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If the words “health care reform” make your eyes glaze over, check out the American Academy of Pediatrics’ (AAP) one-page fact sheets intended to explain the Health Care Reform Law, the Patient Protection and Affordable Care Act, and the Health Care and Education Reconciliation Act of 2010, and how they align with the academy’s core principles:

1. Every child must have quality health insurance.

2. Quality health insurance should be a right, regardless of income, for every child, pregnant women, their families, and ultimately all individuals.

3. All health insurance plans should have a comprehensive age-appropriate benefits package directed to the special needs of the pediatric population as recommended by the AAP.

4. Every child should receive care in a medical home with a primary care pediatrician, and have access to pediatric medical subspecialists, pediatric surgical specialists, pediatric mental and dental professionals, and hospitals with appropriate pediatric expertise.

5. All health plans should have payment rates that assure that children receive all recommended and needed services.

Did you know that the reform act will expand health insurance to cover almost 32 million more children and parents? Did you know it will ban pre-existing condition exclusions for kids, and allow young adults to stay covered by their parents’ insurance until age 26?

Families of children who are uninsured (10 percent of all American children) or on Medicaid (30 percent of American children) will find the fact sheets particularly helpful.  Thanks to the AAP, staying up-to-date on health care reform has never been easier. Click here to access the fact sheets and related news and editorials.

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If you are able to enjoy fresh, local produce at a farmer’s market this summer, consider yourself lucky.

According to The Henry J. Kaiser Family Foundation’s State Health Facts, 23 states have less than 2 markets per 100,000 people. And only 1 out of 5 middle and high schools offer fruits and vegetables as “competitive foods,” or foods sold outside of school meal programs, like in vending machines, school stores, or snack bars. That fact is based on data from 27 states, which means the number of schools that offer such choices is actually less than 1 in 5.

The State Health Facts website might be the most user-friendly health data resource on the health of our nation—good for researchers, journalists, or curious parents alike.

There’s an entire section on children’s health, including breastfeeding information which can be found on the women’s health page. There you’ll find that 73 percent of all women in the U.S. breastfed in 2006, though only 43.4 percent were still breastfeeding at 6 months, and 22.7 percent at 12 months.

The website is called “State Health Facts” for a reason: you can easily compare your state to the rest of the country. You can even create a custom fact sheet. Go to “Individual State Profiles” to see whether your state is as healthy as you think.

©iStockphoto.com/Mishella

We know that breastfeeding reduces the risk of childhood obesity, but how? A new study published in the journal Pediatrics found that it may have to do with babies inability to self-regulate their milk intake—whether that’s expressed breast milk or formula—when they drink from bottles.

Around 17 percent of children and adolescents ages 2-19 are obese, according to the Centers for Disease Control and Prevention (CDC). For children 2-5 years old, obesity increased from 5 to 10.4 percent between 1976-1980 and 2007-2008; for children 6-11 years old, the obesity rate increased from 6.5-19.6 percent; and for 12-19-year-olds, it increased from 5 to 18.1 percent.

Obese children are more likely to become obese adults, putting them at risk for high cholesterol levels, high blood pressure, abnormal blood sugar levels, asthma, hepatic steatosis (liver damage due to high levels of liver enzymes), sleep apnea, and Type 2 diabetes.

That breastfeeding reduces the risk for childhood obesity is old news. Breastfeeding has long been linked with a reduced risk of obesity, based on research from 2004, 2006, and 2007. But this new study is the first to look at infant’s self-regulation of food intake as the possible mechanism.

Research
The question posed by the study authors—“Do Infants Fed From Bottles Lack Self-Regulation of Milk Intake Compared With Directly Breastfed Infants?” demands just one answer, and, according to the study results, that answer is yes.

Researchers Ruowei Li, Sara B. Fein, and Laurence M. Grummer-Strawn analyzed data from the 2005-2007 Infant Practices Study II, a large-scale study conducted by the Food and Drug Administration and the CDC. Participants received monthly questionnaires, and researchers were able to look at complete data for 1,250 infants.

Results
Data showed that babies who were bottle-fed in early infancy were more likely to empty their bottles or cups in late infancy, regardless of the type of milk in the bottle or cup. The numbers are substantial:

• 27 percent of babies who were exclusively breastfed in early infancy emptied their bottles in late infancy
• 54 percent of babies who were both breast- and bottle-fed emptied their bottles in late infancy
• 68 percent of exclusively bottle-fed babies emptied their bottles in late infancy

“Bottle-feeding, regardless of type of milk in the bottle, is distinct from feeding at the breast in its effect on infants’ self-regulation of milk intake,” the study’s authors wrote.

So, do babies who keep drinking until the bottle is dry—regardless of whether they are actually still hungry—repeat this behavior with food and drink as kids? Well, no one can say for sure; in fact, that is one of the study’s self-proclaimed limitations (along with underrepresenting black and Hispanic mothers, and the possibility that reporting errors may have occurred.)

It would make sense that eating patterns established in infancy would affect later childhood. But there is more at work here.

