What if my baby needs surgery?

11
Nov
Posted by Sara

mom-and-preemieThe idea of surgery is scary for anyone. But learning your premature baby needs to have surgery can be terrifying. Learning what you can expect may make things a little easier. The following information is adapted from Preemies: The Essential Guide for Parents of Premature Babies.

Ask a lot of questions

  • Talk to your baby’s neonatologist, the surgeon who will be operating, the anesthesiologist, and any other specialists who may be involved in your baby’s care.
  • Don’t be afraid to ask ANY questions that you have. It may be helpful to write them down as you think of them so that you don’t forget to ask when you see your baby’s doctors.  You may meet with someone unexpectedly and you will not want to miss the opportunity to get answers to your questions. Perhaps keep a notebook or pad in your handbag so you can jot down your thoughts as they cross your mind.
  • Also, take advantage of talking to the NICU nurses. They have cared for many preemies and understand your fears and concerns and can give you an idea of what is going to happen.

Surgery

  • Most premature babies are put under general anesthesia for surgery. This means that your baby will not be able to move during the surgery. She will not feel any pain or have any memory of the procedure.
  • If general anesthesia is used, your baby will not be able to breathe on her own and will need to be on a ventilator.
  • The surgical team will be monitoring your baby to make sure she is as comfortable as possible. During the surgery, your baby will be kept warm. The room temperature will be raised and she will be covered as much as possible. IV fluids may be warmed as well.

Recovery

  • Preemies need very special care after surgery. Immediately after surgery, your baby will remain in a recovery area while the anesthesia wears off.
  • The surgical team will then accompany your baby back to the NICU and update the neonatologists and bedside nurses.
  • It will take some time for the anesthesia to leave your baby’s body. This means she may be on a ventilator to help her breathe. If your baby didn’t have a breathing problem before surgery, she may be removed from the ventilator within hours or up to a few days after surgery. Babies who did have breathing problems will most likely need to be on a ventilator for a longer period of time.
  • Pain can delay healing and recovery, so your baby’s NICU team will be watching carefully for any signs that she is uncomfortable. The medication your baby receives to manage pain depends on a number of factors. Make sure you ask the doctors and nurses if you have concerns.

Asking questions and understanding what to expect before, during, and after your baby’s surgery, can help you feel more confident and better prepared for the procedure. You may also find it helpful to talk to other parents who have been through a similar experience with their preemie. Share Your Story, our online community, will allow you to connect with other moms and dads who can offer advice and support.

And, of course, we are here to answer any questions you may have. Send them to AskUs@marchofdimes.org.

 

 

 

 

Recognizing families who care for preemies

09
Nov
Posted by Barbara

Preemie on oxygen_smIn addition to November being Prematurity Awareness Month, it’s National Family Caregivers Month. These two themes go together well. Caring for a premature baby can take a huge toll on parents and families. The focus is on the baby (naturally) which can be a round-the-clock roller coaster ride. But, who cares for the parents and other children?

Recently I attended a meeting for parents of special needs children. The common theme that day was coping. Parent after parent talked about the impact that one child can have on an entire family. When medical issues are present, as they are with a preemie, it is understood that everything else stops while you care for and make serious decisions related to your baby. If you have other children, they take a temporary back seat to your sick baby. Everyone pitches in to do what they must do to survive the crisis of a NICU stay.

Once the baby is home, the crisis may seem like it is over, but often it is only the start of a new journey – one with visits to more specialists than you knew existed, appointments for speech, physical,  occupational and/or respiratory therapy, a schedule of home exercises, and navigating the early intervention system. Thankfully, these interventions exist to help your baby, but it is clear that this new schedule can resemble a second full-time job.

If a parent is alone in this process (without a partner), it can be all the more daunting. Without a second set of eyes to read insurance forms, or a second set of hands to change a diaper when you are desperate for a shower, it can feel overwhelming.

What can you do?

This month is a good time to remember to reach out and ask for help. Friends often want to take a bit of the burden off of you, but simply don’t know how they can be helpful. Be specific with them. If you need grocery shopping done, send out a group text to your buddies and ask if anyone could swing by the grocery store to pick up a few items for you.

