Who should be screening moms for postpartum depression? More doctors now can

The postpartum depression that can follow having a baby can catch many families off guard and become worrisome not just for the mom experiencing it, but for the baby whose mother might have excessive worries about that baby’s safety or feel a lack of connection to her baby.

That maternal bond is important in the first few years of life as babies learn that if I smile at you, you smile back. If I cry because I’m hungry, you feed me.

“When a baby is parented by a depressed or anxious mother, there is some evidence that long-term exposure can lead to a learning disability, cognitive delays or motor delays,” says Elaine Cavazos, a licensed social worker who specializes in postpartum depression. She is also an adjunct professor at the University of Texas and the clinical director of the Pregnancy and Postpartum Health Alliance of Texas.

Postpartum depression rates vary from 10 percent to 20 percent to ratios of 1 in 7 postpartum women. It depends on what study you cite.

Getting support from groups like Partners in Parenting or finding fellow parents of young babies can help new parents not feel so alone. AMERICAN-STATESMAN 2016

One of the questions among medical providers has been who can screen for it and when should it be done.

In May the American College of Obstetricians and Gynecologists recommended that doctors offer more postpartum care for women by adding follow up within the first three weeks of delivery in addition to a comprehensive visit within 12 weeks of delivery. Part of that recommendation is a response to recognizing that symptoms of postpartum depression often happen before the traditional six-week checkup.

Mothers actually see their child’s pediatrician more regularly throughout that first year than their own doctors. Usually within a few days of birth, then at a month, two months, four months, six months, nine months and at one year.

“One of the critical things is we have access to the moms because we have access to the babies at a pretty high frequency,” says pediatrician Louis Appel.

Pediatrician Dr. Louis Appel visits with 15-month-old Jose Romo as mother, Laura Patricia Romo looks on during a well child checkup at People’s Community Clinic. For about seven years, doctors there have been screening new moms for postpartum depression during their child’s well-check visits. AUSTIN AMERICAN-STATESMAN 2007

Recognizing that, the 2017 Texas Legislature passed House Bill 2466 that allows pediatricians to charge Medicaid and child health plan programs for the screening of mothers for depression within the first year of a child’s life even if the mother isn’t covered by those programs but the child is. Medicaid covers mothers with low incomes while they are pregnant until 60 days after delivery, at which point they might not have the insurance to be screened for postpartum depression. Now they can still get screened after 60 days by going through the child’s pediatrician and insurance.

Once screened, pediatricians can refer mothers to mental health services.

Appel, says about seven years ago, pediatricians where he works at People’s Community Clinic began doing the screenings because they were looking at what they could do to help with early brain development.

“The thing we landed on was screening for postpartum depression,” he says. “That early bonding is so important to early brain development in children.”

People’s Community Clinic screens by having the nurse or doctor ask two questions known as the Patient Health Questionnaire 2:

1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?

2. During the past month, have you often been bothered by having little interest or pleasure in doing things?

If they answer yes to any of those things or if there is a noticeable lack of interaction between mom or baby or an anxiousness around that interaction, the patient would be given a longer 10-question form to fill out.

In this 2011 file photo, nurse practitioner Peggy Wall conducts a prenatal visit with patient Leticia Martinez at in the Women’s Health department at People’s Community Clinic. New guidelines encourage obstetricians to follow up with new moms sooner after birth than six weeks. AMERICAN-STATESMAN 2011

Doctors and nurses then refer patients to the clinic’s social workers, sometimes in-person that day or by phone later. If Appel didn’t have those in-house resources, he says he would refer the mom to her primary care physician or to other community health resources or the national crisis line for postpartum depression. Pregnancy and Postpartum Health Alliance of Texas also keeps a list of providers and what insurance companies they take.

It’s not just moms who can get postpartum depression. It can happen to dad’s, too, and the Centers for Disease Control and Prevention estimates that about 4 percent of new father’s experience it as well. Cavazos says that in her practice, she sees dads as well as adoptive parents.

The depression for moms might start in pregnancy. “The more severe cases probably we might have seen while she was pregnant,” Cavazos says.

This week, the American Academy of Pediatrics recommended that parents actually have a prenatal visit with pediatricians. This can help pediatricians anticipate postpartum depression by looking for any perinatal depression as well as give guidelines for those first few weeks of infant care. It also helps establish a partnership between the doctor and the family, and for the doctor to get a sense of pregnancy complications, family medical histories and any exposure that baby might have had to drugs or alcohol while in the womb.

Cavazos says the hallmark of postpartum depression is intrusive thoughts that something awful is going to happen to the baby or they are going to do something awful to the baby or something awful to themselves and the baby. The mom becomes super vigilant about the baby’s care and won’t let anyone else care for the baby, or she is unable to engage with the baby because she’s afraid she’ll do something wrong.

Cavazos says it’s like she is thinking, “What’s the very worst thing that can happen to her?” and she’s playing it over and over again in her head, but it’s not a Child Protective Case, because it is fear-driven and anxiety-driven, not something she will actually act on, Cavazos says.

Her family will take note that she just doesn’t seem like herself.

Postpartum psychosis, though, can happen, but is very rare. That’s when she doesn’t feel fear or anxious. She feels almost like a deity or something outside herself is making her do things, Cavazos says, and that’s a psychiatric emergency. The mom needs to be separated from the baby and get help immediately.

With postpartum depression, Cavazos will ask the mom if she’s sleeping, and that will get a laugh. She worries if women are getting less than five hours of sleep a day combined. She also wants to know about whether they have access to nutritious food and are eating. She might want them to have their vitamin D and thyroid levels checked to rule out other possibilities.

Sometimes antidepressants will be necessary. Even for moms that are nursing, “the general consensus is if the mom is depressed, the benefits far outweigh the risks of the medication,” Appel says.

Other times, the treatment is self-care and talk therapy.

