Don’t Wash That Baby!

So, I know some of my Labor and Delivery or Newborn Nursery friends are gonna hate me for this post… but too bad, it’s important and our readers deserve the best information! I keep finding myself rushing to check in with friends and family who recently had a baby and try to catch them before the baby has gotten that adorable first bath. Such a cute moment! And the freshly combed wispy hair after?? Alllll the 😍😍.

The thing is, babies aren’t supposed to have a soapy bath so soon after their skin hits fresh air. Their skin has been protected in its own natural lotion called Vernix in a pH balanced amniotic fluid bath for their whole existence up until birth. It’s the most fragile and sensitive their skin will ever be when it first comes into contact with dry, cold air outside the womb.

My dad, a family doctor with a huge amount of experience, trained at a time when as soon as babies emerged from the womb, they were scrubbed down with chlorhexidine – a powerful antiseptic we use to sterilize ourselves before surgery.

It was thought at the time that this would “protect” them from the dangerous bacteria they encountered when they passed by your rear end. That was after the doctor had of course sterilized your vag with copious amounts of iodine solution. He told me this and my eyeballs very nearly popped out of my head. *GASP* The yeast infections that must have caused!! The superbugs that would breed!! NO WONDER so many kids have crazy allergies and autoimmune disease has skyrocketed!!

You see, I have been fortunate to be trained in the time of advances in the “Hygiene Hypothesis”. The understanding we now are working with is that, lo and behold, in the days before all this anti-septic overzealousness, those autoimmune and allergic issues (which are so freaking hard to treat, btw) were lumped into the “rare diseases” category. And while it’s great we now know to wash our food so we don’t all die of dysentery Oregon-Trail-style, we have certainly skewed too far into the anti-microbial realm which is boosting many if not all of these processes*. (In case you’re wondering, my dad was WAY ahead of his time and would not let this happen to his patients’ babies.)

SO back to that brand new baby. Current practice is to wash with your typical Johnson & Johnson baby wash within a few hours of birth. This makes it so that the health care team is not functionally putting their hands on something that came out of your vag when they come to check on baby. Also, it’s cute and baby then smells like what Johnson & Johnson have decided we should all believe a baby smells like. You get that white smooshy vernix stuff off so your photos don’t look like something out of a Halloween movie and everyone is happy.

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Rosie, fresh outta the womb and covered in blood and goo

…..Except the baby. It NEEDS that vernix still on there to protect it. There is no lotion on earth that can really replace that and a soapy scrub washes it all away. A review in Advances in Wound Care sums it up well*:

The retention of vernix on the skin surface contributes to a higher skin hydration, a lower skin pH, and relates to a reduced heat loss after birth

So, washing this off your baby is like slathering your face in a thick layer of Creme de la Mer and then immediately washing your face again to leave your skin naked and dry. But worse. Because you can’t buy more.

This is in addition to the absolutely critical happy bacteria (aka skin flora for the nerds like me) that you worked SO FREAKING HARD to put on your baby if you had a vaginal delivery or labored with your water broken. That “skin flora” has dramatic health implications. So much so that many hospitals are starting to swab mothers’ nether regions to coat the baby in them after c-sections too. A soapy wash kills up to 99% of those bugs and you may never get them back in the same way.

There are studies galore out there going on looking at the benefits those bugs go on to have on gut health, maintaining healthy body weight, absorbing nutrients, allergies, eczema, auto-immune disease and more. I won’t get over-sciency about this, but suffice it to say, we’re going to look back on this hyper-sterile era and cringe.

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Photo by Wayne Evans on Pexels.com

So is it a little weird to think about your baby being coated in all that stuff from your lady parts? Sure. Is it an extra step for the docs and nurses to put on gloves? Yeah. Is it still super worth it to wait a bit for that first bath? HellToTheYes. Bottom line, just wipe the excess gore off, wait at least 24 hours, and preferably do a gentle water wash when you get home. Thank me later.

I would LOVE your questions about this, comment below!!

 

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Dr. Annie is a Family Physician, mom of 2 with 1 on the way (nope, baby’s not here yet, that’s baby #1 over there, also, that’s my husband, not a creeper nurse, he’s a doc too so was working in scrubs when I went into labor) and lover of healthy bacteria in the Sacramento area.

 

 

 


*. 2015 Oct 1; 4(10): 587–595. doi:  [10.1089/wound.2015.0642] Skin Physiology of the Neonate and Infant: Clinical Implications. Teresa OrangesValentina Dini, and Marco Romanelli*

Dr. Annie Answers: Back to School Sniffles

Is back-to-school time giving anyone else the sniffles yet? No, I’m not talking about the emotional “my baby is growing up ones”. Though, holy pregnancy hormones, Kindergarten meet-and-greet had me reaching for the tissues tonight!!

