Category Archives: Newborn & Baby Wellness

Cerebral Palsy And Heredity

cerebral palsy

Damage to areas within the largest part of the brain—the cerebrum—typically before or during birth is called "cerebral palsy." This term refers not to one specific condition but is a name for a broad category of motor deficiencies that result in physical disability. The damage may result from inflammation, infection, or low birth weight or birth defects. Over half of all children with cerebral palsy have been found to have birth defects or low birth weight. Babies born with cerebral palsy may be floppy or stiff. Children with these conditions often exhibit language problems, not necessarily due to cognitive deficits—though such deficits are not uncommon—but as a result of respiratory problems or difficulties with facial muscle control.

The causes of cerebral palsy are not clear. Contrary to what was once believed, babies born with the umbilical cord wrapped around the neck, which actually happens in as many as a third of all pregnancies, are not at significantly higher risk for cerebral palsy. Rather, women who have infectious diseases such as rubella, chickenpox, or toxoplasmosis during pregnancy are more likely to have children with birth defects such as cerebral palsy. Multiple birth are associated with low birth weight, and particularly if there has been a miscarriage, one or more of the infants are at heightened risk for a form of cerebral palsy.

Researchers have also found a family connection in cerebral palsy. Siblings, children, and first cousins of children who are born with cerebral palsy are themselves at higher than normal risk of thee conditions. One study found that, while children who are twins are already three times as likely as single births to have some form of cerebral palsy, when one twin develops one, the other is 15 times more likely to do so as well. The same study showed younger siblings of children with cerebral palsy showed a sixfold increase in risk, roughly the same as children of parents with cerebral palsy.

The good news is that by adolescence, with proper treatment, children with cerebral palsy have quality of life roughly comparable to that of children who are not affected. In a survey, teenagers with cerebral palsy self-assessed as doing as well as—or better than in some areas—their peers.

Weaning

breastfeeding1

The American Academy of Pediatrics recommends that newborn babies be breastfed exclusively for the first six months of life, then gradually weaned over the next year and a half. However, this isn’t always possible for new mothers, either for medical reasons or due to life interfering. Formula is designed to mimic breastmilk as much as feasible, though it is only an imperfect replica and of necessity is not going to match any specific individual’s breastmilk. Breastmilk confers immune benefits and is often easier to digest than formula. Pumping—putting breastmilk into a bottle for bottle feeding—can work as a compromise between breastfeeding and bottle feeding with formula.

This is necessary for women who need to return to the workplace soon after giving birth. or want Outside the office, breastfeeding in public places is a controversial issue. In many places, breastfeeding is legal in public even if exposed breasts would normally violate indecent exposure laws. Private businesses are free to generally make their own rules, but more and more establishments are making an effort to accommodate mothers of newborns who need to feed the while out and about. Nonetheless many women prefer to try to find a quiet corner, or find nursing-friendly clothing. Often, new mothers will try to time outings to allow for feeding in the parked car.

Experts say weaning the child should start at six months, and the child should be more or less completely off breastmilk by age two years. As this schedule suggests, it is a slow, gradual process. It starts with fewer feedings, either eliminating one of the usual feeding sessions entirely every few days or, as the process goes on, replacing it with food or formula, depending on what the child is able to handle.

However, if breastfeeding is going well, some mothers choose to continue it for longer. This is not necessary, and is unlikely to provide measurable benefit, but nor will it do any harm. Successful breastfeeding means that the child is gaining an appropriate amount of weight, the baby is swallowing while eating, the baby is getting fed eight to 12 times a day, and the infant generally seems healthy.

Understanding SIDS

swadled baby

Babies sometimes die, unpredictably, and doctors aren’t really sure why. Sudden infant death syndrome, or crib death, strikes about 2,500 children a year, between one and 12 months old, but because the cause is so hard to pin down, it is almost impossible for pediatricians to prevent or predict. Researchers have traced it to difficulties regulating the carbon dioxide content of blood, but it is not clear why that happens. The strongest hypothesis involves abnormalities in the brain that interfere with proper breathing, or premature babies whose brains are not fully developed at birth, and so less expert in controlling respiration.

Recent research suggests that crib death babies show similar signs as babies who were accidentally asphyxiated, suggesting that oxygen deprivation is at the root of the deaths. The study compared deaths from SIDS to infant deaths from head trauma, infection, drowning, and asphyxiation. Death by asphyxiation leaves behind a chemical calling card in the brain that is seldom present in other types of infant fatalities. The researchers found this same chemical signature present inn the brains of infants who had does of SIDS.