Cavazos will work on what feelings the moms have about the baby, what things cause them to become overwhelmed with the baby’s care, what resources they have to get help, and also normalize what she is feeling.

Often moms don’t stay long in therapy, usually four or five visits to eight visits because of the amount of bandwidth they have. After all, they have a new baby, but sometimes they will make therapy part of their self-care regimen. Sometimes Cavazos will recommend a support group or some sort of parenting group to help the mom not feel so alone. And she’ll help reassure moms that they have good parenting skills and find ways to strengthen those skills.

RELATED: Partners in Parenting help new moms, dads get support

Appel encourages a mom’s partner or support system to help as much as possible and to “give new moms permission to … take any help people can give,” he says. That whole “sleep when baby sleeps” is important. “You should not be doing the laundry or cleaning the house,” he says.

Austin mom shares her experience of when her child almost drowned

Fourth of July is almost upon us. This week and all summer long, we head to pools, to lakes, to any body of water we can get into with our families to cool off from the heat.

But a fun day in the water can turn tragic in a few minutes time.

Teddy Van Winkle, 3, almost drown in June when he went after a beach ball in a neighborhood pool. Tina Van Winkle

Tina Van Winkle learned firsthand how quickly a child can become submerged in water June 9 while swimming with her son Teddy, 3, her baby Roger and her father at a neighborhood pool in the Wells Branch area. It was a quiet Saturday morning with two lifeguards in their stations and more in the office and about 15 people in the pool, Van Winkle says.

The Van Winkles had been swimming, and Teddy had asked to take off his Puddle Jumper flotation device so he could practice floating. Then, when they were all getting out of the pool, her father was carrying the baby and she thought he also had Teddy as well. She swam to the pool ladder to get out of the pool to follow her dad back to the picnic table.

“I had visually registered that Teddy was with my dad,” she says. She had even seen him out of the water and on the pavement next to the pool, following her dad back to their picnic table. “My dad thought I was bringing up the rear … it was a misunderstanding.”

RELATED: Become a water guardian with Colin’s Hope

Teddy had seen their beach ball floating in the pool and jumped in to grab it. When Van Winkle saw that Teddy wasn’t with her dad, she scanned the pool and saw him floating with just his arms above water in the shallow end, which was about 3 feet. She jumped in and pulled him out. The lifeguards had not registered yet what had happened, she says.

Teddy was limp, but hadn’t lost consciousness and he immediately started spitting out water. They walked home, thinking that everything was fine, but Teddy was lethargic and wasn’t himself.

She took him to the St. David’s Children’s Hospital in North Austin, where he stayed overnight for observation because he had fluid in his lungs.

Van Winkle and her father both had years of swimming experience, he as a lifeguard and swim instructor in his youth and she on the swim team in high school. “I know never to take my eyes off of kids,” she says. “And I did.”

 

Tina Van Winkle with sons Roger and Teddy had been a lifeguard in her 20s as had her father. Tina Van Winkle

“Even though I already knew a lot of the guidelines about water safety, I didn’t follow them to the letter,” she says.

The experience confirmed with her how quickly it could happen — she estimates he was out of her sight maybe two minutes — and the importance of having someone within arms’ length of a child anytime you’re around water, and the importance of verbally confirming who is watching each child. It’s also a reminder for parents and guardians to have strong swimming skills themselves, she says, because she could jump in quickly and pull him out of the pool.

Even though Teddy can talk about that day and how scared he was, it hasn’t stopped him from swimming. He has been back in the pool twice since then and will take swimming lessons next month.

“He was fearless again,” she says. “Maybe that’s a bad thing, because it led him to believe he could swim.”

Dr. Elinor Pisano, hospitalist at St. David’s Children’s Hospital

Dr. Elinor Pisano, the pediatric hospitalist that saw Teddy at St. David’s, says the hospital has seen a spike in the number of drownings or near-drownings in the hospital this May and June.

“We do see a spike every spring and summertime,” she says, but this year the number of deaths seems higher. She could not give specific numbers.

Deaths can happen within five minutes she says and the likelihood of a fatality or severe brain damage goes up with each passing minute, she says.

“The key thing is supervision,” she says. “It’s not that there is a total absence of supervision; it’s a momentary lapse of supervision.”

Often it’s a case like the Van Winkles’, where there are multiple caregivers and someone assumes that someone else is watching the child.

“Someone turns their back for just a minute, and they later realized that child is underwater,” she says.

Make sure that there is a designated adult watching the child and that that adult is within arms’ length. If you’re that adult and you have to step away, confirm with someone else that they are watching the child, Pisano says.

If a child does become submerged, pull them out as quickly as possible, ask someone else to call 9-1-1 and start CPR. Make sure the child is seen by either an emergency medical technician or in the emergency room to confirm that their oxygen level is normal and that there are no lasting effects.

Related: Is there such a thing as dry drowning?

Other things you can do to prevent drownings include making sure you have a four-sided fence around your backyard pool with a locked gate that closes behind you; and giving kids swim lessons beginning at age 1. Pisano says there was some old thinking that it would give kids a sense of bravery that they could swim before they really could, but now there’s some evidence that it does provide some level of protection. She does warn, “There’s no way to drown-proof your child.”

While drowning is most common in children 4 and younger, it also is common in teenage boys and when there is alcohol or substances involved.

It also doesn’t always happen in in-ground pools. Wading pools, above-ground pools, lakes, hot tubs and bathtubs all can be dangerous.

RELATED: Before you go swimming know what’s lurking in the water

RELATED: Can pools make you sick? 

Follow our swim safety tips:

Don’t forget that even if the pool is safe, water can be a very unsafe place. Keep these things in mind when you head to the pool, lake or beach this weekend.

Before you dip your toes into whatever body of water you choose, practice these rules for water safety we compiled using experts from the YMCA, City of Austin’s Parks and Recreation Department, Colin’s Hope, Safe Kids Austin, the Lower Colorado River Authority and the Centers for Disease Control and Prevention.

