The Secret to Pain Free Breastfeeding
Breast-feeding is generally considered the most appropriate form of infant feeding, although it probably does not prevent food sensitization or the subsequent development of atopic disease.17,129,130,135 In breast-fed infants, AD may develop within the first weeks of life, often while being exclusive breast-fed. Onset of AD during the early lactation period may indicate sensitiza-tion of the infant to maternally ingested food aller-gens.136 Food antigens are secreted into breast milk and may cause similar immunological reactions as seen in formula-fed infants.92
There will be at least some drug exposure to the infant from nursing mothers taking antidepressant medications. Although there have been rare anecdotal reports of adverse effects (i.e., respiratory depression and seizure-like episodes) in infants exposed to antidepressants through breast milk, no rigorous study has confirmed adverse effects of these drugs, and it is generally accepted that the benefits of breast-feeding outweigh the risks to the infant of antidepressant exposure. However, the decision needs to be made on an individual basis.44
Competition for parental love and favor has been an important driving force in human evolution, just as have parental decisions about how to invest in their offspring. Before 1800, half of all children did not survive childhood, and even minor differences in parental favor would have increased a child's chances of reaching adulthood. Children who lived long enough to become the eldest in a family were often a better Darwinian bet for their parents, because they had survived the perilous years of life and were more likely than their younger brothers and sisters to reach the age of reproduction and to pass on their parents' genes. In every society surveyed by anthropologists, eldest children are accorded higher status. For example, many traditional societies condone infanticide, especially when a child is deformed or when a slightly older infant is still breast-feeding, but no society condones the killing of the older of two siblings.
Caution is crucial, however, because the diet can be seriously deficient in particular nutrients. Studies of people on a macrobiotic diet have been reported in the medical literature. One concerned breast-feeding women, and the rest evaluated the diet for infants and children. The studies were conducted in Belgium, Norway, the Netherlands, Germany, and the United States. Every study found serious deficiencies in infants and children who had been on macrobiotic diets. Problems in children included nutritional rickets with breathing abnormalities, bone deformities, vitamin B12 deficiency, growth retardation, deficiencies of protein, vitamins, calcium, and riboflavin, leading to retarded growth and slower psychomotor development. The study of lactating macrobiotic mothers mirrored these results, finding that the mothers' milk was deficient in essential vitamins. Researchers recommend that children on the macrobiotic diet receive dairy products and eggs to provide the missing nutritional...
The strongest risk factors for developing asthma are exposure to household smokers and a family history of asthma or atopy (asthma, atopic dermatitis, or allergic rhinitis). Family history of nasal polyps or aspirin hypersensitivity can also suggest risk for IgE-mediated atopic disease. Data are mixed on the impact of early childhood infections and bottle feeding versus breastfeeding on the development of asthma, although both are clearly associated with wheezing episodes in the first 3 years of life. Data showing a paradoxical protective effect of early childhood exposure to pets, farm animals, and bacterial antigens are still controversial (Adler et al., 2005 Platts-Mills et al., 2005 Remes et al., 2005 Waser et al., 2005).
Medical contraindications include severe systemic disease, particularly respiratory disease such as severe chronic obstructive airways disease, and severe mental or physical special needs. A number of drug interactions contraindicate the use of intravenous benzodiazepines, particularly if a patient has a history of psychiatric treatment or has been prescribed benzodiazepines over a long period of time, thereby making the patient very tolerant to the drug. Intravenous sedation should be avoided wherever possible in patients who are either pregnant or breast-feeding.
The proximate determinants paradigm provides a second organizing framework. It rests on the observation that the sequential biological process is influenced through only a few mechanisms, specifically, variables that influence sexual activity, the likelihood of conception, and the likelihood that conceptions result in live births (see Davis and Blake 1956). Bongaarts and Potter's (1978) operationalization of the proximate determinants demonstrates that most fertility variability between populations and over time can be accounted for by the following four determinants (1) marriage and marital disruption (as indicators of the segments of the life cycle when women are sexually active), (2) postpartum infecundability (the period after a birth without ovulation its length is determined primarily by the duration and intensity of breastfeeding), (3) use and effectiveness of contraception, and (4) induced abortion. Three other determinants are
Preparation for the birthing process is a key theme around which to discuss care issues and choices such as breastfeeding. Structured educational programs to promote breastfeeding have unclear effectiveness. Pregnant women should be counseled about the risks of possible teratogens, including smoking, alcohol, and drug use, including exposure to medications, prescriptions, OTC drugs, and herbal remedies. Good handwashing is always encouraged because this is one of the best ways to avoid community-acquired infectious diseases. Appropriate immunizations such as influenza and novel influenza A (H1N1) virus should be offered. Common exposures such as workplace conditions and use of hot tubs and saunas should be explored. Exercise should also be encouraged if there is no obstetric contraindication (Box 21-4). Intercourse during pregnancy should be actively addressed because some women are reluctant to discuss this topic even with their physician. Sexual activity can generally...
