Monday, April 28, 2014

How Does Milk Production Work in the Early Days Postpartum?

The first few days and weeks after your baby is born can be confusing. You have so much to learn and so many things to worry about. It's stressful and scary. You want to be sure you're doing the best you can for your baby, and that includes making sure he's getting enough to eat. When you're breastfeeding, it can be hard to tell how much your baby is taking in and whether it's as much as he needs or wants.

So let's talk about how milk production works in those early days, so that you can be more confident that your baby is satisfied.

You start producing the early milk, called colostrum, between 10 and 14 weeks of pregnancy. Colostrum is milk, but it's not the mature milk you'll see a few days after your baby is born. Rather, it's a highly concentrated, thick, golden liquid consisting mostly of protein, beta carotene, and antibodies. Colostrum is sometimes called "liquid gold" because it is so valuable to a newborn baby to help protect his tender new gut, support his undeveloped immune system, and prepare him for life outside the womb.

10mL (2 tsp) of colostrum pumped on my baby's second night of life.

The presence of the placenta and the progesterone it produces keeps your milk volume low, so you won't produce mature milk until after your baby is born and the placenta is expelled. Your levels of prolactin - the hormone that tells your breasts to produce milk - are very high at the birth of your baby, but it's just floating around in your blood stream with no way to send the message until you start actually nursing a baby. The action of the baby suckling at your breast (or of a breast pump or hand expression) creates "prolactin receptors," places for the prolactin to attach within the breast so that the message to produce milk can be sent. The takeaway from this is simple: The more you nurse your baby in the first 3 days of life, the better your milk supply will be even months down the line.

Now, once the baby is born and the placenta detaches, your levels of progesterone, the hormone produced by the placenta that supports the pregnancy, drop, and you've started establishing prolactin receptors. This paves the way for the prolactin to do its job, and your body will begin producing more milk - and that milk will be the mature, watery, white substance we think of when we think of "milk."

It takes about 48 to 72 hours for your milk volume to increase. In the first two to three days of your baby's life, he does not need to eat much. Remember that he was being constantly fed by the umbilical cord while inside you, and his intestines are full of meconium - a greenish-black, tarry substance that coats the intestines. There isn't room for much food until the meconium is cleared out. Colostrum, along with all of its other amazing properties, acts as a laxative to help clear out that meconium. Your baby's stomach is very tiny at first and cannot hold more than about a teaspoon (5mL) of milk anyway, so it doesn't take much for him to feel full. Remember, in the last few weeks of your pregnancy, he was packing on fat stores to help him survive these first few days of life where he suddenly isn't eating much.

Though your baby isn't super hungry at birth, he will have a high need to suck. This high need to suck serves a few purposes. First, when the baby suckles at the breast, it stimulates the release of oxytocin, which helps the mother's uterus shrink back down and slows her postpartum bleeding. Second, as mentioned before, it helps set up receptors for the milk-production hormone called prolactin. Third, the sucking stimulates the baby's intestines to start moving out the meconium to make room for the milk. Finally, newborns find sucking comforting. Babies even suck on their hands inside the womb!

Remember that breastfeeding takes practice. The best thing to do in these first few days postpartum is to bring the baby to breast absolutely as often as possible, at least 12 times in 24 hours, or as often as the baby asks. The quickest and easiest way to learn your baby's hunger signals is to start out by offering the breast every time your baby fusses. You'll begin to recognize certain movements of his head and mouth that indicate that he wants to nurse. You'll learn the different types of cries that mean he's hungry or tired or uncomfortable. By offering the breast every time your baby seems fussy, you'll give yourself and the baby every opportunity to practice nursing and to establish those prolactin receptors and build your milk supply!

By about 72 hours after the birth, you should notice that your breasts feel fuller and are now producing something that looks a great deal more like "milk" than the colostrum did. Some women find they become extremely engorged literally overnight, while others notice a more gradual increase in volume. If your milk hasn't increased in volume by about 72 hours after birth, you may need to speak with a lactation consultant and/or your baby's pediatrician about providing supplemental donor milk or formula until you have a greater volume of milk available. It is important that your baby start eating so that he can grow.

