Tuesday, October 20, 2015


I recently realized that often car seat users are confused about some terminology. I thought I'd try to set the record straight.

There are three types of connectors for your car seat.

Any car seat can be installed in any car using the car's seat belt. Your car seat manual will have instructions on how to properly do so.

You MUST make sure the seat belt is LOCKED. Most cars on the road have automatic locking retractors, which means you can lock them by pulling the seat belt all the way out and then letting it retract. If your car does not have this feature, you must obtain a locking clip and consult your car seat manual on how to use it properly.

LATCH is an acronym for Lower Anchors and Tethers for Children. All cars manufactured in the United States since 2002 are required to have LATCH connectors. These are metal loops usually found in the seat crack. Your car seat has a strap with hooks that connect to these loops and is one method for installing a car seat. Check both your vehicle manual and car seat manual for how to find and properly use the LATCH system.

All forward-facing car seats will have a TOP TETHER. This is a strap that is attached to the TOP of the car seat back. Your car is required to have at least 3 anchor points to attach this top tether to. The tether prevents the car seat from pitching forward in a crash, which helps protect your child's head and neck. The anchor points can be found in one of various locations depending on the type of car and the type of seats you have. In a sedan, the anchors are typically found behind the head rest on the shelf above the trunk. On captain's chairs in a van or SUV, they are often near the bottom of the back of the chair. In some cars, the anchors are in the ceiling behind the seat. Check your vehicle manual for the locations of these anchor points!

Here's where it gets confusing!

You should not use both the LATCH and the seat belt for installation.

You SHOULD use the top tether with every forward-facing car seat, regardless of whether you use LATCH or seat belt to install the car seat.

Monday, August 3, 2015

Moving with Children: Some Thoughts and Advice

I know to most of my readers, I exist in a somewhat static online location, but my family has actually moved twice since I started Jessica on Babies, most recently last month! We moved from Southern California to Northern California two years ago, and this summer moved back down to Southern California.

Both of our recent moves were corporate relocations, which means we were lucky enough to be provided with a packing service. We still had to do some purging and organizing, but at least we didn't have to actually acquire, fill, label, and tape the boxes. Even so, moving is stressful for everyone, especially a long-distance move to a new and unfamiliar place. This most recent move, we didn't even see the house we were moving into until we actually arrived here!

Here are some of my thoughts and bits of advice on long-distance (or short-distance!) moves with children.

Small children may wonder where their stuff is going and if they're going to see it again. Make sure that you keep your child's lovey and a few favorite books and small toys out so that there is something familiar among the chaos. For verbal children, especially preschool-aged ones, explain that their clothes and toys are going into the boxes, but that those boxes are going to arrive at the new house and they'll get to unpack and use their things again.

School-aged children will worry about attending a new school and making new friends. We were fortunate to move in the summer, so my kids don't have the disruption of changing schools in the middle of a school year. They have not expressed a great deal of concern over starting at a new school, but school hasn't started yet. I am nervous for them - especially for my oldest, who will be going into fourth grade. I signed them up for a couple of weeks of summer camp in our new town in the hopes that they'd get to meet some kids their age who live locally, and hopefully some who will be at their new school. It was also an opportunity for me to meet some of the local parents!

Babies and toddlers will adjust the fastest. My youngest didn't much care where he was sleeping as long as he had his familiar blankets, and as long as I nursed him down in his new room. He even got a new bed when we got to our new house. Our only concern with the youngest was that we moved from a one-story house (where he'd been born) to a two-story house, and we wanted to make sure he'd get used to climbing up and down the stairs. It took him a couple of weeks to become comfortable with the steps, but he goes up and down like a pro now. He has enjoyed exploring his new digs.

Maintain your family routines as much as possible. A new house means a new way of life no matter how you slice it, but the basic structure of your day can still stay the same. Children are comforted by keeping to a familiar schedule. They like to know what's coming next. Anything you can do to keep their days as familiar as possible will help them adjust.

DON'T PACK THE LOVEY. I put that in all caps because it's so, so important. If your young child has a favorite blankie or stuffed animal or toy that he or she uses as a transitional or comfort object, make sure it stays near them! When they get to their new room, having their lovey there to sleep with will help them become used to the idea that this place is now their home.

Give fair warning of the move. We decided to make the move quite a while before we told our kids. We spent a long time discussing when was the right moment to tell them. We wanted to give them enough time to ask us questions about the new area, to solidify the idea of the move in their minds, and to let the shock wear off a little, but we didn't want them to be worrying about it for weeks and months either. We ended up telling them about a month and a half before we were scheduled to move. This gave them a chance to say goodbye to friends at school, have some last play dates, look at pictures of the new house, and talk about what we'd be doing during the summer.

Reassure them that you'll be staying for a while. It took my almost-four-year-old a while to understand that this is his new home. We stayed for a couple of nights in two hotels before moving in, which may have been confusing for him. After moving in, he asked repeatedly when we were going back to the hotel, or back to our house, and I had to explain, gently, several times, that we were living here now, that this is our new house, and that we aren't going back to the other house.

