Thursday, December 23, 2010

Pregnancy and Reflux!

This blog series is lovely isn't it?  Symptom after symptom of various ailments and discomforts that come with the joy of a new baby... only to then have your sleep interrupted and sanity stretched =)  Yet... people still opt to have kids!  Ha... we're on #3 and though a bit fearful of what's to come, actually excited.  I suppose I'm always one who rises to challenges.  Though having a nanny is huge and I don't know what I'd do without extra help.

So...  about gastroesophageal reflux or heart burn...

This can happen to folks who are not pregnant but it is a common symptom in pregnancy.  Starts in the 1st trimester and may very well last or even get worse as the belly gets bigger and more pressure is pushing on the stomach.  Usually, one notices discomfort like a burning sensation in the chest and a sour taste in the mouth though sometimes it is subtle and one may only experience bloating or belching.

Foods that can exacerbate heartburn include:
-  tomato based foods
-  caffeine
-  chocolate
-  mint
-  carbonated beverages
-  fatty foods
-  spicy foods
-  dairy

There are some meds that can exacerbate heartburn as well so make sure you talk to your doctor.

Things you can try to do for it include:
-  avoid those list of foods that exacerbate the symptoms
-  eat smaller meals more frequently
-  eat slower
-  drink less during meals
-  avoid bending or exercising right after eating
-  avoid lying down sooner than 2-3 hrs after eating
-  avoid tight fitting garments or belts around the waist
-  avoid smoking and alcohol (well if you're pregnant you shouldn't be anyway!)

If you need meds you should speak to your doctor.  Tums or maalox may help.  You may also be put on something like Zantac or Prilosec or even Reglan.

I'm glad that I actually don't get this symptom too badly though certain meals do trigger it.  I had indian buffet for lunch today which is a lot of food and a lot of creamy sauce... so probably was not the best idea.

Wednesday, December 22, 2010

1st Trimester Fatigue

Alright so I find the first trimester the hardest time of pregnancy because of the onset of symptoms that can occur during this time.  Some folks get it real bad and others not so much... and lucky me I get to experience it all!

My previous blog focused on nausea.  I'll talk about fatigue next because that is usually the other huge give away!  I get soooo tired during this time.  During the day, it is hard to have energy to do the things I need to do.  Being at work and needing to interact with patients is one challenge but being home and chasing around a preschooler and toddler is another thing altogether!  I'm usually so spent that I have no desire/energy to do anything else at night after dinner except crash in my bed.  So my house is a complete mess and I'm so disorganized... which drives me nuts!

So how am I still up right now blogging?  Well,  I think I'm getting some energy back as I'm heading into my second trimester.  Noticed how I didn't blog at all in November?  Heh.  Most people will feel better by the second trimester... only to feel tired again by the third.

It is a challenge to feel so tired and needing sleep... but then having sleep interrupted at night from increased frequency of urination!  That of course is another common symptom in the first trimester.

So what to do about it?

-  may seem counter intuitive but exercise actually does help
-  small frequent meals with extra protein
-  eat healthy with lots of fruits and vegetables
-  decrease activities and cut out unnecessary activities that tire you out
-  get rest!  take a nap if you can
-  hang in there.. should improve in the 2nd trimester

Monday, December 20, 2010

1st Trimester Morning Sickness

I've been waiting for the word to get out before I started blogging about this topic... pregnancy!  Now folks can be radiant and happily pregnant or sick and miserable and then there is everything in between.  I figured I'd share some of my experiences as well as some lessons I've learned.  Here I am on baby #3, you would think that wisdom comes from experience?  Well, not always...

There is so much to talk about!  I'll start with "morning sickness" since this is usually my dead give-away at my work place.  Even though it is commonly called "morning sickness" nausea does not always or only occur in the mornings.  The medical term for this is hyperemesis gravidarum.  It can last all day!  Hide it as I may try, people usually grow suspicious when they hear me hurling in the bathroom.  I had it the worse with my first where I even lost weight during the 1st trimester.  It was somewhat improved with my second child where although I was pretty sick to the stomach, I did not actually vomit enough to lose weight.  With this third child, I actually experienced very little nausea and I think it is because I was training for a marathon and didn't even know I was pregnant until 3 weeks before my race!  Exercise is known to help with 1st trimester symptoms and I can now say first hand that it definitely helped my nausea!

Usually, nausea starts at around week 6 and lasts into the beginning of the second trimester.  Most people feel much better by week 14 or 15, however, there are some reports of unfortunate souls who have nausea the entire pregnancy.  Some folks have it so severely that they end up needing to go to the hospital for IV fluids.  The important thing is to stay hydrated.

So some things that may help with nausea include:
- eating small frequent meals especially foods that are high in protein and complex carbs
- having cheese or crackers by the bedside so you can eat before sleep and even before getting out of bed
- drink water water water!
- ginger (I can't eat this plain but they make ginger candy) and ginger ale helps
- switching to different prenatal vitamin or take different time of day (this definitely made me sick that I had to resort to gummy vitamins)
- supplement with vitamin B6 (I tried this... maybe it helped)
- sea bands (I bought them... I personally did not find it too helpful but maybe I was just too sick for anything to help)

If it is so bad that you are losing weight... then you may be prescribed something like zantac, phenergan, reglan or zofran.  You have to talk to your OB to see what is right for you.

