Grandparents

A friend of mine just became a first time grandparent. Better her than me. Although we are the same age, I am too young to be a grandparent as I am not ready for that responsibility. To be a good grandparent takes introspection, patience, time and for some, a bloody tongue from frequent biting.

Over the years I have given advice to many new parents on how to deal with grandparents. There are many kinds of grandparents. They run the gambit from awful to wonderful. And what makes a good grandparent in one family may be a disaster in another family. So if you are about to have a baby I would suggest you think and discuss between each other and then the grandparents, about what role you want them to play. (And if you already have children and haven't discussed these issues, you might want to think about it.)

Some of the potential topics that I have seen cause problems include:

1. The amount of involvement you want and/or need and from which set of grandparents. There are many types of involvement. In some families, the grandparents breeze in, hold the babies in the hospital and then send gifts on appropriate holidays. In other families, they live in the homes. You, the parents, were raised with different interactions with your own grandparents and have expectations that need discussing. Because what you want may be a fantasy, may be what no one else wants to give or may not be acceptable for your significant other.

2. Advice. We all love to give advice, me included! And grandparents have already raised children, so they have experience and want to pass it on. You might want to set boundaries on this issue right from the beginning. I tell my patients that they are welcome to tell their parents that "Dr. Vicki says to do it this way" if they don't have the fortitude in those first few weeks to stand up to their parents. I'll back them up, even if it's nothing we have discussed, assuming it is at all reasonable. (Yet, there was that grandparent for whom it didn't work. Her answer was: "I don't care what she said - I've raised 3 kids and I know better!") You can let them know that you will come to them as needed, but you are looking forward to the experience of raising your children and they have to remember that you turned out okay.

3. Time. You may have certain baby-sitting needs, particularly if both parents work. They may want to spend more time visiting and hanging around than you want. They may never visit because they want to give you YOUR space and are trying to be sensitive to your wants. So if you need less or more time, you need to speak up. It may not work out perfectly, but if you don't say anything, it definitely won't.

4. Child Raising Techniques and Discipline. I think this one has the potential to cause the most problems. Many of us as children didn't like how our parents disciplined us and swore we would do things differently. And we pediatricians change the advice we give over generations (read different editions of Dr. Spock's Baby Book and you will see what I mean) as well as don't agree among ourselves.

Although this is usually not an issue at birth, it often becomes a generational bone of contention as the child ages. And if your child is going to spend a lot of time with the grandparent, it is difficult for him to have different sets of rules depending on the adult.

So I would suggest addressing this issue before it becomes a major bone of contention.

Grandparents add a richness to a child's life. I do believe there is wisdom that comes with living and they can show and teach children about the world from a different perspective. We have our own issues with our parents which I don't think should color our children's relationships with their grandparents. It's okay if the grandparent "spoils" the child once in awhile. So welcome grandparents into your child's life. And if you are a grandparent reading this, remember, you can't love that grandchild too much!

Breast Pumps, Breast Milk and the IRS

We pediatricians have been labeling breast milk incorrectly. All these years we've been calling it "the perfect food". The end result has been that the IRS has agreed with us: It is just food. They have refused to realize that it is SO much more and that breast pumps are medical devices that should be deductible. Had we doctors labeled it for what it really is, a biologically active molecular solution, we could have gotten our patients' mothers what they needed decades ago. I would like to provide you with information on some of the "chemicals" your breast milk contains in case you have trouble with the IRS when you file your taxes and deduct your pump. Because besides all the nutrients that you normally think of like fats, vitamins, minerals, proteins, etc, there is some pretty amazing stuff in breast milk.

When born, babies have little immunity from disease. Their ability to survive those first few weeks relies primarily with the active substances found in breast milk. Immunoglobulins (antibodies) are highest in colostrum and will bind to pathogens that get into the babies' digestive system and will minimize intestinal diseases. They may also help reduce allergies. Certain proteins in the milk not only have nutritional value but act in ways to fight infection. And some of the non digestible sugars in breast milk bind bacteria and keep them from causing disease. There is new research on CD14, a lipopolysaccharide (in English - a fat/sugar molecule) that seems to be responsible for decreasing diseases like celiac disease and atopic dermatitis.

Breast milk also has stuff like growth factors and cytokines. These do all sorts of things that are just being sorted out. But some of those biologically active processes include getting the intestinal system of the newborn to mature, improving the intestine barrier to dangerous foreign substances at the same time maintaining a tolerance towards food. Pretty cool balance if you ask me.

Breast milk also contains antioxidant properties that work much better than the anti-oxidants that are added to formula. This means that breast milk stabilizes and suppresses DNA damage better because of the natural substances found in it.

There are many more chemical advantages, but I will stop here, because I am afraid that if I continue then the FDA may want to regulate it!

Should Mothers Be Blamed for Everything?

