Handling Conflicting Information

There is one complaint I hear from almost all my patients that makes their entire birth experience and newborn period much more stressful than it needs to be.   It is that every health care provider they come across tells them something different.  The L&D RN tells them to breastfeed one way, then the postpartum RN suggests something else.   A day later, right before discharge, the lactation consultant tells them to change what they are doing, and sends them out the door.  Then they see the pediatrician the next day, who tells them something new, and insists they see me.  I see them 24 hours later, and change the plan again.   They look at me exasperated, and tell me I have contradicted everything they’ve been told so far!  And I feel terrible for them...

What I wish all new parents knew is that every health care provider they have spoken to was probably right, and had the best intentions for their new family. At the heart of the issue is that baby’s change, and they change rapidly, especially in the first month.  Each of these providers is looking for different developmental milestones, and making recommendations based on what they are seeing at that moment in time. So on day one, its lots of skin to skin, we are happy to get a few good feedings in, and not stressed about lack of pooping. That’s not so good on day seven.  Initially, we love long feedings and lots of time at the breast.   But as your milk comes in, those feedings get more efficient and many baby’s might want to skip skin to skin when they are really hungry.  The cross cradle hold with the My Brest Friend Pillow works great in the beginning.  But do you still want to be nursing that way 3 months in and carry that pillow with you wherever you go?

While it is frustrating in the beginning, it’s also a blessing.  Because just when you think you can’t take another feeding frenzy or bad night of sleep, things change.  And they almost always change for the better!  Feedings get more efficient, sleep gets longer and deeper, and you start to feel like you can do it. When things don’t get better, it is usually because your baby is ready for something different, but you are still doing what worked last week. Dr. T. Berry Brazelton calls these moments “touchpoints”- a period of family upheaval that occurs right before a developmental milestone is achieved.   His book, Touchpoints-Birth to Three, is one that I recommend to all our families.  It lets you know what all these milestones are, and what your baby is trying to tell you, and how to get through it.

So rather than get frustrated with all of us in healthcare, please try to trust that we all have your best interests at heart.  Ask for an explanation when you get contradictory advice.  Make an appointment with us or someone else your trust to help you work through what is going on, rather than suffer through it. One of my favorite quotes is that the only constant in life is change. Nothing is truer with children!  Just when you think you have them figured out, they change it up.

Roll with it.  I promise that phase won’t last forever!

Tongue and Lip Ties

Years ago, reflux was the diagnosis that I was seeing on a daily basis in our office.  I am not sure if it was the advent of Zantac or Prilosec, but the vast majority of the babies we saw were on those medications and had been diagnosed with reflux. These days the new diagnosis is a lip and tongue tie.  We are seeing it all the time, and our own Doris Howie, RN IBCLC has become our resident expert!  Here is some information regarding both issues, with all credit to a lecture I attended by Marty Kaplan DDS and to the website of Dr. Fawn Rosenberg.  Both are doctors that we refer to for fix these issues.  Dr. Rosenberg’s website has great pictures that illustrate what I am describing below.  It can be accessed at:

http://www.lexingtoncosmeticdentistry.com/tongue-tied

Many people suffer from tongue-ties, or lip-ties, and they often occur together. It is a genetic abnormality that can range from very minimal in some cases to severe in others. The lingual frenum is a cord that stretches from under the tongue to the floor of the mouth. A tongue tie, or ankyloglossia, are terms used for a lingual frenum is short and restricts the movement of the tongue.  Sometimes it is long and thin and goes from the base to the tip of the tongue, and can cause the tongue to be heart shaped. Other times it is short and thick and anchors the tongue to the base of the mouth.

Some common signs of a tongue-tie are:

• Difficulty moving tongue side to side or up and down

• Inability to touch the roof of the mouth with tongue

• Inability to stick out tongue

• Presence of a notch at the tip of the tongue

The labial frenum is a piece of skin that connects a person’s upper lip to their gums. A lip-tie is when the labial frenum is too short or wide and restricts upper lip movement.

