News Moms Need

In honor of Mother’s Day, we’d like to offer expectant moms one more tool to help promote a healthy pregnancy. Here’s a quick introduction to elective deliveries. Find out why the latest research from the National Institutes of Health (NIH), recommendations from the American College of Obstetricians and Gynecologists, and  information from the American Academy of Pediatrics and the March of Dimes all suggest that women wait until at least 39 weeks of pregnancy to deliver unless medically necessary.
 
What is the safest point in my pregnancy for my baby to be born?

The baby’s brain, liver, and lungs continue important development in the womb until 39 weeks. Unless health risks to the mother or baby require earlier delivery, it is best to wait until at least 39 weeks to deliver and, if possible, to let labor begin on its own. This extra time improves outcomes for mother and baby.

What to ask your health provider before you decide to deliver before 39 weeks of pregnancy:
   • Are there any medical indications that suggest I should induce labor early?
   • What are the potential complications of elective early delivery for my baby?
   • What are the potential complications for my own health?
   • How do you tell when my body is ready for labor?
   • How might inducing labor affect my future pregnancies?

Just a couple weeks can make a big difference for your health and the health of your baby. As you approach the last few months of your pregnancy (or if you’re already there), keep the questions above in mind as you talk to your doctor or midwife about your delivery options. Write them down. Print them out. And watch this video from the NIH on why waiting just a few extra weeks to deliver can be critical for you and your baby.

April 20-27 is National Infant Immunization Week, so today we’re here to remind you of the importance of getting your little one all the vaccines she needs.

I always hated watching my kids get vaccinations (also called immunizations) and winced when they weren’t looking. If you’re a parent, it may actually seem more painful for you than for them! They may be uncomfortable for a minute, but these important shots help protect them from some serious childhood diseases like polio, chickenpox, measles, mumps and the flu. 

All children should be vaccinated for their own health and so they don’t spread infections or diseases to others. It’s important to keep a record of what your little ones have received so you know what’s coming up next. All childhood vaccines are given in two or more doses. Your baby needs more than one dose because each one builds up her immunity. Immunity is her body’s protection from disease. A second or third dose is needed to fully protect her. These doses work best if they’re spread out over time.

In the first 2 years of life, your baby gets several vaccines to protect her. This handy schedule shows each vaccine your baby gets up to 6 years of age. It also shows how many doses she gets of each vaccine and when she needs to get them. Your baby should get vaccinations and boosters regularly, all the way through age 18.

Often health care providers will hand out a booklet or form to parents to help them keep a record of their child’s vaccinations. Ask your child’s doc if he has one for you to use.

Physical Therapy, or PT, can help your child increase strength, flexibility or endurance, and improve posture, balance and movement (such as walking). Therapy can help improve overall function and reduce disability. PT generally involves “gross motor” therapy, which means large body parts, such as the legs, but it can involve the entire body.

PT may be provided for your baby, toddler or school age child, depending on her needs. If you have a child with a developmental delay, disability or medical condition, her doctor may recommend PT.  Likewise, if your child is evaluated for early intervention services by the Child Find services or by your local school district, she may qualify for PT services. (See my posts on early intervention for babies and toddlers or intervention for children ages 3 and older to learn how to request an evaluation for free.) PT falls under the umbrella of “Related Services” which is available for children with disabilities, in order for them to benefit from special education.

In most cases, if your child qualifies (based on the results of an evaluation), she will receive the PT services for free. However, every state has slightly different regulations, so you should check with your state to find out more specifics.

Who provides the PT services?

The IDEA (law) says that physical therapy means “services provided by a qualified physical therapist.” Every state requires a physical therapist to be licensed. A physical therapist is highly educated. In fact, according to their credentialing organization, the American Physical Therapy Association (APTA),  “all physical therapists must receive a graduate degree from an accredited physical therapist program before taking the national licensure exam that allows them to practice. Physical therapists have the most specialized education to help people restore and improve motion.”

Where will the PT take place?

If your child qualifies for PT, services will be provided at a place that is appropriate for your child. This may be your home, a PT center, hospital, or your child’s local school. PTs who work with children are usually very creative. They find engaging ways to interact with your child, making the sessions fun while working toward goals. Kids usually enjoy PT sessions and look forward to them.

Remembering back to when my daughter received PT, she “played” with scarves and bean bags, ran obstacle courses, climbed ropes and balanced on huge balls or balance beams. She loved playing games such as Twister with some of her classmates. She even learned to ride a tricycle in her PT sessions!

What will the goals of PT be?

