About ScienceofMom

I am a new mama to a baby girl, a former research scientist, and now a writer. I have a PhD in Nutrition and years of experience at the lab bench, but these days I spend my time trying to keep up with my almost-toddler. When she naps - I write.

For Premature Babies Born by C-Section, Umbilical Cord Milking Is a Good Option

It’s well-established that infants born prematurely benefit from a delay in umbilical cord clamping. However, many preemies are born by cesarean section, and delayed cord clamping may be less effective and practical after surgical birth. Some obstetricians opt to speed things up by “milking” the umbilical cord, manually pushing blood from the placenta to the baby. A study published in Pediatrics this week shows that cord milking can be just as effective – if not more so – than waiting to cut the cord in premature babies born by C-section [full text PDF].1

No, this baby doesn't look like a preemie! U.S. Navy Medical Officer Cmdr. Michael Cackovic prepares to cut the cord during a cesarean section on an Honduran patient during Southern Partnership Station 2014 (SPS-JHSV 14). (U.S. Navy photo by Mass Communication Specialist 1st Class Rafael Martie, Public Domain)

No, this baby doesn’t look like a preemie! U.S. Navy Medical Officer Cmdr. Michael Cackovic prepares to cut the cord during a cesarean section on an Honduran patient during Southern Partnership Station 2014 (SPS-JHSV 14). (U.S. Navy photo by Mass Communication Specialist 1st Class Rafael Martie, Public Domain)

In premature infants, delaying cord clamping for at least 30 seconds is associated with lower risk of intraventricular hemorrhage (IVH, bleeding in the brain), necrotizing enterocolitis (death of intestinal tissue), and anemia.2 Delayed cord clamping also benefits full-term babies, though the outcomes are less dramatic.3

Since 2012, ACOG has recommended a 30-60 second delay in umbilical cord clamping for preterm infants.4 However, they noted that little was known about the efficacy of delayed cord clamping after a C-section or about umbilical cord milking:

“More studies are needed to evaluate the potential benefits and risks of umbilical cord milking, and at this time there is insufficient evidence to support umbilical cord milking in preterm infants.”

“The ideal time for clamping the umbilical cord after cesarean delivery versus vaginal birth is an especially important area for future research. Premature infants, who may benefit most from delayed umbilical cord clamping, are more likely to be delivered by cesarean delivery because their mothers may have other medical and obstetric complications.”

These gaps in the research are definitely a challenge to implementing delayed cord clamping in premature infants. After a C-section, holding a wet, squirmy baby to delay cord clamping while mom’s uterus is still cut open is an awkward proposition. Research also shows that less transfusion occurs during delayed cord clamping in a C-section compared with a vaginal birth, perhaps because of fewer or weaker uterine contractions to expel the placenta.5 Plus, premature babies are more likely to need immediate medical attention, and while delayed cord clamping might be helpful to these babies, medical providers are understandably anxious to care for them. All of these factors can make delayed cord clamping more challenging and less effective in the babies that could most benefit from it.

For these reasons, the recent study of cord blood milking is a welcome addition to the research on this topic. The study was a randomized controlled trial conducted at two California hospitals. It included 197 preterm infants (<32 weeks), with 154 of these born by C-section. The infants were randomized to either have delayed cord clamping of 45-seconds or to have cord milking, with babies in both groups held at or ~20 cm below the level of the placenta. In the cord milking group, the obstetrician grasped the umbilical cord close to the placenta and slid his or her hand towards the baby to push the blood along through the cord. This was repeated four times, with a couple of seconds between each to allow the cord to refill with blood.

Among the babies born by C-section, the researchers found that several outcomes were better in the babies with cord milking compared with delayed cord clamping:

  • Higher blood flow in the brain and heart (greater superior vena cava flow and right ventricular output) in the first 12 hours of life.
  • Higher hemoglobin and blood pressure during the first 15 hours of life.
  • Higher urine output in the first 24 hours of life.

These results indicate that cord milking transfers more blood to the baby than delayed cord clamping in preemies born by C-section. Greater blood flow might mean better protection against IVH. The incidence of IVH wasn’t different between the delayed cord clamping and cord milking groups in this study, but it wasn’t large enough to detect a difference.

