What they found is that babies who were exclusively fed breast milk for at least three months had a lower BMI than babies who were given mainly formula. The introduction of solid food before six months didn’t seem to matter, and if a mother supplemented a little bit with formula while in the hospital, that didn’t matter as long as she established exclusive breastfeeding afterwards.
What did matter, interestingly, is how the breast milk was delivered to the baby. Mothers who exclusively fed at the breast had babies with lower BMIs than baby’s who received expressed breast milk in a bottle. Regardless of how they got the breast milk, breastfed babies had lower BMI than formula-fed babies.
Instead of children being in rear-facing seats until they turn 2, the American Academy of Pediatrics is now recommending that children stay in rear-facing seats as long as possible until they meet the upper number for that seat’s height or weight limits. That means that most children will outgrow that rear-facing seat anywhere from age 2 to age 5, but there could be some kids who are older than age 5 who are still in rear-facing seats because of their size.
Why make the change?
It’s all based on analysis of trauma data from car crashes, which is the No. 1 cause of death for children age 4 and older.
Children who were in rear-facing car seats had fewer injuries and a decreased chance of death than kids in forward-facing car seats.
Why is that? Kristen Hullum, a nurse and trauma injury prevention coordinator at St. David’s Round Rock Medical Center, says that it’s all about avoiding head, neck and spine injuries. Young children have immature spines and necks and are also head-heavy, she says. The rear-facing seats prevent more movement of the head, neck and spine than forward-facing ones.
“My 5 year old is petite,” Hullum says. “I still have her rear-facing. That might have seemed pretty conservative to many people, but this justifies it,” she says of the new recommendations.
Here is the progression of where and in what your child should sit in the car:
Rear-facing infant carrier in the back seat (or convertible rear-facing car seat if it’s weight range is low enough for an infant) until the child outgrows the height or weight limit for that carrier, which is typically anywhere from 22 pounds to 35 pounds. For infant carriers, that usually happens around age 1, but it could be later.
Rear-facing car seat in the back seat until the child outgrows the height or weight limit for that seat. That could happen any time from age 2 to 5 or even later depending on the upper limits for that seat, which can be 40 to 50 pounds or even more.
Forward-facing car seat with a harnessin the back seat until the child outgrows the upper height and weight limit, which could be anywhere from 65 to 90 pounds. The forward-facing seat should be tethered to the car.
A booster seatin the back seat that raises the child up so that the car’s seat belt fits the child properly until the child is 4 foot 9 inches tall and outgrows the upper limits for that booster, usually around 100 pounds. That could happen anytime between age 8 and age 12. It’s Texas law that children younger than 8 ride in a booster seat or car seat.
In the back seat using the car’s seat belt once they have reached the upper limit of the booster seat’s height and weight limits until age 13.
In the front seat, only after age 13, but also tall enough and heavy enough to not be injured by the air bag. That’s at least 4 foot 9 inches and 100 pounds. Even though it’s hard for preteens to want to be in the back seat, it’s about safety. Airbags inflate at 200 miles an hour, Hullum says.” If that air bag hits them in their face, there’s a significant brain injury,” she says. “The air bag should be at somebody’s chest.”
There are other recommendations and guidelines that parents should know.
Get your child seat professionally installed each time you get a new one. Hospitals and county Emergency Medical Services offer car seat checks that you can sign up to attend.
When picking a car seat, the most expensive one is not necessarily the best one. They all have to pass the same federal guidelines. It’s more of a question of which one has the fanciest cup holders.
If you can’t afford a car seat, your pediatrician or any car seat check location should be able tell you how to get a free one.
Car seats do have expiration dates that are usually between six and 10 years. They wear out with use.
Once a car seat has been in an accident, it is no longer safe to use. Car insurance companies will reimburse you for the cost of the new one.
Unless you know the complete history of that car seat, do not buy or receive a used one.
If you have a truck that only has a front-seat, you can install a car seat in the passenger seat, but you have to make sure the air bag is turned off.
Rear-facing car seats could be a problem for toddlers and preschoolers who get motion sickness. If that’s the case, talk to your pediatrician about what medications or techniques they recommend.
For parents who might be thinking that their 5-year-old is never going to see the world around her if she’s still in a rear-facing seat, Hullum says, not to worry. Her 5-year-old can easily remind her if she’s passed a Chic-Fil-A.
Car seat checks
9-11 a.m. Sept. 7, Dell Children’s Medical Center, 4900 Mueller Blvd.
9 a.m. Sept. 10, CommUnity Care Clinic, 211 Comal St.
9 a.m.-noon, Sept. 13, Williamson County Emergency Medical Services, 1781 E. Old Settler Blvd, Round Rock
2-5 p.m. Sept. 13, Elgin Fire Station, 111 N. Avenue C, Elgin
9-11 a.m. Sept. 17, H-E-B Mueller, 1801 E. 51 St.
