Tuesday, November 1, 2016

BABIES ARE SLEEPING IN MOM'S BED: HERE'S THE NEW RULES

SIDS, SUID, co-sleeping, newborn specialist, nanny, baby, Mom, parents, AAP

BABY’S FIRST YEAR: WHY THE EXTENSION OF THE AAP'S GUIDELINES?

The AAP, the American Academy of Pediatrics, has come out with an extention and more stringent guidelines for parents for the first year of life. But are they really new? What prompted the changes? Busy parents and caregivers need to know, but often don’t get past the scary headlines. It’s important to go a bit deeper and see why the changes were recommended, in order to make the best choices for each family's situation.

Actually, the only new guideline is that the rules should be followed for the first year, rather than the first six months. And, doctors are recommending that babies sleep in the same room as their parents for the first year. 

“The new rules were created because pediatricians are seeing that parents aren’t actually following the old guidelines,” says Terian Gregory, a seasoned Phoenix Certified Newborn Care Specialist. “They realize that parents are sleep-deprived, not making good choices, and are too exhausted to follow the guidelines. They’re inadvertently taking less safe shortcuts,” she explains. "Like taking baby to an armchair or couch and falling asleep. Taking baby into their bed to nurse, and falling asleep. A lot of parents have done it, but it’s risky. The result is that babies are not always sleeping in their own beds, cribs, or bassinets, with a firm surface, with no pillows, blankets or soft toys.”

Pediatricians are recommending co-sleepers, bassinets attached to the parent’s bed or sleeping the baby in a crib in the parent's bedroom.  Mom can pull baby out, nurse, and put baby back without even getting up or leaving the room. Terian explains that what is happening is that doctors are responding to what parents are actually doing. "The AAP often puts out recommendations when there are safety concerns."

According to a recent NPR articleThe updated recommendation, then, is that mothers feed their baby in bed and then place the baby on its own sleep surface afterward. If the mother falls asleep by accident, it's not as hazardous as it would be on a couch. When she wakes again, she should immediately place the baby back in its own bed, since the risk of death increases with the duration of bed sharing.

"I am struggling to find a concrete study,” Terian tells us, “that shows that if parents are actually following the guidelines and sleeping their baby in the baby's crib in the nursery vs. having babies sleep in parent’s bedroom actually keeps a baby safer". These parents are so sleep deprived they just aren’t making good choices.  If the parents put a bassinet in their room, it makes it simply makes it easier for parents to keep their baby safe."

“So what is the AAP really saying?” asks Terian? “They just extended the time of following their guidelines. They’re not just looking at SIDS, but all sleep related deaths. SUID (Sudden Unexpected Death) can include suffocation, aspirating on something, babies put in cribs with pillows, soft toys, or blankets, sleeping on tummies, on their sides. Parents are just not following the recommended practices." Terian stressed that if a baby is sleeping through the night, some of these concerns may not apply.  “As a Certified Newborn Care Specialist, I prefer to be in the same room as the baby. That’s my job. I prefer working with a baby to develop positive fundamentals and begin with "sleep shaping/sleep learning" strategies within the first 12 weeks. I have clients who prefer to have the baby monitor on even though I’m in the baby's room. In that case, I recommend them keeping the sound off.  Parents can see the baby better on a monitor from their room than I can staying in the same room as the baby. Babies make a lot of noise during the night.  They often grunt, pass gas and makes noises and then fall right back to sleep and when the baby is in the same room, parents tend to be over responsive. Monitors actually exacerbate any noises the baby makes. Therefore, the parents get less sleep because the baby's noises are waking them.  The AAP recommends that parents do not use 'Home Cardiorespiratory Monitors'.   It is important that parents understand that this is different than the typical baby monitors that allow them to hear or see their babies. A regular monitor with a baby in their own room, is very workable."

Terian continues by suggesting, "If a mom is nursing those first few weeks, and up every two to three hours for an hour each time, it makes sense to keep baby in the parent’s bedroom."

So, if you’re co-sleeping, follow the recommendations. 
If you’ve been getting up one to two times a night for 6 months or longer, parents are in survival mode, and not typically not making good choices.
However, If your baby is sleeping through the nigd and not making good choices, PLEASE follow the recommendations.

"The medical community is doing their job: saving babies lives, but sometimes these headlines feed on parent’s fears. Parents and caregivers need to dig deeper, read a little more, and make the best choice for their particular family. Parents, Nannies, and Newborn Care Specialists need to assess the particular family's environment, physical, emotional, environmental, and assess this new information, and make the best choice for their particular situation."

