Hopeful for the New Year

I, for one, am not sad to see 2013 go. It’s been a rough year for me. I haven’t been blogging about it – haven’t been blogging about much of anything, actually – and I think it is time for an update.IMG_5374 2013 started with a miscarriage in progress, finally ending with a D&C on January 4. I grieved that lost pregnancy openly on this blog. It was therapeutic for me to blog about it and to feel support from women who had had similar experiences, or at least had empathy for the magnitude of love and hope that comes with a pregnancy. I started to feel better. I was confident that I would be pregnant again soon, and that was the obvious way to fill the gaping hole in my heart.

In the spring, I watched seedlings poke through wet dirt. Our neighborhood burst with color and new life, and I felt hopeful. But as the days grew longer and hotter, I felt sadder and sadder.  I still wasn’t pregnant. My previous due date came and went, now just another day, but such a heavy one for me. Cee and I sorted through newborn clothes in our hot attic, not for a new baby for our family, but to lend to a friend. Cee asked to keep a few onesies for her baby doll. I showed her how to fasten the snaps and then sent her downstairs so I could cry.

In August, I had another miscarriage, this time very early. Then, another one in October, early again (and thankfully spontaneous) but far enough out that I let myself think ahead to another summer due date. That one really crushed me. I know miscarriage is common, and it’s easy to chalk the first up to bad luck. But by the third time around, I had really lost faith in my body. It has failed, repeatedly, to do one of the things I feel it was always meant to do. I’ve always wanted children, and the family that I have, for which I am exceedingly grateful every day, doesn’t feel complete. There’s still a gaping hole here, and it’s only gotten bigger.

Meanwhile, Cee turned three in November. I know my sadness has affected her, and it’s affected my parenting, because my emotional reserve is just plain depleted. I am working hard at being enough for her and at assuring her that she is enough for me. (And she is. She really is. I’ve come to terms with that, most days anyway.)

But Cee would be such an amazing big sister. She is obsessed with babies. She cares for her baby doll tenderly all day long. She also has a set of imaginary friends collectively known as “Baby’s cousins,” whom she visits and calls on the phone several times per day. And most days, Cee walks around with her belly stuck out for a few minutes, telling us that she has a baby in her tummy. Sometimes she rubs her tummy and then lifts a new baby out, like a genie from a bottle. She holds this tiny, invisible baby delicately in her arms and tells me that her name is Alice. “You want to hold her, Mama?” I play along, but it is such an eerie, painful game. I haven’t talked to Cee about wanting another baby, but she’s sharp, and she knows, through her three-year-old lens. It’s as if she’s trying to fill my emptiness with her play.

And, of course, this holiday season was tough. For most of last year’s season, I was pregnant and blissfully unaware that it was failing inside of me. As we went through the holiday rituals this year, my latest memories were of that pregnancy. I didn’t really feel like putting on a happy face for holiday parties, and nobody wants to talk about your latest miscarriage around the punch bowl. Passing the anniversary of the ultrasound showing my failed pregnancy felt like crossing over into the current reality. It was a relief. In December, we also did a few baseline fertility tests, and they basically looked normal. That was reassuring.

I haven’t been blogging about this, and I’m not sure why. I know that blogging about my first miscarriage was extremely helpful to me, and I hoped that by writing about it, I would open the conversation to other women. But there is still a dark undercurrent of shame around miscarriage in our culture. A recent national survey was illuminating: American adults believe that miscarriage is rare, and they pretty much place the blame squarely on the woman. Survey respondents thought that miscarriage occurs in less than 6% of pregnancies, when in reality 15-20% of all pregnancies end in miscarriage. When asked to name the major causes of miscarriage, the two most common answers were stress and lifting a heavy object. This, again, is not the reality; most miscarriages are due to chance chromosomal abnormalities and can’t be prevented. Miscarriage is misunderstood, and that’s a burden on women carrying this quiet grief.

I know that my silence on this topic is in part about shame and vulnerability. But it’s also just been a little too raw for me to share. I seek out support carefully, and blogging and social media often open unfiltered conversations that are just draining to me now. I have been turning inward, dumping my fear and frustrations into my journals. Sometimes this strategy works well for me, but sometimes it swallows me up in loneliness.

My experience, both online and in real life, is that when I open up to another mom about how I’m feeling, two things usually happen. First, my load feels a little lighter. And second, she feels safe to tell me what she’s struggling with right now, too. We all struggle with something, and pretending otherwise hurts us all. It’s always hard for me to hit “Publish” on a personal blog post, but I’ve never regretted it.

And now, I have a book to finish. The last six months of writing have been slow and difficult. When I signed the book contract, I was pregnant, and I envisioned completing most of the manuscript while I prepared for the birth of that baby, giving me a non-negotiable deadline and personal motivation behind my research. Instead, the cycles of emotion that come with trying to conceive, and loss, have made it hard to sit down at my desk and write about… babies. I am still happiest when I am buried in the science, trying to make sense of it all. I just hope that I have the chance to use some of this mountain of knowledge as a mom again. The book is coming along, and I think it will be really great, but it isn’t where I want it to be yet. The manuscript is due in six months, and starting today (yay, resumption of childcare!), I’m putting my head down to finish it.

