Gear: "Is my baby ready to..."
...face front in a car seat?
When it comes time to turn your baby around in the car, which is more important: her weight or her age?
What you need to know Both are equally important: A child should remain rear-facing until she's at least 20 pounds and 1 year old, say experts. Dr. Shu goes even further and recommends keeping your child facing the back as long as she can stand it. "If we all could travel facing backward, we'd be safer. As soon as you face the front, the chance of whiplash goes way up," she says.
But what about kids who pitch a fit because they can't see you? Dr. Brown, mom of a 10- and a 7-year-old, says she's been there. "We flipped my daughter around when she was nearly twelve months old, but she was over twenty pounds at that point. I thought it was actually safer that way -- otherwise, I worried I was going to get in a crash, what with all of the turning around I was doing to quiet her down. But I still tell all my patients to wait!"
...fit in various baby carriers?
The worry: fitting a too-small baby into one of these items.
What you need to know First, check the manufacturer's specifications. After that, here's what experts recommend:
Front carrier. As long as your baby is above the carrier's height and weight specs (depending on the model, usually eight pounds and 21 inches), you can carry him around facing in from the get-go. He'll be ready to face out once his neck is strong enough to hold his head steady, usually when he's about 3 months old. And don't be overly concerned if his head slumps forward when he starts to snooze. It may look uncomfortable, but he'll be able to breathe just fine.
Backpack. No earlier than 3 months, and even as old as 6 months, depending on the type of backpack, say experts. A baby needs adequate head and neck control to keep his head stable and supported.
Umbrella stroller. Six months at the earliest. A baby needs good trunk control -- meaning the ability to sit up independently -- because of the lack of support usually found in these strollers.
Jogging stroller. While some manufacturers say that joggers are appropriate for babies as young as 6 months, Dr. Brown says she wouldn't advise it for babies under 1. "The ride can be quite bumpy for immature spine and neck muscles, especially going over curbs or rocky paths," she says.
Bike trailer or bike seat. A baby should be at least 1 year old before being put in a trailer, say the AAP and other experts. Besides the bumpiness potential, there's the risk of a spill, so your baby will need to wear a lightweight bike helmet while on the ride, and his neck won't be strong enough to support one until his first birthday.
Thursday, January 29, 2009
Thursday, January 22, 2009
When is My Baby Ready To...?
There may be very clear right and wrong answers for much of newborn care, but once my baby was out of the first stages of infancy, the answers weren't so obvious. "So, is it safe...now?" I found myself wondering every few weeks. Will it be safe when she reaches a certain age? Weight? Developmental stage?
Many of these issues have changed since we were kids, so asking my own mom wouldn't do any good -- back when I was a babe, either the category didn't exist (sushi and jogging strollers) or the thinking was very different (putting babies to sleep on their stomachs).
Here, pediatricians -- experienced moms themselves -- share what you need to know about safe sleeping, eating, playing, and more.
Sleep: "Is my baby ready to..."
...snooze on her tummy?
Since 1992, when the American Academy of Pediatrics (AAP) first recommended putting babies to sleep on their backs, the annual SIDS rate has decreased by about 50 percent. While some moms are ignoring the recommendation, most of us have gotten the message so loud and clear that the first time I discovered my 4-month-old on her stomach it was hard not to freak out.
What you need to know Once your baby has the upper-body strength to roll over regularly, at around 5 months, he has the strength to move away from a suffocation hazard, and the SIDS risk goes down. (The greatest risk is during the first six months.)
"I tell my patients: You should still put them down on their backs, but what babies do in the middle of the night is their business," says Jennifer Shu, M.D., director of the newborn nursery at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire, and coauthor of Heading Home With Your Newborn.
...have a blanket in the crib?
The official line from the AAP is to avoid blankets (they're a potential suffocation hazard) until your baby reaches her first birthday.
What you need to know Some pediatricians give the okay for babies as young as 6 months. "A small, crib-size blanket is fine for a child who can lift her head and can push it off or crawl out from under it," says Jennifer Roche, M.D., a pediatrician in private group practice in Amherst, Massachusetts. (Whether or not it stays on her all night is another issue.)
