Category Archives: Pregnancy

Q&A: pacifier weaning too abruptly and sleeping in big boy bed

Peggy writes:

"I read a some of your advice on pacifier weaning. The problem for us is that we had to pull my son off his paci a little too abruptly. He is 2 1/2 years old and has only switched to a big boy bed in the last 2 months (we are expecting a little girl in a few months). I’d say he’s willingly been using the pacifier for naps and nighttime only for the last 8 months without needing it or asking for it otherwise. However, we had to pull him off of it recently because he had taken to chewing on them and and we were afraid the nipple would break off and choke him. When he got down to his last pacifier, we tried to explain to him that he needed to stop chewing on it otherwise it’ll be broken and we’ll have to throw it away. Well, that time came within a few days. It has been terrible since all his pacifiers are gone. He keeps having these fits in the middle of the night where he is looking for the paci, but he is so out of it, we can’t comfort him enough to calm him down. He eventually falls asleep on his own. This might happen 1-3 times a night. Also, because he is in the big boy bed and isn’t fully adjusted to it yet, he comes running into our bed most nights and we can’t get enough sleep (which I really need with a newborn on the way!) I thought it would be better after a few days, but it’s been over a week.

In a related matter, do you have any suggestions for getting our son to lay down in his bed and stay there on his own? Right now, he only goes to bed if both my husband and I lie down with him until he goes to sleep. We read a few books and turn off the light (same routine every night), but he won’t let us leave. We tried using a gate in his doorway but that was too traumatic for both him and me. We thought we had introduced the notion of a big boy bed as best we could in the first place. He got to help pick it out, and he was really excited about it. He doesn’t seem to want to be back in the crib at all, so I don’t think that is the issue."

Before I really start in on any of the specifics of this question, I want to tell you not to underestimate the effect of having another baby on the way. Even if it’s a few months off, your son is likely to be feeling anxious about it since it’s such an unknown. He can’t verbalize those feelings (even if he understands them, which he doesn’t), so they’re going to come out in other areas of his life, including comfort objects, sleep, and behavior. If you can keep that in mind, it’ll help you get through this stuff more easily because you’ll at least know why some of this is happening and that it’s a time-delineated problem.

I think you’re stuck with the pacifier problem until it works itself
out, which could be a few weeks. In hindsight, you maybe could have
saved yourself a little bit of trouble by having some kind of ritual to
get rid of the pacifiers (giving them away to "someone who needs them"
or burying them in the backyard or sending them to the Pacifer Fairy, or just some kind of ritual to mark
the passage). But I don’t think there’s really any good way to get rid
of pacifiers without any trauma at all, and you clearly had no choice
but to get rid of them ASAP, so all this Monday-morning quarterbacking on my part is just hot air.

The only thing I can think of that might help is to talk
about how he doesn’t use pacifiers anymore during the day at least few times every day,
to rehearse it with him so it’ll stick in his head in the middle of the
night. And make sure you talk about it right before bed, too, so it’s
still in there. It might click at a certain point and he won’t be
looking for one in the middle of the night if he remembers that he
doesn’t have them anymore. And even if it doesn’t help him have an easier night, at least it’ll give you something concrete to do to try to alleviate things until he just moves on on his own.

It sounds like your only problem with staying in his bed is going to bed the first
time, correct? I think that’s really common at that age, to want
someone there while they fall asleep. It’s a normal developmental thing, and doesn’t mean you’ll have to do it forever. Honestly, to me the biggest
problem with the scenario is that he wants both of you there. One of
you is reasonable, but two is excessive.

Personally, I’d vote for your husband to be the one to get him
to bed, because when your daughter gets here you’ll be occupied with
her, and your son will most likely regress for the first few months and
need someone to help him get to sleep (even if he starts going to sleep
completely on his own this week). I guess there could be an argument
made that it should be you for now and then when your daughter arrives
it should switch to your husband, but that’s up to you two to figure
out.

Whichever one of you is not the one getting him to sleep
should arrange to be out of the house at bedtime for a few nights. If
you’re not there, then you can’t be roped into putting him to sleep.
(I’m assuming that there are nights occasionally when either you or
your husband aren’t home at bedtime, so this won’t be a completely new
thing for your son. I can’t emphasize enough the importance of having something even once a month that lets you get out at night to do something adult.) Although this is going to be annoying, I’d also recommend having your husband lie down on the floor next to him, instead of in his bed, because that makes it easier just to roll up and walk out, since it won’t shake the bed and risk waking your son. The first night or two might be a little rough for your husband (depending on how tenacious your son is*) but then they should settle into a good pattern, and you can start being home at bedtime again.