Anyway, I wanted to write today to let you know where I’ve been and also that I probably won’t be blogging much between now and July 1. I need some major focus and momentum to finish the book well, and I’m still teaching a couple of classes each term. In the meantime, I have a thick folder full of topics for future blog posts, and I’ll be back to blogging regularly after I finish the book manuscript.

And also, I’m okay. I feel ten times better today than I did a month ago. I survived December and have lots of hope for the New Year, and that hope doesn’t even feel entirely tied to a baby.

New Year’s Eve afternoon was unseasonably warm and sunny for Oregon in December. Our little family hiked up a local trail to catch the last few rays of the year.

IMG_5378The sky filled with pink and orange, and I pointed out the colors to Cee. “I think someone much have gone up there with a paintbrush and painted all those colors,” she said. Curious, I asked her who she thought might have done that. “Baby’s cousins,” she replied self-assuredly. Of course. It made me smile to think of an imaginary pack of kids painting the sky.

IMG_5383We let 2013 go with the sunset.

IMG_5393Then we turned around to hike down in the waning light. We spotted the first star of the night, and I made my quiet wish.

Amylase in Infancy: Can Babies Digest Starch?

Several readers have emailed me to ask about babies’ ability to digest starch. Here’s one:

“I have noticed you recommending cereals for babies several times.  I am sure that you are aware that many people look at feeding a baby grains before the age of one or even two as if you have offered your child strychnine. One of the reasons cited is that they supposedly do not have amylase to digest grains before that time. I have often wondered what exactly is happening to the cereal if it is not being digested, but the only statement I could find is something about it “rotting” in the gut.

I would love to get information from a scientific point of view on this topic.  Everything I have been able to find thus far has been very biased towards one point of view or another. Either “cereal is the perfect first food. Easy to digest and enriched with iron” from the infant cereal companies or “Cereal is junk.  No infant should ever eat grains. It is not natural or traditional and they can’t digest it” from online parenting sites.

I need a little clarity and common sense.”

~Hope

I love the skepticism in Hope’s email, and I can also empathize with her frustration about how difficult it is to find good information about a seemingly simple question: Can babies digest starch? If you search for the answer to this question online, you will run into dire warnings of the dangers of giving starch to babies. But these sites might set off your woo detector – as they should. So, after receiving multiple emails about this question as well as seeing it mentioned in discussions on the Science of Mom Facebook page, I figured it was time to put some evidence-based information about babies and starch digestion on the Internet.

Researching this question has given me an excuse to read some classic nutrition physiology papers harkening back to the 1960’s and 1970’s, and it’s brought back memories of years in the lab, exploring nutrient digestion and metabolism. And starch digestion in infancy, it turns out, is a really neat story.

Let’s start with some basics about carbohydrate digestion.

What is starch? How is it digested?

Starch is a type of complex carbohydrate. Made from lots of glucose molecules bonded together in long, branching chains, it is a plant’s way of storing glucose – product of photosynthesis and source of energy – in a stable form. We find starch in grains, root vegetables, winter squashes, beans, and some fruits, like bananas. Starch is an important storage depot for the plant, and it also makes for tasty staple foods for cultures around the world.

One little section of starch, containing 3 glucose molecules. Wikimedia Commons, public domain.

A chain of 3 glucose molecules, like a tiny section of starch.

Glucose is the major fuel for the cells of the body. When we eat starch, we have to break the bonds in those chains of glucose molecules, liberating them to be absorbed from the small intestine into our blood. Starch digestion begins in the mouth, where salivary amylase starts chopping up those large glucose chains. When this partially digested starch gets to the small intestine, amylase made and secreted by the pancreas jumps in to do more bond-breaking and is responsible for most of starch digestion in adults. A suite of enzymes produced by the cells lining the small intestine, including sucrase, isomaltase, maltase, and glucoamylase, work on the remaining short chains, finishing up the job and making glucose available for absorption.

Starch Digestion in Infants

Infants go through some incredible nutritional transitions in the first months of life. Prior to birth, their growth and development is fueled almost entirely by glucose from mom, absorbed across the placenta. After birth, they have to abruptly transition to an exclusive milk diet, which is high in fat and lactose, still a relatively simple sugar. As they start solid foods, babies have to adapt to a much more complex and varied diet. Around the world, starch is a major source of energy in the diets of children and adults alike. But when infants are first introduced to starchy foods – often in the form of cereals and porridges – starch is a novel nutrient to their digestive tract. They need to turn it into glucose, but are they equipped to do this?

It’s true that infants have low levels of pancreatic amylase, the workhorse of starch digestion in adults. Research in the 1960’s and 1970’s showed that pancreatic amylase activity, measured in samples of fluid from the small intestine, is almost non-existent in newborns. Activity starts to increase within the first six months, however, and continues ramping up throughout childhood. By four to six months, when many babies are introduced to starch in the form of cereals, there is some pancreatic amylase activity, but still much less than that found in older children and adults.