Once the milk supply does increase, you'll want to know that your baby is getting enough to eat. You can monitor how much the baby is getting by counting diapers - what goes in must come out! A 3-day-old baby should have three wet diapers and three poops per day. A 4-day-old should have 4 and 4. A 5-day-old should have 5 and 5, and after that, there should be at least 6 pees per day and anywhere from about 3 to 6 or more poops. In order to be sure that your baby is really producing at least that many wet diapers, you need to check your baby's diaper at least that many times per day. If you're not sure how to tell if the diaper is wet, or you are concerned that your baby isn't wetting as often as he should, you can place a piece of tissue in a clean diaper. When you check the diaper, if the tissue is wet, then your baby has peed.

Another way to reassure yourself that your baby is getting enough to eat is to watch his growth. Your pediatrician will want to see your baby several times in the first two months of life. Your baby should be gaining at least half an ounce a day, if not more, and should be back up to his birth weight by the time he's 10 to 14 days old. Even if you don't get to weigh your baby often, you'll notice as he starts outgrowing his clothing and diapers, becomes heavier for you to hold, and starts to fill out.

If you're concerned that he's not taking in milk, you can do what's called a "weighted feed," where you weigh the baby hungry, then feed him, then weigh him again on the same scale with the same amount of clothing. This requires a sensitive baby scale that can measure in small increments. Many baby boutiques and lactation consultants will have scales like this available to do weighted feeds and to check your baby's growth. Typically, a newborn baby will take in about 2oz. of milk in a feeding, which you can see because he'll be 2 oz. heavier after feeding!

Finally, you can tell if a baby is getting enough by making sure he's not dehydrated. His eyes and mouth should be moist, skin should be smooth and not have dry patches, and the fontanel (the soft spot on top of the head) should not be sunken. He should not be lethargic or floppy, should have periods where he's awake and alert, and should wake on his own to eat. If you see orange urine crystals in his diaper or he has fewer than six pees in 24 hours after day 5 of life, call your pediatrician immediately. Dehydration in a baby can be very serious but is also very treatable.

If you have any reason to be concerned about your baby, don't hesitate to call your pediatrician. Trust your gut. If your baby is not himself, it doesn't hurt to have him looked at. Often the nurse can listen to your concerns on the phone and help you determine if the doctor needs to see the baby.

Remember that a newborn typically eats 12 or more times in a 24-hour period, but that doesn't necessarily mean he's eating exactly every two hours. He might eat three times in three hours, then sleep for three hours, then eat twice more in the next four hours, then sleep for two hours, etc. Watch the baby, not the clock, for when you should feed him next, and follow his cues.

The best way to ensure that your milk supply is healthy and your baby is well-fed is to simply nurse, nurse, nurse. Avoid artificial nipples such as pacifiers and bottles until at least three to four weeks of age, when breastfeeding should be well established. Have your baby's latch evaluated if you have any pain while nursing. Sometimes it may look like your baby is nursing well but he's actually not transferring milk efficiently. Listen for the sounds of swallowing and for a suck-swallow-breathe pattern. If your baby is sucking but not pausing to swallow or breathe, he may not actually be getting any milk, or not enough to trigger the swallow reflex.

Check out my videos on newborn nursing to see what it looks like (and sounds like!) when a tiny baby nurses!

Thursday, April 24, 2014

Guest Post: Baby S's Birth from His Father's Point of View

My husband was kind enough to share his thoughts about our oldest son N's birth here. He issued a challenge for us to reach 200 likes on the Facebook page before he'd write about his impressions of S's birth. So, here is the long-awaited second chapter, S's birth from his dad's point of view.


I know I promised I’d write this when the Facebook page got 200 likes. It passed 200 likes a while ago, but better later than never!

So, birth number two, our son S. I will come right out and say, this one was the hardest for me. For starters, it happened much earlier than we expected. In the afternoon Jessica went for her regular doctor’s appointment, and a few hours later she called me to come to the hospital because they were going to induce her due to high blood pressure.

