Texas Parenting News

Doctor visits—even when children are healthy

Pediatricians and other health professionals recommend that parents take their children for regular visits to a doctor or health clinic throughout the preschool and school-age years.

The schedule for preschoolers recommended by the American Academy of Pediatrics:
2 to 5 days after birth
1 month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months (2 years)
30 months (2 1/2 years)
3 years
4 years

“Why go so often, even when my child is not sick?” you might ask.

These well-child care visits promote your child’s optimal development and overall well-being. The doctor and staff may take physical measurements, arrange for visual and hearing screens, administer immunizations to prevent infectious diseases, review home safety, discuss diet and activity for a healthy lifestyle, and assess development and behavior.

Because both your time and the doctor’s time are limited, it’s wise to write a list of items that you want to discuss. Some tips to make the visit productive:
Bring the list of discussion items with you, and mention it when the doctor first comes in, rather than waiting until the end. The examination may proceed, but you have alerted the doctor that you have concerns that need to be addressed.
If you don’t understand the words the doctor is using, ask for clarification. For example, what exactly does acute mean?
Don’t hesitate to mention concerns that are not specifically medical. For example, you may ask about toilet training and the effect of air pollution.
Don’t be afraid to bring up issues that some people would find controversial, such as guns in the home, vaccine safety, and a vegetarian or vegan diet.
If the doctor prescribes medication or suggest an over-the-counter drug, make sure you understand how to administer it to your child.
If the doctor diagnoses a health condition such as asthma, ask the staff for more information. Among other things, you’ll want to know when symptoms are serious enough to call the doctor or go to the emergency room.
Trust your instincts. If your child is not talking by age 3 and the doctor dismisses the issue, it’s OK to seek a second opinion from another doctor or, in this case, a speech pathologist.
Take notes because once you get home, you may not remember what the doctor said.
Remember that you are your child’s health advocate. Inform yourself using books and websites that provide reliable information. Ask yourself about the qualifications of the sources you consult: a medical doctor versus a TV celebrity, a nutritionist versus a food lobbyist, or a Registered Nurse versus your best friend’s mother-in-law, for example.

For hundreds of safety and health tips, see the academy’s website for families, healthychildren.org.

Can’t breastfeed?

By now, most pregnant and new mothers know the health benefits of breastfeeding for their babies and for themselves. They may also take for granted that breastfeeding will be easy and rewarding, and they get lots of reassurance from doctors, nurses, friends, and relatives.

But take the example of this mother:

“I put my baby son to my breast before we left the hospital and again after we got home. I thought things were going OK, except that he would start crying after a while. He sucked and sucked until my nipples hurt. He kept me awake all night with his crying. I called the La Leche League help line, and they said sweetly, ‘Just keep trying.’ Finally, when I went to the doctor, I was horrified to learn my baby hadn’t gained any weight. The doctor immediately told me to start feeding formula.

“I felt guilty because I had been starving my son. I felt inadequate as a mother. And I was angry. It wasn’t fair. A year later, my sister-in-law, who has nubs for breasts, breastfed her baby just fine. And my mother-in-law told all her friends that I couldn’t make milk. I felt ashamed.”

According to West and Marasco’s breastfeeding guide (2009): “While it’s true that most mothers can make enough milk, we are now learning that there are definitely mothers who really aren’t making enough milk, and for a variety of reasons, their numbers may be rising.” One estimate put the percentage of new mothers unable to breastfeed at 5 percent (Whiteman 2015).

“We’re also discovering that there are more causes of low milk production than was once realized,” (West and Marasco). Common causes can include the mother’s intake of medications, alcohol, cigarettes, and diet. Some causes are physical—breast surgery, infections, obesity, water retention, hormone dysfunction, for example—while others are psychological—birth trauma, sexual abuse, and stress, among others. One might also speculate that one cause may be environmental, given the extent of pollution, chemicals, and pesticides in the world.

How to determine
The best way to judge whether you have a low milk supply is the baby’s weight. While newborns normally lose up to 7 percent of their birth weight in the first few days after birth, they should regain the birth weight after about two weeks. A general guideline is a gain of 5 to 7 ounces a week, and a doubling of birth weight at about 5 months (Hoecher 2014).

Another way to determine adequate milk production is diaper output. In the first day or two after birth, the baby will wet one or two diapers with pale yellow urine every day. The baby will pass meconium (black substance that forms the baby’s first feces) at first, then greenish stools around the third day, then brownish green and finally yellow. Black or brown stools after the fourth day indicate that the baby is not getting enough.

If you suspect low milk production, investigate what might be the cause. In some cases, there may be multiple causes. Until you identify what’s happening, keep in touch with your doctor and follow the medical advice on introducing formula. A great resource for learning how to improve milk supply is The Breastfeeding Mother’s Guide to Making More Milk, which may be available at your local library.

Perhaps you welcome the switch to bottles. You are eager to get back to work, don’t want the challenge of breastfeeding in public, or don’t want to pump. On the other hand, maybe you desperately wanted to breastfeed like all your friends. You wanted to feel the special bonding with your baby, but now feel pressured by negative emotions.