So with this child, I actually experienced very little nausea/vomiting!  That is until last night but I think I caught a GI bug.  Getting sick while pregnant is a whole other topic... not fun.  I'll save it for another post.

Tuesday, December 14, 2010

Two Birthday Celebrations, a Marathon... and Thanksgiving =)

Long time no blog!  November was a crazy month for me and it just flew by.  One daughter turned three, the other daughter turned one... I ran 26.2 miles in between their birthdays and Thanksgiving was thrown in there as well!

Here is a sample of some things I'm thankful for this year:

-  a stimulating and rewarding job where the staff is like family
-  friends near and far to laugh and cry with
-  our church with its dynamic worship, insightful sermons, and a community to grow with and serve
-  willing grandparents sacrificing time and energy to babysit and help with household chores
-  two healthy daughters who make me smile all the time
-  a patient and supportive husband who ran 6+ miles with me during the Philly Marathon!
-  a loving and gracious God who gave me the most meaningful gift of all... His Son, Jesus... it is because of Him that I can have peace that transcends understanding, eternal hope in times of despair, and an ongoing dynamic and intimate relationship with my Father in heaven

Wednesday, October 27, 2010

Being a mom and learning the art of balance

Long time no write!

As marathon date draws closer and my training sessions increase (2-3 hour chunks of time on weekends!)... I find myself just wanting to sleep when I'm done with the essentials of keeping up with my email inbox.  I'm also finding myself hungry all the time!

Now I've posted before on the benefits of exercise and how training for this marathon has done wonders to my overall mood and sanity.  At the same time, I also notice myself getting frustrated when I cannot make a training session as I had originally planned.  For who knew...  infants and toddlers are not so predictable and do not always follow the schedule I put forth for them!  I'm learning the lesson of balancing my expectations and readjusting them to fit what my life will allow.  I admit that it is very hard for a “type A schedule oriented planner” like myself to just “let go and go with the flow”.  I have to tell myself that it is not the end of the world if I am not running the exact number of miles the schedule says I'm to run.  Hey, if I end up finishing the marathon.. great!  But if not... isn’t it also the journey that counts?  I have to say though... I'm going to try really really really hard to finish!

So this post is really about me being a mom trying to balance time and expectations.  It should be okay for it to be about me when I need it to be about me, but not at the expense of my kids and husband!  I need to step back sometimes and remember the big picture.

Now this marathon run did start out as something on my bucket list and was all about me wanting to do something for just me.  I've recently decided to run for a cause.  I joined the Team in Training for Leukemia & Lymphoma Society.  I figured it doesn't have to be just about me and I can raise support to fight blood cancer.  Being a family physician I have several patients with several of these diagnoses and it seems appropriate to run for them.  On a more personal note, I have a good friend who was diagnosed with Multiple Myeloma while overseas doing missions.  He has two small children and is a physician himself.  His and his wife's story of faith through their battle with the uncertainties and pain has been a true source of encouragement for me.  So here I go!  If anyone is interested in supporting this cause you can click here to see my website.

Now on a side note, I’ve always thought there are so many good verses in the Bible that draws analogies with our Christian faith and running!  Here are a couple that come to mind:

"I press on toward the goal for the prize of the upward call of God in Christ Jesus."  (Philippians 3:14)

"I have fought the good fight, I have finished the race, I have kept the faith."  (2 Timothy 4:7)

“Everyone who competes in the games goes into strict training. They do it to get a crown that will not last; but we do it to get a crown that will last forever. Therefore I do not run like a man running aimlessly; I do not fight like a man beating the air. No, I beat my body and make it my slave so that after I have preached to others, I myself will not be disqualified for the prize.”  (1 Corinthians 9:25-27)  

Monday, October 11, 2010

Flu Shots

It is that time of year again for flu shots.  Last year, I did not get my swine flu shot in time and I was really sick with the swine flu... and pregnant!  So this year, I decided to get my shot a little on the earlier side and get everyone in the family vaccinated as well.  The flu vaccine this year combines both seasonal flu as well as swine flu.  For more information from the cdc you can click here.

Being in primary care, I will most definitely be exposed to the flu.  Since my immune system is not the greatest with such sleep deprivation, I need all the help I can get to stay healthy.  The basic idea is to inoculate against a dead virus so that my body will make antibodies.  Then when the real live virus hits... I got my defense system ready to go.  This should translate to no illness or less severe symptoms and shorter duration of illness.  I'm telling you... last year I was coughing and sick for over 4 weeks!  

More importantly, I need to get vaccinated so that I protect my patients and my two small children from being sick.  Sometimes, you may catch what you think is the common cold (when it is actually the flu) and the symptoms seem mild and go away because your immune system is pretty strong.  However, you can then pass along that same virus to someone else who has a weaker immune system (very young or very old) and that person can get very sick... even die.  This is why it is recommended for all healthcare providers to get the flu shot.  It is really to protect the patients who have weaker immune systems.  And in fact, all parents of small children should get the flu shot to protect against their young ones.

