Posts Tagged ‘prematurity’

Pragmatics – helping your child learn the rules of social language

Wednesday, May 18th, 2016

kids-playing-with-a-ballIf you have a child with a developmental or speech delay, you may have heard the term “pragmatics.” It refers to the use of language in a social setting – with friends, at school, and at home. Often, it is not enough that a child learns grammar and vocabulary in order to communicate. He also needs to understand how these words come together in social language.

A child struggling with pragmatics may use few words to express himself or seem disorganized in the way he speaks. He may have a hard time taking turns in conversation, or make inappropriate comments. As he gets older, he may be able to learn to read (sound out and pronounce words), but may not understand what he is reading. Usually a difficulty with pragmatics is not diagnosed until a child is at least four or five years old, and sometimes it is not identified until years later.

The following information is from the American Speech-Language-Hearing Association:

Pragmatics involve three major communication skills

Using language for different purposes, such as

  • greeting (e.g., hello, goodbye)
  • informing (e.g., I’m going to get a cookie)
  • demanding (e.g., Give me a cookie)
  • promising (e.g., I’m going to get you a cookie)
  • requesting (e.g., I would like a cookie, please)

Changing language according to the needs of a listener or situation, such as

  • talking differently to a baby than to an adult
  • giving background information to an unfamiliar listener
  • speaking differently in a classroom than on a playground

Following rules for conversations and storytelling, such as

  • taking turns in conversation
  • introducing topics of conversation
  • staying on topic
  • rephrasing when misunderstood
  • how to use verbal and nonverbal signals
  • how close to stand to someone when speaking
  • how to use facial expressions and eye contact

If you are concerned about your child’s use of language, speak with his health care provider. It may be beneficial to have a specialist, such as a speech and language pathologist, test your child and provide appropriate therapy. If your child is three years old or older, he may qualify for services through your local school district. See this post to learn how to ask for a free evaluation.

To help your child use language appropriately in social settings, see the American Speech-Language-Hearing Association’s Pragmatic Language Tips.

To learn more about social communication disorders, see this article by Understood.

Have questions?  Send them to AskUs@marchofdimes.org

 

Light and sound in the NICU

Wednesday, May 4th, 2016

nicu-baby2We all know that a mother’s womb is the best environment for a developing baby. But when a baby is born prematurely, this environment shifts from the quiet protected womb of mom to that of a bright and often noisy hospital setting. “Developmental care” is known as the effort to provide a preemie with an experience as similar to that of the womb as possible. This is done by making the effort to create a peaceful, stress-reduced environment. It seems to make perfect sense.

Experts agree that sounds should be kept to a minimum, as premature and sick babies are very sensitive to sound. According to the Preemies book, while in the NICU, you should:

• speak calmly in an even tone of voice
• avoid playing loud music
• close isolette cabinets and portholes gently
• avoid tapping fingers or placing bottles on an isolette
• use an isolette cover, which will help dampen noise.

However, not all experts agree on what to do regarding light. Some brain specialists offer the following suggestions:

• dim lights in the NICU
• cover your baby’s isolette with blankets to further shut out light
• use a low bedside light for when your baby needs care
• shield your baby’s eyes from direct light when you pick her up, and
• reduce noise as much as possible.

Yet, other specialists believe that the benefits of shielding your baby from light may depend on your baby’s age – the younger the baby, the more darkness he needs. And some specialists believe that light (as long as it is not glaring) may have positive developmental benefits.

To help figure out what is best for your baby, and to understand more about developmental care, talk to your baby’s neonatologist. You can also read more about it in this book Preemies: The Essential Guide for Parents of Premature Babies, 2nd Edition (2010), which provided the background for this blog post.

Questions? Send them to AskUs@marchofdimes.org.

 

Life-long effects of preeclampsia for mom and baby

Monday, May 2nd, 2016

Pregnant couple with doctorPreeclampsia is serious; it affects 2 to 8 percent of pregnancies worldwide. And it’s the cause of 15% of premature births in the U.S.

Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after you give birth. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Some of these signs include having protein in the urine, changes in vision and severe headache.

