By Dr. David Pommer
Congratulations! You’re surviving parenthood! Your baby or toddler is thriving. Your body has adapted to less sleep, high-pitched shrieks, and some previously unimaginable smells. If you are thinking about having another baby (or if you are hoping to be a first-time mom), what issues should one focus on before a pregnancy?
First, the obligatory disclaimer. I’ll address a handful of issues here, but there is much more that can be addressed and should be individualized for each person. Please see your friendly family physician or obstetrician for complete details.
Folic acid in a prenatal vitamin is key to be taking before you’re thinking of becoming pregnant. Why is it so important? It can decrease the risk of many birth defects, particularly neural tube defects like spina bifida. Specifically, taking 400 mcg per day may decrease the rate of those defects by a whopping 75 percent. But, you need to be on this before pregnancy, as those parts of the fetus are developing early in the first trimester. In general, over-the-counter prenatal vitamins now have this recommended 400 mcg amount of folic acid.
Next, how is your weight? A good objective snapshot is by using a BMI calculator (readily available on the internet). If you are underweight (less than 18.5), there is a higher risk of preterm delivery and low birth weight. If overweight (25 or greater), one can have a larger baby, diabetes, high blood pressure, and shoulder dystocia. As I counsel my pregnant patients later in a pregnancy, we don’t want to find out when pushing that we have a ten-pound baby. As hard as it is, try to optimize your weight prior to conception.
As your baby has been getting shots to be healthy, consider your own immunizations. I would recommend having TDaP and flu shots. If for some reason you didn’t have MMR and varicella shots as a child, those should be updated. And when you get an immunization, try to cry slightly less than your child.
Look closer at the quantity and quality of other things going into your body. Do you drink pop out of a travel container with two handles and wheels? That’s probably too much. Try to keep any caffeine intake to about one serving (or 200 mg) per day. If you smoke, or your significant other smokes, now would be a great time to quit. If you are on prescription medications, talk to your doctor about being on the lowest effective dose, or about if you need it at all. Look for harmful exposures in your workplace. Try to keep fish intake to no more than twice per week.
I would be negligent if I didn’t cover hair dyes. I’m often asked about safety of dying one’s hair during pregnancy, and I respond—we don’t really know. More recently from uptodate.com, these reviewers felt that dyes had very limited systemic absorption, and would be unlikely to cause adverse effects on baby.
Again, I wish those of you congratulations on successful parenthood, and more parenting to come. I suppose the toast can involve single-shot lattes while munching on folic acid tablets (bon appetit!). May there be adequate sleep and manageable amounts of shrieks and odd smells in your enlarging family.
•David Pommer, MD practices family medicine with obstetrics at Selah Family Medicine. He is married with three children.
September 19, 2013 by Scott Klepach
By Dr. David Pommer, MD
On most issues, I speak to you with some experience as a family physician and parent. These are topics that I have counseled parents on and have seen some small victories in my home. On the other hand, I speak more theoretically about the things I have not seen much of or have failed with at home.
Picky eating is one of those latter topics. I have pleaded and cajoled. I have been in your shoes and have not always seen success.
Let’s start with some physiology that I do understand. The rate of growth of our kids slows down around age 12 months. This means appetite usually drops, which allows kids to become pickier. In fact, picky eating is the norm for many toddlers. They may go weeks eating just a couple of preferred foods.
Here are some overarching principles to guide us in this struggle with our picky eaters.
First, try to involve your child in some form of food preparation. This probably doesn’t mean operating the Cuisinart or chopping vegetables, but it may mean choosing between corn and carrots. This investment in the process may make kids more likely to eat at the table.
Second, be patient. It may take 10 or more exposures for your child to try a new food. Praise your child for any attempt to try a new food.
Though this may go against how we were raised, don’t force a child to eat. Stress that what is on the table now is the only thing on the table. Don’t make a separate meal or snack for your child if they don’t eat.
Regarding safety of certain foods, kids can’t grind their teeth well to eat certain foods until about age four. Try to avoid the following until then: raw carrots, raw celery, large sections of hot dog, whole grapes, peanuts and other nuts.
Try to make a variety of healthy foods available. And if your child refuses a food, try another in the future from the same food group. For example, try a deep-yellow or orange vegetable rather than a green vegetable. Not wanting low-fat milk? Try yogurt, cheese or a low-fat flavored milk. Try chicken, turkey, pork or fish instead of lean beef.
Consider adding “eye appeal.” Use a cookie cutter to cut foods into interesting shapes, or add a smiley face on top of a casserole.
In addition, you can present a food that they like along with a food they have refused in the past to see if this increases the rate of success.
You could disguise other foods by adding them into a dish to add nutritional value. This may work with some kids, but others are super sleuths who will detect these unexpected ingredients and perhaps make them pickier.
So I will join you in this meandering journey, of airplane noises while “flying” a spoonful of food to a closed mouth, of puppet shows about the four food groups, of daydreams about large funnels. We will take this journey, with these successes and failures, together.
* David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.
By SCOTT KLEPACH
Parents are protectors, teachers, caregivers and nurturers. These traits add up to another vital parental role: being your child’s best advocate.
Kids at varying ages need parents or guardians to speak up for them to make sure they are receiving the best care, attention or treatment. Sometimes children are too young to physically speak. But even kids entering adolescence may not have the knowledge, experience or social ability to look out for themselves at all times.
The idea of being your child’s advocate is one that gets to the heart of parenting — with all its joys and struggles — because it requires us to wrestle with finding the right balance. Parental advocacy is largely subjective. How involved should I get? What should that involvement look like? Am I hovering or smothering, or do I need to be doing more? Parents will likely ask these questions from their child’s birth to adulthood. It turns out that looking out for your own child can also benefit others.
“Advocacy is always shaped in an individual need that, once met, will benefit the entire group,” says Laurie Kanyer of Yakima, a certified life educator and author with more than 30 years of experience teaching and working with families. “When the parent advocates for an individual child in that situation, there will be common good the entire community will experience.”
Kanyer, who also holds a master’s degree in hearing development, adds the process of advocacy consists of parents doing research, understanding their child’s concern and then accommodating them. Typically, this means parents will let others know about their child’s needs so they can “seek together to find a solution,” says Kanyer.
Knowing your child
Advocacy, continues Kanyer, is “a key parenting skill. When you talk about quality parenting, your job is to look at the needs of your child.”
James Yan and Tina Wang of Yakima understand the need for this type of relationship with their daughters, Joanna, 6, and Susanna, 3.
“We’re Christians, so everything is centered around that belief,” says James. Tina says her family uses the Bible as a source for asking questions, teaching lessons and seeking answers.
A stay-at-home mom, Tina devotes a lot of time talking, singing and playing with her daughters. To her it’s important to maintain an open, honest relationship with them. This dynamic helps the couple understand and protect their children.
“When Joanna has been to school, I will encourage her to share what’s happening at school, to know about her without me around her,” Tina says.