Yes... we still get a lot of people very wary of vaccines.  I can only say you have to weigh the pros and cons and make the best choice based on the facts.  Of course there are real contraindications of why you should not get the flu shot (ie. if you are allergic to eggs or if you have had a bad reaction to it in the past).  Again for more detailed information you can go to the cdc site listed above.

So my kids did great!  My ten month old did cry during the shot but she was crying before the needle, so I think she was just upset because daddy was holding her so tightly.  The parental grip on an infant is an art and can make all the difference in the experience.  The child should feel safe and secure.  The grip should not be so hard as to cause pain or discomfort but yet firm enough that the limb does not move.  The last thing you want is a flailing limb around a sharp needle!

My toddler was amazingly brave.  She watched the needle the whole time and did not even flinch or shed a tear.  Maybe it helped that mommy and daddy got shots first and she watched us get it with no incidence.  However, she did witness the baby crying during her shot... so who knows.  Well, many kids are crying way before the needle is anywhere near them.  I definitely think the fear of the needle and anticipation is far worse than the actual shot itself.  We've had our share of screaming wiggling children putting up quite a fight in our office.

Finally I just want to dispel a common myth about the flu shot.  Flu shots cannot cause the flu!  I really like how WebMD puts it and you can click here for more common myths about the flu:

This is the flu myth most likely to drive experts bonkers.  “There is simply no way that the flu vaccine can give you the flu,” says Hay.  “It’s impossible.”
Why? For one, injected flu vaccines only contain dead virus, and a dead virus is, well, dead: it can’t infect you.  There is one type of live virus flu vaccine, the nasal vaccine, FluMist.  But in this case, the virus is specially engineered to remove the parts of the virus that make people sick.
Despite the scientific impossibility of getting the flu from the flu vaccines, this widespread flu myth won’t die.  Experts suspect two reasons for its persistence.  One, people mistake the side effects of the vaccine for flu.  While side effects to the vaccine these days tend to be a sore arm, in the past, side effects often felt like mild symptoms of the flu. Two, flu season coincides with a time of year when bugs causing colds and other respiratory illnesses are in the air.  Many people get the vaccine and then, within a few days, get sick with an unrelated cold virus.  However, they blame the innocent flu vaccine, rather than their co-worker with a runny nose and cough.

I'm also going to cut and paste this section here from WebMD on dosing of the flu vaccine:

My children are under 9 years old. How many doses of the seasonal flu vaccine do they need?

It's really quite complicated for parents whose children are 8 years old or younger and who have never been fully vaccinated against the flu.
How many doses of flu vaccine will a child under age 9 years need this year? It will depend on two things:
  • Whether the child got any H1N1 vaccine AND
  • Whether the child previously got a seasonal vaccination, when that was given, and how many doses they got.
Children who got a previous seasonal flu vaccine as recommended -- AND got just one dose of the H1N1 pandemic vaccine last year -- need only one dose of the seasonal vaccine this year. We give them credit for getting the priming dose last year, but only if they previously got the seasonal vaccine.
Children under age 9 years who never before got a seasonal flu vaccination will need two doses of the seasonal vaccine this year -- even if they got the 2009 H1N1 pandemic flu vaccine.
Children under age 9 years who have had a previous flu vaccination but who did not get the 2009 H1N1 pandemic flu vaccine will need two doses of the seasonal vaccine this year.
If a child needs two doses of the flu vaccine, the second dose must be given no sooner than four weeks after the first dose.

It's such a hassle to get young children two doses of flu vaccine a month apart. Won't they get at least some protection from a single dose of the vaccine?


Wednesday, October 6, 2010

Terrible Two Tantrums

My older daughter is now almost three years old.  I think she hit the "terrible two" stage when she was around 18 months.  So what is this stage about?

I think this is a challenging time for toddlers and caregivers because there is so much growth, change, and development!  The toddler brain is really like a sponge soaking up and processing so many new words, feelings, and experiences.  Realization about their individuality leads to pushing boundaries.  What's more, it is difficult for a toddler to control their emotions.  So as a result, you can have crazy silly laughter one minute and a total meltdown a second later!

This is also a very fun stage where the most amusing and sometimes very insightful things get said.  All in all, I do like this stage because there is so much meaningful conversation with my little girl.  At the same time, I need to be one step ahead of her and she needs to know who is boss.  Otherwise, if unchecked, the child can easily turn into a "crying brat who always gets her way".

So tricks to dealing with a toddler in the midst of a tantrum?  For me, it helps to step back a little and try to differentiate between a manipulative tantrum versus a frustration tantrum.  Is my child throwing this fit just to get her way or is she throwing a fit because she is frustrated that she is not getting her way?

I do not want her to get the message that all she needs to do is throw a tantrum to get what she wants.  So I try to stay firm with my decision.  If I said "no" to something and now she is throwing a fit.  Well, she needs to know that I will not change my answer to "yes" just because she is throwing a fit.  So in those circumstances, I tell her firmly my answer and reasons and essentially wait out or ignore the tantrum until it passes.

