ask the expert

the baby years

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Q: My husband thinks swimming classes for our 6-month-old baby is a silly idea and we are just as well off going to a community pool as a family. Are there actual benefits for starting a child swimming at this age? And are there any risks?

Q: I know that co-sleeping with an infant is a hotly contested issue. But for those parents who choose to co-sleep with their baby, what steps should they take in order to set up the safest possible sleep environment?

Q: Life with a newborn has me flustered and bewildered. It seems like the crying, rocking, feeding, walking-the-floor insanity is going to last forever. I’m also dealing with extreme fatigue and roller-coaster emotions. What are some ways that I can stay balanced when my new baby totally rocks my world?

Q: When I recently Googled “best toys for babies,” I came up with more than 32 million results. Sure, there are endless opportunities for parents to spend their money on toys, so please help us cut to the chase: What kinds of toys are good for babies?

Q: Finding the right childcare setting for my 6-month-old baby seems overwhelming. What are some tips for finding the right place for him?

Q: Is it ok to give my baby a pacifier when he gets fussy? If so, is there a better type over another? If not, what are the risks in doing so?

Q: My baby is due soon and I want to make sure I purchase the best type of car seat for an infant and that I get it installed correctly – any tips?

Q: Can you prevent type 1 diabetes? My first child was diagnosed with insulin dependent diabetes mellitus when he was 5 years old. I just had a baby and I’m wondering if there is anything I can do to reduce her odds of getting diabetes too?

Q: I know that newborns’ immune systems aren’t built up yet, so they’re more susceptible to illness. Being that I am a bit of a germaphobe, I am nervous about what my newborn should be exposed to. Should I be asking visitors to slather on hand sanitizer before touching her? How do I protect her without going overboard?

Q: Can we travel with our newborn baby? Is it safe to let her fly on a plane?

Q: I want to make sure I have breastfeeding success with my newborn. Is there any problem with supplementing breast milk with a bottle of formula now and then? Will this affect my baby or affect my milk supply?

Q: What are some tips for getting my baby on a regular sleep schedule?

My husband thinks swimming classes for our 6-month-old baby is a silly idea and we are just as well off going to a community pool as a family. Are there actual benefits for starting a child swimming at this age? And are there any risks?

One major benefit of swim lessons is that your child gets comfortable putting her face in the water. This makes transitioning to bath time, showers and other water activities a lot easier. In addition, it’s actually a great workout with kicking and splashing in the water, which allows for strength and muscle building used when crawling and walking. A downside to community pools is that they do not have the proper supervision or educational staff to provide water safety habits helpful for the child to become accustom with at an early age. When taking parent/child classes, the parent is learning the basic swimming skills as well.

The only risk of swim classes, just as taking your child to any pool, is swallowing too much water. This risk is taken even when teaching a child to put her face in the water.

Jessica Randolph holds a Master’s of Education in Special Education and has been involved in youth programs as a certified cheerleading coach, gymnastics coach, swim instructor and lifeguard. She is currently the Camp Administrator with The Alaska Club for their in-service, winter, spring and summer camps.

I know that co-sleeping with an infant is a hotly contested issue. But for those parents who choose to co-sleep with their baby, what steps should they take in order to set up the safest possible sleep environment?

Making the best choice in sleeping arrangements for your baby and your family can be stressful. Balancing feeding, sleeping, bonding and safety are important to every family. The American Academy of Pediatrics encourages families to room share, placing your baby to sleep in his or her own crib, bassinet, play yard or other safe sleep space in the same room as you, even right next to your bed. Bed sharing is discouraged because of an increased risk of a baby suffocating under blankets and pillows or someone unintentionally rolling on top of the baby.

If your family decides to bed share, medical providers have some tips. The most important is that all caregivers in the bed with the baby must not be under the influence of alcohol, marijuana or other drugs, including prescription medicines that may make you sleepy, such as those for pain or anxiety. It is not recommended for infants exposed to tobacco smoke in utero or after birth to share a sleep space since they are more likely to die unexpectedly during sleep.