Often, she asks Joanna detailed, open-ended questions to allow her daughter to share more than just one-word answers. Growing up, Tina considered her own mom her best friend, and she sees this relationship playing out with her own daughters with the hope that they will speak with her candidly.
This agreement to communicate helped when Joanna came home from kindergarten one day. Joanna was troubled by some activities older students were playing that conflicted with her beliefs. She felt pressure to join in but refused. Even so, she was distressed not just with what they were doing, but with the pressure and uncertainty of how to respond.
“The Bible says if you don’t have peace in your heart, don’t do it,” says Tina. “We told her to go read a book, find a quiet time.”
“Basically, we try to understand their world better,” says James. “In this world there are so many evil things, and we help them to have the right perspective. But we encourage teamwork, too, to get along, work in teams.” Says Tina, “I feel after we become parents, we have more to learn.”
“Great advocacy is always seen in teamwork,” says Kanyer. “It’s the kid and the parent in one vehicle, a lifelong vehicle to be a support of that child.”
Building outside relationships
Amy Miller, a Yakima mom of Henry, 14, and Theo, 10, knows the importance of establishing relationships with her boys as well as others who come into her sons’ lives.
“Courtesy really goes a long way,” says Miller, who is a stay-at-home mother who spends many hours volunteering at her sons’ schools. “The fact that I helped in the schools helped [build relationships.] People knew me.”
Building relationships was essential for Miller when Henry was diagnosed with Type I diabetes in March 2012, when he was 12. She and her husband, Marty, had to establish and maintain a positive connection with nursing staff at the Yakima School District and other contract nurses.
“We [took] the time to be courteous and friendly,” she says, “and not just rushing in there and saying, ‘This is my situation!’ We were treating them like people, and that went a long way to having them listen to me.”
The Millers’ relationship with one district nurse helped form other relationships. That nurse acted as a mediator between the family and the other contract nurses.
Institutional change usually comes from individuals, when parents spread awareness and bring others in to enact change. But that doesn’t mean doing everything. “Advocating for a child is not doing for kids the things they can do for themselves,” Kanyer says.
Miller is well aware of this need to empower her children. Eventually, Henry was able to learn to watch his diet and take responsibility for his health, step by step, and soon the nurses were convinced he could handle it on his own.
Amy says the district nurse “really laid out a plan for [Henry] and to care for him in school. She complimented him in the work that he did.”
Kanyer’s own example came years ago when her children were old enough to walk to school. She noticed the route they took brought them perilously close to an intersection with heavy traffic.
“I was concerned about my child’s safety, and in addition concerned about other children. I was doing this for me,” says Kanyer, who experienced the pain and suffering of losing a friend from a traffic accident years ago. “I advocated with the school and the school district and the police department to make that road safer for my kid, and we could as a community get to the school so she’s safer.”
Appropriate research helps you teach others, which can build that sense of respect and open up communication. “It helps to educate yourself and know what you’re talking about before you come in and make demands,” Miller says.
Miller participates in a closed Facebook group for parents of children with Type I diabetes. The experience has allowed her to post when she feels inclined, learn about various issues involving her son’s condition and receive valuable emotional support. As an active participant for some time, Miller says she feels she can help others new to the group.
In this digital era, communicating with others can often take place at a distance behind a screen. While texts and emails can be effective, it’s important to practice all forms of communication when it comes to being a great advocate.
“I figured out sometimes an email works, sometimes a phone call is better. You have to stop and think what a situation calls for,” Miller says. “It’s a lot easier to respect somebody when you have to look somebody in the face.”
That respect works for both parents and those on the receiving end, whether they are parents or guardians, teachers, school administrators, coaches, health care providers or other organizational leaders who have influence in a child’s life.
“Every now and then I go to a teacher and shake their hand, so I can get a visual on them and they can get a visual on you,” says Miller. “It’s about learning how to be a relationship kind of person.”
It’s all too easy to get fired up about a situation when it comes to your own child. It’s OK to be upset and passionate, but be careful. Sometimes parents storm into an office with the intention of protecting their child, but attacking another person is never acceptable. Be sure you have built up relationships and learned about the situation as much as you can to help you approach the situation tactfully. Any given meeting can turn into an educational process for you and provide you with even better ways to help your family.
“Advocacy is not militancy, while it can feel militant, typically for a parent because strong emotion is associated with it … some pain or suffering or concern,” says Kanyer. “It’s a skill to take that pain and suffering and concern, and to take that to someone else who can feel compelled to help. It’s really individual social justice at its very core.”
Try volunteering, too
While it’s not direct advocacy, volunteering is one way to be more involved in your kids’ lives. Parents can volunteer at schools and other places and in many different ways. Whether it’s an infant’s daycare or an elementary classroom, being present and offering a hand is one of the best ways to be educated and address concerns.
“After second grade, I started volunteering in the library,” Amy says. “I still found a way to help in the school in a different way, and I wasn’t hovering over my own kids. It gave me a way to get to know the school staff.”
Parents can also find volunteer opportunities outside of school, such as with a soccer organization, church or camp.
“It’s kind of nice if you have talent as a parent and can help out in some local way,” Amy says. “Don’t you just love when there’s another helpful adult in your child’s life? Volunteering has been a good way for me to build relationships, not just with my own kids, but with other kids.”
Catholic Family & Child Services. Various family resource programs including early learning and mental health services. 5301 W. Tieton Drive, Yakima; 509-965-7100. cfcsyakima.org
Dispute Resolution Center of Yakima & Kittitas Counties. Mediation work and conflict resolution services, including family mediation. 303 E. D St., Yakima; 509-453-8949. drcyakima.org
Children’s Village. Many programs, services and screenings offered for kids with special needs, developmental needs and other support groups. 3801 Kern Way, Yakima; 509-574-3200. yakimachildrensvillage.org
211. Need help locating the right support or social service agency? Dial 211. Local, bilingual operators can point callers to
appropriate agencies for health care, childcare, schools, housing, job training, recreation, retirement, disability and social service information. Call weekdays from 8 a.m. to 5 p.m. If 211 is not available from your phone, call 877-211-9274.
Washington State Family Help Line. Confidential parenting support. Parent Trust: 800-932-4673
Laurie Kanyer recommends Charles Smith’s book, Raising Courageous Kids: Eight Steps to Practical Heroism (Sorin Books, 2004).
Smith is a parenting expert and professor of family studies and human services at Kansas State University. Smith offers parents ways of empowering their own children by sharing stories and providing straightforward steps to follow.
The paperback retails for $14.95.
By JILL ST. GEORGE
I know I’m not alone when I say there are times when we feel defeated as mothers. We go, go, go, and forget to take time for ourselves. But sometimes all it takes is a simple mood-booster to pull us out of our parenting funk. So why not start at home? Here are a few ways to add some happy to your house.
• Color me yellow! Studies indicate that yellow is the color of optimism and joy. Toss in some honey-colored throw pillows or paint a sunny yellow wall to create an uplifting and energetic environment.
• Treat yourself! When you’re out and about, buy yourself a bouquet of flowers. Not only do they look and smell pretty, they have a positive impact on your emotional well-being.