Now most of the time, my child tantrums because she is unable to achieve whatever it is that she had set her mind to... so more out of frustration.  I try to help her in those situations but it is tricky because she will melt down if I try to help too much.

Bottom line... it is all an art.  I do have to stay calm as a parent.  Otherwise it may just escalate the situation.  Identifying tantrum triggers and trying to avoid them is key.  At the same time, giving her something to do and keeping her mind, body, fingers busy is helpful, too.  Fun times...

Saturday, September 25, 2010

Air Travel with Toddlers/Infants

This is a topic I've been thinking about a lot lately especially since we did quite a bit of traveling the end of August and beginning of September.  Most people find traveling to be a pain especially with all the increased security since 911.  Well, imagine doing it all with children 2 and under!

Preparations Before the Trip
I always try to pack as light as possible.  This is not an easy task because when you travel with little ones you have to pack so many things... diapers, food, bath stuff etc!  In addition if renting a car or traveling anywhere by car, we will also need to bring their car seats and possibly a stroller.  The list can go on if you want to bring a pack n play and booster seat and bathtub...

Most places will have a Walmart or Babies R Us.. so we actually decided to just buy diapers and baby food at our destination (can do this if staying long enough or have another baby around the same weight that we can split diaper costs with).  Paying money for an extra checked bag is probably around the same price as a box of diapers.

Thankfully, we were also very fortunate that we had family in both places we traveled to.  They were able to help provide some of these bulky items (pack n play, booster seats) so that we did not have to bring it with us on the plane.  That was a huge help!

Now if one has to bring all this extra stuff, I would recommend just biting the bullet to pay extra money and checking as many things as possible.   Going through security with a million carry-on bags is just stressful and chaotic!

The Airport Experience
Keeping track of luggage as well as a toddler and infant is not an easy task.  I actually carry my infant in the baby bjorn so that my hands are free to help with luggage and to grab my toddler's hands if daddy is busy with luggage.  We use the stroller and carseat to load backpacks, diaper bag, and my pumpbag so there is less to carry.  I've also seen some folks strap their toddler to their carseat and then push the carseat with a handle so it is like luggage.  That is a pretty good idea for the toddler who likes to wander!

So the challenge is to get everything on the conveyer belt while keeping the toddler out of trouble... and without banging my infant in the head (since I'm carrying her in front and have free hands but some of our stuff is bulky!)  Usually, I put my bags on the belt then walk through security with toddler in one hand and infant strapped to me while husband is left putting the rest of our stuff (strollers/carseats etc) onto the belt.  After going through I usually have to wait with the security guy because every time they have to take out my bottles and pump stuff and run some test on them.  I have learned to keep all my liquids in a separate bag that is easy to remove from the diaper bag.  Otherwise, these security people make a mess rummaging through pulling things out and they don't necessarily help put things back!

Finally we are through security.  Whew!  Now we go to the gate and while one parent watches our stuff, I take one kid at a time to the bathroom... diaper change one last time for infant and potty run for the toddler.  We keep her in her pull-up just in case she has an accident as well as xtra pair of clothes.  Thankfully she has been great.  It is such a pain though to go potty with a toddler in those tiny airplane bathrooms!

Most airlines will allow you to pre board if you have kids.  This is a huge help because there is so much stuff.  We usually have to roll our car seat and strollers to the end of the gate runway right before you board the plane so they can take it.  Then we bring our toddlers car seat on board so she can be strapped in it during the flight.  With the narrow aisle to walk down and all our stuff.. it is just cumbersome.  But finally... in our seats!

The Flight
So previously I said to pack light.  However, it is crucial that we remember to bring some entertainment for our toddler for during the flight.  3 hour flight to Houston was nothing compared to the 6 hour flight to San Diego that we had to endure!  Now... timing is everything.  If you have a child who will sleep anywhere and anytime then flying during nap time is great because you know they will be out for 1-2 hours which is less time to entertain them during the flight.  

With out kids... they are not great sleepers and usually get very cranky when they are tired.  However, if we bear with it.. they should pass out.  Our little one screams her little head off.. but will pass out... however, one of us has to hold her and sometimes walk the aisle and bounce to keep her asleep.  The most painful moments are when we are not allowed to get up because of take off or landing or turbulence and she is just screaming.  Oh well.  Little we can do...

Our toddler on the other hand... sigh.  She totally melts down when she is super tired and it is not easy to get her to fall asleep in such an environment.  Now when she does fall asleep, it is just as hard keeping her asleep since her head bobs around.  I thought buying her a neck pillow was the answer but she just would not put it on.  Oh well.. again.  It is what it is.

So I try to bring some new book or new toy that she has never seen as part of her entertainment.  Plus, eating snacks take up some of the time as well.  Finally as a last resort... Dora videos!

