Breastfeeding Beyond The First Year(Part 3/3)

BREASTFEEDING BEYOND THE FIRST YEAR (Part 3/3)
It may pose a unique set of challenges, but overcoming them provides dividends for your baby, writes a mother who shares her experience

By Anita Daubars | Reprinted with permission from Today’s Parents Magazine

Click here to read Part 2 and more photos

BREASTFEEDING & FERTILITY
Lactation delays the return of a woman’s menstrual periods after birth. This lactational amenorrhea lasts for varying periods of time in different women, averaging about 14.6 months postpartum in mothers who totally breastfeed their babies for six months and thereafter introduce solids gradually.

The length of lactational amenorrhea is largely determined by the baby’s breastfeeding pattern: is breastfeeding token in nature and scheduled, with solid being introduced at an early age, or is it ad lib and round-the clock, with a later introduction to solids and with baby satisfying his nutritional and his sucking needs at the breast.

Breastfeeding has a contraceptive effect as it suppresses ovulation. Because of the uncertainty of when ovulation will begin again, nursing mothers are encouraged to find other means of contraception. As the nursling nurses less and consumes more food, a mother’s chances of conceiving increase.

Mother of two Irene Tan continued to express her breast milk for her toddler for several months after he had weaned from direct breastfeeding because of its health benefits. Another mother continued nursing her toddler who had food allergies because breast milk was nutritionally wholesome and nursing helped to soothe her child when she developed allergic reactions to suspect foods.

NURSING THROUGH PREGNANCY & TANDEM NURSING
When a nursing mother finds herself pregnant, she is faced with the decision of continuing to breastfeed through the pregnancy or weaning.

She needs to consider the following: her own parenting values and needs; the part breastfeeding plays in her relationship with the nursling; the nursling’s emotional needs and other nutritional and immunological considerations.

Pregnant nursing mothers face breastfeeding challenges such as sore nipples, breastfeeding agitation and a reduction in milk supply because of hormonal changes.

Ways to cope include limiting breastfeeds and supplementing feeding with other milk.

Tandem nursing is closely related to the practice of nursing through a subsequent pregnancy. Tandem nursing refers to nursing two or more children of different ages at the same time; this may not be physically at the same instant, but one after another.

Advantages of tandem nursing that mothers cite include an easier transition to being a big brother or sister and a tender relationship between siblings right from the start.

The biggest obstacle for extended breastfeeding mothers is criticism from others; instead of giving mothers advice, often, affirming them and expressing confi dence in their ability to make good choices is the most helpful.

A mother nursing her toddler needs encouragement; she may find that, among babies similar in age to her own, her baby is the only one still nursing. For such a mum, it is sometimes a lonely journey and it is crucial that she belongs to a community of women who nurse older babies.

Many a mother has been encouraged to stay the course of breastfeeding because of her friendships with other nursing mothers.

Many believe that children whose dependency needs have been met outgrow these needs and achieve independence. When they are able to do this at their own pace, they tend to be more secure than children force into independence before they are ready.

Source: Breastfeeding Beyond The First Year(Part 3/3)

Breastfeeding Beyond The First Year(Part 2/3)

BREASTFEEDING BEYOND THE FIRST YEAR (Part 2/3)
It may pose a unique set of challenges, but overcoming them provides dividends for your baby, writes a mother who shares her experience

By Anita Daubars | Reprinted with permission from Today’s Parents Magazine

Click here to read Part 1 and more photos

NURSING STRIKES
Another issue nursing mums face are nursing strikes. Features of a Nursing Strike: When the nursling refuses to breastfeed without apparent reason. This can occur at any age, lasting from two to four days although a mother in this situation might wonder if the refusal to nurse is a sign of her baby’s readiness to stop breastfeeding.

A baby who is ready to wean will usually be over a year old, will be consuming other food and drink well and will cease nursing gradually, dropping off one breastfeed at a time.

A baby on a nursing strike may not be consuming other foods well and his refusal to nurse will be sudden and upsetting for him.

The mother can figure out the causes of baby’s sudden refusal to nurse by asking: does the baby have an illness or injury that could be interfering with nursing? Has there been a change in the baby’s life?

To get baby back to nursing as before, mothers can try nursing when the baby is very sleepy and by giving him or her lots of quiet, affection, and skin-to-skin contact.

HEALTH CONCERNS
Many nursing mothers are concerned about their nursling’s nutritional needs. Breast milk, being species specific and nutritionally superior, forms an invaluable part of a toddler’s diet that includes varied complementary foods.

Breast milk contains nutrients for baby’s growth as well as immune factors such as antibodies, growth factors, digestive enzymes and hormones.