Some common signs of a lip-tie are:

• Inability to flair upper lip

• Slurred speech

• Gap between upper teeth

Sometimes, we will see a baby who we notice immediately has either or both of these conditions, and yet, they are doing just fine.  The frenulum is a membrane that can stretched and often does, with no consequences for the mother or the baby. If the baby is gaining weight appropriately, is happy and not causing the mother any pain, I often won’t even mention it.

However, some babies with these conditions really struggle with breastfeeding, which is frustrating for both the mother and infant. Often, they do fine in the beginning, when the mother is engorged and the breast is full of milk.  But as the breast returns to a relatively normal state, these babies may be unable to latch properly, and slide off or chew on the nipple. They never seem satisfied, yet feeding times are prolonged and they are constantly falling asleep at the breast.  They babies exhibit poor weight gain, are often gassy or fussy, and eventually labeled colicky or “Failure To Thrive.”

The poor mom often suffers from excruciating pain when nursing. Many times she is told everything looks great from the outside, and that pain is normal and will go away eventually. This is particularly frustrating for women who deal with the pain 8-12 times per day, and have their heart set on nursing their baby.  One of my patients found this fantastic video online, that perfectly illustrated how she felt while nursing:

These women will often experience creased or flattened nipples after feeding, with bruises or blisters noted.  Breast drainage is often incomplete and plugged ducts are common. A decreased milk supply, mastitis, and thrush are often the result.

Tongue and lip-ties can be easily corrected. The procedure is called a frenectomy. It is also commonly known as a frenontomy or frenulectomy. Some doctors we refer to treat tongue-ties and lip-ties with FDA approved laser that is safe, effective, and minimally invasive. Using a laser for this procedure eliminates the need for needles, general anesthesia, stitches, or a costly hospital visit. When the procedure is done with a laser beam, there will be minimal bleeding, if any at all. Other doctors, usually ENTs, use a scissors to snip the frenulum.   Either way, it only takes a few minutes and the baby can nurse immediately afterwards.

If you are concerned that this might be an issue for you and your baby, talk to your pediatrician and ask for a referral to see a pediatric dentist, ENT, or one of us.  I would start with us, because often, we can help you nurse comfortably and nothing further needs to be done. My advice is to ask for Doris!   Rhode Island also has a pediatric dentist at Children’s Dentistry of Westerly and Wakefield who has recently been trained in these procedures.  Her name Dr. Anna Capalbo, and we have been very pleased with her honest assessment and repair for babies that need it. Whatever you do, just know that nursing with pain is not normal and it can be fixed. We are happy to help, or guide you to someone who can!

Local Professionals We Recommend...

Rhode Island New Moms Connection offers a multitude of pregnancy & new mom groups for women in Rhode Island and surrounding areas. Kristen Kardos and Kathy McGuigan are on a mission to provide women with a non-judgmental space to share their motherhood experience with support, information, useful resources to help women expand their community of new mom friends.   Kristen is a fabulous DONA trained post partum doula who has been working with moms & families since 2009. She is co-chair for the Women & Infants Ob Patient Advisory Council; Kathy is a social worker who has been working with women and children for 20 years.Facilitating New Mom and Pregnancy Support Groups combines her passion for motherhood with her professional skills and experience. She is a member of the Board of Directors for Brown Play School.  Both women are members of the RI Birth Network; and contributing writers for kidoinfo.  There are new groups starting all the time, so check out their website and join them!
 

September Announcements

Did you know that both Harvard Pilgrim and Tufts Health Plan reimburse for our lactation services 100%?  You can see us in your home or our East Greenwich office. Once you pay for the service, we provide you with the detailed receipt to submit to get reimbursed. 

Call your plan directly to confirm this benefit and ask them how to request your reimbursement.  Always get the name of the representative and a reference number for the call!

One For The Dads

My brother-in-law, Greg Wind, wrote the article to share with our Dads back in 2007. There is some great information in here on how they can participate in and support your breastfeeding endeavors. Enjoy!