In this study, 43 babies were born vaginally, and for them, cord milking didn’t improve outcomes over delayed cord clamping. It’s just in C-section births – and perhaps those where the baby needs immediate medical attention – that cord milking may be preferable.

I was interested in this study because cord milking has been a sort of gray area in the delayed cord clamping literature. It’s often offered as an alternative to delayed cord clamping, but as ACOG said in 2012, its safety and efficacy hadn’t been as well-studied. With this and other recent studies, that is changing. A meta-analysis published earlier this year in JAMA Pediatrics included 7 randomized controlled trials with a total of 501 babies. Among preterm babies, it found that cord milking improved hemoglobin and hematocrit, reduced the need for supplemental oxygen, and reduced the risk of IVH, all without adverse effects.6 With the addition of the current study, we have more evidence that cord milking works to improve placental transfusion, and in the specific case of preemies born by C-section, may even be preferable to delayed cord clamping.

I’ve been following the delayed cord clamping literature for some time now, and the evidence is now quite strong that babies, and especially preterm infants, benefit from receiving the blood in the umbilical cord and placenta after birth. More and more, this seems to be true whether the blood transfusion happens through patient waiting or with the help of cord milking.

References:

  1. Katheria, A. C., Truong, G., Cousins, L., Oshiro, B. & Finer, N. N. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants. Pediatrics peds.2015–0368 (2015). doi:10.1542/peds.2015-0368
  2. Rabe, H., Diaz-Rossello, J. L., Duley, L. & Dowswell, T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst. Rev. 8, (2012).
  3. McDonald, S. J. & Middleton, P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst. Rev. 7, CD004074 (2013).
  4. ACOG Committee on Obstetric Practice. Committee Opinion No.543: Timing of Umbilical Cord Clamping After Birth. Obstet. Gynecol. 120, 1522–1526 (2012).
  5. Aladangady, N., McHugh, S., Aitchison, T. C., Wardrop, C. A. J. & Holland, B. M. Infants’ Blood Volume in a Controlled Trial of Placental Transfusion at Preterm Delivery. Pediatrics 117, 93–98 (2006).
  6. Al-Wassia, H. & Shah, P. S. Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr. 169, 18–25 (2015).

S.I.T.! Feeding Your Child Using Stability and Independence at the Table

(Guest Post by Melanie Potock)

Here on Science of Mom, we’ve been discussed starting solid foods over the last few posts. It’s a topic that I spent a lot of time researching for my book, and I ended up devoting two chapters to feeding solids. It’s also highly relevant to me right now, because 5-month-old BabyM is just starting to dabble in solid foods, and I want to be sure that we get off to a good start with his lifelong relationship with food. I was thrilled when Melanie Potock, a pediatric feeding therapist, joined the discussion about starting solids on my Facebook page. She helped me understand the importance of trunk stability for eating solid foods, and I asked her if she could write a guest post about the nuts and bolts of setting children up for comfortable and successful eating at the table. I’m so glad she agreed. After reading her post, you’ll understand why I’m working on improving our high chair with duct tape today!

Melanie also has a book coming out this fall: Raising a Healthy, Happy Eater: A Parent’s Handbook. She’s a wonderful resource, so please feel free to ask your questions in the comments.

S.I.T.! Feeding Your Child Using Stability and Independence at the Table

By Melanie Potock, MA, CCC-SLP

As a pediatric feeding therapist, I visit homes, daycares and preschools to help hesitant eaters become adventurous, healthy, happy eaters. The very first thing I assess is how the child is positioned in their feeding chair. As mentioned in Alice’s recent post on readiness for solid foods here on Science of Mom, babies must be able to sit upright before safely introducing solid foods. Why? Because fine motor development is always dependent on gross motor stability. But, did you know that toddlers and preschoolers also require optimal stability when learning to try new foods? Follow the S.I.T. Model to ensure that your child is seated comfortably and with appropriate support: S.I.T. stands for Stability & Independence at the Table.

S: Stability

Most feeding chairs are designed to hold up to 50 lbs. with the assumption that a small six-month-old or a heavier toddler would be able to sit in the exact same chair. Here’s the problem with that: There is a huge difference in the size of a six-month-old baby just starting to eat solid food and an eighteen-month-old toddler. Every child needs stability while seated as I noted in this article:

“Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It’s very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!”

