for snotty noses 

For “about to be siblings”

Heavenly new recipe- Barley Risotto from this cookbook

this cloth diaper

These adorable baby shoes 

This TV show (yes, I was a big Felicity fan back in the day)

And for the locals- I had such a great experience again with my midwife Dinah Waranch of Lovers Lane Birth Center. My doula, Cheryl Johnson was amazing. My lactation consultant, the fabulous Judy Eastburn was quick to help us with a posterior tongue tie. If you are considering cloth diapering, a trip to the Nappy Shoppe in Plano is a must- they also have a GREAT selection of baby carriers/wearers. And for the cutest kid’s clothes in town, Little Bean.

It seems like everywhere I go over the past couple months, I hear parents of young children talking about this book. The cover of the book has many claims “No purees, no stress, no fuss!” and the subtitle “The Essential Guide to Introducing Solid Foods and Helping Your Baby to Grow Up a Happy and Confident Eater.” Well, who would not want to read this book?

The basis is that spoon-feeding purees is outdated and can actually lead to many of the problems that we are currently seeing in our children from obesity and picky eating to texture and sensory sensitivities. The author’s simple solution is to wait until your baby is at least 6 months old and then allow them to explore solid foods with their hands and eat what you are eating.  The drawbacks being that it is very messy the first few months but in the end you are saving loads of time and money on baby food and you will have a child who has a broad palate and is able to feed themselves what they need and want. There is a strong emphasis that the majority of their nutrition will be breast milk or formula until they are effectively taking solids 10-11 months old. In the meantime, the meal times are a developmental exercise of exploring, working on eye hand coordination, and fine motor skills and social interaction.  Sounds great, right?

So, what is the current standard in the United States with introduction of solid foods? If you talk with 5 different pediatricians, you will get 5 different ways to approach introducing solid foods. The American Academy of Pediatrics (AAP) is frustratingly vague with the section on breastfeeding recommending exclusive breastfeeding until 6 months and the section on nutrition stating that solids should not be introduced before 4 months, but not delayed after 6 months. So, parents have been figuring this out for themselves with the advice of grandparents, friends, and their pediatricians to come up with how and what to feed to their infants. Parents start solids for many reasons: they are hopeful that their child will sleep longer, they think it will be an enjoyable experience for their baby, they think that their baby must need additional nutrition to continue to thrive and grow.

While parents used to rely on commercially prepared baby foods, there has been a shift in the way we think about food in America and that can be seen in the baby food industry as well. Many parents are concerned about where their food comes from and what it contains in relation to preservatives and additives. This can be seen on any baby aisle with hundreds of baby foods labeled as organic, whole grains, added omega-3 s, etc.  There has been a huge movement towards making your own baby food with cleverly marketed products available like the Baby Beaba and Baby Bullet so that you can make your own baby food from what you have at home.

There is a lot for parents to think about, and even more if food allergies run in your family! Should you start with rice cereal (no, too constipating and aren’t carbs bad?), or fruits (no, then they will develop a sweet tooth, is there arsenic in my applesauce?), or vegetables (but not anything that will make them gassy, and not spinach because of phytates?), or fish (but what about mercury?), tofu (what about estrogens?), meat? For every step you might take there are several questions! Eating seems more complicated than ever. But back to the book…

There were a few things that I did raise my eyebrows at and did not agree with. I am most concerned with the choking possibilities with this method of solid food introduction. Choking is a leading cause of morbidity and mortality in children under 3 years old. The most common things that children choke on are food, coins, and toys. Because, in my training at a large children’s hospital, I have witnessed normal healthy children die or be left brain dead after choking on a piece of apple, a grape, and a piece of popcorn, I cannot take the risk of choking lightly or suggest that letting your 6 month old gnaw on a piece of meat is okay.  The book does go over minimizing the risk factors for choking such as never letting the baby eat alone, having them sitting upright, and avoiding high risk foods like hard candies and nuts and cutting spherical foods like grapes, cherry tomatoes, and pieces of hotdog. But I would go further to suggest that most foods should be pureed until primary tooth eruption and incredibly soft or mashed until molar eruption when you child can actually masticate their food.  I would also suggest that all parents take a first aid course for choking and CPR if they have not done so before their child starts to eat solids.

