What is anaphylactic shock?
Anaphylactic shock (also called anaphylaxis) is a rapid and severe allergic reaction, and one of the scariest health emergencies a parent can face. It starts when the immune system mistakenly responds to a harmless substance as if it were a serious threat. This triggers the release of histamine and other chemicals that cause a number of symptoms — some of them life-threatening.
The symptoms in a baby include:
• Swelling of the skin, lips, throat, tongue, or face
• Wheezing or severe breathing problems
• Rapid pulse or irregular heartbeat
• Hives
• Loss of consciousness
• Vomiting
• Diarrhea
• Extremely pale skin and sweating, skin redness, or blue skin color
Symptoms usually appear within two hours after exposure to the substance — sometimes within minutes — although it's possible for symptoms to appear up to four hours later.
Anaphylaxis is uncommon in babies under 6 months, in part because they haven't been exposed to many allergens, especially food allergens. In general, it takes more than one exposure to an allergen for a reaction to occur, and it can take until the toddler years for some allergies to develop. Still, anaphylaxis has been reported in babies as young as 1 month old and in children with no known previous exposure to the allergen.
What substances are most likely to cause a severe reaction?
There are many possible allergens, but these are the most common:
• Peanuts, tree nuts (such as walnuts and cashews), shellfish (like shrimp and lobster), fish, milk, and eggs are the most common culprits, although any food can cause a severe allergic reaction. (A great deal of research is being done on whether delaying the introduction of potentially allergenic foods will delay the onset of allergies in allergy-prone children. If food allergies run in your family, your child may be more susceptible.)
• Drugs in the penicillin family (including the popular antibiotic amoxicillin)
• Insect bites and stings (especially from bumblebees, honeybees, yellow jackets, hornets, wasps, fire ants, and harvester ants)
• Latex (often used in healthcare facilities)
• Food preservatives and colorings (like FDC yellow No. 5)
What should I do if my baby seems to be having a severe allergic reaction?
Call 911 immediately if your baby is having trouble breathing or passes out. Lay him down with his feet elevated to reduce the risk of shock. Try to keep him calm by talking to him and by remaining calm yourself.
Don't give your baby an antihistamine if he's younger than 6 months. Even if he's older, don't give him an antihistamine if he's having any trouble breathing or swallowing, because he may choke on it.
When the paramedics arrive, they'll probably treat your baby on the spot with an injection of epinephrine that will stop the reaction within minutes. (Epinephrine makes the heart beat more strongly, relaxes the muscles in the airway, reduces swelling, and improves tone in the blood vessels to increase blood flow to vital areas like the heart and brain.)
The paramedics will take your baby to the hospital, where he'll be examined and watched for delayed reactions. The doctors at the hospital can help you determine what caused the problem. You'll want to follow up with your baby's doctor, who will probably refer you to a pediatric allergist.
What can I do to protect my baby from anaphylactic shock?
The best prevention is to avoid any known allergens as well as the substances that commonly cause serious allergic reactions.
If your baby is allergic to certain foods, it will take only a trace amount to trigger a reaction, so it's important to read labels carefully and ask at restaurants or friends' houses whether a meal contains any of the off-limit items. You'll need to be vigilant about this for your child until he can do it for himself. For more tips, check out the Food Allergy Network.
If insect bites or stings cause trouble, help your baby find places to play that are free of bugs. Don't rely on bug sprays — they don't repel bees and fire ants, which commonly sting children.
In addition, once your baby can walk, don't let him toddle around outside barefoot. Many children are stung when they unintentionally step on a stinging or biting insect.
If your child has had a severe allergic reaction, his doctor may recommend that when he gets a little older you carry an EpiPen Jr., a penlike injection device loaded with epinephrine. It's designed for children weight 33 to 66 pounds (15 to 30 kilograms) and is available by prescription only.
Also make sure anyone who ever cares for your baby — caregivers, daycare workers, relatives — knows about your child's allergies and exactly what to do if he has a reaction.
Finally, once your baby has had a severe reaction such as anaphylaxis, it's important for him to wear a medical-alert ID bracelet (available in most pharmacies). This will alert healthcare providers to his condition in case of an emergency.
Thursday, March 22, 2007
Anaphylactic shock
How are allergies treated in babies?
The most important thing you can do is reduce your baby's exposure to the allergen. Here are the best ways to do that for the most common allergens:
Dust mites
Dust mites live in fabrics and carpets and are common in every room of the house. But most children are exposed to the most dust mites in the bedroom, where mattresses and pillows are veritable dust-mite condominiums.
The following steps may seem like a lot of work, but they really help. "Parents who take these steps might expect a 60 to 70 percent rate of improvement in their child's allergies," says Virant, "and this should markedly cut down the level of medication needed for the problem."
• Encase your baby's mattress in an impenetrable cover made of very tightly woven fabric, found at allergy supply stores. Unlike vinyl covers, these provide a useful barrier that's breathable and not crinkly. Avoid big, fluffy comforters and use blankets instead.
• Wash bedding once a week in hot water to kill dust mites. Set your water heater to about 130 degrees Fahrenheit before laundering bedding. Don't forget to turn the water heater back down (to about 120 to 125 degrees) afterward so family members won't scald themselves when they go to wash their hands.
• Avoid piling up stuffed animals in your baby's room — they're dust-mite magnets. Wash the few favorites your baby can't live without in hot water weekly or stick them in the freezer for an overnight killing frost.
• Dust and vacuum weekly or every other week, but make sure your baby isn't in the room when you do it. The action of dusting and vacuuming can stir up residual dust-mite particles in the room. Wet mopping can help prevent this.
• Consider investing in a vacuum cleaner with a HEPA (high efficiency particulate arresting) filter, which traps even microscopic particles that pass right through ordinary vacuum cleaners.
• If your baby has a severe dust mite allergy, consider tearing up carpeting and replacing it with a smooth floor.
