Tag Archives: parenting

Down syndrome conference connects families, offers new information

This article has moved to: http://www.raisingarizonakids.com/2012/05/down-syndrome-conference-connects-families-offers-new-information/

Reacting to an autism diagnosis: what’s next?

This article has moved to: http://www.raisingarizonakids.com/2012/04/reacting-to-an-autism-diagnosis-whats-next/

Bike safety rodeo this Saturday, March 31

Every three days a child in the United States is killed while riding a bicycle. Every single day, 100 children are treated in emergency rooms for bicycle-related head injuries.

Proper helmet use reduces the risk of brain injury from these accidents by about 90 percent.

Why don’t more kids wear helmets? For some, it’s the cool factor. For others, it’s the expense.

This weekend, Cardon Children’s Medical Center along with Safe Kids Maricopa County will give away free helmets to the first 300 people to attend their Bike Rodeo.

It’s a chance to practice bike safety skills and to find out more about helmet use. Plus, there’s an opportunity to win a new bike.

More on how to fit a bike helmet

Cardon Children’s Bike Rodeo details:

  • Saturday, March 31
  • 9 a.m. to noon
  • Cardon Children’s Medical Center
  • 1400 S. Dobson Road, Mesa 85202
  • For ages 3-16
  • Bring your bike or scooter

Watch  injury prevention specialist Tracey Fejt, RN, of Cardon Children’s talk about an outreach program she designed that provides safety curriculum and free helmets to schools that agree to “helmet required” policies for students.

Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

Breastfeeding: debunking that “not enough milk” myth

Human babies have survived on their mother’s milk for millions of years, just like all other mammals, says Laurie Jones, MD, IBCLC. And a woman’s ability to make milk and nourish her baby is not based on a fragile system.

The majority of mothers are quite capable of feeding their young.  In fact, Jones says that 95 to 99 percent of mothers make enough milk for their baby.

Well check: Dr. Laurie Jones and one-month-old Sophia Gulbis and her mom, Stephanie Gulbis

When it comes to feeding a new baby, there were no other options but breastfeeding  until the relatively recent past. “We all forget that, says Jones, an AzAAP chapter member who practices at St. Joseph’s Hospital and Medical Center.

But today, says Jones, many mothers believe that when they have a baby, they won’t be able to make enough milk. “So many of their friends or family have planted the seeds of doubt.”

Modern hospital practices tend to inhibit built-in mechanisms for bountiful milk production, says Jones. “New mothers are bombarded with advertising for formula ‘supplements,’ and their doctor or hospital may give them free formula samples ‘just in case.’”

More on how Arizona hospitals are helping new moms to meet breastfeeding goals

And that perpetuates the myth that they won’t make enough.  “Our modern culture, beliefs, medical practices, and artificial substitutes have given rise to a false epidemic of not enough milk.”

Baby Sophia has been exclusively breast-fed since birth and now weighs 10 lbs.

It’s a combination of factors that lead a mother to begin feeding both breast and formula in the first days and weeks after her baby is born, says Jones, and that’s what leads to a reduced milk supply.

“That’s the number one reason mothers stop breastfeeding and do not reach the recommended 12 months,” says Jones. “It’s because of perceived — or real –low milk supply.”

What works

In the first few weeks when the mother’s body is figuring out how much milk to make, it is critical that she is given unrestricted access to her baby with no rules or limits on feeding.

“Many parents mistake a newborn’s constant need to suck as a sign of being underfed,” she says. “But babies are programmed to suckle frequently to bring in a mother’s full milk production.”

Dr. Jones examines Sophia's mouth and palate.

Babies have long been wired that way — because it ensures a safe, close proximity to their mothers. The amount of suckling in the first 5 days is a predictor of the supply for the following six months.  Anything that stands in the way of this natural regulation will prevent a mother from exclusively breastfeeding.

Jones, a pediatrician who is also an International Board Certified Lactation Consultant, helps educate medical professionals on how critical the first few days after birth can be for a new mother to get off on to a good start in establishing her milk supply.

From the moment the baby is born, says Jones, the only thing a new mom needs to do is be close to the baby to allow the mother-baby dance to unfold. Milk production will increase dramatically around the third day post partum.

More on skin-to-skin contact

It sounds simple, and natural, keeping a new mother and her baby close, those first few days right after birth.

But that’s not always what happens for women who deliver in the hospital. Jones points to research showing that on the very first day after birth — post-partum day one –there are an average of 54 interruptions to a mother’s hospital room, with each interruption averaging 17 minutes in length.

Jones sees women start giving formula in the hospital after their baby is born because they think they don’t have enough milk right after delivery. That’s not true, says Jones.

Facts on milk supply from Dr. Jones:  

  •  A woman only needs ONE breast to feed ONE baby. Expectant women begin making milk around 16 weeks in to a pregnancy.
  •  The baby’s stomach can hold about 7 to 15 milliliters comfortably in the first day of life.
  • The average volume of a feeding is 7 to 10 milliliters – about a teaspoon and a half.

    A spoonful of milk is about 7 milliliters

    “It’s amazing how nature delivers the perfect amount to the baby,”  says Jones.

When mother and baby are kept in direct contact with minimal interruptions, the baby will nurse frequently.  A minimum number of feedings is about 8 to 12 per 24 hours.  

  •  How do you know the baby is getting enough? Count wet (W) and stool (S) diapers:  Day 1 (1W, 1S), day 2 (2W, 2S), day 3 (3W, 3S), day 4 (4W, 4S), and day 5 to one month — about 6 to 8 of each.
  •  Pacifiers can steal time at the breast and lower milk supply when used in the first two weeks, too.
  •  Topping off with formula after breastfeeding will decrease a mother’s milk supply, and no formula should be given to a breastfeeding infant without a true medical indication and for a short therapeutic intervention.
  • If the baby won’t latch onto the breast for some reason in the first days after birth, the simplest fastest option is to hand express the milk in the mother’s breast and feed it to the baby on a spoon.
  • Pumps cannot get the colostrum milk out as easily as a mother can by hand, and there is a lot of set up and cleaning and time distraction involved in pumping.
  • Bottles of pumped milk should be avoided in the first 3 to 4 weeks when the fast flow of the bottle can create breast refusal.

More breastfeeding facts from Dr. Jones: Size doesn’t matter

  1. Women with small and large breasts make the same volume of milk per day.
  2. The rare 1 to 5% of mothers with true insufficient glandular tissue (IGT) who cannot make an exclusive milk supply should have a full medical evaluation before they are given that diagnosis.
  3.  The condition would not become apparent until a few weeks after the baby is born, and the infant is exclusively breastfed with inadequate growth.
  4.  Low milk supply is a medical condition that should be evaluated by a team,

Baby Sophia was treated for tongue-tie in the first few days after birth, which helped Stephanie to meet her breastfeeding goals.

including the mother’s obstetrician, baby’s physician, and an IBCLC.   There are maternal hormonal causes of a reduced supply, and some infant conditions, like tongue-tie, that can reduce supply.

Many of these issues can be reversed with the right information and support, and even those rare women with IGT can provide 100% at breast feeds with a combination of their own milk and supplementer tubing-fed donor milk or formula.

You can’t see it…but it’s there!

There’s a misperception that a mother should produce more milk over time, says Jones. But studies show that the milk supply is pretty much the same from month one to month twelve. Jones says that is “shocking to most people who are used to seeing bottle-fed babies take higher and higher volumes over time.”

But the same volume of milk grows a human baby beautifully from month one to month twelve for two reasons: (1) the fat and calorie content of human milk changes from day to day and month to month and (2) breastmilk-fed infants burn fewer calories per day than formula-fed infants.

What to ask a prospective pediatrician about breastfeeding

Drinking cow’s milk formula is an inefficient process that makes an infant require more volume over time, and the caloric content of formula is the same every day of the infant’s life.

Breastfeeding is an elegant, mother-baby biological connection, says Jones, yet several barriers today stand to put a wrench in a system that has nurtured humans throughout history.

“Mothers doubt their own bodies, doctors unnecessarily supplement, hospitals separate mother from baby for convenience, pacifiers are given to quiet the baby, culture dictates a baby be on a schedule, insurance won’t pay for lactation support after hospital discharge.”

There are many forces that attempt to undermine an essential biological process, says Jones, “but a mother with the commitment to breastfeed can overcome all these barriers with the right information and support.”

New findings on what may lead kids to binge drinking

A recent study published by the American Academy of Pediatrics found that that the more exposure teens had to alcohol use in movies, the more likely they were to binge drink.

The age, affluence and rebelliousness of the teens did not seem to matter. And this pattern was observed across cultures in countries with different norms regarding teen and adult alcohol use and drinking culture.

