Category Archives: New Moms

Gross Motor Play for Babies

Gross Motor Play for Babies about 5 to 8 months old

Once your baby is enjoying more “Floor Time” and finding new ways to move his body, incorporating new “gross motor” activities will create fun new ways to challenge his skills.

Always keep safety in mind: stay nearby (or provide hands-on “spotting” if needed), make sure all toys and materials are child-safe and choke-hazard-free, and provide an appropriate surface for the expected occasional tumbles such as carpet or foam-flooring.

Try any of these ideas from about six months onward.

Tunnel Play: a collapsing tunnel is a fantastic play environment that offers many different uses over the coming months and years. Before your baby is crawling, try placing a sheet folded into a long strip all the way through the tunnel. Then, give your baby a “ride”, pulling him slowly through the tunnel, first on his back, and next on his tummy. Once your baby is crawling, he’ll crawl through the tunnel with your smiling face encouraging him at the  other end. Later still, he’ll crawl after a ball or pull toy you roll through the tunnel. And after that, a tunnel can become part of a more complex “obstacle course” set up for your toddler. Best still, when not in use, your tunnel collapses flat and can be tucked in a closet or under a bed.

Rody and Gym Ball play: With your hands-on assistance, your baby will enjoy practicing bouncing on these objects, and tilting from side to side. Slide your hands down to your baby’s hips (rather than holding him under the armpits) to allow his own trunk muscles to work on balance. If you are using a gym ball, you can sit him on top for some activities, and lay him tummy down on the ball for others. Facing a full-length mirror is fantastic when possible.

Bouncing on parent’s lap with songs and rhymes. Your baby is ready for exciting “rides” with bigger rises and (controlled) falls and swoops! Three favorite active bounces to try:

Trot-Trot to Boston
Trot-trot to Boston, Trot-trot to Lynn. Look out little Baby, that you don’t FALL IN!
Bounce baby on your lap and while holding securely, allow your baby to either tilt back or drop through your legs at the end.

Noble Duke of York
Oh, the Noble Duke of York, he had ten thousand men.
He rode them UP to the top of the hill, and he rode them DOWN again!
And when you’re UP, You’re UP. And when you’re DOWN, you’re DOWN.
And when you’re only HALFWAY UP, you’re neither UP nor DOWN!
Sit baby straddled across your leg like a horse and bounce baby rhythmically, raising and lowering baby to the up and down cues of the song. This is a truly a favorite!

Pop! Goes the Weasel
All around the cobbler’s bench, the monkey chased the weasel.
The monkey thought it was all in fun, then… POP! Goes the weasel!
Bounce baby on your lap to the rhthm of the song and while holding securely, do a big lift up at the “POP!”

You may find it a little tiresome singing the same songs over and over, but your baby thrives on the repetition, and begins to anticipate the movements and exciting finish! This familiarity helps him be an active participant in the activity.


Baby Ball Pit
Take one package of Ball Pit Balls and dump the balls into your pop-up travel crib/play-yard. Presto! Easy ball pit!

This is an easy activity and can provide many hours of play when used selectively. The balls are easy to put away and bring out on special occasions when you need a diversion. Meanwhile several balls at a time can be used for other activities such as dropping in and out of a bucket, rolling down a makeshift ramp, playing “catch” by rolling back and forth with caregiver while sitting on the floor, and as your child grows, for “indoor bowling” or counting and sorting by color.

 

Fine Motor Play Ideas from Six to Nine Months

Midway into the first year, your baby will be busy learning and experimenting with how her hands and body work, and how the world works.
There are many easy and fun “fine motor” activities you can incorporate into every day play.

These interactive activities incorporate thinking and learning skills: how to use the hands in a coordinated fashion to achieve a goal, “motor planning” to position the fingers and hands, arms, trunk and body more intuitively to complete a task efficiently, cognitive skills by observing and learning by “cause and effect”, and the satisfaction that comes as your baby anticipates a result and sees it occur as expected.

Some fun toys and activities to add to your play:

Pull toys with string: A classic toy and way for your baby to learn cause and effect and how she can impact her environment. Show her how to pull the end of the string and draw the toy closer to her. Similar activities can be created by placing a folded receiving blanket near your baby and placing a toy or object on the far end. Show your baby how she can slowly pull the edge of the blanket in toward her body to bring the toy into closer reach.

