Pregnancy

All Articles in the Category ‘Pregnancy’

Baby’s Ears When Flying

First off, I have connected with a few engineers and pilots — I may be wrong on one point here: Commercial airplanes typically ascend/climb faster than they descend for a landing. My apologies. I’m clearly no pilot…

That being said, you can help support your baby or child’s potential ear discomfort during flying by having them suck on something like a pacifier, having them breast feed, or offer a bottle during take-off and landing. The motion of their jaw and mouth during sucking and swallowing will help them equalize to the pressure changes. When they move their jaw to suck and swallow this helps facilitate venting in the Eustachian tube that allows your child to equalize pressure from the outside world with the middle part of their ear. That click or pop you feel when you yawn is your ear drum moving back to middle after getting pushed one direction in your ear from a pressure change.

It’s true that discomfort is far greater during pressure changes when there is fluid in our middle ear (from colds to ear infections). Check in with your child’s doctor or nurse practitioner prior to flying if you’re concerned about a potential infection. If that’s not ideal, consider getting Cellscope (an iPhone app that helps you look into your child’s ear, and/or allows you to send the image to their doctor) if you’re a frequent flier and your child is prone to fluid in the middle ear.

Here’s tips for parents about fluid in the middle ear and nice summary about ears & pressure changes from Kid’s Health.

Mix And Match: Goldilocks Formula

Often new parents are nervous about mixing and matching infant formula they offer their babies. They worry if they switch from one formula brand to another, they may cause their baby fussiness, stool changes, upset or worse–that they could put their baby at risk.

It’s safe to mix and match infant formulas if you are following standard mixing instructions. Really.

Although spitting up or gassiness is usually not due to the protein in formula (cow’s milk versus soy versus hypoallergenic), sometimes changing formula helps new babies and their parents who worry. Switching them up can even help clarify worries in some scenarios when a parent worries about excessive gassiness, intolerance, or significant urping or spitting up.

Experimentation with formula brands in an otherwise healthy newborn is okay. But it’s not necessary at all, either.

It’s fine to make a bottle that is ½ formula from the blue can and ½ formula from the yellow one. Fine to serve Simulac one week, Enfamil the next, Earth’s Best or Goodstart followed by Soy formula the following day. Fine to buy one brand that’s on sale only to buy the other brand next week. Read full post »

New Data On Infant Sleep You’ll Want To Know

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.

There are many things that go into the equation of how we get our babies to sleep thought the night. And those of us who struggled after our babies after 6 months of age are in good company. Research shows that about 45% of mothers say they struggle with their 6-12 month-old’s sleep.

Solving the sleep solution requires a diverse mix of instinct, patience with personal and baby temperament, timing, mood, advice we get, and good luck.

The reality is that there isn’t one perfect way to help support an infant who’s learning to sleep through the night. But there are few pearls I believe in: Read full post »

Circumcision For Newborn Baby Boys

Last week, the American Academy of Pediatrics (AAP) issued an update to their circumcision policy statement that attracted significant attention. In it, the task force clarified the previous neutral policy for boys’ circumcision. The AAP stated that research has advanced since it’s most recent report in 2005 to conclude the health benefits of circumcision outweigh the procedure risks. Like any medical test or procedure, circumcision carries both benefit and risk. With global data expanding about benefits of circumcision and protection against sexually transmitted diseases, the AAP changed its stance. Risks from circumcision are reported to be very unlikely and happen less than 1% of the time. Most common side effects can be a small chance of bleeding or a need for antibiotic ointment. The most frequently reported adverse event from parents is a concern not enough foreskin was removed. Fortunately, circumcision revisions are very rare.

The statement doesn’t go so far as to recommend that boys undergo circumcision, rather the task force stated that the procedure should be done under sterile technique by a trained, experienced clinician. Importantly, they stated for the first time that it should be covered by Medicaid and insurance. This with the hope that every family ought to have the right to make a choice for or against circumcision, not just those with private insurance.

