Archive for February, 2011

Ultrasound options

Monday, February 28th, 2011

Over the next couple of days, I’m going to write about ultrasound.  There are different types that are used for different purposes and I’ll review them.

Ultrasonography is the most commonly used tool for viewing a developing fetus. Ultrasound has been safely utilized for over 40 years, but only specially trained technicians and providers should perform an ultrasound, and only for medically necessary reasons.

Using sound waves to bounce off curves and shapes within your body, technicians are able to translate light and dark patterns into images of internal organs or a developing fetus. Standard ultrasound creates a 2-D image of a developing baby in mom’s womb. A woman may have a standard ultrasound during the first trimester to confirm and date the pregnancy (or to find out if she’s having twins like her mother did!)  But not all providers offer it that early in pregnancy, so don’t be upset if yours doesn’t. It also can be used to check the positioning of the placenta or level of amniotic fluid later on.

Most providers request an ultrasound between 18 and 20 weeks. The procedure lasts about 20 minutes and can be performed abdominally (by moving a transducer over the belly) or vaginally (using a slender wand-like device that is placed inside the vagina). A full bladder acts like a mirror and helps the technician get a clearer view, hence the recommendation of drinking a few glasses of water before the procedure.  This is great for the tech, but might get slightly squirmy for mom after a while.

Tomorrow’s post – What’s Doppler imaging (nope, not part of the weather report) and fetal echocardiography?

First steps to a 50 yard dash

Friday, February 25th, 2011

first-stepsWhen will your baby start to walk? Well, as the saying goes, different strokes for different folks. You are likely to see some action somewhere around the first birthday, give or take a month or so.

Once your baby figures out how to pull herself up to a standing position, she’ll have to figure out how to get back down to a sitting position. (Knee bending is much harder to learn than it looks and is enormously frustrating for a few days, so prepare for some crying.) Once the vertical challenge has been conquered, cruising the furniture isn’t far behind.

Practice laps around the furniture pay off. As balance improves, curiosity takes over and can entice a toddler to take a step or two into thin air, her first solo flight, before she realizes what she’s doing. When that ah-ha moment strikes (Look where I am!), she’ll probably plop right down on her fanny.  Amazingly, most toddlers go from shaky first steps to serious walking in a matter of days. This doesn’t mean that she won’t continue to take a tumble or two for a while. Realize that bumps, bruises and boo-boos will show up regularly. Give them a quick check but don’t make a big deal about them. If you don’t fuss too much, neither will she.

By the way, the American Academy of Pediatrics tells parents not to use a baby walker because they eliminate the desire to walk, can tip over easily and lead to accidents. Let your little one cruise the furniture and hold on to your finger. When going outdoors, be sure to provide flexible nonslip shoes and often check the way they fit. Tots this age can outgrow their shoes in just a couple of months!

Jogging stroller recall

Thursday, February 24th, 2011

bob-jogging-stroller1Before you get back out on the paths in the park to jog with your little one, note that a recall of jogging strollers has been issued.  Be sure to check your wheels before heading out.

B.O.B. Trailers, Inc. has recalled about 337,000 B.O.B.® single and double strollers. A drawstring on the stroller can get wrapped around a child’s neck, posing a strangulation hazard. The recall involves eleven different models. They were sold at REI, buy buy Baby and other stores nationwide and on the Web at Babiesrus.com, Target.com and Amazon.com between April 2002 and February 2011. Consumers should immediately stop using the recalled strollers and remove the drawstring. If using a separately purchased Weather Shield or Sun Shield accessory with the recalled stroller, contact B.O.B. Trailers for a free canopy retrofit kit. Click on this link for model numbers and further information.

Insomnia

Wednesday, February 23rd, 2011

bed-rest1If you’re pregnant and having difficulty sleeping, know that you’re not alone. Why? All the surging hormones in your body are conspiring, along with your growing uterus, to keep you up.  And just when you’re about to doze off… it’s time to go to the bathroom, again. Then there are your buddies heartburn and leg cramps who often throw in their two cents during the night.

As tough as it is, it’s important to remember not to sleep flat on your back – it’s not good for you or the baby right now. Try to get used to sleeping on your side. Some providers will encourage sleeping on your left side because this position can improve your circulation and help reduce swelling. But if your left side doesn’t work for you, don’t panic, your right one might. Lying on your side takes the pressure off the vein that feeds blood from your feet and legs back up to your heart. It also reduces stress on your lower back, a big plus right now.

