Posts Tagged 'infants'

Is using a car seat covering safe?

woman carrying infant carrier with canopy

image credit: Amazon

As the winter months approach, children will soon be sledding down snow hills, building snowmen, and really little ones will be traveling in cold weather in their car seats. As a Certified Child Passenger Safety Technician (CPST), I can assure you that there are many steps that a parent can take to ensure their children stay warm and safe this upcoming cold season.

One recommendation is to avoid heavy, bulky coats on children harnessed in their car seats; there are many articles and infographics that discuss why this is important. However, there is a hidden danger that many parents are unaware of: using car seat covers or aftermarket canopies that cover your infant’s head for a long period of time while installed in his or her car seat.

Before diving into the research and reasons why this is potentially dangerous, let’s rewind for a minute. The practical reason for a covering children is to protect them from wind, rain and snow while you transport them in and out of the vehicle. As the parent of a winter-born baby, I can tell you that I covered my child with a blanket in his infant carrier many times after strapping him in the car during our Michigan winters. My job as a CPST is to provide you with information so you can make an educated decision about keeping your child safe.

There is an increasing amount of research that discusses how car seat canopies and other coverings are potentially dangerous. A specific concern is the risk of CO2 rebreathing. During the breathing process, your body inhales oxygen and exhales carbon dioxide (CO2), maintaining a balance between these two gases. However, rebreathing CO2 can have harmful effects on the body. When an infant has soft, fluffy or loose fabric around his face, the carbon dioxide can build up around the baby’s head. Rather than breathing fresh oxygen, the baby is rebreathing the expelled CO2 (Blair, Mitchell, Heckstall-Smith and Fleming, 2008). Many babies may cry, turn their head or attempt to get out of this unsafe situation, however infants who are at-risk (i.e., preterm, respiratory concerns) may have extra difficulty notifying a caregiver they are struggling (First Candle – Rebreathing Carbon Dioxide and Suffocation as they related to SIDS, 2009).

In April 2014, Baby Carrier Industry Alliance (BCIA) issued an executive statement regarding infant carrying that is applicable to car seat safety and any situation to where a child’s face might become covered and breathing could be compromised. It stated, “[C]overing a baby’s face makes it impossible to monitor a child’s breathing, in addition to putting the baby at risk for suffocation, or CO2 rebreathing.”

This does not mean that you have to expose your infant to cold weather and crippling winds when taking baby to the car in the winter. The key is to protect your child with a temporary cover. Use a receiving blanket to protect your child from the elements, but be sure to remove it once baby is secured in the vehicle. The American Academy of Pediatrics (2016) recommends against over-bundling and covering the face and head.

My recommendations

  • Avoid car seat canopies that strap onto the infant carrier’s handle. Parents often pull back the cover and leave the strap for convenience, but this poses a suffocation risk if the fabric accidentally falls down over the infant’s face.
  • Avoid car seat covers that zip close to a child’s face.
  • Always be aware of your infant’s airways and the car seat environment. We recommend using the “visible and kissable” phrase, which means keep your baby’s face uncovered and able to receive kisses at any given moment. This ensures that you can easily see and assess your child’s breathing while in the car seat.

Together we can ensure all babies stay warm and safe while traveling to and from the vehicle. As we know all too well, the sledding and snowman season will be here before we know it.

– Stephanie Babcock, CPST, is an IFS coordinator with the Parenting Program. She’s also the proud mommy of two boys.

A simple guide to torticollis

baby with torticollis

image credit: spinewave.co.nz

You’ve just given birth to a beautiful child. You’re so caught up in joy and awe that you can’t help but take tons of pictures of the little one. But as you scroll through your pictures you may notice a common trend between 1 and 12 months old: your baby is always looking in one direction.

No, your baby isn’t giving the camera his good side. Your baby may have torticollis.

What is torticollis?

Don’t panic. Torticollis is common and a result of muscle tightness and weakness on one side of the neck. Any diagnosis sounds scary, but caught early enough, torticollis is an easy fix. As a physical therapist, I frequently treat patients with this diagnosis. The key is proactive treatment.

Torticollis occurs when the shoulder muscle, sternocleidomastoid, becomes tight. This can happen due to your baby’s position in the womb or from sleeping position. Twins and large babies are more likely to have torticollis from the reduced womb space. Also, babies’ heads are heavy and tend to rotate to one side when they sleep on their backs. The sternocleidomastoid’s action is lateral flexion (tilting) to one side and rotation (turning) to the other side.

So what can you do?