Dads, you just had a screaming, beautiful, pooping, sleeping miracle.  Have you noticed the difference in how time passes yet?  Not so much in a line as in fits and starts, right?  When your baby looks at you, time can stand still, and then you make up for that golden moment trying to feed, change and bathe that child before the next chorus of “the Overtired Breakdown.”  Maybe time will crawl when you try and do the math of infant feeding schedules superimposed on infant sleeping schedules and sprint again as that math goes out the window with a missed nap.  Oh, and don’t forget to take time to enjoy every stage because you’ll never get it back.

 The feeling probably goes double for the mother of that miracle, and if she’s getting up for night feedings and pumping on a regular basis, she’s got less of a day to accomplish everything.  I’d add up the hours for you, but it might depress you and I want you to get to the happy ending below.

 In our over packed lives, why would anyone go for a Stone Age strategy like breastfeeding?  It hurts, it takes longer, it requires exposure of otherwise hidden skin, and on top of it all, if reinforces those nasty prejudices of the woman as primary-to-sole caregiver.

 If you’ve made it to this article, you’ve probably heard about the health benefits for the mother and the baby.  Even the formula people say breast milk is best.  If you’re taking the time to read this, you’re likely in no danger of dropping all of the baby care in mom’s lap.  Plus, there’s that bonding we hear so much about.  My wife, a working mom, says of breastfeeding “you have to, but you get to, too.”  The benefits are real. So why not give it a spin to see if it’ll work?  Remember that no one – no one – talks about the hidden long term benefits of formula.

 If you and your baby are lucky, the tike has a mother that lets you weigh in on baby care decisions – even if it’s to grunt and say “I dunno.”  If you chose to support the breastfeeding decision, you are now committed to supporting the breastfeeding process.  You thought you were getting off the feeding hook, right?  Sorry.  The actual breastfeeding will forever remain a mystery to me and most men, but there are things you can do to help.  Here are just a few:

> Get over it – If you’re squeamish about feeding in public or even being around during feeding, get over this as soon as possible.  Not only is America coming to the realization that breastfeeding is natural and normal, but it’s actually been legislated in many states that women are allowed to breastfeed wherever they darn well please.  If breastfeeding can take place during an outing or while enjoying your company, that’s like adding time to her day.  Doing two things at once = more time! 

> Feed the baby pumped or “expressed” milk – Expressed is actually a good word for it because it takes less time to pump than to feed a baby.  The baby will also usually take a bottle feeding faster than a breast feeding.  If you give the baby a bottle, you are putting time back into the mother’s day and you get a taste of that bonding everyone talks about.  Expressed = faster = more time + bonding for you.

> Wash stuff – You may have noticed that time has become a theme here.  A significant amount of the time required for pumping is in washing the pump components.  You can wash stuff.  You’ll still be a man when you’re done.  If you find this works for you, go ahead and find other stuff to take care of.  Every chore you take off her plate counts double during infant care.  Not that you could ever cash those brownie points in, but it might help you to know that you’re getting twice the credit.

> Keep the list of benefits top of mind – On top of being time consuming, breastfeeding will be frustrating from time to time.  It’s the stuff of thousands of support groups.  I’m not exaggerating.  When mom reaches the end of her rope, it doesn’t always mean she wants to stop.  She might just need support so she can keep going.  Remind her that her options are always open, but she chose breastfeeding for very good reasons.  And it will help you to remember the benefits, too when you aren’t getting the attention you’re used to.  Longer, healthier life for your family = more time.

> Talk to other dads – I’m lucky enough to have a sister and three sisters-in-law going though infant care at the same time.  Talking to them makes my wife feel more confident and happier.  And while they discuss pumping and feeding, I hang out with the boys.  Not only do we all get time out to talk about sports, but on the occasion we feel like talking about breastfeeding (yep, it happens) we’re all coming from the same point of view.  Trust me – you’ll feel far more comfortable talking about it with other new dads.  Try discussing a slow flow nipple with non-dads and see how far you get.

