Warnings for Sharing Mother's Milk

After the birth of her daughter five years ago, Cynthia Li, of Berkeley, Calif., was diagnosed with a severe thyroid condition and was unable to breast feed.

Knowing the benefits of human milk, Li didn’t want to use formula and lamented her situation to a friend. The friend offered to send out a mass email on Li’s behalf asking like-minded moms to donate their extra breast milk.

"I didn’t even know people did that sort of thing," Li said.

Within one day, she received 20 calls. She accepted a water cooler full of breast milk from a woman whose daughter was the same age as Li’s daughter, Rosa.

It may sound unusual, but sharing breast milk is a growing trend, from online trafficking to grass-roots organizations such as Eats on Feets to informal arrangements such as Li’s. It also has a long history, from wet nurses — lactating women for hire — to co-nursing among relatives, particularly in ethnic families.

However, following recent warnings from the Food and Drug Administration and the Surgeon General about the potential risks associated with donor breast milk, experts say that using an accredited milk bank — where donors are screened and expressed milk is processed in a lab — is the best way to provide human milk to a baby who cannot get it from mom.

The Mothers’ Milk Bank of San Jose, one of 10 banks accredited by the Human Milk Banking Association of North America, distributed 420,000 ounces of breast milk last year, a 25 percent increase from the previous year, Executive Director Pauline Sakamoto said. The nonprofit bank is state licensed and the first to receive endorsement from the Food and Drug Administration.

However, there is not an endless supply of breast milk. Half of the bank’s milk goes to hospitalized preemies, whose weak intestinal tracts have trouble digesting formula and need the natural growth hormones in human milk; the other half goes to babies younger than 1 year of age with a prescription from a pediatrician. Typically, they are allergic to formula or mom is unable to nurse because of an illness or other reason.

With the $3-an-ounce price tag, it is not an option for many families.

Experts think the antibodies and white blood cells in human milk are beneficial to growing babies. Breast-fed babies also are at a reduced risk for infections, digestive issues and chronic illnesses. For those reasons, some women are resorting to eBay or Craigslist, where, on March 21, a "healthy, 22-year-old mother" in Alameda listed her excess breast milk for $2 an ounce.

Other women turn to their communities, relying on good instincts to make informed decisions.

The woman that Li received her milk from was in good health and offered her medical records, but Li said she didn’t need to see them.

"As a mother of a newborn, there is a trust," she said. "She wouldn’t give me anything at risk because she was giving it to her own baby."

Since November, Wilma Ruth Torres, of Fremont, Calif., has donated more than 1,000 ounces of her breast milk to Mothers’ Milk Bank. Pumping is time consuming, she said, but well worth it knowing the milk is going to help sick babies.

"That’s why I do it," said Torres, who has an excess of milk from nursing her 9-month-old son, Samuel. "You can be a blood donor your whole life, but this is something special you can do for a short time."

In her work as a midwife, Shell Walker has helped facilitate casual milk sharing for more than 20 years. Now she does it through her Facebook-based nonprofit, Eats on Feets. The group is free and recommends that moms obtain the same donor screenings as the milk banks.

The organization also encourages mothers to make informed decisions about safe handling and home pasteurization.

"We’re just a place for moms to post a need or abundance in their area," said Walker, who manages Eats on Feets Facebook pages in 35 cities.

Still, health professionals and other nursing advocates, including La Leche League International, caution against casual milk sharing because of potential risks to the baby, such as infection, bottle contamination, and the reality that some viruses and diseases are asymptomatic, said Diana Mahar, a pediatrician at Kaiser Permanente Pinole and a breast-feeding spokeswoman for the American Academy of Pediatrics.

"It’s not a decision you should take lightly," she said. "Even if you think you know someone, you can’t be certain about their lifestyle and the medications in their breast milk let alone illicit drugs, alcohol, tobacco, herbal remedies, or the environmental contaminants they’re exposed to at their jobs. Personally, I wouldn’t do it."

Safety aside, some people find the mere idea of milk sharing unsavory.

That’s what happened to Shannon Leckey, of Walnut Creek, Calif. She had a great deal of trouble producing enough milk to feed her son when he was an infant.

Her cousin happened to be nursing at the time and had an abundant supply of breast milk — liquid gold, in Leckey’s eyes — stored in her freezer, which she offered after a routine blood test to rule out any risks.

Leckey’s husband, however, was not on board.

"He could not get over the ick factor and flat out refused to feed our son anyone else’s milk," she said.

The concept, however, is ancient. According to Mahar, before the availability of artificial milk, if a mother was not able to nurse her infant, having a family member or other woman to nurse the baby was lifesaving.

"There were also many places around the world where wealthy women would use wet nurses because it was a sign of wealth and class and, in some cases, because it would allow them to get pregnant again sooner," she said.

Wet nurses fell out of fashion at the turn of the 20th century because of the availability of formula, the increased awareness of disease transmission, and a cultural shift that placed prime importance on a mother caring for and bonding with her own infant, Mahar said.

In an age of antibacterial hand sanitizers, Mahar said that the modern ick factor may stem from our fear of germs. For instance, she said, we don’t cringe at the idea of blood transfusions that come in a sterile bag or vial.

Perhaps in the same way, milk from a milk bank may reduce some people’s trepidation. Donors are put through rigorous screenings. They must be nonsmokers in good health whose blood tests are negative for herpes, HIV and syphilis, Sakamoto said. Their milk arrives to the bank frozen and is thawed, heat-pasteurized to eliminate bacteria, lab tested, frozen and stored before shipment.

That process put Stephanie Lovell-Rose, of El Cerrito, Calif., at ease when it came time to feed her premature twins. Allison and Sophia were born eight weeks early and weighed 3 and 4 pounds, respectively. They needed to be tube-fed for a month. Lovell-Rose’s insurance covered the hospital-grade donor milk; once she brought the babies home, however, the $72 a day was her responsibility.

"It is so worth it; they are really thriving," Lovell-Rose said of her daughters, who are now five months old and weigh about 13 pounds each.

"They’re a long way from the little preemies we brought home."

Laura Lyons, of Oakland, Calif., is paying an equally hefty price to supplement the organic formula that sustains her adopted son, Will. He was born seven weeks early this past April and had an intestinal disorder. Lyons said they desperately needed breast milk for his condition, and she didn’t feel comfortable taking hormones to try to produce it.

Mothers’ Milk Bank provided the solution her baby needed, and for that, she is eternally grateful.

"I don’t know if they (women who donate) are even aware of what a gift this is," she said, through tears. "It makes me emotional just thinking about it."

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Breastfeeding Programs an Infant's Metabolism

Breastfeeding is universally recommended as the superior method for feeding infants because it's linked to long-term prevention of various illnesses including asthma, diabetes and obesity. A study released Monday puts more emphasis on breastfeeding by showing it may have a lasting impact on metabolism.

French researchers analyzed three years of data following 234 children and how they were fed after birth. One group of children received only breast milk for the first four months of life. The other two groups were randomized to receive either a low-protein formula or a high-protein formula. Both of the formula types contained protein amounts that are within recommendations.

The study showed that children who received breast milk for the first four months had a specific pattern of growth and metabolic profile that differed from the formula-fed babies. Even at 15 days of life, the breast-fed infants had blood insulin levels that were lower than the formula-fed infants.

By 3 years of age, many of the metabolic and growth differences between the breast-fed and formula-fed infants had disappeared. However, blood pressure readings were higher in the infants who had been fed the high-protein formula compared with breast-fed infants. The blood pressure rates were still within the normal range.