• Clean or replace filters on furnace and air-conditioners monthly during seasons they're in use. Have heating ducts cleaned each fall.
Pet dander
If your baby is allergic to a pet, the only foolproof solution is to give the animal away. That's not an easy decision to make, of course, and, understandably, you'll want to consider it only as a last resort.
To keep the dander down, wash your pet frequently. (You can find shampoos that reduce dander in the pet store.) Also keep your pet off the furniture and out of your baby's room.
Molds
Use a dehumidifier and air conditioner when the weather is warm and moist, especially in a wet basement or other areas of your home where mold growth is a problem. If your bathroom is a mold factory, clean it regularly with mold-inhibiting disinfectants, such as a little bleach and water or a natural solution like tea tree oil and water. And consider investing in a better ventilation system.
Mold can often be found growing in closets, attics, cellars, planters, refrigerators, shower stalls, and garbage cans, and under carpets. Even a fake Christmas tree can harbor mold.
How are allergies treated in babies?
The most important thing you can do is reduce your baby's exposure to the allergen. Here are the best ways to do that for the most common allergens:
Dust mites
Dust mites live in fabrics and carpets and are common in every room of the house. But most children are exposed to the most dust mites in the bedroom, where mattresses and pillows are veritable dust-mite condominiums.
The following steps may seem like a lot of work, but they really help. "Parents who take these steps might expect a 60 to 70 percent rate of improvement in their child's allergies," says Virant, "and this should markedly cut down the level of medication needed for the problem."
• Encase your baby's mattress in an impenetrable cover made of very tightly woven fabric, found at allergy supply stores. Unlike vinyl covers, these provide a useful barrier that's breathable and not crinkly. Avoid big, fluffy comforters and use blankets instead.
• Wash bedding once a week in hot water to kill dust mites. Set your water heater to about 130 degrees Fahrenheit before laundering bedding. Don't forget to turn the water heater back down (to about 120 to 125 degrees) afterward so family members won't scald themselves when they go to wash their hands.
• Avoid piling up stuffed animals in your baby's room — they're dust-mite magnets. Wash the few favorites your baby can't live without in hot water weekly or stick them in the freezer for an overnight killing frost.
• Dust and vacuum weekly or every other week, but make sure your baby isn't in the room when you do it. The action of dusting and vacuuming can stir up residual dust-mite particles in the room. Wet mopping can help prevent this.
• Consider investing in a vacuum cleaner with a HEPA (high efficiency particulate arresting) filter, which traps even microscopic particles that pass right through ordinary vacuum cleaners.
• If your baby has a severe dust mite allergy, consider tearing up carpeting and replacing it with a smooth floor.
• Clean or replace filters on furnace and air-conditioners monthly during seasons they're in use. Have heating ducts cleaned each fall.
Pet dander
If your baby is allergic to a pet, the only foolproof solution is to give the animal away. That's not an easy decision to make, of course, and, understandably, you'll want to consider it only as a last resort.
To keep the dander down, wash your pet frequently. (You can find shampoos that reduce dander in the pet store.) Also keep your pet off the furniture and out of your baby's room.
Molds
Use a dehumidifier and air conditioner when the weather is warm and moist, especially in a wet basement or other areas of your home where mold growth is a problem. If your bathroom is a mold factory, clean it regularly with mold-inhibiting disinfectants, such as a little bleach and water or a natural solution like tea tree oil and water. And consider investing in a better ventilation system.
Mold can often be found growing in closets, attics, cellars, planters, refrigerators, shower stalls, and garbage cans, and under carpets. Even a fake Christmas tree can harbor mold.
How can I figure out what my baby is allergic to?
It takes some careful detective work and sometimes the help of medical tests to pinpoint the exact cause of an allergy. One clue may be when the allergy attacks occur.
Mold allergies usually develop during damp or rainy weather and can be hard to distinguish from colds. Dust mites or pet allergies often cause morning congestion throughout the year. Pollen-related allergies are more common in spring, summer, and fall.
Unfortunately, sending Fluffy away for a few days won't tell you for sure whether your baby has a pet allergy. Studies at Johns Hopkins University suggest it can take more than a year for cat dander to degrade in a room, for example.
On the other hand, if you take your baby away from the pet (on vacation, for example) and she seems better, then you have a good — but by no means conclusive — lead. (You'd also want to consider that your baby might be allergic to something else in your house.)
If your own sleuthing doesn't give you the answer, it's time to see the doctor. He'll examine your baby and ask lots of questions. If he believes the problem is allergies, he may refer you directly to an allergic specialist or he may suggest a blood test to measure levels of IgE (allergy) antibodies in your baby's blood.
Blood tests may be less accurate than skin tests, especially for infants. So if the blood test does suggest an allergy, the next step for your little sniffler is a skin test. You'll need to see an allergist for that.
During a skin test, an allergist applies small amounts of common allergens to your child's skin. If your baby is allergic to a substance, she'll have a reaction (similar to a mosquito bite) on that spot. Infants may have smaller reactions than older children, but the tests can still be very useful.
"Keep in mind that testing tells you what your child is allergic to at that point, but it may change as your child gets older," says Seattle pediatric allergist Frank S. Virant. If your baby has a negative skin test but continues to have allergy symptoms, have her reevaluated in six to 12 months.
If my baby is allergic, will I know right away?
Probably not. It can take time for an allergy to develop. Each allergic person has a threshold that must be met before an allergen causes a reaction, and this can take several months.
So if your baby inherited the tendency to be allergic to cat dander, she may have no trouble at all for the first few months she's around Fluffy, or she may have a reduced reaction. But then one day, when the exposure level reaches her threshold, her body will react and mount an offense.
Seasonal allergies to things such as pollen and grass usually don't rear their ugly (and stuffy) head until a child is about 3 to 4 years old.
What causes allergies?
