Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.
Both of my babies loved to be swaddled. It helped them calm down and I always experienced them happier and easier to console while snuggled & bundled. My experience isn’t unusual. Research in the past has found that swaddling rates are increasing and it can help newborns with sleep awakenings while also creating a slight reduction in crying in babies under 2 months, and may help babies have more quiet sleep. So the new study out today in Pediatrics evaluating the relationship between swaddling and Sudden Infant Death Syndrome (SIDS) therefore caught my attention. The study pooled research and data from 4 previously published studies to look at risk for babies who are swaddled. Although the data and findings in this new study don’t prove relationships, it does evaluate risks for babies who are swaddled versus risks for babies who were not.
Pediatrics Study Finds Swaddling On Side And Stomach Increases SIDS Risk
- Meta-analysis of 4 studies looking at relationship of swaddling with SIDS risk that spans data from babies in 2 decades and 3 diverse areas of the world: United Kingdom, Australia, and United States (Chicago).
- Conclusion: Current pediatric advice to avoid tummy and side positions for sleep especially applies to infants who are swaddled.
- Swaddling risk increased with age in infants. Infants who were swaddled over the age of 6 months had a double increased risk of SIDS.
- Swaddling risk varied with position of sleeping. The risk was highest for babies swaddled and put on their tummy while also higher for babies put on their side and then those swaddled and put on their back compared with babies not swaddled.
What we feed our babies matters. No question one delightful and soulful part of raising our babies is introducing the world of solid food. I mean really, it’s hard to describe a competing parenting moment with feeding our children healthy food, at any age. For decades, rice cereal as a first food seemed to make sense but major groups reporting out on only feeding rice with caution. The Food and Drug Administration (FDA) recently proposed new limits for inorganic arsenic in rice cereals (think: potentially cancer causing toxin that is increasingly known to cause harm early in life). Many families start their transition from breastmilk/formula to solid foods by adding in rice cereal. Doing so is convenient, makes for great consistency, but rice cereal is a leading source of exposure to the toxin. Arsenic is an abundant element in the earth’s crust, coming in two forms (organic, inorganic), the inorganic form being tied to bad health outcomes. The reason rice has more arsenic compared with other foods is how rice is grown (in watery fields) and its unique tendency as a crop to absorb the arsenic while growing. Here’s what the World Health Organization (WHO) says about inorganic arsenic:
- Arsenic is naturally present at high levels in the groundwater of a number of countries.
- Arsenic is highly toxic in its inorganic form.
- Contaminated water used for drinking, food preparation and irrigation of food crops poses the greatest threat to public health from arsenic.
- Long-term exposure to arsenic from drinking-water and food can cause cancer and skin lesions. It has also been associated with developmental effects, cardiovascular disease, neurotoxicity and diabetes.
- The most important action in affected communities is the prevention of further exposure to arsenic by provision of a safe water supply.
Why are infants particularly vulnerable to arsenic in rice? The FDA says: “relative to body weight, rice intake for infants is about three times greater than for adults.” In their evaluation, they tested 76 different rice cereals and found that 1/2 exceeded the inorganic arsenic limit. Some companies and products are advertising for safety — for example Gerber rice cereal manufacturers announced that their products already meet the FDA’s proposed limits but it will be with time that the food source is changed for good in all products packaged and marketed for babies.
Knowledge about what exactly rice cereal does to babies and their developing bodies continues to unfold but infancy is a time of profound growth and development. Also a time we really want to limit toxins that could change risks. Researchers in JAMA Pediatrics explain: Read full post »
I’ll continue to monitor and track Zika news to share with you as I learn about it. My inboxes keep filling up with Zika questions even though I think the risks to our families, if you’re not pregnant or not thinking of getting pregnant, is low. That being said, if you’re thinking of having a baby now or in the next 6 months or if you are not using contraception and are sexually active, listen up.
Last Friday, the Centers for Disease Control and Prevention (CDC) presented new guidelines for preventing the sexual transmission of the Zika virus. The news and recommendations regarding transmission and our behavior is evolving and changing rapidly as researchers, doctors and medical experts learn more about Zika. This science is not complete, but these guidelines best attempt to keep our population the safest it can be with the information we have. Here is a short rundown on the new guidelines.
New CDC Updates And Reminders About Zika:
Number one reason for this is that although daytime-biting mosquitos are the primary transmission of Zika virus (in areas with Zika — click here for info and world maps) sexual transmission of Zika has been documented here in the United States after travel/exposure —> infection). As of March 23rd, of the 273 travel-associated Zika infections documented in the US, 19 cases are in pregnant women and 6 were sexually transmitted.
