Quarterly Publication of the International Chiropractic Pediatric Association
Breastfeeding & Bedsharing Facts About Co-Sleeping and SIDS Nourishing Your Independent Toddler The Due Date Cesarean Section Breastfeeding in Public 5 Reasons to Stop Saying “Good Job” The Well-Balanced Child
brought to you courtesy of:
International Chiropractic Pediatric Association
Chiropractic Family Wellness Lifestyle
FEATURE International Chiropractic Pediatric Association
ABOUT ICPA The ICPA values and respects parents’ rights to make informed health care decisions for their children. Through education, training and research in the care of children and pregnant women, the ICPA is advancing awareness of the chiropractic family wellness lifestyle. PathWAYS is a quarterly publication of the International Chiropractic Pediatric Association Editorial Board of Advisors Bruce Lipton, Ph.D. Stephen Marini, Ph.D., D.C. Randall Neustaedter, O.M.D. Jeanne Ohm, D.C. Larry Palevsky, M.D. Jane Sheppard ICPA 327 N Middletown Rd Media, PA 19063 www.icpa4kids.com firstname.lastname@example.org 1 800-670-KIDS © 2005-2006 Design by Tina Aitala Engblom www.taedesign.com Printed by Beard Printing & Publishing The individual articles and links to health care information in Pathways are based upon the opinions of the respective author, who retains copyright as marked. The information provided is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information. The ICPA encourages you to make informed health care decisions based upon your researched knowledge and in partnership with a qualified health care provider.
CHIROPRACTIC FOR LIFE
PREGNANC Y MATTERS
FA M I LY L I F E
FA M I LY W E L L N E S S F O R U M
2 Breastfeeding & Bedsharing 12 Facts About Co-Sleeping and SIDS 16 Nourishing Your Independent Toddler 18 FAQs about Children & Chiropractic 20 The Due Date 24 Cesarean Section 26 Breastfeeding in Public 30 5 Reasons to Stop Saying “Good Job” 34 Intent 36 The Well-Balanced Child 38 Keep Your Young Athlete Healthy & Fit 40 News to Know & Share 43 Kids Who Don’t Get Adjusted 44 Baby Prefers Tummy Sleeping
from the editor
As more parents are realizing the real benefits of chiropractic care, they are coming to our offices seeking wellness chiropractic care for their families. Less obvious are the chemical and emotional stresses we In other words, parents are looking for family health care are subjected to since conception that affect nerve system even before their children have any symptoms or conditions. function and development and therefore our health and They are realizing that working to complement the body’s well-being. Our articles in Pathways are selected to inform natural abilities for health before symptoms appear makes parents about the many approaches and choices we have sense and is cost effective as well. for our families. Our regular topics address family lifestyle The nervous system controls all of the body’s systems and
issues presenting perspectives and
functions. Any interference to its ability to perform can affect
options that are supportive of wellness.
our health and well-being. Chiropractic care works specifi-
In this issue we look closely at co-
cally to alleviate stress to the nervous system that is caused
sleeping, a custom not so easily prac-
by spinal and cranial misalignments. The body’s ability to
ticed and accepted in our western soci-
function optimally is maximized.
ety. Yet clearly, when reading the feature article, we see the practice of co-
In Pathways, we refer to the Chiropractic Family Wellness Lifestyle. This of course includes regular chiropractic check
sleeping is normal, healthy and advantageous for the child’s developing nerve system function.
ups for all members of your family to keep their nerve systems free of interference from spinal and cranial misalign-
Achieving health for our families is accomplished daily
ment. The Chiropractic Family Wellness Lifestyle, however
through the many choices we make. These choices begin
advances beyond the chiropractic adjustment and includes
as early as conception, continue throughout pregnancy,
choices we make as parents to reduce overall stress to our
birth and childhood. Each choice we make as parents
nervous systems and enhance better body function.
affects our children’s health. It is our hope that Pathways guides you with perspectives consistent with the
Most doctors of chiropractic will offer their patients postural
Chiropractic Family Wellness Lifestyle.
and structural guidelines helping this process. How we sit, how we move our bodies, activities we involve ourselves in are all relevant to maintaining a healthy spine and nervous Many Blessings, system. It becomes relatively easy for us to relate to the Jeanne Ohm, DC many daily physical activities we undergo that may cause nerve system stress.
f e at u r e
Breastfeeding & Bedsharing still useful (and important) after all these years 2
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James J. McKenna, PhD
Mothers and infants sleeping side by side, also known as co-sleeping, is the evolved context of human infant sleep development. Until very recent times, for all human beings, co-sleeping constituted a prerequisite for infant survival. For the majority of contemporary people outside of the Western industrialized context, it still does. Because the human infantâ€™s body continues to be adapted only to the motherâ€™s body, co-sleeping with nighttime breastfeeding remains clinically significant and potentially lifesaving. pathways | issue 9
This is because, of all mammals, humans are born the least neurologically mature (25% of adult brain volume), develop the most slowly, and are the most dependent for the longest period of time for nutritional, social, and emotional support, as well as for transportation. Indeed, in the early phases of human infancy, social care is synonymous with physiological regulation. That is, holding, carrying, and/or caressing an infant, and emitting odors and breath in his or her proximity, induce increased body temperature, less crying, greater heart-rate variability, fewer apneas, lower stress levels, increased glucose storage, and greater daily growth.1 Moreover, since the content of human milk is relatively low in fat and protein and high in sugar, which is metabolized quickly, and since human infants are unable to locomote on their own, continuous contact and carrying, with frequent breastfeeding day and night, is required. Thus, any biological scientific study that attempts to understand “normal,” species-wide, human infant sleep patterns without considering the vital role of nighttime contact in the form of breastfeeding and maternal proximity must be considered inadequate, misleading, and/or fundamentally flawed.2
Co-sleeping: The Importance of Taxonomic Distinctions Much of the controversy surrounding the question of the safety of mother– infant co-sleeping involves the ways in which investigators define and conceptualize it. Co-sleeping is not, as the Consumer Product Safety Commission (CPSC) assumes, a single, coherent practice. Rather, it is best thought of as a generic, diverse class of sleeping arrangements composed of many different practices, each of which requires proper description and characterization
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before the issue of safety and clinical outcomes can be understood. A safe co-sleeping environment must provide the infant with the opportunity to sense and respond to the caregiver’s signals and cues, such as the mother’s smells, breathing sounds and movements, infant-directed speech, invitations to breastfeed, touches, and any hidden sensory stimuli, whether intended or not.3 Moreover, to be designated as safe, the physical and social co-sleeping environment must involve a willing and active caregiver who chooses to co-sleep specifically to nurture, feed, or be close to the infant in order to monitor or protect him or her. The co-sleeping environment also must be carefully constructed to avoid
known hazardous conditions, recently revealed by epidemiological studies.4 Dangerous types of co-sleeping include sleeping with infants on sofas or couches, bed-sharing with mothers who smoke, and positioning toddlers next to infants. Parents or caregivers desensitized by drugs or alcohol create an unsafe co-sleeping environment. Other dangerous co-sleeping environments occur when an infant sleeps with a larger person on a soft mattress or is placed on large pillows in a bed with a parent.5,6,7 While all forms of bed-sharing are examples of co-sleeping, bed-sharing is only one of perhaps hundreds of different ways to co-sleep practiced around the world. For example, some
parents in Latin America, the Philippines, and Vietnam sleep with their infant in a hammock, or place the infant in a hammock to sleep next to them, while they sleep on mats or beds. Some parents place their infant in a wicker basket and put the basket on a bed, between the parents. Other parents sleep next to their infants on bamboo or straw mats or on futons (as in Japan). Some place their infant on a cradleboard, keeping the infant within arm’s reach; others co-sleep by room-sharing, having the infant sleep on a different surface, such as in a crib or bassinet, which is kept next to the parental bed, within arm’s reach.
Co-sleeping Has Not Outlived Its Biological Usefulness Although forms of infant sleeping vary enormously from culture to culture, the potentially beneficial physiological regulatory effects of maternal contact on human infants during sleep do not. Up to one degree of temperature can be
apneas by as much as 60%, in addition to physically drawing the infant subjects to sleep in direct contact.10 Moreover, when resting on their mothers’ (or fathers’) chests, skin-to-skin, both premature and full-term infants breathe more regularly, use energy more efficiently, grow faster, and experience less stress.11,12,13
Clinical Outcomes Depend on How Co-sleeping Is Practiced Exactly how co-sleeping may be beneficial or dangerous to the infant varies as a function of the particular social and physical environment (family circumstances) that it is practiced in. This is why there is no single outcome associated with forms of co-sleeping, especially in urban Western cultures, and why there is so much debate about whether co-sleeping, especially in the form of bed-sharing, is safe. For example, in industrialized urban societies, among middle- to upper-
When resting on their mothers’ (or fathers’) chests, skin-to-skin, both premature and full-term infants breathe more regularly, use energy more efficiently, grow faster, and experience less stress. lost when a newborn human is removed from the mother’s stomach following birth, even when the infant is placed in an incubator with ambient temperatures set to match the mother’s body temperature.8 Richard found that among 11- to 16-week-old infants, solitary-sleeping infants exhibited lower average axillary skin temperatures than breastfeeding infants sharing a bed with their mothers.9 Thoman and Graham discovered that even mechanical breathing teddy bears placed next to apnea-prone human newborns have the effect of reducing
class families where bed-sharing and breastfeeding are practiced by nonsmoking mothers, infant mortality, including deaths from sudden infant death syndrome (SIDS), is low. The most recent international study of childcare practices in relationship to SIDS rates, conducted by the SIDS Global Task Force, shows dramatically that low SIDS awareness and low SIDS rates are associated with the highest co-sleeping/bed-sharing rates. At the most recent International SIDS Meeting in Auckland, New Zealand,
Sankaran et al. presented data from Saskatchewan, Canada, showing that where breastfeeding and forms of co-sleeping coexist, SIDS deaths are reduced.14 This finding is consistent with a study in South Africa indicating that bed-sharing babies have higher survival rates than solitary-sleeping babies.15 In Hong Kong, where co-sleeping is the norm, SIDS rates are among the lowest in the world.16,17 The same is true in Japan, where rates of not only SIDS but infant mortality in general are among the lowest in the world, according to the Japan SIDS Family Organization’s 1999 report.18 Moreover, during a span of about four years in Japan, where maternal smoking has decreased while breastfeeding, co sleeping, and supine (face up) infant sleep have increased, SIDS rates have decreased—the exact opposite of what co-sleeping critics would predict. In many other Asian cultures where cosleeping is the norm, including China, Vietnam, Cambodia, and Thailand, SIDS is either unheard of or rare.19,20,21 In one study conducted in Australia, an immigrant Vietnamese mother was told about SIDS, with which she was unfamiliar. She said, “The custom of being with the baby must prevent this disease. If you are sleeping with your baby, you always sleep lightly. You notice if his breathing changes…Babies should not be left alone.” Another Vietnamese mother added, “Babies are too important to be left alone with nobody watching them.”22 Of 40 Chinese women interviewed at Guagzho University Hospital by SIDS researcher Elizabeth Wilson, more than 66% of new mothers intended to have their infants sleep with them in the marital bed, and the rest of her sample planned to have the infant sleep alongside the bed. One informant represented many when she stated that the
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baby is “too little to sleep alone” and that co-sleeping “makes babies happy.”23 In contrast, in Western urban subgroups, co-sleeping is associated with increased risks to the infant, especially but not exclusively when it occurs in association with maternal smoking, drug or alcohol use, chaotic lifestyles, lack of education and opportunities, prone sleeping, and other dangerous factors.24 For example, bed-sharing deaths (which often erroneously include couch-sleeping deaths in the CPSC data bank) are especially high in the United States among poor AfricanAmericans living in large cities such as Chicago; Cleveland; Washington, D.C.; and St. Louis—the four cities from which data used to argue against the safety of all co-sleeping, regardless of circumstances, emerge.25,26 Moreover, epidemiological studies show consistently across cultures that among economically deprived, indigenous groups, such as the Maori in New Zealand, Aborigines in Australia, Cree in Canada, and Aleuts in Alaska, bed-sharing and other forms of co-sleeping can be associated also with increased risks to infants and increased infant deaths.27,28 The SIDS Global Task Force accounts for these differences in bed-sharing outcomes in a way consistent with my own view, pointing to factors such as parental smoking, drug and alcohol use, infants sleeping prone on soft mattresses, infants sleeping alone on adult beds with gaps or ledges around the bed frame or between the mattress and a wall or piece of furniture, dangerous furniture or furniture arrangements, and infants sleeping next to toddlers or on sofas with obese adults. Perhaps it is best to conceptualize outcomes related to bed-sharing in terms of a benefit–risk continuum. For example, if mothers elect to bedshare for purposes of nurturing and
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breastfeeding and are knowledgeable about safety precautions (e.g., use stiff mattresses, do not over-wrap the infant, or lay babies supine), we can expect that bed-sharing will be protective or reduce SIDS risks. But when bed-sharing is not chosen as a childcare strategy but rather is a necessity because there is no other place to put the baby, and mothers smoke, take drugs, and do not place an adult in between a toddler and a baby sharing a bed, increased risk of SIDS or asphyxiation can be predicted.
never be permitted to fall asleep at the breast or in the mother’s arms, even though this is the very context within which the infant’s natural falling asleep evolved. As many parents will attest, this advice proves highly problematic. The exaggerated fear of suffocating an infant while co-sleeping may stem, in part, from Western cultural history. During the last 500 years, many economically destitute women in Paris, Brussels, Munich, and London (to name but a few locales) confessed to Catholic priests of having murdered their infants by overlying, in order to
The exaggerated fear of suffocating an infant while co-sleeping may stem, in part, from Western cultural history.