Getting Off
Getting off the plane is a little harder I think.  We have to gather all our stuff from different overhead compartments as well as the stuff under the seats and we have to unstrap the car seat our toddler is sitting on!  Some people choose to sit all the way in the back.  This way we don't feel like we are holding other people up.  Plus it is closer to the bathrooms and to the back area in case we have to get up to bounce our little one.  

As a side note... where you end up sitting can actually make or break an experience.  Folks who like kids and try to entertain them before/during/after the flight are probably the ideal folks to sit near.  Ha.. they should probably add a feature to the online booking where you can designate if you want to be as far away from kids as possible.  Folks who do not like kids are a nightmare to sit next to... adds to the parents' stress I think.

So how to have an overall good airplane experience?  Attitude is key!  Gotta think positive... lower expectations... expect the unexpected... plus a sense of humor always helps =)  Bon voyage!

Saturday, September 4, 2010

Mommies need to exercise!

Long time no blog!  The summer is flying by and between work... putting my kids to sleep at night... and trying to train for the marathon... it has been hard to find time to write since I just want to go to sleep by the time I turn on my computer.  Yes, I'm going to run the marathon!  It is on my bucket list and I feel this is the year to do it.  So here is a quick blog about exercise...

I used to be this almost fanatical field hockey player.  It took up a big chunk of my time/energy/passion.  This was especially true during high school, but was also a significant part of my life during college.  So then after college, without the structure and discipline of an organized sports team, it took more effort on my part to exercise.  In medical school, I was able to play club volleyball because I had friends who played.  Therefore, there was always some outlet for my stress.  Once I started residency and was working 80 hour weeks... exercise kind of took a backseat.  I'd try to go to the gym to run every now and then but it was hard to be motivated and hard to be consistent.  Then I had kids and exercise pretty much went out the window!  It is no wonder I started feeling like I was going crazy!  Not only did life just become so much more chaotic but I also stopped the one thing that was always my source of stress release.

So I am someone who needs a goal to stay motivated.  Just deciding to run on the treadmill everyday is not enough incentive... I had to tell myself that I need to run so that I can finish a marathon race.  Once I really started training I was amazed at the huge difference it made in my mood.  It seriously feels like I'm taking a "happy pill"!  I'd get home past 11 o'clock at night (because I can't run until my kids are asleep... which is usually past 9pm) but be full of energy and glee.  I have always advocated exercise to my patients and know you can get this endorphin kick, but actually experiencing it is beyond what words can describe.

Of course, the trick is to actually do it.  It may require getting an accountability partner or like in my case, need to set some sort of goal.

Here are 10 reasons to exercise from the Mayo Clinic:

  1. Keep excess pounds at bay. Combined with a healthy diet, aerobic exercise helps you lose weight — and keep it off.
  2. Increase your stamina. Aerobic exercise may make you tired in the short term. But over the long term, you'll enjoy increased stamina and reduced fatigue.
  3. Ward off viral illnesses. Aerobic exercise activates your immune system. This leaves you less susceptible to minor viral illnesses, such as colds and flu.
  4. Reduce health risks. Aerobic exercise reduces the risk of many conditions, including obesity, heart disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer. Weight-bearing aerobic exercises, such as walking, reduce the risk of osteoporosis.
  5. Manage chronic conditions. Aerobic exercise helps lower high blood pressure and control blood sugar. If you've had a heart attack, aerobic exercise helps prevent subsequent attacks.
  6. Strengthen your heart. A stronger heart doesn't need to beat as fast. A stronger heart also pumps blood more efficiently, which improves blood flow to all parts of your body.
  7. Keep your arteries clear. Aerobic exercise boosts your high-density lipoprotein (HDL), or "good," cholesterol and lowers your low-density lipoprotein (LDL), or "bad," cholesterol. The potential result? Less buildup of plaques in your arteries.
  8. Boost your mood. Aerobic exercise can ease the gloominess of depression, reduce the tension associated with anxiety and promote relaxation.
  9. Stay active and independent as you get older. Aerobic exercise keeps your muscles strong, which can help you maintain mobility as you get older. Aerobic exercise also keeps your mind sharp. At least 30 minutes of aerobic exercise three days a week seems to reduce cognitive decline in older adults.
  10. Live longer. People who participate in regular aerobic exercise appear to live longer than those who don't exercise regularly.

Wednesday, August 4, 2010

Sleep Training

Well, I know I've blogged about this topic already and I also know there are hundreds of websites out there on this topic.  However, since we are currently sleep training my little one I figure I'd document the occasion.

I'm super tired and should be sleeping since my kids are currently sleeping.. so here is the quick and dirty.

Basic idea of sleep training is to teach the child that he/she can fall asleep on his/her own.  Therefore, if he/she happens to wake up in the middle of the night due to whatever it is, he/she can then fall back asleep without crying and needing to be rocked or nursed.

I love this analogy I read in a book about how even adults have sleep associations.  For instance if my pillow falls to the ground in the middle of the night and I happen to wake up I will look for the pillow and put it back in bed with me before falling back asleep.  In the same way if a child is used to falling asleep while nursing or while being rocked, then he/she will want that comfort if he/she wakes up in the middle of the night.

