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131119EPA GunControl-1The right to bear arms is part of the Constitution of our nation. The number of privately owned guns in the United States is estimated at 300 million, and continues to rise each year at a rate of about 10 million. In Lane County, three out of four homes possess at least one gun.

Most guns are not used to shoot people but, nonetheless, gunshot injuries rank second only to motor vehicle accidents as a cause of death for American teens. Between 2001 and 2010, nearly 30,000 children ages 0 to 19 years died; another 155,000 needed emergency medical care for gunshot injury. Some of these tragedies are intentional violence, while others are accidental gunshot wounds.

Those are the latest statistics published by local authorities, the National Rifle Association and the American Academy of Pediatrics (AAP). I mention them because I find guns to be a challenging topic to discuss during wellness exams. Emotions on this subject are often polarized and veer too quickly to party politics, when the real conversation in my mind is how to keep kids safe while letting adults do what they wish.

Posted by on in News

AAP

Today, the U.S. Food and Drug Administration proposed a new "action level" for inorganic arsenic in apple juice of 10 parts per billion, the same level set by the Environmental Protection Agency for drinking water. The FDA tested hundreds of samples of apple juice for arsenic and found the overall level of arsenic is low. Because a small proportion of samples had higher levels of arsenic, the FDA is proposing the new action level. The FDA is not recommending any change in juice consumption and has emphasized that the data show it is safe for children and adults to drink apple juice.

The AAP is reminding parents that it is not necessary to offer children any juice to have a well-balanced, healthy diet. For years, the AAP has recommended limited intake of all sweet beverages, including juice, to reduce the risk of poor nutrition, obesity and childhood cavities. If parents want to include juice in their children’s diet, juice should be limited to 4 to 6 ounces a day for children ages 1 to 6 years, and 8 to 12 ounces a day for children age 7 and older. Children should be encouraged to eat whole fruits to meet their recommended daily fruit intake.

The AAP has assembled resources to help members communicate about the FDA report with their patients.

FDA Report

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Tagged in: AAP Advice Children FDA

Posted by on in News

EPA-cosleeping2-1I appreciate the many comments I received about my blog post on bed-sharing. The acceptance I saw of opposing viewpoints contributed to a healthy conversation. It allowed us to think more deeply, and I thank you for that.

The question of whether you feel comfortable sharing your bed with your baby is highly personal, and I respect the varied opinions. During my 15 years as a pediatrician, my observation has been that parents make decisions about their children’s health by reviewing a variety of sources, and then assessing the risks and benefits.

On any topic, I believe my job as a pediatrician is to give you the most up-to-date information available, add my own best advice as an experienced physician and then encourage parents to make their own decisions. So, as a response to my recent post, I provide here some comments and additional data for further consideration.

Many of you commented that in other countries parents co-sleep, so why shouldn’t we? The devil is in the details, and those details are often hard to find.

For example, the specific bed-sharing practices in those countries with high rates of bed-sharing and low rates of Sudden-Infant Death Syndrome (SIDS) are often different than in the United States. Parents in these other countries often sleep on the ground, a floor or very firm surface (like a futon), and use no heavy bedcovers.

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Posted by on in News

EPA co-sleeping-1A controversial subject, co-sleeping (sharing a bed with your infant) may provide rest and convenience for breastfeeding and sleep-deprived moms, but it comes with serious risk of infant death caused by suffocation, asphyxia and entrapment.

The American Academy of Pediatrics (AAP) published a strong position statement against co-sleeping recently, which provided detailed instruction on the best ways to keep your baby safe while sleeping.

AAP offers extensive data on pediatric deaths in bed with parents, as well as research on infant respiration to support its instructions, which are as follows:

  • Infants should only sleep on their back, in a bassinet or crib that meets modern safety standards.
  • Babies should be in a bare crib – no bumpers, pillows, blankets or quilts; mattresses should be firm and should maintain their shape, even when a fitted sheet is used.
  • Infants should stay in their parents’ room until 6 months of age, then can be moved into a different room; room-sharing without bed-sharing provides close proximity, which facilitates feeding, comforting and baby monitoring.

