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First Year: Surviving Those First Shots

10/20/2015

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A calm parent will help baby with stress of immunizations.
Question:

Our beautiful baby girl is 2-weeks old and we just had our first visit with her pediatrician. She spent lots of time with us and answered all of our questions but I was embarrassed to ask about my biggest worry, which is starting shots. I am scared of shots myself and I hate the idea that she will have to have so much pain. I don’t know what to do. I know the immunizations are important, but I don’t want my baby to suffer. What can I do?

Answer:

First, congratulate yourself about being aware of your feelings and thinking ahead so that you can help your baby get through her immunizations with the least possible stress. Many parents have the same worries that you are expressing and don’t know that they have the ability to help their babies and toddlers avoid the fear of “shots” that is so common in older children and adults.

The good news is that parents, by offering comfort and soothing before and during the immunization process, really can make a difference. Even more good news is that there is excellent medical research supporting the importance of these methods. Even better, using these methods now is the way to prevent your baby from developing the fears that you have expressed.

Here’s how to help your baby:

Plan ahead for your visits by practicing at home how you will help your baby. Babies get the most comfort from parents when they are held in a position of comfort. For younger babies, that will be cradled in your arms. Wrap her in a blanket folded so that you can unwrap her leg or arm for the injection. As babies get older an upright position sitting in your lap facing towards or away from you may be better. If your baby is a wiggler, practice how you can use a blanket to wrap her and help her stay still in your lap rather than placing her on a table. You know already how to comfort your baby, but since you may feel anxious at the visit, practice now how you will take slow, deep and rhythmic breaths while you are
holding her.

A number of studies have shown that breastfeeding your baby beginning a few minutes before an immunization significantly reduces observable pain and stress. There is no evidence that nursing during immunization will cause a baby to choke. Sucking on a pacifier that has been dipped in glucose water (1 teaspoon of sugar mixed in 2 teaspoons of water) can be equally effective. Let your baby continue to suck while injections are being given and for a few minutes after. Let your healthcare provider know that you would like to do this so that you can be seated comfortably ahead of time.

Older babies are soothed by watching the movement of a rattle or seeing and listening to a musical toy, so take a few with you to help her feel relaxed before and distracted during the immunization. Practice at home how you will wrap your baby with one arm to hold her while holding a toy with the other (or enlist someone else to help — this is a great job for an older sibling!)  And of course, many parents find that smartphone screens and music will focus a baby’s attention for a few minutes.

As important as the way you hold and comfort your baby is the way you take care of yourself. You know, of course, that you will help your baby the most by staying focused on her needs and letting go of your own fears. Your state of calm is the single best way to shape your baby’s experience during any stressful experience. Before you go into the pediatric office, take some time to practice deep breathing and visualize yourself cuddling and holding your baby when she needs you. You will be going through this experience on every well-baby visit, so taking measures to manage your own feelings well is key.

Most pediatric office will be supportive of your desire to minimize your baby’s discomfort. The suggestions here may already be standard practice. However, you may have to politely explain your approach and occasionally you might be told that there is not time or space to offer your baby this type of comfort. You may have to advocate for your baby and explain that the extra time needed to prepare and soothe a baby now will be more than made up for in the months and years to come when your child is cooperative with other immunizations and procedures. In fact, most public health officials agree that a serious barrier to adult immunizations is the fear of “getting shots” that dates back to early childhood.

Even if your baby cries during the immunizations, remember that her experience of being cared for by her parent while she is unhappy is one of the ways she learns about love.

MEG ZWEIBACK, R.N., M.P.H., PEDIATRIC NURSE PRACTITIONER
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Co-Sleeping, Sids and You

2/16/2015

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What are your thoughts on co-sleeping?” asked a patient who had recently given birth to a wonderful, healthy new baby. It’s one of those loaded questions that you know will lead to more. Sure enough, she fired off in rapid succession: “Is there really a higher chance of Sudden Infant Death Syndrome (SIDS)? “How could I possibly roll over on my own child?” And then the final clincher: “What did you do with your kids?” The last one made me smile because it’s probably the most important question you could ever ask any doctor. 

My cautious answer was: “Yes, we chose to co-sleep with our children, but that may not be right for everyone.” The fact is, my wife and I deliberated on this topic for a long time and finally came to the decision based on what we felt best for our family. Thankfully we are not alone and most often the answers are out there.  

With decisions of this magnitude, it’s a good idea to take a world-view of the problem. Currently, Japan leads the way with the lowest overall infant mortality rates. They also have the lowest rate of SIDS. Coincidentally, they also have a cultural belief in cosleeping and shared living arrangements. This doesn’t mean it’s a direct causation, but it’s a very important connection.

Next we took a basic Pro and Con approach:
Cons - range from serious dangers such as asphyxiation, over-lay, and thermoregulation issues to simple inconveniences like lack of sleep.
Pros - family bonding benefits, health benefits including improved immune status and digestive function (from regular nursing patterns), improved neurologically based infant responses (reaction to smells of mother, movement and touch reactions), decreased stress response (decreased cortisol levels), increased oxygenation, and reduced chances of SIDS (by up to half according to recent research).