This improved understanding may be able to help medical professionals get a better grasp on what advice to give to parents that can help prevent crib death. There are some recommendations that are already known to reduce the incidence of SIDS. Babies should be put to sleep on their backs. Particularly if crib death is a form of asphyxiation, it is better for a child too young to roll over not to be facing the mattress. According to some studies, a baby sleeping face-down has as much as 12 times the risk of SIDS. Similarly, a crib is actually a safer place for the baby to sleep than a big soft bed. Newborns who sleep in the same room as at least one parent are less prone to crib death.

The same room, however, does not mean the same bed. Despite the benefits of proximity, more than two thirds of infants who dies were in bed with their parents at the time of death, according to a study. Different research found that babies who co-sleep have five times the SIDS risk of those in their own cribs.

About Cystic Fibrosis

lungs-md

A single mistake on a single gene can cause serious medical problems. In fact, it is just such a mistake, the omission of a three-letter word from the genetic code, that causes cystic fibrosis, a congenital lung disease that also affects the digestive system, in 90 percent of the about 30,000 cases in the United States. This deletion, or any of the approximately 1,500 other mutations that can cause cystic fibrosis, can be inherited from other parent, but only causes disease when it is inherited from both. All these mutations have similar effects, mucus forms in the lungs, interfering with breathing and leaving the person prone to infection. Cystic fibrosis also causes poor growth, infertility, and a reduced lifespan.

In fact, some researchers are suggesting that the mutation is associated with two or more different illnesses. One is the disease commonly thought of as cystic fibrosis, in which unusually thick mucus is produced, coating the lungs and causing the respiratory symptoms associated with the disease; another, often considered harmless, is now believed to cause problems with the pancreas and digestive system, with the reproductive system, with the sinuses, or elsewhere in the body.

Thickened mucus is not the only reason people with cystic fibrosis are especially prone to lung infections. People with cystic fibrosis also have high rates of an infection called cepacia syndrome, which disrupts the immune response. Cepacia syndrome is also a disease in its own right, causing fever, pneumonia, and, often, death. However, there is new evidence emerging that cystic fibrosis itself causes damage to the immune system. People with cystic fibrosis are missing a crucial immune system molecule that makes it possible for the immune cells to identify pathogens, in order to be able to hunt them down and destroy them. When the pathogens go unrecognized, they are allowed into the body to cause harm.

Fortunately, there is good news. Scientists are reporting that cystic fibrosis patients born in 2010 have a longer expected lifespan than their predecessors. Overall, only about half of cystic fibrosis patients live to 40—itself an improvement on the days when few reached elementary school age—but improvements in treatment and management mean those born this decade are expected to make it well into their 50s.

Vaccination And Pertussis

pertussis vaccine

Pertussis, or whooping cough, is a disease of the bad old days, now largely eradicated through vaccination—except that it’s making a comeback. It starts out resembling an ordinary cold, but "cough" is an understatement. A pertussis patient will cough constantly, sometimes to the point of nausea. It interferes with sleeping, eating, drinking, talking. Sometimes, the coughing leaves patients gasping for air, or they cough hard enough to break ribs. Whooping cough can last for months.

Thanks to vaccination, pertussis almost disappeared entirely. However, thanks to an increasing tendency for parents not to vaccinate their children, more and more children are getting the disease. The disease can be annoying in adults but fatal to babies, but in 1940, a vaccine was introduced, and within a few generations became a standard part of childhood.

In recent years, however, vaccination has begun to be perceived, wrongly, as dangerous, and the diseases such as pertussis that it prevents perceived, also wrongly, as harmless, and the numbers have accordingly gone up—30 percent over last year, according to the Centers for Disease Control and Prevention. In 21 states, whooping cough cases have more than tripled. That’s nearly as many states as require only a doctor’s note, or less, for an exemption from vaccination requirements. Marin County, California, which has among the highest vaccine exemption rates in the country, also has the second highest rate of whooping cough.

Refusal to vaccinate doesn’t affect only the unvaccinated children. When enough people in a community are immune to a disease, it is impossible for the disease to establish a foothold, protecting even babies too young to be vaccinated or the tiny minority in whom the vaccine itself was ineffective. This herd immunity, however, requires that 93 percent of the population receive the vaccine.

That’s why medical professionals are working on ways to ensure that more people are vaccinated. One approach is to give pregnant women the TDaP vaccine, which combines the vaccine for pertussis with those for tetanus and diphtheria, during the third trimester. This has been found to have no adverse effects on the mother or the fetus, and, once born, the baby starts out with temporary immunity during what would otherwise be the most vulnerable period of life.

