“[T]he mandatory crib standards will: (1) stop the manufacture and sale of dangerous, traditional drop-side cribs; (2) make mattress supports stronger; (3) make crib hardware more durable; and (4) make safety testing more rigorous.”

The rules start rolling out in June with crib manufacturers and retailers, and allow 2 years for compliance by child care centers, hotels and other facilities providing cribs:

“Effective June 2011, cribs manufactured, sold, or leased in the United States must comply with the new federal standards. Effective 24 months after the rule is published, child care facilities, such as family child care homes and infant Head Start centers, and places of public accommodation, such as hotels and motels, must have compliant cribs in their facilities.”

The CPSC believes that most drop side cribs are less safe than fixed side cribs and lists manufacturers issuing recalls and providing immobilizers for drop sides. They also created a Questions & Answers page to explain the regulations in more detail.

Safer cribs are a great thing, the only challenge will be reaching over the rail to get older babies and toddlers out of the cribs when the mattresses are at the lowest settings. Be careful of your lower back!

Encouraging women to “Speak Up When You’re Down”, PSI works with health care providers and states to create and support education and treatment programs. The PSI site is a great resource for women too, offering free live chats with an expert every week. We also find thoughtful insights and helpful links at the blog Postpartum Progress.

Part of the challenge with maternal depression is women may feel uncertain about asking for help, and friends and family may not realize when a mom needs support. Living in LA after the birth of one of my kids, I remember feeling particularly overwhelmed one day as I sat nursing the baby on the couch. I looked out the window to see Brooke Shields pushing a stroller past, smiling and laughing with a friend. In that moment I wanted to be her, outside on a sunny day, happy. Months later when Shields shared her experience with postpartum depression, which was happening right around the time she walked past my living room window, I thought about the unyielding emotional range of motherhood. And how much we can help each other by sharing our stories.

Rear Facing Car Seat Until Age 2: The AAP now recommends that children remain rear facing in car seats until 2 years old. The rear facing car seat protects a child’s head and neck from flying forward in a crash. Children are 75 percent less likely to suffer severe or fatal injuries in the rear facing position.

Booster Seat Until 4 feet 9 inches tall and 8-12 years old: Children under this height need to use a booster seat for the seat belt to fit properly across their lap and shoulder. For us, the booster update is the more challenging change as our school age kids have friends who don’t use boosters and they wonder why they must when others do not. We took out the tape measure to see how tall they are, then read the new AAP announcement with them and explained that we decided to follow the guidelines.

The AAP also recommends that children ride in the back seat until they are 13 years old, a concept we’re introducing now since 12 years old has been the much looked forward to demarcation line.

More helpful info on car seats: AAP Car Seat Guidelines and Healthier and Safer Car Seats.

California wants manufacturers to change to lead-free vinyl and party rental stores to include warnings about lead in bounce houses. Until the new lead-free editions, we can wash kids’ hands and faces after they play in a bounce house. We also are pulling out new party ideas–cookie decorating, fishing in a kiddie pool, painting and planting flower pots, decorating magic boxes and treasure hunts.

The new guidelines are in response to ACOG’s former guidelines which led many hospitals and doctors to limit VBACs, or refuse to allow them, for fear of liability if they did not follow ACOG’s more stringent recommendations. The former guidelines were interpreted by some health care providers as requiring a surgeon and anesthesiologist to be at the hospital at all hours, and even the presence of two doctors during a VBAC. Cesarean rates have increased to reach 31% in 2007, an alarming number that obstetricians are working to reduce for the health of mothers and their babies. ACOG now recommends that early in their pregnancies women discuss the risks and benefits of VBAC and potential complications from repeat cesareans. They do not want hospital restrictions to dictate that a woman have another cesarean if she prefers a vaginal delivery.

The guidelines are a positive step. They give women, their doctors and midwives an opportunity to talk in more detail about labor and delivery, and empower women to participate in making decisions about their health.

Following this warning, today Infantino Baby Slings were recalled. The CPSC advises to stop using the slings immediately and provides Infantino’s contact information for a replacement.

The Moby Wrap and ERGObaby Carrier are alternatives which hold babies in a more upright position–but until the CPSC completes it’s safety standards for baby slings, be sure to review the CPSC diagrams.

The Three Faces of Work-Family Conflict explains how the media misconstrues work-family issues by focusing either on upper middle-class mothers opting out or lazy welfare mothers dependent on government aid–when the reality for these families is far different, and middle class struggles are ignored. Williams and Boushey argue that work-family strains can be resolved for all of these families with short-term and extended paid leave, work flexibility rules, high-quality, affordable childcare, and ending discrimination against workers with family responsibilities.

The report summary is short and worth the read, we were struck by the economic data and started to feel like these public policy changes might one day be possible.

While some experts cite the change as a result of better mortality reporting, initial investigations from the California Department of Health task force find there is an actual increase in deaths. Advocates for maternal health want the increase studied and steps taken to change the trend. Doctors are considering obesity, diabetes and complications of cesarean sections as possible factors. The rate of C-sections has increased 50 percent in the same ten year period, and having an induction doubles the likelihood of a C-section.

The California task force has started pilot projects in hospitals to improve their response to hemorrhages and tracking of women’s medical conditions, and to reduce inductions.

For more about the investigation and research on maternal health, see Michael Krasny’s Forum interview Pregnancy Related Deaths on the Rise? with Nathanael Johnson, the journalist who wrote the California Watch article and Dr. Elliot Main, chief of Obstetrics and Gynecology at the California Pacific Medical Center and principal investigator for the California Maternal Quality Care Collaborative.

Pediatrician Dr. Jay Gordon has written another letter about Swine Flu to families in his practice, with helpful information about how viruses work and advice for boosting children’s immune systems. Jay Gordon speaks and writes about children’s health issues, and is the author of books about sleep, nutrition and ADD/ADHD. In his first letter to families, he discussed protocols and debates about Swine Flu.

Here is Dr. Gordon’s most recent letter, which he calls Swine Flu and High Anxiety:

We’re a month into the school year and it’s the time of year when it seems our kids are spending more days sick than well.

Please don’t be fooled into thinking that this winter is so different from previous winters.

Swine Flu does not pose a realistic risk to your family:  There will be millions of cases reported and rare fatalities highly publicized.
Some of us will get high fevers and have to miss school and work for a few days and 99.9999% of us will remain completely unaffected after the flu season except that those who contract Swine Flu this year will be protected if it gets meaner and more virulent in coming years as expected.

Every winter there are dozens and dozens of different viruses.  The immune system is built by catching and beating these bugs and acquiring antibodies and “memory cells” for the next time the virus appears.

There is no way around this process and no shortcut.  Children, in particular, must suffer through a lot of winter illnesses because their immune systems are so inexperienced.

Colds and coughs have an acute phase of 2, 3 or 4 days during which children are contagious and may need to stay home from school.

Following this contagious period, there can be extra mucus, congestion, cough and malaise for another week or so.  By the end of this ten-day period, most children will have been exposed to, and maybe contracted, another 2 or 3 other viruses!  It’s really no surprise that your children and many others might seem to be sick for weeks on end.

Some children and adults have allergies which compound the congestion and coughing problem.

A new study showed that when you examine the blood of children who’ve been sick for a couple weeks or more the majority of these kids show antibodies to 2 or 3 different viruses:  In other words, children and adults don’t have ten-day viral illnesses, they have a series of 2 and 3 day bugs which might look daunting but are actually just a part of a normal winter viral season.

Why do we get more illnesses in winter?  There are more social and school gatherings in confined spaces, the air is drier, more people travel during winter holidays and we eat more junk food during these months.

New viruses get more people sick than older ones and this year the Swine Flu H1N1 virus is the newest common infection.

The media are taking advantage of this situation and are creating more anxiety about winter illness than at any time in recent memory.

Except, maybe, for the SARS scare.

Or the Bird Flu scare.

Or the West Nile Virus scare.

The CDC released fatality data this past week and were quite clear in their assessment of this relatively non-virulent strain of influenza:

75-80% of the 76 children had significant or severe underlying medical problems.

Any child’s death creates an extremely difficult public discussion but of the 300,000,000 Americans there are 45,000,000 children and teens and there have been 76 deaths of younger people.  About 15 of these deaths occurred in seemingly healthy children and teens.

Please put all of these numbers in the proper perspective and realize that there are many important lifesaving topics for the media to publicize but none which sell papers and create TV viewership quite as well as this new flu.

