur at room temperature. Polycarbonate plastic, widely used for the last thirty years or more, was believed to be safe. Unfortunately, recent studies have found links between low level exposure to BPA and adverse health effects in laboratory animals, including early onset of puberty, increased risk of breast cancer, increased risk of diabetes and hyperactivity. A recently released study has associated fetal exposure to BPA with a predisposition to obesity later in life.
JPMA’s first statement, released on April 17, 2008, states that the JPMA “stands by the scientific research indicating that plastic baby bottles are safe.” JPMA goes on to say that the finding of the National Toxicology Program’s draft report “provide reassurance that consumers can continue to use products made from BPA.”
What the JPMA does not say is that the NTP draft report on BPA finds that “there is some concern for neural and behavioral effects in fetuses, infants, and children at current human exposures. The NTP also has some concern for bisphenol A exposure in these populations based on effects in the prostate gland, mammary gland, and an earlier age for puberty in females.”
What does this mean? JPMA uses basically a five point scale – negligible concern, minimal concern, some concern, concern and serious concern. So, the NTP effectively places the concern at a 3 on a scale of 1 to 5. I don't agree with the JPMA that the NTP’s draft report therefore provides reassurance that I can continue to use polycarbonate plastic. A rating of 3 on a scale of 1 to 5 isn't safe enough for me.
The NTP draft report goes on to state that “the scientific evidence that supports a conclusion of some concern for exposures in fetuses, infants, and children comes from a number of laboratory animal studies reporting that ‘low’ level exposure to bisphenol A during development can cause changes in behavior and the brain, prostate gland, mammary gland, and the age at which females attain puberty. These studies only provide limited evidence for adverse effects on development and more research is needed to better understand their implications for human health. However, because these effects in animals occur at bisphenol A exposure levels similar to those experienced by humans, the possibility that bisphenol A may alter human development cannot be dismissed.”
So the NTP’s draft report finds that the low level BPA exposure studies in laboratory animals cannot be dismissed. And I have to agree. The JPMA also does not explain that fetuses and infants do not have the necessary liver enzyme to metabolize BPA, while adults do. As a result, fetuses and infants may be much more susceptible to BPA. So why would you want to use a baby bottle for a potentially susceptible infant?
The JPMA also does not explain that the scientific research indicating that polycarbonate plastic is safe is primarily based upon studies funded by industry and many of which also predate the development of scientific technology capable of measuring low concentration levels at issue now. For whatever reason, it seems like the studies funded by the chemical industry don’t find health effects. An investigation by Journal Sentinel looked at 258 studies and found that four out of five found health effects. Of the studies that did not find any health effects, most were paid for or partially written by scientists funded by the chemical industry. The plastics and chemical industries have been accused of paying to manufacture doubt.
The JPMA ignores that the health effects from very small doses that only recently could be detected are just now being understood. Emerging, substantial evidence indicates that BPA can harm laboratory animals at concentrations below the daily levels to which most of us are already exposed. In fact, the Chapel Hill expert panel’s consensus statement evaluated the strength of data from more than 700 BPA studies and labeled as “confident” its assessment that BPA at low doses has had a negative effect on experimental animals. The panel concluded that BPA exposure in the womb can permanently alter genes of animals, impair organ function in ways that persist into adulthood, and trigger brain, behavioral and reproductive effects, including diminished sperm production.
JPMA’s second statement concerns Health Canada’s announcement banning polycarbonate plastic baby bottles. Again, JPMA reiterates the safety of polycarbonate plastic baby bottles.
So, even with all that, you may still be wondering whether polycarbonate plastic is safe to use. The answer remains uncertain. So, what should you do? To me, the decision was easy. Given the potential adverse health effects, and the wide variety of BPA-free baby bottles, sippy cups, etc., available, it was easy to decide to use something other than polycarbonate plastic. I decided it just wasn't worth the risk. I also am careful about canned foods and beverages. Epoxy–based resins containing BPA are used to line almost all canned foods and beverages. So, I try to use fresh, frozen, dried or jarred in glass instead.
