Wednesday, February 26, 2014

(New) Baby Mama Drama, Part 2: CHILD PASSENGER CAR SAFETY

If you offend easily, this is not the blog for you...

I've made a very good living off of other people's bad choices. And frankly, in this day and age, there's no excuse for ignorance in the arena of car safety. I've seen statistics anywhere from 73-98% of car seats are used incorrectly. So here's the down and dirty on keeping your kiddos safe in the car.


Law mandates that a child less than 8 years old and less than 4 feet, 9 inches must be in a car seat device at all times and restrained according to the seat's instruction. Right off the bat that means if you have a 1 year old, they must be in a 5 point harness and rear facing. Period. It's law. Along with that, if you have an older child that no longer sits in a safety seat, they have to be in a seat belt at all times including the shoulder strap. So if you're taking a long road trip and Jr wants to lay down to sleep, he has to stay in the shoulder strap. Period. It's law.

Why is the "law" important? Well if you're asking that question, we have several other things to talk about. But think of it this way....the law is always several years behind expert recommendations. So if it's written in law that something is's really, really necessary.


So what do the experts recommend? A big push that we are trying to make is to keep your baby rear facing until at least 2 years of age or longer. 

Longer?!? But my kid can't see!! His legs are bent!! He doesn't look comfortable!!!

So what. He doesn't know any different. Comfortable? You know what's uncomfortable?? A traumatic brain injury. Skull fractures. Having your face busted into a hundred tiny pieces. That's uncomfortable. And you know what? It happens all the time. Often. Frequently. Don't test me on this. And honestly, have you not seen how kids sit on the floor? If he has to sit with his legs crossed in his seat, he'll live. Thankfully. (And on that note, children are not to ride in the front seat until their 13th birthday.)

And guess what? Other countries with lower death and injury rates keep their kids rear facing well through the toddler years. Think 4 years old. And this is normal to them. Read about it here and watch the video below.

INSTALLATION (of seat and child)

Some installation tips and videos can be found here on the Safe Kids website.

There was once a time when people said you can go to the Firestation down the street to get your seat checked, but that's no longer a great idea. Firemen are not car seat technicians. They can help you read the directions, but that's about it. If you're in the Fort Worth area you can call Safe Kids Tarrant County at 682-885-2634 to schedule a FREE car seat check. Other car seat techs can be found by visiting the Safe Kids website of your area.

But how do you know if your child is in the seat correctly?? Here's a good list to review! Unfortunately this list doesn't discuss proper clip placement. The chest clip should be at the nipples/armpit area. Not lower - this can cause significant abdominal organ injuries.

The tightness is also important. Children do in fact fly out of seats and through windows when their seats are installed correctly but aren't tight enough in the straps. Do the pinch test.

The safest place for them to sit is in the back middle seat. If you don't have a back middle seat, the next safest place is directly behind the driver. (I can already hear the cries of the ignorant mothers...."But I can't see him! What if I need to get to him?" Again I say this: So what. You can't see him. You really need to get to him? Then pull over. You shouldn't be reaching back there anyway to get to a rear facing child. Pull over.)

If you have multiple child passenger safety seats that need to be installed, the infant seat should go in the middle. It is not side impact reinforced. Larger convertible seats are, so they are safer to go behind the driver or passenger. And they should be rear facing. Still.

If you don't want your children to be flying objects in a crash, don't put them in a big fluffy coat in their car seat or booster. I promise they won't freeze to death. Just take their coat off before getting in the seat and give them a blanket (as long as they aren't newborns) and they'll be fine. I can't make that same promise if you put them in a fat coat. When a crash happens, the coat compresses and they can fly out of their seats. At high speeds. Through windows. Please hear me: soft skin does not fair well against concrete and asphalt. Nor do growing brains.

Other flying objects include coffee mugs, cds, books, strollers, or anything else you don't have tied down. You think this is over reacting? Let me tell you the story about a kid I saw who had a wreck with a box of ceramics in the back.

And next time, put your paint in the trunk.

Here's the thing guys. This is simple. It's not difficult. We aren't suggesting you build a fort to place around them anytime they leave the house. This takes no extra time and very little if any extra effort. I would love to place pictures of what my forward facing patients look like, but apparently that's illegal. It's a shame. I think that's the only way some of you would see the risk you take. But please, let my professional knowledge and experience be enough for you to do the wise thing and follow these recommendations.

Thursday, February 20, 2014

The Breastfeeding Propaganda

Oh yes. Yet another post about breastfeeding.

I've become very weary of the anti-breastfeeding world. And I'm not talking about the mamas who feel like they can't do it, or even the mamas who don't want to do it. I'm talking about the mamas who treat those of us who are doing it like we're weird or crazy or "granola." Whatever that means.

