©iStockphoto.com/onebluelight

Not ready for another baby just yet? Breastfeeding mothers everywhere struggle to find a method of birth control that is most likely to prevent pregnancy and least likely to affect their milk supply. Although hormonal methods such as combined oral contraceptive pills, patches, and rings (products containing both estrogen and progesterone) are commonly used in the U.S., their early use by breastfeeding mothers has been discouraged—until now. The Centers for Disease Control and Prevention (CDC) as part of its Morbidity and Mortality Weekly Report (MMWR) has released new recommendations on the use of methods of birth control.

The CDC report is based on a similar report by the World Health Organization (WHO)—Medical Eligibility Criteria for Contraceptive Use (MEC)—first published in 1996 and now in its 4^th edition. With the help of a group of experts, the WHO document was adapted by the CDC for use in the U.S. But several of the revised recommendations are creating a stir in the breastfeeding community—specifically those related to the use of hormonal methods (contraceptives containing estrogen or progesterone) by breastfeeding mothers in the first days after birth.

Previously, breastfeeding mothers were told to wait six months before taking combined oral contraceptives (COC)—those containing both estrogen and progesterone; and six weeks before using progesterone-only methods, including progesterone-containing intrauterine devices (IUDs), DepoProvera (a shot containing progesterone), and progesterone-only pills (POP). The new CDC guidelines allow for the use of COC immediately after birth. But given that the risks associated with early use usually outweigh the advantages, breastfeeding mothers should be counseled to wait four weeks, at which time the advantages generally outweigh the risks. The guidelines also allow for the immediate use of hormonal contraceptives containing only progesterone, stating that the advantages of immediate use generally outweigh the theoretical or proven risks, and that by four weeks there is no discernible risk.

Dr. Jerry Calnen, president of the Academy of Breastfeeding Medicine, expressed concern that the new guidelines ignore basic facts about how breastfeeding works. “The data are limited,” says Calnen. “But for now, the state of the science suggests that early progesterone exposure undermines breastfeeding.”

Those, like Dr. Calnen, who oppose the revised recommendations, worry that early use of hormonal methods will reduce milk production and have a negative effect on breastfeeding rates—both exclusivity and duration. Those who support the new guidelines argue that early access to hormonal methods of birth control will prevent a greater number of unintended pregnancies.

Dr. Robert Hatcher, professor of obstetrics and gynecology at Emory University and author of Contraceptive Technology, and Dr. Miriam Labbok, professor of public health at the University of North Carolina, were among the 31 experts brought together by the CDC to review the scientific evidence and the proposed guidelines.

According to Dr. Labbok, “The CDC bases its decisions on published research. Admittedly, there is little research on immediate postpartum use of hormonal contraceptives during lactation because many institutional review boards (IRBs) and researchers feel such research would put lactation at risk.”

“Aside from anecdotal data there is no evidence to support the theory that early use of COC (those containing estrogen and progesterone) causes problems,” says Hatcher. “Use during the first four weeks is a no, but after four weeks, the benefits may exceed the risks.”

“Historically, I did not provide COC to breastfeeding mothers until they were no longer breastfeeding exclusively, recommending a progestin-only method instead,” added Hatcher. “But if a woman, despite my encouragement to use a progestin-only method insists on using a COC—due to cost, availability, or concerns over irregular bleeding—I would accommodate her request.”

With regard to the use of contraceptives containing only progesterone, Hatcher says, “Currently there is no scientific evidence to show that early use of progestin-only contraceptives interferes with milk production—only anecdotal reports. The recommendation could change as more evidence becomes available, but until then, science does not support delaying their use.”

“The problem with the argument for early use of progesterone-only contraceptives,” says Labbok, “is that the science also does not support the safety of early use. There are no good studies on the use of hormonal contraceptives during the first days after birth that show the short- and long-term effects in breastfeeding mothers and babies.  DepoProvera is commonly given to breastfeeding mothers before they leave the hospital, with little or no counseling as to the risks. That DepoProvera is most often given to low income, minority women, makes the ethics of this practice all the more concerning.”