Babies should always be placed on their backs when they sleep. They should never sleep on a couch, recliner, water bed or similar soft surfaces. If sharing a bed with others, there should not be any pillows or blankets, as these can potentially cover the baby’s nose or mouth. Babies should not be placed between two adults or be positioned so they could become wedged between a mattress and a wall or bed frame.

Commercial products such as pulse oximeters or positioners have not been shown to prevent infant death and they may even increase the risk.

We encourage families to follow the ABCDs of safe sleep for infants:

A: Alone – not sharing a bed or sleep space with anyone else

B: Back – back to sleep for every sleep

C: Crib – the crib or bassinet should be free of pillows, stuffed animals, bedding and bumpers

D: Danger – caregiver intoxication greatly increases the risk of tragedy

Everyone wants the best for their babies, and part of that is being aware of the safest options for your family’s sleeping arrangements, so that you can enjoy this very special time.

Sabra Anckner, RN, BSN, is a Perinatal Nurse Consultant with the State of Alaska Department of Public Health, Section of Women’s, Children’s and Family Health. She is the nurse manager for the department’s infant safe sleep work, the newborn bloodspot screening follow-up program, critical congenital heart disease screening, and the Hepatitis B vaccine first dose program.

Life with a newborn has me flustered and bewildered. It seems like the crying, rocking, feeding, walking-the-floor insanity is going to last forever. I’m also dealing with extreme fatigue and roller-coaster emotions. What are some ways that I can stay balanced when my new baby totally rocks my world?

Oh, I know those feelings so well, as a momma and as a midwife: the exhaustion, the frustration and SO MUCH love! The most important thing for us to remember in those challenging first few weeks is that babies have a biological need to be close to us. From a biological, historical and evolutionary perspective, we are not solitary beings! Our new babies want and need to be close to us; they need to be nourished, soothed and even the most simple functions of living such as breathing and body temperature, are regulated based on being close to mom or dad. Because of this, I recommend that every new parent invests in a good, comfortable baby carrier like a wrap, a ring sling, or a soft-structured carrier. Wearing your baby allows baby to be comforted by your breathing, your warmth and your movement. It’s a win-win...for both baby and your sanity!

Keep the concept of “the 4th trimester” in mind for mom and baby – meaning that this is a transitional period for both. Babies are still going through a tremendous amount of growth and brain development and are very needy. Moms should focus on bonding with baby, healing and nourishing their body. I know it’s so hard when the house seems to be caving in, the dishes aren’t doing themselves, and everyday life is around you...but really, some of those things can wait! For the postpartum fatigue and ups and downs of emotions, be sure to nourish yourself with real, whole foods, a diet rich in iron and good fats, continuing with Vitamin D3 supplementation, and getting outside – even for just a few minutes a day.

Wearing your baby, lowering your expectations of yourself with all of other life’s demands, and nourishing your body, will help so much!

Tara Elrod is an Alaska licensed and practicing Certified Direct-Entry Midwife. She is the Director of the free-standing birth center The Center for Birth (Palmer and Anchorage). For more information, visit akbirth.com.

When I recently Googled “best toys for babies,” I came up with more than 32 million results. Sure, there are endless opportunities for parents to spend their money on toys, so please help us cut to the chase: What kinds of toys are good for babies?

When I recently Googled “best toys for babies,” I came up with more than 32 million results. Sure, there are endless opportunities for parents to spend their money on toys, so please help us cut to the chase: What kinds of toys are good for babies?

Keeping in mind these three criteria will help guide you to a good toy:

• Interactive
• Open-ended
• Creative

Interactive
Interactive toys require participation rather than “turn it on and watch it.” Active participation is a powerful part of play and learning. Making things happen is more interesting and beneficial to a child than simply turning it on and watching it work. Observe what makes them tick, and go in the direction of their interests.