Looking at these results, scientists questioned whether babies could handle starch very well. But they didn’t throw up their hands and declare, “No starch for babies!” They kept asking questions and seeking answers. They must have been puzzled by the fact that babies appeared to digest starch just fine. For example, think of the experience of those who are deficient in another carbohydrate-digesting enzyme, lactase, which allows us to digest lactose, the carbohydrate in milk. What happens if they drink a glass of milk? They have obvious, uncomfortable symptoms of diarrhea, nausea, cramping, bloating, and gas. These symptoms weren’t apparent in young babies eating infant cereals, which in the U.S. in the 1970’s, were usually introduced to babies by 1-2 months of age. My mother-in-law recorded my husband’s first teaspoon of doctor-recommended rice cereal in his baby book at 4 weeks, yet her careful records didn’t include any concerns about a sudden onset of diarrhea.

Baby book, ca. 1975

Baby book, ca. 1975

And this approach to infant feeding wasn’t that unique to the U.S. Ethnographic reports are filled with examples of starchy first foods for young infants around the world: Millet flour at 3 months in Tanzania; corn porridge at 3 months in Zimbabwe; beans and rice at 4 months in Brazil; a little butter and flour at 3 days in Bhutan; rice mash at 3 weeks in Nepal; and prechewed taro root at 2 weeks in the Solomon Islands. If babies were eating starch this young, with no apparent clinical signs of malabsorption, there must be more to the story.

The studies of pancreatic amylase activity had only measured its activity in a test tube in the lab. Next, researchers took a more holistic approach and measured starch digestion in the babies themselves. A 1975 Italian study added starch from different sources (potato, tapioca, corn, wheat, and rice) to 1-3-month-old babies’ formulas and then checked to see what came out at the other end –- in the babies’ poop. It turned out that very little starch ended up in these babies’ diapers. When they were given between 1 tablespoon and ½ of a cup of starch per day, they appeared to digest more than 99% of it. The researchers then tried a larger dose, giving several 1-month-olds a full cup of rice starch. Three of these infants absorbed more than 99% of this amount. Two absorbed just 96%, the other 4% ending up in their diapers, along with some diarrhea. In other words, within the first few months of life, babies can digest small amounts of starch just fine, but give them too much and you’ll see some diarrhea. (And no, I’m not suggesting that we feed 1-month-olds cereal – this was just the research at the time.)

How is this digestion of starch possible if babies have so little pancreatic amylase at work?

There are probably several mechanisms at play:

1. Babies make lots of salivary amylase. Although newborns secrete little salivary amylase, production increases quickly in the first few months after birth [PDF], reaching near adult levels by 6 months of age. Salivary amylase appears to survive the acidic conditions of the stomach reasonably well and is protected by both the presence of starch and breast milk. Once it is dumped into the small intestine, where pH is more neutral, it resumes its work of breaking down starch.

2. Human breast milk has lots of amylase, 25x that found in raw cow’s milk. Interestingly, it is highest in colostrum, and decreases slowly during infancy, as salivary and pancreatic amylases are increasing. Like salivary amylase, breast milk amylase retains at least 50% of its activity even after several hours of exposure to the low pH of an infant’s stomach, passing into the small intestine ready to get to work. It also seems to be protected by proteins in breast milk. One researcher estimated that the amylase in 100 ml of breast milk was capable of digesting 20 grams of starch (equivalent to 2/3 cup of dry rice cereal) in one hour. This is one good reason to use breast milk to make up cereals for young babies, and studies show that amylase is stable in breast milk for hours even after repeated freezing and thawing.

3. Glucoamylase helps out in the small intestine. Glucoamylase is an enzyme made by the cells lining the walls of the small intestine. Like amylase, it breaks the bonds between glucose molecules in starch and shorter glucose chains. But unlike pancreatic amylase, glucoamylase is very active in infants, reaching adult levels as early as 1 month of age.

All of these sources of starch-digesting enzymes – salivary and breast milk amylase, as well as glucoamylase in the small intestine – appear to work together to help babies digest starch to glucose. But that isn’t the end of the story.

Studies have shown that a significant fraction of dietary starch isn’t digested in the small intestine of babies but passes on to the large intestine. Is this where it “rots” in the gut, as the alarmist blog posts claim? Not so fast. Bacteria in the colon ferment (quite a different process from rotting) these undigested carbohydrates as part of the healthy symbiotic relationship between our gut microbes and us humans. It happens in adults, too. Even with their full activity of pancreatic amylase, some starch escapes digestion in the small intestine, as does dietary fiber. These undigested foods help feed the microbes, who kindly benefit us in lots of ways. The end products of microbial fermentation in the colon are short chain fatty acids, which can improve nutrient absorption, enhance gut health, and even be used as a source of energy for both the microbes and the human host. Babies and toddlers may actually have faster colonic fermentation of starch than adults, which might represent an important pathway for them to fully capture the nutrients in their food. The addition of complex carbohydrates, including starch and fiber, to the diet of older babies and toddlers might help to develop those healthy microbes.