Clearly, the decision to circumcise a newborn baby boy isn’t made simply in the content of medical data. Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief. Ultimately, the decision is a private one for families to make. A pediatrician, family doctor, or ARNP should help you go over medical benefits/risks as needed. As a parent, you go over the rest. Read full post »

Understanding Risks For SIDS

New research helps clarify ways we can reduce risks for Sudden Infant Death Syndrome (SIDS) or Sudden Unexplained Death in infancy. A recent Pediatrics study found that the convergence of risks (see diagram below & listen to video) for infants is meaningful–reducing number of risks may reduce SIDS deaths. Avoiding multiple and simultaneous SIDS risks may help– especially for babies who are vulnerable due to family history, genetics, prematurity or prenatal exposures. Further, research published the same month in The American Journal of Public Health (April 2012) confirms that sleep environment hazards (co-sleeping, soft sleeping surfaces, shared sleep surfaces with people or animals) contribute to SIDS. 70% of infants who died from SIDS were sleeping in a surface not intended for infant sleep (adult bed, couch, chair) and 64% of infants who died were sharing a sleep surface, with half sharing with an adult. We can decrease SIDS risk by controlling our baby’s environment, knowing their vulnerabilities, and sharing what we know. Put babies on their backs without soft bedding (bumpers/pillows/blankets) in their own crib until 1 year of age.

Read full post »

Cocoon A Newborn, Only An Email Away

This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.

In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.

Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.

Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.

You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.

Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.

Write an email to family and friends to explain.

A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »

When Is It Okay To Fly With My Newborn Baby?

I think it’s okay to fly with your newborn baby straight away. After 1 week of age the Federal Aviation Association (FAA) says it’s okay, as does the AAP, but always recommends a separate seat for your infant whenever possible.

The biggest risk flying with a healthy newborn is exposure to infection. So, like any decision in life, you have to weigh the risks and benefits of a decision. Because we take fever very seriously in babies under 3 months of age, we want to avoid infections when possible. Take precautions, wash your hands frequently, and wipe down seat backs, tray tables, and seatbelts on board.

All that being said, I flew with O when he was just 6 weeks old. It was important for us to travel to see family in California for the holidays. I took precautions, loaded up on hand sanitzer, and backed extra diapers. It was a wonderful Christmas…

For more on traveling with children, check out:

TSA Tips For Traveling With Children

Is Air Travel Safe For an Infant (the short answer is “yes”)

All Grandparents Need A Tdap

Some of my best friends are about to have a baby, the due date only a few weeks away. I’m teary thinking about it as my excitement for her arrival exceeds the speed limit. They asked my opinion this week for getting their extended family immunized in light of the recent Whooping Cough (pertussis) outbreak in our area. I advised them that all teens and adults (including grandparents) need a Tdap shot before they are with the baby. Even pregnant women are getting immunized after 20 weeks gestation to protect their newborns at and after birth.

Ideally, everyone should have the Tdap shot at least 2 weeks before the baby arrives.

My friends advised their parents. But both grandmas were turned away–one here in the US and one abroad. Each were told by a physician that they didn’t need the Tdap shot because they were over 65 years of age.

That physician was wrong. Whooping Cough (pertussis) knows no age. And immunization recommendations for pertussis protection have changed this past year because of rising rates of infection and infant deaths.

The best way to protect a newborn baby from getting Whooping Cough is to cocoon them with family and friends who are immunized against it.

Here is an overview on protecting your family from Whooping Cough.  <——Share this link with friends having new babies.

All grandparents, all adults, and all teens need a Tdap shot before holding a newborn baby.

Ask questions, please. And one more thing, can you suggest girl names? My friend is beside herself that they don’t have one picked out…I’ll buy you coffee if you suggest the name she chooses (hint: use a real email)

Pacifiers: A Love Affair Worth Having?