Open-ended
Open-ended play means there are endless ways to play (no instructions included). Wooden blocks are great examples of an open-ended toy. They are super durable and will provide an entire childhood of play. Wooden block play evolves with your child. As an infant, they will touch and grip larger, textured blocks. As toddlers, they will begin to combine, stack and line up. Tip: Always look for “unit” blocks. The term “unit” is an indication each block is a standard dimension, and can be used interchangeably with any other brand of “unit” blocks. This is critical for expandability. Unit blocks allow you to easily expand your set so your child can get more creative with their construction.

Creative
This criterion may have a bit less weight for infants, but it is important to development. Try to find toys that let your child imagine a world they create on their own. Keeping it simple inspires creativity and encourages ownership of the toy. Creativity can come with any toy, not just crafts or projects.

A tip from a wise toy rep 20 years ago: When any child presents you with a creation or Lego guy that she/he is “bringing to life,” don’t ask “what is that?” but rather say “tell me about your work” or “tell me about your friend.”

Ed Dodd (shown here) and Kari Dodd have owned and operated Classic Toys since 1998. Classic Toys opened its doors in 1985. toydango.com

Finding the right childcare setting for my 6-month-old baby seems overwhelming. What are some tips for finding the right place for him?

Choosing an early care and learning program for your young child is such an important and emotional process. Such a significant decision takes time, and you may find waiting lists that are months-long, especially for infants. So, I encourage you to start your search as early as possible. Since you know your child best, begin by thinking about your child’s individual needs and temperament. Would he do well in a family child care setting where the teacher cares for a small group of children in her home? Or would a larger, center-based program with multiple teachers and classrooms better suit him? Don’t be shy to ask other parents you know about their experiences. Next, look for tools and resources that can help you make the best decision – things such as indicators of quality care, who to contact if you need help paying for care, or interview questions you can use when visiting potential programs and centers. Once you have narrowed down a list of potential programs, be sure to call and visit each one to make sure you are selecting the best program for your family. Ask questions about how they can accommodate you for visits during the day or if you are nursing. Consider things such as their daily routines and how your child’s needs will be met. Can you bring your child’s favorite toy? Use all of the information you gather to make a decision you are comfortable with and ensure your child has licensed care that is safe, healthy and playful.

Stephanie Berglund is the CEO of thread, Alaska’s Child Care Resource and Referral Network. For information and free child care referrals, visit threadalaska.org.

Is it ok to give my baby a pacifier when he gets fussy? If so, is there a better type over another? If not, what are the risks in doing so?

To a mother, especially a new one, a pacifier can be the difference between complete joy and a trip down insanity lane. Pacifiers are, without a doubt, a life saver. However, the debate of whether or not they are good for your baby (i.e., nursing confusion, jaw growth, teeth growth/formation/alignment, etc.) is always going to be there. Bottom line, pacifiers are absolutely ok for your fussy baby – to a point.

There are many “wives tales” out there surrounding the negative side of pacifiers. I will touch on two of the most popular and hope to put some of your concerns at ease.

Nipple confusion. Myth. If you are nursing, it has been suggested that pacifiers should be used minimally until the age of 4-6 weeks old. The jury is still out on that, but what is known is that use of a proper, orthodontically designed pacifier can actually support and promote healthy, proper breastfeeding.

Crooked teeth/jaw misalignment. Myth. Again, using one that is orthodontically designed, a pacifier can actually help with tooth alignment and jaw growth. It is suggested, however, that by the age of 18-24 months, when most, or all, baby teeth are in the mouth, that the pacifier be limited as much as possible, if not stopped all together. Consider this: Thumb and finger suckers do more damage to the developing teeth and jaws (crooked/misalignment) than pacifiers ever could. Pacifiers can be thrown in the trash if weaning needs to be instant. Thumbs and fingers are there for life – especially at 2 am when you’re not there to stop it.

So, are pacifiers ok? Absolutely. But, use your best judgment and research any concerns you may still have. Is there a better type over another? Absolutely. Always look for an orthodontically designed one. Are there risks in using a pacifier? Some. When using a pacifier, as with everything else in life, there are “cons.” None of which are strong enough that it should deter you from using one.