Find lots of positive things to talk about. For myself as much as for the kids, I spent a lot of time listing the things that would be better or easier or more fun in the new location. At the same time, I acknowledged the things we would miss about our old town. Validate their feelings. There will be a mix of excitement and nerves, sadness about leaving friends but a little bit of the thrill of adventure all mixed up. It's okay to be sad. Yes, you'll miss your friends. I'm sad, too. I'm going to miss a lot of things about this place. But think of all the neat things about our new city! I was able to list many positives about the move, which helped all of us get used to the idea. We were fortunate to be moving closer to several family members the kids enjoy seeing, so we could talk about how they'd get to see these family members more often, for example.

Be honest. Our kids wanted to know why we were moving. We told them, to their level, the reasons. There were several factors that went into the decision, and they didn't need to know the entire decision tree, but they deserved to know that we had thought a lot about what we wanted to do. We uprooted them as much as we uprooted ourselves, and it was important to me that they understand that Mommy and Daddy made the decision we thought was best for the whole family.

Follow their lead. All kids are different, and some may have a great deal of trouble with the change while others will embrace it head-on. Don't make worries where none exist, but don't downplay the genuine emotions they have. If you can reflect and acknowledge what your child is actually feeling, they will feel more secure in knowing that you truly understand what's going on in their heads, and you can help them work through those complicated emotions.

Find some new favorite places. We immediately located and went to some favorite chain restaurants and new-to-us stores. We went to the grocery store, toured the neighborhood, and perused Google Maps for places we specifically wanted to go. This helped establish this new city as our home base right away.

Be kind to yourself. You will be under a great deal of stress. Go easy on yourself, and, especially, go easy on your kids. Everyone's emotions will be running high in the days leading up to the move and for a little while until you feel settled. Own those feelings, acknowledge them within yourself, and let go as much as you can. Eat off paper plates, cook as little as possible, take a few days off from work if you can. Moving sucks. There's no two ways about it. Don't bury the stress or you'll explode. Ask me how I know!

That's all I can think of right now. Have you made a major move with your kids? What would you add to this list?

Thursday, July 16, 2015

Let Me Answer That For You: A Response to All the [Negative or Unsupportive] Comments on Any Article about Nursing in Public

I don't know why I bother to read the comments on articles that reference breastfeeding in public. There's never anything new, and there are never any surprises, and I'm never left feeling like there's any hope for humanity. But I persist. I keep hoping to see something different.

Take, for example, an article on The Huffington Post yesterday. It was entitled, "Why Breastfeeding Moms Are Praising Target". The article shared a picture from Facebook that shows major retailer Target explicitly stating its policy on how employees should treat breastfeeding mothers in all Target stores. The policy states:
"Guests may openly breastfeed in our stores or ask where they can go to breastfeed their child. When this happens, remember these points:
  • Target's policy supports breastfeeding in any area of our stores, including our fitting rooms, even if others are waiting
  • If you see a guest breastfeeding in our stores, do not approach her
  • If she approaches and asks you for a location to breastfeed, offer the fitting room (do not offer the restroom as an option)
If you have any questions, partner with your leader."
Breastfeeding mothers are lauding Target for making it abundantly clear that they are welcome to breastfeed anywhere in a Target store, that they will not be approached or harassed by Target employees, and that employees are to offer a fitting room - and not a restroom - to a mother who asks for a private location to breastfeed.

Because I apparently enjoy a trainwreck as much as the next guy (or girl), I clicked on the comments on HuffPost's Facebook post about this article.

And, as usual, there were no surprises.

So, I present: "Let Me Answer That For You," a response to All The Comments, Ever, on any article discussing breastfeeding in public.

"I don't want to see that." 
Then I have good news for you! You don't have to look! And if you happen to be looking in my direction and are *gasp* treated to a brief view of some side boob or flabby mommy-of-4 tummy, then may I offer you some eye bleach? There are lots of things out there I don't want to see. You know what I do about it? I look in another direction.

"There are children watching."
Uh huh. And I bet a lot of those children breastfed and will go up to have babies who breastfeed. I bet none of those children are offended by what they are seeing. I bet none of those children have any reason to think they should be offended by what they are seeing. I guarantee not one of them will be psychologically damaged by witnessing a baby eating. I am 100% certain that my breasts do not produce harmful radiation, project dangerous laser beams, or are bright enough to cause retinal burns. And if your child turns to you and asks, "What is that lady doing with that baby?", all you have to do is say, "She's feeding him," and your child will go back to telling you about brown dogs, fire hydrants, and how they don't like broccoli.

"There are men around. You know how they are!"
To be honest, I see more negative comments from women than men about public breastfeeding. Most men don't seem to care one way or another, and I've certainly never felt that one is staring at me hoping for a nip slip. And if he is? That's his problem, not mine. Why do you care?