The study suggests that if breast-feeding is not possible, infants should be fed formula that has a metabolic profile as close to human breast milk as possible.

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Breastfeeding Linked to Better Behaviour

Babies who are breastfed for several months develop fewer behavioural problems in early childhood than those who are bottle-fed, researchers have said.

The British study which involved around 10,000 mothers and their babies found that breastfeeding for at least four months lowered the risk of behavioural problems in children aged five by one third.

Researchers say the findings, published in the journal Archives of Disease in Childhood, add to a wealth of existing evidence on the benefits of breastfeeding.

Children raised on bottled milk formula tended to show more signs of anxiety, hyperactivity or lying and stealing, researchers found.

"We're not necessarily talking about tearaway, unmanageable five-year-old kids," said Maria Quigley from Oxford University, who led the research.

"It might be unusual anxiousness, restlessness, inability to socialise with other children or play fully in groups."

Scientists said the results could be explained either by the fatty acids in breast milk which aid brain development or the bonding between mother and child, which may affect learned behaviour.

Researchers from the Universities of Oxford, Essex, York and University College London analyzed data from a survey of 10,037 infants born in the UK between 2000 and 2001, who took part in the the wider Millennium Cohort Study.

Mothers were asked to assess the behaviour of their children by the age of five, giving scores for different behaviours, such as clinginess and restlessness.

Raw figures showed that only six percent of breastfed children were given abnormal scores indicating behavioural problems, compared with 16 percent of formula-fed children.

However, mothers who breastfed tend to be older, better educated and from a higher socio-economic background than those who don't, the study said.

Researchers therefore adjusted the figures to take those factors into account, concluding that there was a 30 percent greater risk of behavioural problems among formula-fed children.

"Our results provide even more evidence for the benefits of breastfeeding," Quigley added.

"Mothers who want to breastfeed should be given all the support they need."

Janet Fyle, from the Royal College of Midwives, agreed that the study backed evidence that breastfeeding is best for babies but warned against victimizing women who choose not to.

"We need to be careful to keep a balance when interpreting the results, so that we do not send a negative message to mothers that they have failed or make them feel guilty because they bottle-fed their babies," she said.

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Stillbirths tied to Secondhand Smoke

Pregnant women who live or work with smokers may be at slightly higher risk of having a stillborn baby, giving birth to a slightly smaller baby or having a baby with a smaller head, according to a Canadian study.

Secondhand smoke is thought to expose people to about one per cent of the smoke that active smokers inhale, and the study adds to evidence that even passive smoking can harm unborn babies.

“This information is important for women, their families and healthcare providers,” wrote Joan Crane, of Eastern Health in St. John’s, Canada, in the BJOB: An International Journal of Obstetrics and Gynaecology.

“Undiluted sidestream smoke contains many harmful chemicals and in greater concentration than cigarette smoke inhaled through a filter.”

Crane and colleagues noted that those chemicals may harm the fetus in a variety of ways — for instance, by restricting blood flow and possibly damaging the placenta.

Using a database of pregnant women from the Canadian provinces of Newfoundland and Labrador, they looked at the rate of stillbirths as well as other birth outcomes, such as head circumference, which has been linked to the later intellectual development of children.

Of nearly 12,000 women in the database, 11 per cent said they had been exposed to secondhand smoke.

The rate of stillbirth, in which the baby dies during the third trimester of pregnancy, was 0.83 per cent in passive smokers and 0.37 per cent in women who didn’t breathe tobacco fumes.

This doesn’t prove that smoke itself was the culprit, yet when researchers accounted for other risk factors — including age and the women’s drinking and drug habits — passive smokers still had three times the odds of stillbirths.

In other words, if smoke is indeed to blame, one extra baby would die in the womb for every 117 women exposed.

“This is huge,” said Hamisu Salihu, an expert on stillbirth at the University of South Florida in Tampa.

“We can now inform patients to secondhand smoke means they can lose their baby.”

That link had not been firmly established until now, Salihu, who was not involved in the study, told Reuters Health.

The Canadian researchers also found that babies born to passive smokers weighed 54 grams, or nearly 2 ounces, less than babies whose mothers lived and worked in smoke-free places.

And their heads were slightly smaller too, measuring 0.24 centimeters (about 0.1 inch) less on average.

Salihu said head circumference has been associated with IQ, although the link is indirect.

“Policy makers should really take this matter seriously. We need to enact laws to protect these babies,” Salihu added.

On a global scale, the most common causes of stillbirth are complications during childbirth, infections during pregnancy such as syphilis, health problems such as high blood pressure or diabetes, fetal growth restriction — in which babies fail to grow at the proper rate — and birth defects.

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Pregnancy Weight Gain

About Pregnancy Weight Gain


Talking to your doctor about your weight gain is important. Try not to worry if you're slightly above or below these weights. Working with your doctor on food intake will get you on track.

Facts About Weight Gain


The American College of Obstetricians and Gynecologists recommends a weight gain of 25 to 35 pounds during pregnancy, for women who are at normal weight when pregnancy occurs.

Women who are underweight should gain 28 to 40 pounds, unless your doctor says differently.
Women who are overweight should gain 15 to 25 pounds, unless your doctor says differently.
Women who are obese should gain 11 to 20 pounds, unless your doctor says differently.

Eating low fat meals will allow you to gain weight correctly for your pregnancy. Putting on weight that is unnecessary is easy to do when eating junk food and foods that are higher in fat.
Eating a well-rounded diet is important. According to the American College of Obstetricians and 
Gynecologists, pregnant women should have 4 servings of milk, 3 to 4 servings of protein (2 to 3 from animal and 1 to 2 from legumes/nuts), 5 servings of fruits and vegetables (2 of Vitamin C, 2 of Vitamin A, and 1 of another), 4 servings of whole grain products, and 2 servings of other.


Weight Distribution


7 ½ pounds is about how much the baby will weigh by the end of pregnancy
1 ½ pounds is how much the placenta weighs
4 pounds is attributed to increased fluid volume
2 pounds is the weight of the uterus
2 pounds is the weight of breast tissue
4 pounds is because of increased blood volume
7 pounds is attributed to maternal stores of nutrients and muscle development
2 pounds for the amniotic fluid

Total: 30 pounds

On a Trimester Basis


First trimester: 1 pound per month
Second trimester: 1/2 a pound per week
Third trimester: 1 pound per week

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Fetal alcohol spectrum disorders (FASDs)

 

Facts about FASDs

Fetal alcohol spectrum

disorders (FASDs) are a 

group of conditions that

can occur in a person

whose mother drank

alcohol during pregnancy. 

These effects can include 

physical problems and 

problems with behavior

and learning. Often, a person

with an FASD has a mix of

these problems.

Cause and Prevention

FASDs are caused by a woman drinking alcohol during pregnancy. There is no known amount of alcohol that is safe to drink while pregnant. There is also no safe time to drink during pregnancy and no safe kind of alcohol to drink while pregnant.

To prevent FASDs, a woman should not drink alcohol while she is pregnant, or even when she might get pregnant. This is because a woman could get pregnant and not know for several weeks or more.  In the United States, half of pregnancies are unplanned.

Signs and Symptoms

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
• Small head size
• Shorter-than-average height
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty paying attention
• Poor memory
• Difficulty in school (especially with math)
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidneys, or bones 

Types of FASDs

Different terms are used to describe FASDs, depending on the type of symptoms.

• Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.
  
  
• Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
  
  
• Alcohol-Related Birth Defects (ARBD):  People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).

Diagnosis

The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.
Diagnosing FAS can be hard because there is no medical test, like a blood test, for it.  And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FAS, doctors look for:

• Abnormal facial features (e.g., smooth ridge between nose and upper lip)
• Lower-than-average height, weight, or both
• Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
• Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Treatment

 FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. 

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches.  No one treatment is right for every child.
Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.
Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential.

Protective factors include:

• Diagnosis before 6 years of age
• Loving, nurturing, and stable home environment during the school years
• Absence of violence
• Involvement in special education and social services
  

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Fatherhood

When You're Expecting

Pregnant women experience a variety of emotions and life changes. But most first-time dads have their own feelings and concerns to deal with, too.


If you feel shocked, panicked, overwhelmed, scared, or like you're just not ready, you're not alone. Like any big change, this will require a major adjustment. And if the pregnancy wasn't planned — half of all pregnancies aren't — you may be feeling these emotions even more intensely.

You don't have to feel guilty or anxious about having mixed emotions; it's completely normal. And you can take steps to get more comfortable with the pregnancy, the idea of parenthood, and the preparations that can make both go as smoothly as possible.
Here are a few concerns that may be bothering you and ways to keep them in perspective:

Will I be capable of caring for a baby?

No one is born knowing this stuff, not even your pregnant partner — that's why there are childbirth classes. Depending on what's available in your area, you can take classes as early as the 12th week of pregnancy or one that focuses just on the day of labor and can be taken as late as the eighth month. And some communities offer classes designed just for first-time dads.

Most classes teach how to change a diaper, hold the baby, feed and burp the baby, put the baby to sleep, install a car seat, and childproof your home. You'll also learn where to park your car when you get to the hospital, how to get through labor, and how to care for your baby and your partner when you get home from the hospital.

Along with the lessons, you'll meet other guys going through the same experience who might be dealing with similar feelings, and that can be a huge help. The nurses and childbirth educators who lead these classes have seen dads in a variety of emotional states, so don't feel embarrassed or hesitant about asking them for help.

Will I be a good dad?

Remember that you're not going to have to tackle every part of fatherhood at once. For the first few years, a lot of the parenting involves skills taught in childbirth classes and mastered through practice.
It's much like other new roles that you might take on in your life. If you're married, you didn't automatically know how to be a good husband. You learned along the way with your wife.

You have plenty of time before you have to set curfews, teach your child to drive, and dole out relationship and career advice. These opportunities to teach your child will feel like a natural progression when they arrive. If you need guidance, check for resources in the community, including parenting classes.
It may help to talk to and spend time with other fathers and discuss issues you may be grappling with. If you feel like you have issues about your own father to work through, try to talk with someone — maybe a counselor or a family member — before the baby arrives so that they don't interfere with your relationship with your own child.

How can we afford this?

Feeding, clothing, and educating another human being is going to cost money that's now spent on other things — there's no question about it. But you can reduce your stress about the finances.
It may help to get a sense of what your costs will be right after the baby is born. Your health insurer, employer, or your partner's employer may be able to give you an idea of the costs and what is covered. Many workplaces now offer some paid paternity leave, so be sure to ask.

Consider meeting with a financial planner to get some money-management guidance. You may also want to talk to other new parents you know to get an idea of how they managed and what unexpected expenses cropped up.

You can open a college fund — or any kind of bank account — any time to save for new expenses. You may want to start putting away a few dollars each week to fund items like childcare and diapers. That way, you'll have a head start on meeting your child's financial needs.

Remember, you won't have to pay for certain expenses. For instance, if your partner decides to breastfeed, you'll save money on the cost of feeding your newborn. Also, many families share maternity and baby clothes because pregnant women and babies wear a particular size of clothes for such a short time.

Is this the end of my independence?

Fatherhood doesn't have to spell the end of fun. True, you may not get much sleep or time for yourself during the first few months until your baby starts sleeping through the night. But when the baby sleeps more, you and your partner will have more time for things you enjoy, together and individually.

Again, it's important to work together, communicate, and trade off on the childcare responsibilities so that you each get what you need. And try to get to know other new parents, who can share their perspectives and offer a sounding board.

In the early years, you can include your little one in many activities — maybe your child can sit with you while you watch a basketball game or read the newspaper or a book. Check out the special baby carriers that let parents take their tots along on walks and hikes.
It's easy to fear losing out on free time, but most moms and dads discover that once their child is born they treasure time spent with their baby.

How will this change our relationship and sex life?

Pregnant women experience huge physical, hormonal, and emotional changes, while also grappling with the same life changes as the dads-to-be. As the pregnancy progresses, it may affect both of you emotionally.
Moodiness can be tough to deal with, no matter what the cause, but your patience and understanding can go a long way. Try to help your partner work through any stress she might be feeling about the pregnancy and parenthood.

If you're not feeling stable or good about your relationship, try to work through the issues as soon as possible. Many couples mistakenly think that a baby will bring them together. But a baby can't fix a troubled relationship — that's the job of you and your partner. And the sooner you find a way to work together, the sooner you'll feel more comfortable with your impending parenthood.

You can enjoy sex during pregnancy as long as the pregnancy is considered low risk for complications of miscarriage or preterm labor. Discuss with your doctor, nurse-midwife, or other health care provider any risks that may be relevant to you and your partner. You don't have to feel embarrassed; they're used to such questions. As with any other aspect of pregnancy, it's important for you and your partner to speak openly about what feels right for each of you.

Of course, just because sex is safe during pregnancy doesn't mean you and your partner will want to have it. Many couples find that their sex drive — and comfort level — fluctuates during the different stages of pregnancy as both get used to all of the changes. Again, keeping the lines of communication open is key.

How am I going to get through labor?

As far as the gross-out factor goes, no rule says you must catch the baby when he or she emerges, cut the umbilical cord, or even be in the delivery room.

In childbirth classes you'll learn about massage and pain-management techniques where you'll stand behind your partner at her head and shoulders while she is pushing. As you learn about this, talk to your partner about what you're each comfortable with.

It's common to fear fainting, but the truth is that few men do. In fact, many men come out of it thinking that there's much less blood in the process than they expected!

Expectant moms, of course, do the hardest work during labor, but dads still play a crucial role. Your partner will need someone to look out for her interests and needs. Long before the due date, it's important to discuss preferences about pain management, medication, and treatment so that you can tell the health care team if your partner is unable to. You'll also be the connection between your partner and your families during the birth.

How can I help my partner?

Your doctor will probably warn you about things that can go wrong, particularly if you and your partner are older. And it's likely that you'll both have various tests and screenings for birth defects and other health problems.

Hearing all of this can be frightening. But you can do many things to help your partner — and your unborn baby — stay healthy during the pregnancy.

If you know other families with newborns and young kids, it may be helpful to spend time with them. If you don't know other new parents, your doctor or local childbirth center might be able to put you in touch with other families in your area.

Try to go with your partner to doctor appointments, where you can ask questions, gather information, hear the baby's heartbeat, and see an image of the baby on a sonogram. You may also want to tour the maternity ward at the hospital or birthing center where you plan to have the baby.

Start preparing your home for the baby by making any needed home improvements or renovations.
Remember that anxiety about pregnancy and parenthood is like anxiety you might feel about anything. Use stress-relief strategies that work for you — perhaps exercise or enjoying movies, books, music, or sports.