What can parents do to make sure kids don’t pick up the cues from the many movies out these days that show alcohol use? And what are some ways that parents can prevent a child from binge drinking?

Dr. Dale Guthrie, a pediatrician in practice at Gilbert Pediatrics, says communication is the key.

Guthrie, who serves as vice president of the Arizona Chapter of the AAP, encourages parents to stay involved — and to make sure to meet and know their children’s friends, from the early days of pre-school right on through high school.

More tips from Dr. Guthrie on how to help prevent your child from using alcohol and other drugs:

  • Know where your teen is at all times.  Teens may act as if they don’t like it but teens are actually more secure knowing their parents care enough to know where they are and what they’re doing.
  • Consciously and genuinely praise your teen for something good he does every day.
  •  Make sure she knows she can talk to you about anything, at any time, if it is important to her and that she won’t be interrupted judgmentally with a lecture.
  •  Remember you are his parent, (not his best friend, afraid to step on his toes) and offer advice when requested and at opportune teaching moments in short phrases, not long lectures which are tuned out anyway.
  •  Better yet, ask inspired questions of your teen—the kind which help her arrive at the correct solution.
  •  Attend movies with your teen and then ask open-ended questions about what he thought about it.
  •  At a nonthreatening time, (not right as your teen is headed out to a movie), sit down as a family and discuss what are your family goals and standards.  As part of that, set family standards for what types of movies you will view and which are beneath your family standards.
  •  When your teen returns from being out with friends, it is helpful to have a “check-in” with parents.  If the tradition has been set that he will give parents a hug (or even a kiss) no matter what time he returns, parents will know more about what he’s been doing  just by being close to him, listening and observation.

Parents of younger children might not be thinking about the teenage years, but is there anything they can do to lower the risk that their child will abuse alcohol down the road?

Will your six-year-old become a teen drinker?

One very simple way is for parents to make sure they truly listen to their child right from the start.

Guthrie says that children need to feel that what they say is of prime importance to their parents. “Then when she has something really serious to discuss, he adds, “she will feel comfortable coming to you.”

Modeling healthy behaviors themselves, and engaging kids in conversation at opportune moments (short snippets in lieu of lengthy lectures) are other ways parents can make a difference, says Guthrie.

RAK Archives: Talking to teens about alcohol poisoning

More on talking to kids about drugs and alcohol, and upcoming Parent Workshops from the Partnership for a Drug-Free America, Arizona Affiliate

Getting breastfeeding off to a good start

Where you choose to deliver your baby may have a tremendous impact on reaching breastfeeding goals, says pediatrician and lactation consultant Laurie Jones, MD, IBCLC.

Laurie Jones, MD, and Tanya Belcheff, CNM, examine day-old Judel Alia

That’s because a key predictor of long-term success for breastfeeding rests on what happens between a mother and her newborn in those precious hours after birth.

Doctors, nurses, hospital policies, and family member interaction- even well-meaning visitors—can “make or break” the early breastfeeding relationship. “Babies and mothers are programmed with instincts to breastfeed, says Jones, who practices at St. Joseph’s Hospital and Medical Center, “but modern hospitals and health care providers mostly get in the way or interrupt those instincts.”

Jones, a member of the Arizona Chapter of the American Academy of Pediatricians says the Arizona Baby Steps program, launched by the Arizona Department of Health Services (AZDHS), has worked wonders at hospitals across the state to train nurses, doctors, and administrators in the best ways to support breastfeeding mothers after delivery.

More on how Arizona is helping moms to meet breastfeeding goals

The program promotes the implementation of five evidence-based maternity care practices that help a new mom to meet her breastfeeding goals.

Funded in part by the Centers for Disease Control and Prevention (CDC), the voluntary program was offered to hospitals in Arizona by the AZDHS, and implemented beginning in early summer, 2010.

The most important thing a mother can do to get breastfeeding off to a good start, says Jones, is to have unrestricted and uninterrupted time “skin-to-skin” in the first days following birth.

That first hour immediately after birth, says certified nurse-midwife Tanya Belcheff, MSN, CNM, should be considered the “golden hour.”  Belcheff, who also practices at St. Joseph’s, says it’s a time to cuddle, to bond- and can even predict the duration of the breastfeeding relationship.