Again, these are only two of the many different topics surrounding pacifiers. If you still have questions about the pros and cons of using a pacifier, consult with your child’s dentist or pediatrician. I’m sure they would be more than happy to help.

Dr. Christopher Coplin is a General Dentist licensed to practice in the states of Alaska, Idaho and Montana. His office, Alaska Dentistry for Kids, is in Anchorage and focuses solely on the oral health and well being of infants, toddlers, adolescents and those with special needs. For information, visit alaskadentistryforkids.com.

My baby is due soon and I want to make sure I purchase the best type of car seat for an infant and that I get it installed correctly – any tips?

Actually, there is no specific car seat that is “best.” The “best” car seat is one that fits your child’s height and weight, you can install correctly in your vehicle, and is easy for you to use correctly every time. All child restraints sold in America must pass the same Federal Motor Vehicle Safety Standards. A higher-priced seat does not necessarily equate to more safety. Two styles of child restraints can be used for infants:

Rear-facing Infant Seats

Infant seats can ONLY be used rear-facing. Generally, infant seats fit babies weighing 5-22 pounds. There are seats on the market that accommodate lower minimum weights (4 pounds) and maximum weights of up to 35 pounds. Infant seats have a handle to use as a carrier. New infant seats typically have a 5-point harness system (two shoulder straps, two hip straps, one crotch strap), which is the best choice for a newborn.

Advantages: Carrying handle, may attach to a stroller, and may lift off a base that remains in the car.

Disadvantages: You must purchase a convertible car seat when the baby reaches the upper weight limit of the car seat or when the baby’s head is within one inch of the top of the seat.

Convertible Car Seats

Convertible seats fit children between 5-40 pounds (or more) and up to 40 inches. They can be used rear-facing in a reclined angle for children up to about age 2 and then convert to an upright forward-facing seat. Many convertible car seats allow for rear-facing use to 40 pounds. Convertible seats typically have a 5-point harness system.

Advantages: Requires purchasing only one seat for a child from birth to approximately 40 pounds/40 inches (or more).

Disadvantages: It is not easy to install a rear-facing convertible seat in many vehicles. Convertible seats are not used as infant carriers, do not have sun shades, or attach to strollers.

Parents and caregivers are encouraged to set up no-cost private Child Passenger Safety checkup appointments with a local fitting station agency. A full list of statewide fitting stations is available on the Alaska Child Passenger Safety Coalition website, carseatsak.org, under the “Checkup Locations” tab. See you soon!

Sara Penisten, RN, is the Safe Kids Alaska state coalition coordinator. She is employed by Providence Alaska Medical Center, has been involved in child passenger safety since 1998, and is a certified child passenger safety technician instructor.

Can you prevent type 1 diabetes? My first child was diagnosed with insulin dependent diabetes mellitus when he was 5 years old. I just had a baby and I’m wondering if there is anything I can do to reduce her odds of getting diabetes too?

Congratulations on your new baby! Unfortunately, type 1 diabetes cannot be prevented. As you know, diabetes is a disease where the body is unable to use sugar (or glucose) for energy. This is because there is not enough insulin, the hormone that allows the cells to take the sugar from the blood. As a result, the amount of sugar in the blood rises to very high levels. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease, where the immune system attacks the pancreas and destroys the cells that make insulin. This is different from type 2 diabetes where the body does not respond to the insulin that is being made. Although there are ways to prevent type 2 diabetes, through healthy diet and exercise to improve how the body responds to insulin, preventing type 1 diabetes is much more complex. Many researchers are trying to find ways to prevent this lifelong disease. Some research suggests that breastfeeding may help to lower the risk of a child developing diabetes, which is good since we know that breastmilk is best for babies. There are many clinical trials that are studying why people develop type 1 diabetes and how we might be able to prevent it. The Juvenile Diabetes Research Foundation (JDRF) and American Diabetes Association (ADA) are helpful resources if you or your family members are interested in participating in some of this research. In Alaska, the Blood Bank of Alaska is participating in TrialNet, a nationwide network of centers studying type 1 diabetes and ways to delay or prevent it. Hopefully, the research that scientists are doing in Alaska and all over the world will help us to one day prevent and cure type 1 diabetes.