Specific needs and goals will be outlined in your child’s individualized plan. This is called an IFSP – Individualized Family Service Plan (for kids from birth to age 3) and an IEP -Individualized Education Program (for kids ages 3 and older). This document will provide details of the services she will receive, such as the specific goals to be achieved, how often she will see the physical therapist and the place where services will take place. Parents, as team members, have input into the creation of this very important document.

Often a PT will coordinate therapy goals with your child’s other therapists, such as an occupational therapist, to maximize results. And, it is important that a child’s teacher understand the goals and objectives of the PT sessions so that progress can be integrated into the classroom.

Remember, the goals to be achieved are specific to each individual child, and is based on her needs. Every child is unique! There is no one-size-fits-all plan. And, at a minimum, goals need to be reviewed and updated yearly. See my prior post on how to create a good IEP.

Bottom line

Physical therapy has helped many babies, toddlers and children to overcome obstacles. If your child qualifies to receive this service, it may make a huge difference in her life!

Have questions?  Send them to AskUs@marchofdimes.com

Note: This post is part of the weekly series Delays and disabilities – how to get help for your child. It was started on January 16, 2013 and appears every Wednesday. Feel free to go back to look at prior posts as the series builds on itself. As always, we welcome your comments and input.

April is Autism Awareness month. Did you know that the March of Dimes funds Autism research? In fact, in the past 10 years we have funded 55 grants totaling over $10.8 million. It is our hope that one day the answers we find will make further research unnecessary.

This month, many organizations are helping to spread the word about this serious disorder and the impact that it has on an entire family. And, at the same time, they are helping these families have a great time together. Here are two exciting initiatives that I want to share with you. Both welcome the kids and families affected by Autism in a very positive and FUN way!

The first is Major League Baseball’s decision to have all 30 of their Clubs raise awareness for the disorder during one home game in April, or on another date during the regular season. Many of the MLB Autism Awareness games throughout the league will provide special opportunities and a safe, friendly environment for families and individuals affected by autism.  All too often, kids with Autism (and their families) miss out on doing fun stuff like going to a baseball game. On these designated days, MLB teams up with Autism Speaks or other local autism charities to offer special events. Kids with Autism will have special opportunities to participate and enjoy the game.
 
For more information about MLB Autism Awareness and to check on your favorite team’s Autism Awareness dates, please visit MLBCommunity.org.

The second initiative involves AMC Loews and the Autism Society. They have teamed up to present sensory friendly films to families with children with Autism. Often, kids with Autism are particularly sensitive to sounds and can’t sit through a movie due to the volume of the soundtrack. In addition, kids with Autism are often sensitive to light and many can’t munch on typical movie theater snacks due to special dietary restrictions. So, on designated dates, the movie theater will brighten the theater and turn down the sound, eliminate ads and previews, and allow families to bring in their own snacks. Kids can even dance in the aisles if they want to! As AMC says, their “Silence is Golden®” policy will not be enforced unless the safety of the audience is questioned.” Sounds like a gift to parents as well as to any child with a sound or light sensitivity - a win-win for all.

To find a participating AMC Theatre near you, click here.

So, how great is this…?!  I recommend you get the family out and enjoy these special events and help raise awareness at the same time.

Who doesn’t love to watch a baby take his first steps? It will put a smile on anyone’s face! Look at these adorable tots and consider walking with us for stronger, healthier babies.

Speech and language therapy (commonly referred to simply as “speech therapy”) is a special kind of therapy to help your child communicate.  If your child has difficulty expressing his needs, he may become very frustrated and display behaviors such as crying, tantrums, withdrawing, etc. If it is due to a delay or disability, the sooner your child begins therapy, the sooner he will be able to understand language, express his needs and be understood. Once he is no longer frustrated, the happier he and the whole family will be!

Are speech and language problems all the same?

No. There are many different aspects to speech and language. For example, a child may have difficulty speaking due to a structural problem in his mouth or for another reason. Other times a child can understand language but has a hard time getting words out and expressing himself. Yet other times a child does not understand the spoken word (which may be due to a hearing problem, but it could also have no known cause).   Some children develop language more slowly than their peers (a delay), while other children have more choppy development or have more serious problems (a disorder). Sometimes a speech or language problem is one part of a larger diagnosis. It is different for every child.