“Clients should be counseled as to all available family planning options and the risks and benefits of each,” says Labbok. “Describing a contraceptive method as ‘generally acceptable’ in the absence of new data is in my opinion a leap of faith that good counseling will be a part of each encounter.”

Given the concerns surrounding hormonal methods and the proven effectiveness of intrauterine devices (IUDs) why don’t more women, breastfeeding and non-breastfeeding, opt for IUDs?

According to Hatcher, data coming out of the Choice project, a family planning program at Washington University in St. Louis, show a trend toward greater use of IUDs and other long-acting reversible contraceptives (LARC) including implants and shots (DepoProvera). More than 6,000 women have participated in the program so far. Nearly 70 percent have chosen either an IUD (the progestin-containing Mirena or the copper-containing ParaGard) or an implant (Implanon) compared to less than 5 percent of women nationwide.

How did this program achieve such high rates of LARC use? There are two reasons. First, the researchers recognized that cost is a deterrent to choosing an IUD or implant, so both devices are provided free of charge. Second, as a prerequisite for joining the study, participants must agree to change their current method of birth control. Researchers have found that when women are told the many benefits of LARC—cost-effective, convenient, less bleeding and pain with monthly periods, less risk for anemia, less risk for endometrial cancer, and less blood loss and pain caused by endometriosis and uterine fibroids—many will choose an IUD or implant.

In addition to concerns over early use of hormonal contraceptives, Labbok points out that the new CDC guidance has no data showing the effectiveness of breastfeeding (exclusively or almost exclusively) in family planning. “Birth spacing is very important for maternal health, but so is breastfeeding. While there are many contraceptive options that can be considered instead of hormonal contraceptives, there is no effective alternative to breastfeeding given its impact on maternal and child health,” says Labbok.

Many would agree that breastfeeding can and should be an integral part of any family planning program. Exclusive breastfeeding is one of the most common strategies for spacing births worldwide, providing protection comparable to to that of birth control pills. Commonly referred to as the lactation amenorrhea method (LAM), exclusive or almost exclusive breastfeeding is a highly effective method, albeit a temporary one. Suckling is the key ingredient. The more time a baby spends suckling at the breast, the less risk the mother has of becoming fertile. As the baby’s suckling time goes down due to the use of pacifiers, supplements, solid foods, or long stretches of sleep, the mother’s risk for ovulation (the release of an egg from her ovary) goes up, along with her risk for pregnancy. For LAM to be effective three criteria must be met:

• Mothers must not have resumed menstrual periods;
• Babies must be fully or nearly fully breastfed day and night; and
• Babies must be less than 6 months old.

According to Labbok, “LAM has been shown to be effective for 9 to 12 months in mothers who have maintained a high frequency of feeds and who breastfeed before each complementary feed.”

While the effectiveness of LAM is well-documented, if any of the criteria are not met, another method of contraception should be used.

Birth control pills along with female sterilization are the leading methods of birth control in the U.S. A recent survey by the National Center for Health Statistics found that during 2006-2008 an estimated 10.7 million women ages 15 to 44 used the pill and another 10.3 million chose to be sterilized. Despite these figures, half of all pregnancies in the U.S. are unintended, highlighting the need for greater use of long-acting reversible contraceptives including IUDs, implants, and shots.

Even among breastfeeding mothers, contraceptive needs vary. Talk with your health care provider about the birth control method that is best for you with consideration given to cost, convenience, availability, and effectiveness. Learning all that you can about the benefits and the risks of various options will allow you to make an informed decision based on a clear understanding of the facts.  For more information about contraception visit Managing Contraception.

“Personally, I believe contraceptives should be treated like immunizations and be made available to everyone regardless of their ability to pay,” says Hatcher, and Labbok agrees, adding the need for proper counseling. This is sage advice, given the public health implications of immunizations, contraceptives, and breastfeeding.

