Friday, May 20, 2011

AAP Surprises

There are a few things you may not know are recommended by the American Academy of Pediatrics. Some people get outdated information and others simply misunderstand the language. Here are a couple things that are not considered mainstream (but should be!) that the AAP, who is supposed to be the mainstream 'go-to' (especially for pediatricians) recommends.

The first thing that comes to most minds when they hear "cosleeping" is baby in the parents' bed. But really, that's just one type of cosleeping, referred to as 'bed sharing' to be specific. Another form is to have baby in a crib or cosleeper attached to the bed and yet another is to have the crib in the parents room. The AAP actually recommends that babies spend the first six months of life in their parents' room, in a separate sleeping area (a bassinet, cosleeper or crib). This benefits both the research that cosleeping is better for babies and crib manufacturers, who hate those studies. "Mother and infant should sleep in proximity to each other to facilitate breastfeeding."

Rear-facing for Two Years (and beyond!)

Her chest clip needs to be adjusted a little bit here, but this is Lilly, rear-facing at 2 1/2.
The AAP advises parents to keep kids rear-facing as long as possible, up to the maximum limit of the car seat. The current (new) minimum recommendation is now 2 years. Most people aren't aware that this is the recommendation, because they have been following the minimum law (if at all), much to the potential detriment of their children. Children under 2 who are rear-facing are 75% less likely to be fatally injured in a car accident.

Feed On Cue, Not Schedule
Feeding the wild
There are repeated comments on this in the official AAP guidelines, from "Crying is a late indicator of hunger," to "During the early weeks of breastfeeding, mothers should be encouraged to have 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger such as increased alertness, physical activity, mouthing, or rooting."
Breastfeeding Past the First Year

The AAP's official stance: "There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer."

So there you have a few things you may not have know that the AAP recommends.

Saturday, May 14, 2011

Don't Schedule Cesareans for Breech babies!

Breech presentation is not a valid reason to schedule a cesarean. Yet, whenever a care provider finds a baby in the breech position in the last few weeks before the EDD, they ask the parents to pick their baby's birth day.

Now, people consider breech presentation one of the main reasons to have a cesarean. However, while I'll agree that with the prevailing ignorance of the average obstetrician in catching breech babies, in the hospital, it may be safer to have a cesarean--if the baby is presenting breech in labor.
Babies can turn in the womb as late as in active labor, into a vertex, or head down position. So, scheduling a cesarean is foolish, especially if it's scheduled before your EDD. An EDD is not a good measure of when the baby is coming, unless you see it as the middle of the average: 38-42 weeks. So, scheduling a cesarean for 38 weeks is not a good idea unless you have full placenta previa or another reason that labor must be avoided.

Ideally, you should go on with a breech pregnancy with the belief that baby will turn. You can use the techniques at Spinning Babies to help a stubborn baby point in the right direction. If you are approaching the big day and you've tried positions, inversions, chiropractic care, shining a light down low, etc. and baby is still breech, many obstetricians can perform what is called an external cephalic version.

A version should be a last resort, as it is uncomfortable and comes with its own set of risks, including PROM (premature rupture of membranes), premature labor, bleeding and fetal distress leading to the need for an emergency cesarean. The success rate is around 65%.

Ideally, you will have a care provider who is trained in breech vaginal birth, which 70% of breech babies are candidates for. This is not a 'new' thing. In fact, it is an old skill that has been virtually lost with the popularity of the cesarean. A transverse baby is a definite risk out--you can't birth a baby shoulder first! Footling breech is considered too dangerous by most care providers to attempt a vaginal breech birth. Baby breathes through the cord and it can become dangerously compressed in a breech birth. The likelihood of this in a footling breech is 15-18%.

Frank breech is the ideal for a vaginal breech, as the baby's legs protect the cord. In full-term, vertex babies, 0.4% suffer from cord prolapse. In frank breech, 0.5% will experience this complication. So, you can see the rate is very similar. The next risk comes with complete breech babies, which have a compression rate of 4-6%, a significant rise, though not as dangerous as footling breech.

Ideally, you should give baby time in labor to finally turn vertex. At the worst, if you end up with a cesarean due to an unsafe breech position that will not resolve or you are uncomfortable with the risk of breech vaginal birth, you will have given your baby all the time he or she needed to 'cook' and even a brief trial of labor can give the baby the benefits of labor, which prepares the baby for life on the 'outside.' At best, your baby will turn in early labor and you will go on to have the birth that you desired and that gives your baby the best start in life.

At the very least, you should research your options and remember that you have the right to make this choice! A cesarean is major abdominal surgery. As common as it is, so are complications--for both you and baby. Scheduled cesareans may be more convenient, but they are not safer than vaginal birth (except when labor would be dangerous in the first place).

Happy Birthing!

Tuesday, May 10, 2011

ADHD Doesn't Need a Cure

Some of this is lacking coherent transitions, please forgive my pregnant brain. I also probably should cut off most of the end, but I wanted to get all my thoughts on this subject out in just one entry.

Something that comes up as often as people looking for a cause for autism is a cause for ADHD. Because if there's a cause, like some kind of infection, it can be rooted out and cured. But I don't believe that. I don't believe it's as simple as people want it to be. If you've read any older literature, you know ADHD has been around longer than televisions, ultrasounds, vaccines and artificial dyes. It's not likely any more prevalent today than it was 200 years ago--we just have a name for it now. A 'diagnosis' and a 'fix' (or twenty). When you look for something, you are much more likely to find it than you are when you don't even know it exists.