What does this mean for moms?

If a woman had preeclampsia during a pregnancy, she has 3 to 4 times the risk of high blood pressure and double the risk for heart disease and stroke later in life. She may also have an increased risk of developing diabetes. And for those women who have had preeclampsia and delivered preterm, had low-birthweight babies, or had severe preeclampsia more than once, the risk of heart disease can be higher.

These facts are scary, especially since heart disease is the leading cause of death for women. But having preeclampsia does not mean you will definitely develop heart problems, it just means that this may be a sign to pay extra attention to your health.

What about babies?

Women with preeclampsia are more likely than women who don’t have preeclampsia to have preterm labor and delivery. Even with treatment, a pregnant woman with preeclampsia may need to give birth early to avoid serious problems for her and her baby.

Premature babies and low birthweight babies may have more health problems and need to stay in the NICU longer. And some of these babies will face long-term health effects that include intellectual and developmental disabilities and other health problems.

If you had preeclampsia in the past, there are things you can do now to reduce your future risk:

  • Talk to your health care provider. She can help you monitor your health now to reduce your risk for heart disease later.
  • Get a yearly exam to check your blood pressure, cholesterol, weight, and blood sugar levels.
  • Add activity into your daily routine. No need to run laps around the track, though. Here are some tips to help you get moving, whether you are pregnant or not.
  • Stick to the good stuff. Eat from these five food groups at every meal: grains, vegetables, fruits, milk products and protein. Check out our sample menu for creative ideas.
  • Ask your provider if taking low-dose aspirin daily may be right for you.
  • If you are a smoker, quit. Try to avoid second-hand smoke as well. Tobacco can raise blood pressure and damage blood vessels.

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

Prematurity, disabilities and special education

Wednesday, April 6th, 2016

Preemi in NICU_smA mom recently wrote to AskUs inquiring about services for her child who was born 12 weeks early. Her child was now in elementary school, had a hearing impairment, and was falling behind in school. She wanted to know how she could help him.

Research has shown that children born prematurely may have difficulties with learning, experience developmental delays, or have a disability. But, whether your child was born prematurely or not, if he is evaluated and has one of 14 conditions, he may be eligible to receive special education and/or related services. Often, a “developmental delay” is enough for a child age three or older to be eligible for services. In order to qualify, a child’s educational performance must be adversely affected due to the disability.

The 14 qualifying conditions are:

Autism
Deaf-blindness
Deafness
Developmental delay (subject to each state’s specific criteria, and usually only up to age 9 and sometimes younger)
Emotional disturbance
Hearing impairment
Intellectual disability
Multiple disabilities
Orthopedic impairment
Other health impairment
Specific learning disability
Speech or language impairment
Traumatic brain injury
Visual impairment

Next steps

You can request an evaluation (which is free to you) through the special education administrator of your school district or the principal of your local elementary school. Sending the request in writing is always a good idea – such as an email. Then, the school should contact you to set up an appointment for an evaluation.

Learn more about who will test your child, the steps involved in the process and what happens next, in this blog post. If your child qualifies for services, they could be life changing. The first step is to seek help and ask for the evaluation.

Find other relevant posts in our series on Delays and Disabilities: How to get help for your child.

Have questions? Send them to AskUs@marchofdimes.org.

 

Pneumonia and preemies

Wednesday, March 16th, 2016

BabyOnChest-Pneumonia is an infection in the lung(s) which can make it hard to breathe. Premature infants are more prone to developing infections due to their immature immune systems. They were born before they could acquire their mother’s antibodies to fight off infection, which are usually transferred in the third trimester. In addition, due to prematurity, their lungs are not fully formed, making it easier to develop infections such as pneumonia.

Causes and treatments

Pneumonia can have different causes: viral, bacterial or even fungal. It can be hard for doctors to diagnose pneumonia, as it can look like other common preemie disorders, (eg. Respiratory Distress Syndrome). In addition, it may take some time for blood, urine or other lab tests to confirm the diagnosis. Therefore, as soon as pneumonia is suspected, most babies will receive an antibiotic that can fight a broad spectrum of bacteria to help combat the infection. Once the tests confirm the type of infection, the medication may be altered.

