Friday, February 26, 2016

The Back to work transition

Please see the updated post March 2018 

The first couple of weeks home with your baby is a tumultuous time to say the least. It is full of so much amazement, sleep deprivation, joy, learning, and love. You might be in such a haze that you may or may not even remember this period very clearly.

It is the minority of families in our practice who have the luxury of having one parent stay home with the baby full time. Most families are faced with the huge transition that hits when one or both parents need to return to work. The luckiest families have flexible, understanding jobs and a local grandparent who can’t wait to baby sit. If you can work part time, that is often the perfect balance. The rest of you are left trying to figure out the best option.

One of the biggest issues that many of the breastfeeding moms face is how to successfully continue to nurse. If your baby has never taken a bottle, try to give yourselves enough time for them to get used to one. Babies may refuse to take the bottle from mom. They know that breast is right there! They can smell it! It is best to have the other parent or caregiver be the one to offer  the bottle. Ideally offer fresh breast milk, so that there aren’t too many changes at once. Try the bottle a bit before the baby is genuinely hungry. Some babies are remarkably easy and go back and forth between breast and bottle with ease. Others like my daughter Alana, can make it much more stressful. Alana screamed for an entire day. Luckily she was with a very patient and experienced caregiver who eventually had success.

Local lactation guru Nurse Charity shared some successful pumping tips. She suggests that you start pumping 7-10 days prior to going back to work.


Yes, this will bump up your supply, but going back to work usually does tend to decrease the supply over time, so starting at a higher level is good. Prior to pumping do an all over breast massage. Bring a photo of the baby or an outfit with that wonderful baby smell. Hopefully your job will be supportive of your need to pump and you will have a comfortable area. Frequent short pumps are just as good as trying to carve out one or two long sessions. Nurse Kenlee suggests making a “nursing play list” or having some strong association with nursing that you can take with you when you are pumping away from the baby.

In general in order to protect your supply, make sure you drink plenty of fluids. Eat a healthy diet and make sure you get adequate rest. (I know, I know, but I had to add that)
Do lots of skin to skin contact when you are with your baby. It takes some effort but many moms are able to successfully produce enough milk that supplementing is not needed.

KellyMom is an excellent source for guidelines on storing the milk. If you have fresh milk, use it prior to defrosting your frozen stores. I always suggest putting a baggy full of ice cubes in the freezer. As long as they stay frozen as cubes, you are assured that the freezer has maintained the correct temperature. If the ice cubes refreeze into one clump, the milk can no longer be trusted.
Make sure that all the milk is dated.

Make sure that your milk freezes well. Some moms have an excessive amount of the enzyme lipase in their milk. The milk remains safe but has a nasty smell. Scalding the milk prior to freezing it will eliminate this issue. You don’t want to be the one who discovers this after you have a freezer full. The lipase has some health benefits, so if it isn't causing problems, don't bother scalding the milk.

While many moms have no trouble keeping up with their supply, others are not so lucky. Please don’t spend even a minute beating yourself up. Do not be the parent who limits the amount of milk the baby is allowed to have due to supply. Do not be the parent who is incredibly stressed out if they are an hour late home from work because the baby will starve. Simply do the best you can and take advantage of the fact that there are many excellent formula supplements out there. Being a good parent is not only about the breast milk.

Be careful that your child doesn’t swap their days and nights. If moms aren’t careful, some babies refuse the milk during the day, but wake up every couple of hours to nurse during the night. Sure, the baby is getting the milk they need, but mom will lose her mind from sleep deprivation. Let me repeat myself. An intact mom is more important than breast milk.

Beyond the issue of feeding is the huge question of finding a loving caregiver in your home or a safe place to send the baby while you are at work.

Many of our parents have success with small family day cares or nanny shares. Once kids are away from the safe relative quarantine of your home, they are going to start getting all of the little childhood colds and viral syndromes that are a rite of passage for most kids. Having a solid conversation with the daycare, other parents and/or nanny is essential so that everyone is on the same page regarding which symptoms necessitate staying home. 


Take a moment to click on one of my all time favorite blog posts. It is all about striving to find balance between all the various aspects of your life. It is never more relevant than during this transition.