Here are some common types of speech and language problems:
    • expressive language - how a child speaks or expresses himself
    • receptive language - whether a child can process and understand what is said to him
    • mixed expressive/receptive language- a combination of both problems
    • social language or pragmatics  - using language correctly in a social setting
    • dysphagia – a swallowing disorder
    • dyslexia and language based learning disabilities  – when a child has trouble understanding the written word (reading), learning new vocabulary, expressing ideas clearly, understanding directions, spelling, numbers or telling time.

You can read more about the different kinds of speech and language problems as well as important language milestones here.

How do you get speech and language services for your child?

The first step is to talk to your child’s health care provider about your child’s speech or language milestones.  You can request to have your child evaluated for free through programs provided by your state (for babies and toddlers) or by your school district (for children age 3 and older). This is provided to you under the IDEA, (the Individuals with Disabilities Education Act). This is the federal law that ensures that children with developmental delays or disabilities receive the help that they need.  Speech and language therapy falls under the umbrella of Related Services.  Keep in mind that parents can request an evaluation without a referral from a doctor or school. See my prior posts for info on how to have your baby and toddler or child age 3 and up evaluated for free. 

According to the IDEA, a “Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.”  The key words are articulation, fluency, voice and language. For a closer look at each one, please see NICHCY’s discussion. 

Once your child has been evaluated and the professionals have met with you to discuss the results of the testing, they may recommend that your child receive services provided by a Speech and Language Pathologist (a professional who provides therapy for communication problems). Therapy may include services for addressing communication problems as well as counseling and guidance for you and your child’s teachers. Although the primary aim is to get your child to learn to speak clearly and understand language, it is sometimes necessary for a child to learn sign language or rely on picture books in order to be able to communicate. Every child is different.

When and how is speech therapy begun?

Speech therapy often begins in infancy for a baby with oral structural problems, and in toddlerhood or preschool for children with delayed speech or other language issues. However, it can begin at any age. If your child is not identified as having a speech and language problem until he is in elementary, middle or even high school, do not despair. The positive effects of therapy may still be very helpful.

If it is decided that your child will receive speech and language therapy, his specific needs and goals will be outlined in his IFSP – Individualized Family Service Plan (for babies and toddlers up to age 3) or IEP – an Individualized Education Program (for kids ages 3 and up). This document will provide details of the services he will receive, including how often, where and with whom. Remember, parents are members of the team that write up the goals for the IFSP or IEP. 

Will your child like the therapy?

Most children thoroughly enjoy speech and language therapy – I know my daughter did. SLPs incorporate games and creative ways of learning into the sessions which make it fun and enjoyable for your child. For example, blowing bubbles helps to develop oral facial muscles and also breath control, which are necessary in learning to speak.

The bottom line

If your child is referred for speech and language therapy, be glad that he is going to have the specialized attention he needs to help make communication easier for him and you. It is important to address all communication needs as soon as you learn of them because your child will benefit from the therapy for the rest of his life. 

On a personal note, my daughter started speech and language therapy at age 3 and continued through early high school. It helped so much! She became a thespian in high school and continues to act in plays with a local community theater group. In college, her highest grade (A+) was in a Public Speaking course!  Without receiving speech therapy, I doubt she would have overcome her obstacles to the point where she could speak in front of large groups or act on a stage in front of a live audience. Never say never!

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

Note: This post is part of the weekly series Delays and disabilities – how to get help for your child. It was started on January 16, 2013 and appears every Wednesday . Feel free to go back to look at prior posts as the series builds on itself. As always, we welcome your comments and input.

A new study from the CDC released in today’s journal Pediatrics revealed that 40% of mothers surveyed gave solid food to their baby before the age of four months. While the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Academy of Family Physicians all recommend breastfeeding or formula feeding exclusively to the age of six months, many of the 1134 mothers involved in the study introduced cereal and fruit long before then, some as early as four weeks.

This early introduction of solid food occurred more than twice as often in women feeding with formula over breastfeeding women. The main reasons women gave for starting solids so early were “My baby was old enough,” “My baby seemed hungry a lot of the time,” “My baby wanted the food I ate,” “A doctor or other health professional said my baby should begin eating solid food,” or “It would help my baby sleep longer at night.”

This low adherence to infant feeding recommendations is of concern because, developmentally, younger infants are not prepared for solid food. Researchers have suggested that “early introduction of solids may increase the risk of some chronic diseases, such as diabetes, obesity, eczema, and celiac disease.” The health benefits of breastmilk (lower risk of ear and respiratory infections, diarrhea, diabetes, obesity, and sudden infant death syndrome) are significantly impacted when women cut back on breastfeeding as they introduce solids.