To achieve stability in the trunk, begin by sitting your child upright in her chair. Be sure that the pelvis is tilted forward just slightly, as shown in this diagram.

www.MyMunchBug.com-1First, put a rolled-up kitchen towel behind the arch of her back to ensure that the hip angle tilts forward or is slightly less than ninety degrees. Continue reading

4 Signs Your Baby Is Ready for Solid Foods

My last post went into great detail about the research on age of starting solids and health outcomes, including nutrition, growth, illness, and allergies. If you read that post, you know that there are small risks and benefits of starting earlier or later (in the range of 4-6 months), but there’s no evidence for an optimal age of starting solids for all babies. Here’s what to look for instead, starting with a brief summary of the data on age:

1. Your baby is at least 4 months of age.

Read my post on this if you want to know the details and see the references. If not, here’s a summary:

  • There is good evidence that it’s best to wait until at least 4 months of age to start solids, unless advised otherwise by a doctor for a specific medical reason.
  • Starting solids between 4 and 6 months of age may give babies a boost in iron nutrition, assuming they’re getting some good dietary sources of iron. Exposure to potentially allergenic foods, such as wheat and eggs, by about 6 months may reduce the risk of allergy to those foods.
  • Exclusive breastfeeding until 6 months of age may reduce your baby’s risk of minor gastrointestinal infections, although this isn’t shown in all studies. For moms, it may also result in greater weight loss and prolonged lactational amenorrhea.

Whether or not you start solids at 4 months, 6 months, or somewhere in between is up to you and your baby. The research on this topic is still evolving, and either is a fine choice. In fact, given that babies develop at different rates, it seems unlikely that all babies would be ready to start solids the moment the clock strikes midnight on their 4-month birthday or 6-month birthday.

This was the same sentiment eloquently expressed in a 2009 editorial by British pediatrician Martin Ward Platt, using the term “weaning” to mean starting solid foods:

“The weaning debate has been largely predicated on the notion that there is some magic age at which, or from which, it is in some sense ‘‘safe’’ or ‘‘optimal’’ to introduce solids. Yet it is highly counterintuitive that such an age exists. In what other area of developmental biology is there any such rigid age threshold for anything? We all recognize that age thresholds are legal inventions to create workable rules and definitions, and have no meaning in physiology or development, yet when we talk about weaning we seem to forget this.”1

Given this, it’s really up to you to follow your baby’s lead, watching for the developmental signs discussed in the rest of this post.

2. Your baby can sit upright and hold his head up straight.

These gross motor skills signal that your baby has the core body strength and stability needed to eat solid foods. Pediatric feeding specialist and certified speech language pathologist Melanie Potock explained why this is so important on my Facebook page:

“Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It’s very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!”

[I’m thrilled that Melanie Potock wrote a guest post explaining more about why stability is so important and how to best seat your baby comfortably at the table here: S.I.T.! Feeding Your Child Using Stability and Independence at the Table]

In other words, when babies have gross motor stability in place, they’ll have a much easier time with the fine motor and oral motor skills needed for feeding. That means that baby should be able to sit comfortably upright, on his own or with a little support, and hold his head up to face you. In one study, babies were able to sit in a caregiver’s lap without help at 5.5 months, on average, but this milestone was quite variable (standard deviation of 2 months).2

Trunk stability is also important because it allows you and your baby to be able to be face-to-face during feeding and for your baby to be an active participant in deciding whether, how much, and how fast to eat. You offer baby a bite, and he leans forward and opens his mouth if he’d like to accept, or he turns his head away to say no thanks. With good trunk stability, a baby can communicate his wants and needs to you, and you can be responsive to them. This way, feeding becomes a respectful and pleasant conversation between the two of you.3

Feed your baby responsively, watching for his cues of wanting more or being done, like a back-and-forth conversation.

3. Your baby has the oral motor skills to handle solid foods.

At birth, most babies are already skilled at sucking. Sucking is an involuntary reflex that develops around 32 weeks of gestation, and babies practice it in utero before birth. Sucking gives them the skill to efficiently transfer milk through a nipple, whether from breast or bottle.

To eat from a spoon, a baby needs a different set of oral motor skills. Continue reading

Starting Solids: 4 Months, 6 Months, or Somewhere In Between?

