We thought we were golden with our 3.5 year old’s sleep pattern: um, yeah, right! We have had lots of middle-of-the-night wakeups from nightmares and now- growing pains. When our son wails from the pain, I get it. I had them too.  But, what I don’t get is what they are and how to help him.

According to KidsHealth, growing pains usually happen when kids are between the ages of 3 and 5 or 8 and 12. Doctors don’t believe that growing actually causes pain, but growing pains stop when kids stop growing. By the teen years, most kids don’t get growing pains anymore.

What are the symptoms?
Most of the time they hurt in the front of the thighs (the upper part of your legs), in the calves (the back part of your legs below your knees), or behind the knees. Usually, both legs hurt.  Growing pains often start to ache right before bedtime. Sometimes a child can go to bed without any pain, but then might wake up in the middle of the night with their legs hurting. The best news about growing pains is that they go away by morning. MayoClinic reports that some children may also experience abdominal pain or headache during episodes of growing pains. Dr. Greene cautions that if the growing pains occur during the day, or there is limping, redness or any other complaints, you should see your pediatrician.

What causes growing pains?
Kidshealth reports that growing pains don’t hurt around the bones or joints (the flexible parts that connect bones and let them move) — only in the muscles. For this reason, some doctors believe that kids might get growing pains because they’ve tired out their muscles. When you run, climb, or jump a lot during the day, you might have aches and pains in your legs at night. Dr. Greene says the muscles or tendons are still a little too tight for the growing long bones. Muscle spasms lasting from 1 to 15 minutes cause the pain. Many of these children are unable to touch their toes with their fingertips without bending their knees.

How can you help with the pain?
Kidshealth suggests an over-the-counter pain medicine like acetaminophen or ibuprofen. Kids should not take aspirin because it can cause a rare but serious illness called Reye syndrome.

There are three other things that might help you feel better:

1. placing a heating pad on the spot where their legs hurt
2. stretching their legs or having the child stretch like you do in a gym class
3. massage their legs

Dr. Greene suggests that during a pain episode, stretching the foot and toes upward will often resolve the muscle spasm. Gentle massage and moist heat over the painful spot can also help. In most cases the pain can be prevented with simple, daily stretching exercises. These exercises must be continued even after the pain subsides in order to keep the muscles and tendons relaxed and able to accommodate the next growth spurt. Some physicians recommend giving a glass of tonic water before bed. Though he has never seen any studies evaluating this suggestion, he does say that plenty of fluids should make cramping less likely.

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Post tags: growing pains, how to prevent, massage, preschool, symptoms of growing pains, teenager, Toddler, tween, what age get growing pains, what are growing pains, what causes growing pains

I was having problems with frequently choking and was prescribed some medicine for “silent reflux” by an Ear, Nose and Throat doctor. She said that the medicine was “fine for a nursing mom”…..without checking. I wasn’t convinced she really knew.  I called my general practitioner to see if the medicine was okay for a nursing mom.

“NO!” she said, “take Pepcid instead.”

Just to double check that Pepcid was okay for a nursing woman, I called Kathy Lilleskov, who was my (amazing) lactation consultant with Willow. She looked Pepcid up in the trusty Thomas W. Hale book, “Medications and Mothers Milk.” Kathy did some of the medical translation for me and told me that Pepcid was an L-1 medicine. Huh? L-1 is a category for a medicine considered safe while breastfeeding. It was so nice to get immediate, trustworthy information.

If you don’t want to go out and buy the book, check out Thomas W. Hale’s website/forum.  He has some helpful information on the site and a great forum.  Hale will no longer answer questions from the public, but will from health professionals. However, search through the forum and you will see some of the answers he has posted.

The other site I love for information about medications and breastfeeding is Kelly Mom.  Between both sites and perhaps the book, you should be able to get your questions answered immediately.