Pillows can be tremendously helpful.  They come in all shapes and sizes, from fluffy down that’s nearly flat to full-size body pillows.  I have one that’s shaped like a candy cane that’s pretty neat. Tuck one between your legs, use more to support your back and belly or lift your upper body.  Some mattress stores sell a variety of pillows that you can test drive in the store for comfort.  It may be worth investing a little of your time to find the one that’s right for you and will help you get your Zzzzzs.

We’ve got lots of suggestions for helping you cope (from naps to warm baths to exercise or meds) on our web site.

Shoulder dystocia

Tuesday, February 22nd, 2011

Dystocia means “slow or difficult labor or delivery.” Shoulder dystocia occurs when a baby’s head is delivered through the birth canal, but his shoulders are too big to get through and he gets stuck inside the mother’s body. This creates risks for both mother and baby.

Shoulder dystocia can happen when a baby is unusually large. Overweight women and women with diabetes are at risk for having very large babies, or babies with macrosomia.   It also happens when a mother’s pelvic opening is too small for the baby’s shoulders to pass through.

Although there are risk factors for shoulder dystocia, health care providers cannot usually predict or prevent it. They often discover it only after labor has begun. A pregnant woman may be at risk for shoulder dystocia if:
• Her baby is very large. (But, oddly enough, in most cases of shoulder dystocia, the baby’s weight is normal. And for most very large babies, shoulder dystocia doesn’t occur.)
• She has diabetes.
• She is pregnant with more than one baby.
• She is obese.
• She delivers after the baby’s due date.
• She has had shoulder dystocia or a very large baby during a past delivery.
Shoulder dystocia also may occur when the woman has no risk factors.

In most cases, the baby is delivered safely. Performing a cesarean section after labor has begun may be necessary, but because shoulder dystocia is hard to predict, a planned c-section is usually not recommended to prevent it.  You can read more about what happens in the delivery room and possible complications to the mother or baby at this link.

New drug treatment for ROP?

Friday, February 18th, 2011

Retinopathy of Prematurity (ROP) is an abnormal growth of blood vessels in the eye. It occurs in babies born before 32 weeks of pregnancy. ROP can lead to bleeding and scarring that can damage the eye’s retina (the lining at the rear of the eye that relays messages to the brain). This can result in vision loss.

An ophthalmologist (eye doctor) will examine the baby’s eyes for signs of ROP. Most mild cases heal without treatment, with little or no vision loss. In more severe cases, however, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina, but can have complications or side effects.

Some babies with ROP may soon have an alternative to laser or cryosurgery, according to an article published this week in the New England Journal of Medicine.  A drug, bevacizumab (also called Avastin), used against some cancers because it inhibits vessel growth, was tested in infants with ROP.

In the study, 143 babies with ROP received either laser surgery or were administered bevacizumab. Of these infants, 64 had ROP centered around the optic nerve (Zone 1), and 79 had abnormal vessel growth outside that area. In the Zone 1 group, the babies benefitted much more from bevacizumab than they did  from laser surgery, as evidenced in the ROP recurrence rate several months later.  (The Zone 1 group had two out of 31 recurrences, while the laser surgery had 14 out of 33 babies showing a recurrence.) The 79 infants with ROP outside of Zone 1, however, showed no significant difference in outcome from either therapy.

This is an exciting and promising study, but it is still too soon to know the long-term effects of this drug. What are the risks compared to the benefits? Follow-up research and confirmation of results is needed before this can become widely available, but this study does provide hope for treating one of the more disabling results of early premature birth.

Cold weather tips for tots

Thursday, February 17th, 2011

snowsuitToday and tomorrow are warm days – woohoo!! But this weekend we’re going back into the deep freeze – ugh!  This winter has been a bear! Nasty weather has covered most of the country and many of us have stayed indoors far too long. Getting cabin fever? Take your tot outdoors to play, but make sure he’s well protected.  Here are some tips:

Dress in layers so you can peel one off if the red cheeks come from overheating. Be sure to slather on plenty of sunscreen to protect those rosy cheeks from UV rays.  Hats are a must because they help stop your head from acting like a chimney and letting a lot of body heat escape.  Mittens protect little fingers, but good luck keeping them on.  If you’ve got any good tips, please share them! Make sure boots aren’t too tight because that can increase the risk of frost bite when it’s really cold. Warm socks and some room to spare inside your boots work best.

Remember that regulating body heat is harder for preemies, so grab an extra blanket for the stroller and protect them from cold winds.  At bedtime, dress your little one in footsie pajamas that are warm enough by themselves so that blankets are not necessary in bed. Throughout the day, don’t forget to offer water to your little winter athletes because the outdoor exercise and indoor dry heat can make them thirstier than you think.

If it’s still really cold where you are, remember that, according to our friend the groundhog, spring is just around the corner. (I believe, I believe!)

Tax help for breastfeeding moms

Wednesday, February 16th, 2011

Good news during tax time! The IRS has added breast pumps and other breastfeeding supplies to the list of items that can be designated as medical expenses for purposes of tax deduction.  They now also will be considered an allowable expense for people who have Flexible Spending Accounts, Medical Savings Accounts and Health Savings accounts.

In the past, the IRS did not consider breast pumps a medical expense, but the Service has now changed its policy.  This is a very positive step for both women and children.  The cost of breastfeeding supplies was a barrier to breastfeeding for many mothers and the decision of the IRS to reverse its ruling was a great victory for nursing mothers everywhere.

Breastfeeding has many health benefits including lowering the risk for many medical conditions for infants including asthma, respiratory illness, infections, leukemia, and type 1 diabetes. The American Academy of Pediatrics recommends all children be fed exclusively breastmilk for six months, with continued breastfeeding and appropriate solids for at least one year.  The World Health Organization recommends continuing breastfeeding at least two years.

The March of Dimes is very pleased that breast pumps and medical supplies that assist lactation will now be regarded as a medical expense.  This change in policy was needed and long overdue. It will benefit all women, especially women in the workplace who want to breastfeed their babies.

Adjusting age for preemies

Tuesday, February 15th, 2011

dad-with-preemieBabies who are born prematurely often have two ages:  Chronological age is the age of the baby from the day of birth—the number of days, weeks or years old the baby actually has been in the outside world.  Adjusted age is the developmental age of the baby based on his due date.

To calculate adjusted age, you take your premature baby’s chronological age (for example, 20 weeks) and subtract the number of weeks premature the baby was (born 6 weeks early).  In this example, the baby’s adjusted age would be 14 weeks.  Health care providers may use the adjusted age when they evaluate the baby’s growth and development.

Barring serious physical or neurological injury, most premature babies “catch up” to their peers, developmentally, in two to three years. After that, any differences in size or development are most likely due to individual differences, rather than to premature birth. Some very small babies take longer to catch up. You can stop adjusting your baby’s age when it feels most comfortable to you.

MOD history – Charles H. Bynum

Monday, February 14th, 2011

bynum-anderson1Today’s post is from the March of Dimes archivist, David Rose.

In the 1940s, when the March of Dimes was known as the National Foundation for Infantile Paralysis and our mission was focused on polio, our work was complicated by the problem of racial segregation. The civil rights movement of the 1950s and 1960s changed all that, but the March of Dimes nevertheless faced this problem squarely by hiring an African-American executive named Charles Hudson Bynum.

Charles Bynum (1905-1996) was a high school biology teacher and a civil rights activist. He became the Director of Interracial Activities for the March of Dimes, serving for nearly three decades, from 1944 to 1971. His path-breaking work of outreach to African-Americans throughout the United States helped to ensure that black children and adults received proper medical care in polio epidemics. Mr. Bynum was born in Kinston, North Carolina and had been dean of Texas College in Tyler, Texas and assistant to the president of the Tuskegee Institute in Tuskegee, Alabama.

Charles Bynum traveled throughout the nation, but especially through the South, to facilitate the March of Dimes service program of patient care for blacks suffering from polio and to organize fund-raising efforts for rehabilitation and epidemic relief. He made sure that the March of Dimes pledge that polio care would be made available for anyone affected by this disabling disease without regard to race, color, creed, or religion. He also advocated that African-American children with polio should appear in our publicity posters in order to get our message to local communities effectively. Consequently, black children with polio were featured prominently in our national posters each year from 1947 to 1960.

Times were very different then, but the March of Dimes continues to ensure today that everything we do to fight the problem of premature birth is done equally and fairly. We recognize the cultural and ethnic diversities that make our society so wonderfully complex, and we honor those differences, individual and cultural, with programs of outreach and support in places as different as a native American reservation, a rural community on the Great Plains, and neighborhoods in cities of the east coast. From promoting Centering Pregnancy programs to providing NICU Family Support at local hospitals, the March of Dimes continues to honor the lead of a great but overlooked champion of polio care, Charles Bynum. In following his lead, the March of Dimes continues to stand by its commitment as the champion for all babies.

•  Photo: Charles Bynum presents March of Dimes award to The Links, 1956; Left to Right: Opera contralto Marian Anderson, Pauline Weeden of the Links, Mr. Bynum, and E. Frederick Morrow