Wednesday, October 31, 2012

Pumpkin eating baby



 We have had a couple of activities for Halloween already and today I am going to my daughter’s school to carve pumpkins.  I think it is technically part of her science class.  I will have to update you later.  I found a friend to watch Jujube, but I am bringing the baby with me.  I had to laugh when my instructions said to be prepared to get messy.  I will be wearing the baby in my Moby wrap.   We will see if baby eats pumpkin.

Many of you have heard how much I enjoy the spacing of our children.  We have 7 years between the two middle kids.  I always wanted four kids (or more) and my husband thought he would enjoy two sets of two.  The timing also allowed me to go to school to become a nurse practitioner between babies.  The girls are big enough to help out a lot and give me more flexibility to have mom time.

I am finding Halloween is a slight downside.  Last year I took all the kids with friends who also had kids with a wide range of ages.  We had a lot of fun.  But this year we don't have friends like this to share Halloween.  Jujube (and I) got tired before the girls were done gathering candy last year.  I guess they decided to solve this problem by finding friends to trick or treat with.  They will have fun.  But they are growing up.  I am a little sad as it is the first time that I won't be going with them.  Tonight, when its cold and rainy and my husband takes Jujube out early and I stay warm with the baby, maybe I will feel better.  I think I will spend the time making pumpkin pie.  And if baby hasn't had his fill already maybe he can try some pumpkin before it turns into pie.

Anyway, here are some photos.




Tuesday, October 30, 2012

After the storm

Last night my heart was crying out to God for mercy for the doctors and nurses at NYU Hospital.  The power went out and the generators went down.  For a nurse in a hospital there is nothing scarier.  I remember training for the possibility at my hospital before Y2K.  And praying that nothing would happen, for the patients sakes, but also for me because I was scheduled to work that New Year's Eve. 

Liberty by gordontarpley on Flickr


I am imagining trying to keep my patients alive without power.  And moving them at the same time, down nine flights of stairs and into flooding and hurricane winds.  The equipment usually has a battery that will last for a while.  Lord willing they last long enough.  Hand ventilating patients on ventilators is…well, horrifying.   Last night I was praying for the first responders, and the nurses, and the doctors who had to work harder than usual to keep people alive.  Babies in the NICU.  These first responders left their own families to help others.  That is why we do it to begin with.  Because we love God’s children and we want to help the way we can.  The way He has gifted us.  

And today I am still home praying for them.  Knowing how hard it is now to look back.  Those of us who are Christians know in our heads that God has numbered the days of each person’s life.  But when one of our patients dies, our heart's question everything.  What else could I have done.  Second guessing each decision.

In the moment however, is God’s grace.  In the times when I have had to deal with real emergencies, it is as if time slows down.  Everything becomes razor sharp and it seems as if every second lasts an eternity.  And through God’s grace each moment is taken one at a time.  Decisions made one at a time.  Adrenalin keeps the exhaustion away.  And you just do whatever it takes until it is over.  

And so this morning when you read this and we begin to find out exactly what happened.  We will hear of the cost, the price that Sandy exacted.  And the first responders will begin to process what they have been through.  And I ask you to continue to pray for all of them.

Monday, October 29, 2012

Time to wean baby?

So the baby is five and a half months old and ready to start eating foods. It is funny how different I feel about starting him on food than I felt for the first two. With both of the first two I wanted to put off feeding them solids for as long as possible. My oldest had different ideas than I did though. I had been taught that if a baby had teeth, could sit up well and started trying to steal your food, then they were ready for foods. I was also taught that rice cereal is the food you start with. Followed by yellow and orange veggies and then bananas.



I was planning to not start the first until, oh maybe eight months old. But, she could sit at four months and she had teeth. I thought, four months is too young to start foods. And then she stole my banana one day while I was on the phone. I wish I had a photo for you. Basically, I had been holding her on my left hip with my left arm and was eating a banana with my right hand. The phone rang, I transferred the banana to my left hand and answered the phone with my right. After saying hellos and maybe a sentence or two, I looked at my banana and my daughter who had put that banana right in her mouth and proceeded to eat it. I was a little aghast at what had happened. But quickly reassured myself that it was only a banana and she was obviously ready to begin eating. I did not know that this could or would be called baby led weaning and quite popular in England in ten years. I guess Miss Froggie was ahead of the times.

