27 September 2011


Supporters of breast feeding are generally applauding the trend that fewer hospitals are giving away free samples of formula to new moms. I certainly see the argument. Even if the hospital hires lactation consultants and gives lip service to the benefits of nursing for both mother and child, the act of handing over the formula (which hospitals usually receive free from formula manufacturers) is seen as complicit support of formula as the diet of choice for newborns.

When the resurgence of breast feeding amongst women in the U.S. meant that formula sales fell instead of continuing to rise as expected, Nestle sent Caucasian employees dressed in white coats to places like Africa to give free samples away. These were not doctors, but they were dressed like doctors. The result was that women who had fed their families successfully for generations were led to believe that formular is better than breast milk. Unfortunately, while an adequate source of nutrition and certainly not overtly dangerous to the infants whose mother's cannot or chose not to nurse them, in communities with no clean water supply and where financial limitations mean that formula is likely to be mixed at half-strength to save money, formula is in fact dangerous. Dirty water and the diarrhea it brings with it kill infants, infants who would never have fallen ill had they been nursed.

In the United States the stakes are not quite so high, the situation not so dire. Still, the protective effects of breast milk have very real financial impact on the health care system and on families as a whole. Fewer childhood illnesses translates to fewer missed days of work for parents and fewer doctors visits.

So I do support breast feeding and not only because the AAP tells me to. But I also support having a few bottles of formula in the back of a cupboard somewhere and, since no gung ho new nursing mom wants to have to walk into a store and actually admit that she is going to buy formula, then by all means let the hospitals give it to them for free.

Emmaline got no formula in the hospital when she was born. We had no formula in the house when we went home. She had no formula for the week that I sobbed each and every time she nursed because we were not latching right. And that meant we had no formula within easy arm's reach when I spiked a fever of one-hundred-and-two from the mastitits I had developed and that I, despite feeling as if I had been hit by a truck, continued to be her only source of food.

We nursed for another year. We were by no means breast feeding failures. And I don't know for sure that if I had guilt-free formula stashed away somewhere that I would have actually used it. But even if I didn't, just knowing it was there would have made nursing Em a choice and maybe I wouldn't have felt so scared or helpless. Maybe I would have taken a break and been able to heal before the bacteria took hold beneath my skin and I ended up back in the hospital and on IV antibiotics for 4 days. Maybe we would have been healthier, the two of us, with a little formula on the side, our dirty little secret.

Em, of course, didn't care. She nursed like a champ even when she was biting holes in me to do it. She gained weight. We eventually got the hang of it and I wouldn't trade the closeness of those moments for anything in the world. But when a new mother looks at me on the day she is about to go home from the hospital and tells me that she doesn't know if she can make it on breast milk alone, I tell her I understand.

I make a hard sell for exclusive breast feeding, of course, but then I tell her that if she takes some formula home and hides it somewhere at least she won't have to worry. If there is a night she is throwing up and can't get out of bed, then she can take care of herself while her partner takes care of the baby. Because nursing, health benefits or not, is not worth it if it detracts from instead of adding to the joy of having a child. Nursing is hard work. But, like baseball, it's the hard that makes it great.

24 September 2011

The Penis Pronunciation

Now that Emmaline is two, it is a whole new world. She learns something new every day. For instance, how to make breakfast.

Or how to take care of the livestock...

To ride in a rodeo...

To prepare for the catwalk...

To turn brand new blue shoes to black in less than sixty seconds...

Or even how to seek out new worlds and new civilizations.

But perhaps the most impressive strides she's made lately is in her ability to communicate. Sure, this often takes the form of earth shattering shrieks and a deluge of tears. But more often than not there's a sentence thrown in there somewhere.

"Stop Mama, no kissing me," was not a sentence I particularly wanted to hear today, but it was a sentence nonetheless.

And though she says much that we don't understand and says even more that you wouldn't understand, when she chooses a word, it is usually correct. Once she pins down the syllables, she rocks them like a beat poet and expects her audience to appreciate her efforts.

So it was unexpected when, after introducing peanut butter for the first time, she got it so entirely wrong when asking for seconds. The peanut butter lollipop was a favorite of mine when I was younger, probably because it was within the reach of my culinary skills consisting as it does of peanut butter loaded onto a spoon. Emma had some. She liked it. She did not demonstrate any feared allergic reaction but instead smiled and asked me for more.

"Like more penis pop, please."

"You want more peanut butter lollipop?" I asked innocently.

"Yes please, I love penis lollipop."

