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Heather Joyce, MD
Rachel Brewer, MD
Ped For Parents
Pediatricians for Parents. We pediatricians dedicated to sharing useful information with parents about common childhood ailments.
Wednesday, August 22, 2012
Saturday, July 28, 2012
Breastfeeding - Is it Safe to Exercise?
So ... you've decided to breastfeed. You also want to get back in shape following your baby. While breastfeeding is a huge topic of conversation, there's not as much talk about breastfeeding and exercise. Here's a few questions you may be asking ...
Will baby refuse the breast after exercise? You may have heard that babies don't accept breast milk as readily after mom has exercised because of a buildup of lactic acid. However, most studies have found no difference in acceptance of the breast, even after maximum intensity exercise. Research has also not shown a noticeable increase in lactic acid buildup after moderate exercise. Even with maximum intensity exercise where there is a minimal increase in lactic acid in breast milk, there are no harmful effects for the baby. While there may be a change in taste of breast milk from lactic acid, babies will not subsequently refuse to breastfeed because of it. More plausible reasons for why your baby may refuse to breastfeed after you exercise are issues such as the salty taste of sweat on your breast post-workout.
Is the composition of antibodies of breast milk affected by exercise? Exhaustive exercise does cause IgA levels (a type of antibody) to decrease for a short amount of time. However, these levels return to normal within an hour - a decrease in IgA levels in one feeding per day is not likely to be significant. Moreover, moderate exercise does not affect antibody levels.
Is your milk supply affected? In short, no. In fact, some studies have shown that women who exercise regularly had a slight increase in milk supply. However, if you exercise to the point of exhaustion, or train for an event such as an Ironman, your body may be depleted to the point where producing milk is its last priority. Bottom line - moderate, regular exercise should not affect your milk supply.
What types of exercise are best? There really is no "best" type of exercise for breastfeeding moms. It's really more about what you enjoy and what makes you feel good. Because breastfeeding moms are a bit more top heavy, things like running may be more uncomfortable, but it can still be done with the right type of support/attire.
What attire provides the most support for breastfeeding moms? The key to being comfortable while exercising is finding a good supportive bra that fits you. I would suggest getting measured at a sports specialty store for women (e.g. Athleta, Title Nine, etc) so that you know exactly what you need. It really does make a huge difference. You can avoid the two sports bra routine if you find the right bra that fits you :)
Other tips ... Definitely try to breastfeed right before a session of exercise. Clearly, this is more comfortable, especially for weight bearing activity like running. You may develop plugged ducts if you lift weights involving repetitive upper arm strengthening (if that happens, start with lower weight/reps). And make sure you drink and stay well hydrated!!
Rachel Brewer, MD
Will baby refuse the breast after exercise? You may have heard that babies don't accept breast milk as readily after mom has exercised because of a buildup of lactic acid. However, most studies have found no difference in acceptance of the breast, even after maximum intensity exercise. Research has also not shown a noticeable increase in lactic acid buildup after moderate exercise. Even with maximum intensity exercise where there is a minimal increase in lactic acid in breast milk, there are no harmful effects for the baby. While there may be a change in taste of breast milk from lactic acid, babies will not subsequently refuse to breastfeed because of it. More plausible reasons for why your baby may refuse to breastfeed after you exercise are issues such as the salty taste of sweat on your breast post-workout.
Is the composition of antibodies of breast milk affected by exercise? Exhaustive exercise does cause IgA levels (a type of antibody) to decrease for a short amount of time. However, these levels return to normal within an hour - a decrease in IgA levels in one feeding per day is not likely to be significant. Moreover, moderate exercise does not affect antibody levels.
Is your milk supply affected? In short, no. In fact, some studies have shown that women who exercise regularly had a slight increase in milk supply. However, if you exercise to the point of exhaustion, or train for an event such as an Ironman, your body may be depleted to the point where producing milk is its last priority. Bottom line - moderate, regular exercise should not affect your milk supply.
What types of exercise are best? There really is no "best" type of exercise for breastfeeding moms. It's really more about what you enjoy and what makes you feel good. Because breastfeeding moms are a bit more top heavy, things like running may be more uncomfortable, but it can still be done with the right type of support/attire.