LMWHs are currently widely used for the prevention and treatment of gestational VTE. In our institution, women on prophylactic doses of LMWH are advised to have the dose of the LMWH tailed off at the end of pregnancy and omit their dose if labor is suspected. Women on a therapeutic dose of LMWH are admitted in advance ofplanned induction to be converted to the therapeutic dose of intravenous UFH. They should omit LMWH on the day of admission and should be started on UFH, aiming for an APTT ratio of 1.5-2.0. UFH should be reduced to 500 IU h when contractions start, aiming for an APTT ratio 1.5. Postpartum, the heparin infusion can be restarted 4 h post-delivery at 500 IU h, providing there is no bleeding. Patients are restarted on a therapeutic dose of LMWH 2-3 days after delivery. Warfarin can be started 4-5 days post-partum, and LMWH should be continued until an international normalized ratio (INR) of 2.0 or greater is reached on two consecutive days. Breastfeeding is safe on UFH,...
Pregnant women on zidovudine therapy must be followed for bone marrow suppression and liver toxicity on a monthly basis. Although long-term studies are not available, the drug appears safe for the fetus. The quantity of viral load (HIV-1 RNA) in the mother appears to be a significant risk factor to fetal infection (Mofenson et al., 1999). Mode of delivery is controversial, with many experts recommending cesarean section to those women with high viral load. During vaginal delivery, artificial rupture of membranes and placement of a scalp electrode onto the fetal head are contraindicated. Amniocentesis and breastfeeding are also contraindicated in HIV-infected women. Women diagnosed as HIV positive during pregnancy should be informed that interventions such as antiretroviral therapy, cesarean section, and avoidance of breastfeeding can reduce the risk of mother-to child HIV transmission (SOR A). Amniocentesis and breastfeeding are contraindicated in HIV-infected pregnant patients (SOR...
The factors contributing to the problem of acute diarrhea are well known. However, their modification will not be easy because of cost and required changes in behavior. The important variables that will require attention include the following availability of plentiful potable water adequate systems of sewage removal improved personal and food hygiene improved nutrition through food supplementation programs discontinuance of the practice of using night soil as fertilizer promotion of breast feeding effective measles vaccine programs availability of adequate health care to administer oral rehydration therapy and selected antimicrobial therapy family planning insect control vaccine development and implementation for certain enteric infections such as cholera, enterotoxigenic E. coli diarrhea, rotavirus gastroenteritis, shigellosis, and typhoid fever. Because achieving all of these activities will initially be too costly in developing areas, research in developed countries will be...
When is a good time for mothers who've held outside jobs (either of necessity or choice) to plan to go back to work The longer they can have to feel they are mothers the better of course, it will depend on family finances. Breast-feeding can often be continued after returning to work by bringing the baby to the office, or by one trip home if it's not too far, both of which will depend on the tolerance of the boss and of fellow workers. Or someone can feed the baby a bottle. (However, the fewer the bottles the longer the breast-feeding can be maintained.)
Infant and child mortality levels showed little evidence of a trend before 1900, but there were important differentials between the villages that are part of the sample. Infant mortality was highest in Bavarian villages and lowest in East Frisian villages, with Baden and Waldeck villages occupying an intermediary position. There was direct survey evidence, collected in the late 19th century to investigate mortality differentials, that women avoided breast-feeding their children in Bavaria and in other parts of southern Germany. This suggested that child feeding patterns provided an explanation of mortality differentials. Two analytical techniques confirmed such an explanation. First, the interval between confinements was considerably reduced in Waldeck and the East Frisian Villages when the first child had died during the first month of life, a circumstance that would interrupt suckling in populations that would commonly practice breastfeeding. In Bavaria, however, the reduction...
Data on the association of early milk feeding and AD are not conclusive, and the protective effect of breast-feeding on AD is not universally accepted. About a decade ago, a large 10-year longitudinal study from New Zealand failed to demonstrate a significant association between early cow's milk feeding and AD.125'126 Similarly, a more recent study of 1314 infants found that breast-feeding did not prevent the onset of AD in infants with an affected parent, and the duration of breast-feeding appeared to increase the risk for AD.127 Another study of 6209 infants also suggested that prolonged breast-feeding may increase the risk of IgE sensitization.128 These findings are in contrast with a recent study of 1121 infants that assessed the effect of exclusive breastfeeding and delayed introduction of solid foods on the risk of developing AD at 12 months of age.42 In that study, the risk of AD was reduced by about 50 in infants who were exclusively breast-fed to 4 months, compared with...
Many of the nutritional issues in lactation are influenced by the nutritional status of the pregnant woman. The nutritional stores of the newly delivered woman are an important source of supplies for her and the infant. Certain nutrients are stable regardless of the maternal diet (Table 37-7). Studies of lactation have found that after about 6 months of breastfeeding, maternal weight decreases by about 10 pounds without any changes in the composition or production of breast milk (Barbosa et al., 1997). This may be important when considering that the average weight retained with each pregnancy is about 10 pounds.