She said lollipop. She also says helicopter and refrigerator and lullaby and thunderstorm without difficulty. But she cannot say peanut butter.

I didn't laugh. I didn't draw attention, though this was one of the hardest things I have ever had to do. I simply repeated the words peanut butter to her as often as possible in the days that followed, waiting patiently for Emmaline to get it right. Granted, I've been waiting less than a week, but we're not making progress.

This afternoon, while lying underneath the kitchen table to let Scout lick the remains of her snack off of her face, Emmaline exclaimed, "Mmmmm, I love penis crackers!" Then she said, "Crazy dog, stop licking me."

At least she's getting some things right. In the meantime, I'm waiting for the knock on the door from social services. And I have a feeling I'll be talking about peanut butter a lot.

15 September 2011

Spongiform Encephalopathy

It seems the big news this week is that Sponge Bob turns young brains to mush. I tried to ignore it when I first spotted this article. After all, there wasn't much about that statement that struck me as surprising. Sure, researchers have long been asking questions about how much television is good, bad, or has no impact at all. When Sesame Street debuted in 1969 with the goal of helping young children learn, studies were designed to look at test scores of children who would have been exposed to the programming compared with children who were not.

What do the studies tell us? Well, while there are certainly fascinating tidbits to be found here and there and that will amuse developmental specialists for decades to come, I would venture to say that the bulk of the literature echoes what common sense should have clued us into from the very start. Certain television, aimed at keeping your children entranced and slack jawed on the couch, is probably not boosting their IQs. Other shows, ones that reinforce simple concepts and encourage audience participation, are probably not so bad. You might want to turn them on, for example, when you hop into the shower or fold the laundry. No harm, no foul.

Should you park your child in front of the television all day? Should you depend on television to teach your child to count or to be kind to strangers or spell his or her name? Of course not. Do we sometimes turn on television that we know is not necessarily educational because we just need a break? Yes, and that's absolutely okay.

At the park this last weekend Emmaline saw a horse she has seen many times since we moved to our new neighborhood. Usually she yells, "Horsie!" Or she squeals what is meant to sound like a neigh. This time, however, she said "Yee haw!" because that is what Jessie from Toy Story shouts. It's a movie that she doesn't really understand and, yes, she does get slack jawed sitting in front of it.

But here's where I think it differs from Sponge Bob, if we've reached the part of this post where I defend my parenting choices. I enjoy it as much as she does. That means that as much as the movie is entertainment and not education, it is something we share, that we discuss even when the television is off. The stories we love can define us just as much as how quickly we learn to read or write. In fact, I think that one inspires the other.

In healthy moderation, as with all things. But then, I didn't need a study to tell me that. It's something my mother taught me a long time ago.

13 September 2011

Bite Me Michelle Bachmann

It's been made clear to me during my years of training and practice that pediatricians are meant to be happy, comforting people who love to cuddle babies and who want to fix boo boos and all sorts of other adorable things. So fine, I wear socks that have sheep and teddy bears on them because, let's be honest, they are what I would choose to wear anyway. And I try to be a nice person. I try to smile at work and even just out on the street. I try to pick up trash when I find some. I open doors for people. I give up my seat on the T to older people or women who are burstingly pregnant.

I try to be a good person. I try to behave.

But then Michelle Bachmann went on national television and said that the vaccine for HPV, a vaccine that prevents cervical CANCER, causes mental retardation.

The words that I have in response to this heinously irresponsible statement are not words I'm allowed to say in front of my daughter. In fact, those words, those dirtiest of insults that I have at my disposal, are not dirty enough for the venom I feel.

To be in the public spotlight, as Bachmann and other politicians are, brings with it a certain responsibility. It is a responsibility that should be akin to the one that I accepted when I became a doctor. You should promise to be nice. You should promise to do what is best for people and not what you think will be politically advantageous. You should promise to make sure that the things you say, things people will rely on to make important life decisions, are actually true.

Bachmann has failed in this before and she failed again and again this week as she continued to spout completely false allegations. So just to be clear. Women DIE from cervical cancer. There is now a vaccine to PREVENT more women from DYING. And to say that the vaccine is dangerous before a national audience because "a woman...said her daughter...suffered mental retardatio as a result" (of the vaccine) without ever looking into the credibility of such a claim is atrocious.

What sort of executive leader would this woman be if someone told her that Canada was evil and was planning to invade Buffalo and so she ordered a military offensive based only on hearsay? Have I gone to far? No, I don't think so. But she has.

What can I do about it? Not much. But I did just write a check to Planned Parenthood. I guess that's a start.