Solitary Infant Sleep: A Historical Novelty Emotions, designed by natural selection and controlled by the limbic system of the brain, motivate infants and children to protest sleep isolation from parents by crying. These emotions undoubtedly evolved to ameliorate what was throughout our evolution a life-threatening situation: separation from the caregiver.29 In recent decades, Western childcare strategies have favored early infant autonomy. Health professionals teach that parents should condition infants to sleep alone throughout the night with minimal parental intervention, including breastfeedings (according to some advice givers, the fewer number of breastfeeds the better).30,31 Parents are encouraged by some health professionals to train their infants to soothe themselves back to sleep. Pediatric sleep advisers say that infants should
control family size. The priests threatened excommunication, fines, or imprisonment—and banned infants from parental beds.32,33 The legacy of this particular historical condition in the Western world probably converged with other changing social mores and customs (the emphasis on privacy, self-reliance, and individualism), providing a philosophical foundation for contemporary cultural beliefs and making it easier to find dangers associated with co-sleeping than to find (or assume) hidden benefits. The proliferation throughout Europe of the idea of romantic love, coupled with the belief in the importance of the husband–wife relationship, also may have promoted separate sleeping quarters. This physical separation, especially of the father from his children, also was seen as maximizing the father’s ability to dispense religious training and to display moral authority.
Co-sleeping and Solitary Sleeping Arrangements: Effects on Children As I have noted elsewhere, the first published studies of people who coslept as infants contradict conventional Western assumptions that co-sleeping leads to negative psychological, emotional, and social outcomes later in life.34,35,36 A recent cross-sectional study of middle-class English children shows that children who never slept in their parents’ beds were more likely to be rated by teachers and parents as “harder to control” and “less happy” and exhibited a greater number of tantrums. Children never permitted to bed-share were also more fearful than those who slept in their parents’ beds.37 Other findings point to further advantages of co-sleeping over solitary
sleeping. A survey of college-aged individuals found that men who had coslept with their parents between birth and five years of age had significantly higher self-esteem, experienced less guilt and anxiety, and reported greater frequency of sex. Men who had coslept between 6 and 11 years of age also had higher self-esteem. For women, co-sleeping during childhood was associated with less discomfort about physical contact and affection as adults.38 Another study found that women who had co-slept as children had higher self-esteem than those who did not.39 Indeed, co-sleeping appears to promote confidence, self-esteem, and intimacy, possibly by reflecting an attitude of parental acceptance. A study of 86 children on military bases revealed that co-sleeping chil-
dren received higher evaluations of their comportment from teachers than solitary-sleeping children and that they were underrepresented in psychiatriccare populations compared with children who did not co-sleep. The authors stated: Contrary to expectations, those children who had not had previous professional attention for emotional or behavioral problems co-slept more frequently than did children who were known to have had psychiatric intervention and lower parental ratings of adaptive functioning. The same finding occurred in a sample of boys one might consider Oedipal visitors (e.g., three-year-old and older boys who sleep with their mothers in the absence of the father)—a finding which directly opposes traditional psychoanalytic thought.40
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The largest and possibly most systematic study to date, involving more than 1,400 subjects from five ethnic groups in Chicago and New York, found far more positive than negative adult outcomes for individuals who co-slept as children. The results were the same for almost all the ethnic groups (African Americans and Puerto Ricans in New York; Puerto Ricans, Dominicans, and Mexicans in Chicago). An especially robust finding, one that cut across all ethnic groups, was that co-sleepers exhibited a greater feeling of satisfaction with life.41
Physiological Studies of Mother–Infant Pairs A study at the University of CaliforniaIrvine School of Medicine quantified differences in the sleep behavior and physiology of 70 Latina mothers and infants. More than 200 eight-hour polysonographic recordings were made of mothers and their infants sharing a bed or sleeping apart in adjacent rooms over three successive nights.
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We specifically compared how the solitary sleep environment and the bed-sharing environment affected two kinds of mother–infant pairs: pairs who routinely bed shared at home and pairs who routinely slept apart. In randomly assigned order, each mother–infant pair spent two nights sleeping in their routine (home) sleeping condition and one night sleeping in the non-routine condition; that is, routine bed-sharing pairs slept in different rooms, routine solitary sleepers bed shared. All mothers and infants were healthy and nearly exclusively breastfeeding. The infants ranged in ages from 11 to 15 weeks (the peak age for SIDS). We found that bed-sharing doubled the number of nightly breastfeeds and tripled the total nightly duration of breastfeeding. Bed-sharing also correlated with shorter average intervals between breastfeeding sessions. Among 70 nearly exclusively breastfeeding mothers, we found that the
average interval between breastfeeds was approximately an hour and a half on the bed-sharing night—the approximate length of the mothers’ (adult) sleep cycle. That is, infant nighttime nutritional needs and feeding cycle while co-sleeping correlated with the general length of the ultradian (subcycle of sleep) sleep cycle (90–120 minutes) of the human adult—a correlation never before observed or proposed. When sleeping in separate bedrooms (but still within earshot), the breastfeeding interval was at least twice as long.42 The supine position is the universal sleep position for infants, having evolved specifically to facilitate and make possible nighttime breastfeeding. Indeed, our studies reveal that without instruction, breastfeeding mothers who routinely bed-share practically always placed their infants in the safe, supine position, probably because it is difficult, if not impossible, to breastfeed a prone, sleeping infant. From our infrared video studies of bed
If, as studies indicate, breastfeeding promotes the choice to bed-share, and more American parents are bed sharing than ever before, then perhaps these practices have also contributed to the reduction of SIDS since 1992. sharing mothers and infants, it appears that supine infant sleep maximizes the infant’s overall ability to control its microenvironment, and especially to elicit breastfeeds.43,44 In addition to permitting the infant to move toward and away from the breast, back-sleeping permits infants to remove blankets covering their faces, turn to face toward or away from the mother, touch their faces, wipe their noses, and, without a great deal of effort, suck on their fists or fingers, thus making loud sounds that will awaken their mothers, who often then offer breastfeeding. Our studies also suggest that supine infant sleep in the breastfeeding/bed sharing context maximizes the chances of the baby detecting and responding in synchrony with the mother’s movements, sounds, and touches, and vice versa.45,46,47 The supine position of the infant promotes easy and constant communication between infant and mother, thus furthering mutual attachment and trust (a prerequisite for healthy infant development); in addition, it may stimulate the infant, through olfactory cues, to want to breastfeed more frequently, therein further suppressing the mother’s ovulation. This model constitutes yet another reason to view the mother– infant relationship not simply in terms of how mothers regulate their infants, but rather how mothers and infants mutually regulate each other’s physiology, including the mother’s reproductive status. The increased breastfeeding that accompanies bed-sharing raises the
possibility of enhanced immunological protection for the infant from potentially dangerous bacteria and viruses. Because bed-sharing in the context of a breastfeeding mother leads to the use of the single most important defense against sudden infant death syndrome (SIDS), the supine infant sleep position, we argued that the combination of breastfeeding and bed-sharing may provide and enhance potentially significant health gains for the baby and nonsmoking mother alike, including reducing the infant’s chances of dying from SIDS. Indeed, from the back-to-sleep campaign in 1992, which no doubt largely accounts for the significant reduction of SIDS, to the present, breastfeeding rates have increased to historic highs. If, as studies indicate, breastfeeding promotes the choice to bed-share, and more American parents are bed sharing than ever before, then perhaps these practices have also contributed to the reduction of SIDS since 1992. Most American breastfeeding mothers do not smoke and have access to safety information. Hence, the American situation of high rates of breastfeeding, high rates of supine infant sleep, reduced maternal smoking among this group, and safe bed-sharing could well parallel the situation in Japan, discussed above.
Infant–Parent Sleep Difficulties Because infant sleep biology changes much more slowly than cultural values, sleep environments that are optimal for infants may not be the ones encour-
aged by the culture. Moreover, widely accepted infant sleep management strategies may be sufficient for some infants and children but unsuitable for others. Some families may apply norms established for bottle-fed, solitary-sleeping infants to their own children when it is inappropriate to do so, leading parents to conclude either that their parenting skills are deficient or that their child is uncooperative. Ironically, this situation best describes what occurs in developed countries such as the United States, Great Britain, and Australia, where as many as one out of every three otherwise healthy children may have problems falling or staying asleep, after having first been conditioned to sleep alone.48 Rather than infant or caregiver deficiencies, such high percentages probably reflect overconfidence in the validity of our definitions and expectations about how infants should sleep, and the rigidity with which parents interpret and apply messages offered by health professionals. Indeed, parents’ rigid expectations concerning how their infants should sleep can be used to predict the likelihood that infant/child sleep problems will manifest: The more rigid the expectations, the more likely it is that parents will report dissatisfaction with their child’s sleep behavior.49 Night awakenings constitute a problem only for parents who expect their children to sleep through the night. It is only in the last century or so, and in a relatively small number of cultures, that parents and health professionals have become concerned with how infants should be conditioned to sleep. And, only in Western cultures are infants thought to need to learn to sleep, in this case alone and without parental contact. Most cultures simply take infant sleep for granted. pathways | issue 9
The Cultural/Scientific Bias Against Co-sleeping It has been easy for public officials to conclude that the problems associated with co-sleeping are not worth solving, in part because of our society’s unique cultural history. In popular parenting books and childcare magazines, co-sleeping may be (1) described as if it were a homogenous concept, (2) ignored completely, or (3) presented in terms of the likely or inevitable “problems” that could arise, especially the danger of suffocation. Sometimes co-sleeping is explicitly discouraged; at other times the message is subtler. The most frequently cited reasons for recommending separate sleeping quarters for parents and children include preservation of the marriage; promotion of the child’s individualism and autonomy; avoidance of incest and suffocation; promotion of the child’s social competence; and strengthening of the child’s gender and sexual identities. Indeed, where a problem or potential problem with co-sleeping can be identified, rather than being considered simply something to be solved, it becomes an argument against the practice, as if all families who co-sleep will experience the same problem. Furthermore, problems associated with co-sleeping are presented as if they cannot be solved in the same manner as, for example, problems associated with solitary sleep. Throughout the literature, co-sleeping is described as the cause of marital discord; although, data from Sweden refute this notion.50 Co-sleeping is also cited as the cause of sibling jealousy; while possibly true, it is probably only one of many causes. Parents are warned that co-sleeping creates a bad habit, one that is difficult to break. Co-sleeping is said to confuse the
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infant or child emotionally or sexually, or to induce over stimulation: “Sleeping in your bed can make your child feel confused and anxious rather than relaxed and reassured. Even a young toddler may find this repeated experience overly stimulating.”51 But no evidence is offered to show how, when,
deleterious consequences of co-sleeping. Probably few researchers, clinicians, and parents routinely co-slept with their own parents, a factor that would strongly influence their comfort with the practice. Perhaps an appreciation of diverse childcare practices, including co-sleeping, will come only
Any public safety campaign should recommend that at the very least every infant should be placed, preferably within arm’s reach, sleeping on a different surface, alongside a responsible adult caregiver.
and under what circumstances this happens; nor is there any acknowledgment that perhaps under stimulation could be a more serious clinical and psychological problem. A child needs to sleep alone, it is said, in order to establish a lifetime of good sleep hygiene, as well as to create a sense of self and comfort with aloneness, skills that presumably foster self-reliance and a strong sexual identity, all moral goods. Again, not only is no evidence presented that supports these statements, but also new evidence from a number of studies shows the opposite. In fact, when bed-sharing occurs in the context of ongoing healthy social relationships, toddlers and children are more independent, not less, and when they’re older, they have stronger sexual identities, not weaker ones, and are able to handle stress better. Scientific paradigms do not change quickly or easily. The concept of infant–parent co-sleeping is not readily assimilated by those who have spent their scientific lives documenting the normality of solitary infant sleep and accepting uncritically the alleged
with the growing populations of nonEuropean immigrants in Western countries. As demographics on that score suggest, the question is not if the paradigm will change, but how soon.
