Things I Wish Everyone Knew Before Breastfeeding

By: Dr. Lindsey Moore

My son, Henry, is now 3 years old. For the first 2 years of his life, he was breastfed. Initially, it was incredibly hard with concerns of poor weight gain, struggles with a tongue tie and the pain of a disorganized latch. However, with the help of friends, our monthly breastfeeding support group, my amazing husband, and an angel of an IBCLC (International Board Certified Lactation Consultant), we finally caught our stride and were successful. Warming my heart, Henry is now able to tell people that he used to have “Mama’s Milk”. Here are some things that I learned on my breastfeeding journey that I wish I had known at the outset!

It can be hard.
While some new moms sail through breastfeeding and make it look easy, many of us struggle – with supply, with pain, with feelings of guilt and isolation. Having a village of people who support you and can talk you through the struggles can make a world of difference.(For more on the importance of a village, please see this attached article!)
If the latch “looks perfect”, but it still hurts, then it is definitely not perfect. 
A little pain at the beginning of the latch and at the beginning of the breastfeeding journey can be normal, but your nipples should not be painful for the duration of feeds, painful after, or raw or misshapen once a feed is complete. If you are experiencing anything beyond mild pain or discomfort at the beginning of the latch, it is time to seek some assistance.
Breastfeeding looks different for everyone, and this is entirely fine.
Some people are able to exclusively breastfeed their baby directly from their breasts, some people exclusively pump breast milk for their babies, some people have to supplement with formula, and some people exclusively use formula for a variety of reasons. All of these journeys look different, but are driven by the desire to do what is best for the baby and the mother. As your pediatrician, we are here to support you no matter what your journey looks like. As parents, we should all support one another and recognize that parenting is hard and that having compassion for one another is the best way to make it through.
Feed the baby, not the freezer.
Some moms are oversuppliers (meaning they make more milk than their baby consumes) and accordingly, have very well-stocked freezers. As a new mom returning to work, it can be tempting to try to have a freezer full of pumped breast milk stock-piled. However, for most of us, we are exact-producers and can only stockpile a little milk away at a time. For me personally, it was comforting to remember that I only needed enough pumped milk for the next day when I was away from my son.
Feed the baby, not the clock.
It can be very tempting to try to get a baby “on a schedule”. However, babies cannot yet tell time and can become hungry at any point during the day. If your baby is showing hunger cues by lip-smacking, turning towards your breast, or trying to pull at your shirt, it is time to feed them, no matter when their last feed was.
Breastfed babies often like to eat frequently in the middle of the night. 
Breast milk is digested differently than formula, and breast milk production, thanks to the release of a hormone called Prolactin, peaks in the early morning hours. Thanks to these factors, as well as a few others, most breastfed babies awaken frequently to eat overnight. This is normal, but setting a good bedtime routine and having good sleep hygiene habits early on can help combat the parental fatigue that this can lead to.
Breastfeeding can sometimes be isolating and feel lonely.
Many new moms feel comfortable nursing in public and on the go, but many of us are also scared about what people may think about the way we are choosing to feed our babies or about how much skin is exposed when we are feeding babies. Many moms and babies have favorite positions, including ones such as the side-lying or laid back position, which can be difficult to replicate in public places or have a favorite breastfeeding pillow that can seem ungainly to use when out of the house. Surrounding yourself with a village that supports you and will help you work through these situations can be invaluable. Using a resource such as a breastfeeding support group where the feeding of infants is talked about in open and honest manners and where breastfeeding is normalized can be an amazing source of support.
There will be highs.
The first time you have a successful latch, the first time you use your pump successfully, the first time you pump in the car, the first smile you get when a nursing session is complete, the amazing feeling of having a baby fall asleep in your arms contentedly – these are the things that will warm your heart and soul.
There will be lows. 
Low milk supply, breast infections, clogged ducts, pressure from family or friends, pressure from yourself. There will be times when breastfeeding feels less than ideal – when you have these moments, and they will come, reach out for support.
It’s okay to stop.
Any amount of breast milk you are able to provide to your baby is worth celebrating. Focus on the positives of your breastfeeding journey, no matter how short or long, and don’t let anyone, especially yourself, make you feel guilty about what your journey looks like.
It’s okay to keep going.
Nursing a toddler is something that our culture is still learning to accept. However, increasing evidence shows benefits of prolonged nursing – in fact, the World Health Organization, recommends mothers worldwide to exclusively breastfeed infants for their first 6 months of life and to continue breastfeeding, along with nutritious, complementary foods up to the age of 2 years or beyond, if mutually desired. You should never feel embarrassed or unnatural by continuing to breastfeed your baby. You know your body and baby best, and the decision to breastfeed, and for how long, is yours to make.
At Cedar Park Pediatric Family and Medicine, we are deeply committed to helping you achieve your feeding goals. All of our pediatricians strive to stay up to date on the latest and greatest in breastfeeding medicine, we offer complimentary initial LATCH assessments (an evidence-based approach to help trouble-shoot breastfeeding difficulties) done by an area IBCLC (International Board Certified Lactation Consultant) to all nursing families every Friday afternoon by appointment at our Ronald Reagan location, and we have a monthly breastfeeding support group where we discuss the highs and lows of nursing journeys and answer any and all questions. Happy National Breastfeeding Month to each and every one of you!