• Oils are essential! Peppermint clears the mind, while lavender helps you unwind. Aromatherapy is a century-old practice, used for mood-enhancement, balance and well being. A spritz of sweet orange oil is sure to lift your spirits.
By DR. DAVID POMMER
What does your back to school shopping list look like? Number 2 pencils, glue sticks, Pee Chee folders or even (if you can find one) a Trapper Keeper? Before you head to the checkout line, let’s take a detour to the breakfast aisle.
Breakfast is an important way to prepare for the school day as well.
About 8-12 percent of school-age kids skip breakfast, and in teens this number creeps up to 20-30 percent. Many kids will opt for sleeping in an extra 15 minutes rather than eating a bowl of cereal. Some may choose to skip breakfast to try to lose weight (this typically backfires; more on that later).
We do know there are many benefits to eating breakfast. Children do better in school, have increased concentration and more energy. The fiber consumed can help with weight control and lower cholesterol. Calcium builds stronger bones (helping children for decades to come) and Vitamin D helps with absorbing that calcium and may boost immunity.
The misconception of weight gain from eating breakfast was debunked in a 2008 study in the journal of Pediatrics. This study showed teens who ate breakfast daily had a lower BMI (body mass index) than teens who never ate breakfast or occasionally ate breakfast.
Before we discuss what to eat, let me address things that might be in our shopping carts that we should take out. First, if your child has energetically argued that a marshmallow-based cereal is a critical part of the four food groups, kindly explain to him that it is not, and remove it from your cart. The nursery song goes, “Do you know the muffin man?” Well, we probably shouldn’t. If your toaster is exclusively used for Pop Tarts, that habit should probably change. And if you are giving your breakfast order at a drive-thru window, that habit should change as well.
What are some healthy alternatives?
One of my favorites is dry cereal that I throw in a sandwich bag and eat on my commute. This could include oat squares or mini-wheat biscuits. Cereal bars and granola bars are also healthy options. Fresh fruit, dried fruit and yogurt could also be eaten on the way to school. Try toast with peanut butter, or spread peanut butter on a pancake and roll it up. Even though our culture has frowned upon carbohydrates in general, kids need healthy carbs to give them energy for the school day.
Ideally, the more food groups you can have for breakfast, the better. And if you can sit down and eat breakfast with your child, that would be marvelous. If there’s not enough time for breakfast, earlier bedtimes may be in order (perhaps for both you and your child).
As a parent, you set the best example of what your child should be eating for breakfast. If this article has been good food for thought, keep it in the front of that new Pee Chee folder. You may now head to the checkout line.
* David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.
June 26, 2013 by Scott Klepach
Here’s a chance for boys and girls ages 11-13 to get trained to babysit.
This summer, Yakima Valley Memorial Hospital will offer several Safe Sitter classes. The one-day class runs 8:30 a.m.-4:30 p.m. July 11, 19 and 25 and Aug. 1.
Students will learn safe and nurturing techniques, behavior management skills and how to handle emergencies with children. While students will not become CPR-certified, they will learn infant and child CPR and choking child rescue techniques.
The cost is $40 per person, which covers the one-day class, a Safe Sitter manual and a completion card. Registration is required is open online at yakimamemorial.org/safesitter.
The classes are held at Children’s Village, 3801 Kern Rd. in Yakima. Call 509-225-3179 for more information.
May 28, 2013 by Scott Klepach
By Dr. Pommer, MD
For you faithful Playdate readers, which I’m assured most of you are, you may recall my column on sweetened beverages last summer. Though soda may taste good, your dentist likely doesn’t want you to gargle with it. It’s best to limit your soda consumption in the summertime.
In addition to avoiding soda and sweetened beverages, what else should we know about keeping your toddler hydrated in the summer?
First, water is your friend. Water doesn’t have the excess calories of other beverages — or the potentially harmful stimulants of some sports and energy drinks. Tap water should be just fine for most people in the Valley. I can’t condone the extra expense of buying bottled water. Plus, tap water in your own water bottle is more environmentally friendly than buying bottled water. If your toddler has a discriminating palate, serve chilled or with ice.
Second, consider making a “fluid schedule” for a child. Make sure your child is well-hydrated before you go out in the heat by offering water ahead of time. Give water frequently when outside, and even more when it is hot and your young ones are sweating. And give water after the outside activity is over.
How much water should your child drink when active in the heat? Here are some examples for older kids. An 88-pound child should drink 5 ounces of cold tap water every 20 minutes when exercising in hot weather. For a 132-pound child, this should increase to 9 ounces of cold tap water every 20 minutes. Another rule of thumb: 1 ounce is about two kidsize “gulps” of water.
This is all well and good, unless you are reading this article for the first time at an outdoor sporting event and wondering if your child is dehydrated. Are you too late? What should you look for in a dehydrated child?
Let’s talk about heat exhaustion. This syndrome is characterized by headache, weakness, dizziness, vomiting, a fast heart rate and a fast breathing rate. If you are seeing these signs and symptoms in your child, it’s best to stop the activity, drink a lot of water and get to a cool environment.
But if your toddler is not overheated and well-hydrated, a sure sign is a full pull-up. In other words, toddlers who are urinating frequently show they are well-hydrated. I remember a professor in medical school who stated that happiness in the ICU is a full Foley catheter bag; if the patient’s kidneys are working, he is not in septic shock. Similarly, make sure your child is drinking plenty of water so that he or she is urinating frequently.
So, when the temperature starts to soar this summer, be sure to reach for water if you or your toddler is in need of hydration. Your body and your physician will appreciate your choice.
* David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.
April 30, 2013 by Scott Klepach
The summer session of DivorceCare and DivorceCare 4 Kids starts May 11 and concludes Aug. 3.
DivorceCare is a support group for adults who are divorced, separated or reconciling. Both adult and children (ages 5-12) sessions take place at the same time.
Participants are not required to attend every week, and can come at any time during the series since each week covers a new topic. The sessions are free, but the workbook that corresponds with the program costs $15. Other social activities are planned outside of the weekly meetings.
The summer support group has a new meeting time and location, from 6:30 to 8 p.m. Saturdays at Rose Street Community Center, 109 Rose Street, Union Gap. Several contacts are listed: Tom Burke, 509-930-7074; Tracy Johnson, 509-930-5855; Dan Whitney, 509-930-1420; Mary Whitney, 509-930-1421; or firstname.lastname@example.org.
You can also find out more information on the support group’s website at yakimadivorcecare.net.
March 14, 2013 by Scott Klepach
By Aubrey Does, Frugal Yakima Mom
As new parents, we were absolutely filled with excitement when the doctor gave us the go-ahead to feed our son his first baby food. The initial joy wore off rapidly as we realized that it was not easy to get a baby to eat and it was majorly time-consuming. The “baby food stage” quickly became my least favorite and I longed for the day he could feed himself. Spending 50 cents on a jar of food was no big deal when I knew there was convenience involved.
