Tuesday, April 20, 2010

Car seat safety

The National Highway Transportation and Safety Administration reports that motor vehicle crashes are the leading cause of death for children in age groups three to six and eight to 14. Make sure your child is protected in every vehicle in which they are a passenger.

Among the factors that contribute to preventable injuries in a vehicle are: 1) car seats installed or used incorrectly; 2) a child being placed in the wrong type of car seat; and 3) moving a child into regular seat belts before the seat belts fit properly.

Car seat installation and use

When installing a car seat there are three important steps:

1) Read the vehicle manual – the vehicle manual will tell you how the seat is intended to be used in that particular make and model.

2) Read the car seat manual – the car seat manual will tell you how the car seat is intended to be installed in a vehicle.

3) Have a certified car seat inspector inspect the installation – the National Highway Transportation and Safety Administration estimates that three out of four car seats are installed incorrectly. Find a local car seat inspection station here.

Be sure to:

-Tighten the harness straps so that you can just fit your fingers between the strap and your child. Also be sure the straps are not twisted and are in the correct position. The harness chest clip should line up with your child’s nipples.

-Check to see that the seat belt is still fastened if the car seat is attached with a seat belt. If using LATCH, be sure that the LATCH locks are still in place.

-Not to place an infant seat in the path of an airbag.

Right type of car seat
Infants
Infants should be kept in a rear-facing car seat, as long as possible up to the height or weight limit of the particular seat. While most institutions still state the policy of one year of age and 20 pounds as the mark to turn a child front-facing, these marks are actually the minimums. Research is trending toward recommending that children be kept rear-facing until the age of two.

Toddlers
After a child outgrows his rear-facing seats, they should ride in forward-facing child safety seats until they reach the upper weight or height limit of the particular seat (usually around age 4 and 40 pounds). Note that toddlers should always ride in the back seat of the vehicle.

Young Children
When a child outgrows his forward-facing seat, he should graduate to a booster seat. The child should still ride in the back seat until the seat belts fit the child properly.

Moving a child to a seat belt
A seat belt fits properly when the lap belt lays across the upper thighs and the shoulder belt fits across the chest. In most vehicles, the fit is right when the child is 4’9” tall.

The back seat remains the safest place for a child until the age of 12.

There are so many seats on the market. All seats sold in the United States must meet federal safety standards. The extra money you pay for some seats is for added safety features (as determined by the manufacturer) and comfort features. The most important thing in car seat safety is that you use the seat correctly. For ease of use ratings, click here.

Two final notes. Do not use a car seat that has been involved in a motor vehicle accident. Remember to register your car seat with the manufacturer so that they can notify you of any repairs or recalls.

Wednesday, April 7, 2010

All About Teething

Unless you are the parent of one of 2,000 babies born with teeth, you are probably going to be staring at that adorable gummy smile for at least three months. Unless you are the parent of a child with an extremely rare condition that results in the child not ever growing teeth (a type of agenesis), you will deal with teething at some point.

While the tooth buds developed in your womb, your little one will not likely show his first pearly white until between four and seven months.

Pain
Most parents dread teething because of the expected pain for the child. The truth is that some children really do not feel any pain at all. For some children, a tooth sprouts overnight without bothering the child at all. Of course, for others, it is an incredibly painful and drawn-out process. Some theories state that teething does not cause any symptoms at all, including pain. I do not personally know anyone who does not attribute their child's fussiness, wakefulness, etc. around this age to teeth breaking through those adorable gums.

Dealing with pain
There are few things sadder than watching your baby cry and not being able to do anything about it. (I have to admit, though, sometimes I do find it adorable through the sadness!) So what can you do to help to alleviate some of your baby's pain?

There are well-known teething toys like Sophie the Giraffe. There are also sterile water-filled teethers, soft tube teethers, and vibrating teethers meant to massage. Of course, you may find that your child's favorite teething toy is his (or your) fingers. Some children, like mine, do not have a preference - they will chew anything in their reach.