©iStockphoto.com/ARTPUPPY

Tricia has struggled with weight for as long as she can remember. Before she became pregnant with Lizzie, her first child, she was more than 50 pounds overweight, and during her pregnancy, she gained even more.

Since Lizzie was born six months ago, Tricia has been trying to shed the excess pounds. Even though Lizzie is just a baby, Tricia tries to eat healthy meals in front of her daughter, just in case Lizzie is taking note. Already, Lizzie’s weight is in the 90^th percentile. Tricia is worried about how her obesity might affect the weight of her child, and according to researchers, Tricia has reason to worry.

Data show that children with two obese parents—defined by having a body mass index, or BMI, of 30 or more—were 12 times more likely to become obese during childhood compared to children with parents whose weight was appropriate. The researchers found that the mother’s weight had the greatest influence, and experts speculate that the reason for this is twofold: prenatal factors and the fact that mothers typically prepare meals for their children.

Research
Published in the American Journal of Clinical Nutrition, this was the first study to use measured weight and height directly, rather than using self-reported means.

The research team, led by Dr. Jane Wardle, a professor of clinical psychology at University College London, looked at data from more than 7,000 children and their parents, all of whom took part in a national health survey in the UK. The data was recorded by trained interviewers using electronic measurements.

Results
Parental weight increases a child’s risk for obesity, more so among girls than boys.

• Only 2 percent of children with two healthy-weight parents were obese, compared to 22 percent of children from families with two obese parents.

• When both parents were overweight but not obese, nearly 5 percent of the children were obese.

• Nearly 12 percent of children with an obese father were obese, compared to 14.3 percent of children with an obese mother. Those numbers fell to 4 percent and 3 percent, respectively, with a healthy-weight father and a healthy-weight mother.

The conclusion: maternal health has a profound effect on a child’s weight gain. The question is why?

Prenatal factors
“Maternal link might be stronger for obesity as we inherit our mitochondria—the energy manufacturing center—from our mothers,” explains Dr. Carson Liu, a Los Angeles-based bariatric surgeon, who was not affiliated with the study. In other words, some of a child’s obesity risk comes from genetic factors, including the way we burn energy, which are passed down from mother to child.

There are other genetic factors at work too, explains Dr. Anatoly Belilovsky, a pediatrician in Brooklyn, N.Y. “Maternal genes are passed to the child, so a child of a mother prone to obesity may have that inclination regardless of what happened during gestation. Secondly, the amount of nutrients presented to the placenta—glucose, fats, proteins—depend on their level in maternal blood, which in turn depends on maternal diet and weight gain.”

“The most important connection is through insulin,” Belilovsky explains. “Glucose, but not insulin, crosses the placenta to the baby.  High maternal blood glucose causes high insulin production in the baby, which will drive down baby’s blood glucose—sometimes to dangerously low levels—but also stimulate baby’s appetite after birth.”

What this means for you: to put it simply, if you’re pregnant, or thinking about becoming pregnant, begin modifying your diet now. Healthier choices for you mean healthier nutrients for your baby.

Postnatal factors
While maternal obesity during pregnancy is potentially risky to the developing fetus, it does not mean that a child will inherently become obese.  “Genetics play about two-thirds of a role,” Liu says. “The rest is environmental, which means minimizing excessive carbohydrate intake and [engaging in] daily exercise. And teaching kids to be active and not sedentary with TV and video games.  After becoming obese, it is harder to lose the weight permanently.”

After you’ve had a baby, if you’re obese—or even just overweight—it’s important to begin setting a positive example for your child. Become physically active, model healthy eating habits especially as you begin to prepare your children’s meals at home, and encourage physical activity at an early age. “Kids need good role models,” says nutrition expert Jackie Keller, a certified wellness coach who has worked with celebrities including Angelina Jolie, Uma Thurman, and Jessica Alba. “Study after study confirms that these patterns are learned at home, long before less healthy patterns are learned at school.”

