Ask Amma

Posts Tagged ‘health’

Disease Prevention

In Wit on 9 May 2012 at 3:35 am

Kids Just Say the Darnedest Things!

I just got a great idea for disease prevention.  In your dream, you eat something dirty.  It won’t be harmful – unless you walk in your sleep – but your body could make antibodies just in case.

– Khiyali, age 8

Birthday party – let them eat cake?

In Yes / No on 11 April 2012 at 4:34 pm

Till now my son’s birthdays have been family affairs but this time we’re inviting his friends to a party in a park, taking a home-made cake without added sugar. My cousin says this is not a “real” birthday party and guests will be disappointed. Of course I want everyone to have fun, but without the junk.  Am I asking too much?

– mother of a soon-to-be 4-year-old in Delhi

Chetana Amma has written about today’s birthday parties and how to fill them with simple pleasures.

 

 

Daughter had a tantrum in the hotel

In What on 17 February 2012 at 5:22 pm

We were at a hotel with my sister and her children. My niece said that she would not have a milkshake because she had a cold. My daughter also had a cold but she insisted on having the milkshake. When I said no she lay under the table and cried. Ultimately I gave in to her demand, only requesting that it be served warm. I feel that I should have remained firm and not given in.
– mother of a 2 year old in Sion.

First of all congratulations on finding an alternative that alleviated your worries about the cold and satisfied her desire. It is not an easy situation. I gather what is bothering you more than the milkshake is that you "gave in" and "rewarded" the tantrum, weakened the belief that milkshakes are not good when one has a cold, or further, shaken the faith in mother knowing what is good for you. And being embarrassed in the hotel, in front of your sister and her well-behaved niece.

One thing I learned from Alfie Kohn is, in the event of tantrums, respond to your child only. Forget all observers. Tension about what they think will only make you less graceful under pressure. People may look, but once they see that you are in charge, they go back to their business.

Though it might appear that the tantrum was occasioned by the desire for a milkshake, bolstered by the desire to "get her way" I would ask you to consider other causes. When my daughter has a tantrum I think back through the day / week. What might have led to this frustration? Did she not get enough time to do things she wanted to do? Was she rushed? Hungry? Was she not heard? (Often when I am talking with someone else she feels a greater need to be heard!)

Regarding the milkshake, I leave it to you to decide what is healthy for your child, but I ask that you be transparent in your decisions. When you introduce your child to a food that you feel ought to be regulated in any way, explain all the regulations and hear her views on the matter as well. If you are not ready to consult your child in this way (or feel that she is not old enough), then defer introducing the food until that time. If a rule seems arbitrary then a child has no reason to respect it, or the person who pronounces it. When you respect her decisions, she will respect yours. Milkshake or no milkshake will not reflect who "got her way."

But if you should happen to find that you have said no, faced a tantrum, and then said yes, please go one step further and say, "Enjoy the milkshake." Say it with a giggle and a hug. If she has the milkshake AMA (against mother’s advice) that stress might lower her immunity more than the milk/sugar, thus rendering invalid any "I told you so" that one might be inclined to say, should aforementioned cold get worse.

This does not mean, mind you, that there will be no tantrums. While we work to prevent them by addressing underlying needs, our role is not to silence them when they occur. There will be times when there is no milkshake or other specific thing that will satisfy the child. Offer a shoulder to cry on, a comforting cuddle, a sympathetic ear.

When should I wean my daughter?

In When on 17 February 2012 at 5:22 pm

When should I wean my daughter?
mother of a 14 month old in Mumbai

Who is asking? You? Your baby? Your family? Random strangers on the bus? (It has happened to me.) Since you have asked me, I will go by the book and say, after at least 2 years of age, when you and baby are ready. The World Health Organization has taken care of defending the importance of breastfeeding for two years and beyond so let me talk about the further years.

Of all the years of nursing my daughter, I would say I am most grateful for the fourth.  It was in that year that my daughter fell ill three times, each time with high fever and loss of appetite.  By that age (three-and-a-half) she had grown bold in exploring the world; that may have exposed her to more bugs. Whenever she was sick, she nursed day and night – so not only did she get rest and nourishment, but I didn’t lose sleep either, because she was comfortable throughout the illness.

What if baby shows signs of pausing or stopping nursing?  Thanks to the WHO, before age 2 is generally regarded as too young to stop, and mothers are encouraged to try more skin contact and other measures to keep nursing . (See Kelly Mom for more tips.)   While two years is the recommended minimum, there is no recommended maximum.  Nursing continues to be healthy for years beyond the minimum age of two.