I think you guys should be prepared to have to be in there with him to drift off to sleep until a few months after the baby comes. (I’m being realistic here. It’s not my goal to blow smoke up anyone’s skirts by saying it’ll take a week at this particular point in his life. If the baby wasn’t on the way, it might only be a few weeks, but this is a fragile time. And who knows? Your son might start going to bed just fine on his own after a day or two anyway.) When you feel like he could be loosening up and not really needing your husband anymore, your husband can use the tried-and-true method of saying he has to leave to go to the bathroom but will be back. Then gradually he stays away longer and longer, to see how long it takes your son to fall asleep once he’s out of the room. One day your son will forget to ask for him to stay, and everything will have clicked into place without anyone realizing it.

Good luck. This is such a tough time because of the transitions happening, but it will get easier in a lot of ways once the baby comes.

* Hey, tenacious is a really really good quality in a person. It bodes really well for later success. It’s just a little inconvenient when you’re trying to change that toddler person’s sleep patterns.

Q&A: paint fumes affecting a fetus (updated)

Angie jumps right to the front of the long queue with this:

"I just arrived at my parents house for Christmas, with my partner and10-month-old baby.  I am 15 weeks pregnant, and haven’t told anyone as
I’m waiting for the amnio results.  We found out as we arrived that my
mother painted the whole house a week ago with both latex and oil
paint, to spruce up for the holidays.  A little shortsighted, since she
lives in New England and it is too cold to leave the windows open. 
Despite trying to air out the fumes for a week, the house reeks in all
rooms, including where we are sleeping.  I am miserable because of my
superhuman sense of smell due to the pregnancy, but I am especially
worried about exposure to the fumes for the fetus, as well as for the
10-week old.  We are supposed to stay here for a week, which I am not
sure I can stand.

Do you have any input or thoughts, or better skills than I at extracting specific info from the internet?"

Who leaves people hanging for amnio results over a holiday weekend?!

I wish I could say, "Don’t worry–it’s totally fine," but I obviously can’t. On the other hand, I wouldn’t spend much time worrying about it for two reasons. The first is that the rooms were painted a week ago so the paint is dry, and it’s just the smells and chemicals outgassing, not actual wet paint fumes. Is there any chance that the house is one of those charmingly drafty New England homes, the kind with high heating costs and no danger of radon scares? If so, then you have even less to worry about.

The other thing that makes me not worry so much is that you’re in your 15th week. From what we’re learning about fetal alcohol exposure, weeks 3-6 appear to be the most critical for staying away from exposure to damaging toxins, but the rest of the first trimester is also the time of greatest and most significant development. A day or two of exposure to smelly paint fumes at 15 weeks is hardly the same as it would be at 5 weeks.

If you want to leave the house, you’ll have to bring up the highly legitimate concern of whether your 10-month-old baby should be exposed to paint fumes. It sounds like your mother just wasn’t thinking clearly, and thought the fumes would be gone by now, because surely she wouldn’t want to expose her grandchild to the fumes. Use that to get you out of the house as much as possible, even if it’s just to go stand by the back door inhaling some clean air, or going out to post-holiday sales, or going to visit other people. You can always use the old standby of blaming your pediatrician as an excuse to get out as much as possible.

(FWIW, when I was nine weeks pregnant with my second, my aunt highlighted my hair for me. When I went to wash it out in the shower the fan in the bathroom was broken. I was sucking down hot ammonia steam for a solid 10 minutes, trying desperately to get it out of my hair and my system. I still look at him and wonder if he wouldn’t bite me so much if I hadn’t inhaled all that ammonia. I don’t really think it did him any harm, but I also don’t think I’ll ever stop feeling guilty about it completely.)

I hope your amnio results come back with no cause for concern.

Are there any toxicologists reading who know more about paint fumes specifically? Or anyone else to offer pseudo-comforting toxin exposure stories like my ammonia confession?

UPDATE: Reader Sarah reminds me that the best place to find out info about any kind of prenatal exposure is to call the counselors at OTIS, the Organization of Teratology Information
Specialists.  Their number is 1-866-626-OTIS.  They are experts at
giving pregnant women information about all sorts of situations like
this — this is the service the CDC refers women to when they call about exposure issues.

Thanks, Sarah!  

Q&A: 2-year-old sleeping (and everything else) problems

Katie P writes:

"I’ve thoroughly enjoyed all your advice, and I’ve poked through the archives, but haven’t seen anything that quite explains what is going on with my two-year-old son (technically, he’ll be two on July 1). My formerly good sleeper is now taking well over an hour every night to settle down and go to sleep, and even that takes me going in there and either hushing him to sleep or rocking him.

Caveats: There’s a whole lot going on right now. We just — as in we’ve been in this house less than a month now — moved 400 miles west, and the daylight is different. It’s not more daylight or less, just a time shift since the sun sets about half an hour later than it did where we were before. This does mean that it stays light in his room longer, although we’ve tried to fix that with a light-blocking shade (which we used before). The move also marked his transition out of the crib, in part because I’m 26 weeks pregnant and we wanted him to have plenty of time to adjust to being in a big-boy bed before the baby arrives.