We were pretty new to the area and did not know many people. We had no one to leave N with, so I brought him with me to the hospital. This was fun for a while. We hung out with Mommy, and he was on his best behavior and really sweet and cute. 

Later on, as my wife’s labor got more intense, we played “Let’s scream with Mommy!” By then it became obvious that we needed to find a solution for him. He couldn't stay there anymore. We eventually found a friend who could pick him up and bring food for me, but it would take him some time to get there. I was hoping he would make it before the birth!

Let’s back up a little. By the time I got to the hospital, Jessica was already in her Labor and Delivery room, and ready in the hospital gown and hooked up to an IV, and assigned a nurse. This already felt weird for me. I got there later; I did not take her there. I felt like I was just a spectator. The nurse was flaky, weird, and, well, I did not like her very much. In return, she seemed to not care for me much either. She pretty much ignored me most of the time. I was there with my wife, but detached from the process. Of course, having N there with me, distracting me from the labor, did not help that much either.

Finally, our friend arrived and I took N out to meet him. N was screaming and unhappy; he thought he was going home with me. I felt terrible about that. By the time I got back up to Jessica’s room, she was already pretty advanced. I do not remember much from the whole birth. I only remember feeling like I was not wanted there by the medical staff, by the nurse. I resented that for quite a while. I kept reminding myself that it is not about me, I am just there to support my wife, and will do what she needs me to do.

S finally arrived, vaginally. I was happy for her, as this is what she wanted. They placed him on her, as she wanted him skin-to-skin right away. He was just with her, he was her baby. I think I did not get to hold him until much later, maybe it was next day when brought N to see him, maybe it was when we brought him home. I just recall feeling like I had very little to do with anything at that point, and fighting the feeling that I did not think this was right, insisting to myself that this moment was about her. I was there to support her. I became edgy waiting for the nurse to come back, to move to another room, settle down, so I could go back home and pick up N from our friends’.

Finally the flaky, cheery nurse who ignored me (bear in mind, I might have imagined that she was ignoring me – that’s just how it felt to me) came back and took us to the postpartum room, but not before triggering a bunch of alarms because she went through the wrong door with the baby. After that, I was free to go and pick up N. I had great time with him for a few days, just him and me. But, I was bitter about the birth. I had wanted to be part of it, like last time. I did not want to feel like a guest at my own kid’s birth!

Today when I think of it, I realize what I did wrong. It was my mistake. I was trying to be there for her only. I did not factor myself into it at all. Partly because of what I felt, part because this is what society tells us, or was telling me at the time, men are only guest at the birth, they shouldn't interfere. But in the end that’s what caused me to feel so alienated, to be so frustrated. The fact that I ignored my own wishes, never spoke up to her or the medical staff about how I wanted to be involved. I just accepted it as it was. I made myself not important. I made myself just being there. Sure, it might have been done with good intentions, but unhappiness in any relationship is not good. It left me distant from S for a very long time after his birth.
My only advice for men would be, take a stance, but accept hers as well and be ready to be wrong. Because speaking up for what you want and letting her know what you think is support, too. It is what opens up a dialog and shows her that you are interested in the process and want to be a part of it. Just accepting her wishes creates a distance and disinterest for yourself in the birth and in your baby.

That, and bring food. Always remember food.

Saturday, April 19, 2014

What Did I Make Tonight? A Go-To Simple Sauce

It can be nice to have a few "go-to" methods and recipes in your head when you cook on the fly. You use that as the base of your dish and build dinner around it. A couple of years ago, a friend posted a recipe she found for pad tai with a simple-yet-delicious sauce consisting of soy sauce, lime juice, and brown sugar. I memorized the sauce recipe and ran with it, and I use variations of it often over stir-fried vegetables, noodles, rice, Israeli couscous, or quinoa. I use it with tofu and chicken. I use it with fake ground beef and with real meat. It's insanely, ridiculously adaptable, malleable, EASY, and tasty!

The original recipe called for:
3 tbsp soy sauce
2 tbsp lime juice
2 tbsp brown sugar

You mix that all together and then pour it over the pad tai and stir fry everything for a minute or two. (I'm not writing a pad tai recipe here, but that was the inspiration for this sauce.)