What’s Inside, #1? Take some random objects or toys safe for exploring, and wrap each one in material that will be safe for your child to unwrap: a scarf, a receiving blanket, tissue paper, gift wrap. Let your baby practice unwrapping the packages to discover what is hidden inside.

What’s Inside, #2? Take a baby-safe toy or rattle and place it inside a clean sock, initially with an edge of the rattle exposed. Show your baby how to work to pull the sock off the object, or take the object out of the sock, and cheer when she succeeds. This can be made more challenging over time depending on the item “hidden” in the sock. Try a small safe ball. That’s hard!

What’s Inside, #3? Use safe containers like a cardboard shoe box with lid or a purse for your child to investigate. Place a stuffed animal or several small safe toys inside. Demonstrate how to take items OUT, place them back IN, and close the lid or top. Ask, “Where is it?” and show that it’s still in there where you put it.

Ball Ramp: Take a long cardboard tube and cut it in half. Use this as a ramp to roll a baby-safe small ball or car down the tube. Initially, your baby will probably be on the receiving end, catching the ball as it rolls down the ramp, but soon, she will have the skills to place the object at the top of the ramp and let go so down it rolls!

Large Knobbed Puzzle: A chunky wood “beginner” puzzle will be of interest now, even if your baby initially is more interested taking the pieces out, tasting them and banging them against the table. By modeling how the pieces fit back into the frame, your baby will soon try to imitate that action as well. Hint: secure the frame of the puzzle to the table surface with painter’s tape to reduce frustration from the frame sliding around or falling off the table.

Quick Tip: Too many toys piled up can be overwhelming. Instead, put out a small selection of toys at a time, and rotate new ones in and out of the mix every few days to keep things fresh and stimulating/ Of course it’s fine to leave favorite items that are frequently used.

Bronchiolitis and Croup

Bronchiolitis: A common respiratory illness during a baby’s first year

Your baby will (unfortunately) contract six colds, on average, during his first year. Most colds will have upper respiratory symptoms (runny or stuffy nose, perhaps a cough, possibly a fever). Most colds will last for 5-10 days (yes, it takes longer for babies to shake a cold than an adult. Also, the baby’s symptoms are much more obvious since they cannot blow their nose, and they let you know when they are not feeling their best).

Occasionally, some colds have a “Stage Two” attached.
There are three common “Stage Two” parts of colds: some babies will get an ear infection after a cold (due to physiologic anatomy and nasal congestion), some cold viruses will result in a body rash (“viral rash”) one or two weeks after the cold virus has resolved, and finally, some colds will travel lower in the baby’s respiratory tract and continue on into a Croup or Bronchiolitis. Croup is more common in 1-2 year olds. Bronchiolitis is more common during a baby’s first year.

So, think of bronchiolitis as “part two” of a cold. The cold virus unfortunately has moved lower in the baby’s respiratory tract, to the smallest of the airway branches, called the bronchioles. An adult typically gets “bronchitis” from a chest cold (inflammation of the bronchi), but an infant gets “bronchiolitis” – inflammation of the smaller branches of the respiratory system.

These respiratory infections are unique in that they typically impact infants and toddlers, but not adults. However, the very same virus that may cause a basic cold in anyone, a “head cold” or “chest cold” for others in the home, may result in croup or bronchiolitis in an infant or toddler. It’s not the virus itself that causes the bronchiolitis (or croup, or ear infection), rather, the virus causes the infection, and the infection progresses to a symptom in the bronchioles (or middle ear).

Bronchiolitis is an infection of the respiratory tract that affects the smallest airways of the lung. The swelling and obstruction of these tiny airway passages creates shortness of breath, wheezing or whistling noises. You might notices an infant with bronchiolitis is working harder, with rapid, shallow breathing, with neck or chest “accessory muscles” moving with the breathing efforts.  You’ll likely notice more irritability or crankiness, restlessness and decreased appetite as the body’s efforts must go into breathing and oxygenation rather than eating and nutrition.

Since the virus that causes bronchiolitis is often the same virus that causes the common cold, you may see cold symptoms including a runny or stuffy nose, cough and fever. Bronchiolitis or croup may start with a common cold, but progress to the lower respiratory tract.

Even if your baby doesn’t seem to be struggling to breathe, restlessness may be a sign of low oxygen levels in an infant, so it’s worth a call to your pediatrician if your baby has a fever, congestion, is breathing rapidly and seems very unsettled or unhappy. It’s better to call and be told what to watch for, than worry about if you should call or not!

Bronchiolitis is most common in the winter and spring but may occur at any time. It is most common in babies under a year old, boys are more commonly affected and exposure to smoke, daycare or older siblings makes a baby more likely to get more frequent colds, so also increase the risk or rate of bronchiolitis. Avoiding obviously sick people (hard to do in daycare where seemingly 75% of children appear to have some stage of a cold!) and good hand washing are always good practices to reduce risk of catching a cold or virus.

RSV (respiratory syncytial virus) is the most common viral cause of bronchiolitis (though the flu virus or a regular rhinovirus – the common cold virus – may also result in bronchiolitis in an infant). Premature and other vulnerable infants are more susceptible to RSV, or may have a harder time managing RSV illnesses, so some higher-risk babies may receive a vaccine to prevent RSV.

Your pediatrician will diagnose bronchiolitis by listening to your baby’s chest, checking a pulse oximetry oxygen level and perhaps ruling out pneumonia or another diagnosis by requesting a chest x-ray. Presense of the RSV virus may be confirmed using a nasal swab in the pediatrician’s office.

Treatment for bronchiolitis will depend on your baby’s specific symptoms and severity. Most bronchiolitis cases are mild and will be cared for at home by offering fluids, anti-fever medications, and using a humidifier and saline nose drops to keep breathing more comfortable. Occasionally “nebulizer” breathing treatments may be done in the doctor’s office or at home. Rarely, a baby may need to be briefly hospitalized for breathing treatments or extra oxygen but this is not typical at all. Antibiotics will not help bronchiolitis, which is the infant’s respiratory response to a virus similar to a cold.

Diaper Surprise! 12 Freaky Things to See in Baby’s Diaper during the first year

Changing your baby’s diaper may feel a bit like unwrapping a surprise gift or delicately defusing a small package bomb. You’re never quite sure what’s inside until its too late, and the contents may shock you, amuse you, or make you run for Dr.Google.

Don’t underestimate the fascination you may have with your baby’s diaper contents. Embrace this stereotypical new parent obsession, though do try to limit detailed diaper discussions to other new parents, and those who feign polite interest without turning white or audibly gagging.

Surprise! Here are 12 freaky things you might find in your baby’s diaper during the first year:

Day 3: Brick dust (uric acid crystals) – a rust or pinkish colored residue staining the front of the diaper. This resolves as baby’s urine becomes more dilute.

Week 2: Gel crystals. These look like oversized grains of sugar stuck to your baby’s genitals. Don’t panic – they’re not coming from your baby! Instead, they’re from the absorbent lining escaping from tiny tears in a disposable diaper.

Week 6: Green spinachy-looking poop. Like the occasional random projectile vomit, these bizarre baby things sometimes happen, possibly on days when baby is nursing more than usual. Unless it’s frequent, frothy, with mucus and blood, don’t worry about occasional green poop in the diaper.

Month 3: Nothing. No poop. Nada. Perhaps several days or even a week may go by with nary a stool. Perfectly normal for breastfed babies, as long as baby is content and pee is plentiful. No need to intervene. What goes in will eventually come out (and usually at the least opportune time and in abundance), so be fully prepared for a poop explosion.

Month 4: Containment Failure or Blow Out. When baby is in a seated position (car seat, bouncer, baby carrier) there’s really only one place for poop to go, and that’s UP. Tell-tale sign of the Blow Out is a yellowish wet spot located at the small of the baby’s back. Usually involves a complete change of clothes, bath optional. For both of you.

Month 5: Mom’s hair (because it’s falling out everywhere). Tip: Time to get a short, sassy hair cut. Hint: Beware the Hair Tourniquet.

Month 6: Slimy mucus in poop when baby has a cold. Swallowed mucus isn’t absorbed by the GI tract and will pass through unchanged into the diaper with poop.

Month 8: Little black threads which look exactly like tiny worms. These are from baby eating fresh bananas (not jarred). They’re just like the little black strings you see in homemade banana bread. Mmm. Banana bread.