Science of Mom reader Roxanne left a comment on my post about the recent peanut allergy study. She wondered about starting solid foods with her 4-month-old baby boy:

“Do you have an opinion on starting solids at 4 months versus 6 months? I noticed that many of the studies on allergy include babies in the 4-6 month range, but I think that the current recommendation is to wait until 6 months. I ask because my baby WILL NOT drink out of a bottle while I’m at work. He is miserable all day. I’m only gone 8-3 including travel time, so if he could just get a little something at 11am, I think he might actually nap and not cry all day. We have tried everything. If you know of any studies please let me know. He is 18 weeks old.”

I totally understand Roxanne’s confusion, because there’s lots of conflicting advice on this topic. This is a question that I tackled in-depth in my book (due out in July!), but I wanted to offer some of this information on my blog as well.

Let’s start by getting our terminology straight.

Starting solids is just the beginning of a slow transition from an exclusive milk diet to a diet of table foods. In some countries, this is also called “weaning,” which is confusing since the same term means stopping milk feeding in the U.S. (i.e. weaning from breastfeeding, weaning from a bottle). “Complementary feeding” is often used in the research and public health worlds. This is an apt term, because the goal with feeding solids to babies is to complement breast milk or formula, which will continue to provide most of babies’ calories through at least the end of the first year.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

What is the history of starting solids?

There is a common assumption that longer exclusive breastfeeding – and longer delay in starting solids foods – must be more natural, and hence, healthier. But looking at traditional human cultures, with no access to commercial baby food, modern pediatricians, or divisive Internet forums, can give us valuable perspective on what is “natural.” A survey of childbirth and breastfeeding practices in 186 non-industrial cultures reported that solid foods were routinely introduced before 6 months, a finding that surprised the author:

“Contrary to the expectation of a prolonged period of breast-milk as the sole source of infant nutrition, solid foods were introduced before one month of age in one-third of the cultures, at between one and six months in another third, and was postponed more than six months for only one-third.”1

A more recent cross-cultural analysis of 113 nonindustrial populations from around the world found that parenting introduced solid foods before 6 months in more than half, with 5-6 months being the most common time for introduction.2

Human diets and infant care practices vary tremendously around the world, so it’s impossible to say if starting solids at 4 months or 6 months is more natural. As to which is healthier – well, that’s where we need to look at the science.

What is the official advice about starting solid foods?

Public health and professional organizations fall into two camps when it comes to recommendations about solids foods: they either recommend starting between 4 and 6 months OR at 6 months. There are well-respected organizations on both sides. Continue reading

My Book – The Science of Mom – is Available for Pre-order!

UPDATE – June 2015 – The publication date of my book has moved around a bit. I now expect it to be available in mid-August. You can still pre-order the book on Amazon.

_____

Imagine my surprise when, last week, my editor at Johns Hopkins Press emailed me to ask that I check over the Amazon page for my book. What? There’s an Amazon page?! As far as I knew, my book wasn’t coming out until the fall. I did a search for my name and book title on Amazon, that great vault of hundreds of thousands of books, this is what I found:

Screen Shot 2015-04-20 at 8.18.02 PM

(This is an affiliate link, so if you order my book through this link, I’ll get a little added commission. Thank you!)

I guess this is really happening, dear readers! And it’s happening sooner than I thought. The book will be released on July 2, and it’s available for pre-order now!

science of mom cover

(Affiliate link)

This is super exciting but also terrifying at the same time. It means that some people might actually read my book. They might like it or they might not, and that’s just the way it is. I hope you read it and like it, though. I would not have had the motivation or courage to write this book if not for all of you – smart people who read my blog and comment on it. You showed me that there are other parents out there, like me, who are curious and want to know more about the science of parenting. You showed me that tone matters – that if we are going to communicate and support each other, we have to start from a place of respect for each other. You showed me that our stories matter, and that nuance is important. As I dug into the science of parenting decisions, I found examples where science gives us a clear course of action but just as many where the science is so murky that we are left to follow our hearts, well-informed as they may be, and hope for the best.