OK, so maybe babies can handle starch just fine. But is there any harm in waiting a year or two to introduce it, just in case?

I can think of a few reasons why we should be careful about limiting starch in a baby’s diet:

1. Waiting too long to introduce grains to your baby could end up increasing the risk of developing celiac disease, Type 1 diabetes, and wheat allergy. There seems to be a sweet spot kind of window in mid-infancy – probably between about 5 and 7 months, where introduction to a variety of foods, including grains, decreases baby’s risk of developing chronic disease and allergies later in life.

2. Eliminating starch can make it more difficult for babies to get the nutrients they need. Infant cereals are fortified with iron, one of the nutrients most likely to be limiting to infants, even in the developed world. They are stable for long-term storage, and it’s convenient to mix up just a tablespoon of cereal at a time. You can certainly meet the nutrient needs of babies without cereals, but it takes more work and experimentation. When Cee was a baby, she was not at all interested in eating fortified baby cereals, and I found other sources of iron for her. But if your baby likes cereals, I wouldn’t hesitate to include them as one of a variety of foods in his diet. Also, this concern about starch digestion and amylase tends to be focused on avoiding grains, but remember that legumes and many fruits and vegetables also have lots of starch. If you truly tried to avoid starch, you would really be limiting your baby’s opportunities to gain nutrients and experience with different tastes and textures.

By Keith Weller, USDA ARS [Public domain or Public domain], via Wikimedia Commons

3. There may be negative consequences to being anxious and restrictive about food with young children. We seem to have an ongoing obsession with restrictive diets. It used to be all about restricting fat, then all carbohydrates, and now grains are getting a bad rap. I don’t think this is healthy. Barring allergies or intolerances, eating a variety of foods from all the food groups pretty much ensures that you’ll meet your nutrient requirements without even trying. It allows you to relax and enjoy your food with the people you love, which is really what eating should be about. When you start eliminating food groups, you increase your risk of nutrient deficiencies, increase anxiety about food, and make it more difficult to share food. It’s one thing to make this choice as adults, but in my opinion, to impose it unnecessarily on our kids isn’t fair. When a two-year-old isn’t allowed to have a cupcake at a birthday party, he might feel different and deprived, and he’s lost a chance to practice eating treats in moderation. Parents of kids with food allergies have to work carefully to manage these situations, but for the rest of us, this kind of restriction is unnecessary.

The bottom line is that it is safe to feed babies starchy foods. They can digest them, and they are one part of a varied, balanced diet for babies that are ready to begin eating solid foods. I’ll be writing more about the transition to solid foods in the next few weeks.

What information did you get about introducing grains and other starchy foods to your baby? What did you actually do?

Two Mom-Driven Media Ventures You Should Follow (and Support!)

I want to take a minute to highlight a couple of newish media ventures that I think readers of this blog would love. Funnily enough, both are a little old-fashioned. One is a literary magazine, printed on real, honest-to-god, paper. It arrives in my mailbox, and I know I need to clear my evening – put away my laptop and phone and snuggle into my bed a few hours before I actually intend to go to sleep. And the other is a podcast. Maybe that doesn’t count as old-fashioned, but as I listen, this form brings all the warmth and comfort of a radio show that makes me want to slow down, close my eyes, and just listen.

Both of these projects are doing something special and filling our need for real parenting voices amidst the chatter from popular websites and advice-filled magazines.  After every installment, they leave me wanting more.

longest shortest time headerThe Longest Shortest Time is a podcast and accompanying blog created by Hillary Frank. Hillary is a writer and a professional radio producer, and her experience shows in the podcast. I love good radio, and this is good radio. I just discovered the Longest Shortest Time last summer, at the recommendation of a friend. I was immediately hooked, and I plowed through the 20 existing episodes, recorded over the last three years, while I packed up our house in preparation for our move.

The Longest Shortest Time is about stories. But stories are different when they’re told from one friend to another, or one mother to another, empathetic mother. That’s something that Hillary recognized. She says:

“Something I did know from having been a radio producer for about 15 years, is – if you have a microphone, and you stick a microphone in someone’s face, they will tell you just about anything, and it’s not awkward. I just started sitting down with moms and calling moms, and dads too, to hear their stories of struggles in early parenthood.”

These are some incredible stories. The most memorable is Hillary’s conversation with her friend Kelly McEvers, an NPR war correspondent, about what it was like to combine early motherhood with her very dangerous line of work. That’s a perspective that I’d never heard before. I am nothing like a war correspondent, in my personality or work, and my experience with motherhood is nothing like Kelly’s. But still, I felt a certain amount of kinship with Kelly when she said this:

LST kelly quote

(The above image is an example of a *spark*card, quotes from the podcast printed on business card-sized paper. Hillary created these as a brilliant way to spark conversations between parents, with the idea that handing these out at your breastfeeding support group, mom-baby yoga class, or just between friends might help continue the conversations that she begins with her podcast. And spread the word about the Longest Shortest Time.)