To get you started, we compiled four easy can-do steps to a healthier lifestyle at home:

• “Start kids early on drinking water instead of soda —diet soda included—or even juice,” Keller says. “Drinking water is fundamental to health and becomes habitual if encouraged constantly.”

• “Take walks with your children—everyday,” Liu says. Or, suggests Keller, “Incorporate something active into every day. Being consistent with activity is part of developing a pattern of healthy behaviors that can help keep a child at a healthy weight for a lifetime.”

• “Always have fresh fruit and vegetables—fresh is best, frozen is next—on hand for meals and snacks and eliminate highly processed foods and grains products from your menus,” Keller says. “Teach your children to eat small meals throughout the day.”

• “Don’t think that kids have to have sweets,” Liu says. “Kids don’t have a different food pyramid that consists of mac and cheese, cheese pizza, chicken fingers, grilled cheese, and cheeseburgers. They can eat healthy foods to start early on in their lives, including fish, cooked vegetables, eggs, and non-processed foods.”

©iStockphoto.com/abu

Sunscreen is a must every day—365 days a year. But it’s especially important during the lazy, hazy days of spring and summer when you and your family spend more time outdoors. Everyone knows the sun’s ultraviolet (UV) rays can cause skin cancer and burning; what you may not know is that just five sunburns at any age doubles one’s risk of melanoma, the deadliest form of skin cancer. And just one blistering sunburn in childhood or adolescence more than doubles the risk of melanoma. To stay safe in the sun, slather sunscreen on yourself and children over the age of six months. Make sure it has an SPF (Sun Protection Factor) of at least 15 and that it blocks both UVB (ultraviolet B, or short-wave) and UVA (ultraviolet A, or long-wave) rays. Look for these words on the label: “broad spectrum,” “multi-spectrum,” or “UVA/UVB protection.” Use at least one ounce (a shot glass full) for an adult and half an ounce for a child and don’t skip spots like the back of the neck, ears, lips, and top of feet. Click here for more sun safety tips.

©iStockphoto.com/loooby

Most moms would agree that staying healthy and setting a good example for their kids is a top priority; however, keeping up with all those annual health screenings isn’t always at the top of every mom’s to-do list. Help is here—at least when it comes to the annual skin exam (yes, everyone should be getting one each year). The Skin Cancer Foundation just kicked off their Road to Healthy Skin Tour. From now until the end of September, dermatologists will drive around the country in the foundation’s customized RV to provide free, full-body screenings for skin cancer, the most common form of cancer in the United States. Since the foundation started the tour three years ago, over 2,000 cases of pre- skin cancer and cancer have been discovered.

More than 13 million cases of skin cancer (the most common cancer in the world) are diagnosed annually and worldwide. More than 65,000 people die every year from skin cancer; more than 20 Americans die each day. As a result, early detection is key. During the tour, The Skin Cancer Foundation will offer the latest information on skin cancer prevention and pass out free samples of sunscreen.

The Road to Healthy Skin Tour will stop in approximately 80 locations nationwide. Visit SkinCancer.org to find a location near you.

©iStockphoto.com/btrenkel

Company WEU has 20 employees. Ten or more are women. BWEU provides no maternity benefits, no flexible work schedules, no onsite childcare, and no lactation rooms. Despite women supplying more than 50% of the U.S. workforce, gaining accommodation in the workplace for those things uniquely woman such as pregnancy and breastfeeding is difficult at best, impossible at worst.

Many employers recognize that breast milk is the best source of infant nutrition. It promotes optimal growth and development, protects babies against diarrhea, respiratory infections, allergies and diabetes, and reduces mothers’ risk for ovarian cancer and premenopausal breast cancer, yet few employers  have a policy for breastfeeding in the workplace and even fewer provide actual breastfeeding support.