Another surprise when I scanned through my book’s Amazon page for the first time was the reviews. I hadn’t seen these yet, and they brought tears to my eyes. What I was trying to do with this book came through to these readers, and that made me so happy. Here’s what several wonderful folks had to say about my book:

Finally, someone has brought some science—and some sense—to the mommy wars. Should be required reading for all new (and old) parents. 

~Emily Oster, Brown University, author of Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—And What You Really Need to Know

Alice Callahan has written a breakthrough book, combining the compassion, warmth, and angst of a mother with the measured reasoning of a scientist. She helps parents not only understand how science works, but how they can access that science to answer their questions. She’s found a way to access the scientist in all of us.

~Paul A. Offit, MD, The Children’s Hospital of Philadelphia

Yes! An easy-to-read, fascinating, nuanced review of the science behind new parents’ biggest health questions. Many of these issues—infant sleep, breastfeeding, vaccines—have or will hit your ‘Should I panic?’ button. With gentle guidance, Alice Callahan puts your fears to rest.

~Tracy Cutchlow, author of Zero to Five: 70 Essential Parenting Tips Based on Science (and What I’ve Learned So Far)

Too many of today’s parents treat science as a weapon, using it to justify some choices and condemn others. Yet, most don’t fully understand what science can and cannot tell us. By giving parents a comprehensive understanding of how science relates to parenting, Alice Callahan has helped us turn this weapon into a tool for peace. Callahan untangles basic scientific concepts, reveals the realities and limitations of research, and advocates for a measured approach to parenting science that eschews absolutes and acknowledges nuance. The Science of Mom is a rare gem in the parenting canon—smart, sensitive, and a lifesaver for a generation of parents caught in the nebulous spider’s web of Internet ‘wisdom.’ 

~Suzanne Barston, author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t

Families routinely search for health information. The Science of Mom makes it easy collecting evidence for health decisions and putting it into perspective with a mom-to-mom connection. Callahan’s advice is thoughtful, backed by science and feels fueled of love. She is willing to provide powerful advice when detailing the science and safety of vaccines. Keep this book in arm’s reach as you support your infant for calm and direction. 

~Wendy Sue Swanson, MD, MBE, FAAP, Seattle Children’s Hospital, author of Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance

Fascinating! Think of all the controversial, hot-button topics that parents obsess about in a child’s first year—from vaccines and feeding, bed-sharing to sleep training. Weighing the scientific evidence, Callahan offers balanced insights and in-depth answers—a far cry from the oversimplified advice prescribed by many ‘parenting experts.’ The result: a must-have guide that’s substantive and extremely engaging. 

~Jena Pincott, author of Do Chocolate Lovers Have Sweeter Babies? The Surprising Science of Pregnancy

I’m so grateful to these thoughtful people, all authors themselves, for taking the time to read my manuscript and write short reviews.

I hope you’ll check out my book and let me know what you think!

A Letter to My 3-Month-Old: On the First Season of Your Life

Dear BabyM,

You are 3 months old, and as your mother, there is something I must confess to you: I haven’t yet cracked open your baby book. It sits neatly on my nightstand, undisturbed and unmarked, while a succession of telling objects rotate around it as the nights go by: pacifiers (mainly rejected by you), nipple cream, novels, water glasses, vitamin D drops (barely remembered by me), burp cloths, tiny nail clippers, cards of congratulations, a copy of Goodnight Moon, and a messy pile of kids’ books and scribbled papers left by your older sister. These last three months have been wonderfully full. I marvel at how much you’ve changed in such a short amount of time and know how quickly these present moments will slip into the past. I don’t want to forget them.

You were born in the cold drizzle of the Oregon winter. Trees stood leafless, like skeletons against the gray sky. On the coldest mornings, a lone hummingbird urgently probed the frozen hummingbird feeder for nectar, returning again and again. Inside, our Christmas tree twinkled. Our house was full of good smells as your grandmothers cooked us biscuits for breakfast, soup for dinner, and pie for dessert.

On the morning you were born, a nurse placed you on my chest. Your skin was gray like the sky, but it warmed to pink as your small lungs found their rhythm. You were born with a full head of dark hair, still wet, matted down on your head. You bobbed your head up and down on my chest and pushed your feet into my belly, full of instinct to find my breast. You fed with ease and gazed up at me with bright eyes.gazing with babym

From that first day, I’ve loved your eyes. We still don’t know what color they are, but they are wide, observant, and calm. Your gaze still stops me in my tracks every day. It makes me put down my phone, forget my to-do list, and sit with you a little longer.