Early Intervention For Spina Bifida

bifida

Spina bifida means split spine. Fetuses with spina bifida, one of the most common birth defects, develop with the two sides of the neural tube, a sheath of tissue that will form the spine, incompletely joined. This leads to gaps in the protective covering the spine normally provides for the spinal cord. When this happens, the baby’s nervous system is highly prone to infections that the neural tube ordinarily protects against. These infections can result in lifelong nervous system damage. In addition, the damaged neural tube causes cerebrospinal fluid to build up in the skull, putting pressure on the brain.

Infants with spina bifida may have paralysis of the legs, bowel and urinary incontinence, cognitive difficulties, or learning disabilities. The cerebreospinal fluid can cause or exacerbate these difficulties. In some cases, different parts of the neural tube, which will become parts of the brain itself, fail to join, leading to brain damage when the baby is born.

It is unclear exactly what causes spina bifida. There is a genetic component, but environmental factors are also known to be partly responsible. In particular, folic acid levels seem to be related to proper fusion of the neural tube, to the point that, though only about a third of pregnant women take folic acid, women who do so are 70 percent less likely to have babies with spina bifida. However, neural tube fusion is supposed to happen less than a month into pregnancy, before the expectant mother even necessarily realizes she’s pregnant. For this reason, some experts recommend that all women who intend or expect to become pregnant should take folic acid.

Another possibility is surgery on the fetus in the uterus. If ultrasound or other imaging shows incomplete neural tube fusion, surgical techniques are being investigate that will allow a surgeon to go in and fix the damage before the birth. In one study, this was shown to be cost-effective, sparing parents the financial costs of repeated surgeries and other treatments after birth. Prenatal in utero surgery also means the damage that the condition starts doing immediately after birth can be reduced, if not entirely eliminated. Research has shown that prenatal surgery prevents the buildup of cerebrospinal fluid, and babies born after surgery are more likely to eventually be able to walk unaided.

Living With Cerebral Palsy

ganglia

Cerebral palsy is a term referring to any of a number of types of brain damage affecting the cerebellum, the largest part of the brain. Often, the damage is due to inflammation, caused by infection or related to low birth weight or birth defects. Over half of all children with cerebral palsy were found to have birth defects or low birth weight. Doctors once believed that cerebral palsy often resulted from obstructions preventing oxygen from reaching the baby’s brain during or immediately after birth, for example, the umbilical cord being wrapped around the baby’s neck. While this does occur, it is usually harmless, and rarely leads to cerebral palsy.

While causes of many cases of cerebral palsy have been found, it is not always clear why these things happen. Women who have rubella, chickenpox, toxoplasmosis, or certain other infectious diseases during pregnancy are more likely to have children with birth defects. Children born as multiples are likely to have low birth weight, and, especially in cases in which one of the children miscarried, are prone to cerebral palsy. Recent studies have also found a family link. The children, siblings, and even first cousins of people with cerebral palsy are particularly at risk for having the condition themselves.

There is no cure for cerebral palsy, but there are interventions that can help minimize the deficit and improve the child’s capabilities. These interventions are most effective the sooner they are given, when the brain tissue is less specialized; they generally involve training a healthy portion of the brain to take over or augment a function of the damaged part. That is why doctors try to make a diagnosis sooner rather than later, by tracking children known to be at risk of developing the disease, by looking for delays in reaching developmental milestones in the first year, an by looking for symptoms of cerebral palsy such as poor muscle tone and abnormal movements.

Researchers have now found a better way to treat the movement problems that cerebral palsy can cause. They have devised a rubric for classifying patients based on the nature of the deficit, determining that different types of movement issue benefit from different types of treatment. This will make it easier for treatments to be used that are tailored for the person’s needs.

Feeding The Baby

infant

Breastfeeding a newborn is ordinarily a great way to be sure they get the nutrition they need. That’s because the nutrients in a mother’s milk are exactly matched to her baby’s needs. It is considered a complete source of nutrition and suited for a newborn’s developing digestive system. That’s why the American Academy of Pediatric recommends breastfeeding, when possible, to provide the best start through baby’s first year; some experts say babies should be fed exclusively on breastmilk for the first six months, and then continue to nurse, complemented with other safe and appropriate foods—babies who are breastfed exclusively often need extra vitamin D—until age two.

However, while breastfeeding is natural, it isn’t instinctual—at least, not for the mother. The baby, born with a suckling instinct, will almost always get the idea, particularly if nursed soon after birth—within the first hour is the recommendation—but it can sometimes be a little difficult for new mothers. One thing that helps, then, is to let the baby take the lead. The baby knows when to start and when to stop; the mother needs to do little more than watch for signs of hunger and position the baby properly. That means bracing the baby’s head and neck with one hand and hips with the other, leaving room for the wriggling that is part of finding the breast. A mother who is having problems should not hesitate to seek help—most maternity facilities have lactation consultants on staff, or family, friends, or breastfeeding organizations may be able to give useful advice.

Despite all advice and assistance available, some women are unable for one reason or another to breastfeed. This isn’t a sign of failure, it’s just something that happens. It helps for the mother to eat a healthy diet, get as much rest as a newborn allows—if possible, finding or hiring someone to take care of non-infant-related tasks—and try to stay calm about the whole thing. As beneficial as breastfeeding is, not being able to do so is not the end of the world; infant formula is intended to replicate natural milk as closely as possible. Many of the non-health benefits of breastfeeding—better relationship with the parents later in life, better mental health, better cognitive function—are not well supported by research.

Rotavirus Protection

rotavirus

According to the Centers for Disease Control and Prevention, the biggest single cause of infant diarrhea and dehydration in the world is rotavirus. In fact, experts believe that by the age of five, nearly every child has experienced at least one rotavirus infection. Indeed, the resistance these repeated infections build up is a major part of the reasons adults are so rarely made ill by rotavirus. Unfortunately, not all infected children survive to adulthood; it is estimated that rotavirus gastroenteritis kills 450,000 children each year, typically by dehydration. Rotavirus destroys cells in the digestive system, leading to vomiting and then diarrhea that can last more than a week.

Adult immunity is somewhat a double-edged sword. While adults show no symptoms of the infection, the virus itself remains active, and can by transmitted from person to person as any other infection can. Statistics show sanitation having little effect on the incidence of rotavirus infection. What does help is vaccination. Rotavirus gastroenteritis is asymptomatic in infants younger than two months, and two months of age is when doctors recommend the first dosage of rotavirus vaccine to be given. Needed further doses—up to three all told—are given at two-month intervals subsequently. Pediatricians say rotavirus vaccination saves parents and health care facilities almost $1 billion since 2010.

That, perhaps, is one reason people are trying to make the vaccines easier to get. In New Zealand, a government-sponsored program aims to vaccinate every child born in the country. The goal of the program is to ensure that, by the end of 2014, at least 95 percent of toddlers under eight months in New Zealand have been vaccinated. Reports say that the program is on schedule and children are getting the protection they need.

The vaccine has additional benefit that researchers were not aware of. As well as causing gastroenteritis, rotavirus is associated with some forms of seizure disorder. Vaccinating children against infection, then has the further effect of reducing the risk of seizure-related hospitalization by 20 percent. That translates to preventing 5,000 emergency room visits due to seizure. That alone saves more than $7 million in health care costs. What’s more, researchers now say there are connections between rotavirus and type 1 diabetes. Though susceptibility to type 1 diabetes is hereditary, it requires a trigger to develop. Vaccination means rotavirus is not such a trigger.

Taking Care Of Infants

baby with pacifier

Having a new baby is more stressful than new parents expect. This is particularly true for first-time parents, to whom the entire experience is new. Fortunately, newborns are resilient, certainly emotionally—nothing a new parent does in the first few weeks, or even months, is likely to have a permanent effect on the child’s psyche. Indeed, averaged out over years of parent-child interactions, one wrong step, or even a handful of wrong steps, is unlikely to do any lasting harm in the grand scheme of things.

Nonetheless, there are things new parents should know. For mothers who choose to breastfeed, there’s a learning curve—it’s not something a new mother will automatically be able to do correctly right out of the gate. That means that if the baby doesn’t feed correctly on the first try, it’s not a failure on the mother’s part. In any case, if breastfeeding proves impossible or impractical, it’s no big deal. While breastfeeding is by no means unhealthy, many of the claimed benefits are exaggerated, or have no real evidence backing them up.

New parents should also know about common health problems with newborns. Colds and coughs, even fever are normal. Vomiting—or spitting up—is pretty much inevitable. None of these are typically signs of a major health problem, and they usually go away after a few days. If they seem unusually serious or last for a long time, however, it’s a good idea to call the pediatrician. Even a parent who has a vague feeling of something not right can benefit from calling the doctor, if only for peace of mind. Pediatricians are used to first-time parents, and generally have a good sense of what’s simple worry and what is an actual problem.

In general, in fact, new parents who aren’t sure about something should ask—the obstetric nurses, doctors, friends, family. There is such a thing as too much advice, but risking that is worth the comfort a parent has knowing that they’re doing it right. Instinct is a good guide; it is vanishingly rare for something that feels right to be completely wrong, and doctors and nurses will usually be able to warn about these things. Cleanliness is something else that occupies the attention of new parents, but in fact, children can safely get dirty. The important thing to remember is that parenting has been done successfully for millions of years.