There are lots more mundane stories as well: stories of babies that won’t nap, breast milk that isn’t enough, and embarrassing episodes of pumping at work. Even if you haven’t had these experiences, you’ll find that you can relate to these other moms. And you’ll want to hold them up, cheer them on, and thank them for telling their stories, because they are a reminder to us all that we are not alone.

Hillary launched a Kickstarter campaign to fund Season 2 of the podcast about a month ago. I’m woefully late at getting this blog post up, because the Kickstarter campaign ends TOMORROW! She’s already met her original goal and attracted lots of attention from business sponsors as well. This is awesome – these are exactly the kinds of mom-driven media ventures we should all support. She extended her goal, and I still donated this morning, because I want to cheer her on, and I know that she’ll only create more goodness with this funding.

I encourage you to check out the Longest Shortest Time. If you love it like I do, maybe you’ll want to donate to the Kickstarter. But you can also lend your support to this venture by listening to the podcast and passing it on to your friends. It’s a lovely, vital resource, particularly for new parents.

stealing time

Stealing Time is a literary magazine for parents run by a group of writer moms in Portland, Oregon. If I remember correctly, it was born out of the void left by Brain, Child when it closed its doors a couple of years ago. Brain, Child came back, and I’m a subscriber and a big fan of both magazines. But Stealing Time has turned out to be completely different. It’s raw and real. It’s full of stories, poems, and nonfiction that broaden my understanding of the parenting experience. They inspire a feeling of kinship, rare in this day of parenting media that plays to the mommy wars. This is no mistake; it’s part of the magazine’s mission:

Once we became parents, we knew part of the journey of parenting was writing and reading about it. And it was difficult to find the sort of stories we yearned for. We became disenchanted with media that aimed to provoke and shock and appeal to shallowness. We are tired of being pitted against other parents, we are tired of being told to feel shame for trying too hard or not trying hard enough, we are tired of stories about parenting that pretend that there is only one best way to parent.

And so we discovered our mission: To provide a venue for quality literary content about parenting: no guilt, no simple solutions, no mommy wars.

This magazine honors real stories, the ones that transcend pettiness fostered by much of modern parenting media. It also honors good writing. You know that moms and dads have toiled over telling their stories in just the right way, in stolen moments at a coffee shop before school pickup or late at night, after the kids are in bed. These stories inspire me to think about how to better tell my own. And between all the reading and the writing, this magazine feels like it is full of kindred spirits.

You can read some of the literary work publishing in Stealing Time on their website. If you like what you read, subscribe to the print version so that you can snuggle in your bed and turn the physical pages, as I love to do. The next issue of Stealing Time is a special Pregnancy and Birth issue. I’m told it is at the printers now, and I can’t wait to read it.

Passing time and finding time are universal themes of parenthood, right? Check out the Longest Shortest Time and Stealing Time. In a few spare moments, they will both enrich your parenting life.

Breastfeeding, Gluten Introduction, and Risk of Celiac Disease

A study published yesterday in the journal Pediatrics suggests that later introduction of gluten and breastfeeding beyond 12 months both increase the risk of a child developing celiac disease. These new findings add to the already muddy waters of our current understanding of the role of infant feeding in celiac disease.

Photo by Shree Krishna Dhital, via Wikimedia Commons

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. Celiac is characterized by inflammation and damage to the small intestine, leading to symptoms such as diarrhea and digestive pain. In the U.S., celiac disease is present in about 1 in 141 people, although many of these cases go undiagnosed. Infants that develop celiac disease often have poor growth or weight loss, because intestinal damage compromises nutrient absorption. They also may have chronic diarrhea and a swollen, painful belly.

Celiac can usually be treated with a gluten-free diet, but there isn’t a cure for the disease. Multiple genetic markers have been identified for celiac disease, but many genetically susceptible individuals tolerate gluten and never develop symptoms, leading to speculation about other risk factors, including early childhood nutrition.

This latest study was a large, prospective survey of infant feeding practices and development of celiac disease in Norwegian children. Parents were asked when they first introduced gluten and how long they breastfed their babies. Children that developed celiac disease were tracked through Norway’s national medical system. The study included 324 children with diagnosed celiac disease and 81,843 without celiac. The researchers then looked for patterns in the data that might help to explain why some children developed celiac disease and others did not.

There were two major findings to emerge from this study:

  1. Children that had not yet tried gluten by 6 months of age were more likely to develop celiac disease.
  2. Breastfeeding at the time of introduction to gluten did NOT appear to be protective. In fact, breastfeeding for longer than 12 months was associated with an increased risk, although it was borderline significant (P=0.046).

Both of these findings are contradictory to current infant feeding advice in the U.S. The AAP’s Section on Breastfeeding recommends exclusive breastfeeding for about 6 months before introducing solid foods, followed by “continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” The same AAP policy goes on to say, “There is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure.” But this Norwegian study effectively found that following the current advice of the AAP seems to increase a baby’s risk of celiac, not decrease it.