So when you add all of that time back into the day, bond with the baby and take time out to discuss the designated hitter, you’ll find that breastfeeding is a pretty good deal for you.  You get a chance to be an everyday hero just by washing stuff and understanding.  Mom will feel the pride of feeding her baby with her body and that will make you both happier.  Everyone will be healthier.  Plus (I promised a happy ending, remember?) it’s free.  Take those thousands of dollars and put it toward the college fund, or better yet, reward yourselves for all of the time you gave the baby and take some time to feed the parents at the nice restaurant or sports stadium of your choice.  Just remember to have a couple bottles ready for the sitter.

The Benefits of Breastfeeding

A few years ago I had the pleasure of attending a conference about the “Use of Human Milk and Breastfeeding Education for the Registered Nurse.” The speaker was Diane Spatz, RN PhD, an associate professor at the University of Pennsylvania and a clinical nurse specialist at the Children’s Hospital of Philadelphia. It was a fascinating day, and as usual, I learned a lot. Her most interesting lecture was her first one about the benefits of human milk. I thought I would pass this information along to all of you, as a reminder of the wonderful gift you are giving your baby!

Most women cite infection prevention as their number one reason for breastfeeding. Babies who are breastfeed have decreased incidence and severity of RSV, gastroenteritis, diarrhea, respiratory, ear and urinary tract infections. For premature babies, the benefits are life saving with a decrease in the incidence and severity of meningitis, blood infection, sepsis and necrotizing enterocolitis. ($200,000 is spent of each case of NEC alone!) These babies also have a decreased incidence of retinopathy of prematurity, SIDS, diabetes, and obesity. Their hospital stay is shorter and less expensive than formula fed preemies. Breastfeeding for these compromised babies is truly medicinal.

But do you know why that is? It is due to something called the “Enteromammary Pathway.” This is a maternal response in which anything the mom comes in contact with (microorganisms, food antigens etc.) travels thru her gut and lymphatic system causing antibodies to be produced that are then passed along thru her breast milk to protect her baby. It is for this reason that mothers of preemies are encouraged to touch everything their baby comes into contact with in the NICU.  Their exposure to everything their baby is exposed to protects their baby from hospital borne illnesses.

In addition to the infection protection, breast milk has a biological specificity that is exactly what the human newborn needs. The fat content of breast milk accounts for half the calories and it adjusts throughout the feeding and the day. Amazingly, the fat content is 30% higher in mother’s who deliver preterm infants, because those babies need it! The DHA and ARA in breast milk (which have now been artificially added to formulas) enhance the babies’ visual acuity and brain maturation.  Some fats are also anti-viral, anti-fungal and anti-bacterial. The lactose in breast milk enhances calcium absorption and is easily broken down to provide a constant nutrient flow to the brain.  Other carbohydrates promote the growth of healthy bacteria in the gut and decrease pathogens by increasing the acidity. Protein in breast milk is low in quantity but high in quality and is primarily the easy to digest whey protein. It is also immunologic with proteins that breakdown infectious agents.  Lastly, breast milk is full of antibodies, infection fighting white blood cells, hormones, vitamins and minerals that are essential for the general hydration and nutrition of your baby.

But you already knew all that didn’t you?  Keep up the good work!

Introducing the Bottle

Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!

When can I get my baby on a Schedule?

An oldie but goodie that we first shared in 2007.

This is the one question I am asked most often! Many new parents are anxious to get their baby into some kind of a routine and restore order to the chaos a newborn creates in their home. Unfortunately, imposing any kind of structure on a newborn that suits the parents’ schedule, usually results in a tired and cranky baby. Eventually, that baby will have tired and cranky parents and your family life will be anything but peaceful!

But what if you took a different approach to trying to get your baby on a schedule? What if you simply accepted that your baby has basic needs related to hunger and sleep that are beyond your control? What if, instead, you did everything you could to accommodate your baby’s natural schedule rather than trying to force him or her to follow yours? I can guarantee that if you did that, your life would fall into a very predictable routine. It would allow you to plan your day and actually feel as if you are able to accomplish things and in control. Why not give this approach a try? What have you got to loose, other than some more sleep?