Dr. Shah’s Taco Soup

Recipe
2 cups of elbow macaroni
1 can of Tomato Sauce
1 Green Bell Peppers
1 medium Onion chopped
16 ounces or 1 can of Black Beans
15-16 ounces or 1 can of Corn
1 Packet of Taco Seasoning or create your own Taco Seasoning:

2 Tbsp. chili powder
2 tsp. ground cumin
1 ½ tsp. garlic powder
½ tsp. onion powder
1 tsp. dried oregano
¼ tsp. paprika
1 tsp. sea salt
¼–½ tsp. cayenne pepper (optional)

Directions
– Cook black beans until soft
– Boil pasta until cooked al dente
– Put in a pot
– Add tomato sauce and water for the quantity desired and to get a soupy texture
– Sautee green bell peppers, onions and corn
– Add to soup
– Add taco seasoning, salt and a little sugar to taste
– Cook for 20 minutes
– Serve with chips on top and shredded cheese

Preventing Mosquito Bites

Outdoor picnics can be so much fun until the tables turn and we become the meal! Mosquitos are not only annoying but can also carry disease. In order to protect yourself and your family, we recommend the following:

  • Wear protective clothing including long sleeve shirts, pants, socks and hats to create a physical barrier from mosquitoes.
  • Use mosquito repelling clothing treated with permethrin which lasts through 6 washes.
  • Avoid being outside during sunrise and sunset when the insects are most active.

The current AAP and CDC recommendation for children older than 2 months of age is to use 10% to 30% DEET. DEET should not be used on children younger than 2 months of age.

When choosing the concentration of DEET, keep in mind that the effectiveness is similar for 10% DEET and 30% DEET but the duration of effect varies. Ten percent DEET provides protection for about 2 hours, and 30% protects for about 5 hours.

Picaridin is another option for insect repellent. Concentration of 7% Picardin provides protection for about 1-2 hours and 20% Picaridin provides 4-5 hours of protection. Picaridin is a synthetic compound developed from a plant extract from the genus Piper, the same genus that produces table pepper. Picaridin has been available since 1998 in Europe but was approved for sale in the U.S.A. only in 2005.

AS with DEET, the EPA has concluded that the normal use of picaridin does not present a health concern. Picaridin is sometimes preferred over DEET because it is odorless, non-greasy, and does not dissolve plastics or other synthetics. With any type of insect repellent, remember not to apply to a child’s hands, eyes, mouth, or cut or irritated skin.

And finally, children should wash off repellents when they return indoors.
Recommended brands of insect repellent:
Repellents that include picaridin include Cutter Advanced, Sawyer Premium and Repel Smart Spray.