Seriously though, I’m talking about the cold virus, mucus-attack-from-all-the-new-people-germs ones.

Cold and Flu Season

“Back-to-school” in my line of work means office visits are about to pick back up to packed days of people suffering with upper respiratory infections (URIs). If your kid is in daycare or just starting school after staying home with you – get ready for the fall/winter viral rodeo! We expect normal young children to get between 6-8 viruses per ‘school season’ in those first few years of exposure. Yep, that means pretty much one per month. This is all part of developing their little immune systems. Yayyyyy! Not.

Don’t despair though, people – once they get this immune system 101 out of the way, the frequency of illness decreases dramatically – generally by the time they hit 5-7 years old. Not everyone thinks this is a good thing – there were many, many tears from my 5 year old last year when 3 year old sister kept getting fevers and staying home from daycare with me, “I never get sick!!! It’s not FAIR!!!”. Proof that you can’t please everyone as a mom.

What the health?

Three questions come up over and over and over again in my office:

  1. Is it contagious?
  2. Do they need antibiotics?
  3. Do they need to stay home from daycare/school?

The answers to those, respectively are:

  1. “Yes, duh. If you are acutely sick with pretty much anything that is not food poisoning or an actual venomous snake/insect bite it is contagious”
  2. “Probably not. 85-95% of these are viruses not bacteria so antibiotics will do nothing except mess up your kid’s microbiome, probably give them diarrhea and probably increase rates of obesity.” Did that last part catch your attention? Check out This Article in Scientific American if you want to read a little more…
  3. “That depends.”. Let me expand on number 3 a bit.

And in case you’re wondering – no, that is not how I communicate with patients at my office. But this is Real As A M*ther and I’m gonna shoot you straight here.

To Stay Home or Not To Stay Home

That is the question, amiright? For me, staying home with one of my kids sick means either my husband or myself cancel 15-25 patients’ visits that they’ve been waiting for sometimes for weeks. Plus using my nearly non-existent PTO (no, doctors do not get great benefits a la Google employees). If I don’t really need to keep my kids home, I’m not gonna.

On the other hand – I know that other people who’s precious little ones are in our daycare or school are in a similar boat, so I’m also not going to go all Typhoid Mary and send my kids in to take down the class.  Here are the rules we go by – some dictated by science and some by school policy and some by just plain ol’ common sense.

  1. Pukers stay home until they’re eating normal food for 24 hours without relapse. This one is science + common sense.
  2. If fever happens (over 100.4F on oral or rectal thermometer), kid stays home until fever-free for 24 hours. This one is usually a daycare and school policy. It’s a little arbitrary since you can still be contagious with a virus for several days after the fevers go away. Usually you’re shedding less of the viral badness by then though. I would go with this as a minimum rule *but* if your kid has no temperature and yet still seems pretty sick, give it another day or two. 
    • IMPORTANT: This rule is different if you choose not to give your child a flu shot or the other routine childhood vaccinations. I’m not getting into any rights/wrongs here, but bottom line, if your child does not have flu or other major immunities and they get a fever, you MUST quarantine them for at least 10-14 days after any febrile (fever) illness. That means at HOME. Not taking them with you to Target to pick up a few things. Not hanging out at the library or the park. You do not get to take those germs in public to potentially kill other babies or people with weak immune systems. Period. Moving on…
  3. Diarrhea is a little tricker… in so many ways. This generally also earns a home-stay until it at least slows down to non-urgent, soft but not watery poos only a few times a day (I’m not being gross, you’re gross. Doctors have no TMI mode). If your kid is potty trained and old enough to wash their hands well or little and still fully in diapers, they can go back then. If they’re still in potty training mode and likely to have an accident, they should be kept home until they’re back to normal because that poo is still highly contagious for up to 2 weeks and who knows where it will end up. 
  4. Sniffles and coughs are generally ok to go in if they come without fever or rashes. However, if your child has asthma and needs to be watched more carefully or seems too sick to be able to be managed with only the offer of tissues or sips of water, keep them home until they’re better.
  5. Mouth sores, fever with a rash or a very sore throat should usually be checked out by a doctor before going to school. Some kids will get a ‘viral exanthem’ or viral rash at the end of the fever part of illness that is fine if it’s super mild – like you barely can tell it’s there, but if you’re not sure, get them checked.
  6. If they’re given antibiotics because the doctor is SURE it’s something bacterial like strep throat or true pink eye, they need to be on the meds and ALSO fever free for 24 hours before returning.

Gesundheit!

Got it? Great! Tell your friends and your mom and your sister and your cousin with all those kids. And as always, remember I’m not your personal doctor so take this as fun information and ask them specifically about any questions or worries. Getting your kiddo checked out in the office is always an option.

DSC_4458BW Dr. Annie is a family doctor, mom of 2 with 1 on the way and expert booger catcher in the Sacramento area.