The key pieces to remember are soy sauce, acid, sweet, and the ratio is 3:2:2. Now, you can build a sauce using whatever you have.

I rarely have fresh limes around unless I plan ahead, but I always keep rice vinegar in my refrigerator. I also try to keep soy sauce and brown sugar stocked. So my "I have this in my pantry" variation is:

3 tbsp soy sauce
2 tbsp rice vinegar
2 tbsp brown sugar

You can substitute white sugar, honey, or agave syrup easily for the brown sugar, and you can use any acid in place of the lime juice or vinegar. Lemon juice would work, as would regular white vinegar, apple cider vinegar, or red or white wine vinegar. Each version will have a slightly different flavor, tending toward more tart or more sweet depending on what you use. Experiment and see what you like best.

When I'm cooking for the whole family, I usually need to double the amount of sauce, so it becomes 6:4:4 instead of 3:2:2. And I usually just grab a soup spoon to get approximate measurements. I don't always whip out the official measuring spoons!

To use the sauce, I first stir-fry vegetables, meat, and/or tofu in a skillet (I'll describe this in more detail in another post). I cook my starch (rice, couscous, pasta, rice noodles, etc.) appropriately, then add the cooked starch in with the stir-frying veggies and protein. Pour the sauce over the whole thing, bring to a simmer, and let it cook for five minutes or so, stirring frequently, to incorporate the flavors.

You can play with this further by adding ground ginger and garlic power (or fresh minced ginger and garlic) to the basic sauce (a teaspoon or so). For some heat, 1/4 tsp cayenne pepper, a few dashes of sriracha, or a squirt of some other hot sauce will do nicely, or try red pepper flakes (found in the spice aisle as well).

Monday, April 14, 2014

Yes, I'm "Still" Breastfeeding My Toddler

My third son, G, is now 31 months (that's 2 years and 7 months for those less month-county than I am). I had originally thought I would nurse him until he was two, as I had his older brother. However, during my fourth pregnancy, my milk dried up for the most part, several months before G turned two. I allowed him to continue to comfort-nurse and drink any colostrum he could extract, but I knew he wasn't getting all the benefits of breastmilk I had hoped to keep providing.

After Baby Y was born, when G was around 25 months, my breasts sprang back to life, overflowing with milk once again. I hadn't planned to "tandem nurse" - breastfeed more than one child at a time - but it sort of just happened that way. I hadn't stopped G from comfort nursing, and when he was actually getting milk again, he loved nursing even more.

In the early days, when Y was very little and needed to nurse often, I tried a few times to nurse the baby and G simultaneously. It was awkward and uncomfortable for me, but it was also the easiest way to please both of them.

Now, though, five months on, I don't try to nurse them simultaneously anymore. I leave the baby somewhere safe and happy, and I take G to his bed or mine. I find I don't mind nursing G by himself once in a while. It's a wholly different experience from nursing the baby. G only nurses once a day, at naptime, and not even every day. It's so easy to get him to lie down in bed and try to take a nap if I offer to let him nurse! It's incredibly cute how excited he gets when I agree to nurse him. He races down the hallway exclaiming, "I gonna nurse! You gonna nurse me! I gonna nurse! I gonna nurse in my bed!"

I've asked him what the milk tastes like, but all I get in response is "milk." Which is hard to argue with.

For those who are concerned about having enough milk for a toddler and a baby, you can absolutely nurse two children. Remember that your body makes milk based on the demand, so if you have a toddler and a newborn both demanding milk, your breasts will produce enough milk for both. See my series on nursing through pregnancy for more information about tandem-nursing a toddler and a newborn. My milk supply this time around is copious, partly because of my daily pumping in the first few weeks postpartum and partly because I nurse my toddler several times a week in addition to the baby's exclusive breastfeeding.

I never set out to be nursing a 2-1/2-year-old. I didn't have a specific plan for how or when to wean him completely. When his baby brother was born relatively close to his second birthday, I didn't think it was fair to G for Y to usurp his place at the breast at the same time he usurped his place as "the baby." We had long since night-weaned, so I didn't have the stress of trying to nurse two kids through the night. That might have affected how I felt about continuing to nurse him. Now, I would rather just nurse him once every couple of days than to deal with the tantrum and tears when I refuse. I'm sure if I refused enough times in a row, he would stop asking, but I don't see a reason to put us both through that stress right now.