Talking About It

Communication can be a challenge for expectant couples. Even before the pregnancy shows, moms-to-be have strong physical reminders that a baby is on the way and life is going to change dramatically. So your partner might want to talk about the pregnancy while you're still adjusting to it.

If you're not ready to talk to her yet, you have other options. You may be more comfortable confiding in friends, relatives, and other new dads, who can offer reassurance and helpful suggestions. Many hospitals and childbirth centers also have professionals who work with new parents and can speak with you confidentially.

Remember that billions of guys before you experienced — and survived — fatherhood. There's no secret handshake and you're not supposed to instinctively know how to be a good dad. Just do your best to prepare for the birth, know that what follows will be on-the-job training, and reach out for the many resources that can help.

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Preparing Your Child for a New Sibling

Preparing Kids

The arrival of a new baby can bring many changes to a family. Parents spend a lot of energy on preparations, and after the baby arrives, much of the family's attention involves meeting the newborn's basic needs.

All this change can be hard for older siblings to handle. It's common for them to feel jealousy toward the newborn and to react to the upheaval by acting out.

But parents can prepare kids for an addition to the family. Discussing the pregnancy in terms that make sense to kids, making some arrangements, and including kids in the care of the newborn can make things easier for everyone.

During Pregnancy

There's not one right time or perfect way to tell a child about an impending sibling. When discussing the pregnancy, consider your own comfort level and your child's maturity level. Preschoolers, for example, may not grasp concepts of time, so it might not mean much if you say that the baby will arrive in a few months. It may be more useful to explain that the baby will arrive in a particular season, such as winter or when it's cold outside.

How much detail should you provide? Let your child's questions be your guide. For example, a 4-year-old child may ask: "Where do babies come from?" Despite how it sounds, the child isn't asking you to explain sex but probably wants to know where, literally, they come from. It may be enough to explain: "The baby comes from the uterus, which is inside the mother's belly." A child who wants to know more will ask.

If your child shows more interest in the baby, these activities can encourage that:

• going through your child's baby pictures
• reading books about childbirth (make sure they're developmentally appropriate)
• visiting friends who have infants
• packing a bag for the hospital
• thinking of potential baby names
• going to the doctor to hear the baby's heartbeat

Also look into sibling birth classes, which many hospitals offer to provide orientation for soon-to-be brothers and sisters. These classes can include lessons on how to hold a baby, explanations of how a baby is born, and opportunities for kids to discuss their feelings about having a new brother or sister.

Planning for Childbirth

As your due date draws near, make arrangements for older kids for the time when you're in the hospital. Discuss these plans so kids know what to expect when the day arrives.

Consider letting your child visit you in the hospital as soon as possible after the baby is born, ideally when no other visitors are around — this helps reinforce the birth as an intimate family event.

Try to keep routines as regular as possible in the days and weeks around the baby's arrival. If you plan to make any room shifts to accommodate the baby, do it a few weeks before your due date. If older kids are approaching a major milestone, like potty training or moving from a crib to a bed, try to make those changes well before your due date or put them off until after the baby has been home for a while.

Bringing the New Baby Home

Once the baby is home, you can help your other kids adjust to the changes. Include them as much as possible in the daily activities involving the baby so that they don't feel left out.

Many kids want to help take care of a new baby. Though that "help" may mean that each task takes longer, it can give an older child a chance to interact with the baby in a positive way. Depending on their age, a big brother or sister may want to fold or fetch diapers, help push the carriage, talk to the baby, or help dress, bathe, or burp the baby.

If your child expresses no interest in the baby, don't be alarmed and don't force it. It can take time.

Some occasions, like breastfeeding, excludes older kids. For these times, try to have toys on hand so that you can feed the baby without being interrupted or worrying about an older child feeling left out.

Try to take advantage of opportunities for one-on-one time with older kids. Spend time together while the baby is sleeping and, if possible, set aside time each day for older kids to get one parent's undivided attention. Knowing that there's special time exclusively for them may help reduce any resentment or anger about the new baby.

Also remind relatives and friends that your older child might want to talk about something other than the new baby.

Dealing With Feelings

With all of the changes that a new baby can bring, some older kids might struggle as they try to adjust.

Encourage older kids to talk about their feelings about the new baby. If a child cannot articulate those feelings, don't be surprised if he or she tests limits or reverts to speaking in baby talk.

If your child acts up, don't bend the rules, but understand what feelings may be motivating that behavior. It could be a sign that your child needs more one-on-one time with you, but make it clear that although his or her feelings are important, they have to be expressed in appropriate ways.

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Labor and Birth with Twins

Giving birth is always amazing. The process for giving birth to twins is doubly amazing. Here are some of the things that a twin mom will need to consider when giving birth to her twins.

Babies Positions

The position of the babies will largely determine how the twins are born - vaginally or by cesarean. About 40% of twins are both head down (vertex) at term, another approximately 30% see the first baby (Twin A) vertex and Twin B breech. Both of these positions are acceptable to consider a vaginal birth.

Other positions of the babies like two breeches, two transverse or Twin A breech and Twin B vertex are usually delivered via cesarean surgery. This is usually known ahead of time with ultrasound technology. However, even twins can change positions late in the game and even into labor. This is particularly true of Twin B after the birth of Twin A.

Vaginal Birth

More than half of twins will be born vaginally. Whether this option is the right one for you and your babies is a discussion that should be discussed with your doctor or midwife. The good news is that even though you have two babies - you only have to labor once!

Once the cervix is open, each baby will have it's own pushing stage (second stage). This means you will have to push twice, but the majority of the time the second twin is born much more easily than the first. This is because the first twin has paved the way, so to speak.

The average time between the birth of the first and second baby is generally about 17 minutes. However, as long as the second baby is doing well (they will still be monitoring this baby), there isn't much need to speed things along. Sometimes during this phase of waiting, you will have an ultrasound to confirm the position of the second twin and your practitioner will decide how it is best to deliver him or her.

Sometimes, the second twin simply comes down head first like Twin A, this is handled in exactly the same manner. If Twin B is breech, your practitioner may decide to allow the baby to deliver breech, to turn the baby externally or internally or even do something called a breech extraction (pulling baby out by the feet).

Cesarean Birth

While having twins does increase the risk of you having a cesarean, fewer than half of twins are born this way. While positioning of your babies will play a large part in the decision as to what type of birth you will have, there are also all of the normal reasons for cesareans. These include, placenta previa, placental abruption, maternal indications like PIH, active herpes, and labor complications like fetal distress, etc.

If you give birth by cesarean prior to labor, the date will most likely be set between 37-40 weeks. If you go into labor prior to the scheduled date, your cesarean will likely happen then. There is no real difference in the surgery or recovery from a cesarean with twins.

Combined Vaginal/Cesarean Birth

This is actually not as common as you might believe. One baby being born vaginally with the second twin being born via cesarean occurs in only about 3-4% of all twin births. Usually this is done for an emergency with Twin B, like a cord prolapse (This is where the cord comes out with or before the baby, thereby cutting off the baby's oxygen supply.), severe malpresentation (like a transverse baby that cannot be moved by internal or external forces), placental abruption (This is where the placenta tears away from the wall of the uterus prematurely.), etc.

Prematurity

More than half of twins will be born prior to 37 weeks. This can also impact how your babies are delivered. Talk to your practitioner about staying healthy and maintaining adequate hydration, rest and nutrition to care for your growing babies and body.