Dr. Annie Answers: Plastics & Poisons, what the AAP statement means for you

Parenting life is full of trying to balance our desperate, borderline insane level of worry about our children’s health and wellbeing with just getting through the day with everyone alive and fed. It can be so hard to know which of the internet warnings are worth the extra effort in an already chaotic day and which are probably overkill. Even for me – a board certified physician. A recent biggie just came out that I want to break down for you all – plastics and food processing. As always, this is general information – if you have questions, ask your own health care provider.

The AAP Statement

In the August issue of Pediatrics journal, the American Academy of Pediatrics (AAP) issued a statement “that some chemicals found in food colorings, preservatives, and packaging materials may harm children’s health” (See full article and references here “Food Additives and Child Health”, published online July 23). They recommend that some chemicals which are currently allowed in US products and food processing should probably be avoided whenever possible.

Bisphenol, phthalates and dyes, oh my!

“What are we worried about this time?” you might be asking. Some of these have been on the watch list for a while, others you may not have heard of before. I’ll give a super brief run through here derived from this AAP review:

  • Bisphenols: This includes the dreaded BPA. In hard plastic containers & metal can lining. Can act like estrogen and mess with  puberty, fertility, body fat, and even affect the nervous and immune systems. BPA is now banned in baby bottles and sippy cups, but other bisphenols are not (yet).
  • Phthalates: Used to make tubes used in industrial food production flexible. These “may affect male genital development, increase childhood obesity, and contribute to cardiovascular disease” . Also banned in some products such as teething rings – AAP is working on more bans.
  • Perfluoroalkyl chemicals: That’s a mouthful – aka PFCs. Used to grease-proof food packaging, “may reduce immunity, birth weight, and fertility”. Research shows PFCs may affect the thyroid also.
  • Perchlorate: This is added to some dry food packages for static electricity control. Can “disrupt thyroid function, early life brain development and growth”.
  • Artificial food colors: Yikes guys, in so many “kid foods”. These may be associated with ADHD symptoms and research shows cutting them out made ADHD symptoms less in many kids
  • Nitrates/nitrites: Food preservatives and used to enhance color, especially in cured and processed meats. These can mess with thyroid function and blood oxygenation. Also have been linked with gastrointestinal and nervous system cancers.
  • (See AAP review here for info/references on each of these)

Um… so that’s scary

Action Items

You can take some simple steps to get these out of your kid’s and preferably your own life ASAP – especially if you’re pregnant.

1) Go Fresh

Get fresh or frozen meats, fruits and vegetables rather than canned, processed or preserved. More and more alternatives to canned goods are now available in safely packaged boxes or pouches instead. Here are a couple of my go-to’s – added bonus, no can-opener needed and they look super cute in your pantry stacked up:

Pomi Finely Chopped Tomatoes - 26.4 oz (4 Pack)Green Valley Organics Black Beans Pouch, 15.5 Ounce (Pack of 12)

Green Valley Organic Bean Pouches and Pomi Tomato products in boxes.

All Beef: Healthiest: Applegate Naturals Beef Hot Dog

For meats, it is worth eating a little less and spending a little more when you do to get all natural, organic and/or grass-fed. Look for deals on these, stock up and freeze. Or better yet, follow Kristy’s lead and invest in a partial butchered animal.

2) Upgrade your containers

Use alternatives to plastic, such as glass or stainless steel, when possible. If you can’t afford to replace your food storage (tupperware, etc…) and sippie cups right now, at least avoid microwaving food or beverages (including infant formula and pumped breastmilk) in plastic. Also avoid putting any plastics in the dishwasher. If you can afford an upgrade, here are some great products for kids:

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LunchBots bento containers $41.99: dishwasherable, different colors and safe and

PlanetBox ROVER lunch bento boxes $79.95: A little pricier, also keeps food more segregated.

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Snapware Total Solution Pyrex Glass Food Storage Set, 24 pieces $55.99:

These go on sale at Costco regularly – nab one or two sets and let go of your old plastic ones!

 

Dr. Brown's Options 3 Piece Wide Neck Glass Bottle in Silicone Sleeve, Green/Mint/Blue, 9 OunceJoovy Boob Glass Bottle and Sleeve, Blue, 8 OuncePhilips Avent Natural Glass Baby Bottles, 4 Ounce (3 Pack)

Baby Bottles: There is a great blog post here on Gentle Nursery about this alone. Three good options to try are Dr. Brown’s, Joovy Boob and Avent. I always recommend buying 1-2 of each of a few different bottles to see which your baby prefers.

