Ask The Doctor

My baby is 22 months now and is still breastfeeding

08-04-09t:04:z

Dear Dr. Markel,
My baby is 22 months now and is still breastfeeding. I thought he would stop on his own but he refuses to stop and doesn't really like milk and worst with soy. He also still feeds at night. He sleeps in our bed so when he wakes he wants to feed. I've tried not giving it to him but he cries and cries and I'm already sleep-deprived to I give up. Any advice?

]]> Dear Concerned,
Today, mothers are often separated from their own parents and siblings, and have fewer people to turn to when they feel tired, ill, or simply in need of a break from child tending. Probably nowhere do cultural expectations and the reality of children’s needs conflict more than in the area of sleeping behavior. Because of these factors, a baby’s needs can feel emotionally and physically overwhelming.

All babies normally wale up several times during the night. It seems that your baby has never learned how to fall back to sleep on his own. Children learn to associate a certain sequence of events with falling asleep, such as being held, sung to, rocked, or nursed. Babies can become dependent on these learned routines and they can't fall asleep until they experience the accustomed sequence. This is what is called "sleep onset association" If you have always held, nursed or rocked the baby until he is completely asleep, this has become a habit and he relies on that. You find yourself having to do that same thing several times at night.

In the case of a 22 month old, there is an element of separation anxiety. When he wakes up in the night, he knows that you must be nearby, so he wants to be comforted by you, to feel safe and secure. If you are anxious and exhausted, I suspect that these feelings are transmitted to the baby who then becomes anxious and upset.

You are obviously a concerned and loving mother. As you approach this situation with confidence, you will be less anxious yourself, and able to take control. Particularly if you keep the baby in bed with you, in a firm but soothing voice you can let you baby know that you love him but that this is sleep time, that mommy is tired and that there will be no rocking but that you are together.

In general, when evaluating a particular method, ask yourself if this advice sounds sensible. Does it fit your baby’s temperament? Does it feel right to you? I suggest that you follow your instincts rather than some stranger’s sleep training advice. You and your baby will eventually work out the right nighttime parenting style for your family.

If your current routine is not working for you, think about what changes you can make in yourself and your lifestyle that will make it easier for you to meet your baby’s needs. This is a better approach than immediately trying to change your baby. Advice that promises a sleep-through-the night convenient baby involves the risk of creating a distance between you and your baby and undermining your mutual trust. Babies are adaptable and most will eventually adjust to whatever method seems to fit your lifestyle. The most important thing is that the baby not lose the sense that his needs will be consistently met by a loving and nurturing caregiver.

My 16-month-old son is still not sleeping through the night

08-03-26t:03:z

Dear Dr. Markel,
My 16-month-old son is still not sleeping through the night. I've established a bedtime routine, which we follow each night even if it's off by a minute or two, and it's helped with bedtime, but not with his sleeping. He gets up 2-6 times each night, and while he doesn't night-nurse anymore, he still wants to be held and/or
rocked. And if that doesn't work, he wants to sleep with me. He's such a restless sleeper that I don't get any more sleep than I do when he sleeps in his crib.

I feel like I'm losing my mind because I'm so sleep-deprived, but nothing has worked. I'm dead set against the Let-them-cry method, not only because we have a common wall with our neighbors, but because that's just not the kind of parent I aspire to be. On the flip side, I'M EXHAUSTED and don't know what else to do, especially since he consistently naps for a couple hours each day.

I even tried a homeopath when my son was around 9 months old, but his remedies didn't make a difference.

Is there a such thing as a pediatric sleep specialist? Would we benefit from seeking and consulting one? I live in the San Francisco area and am open to new ideas. ]]> All babies normally wake up several times during the night. Usually they move around a bit, perhaps look about drowsily, and then fall back to sleep. If for some reason they have difficulty falling back to sleep, they may become upset and cry.

Difficulty falling back to sleep can have several causes. Sometimes the problem arises because the baby has never learned how to fall asleep on his own. Whatever you have done to help your baby fall asleep in the past, he may come to rely on that as a sleep-onset association. You find yourself having to do that same thing several times at night.

In other words, children learn to associate a certain sequence of events with falling asleep, such as being held, sung to, rocked, or nursed. Babies can become dependent on these learned routines and they can't fall asleep until they experience the accustomed sequence. When a parent always holds or rocks the baby until he is completely asleep, the baby develops a habit of having to be in a parent's arms before he can fall asleep. This is called sleep-onset association: The baby associates the feeling of being held with the process of falling to sleep. Without the holding, he simply can't fall asleep.