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Post tags: best book about breastfeeding, best book about nursing, book about safety of medicine and nursing, medicine and breastfeeding, medicine and pregnancy, medicine while nursing, what can I take when nursing, zantac and nursing

Germs, Visitors and Going Outside

by Dr. Hugh Gilgoff

Who’s Allowed Near the Baby?

The birth of your baby is a time of utter joy and celebration.  Friends, family, and even complete strangers on the street want to see and even touch your beautiful little one.  The problem is that your baby does not yet have a developed immune system.  Even if you breastfeed your baby and pass some of your immunity on, there are a plethora of illnesses that are just too easy to catch.

Germs are spread either by touch or by respiratory droplets.  With this recent H1N1 swine flu epidemic, we are all aware of the need to wash hands thoroughly and frequently.  But even if you have clean hands, you can still spread a virus or bacteria by coughing, sneezing or even breathing on a baby.

You will hear slightly different advice from different doctors (and different grandmas), but I think the happy medium would include having a high threshold for visitors during the first 2 to 3 months.  If you have adult family or close friends who want to visit, take a quick medical history first.  Are they sick, or even starting to feel sick?  Do they have a family member, especially a child at home who is now sick?   If an adult is definitely healthy, and promises to wash their hands often and not necessarily kiss the baby near the mouth, then it is “okay” in my book to have them visit.

I really would not want any little ones near your newborn.  Toddlers are rarely without a runny nose.  They are also notoriously putting their hands in their mouth or noses, so hand washing becomes “a wash” itself after a minute!  Now if there is another baby who comes, that is okay – because they won’t touch your baby.  As for those older kids, perhaps 7 or 8 years old, they can usually be trusted to wash their hands and look at the baby, but not necessarily handle him or her.

Now some of you are saying, “C’mon Dr. G – you sound a bit over-protective.  You know everyone wants to see my new baby now!”  So let me explain where I am coming from.  First of all, it is just not worth seeing your newborn catch even a little cold if you can avoid it.  They won’t eat well, and often gag or even throw up when they are congested.  They will sleep even worse and cry even more, and they can suffer for 3-7 days from even a common cold.

Furthermore, and perhaps more importantly, your newborn will have very little clinical or behavioral cues to allow us doctors to NOT worry when they are sick.  Whereas an older child is more like an adult – and can verbalize and localize their pains – a newborn is going to just act very irritable and even lethargic.  On top of that, they respond with a fever quite easily, and any fever in a newborn is an emergency until proven otherwise.

What if a Baby Gets a Fever?

Each and every pediatrician will treat the newborn with a fever (or even one without a fever, but with lethargy or other signs of serious illness) the same way.  We must assume the worst, and search for signs of infection, especially dangerous bacteria, in the blood, urine and even spinal fluid.  Then we must actually admit the baby into the hospital for 2 to 3 days and administer antibiotics through an IV until the cultures prove whether there is a bacterial infection or not.

The reason for doctors being so aggressive in our approach to newborns who are sick is in the statistics.  Babies who have high fevers can get sick very quickly. Whereas, with an adult with a serious infection, you often have many days to catch and treat an illness.  There have been too many cases (and I have unfortunately seen this) where a baby is critically ill, or even dead in hours as a result of an overwhelming bacterial infection.

So, while the vast majority of fevers are going to be viral colds in origin, and the majority of colds are actually going to pass in a few days even in a newborn, it just isn’t a good thing to have your little one catch a fever.  If you are concerned, measure your baby’s temperature using the most accurate method – rectally.  You don’t have to check it daily, or really ever – but check it any time they feel warm or are acting sick.  Any fever over 100.4, (or 38.0 Celsius) is an immediate trip to emergency room.  Call us while you are on the way or when you are there so we can help.  Certainly, don’t give Tylenol and wait until the morning.

After two to three months of age things start to change, and we don’t have to be as aggressive.  At that point, the immune system is improving and hopefully the first vaccines are on board.  Perhaps more importantly, there are now clinical cues that appear in the baby such as: how interactive they are, how well they are eating, smiling, sleeping, and even playing.