In July CDC and World Health Organization officials stopped counting the number of cases of Swine Flu and are now relying on a patchwork reporting system which is reporting both “lab confirmed” cases of H1N1 and fatalities from cases which are associated with symptoms of Swine Flu.  The science is terrible but the publicity is geared towards increasing fear, selling vaccines and Tamiflu and keeping us all on edge.

They are reporting deaths from “secondary” bacterial infections and some unofficial  sources are even urging people who might be sick with Swine Flu to immediately see their doctors to get vaccines which might prevent bacterial pneumonia.  This, by the way, is a serious misinterpretation of certain vaccines’ purpose and an even more serious misunderstanding of how long it takes a vaccine to work.

Vaccines, including the flu shots, should not be given to sick children or adults.

In the past 18 months, budget cutbacks have led to the loss of over 15,000 public health department jobs.  It might be overly cynical to assume that a full court press about H1N1 could lead to some of these jobs being restored or, at least, might stem the budget cutbacks and preserve further job loss.

Every winter I tell the families in my practice that winter viruses–including this new H1N1–are very unlikely to cause serious illness in healthy people but you may choose to so do your very best to avoid them before a vacation, an important school event or just because you want this to be a quieter winter for your family.

I don’t think that this year’s pair of flu vaccines will create disasters but I also don’t think that they’re a good use of our health care dollars.  They are definitely not worth the amount of media and medical attention they’ve received and continue to receive.

Swine Flu vaccines are now available and they may be just as safe as the CDC and others say they are but they are not the most important measure for keeping your children free of viral illness.

Try to get a good night’s sleep!!  Somehow.

·    Wash your hands. Teach your children to wash their hands. A good long hand washing, about as long as it takes to sing “Happy Birthday” twice or the ABC’s once through is about what it takes. Hand sanitizer is acceptable in moderation when there is no soap and water.

·    Work with your children’s schools to have children wash their hands, especially before they eat snacks or lunch. Hand washing is no small benefit in flu and cold prevention but involves a good deal of parental requesting to truly implement at most busy schools.

·    When you and your children come home, wash hands again.

·    Avoid refined sugars, dairy and fried foods which make you and your children less healthy, replace with antioxidant-rich fruits and vegetables that may lower your immunity. Work with your children’s schools to stop serving cupcakes at each and every birthday. If one kid’s mom or dad brings in sweets for celebrating, then everyone’s mom and dad does. Make it a “no one” does policy, so no one feels singled out and everyone stays healthy. Ask your child’s school to not serve sweet sugary snacks at all. Get your Parent/Teacher groups on board. Pack healthy and well-balanced meals for your kids.

·    Support your child’s immunity with herbs and supplements (look for brands that are not loaded with additives and sugars)  For the most part, they’re not proven effective but most have centuries of safe use behind them and seem to help promote good health and stronger immunity.

•    Astragalus:  one dose three times a week will help support immunity during flu season (This herb seems to be valuable only before an illness and not during.).
•    Echinacea and Goldenseal:  one dose every day in a liquid or chewable form.  My favorite is echinacea tea.
•    Vitamin C and Bioflavonoids:  I recommend for children (and take) 500 mg of vitamin C per year of age divided into 3-4 doses each day during cold and flu time.  (A five year old would get 2500 mg and a 10 year old 5000 mg.  The maximum dose is 10,000 mg–Less if C gives you diarrhea.)
•    Elderberry is a patented and proven viral treatment
•    Probiotics: 5 to 10 billion CFUs each day to build immunity

Fever is one of the immune system’s best tools for fighting viruses and bacteria and should be left alone whenever possible. Higher fever might need to be decreased  for a child’s comfort and, mainly, for assessment.

104 degree children all look like they might have a terrible illness.  Using a long bath, natural remedies and even Tylenol or Ibuprofen will give you a “window” to look at a child with a much lower temperature.  A cooler child will usually smile more, drink more and look more like herself.

You can then see that there might be a pretty big fever but the illness underlying the fever is a small illness.  Worry and stress levels can drop.

If your child has an illness which is preventing good hydration or if lowering a child’s fever still doesn’t allow you to adequately evaluate the illness, call your doctor.

Again, this winter is not different than previous winters.  Swine Flu does not pose a realistic risk to your family.

Best,

Jay Gordon, MD, FAAP