A baby’s sleeping and eating pattern really does have some predictability to it throughout the newborn period.  Unfortunately, most parents of newborns are too tired to even realize it. I am certain at some point you will read this and think “That’s what my baby is doing right now!” Learning about it beforehand makes it much easier to recognize and deal with when it happens to you.

The first few days of a newborn’s life are full of sleep. The baby will usually be alert and awake for the first 4 hours after delivery, which is just one more reason to keep him with you and nurse in the delivery room! This is a great time for Mom, Dad, and baby to bond. After that, it’s lights out for days. Many parents tell me at this stage how good their baby is! I am constantly reminding them to make sure they wake the baby up every 2 to 3 hours during the day to feed him. If you don’t, he won’t eat. On or around day 4, Mom’s milk comes in and it’s a new ballgame! The baby eats all the time and is now vigorously demanding feedings. If he is doing this, you probably will not need to wake him anymore, provided he is voiding, stooling and gaining weight. Just feed him when he wakes up and asks for it! In addition, babies will start to have a fussy period that lasts a couple hours a day, usually in the evening. This fussiness usually peaks around 3-6 weeks and is almost always over by 3 months. This is a great cause of concern for mothers especially, who will begin to doubt their milk supply. It’s the perfect time to take a walk or ride in the car or break out the Snugly, swing, or vibrating infant seat. Don’t fight your baby’s fussiness! Feed him as much as he wants and do whatever else helps to make him happy. Nothing you do now is going to start bad habits and ruin him for life. You are simply giving him what he needs now, as any good parent would do.

At around 3 weeks of age, your baby will have a growth spurt. It is usually preceded and/or followed by a lot of sleep. He will nurse constantly for days, until you think you can’t stand it anymore! But when it’s over, he will fall into another predictable pattern. He may go as long as 3 hours between feedings during the day, and start sleeping for longer stretches at night. Another growth spurt happens again at 6 weeks and by that time, your baby should be sleeping from about 10pm to 4 or 6am. They usually nurse at that morning feeding and go right back to bed for a couple more hours. Another growth spurt then occurs again at 3 months of age, and is in many ways identical to the ones that preceded it. The best part about it is that when it’s over, the fussiness tends to diminish significantly and the sleep tends to become more regular and last longer. You may get a few good daytime naps and a good 8 hours of straight sleep at night!  It is at this time that I strongly recommend your baby is in his own crib in his own room (if possible of course!). I also advise parents to keep the baby in his bedroom from around 7pm to 7am, so he gets used to being in his room at night. The baby may go down at 7 and wake a few times throughout the night. But with a feeding and minimal stimulation (no TV, siblings, other adults) they usually eat and go straight back to sleep. This is usually a welcome relief to parents who have been up for hours during the night with their newborn.

Babies at 4 months of age generally are capable of and need to sleep from 7 at night to 7 in the morning. They may still wake once for a feeding anytime around 4 to 6, but they generally grow out of that rather soon. Problems at this age usually arise because your baby is now a little social being and has a pretty good idea that things are still going on in his family while he’s in his room and down for the night. At this stage, you may get some serious protesting at bedtime. But in my experience, babies who have been allowed to sleep and eat as they need to, are well accustomed to their crib and room, and have learned to fall asleep on their own, have no problem making this transition. And it is a very important one, because it now provides the parents with some quiet time in the evening for each other, other children, or additional sleep! In addition, once sleeping thru the night occurs with regularity, daytime naps start to happen with predictability as well, and your days get easier.

This routine of 12 hours of nighttime sleep and 2 daily naps in the morning and afternoon usually lasts from 4 months until about 15 months. At 15 months, your baby will start to phase out the morning nap, and tend to take one long nap in the afternoon. Many parents are happy to see that morning nap gone, as they are now free to leave the house in the morning and take the baby out for activities or errands.