Water Safety

by Dr. Jennifer Cardwell
Summer is here and we are all ready to enjoy our pools and local water parks!  Here are some tips to keep your children safe.
Drowning is the leading cause of injury-related death in children.  Toddlers and male adolescents are at the highest risk for drowning.  Most victims of nonfatal drowning recover fully with no neurologic deficits, but severe long-term neurologic deficits are seen with extended submersion (greater than six minutes), prolonged resuscitation efforts, and lack of early CPR.
Most infants drown in bathtubs and buckets, whereas the majority of preschool-aged children drown in swimming pools.  Alcohol is the leading risk factor for fatal drowning in adolescents, contriuting to 30-70% of recreational water deaths among US adolescents and adults.
Prevention of Drowning Recommendations:
  1.  Parents and caregivers should never (not even for a moment!) leave young children alone while in or near bathtubs, pools, hot tub, or wading pools or anywhere there is standing water.
  2. Be aware of drowning risks associated with hazards in the home.
    1. Infant bath seasts can tip over or they can slip out of them.  Infants can drown in even a few inches of water, so an adult should always be with them.
    2. Empty containers of water from pails and buckets immediately after use.
    3. Either place a lock on the toilet or stay with young children and don’t leave them alone in the bathroom.
    4. Prevent unsupervised access to the bathroom, swimming pool or open water.
  3. If you have a pool, it should be surrounding by a fence with a self-latching gate.
  4. Learn CPR!
  5. Swimming should be the first sport your child learns.  The AAP recommends swim lessons as a layer of protection against drowning that, for many children, can began as young as one year of age.
  6. Wear life vests when you are on a watercraft.
  7. Jumping or diving into water can results in devastating spinal injury.  The first entry into any body of water should be feet first.
Water Park Safety:
  1.  Know the rules of the water parks.  Follow ride directions and especially the size and weight restrictions.  Smaller riders can be thrown from the ride.
  2. Know your swimmer and how confident they are in the water.  Wave pools carry the biggest drowning risk because they can be chaotic with a large number of people.  This can make it difficult to spot a swimmer in trouble.  Close parental supervision is so important!
  3. Know what’s in the water.  The Centers for Disease Control and Prevention state that most people have about 0.14 grams of feces on their bottoms that can rinse off and contaminate the water.  They reported that in one year, 58% of public pools tested positive for EColi, which is a marker for fecal contamination.  Yuck!  Tell your kiddo never to drink pool water and take them to the bathroom once an hour and check swim diapers every 30-60 minutes.  If your child has diarrhea, do not go to the pool.
  4. Know who’s watching.  Some water parks have lifeguards, some don’t.  Make sure you assign a responsible adult who knows how to swim to watch your children.
  5. You might want to wear water shoes to help prevent slips and falls.
  6. Consider having your child wear a life jacket, especially if they are not a strong swimmer.
The American Academy of Pediatrics Website (http://www.aap.org) contains educational material for parents from the Injury Prevention Program about home water hazards for young children, life jackets, pool and water safety and has links to other water-safety information.
Have a great summer everyone!

Sun Safety

As we enjoy more bright and sunny days, the risk of sunburns and skin damage rises for everyone.  Take these steps now and your skin will thank you in the long-run.

Ultraviolet (UV) rays from the sun or indoor tanning damage the skin. Even a tan is a response to injury, not an indication of good health, as some may perceive. There are many risk factors that can contribute to sunburns, and skin cancer including: family history of skin cancer, sun exposure sun through work and play, history of sunburns (especially early in life), history of indoor tanning, freckles, skin reddens easily or becomes painful in the sun, if you have blue or green eyes, blonde or red hair, and certain types of moles and/or a large number of specific types of moles.

Now that you know your risk factors for UV damage the next step is reducing your risk.

Protection from UV rays is important all year round, not just during the summer months. UV rays from the sun can reach the Earth on a cloudy, hazy day as well as bright and sunny days. UV rays also reflect off of surfaces such as water, cement, sand, and snow. The hours between 10:00am and 4:00pm during late Spring and Summer are the most hazardous for UV exposure outdoors in Central Texas.

The Center for Disease Control and Prevention (CDC, 2014) recommends easy options for protection from UV radiation for adults and children.

  • Stay in the shade during peak hours (10:00am to 4:00pm) Plan indoor activities with children during this time unless you can be under an umbrella, seek shade under a tree, or under a pop up tent. An infant’s best defense is sun avoidance.
  • Wear clothing that covers your arms and legs. Long sleeve shirts and pants may not always seem practical in the Texas summer, but a t-shirt, long shorts, a beach cover-up are good choices too. It is wise to double up on protection by applying sunscreen in the shade when possible.
  • Wear a hat that has a brim to protect your eyes, head, ears, and neck. Baseball caps do not protect ears and neck, so you must apply sunscreen in those exposed areas.
  • Wear sunglasses that wrap around and offer both UVA and UVB protection.
  • Use Sunscreen with sun protective factor (SPF) 15 or higher and UVA /UVB protection. Plan ahead, keep a spare bottle of sunscreen in the car, in your purse, or a child’s backpack. For best protection apply sunscreen generously 30 minutes prior before going outdoors. Don’t forget to protect your ears, nose, lips, and the top of your feet! Always follow the directions on the package. All products do not have the same ingredients. If you or your child’s skin reacts to a product, call your primary care provider and avoid that product.
  • Reapply sunscreen.   Especially if outdoors swimming or exercising. This applies to both water resistant and waterproof products as well.
  • Avoid indoor tanning beds and booths.