Enter CARE.

Through its work around the world, CARE promotes breastfeeding as a health-giving, life-saving strategy. Now CARE USA is demonstrating its support for breastfeeding right here at home by providing a workplace environment and an organizational culture that truly reflects the values espoused by CARE.

Baby gooroo is pleased to share with permission, CARE’s newly released Breastfeeding in the Workplace policy. The policy is currently in place for CARE’s US-based offices, but future plans call for expanding the policy to CARE offices worldwide. Read on. (You’ll wish you worked for CARE!)

Breastfeeding in the workplace
CARE USA provides a workplace environment and organizational culture that supports breastfeeding in order to enable the mother and child to experience the full benefits of breastfeeding:

• Flexible and adaptive scheduling—subject to the needs of your department, your manager can work with you to develop a schedule that eases the transition back from parental leave, whether that includes flexible or reduced working hours, telecommuting options, or time off to meet infants’ health care needs

• Lactation time and space—for offices of at least 50 employees, CARE USA seeks to promote clean, comfortable, and private lactation rooms or spaces that  are convenient for expressing or pumping breast milk or nursing (including access to a refrigerator, sink, and microwave).  When it is not possible to provide a dedicated room, particularly in smaller offices, privacy accommodations will be made for employees in cubicles or other non-private spaces (i.e. empty offices, conference room, etc.)

CARE USA allows and encourages breastfeeding employees to take breaks to express breast milk, recognizing that a woman who is separated from her infant needs to express her milk at least three times within an 8-hour work day. CARE USA considers these breaks part of the normal, paid workday and will not require employees to make up this time.

Infants in the workplace
Employees may also bring infants under six months of age to the workplace in order to breastfeed, while maintaining a conducive work environment that is not disruptive to others and does not compromise other aspects of quality care for the infant. Staff with private offices may keep their children in their office. Where possible, accommodation will be made for individuals who work in cubicles to have a private space for this time period.

Travel
If a breastfeeding employee chooses or is required to travel, CARE USA will not cover any charges associated with the infant, and it will be the responsibility of the employee to ensure that infant care is provided during work hours. CARE USA will also respect a breastfeeding employee’s wish to limit her travel by using creative teamwork to reduce the need for her to be separated from her baby during the breastfeeding period.

Mutual responsibility
It is the responsibility of both the manager and the employee to ensure an environment that promotes breastfeeding while also meeting organizational needs. For any of the above options, an agreement must be signed ahead of time by both the employee and the manager to set mutual expectations, and will include the following:

• Nature of accommodation

• What and how work will get done

• Length of time the agreement will be in place

• Expected behaviors (example—employee will ensure that the accommodation is not disruptive to others, manager will respect and ensure privacy during breastfeeding)

Support
CARE’s work around the world promotes optimal breastfeeding practices to support families’ efforts to improve their food, health, and household livelihood security.  As a result, there are CARE employees who are experts in lactation who are happy to support the promotion of breastfeeding among CARE’s staff. In addition, La Leche League International (www.llli.org) is an organization that strives to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother. Resources are available in English, Spanish, French, and Arabic, and services include online as well as personal support.

CARE USA will not tolerate discrimination against pregnant and breastfeeding employees. Reports of such behavior will be investigated and offending parties disciplined if discriminatory behavior is confirmed.

Kudos to CARE for showing that it cares!

©iStockphoto.com/Mishella

The real life stories of the many women suffering with undiagnosed and/or untreated depression go unreported, until one day a desperate mother drowns her five young children in a bathtub. While this is a rare event, it underscores the seriousness of the disease known simply as postpartum depression.

It is estimated that one out of 10 women in the United States take antidepressants, many of them while pregnant or breastfeeding. According to the Centers for Disease Control and Prevention (CDC), between 1995 and 2002 the use of antidepressants rose 48%. Antidepressants are among the most prescribed drugs in the U.S. For many this is good news, suggesting that women and men suffering with depression are finally seeking help. Others are less enthusiastic, citing the increased use of antidepressants among children and adolescents, despite a lack of evidence to show that they are effective or safe.