What does drowning look like?

Unlike what we see in the movies, “drowning is a silent thing. There’s no splashing, yelling or choking,” says Stephanie Hebert, the injury prevention coordinator at Dell Children’s Medical Center and the Safe Kids Austin coordinator. “They go under and when they are under, you don’t hear them, you don’t see anything.”

Drowning also doesn’t take long. Irreversible brain damage happens in as little as four minutes. Children who drown are usually missing for less than five minutes and usually are in the presence of at least one parent.

For children younger than 15, it’s the second-leading cause of unintentional injury-related deaths, behind motor vehicle accidents. Children younger than 5 are more at risk. Boys also are more susceptible because they tend to take more risks.

It can happen anywhere. Pools with lifeguards, natural bodies of water, bathtubs and toilets.

As of mid-May this year, 16 children already have drowned in Texas, according to the Texas Department of Family and Protective Services.

It’s also preventable, so let’s focus on that.

Watch the water

The No. 1 thing parents can do to prevent a child from drowning is supervise their children.

For young children, that means getting in the water and having hands-on contact or being within arm’s length.

For older children, that means watching them in the water at all times. Reading a book in a lounge chair or talking to a fellow parent or texting isn’t supervising.

The Austin-based drowning prevention nonprofit group Colin’s Hope distributes 75,000 water safety packets every year that include a Water Guardian bracelet. The bracelet slips on and signifies that you are the designated adult watching the children in your group. If you need to take a break, you hand it to another adult, whose sole job is watching the water.

The City of Austin ordinance requires that kids 9 and younger have an adult with them to be in a city pool and that kids ages 10 to 14 can be by themselves if they pass a swim test, but why chance it? Supervise everyone in your group.

Vacation is also no time to let your guard down. Kids can drown in cruise ships and hotel pools.

Always have a phone nearby and learn CPR. A water safety class is also a great idea.

Good swimmers drown, too

Even kids who know how to swim can drown, says Alissa Magrum, executive director of Colin’s Hope, which was started by the parents of Colin Holst, a 4-year-old who drowned in an Austin pool in 2008. Colin had had swim lessons and was at a life-guarded pool with his family and friends watching.

“A lot of families think, ‘My kids are decent swimmers; they’ve had swim lessons, they are fine,’ ” Hebert says.

But things happen. Children accidentally swallow water. Or they hit their heads. Or they misjudge their abilities. Or they get tired or dehydrated or hungry.

Donita Grinde-Houtman, the aquatic supervisor for Austin Parks and Recreation, says lifeguards respond most often between 2 and 6 p.m. because kids get tired. “Kiddos have been at the pool all day long, they’re getting tired, and they don’t recognize that they don’t have the energy to swim as far as they need to.”

Take frequent breaks. End earlier than you think you should. Rehydrate and refuel throughout the day.

Not-so-good swimmers need more help

That doesn’t mean water wings, pool noodles and other pool toys to stay afloat. Put a U.S. Coast Guard-approved life jacket on your budding swimmer. They have to have one on for getting in a boat, so why not extend that to any body of water?

Before you go to a pool, define where the shallow end is, especially for not-so-good swimmers. One of the most common reasons lifeguards make a water rescue, says Bret Kiester, the executive director of the Hays Communities YMCA and the aquatic directors liaison for all the Austin-area YMCAs, is when kids who aren’t good swimmers find the deep end. Sometimes they’ve monkey-crawled along the side of the pool to that end; other times they’re following an older sibling or they don’t know where the deep end starts.

Lifeguards are great but not a guarantee

Be hesitant to swim in a place without a lifeguard because they add a layer of protection. However, they’re not insurance.

One lifeguard Magrum was working with put it this way: “We are not baby-sitters. We are here in an emergency.”

Lifeguards have a lot of people to watch, not just your child. Their job gets even more difficult the more people are in the pool and the less-clear the water is. They also get distracted by children horsing around (i.e. running around the pool) and other emergencies not in the pool.

Lifeguards, who go through similar training programs, are supposed to scan 180 degrees every 10 seconds from top to bottom, from right to left. If you see a lifeguard who isn’t doing that or you notice that lifeguards aren’t getting frequent breaks and rotating out, alert a supervisor.

Swim lessons

Swim lessons statistically have been shown to reduce a child’s chances of drowning, but it’s not a magic shield.

The YMCA and the City of Austin’s Parks and Recreation Department start swim lessons as parent-and-child classes at age 6 months, old enough for a child to have good head control.

Those early classes are about familiarizing the baby with water and teaching parents good water safety with their children.

By age 3 or 4, children can take solo lessons, but if you’ve missed that age, don’t worry. “It’s never too late to learn how to swim,” Kiester says. He’s had students as old as 92 learn to swim.

Kids are grouped by age, then by ability, and there are adult classes, too — something parents who don’t know how to swim should consider in order to be able to save a child in danger.

Swim lessons are not just about learning strokes. They teach about being comfortable and water safety.

Sometimes kids will have a bad reaction to swimming lessons. It might be the time of day or it might be the coolness of the water, Grinde-Houtman says.

If your child is truly afraid of the water, Grinde-Houtman says, you might have to take a step back and start with something like sitting at the side of the pool and putting her feet in the water.

Free swim lessons are available from the Austin American-Statesman’s Swim Safe program, which provides lessons at YMCA locations and City of Austin pools.

A great time to do swim lessons is in the winter, Kiester says. They tend to be less crowded and when summer starts, kids won’t have to re-learn to be comfortable in the water again.

Natural bodies of water

Rivers, lakes, springs and oceans get tricky. The surface is uneven. “You might be wading in waist-deep water and the next step you’re in 16 feet of water,” says Clara Tuma of the LCRA.

You also can’t see the bottom to know if someone has fallen in.