Your baby may also receive oxygen to help him breathe easier, or he may be placed on a ventilator. Keeping your baby well hydrated and nourished are also top priorities – his body needs nutrients to fight the infection. With all of this treatment, your baby’s lungs can begin to repair themselves.

Can pneumonia be prevented?

A premature baby may develop different infections for the reasons noted above. But the spread of infections can be avoided through the use of proper hygiene. Visitors who come to the NICU should be free from illness (colds, sore throats, coughs). All visitors should wash hands thoroughly or use foam disinfectant before seeing or touching your baby.

Some infections can spread through the air. Having visitors wear a face mask that covers the nose and mouth can provide an added layer of protection for your baby. NICU staff follows strict protocols regarding hand washing and keeping equipment squeaky clean. They are aware of how to prevent the spread of germs.

The good news

Most babies respond well to medications and recover without lasting issues.

Have questions? Send them to AskUs@marchofdimes.org

The holidays are here…

Monday, December 7th, 2015

pregnant woman in bedBesides the usual stress of pregnancy and getting ready for your baby, the holidays often add more pressure, which can take a toll on your health. Feeling stressed is common during pregnancy, but too much can make you have trouble sleeping, have headaches or lose your appetite. High levels of stress that continue for a long time may cause health problems like high blood pressure, which can increase the chances of having a premature baby.

December is a very busy time: there are friends and families to see, holiday gatherings to attend, meals to cook, and gifts to buy. So much to do! During this time, remember to take care of yourself: breathe deeply, relax and concentrate on your pregnancy.

Here are some tips:

  • Keep moving. Exercise can help reduce your stress and prevent pregnancy discomforts. If you are shopping for gifts, walk an extra loop around the mall before you head out to your car. Park further away in the parking lot (this way you can also avoid some of the traffic of shoppers trying to park close to the mall entrance).
  • Holidays are a time for delicious desserts and heavy meals. Before you sit down and indulge in your family dinner, eat a healthy breakfast and lunch earlier in the day.
  • Extra sleep is important during this time, but taking breaks is just as important. If you have some free time between wrapping gifts, put your feet up, read a book or magazine, or watch a favorite TV show. Even just a 15 minute break can help you relax before your next task.
  • Ask for help. Holidays are a time of giving, but also receiving. Accept help when a friend or family member offers and ask for help when you are feeling tired or overwhelmed.
  • Cut back on activities you don’t need to do. Instead of spending time making a holiday dessert, why not have your favorite bakery do it for you?

Holidays can be stressful, but remember to take time for yourself.

Have questions? Email AskUs@marchofdimes.org

Hearing loss in babies

Wednesday, December 2nd, 2015

baby's hearing testHearing impairment is the decreased ability to hear and discriminate among sounds. It is one of the most common birth defects.

We’re not sure what causes hearing loss in babies. Some possible causes are genetics (if you or your partner has a family history of hearing loss), viruses and infections during pregnancy, premature birth, low birthweight (less than 5.8 pounds), and infections after birth.

There are degrees of hearing loss, too. A baby can have mild, severe or complete hearing loss. Other times a child can hear but the sounds are garbled. Hearing loss is a common birth defect affecting 12,000 babies in the U.S. each year (nearly 3 in 1,000). If a child can’t hear properly, he may have trouble learning to talk.

Newborn screening

Ideally, your baby should have his hearing tested as part of the newborn screening tests which are done in the hospital after your baby is born. The CDC recommends that all babies be screened for hearing impairment before 1 month of age. Language and communication develop rapidly during the first 2 to 3 years of life, and undetected hearing impairment can lead to delays in developing these skills. Without newborn screening, children with hearing impairment often are not diagnosed until 2 to 3 years of age. By then, they have lost precious time to develop speaking skills. A timely diagnosis is important!