Part of their so-called "sleep onset association" might be being in a certain place. For example, if your son falls asleep with you in your bed he then can't fall back asleep in his crib in the middle of the night. Is there a reason that you cannot simply keep the baby in bed with you during this time? Many advocates of the family bed are strong believers that this is the best way to give babies the security that they crave and avoid sleep problems altogether.

In the case of a 16 month old, there is an element of separation anxiety. When he wakes up in the night, he knows that you must be nearby, so he wants to be comforted by you, to feel safe and secure. If you are anxious and exhausted, I suspect that these feelings are transmitted to the baby who then becomes anxious and upset.

The key to getting your baby to sleep might be to be less anxious yourself, to feel confident in your abilities as you approach the situation with firmness. Particularly if you keep the baby in bed with you, in a soothing voice you can let you baby know that you love him but that this is sleep time, that mommy is tired and that there will be no rocking but that you are together.

Pros and Cons of Vitamin K

08-02-27t:02:z

A reader has asked about the necessity of the Vitamin K injection. The practice of administering Vitamin K injection to the newborn in the delivery room was instituted in hospitals during the era of routine mother-infant separation. Although controversial in other countries, injection of the newborn with Vitamin K right after birth is almost universal in the United States. The rationale for this is that newborns are born with a "deficiency" of Vitamin K, which they also do not receive in breast milk. This leads to a decrease in Vitamin K-dependent blood coagulation factors, making newborns more susceptible to hemorrhage in the first several days of life until Vitamin K is manufactured in their systems.

]]> A small dose of 1 mg seems to have no ill effects on the baby beyond the pain caused by the injection itself. If newborns are allowed to breastfeed soon after birth, the injection of Vitamin K is less necessary, since the colostrum that comes immediately from the mother's breast before her milk lets down is usually rich in Vitamin K. Some midwives feel that the risk of cerebral hemorrhage is heightened in very fast or very long labors, when the baby has a strongly cone-shaped head, or when the baby demonstrates significant heart-rate decelerations during late labor. However, breastfed babies born with "easy births" do not necessarily need Vitamin K.

The pain that the individual newborn feels from a shot with a needle, although a real consideration, is not usually taken into account. Although some hospitals do allow oral Vitamin K instead of the intramuscular injection, the general medical practice has been to standardize the Vitamin K injection for all newborns, just as newborns are given antibiotic prophylaxis to prevent blindness in the assumption that the mother has gonorrhea.

It might be said that the standardization of the Vitamin K injection and indeed all the routine procedures performed on the newborn baby reinforce the messages to both baby and mother that nature is inadequate, that they are now dependent on the medical profession for their health.

How can I get my daughter to latch on to my breast?

08-02-27t:02:z

Dear Dr. Markel,
How can I get my daughter to latch on to my breast? She is three weeks old and we have been using a breast shield, and sns to feed her. We have started giving her bottles when I can't take it anymore. She is really fussy when she eats even with the shield. Any advice?

]]> Dear Mother,
For a successful breastfeeding experience, avoid breast shields. Offering the baby something other than the breast interrupts the natural rhythm that takes place for breastfeeding to work. Breast milk supply is dependent on the amount of stimulation the nipple receives from sucking. Milk supply can be easily altered by the use of breast shields where the baby is not sucking directly on the breast. Moreover, there is more to breastfeeding than sucking. The baby uses the jaw for squeezing on the breast, and that does not occur with the shield. If you have problems with the baby latching on, a professional can observe the baby breastfeeding and help with proper latch-on and adjustments of positioning.

How long should a baby be in a baby carrier?

07-11-19t:11:z

Dear Dr. Markel,
Just wondering if there's a recommended time limit to carrying a sleeping baby? Is it ok for their back/spine, development, and breathing etc., for them to be in a carrier for hours asleep (or awake)?

Thanks for the help!
Li Ling ]]> Many supporters of baby carrying say that babies should be carried constantly for the first few months of life.

Jean Liedloff author of The Continuum Concept: Allowing Human Nature to Work Successfully, based her work on spending several years with the people of the Yequana tribe in South America. She noticed that the Yequana babies were content, happy and well behaved. She put this down to the benefits of baby carrying and from it she developed the Continuum Concept which she says, "Consists, simply, of the infant having 24-hour contact with an adult or older child. For millions of years newborn babies have been held close to their mothers from the moment of birth."

Of course, the baby’s positioning is important in all carriers. Ideally newborns should be positioned lying on their backs in a cradle position, like a hammock, or tummy-to-tummy with the head and the spine supported along its length.

Older babies who can sit by themselves can enjoy sitting in a front or backpack-style carrier. Backpack styles are only suitable for use with babies over the age of six months old, when infants are able to sit up on their own and have fully developed neck muscles to support the head properly.