What are SSRIs?
Selective serotonin reuptake inhibitors (SSRIs) are among the most common antidepressants. The first drug in this class, fluoxetine, commonly known as Prozac, was released in1987 followed by Paxil, Zoloft, and others. SSRIs are designed to boost serotonin levels. Serotonin is a hormone produced in the brain that helps transmit signals from one part of the brain to another. Serotonin can affect a wide range of body functions including mood, memory, appetite, temperature, sleep, and social behavior. It is widely believed that serotonin plays a role in depression. People suffering from depression typically have low levels of serotonin. It’s unclear whether low levels of serotonin cause depression or if depression brings about low serotonin levels. Recent data suggest that serotonin may also play a role in milk production.

Do SSRIs affect milk production?
In a study in the Journal of Endocrinology and Metabolism, Aaron Marshall, Laurie Nommsen-Rivers and colleagues at the University of Cincinnati and the University of California at Davis examined the effects of SSRI drugs on lactation using laboratory studies of human and animal cell lines and lactating mice.

Because the breasts’ ability to secrete milk is related to the body’s production and regulation of serotonin, the researchers hypothesized that women taking an SSRI drug might experience a delay in the onset of abundant milk production (a phenomenon referred to as lactogenesis) that typically occurs in the early days after birth.

“I was able to examine this hypothesis using data from an observational study of 431 breastfeeding, first-time mothers. Only eight of the women were taking an SSRI medication, but it is notable that seven of the eight did experience delayed onset of lactogenesis (defined as occurring after 72 hours postpartum) and the eighth woman experienced onset right at 72 hours.  Median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRI drugs,” said Nommsen-Rivers.

“Perhaps the most alarming finding is the timing of lactogenesis for the entire sample of women (69.1 hours),” said Nommsen-Rivers.  “Evidence is mounting that the timing of lactogenesis is occurring much later in mothers here in the U.S. as compared to other countries, and this broader issue deserves our attention.”

What about my baby?
The effect of SSRIs on breastfeeding babies depends on a number of factors such as the gestational and chronological age of the baby, the health of the baby, the dose of the drug, and the drug’s characteristics (bioavailability, molecular weight, half-life etc.) According to Thomas Hale, PhD., author of Medications and Mothers’ Milk, available data suggest that Zoloft (sertraline) and Paxil (paroxetine) are far less likely to transfer into mothers’ milk and therefore babies compared to Prozac (fluoxetine). If women taking Prozac are unable to switch to another SSRI, given the many benefits of breastfeeding, Dr. Hale suggests that these women still be encouraged to breastfeed, mindful to watch their babies for possible side effects such as irritability, excessive crying, colic, and seizures.

Take home message
Given the small number of SSRI users in the study, these results must be interpreted cautiously. Even though seven of the eight women experienced a delay in the onset of abundant milk production, all went on to breastfeed successfully. More human studies are needed before any type of clinical recommendation can be made regarding the use of SSRI medications. In the meantime, women taking SSRIs should be encouraged to breastfeed, but should be made aware that the onset of abundant milk production may be delayed. Also, health care providers should be prepared to provide additional support if needed.

Women who are pregnant or breastfeeding should check with their doctor or their baby’s doctor before taking any medication, including drugs available over-the-counter. As with all medications, consideration must be given to the benefits and the risks. Although there may be risks associated with taking SSRIs while breastfeeding, untreated depression can be far more dangerous for mothers and babies.

©iStockphoto.com/SensorSpot

I cultivated my sweet tooth at a young age, born into a family where Hostess Sno Balls and Twinkies were the preferred after-school snack. I could have/should have washed down the crumbly treats with a glass of milk, but chose instead an ice cold Coke—21 teaspoons of sugar, the equivalent of 90 grams or 450 calories. Is it any wonder that my siblings and I struggle with weight gain?