You wouldn't be calling Eve "granola" or treating her like she's a loon for feeding her child the way God made her body to. Even the formula companies agree that "breast is best."

And HEAR ME - I am NOT saying if you didn't nurse your kid that you made a wrong choice or that you're a bad mom. What I am saying is just because you didn't breastfeed doesn't mean you should make me feel like a Crazy for doing it!! It may have been inconvenient for you to nurse but it's extremely convenient for me (and my baby) to nurse. And we'll do it until he's done.

This blog popped up in my feed today and it was a homerun as far as I'm concerned.

If I get one more question or snarky comment about covering up in public for modesty's sake (which I do) or about people's "rights" to do as they please in this arena, I might pop.

What the non-breastfeeding crowd doesn't understand is that those of us who do nurse our children are just as much (if not more so) persecuted for our choice than they. There's a lot of irony there.

Eat up babies. No matter how you do it. And tell your mamas to be nice.

Thursday, February 6, 2014

(New) Baby Mama Drama, Part 1: FEEDING

Don't worry New Mama. We've all been there...what the heck are those for anyway???

Here's the thing. You've heard the expression "There's more than one way to skin a cat," right? Well, there's definitely more than one way to have a baby and raise a baby. I get asked by new mama's all the time about car seats, breast feeding, sleep problems, starting solids....and I'm no expert, but between having 2 kids of my own and nearly 10 years of experience in pediatric medicine, I've got a few tricks up my sleeve. So here is one of my favorites:


I hit this one first because it's the most special to me. Not the most important necessarily, but real dear to my heart. I have been fortunate enough to nurse both of my babies. And loved, loved, loved that special bonding time. My oldest nursed for a little over 12 months, and so far I'm about 7 months on my second one. Please hear me mama's that did nurse or give pumped breast milk - I am not judging you, shaming you, or saying you did wrong by your baby. skinning.... Ok. Now that that's out of the's a few tips for you to be successful.
   -  when your baby eats, you are either feeding them straight from the breast or pumping (This is crucial. The amount of milk you make works off supply and demand. So if for some reason your doctor or midwife is having you supplement with formula, give the baby the formula and then pump!!! Every. single. time. If you aren't stimulating the nipple when the baby eats, your body doesn't know to make more.)
   -  your job for the first couple of weeks is to feed that baby whenever they are hungry. If he starts to fuss for more milk just 30 minutes after you feed him , feed him again. If he wakes up at night to eat, feed him. Frequent feedings early on will help set your breast tissue up to make more milk now and in the future. If you want to try to sleep train him later, then wait until you've got a good solid supply which will take a good 6 weeks.
  -  it's always good to take a change of shirts out and about for you when you're newly feeding. Milk happens. :)
  -  the American Academy of Pediatrics recommends exclusive breastfeeding for 6 months. This allows baby to get all of their needed nutrients straight from mama with all the added benefits of immunity without risks of food allergies. Some studies have shown that adding in food (or even supplementing with formula) before 6 months decreases the effectiveness of the immunity that baby gets from your milk. So unless there's a milk supply issue, try not to supplement with formula.
  -  keep taking your prenatal vitamin with DHA (good for baby, good for mama's energy)
  -  eat one extra small meal a day. This isn't your cue to go crazy, but if you are still hungry, eat again. Don't worry about losing that baby weight. Breast feeding will do it for you. And if you're hungry, your body needs it. I recommend a daily (or twice daily) Bod-e shake that you can get here. This has great health properties, is super easy, and tastes like melted ice cream. I use it a breakfast, for a snack, and even for dessert occasionally. Yes, I do.

  -  If it hurts real bad, there's a very good chance there's something wrong. Check with your hospital to get a follow up lactation consult. Sometimes they'll come to your house, and it may be included already in your hospital stay. You can also contact For Babies' Sake and they'll help you out!
  -  super sore nipples can be cured (yes, cured) with a prescription from your doctor or midwife. (only the midwives with a masters degree in nursing can write prescriptions - so if you had your baby with a midwife in the hospital, they're able to write prescriptions; the majority of RN midwives do not deliver at birthing homes or in homes.) Jack Newman's All Purpose Nipple Ointment will have you better in less than a day. You will need a compounding pharmacy and it may take a few calls back and forth to make sure they have the ingredients. Tell them that it is imperative you get the prescription today and if they can't do it, you will need to call another pharmacy. If you're in Arlington/Ft Worth area, the Randol Mill Pharmacy has been incredible! Some prescriptions call for an added advil powder as well. Make sure your pharmacy is making an ointment and not a cream.  If your healthcare provider is unfamiliar with APNO, tell them the formula and that it can be found online from multiple breastfeeding resources. A lactation consultant will also recommend it.