Parents must make sure that the child is supported all along the baby's body to reduce spinal compression. This includes support around the thighs and buttocks. All Ergo baby carriers, whether the baby is in the sitting or lying position, afford excellent support for the developing hips and spine.

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Dr. Susan Markel, MD, is a Board Certified Pediatrician, and Attachment Parenting Advisor. She is also the author of, "Ask The Doctor," in partnership with ERGObaby. If you have additional questions, please feel free to visit her website at http://www.AttachmentParentingDoctor.com and request a private consultation.

Letting down during breastfeeding

07-11-07t:11:z

Dear Dr. Markel,
I am really struggling with breastfeeding my daughter. She is 6 months old and I am still pretty much exclusively breastfeeding her. Every time I feed her I have trouble letting down. Sometimes I can't let down at all which leaves both of us frustrated. I breastfed my son for 14 months and never had a problem. I think the more it continues to happen the more anxiety I retain about feeding her. I am not sure how to get back into a good rhythm with my feedings.I have spoken with women from the La Leache League but none of their suggestions have helped me to get back to an easy going breastfeeding relationship with my daughter. I will take any suggestions you have and look forward to hearing from you.
Thank you,
Kristin

]]> Dear Kristin,
When breastfeeding your son, you did not have another child who needed your attention. This is a different situation with your daughter. There are more demands on your attention and your time. You have gotten into a situation with your daughter, and in your own word you are “struggling” and “frustrated” with increasing “anxiety”. We need to get you out of this cycle of increasing despair. There might be other factors as well, in your life that are causing anxiety and frustration, which need to be addressed.

Start again, with no demands on your or your time. This will require that you temporarily relinquish all of your responsibilities other that taking care of and feeding your daughter. You cannot be responsible for answering the phone, entertaining visitors, doing laundry or dishes. You can ask a mother’s helper, your husband, or the grandparents take care of your son.

Get into a relaxing situation and a relaxed frame of mind, by perhaps getting into a warm bath with the baby. Give yourself three or four days (the amount of time it takes with a newborn for a successful breastfeeding pattern to be established).

If you continue to have problems you can contact me via my website for a personal consultation.

Good luck.

Sleeping location alternatives

07-11-07t:11:z

Dear Dr. Markel,
Our 2-month old baby boy sleeps wonderfully in the ERGO for naps, and for that we are grateful! He also sleeps well at night all swaddled in the co-sleeper next to our bed (or sometimes in our bed). However, if we try to put him down for a nap during the day in the co-sleeper, his crib (which we haven't really transitioned him to yet) in his room or in our bed, he won't have it. It happens on rare occasions, but usually involves an hour or more of soothing before he'll nap there. How do we get him to nap in these other places when we can't carry him all day?
-Ali
]]> You are obviously wonderful parents who are creating a secure, loving environment for your baby. I don’t quite understand the difference in the situation, if any, that you are providing at night vs. the daytime nap. He sleeps well at night all swaddled in the co-sleeper next to, or in, your bed. If the conditions are the same, he should be able to sleep during the day. Perhaps there is too daylight in the room and you need to draw the shades. Certainly consistency is important as you respond to your baby’s needs and wants. On the other hand, if you decide to change some aspect of your routine, it will take some time for the baby to adjust.

Pregnancy and the ERGO

07-11-06t:11:z

Dear Dr. Markel,

I was wondering if it is safe to wear the carrier while pregnant? I understand that I need to wear it lower on the hips, but can it cause any problems with pregnancy?]]> Please consult your physician.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Best way to transport our baby?

07-10-09t:10:z

Dear Dr. Markel,
We are getting ready to welcome our first baby and looking into gear. We are wondering which is better for an infant when we are out for a long time: being a car seat attached to a stroller base or having a bassinet on a stroller. We live in the city and could easily spend 5-6 hours out running errands or just walking around and we want to make sure our baby is not going to be uncomfortable or her development compromised.

Thanks!
Silvia

]]> Dear Silvia
I urge you to consider carrying your baby in a front or back carrier for a substantial part of the day. The constant motion and touch has beneficial effects on the neurological and emotional development of the baby. In much of the rest of the world, babies are always carried or worn in a sling all day until they can walk. In industrialized western cultures, parents have been conditioned to believe that babies need to be carried or pushed in beby equipment like car seats and strollers. Babies who are held and carried all the time and have their need for touch met in their first year cry much less and they grow to become happier, more intelligent, more independent, more loving and more social than babies who spend much of their infancy in infant seats, swings, cribs, and all the other plastic baby-holding devices that don't provide babies with human contact.