Try combining sunscreen with other options such as hats, sunglasses, and shade options to prevent UV damage!

Heat Illnesses

by Sarah Givner, MD, MPH

The summer sun in all its glory gives rise to hot, hot weather and consequently, heat-related illnesses. Heat illnesses are those conditions brought about by prolonged exposure to heat and humidity without adequate hydration to cool the body down. They include heat cramps, heat exhaustion and heat stroke. Children and adolescents adjust to environmental changes more slowly than do adults and tend to bear the brunt of these illnesses.

Heat Cramps

Heat cramps are the mildest form of the heat-related illnesses. They are painful spasms and cramps that occur after exercise in high heat conditions. Skin is typically flushed and moist when they occur.

If your child is suffering from heat cramps, stop activity participation, move to a cool, shaded place and rest. Remove excess clothing, fan skin and place cool compresses on the body. Drink chilled sports drinks containing a mixture of salt and sugar (Pedialyte, Gatorade, Powerade) and stretch out the affected muscles gently and slowly.

Heat Exhaustion

Heat exhaustion is more severe than heat cramps and results when the body is unable to cool itself properly. It results from water and salt loss in conditions of extreme heatand excess sweating without adequate fluid and electrolyte re-hydration.

Symptoms include muscle cramps, pale (as opposed to flushed) and moist skin, fever over 100.4 F, nausea, vomiting, diarrhea, headache, fatigue, weakness, anxiety and feeling faint.

If your child is suffering from heat exhaustion, again, stop activity participation, move to a cool, shaded place and rest. Remove excess clothing, fan skin and place cool compresses on the body. Drink chilled sports drinks containing a mixture of salt and sugar. If this is insufficient, or your child is unable to keep fluids down, go to the emergency room immediately. IV fluids may be required.

Heat Stroke

Heat stroke is the most severe of the heat illnesses and occurs when the body’s thermoregulation system is overwhelmed by the extreme heat. It is a life-threatening medical emergency and requires immediate attention.

Symptoms include warm, pale and dry (as opposed to moist) skin, high fever (>104 F), rapid heart rate, loss of appetite, nausea, vomiting, headache, fatigue, confusion, agitation, lethargy, stupor and seizures.

If you believe your child is suffering from heat stroke, call 911 or your local emergency medical services IMMEDIATELY. In the interim, remove excess clothing, DRENCH skin with cool water and fan skin. Place ice bags under armpits and in the groin. Offer chilled fluids, if your child is alert and able to drink.

Ways to Avoid Heat Illnesses (or as they say, an ounce of prevention is worth a pound of cure)

  • Drink plenty of fluids during both strenuous and non-strenuous (such as sunbathing!) outdoor activities on hot days. Drink water and sports drinks (again with a mix of salts and sugars). Avoid alcoholic and caffeinated beverages (tea, coffee, soda) as they can be dehydrating.
  • Dress in light-colored, lightweight and loose-fitting clothes on hot, humid days
  • Schedule vigorous outdoor activities outside peak sun hours – go in the morning, late afternoon or evening
  • Take shaded (and frequent!) rest brakes
  • Wear sunscreen (at least SPF 15), a hat and sunglasses
  • Have kids mist themselves, go swimming, or play in splash pads during the day

Lastly, enjoy the heat! And be safe!

Sports Nutrition for Busy Families and Lifestyles

From the American Academy of Pediatrics:

Busy nights juggling sports, dance class, homework, and work or school events can create the perfect storm for making some regrettable food choices.

We know 1 in 3 American children and teens eat fast food daily, according to a report from the Centers for Disease Control and Prevention’s National Center for Health Statistics. As parents and role models, you are responsible for stopping the fast food cycle and getting creative with quick dinner options.

The American Academy of Pediatrics (AAP) offers the following tips to help busy families eat and drink better before, during, and after game time.

What Busy Families Should Eat and When
Preparing healthy food ahead of time makes you a proactive parent instead of a reactive one. Plus, it saves money in the long run—who could argue with that!