An allergy is a special immune reaction to a substance in the environment. When a child with allergies comes into contact with one of these substances, known as an allergen — either by touching it, breathing it, eating it, or having it injected — her body views it as a dangerous invader and releases histamines and other chemicals to fight it off. These chemicals irritate the body and cause symptoms such as a runny nose, sneezing, itching, and coughing.
Possible allergens include food, drugs, insects, animal dander, dust mites, mold, and pollen. Depending on the type of allergy, it can cause respiratory symptoms (allergic rhinitis), skin symptoms (like eczema), or intestinal problems (from food allergies, for example).
The most likely culprits of nasal allergies in babies are:
• Dust mites — microscopic organisms that thrive on human skin flakes (nearly 85 percent of allergy sufferers are allergic to dust mites)
• Animal dander — those white flaky specks (shedding skin and hair) on cats, dogs, and other furry animals
• Molds — fungi found in wet, damp places such as bathrooms and basements
Some children are allergic to down and feather pillows, or chenille or wool blankets. And while most experts don't think children can be allergic to tobacco smoke, it can certainly make their allergic symptoms worse.
A child will inherit the tendency to be allergic, but not necessarily the specific allergies. For example, if one of your child's biological parents has hay fever or pet allergies, there's a 50 percent chance your child have some sort of allergies as well. That probability jumps to 75 percent when both biological parents have allergies. Family members may differ widely in the kinds of things they are allergic to.
How can I tell if my baby has allergies or just a cold?
Because the symptoms of nasal allergies (also known as allergic rhinitis) are much like cold symptoms — runny nose, watery eyes, cough, nasal congestion, sneezing — it can be tough to tell the difference. There are some telltale signs of allergies, though. Ask yourself the following questions:
• Does it seem like your baby always has a cold? (Colds usually wind themselves down in a week to ten days; allergies don't.)
• Is your baby's nose always stuffy or running?
• Is she constantly wiggling, wiping, or pushing her nose up in what doctors call the allergic salute?
• Is the mucus that drains from her nose clear and thin (as opposed to yellow or greenish and thick)?
• Does she seem to sneeze a lot?
• Are her eyes itchy, red, and watery?
• Does the skin under her eyes look dark or purple or blue (doctors call these allergic shiners)?
• Does she breathe through her mouth?
• Does she have a dry cough?
• Is her skin irritated or broken out in an itchy red rash?
If you answered "yes" to one or more of these questions, there's a good chance your baby is allergic to something in her environment. Kids with nasal allergies are also more prone to ear infections, asthma, and sinus infections.
Saturday, March 17, 2007
How can we find a good babysitter?
Candi says, "We just moved to Texas and we don't know many people yet. I stay at home with our son and my husband works long hours. We haven't had a night out in months and we need a break. Can you offer any tips on finding a trustworthy and reliable babysitter?"
"I've decieded to hire a tenneager to help me with the baby & with basic household chores this way I can get to know her 1st! Or you can ask other parents in the neighbourhood about their sitter(s)."
-- Kelly
"Candi - I work for a YMCA which hosts "Parent's Nights Out". Y staff watch the kids, offer crafts, they watch a movie and eat pizza while the parents get to have a night on their own. Also, we offer a babysitters training for local teens. Check with your local Y branch and see if they have any similar programs. Good luck!"
-- Anonymous
"I would recommend calling your local church and seeing if they have a list of babysitters. I am getting ready to return to work after the birth of my first child and that is how we are finding our full time care, they also have part time for just an evening out."
-- ethansmom
"Want a reliable, CPR-certified person to watch your child in a guaranteed safe home? If you are willing for your son to go to some else's home for the couple of hours, I would recommend contacting your local Child Care Resource and Referral (CCR&R) if you have one. I don't know your location, but in my experience most towns have some version. The services are FREE, and you are given names and numbers of licensed/certified child care providers in your area that are available the day/time you are looking for. Feel free to email me at McKessidy@attbi.com if you need more information, and good luck!"
-- Mother of 2 under 2
"Make sure you do vigorous interviewing before you decide on someone... ask plenty of questions. For example, ask them what they would do if the baby started crying. When they answer, ask them what they would do if that didn't work. Everytime they answer, ask them what they would do if their previous answer didn't work. After a few times of this, they will get frustrated.. just as they would if the baby was crying and none of the things they tried worked. This will give you an idea of how they deal with the emotional strain of caring for an infant. Lots of luck."
-- Janelle
"Hi. I checked with neighbors and our church to find names of teenagers who are of babysitting age. I found a young girl across the street and had her over a couple of days a week afterschool to spend time with my son while I did things around the house. I was able to see her interact with my son and teach her a few things. Once I felt comfortable, I left for an hour or so. Now I have no problem leaving him at night or for several hours. I also found an experienced sitter at church. Ask around. Other parents know which babysitters are trustworthy."
-- Karin
"My husband and I found a sitter and now after a month we are starting all over again. Now with no sitter one of us has to take care of the kids and still manage to keep our jobs! Someone please give us some kind of advice, we've tried everything."
-- ewmorley msn.com
"Have your husband ask his co-workers about their babysitters or if their children do any babysitting. My daughters friend has an older sister so we gave her a chance and now she is not only the first babysitter we have ever had, she is our weekly sitter."
-- Anonymous
"I'm a stay at home mom of a special needs child and needed to find qualified sitters. Monstertrak.com is a nationwide service that advertises at colleges and universites nationwide, there is a small fee; however in my opnion worth the time and money! Good Luck"
-- Katie
"Churches are great resources, as mentioned, and creating a babysitting co-op is great, too. You can also look into whether your community has some sort of child care council. We have one, and I've gotten references that were great. Everyone has to be fingerprinted and have a background check so that the freaks are filtered out. Good luck."
Home daycare: Overview
Introduction
Home daycare, also known as family daycare, is exactly what it sounds like — daycare in a home instead of a center. This arrangement has been around as long as women have had neighbors and friends nearby to help care for their kids. Today it's a way for many moms who prefer to stay at home and who truly enjoy taking care of children to do work they love and contribute to the family finances at the same time. "Most home providers have made a conscious decision to do this as a career," says Anne Mead, treasurer of the National Association for Family Child Care.