There's a story that was told by Sir Ken Robinson at a TED talk in 2006:

“And the third thing about intelligence is that it's distinct. I'm doing a new book at the moment called Epiphany, which is based on a series of interviews with people about how they discovered their talent and actually about how people got to be there. It was really prompted by a conversation I had with a wonderful woman who most people have never heard of; she’s called Gillian Lynne. … She's a choreographer, and everybody knows her work. She did Cats and Phantom of the Opera. …

"Gillian and I had lunch one day, and I said, 'How did you get to be a dancer?' She said it was interesting. When she was at school, she was really hopeless. And the school in the 30’s wrote to her parents and said, 'We think Gillian has a learning disorder.' She couldn’t concentrate; she was fidgeting. I think now they'd say she had ADHD. Wouldn’t you? But this was the 1930s, and ADHD hadn't been invented at this point. It wasn't an available condition. People weren't aware they could have that.

"Anyway, she went to see this specialist … She sat on her hands for twenty minutes while this man talked to her mother about all the problems Gillian was having at school. … In the end, the doctor went and sat next to Gillian and said, 'Gillian, I've listened to all these things that your mother's told me. I need now to speak to her privately. Wait here; we'll be back. We won't be very long.' And they went and left her.

"As they went out of the room, he turned on the radio sitting on his desk. When they got out of the room, he said to her mother, 'Just stand and watch her.' The minute they left the room, she said she was on her feet, moving to the music. They watched for a few minutes, and he turned to her mother and said, 'You know, Mrs. Lynne, Gillian isn't sick. She's a dancer. Take her to a dance school.'

"I said 'What happened?' and she said, 'She did. I can't tell you how wonderful it was. We walked into this room, and it was full of people like me: people who couldn’t sit still, people who had to move to think.' … She was eventually auditioned for the Royal Ballet School; she became a soloist; she had a wonderful career at the Royal Ballet. She eventually graduated from the Royal Ballet School and found her own company, the Gillian Lynne Dance Company and met Andrew Lloyd Webber. She's been responsible for some of the most successful musical theater productions in history; she's given pleasure to millions, and she's a multimillionaire. Somebody else might have put her on medication and told her to calm down."*

This principal is trying to work to change people's views on ADHD, which I think really needs to be the goal. The perspective on ADHD needs changing, not the children. It's very defeating to hear that you are a 'problem' that needs to be 'fixed.' Especially when that problem is the way your mind works.

I, too, can think most effectively when I'm in motion--or when I have everything else in the world shut out through music. I put on headphones, point myself at a computer and words pour out by the thousands--no exaggeration. I wrote an entire book in a matter of weeks doing this. I'm only just now learning how to work with the way I think, because I wasn't given the chance to adapt and adjust and know my own mind, from a short time after I was diagnosed with ADHD.

We all know ADHD is highly over-diagnosed. But I think there is a secondary problem, too: a 'mimic' condition that presents as ADHD, but does have a cause. Like heavy metal toxicity emulating autism and being curable, some children diagnosed with ADHD can be 'cured' by adjusting their diet. This isn't a new idea, I first heard about it in the 90s. But I've also seen this strategy fail and it's not a cure-all for ADHD. Because there isn't one.

Because it doesn't need to be 'cured.'

Now, I don't have grandiose ideas about how to help educators deal with the unique needs of children with ADHD. Frankly, I'm not a fan of public schools (largely due to my run in them) or any form of institutionalized schooling, for that matter. Particularly not for anyone with an unconventional mind. I'm not an unschooler, I believe in structured schooling. I think. Ask me when my four year old is closer to eight and maybe I'll have a more firm idea on that. I'm still new at this.

I know that children who must go to school must get along in school. But I strongly disagree that forcing them into patterns of instruction that they do not learn from and giving them drugs for the benefit of others and not the child receiving the drug is the answer. It's not. Concessions need to be made. I don't have the answers as to what--but I believe that's where ADHD research should be focused. Not on drugging away the special way that ADHD kids think, but in teaching educators how to use it, instead.

I think this is easiest for homeschooling families, as they have a wide berth to individualize their teaching and typically don't have 20+ students in one room, trying to learn the same thing. I know I've read at least one homeschooler's blog where she had adjusted for her two sons who have ADHD--they could do their work, right on track with peers, but needed to be able to move around while they did. I wish I could find that blog to link to it, she had such a wonderful outlook and great ideas on alternative education ideas.

Some parents refuse to get the child tested, for fear of a 'label.' I don't think that's helpful for everyone... I know how much labels hurt, but I also know that they help you to understand what's going on to adjust for it. Children without labels are equally stigmatized in school--they just don't get any compassion, either, because they're still going to be labeled: troublemakers. The problem is that some teachers automatically apply that label when they hear "ADHD" but many will have more empathy with the diagnostic label than just their own.

We can't stop teachers from being human. We shouldn't be trying to stop our children from it, either. I don't see ADHD as a psychiatric disorder--I see it as a personality trait. Yes, it's caused by chemical reactions in the brain being different from the average person. So what? We all have different chemical reactions in our brain. Some of us just have more obvious differences than others.

ADHD kids just think differently... and society needs to start thinking differently about ADHD.

*Here, you can watch the entire twenty minute talk, “Do schools kill creativity?” that this story was taken from (about 15 minutes in)