Hospital Concerns

Some hospitals require that all twin mothers give birth in the operating room, even if they have a vaginal birth. You might also ask about the use of epidural anesthesia, as it is also sometimes a requirement, even if there are no medications placed inside the tubing. This allows immediate anesthesia should it become necessary. There may be other concerns you have like rooming-in or breastfeeding two babies. Be sure to talk to your hospital at length about issues you may be concerned about with your babies.

No matter how your twins come into the world, be prepared for a sudden change. Be willing to accept help when offered and take the time to get to know each of your new little bundles.

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Twin Pregnancy

People are very fascinated with twins and other multiples. 

It seems mysterious how one pregnancy can result in more than one baby.

Multiple pregnancies are on the rise in recent years with more and more twins and other types of multiples being born. 

The majority of the reason for this rise is the increased use of fertility drugs.

There are a couple of ways that multiples are conceived:

• Multiple eggs are released or there is more than one ovulation. Both (or more) eggs are fertilized and you have fraternal twins. This can happen with or without fertility drugs.
• One egg is release but splits in two. Identical twins are made. This can happen with or without fertility drugs.
• In cases of IVF, there are usually 3 or more fertilized eggs put back into the uterus. The rationale is that not all of these will implant, though sometimes they do.

Once conceived you have a lot of possibilities on placentas, implantation locations, number of amniotic sacs. For example, you can have two babies, two placentas, and two sacs. You can have two babies one placenta, two sacs. It will be important to know exactly what you are dealing with, particularly when it comes to amniotic sacs.

How Multiples Are Discovered

Many people learn about their multiples at an early ultrasound. Although some critics say that before twelve weeks gestation there is still a high risk of Vanishing Twin Syndrome (VTS), where one baby stops growing and is either absorbed back into the mother's body or is still born when the other twin is born.

Some people find a rapid rate of grow in their uterus which leads some to suspect twins. I will say, for all of you second timers out there, that your bellies will grow faster than with your first pregnancy, so don't automatically assume twins.

Sometimes multiple heart beats are heard, leading your practitioner to believe that there is more than one bundle of joy in your uterus.

Some women find out when they have abnormally high levels on the AFP test that multiples are on the way, since multiple babies would increase the levels of these hormones. It's also sometimes possible to detect multiples with serial hCG levels in early pregnancy. The more babies the faster the rate of rise in the hCG which should nearly double every 48 hours with a singleton.

About 3% of all twin pregnancies are undetected until birth. It is possible to have an ultrasound and not see the other baby, though rare.

Multiple Pregnancy

Being pregnant with multiples is not necessarily a high risk situation, except when dealing with higher order multiples or specific problems. Someone on the bulletin board phrased it as being "high need." I really think that this is a positive shift away from the technical side. Find a practitioner who is experienced with multiples births, but one who will not panic at every corner.

In general you need to increase the amount of protein that you eat. Protein is the building block of every cell in your body and your babies' bodies. It will help you build a good placenta and a strong amniotic sac. A healthful diet will also help fight against infection.

You will probably see your practitioner more frequently towards the end of pregnancy. You may have more testing than most women during pregnancy, but not always. Some of these might include: non-stress testing, more ultrasounds, etc.

Complications

There can be a higher risk for complications. You will be monitored for the normal complications of pregnancy like high blood pressure, and fetal growth. However, twins and other multiples can have higher incidences of things such as Intrauterine Growth Restriction (IUGR), Twin to Twin Transfusion (TTTS), and others. Remember to keep your appointments, watch your diet and do your Fetal Kick Counts.

Multiple Birth

In years past cesarean became popular for multiple births. Now that rate is about 50% for twins, and declining. We've found that vaginal birth is usually very safe for multiples, who frequently need the stimulation 

and rise in hormones levels associated with labor.

Whether or not you will have a vaginal birth will depend on many factors, including the position of the babies, and how the babies tolerate labor.

If your babies are in a position where neither can move, they are said to be locked. These babies will have to be born via cesarean.

Breech babies really depend on the size of the baby and the skill of the practitioner. Usually if baby A (The first baby in the pelvis.) is head down a vaginal birth will be attempted. If Baby B is breech or transverse an internal or external version may be attempted to help facilitate the birth, or that baby may be allowed to be born breech.

Monoamniotic twins will also be born via cesarean, due to the added risk of cord entanglement.

No matter how your twins were conceived, or how they were born, babies are delightful. Parenting multiples has its special challenges, but it also yields special rewards.

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Toy Confusion

Struggling With Too Many Toys

Once children have celebrated a few birthdays and holidays, they may be drowning in a sea of brightly coloured plastic and plush animals. The problem: kids frequently pull out too many things at once and then are unable to focus on any one thing. Cleanup becomes one big dump into a frustrating jumble.

If this is your child, start by restoring some order to the area where toys are played with and put away. These tips may help end toy confusion before the next glut of toys arrives from Santa and generous doting relatives:

• Use plenty of low shelving to display favourite toys and games with parts. Use large bins/boxes for big stuffed animals or larger simple toys. 

• Display collections of things like rocks or seashells in clear plastic jars so they can be enjoyed by the child. 

• Store art supplies like coloured pencils, crayons and markers in separate small bins on the shelves for easy access. Do the same for puzzles and toys with small parts. Label the containers. Self-stick labels work well. 

• Rotate toys if there are too many. After a toy is out of sight for a few weeks, your child may have renewed interest when it reappears. 

• Throw out broken or incomplete toys.

• Encourage your child to sort through and donate good outgrown toys to a younger child or children's charity. If you're having a garage sale, your child may enjoy participating and pocketing the proceeds. 

• Buy fewer and higher quality toys that your child can treasure.

• Teach your kids to put a toy back on the shelf before taking out another for play. 

• Consider a birthday party with donations to a charity of your child's choice instead of presents. Don't force this idea if your child isn't ready.

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Scratching Face

How To Stop Baby From Scratching Their Face

Babies can do all sorts of things without knowing. Sometimes babies will scratch their faces with their tiny nails as they touch their faces and sleep at night. The last thing you want is a baby with a face full of little scratches so it's your job to prevent them from injuring themselves. All you have to do is a take a few precautions.

Instructions

Things you'll need:

1. Swaddler

2. Mittens

3. Nail clippers

4. Medical tape

• Clip your baby's nails with specialized baby clippers. It is often easier to do this when the baby is asleep. Clip the nails weekly so they stay nice and short. Be very careful not to clip them too short though as it will cause your baby discomfort and they may try to bite their fingers and actually end up hurting themselves.

• Put mittens on the baby's hands after cutting their nails. There are several kinds of lightweight cotton mittens that will cover their hands and thus prevent them from being able to scratch themselves.

• Put the baby in a swaddler when putting them down for a nap. The swaddler is meant to mimic the womb and thus holds their hands down at their sides in a tight cloth that wraps all the way around their bodies. It's not only good and comforting for your baby but it also prevents them from touching their faces and scratching themselves.

• Tear off little bits of medical tape and wrap them around the baby's fingertips. This will cover the nails and stop the baby from hurting themselves if they touch their face or body often. Replace the tape daily and make sure to buy hypoallergenic tape that won't irritate the skin.

 

 

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Is your Child Coloring Walls?

The Handwriting  On the Wall Means I found Crayons!!