How to cope
It’s important to deal with negative feelings that arise, lest you wrestle with them long into the future. “It haunted my sister forever, and she’s in her 60s now,” said one woman.
Acknowledge your feelings. Recognize that you’re not the only mother who can’t breastfeed. Read comments by other mothers on the blog “Moms that can’t breastfeed,” and leave your own comment, if you wish, at Breastfeeding-problems.com, www.breastfeeding-problems.com/cant-breastfeed.html. Accessed Nov. 24, 2015.
Distinguish between guilt and regret. “Guilt assumes that you deliberately decided to do something knowing what the outcome would be. Regret happens after we learn something that we did not know at the time of the decision” (West and Marasco). Chances are you did the best you could with the information you had at the time.
Lessen anger and resentment by talking it over with a sympathetic partner or friend. If you’re angry at someone in particular, remember that the person may have a limited perspective or experience. Accept your situation, knowing that breastfeeding can be more complicated than it appears.
Overcome feelings of inadequacy by remembering that there’s no such thing as a perfect mother. “Many kinds of milk can nurture the body, but only your love can nurture the soul” (West and Marasco).
Respond to insensitive remarks with a neutral statement, such as “Thank you for your opinion.” It’s impossible to know what’s behind another person’s hurtful comment. It could be a closed-minded belief about infant feeding, lack of empathy, or a need to spread gossip.
Most important, avoid feeling that your baby has rejected you. Watching a baby showing greater satisfaction with a bottle than your breast can undermine your confidence in your mothering ability. Know that you have a lifetime of opportunities to create a loving relationship with your child.

For more information, check these resources:
Hoecker, Jay, M.D. Oct. 10, 2014. “How much should I expect my baby to grow in the first year?” Infant and toddler health, Mayo Clinic, www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/infant-growth/faq-20058037. Accessed Nov. 24, 2015.
West, Diana and Lisa Marasco. 2009. The Breastfeeding Mother’s Guide to Making More Milk. New York: McGraw-Hill.
Whiteman, Honor. Aug.5, 2015. Do some women feel stigmatized if they are unable to breastfeed? Medical News Today, www.medicalnewstoday.com/articles/280769.php. Accessed Nov. 24, 2015.

Why take preschoolers to the library

In a time when nearly everyone can communicate via cell phone, download books and movies on laptops, and get answers by asking Google, going to the local library may seem quaint and outdated.

But taking children to the library offers many rewards. Here are a few.
Your neighborhood library probably has more books, magazines, newspapers, and videos than you can afford to buy. If you’re on a budget, a library offers a treasure trove of entertainment, news, and information at no cost.
Borrowing books and reading to your preschooler lays the foundation for reading and school success. Reading, listening, and conversation aid language and brain development.
The mere experience of being surrounded by lots of books and materials has a huge influence on children. The act of finding a book clues your child into a sense of organization and seeing row upon row of books suggests a wealth of knowledge and culture.
Many libraries have computers connected to the Internet. You and your children can take classes in how to use electronic devices and use the Internet at no charge.
Many libraries offer a wide range of activities for children: storytelling, puppet shows, crafts activities, puzzles and games, and play areas as well as special programs in the summer and during holidays. Such literacy and social activities challenge children’s thinking and behavior far more than sitting passively in front of a TV.
Visiting the library as a preschooler introduces the child to a resource that will be essential throughout schooling, college, and adult life.

Tips for using the library
Before bringing children for the first time, inform them about what to expect. Explain the need to be relatively quiet, walk instead of run, and not climb on furniture, for example.
Get a library card for your child. Borrowing books in one’s own name helps children feel responsible and trustworthy.
Ask the children’s librarian to recommend books based on the child’s age and interests. Go online and reserve books to be sure to get what you want and save time.
Talk about treating books with care—not to mark in them, tear pages, or eat or drink near them, for example.
Ask how many books the library will allow you to borrow at a time, or set a limit depending on how soon you can read them all.
Bring a canvas or roller bag for carrying the books. You may need to have one hand free to hold your child’s hand and walk safely across the parking lot.
Be aware of the date each item is due back. You may be allowed to borrow a book for three weeks but a video, only one, for example. Remember that you can probably renew materials online, unless another person has reserved them.
Post the check-out slip on your kitchen bulletin board or make a note in your cell phone so that you will bring books back on time. Your library may send you an email message a few days before a book is due. Fines for books are nominal, but checking out several and keeping them past the return deadline can add up.
Take note of library locations and hours. You may request that a book normally held in a central library be brought to one close to your home. Because of funding cuts, a library may open late or be closed on certain days.
If your library doesn’t have a book that someone has recommended or that you’ve seen on the Internet, ask about interlibrary loan. Your library may be able to borrow it from another town or school.

A quote worth remembering:
“I received the fundamentals of my education in school, but that was not enough. My real education, the superstructure, the details, the true architecture, I got out of the public library. For an impoverished child whose family could not afford to buy books, the library was the open door to wonder and achievement, and I can never be sufficiently grateful that I had the wit to charge through that door and make the most of it. Now, when I read constantly about the way in which library funds are being cut and cut, I can only think that the door is closing and that American society has found one more way to destroy itself.” —Isaac Asimov, I. Asimov: A Memoir