The study authors suggest three main reasons to explain the disparity in self-regulation:

1. Breastfeeding babies control intake since they decide when to start and stop suckling; bottle-fed babies are less likely to control milk intake. When babies are encouraged to finish a bottle completely despite being full, they don’t learn to regulate their intake.
2. Breastfeeding requires both non-nutritive and nutritive sucking. The baby’s sucking triggers the let-down reflex, so there are moments in which the baby is sucking but not actually getting any milk. This very transition in sucking styles may affect self-regulation: when babies control the milk flow by adjusting their sucking, “they may establish a greater level of responsiveness to internal cues of hunger and satiety,” according to the study. This way of sucking does not exist in bottle-feeding.
3. Breast milk varies in composition and taste. Near the end of a feeding, the fat content in the breast milk is higher, which may signal to the baby that the nursing session is coming to an end. This signaling doesn’t happen with bottle-feeding. The study’s authors also suggest that missing out on the “sensory experience” of varied breast milk flavors may effect the regulation of food intake later in life.

Recommendations
All children, regardless of how they were fed as infants, can maintain a healthy weight throughout their lives—with their parents’ guidance.

If you bottle-feed your baby, remember that newborns may take only an ounce or two of formula at each feeding; by two months, it may be just 3-4 ounces. Watch for hunger cues (your baby may smack his lips or put his hands to his mouth) and check for his rooting reflex (turning his head toward your hand when you touch his cheek). And remember that crying is actually a late indicator for hunger, so don’t wait for your baby to cry to feed him.

When your child is older, continue to encourage healthy eating habits and regular physical activity; you can find inspiration in the CDC’s tips on preventing childhood obesity. If you struggle with weight, become an example for your child and strive to stay healthy together. Take a look at the newest version of the food pyramid and be an active participant in your child’s life.

The best advice for new moms is to breastfeed your baby for at least a year (exclusively for the first six months). However, any amount of breastfeeding for any length of time benefits your child—and you.

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Two new Pediatrics studies share disturbing information: there are increasing instances of young children swallowing batteries—especially 20mm-diameter lithium cell batteries found in remote controls.

What’s the big deal you might ask? You probably swallowed a quarter or two as a kid. I’m pretty sure my son ate a Band-Aid. But small batteries are not nearly so benign.

There are serious—even fatal—consequences to ingesting button batteries, which can lodge in the esophagus (the tube that carries food to the stomach) and cause severe tissue damage within just two hours. Even after the button-sized battery is removed delayed complications can occur including a hole in the esophagus, a tracheoesophageal fistula (an abnormal connection between the esophagus and trachea), and paralyzed vocal chords. The batteries can also cause narrowing of the esophagus (making it difficult to swallow) and excessive bleeding.

It’s clear that button batteries and their widespread use are the real problem, according to the study, “Preventing Battery Ingestions: An Analysis of 8648 Cases.” After analyzing the aforementioned cases that were reported to the National Battery Ingestion Hotline, researchers found that the majority of the batteries ingested (over 61 percent) were taken directly from household products, suggesting that their battery compartments are not childproof and are too easy to open. Almost 40 percent of the ingested lithium cell batteries were intended for remote controls.

In another study titled, “Emerging Battery-Ingestion Hazard: Clinical Implications” researchers suggest revised guidelines for treating battery ingestion—mostly that the battery needs to be removed immediately, and that doctors shouldn’t hesitate to order urgent radiographs (imaging tests) and look for delayed complications.

Researchers found more evidence that battery ingestions were increasing by looking at three data sets—56,535 cases from the National Poison Data System; 8,648 cases from the National Battery Ingestion Hotline; and 13 deaths in both medical literature and the National Battery Ingestion Hotline. The study found that in each data set, button battery ingestions rose (1 percent to 18 percent from 1990-2008) and serious complications were reported within two hours. Almost 30 percent of cases involving serious complications and over 50 percent of fatalities were misdiagnosed at first.

In “Preventing Battery Ingestions” researchers urge manufacturers to redesign household products, making the battery compartment more secure and harder to open. Meanwhile, we encourage our readers to check out our guide on choking prevention—and to put those remote controls in an out-of-reach place.

©iStockphoto.com/chuwy

I’ve heard it from my own husband and other fathers: when it comes to discussions of parenthood, dads are routinely left out, even though they are experiencing many of the same things as moms.

In the early days, dads are just as confused, intimidated, elated, anxious, and sleep-deprived. They have that same moment of clarity of realizing that parenting is little more than winging it. They understand that brand-new and fierce instinct to protect and nurture at all costs.

Here, dads from around the world share their views on birth, surprises, and lessons from their smallest teachers.