How to Prevent your Child from Coloring on the Wall:

This will give you the simplest way to stop your child from drawing/glueing/coloring on the walls

Instructions

Things you'll need:

1. Paint

2. Tarp

3. Time

4. Dry Eraser

5. Hard Work

• Go to the area where your child has made a complete mess of the walls and ask them what it would take for them to stop coloring, drawing, or even gluing stuff to the walls.

• Clean, prep the walls by getting rid of all the drawing, coloring and gluing stuff that is on them before you even buy the paint.                                                                 

• Ask them if they paint the walls a certain color that they like if they will then stop doing this.

• Have them go with you when choosing the paint for that room, so that by them choosing the paint that they want that room to be they will stop doing this. Also buy a tarp and anything else that you will need for painting and protecting the items in the room.

• Paint the room, you can use one color or many colors per your child's instructions.

• Once done what you can have your child do it to put up things on the walls via thumb tacks or any other way that they want to put something up.

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Feng Shui Baby Nursery

Feng Shui For Your Nursery: How To Guide.

Decorating your baby's nursery is often one of the most anticipated and enjoyed events during pregnancy. Parents love to come up with unique themes and find that perfect nursery bedding that will help their child have sweet dreams night after night. Although you may be busy exploring fairy tale themes and animal themes for your little ones soon-to-be bedroom, have you given much thought to the layout of the room? Before you decide to just stick the crib here and the changing table there, you may want to consider what feng shui decorating could do for your baby.

What is Feng Shui?
Feng Shui is the 3000-year-old Chinese practice of interior decorating that allows for the open flow of energy in a home, school or office environment. Originating from the Chinese religion and philosophy of Taoism, feng shui, literally "wind water" in Chinese, has traditionally been used when designing a home and arranging space within a home. Feng Shui practitioners believe that, to have a home where prosperity, good luck and success will thrive, space must be arranged accordingly for energy or "chi" to flow freely. In the case of the arrival of a new baby, Feng Shui can be used as an important tool to ground your child in a healthy and flourishing environment.

According to Kathryn Weber, a master Feng Shui practitioner, there are several Feng Shui principles to consider when arranging a baby's nursery. These principles are the location of the baby's bedroom within the house and furniture arrangement as well as the color and movement in the bedroom.

Location of Bedroom
There are a few no-no's when it comes to the placement of your baby's nursery. A baby should never be placed over a garage or empty space in a house. Likewise, a baby nursery shouldn't be somewhere that a baby will be disturbed by excessive noise. Ideally, a baby boy should be placed in a nursery located in the east and north parts of the house while a baby girl should be placed in the south, southeast or west parts of the home.

Furniture Arrangement
As for furniture arrangement, crib or bed placement is an essential factor to consider in a baby's room. The crib should not be placed along a wall that is shared with a bathroom or storage room because this will adversely affect the baby's health. The baby should be able to see his caregivers as they enter the room in order to feel safe and protected, so put the crib next to a solid wall that faces the door.

Room Color
The color of the baby's nursery is usually decided by the parent's personal preference or by the colors traditionally assigned to a baby's gender. If you want to determine the color of your newborn baby's room according to Feng Shui, though, you can use a Feng Shui bagua. This is a wheel chart that assigns particular colors and elements to certain areas in the home as well as aspects of life, such as relationships, career and children.

The Feng Shui bagua dictates that the best color for children is white since this is the color associated with creativity. While children will benefit from a white room, if you prefer to have some color on those walls, than choose a soft, muted color. Using a soft color for your baby will help promote proper health and rest. Although bright colors can be attractive, they are considered in feng shui to be too stimulating for babies.

Movement in the Room
To create good movement in a baby's room and soft energy flow, a fan kept on a low setting can create air movement. If you'd like to room to have a bit more movement, soft music can be played and a mobile hung near a window to sway in the breeze.

Other Design Factors to Consider

Lighting
The lighting should be balanced in a baby's room. It should neither be too dark nor too bright as brightness can affect a baby's level of deep sleep and darkness is discouraging. Instead, opt for blinds. This will allow you to let more or less light into the nursery according to the time of day or need for light or darkness.

Room Decorating
It is important to consider what types of designs or pictures might be hung on the wall in a baby's nursery. Feng Shui experts warn that animal or jungle prints can be intimidating for a newborn baby and should be avoided. Water and sea motifs are also to be avoided as in Feng Shui belief these themes may cause respiratory, lung, nasal or kidney problems or may worsen a baby's asthma. Nature designs that are pleasant, warm and inviting are encouraged as they will make a baby feel safe and healthy. If you had your heart set on using animals or a water theme, you can still do so, just go easy on the imagery, perhaps balancing it out with something more Fen Shui friendly.

Clear Away the Clutter
One of the most important ways to obtain good energy or "chi" for you and your baby is to organize and clear away clutter in your house. Unnecessary clutter can block physical, mental and creative energy and lead to discouragement. With the responsibility of a newborn baby, comes a much more hectic life and your home space needs to be organized for this new chapter in your life.

Repairs and Renovations
If there any repairs or renovations that need to be done, aim to have them complete before you bring home your newborn. When it comes to cleaning, use all-natural products; harsh chemicals should not be used as these are harmful to your baby.

As for the painting, while pregnant women shouldn't paint an entire nursery, touches may be done so long as you are painting in a well-ventilated area. Also, be sure to use water-based, toxin-free paint. And if oyu have wall-to-wall carpeting, then it's time to rip it out. This type of carpeting is a haven for mold and dust mites. If you have carpets or wood tiling that contains toxins, then remove those as well.

Welcoming a New Baby
In the days, weeks and months after your baby's birth, your life as a parent will be inundated with the duties and joys of caring for your new baby. Help make your life easier, as well as your baby's nursery less cluttered, by only getting those items you need. Stock up on just the necessities, like diapers, and food, to look after your baby in those first few months.

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Crocheting a baby blanket

Crocheting or Knitting

Ask any knitter why they knit, and you'll get an incredulous look. "Why knit?" asks Elizabeth Boyle, the mother of two boys from Seattle, Wash. "Oh, goodness, if you were a knitter you wouldn't even ask that."
For long-time knitters, continuing while pregnant comes naturally. "Knitting is something that is so much a part of motherhood, whether you are expecting your first or your fifth," Boyle says. "Knitting a project is just like expecting a baby."

What makes knitting perfect for that nine months waiting for your baby to arrive? "Knitting is relaxing," says Marie Connolly, author of The Expectant Knitter: 30 Designs for Baby and Your Growing Family (Potter Craft, 2008). "The movement of the needles, working with wonderful fibers, creating special garments/gifts for your new baby, it is all a wonderful way to connect to the new baby. And in the end, the finished pieces help to link the pregnancy to the post delivery. Nine months can be a blur, but you can remember the knitting and enjoy the garment/gifts long after the pregnancy is over."

For relaxation, few things beat the clacking of needles as you express your creativity with fibers from acrylics to silks, wool to cashmere. "It is meditative, contemplative, quiet and reliable," Boyle says. "It is there when you need just a few moments to de-stress and when you have a few hours to curl up and finally have some 'me time.'"

Another benefit of knitting is its culmination in an item that can become a family heirloom. "What else gives such a satisfying sense of producing something useful and/or beautiful and long-lasting?" says Shirley Robb, a mom from Decatur, Ga., who has been knitting since childhood and continued throughout her pregnancies. "Unlike gourmet food, which must be challenging and fun to make, handmade items may be around for generations. A knitted blanket my mother made in 1954 for my first baby was used by all five of [my children], then by some of their 15 children, and now by my six great-grandchildren."