  -  remember, when your baby is eating, you are either feeding them from the breast or pumping. This is key to keeping up your supply.
  -  fenugreek and mother's milk tea are extremely helpful to most people. Here's more about it from Kelly Mom.
  -  you may have a well meaning pediatrician, midwife, or nurse practitioner that tells you to supplement with formula. This is usually not necessary unless there are other issues going on. If your baby is gaining weight, there is no need to supplement. Doing so will only cause your supply to decrease further. If your baby is not gaining weight properly or is losing weight, you may need to supplement for a short period of time while you work on your supply. You do that by pumping. And pumping. And pumping some more. Feed your baby from the breast first every time, then pump while they take a bottle. This takes time, energy, and a lot of patience. But it can be done! If you're not sure how much milk you're making, you can exclusively pump for a couple of days and give baby that expressed milk. This will let you (and your healthcare provider) know how much milk you're making. Keep in mind that your baby is more effective than a pump so they are probably getting out more milk than what you are able to pump. Here is a great article on the issue.

This is a heavy question. Not only is this one of the sweetest bonding times you can ever have with your baby, but you can both have extremely great physical health outcomes from it.  Breast feeding has been known for a very long time to reduce ear infections, respiratory infections, and many other childhood illnesses, (not to mention much faster weight loss for a previously preggo mama!) but we're also finding some new things it does! Including:
  -  reducing obesity
  -  improving brain development 
  -  increasing IQ
  -  reducing breast cancer, heart attacks, hypertension for mom

  -  A recent study showed that mom's who had a "breastfeeding only" goal missed their mark. What does that mean? They aren't getting the support they need. Wether that's from healthcare providers answering questions, family members (including dads), or their workplace, mama's need help!! Here's a great link about workplace laws and breastfeeding for us working mamas out there.  Please know this, there is help out there. Ask questions!! Don't give up, because you can do it! You can always email me for ANY questions you have. If I can't help you, I can point you to the right person. It's not a bother. At all.
  -  You're not alone. Other mamas have trouble and need help. So pick up the phone, get on your email, and get some help! We all need help, no matter who we are.

Bottom line is this: if you can't breastfeed, get tired of breastfeeding, don't have the support, or just flat out don't want to do it, that doesn't make you a bad mama. Your child will still love you. They can still be doctors or lawyers or rocket scientists. They can still grow up to be healthy, well-rounded people. So cut yourself some slack. If you are like one of those mama's that really wants to breastfeed and wants to be successful at it, then find the help you need to do it.

Kelly Mom
For Babies Sake
La Leche League of Texas
THR Lactation Consultants

In The News: Many First Time Mother's Experience Breast Feeding Difficulty

From NAPNAP's PNP Daily News email 9/24/13:

Many First-Time Mothers Experience Breastfeeding Difficulty.

In continuing coverage, Reuters (9/24, Pittman) reports that breast-feeding can prove difficult for new mothers. In an analysispublished online Sept. 23 in Pediatrics, after interviewing first-time mothers, researchers discovered that 92% reported that they experienced difficulty with breastfeeding starting the third day of the infant’s life. Problems included difficulty feeding, concerns regarding milk supply and pain. Reuters adds that exclusive breastfeeding is recommended by the World Health Organization until the child reaches six months. After six months, breast-feeding is to be continued “with the addition of appropriate foods through age two.”
        CBS News (9/24, Jaslow) reports on its website that researchers have reached out to hospitals to “develop strategies to reach concerned moms early on into the postpartum period.” Dr. Laurie Nommsen-Rivers, the study’s lead investigator, stated that a two-prong approach is necessary to assist mothers with breastfeeding: First, “strengthening protective factors,” like peer support andbreastfeeding education, and second, providing professional lactation support to address their concerns.
        Breastfeeding Concern Raises Questions Regarding Bed-Sharing. The Los Angeles Times (9/24, Brown) reports that another study published online Sept. 23 in JAMA Pediatrics explored the relationship between sharing a bed with an infant and breast-feeding, which determined that breast-feeding lasted longer for infants who “slept on the same ‘sleeping surfaces’ as their mothers.” Ninety percent of new mothers reported in this survey that they, too, experienced issues with breast-feeding shortly after childbirth, and while bed-sharing may alleviate those problems, the authors of the study warned mothers of the safety risks associated with infant-parent bed-sharing.
        Reuters (9/24, Pittman) reports that although the American Academy of Pediatrics recommends that infants remain close to their parents while sleeping, sleeping in the same bed may increase the infants’ risk of sudden infant death syndrome (SIDS).
        The story is also covered by the NPR (9/23, Shute) “Shots” blog, the Time (9/23, Sifferlin) “Healthland” blog, HealthDay (9/24, Salamon), and MedPage Today (9/24, Walsh).

From PNP Daily News email 9/23/14:

Nursing Difficulties Could Lead New Mothers To Stop Trying.