However, there are advantages to keeping the baby close so you don't have to get up to feed her. To the surprise of many doctors and parents, the amount of sleep time for baby and mother is Increased among those who share a bed. Mothers actually report feeling as though they had a better night's sleep compared to awakening and going to another room to feed the baby. Not surprisingly, the frequency and amount of time breast-feeding is increased. And parents who prefer to sleep with their children say there is a closeness and bonding as they become aware of each others movements and sounds during brief periods of arousal from deeper sleep.
Skin-skin contact is a simple procedure that can be carried out even for the sickest women and can be beneficial to women as well as their babies it assists in the effective introduction of breastfeeding and has relaxing properties for women and babies
1 (breastfeeding) breastfeeding Progesterone-only contraceptives can be taken by breastfeeding women when they do not have access to other methods. It is not recommended for women with multiple risk factors for arterial cardiovascular disease or with unexplained vaginal bleeding. A theoretical concern is the effect on the neonate for breastfeeding women
Produce about 1 litre (2 pints) of milk per day. Problems soon after childbirth are often associated with establishing breast-feeding. However, these problems are usually shortlived. In most cases, breast-feeding is still possible and is the best option for the baby (see Feeding your baby, below).
Action Your doctor will examine you and will probably prescribe antibiotics. You should continue breast-feeding from both breasts. If an abscess has developed, you may be referred to hospital so that the pus can be removed under a local anaesthetic, using a needle and syringe. This procedure may need to be repeated until the condition improves.
The main focuses of the MCH Community are to improve maternal health and reduce maternal mortality, and to improve child health and reduce infant and child mortality. The MCH Community has now been in action for almost a year, with membership growing from 130 to 725 during this time, representing 28 states and union territories of India and a few members from outside India as well. Discussions have ranged from skilled attendance at birth, setting up a telemedicine center, exclusive breast-feeding and complementary feeding, operationalizing urban Integrated Child Development Services, medical termination of pregnancies, etc.
Some nutritional factors have been suspected of being involved in the etiology of type I diabetes, although again there is no consistent epidemiological picture. Excess caloric intake does not seem to be the important etiologic factor it is in type II diabetes. A Danish study has reported a negative correlation between breast-feeding and type I DM, and finally T. Helgason and M. R. Jonasson (1981) suspect that AT-nitroso compounds from smoked mutton may be responsible for the seasonal incidence of type I diabetes found in Iceland, where this meat is traditionally consumed at Christmas time. The range of nutritional factors implicated in type II diabetes is much greater and is discussed below.
Lactotrophs are PRL-producing cells constituting 20 to 30 of the anterior lobe. They are scattered throughout the pars distalis with some accumulation within the posterolateral region. A sharp increase in the number of PRL cells (hyperplasia) occurs during pregnancy and lactation. PRL is a 198-amino acid peptide primarily known for its lactogenic properties. It is unique among pituitary hormones in that its secretion is spontaneous in the absence of any stimulation from the hypothalamus. The primary mechanism controlling PRL secretion is tonic inhibition by hypothalamic dopamine secretion. In addition, PRL secretion can be inhibited by somatostatin. PRL-releasing factors (PRFs), including thy-rotropin-releasing hormone (TRH), estrogen, vasoactive intestinal peptide (VIP), and oxytocin, stimulate PRL. Serum levels range from 4 to 20 mg L and are 20 to 30 lower in men. During the third trimester of pregnancy, the PRL levels increase up to 200 to 300 mg L. PRL levels fall rapidly after...
Other primary prevention strategies constitute in main part of the avoidance of early allergen exposures, i.e. food and inhalation or breast-feeding, which is considered as the first choice for atopic infants. As another strategy, it has been found that the administration of antihistamines over a time period of 12-24 months was able to delay prevent the development of asthma in AD children later in their lives.17
Fertility is the other major demographic variable in which interventions have been tried. This variable remains crucial in numerous countries that have not completed their demographic transition (Bulatao 1984). In particular, youthful age structure and above-replacement levels of fertility are recognized as being key to the future of population growth. John Bongaarts (1994) has refined this analysis by disentangling the effects of unwanted fertility and the desire for a large family size (more than two children). This distinction has the advantage of being operational because it addresses, first, unwanted fertility by reinforcing family planning programs and, second, the desire for a large family by expanding information, education, and communication (IEC) programs and behavioral communication for change (BCC) campaigns. Finally, sound actions on fertility also require distinctions among the proximate determinants of fertility (biological and behavioral variables such as union...
