|
|
Beginnings Guides Blog
|
Sandra Smith, PhD, MPH: Posted on Wednesday, February 22, 2012 8:31 PM
The home visitors at Aspiranet
Welcome Home Baby Program and their
supervisor, Odessa Caton sent in two questions about the recent BulletinBlog alerting Beginnings Guides user’s to findings
that use of a pacifier reduces the risk of SIDS up to 90%. They ask, Does the pacifier
recommendation apply to
breast fed and bottle fed babies? Does the research still indicate that
pacifiers are barriers to breastfeeding?
The short answers: Yes. No. Pacifiers, SIDS & Breastfeeding recommends against any pacifier use for breastfeeding infants. Another
BG
Bulletinreader, Cathy Morris of the Heart of Georgia Healthy Start
Coalition,
suggests waiting one month before offering a pacifier to a
breastfeeding baby in
order to firmly establish breastfeeding. Both of
these advisories are supported by a number of studies linking pacifiers
to
reduced breastfeeding. And they illustrate the ongoing controversy
fueled in
part by a few studies that have found pacifier use promotes or
supports breastfeeding, and in part by competing goals of promoting
breastfeeding and
protecting against SIDS. None of
the reported studies
is able to tell if pacifier use is a signal of
breastfeeding difficulties leading to early weaning, or the cause of such
difficulties. There is some new,
perhaps more definitive research.
New Findings A 2012 Cochrane Review of more recent and stronger
evidence from
randomized trials reached this opposing conclusion: For mothers who are motivated to breastfeed
their infants, pacifier use before or after breastfeeding was established did
not significantly affect the prevalence or duration of exclusive or partial
breastfeeding for up to four months of age.
The authors warn that this finding may not apply to mothers
who are less motivated; so the chicken-or-egg question about pacifiers and
early weaning
remains.
At least one author contends the Review is severely
flawed. So the longer, final answers to these good questions depend on who you
ask and how you
interpret the evidence.
Editors’ Conclusion SIDS is rare before age one month, (highest risk is 2-4
months); so there is
little risk in waiting to offer a pacifier to a
breastfeeding baby. Recent
research on the highly protective value of
pacifiers, along with new evidence
that pacifiers interfere with breastfeeding
less than previously believed
warrants a recommendation to offer a pacifier to
both breast fed and
formula fed babies at all sleep times during the SIDS risk
period
(age 1 to 6 months). You’ll see the change in the new 2012 edition
to say about the new Review. Stay tuned.
References Jaafar SH, Jahanfar S, Angolkar M & Ho JJ. (2012).
Pacifier use versus no
pacifier use in breastfeeding infants for increasing
duration of
breastfeeding (Review). The Cochrane Collabortion. Wiley &
Sons.
Abstract free online:
Jenik AG & Nestor V. (2009). The pacifier debate. Early Human Development 85; S89-S91.
|
|
|
Sandra Smith, PhD: Posted on Tuesday, February 21, 2012 5:38 PM
Lead
is a toxic metal that is harmful if inhaled or swallowed.
Lead is found in air, soil, dust,food
and water. The greatest
exposure to lead is swallowing or breathing lead paint
chips
and dust. Another risk is drinking water contaminated by lead
plumbing or
water lines. Blood lead levels in the US dropped
dramatically after 1978 with
the ban on lead in gasoline.
Blood
lead levels continue to drop, but no safe threshold has
been identified.
Current efforts and recommendations focus
on primary prevention.
Lead
is especially dangerous to infants and toddlers because
they live close to
the ground with their hands in dust and soil;
and their favorite way to explore
anything is to put it in their
mouths.
Also, growing bodies absorb more lead and growing brains and nervous
systems are more sensitive to harmful
effects.Blood lead levels peak around
age 2 when most toddlers
stop chewing on everything in reach; then they decline
without
treatment unless exposure continues.
Here’s
the big worry: harmful effects are long lasting, perhaps
permanent,
potentially including brain and nervous system
damage resulting in lower IQ and
behavior problems (reduced
ability to pay attention and follow instructions,
hyperactivity,
aggression, reading disabilities, hearing and balance problems).