Infants can be worn while they sleep, and also can be breastfed comfortably. It is true that proper position in the sling/carrier is important for the infant's hip, pelvis and spine growth. A carrier should not put all of a baby's weight on a narrow band of fabric at the crotch. Carriers such as the Ergo appropriately disperse most of the infant's weight between the hips and thighs.

There are so many baby carriers available on the market today it can be quite confusing for parents to decide on one particular type. Some important issues are that the carrier design offer various carrying positions for the baby and the wearer (front, sides and back), and that the child's growth and postural development are accommodated.

Front/back babycarriers are made for simple front or back carry, baby facing in or out. They are worn over both shoulders, thus distributing the weight of the baby Only front carriers are suitable for newborns.

Soft carriers are easy to use, are suitable for beginners, and these are usually the ones that modern western parents most associate with baby carriers. More structured ones may have buckles and padded straps as well as shaped sitting/baby carrying part. It is possible to breastfeed in front positions. An example of soft structured carrier is ERGO. The ERGO enables parents to purchase one carrier for all their needs from infant to toddler and it can be worn on the front, back and hip positions.

The ERGO was specifically designed in support of Attachment Parenting International's Ideals of Baby Wearing

Babywearing helps satisfy the baby's need for closeness, touch and affection.
Babywearing promotes and strengthens parent's emotional bond with their baby.
The movement that naturally results from carrying your baby stimulates their neurological development
Babies cry less when worn or held.
Holding helps regulate their temperature and heart rate.
Baby feels more secure. Babywearing facilitates easy outings and travel.

You can find more information about carrying on my website. Good luck.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Adoption Adjustment Period

07-10-08t:10:z

Dear Dr. Markel,

We adopted a wonderful 9 month baby girl from China in June and our adjustment period was very stressful. After a couple of months she was able to sleep through the night in her crib. For some reason there was a setback that started a few weeks ago. She now refuses to go to bed (both for a nap and at night)and she wakes up several times in the middle of the night crying. She did have an ear infection which was immediately treated but this behavior has not changed. As a result, she is cranky and whiny during the day. I would appreciate any feedback.

Thank you,
Sue
San Diego

]]> Dear Sue from San Diego

You and your baby had a rough start, as you were unable to form the attachment bonds early. It is never too late, but you will need more patience than in a typical situation where the family is together from birth. If your baby did not have her needs responded to consistently and lovingly before you brought her from China, then she might not be feeling safe and secure. She might fear being abandoned because her situation changed so dramatically in the past. All that you can do from this point is to provide a nurturing environment where her calls for help are answered with love. It seems that she would be more content and she would feel safer if she were in bed with you. Also, I question whether or not she truly had an ear infection, and more to the point, if the so-called treatment for the infection might have disrupted her gastrointestinal tract enough to cause discomfort thus compounding her problems and intensifying her needs.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Too late to start the continuum concept?

07-10-08t:10:z

Dear Dr. Markel,

I have only just discovered the continuum concept and I already have a 2 year old (2 today in fact!) and a 6 month old. I have been parenting in a very different way - very much routine based and the children sleep in their own cots in separate rooms and have done so from about 4 months old. Is it too late to change how I am doing things? Where do I start! Will my children respond well as they have been so used to sleeping by themselves and having their meals at certain times etc. My other concern is how will I meet both their needs if i am letting them lead me?

]]> Dear Concerned Parent,

You have already started, by acknowledging that there might be a better way, and showing a willingness to change. It is never too late to define a new type of relationship with your children. Your maternal instincts, without outside influence from so-called “experts” will lead you to do what comes naturally, which encompasses breast feeding, holding your baby frequently, and responding to your children’s needs without judgment. Responding with love does not mean letting your children lead. A two-year-old does not want to lead – that would be very frightening. He or she needs to feel safe, by having a consistent, confident and competent caregiver who treats the child with respect while guiding the appropriate behavior. For more understanding of these concepts, I invite you to view my website. Congratulations and good luck.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Chicken Pox and Vaccinations

07-10-08t:10:z

Dear Dr. Markel,

I had my two children who are 4 yrs and 2 yrs old vaccinated for chicken pox. I've been researching the vaccination more now and I believe I made a big mistake. This shot is only 70-85% effective on minor cases. I have a friend who had her children vaccinated and they have gotten chicken pox 2-3 times(minor cases).This shot sounds like it helps you get minor cases of chicken pox many times in your life. I had chicken pox when I was tiny and now I should be immune for life. I don't believe this is the case for my children. There is a booster now required before kindergarten, should I have my children get the booster? Will this prolong there exposure until they are older when it is more dangerous to get chicken pox?