Month 9: Gas-mask worthy smells. The strongest odors yet are typically from introducing more protein foods. Whew. Just. Wow.

Month 10: Bits of paper are likely from the tag she was chewing in the store or cardboard from gnawing on the corner of a board book. Paper is one of the four basic food groups of mobile babies. Bonus points if you can still read a letter or word.

Month 11: Easily identifiable bits and pieces of food. Oh, there’s a blueberry! Hey, look, a lima bean! Tip: If you want to know how long it takes for food to make it through your baby’s digestive tract, feed baby some corn. My estimation is you’ll see it again in about 18 hours.

Month 12: Poop that looks (and smells) just like big-people poop. If it’s not too squashed, you can shake it into the toilet instead of sealing it up in the diaper. The more solid food your baby eats, the more their poop will start to look more “familiar”.

Bonus – 18 months: Brightly colored flakes – from that crayon you needed to pry out of your toddler’s mouth. Makes for some pretty poop, though!

Pumping at Work: Uneven Production

I’m back at work and my baby is 14 weeks old. I have been pumping twice during my workday (9 AM and 1 PM) and I can pump about 10 to 12 ounces a day with these sessions.

My left breast is producing a lot more milk than my right, and might look a little larger. 

After 2 min of stimulation, milk starts to flow from my left breast. I don’t see any milk from right breast until about 5-8 min into pumping, and maybe collect two ounces by the time the session ends between 15 and 20 min. Suggestions? ( I’m using size 27 cups with Medela freestyle).

Congratulations on making the (hard, so hard!) transition back to work, and wow, expressing 10 – 12 ounces in two sessions is great. Good job, you!

Since you mention pumping at 9 AM and 1 PM, you might consider adding a “before leaving work” pumping session after you’re done for the day but before leaving. This might mean that you arrive home with 15 ounces instead of the 10 – 12, if that is important to you. You can pump at work and still breastfeed on arrival home or to childcare.

When pumping,  see if the 24mm flange might do better on the right breast, even if the 27mm does better on the left. If that is the case, it may stimulate more milk let down and removal over time. Try a dab of olive oil for lubrication and use my suggested pumping techniques (hands-on, massage and compression, repositioning angle of nipple several times, varying vacuum strength and cycling speed accordingly)

It’s normal to find a discrepancy between the two breasts – we are not mirror-image or symmetric people (we have one liver, one spleen, one heart) and each breast functions independently from the other. Between the two breasts, you should be able to make all the milk baby needs and then some, but you may not make an even amount from each.

Some women become aware that one breast makes a lot more milk than the other only once they begin doing a lot of pumping. Other moms can see physical differences in breast size (up to 1 – 2 bra cups sizes) and some moms or babies have a clear preference due to production (with oversupply or very heavy let down, baby may prefer the slower-producing other breast!).

How can you “even things out”?

When nursing your baby, you could try to start her on the right breast – babies are typically most vigorous at the beginning of the feeding session and this “enthusiasm” might help encourage the milk to flow and assist with production. Use lots of breast compression and massage to help things along.

Another perspective: if she is cranky when starting on the “slower” side because she’s used to a fast flow from the bottles and frustrated at having to work hard and wait for the milk when starting on the right side, then instead, you could try starting her on the left breast, and then switch her over to the right to nurse and linger longer. There’s no definitive answer, just try out some of these ideas and see if one helps more than the other.

Keep up the awesome hard work, Mama!

 

 

Help! Baby Won’t Take Bottle! and IBBM Method

Hello,
Since you’re here, you’re probably pretty stressed. Sorry about that. I’m here to help with resources and support. I have a pretty good track record on this – which is why you’re here 😉
Hang in there.

Please READ:
Won’t Take a Bottle
Selecting Bottle Nipple
Bottle Feeding the Breastfeed Baby

Please WATCH:
Help, Won’t Take Bottle.

Please TRY IBBM 2x/day for 5 days.

Personalized Support – Home and Phone Consults

Changes in Routine over the Holidays

It’s easy for everyday routines to be disrupted over the busy holiday weeks. Travel, visitors, parties, new decorations, and changes in childcare or playgroup routines , plus alterations in meals, nap and bedtime routines may result in both excitement and stress for infants, toddlers and parents.

Some simple steps may help to maintain a sense of security and routine during these busy days:

Keep mealtimes as regular as possible, or offer healthy snacks if a family meal is being held later than your child might like. Most toddlers have a short attention span in the highchair, so bring along some appropriate diversions to keep a child content at the table a little longer, or allow him to play with quiet toys on the floor next to the table if appropriate.

When traveling overnight, bring along some favorite toys, books, music and blankets and try to keep to your regular bedtime routine, even if it’s a little briefer or later than usual. If you usually bathe, read, rock, sing with your little one at bedtime, follow that pattern. Your baby will recognize the familiar rituals, even in a new environment. White noise may help mask unfamiliar city or party sounds.

Unfamiliar faces or crowded rooms at parties may take your child some time to get used to. Sometimes visitors are so eager to see the baby that they want to rush in and envelop the baby in a hug. Explain to visitors and relatives that most young children need some time to acclimate to new places and people (even grandparents, if it’s been awhile since their last visit). Hold your child and let her watch you interact with friends and relatives first. Wait until she seems more relaxed and shows a willingness to explore the environment or be held by someone new.  Using a sling or frontpack is a great way for relatives to see and interact with the baby, while parents are still able to maintain a sense of safety and security.

Keep extra-vigilant at holiday gatherings and parties when there are many adults and children present. It’s often assumed that someone else is watching a child, when in fact the toddler may be unobserved exploring an area that is unsafe or mouthing a potential choke-hazard. Sometimes a well-meaning relative may give a baby or toddler a food or plaything that is unsafe or not age-appropriate. Party foods (including candy, nuts, chips and baby carrots), festive decorations and toys for older children are all tempting and potential hazards for a crawling baby or young toddler.

 

Baby’s Head Shape: Flat Spots, Torticollis & Plagio

Does your baby have a flat spot on the back of his head? Many babies do. Fortunately, most flat spots, called Positional Plagiocephaly, are mild and need no treatment other than positioning changes and monitoring. Learn how to prevent and treat flattening of your baby’s head, and when to speak with your pediatrician about concerns.

 What is Deformational Plagiocephaly or “Flat Head”?
Also called Positional Plagiocephaly, Deformational Plagio refers to the misshapen or asymmetric shape of the head. The flat spot is usually on the back of the baby’s head, though in some cases, for example, with torticollis, the flat area may be on one side of the skull.

What causes deformational plagiocephaly or “Flat Head”?
The most common cause of deformational plagiocephaly is positional. A newborn’s skull is soft and designed to grow quickly. When babies rest in one position for long periods of time, the skull begins to flatten from the external pressure against it. Since babies can spend a lot of time in the “passive recline position” (car seats, bouncer seats, swings, back-to-sleep position), it’s possible for a flat area to develop. Once a flattening occurs, it’s easier for the head to “resettle” there each time, allowing other parts of the skull to grow but not the flat area.

Shifting your newborn’s sleeping and resting positions is the best prevention for developing a flat spot. During diaper changes and for sleep, try alternating his “head and feet” position, reversing the way you usually lay your baby on his back. When your baby is awake and observed, use more tummy time and side-lying positions. Lots of awake tummy time with encouragement will also help by strengthening the neck, shoulder and arm muscles, which will eventually help your baby shift his own positions. Carrying, holding or “wearing” your baby without pressure on the back of his head will also encourage muscle development and prevents pressure against the flat spot.

Is a Bald Spot or stripe on the back of the head cause for concern?
No. It’s common for babies between 4 – 7 months to “wear away” an area of hair from turning their head side to side when in car seats, bouncer seats or sleeping on the back. This bald patch is normal and if not accompanied by significant skull flattening, is not a cause for worry. Bald patches tend to resolve between 9 to 12 months, as your baby will be sitting, crawling and moving more, spending less time on his back, allowing hair time to fill in again. Many fashionable babies sport a fine mullet.

Torticollis and Flat Head – 
A common cause of deformational plagiocephaly is muscular torticollis. Muscular torticollis (sometimes called “wry neck”) is a tightening of specific neck muscles, which prevent full motion and keep the baby’s head slightly tilted or turned to the side. Because torticollis causes the baby to keep his head at a specific angle, a flat spot may form as the baby’s head rests against the mattress or seat at the same position for repeated periods of time, leading to positional plagiocephaly.