Conclusions and Recommendations The vast majority of scientific studies on infant behavior and development conducted in diverse fields during the last 100 years suggest that the question placed before us should not be “Is it safe to sleep with my baby?” but rather, “Is it safe not to do so?” An objective reading of the CPSC’s own database leads to a very different conclusion than the one it reached— namely, that no infant should sleep outside of the supervision and company of a responsible adult caregiver. The issue is too complex to recommend in a sweeping way that all families should bed-share; still, any public safety campaign should recommend that at the very least every infant should be placed, preferably within arm’s reach, sleeping on a different surface, alongside a responsible adult caregiver. Room-sharing alone reduces
the infant’s chances of dying from SIDS fourfold, according to the largest epidemiological study of SIDS yet undertaken.52 Recall that, until recent history, nighttime breastfeeding and infant and maternal co-sleeping functioned in tandem in all societies, and that both patterns remain an inevitable and inseparable system for most people today, including a growing number of Western parents. When practiced safely, co-sleeping with breastfeeding (whether bed-sharing or not) represents a highly effective, adaptive, integrated childcare system that can enhance attachment, communication, nutrition, and infant immune efficiency thanks to the increased breastfeedings and the increased parental supervision and mutual affection that accompany this practice. Moreover, bed-sharing and breastfeeding contribute indirectly to maternal and infant health by maximizing the intervals between succeeding births, therein lessening sibling
competition for limited maternal resources. Co-sleeping infants appear more content than those who sleep (or try to sleep) by themselves. With increased maternal contact and feeding, crying is significantly reduced, and, contrary to conventional thinking, maternal and infant sleep can be increased. Consequently, less energy is siphoned away from essential infant activities such as growth and defense against infectious disease. As renowned child psychotherapist D. Winnicott said half a century ago, “There is no such thing as a baby; there is a baby and someone.” Perhaps no childcare practice better reflects this truth than that of a human infant sleeping and breastfeeding next to its mother’s body, enjoying her loving and protective responses. For these reasons, neither governmental regulatory agencies, associations of crib manufacturers, nor medical authorities, many of whom confuse their personal preferences and ideologies for science, will
ever be able to deny parents and infants what they want to do naturally—and that is to sleep and feed side by side. Dr. James J. McKenna is a professor of Anthropology and Director of the MotherBaby Behavioral Sleep Laboratory at the University of Notre Dame. He also serves on the Health Advisory Board of La Leche League International. He has served on the Executive Committees of the American Anthropological Association and Society For Medical Anthropology and is a member of the American Academy of Pediatrics. He lectures nationally and abroad on the importance of re-conceptualizing what constitutes healthy childhood sleep, and along with his undergraduate students, continues to study family sleeping arrangements and the importance of breast feeding in promoting the health of mothers and infants. Access references to this article on line: www.icpa4kids.org/research/references.htm
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Linda Folden Palmer, DC, and Jeanne Ohm, DC
Facts about Co-Sleeping and SIDS In our Western societies, more and more parents are choosing to return to the natural practice of co-sleeping. Simply defined, this practice is consciously choosing to sleep with your infant to provide him or her with the essential physical, emotional, nutritional, neurological, and nurturing benefits of continued contact from womb and throughout infancy. The numerous benefits are well documented, although not well known by most parents and certainly practiced by far too few parents. There are those who remain ignorantly adverse to the practice of co-sleeping and their efforts to discredit it— even announce it as dangerous cause parents to form, fear based judgments, and erroneous conclusions about it. Probably the greatest misrepresentation about co-sleeping has been the charge that it causes SIDS (Sudden Infant Death Syndrome) A recent study in Pediatrics, the official Journal of the American Academy of Pediatrics (AAP) has raised controversy about sleeping with infants. Parents who co-sleep are being criticized and other parents who are looking into the benefits of co-sleeping may be led to erroneous conclusions and, therefore, choose not to initiate the safe and beneficial practice of sleeping with their newborn. Sensational headlines such as: “Bed Sharing Increases the Risk of SIDS” and warnings from the Consumer Product Safety Commission, such as, “Don’t sleep with your baby or put the baby down to sleep in an adult bed. The only safe place for babies is in a crib that meets current safety standards and has a firm, tight-fitting mattress. Place babies to sleep on their backs and remove all soft bedding and pillow-like items from the crib,” tend to initiate waves of fear and doubt about co-sleeping rather than present the facts so parents can make informed, safe choices for their babies. It is important when reading the sensational headlines, we as parents look deeper into the research to determine the reality of the situation. The study referred to as the “Chicago Infant Mortality Study” and the recent AAP recommendation (Fall 2005) based on this study has raised significant discussion about this issue. The authors of the Chicago study concluded,
“It seems prudent to discourage bed-sharing among all infants <3 months old. Young infants brought to bed to be breastfed should be returned to a crib when finished.” The AAP recommendation is consistent with this conclusion, yet does not offer any statements of differentiation between irresponsible bed-sharing and conscious co-sleeping. Nor did it choose to emphasize the study’s findings that breastfeeding infants have one fifth the rate of SIDS. When someone researches the facts on both sides of this issue, and compares the facts to the slanted media reporting, it is hard not to wonder if the AAP, baby product industry, and media want you to hear only the sensationalized incomplete findings. The Chicago study reported a nearly doubled SIDS rate for co-sleeping, but this study did not remove the powerful effect of smoking parents from their statistic. When other studies removed this behavior, they found the remaining infants enjoyed a greatly lower rate of SIDS for co-sleeping versus isolated crib sleeping. What the study actually revealed was that many of the mothers were not co-sleeping because of conscious choice, but rather because of lack of bed space in their homes. Most of the mothers did not breastfeed and a photo of one victim’s mother’s bed showed a sloppy, unkempt room with soda cans lined up along side of the bed—another clear indicator that there was not a high level of conscious health awareness in that household. These households should not be confused with those homes of families making informed decisions for their families’ wellness. There are two kinds of bed-sharing: the first being one of negligence and or irresponsibility (falling asleep with baby after drinking or with a smoking mother) and the second being co-sleeping: that conscious decision made by highly attentive parents, When sofa sleeping and wedging dangers are also removed, the family bed shines as safest.
The SIDS/Suffocation Risk Factors for Co-Sleeping: •
Bed sharing not being the accustomed sleep arrangement
Unsafe space between mattress and headboard or wall
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Parent compromised by drugs or alcohol
Overly heavy or fluffy bedding
Sleeping with sibling (for tiny infants) or non-interested adult
Sleeping without protective parent in room
Clearly co-sleeping and adult beds can be made to be safer. This would be a much more appropriate service for the Consumer Product Safety Commission to provide, rather than their thoughtless suggestion against co-sleeping. Also, clearly, responsible parents consciously creating a safe co-sleeping environment are safely providing the best of all worlds for their baby.
When crib deaths were much higher than they are now, the decision was to make the crib safer, not to throw out the crib. Most of the improvement in the crib death rate occurred from the “Back to Sleep” campaign. Babies can sleep supine in adult beds as well, although there’s no evidence that side sleeping with mother, as may occur after nursing, is a risk. Co-sleepers and side-beds that attach firmly to the mattress are good options to preventing falling out, suffocation, and entrapment, whether baby is in the co-sleeper or in the adult bed. Adjustments should be considered for the space between headboard and mattress, especially for “creepers.” Some parents simply put mattresses on the floor, eliminating entrapment concerns. Why does the United States rank only 43rd in infant survival* in the industrialized world (some non-reporting nations are thought to rank better than us as well)? Our difference from the best-ranking nations is a high predominance of formula feeding, isolated sleep, and medical intervention. The highest co-sleeping/breastfeeding nations rank with little more than half our overall infant death rate (and negligible SIDS rates). Remember…we rank #1 in medical intervention.
* based on data published in The World Factbook
Shared Sleep and Safe Sleeping
It is important to be responsive to a
Safe bed-sharing requires:
Advantages to baby:
baby’s nighttime needs. Attachment
Not smoking around baby
Parenting International (API) advocates
Not using alcohol or drugs
Studies indicate that cultures that cosleep have reduced incidence of SIDS
keeping baby in close proximity in a safe sleeping environment. In many cultures, it is considered normal and expected for parents to sleep with their children. Recent research has shown that some of the benefits include better quality of sleep for mothers and reduced risk of sudden infant death syndrome (SIDS) for babies. Safe bedsharing includes a safe, firm mattress and parents who are not using drugs or alcohol and who do not smoke near
A firm mattress free of fluffy bedding and stuffed animals Using safety measures such as bed extenders or safe placement of the family bed
There are more periods of light sleep beneficial to creating stable heart rates and breathing patterns Breastfeeding is better established through frequent nursings, which are facilitated by co-sleeping
Avoiding gaps of any kind, for instance between mattress and bed-frame or siderails that may easily slide out from the mattress.
Baby feels warm and secure, therefore cries less
Never leaving a baby unattended in an adult bed
Never placing a baby to sleep on a couch or chair
Advantages to parents: Improves length and quantity of breastfeeding
baby. If a parent is not comfortable with
Mother worries less about her infant
the idea of bed-sharing, remember the
Parents develop a closer bond to baby
key is close proximity and responsiveness to the infant’s nighttime needs. Available online at: www.attachmentparenting.org/idealsleep.shtml
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Just 20” x34”of floor space Newborn to 23 lbs.
Baby sleeps snugly and safely attached to parents’ bed
Dr. William Sears Author, infant & child care authority
“. . . a truly wonderful nighttime attachment tool—allows baby to sleep safely close for comfort and security.”
Patented secure attachment system. Ventilated floor and sides. Large zippered compartment and 4 side pockets. With 100 % cotton fitted sheet and handy carry bag. No assembly required. Leg extensions available to meet every bed height (purchase separately). For information on the benefits of co-sleeping, store list and fabric choice, please go to www.armsreach.com (800) 954-9353 or (805) 278-2559
ARM’S REACH CONCEPTS, INC. © 2004 Arm’s Reach Concepts, Inc. Patent Pending ARM’S REACH, CO-SLEEPER, Mother & Child Logo and all other trademarks are stringently protected. All rights reserved.
Conver ts to changer or free-standing unit
Nourishing Your Independent Toddler Cathe Olson
Somewhere between 12 and 18 months of age, your easygoing infant becomes a toddler striving to take control of his or her activities. When you want her to get dressed, she decides pajamas would be perfect for the park. When you call him to come in, he runs away laughing as you chase him. Mealtimes are the worst. While your baby used to eat anything you put in front of her, you may now have a finicky eater on your hands. Don’t let the table become a battleground. Here are a few ways to make meals enjoyable for the whole family and to help your child develop a healthy attitude toward food.