The United States has more than 280,000 regulated home daycares — almost three times the number of licensed childcare centers. According to a 1996 report by the National Center for Education Statistics, home daycares (and probably many more that aren't regulated) provide care for 14 percent of the more than 21 million U.S. children under six, making home daycare the third most popular option after center care and relative care.
Home daycare often appeals to parents who want to keep their child in a warm, friendly, homelike environment but can't afford a nanny and can't or don't want to use a relative. But home care has its drawbacks, too. Licensing requirements in some states are less rigid for home daycares than they are for childcare centers, and home daycare providers often have little or no background in early childhood education and development, something most centers can boast. Home daycare usually provides no backup if your provider gets sick. And, unless she has an assistant, no one supervises her activities.
But if you find a good home daycare — one you feel comfortable leaving your child in every day — it can be a wonderful alternative to in-home care or center care. Your child has all the comforts and security of a home setting as well as other children to play and socialize with.
What do the experts think?
Studies show that home daycare is a good option because groups are often smaller than they are in centers, the homelike environment is comforting and reassuring, kids have a single, consistent caregiver (sometimes two, if the provider has an assistant), and children may be exposed to fewer illnesses. Of course, that's all assuming you've found a great provider. An ongoing study by the National Institute of Child Health and Human Development confirms the importance of quality in childcare, no matter what kind you use.
Should I pay a relative to care for my child?
This is a tricky question. Yes, you should pay, but that doesn't mean your relative will accept money. Some family members refuse payment, saying it's their pleasure (or duty) to help take care of a member of their family.
If you're lucky enough to have a loving relative nearby who's willing to take care of your baby at no charge, you might want to find some type of non-monetary compensation. Get her gift certificates for restaurants, movie theaters, or her favorite store, surprise her with a thank-you card and flowers every few weeks, or offer to pay a bill or help with household chores or yardwork. You should also plan on giving your relative days off and vacation time.
How much will nanny care cost?
A nanny is usually your most expensive option. Keep in mind that when you hire a nanny you become an employer, and the government expects you to pay your nanny's Social Security taxes and fulfill other responsibilities.
Depending on where you live and how stiff the competition is for qualified candidates, you'll probably pay a nanny between about $350 and $700 a week — though your costs could be lower if it's a live-in situation. (According to the International Nanny Association, nanny salaries are highest in Massachusetts, New York, and Connecticut.)
Since a nanny is an employee, many parents pay for their nanny's health insurance. If you do this, the nanny usually picks her own health plan and provides you with the financial breakdown. You can then decide to pay for all or part of the premium. You may also want to offer other benefits, such as paid holidays, vacation, and sick days.
How much will home daycare cost?
According to the National Association for Family Child Care (NAFCC), pinning down a nationwide average for home daycare costs is difficult. Prices vary depending on the size of the facility, the region, and whether the facility is licensed. Some providers charge almost as much as daycare centers, while others charge very little, especially if they're close friends or neighbors of the families whose children they're caring for. On average, however, home daycares charge about $6,000 a year ($500 a month) for toddlers and $8,400 a year ($700 a month) for infants.
On the higher end, a recent survey of childcare in the Cambridge, Massachusetts, area found that the cost of full-time home daycare ranged from about $12,480 to $18,720 a year. A similar survey by the city of Boulder, Colorado, found that home daycare there cost between $7,800 and $10,400 a year. Debbie Moore, vice president of the NAFCC, suggests that parents call their local CCR&R; in most cases they can give you a range of local prices.
How much will a daycare center cost?
Depending on where you live and on the quality of the daycare, costs can range from $3,000 to $15,000 a year ($250 to $1,250 monthly), according to data from the Children's Defense Fund and Runzheimer International, a Rochester, Wisconsin, relocation consulting firm. Daycare centers in large cities such as New York and San Francisco are notoriously expensive; they're cheaper in parts of the South and the Midwest. You'll pay more when your baby is under a year old, because babies require more hands-on care so the center must hire more caregivers.
To find out more about daycare options and costs in your area, contact your local Child Care Resource and Referral (CCR&R) agency. There are more than 850 CCR&R agencies throughout the country that provide families with information about local childcare options and resources. To find an agency near you, call the hotline at (800) 424-2246 or visit this website. (The website features a helpful tool that tells you the average cost of home daycare and daycare centers in your ZIP code.)
How much will I spend on childcare?
The cost of childcare is an important consideration as you plan a financial future that includes your new baby. How much of your budget will go to childcare depends on a number of factors, including the following:
• Where you live
• What type of childcare you choose
• Your baby's age
• How many hours a week your baby spends in childcare
Where you live is what really determines the bottom line. Nanny care will cost significantly less in, say, St. Louis than in San Francisco simply because the cost of living is lower there and so are wages. And daycare — whether in a center or in someone's home — could cost hundreds more per month in a relatively expensive city than in a cheaper area. Your best bet is to check with friends and caregivers near you to determine the going rate for the type of childcare you prefer.
There are costs associated with being your child's full-time caregiver, too — typically the loss of your previous income. Read our complete article on affording staying home.
If you're deciding among childcare options read on to find out about the relative cost of each, and check out our chart listing the pros and cons of each of these options.
Building a good relationship with your child's caregivers
Your work isn't over just because you've found your dream preschool or daycare center. In fact, it's only beginning. Your child's caregivers are counting on you to keep up your end of the bargain — they keep your child safe and secure while you're at work, and you agree not to take advantage of them.
"We're a team," says Elice Webster, founder and director of the Children's Cultural Center of Marin in Sausalito, California. If it takes a village to raise your child, she says, your village consists primarily of your family, friends, and your child's daycare center or preschool.