Torticollis is often missed by parents and health care providers, since newborns have short necks and tend to lean or “slump” to one or another side. Make sure your baby is an “equal opportunity slumper” – sometimes leaning to the right side and other times the left, when sleeping, and check that your baby can turn his head equally to both sides. If you’re concerned about your baby’s persistent head-tilt or suspect restricted neck motion, speak to your pediatrician.

Treating Torticollis – for a baby with torticollis, treating the tightened muscles early is important to achieve full head movement as baby grows. Full motion of the head and neck helps with balance as well as the physical appearance of the head shape (and sometimes facial symmetry). Torticollis is best treated early, during your baby’s first several months of life when specific stretching and repositioning techniques are most effective. Your pediatrician may refer you to a pediatric physical therapist to learn specific stretching exercises and positioning tips for your baby’s particular needs.

What about Helmets?
Maybe you’ve seen a baby out in the store or mall wearing what seems like an infant-sized football helmet. This is a therapeutic device called a Cranial Band or Orthotic, worn to help correct a misshaped head.  In more severe Plagio, when flattening or asymmetry is significant and beginning to affect facial appearance (one eye or ear may begin to move out of line with the face), or, in situations where a baby was born very prematurely or has early closure of the skull bones, an Orthotic may be recommended. Made by a specialist, baby helmets are very lightweight, with a hard outer shell and foam lining. Very gentle pressure restricts growth in some areas while allowing the skull to “fill out” and freely grow around the flattened areas, rounding out the head. Helmet therapy typically takes 3 to 6 months with good results.  Babies generally adjust to wearing a helmet quickly – it’s harder on the parents usually due to comments from well-meaning strangers and additional appointments. But remember that mild flattening is common and usually doesn’t require treatment with a helmet.

 

Links and such

(This may look like a random collection of links to most. That’s ok, feel free to click and enjoy)

five babies on bolsters

History, Legacy, Feel-Good Stuff:
Great Beginnings New Mothers Groups. My Legacy. Begun in West Roxbury, 1995. Ended in 2014, after reaching 25,000 families in five states and thirteen locations. The curriculum is continued in a variety of community centers, childcare programs, birth centers and parenting programs nationally.  See the experiences of some original Isis participants. 

Magic Beans says a thoughtful Goodbye to Isis Parenting and Nancy

The Atlantic covers the MIT Program Building a Better Breastpump 

Boston Globe’s thoughts on  What Happened to Isis. (they only get it half-right, but it’s still nice)

Journal of Obstetric, GYN and Neonatal Nursing (JOGNN) free access to my publication abstract on Early Parenting and Sleep.

AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) see my  Super Cool Sleep Poster presentation on supporting parents around infant sleep.

Links Related to Topics Discussed

Go on, take a bath together! Newborn Co-Bathing is a thing if your baby hates the baby tub.

Brief Pump, Store and Feed Careplan may be useful. More on this later.

Breastfeeding Webinar Five Tips for Better Pumping with info about why I recommend pumping after breastfeeding, not mid-way between feeds.

How to Nurse Sidelying  and on both sides!  Best tweaked in person – remind me.

Soon less crying, more playing on the Changing Table! I promise!

Cradle Cap from Mayo Clinic (a trustworthy clinical source for parents IMO) – we can discuss if you want to use Head’n’Shoulders ( if pedi-approved)  and get rid of it in a week, or nothing or jojoba or coconut oil and get rid of it in 1-2 months. Either way works.

How to SAVE a Baby’s LIFE –  INFANT CPR ! Watch this 3 min. video. Also, a 2 minute choke-saving skills video review. Let’s review both of these important skills!

For S.: my favorite Infant Massage music – the original House at Pooh Corner.  We also talked about Tummy Massage for Gas.

 

Verify Credentials:  RN CPN IBCLC

RN: View my Registered Nursing License here, current and in good standing since 1989.  That’s 30 years if you are sleep deprived 😉 Check credentials.

CPN: View my Board Certification for Pediatric Nursing here, an advanced credential held for a decade and recertified every two years. View verification

IBCLC: International Board Certified Lactation Consultant – in continuous practice  since 1998. Yes, I have been a BOARD CERTIFIED feeding specialist for over 20 years, learning more each week from every mom and baby I meet. Verify IBCLC credential