The below info helps shape ways to protect yourself:
- WOMEN: If a woman has been diagnosed with Zika (or has symptoms of Zika after possible exposure) it’s recommended she wait at least 8 weeks after her symptoms first appear before trying to get pregnant. As a reminder, symptoms of Zika include rash, red eyes, joint aches, overall feeling of being unwell. Secondary reminder, and one that makes this advice a bit of a challenge to interpret, only 1 in 5 who get Zika virus will have symptoms in the first place. Therefore, if we want to be really careful consider this: if you’ve traveled to a Zika-affected area you may want to wait 8 weeks after returning home before attempting to get pregnant, with or without symptoms.
MEN: If a man has been diagnosed with Zika (or has symptoms of the illness), he should wait at least 6 months from those first signs of the illness before having unprotected sex. This recommendation comes off news that the virus has been found live in semen 62 days. The 6 months is a conservative calculation.The CDC took the longest known risk period (about 2 months) and then multiplied that by 3 for conservative recommendations to ensure no transmission.
- MEN WHO TRAVEL AND HAVE PREGNANT PARTNERS: Men who travel to areas with Zika outbreaks need to prevent transmission to pregnant partners for the rest of the pregnancy. CDC recommends: “Men who have traveled to or reside in an area with active Zika virus transmission and their pregnant sex partners should consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) or abstain from sex for the duration of the pregnancy. This course is the best way to avoid even a minimal risk of sexual transmission of Zika virus, which could have adverse fetal effects when contracted during pregnancy. Pregnant women should discuss their male sex partner’s history of travel to areas with active Zika virus transmission and history of illness consistent with Zika virus disease with their health care provider; providers can consult CDC’s guidance for evaluation and testing of pregnant women“
- The CDC is NOT recommending that that men and women living in Zika-affected regions postpone pregnancy all-together like other countries (think Ecuador).
- Infectious Disease experts feel that a Zika virus infection in a woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood (roughly about a week after infection is over).
- They have also updated their Question/Answer page that is chalk full of helpful information.
Blood Testing For Suspected Zika Virus:
For Men, at this time, CDC advises that testing of exposed, asymptomatic men (men with no Zika symptoms but who have traveled) for the purpose of assessing risk for sexual transmission is not recommended.
For men and for women, regardless of pregnancy status, get tested if you develop two or more of the following symptoms during or within two weeks of travel to an area of active Zika virus transmission OR within two weeks of unprotected sex with a man who tested positive for Zika virus or had symptoms of Zika infection during or within two weeks of return from travel to an area with Zika transmission: Read full post »
Image c/o CDC
Zika virus scares continue to worry expecting parents and pregnant moms. In addition, we’re now just learning about a state of emergency in the big island of Hawaii because of the rising cases of Dengue virus, a virus also transmitted by mosquitoes. Shifting lifestyle advice for growing families will continue as researchers and public health officials learn more. We should expect that the recommendations for travel will change and evolve this summer. As of today, news reports from Brazil coupled with public health officials new knowledge and evolving medical research from around The Americas has clarified a number of things for pregnant moms and families thinking about having babies. Some things we DO know:
- What is Zika: Zika virus is predominately spread by mosquitoes. It is a virus causing joint aches, red eyes, rash and overall yuck feelings in about 1 in 5 people who get it. Typically the virus causes mild symptoms and goes away on its own even in the minority of people who have symptoms. The virus typically clears the blood stream a week after symptoms show up but we know it can remain for longer periods in other bodily fluids (urine, semen). Zika has been around for decades but warmer climate and travel has spread the mosquitoes and the virus around the world. Then it caused a massive outbreak in Brazil (over a million people estimated to have had the virus). During the same period a surge in cases of birth defects worried health officials about a possible connection of serious side effects from the virus during fetal development.
- Where is Zika: Outbreaks of Zika have been reported in over 30 countries, including some cases (not outbreaks) in the United States. Zika is often found in small pockets of countries who have reported cases (costal areas, low-lying areas with standing water) and not ubiquitously throughout the entire landscape. It’s not a risk everywhere you go in Central America but it has touched every country. Further, even though we expect to have cases of Zika in most parts of the US over the upcoming months, you’re simply not likely to get Zika in most parts of the United States for a few reasons: mosquitoes that carry and transmit Zika typically only live in the gulf coast and Southeastern US, our measures to control mosquitoes in the US are effective, and many of us who live in warm climates where mosquitoes live spend the majority of the day in air-conditioning and have access to repellent if outside.OUTBREAKS ARE NOT EXPECTED here in the US but we certainly have no guarantee. Here is a nice infographic from Vox depicting the distribution of mosquitoes who can potentially transmit Zika in the US.