So what is our strategy/plan?  Yes.. there is some crying involved.  However, I check on her and make sure she is alright.. 5 min, then 10 min, then every 15 min after that.  Based on the type of crying, I can actually tell if she will fall asleep soon.  So if she is not screaming her head off I may just let her cry.  Otherwise, going in there sometimes make her cry even harder.

Plus, what really helped is having daddy going in there to comfort in the middle of the night instead of me because then she cannot look to nurse.  When I go in there, I tend to give in and just nurse because it is so much easier to get her back to sleep that way!

The other challenge to sleep training our second child is I am so fearful of waking up my toddler that I actually delayed this for a really long time.  My child is 8 months already!  In retrospect, I probably could have started this sleep training when she hit 6 months and was taking solids.  Because then I know that she can last through the night without starving...

So at the end of the day, it is an art.  I do not think there is a magic formula.  Every kid is different and therefore I think the exact method needs to be adjusted somewhat.  My older daughter was a real tough one.  I had to almost lay on top of her in the crib and pat her butt so that she feels me real close (but I wasn't holding her).  Then I transitioned to just patting her butt... then to just sitting near her and singing.. then to sitting farther away.. then to outside her door.  Now she sleeps great from 8ish a night to 8ish in the morning just about every night!

My younger daughter does not seem as determined and I'm real hopeful that in about a day or two she will have this down.  Boy.. my other daughter was almost 15 months before she finally slept through the night.  It will be so great if I can get this second one to sleep through before she hits 1 year old!

So here are some books I read on this subject:

No Cry Sleep Solution
Ferber Method
Happiest Baby on the Block

Wednesday, July 21, 2010

Separation Anxiety

Today marks the first official day of my training for the Philadelphia Marathon!  Unfortunately, my run at the gym was cut short because one of the childcare workers came running to me while I was on the treadmill to tell me that my daughter was "screaming".  She was not just crying... she was "sss-creeee-ming"!  Uh oh... she is hitting 8 months which means she could be developing stranger anxiety.  She just took a one hour nap and it was not quite feeding time yet.  My suspicion is confirmed when my little one started smiling and blowing bubbles at me the minute I put her in her usual play area at home.

So stranger anxiety is fairly common and can be a part of normal development.  Some babies get it much worse than others.  Usually it starts at around 8 months and can last well into the toddler years.  Before this stage, babies are pretty oblivious to what is new and what is usual in their environment.  They become accustomed to their caregivers familiar faces and new faces and/or new surroundings can cause fear and anxiety.  In order to get over stranger anxiety one must be able to:

  • feel safe in their home environment
  • trust people other than their usual caregivers
  • trust their caregivers will return
Now to accomplish this is no easy task.  I think some kids just get over it faster because of their personalities in addition to what they are exposed to.  A child who has the same caregiver all the time in their own home will likely have a harder and longer time adjusting than another child who goes to daycare.

Now my kids get a combination of me at home about fifty percent of the time and a rotation of 2-3 other caregivers the other times.  So my two year old is pretty outgoing and fearless right now.  She can probably run off in a crowded place without looking back and lose me.  However, I do remember she also went through a period of much crying and distress when I used to leave her at the gym child care center or even the church nursery.  Now for me, what was difficult was feeling bad for the workers and fearing that my child may get hurt or slighted in some way if the workers got too annoyed.  Of course, I felt bad for my stressed out child as well, but I figured she would get over it eventually and this was all part of the process of learning to cope.

So.. here we go again.  I sure hope it will not be as bad with this second child but I'm bracing myself because this second child sure has a set of lungs!  She does not usually cry and is very happy and smiley almost all day long.  However, when she gets upset... she just screams and screams.  There is no in between for her.  So this should be fun...  ah parenting... does it ever get easier?

Thursday, July 8, 2010

Is ringworm contagious?

So I think we got it!  First it was my older daughter... small circular red rash on her left forearm.  I have no idea where she got it from.  Since incubation is around 10 days after exposure, it may be hard to pinpoint.  The rash went away in a couple of days after treatment with topical antifungal cream.  Unfortunately, my younger one got it too but more widespread so it is taking longer to completely go away.  Plus, I think she is rolling around too much and we probably should have done a better job washing all her bed sheets and clothing when we initially found the rash.  Now that we are nearing 2 weeks of treatment, it is mostly resolved and I think the lesions left are actually eczema.  In fact, children with eczema are more prone to ringworm.

So what is ringworm?  Some may actually think has to do with worms because of the name.  Not the case. Ringworm is a fungal infection that is fairly common especially in children.  Itchy red, raised rash that is usually circular... usually found on the extremities and sometimes the scalp.

Is it contagious?  Yes, usually by skin to skin contact or sometimes by contact with things like clothing, bedsheets, etc.  Wrestlers are known to transmit this back and forth because of close skin to skin contact and wrestling mats.  Kids are usually sent back to school/daycare after treatment is started and after 48 hours of treatment it is no longer considered contagious.

How is it treated?  Usually topical antifungal cream will do but sometimes may require an oral antifungal, especially if it is on the scalp.

Tuesday, June 29, 2010

Testing for food allergies

I just read another interesting article about a new method to test for food allergies that is supposed to be more accurate than the current skin and blood tests out there.   If anyone is interested in some nerdy reading, check this out at MIT news.  Basically, they are claiming more accuracy because this technique is measuring the amount of cytokines produced (which happens in an allergic reaction) instead of just measuring the antibody to a particular food (which can cause false positive results).  There still needs to be more clinical studies to make sure this works but it would be a neat tool to have especially in the primary care setting.  Right now, our office does quite a bit of allergy testing using Immunocap.

Fortunately, our older daughter has no food allergies that we are aware of.  We started our second daughter on solids a couple of months ago and so far she does not seem to have any allergic reactions to any of the foods.  This is fortunate because it is pretty common these days for children to have food allergies or food intolerances.  Common foods that can cause allergies include peanuts, milk, eggs, soy, and wheat.

So breastfeeding is supposed to help prevent food allergies.  Plus, there is a line of thought that delaying solids and introducing foods in a certain order will help.  Well, we shall see what happens with child #2.  I breastfed my firstborn a few months past her first birthday!  I'm not sure I can last that long with this second child...

Sunday, June 27, 2010

Toothbrushing and heart attacks!

How many of you find it challenging to brush a two year old's teeth?  I think we got the routine down but I cannot be completely sure how well a job we're doing.  I get to brush her teeth first then I let my daughter brush herself for a few seconds.  We even have the "swish and spit out" down.  Sometimes it splashes everywhere and gets on her clothes.  There is always more messy-ness when a toddler is involved!  So initially we were just brushing with plain water but since around two years old, we've been using one of those toddler toothpaste gels.  Again, I'm not sure how well I'm brushing because I have to brush fairly fast and it is somewhat awkward brushing teeth that is not your own.  But at least we are doing it!

Now I've completely dropped the ball with my second child who just turned 7 months today!  There are those baby toothbrushes that you can put on your finger to brush the gums.  I did it with the first child and somehow in all the craziness, I've completely forgotten with the second.  I kept thinking that I'd just wait until she starts solids.  Well, she has started solids for almost 2 months now!  Oops.

I'm thinking about all this because I just read an interesting study that shows toothbrushing less than twice a day increases your risk for heart attacks!  It has to do with increased inflammation which can lead to atherosclerosis (clogging of your arteries).  The article broke down risk by those who brush twice a day, once a day, and less than once a day.  Boy, I have a hard time imagining how someone can brush their teeth less than once a day.  Brushing has become such a habit that to break that habit would feel really strange to me.

Well... gotta start good habits young...  

Wednesday, June 23, 2010

Sleep deprived mom

Today I was like a zombie at work because I've gotten such little sleep 3 days in a row.  After two nights of trouble, my toddler slept through last night peacefully.  However, my younger one had a rough night.  I spent from around 10pm to around 2am trying to soothe her to sleep.  I even gave her Advil and got blue medicine all over her white onesie!  Haha.. has anyone tried holding a squirmy fussy baby with one hand while trying to slip sticky medication from a dropper into the mouth of a screaming child?  Quite a challenge... Oh and it was also in the semi dark because I didn't want to overstimulate her with too much light!

So she finally went back to sleep around 2a but was up again at 4a.  Then back down by 5a and slept till 10a!  However, I had to get up by 7a.  Therefore, I only got 4 total hours of interrupted sleep.

Haha.  I thought residency days were hard being on call every 4th night and sometimes every 3rd night.  When you are on call in the hospital, you may get very little sleep if any sleep at all... however, with the new sleep rules now, you know you will go home by noonish the next day and will be able to sleep the following few nights!  There is no such predictability with kids.

I think my biggest struggle is the fact that I have absolutely no control.  I love control... I need to plan out my life... years at a time even.  Right now I am so disorganized and out of control, it is driving me nuts...

So deep breath!!  I'm learning to be more flexible.. to chill... to take it as it comes... and I'm trying to enjoy the little joys since I know this will be gone in a flash.  Though I'm so super tired and can hardly keep my eyes open when holding my little one in the middle of the night, I also have a hard time putting her down because she is so darn cuddly, soft, and cute.

So that is where I am right now... sleep deprived...  trying to function... going crazy and wanting the time to past at times... but then wanting to freeze the moment and just snuggle forever the other times...

Teething teething teething!

I believe my little one is teething.  She is gnawing on everything she can get her little chubby hands on.  For most of the day, she is happy and smiling and will crack up if you play with her and make funny sounds.  Then there are those moments at night where out of the blue we get high pitched screaming... not easily consolable.

So some myths about teething I want to dispell:

  • teething does not cause fever > 100.4
  • teething does not cause diarrhea
  • teething does not cause rash
Now since she is chewing on everything, she is exposed to more viruses/bacteria and therefore may develop the above but teething alone is not the sole cause.

Oh boy, there she goes... may have to whip out the generic acetaminophen to soothe...

Monday, June 21, 2010

Falling out of bed!