Try to set aside a couple of hours each week, on a regular basis, when you know you will have a respite. It could mean that your spouse takes care of the baby while you go take a walk or join a friend for coffee. Or, your parent or grandparent could take over for a bit so you and your spouse could watch a movie together. It doesn’t have to be a lot of time – but just knowing it is scheduled gives you something tangible to look forward to, which helps to keep you going and lift your spirits.

In other blog posts, I share ways parents can take the stress off. See this post for a list of survival tips, and this post for how to care for the brothers and sisters of your special needs child. They need special TLC!

Be sure to check out the Caregivers Action Network’s helpful tips for families as well as their useful caregiver toolkit.

If you are like me and have trouble relaxing, see “Stop. Rest. Relax…Repeat.” It may just inspire you to break the go-go-go-all-the-time pace and find ways to relax. Believe me – once you grab those precious moments to refuel, you will be glad you did. Your body and mind will thank you, and so will your family.

Do you have tips for coping? Please share.

View other posts in our Delays and Disabilities series, and send your questions to AskUs@marchofdimes.org.

 

 

Three factors you can control to help prevent premature birth

07
Nov
Posted by Lauren

preemie and momAlthough there are certain risk factors for premature birth that a woman is not able to change, the good news is that there are three risk factors that most women can do something about.

Researchers at the March of Dimes Ohio Collaborative Prematurity Research Center are making big strides. According to their published study, up to one-quarter of preterm births (before 37 weeks of pregnancy) might be prevented if we focused on three risk factors – birth spacing, weight before pregnancy and weight gain during pregnancy.

What did the research show?

The study looked at the records of 400,000 single births and found that more than 90% of the women had one of these three risk factors. The women in the study who had less than a year between pregnancies, were underweight before pregnancy and gained too little weight during pregnancy had the highest rates of preterm births – 25.2%, according to the researchers. The good news is that women may have more control over these risk factors than other factors, which can influence preterm births.

Birth spacing

Birth spacing is the period of time between giving birth and getting pregnant again. It’s also called pregnancy spacing or interpregnancy interval (also called IPI). Getting pregnant too soon can increase your next baby’s chances of being born prematurely, as well as being born at a low birthweight or small for gestational age (SGA). It’s best to wait at least 18 months after having a baby before getting pregnant again. If you’re older than 35 or have had a miscarriage or stillbirth, talk to your provider about how long to wait.

Weight before pregnancy

Getting to a healthy weight before pregnancy is important. Women who are overweight or underweight are more likely to have serious pregnancy complications, including giving birth prematurely. How do you know if you’re at a healthy weight? Schedule a preconception checkup with your health care provider. This is the best time to discuss your weight and make sure you’re healthy when you get pregnant.

Weight gain during pregnancy

Gaining too much or too little weight can be harmful to you and your baby. It’s important to gain the right amount of weight for your body. Your provider can help you determine how much weight you need to gain during pregnancy.

Bottom line

There is still much we do not know about the causes of premature birth. But, knowing some things that a woman can do to decrease her chance of giving birth early, is good news.

Check out the cutting edge research our Ohio Collaborative is working on.

Understanding retinopathy of prematurity (ROP)

04
Nov
Posted by Sara

baby-eyesRetinopathy of prematurity is an abnormal growth of blood vessels in the eye. It mainly affects babies weighing about 2¾ pounds (1250 grams) or who are born before 31 weeks of pregnancy. ROP affects about 14,000-16,000 babies in the United States each year. If your baby has ROP, getting treatment right away is really important. The disease can develop very quickly and cause vision problems or even blindness if it’s not treated.

What causes ROP?

During the last 12 weeks of pregnancy, the eye develops quickly. When a baby is born full-term, the growth of the blood vessels that supply the retina is almost complete. The retina then typically finishes growing the first few weeks after birth.

However, if a baby is born too early, the blood vessels may stop growing or not grow correctly. Scientists believe that the edge of the retina then sends signals to other areas of the retina for nourishment. This results in abnormal vessels growing. These abnormal vessels are fragile and can bleed easily and cause retinal scarring. If the scars shrink, they pull on the retina and cause it to detach.

Risk factors for ROP

Some things make a baby more likely than others to have ROP. They include:

  • Premature birth.
  • Apnea. This is when a baby’s breathing stops for 15 to 20 seconds or more.
  • Anemia. This is when the body doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
  • Heart disease
  • Infection
  • Trouble breathing or respiratory distress
  • Slow heart rate (also called bradycardia)
  • Problems with the blood, including having blood transfusions.