Getting help

If you have any concerns about your child’s hearing, don’t wait – have a conversation with his healthcare provider (a pediatrician or nurse practitioner). Here are other options:

  • Every state has an Early Hearing Detection and Intervention (EHDI) program. You can click here or call 1-800-CDC-INFO to locate your local EHDI program for services and information.
  • The CDC’s National Center on Birth Defects and Developmental Disabilities has a website on hearing loss in children, with specific pages for families, health care providers and others. The site contains information on prevention, signs and symptoms, screening and diagnosis, treatment of hearing loss, as well as statistical data on hearing loss. If you have any concerns about your child, start with the “Basics” and “Treatments” sections.
  • Additional resources and support networks related to hearing impairment and deaf children can be found here.
  • If your baby has a hearing impairment,  he may benefit from early intervention services, such as speech therapy. Learn how to access early intervention services in your area.

Bottom line

If your child has been diagnosed with hearing loss, getting help early is very important – preferably before 6 months of age.

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

Photo credit:  Baby’s First Test

Is donor milk right for your preemie?

Monday, November 23rd, 2015

feeding in the NICUFor premature babies, breast milk can be lifesaving. It is more easily digested and provides protection against many diseases. Providing breast milk, however, can be a challenge for some moms. Many moms are not able to provide their baby with their own breast milk for various reasons, they:

  • are recovering from surgery or have certain medical conditions that make it difficult to initiate and maintain a milk supply;
  • find it difficult to pump enough milk to meet their baby’s needs;
  • have chronic conditions and need to take medications that may make their breast milk unsafe.

In these cases, donor milk may be the best option for your preemie, and a better alternative to formula.

What is donor milk and where does it come from?

A milk bank is a service that collects, screens, processes and distributes safe human milk to babies in need. All donated milk goes through a pasteurization process to eliminate bacteria while keeping the milk’s essential nutrients. The milk is then packaged, stored and ready to ship to hospitals or individual recipients at home. Lactating women who wish to donate their breast milk may do so through a milk bank.

Does your preemie need donor milk?

The nutritional needs of each baby depends on many different factors. It’s important to talk to your baby’s doctor to see if donor milk is right for your baby. Some hospitals have their own donor milk bank or have a partnership with a milk bank near them. If your baby’s doctor indicates that your baby will benefit from donor milk, he can write a prescription. For more information about the milk bank closest to you, visit the Human Milk Banking Association of North America.

Can you buy breast milk from another mom who has milk to spare?

There are risks with getting breast milk from a stranger or a friend; this milk is not tested or screened for infectious diseases or contamination. A study published in the American Academy of Pediatrics showed that out of 101 samples of milk purchased online from different mothers, 74% of samples were contaminated with bacteria and 21% of samples contained cytomegalovirus (CMV) bacteria.

It’s important to be informed when making feeding decisions for your preemie. If you have any questions about donor milk or your baby’s nutritional needs, speak with your baby’s healthcare provider.

Knowing your family health history may help your baby

Wednesday, November 18th, 2015

Family at Thanksgiving dinnerRecently I had an appointment with a new healthcare provider and had to complete a health history form at my first visit. It was 3 pages long and took me about 20 minutes to do while in the waiting room. As I was sitting there, I realized that I didn’t know the answers to some of the questions, especially about my relatives.

Was this really that important?

In one word? Yes.

A family health history (FHH) form is a record of health conditions and treatments that you, your sisters, brothers, parents, aunts, uncles, grandparents and great grandparents have had. It can help you figure out the medical problems that run in your family. Knowing your FHH may just save your life. It may also have a direct effect on your baby’s health.

How can a FHH form help your baby?

The FHH form will help your provider see if any of the conditions or diseases that run in your family will affect your baby. For example, premature birth can run in families. And, certain conditions such as diabetes or high blood pressure put you at a higher risk to have a premature baby.

If you and your partner complete a FHH form and share it with your prenatal provider, you may learn about the health of your baby before she is born. The earlier in your pregnancy that your provider is aware of health conditions, the sooner your provider can decide on treatments for you.

It would be even better if you could complete and share this information with your provider before pregnancy, at a preconception checkup. This way, your provider can help you become as healthy as possible before pregnancy.