BravaWare Stainless Steel Cups and Silicone Sippy Lids for Kids Toddlers Babies BUNDLE: 4-8oz Cups and 4 Sippy Lids - BPA free Sippy Cup Set with Safe Rolled EdgesMunchkin Miracle Stainless Steel 360 Sippy Cup, Blue, 10 Ounce

Sippie Cups: There are lots of options for cups with straws in glass and stainless steel. These two are great sippie cups – BravaWare and Munchkin Miracle. IMHO, if you’re handing a cup to a kid, probably best to avoid glass until they’re older, even if it has the nifty silicone protector.

I, myself am utterly addicted to my Hydroflask which has legit kept ice in my water for over 24 hours at a time. I try to get through 2 of the 32 ouncers daily.

Above all, look for and AVOID plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless they are labeled as “biobased” or “greenware.”

Wash it up

  1. Clean all fruits and vegetables that cannot be peeled. At a minimum, ALWAYS rinse thoroughly with clean water. To be more thorough, you can buy special organic fruit and veggie wash or make your own:
    • 1 tablespoon lemon juice
      2 tablespoons distilled white vinegar
      1 cup cold tap water
  2. Wash hands thoroughly with soap and water before and after touching said food

Honesty Time

Maybe you have already done all of this and your child has never had plastic touch their precious lips. If so, that is awesome and you should for real pat yourself on the back! These changes are also WAYYYYY better for the Earth so, double win!

Guess when I changed over from microwaving my kids’ milk in their plastic sippie cups? Last night when I sat down and read this statement for myself. Cue #momguilt explosion.

Motherhood and life in general is a learning process. Let’s keep updating ourselves and do the best we can. And if you’re like me and just now realized that “hippie friend” was right about all this? The chance you’ve inflicted any permanent damage on your kid is low. Do what you can, take a deep breath and give yourself some grace.

xoxo, Dr. Annie

Pregnant, MD: What’s Safe in Pregnancy Myth vs Fact, Part 1

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Photo Credit: Fiona Margo Photography

Hey mamas and mamas-to-be! There is a lot of confusing and alarmist information out there on the interwebs about the safety of lots of things everything in pregnancy. We all want to be safe, but also to not be deprived of allofthethings for 9+ months. This post is a quickie guide to set the record straight on some of the most common questions we pregnancy providers get. This, like all my posts, are not ever meant to replace the personal guidance of your own health care provider – when in doubt, as them! I’m breaking this down on the following very non-scientific scale:

Myth – Mostly Myth – Kind of Fact – Mostly Fact- Fact

No Coffee – Myth

Our family lived in Portugal when I was in Kindergarten and first grade, so that was about the time I started drinking coffee. No joke. So, when I was learning about pregnancy, you better believe I looked up all the information on this topic! I can’t tell you how many people I have talked to – even other doctors – who are under the impression people have to stop drinking all caffeine the moment they conceive. That’s just cruel.

My actual face if you told me not to drink coffee while pregnant.

The truth is, The Cochrane Review looked at the research and the best studies have shown no difference in pregnancy outcomes with moderate caffeine intake. What’s “moderate caffeine intake”? About 200mg caffeine daily. That’s one tall Starbucks brewed coffee or an espresso drink with 2 shots. Strong black tea has about 50mg per cup and regular or diet soda (bad for other reasons….but) about 35mg. Energy drinks vary widely – if you want to look up your specific fave bev, check out Caffeine Informer.

No Hot Tubs – Mostly Fact

This one is legit. Studies have shown that raising your core body temperature can increase the risk of miscarriage in early pregnancy and other complications later on in pregnancy. This is true whether it’s a high fever from being sick or you are in a hot tub, sauna, hot yoga, or even hot bath or shower at home.

Does this mean you can’t take a quick hot shower ever? No! You can go in any of these warm environments for a little while. What’s a little while? As soon as you feel hot, break a sweat, or of course if you feel light headed at all, leave and cool off immediately. If you can’t trust yourself to make that judgement, avoid altogether.

No Hair Treatment – Mostly Myth

The old types of hair treatments for dying and perming had toxic chemical derivatives which were potentially dangerous, especially in first trimester of pregnancy.

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Definitely got my hair did before these pics.

Newer dyes should be free of these chemicals and are ok. Highlights that aren’t applied to your scalp are also fine – just stay in a well-ventilated area because your breathing can be more sensitive during pregnancy. Perms and straightening treatments again vary – ask your salon if they offer safe, natural alternatives to the older more harsh treatments. More info HERE on American Pregnancy’s Website.

No Nail Polish – Mostly Myth

You can get your nails did with no worries as long as the salon uses good hygiene practices. One of my favorite midwives from my training at UCSF, Judith Bishop, wrote a great summary HERE on this. Any kind of polish and even fake nails are ok. Beware though – the chemical smells might make your sensitive nose and stomach unhappy!