Making introductions
“My son was born premature, 28 weeks in…I got a call just after 1 in the morning saying to get to the hospital because [Neil's mother] was having an emergency C-section. So I was a bit panicked while driving to the hospital. Ran two red lights, but stopped at each one first. Raced up to her floor and was directed to just outside the O.R. when [my son] was wheeled out in a plastic box. They stopped the cart for a second so I could get a look at him, connected to tubes and wires. I never felt scared that he would not make it, just that he was not ready yet…I wasn’t quite ready yet either.”—Ed, father to Neil (7), Columbus, Ohio

“The first thing I thought when Ginny was born was how she looked exactly how I pictured she would. We got a great 3D ultrasound picture of her and my mind filled in the missing parts. When Griffin was born, he had some fluid in his lungs so the nurses immediately took him away to examine him. He screamed the whole time. I remember feeling like I was about to push the doctor and nurses out of my way to be with him and give him some comfort.”—Scott, father to Ginny (4) and Griffin (1), Bethlehem, Georgia

“I saw my daughter being born, it was an amazing feeling! It was kind of unreal, but fantastic. I was extremely proud and impressed by my wife! She’s much tougher than I am.”—Mathias, father to Elin (7 months), Kungsbacka, Sweden

“The moment was frozen in time, every detail was crystal clear. With Donovan, we brought him into the world to the strains of The Edgar Winter Group’s ‘Frankenstein.’ Elias was born peacefully at home; it felt like a major triumph to have a healthy baby without any interventions. I was proud of Rachel and I got to catch the baby. With Elias’s birth, our family finally felt complete.”—James, father to Donovan (2) and Elias (1 month), Athens, Georgia

I first felt like a dad when…
“Maybe 56 days later when we finally got to take [my son] home.”—Ed

“I  started saying things to Ginny or Griffin that sounded just like the things my dad said to me when I was young.”—Scott

“We woke up the day after she was born. Then it was real.”—Mathias

“I drove all the way home from the hospital at 20 miles per hour. That was the first time I had this incredibly defensive feeling about my daughter—that I am the person who is here to protect her.”—Graham, father to Sylvia (3), London, England

“I mastered all of the daddy disciplines. After overcoming the extreme mommy-dependence of a high-needs baby, I was finally able to be an equal partner in Donovan’s child care. I could handle him on my own without relying on the ‘Mommy Fix.’ Finally, I was no longer on the outside looking in.”—James

Surprises
“The amount of acceptance, empathy, and tolerance you have for other peoples’ children—especially when their child acts out.”—Ed

“The thing that surprised me most about being a dad is just how much I love my children. When Ginny was born, I just wanted to tell everyone who would listen how great it was to be a dad and how my daughter was the most beautiful creature in the universe. So when we found out we were having Griffin, I was concerned that he would be short-changed because I couldn’t see how I could love him as much as I loved Ginny. But my fears were put to rest as soon as he arrived. So now I tell people how great it is to be a dad and how I have the most beautiful daughter and handsomest son in the universe.”—Scott

“Wondering what I ever did with my time before becoming a parent! And the physical pain of even a brief separation from the kids. You spend time anticipating, orchestrating, and executing a night out, and spend the whole time speculating about what the little ones are up to.”—James

“I am constantly being surprised by the speed with which our daughter is developing. It seems to me she is learning new things every day! People told me time passes so quickly the first year, I didn’t really believe them, but now I know they were absolutely right!”—Mathias

What fatherhood has taught me
“My son has autism. There is no longer any such thing as normal.”—Ed

“Life is short and you should try to enjoy every minute you can with your kids. All the things people say about kids growing up fast is much too true. That realization has really helped set my priorities straight.”—Scott

“It has taught me what really matters. Now I understand why my parents were worried about me when I was out late…Our daughter is only 7 months old so I think I have much worrying to look forward to!”—Mathias

“There is no joy greater than a child who truly loves you.”—Graham

Cheers to you, dads!

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Be careful when you Google “Booby Trapper.” Because there’s a horror movie by the same name that apparently is about a bloody hatchet colliding with some unfortunate campers.

No, the “Booby Trapper” you will want to look for is the latest tent-like device designed to give you privacy while you breastfeed, all the while shielding the eyes of passersby who might faint when confronted with a baby eating.

This Booby Trapper was recently named the grand prize winner of the Progress2Capital business planning competition organized by the Regina Regional Opportunities Commission.

Baby gooroo mentioned the Booby Trapper when it was included in the Golden Globes gifting suite (you can see photos from the day here. From the photos, it looks like the women are wearing a gigantic apron, which, frankly, draws much more attention than a latched-on baby whose head covers nearly everything a shirt would cover.

Clever names aside, what does it mean that such a product exists?

It means that women want to nurse in public (yay!) and want to feel comfortable doing so (of course!). It means that some women uncomfortable with breastfeeding in public may give it a go (big yay!). This is something we can get behind: a feeling of empowerment and comfort that encourages mothers to breastfeed.

But it’s unlikely that many women will be encouraged to breastfeed as long as the act remains invisible. Hidden breastfeeding perpetuates the idea that public breastfeeding is shameful, weird, possibly gross, and definitely not normal. And that needless concept is just what the Booby Trapper (along with other similar nursing cover-ups) offers.

Boo. Big, big, boo!

©iStockphoto.com/Mishella

Lactation consultants know their stuff. Years ago, one of them told me that breastfeeding enhances the effects of some vaccines, and she also recommended breastfeeding as soon as possible following vaccinations, since doing so is a natural pain reliever for baby.