Some pointers on building a good relationship with your child's caregivers:
• Pick up your child on time. Emergencies do happen, and you're bound to be late once in a while, but make every effort to be prompt. If you anticipate a delay early in the day, call the center or provider. "Caregivers have lives, too," says Webster, and when you're late, you make them late for their own appointments. She says teachers may have kids of their own that they must pick up on time.
• Turn in all necessary paperwork. Even before your child attends his first day of school you'll need to submit a bunch of documents such as immunization records and medical health release forms. State law mandates that all centers comply with this law, so help your center out and hand in forms on time.
During the school year you'll need to sign permission slips for field trips or authorizing teachers to give your child medications, such as antibiotics for an ear infection. Sign these right away and turn them in.
• Bring up any problems immediately with the preschool director or the lead teacher. "It's really the most efficient way to get problems addressed," says Webster. "You're doing me a favor when you point out a blind spot in my operation."
• Read all notices and mail you get from the center. When you see a sheaf of papers in your child's cubby, don't toss it in the recycling bin. You might miss out on valuable information about school closings, field trips, or special events. "It's not junk mail," says Ron Lynch, owner of two daycare centers in Ann Arbor, Michigan. "We try to keep you abreast of all activities we'd like you to participate in." While you're at it, check the bulletin board at the school for other announcements.
• Attend all mandatory meetings, and if you're unavailable for emergency reasons, let the staff know. Whether it's a parent-teacher conference or a special workshop on discipline, your center recommends events like these because the staff truly feels parents will benefit from them. And school events are a great way to meet other parents who'll gladly trade tantrum stories and playdates.
• Make sure your child has all the supplies she needs. Keep extra clothes in her cubby in case of spills and potty accidents. If your child comes home wearing the spare clothing, make sure you bring a fresh set the next day. If your child's class is doing a special art project, be sure she has the tools she needs.
• Report any illnesses to your center or preschool. Germs travel fast among children. The caregiver needs to know if your baby has been exposed to any highly contagious disease such as pinkeye or chicken pox, or a more common ailment such as a cold or cough. "Anything contagious has to be reported because we spread the word to other parents," says Lynch.
• Let caregivers know if your child needs extra care on a particular day. If your little one didn't sleep well the night before, or your partner is away on a business trip and junior's missing him, let the staff know. That way they'll be able to give your child some extra TLC.
• Let the staff know if your child's routine will change on a given day. If grandma's in town and wants to pick up your child in the afternoon, tell the caregiver. Centers and preschools are not allowed to release your child to anyone but you unless you give permission. If you'll be picking up your baby early for a doctor's appointment, let them know that, too.
• And of course, pay your fees when they're due. It's only fair. Don't get caught with a zero bank balance when it comes time to write your center a check. It's bad form to keep them waiting for your payment.
Backup childcare plans
What are my options when either my child or childcare provider is ill?
Not many, unfortunately, which is why so many parents dread the onset of a fever, diarrhea, or a stomachache. Most childcare centers have fairly strict sick-child policies to help prevent the spread of illness. Your challenge is even greater if you use home daycare, a nanny, or relative care: When your caregiver gets sick, no teachers are standing by to fill in, as they are at a center.
Most backup options fall into two main categories: finding someone else to take care of your child or staying home yourself. Try to have some kind of backup plan in place before you need it. Some options:
Find someone else
When you're conducting your childcare search, ask about backup care up front. Ideally, your home daycare provider, relative, or nanny (or her agency) will have someone else lined up in case of an emergency, though it's not ultimately their responsibility. If so, ask to meet her (or him) ahead of time so you're comfortable having that person care for your child. If not, try to track down an alternate yourself. These suggestions may help:
• Ask a relative. If you have a reliable relative nearby who doesn't mind occasionally pitching in to care for a sick child, count yourself lucky. You may find yourself pledging your share of the family heirlooms to seal the deal, but if you can make it work, it's worth it. "I actually moved across country to get the backup support of my sister and mother," says Susan Webb, who just moved from Boston to San Francisco. "Okay, maybe that wasn't the only reason — but it was a strong factor in our decision."
• Try share care. If another family in your neighborhood uses nanny or relative care, see if you can set up a swap: They'll take your daughter when your nanny's sick if you promise to do the same for them. Even if you don't have a nanny and your friends do, this can still work — their nanny gets your money and they get your offer to babysit.
• Call an agency. If you found your nanny through an agency, ask if they have a roster of emergency caregivers. More rarely, you may be able to find an agency near you that provides in-home care for sick children. This will probably cost you an arm and a leg, but it may be worth it if you just can't miss work.
• Track down sick-child care. A few hospitals and childcare centers specialize in caring for sick children; if your Yellow Pages list one near you, thank the childcare gods. Like in-home care, this option tends to be a little costly — Feeling Better, a sick-child center in Silicon Valley, charges $65 to $70 per day — but some companies will subsidize the expense to keep a key employee (you) from missing an important meeting or presentation.
"Parents can get in a full day of work knowing that their sick child is being cared for by nurses and getting the right medical treatment," says Heather Luftman, director of Feeling Better. In some bigger cities, like San Francisco, you may also find company-subsidized centers that offer last-minute childcare for healthy kids. That can come in handy if it's your caregiver — not your child — who's under the weather.
• Tap into your community. Your clergyman and local community college may be good resources for alternate caregivers, says Ann Douglas in The Unofficial Guide to Childcare. The former may have a list of willing helpers on hand, and the latter may be able to refer you to reliable student nurses. Plan ahead on this one and meet the person before leaving your child with her for the day.
Stay home yourself
No one can plan for every situation. Inevitably, the day will come when you're caught with a sick child and have no one to turn to but yourself or your partner. But like lining up a backup caregiver, this option has several variations:
• Take the day off. If you have enough sick / vacation days (or a personal day or two stashed away somewhere) and you can use them to care for your child, this may end up being your only choice. If you don't have any more days left, see whether you can work out an arrangement with your boss. "My employer is very understanding and flexible," says one BabyCenter mom. "If I need to be out a couple of days, I'm welcome to work extra hours during the week or come in on the weekend to make up time. That way I don't have to use up my vacation and sick days." See if your boss will do the same.