Use our FHH form

Here is a form that you can print out and complete.  Print one copy for yourself and one for your partner/spouse. We suggest you take it with you to family gatherings (Thanksgiving anyone?) and ask your relatives to help you fill in the blanks. You may very well find out information about diseases and conditions that run in your family and put you at risk. Early detection is often key in successfully managing a disease.

Here are tips on how to gather information from relatives.

Knowing your risk for certain conditions and that your provider is on top of treatment options, should put your mind at rest. And, knowing you are doing your best to take care of your baby’s health should make you feel even better.

So, when you sit down to apple pie, start a conversation, and fill in your FHH form. The information you share with your family may make a positive difference in everyone’s lives.

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

Crazy luck – one mom’s story

Tuesday, November 17th, 2015
CharlieNICU (2)Today, in recognition of World Prematurity Day, we are honored to share this post written by a mom of a preemie about what Prematurity Awareness Month means to her.

Lots of people don’t know what it means to have a premature baby. I didn’t know either, before I had my baby. Charlie was born  at 25 weeks, weighing 1 pound 15 ounces.

If you had told me that I, a healthy person with not a single complication in my first 25 weeks of pregnancy, would have a baby before I even reached my third trimester – I’m not sure I would have believed it. And yet, it happens, WAY more than it should. Yes, it sometimes happens to moms who don’t have access to good prenatal care. But it also happens to moms who do take care of themselves, who get prenatal care… moms like me.

In this day and age, where doctors can predict, know, and treat so much, the miracles of fertility, pregnancy and prematurity are still mysteries in a lot of ways. In our case, we still don’t know for sure why Charlie came early – and why there were no advance signs that gave the doctors any chance to prepare him for an untimely arrival.

My “incompetent cervix” (worst medical term ever, by the way) was part of the problem, but the fact that my body was contracting and ready to birth a baby at just 25 weeks was another, totally unexplained, part of the problem. And between the time I walked to the hospital that morning and he was born that afternoon, there just wasn’t enough time for them to do anything to keep him inside a few more precious days. Those days really are precious, too. That early in gestation, every week increases the chances of survival a lot, and likely reduces the number of complications the baby is going to face. Unfortunately for us, by the time they knew I was in labor, there was no stopping it or even slowing it down.

Our story has a happy ending – at least at this point! Our boy is happy, a total handful, and most importantly, healthy – for the most part, although the hacking cough he has right now might indicate otherwise. Today I picked him up from school, and he and his best buddy (another Charlie) wanted to run wild on the playground a bit before heading home – all that time sitting in a classroom is hard on a first grade wild man!  So they ran – and then they both planted themselves on a bench and coughed and coughed, like little old men. The common thread? Both are preemies. Coincidence that they’re the ones hacking when the other kids are running non-stop?  I think not. I think these former preemie lungs seem to be more impacted by this unusually warm, moist fall we’re having – and by pollen-heavy springs, and pollution, etc. Though our boy grows and grows, his premature past still rears its ugly face here and there.

I recognize that we are CRAZY lucky to have such a vibrant, busy, healthy boy. I think most moms probably reflect all the time on their kids’ successes and strengths and feel pride and joy. But for me, there’s the added reminder of what could have been. I can guarantee you, I take none of these skills and accomplishments for granted. I think ALL THE TIME about the tears I shed over that tiny, struggling baby in the isolette, and how the life I’m living now was the stuff of daydreams back then. And I will never forget where we started, and just how far he’s come.Charlie2015

So that’s it, that’s why this month is important to me. Prematurity awareness is important because it helps people realize that it really matters to support the March of Dimes, which works constantly to reduce the numbers of premature babies born every day. And it’s important because it reminds me to be oh so grateful for how far we’ve come, and how many doctors and nurses and therapists and scientists and family and friends have helped us get here.

Marie lives in Alexandria, Virginia, with her husband and Charlie. Charlie was born at 25 weeks and weighed 1 pound 15 ounces at birth. He spent 85 days in the NICU at George Washington University Hospital in Washington, DC.