Young children will continue to go through phases when they nurse more as well as times when they nurse less.  Gradually the peaks of increased nursing grow less frequent and eventually do not return.

Around age two most children are eating a variety of solid foods and also increasing the range of their social interactions.   Whenever exposed to illness, and especially when sick, children nurse more.  Breastfeeding enhances immunity and also supports the mind and body while little children go through physical, emotional or intellectual growth spurts.  Just observe after a spree of nursing – you will find that something exciting follows.

You may not know when your child feels a queasy stomach or bad throat coming on, but his body will signal him to take less solid food and nurse more.  This eases the work of the digestive system, brings in fluids and channels resources to the immune system for the job at hand.   Many times a baby who is allowed to listen to her body and adjust her diet as needed will nip an illness in the bud, and will remain in tune with her body even beyond the nursing years.

At other times your little one will need less milk and your body will continue to make just the right amount for him, since the more he drinks the more you make. He himself will gradually take less and less and you don’t have to worry about when.  Remember that nursing supplies far more than food, it is also a source of comfort.  Having a safe haven to return to definitely encouraged my little one as she became more outgoing.

While there is no uniform age at which the nutritional, immunological, intellectual and emotional benefits of nursing disappear, every child weans, even without any suggestion or push.   As I read in Norma Jane Bumgarner, Mothering Your Nursing Toddler, the answer to the question of weaning, as far as health is concerned, is that you do not need to think about it.  The wide world beckons and they are little only once.

My nursing / weaning story is here.

Baby hungry after feeding, spits up

In What on 17 February 2012 at 5:17 pm

My son drinks about 4 or 5 oz of expressed breastmilk and wakes up in an hour and fusses a lot. He acts hungry but if I try to feed he spits up. He won’t calm down with rocking, singing, diaper change, holding closely or anything else. Doctors tell me to let him cry and feed him once in three hours. If I feed him more often, what do I do about his spit up problem?
– mother of a 10-week old in California

As they say, spit-up is a laundry problem, not a health problem. If baby is gaining weight, don’t worry about the spit milk – it is usually not more than a couple of spoons. As you know, breastmilk is easily digested so there is nothing unusual about getting hungry again after an hour or even less. If the gap is too long the baby may get overly hungry and find it difficult to relax into the feeding.

Does he nap-nurse or nurse while asleep or nurse just as he is preparing to wake up? If you can feed him before he expresses full-blown hunger that may also help – it gives him more time to spend in the state of "quiet alertness" where he is not having to use his energy to get needs met, but can take interest in what is going on around him. There is no need to follow a timetable with regards to feeding, just offer the breast whenever you think of it and soon you will find the right rhythm.

Babies also need a lot of unconditional holding and carrying. And, sometimes, a loving shoulder to cry on. Even if we do not know why they are crying, they should not have to cry alone.

Weaning … and Free Learning

In How on 27 October 2011 at 3:00 am

My weaning story, originally titled “Weaning: Fountain of Free Learning,” was edited and published in Breastfeeding Today, October 2011 here on page 14. I think they did a decent job condensing.  Here is what I wrote in 2009:

Weaning: Fountain of Free Learning

Weaning: Fountain of Free Learning

     We often hear that nursing a baby provides not only food but also love, comfort and immunity.  As a mother, I found it was all this and more.  I discovered breastfeeding to be a quintessential experience of free learning, right up to and including child-led graduating.   Natural, free, unscheduled, ungraded, untested and self-guided, the experience of breastfeeding gives the child far more than nutrition or even the oft-remarked “brain-boosting DHA.”  Reflecting back on nursing my daughter, I find that it gave her precious time, space and context to learn numerous life skills – not only eating, but also ways to understand her body, her mind and the world around her.  No one could give her a certificate that she had learned.  She moved on when she was ready.

*   *   *   *  *

It is over year since my daughter’s last breastfeeding.  She weaned over a period of 2-3 months, as the gaps between nursings became longer and more frequent … and then I realized it was no longer a gap.  It was all.  One June day when I first noticed a gap of more than a week, I couldn’t resist asking my daughter about it, though I was not sure if I was “supposed” to bring it up at all.  She simply said, “I don’t need it anymore.”  (She did nurse a few more times in July and August.)  My husband gasped, “what?  but you are supposed to have ampa (short for amma-palu, which in Telugu means mama-milk).”  They both giggled.

At the time I hardly talked to anyone about it. I have always been vocal about breastfeeding, calmly answering people who were shocked to see me breastfeed and NIP (nurse-in-public) well past the World Health Organization’s recommended minimum of 2 years.  Though I was bursting with it, what time or place to bring up the story?  Most of my family and friends might not have known she was “still” nursing, or even thought about it.   Without planning to, I did pour out to one friend, a fleet-footed newlywed engineering consultant in Washington, DC, whose views on breastfeeding or motherhood I knew not in the slightest.   She listened.   We laughed through moist eyes.   Later one day, entirely by luck, I found myself in the library on the day of our monthly La Leche League meeting.  I shared my experience.  Recently I again attended LLL after more than a year’s gap and a couple of moms remembered my story.  They had understood (of course).

They encouraged me to “write it down.”  And so here it is.

I always knew that I would breastfeed.  My mother was in La Leche League when my little sister was born and I went to my first LLL meeting  (as an adult) while I was pregnant. Though we had difficulties in the beginning, we got established after a few days and nursing was smooth after that.   There were ups and downs, of course.  At nine months my daughter loved idlis (steamed rice-and-bean cakes) so much I worried that she was not nursing enough.  At 15 months there was a time when she did not nurse for more than 24 hours and I worried because I knew that was too early to wean.  At 22 months she was nursing like a baby, waking up every 2 hours at night and all.  (Soon after the nursing spurt she had a growth spurt.)  Through all these ups and downs, I never lost confidence in nursing; moreover I had terrific support from mothering.com/discussions and La Leche League online community forums, even though I knew few nursing moms in real life.

When my daughter was three I observed that she was nursing 3-6 times / day.  To sleep, to wake up, once in the middle, and often a couple of times during the day.  I remember noting that it did not seem to be tapering off in any way.  Could this actually end?

When she was 3 ½, I was most grateful that she was nursing.  That winter she got sick three times in three different places  – Delhi, Bombay, and Rasuru (Orissa), each time with high fever, and once with measles.  Each time she nursed right through her illnesses.  Though she was sick and needed to direct all her energy towards healing, she was not uncomfortable.  Through breastfeeding, mostly in her sleep, she was getting plenty of fluids, rest and nutrients.   She certainly couldn’t keep any food down (we tried that too).

Nursing helped our daughter to develop healthy eating habits.  She ate on her own, right from her introduction to ragi (millet) at 6 months, and soft fruits like banana and sapota, soft vegetables like peas, sweet potatoes, plantain, beets, and onwards to grains, beans, and beyond.  She ate whole grains from the beginning – whole millet, brown rice, whole wheat bread, mung and urad dal were also unpeeled.   We simply served her food and she ate as much as she wanted, with her own hand.  We usually ate together.  If she needed more time she would eat by herself as I took care of other work.  Or read a book.  Eating was always a happy and relaxed experience; never a chore, either for her or for us.  Through mother’s milk she became familiar with the diverse tastes of all that I ate; I think that served as a preview to whet her appetite for the real thing. Since she was breastfeeding I knew she was getting her nutrition so it did not matter how much solid food she ate.  With this freedom she embraced, at her own pace, the array of whole, natural foods we prepared.

Weaning from the breast signified not only a transition from one source of food to another, but also a transition in the way my daughter understood herself and dealt with the world. The basic ability to gauge one’s own hunger and satiety, cultivated at the breast, will serve one well at the plate.  Over the years I came to recognize that breastfeeding offers so much more than nutrition.  It offers immunity not only to germs but also to excessive stimuli from the environment.  It nurtures one’s sense of wholeness, it is comfort after a fall or stress, and of course, it is a warm cozy place to let down one’s guard and sleep.  The world offers alternatives for all of these functions, and the child who learns to avail these at her own pace will utilize them wisely.

Because breastfeeding often required me to take my daughter to work, it allowed her to be in interesting environments observing adults busy in various activities.   Also, it gave adults a chance to share time and space with a child and accept a nursing toddler as normal.  One small step towards building our continuum society.

Around age four, I again noticed that she was nursing nearly every night and sometimes during the day as well.  I wondered how long she would nurse, but did little more than wonder.  Once when she skipped a day I spent hours writing in my journal.  What does this mean?  But the next day she was back; meaning was forgotten.

It started soon after her fifth birthday.  Till then she was going strong with no signs of tapering off.  Two weeks later however, I observed that she’d skipped several days.  Was I ready for this?  I couldn’t say she was too young.  She was even past the oft-quoted “worldwide average” of 4.2 years.  So what was I missing?

Wasn’t I now supposed to be celebrating – increased wardrobe choice, one less mile to go before I sleep?  Sure, there would be plenty of days ahead to enjoy that.  Now I was immersed in a rush of feelings, and savoring that rush.   It passes all too quickly.

The author nursing her daughter at the grand canyon, Arizona.