No Cheese – Mostly Myth

The key here is *pasteurized*. You can get Listeria, a dangerous bacterial infection that can cause miscarriage, from unpasteurized dairy products. Pasteurized cheeses that are within their expiration dates and have been properly stored are fine. Even soft cheeses. Most restaurants should be able to tell you if their cheese is “raw” or pasteurized – if they can’t skip it.

appetizer assorted bowl cheese

No Lunchmeat – Kind of Fact

This again is due to Listeria concern. You should avoid lunch meat unless it’s been heating to steaming in the microwave, stovetop or oven. Not sure how you feel about warm lunchmeat, but this preggo is NOT for it! Opt for grilled chicken, tuna salad (no more than 2 servings per week though) or other choice if you don’t like warm sliced meat.

 

No Fish – Kind of Fact

Speaking of tuna…. The main concern with seafood is about mercury. Check out and print yourself THIS PDF from American Pregnancy if you want a quick guide to which fish are “highest mercury” aka, avoid entirely or just “high mercury” aka have no more than 2 small servings weekly or lower and you can enjoy at will.

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Photo by Skitterphoto on Pexels.com

What about sushi?? So, cooked sushi is always ok as long as you are paying attention to mercury issues. Raw sushi *theoretically* should all be flash frozen based on USDA safety regulations and therefore should NOT have the parasites that are of concern in pregnancy. However, you are putting your trust in the sushi fish purchaser and preparer in this care, so approach with caution.

 

 

 

 

No Strenuous Exercise – Mostly Myth

There are no strict guidelines regarding exercise in pregnancy because this is highly variable as to what is safe and normal for YOU. There are elite athletes who’s “norm” is to run 10 miles or lift hundreds of pounds of weights on the regular. There are couch potatoes who get winded walking up a single flight of stairs.

Seriously, though… Exercising in pregnancy is actually key to having a healthy pregnancy, easier delivery, and – get this – fewer stretch marks! The main guide here is how the exercise makes YOU feel. Yes, that’s right, you have to listen to your body. This is not the time to “push through” and override your body telling you it is hot, too winded or  overworked. You will need to be more cautious with yourself because your blood flow is altered, your body shape is changing and your muscles, ligaments and tendons will be affected by relaxin hormone eventually.

No Sex – Mostly Myth

OK, think about it. If having sex while pregnant was dangerous, do you really think humans would have survived this long? A lot of pregnant woman have their libido skyrocket thanks to increased blood flow to the lady parts (though if you don’t that’s nothing to worry about). It is ok and GOOD to have sex if you want to in pregnancy. Get. It. On.

A few words of caution though… If you have pain or bleeding during sex, stop. Have your doctor check you and tell you if it’s safe to continue having intercourse during your pregnancy. And if you’re pregnant and single – you need to be ultra careful about not contracting an STD. They can cause severe birth defects, miscarriage or stillbirth if contracted while you are gestating. Safe sex – good. Unsafe sex – bad.

No Smoking – Fact

This includes ALL smoking. Smoking cigarettes and being exposed to second-hand or even third-hand (if you smell it even though no smoke is around, that’s third-hand smoke) can cause complications in pregnancy. If you are smoking when you conceive, talk to your provider right away about how they can help you quit. If people around you are smokers, same goes. It is NOT sufficient for them to just go outside. If your sensitive sniffer can smell the smoke, you’re being exposed. 

What about pot? It’s legal now and stuff, and doesn’t it help with appetite? NO, not safe in pregnancy. Marijuana has been shown to increase rates of ADHD, anxiety and other cognitive disorders in children who were exposed in utero. Stay away.

No Alcohol – Mostly Fact

Saved the most controversial for last! So, here in the USA, all of the official guidelines from the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, etc… go along these lines, “There is no amount of alcohol known to be safe in pregnancy”. So, pregnancy providers will tell you to abstain completely from the time of ovulation if you might conceive through birth.

The Royal College of OBGYNs (Britain’s version of ACOG) takes a slightly more relaxed tone, saying “The safest approach is not to drink alcohol at all if you are pregnant, if you think you could become pregnant or if you are breastfeeding. Although the risk of harm to the baby is low with small amounts of alcohol before becoming
aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant”. None of the large studies done recently showed negative effects on the baby or child with having a few drinks per week. However, the risk of preterm birth with alcohol exposure and of the devastating fetal alcohol syndrome makes pregnancy providers approach this with significant caution.

I know you are looking for a straight forward “yes you can have a glass of wine now and then” or “no, alcohol is truly dangerous”. We don’t have that yet. As a health provider, I follow the lines of saying, no amount is safe. As a woman physician, I know a whole lot of doctors who have read the studies and comfortably go ahead and have a drink now and then in the later parts of pregnancy. Ultimately, you’re in charge of making that decision for yourself and your unborn. Think about whether the anxiety when your kid seems hyper at age 3 that maybe they have subtle effects because you had a glass of wine at that dinner party is manageable vs the benefit you’ll really get from said glass of wine. You should for SURE never get drunk or even tipsy – that’s a no-brainer.