Start with these two stretches

  • Rotate your child’s head in the opposite direction your child usually looks. Do this hold for 15 to 20 seconds with light pressure every time you change your baby’s diaper (which let’s be real, is 10+ times per day). This improves range of motion and reminds the baby that there is another half of the world to see.
  • The other is the football carry. Place the baby facing out toward the world and turned on his side. Position so that the side of the neck the baby typically tilts is facing down. Put one hand on the side of their head and the other between their legs for support. Use your hand on the side of their head to lightly stretch the baby’s neck. This addresses the tilt component to the muscle tightness.

If you can’t visualize these stretches, I recommend an appointment with a physical therapist. You will see the stretches in person and applied to the specific direction of your child’s rotation and lateral flexion, as well as to learn other exercises for neck strengthening.

Lifestyle tips

  • Feed your child to the direction he doesn’t like to look in order to facilitate active rotation.
  • Adjust crib position so that your child has to turn his head to see what’s happening outside.
  • At playtime, put toys on the opposite side of baby’s head.
  • Have family members stand on the side your child looks to least often when they interact with them.
  • Encourage increased tummy time if your baby has a flat spot on the back of their head so he isn’t falling into that pattern of rotation when on his back.
  • Every adjustment helps!

If torticollis is left untreated, it can lead to a child favoring one arm during sitting and reaching activities, having one-sided weakness, and having an altered crawling or walking pattern. Although it’s an easily treated and often mild condition, ignoring it is the worst thing you can do. Allow your child to see the world from the proper angle and prevent future complications; treat torticollis early!

– Amanda Kirk, DPT, is a physical therapist with Beaumont Macomb Pediatric Rehabilitation.

Childproofing your home

Toddler opening a cabinet

Unaltered image. Jed De La Cruz, Flickr. CC license.

As a parent, it is our job to keep our children safe. So how do you know when to start childproofing and where to start? This can be an overwhelming process for many parents. Have you ever just stood in the safety section at your local baby store? There is an entire wall chock full of products with a variety of door handle covers, outlet covers, drawer and cabinet locks, and other items that you never even knew existed. Here is some advice on how to make sure your home is safe for your baby.

  • Get down on the floor at baby’s level. The world looks a whole lot different from there. Pay attention to what baby can see and reach.
  • When should I start? The sooner the better, however once baby is able to start rolling (typically 4 to 6 months), you want to make sure you’ve started your childproofing.
  • Know your baby. Some babies are much more mobile and curious than others. Some babies need to climb and get into everything. For these children, you may need to be much more thorough.
  • Keep all medications, chemicals, soaps, and detergents away from baby. Make sure these items are in locked cupboards or above baby’s reach in the kitchen and bathrooms.
  • All items that fit within a toilet paper tube pose a choking hazard to baby. Anything that fits inside should be kept away from baby, especially small items like coins.
  • Make sure you have the number for poison control in your cell phone and a central location in your home (800) 222-1222. You can also download an app to your phone.
  • Register for the Consumer Product Safety Recall list to be alerted for recalled items.

Recommended safety items

  1. Outlet covers
    1. Babies are very curious and the outlets seem to attract little fingers.
    2. If you don’t like the outlet covers, you can swap out all of your outlets with ones that have covers built into them.
    3. When traveling to a relative or friend’s home, bring an extra pack of outlet covers to keep your baby safe.
  2. Gates
    • You must use gates mounted with hardware at the top and bottom of stairs.
    • Pressure-mounted gates can be used in hallways and doorways.
    • Some gates have extension pieces to make sure they fit your space properly.
    • If you need to mount your gate to the banister, you can purchase a kit that lets you install the gate without drilling holes into your banister.
  3. Furniture straps
    • All furniture (including dressers and book cases) should be strapped to wall in rooms that baby will be in. These help to prevent furniture from falling on top of baby.
  4. Door locks/handles
    • Make sure you have the correct type of door lock for the correct door:
      • Bi-fold door locks
      • Sliding door locks
      • Universal locks
      • Appliance locks (e.g., refrigerator, drawer under oven/washing machine, dishwasher, etc.)
      • Door latches are very inexpensive and perfect for basement doors.
      • Toilet locks keep children from “playing” in toilet.
  1. Drawer and cabinet locks
    • Plastic locks that screw into the inside of cabinets or drawers.
    • Magnetic locks are less visible, but more expensive).
  2. Cord protectors
    • Mini blind cord protectors
    • Power strip protectors
  3. Thermometer for bathtime
    • Ensures water is not too hot or cold for baby

– Amy Weiss, MPT  Supervisor of Outpatient Physical Therapy at Beaumont Physical Therapy Berkley

 

How can I tell if my child is really talking?

Two baby girls "talking" on a bench

Unaltered image. Dean Wissing, Flickr. CC license.

Communication begins at birth, but talking is harder to define.