"You should time your errands around your child's feeding schedule."
No. I shouldn't. I shouldn't have to. First of all, what if I have more than one child? What if I have this exact two-hour window between preschool drop-off and pickup to run to Target to buy diapers, hit a grocery store to replenish the milk and eggs we used up at breakfast, ship some stuff at the post office, and deposit a check at the bank? And what if, shocking as it may be, my baby happens to get hungry during those two hours? It's quite likely that she will, and when she does, if I don't feed her, she will scream. She will cry. And then you will look at me and say to your friend, judgmentally, "Ugh, why is she letting that poor baby cry?" Babies don't always have predictable feeding times. Exclusively breastfed babies may sometimes go two hours between meals and other times, sometimes on the same day, go only 45 minutes between meals. And a key to maintaining healthy breastfeeding is to feed when the baby is hungry, whether you're at Target or sitting in your bedroom. Besides, if I get hungry while I'm out, I'm very likely to grab a bite to eat. If I have my preschooler with me and he gets hungry, I'll give him a snack. Why does my baby have to be different just because her "snack" comes from my breasts instead of my diaper bag or McDonald's?

"Why don't you pump before you leave so you can give them a bottle while you're out?"
Where do I begin, here? Well. (a) Some babies refuse to drink from a bottle; (b) Many women do not respond well to the pump and can't express enough milk to fill a bottle; (c) Maybe I did just that but he got hungry again and I don't have another bottle for him; (d) If I don't pump on a regular basis, I probably won't be able to produce enough during the rushed 15 minutes before walking out the door to provide that bottle; (e) Feeding from a bottle is not the same as feeding at the breast, and it's a million extra steps instead of simply latching on and going; (f) Don't nobody with a young baby got time for an extra pumping session before running errands! (g) When, exactly, should I pump? Between feedings? Should I leave him crying in his car seat while I squeeze out a few drops of milk before I load up the car and go? Do you have any idea how much longer it takes and how much more work it is to pump as opposed to just feeding from the breast? I have a family to raise!

"Leave the baby at home when you go out."
With whom? Are you volunteering to babysit? Because, actually, running errands without my baby in tow sounds heavenly, but I'm it when it comes to childcare. Also, what if she gets hungry while I'm out? Who's gonna breastfeed her? You? See above for reasons I might not be able to just leave a bottle of pumped milk. And, yes, I'm aware that formula exists, and, no, I don't want to give him any. Thanks for the tip.

"Breastfeeding should be a private and intimate act."
Do you set up a romantic, private table, with candles and wine, for every meal? Does your family never shovel food in their mouths while packing up for school and running out the door? Is every meal in your home a private bonding moment? No? Because neither is every breastfeeding. Sometimes breastfeeding is just feeding. It's a meal. It's a brief stop in between returning books at the library and getting gas. Yes, breastfeeding in a quiet room, just me and the baby, can be very nice, but there isn't always time for that, and it isn't always appropriate. Sometimes, you just gotta feed the baby and move on.

"Just because it's natural doesn't mean everyone needs to see it. Sex/urinating/defecating is also natural!"
I really don't want to have to go there again, but I will, since you brought it up. Breastfeeding does not involve unsanitary bodily fluids such as urine, nor waste products such as feces. Breastfeeding is feeding. Breastmilk is food. Just because it happens to involve the breast does not mean it's the same as having sex. We do not flush breastmilk down the toilet. We do not have sex as a form of nourishment. We do not eat in the bathroom. Orgasm does not provide calories, fats, vitamins, and minerals to help us grow. Give me a break. It's not the same thing. Hugging my child is natural, and I do that all the time in public. Eating a salad is natural, and I do that all the time in public, too (okay, maybe a hamburger, not a salad. You caught me). On the other hand, driving a car, wearing clothes, and getting a manicure are not natural, but we do those things in public. Your logic doesn't hold.

"Why do you want your boobs hanging out?"
I don't. But apparently you do in that low-cut top. You can't see much when I breastfeed. Frankly, if you glanced at me while I'm breastfeeding, half the time you probably wouldn't even realize what I'm doing. And even if you did, the most you'd see is my flabby tummy, not my boobs. If that offends you, I sincerely apologize. I haven't had a chance to meet with my personal trainer, dietitian, and plastic surgeon because I'm busy caring for my family.

"I don't mind if you breastfeed in public, but you should cover up when you do."
Oh, thanks for that. I don't mind if you chew with your mouth open in public, but I wish you'd throw a blanket over your head when you do. What, you don't want to eat with a blanket over your head? My mistake. All snark aside, some babies refuse to nurse under a cover. Many babies will pull it aside, kick it, grab it, or swat it away. A cover makes it more difficult to see while you latch the baby on. A cover is hot. A cover slips off. And, frankly, a cover draws MORE attention to what I'm doing than if I just life my shirt slightly, latch baby on, and go on about my business. Plus, it's yet another thing to carry.