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Photo Credit: Fiona Margo Photography

What else?

This is why I called this Part 1… Please, comment away with questions, Myths you want busted, funny examples of crap your mother in law told you was unsafe in pregnancy! Part 2 will be based on your input. Whatcha wanna know??

Dr. Annie is a married mom of 2 with 1 more on the way (bump captured by Fiona Margo in the above pics, if you’re in the PNW look her up!!) and family physician in California.

Dr. Annie Answers: Water Safety

TRIGGER ALERT, Child loss and drowning discussed in this post. It’s not fun to read about but it might, just might, save your kid’s life.

Yesterday, we got to enjoy a rare hot and sunny Washington day on our friend’s ski boat. After the husbands took turns reliving their glory days on wakeboard and mono-ski, we put out the “Sidewinder” tube and my good friend went out for a much more tame go with her son and our two girls.

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Everyone was safely ensconced in life jackets. My husband, ER doctor and former lifeguard, was perched on the back of the boat ready to leap in if anyone was jostled off. Both girls know how to swim without floaties. We never went over 15 mph. And still, with every bump, every turn over the wake, my heart was in my throat imagining one of them popping off into the water and drowning.

As a doctor, I know that drowning is the leading killer of children aged 1-4. If there is only time for 1 thing to talk about at the end of a well-child visit, that’s the one I target. It’s something most parents worry about whether they know the statistics or not. And yet – we still miss the biggest risk most of the time.

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Kids are not at high risk of drowning when we are all playing together in the pool. They’re not at high risk even when bouncing along in a life jacket behind a boat. It’s when we don’t think they’re going in the water at all that the danger is highest.

The day before our boating, I had lounged and gabbed with our friends on the beach – Rosie and Mimi 200 yards down the empty shore collecting seashells and I was honestly more worried that the bald eagle we kept spotting would come carry one of them away than the very real danger they could wander down to the water’s edge without us noticing and drown in moments. We ALL forget that it’s these unguarded moments that are the real danger. Even the professionals. 

The recent stories of toddlers drowning in the media – including the tragic loss of Bode Miller’s daughter and Nicole Hugh’s son – have started a new fight to promote water safety with the AAP and in the public eye. They highlight just how quickly the lives of even the best parents can be changed by drowning. And also, that you can do things to decrease the risk and improve chances of survival.

So, what can you do? Should we all keep life vests on our kids 24/7 when we are in walking distance of water? Should we just give up and never let them around water deeper than an inch? Leashes? Well…. I mean you could. But, there are more practical solutions.

1) Education

Talk to your kids about water safety from the beginning. I have erred on the side of scaring them about it because I’d rather they be a little timid as swimmers than over-confident.

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Strongly consider enrolling them in ISR Self Rescue classes sometime after age 6 months and before 6 years old. These classes teach infants to toddlers how to roll over and float safely if they fall into water.

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Photo credit: Brendan Nicholson

I think my friend, the super smart mama Dr. Elizabeth Nicholson (that’s her cutie above), says it best:

I’ve seen conflicting opinions of ISR over the years … As an Emergency Medicine physician, I am painfully aware of drowning risks. Each summer, I console at least one family after the loss of their child. Primary prevention, such as locked fences and sturdy pool covers are the most important, but we all know that even the most attentive caretakers have escape artists for children. It takes only seconds.

I wanted to have extra seconds to find my kids. I viewed drowning prevention through ISR like buckling a car seat or holding my hand in a busy parking lot. It might not have been fun every minute, but crucially important.

Our instructor is wonderful. She pushes the kids in a safe a supported manner. They are reassured during class and proud after learning new skills. Even with vastly different temperaments, both of my kids have learned the skills AND love the water. See for yourself!

 

 

Want to see it in action? Check out the video of the “final lesson”, falling in with clothes on below:

Look up the closest certified program to you here.

2) Tools

  1. Barriers: If you own a pool, a pool fence or safety-focused pool cover is a MUST. We moved into the gorgeous backyard oasis above, but all I saw was drowning risk until we got our All-Safe Pool Fence. If you’re inside and not in “swim mode”, keep the kids behind locked doors – make sure the locks are child-proof. A hook lock at home or simple stick-on child lock at a vacation rental can be applied to most sliders above child’s reach to be safe.
  2. Lifeguards: If you’re at someone else’s home or on a watery fun vacation without a fence, treat watching the kids like lifeguards do. Someone should always be the primary observer. If that person needs to go, they need to actively and explicitly hand off duty to another adult. When you’re in a group setting without this designation, it is WAY too easy for everyone to assume someone else is watching the kids – which is what happened to this family
  3. Life jackets: If the kids are just playing in the yard around an open pool or on the beach near the waves, they still need life jackets on and/or an adult “lifeguard”. 20045346_10100140255349096_1854036280355769801_o.jpg
  4. Pool alarms: Again, if this is your home or somewhere you go frequently, a good back-up measure is an alarm so you know it they’re in the vicinity.