These symptoms can occur even with low exposures.
The
source of most lead poisoning in children is dust and chips from lead paint
on interior surfaces. Lead paint was taken off
the market in the 1970s. But it
is still present in homes built before
1978. In most cases, lead paint in good
condition is not a hazard.
But when it chips, peels, or flakes; and when it is
sanded or
otherwise disturbed, it’s highly toxic. U.S. water sources are lead free, but old plumbing can be toxic. (The Latin word for
plumbing translates literally as lead.) Children
living in poverty are most at risk. The American
Academy of Pediatrics
recommends that all Medicaid-eligible children be tested for lead at age1 and
again at age 2.
Medicaid covers the two
tests and requires one at age 2,
which may be too late to prevent
damage. Other children should be
tested if their living conditions or parents’
occupations warrant.
Beginnings
Parents Guide first addresses lead poisoning on a
page 26 (Book 1, 2-12
weeks).. The text focuses on avoiding
Baby’s exposure to lead carried on the
shoes, clothes and skin
of parents/caregivers in certain occupations. The new
2012
edition will add content to aid parents in assessing and ensuring
the
safety of their home, particularly the presence of lead paint and lead
plumbing.
Test
all Medicaid eligible children at age 1 and 2. The current
edition suggests a lead test at six months, and
includes a self-test for parents to determine if their chid needs a lead test.
This
information will be revised and relocated to reflect the policy
of testing
all Medicaid eligible children at age 1 and 2 years,
and other at-risk
children, including those who spend time in a
home built before 1978.
New
Resources on this Beginnings Guides website. Find out about lead in
drinking water in your area. National Hotlines and the
National Lead Info
Center. Info for families renting, repairing or
References: American
Academy of Pediatrics, Committee on Environmental Health. (2005) Policy
Statement. Lead Exposure in Children: Prevention,
Detection, and Management. Pediatrics 116 (4) p1036-1046
Note,
this policy was reaffirmed in 2009
National Lead Information
Center 1-800-424-LEAD
|
|
|
Sandra Smith, PhD, MPH: Posted on Thursday, February 16, 2012 9:05 AM
Part of health literacy is
understanding information. But it is using
information that makes
a difference in outcomes. Last time in this space we
discussed new federal regulations from the Consumer Products Safety Commission
that aim to improve crib safety.
That’s good information for health promoters and healthcare professionals,
but how can we offer this information to parents in a way they can use it?
To use information, we first
personalize it using interactive and reflective skills. When a
mother
personalizes health info, she reflects on: What
does this mean for me, in my
situation,in my family with my income,
experience, education, values and living conditions?
And then: Now that I have this information, how do I
want to respond? What do I want to do?
Information is
most easily personalized and applied in context when it uses familiar words
that do not require judgment or background knowledge.
For example, if the info says,
“Slats should be less than 3” apart”, it will pass the readability tests, but
the learner must know the meaning of slats,
know that the symbol “ means inches,
and know or how to use a ruler to measure. And s/he must judge whether should means the
distance between the slats is a vital concern or
just a suggestion, so that she can judge
whether it worth the trouble to go
find the ruler or someone who knows how to measure.
I found few parents used the word slats. More parents used – and nearly
all understood bars.
If the info uses
something familiar and handy as a measure, no one needs to understand inches or use measuring devices to
check the space between bars.
Further, info is easier to
personalize and put into action when it contains only what the
learner needs to
know to take appropriate action. For example, a mother does not need to
know
that the Consumer Product Safety Commission sets crib safety standards. She
needs to know how to tell if her crib
is safe for her baby
Crib Safety Checklist If you can check Yes for all these statements,
you have a
safe crib.
·The bars are
close together so the baby cannot get stuck between them. The space between
bars is no wider than four adult fingers.
[ ] Yes [ ] No
©Practice Development Inc |
Beginnings
Parents Guide makes crib safety info easy to use with a Crib Safety Check
List.