The second issue that struck me with the book was the amount of effort involved in this “no fuss” feeding method. One suggestion in the book is that you cut your fruits and veggies with a crinkle cutter to make the pieces easier to hold and that you keep extra veggies on hand in the freezer. The preparation methods are roasting, boiling, and steaming and not adding salt.  So, it seems to me that the only step you are saving is the actually pureeing, which in my experience is the easiest part!

And finally, my third problem with this book is the woefully inadequate references. I eagerly flipped to the back to see all the wonderful developmental pediatric articles to support this book only to be hugely disappointed. She has one very small research study cited, two dictionaries (dead serious), and a few websites. She also references herself, which I find to be a little obnoxious.

So, in summary, I loved it at first but then was disappointed. I think that this method might work really well for some families. If you can be a parent that is laid back about mess, wasted food, and not going to be fixated on being able to quantify how much your child is eating, then this might really work for you. And all I would suggest is a choking CPR course and keeping the foods on the softer, mushier, smaller side of things.

My two cents is that all babies are individuals and that some may be ready before 6 months and some after. I have told my families that a good time to introduce solids is when the child is trying to grab food off your plate and in general, is very interested in what you are eating. With most children who have no family history of food allergies, I suggest introducing eggs, dairy, and fish around 9 months, and even nut butters.  I think that spoon-feeding is fine so long as it is never forced and that you respect your child’s cues. An open mouth meaning “more please” and a turned head meaning, “I am done with that”.  I think that letting your child start with finger foods early is great and having them eat what you eat is wonderful but I would keep the pieces small and soft (think peas and rice) and watch them closely. I also love and support the early introduction of cups (shot glasses work really well) and utensils to encourage independence and confidence as well as fine motor development.

So, Baby-Led Weaning was a good read and has some interesting ideas, but not for everyone and maybe not as simple as the cover would have you believe.

References:

Rapley, Gill, and Tracey Murkett. Baby-led Weaning: The Essential Guide to Introducing Solid Foods and Helping Your Baby to Grow up a Happy and Confident Eater. New York: Experiment, 2010. Print.

AMERICAN ACADEMY OF PEDIATRICS: Policy Statement—Prevention of Choking Among Children COMMITTEE ON INJURY, VIOLENCE, AND POISON PREVENTION Pediatrics .2009-2862

AMERICAN ACADEMY OF PEDIATRICS: Policy Statement: Breastfeeding and the Use of Human Milk SECTION ON BREASTFEEDING Pediatrics 2012; 129:3 e827-e841

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas Frank R. Greer, Scott H. Sicherer, A. Wesley Burks, and and the Committee on Nutrition and Section on Allergy and Immunology Pediatrics January 2008; 121:1 183-191

So, I just finished this book while traveling with my 2 year-old and nearly 7 months pregnant with #2.  I have to say, I really enjoyed it and found it fascinating. American parenting is out of control. I know I am not alone in thinking this.  The fast paced, high pressure, child centered culture is making us all nuts.  Shortly after I had my daughter, I read Judith Warner’s Perfect Madness. I recommended this book to everyone I knew- SAHM and working moms alike. Turns out, most of my friends did not care for it or even finish it.  They told me it was too depressing.  I think that Bringing up Bebe has a much more positive and proactive spin on the same basic concept that our modern parenting culture is taking away from the joy of raising children and doing our children a disservice.

The stereotypes are the thin calm French mother with well-behaved children that respect her and the overweight or anorexic, depressed and anxious American mother who puts her children FIRST and has impatient, rude, picky-eating children who hit her. Of course these are nothing more than stereotypes, but it does sound kind of familiar.

The book highlights what the French do differently and the reasoning behind it based on philosophers like Francoise Dolto and Jean-Jacques Rousseau.