Friday, May 16, 2008
This is the last installment of 3 Pearls I learned from Jill Stamm, author of Bright from the Start.
I had never really thought too much about this next Pearl, but after hearing Dr. Stamm discuss it, it was an “Aha” moment for me. Car seats are HUGELY important for keeping a baby safe in the car, but maybe not so great for other times. Because they are so convenient and multi-purpose, many babies are spending LOTS of time in the Travel system. Here’s the problem. If a baby is deep within a car seat while awake, he/she can’t see out. They can’t see the dog that is barking and make the connection. They can’t follow mom’s eye gaze to see who she is waving at. Researchers are learning that a child’s ability to follow eye gaze and orient to sounds is important for the effective wiring of the attention system and the systems involved in social interaction. An example Jill Stamm gives: When a baby hears a doorbell, turns her head instinctively to follow the sound, but can’t see anything, she may signal distress about this frustrating lack of connection by fussing. But after this disconnect occurs over and over and over, she’s less likely to keep trying to turn her head to follow along with the situation around her. She tunes out.
Dr Stamm suggests limiting the time in the seat to car time only. If the baby is asleep when you arrive at your destination, of course let them continue to sleep in their seat. But, when the baby is awake, pop them on your hip, in a sling, a chest carrier or a back carrier so they can see what is going on. At home when you need to put a baby down, Jill suggests placing them in bouncy seats, or swings whose sides don’t restrict the range of vision. By the way, babies are less likely to develop “flat head syndrome” if they are up in your arms or in a carrier rather than lying on their backs in their car seats.
Hey People—You will learn so much from this wonderful book. You and your child will reap huge rewards.
Tuesday, May 13, 2008
This is the second installment of 3 Pearls I learned from Jill Stamm, The author of Bright from the Start
Dr. Stamm talked about DVD's for babies that are marketed in such a way that parents might believe that by having their babies watch these videos, they would become smarter. Oops! Research demonstrates that watching this stuff does not make kids brighter! In fact Jill shared some research that was eye opening indeed: For every hour of TV (or videos) watched per day before age 3, a child is 10% more likely to receive a diagnosis of ADD or ADHD by the age of 7. So 3 hours of TV/day — 30% increased risk. No one needs to panic here. Dr Stamm isn't talking about the occasional glance at a TV while you watch the Laker game, but rather the purposeful “plunking” of a child in front of the television set. There is new research from the University of Washington that was also shared: When babies are around TV, they are compelled to look at it. They are not interested in the content, and are not learning, they simply cannot look away. Although more research is needed, Dr Stamm felt that using a few minutes of TV a day, so mom can have a shower and dry her hair may make a huge difference in how a mom feels — therefore affecting her happiness. Happy moms make for happier babies. According to Jill this limited amount of TV probably won't be a problem. She actually put her girls in front of Mr. Rogers every day for a few minutes and I let my kids watch Sesame Street so I could fix dinner–NO GUILT–BALANCE! I still love the song Rubber Ducky.
Oh Yeah—be careful when attending the Mommy movies. Try to keep your baby facing away from the big screen. Nursing with your baby facing you or letting your baby sleep in the carrier or sling would be perfect.
Dr Stamm recommends:
- No commercial TV for babies and young children. Quick hits with lots of interruptions from commercials and scene changes are a risk to the developing attention span.
- Skipping the evening news is a good idea for young kids. It is filled with terrifying information that can cause unnecessary apprehension about bad things and bad people in this world. Kids have no concept that Iraq is far away. Heck — I can't stand the news before I go to bed either. When I was in grade school, our teacher showed us a film about the dangers of fire. I remember like it was yesterday a scene of a woman leaving her iron unattended which started a fire — the next scene is of her entire body swathed in bandages. It scared the wits out of me; I had a horrible time sleeping, and had nightmares for months afterwards.
- No TV in kid's rooms. Watching TV alone in their room pulls time away from social interaction and gives parents no control over what is watched.
- No TV in the car
By the age of 5 kids can learn from appropriate use of television.
By the age of 5 kids can learn from appropriate use of television.