Friday, February 19, 2016

Vicks VapoRub on the feet (update)


I saw an interview recently where a well respected pediatrician completely dismissed the value of any natural remedies. He didn't believe in doing anything for his patients that wasn't completely "science based". In his practice, coughs just have to run their course.
He and I wouldn't get on very well. I love science too, but in my  years of practice I have seen many people feel quite a bit better from reaching for some alternative solutions. As long as they are benign and not taking the place of necessary prescribed medication, I love to see what relief can be achieved without standard medication. This post is all about one of the odder things I have tried. It seems to help!

Seasons come and go. Occasionally I find something that seems to work well for patients, but then the illnesses quiet down and I don’t think about it much. With all the never ending coughs plaguing my patients and families, I recently added a link in the “what’s going around section”. The link was to one of my earliest posts about the benefits of putting Vicks Vaporub on the feet. Several dozen folks clicked through and followed up with feedback that this seemed to be the difference maker. The kids had much quieter nights without nearly as much coughing. With cold season in full force, it seems like it is worth updating and re-posting.

The internet is a minefield. It is a goldmine of valuable information. Unfortunately, it also has the power to terrify unwitting folks who go online to look up symptoms or whatnot.
Most wise folks know enough to realize that the good information is muddled up with loads of crap. It is hard to know what is real. Therefore, when I got an email several years ago touting the magic of applying Vicks VapoRub to the feet to stop a cough, I promptly dumped it into my spam. Frankly anything that tells you that it works 100% of the time is 100% false (have fun with that statement!) But then a variation of the same email came to me again and I thought it might be fun to see if there was any merit to it.

The claim is that covering the soles of the feet with the VapoRub and then putting socks on is very helpful for coughs. I am always looking for safe, natural remedies to help relieve symptoms of colds and coughs for my patients without loading them with systemic medications. So, several winters ago I set out to do a completely unscientific study.
While talking to the hundreds of my Noe Valley Pediatric parents who were trying to relieve the coughs that were keeping their kids up at night I enlisted them to give the "Vicks on the feet" a try. I asked them to report back.

To my surprise, well more than 50% of the folks who tried this seemed to find that it was quite helpful; imagine that! Even Snopes doesn't completely debunk it; just labels it as unproven. No one who tried it had any ill effects. I occasionally completely forget about this, but someone asked me about it the other day. With the colds and coughs out there in full swing, this might be something you want to try.

Before applying anything topical, it is important to make sure you or your child do not have a reaction. Place a small dab on the leg and rub it in. If there is no irritation within 30 minutes or so, you should be fine. (I do this same test with a new sunscreen.)

 Folks ask about the difference between the adult and the baby Vicks. I think that either is safe for the feet. If you happen to have only the regular Vicks in the house, feel free to use it. If you are going out to the store and you have options, go ahead and get the baby version.That is especially preferable if you are going to put in on the chest as well as the feet.

Along with the Vicks, don't forget about steam, sinus irrigation and keeping heads of beds/cribs on a slant.
If you have an infant who is under 4 months of age with a cough that is keeping them up or interfering with their eating, they need to be seen.
If the cough is lasting more that a couple of weeks it is probably worth a listen.
Any significant shortness of breath needs to be evaluated.
Tis the season and we are seeing loads of coughs and colds out there, so if you or your family members are hacking away, unfortunately you are running with the pack.

I still do love getting feedback, so if the Vicks works magic, let me know!!

One of my mom readers who is also a physician shared the following warning from a physician reference called Up To Date and it is certainly worth adding to this post.
Approximately 11,000 pediatric camphor exposures are reported to United States poison control centers annually [2]. Exploratory ingestion of camphor-containing products by children younger than six years of age is most common, accounting for about 80 percent of exposures. Toxicity from topical absorption of camphor is less common than from ingestion but has been described after application of unlabeled camphor oil in a four month old infant [4] and copious application of a labeled topical ointment hourly for 10 hours in a three year old child

With anything, please use common sense child proofing precautions and don't leave your kids alone with  anything that they can ingest.
I remain confident that the ingredients in Vicks, when applied topically are quite safe.
Nurse Judy