Stages of ROP

ROP is classified into 5 stages:

  • Stage 1 – Mildly abnormal blood vessel growth. These babies often get better without treatment and go on to have healthy vision.
  • Stage 2 – Moderately abnormal blood vessel growth. These babies often get better without treatment and go on to have healthy vision.
  • Stage 3 – Severely abnormal blood vessel growth. Some of these babies get better without treatment, but others develop a condition called plus disease. This means the retina’s blood vessels get big and twisted. Plus disease is a sign that ROP is getting worse, but treatment can help prevent retinal detachment.
  • Stage 4 – Severely abnormal blood vessel growth and part of the retina detaches. These babies need treatment because part of the retina pulls away from the inside wall of the eyeball.
  • Stage 5 – Total retinal detachment. The retina is completely pulled away from the inside wall of the eyeball. Without treatment, a baby can have severe vision problems or blindness.

Treatment options

Laser or cryotherapy are the most effective treatments for ROP. Laser treatment uses a laser to burn and scar the sides of the retina. This stops abnormal blood vessel growth and prevents scarring and pulling on the retina. Cryotherapy uses a metal probe to freeze the sides of the retina, thereby preventing additional blood vessel growth.

Laser treatments and cryotherapy are done on babies with more advanced ROP, such as stage III.

Later stages of ROP require more intense treatments. Scleral buckle involves placing a silicone band around the white of your baby’s eye (called the sclera). This band helps push the eye in so that the retina stays along the wall of the eye. The buckle is removed later as the eye grows. If it isn’t removed, a child can become nearsighted. This means he has trouble seeing things that are far away.

In a vitrectomy, the doctor removes the clear gel in the center of your baby’s eye (called the vitreous) and puts saline (salt) solution in its place. Your baby’s provider can then take out scar tissue, so that the retina doesn’t pull. Only babies with stage 5 ROP have this surgery.

About 90% of infants with ROP fall into the mild categories and do not need treatment. But ROP can get worse quickly so early diagnosis and appropriate treatment (if needed) are very important. Your baby should be seen by a pediatric ophthalmologist. This is a doctor who identifies and treats eye problems in babies and children. The first eye exam should take place 4 to 9 weeks after birth, depending on when your baby was born.

You can read more about ROP on our website.

If your baby has ROP, visit our online community at Share Your Story to find a network of parents of babies with ROP. You can connect with them for support and comfort throughout your baby’s treatment.

Have questions? Text or email us at AskUs@marchofdimes.org.

Prematurity 101

02
Nov
Posted by Barbara

Passing the time while your baby is in the NICUNovember is Prematurity Awareness Month. There are many facts that you probably already know about prematurity, but some that you may not. Here is quick cheat sheet on Prematurity 101. See if you can find the one statement that is false. (Answer is at the bottom – no peeking!)

Premature birth is the #1 cause of newborn death (1st 28 days of life).

Worldwide, 15 million babies are born preterm (before 37 weeks of pregnancy) and more than a million die as a result.

Babies who survive a premature birth often have lifelong health problems.

Preemies can suffer from cerebral palsy, vision and hearing loss, intellectual disabilities and learning problems.

Birth defects is the #1 cause of infant death (1st year of life).

We only understand about half of all the causes of premature birth.

Each year in the U.S., about 1 in 10 babies is born prematurely.

A baby’s life-long health problems can have a devastating financial effect on a family.

Babies born at 36 – 38 weeks of pregnancy may struggle with learning in school.

If your pregnancy is healthy, it’s best to stay pregnant for at least 39 weeks to give your baby’s brain and other organs the time they need to develop before birth.

If a baby is born prematurely and seems fine, he won’t have any problems as he gets older.

Which is the false statement?

They are all true except for the last statement. Just because a premature baby seems fine when he leaves the hospital doesn’t mean he won’t struggle with learning, experience developmental delays, or have disabilities as he gets older. About 1 in 3 children born prematurely need special school services at some point during their school years.

Learn more about the impact of premature birth on a family and society and how the Institute of Medicine (IOM) estimates the cost of premature birth in the United States to be $26.2 billion each year.

See our article to understand the emotional toll of prematurity on a family, especially as they face days, weeks or even months watching their baby fight for his life in the hospital.

What can YOU do?