Photo by Amanda Reed

Photo by Amanda Reed

Your first days with us were cozy and warm, sleepy and slow. You nursed and then drifted into sleep, your body going limp into mine with certain trust. I watched you sleep and felt full of gratitude.BabyM sleeping newbornWhat else can I tell you about newborn you? You sucked on your hands from your first day. You did not like to be swaddled, preferring to have your hands close to your face. You liked to sleep close to me and feed often, around the clock. When you weren’t eating or sleeping, you were alert, and usually calm. You stretched your limbs, and your eyes followed our faces and voices.

You became a part of our family. We waited a long time for you, and once you were here, it seemed like you filled a spot that was always yours. Your sister dotes on you, and she is mostly generous in sharing me with you. One of our biggest challenges has been to convince her to let you sleep, because she really wants to play with you. You also adored her from the start, turning your head towards her voice. Some of your very first smiles were for her.

Already, the season has changed. Now our world is filled with blossoms of spring: daffodils, hyacinths, and forsythia. Three hummingbirds compete for a spot at the feeder, then flit off to cherry blossoms for more nectar. The days lengthen, and the sun shines.cherry blossomsAlready, you have outgrown a drawerful of tiny outfits. Your cheeks have filled out, and your body has lengthened. Your skin has lost its translucence. You kick with happiness and wave for attention, your movements more confident and strong each day. You watch the world with awareness that you are part of it. You smile easily. You are a steady little person, not easily bothered by our barking dog or the sound of your sister’s steps thundering down the hall. You sleep for long stretches in the night and greet me in the morning with a happy grin. You open your mouth wide as if to let out a big laugh, but all that we hear is a soft coo.

BabyM tummy timeI worry that one day you’ll read this and think I wasn’t being honest – that I composed a history happier than the reality. I guess I should mention that you do cry through most of every car ride and sometimes when you’re tired. And yes, there are lots of days when I feel exhausted or overwhelmed. But these words are all true, and in fact, they feel inadequate to describe how much happiness you’ve brought to our family and how much we enjoy spending time with you. I want you to know that.

I know how quickly the time will pass. The cherry blossoms will dry out, shrivel up, and drop to the ground – or get knocked down with the spring rain. It will happen gradually, but one day we’ll suddenly realize that the blossoms are gone and the trees have fully leafed out. Just like one day you’ll be rolling, then crawling, then walking. The days will pass by like pages in a flip book, each one distinct and full, but together, a blur from one season to the next.

I’m in no hurry for this season of your infancy to pass, but there is no stopping it. In the end, what will we hold of this time? We take photos and videos, and I will write in your baby book, I promise. Still, I know the details will slip away, like petals from a tree. What will remain of your infancy? A feeling, I suppose. A sweetness, I hope, one that we can savor for years to come. And you – because the person you are now is just the beginning of the person you will become.

A Bedtime Conversation with My Daughter

Cee is four. Four-and-one-third, but she can’t wait to be four-and-a-half. We’ve drawn out those fractions. And she asked if we could make a cake for her half birthday. Four-and-a-half is a big deal when you’re four-and-one-third.

Cee paintingShe’s exploding with awareness about the world, and I’m just trying to keep up. She wants to know what the sky is made of, how many pennies are in a dollar, and why it’s still light at her bedtime now. She “reads” books to BabyM and her dolls with the confidence of a librarian, and she makes art every day (usually with glitter). She sits on the workbench in the garage and watches her dad work, and she knows better than I do where to find tools. She is eager to help and independent.

Until suddenly she’s not. Tears spring from her eyes, seemingly out of nowhere. She clings to me or stomps her feet in anger, depending on the catalyst for the meltdown. She’s four (and a third!), after all. She has a new little brother, and she has to compromise sometimes. And that can be really hard.

Anyway, that’s Cee now. Days with her are full of surprises, mostly good ones.

At bedtime tonight, we read a long book and then talked about our day together. We sang our “Twinkle, Twinkle, Little Star,” the way we have ended our bedtime routine since she was a tiny infant. (I wonder when she’ll outgrow that. I’m in no hurry.) I kissed her four times (cheek, butterfly, nose, and cheek again). All a very sweet bedtime routine, until it’s over.