• Work from home. In today's digital world, many employers allow their employees to telecommute now and then. As long as you're sure you can handle taking care of a sick child and getting your work done, this may be the perfect solution.
• Take turns with your partner. If your child's sick for a few days, you can trade off days, or, like Sylvia Shragge and her husband, Jim, of Berkeley, California, split each day up between them. "We've always handled it the same way," she says. "Tag team! If our son, Nick, is sick the night before, I'll go into the office extra early, stay a few hours, and bring work home. Then Jim goes to his office."
Twenty tips from breastfeeding veterans
Friends and family members who mean well are sometimes all too ready to offer guidance to new parents, whether you want it or not. Take whatever advice you get with a grain of salt. After all, nursing is a different experience for every mother and every baby, so what works for one woman may not work for the next.
That said, there are plenty of time-tested techniques for improving milk flow, clearing blocked ducts, and more. Read on to find out how some of our BabyCenter members faced, and overcame, some of breastfeeding's most common challenges.
Here's what some breastfeeding mothers have to say:
I attended a class offered at the hospital. It gave a lot of the basics along with the encouragement that if breastfeeding didn't seem like second nature at first, baby and mom eventually would find their rhythm.
— R.L., Racine, Wisconsin
Don't watch the clock to see how often or how long your baby is nursing. Instead, go with your instincts. If your baby is rooting around or crying, then feed him or her — even if you just did.
— Gina Locke, Grapevine, Texas
Make sure your baby's mouth covers a large part of the underside of your nipple. I spent the first few weeks in a lot of pain because my baby wasn't latching on properly. What a difference the correction made!
— Heidi Hudson, Oakland, California
I'm a pediatrician mom of a 3-year-old whom I breastfed for eight months. My son was extremely hard to start: Despite making our first attempts (unsuccessful) in the first hour, and knowing what to do, it took almost two days to get him latched on. In the interim, we finger-fed with an SNS (Supplemental Nursing System) and glucose water while I pumped to get my milk supply going. The SNS was a lifesaver. We finally hooked it to my breasts and were able to get him latched on by the third day.
— Dara Hogue, Cupertino, California
I used Lansinoh lanolin ointment on my nipples faithfully morning and night, and never experienced any cracking or bleeding when I started nursing. My soreness was minimal, and the ointment soothed my skin when it was chafed. I have very fair, thin skin, so that was a wonderful tip for me! I even included a tube with my shower gift to a friend.
— Rachel L. Sarantopoulos, Dayville, Connecticut
I have been solely nursing my baby since birth and now, at 9 weeks, she's a big healthy baby. I had very sore latch-ons at the start, and I found that if I stayed ahead of her intense hunger I was better off. I would check on her around the time I thought she would be waking to eat and watch for tongue-sucking and lip-smacking in light sleep. If I put her to the breast when she showed early signs of hunger, she wouldn't suck as hard as when I waited until she was fully crying and starving.
— Kathy Kent-Knurek, Chicago
The best — and probably hardest — breastfeeding advice is to relax! Remember that you and your baby are learning.
— Sandy Kenniston, Green Bay, Wisconsin
When I had my daughter, I knew I wanted to breastfeed. Unfortunately, she didn't latch on right away, so I began supplementing with formula. Hospital staffers tried everything from round-the-clock attempts to pumping and inserting feeding tubes in the baby's mouth while I tried every nursing position known. The baby knew how to suck, but she just wasn't getting the knack of it. Finally, we tried the plastic breast shield. My baby was able to suck the large plastic nipple and draw the milk rather than search for my small nipple.
I had visions of using the shield from then on, but luckily I lost it and was forced to teach the baby to take my own nipple. I had to use a syringe to "pull" the nipple larger, but in time, thanks to the baby's suckling, my nipples conformed. The rewards for not giving up have been great!
— Alison O'Donnell, Pawtucket, Rhode Island
I've had a real problem with leaking breasts. The nursing pads never worked well enough for me, so I came up with my own solution — sanitary napkins! I buy the ultra-thin kind and fold them in half. I can wear them all day and they never leak. It's cheaper, too.
— Cindy Brown, McKinney, Texas
For me, preparing for nursing meant reading all I could. I had several magazine subscriptions going while I was pregnant and almost every issue had an article on breastfeeding. I found new facts and ideas in each, but the bulk of the article was the same. Every time I read these articles, it reinforced all the information I had previously read. When the time came to put it all to use, I felt pretty confident. I felt like I really understood what was coming next and as a result, breastfeeding seemed relatively easy.
— Ginger Renae Koontz, Pasadena, Maryland
I didn't "ease" into breastfeeding. It was one of the hardest, most frustrating, heart-wrenching things I've ever done. I stuck with it though, and four months later I have a healthy, entirely breastfed baby boy. I suggest telling mothers it may be hard and frustrating. With all the talk about how it is so good for you and the baby, and what a great bonding experience it's supposed to be, a new mother feels guilty if she dreads each feeding and wonders if perhaps she doesn't love her baby enough. Eventually she'll get the hang of it, but the odds are pretty good that she'll actually hate it the first couple of days — or even longer.
— Libby Bollino, Abbeville, Louisiana
When I started breastfeeding, I felt like I needed two or three extra hands. I was so nervous about holding my newborn and supporting his head properly that trying to get him in the right position to latch on seemed impossible. It wasn't until several months later that I got a breastfeeding pillow as a shower gift. It's amazing. It props the baby up into the perfect spot so I can concentrate on the latching-on, which is the hardest part when you're new to nursing. I wish I'd had one of these when I was learning to nurse and fumbling around with ordinary pillows and blankets and propping and leaning.