Does this all sound impossible and too good to be true? I promise you it isn’t! If you think of sleep as something that your baby needs just as much as food, love, shelter and safety, it becomes something you feel the responsibility to provide for him as well. To learn more about this very important topic, I highly recommend the book Healthy Sleep Habits, Happy Child, by Marc Weissbluth M.D. He discusses this topic at considerable length and teaches you how to recognize fatigue in your baby. He also reveals many good habits to start before that 4 month mark that make the transition to a full night of sleep an easy one. He believes strongly, as I do, that a well-rested baby is a healthy, happy child, with a happy mom!

If things aren’t  going this smoothly for you, we offer a sleep class and even a sleep consult if you need one.  Just call our office at 401-884-8273 to let us know what we can help you with!

Rhode Island is the First US State to Support Breastfeeding Mothers by Becoming Bag-Free!

Through the hard work and dedication of many hospital employees throughout the state, and the gentle insistence of our Health Department, Rhode Island became the first “Bag Free” state in the nation. I realize it is old news by now, but for those who don’t know, this means “women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital.”(www.banthebags.org) In an event held at the State House on November 28, 2012 Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign all celebrated this achievement and “spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding.”(www.banthebags.org)

I think that most everyone who heard about this knew that it was a good thing for the health of babies in our state. Some weren’t happy about it, but I really don’t think they understood what it means. And let me be clear: it does not mean that mothers will not be able to receive formula in the hospital if they choose not to breastfeed. The hospitals will still have formula, and will still provide it for your child if you want it. What they will no longer do, is routinely give out discharge packs with free formula to mothers as they leave the hospital. Dr. Melissa Bartick, a Boston MD, wrote in a very public debate with MA Governor Mitt Romney that giving formula samples to new mothers was akin to giving Big Macs to patients on a cardiac floor. As Marsha Walker has said many times, “Hospitals should market health, and nothing else.” When nurses send new mothers home with a bag of free formula, it is an implied endorsement of that product. “State health officials noted that studies link these giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.”(www.banthebags.org)

We all know the benefits of breastfeeding. This information has been well promoted among the public health community for years. But “because breastfeeding is the gold standard infant nutrition that provides optimal healt
h for both mothers and infants, lactation experts have recently shifted to describing the risks of formula feeding rather than the benefits of breastfeeding. For mothers, not breastfeeding is associated with an increased risk of post-partum blood loss, post-partum depression, and ovarian and breast cancer when compared with women who do breastfeed. For children, risks of formula feeding include an increased incidence and severity of a wide range of infectious diseases as well as chronic diseases such as diabetes mellitus and obesity.” (MacNamara et al, 2012) When framed that way, doesn’t it make sense not to promote an unhealthy behavior? Especially in a hospital, where we really have the opportunity to help mothers get off to a great start establishing healthy habits with their baby!

So our tiny little state has really done a big thing for families who deliver their babies here. Next on our agenda: having Rhode Island become the first state in the nation with all birthing hospitals designated as Baby Friendly. “The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.”(www.babyfriendlyusa.org) Currently in Rhode Island, Newport, South County and Westerly hospitals have all achieved this status. Throughout the world, the majority of hospitals are Baby Friendly. It is only here in the USA, which is so heavily influenced by the business of formula marketing, that Baby Friendly hospitals are in the minority. Interested in helping to make this happen? Contact your local hospital and ask that they do everything they can to achieve this designation and deliver only at a hospital that has it. Consider joining the Rhode Island Breastfeeding Coalition (RIBC) and joining our advocacy efforts. You can read more about this wonderful organization and ways to get involved at the following link: www.health.ri.gov/partners/coalitions/breastfeeding. We hope that you will join us!

SIBLING RIVALRY

Written in 2010

My three younger sisters are the only thing getting me through this phase of my life. My relationships with them help me to hold out hope that one day my children will not only be civil and kind to each other, but they may actually want to spend time together. I vaguely remember tension between my closest sister and me, as she was only 11 months younger than I was. I recall viscous fights and terrible things said to each other. But with the two younger ones, I only remember fun. Now, as we all raise our children together, there really are no other women I would rather be with. Will my kids ever feel that way? If you spent an hour in my house, you wouldn’t think so.