What attire provides the most support for breastfeeding moms? The key to being comfortable while exercising is finding a good supportive bra that fits you. I would suggest getting measured at a sports specialty store for women (e.g. Athleta, Title Nine, etc) so that you know exactly what you need. It really does make a huge difference. You can avoid the two sports bra routine if you find the right bra that fits you :)
Other tips ... Definitely try to breastfeed right before a session of exercise. Clearly, this is more comfortable, especially for weight bearing activity like running. You may develop plugged ducts if you lift weights involving repetitive upper arm strengthening (if that happens, start with lower weight/reps). And make sure you drink and stay well hydrated!!
Rachel Brewer, MD
Sunday, July 22, 2012
Breastfeeding - The Initiation
I have been asked by several friends and patients to write a blog about breastfeeding. Turns out, I can go on FOREVER about this subject, so I am going to break it up into topics, starting with the initiation of breastfeeding. My experience comes not only from working with mothers and newborns in the NICU, nursery, hospital and clinic, but also from having spent two years of my life breastfeeding/pumping. During pregnancy, you will develop your own opinion about breastfeeding, every person has a different goal in mind, from formula feeding only, to extended exclusive breastfeeding. Research has shown that most mothers in America set a goal of breastfeeding for at least 3 months, though less than 30% reach that goal. If you decide that breastfeeding is best for you and your infant, I would like to provide my support by answering questions and sharing information to help you be successful in reaching your goal.
Once you have made the decision to breastfeed, you will hear differing advice from EVERYONE - your relatives, friends, co-workers, doctors and lactation consultants. You will hear about how natural, beautiful, and rewarding breastfeeding is, but few people will admit how difficult, painful, and anxiety provoking it can be. During my course of breastfeeding, I have felt all of these emotions and more. In the end, listen to all the advice offered and use only what works for you. Not every breastfed infant is fed the same way, some breastfeed exclusively, some take pumped milk from a bottle, and others take a combination of breastmilk and formula. Infants benefit from any amount of breastmilk, however, it is best if they get at least half of their milk as breastmilk. In the end, the most import part of breastfeeding is the health of your infant, so if there are medical complications, like prematurity, poor weight gain, or jaundice, your infant my need to supplement with formula or pumped milk for a short period of time.
The best time to start breastfeeding is within the first hour after delivery. After an uncomplicated vaginal delivery, most infants are awake and alert for about an hour and will latch and start to suck right away. Not all infants are able to go to the breast immediately and it is OK to wait until you and your infant are ready. Some have problems with blood sugar after birth and need a small amount of formula or sugar water to keep them safe - this is common practice in most hospitals. These infants will not have the energy to breastfeed if they do not get their blood sugar into the normal range. If your infant requires supplementation in the hospital, I recommend pumping every time this occurs, even if you don't produce any milk - this will let your body know that your infant needs more milk and will help your supply.
During the first days of breastfeeding, most mothers produce a small amount (5-10 ml) of colostrum with each feed. You will feel tugging and pulling, but should not feel severe pain. If you do, then your infant's latch may need to be adjusted. Take advantage of the nurses, doctors and lactation consultants in the hospital - they will have lots of advice and can provide hands-on help. You will also feel uterine cramping with each feed, this the due to hormonal contraction of the uterus - it hurts, but is good for your body. The more often your baby breastfeeds, the more milk you will produce, the more contacted your uterus will become, and the more experienced you and your infant will be prior to going home.
You will not "know" how much milk your infant is getting, but if they are waking to feed every 1-3 hours, having wet diapers and clearing their meconium, they are getting enough. All infants loose weight after delivery, but should start gaining it back after 5-7 days. Your infant should see the pediatrician for a jaundice and weight check within 3 days after discharge from the hospital.
Breastfeeding for the first time will be uncomforable and sometimes stressful for the fist couple of weeks, but it gets easier. If if continues to hurt or your infant is not getting enough milk to gain weight, then find support. Most hospitals, doctors offices, and specialty baby stores have lactation consultants available. You can also talk with an experienced breastfeeding mother, who may have some great tips for you. Just remember, for every person who tells you that breastfeeding was the easiest, most natural part of motherhood...there are 10 others who will give you a different story.
Next up...the first days home and pumping (aka The Milk Machine).
Heather Joyce, MD
Once you have made the decision to breastfeed, you will hear differing advice from EVERYONE - your relatives, friends, co-workers, doctors and lactation consultants. You will hear about how natural, beautiful, and rewarding breastfeeding is, but few people will admit how difficult, painful, and anxiety provoking it can be. During my course of breastfeeding, I have felt all of these emotions and more. In the end, listen to all the advice offered and use only what works for you. Not every breastfed infant is fed the same way, some breastfeed exclusively, some take pumped milk from a bottle, and others take a combination of breastmilk and formula. Infants benefit from any amount of breastmilk, however, it is best if they get at least half of their milk as breastmilk. In the end, the most import part of breastfeeding is the health of your infant, so if there are medical complications, like prematurity, poor weight gain, or jaundice, your infant my need to supplement with formula or pumped milk for a short period of time.