Everyone can participate in Prematurity Awareness Month and World Prematurity Day on November 17th by visiting https://www.facebook.com/worldprematurityday. Help us light the world purple to spread awareness!

Join the conversations on Twitter – see our upcoming chats about prematurity here.

Have questions?  Text or email them to AskUs@marchofdimes.org.

 

It’s Prematurity Awareness Month – Come chat with us!

31
Oct
Posted by Barbara

parents in the NICU

We have several Twitter chats scheduled in November, in honor of Prematurity Awareness Month.

Please join us:

Wednesday, November 2 at 1pm ET with neonatologist Dr. Suresh of Texas Children’s Hospital. Use #preemiechat

Topic:  Prematurity – causes, complications, and coping in the NICU

 

Wednesday, November 9 at 2pm ET with Mom’s Rising. Use #WellnessWed

Topic: Can your preconception health reduce your chances of giving birth early?

 

Tuesday, November 15th at 2pm ET with Genetic Alliance and Baby’s First Test. Use #preemiechat

Topic: Is prematurity caused by genetics? Can it run in families?

 

We hope to see you on Twitter!

For questions or more information about these chats, text or email AskUs@marchofdimes.org

birth announcement

Safe sleep: room share, don’t bed share

28
Oct
Posted by Sara

cropped sleeping babyIn an update to their safe sleep guidelines, the American Academy of Pediatrics (AAP) says that infants should sleep in the same room, but not the same bed, as their parents ideally for the first year of life, but for at least the first 6 months. Evidence suggests that sleeping in the parents’ room but on a separate sleep surface decreases the risk of sudden infant death syndrome (SIDS) by as much as 50%. In addition, this sleeping arrangement is most likely to prevent suffocation, strangulation, and entrapment that may occur when the infant is sleeping in the adult bed. The AAP’s safe sleep recommendations include:

Back to sleep for every sleep. Your baby should be put on his back every time, by every caregiver until he is 1 year old. Side sleeping is not safe and is not advised. Premature babies should be placed on their backs to sleep as soon as possible. The AAP states, “Preterm infants are at increased risk of SIDS, and the association between prone [stomach] sleep position and SIDS among low birth weight and preterm infants is equal to, or perhaps even stronger than, the association among those born at term.”

Use a firm sleep surface, such as a crib mattress covered with a tightly fitted sheet. Use only the mattress made for your baby’s crib. The mattress should fit snugly in the crib so there are no spaces between the mattress and the crib frame. The mattress shape should stay firm even when covered with a tightly fitted sheet or mattress cover. Don’t let your baby sleep in his carrier, sling, car seat or stroller. Babies who sleep in these items can suffocate. If your baby falls asleep in one of them, take her out and put her in her crib as soon as you can.

Babies should sleep in the parents’ room but on a separate sleep-surface. Parents should not bed-share. Bed-sharing is the most common cause of death in babies younger than 3 months old. Keep your baby’s crib close to your bed so your baby is nearby during the night. Share your bedroom with your baby but not your bed.

Breastfeeding is recommended. Breastfeeding is associated with a reduced risk of SIDS.

Keep soft objects and loose bedding away from the sleep area. Crib bumpers, pillows, blankets, and toys in the crib put your baby in danger of getting trapped, strangled or of suffocating.

Offer your baby a pacifier at nap time and bedtime. It is not clear why, but studies show that pacifiers protect your baby from SIDS. This is true even if the pacifier falls out of the baby’s mouth. However, don’t hang the pacifier around your baby’s neck or attach the pacifier to your baby’s clothing or a stuffed animal.

Avoid smoke exposure, alcohol, and illicit drugs during pregnancy and after birth. Babies who are around secondhand smoke are more likely than babies who aren’t to die of SIDS. And there is an increased risk of SIDS with maternal use of alcohol or illicit drugs.

Avoid overheating and head coverings. It is difficult to provide specific room temperature guidelines but in general, dress your baby appropriately for the environment. A blanket sleeper can keep your baby warm without covering his head or face.

Avoid the use of sleep positioners, wedges, or other devices that claim to reduce the risk of SIDS. Don’t use home cardiorespiratory monitors as a way to reduce the risk of SIDS. These monitors track a baby’s heart rate and breathing. Some babies need this kind of monitor because of medical problems, but this is rare. There’s no evidence that the monitors help reduce the risk of SIDS in healthy babies.

