Rear-Facing or Forward-Facing

Kariana is officially one month away from her first birthday. The first birthday is always a big event. It also used to be when young children were switched from riding rear-facing to forward-facing in their car seats. If you don’t often ride with a little one in your car, you might not appreciate how much of a life changing event this can be for both mom and baby. I find having Kariana rear-facing extremely frustrating. Babies don’t like to be in the car and in baby talk the question “Are we there yet?” is simply “WAAAAHHHH!” It is virtually impossible to drive safely and monitor what Kariana is doing while she is rear-facing.

The long-standing recommendation by the American Academy of Pediatrics (AAP) suggests that all infants should ride rear-facing until they are at least one year of age and weigh at least 20 pounds. Earlier this year new research was released that shows toddlers are more than five times safer if they remain rear-facing until age two. Following the release of this new research, the AAP issued a news bulletin suggesting they may soon upgrade their minimum “one year and 20 pounds” recommendation to two full years of rear-facing. The news bulletin was issued in April 2009 and was quickly viewed as prepping parents for the potential change.

The statements by the AAP that followed the news bulletin are not so clear. It now seems the AAP is not updating their official recommendation at this time. In an email to child passenger safety advocates, an AAP representative said, “A Parent Plus box in the April 2009 issue of AAP News appears to contain a revised AAP recommendation on how long babies and young children should ride rear-facing. However, Parent Plus boxes and AAP News articles do not constitute AAP policy." The email also says “AAP’s recommendation has not changed at this time.”

So we have new research that suggests young children are safer riding rear-facing until they are age two and a statement (but not an AAP policy) on the AAP’s website that says “It is best to ride rear-facing as long as possible.” The question for mom and dad is what does this mean for Kariana? To complicate matters we weighed Kariana at the pediatrician’s office yesterday and she weighs 18 pounds 7 ounces – we’re not quite at 20 pounds yet and probably won’t be by her first birthday. I guess the next question we have to ask is the mental torture worth the risk?

What happen to Robitussin?

On Sunday Kariana woke up with her first runny nose/cold and as I reflect on the past few days I realize I have mixed feelings about Kariana’s first cold. I also realize that as a neurotic and overly protective mother it’s not surprising that I am analyzing my baby’s first cold. Some of you may find this obsessive/compulsive. I like to think of it as staying well-informed.

On one hand, I’m proud that we’ve gone 11 months without a cold. Although I know it comes with the territory, I find myself looking at other mothers whose kids have sniffling, sneezing, snotty noses with a bit of scorn. Don’t those mothers have sense enough to take care of their crusty nose kids? But now I am one of those mothers with a sniffling, sneezing, snotty nose kid. It’s not an easy task to fight with your irritable child who isn’t feeling well to wipe the crusty off her nose. These little ones have a mind of their own which probably explains why there are a lot of crusty nose kids running around this time of the year. It is flu season and I am glad we’re dealing with a cold and not the flu.

On the other hand, I feel some sense of relief that we’re going to make it through our first cold and it hasn’t been too terribly bad (knock on wood). It was inevitable that Kariana would get sick at some point. It’s not really the fault of other mothers who bring their sniffling, sneezing, snotty nose kids to playgroup, music class, etc., right? Kariana isn’t sick, sick. I mean we’re not battling a high fever and we’re not staying up with her all night because she won’t sleep. She just has a sniffling, sneezing, runny nose which is making it hard for her breath. I imagine it’s a lot worse for these little ones when they get a cold because they can’t blow their nose. So the snot makes them feel congested and it has no place to go other then running down and out their little noses!

So we’ve done all we can for Kariana – nasal spray rinses, steamy baths, rubber suction bulb (yeah, right), a humidifier in her room, Vicks BabyRub on her nose and regular doses of Infant Tylenol every 4 to 6 hours. This is the recommended treatment for symptoms of the common cold from the brilliant minds in the U.S. medical profession. But what ever happen to Robitussin?

Before I continue, you should know that I’m not being sarcastic when I refer to the brilliant minds in the U.S. medical profession. I honestly have the utmost respect and admiration for physicians and medical providers in the U.S. I believe we educate and train some of the best and brightest in the medical profession. The doctors and medical providers I know are some of the most brilliant people and I believe most of the idiosyncrasies that occur in the medical profession are not their fault. One might argue that it’s the legal profession that is at fault and I don’t necessarily disagree! Now, back to my point . . .

