From the Stump: Umbilical Cord Care

Once my daughter was out of the NICU, one of my biggest preoccupations was with her umbilical cord stump. The NICU nurses told me to keep it dry and leave it alone - it would fall off in due time. My mother told me they gave her Gentian Violet for the care of my and my sister's stumps. My sister in law was told to put alcohol on it. I had heard through the grapevine that breastmilk was the best for cord care.

So many opinions on what to do! In the end, I followed the NICU nurses' advice and left it alone. It fell off in about 2 weeks and now my little girl has a perfect baby "innie". I was still left wondering, however, what is the best way to care for a cord stump?

An article published last year in the Iranian Journal of Pediatrics touts breastmilk as "an easy, cheap and non invasive way for cord care" (1). They found that stumps fell off faster if treated with breastmilk as compared to no treatment (just left dry). An additional study found no correlation between the prevention of stump infection and treatment with breastmilk as opposed to iodine or dry treatment, but did note that stumps treated with breastmilk or left alone fell off sooner than stumps treated with iodine (2). Both of these studies indicate a 'less is more' approach.

In developing areas, it seems to be a different story. A study conducted on a population in Bangladesh found that repeated treatment of umbilical cord stumps with chlorhexidine, an antiseptic effective against many types of bacteria, decreased the amount of time a stump stayed attached and increased infant survival rate by lowering infection rates (3).

The official stance of the American Academy of Pediatrics is to keep the stump dry and let it fall off on its own. How did you care for your infants stump?

1.Aghamohammadi, A., Zafari, M., & Moslemi, L. (2012). Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn infants. Iranian Journal of Pediatrics, 22(2),2.Vural, G. and Kisa, S. (2006), Umbilical Cord Care: A Pilot Study Comparing Topical Human Milk, Povidone-Iodine, and Dry Care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35: 123–128. doi: 10.1111/j.1552-6909.2006.00012.x3. Mullany et al., (2013),Chlorhexidine cleansing of the umbilical cord and separation time: a cluster-randomized trial., Pediatrics, 131(4).

Routine Infant Circumcision - What's the real deal here?

In many western cultures, routine infant circumcision (RIC) in boys is commonplace. Some cite aesthetic, religious, or hygiene as the reason for its widespread practice. In modern discourse, the lines have been drawn in the sand. Those who are staunchly against RIC liken it to female genital mutilation, a practice in some African cultures where a young girl's clitoris is cut or removed. Others against it feel that it is taking the choice away from the boy with an unnecessary and risky procedure. Those for RIC are typically in the hygiene camp - the CDC recommends RIC to help prevent urinary tract infections, and the spread of some sexually transmitted infections, including HIV.

Scientific literature is also somewhat divided. In an article published in the Cochrane Database of Systematic Reviews in 2012, the authors found no information that would lead a doctor to believe that RIC help prevent UTI's in boys, and according to the most recent recommendations from the American Academy of Pediatrics, there is not enough data to advise parents to have their sons routinely circumcised. 

On the flip side, information published in the Journal of Urologic Nursing in 2012 cited an increased risk of penile cancer in uncircumcised males, as well as a decreased risk in contracting HIV from a heterosexual partner. There is also recent evidence to suggest that circumcision offers protection against HIV transmission in homosexual relations as well. This is important because, according to the CDC, homosexual males are in a high risk category for HIV transmission.

So it appears that the jury is still out on this debate, and there are good points on either side of the argument. I'd love to hear your thoughts - on which side of the argument do you find yourself, and why?

(Urol Nurs. 2012 Jan-Feb;32(1):10-8; quiz 19. To circ or not: a reappraisal. Ahmed A, Ellsworth P. Source Providence VA Medical Center, Providence, RI, USA.

and

Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009129. DOI: 10.1002/14651858.CD009129.pub2.)

The Case for Baby-wearing

Baby-wearing, or the practice of using wraps, slings, carriers, or other devices to hold a child onto a caregiver during daily activities, has become increasingly popular in Western cultures. Many mothers and fathers see this as an exercise in convenience and bonding, allowing for hands free cuddling with their child, from infancy into toddlerhood. There is a great deal of anecdotal and data based evidence that indicates children who are worn are less likely to cry, sleep better at night, and learn more about their environment as compared to babies who spend the majority of their time in bassinets, strollers, swings, etc. Until recently, however, there has been little exploration into why babies who are worn seem to cry less.

An article published this month in Current Biology by Gianluca Esposito and others tackles this very question. Their approach was two-fold. First, they carefully watched the crying, heartrate, and overall movement of infants left to lie in a crib, held by the mother seated in a chair, or held by a walking and moving mother. In all cases, heart rate decreased, movement slowed, and crying halted in the babies carried by a walking mother as opposed to babies held by a stationary mother or babies left to lie in their cribs. This can be interpreted to mean the 'carrying' of infants has a significant calming effect.