Fast-forward to my second son. By the time he was ready to eat, I was much more budget-conscious. I also knew what feeding the baby involved and waited a full two months longer to start than I did with my first son. Around this time there were two big events that were a turning point in my decision to make my own baby food.
1. The “Baby Bullet” was invented.
2. A real-life mom friend of mine introduced me to the idea of using frozen food.
She explained how she bought bags of frozen fruit and vegetables and pureed them in her blender. Whaaaaaaat??? I had been picturing picking through fresh produce for the purest of the species and then taking them home for a cooking experiment that involved some sort of seven-pan medley on my stove top.
After discussing it with my hubby, I decided to purchase a Baby Bullet. You don’t have to have this item to make baby food, as any old blender will do, but I didn’t have anything so I went for the one that was cute and came with a ton of storage containers.
I’m sure that there are really attentive moms who only select the freshest organic produce for their baby’s sensitive belly. I just went straight for the store-brand bags of frozen veggies and tried to buy in bulk when they went anywhere lower than 75 cents a bag. For fresh produce that can’t be frozen (like bananas and avocados), he mostly ate what went on sale that week.
There are lots of different foods you can feed your baby, and it’s up to you to decide in what order you introduce those foods. One example is peas. These you can buy frozen and they were super easy to whip up. I just dumped the peas into a strainer in my sink and shot them with water until they weren’t frozen. You could also just leave them there to thaw. I put them into the blender with a little bit of water and pureed until smooth. Voila! One small frozen bag of peas made 4-6 servings of food. You basically use this same method for any kind of frozen veggies that are good for babies.
Another example is a fresh food like bananas. These I would just break into chunks, throw into the blender with a little water and puree until smooth. Voila! One banana is 2-3 servings of food. Bananas brown easily, so this is more of an “as-you-go” food.
Some of you may be thinking that you would rather use fresh produce. Or you’re thinking about your garden full of food that you want to use because it’s free and organic. If you have a baby young enough to just start eating solids and a garden that’s producing food, kudos. The general principle on using fresh produce (such as green beans, carrots or potatoes) is to boil until tender enough to puree and then puree with a little water until smooth.
The consummate resource for all things baby food is www.wholesomebabyfood.com. It has extensive info on feeding babies and exactly how to cook each type of food. It has way more than I can give you in one article, and you’ll find some really creative recipes!
Storing the baby food you make is easy. You can use any type of reusable container (for glass, make sure it’s labeled freezer-safe). Another popular method of storage is using ice cube trays. Pour a little of your prepared baby food into the wells of an ice cube tray, cover with plastic wrap and freeze. Then move the cubes into a plastic bag and store in the freezer until you’re ready to thaw and use.
I hope I have given some good pointers to get started. If you think this is something you want to try your hand at, make a small batch to start and see how it goes. The best-case scenario is that you’re on your way to making all of your own baby food for a fraction of the cost!
* When she’s not chasing two very busy little boys, Aubrey Does loves drinking coffee and blogging deals. You can read more of her frugal adventures at frugalyakimamom.com.
March 14, 2013 by Scott Klepach
By Dr. David Pommer
A recent photo from a relative of an infant suffering from a rash reminded me of how common skin changes are in newborns. Fortunately, most are benign. Let’s take a few moments to cover the most common rashes: erythema toxicum neonatorum, baby acne, heat rash, cradle cap, stork bites and the infamous diaper rash.
Erythema tocixum neonatorum (ETN) is fairly common, occurring in 40 percent to 70 percent of newborns. It shows up about two to three days after birth. These red bumps cause the baby to have a “flea-bitten” appearance. The rash covers the face and trunk and no treatment is needed. It tends to improve within one week.
Baby acne (acne neonatorum) occurs in about 20 percent of newborns. It may be due to high hormone levels in mom and baby. Focused on the forehead and cheeks, it tends to improve by four months of age without scarring; no need to purchase “zit cream” while buying your diapers.
Heat rash (miliaria rubra) is caused by a deep level of sweat gland obstruction. It appears on covered portions of the skin. Treatment includes removing excess clothing, cooling baths or avoiding situations that cause overheating.
Cradle cap (seborrheic dermatitis) involves redness and greasy scales on the scalp. This tends to improve over several weeks to months. You can use petroleum jelly to soften scales so they are more likely to comb out with a soft brush. Other treatments include use of a tar shampoo or soaking the baby’s scalp with vegetable oil overnight and then washing with shampoo in the morning.
Stork bites (nevus simplex) are a vascular (blood vessel) birthmark. These can be on the back of the neck and scalp. They are benign and most go away by 18 months of age.
Finally, diaper rash. I’m often asked by new parents for the best remedy. If it’s mild, frequent diaper changes and using a zinc oxide cream, such as Desitin, or leaving the diaper off for short periods of time (hopefully you don’t have new carpet) can treat it. If it doesn’t improve and there are distinct red spots on the diaper area, stomach and thighs, it may be time to see a doctor and to start a medicine for yeast infections, such as clotrimazole.
There are many possible rashes in newborns. Fortunately, these tend to be self-contained and don’t indicate a more serious problem. Don’t follow my example as a new parent and reach for your loofah. Just give it some time and most rashes will improve on their own.
February 13, 2013 by Scott Klepach
By Dr. David Pommer
As we ponder our New Year’s resolutions from a month ago and slowly consider coming out of hibernation, let’s take a moment to reflect on times we were physically active as youth.
Perhaps it was in organized sports. Or it was a weekly race to catch the ice cream truck before it got to the next block. If you were like me, it may have involved evading dodgeballs while trying not to shriek in terror and lose bladder control.
Whatever your experience, hopefully we can collectively promote memorable physical activity for our kids that will develop into lifelong habits.
Exercise (“physical activity”) recommendations from national groups may be more than you would anticipate. The American Academy of Pediatrics recommends 45-60 minutes of activity “as many days as possible” (healthychildren.org). The Centers for Disease Control recommends 60 minutes or more every day for kids.
So how can kids come close to making the grade? First, let’s talk about scheduled times for activity, then how to add or “sneak” more activity into other parts of their day.
Time outside is often advantageous. If snow abounds, consider building a snowman or snow fort, cross-country skiing, sledding (and walking back up the hill) or snowshoeing. As the weather warms, transition to playing tag, jumping rope and riding bikes.
Older kids might benefit from the camaraderie of team sports. Try to choose sports with a good aerobic component to them, such as swimming, cross country, soccer and basketball. Check out parks and recreation offerings and the local YMCA.
How can you motivate children without an ice cream truck? For younger kids, denoting times of activity through sticker charting might be a good start. Turning off TVs and all “screens” can be beneficial. Consider imposing a rule that before sedentary activity (i.e. video games or a movie) that there first must be meaningful physical activity. For teens and adults, use a pedometer to count steps (with a goal of 10,000 steps per day) or consider a workout partner. A friend participating in healthy activities can be a great motivator.
Next, how do you “sneak” additional physical activity into a day? My own kids’ preference is to follow a cheeseburger and soda with the accompanying Playland, but I think we can be more creative than that. Walk or bike to a destination rather than drive. If you have a dog, take it on regular brisk walks. Park farther away from the entrance in parking lots and use stairs instead of elevators. Stop by a park or the Yakima Greenway in the midst of errands during the day.