Take a closer look at the label on any children’s OTC drug. I just discovered this in the past two days by standing in the children’s medicine aisle of CVS at 9 o’clock at night. I’ll use Robitussin as an example because it is one of the most trusted brands on the market and after Tylenol has probably been around the longest. Robitussin Children’s Cough has one active ingredient, Dextromethorphan, which is a cough suppressant, and the label reads “children under 4 years – do not use.” The label on Robitussin Children’s Cough and Cold, which has three active ingredients, a cough suppressant, expectorant and nasal decongestant, reads “children under 4 years – do not use.” The label on Robitussin Children’s Cough and Cold Long Acting, which has two main ingredients, an antihistamine and cough suppressant, reads “children under six years – do not use.” Since standing in the aisle of CVS reading these labels the other night, I did my research and learned that the current labels on most children’s OTC drugs are relatively new (since 2007). These new labels came in the wake of advice by the U.S. Food and Drug Administration’s (FDA) advisory panel that cough and cold medicines that have been sold over the counter for years should not be given to children under six. I found the following answer to a Q&A on the Center for Disease Control’s website:

“The Consumer Healthcare Products Association (CHPA), a group that represents most of the makers of nonprescription over-the-counter (OTC) cough and cold medicines, recommends that these products not be used in children under 4 years of age. The Food and Drug Administration supports this recommendation. Overuse and misuse of OTC cough and cold medicines in young children can result in serious and potentially life- threatening side effects.”

Following these new recommendations, pediatricians and public health officials across the U.S. asked the FDA to restrict sales of OTC cough and cold remedies for children, complaining that the drugs are not effective and can even be injurious to young children. If this is the case, then you have to ask yourself the following questions: Are these new recommendations a result of a few unfortunate overdosing incidents because some parents simply can’t read labels? Is this the government and the drug manufactures trying to protect themselves from stupid parents? Doesn’t this beg the question whether these OTC drugs are dangerous to all of us – even adults? However, the drug manufacturers assure us “there are no problems with the medicines themselves,” but we just shouldn’t give them to small children.

I am not saying that I fall on one side of this debate or the other. I am just expressing my frustration as a mother who is trying to do the best for her young child amongst the rapidly changing and confusing advice. For now I’ve decided to follow our pediatrician’s advice and treat Kariana’s cold with the simple home remedies suggested above and maybe a little Infant Tylenol to ease the pain for both mom and baby. Have you ever tried using a rubber suction bulb on your baby’s nose when she is cranky and irritable? That's what a thought – good luck!!

Final Thoughts: After writing this lengthy blog this afternoon, I took Kariana to the pediatrician. I wanted Kariana's pediatrician to check her ears and it just so happens that I had planned on taking Kariana in to get her flu shot this week anyway. I'm happy to report Kariana's ears look good (knock on wood) and it is officially confirmed that she just has a cold, but unfortunately what I also found at the pediatrician's office was organized H1N1 (a/k/a "swine flu") chaos. Even Kariana's pediatrician was a little taken back by the number of patients they are screening for H1N1 so early in flu season. It's only September and flu season usually doesn't kick in until November. So today Kariana got her first of a series of two flu shots, but next I'm going to have to decide whether I want her to get vaccinated for H1N1. The new H1N1 vaccine will be approved and on the market in a few weeks and it is being highly recommended for all children under the age of six. Sigh . . . . back to the drawing boards with my research.

The Forgotten One

It seems important for me to pay tribute to one of the best cats on the planet – at least the best cat after my first cat, Katie, who is no longer with us.

In 2006, Stripes decided to turn in “street living” for a warm and cozy home. Stripes was a stray cat who was scared of people. She was rough and tough around the edges, but showed up at our doorstep one day looking for a home. Every evening I sat outside with her while she ate her dinner and we spent time getting to know each other. Shortly thereafter Stripes decided she wanted to become part of our home.

We tried to make Stripes an indoor cat on several occasions, but this was not an easy transition for Stripes and not one that she was going to fully accept. Stripes enjoys spending her days roaming fields and chasing bugs, birds and field mice. She often brings some of these creatures home with her (dead or alive) so we’ve all had to compromise a little, but we let Stripes set her own schedule. This typically means she spends her days outside, and then she shows up in time for dinner and to curl up on the bed with us for the night. Stripes has become a fair weather cat and on rainy days or days where the temperature falls below her comfort zone we often find her curled up on the bed during the day.

Poor Stripes could not have predicted how her quiet and peaceful world was going to be turned upside down with the arrival of Kariana. How can you really prepare a cat for a new baby? I can’t say that Stripes has accepted Kariana with loving paws but from a distance Stripes is tolerant of Kariana. On the other hand, Kariana is very fond of Stripes and gets overly excited when she sees Stripes. Her arms flap around and she giggles and squeaks. She eagerly tries to crawl after Stripes, but fortunately she doesn’t stand a chance. Stripes is a cat and quite agile. Her street smarts tell her to keep her distance from Kariana.

Although Stripes probably hasn’t received the amount of attention that she used to receive from us, she still curls up with us and sleeps at our toes on the bed each night. We’ve all settled into our new routine and we want Stripes to know we love her just as much as we always have!! Enjoy these pictures of the family together. The first picture is of Stripes before we brought Kariana home from the hospital. The second picture is Tobin, Kariana and Stripes during the first few weeks.