 This first experiment establishes that carrying an infant is calming, but any parent knows that. The second experiment delved into the 'why' of it all. The researchers surmised that infant carrying in human mothers was similar to mice carrying their pups by mouth. Lo and behold, baby mice who are carried also show the same characteristics as carried infants - decreased movement, vocalization, and heartrate. The researchers noted that the important cues to inducing this type of response were related to maternal-like touch (i.e. holding near the body in infants or holding by the scruff in mice) AND the sensation of movement. The other senses (maternal smell, sight of mother or moving surrounds, hearing cues) seemed to matter very little to this response. Further, this whole process seems to be governed by the 'parasympathetic nervous system' (the part of the nervous system associated with resting, digesting, and non "fight or flight" responses).Finally, they found that uncooperative pups (baby mice that would not calmed down when carried) made carrying too difficult for the mother, and she refused to carry them. This may have important implications into the evolutionary purpose of this response. A mother is better able to carry a compliant child, so the child's nervous system slows down, almost like a reflex, to allow for easy carrying, something that would have been helpful to avoid predators, move to new locations, or locate food.

In short, baby-wearing allows a parent to carry a child more often, and a carried child is a calm child. Its not just speculation, its SCIENCE!

(Gianluca Esposito, Sachine Yoshida, Ryuko Ohnishi, Yousuke Tsuneoka, Maria del Carmen Rostagno, Susumu Yokota, Shota Okabe, Kazusaku Kamiya, Mikio Hoshino, Masaki Shimizu, Paola Venuti, Takefumi Kikusui, Tadafumi Kato, Kumi O. Kuroda, Infant Calming Responses during Maternal Carrying in Humans and Mice, Current Biology, Available online 18 April 2013, ISSN 0960-9822, 10.1016/j.cub.2013.03.041. (http://www.sciencedirect.com/science/article/pii/S0960982213003436))

Elective Induction of Labor

I'll start by saying this; I was not a very 'good' pregnant woman.

At about 8 weeks pregnant I developed hyperemesis gravidarum, a particularly vicious form of morning sickness. By the time I got treatment at 12 weeks, I'd lost almost 30 pounds.

I had the litany of other pregnancy complaints too. I was exhausted, had horrendous sciatica, pregnancy induced hypertension, and later, pre-eclampsia, which led to my induction at 36 weeks.

I understand the misery of pregnancy. I didn't glow, I didn't float. I shambled around like a deteriorating zombie with an ever-swelling belly. I only made it 36 weeks, and I understand the feeling of not wanting to continue to be pregnant one more day.


For these reasons, some women are choosing to be induced as soon as their pregnancy comes to term, at about 37 weeks. Others wait till 40 weeks until they issue the eviction notice. Other moms feel pressure to undergo an induction at the behest of their practitioner.

Fresh evidence published this month in The Journal of Maternal-Fetal and Neonatal Medicine shows why unnecessary inductions should not be a go-to procedure for miserable moms or harried docs.

According to a study by David Baud and others, more than 40% of labor inductions we're elective (that is, not medically needed). These women were at a significantly increased risk of an emergency C-section, post-partum bleeding, and prolonged hospital stays as compared to women who delivered without induction meds. Moreover, their babies were at a greater risk of needing a NICU stay due to low muscle tone and bleeding on the brain.

This study highlights the importance of letting little ones 'bake' as long as they need, rather than ousting them for convenience or to alleviate some nuisances.

I would never suggest, however, that a woman put herself at risk and avoid a medically necessary induction. I walked the path of an induction to save my life from deteriorating pre-eclampsia - but with such a risky procedure, why not wait it out, just a few more weeks?

Introduction

It seems that there is quite a lot of bad information available to parents, these days. Do vaccines really cause autism? Is formula just as good as breastmilk? What can I do to make this baby SLEEP?! Everyone has an opinion. But evidence based science has always been there for us, even if we choose to ignore it. One by one, I'll tackle all the parenting questions I can, digging deep into scientific literature to find the most up-to-date answers* I can find.

Why?

Because I know every parent wants to do 'right' by their child, but there is so much (mis)information available that your average Mom, Dad, Grandparent, Aunt, Uncle, or other caregiver is drowning. Which end is up?

I intend to decode the latest science on parenting choices and break them down into bite-size, jargon free language.

With that said, I welcome any questions, sane discourse, and disagreements. After all, science would not exist if we could not look at the world around us critically.

(*"answers" is a subjective term, not meant to imply the be-all end-all of parenting knowledge)