Ideally, the checklist is
the focus of a reflective
conversation on sleep safety, or it may be
used in
self-directed learning. The checklist is interactive and reflective; it
requires the
learner to think and check Yes or No to three
statements. This
takes the learning deeper faster by using muscles in addition to the
brain. In the process, the learner
teaches herself
to determine whether the crib is safe and what
makes it safe or
not.
Here’s
the part about distance between slats. No rulers or knowledge of measurement
needed.
No polysyllabic words. The
text sounds like something a person would actually say in
conversation. See the
full Checklist here (choose Parents Guide and go to page 22).
The
2012 edition will add this item to reflect new safety standards: ·
The sides of the crib do not fold down…. |
|
|
Sandra Smith, PhD, MPH: Posted on Wednesday, February 15, 2012 8:59 AM
This information is important for families
borrowing or re-using a crib sold before July 2011
Revised
information for Beginnings Parents Guide recommend that infants up to age six months sleep in a crib
near the parents’ bed where mother
and baby can see each other. The time frame
reflects that SIDS is rare after age six months;
the period of greatest risk is
age two-four months. Close proximity and only temporary bed
sharing (e.g. to
breastfeed) seems to be the best combination of safety and closeness, providing
the parent(s) do not smoke and the crib is safe. (Stay tuned for more on third
hand smoke.) No drop-side rails The Consumer
Products Safety Commission recalled over 11 million cribs in 2007-11. Most of
the
cribs removed from the market had drop-sides with detaching side rails
which have been associated
with infant suffocation and strangulation. Other
recalled models had faulty or defective hardware.
Since July 2011, federal regulations
prohibit importing, manufacturing or selling traditional drop-side cribs of any
size. In addition, new standards call for stronger slats, stronger hardware,
firmer
mattresses, and tougher testing. The New Beginnings
Parents Guide will urge parents to obtain a new
crib if possible and not to
borrow or re-use a crib with drop-side rails.
Child Care
Facilities Must Meet Crib Safety Standards All child
care providers are required to replace cribs that do not meet the new standards
by December 28, 2012. The 2012 Parents
Guide’s information on selecting child care providers will be revised to
include advice to check that cribs meet safety standards.
Need more
information? Wondering if a particular crib is safe? Call CPSC Recall
Hotline: 800-638-2772
Reference:
US
Consumer Products Safety Commission. News release #11-260, June 28,2011. Safer Crib for Babies Available Starting
Today.
|
|
|
Sandra Smith, MPH, PhD: Posted on Friday, February 10, 2012 6:21 PM
What Protects against
SIDS? Recently in this space, we’ve been looking at the latest
evidence on risk factors for SIDS. Briefly, the primary Dont's are prone
(face-down) sleeping and parental smoking. Bed-sharing increases
the risk when either parent is a
smoker or has been using alcohol or drugs. Any soft sleeping
surface (sofa,
water bed, less-than-firm mattress) and loose bedding (quilts, comforters,
pillows,
stuffed animals) increase the risk of sleep-related infant death. Now we turn to protective factors.
Pacifier Use Reduces
SIDS Risk by up to 90% A simple,
inexpensive protection against SIDS is use of a pacifier at sleep time (naps
and nights).
Several studies
suggest that pacifier use reduces the risk of SIDS by up to 90%. Pacifiers are
most
effective when used with other known protections such as breastfeeding,
not smoking and adequate prenatal care. But, the news is especially good for families who are unable
to provide an optimal sleeping environment. Pacifier use also seems to offer
protection against SIDS for babies who share a bed, sleep face-down, or have
loose bedding in their sleeping space. It may be that pacifier use
offers
protection against SIDS for all infants.
for
babies who sleep on their side of stomach, share a family bed, or live with a
smoker. It will
continue existing
promotion of breastfeeding, non-smoking and prenatal care participation.
Reference:
Moon RY, Tanabe KO, Yang DC, Young HA & Hauck, FR (2011). Maternal
and Child Health Journal (epub ahead of print).
http://www.ncbi.nlm.nih.gov/pubmed/21505778 |
|
|
Sandra Smith, PhD, MPH: Posted on Wednesday, February 08, 2012 6:13 PM
This just out. An international team of researchers
have analyzed 11 studies on bed-sharing
and sudden infant death syndrome in an
attempt to clarify what is known about the risks of
the family bed. The studies
were selected from all studies published on the topic since 1970.