You will often hear people talk about a frozen washcloth working well, but do keep in mind that sucking on a frozen washcloth, means consuming water (and possibly some laundry detergent).

Also on the market are teething gel and teething tablets. My mother-in-law insists that nothing works like rubbing whiskey on the child's gums, but I have chosen an alcohol-free childhood for my son. (There is more on the whiskey idea all over the Internet, but it is strongly advised against for obvious reasons.)

Symptoms
A rise in the child's gums is common, but can be there for several weeks prior to tooth eruption and may not appear at all in some children.

Fussiness - the soreness of the tooth rising closer to the surface may cause some fussiness. This tends to be the worst for the first teeth and the molars. Of course, you might be the lucky parent who never sees an increase in fussiness or the unlucky parent whose poor baby is sore (and therefore fussy) throughout teething.

Drooling - teething stimulates drooling. Again, the amount will vary baby to baby.

Coughing - your baby may cough due to increased saliva production.

Chin rash: extra drool = extra irritation to the skin. Be sure to keep up on your wiping to help prevent this.

Gnawing - As discussed above, teething babies very often like to gnaw on anything and everything. Biting causes pressure above the gums that helps relieve the pressure from under the gums.

Cheek rubbing - Pain in the gums may travel to the cheeks, especially when the larger teeth (molars) begin to erupt.

Ear pulling - Same as the cheeks, but keep in mind that this is also a symptom of an ear infection so do not dismiss it.

The medical community disagree whether two symptoms are actually teething symptoms - diarrhea and low-grade fever. If diarrhea lasts more than two bowel movements, or fever lasts more than two days, be sure to contact your doctor.

Sleeping less (and less well) - Teething pain does not stop for nights and naps. Your baby may wake more frequently due to pain.

Does my baby need a dentist?
The American Academy of Pediatric Dentists recommends that your child see a dentist when the first tooth appears, but no later than his first birthday. There are pediatric dentists, who specialized in school in the dental treatment of children. It may seem silly to take a child with one tooth to the dentist, but baby teeth help children learn to speak clearly and chew naturally and they help to form the path for permanent teeth. Further, going to the dentist early in life and having a positive experience can prevent odontophobia in later life and establish good dental hygiene patterns for your child.

Monday, April 5, 2010

Solids - who knew food was so complicated?!

Food is pretty much the most basic thing in existence, right? We need to eat to stay alive and, outside of breathing, there is really no easier activity than chewing. So, why are solids so complicated when it comes to our babies?

Food Allergies
The first decision you will likely have to make is when to start feeding your baby solids. The American Academy of Pediatrics recommends exclusively breastfeeding your child for 6 months. Of course, not all families take this route, so this piece will recognize that starting at 4 months is an option if you want it to be and if your pediatrician is on board with it.

Studies about age at which a child first starts solids are of little help. The "open gut" theory is that, between four and six months of age, babies have an "open gut," which means that the small intestines's cells have spaces that will allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream. Some studies say that this is true because nature wants babies to be able to readily accept antibodies from breastmilk and that the danger is that large proteins from other foods and disease-causing pathogens can also get through. These studies cite evidence that starting solids before 6 months increases a child's risk for food allergies.

Of course, there is the other side. Other scientific studies have recently shown that delaying introduction of solid foods may be associated with increased risk of food allergies.

In other words, science is on your side for reducing your child's chance of allergies whether you choose to introduce solids at four months or six months. In more other words, nobody seems to know, so go with your gut (pun intended).