So what memories can you create with your children through healthy activity? What habits do you want to change? Let’s try to resist the lure of the ice cream truck together. Best wishes for an active 2013!
November 28, 2012 by Scott Klepach
Story and photos by Suzanne Voldman
“Your son is allergic to peanuts and tree nuts. You must practice ‘strict avoidance.’ He must have two doses of epinephrine with him at all times. He is at risk for anaphylaxis.”
Those are the words that changed our lives two years ago. Our pediatric allergist gave us a book, some pamphlets and a 5-minute Epi-pen training. He gave us a prescription for Epi-pens and sent us on our way.
By the time we made it to the parking lot, I was sobbing. The words were sinking in and I knew our life had changed forever. My husband, who was still not really sure what had just happened, seemed confused by my emotional reaction. I knew he didn’t really “get it” yet, but the scary reality of the situation sank in for him, too, over the next few weeks as we both educated ourselves on managing life-threatening food allergies.
The diagnosis was in such a matter-of-fact manner that it was hard to comprehend the profound impact it would have on all aspects of our life. The word “anaphylaxis” loomed heavy on my mind. Most people understand that anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death, but for me this word was very real.
The previous year I had seen my mother hospitalized after suffering an anaphylactic drug reaction. She was put on a ventilator for a week and despite the predictions of her doctors, she suffered no brain damage. She recovered, but the future for Abe, my then 18-month-old son, looked terrifying.
I read everything I could about food allergies. I found many online communities that shared valuable information and the empathy and support that none of my friends or family could really give to me. Most of all I desperately wanted to talk to someone personally who understood.
I contacted two friends I had known in high school who had children with food allergies. I wanted someone to tell me the secret to dealing with the fear and anxiety that a food allergy diagnosis brings. They gave tips and advice, sharing ideas about how to deal with birthday parties and pointing out “safe” restaurants and products.
Ultimately, each shared the same advice distilled in this way: “Your son deserves to live his life fully. Do the very best you can to keep him safe by educating yourself and everyone else around you. You will get tired of repeating yourself with friends and family, but that is what you need to do. Don’t let the fear rule your life. Pray.”
While I was still in the pit of grief, this advice seemed rather simplistic and it left me feeling rather helpless. Is this really all I could do? They had been dealing with this for a long time; surely there was some other secret to managing this new life? It took months and months for me to appreciate and understand the wisdom they had shared.
As I researched more, I began to feel somewhat lucky that the only allergies we faced were peanuts and tree nuts. I learned that many people deal with multiple food allergies that severely restrict their diets. Our diets were more limited than one would suspect, however, because although it is easy to remove nuts and nut butters from a diet, “cross contamination” from nut products during the production process makes many more products dangerous.
Foods like ice cream, bakery items and most chocolate became off-limits because the cross contamination risk was too high.
I learned about the real risk of “cross contamination” when my son developed mild hives after eating a pancake mix. There were no nuts listed in the ingredients, but after a call to the manufacturer I discovered that the production line used for the pancake mix was also used for a trail mix containing almonds. “Cross contamination” had been a vague, unlikely concept before this. It is really difficult to imagine that such miniscule particles can be life-threatening, but that incident made it a very real and believable concept. This constant level of scrutiny and fear can make food feel like an enemy.
I was just starting to come to terms with our situation a month after the initial diagnosis when Abe had another reaction to tangerines. The next few months led to new reactions and more rounds of testing. Six months after our initial nut and tree nut allergy diagnosis, Abe had been diagnosed with allergies to peanuts, tree nuts, most legumes (including peas and lentils), peaches, pineapple, kiwi, oranges, tangerines and lemons. I was now one of the “multiple food allergy” moms I had felt sorry for only months before.
I researched obsessively. I talked to other families in online support communities. I read articles, blogs and books that gave tips about reading labels and cooking for children with allergies. I got a lot of answers, but for those six months I became obsessed with questions. Would his grandparents understand and be willing to keep him safe? How will we ever have a playdate? Would we ever be able to leave him with a baby sitter? How will he ride the bus safely? Will I trust his teachers to understand and keep him safe? How will he go to school safely? When he becomes a teenager will he be able to protect himself? Will I make a mistake?
The questions I had were difficult and during that time felt overwhelming. Over the next year and a half I have come to terms with those questions. Most of them have no real answers. My friends’ advice has echoed in my mind. I get it now. This is what I have to do. I don’t like it. I wish it was different. A life of “strict avoidance” is not convenient, and it’s not fun sometimes. Our lives revolve around food, and almost every social situation will involve food.
There are lots of misconceptions about food allergies. I do get tired of repeating the same information and answering the same questions, but those questions are important because the answers I give keep my son safe. Awareness keeps him safe. Teaching others about food allergies is my responsibility now. Every day I work to let go of my anxiety and refuse to let fear rule my life.
My son is probably going to live with this condition for life. I am showing him how to ‘live fully’ with this challenge. I want him to be safe, not live in fear. We try to focus on the food we can eat instead of focusing on food we miss. We eat good, healthy food that makes us happy and is safe for all of us. As parents, we want to be the role models that show him how to advocate for himself without apology or shame. We need to show him how to manage social situations with grace so that as he enters adolescence he feels comfortable doing it himself.
I have also come to terms with the fear that I will make a mistake. I will. I have. It will probably happen again. Part of living with food allergies is knowing this fact and being prepared to deal with it effectively, and so I pray. I pray for the courage and strength to do all of this with grace for myself and others.
The simple advice my friends had given me months before was, in fact, my new strategy for life with food allergies: “Eat, Read, Teach, Pray.”
* Suzanne Voldman is the mother of two boys. She is is a food allergy advocate and runs a local non-profit group that promotes cloth diapering.
Food Allergy resources
Allergic Living magazine. First started in Canada, the U.S. version of Allergic Living kicked off in 2010, and features food allergy and asthma news, personal stories, tips, medical information and recipes. allergicliving.com
Food Allergies for Dummies. By Robert A. Wood, MD. An accessible, thorough book on food allergies. Part of the “For Dummies” series, published in 2007. $19.99 in paperback.
The Food Allergy & Anaphylaxis Network (FAAN). The website offers a wealth of information on all major food allergies and includes a link to a useful pamphlet called “The Peanut Answer Book.” A toll-free number is available any time of day or night if parents need to call to ask questions. foodallergy.org
Kids with Food Allergies. A nonprofit organization that promotes and develops plans for children with food allergies to live nutritious and healthy lives. The group focuses on educating the public about food allergies and providing networking to those with food allergies. kidswithfoodallergies.org
How to Manage Your Child’s Life Threatening Food Allergies: Practical Tips For Everyday Life. By Linda Marienhoff Cross. Another acclaimed and helpful resource book, first published in 2004. $16.95 in paperback.