SLEEP:

They do not sleep train or babywise their children, they do not struggle with “crying it out”. They simply PAUSE before they pick their infants up. If the child is making noises, or starting to cry, they wait for a minute to assess what is going on.  Is the child stirring between sleep cycles or cold or truly hungry? I know in the middle of the night all my infant daughter had to do was grimace and I was stuffing my boob into her mouth so that she might nurse and go back to sleep as soon as possible. I did everything in my power to prevent her from crying and getting worked up. In hindsight, maybe I trained her to eat every 2 hours when she might have just fallen back to sleep on her own.

PLAY:

They do not narrate their children’s play. They let them play by themselves. They let them run around the playground, rather than climbing up the equipment behind them. They let the children play with other children and do not stress out about who is sharing and who is not.  They value children who can entertain themselves and give children the chance to learn to play by themselves by not interrupting them when they are engaged in an activity with comments and observations.  They let their children explore and awaken as individuals. They let them try by themselves and they let them fall.

EAT:

They let them get hungry.  In general, French children eat 3 meals a day with one afternoon snack. If they are hungry before then, they are told to wait until the next eating time. Imagine the freedom of not caring around a purse full of snacks and it being acceptable to say, “sorry you are hungry, we will eat lunch at noon”.  The French parents allow their children to have candy and chocolate- but all in moderation and only at certain times of day. You cannot have a cookie when you see one, but you can save it and have it at your snack time.  Sweets are not rewards or given only when you finish your vegetables, they are given just as any other course. If a child refuses a particular food, parents are encouraged not only to keep introducing it as American parents do, but also to vary the cooking style and seasoning.  Children are not forced to eat, but they are strongly encouraged to try everything.  This reminds me of the “the parent chooses the food and the meal time and the child chooses to eat or not eat ” philosophy that many of the parents I know practice.

BEHAVIOR:

The French parents are the authorities in the household and the children understand that. Their world is predictable and coherent which results in confident and content children. There is a focus on being courteous to others- this is less about “please and thank you” as it is saying “hello and good bye” and greeting adults even though it might be uncomfortable for the shy child.  They are very strict about a few things and relaxed about everything else.  For instance, the child can choose her clothes, choose her DVD, but cannot chose her dinner or her bedtime. The parent is ultimately “the one who decides” and the child cannot do “whatever they like”.  The French parents also practice the wide eyes. I laughed reading this, because my mother also raised me with the wide eyes. When we were in public, if I was being sassy, rude, or not behaving, my mother only had to look at me with her “wide eyes” and I knew she meant business. She never had to raise her voice or explain to me what I was doing wrong. The wide eyes meant one thing “I am the boss and I do not approve!” So, its not about time outs or spankings or 123s. It is about the natural hierarchy in the family. It is simply about believing that you as the parent have the authority over your children and once you believe it, your children will as well.

So- long and short- I will certainly be trying “the pause” with my next infant. I will no longer feel guilty about letting my child eat chocolate, as I believe that it has its place in our diet. I have already started practicing my “wide eyes”.  But in reality, it is challenging to apply a counter-culture parenting philosophy in America.  It is hard to explain to your child why they are the only ones without an iPad or portable dvd player at the restaurant.  It is hard to explain to them that it’s not time to eat when every child you see seems to be strolling around with a sippy cup in one hand and a Ziploc of something in the other. At best, after reading this book you can free yourself of the guilt-inducing hyperparenting surrounding you and pick up some fresh ideas about what it means to be a parent.  At worst, you will be berating yourself for not being in skinny jeans and serving your child braised sole for dinner.

The frustrating thing for parents is that the most enjoyable time we can take our children outside in the summer is early in the morning and in the evening- the peak mosquito hours. So- here are a few things you can do to limit those mosquito bites for yourself and your munchkin.

-       dress appropriately: for peak hours try light weight, light colored long sleeves and pants- avoid floral or brightly printed sleeveless shirts and shorts. I’m thinking about a white long sleeved shirt and karate pants for my daughter.

-       For the non-mobile children who will be in a carseat or stroller outside, drape a mosquito net over them and you should be good to go. This is great especially in children under 2 months that you will not be able to use bug spray on.

-       Spray them a little, not a lot. See below about which spray to chose but for all of them- spray on top of clothes and exposed skin (not under clothes), do not spray on the face or hands of kids but rather spray it on your hands and gently rub it on their face and the tops of their hands and wrists.

-       If you are also going to be applying sunscreen- apply the sunscreen first and avoid combo sunscreen/insecticide products.

-       Keep your outdoor space clean. Drain all standing water and keep grass short to minimize mosquito breeding grounds.

-       After playing outside its time for a bath or shower to get the bug spray off and throw the clothes in the laundry.  Use fragrance free soap and detergent to make your children smell less desirable to the mosquitoes.

WHICH BUG SPRAY TO CHOSE:

DEET has been around since the 50s and is the most well studied and researched repellant. It is extraordinarily effective and has been approved for use in children above two months old by the American Academy of Pediatrics and the Centers for Disease Control. DEET is available in multiple concentrations. You can select any concentration 30% or below for children based on how long you will be outside. You only want to apply this once per day- so make sure you are using a high enough concentration that you will not have to reapply. DEET toxicity is associated with inappropriate use of the insecticide by over application or ingestion or chronic use. You can prevent accidental ingestions or over applications by keeping the bug spray in a locked cabinet and not allowing children to apply it themselves.

Picardin is another popular, well studied repellant in popular products like Avon’s “Skin so soft”. It has been widely popular in Europe and Australia and recently in the United States. The American Academy of Pediatrics recommends 5-10% concentration applied once daily to children above 6 months.

Oil of lemon eucalyptus (OLE) and PMD (the synthetic version) appear to be effective but are not well studied and the EPA does not recommend their use in children under three.

On the use of essential oils: there are some recipes for homemade insect repellants but most are not recommended in children less than 5 years old which is not very helpful because most parents are looking for a natural alternative to the chemical bug sprays in their young children and infants as well. My only problem with essential oils is that they actually can be very dangerous in their own right and they are not regulated by any agency. They are “natural” but have also been concentrated and suspended in an oil that can be toxic if ingested. So, I would not consider all of these oils as “natural and therefore safe” around my child.

I think I will purchase a DEET or Picardin containing bug spray for my family and just use a few sprays when I see mosquitoes but not necessarily using it everyday and every time we go outside. But I will make an effort to minimize our skin exposure from dusk to dawn when we are outside.

What about those fancy mosquito misting systems? The majority use permethrin (the synthetic version of pyrethrum- a chrysanthemum extract) or pyrethrum itself. As opposed to the above ingredients which are mosquito repellants, this ingredient is a pesticide that kills mosquitos and unfortunately some other “helpful” bugs like ladybugs. If you are going to use one of these systems you need to be aware that you cannot be outside while the misting system is in use. The EPA has considered these probably safe with the disclaimer that no pesticide is 100% safe. Personally, I would prefer to steer clear of pesticides, naturally derived or not, and keep my good bugs in the yard. (And save the money for the numerous shaved ices I will be buying this summer!)

This was lengthy but I hope helpful!

Beyond the Sling: A Real-Life Guide to Raising Confident, Loving Children the Attachment Parenting Way by Mayim Bialik

Full disclosure, I have always liked Mayim Bialik. I cried my eyes out watching Beaches as a little girl and never missed an episode of Blossom. So naturally, when her book about attachment parenting (AP) came out, I was psyched. Now, while AP has always resonated with me, I can tell you that I am not an AP mother. I wanted to be and had a natural birth, breastfed and wore my baby until she would not sleep anywhere but snug between my boobs in the Moby. But I went back to work, sleep trained, and eventually weaned my little munchkin because I wanted to get out of town and not take a breast pump or my sweet little girl with me. Blossom (I simply cannot think of her by any other name) is a true AP die-hard. We are talking family bed, elimination communication, no date nights, breastfeeding for years, etc. Blossom brings her PhD in neuroscience to the table as well as her personal experience mothering two children. Her writing style is more endearing than preachy and the book flowed nicely. I think that people who are already leaning towards AP will appreciate this real life description of living as an AP family. AP is certainly a departure from “traditional” parenting in America. It’s nice to have a personal account from a well-educated mother with a sense of humor. Her children are still young, and so it will be interesting for her to do a follow up book when they are teenagers or adults. Overall, I enjoyed the book and found that it made me appreciate and enjoy the 4 am pitter-patter down the hallway when my daughter comes to get in bed with us rather than worrying about setting up bad sleep patterns.