Go for small frequent meals and snacks. Try to spread calories throughout the day and avoid large meals in close proximity to exercise. If your entire evening is spent on a ball field or on the go, loading food up and taking it with you is a practical option. No matter how long you will be out for, always have a piece of fruit or a healthy protein or nut bar with you. Eating every 3 hours will help to keep your child’s blood sugar steady and also decrease overeating at meal times.

Healthy snacks in the car are ok! While the single serving snacks from the store are handy, try creating your own pre-packaged snacks that feature the foods your kids like most such as a half sandwich on whole grain bread or a bag of sliced fruit. Don’t forget about apples, oranges, bananas, grapes, and other fruit that also comes pre-packaged in a single serving size. While fruits can be high in sugar, they also offer other nutritional components that make them a win for busy child athletes. Other good snack ideas include dried fruit and nuts, hard boiled eggs, and unsweetened applesauce. See Choosing Healthy Snacks for Kids for more ideas.

Have a fueling and hydration strategy. Young children participating in light activities lasting 1 hour or less may not need to snack before and after exercise. Rather, help these children focus on good nutrition every day. Older, more active kids may benefit from some of the fueling and hydration strategies listed below.

Before exercise: Around 3-4 hours before exercise, an athlete should eat mostly carbohydrates with a moderate amount of protein. This small meal should be low in fiber and fat, as these can cause an upset stomach. A 70-pound child should drink around 8-10 ounces of water around 2-3 hours prior to exercise while a teenager or adult should have 12-20 ounces of water. Drinking an additional 6-8 ounces directly before exercise will be helpful.

During exercise: Hydrating is important during exercise. Encourage your child to have a small amount of fluid (3-4 ounces) every 15 minutes. For activities less than an hour, water is sufficient. For activities lasting longer than 1-2 hours, or in very hot environments, sports drinks can help replenish carbohydrates and electrolytes. Sports drinks are very different from energy drinks which have caffeine and excess sugar. Energy drinks are not recommended. See the AAP policy statement, Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?, for more information.

After exercise: Within 30-60 minutes after exercise, it’s important to replenish any fluids lost and to refuel with an appropriate source of energy. Focusing on a snack that is rich in carbohydrates and proteins will help rebuild and restore muscles. Chocolate milk is an excellent example of a recovery drink.

Find energy balance. Athletes need more energy during times when they are more active than normal (e.g., try-outs, tournaments, multiple or overlapping sports). Encourage and plan specifically for extra food and fueling during these periods. Snacks that combine a carb like a cracker and some protein like peanut butter are the most energy efficient. Make sure your child has access to these kinds of power-packed snack options.

How to Still Eat as a Family
The busy schedules of our families’ means that many nights we are not all home at the same time to have a nice, sit-down dinner. Dump the guilt. Family meals may not happen every day—that’s ok! Make the most of your family meals when they do occur—and it doesn’t have to be dinner. Why not make your family meal breakfast? It is more likely that everyone will be home at the same time early in the morning which means it is easier to get everyone around the table for some healthy food and family bonding.

Eating Out the Smart Way
It’s important for everyone in the family to make smart choices when you sit down at the restaurant or step up to the fast-food counter. Look for whole grains, fruits and vegetables, and words like steamed, baked, poached, roasted, broiled or grilled. Do your best to avoid foods with the words fried, au gratin, crispy, escalloped, pan-fried, sautéed or stuffed—good indications that the foods are high in fat and calories. Watch portions and serving sizes. See Choose This, Not That: Healthy & Unhealthy Choices at Fast Food for more tips and ideas.

The AAP policy statement, Snacks, Sweetened Beverages, Added Sugars, and Schools, also recommends keeping beverages simple. Stick with milk (including non-dairy milk) and water as your child’s main beverages.

Bottom-line: Make sure whatever you would choose at that restaurant is something that you would prepare at home for your family—if, of course, you could find the time!​

Remember…
There is no magical food or supplement that can transform an av­erage athlete into a superstar. No matter what the age of your child, the most effective way to improve sports performance is to pay close attention to the basics: fluids, calories, training, conditioning, and rest.

A well-balanced diet provides a mix of carbohydrates, proteins, and fats with essential micronutrients—calcium, vitamin D, B vitamins, iron, zinc, magnesium, and antioxidants like vitamin C. These are all important for bone health and immune function. Eating either too many or not enough calories can contribute to fatigue, injuries, illness, poor performance, and prolonged recovery from sports injuries.

Resource:

https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Sports-Nutrition-for-Busy-Families-and-Busy-Lifestyles.aspx

Additional Resources: