Friday, June 29, 2012

A Piece of Equipment I Will Never Recommend

Parents seem eager to get their babies up and walking. So much so that there is a whole market in devices designed to do just that. Baby walkers have gained in popularity and many families use them instead of a playpen or baby yard. But baby walkers have more drawbacks than benefits.
Baby walkers are dangerous. Both in themselves and because they give baby access to things they should not be able to reach. Around 15,000 (yes thousand) babies go to hospital related to using a baby walker and a few have died. Some have fallen downstairs or caught themselves on the walker. Others have pulled down cups of coffee or pulled on electric cords.  Babies who cannot walk are not mentally ready to walk and should not be in that position. The American Academy of Pediatrics has issued a warning against walkers and Canada has banned them.
Contrary to what you would think, being in a walker does not help a typical baby walk sooner.  First of all, the walker holds them upright and they do not improve their balance while in a walker. Secondly, the foot pattern for moving the walker is different from that for walking. Some studies have demonstrated that babies who spend time in walkers are, on average, 3 weeks behind those who are not. In my practice, I have seen several babies qualify for services because they were delayed in motor skills. When the walker was removed, they quickly picked up the skills. Babies need to spend time moving around on the floor by themselves and standing at the furniture by themselves to develop the skills needed for walking. While walkers do not prevent typical development, for many babies they do slow it down.
Baby walkers are big pieces of equipment. Even the manufacturers suggest that a baby not use a walker until they can stand at furniture by themselves. It is recommended that babies spend no more than 15 minutes at a time and no more than 2 sessions a day in a walker. This is a costly and space consuming piece of equipment for such short use. By the time a baby stands at the furniture, it won’t be long before she is walking independently and the walker will be of no use anyway.
Bouncers and stationary standers do not move around and many of the safety issues can be avoided. These do have activities to keep baby entertained while mom is cooking, without letting baby move around.  Play yards have the advantage of allowing the baby to move independently and to have the activities changed by changing the available toys.  Play yards (Play pens) take up more space than standers. Babies should not spend extended amounts of time in any of these pieces of equipment but there are times when you need a safe place to keep baby entertained for a few minutes. Walkers are not the answer.

Friday, June 22, 2012

Traveling with baby or babies!


 Summer! time for vacation! Travel with baby!?! It can be done. It takes a little planning. My children's grandparents lived  16 hours flying time from each other so we did lots of travelling when our children were little. With a little planning, it was easier with infants than with young children because they did not need much entertaining. I was also grateful that I was breastfeeding. I had the food and comfort packed and ready with no suitcase, no refrigeration needed. Still, of the 4 allowed suitcases, one was for my husband and me and the other three were for baby. The baby also dominated the carry on luggage. I tried to minimize the carry-on (again thanks to breastfeeding) to the very necessary supply of diapers, clothes, clean wipers and some toys. For over one year olds, you could order a kids meal that they could eat ( I am not sure if that is still an option but it was useful).
People recommend that you book the bulkhead seats when you travel with children but I did not find that convenient. When mine were very young, the bassinet seat was convenient but I usually had to sit away from my husband and the bassinet was sometime above my head which made me uneasy. When they could walk, the bulkhead seats were in the middle and we could not block both ends. You also cannot place your luggage under the seat in front of you because there isn't one so the luggage is in the overhead and harder to get to, or after take off, all over the floor taking up your foot room. I always preferred the seats on the side. When the baby is over 2 they get an assigned seat and you can sit on the aisle with the baby inside. And the diaper bag was convenient. But that was me. Others swear by the bulkhead seats.

If you are using baby foods, you will need a supply and need to check with airlines on what you can carry on with you as they have new rules about how much of what texture you can have with you. You usually can not take water through the security check but can buy a bottle or refill an empty bottle on the inside of the check and take that on the plane.

The experience is tiring for all concerned and when you add time zone changes, you are going to face disruptions in your schedules. A long car trip or a long plane ride is not the time to try to regulate sleeping and eating hours. You do have to be flexible. One tip, Landing and taking off in a plane will cause your ears to pop. The same thing happens to baby and it is uncomfortable to say the least. Just as chewing gum will help your ears, sucking on something will help baby's. I always tried to breastfeed during both take off and landing but a pacifier will help if your baby uses one, or letting him suck on your finger will serve as well.