- Birth defects from Zika: The long-term effects from Zika remain unknown, however there are serious concerns about Zika virus and the association of a constellation of symptoms on developing babies, specifically life-altering brain and neurologic changes (microcephaly and developmental delays & changes in the eye). More evidence connecting Zika as the culprit has unfolded in recent weeks. Zika has been found in the brains of babies with microcephaly, it’s been found in the placenta of women who have miscarried, and it’s been found in affected babies eyes. These findings don’t yet prove a cause-and-effect relationship between Zika and these defects but it is more data to construct the case. It is unknown exactly how Zika could cause such devastating changes to a developing baby (for example, researchers cannot yet prove that it’s the virus itself versus our own immune response to the virus that causes devastating side effects in developing babies).
It’s January, 2016. News stories have inspired significant anxiety about Zika virus. It’s a scary topic because news about the outbreaks are just unfolding and this affects an already anxious group, PREGNANT mamas and expecting families. I want to share with you real time information and data to try to alleviate anxiety and educate the best I can. I suspect with time some of this will change. I’ve curated the most common questions and answers directly from the Centers for Disease Control (CDC) below. The most alarming information coming from these outbreaks are the effects of Zika on pregnant women and their babies. First things first, Zika virus will only affect an unborn baby who is exposed to Zika in utero if mom is infected WHILE she is pregnant. Meaning, women not pregnant who get Zika can have Zika virus, clear the virus from her bloodstream (typically about 1 week after illness resolves) and not transmit Zika to future babies. If you are pregnant, there is no question it makes sense to think carefully about travel. That babymoon just can’t be the priority if it will put you at risk. Zika is potentially dangerous to a baby during any trimester or pregnancy or at the time of delivery.
Zika virus is unusual in a couple ways: only 20% of people who get it know it — meaning most people infected won’t develop any symptoms. Secondly, we don’t have a vaccine and we don’t yet have an anti-viral to protect pregnant moms and their babies from side effects. So, unlike infections caused by influenza and polio, or rubella or mumps, we have to change our social determinants of health — basically pregnant moms have to take precautions with where they go and how they expose themselves. I’ve found this CDC Q/A extremely helpful.
What Is Zika Virus Disease?
CDC: “Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week.”
Like mosquitoes all over the world, the mosquitoes that carry the virus and spread it to people breed in open ponds/pools of water. The ones that carry Zika tend to bite and infect primates and humans during the day. These little buggers can get the virus from an infected person and then bite another person and transmit it during outbreaks.
What Are The Symptoms Of Zika?
CDC: “About one in five people infected with Zika will get sick — symptoms from being ill. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected. The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito.”
Remember, 80% of people who get Zika won’t have any symptoms. So heading off to a country with an outbreak and coming home feeling fine doesn’t ensure you haven’t been exposed. This is key in protecting those at risk. We can’t make a lot of assumptions of who has it and who doesn’t.
How Is Zika Transmitted?
CDC: “Zika is primarily transmitted through the bite of infected Aedes mosquitoes. Aedes mosquitoes, which spread the virus, live in every Western hemisphere country but Canada and Chile. It can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. We do not know how often Zika is transmitted from mother to baby during pregnancy or around the time of birth.”
Research will likely evolve through these outbreaks. What we know is that unborn babies are at most risk for serious complications. They are dependent on their moms making great decisions during pregnancy. Holy moly, it’s always a lot of pressure but this sure is another one for us to bear.
More on who is at risk, what to do if you’re planning a trip to Mexico for a babymoon, and ways to prevent getting Zika:
I cleaned out the closet for houseguests last week and discovered an old bumper. Instead of giving it away I am literally cutting up the fabric for crafts and putting the rest in the garbage. A no-brainer savvy parenting tip: baby crib bumpers are dangerous. Don’t use them, don’t even give them to charity, don’t pass them on to friends. Let’s get them out of circulation, outsmart the marketers, protect these little babies.
Smart parents just don’t use crib bumpers. More data out this past month to prove it.
Crib bumpers are soft bedding that can pose risk of suffocation, entrapment, strangulation, or additional risks from causing a baby to be wedged into an unsafe position. It may seem like they protect babies, but there is no evidence they prevent serious injury in infants. Choosing a crib can be an exciting nesting activity, here’s tips for doing it with smarts.