The latest news is working mothers make their children fat (have increased BMI's). When I heard that I immediately felt guilty even though my daughter is grown and has a normal BMI, but I am a (working) mother and prone to feeling guilty whether it's warranted or not.We parents need to stop feeling guilty and look at facts of studies. If you are not a mother, you shouldn't feel guilty. If you are a mother and your children are not overweight, you shouldn't feel guilty. If you are a mother and do not have paid employment (anyone who thinks being a parent is not working is nuts), you do not have to feel guilty. And if you are a working mother whose children's BMI is too much, you also do not have to feel guilty. Because that study did not prove what many reports say. If you want "just the facts, ma'am" and are not into nitty-gritty, just skip to the end and read my conclusions. But I would suggest that you don't do that. Because that is what many people did with the study and accepted the author's conclusion that working mothers cause their kids' obesity. You can instead follow my reasoning and then make up your own mind (or you can also read the study.)
I teach first year medical students. And one of the things that we spend time on is how to analyze studies and whether or not the conclusions drawn are supported from the study. Which means the "devil is in the details". If you investigate the reports about this study, or listen to the interviews of the author, or the "experts" reporting on this study, the details that I am about to reveal have not been discussed. (At least I couldn't find them; I must admit I did not do an exhaustive literature search of other people's opinions.) And this is the meat of the matter.

This paper accepts the conclusions of existing research that shows associations of maternal employment with increases in children's BMI. Next, the authors look at data that was gathered for other reasons to support their hypothesis. But buried in their paper they state that children whose mothers changed their working conditions and schedules had higher BMIs than mothers who worked the entire time. They also found that if they looked at individual children they found these children had increased BMI, but not if they looked at groups of children of working women. The last important point is that they noticed the largest increased BMI if the mother started working when the child was in 6^th grade. (They looked at the Home environment in 3^rd and 5^th grade, but not in 6^th.)

Here are the problems that I find with this research:

1. This was a retrospective study. (They formed a hypothesis and found data that supported what they thought .)

2. Associations are not proofs. (There could be other things going on that caused the increase BMI that were the real etiologies.)

3. There were a lot of suggestions of why children of working mothers had higher BMIs, and many theories given; but no proofs.

4. They stated that studies "have linked maternal employment to children's weight, but the mechanisms that may mediate these associations remain largely unknown." (pg 69).

5. "(A)mong sixth graders, a mother's entry into employment was associated with an increase in BMI …and those children were about 6 times more likely to be overweight" and yet they did not have available a HOME score done in 6^th grade (which measured the Home environment which assessed the "quality and quantity of support and stimulation provided to the child In his or her home environment". )

6. They did not record the children's Tanner Stage, which is a measure of a child's stage of going through puberty. (Pediatricians know that prior to a growth spurt children put on an extra layer of fat which temporarily increases the BMI. This is what you would expect around 6^th grade. Girls go through puberty earlier before boys, and there are racial differences, so that could explain what is happening in sixth grade as the groups were not controlled.)

7. The people doing the study are not pediatricians. Although they all have PhDs, they are researchers and you get a different perspective when you are a clinician.

They did conclude 2 specific things:

1. It appears that the significant factor of BMI is the change in the maternal status of employment for the individual child and not whether or not the mother is employed. 2. A mother's entry into the work force at 6^th grade seems to be most significant.
Here is what I take away from the study. There is definitely SOMETHING going on. I have always said that children are windows on a family. And another way to think about this study is that there is change going on in these individual families. When a parent changes her/his role in the family, it always effects the whole family (think about all the unemployment today and I wonder what a study that looked at the BMI of the children in these families would show us?)
And I think one of the most telling facts about the study is the large effect on the child if the mother enters the workforce in 6^th grade. There is so much missing information from this study that I would assign this paper to my students to discuss what this paper does not tell us and have them discuss why they cannot draw the conclusions that they did.

What I can tell you from a pediatrician's perspective is 6^th grade is an extremely stressful time for all children. They have major physical and hormonal changes, and if you add family changes to their social changes, I am not surprised to see that the biggest BMI change is at this time. My theory (which I think has as much validity as theirs, but is still a theory) is perhaps the mechanism is one of stress eating. Many of us do it. So instead of all of us feeling guilty and start our own stress eating, I would make some recommendations for stress reductions:
1. Do something fun with your child that is physical. (That will be the subject of some columns to come.)

2. . If you are going to stress eating, make sure it is the kind that will not add to your BMI.

So here are some suggestions in the food snacking area:

1. Air-popped popcorn (if you need to put something on it you can get butter-flavored salt or honey mustard powder shake)

2. Sugary cereals. When I was a kid we were not allowed to eat this for breakfast, but for a treat my mother would make a tin-foil cup and fill it with a breakfast cereal (On average, I cup of this stuff has less than 1 tsp of sugar in it!)

3. Baby carrots

4. Berries

You are Smarter Than Your Newborn

My daughter’s friend, a PhD graduate student in physics (!) just had her first baby, a girl. Congratulations to her and all of you who just entered the world of parenting. Obviously, anyone who is getting a PhD in physics has got to be pretty smart. But it makes me think about how many smart new parents I have known who have been TOTALLY overwhelmed and felt so inadequate facing a 7 and 1/2 pound newborn. So I’m here to tell you, “You ARE Smarter Than A Newborn”, just too tired to know it.