Mayo Clinic. The website lists the eight most common food allergies and their symptoms. These food allergies are milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. The site also provides tips on reading labels properly and how to allergy-proof your house. mayoclinic.com/health/food-allergies/AA00057
The Nut-Free Mom blog. Jenny Kales runs one of the most popular and informative blogs on the subject of peanut and tree nut allergies. nut-freemom.com
WAFEAST — Washington Food Allergy, Eczema, and Asthma Support Team. Based in Seattle, WAFEAST provides networking, support groups and education for those dealing with food allergies, asthmas and other concerns. wafeast.org
Y-FAST — Yakima Food Allergy/Intolerance Support Team. Brand-new food allergy/intolerance support group in Yakima. Stay tuned for resources, events, and connecting opportunities. Playdate magazine will offer updates.
November 28, 2012 by Scott Klepach
By Dr. David Pommer
As a physician, I get a lot of junk mail. I shudder at the number of rain forests that have been clear-cut so that I can receive glossy brochures of new medicines and esoteric conferences.
Most of the mail hits the recycling bin unread. As I skimmed one magazine recently before its inevitable freefall, I read about a consultant who explained how physicians can see 10 patients per hour. Ten patients per hour? I laughed out loud. I’m lucky if I can see three or four.
Fortunately, I have not had those kinds of expectations placed on me. But your doctor may be under pressure to see more patients and spend less time with each patient. How do you maximize the available time? Here are some tips to keep in mind for that next office visit.
First, let your provider know within the first minute or two what your priorities are. I don’t want to spend 15 minutes talking about toenail fungus, and then find out your child was in the emergency room last week for a seizure. Consider making a list of what you want to address, and share that early in the visit. Be flexible about having everything addressed. You and your doctor can determine the top priorities and hit the high points that day.
Second, bring outside records and prescriptions with you. What happened in the emergency room? And what exactly was that good-tasting pink medicine you were prescribed? This will also save time for nurses, so that they are not playing phone tag with other hospitals or clinics to get old records. By supplying your care team important information, the best decisions on future care plans can be made.
Third, use the art of paraphrasing. This is a two-way street. A good physician will briefly summarize what you’ve told him or her and “check for understanding.” As a parent, you should similarly try to paraphrase your provider’s diagnosis and treatment plan in a sentence or two at the end of the visit. This will give the provider an opportunity to clarify any element that wasn’t communicated clearly.
Fourth, be on time. I know what you’re thinking: why do I have to be on time, but the doctor is almost never on time? I try to apologize readily when I am running late, which is more often that I would like. But if you show up 10 minutes late for a 15-minute visit, that doesn’t provide us much time to address your needs.
Fifth, please limit technology. If you are answering a phone call or texting when we are talking, it makes it more difficult to obtain the information I need so we can make the best plan for your child.
Finally, and this should go without saying, try to see your own provider. Continuity of care is a hallmark of family medicine and makes for the best medicine. Do your best to see your own primary care provider whether it is for preventative care or an urgent visit.
That is, unless they happen to be at a nice conference in Hawaii. Now where did I put that glossy brochure, anyway?
* David Pommer is a family physician at Selah Family Medicine. He is married with three children. It did take him more than six minutes to write this story.
September 20, 2012 by Scott Klepach
Now you can eat for two or three people at Thanksgiving and not feel quite as guilty about it.
That is, if you follow up those meals by participating in Camp Prime Time’s annual Leftover Turkey Trot, set for 10 a.m. Nov. 24 at the Yakima Greenway.
This 5K walk or run (or hobble-while-you-gobble … I don’t think anyone would really mind) will help you lose those calories while gaining funds for Camp Prime Time.
The cost is $20 for adults and $7 for children 10 and under. The fee includes a T-shirt. Call 509-453-8280 for more information, or visit campprimetime.org.
September 20, 2012 by Scott Klepach
By David Pommer, MD
Allow me to present a familiar scene. Imagine you and your significant other are about to take a trip after months of planning. Tickets have been purchased, reservations have been made and bags are packed. The night before departure, your toddler develops a cough. You might be asking yourself, “Why now and what should I do?”
When I first see children with a cough, I often ask questions about other aspects of their health. Do they have a significant fever? How is their appetite? How is their energy level? If these areas are abnormal, my ears perk up: this child may be fairly sick.
Next, I may ask about duration of the cough. Did this start a day or two ago? If the answer is yes, I may lean toward this being a self-limited viral upper respiratory infection. If the cough has persisted for multiple weeks, I may give stronger consideration to pertussis, bronchitis, asthma or other maladies.
Let me walk you through some of the things I look for during an exam that you can look for at home without a stethoscope. Initially, I try to determine if a child is very sick (and perhaps needs to be in the hospital) or if he or she is just feeling a bit under the weather.
If a child is experiencing abnormal breathing, we call this respiratory distress. Here are some signs that your child may be in respiratory distress. First, their nostrils may be flaring in and out due to rapid breathing. The child also may grunt when trying to breathe. When you look at the skin between the ribs, it may move in-and-out quickly; we call these retractions. The fingers and toes may have a bluish hue, suggesting the child is not getting good oxygenation to the extremities. These are all reasons to be seen right away at an emergency room.
I mentioned earlier about appetite and energy level. If a baby or toddler can’t feed well because of difficulty breathing, that is a red flag. A significant decrease in wet diapers suggests dehydration. Finally, if a child is lethargic and difficult to arouse, that is another reason to be seen right away.
For kids with milder symptoms, a question I hear often is will cough medicine help? The answer will vary by physician, but I would say in most cases that cough medicines are not particularly helpful. You would think with the amount of over-the-counter medications available they would be very helpful, but that has not been found to be the case. And in toddlers, some cold medications are no longer made because of adverse reactions.
Sometimes a child can have a significant and persistent cough and when you take them to see a doctor you don’t leave with an antibiotic prescription in hand. That is because many causes of cough do not warrant an antibiotic. Viral upper respiratory infections, RSV (respiratory synctial virus), and bronchitis don’t respond to antibiotics. When you don’t receive an antibiotic, please resist the urge to think negative thoughts about your provider; medical professionals truly have your best interests in mind.
So let’s reconsider the article’s headline: When should you see a doctor for a cough? Long duration, fever, lethargy, poor oral intake and respiratory distress are good reasons to pay a doctor a visit. For less severe and mild symptoms, it might be wise to stick to ensuring adequate rest and good hydration for a few days. If the symptoms don’t improve on their own a visit may be warranted. And if you read last issue’s installment on immunizations, thanks for being immunized against pertussis and the flu; I won’t get to see you quite as much.
David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.
July 25, 2012 by Scott Klepach
Don’t Miss the Point: Immunizations
By Dr. David Pommer
There remain many misperceptions about the benefits of immunizations. As a physician, I take responsibility for informing parents and patients on the importance of this public health defense. And as kids head back to school, I believe this is a good opportunity to readdress immunizations and dispel some of the more common myths.
In medicine, there have been few triumphs as great as immunizations. We have not conquered cancer or vanquished diabetes or obesity. But we do have fewer infections. How often do we see children suffering from polio, measles or meningitis — diseases that were commonplace and deadly for much of the 20th century?