Can I Take my Baby Outside?

In the old days, the above concerns sometimes led to parents waiting inside for a month or two with their newborn.  After all, since there are indeed tons of germs outside, that might seem a valid option.  But I think, once again, we need to balance fear with reality (and mom’s sanity) and find that middle road.

Although there are germs and sick people outside, the only way your newborn is going to catch those germs is if people cough on or touch your baby.  So as long as you are quick with a stiff arm and strong glance (or loud shout, perhaps even with a bull horn), you should be okay taking your baby for a quick walk after a few days of life.  Indeed, we want to see all newborns for a full physical exam on day 3, 4 or 5 at the doctor’s office, so all babies will come out at least once that first week.  But, it also should be okay to take a quick walk (weather permitting) down the promenade, in the park, or even to get a coffee (decaf please!).

When your neighbor, best friend, or absolute random, well-meaning Brooklynite approaches the stroller you need to explain and prevent anyone coming within five feet.  You can blame the pediatrician.  It’s okay for them to look for a moment from far away, but they really shouldn’t come close or touch your baby.

As your child gets older, you will likely relax a bit about germs.  You will still wash their hands often, but the truth is that kids at the playground will share their puffs, goldfish and their germs.  You choose your battles and do the best you can.  But with those newborns, it’s always best to be over-protective, and to err on the side of caution.

Other articles by Dr. Gilgoff:

• Vaccines- Thoughts from Dr. Gilgoff
• Colic and Nutrition for your baby
• Fever, Jaundice, Rash, Spit Up and More
• Fever- A Discussion by Brooklyn Pediatrician
• When can a baby sleep through the night?
• How to deal with constipation in children
• Does your child have allergies?
• What does asthma look like?
• Starting Solids

Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans. To see his listing information and read parents’ reviews, check the blog here under “Recommended Pediatricians”. Dr. Gilgoff also has his own website now too: www.drgilgoff.com

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Post tags: germs and baby, germs and newborn, infant temperature, newborn outside, strangers and newborn, when can vistors see a baby, when can you take a baby outside

If your child has allergies or you suspect they might, you should consider this insightful article about allergy testing that came out in the January issue of Pediatrics: Robert Wood of the Johns Hopkins Children’s Center and Scott Sicherer of Mt. Sinai Hospital in New York, warn that blood tests and skin-prick testing are not enough to diagnose allergies on their own. Instead, they argue, these diagnostic tests should be used to confirm an allergy. According to an article Johns Hopkins put out last week, Wood says. “Many children with positive tests results do not have allergic symptoms and some children with negative test results have allergies.”

The JH article goes on to say: “Test results….., should be interpreted in the context of a patient’s symptoms and medical history. If a food allergy is suspected, Sicherer and Wood advise, the patient should undergo a food challenge — the gold standard for diagnosis — which involves consuming small doses of the suspected allergen under medical supervision.

Blood tests and skin-prick testing “can tell whether someone is sensitive to a particular substance but cannot reliably predict if a patient will have an actual allergic reaction, nor can they foretell how severe the reaction might be… Many people who have positive skin tests or measurably elevated IgE antibodies do not have allergies, they caution.”

I found this particularly interesting from their research: “Screening panels of food allergens without previous consideration of the history is not recommended, because sensitization without clinical allergy is common. For example, ∼8% have positive test results for peanut, but ∼1% are clinically allergic.¹⁶

Another note of caution: Commercial tests vary in sensitivity and labs may interpret tests results differently.

The researchers helpful summary lays out what they found:

1. Treatment decisions for infants and children with allergy should be made on the basis of history and, when appropriate, identified through directed serum sIgE or SPT testing. Newer in vitro sIgE tests have supplanted radioallergosorbent tests.

