Category Archives: Experts

Drug Safety Fact Sheets for Pregnancy

(Scroll up for today’s Q&A.)

Reader Sarah sent me this link to fact sheets on the safety and effects of various drugs during pregnancy from the Organization of Teratology Information Specialists (OTIS). It also has the phone number to call to ask them about any drugs you don’t see on their list.

http://otispregnancy.org/otis_fact_sheets.asp

Aquí hay información sobre la seguridad de alguna drogas, antibióticos, y medicamentos durante el embarazo:

http://otispregnancy.org/otis_fact_sheets.asp

Here are the fact sheets available in English at the OTIS site about various drugs (and other conditions) while pregnant:

Accutane (isotretinoin)
Acetaminophen (Tylenol)
Acyclovir (Zovirax)/Valacyclovir (Valtrex)
Antiviral Medications to Treat/Prevent Influenza (Flu)
Benzodiazepines
Chemotherapy
DEET (N,N-ethyl-m-toluamide)
DepoProvera
Flagyl (metronidazole)
Ibuprofen
Lithium
Metformin (glucophage)
Methamphetamine / Dextroamphetamine
Paxil (paroxetine)
Phentermine 
Propecia/Proscar (finasateride)
Prozac/Serafem (fluoxetine)
Retin-A
Tegretol (carbamazepine)
Tetracycline
Thalidomide
Desyrel® (trazodone) and Serzone® (nefazodone)
Zoloft (sertraline)

Herbal products
Echinacea
St. John’s Wort (hypericum)

Infections and Vaccines
Chicken pox (varicella) and vaccine
Cytomegalovirus (CMV)
Fifth disease (parvovirus)
Hepatitis A
Hyperthermia (fever)
Influenza and vaccine
Listeriosis
Lymphocytic Choriomeningitis Virus (LCMV)
MMR (Measles, Mumps, Rubella) Virus and Vaccine
Staphylococcus Aureus
Toxoplasmosis
Vibrio
West Nile Virus
Vaccines

Maternal Medical Conditions
Breast-feeding Following a Natural Disaster
Diabetes
Exercise
Maternal PKU
Nausea and Vomiting in Pregnancy (NVP)
Stress

Illicit Substances
Cocaine
Methamphetamine / Dextroamphetamine

Other Common Exposures
Alcohol and Fetal Alcohol
Caffeine
Carbon Monoxide
Hair treatments
Hyperthermia (hot tubs, saunas)
Lead
Methylmercury (fish)
Mold
Paternal exposures
Pesticides

Q&A: 11-week-old and self-soothing

ValleyGal, like, writes:

"So I know Sleep Week is over, but I have a sleep questionanyway.  How do you “encourage” a child to develop better self-soothing
skills?  My 11 week old son is only able to self-soothe to sleep in two
places: his swing (after some fussing) and in my bed.  Now, I know that
most people would consider that an accomplishment and let him nap in the swing
(which I often do) and co-sleep (again, often done).  But, while he sleeps
like an angel when he co-sleeps, I don’t.  I barely get any
sleep.  So, I don’t want to co-sleep as a general practice.  He
will happily sleep in his crib, but will only allow me to put him down when he’s
in a deep deep DEEP sleep.  Which is fine, except now I’m so
exhausted that I fall asleep in the rocking chair and end up spending half the
night in the chair (getting painful, crappy sleep) and half the night in the
bed (also getting crappy, but less painful sleep).  I know crappy sleep is
better than no sleep and I know that at some point, he’ll be able to be
put down either awake or drowsy or mostly asleep, but I’m looking for help
in getting him there.  Neither one of us is ready for CIO, so that’s
not an option (although I am okay with FIO (fuss it out)).   

What can I do to help him develop self-soothing
skills?  Am I doomed to several more months of this and then a CIO battle
at 4 or 6 months?  Do I need to let him stay awake longer/shorter before
we start the soothing process?  Put him on a strict schedule?  Find
the magic gadget that works for my kid (crib thingie, sound thingie,
etc.)?  Am I just an anxious over-tired first time mother who doesn’t
know how good she has it?  Help!"