I am the mother of four boys. The youngest is 7 and adorable. His older brothers love him. He has not yet become annoying. The three other ones are 12, 15 and 18, so there is a lot of testosterone in my house. And with that comes trash talk, bullying, and the occasional “accidental” bat to the teeth. I wish I was kidding about that one. 

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Coming from a family of girls, I am unaccustomed to the sheer physical nature of their interactions. My two oldest boys now have the bodies of men and tower over me. It seems that no one walks by the other without a nudge, flick or swat to the head. All when I have my back turned, of course. The verbal insults I can at least hear, but often wish I didn’t. I find it heartbreaking the way they speak to each other. Then I have to endure all the different versions of how things went down, who started it and how they should be punished. Invariably, someone is upset that I haven’t taken their side and I feel like I am the one beaten down in the end.

I hear from other men with brothers that this is normal behavior; that what I am experiencing is relatively tame and butting out is the best option. But don’t we have a responsibility as mothers to point out bad behavior? And to protect them from each other? Someone could get really hurt, right?

My mother-in-law stayed with us for a week once and she gave me advice that helped eliminate some volatile exchanges. She suggested that I not put the particularly combative ones together while doing chores, babysitting, on car rides etc. It really worked! My problem is that I frequently forget that advice. In my hurry to get things done, I bark out orders and put them in situations that foster the bad behavior. But I find that now that they are bigger and stronger, I really need to pay attention to what I am asking of them and determine whether they can handle it with everything else that is going on in their life. If they are having a good day and are relatively happy, they might find it fun to be with their brothers and endure a little good-natured ribbing. If not, look out. Someone else is going to bear the brunt of their difficult day.

I’ve tried to put some thought into what each child seeks from another. The older ones really want respect. They want the younger ones to take what they say to heart, to do what they ask the first time, to have their privacy, and their possessions left alone. The younger ones just want to be with the older ones and to be an important part of their lives. None of them need additional parents. I keep saying things like “Just be the cool big brother” or “Be what you want him to become.” Let the parents actually engage in the parental behavior.

Sometimes, I feel their bad behavior is an attempt to get some attention from me. I might be flattering myself, but I do know that if I make the effort to spend time alone with each one, things tend to be better at home. So when I can, I take a boy with me. Whether it is to the grocery store, bank or post office, you can learn a lot when alone for a half hour with a boy. In addition, almost

every day each of them wants/needs something from me- a permission slip signed, form filled out, a button sewn back on their pants. Silly little stuff, but important to them. And when I take care of it, they are more inclined to take care of each other. Sometimes I really have to stop myself and pay attention to what is important to them. I think that is important advice for mothers of children of any age. When we look them in the eye and take their requests to heart, it validates them and lets them know we think they are important.

So in a nutshell, here is what I have found works:

Don’t take sides. If you didn’t see it, you cannot make a judgment about it. Listening to all sides of the story makes you pick sides and someone will be unhappy. My husband came up with a grand plan of punishing all involved equally, regardless of who started it or did what. This has made them think long and hard before coming to us, and they tend to resolve things amicably themselves.

Physical and verbal abuse/ bullying is never acceptable. There is no excuse for it regardless of the behavior that provoked it. When you see or hear it, stop it immediately and remove the offender from the situation. Take away a privilege if the behavior continues.

Don’t put kids who are combative in a situation where they are forced to work together without adult supervision. I have learned who works well together and when I need to, I am involved in supervising the activity. My presence usually keeps the situation under control, without them realizing that is my intention. Sometimes they even have fun together!

Give each child some one-on-one time with a parent as often as you can, especially if they seem to be having a hard time within the family. Reinforcing your unconditional love and letting them know they have you to protect them does wonders for their self esteem and gives them the strength to stand up for themselves.

For the younger kids, teach and model empathy every chance you get. This has been reported to be a critical developmental milestone. If they are able to put themselves in another’s shoes and understand how they feel, it goes a long way in keeping them from treating others badly. And it can be the basis for everything ~sharing, taking turns, manners and respect.

And maybe someday, they will look back on this time fondly, while hanging out with their siblings and their own children. At least we can hope for that, right? I know I do, every day.