Recently I heard about baby-led weaning. In England where this feeding method is popular, this does not mean the stopping of breastfeeding. It means the introduction of solids. I think I will use the other term, baby-led solids. From what I have read so far there are a few main differences between “traditional” introduction of baby foods and the baby led method. The first is the consistency of what is offered. In baby led solids, the baby is put in the high chair and very soft foods are placed on the tray. These foods are big enough for baby to grasp, but soft enough that they mash very easily in baby’s mouth. Then baby grabs foods and puts them in his mouth.

This leads to the second difference: in the traditional method it seems baby first learns to swallow foods that are put in his mouth with a spoon. With the baby led method the baby first learns to get the food in his mouth and chew it up. Apparently baby won’t be able to get the food to the back of his mouth and throat where he could choke on it before he has developed the ability to swallow it. This makes it important to not help baby get foods in his mouth.

The third part of baby-led solids is that the baby eats what the family is eating. To me this makes eating part of a social experience and the parents are not making extra foods and feeding baby separate from the family meal. From what I have read, there have only been a few research articles on baby-led solids.
According to a recent study published in the British Medical Journal “weaning style impacts on food preferences and health in early childhood”. The study suggests that infants weaned through the baby-led approach learn to regulate how much food they eat which leads to a lower BMI and a preference for healthy foods. The researchers propose that together these factors could protect against obesity. It also reported that 93.5% of the baby-led group reported that their child had never experienced a choking incident.

Also, the American Academy of Pediatrics had an article in 2008 where it said there was “no current convincing evidence” that avoiding allergenic foods after 6 months of age has any effect on preventing allergies.

So I am interested in trying this method. I still have to do some more research to do and I need to get my hands on the book Baby-led weaning: the essential guide to introducing solids by Gill Rapley and Tracey Murkett. I also want talk to our pediatrician at his six month visit which is coming up. But, I am wondering: Has anyone tried this type of feeding intentionally or not? How did it go?


Resources :
http://baby-led-solids.blogspot.com/
http://www.babyledweaning.com/
http://www.rapleyweaning.com/assets/blw_guidelines.pdf

Thursday, October 25, 2012

Finding my Voice

Five Minute Friday

Now, set your timer, clear your head, for five minutes to just write without worrying if it’s just right or not.

Five Minute Friday

1. Write for 5 minutes flat – no editing, no over thinking, no backtracking.
2. Link back here and invite others to join in.
3. And then absolutely, no ifs, ands or buts about it, you need to visit the person who linked up before you & encourage them in their comments. Seriously. That is, like, the rule. And the fun. And the heart of this community..
Oh and Ahem, if you would take pity and turn off comment verification, it would make leaving some love on your post that much easier for folks!
OK, are you ready? Won’t you please give me your best five minutes on:


Voice
Then…I used to sing in chorus and choir. But I would frequently lose my voice. My voice coach wondered if I had vocal nodules. Something like calluses on the vocal cords. And I did. I had to go two weeks without speaking. And relearn to talk in a way that was not damaging to my voice.


Now again I look for my voice, for but this time not my oral voice. This time I seek to establish my blogging voice. And instead of a voice coach I look to God to coach me.

Wish I had more...

Today on the breastfeeding blog hop we are sharing photos of breastfeeding.  So, I went through six years of photos.  More than eighteen months for each of my three older kids plus six months for the current baby.  And I discovered that Motherwear breastfeeding shirts last a long time.  From Virginia, to California, Texas, Washington, Ohio, and most places in between, those shirts, my babies, and I have been nursing all over the country.  I am not afraid to breastfeed in public, but apparently I am camera shy.  I have very few photographs of me actually nursing.  So I added a few photos I found on Flickr to my collage.  I hope you enjoy it.




Mother and children by blmurch on Flickr


DSC_7813 by Mothering touch  on Flickr
Breastfeeding baby by rkimpeljr on Flickr
Mother's Love by koshyk

Mother and children by blmurch, Breastfeeding baby by rkimpeljr
 DSC_7813 by Mothering touch, Mother's Love by koshyk all on Flickr

Wednesday, October 24, 2012

Chicken Soup just for flu season?

Probably not.  In previous posts about I have mentioned the immune system and its role in preventing the flu and other illnesses.  One of the recommendations was to eat a diet rich in vitamins and minerals.  There are many diseases such as diabetes, heart disease, and cancer that occur less frequently in people who eat vegetables frequently.  But many kids don’t want to eat their veggies.  And fresh vegetables are frequently expensive, especially the organic ones.  (The American Academy of Pediatrics just commented on the benefits of organic foods.  You can check it out here)  So, what is one simple addition to your monthly or weekly meal plan that will provide cheap vitamins and minerals in a form that is easily absorbed but won’t break the bank?