2. Allergy tests for sIgE must be selected and interpreted in the context of a clinical presentation; test relevance may vary according to the patient’s age, allergen exposure, and performance characteristics of the test.

3. Positive sIgE test results indicate sensitization, but are not equivalent to clinical allergy. Large panels of indiscriminately performed screening tests may, therefore, provide misleading information.

4. Tests for sIgE may be influenced by cross-reactive proteins that may or may not have clinical relevance to disease.

5. Increasingly higher levels of sIgE (higher concentrations on serum tests or SPT wheal size) generally correlate with an increased risk of clinical allergy.

6. sIgE test results typically do not reflect the severity of allergies.

7. Use of a multiallergen serum test can be helpful for screening for atopic disease if there is a clinical suspicion. If positive, allergen-specific testing may be considered.

8. Tests for allergen-specific IgG antibodies are not helpful for diagnosing allergies.

9. Because test limitations often warrant additional evaluation to confirm the role of specific allergens, consultation with a board-certified allergist-immunologist should be considered.

We have a list of allergist in NYC on our Marketplace- check them out here.

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Post tags: allergist in brooklyn, allergy testing, childrens allergist, immunologist, nyc, nyc allergist for kids, pediatric allergist, pediatric journal

How do exposures in the womb and during early childhood put our children at risk for disease later in life? Join Mount Sinai’s Children’s Environmental Health Center (CEHC) for a half-day workshop that examines the environmental causes of some of the most common diseases: ADHD, autism, breast cancer, obesity and infertility. Learn how to keep your family healthier by preventing these toxic exposures.

WHEN: Monday, December 5

WHERE: New York Academy of Medicine (1216 Fifth Avenue, New York City)

TIME: 9:30am – 12:00pm

Pre-registration is required, guests are encouraged.

To register please contact katherine.southwick@mssm.edu or register online here.

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Post tags: chemical exposure in womb, childrens environmental health center, mount sinai, toxic chemicals during pregnancy, workshop by cehc mount sinai

Acetaminophen in concentrated infant drops will no longer be produced by manufacturers- and that’s a very good thing. There were dosing errors as people used concentrated infant drops on older children. It was easy to get it confused: if a child weighs twice as much as in infant, wouldn’t it make sense to give them twice the infant dosage? Of if you give one teaspoon of children’s Tylenol/Acetaminophen to your child- then couldn’t you give them one teaspoon of infant drops for the same result? With that understandable reasoning, the danger begins. Dr. Hugh Gilgoff of LICH Pediatrics explains, “if you use one teaspoon of the concentrated infant drops you will be giving 500mg!  This is an adult dose, and this potential for confusion or a real overdose is the very reason they are now taking the concentrated drops off the market.” Now, there will be just one dose- 160/5 ml.