"Why don't you go do it in a [private location such as a car or bathroom]?"
Sometimes I do, although usually not the bathroom. But when I've got a half-full shopping cart, or I'm in the middle of a meal at a restaurant, or I'm watching my other children play at the park, it's impractical or impossible to find somewhere else to breastfeed. I don't want to feel isolated. I don't want to have to leave my companions. I don't want to feel segregated or left out. And I don't want to pull my other kids away from their play or their meal so that I can go somewhere else to feed their baby brother. That seems quite unfair to them, don't you think? I don't want to abandon my cart in the middle of the grocery aisle. I don't want to interrupt my shopping process. And I really, really don't want to sit in a dingy bathroom to nurse.

"Wait until you get home. The baby won't starve."
He might. And even if he won't, what if I won't be going home for a few more hours? What if home is an hour away? And in the meantime, he'll be screaming and crying, getting more and more upset, becoming distressed. My breasts will be filling with milk with nowhere to go and I'll be in pain. If my baby is struggling to put on weight, or I'm struggling to maintain a full supply of milk, feeding on demand and not delaying feedings is vital. Yes, vital. If it'll be 10 minutes, yes, sometimes I will wait until I get home because we'll both be more comfortable there. But if it's going to be three hours, waiting until I get home is simply not an option. He'll probably need to feed twice more in that time!

Whew, I'm glad to get all of that out of my system!

What other hurtful, unsupportive, or negative comments have you seen when it comes to breastfeeding in public. How would you respond to these common ones I've listed?

Monday, May 18, 2015

A History of Sleep Deprivation

I've been enjoying the TimeHop app on my phone. It's fun to see old Facebook posts about things my kids said, or pictures of them, or other random happenings, or information I came across and wanted to share.

What has struck me, though, is just how many of those posts are about sleep, and how I wish I could get more of it.

Since I've been on Facebook for about seven years, give or take, some of these posts go back pretty far, at least to S's infancy. And almost daily, one of the posts from one of the years going back to when S was a baby has said something along the lines of, "I hope [whichever baby] lets me sleep tonight," or "WHY is [baby] not asleep yet?" or "I need more coffee," or "[Baby] actually slept through the night last night!"

And I'm still feeling that way, with Y approaching 19 months. Sleep is such a feature when it comes to babies and toddlers, it's such a central theme. I've had a baby or a toddler in my life nonstop for 8-1/2 years now, and in all that time, I've had just a few months here and there in which everybody in the house was sleeping through the night. This is not an exaggeration. It's simple truth. My Facebook history is witness to that.

Sleep is such an issue that there is a whole growing industry of "sleep consultants" who will meet with you in person or virtually, assess your baby's sleep habits and environment, and give you a personalized plan to get your baby sleeping through the night. A consultation and plan, with follow up, can run in the hundreds of dollars, and I imagine many parents feel it is money well spent. I feel like I know enough about infant sleep that if I had the will and the strength, I could do all this myself and have my kids sleeping through the night. But since I don't have that willpower, I don't think I could bring myself to follow someone else's plan, either. I'm not saying you shouldn't use a sleep consultant if you think it will help. I'm just saying I don't think it's the answer for my family.

The problem is that there is such a wide range of advice and rhetoric around infant and toddler sleep. At one end of the spectrum are those who say that by three to four months of age, you should put your baby in a crib in a dark room at a set bedtime, shut the door, and walk away, and don't return until the time he is "allowed" to wake up. No amount of crying from him should sway you to comfort him or in any way appear to be giving in to him. Because, they say, babies need to learn to sleep on their own, and if they don't learn it young, it will be harder and harder to learn it as they get older!

At the other end of the spectrum are those who say that a baby needs what she needs, and you should respond every time she asks for you. Indeed, if she needs to sleep in bed with you and suckle at your breast all night, then that's what you should do so that she feels safe and protected and secure, and so she knows that you will always be there for her. Some kids will need to sleep with you until they're five or six, but most will ask for their own bed at some point. After all, they say, in other cultures, the whole family sleeps together in one big bed anyway, so why do we in the West think it's wrong?

With this kind of contradictory advice about what you "should" be doing for your baby, and what your baby "should" be doing, what is a new parent to believe? Who's right?

I think both are right. And neither. I think parents and baby have a right to a good night's sleep, have a right to their needs being met, and have a right to negotiate the best possible sleep for everybody. I adamantly disagree that if you don't "teach" a baby to sleep through the night when he's six months old, then he'll be waking at night for years. I also adamantly disagree that if parents are simply uncomfortable allowing a baby or toddler to sleep in their bed, they should do it anyway for the best interests of their child.

How you go about finding this middle ground will vary depending on your personality and parenting style. I'm a hands-off type, and after four kids, I've learned that eventually you hit a wall and have to make a change, and usually at that point it's easier than you expected it to be to make that change. I'm also lazy about enforcing a schedule or pattern, and I am pulled in too many directions at night to focus so strongly on just one of the kids. Usually I get a sense of what I need to do, then find a way to work up to it, and then suddenly implement the new rule, which takes a few nights or weeks to stick. I tend to take things in stages. First, put him in his own bed (as opposed to mine). Next, wean him from needing to nurse at night (in the hope that if he doesn't have that to wake up for, he won't bother waking up). Finally, if he is still waking for comfort even if he's not nursing, help him learn self-soothing techniques so he can put himself back to sleep instead of calling for me. This was the general process I did with G starting at about 15 months, and it took about eight months until he was totally falling asleep on his own, in his own bed, and sleeping through until morning without waking me.

