Can I Spoil My Newborn?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Photo Courtesy – http://blog.kidsfunplaza.com/

Parents of newborns often ask me if holding their baby too much will spoil him or her. The answer to this question is a resounding “No”.

Newborn babies are accustomed to being held 24/7. This was their existence during their entire gestation. Any amount of time that a newborn is not being held can be stressful. An infant does not need to learn and cannot learn to be independent immediately after birth. Newborns do not have the capacity to be lazy or manipulative at this stage.

The best way to comfort and care for a newborn is to imagine recreating the feeling of being in utero. If your baby falls asleep on your chest, enjoy it. Newborns regulate body temperature, heart rate and breathing best when lying chest to chest with mother or father.

Because of this, baby wearing has become popular of late and is a great way to nurture your baby hands free while taking care of yourself and even your other kids.

However, this does not mean that you need to be a slave to your baby. If you need to put your baby down and he cries, it will not harm him in the long run.

My advise is to follow your instincts. Hold your baby whenever you want to without the guilt that you are spoiling him.

Cherish this time. All too soon he will be grown up. On the other hand, do not fret if you have to or want to put him down to take care of something. Consider using a sling which will allow you to multitask.

As babies grow up, this advice changes. Older babies do benefit from learning how to self soothe. For now, enjoy those first few months. Forget the laundry, cooking, entertaining and other chores unless critically important. Spend this time bonding with your newborn and enjoy every moment while it lasts.

 

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

Is Your Child A Proud Member of The Picky Eaters Club?

Written by Melissa Arca, MD., FAAP – This post appeared originally on Dr. Arca’s blog Confessions of a Doctor Mom. Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

Having a picky eater seems to be the norm these days. I’d almost dare to say that children between the ages of 2-7 more often than not wind up in the picky eater category.

Why oh why the sharp jump in membership of The Picky Eaters Club during this time? Researchers believe it could be evolutionary. That way young “cave toddlers” wouldn’t walk around tasting every potentially dangerous thing in sight. Can you imagine? Still, there are far more factors involved here: genetics, personality, and family eating habits to name a few.

My son is no exception. He is a proud card carrying member of The Picky Eaters Club and I am a reluctant member by association, trying to sway my son in another direction.

It all began at the ripe old age of 2. Previously my baby boy would gobble anything placed before him: peas, squash, avocados, blueberries, you name it. I was proud as could be, snapping up pictures of his cherub face smothered in green bean puree.

Then at the age of 2, it was like a switch was turned off (or on, depending on how you look at it), and he was suddenly suspicious of everything that was placed before him.

Pancakes, orange juice, and chocolate milk seemed like the only foods acceptable to his new found sensitive taste buds.

This sent me in a crazy spin for awhile. I wondered what I had done. Certainly I must have caused this sudden disdain for all things considered healthy. I was convinced it was because I introduced bananas first. Or, that I failed to introduce the veggies in the proper order.

Worse yet, I figured I must be missing the magic mommy touch. You know, I didn’t have the finesse to cajole, coerce. or otherwise threaten bribe my child to eat well.

I know (now) that none of that is true. He is five now and I finally took a step back and realized there is only so much I can do. I can’t force feed the kid.

Although I admit, the thought had crossed my mind. I finally made a mental list of the things I could do and stuck to those. The rest is up to him and his discerning palate.

I continue to offer him his daily dose of veggies. All I ask is that he give them a try. It’s up to him whether or not he eats the rest. Did you know it can take up to 10-15 times of being offered a new food before a child will try it? Except, in my son’s case, it’s more like a 100 times…I’m still waiting.

He’s old enough to understand that his body requires a balanced diet. We talk to him about needing protein, fiber, and the good vitamins found in fruit and veggies.

He gets it. Hopefully one day it will sink in enough to not gag at the mere sight of broccoli.

Getting upset at him because he won’t eat the peas on his plate won’t make him want to eat those peas. He knows that he must taste them. Then, we move on. No long drawn out bribing session. We do encourage and praise his efforts though.

I have to admit I still do modify his meals somewhat. If we’re having spaghetti and meat sauce, he gets plain spaghetti with Parmesan cheese and a side of chicken. This is a kid who used to scarf down spaghetti and meat sauce at 18 months old…and yes we have a picture of that too!

Him being a picky eater has nothing to do with my mothering ability. Thankfully my daughter taught me this. At age 3, she is a much more adventurous eater and will gladly eat carrots, broccoli, edamame, and tomato soup. I can’t take credit for that either. Just the luck of the draw really.

I remind myself to look at the big picture. Instead of dissecting what he eats at each meal, I look at how he eats over the course of the week. Some days are better than others but overall, I am usually surprised to discover that he covers most of the dietary bases.