Infant Reflux

Kariana lying on Tobin's chest and sleeping at 7 weeks old.

The other day Grandpa Bergen asked me why I hadn't written about the issues we had with Kariana's reflux when she was a newborn. I'm not sure I have an answer. Maybe I've tried to block it out or maybe the first 2 1/2 months were such a blur I've already forgotten. Neither is really true so let me try to re-cap the first 2 1/2 months with Kariana.

GER (Gastro Esophageal Reflux, a.k.a.“reflux”) is simply defined as the backward flow of stomach contents into the esophagus (the tube that connects the mouth to the stomach which is not fully developed in newborns). The prevalence of GER in infants peaks between 1 to 4 months of age, and usually resolves by 6 to 12 months. As a new mother, I had read and heard a lot about colicky babies, but no one seemed to focus closely on GER or “infant reflux.” I later learned the reason for this is that not all pediatricians recognize reflux in babies. Kariana was fortunate to have a pediatrician who immediately caught on to her signs/symptoms of infant reflux.

It became obvious within the first few weeks that something was making our precious little bundle very uncomfortable, but it took us a few weeks to figure it out. Kariana was a very fussy newborn. Tobin and I didn't know what was a normal amount of crying and fussiness for a newborn and it had been a long time since Grandma and Grandpa Bergen, who were staying with us and helping us out, had had me so they didn’t remember either. The four of us worked as a team (well, at least, we tried) and we limped along those first few weeks on very little sleep trying to do the best we could for Kariana who was our focus 24/7. Looking back at those first 2 ½ months, the signs of infant reflux were obvious, but it took many sleepless nights and several trips to the pediatrician to get Kariana’s reflux under control.

Kariana demonstrated classic signs of infant reflux. She “spit up” after her meals and continued to spit up hours later. She would cry after meal time because she was in pain from the reflux. It was clear that her spit ups were not just a laundry nightmare, but that her reflux was making her uncomfortable. Kariana also cried whenever we laid her on her back to change her diaper or to put her to sleep. In fact, Kariana would not sleep on her back at all. Her favorite position was to lie in an upright position on her belly on our chests. This seemed to be the only position Kariana would sleep comfortably. So Tobin, Grandma Bergen and I took shifts sitting on the chair with Kariana sleeping on our chests for hours at a time.

Then Grandma Bergen began lying Kariana on her belly across her legs and it became obvious Kariana was more comfortable sleeping on her belly. Much to my concern, we began lying Kariana on her belly in her crib to sleep at night. In a world where SIDS is indoctrinated into a new mom's brain, having Kariana sleep on her belly was hard for me to come to terms with. I insisted we sleep on an air mattress on the floor in Kariana’s room with her.

We also started Kariana on prescription medication to reduce the acidity in her stomach that was causing her to reflux (Kariana took Zantax; Prevacid did not work for her). We also gave Kariana Mylanta after her meals to sooth the burning sensation caused by the reflux. In the beginning, I did not like giving my newborn all of these medications. I was concerned I was overmedicating my precious little bundle. Those not familiar with infant reflux wanted to attribute the fussiness to colic and/or gas and suggested Gripe Water and Mylicon Drops. We tried both with no luck. We knew Kariana wasn’t colicky or gassy. She was suffering from infant reflux and it was obvious that the prescription medication made her more comfortable.

Because of her reflux, Kariana needed to be held upright and consequently she spent a lot of time in our arms. We held her upright for 20 to 30 minutes after each meal to help her digestion. She never spent any time on her back because it made the reflux worse for her. It was difficult for us to take Kariana on outings outside the house. She cried in her stroller because it jostled her too much and made her spit up. She cried in her car seat because the car ride did the same. Kariana needed to be held upright and the Baby Bjorn was our savior those first few months.

Kariana gradually grew out of her reflux. By 6 months she spit up a lot less and by 9 months we discontinued all of her medications. I am happy to report that Kariana is a healthy happy baby and those first 2 ½ months seem like a long time ago.

Howling Halibut

Tonight we had Halibut and green beans for dinner and this is where this short story begins. When Kariana was just weeks old Tobin started calling her “Howling Halibut” whenever she cried. Being the proud Pacific Northwesterner that he is, Tobin couldn’t wait to see if Kariana would like Halibut. Kariana’s pediatrician recommended not feeding her fish until she is a year old because of the concern of allergies. As you might guess, our trip to the Oregon Coast was the perfect opportunity for Kariana to try Halibut and I crossed my fingers that we wouldn’t have any major allergic reactions while on vacation. Kariana loved her Halibut and no one had to run to the drug store to find Benadryl that evening. Since then we’ve also tried scrambled eggs, which are another no-no because of allergies to egg whites until one year of age, but Kariana loves scrambled eggs too! I am so thrilled that Kariana is trying such a variety of foods and loving them all. Now, I’m crossing my fingers it carries over into toddlerhood.