One study from the Netherlands indicated that 65.9 of breast-feeding women took at least one medication (53 after exclusion of vitamins and minerals) over a 6-month period. The most popular medications were vitamins, analgesics, iron, antimicrobials, homeopathic remedies, oral contraceptives, cold and flu medications, and laxatives.4
Far exceeds the concordance rate of 20 observed among dizygotic twins.7,8 These data clearly indicate that the genetic contribution to the expression of eczema is substantial. In addition, studies on the vertical transmission of eczema and atopic disease show that children are more likely to inherit these disorders if the mother is affected (parent-of-origin effect).9 The predominance of maternal inheritance may be due to environmental factors such as uterine milieu or breast feeding, but may also arise due to genetic mechanisms such as parent-specific gene expression (genomic imprinting).10 Parent-of-origin effects should therefore be taken into account in the search for eczema genes.
Some intervention attempts show promise. A review of trials in which physicians briefly counseled nonpregnant women who were problem drinkers found no consistent decrease in drinking. Trials of personalized advice to pregnant women have also been found to be no more effective than written information alone. A written self-help manual, however, did improve cessation rates in women at a prenatal clinic. The CDC sponsored a pilot project to encourage alcohol cessation and effective contraception in women at risk for alcohol-exposed pregnancy (Muchowski and Paladine, 2004). Although not a controlled trial, this more extensive intervention showed promise. Of the 143 women enrolled, 68.5 had stopped their alcohol consumption or were using effective contraception by the 6-month follow-up. Women should not be discouraged from breastfeeding, if they are not using illicit drugs and do not have specific contraindications such as HIV infection (McCarthy and Posey, 2000).
Lithium can cause hypotonicity and cyanosis in the neonate, usually termed the floppy baby syndrome. Most data indicate normal neurobehavioral development once these symptoms resolve. Lithium is readily transferred via breast milk. Breastfeeding is not advised for patients who are taking lithium.28
Approach with the aim of clearing existing psoriasis lesions, and a maintenance phase, with the main aim of preventing disease relapse. The different phases are not necessarily well separated in time. Long-term disease-modifying strategies can be adopted at the same time when a treatment modality for reaching clearance has been started. An example is the treatment of atopic dermatitis by topical steroids and diet. Most randomised clinical trials in dermatology use a simplified approach to evaluating treatment effects and most of them analyse the effect of a single manoeuvre over a limited time span. One as yet not fully explored issue is the potential for combining different treatment approaches in a simultaneous or subsequent order. There are examples of combinations of such treatment modalities as calcipotriol and ultraviolet B radiation in psoriasis treatment, but other rational combinations are not fully explored. A way of addressing the issue is by relying on factorial design. An...
Maternal-to-infant transmission can occur in utero, during labor and delivery, or postnatally by breast-feeding. y Both the risk factors of mother-to-infant transmission and its timing are under active investigation. In utero transmission before 20 weeks of gestation is well documented. However, current evidence suggests that transmission during the third trimester and at parturition may be most common. y y y '43' y y y y y y y The rate of mother-to-infant infection is estimated at about 25 percent (range 13 to 45 percent).y Maternal factors reported to be associated with increased risk of transmission include low CD4+ counts, high viral titers, advanced primary HIV-1 disease, AIDS, placental membrane inflammation, premature rupture of membranes, premature delivery, increased exposure of the infant to maternal blood, and low vitamin A.y y y , y , y y y
In accordance with the recommendations of the American Academy of Pediatrics (1988), Satter (1999) and Kleinman (2000) outlined recommendations for feedings of infants and young children, and these recommendations have remained fairly consistent over the past 40 years. The transitions in types and textures of foods have been shown to relate closely with motor and oral feeding development (Carruth and Skinner 2002). Specifically, these guidelines recommend breast feeding or formula feedings for the first 4-6 months of life and up to at least the first year of life. Smooth foods and pureed textures are usually introduced at about age 6 months, and easily dissolvable foods between 6 and 9 months. By age 12 months, most children are introduced to table foods, and by age 24 months, most children are eating a diet consisting primarily of solid foods similar to those eaten by the entire family (Satter 1999). These guidelines caution against introducing small, hard foods during the first 2-3...
Infant nutrition is intimately connected with health. Breast feeding was always recognized as the ideal method of nourishing infants but was not always practicable. If a mother was unable or unwilling to suckle her baby, wet nursing was a socially acceptable alternative until the beginning of this century. In poorer families, however, nursing could be re A somewhat different situation prevailed in France, where it had become common practice by the eighteenth century for infants to be sent into the countryside to be wet-nursed together with the foster mother's own baby (Sussman 1982). Infant mortality was even higher than in English-speaking countries, the fertility rate was lower, and in part because of the threat of depopulation, concerned French physicians finally introduced novel methods for improving infant survival. In 1892 Pierre Budin, professor of obstetrics, organized a Consultation de Nourrisons at the Charit Hospital in Paris. Women who had been delivered at the hospital...