Banning bumpers feels to many like an inconvenient truth. Perceived risk is low and they are so darn cute. But with all the time we spend as parents spend doing everything we can to protect our babies this is an easy opt-out. Forget spending time worrying about organic baby food and what brand of stroller of you want and just get rid of your bumper. Or better yet, don’t buy one in the first place. Let’s get them off baby registry lists, out of marketing and advertising and most importantly OUT of baby’s crib. Read full post »
Warm weather is here and summer is approaching and if mother nature is kind, we’ll have plenty of sun-filled days over the next few months to spend by the pool or at the beach. Unfortunately, this is also the time of year when drownings increase. Young children are especially high-risk because of their profound curiosity around water and lack of awareness of danger.
Drownings are preventable deaths but even the thought of them spooks most of us. Often, a drowning event looks, sounds, and appears unlike we’d expect. I’ve written before about the silent danger of drowning, but rather than reiterate the warnings of how to prevent drowning, this year I wanted to find out what you should do if you realize your child is actually drowning. Put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.
I tapped Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s for information on what to do if you come upon a infant/toddler, school-age child or teenager is drowning. Preparing for this can help boost awareness and response if ever you support or discover an infant or young toddler in need for rescue. Read full post »
There’s new data out to support stronger recommendations for introducing peanuts during infancy. Like hemlines, it may seem like this data keeps changing. As time, the science and our understanding of risk unfolds we’ve seen shifts in advice about starting solids that have left many parents wondering what really is best when starting foods and wanting to decrease risk for food allergy.
Briefly, and in general, it’s best to start a variety of foods for your child during infancy, starting around 4 to 6 months of age. In fact its now believed that it may be protective to introduce things like wheat, egg, soy, fish, and peanuts even before a child takes their first step around a year of age. The 2013 recommendations (that exclude information about peanuts) are explained in this post, “When Should I start Baby Food?”
The recommendation to share diverse foods during infancy that includes fish and eggs may feel new to you. For example, when my babies were born (mid-2000’s) advice and consensus suggested that avoidance of peanuts until after a year of age was best — the thought that avoidance of peanut during critical development may be protective against severe allergy development. Now, concomitant with a doubling in food allergies, we face an utter and potentially embarrassing reality — perhaps medical advice and our work to improve allergy risk by restricting foods in infancy did just the opposite. Perhaps avoidance was exactly the wrong thing to do. Maybe we’ve engineered part of the problem.
This kind of advice can feel intense when raising children. “Do this, don’t do that, do this now, don’t do this now!” Doing the right thing is what we all want but doing right can remain elusive, especially when recommendations shift. I remember a fellow pediatrician questioning my eating a peanut butter sandwich while I was pregnant with my second son. She couldn’t believe I’d made that choice. At the time I remember not only feeling judged but a little terrified too. Perhaps I’d not take the data seriously enough? Oh goodness, I thought, as I diligently didn’t introduce “high allergy” foods until toddlerhood for my boys. Today I realize that wasn’t all that right either. It can feel like another hemline change for sure and yikes these sure are shorter skirts!
Fast forward 7 years to 2015. A New England Journal of Medicine study out this past month systematically evaluated risk for development of peanut allergy in children who were at higher risk for developing the allergy in the first place. And they started with infancy and introduced peanuts early in some of the babies. Researchers found if infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased.
The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy. ~ New England Journal Of Medicine
Feeding a toddler is hard work because of all sorts of normal shifts that happen after the first birthday. But new data out this past month (see below) reminds us how pre-packaged baby food isn’t the best food source, despite package claims. Whole food, the food your family eats, and the fresh stuff is the way to go.
Infant hunger matches their rapid growth; we’re used to our babies ravenous and near consistent basis from day one yet as infancy progresses feedings space out and form meals. By a year of age most children go 4 hours or more between eating. Toddlerhood is a completely different story; growth slows after a year of age and toddlers start to test limits in profound ways. Food is no exception. It can be tempting to reach for whatever’s convenient that you know your kid will eat (fish crackers, anyone?) but in the long run making good nutritional choices for whole food regularly will exceed the nutritional detriments of pre-packaged “toddler” food. In fact, a new policy statement released by the AAP this month is urging parents (and schools, daycares etc.) to take a “whole diet” approach to kids’ nutrition, namely focusing on a mix of foods from the five food groups and avoiding highly processed foods. Read more about the policy here from my friend Dr Claire McCarthy. These “fresh is best” ideas aren’t new to you I suspect but the data about food being marketed to us (and our children) is: Read full post »