I’ve tried to keep our bedtime routine pretty much the same as it was before we moved, although I have played around with the actual time itself a bit, and it hasn’t helped. I used to go through the routine, put him in the crib and tell him "Night night, Mama loves you," and he’d put himself to sleep with no crying in about five minutes. Now there’s some extended playtime (he likes to get up and shut the door to his room all the way, among other things) and wailing before he settles down. And again, it’s taking me having to go in there and either sit on the bed and say "hush" to him or pick him up and rock him in the living room before he’ll go to sleep. But I cannot take this much longer: the last couple of nights it’s been 10 p.m. until he’s in bed, and then he’s sleep-deprived and cranky during the day. Which, by the way, is now spent entirely with me, since I stopped working when we moved, too.

We won’t even get into the issues with him flat out ignoring me when I ask him to do things like go get a diaper change or pick a toy up off the floor (he closes his eyes because if he can’t see me, then he doesn’t have to listen). Not to mention that as soon as Daddy gets home, I might as well not exist anymore, which is hard on my husband who feels he gets no time to himself to relax in the evenings. Oops, I guess I got into them after all.

Help! Where do I even start?"

What I find fascinating about this email is that the child’s whole demeanor, day and night, is going kablooey, but Katie titled her email "Another sleep question." Isn’t it funny that we’re able to put up with so many troubling phases our kids go through during the day, but they really bug us at night?

It sounds like this kid is dealing with a bunch of things right now. The first are the things all kids go through at this age: the second major separation anxiety phase, a big gap between receptive language and expressive language, and the normal control issues that seem to fluctuate by the day.

Then add onto that a move, losing all his friends, losing his daycare provider(s), a new house, a new bed, spending more time with his mother (a positive stressor, but still a stressor), the different light schedule in the new place, and a sibling on the way.

Of course he’s freaking out. Frankly, I’m surprised that he’s not waking up multiple times in the middle of the night with all the stuff that’s going on in his brain.

Time is eventually going to fix all the problems he’s having, because he’ll adjust to the new house, new schedule, new time with his mother. He’ll make new friends and get engrossed in new activities. It will all become normal to him and he won’t be stressed out about it anymore (except for the new sibling, but that’s just part of being the older child).

In the meantime, probably the best thing you can do is focus on maintaining a solid, predictable, almost rigid daily schedule. He needs to feel like he knows what’s going to happen over the course of the day when he wakes up in the morning, and what’s going to happen the next day when he goes to bed at night.

When he wakes up, review what’s going to happen that day. You might even consider doing the picture schedule some daycares and preschools do, where there are pictures of the different activities up on a wall so non-readers can keep track of what’s going to happen next.

As you finish one activity, talk about what’s going to happen next. Keep talking about what’s going to happen all throughout your daily activities. Before bed, talk about what’s going to happen the next day.

Giving him a solid, predictable routine is going to help him feel more secure. Try to build playdates and errands into the same time slots every day. That way he’ll know that right after breakfast you go outside and meet someone else at the park, and after lunch you go out in the car to run errands, or whatever you decide the schedule should be. It doesn’t matter what you do when, as long as it’s predictable and comforting for him.

This isn’t going to transform your son into a smiling, obedient cherub,
but it will probably cut down on some of the tantrums and control games
he’s trying to engage you in.

You’ve only been a SAHM for a month, but I’m sure you’ve already figured out that sticking to a routine (even a flexible one) is essential or else you both end up still in your pajamas at 3 pm. (Er, not that there’s anything wrong with that.) So having a strong routine for the next few months is going to end up helping you get stuff done and get established in your new town, too.

I don’t have any good advice specifically for bedtime. When we were having the same problem I tried putting my son to bed much earlier, then putting him to bed much later (figuring that if he was going to be up until 10 anyway I might as well start with the bedtime routine at 9:40), then being strict and mean at bedtime, and then letting him fall asleep in our bed. Eventually he did start going to bed again easily, but I don’t think it had anything to do with anything I did. You might end up happening on something that will help your situation if you can figure out what exactly is causing him to stay up. Is he afraid that when he wakes up things will be different? Is he too excited from some activity you’re doing in the afternoon or evening in the new place that you weren’t doing in the old? Is he working on some new skill? Or is it just the lightning rod of all his stress?

If you can’t figure out exactly what his particular bedtime issue is, don’t feel bad about it. Just know that it will get better as he gets more comfortable in your new place with your new routine. And see if you can trade off bedtime duty with your partner so neither one of you has to deal with it too many nights in a row.

Q&A: finding a pediatrician

Mary writes:

"Everyone tells us we need to go out and start interviewing
pediatricians (I’m 30 weeks pregnant).  Ok, fine, but what do we ask
them?  And how do we find ones to interview?  A coworker recommended
one that she used to work with but other than that, we’re kind of
clueless, as we are with most of this baby stuff."