9 a.m. Sept. 19, Gus Garcia Recreation Center, 1201 E. Rundberg Lane
9 a.m.-noon Sept. 29, St. David’s Emergency Center, 601 St. David’s Loop, Leander. Free car seats will be available at this event.
9 A.M. Oct. 2, Dove Springs Recreation Center, 5801 Ainez Drive
9-11 a.m. Oct. 5, Dell Children’s Medical Center, 4900 Mueller Blvd.
9 a.m. Oct. 9, CommUnity Care Clinic, 211 Comal St.
9 a.m.-noon, Oct. 11, Williamson County Emergency Medical Services, 1781 E. Old Settler Blvd., Round Rock
9-11 a.m. Oct. 15, H-E-B Mueller, 1801 E. 51 St.
9 a.m. Oct. 17, Gus Garcia Recreation Center, 1201 E. Rundberg Lane
Call 512-943-1264 to register for an appointment with St. David’s or Williamson County EMS. Call 512-324-8687 to register for an appointment in Elgin, Dell Children’s Medical Center or H-E-B. Call 512-972-7233 for CommUnity Care Clinic and recreation centers.
The Centers for Disease Control and Prevention released its 2018 Breastfeeding Report Card. How is the U.S. and Texas doing when it comes to reaching the Healthy People 2020 goals that were established in 2010 by this committee that has representatives from the U.S. Department of Health and Human Services, the U.S. Department of Agriculture and U.S. Department of Education.
In many areas, we’re meeting those goals. 83.2 percent of infants in the U.S. have been breastfed at least once. (the goal was 81.9 percent). We’ve also more than met the proportion of infants who are breastfed at a year (35.9 percent are); and the percentage at three months (46.9 percent are). The six-month mark we didn’t quite hit the mark in infants who are breast fed (57.6 percent vs. the goal of 60.6 percent) or those that are exclusively breastfed at that time (24.9 percent vs. the goal of 25.5 percent). We also didn’t do as well as hoped in the percentage of infants given formula before 2 days old (17.2 percent instead of 14.2 percent).
What can you do to encourage a new mom to breastfeed?
Make sure she checks out what kind of support she’ll receive at her hospital when it comes to lactation consulting. Hint: It’s usually 3 a.m. when you need a consultant. Babies feed just great from 9 a.m. to 5 p.m.
She can also ask the hospital what percentage of their infants are given formula vs. babies that are exclusively breastfed while there.
Feed her. Bring her healthy meals and plenty of water.
Offer to take care of her other child, help around the house or hold the baby while she takes a nap.
If she’s a work colleague, link her to another mom who has been pumping at work, who can help her make the transition back to work easier.
46th in midwives and obstetrician/gynecologists per capita
36th in pediatricians and family doctors per capita
37th in parental leave policy
29th in hospital Cesarean-delivery charges
28th in hospital vaginal-delivery charges
19th in infant mortality rate
28th in low birth weight
10th in annual cost of early child care
26th in child-care centers per capita
What does all this mean to Texas moms? It means that they might have to travel farther to see a midwife or OB/GYN or go to a pediatrician or family doctor than people in other states.
The Economist also came up with another interesting statistic: delivering a baby in the U.S. costs about $10,808, part of the total of about $30,000 for before and after birth care. Most people with insurance pay about $3,000 in hospital delivery costs after insurance. Many women in Europe have birth and delivery available for free by their country’s medical care system. Then if they want an upgrade of a private room in a luxury hospital, they might pay an additional fee. Duchess Kate spent about $8,900 for her private room in the St. Mary’s Hospital in London.
The Austin Diaper Bank would be happy to have your donation. Right now, they particularly need size 5 and size 6, but they’ll take any size diapers and they’ll take ones for adults, too.
“While diaper donations slow during the summer, the need does not,” said Holly McDaniel, executive director of the Austin Diaper Bank, in a press release. “If we can’t replenish some of our supplies, some of our neighbors in Central Texas may not get the diapers they need to keep babies or other family members clean, dry and healthy during these hot months.”
Dell Children’s Medical Center of Central Texas is the 11th children’s hospital in the country to be verified by the American College of Surgeons as a Level I Children’s Surgery Center. It earned the certification by meeting the highest criteria in the college’s new Children’s Surgery Verification Quality Improvement Program.
The program will help the hospital to continue to improve the quality of surgical care and ensure it is following the highest standards of care.
“I’m a mom,” said Dell Children’s chief surgeon Dr. Nilda Garcia. “One of the things I fear most is anything happening to my child. For me, being a mom, it means this hospital has gone above and beyond in their care of my child.”
Texas Children’s Hospital in Houston is the only other hospital in Texas to receive this verification.