The Pregnant Pause

I was barely pregnant with Emmaline when a colleague asked me to evaluate a patient he believed needed to be transferred to the ICU where I was working. Chatting with the family about how moving their child to another floor would allow her to have a nurse and team of doctors watch her more closely, I did not think to move out of the room when the portable x-ray machine rolled in. The friend who had called me in motioned me violently into the hall.

"Don't you want to step out?" he asked. Then, after a pause, "Congratulations."

News, it seems, spreads quickly in a hospital where pregnancies (even in those first delicate weeks when miscarriage is entirely possible) must be protected against radiation, certain chemotherapeutic or radiation therapies, and the variety of other hazards our young patients carry. Also, and this quickly became apparent to everyone I worked with, it was impossible not to throw up after being awake for more than twenty-four hours straight.

Being a resident and being pregnant are both enormously draining and doing both at the same time was exhausting. Generally, however, I found comfort in the fact that nearly every other married female in my program became pregnant within months of each other and approximately 9 months before we were scheduled to finish our training. So as awful as it seemed during certain overnight shifts, we were in it together and the end was in sight.

This time, planning a pregnancy was somewhat less complicated. Yes, Emmaline would have a serious transition to endure from she-who-is-adored-by-all-and-receives-undivided-attention into Big Sister and one-who-must-learn-to-share. Yes, my husband has just (at the request of his employers, who are footing the bill) just started attending law school in addition to real work. Yes, I still work with snotty nosed children who carry horrible viruses like CMV and (soon at least) influenza and pose a real risk to the future child it is my job to protect.

Yes, I am still a little bit crazy and, yes, I use a lot of hand sanitizer.

But I was also feeling a lot more level headed about the whole enterprise. Did we get pregnant the first month we tried? No. Did I freak out? Okay, maybe a little. But I got over it. And then we did get pregnant and I thought to myself, I can handle this maturely, coyly even. I can play it cool and not make a big deal out of it until people start to ask me why I'm so fat.

That was the plan.

Then I had to do a sedation for a nine-year-old with a broken arm that needed reduction and it was just me and the orthopedist and the nurse and the kid in a room with the fluoroscopy machine and no lead drapes in sight.

"I guess you should leave if you are prengnat," the orthopod joked to us before shooting the film.

The kid did not move, since he was sedated. The nurse chuckled wistfully. I froze for one single moment and then I ran.

In the end it worked out for the best since I am not actually coy or cool or even mature. And having an ER full of nurses know there is a potential baby in your belly and an ultrasound idling in the hall means a whole lot of extra chances to take a look and say hello.

11 September 2011

The Terrible Twos

As Emmaline's second birthday approached she continued to be a wonderful child. Yes, there were several screaming fits triggered by no discernible cause, but she also demonstrated extraordinary caring and love both in her actions and with her ever growing vocabulary. For the most part that love was directed at cats, or the dog, or her stuffed animals (who enjoyed frequent tea parties and gifts of band aids for their various boo boos), but she also, on occasion, would spontaneously utter the phrase, "Mama, I love you." How terrible could the twos be if they came wrapped in sentiment like that?

The thing was, we reasoned unreasonably, Em has developed some fairly impressive communication skills. Upon being presented with yogurt for breakfast accompanied by something as insulting and bourgeois as a plastic infant spoon, she made her objection and its cause abundantly clear. "No, Mama, proper spoon."

Fine. Stainless steel flatware for the little lady. And here's hoping she never realizes there's a drawer with actual silver.

So maybe the terrible twos wouldn't be so very terrible. She can indicate needs and wants, which the experts all say is where many of the frustrations of this age stem. She plays well with others.

She shares things like her wagon and toys and her rocking chairs without reservation.

Her block stacking skills continue to become more refined, which is sure to continue to be a party favorite through high school and maybe even into college.

And she has learned that it's important to travel in style, even just to the doctor's office to get your flu shot.

Could it be possible that we would reap the benefits of all these milestones without suffering the deafening screams of the tantrum that must be had for the tantrum's sake if for no other reason? That Emmaline would learn to choke back her tears for long enough to explain, "Band aid fell down the backpack," allowing us to rescue said soiled bandage from the pocket into which it had slipped off her finger and disappeared, thus averting disaster?

Yes. But only sometimes.

For though she continues to impress with her solo performances of Baa Baa Black Sheep and her recitations of Humpty Dumpty, she also CANNOT BE REASONED WITH when it comes time to bid the playground farewell.


We had been doing so well.