Obviously, we need more information here. And as usual, one study isn’t enough to give us the full picture of what we know and don’t know about this topic.

To understand the evolving hypotheses around celiac disease and infant feeding, we need to go back to Sweden in the mid-1980’s, when the rates of celiac disease in young kids suddenly quadrupled from an incidence of 1 in 1000 births to 4 in 1000 births over just a few years. It was an epidemic, and it appeared to be isolated to Sweden; neighboring countries weren’t affected. What’s more, celiac was showing up in really young kids. The median age of diagnosis during the epidemic was just about a year old. In 1995, celiac disease in Sweden plummeted back to pre-epidemic levels, and the median age of diagnosis increased to 4 years of age. Continue reading

The Magic and the Mystery of Skin-to-Skin

I meant to do skin-to-skin with Cee after her birth, I swear. It was in my birth plan. But after a long labor, Cee was born blue and limp, and the understandable concern about her health trumped any ideas I’d had about optimizing our postpartum experience. Cee was whisked away to a warmer on the other side of the room and encircled by the NICU team. Thankfully, I heard her cry within a few moments, and she was in my arms soon after. But by then, she was wrapped in a pink and blue flannel blanket, and I was too overwhelmed and taken with her to think of unwrapping her. Instead, I held her, and we gazed into each other’s eyes. She started rooting and was nursing within a couple of minutes. It was a magical first meeting, and it wasn’t until later that I realized that I’d screwed up and forgotten to do skin-to-skin.

IMG_3113

What’s wrong with this picture? (besides the fact that I hadn’t slept or brushed my hair in 48 hours)

I’ve been researching this topic for a chapter in my book about the postpartum period. I’m writing about what we know and don’t know about getting to know our newborns, establishing breastfeeding, rooming in, and yes, skin-to-skin. When I started working on this chapter, I thought the skin-to-skin thing was a slam-dunk, maybe even too obvious to be of much interest to my readers.

Modern-day interest in skin-to-skin, also called kangaroo care, began in 1978 in the NICU at San Juan de Dios hospital in Bogotá, Columbia. For every 10 premature babies born there, only 3 survived. There weren’t enough incubators or nurses. Babies were tucked two to three at a time in incubators, and infections were rampant. Parents weren’t encouraged to be involved in the babies’ care, and having little emotional connection to them, many abandoned their sickly babies at the hospital. Kangaroo care was a desperate attempt to care for these vulnerable babies. Mothers were essentially asked to be their babies’ incubators, holding them skin-to-skin 24 hours per day and breastfeeding on demand.

The results were astounding. The kangaroo care babies in Bogotá grew well, were more likely to be breastfed, and were less likely to get severe infections or be abandoned. The power of kangaroo care for low birth weight babies has since been confirmed in multiple studies. A 2011 Cochrane review concluded that skin-to-skin helps stabilize premature newborns, reduces mortality, infections, hypothermia, and length of stay in the hospital. These benefits are particularly clear in developing countries, but many hold in industrialized nations as well.

With the impressive success of skin-to-skin care for preemies, it seemed natural to assume that full term babies would benefit from it as well. But the research in this area is disappointing. Continue reading

Traveling with Kids: It Isn’t All Bad (plus 7 tips to keep it that way)

I apologize for my long absence from the blog. It’s been a busy couple of months. We finally bought a house, and with the help of many friends, got moved to our new home. Then the projects began – and continue. Summer school term wrapped up, and I’m prepping for fall term to begin in a couple of weeks. My book is coming along slowly what with all of the above. The blog has been completely neglected.

But I need to get back here. It’s like running and yoga for me; once I get out of the habit of lacing up my shoes or rolling out my mat or actually hitting “publish” on a blog post, these things I love seem to get a bit harder to do. So today,  I thought I’d share my latest installment of Things I’ve Learned About Traveling with Children. (Follow the links to previous installments on traveling with babies and toddlers).

Last week, Cee and I traveled together to Kentucky, where I grew up. It was a last-minute trip, tickets booked just days before our flight. Husband was working and couldn’t leave on such short notice. The reason for our trip was bittersweet. A dear friend died unexpectedly, and we went to mourn her loss and celebrate her life. Despite the sadness, it was a special trip with Cee. It was her first visit to Kentucky, so she met (and vice versa) lots of old friends, many of whom now have kids of their own. (I no longer have immediate family in Kentucky, so we don’t visit there often.) Together, we explored the little house where I grew up, touched the grave of my father, and splashed in the creek where I spent the summers. My mom and my brother also came, so it was full reunion of family and friends.apple tree kids

Something else made this trip special: Cee was an absolute joy as a travel companion. Until this trip, travel always felt like a scary limbo – so long as we were in airports or on planes, until we had a bed and a home base, I carried the knowledge that everything might fall apart at any moment. There could be a poop explosion on the plane or projectile vomit upon landing. My bare boobs might fly out of my shirt as my nursing baby squirmed, the two of us wedged in the middle seat between two strange men.There could be two hours of inconsolable crying on a fully booked red eye from Oregon to New York. I say this because all of these things have happened over the last few years of traveling with Cee. We’re experienced travelers, we know the tricks, and we roll with the punches when things get messy. And they usually do, so I don’t much look forward to traveling.

But now… Cee is potty trained, so no poop explosions (although she did wear a pull-up while we were flying, just in case). She can now tell me when she feels nauseous, so we had plenty of time to get out the little complimentary motion sickness bag. And she’s weaned, so no need to lift my shirt. She sleeps when she’s tired, avoiding that dangerous over-tired state. sleepy headCee is two, but when people ask how old she is, I now feel the need to add that she’ll be three in November. Especially after this trip, she doesn’t feel like a toddler anymore. Continue reading

What’s Your Feeding Style? (Fearless Feeding Review and Giveaway)

Do you have a feeding philosophy? What’s your feeding style?

These are not the most common topics in parenting discussions. We’re often too busy talking breast and bottle, baby led weaning or purees, organic or conventional, and how to get our kids to eat more vegetables. But the question of feeding style, I believe, matters more to children than any of these oft-discussed topics.

I am really pleased to have a new book on my shelf that covers the HOW and WHY of feeding children just as well as it covers WHAT to feed: Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, by Jill Castle and Maryann Jacobsen. Both authors are registered dieticians, mothers, and bloggers. They take a long-term view on feeding – that we shouldn’t just be concerned with what our kids are eating today, but also about teaching kids to eat well for a lifetime.

9781118308592_Castle.inddFeeding style is one of the first topics in Fearless Feeding, so if you’re not sure how to describe your own feeding style, here’s your chance to give it some thought. Castle and Jacobsen discuss 4 feeding styles, analogous to parenting styles that may be familiar to you: Continue reading

Potty Training: 7 Lessons Learned

Cee has been wearing undies for six months, and I think I’ve drafted a potty post for each of those months. Each time, before I had a chance to edit and publish it, something would change, and the post would seem irrelevant. Potty training is truly one of the hardest things I’ve done as a parent, but not in any of the ways that I expected. I thought I’d finally share some of the lessons I’ve learned so far. In other words, this post is mainly about my missteps and mistakes.

I write this knowing that your process, and the challenges that you face along the way, might be very different. Every kid is different, as is every parent. Like any two-year-old, Cee really wants to do things herself, but she is also a really sensitive kid. And as she’s been learning to use the potty, I’ve been learning more and more about her and how she ticks.

1. Begin when your child is ready.

Okay, I actually think that we got this part right. Cee started showing some interest in using the potty around 18 months. When she started daycare last fall, she jumped into the potty rotation with the bigger kids. By January, she was coming home at lunchtime in the same diaper (dry!) as when I dropped her off in the morning. And in February, after admiring her friends’ underwear, Cee told me that she wanted some too.

Cee was around 27 months when we made the switch to undies. Some would say that’s late, and some would say that’s early. I don’t think there’s a magic age, but I can’t imagine starting this process if Cee wasn’t interested in it. It’s been challenging enough as it is.

Of course, I did dig into the scientific literature to see if I could find some guidance on optimal timing and “methods.” But I think this is an area where the science is just not that helpful. Melinda Wenner Moyer recently wrote a review of scientific support for different methods of potty training at Slate, and she concluded that there’s decent support for parent-led and child-led and quick and gradual methods. This is true, but I also think that the potty training research is limited by the bias of the authors. Potty training is a culturally diverse practice, and a study conducted in a given place at a given time is always going to be framed by the norms of that place and time. Lacking good science, and considering that Cee is not interested in doing things just because I want her to, I waited until it was her bright idea to try going diaper-free. I began with the simple strategy of following her lead, praising her successes, and responding to accidents in a neutral way. Easy, right?

2. Ultimatums don’t work.

Here’s where I made my first mistake. Continue reading

Preparing Your Child for a Big Move (Book Giveaway!)

So, we’re moving this summer. At least, we think we are. The deal isn’t done yet, and we’re not even sure of our exact closing date, which is maddening. But probably, by the end of the summer, our little family will move to our first-ever, very-own home, just about a mile away from our current rental.

Talking about a move with Cee has been interesting. She’s been coming to look at houses with us from the beginning, starting in February. We struggled to explain to her why we were spending so much time dragging her through empty houses. We talked about moving to a new house, and she just looked confused. “Why, Mama?” Why, indeed, would we want to leave the only home she likely remembers? (We moved from Arizona to Oregon when she was 7 months.) What could be better than this house, the place of warm memories and celebrated milestones?

Cee thrives on the familiar. Even though we’ll still be living in the same neighborhood and not much else about her life will change, I know this move will be stressful for her. Heck, moving is stressful for everyone. So what can we do to ease the transition? I’ve had this question at the back of my head all summer.

I received the following guest post a couple of weeks back from the folks at Twigtale, a small parent-owned company that makes custom photo books to help kids with transitions. The Twigtale books are really cool, and I encourage you to check them out. Putting together a custom photo book for a big event is the kind of thing I might intend to do for Cee but never get around to, but Twigtale makes it easy with with a template and text written by child development experts. (Cee loves looking at our photo albums, but you know how long those take to put together. I’m still working on our 2012 family photo book!) So, I’m posting this article for those of you who, like us, might be approaching a move and as a sort of shout-out to Twigtale. They’ve also kindly offered to give away any custom photo book (about moving or any other topic they cover) to one Science of Mom reader. See the end of the post for more details!

Moving Guide – Preparing Your Child for a Big Move

By Allison LaTona, MFT

Summer is here, and with the warm weather and sunshine comes a lot of change for families.  The structure of the year gives way to more down time and loose fun.

Kids may be anticipating a new school year, with new teachers and classrooms, or perhaps starting school for the very first time.  Some parents decide to work on potty learning in the summer, as they can take advantage of the warmth outside providing more “naked time” for their children to better listen to their bodies.  And perhaps most stressful of all, you may be moving this summer.

So the burning question is, how to best prepare your young children for the move? Continue reading

My Favorite Parenting Strategy

A few weeks ago, I blogged about Cee’s long, drawn-out process of getting ready in the morning. She was maddeningly slow at changing from pajamas to her clothes for the day, but she also insisted on doing it herself. If I tried to help, the pace of progress slowed even more. If I tried to take over, it became a physical battle, and I was sure that wasn’t worth it. I tried a few strategies to keep our mornings moving, and readers offered more great ideas in comments on my post.

One of my more brilliant ideas, I thought, was a hand-drawn morning schedule for Cee. I drew a step-by-step diagram of what she needed to do each morning – get dressed, go potty, brush teeth – and then I showed that we could have a few minutes to read a book or play together before leaving the house, assuming she could move through her schedule at a reasonable pace. We drew out the schedule and discussed it the night before, and she was really into it. She showed it to Daddy and carried it around for her bedtime routine, then carefully placed it by her bed before she went to sleep. In the morning, she was excited to follow the schedule and get to book time, and she did it! I thought it was quite a success story. But, by the next morning, Cee was bored with the schedule idea. In fact, I’m pretty sure she saw right through it as one more pressure tactic from me. Cee doesn’t respond well to pressure, thinly disguised or not.

So. I settled on my favorite parenting strategy: patience. Honestly, I can’t think of a more important asset to the parent of a toddler.

I did a lot of little things to ease our morning crunch. I got as much ready the night before as I could; I went to bed and got up earlier to get some work done before Cee woke; and I asked Husband to take over on mornings when he could squeeze it in his schedule, just to ease my nerves. And then, I tried to summon more patience and relax. I trusted that this was a phase that wouldn’t last forever.

dressed and ready

Dressed and ready to go

I’m happy to report that I was right. For the last few mornings, I have woken to the sound of little feet running down the hall. Cee has been waking early, dressing herself, and then coming to wake me up with bed head and a big smile. That whole dressing fiasco? It’s gone. She’s getting dressed on her own, while I’m still snoozing.

Why the change? It isn’t anything I did. Me telling her that she needed to get dressed faster had zero impact, I can assure you. It’s more likely that it prolonged the process. Maybe she’s discovered that it’s more pleasant to get dressed without me breathing down her neck. Maybe she herself got bored with the snail-paced process and figured she’d rather get on with more interesting things in her day. But whatever it is, she is very proud of herself, and I am too. We’re both relishing her autonomy.

But now Cee has moved on to other time-consuming projects. Lately, she’s been wanting to buckle her own car seat. She can do this, but it takes long minutes of sitting in the car waiting for her. Sometimes we’re in a hurry, and I tell her that I have to do it this time, and sometimes that causes a meltdown. But if I can, I try to find my patience and let her do it herself. Just like the dressing process, the learning part takes time – much longer than if I did it myself. But I trust that at some point she’ll get really good at buckling her own seatbelt (always followed by my check). And then she’ll feel proud and independent, and ultimately that means that she does more things for herself. So again, patience.

Patience tells a toddler: You don’t have to be more than you are right now. And when I choose the patience strategy, I’m telling myself the same thing: You don’t have to fix this. You don’t have to have an answer. Staying calm is enough.

It’s tempting to try to fix the little challenges of every stage, but so much of childhood we really can’t control. We can try to prevent meltdowns with attention to sleep, food, daily rhythms, and choices, but when it comes right down to it, the meltdowns are bound to happen at some point. We can do everything right (whatever that means) in the transition from diapers to undies, but we’re probably still going to have some accidents and setbacks along the way.  We can cosleep or sleep train or something in between, and we’re still going to have days when we’re dead tired. So much of parenting is riding out the stages, focusing on the parts of each that we love and then coping with the tough parts as best we can. And then waiting, with patience, trusting that we’ll come out the other side with our kids, who will be moving on to new challenges before we know it.

What are your kids working on that is requiring your patience? And maybe more importantly, where do you find more patience when you’re running low?