Probiotics are foods or supplements that contain living microorganisms that cause changes in your intestinal bacteria population. Prebiotics are foods or supplements that contain a nondigestible ingredient that stimulates the function or growth of naturally occurring probiotics.

What are some examples?

Breastmilk contains prebiotics and possibly some probiotics.

Live active culture yogurt contains both prebiotics and probiotics.

Of course, they can both be added to different foods, infant formulas, and available separately as supplements.

What is everyone so excited about?

There is a lot of exciting research regarding probiotics and prebiotics. There have been claims of probiotics preventing and treating everything from atopic dermatitis (eczema) to cancer. As a pediatrician, the research regarding the prevention of necrotizing entercolitis in premature babies is the most exciting. The most well studied area for general purposes is in the treatment and prevention of diarrhea. Research has shown that probiotics can shorten the duration of an acute gastroenteritis but not prevent it all together.

Do I need to be giving them to my kids?

With any new health food craze or supplement, especially in regards to children, it is important to keep a level head and do your research. I always try to remind families that just as they are cautious about antibiotics and over the counter medications, so should they be about the tempting vitamin and supplement aisles of Whole Foods.

So- what is the bottom line?

As always- breastfeed! Just kidding. But seriously, if you are breastfeeding your child, you can check this off your list.  If you have a healthy infant, you can use the infant formulas that have added prebiotics and probiotics if you feel inclined. There is not enough research to say that it is beneficial but enough to prove that it is safe and reasonable. Also, when your child gets sick with the stomach bug- you can reduce the length of their diarrhea by a day or so by supplementing with probiotics. In children with chronic medical illnesses or that have compromised immune systems, I would recommend avoiding any probiotic/prebiotic supplements. There have been reports and cases of the microorganisms in the supplement leading to infection and illness in these fragile children.

In a word, keep it natural. Breastfeed your baby and feed them yogurt when they are old enough. End of story.

A stethoscope

Otoscope and Ophthalmoscope for looking in eyes and ears

Thermometer

Blood pressure cuff

Pulse oximeter (to measure oxygen saturations)

Glucometer (to measure blood glucose level)

Tongue depressors

Measuring tape

Supplies for obtaining blood and urine samples

Sharps biohazard container

Band-aids

Alcohol swabs

Epi-pen

Buzzy, cold spray and emla for pain relief with injections and blood draws

Rapid strep test, urine dip sticks

silver nitrate sticks ( for newborn belly buttons )

a vision chart

1.  Limit the time and frequency of baths- but wait, you might be saying “but my child loves her bath!”- I hear you, so does mine. You can let them play in the water- just use soap sparingly and only when needed and be sure to rinse it well. Try to keep your child from sitting in a soapy bath for more than ten minutes

2. After the bath- get that moisturizer on fast! Your moisturizer will work more effectively if applied to skin fresh from a bath. If you were using lotion in the summer, amp it up to a cream or ointment for the winter. I like Aquaphor for the face and dry spots and Aveeno eczema therapy cream for the rest of the body.

3.  Consider using a cool mist humidifier- this will help combat the drying effects of the heater in your home and help out those stuffy noses!

4. Consider a dietary supplement- We all know that omega-3s are important for healthy skin- but since it is the rare toddler that is eating flax seed encrusted salmon sticks- consider adding a supplement. If you are breastfeeding, you can take extra omega-3s yourself and pass it along through your breast milk. If you are not, add one teaspoon of flax oil daily to your babies bottle of formula. Toddlers can take one tablespoon of flax oil daily-try sneaking it in their yogurt.

5. Stay Hydrated- always, right?  Try to teach your baby the sign for water early on- so that they can communicate with you when they are thirsty before they have the words to express it. Start giving your baby water regularly when you start feeding them solids and always have water available.