Choosing a pediatrician is a lot like planning a wedding. There are a hundred things to think about, and things you have strong opinions about will be completely unimportant for other people, and vice versa. The trick is to figure out what you care about. Then you can ask those questions and just not worry about the other things.

To find doctors to interview in the first place, ask everyone you know who they use(d). Also go to your insurance company’s website and get a list of names. Once you’ve figured out what you’re looking for (which I’ll cover below), call up and ask your first level of weed-out questions over the phone. You may not have to interview more than one or two people in person.

The first thing I’d think about is your parenting style. Are you going to be laid-back or highly managerial? When my son was maybe 10 weeks old he had some rash that I asked my doctor about. He told me, "Squirt some breastmilk on it. At this point breastmilk, either in him or on him, is pretty much the cure for every problem he could have." I was happy with that answer (and the breastmilk did clear up the rash), but a more highly managerial parent would have been upset that there wasn’t a definite diagnosis with a clear treatment path including a plan for contingencies. If you call and ask a question, do you want to know exactly why things are happening, or just that they’re normal? A mismatch between your style and the pediatrician’s style will leave you feeling inadequate and judged or frustrated and angry.

Don’t confuse this with the parenting philosophy you follow, which is another thing you should ask potential doctors about. If you have definite opinions about things like scheduling, feeding, sleeping, pacifiers, vaccinations, circumcision, etc. you want someone who’s going to support you, not someone who makes you feel like a bad parent for choosing those things. Your pediatrician doesn’t necessarily have to agree with you about everything, but s/he does have to support you without being judgmental. If you say, "We intend to cosleep. How do you feel about that?" the correct answer should be something like "There are a number of families in my practice who cosleep" at a minimum (because it doesn’t necessarily imply endorsement, just familiarity and acceptance) or "I think cosleeping is wonderful for babies and parents" as an ideal. If you hear "I don’t recommend it. You’ll end up with a 5-year-old in your bed," move on to the next doctor on your list. (Obviously the same thing goes if you want to have your child sleeping in a crib and you get a less-than-enthusiastic response from an interviewee ped. Next.)

There are, of course, going to be some things you don’t care about. Just don’t ask about those. If you have someone who matches your views on the things you are most concerned with it doesn’t really matter if you match on the other things. Make sure you take into consideration the style issue, though.

Breastfeeding is another thing to ask about. Every pediatrician (unless s/he’s stupid) will claim to be supportive of breastfeeding. But claiming to be supportive and actually being supportive and having the knowledge to help with common nursing problems are two vastly different things. How many mothers in the practice nursed for 6 weeks? 6 months? 1 year? The answers to those questions are going to tell you how much emotional support the doctor gives to breastfeeding and how much practical help the doctor gives (that includes being able to recommend and partner with a good lactation consultant). Medical school still does not teach much about human lactation, so what pediatricians know about breastfeeding is what they’ve chosen to learn. A good ped either has made the effort to become educated about breastfeeding (beyond the info pamphlets the formula companies send–at a minimum the doctor should have taken the same 3-hour class you took) or recognizes that an IBCLC lactation consultant is an expert on breastfeeding and treats her as a colleague and not an underling.

Antibiotics are another hot issue. Some doctors prescribe them at the drop of a hat, some are more circumspect, and others only prescribe them under duress. Here’s a pretty concise overview of why overuse of antibiotics isn’t a good idea. You want someone who will reserve use of antibiotics for when there’s an actual bacterial infection present.

I’m sure you’ve heard the old chestnut "What do you call the person who graduates at the bottom of his or her med school class?" "Doctor." You should also use interviews to try to weed out doctors who are ignorant or just plain stupid. A friend of mine (who is 5 feet tall with a husband who’s 5’6") was told by her pediatrician that her daughter was "too short" and that he was concerned because "We want every child in our practice to be in the 50th percentile." Where do you even start with a doctor who doesn’t understand the basic concept of a bell curve? Or that a child with short parents will probably be on the short side of the curve? He then continued by telling her that he thought her "extended" breastfeeding (their baby was 9 months old at the time) was stunting the baby’s growth, and he wanted her to cut down on nursing and feed the baby more apples and green beans to make her grow taller. Um, yeah.

You don’t want to end up with a doctor who’s so ignorant on so many levels, or one who’s overly concerned about things that are normal. If your baby is likely to be particularly short or tall or skinny or fat or pale or of Asian descent (and thus prone to those birthmarks that can look like bruises) or bald or hairy or a carrier of a genetic disease or whatever, bring that up at the interview and ask the doctor what s/he thinks. Any answer like "Someone’s got to be in the 95th percentile, so someone else’s got to be in the 5th percentile" or "It would be ridiculous to expect that a child with parents as tall as you are won’t be off the charts" or something else that recognizes that kids are all different and should be taken on a case-by-case basis is what you’re looking for.