Chicken soup!  Chicken stock is one recipe you can easily make from scratch yourself.  It is much cheaper and healthier than buying it in a can or box at the store.  And preliminary research indicates it likely has immune boosting powers as well.  Grandma was probably right about chicken soup.
When chicken stock is made by simmering the bones in water and maybe a splash of vinegar the minerals leach into the stock in a form that is easily absorbable. 

Chicken stock has zinc, iron, selenium, calcium, phosphorus, potassium, and magnesium in it.  The sodium and vitamin content in it would depend on what vegetables are used and how much salt you add.  I usually simmer my stock overnight in the crock pot.  Then you can remove the vegetables from the stock that your kids will not eat.  For instance, I always use onions in my stock, but I do not generally serve chicken soup with onions. 

Beside vitamins and minerals, there are other health benefits that have been identified.  There is much research left to be done for conclusive evidence, but several articles indicate that chicken soup can decrease symptoms of upper colds, increase the movement of nasal mucus and also improve the function of protectivecilia in the respiratory tract.  And in Arthritis Research and Therapy they found that collagen from chicken bones can reduce symptoms of rheumatoid arthritis.


Finally, there are many health benefits of chicken soup that our traditional medical system is just beginning to research but complementary health providers and traditional people have known.  For more information see: 


day2day joys

Tuesday, October 23, 2012

Your biggest parenting choice


What is the one thing you have complete control of as a parent that can influence whether your child grows up to read, have a good attention span, finish high school, go to college, or be aggressive, use alcohol or tobacco, be sexually active or overweight?  The answer is watching more than two hours of television a day.  Why?

Watching TV.  A photo by Oddharmonic on Flickr
  1. Watching violence on TV is associated with aggressive behavior.
  2. Watching more TV increasing the chances of dropping of of school and decreased chances of getting a college degree   
  3.  Being awake and in the room with television on more than two hours a day is associated with being overweight. 
  4. Television may cause a decrease in metabolism. 
  5.   Children who watch television are more likely to have altered sleep patterns and sleep disorders.
  6. Watching more TV in childhood may increase school drop out and decrease the chances of getting a college degree. 
  7. Watching TV at ages 1-3 years old is associated with shorter attention spans and fewer parent-child interactions.
  8. Increased television watching is associated with less reading.
  9. Watching the use of alcohol, cigarettes, and sex on television normalizes it and makes your child think it is acceptable, even desirable behavior.


Confession time.  I let my three year old watch too much television. I have done this even though I know the American Academy of Pediatrics advises against more than two hours of television a day.
So, why would I let my child watch too much TV?  Well, let’s just say that each morning I always intended to turn it off in two hours.  Just long enough for me to get my work done, I’d think.  But I guess I always have more than two hours of work to do.  Don’t you?  Cooking three meals a day for one or more kids, dishes, laundry, tidying up, cleaning, nursing the baby, and blogging all take time.  I was using the television like a babysitter.  I was starting the day with television and not getting it turned off.  I wasn’t including my little one in the chores I was doing.  And he wasn’t learning to play by himself.

But no more.  I am going to cut the television time down to 2 hours or less a day.  Actually, we had our first day today.  I told Jujube on Sunday night that there would be no television tomorrow until Miss Froggie got home from school.  I also told him we would play in the playroom together and go to the park.  Why did I do this?
1.        Kids do better when they know what to expect.  I also gave him something to look forward to instead of just taking away something he likes.
2.       If I said it, then I would be more likely to do it.
3.        I gave him a time frame that he could understand in order to decrease how often he would ask for television the next day.

What else did I need to do?  I needed to prepare to be firm, no matter what.  I knew that he was going to test me today.  And I needed to win this battle or cutting down on the TV would only get harder.  I believe that consistency, for all aged children is key.  And pick your battles.  Don’t start a battle when you aren’t prepared to win.  If you are going to cut out television, don’t do it when someone is sick, or your support system is out of town.  Set yourself up to have extra help, or at least to devote more time to teaching a new behavior.  These guidelines help me whenever we need to make a change in our schedule.