That was news to me. When I mentioned it to my son’s pediatrician, he said feel free to stay in the examination room following the shots to breastfeed for as long as I’d like (which I appreciated very much) but it made me wonder, would he have recommended the breastfeeding remedy to me had I not suggested it? Only the lactation consultant had ever advised doing so in the first place.

Go hug a lactation consultant.

Research
Lucky for new moms and dads, word is spreading. A new study published in Pediatrics links breastfeeding to reduced fever following vaccinations, after examining 450 infants’ temperatures on the evening they received vaccinations plus the following three days.

Results
The infants who were not breastfed at all had much higher reports of fever than those who were exclusively breastfed. Fever was reported in 30 (25 percent) exclusively breastfed children; 48 (31 percent) partially breastfed children; and 94 (53 percent) of children who were not breastfed at all.

We already know that breast milk is an immune booster which may explain why the body’s response to vaccines is more effective in breastfed children. Breast milk also has anti-inflammatory properties which may explain the reduced risk for swelling and redness at the vaccination site as well as post-vaccination fever. It’s also believed that the skin-to-skin contact inherent in breastfeeding helps—a feverish baby might find comfort in being held close to his mother. The authors of this study suggest that the reason breastfeeding helps reduce post-vaccination fevers is partly based in emotion: babies who don’t feel well want to nurse for comfort. A lot. So, in this instance, breastfed babies end up getting more calories than bottle-fed babies. Extra caloric intake has been shown to help prevent fevers. Meanwhile, it has been reported that bottle-fed babies have a reduced caloric intake after being immunized, which could increase their risk for fever.

Recommendations
Some breastfeeding mothers may not be at all surprised by this research; most instinctually soothe an upset child by nursing. Once, when my then-infant son was ill, my older sister (who breastfed her two children) gave me this simple advice: “Breastfeed, breastfeed, breastfeed.” Without the knowledge of this study to back her up, she knew—as countless other mothers know—that breast milk not only comforts but protects.

“When infants are sick and after a vaccination shot, they need not only water, food and a calm environment, but also to be protected,” Dr. Alfredo Pisacane, one of the study’s researchers, tells Reuters. “They need the warm body of their mothers. Breastfeeding provides all what an infant does need during illness.”

For moms who don’t—or no longer—breastfeed, skin-to-skin contact and lukewarm sponge baths may help bring down a baby’s fever. All parents should talk with their baby’s doctor about using infant acetaminophen or ibuprofen (when to administer, accurate dosage, signs of fever). And while we are sure you have seen this already, check out the list of recently recalled children’s Tylenol products.

Most importantly, love your sick baby.

That said, The Complete Idiot’s Guide to Vaccinations: A Balanced Look at the Pros and Cons by Michael Joseph Smith and Laurie Bouck, gave me pause. It’s straightforward intentions are well-written in a way that anyone can understand—hence the title. The book has one plain and simple mission: tell readers why they must vaccinate their children. The book, which advocates sticking to the American Academy of Pediatrics’ vaccination schedule, was published in late 2009 and remains relevant during a time when more and more parents are delaying or outright refusing vaccines for their children.

In fact, 39 percent of parents refused or delayed vaccines in 2008, up from 22 percent in 2003, according to a new study by the Centers of Disease Control and Prevention (CDC), the University of Rochester, and the National Opinion Research Center. The main reason? Fear. According to the study: fear of efficacy; fear of too many shots at once; fear of possible side effects including autism (despite the fact that the 1998 study that linked vaccination and autism has been fully retracted).

By reminding parents of the “pros” to immunizations, this book attempts to eliminate these fears; though it makes a misstep in its subtitle, which hints that it takes the “cons,” whether real or perceived, seriously. For example, the chapter called “Do Vaccines Cause Medical Problems?” could have been one word long: “No.” Readers who are unsure of vaccines may expect a certain transparency, one that gives credence to parents’ fears—maybe something along the lines of Robert Sears’ The Vaccine Book: Making the Right Decision For Your Child which allows for delaying or skipping vaccines altogether. But this book might as well be an official CDC guidebook. Any “cons” are quickly debunked as myth.

Because of this, readers who already have strong anti-vaccination views will bristle at the book, but still might enjoy reading at least the first (and possibly most interesting) part of the book, which tells the story of the very first inoculation—Edward Jenner’s smallpox vaccine, administered to a young boy in England in 1762. Jenner, a surgeon’s apprentice, noticed that the milkmaids who caught cowpox became immune to smallpox. Cowpox was a less severe disease than smallpox, so Jenner collected “biological material” from a cowpox-infected milkmaid and injected it into the young boy, thus making him immune to smallpox, too.

But, in the pages that follow, the book treads familiar territory: the difference between live and inactive vaccines; how vaccines are made; how they are delivered; and how they actually work. What sets it apart from other books on the subject is the authors’ ability to explain everything you need to know about vaccines clearly and without misinformation.

According to the authors—Smith, an assistant professor of pediatrics at the University of Louisville and an attending physician at Kosair Children’s Hospital; and Bouck, an established medical writer—concerns over vaccines are unfounded. One of the last sections of the book addresses common vaccine concerns and controversies.