Rachel Lescher, MD, FAAP, is a board-certified pediatric endocrinologist at Alaska Native Medical Center in Anchorage. She sees children from across Alaska with diabetes and hormone problems. For more information, visit anmc.org.

I know that newborns’ immune systems aren’t built up yet, so they’re more susceptible to illness. Being that I am a bit of a germaphobe, I am nervous about what my newborn should be exposed to. Should I be asking visitors to slather on hand sanitizer before touching her? How do I protect her without going overboard?

All parents worry about exposing their newborns to lots of germs. Research has shown that exposing your baby to some germs is not only fine, it may actually be protective and help in building a strong immune system. But where do you draw the line on protecting the baby?

Certainly, if your baby was born prematurely (before the 37th week of pregnancy), you need to be extra cautious. These babies, along with other babies at risk for respiratory illnesses, should avoid exposure to large groups of people. There is a good chance that someone in the crowd is sick, especially during the cold and flu season.

If your baby was born healthy and full term, you won’t need to be as cautious, but there are still some general guidelines to keep in mind.

1. Wash your hands and your baby’s hands often. Good hand washing is the best way to prevent disease transmission. If you are away from a sink, bring along some instant hand sanitizer instead.

2. When friends and family come to visit, welcome them and say, “The baby is so excited to see you! Let me show you where the sink is so you can wash your hands.”

3. Remind visitors to stay away if they are sick. There will be plenty of time for hugs and cuddles once they are well.

4. Wear your baby. Baby wearing is wonderful in many ways including keeping strangers’ hands away from your newborn. Strangers are way more likely to touch your baby in a stroller than in a front pack.

As your newborn gets older and his or her immune system gets stronger, you’ll relax more taking your baby out in public. But for now, a little common sense and good old fashioned hand washing will give you plenty of peace of mind.

Jennifer Aist is a board-certified lactation consultant and parent educator at The Children’s Hospital at Providence. She has been working with new families in Alaska for the past 21 years. For information, visit alaska.providence.org.

Can we travel with our newborn baby? Is it safe to let her fly on a plane?

When I moved to Alaska, I discovered that babies here often are traveling at a very young age, and often by plane. Most babies tolerate traveling very well; much better than toddlers who don’t want to be sitting in one place for more than a few minutes! That said, there are a few cautions for parents who have trips planned in the newborn period.

Traveling by car

Most parents already know the basics: use an approved car seat, less than five years old, in the backseat, facing backwards. With a newborn, I’d probably have an adult in the backseat also just to keep an eye on your infant. If it’s below freezing, you may want to pre-warm the car. And of course, make sure no one smokes in the car!

If you are traveling more than an hour or so, you’ll need to stop frequently, every 2-3 hours, for feedings and to change diapers. Allow lots of extra time and take twice as many diapers as you think you’ll need. Diapers and wipes are hard to find and expensive on remote Alaska highways.

Traveling by plane

It is safe for a newborn to fly by plane, as many in Bush communities know by experience. (Although if your baby was premature, or has lung or heart disease, I’d recommend asking your doctor if there are any special precautions.) Because babies have very flexible ear canals, they don’t develop the ear pressure discomfort that some of us older folks do. As of this writing, babies under 2 years of age can still sit on a parent’s lap for air travel. This usually works just fine since a mother can easily breastfeed if her son or daughter gets hungry, and can even maneuver a diaper change in the seat if necessary. If your baby is bottle-fed, the flight attendants can help with formula preparation. Allow extra time to get to the airport and for transfers to other planes. And try not to plan a “busy” trip; both baby and parents need lots of rest during the newborn period.

Mary Ann Jacob, MD, FAAP, is a board-certified pediatrician in solo private practice. For more information, visit anchoragepeds.com.