Terian concludes with, "Caregivers need to educate themselves to make the best choice for their families. For example, how does the family plan on parenting? What's they physical layout of the house? Is baby’s room across the house or upstairs? What is Mom’s physical condition? Is there a lot of anxiety? Is she going back to work or will she be a stay at home Mom? Our goal is to empower parents and caregivers."ht, or if you can safely get up during the night and put the baby in his own crib after nursing, there is not a reason not to put him in his own room.  But, if you’re sleep deprived and not making good choices, PLEASE follow the recommendations.

"The medical community is doing their job: saving babies lives, but sometimes these headlines feed on parent’s fears. Parents and caregivers need to dig deeper, read a little more, and make the best choice for their particular family. Parents, Nannies, and Newborn Care Specialists need to assess the particular family's environment, physical, emotional, environmental, and assess this new information, and make the best choice for their particular situation."

Terian concludes with, "Caregivers need to educate themselves to make the best choice for their families. For example, how does the family plan on parenting? What's they physical layout of the house? Is baby’s room across the house or upstairs? What is Mom’s physical condition? Is there a lot of anxiety? Is she going back to work or will she be a stay at home Mom? Our goal is to empower parents and caregivers."

Beth Weise

Friday, May 27, 2016

ROUTINE POSTPARTUM DEPRESSION SCREENING FOR NEW MOMS

When I brought my second baby home, I felt overwhelmed. I had trouble connecting with him, feeling blank. One day when I ran out of fresh diapers, I felt paralyzed. This was before disposable diapers and clothes dryers and the diapers were clean, but were hanging on the clothesline in the back yard. I laid on my bed,thinking,“This is how people feel when they’re depressed.” I knew I had a choice. I could give up, or go out there- a blustery April day, and pull a diaper off the line. I got the diaper that day, but It wasn’t until two weeks later when I saw a full page picture of a baby’s heart in a Time magazine add, that the numbness melted, and thankfully, it didn’t return.

But for 9% to 10% of pregnant and postpartum Moms, it's more serious.

The medical industry is now recommending that pregnant women and new moms need special attention in screening for depression, according to the U.S Preventive Services Task Force. This panel was appointed by the Department of Health and Human Services, and now formally supports that advice.This is a first of it's kind  call for doctors to routinely screen women either pregnant or who have already given birth. There are extra hormones working in women during these times and a lack of sleep can trigger depression. Dr. Eleanor Martinez, M.D., told ABC7 News, "By making this recommendation we are putting it up in the front and saying, 'Listen, this is a diagnosis. This is a disease. We need to embrace it like anything else.'"

Evidence shows that new mothers can be accurately diagnosed and successfully treated with the help of alert pediatricians, family doctors and OBGYNs. Not taking depression seriously is harmful to both mother and the baby. Research shows that untreated moms have  babies and toddlers, with sleeping problems and take longer to be comforted. Until now, depression in these new mothers  has been under recognized and under treated. A routine test can be given to the mom while she is waiting for her appointment. It will tell the doctor if she needs further screening for depression.

Treatments that work are “talk therapy" or drug therapy, or a combination on them are most successful. However, part of the problem is motivating a depressed mom to keep trying while the right treatment starts working. Plus there is a small risk of miscarriage and preterm birth leaving talk therapy as the best choice, and a nursing mom will be hesitant to take any drug.

Legislation in Congress may authorize Washington to fund screening and treatment for moms with babies one year and under, but as for now, there is none.
If you’re pregnant or a new mom the questions a doctor may ask to determine if you are at risk may be:
“Have you felt down a lot in the last few weeks?
How often have you felt tired or were unable to concentrate?"

Anyone working with a new mother, family members, friends, or a nanny should be aware of symptoms. Mild depression, anxiety and mood swings are common in new mothers and this is called Baby Blues. This is normal in new moms and usually fades away after the second week. The entire process of giving birth is exhausting, hormones are raging, sleep can be sketchy. Most moms go through this.
How is postpartum depression different?  It brings more severe emotions that don't go away, with thoughts of suicide, or feeling like one is unable to care for the baby. The Edinburgh Postnatal Depression Scale is a set of 10 questions  to determine if  medical help is indicated.

 I got a call one Sunday morning from a distraught Dad, who reported that his wife had come out of the bedroom  stating that she had thought of suicide three times that morning. The baby was 5 days old, and we were able to find a Newborn Specialist for this family for a few weeks to get up at night with the baby and do all the night feedings so the parents could get their much needed sleep.

Beth Weise