Sleep
My mom was constantly telling us how much better my son would sleep once we started feeding him solids. Then, once we started him on solids and his sleep patterns did not change, she kept saying how surprised she was that he was not sleeping better. This is one of those wives' tales that just will not die. Science no longer believes that solids make a baby sleep for longer periods or more soundly, perhaps with the exception of babies who are not getting enough to eat or are not properly gaining weight. (See Committee on Nutrition American Academy of Pediatrics. Supplemental foods for infants. In: Pediatric Nutrition Handbook, 4th ed, Kleinman, RE (Ed), American Academy of Pediatrics, Elk Grove Village, IL 1998. p.43. I cannot seem to get a link to this for some reason.) From my experience, zero difference.

Is Organic Necessary
The American Academy of Pediatrics says that organic baby food is no more nutritious or safer than other baby foods. Organic baby food is also more expensive that other baby foods. As we all know, however, organic does expose your baby to fewer pesticides and other contaminants in raw food. This is really an interesting topic to me because I had decided, before starting my son on solids, that I was going to make all of his food. Then, I went to start with peas as his first vegetable and the amount of salt in the organic peas available at Whole Foods was 10 times greater than the amount of salt in the Earth's Best jarred organic peas. So, his very first non-cereal food was from a jar.

Here is what I have decided to do. With the "dirty dozen" foods (peach, apple, bell pepper, celery, nectarine, strawberry, cherry, kale, lettuce, grape, carrot, pear), I will be buying organic and making it myself. Anything I can buy fresh, I will buy fresh and make myself (organic or not). Anything I have to buy frozen or canned, I will be buying from Earth's Best.

What comes first?
At four or six months, or any other age, regardless of whether the food is organic, you are going to have to decide what type of food to first (and second, and third...) give to your baby.

Of course, there are theories on this as well. Some people believe in letting your child eat with his hands first (baby-lead weaning). Some people believe in starting with rice cereal and going from there. Still others, start with a puree of their own choosing on a spoon. Bananas is a popular first choice because it tastes most like breast milk. (I note that diet does affect the taste of breast milk, so this really may not be even close to true for some people.)

We started with rice for five weeks, moved to oatmeal for one week, and then to peas (this is where we are at this piece's writing). Basically, we chose a very traditional route with our choices. My son is eating from a dish with a spoon. I might add that he loves to grab the spoon and "feed himself!"

Some final notes:
Breast milk or iron-fortified formula should be your baby's primary source of nutrition until the age of one year.

Always wait at least three days between introducing a new food and watch your child for signs of allergies. Allergy symptoms include: loose stools, excess gas, diarrhea, nausea, vomiting, streaks of blood or mucus in the stools, constipation, hives, ear infections, stuffy noses, runny noses, watery or red eyes, wheezing, asthma flare-ups, and eczema. Sometimes eczema or even fussiness id the only sign of a food allergy. If so, those are likely to disappear if you cease giving your child the offending food.

If you have a family history of food allergies, delay introduction of things like nuts, shellfish, and egg whites until the age of one year.

If you choose to make your own baby food, there are some recipies here. Just remember, it is often as easy as the food and a little water!

Be sure to ask your pediatrician about solids introduction and for guidance as to what foods to choose. Remember, though, it is your choice in the end!

Friday, April 2, 2010

Formula - so many choices

The first choice you will have had to make to have this post be useful to you is to either supplement your breastfeeding with formula or exclusively formula feed. Yes, the American Academy of Pediatrics recommends breastfeeding exclusively for the first six months of your baby's life, but that does not work for every mom. I also note that this post is meant to discuss formula for infants, birth to 12 months. For those of you with babies older than one year, this will not apply.

Major brands of formula:
Enfamil (Mead Johnson)
Good Start (Nestle)
Similac (Ross)
Store Brands (Target Up-and-up, etc.)

Formula types:
Powder in a can
Powder in individual packets
Concentrate
Ready-to-feed

Ready-to-feed is generally considered to be the most convenient. If your baby does not have a preference about the temperature of his bottle, you just open and feed with this stuff. It is also the most expensive. Powder in a can takes the most effort, but it is also the least expensive. If you use powder in a can, I highly recommend using the Dr. Brown's pitcher. In addition to helping you make all of the bottles at once, it drastically reduces the bubbles, which are so often a cause of gas in our little ones.