It is my opinion that almost nothing you do has any lasting effect on how your kid sleeps.

I base this opinion on the fact that at any given age, a huge number of babies will be displaying the same sleep "issues" (sorry for taking you back to 1992 with the lingo), no matter what their parents have done or are doing with regards to sleep. Most 4-month-olds are sleeping poorly whether they’re in their parents’ beds or in co-sleepers or in cribs in their own rooms, and I assume kids who sleep on animal skins or tatami mats or in hammocks still have the same disrupted sleep around that time, too. My friends who did CIO (or FIO, or even SIO) and had kids who slept all night at 5 or 6 months found that the sleep crept back into a few wakings, or problems going down to sleep, within a few months. And remember how thrilled I was that the flax seed oil supplements I took made El Pequeño sleep for 7 hours at a stretch during his first few months of life? Well, not even the super-powers of Omega 3 supplementation* could save me from the 8-9-month sleep regression. Talk to the mother of any 18-month-old, and she’ll say either a) "He was sleeping through the night with no problems and now all of a sudden he’s waking up 3 times a night!" or b) "He never slept through the night and now all of a sudden he’s sleeping through even though we didn’t do anything differently!" There are just crappy times for sleep that have nothing to do with the parents at all.

So I think, basically, the way your kid sleeps is a function mostly of your child’s sleep personality, and also of your child’s age.

Knowing that, I think the way you can "teach" your child to self-soothe is just to bide your time. Because the older a child gets, the better able s/he will be to soothe himself or herself to sleep. A little baby has no knowledge of the world and also no sense of time, so there’s really no way a baby that small can understand that you’re in the other room but are still in the world. For a small baby, if you’re not there, you don’t exist, and s/he’s alone in the world. Some kids are extremely bothered by that and will cry and cry, but others don’t seem to mind being alone. In a few months, though, those babies will have learned to trust that you are there, that you’ll come when they need you, and they’ll be able to determine when things aren’t bad (they just wake up between sleep cycles and can go right back to sleep on their own), or when something’s so bad that they need you (like a nightmare or hunger, which makes them cry to get you to come).

Because kids are all different, you’re going to have to really pay attention to how your child is and what he needs. There are some kids who just always need to be nursed or rocked to sleep. For months and months and months, until you think you’ve made a huge error in rocking them in the first place because now they’re dependent on it. But then one day, the kid just won’t need to be rocked to sleep anymore and will go to sleep happily and without incident. Other kids seem to need to fuss to sleep, others need to be left alone to go to sleep (I was one of those, apparently), others need some kind of music to help them get to sleep, etc. until one day it doesn’t seem to matter and they go to sleep on their own. None of us had to take our mothers with us to college, after all.

I really think it’s important to listen to your child and figure out what s/he needs, and not listen to anyone who’s trying to sell you on a one-size-fits-all method. Especially if that expert is predicting all kinds of gloom and doom about what will happen if you don’t "teach" your child to self-soothe by doing CIO. How, exactly, does crying it out teach a child to soothe him- or herself? All it teaches is not to bother crying for you because you won’t come. It’s effective in taking you out of the loop of night-wakings, but it certainly isn’t teaching your child to self-soothe–it’s actually creating anxiety in the child. (Note that I’m not talking about "fuss it out," which some kids seem to need to do to wind down, or the thing you do when you go in every 5 minutes to soothe, which seems more like sleep training the parents to me, but seems to work for some people.)

