Posts Tagged ‘ M.D. ’

A Ban on Swaddling?

Monday, March 11th, 2013

This is a guest post from pediatrician and Parents advisor Harvey Karp, M.D.—whom parents know as the creator of The Happiest Baby on the Block book and DVD. Dr. Karp wanted to weigh in on the controversy surrounding swaddling and share his insights on the topic. As the author of The Happiest Baby Guide to Sleep, he’s passionate about the role proper swaddling can play in getting babies to sleep.

Some baby-care ideas are totally 21st century, like using a CD of special white noise—all night—to boost a baby’s sleep throughout the first year. Some practices, on the other hand, are totally old school, like swaddling.

Baby wrapping is ancient and was super popular until the 1800s when American moms began abandoning it en masse. Some stopped it because they felt it was passé, while other moms bought into the spreading new belief that wrapping deprived new babies of their freedom.

Then, in 2002, parents began to take a new look at this old technique (thanks in no small part to the swaddle advice in my The Happiest Baby DVD/book). This came on the heels of renewed interest in other ancient, but neglected, traditions, like yoga, meditation and breastfeeding. These time-honored health traditions surged in popularity… because they work!

Likewise, swaddling made a huge comeback propelled by the great success parents had with it and the multiple studies finding it effective at reducing crying and boosting baby sleep. Today, swaddling is recommended in most parenting books and the American Academy of Pediatrics’ (AAP) website. Swaddle blankets have even become one of America’s top baby shower gifts.

But, unexpectedly, all of that is being put in jeopardy by a dramatic—and unscientific—new day care regulation being pushed by the National Resource Center for Health and Safety in Child Care and Early Education, in Aurora, Colorado.

In 2011, the group decided swaddling (even in gossamer thin blankets) was unnecessary and risky and should not be used after a couple of weeks or months. They said swaddling might hurt a baby’s hips—but while there has been a connection between improper swaddling and hip dysplasia (with legs wrapped tightly while straight), it’s safe when swaddling allows legs to bend up and out at the hips. The group also said that swaddling might overheat a baby (no study shows overheating from swaddling, unless the head is covered or the room is hot), or might cause SIDS if loose blankets wrap around the baby’s face (studies show that only loose bulky bedding—like comforters—are a SIDS risk, not light muslin ones).

The NRC’s work is usually quite good, but this time they went way out on a limb…without the science to support them. And now, many state governments (including Minnesota, Pennsylvania, and Texas) have taken these unfounded recommendations and turned them into ridiculous – even dangerous – new regulations that literally ban swaddling in day care settings.

While it is true that the AAP warns parents not to put loose or bulky bedding in a baby’s crib, they never said that correct swaddling is unsafe. In fact, a new AAP review praises snug wrapping: “Swaddling, when done correctly, can be an effective technique to help calm infants and promote sleep.” The AAP believes that more studies may even show swaddling to be a useful way to reduce SIDS.

We doctors are very concerned about SIDS. Crib death plummeted 50 percent after we started implementing the Back to Sleep campaign in the mid-1990s, but rates have not dropped in over a decade (2000 deaths/yr). And, even more upsetting, is the fact that infant suffocation is up 400 percent over the past 15 years!

Why so many sleep deaths? Because babies don’t sleep well on the back. (Did you know that babies sleep so much better on the stomach that, before 1992, parents were told never to let the baby sleep… on the back?!) Today, leading SIDS experts recommend correct swaddling to prevent fussy babies from accidentally rolling to the stomach or exhausted parents from using unsafe sleep practices (stomach position or bedsharing) in a desperate bid to get more sleep.

(The wisdom of this advice is supported by a recent study which found that moms who swaddle are about twice as likely to put their baby down in the safer back position.)

And, besides reducing SIDS risk, safe swaddling may also prevent the other serious problems triggered by infant crying and parental exhaustion, like postpartum depression, breastfeeding failure, child abuse, overuse of medication, trouble losing your pregnancy weight; and even the burden on companies from the reduced productivity and increased health care costs of exhausted new parent employees.

Swaddle bans are shortsighted and wrongheaded. They will confuse parents and may well lead to more infant crying… more parent exhaustion… and more serious complications and deaths.

If you are unhappy with the swaddle ban at your daycare, take action! Make a petition asking to return the right to you to decide whether or not your baby can be swaddled, circulate it to other parents in your center, and send it to your state’s governor. (And, please let me know when you do it! Twitter: @drharveykarp).

Check out the proper way to swaddle in this video.