It’s also hard to judge distances. People often get in trouble because they pick a point to swim to and underestimate how far it is. “They run out of energy halfway there,” Tuma says. “They can’t just stop and sit under a tree.”

Wearing a U.S. Coast Guard-approved life jacket allows them to rest and float if they need to.

And often people get confused as to where they are to report an emergency.

Swimming on natural bodies also means you’re not the only thing out there. Keep a look out for boats and personal water crafts that might not be able to see you.

In oceans, teach kids how to deal with rip currents that push swimmers away from the shore.

Never swim alone no matter what type of water you are in.

Keep safe at home

Each year many kids drown at home. Kids can drown in as little as 1 inch of water.

Never walk away from a young child in a bathtub, not even to answer the phone or grab a towel.

Keep locks on toilets if you have infants and toddlers. Keep plastic kiddie pools empty as well as mop buckets.

If you have a backyard pool, install a locking gate system on all four-sides of the pool. If a child goes missing, check the pool or hot tub first before looking inside the house.

Teach baby-sitters about pool safety.

 

Know which sunscreens work best and what to look for in a sunscreen. AMANDA VOISARD / AMERICAN-STATESMAN

Don’t forget to wear your sunscreen and bug spray, too. 

We tested more than 20 sunscreens last week to see which ones worked best and last year we tested 16 bug sprays to see which one actually repelled mosquitoes. 

What dads can teach their daughters to help them become empowered women

For dads, raising daughters can sometimes be mystifying. The same could be said for mothers raising sons or really any parent raising a kid who isn’t like they were growing up.

But dads do some great things for daughters, including setting the example of how men should treat women, which feels especially important in this year of #MeToo.

Devin Price holds his daughter, Ada at a Partners in Parenting meeting. AMERICAN-STATESMAN 2016

Sheri D. Engler, psychologist and author of “The Pearls of Wisdom: A Fairy Tale Guide to Life’s Magic Secrets for All Ages,” offers these tips for dads raising daughters:

  • Treat women with respect.  Your daughter is watching how you treat women, and it will have a lifelong impact on her in ways you can’t imagine. You must be cognizant of your attitude and behavior around women at all times. This includes not saying negative things about her mother if you are divorced. See yourself as a role model of the kind of man you would want your daughter to marry one day, because that frequently influences how women choose their partners.
  • Give her compliments about things other than her beauty. It is OK to tell your daughter she’s pretty, but that should not be the only compliment you give her. Compliment her intelligence, her resourcefulness, her imagination, her many skills, her hard work, and her strength. Honestly tell her the unique things you love about her, the things that make her a good and special person.
  • Teach her the magic of self confidence. Teach her about the power that comes from believing in herself and believing she can achieve greatness in the world, while understanding that there are many girls who simply want to be a “mommy” like their , which is the most important job in the world. In this case, they may fear failing their father’s expectations of greatness. There is a critical difference between encouragement to be who they are and pressure to be who they aren’t.
  • Teach her about what has traditionally been “guy stuff.”  Teach her self-reliance, such as routine car maintenance, or mechanics in general. Teach her how to use tools while building a treehouse. Go fishing together. Take her to see planes at air shows, teach her photography and go birdwatching with her. It matters to spend quality time with her because it makes her feel she is worth her dad’s time. And it doesn’t have to stop in childhood. What could you be teaching your adult daughter?
  • Let her get gritty like the boys.  Teach her how to play sports from early on. This fosters tremendous social confidence as well as body confidence. Or just let her play in the mud and get dirty if that is what she wants to do. Girls don’t always have to be clean and pretty.
  • Introduce her to books with girl heroes. There are plenty of books to choose from, so when reading to her let her enjoy a variety of adventures including books with strong female leaders. This will send the message that you believe in her. Or perhaps help her write a story of her own imagining herself as the hero or lead character. If nothing else, this will give you a valuable view of how she sees herself so you know what’s going on with her.
  • Share music with her. Play your favorite music and tell her why you like it and let her do the same. Take her to concerts. If she wants to play an instrument, help her learn how. Music, and the arts in general, can be very bonding experiences.

Matt Coyne’s first year of fatherhood turned into ‘Man vs. Baby,’ the book

Head to any bookstore or online bookseller and you can find dozens of new titles about motherhood. Some are deeply moving, some are instructional and still others find the humor in this difficult job.

Books about fatherhood? Not as many.

On Dec. 7, 2015, Matt Coyne, a graphic designer from England who had become father to Charlie three months before, sat down and wrote a Facebook post about what these first three months had been like. He was honest about his ineptitude, he was real about his role versus his partner’s role (you just can’t compare the level of tired or the work she’s doing), and he was hysterically funny. Side-splitting, make-you-wet-your-pants (especially if you’ve had children) funny.

“I used to think the theory that the moon landing was a hoax was total bullocks, just because it required a huge amount of people to share a secret,” he writes. “I now think it’s a distinct possibility, given the conspiracy of silence about how horrendous labor is. The labor suite is like being in ‘Nam. It is nothing like you see in sitcoms or in films, unless that film is ‘Saw IV,’ or it’s the chest-bursting scene from ‘Alien.’ So, to those who told me that the birth would be a magical experience … you’re a bunch of (expletive) liars.”

Matt Coyne became a father to Charlie almost three years ago. He wrote “Man vs. Baby: The Chaos & Comedy of Real-life Parenting,” ($17, Simon & Schuster).

Oh, yes, there are obscenities sprinkled throughout this recap of the first three months. He doesn’t hold back on Charlie peeing into his eye during diaper changes, the lack of sleep, the family coming to see Charlie, the fact that the baby is all-consuming.

“I was trying to make sense of what I had learned, which is nothing,” says Coyne, 43.

At first he got 20 likes on his Facebook page. Then friends reached out and requested that he change the privacy settings so they could share it with other friends. It wasn’t supposed to be anything, really; just something he wrote in the Notes app on his phone and then posted to Facebook.