Pacifiers, a love affair worth having? It’s up to you, of course. Pacifiers are hotly debated among some parents, some pediatricians, some lactation consultants, and some dentists. I say some, as I believe not all clinicians have strong impressions/judgments. That’s because pacifiers don’t cause excessive harm. Yet most parents agree on one thing: they all have an opinion about what to do with one. Some hate them, others adore them. Just like babies. Silicon pacifiers can be all the rage, or none of it…

At our house, we had a love affair with a pacifier. Twice. Without even trying. And it all happened by accident.

Although the American Academy of Pediatrics and National Institute of Child Health and Human Development recommend using a pacifier at night to decrease the risk of SIDS, if your infant doesn’t like one, you certainly DON’T need to force it upon your content baby. Don’t over-think or over-value the pacifier, either.

With F (our first born), I waited, held off, and withheld the pacifier hoping to improve my changes of successful breastfeeding. We had a few sleepless weeks (with the fussing and crying normal for a newborn) until a couple weeks of age when we realize it really was the “plug” he was looking for. F’s crankiness improved, and we had another tool to help support him when holding, rocking, feeding, changing diapers, or swaddling didn’t soothe him entirely. The pacifier was just something he loved.

With O (our second), I didn’t get the choice. While in the NICU, the nurses used the pacifier to “quiet” him down. I asked that they didn’t, but when I returned to feed him, there it was again, in his mouth. And he was in love. So we continued to use it and I didn’t take it from him. As I’ve written before, I loved to see him enjoy and indulge with that pacifier. I mean, he really craved and adored the time he got with it (mostly during sleep or in the car). Weaning him from it was harder on me, it turns out. And I faltered a couple of weeks after the wean during a moment of weakness…

We used pacifiers in our homes until both the boys were just under 2 years of age. And like I said, it really was a love a affair.

The reason is simple, babies soothe by sucking and pacifiers are a perfect tool. My advice on pacifiers: follow your instincts. You’ll be able to find studies both that support use and studies that dissuade use to back up either decision. So don’t over-think this. And stop beating yourself up for using one if you are…

Mama Doc’s Cliff Notes On Pacifiers:

  1. These are things you already know: Wash the pacifier regularly (dishwasher safe are easiest) in warm soapy water, get rid of old pacifiers that show cracking or damage, and use a one-piece silicone design if possible. Don’t dip the pacifier in anything (ie sugar water, honey, etc) ever. And never tie the pacifier around your baby/toddler’s neck.
  2. As your child grows, the pacifier should, too. Don’t let toddlers have infant sized pacifiers due to choking risk. Smaller pacifiers may rest more on their front teeth as well and cause more malocclusion or “bucking” of teeth. Get the correct size pacifier if your older toddler or preschooler still uses one.
  3. When your child approaches 6 months of age, consider weaning. If neither of you are interested in breaking up with pacifier, try again at 2 years of age. By 3 years, get it out of the house or the love affair will cause a most terrible break-up.

Additional Safety Tips on Using Pacifiers:

Mayo Clinic’s Do’s & Don’ts on Pacifiers

Review article about dental problems caused by pacifiers after age 3.

Satisfying your baby’s needs: Pacifiers

Sleep Through The Night

Getting your baby to sleep through the night is a major milestone for baby and for you. If I had to distill down the best sleep advice I’ve ever heard it would be these 4 things:

  • Your consistency with the sleep routine is far more important than what method you choose to help get your baby to sleep. The ritual at bedtime (reading, bath, rocking, etc) is one of the most important daily activities you establish for your child from day 1 (or day 30).
  • Letting your baby learn to fall asleep all on her own at 1 to 2 months of age will serve you and your child again and again. Research shows that infants and children who are allowed to learn to self-soothe and get themselves to sleep will often be far better sleepers, even as adults. Consider letting your baby learn to self-soothe and “cry it out” in the middle of the night after 4 to 6 months of age.
  • If you’re concerned about your baby’s sleep challenges, talk directly with their doc. Recent research found that 1 in 10 children under age 3 has a sleep challenge, and often sleep trouble persists from infancy to toddlerhood.
  • Sleep needs to be a priority (for us all). Making sacrifices to support routine bedtimes and sleep routines will always be worth it.