...ditch the bumpers?
Who would have thought a simple decorative touch in the nursery would end up being controversial? Some experts say bumpers are suffocation hazards and shouldn't be in the crib at all; others take a more pragmatic approach.
What you need to know To be on the safe side, avoid large, fluffy bumpers and remember to tie them to the crib as tightly as you can. Also, make sure there are no gaps -- that way your baby can't get his head stuck between the bumper and crib railings.
According to some doctors, you should take them out of the crib when your baby is sitting, around 6 months, but definitely no later than 9 months, when he begins to pull himself up to stand. Although it's not very likely, he could use the bumper as a step and launch himself out of the crib.
...sleep with toys in the crib?
With all of the nervousness about possible SIDS hazards, parents might worry about putting stuffed animals or other playthings in their infant's crib.
What you need to know depends on the plaything.
Stuffed animals. While the AAP doesn't recommend that babies sleep with plush loveys until they're 1, Ari Brown, M.D., coauthor of Baby 411, says it's okay once a baby is 6 months old, with these caveats: The stuffed toy is a small one (no bigger than the size of her head) and has no removable eyes or buttons. Your baby should also be rolling over and moving around on her own.
Mobiles and other crib toys. You should remove the mobile from the crib at the 6-month mark -- babies may then be able to make a grab for them when they sit up. As for attachable toys, as long as they don't contain small, "choke-able" parts, the only consideration is whether your baby can handle the stimulation. "Some will push the buttons repeatedly until they get sleepy. Other kids will just get more and more wired," says Dr. Shu, the mom of a 4-year-old.
Books. Since babies are likely to chew on board books, doctors recommend giving them only fabric ones in the crib -- after they turn 1.
Many of these issues have changed since we were kids, so asking my own mom wouldn't do any good -- back when I was a babe, either the category didn't exist (sushi and jogging strollers) or the thinking was very different (putting babies to sleep on their stomachs).
Here, pediatricians -- experienced moms themselves -- share what you need to know about safe sleeping, eating, playing, and more.
Sleep: "Is my baby ready to..."
...snooze on her tummy?
Since 1992, when the American Academy of Pediatrics (AAP) first recommended putting babies to sleep on their backs, the annual SIDS rate has decreased by about 50 percent. While some moms are ignoring the recommendation, most of us have gotten the message so loud and clear that the first time I discovered my 4-month-old on her stomach it was hard not to freak out.
What you need to know Once your baby has the upper-body strength to roll over regularly, at around 5 months, he has the strength to move away from a suffocation hazard, and the SIDS risk goes down. (The greatest risk is during the first six months.)
"I tell my patients: You should still put them down on their backs, but what babies do in the middle of the night is their business," says Jennifer Shu, M.D., director of the newborn nursery at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire, and coauthor of Heading Home With Your Newborn.
...have a blanket in the crib?
The official line from the AAP is to avoid blankets (they're a potential suffocation hazard) until your baby reaches her first birthday.
What you need to know Some pediatricians give the okay for babies as young as 6 months. "A small, crib-size blanket is fine for a child who can lift her head and can push it off or crawl out from under it," says Jennifer Roche, M.D., a pediatrician in private group practice in Amherst, Massachusetts. (Whether or not it stays on her all night is another issue.)
...ditch the bumpers?
Who would have thought a simple decorative touch in the nursery would end up being controversial? Some experts say bumpers are suffocation hazards and shouldn't be in the crib at all; others take a more pragmatic approach.
What you need to know To be on the safe side, avoid large, fluffy bumpers and remember to tie them to the crib as tightly as you can. Also, make sure there are no gaps -- that way your baby can't get his head stuck between the bumper and crib railings.
According to some doctors, you should take them out of the crib when your baby is sitting, around 6 months, but definitely no later than 9 months, when he begins to pull himself up to stand. Although it's not very likely, he could use the bumper as a step and launch himself out of the crib.
...sleep with toys in the crib?
With all of the nervousness about possible SIDS hazards, parents might worry about putting stuffed animals or other playthings in their infant's crib.
What you need to know depends on the plaything.