The debate will continue since some
studies indicate that bed sharing does not
increase the
risk of SIDS for infants of non-smoking parents. Currently some countries advise parents
simply not to share their bed in certain circumstances.
These are the
circumstances in which bed-sharing is a major risk for SIDS:
· Parents
who smoke: Among babies whose mothers smoke, an infant sharing the mother’s
bed is more than 6 times as likely to die of SIDS than if s/he sleeps
separately. In comparison,
an
infant who sleeps with a non-smoking mother is no more likely to die of SIDS than
if sleeping
alone.
A 2011 study not included in the meta-analysis found a further increased
risk if both parents
smoke, and demonstrated that fathers’ smoking also is a
risk. When one parent smoked,
compared to none, the risk of SIDS with bed sharing increased two and half
times, and slightly
more if the smoker was the father. When both parents smoked,
the risk increased four and
half times.
· Baby
under 3 months old. Bed
sharing with infants <12 weeks old was investigated by
three studies.
Combined findings showed a greater than 10-fold increase in the risk of SIDS
when babies slept with another person. In contrast, for older infants, there
was no significant
increase.
· Only
occasional bed sharing. For
babies who shared a bed on the night they died, but
routinely slept separately,
the special-occasion bed-sharing doubled the risk of SIDS. This may
be partly explained by the
infants’ illness that was the reason for bringing the baby into the parents’
bed. Notably, for babies who routinely shared the bed, there was no significant
increase in risk. Further, babies
who are returned to their own bed during the night are not at increased risk.
This suggests that temporary bed-sharing to breastfeed or comfort the baby adds
no risk of SIDS and may be beneficial.
· Inappropriate
surfaces Sharing a sofa,
waterbed or other very soft surface creates excess
risk of SIDS. Further the US
Consumer Product Safety Commission reports the majority of sleep-related
infant
deaths are attributable to suffocation involving pillows, quilts, and extra
bedding. So the
guidelines for safe crib bedding also apply to the family
bed.
· Parents
using alcohol and drugs Less conclusive emerging evidence shows
the risk of bed sharing is increased when parents’ responsiveness is reduced by
alcohol or drugs. warn against bed sharing if either parent smokes or has consumed alcohol or
drugs. It will continue to emphasize use of tight-fitting bedding and no pillows, loose blankets, or
stuffed animals. It will
add a warning against parents sharing their bed with a
baby under three months of age, whether or not they smoke.
References Vennemann MM, Hense HW, Bajanowski T, Blair PS, et al. (2012) Bed Sharing
and the Risjk of Sudden Infant Death Syndrome: Can
We Resolve the Debate? Journal of Pediatrics 160: 44-48.
Available online at www.jpeds.com
Liebrechts-Akkerman G, Lao O, Liu F, et al. (2011) Postnatal parental
smoking: an important risk factor for SIDS. European
Journal
of Pediatrics 170:1281-1291
Chowdry
RT. (2010) Nursery Producut-related Injuries and Deaths Among Children Under
Age Five. Washington, DC: US Consumer
Product Safety Commission |
|
|
Sandra Smith, PhD, MPH: Posted on Tuesday, January 31, 2012 4:22 PM
Dare we talk about
bed sharing? “There is insufficient evidence to
recommend any bed-sharing situation.…” So says ACOG in its latest (2011)
Recommendations for a Safe Sleep Environment. This continues earlier official recommendations aimed at
preventing SIDS, sudden infant death syndrome. Some practitioners interpret this to mean the “family bed”
should not be discussed, except to instruct against it. A few have refused possible.
Dare we not talk about it? To me this is the more salient
question. Around the world and
among US families, bed-sharing is common. Despite two decades of dire warnings, nearly half of parents
(45%) reported sharing a bed with their infants at some time during the
previous two weeks. Researchers
believe routine bed-sharing is even more common among certain racial/ethnic
groups.