I think when we talk about nursing an older toddler, one who speaks in complete sentences and has a mouthful of teeth and eats plenty of healthy foods and drinks water and juice and other milks, it's hard for people who haven't been there to understand that we're not just walking down the street, picking up a random toddler, and nursing him. We don't start out nursing a toddler. In fact, many women don't plan to nurse a toddler. Some mothers can barely look beyond the next day or the next week when they begin nursing their newborns. The progression from newborn to infant to toddler is so gradual that it seems natural once we're doing it. There's no switch that flips at one year or two years or 27 months or 33 months or September 4th or July 17th when it is suddenly no longer appropriate, necessary, or reasonable to be nursing a child. Most children will gradually wean on their own between two and four years of age, too busy with life to stop to nurse. But those children who continue to ask for it obviously still have a deep-seated need for the closeness of Mom, the sweetness of milk, the comfort of suckling, their first memories of shelter from the big, bad, scary world.

I think there's also a perception that when we say we're "still" nursing our two-year-old, or 27-month-old, or 34-month-old, that we mean we are nursing him like we would an infant, that he's coming to us six or eight or 12 times a day to feed, but it's not so. Most older toddlers nurse maybe once or twice a day, perhaps to help them fall asleep, or to go back to sleep at a night-waking. They may nurse more when they're sick, and it is a wonderful gift to give your sick child, the warm, disease-fighting, easy-to-digest milk tailored to his needs. But it's not the same as a newborn nursing for his sole source of nutrition, or an infant who only supplements his milk diet with solid foods.

How old is too old to still be nursing? Some would say once a baby has teeth, he should stop breastfeeding. Some say when the baby can ask for it, she should be weaned. Some say once he can ask for it in a complete sentence, he's too old. I think there's no rule. A child is too old to nurse when his own mother decides she is no longer happy or comfortable nursing him. A child is too old to nurse when he decides he doesn't need it anymore.

There was a wonderful research article written by anthropologist Katherine Dettwyler almost 20 years ago in which she set out to determine when a human child would naturally wean absent social constructs and societal pressure. Using several different methods based on other primates' weaning ages, she concluded that humans would naturally wean between 2.5 and 7 years of age, probably closer to the 4-6-year range. This is when the first permanent teeth start to come in (six-year-old molars erupt and baby teeth start falling out). She also examined other factors such as weight, length of gestation, and immune system development. All methods agree on that range.

I did not expect to continue to nurse G this long, but now I understand how it happens. You just... don't wean. Allowing a child to decide when he is finished nursing is called "child-led weaning" and is the most gentle and biologically normal way to slowly back away from breastfeeding. I don't think it will be long before I'm back to nursing just one baby. Often, G pops off and says he's done without falling asleep and without prompting. Many times, he tells me that "it's the baby's turn now" and sends me on my way. Interspersed are the days when he peacefully drifts off to sleep, one hand holding his blanket-lovey, the other resting gently on my breast. On those days, I unlatch him carefully (mindful of that mouthful of teeth), with a finger between his molars. Sometimes, he wakes up and runs off. Other times, he smacks his lips and re-settles, then sleeps for an hour or two on his own.

Will I still be nursing him when he's three? I don't know. I don't think so. I don't have a plan for when he has to stop breastfeeding. I'm sure he doesn't either. But the day will come, probably sooner than later, when Y gets all the milk to himself, and then some day, a few years down the line, my milk will dry up for good and I'll be done nursing forever. I see no reason to rush toward that day, and neither do my babies.

Tuesday, April 8, 2014

Let's Not Let Any More Babies Die in Hot Cars

It's (finally) spring, and some parts of the country and world are starting to warm up quickly. With the sun coming out come the reminders about the dangers of leaving kids (and pets) in the car. Cars warm up very quickly in direct sunlight, even when the temperature is fairly mild, and a child or animal trapped in a hot car can suffer dehydration, heat stroke, hyperthermia, and even death if left long enough.