Stuffed animals. While the AAP doesn't recommend that babies sleep with plush loveys until they're 1, Ari Brown, M.D., coauthor of Baby 411, says it's okay once a baby is 6 months old, with these caveats: The stuffed toy is a small one (no bigger than the size of her head) and has no removable eyes or buttons. Your baby should also be rolling over and moving around on her own.
Mobiles and other crib toys. You should remove the mobile from the crib at the 6-month mark -- babies may then be able to make a grab for them when they sit up. As for attachable toys, as long as they don't contain small, "choke-able" parts, the only consideration is whether your baby can handle the stimulation. "Some will push the buttons repeatedly until they get sleepy. Other kids will just get more and more wired," says Dr. Shu, the mom of a 4-year-old.
Books. Since babies are likely to chew on board books, doctors recommend giving them only fabric ones in the crib -- after they turn 1.
Sunday, January 11, 2009
Pregnancy at 45 to 49
Ages 45 to 49
YOUR BODY
The percentage of women who have babies in this age group is .03, and the chance of successful infertility treatment drops tremendously. Just being able to conceive and sustain a pregnancy is an achievement and to some degree a reflection of your own good health. "We all hear success stories of women who had children in their late forties through in vitro fertilization," says Dr. Younger. "But more than half of all pregnancies conceived through IVF in women over age forty are produced through donor eggs."
Once you've conceived, you're more likely to undergo rigorous testing than you would if you were younger. Most pregnant women in their 40s have some stress testing to check their cardiovascular health, and they'll be more closely monitored for signs of diabetes or kidney problems than those in their 20s, says Dr. Younger.
Even if you're in top physical shape, carrying and delivering a baby will be more difficult than it would be if you were in the same physical shape in your 20s. "Pregnancy, in a sense, is like an athletic event," says Dr. Niebyl. "Blood volume nearly doubles, increasing the strain on your heart, and the extra weight puts some strain on your muscles and joints."
YOUR EMOTIONAL SELF
Most women in their mid-40s are concerned about the health of their baby as well as their own health -- with good reason, since there are increased risks for both at this age. But most pregnancies, even among women in their 40s, have good outcomes. The better you care for yourself, the more successful your pregnancy is likely to be.
RISKS TO YOUR BABY
More than half of all pregnancies in women over age 45 end in miscarriage (before 20 weeks gestation). Risk of stillbirth is doubled for women in their 40s, compared with those in their 20s; for this reason, many doctors perform more stress tests and ultrasounds in the last weeks of pregnancy in older women. The chance of chromosomal abnormalities increases sharply. At age 45, there's a 1 in 30 chance of delivering an infant with Down syndrome and a 1 in 21 chance of having a baby with any chromosomal abnormality. In a 49-year-old those risks rise to 1 in 11 and 1 in 8, respectively.
OVER 50
The average age for menopause is 51, but typically the range runs from 45 to 55. Almost all pregnancies beyond age 50 require some assistance, whether from fertility drugs, hormone supplements, or, more often, donor eggs. Women still ovulating usually have to take progesterone for at least the first two months to maintain the pregnancy. Women who have stopped ovulating need donor eggs to conceive and must take estrogen and progesterone for much of the pregnancy, until the placenta begins to produce those hormones on its own.
At this age, there's a high rate of complications -- including hypertension, kidney problems, and placental problems -- that requires strict monitoring and care.
Then there's the issue of the woman's age once the baby is born. We all know 50-year-olds who are more energetic and alert than their 20-year-old counterparts, and they have the added benefit of maturity and experience. But women over 50 may need extra energy -- not to mention stamina -- to awaken every two hours with a newborn or to chase after a toddler.
Statistics show that once a woman has gotten pregnant, if she takes good care of herself and if prenatal screening tests are negative, she's much more likely to deliver a healthy baby than not -- regardless of her age. The rate of fetal deaths has dropped by about 70 percent since the 1960s. That's great news for all pregnant women.