Perinatal infection (also known as vertical transmission or mother-to-child transmission MTCT ) can occur during gestation, at or near delivery, and during breastfeeding. The risk of MTCT up to and including delivery is approximately 25 , while the risk of transmission during breast-feeding is approximately 15 to 20 within the first 6 months of life. Because a high rate of HIV replication in the blood is a significant risk factor for transmission of HIV, it is important to treat women for their HIV infection during pregnancy. After delivery, mothers are strongly recommended not to breast-feed if safe alternatives are available.
As a deficiency disease involving sunlight and diet, cultural and socioeconomic factors interacting with climate are important in the epidemiology and geographic distribution of rickets and osteomalacia. In general, rickets is uncommon in sunny climates however, even sun-rich areas may have rickets. For example, nearly 30 percent of children seen at an Ethiopian clinic had clinical evidence of rickets, primarily related to a shortened period of breast feeding and swaddling of infants to avoid the evil eye (Mariam and Sterky 1973). In many Moslem countries, the custom of purdah the complete shielding of women and young children indoors or with veils is a major factor in rickets and osteomalacia. A study of 1,482 Moslem girls in India, aged 5 to 17 years, showed that 40 percent had skeletal evidence of rickets (Wilson 1931).
The etiology of dental caries is multifactorial with an interplay between microflora (plaque colonized with Streptococcus mutans), substrate (fermentable carbohydrates from breast milk, formula, or juice), and host (saliva and teeth). Nursing or milk bottle caries results from prolonged and frequent night time breastfeeding or sleeping with a bottle containing milk or sugar-containing juices. The sugars are fermented by the bacteria in plaque, lowering the pH in the mouth and resulting in demineralization of the tooth enamel. The condition generally occurs before 18 months of age and is more prevalent in medically underserved children. Upper central incisors are most commonly involved. Dental referral is
Breastfeeding support should be provided throughout hospi-talization, beginning in the first several hours of the infant's life. Assisting the mother in holding the baby at the breast and establishing a good latch-on are important in facilitating successful breastfeeding (Sinusas and Gagliardi, 2001). Trained obstetric nurses, lactation consultants, or other trained providers should be available to help the nursing mother begin breastfeeding. Breastfeeding mothers are often worried that they will not produce enough milk for their baby. In the first 2 or 3 days, as milk production is being established, the infant is primarily receiving low volumes of high-calorie colostrum, and mothers may think their baby is not receiving enough from the breast. Parents should be reassured that the normal newborn does not need supplementation with formula unless there is a specific medical indication (e.g., true dehydration, sepsis) (AAP, 1997b). A trained professional should observe the breastfeeding...
Proper physical growth and appropriate cognitive development depend on adequate nutrition. Infants and young children with severe iron deficiency anemia were found to have significantly lower verbal and full-scale IQ scores and lower achievement test scores in arithmetic and writing than non-iron-deficient infants, even 10 years after treatment (Lozoff et al., 2000). An increase in behavioral problems was also reported, although this could not be directly linked to the preceding iron deficiency. In the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), 7.2 of 12- to 16-year-old girls had iron deficiency, but only 1.5 demonstrated anemia (Halterman et al., 2001). Adolescent iron-deficient girls scored significantly lower math scores compared with non-iron-deficient girls. Vitamin D deficiency and insufficiency in children and adolescents has been reported worldwide, including North America (Wagner and Greer, 2008). Mealtime also represents a time for social...
The key to management of the neurological complications of rubella is prevention. The rubella vaccine licensed for use in the United States is a live attenuated RA 27 3 rubella virus. y The immunogenicity of the vaccine is reduced by whole blood transfusion therefore, it is recommended that rubella vaccine not be given for 3 months after immunoglobulin or whole blood transfusion. y The incidence of arthritis after vaccination is low when the RA 27 3 strain of rubella vaccine is used. Breast feeding is not a contraindication to postpartum immunization. Infants infected with the rubella virus through breast milk may experience a mild rash, but the majority remain asymptomatic, and no serious adverse effects have been reported. y Currently, the first dose of rubella vaccine is given to
Counseling is often anticipatory guidance for the upcoming stages of pregnancy, delivery, and the postpartum period. Counseling for breastfeeding is a key preventive component to prenatal care, as is the use of prenatal vitamins and influenza vaccine administration. Chapter 21 discusses care of the pregnant patient, including prenatal preventive services.
The best way to satisfy your baby's sucking needs is to provide a long enough feeding time to satisfy not only hunger, but also the need to suck. Breast-feeding usually takes care of this problem if the baby is allowed to nurse until he is satisfied. Usually twenty minutes is enough time to satisfy both hunger as well as sucking needs. If you bottle-feed, make sure the holes in the nipples are not so large that the baby finishes the milk in say ten minutes, but hasn't had a chance to satisfy his sucking needs.