Once complementary foods have been introduced at around six months of age, the other benefits of breast milk continue.

As such, breastfed toddlers tend to fall sick less often than their nonbreastfed peers and illnesses tend to have a shorter duration.

Nursing toddlers generally have: fewer ear infections; fewer respiratory infections; better digestion with fewer intestinal infections and less constipation; heart health; protection against allergies; less exposure to potential allergens also reduces the baby’s risk of infections, which may trigger allergies; and an intellectual advantage.

EMOTIONAL DEVELOPMENT
Mothers sometimes wonder if breastfeeding into toddler hood would cause baby to be clingy as a toddler. However, being clingy towards his primary caregiver at certain times is typical of almost any toddler, regardless of whether he is breastfeeding.

Pediatrician Dr William Sears believes that children who are allowed to breastfeed for as long as they need have a less anxious attachment to caregivers.

Click here for next Part 3

Source: Breastfeeding Beyond The First Year(Part 2/3)

Breastfeeding Beyond The First Year(Part 1/3)

BREASTFEEDING BEYOND THE FIRST YEAR (Part 1/3)
It may pose a unique set of challenges, but overcoming them provides dividends for your baby, writes a mother who shares her experience

By Anita Daubars | Reprinted with permission from Today’s Parents Magazine

WHEN I was expecting my first baby, I had been keen to try breastfeeding my newborn. However, I never thought that my breastfeeding story would turn out the way it has.

I exclusively breastfed my daughter until about six months of age, then began introducing semi-solid food to her. It was around this time that we discovered her allergy to dairy and wheat products.

After taking food containing these ingredients, she would throw up continuously for many hours, and be irritable and fussy. She would also refuse to nurse or eat any other food. After a few hours, she would begin to nurse but would still refuse solid food.

This refusal lasted for many days after each allergic response; during this time, she relied on breastfeeding for her nutritional needs as well as to comfort her. As we identified the specific suspect foods and avoided them in her diet, her allergic episodes became fewer.

Breastfeeding continued to fulfill a large part of her dietary needs. My daughter’s first birthday passed but weaning her felt arbitrary and somewhat odd.

My faith in breast milk’s ability to nourish my baby in the gentlest way, my wariness of triggering further allergic reactions, together with nursing being able to meet my baby’s intense need for closeness motivated me to continue breastfeeding her for as long as it felt ‘right’ for us both.

Most babies do not have such allergic tendencies, and for each individual family, breastfeeding, extended or otherwise, takes its own shape and style.

Nursing mothers whose babies have passed their milestone first birthdays and who continue to find breastfeeding a fulfilling way to meet their babies’ needs face a unique set of challenges.

Those who have resolved early problems with baby’s latch-on technique sometimes find that their baby’s latch becomes more relaxed as she grows bigger, and they begin to have sore nipples once again. The mother then needs to reassess her nursling’s latch and initiate a better latch. The same applies for the nursling’s position.

Nursing toddlers tend to engage in ‘nursing gymnastics’, wriggling and squirming during nursing. They comfortably get into a myriad positions to breastfeed.

Mothers often have to emphasize to their toddlers to stay properly latched on throughout nursing. Toddlers also tend to be busy, distractible people.

Yet, continuing to nurse after the first year sustains the emotional connection between mother and toddler and serves as moments to touch home base and reconnect with their mothers between their outbound exploration trips. Many toddlers settle on having shorter breastfeeds.

According to the American Academy of Pediatrics (AAP), breastfeeding should continue at least until age one, and thereafter, for as long as is mutually desired by mother and child; extended breastfeeding provides significant health and developmental benefits for mother and child, and there is no upper limit to the duration of breastfeeding.

Click here for next Part 2

Source: Breastfeeding Beyond The First Year(Part 1/3)

Pregnancy Tips: Water Breaking vs. Normal Leakage

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

How do you distinguish between water breaking and normal leakage?
Water breaking should not happen before pregnant women go into labour. It does not happen before labour (anytime before 37 weeks). You should consult a gynaecologist as soon as pre-term pre-labour rupture of membrane (pprom) happens. There is no normal leakage, only vaginal discharge.

Source: Pregnancy Tips: Water Breaking vs. Normal Leakage

Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

I am now 32 weeks pregnant. A few days ago, after my shower, there was some yellowish discharge from my breast. Is this discharge from the nipples colostrum? How can I stop it from flowing out? Will I have enough colostrum to give my new baby when I deliver, if it continues?

During the last trimester, there will be a small amount of milky discharge from the nipples called colostrum. Do not squeeze or stimulate the nipples as it will usually stop on its own. Yes, you will have enough colostrum to give your baby when you deliver.