(I’m also highly suspicious of any expert that claims a baby needs to learn to go down awake and get himself or herself to sleep within the first few months. Why, exactly? Kids who are rocked or nursed down to sleep all learn to go down by themselves anyway, so who cares if they can go down awake by a certain number of months? Given the choice between rocking to sleep for 15 minutes and knowing my baby will definitely fall asleep, or struggling for 45 minutes to get my kid to go down awake with no guarantee the baby will actually fall asleep, it seems like the "going down awake" plan is the clear loser. But people believe the predictions of disaster that their child will "have problems" if they don’t get them to go down awake. I call bullshit. It seems like something designed to create guilt and feelings of inadequacy in the parents, who will then run out to buy more books from that author. Follow the money…)

(Oh, and I’m also suspicious of any expert who says that all babies need to co-sleep for any set period of time. We’re a co-sleeping family, and I think anyone who has their kid in a separate room for the first few months is a little crazy because they’re creating a bunch of extra work for themselves in the middle of the night, and who needs extra work in the middle of the night? But it’s asinine to think that all babies need or want to sleep with their parents for any set amount of time. If your baby sleeps better alone, then you’re not compromising anything by having separate sleep space. Your baby will give you cues about when it’s time to move to another bed, so pay attention and it’ll be an easier transition than you anticipate.)

So, this has been my long-winded and highly opinionated way of saying your baby is totally normal. Very few 11-week-olds can be put down without being in a super-deep sleep. None of them can truly self-soothe (although some of them don’t seem to mind being alone, so they don’t fuss, so people think they’re self-soothing). And it’s so normal to feel trapped and at the end of your rope at this point in your child’s life.

It will get better even if you do nothing. But it’s just too demoralizing to do nothing, so here are a few tricks you could try to rearrange things more to your liking:

  • Borrow a co-sleeper or take off one side of the crib and tie it to your bed to be a sidecar. Then nurse the baby to sleep and gently roll him into the cosleeper/crib when he’s asleep. Or, if your boobs are big enough, put him in the cosleeper/crib and then nurse him to sleep (on your side, boob sticking into the sidecar), then sneak out of bed yourself.
  • Get a musical lovey, like a stuffed animal with a music box in it. At a time of day when he goes to sleep easily (maybe the first nap of the day if he’s taking regular naps yet–snort, or going to sleep at night), put the lovey with the music going snuggled in with the two of you while you nurse him to sleep. After a few weeks of this, after you nurse him, when you do the transfer to the crib, wind up the lovey and put it right next to him as you do the transfer, so he gets soothed back to sleep before he really wakes up all the way.
  • Do the same thing with a non-musical lovey, although I think the effect will be stronger with the addition of music.
  • Start doing a solid routine at night. Bath, jammies, books, nurse to sleep. The same exact sequence every night, starting at the same time. In a week or two he’ll start to anticipate it and it will be easier to get him to sleep once you hit that point in the routine. This is probably your best bet, and is definitely the one thing I’d recommend to anyone, even if their child sleeps well generally.
  • Associate words with actions. Every time you latch him on, say clearly "nurse" (or whatever word you use for it). When it’s time to go to sleep, say "sleep." When you put him in the bath say "bath." In a few days or so he’ll start to put it together, and he’ll get the predictability of it. And if he’s cranky you can ask using the word, and he can tell you what he wants by responding.
  • Start watching him like a hawk during the day to see if he’s doing anything like the 2-3-4 nap pattern. If he is, run with it, because the more regular the naps are, the easier all his sleep will be. Of course, it’s usually easier to get naps into place once the nighttime sleep is more regular, but it’s worth a shot.

You’ll notice that none of these things are instant fixes, but most of them are things that will end up helping you communicate better with your son. That’s the big payoff, because once you’ve got that strong communication going, everything will be easier for both of you. Less crying, better sleeping, more laughing. For both of you.

*For those of you who have been asking for details of flax seed oil supplementation for pregnancy, I’m working on a post about it as you read this, and will get it up soon.

