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February 12, 2018
I’m covered in crumbs. Also, in milk, in about a tablespoon of applesauce and in sweat. That’s because I’ve been on an airplane wrangling my 17-month-old toddler and my four-year-old daughter for the last five hours. The four-year-old is doing just fine, actually. She’s getting a ton of screen time and I know I’ll pay the price later for the movie marathon we’ve allowed, but I’m okay with it given it’s a special circumstance. The toddler on the other hand? Well, it’s just a tough age. Too old for cuddling and napping as we zoom through the sky, too young to hold her focus for any length of time. She’s in constant motion. If this plane does not speed up and get to our destination ahead of schedule, I may collapse in an exhausted heap.
Our trip (for which I am actually completely grateful – it’s a privilege to take my kids to a new place with new adventures) made me think about the first time I ever traveled with a child. It took me back to how I overpacked, how I overstressed and how I underappreciated how simple it could actually be. There are tons of parents who ask me in my office if I have any advice for the plane or the airport with a baby. Turns out, you can optimize your travel experience by taking these easy steps:
1. Carry As Little As Possible, Check the Rest
Know how, when you go through the airport, your carry-on luggage and personal item seem to somehow get heavier and heavier the further you walk? Multiply that times ten with a baby because you now have an extra PERSON you are lugging. There are obviously some items you have to bring with you – a small stack of diapers, wipes, a change of clothes, bottles if formula-feeding. But, the less stuff you have to lug through security, through the terminal or into the overhead bins, the better. Better to check it and forget it, in my book.
2. Don’t Spend Extra Time In the Airport, Except When Boarding The Plane
A lot of new parents think they should get to the airport super early if they are traveling with a baby or child. Usually, though, that just means extra chances for meltdowns (for your baby, not you) and germs. Obviously, give yourself enough time to make your plane, but don’t plan to linger excessively. On the other hand, when it’s time to board the plane, consider your unique situation. Airlines offer family boarding early on in the boarding process, which can be tempting. If you don’t have an assigned seat or you have carry-on luggage that demands overhead bin space, take full advantage of this perk. If you haven’t brought much with you, though, consider minimizing the amount of time you have to sit “trapped” in a small space with your infant.
3. Stay Away From Sick People
This is a hard one since, notoriously, airports and airplanes tend to be germ fests. The number one way to avoid a baby getting seriously ill from air travel? Don’t take them until after they are old enough to receive their first set of vaccines and are out of the highest infection risk zone (in our practice, we don’t give the first set of vaccines until at least six weeks old and recommend waiting a few weeks after vaccination for the shots to take effect before flying. I waited until about three months until flying with my first baby). Once you’re on your way, it pays off to wash your hands well with soap and water often and to keep your baby away from direct contact with sick people.
4. Give Baby Something to Suck On
Once you depart on your flight, you’ll want to help minimize discomfort in your baby’s ears, which can build as the pressure changes with altitude shifts. Giving baby something to suck on (a pacifier, a bottle or a breast) can really help. On the way up, it’s obvious when you need to pay attention to helping your little one with this but, on the way down, it’s easy to get the timing wrong. Instead of waiting for the flight staff to tell you you’ve started your descent, be observant. When you start to feel the plane descending, get your baby going on an ear pain prevention plan by initiating some type of sucking motion (note: if they are asleep, let them sleep).
5. Forget Over-Apologizing
So you have a baby on a plane? Oh, well. Tons of other passengers have been in your situation and we’re not irritated when we hear your baby cry. Those who are will have to just suffer through. If your baby wails the entire trip, it makes sense to at least acknowledge the patience and understanding of others around you. But those little gifts some propose to assuage your neighbors preventatively? Unless you have tons of free hours you would not rather spend doing ANYTHING else, I say forget it. You paid to be on the plane just like everyone else and you’re doing way more hard to work to make the trip successful than any of your seatmates.
In the end, traveling with a baby can actually be significantly easier than you first imagined. Hey, at least it’s not traveling with a toddler. Pack light, get the timing right and feel confident – you’ll be there in no time.
For more on traveling with kids, read Your Family Vacation or Holiday Travel Success Guide
January 25, 2018
Apparently, there is a shimmering mermaid living in my house. She sings “We Are The Daughters of Triton” at the top of her lungs, she pretends to scatter shells for the merfolk in her kingdom on the pool steps while we’re on vacation – she even picked out a blue mermaid swimsuit, complete with scales and a jeweled neckline, for our trip to Hawaii.
When my daughter is not playing sea kingdom, she is almost always in full princess gear. We do have a rule that no costumes are allowed for school, music class or soccer (it’s just too distracting) but, otherwise, it’s on. To say she is usually in pink or purple or some other variation on that theme would be a huge understatement- the girl lives for girlie.