“Very little I do is calculated,” he says.

It’s now been viewed 18 million times.

Book publishers reached out and news shows. While he has a degree in English, he wasn’t sure he could turn one Facebook post into a full book. He began with a blog he called Man vs. Baby.

It has now turned into a book about this first year, named after the blog, but with the subtitle: “The Chaos & Comedy of Real-life Parenting.” ($17, Simon and Schuster).

“I was a graphic designer,” he says. ” I was very bad at it. … Now this is what I do for a living until it goes horribly wrong.”

Fatherhood has come with its share of surprises, which Coyne writes about, and talks to us about by telephone.

“All of the sudden you have no time to do anything other than focus on this human being,” he says. “It comes as a massive shock to the system. You can’t decide to go to a restaurant. You can’t decide to flip on the TV,” without thinking about the baby and the baby’s schedule and whether or not you’ll wake him up.

He went into it knowing he would be sleep deprived, but he had no idea just what that would feel like. He writes: “For two weeks, I didn’t shower, didn’t shave, and barely ate, and neither of us escaped from bathrobes and sweatpants. We looked like forgotten patients in the basement of a Victorian asylum.”

Coyne’s theory is that every parent thinks that the time they are in the hardest part. The first three months seemed like the hardest part, but then friends told him the toddler years were far harder. Now they tell him to just wait until Charlie’s a teenager.

“It’s never boring,” he says.

On this Father’s Day, he says, “the ultimate goal is just like a Mum on Mother’s Day — to do absolutely nothing and get on with doing nothing. I’m supposed to say, ‘spend a lot of time with the kid,’ but I do that all year long.”

Actually, instead of watching Netflix like he’d like, he and the family are going to a working farm in England to do things like pet and feed the animals.

The response to the blog and now the book has been surprising to Coyne. The readers of the blog are 90 percent women.

“They are moms who are interested in a dad’s perspective,” he says.

“You would think there would be differences,” but he says, “I’m not convinced there’s so much of a difference.”

Well, there is one thing: How much time dads spend in the bathroom. “Clearly we use excuses all the time,” he says.

The American audience found the blog after celebrities started sharing it. “They’re really lovely about it,” he says of his American readers.

There are actually two versions of the book: The English version and the American version that explains some of the English phrases in footnotes.

Sometimes they call him on the fact that he swears a lot. “That’s an English thing,” he says. “They’re called sentence enhancers.”

He also gets comments when he talks about vaccinations, and he feels a twinge of guilt that an English doctor started the controversy.

Coyne is now working on a second book about the next year of Charlie’s life. Charlie will turn 3 in September.

The first book was planned out during that first year based on milestones leading up to ending with Charlie walking. Of course, Charlie didn’t follow that script.

“You’re desperate for it to happen,” he says, then you ask, “why did I want it to happen?”

His next book will include maps of Charlie’s walk to the park. In the first book, the map is a round-about way to avoid an elderly neighbor who turns a wave hello into an all-day event fawning over Charlie. In this next book, it will show the day they didn’t move from their front step for three hours because they saw a ladybug, or the day that they walked for miles chasing a cat.

“Now I need all my energy to keep up with him,” he says.

There won’t be a book about adding a sibling to the family, though.

“The idea of having another one might finish me off,” he says.

And if it sounds like Coyne is complaining, he’s not. Fatherhood has been the most positive thing. “I wasn’t expecting to be quite so attached to him,” he says.

New children’s store opening near downtown Austin

St. Edward’s University alum Karina Drake is opening up a new children’s boutique near downtown Austin Saturday. The store, Alexa James Baby, is named after Drake’s own daughter.

She was inspired by raising Alexa James in New York City until the family moved home to Texas.

“Living in the city had its challenges, but exploring NYC through Alexa’s eyes was very inspiring,” Drake says in a press release. “There was something really special about mixing the magic of childhood with such a modern, adult setting.”

The store will feature clothing from sizes newborn to 6 toddler as well as toys, books, items for the nursery and cards. Drake will stock items from local designers as well as European designers.

The new Alexa James Baby boutique opens on Saturday. Kate Weaver

Drake wanted the store to be more than a place to buy things. Interior designer Claire Zinnecker created reading nooks as well as play areas. Drake plans to offer story times, happy hours, coffee and more events.

You can find clothing and toys at Alexa James Baby. Kate Weaver

Drake said she wanted “to create a space that fostered community, especially for mothers. After having Alexa, I found myself searching for escapes and destinations in the neighborhood. I would walk to beautiful baby shops in Tribeca and SoHo more for the amazing experience they offered than the actual items I was purchasing. My goal is to create an environment like that here in Austin.”

The store at 908 W. 12th St., No. C, will celebrate its grand opening 10 a.m. to 2 p.m. Saturday. The first 20 people will get special gift bags, but you’ll also find samples, in-store discounts and more. RSVP on Eventbrite. Find more information on AlexaJBaby.com

Alexa James Baby. Kate Weaver

Orajel for teething? No, says new FDA statement, which links drug to breathing problems

Wednesday, the Food and Drug Administration told manufacturers to stop marketing over-the-counter teething products with the drug benzocaine. You know these products as  Anbesol, Baby Orajel, Cepacol, Chloraseptic, Hurricaine, Orabase, Orajel and Topex as well as the store-brand versions.

In its press release, the FDA stated “teething products containing benzocaine pose a serious risk to infants and children.”

“Because of the lack of efficacy for teething and the serious safety concerns we’ve seen with over-the-counter benzocaine oral health products, the FDA is taking steps to stop use of these products in young children and raise awareness of the risks associated with other uses of benzocaine oral health products,” said FDA Commissioner Dr. Scott Gottlieb in the press release.

Orajel is displayed for sale in a pharmacy in New York Wednesday. Stephanie Nano/Associated Press

So, what’s the problem with a little Baby Orajel on your baby’s gums?