The best time to start breastfeeding is within the first hour after delivery. After an uncomplicated vaginal delivery, most infants are awake and alert for about an hour and will latch and start to suck right away. Not all infants are able to go to the breast immediately and it is OK to wait until you and your infant are ready. Some have problems with blood sugar after birth and need a small amount of formula or sugar water to keep them safe - this is common practice in most hospitals. These infants will not have the energy to breastfeed if they do not get their blood sugar into the normal range. If your infant requires supplementation in the hospital, I recommend pumping every time this occurs, even if you don't produce any milk - this will let your body know that your infant needs more milk and will help your supply.
During the first days of breastfeeding, most mothers produce a small amount (5-10 ml) of colostrum with each feed. You will feel tugging and pulling, but should not feel severe pain. If you do, then your infant's latch may need to be adjusted. Take advantage of the nurses, doctors and lactation consultants in the hospital - they will have lots of advice and can provide hands-on help. You will also feel uterine cramping with each feed, this the due to hormonal contraction of the uterus - it hurts, but is good for your body. The more often your baby breastfeeds, the more milk you will produce, the more contacted your uterus will become, and the more experienced you and your infant will be prior to going home.
You will not "know" how much milk your infant is getting, but if they are waking to feed every 1-3 hours, having wet diapers and clearing their meconium, they are getting enough. All infants loose weight after delivery, but should start gaining it back after 5-7 days. Your infant should see the pediatrician for a jaundice and weight check within 3 days after discharge from the hospital.
Breastfeeding for the first time will be uncomforable and sometimes stressful for the fist couple of weeks, but it gets easier. If if continues to hurt or your infant is not getting enough milk to gain weight, then find support. Most hospitals, doctors offices, and specialty baby stores have lactation consultants available. You can also talk with an experienced breastfeeding mother, who may have some great tips for you. Just remember, for every person who tells you that breastfeeding was the easiest, most natural part of motherhood...there are 10 others who will give you a different story.
Next up...the first days home and pumping (aka The Milk Machine).
Heather Joyce, MD
Thursday, July 5, 2012
It is Safe to Play Outside in this Heat?
Every year there are heat-related deaths on the sports field. This happens particularly in August when the heat is at its worst and fall related sports are getting into full swing. How does this keep happening you ask? Well ... state high school sports associations have been slow to adopt rules to make practices safe in extreme heat (although things are dramatically better than they used to be). And of course, kids sports prior to high school age are often not legislated at all in terms of rules regarding practicing/playing in the heat.
So when does it become unsafe to practice outside? And what precautions should be taken? Generally, when the heat index (which takes into account relative humidity) climbs above 100, practicing and playing outside assumes a much larger risk of dehydration, heat illness, and heat stroke. When the heat index is 90-100, ample water should be provided, and athletes should have unrestricted access to it (for example, there shouldn't only be one water break per practice). And the heat index should be re-checked one or more times during a practice or game if the heat index is approaching 100.
If the heat index is 100-104, you should begin to think about canceling outdoor activities. Water breaks should be mandatory every 30 minutes, and toweling down with ice cold towels should be encouraged. And when the heat index is 105 or above, play or practice should be stopped and moved inside. Two-a-day practices (common practice in fall sports like football) should be reconsidered when the heat becomes an issue, and certainly, practicing when it is cooler earlier in the morning is a smart idea.
What are the consequences or the heat and how do athletes get in trouble? Severity of heat related medical problems ranges from dehydration, to muscle cramps, to heat exhaustion, to heat stroke. With each step, an athlete gets progressively sicker and important attention needs to be paid to an athlete progressing towards heat stroke. The biggest indicator that an athlete is headed toward trouble is if he or she starts acting abnormal (aka altered mental status). They may become combative, aggressive, and clearly not act like themselves. If medical personnel are available at that point, the athletes temperature should be taken and they should be immediate immersed in an ice bath if possible. And call 911!
The heat shouldn't be ignored when your child is playing a sport outside. As a parent, you definitely have a role if you think limits are being pushed in play or practice!