I started this post with the major brands and types because your baby may react very differently to formula based on these two things. One baby will perfectly digest Enfamil's powder in a can, while another will not tolerate anything other than Similac's ready-to-feed liquid. So how do you know what to buy?

In large part, you play the try-and-hope-you-succeed game. You should know going in that you are also playing the I'll-probably-guess-wrong game. It may take some trial and error to find the right match for your baby. Just watch for signs like gassiness, extra fussiness, and constipation. Those types of things (unless a medical condition is involved) will tell you the formula is not the right match for your baby. *Remember, constipation is not inability to have a bowel movement. It is actually passing hard stool. It is not uncommon for a baby to go three days without a bowel movement. That said, you will (scarily) get to know your baby's poop habits and know when something is amiss.*

What if you have tried every combination and nothing is working? Specialty formulas are out there, too. I would definitely recommend keeping an open discussion with your pediatrician about the types of formula you are using, thinking of trying, etc. Be prepare for direction/advice from the doctor if your baby is not gaining weight or is otherwise seemingly not getting the right nutrition.

Types of specialty formulas:
Soy
Allergy (a.k.a. predigested)
Thickened (for acid reflux)
Lactose-free (for acute diarrhea)
Premature discharge (for preemies)

What did we do?
We started off exclusively breastfeeding. When we made the move to formula, we started on Enfamil Premium. My son tolerated it, but was very gassy. We switched to Enfamil's Gentlease (reduced level of lactose) for about a month and then went back to the Premium. When we switched back, he tolerated the Premium perfectly. His little belly just needed some extra time to learn to handle the lactose content!

One last reminder - no cow's milk for babies until they are one year old. They just can't digest it until then!

One last note, too - The AAP recommends that you do not exceed 32 ounces of formula for your baby per 24 hours. Many pediatricians will tell you that you can go to 35 or 40 ounces. If your child is still seemingly hungry after 32, try a pacifier to see if it is really just a sucking need, not a feeding need, that needs to be satisfied. If that and distraction play do not work, consider whether you are ready for your baby to start solids (with pediatrician agreement, of course). There is a balancing act on this one - start solids early (which is controversial and against what the AAP advises) or feed more formula (which is controversial and against what the AAP advises). Ah... the tough calls of mommydom.

Thursday, April 1, 2010

What's best for your child?

As parents, we constantly ask ourselves what is the best course of action, product, etc. for our child. We talk about it with our significant other, our parents, and our friends. We analyze it with strangers on Web forums. Even the seemingly obvious answers are not simple.

Breast milk vs. Formula - Let's start there. We all know that "breast is best" - breast milk provides benefits that science can prove but not replicate. What if, though, breastfeeding causes the mother a tremendous amount of pain or stress or conflict with her spouse. Is it still the best for the child? In those cases, formula may prove best for the child because a child can sense stress. They are little sponges and a happy mommy makes for a happy baby.

Staying at home vs. Working - For a long time, people touted the benefits of a child having one parent stay at home. More recent studies are starting to show that children benefit from having two working parents, too - just for different reasons.

TV vs. No TV - There is a happy medium on this one. Educational TV. Experts still say, though, that no TV until age two is optimal for brain development and learning skills. Some people swear by "My Baby Can Read," "Baby Einstein," and other educational programs like Sesame Street.

There are so many other debates that are ongoing, sometimes raging, about raising children. To me, the funny thing is that people with much less information that we have today have been raising children since the beginning of time (literally). The human race has continued and the majority of children turn out just fine.

I was reading the latest Jodi Picoult book last night and this sentence caught me: "If you worry about being a good mom, then you already are one." Indeed. If you think about these things, wonder if you are making the right choices, and act in what you believe to be in the best interest of your child, you are a good parent. Remember - we don't have to be perfect. Just good enough.