First of all, babies are a lot tougher than they look. If you think about it, babies have survived their parents for millennia. You survived your parents, and your baby will survive you. So don’t be paralyzed by the idea that you might make a mistake and ruin your child for life.

Secondly, trust your instincts. After taking your baby home from the hospital, you will have spent 48-72 hours with that cute little bundle. Your baby is an individual right from the start. Although you have read all the latest child raising books, gotten plenty of free advice from friends (with and without children), and heard from the grandparents that their way is best, none of them know your baby as well as you do. So, ultimately, you get to decide what’s best.

And lastly, make sure that you enjoy your baby. You cannot love or hold your newborn baby too much!

Lentil Soup and Babies

New moms get fixated on their baby's spitting-up and pooping and if they are breastfeeding they are convinced that whatever it is that they ate is related to whatever it is their baby just did. So here is some factual information.
1. Your baby did not just throw up everythinghe just ate. It just looks like it. The best way to reassure yourself that what I just wrote is true is to measure out one tablespoon of water. Now spill it on one sheet of paper towel and you will see that it completely soaks up that one sheet. (For those of you who are too tired to do this experiment, or don't want to waste water, see photo below.)2. What you ate 30 minutes ago is not in the breast milk. First, you have to digest the food. Then it has to get into your blood stream, travel to the breast and get incorporated into the breast milk. This process can take on average 12-24 hours. So it is always difficult to correlate your milk with your baby's behavior. But generally speaking, if it makes you gassy, it probably will make your baby gassy.
3. Infant's guts are worthless! They are not good at digesting, so they alwayshaving runny bowel movements at first. As they get more efficient, they go less frequently, but they are still on a liquid diet, so still no one wants to change their diapers.

I was thinking about this because lately I've been helping a friend with cancer and I decided to make her lentil soup. Lentils are legumes which are a type of seed and are rich in protein. They were so important in the ancient world that a prominent Roman family, Lentulus, was named after them. They do not produce gas like beans do, so this would be good for a nursing mother to eat. It gives her extra liquid and lots of energy. She doesn't have to worry about what it will do to her infant. And if she has other kids, they should enjoy it, too. Have the significant other pick up a loaf of bread and a salad on the way home and there's dinner!

Ingredients for All Variations of Lentil Soup
1 onion1 stalk of celery
2 carrots
1 lb of lentils (fresh if you can find them; dried if not)
4-5 sprigs of parsley
1 stalk of green garlic (that's fresh garlic if available)

Minimal Spicy
1 parsnip
1-2 cloves garlic

More Spicy
Add 1-2 turnips

Not Vegetarian
Sausages (4-6) or some kind of fatty meat
Meat Broth

Wash the lentils.
Dice the vegetables. If you use a food processor, pulse it.
Brown the meat.
Add the vegetables. (If you did not use meat, put some butter in it.) Wilt the vegetables until they are soft, but not brown.
Add the lentils.
Put in 4-8 cups of water.
Add salt and pepper to taste. (If you used sausage, you will need less of this. If you did not, you will need more.)
Cook for about 2 hours until the lentils are soft. If you want it more soupy, add more water. If you managed to find fresh lentils, you will need only about 1 hour of cooking time.

This should take about 30 minutes to throw together.

Dr. Vicki's "Kitchen Sink"

I have been interested in food since I was a kid. My mom was a working mother, so whoever got home first would start dinner. More often than not, it would be me. As you can tell by my name I have Italian blood and I was definitely raised on Italian food and culture. A family eating together is part of a way of enjoying life. But lately in the news, there is an inordinate emphasis on the negative aspects of eating. About all I ever hear on the subject of food is obesity, obesity, diabetes, fats, sugars and then there is: obesity. It’s enough to make any parent approach the kitchen with trepidation!

What I want to do with this blog is to bring back the fun in eating, along with the good nutrition. Prevention is the key to many of the problems we see today with kids’ eating woes. But pretty much everything you read discusses in a scolding, accusatory tone what to do after there is an issue. So I am going to discuss food from infancy, (and occasionally before the baby is born – although primarily that area belongs to the OB) to try and prevent problems. I also will be like “Law and Order” and address food and nutrition issues that are “ripped from the headlines”. Meaning, as things come up in the media, I want to discuss them on a timely basis.

What makes me uniquely qualified to do this? First of all, I am a pediatrician. Infants, in particular, have very specific dietary needs. That is why their needs are not addressed in lay publications. I have studied nutrition, but I also am a cook (as opposed to a chef). There are many doctors who know nutrition, but very few who also are working mothers who know what it is like to come home and have someone in the family yell “Mom, what’s for dinner?” the second they walk in the door! Professional chefs can give you (complicated) recipes; parents can write what they did, but neither of these have the expertise, nor are they reading the medical literature to make sure that they stay up to date.

So expect to find in this blog a fun read on surviving parenthood, while balancing nutrition, good food, family fun and whatever comes up under the topic of TYKES!