YOUR BODY
The percentage of women who have babies in this age group is .03, and the chance of successful infertility treatment drops tremendously. Just being able to conceive and sustain a pregnancy is an achievement and to some degree a reflection of your own good health. "We all hear success stories of women who had children in their late forties through in vitro fertilization," says Dr. Younger. "But more than half of all pregnancies conceived through IVF in women over age forty are produced through donor eggs."
Once you've conceived, you're more likely to undergo rigorous testing than you would if you were younger. Most pregnant women in their 40s have some stress testing to check their cardiovascular health, and they'll be more closely monitored for signs of diabetes or kidney problems than those in their 20s, says Dr. Younger.
Even if you're in top physical shape, carrying and delivering a baby will be more difficult than it would be if you were in the same physical shape in your 20s. "Pregnancy, in a sense, is like an athletic event," says Dr. Niebyl. "Blood volume nearly doubles, increasing the strain on your heart, and the extra weight puts some strain on your muscles and joints."
YOUR EMOTIONAL SELF
Most women in their mid-40s are concerned about the health of their baby as well as their own health -- with good reason, since there are increased risks for both at this age. But most pregnancies, even among women in their 40s, have good outcomes. The better you care for yourself, the more successful your pregnancy is likely to be.
RISKS TO YOUR BABY
More than half of all pregnancies in women over age 45 end in miscarriage (before 20 weeks gestation). Risk of stillbirth is doubled for women in their 40s, compared with those in their 20s; for this reason, many doctors perform more stress tests and ultrasounds in the last weeks of pregnancy in older women. The chance of chromosomal abnormalities increases sharply. At age 45, there's a 1 in 30 chance of delivering an infant with Down syndrome and a 1 in 21 chance of having a baby with any chromosomal abnormality. In a 49-year-old those risks rise to 1 in 11 and 1 in 8, respectively.
OVER 50
The average age for menopause is 51, but typically the range runs from 45 to 55. Almost all pregnancies beyond age 50 require some assistance, whether from fertility drugs, hormone supplements, or, more often, donor eggs. Women still ovulating usually have to take progesterone for at least the first two months to maintain the pregnancy. Women who have stopped ovulating need donor eggs to conceive and must take estrogen and progesterone for much of the pregnancy, until the placenta begins to produce those hormones on its own.
At this age, there's a high rate of complications -- including hypertension, kidney problems, and placental problems -- that requires strict monitoring and care.
Then there's the issue of the woman's age once the baby is born. We all know 50-year-olds who are more energetic and alert than their 20-year-old counterparts, and they have the added benefit of maturity and experience. But women over 50 may need extra energy -- not to mention stamina -- to awaken every two hours with a newborn or to chase after a toddler.
Statistics show that once a woman has gotten pregnant, if she takes good care of herself and if prenatal screening tests are negative, she's much more likely to deliver a healthy baby than not -- regardless of her age. The rate of fetal deaths has dropped by about 70 percent since the 1960s. That's great news for all pregnant women.
Categories
pregnancy
Friday, January 2, 2009
Pregnancy at 40 to 44
Ages 40 to 44
YOUR BODY
First the good news: A recent study shows that women over 40 who have babies without help from fertility drugs or other assisted reproductive technologies tend to live longer than those who don't. Why? One theory is that estrogen, which is still produced in abundance in fertile women, has life-lengthening effects on the heart, bones, and other organs. However, fewer than 1 percent of women ages 40 to 44 have babies. The chance of becoming pregnant during any one month drops to only 5 percent after age 40.
How well you carry and deliver a baby in your 40s depends on several factors, including your level of fitness, overall health habits, and whether this is your first baby. "The biggest complaint I hear among my pregnant patients in their 40s is how tired they feel," says Jennifer Niebyl, M.D., a professor and head of the department of obstetrics and gynecology at the University of Iowa. "Hormonal changes in pregnancy make all women feel tired, but fatigue seems to be more pronounced in older ones and can be compounded if there are young children to care for."
If you've already had a baby, you may also be more prone to hemorrhoids, pressure on the bladder, prolapsed tissues in the uterus and vagina, and sagging breasts than you would have been 20 years earlier, simply because the muscles and other tissues in these areas have already been stretched. You can minimize these effects by making sure not to gain an excessive amount of weight during pregnancy, keeping moderately active, and doing Kegel exercises to keep your vaginal muscles strong.