Image: Baby via Shutterstock

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Drown-Proof Your Child

Tuesday, July 10th, 2012

Last summer, one of our advisors, pediatrician Ari Brown, M.D., shared a very sad story with us: One of her patients, 4-year-old Colin, had drowned a few years earlier in a community pool in their hometown of Austin, Texas–with family and friends all around. Colin’s parents have since founded Colin’s Hope, a nonprofit dedicated to raising awareness about water safety and drowning prevention, and their work has provided swim lessons for children who need but can’t afford them, and educates the public about what it takes to prevent drowning.

Dr. Brown wrote about Colin, the organization, and everything we as parents should be doing to keep our children safe around the water in our August issue. Just as the issue arrived in our offices, tragedy struck a family in the town next to mine: Two brothers, ages 3 and 5, left their house, climbed their next-door-neighbor’s fence, and drowned in the neighbor’s pool.

This makes me think about a product called Safety Turtle. It’s a wristband (with a turtle’s face) that a young child wears whenever he’s not supposed to be around water. You have to lock it on your child (literally, with a key) so that it can’t come off. Should the wristband become immersed in water, an alarm on the wireless base unit sounds, and doesn’t stop until you reset it. Dr. Brown asked Jan Emler, the founder of a swim school in Austin, for her thoughts on a product like Safety Turtle. She said, “Since the majority of preschool drowning deaths occur in backyard pools, we are in favor of an alarm system that stays with the child. As long as supervising adults make certain the child is wearing the wristband and properly power the base station, this alarm system can be an effective weapon in the arsenal used to fight childhood drowning. It’s one more layer of protection–along with uninterrupted adult, visual supervision; formal swim lessons; and four-sided fencing.” Safety Turtle works best in fresh water, but there are ways to use it in salt water, explained here.

I can’t help but think of those two little boys, whose lives could have been saved if they’d been wearing something like this.

Safety Turtle, $280.

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Here Comes the Sun

Monday, May 14th, 2012

Now that it feels like spring is really here (today’s yucky weather in NYC aside), it’s time to start talking about sun safety. In our June issue, we have a whole feature where we answer your most common sunscreen questions.

It’s important to remember that another smart way to protect our skin is to seek shade. Mona Gohara, M.D., a dermatologist, mom of two, and member of the Women’s Dermatologic Society, participated in a cool program last week called Play Safe in the Sun. She and her fellow WDS members “sunproofed” the Grace Church School in New York City by creating a safe, sun-shielded, shaded area in the playground, by integrating sun safety into the school’s curriculum, and by doing free skin checks on school families. (That’s Dr. Gohara in yellow, at the ribbon-cutting ceremony for the shade structure at the school, with all the hat-wearing students who’d be benefiting from it!) She shares these tips to help keep your family safe in the sun:

1. Go Green  Plant little trees with your family to add more shade in your backyard, this will help Mother Earth and your skin all in one shot! For those living in a city, choose a different tree to play under with each visit to a park, then go home and learn about it- a great way to promote environmental awareness!  Remember, children who play in the sun between 10 am and 4 pm are at a higher risk for skin cancer later in life.

2. Special Thoughts for Special Spots Use a SPF stick for your child’s eyelids (to avoid product running into the eyes) and lips. In general, remember to reapply a broad spectrum SPF 30 or higher every 2 hours when outdoors or after excessive swimming/sweating.

3. Don’t Slip During That Trip Ultraviolet light easily shines through car windows (and home windows, for that matter!) so make sure to place UV-blocking shields on windows your children are exposed to. This will help them avoid passive, intense sun exposure that can lead to skin cancer later in life.

4. Channel Your Inner Politician: After teaching your older kids about the dangers of indoor tanning, think about ways to contact local politicians, or sign petitions to restrict tanning bed use. As of January 2012, kids under the age of 18 have been banned from indoor tanning in California, and New York State is requiring in-person signed parental consent for would-be tanners between the ages of 14 and 18. Raise public awareness together and save lives.

And here are more important tips from her fellow WDS members:

“Grandmothers can set a good example by providing cute sun protective hats and making a ritual of applying sunscreen before going out.”  —Janet Hickman, M.D., WDS President, retired Virginia dermatologist, mother of three sons and two young granddaughters

Chemical-free sunscreens are great to use on children’s faces to prevent burning eyes that often occur with more traditional chemical sunscreens.”  —Lauren C. Hughey, M.D., associate professor of dermatology, University of Alabama at Birmingham and mother of three young children

When protecting your family, be sure to protect with sunscreen these frequently missed spots: ears, behind the neck, tops of hands, wrists, feet and toes.”  —Latanya Benjamin, M.D., F.A.A.D., F.A.A.P., clinical assistant professor of dermatology and pediatrics, interim director and service chief, pediatric dermatology, Stanford University School of Medicine, Lucile Packard Children’s Hospital

“Once a month go on an outing and buy a different type of SPF…when you have that family outdoors activity you can share your favorite picks. SPF comes in liquid, spray, solid stick, lip balm and makeup so there is something for every member of the family.”—Wendy E. Roberts, M.D., F.A.A.D., Rancho Mirage, California, generational and cosmetic dermatologist

WDS holds free skin cancer screenings all over the country; click here to see if there’s one near you.