Infant botulism is an uncommon and often unrecognized illness. In the United States about 75-100 cases are diagnosed annually, and 1290 cases were reported for the years 1976-94. Almost half of US cases have been reported from the State of California. Reflecting the known asymmetry of the soil distribution of toxin types of C. botulinum, most cases west of the Mississippi River have been caused by type A strains, while most cases east of it have been caused by type B strains. One case each in the states of New Mexico and Oregon resulted from C. baratii and its type F-like toxin, while two cases in Rome, Italy, resulted from C. butyricum and type E-like toxin. Identified risk factors for illness include the ingestion of honey and a slow intestinal transit time (less than one stool per day). Breast-feeding appears to provide protection against fulminant, sudden death from infant botulism.34 Under exceptional circumstances of altered intestinal anatomy, physiology and microflora, older...
Persons with epilepsy face additional demands when they are parents. Careful planning and extra support are essential for effective family functioning. Concerns in pregnancy may range from the effect of seizures and medications on the fetus to postpartum worries about breast feeding and safety. Safety remains a concern throughout life for parents with epilepsy, particularly those with uncontrolled seizures. Other parenting issues, such as involving a child in caring for a parent during or after a seizure or explaining seizures to a child, need to be addressed with all families.
Lithium can cause short-term side effects including tremor, gastric irritation, nausea, abdominal cramping, diarrhea, vomiting, increased white blood cell count (up to 15,000 cells mm3), polyuria and polydipsia, dermatitis, extrapyramidal reactions, fatigue and muscle weakness, and flattening of T waves, T-wave inversion, or U-waves on an electrocardiogram. Long-term side effects include weight gain, hypothyroidism (5 to 30 percent), diabetes insipidus, potential kidney damage, and hence decreased glomerular filtration rate, hyperthyroidism, and hyperparathyroidism (Gelenberg and Schoonover, 1991). Lithium has been reported to cause fetal heart anomalies but recent data suggests the incidence is low, so risks must be weighed versus benefits. Because lithium is excreted in breast milk in significant quantities, breastfeeding should be approached with caution.
Within the first 24 hours, the mother's pulse rate drops and her temperature may be slightly elevated. Generally, the white blood cell count increases during labor, with a marked leuko-cytosis (to 20,000 ) occurring in the first 24 hours postpartum. The vaginal discharge is grossly bloody (lochia rubra) for the first 3 or 4 days. During the next few to 10 days, the lochia becomes more serous and pinkish brown and decreases in amount (lochia serosa). Finally, 7 to 10 days postpartum, the lochia becomes pale yellow-white and decreases even more in volume. Urine output temporarily increases and might contain protein and sugar, reflecting a maternal diuresis. This loss of fluid with the accompanying decrease in intravascular volume artificially elevates the hematocrit for a few days. The uterus involutes progressively after 5 to 7 days, it should be firm and nontender, extending midway between the symphysis and umbilicus. By 2 weeks the uterus should no longer be palpable abdominally....
Whether present at the delivery or taking care of a new infant in the newborn nursery, the family physician plays an important part in newborn care during the early days of life. At the moment of birth, the newborn infant undergoes many changes and is vulnerable in the new environment. This chapter discusses these physiologic changes as well as the basics of neonatal resuscitation. The initial examination, common benign findings in the newborn period, developmental dysplasia of the hip, and audi-ology screening are described. Signs and symptoms of concern and common problems in the newborn period, including group B streptococcal infection and hyperbilirubinemia, are discussed, as well as infant safety, parent education, hospital follow-up, and care after discharge from the neonatal intensive care unit.
If the infant is asymptomatic and alert, low blood sugar can be treated by breastfeeding or by giving formula and repeating the serum glucose concentration after the feeding. If the infant is symptomatic, intravenous (IV) glucose is recommended. The exact concentration and amount of IV glucose to deliver depends on the amount of decrease in the serum glucose concentration. Guidelines for management can be found in the Harriet Lane Handbook (Robertson and Shilkofski, 2005).
Both WHO and AAP promote exclusive breastfeeding for the first 6 months of life. However safe, nutritious solid foods may be introduced between 4 and 6 months of age, when the infant is developmentally ready. The order of introduction of solid foods is generally not critical however, single-ingredient foods should be tried for 1 week at a time to observe for possible allergic reactions before introducing another food or mixtures of foods. Single-grain infant cereals such as rice (which lacks gluten) are usually well tolerated and provide a source of fortified iron. Homemade infant foods should not have added salt or sugar. Honey is associated with infant botulism and should not be given to infants younger than 1 year. Teething biscuits or finely chopped foods may be given by 8 to 10 months of age. However, foods such as popcorn, nuts, or rounded candies should not be offered to infants or toddlers because of the risks of choking, aspiration, and even death. Potentially hazardous foods...
Candidiasis presents with severe and persistent nipple pain which can be throbbing and radiating to the breasts and back. The pain is usually more intense during and immediately after breast-feeding. The infant can be symptomatic or asymptomatic. Candida albicans is the most commonly found type of Candida species. It is recommended to breast-feed more frequently than usual for a shorter period of time. Milk does not have to be discarded however, clothes and towels in contact with the breasts and the baby's mouth should be washed in hot water. Antifungal treatment must to be given to the mother and the baby simultaneously (Table 47-8). If no improvement is seen within 24 to 48 hours, the treatment should be reevaluated. Analgesics (e.g., acetaminophen, ibuprofen, or naproxen) can be used to relieve pain.