A newborn initially communicates primarily by crying, then soon after, eye contact, smiling, laughing and vocal play emerge. A child of 6 months is generally babbling, using sounds in repetitive sequences (e.g., “bababa,” “dadada”), including intonation, to communicate mood. Before any real words emerge, babies should be making a lot of sounds, both independently and in imitation.

Children are expected to use their first real word around the age of 1 year, with the most common words being “dada” or “mama.” (Sorry Mom, the /d/ sound is easier than /m/, so many babies say “dada” first!) Sometimes the first word is “hi.” Sometimes it’s “no.”

So how can you tell if something your baby says is really a word?

Since babbling can sound similar to real words, it might be difficult to know whether a vocalization can be considered a true word. It really comes down to consistency and intent. A word, no matter how clear, is a true word if it is used consistently for the same specific purpose.

For example, a child who always says “mama” when looking for his mother and interacting with her is likely to be using it as a real word.

However, a child who says “mama” all the time, while interacting with his mother, but also while playing with his toys, looking out the window, sharing a snack with dad, and waking up from a nap might not be using it as a real word. The word isn’t being used specifically for his mother.

Another potentially confusing element of learning to speak is jargon. Jargon is characterized by long strings of unintelligible sounds that include adult-like stress and intonation. Quite simply, it sounds like your child is speaking a language you don’t understand. Is this talking? Kind of. While jargon is not made up of real words, it is part of the process of children learning to converse like adults. Further, real words may be mixed in with long strings of jargon. It is a good idea to respond to jargon, and the intermittent real words within it, as if your child is talking with you. Jargon should peak around 18 months, and then decline as children’s expressive vocabulary and utterance length increase. You can read more about expressive language skills here.

If you have questions about your child’s language development, talk to your pediatrician, or contact a speech-language pathologist.

– Kellie Bouren, M.A., CCC-SLP, Speech and Language Pathologist, Children’s Speech Pathology Department, Beaumont Children’s

Helmeting from a physical therapist’s perspective

Parenting holding a baby wearing a therapeutic helmet

Cropped image. Marie-Claire Camp, Flickr. CC License.

The Back to Sleep initiative (always placing babies on their backs when laying them down to sleep) started with the goal of educating parents, caregivers and health care providers about ways to reduce the risk of SIDS. Thankfully, this program, per the American Association of Pediatrics, decreased the number of deaths associated with SIDS by 50 percent since 1994. This being said, with the frequency that newborns sleep and the significant amount of time on their backs, there now appears to be an increased number of children who have plagiocephaly (abnormal head shape). Plagiocephaly is most often seen as a flat spot on the back or one side of the head generally caused by remaining in a specific position for too long.

Tummy Time

If you have concerns regarding your baby and an increasing flat spot to his head, the most important step to start with is to promote tummy time. Positioning your child on his tummy while you are with him for periods of play throughout your day will encourage time spent off the back of his head. It will also increase important shoulder girdle, neck, and back muscles. Continue to encourage tummy time even if your child fusses; it’s a difficult position at first, but will get easier as baby practices.

You can also spend time playing in a supported sitting position or increase carrying time as opposed to keeping your baby in his car seat to sleep or nap when not traveling in your car. Essentially, work to decrease the excessive amount of time your child spends on his back throughout the day. Although some equipment or supported seating devices on the market keep the baby off of the back of his head, tummy time is still the best in promoting overall motor development.

Torticollis

Some babies form a tendency to turn their heads in only one direction. This can sometimes lead to a tight neck muscle called torticollis. As a parent, be on the lookout for this limitation in neck movement, and encourage your child to turn his head in both directions, especially in the first six weeks. This time frame is recommended as the child hasn’t yet developed good head control and can comfortably be moved in various positions.

Therapeutic Helmets

If tummy time isn’t enough to correct a moderate plagiocephaly, a therapist or physician may recommend a therapeutic molding helmet to help correct the flatness. A special scan can be performed at the orthotist’s office (where the helmet is made) to assess your child to determine if the flatness is severe enough to warrant a helmet.

Typically a helmet isn’t recommended prior to 3 – 4 months of age, as little ones are just beginning to build the neck strength necessary to hold up their own heads, let alone the weight of a helmet (though the helmets are incredibly lightweight). An optimal age is generally 4 – 8 months; however, a therapist or physician can recommend a helmet up to a year old. After this point in time, your baby’s soft spot or fontanels are closing up and minimal progress will be made with a molding helmet.

If you have questions regarding your child’s flat spot, or believe a molding helmet will be of benefit to your child, contact your physician to obtain a prescription for a therapeutic molding helmet consult.