YOUR EMOTIONAL SELF
By the time you've reached your 40s, you have a wealth of experience and maturity to draw upon when raising a child. Chances are, you'll also be more patient than you would have been in your 20s. But you'll probably have concerns. "What I hear most often is, 'I'll be so old by the time this baby starts college!'" says Glazer. "Or a couple will look down the road and see that their nest won't be empty until they're 60 or 70. Older parents have to balance feelings of loss of freedom and spontaneity with the joy they'll feel in raising the child."
RISKS TO YOUR BABY
About one-third of all pregnancies in women ages 40 to 44 end in miscarriage. There are several reasons: The eggs may be defective to start with, the uterine lining may not be thick enough, or the blood supply to the uterus may not be rich enough to sustain a pregnancy. The risks of placenta previa (in which the placenta lies low in the uterus, partly or completely blocking the cervical opening and creating a high risk of hemorrhage) and placental abruption (in which all or part of the placenta separates from the uterine wall) are also increased. Babies born to women in their 40s are also more likely to have lower birth weights (under 5 1/2 pounds).
Risks of chromosomal birth defects rise steadily with each year into your 40s. If you give birth at age 40, your baby has a 1 in 106 chance of being born with Down syndrome and a 1 in 66 chance of being born with any chromosomal abnormality. But by age 44, those risks rise to 1 in 38 and 1 in 26, respectively.
YOUR BODY
First the good news: A recent study shows that women over 40 who have babies without help from fertility drugs or other assisted reproductive technologies tend to live longer than those who don't. Why? One theory is that estrogen, which is still produced in abundance in fertile women, has life-lengthening effects on the heart, bones, and other organs. However, fewer than 1 percent of women ages 40 to 44 have babies. The chance of becoming pregnant during any one month drops to only 5 percent after age 40.
How well you carry and deliver a baby in your 40s depends on several factors, including your level of fitness, overall health habits, and whether this is your first baby. "The biggest complaint I hear among my pregnant patients in their 40s is how tired they feel," says Jennifer Niebyl, M.D., a professor and head of the department of obstetrics and gynecology at the University of Iowa. "Hormonal changes in pregnancy make all women feel tired, but fatigue seems to be more pronounced in older ones and can be compounded if there are young children to care for."
If you've already had a baby, you may also be more prone to hemorrhoids, pressure on the bladder, prolapsed tissues in the uterus and vagina, and sagging breasts than you would have been 20 years earlier, simply because the muscles and other tissues in these areas have already been stretched. You can minimize these effects by making sure not to gain an excessive amount of weight during pregnancy, keeping moderately active, and doing Kegel exercises to keep your vaginal muscles strong.
YOUR EMOTIONAL SELF
By the time you've reached your 40s, you have a wealth of experience and maturity to draw upon when raising a child. Chances are, you'll also be more patient than you would have been in your 20s. But you'll probably have concerns. "What I hear most often is, 'I'll be so old by the time this baby starts college!'" says Glazer. "Or a couple will look down the road and see that their nest won't be empty until they're 60 or 70. Older parents have to balance feelings of loss of freedom and spontaneity with the joy they'll feel in raising the child."
RISKS TO YOUR BABY
About one-third of all pregnancies in women ages 40 to 44 end in miscarriage. There are several reasons: The eggs may be defective to start with, the uterine lining may not be thick enough, or the blood supply to the uterus may not be rich enough to sustain a pregnancy. The risks of placenta previa (in which the placenta lies low in the uterus, partly or completely blocking the cervical opening and creating a high risk of hemorrhage) and placental abruption (in which all or part of the placenta separates from the uterine wall) are also increased. Babies born to women in their 40s are also more likely to have lower birth weights (under 5 1/2 pounds).
Risks of chromosomal birth defects rise steadily with each year into your 40s. If you give birth at age 40, your baby has a 1 in 106 chance of being born with Down syndrome and a 1 in 66 chance of being born with any chromosomal abnormality. But by age 44, those risks rise to 1 in 38 and 1 in 26, respectively.
Categories
pregnancy
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