Frida had vastly different relationships with her parents. Frida's mother was still in deep grief over the lost of her baby son when Frida was conceived. Matilde may have suffered from postpartum depression and she was unable to breast-feed baby Frida. Soon after Frida's birth, her mother became pregnant with her sister Christina. This may have deepened her mother's depression and overwhelmed her. Frida felt unloved and abandoned by her mother and became competitive with Christina.
As in ulcerative colitis, etiologic hypotheses vary widely, from the excessive eating of cornflakes, refined sugars, or margarine, to bottle-feeding rather than breastfeeding, environmental pollutants, the indiscriminate administration of antibiotics, and the use of oral contraceptives among young women. A wide variety of bacteria and viruses have been implicated, and although none has achieved etiologic status, the new microbial pathogens now being identified have renewed interest in microbial possibilities including mycobacteria. Other suggested but un-proven etiologies have included blunt trauma to the abdominal wall (e.g., seat belt injury) the ingestion
While there has been some argument as to how much all the data collected by these surveys has contributed to knowledge concerning the social and economic determinants of fertility (Caldwell 1985 Davis 1987), there is no doubt they have provided an accurate and detailed accounting of three of the four main proximate determinants of fertility, including contraceptive practice, breast-feeding, and marriage during the course of the fertility transitions that have taken place during the last three or four decades (Bongaarts 1982). They have also yielded comparable estimates of the shifts in ideal family size and the prevalence of unwanted fertility (Westoff 1988a, 1988b). The one area where survey research has often failed to produce reliable estimates is with respect to abortion, both spontaneous and induced, especially in those countries where abortion is sanctioned on either moral or legal grounds.
Diphenylmethane derivatives (e.g., bisacodyl) and anthraquinones (e.g., senna) have a selective action on the nerve plexus of intestinal smooth muscle leading to enhanced motility. Enteric-coated bisacodyl tablets should be swallowed whole to avoid gastric irritation and vomiting. Ingestion should be avoided within 1 to 2 hours of antacids, H2-receptor antagonists, proton pump inhibitors, and milk. The onset of effect is rapid but the effects can be harsh (cramping), depending on the dose taken. Castor oil is another member of this class that is used less frequently. Castor oil is classified as Pregnancy Category X. It is associated with uterine contractions and rupture. The use of castor oil in breast-feeding is considered as possibly unsafe. Laxatives may provide appropriate relief when constipation occurs during the postpartum period, when not breastfeeding, and in immobile patients. Patients who are not constipated but who need to avoid straining (e.g., patients with hemorrhoids,...
The AAP Subcommittee on Hyperbilirubinemia established a clinical practice guideline in 2004. The guideline recommendations have 10 key elements. One recommendation is to establish nursery protocols for identifying and evaluating hyperbilirubinemia. Another key recommendation is to interpret all bilirubin levels according to the infant's age in hours. All infants should be assessed for the risk of severe hyperbilirubinemia before discharge. Factors that put the infant at high risk include jaundice in the first 24 hours of life, blood group incompatibilities, other known hemolytic diseases, prematurity, exclusive breastfeeding when feeding is going poorly, cephalohematoma, and extensive bruising. The history of a previous sibling requiring treatment with phototherapy also places the infant at higher risk (AAP, 2004b). The recommended method for assessing the risk of subsequent hyperbilirubinemia is to measure the total serum bilirubin or transcutaneous bilirubin and plot the results on...
Nonpharmacologic measures, such as cold or warm compresses and more frequent breast-feeding should be encouraged. If a woman is not breast-feeding, it is important to empty the infected breast with a pump to prevent milk stasis. Several antibiotics can be used (Table 47-8). Analgesics (e.g., acetaminophen, ibuprofen, or naproxen) can be used to relieve pain.44
Building on the work of Freud and Abraham, particularly on the influence of objects on the ego, Mclanic Klein extended Abraham's position by arguing that libidinal development cannot be properly realized until hostile, destructive phantasies toward the object have been integrated into it. Klein posited an earlier onset of oedipal fantasies and anxieties than did Freud, locating their inception during the early part of the first year of life, when sadism in phantasy reaches its peak. There was no pre-ambivalent stage for Klein. Breastfeeding and weaning, denoting a complex and difficult separation from the mother's body, were held by Klein to be of critical importance in terms of their impact on phantasy, including oedipal fantasies. For Klein, an object-relating ego exists from birth, and early objects, albeit partial, epitomized by the function of the breast, are experienced either as good or bad depending upon whether they are viewed as nourishing or as hostile and dangerous...