Grab Those Needles!

Even if you've never picked up a pair of needles before, it's not too late to learn. Knitting books abound, many, like Connolly's, with instructions for beginners.
Shelley Brander, owner of the Tulsa, Okla., yarn store Loops (www.loopsknitting.com), loves the bestselling book Stitch 'N Bitch: The Knitter's Handbook for its beginner's instructions and funky patterns. But she admits learning from a book can be difficult. "Classes really are the best way to go," Brander says. "Check for a local yarn store in your area. If you don't have a good one, try online video tutorials, like the ones at www.KnittingatKnoon.com. Videos are much easier than written instructions and pictures."

You'll find most knitters love to pass along the skill to a new generation. "Does your mother knit? Or what about your mother-in-law? This might be a great way to announce the pregnancy and bond with the soon-to-be grandparents," says Connolly, who owns two Stitch DC stores in the Washington, D.C., area.
Other suggestions include joining a knitting group. Women coming together to knit and talk about their pregnancy experiences can have the added benefit of stitching together a lifelong friendship.


Hats and booties. Sweaters and blankets. What are the best projects to knit while expecting? Boyle's first pregnancy project was a blanket. "[It was] just a rather simple blanket knit out of acrylic yarn," she says. "Then I knit a more complicated sweater, which actually took my mind off the fact that I was on forced bed rest, and filled in all that with the usual assortment of cute hats and booties."

Kathryn Michelotti, a mom from Everett, Mass., knit both for herself and others while pregnant. "I knew eight people who were pregnant while I was," she says. "I had already knitted a lot of baby hats for friends who had babies, so I made mostly hats."

For beginners, Brander suggests starting simple. "A burp cloth or small blanket is the best way to start – something with straight sides, which requires no increasing or decreasing (that's why most beginners start with a scarf)," Brander says.

Brander says another popular item among knitting moms is the "soaker," knitted pants that go over cloth diapers. Robb was making soakers many years ago, too. "Cloth diapers were all that were available then, and plastic pants hadn't been invented, but wool is quite water-resistant, so a simple outer covering, often hand-knitted, was worn by lucky babies – or I should say, by lucky adults whose laps stayed dry," Robb says.

Connolly suggests knitting cotton washcloths as a beginning project. "Another great beginner project is the Easy Sweater," Connolly says. "Knit in machine washable cashmere and merino blend yarns and almost all in one piece, a beginner could make this sweater [which can be found in The Expectant Knitter]." Toys are also a fun advanced project, with knitted stuffed animals being popular.

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Pinkeye

About Pinkeye

Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.

While pinkeye can be alarming because it may make the eyes extremely red and can spread rapidly, it's a fairly common condition and usually causes no long-term eye or vision damage. But if your child shows symptoms of pinkeye, it's important to see a doctor. Some kinds of pinkeye go away on their own, but other types require treatment.

Causes

Pinkeye can be caused by many of the bacteria and viruses responsible for colds and other infections, — including ear infections, sinus infections, and sore throats — and by the same types of bacteria that cause the sexually transmitted diseases (STDs) chlamydia and gonorrhea.

Pinkeye also can be caused by allergies. These cases tend to happen more frequently among kids who also have other allergic conditions, such as hay fever. Triggers of allergic conjunctivitis include grass, ragweed pollen, animal dander, and dust mites.

Sometimes a substance in the environment can irritate the eyes and cause pinkeye; for example, chemicals (such as chlorine and soaps) and air pollutants (such as smoke and fumes).

Pinkeye in Newborns

Newborns are particularly susceptible to pinkeye and can be more prone to serious health complications if it goes untreated.

If a baby is born to a mother who has an STD, during delivery the bacteria or virus can pass from the birth canal into the baby's eyes, causing pinkeye. To prevent this, doctors give antibiotic ointment or eye drops to all babies immediately after birth. Occasionally, this preventive treatment causes a mild chemical conjunctivitis, which typically clears up on its own. Doctors also can screen pregnant women for STDs and treat them during pregnancy to prevent transmission of the infection to the baby.

Many babies are born with a narrow or blocked tear duct, a condition which usually clears up on its own. Sometimes, though, it can lead to conjunctivitis.

Symptoms

The different types of pinkeye can have different symptoms. And symptoms can vary from child to child.
One of the most common symptoms is discomfort in the eye. A child may say that it feels like there's sand in the eye. Many kids have redness of the eye and inner eyelid, which is why conjunctivitis is often called pinkeye. It can also cause discharge from the eyes, which may cause the eyelids to stick together when the child awakens in the morning. Some kids have swollen eyelids or sensitivity to bright light.
In cases of allergic conjunctivitis, itchiness and tearing are common symptoms.

Contagiousness

Cases of pinkeye that are caused by bacteria and viruses are contagious; cases caused by allergies or environmental irritants are not.

A child can get pinkeye by touching an infected person or something an infected person has touched, such as a used tissue. In the summertime, pinkeye can spread when kids swim in contaminated water or share contaminated towels. It also can be spread through coughing and sneezing.

Doctors usually recommend keeping kids diagnosed with contagious conjunctivitis out of school, day care, or summer camp for a short time.
Someone who has pinkeye in one eye can also inadvertently spread it to the other eye by touching the infected eye, then touching the other eye.

Preventing Pinkeye

To prevent pinkeye caused by infections, teach kids to wash their hands often with warm water and soap. They also should not share eye drops, tissues, eye makeup, washcloths, towels, or pillowcases with other people.

Be sure to wash your own hands thoroughly after touching an infected child's eyes, and throw away items like gauze or cotton balls after they've been used. Wash towels and other linens that the child has used in hot water separately from the rest of the family's laundry to avoid contamination.

If you know your child is prone to allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy, and dust and vacuum frequently to limit allergy triggers in the home. Irritant conjunctivitis can only be prevented by avoiding the irritating causes.

Many cases of pinkeye in newborns can be prevented by screening and treating pregnant women for STDs. A pregnant woman may have bacteria in her birth canal even if she shows no symptoms, which is why prenatal screening is important.

Treatment

Pinkeye caused by a virus usually goes away on its own without any treatment. If a doctor suspects that the pinkeye has been caused by a bacterial infection, antibiotic eye drops or ointment will be prescribed.

Sometimes it can be a challenge to get kids to tolerate eye drops several times a day. If you're having trouble, put the drops on the inner corner of your child's closed eye — when the child opens the eye, the medicine will flow into it. If you continue to have trouble with drops, ask the doctor about antibiotic ointment. It can be applied in a thin layer where the eyelids meet, and will melt and enter the eye.

If your child has allergic conjunctivitis, your doctor may prescribe anti-allergy medication, which comes in the form of pills, liquid, or eye drops.
Cool or warm compresses and acetaminophen or ibuprofen may make a child with pinkeye feel more comfortable. You can clean the edges of the infected eye carefully with warm water and gauze or cotton balls. This can also remove the crusts of dried discharge that may cause the eyelids to stick together first thing in the morning.

When to Call the Doctor

If you think your child has pinkeye, it's important to contact your doctor to learn what's causing it and how to treat it. Other serious eye conditions can mimic conjunctivitis, so a child who complains of severe pain, changes in eyesight, or sensitivity to light should be examined. If the pinkeye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor.

If your child has pinkeye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your doctor. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.