I have the benefit of knowing that they do eventually sleep through the night. My 8 and 6-year-olds take their own bath or shower, get themselves in PJs, and read to themselves in bed, then put themselves to sleep and sleep through until morning (barring illness, bathroom, or nightmares, of course). Neither was always that way, and indeed both woke me many, many, many times at night until I finally decided to attempt a change. Change is slow but inexorable, and eventually you realize, hey, it's been a while since I needed to tend to him at night!

I'll be starting the next stage of this process with Y soon. He's already sleeping in his own bed, but, unfortunately, I usually end up sleeping there with him most nights. He also nurses several times a night and nurses to sleep for naps and bedtime as well. My next project will be to night-wean him, so that he no longer needs or asks to nurse at bedtime or throughout the night. I hope that he will simply start sleeping through the night at that point, but, judging from my experience with G, I will probably have to tend to night-wakings for a few more months, and possibly do some light sleep training, before everyone in the house goes to bed, goes to sleep, and sleeps through until morning.

What a luxurious time that will be!

Maybe a few years from now, when I look at my TimeHop or my Facebook history, I won't be inundated with complaints about my babies' sleep. Instead, I'll be relatively well-rested, alert, and able to focus more of my energies on living life, instead of craving sleep.

I wish you all good nights and good sleep.

If you have any questions about infant sleep, I've written on this subject many times. Check out the sleep tag for lots of stories and information.

Wednesday, May 13, 2015

Socks for Mother's Day

I wear socks All The Time. I hate walking around barefoot, but I also hate wearing shoes indoors, so I tend to kick off my shoes when I get in the house and then walk around in my socks all day. (I'm in my house almost all day, most days.) The unfortunate consequence of this habit is that my socks wear out pretty quickly and need replacing.

The problem is, one of the last things I would think to buy for myself is socks. There's always something else that needs buying. The kids need new clothes and shoes. There's a field trip coming up. Everyone needs haircuts. We need groceries, diapers, baby wipes. This bill or that bill is due. Socks? Who would put socks on the list when there are so many more immediate needs to fill?

And so, on Mother's Day three years ago, my husband left me to spend the day with my mother and G, who was a baby at the time. He took N and S, the two older boys, off to have lunch and go shopping. When we reunited later that afternoon, he handed me two big packages of socks that he and the boys had picked out for me. One set had various types of smiley faces on them. Another was colorful with various patterns. No boring socks around here!

I thought it was such a great idea, to get me socks. It's not an extravagant gesture, but I don't need or want extravagance. I feel guilty when I spend our money on myself, and something expensive and overwhelming would make me wonder what bill I now couldn't pay because of money spent on something I didn't really need. But socks are useful, and I could tell he had picked out ones he knew I would like.

This quickly became a tradition, and now every year on Mother's Day, I receive several pairs of fun new socks to replace the ones that are wearing out.

This year, my husband outdid himself and entered into a conspiracy with my aunt to purchase not only socks but a pair of slippers, to be delivered to her house and paid for with her credit card (he reimbursed her with a check) so that I couldn't see the charge on our bank activity! I had mentioned in passing a while back that I should get some slippers, and he remembered and sought out a pair for me.

Mother's Day is about honoring the mother or mothers in your life. It's about thinking of them, and letting them know you're thinking of them. Even though it's a small thing, socks for Mother's Day, to me, means, "Here, you deserve to take care of yourself first once in a while." It means, "I noticed your socks all had holes in them, and that can't be comfortable to walk around in!" And it means, "I remembered that you wanted slippers, so I got you some."

What are your "socks" for Mother's Day?

Friday, May 1, 2015

More on Vaccination: A Simple Risk-Benefit Analysis Regarding the Measles Vaccine

The other day, I took my perfectly healthy, 18-month-old son to the doctor. The nurse weighed him and measured his height (27lbs., 4oz., and 33.25"). The doctor looked in his eyes, nose, mouth, and ears, felt his abdomen, listened to his heart and lungs, asked some questions about his development. Then the nurse came back, and I held him still for a minute while the nurse swabbed his bare thigh with some alcohol and jabbed him with a needle. My son cried indignantly. I put his pants on, thanked the nurse and doctor, declined to make a further appointment at the moment (his next checkup will be when he turns two), and left the office. I buckled him and his brother into their car seats (checking to make sure their straps were properly tightened and their chest clips were aligned with their arm pits), then drove them to the park, where they played for an hour with a babysitter while I went to appointment of my own. It was a sunny, gorgeous, perfect day, and the boys had fun going down the slides, swinging, and eating a snack. I picked them up, buckled them carefully into their car seats again, and drove to McDonald's, where they ate a special lunch. Then we got back in the car and drove home, following traffic laws. I nursed the toddler in his bed, and he fell asleep and took a nap while his brother watched TV. The rest of the day was similarly uneventful.

The next day while getting the toddler dressed, I checked his thigh where he had been given the shot and couldn't find the spot where the needle went in.

Today, he is cheerfully playing with his brother in the living room. We're going to the supermarket soon. Later, we'll go see the oldest in the school talent show and have tacos for dinner.

If you're waiting for some kind of dramatic, "AND THEN," you're not going to get one. And that's the point.

I have "come out," as it were, as pro-vaccination. I believe that vaccinations are one of the greatest medical advancements and discoveries of the past several centuries. I have seen the data and charts and listened to the expert researchers. I have read articles by people who believe vaccinations are in some way harmful and do not find their arguments to be convincing. All four of my children are and will continue to be vaccinated according to the schedule recommended by the CDC and their pediatrician. The only vaccination I refuse is the hepatitis B shot at birth, because I have done my research and learned that the purpose of the newborn hep B vaccination is to prevent vertical transmission of hepatitis B from the mother. Since I know I do not have hepatitis B, I feel it is unnecessary to give this vaccination immediately upon being born. My concern is that so much happens in the first day or two postpartum that I want to do as little as possible to disrupt my new baby's simple needs to be near me and breastfeed, while still taking the recommended courses of action when medically appropriate. Thus, my children begin the hep B series at their two-month checkup, along with several other shots.

You only hear stories about people who have a story to tell. When their day is as completely ordinary as mine was, it's not interesting. And since most of the millions of children who receive vaccines each year have completely ordinary days afterward, we don't hear their stories. See, it's easy to use scare tactics to drum up public outrage and support for your cause. And when you've personally witnessed a child who had a bad reaction to a vaccination, it's completely understandable that you would be scared that something like that could happen to your own child. I get that.

The problem is, what I encounter again and again when I see anti-vaccination rhetoric is a complete misunderstanding of statistics and how they work.

For example, someone might say: "Measles was on the decline before the vaccine was introduced." But that is not a correct interpretation of the statistics. Measles deaths were on the decline, due to better sanitation and medical care, but measles cases were still quite frequent, and so were complications of measles. According to the CDC: "In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles" [my emphasis]. However, "Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era."

Another misuse or misunderstanding of statistical information I see frequently is the assertion that while measles has caused no (or less than a handful) of deaths in the past 15 years, the measles vaccine has caused over 100. This represents a clear misunderstanding of how statistics and risk-benefit assessments work. Consider the number of measles cases there were in 15 years, and divide the number of deaths by that relatively small number. Your result is the risk of dying from measles in this century. The number of measles cases in the United States in 2014 was almost 600, and so far in 2015 is close to 200. So let's say there were 800 measles cases in the last year and a half (in the United States - there are millions of cases of measles yearly in other parts of the world and tens of thousands die from it). As far as I can tell there have been no deaths from measles in that same period - in the United States - or perhaps one. A toddler did die of measles in Germany recently (also a First World country with good sanitation and health care). If we say one death out of 800 cases of measles, we get a risk of 1/800 = 0.00125 or about 0.1% (which was also the risk of death from measles before the vaccine was introduced). Indeed, according to studies, the general risk of dying from measles is about 0.1 to 0.2%, or 1 to 2 out of 1000. Now, the only reasonable comparison to make with this is the risk of death from the measles vaccine. To find out the risk of dying from a measles vaccine, we need to know how many measles vaccines were administered in 2014 and how many died from receiving that vaccine, and do the same math. That number is harder to come by, but we can estimate. There are close to 4 million babies born in the United States each year. About 98% of these babies will receive an MMR vaccine at age 12 - 15 months. 98% of 4 millon = 3,920,000 (3.9 million). I can't find data on how many deaths are attributed to the measles vaccine in a given year, but for the sake of argument, let's take the CDC's report that there were possibly 3 deaths from encephalitis that apparently was caused by the MMR vaccine. (If I'm reading this correctly, that's three deaths ever, not three deaths per year, so I may be considerably overestimating this number. But, for the sake of argument, let's use it anyway.) So if three infants die because of receiving the MMR vaccine, out of 3.9 million who received it, that's a risk of death of approximately 0.000001, or 0.0001%. That's much smaller than the risk of dying from measles itself. If people stop vaccinating because they believe that the vaccine is more dangerous than the disease, then we will begin seeing deaths in the hundreds again, once mass outbreaks start occurring with the regularity they did in the 1950s and 1960s.

Of course, measles deaths aren't the only concerns. There are plenty of other complications possible from measles, not the least of which is that your child will have to stay out of school for a week or two, as will all of your other children as they almost inevitably come down with measles as well. This is an economic risk more than a health risk, but it's worth considering!

Now, I understand that if your baby was one of those three that died of MMR-related encephalitis, it is no laughing matter, and knowing the stats is no comfort. But sometimes, even if we do a proper risk-benefit analysis, and we make the obviously safer choice, we might still fall into the unfortunate, tiny percentage. That's true in many areas of life.

Here's a good example of how that kind of thinking works: Let's talk about seat belts. You won't find many people who would say that you're safer if you don't wear a seat belt, right? I mean, really, almost everyone agrees that you should wear a seat belt when you're in the car and that seat belts save thousands of lives every year. Most states have laws requiring some or all of a car's occupants to wear a seat belt when the car is in motion. Very, very rarely, we hear of a case in which a person's life was saved by the fact that they were not wearing a seat belt. Perhaps the car hit a guard rail and then went into a river, and if the driver had been wearing their seat belt, they would have gone into the water, but because they were ejected from the car on the first impact, they didn't drown. Most reasonable people would agree that there is a minuscule chance of being saved by not wearing a seat belt, and this is not a reason to quit wearing your seat belt regularly. There are far, far, far more cases in which people are saved because they were properly restrained, or, tragically, they died because they were not wearing their seat belt.

If you knew that one-in-a-billion person who was saved by not wearing a seat belt, you might be inclined to think that seat belts aren't as safe as the "experts" say they are, that wearing a seat belt is actually dangerous because it can cause bruising, or that wearing your seat belt means you'll be trapped in the car after a bad crash. You might be inclined to think that because your friend survived by not wearing a seat belt, this might happen to other people, too, and you wouldn't want to be the one who keeps wearing a seat belt and put yourself in danger of dying in a similar situation to the one your friend survived.

That all sounds ludicrous, right? The same type of arguments are made with regard to vaccines. Yes, unfortunately, tragically, some children suffer adverse effects from vaccines. A very, very small percentage of babies and children have experienced severe side effects related to receiving a vaccine. (Note: Study after study has failed to identify any risk of autism from vaccines. But other vaccine injuries do occur and are noted by the CDC on their website as possible complications.) I don't take this lightly. Indeed, I think more research needs to be done to try to identify individuals who are at risk of complications so they can be protected.

A final thought on this for the day.

If my car is broken, I take it to a mechanic to fix it. I might do some quick research on the internet to find out what the likely problem is and how much I can expect to pay to fix it. I might even look to see if it's something I can try to fix myself. But it is often the case that I need someone who knows more about cars than I do to investigate the problem and fix it. Sure, I could spend weeks learning all there is to know about my Toyota, find a supplier for the parts I need, and have a go at it, but most likely I would not do as good a job as someone who is an expert in the field. I haven't seen hundreds of Toyotas with this problem. I haven't fixed it dozens of times. I don't know all the pitfalls and tricks and shortcuts that can make the task easier, more efficient, and safer. And I might end up doing more harm than good if there's actually something else going on.

People specialize in various fields and become experts in those fields. Most people cannot be experts in everything. When we need information or action regarding a field we are not as familiar with, we consult someone who lives and breathes that subject. If we don't like what they have to say, we find another expert and get another opinion from someone who also lives and breathes that subject. If I don't like the quote the first contractor gave me for replacing the floor in my kitchen, I'll call another one. I don't know how to lay flooring and I don't think I'd do a good job. If I don't like the landscape design the first gardener proposed for my front yard, I might call another gardener and get his thoughts. I don't know anything about gardening and design, or irrigation systems, or native plants, so I wouldn't trust myself to do a good job.

In a similar vein, I can do some reading on the internet about vaccines, how they work, risks and benefits, and so on, but I don't trust myself to be able to completely assimilate all of this information because I don't understand all of it. I haven't spent years studying biology, epidemiology, immunology, statistics, anatomy, physiology, and so on. The best I can do is some shallow research, learn what questions I'd like to ask, and then ask the people who have spent years studying those things, and who live and breathe this kind of work, to explain it to me as best they can. And when those experts recommend a course of action - and not just one of them, but something close to all of them - then it makes sense to me to follow that advice.

This is also my stance when it comes to other aspects of life. For example, overwhelming evidence from decades of research has concluded that breastmilk is the optimal nutrition for babies and that breastfeeding results in healthier babies and a healthier population. Thus, I advocate for breastfeeding, breastfeeding education, and breastfeeding support.

When there is more ambiguity in the research results, such as those that report on various types and effects of diet and exercise, then I read what I can and make a decision I feel comfortable with based on what we know so far. I may also consult people whose opinions I trust for what they recommend or understand about the subject.

I understand enough about statistics to look at the statistics I'm given even by people who are against vaccination and make an informed risk-benefit analysis. I am comfortable - very comfortable - with my decision to administer vaccines to my children and to have appropriate ones administered to me as well. And, from the standpoint of public health, I understand enough about how disease spreads to know that it's important for as many people as possible to receive those vaccinations.

Wednesday, April 29, 2015

But WHY Is There A Correlation Between TV and Obesity?