Give your baby supervised tummy-time while he is awake. Babies need to develop their neck, shoulder and arm muscles and tummy time helps. You can find some tummy time activities here.

It is important that all people who will care for your baby know these guidelines and follow them to keep your baby safe while he sleeps.

Have questions? Text or email us at AskUs@marchofdimes.org.

Respiratory Therapists help babies and families breathe easier

26
Oct
Posted by Barbara

help-breathingIf your baby is in the neonatal intensive care unit (NICU), it can be nerve wracking to see him hooked up to machines, especially if he is having difficulty breathing. This is when a respiratory therapist (RT) can help.

“If a baby needs respiratory support, parents should not be afraid. We give them only what they need” says Ana Anthony, a respiratory therapist at Children’s National Health System in Washington, D.C., one of the finest children’s hospitals in the nation.  Ana notes that “Every day may be a different challenge. The babies will go through ups and downs – the body is very complex. Our goal is to have the baby breathe on his own.”

It’s Respiratory Care Week, a time to recognize the respiratory care profession and to raise awareness for improving lung health. According to the American Association for Respiratory Care, “Respiratory therapists provide the hands-on care that helps people recover from a wide range of medical conditions.”

Respiratory therapists work in a variety of settings including a hospital NICU. Babies born too early run the risk of having breathing problems because their lungs may not be fully developed. Other babies might have breathing issues because of an infection or birth defect.

Due to numerous medical breakthroughs, more and more babies who need treatment for breathing problems or disorders benefit from respiratory therapy. In fact, neonatal respiratory therapy has become its own medical sub-specialty. A neonatal-pediatric RT is trained to use complex medical equipment to care for the smallest babies with mild to severe breathing challenges. They visit their patients daily, as often as needed.

You may have been introduced to your baby’s respiratory therapist if you have a baby in the NICU. A respiratory therapist would have evaluated your baby’s breathing soon after your baby arrived. The RT looks to see if your baby is breathing too fast, if the breaths are shallow, or if your baby is struggling to breathe. Then, together with the NICU healthcare team of doctors, nurses and other specialists, the RT develops a care plan to help your baby.

Respiratory therapists are rigorously trained, first earning a college degree and then specific certifications. For example, Ana holds several credentials: a BSRC (bachelor’s degree in respiratory care), RRT-NPS, (registered respiratory therapist with a neonatal pediatrics specialty), AEC (asthma education certification) and ECMO (extra corporeal membrane oxygenation). If these titles sound impressive, it’s because they are! RTs are put through intense education and hands-on training and stay current with breakthroughs or changes in the field by obtaining different certifications.

Ana Anthony speaks for all RTs when she says “We love what we do and strive to have the best outcome possible for all our patients.”

 

You can learn more about respiratory issues that preemies may face, in our article. Did your baby receive care from a respiratory therapist? Tell us about your experience.

Have questions? Text or email AskUs@marchofdimes.org.

Note:  This post is part of the series “Delays and Disabilities: How to get help for your child.

 

Two vaccines that every grandparent needs

24
Oct
Posted by Sara

grandma and babyInfants are at risk of serious complications from both whooping cough and the flu. Grandparents, caregivers, and anyone who is going to be in contact with your baby should be up to date on their vaccinations for these two illnesses.

Flu

With rare exception, the CDC recommends that ALL people, 6 months and older get an annual flu vaccine. Flu viruses change every year, so just because you got a flu shot last year, doesn’t mean that you are protected this year. The flu shot is designed to protect against the flu viruses that are predicted to be the most common during the flu season. Also, immunity from vaccination decreases after a year. This is why everyone needs a flu vaccine every season.

It is especially important that people who will be around children younger than 6 months get the flu shot. Children under 6 months cannot get the flu vaccine and they have the highest risk for being hospitalized from flu compared to children of other ages. When your baby is 6 months old, she can get her own flu vaccine.

Whooping cough

Whooping cough (or pertussis) is a very contagious disease that can be deadly for babies. It is spread from person to person, usually by coughing or sneezing while in close contact with others. In most cases of whooping cough, someone in the baby’s family is the source of infection. It is possible for an adult to have whooping cough and not even know it.