And, of course, you know how it goes- once the word gets out that there’s a girl interested in princess stuff in the house, all future gifts from every relative and friend tend to fit that theme. At least I think that’s how I ended up with 20 dress-up costumes hanging neatly in my playroom. My little royal wants to wear her crown and necklace whether we’re headed to Target or to the airport- it doesn’t really matter the destination.
The other day, at the coffee shop in a full-on Snow White outfit my eldest picked out herself, I watched the reactions of two patrons toward her. One rolled her eyes and snarked, the other grinned and gave me a knowing wink. I get the gut response of both onlookers: the desire to not let our daughters’ accomplishments stop at being saved by Prince Charming, the fact that kids have minds of their own and often have a very specific wardrobe plan from the moment they wake up, the reality that most parents learn to roll with it sooner or later.
But there is a limit. When I think about how far is too far when it comes to the whole princess thing, it really boils down to one thing: what is my child learning as she plays? My goal (the same goal I would have if my house was filled with all boys) is to support and encourage my children to fall in love with learning and to embrace imaginative play. And that means encouraging them to fall in love with learning whatever THEY are the most excited about. If they’re into superheroes, awesome. Explorers? Sweet. Math and science? Works for me. Far be it from me to make decisions for my littles as to who they will get excited about imagining themselves to be.
Let them wear pink, I say. It’s going take more than an outfit choice to determine my kids’ futures. I feel confident I’m still leading them down a path of empowerment. That’s because, while I’m easy on the wardrobe choices, I’m a stickler when it comes to these things:
1. I intentionally provide a variety of storyline exposures in book and screen time form. Our favorite books right now are Iggy Peck, Architect and Rosie Revere, Engineer. I also love Good Night Stories for Rebel Girls and the series Ordinary People Change The World– kid-friendly, inspiring true stories of male and female heroes who fight against all odds (and stereotypes) to accomplish their dreams. Olivia and the Fairy Princesses is my all-time favorite, super silly book about caring more about choosing your own path than about fitting onto someone else’s.
2. I prioritize real-life interactions for my kids with women and men who are pursuing their professional passions and helping others. Chefs, photographers, lawyers, doctors, artists- I make sure my kids see that being successful means you love what you do and choose the profession that makes you satisfied- not the one that satisfies someone else’s expectations of you.
3. I try to limit the grossly stereotyped stories we do see or listen to. When we come across those books or shows, we try to talk through the gender roles that come up and we (usually in a silly way) question the assumptions those shows make. I remember listening to my husband read my eldest a bedtime story about Rapunzel last year, shifting the narrative slyly for her. “So why do you think The Prince wanted to go see Rapunzel? I think it’s cause she is SO good at Algebra- he thinks that’s really neat.” He probably knew I could hear him downstairs but, hey, I’ll take it!
4. I Make it a point to develop girl AND boy relationships for my daughters. Of course, I love my little girl’s girlfriends, but we mix it up. Diversity in gender, in ethnicity, in religion, in family make-up- the more my girls can appreciate the preferences and rituals of others, the better they can define their own as they mature. In the same vein, we talk about and demonstrate shared household and work responsibilities between my husband and I. My daughter knows I work full-time and run a website. “Mommy, how many visitors did you get this week?” She asks me all the time, then gives me a huge high-five as I tell her, “We’re killin’ it!”
It’s going to take way more than some pink gowns and a pair of fairy wings to pigeon-hole my babies. I’m focusing less on their chosen attire and more on their overall exposure and my overall messaging, knowing they’ll end up whoever they’re supposed to be – princess, pirate or both.
January 11, 2018
You’re there in the hospital, a new mom, just trying to get your feet wet with the whole baby feeding thing. Well-wishers, relatives, hospital staff -they all have a ton of advice. And, given the gravity of the situation, the sinking feeling that you are now responsible for another human being and that his or her safety depends solely on you, it’s understandable you would be a little overwhelmed.
There, in the sea of recommendations and guidelines, one crucial principle often gets missed. It’s critical to early breastfeeding success. It’s a simple rule that, with incredible fatigue and postpartum recovery issues, can be hard to concentrate on: babies need to eat.
On the surface, that may seem over-simplified. I mean, OF COURSE, babies need to eat. You knew that already. But the specifics of what they need and when they need it can be a bit more complicated:
In the first few days to weeks, babies need to have a feeding attempt at least every three hours. We call it “three hours start to start” in my office – that is, it should be no longer than three hours from the start of one feeding to the start of another. Babies will often want to feed WAY more often than that, which is great and perfectly okay, but at the very least they need that every three-hour cueing.
Why? Breastfeeding is a two-way feedback loop – The first feedback loop is for the mom; the more a baby’s suckling stimulates the breast, the more milk the mom’s body makes. The second feedback loop is for the baby: the more the baby eats, the more food it takes in, the more alert and hydrated the baby, driving hunger and allowing the baby to eventually regulate its own feeding needs.
You may have heard two things that contradict this advice, so let me address them both:
First, people talk all the time about the fact that babies should feed, “on demand” – that they should drive their own hunger and can do so. That breastfeeding should be natural. That’s totally true…eventually. But, in the beginning, a baby needs help to get their system going. Breastfeeding IS natural, but it’s not usually easy in the beginning for a new baby or a new mom – both have to learn new skills and how to “rev up the system.”
Second, there’s a lot of talk in prenatal classes about how a baby’s stomach is really small at first and they don’t need much milk. About how they really only need the tiny bits of colostrum in the first few days. That is absolutely true. Babies are often sleepy in the first 24 hours after they are born, mom’s milk hasn’t come in yet, the system is set up so that there’s a little grace period. But here’s the catch – that is the time to prime the pump(s) by nursing frequently so that the milk actually does come in and so that baby is alert enough at day three to four so they can take the milk mom starts making. In some cases, if that doesn’t happen, blood sugar levels can drop, making babies lethargic and harder to feed. Babies can get dehydrated, contributing to jaundice (the yellow color that can develop in a baby’s skin).
Alright, so you’ve got it – you’re planning on feeding often. All set, right? Well….. you’re going to want to do THESE things, too:
Keep your baby active at the breast. You may need to stimulate your baby (tickling baby’s feet, using a cool washcloth at the forehead, getting baby undressed down to the diaper, rotating her arm gently) to get your baby to feed effectively (otherwise, they may burn energy on sucking without getting much back in return).
Get lactation help. Of all the advice I offer, this is the most important. Get help from the get-go with latch. Ask your nurse at the hospital to position correctly. Ask for a lactation consultation if you have any concerns at all (this is pretty much every new mom I meet, so don’t feel like you have to have major worries in this area to justify getting extra assistance. Sometimes, you don’t realize the questions or issues you have until an expert helps you out). Like I’ve said before, if you lived in a home with all of your breastfeeding friends and experienced breastfeeder family members, you wouldn’t need all this outside help but, the reality is, you probably don’t.
New parents care the most about one thing: making sure their babies are safe and healthy, but the newborn period can feel a little hectic and confusing sometimes. That’s normal. Even if you follow every single piece of good advice you hear, not all postpartum issues are avoidable. Part of having a baby is problem-solving on the fly. Even so, it pays to concentrate first on getting a good feeding cycle in place and getting help when you need it – so many other infant care issues will fall into place if you do.
Want more? Read more about being a new mom and the ups and downs of feeding a baby (including not allowing breastfeeding success to define your worth as a mother) here.
January 4, 2018
It’s sick season. That means, in pediatrician offices across the country, lots of congested, coughing kids (and lots of worried parents). I’ve officially joined the ranks of all those snot-covered, sleep-deprived moms and dads this month. Four weeks ago, my littlest came down with Croup and spent three nights hacking away like a baby seal. I came home from work to her lying on the rug in my living room, curled up in a tiny ball, clutching a stuffed animal while my husband rubbed her back. Then, New Year’s Day, she wound up in Urgent Care after waking from a nap with a 103 fever and labored breathing, bless her little heart.
Needless to say, the mama inside me outweighed my medical degree both of those evenings. I had to force my mind to “think like a pediatrician.” I also had to take a deep breath and try NOT to think about all the work I would inevitably miss, the wasted childcare dollars I would no doubt forfeit and the sleepless nights I was bound to encounter before she recovered from her respiratory illness.
It made me think, as I reminded myself to stay objective, of all the sick kid parenting pearls I try to share with my patients’ parents in clinic week after week, but especially during sick season:
Follow your gut. If you are worried about your child, call someone. Make an appointment. Get them in front of a medical professional. You know your kid best so, if they seem off to you, listen to that little voice inside your head telling you to take action. Pediatricians aren’t irritated when a parent wants their child to be seen “just to be sure everything is okay.” Actually, we would much rather that than the alternative – a serious condition gone unchecked. Kids tend to rally well at first with sickness but then can crash pretty fast. It’s better to get the advice you need early on so you don’t get to a more critical point.
If you’re a new parent, that may mean you call as soon as your child gets a small cough. No problem. Your doctor or their nurse can guide you through what to expect and what to do- consider it your sick kid mini-education. As you get more and more experienced, you’ll gain confidence, you’ll know the basic ways to handle minor illnesses and you likely won’t need as much assistance.