He continues to broaden his food horizons over time. It’s not overnight and I give him a multi vitamin to fill in the gaps. I hope someday he will allow a green vegetable past the obligatory “no thank you” bite. However, I am confident that his membership in The Picky Eaters Club is not lifelong.

So my fellow reluctant members of The Picky Eaters Club, take heart, it won’t last forever. I promise. One day you’ll wake up and find your formerly picky eater can’t get enough of your famous beef stew with peas and carrots.

Are you dealing with your own picky eater? Have you found ways to enjoy mealtime in spite of it?

Gifts of a Father’s Presence. Part 3 of 3

Written by David R. Sprayberry, MD

My last few posts have revolved around the negative effects that absent fathers have on their children.  So far, we have talked about how the absence of a father contributes to poverty, substance use and abuse, psychological and behavioral problems, poorer educational performance, and increased participation in criminal activities.  Today we turn to the positive things that a present father brings to the lives of his children.

Effects on Infants

Let’s starts with infants.  Even in the first few days of life, the effect of a father’s presence can be discerned.  Newborns will preferentially turn their heads to the voice of their fathers over the voices of other men.  Premature infants whose fathers visit the NICU more often tend to have better weight gain during the hospitalization and perform better on behavioral and social-developmental tests during the first 18 months of life.  Infants who demonstrate the most emotional security and attachment have fathers who are affectionate, who spend time with their children, and who have a positive attitude.  Keep in mind that these effects are happening long before the child can even walk and talk.

Effects on Mothers

What about mothers?  When fathers are involved, their children’s mothers are more likely to start and continue breastfeeding.  Mothers with positive relationships with their children’s fathers also demonstrate better parenting skill and fewer emotional difficulties.  Mothers who are feeling supported are more likely to encourage the fathers to be involved with the children.

Early Childhood

Fathers can help reduce the likelihood of stranger anxiety in their children.  Toddlers with present fathers are also less likely to worry and less likely to disrupt the play of other kids.  Preschool children of involved fathers have been found to have higher cognitive development.  They also exhibit more empathy and have a greater sense of mastery over their environment than their peers with less involved dads.

Long-term Benefits

Children who live with both parents are more likely to finish high school, be economically self-sufficient, and be physically healthy.  Fathers have a unique and strong influence on their children’s gender role development and serve as important role models for both boys and girls.

Discipline

Fathers who set appropriate limits for their children and who provide sufficient autonomy have children with higher academic achievement.  Fathers who discipline harshly and/or inconsistently have a negative impact on emotional and academic development.

Educational Benefits

When dads are involved, kids tend to have improved educational outcomes.  Children of fathers who are involved in their children’s education are more likely to achieve better grades, more likely to enjoy school, more likely to participate in extracurricular activities, and are less likely to have repeated a grade.

Additional Benefits

There are numerous other benefits that result from fathers who are involved.  Fathers who spend time alone with their kids and perform routine childcare at least twice a week raise the most compassionate adults.  Physical play with fathers promotes intellectual development and social competence.

Fathers are capable of doing incredible good to their kids by staying involved in their lives.  Dads, you only have a few years with your kids at home.  Make the most of them and be their dad!  Perfection is not necessary.  Presence and participation are.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

On Mother’s Day, We Should Be Supporting ALL Mothers

By Jennifer Shaer, MD FAAP IBLC

Time Magazine has caused quite a stir this week with its cover featuring a three year old breastfeeding. The article is about a philosophy of parenting called attachment parenting and the controversy is two-fold.

The first issue surrounds the cover title “Are you mom enough?”. This provocative title implies that if you do not breastfeed your child until he is three and do not practice attachment parenting then you are less of a mother.

While attachment parenting works for many, to imply that it is the only way to raise a well-adjusted child is misleading and inflammatory.

The second issue surrounds the cover photo and the concept of nursing a toddler. As a pediatrician and a breastfeeding medicine specialist the photo of a three year old standing up while nursing and looking at the camera should be easy for me to look at, and yet it is not.

Why does this photograph evoke such emotion?

Medically speaking, there is every reason for a child to continue nursing until he self-weans. In most societies that embrace self-weaning, children routinely breastfeed until well over two years old.

However, it is so rare to see a toddler in our society nursing that the image is unsettling. I ask myself, “why am I uncomfortable looking at this picture when I am such a strong supporter of breastfeeding?”

There is truly a societal and social expectation that is ingrained in all of us, and it works to the detriment of breastfeeding as a whole. As I think about my patients, I recognize a pattern.