People noticed that babies sometimes struggled to breathe when using these treatments. They had a condition called methemoglobinemia, which is an elevated amount of methemoglobin in the blood. That reduces the amount of oxygen in the blood.

Dr. Arti Lal, a pediatrician at Baylor Scott & White Clinic – Austin, Northwest, says that babies were being sent to the emergency room to get an antidote for methemoglobinemia. Even with an antidote, it’s still scary to see your baby struggling to breathe, she says.”You don’t want your baby to have that.”

The first signs that there were problems with benzocaine, were about a decade ago, Lal says, but Thursday’s announcement is a much stronger statement from the FDA.

Of course, let’s also go back to the fact that those over-the-counter treatments also didn’t really work.

Dr. Arti Lal, pediatrician at Baylor Scott & White Clinic – Austin, Northwest

Lal says she likes to remind parents that teething is a normal physiological occurrence. It’s what the body does in the process of getting teeth.

Most babies start teething around 5 or 6 months, but it can start as early as 4 months and as late as 10 months, Lal says. It usually goes until age 2 or 2 1/2. The first year is definitely the most painful because of the type of teeth as well as it being a new experience for babies.

To ease that pain, Lal recommends cleaning your hands and then rubbing your baby’s gums gently with your finger.

You also can keep teething toys in the refrigerator or clean, wet washcloths. The cold is soothing, but only use the refrigerator, not the freezer. The freezer could damage gum tissue and cause it to die.

Parents also can give babies ibuprofen or acetaminophen to help with the pain.

Your grandmother’s trick of putting a little bourbon on a wash cloth or on your finger on baby’s gums, also isn’t a good idea. It doesn’t really work on the actual teething problem and now you have an intoxicated baby.

Teething often comes with a lot of drool. Sometimes the gums will be very red, and they can even bleed. If that’s happening a lot, you should see a pediatric dentist, Lal says.

Teething does not cause a fever. If your baby has that, something else is happening. Lal says she’s known parents who thought it was just teething when it was meningitis. A fever should be checked out.

Teething also should not be causing babies to wake up at night, she says.

It also doesn’t make babies more hungry. They might seem like they want to eat all the time, but that’s just because they want to gnaw on something, Lal says. She likens it to the puppy who always wants to tear something up.

“They’re just trying to feel better,” Lal says.

 

That hotel pool could make you sick this summer, CDC study finds

The Centers for Disease Control and Prevention released this bit of information last week:

1 in 3 waterborne disease outbreaks traced happen in hotel pools or hot tubs.

There have been about 500 waterborne disease outbreaks from 2000 to 2014. In addition to hotel pools and hot tubs, water parks have also been to blame.

Infographic: Swim healthy, stay healthy

 

Diseases include things like Cryptosporidium, Pseudomonas, and Legionella. These diseases are also really tough to fight. Crypto can survive in even properly maintained pools and pseudomonas and legionella can survive disinfectants.

In the 493 outbreaks from 2000 to 2014, 27,219 people got sick and eight people died. More than half of them happened in the summer.

These disease cause things like skin infections, respiratory disease and diarrhea.

Austin had its own Crypto outbreak in 1998, when 1,300 people got sick.

RELATED: Before you go swimming know what’s lurking in the water

The CDC offers these suggestions:

Protect yourself and your family from germs spread through the water we swim in and share

Take the following steps to protect yourself and loved ones from germs when swimming in pools, soaking in hot tubs, or visiting water playgrounds:

  • Don’t swim or let your kids swim if sick with diarrhea. If Crypto is the cause of the diarrhea, wait until 2 weeks after diarrhea has stopped to go swimming.
  • Check the pools, hot tubs and water playground inspection scores.
  • Before getting in the water, use a test strip from your local retailer or pool supply store to check if the water’s pH and bromine or free chlorine level are correct.
  • Don’t swallow the water.
  • Take kids on bathroom breaks hourly, and change diapers in a diaper-changing area and away from the water.

Healthy and Safe Swimming Week

Healthy and Safe Swimming Week begins Monday. CDC encourages swimmers to help protect themselves, family and friends from germs and encourages the aquatics sector to follow recommendations for the design, construction, operation, and management of recreational water facilities. For more information and other healthy and safe swimming steps, visit www.cdc.gov/healthywater/swimming.

RELATED: How safe is your local pool?

Brigitte Decato, a swim instructor with the Swim Safe program at the YMCA, works with Octavio Ruiz, 5, (center) on the backstroke. 2007 Laura Skelding AMERICAN-STATESMAN

Follow our swim safety tips:

Don’t forget that even if the pool is safe, water can be a very unsafe place. Keep these things in mind when you head to the pool, lake or beach this weekend.

Before you dip your toes into whatever body of water you choose, practice these rules for water safety we compiled using experts from the YMCA, City of Austin’s Parks and Recreation Department, Colin’s Hope, Safe Kids Austin, the Lower Colorado River Authority and the Centers for Disease Control and Prevention.

What does drowning look like?

Unlike what we see in the movies, “drowning is a silent thing. There’s no splashing, yelling or choking,” says Stephanie Hebert, the injury prevention coordinator at Dell Children’s Medical Center and the Safe Kids Austin coordinator. “They go under and when they are under, you don’t hear them, you don’t see anything.”

Drowning also doesn’t take long. Irreversible brain damage happens in as little as four minutes. Children who drown are usually missing for less than five minutes and usually are in the presence of at least one parent.

For children younger than 15, it’s the second-leading cause of unintentional injury-related deaths, behind motor vehicle accidents. Children younger than 5 are more at risk. Boys also are more susceptible because they tend to take more risks.

It can happen anywhere. Pools with lifeguards, natural bodies of water, bathtubs and toilets.

As of mid-May this year, 16 children already have drowned in Texas, according to the Texas Department of Family and Protective Services.