When beginning solid foods in your baby’s diet, it’s important to know that solid foods are meant to complement your baby’s overall nutrition, not replace breastmilk or formula. During this transition, your baby’s primary source of nutrition should still be breastmilk or, if he is bottle-fed, formula.

Speak with your baby’s health care provider before introducing solid foods into his diet. Remember these things when you do start:
    • Although you’re starting your baby on solid foods, you don’t need to wean him from breastmilk right away. Some babies may no longer have an interest in breastfeeding after 1 year of age. But breastfeeding can continue beyond the first year of life if mother and child wish.
    • Don’t feed your baby solid or pureed foods through his bottle. This takes away from your baby’s overall learning about how to hold and eat foods. It can also put him at risk for eating too much and becoming overweight. It’s best to use a teaspoon to feed your baby solid foods. Also, feeding baby with a spoon plays an important role in your baby’s language development.
    • Do not give your baby cow’s milk until he is at least 1 year old. At age 1, cow’s milk can become a major source of essential nutrients for your baby. Babies should be given whole milk until age 2.
    • Do not give food or sweets to your baby as a reward for good behavior. Instead reward him with praise, kisses, love and attention.
    • Practice good oral hygiene for your baby right away. As soon as he has teeth, start cleaning them with a small wet washcloth.

Pregnancy usually lasts 280 days (40 weeks) from the first day of the woman’s last menstrual period. Here’s a link to our interactive Due Date Calculator that will help you estimate the date your baby will arrive.

Remember, though, that this calculator is a general guide: every pregnancy is unique, and sometimes babies arrive sooner or later than expected. Always talk to your health care provider about your due date. And be sure you know the signs of preterm labor and what to do, just in case.

When a baby born early is in the NICU, it’s usually because he needs to be closely monitored in a safe, protected environment so he can continue to develop like he would if he were still inside Mom. This high level of care can’t happen in the cute nursery you have set up at home. That has to wait until later.

Since premature babies cannot regulate their body temperature well, they often are placed in a radiant warmer for a couple of days. This odd-looking open bed may not look like it will do much, but a special sensor taped to the baby’s skin keeps track of his body temperature and adjusts the heat around him as needed. The openness of the bed allows easy access for medical attention during constant monitoring.

Once stabilized, babies usually are transferred to an isolette. This plexiglass box is an incubator that protects the baby from temperature fluctuations in the room. It has portholes on the sides for medical staff to reach through in order to provide different treatments, diaper changes, etc. One wall of the isolette can be unhinged to provide complete access to the baby. As in the radiant warmer, the temperature within the isolette is regulated in accordance with the baby’s temperature needs. Some isolettes also provide moist, humidified air to prevent the baby’s environment from becoming too dry.

Many parents of a baby in the NICU want to decorate their baby’s isolette, make it personal. In time, that will be a great idea, but in the beginning babies often can’t handle any extra stimulation. Very tiny babies may not even be able to handle being touched for the first week or so. It’s hard for parents to see their baby in such a sterile environment. Items such as a special isolette cover, a stuffed animal or family photo can provide a touch of home. By talking with the NICU staff caring for their baby, parents will learn when and how much of a personal touch will be best for their little one.

If you had a baby in the NICU, how long was it before you were able to personalize your baby’s bed?

Your risk may be a little higher, but just because you’ve already had a premature baby, it doesn’t mean your next baby will be born early.

Your health care provider may not have been able to tell you why your baby was born early. Sometimes labor just starts early without any warning. Other times doctors have to deliver a baby early if a mother’s health or the baby’s health is in danger.

There may be things you and your doctor or midwife can do to help you stay pregnant longer. It’s best to have an open conversation about these things before you get pregnant again. When you decide you’re ready to get pregnant again, talk to your provider about seeing a specialist who is trained to care for women who are likely to have pregnancy complications, including premature birth. These doctors are sometimes called maternal-fetal medicine specialists, or perinatologists. Your doctor or midwife can help you find a specialist.

There are some risk factors that make a woman more likely to have her baby too early. Some risk factors are things you can’t change, such as already having had a baby born too early. But other risk factors are things you can do something about, such as quitting smoking.  Click on this link to read about different risk factors and what you can do about them. 

What can you do about preterm labor? Learn the signs of preterm labor (labor that begins before 37 completed weeks of pregnancy) and what to do if they happen to you.

If you’d like to talk to other women like you who are thinking about pregnancy after having a premature baby, visit the discussion group “Pregnant? On Bedrest? Trying Again?” in the March of Dimes online community Share Your Story.  You’ll be able to connect with lots of women who are or have been in your shoes.