And then the stalling began. There were questions about today and questions about tomorrow. There were demands for more kisses and hugs. There was a hangnail on her pinkie that she swore would keep her awake. I sat back down on the side of her bed.

“Cee, do you know what I do after you go to sleep?”

“No.”

“I write.”

“What do you write?”

(She knows that I wrote a book. I’ve been working on the page proofs and the index for the last month, tasks that aren’t exciting to me, much less a 4-year-old. But now that all that is done, I had to pause for a minute to think about her question before I answered.)

“Sometimes I write stories. Sometimes I write about science. Sometimes I write about my day so that I can remember it a long time from now.”

Her eyes lit up with the first mention of stories.

“Oh, mama! Do that! Write stories!”

For the first time, I felt like Cee could appreciate my life outside of her. I’ve been writing and teaching, and often leaving her to do it, for the last couple of years, but I don’t think she’s thought much about that work except that it takes me away from her.

That thought is also always in my mind when I work – it takes me away from my kids, or at least means a sacrifice of much-needed sleep. As a mostly stay-at-home mom, work feels like a guilty pleasure to me now. Finally, a little time alone at my computer! It does little to contribute to my family’s income, but it enriches my life.

Finally, I can see how my work might enrich my daughter’s life, too. On her face tonight was admiration and respect for me, a writer of stories. It made me want to write more, for myself and for her.

Of course, I still had to get out of her room at bedtime, and I still had to endure another round of stall tactics. That’s life with a four-and-one-third-year-old, even one starting to understand that the world doesn’t completely revolve around her.

What To Do About Babies and Peanuts: New Study Finds Early Exposure Can Prevent Allergy

You’ve probably already seen headlines about a study showing that feeding children small amounts of peanut products in the first 5 years of life can prevent the development of peanut allergy. The study was conducted in the U.K., led by Gideon Lack of King’s College London, and was published this week in the New England Journal of Medicine (free full text available here).1

Why is this study important?

Photo by Sanja Gjenero

Photo by Sanja Gjenero

Food allergies are on the rise in Western countries, and peanut allergy is one of the scariest. In the U.S., more than 2% of children and their families are now living with a peanut allergy, representing a 5-fold increase in prevalence since 1997.2,3 And this allergy isn’t just an inconvenience; it’s now the biggest cause of anaphylaxis and death related to food allergy in the U.S.4 This is a huge concern to parents wondering when and how to introduce peanuts to their kids, but the advice on this matter has been really confusing over the last 15 years.

In 2000, the AAP recommended delaying the introduction of peanut and other commonly allergenic foods (i.e., wheat, eggs, fish, cow’s milk) until at least the first birthday and until age 3 for kids thought to be high-risk for allergy.5 While this advice may have seemed reasonable, it was never based on good evidence – just a best guess based on knowledge at the time.

Meanwhile, the incidence of food allergies continued to climb, and epidemiological evidence emerged that avoiding allergens might backfire. In 2008, the AAP issued new guidelines stating that there was no evidence that delaying introduction of solid foods, including common allergens, beyond 4 to 6 months of age would protect children from developing allergies.6 This document was intentionally vague, because at the time, there weren’t any studies to give more specific guidance on when to introduce what, in what amounts, etc. And this flip-flop in advice, which was also mirrored in many other countries, has left a lot of parents confused.

Gideon Lack and colleagues published a study in 2008 that found that the incidence of peanut allergy among Jewish children in the U.K. was 10-fold higher compared with those growing up in Israel.7 Comparing the mean age of introduction of peanut protein between the two countries, they found that babies in Israel were commonly introduced to peanut in their first year, while babies in the U.K. were not. This led them to their hypothesis that early exposure to peanut might help prevent the development of peanut allergy, and that’s what the current study tested.

How was this study conducted?

The researchers recruited babies between the ages of 4 and 11 months that were high risk for developing peanut allergy because they had severe eczema, egg allergy, or both. Continue reading

International Travel with Kids: 10 Lessons Learned

By Sarah Ruttan

In yesterday’s post, I talked about the highs and lows of traveling abroad with young kids. While we’re not planning any international trips in the near future, we definitely learned some important lessons on this trip that we’ll take into account when planning future travel. Some of this advice relates to any type of travel with children, but there are special considerations when traveling out of the country.

1. Travel light. We didn’t bring a stroller, opting instead for our trusty Ergo. I almost felt naked getting onto the plane, yet also slightly liberated. The cobble stone streets of colonial Peru wouldn’t have made a stroller any fun, anyway. Depending on your destination, mode of travel, and itinerary, you may be able to leave car seats behind, or rent them for any car rides you’ll take. We planned our trip so that we were primarily traveling by plane or boat and made do without car seats for the short taxi ride from the airport. (Once there, we also found that most taxis didn’t have seat belts or clips, so we wouldn’t have been able to use car seats had we brought them.) We strategically packed a few clothing items that both kids were about to outgrow so that we could leave the clothes and have room for a few souvenirs on the return trip. [This paragraph was edited after posting to emphasize that the car seat decision is really dependent on where you’re traveling and how you plan your trip. It isn’t one to be taken lightly, and Sarah and her husband carefully considered their options before deciding not to bring them. ~Alice]

A word about diapers: We only had one child in diapers and brought just enough with us to last until we knew would be in a city where we could buy more (4 days worth). Diapers are bulky to pack and widely available in most cities, so only bring what you absolutely need.

Photo by Sarah Ruttan.

Photo by Sarah Ruttan.

2. Think about time zones. Sometimes you can’t choose where you travel, but when you do have a choice, consider how many time zones you want to cross with young kids. Jet lag can be brutal for adults, and it’s worse with toddlers who often take several (painful) days to adjust. We didn’t choose Peru because of time zones, but it was definitely a nice perk to only contend with a one-hour adjustment. We’ll likely save crossing the Atlantic or Pacific until our kids are a bit older and able to entertain themselves once we’re home and I want to sleep!

3. Choose an itinerary that will work for your kids at whatever stage they’re in. Continue reading

Stamps in their passport: The highs and lows of travel with children

I’m really excited to welcome my friend Sarah Ruttan as a guest blogger this week. Sarah and I had our first babies 5 weeks apart when we both lived in Tucson, AZ, and we developed a tight bond as we shared the early months of motherhood. Sarah is also an experienced traveler – with and without kids – so I was thrilled that she offered to write about some of her experiences with international travel with young children on Science of Mom. Today, she reflects on why she and her husband choose to travel with their kids and how it has pushed her to the edge of her parenting comfort zone – and maybe beyond. Tomorrow, she shares her best tips for pulling off an international trip with kids. Enjoy, and please feel free to share your own experiences in the comments!

Stamps in their passport: The highs and lows of travel with children

By Sarah Ruttan

Our family recently returned from a trip to Peru. It was our first travel adventure outside of the U.S. with both our son (almost 4) and daughter (16 months). My husband was headed to Peru for a training program and we decided to try making the journey together. Before you congratulate me on successfully traveling to another continent with two kids in tow, I have a confession to make: I’m REALLY tired. And the trip – while a good experience – was only sort-of-fun, in the way that many experiences with young kids end up being: great highs, followed by meltdown lows.

I’m a slow learner when it comes to this parenting thing. I should have recognized that hauling two kids to Peru was going to be a lot of work and that we would arrive back home exhausted, barely able to process the experience, wondering if it was worth it. Yet, I needed to do it to know what my limits are when traveling with kids, to know how much is too much and what the right balance of adventure is for us at this point in our lives.

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The author entertains her 16-month-old daughter on a 1.5 hour boat ride on the Amazon River in Peru.

Let’s be honest – there was an element of “We just want to prove that we can still do this” in our trip planning. Of all the things we missed most about life pre-kids, it was travel, and in particular, international travel. My husband and I have traveled to more than 30 countries. Some of those trips were taken as a couple in our pre-kid days, others on our own before meeting each other. I have fond memories of both my solo trips and our later trips together – carrying a backpack and exploring new cities, seeing foreign landscapes from the window of a train or bus, and clumsily navigating menus in languages we didn’t speak. These journeys expanded my view of the world and my place in it. We talked on those trips about what kind of travel we wanted to do when (if) we had kids. Continue reading