To clear it all up and explain how and when to use Acetaminophen and Motrin, our Expert Pediatrician for the blog, Dr. Hugh Gilgoff of LICH Pediatrics, clears it all up.
What is Fever?
Fever is a sign of an infection – either a virus or bacteria.  Fever also comes at times as a reaction to vaccinations.  Fever by itself is not dangerous, but you may want to bring your child to see the doctor if you are not sure where the fever is coming from.  If there is a mild cough and cold, it is most likely a virus, and no antibiotics are needed.  But if your child is acting very sick, and is not energetic and/or the fevers are getting higher and lasting many days, you should bring them in so we can diagnose the source of the infection and give medicines if needed.  We usually say fever is any temperature above 100.4 if the baby is less than 2 months old, and then anything above 101.  Higher fevers are not necessarily predictive of more serious diseases, as many viruses can cause high fevers.  True lethargy or breathing fast is always worrisome regardless of the temperature.  I encourage parents to bring down fevers mainly to make the child feel better, and therefore eat, drink and play more.  With a bad bacteria, even when a fever is down, the child will often remain lethargic, but with a virus, they often perk up.  There is not rule that is 100% – that is why computers will never replace a good pediatrician!
Fever Medicines
Fever medicines are safe if used in the right doses.  The real reason to use a fever medicine is to make your child feel better, as they are usually not as happy with a real fever.  You can use Tylenol, and after 6 months, you can use Motrin.  The real name of Tylenol is Acetaminophen.  The real name is Motrin is Ibuprofen.  There may be different manufacturers, and the actual name brand of Tylenol and Motrin was actually taken off the market in certain ages/concentrations, so any generic version is fine to use.
Confusion
There is confusion now because they are phasing out, or taking off the market a certain concentration of Tylenol/Acetaminophen.  This concentration was stronger, and therefore you needed to give less of this liquid to achieve the same strength.   This was called the infant version, and came 80mg/0.8ml and the dropper was graded as 0.4 or 0.8ml.  The way that we dose all fever medicines – both in adults and children and infants, is by the medicines’ strength or milligrams.  The newer infant Tylenol is in fact the same concentration as the children’s liquid.  They are both 160mg/5ml, which means that IF you gave 5ml, which is one teaspoon, you will be giving 160mg.  If you wanted to give 80mg, you would then give half that amount, or 2.5ml.  This 80mg would the SAME 80mg as 0.8ml of the older infant Tylenol.
What was the big deal? What do we change?
If you have the older infant Tylenol dose, you can still use that medicine.  Just make sure that you are using the correct dose.  If you use one teaspoon of the concentrated infant drops you will be giving 500mg!  This is an adult dose, and this potential for confusion or a real overdose is the very reason they are now taking the concentrated drops off the market .
Again, the children’s Tylenol, at 160mg/5ml is ok to give to babies, as long as you give the correct dose, and that dose is based on their weight and not age.  After a 2 month old gets their shots, you can surely give Tylenol, and you can give the dose every 4 hours overnight.  After 6 months old you can use motrin/ibuprofen, and you can use only Motrin, or only Tylenol or you can rotate the medicines every 3 hours.  The Tylenol medicine can only be given every 4 hours, and the Motrin medicine can only be given every 6 hours, but you CAN give one medicine one hour after giving the other if the fever has not come down enough.  You can check drgilgoff.com for doses of the medicines based on your child’s age/weight.
Is a Fever ever Dangerous?
There are situations where the fever shoots up very quickly and a young child can get a “fever seizure”.  These are very scary, as your child is shaking and having a real convulsion for many minutes.  If it is a straightforward, “simple” fever seizure, it is not dangerous.
We don’t give aspirin to children.  Be careful of combination products, like those cold medicines that have Tylenol in addition to Sudafed, as you can’t use these AND give Tylenol on top of it, or you risk an overdose.  We don’t recommend cold medicines in young children anyway, as they don’t work well and can have side effects.
Your child is bound to get some fevers!  It is a right of passage, as kids just love to share their germs!  But hopefully you now feel better equipped to assess and then help treat that fever.

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This year for various reasons we needed to test Birch’s hearing.  You can see from the photo above, he had a great time with the place we found (and this was even at the end of his appointment).  I had asked on my Facebook page if people could recommend a pediatric ENT and quite a few people recommended I start with the NY Eye and Ear Infirmary.

Fortunately, the New York Eye and Ear Infirmary takes many different kinds of insurance, however if you use their Urgent Care, they are not authorized to bill for emergency services, therefore all those visits are  billed as a clinic visit.

I called the Ear Institute and got an appointment at the Hearing and Learning Center the next week.  The Hearing and Learning Center specializes in evaluating and rehabilitating extremely young children, difficult to test children and children with auditory processing disorders. I was so glad to know that they would be patient with my doctor-sensitive child.

The Ear Institute, as a whole, treats not just kids but also adults who need cochlear implantation, medical and surgical otology and neurotology, hearing and balance disorders.

The experience there was fantastic. The Center had appointments at many convenient times, they greeted us warmly at the reception desk and there were small waiting rooms that were private and cozy.

But the real test came when the audiologist and her assistant came to greet us and showed us into the special soundproofed room for diagnostic evaluation.

The effervescent audiologist explained the testing process thoroughly to Birch and me, let him handle the equipment and even insert the ear tubes himself, that we had no problem at all when it came to the test.

We got a copy of the full report in the mail a few days later, and an additional copy was sent to our pediatrician. They took care of everything, and we even got lollipops at the end of the visit. (P.S. – his hearing, luckily, turned out to be fine).

The Ear Institute
The Hearing & Learning Center
The Cochlear Implant Center
The New York Eye and Ear Infirmary
380 Second Avenue (21st-22nd Streets)
9th Floor
New York, NY  10010
(646) 438-7800 Main Number
(646) 438-7809 FAX
(646) 438-7801 Audiology
(646) 438-7802 Cochlear Implants
(646) 438-7806 Hearing Aid Center

** 24-Hour Urgent Care **

The New York Eye and Ear Infirmary
310 E. 14th Street at Second Avenue)
New York, NY 10003 (in Manhattan)
Appointment Line: (212) 979-4192

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Post tags: audiology appointment, auditory processing disorder, beth israel, brooklyn, diagnostic center, doctor, ear institute, early intervention testing, eye and ear institute, hearing and learning center, hearing test for babies, hearing test for children, hearing test for infant, hearing test in nyc, kids audiologist, new york eye and ear infirmary, nyc, pediatric audiologist, pediatric hearing test, review of eye and ear institute, where to get a hearing test in nyc

My first visit to the OB/GYN after I gave birth was so anticlimatic. I wanted to talk about the labor and all its details, but my OB/GYN was only interested in asking “what are you going to use for birth control?” I had been out of the market for birth control for so long that I had no idea that “the pill” was no longer the standard option. “The ring”, IUDs, “implantables” and “the patch” seem to have taken over.

My biggest disappointment was that my OB/GYN just told me the options, without a lot of information.  Anyone else have that experience? I needed a lot more information to make a decision, so I turned to the internet. An article in Parenting Magazine called, A Mom’s Guide to Birth Control by Dana Sullivann was helpful. I wanted to post some excerpts here.

Maybe some of you will have suggestions as to what has worked for you?

I’ve always been on the Pill, but now I’m breastfeeding. That means I can’t go back on it, right?

Not necessarily. The main thing to avoid is contraceptives that contain estrogen, which can reduce your milk supply. So women who are exclusively breastfeeding need to steer clear of birth-control pills that contain both estrogen and progestin, as well as the Patch (a bandagelike square that delivers hormones into your bloodstream) and the Ring (which you insert into your vagina, where it releases hormones).

Instead, you could use a “mini-Pill” — a progestin-only contraceptive, such as Micronor, that won’t affect milk supply. (One caveat: It’s important to take the mini-Pill at the same time every day for optimal effectiveness.)

You can also safely use an intrauterine contraceptive (IUC) or try any barrier method, such as a diaphragm, cervical cap, sponge, condom, and Leah’s Shield (a reusable rubber insert), says Karen Meckstroth, M.D., assistant clinical professor of obstetrics and gynecology at the University of California, San Francisco.

I’m not sure whether I’m done having babies, so what’s long-term but not permanent?

An IUC is ideal, and there are two types. The first, the Mirena IUC, releases a steady stream of progestin and is the most popular birth control with female ob-gyns.

It’s even more effective than tubal ligation if it stays in place, says Dr. Meckstroth. It most likely works by changing the texture of cervical mucus so that it blocks sperm from reaching the eggs. It can also prevent ovulation. It’s approved for up to five years, and once it’s removed you can get pregnant right away.

There’s also ParaGard, an IUC that’s approved for up to ten years and doesn’t use hormones. It releases copper instead, which experts think creates an environment that’s toxic to sperm. It may also keep the egg from attaching to the uterus.

Another option: Implanon, a matchstick-size rod that’s implanted under the skin of your arm to release progestin and lasts for up to three years. One downside: It often causes breakthrough bleeding, so you’d have to be willing to put up with that.

My husband got a vasectomy after our first child, but now we want to have more. Is it really permanent?

It can be reversed, but it’s pricey (from $6,800 to $13,000) and the success rate is only 30 to 40 percent. Another option to consider: A physician can use a needle to remove sperm from the testicles and then perform in vitro fertilization.

This is from WomensHealth.org and is a list of some of the options are available:

Intrauterine Devices or IUDs

An IUD is a small device shaped like a “T” that goes in your uterus. There are two types:

• Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. It fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.

• Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can’t reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Implantable Rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Oral Contraceptives — Combined pill (“The pill”)

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the “extended cycle” pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don’t contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

Your doctor may advise you not to take the pill if you:

• Are older than 35 and smoke
• Have a history of blood clots
• Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

Oral Contraceptives — Progestin-only pill (“Mini-pill”)

Unlike “the pill,” the mini-pill only has one hormone –– progestin. Taken daily, the mini-pill thickens cervical mucus, which keeps the sperm from joining the egg. Less often, it stops the ovaries from releasing an egg.

Mothers who breastfeed can use the mini-pill. It won’t affect their milk supply. The mini-pill is a good option for women who:

• Can’t take estrogen
• Are older than 35
• Have a risk of blood clots

The mini-pill must be taken at the same time each day. A backup method of birth control is needed if you take the pill more than 3 hours late. Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

The Patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don’t use a patch the fourth week in order to have a period.

Shot/Injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.

Vaginal Ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.

It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.

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Post tags: after birth, best methods for contraception, birth control, birth control after baby, breastfeeding birth control, Childbirth, contraception after baby, IUD, IUDs, method, mini pill, Nursing, ob/gyn recommend, oral contraceptive, safe, the patch

This cutie pie looks like she's enjoying her ride...but maybe in an hour...

If you don’t have a child that gets motion sickness or car sickness, count yourself one of the lucky ones. The rest of us worry about “that look”, that queasy look: pale grey face, open mouth, cold sweat and….STOP! There are ways to work with motions sickness, from the traditional advice of: “open the window” to “ginger root.” Most of them are suggestions I have culled from sites where  parents have figured out how to help their kids “stomach” being in the car.

P.S. – my son never got car sick until he was 4 years old, so tuck this post away for the future…just in case!

What is motion sickness? Basically, motion sickness results from a conflict between the eye and ear: the inner ears detect that the car is moving, but the eyes– focused within the car– do not. The brain gets conflicting signals, and nausea results, About.com states.

As KidsHealth explains, For example, if you’re riding in a car and reading a book, your inner ears and skin receptors will detect that you are moving forward. However, your eyes are looking at a book that isn’t moving, and your muscle receptors are telling your brain that you’re sitting still. So the brain gets a little confused. Things may begin to feel a little scrambled inside your head at that point.  When this happens, you might feel really tired, dizzy, or sick to your stomach. Sometimes you might even throw up. And if you’re feeling scared or anxious, your motion sickness might get even worse.

How to tell if your child is queasy? If your child is old enough, they might say their stomach hurts, or they feel sick, or complain that their throat or neck hurts– all of which gives you time to fix the problem before the vomiting starts. They also might break out in a sweat, get restless and look pale.  If your child can’t verbalize it, they might cry a lot while in the car.  Their skin might look pale or wiggle around in their car seat.  It turns out that rear-facing car seats are the enemy of car sick children. It’s a total bummer, but it’s true.