— Laura Jaglowitz, Hedley, British Columbia
Long before you nurse — and before you get pregnant — quit smoking. It's awful to smoke around your baby, and I've read that smoking flavors your milk and can make it taste off.
Invest in a huge supply of bottled water or add another filter pitcher to your supply. You'll be very thirsty while breastfeeding and it is absolutely imperative that you drink your water!
— Deb Koslowsky, Tujunga, California
The single most beneficial thing I did was to attend a La Leche League meeting while I was pregnant. I learned a tremendous amount and got to see other women nurse their babies, which I had never really seen before. After my baby was born, I continued to attend LLL meetings and have received a great deal of knowledge, support, and encouragement from the leaders and the other mothers. I also made some terrific friends.
— Debbie Strelevitz, Rock Tavern, New York
My mother gave me a great tip for getting through those first couple of weeks when breastfeeding hurt: Drink very cold water through a straw as the baby is latching on. The cold water will help defer the pain. Other things that help include listening to relaxing music and minimizing distractions so that you can relax and focus on the task at hand.
— Wendy Katzman, Seattle
When my daughter was born, I told my breastfeeding consultant about my horrible experience with mastitis and bleeding nipples when I breastfed my first child. She recommended some herbal products that have worked great: lecithin, for avoiding clogged milk ducts; blessed thistle, for increasing milk flow when I return to work and need to pump; and alfalfa, for enriching my milk. I haven't had any episodes of mastitis. I swear by the herbs — they've made all the difference!
— Ruth Tutterow, Greensboro, North Carolina
Take all the help and support you can get. The lactation consultant got my husband involved in the learning process so he would know how to help me get the baby latched on until I was able to do it by myself.
— Candice Gray, Paulina, Louisiana
The best advice I got for dry and sore nipples came from my doctor. She said not to bother buying those expensive ointments but instead, after breastfeeding, express just enough milk to spread on the nipples. It really does work with the dryness and cracking.
— Anonymous
During those early stages, I frequently got blocked milk ducts. When I could feel the full duct even after Doug had fed, I'd put on the warming bag (the kind that you heat in the microwave). I'd also take one ibuprofen tablet. The next time I fed him, I'd start with that breast and massage and "milk" the duct as he sucked. Sometimes I'd keep the warming bag on as he sucked. Usually after three or four feedings it would clear.
— Laurie Reid, Toronto
Avoid underwire nursing bras.You're more likely to get a breast infection like mastitis. Plus, they're not nearly as comfortable as the racing-bra styles.
— Heather H., Maryland
Thursday, March 15, 2007
Bathing your newborn
Sponge baths
For the first week or so, until your baby's umbilical cord stump falls off and the area heals, it's best to stick to sponge baths with a lukewarm, moistened washcloth. Wash his face and hands frequently, and thoroughly clean his genital area after each diaper change.
Tub baths
After the umbilical cord stump dries up, falls off, and the area heals, you can start giving your newborn tub baths. While a baby is tiny, it makes the most sense to use the kitchen sink or a small plastic baby tub instead of a standard tub. Although some parents bathe their babies every day for the sheer pleasure of it, until a baby is crawling around and getting into messes, a bath isn't really necessary more than once or twice a week. When you do bathe your newborn, you may find it a little scary at first. Handling a wiggling, wet, and soapy little creature takes practice and confidence, so stay calm and maintain a good grip on him. Some babies find the warm water very soothing. If this is the case with your baby, let him linger. Others cry through the whole bath — that's when you'll want to get him in and out. Keeping the bathing room warm can help.
Bath safety
• Never leave your baby unsupervised, even for a minute. If the doorbell or phone rings and you feel you must answer it, scoop him up in a towel and take him with you.
• Never put your baby into a tub when the water is still running (the water temperature could change or the depth could become too high).
• Set your water heater to 120 degrees Fahrenheit. A child can get third-degree burns in less than a minute at 140 degrees.
• Never leave your child unattended. (Yes, it's so important we listed it twice). A child can drown in less than an inch of water — and in less than 60 seconds.
How to give your baby a bath
1. Gather all necessary bath supplies, and lay out a towel, a clean diaper, and clothes.
2. Fill the tub with 2 to 3 inches of water that feels warm but not hot, about 90 degrees Fahrenheit (32 degrees Celsius).
3. Bring your baby to the bath area and undress him completely. (TIP: If your baby cries through every bath, leave the diaper on at first. It can give him an increased sense of security in the water.)
4. Gradually slip your baby into the tub feet first, using one hand to support his neck and head. Pour cupfuls of bath water over him regularly during the bath so he doesn't get too cold.
5. Use mild soap and use it sparingly (too much dries out your baby's skin), as you wash him with your hand or a washcloth from top to bottom, front and back. Wash his scalp with a wet, soapy cloth. Use moistened cotton balls (no soap) to clean his eyes and face. If dried mucus has collected in the corners of your baby's nostrils or eyes, dab it several times to soften it before you wipe it out. As for your baby's genitals, a routine washing is all that's needed.
6. Rinse your baby thoroughly with cupfuls of water and wipe him down with a clean washcloth. Then lift him out of the tub with one hand supporting his neck and head and the other hand supporting his bottom, with your fingers around one thigh (babies are slippery when wet).
7. Wrap your baby in a hooded towel and pat him dry. (If his skin is still peeling from birth, you can apply a mild baby lotion after his bath, but this is generally dead skin that needs to come off anyway, not dry skin.) Then diaper him, dress him, and give him a kiss on his sweet-smelling head.
What to look for when buying
Because of the controversy surrounding bath seats and rings, few new models are on the market these days. But there are some general things to look for when buying:
• Make sure the seat has a T-bar or strap that runs between your baby's legs.
• Check out display models in a store — do they seem sturdy and well-made? Might they tip easily?
• If it's a model that clamps to the side of the tub, measure the thickness of your tub's wall to make sure the clamp will fit.