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A Crazy Chickenpox Story

Monday, November 7th, 2011

Have you heard about the moms who are going online to buy lollipops that have supposedly been coated with the saliva of kids with chickenpox… and then having their own children suck on them? (You can see some of these parents in a news report here.) They’re doing it in hopes of infecting their little ones and obtaining “natural immunity” from the virus. They’re avoiding the varicella vaccine, which some parents believe is more dangerous than having chickenpox itself. As a mom who physically recoils when I see one of my children’s friends so much as cough near our toys, this is completely beyond my comprehension. Even if it was smart to expose your child to the virus this way (which it’s not) and even this method was effective (very unlikely), what on earth else might be on that lollipop that you’re serving up to your child? I’m shuddering.

I asked one of our advisors for her opinion. Wendy Sue Swanson, M.D., is a pediatrician who has two young sons (and a fantastic blog called Seattle Mama Doc). “There’s nice data on how effective the vaccine is. But as pediatricians, we’re losing parents when explaining the benefits of the vaccine,” Dr. Swanson says. It’s not that your child can’t get chickenpox if he’s vaccinated, she explains: “But the illness will be much less severe and the likelihood of infecting other children is essentially zero. We’re giving the shot to prevent the serious, life-threatening complications that can come along with the virus, such as a brain infection or flesh-eating bacteria in the sores. We can’t tell which kids will have a run-of-the-mill, mild version of chickenpox, and which will go on to have the deadly secondary infections.” Dr. Swanson’s bottom line? “I gave this vaccine to my children without hesitation, as recommended by my pediatrician.”

If you’re still not convinced, talk to your own doctor.

Image: Lollypops isolated on white, via Shutterstock.

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The (Strict) New Safe-Sleeping Guidelines

Tuesday, October 18th, 2011

If you have a baby younger than 1 year of age, chances are that he or she is sleeping in a way that goes against the latest recommendations from the American Academy of Pediatrics (AAP). At the AAP’s national conference in Boston, which wraps up today, the Academy released their revised policy statement on safe sleeping and SIDS prevention.

Until babies are 1 year old, they should:

Be put to sleep on their back. Always, always, always. At some point, your baby will be able to roll from her back to her front and from her front to her back—and at that point, you can leave her in whatever position she ends up.

Sleep in the same room as—but not the same bed as—their parents. To keep a baby in your room until age 1 may seem… let’s say… difficult, but “these recommendations are most important in the first few months,” says pediatrician Rachel Moon, M.D, lead author of the new guidelines and chair of the AAP SIDS task force. Bedsharing is not recommended at any age, even if you’re using an actual cosleeping device that attaches to the side of your bed. “No bedsharing can be classified as safe,” says Dr. Moon, who adds that babies under 3 months are at a “very, very high risk” of suffocation.

Use a pacifier as often as possible. Pacifiers are associated with a decreased risk of SIDS, perhaps because it may position the tongue in a way that helps keep the airways open, Dr. Moon says. Pacifiers also tend to arouse babies as they sleep (I’ll say! Who else has experienced that sinking feeling every time their newborn’s pacifier popped out of her mouth and woke her up?!), and when babies are able to be easily woken, their risk of SIDS goes down.

Be breastfed. Lots of research backs up the positive connection between nursing and SIDS risk reduction.

Be fully immunized. There may be a protective effect here, too; evidence points to a 50 percent decrease in the risk of SIDS.

Not have anything in their cribs (or bassinets or Pack & Plays) except a tight-fitting sheet. No bumpers—not even the mesh kind. (Chicago now bans the sale of bumpers.) No stuffed animals. No pillows. No blankets. Nothing between the mattress and the sheet to make the surface softer. (“Soft does not equal safe,” says Dr. Moon. “Soft is bad.”) No elevating the head of the crib mattress by propping pillows underneath it, either, because babies can slide down to the bottom of the crib and end up in a position that obstructs their airway, or get wedged between the mattress and the side of the crib.

Not sleep in a car seat, stroller, swing, or sling for more than 60-90 minutes, and even then only under close supervision. Nothing but a crib, bassinet, or Pack & Play is recommended for extended periods of sleep. If your baby falls asleep in one of those other places, Dr. Moon recommends moving him as soon as is practical. Otherwise, they run the risk of sliding or slumping down and boosting the chance of suffocation.

Not sleep with the help of any products marketed as reducing the risk of SIDS. This goes for wedges, positioners, and home apnea monitors. “Parents believe that if a product is sold, it must be safe. They don’t always understand that these items don’t have to be tested or proven to work in order to be in stores,” says Dr. Moon.

She made an important point about why some parents don’t follow safe sleep recommendations. “Everybody thinks their baby is the exception to the rule,” she explains. “They’ll say ‘My baby has reflux.’ ‘My baby was premature.’ ‘My baby’s not a good sleeper.’” But she sees more than her share of infant deaths—at least one per month in her hometown of Washington, D.C. “We have to get the message out.”



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Ask Your Baby Skincare Questions Tomorrow!

Wednesday, June 29th, 2011

ss_FAN2012898Yesterday my sister asked me what she should tell a friend who’s looking for a good sunscreen for her 8-month-old son. I gave her a few recommendations, but also suggested that her friend go to our Facebook page tomorrow–that’s when we’ll be hosting a live chat with dermatologist and mom Mona Gohara, M.D. From 12:15 p.m. EST to 1:45 p.m. EST, you can ask anything you want to know about protecting your child from the sun, just in time for the holiday weekend. Sun safety is one of Dr. Gohara’s passions; she created K&J Sunprotective Clothing, a line of cool t-shirts for babies and children that have a UPF rating of 50+. This means that only 1/50th of the sun’s ultraviolet rays will get through. (Most regular cotton shirts have a UPF rating of  5 or 10.)

So mark your calendars for tomorrow at 12:15 p.m. EST. Dr. Gohara will be standing by!

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The Jenny McCarthy Effect

Monday, November 8th, 2010

imagesIn 2009, the number of kids in commercial health plans who were vaccinated dropped almost four percentage points. This finding comes from the National Committee for Quality Assurance (NCQA), a nonprofit dedicated to improving healthcare quality. One reason for the decrease, suggests NCQA, is what some call the Jenny McCarthy effect: the unproven theories connecting vaccines to autism, put out loudly by celebrities like Jenny. “The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” says NCQA president Margaret O’Kane.

This finding made me think about a talk I heard at the American Academy of Pediatrics conference last month. Paul Offit, M.D., chief of the division of infectious diseases and the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, was talking to a packed room of doctors about vaccine exemptions. He said that when growing numbers of parents choose not to immunize their children because of religious or other non-medical reasons, there’s one nearly guaranteed outcome: Unwanted diseases start coming back. He gave several examples of recent outbreaks, including measles, mumps, and Hib (which is the leading cause of bacterial meningitis). They’ve all cropped up in communities where parents have chosen not to vaccinate their children.

Dr. Offit also took “alternative vaccine schedules” to task, citing the unfortunate popularity of Dr. Bob Sears’ suggestion that parents delay several vaccines. Waiting to give your child certain vaccines may sound reasonable enough, but the end result can be as dangerous as if you don’t immunize your child at all. “At the very least, they will increase the time during which children are susceptible to vaccine-preventable diseases,” Dr. Offit has written. “If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases.” In person, he was a little more emotional, describing the rigorous science behind the Centers for Disease Control and Preventions recommended schedule as well as that of the AAP’s and contrasting that to Dr. Sears’. If it weren’t so scary, he said, “It would be funny: You’ve got the CDC, the AAP, and ‘Dr. Bob’s Schedule.’ You’ve got to admire the hubris.”

We at Parents really do understand how confusing the issue of vaccines can be. Our most recent story addresses parents’ most pressing concerns and gets to the truth behind them.

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Sure Shot

Tuesday, April 27th, 2010

This is National Infant Immunization Week, commemorated by the Centers for Disease Control and Prevention to stress the importance of vaccinations. This year there’s a new component: the Protect Tomorrow campaign. The point of this campaign, launched by the American Academy of Pediatrics, is to remind parents of the diseases that once wreaked so much havoc in the lives of children—ones like mumps, measles, and diphtheria—which are all nearly eradicated, but could easily resurface in a big way if we don’t immunize our kids.

One of our advisors, pediatrician Alanna Levine, M.D., is a big supporter of Protect Tomorrow. “I feel especially connected to this project because my father suffered from polio as a child,” she told us. “His story of being 13 years old and sitting in a glass cubicle, watching the man next to him die, has had a huge impact on me, and I hope it will do the same for parents who have concerns about vaccinating their own children.”

We at Parents stay on top of the research on vaccines. We understand the fears mothers and fathers have. And we realize that all of the conflicting advice out there can be unnerving. But ultimately, we emphasize that all approved vaccines are safe for healthy children. To this end, we’re running a story in our May issue called “Vaccines: Getting to the Point.” It’s a thoroughly reported examination of the theories and myths that still abound on the topic, and it may put to rest a few of your own.

Photo via.

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