– Kristen Bielecki, MPT and Holly Timmreck, PT, DPT are with Pediatric Rehabilitation at Beaumont Children’s Hospital

Special Touches Add to Patient, Family Experience at Center for Children’s Surgery

Karen Justin just created a growth chart for the kids. Most of them measure how tall they are by the animals and tree branches, not the numbers.

Karen Justin just created a growth chart for the kids. Most of them measure how tall they are by the animals and tree branches, not the numbers.

Talking to Karen Justin about why she loves her job, you’d swear that she gets teary eyes. A patient and family liaison in the Ghesquiere Center for Children’s Surgery at Beaumont Hospital, Royal Oak, she treats each child as someone special.

“I love children,” says Karen. “To make a child smile is the best part of my job. Just seeing their face light up when we can do something special for them that takes their mind off their procedure is priceless.”

Though she’s been a member of the Beaumont family for 20 years, she’s a newbie in the surgery center. “I’ve been here since January,” says Karen. “When I saw this job open up, I knew it was my dream job.”

For the last eight months, Karen has worked on making the surgery center experience as pleasant as possible for the kids and their parents. She created a play area with a zoo theme using images of animals that she laminated and placed around the walls. She also worked with Childlife Services to have zoo and animal-themed toys available.

There’s now a coloring table with an assortment of crayons and pages to decorate. “I make it fun for them,” she says. “I hang up the pictures the kids color around the front desk and that makes them so proud. When they come out of surgery, some of the kids actually look to make sure their picture is still hanging up.”

But perhaps one of the most meaningful things she does for the kids is something that she does on her own time. Several years ago, Comfort Bears for Kids started dropping off stuffed bears for the children having surgery in the Ghesquiere Center. The donor was dropping off the bears himself, but was unable to keep up the schedule.

Hearing about this, Karen and her husband Tom took up the task. “We don’t mind doing it, and we’ll keep doing it until the donor stops,” she says. “To see those kids smile when they get those bears just makes my day. We see some kids frequently here and one time there was a little boy yelling down the hall, ‘I gotta go get my bear!’”

As the seasons and holidays change, Karen decorates the waiting room, and hands out bears accordingly. For St. Patrick’s Day, everyone gets a green bear. On Valentine’s Day, the bears are red. For her, every gesture has meaning. Even though the Ghesquiere Center is for children’s surgery, some adult surgeries take place there, too. Karen can see patients who are preemies and older adults. But she doesn’t care how old they are. “We’re here to make people happy,” she says. “That’s why we’re here – for service.”

You’ll Never Be Prepared To Become A Parent

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No matter how “prepared” I thought I was to be a parent, I wasn’t. I became a mom at 35, so I watched friends and family have kids. Before my kids came into my life, I would say to myself, “When I’m a parent, I’m going to do [fill in the blank].”

Oh, honey. No, you’re not.

Being a parent is the single hardest thing I’ll do in my life. The fact that my kids are twins adds a whole new dimension. But there are a few things I wish I had known or thoroughly understood before holding my two little bundles of joy.

There will come a time when bodily fluids won’t gross you out. My little girl had reflux, so being covered in spit up regularly was par for the course. Remember that show, “You Can’t Do That on Television”? The one where everyone got slimed? Yeah, that was our house. Also, we have a boy. Catching pee so it didn’t hit the TV remote or the leather couch became the norm as well. Note: Spit up and pee aren’t even the grossest things that can happen in a day.

You will mourn your old life and that’s okay. It wasn’t easy for me to adjust to the life of a mom with twins. I thought I’d be able to do all the things I usually do, just with two babies in tow. That doesn’t work out at the beginning; or right now, actually. With feeding schedules and naps, the winter cold and sicknesses, my personal life changed drastically. But even though it’s not the same, it’s better now. It took me a while to get there, but here I am. Late, as moms of twins tend to be.

You do not know the meaning of the phrase, “sleep deprivation.” You don’t. Just accept that. At first my kids fed every two hours. They took 30 minutes to eat and 30 minutes to sit up and digest. An hour later we were back at it. We still get woken up at night, but nothing a re-tucking of the covers won’t fix. I am assured that one day, I will wake up AFTER the sun has risen. One day.

Hot food is a luxury. I think I’m just used to eating lukewarm or cold food now. By the time dinner is ready and you get everyone in their seats with bibs and cups, cut up their food, serve your own, get whatever they dropped on the floor, sit down and get back up to get something else, your food is cold. When you get the chance to eat hot food, take it.

You will be surprised that you are capable of feeling so intensely. It might not come right away, but soon enough, you’ll be so in love with your kids that you can’t imagine anything you wouldn’t do for them—including not flinching when someone hands you a half-chewed olive at the dinner table during your mother-in-law’s birthday party.

—Rebecca Calappi, Publications Coordinator at Beaumont Health System and adoptive parent of multiples


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