Home Births, World Trade Center Attacks, Baby Rules – PediaCast 108
- Home Births
- World Trade Center Attacks
- Baby Rules Meal Time
- Baby Rules The Night
- Lifetime Registration For VladStudio
- ACOG Statement On Home Births
- Behavioral Problems In Preschool Children Linked To World Trade Center Attacks
- PediaScribe: Saturday Photo Hunt – Heavy
Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.
Announcer 2: Welcome to PediaCast, a Pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome to PediaCast Episode 108, for Tuesday, February 12th 2008. Home Births, World Trade Center Kids, and Babies Rule. That's what we're calling this one.
I do have a special announcement for you. Although, this is another one of those times when you have to act kind of fast. Although even when you look at the regular price of what I'm going to tell you about, it's still a pretty good deal.
Those of you who have listened at the program a long time, know that really if you only listen a couple times, you know that at the end of each episode, one of the people I thank is Vlad over Vladstudio.com for providing the artwork for the website and the picture that you see in our feed.
You know our picture I'm talking about, it's the one with the man and the kid and they're etching the bubble. The kid's blowing bubbles. Actually, the dad… or I guess it's a dad figure, overly analyze it.
He's in the bubble floating upside down and the child is actually standing on a bubble and blowing bubbles. You know what I'm talking about, it's cute.
You can see a lot more of Vlad artwork both at the website for the show Pediacast.org and also on Karen's blog at PediaScribe.com.
Now if you go to Vlad's website, Again, it's Vladstudio.com, you can get a lifetime subscription to his site for just $19.99 until February 14, I know that's only a couple of days. It's regularly $29.99, 30 bucks it's still a deal.
It's a lifetime subscription. Now, what does it get you? Well, first, you help support a struggling artist, right? I mean, this guy is in Russia, he makes these computer files that people can download. So you know it's not making a ton of money doing that.
So, you're supporting an artist. You get access to high resolution pictures and all these pictures, high res and lots of different sizes and resolutions including dual monitor.
If you have a studio with two monitors, even has cell phone sizes that are available for subscribers to the website. He also have this really cool things called wall paper clocks and those are for Windows and for Mac depending on which operating system you have, you can get it.
Also, the pictures are all signature free, so they don't have little Vladstudio mark down at the bottom right hand corner. And you even get the Photoshop source file so you can play with the images yourself if you are a subscriber to the site.
Now, all of this is of course is for personal use only. You don't want to use it for commercial purposes without permission. Here at PediaCast we have permission to use these pictures. And even if you don't become a registered user, you may want to consider checking out some his posters, they make great items to decorate nurseries.
And you can get the posters through Zazzle, actually if you go to his site at Vladstudio.com and then click on the poster link, it takes you to Zazzle which is an American company based in California and you can buy a variety of his friends, Vlad friends and poster size with different finishes, glossy, matte, embossed, also a bunch of frame options are available as well.
And by the way, even though he is in Russia, when you register for his site the financial aspect given your credit card number and all that is handled by Plimus which is an e-commerce solution that's also based here in the United States and California.
So, I assume it safe, I've done with myself. I've been a lifetime subscriber since we started the program and I started using his pictures in the feed and on the website. So, I'm not getting paid for this endorsement. He didn't write to me and ask me to do it. We mention a little blur at the end of every show and I though "My golly it's about time that we put him front and center because his artwork really is just fantastic….
I loved it. I get so many comments through the website and so does Karen on the Pediascribe blog asking us who does the artwork? Where do you get it? It's so cute. I loved the pictures and again it's over Vladstudio.com and he's running a special the next couple of days.
You can get a lifetime subscription for just $19.99 regularly $29.99. If you ask me, I would even wait until after February 14th, and just pay the $30. I mean 30 bucks it's a couple of pizzas and you get lifetime subscription.
I can tell you he adds new pictures every week. I mean this is the guy who loves art. I mean, he just loves what he's doing and it really comes across in the artwork. So, check that out.
All right, we're going to talk about today, Home Births, The World Trade Center attacks and Its Effect on Preschool Children. Baby Rules the Meal Time and Baby Rules the Night. And you'll see what that's all about, coming up.
If there's a topic that you would like us to discuss on PediaCast, just go to Pediacast.org, click on the contact link you can also e-mail email@example.com or call the voice line at 347-404-KIDS. Don't forget the information presented in the show is for educational purposes only.