MedPage Today (9/23, Raeburn) reports on a prospective study published online in the journal Pediatrics, which found that “new mothers who had problems breastfeeding, especially during the first 2 months postpartum, were at risk of giving up nursing and using formula.” According to researchers, “the peak adjusted relative risk (ARR) for stopping breastfeeding at day 3 was 9.2 (95% CI 3.0-infinity) among women who expressed concerns.” The data indicated that “breastfeeding concerns that yielded the largest adjusted population attributable risk (PAR) for stopping were ‘infant feeding difficulty’ at day 7 (PAR 32%) and ‘milk quantity’ (PAR 23%) at day 14.”

Monday, February 3, 2014

Hot off the Press: US Abortion Rate Declines

Abortion Rate At Lowest Level In More Than Three Decades.

Major newspapers, wire sources and other media outlets report that the US abortion rate has reached its lowest level since 1973, according to a study called “Abortion Incidence and Service Availability in the United States, 2011,” which was issued by the Guttmacher Institute, a supporter of legal access to abortion.
        The New York Times (2/3, A10, Eckholm, Subscription Publication) reports that in the US, “the abortion rate...declined to its lowest level in more than three decades in 2011, according to a new report released Monday.” The report also found that “the decline in abortions from 2008 to 2011 was mirrored by a decline in pregnancy rates.”
        According to the Washington Post (2/3, Somashekhar), the report found “there were fewer than 17 abortions for every 1,000 women in 2011, the latest year for which figures were available.” This represents a decline of “13 percent from 2008 and a little higher than the rate in 1973, when the Supreme Court handed down its landmark Roe v. Wade decision.”
        USA Today (2/3, Jayson) reports that declines “were seen in all but six states.” Study author Rachel Jones “attributes the decline to more women using ‘highly effective contraceptive methods such as the IUD’ and the fact that the study period was during the recession and sluggish recovery.”
        The Wall Street Journal (2/3, A4, Radnofsky, Subscription Publication) notes that from 2008 through 2010, US states enacted 44 laws that restricted how abortion is regulated. In 2011, another 62 laws were passed, but many of these were not immediately put into effect following their passage.
        The Los Angeles Times (2/3, Hamedy) reports other findings from the report, such as the fact that “more abortions came earlier in the pregnancy and medication abortions constituted a larger share of the total.” The report, called “Abortion Incidence and Service Availability in the United States, 2011,” noted, “An estimated 239,400 early medication abortions were performed in 2011, representing 23% of all nonhospital abortions, an increase from 17% in 2008.” The report will appear in the March issue of the journal Perspectives on Sexual and Reproductive Health.
        The AP (2/3, Crary) notes that the highest rates of abortions were found in “in New York, Maryland, the District of Columbia, Delaware and New Jersey; the lowest were in Wyoming, Mississippi, South Dakota, Kentucky and Missouri.” But, according to the report, “many women in Wyoming and Mississippi, where providers are scarce, go out of state to get abortions.”
        Also covering the story are Reuters (2/3, Moon), theHuffington Post (2/2, Bassett), the NPR (2/3, Rovner) “Shots” blog, and CQ (2/3, Adams, Subscription Publication).

Post copied from NAPNAP's daily email PNP In The News

Sunday, February 2, 2014

On the Menu: Perspective

Ever have those days when you just feel down right sorry for yourself? I wish I could say that was completely below me. That of course I'm never ungrateful. That it can't cross my mind to take for granted all the blessings in my life.

But. Guess what. I can't say that.

And the funny thing is I am usually the first one to remind you that "it can always get worse." I have an entire career involving people's "worse" days. If anyone knows it can get worse...Maranatha.

So on the menu for today: some fresh, clear, well seasoned perspective.

After a while of feeling sorry for myself, I gathered up letters from each of my 5 Compassion children. Each letter is written with care. Nearly every word has a different meaning to me than it does to it's precious author. Why? Perspective. When Ilder in Guatemala says to me "I thank you for the letter you sent me. It is very nice. I keep it in a special place," I wonder what this "special" place looks like. Thinking of the 4 walled home and dirt floor he shares with his parents and siblings snaps me back into reality. No longer can I feel sorry for myself that an offer fell through on a home. I still have a home. With heat. With electricity. And with clean running water. In 3 different places. He prays for "blessings" in our lives. What does this look like to him? What is a blessing to a 16 year old boy living in extreme poverty? It's a little different than the blessings we begin to expect, or heaven forbid feel entitled to.

So I drive to work, and again lose perspective. It's the Lord's Day, Sunday, and I'm going to work. Not only that, but my family is enjoying themselves some dear friends' house. Cue the violin. Agnes from Tanzania says to me, "I am happy at school with tailoring studies. When I am done, I will employ myself because I will make clothes for others, and I know I will get a good place to do my work."  Thank you Agnes. That was a fresh heaping plate of perspective. And it warms my soul.