Here are some suggestions from parents:

• Put your child closer to the middle of the vehicle (or boat for that matter). Being on the outside seats of a vehicle make children queasier.
• Have them look out the windshield at the horizon, not the side windows. Thus #1 becomes a big part of this solution.
• There is something about ginger that helps with motion sickness. Try favored ginger snaps, ginger root capsules and ginger ale. Consume the ginger before the trip and also intermittently during the trip.
• Seabands work for my niece. They are elastic wrist bands with hard buttons that push into the inside of each wrist, creating accupressure points to help with the nausea. My niece puts them on before she gets in the car. You can buy them at any pharmacy.
• My niece also gets a dose of  Drammamine a couple of hours before a car trip. (Though talk to your pediatrican beforehand about this and dosages.) Other parents suggest Benadryl.
• Wear wrap around sun glasses- yes, really. This creates a visual vacuum.
• Some people swear by lollipops. They work for me.
• Open a window: fresh air can adjust your brain signals to understand that you are in motion.
• Keep vomit bags and a change of clothes in the car.

If you have any tips or suggestions, please leave them here so the rest of us can benefit!

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Post tags: baby crying in car seat, car sick, car sickness, crying in car seat, ginger, ginger for car sickness, kids with car sickness, motions sickness, neck hurts, prevent, prevent motion sickness, queasy, rear facing car seat, remedy, sunglasses, throat hurts, treat

Lithium Button Cell Batteries

At the beginning of parenthood there is nothing more challenging than policing everything that goes in your child’s mouth.  There are hazards everywhere: coins, game pieces, paperclips and now, an increasingly serious danger according to a recent article in the NY Times: lithium cell batteries.

I freaked out after I read the NY Times article and promptly pulled the lithium battery out of our scale. Added bonus: I no longer know what I weigh!

Where are lithium batteries in your home?
You can find small disc-like lithium batteries in just about everything now: cameras, scales, watches and yes, toys.  Just like coins, the round smooth shape of the lithium button batteries is appealing to children. And, just like coins, they are being swallowed by children.

According to Wikidpedia, lithium cells can produce voltages from 1.5 V to about 3.7 V, over twice the voltage of an ordinary zinc-carbon battery or alkaline cell battery.

Why are these batteries the worst?
The NY Time article reported that “About 3,500 cases of button cell battery ingestion are reported annually to poison control centers. But while swallowing batteries has occurred for years, the development of larger, stronger lithium cell batteries has increased the risk of severe complications.  Data from the National Capital Poison Center in Washington found a sevenfold increase in severe complications from button cell ingestions in recent years. Moderate to severe cases have risen from less than a half percent (about a dozen cases per year) to about 3 percent (nearly 100 cases per year), based on a review of 56,000 cases since 1985.”

So, what is the worst?
The NY Time article states that “among the serious complications, the chemical reaction triggered by the batteries can damage vocal cords, leaving children with a lifelong whisper. Damage to the gastrointestinal tract means some children require feeding tubes and multiple surgeries. “The injuries are so much more serious,” said Dr. Toby Litovitz, director and lead author of both articles in Pediatrics. ‘It’s like drain opener or lye. It’s not something you want in the esophagus of your child.’  The batteries that pose the greatest risk are those that begin with the number 20, which stands for 20 millimeters. They are newer and stronger than older models. Batteries numbered 2032, 2025 and 2016 are responsible for more than 90 percent of serious injuries.”

What happened in our home:
I noticed last week that my standing scale had one of these lithium button batteries and only a flimsy backing to keep it in place.  I only became aware of it because my 20 month old was carrying the scale around and the battery looked like it was being jostled out of its place. She noticed it too and tried to take the battery out before I swiped the scale from her hands.  As the  NY Time article points out, “When children ingest batteries, it’s usually not because they found one loose in the home. In 60 percent of the cases involving children under age 6, the child has removed the battery from the electronic device. The problem is that most parents are not even aware when it happens, yet studies show the battery begins to cause severe damage within just two hours of ingestion.”

It’s worth considering baby-proofing for these batteries and helping other parents become aware of their potential danger too.

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Post tags: button battery, choking hazard, ingest battery, lithium battery, swallow battery