How long will it take?  It depends on your child.  Be prepared for 2-3 weeks of hard work.  But it may not take that long.
So, does anyone want to join me in decreasing TV time?  And those of you who already have no television during the day, what do you have your three year old do for independent play?  Are they any tricks you have for getting young children to play by themselves?  I have found that Jujube likes me to be in the room, but he will often play by himself if I am close by.


Resources:
http://www.janetlansbury.com/2012/07/how-to-break-your-toddlers-tv-habit/
http://www.janetlansbury.com/2010/07/a-creative-alternative-to-baby-tv-time/

 American Academy of Pediatrics, Committee on Public Education. Media violence. Pediatrics. 2001 Nov;108(5):1222-6. Available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/5/1222.
Bushman BJ, Anderson, CA. Comfortably numb: desensitizing effects of violent media on helping others. Psychological Science. 2009 21(3):273-277.
 Rich M, Woods ER, Goodman E, Emans SJ, DuRant RH. Aggressors or victims: gender and race in music video violence. Pediatrics. 1998 Apr;101(4 Pt 1):669-74.
Klesges RC, Shelton ML, Klesges LM. Effects of television on metabolic rate: potential implications for childhood obesity. Pediatrics. 1993 Feb;91(2):281-6.
Thompson DA, Christakis DA. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics. 2005 Oct;116(4):851-6.
Johnson JG, Cohen P, Kasen S, First MB, Brook JS. Association between television viewing and sleep problems during adolescence and early adulthood.  Arch Pediatr Adolesc Med. 2004 Jun;158(6):562-8.
American Medical Association. Brain Damage Risks. Available from: http://www.ama-assn.org/ama/no-index/physician-resources/9416.shtml. Accessed 30 June 2010.

Monday, October 22, 2012

Flu shot anyone?



The flu vaccine.  What do we need to know to decide if we want to get it for ourselves and for our kids?  I am going to be honest.  This is a difficult post to write.  There are strong emotions associated with vaccinating and not vaccinating our children.  

Children, even healthy children, can die from the flu.  How many die each is year varies with the circulating virus and the severity of the flu season.  The worse season was the 1918-1919 pandemic when more than 20 million people died. 
Some day I should write an "Immune System 101" post.  But here is a quick description.  The immune system has two kinds of "troops" for fighting a virus or a bacteria.  It had general or non-specific troops and it has specialized or specific troops.  The general troops are the first responders.  They catch a virus.  If the body has seen it before it usually will have specialized troops that are more efficient at killing the virus.  If it has these specialized troops, the immune system will send them out and quickly make more for the fight.  If you have enough of these troops you don't get sick.

If you don't have specialized troops, you body develops them so it can fight the virus.  But this takes time and the general troops may not be able to keep up.  That is when you get sick. 

Usually, adults' immune systems have seen a flu virus and have some specialized troops available to attack a flu virus, but in the 1918 virus "looked" different enough that for most people specific immune system did not recognize it .  And that is why so many people died that season.

You have heard the phrase use it lose it?  That applies to your specialized troops.  If your body doesn't ever use the specialized troops for flu, it may stop making them.  So based on all of this information about the flu, it is thought that by getting the vaccine each year, people will not only be able to avoid getting the flu this year, but the immune system may become better at recognizing it.  Possibly even strains that are not in the vaccine. 

Worst Case Scenario

So, to basically make an informed decision about the flu shot, we need to have an idea of what is most likely to happen if you or your child gets the flu and look at the worst case scenario.  I discuss this more here.  But depending on your child’s health and age, most likely he would be sick for a week or two with fever, cough, runny nose, and sneezing.  He could get an ear infection, pneumonia, or other complication. He could be hospitalized.  You could be hospitalized if you catch it as well.  Worst case scenario is death. But the risk of catching the flu depends on your environment.  

I have a relatively high risk of catching the flu as a healthcare provider seeing sick kids during flu season with my own children attending public school.  Someone else who works from home and homeschools their children is going to have much less exposure to the flu virus.
The h1n1 Swine Flu virus vaccine shot for Emilio. Side effect symptoms: "Squeal like a Pig" by Dj Crazy Gabe
The h1n1 Swine Flu virus vaccine shot for Emilio. Side effect symptoms: "Squeal like a Pig", a photo by Dj Crazy Gabe on Flickr

 

Effectiveness

We also need to know how effective the vaccine is and what all the possible consequences or side effects of the shot are.   From my review of the literature there is not a clear answer to how effective the vaccine will be.  This is because effectiveness changes each year depending on the circulating virus and the match of the vaccine.  And it depends on how old the people receiving the vaccine are and whether they get the TIV or LAIV.

Oops, I just threw some abbreviations at you.  Let me explain.  The TIV stands for the trivalent (or three strain) inactivated (killed) vaccine.  LAIV stands for live attenuated influenza vaccine.  It is a nasal spray.  The only live flu virus that is FDA approved in the United States is FluMist. According to the CDC,
“the nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened) and cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist”.
Back to effectiveness.  Overall, the flu shot is effective approximately 50-70% of the time.  Meaning, your immune system responds to the vaccine enough to protect you from the virus slightly better than half of the time.  The flu shot effectiveness is higher for kids under 6, and slightly better for FluMist in this age group.  The injection seems slightly better for healthy adults.  And there is not enough evidence for effectiveness in adults over age 65.  Actually, in reading the evidence, numbers seemed to vary greatly.  In fact, some meta-analyses showed the effectiveness at less than 50% for healthy adults.  And many of the studies are funded by the pharmaceutical company who manufactures it.  I agree with the call for more publicly funded (not potentially biased) studies at each age group.  I will list links to the research I looked at following the post.



Reactions and Side-Effects

OK, on to reactions to the vaccine.  All the vaccines are made with eggs, so an allergy could cause an allergic reaction to the vaccine. "Although," according to Children's Hospital of Philadelphia (CHOP),
"the influenza vaccine is made in eggs and some people are severely allergic to eggs, the quantity of egg proteins in the vaccine is insufficient to cause a severe allergic response. But just to be sure, people with severe egg allergies should remain at their provider's office for about 30 minutes after receiving the influenza vaccine."
There may be an extremely small chance of experiencing Guillain-Barre syndrome after immunization, but this has not been shown in current studies. Most people have soreness at the injection site if they receive a shot.  People who get FluMist could have cold symptoms: runny nose, fever, fatigue, aches, chills, or sore throat. There is no evidence of death as an adverse reaction to the flu shot or FluMist.  However, according to the recent Lancet article more research is necessary on "potential harms".

Recently, the CDC has been investigating whether there is an increased risk for seizures following a influenza shot.  It appears that in children under 5 who also receive a Prevnar shot on the same day, there may be an increased risk for febrile seizure.

Many people also consider the preservative and other components in the vaccine.  Thimerosal (mercury-based) is used as a preservative in some flu shots and is left over from the process of creating the flu vaccine in other shots.   If the flu is in a multi-dose vial, it will have a preservative in it.  If it is in a single dose it usually does not have Thimerosal.  Fluvirin single dose has trace amounts  .FluMist is always prepared as a single use and does not have a preservative in it. To see which vaccines have Thimerosal look here and to learn more about it look here.  By the way none of the the flu vaccines have aluminum in them.

Formaldehyde.  Yes there is a small amount of formaldehyde is all flu vaccines.  But, small amounts of formaldehyde is present in the human body already.  According to CHOP,
"First, formaldehyde is essential in human metabolism and is required for the synthesis of DNA and amino acids (the building blocks of protein). Therefore, all humans have detectable quantities of natural formaldehyde in their circulation (about 2.5 ug of formaldehyde per ml of blood). Assuming an average weight of a 2-month-old of 5 kg and an average blood volume of 85 ml per kg, the total quantity of formaldehyde found in an infant's circulation would be about 1.1 mg, a value at least five-fold greater than that to which an infant would be exposed in vaccines."
Finally, in my research on the flu shot I came across a great post from healthyfellow with more options for preventing the flu.


References

Look at the CDC, FDA, and CHOP sites for more information.
 
Jefferson T, Di Pietrantonj C, Rivetti A, Bawazeer GA, Al-Ansary LA, Ferroni E. Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD001269. DOI: 10.1002/14651858.CD001269.pub4.

Manzoli L, Ioannidis J, Flacco M, De Vito C, Villari P. Effectiveness and harms of seasonal and pandemic influenza vaccines in children, adults and elderly: A critical review and re-analysis of 15 meta-analyses. Human Vaccines & Immunotherapeutics 2012; 8:851 - 862; PMID: 22777099; http://dx.doi.org10.4161/hv.19917.

Osterholm MT, Kelley NS, Sommer A, Belongia EA.  Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.  The Lancet Infectious Diseases - 1 January 2012 ( Vol. 12, Issue 1, Pages 36-44 ) DOI: 10.1016/S1473-3099(11)70295-X