So it is clear that parents are going to bring their babies
to bed with them; for breastfeeding, for bonding, for safety, for the pure joy
of it. Simply telling them not to do it or attempting to scare them into
compliance disrespects and underestimates parents with no affect on behavior. Not talking about bed-sharing is not going to prevent it. So Beginnings
Parents
Guide’s forthcoming fourth edition will not recommend bed-sharing,
but will continue to offer parents information they need to make decisions
about their family sleeping arrangements, including how to reduce the risk of
bed sharing when that’s their choice. |
|
|
Sandra Smith, PhD, MPH: Posted on Thursday, January 26, 2012 4:30 PM
 Beginnings Parents Guide is temporarily sold out. We are
accepting backorders for the New 2012 Edition. It will, of course, be easy to
read, interactive and evidence based.
Evidence based
content The scientific evidence for each topic
in
the Guide is being reviewed and incorporated into the text. The
Toddlers and Families, as well as the current
public health literature. will be checking all these and other sources for the
latest evidence
and best practices.
Plain Language Beginnings Guides
use plain language and a fourth grade reading level. This does not mean the information is
suitable for a fourth grader. It does not mean the
Guides “talk down” to
readers. Rather it means the information is easy to understand and use independently for about 80% of
individuals with 9 to 12 years of schooling and half of those with 6 to 8
years. Everyone, regardless of reading ability, benefits by review and
discussion. That is because we readers make meaning from information and figure
out how to use it by talking with others.
Using your input The Parents Guide
was developed by and for home visitors and the families
they serve. Over 40
home visitors participated in content development and testing. I routinely
collect comments from parents and their home visitors, parent educators, case
managers and
outreach specialists who rely on Beginnings Parents Guide for teaching and learning about early parenting.
These comments are reviewed first as we plan the update. If you have additions or changes to recommend, now is the time. Send me
email.
Text Reviews I am now working on the text
review. The Parents Guide is one of
the most reviewed documents on the planet. It was first published in 1999 with
technical support from
ZERO TO THREE and has been updated regularly. So the
text is already well honed and mother- tested. Our editorial standards require
that it be easy to read, understand, and especially easy to use. The text serves both as a teaching
aid and for independent learning.
It reads like something you would actually say to a mother sitting
across from you. In fact, you can use the text as a script
to open discussion
of difficult topics that mothers are unlikely to bring up, and that may leave
feeling at a loss for words. So far, I’ve found two bits of American slang to clarify: Do not try to
“go it alone”, and You might feel you are at the “end of your rope”. These common expressions
may not be understood by all parents. They will be clarified.
evidence and decisions regarding changes, additions and deletions. As
always your comment will be
welcome, appreciated and fully considered.
Next: Sleep Safety There is perhaps no
more emotional or controversial issue for new parents
than sleeping
arrangements.
Stay tuned. ss |
|
|
Sandra Smith, PhD, MPH: Posted on Tuesday, January 24, 2012 10:55 AM
Adverse Childhood Experiences are emerging as major
players in adult’s physical and emotional health. ACE refers to growing up
experiencing in the household before age 18:
·
Recurrent
physical abuse ·
Recurrent
emotional abuse ·
Contact sexual
abuse ·
An alcohol
and/or drug abuser in the household ·
An
incarcerated household member ·
Someone who is
chronically depressed, mentally ill, institutionalized, or suicidal ·
Mother is
treated violently ·
One or no
parents ·
Emotional or
physical neglect
Experiences
in these categories, and witnessing them,
are linked to alcoholism, drug abuse,
depression, and suicide attempt, poor self-rated
health, obesity, heart disease, and liver disease.
See previous blogs. Home
visitors, case managers, parent educators, social workers and clinical practitioners are very likely to encounter mothers who struggle with the
lifelong effects of ACEs.
Often
the topic is not discussed because no one knows quite how to talk about it.
See how to talk about ACEs. So
today I want to share an excellent webinar that will prepare home visitors to
address ACEs in a respectful reflective way. It is presented by my colleagues at University of WA Northwest
Center for Public Health Practice through a grant from HRSA. I particularly recommend
the second half (about 25 minutes) as part of a staff meeting. It will jump
start your ability to address this issue
that is fundamental in the lives of so
many of the families you work with every day.