Dell Children’s had to meet strict criteria and send a lot of data to the verification team over the course of about a year. Three doctors representing the college came to Austin in late April to verify Dell Children’s had met the criteria.
To meet this certification level, Dell Children’s had to make some changes. It joined the National Surgical Quality Improvement Program, which requires sending a lot of data about procedures, outcomes and complications to the college. The college gives feedback about how Dell Children’s compares to other hospitals in the country.
The hospital also created an office specifically to look at surgical quality, what kinds of criteria it should establish, why certain cases fell out of that criteria and how the hospital can improve.
Dave Golder, who is the director of the surgical quality program at Dell Children’s, says the hospital has reduced the number of CT scans it uses to diagnose things such as an appendicitis, instead relying on a physical exam by a doctor and an ultrasound by someone trained in detecting an appendicitis to diagnose one. This reduces radiation exposure to kids. Staff have reduced the number of Foley catheters used in surgeries, which reduces the risk of infections, and have reduced the amount of blood transfusions given.
Golder says he’s most proud of how the hospital outperformed other hospitals in preventable harm events such as sepsis, surgical infections and urinary tract infections following surgeries.
“Standardized care is a cultural thing and it has taken off (at Dell Children’s) in the last five or six years,” Garcia says. “The interest in adhering to (criteria) has been remarkable really.”
Going forward, the hospital is working on how it controls patients’ pain to reduce the amount of opioids given, as well as reducing the amount of unnecessary antibiotics given. It’s also working on how to implement Enhanced Recovery After Surgery programs that will do things such as give carbohydrates to patients before surgery, get patients moving quicker after surgery and shorten the length of stay after surgery.
Dell Children’s will continue to submit data every year to the college and will be reverified for the Level I certification every three years.
“We are maturing,” says Garcia, “and this is a step toward that.”
The company announced it would appeal and issued this statement:
“Johnson & Johnson remains confident that its products do not contain asbestos and do not cause ovarian cancer and intends to pursue all available appellate remedies,” spokeswoman Carol Goodrich said.
What does this mean to women who use baby powder as a moisture absorber in delicate areas?
Dr. Angela Kueck, gynecologic oncologist with St. David’s North Austin Medical Center and Texas Oncology, says she definitely has patients asking her about the case and other cases and baby powder, and she has patients with ovarian cancer who believe the baby powder they used might be the cause, but she cautions them, “In reality, it’s hard to link each individual case,” she says.
The problem with baby powder seemed to be the talc that was in it through the 1970s. (Talc is still found in makeup and other products.) The talc or talcum powder would be sucked up and doctors would find talc crystals inside women.
The research isn’t there to indicate how much baby powder over how many years would cause cancer, she says. “The data,” she says, “is not really strong.”
Even though there still are questions about the link to baby powder and ovarian cancer and even though talc is no longer in most baby powders, should you still use it?
Kueck says you can use baby powder, but look for powders that are pure corn starch, or have baking powder or baking soda or are specifically made for that area. Anti-fungal powders can work, too. Avoid using anything with fragrance because that can irritate the area.
Also, don’t use home remedies, Vasoline or deodorant. “In reality, if it’s not for that area, it doesn’t go down there,” she says. Anything you put there can ascend inside you, she says.
The purpose of the powders is to avoid excess moisture because that can lead to yeast infections on the skin, which can be painful. Moisture in that area especially in the summer can be an issue.
If you are finding that you’re needing to use a powder every day for more than two weeks, you should be having a conversation with your doctor about why that is, she says. There could be something happening medically that needs to be addressed in a different way.
For a long time, we’ve known that cats (specifically their poop) can carry toxoplasmosis, which can infect pregnant women and their fetus. It could affect the eyes or the brain of the baby. We’ve been telling pregnant women to have someone else in the house deal with the kitty litter. Pregnant women everywhere were happy to heed this advice.
What about dogs, birds and farm animals? Would the same caution about pregnant women avoiding feces be true?
Recently, there have been a few cases of pregnant women or children contacting a disease from dogs — specifically pregnant dogs or newborn puppies. You see, mama dogs, or wannabe mama dogs in heat, can carry a disease called brucellosis. They also can pass it onto their puppies through the birth canal. Humans tend to get it by handling newborn puppies or helping in the delivery of the puppies.
Dr. Sina Haeri, director of perinatal research and co-director of maternal fetal medicine at St. David’s Women’s Center of Texas, says brucellosis can cause people to have a fever, joint weakness and fatigue. In pregnant women, they could miscarry if they are in the first trimester. Later on, they have a higher risk of preterm labor and stillbirth. Doctors will want to monitor their cervix closely for signs of preterm labor and the fetus throughout the pregnancy. We don’t have enough data about birth defects from brucellosis, Haeri says.
Contacting brucellosis from dogs, though, is rare. In Haeri’s career here, where he also works in the Marble Falls and Fredericksburg area, and in rural North Carolina, he has seen seven cases. None of them from dogs. Instead, they have happened after a pregnant woman helps a mama sheep, goat or cow deliver their babies. His most recent case was a mama goat biting her pregnant human helper during labor. (See goats don’t handle labor well, either.)
The good thing about brucellosis is it is avoidable in most farm animals because they can be vaccinated against it. Also avoid it by not performing those birthing and breeding activities during pregnancy. In dogs, though rare, pregnant women also should not handle dogs giving birth or their newborn puppies.
Brucellosis is not something that doctors will screen for, so if you are pregnant and have been exposed to birthing farm animals or dogs, let your doctor know about that if you have a weird fever or joint pain. The treatment would be a six-week course of a two antibiotics.
Toxoplasmosis from cats is much more of a concern. Haeri calls it, “the bane of my existence” and the No. 1 reason why women get referred to him by their obstetricians. The screening for toxoplasmosis comes with a lot of false positives. If you have a negative reading, you can be sure it is negative. If you have a positive one, don’t panic, don’t make any drastic decisions, you might not have it and your baby might not have it. See a specialist for further screening.
Haeri encourages women to exercise good caution. Most indoor-only cats are probably fine; outdoor cats are typically the carriers of toxoplasmosis. If you cannot get someone else to do the kitty litter, wear a mask, gloves and wash your hands afterwards.
He also encourages pregnant women to avoid bird droppings as well because of parrot fever aka psittacosis. It gives women flu-like symptoms.
A good rule– no matter what the pet — is to practice good hygiene and have someone else deal in the droppings during pregnancy. Haeri also says why not throw in the dishes and cleaning the house, too?
The Breast Express is coming to Austin. On Monday, the traveling RV by breast-feeding support app PumpSpotting will be at IBM in North Austin, which PumpSpotting is recognizing for being a supportive company for employees who are lactating.
At IBM from 10-11:00 a.m. Monday, the Breast Express will be offering families breastfeeding support, demonstrations of infant massage, babywearing and fitness. From 11 -11:30 a.m., a panel of local breastfeeding resources will offer tips and information on how to get more support.
On Tuesday, the Breast Express heads over to the new Mothers’ Milk Bank location, 5925 Dillard Circle, from 10 a.m. to 2 p.m. Mothers’ will be giving tours of the bank’s milk-processing labs. You can also see the Breast Express Pump Suite, where you can try different pumps; hear from experts, and learn how donating milk can help premature and medically-fragile babies.
Experts include Kim Updegrove, Mothers’ Milk Bank executive director; Amy Van Haren, founder of PumpSpotting; Angie Liuzza and Christine Snowden, donor milk recipient family; Megan Frocke, milk donor and PumpSpotting user, and Megan Oertel, nursing mom, breastfeeding advocate and representing mother-friendly employer Sparefoot.
Every morning you make your kids breakfast and that breakfast includes a multivitamin in chewable or gummy form. You think, “Hey, even if they aren’t eating as many of the fruits and vegetables the food pyramid might recommend, at least this is something healthy we’re doing.” Right?
“Most kids, if they take a supplement like a standard daily vitamin, it won’t cause any harm,” Abrams says. “For the most part, it probably won’t do any good, either.”
Rather than giving them vitamins or supplements like Pediasure, he would rather parents concentrate on finding healthy foods their children like and encouraging them to try new things, but not force them. Remember that what they get in the food they eat is more than just the vitamins. In fruit it would be antioxidants and fiber as well.
Many parents will ask about their picky eaters, but he says, kids are probably getting more variety in their diet than we recognize. “If your child is growing normally, there’s a really good chance he’s eating better than you think.”
If not, talk to your pediatrician and do some tests to see if there is a vitamin deficiency, chronic illness or other circumstance that would make your kid an exception to the general rule that vitamin supplements aren’t necessary. For example, Abrams says, teenage girls sometimes might need an iron supplement if they become anemic.
Babies who are exclusively breastfed also might need Vitamin D, because breast milk doesn’t have any Vitamin D in it, but formula does, Abrams says. In Texas, often babies can get Vitamin D through a bit of sun exposure. Moms also can put Vitamin D drops either in a bottle of breast milk or on her nipple when nursing. Breastfed babies also need iron when they turn 4 months old, he says, until they are getting it through their diet after meat or fortified cereal is introduced.
Taking vitamin supplements usually isn’t dangerous unless kids are treating them like candy or are using them instead of medication. Abrams gives examples like using Omega 3 instead of medication to control attention-deficient hyperactivity disorder, or using Vitamin D to try to prevent the flu instead of a flu shot.
Also, supplements with a high concentration of caffeine could be dangerous as well.