Just before travelling with baby is not the time to introduce major life changes such as toilet training. ending the paci or weaning. If you plan to travel with baby, wait until you are back home to begin these things. In addition to the problem of working with the new skill you will probably lose ground anyway with all the changes involved in travel. The slight delay will just mean that baby is more ready when you start.
Below are links to articles about travel with baby (from blogs I follow) that offer a wealth of advice and suggestions.

Sunday, June 17, 2012

Notes on Parent Infant Sharing of Knowledge

Last night I attended a presentation entitled “Listening to Children’s Wisdom”. The presenter is a Buddhist nun, Didi Ananda Uttama.  The general message of the presentation was that parents are not the only ones who bring something to the parent-child relationship. The child also has a significant contribution. Her belief is that the child is still more in tune with its spiritual nature and, because of this, willingly offers unconditional love to the parent. By recognizing and accepting that love, parents can relearn its meaning in their lives. It is the parent who needs to find that understanding and build on that connection in forming a relationship with the child. The infant offers it openly and freely. She went on to suggest that children submerge that spirituality as they grow older (hence, why parents need to relearn it).  As a result, conscious effort needs to be given to maintaining that open, loving connection that is present in the infant and the parents in the first months throughout the relationship.

Didi went on to say that in her belief system, the child chooses to be born to the particular parents. The match is made, again, by both and not just the parents. Therefore, the child is where it is supposed to be and the parent does what he or she is supposed to do. This is to say that some of the choices you think you make, such as the type of birth experience you have and if you breastfeed or not, are somehow guided by the needs of your child as well as of you. She is collecting stories of mother’s experiences where their children gave them a sign or taught them spiritual lessons. I hope I got the gist of her message. The attendees were mostly young mothers and proceeded to give her stories about their children at that point.

I have to agree that the infant contributes to the infant parent relationship. Each child is born with a unique personality and a unique set of sensitivities. Whether these are genetic or from the experiences during the 9 months in the uterus or, as in many eastern spiritual ideas, the result of previous life experiences is not for me to say. It is true that from day 1, possibly before, the baby brings its own personality to the relationship. Babies are NOT blobs of clay to be molded in the image the parent chooses. As parents, we must reconcile our image of what we expect to be with the real (and certainly more beautiful) infant that we meet after birth. Babies do give us unconditional love but we also need to make the adjustments to our personalities to meet the new person halfway. Most of us do this through our daily interactions in caring for the physical needs of the baby, feeding, cleaning, calming and entertaining. We are constantly learning from our baby and adjusting ourselves if we are listening to them, Babies are constantly learning from us as well. It is a give and take relationship throughout life and one we must nurture.

Monday, June 11, 2012

Coping with breastfeeding a newborn while entertaining a toddler

Breastfeeding the second time around was SO much easier. Probably because I had the confidence. I breastfed my first for 2 years, so I ‘knew’ I could do it again. I just felt way more comfortable, and I knew the early pain was normal and would get better in a few days. It’s been tough because my toddler still needs attention, but the baby needs to eat! So we’re working on it and figuring it out together. But overall, it has been way easier and more comfortable the second time around.”

This is the start of an article from Bay Area Breastfeeding and Education. Full of encouragement and practical suggestions for breastfeeding mothers. One of my favorite sites.

Thursday, June 7, 2012

What do milestones really mean?