As you can see, our ‘pros’ list quickly out-weighed our ‘cons’ especially when we factored in some of the causes for serious dangers that have links to drug and alcohol use. With that being said, if you are leaning towards co-sleeping, remember to do your own due diligence. Assess parents depth of sleep - delta versus deep REM sleepers - and determine how quick to wake you are. Reduce excess bedding, place the mattress on the floor and be sure there are no crevices for your child to fall into. Also, no soft mattresses and definitely no old-style waterbeds.  

Above all else - be smart, use your own intuition and use your best judgement.  
From my family to yours - be well.  
Dr. Chris Pieda DC 
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Dr. Pieda is owner/operator of Back To Health Chiropractic, a family-focused practice serving the East Bay since 2004. For more information, questions or concerns please visit:
BackToHealthAlameda.com or call 510-523-5000.

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When Grandparents and Babies Collide

12/15/2014

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The Art of Interacting With Infants

Question:

     Our baby Marie is the first grandchild in the family and of course she gets lots of wonderful attention when we visit relatives. Unfortunately, she is not fond of being held by very many people other than her parents. (We have a nanny share, and she’s fine with the nanny but doesn’t seem to care for the other parents.) We hoped she would get easier as she got older, but if anything she’s worse. She’s almost 7 months old now. At the last family dinner, she started crying as soon as her grandfather leaned towards her! He says we’re spoiling her by giving her too much attention. I’m starting to dread family events.

Answer:
      A new baby is irresistible to first-time grandparents and any other baby-friendly people who come near. Some babies are naturally adaptable and outgoing. They can be passed around a group of relatives like a bowl of salted peanuts. Other babies are more cautious about the unfamiliar. In new situations they may be reluctant to leave the familiar arms of their parents. As you have discovered, family gatherings can be particularly difficult. The bustling activity and new voices and sights may be so stimulating to an infant that she pulls back and clings even more to the people she knows best.
      Grandparents, who are dying to get hands on a new grandchild— especially the first! — may interpret the baby’s pulling away or distress as a personal rejection. If a grandparent doesn’t know how to gently communicate with a baby to win her acceptance, he may simply blame the parents for being overprotective. Your baby’s grandfather is a first-time grandparent, so he does not have much experience in playing with babies who don’t know him well. He may not realize that you don’t have much control over your baby’s initial reactions — they are just who she is right now. His putting blame on you for “spoiling” doesn’t solve the problem and may actually make it worse with Marie sensing his frustration.
     Marie’s responses are very common among babies. Every baby has certain characteristics that are inborn, part of her natural temperament. It sounds like Marie is the type of baby who has an initial response of withdrawing from new situations, is somewhat slow to adapt and is sensitive. These temperamental differences are not deficiencies. They are a part of who we are, just like the color of our hair.
      Try to explain to your relatives, especially Marie’s grandfather, that Marie seems to be a very discriminating baby who needs time to get comfortable with people. In addition, she is at a stage of development where babies are noticing visual differences. (If a parent shaves off a beard or changes the style and color of her hair, a baby this age may become very upset.) A 7-month-old baby can’t “remember” that these people she sees only occasionally are her relatives who adore her. To her, they are strangers. She needs time, and her relatives need patience.
     You can help your father and other relatives to “woo” Marie by trying these ideas:
•    Try to arrange visits for times when Marie is rested. A tired baby will be reluctant to let anyone but Mom or Dad hold her.
•    When you go to visit or when relatives come to see you, protect Marie from being suddenly surrounded by new faces and voices. She’ll do better if she just sees one new person at a time.
•    Hold Marie in your lap and let her watch her grandfather while you talk to him. It’s usually very effective if the “new person” avoids making eye contact with the baby for awhile. Marie can then examine him from a safe place and get used to his voice.
•    Ask Marie’s grandfather to speak very quietly. Loud and deep voices can make babies pull back or turn away, while soft and higher pitched voices will cause them to lean forward and become interested.
•    Give Marie’s grandfather a brightly colored toy to dangle in front of her to engage her interest. He can talk to you while he does this, letting her watch without being asked to respond. As she starts to focus on the toy, he can gently move it or even playfully pass it back and forth to her. As the two of them begin to engage over the toy, he can begin to say a few words directly to her. The trick is to be slow and low-key.
•    If Marie pulls back, her grand­father should follow her cue and sit back as well. If she responds again, he can gently move forward. Engaging a baby is a bit like learning to dance with a new partner —  it can take time to figure out the steps and the rhythm.
      It can take a while to teach anyone, especially a grandparent, the art of interacting with a baby. Just as grandfathers get nowhere with impatience, you won’t get anywhere that way either. However, if Marie’s relatives are patient enough to learn how to engage with her, their relationship will flourish.



Meg Zweiback is a certified pediatric nurse practitioner and family consultant in Oakland. She is an associate clinical professor of nursing at University of California, San Francisco and posts articles and other resources on her Web site, bringingupkids.com.  To possibly have your question included, please send your questions to editor@parentspress.com
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