Q&A: toddler eating and drinking

Kat writes:

"My babies are 13 1/2 months now, and both of them act as if I amchoking the heck out of them when I try to feed "solid" solid foods.
Things they can/will eat: 1) cheerios, tofu hot dogs cut into small
pieces, macaroni and cheese, shredded cheese.  Anything else I offer,
small cut up pieces of chicken, green beans, kidney beans, baked beans,
black beans, julliened(sp?) cooked carrots, any other foods I think
might be "soft" enough, like a bite of lasagna, for example, is
promptly spit out of their mouths or choked on.  I am at my wits end,
imagining that I will still be spooning baby food jars of green beans
and rice at 2 years old.

Also, we are having a heck of
a time encouraging the sippy cup.  They seem to rather not drink
anything than to drink milk from the sippy (although strangely enough
they will guzzle water from the sippy).  Mini I can understand as she’s
only for the boob, but Jr. only takes a bottle, I thought he’d be
easy.  People are making faces at me for continuing to offer the bottle."

 

I’m going to start at the end of this question.

<rant>

I hate, no make that despise, the crazy fervor in this country to get kids off the bottle at exactly the 12-month mark. If you can keep a kid on the breast past 12 months (and let’s remember that the WHO recommends nursing until at least 2 years, so no one ought to be telling anyone to wean at 12 months if she doesn’t want to) then you can keep a kid on the bottle past 12 months. But we seem to have this bizarre preoccupation with taking away anything that resembles comfort for our babies to encourage them to be independent. Because God forbid a toddler might actually need comfort, and all the ills of the world are clearly caused by having used a bottle too long.

<insert eyeroll></rant>

But now to circle back around to the front of the question.

I’m not sure about the choking, honestly. Is it that they’re engaging in a power play or just don’t like to eat those foods and are pretending to gag (which sounds dead on for that age), or are they actually physically choking on them? If you’re going in to the pediatrician at 15 months, just mention it and see what s/he says. If the ped thinks there’s anything going on, s/he’ll give you a referral to a physical therapist who will evaluate them.

Best case scenario: They get evaluated and it’s nothing, and you can stop worrying.

Worst case scenario: They get evaluated, and it’s something that can be dealt with easily with regular therapy, and you can stop worrying.

Linda (also a mom of twins–hmmm….) asked me a sippy-cup-related question recently, too, so I’ll add hers to yours:

"I hate sippy cups.  I posted on my blog forever ago about it and I
still haven’t figure them out.  My kids will only drink from the soft
tipped ones.  I can’t get them to drink from the hard tipped ones at
all.  The problem is that they chew on the soft tipped ones and then
break the valve and render them useless.  I think you recommended the
straw cups.  Do you stand by that?  And when can they start (reliably
and relatively neatly) drinking from a topless cup?"

I don’t really get the sippy as this new "skill" or "milestone" people act like they’re teaching. It’s not something that really builds to anything, since most of us don’t do any kind of motion like drinking from a sippy as adults. The real point of the sippy is that it doesn’t spill when it’s tipped over, not that it’s something kids need to learn to use.

OTOH, learning to suck things from a straw is a useful skill. Straws are fun, and you have the chance to use one every time you drink anything at a restaurant. You use the same motion when you drink from a sports bottle. If you don’t want to mess up your lipstick, you have to use a straw. And–here’s the kicker–it’s an easier, more natural muscle motion for kids to learn. El Chico was a sippy conscientious objecter when he was a toddler, but when someone suggested a straw cup I tried it and he got it immediately. We’ve used the Playtex Straw Cup and also the Rubbermaid straw cup and found both to be delightful.

We have a couple of friends who were diagnosed with low muscle tone (hypotonia) in the mouth muscles, and one of the things they’re supposed to do is drink out of straws every day. So there’s that.

Kat, I don’t think it’s at all odd that they won’t drink milk from anything that they haven’t been using all along (the breast for your daughter and the bottle for your son). Milk is the basic, bedrock comfort, and they don’t want anything changed about it. El Chico would never take breastmilk from a straw cup (only me or the bottle), but would take ice cold cow’s milk from the straw cup. I’ve heard similar things from lots of other moms–that their child would take breastmilk or formula only from boob or bottle, but would take other liquids from the straw/sippy.