 

In the United States, parent-infant bed-sharing is still common despite the known risks. In one national survey, 45 percent of parents said they had shared a bed with their infant (8 months of age or younger), according to AAP.

Then why do so many mothers (including Dr. B, who did so at times with her own babies) so often sidestep the established recommendations? And how do I, as a pediatrician who has done it myself, reconcile this conflict for parents in my own practice?

As a mother, I believe much of our motivation to co-sleep stems from pure exhaustion. We sleep-deprived moms realize quickly that babies emerging from 10 months in our womb are more peaceful if they are close to our bodies. And nursing is easier when your baby is at arm’s length, eliminating the need to sit up, get up or fully wake up.

Additionally, many breastfeeding advocates strongly endorse co-sleeping, muddying the waters as mothers seek expert opinions that support their own choices.
 
Our son, Jack, was exceptionally colicky. One of the few things that quieted him was sleeping next to me. One night, in a near comatose state caused by weeks of dealing with a fussy baby, I woke up in a panic because I had fallen so deeply asleep that I no longer knew where my baby was sleeping.

Knowing that I had slept so soundly and that I could easily have rolled onto him shocked me and provided enough fear that I realized he needed to sleep in his bassinet. It was a struggle, because he didn’t like the bassinet; it was cold, impersonal and isolating. But I learned a few tricks along the way, including preheating his bassinet with a heating pad, then removing it before putting him down. I was trying to imitate my body heat, and I think it helped. I also had the bassinet arranged next to the bed, so that my arm could lay next to his little body. Draped over the edge, my arm fell asleep right along with him. But I felt better knowing that he was in a safe environment. There are other tricks, as well, such as swaddling.

As a pediatrician, I often struggle advising new moms and dads. But the AAP recommendations could not be clearer. If I provide advice that is in direct opposition to the AAP, a family whose child dies in a co-sleeping situation can sue me. On the other hand, I run the risk of alienating parents if I press the issue.

I have chosen what I hope to be a wise middle ground. I tell everyone that AAP never recommends co-sleeping, and I explain all the reasons why. I also acknowledge the need for parents to sleep and their desire to breastfeed easily. And I often tell them my own story.

As in every aspect of parenting, I feel that my role as a pediatrician is to educate, to provide data when it’s available, to share my own experiences and, finally, to support the choices my patients’ families make.

 

 

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The AAP recently published a policy statement that significantly strengthens its recommendations for a safe infant sleeping environment.  Among its recommendations:

  • •  Always place your baby on her back on a firm sleep surface, particularly a crib or playpen that conforms to current safety standards.  Adult’s mattresses, couches, and recliners are not recommended.
  • •  SIDS may be decreased by as much as 50% by having infants sleep in the same room as their parents, but NOT in the same bed with parents.  The AAP policy states that infants may be brought into bed for feeding but should be returned to their bassinet or crib as soon as feeding is done.  This arrangement markedly decreases the chance that baby will be accidentally harmed during sleep.  Particularly risky for cosleeping are infants whose parents are smokers, excessively tired, or medicated with alcohol, street drugs, or prescription drugs that cause fatigue.
  • •  The crib should be bare.  No bumpers, blankets, sheets or stuffed animals should be in an infant’s crib during sleep.
  • •  Commercial devices to position a baby (including wedges, nursing pillows, sleep nests) should not be used.
  • •  Carseats should not be used for sleeping due to the possibility of the baby’s head falling forward and obstructing the airway.
  • •  Tummy time of 30-60 minutes per day with an adult supervising is recommended to facilitate development and minimize positional flattening of the skull.
    •  Home heart and breathing monitors to prevent SIDS are not effective and should not be used.

Dr B has long taken a relaxed stance on cosleeping, as she coslept with her babies when they were young.  However, given the mounting evidence that infant safety can be greatly enhanced by increased vigilance about returning babies to their own beds after nighttime feeding, Dr B agrees with the newer recommendations to help keep babies safer.

Tagged in: AAP Sleep