The author nursing her daughter while on a hike.

Aravinda Pillalamarri, 2009

 

Cow’s milk for babies?

In What on 26 September 2011 at 8:33 am

We get our fresh cow’s milk from our neighbour and she uses no oxytocin injections or other such chemicals. I’m aware of research from the west that finds against giving cow’s milk before 12 months, and that there is a risk of anemia and allergies but do you think this applies to Asian babies or in communities where cow milk consumption is highly prevalent? We would like to cut back on formula and thinking of introducing cow’s milk when our baby turns six months old, as many other rural families in Himachal Pradesh do.

– nursing mother with low supply

So sorry to hear about your supply difficulties.  Your concerns about formula milk ring true to me.  First let’s look at iron.  Studies show that the percentage of iron that babies absorb from milk is 50-75% for breast milk, 10% for cow’s milk and as little as 4% for formula milk.

I would first try to find milk from another human mother who was willing to supply.  She could nurse your baby or you could provide a pump and then feed the expressed milk by bottle, spoon or cup to your baby.  In exchange you could offer fruits or other goodies that would be helpful for the donor’s family.    La Leche League and Eats on Feets are groups that can help facilitate mother-to-mother milk sharing.

Second, the question of allergies that may arise from early introduction of dairy products.  To assess the risk level, before introducing milk from another animal, such as cow or goat, I would introduce a few drops on the skin and then by mouth, and increase gradually. At the first sign of allergic reaction or other problem I would slow down or stop entirely.  You can also test for dairy allergy if you are in doubt.    If he is not allergic to it, then even if the iron is poorly absorbed, there may be other nutrients in the milk that he will absorb.  Certainly the freshness of the milk available to you and the diet and exercise that the cows enjoy locally makes a difference, and you may want to look into raw milk as well.

At the same time I would also gradually increase the entire range of fruits, vegetables and grains in baby’s diet.

Sources: Dr. Sears  Nutrient by Nutrient
Mayo Clinic Milk Allergy Test
J Pediatrics 1977 Jul;91(1):36-9.  Iron Absorption in Infants

Fruits vs. added sugar

In Why on 14 June 2011 at 3:20 pm

My dad says I am being silly being so strict about no added sugar while my daughter gobbles tons of whole fruit ! Any good argument other than the fact that fruits contain other nutrients and not just fructose too?:)

– mom of a 2.5 year old in Dallas

Obviously whole food is better than processed food. Because whole foods take time to chew, the body has time to feel full before one can overeat. Fruits contain fiber, and innumerable nutrients, not only the few that appear on the labels of packaged food. Michael Pollan writes in In Defense of Food that many nutrients that are available in the fresh, whole form are not absorbed from the processed versions (juice, jam etc). Nutrients are absorbed in synergy, chewing, etc. I have never heard of "overdoing" whole fruit but if you are concerned, I would look for foods from other food groups, rather than added sugar to balance the diet.

Most people, and most of our families a generation or two ago, eat food that was neither packaged nor processed, other than the processing done at home. Because this takes time, it is naturally limited. Now when processed sugar is far cheaper than whole foods, and packaged food is everywhere, how would we limit it?

There are a variety of approaches to food. Let me share my approach and why I believe it worked well in helping us have not only healthy eating habits but also healthy attitudes about food.

What I did was to avoid added sugar and refined grains entirely in the first few years of life. In the first year I avoided salt as well, This allowed my daughter to taste food on its own. Using these years to introduce a wide variety of foods, as close to their whole form as possible, set the foundation for a healthy and balanced diet. Introducing processed / sugary foods after she had years of experience with whole foods gave the whole foods an advantage – she didn’t like white bread or white rice – and allowed her to understand that different roles different foods played in our diet.

In the initial years we also avoided packaged food almost entirely – exceptions started with puffed rice / puffed millet and grew gradually. But mostly we cooked from scratch. Parents who followed this approach have told me that their child rejected "baby food" from the jar though when they made the same thing at home the child ate it quite happily.

By the time I was prepared to introduce refined / added-sugar foods, I was confident that my daughter and I could have a meaningful conversation about

– roles of a wide variety of foods
– limiting intake of refined foods e.g., after meals, not every day, not too much

– need to brush teeth (or in a pinch, eat a carrot / celery / apple) after sweet / sticky foods.

Above were guidelines we used in our family, yours could be different – the important thing is that you be ready to explain your guidelines, be answerable (why?) and also be flexible. [And feed them before birthday
parties ;-)]

In my experience, the "strictness" in the initial years makes restrictions obsolete in the later years. Incidentally I found the same approach effective with media as well.