Any answer that starts with "We want all the kids in our practice to" is bad news. My friend’s pediatrician got all worried because her son wasn’t walking at 18 months (the range of normal is around 9-16 months for walking, so he was late). The ped gave my friend the "We want all the kids in our practice to be walking by 18 months" line (to which I said, because I’m a smartass like that, "I’m not really sure that it matters what she wants, now, does it, if he’s not walking?") and sent him to be evaluated for cognitive developmental delays. In the meantime, the child was drooling constantly and his speech was extremely hard to understand, but his responsive language was way ahead of his chronological age and he was ahead of the curve with imaginitive play and stuff like that. It turned out that he had low muscle tone in the jaw and chest (which explained why he wasn’t walking yet, was drooling, and couldn’t enunciate) which was treated easily with regular physical therapy. The pediatrician absolutely missed the boat and focused on the wrong thing because she was so concerned with what she "wanted" all the kids in the practice to be doing.

Another thing to consider is whether you want to go with a pediatrician or a family doctor. There are advantages to both. A pediatrician is going to be more focused on specific childhood illnesses and conditions. A family practice doctor is going to have more of a long-range view and might not be as concerned about things that are only issues for a short time. A pediatrician is going to be dealing with huge numbers of kids so s/he’ll have a real picture of where your kid is compared to other kids. A family practice doctor will be able to treat your entire family. Think about which model you prefer.

There’s an excellent list of questions to ask your child’s doctor here. It covers things like whether the doctor will come check out your newborn in the hospital or wait until the baby comes home (a hospital pediatrician or intern will check out your baby in the hospital if your own ped doesn’t–it’s routine and no big deal). It also covers procedures for scheduling appointments, after-hours problems, and getting sick kids in for emergency visits.

Often times these things are a balancing act. I love my doctor (a family practice doctor who treats me, too) because he’s very laid-back and treats me like a true partner in care (not someone who needs to be told what to do). He asks things like "Are you happy with the kids’ sleeping arrangements? If you’re not, I can help you troubleshoot" and he gets my jokes. But the downside is that he’s only in the office a couple of days a week and he’s always overscheduled. For me it’s worth it to be so happy with what he does for us when we need him that I just accept the burden of scheduling way in advance. We’ve also been lucky in that our only emergencies have been off-hours so he was pageable. Other parents are going to want easier, more immediate access and will put up with more editorializing from their doctors. As long as you know what you want and choose a doctor based on that, you’ll be happy.

Another thing to think about is where the emergency room your doctor admits to is. All other things being equal, you should go with the doctor who admits to the closer ER. (Within reason. If there’s only a few minutes difference in travel time, go with the better ER.) When your baby can’t breathe from croup in the middle of the night, you don’t want to have to drive 30 minutes to the ER.

The bottom line, though, is that you have to feel good on an interpersonal level with your doctor. A doctor can be brilliant and knowledgeable, but that doesn’t mean s/he’s kind or humane. If there’s something you don’t like about the doctor don’t go with him or her, even if everyone you know raves about the doctor. You don’t want to feel any hesitation (ever) about calling to ask a question or bringing your child in to the office. So it’s important that you feel good about the person professionally and personally.

Again, read the list of questions from The December List here. Other than that stuff, is there anything we forgot?

Q&A: pelvic pain in pregnancy

Megan writes:

"I’m almost 6 months pregnant and about a month ago I’ve noticed a lot
of pain around my lower back/sacrum.  After some research I found
that I’m experiencing "posterior pelvic pain", mostly due to the
loosening of tendons (thanks to relaxin,
a pregnancy hormone) and the extra pressure of the baby’s weight in the
pelvic cavity.  I know that this is a common pregnancy ailment but
I haven’t been able to find much useful information on how to alleviate
my discomfort.  Some resources recommended a pelvic belt.  Do
those work?  The pain is so bad that I often have a hard time
standing or walking, especially after sitting or lying down for long
periods of time.

Do you (or your readers) have any advice?"

I’ve never used a belly belt, but friends have reported that they helped relieve some pressure and pain. I think your most direct route to relief, however is going to be the combination of chiropractic care and Pilates or yoga.

You should find a chiropractor who specializes in pregnant women and is trained to do the Webster Technique (the adjustment that helps relieve hip pain and turn a breech baby head-down). I’d ask your midwife or OB for recommendations. If they don’t know of anyone, look up a chiropractor who specializes in children, because there’s usually a lot of overlap between chiropractors who specialize in pregnancy and who specialize in children. You’ll probably have to go for 2-3 treatments before you feel significant relief, but after that you should be able to maintain with visits every week or so. Chiropractic in pregnancy is very gentle, and the chiropractor won’t do any x-rays to assess you.