Whenever possible, you want a medical provider caring for your child who really knows their stuff – someone trained specifically in pediatrics (obviously, if you are on vacation or in an emergency situation, that’s not always realistic). When you do have a choice, choose pediatric-trained providers so they can get the most accurate medical history possible and can provide the most up-to-date care.
Understand Honesty is Important and Details Matter. If your child has had a fever for one day or for five days, those are completely different situations, each of which triggers different levels of testing and medical interventions, depending on age. As I sat in the urgent care clinic with my daughter last week and watched a practitioner shrug a little when I said she had just developed her fever, it was tempting to try to sell how bad her illness was. Sometimes, I know, it feels like elaborating a tiny bit to get the attention of medical providers will help when it comes to a sick kid, but that can backfire. You don’t want your child to have extra bloodwork, imaging (X-rays, etc) or medications when they don’t need them. It can lead to unnecessary and sometimes harmful side effects and even hospitalizations.
Believe That We Believe You. I cannot count the number of times someone has brought their febrile child into my office, completely miserable, so that I can see how sick they really are. No fever-reducers on board, the poor kids and their parents must have had a horrible time on their car ride over to clinic. But there’s no need to show us your child at their worst. It’s fine to give your son or daughter acetaminophen or ibuprofen (these medications can be age- and condition-dependent – check with your health professional if you’re not sure) before your doctor’s visit. In fact, the best way for medical professionals to accurately assess how your child is doing can be to see them WITHOUT THE FEVER when possible, since they sometimes look worse than they actually are when febrile.
Use Antibiotics Judiciously. Sometimes, a parent will seem disappointed when I tell them their child has an upper respiratory infection (aka a cold) and doesn’t need antibiotics. Remember, it’s a GOOD thing if there isn’t a need for extra medicine. You don’t want antibiotics unless you really need them. Every drug has side effects and, if we give antibiotics for colds, a. It doesn’t change a thing about how fast a child gets better, b. It may give them issues with diarrhea and c. It contributes to antibiotic resistance (when an antibiotic stops working against the bacteria it was designed to treat and makes it harder and harder to treat serious illnesses). It’s hard to wait out a viral illness, letting the storm pass until the sun comes out again, but it’s worth it to concentrate on comfort care if your doctor prescribes it versus fighting for an unnecessary medicine.
Accept Illnesses Can Change Quickly. When we see you in the office, we’re catching your child at a moment in time. We hear about what has happened so far and we base our diagnosis on our exam that day. It’s one data point. Often, though, an illness can change within hours or days and, without a crystal ball, it’s impossible to predict which direction a sickness will go. It’s not surprising to us when we need to schedule a re-check appointment to make sure things are improved or when a parent calls us back to say a child is still sick. That’s why we give so many contingency after-visit instructions. Most of the time, we can solve an issue with one evaluation but it can take a bit more complex problem-solving with multiple visits at other times.
Find a Provider Who Welcomes Your Questions. Part of my job as a pediatrician is to make sure I translate all the medicalese for my patients and their parents, assuring they leave with a solid understanding of what’s wrong with their child and what they can expect as they recover. I know it is sometimes terrifying (or sometimes just super inconvenient) to have a sick kid and that parents need answers and explanations. I’m used to it. ALL doctors are. So, ask away. Clarify. Pull out the list of worries. Let us know the underlying issues (like, “When will my child be better and when will I be able to go back to work?”). We’re all ears and, in the end, it’s easier for all of us to be on the same page from the get-go than to let frustration or confusion play a role in your child’s illness.
I’m not gonna lie – having sick kids is one of the most challenging parts of modern parenting. The schedule re-arranging, the miserable little one, the scary unknowns of illness – it all adds up. Remember, pediatricians know how hard it is to care for sick children (I do it myself all the time!) and we want your child to get better as fast as possible, too. Access the resources you have, get the answers you need. Above all, follow your gut – if you’re worried, get help (or just peace of mind). ’Tis the season for sickies and sickness and you’re not alone in just checking to make sure everything is alright.
December 28, 2017
We’re excited at Modern Mommy Doc to introduce our new, re-branded, re-designed website. It has been a huge labor of love and took the effort of so many talented people. Personally, it marks the culmination of 15 years of planning, hoping, and dreaming. Finally, I’m able to marry my two major passions (medicine and writing) with the hope of:
moms who want to win at parenting without losing themselves.
Now, over six months in, it’s time to take this side project to the next level, expanding our free mini-courses to include help for parents-to-be, parents of toddlers and parents who need help getting on the road to self-care (that’s all of us, am I right?).
Of course, we’ll continue providing tons of practical, realistic guidance and perspective via our regular blog posts and comprehensive self-care and newborn care programs.
Welcome to the New Modern Mommy Doc!
With lots of gratitude and respect,
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