Photo credit: Alaska Regional Hospital

I want to make sure I have breastfeeding success with my newborn. Is there any problem with supplementing breast milk with a bottle of formula now and then? Will this affect my baby or affect my milk supply?

Yes, you can feed your baby an occasional bottle of breastmilk or formula when breastfeeding! It will work best if you keep a few tips in mind:

1. Get breastfeeding off to a good start after the birth of your baby. This may take four to six weeks for your baby to learn how to latch effectively and for your body to develop good milk production. Pacifiers or bottles in the first month may interfere with these. The first month is a busy time of adjustments for the family and preparing bottles and expressing milk may be work that you don’t need to do. Make it as easy as possible on yourself by just breastfeeding.

2. When you give bottles, your breasts will still be making milk. You may need to express out some milk to avoid over fullness. Practicing hand expression or using a pump before you really need to express milk so you will be as relaxed as possible. It may take several “practices” before you are good at getting milk expressed. Don’t expect to fill bottles since your baby may not be taking that much each feeding.

3. If you feed from the bottle too much, your milk production may go down. Your milk continues to be made by how much is removed and if your breasts get too full, your milk cells get the message that you are making too much milk and begin to shut down production.

4. Bottles flow differently. If you give bottles too often or too soon, your baby may forget that they need to suck to get your milk flowing since the bottle pours into their mouth as soon as they put their gums on the nipple.

You may find it easier to breastfeed your baby in a quiet spot. When he is not with you, you will be comforted knowing he is still getting your milk that you previously expressed. Contact an international board-certified lactation consultant for specialized care and answers to your breastfeeding questions or a La Leche League Leader for help and ongoing support with normal breastfeeding issues.

Terriann Shell, IBCLC, ICCE, FILCA has been supporting and encouraging new mothers for 14 years at Alaska Regional Hospital and has been an international board-certified lactation consultant for 26 years. For more information, visit alaskaregional.com.

Photo credit: Candid Chaos Photography

Sleep, Baby, Sleep!

What are some tips for getting my baby on a regular sleep schedule?

Strategies for getting your baby on a regular sleep schedule will vary and adjust as she grows. First, consider your baby’s current development, both physical and emotional. Having an understanding of what is age appropriate developmentally will help you create realistic sleep expectations and goals. Babies’ sleep needs change over time, so being familiar with how much sleep your baby needs for nights and naps is important.

Create a predictable, daily routine. The idea behind a routine is for it to be regular, not rigid.

How well your baby sleeps at night is heavily influenced by her daytime flow. Allow and encourage regular naps. Not only are naps critical for learning and development, but they also help in keeping your baby refreshed to be able to sleep more productively at night. It seems counter-intuitive, but babies need to sleep during the day to be able to sleep at night. Yes, you may have to sacrifice some play dates or outings while you’re working on a sleep schedule for your baby; but once healthy sleep habits are established, veering off course every now and then won’t result in sleep disaster.

Other factors to consider are nutrition (when and what your baby is eating), having a calm and soothing bedtime routine, and her independent sleep abilities. Each child and family dynamic is unique so choose an approach that fits your lifestyle and parenting philosophy. Otherwise, staying consistent will prove even more difficult.

Make sure your baby’s sleep environment is sleep friendly. Exposing your baby to light during the day can help with organizing her biological rhythms and signaling to her awake time. However, the sleep environment should be darkened, even during naps. Check the room temperature to make sure it’s comfortable, and dress your baby accordingly. Consider adding white noise to help block out outside sounds like a barking dog or noisy cars. Finally, check the humidity.

The key to sleep success is finding what works best for you and your family, and then being consistent. What works for you now may evolve over time, and that’s to be expected. It’s a growing process for you and your baby.

Before making any sleep modifications, be sure to check in with your pediatrician to rule out any possible medical issues or illness.

Dominique Brooks is a certified maternity and child sleep consultant and founder of Dream On Maternity and Child Sleep Consulting in Anchorage. More information about Dominique can be found at dreamonsleepconsulting.com.

Photo credit: Kara Milligan Photography