We look for new skills in our babies to see if they are developing well. We check the lists of “milestones” and match our baby’s skills to it. There are some things we need to keep in mind.  Obviously, I believe in the sequence of development. Obviously, I am contributing to the “milestone mania” by printing the lists of milestones on the pages above but I want to caution you to use them carefully.
A first and important issue is that milestone lists are based on average. This means that half of babies will meet the milestone before and half will meet the milestone a little later. Milestone lists can either be at the time after most children will achieve the skill or most common time. No baby is common so it will be a rare baby who hits all the milestones when they are listed. My favorite developmental screening tool (photo and more on testing later) actually lists the skills on a bar that crosses several age zones and starts when 1% of infants show a skill, has marks for when 25% and 50% demonstrate the skill and finishes when 90% of infants demonstrate the skill. If your child is anywhere on the bar when the skill begins it is within normal limits.
An example of The Denver Developmental Screening Test.
A second factor is that development is not a smooth, even process. It occurs in fits and starts. Some babies will be at the same level for a period of time and then will jump in all areas. Others will make huge steps in one area of development while others rest. Most mothers notice and mention that there is a slowdown in speech when babies start walking. What this means is if you check your baby just before a development spurt he may seem behind but a week or two later just after a spurt, he may seem ahead.

You have heard the old expression, “you can’t walk, until you crawl.” Well, technically that is not true. Roughly 12% of typically developing babies never crawl and go on to learn to walk at a typical age. They do tend to find a way to move forward, most by hitching while sitting, but not on their hands and knees. We go back and get these children to crawl after they have walked to get the benefit of crawling for their hands and arms and senses but it shows that crawling is not absolutely essential to motor development. The same applies in all areas of development. Your baby may skip a step or two here and there before achieving a higher skill and may go back later or may never pass some stages.
Many of the items used to test milestones are based on cultural practices. For example, self feeding is often used as a measure of social development or of fine motor development. In some cultures, babies are not allowed to feed themselves at an early age and would have no experience with this.   Even children from other cultures, who have not been allowed to feed themselves perhaps because it is messy, would not be demonstrating this skill. Children may start to scribble on paper by about 15 months, but an infant who has never seen crayons or watched her mother or siblings color, is just as likely to put the crayon in her mouth as to mark paper without a demonstration. Some degree of experience is assumed in setting milestones as the majority of infants will have had it but not all.

In order to understand this, we must remember that development starts at conception. A baby born at 40 weeks has been developing for 40 weeks but one born at 25 weeks has only had 25 weeks of development and still needs the extra 15. This means that, if your baby was more than 3 weeks early, you need to count that time for intrauterine development. When checking milestones, you need to use the due date and not the actual birthdate.  Most professionals will do this until your baby is 2 years old. It isn’t that he has suddenly gained that extra couple of weeks at 2. It is just that, by 2, there is so much variation in normal development that we no longer measure in months but in 3 to 6 month increments. I worked with children up to 3 years of age and I kept in mind any prematurity until then, when testing.
Most infant testing is looking at development based on milestones. They tend to look at 5 areas of development, Gross motor, Fine motor (hand skills), Cognitive, Language and Social development.  The results of testing are impacted by all of the above.  More importantly, most infant testing has very poor predictive validity. This means that infant test tell you what your baby is like today. This is useful for doctors and people working with children and you for choosing suitable activities for your child but it is not useful to say anything about your baby’s future develoment. One reason for this is that infant brains are still forming and can change with the proper stimulation. There are several types of testing and most milestone charts fall into the category of screenings. These tests may suggest that there may be a delay but a more complete test would be needed to confirm that. Further testing is much more involved and needs to be done by a specialist. Some delays are due to environmental issues. Babies cannot learn to crawl if they are not on the ground, for example. These can usually be corrected with changes to the environment. Others have their roots in physical causes and may be life-long but all infants can make some progress with early intervention.

According to the Denver Development Screening Test, you should not be worried until you baby has not demonstrated 3 or more of the skill bars that are fully completed below her age range or, for premature babies, adjusted age.  This means that your baby may not show one or two of the skills at age level on a milestones list but that should not cause concern. If your baby is not demonstrating most skills that are 2 months behind his age in any area, you may want to consult your doctor. In any case, never be afraid to bring up your concerns to your pediatrician. You live with the baby. The pediatrician only sees the baby for a few minutes every few months, and usually the baby is distressed simply by being handled by the doctor. They can tell a lot from the weight and height and medical measurements but need your input on daily development issues under normal circumstances. Bringing up your concerns will, at the very least, give you some relief as the pediatrician can reassure you or refer you for help, whichever is needed.