Rachel Brewer, MD
Thursday, June 28, 2012
Poison Ivy
A huge part of summertime fun is playing outside. Naturally curious, most children love to explore overgrown areas of the yard or park. Unfortunately, poison ivy thrives in these areas. The rash that develops after exposure to poison ivy is a contact dermatitis to the chemical urushiol and can usually be treated symptomatically with home remedies.
Prior to summertime excursions, look at pictures of poison ivy and teach children to avoid it. Tell your children to count the leaves on plants and look for the "three, almond shaped, sharp-teeth leaves" that are classic for poison ivy. Dress your child in protective clothing - long pants, shirts, and shoes with socks for outdoor adventures.
If your child comes into contact with the plant and you notice prior to the rash appearing, wash the area well with soap and water. Remove the clothing that your child was wearing and wash it in hot water.
If the urushiol absorbs into the skin, a red, itchy, blistering rash may appear. It usually appears in straight lines because of the way the plant comes into contact with the skin, but may be diffuse and appear spreading. The rash does not spread with itching or breaking the blisters, but if your child's skin comes into contact with urushiol again (from clothes/pets/repeat exposure), it will continue to spread. Urushiol will continue to occupy any surface if it is not washed off, including dead poison ivy plants.
Home remedies to try if your child develops a rash:
1) Cool oatmeal baths
2) Calamine lotion
3) Vaseline
4) Cool compresses
If itching is severe and keeping your child from sleeping you may try diphenhydramine (Benadryl) or 1% hydrocortisone cream to the red areas.
The rash typically lasts 1-2 weeks, but may last as long as 8 weeks, depending on how your child's skin absorbs the urushiol and reacts to it.
The rash may become infected with bacteria if you child is itching it, so seek medical care if they develop fever, yellow or white drainage, yellow crusting, severe swelling or warmth to the area. Also, your child may require strong antihistamines or oral steroids if the rash spreads to the face, mouth, eyes, genitals or involves the entire body.
Heather Joyce, MD
If your child comes into contact with the plant and you notice prior to the rash appearing, wash the area well with soap and water. Remove the clothing that your child was wearing and wash it in hot water.
If the urushiol absorbs into the skin, a red, itchy, blistering rash may appear. It usually appears in straight lines because of the way the plant comes into contact with the skin, but may be diffuse and appear spreading. The rash does not spread with itching or breaking the blisters, but if your child's skin comes into contact with urushiol again (from clothes/pets/repeat exposure), it will continue to spread. Urushiol will continue to occupy any surface if it is not washed off, including dead poison ivy plants.
Home remedies to try if your child develops a rash:
1) Cool oatmeal baths
2) Calamine lotion
3) Vaseline
4) Cool compresses
If itching is severe and keeping your child from sleeping you may try diphenhydramine (Benadryl) or 1% hydrocortisone cream to the red areas.
The rash typically lasts 1-2 weeks, but may last as long as 8 weeks, depending on how your child's skin absorbs the urushiol and reacts to it.
The rash may become infected with bacteria if you child is itching it, so seek medical care if they develop fever, yellow or white drainage, yellow crusting, severe swelling or warmth to the area. Also, your child may require strong antihistamines or oral steroids if the rash spreads to the face, mouth, eyes, genitals or involves the entire body.
Heather Joyce, MD
Wednesday, June 13, 2012
Bike Safety
Did you know that more children are seen in emergency departments for injuries related to biking than any other sport? On average, over 500 kids a day are injured due to cycling related crashes! Bike safety is something the whole family needs to learn about to avoid potentially serious injuries.
This first and cardinal rule of bike safety is obvious. Every time you and your child ride a bike, wear a helmet. It's that simple. Younger kids are more apt to make this a habit, while older kids tend to steer away from helmets because of the "cool factor." But don't let this rule slide ... it is clearly shown to save lives.
Helmet fit is crucial. A helmet should sit on top of the head in a level position, and shouldn't be loose enough to rock side to side or forward and backward. It must always be buckled, but not to the point where your child can't breath or feels like her or she is going to choke. Don't forget - helmets aren't just for biking. It is just as effective for preventing injuries in activities like riding a scooter, roller blading, skateboarding, and riding an ATV.
I like the "eyes, ears, and mouth test." This is a good test for helmet fit:
Eyes: Look up and you should see the bottom rim of the helmet. It should be 1-2 finger widths above the eyebrows.
Ears: The straps of the helmet should form a "V" under your ears when buckled. Remember, it should be snug and comfortable.
Mouth: When you open your mouth as wee as you can, the helmet should hug your head. If not, tighten the straps.
Click here for a video of a demonstration showing proper helmet fit.
Just like for adults, making sure the bike actually fits the child helps avoid injury. When sitting on the seat, the child's feet should be able to touch the ground. Of course, it's helpful if the gears, brakes, and bike components work properly.
Adult supervision and modeling bike safety will help your child learn to ride safely from an early age. Riding as a family can be very fun and enjoyable - obey the rules of the road (ride on the right side of the road, use hand signals when applicable, and stop before entering an intersection, etc), and your child will understand how to ride a bike safely!
Rachel Brewer, MD
This first and cardinal rule of bike safety is obvious. Every time you and your child ride a bike, wear a helmet. It's that simple. Younger kids are more apt to make this a habit, while older kids tend to steer away from helmets because of the "cool factor." But don't let this rule slide ... it is clearly shown to save lives.
Helmet fit is crucial. A helmet should sit on top of the head in a level position, and shouldn't be loose enough to rock side to side or forward and backward. It must always be buckled, but not to the point where your child can't breath or feels like her or she is going to choke. Don't forget - helmets aren't just for biking. It is just as effective for preventing injuries in activities like riding a scooter, roller blading, skateboarding, and riding an ATV.
I like the "eyes, ears, and mouth test." This is a good test for helmet fit:
Eyes: Look up and you should see the bottom rim of the helmet. It should be 1-2 finger widths above the eyebrows.
Ears: The straps of the helmet should form a "V" under your ears when buckled. Remember, it should be snug and comfortable.
Mouth: When you open your mouth as wee as you can, the helmet should hug your head. If not, tighten the straps.
Click here for a video of a demonstration showing proper helmet fit.
Just like for adults, making sure the bike actually fits the child helps avoid injury. When sitting on the seat, the child's feet should be able to touch the ground. Of course, it's helpful if the gears, brakes, and bike components work properly.
Adult supervision and modeling bike safety will help your child learn to ride safely from an early age. Riding as a family can be very fun and enjoyable - obey the rules of the road (ride on the right side of the road, use hand signals when applicable, and stop before entering an intersection, etc), and your child will understand how to ride a bike safely!
Rachel Brewer, MD
Wednesday, June 6, 2012
Hives
Hives are very common in children. The rash is itchy, red, raised welts that often move from one location to the next within minutes. If you are like most parents, your first thought is an allergic reaction and you rack your brain trying to figure out what your child may have eaten or touched. However, hives have many different causes, the most common in children being illness, either viral or bacteria. Allergen exposure is second on the list. Allergens may be food, medications, lotions, insect bites, soaps, detergents, fabric softener, clothing ...just to name a few. In many cases, it is difficult to figure out the exact cause.
Hives may last for hours to weeks, but most often 1-2 days. If they are due to an allergen exposure and the substance is taken away, the hives usually resolved within 24 hours with treatment. However, with illness, you may have to wait until the illness resolves for the hives to fully go away.
Most often, symptomatic treatment for hives is the best course of action. Antihistamines, like diphenhydramine (Benadryl) are very effective at treating hives, however this medications may make your child drowsy or hyperactive. Your doctor may recommend a long acting antihistamine like loratadine (Claritin), fexofenadin (Allegra), certirizine (Zyrtec), or desloratadine (Clarinex) if the hives last longer than 2-3 days.
Home remedies to make your child more comfortable include placing your child in a cool bath (with or without oatmeal to sooth the skin) and dressing your child in light, airy clothing. Do your best to try and keep them from itching!
If your child develops swelling of the face, tongue, lips, or joints they need to be seen by a physician. If they develop difficulty swallowing or breathing, vomiting, abdominal pain, or pass out with hives - it is a medical emergency and can be a sign of a severe allergic reaction.
*Above is a picture of my son with hives due to a viral illness
Heather Joyce, MD
Hives may last for hours to weeks, but most often 1-2 days. If they are due to an allergen exposure and the substance is taken away, the hives usually resolved within 24 hours with treatment. However, with illness, you may have to wait until the illness resolves for the hives to fully go away.
Home remedies to make your child more comfortable include placing your child in a cool bath (with or without oatmeal to sooth the skin) and dressing your child in light, airy clothing. Do your best to try and keep them from itching!
If your child develops swelling of the face, tongue, lips, or joints they need to be seen by a physician. If they develop difficulty swallowing or breathing, vomiting, abdominal pain, or pass out with hives - it is a medical emergency and can be a sign of a severe allergic reaction.
*Above is a picture of my son with hives due to a viral illness
Heather Joyce, MD
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