Helping A New Mother

     After you deliver a baby, you get lots of offers for help. There are some you should accept and others you should politely decline.

     Some friends and relatives will come over and, after an appropriate amount of “oohing “and “aahing” will start doing your dishes. They may bring you food or tell you to take a walk in the park while they watch the baby. These are people you want around you. It may be hard to have people doing things for you, but the right people will listen to you when you tell them what you need and don’t need. 
     Some people will come over, hold the baby (as long as he is dry) and hand him back to you if he fusses, throws up or poops They will consider themselves guests and will expect you to wait on them and treat them as guests. Avoid these people.

     Another group in the avoidance category are the people “Who-Know-More-Than-You-Do-About-Babies”. Don’t get me wrong. Advice is a good thing (especially if written in an old pediatrician’s blog), but there are people who are always looking for the Wrong Way you are doing things and are anxious to tell you the Right Way. Included in this group are the people who know the “latest study” which proves that what they have advised will ensure your baby’s entrance into Harvard and what you are currently doing will cause your child to fail kindergarten. This group also includes the people who cause you to feel guilty, even though you don’t exactly know why. Finally, it includes the people who are happy to tell you horror stories about the terrible things that happened to your great-aunt’s baby when auntie turned her back for 5 seconds.

     While on the subject, there are also things you should avoid in the first few weeks after birth. Don’t plan on moving to a new house. Don’t plan on having 50 people over for Thanksgiving dinner. Don’t try to maintain the same level of cleanliness that you are used to. Get used to fast food, dirty clothes and totally upset schedules. You have elected to live with a total stranger for the next 18 years. Allow yourself some time to adjust.

Advice On Breastfeeding

     My daughter just gave birth to her first child - a 10-pound baby girl. Neither she nor her baby had diabetes or blood sugar problems. My granddaughter is just a big, healthy baby. On the first day I spoke with my daughter (we’re 1000 miles apart), she said happily, “She is a good feeder and a good sleeper”. 

     Within three days, my daughter was exhausted, confused by all the conflicting advice she had received in the hospital and feeling frustrated with breast-feeding in general. Her baby had become fussy and was only feeding small amounts. Why the change? Simple. She had been told to wake the baby up every three hours - day and night - to feed the baby. She was told that, if she didn’t do this, the baby “might not get enough milk”. With that worry hanging over her, she was trying to follow what is an impossible schedule that no human could actually do.  Whenever my daughter woke up the baby out of a sound sleep, the baby wasn’t really hungry, so she went from feeding well (when she was feeding on demand) to sucking poorly and falling back asleep with each attempt to feed.

      Waking the baby every three hours both day and night creates exhaustion in both mother and baby. Rather than improving breast milk production, the fatigue, worry and frustration that this schedule creates are guaranteed ways to shut off breast milk production. It also creates a sleep-deprived, fussy infant whose natural rhythm is totally out of sync. 

     A healthy baby who is sleeping quietly is not hungry. If he poops or jerks, he might wake up one hours into a two-hour nap. After a diaper change, he may need a few sucks on a pacifier, a breast or a bottle to get back to sleep (if he is fussy between meals, a bottle of water is also a good substitute). If he goes to sleep after a few sucks but then cries after he is laid down, he is still tired. Leave the room and let him cry himself back to sleep. (No, he’s not too young to let cry – at least give him 5 minutes!). When the baby gets hungry, he will wake up by himself and cry. If you wait until that happens, he will feed well. After feeding well on the first breast for a while, if he starts to fuss again, the first breast may be empty or may not be giving the milk fast enough. Switch sides and allow him to feed on the second side until he is satisfied or until he gets fussy again. If he still acts hungry, switch back to the first breast and then try the second breast again to be sure they are both empty. There will be times when the baby needs more milk than you’ve produced. If the baby empties both breasts and still acts hungry, then feed the baby enough formula to satisfy him. Feeding both breasts until they are empty creates more breast milk and eventually the baby will stop needing the formula supplementation. However, if you don’t give the formula supplementation, you will spend the day listening to a crying, hungry baby.

    Trust your instincts. Your baby will tell you what he needs. Clear your mind of worry, guilt and bad advice. When the baby is wet, change him; when he is hungry, feed him and when he is tired, let him go to sleep. But, for both your sake and your baby's sake, never wake up a sleeping baby!

A New Test For Food Allergies

    Food allergy is reported commonly in children. Most food allergies in childhood cause mild symptoms and are outgrown. However, some food allergies cause more severe symptoms, even loss of consciousness and death. Doctors have always searched for more precise ways to diagnose food allergy.

     There are some ways of testing allergy that are simply worthless – like putting a substance under the tongue and then measuring changes in muscle strength. Legitimate allergy testing was originally done by injecting the allergic substance deep into the skin, but this could sometimes cause serious allergic reactions. This was replaced by the safer, superficial skin-prick method. Another way to accurately diagnose food allergy is to do a food challenge (allowing the child to eat the suspected food). In a food challenge, the food is given to the child under very closely controlled conditions in a doctor’s office. This method is not often used because it is difficult, dangerous and should only be done under a specialist’s care.

     In the late 1960’s, a protein produced in the body was found to be the substance that caused allergy. The protein is called IgE. Doctors began measuring the level of IgE in the patient’s blood to diagnose allergy and, over the years, our ability to measure this allergy protein has become more specific and accurate allowing us to test for allergy to individual foods. It is now the most popular form of allergy testing.   