Quen
Zorrah discusses how public health nurses [and other practitioners] can
effectively educate
and screen clients for ACES and plan, with the client, ways
to decrease the risk for inter-generational transmission of these experiences,
strengthen the parent-child relationship, and build resiliency for both the
survivor and the child.
The
first half of the webinar will be of particular interest to Parents as Teachers
parent educators and others who work with school districts.
What is your ACE score? A
first step to making information on ACES and how to talk about them meaningful
might be to determine
References:
|
|
|
Sandra Smith MPH PhD: Posted on Tuesday, January 17, 2012 11:13 AM
 Think Link & Respond
Reflective parents take time to listen, watch and think about what is happening with Baby. They tap
into their knowledge and experience & consider possible explanations; then they choose a response.
Parents who do not reflect, react to their emotions rather than responding to baby's needs.
The Three Moms Three breastfeeding moms all went to a party and ate salsa. Their three babies had reactions to the salsa.
(I know, this is unlikely; please suspend disbelief for the sake of illustration.) Let’s look at their levels of reflective functioning.
At home after the party, Alice’s baby woke crying. Alice thought to herself, “Why is he awake? Uh, oh...
all that salsa. Celeste (her home visitor) told me Baby might have a reaction. Sorry, Baby.” She rocked him
singing softly until he finally fell back to sleep.
Alice thought about – reflected on - why her baby woke up crying. She linked Baby’s crying to her own
behavior (eating salsa) and to what she had learned about breastfeeding. She chose an appropriate response. Alice demonstrates strong reflective functioning and responsive parenting. Remember the reflection
process: Think, Link & Respond – Alice got all three steps.
Across the street, Bella’s baby woke up about the same time. Bella looked for what might be bothering her
daughter. She checked for wet diapers, noise, too much light. Baby wouldn’t eat and would not stop crying. Near panic, Bella loaded Baby into the car and sped to the ER. There she waited. By the time they were seen,
Baby was sleeping soundly. The doctor said he was fine and they went home.
Bella thought about possible explanations for her Baby’s upset. But she missed a Link. Either she did not know,
or did not recall the possible link between eating salsa and Baby’s reaction. Without that link, her thinking
broke down as she approached panic and triggered unnecessary intervention. Cathy exhibits beginning reflective skills, and a gap in knowledge. Happily, the nurse at the ER took time to talk with Bella and filled the information gap. Next time, Bella will make the link.
Down the road, Cathy’s baby woke up crying, too. Cathy covered her ears. The crying continued. She got
up went to the crib and shouted at Baby, “Shut up! There is nothing wrong with you. You are just trying to make me mad and it’s working.” She slammed the door and went back to bed. Eventually Cathy and
her baby both got back to sleep.
Cathy reacted. She did not think or link or respond. She was unable to observe her own behavior and
feelings, consider her possible role in the situation, or see that Baby’s behavior was not directed at her.
She did not consider that she may need more information. She did not weigh the possibilities and options.
Cathy has low (no) reflective function.
Reflect on the Moms' Behavior We can see from the story that one barrier to strong reflective functioning is lack of knowledge. One way to promote reflective, responsive parenting is to increase parents’ background knowledge.
When parents respond inappropriately, assume they are doing the best they can now. Take a cue from the ER nurse who acknowledged Bella’s strong desire to do her best for her Baby. The nurse worked with Bella to discover what knowledge would enable her to formulate a more appropriate response.
Reflect now on Cathy’s unthinking reaction. Wait to judge – assume that she did the best she could at the
time. What might explain her behavior? Perhaps Baby’s crying in the night reminds her of her own childhood
traumas, so she cannot link her feelings to current events. If she is accustomed to chaotic, painful,
overwhelming feelings, she is probably in the habit of shutting down in order not to experience them.
Maybe she does not have the cognitive ability to reflect – that would be an exceptional case. More likely,
she can think about possible explanations and solutions; that just is not her habit.
|
|
|
|
|