It’s also preventable, so let’s focus on that.

Watch the water

The No. 1 thing parents can do to prevent a child from drowning is supervise their children.

For young children, that means getting in the water and having hands-on contact or being within arm’s length.

For older children, that means watching them in the water at all times. Reading a book in a lounge chair or talking to a fellow parent or texting isn’t supervising.

The Austin-based drowning prevention nonprofit group Colin’s Hope distributes 75,000 water safety packets every year that include a Water Guardian bracelet. The bracelet slips on and signifies that you are the designated adult watching the children in your group. If you need to take a break, you hand it to another adult, whose sole job is watching the water.

The City of Austin ordinance requires that kids 9 and younger have an adult with them to be in a city pool and that kids ages 10 to 14 can be by themselves if they pass a swim test, but why chance it? Supervise everyone in your group.

Vacation is also no time to let your guard down. Kids can drown in cruise ships and hotel pools.

Always have a phone nearby and learn CPR. A water safety class is also a great idea.

Good swimmers drown, too

Even kids who know how to swim can drown, says Alissa Magrum, executive director of Colin’s Hope, which was started by the parents of Colin Holst, a 4-year-old who drowned in an Austin pool in 2008. Colin had had swim lessons and was at a life-guarded pool with his family and friends watching.

“A lot of families think, ‘My kids are decent swimmers; they’ve had swim lessons, they are fine,’ ” Hebert says.

But things happen. Children accidentally swallow water. Or they hit their heads. Or they misjudge their abilities. Or they get tired or dehydrated or hungry.

Donita Grinde-Houtman, the aquatic supervisor for Austin Parks and Recreation, says lifeguards respond most often between 2 and 6 p.m. because kids get tired. “Kiddos have been at the pool all day long, they’re getting tired, and they don’t recognize that they don’t have the energy to swim as far as they need to.”

Take frequent breaks. End earlier than you think you should. Rehydrate and refuel throughout the day.

Not-so-good swimmers need more help

That doesn’t mean water wings, pool noodles and other pool toys to stay afloat. Put a U.S. Coast Guard-approved life jacket on your budding swimmer. They have to have one on for getting in a boat, so why not extend that to any body of water?

Before you go to a pool, define where the shallow end is, especially for not-so-good swimmers. One of the most common reasons lifeguards make a water rescue, says Bret Kiester, the executive director of the Hays Communities YMCA and the aquatic directors liaison for all the Austin-area YMCAs, is when kids who aren’t good swimmers find the deep end. Sometimes they’ve monkey-crawled along the side of the pool to that end; other times they’re following an older sibling or they don’t know where the deep end starts.

Lifeguards are great but not a guarantee

Be hesitant to swim in a place without a lifeguard because they add a layer of protection. However, they’re not insurance.

One lifeguard Magrum was working with put it this way: “We are not baby-sitters. We are here in an emergency.”

Lifeguards have a lot of people to watch, not just your child. Their job gets even more difficult the more people are in the pool and the less-clear the water is. They also get distracted by children horsing around (i.e. running around the pool) and other emergencies not in the pool.

Lifeguards, who go through similar training programs, are supposed to scan 180 degrees every 10 seconds from top to bottom, from right to left. If you see a lifeguard who isn’t doing that or you notice that lifeguards aren’t getting frequent breaks and rotating out, alert a supervisor.

Swim lessons

Swim lessons statistically have been shown to reduce a child’s chances of drowning, but it’s not a magic shield.

The YMCA and the City of Austin’s Parks and Recreation Department start swim lessons as parent-and-child classes at age 6 months, old enough for a child to have good head control.

Those early classes are about familiarizing the baby with water and teaching parents good water safety with their children.

By age 3 or 4, children can take solo lessons, but if you’ve missed that age, don’t worry. “It’s never too late to learn how to swim,” Kiester says. He’s had students as old as 92 learn to swim.

Kids are grouped by age, then by ability, and there are adult classes, too — something parents who don’t know how to swim should consider in order to be able to save a child in danger.

Swim lessons are not just about learning strokes. They teach about being comfortable and water safety.

Sometimes kids will have a bad reaction to swimming lessons. It might be the time of day or it might be the coolness of the water, Grinde-Houtman says.

If your child is truly afraid of the water, Grinde-Houtman says, you might have to take a step back and start with something like sitting at the side of the pool and putting her feet in the water.

Free swim lessons are available from the Austin American-Statesman’s Swim Safe program, which provides lessons at YMCA locations and City of Austin pools.

A great time to do swim lessons is in the winter, Kiester says. They tend to be less crowded and when summer starts, kids won’t have to re-learn to be comfortable in the water again.

Natural bodies of water

Rivers, lakes, springs and oceans get tricky. The surface is uneven. “You might be wading in waist-deep water and the next step you’re in 16 feet of water,” says Clara Tuma of the LCRA.

You also can’t see the bottom to know if someone has fallen in.

It’s also hard to judge distances. People often get in trouble because they pick a point to swim to and underestimate how far it is. “They run out of energy halfway there,” Tuma says. “They can’t just stop and sit under a tree.”

Wearing a U.S. Coast Guard-approved life jacket allows them to rest and float if they need to.

And often people get confused as to where they are to report an emergency.

Swimming on natural bodies also means you’re not the only thing out there. Keep a look out for boats and personal water crafts that might not be able to see you.

In oceans, teach kids how to deal with rip currents that push swimmers away from the shore.

Never swim alone no matter what type of water you are in.

Keep safe at home

Each year many kids drown at home. Kids can drown in as little as 1 inch of water.

Never walk away from a young child in a bathtub, not even to answer the phone or grab a towel.

Keep locks on toilets if you have infants and toddlers. Keep plastic kiddie pools empty as well as mop buckets.

If you have a backyard pool, install a locking gate system on all four-sides of the pool. If a child goes missing, check the pool or hot tub first before looking inside the house.

Teach baby-sitters about pool safety.

Know which sunscreens work best and what to look for in a sunscreen. AMANDA VOISARD / AMERICAN-STATESMAN

Don’t forget to wear your sunscreen and bug spray, too. 

We tested more than 20 sunscreens last week to see which ones worked best and last year we tested 16 bug sprays to see which one actually repelled mosquitoes. 

Before you head out, read our research.

Have a safe summer!

Morgan Shirley, 7, leaps into Mabel Davis Pool. Shelby Tauber / AMERICAN-STATESMAN

 

 

Dell Medical School, Seton lessen amount of opioids given to women after childbirth

Doctors at Dell Medical School at the University of Texas and at all Seton Healthcare Family hospitals are rethinking they way they treat mothers for pain after a Cesarean section or a vaginal delivery.

The new protocol has decreased the use of opioids by more than 40 percent while new moms are in the hospital. “We changed the way we want to manage pain,” says Dr. Amy Young, chair of the Department of Women’s Health at Dell Medical School and head of Women’s Health at Seton.

Dr. Amy Young is chair of the Department of Women’s Health at Dell Medical School at the University of Texas.

Beginning in February 2017, Seton and Dell Medical School changed the questions doctors and nurses asked about pain level, the way they measured that pain level and the way they gave out pain medication.

The hope was that they could lessen the amount of opioid medications given after birth to then lessen the possibility of addiction later.

The opioid epidemic continues to affect thousands. (Dreamstime)

In 2012-2015 in Texas, drug overdose was the No. 1 cause of accidental death in women within a year of giving birth, according to state Department of Health Services. That same study found that more than half of those overdoses involved an opioid.

Now instead of asking moms to rate their pain on a scale of 1 to 10 or to look at a series of smiley and not-so-smiley faces, doctors and nurses are asking moms how they are doing with functional activities such as the ability to get up and go to the bathroom and the ability to sleep comfortably.

The previous pain scales were subjective, Young says. “I’m a big gigantic ninny when it comes to pain,” she says. “I’m terrible at it. My 1 might be your 10.”

Using the number scale might mean that a mom might say she was a 3 and be given one pain regimen, but really her pain was the same as another mom’s 7, who got a different pain regimen.

Now doctors and nurses are automatically giving moms a combination of acetaminophen (Tylenol) and ibuprofen (Advil) every six hours, unless they are allergic or don’t want it. Those two drugs work differently when it comes to how they control pain. Nurses also aren’t waiting for a woman to be in pain before giving her those medications.

What doctors and nurses found was that for many women, that was enough. They didn’t need the narcotics. For other women, who still reported pain when trying to do functional things, they were first given oral hydrocodone. If that still didn’t do it, they are given an intravenous pain medication like morphine.

Women who had had C-sections were more likely to need more than the acetaminophen/ibuprofen combination than those who had a vaginal birth.

RELATED: Dell Medical School is expanding a program to treat disorder that 40 percent of women experience

They also watched how patients rated their pain management in surveys. The hospital and school actually found those numbers either stayed the same as before they changed the protocol or improved slightly.

“This was a culture change,” Young says, “that took pretty embedded prescribing practices and changed them.” The fear was that patients would be in pain or that the acetaminophen/ibuprofen combination wouldn’t be enough, she says.

The change means that more moms aren’t leaving the hospital with the side effects of opioids such as constipation, feeling sedated and not being able to care for their babies because of that, or having withdrawal symptoms, she says.

“Any reduction that you can make (in opioid use in the hospital) should translate into a reduction in outpatient utilization,” Young says. “It’s a reduction of the number of narcotics floating around. It’s my little tiny place in the fight.”

A future study will look at opioid use after birth to compare what doctors are prescribing patients as they leave the hospital and what they actually fill and use.

Other hospital systems are looking at what Seton has done and some have even adopted Seton’s protocol, Young says. She plans to publish a paper on what they found in changing the pain protocol.

RELATED Study: Number of kids treated for opioids in hospital intensive care units doubled

RELATED: American Academy of Pediatrics reports: Kids are addicted to opioids, too

Where’s the best place to be a working mom? Hint: It’s not Texas

Wallet Hub released its annual ranking of best states to be a working mother, just in time for Mother’s Day.

Texas ranked No. 42. Idaho was the worst out of 50 states and the District of Columbia. Vermont was No. 1.

Is Texas a great place to be a working mom? (Credit: Eric Doggett)

What do moms in other states have that we don’t? They have a better work-life balance. Texas ranked No. 49 in that index. Only Maryland was worse.

We also didn’t do well in the female executive to male executive ratio index. We were No. 47.

In two indexes, we do OK: child care cost (No. 29) and professional opportunities (No. 31).

Women in the United States make up about half of the work force and about 70 percent of women with young children work. Yet, we have some work to do. Women earn about 82 percent of what men earn. Only about 5.2 percent of the head of the S&P 500 companies are women.

Find the rankings here:

New hotline for new moms with postpartum depression

Postpartum Support International has several ways that new moms can get help. Of course, you also should check in with your own doctor, but if you can’t get in right away or while you’re waiting for the appointment, check out these resources:

A 24-hour, 7-day a week helpline. You can leave a message in English or Spanish and someone will call you back with encouragement, information as well as connect you to local resources.

You also can do a Text to Helpline: 503-894-9453. A volunteer will send you back information, encouragement and local resources.

Postpartum Support International also has Tuesday Online Support meetings at  postpartum.net/psi-online-support-meetings/ in English and Spanish. 

And Weekly Wednesday Chats with other moms and health experts. You have to preregister for them at postpartum.net/chat-with-an-expert/ The first Monday of the month, Postpartum Support also offers a chat for dads.

RELATED: Can men get postpartum depression? 

RELATED: Austin mom shares motherhood journey in thoughtful way?