Fortunately, we witness these diseases rather infrequently. However, that trend is slowly changing in areas where fewer kids are immunized.
Here is some interesting data from the Children’s Hospital of Philadelphia (vaccine.chop.edu) about infectious disease in the 1900’s prior to vaccines being widely available. In one year, one could expect:
- Polio to paralyze 10,000 kids
- Measles to take the life of 3,000 children
- Haemophilus to cause 15,000 cases of meningitis — resulting in permanent brain damage for many.
We tend to have a short-term memory about the devastating effects of vaccine-preventable illnesses.
More recently, we have been bombarded with articles and studies trying to link vaccinations with various childhood diseases and disorders — most commonly, autism. In fact, a British journal recently retracted a study from the 1990’s that had fabricated data linking vaccination shots and autism. And what about mercury’s side effects on children? In vaccines, trace amounts of mercury had been used as a preservative. Today, mercury is used only in multi-dose flu shots and there have been more than six studies investigating mercury and autism, concluding that there is no evident link between the two. Vaccines and mercury do not cause autism.
There are also varying viewpoints on the best time to deliver immunizations. One viewpoint is that delaying shots may be better for a child’s immune system. In reality, infants are colonized with trillions of bacteria, and face more immunological challenges in their first week of life then they will from immunizations. Delaying immunization shots is not a recommended practice.
As a parent myself, I understand that many parents may view immunizations as a personal decision. It most certainly is. But the decision to skip or delay your child’s immunizations also affects our community and those around you too. As physicians, we refer to this as “herd immunity.” It is based on a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not yet developed immunity. I’ll provide a brief example to illustrate the importance of this concept:
On most days, my waiting room is filled with children of all ages. Some of those children may be too young to have received certain immunizations. When an older child who is behind or has skipped some immunizations comes into the room with pertussis or chicken pox, this could infect the younger kids (even if they weren’t licking the toys). In contrast, should most or all of the older children be up-to-date on their immunizations, the likelihood of the younger kids getting infected is diminished greatly.
I understand that this is a very short synopsis on immunizations, and I leave myself open to sharp and pointed attacks. But I am a promoter — or a booster if you will — of the immunization process.
Is your response, “ouch!”? If so, feel free to let me know if you see me in the clinic. Or email me at email@example.com.
For more information, go to
June 1, 2012 by Scott Klepach
Sweetened Beverages: Not Ideal for Thirst or Flying
By Dr. David Pommer
The marketers for Red Bull energy drinks use metaphors to depict the benefits of their sweetened beverage. The problem with their slogan — “giving you wings” — is that unlike birds, human bones are not hollow. And with the extra calories these sweetened beverages add to your waistline, any child or adult would find it difficult to “lift off.”
So as warmer weather approaches and kids leave the classrooms for summer break, they will likely find themselves with increased levels of thirst. The question is, what thirst quenchers will they choose? Hopefully this column will give both you and your child the information necessary to make an informed decision.
Sweetened beverages or any drinks that include sugar — such as soda pop, juice, chocolate milk, strawberry milk, sports drinks and energy drinks — pack a lot of calories. And with a growing childhood obesity epidemic, these are not calories they need for a healthy developing body.
Let’s turn to our nutritionist friends for help in crunching some of these numbers:
It takes 3,500 calories to make one pound of fat.
- Your standard-issue juice box has about 110 calories. So, let’s say you had a juice box every day. Over a year, you would gain about 11 pounds.
- A 12-oz. can of soda has approximately 150 calories per can. Over a year, you may gain up to 15 pounds.
- Drinking a large fountain drink or an energy drink could create upwards of 40 pounds of additional weight.
Not only do you need to be concerned about calories, but also about serving sizes. Actual drink sizes have gotten bigger over the years, even as the official “serving” size has remained constant. Today, a “kids”-size drink from a fast-food establishment is about the size that an adult drink was decades ago. If you order a beverage and it comes with two handles and wheels, consider that a sign to send it back. [what comes with two handles and wheels?]
And what about those energy drinks? The truth is, while it may provide a boost of energy, many people consume these drinks for activities that don’t require a lot of energy. One of my colleagues commented on a patient drinking energy drinks to play video games longer. While that may benefit the folks at Red Bull, a sedentary lifestyle compounds the problem of the extra calories from this sweetened beverage. And as a side note, the other additives that give an energy drink its “kick” are not particularly healthy either.
So what can we do? The American Academy of Family Physicians recommends that kids have no more than one sweetened beverage per day. If a child is overweight, this amount should be reduced significantly, preferably to none.
Recently my 11-year old asked to have some sweetened coffee, which reminded me how I can serve as a positive or negative role model. Whether we are aware of it or not, our examples influence our kids’ decisions and choices. (Note to self: put down my juice box.)
So I encourage you to let water, milk and other unsweetened beverages pass your lips this summer. Not only will you and your children drink more responsibly and quench your thirst, I won’t need to explain how weight influences aerodynamics in my waiting room.
–David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.
By Tysa Kihn
My pregnancy was all about the numbers.
I was comparing early blood test results, discovering that my conception date was exactly two years after the date of my tubal ligation.
At that time, I learned that the chances of my pregnancy were 5 in 1,000.
Now, I saw that I was going to have two babies.
But the numbers that meant the most: our boys had a 100 percent chance of dying from Twin to Twin Transfusion Syndrome, if left untreated. Treatment offered a 95 percent chance that one boy would survive, and a 70 percent chance that both boys would survive.
It began at the end of February 2009. Something told me that, in spite of my tubal ligation, things weren’t right. Two blue lines confirmed my suspicion. The next two weeks were spent in and out of the lab and waiting for those numbers to tell us if it was a viable pregnancy.
Finally, an ultrasound confirmed that we were having a baby. It was a big adjustment, and even more so when at nine weeks an ultrasound showed two babies.
Life became busy after my husband Dana’s eye surgery and recovery. Distracted by caring for him, I ignored how my belly seemed to have grown rounder and heavier almost overnight. Walking became difficult, and my back was so sore. I attributed it to being over 30, and carrying two babies instead of one. I reasoned that it wasn’t just because I was having twins; I was working full time, chasing around two older kids, so my body was complaining.
We went in for the big gender ultrasound at 18 weeks. We couldn’t wait to find out whom we would be meeting that November.
It was during the ultrasound I began to realize something was wrong. Baby A measured right on. But Baby B was measuring behind in growth. The ultrasound tech couldn’t get many measurements; my baby hardly moved. She couldn’t even find his bladder.
With each measurement, the words Twin to Twin Transfusion Syndrome came to me. I’d read that it was a risk in identical pregnancies, and that it wasn’t good. I didn’t want to believe that’s what we were seeing, but when Dr. Rowles came into the room, I knew by the look on his face what he was going to say.
It was a Tuesday, the day before our ninth anniversary. All of a sudden the world seemed to be crashing down on us. The babies that we never expected, and never thought we wanted, were now so dear and we could lose them.