Every year in the U.S., more than 30 children die from being left in hot cars. Most of these incidents are unintentional. That is, the parent or caregiver didn't mean to leave the baby in the car. Rather, they forgot the child was there and only upon returning to the car discovered that they had made a tragic error.

When news of such horrendous events gets out, two responses typically emerge. The comments start off with some type of judgment against the parent, such as, "He must be an abusive parent" or "She was obviously neglectful," or "If she can't remember her kids, she probably shouldn't have them." It is assumed that a parent who would leave a child in the car long enough to die in the hot sun must by definition be a "bad" parent. Next, you'll find a series of sanctimonious declarations that, "My children are always the first thing on my mind. I would never do that" and "How could anyone forget their kids? That would never happen to me!"

Five years ago, Gene Weingarten wrote a Pulitzer Prize-winning piece for the Washington Post on this subject. He tells the terrible stories of parents from all walks of life who returned to their cars to find their babies dead in their car seats. Some forgot they were supposed to drop the baby off at daycare and continued on to work. Some thought they had made the drop off only to show up at daycare for pickup with the child still in the back seat of the car. Every year, there are dozens of stories like this.

Weingarten interviewed a memory expert who explains that, " situations involving familiar, routine motor skills, the human animal presses the basal ganglia into service as a sort of auxiliary autopilot. When our prefrontal cortex and hippocampus are planning our day on the way to work, the ignorant but efficient basal ganglia is operating the car; that's why you'll sometimes find yourself having driven from point A to point B without a clear recollection of the route you took, the turns you made or the scenery you saw." 

In other words, when we're preoccupied with other things, we go on autopilot for the routine things. I'm sure we've all had the experience of getting in the car and starting to drive to work when we really meant to go the opposite direction to the grocery store, or of setting the table for the usual four people when only three are home that night, and so on. We do things without thinking about them while our conscious mind is busy with something else, like planning the meal we're about to make or thinking about tomorrow's schedule or making a phone call.

Weingarten's expert explains that when we are stressed, "What happens is that the memory circuits in a vulnerable hippocampus literally get overwritten, like with a computer program. Unless the memory circuit is rebooted -- such as if the child cries, or, you know, if the wife mentions the child in the back -- it can entirely disappear." 

So something that is not routine - like the fourth person not being home for dinner, or not going to work on a weekday - can be easily forgotten by the conscious memory if it's not reinforced, and the autopilot takes over.

The article is wonderful, for its excellent writing (as anyone would expect from Gene Weingarten), its sensitive handling of a delicate subject, and its exploration of how and why these tragedies happen. It is not, as Weingarten point out, because the parents are "bad" or "neglectful." It's not because they don't love their children. There's usually a perfect storm of stress, preoccupation, distraction, and change of routine that leads to a parent doing the unimaginable and leaving their child to die in the car.

We, the public, of course, hear about this happening when a child dies, but I wonder how often it happens that the child is forgotten but found and rescued before overheating, or that the baby is discovered or remembered by the parent before anything terrible happens. How often does it happen on a cold, cloudy day where the child might be hungry and upset but thankfully not overheat? How many times have parents left for just a few minutes before something reminds them to go back to the car and get the baby? I'm sure it's not as uncommon as we'd hope.

The trouble with the assumption that only neglectful, abusive, unloving parents would forget their baby in the car is that it means that those of us who know we are good, loving, attentive parents may not take precautionary measures. After all, if it's not going to happen, why bother worrying about it? The problem with knowing it wouldn't happen to us means that we are just as susceptible.

But what can we do to prevent it?

It's important to remember that these "forgetting" incidents usually happen when we are doing something outside our normal routine. If Mom usually takes the baby to daycare but today Dad is doing it, Dad's routine is disrupted. If Mom doesn't usually take the baby to the store with her but today she does, then Mom's routine is disrupted. If there is usually a baby-sitter at home but today the baby was going to Grandma's house, then the parents' routine is disrupted by dropping the baby off somewhere instead of going straight to work. Also, the typical scenario seems to be that not only is the routine disrupted, but that there are additional distractions, especially stress, that prevent the hippocampus from recording the memory that the baby is in the car. 