The American Heart Association (AHA) recommends that women consume no more than 6 teaspoons of added sugar a day (100 calories or 25 grams). For men the recommendation is no more than 9 teaspoons (150 calories or 38 grams)—the equivalent of one 12 ounce can of Coke for guys and one cup of vanilla ice cream for gals.

In 2009, the AHA, citing new evidence showing that added sugars increase the risk of obesity, heart disease, and diabetes, issued a public warning, “Dietary Sugars Intake and Cardiovascular Health,”  cautioning Americans to limit their intake of added sugars.

Added sugars (as opposed to sugars that occur naturally in foods) have been described by the AHA as discretionary calories. For example, an average woman needs 1800 calories a day. In order to get the amounts of vegetables, fruits, lean protein, dairy products, and whole grains her body needs, she will spend 1600 calories, leaving only 200 calories for whatever else she wants to eat or drink. If what she ‘wants’ exceeds 200 calories, she will need to burn those extra calories or risk gaining weight.

Between 1970 and 2005, Americans’ average annual intake of sugar increased by 19%, with sugar-sweetened beverages, particularly soft drinks leading the way. In a study of 51,000 women, those who gained the most weight over a four-year-period were those who went from drinking no more than one soft drink a week to drinking at least one a day. So much for, “Have a Coke and a smile.”

While weight gain, especially in the mid-section can increase the risk of heart disease, data suggest that sugar-sweetened beverages may cause heart disease regardless of whether you gain weight. Harvard researchers followed nearly 90,000 women for 24 years and found that those who drank two or more sugar-sweetened beverages a day had a 20% higher risk of heart disease compared to those who drank less than one a month. Researcher have theorized that the increased risk may be related to the fact that sugar, specifically fructose, raises triglyceride levels.

Fructose versus glucose
Sucrose (table sugar) contains equal parts of fructose and glucose. Fructose is taken up by the liver where it is converted into fat. Much of the fat is excreted into the bloodstream, increasing triglyceride levels and the risk of heart disease. In contrast, glucose is absorbed directly into the bloodstream, increasing blood sugar levels and the risk of diabetes. When it comes to sugars, one is as bad as the next.

Calorie-free but not risk-free
Research shows that artificial sweeteners can reduce the risk of weight gain. But given the lack of safety data, artificial sweeteners should be used with caution, especially in children and young adults.

The bottom line
Added sugars have no redeeming value. Most sugary foods are simply junk foods. The following suggestions will help keep you and your family healthy:

• Limit added sugars to no more than 100 to 150 calories a day for women and men.
• Avoid all sugar-sweetened beverages.
• Limit fruit juices to no more than 1 cup a day.
• Estimate your calorie needs and those of your children at mypyramid.gov

In case you were wondering, a two-pack of Hostess Twinkies and Sno Balls contain 9½ and 11½ teaspoons of sugar respectively—two days’ worth of added sugar.

While many find the slow pace of change frustrating, age confers a level of patience and confidence in knowing that measured, thoughtful change is more often lasting.

How we view breastfeeding was the subject of “Nurture,” a solo exhibition by New York- and New Hampshire-based artist Amy Jenkins, held January 9-February 28, 2010 at the Athens Institute for Contemporary Art (ATHICA) in Athens, Georgia. As compelling as the exhibit, is an accompanying essay by baby gooroo contributor Mary Jessica Hammes.

Hammes explores attitudes toward non-sexual nudity, artistic censorship, competing business interests, and the health benefits of breastfeeding.

“Nurture,” says Hammes, explores “the different meanings of what it means to nurture a child, to raise a human being, starting with the simple act of feeding one.”

But Hammes’ essay, like Jenkins’ images is about so much more than nutrition.