Source: Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

Pregnancy Tips: What Is Dilatated Renal Pelvis?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine

I’VE JUST HAD MY 20-WEEK ANOMALY SCAN AND HAVE BEEN TOLD MY BABY HAS A DILATATED RENAL PELVIS. ALTHOUGH I’VE BEEN REASSURED THIS CONDITION WILL PROBABLY CORRECT ITSELF, I’M WORRIED.

Mild renal pelvic dilatation (swelling of the collecting system in the foetal kidney) occurs in 1 to 3 percent of pregnancies. It is more common in male foetuses. It is usually defined as an antero-posterior diameter of > 5 mm before 24 weeks and > 7 mm after 25 weeks.

Usually the condition will resolve on its own, but worsening renal pelvis dilatation may be due to some underlying problem in the urinary tract like obstruction, or certain abnormalities in formation of the kidney, for example, a duplex kidney or a multicystic kidney. If there is no family history of kidney disease, and there are no other abnormal findings on ultrasound, the outcome in the baby depends on whether the dilatation worsens as the pregnancy progresses.

If there are no other abnormal findings in addition to the dilatated renal pelvis, there is no need to check for chromosomal abnormalities in the foetus.

If the dilatation remains static or is less than 10mm, then an ultrasound scan of the urinary system will be done three to four days after birth. If this is normal, a follow up scan should be repeated one, six or 12 months later.

Unfortunately, the clinical significance of persistent neonatal renal pelvic dilatation is unknown as long-term follow up studies are not available. Even if the dilatation persists, the likelihood of serious urinary tract problems is very low.

If the dilatation is > 10 mm in a follow up ultrasound scan after 28 weeks gestation, your baby will be continued to be monitored closely after birth and other specialized tests of urinary tract function may be necessary.

Source: Pregnancy Tips: What Is Dilatated Renal Pelvis?

Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

GREAT EXPECTATIONS
By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

I had a C-section during my first pregnancy due to bleeding at 32 weeks.
After a three-year gap, will there be any risk involved if I choose a natural birth for my second pregnancy?

The few studies available suggest that an interpregnancy interval shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes.

There is emerging evidence that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous Caesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa).

Hence, a three-year gap is an advantage.

The main risk in attempting a vaginal delivery after a Lower Segment Caesarean Section (also called VBAC, or Vaginal Birth After Caesarean Section) is an increased risk of uterine rupture (tearing open of the uterine wall) during the delivery.

The risk of rupture is 0.2 to 1.5 percent.

The rate of foetal death is low with both VBAC and C-section.

However, because the risk of foetal death increases with uterine rupture, foetal death occurs more frequently with VBAC than with repeat Caesarean delivery. Maternal death is rare with either type of delivery. VBAC is an acceptable option for women in the following situations:

* Does not have other conditions (as an example, placenta previa) that requires Caesarean delivery

* Has only one low transverse uterine incision from a past Caesarean delivery

* Has no other uterine scars (eg from a previous surgery for fi broid removal) and has never experienced a uterine rupture

* Does not have pelvic problems or abnormalities that prevent vaginal delivery

* The baby is in the proper position (head down)

In addition, VBAC should only be considered if facilities are available or an immediate Caesarean Section should it be necessary.

Dr. Low Kah Tzay is a paediatrician working at Mt Elizabeth Hospital. He specializes in the management of growth and development of children; such as feeding difficulties, language delay, sleep disorders, attention disorders, autistic spectral disorders and learning difficulties. His website: www.pediatricdoctor.net.

Source: Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine
I HAVE BEEN TRYING UNSUCCESSFULLY TO CONCEIVE FOR THE LAST SEVEN MONTHS. MY GYNAE DISCOVERED I HAVE FIBROIDS. WHAT SHOULD I DO AND HOW DOES THIS AFFECT MY CHANCES OF HAVING A CHILD?

Uterine Fibroids (myoma or leiomyoma) are very common – they are benign (noncancerous) growths of the uterine muscle. The size and location of the fibroids are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function.

There are three general locations for fibroids:

(1) Subserosal – on the outside surface of the uterus
(2) Intramural – within the muscular wall of the uterus, and
(3) Submucous – bulging into the uterine cavity.

The only type that will have any impact on reproductive function (unless it is very large) is the submucous type that is within the uterine cavity. These are much less common than the other two types of fibroids.

Because of their location inside the uterine cavity, submucous fibroids can cause infertility or miscarriages and may be removed hysteroscopically (a slim instrument inserted through the cervix into the uterus).

Other causes for infertility should be considered before treatment is initiated for subserosal or intramural fibroids which do not distort the uterine cavity.