Encourage independence Allow your child to feed himself. Let food be something he wants and goes after rather than something he submits to. Prepare bite-size dishes like noodles, diced poultry or tofu, steamed broccoli florets, and diced carrots. Kids love to dip things. Serve pancakes, French toast, or waffles with applesauce or yogurt for dunking. Encourage (but don’t force) your toddler to try different foods. Allow your child to have some choice in what he eats.
Accept the method If your toddler is most comfortable using her fingers, let her. If she manages to use a spoon or fork, all the better. Don’t discourage any effort your children make to eat on their own. To encourage your baby to spoon-feed herself, serve a bowl of her favorite food with a small, easy-to-manage spoon. Try applesauce, yogurt, mashed sweet squash, etc.
Permit any order Let your kids eat food in the order they choose. If they want to eat applesauce first and vegetables last, that is their prerogative. Both my daughters pick all the raisins out of their oatmeal to eat first. I used to be afraid they wouldn’t eat their cereal afterwards but they always did. Children notice if you are placing more importance on sweet food. Example works very well here. Let them see that you enjoy broccoli and carrots as much as fruit or cookies.
Keep it simple Chances are, if you go through a lot of trouble preparing a fancy, gourmet meal for your children, that will be the dish they refuse. Toddlers’ tastes change from day to day, and you will end up frustrated or disappointed if they won’t eat
Toddlers like having the chance to feed themselves—encourage it, even if it is a bit messy).
banana-oatmeal cookies These moist, delicious cookies contain no sweeteners, butter, eggs, or wheat. 2 cups rolled oats 2/3 cup almonds 1 teaspoon baking powder 1/4 teaspoon sea salt 1/2 teaspoon ground cinnamon 1/4teaspoon ground nutmeg 1 1/2 cups mashed banana (about 3 bananas) 1/4 cup oil 1 teaspoon pure vanilla extract
Preheat oven to 350 degrees. Lightly oil baking sheet. Grind oats and almonds to a coarse powder in food processor or blender. Pour them into a large mixing bowl. Stir in baking powder, salt, cinnamon, and nutmeg. In separate bowl or in food processor, beat together bananas, oil, and vanilla until smooth and creamy. Add banana mixture and raisins to oat mixture. Mix well. Drop cookie dough by tablespoons onto prepared baking sheet. Bake for 13 to 16 minutes, or until bottoms are golden brown. Makes 3 dozen. Variation: For older children, replace the raisins with carob or chocolate chips if desired.
3/4 cup raisins
your special dinner. Don’t make your child feel guilty if he genuinely doesn’t like what you have prepared. Simply give him something easy like a bowl of rice or peanut butter toast, and let the rest of the family enjoy what you have prepared.
Believe your child will not go hungry Toddlers often refuse to eat their meals causing their parents to worry. Pediatricians agree this should not be a source of concern. Your child will eat when she is hungry, and missing a meal here or there will not cause malnourishment. We have our toddler sit at the table with us at mealtime even if she doesn’t want to eat. Usually, it’s only a few minutes before she realizes she is missing out and reaches for her meal. Try not to make a big issue out of getting your children to eat. The more they see it is important to you, the more they will dig in their heels and resist.
Limit snacks Your children will not eat meals if they spend the day snacking. Establish a morning and afternoon snack time. Serve healthful snacks like fruit, crackers, cheese, etc. Avoid very sugary or salty snacks as they encourage overeating. Give water between meals as milk and juice can leave your child too full to eat his meal. Serve milk or juice with meals if desired.
Do not mix food with discipline Toddlers are constantly testing their limits. Resist the temptation to use food as a bribe, reward or punishment, as this will not foster a healthy relationship with food. A treat should not be given because a child is good and withheld
when she is naughty. Treats are simply on the menu some days and not on the menu other days.
Know when to end the meal When your child stops eating or says she has had enough, end the meal. Don’t insist she finish every bite on the plate. Some food may be wasted, but insisting a sated child finish his meal is not healthy. Kids know when they are full. Encourage them to listen to their bodies so they will not overeat. Treat your pet or compost pile to the leftovers.
Enjoy mealtime Tense, stressful mealtimes will not help your children to develop a positive attitude toward food. Certain rules to maintain order (i.e., no yelling or throwing food) are necessary for the enjoyment of the rest of the family. More subtle table manners can be learned by example rather than authority. Your child wants to act grown up and will try to imitate you. Young children may act up at mealtimes because they are bored. Include your toddler in conversation so he feels part of the family. It’s a great time for your child to practice speaking and increase her vocabulary. You may be surprised by what your toddler has to say. Cathe Olson, her husband and their two daughters live in the hills of central California where they raise organic vegetables, fruit and herbs. Cathe is a freelance writer and the author of Simply Natural Baby Food: Easy Recipes Your Infant and Toddler Will Love. For more information or to order a book, visit www.SimplyNaturalBooks.com. © Cathe Olson
chiropractic for life
Questions Parents Frequently Ask About
Children and Chiropractic
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Children are susceptible to trauma in their spines from various activities and events. These microtraumas can cause nerve system stress. Doctors of Chiropractic describe this nerve system stress as subluxations or misalignments of the bones of the cranium and the spine. Nerve system stress, left unaddressed, impairs the child’s ability to function in a state of optimal health and well-being. Although symptoms, such as pain and malfunction may not show up for many years in the child, injury to their vital nerve systems can have a lifetime of damaging effects.
Children should be checked right after birth because of the potential damaging effects of the birth process. Even the most natural births are somewhat traumatic to the infant and may cause “hidden nerve system damage”. Any pulling on the baby’s fragile neck and spine during birth may cause stretching and injury to the brain stem and spinal cord. It has been shown that many children who experience symptoms of difficulty sleeping, breastfeeding, digestion (colic and reflux), repeated ear and respiratory infections have impaired nerve system function. The accumulated effects from this initial damage will have lifelong consequences. Early detection and correction of cranial and spinal nerve stress by a Doctor of Chiropractic can restore normal nerve function in the infant and offer the infant an advantage for greater health potential.
Does it Hurt?
Chiropractors who work with children regularly use very specific, gentle techniques catered to the childâ€™s specific needs. In the very young child, the adjustment is as light as a finger touch. Frequently, newborn babies will sleep through the adjustment. Older children enjoy chiropractic care as well and usually look forward to having their spines checked. Doctors of Chiropractic who are members of the International Chiropractic Pediatric Association utilize advanced techniques specific to the care of pregnant mothers, infants and children.
Most ICPA members offer complimentary consultations. This gives parents the opportunity to come into their practices, to meet the doctor and staff, to find out more about chiropractic and to discuss their familiesâ€™ individual needs. You can find a Doctor of Chiropractic in your area by visiting our membership directory at www.icpa4kids.org
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p r e g n a n c y m at t e r s
The concept of a due date is based on a gestational length established by fiat in the early 1800s. Franz Carl Naegele officially declared that pregnancy lasted 10 lunar months (10 x 28 days), counting from the first day of the last menstrual period). However, when Mittendorf et al. measured the median duration of pregnancy, they found that healthy, white, private-care, primiparous women with well-established due dates averaged 288 days and multiparas averaged 283 days, values significantly different from both Naegele’s rule and each other. Others have found similar results. Mittendorf et al. also cited other studies showing racial differences in gestational length. For example, one showed that black women averaged 8.5 days fewer than white women of similar socioeconomic status. Moreover, ultrasound-determined due dates are not accurate. One study used the date established by ultrasound at 16 to 18 weeks to test the validity of dating by the last normal menstrual period (LNMP). It found that as gestational age went past term, positive predictive values for the LNMP declined from 95% to 12%. The authors took this to mean
the LNMP was inaccurate, but, of course, the ultrasound date is the problem. Even first trimester measurements have an error bar of +/- 5 days in the second trimester and +/22 days in the third. Few practitioners appreciate the limitations of ultrasound or clinical data. Otto and Platt say the due date should not be changed unless the discrepancy is more than two weeks, yet they see doctors changing a due date by a few days, no trivial alteration if a woman will be induced when she exceeds a certain date. Some risk does accrue in healthy postdate pregnancies (notably meconium passage and big babies) but it does not follow that we should induce all women. Studies have found that as gestational age goes from 37 to 44 weeks, perinatal mortality and morbidity distribute in a U-shaped pattern. If we try to eliminate postdate pregnancies on grounds of increased complications, should we not equally logically try to delay labor onset in the early-term group? Henci Goer, Obstetric Myths vs. Research Realities, Bergin & Garvey 1994
Wood’s method: Carol Wood, Yale nurse-midwifery professor, came up with a method to calculate the due date that takes into account individual variations in the menstrual cycle as well as the effect of a woman’s having had previous pregnancies.
Try this method 1. Add 1 year to the first day of the last menstrual period, then
For first-time mothers, subtract 2 months and 2 weeks For multiparas, subtract 2 months and 2.5 weeks (18 days)
your due date.
2. Add or subtract the number of days her cycle varies from 28 days *1st-time mothers with 28-day cycles: LMP + 12 months - 2 months, 14 days = EDD *Multiparas with 28-day cycles: LMP + 12 months - 2 months, 18 days = EDD *For cycles longer than 28 days: EDD + (actual length of cycle - 28 days) = EDD *For cycles shorter than 28 days: EDD - (28 days - actual length of cycle) = EDD EDD: Estimated day of delivery LMP: Last menstrual period
Anne Frye, Holistic Midwifery Vol. 1, Labrys Press 1995
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How long should a woman feel comfortable going overdue? Laurie Morgan I would never put a number on how long a woman should feel comfortable going “overdue.” For one thing, errors are too easily made in recording of dates, and length of natural gestation varies widely, not only from woman to woman, but also from baby to baby. Instead, I would just focus on my overall health and the well being of the baby. We all have a wisdom inside us that we need to listen to, to let us know if something is not quite right to the point of needing intervention, be it early or late in the pregnancy. Plus, there are physical signs of wellbeing that are common sense that I can always look for. Is the baby moving like usual? Am I feeling well? I would like to encourage all pregnant women and their loved ones not to think about pregnancy, labor, and birth in superficial, mechanical terms (e.g., what color this is, what size that is, how much of that came out, what number of those there are...). Instead, pay attention to your overall well-being and that of your baby. Focusing on external “danger signs” can actually distract mother from receiving important inner cues. Mothers carry everything they need within them, whether it is the wisdom and power to seek out necessary help or to give birth completely alone. During pregnancy, just like during labor, mothers don’t need to be searching for problems, but instead remaining receptive to messages their bodies give them. As a general rule
A prospective study was conducted at a West German US Army Hospital to compare the accuracy of fetal weight estimation by a physician's clinical estimate as compared to ultrasound. One hundred women had Leopold's and vaginal examinations, an estimate was made. Then the same examiner performed an ultrasonic estimation of weight. The exam was done within 48 hours of delivery. The mean error for the clinical estimate was 7.9%. The error by ultrasound was 8.2%. There was no significant statistical difference between the two types of estimates, including for the extremes of birth weight. Journal of Reproductive Medicine, Vol. 33 No. 4, April 1988
just take good care of yourself and your baby, be “in tune” with your inner wisdom, and don’t let arbitrary rules and measures influence you. I, personally, went 20 days past the due date I’d estimated with my last daughter. I quit believing in the accuracy of due dates long ago, but since I did know when we conceived I figured it out for fun (ha!) I don’t plan on doing that ever again. I was comfortable staying pregnant as long as my baby needed me to, but the pressure and negativity that family members and strangers heaped on me was unnecessarily stressful. When the baby comes, the baby comes. I’ve decided (and would highly recommend) not to ever even bother predicting when my future babies are going to come. There will be no charting, no recording dates of menstruation, intercourse, or conception, and no addition, subtraction, multiplication or division at all. I’m very excited at the thought of going through an entire pregnancy without a single guess as to when the baby will be born next time. Fewer than five percent of babies are born on their due dates anyway! How much simpler it will be to listen to my body’s cues without that inaccurate and irrelevant date to compare with. In all things, listen to your heart and things may not go as you plan, but you surely won’t go wrong!