I suggest a two-pronged approach. 

First, we need to inform and educate. People need to know that this happens to wealthy parents and poor parents, working parents and stay-at-home parents, white parents and minority parents, adoptive parents and birth parents, parents of many children and parents of one child. Be aware that it could happen, and the circumstances under which it is more likely to happen. Rethink your judgment of others when you read about it in the news. Don't let your knee-jerk reaction be, "I wouldn't let that happen to my child," but rather, "How can I make sure I don't make the same mistake?" 

Also on the subject of education, many people don't realize just how hot a car can get and how fast it can get there. The interior of a parked car on a sunny, mild day can reach 110 degrees Fahrenheit in about 90 minutes even with the windows cracked open. Within 15 minutes, the temperature will already be uncomfortably warm. Think about how it feels to get into your car after it's been sitting in the sun for a few hours. It's hot! You open the windows to cool it off, blast the A/C, try to bring the temperature down to a comfortable zone. Well, imagine that you had been sitting in that car for an hour or two. You'd be very, very hot. Now, remember that babies are not as efficient at regulating their own body temperature as adults are. Plus, they tend to be overdressed for the weather (we don't want them to be cold!) and are cocooned in their bucket-style car seats. They can't unbuckle themselves and open a door to cool off. They can't take off an outer layer of clothing or fan themselves. They'll just keep getting hotter and hotter with no way to get relief. Many well-intentioned parents simply are not aware of the danger they are placing their babies in by leaving them in a car for any length of time (even 10 minutes) on even a mild day.

Second, we need to devise strategies for ourselves to prevent this memory blip from happening in the first place, or to recover the memory before anything terrible happens. Keeping in mind that these events often happen when you are out of your routine, come up with something you do as part of your normal routine and try to disrupt that as well, to jog your conscious memory into thinking about the baby. Once you've decided that you are going to take preventative measures, it's simply a matter of taking steps to minimize the risk. Some suggestions I have are:

  • When the baby is in the car, put something you'll have to take with you when you get out of the car beside, under, or near the baby's car seat in the back, for example, your briefcase, purse, cell phone, work badge, or office key. This way, when you reach for said item and it's not where you'd expect it to be, you'll remember it's in the back with the baby.
  • Leave yourself some kind of visual reminder, such as a brightly-colored Post-It note on the steering wheel or dashboard when you start driving. Maybe write on it "BABY".
  • Give yourself a visual cue for when you glance in the rear-view mirror and see the baby's car seat that will remind you that the baby is in the seat. Perhaps a red ribbon around the handle, or something else that will catch your eye that is only there if the baby is.
  • Keep a teddy bear in the car seat when it's empty. When you put the baby in the car seat, put the teddy bear in the front seat with you. If the teddy is in the front seat, then check the back for the baby!
  • Talk to yourself about the baby and the fact that you are taking the baby somewhere as you drive to reinforce the memory. Better yet, talk to the baby!
  • Have a plan with your partner that whenever you take the baby somewhere s/he will call to check in. For example, if Mom takes the baby to daycare, Dad should call Mom in the morning and ask how drop-off went, or if the baby did anything cute, just to jog the memory.
For resources and information about kids' safety in and around cars, see For more on vehicular hyperthermia/heatstroke specifically, see

Thursday, April 3, 2014

What Did I Make Tonight? Stir-Fry Noodles and Vegetables

When you need a very fast meal from prep to table, try this one on for size. I watched the clock while I prepared this, and it was about 20 minutes, certainly less than 30. And it's a crowd-pleaser, too.

As all my dishes, this one is very versatile. I'll offer suggestions for substitutions or variations as I go along. Some of the variations or substitutions may make this take a bit longer, but it's still a very quick meal.