Taking a prenatal Pilates or yoga class should also help keep your back pain-free. If you can’t find a prenatal Pilates class in your area, there are several DVDs you could get. If you’re not usually an exerciser and want something to help you stretch but not to tax you too much, get Pilates in Pregnancy. It moves reeaaallllyyy slowly, but if you can stay awake you’ll get a nice stretch. If you’re already used to Pilates and want more of a workout, try Pilates During Pregnancy with Niece Pecenka. Pregnancy yoga is all about breathing and stretching, and you may find it easier to get into some of the tougher poses because you can stretch so much more easily with the relaxin.

Another suggestion is to try to sit upright as much as possible (facing backward on a chair with a back or on an exercise ball) instead of reclining. This will help put the baby in the best position both for birth and to relieve the pressure on your back. The website spinningbabies.com is full of information about positioning for comfort and easier labor, as well as an explanation of how to figure out which way your baby is turned in the womb.

You could also try acupuncture, which does really well at alleviating nausea and muscle pain, so you may want to give it a shot for this, too. SInce it’s noninvasive you don’t have much to lose in trying it.

Anyone else? Any specific recommendations for a brand of belly belt? Was there something that relieved your posterior pelvic pain?

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

Reader needs help

(Scroll down for today’s Q&A after you read this.)

A reader writes:

"Do you know anything about the use of CoQ10 during pregnancy?  I take it for my heart as I have a heart condition and things have improved immensely for me.  My doc says it’s unbelievable and to keep doing what I’m doing.  I am getting mixed answers on CoQ10 use during pregnancy since there has been no testing so I am wondering if you or any of your readers know of or have heard anything."

All Google searches are revealing that the information out there is inconclusive and contradictory. If anyone has any information about CoQ10 (an enzyme) and pregnancy, please leave it in the comments or email me directly.

Thank you.

Q&A: preparing a preschooler for a new sibling

PumpkinMama writes:

"I was wondering if you could do an Ask Moxie post about preparing a young one
for an impending sibling.  My son will be not quite 3.5yo when #2 is expected to
arrive this fall and I am looking for tips and tricks on preparing him for this
big change.  He is a very sensitive little guy who is used to being the focus of
our lives, and on top of that he does not handle changes terribly well. I am
worried for him, as this will extremely difficult for him process, I think.  We
have only talked about it briefly so far (I’m still in my 1st trimester) and he
gets very serious and sad looking whenever I mention having a baby/sibling in
the house.  If I ask him outright if he’d like a little bro/sis to play with, he
says "No, thank you."  I don’t want to get too heavy about it with him, but I
also don’t want to just brush it off and utterly wing it when the time comes."

I know you’re really excited about the baby (and congratulations!), but I think it’s way too early for your son to really process what that means, and certainly for him to be excited about it. And would you really want him excited about it this early anyway? It would be like one long, nightmarish version of "Are we there yet?" for the last two trimesters until the baby finally showed up.

Realistically, I think your son’s not going to start processing it until you’re showing, and maybe not even until he can feel the baby start moving. (Since he’s 3, he’ll probably get it at that point. A toddler won’t even process it then.) So I’d focus my energy right now on getting your ducks in a row for what’s going to happen during the birth and postpartum period so you have that all set. Then start working on prepping your son once it’s a little more concrete for him. You can start mentioning it every once in awhile or reading a book here or there, but don’t expect it to connect with him until much later in the process.

You’re going to have to figure out where your son will be while you’re having the baby, and with whom. If you’re leaving your house to have the baby, you’ll need to figure out it you want someone coming to your house to stay with your son, or if your son should go stay with that person. Factor in that you might go into labor and need to leave for the hospital or birthing center in the middle of thie night while your son’s asleep. If you’re having a homebirth, you’ll need someone to come take care of your son during the birth. (That person should not be someone who really wants to see the birth, since there’s no guarantee that your son will want to be there when it happens. My midwife told me that she’d attended quite a few births in which the older sibling was totally excited for the baby to come, but then noticed that Dora was on and wanted to watch that instead of the birth. C’est la vie. So make sure the person assigned to care for your son isn’t invested in seeing the baby come out.) Some likely people to ask are your family or in-laws, close friends, your regular babysitter, or other parents in your playgroup. And don’t feel like it’s a huge imposition–it’s a way people can do you a great kindness and participate in your baby’s birth in a concrete and necessary way, so most people will feel honored to be asked.

You’re also going to have to figure out who’s going to be helping you out after the baby comes. Your physical and emotional recovery will probably be much easier this time, so you won’t need as much help with the baby or with yourself. But your older child will need a ton of attention and you simply won’t be able to provide it, no matter how much the baby sleeps and how great a carrier you have (although you’ll definitely need a great baby carrier so you can strap the baby on and go about your business as much as possible). So think about who you want to come and help you postpartum. For a first baby it’s important to have someone you get along with. For a subsequent baby it’s important to have someone your older child gets along with–you can put up with a lot of days of an annoying mother or MIL if she runs your older child ragged at the playground all day and makes your older child feel special while you’re learning the new baby.

(IME weeks 3-6 were the toughest. My mom had gone home, but the baby was still so needy every second, and my older son was starting to be Not Happy At All about having to wait his turn. In hindsight, I should have hired a postpartum doula to come a couple of times a week for those weeks and asked my part-time babysitter to work a few more afternoons. Other moms of 2+ kids, what weeks did you think were the hardest?)

If your older one will be in school, don’t forget to arrange for some help to do drop-off and pick-up.

By the time you’ve thought all those things through, you’ll probably be closer to showing, and your son might be a little more able to connect with the reality of the baby coming. You’ll want to open up a dialogue about the baby without bringing it up so often that he’ll be sick of it. You also want to make sure that you allow him to have and verbalize his own feelings about the baby, even negative ones. (Our standard line was, and still is, "You don’t have to like the baby but you can’t hurt him.")

Probably the most popular way of prepping a child for an impending sibling is to read books about having babies. I’d like to give you a long list of our favorite books about a new baby coming, but, well, I can’t, because my son didn’t want to read them. I got a few out from the library, but he just wasn’t that interested in them. I know the readers will come through with good titles, or you can ask the children’s librarian for help when you go to the library.

My son was way more interested in looking at pictures of the baby growing inside me. I looked and looked for a kids’ book with drawings of the baby growing, but couldn’t find one. (I was thinking it would be cool to have one that looked like one of those anatomy coloring books, but simplified a little for kids.) Instead we looked at the drawings inside my pregnancy books (there are some in the Sheila Kitzinger The Complete Book of Pregnancy and Childbirth and in the Martha/William Sears Pregnancy Book) to show how the baby was growing in relation to my body. We also spent some time looking at the cool photos in Lennart Nilsson’s A Child is Born. (Although there aren’t many good photos of the baby growing after week 20, and you’ll have to judge whether your child can handle looking at the photos of the actual birth.)

If your son doesn’t already have a doll, now’s the time to get one. He can play with the doll now, and it will open up some more conversations about the baby. When the baby arrives he can take care of his doll while you’re with the baby. I don’t know if girls are as into anatomically correct dolls as boys are, but boys seem to be really into dolls that look like they do. Here’s a nice hard nylon one (it comes in boy and girl, black and white). Here’s a nice soft fabric one (it comes in boy and girl, white, black, latino, and asian).

We found it extremely helpful to take a sibling preparation class with our son. He got to meet other kids who were going to become big siblings, and the teacher of the class was great in terms of telling the kids what to expect, and in telling us what to expect. There’s a pretty specific timeline of the way kids usually act when a new sibling comes. I wrote it up in detail in this post, but basically the older child will act out and get more and more unmanagable as the due date approaches, then relax when the baby is born for a few weeks, then start acting up once the novelty of the baby wears off, but then start to enjoy the baby once the baby is old enough to start crawling.

The largest part of our preparation involved answering questions when my son asked them (ranging from "How did the baby get inside you?" to "Is the baby going to play with my toys?"). In our case, it seemed that my son was OK with the idea of a baby (he liked his friends’ siblings) but was apprehensive that the baby would take over his bed, his toys, his friends, and his life. We spent a ton of time talking about how the baby wouldn’t be able to move around or play with his stuff, or sleep in his big boy bed. I was careful to allow him to express negative and indifferent feelings about the baby, even once the baby arrived. He still escalated in fears and negative behavior up until the birth, but we knew it was normal and tried to be more gentle with him than usual.

I’m guessing that your son’s sensitive nature will be helpful in the process, because he’ll be able to express to you what he’s afraid of. Instead of keeping it all inside like the "tougher" kids, he’ll tell you what he’s really afraid of. If he’s freaked out, you’ll know it, so you’ll be able to respond.

Even if you ignore the rest of the advice in this post, definitely read the book Siblings Without Rivalry by Faber and Mazlish. Every parent of more than one child should read this book. Heck, every person who has a sibling should read this book. Everything in it is common sense, but stuff you wouldn’t think of on your own. My favorite parts are the section about not allowing your kids to assign themselves roles (even if you’re scrupulously careful not to assign roles your kids might do it themselves) and the flowchart about how to know when to step in on an argument and how to know when to let them work it out themselves. The book is in cartoon format, so it’s a quick read.

The biggest thing to remember in the whole process is that you’re going to feel guilty about changing your son’s life. He’s been your only guy for so long that it’s just natural to feel like you’re wrecking his life by having a new baby. My mom says, "The guilt begins as soon as you get pregnant with the second one," and it was definitely true for me. But kids’ lives are only enhanced by having siblings (assuming the parents are good parents and don’t play favorites). It takes awhile to get over the initial bumps. The first 6-12 months will be hard. You’ll feel like a shitty mother. But if you can keep your eyes on the long picture–having kids who like who they are, respect each other, and can work through their own disputes–you’ll end up with kids who are thrilled to be each others’ siblings.

Q&A: depression during pregnancy

Jodi writes:

"This will be short and sweet. This is my
first pregnancy and I am almost three months along. I am very excited
and feel lucky because I got pregnant the first time I ever went
without protection (thank god I was a responsible teen). I am 33 and as
my ob/gyn said "On the senior citizen side of birthing"  (hell of a
bedside manner I know ). Anyway here is my thing I have been feeling
DOWNRIGHT DEPRESSED for a few weeks. I am usually outgoing and love to
have fun but I just feel sad and kind of remorseful that I have not
done more of the things I set out to do. Did you ever experience
this? It is making me feel very guilty."

33? Is old?

Bwahahahahahahahahahahahahahahahahahahahaha. Hahahahaha. Ha.

Excuse me while I wipe the tears from my eyes.

I think your OB must have had extremely limited experience if s/he thinks 33 is "on the senior side" of first-time pregnancy. Even the technical definition of  "older" first-time mother doesn’t start until 35. I had my first baby at 29 and I’ve always been The Kid with other moms of children my son’s age. (Now that the kids are around 4, all the other moms at my son’s school seem to be in the 38-45 age range.)  I know a ton of women who didn’t have a first baby until age 38 or 39 (note that I’m not saying that it’s advisable to wait until that age specifically, or that you’ll have an easy time conceiving then, just that I know plenty of people who had first babies then).

All this is to say that 33 sounds positively early to have a first baby to me. Your OB’s comment is uninformed and a wee bit insulting.

But about the depression. Did I ever experience this?

YES.

I spent the first trimester of my first pregnancy in a serious, almost debilitating depression. I had just started building a little teeny career in something I liked better than my old "career." All of a sudden I was pregnant (with a baby we’d been trying to conceive, but somehow didn’t think would come so soon) and felt like I had nothing to show for my life, which would now, of course, be over, because you can’t do anything with a baby.

I dragged through the days, too exhausted from the pregnancy and too heartsick from the depression to do more than two things each day (and sometimes one of them was take a shower). I started having panic attacks. When I went in to a prenatal visit the midwife could tell I was not doing well and she basically twisted my arm to see the therapist that worked with women at the birth center.

What the therapist told me was this: There are extremely powerful hormones surging through your body when you’re pregnant. Different women react to them in different ways. Many women become depressed under the influence of these hormones. The only thing to be done about it is go through the motions of living day by day as best you can. Getting up in the morning is a victory.

What I know is that the depression may change or lessen or disappear by the end of the pregnancy, or it may not. I felt a little better in the second trimester (until the World Trade Center was attacked a few miles from my apartment), and then the depression came back slightly in the third trimester. Since I have had depression in my "normal" (non-pregnant and non-lactating) life, I knew I was at a higher risk for post-partum depression, but I never developed it (I made a hard-core plan to prevent it and it worked).

There’s a website called Pregnancy and Depression that has collected all the available research studies about depression in pregnancy (it also has some info about treating depression while breastfeeding and during mothering, and some info about bipolar disorder). Most of the studies are evaluating the risks to babies of exposure to antidepressants while in utero, but I thought this study was interesting and kind of sad. The conclusion is "Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed."

I can tell you what I think the maternal and fetal consequences of prenatal depression are. I think those of us who are depressed during pregnancy doubt ourselves. I think we feel guilty that we’re not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won’t enjoy being mothers. I think we’re afraid that there’s something inherently wrong with us that means we won’t be good, or even adequate, mothers to our children. I think we think that if we’re so depressed during pregnancy we don’t deserve to have children. I think that’s why no one talks about prenatal depression.

But it’s real. It exists. It’s caused by hormones and the enormous changes we’re going through in our views of ourselves and in our relationships. It doesn’t have anything to do with how much we’ll love or enjoy our children, and it certainly doesn’t mean we won’t be damn good mothers. It does not have to mean that we’ll get PPD. It just means that we’re not the happy preggos in the magazines. But that’s OK. We’ll keep on getting up every morning, and we’ll waddle through our days until delivery, and then when the baby is crying at 3 in the morning we can think "At least I’m not still pregnant."

So, Jodi, don’t feel guilty. You’re going through a ton of changes and you have enough hormones to kill an elephant racing through your system. If you end up coccooning yourself your friends will understand. And life’s not over when you become a parent. You can’t do much of anything for the first year or two, but then you’ll get your groove back, only with renewed efficiency and a BTDT kind of fearlessness (that undoubtedly comes from knowing rightly that once a small person has puked into your mouth there’s really nothing left to be afraid of).

If you’re not already supplementing with flax seed oil, consider starting now–it can’t hurt. But try to cut yourself a break, and know that better things are coming for you soon.