“In Jenkins’ images, breastfeeding begins to mean something deeper—something that links us to those hunter-gatherers of long ago, something that sustains modern families as we navigate contemporary parenting. At the very least “Nurture” makes breastfeeding visible. And if visibility makes something feel normal and therefore more accepted by our culture, then exhibits like “Nurture” could make a big difference in what goes into the mouths of babes.”

I hope Hammes is right. Time is running short.

©iStockphoto.com/nu-creation

Employed by the Red Cross after the devastating earthquake in Haiti, text messaging contributed to record donations. In less dire circumstances but indicative of the popularity of text messaging, millions text their vote for their favorite American Idol. But what can text messaging do for you?

With text4baby, the National Healthy Mothers, Healthy Babies Coalition (HMHB) is flipping the text message and using it to help expectant and new moms.

The familiar ping, ding, or ringtone sounds out from your handset:

“Give your baby a good start by not drinking alcohol, smoking or using drugs. For help call 800-784-8669 (smoking); 800-662-4357 (drugs & alcohol).”

“Feeling happy one minute and sad the next? It’s just your hormones changing. But if you’re always sad and anxious call your doctor or 800-944-4773.”

HMHB partnered with more than 150 communications and health care providers to deliver customized health information right into the hands of pregnant women and new mothers.

Text4baby subscribers receive free messages about what to expect during pregnancy and/or how to care for their health and the babies’ health during the first year after birth.

Women who are not frequently online will find text4baby a useful alternative to weekly pregnancy and parenting e-mails coming from so many directions. For women who are sometimes or often online, the text updates may serve as a supplement to the more detailed weekly email messages.

Since its launch just a few weeks ago on February 2nd, text4baby has gained more than 16,000 subscribers from across the U.S.

Who’s behind the messages?
HMHB is the driving force behind text4baby, but it relies on a broad public-private partnership of government agencies, corporations, academic institutions, professional agencies and non-profit organizations. If it sounds like a big umbrella, it is. More than 150 organizations are working together to help this project succeed.

Founding partners include HMHB, Voxiva, CTIA—The Wireless Foundation, and Grey Healthcare Group, while Johnson & Johnson is a founding sponsor. Premier sponsors include WellPoint, Pfizer, and CareFirst BlueCross BlueShield. Several agencies of the federal government are also partners, including the White House Office of Science and Technology Policy, the Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), National Institute for Child Health and Human Development (NICHD), and the Department of Defense Military Health System. Other partners include wireless service providers, MTV Networks, and BabyCenter.

Written by HMHB in collaboration with HHS, CDC, NICHD, physicians and nurses, the messages cover topics ranging from health care access, labor & delivery, immunization, breastfeeding, nutrition, and prenatal care to drugs and alcohol, emotional well-being, smoking cessation, mental health, care seat safety, safe sleep, oral health, pregnancy symptoms & warnings, exercise, and developmental milestones. There’s something for everyone here.

Based on the due date or date of birth the women enters when she subscribes to text4baby, messages are customized accordingly. For example, a pregnant woman is reminded of the proper way to position a seat belt across her pregnant belly: “A seat belt protects you & your baby. Shoulder belt goes between your breasts & lap strap goes under your belly (not on or above). Wear it every time.”

A new mom might be given a phone number to call for help with postpartum depression: “It’s normal for new moms to feel tired & overwhelmed. But if you’re crying a lot or feeling anxious or hopeless, please call 800-944-4773.”

Later, as she is settling into her baby’s routine she might be reminded about dental care: “Keeping your baby’s mouth clean is important even before she has teeth! Wipe her gums with a wet washcloth or use a soft baby toothbrush.”

How to sign up?
Women can sign up with just two simple steps:

1. Text BABY (or BEBE in Spanish) to 511411.
2. At the prompt, enter zip code and baby’s due date or date of birth.

New subscribers receive a welcome message followed by approximately three free tips each week. Messages end when a subscriber texts STOP to the same number, or on the baby’s first birthday. It couldn’t get any easier than that.

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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.