We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, make sure you call your doctor and arrange an interview and physical examination and all that business.
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The American College of Obstetricians and Gynecologists reiterate its long standing opposition to home birth. While child birth is a normal physiologic process that most women experience without problems monitoring of both the women and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low risk pregnancies.
Obstetricians acknowledge the women's right to make informed decisions regarding her delivery and to have choice in choosing her healthcare provider but they do not support programs they advocate for or individuals who provide home births.
Nor did they support the provision of care by midwives who are not certified by the American College of Nurse Midwives or the American Midwifery Certification Board. Child birth decision should not be dictated or influenced by what's fashionable, trendy of the latest progressive cost.
Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life threatening for both the mother and baby.
Although a vaginal birth after Caesarean is particularly dangerous at home because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences including death, unless the women is in the hospital, an accredited free standing birthing center or a birthing center within hospital complex with physician's ready to intervene quickly if necessary.
She puts herself and her baby's health and life at unnecessary risk. Advocate cites the high US caesarean rate as one justification for promoting home births. The caesarean delivery rate has concerned the American College of Obstetricians and Gynecologists for the past several decades and they remain committed to reducing it, but there is no scientific way to recommend an ideal national caesarean rate as a target goal.
In 2000, the professional group issued its Task Force Report "Evaluation of Caesarean Delivery" to assist physicians and institutions in assessing and reducing, if necessary, their caesarean delivery rates. Multiple factors are responsible for the current caesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity, and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome.
The American College of Obstetricians and Gynecologists believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, and the National Association of Birth Centers that should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, midwives attending to home births are unable to perform life-saving emergency caesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
The American College of Obstetricians and Gynecologists encourages all pregnant women to get prenatal care and to make a birth plan.
The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.
For women who choose a midwife to help deliver their baby, it is critical that they choose only midwives certified by the American College of Nurse-Midwives or those who have a nod from the American Midwifery Certification Board.
In addition your midwives should collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
OK. I, I mean complete agreement with this stance and some point you know that I have a lack of experience in conversing with a progressive audience and don't worth themselves and do it easy because I consider homebirth an alternative or uneducated option after all it's not the norm, right? Well that's fine if I can change one mom to this mind in the following sense and reason and perhaps, save her life or her baby's life in the process then the ridicule I get from you progressive types will be well worth it.
A study published by the Archives of Pediatrics and Adolescent Medicine reports that exposure to both the World Trade Center attacks and another traumatic event is associated with the behavioral problems among pre-school children when compared to exposure to just one event or to none.
Researcher Claude M. Chemtob of the Mount Sinai School of Medicine in New York, and his colleagues, note that there is a paucity of research regarding the effects of terrorism on preschoolers. It is possible that young children may be especially defenseless to the adverse psychological consequences of such trauma.
The authors studied 116 preschool children with an average age of 3.9 years who were directly exposed to the World Trade Center attacks of 2001 and who lived or attended preschool in lower Manhattan. Parents filled out a survey about their children between March 2003 and December 2005 – averaging about 35 months after the attacks.
The questionnaires provided information on demographics, as well as the exposure level to the attacks and information on the occurrence of other traumatic events such as death of a family member, exposure to a natural disaster, or witnessing a serious accident. The researchers also assessed emotional and behavioral factors.
Twenty-three percent of participants experienced one or more high-intensity World Trade Center events such as the towers collapsing, injured or dead bodies, or people jumping out of buildings. Compared to children who were not exposed, those exposed preschoolers had almost five times the odds of sleeping difficulties and nearly three times the odds of experiencing depression or anxiety.
The authors found that for children who also experienced another traumatic event, behavior problems appeared more severe. Those who were exposed to the World Trade Center attacks and another traumatic event had 21 times the odds of having emotional problems or being anxious or depressed and 16 times the odds of having attention problems compared with children who were not exposed to high-intensity World Trade Center events or to other trauma.
The researcher's findings are consistent with what is known as an allostatic load hypothesis of stress as exposure to traumatic events is accrued over time, the risk of psychological effects increases.
They conclude by advising that, "physicians seeking to assess the impact of terrorism and disaster on very young children should look for disaster-related exposure and other trauma." In addition, Chemtob and colleagues suggest that public health policy after disasters should include "more vigorous outreach to trauma-exposed preschool children."
Sounds like good advice. All right. We'll part ways for 30 seconds or so. We'll be back with your questions, right after this.
Ella: Hi, my name is Ella. I had a son, 15 month old and he was eating very well the regular foods and salads since he was like nine months old and he was eating everything by me and by the babysitter.
At a certain point, he stops eating by me and he only wants berry, like yogurt and cheese and those types of stuff – that type of stuff. And by the babysitter, he was still eating. Now he's eating most of the time by the babysitter and as always, and by me only dairy stuff.
And if I gave him something else he just scrapes everything off his tongue. It's Ella for Brooklyn. Thank you, hopefully you can answer my question on the podcast and I will listen to you show be well, bye.
All right, well thanks Ella from Brooklyn with a 15 month old son. And basically the story is, as I understand that your son's been eating well, regular foods and salads since nine months of age and eating well for you and the babysitter, still eating well for the babysitter but for mom he only wants dairy such as yogurt and cheese and if mom give anything else he, I'm going to think you said "scrapes it off his tongue….
I'm not sure that's the word that you used, feel free to rewind if you're not quite sure what Ella said. OK the bottom line is the kids push in his stuff out of his mouth if it's not dairy. So what's happening here is I think the baby is ruling mom. The baby rules, you know. Baby knows what he wants. Baby's knows how to get it and you know he's got it figured out.
And what makes you think that is because, well for one he's taking everything else for the babysitter. So this is an issue when mom gives them food that he wants dairy and he knows how to get it. Now will a baby be stubborn to the point of dehydration and starvation.
So in other words, if you don't let the baby win and you basically outlast the baby are you going to be in the situation where the baby becomes dehydrated or starving. OK it's extremely unlikely. Will the baby be stubborn to the point of dangerously low blood sugar? Again, extremely unlikely at this age that might be an issue for a newborns but again newborns aren't develop yet to the point of knowing what they want and how to get it.
So the solution here is that you have to be more stubborn than your child. You have to win. Granted kids have preferences for foods that are allowable, I mean I don't have a problem with that I don't like tomatoes or cantaloupe, OK fine.
But when your baby is refusing everything except a single food group then, this is a control issue. This is not an allowable preference, so what do you do? Well really parents have to become the psychologist here or to put it in survivor terms you have to outwit, outlast and outplay.
And here's what I would do, I would say first, don't offer anything dairy right at the beginning, keep it out of sight. Offer something else first, yeah he's going to push it out of his mouth, he's going to complain and you're going to just sort walk away and then offer to him again.
And like a broken record he'll throw it out of his mouth you offer it again, throw it out of his mouth, you offer it again; throw it out of his mouth, you offer it again over and over and over but I guarantee you the next day it won't take as many times.
When your child eat just a little of this other thing, he will eats it, swallows it, he's kind of reserve themselves to the fact that you've won then I will give him a big hug, "Yay you do it, you did it… and then out comes the dairy. So he gets what he wants but only after he does what you want him to do.
They say mean it's not progressive but it works until the next meal, they're going to eat little more and because the dairy is coming. And then the next day they'll eat a little more, the next day they'll eat a little more and each time they get a happy response and then a dairy comes out.
Yipeee! One more point, the babysitter and the mom, you have to be on the same way of length here. I mean the plan has to be identical at both places, so that there's consistency in the child's life between babysitter and home. So that's important. So I hope that helps Ella.
Let's go ahead and move on to our next call.
Chona: Hi, Dr. Mike. It's Chona from Athens, Georgia and we really need your help. We have an 18-month-old son who lately has refuse to sleep on his own bed, he's in a crib and we put him in to sleep and he say she sleep for a couple hours, sometimes less, sometimes more and when he wakes up and when we pick him up he's definitely sleepy.
If we sit down and hold him he will go back to sleep in fact my husband will sit in a recliner and they sleep in the recliner the rest of the night. But just as Calvin pulls him further and makes him want to get to bed even more. We tried going under to see if you're up, you're up and you're not going back to sleep in someone's arm.
Chona: But then he just screams and we tried leaving up his bed, checking on him every five minutes and then every 10 minutes and then gradually making it longer and longer, but we've gone up to 30 minutes to an hour with him screaming.
So my husband proposed the following solution which I don't necessarily agree with that he wants his crib, he's wanted those cribs that converge. So he thinks that sleeping with his mattress in uncomfortable, and he would like to go ahead and get converted bed and put a full sized mattress on it.
To me that seems like that would only make him very upset more and he would just come find us instead of crying. But anyway, any help that you can give us would be greatly appreciated. My husband is getting ready to go on a night shift, so he would be working at night and I will have this lovely duty myself and I will be working all day the next day so this is not going to be fun in our family. Please help us, thanks. Bye-bye.
Dr. Mike Patrick: All right, well thanks for the question Chona, I appreciate it. You're right it's not going to be fun. OK. I do think though that you can improve the situation and fairly short order but again you're going to have to outwit, outlast and outplay as long as your son knows what he wants and how to get it, the behavior is not going to change.
So, let's going to step through the scenario and talk about at this we go. So, Chona has an 18 month old son who's refusing to sleep on his crib. You put him to sleep and then he sleeps a couple hours, he wakes up and he wants up.
First I'd say, you really need to put him to bed awake, now yeah it's going to be bad. You know he's going to scream, he's not going to want to be there, you're going to be dealing with it but you're going to be dealing with it when you're a little fresher, it's not going to be two in the morning it's going to be when you're so pretty wide awake.
And the other thing to is if you deal with this earlier in the evening when you first put him to bed, he's going to wear himself out because he's going to cry a lot in the beginning and so then he may sleep better and longer through the night.
Now I know that sounds mean but, it's going to happen and you might as well do it at the beginning of the night so that then when he does fall to sleep, he's exhausted and he sleeps to the night. Now you could be saying to yourself, but that's my time.
That's the time when I want to watch TV, when I get some housework done. We're not talking forever here; it's just going to take few days, really.
And the other thing too, the other reason, it's a good idea to put him to bed awake is because then when he does wake up in the middle of the night he is where he was when he fell asleep and he's less likely to have a bit of anxiety about being there.
So if the last thing you remember is being in your arm, in a rocker, and then he wakes up and he's by himself in a dark room. Yeah, he's going to be upset, but if he wakes up and he's where he was when he fell asleep then he's more likely to sue himself back to sleep eventually.
OK, so what you guys do, you pick him up when he cries, and he's upset. He's sleepy, he goes back to sleep with dad in the recliner and there they stay the rest of the night. And mom thinks, this is not helping and it only makes the child want to get up.
I am in total agreement there, but again, baby knows what he wants, baby knows how to get it. Baby wants to sleep with dad in the recliner and hey this pattern is working for him. The baby rules.
You've tried too bad routine, just let him scream it out, you pick your head in the room every 10 minutes and you gradually make it longer and you've let him go 30 minutes to an hour with him screaming. See this is though where they outlast comes in. How long is too long for an 18-month-old baby to cry?
Well, when it's been too long, he'll stop. OK, when it's been too long he'll stop crying that might be 20 minutes and it might be three hours. Now granted no mom likes to listen to their baby cry for three hours. I understand that, but if the baby is crying it's still because he thinks he's going to be able to get what he wants.
And as long as it works even if it's a long time, he knows if I cry long enough it's going to happen. Some of this kids even, will get themselves so work up they throw up, they puke and then, oh mom feels terrible, you go in, you clean it up, you hold him, you pick him up, bang! Baby got what he wanted.
And he learns if I get myself so upset that I puke and then you get a kid who puke's when want what they… you know, when they're not getting what they want. I see it, I see it. It happen folks.
It can be avoided if right from the beginning you let him cry. Now I will say with today's technology, it's a little bit easier to actually do this because you can put a video monitor to really come down on price, they're not too expensive.
You can put a video monitor in their room to make sure that the baby's safe. I mean, you don't want him crying because he's tangled and something or he's thrown up and he's lying face down on it.
I mean you want to make sure that they're safe. There's no question about that. Also just like the feeding, if the first night it's three hours that he cries, I'll bet the next night will be two-and-a-half hours and the next night will be two hours, and the night after that will be an hour and half, night after that will be an hour, the night after that that'll be 20 minutes and there will be nothing.
No crying. I have to… I cannot tell you, I've been doing these 10 years folks. I've talked to parent after parent, after parent and describe this plan and I cannot tell you the number of parents who come back and say "thanks it worked,… it really does work, you just have to trust me on this.
Now, there are those who are going to say what is the psychological effect of an 18-month-old crying for three hours? But I ask you, what is the psychological effect of a baby learning how to get his or her way on issues that parents feel strongly about and issues that parents know what's best. I mean, it starts in infancy folks.