]]> Dear Concerned Parent,

Varicella (chickenpox) is a relatively mild disease, especially compared to other diseases for which vaccines have been developed. The main reason that the varicella vaccine was developed by Merck Laboratories is that if working mothers could keep working instead of taking time off to care for their sick children, businesses would save hundreds of millions of dollars.

The vast majority of children who contract natural varicella recover completely and have lifelong immunity. Children who receive the vaccine, however, have now been found to have immunity that wanes over the next several years. This then leaves the prospect of a future population of adults who were vaccinated but whose immunity has waned enough to leave these individuals susceptible, and so you are correct that it is now required that children get yet a second varicella vaccine before kindergarten.

You have learned innocent children are often exploited for the good of interests such as big business. You will now have to take all of the facts into account to make an informed decision as to how to proceed. Being forced to give your child a second vaccine because it is now apparent that the first is inadequate for immunity is indeed a frustrating predicament.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Easing The Teething Blues

07-10-08t:10:z

Dear Dr. Markel,

Hi my baby girl is 5 months old and going through rough teething moments. She is working hard to cut the bottom two front teeth. But she is so uncomfortable.

She sleeps right beside us at night and wakes every few hours. I end up holding her until she falls in a deep sleep and then I put her to sleep in her crib beside our bed. We give her hylands teething tablets and gripe water and I have started drinking chamomille tea. She really doesn't seem to like teethers. What do you recommend to ease there pain? What are the best options for teething. I breast feed still and so I know frozen food to suck on is not the answer at the moment. Please suggest the best natural remedies for me to use to alleviate her pain and to give to her.

Thanks!

]]> Dear Concerned Parent,

I agree that it seems as if your beautiful five-month-old baby girl is teething. Typically, your baby is fussy, with a bulging middle bottom gum; drooling, waking at night, and biting. The best remedy is anything cold and hard. Every pediatrician probably has their favorites; here are mine:

Frozen bagel
Frozen wet washcloth

Good luck,

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Transitioning a baby from Co-Sleeping to their own room

07-09-04t:09:z

Dear Dr. Markel,
I love being a mother, even when I was sick during my pregnancy. We were in and out of the hospital at least once per month for the whole nine months. I love that she sleeps close to me in her bassinet, but she will be six month old on September 10th. She wakes from her sleep a couple times in the middle of the night and I feed her. Then I put her back in the bed until at least 5 am. The problem is that we would like to have her start sleeping in her crib in her room. I don't want to go backwards were she is sleeping in our bed every night. How do you suggest we move forward with this transition, so it is smooth for me and her.Thank you and look forward to her from you.

]]> Dear Concerned Mother,
I suspect that if you follow your natural instincts, rather than listen to so-called “experts”, you will make the decision that having your baby in bed with you is right for your child.

Every scientific study of infant sleep confirms that babies benefit from co-sleeping, and science consistently provides evidence that the American social norm of isolating babies for sleep can have deleterious effects. Babies who sleep in the family bed learns that their needs will be met and end up well-adjusted, they perform better in school; have higher self esteem, and fewer health problems. Co-sleeping is the norm in most parts of the world. As well, parents who bring their babies to bed sleep longer and better.
Babies who sleep in a family bed learn that their need for warmth and reassurance will be met. They learn that important figures in their emotional world can be trusted to understand and respond with a caring attitude.

Children do, of course, progressively develop the desire to move on and have their own space, including their own sleeping space. Therefore, you do not have to worry that the child will want to stay in the family bed indefinitely.

Susan Markel, M.D.
“peaceful parenting for a peaceful world”

Baby's First Food

07-09-04t:09:z

Dear Dr. Markel,
My baby is 6 months old and showing signs that she is ready for solid food. I have heard that starting your baby on grains - like rice cereal - can increase their chances of getting food allergies and diabetes later in life. Is this true? What food do you suggest we start our baby on? Someone else suggested egg yolks and avocados, however, I've also heard no avocados until month 7 or 8? Yikes, there is so much conflicting evidence out there!

]]> Dear Chez Maman,
Yes I agree that "there is so much conflicting evidence out there" and that it why I encourage you to trust your instincts regarding what is right for your child. Every family and every baby is different. Your baby does not "need" any food other than breast milk until approximately nine months. Between six and nine months can be a fun time to see if your baby enjoys any particular tastes or textures. Unless there is a specific concern about food allergies you do not have to limit choices. The only requirement is that the food be natural and wholesome, perhaps what the rest of the family is eating, in a softer consistency by using a food grinder. There must be no pieces that can cause a choking hazard of course.

Good luck,

Susan Markel, M.D.
“peaceful parenting for a peaceful world”