Friday, May 9, 2008
According to the latest report for the Center for Disease Control, more than three-quarters of new mothers are now nursing their infants. This is the highest mark in at least 20 years. The most dramatic increase occurred among African-American women, rising from 36 percent to 65 percent. Reasons for this elevation include the rise in education campaigns claiming that breastfed infants are better protected against disease and childhood obesity than formula fed babies. Additionally, there may be a changing culture in the U.S. which supports the nursing mother.
In the spirit of our month-long celebration of mothers, I would like to propose an additional hypothesis. Time and again I have had the privilege to observe mothers generously supporting one another. During those first few weeks when a new mother is struggling with common challenges of breastfeeding, knowing that other women have successfully dealt with sore nipples and engorgement is extremely reassuring. As new mothers are often unsure of their ability to feed their babies, having a knowledgeable breastfeeding mom share her experiences and support is invaluable. The more experienced mothers we have acting as role models and continuing to lend advice and support to the new mother, the higher the breastfeeding rates will climb. A mother tutoring new mothers in the art of breastfeeding is powerful. It is profound. It is one of the things I love most about my job.
Tuesday, May 6, 2008
It’s a common myth that having a baby will bring a couple closer together. What can you do when you find this to be alarmingly not the case???
Well, we've turned to Julie Wright and her husband Scott L. Johnson to help address this problem. Julie is an MFT, Psychotherapist and leader of Mommy & Me classes here at the Pump Station & Nurtury™ and Scott is an MFT and a Psychotherapist who specializes in couple’s therapy. Seeing a real need for attention to this critical issue and combining their respective areas of expertise, Julie and Scott will be leading our upcoming Sizzling Hot Topics focused on “Reconnecting with your Partner after the Birth of your Baby”. Using a mindful approach, Julie and Scott explain that romance after baby takes planning (get out your Blackberries) and a lot of talking!
As a guest blogger this week – Julie shares some highlights from her class:
by Julie Wright, MFT
In my Mommy & Me classes I explore with my moms – what we call the “Myths of Motherhood”. Inevitably, the topic veers to and settles on these moms' concerns regarding “connectedness” in their marriages. It shocks me to see how this is such a common issue among so many mothers. Here are some important things to be aware of as you find yourself to be one of these moms who is feeling such a strain on her relationship:
- You are not alone! Many couples have these same problems. Relationships are hard – communication is critical!
- You are tired, you are exhausted and you feel burnt out. Another “little person” is not a “little” workload – caring for a child is a tremendous drain on you, your spouse and your relationship. As exhausted as you both are – you must work that much harder.
- As new parents, the division of labor has become more noticeable – i.e. money maker vs. home maker. Time management issues become that much harder to handle. Often the mother struggles to release control of baby care and baby care styles differ. As parents you feel less confident in your ability to know what to do at any given moment.
- The baby arrives, your relationship has lost its “luster” – you sense a “state of emergency” This heightened state of discomfort gives you both the opportunity to finally do the work necessary to move toward the intimacy we all crave.
- Don’t panic! You have enough pressure in your life as it is.
- Being aware of these issues and being willing to talk openly about them is an enormous first step. Knowing you are not alone can open the door to choosing a new way of being with your spouse/partner.
- Talk to your spouse/partner! Communicate, talk, share, discuss, empathize, listen and learn more about each other's needs and desires.
- Make time for each other! You’re probably spending a great deal of time tracking when your baby eats, poops and sleeps – do your best to fit your partner/spouse into that schedule.
- Take out that Blackberry and schedule Date Night's with your partner! Yes, you may feel guilty about taking time away from your baby – but you must realize: it is critical – you need to give your relationship every possible chance of survival – this is the most essential gift you can give to your child!
Hopefully, my suggestions will help to bring you and your spouse/partner closer together. I think it is important that I also note – sometimes there are issues you may have had as a couple before having a baby – these will not be solved by having a baby – but instead can be amplified and your levels of frustration in dealing with these issues will only increase. Raising a couple’s awareness of these issues opens the doors for the two people to actually talk about their problems. Sometimes these issues are best addressed in couple’s therapy. It is important that you and your spouse/partner are open to different options in order to insure the happiness of your new family.