Upon initiating breastfeeding, most women are proud to give their baby the best start to life and are proud of themselves for being successful in the first big parenting challenge. However, as mothers continue to breastfeed, there comes a point when they turn from proud to embarrassed.

I see the look on their faces or the tone in their voices when they tell me that the 15 or 18 month old is STILL nursing. The mother who was once confident and proud begins to feel like an outcast and a social deviant.

Many women at this point either force the baby to wean, secretly nurse (the “closet nurser”) or stand up for themselves as Jamie Lynne Gumet has done in this article.

What can I say about this situation? This child is not being forced to breastfeed. He is not being abused and this is not pornography as some people suggest. Nobody can force a 3 year old child to do most of anything that he doesn’t want to do, let alone breastfeed.

The problem with this image is that it is so contrary to what we accept as normal. The problem with this image is that we as a society cannot accept breastfeeding a toddler.

I know in my heart that this is normal but my gut reaction can’t easily be changed. Just as I know in my heart that gay couples should have the right to marry, yet when faced with two men kissing in front of me, I am uncomfortable.

The unsettled feeling that I get when looking at this picture is my own weakness. I applaud Jamie Lynne Grumet and Time Magazine for helping me take one step closer to accepting what is biologically normal.

On mother’s day, we should be supporting ALL mothers. If we stop passing judgment on one another then we will truly be showing our children how to behave as adults.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

To Teen Guys: Yes, We Really Need To Check ‘Em

Recently, I was called to our community hospital to consult on a teenager with severe lower abdominal pain. The young man, whom I’ll call Dan (not his real name), lived outside of our community, and I’d never met him before. I arrived in Dan’s hospital room, introduced myself, and started talking to him and his mom about his symptoms. After reviewing his chart and getting his history, I proceeded to examine his heart, lungs, and belly. Then I told him, “OK, I need to check your privates, to make sure everything looks healthy and normal. Is that OK?” I was unprepared for Dan’s surprised, negative, very forceful reaction: “NO WAY!” and his mother’s simultaneous exclamation, “No, you DON’T need to do that!”

I asked permission, as I always do, and he definitely hadn’t given it! So I backed up a little bit. “I know it’s embarrassing to have your privates checked. But we don’t have a good explanation yet for the pain you’re having, and if it’s related to something going on with your genitals or your bottom, I definitely don’t want to miss that.”

Dan was still pleasant, but I could see in his eyes he was definitely not buying my explanation. “If you would feel more comfortable with a man doctor, or without your mom in the room, we can definitely do that.” His horrified expression spoke volumes; I think he would have preferred a spinal tap without anesthetic.

His mom said, “Why do you have to do that? The emergency room doctor and the surgeon who’ve seen him today didn’t feel that was necessary.” I explained, in that case, if no one else had checked “down there,” I felt even worse about blowing off that part of the exam. Dan, still with the deer-in-the-headlights look, volunteered, “I had it checked at the clinic where I got my sports physical done. Can we count that?”

We talked about it some more, but Dan stood firmly to his position: “My genitals are not your business, doc!” In the end, I never did perform this important exam.

Clearly, I failed Communication 101 with Dan at explaining the importance of a complete body check, especially in a kid who’s sick enough to be in the hospital. I suspect if I’d known Dan better, he might not have felt so awkward. What I really wanted to communicate was this:

• It needn’t take very long. A comprehensive external genital exam takes under a minute in boys.
• We can do whatever it takes to satisfy modesty and cultural appropriateness. It’s OK to kick your mom out and have your dad come in. Or vice versa. It’s OK to request a male doctor. Or vice versa. It’s OK to have a chaperone — in fact, I prefer it that way.
• We do find problems “down there.” Honestly, most doctors are in such a hurry – we wouldn’t waste time doing something if we never found a problem. In Dan, a rectal exam for his kind of pain would have helped reduce his need for expensive, high-radiation tests. From time to time, either as part of a problem check or as part of a checkup, we’ll find hernias, hormone problems, cancer, eczema, abnormal birthmarks, ulcers, urinary issues, and infections of many kinds (not just STDs). Many years ago, a wise pediatric infectious disease physician taught me to check the whole body – even the unmentionables – for clues to “mystery patients.” He was right, and since then I’ve diagnosed herpes encephalitis, Behcet’s disease, and Crohn’s disease – based primarily on what I found in the genitals and rectal area.
• Parents, assume nothing. You may think your child has no concerns about his genitals because he’s never mentioned them to you. You may think your son could never have an STD. You may think your son would notice if he had a small amount of blood in his stool. You may think he knows what a hernia or testicular mass feels like. And all these things might be completely true. But they might not.
• Getting it all “out in the open” makes it easier for a child to bring up a concern. Let’s say a young man discovers a small lump on his genitals, and it’s worrisome to him. When I’m doing a genital exam and already have things uncovered, it seems easier for a concerned teen to “casually” point to the spot and say, “Hey, [indicating] is this OK?” I can easily say, “Oh yes, that’s a ______ and lots of guys have those. They’re normal and won’t interfere with peeing or sex or anything. I have a great handout about that for more information.” It’s harder for a kid to bring up issues “down there” if he thinks that a genital exam isn’t part of the equation. Will I think he’s a pervert or weird for asking: “So… doc…. I have this… thing… on my… privates?”
• Your female counterparts seem to have gotten over this. I’ve noticed (and I’m not sure why – maybe because I’m a woman) that I rarely have girls or their parents look horrified or surprised when I ask to check a girl’s breasts or pubic area. Much more frequently, I have mothers ask me, “Are you sure 13-year-old Kathy doesn’t need a complete pelvic exam, now that she’s having periods?” Sometimes this is a subtle hint to check for pregnancy or STDs; sometimes parents are trolling for information about their child’s sexual activity, or lack thereof. But much of the time, parents know that ensuring “the lady parts” are important to keep healthy, just like everything else.