Whooping cough can cause serious and sometimes life-threatening complications in babies, especially within the first 6 months of life. Many babies with whooping cough don’t cough at all. They stop breathing and turn blue. About half of babies who get whooping cough end up in the hospital.

Your baby can’t get her first whooping cough vaccine until she is 2 months old. And while most adults were vaccinated as children, or they may have even had whooping cough, protection unfortunately wears off over time. That is why it is especially important for pregnant women, dads, and ANYONE else who will be in close contact with your baby, including grandparents, to make sure that their whooping cough (Tdap) vaccine is current.

Cocooning your baby

Grandparents and other visitors to your newborn should get the Tdap and flu vaccines at least 2 weeks before meeting your baby. This strategy of surrounding babies with people who are protected against a disease, such as whooping cough, is called “cocooning.” A single Tdap shot is recommended for any adult (19 or older) who plan on having contact with your baby. If they already received their Tdap vaccine as an adult, they do not need to be vaccinated again. (However, pregnant women need to be vaccinated with Tdap during each pregnancy.)  And of course, everyone older than 6 months, should get their flu shot before spending time with your baby.

REMEMBER: Making sure that the people who will be in close contact with your baby are immunized is NOT a substitute for staying up to date with the childhood vaccination schedule. But it will help to your baby somewhat protected until she is old enough to get her own vaccines.

Have questions? Text or email us at AskUs@marchofdimes.org.

Due to changing hormones during pregnancy, dental care should be a priority

21
Oct
Posted by Barbara

Smiling pregnant woman lying on couchPregnancy is a time of many changes to your body. Some are exciting and amazing, while others are not as much fun. Did you know that because your hormone levels increase, your gums and teeth may change during pregnancy? You’re more likely to have some dental health problems that you did not have before you became pregnant.

Changes in hormone levels can affect your body’s response to dental plaque bacteria, causing swelling, sensitivity and tenderness in your gums. Most pregnant women have some bleeding of their gums, especially while brushing or flossing. Your gums are more likely to become inflamed or infected. Gum inflammation is called “gingivitis;” it’s an early form of periodontal disease, which can ultimately result in tooth loss or other oral health problems.  Other dental issues that may occur include loose teeth, tooth decay or loss, and lumps or non-cancerous tumors which form on gums in-between teeth. Also, you may notice that your mouth produces more saliva.

Here’s what can do if you are pregnant:

Step up your oral care routine; fight plaque at home every day.

Use a soft-bristled toothbrush and brush thoroughly twice a day. If you have a lot of sensitivity, try using toothpaste designed for sensitive gums. If your gums hurt after brushing, apply ice to soothe the pain.

Make sure the toothpaste and mouthwash you use fight gingivitis. Read product labels as many toothpastes and mouthwashes do not contain gingivitis fighting ingredients. A toothpaste containing stannous fluoride is a great choice as it not only fights cavities and sensitivity, but also helps reduce gingivitis. Floss once a day to clean in between your teeth. If you’re vomiting (so sorry), be sure to rinse your mouth with water or clean your teeth afterward to get rid of extra stomach acids in your mouth.

Cut down on sweets

Candy, cookies, cake, soft drinks and other sweets can contribute to gum disease and tooth decay. Instead, have fresh fruit or make other healthy choices to satisfy your sweet tooth. Watch out for some dried fruits, like raisins and figs, that can stick in the crevasses of your teeth. They’re delicious but contain lots of natural sugar, so remember to brush!

Get regular dental care

If left unchecked, some conditions, like gingivitis, may lead to more serious gum disease. Be sure to have a dental checkup early in pregnancy to help your mouth remain healthy. You may even want to see your dentist more often than usual. Although it’s best to have your teeth cleaned and checked for any trouble spots before pregnancy, being pregnant is no reason to avoid your dentist.

Don’t put off dental work until after delivery

Decaying teeth can cause infection that could harm your baby. If you think you need a dental filling, don’t panic. Go get it checked out. Always be sure to tell your dentist that you’re pregnant and how far along you are in your pregnancy.

Bottom line

A good daily oral care routine, keeping up with seeing your dentist, and regular visits to your prenatal care provider are all essential parts of a healthy pregnancy.

Looking for more information? Learn how pregnancy affects your dental health and check out if you are at risk for gum disease.

Have questions? Text or email them to AskUs@marchofdimes.org.

March of Dimes does not endorse specific brands or products.