Studies of infertile women with submucous fibroids distorting the endometrial cavity found significantly lower pregnancy and delivery rates, compared with infertile women without fibroids.

It is important to note that removal of submucous fibroids led to a significant increase in the pregnancy rate compared with the case in infertile women without fibroids.

Source: Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

Pregnancy Tips: Are Migraine Medications Harmful For Me?

GREAT EXPECTATIONS

By Dr Lai Fon Min

Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine
I AM EXPECTING MY FIRST CHILD AT THE AGE OF 32. I AM PRONE TO MIGRAINES BUT AM AFRAID TO USE ANY MEDICATION AS IT MAY HARM MY BABY. PLEASE ADVISE.
Migraine does not increase the risk for complications of pregnancy for the mother or the foetus.

Several studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70 percent of women either go into remission or improve significantly, mainly during the second and third trimesters.

Management of migraine during pregnancy should first focus on avoiding potential triggers; for example, stress, change in sleep pattern, bright lights or excessive computer use, irregular meals, smoking, alcohol and certain foods containing red wine or MSG.

Consideration should also be given to non-drug therapies.

If medication becomes necessary, paracetamol (Panadol) can be used safely. NSAIDs (aspirin, ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester.

A common antimigraine drug is ergot in combination with caffeine – Cafergot. Ergot is contraindicated in pregnancy.

For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine and metoclopromide can be used to help with the nausea and vomiting in severe attacks; metoclopramide should be restricted to the third trimester.

In some refractory cases, steroids like dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g. propranolol) should be avoided.

Source: Pregnancy Tips: Are Migraine Medications Harmful For Me?

Is Myopia In Kids Preventable? (Part 2/2)

Can You Prevent Myopia In Kids?
Parents guilty of passing on the myopia genes should not fret since they can still play a role in controlling their children’s myopia

By Jessie Kok | Reprinted with permission from Today’s Parents

Click here to read Part 1 of this story

Dr Gerard Chuah, senior eye surgeon at Total Eyecare Centre (Camden Medical Centre), and Dr Chew Wai Kwong, chief optometrist at Capitol Optical, answer frequently asked questions about myopia:

What exactly changes in the eyeball that causes myopia?
“Unlike normal children or adults, highly myopic people have elongated eyeballs which means the tissue at the back of their eyes is stretched,” says Chew. “Tissues like the retina, when highly stretched, become weaker and more vulnerable to retinal tear, resulting in higher risk of developing glaucoma and macular degeneration.”

Is it true that leaving the light on at night for babies may predispose them to myopia?
It is common for parents to leave a light on for babies while they sleep. While recent studies in America show that leaving a light on might lead to the development of myopia, more studies would need to be done to show conclusive evidence.

Are all cases of myopia irreverisble?
General cases of myopia are irreversible. However, another type of myopia – pseudomyopia – which occurs when there is excessive spasm of the focusing muscles in the eyes and more commonly seen in young children is reversible.

How is pseudomyopia treated?
When young children first visit an optometrist cycloplegic refraction is routinely done to eliminate pseudomyopia. Optometrists also rely on objective methods of retinoscopy and fogging to check on these cases.

How can eye drops assist in cases of myopia?
Currently, Atropine 1 percent eyedrops are used in some hospitals and clinics as a tool to address myopia progression. The Singapore National Eye Centre (SNEC) has ongoing studies to assess the role of the drops. There are promising preliminary results that show Atropine may help to retard the progression of myopia but more overseas and local studies are required for conclusive results.

Can certain types of food or supplements boost vision?
According to Dr Chuah, there is no conclusive evidence in studies that show consuming more vitamins and minerals can help to improve or control myopia, unless the child is severely malnourished. It is more important to get a child to relax her eye muscles by looking at faraway objects. “It’s got nothing to do with the colour of the object but more about letting the eye muscles rest after doing near-work,” he says.

Dr Chuah also highlights the efforts by the Ministry of Health in their myopia control programme that teaches students good eyecare habits such as taking breaks after 45 minutes of near-work and simple eye exercises.

A beneficiary of this programme is Kevan, who has successfully helped to control his children’s myopia. Now grown up and aged 11 and 13 respectively, Sarah and Sean have managed to control their myopia over the years through sporadic rests in between studying, and doing simple eye exercises as instructed by their father.

While Kevan does not expect complete recovery in his children, the improvement and control of his children’s myopia that gives him a sense of satisfaction.

“I know we cannot control hereditary symptoms,” he says. “But every parent can play a part when it comes to environmental factors to ensure the best management of childhood myopia.”

Source: Is Myopia In Kids Preventable? (Part 2/2)