Two days later, we were at the University of Washington with a full day of examinations. I was scheduled to see Dr. Walker at Eastside Maternal Fetal Medicine in Kirkland first thing Friday morning, one of only a handful of doctors that perform the surgery to treat TTTS. I didn’t know then how lucky we were not to travel several states away for surgery, like many parents.
TTTS happens only in identical twin pregnancies when the twins share a placenta. Due to the shared placenta, there are often blood vessels in the placenta that cross each other. In TTTS, one baby begins to get too much blood and becomes the recipient twin. The other baby doesn’t get enough blood, and is called the donor. The donor becomes malnourished, while the recipient begins to have heart issues from the stress.
The fear that we had for the lives of our sons lessened once we met with Dr. Walker’s staff. They went through a huge binder explaining the surgery, and were very clear on the numbers. He determined the boys were in stage 2. Stage 4 means death. Dr. Walker was committed to saving our babies, and surgery was scheduled for Monday, June 15, 2009.
I thought I would be a wreck that weekend, but instead I was filled with a calm spirit. Monday morning, we watched on a screen as a fetal scope was inserted into my belly, and methodically each shared vessel was lasered. Once they felt that they had separated all the vessels, and drained a liter of fluid from Baby A’s amniotic sac, they turned the camera on the boys. We were able to see our boys’ faces and elbows and feet. It was amazing. The next day I could already tell how much lighter I was, and how much smaller my belly was.
The next few months were full of doctor visits in Seattle. Once I had reached 32 weeks I was considered in the clear and my appointments were moved back to Yakima. On October 15, Bryce Walker (Baby A) and Brendon Quinn (Baby B) were born. They were 6 pounds 3 ounces and 5 pounds 6 ounces, respectively. The delivery was a recommended C-section, and after the doctors and nurses checked out the placenta, still bearing the marks of surgery, it was packed up to be sent off for study.
Too many parents lose their twins to TTTS. Their obstetricians don’t know what to look for. The moms don’t know what to look for. By the time it is determined something is wrong, it is too late. If I had known some of the warning signs, I may have been able to request an ultrasound earlier.
If you learn you are pregnant with twins, ask the doctor if they could be sharing a placenta. If so, regular ultrasounds are a must. The near overnight growth of my belly was a sign of TTTS. The extreme lower back pain and exhaustion were signs of excess amniotic fluid weighing my belly down. I didn’t know that, and if I’d had another doctor, we may not have known until it was too late. Instead we had the best medical care all around, and two fantastic boys to prove it.
Video of the surgery and the boys can be found on Tysa’s blog, dtkmkihn.blogspot.com.
March 22, 2012 by Scott Klepach
Autism: when a winter coat tastes like a marshmallow
By Dr. David Pommer
April is Autism Awareness Month. In this issue, I present a definition and a few issues regarding this disease.
Autism is becoming more and more common. Approximately one in 110 children has autism, affecting four times more boys than girls. And the challenges we face will grow right along with these children as they become adults who might require long-term assistance.
Defining autism is kind of like nailing Jell-O to a wall. In fact, the medical community will likely have a modified definition in a few years. With several different types of autism, it is actually a spectrum of diseases. Three core features characterize the spectrum: delays in social interaction, impairments in language, and restricted and repetitive behavior.
Perhaps because autism can look so different between people, there is still some disbelief. There are segments of society that feel that autistic children are products of poor parenting or a misguided medical community.
My wife and I are more aware of autism than we would like to be. Our oldest son, Josiah, has autism. I’ll use Josiah’s story to illustrate and explain the three core features.
First, his social interaction was different when he was a toddler. He had limited eye contact. Most children learn how to coordinate the use of eye contact, facial expression, gestures and language together as they grow up. This is nearly impossible for those with autism. Usually, when you point out something to a toddler, the toddler will look at the object. Josiah was more fascinated by the finger being pointed. He couldn’t develop peer-to-peer relationships well, which still affects him today.
Second, he has had language impairments. His first words were delayed. Normal speech development starts by age 1 with some words, growing to 10-20 words by 18 months. Josiah was still working with a small handful of individual words at age 2 while his peers were starting to combine words. He also has echolalia, evidenced by wanting to repeat words said by a teacher or a public speaker. This makes school, church and going to movies problematic.
Finally, he has restricted and repetitive patterns of behavior. He fixates on certain patterns (for example, he can only wear a particular article of clothing on a certain day of the week), which makes it harder for the household to function. Regarding repetition, he often asks the same question again and again and watches the same video over and over.
All of these traits combined to produce some interesting life moments, like when Josiah put his mouth on another student’s coat. Granted, I had not sat my son down to explain that we don’t eat inanimate objects, particularly other people’s coats. But as we got more information from him, we learned that he was hoping that the coat, which was made with a puffy white material, would taste like a marshmallow. No such luck. Lesson learned.
If you are concerned that your child shows signs of autistic behavior, your doctor can screen your child for autism by age 2. And if you are around parents of children with autism, please extend some extra grace. It will be appreciated.
I remember the tidal wave of emotions I felt after the birth of our first child. The fear and sense of responsibility driving home from the hospital. The sense of wonder watching him gaze at his surroundings. The joy in my heart seeing him coo or smile. Except for the times he had projectile vomiting, I wanted to be around this little guy all the time, awake or asleep. And so I was first confronted with the issue of co-sleeping.
Let’s first define what co-sleeping is in regards to this article. Co-sleeping is when a parent sleeps next to his/her infant in the same bed. (Incidentally, my least favorite form of co-sleeping is in a motel room with family — usually because there is little sleep.)
What are some of the potential benefits of co-sleeping? Moms may not need to get out of bed to breastfeed. It may deepen the relationship between mother and child. And some may sleep better in this arrangement.
But studies indicate there are pitfalls to co-sleeping as well. The most important potential danger is SIDS (Sudden Infant Death Syndrome). Co-sleeping becomes more dangerous when parents use tobacco or alcohol or when a parent is overly tired or sleeps on a couch. The United Kingdom Department of Health advises that the safest place for an infant to sleep is in a crib in the parents’ room for the first six months of life. Similarly, the American Academy of Pediatrics, in a November 2011 report, recommends that baby can sleep in the same room as parents, but not in the same bed. Sharing a room is OK, but sharing a bed is not.
Let’s re-examine some of those purported benefits. If co-sleeping works while baby is small, fast-forward a year to when that toddler needs to graduate to his or her own bed — that could be a more difficult task. There are other ways to bond, as well: taking a walk, reading a book or playing games.
And on a related note, please place your baby on his or her back to sleep, and avoid blankets and toys in the crib (please see healthychildren.org for more information). The above AAP report also notes that immunizations and breastfeeding are associated with a lower incidence of SIDS.
Many mothers go the extra mile in pregnancy, avoiding over-the-counter medications, caffeine, soft cheeses and fish. Parents fill their homes with safety latches, gates and CO2 detectors. I would challenge parents to think of co-sleeping as a similar safety issue, where good choices can potentially save lives.
David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He co-sleeps with his pager, and he is happily married with three children.