The pregnant headache patient should be treated conservatively, with nonpharmacological treatments first. If the patient does not respond to this form of therapy, acetaminophen (alone or with prochlorperazine or narcotics) can be used and NSAIDs may be used in the first two trimesters. Very severe attacks should be treated with IV fluids, prochlorperazine, or narcotics. Prednisone has occasionally been used, but aspirin, barbiturate, and benzodiazepine use should be limited. Ergotamine and sumatriptan should be avoided completely. In the breast-feeding migraineur, ergotamine and lithium should not be used, because these drugs readily transfer to the baby via breast milk and can cause significant toxicity. Benzodiazepines, antidepressants, and neuroleptics may be used cautiously. Acetaminophen is preferable to aspirin. '171
Treatment is with tetracycline ointment or erythromycin four times daily for 4 weeks. In addition, both parents should be treated with oral tetracycline or azithromycin. Alternative treatments include oral erythromycin or doxycy-cline for 3 weeks. Systemic tetracycline should be avoided in breastfeeding women with this infection.
All CDC recommended first-line therapies for gonorrhea are deemed compatible with breast-feeding by the AAP.19 Since the number of quinolone-resistant species is increasing, the CDC recommendations should be consulted before prescribing a quinolone.3 Perform an endocervical swab culture for gonorrhea 3 weeks after completion of therapy. Acyclovir and valacyclovir are deemed compatible with breast-feeding, but no recommendation can be made regarding the safety of famciclovir during lactation.19 Infants born to mothers with active disease at birth should be monitored for signs and symptoms of disease. Women requiring single-dose metronidazole during lactation should discontinue breast-feeding for 12 hours in order to minimize the infant's exposure to the drug.19,30
Contemporary scholars, concerned with the high levels of infant and childhood mortality, were clearly aware of their causes. Some were environmental factors, such as foul air, contaminated water, and poorly ventilated, overcrowded housing, which contributed to the high incidence of a variety of infectious, respiratory, and parasitic diseases. Other causes were related to poor child care, including inadequate and unsanitary delivery conditions and improper feeding practices, notably a lack of breast feeding and the associated consumption of contaminated milk, all of which led to high rates of mortality from diarrheal diseases (Woods, Watterson, and Woodward 1989). Moreover, it had generally been known since at least the mid-nineteenth century
At one time the general geography of PEM seemed straightforward. Kwashiorkor existed in the year-round wet tropical forest zones of Asia, Africa, and Latin America, where root and tree crops make up the predominant food staples. By contrast, marasmus was found in wet dry areas because of seasonal or longer shortages of the staple cereal grains. Marasmus also predominated in the cities as a result of the substitution of bottlefeeding for breastfeeding. Changing etiologic knowledge has put this neat generalization to rest, and, in point of fact, little can be said about the precise distribution of PEM. Field surveys are limited in number, and many of them are of small sample size. Additionally, studies are difficult
Feeding problems associated with clefts of the lip alone are unusual. Mothers should be encouraged to attempt breast-feeding as an adequate lip seal over the nipple can be achieved. Clefts of the palate, and especially the secondary palate, result in an inability to generate sufficient oropharyngeal negative pressure and tongue compression against the palate. Milk reflux into the nasal cavity and associated problems such as respiratory difficulties and fatigue, as well as frustration on the part of the mother, compound the problems. Historically, feeding with spoons and cups have been advocated to allow gravity-assisted presentation of the feed into the oropharynx, as the ability to swallow is not affected by palatal clefts.
After separation, uterine contractions decrease the size of the implantation site to arrest bleeding from this area. Maternal expulsive forces may be required to deliver the placenta along with gentle traction on the cord. Uterine massage and immediate breastfeeding will aid in maintaining a contractile state of the uterus and decrease uterine atony. In some cases, oxytocin may be required to maintain uterine contractility. After separation of the placenta, the episiotomy (if cut) and any lacerations should be repaired.
The majority of twins will present both head first, cephalic-cephalic (Fig. 21-6, A), or first one cephalic, second one breech (cephalic-breech, 21-6, B). Any other combination can be seen, although cephalic-transverse (21-6, C), and breech-cephalic are the most likely in this remaining group. Once well into the third trimester, the first presenting fetus most often stays in its position the second fetus often changes position, occasionally even during early labor. Twins who are cephalic-cephalic can be delivered vaginally. Those who are cephalic-breech and cephalic-transverse can also be attempted vaginally by skilled operators in carefully chosen women. When the first fetus is presenting other than cephalic, delivery is often best accomplished by cesarean section. Breastfeeding has been successful in many women with twins and should be encouraged.
In addition, 62 Comprehensive Emergency Obstetric and Newborn Care (CEONC) centers have been established for providing 24-h maternal and child health-care services, including Cesarean sections. These centers have been so located as to be accessible within an hour's travel from anywhere in Tamil Nadu. In the second phase, more hospitals will be upgraded as CEONC centers so as to reduce the time to 30 min.
New Mothers Guide to Breast Feeding
For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.