So: It’s OK to be embarrassed. It’s OK to sigh, blush, groan, and/or roll your eyes at the doctor. But guys, yes, we really need to check ’em.

Suzanne Berman is a general pediatrician in rural Tennessee. She tries to minimize embarrassment to her husband and son, too.

The Toddler Who Refuses to Nap

Written by Melissa Arca MD

Toddlers and not napping are three words that never go well together. And yet, right around the ripe old age of two, many children start to put up quite the fight when it comes to naptime.

Does this mean they don’t need a nap? Should I make my child take a nap? Help, my toddler doesn’t nap anymore!

These are questions and pleas I hear all the time from mothers in desperate need of that one to two hour window of reprieve. Sleep is important for all of us, this much we know.

But, how exactly do we make a toddler take a nap? As you and I both know, we really can’t make a two year old do anything.

The art comes in the form of gentle coercion and setting the magical scene that will translate into a solid and predictable nap-time.

Sounds simple right? Believe me; I know this can be quite the struggle. My son gave up his naps right before he turned three. This seemed way too early for me, especially since I had a newborn on my hands and rest at that point was not just a luxury, it was a necessity. Unfortunately, his naps never magically reappeared. I cursed the nap gods but realized he was catching all the zzz’s he needed at night.

So while trying to determine whether naps are gone from your life forever or whether you’ve simply hit a bump in the road, the two questions you should ask yourself are:

how many hours is my child sleeping at night and is this enough?

Children between the ages of 2 and 4 need about 11-15 hours of sleep within a 24 hour period. This is such a huge range and if you’re lucky enough to have a child that falls on the latter end of the spectrum, your child will most definitely still be taking a midday snooze.

I, however, had a wonderfully active toddler who clocked 11 hours at night and apparently that’s all he needed. If I was fortunate enough to lull him into a nap, it always came at a price, namely a super late bedtime. So, I no longer enforced his naptime.

He (and I) still needed some down time during the day, so I starting scheduling quiet time (for both of us). More on that later.

Now that you’ve figured out how much your child regularly sleeps at nighttime, how do you know if that is enough, or if he still needs a nap? If he regularly shows you signs that he’s sleepy, such as eye rubbing, yawning, zoning out, or is easy to meltdown, then in spite of his resistance, naps should still be part of his day.

Create a naptime routine that is a mini version of his bedtime ritual. Give him fair warning too. Tell him that after his snack and some coloring, it’s time for a nap. Children this age refuse naps because they can.

It’s an opportunity for them to exercise some control over their world. By letting him know what to expect and prepping him with a naptime routine, he can better accept what is to come.

Still won’t nap? Start instituting quiet time.

Even if he’s ready to kick those naps to the curb, he would still benefit from some down time. You will too. Tell your resistant napper that he may play quietly in his room with books, cars, or puzzles. Let him know that you will set a timer and that he can come out to play after an hour.

I have been doing this with my three year old daughter recently as she has started to resist naps. About half the time, she ends up dozing off and on her own terms. Quiet time is completely working in our favor.

As you can see, nap scenarios vary from one child to the next. Some will stop napping at age two, while others will be on the verge of entering kindergarten and still crave a midday nap. The key is determining your child’s sleep needs and making sure she gets it within a 24 hour period.

The bottom line is this: nap or no nap, children and parents need down time during the day. Whether this comes in the form of a nap or quiet time will depend on the needs of both you and your child.

When did your child give up napping altogether? Did you benefit from some quiet time?

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom