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Daily Dose

Pregnancy & Sleep

1:15 to read

Why is it that as you get further into your pregnancy you sleep less?  I am sure that it is just a factor of being “bigger” and as one mother said to me, “having another human inhabit your body”. It is often hard to find a comfortable position to sleep in, and even if you do, the baby may not want to stop moving when it is your bedtime.

But, I also really think this is all in God’s plan to get a mother (and father who often says his wife keeps him up) ready to be new parents. It is just foreshadowing of the weeks to come when you bring that newborn home from the hospital.  You have already learned to “survive” with less sleep.

The first few weeks at home with that most precious baby is really just about survival. I don’t care what you read or how many classes you take...there really are no “rules” or “tricks” to get thru the first 6-8 weeks of being a new (or seasoned) parent.  

I tell my parents the only “rule” is that the baby MUST sleep on their BACK..other than that try to do the feed, play, sleep routine that you think will just happen, but know at times your baby just does not want to go to sleep when you want them to!! They are not abnormal and you are not a “bad” parent.....they are just newborns with developing brains and sleep cycles. I promise, this too shall pass and longer sleep cycles will come.

So, if you are awake one night toward the end of your pregnancy and reading this, look at the bright side.  Your body is just getting you even more prepared to be a “great” parent....you already know how to survive with interrupted and less sleep.      

Parenting

Talking to Your Child About School Shootings

3:00

When something as emotionally overwhelming and tragic as a school shooting occurs, children are bound to worry if something like that could happen at their school.

Children’s mental health experts say children need an outlet to express their fears and worries, but oftentimes parents and caregivers are at a loss for words. 

According to Mental Health America (MHA,) a community based non-profit dedicated to promoting mental health throughout the country, knowing how to talk with your child about school safety issues could be critical in recognizing and preventing acts of violence, and could play an important role in easing fear and anxieties about their personal safety.

MHA offers these guidelines to get the discussion started and how to steer the conversions for a positive outcome.

  • Encourage children to talk about their concerns and to express their feelings. Some children may be hesitant to initiate such conversation, so you may want to prompt them by asking if they feel safe at school. When talking with younger children remember to talk on their level. For example, they may not understand the term “violence” but can talk to you about being afraid or a classmate who is mean to them.
  • Talk honestly about your own feelings regarding school violence. It is important for children to recognize they are not dealing with their fears alone.
  • Validate the child’s feelings. Do not minimize a child’s concerns. Let him/her know that serious school violence is not common, which is why incidents such as the latest school shooting in Parkland, Florida, and previous shootings attract so much media attention. Stress that schools are safe places. In fact, recent studies have shown that schools are more secure now than ever before.
  • Empower children to take action regarding school safety. Encourage them to report specific incidents (such as bullying, threats or talk of suicide) and to develop problem solving and conflict resolution skills. Encourage older children to actively participate in student-run anti-violence programs.
  • Discuss the safety procedures that are in place at your child’s school. Explain why visitors sign in at the principal’s office or certain doors remain locked during the school day. Help your child understand that such precautions are in place to ensure his or her safety and stress the importance of adhering to school rules and policies.
  • Create safety plans with your child. Help identify which adults (a friendly secretary, trusted teacher or approachable administrator) your child can talk to if they feel threatened at school. Also ensure that your child knows how to reach you (or another family member or friend) in case of crisis during the school day. Remind your child that they can talk to you anytime they feel threatened.
  • Recognize behavior that may indicate your child is concerned about returning to school. Younger children may react to school violence by not wanting to attend school or participate in school-based activities. Teens and adolescents may minimize their concerns outwardly, but may become argumentative, withdrawn, or allow their school performance to decline.
  • Keep the dialogue going and make school safety a common topic in family discussions rather than just a response to an immediate crisis. Open dialogue will encourage children to share their concerns.
  • Seek help when necessary. If you are worried about a child’s reaction or have ongoing concerns about his/her behavior or emotions, contact a mental health professional at school or at your community mental health center. Your local Mental Health Association or the National Mental Health Association’s Information Center can direct you to resources in your community.

Educational psychologist and Parents Magazine advisor, Michele Borba, EdD, also has some tips to help parents with these important conversations.

"Chances are your child got wind of the shooting in class or from friends, but kids can easily get the facts wrong or misinterpret them, which escalates their fears," says Borba. Grade-schoolers especially tend to exaggerate things -- "That school is right next to ours!" or "50,000 kids were shot" -- and you want to make sure your child's not worrying over something completely unfounded.

Because peer interactions in schools play such an enormous role in how kids react to something, Borba suggests parents ask their child what their friends are saying about the event.

Tweens and teens -- and boys especially -- might be reluctant to open up and let you know that they're afraid or worried for their own safety. But they might be more apt to come clean with "Kyle was really upset about what happened," says Borba. Asking this question is also another way to ensure your child and his friends have the story straight.

Parents should reassure their child that their school is safe. Schools should be able to provide parents with an outline of precautions and safety procedures that are in place in case something like this should happen. Parents can ask school administrators the tough questions and relay the answers to their children in age-appropriate language.

With current technology, people have the ability to get almost real-time information when any event takes place anywhere in the world. Let your child know that they can talk to you about anything; the good, the bad, the frightening. 

Give serious thought to how you can talk to your child about these types of anxiety producing events. It’s difficult because everyone wonders how these kinds of tragedies keep happening, but as parents, you can help your child cope better when you’ve got a plan and have thought it through.

Story sources: http://www.mentalhealthamerica.net/conditions/talking-kids-about-school-safety

Laura Wiener, http://www.mentalhealthamerica.net/conditions/talking-kids-about-school-safety

 

Your Toddler

Fidget Spinners Can Be Dangerous for Young Children

2:00

Fidget spinners may offer some kids a release from built up tension, but in the hands of toddlers & preschoolers, they could be dangerous, doctors warn.

A 3-year-old boy and a 4-year-old girl suffered severe esophageal burns after they swallowed button batteries from fidget spinners, according to one new report.

Two other case reports describe esophageal injuries suffered by children who swallowed broken fidget spinner parts, but no batteries. The pieces were removed by emergency endoscopy.

Batteries can cause serious burns when they come in contact with bodily fluids. In children’s toys, batteries are usually well secured, but in devices not made specifically for children, that’s not always the case.

The new reports add to growing evidence about the hazards fidget spinners pose, especially to toddlers and young children.

"Having an unlabeled button battery in a toy or product that children can handle and break poses a potential danger to children," Drs. Athos Bousvaros and Paul Rufo, of Boston Children's Hospital, wrote in a journal news release.

Fidget spinners are available just about anywhere you go. They’re sold at gas stations, stores and big toy chains. They’ve actually been around for years and are often given to children with autism to help them concentrate. In the last year, their popularity has exploded. The gadgets appeal to adults as well as kids.

Doctors are issuing a warning to parents to make sure that they are aware of the possible dangers to the younger kids in a household.

The reports are described in the January/February issue of the Journal of Pediatric Gastroenterology and Nutrition.

Story source: Robert Preidt, https://consumer.healthday.com/kids-health-information-23/child-safety-news-587/fidget-spinners-may-be-dangerous-in-the-wrong-hands-730642.html

 

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Your Baby

SIDS Risk Higher in Certain States

3:00

SIDS (sudden infant death syndrome,) also known as “crib death,” continues to be a baffling and tragic problem for many families in the United States. According to the Centers for Disease Control and Prevention (CDC,) around 3,700 SIDS deaths were reported among infants less than 1 year old that had no immediately obvious cause.

And in some states, the toll is heavier than others, health officials report.

 "Despite continued updates and refinements to the American Academy of Pediatrics' (AAP) safe sleep recommendations, declines in SIDS have slowed since 1999," said lead researcher Alexa Erck Lambert.

"Our analysis also found that trends in SIDS vary by state," she added. "Although some states have experienced notable declines, wide variations in SIDS rates by state still exist."

While SIDS has declined in several states, it has increased in others.

The greatest declines in SIDS rates were seen in California, Colorado, the District of Columbia, Florida, Kansas, Missouri, New York, Oregon, Washington and Wisconsin.

On the other hand, the highest SIDS rates were found in Alaska, Arkansas, Alabama, Kentucky and Louisiana. Significant increases in SIDS cases were also seen in these states between 2000-2002 and 2013-2015.

The rate of SIDS cases dropped about 7 percent from 1999 to 2015. From 1990 to 1998, however, these deaths fell nearly 45 percent, the study authors reported.

The researchers can't say why there are state differences or why the number of SIDS cases has flattened.

"The reasons for the trends are outside the scope of this study and impossible to tease out from vital statistics data," Erck Lambert said. "Our goal was to illuminate the trends and state variation."

One child health specialist, Rebecca Carlin, a pediatrician at Children’s Health Center Hospital in Washington, D.C., believes there may be several factors contributing to the higher SIDS risks in certain states such as cigarette smoking, cultural differences and SIDS education availability.

"All five of the states with the highest and increasing SIDS rates also have some of the highest rates of smoking, whereas only one of the nine states with the biggest fall in SIDS rates had as high a rate of tobacco use," she said.

In addition, laws that cover training childcare providers on infant safety vary from state to state, as do rates of health insurance coverage, said Carlin, who co-authored an editorial that accompanied the study.

"There are also racial differences in SIDS rates, with American Indian and Alaskan Native and non-Hispanic African American infants having the highest rates, and Hispanic American and Asian American infants having the lowest rates," she said. 

Moreover, some states have home-visiting programs and other initiatives that have been helpful in educating parents on safe sleep, Carlin added. 

"In the U.S. as a whole, but particularly in states where the number of SIDS deaths are increasing, we need to invest in programs to effectively decrease smoking and substance use, increase prenatal care and promote safe sleep environments in order to better protect infants," she said.

The Back to Sleep campaign has been updated over the years and is now called the Safe Sleep campaign. Although SIDS is not preventable, there are ways for parents and caregivers to reduce the risk of SIDS and other sleep-related causes of infant death. Many of these actions aim to create the safest possible sleep environment for baby.

The AAP offers these Safe Sleep recommendations:

  • Always place your baby on his or her back for every sleep time.
  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
  • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
  • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
  • Wedges and positioners should not be used.
  • Pregnant woman should receive regular prenatal care.
  • Don’t smoke during pregnancy or after birth.
  • Breastfeeding is recommended.
  • Offer a pacifier at nap time and bedtime.
  • Avoid covering the infant’s head or overheating.
  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
  • Infants should receive all recommended vaccinations.
  • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

The report was published online in the journal Pediatrics.

Story sources: Steven Reinberg, https://consumer.healthday.com/kids-health-information-23/sudden-infant-death-syndrome-sids-news-643/babies-face-higher-sids-risk-in-certain-states-731009.html

https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/aap-expands-guidelines-for-infant-sleep-safety-and-sids-risk-reduction.aspx

https://www.cdc.gov/sids/data.htm

 

 

Daily Dose

New Dietary Guidelines

1:30 to read

The United States Department of Agriculture issued their new dietary guidelines for 2015-2020. This seemed like a good time to re-visit the topic of healthy eating habits for families…..always a topic of conversation with my patients.

While so many of us talk about healthy eating and reducing needless calories, the government is now also focusing on one of the main culprits, SUGAR.  The new guidelines recommend that we limit sugar intake to about 12 tsp of sugar a day which may sound like a lot until you realize that a can of Coke contains nearly 10 tsp of sugar.  Studies have shown that the “average” (not defined) American currently consumes 22 tsp of sugar /day.  It seems that nearly half of the sugars in our diets are from sweetened beverages and sports drinks. While I know that many the families in my practice have cut out soft drinks, their kids do drink a lot of sports drinks. If it’s a sticky drink it probably has sugar.

At the same time the FDA is also proposing that food labels be changed yet again, to list added sugars. While the current labelling lists “total sugar”, this is a combination of added and natural sugars.  There is a difference between natural sugars found in fruits such as apples and berries, than there is in the processed added sugar found in a chocolate chip cookie or granola bar.  Kids can attest to that all day long!  There are also added sugars in many of the pouches that are marketed for babies and young children…despite the fact that they may be “organic” some have a lot of sugar that also sticks to their teeth as they “suck” on the yogurt or applesauce rather than eat it from a spoon.

The new guidelines also state that teenage boys and men are eating too much protein. The guidelines now recommend, “men and boys reduce their overall intake of protein foods such as meat, poultry, and eggs”.  This group (and all of us I think) should add more vegetables to their diet.

The newest guidelines really seem to focus more on healthy eating habits, rather than on individual nutrients, which seems to have been the take home message. I think we all “know” that eating more fruits and vegetables is good for you, but many people need more guidance than that broad statement. Eating a diet that is colorful which means more fruits and veggies and less carbs and meat has been the goal for a long time.

These guidelines are especially important as they affect the foods that are chosen for our children’s school lunch programs which feed more than 30 million children each day.  The guidelines also contribute to how food assistance programs like WIC are determined.

But, back to basics….eating family meals at home is always important. Making even small changes towards a broader, colorful diet rich in lean meats, fruits, veggies and whole grains will be beneficial to everyone. Lastly, why not try a meat free night once a week as well…have you tried cauliflower steaks yet?

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Parenting News You Can Use

Daily Dose

Valentine's Day

1:00 to read

Valentine’s Day is always a good time to remember how important it is to show affection…and in reality we parents hopefully show our children affection throughout the year.  But we can all be reminded that children need to hear positive and encouraging words from parents. The American Academy of Pediatrics recommends that parents “avoid using sarcasm or mockery and get rid of put-downs” when talking to children. Being a good role model and modeling the behavior that you would like to see in your child is the key to positive parenting.

 

Children, like adults, can also get in bad moods. I sometimes see patients during clinic where the chief complaint from the parents is…”my child has to be sick because they are SO CRANKY!”.  That makes me smile, as I remember days in my own home where I would say to myself, “if I wasn’t a pediatrician I would take my child to the doctor as there must be a reason for this behavior”. Actually, when your child is angry or even just in a bad mood try giving them a hug, cuddle or just quick kiss on the cheek to let them know you love them….and if they are older save the discussion for what is causing the moodiness for a later time. Picking the time for talking is really important…boy did I have to learn that!

 

It is always important to spend time alone with your child…even when life is so busy. Setting aside a special time each week for a game, a bike ride, or even a ball game gives your child something to look forward to. For Valentine’s Day what about making homemade Valentine’s for younger siblings or for the grandparents. All ages can be involved in this project and everyone cherishes a handmade Valentine.  

 

One of the things I really love to do with my grandchildren is to bake cookies and decorate them together. So, we have a date scheduled to bake cookies this week and I have all of the icing, sprinkles and glitter ready for decorating…and giving for Valentine’s Day treats!!!

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Potty Training

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