Concerned about autism? Don’t be. Aluminum and formaldehyde? Don’t sweat it—your kid gets enough of it normally in the environment as it is, and at higher quantities, too. DTap does not cause SIDS. No link has been found connecting asthma rates to the number of vaccines children receive. There is no connection between hepatitis B vaccination and the onset of multiple sclerosis. Researchers have not found that vaccinations can cause diabetes. Multiple vaccinations? More vaccines than parents got when they were small? No worries. Today’s vaccines contain significantly less antigens than those of yore, so your kids are actually exposed to fewer antigens than you were, despite the increase in their number of shots.

That said, there is a chapter called “When Vaccines Harm or Fail.” It would be more aptly titled, “Vaccines Don’t Harm or Fail, Except for Extremely Rare Adverse Events Which Might Not Even be Related to the Vaccine in the First Place.”

As excerpted from the book: “On rare occasions, vaccines can cause problems. Vaccine-preventable illnesses have become much less common in the United States because so many people are vaccinated against them. Every vaccine, however, has some risk of causing a bad side effect.”

And that’s the crux of it all.

Choosing not to vaccinate is risky. But getting vaccinated isn’t without any risks, either—as baby gooroo has said before, “Few things in medicine work 100 percent of the time. Few things in medicine are risk-free. Researchers are working continually to improve the safety of immunizations.”

Apparently, more and more parents are simply unwilling to take those risks, however statistically small they may be.

Take the combination measles, mumps, rubella, and varicella vaccine (MMRV). The combined shot is meant to maximize vaccine coverage—getting one shot during one doctor’s visit is more convenient for a lot of parents, especially for low-income families, who are more likely to be delayed or lacking in vaccinations than higher-income families.

But there are problems with the MMRV, as illustrated in the CDC’s recent Morbidity and Mortality Weekly Report. The MMRV is no more effective than the plain old MMR, and no formal studies on the MMRV’s clinical efficacy have been performed. What is known is that the MMRV carries a higher risk of fever, rash, and febrile seizures—a kind of seizure the report says is common and not even particularly dangerous, but would no doubt be terrifying to witness. The CDC surveyed physicians in 2008 and parents in 2009, and found that neither group was terribly in favor of the MMRV: 67 percent of family physicians and 59 percent of pediatricians said they’d definitely or probably recommend the MMR and varicella vaccines separately; only 9 percent and 21 percent, respectively, would definitely or probably recommend the MMRV (24 and 20 percent, respectively, said they’d leave it up to the parents).

As for the parents, 41 percent said they’d accept the MMRV vaccine for the first-dose vaccination if the pediatrician recommended it; 31 percent said they’d refuse. According to the MMWR report: “Mothers who reported that they would refuse the MMRV vaccine said they were unwilling to accept any additional risk over that of MMR vaccine and varicella vaccine, regardless of how small.”

Well, of course they are unwilling to accept any additional risk. Does that surprise anyone?

Recently, a pediatrician wrote an article about how his approach to dealing with reluctant vaccinators has changed over the years. Instead of refusing to work with such parents, he now listens, commiserates, offers flexibility, inspires trust—and, maybe, eventually convinces the parent to vaccinate. Nearly all the comments for the article were written in favor of delaying or completely foregoing vaccinations.

It’s easy to understand why some parents’ faith in vaccine safety wavers. Consider the rotavirus vaccine. An earlier incarnation of it was taken off the market due to reports of intussusception (a sometimes life-threatening folding of the intestines), then replaced with another vaccine. That vaccine was temporarily suspended just last March, and now, this month, the Food and Drug Administration has reversed that decision, declaring Rotarix safe.

Regardless of the reasons behind those decisions, that’s a whole lot of back-and-forth for a parent already freaked out about vaccines.

The questions remain: Are you a negligent parent if you don’t vaccinate? Are you putting your community at risk if you don’t vaccinate? If you read this book, you’re likely to think so. Having known several parents who chose to delay or forgo vaccinations, I feel it’s simply a matter of deciding which risk—disease or side effects—a parent is more comfortable with. It doesn’t take a genius to see why parents are confused and conflicted about vaccinating their children; and it may take more than an easy-to-read book to convince them to do so.

“I dreamed I was having milk,” Tommy said, his voice shaking a little. “And I’m so glad because I love having milk!”

“Having milk” was what my 3-year-old son called nursing, an activity we had ended three weeks ago. And he was still talking about it.

“Um, are you thirsty?” I asked. “Would you like some water?”

He said he would, so I stumbled out of bed while he climbed into it. It was still very early and we snuggled together for a while after he drank his water. He didn’t mention breastfeeding again that morning.

But he hasn’t stopped talking about it completely. Every once in awhile he’ll bring it up. He has started a new thing, too: lifting up my shirt just a little bit to passionately smash his face into my bare stomach. He calls it “hugging my belly.” I wonder if he misses the skin-to-skin contact of nursing. Or maybe he just really likes squishing his face into my post-baby belly. It probably feels like a giant pillow to him.

In any case, every wistful mention of “having milk”—whether he means it or is just playing around—feels like a punch in my gut. Every time, I wonder if weaning was the right choice, if he had been ready. If I had been ready.

To be honest, he technically weaned himself, although I had gently pushed him in that direction. He had only been nursing in the mornings, often when I was half-asleep, and I was fine with that. But my son was gigantic and gangly, several heads taller than any other child his age, and his idea of cuddling while nursing was becoming painful and annoying. Also, I could tell my milk supply had significantly decreased, to the point where I wondered if he got anything at all some days. I was ready to bring this journey to a close.

So we talked about it.

“You know,” I said, “My body is making less milk now. Soon it will stop making milk completely. But that’s OK, because you don’t really need it anymore, do you?”

“Nah,” he said, but it was hard to tell if he was listening.

“I think you’re going to stop nursing soon,” I said. “Are you OK with that?”

“Yeah,” he said.

My husband planned to take Tommy out of town for a few days, just the two of them. It would be the first time I’d ever slept away from my son. The reasons were numerous—they’d visit family; I’d finish a big writing project in peace—but the obvious idea was that weaning would actually happen.

We talked about that too.

“You’re not going to have milk when you’re in Savannah, you know,” I said. “And when you come back, I’m not going to be making any more milk. Are you OK with that?”

“Oh, yeah,” he said.

But then, two days before they left, he stopped nursing by himself in the morning. He asked me, “Have you stopped making milk?”.

I didn’t know what to say, but finally settled on, “Yes.” I felt half-deceiving, half-truthful. This was a kid who decided on his own that Santa didn’t exist, and when he asked us, we confirmed it. We had always been honest with him.

“Can I have some soy milk in a cup?” he asked. He didn’t sound upset at all.

And so they left. And I finished my writing project and enjoyed the wonders of a quiet house. While they were away, my husband said he mentioned “having milk” just once—he said “it made him a little sad” to stop, but he didn’t seem very affected as he said the words. In fact, he had a great visit with his Nana, who happily indulged my son’s desire to spend hours watching boats on River Street or the cogs and gears of taffy-pulling machines in the candy shops.

I thought he’d forget about breastfeeding completely, that he wouldn’t mention it to me after his return. Isn’t that what you read? The kid stops nursing and a day or so later, the memory of ever having done it all is wiped clean from their young, malleable minds. Life goes on. Breastfeeding becomes a sweet memory.

Not my kid. Every once in awhile, he’ll wake up in the morning, clamber into our bed (if he’s not there already) and say, dramatically, “Oh, I wish I could have milk.” (His pathos disappears upon an offer of water or almond milk, leading me to believe he’s simply thirsty and slightly manipulative.) Occasionally at bedtime, when it’s my turn to tuck him in, he’ll mention it again—despite the fact he stopped nursing at night ages ago.

I was talking on the phone about this to a friend recently, about weaning and guilt and wondering whether I did the right thing. She told me something very clear that I heard even over the din of my son hollering in the background: A lot of mothers who wean—whether it’s at 3 weeks, 3 months, 3 years—wonder and worry. They aren’t sure if they could have done more. They second-guess themselves. Instead, why not frame it like this: This is how it happened. This is how you weaned your son.

So, this is how I weaned my son. I breastfed him in the hospital right after his birth, marveling at his quiet alertness. I breastfed him in those early weeks, when I was so sleep-deprived that I was miserable and wondered what I had done to ruin my life so thoroughly. I breastfed him when I finally knew that no, it had not been a mistake, that I loved this small creature more than life. I breastfed him through teething and illness and first steps and first words. I breastfed him until we stopped breastfeeding.

And that’s how it happened.

©iStockphoto.com/ArtisticCaptures

Both you and your baby are going to sleep terribly, possibly for months, so you might as well get used to the idea.

But don’t freak out—this is totally normal. All you have to do is make sure everyone lives through this tumultuous time. Pretend there’s a zombie war going on outside and your priority is basic survival. Do whatever it takes to stay alive. Believe that this too shall pass.

For those of you in the midst of intense sleep deprivation, you would probably like to take your computer and throw it at my head right now. No one wants to be told “this too shall pass.” You want immediate solutions that will make your baby sleep so you can feel like a person again. Trust me, I know; I’ve been there.

And it’s not enough that you’re tired; you’re likely terrified that even minute bedtime choices will ruin your kid for life. Over 30,000 people responded to a Babycenter.com poll about toddlers sleeping in their parents’ bed, and it turns out that 44 percent answered that their children “almost always” co-sleep. When asked how they felt about it, 26 percent said “I love it,” but 43 percent called it “not ideal.”

Are adults who like to co-sleep doing something wrong? Some sleep experts say yes. There are plenty of sleep advice books out there, but they all offer different advice when it comes to getting your child to sleep.

So what do the authors of the leading sleep advice books have to say, from stern Ferber to groovy Pantley and a few others in between?

Richard Ferber, Solve Your Child’s Sleep Problems (Fireside, 1986, 2006)
If you’ve heard someone talk about “Cry It Out” (or CIO, or “Ferberizing”), that person is talking about the technique developed by Richard Ferber, director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston. With CIO, you basically let your child scream his or her head off for specified, timed increments (which grow gradually longer over a few days’ time) until he or she finally figures out you aren’t coming and gives up (or passes out). I’ve always associated this approach with distraught parents who dread bedtime and their screaming children they feel forced to ignore. Once upon a time as a nanny, I was instructed to use this method at naptime for the children under my care, and let me tell you, it was no picnic (although it sometimes—not always—worked).

I was prepared to read “Solve Your Child’s Sleep Problems” with a derisive eye, already knowing that my parenting style didn’t jive with Ferber’s method. However, I discovered his technique, especially as explained in an updated edition of the book, isn’t quite as rigid as I had thought.

“Simply leaving a child in a crib to cry for long periods alone until he falls sleep, no matter how long it takes, is not an approach I approve of,” Ferber writes in the 2006 preface. “On the contrary, many of the approaches I recommend are designed specifically to avoid unnecessary crying.”

He calls his technique “progressive waiting” that encourages frequent (but somewhat detached, I thought) comforting throughout the process.

More helpful in the book is his section on helping your child learn new sleep associations–different ways to find comfort and go back to sleep after nighttime wakings. After all, it’s normal for both children and adults to wake during the night. Ferber suggests using a “transitional object” (like a favorite blanket) for comfort.

He also says that having a regular daytime schedule will help set a reasonable nighttime schedule, and that you must choose your child’s bedtime and keep it consistent.

What about co-sleeping? Well, the 1985 edition is clearly against the notion. “We know for a fact that people sleep better alone in bed,” he writes. (Is he suggesting that parents sleep in separate twin beds, like Rob and Laura Petrie on “The Dick Van Dyke Show”?)

“Sleeping in your bed can make your child feel confused and anxious rather than relaxed and reassured…If you allow him to crawl in between you and your spouse, in a sense separating the two of you, he may feel too powerful and become worried,” he writes. I confess I laughed out loud at that part, as I suspect many parents who have co-slept would. I wonder what an actual psychologist might say about that (maybe I should ask my father, a retired psychology professor who had no worries when I routinely slept with my parents as a child).

Ferber also insinuates that co-sleeping parents might have a screw loose. “If you find that you actually prefer to have your child in your bed, you should examine your own feelings carefully,” he writes, suggesting that such a desire hints at underlying selfishness or other issues that may require “professional counseling.”

Yet again, the 2006 edition has some changes to it, suggesting a more laid-back Ferber. Co-sleeping children, he writes, “are not prevented from learning to separate, or from developing their own sense of individuality, simply because they sleep with their parents. Whatever you want to do, whatever you feel comfortable doing, is the right thing to do, as long as it works.”

Elizabeth Pantley, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night (McGraw-Hill, 2002)
The No-Cry Sleep Solution for Toddlers and Preschoolers (McGraw-Hill, 2005)
Pantley is like the anti-Ferber. Your first clue is title: “No-Cry” and “Gentle.”Another clue is that she calls CIO “mutual agony,” noting that babies are totally dependent and cry to remind you they have biological needs that need attention.

As someone who champions co-sleeping (as long as you follow safety precautions) and has practiced it herself, Pantley is a favorite among followers of attachment parenting. However, she does not advocate constant tending at the expense of your own sleep.

She talks about “sleep association,” in which babies associate (and feel they need) certain things with falling asleep. Pantley says she nursed one of her children to sleep for at least a year, and disagrees that it’s a negative sleep association (as the other sleep authors discussed here propose).

“It is probably the most positive, natural, pleasant sleep association a baby can have,” she writes in “The No-Cry Sleep Solution.” “The problem with this association is not the association itself, but our busy lives. If you had nothing whatsoever to do besides take care of your baby, this would be a very pleasant way to pass your days and nights until he naturally outgrew the need. After all, this is natural. You may not even see this as a problem, in which case it is not. It’s all a matter of your perception and your personal needs.”

She does acknowledge that “few parents have the luxury of putting everything else on hold until their baby gets older,” so she recommends gradual (not cold turkey) changes, namely ending a feeding session when the baby is drowsy but still awake.

In her The No-Cry Sleep Solution for Toddlers and Preschoolers, there’s an entire section called “The Nighttime Nursling.” In it Pantley sings breastfeeding’s praises, explains why a toddler might still want to nurse to sleep (and why parents may not want to give it up either), but suggests options like ending a nursing session gradually (following the blueprint laid out in her book the “Sleep Solution” ) and creating new routines. She even has advice on how to continue co-sleeping without breastfeeding.

“If your child is getting enough sleep, you are all sleeping well, and the people who live in your home are happy with the way things are working out, then nothing needs to be fixed, regardless of what anyone else has to say about your family’s sleeping solution,” she writes.

Kim West, The Sleep Lady’s Good Night, Sleep Tight (Vanguard Press, 2010)
In the interest of full disclosure: a photo of my son appears in this book and is used with permission.

Now that we’ve got Ferber and Pantly out of the way, this book is pretty middle-of-the-road, appealing to those who are wary of both CIO and co-sleeping. West, a licensed clinical social worker, seems more lenient with co-sleeping, but you can tell she’s not a huge fan (one of her chapters is called “Whose Bed Is It Anyway?”). If you invited West and Pantley over for a slumber party, Pantley would braid your hair and enthuse about co-sleeping bonding, while West would be at the foot of the bed saying, “Well, if it works for you, but…”

She’s coined a catchy phrase for her approach: The Sleep Lady Shuffle. It’s similar to CIO in that there are timed intervals of interaction, and the goal is to detach yourself from your baby as he cries—but you stay in the room for much of it. Over a series of nights, you move your position within the room closer to the door, using minimal touches to comfort the child, until you eventually find yourself outside the door.

She recommends against nighttime feeding entirely at a certain point. “One of my hardest tasks is convincing mothers that most healthy six- to eight-month-old babies on a normal growth curve don’t need to eat at night,” she writes.

Alison Scott-Wright, The Sensational Baby Sleep Plan (Transworld Publishers Ltd, 2010)
I recently read a very favorable Telegraph review for this book, so I thought I’d check it out. Scott-Wright, a former maternity nurse, sounds like a lovely woman who is well-liked by those who say they have found salvation through her help.

Alas, the actual sleep plan is nothing ground-breaking,and most of the book is devoted to infant feeding and consistently offers false information.

Scott-Wright makes a big deal about not vilifying women who are unable to or choose not to breastfeed, a sentiment with which I completely agree. But she goes to rather astonishing lengths—sometimes making statements that completely contradict research and what we have long known to be scientific truth—to make the point that formula feeding is actually preferable to breastfeeding.

“We all know, and are certainly told often enough, that ‘breast is best,’ but in my view it is better to adopt an approach that can be adapted to your lifestyle than to restrict yourself to a method that you may find difficult to maintain,” she writes. “I promote and support breastfeeding, but never to the detriment of mother or baby.”

Later, she lists seven benefits to exclusive breastfeeding (101 reasons can be found here), but 11 benefits to “Breastfeeding and expressing breast milk” and 13 to “Exclusive formula feeding.”

Some of the listed benefits to exclusive formula feeding are simply untrue, or are unsubstantiated opinions. We know that breastfeeding mothers do not have more dietary restrictions (she even includes a list of foods that “seem to cause problems,” including citrus fruit and curries). We know that breastfeeding mothers do not necessarily feel like “feeding machines.” We know that babies with reflux do not respond better to formula (good grief!) or that formula relieves a mother of “physical and emotional strain” (Um…ever hear of prolactin?). And it’s completely wrong (and dangerous, I feel) to suggest that formula-fed babies receive “more lasting satisfaction.”

Elsewhere, she suggests putting newborns on a breastfeeding schedule of 2-3 hours. She also includes recommendations on weaning, starting as early as 4 weeks of age. She devotes several pages to the common woes of breastfeeding problems, then writes, “It is a shame in today’s society that formula-feeding, when used in preference to breastfeeding, is almost frowned upon.” Research promoting breastfeeding over formula is “flawed,” she writes, right before several pages on how to choose bottles and nipples, making bottle-feeding sound absolutely fantastic—as if magical genies await your command to sterilize bottles and mix powder in the middle of the night. Dreamy!

Honestly, this book sets back breastfeeding promotion, I don’t know, let’s say a million years.

I really would like to say something positive about this book, but it takes three chapters to even get to what the “plan” is, and it appears to simply be a feeding schedule, which for newborns is every three hours during the day and every four hours during the night (with recommendations to supplement with formula by week two!), which again is counterproductive to establishing breastfeeding.

Near the end of the book, Scott-Wright addresses “sleep training,” which I assumed would be something along the lines of cry-it-out. But her sleep plan consists of creating a calm, quiet atmosphere, feeding the baby, putting him or her to bed and saying good night. If necessary, go back in to the room to reassure the baby, tell him good night again, and walk away. There are no timed intervals. If the baby cries, she simply advocates  doing the same thing over and over again until it works.

In other words, it’s the kind of common sense “sleep training” that doesn’t require a book to explain it.

So, whose advice should you follow?
When I mentioned on Facebook that I was working on this article, I immediately got comments from very tired parents, pleading for information that would help their babies and toddlers sleep better… and several almost apologizing for their babies who slept through the night, no Ferberizing required, by three months.

I wish I could give you the definitive advice that will help your baby sleep better, but that’s impossible. Some advice makes sense—like having a consistent and early bedtime routine—but when it comes to selecting cleverly named sleep plans, methods of inching your way out of your kid’s room, or your comfort level for hysterical screaming, only you can choose what works for your family.

You could pick and choose the bits and pieces you like the best— a little Ferber here, a little Pantley there. To paraphrase a friend, “use what works and leave the rest.”

Remember my initial analogy. There are zombies out there, and you have not yet succumbed—no, you will not succumb. You will survive! When the tanks come in to blow off the undead’s heads, you’ll still be there—cozily tucked up in your bed, fast asleep. Just keep telling yourself that.