The parent has to be in-charge. Now dad proposes a solution. Dad thinks the mattress is uncomfortable and that the crib converts to a toddler bed and so he wants to put a full size mattress on it and basically, allow the baby out of the crib. And mom think as, we just upset more and now the child's going to find them instead of just crying. And of course you're right mom.
I mean who here in the audience thinks that mattress being uncomfortable is the problem? No, the problem is that the baby knows what he wants and how to get it even against reasonable parental wishes. Look, learning how to go to sleep at bedtime, learning how to sued oneself back to sleep, these are skills that babies have to learn.
And rarely, rarely, rarely do these problems just proof go away in their own. Parents have been through this know what I'm talking about. Sure you got to have a night time routine that's going to help suiting activities before bedtime, bedtime at the same time every night. You want to make sure they don't have a legitimate need.
You know they don't have a fever, they're not too hot, they're not too cold, they're not hungry, they don't need a diaper change. You want to make sure they don't need something but beyond that it's time to get down to the business of making hard choices regarding your kids.
It's time for tough love and by the way I agree with mom, as long as there is no fear of an 18-month-old climbing or falling out of the crib, I would not graduate to a toddler bed until the sleep issue is work out otherwise, you will have a bigger problem on your hands.
And then dad's getting ready to go on a night shift he'll be at work all night. So, Chona has going to have to deal with this on her won and she doesn't thinks it's going to be any fun. And again, it's not going to be fun, it's going to break your heart. It shouldn't break your heart.
I mean hearing you child scream had better break your heart and of course you need to assure yourself that they're safe and they don't truly need something. Now the other's going to be those who argue. Yeah, need something, they need their mom.
But folks it doesn't work that way. It just doesn't work that way. It just goes on and on and on and on. So once you're sure their needs are met, I would let them cry. Each night would be better than the one before and may take a week. Gosh it hardly ever takes two weeks.
I've never seen it take a month. I mean, in 10 years I have never seen it take a month. Honestly, a week is not very common either. I mean most kids just takes three or four night of you outlasting them. That's what it takes.
All right we're going to take a break and we will be back.
Thanks to all the Nationwide Children's Hospital for providing the Bandwidth for our show today. Also Medical News today for providing the news department and Vladstudio, Vladstudio.com. Please support Vlad and consider getting a lifetime registration to his site only $19.99 through Valentine's Day and you can get that at Vladstudio.com.
Of course thanks to all of you for making us part of your day, of your routine and for contributing of the program as well by sending us questions, comments, your thoughts and calling the Skype line.
All right Karen's Pediascribe blog, last Saturday is photo hunt theme was heavy and she included a picture of yours truly not because I'm heavy although there was an issue there but I'll get to that.
Actually, I was holding a King Salmon from the Canadian waters of Lake Ontario, and yes there was one that I caught. There'll be a link in the show notes, so you can see a picture of me at the back of the boat holding a beagle fish. And by the way, speaking of heavy may be this is why she did it. I though, I honestly thought that she pop with this picture here because the fish looks heavy.
But you can see a little gut tire under my t-shirt and I know that all of you can see the gut tire when you look at this picture and that sort to motivate me to keep working out. And I thought it was just kind of a funny on the side, but no. all of the sudden, I'm thinking that she put that there because she thinks I look heavy (I'm going to have a talk with her).
All right speaking of posting pictures and t-shirts and may be even your own gut tire, I don't know. I have a proposal for you. If you go to the PediaCast shop, now, I have had many sales there lately. We did at the beginning but it's been a while.
Nonsense Christmas I don't think and again, I don't make any money on the t-shirts, there in the PediaCast shop but it is a great way to spread the word about the show. So if you get a t-shirt and you were in some place fun, some place everyone can recognize and you've seen this kind of pictures before, in front of the White House, in front of the Eiffel Tower, in front Mount Rushmore. I mean, you know the drill.
So if you send me a picture with a PediaCast t-shirt on, we'll put a picture up on the website and then we will at some point when we have enough of them, pick one of those pictures at random and hand out a price of some sort. So I'll give you a little motivation to do that and by the way, while you are wherever you are be sure to tell your fellow travellers about PediaCast, that's a great way to spread the word about the program. And also about Vlad's artwork because it's featured on the t-shirts as well.
All right we are going to have another show this week on Thursday and until then. This is Dr. Mike, saying, "Stay safe, stay healthy, and stay involved with your kids….
So long everybody.