• Will your baby fit into it? Bath seats come in one size, but not all babies are built alike — yours may not fit comfortably into it, or be able to be pulled from it without difficulty.
• Consider a seat that comes with spinning toys to make bath time fun.
• Watch out for any rough edges that might scrape your baby's skin when you pull her in and out of the seat.
• As with any children's product you buy or receive as a gift, check our product recall page regularly to make sure it hasn't been recalled.
How to use them safely
Because newer designs are safer, Davis recommends that parents avoid older-model, secondhand bath seats (such as those with suction cups and larger leg holes). The older models' suction cups could give way, causing the seat to tip your baby face-first into the bathwater. And the larger leg holes can allow babies to "submarine," or slide underwater, where they might become trapped.
Newer models have an arm that fits over the side of the tub, but Davis notes that these don't work well on sunken tubs, and the seat can still tip or even break. Follow the manufacturer's instructions when installing the seat, she advises.
Bath rings are inflatable circles that can help your baby stay upright in bathwater. But these may require much more water in the tub to be effective. Safety groups advise keeping the water shallow to minimize the risk of babies drowning.
Most important, no matter which bath seat you choose, never be more than an arm's length away from your baby. Leaving an older, seemingly capable child with your baby isn't safe either. Davis notes that most baby drownings happen while the baby is either unattended or left in the care of an older child.
The lowdown on baby bath seats and rings
Once your little one is old enough to sit up on her own, usually between 4 and 7 months, she's really too big for a baby bathtub. One option is to graduate to a bath seat or ring. These can help keep slippery babies in an upright position, which is handy when your baby is just learning to balance on her bottom and topples easily. But bath seats and rings aren't essential. Many parents manage the precarious job of bathing babies by climbing into the tub with them.
Bath seats and rings are a bit controversial. Many argue that they aren't safe because they give a false sense of security about leaving a baby alone in the tub for a few moments to answer the phone or run to the linen closet. And older designs of bath seats, with suction cups and larger leg holes, can tip over or allow a baby to slide underwater, even with a parent close by.
Some public groups have asked the U.S. Consumer Product Safety Commission (CPSC) to ban baby bath seats and rings, but the CPSC has instead been working with voluntary standards groups and manufacturers to create safer designs. And, more important, they've been working to make it clear to the public that even in a bath seat or ring, a baby should never be left without a capable adult at arm's reach. Bath seats are bathing helpers, not safety devices.
"Baby bath seats are not babysitters," says Patty Davis, spokesperson for the CPSC. "Never walk away, even to answer the phone — your child can tip over in seconds, and drown in just a few inches of water."
Sunday, March 4, 2007
Seven reasons babies cry and how to soothe them
Babies cry. There's no way to avoid it — it's one way they communicate. Since your baby can't flat out tell you, you may worry, "How will I know what she wants?" It can be difficult at first, but a large part of parenting is trial and error and you'll soon learn to anticipate her needs, read her cues, and wipe away her tears. Here are the most common reasons babies cry. If your little one is wailing, work your way down the list and chances are you'll find something that helps.
How can I tell why my baby is crying?
She's hungry
Once you learn to recognize the signs that your baby wants to eat — she'll fuss, make noises, and root around for your breast if you pick her up — you'll get pretty good at feeding her before she starts to really cry. Until then, checking to see if she's hungry is a good first step when your baby cries. Food might not stop her crying right away, but let her keep eating if she wants to. She'll stop once her stomach is full.
She needs a fresh diaper
Some babies let you know right away when they need to be changed. Others don't mind when their diapers are soiled — it's warm and comfortable to them. (Parents are often surprised when they pick up their infant and find she's been sitting in a dirty diaper and never made a sound.) Either way, this one is easy to check and simple to remedy.
She's too cold or hot
Newborns like to be bundled up and kept warm. (As a rule, they need to be wearing one more layer than you need to be comfortable.) So when your baby feels cold, like when you remove her clothes to change her, she'll express her discomfort by crying. You'll learn how to quickly change a diaper and wrap your baby back up. Be careful that you don't overdress her, since she's less likely to complain about being too warm than about being too cold and won't cry about it as vigorously.
She wants to be held
Babies need a lot of cuddling. They like to see their parents' faces, hear their voices, and listen to their heartbeats, and can even detect their unique smell (especially Mom's milk). After being fed, burped, and changed, many babies simply want to be held. You may wonder if you'll "spoil" your child by holding her so much, but during the first few months of life that isn't possible. Infants vary a lot in how much they want to be held. Some demand a lot of attention, while others can spend long periods of time sitting calmly by themselves. If your baby likes the attention, pick her up, wear her in a front carrier or sling, or place her next to you.
She can't take it anymore
While newborns often thrive on attention, they can easily become overstimulated and have a meltdown. You may find that your baby cries longer than usual after spending a holiday with many adoring family members or has periods at the end of each day when she seems to cry for no reason. Newborns have difficulty processing all the stimulation they receive — the lights, the noise, being passed from hand to hand — and can become overwhelmed by too much activity. Crying is their way of saying, "I've had enough." This usually happens when your baby is tired. Take her somewhere calm and quiet and let her vent for a while, and then see if you can get her to sleep.
She doesn't feel good
If you've just fed your baby and checked that she's comfortable (she can be troubled by something as subtle as a hair wrapped around her toe or a clothing tag that's poking her), but she's still crying, consider checking her temperature to make sure she isn't ill. The cry of a sick baby tends to be distinct from the hunger or frustration cry, and you'll soon learn when your baby's cries "just don't sound right" and she needs to be taken to the doctor.
None of the above
Sometimes you might not be able to figure out what's wrong. Many newborns develop periods of fussiness when they're not easily soothed. These fussy periods can range from a few minutes of crying to full-blown colic. Colic is defined as inconsolable crying for at least three hours a day and at least three days a week. Even if your baby isn't crying this much, these episodes may be difficult for you. When all else fails, try the tips below.