New Blog Site

I'm blogging for Spectrum Health Medical Group again, and have a new site @ www.doctormommyblog.wordpress.com

Peanut with the jellies at Monterey Bay Aquarium

So... that was an unplanned blogging break.  Things are getting a little hectic for our family as we wrap up our year in San Francisco, and prepare to move back across the country.  We'll be living out of suitcases for most of June, but I'll try to update as often as possible!  I'll post blog updates on twitter and facebook once I publish them.  We are very excited for this next transition!

Peanut is 3!

One of the reasons I write this blog is to remember... This is one of those posts.  I wrote this for our precious Peanut as she turned three years old last week.

You are three today.  Mommy and Daddy are so proud of you.

We love watching your personality and sense of humor develop.  There was a particular day, about a month ago, when I realized you are becoming you all on your own.  We were running late to preschool.  I couldn't find the keys because you had taken them off the counter and hidden them in a knit hat and placed the hat under other toys in the other room.  (You are very active - some days you are able to move every single thing in the entire house, but we love your energy and curiosity.)  After we finally found the keys (you remembered where you put them upon further prodding), we arrived at preschool about twenty minutes late.  We approached the classroom to see your friends and teachers already playing. You stopped in the doorway and jumped, extending your arms, then shouted, "Surprise!" Your teacher turned to find you and gave you a big hug.  She said, "you are the best surprise."

You realized that the class had started and then spontaneously used your sense of humor with the courage to speak to your whole class and teachers.  I will always remember that moment when it became clear to me that you are not a baby or a toddler anymore.  You are a little girl.  Well, a little big girl.  It suddenly seems that you being this grown-up shouldn't be possible.  How did this happen so fast?

Daddy and I love your enthusiasm, your wit, your contagious excitement, your desire to learn, your negotiating skills, and so much more.  But, the trait we are most proud of is how caring you are.

When baby sister was getting ready for her first bath, you dragged your little chair into the bathroom, and climbed up on the chair to help.  You said to baby sister, "Don't worry, I'm right here."  You told her you were her big sister.  You are such a good big sister.

You show your concern for others.  When baby sister was crying, you didn't want Auntie Carli to worry, so you explained to her with your serious look, "Babies can't talk, that's why she is crying."  Once you said, "She's not sad, that's how she talks."  Some things you understand better than Mommy.

Daddy and I feel so lucky that you are our daughter.  You are changing so quickly, and although I want to keep you my baby forever, it is so fun to watch you grow.

Your vocabulary seems to expand everyday. (You actually know the word, vocabulary, too.) Some of my favorite words that you say are: wonderful, incredible, perfect, delicate, toxic, choking hazard, stable, quite, actually, seems, wonder, fancy, please, thank you, no thank you.

Some of your favorite books are: Goodnight, Goodnight Construction Site; Fancy Nancy; Gingerbread Baby; The Mitten; Berenstain Bears and the Dinosaur Bone.

Your favorite toys are cars, trains, blocks, and cranky the crane, but lately, you've enjoyed setting up a picnic and bringing your stuffed animals to the party.  You recently became interested in playing go fish, old maid, and matching games.

Always running.  Here with your friends at your birthday party.

I want to remember these days as vividly as I can.  Happy birthday my "sweet and tiny peanut."

Baby Chairs, Walkers, and Carriers

I don't know what I would have done without Sweet Pea's carrier through her colic phase.  Wearing her in that carrier was the only thing that would calm her down between the hours of 7pm-10pm nightly.  And it worked nearly every time.  (I just couldn't sit down.)

That's why I was concerned when I read this about the hazards of baby carriers and baby seats on baby's motor development and cognition.  I decided to search for evidence-based articles and share my findings here.

Baby Walkers

Most of the research done on these devices is in regards to baby walkers.  Pediatricians and Family Doctors advise against using a baby walker for good reason.  (I was surprised to see them still sold in baby stores.)  The main reason to avoid baby walkers is that they can lead to injury, such as skull fractures from tips and falls down the stairs.  From data I read, injuries resulting in visits to ER from baby walkers are not uncommon.

Additionally, research has shown that baby walkers actually delay walking and crawling in infants.  Also, I found evidence that use of baby walkers was correlated with lower scores on mental development (in infants 6-15 months).  The authors explained that walkers by design limit visualization of the infant's moving legs.  When infants used the walkers, they were deprived of visual feedback important for neurodevelopment.

Baby Chairs


The Bumbo seat has received some bad publicity lately, due to reports of severe injuries from falls in the seat.  It should never be used on an elevated surface.

I actually like the Bumbo seat, as long as it is used appropriately.  Both Peanut and Sweet Pea enjoyed/enjoy being able to sit up to see everything in this chair.  And, since babies should be put to sleep on their backs, they do end up spending a lot of time on the back of their heads.  We've seen an increase in the cases of "positional plagiocephaly" (or flat back of the head) in babies since the "back to sleep" campaign.  (Still, we must put babies to sleep on their backs.) The Bumbo helps babies spend less time on the back of their head.

Per my literature search, I could not find any studies relating baby chairs to motor development or neck/back strain.  As far as I could find, information regarding potential harm of baby's neck and back is theoretical.  Although, the theory does make sense to me.  Babies develop their strength from the head down, which is why the Bumbo works to keep an infant upright.  Babies neck is strong enough to be held upright before her core is ready to support the seated position.  The Bumbo supports the back/core while the neck does the work to keep baby upright, creating the potential to strain the neck if left in the seat too long.

I used the Bumbo with both Peanut and Sweet Pea once they each were about 4 months old and once they had very good neck control.  I would not recommend using it before 3 months of age.  I am within an arm's reach of Sweet Pea while she enjoys the chair and I only leave her in the chair for about 5 minutes at a time (she's 4 months old now).  Once she shows any signs of fatigue, I take her right out.

Please, never use a Bumbo on an elevated surface.  These chairs may topple.

Exersaucers


Exersaucers were meant as an alternative to baby walkers, because they are essentially a stationary walker, which also includes activities around the circle.  I did not find any studies regarding harm of motor development that have been done yet, but I think we will find many of the risks of the baby walker will apply.  (Again, infant is not able to see her feet when she pushes off the ground to rotate the exersaucer.)  These devices can still topple, but at least they are not as likely to go down the stairs. We never had one of these - I figured Peanut and Sweet Pea wouldn't stay in them long enough for me to go to the bathroom anyway.  I think moderation is the key here (as well as safety and monitoring baby while using).

Baby Carriers


I honestly don't know what I would do without mine.  When Sweet Pea is crying if put down, and I need to get Peanut through the bedtime routine while Daddy MD is at work, Sweet Pea goes in the carrier.  And, colic would have been impossible to survive without the carrier for me.

The reported risks with baby carriers include the risk of asphyxia especially from the sling design, where babies neck can become to flexed, inhibiting breathing.  Here is a good diagram for positioning.

Additionally, we want to make sure that an infant's head and neck is adequately supported.  For my girls,  I didn't use one the first month of life.  I felt like I needed to hold their necks with one hand if they used it early on.

I also was concerned that Sweet Pea would get stiff riding in the carrier, just as you and I would become stiff if forced into one position for a period of time.  Even in the womb, the baby can kick out her arms and legs.  In some baby carriers, I feel that the limbs can be too restricted.

My bottom line on carriers:  Many babies love them.  Many moms love them.  We can tend to other duties while our baby is content and we feel closeness with our baby.  Use them in moderation and allow plenty of free movement and stretching time for baby.

Conclusions


Babies don't need expensive activity chairs.  Babies need a safe place on the floor to self explore and plenty of supervised tummy time.  We should create a safe environment where babies can reach milestones naturally.

Vacation

We had a nice vacation and visits from family over the last couple weeks.  We took a little road trip to Yosemite National Park, which was unbelievably beautiful!

The girls did pretty well in the car and I didn't end up squeezed in between the two in the back until the end of the trip.  It helped that we scheduled the drive time during nap times for Sweet Pea, and Peanut was content with her new Dora DVD, Crayola magic markers, and books.  Of course, Peanut did not sleep for one minute of the entire trip.

The girls LOVED Yosemite.  It was the perfect vacation for our little explorer Peanut, and for outdoor baby Sweet Pea.  

Peanut was so excited and ran non-stop as usual.  At one point, one of the other guests at the Lodge who was watching Peanut commented to us, "She's a highly spirited child."

Daddy MD turned to me and said, "That's the understatement of the year."

Sweet Pea rode happily in her carrier for most of the day.  The next morning when I put her in, she got so excited and started smiling and giggling.  She just loved hiking!

It was so nice having family stay with us last week!  We all miss everyone already. 

10 Ways To Limit Media Use for Kids

We all know we should be limiting television and electronic games for our kids, but how to do that is sometimes a challenge.  I was inspired to write this post due to my own mommy guilt from relying a little too much on TV once Sweet Pea came along (and I was exhausted and sleep-deprived from taking care of a newborn and a toddler).  Here are some ways I have found to limit media:

1. Satisfy your child's need for your undivided attention first, then they will be more likely to entertain themselves.  I've found it really only takes about twenty minutes of your full attention to facilitate the transition to independent play.

2.  Resist the urge to constantly stimulate.  Boredom can be a good thing, and can foster creativity.

3.  I think playpens are not only ok, but actually beneficial.  Baby can be placed in a safe spot with a few simple toys for self-learning.  Restricting her play area can also build creativity.  I previously thought the opposite was true (that giving her free range and lots of options for exploration would stimulate learning).  However, if she has to think of ways to play on her own, she will need to develop creative thinking and problem solving.  A balance between freedom and boundaries is ideal.

4. Make activity bags.  When you have some time (right... I know), make up some ziplock bags filled with age-appropriate activities (beads, stamps, stickers with scenery cards, the dreaded play doh, mixing sticks, rocks, etc).  Keep them stored away and pull them out when you need a few minutes of child-directed play.

5.  Rotate toys.  A "new" toy can keep a child entertained longer than one that is always available.  We kept that Dora guitar high up in the closet for awhile.  When Peanut found it, she engaged in thirty minutes of annoyingly loud and twangy play. (Not sure if this was better than TV for our sake anyway.)

6.  Never put a television in a child's bedroom.

7. No TV at meals.  Encourage socialization at mealtime instead.

8.  Give your child a box and some washable crayons/paint/markers.  (Although, I've found the markers we have aren't very washable).  Leave the room and see what she does! (If you dare...)

9.  Make media a privilege and not a right.  In our house, if whining is ongoing, and quiet time is being ignored, we lose television and ipad privileges for the day.

10.  Go outside.  There is no TV outside, and a nice walk can be a reprieve from media for the whole family.

I had to tend to fussy, tired Sweet Pea, so I gave Peanut paint. I returned to find her picture already hung up on the refrigerator.  When I gave Peanut hugs and praise she said, "It's just for you, Mommy." Love my sweet girls.

Would love for you to add your ideas to limit media!

On Dogs and Kids

I wrote this blog post a while ago, but wanted to repost this one...

Another call night for Daddy MD, another dog bite for Daddy MD to repair.  Over the past five years of his plastic surgery call, I have become accustomed to this pattern.  Last night, he arrived home after yet another 2 hour ER laceration repair on a child's face.  "Parents thought it was a good idea to have a pit bull with a 5 year old again," he mutters as he tiredly closes the front door.  My initial reaction to this situation was a gasp in disbelief; now, unfortunately this reaction has become a sigh, as the scenario is all too common. 

Daddy MD's countless nights spent in the ER repairing the faces and limbs of young children and even babies after dog bites, has compelled me to write this public service announcement.  If you know my blog by now, you know I like to attempt to incorporate some humor, and I tried to think of a way to make this particular blog lighthearted, but I just cannot.   Tragedies with children and dogs are just too serious.  So please, bear with this blog entry, as I publicize this under-recognized public health problem.

As a family physician, I give anticipatory guidance to parents about their children's care, safety, growth and development daily.  We have forms listing topics to review during well child exams, and check boxes to show we went over the important advice.  None of these boxes are for discussion of child appropriate pets.  Why is pet safety not as advertised as wearing helmets, choosing car seats, and keeping small objects away from babies? 

I think this is because dogs (and the family pets) can be an emotional conversation, and people feel strong connections with their beloved animals.  No one wants to think little pooch could ever harm a family member.  After all, little pooch is part of the family.  This post is not meant to infer that you need to give away your pet ASAP, but rather to make you aware of the facts, and possible consequences of dog ownership.

I'd like to make a list of myths and facts:

Fact: There are 4.7 million dog bites a year and most of the victims are children.  Compare this to the 10,000 children treated in ERs every year for choking.  Dog bites seem worthwhile to discuss.

Myth: Our dog won't bite, because we know our dog, and she is a good dog.

Fact: The vast majority of biting dogs (77%) belong to the victim's family or a friend.

Myth: Dog bites are unlikely to occur.

Fact: Dog bites are one of the top 5 reasons for a child to visit the ER.

Myth: Our dog is safe, because we keep her and our children in a safe environment.

Fact: Most dog bite injuries in young children occur in everyday activities interacting with familiar dogs.

Myth: Our dog won't bite, she is not a dangerous breed.

Fact: The most likely breeds to attack are pit bulls (50.9%) and rottweilers (8.9%).  (Pediatric Dog Bite Injuries: A 5-year Review of the Experience at The Children's Hospital of Philadelphia. Plast. Reconstr. Surg. Aug 2009. Vol 124, No 2.)  However, any Dog can be turned into a dangerous dog given the situation and one cannot count on breed predictability.  Thirty different breeds of dogs were mentioned in the above study.  Finally, remember, dogs genetically are wild animals, and will use their instincts to protect themselves, their homes, and their food.

Now, here's a list of some pet safety tips (some from the American Veterinary Medical Association):

1.  Choose an appropriate dog.  Pit bulls or Rottweilers should not be anywhere near children.

2. Train your dog. 

3. Avoid playing aggressive games with your dog.

4. Neuter your pet.  Neutered dogs may be less likely to bite.

5. Teach your children to never bother a dog if it is sleeping or eating.

6. Never leave a baby or small child alone with a dog.

7. Teach your children to ask permission before petting any dog and to avoid petting the face and tail.

With all of this information being said, I am not completely against having a dog when children are young.  Kids and dogs can really love each other!  "Doggie" was Peanut's first word.  She is so excited when we go to visit Grandma's labradors she cannot even sleep.  During our last visit she woke up at 3am, realized we were at Grandma's house, and started bouncing in her crib saying, "doggie, doggie!" "Roof, roof!" 

There may be many benefits including a longer, happier life for dog owners.  A dog can help teach a child responsibility, when he/she is old enough.  My hope is to raise awareness on pet safety, and also keep your child and Daddy MD out of the ER for dog bites!

This is the dog I have wanted for years! A Havanese puppy - how could anyone not smile at him? Adorable. (Picture via google images.)