Last night while trying to watch a video after the kids were in bed, my husband and I heard a loud "thump" and looked at each other.     It sounded like a fall, so I rushed into my toddler's room.  Sure enough, she was laying on the floor.  How did she end up there when there is a rail?  The next hour or so took a lot between my husband and I taking turns trying to calm her down.  After the first few minutes, we determined that she was not seriously injured only scared and upset and very very tired.  At the end of it all, we got the futon and laid it on the ground of our room and I laid next to her until she fell asleep.  This morning, she seemed to have no recollection of the whole event.  Hopefully, I did not start a bad sleep habit that I have to now try to break...

So that was the second time she fell out of bed while sleeping!  The first time, we were in a hotel room and she was sleeping on a double bed with no rails.  Maybe we'll have to look into bed side rails or something...

So when to call the doctor or go to the ER if your toddler falls off the bed?  I say, when in doubt, call your doctor for that is what our urgent lines are for.  But in general...

  • Stay calm (kinda hard to do as a parent..)
  • Look for bruises, bumps, lumps, cuts, scrapes, deformities...
  • If there are bumps... ice!
  • If there is a cut... put pressure to stop bleeding...
More urgent signs would include things like
  • loss of consciousness
  • vomiting
  • altered mental status
  • loss of balance
  • prolonged crying
  • anything funny with the eyes
  • headache
  • anything funny with breathing, color
  • any funny twitching
When in doubt... I'd call your doc to be on the safe side.  

This toddler stage is such an active stage and we have a super active child... even when she sleeps!  Hopefully, no more falls from beds...

Thursday, June 17, 2010

Coupon vouchers for recalled McNeil products

We just received in the mail today our coupons for the recalled Children's Tylenol, Benadryl, and Motrin.  There were two coupons for $7  and one $11 towards a McNeil product.  The coupons expire May 2012 and came with a letter explaining that they are doing all they can about the situation and to use the coupons once the stores have the products stocked back up.  Well.. who knows when that will be given this more recent expanded recall!

I'm debating whether it is worth claiming the adult versions of the Tylenol and Benadryl... even Rolaids got recalled!

Wednesday, June 16, 2010

More Tylenol and Benadryl Recalled

Long time no write!

So my aunt sends me a link to this site reporting the latest recall of Tylenol and Benadryl by J&J and McNeil.  This time it affects adult strength like it did last fall.  In fact, in the last 8 months McNeils recalls include:

  • Nov 2009  - Tylenol Arthritis Pain 100 count with EZ open cap (because of unusual odor leading to nausea, stomach pain, vomiting, and nausea)
  • Dec 2009 - expaneded to all products of Tylenol Arthritis 100 count with EZ open cap
  • Jan 2010 - widened to more Tylenol, Motrin (complaints of odor causing people to feel sick)
  • May 2010 - children version of these meds were recalls due to quality and safety concerns

Well, all this is troubling to me because I advise my patients to take Tylenol and Benadryl all the time!  They are staples to have around the house!

To get an entire list of products affected, you can go to McNeil's webpage.  You can also enter your lot# and call a toll free number to claim your refund or voucher.

Okay, so what are the Tylenol and Benadryl alternatives?

  • Tylenol - generic name is Acetaminophen (so any store brand generic)
  • Benadryl - generic name is diphenhydramine (again any store brand generic)
The thing is I would have expected issues with the generic versions and not the brand.  This all makes me wonder if there are issues with other meds or brands that are just not discovered yet.  Oh well... it is what it is.

Thursday, June 3, 2010

Babies and constipation

My poor ltitle girl did not poop for 5+ days... starting solids can do this sometimes and of all things carrots were her staple the last few days we were in Florida.  

So foods that may constipate include:
  • Bananas
  • Rice
  • Cooked carrots
  • Squash
  • Applesauce

Funny thing is those are usually the recommended starter foods.  Go figure...

So after much crying and pushing she finally went today!  Yay!  I will have to get some prunes or apricots in her and try to increase fluids.  Pumping her legs and rubbing her belly is supposed to help as well.  If all else fails... there is manual rectal stimulation (which I actually did do today)... then the glycerin suppository.  Hopefully, we will not need to go there!

Tuesday, June 1, 2010

Getaway without the kids! (Part 2)

So the thing about returning home from a getaway is that there is less alone downtime and a ton of errands to do (laundry, getting kids to sleep, etc)!  Part 2 will have to be significantly truncated because I'm super sleepy and want to hit the sack...

So quick recap from Day #1:
  • needing to be resourceful to pump on the go
  • flying with captain Sully
  • getting a green camaro to drive around
  • realizing too late we gotta drive 4 hrs to the place we are staying!

Here's a quick recap for Day#2:
  • I threw the car keys in the trunk of the green camaro and shut it without thinking!  Good thing for OnStar...
  • Hubby turned left on a one way road and we nearly said goodbye to our green camaro... and one another...
  • Much less success this day in finding any bathroom that had an electrical outlet!
  • Had very yummy sushi and seafood at a restaurant with outdoor seating... opened up to the ocean!
  • Oh.. and we parked next to Bumblebee from Transformers... a yellow camaro =)

Will elaborate if there is time tomorrow...