  • 2 tbsp. oil - I used a combination of sesame oil and canola. Olive would also be fine. Or whatever you have.
  • 2 or 3 packages Yakisoba Stir-Fry Noodles - I find them in my supermarket's produce section with the tofu products. They were on sale 3/$5 so I picked up a bunch.
  • 2-3 carrots
  • 2-3 ribs of celery
  • Half a small head of purple cabbage or 1/4 of a large head of purple cabbage (Or use any other cabbage you have on hand, or if you have bagged shredded cabbage, so much the better. Napa cabbage is fantastic in this if you want to get fancy.)
  • 1 small onion or 1/2 a large onion (I used a white onion, but yellow or purple would be fine. Even a few green onions instead would be fine!)
  • 1 16oz. bag of frozen peas
  • 1 bag of MorningStar Farms Grillers Recipe Crumbles (or other veggie meat, or a block of tofu diced, or real ground beef, or ground turkey, or diced chicken breast or thigh - if you're doing tofu or meat, you'll need to brown it first)
  • 1/4 cup soy sauce
  • 2 tbsp. lemon, lime, or orange juice (I used a small blood orange we got from our CSA. It gave it a slightly tart-sweet flavor that I really enjoyed)
  • 1 tbsp. rice vinegar (or more citrus juice, or other kind of vinegar, whatever you have on hand)
  • 2 tbsp. brown sugar (or honey, or white sugar, or whatever other sweetener you like to use)
  • 1 tsp. garlic powder
  • black pepper
  • salt

  • Knife
  • Cutting board
  • Juice glass or measuring cup
  • Skillet
  • Stirring spoon
  • Fork
  • Put your skillet on the stove, add the oil to the skillet, and turn the burner to MEDIUM

  • Chop your veggies. The smaller the pieces, the faster they'll cook and the faster your meal will be ready.

  • Add the veggies to the pan

  • Add a pinch of salt and stir everything around to make sure everything gets exposed to the hot oil.
  • Make your sauce: mix together the soy sauce, citrus juice and/or vinegar, brown sugar, garlic powder, a grind or two (or shake or two) of black pepper, and about half a cup of water in a measuring cup or juice glass or whatever. Stir it up so the sugar dissolves. Set aside.

  • Allow the veggies in the pan to cook for about 7-10 minutes, stirring occasionally, until the onions are translucent and the carrots are softened.

  • Add the bag of peas and the veggie meat
  • Stir.
  • Now prep your noodles. The directions on the package should give you two ways to soften the noodles. Typically, you remove them from the outer package but leave them in their plastic bag and either run them under hot water for a few minutes or pop them in the microwave for a few seconds. Do whatever your package says. (If yours came with a seasoning packet, we're not using that in this recipe. Keep it to use some other time or just toss it out.)
  • When noodles are softened, add them to the pan and break them apart with a fork as best you can. As they heat and cook, they'll separate more.

  • Add the sauce to the pan and turn the heat up on the burner to HIGH to bring the sauce to a boil. Mix everything around so the noodles get into the sauce so they can cook. Once the sauce is simmering, turn the burner back down to MEDIUM.
  • Let everything cook for another 3 or 4 minutes until the noodles are ready, stirring occasionally.
  • Serve!
I tried to include the oven clock in a few pictures so you could see how much time really passed while I made this. The first picture shows the time as 4:47, and the final picture shows 5:09. I served it just a few minutes later.

As always, this is a method not a firm recipe. Add or subtract vegetables according to what you have and what you like. Add in bell peppers, for example, or asparagus, or broccoli, or green beans. Use rice or pasta or quinoa instead of the yakisoba noodles (if you do this, you'll have to cook your starch separately and then add it in at the end. I'd use about a cup of rice or quinoa or half a pound of angel hair pasta. See my Basics article for tips on making pasta and rice.). If you want to use meat, brown it in the pan first, then remove it, cook the veggies as above, and then add it back in after the veggies have cooked. If you want to use tofu, cube the tofu and brown it first, maybe tossed in some cornstarch before browning, remove it from the pan, do the veggies, and then add the tofu back in before the sauce.

You can do a lot with this basic dish, and the idea is to kind of use up vegetables you have in your fridge and make a quick meal on a busy night. You could even prep the veggies earlier in the day or week and just throw them in the pan once the oil is hot to speed up the process even more!