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Infant botulism

Infant botulism is an illness that can occur when an infant ingests bacteria that produce a toxin inside the body. The condition can be frightening because it can cause muscle weakness and breathing problems. But it is very rare: Fewer than 100 cases of infant botulism occur each year in the United States, and most babies who do get botulism recover fully.

Infant botulism is treatable, but because of its severity, it's important to learn the symptoms so you can recognize it early. Also know that honey is a known source of the bacteria spores that cause botulism. For this reason, honey shouldn't be given to babies under 12 months of age.

About Infant Botulism

Infant botulism can occur when a child ingests spores of Clostridium botulinum bacteria, which are found in dirt and dust and can contaminate honey. This illness typically affects babies who are between 3 weeks and 6 months old, but they're susceptible to it until their first birthdays.

These bacteria are typically harmless to older kids and adults because their mature digestive systems can move the spores through the body before they cause any harm.

But very young babies haven't developed the ability to handle the spores yet. So once an infant ingests them, the bacteria germinate, multiply, and produce a toxin. That toxin interferes with the normal interaction between the muscles and nerves and can hamper an infant's ability to move, eat, and breathe.

Two other types of botulism tend to affect older kids and adults: wound botulism occurs when the bacteria infect a wound and produce the toxin inside of it; food-borne botulism is usually caused by eating home-canned foods that contain the toxin.

Signs and Symptoms

Symptoms of botulism appear between 3 to 30 days after an infant consumes the spores. Constipation is often the first sign of botulism that parents notice (although many other illnesses also can cause constipation). Call your doctor if your baby hasn't had a bowel movement in 3 days.

Other symptoms can include:

• flat facial expression
• poor feeding (weak sucking)
• weak cry
• decreased movement
• trouble swallowing with excessive drooling
• muscle weakness
• breathing problems

Infant botulism can be treated, but it's important to get medical care as soon as possible. Call your doctor right away if you see any of the warning signs in your baby.

Treatment

Infant botulism is treated in the hospital, usually in the intensive care unit, where doctors will try to limit the problems the toxin causes in the baby's body. The toxin can affect the breathing muscles, so doctors may put the infant on a ventilator. Because the toxin can affect the swallowing muscles, they may give the baby intravenous (IV) fluids to provide nourishment.

An antitoxin is now available for the treatment of infant botulism called Botulism Immune Globulin Intravenous (BIGIV), which should be given as early in illness as possible. Babies with botulism who have received BIGIV recover sooner and spend less time in the hospital.

With early diagnosis and proper medical care, affected infants should fully recover once the effects of the toxin wear off.

Prevention

Like many germs, the Clostridium botulinum spores that cause botulism in infants are everywhere in the environment. They're in dust and dirt, and even in the air. Experts don't know why some infants contract botulism while others don't.

One way to reduce the risk of botulism is to not give infants honey or any processed foods containing honey (like honey graham crackers) before their first birthday. Honey is a proven source of the bacteria and has led to botulism in infants who've ingested it. Light and dark corn syrups were thought to be a source of spores, but no proven cases of infant botulism have been attributed to ingesting them. However, check with your doctor before giving these to an infant.

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Gestational diabetes

Pregnancy is a time of promise and expectation, but it can also raise the possibility for some women that they will develop gestational diabetes mellitus (GDM).

Finding out you have GDM can be very frightening. Not only do you have to deal with all the emotions (the ups and the downs) and the questions that come with being pregnant, but also the uncertainty of this new-found condition. Fortunately, as with all types of diabetes, there are many well-informed health professionals to help answer your questions and to guide you through this very important time in your life. The more you know, the easier it is to accept and make the necessary changes for a successful and happy pregnancy.

GDM is defined as high blood sugar (hyperglycemia) with onset or first recognition during pregnancy. In Canada, GDM is higher than previously thought, varying from 3.7% in non-Aboriginal women to 8–18% in Aboriginal women.

Risk factors for developing GDM:

• a previous diagnosis of GDM or delivery of a macrosomic (excessive birth weight) infant
• being a member of a high-risk population, including women of Aboriginal, Hispanic, South Asian, Asian and African descent
• being 35 years of age or older
• being obese (BMI of 30 kg/m2 or higher)
• a history of polycystic ovary syndrome (PCOS)
• acanthosis nigricans (a skin disorder characterized by the appearance of darkened patches of skin)
• use of corticosteroids

Although some women are at greater risk than others, the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend that all women be screened for GDM between 24 and 28 weeks' gestation using a gestational diabetes screening test†. For women with multiple risk factors, this screening test should be done during the first trimester, then again during the second and third trimesters, even if the first test is negative.

Prompt diagnosis of GDM is important, as it carries several risks to both mother and infant. For example, children born to mothers with GDM may be “macrosomic”, a medical term meaning “excessive birth weight”, associated with higher rates of cesarian deliveries. This poses a risk of trauma to both mother and baby during the delivery. These babies also have a higher risk of dangerously low blood sugar levels after birth (hypoglycemia) and excess levels of insulin in the blood (hyperinsulinemia). They are also at higher risk for potential long-term obesity and glucose intolerance.

Although the diagnosis should be taken seriously, GDM can be managed by some of the same measures with which type 2 diabetes is managed.

Lifestyle

During pregnancy, women with GDM should be evaluated and followed by a registered dietitian to ensure that nutrition therapy promotes normal levels of blood glucose, appropriate weight gain and adequate nutritional intake. Physical activity is encouraged with the frequency and intensity of activity decided with your doctor based on your pregnancy and risk factors.

If women with GDM do not reach the recommended blood glucose target levels within two weeks of nutrition therapy alone, insulin therapy may be initiated. Certain types of insulin can be safely used during pregnancy.

Recommended blood glucose targets during pregnancy*

	A1C**	Fasting blood glucose / blood glucose before meals (mmol/L)	Blood glucose one hour after eating (mmol/L)	Blood glucose two hours after eating (mmol/L)
Target for most pregnant women	≤6.0% (normal)	3.8 to 5.2	5.5 to 7.7	5.0 to 6.6

* This information is based on the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and is a guide only. In some women, particularly those with type 1 diabetes, higher targets may be necessary to avoid excessive low blood sugar (hypoglycemia). Talk to your doctor about YOUR blood glucose target ranges.

** A1C is a blood test that indicates an average of your overall blood glucose levels over the past 120 days.

After the baby is delivered

Women who have had GDM are at increased risk of developing subsequent type 2 diabetes later in life. A blood glucose test should be performed between six weeks and six months after the baby is born.

To reduce the risk of developing type 2 diabetes in the future, women with previous GDM should:

• Be encouraged to breastfeed
• Follow a healthy lifestyle
• Be screened regularly for the development of type 2 diabetes or impaired glucose tolerance
• Consult their physician and be screened for type 2 diabetes when planning another pregnancy

With prompt diagnosis and good management, women with GDM can expect to have a healthy pregnancy and a happy, healthy baby.

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The suggested test for GDM is the Gestational Diabetes Screen (GDS). This test usually takes place in a medical diagnostic laboratory. An initial sample of blood is drawn (to be used as a baseline blood glucose reference level). The person then drinks a liquid that contains 50 grams of glucose (sugar). After one hour, a second blood sample is drawn. The purpose of this test is to see how well the body deals with the glucose in the blood over time. In a person without diabetes, glucose levels rise and then fall quickly. In someone with GDM or diabetes, glucose levels rise higher than normal and fail to come back down as quickly. The 2008 Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend diagnosing GDM if glucose levels 1 hour after the GDS is 10.3 mmol/L or greater.

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