The Due Date Dilemma A recent report in the OB/Gyn Journal December 2001 states that eliminating the concept of a due date, “may be helpful to all involved.” The process of calculating due dates may be flawed as not all women ovulate 14 days from the onset of their menstruation. Additionally, other health factors of the mother play a role in delivery time. In reality, only 5% of all babies are born “on schedule”, anyway. Because of the due date women feel pressured, become anxious and are led into inductions by their practitioners. Inductions usually lead to further interventions in birth. Interventions in birth frequently lead to trauma for both the mother and baby. Dr. Vern Katz suggests that doctors expand the concept of a due date to a “due week.” In doing so, “it may allow biology to take its course a bit more.” Katz VL, Farmer R, Tufariello J, Carpenter M Why we should eliminate the due date: a truth in jest Obstet Gynecol 2001 (Dec); 98 (6): 1127-1129
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f e at u r e
make the choice!
www.icpa4kids.org/e-news.htm More and more parents are taking an active role in choosing wellness for their families. Our free e-newsletter brings pertinent research and topics right to your desk so you have the resources to make informed health care choices.
International Chiropractic Pediatric Association Seek health care options which support your childrenâ€™s own natural ability to be healthyâ€Ś
Be Informed Make knowledgeable health care choices for your family. Stay Connected Sign up for our free e-newsletter: Family Wellness First. Share the Wealth Refer other families to discover chiropractic. Get the Facts Review the most current research and articles.
Things You Can Do to Avoid an Unnecessary Cesarean The Public Citizen Health Research Group in
Washington, D.C. has estimated that half of the
Educate yourself. Read and attend classes and workshops, both inside and outside the hospital.
nearly 1 million Cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, these Cesareans could have been avoided. Clearly, there are times when a Cesarean is necessary; however, Cesareans increase the risk to both mothers and babies. Here are suggestions of things you can do to avoid an unnecessary Cesarean and to help ensure that your birth experience is as healthy and positive as possible.
Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center. Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest? Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor. Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc. Become aware of your rights as a pregnant woman. Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of Cesarean. Help ensure that you and your baby are both healthy by eating a well-balanced diet. If your baby is breech, ask your care provider about the chiropractic adjustment called the Webster technique, exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion. If you had a Cesarean previously, seriously consider VBAC. According to the American College of Obstetricians and Gynecologist, VBAC is safer in most cases than a scheduled repeat Cesarean and up to 80% of woman with prior Cesareans can go on to birth their subsequent babies vaginally.
Think about It: Choosing Cesarean Birth Does a woman have an inalienable “right” to choose a Cesarean section [CS]? It has been clearly established in law that an individual has the right to refuse medical treatment, but it does not follow that the converse is also true that an individual has the right to demand treatment that is not medically indicated. If a woman asks for a CS, but is refused because there are no medical indications, is it correct to say
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she will have a “forced” vaginal delivery? Pregnancy is not an illness. Most women need no medical or surgical treatment during pregnancy, delivery and the puerperium. Vaginal birth is the consequence of being pregnant, a state for which the woman and her sexual partner must take responsibility, not the medical profession. — Marsden Wagner, MD
In 2003, about 27% of births in the U.S. were by C-section. Another Reason for Vaginal Births DURING LABOR Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you. Continue to eat and drink lightly, especially during early labor, to provide energy. Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation. If your bag of water breaks, only have vaginal examinations when medically indicated. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection. Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of Cesarean without related improvement in outcome for the baby. Avoid an epidural, if possible. Medical research has shown that epidurals can slow down labor and cause complications for the mother and the baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing. Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest. Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short- and long-term effects on you and your baby, and what are your other options. Remember, nothing is absolute. If you have any doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.
This material was reprinted with permission and retained copyright of International Cesarean Awareness Network, INC. All rights reserved.
It is not necessary for research to “prove” that vaginal birth is healthier for both the mother and baby. It is, however, interesting to read the many reasons why a mother should do everything possible to avoid Cesarean sections, commonly called C-sections. The following study offers valuable information about the relationship between C-sections and infants burdened with gastric upset and allergies. This study examined 865 full-term, healthy infants, born to parents with a history of allergies. At birth, all mothers were given uniform nutritional recommendations, and infant formula was given only when breast-feeding was not feasible during the first four months of life. The infants were tested at 12 months and checked for antibodies to common allergens including cow’s milk, eggs, and soybeans. The 147 babies in this study who were delivered by C-section were twice as likely to exhibit food allergies and had 46% more diarrhea than babies who were vaginally birthed. The researchers concluded that C-section delivery might be a risk factor for diarrhea and allergic sensitization in infants with a family history of allergy. Why were the babies born by C-section more at risk for allergies? Researchers believe that C-section babies are lacking in the natural, protective, “friendly” bacteria that vaginally-delivered infants acquire during birth. This natural exposure helps to protect them, and is believed to be key in the development of healthy immune system function later in life. Birth by C-section used to be a relatively rare occurrence. A C-section was performed only when a known medical problem would make labor dangerous for mother or baby, or if there were complications in labor such as dystocia. In the last 10 years, the C-section rate has increased because of perceived maternal convenience, incorrect diagnosis of dystocia, and fear of malpractice. In 2003, about 27% of births in the United States were by C-section. There is no doubt that C-sections are sometimes necessary; however, all precautions to prevent it as a routine practice are vital to the child’s future health potential. Please read the adjacent article: “Things You Can Do to Avoid an Unnecessary Cesarean” put out by the International Cesarean Awareness Network to optimize your chances of having a natural, vaginal delivery.
Breastfeeding in Public The term ‘nursing discreetly’ typically refers to covering up the breast and especially nipple while breastfeeding in public. Some women use a blanket to cover the whole situation, including the baby. The need for discreet nursing stems from the idea that seeing an exposed breast supposedly arouses sexual feelings. Indeed it does so in the United States, but only because this society is so obsessed by women’s breasts and has MADE them into sexual objects. However; this perspective is peculiar to United States and some other countries that have been influenced by US culture. In times past a breast was not considered a sexual organ and therefore there was no need to conceal nursing. This is still true today in many parts of the world. It is good to be discreet in presence of others if you know they might be offended by your breastfeeding— which is true if you are nursing in public. However, it is worth considering what is really considered more discreet and getting less attention: a blanket set-up might only point out in big letters that you are breastfeeding; whereas lifting your shirt quickly and just enough to let baby latch on is probably much more unnoticeable. And, when people don’t notice or pay mind to your nursing, you are being very discreet. (In fact, the older baby might plain
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refuse to nurse underneath a blanket or it might sometimes be dangerously hot to nurse with all covers on.) Also, for the laws’ sake you do NOT need to cover yourself up totally with a blanket. There is nothing in the legislation stating that a nursing mother would need to only show x amount of bare skin/nipple. It naturally takes a little time to get baby to the breast, and is very common for older babies to sometimes let go of the nipple to see what’s going on. So, don’t be overly afraid if your nipple shows for a LITTLE while getting your baby to latch on—it is just part of the normal breastfeeding experience and people should understand that. Many nursing moms find that people in
general don’t stare, and after a while they become more comfortable with nursing in public and don’t think about it anymore. As far as being concerned about men staring at the partially bare breast, some men indeed might get aroused by the sight, but many probably just try to not pay attention. Men are simply curious about female breasts and breastfeeding since society has made it a taboo. They are not necessarily looking at you with lust, but are simply interested, as it is something they may have not seen before. It is well known that if you make the taboo available and expose it (whatever the taboo might be), then it gradually loses its attractiveness. For example, at a certain time in the past, a woman’s ankle was a
By nursing in public you can actually help individuals whose thinking has been turned backwards by media and society.
photo © cathy mccaughan
fetish—today men are not turned on by seeing women’s ankles.
uals whose thinking has been turned backwards by media and society.
Covering something up makes it seem forbidden, which produces feelings of curiosity. It is noted among naturists and nudists that they have lower rate of teenage sexual relationships. Why? Because to those teens the human body is not a taboo; they know what it looks like and are not obsessed by bare skin.
One of the main impacts that nursing mothers can have is by affecting how the general public feels about breastfeeding in public. Just imagine, if practically all mothers nursed their babies, then it would be commonplace to see nursing infants and older babies in public, too. Women wouldn’t have to be embarrassed, and others would not pay attention to such an everyday occurrence. And, though it might be difficult, nursing mothers can change other people’s views about breastfeeding. So, be encouraged to nurse in public places—you are making it a little easier for all the other moms, while at the same time you can let men and
Similarly, the more women breastfeed openly, the more everybody, especially men, gets to see the normal breast fulfilling its natural function of feeding babies, the less taboo the breast will becomes, and the less obsessed by bare skin society will be. So, by nursing in public you can actually help individ-
boys seen the real purpose of breasts. Our society is desperately in need of mothers nursing their babies in public openly. We also need books and TV programs featuring breastfeeding mothers. Our children need breastfeeding dolls, not bottle-feeding ones. If a girl grows up thinking that breastfeeding is the normal way to feed a baby, she will be much more likely to try it, and knowing that a lot of women can do it with no difficulty, she’ll have more confidence in herself as a nursing mother.
This article was reprinted with permission from: www.007b.com/breastfeeding_public.php
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Make an Impression Donate to Chiropractic Research For over 100 years, families have enjoyed the benefits of chiropractic care for their overall health and well-being. Many of these people see ways to give back to the source which improved their overall quality of life. With your donation we are able to… • Conduct research relevant to health in pregnancy, birth and childhood
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As a nonprofit, 501(c)(3) organization, the ICPA depends on our members to help fund our work. Whether you are a practitioner or layperson, we welcome your support and are grateful for your generosity.
Come visit us in Santa Fe!
our th anniversary with us!
May 12-14, 2006 Mother’s Day Weekend Santa Fe, New Mexico We invite our Mothering readers and our Santa Fe community to join us during this family-friendly weekend of art and celebration.
Open House & Anniversary Party Art of Mothering Exhibition Mothering: The Monologues Booksigning with Peggy O’Mara In the Mother Tongue Poetry Mother’s Day Brunch Hot Mamas Fashion Show Mothering at the Movies
For details, go to www.mothering.com/anniversary
pa r e n t i n g
Hang out at a playground, visit a school, or show up at a child’s birthday party, and there’s one phrase you can count on hearing repeatedly: ‘Good job!’ Alfie Kohn
Here’s why it may not be the best thing to say. Even tiny infants are praised for smacking their hands together (‘Good clapping!’). Many of us blurt out these judg-
ments of our children to the point that it has become almost a verbal tic. Plenty of books and articles advise us against relying on punishment, from spanking to forcible isolation (‘time out’). Occasionally someone will even ask us to rethink the practice of bribing children with stickers or food. But you’ll have to look awfully hard to find a discouraging word about what is euphemistically called positive reinforcement. Lest there be any misunderstanding, the point here is not to call into question the importance of supporting and encouraging children, the need to love them and hug them and help them feel good about themselves. Praise, however, is a different story entirely. Here’s why.
Reasons to Stop Saying
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Manipulating children Suppose you offer a verbal reward to reinforce the behaviour of a two-yearold who eats without spilling, or a five-year-old who cleans up her art supplies. Who benefits from this? Is it possible that telling kids they’ve done a good job may have less to do with their emotional needs than with our convenience? Rheta DeVries, a professor of education at the University of Northern Iowa, refers to this as ‘sugarcoated control’. Very much like tangible rewards—or, for that matter, punishments—it’s a way of doing something to children to get them to comply with our wishes. It may be effective at
producing this result (at least for a while), but it’s very different from working with kids—for example, by engaging them in conversation about what makes a classroom (or family) function smoothly, or how other people are affected by what we have done— or failed to do. The latter approach is not only more respectful but more likely to help kids become thoughtful people. The reason praise can work in the short run is that young children are hungry for our approval. But we have a responsibility not to exploit that dependence for our own convenience. A ‘Good job!’ to reinforce some-
Florida, discovered that students who were praised lavishly by their teachers were more tentative in their responses, more apt to answer in a questioning tone of voice (‘Um, seven?’). They tended to back off from an idea they had proposed as soon as an adult disagreed with them. And they were less likely to persist with difficult tasks or share their ideas with other students. In short, ‘Good job!’ doesn’t reassure children; ultimately, it makes them feel less secure. It may even create a vicious circle such that the more we slather on the praise, the more kids seem to need it, so we
thing that makes our lives a little easier can be an example of taking advantage of children’s dependence. Kids may also come to feel manipulated by this, even if they can’t quite explain why.
praise them some more. Sadly, some of these kids will grow into adults who continue to need someone else to pat them on the head and tell them whether what they did was OK. Surely this is not what we want for our daughters and sons.
Creating praise junkies
To be sure, not every use of praise is a calculated tactic to control children’s behaviour. Sometimes we compliment kids just because we’re genuinely pleased by what they’ve done. Even then, however, it’s worth looking more closely. Rather than bolstering a child’s self-esteem, praise may increase kids’ dependence on us. The more we say, ‘I like the way you…’ or ‘Good __ing’, the more kids come to rely on our evaluations, our decisions about what’s good and bad, rather than learning to form their own judgments. It leads them to measure their worth in terms of what will lead us to smile and dole out some more approval. Mary Budd Rowe, a researcher at the University of
Stealing a child’s pleasure
Apart from the issue of dependence, a child deserves to take delight in her accomplishments, to feel pride in what she’s learned how to do. She also deserves to decide when to feel that way. Every time we say, ‘Good job!’, though, we’re telling a child how to feel. To be sure, there are times when our evaluations are appropriate and our guidance is necessary—especially with toddlers and preschoolers. But a constant stream of value judgments is neither necessary nor useful for children’s development. Unfortunately, we may not have realized that ‘Good job!’ is just as much an evaluation as ‘Bad job!’ The most notable feature
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of a positive judgment isn’t that it’s positive, but that it’s a judgment. And people, including kids, don’t like being judged. I cherish the occasions when my daughter manages to do something for the first time, or does something better than she’s ever done it before. But I try to resist the knee-jerk tendency to say, ‘Good job!’ because I don’t want to dilute her joy. I want her to share her pleasure with me, not look to me for a verdict. I want her to exclaim, ‘I did it!’ (Which she often does) instead of asking me uncertainly, ‘Was that good?’
‘Good painting!’ may get children to keep painting for as long as we keep watching and praising. But, warns Lilian Katz, one of the country’s leading authorities on early childhood education, ‘once attention is withdrawn, many kids won’t touch the activity again’. Indeed, an impressive body of scientific research has shown that the more we reward people for doing something, the more they tend to lose interest in whatever they had to do to get the reward. Now the point isn’t to draw, to read, to think, to create—the
everyday basis than other children were. Every time they had heard ‘Good sharing!’ or ‘I’m so proud of you for helping’, they became a little less interested in sharing or helping. Those actions came to be seen not as something valuable in their own right but as something they had to do to get that reaction again from an adult. Generosity became a means to an end. Does praise motivate kids? Sure. It motivates kids to get praise. Alas, that’s often at the expense of commitment to whatever they were doing that prompted the praise.
Reducing achievement As if it weren’t bad enough that ‘Good job!’ can undermine independence, pleasure, and interest, it can also interfere with how good a job children actually do. Researchers keep finding that kids who are praised for doing well at a creative task tend to stumble at the next task—and they don’t do as well as children who weren’t praised to begin with. Why does this happen? Partly because the praise creates pressure to ‘keep up the good work’ that gets in the way of doing so. Partly
it actually promotes the less desirable motive by making children more likely to fish for praise in the future.
Once you start to see praise for what it is (and what it does) these constant little evaluative eruptions from adults start to produce the same effect as fingernails being dragged down a blackboard. You begin to root for a child to give his teachers or parents a taste of their own treacle by turning around to them and saying (in the same saccharine tone of voice), ‘Good praising!’ Still, it’s not an easy habit to break. It can seem strange, at least at first, to stop praising; it can feel as though you’re being chilly or withholding something. But that, it soon becomes clear, suggests that we praise more because we need to say it than because children need to hear it. Whenever that’s true, it’s time to rethink what we’re doing. What kids do need is unconditional support, love with no strings attached. That’s not just different from praise— it’s the opposite of praise. ‘Good job!’ is conditional. It means we’re offering
I want her to exclaim, “I did it!” instead of asking me uncertainly, “Was that good?”
point is to get the goody, whether it’s an ice cream, a sticker, or a ‘Good job!’ In a troubling study conducted by Joan Grusec at the University of Toronto, young children who were frequently praised for displays of generosity tended to be slightly less generous on an
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because their interest in what they’re doing may have declined. Partly because they become less likely to take risks—a prerequisite for creativity —once they start thinking about how to keep those positive comments coming. More generally, ‘Good job!’ is a remnant of an approach to psychology that reduces all of human life to behaviours that can be seen and measured. Unfortunately, this ignores the thoughts, feelings, and values that lie behind behaviours. For example, a child may share a snack with a friend as a way of attracting praise, or as a way of making sure the other child has enough to eat. Praise for sharing ignores these different motives. Worse,
attention and acknowledgement and approval for jumping through our hoops, for doing things that please us. This point, you’ll notice, is very different from a criticism that some people offer to the effect that we give kids too much approval, or give it too easily. They recommend that we become more miserly with our praise and demand that kids ‘earn’ it. But the real problem isn’t that children expect to be praised for everything they do these days. It’s that we’re tempted to take shortcuts, to manipulate kids with rewards instead of explaining and helping them to develop needed skills and good values. So what’s the alternative? That depends on the situation, but whatever
we decide to say instead has to be offered in the context of genuine affection and love for who kids are rather than for what they’ve done. When unconditional support is present, ‘Good job!’ isn’t necessary; when it’s absent, ‘Good job!’ won’t help. If we’re praising positive actions as a way of discouraging misbehaviour, this is unlikely to be effective for long. Even when it works, we can’t really say
fluke. If children are basically evil, then they have to be given an artificial reason for being nice (namely, to get a verbal reward). If that cynicism is unfounded—and a lot of research suggests that it is—then praise may not be necessary.
Say what you saw A simple, evaluation-free statement (‘You put your shoes on by yourself’ or even just ‘You did it’) tells your child
We need to consider our motives for what we say as well as the actual effects of doing so. the child is now ‘behaving himself’; it would be more accurate to say the praise is behaving him. The alternative is to work with the child, to figure out the reasons he’s acting that way. We may have to reconsider our own requests rather than just looking for a way to get kids to obey. (Instead of using ‘Good job!’ to get a four-year-old to sit quietly through a long class meeting or family dinner, perhaps we should ask whether it’s reasonable to expect a child to do so.) We also need to bring kids in on the process of making decisions. If a child is doing something that disturbs others, then sitting down with her later and asking, ‘What do you think we can do to solve this problem?’ will likely be more effective than bribes or threats. It also helps a child learn how to solve problems and teaches that her ideas and feelings are important. Of course, this process takes time and talent, care and courage. Tossing off a ‘Good job!’ when the child acts in the way we deem appropriate takes none of those things, which helps to explain why ‘doing to’ strategies are a lot more popular than ‘working with’ strategies. And what can we say when kids just do something impressive? Consider three possible responses:
Say nothing Some people insist a helpful act must be ‘reinforced’ because, secretly or unconsciously, they believe it was a
that you noticed. It also lets her take pride in what she did. In other cases, a more elaborate description may make sense. If your child draws a picture, you might provide feedback— not judgment—about what you noticed: ‘This mountain is huge!’ ‘Boy, you sure used a lot of purple today!’ If a child does something caring or generous, you might gently draw his attention to the effect of his action on the other person: ‘Look at Abigail’s face! She seems pretty happy now that you gave her some of your snack.’ This is completely different from praise, where the emphasis is on how you feel about her sharing.
Talk less; ask more Even better than descriptions are questions. Why tell him what part of his drawing impressed you when you can ask him what he likes best about it? Asking ‘What was the hardest part to draw?’ or ‘How did you figure out how to make the feet the right size?’ is likely to nourish his interest in drawing. Saying ‘Good job!’, as we’ve seen, may have exactly the opposite effect.
control over her life—or to constantly look to us for approval? Are they helping her to become more excited about what she’s doing in its own right— or turning it into something she just wants to get through in order to receive a pat on the head? It’s not a matter of memorising a new script, but of keeping in mind our long-term goals for our children and watching for the effects of what we say. The bad news is that the use of positive reinforcement really isn’t so positive. The good news is that you don’t have to evaluate in order to encourage. Alfie Kohn is the author of Punished by Rewards: The Trouble with Gold Stars, Incentive Plans, A’s, Praise, and Other Bribes. This article was published in Young Children, September 2001; and, in abridged form (with the title “Hooked on Praise”), in Parents Magazine, May 2000. Reprinted with permission by the author. For more on this topic, please see www.alfiekohn.org and the book Punished by Rewards.
This doesn’t mean that all compliments, all thanks, all expressions of delight are harmful. We need to consider our motives for what we say (a genuine expression of enthusiasm is better than a desire to manipulate the child’s future behavior) as well as the actual effects of doing so. Are our reactions helping the child to feel a sense of
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m i n d — b o dy
“Intention is the most powerful forces in healing.” “Intent is not just in your head, it is a force of nature that orchestrates the movement of information and energy into physical reality.” —Deepak Chopra
intent Gregg Stern, DC, FICPA According to Dr. Chopra: Intention = Information Attention = Energy When you focus your attention on your intention, you cause your intention to manifest itself into physical reality. In essence, with good intention and focused attention, you can make wonderful things happen and the inverse is true as well. So, I ask you, where is your heart and mind when you do what you do? There is nothing like, no replacement or substitute for, chiropractic care. A specific and gentle chiropractic adjustment of a subluxation (dysfunction of a spinal joint causing interference in your nervous system) is completely different than a wrenching “manipulation” of that same joint that may be performed by those in other professions. It differs in
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many ways including the Intent behind each adjustment. Chiropractic is not just a form of natural treatment for pains and problems; it is a lifestyle that promotes health and wellness for people of all ages with the core premise being: The body is a tremendous self-healing and self-regulating organism. The nervous system is the master control system of the body. If there is interference in the nervous system, the body will not function properly and will have a reduced ability to heal itself. Chiropractors reduce nervous system interference. Chiropractors who specialize in family wellness, and pediatric and maternity care have a very strong philosophical attachment to this core premise and every adjustment that we provide is delivered with a deep and unwavering Intention of loving healing. As we have seen, “Intention is the most powerful forces in healing” and in our offices we incorporate positive intention with
focused attention. Knowing this, how could you not be motivated to get you and your children checked for subluxation. If present, subluxation can lead to dis-ease in the body and then disease. But, if the dis-ease is removed through chiropractic care, you not only avoid disease, but gain enhancement of overall health and well-being. Now you see how our intent can help you, and your family, friends, and coworkers, let’s see how your intent can help you, your family and all those around you. I go back to the question, where is your heart and mind when you do what you do? Do you give a dollar to the person outside the grocery store holding a collection can for a charity so they will leave you alone or to help those they are collecting for? Do you help others because you hope for something in return or just because you want to help them? We all have times where we do things for the “right” reasons and
for the “wrong” reasons. If your intent is not present, pure, and steadfast, the positive manifestations will not occur. Is it possible to consciously develop your intent? Absolutely! It takes work, but it is worth it. Through techniques such as goal setting and daily affirmations, you can mold your intention however you see fit. You must first determine what your core values are. Set aside a period of time where you can be alone with your thoughts and determine what things are most important to you…the type of person you would like to be…the way you would like to act and feel all the time. Feel free to think about the people you think are already like this and model their characteristics. Now, you can write out goals in accordance with these core values. Once you have written out your goals, you can create daily affirmations that will reinforce these core values and goals. This is
not easy work but when you get in a habit of goal setting and daily affirmations you will be able to start to live your life in full congruency with your beliefs. When you live your life in full congruency with your beliefs, your intent will be present, pure and steadfast and your intent will be manifested through your attention and create whatever it is that you choose to create. I strongly encourage everyone to make these efforts and work with your children to form these habits early. The world can be changed and improved, one person at a time. Step up and be that next person to make a positive contribution through your positive intention and teach our next generation of citizens to do the same. Set your intentions on a healthier, happier world and begin to fulfill this goal by deciding that you and your family are going to be healthy and well adjusted.
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fa m i ly l i f e
Well-Balanced Child Claudia Anrig, DC Every parent wants to raise the perfect child: healthy, happy, loved, and respected with high achievements and even higher goals. We want our children to have the things we didn’t have and to achieve their dreams. This is all well and good, unless we become so focused on our desires for our child that we forget what’s inherently best for the child.
Hyper-Parenting The term hyper-parenting describes a dangerous trend in child rearing in middle- and upper-middle–class homes. In hyper-parenting families, parents become overly involved in every detail of their children’s academic, athletic, and social lives. They unnecessarily augment their children’s environment and overschedule them. In these parents’ heartfelt desire to help their children succeed, they hinder the kids by not allowing them to be, simply, children.
Over-Activities Children today are getting so much more than just basic schooling. Many participate in several of the following extracurricular activities: sports, clubs, music lessons, art lessons, foreign language lessons, necessary tutoring, and internet. Individually, these activities are valuable, but combined they can leave parents and children frazzled.
We worry about what a child will become tomorrow,
Some parents claim that they involve their children in these activities to avoid the risk of boredom.1 What they are forgetting is that boredom is a catalyst for creativity. Boredom can fuel a child’s imagination; while over-scheduling the child doesn’t allow them the opportunity to exercise their innate ability to entertain themselves.
yet we forget that he is someone today. ~Stacia Tauscher
Competitive-Parenting Raising the perfect child has almost become a competitive sport, with the prize being speaking early, qualifying for gifted and talented programs, or earning admission to an elite university. These things, and not a well-balanced and happy child, have become the measure of parental accomplishment. According to Alvin Rosenfeld, MD, “The competitive parents react to the latest science reported in the media—which professionals know is of dubious validity—by broadcasting Mozart into their infants’ nurseries to stimulate mathematical ability, enrolling toddlers in organized gymnastics programs
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to fine-tune large motor development, and putting children too young to comprehend the rules in competitive team sports. They insist that kids who are barely awake sit for 7 AM piano lessons and that high-schoolers manicure their resumes to fit profiles elite colleges supposedly are looking for.”2 Many parents may recognize these characteristics in themselves but, despite the fact that they know their children are over-scheduled, many parents will choose to keep up the pace for fear that cutting back may harm their child’s future.
The Pressure Where is this pressure coming from? Why do parents feel this overwhelming drive to push their children to not only succeed but to excel? There was a time when parents were urged to trust themselves and their instincts. Not so today, when experts imply that each decision made for children will have crucial future implications and, with its tone of urgency and authority, raises parental anxiety to a fever pitch and brings out the worst in everyone. The pressure also comes from the schools that find themselves at the other end of a pass-the-buck relay race to produce the best and most highly educated children. The schools have to show results for those tax dollars they’ve been receiving and they react to the pressure by placing higher demands on the children, usually under the guise of increased homework that is supposed to enhance future performance. 3 An additional contributing factor is the incorrect belief that child development is absolutely linear. Many parents mistakenly believe that if their child reads early, 15 years down the road they’ll score higher on their verbal SATs. So, parents push their children to achieve milestones early and to develop skills faster than their counterparts, expecting this will help them achieve greater things in the future.
The End Results We have to wonder how this kind of life is affecting the children. What are the children feeling when faced with an endless parade of activities? Consider what damage this could be doing to a developing self esteem. The subliminal message that kids are getting from this constant scrutiny and hyperactivity is that they are inadequate in their current unpolished state. The children convince themselves that if they were acceptable just as they are, then they wouldn’t need all of this extra enrichment. They begin to feel inadequate and inferior; this results in children spending more time buried in the Gameboy, Nintendo, or latest computer games. Taken to the extreme, these children will sometimes go so far as to drop
out of school; feeling that they’ll never measure up anyway, they quit trying.2 It’s clear that possibly hyper-parenting may be a contributing factor to the increased incidence of teenage depressions, substance abuses and other forms of acting out.
Conclusion It’s time for parents to realize that their child may not be the next prima ballerina, concert violinist, quarterback, infielder, or President of the United States, but that doesn’t mean that they won’t have equally fulfilling lives. What a lot of parents don’t realize is that, even without all of the extra-curricular activities, their children are well on their way to being everything they could hope for and more. Dr. Claudia Anrig has had a family wellness practice since 1982. She has edited chiropractic pediatric and clinical text and written numerous articles on the topic: Chiropractic Care for Children. She currently serves on the Board of Directors for the ICPA. Access references to this article on line: www.icpa4kids.org/research/references.htm
Ten Recommendations for the Over-Scheduled Family 1.
In a family with three or more children, each child should have just one outside activity—this will sometimes mean choosing between two favorite activities.
2. To add an activity, the child must give up a current activity. 3. Set family nights on your calendar and make them a priority. 4. Help your child learn to say no to activities that don’t really interest them; make it a point not to live vicariously through your children. 5. Do not agree to any new activity for yourself or your child without careful consideration. 6. Assess your irritability quotient. How often are you yelling at the kids to hurry up because you’re running late to a function? 7. Resolve to eat dinner together as a family every night. This may take some time but it’s worth the effort. 8. Schedule goof-off time for your family. Give your child down time to spend on a hobby or just playing outside. 9. Make spending time together as a family every week a priority. Go to the park, the batting cages, the zoo, the museum, etc., at least once a week. 10. Get adjusted regularly and ask your family Chiropractor for advice on how to better schedule your children.
Pamela Stone, DC, FICPA It is March, the time of year when your children are starting to play little league baseball, softball, soccer, or some other spring sport. Playing outdoors brings a lot of enjoyment for children and parents, especially after a few months of indoor winter activity. As a result, exercise levels tend to increase and often times, injuries appear. Injuries to childrenâ€™s spines are not unique to contact sports like football, soccer, or martial arts, though they are also seen in non-contact sports like competitive cheerleading and gymnastics. As more and more kids are becoming involved in sporting activities, many parents (and their children) could be overlooking the importance of proper nutrition and body conditioning needed for preventing injuries both on and off the playing field. Most sports provide a very positive experience for children, though if not properly prepared, playing any sport can turn into a bad experience.
Keep Your Young Athlete
Healthy and Fit 38
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The best advice for parents who have children involved in athletics is to help them prepare their bodies, and to learn to protect themselves from sports-related injuries before they happen. A proper warm-up exercise and stretching program is essential for youths involved in sports. However, many children learn improper stretching techniques, or do not stretch at all, making them more susceptible to injury. Both parents and coaches need to work with their kids and make sure they receive the proper sports training. Before participating on any given day, young athletes should begin with a slow jog to warm up, and stretch all the major muscle groups, including the legs, arms, and back. Holding the stretches, rather than bouncing, for 5â€“10 seconds will gain the most benefit. As children get older, the stretches can be held for longer periods of time and proper weight lifting can be introduced when they become teenagers. Proper nutrition and hydration are also extremely vital. The requirement of drinking eight to ten 8-ounce glasses of water every day is not only for adults. These days, too many youths drink soda, juice, and milk for hydration, even though water is the best for proper absorption into the body. Young athletes today often think they are invincible. The following tips can help ensure your child does not miss a beat when it comes to the proper fitness, stretching, training, and rest that the body needs in order to engage in any sporting activity.
Encourage your child to: Follow a warm-up routine. Be sure your child or his/her coach includes a warm-up and stretching session before and after every practice, game or meet. A slow jog, calisthenics, and/or lifting small weights reduce the risk of ripped or torn muscles. Flexibility becomes key when trying to score that extra goal or make a critical play. Maintain a healthy weight. Children that are overweight are unhealthy just as much as youths that are underweight. Be sure your child does not feel pressured into being too thin and that he/she understands proper nutrition and caloric intake is needed for optimal performance and endurance.
Drink water. Hydration is a key element to optimal fitness and function. Teenage athletes should drink at least eight 8-ounce glasses of water a day. Younger athletes should drink five to eight 8-ounce glasses of water. Avoid sugar-loaded, caffeinated, and/or carbonated drinks. Sports drinks are a good source of replenishment for kids engaged in long-duration sports, or those exercising more than 60 minutes. Wear the proper equipment when required and make sure that the equipment is properly fitted to the child. Make sure all equipment, including gloves, shoes, and helmets fit your child or adolescent properly. Eat healthy meals. Make sure your young athlete is eating a well-balanced diet and does not skip meals. Avoid high-fat foods, such as candy bars, fried food, and fast food. At home, provide fruit and vegetables rather than cookies and potato chips. Get plenty of rest. Eight hours of sleep is ideal for young athletes. Lack of sleep and rest can catch up with the child and decrease performance. Have your child examined by a Chiropractor. Doctors of Chiropractic are licensed and trained to care for the neuromusculoskeletal system and can provide advice on sports training, nutrition, and injury prevention to young athletes. A proper chiropractic evaluation by a qualified pediatric chiropractor can keep them in the game and help to minimize if not prevent injuries, particularly injuries leading to spinal injuries. Often, minor spinal injuries go unnoticed until adulthood, when pain sets in and it thus takes longer to make corrections. Dr. Pamela Stone is in private practice in Kennesaw and works with many athletes, children, and pregnant women. The Family Chiropractic Center is located in the Publix Shopping Center at the intersection of Highway 575 & Bells Ferry Road. Dr. Stone can be reached at: 770-926-8746 email@example.com www.stonefamilychiropractic.com
Back Pain During Pregnancy As your pregnancy advances and your uterus enlarges, you’re likely to feel some discomfort. Back pain is a common complaint. But you don’t have to grin and accept back pain as a normal part of your pregnancy. You can take steps to stop the soreness. It’s a good idea to learn these techniques now, because you’ll probably need them again later when your back is bearing the strain of constantly lifting your 7- to 10-pound baby or your 20-pound toddler.
What causes back pain in pregnancy? At least 50 percent of women experience back pain during pregnancy. Pregnant women are prone to backaches and back pain for a number of reasons: Extra weight. The weight you gain during pregnancy is good for your baby, but it can be bad for your back. Change in center of gravity. As your uterus grows, your center of gravity shifts forward. Gradually— and perhaps without notice—you begin to adjust your posture and the way you move. These compensations can lead to backaches and back pain. Your hormones. During pregnancy, the hormone relaxin causes the ligaments between your pelvic bones to soften and your joints to loosen in preparation for your baby’s passage through your pelvis during birth. As the structures that support your pelvic organs become more pliant, you may feel considerable discomfort on either side of your lower back, often with walking, Exercising can help aches. especially up and down stairs. Back pain can occur at any time during pregnancy. For many women, it interferes with daily activities and the ability to get a good night’s sleep.
What can you do? These self-care strategies can put your back on track: Pay attention to your posture. The healthy posture that you learned before you were pregnant still applies in early pregnancy, before your uterus is above your bellybutton. Tuck your buttocks under, pull your shoulders back and downward, and stand straight and tall. Later in pregnancy, as your uterus enlarges, you naturally pull your shoulders back farther to offset the weight of your uterus pulling you forward. This can actually cause back
strain. Talk to your doctor about adjusting your posture to accommodate your growing belly. Make adjustments when sitting or standing. Sit with your feet slightly elevated, and don't cross your legs. Change position often, and avoid standing for long periods of time. If you must stand for a while, rest one foot on a low step stool. Strategically place your pillows. Sleep on your side, with one or both knees bent. Place a pillow between your knees and another one under your abdomen. You may also find relief by placing a specially shaped total body pillow under your abdomen. Avoid lifting heavy objects or children. When lifting a smaller object, don't bend over at the waist. Instead, squat down, bend your knees and lift with your legs rather than your back. Try to avoid sudden reaching movements or stretching your arms high over your head. Get the right gear. Wear supportive, low-heeled shoes and maternity pants with a low, supportive waistband. Or consider using a maternity support belt. Try heat, cold or massage. Apply heat to your back. Try warm bath soaks, warm wet towels, a hot water bottle or a heating pad. Some women find relief by alternating ice packs with heat. A back massage also may help. Stay fit. As long as your health care provider approves, an exercise program can keep your back strong and may actually relieve back pain. Some women enjoy swimming, and doctors highly recommend it—the body's buoyancy in the water offers relief from the extra weight of pregnancy. You also might like walking or taking a prenatal exercise or yoga class. On your own, you can try an exercise called a pelvic tilt or cat stretch: Kneel on your hands and knees with your head in line with your back. Pull in your abdomen, arching your spine upward. Hold the position for several seconds, then relax your abdomen and back. Repeat three to five times, working gradually up to 10. If these self-care steps aren't working or your back pain is severe, talk to your health care provider. He or she may suggest a variety of approaches, such as special stretching exercises, that can alleviate pain without causing concern for your unborn baby. Pain in your back may be a sign of a more serious problem if it's severe and unrelenting or if it's accompanied by other signs and symptoms. A low, dull backache may be a sign of labor or preterm labor. So, it's best not to ignore your aching back. www.mayoclinic.com/invoke.cfm?objectid=791DC4F0-AF394D30-B321C5CD694CD04E
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Watching the Doctors Randall Neustaedter, OMD, LAc Modern technology may be bringing wonderful advances to medical care, but some doctors are not so happy with the possibilities it offers. Parents typically record the births of their babies to remember the moment and rejoice in their happiness. Doctors, however, are viewing the videos as possible threats to their own well being. Here is a comment published in Pediatrics, June 2005. “Concerned that family videos of the birth of a child could be used against them in medical malpractice cases, doctors and hospitals are limiting videotaping in delivery rooms. ‘What once used to be really fun and warm and cozy and so forth is now a potential nail in the coffin from a liability perspective,’ said Dr. John Nelson, the president of the American Medical Association and an obstetrician. Dr. Nelson does not allow families to videotape the birth itself, but they are free to record other events, such as the mother’s first moments with the child.”
Some doctors may not permit videotaping your baby being born. Why?
Perhaps it is time that we routinely record all surgeries and births on video. What do doctors fear? Do they fear that an actual visual record will provide more reliable and damaging data for documenting negligence than reliance on eyewitness testimony or the opinions of experts?
Anemia Link to Postnatal Depression Joint research by three American universities indicates that postpartum iron deficiency can cause anxiety, stress, and depression. The study looked at 64 South African women who were mildly iron deficient ten weeks after childbirth. Half the group was given iron supplements. Women who received no treatment appeared bored and distant and were more likely to interrupt their baby’s play at inappro-
priate times. The study also found that their babies were less responsive and less involved with them. Iron deficiency is very common during pregnancy, particularly during the third trimester. If you are concerned that you may be anemic, consult your doctor, or your pharmacist, who can recommend an over-thecounter supplement.
Epidural Anesthesia Leads to More C-Sections Despite recent headlines to the contrary, the results of a flawed three-year study published in the New England Journal of Medicine did not show that early epidurals are safer than late epidurals. The real news was that so many of the first-time mothers even had Cesarean sections—17.8% of women who had early epidurals versus 20.7% of women given epidurals late in labor.
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Long-Term Cognitive Development in Children with Prolonged Crying background: Long-term studies of cognitive development and colic have not differentiated between typical colic and prolonged crying. objective: To evaluate whether colic and excessive crying that persists beyond
Do happier babies grow to be smarter children?
3 months is associated with adverse cognitive development. results: Children with prolonged crying (but not those with colic only) had an adjusted mean IQ that was 9 points lower than the control group. Their performance and verbal IQ scores were 9.2 and 6.7 points lower than the control group, respectively. The prolonged crying group also had significantly poorer fine motor abilities compared with the control group. Colic had no effect on cognitive development. conclusions: Excessive, uncontrolled crying that persists beyond 3 months of age in infants without other signs of neurological damage may be a marker for cognitive deficits during childhood. Such infants need to be examined and followed up more intensively.
Forceps and vacuum delivery pose the same mortality risk for babies
Research to Remember The most common risk factor for shoulder dystocia is the use of a vacuum extractor or forceps during delivery. Dystocia occurs to varying degrees in infants with a birth weight of 2500 grams (0.6% to 1.4% increased risk) and in infants weighing 4000 to 4500 grams born to diabetic mothers (5% to 9% increased risk). However, most dystocia occurs with infants of normal birth weight, making prenatal identification of risk factors difficult. Maternal complications of dystocia include postpartum hemorrhage (11%) and fourth-degree maternal lacerations (3.8%), and fetal complications include brachial plexus palsies (4% to 15%), which nearly always resolve within 6 to 12 months after birth. The degree of practitioner experience has no bearing on the incidence of fetal complications. American Family Physician, 1 April 2004
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Neonatal mortality is similar after vacuum delivery and forceps delivery. Demissie and colleagues (p 24) analyzed more than 12 million deliveries in United States and New Jersey birth cohort files and found that, compared with babies delivered with forceps, those who had vacuum deliveries had a lower risk of birth injuries, neonatal seizures, and assisted ventilation but a higher risk of postpartum hemorrhage and shoulder dystocia. Fetal distress was more common with instrumental delivery, and nulliparous women (those who had not previously borne children) were more likely than parous women (those who have had children) to have instrumental deliveries. Vacuum extraction does have risks, but it remains a safe alternative to forceps delivery, conclude the authors. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis Kitaw Demissie, George G Rhoads, John C Smulian, Bijal A Balasubramanian, Kishor Gandhi, K S Joseph, Michael Kramer bmj.com/cgi/content/abstract/329/7456/24?ecoll
pa r e n t ’ s p e r s p e c t i v e
What Happens To Kids Who Never Get Adjusted? By Kevin Donka, DC A few years back, I was adjusting a family who had been under care for several years. This family consisted of a dad, mom and three children. Prior to receiving care, all three children had been dealing with recurrent ear infections and bad behavior. The oldest, had also been labeled as “developmentally delayed” because she had “learning disabilities.” As I worked on her children this day, their Mom, was marveling at how their lives had changed with chiropractic care. There had been no ear infections at all. In fact, there had not even been any colds for more than a year now.
What if she was meant to be something much
As the Mom testified to me about these miraculous changes, she asked me a question I had never been asked before, “What happens to kids who never get adjusted?” I answered her in the following way. “Well, some kids have a lifetime of recurrent illnesses, much like you and your kids were experiencing prior to coming in for care. But most of them…they are just average kids.” She looked at me with wonder on her face as I said this, and she followed up with another question, “I don’t understand! Are you saying that most kids don’t need chiropractic care?” “NO!” I replied, “Not at all! Here is what I mean by that. There is nothing wrong with a child being average…if that is her potential! But, what if that’s NOT her potential?
Send it to: firstname.lastname@example.org and we will use it in an upcoming issue in Pathways to allow more parents to understand the many benefits of family chiropractic care.
“The only way for your children to reach their potential in life is to have nerve systems that are free from interference so that they can adapt to all of the physical, chemical and mental stresses they encounter each day. That way, their energy can be used to access higher levels of creative thought instead of just trying to get through the day. In other words, they have the best possible chance of reaching their full potential in life!”
more than average?
The oldest, now in third grade, was not only free of her so-called “disability,” she was one of the top students in her class!
Do you have a chiropractic story about yourself or a family member that you want to share with us?
What if she was meant to be something much more than average? Even if she is meant to be what we call average, she will not even reach that level if her brain and body can’t communicate effectively with each other.”
She looked at me and began to get tears in her eyes as she realized fully for the first time, just how important their chiropractic care had been. Because her daughter’s disability had resolved under care, she was really able to understand how a person’s potential could blossom with chiropractic care. Sometimes it may seem difficult to explain the importance of chiropractic care to other parents, especially when their children do not seem to have any symptoms. It is important to remember chiropractic care is so much more than the elimination of symptoms—it is really about expressing our maximum potential in life. If you find it difficult to get other parents to understand, ask them speak directly with your chiropractor. B.J. Palmer, the developer of chiropractic once said, “You never know how far reaching something we say, think or do may affect the lives of millions tomorrow.” One short moment, one small word may change someone’s life forever. After all, every one deserves the opportunity to express their greater potential in their own unique, individual way.
pathways | issue 9
fa m i ly w e l l n e s s f o r u m
When Baby Prefers Tummy Sleeping What is your recommendation about infant sleep position? We have a two month old (our third) who is having a really hard time staying asleep on her back. She seems to be happier on her tummy and seems to have no trouble lifting and turning her head when face down. I know about the medical establishment's recommendation about back sleeping to reduce the risk of SIDS but wondered if there was more to the story? When our six children were young, it was still the recommendation to put children on their bellies to sleep. Being Doctors of Chiropractic, my husband and I chose not to. Basically, what we saw in our practice was that our patients who were stomach sleepers had chronic neck problems and even when they began chiropractic care, they did not hold their cervical (neck) adjustments well. From a biomechanical perspective it did not seem right to put our children on their stomachs either. We chose to have them sleep with us, primarily on their sides. It is true that the American Academy of Pediatrics now recommends that children sleep on their backs to reduce the incidence of SIDS. Since this “Back to Sleep” program was initiated, the incidence of SIDS has been shown to decrease. Being a Doctor of Chiropractic I am always concerned with “cause”. When I heard about this “Back to Sleep” campaign and its results, I looked at the biomechanics. Why would back sleeping reduce the incidence of SIDS? From a biomechanical perspective it was clear to see that when a baby is placed on his or her back, there is no stress to the baby’s neck or lower cranium. However, when a baby is placed on his or her belly for sleep, the head and neck will be in constant rotation to one side or the other. This rotation along with the pressure and
When a baby is placed on its belly for sleep there is constant irritation to the cervical spine—where respiratory centers are. weight of the head holding it in rotation causes continuous irritation to the cervical spinal cord and nerves. This area in the neck is also the area where the respiratory centers are. This continued irritation during sleeping hours may adversely affect that area of the spinal cord and therefore adversely affect proper breathing function. SIDS is defined as a condition where a baby just
stops breathing. Although a cause has not yet been defined, most studies relating to SIDS have explored and discovered a malfunction of the respiratory system in the infant.
My question has always been: What then can cause this malfunction? Why would a primary system like respiration just stop? Since it is the nerve system that controls respiration, what could have happened to affect normal nerve function responsible for respiration? Was there any potential injury or trauma to the nerve system causing interference to normal respiratory function? When you look at the amount of pulling and rotation done by most operators in the majority of births today, there is good reason to believe that this type of pulling has caused irritation and even injury to the cervical spine and therefore the nerves it protects. Even in what is considered to be “natural births” there is often undue pulling and stretching of the infant’s spine. Now take a baby who has even slight irritation or injury to the cervical nerves because of pulling at birth and picture placing this same baby on his or her stomach for the many hours he or she sleeps. As mentioned, this belly position will force the baby’s neck to be rotated to one side or the other creating what is called “noxious stimulation” to the cervical nerves and spinal cord. The result is additional irritation to a possibly already injured area. From a biomechanical point of view, this spells SIDS. You mentioned that your child has difficulty sleeping on her back. Is she also arching her spine? Is she sensitive when you touch her neck and the back of her head (the occipital portion)? Does she seem to have a tilt in her neck to one side or the other when you lie her on her back or hold her up in front of you? All of these signs are indicators that she is experiencing spinal nerve stress and would benefit from a chiropractic check up.
I would suggest that you give serious recall as to how “gentle” your child’s birth was, research the safe options and advice about co-sleeping to offer her more comfortable sleeping postures and make a choice that is right for your baby. Additionally, you can locate a Doctor of Chiropractic on our membership directory who cares for infants. Alleviating any spinal nerve stress early in life will have profound effects on your child’s overall health and well-being.
Jeanne Ohm, DC
Send your questions to Dr. Ohm at email@example.com pathways | issue 9
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