    Although the blood test for allergy protein is widely accepted, it often gives false-positive results. This means that the test can report that the child has an allergy to a certain food, but when the child actually eats that food, he does not have an allergic reaction. False-positive results are common in children who have other allergic problems such as asthma and eczema. False-positive IgE tests also are the cause for many children to be diagnosed with multiple food allergies (“Johnny’s allergic to milk, eggs, nuts, chocolate, and fruit!”).

     False-positive tests are especially troublesome with the diagnosis of peanut allergy because peanut allergy is the most serious food allergy and frequently causes life-threatening reactions. A false diagnosis of peanut allergy can create unnecessary years of worry and difficulties in choosing the child’s diet.

     In May of 2011, the U.S. Food and Drug Administration allowed production of a much more accurate form of IgE allergy testing. It still involves drawing blood but it is more specific and can actually tell whether the child has the unique form of the protein that causes the allergic reaction. This testing is called molecular allergy testing and its use is spreading. Most doctors who test for allergy should be using it soon. It is the best way we have of testing for allergy and may eliminate the problems with false-positive results. If your child has been diagnosed with food allergy, talk to your caregiver about molecular IgE allergy testing.

Acetaminophen

     Acetaminophen is a drug frequently taken by adults and children. The most recognized brand names in this country are Tylenol, Panadol and Tempra.  Acetaminophen is used to lower fever and relieve pain. However, it can be dangerous if overdosed. Overdose of acetaminophen can cause fatal liver damage, especially in young children. It can occur from a single large dose or from too many smaller doses given too frequently.

     It is easy to overdose acetaminophen because of two reasons: Children’s preparations of acetaminophen come in multiple dosage forms that are confusing. The infant acetaminophen drops have a different concentration than the liquid given to toddlers. Chewable tablets have a different concentration than tablets designed for swallowing. Parents need to know how much acetaminophen is appropriate for their child’s weight and age and to know how much acetaminophen is in the dose they give to their child. They also need to know how often they can repeat the dosage. This seems like a lot, but dosage information is on the bottle of the acetaminophen and your pharmacist can help you. The information can also be obtained on-line or through your caregiver’s office.

      The other reason acetaminophen can be easily overdosed is that it is commonly added as an ingredient in cold and cough medications. Parents might give acetaminophen for the child’s fever, but then also give a cold medicine without realizing that it also contains acetaminophen. We need to take the time to read the labels of any medications we give our children to be sure we aren’t “double-dosing”.

     If there is the possibility that your child may have had too much acetaminophen, contact the child’s caregiver immediately. In the first hours after an overdose the child may have no symptoms or may only have decreased appetite, fatigue or nausea (flu-like symptoms which might prompt the parent to give more acetaminophen). After a day or two, a child who has taken an overdose may develop abdominal pain, vomiting and dehydration. After 3 to 5 days liver failure and death can occur. If the overdose is caught within 2 hours, a medicine can be given to keep the acetaminophen from being absorbed into the child’s system. 4 hours after ingestion, a laboratory test can be done to determine whether an overdose of acetaminophen was ingested and a treatment can be started which could be life-saving.

    When our children are sick, we, as parents, feel the need to do something to help them.  But fever, cough and congestion are all symptoms that the body develops to help fight off a viral infection and don’t need to be treated. Giving a little acetaminophen to help relieve a child’s discomfort is O.K., but time and love are the best cures for most of the illnesses of childhood.

Problems With Infant Poop

     Few things cause more concern for parents than their infant’s stool habits.

      Infants’ stool patterns vary from week to week with no real reason. Normal infants can poop from 6 times a day to once every 6 days. Stools can be pure water or rock hard. They can be any color from bright yellow to dark black with all shades of green in between, even without changes in diet. If your infant is eating, smiling and acting normally, the poop is probably normal, too. 

     Parents need to know that different pooping patterns are normal and can change at any time without any reason. However, the parent can help the infant get through whatever pooping phase that the infant happens to be in.

     When stools are liquid and frequent, the skin can get irritated and the infant can develop a red, flat butt rash around the rectum that can bleed from small, open areas when you wipe it. If this happens, protect the skin with a butt paste that has zinc oxide in it. Use lots of it and use it as thick as possible with every diaper change. When you open the diaper, you should see the stool sitting on the butt paste. If you can see the skin when you open the diaper, the stool can touch the skin and irritate it. If the skin has bleeding spots, use even more butt paste. The baby will cry when you put on the cream, but continue to apply it until the raw spots heal. (This rash is different from a yeast infection, which is a slightly raised, bright red rash in the skin folds around the genital area.)

     When the stool is hard, the infant may strain and cry for an hour before pushing out a rock-hard lump of poop. Then he’ll stop crying and smile at you. You can help him by using a glycerin suppository (available in the pharmacy) when he is trying to poop. The glycerin suppository will help stretch the rectum and make it greasy. This just makes it easier for the baby to poop out those hard balls. The parent can also feed an older infant fruit – real fruit – not fruit juice or fruit snacks. The fiber in the fruit helps to pull water into the colon and soften the stool.

     Remember that the child who has hard stools this week will probably have runny stools next week no matter what you do, so relax and just try to make him comfortable.