I read an article the other day about a study that found (again) a correlation between TV watching and obesity in kindergartners and first graders. According to the article, the study found that these young children who watched more than two hours of TV a day had a much higher risk of being overweight or obese than children who watched less than one hour. But children who watched between one and two hours also had increased risk of obesity, even though the AAP suggests a maximum of two hours of TV per day for that age group. The takeaway here is, more than one hour of TV a day in 5 and 6-year-olds correlates to a greatly increased rate of obesity.

A simple response, then, is, "Kids shouldn't watch TV." But it isn't that simple.

Two things stick out for me.

1) This is a correlation, not a causation. They did not say that watching TV causes obesity. They even stressed that in the article. We see a correlation, but we don't know why. Why does watching more than an hour of TV seem to correlate to higher obesity rates? They also found that using a computer more than an hour a day did not have the same correlation to obesity, so it isn't the use of a screen, or the sitting and staring, that's a problem. It's the TV, specifically.

2) Didn't we already sort of know this? I mean, researchers have been studying TV watching for decades, and every so often they come out with another study that says, basically, "Kids are watching too much TV and it's making them fat." But they still don't know why. They used to think it was simply because TV was replacing physical activity, but that doesn't seem to be the case, exactly (see above).

Another article reported one older theory as to the reason TV watching correlates to obesity: It's the commercials. Kids are exposed to commercials that make them crave unhealthy food, and that contributes to weight gain. This is an interesting theory. To me, it makes sense, then, to study what kind of TV kids are watching, and how. With Netflix and other streaming services enjoying such high popularity these days, lots of kids are avoiding commercials. My kids rarely see commercials because they watch their shows on Netflix and Amazon Prime. So if there were a study that took two groups of kids, one that watches more than two hours of TV per day but exclusively on an internet streaming service, and one that watches more "traditional" network TV and are exposed to commercials, would we see a difference in obesity rates?

I'd like to offer a few other questions that should be asked.

- Are the kids who are sitting and watching TV more likely to be snacking while they watch?

If so, what are they snacking on? Perhaps kids using computers and iPads are not eating, because their parents don't want sticky fingers on the electronics. In this case, there should be a difference between TV-watching and other screen use, but there should not be a difference in Netflix versus network TV.

- Why are these kids watching so much TV?

Maybe the TV-watching and the weight concerns share the same underlying cause, rather than the TV directly causing the obesity. The L.A. Times article linked above said that the researchers controlled for variables such as socioeconomic status and demographics (which were the first variables my own mind jumped to for a possible explanation), but I'd posit that, for example, kids at home in the afternoon watching TV and snacking can cross demographic and socioeconomic lines, so there may be more that can be investigated here. My kids usually get up in the morning and watch some TV while my husband and I get ready. After school, I'm often working or getting dinner together and whatnot, so my kids, again, are watching TV while I do that. I'm lucky enough to live in a neighborhood where I can send my older two outside on their bikes to play most of the time, but there are plenty of kids in all demographics who don't have that luxury. Learning more about the environment these children spend so much of their time in would be helpful.

- What's the difference between using computers and playing video games and watching TV?

Why is computer use not correlated with obesity but TV is? Is it because the child's brain is more actively engaged when playing a video game than when he's sitting passively and watching TV? What is the fundamental difference, here? I watch my 6-year-old play video games and he's jumping up and down and shouting and generally enjoying a full-body experience while he plays. That same 6-year-old will then sprawl on the couch like a lump while watching Ninjago or My Little Pony. There's a clear difference in physical engagement with the media. I feel strongly that this issue requires more study.

My kids watch a lot of TV, so this data concerns me. My kids also play video games and use the computer, so it's not just hours of TV every day, but they do watch a lot of straight-up TV. I know why and how they've ended up watching so much TV, and the ball is squarely in my court to make the change, if a change is needed. Now, while my oldest admittedly is struggling with his weight, my other three are of average weight for their height and age, and I don't think the reason for my oldest's being overweight is that he watches TV. Frankly, my younger three have watched more TV at a younger age than he did. Now, an anecdote is not data, and my family by itself is not statistically significant, but the results of these studies may still affect my parenting. As a parent who likes data and science and evidence-based philosophies, I really want to know more about this phenomenon so that I can make an informed decision about my children's screen use. If I am given a compelling reason as to why there is this correlation between weight and hours of TV, then I can decide if I need to cut way back on the screen use or if there are other factors I can control that will mitigate the effect of the TV itself.

I watched a lot of TV as a child. Even in the 1980s, researchers and doctors were becoming concerned with the strong association between hours in the front of the TV and weight. I was far from an overweight child despite my television watching habits. But there are many more options out there now than when I was a kid, and there are other screen-time possibilities besides simply switching on the tube and watching what's on. There are other ways to watch TV, such as on a tablet, computer, or phone. There are premium and subscription services. There are tablet games and phone games and PlayStations and XBoxes. "Screen time" doesn't just mean TV time anymore, and it's very important to sort out what's the most harmful and why and to figure out what, if anything, can be done to help improve the situation.

Sure, it's easy to say, "Watch less TV." But sometimes that's not as easy as it sounds.