3) Rescue

If you haven’t already, enroll yourself and your adult family members in a CPR class. Make sure to continue updating it when it expires. Drowning happens quickly and silently and you can’t be sure how long the kid has been in the water. If you get to them quickly, rapid initiation of CPR while someone else calls 911 can absolutely save their lives.

Adult & Child CPR Anytime Kit

You can look up classes in your area here or get at home kits. Don’t let this be one of those, “well I was meaning to do it, but we were just so busy….” items. Look it up today. Put it on the calendar for within the next month. Chances are you might literally save a life.

4) Spread the word

Tell. Your. Friends. If you see unsafe practices around water – say something. We can’t know how many lives have been saved by the preventive measures above, but it’s definitely significant. Not sure where to start? Send them this blog article or post a pic on social media saying “PSA: pool fences save lives” or whatever speaks to you. Just keep people talking about it. We should be talking about this AT LEAST as much as preventing SIDS or the proper carseat positioning in your vehicle or which screen time is the least evil screen time because it still remains the leading cause of early childhood death.

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Alternatively… stick to inland splash pads.

Dr. Annie is a married mom of 2 plus 1 on the way and family physician in the Sacramento area.

Dr. Annie Answers: A Parent’s Intuition

Many of the things that people have said they appreciate about me as a doctor are the direct result of advice from one of my best mentors. One thing – trusting a parent’s intuition – has literally saved the lives of multiple patients of mine, and now hopefully, also that of my nephew. He’s in the womb below, while I was also preggers with baby #2.

As a resident, I remember feeling so lost in the beginning about offering advice on things like breastfeeding or colicky babies or a kid with a weird rash. I had been around lots of kids, sure, but I had never been pregnant, had never tried to breastfed a baby, or to get a fussy toddler to take medicine.

I, for sure, gave some asinine advice in those early days and more than once had patients laugh in my face (sorry pregnant patient who I tried to tell to work on her core strength for third trimester back pain!!). What Dr. Pippitt told me was, “Of course you don’t know their kid better than they do, but you do know medicine better than most of them.” Her advice now seems so obvious – let parents be the experts on their own kids. This applies to people being the expert on their own bodies also, but I’ve found we misinterpret ourselves more than parents do their kids…. so paying attention to what parents think is even more important IMHO.

Since then, I, of course, have become a mom twice over. I know tons more practical advice and can be quite a bit more helpful in treatment strategies. But! I still know that every parent is the expert on their own kid. My bottom line advice for when to have something checked out, followed up on, checked out again is always “if you, as the parent, are still worried or feel something’s not right”.

The validity of this was recently driven home in a tragic way. My sister, back in March, called me on FaceTime to show me a lump on her 3 year old kid’s neck. I took one look at it and thought, “that’s not normal”. My sister and her wife agreed and took him in to their pediatrician right away. The doc told them it was nothing to worry about. But… they were still worried when it didn’t go away. They saw ENT who also said it was nothing. But… they were still worried. Finally at 2 month follow up, it was bigger, not smaller. A few weeks later an MRI and biopsy had confirmed it was Hodgkin Lymphoma, an extremely rare, but very treatable diagnosis in someone his age.

Their intuition was right on, and had they not followed up despite being told it was nothing, it could have been caught at a later and more dangerous stage.

So, the next time you find yourself with that, “something’s not right” feeling, go ahead and get checked. This goes for your own body too, of course. Make sure the provider you see is able to make you feel confident that your fear can be ruled out before you go. This doesn’t mean they will do every test imaginable every time – sometimes we can take a look at something and tell you with high level of certainty, “you don’t need to worry”. We did go to school for a long time to learn that medical side of things, after all. But, if your care provider doesn’t listen to or respect your knowledge about your own kid or your own body, find a new one.

Dr. Annie is a married mother of 2, aunt of dozens of other amazing kids and family doctor in the Sacramento Area.

Ps. If you want to support my sister & her family, you can find them on Caringbridge.com under starlinglynnalesker

Dr. Annie Answers: Getting Pregnant

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It’s kinda crazy to me that a lot of us spend so much of our lives worrying about NOT getting pregnant and then you go straight from that to worrying about getting pregnant. This, like many issues addressed here, can be influenced by many personal health issues. Talk about it with YOUR doctor. I’m just here to give some basic info. This advice also is less applicable if you’re using a sperm donor or other fertility treatments for any reason, but some of it still applies.

So you think you want to get pregnant…

Number 1: Start a prenatal vitamin. *Ideally* you’re already taking one if you are of childbearing age (aka teens through 40s). If not, start NOW. You should be on a prenatal vitamin at least 3 months, and ideally 1 year before you conceive. What if you’re already trying to conceive? Start now. Better today than next week. Just, the sooner the better.

Which prenatal vitamin is right for me? There are lots of brands, gummy options, drinkable options, etc… to choose from. Find one that you can tolerate taking. The basics it needs to have are 400-1000mcg of folate, 27mg iron, 1000 units vitamin D, and 100mcg iodine. If your diet does not have a lot of healthy omega oils, also get a 1000mg daily DHA/EPA supplement. I personally use Honest company prenatal and DHA.

Talk to your health care provider about any medications you’re taking and if they are safe while trying to conceive. Make sure any chronic health issues such as thyroid problems, diabetes, or high blood pressure have been checked and are in good control. Plan ahead for these!

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This depends a little on what you were using. You CAN get pregnant the month (or week) you stop any form of birth control. So don’t stop using anything unless you are A-OK with being pregnant right away. That being said, hormonal birth control is more likely to have a “wash-out” period where you don’t ovulate regularly and are less likely to conceive. DepoProvera, oral pills (especially if you’re skipping periods), the patch, the nuva-ring and Nexplanon/Implanon all have a 3-6 month expected wash-out. I have seen it take up to a year with Depo. IUDs are less likely to have wash-out, but we wouldn’t be surprised if it took 3 months or so.

So, let’s say you want to get pregnant “sometime in 2019”. Easy. Go off birth control after you have that New Year’s blow-out party. What if you have a more specific window? You can plan to go off birth control 3-6 months in advance of that window, but use condoms to prevent pregnancy until then. Know that condoms are only 85% effective at best and you could still get pregnant earlier than you think. So, if, for example it would be devastating to get pregnant in February (calculate due date from theoretical conception date out here), don’t stop birth control until after that.

How to get pregnant….

SO, um, there are of course some basics here I’m assuming everyone knows about human reproduction. If you’re confused on the what goes where, may I refer you back to wikipedia under “birds and bees”. If you’re not in a relationship where sperm is readily available or you can’t have intercourse for any reason – see a fertility specialist about how to get that all going.

If those exceptions above don’t apply to you… the most reliable way to get pregnant is also the simplest. Have unprotected intercourse every other day from right after your bleeding stops until you start bleeding again. Every. Other. Day. Not every 3 days. Not twice a day (but good for you if this is your issue!). This gives you optimal semen volume and you will never miss your fertile window because it lasts 2-4 days. Boom.

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Now we get to the people who are absolutely opposed to having sex every other day. For some couples, that’s not sustainable over the several months it can take to get pregnant. That’s totally fine! If that’s the case, I usually recommend the Glow Ovulation, Period Tracker App. This lets you track cervical mucus, basal body temperature, ovulation sticks and pregnancy tests, sexy time and everything else about your cycle. Take at least 1 month to track everything while still using condoms so you get some understanding of your cycle.

Then, go for that fertile window! Again, sex every other day or daily. What kind of sex? Pretty much whatever. Position doesn’t matter. Ideally, the person trying to conceive should have an orgasm during or after (though there isn’t evidence that this is necessary, it has little down side!). And if you’re gonna use lube, use this lubricant. Chill out for 5-10 minutes after sperm gets in there then go about your business.

Did you say cervical mucus? Sounds so gross, but is actually the easiest way to check if you are fertile. Just look at the TP after you wipe when you go pee. When you’re approaching fertility and fertile, you’ll notice a clear discharge like egg white. When this is super gooey/stretchy – that’s peak fertility. More nitty gritty here.

How long is this going to take?

If you’re under age 35 it is normal to take up to 1 year to get pregnant depending on your health and the health of your partner. Most couples will get pregnant within 3-6 months. If you’re over 35, the timing gets a little more pressured because fertility starts to decline significantly around age 37. In this case, we would usually only give you 6 months before further testing. If you’ve already been trying to conceive for that long – go see your doc.

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Photo cred: FionaMargoPhotography.com

Final note: Don’t sabotage your efforts.

If you’re in the exciting phase of ‘trying to conceive’, don’t do things that are going to stress you out and make it harder or threaten an early pregnancy. Ask your health care provider if any medications you’re taking are safe. Don’t go binge drinking. Don’t smoke marijuana. Don’t smoke anything for that matter. Have your sperm provider avoid hot-tubs, tight underwear and long bike rides. Eat lots of healthy fruits and vegetables and proteins and fats (first trimester is ROUGH ya’ll, you will need those nutrients stocked up). Exercise regularly. Avoid over the counter medicines other than tylenol and tums without asking your healthcare provider. And… enjoy the ride!

ps. Make sure you follow us for an update on my own adventure trying to conceive baby #3 coming soon 😀

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Dr. Annie is a family physician and married mom of 2 in the Sacramento Area.