So I’d say just to forget about getting rid of the bottle (unless it’s actually bugging you) because undoubtedly you’ve got some bigger fish to fry at this point, and don’t expect them to take milk from the straw/sippy. Use it for other liquids, instead. That’s my famous Lower Your Expectations method of parenting, BTW.

I bet people are actually making faces at you because they’re jealous that you look so good despite having twin toddlers, not because of the bottle.:)

Linda, I thought I could say that 3 was when they could reliably and neatly drink from a topless cup, until we hit 3 1/2.

Have you read any of the Ames and Ilg series of books on child development?  They were recommended by the amazing Dawn, and they are dead on. They all have funny titles like Your Two-Year-Old: Terrible or Tender and Your Three-Year-Old: Friend or Enemy, and some of the things are horribly outdated (assumptions that the mother is at home all day with the child, and that kids aren’t in school ever until age 5) because they were written in the 70s, but they are scarily accurate. You think your child is some sort of freak and that you’re raising a monster, and then you read the book and every odd thing your child is doing is typical behavior for that age and will go away in six months. Highly comforting.

Anyway, Ames and Ilg say that kids alternate between equilibrium (emotionally and physically confident and sure) and disequilibrium (in emotional upheaval and physically clumsy) for years. On the year seems to be equilibrium and on the half year seems to be disequilibrium. So at 3 El Chico and his friends could walk around with open containers and not spill any. But then a few months later they’d spill every freaking time I’d give them a cup. We’re starting to go back to mastery, though.

So you probably want to stick with the white grape juice for a few more years. But try the straw cups now, and let them use topless cups outside next summer so they can practice.

I’m Here To Help

A few days ago I was reading a friend’s blog. She’s a new mom, and she posted that she’d read something in a book that helped her figure out an aspect of her child’s routine. A few commenters posted that they were glad she’d had this insight, etc. But others started falling all over themselves to declare their total devotion to the author of the book. One mom said the author was her "hero." Another said she had "undying love for" the author and saw him as almost a benevolent relative to her children.

I don’t think they realize that he’s not the only person who knows this particular bit of information about babies.

When my mom was here after El Chico was born, she was reading my copy of a popular parenting book by a different author. About five pages into it she screwed up her face and said, "Does this guy think he invented this? We were doing this back in the 70s, only we just thought it was normal."

That’s got to be the thing I hate third-most about parenting: No matter what path you take, there’s someone who’s written a book telling you that there’s only One True Way, and if you deviate from it you’re going to raise children who have no control/are too tightly controlled/are too dependent on you/aren’t attached to you/won’t ever sleep through the night/won’t be good Christians/will turn into fundamentalists of one sort or another/will wet their beds until they’re teenagers/won’t come visit you when you’re 90/won’t be able to learn Latin/will only speak in Pig Latin. And they act like this dogma is a huge revelation that only they’ve had. So not only do you have to do what they say, you have to think they’re the only ones who could have come up with their position.

All this is a really roundabout way of saying that none of us has unique information. Sears doesn’t, Weissbluth doesn’t, Ferber doesn’t, Leach doesn’t, Spock didn’t, Hogg didn’t, Pantley doesn’t, Supernanny doesn’t, even Ina May doesn’t. Dobson doesn’t, Cohen doesn’t, Karp doesn’t, Faber and Mazlisch don’t, and Gary Ezzo certainly doesn’t. Your MIL doesn’t. My mom doesn’t. Your pediatrician doesn’t. And I don’t. All these people (including me) have done is gathered the wisdom of the universe, digested it, and spit it out with their own personal biases.

So before you read what anyone else says about raising kids, stop and think about the fact that you know your child best. Not me or any of those other people. We can give you ideas, or help you see things in a new way, or make you feel better or worse about what you’re doing. But you’re the one who knows. So trust your instincts. And keep on rocking the mama thing.