“Studies show that the number of minutes you can have your baby skin-to-skin immediately after delivery, says Belcheff, “directly correlates with the number of months that you are successful at breastfeeding.”

It’s a new-old concept, she adds,  which helps regulate a newborn’s temperature, glucose levels, and breathing rate.

Also known as “metabolic stabilization,” Jones says that a baby will warm faster on a mother’s chest –or a father’s chest, or a partner’s chest, for that matter — rather than the traditional warmer used in hospitals. No matter what the feeding method is — breast or formula – this early contact is best for a new baby.

If moms come in asking for skin-to-skin contact during labor, and the nurses understand the importance, they are more likely to get it, says Belcheff, so it is important for labor/delivery professionals to educate their patients during pre-natal care.

Dr. Jones with Dr. Plimpton, who delivered Judel

Dr. Steven Plimpton, MD, an OB-GYN in private practice in Phoenix, says that that skin-to-skin contact is often offered as routine by labor and delivery nurses who understand and appreciate the benefits. “The mom will do it right away, assuming that it is the best thing for the baby.” This early contact helps bring in the breast milk, too.

A first bottle during the very early hours, says Plimpton, can interfere with the process. “The baby sucks it down like it’s the best thing in the word, and then the mom thinks she’s inadequate because the baby doesn’t suck on her like that, or cries when she tries to put her to the breast. The more you promote it right at the beginning, I think the more successful it’s likely to be.”

AAP new updated policy clearly says that all procedures should be delayed until after the first feeding, says Jones. But expanding that policy beyond the pediatric literature takes time.

Preparing for breastfeeding: what to ask your pediatrician

Getting everyone on board – obstetricians, midwives, family practice doctors, nurses –who helps participate in the birthing experience — is the best way to get baby off to a good start.

That’s why policies like Arizona Baby Steps are needed, so that nothing is left to chance. As long as the baby has a healthy Apgar score, which can be taken while the baby is on mom’s chest, says Jones, other routine procedures, like weighing and giving medicines – can wait.

Expectant moms should make a birth plan, says Belcheff, and discuss their wishes with their care provider. Jones says that a mother can reach her breastfeeding goals with a strong belief that she can do it and by making choices that support her goal. “Don’t overthink things in the first few days — human mothers have been doing this with no other option for 267 million years. And you can, too!”

 Jones offers the following tips on what expectant moms should know in order to get breastfeeding off to a good start:

  • Choose a hospital that has inpatient lactation consultants (designated as IBCLC) seven days a week and trains nurses and other providers in basic breastfeeding support.
  • There are still many hospitals that keep babies in a separate unit to get routine phototherapy or routine antibiotics which is very disruptive and always detrimental to the early establishment of a mother’s milk supply.
  •  Discuss a birth plan with your birth provider that includes immediate skin-to-skin after delivery and keeping mother and baby together at all times during the hospital stay with minimal interruptions.
  •  Let the nurses and doctors know that you do not want any formula, bottles, or pacifiers given to your baby.
  • Ask friends and family to visit during a limited window of time so that you have as much uninterrupted time with your baby as possible to be free to learn your baby’s hunger cues and needs.
  • Avoid any hormonal contraception until breastfeeding is well-established at the earliest around 6 weeks post-partum.

Arizona Baby Steps to Breastfeeding participating hospitals and medical centers

Greater Phoenix Area:

Banner Baywood Medical Center

Banner Del E. Webb Medical Center

Banner Desert Medical Center

Banner Estrella Medical Center

Banner Gateway Medical Center

Banner Good Samaritan Medical Center

Banner Thunderbird Medical Center

Chandler Regional Medical Center

Maricopa Integrated Health System

Mercy Gilbert Medical Center

Mountain Vista Medical Center

Phoenix Indian Medical Center

St. Joseph’s Hospital and Medical Center

Other participating Baby Steps hospitals in Arizona:

Carondelet Holy Cross Hospital, Nogales

Carondelet St. Joseph’s Hospital, Tucson

Casa Grande Regional Hospital

Flagstaff Medical Center

Kingman Regional Medical Center

Northwest Medical Center, Tucson

Sierra Vista Regional Health Center

Summit Healthcare Regional, Show Low

Tucson Medical Center

The University of Arizona Medical Center, Tucson

Yavapai Regional Medical Center

Yuma Regional Medical Center

Source: Anne Whitmire, Breastfeeding Program Manager

Arizona Department of Health Services