Women who have had breast reduction surgery may find that their milk production is limited. With the removal of breast tissue, nipples and areolas are occasionally repositioned on newly formed breasts, which damages milk ducts, nerves, and blood vessels. You can still breastfeed your baby, but you may need to supplement with donor human milk or infant formula if your baby gains too little weight. Let your baby’s doctor know about your surgery, so that he can check your baby’s weight frequently during the early months and ensure that your baby is getting enough to eat.

Many women with breast implant surgery (breast augmentation) can breastfeed fully, without having to use supplements. However, breastfeeding problems are more common in women with breast implants. If incisions are around or near the areola, the risk of damage to milk ducts, nerves, and blood vessels is greater. Women concerned about the condition of their implants (particularly women with silicone implants) are urged to get a magnetic resonance imaging (MRI) exam, which will show if the implants are intact or leaking.

Lumpectomies rarely cause breastfeeding problems unless the incision is on or near the nipple and areola. If a breastfeeding mother discovers a cancerous lump that requires radiation or chemotherapy treatment, she may need to interrupt or stop breastfeeding. Talk with your doctor and your baby’s doctor about a treatment plan to determine whether it’s necessary to interrupt or stop breastfeeding. The Infant Risk Center can also provide valuable information.

Women who have had a mastectomy (the removal of a breast) can still breastfeed on the remaining breast, using a variety of breastfeeding positions.

If you are considering having breast reduction or breast augmentation surgery and know you want to breastfeed, talk with your surgeon beforehand. Discuss both the benefits of surgery and your breastfeeding concerns. You may find out only afterward that you are unable to breastfeed fully. If so, remember that any amount of breastfeeding benefits you and your baby.

U.S. children typically master crawling between 7 and 10 months of age, but the form of crawling can vary (hand-and-knees, army crawl, scooching) and some perfectly normal babies never crawl. Instead, they go from sitting to walking.

In order to crawl, babies must first be comfortable lying on their abdomens. They must also have strong back, arm, and leg muscles. Once your baby is able to lift her body up, she will likely spend time rocking back and forth on her hands and knees. Stronger arm muscles than leg muscles might cause her to propel herself backward before being able to move forward. Eventually, she will learn to dig in her knees and move forward.

You can encourage your child to crawl by getting down on the floor on your hands and knees and showing her how it’s done! It sometimes helps to position a favorite toy just out of reach, giving her something to crawl toward.

Children who never crawl still manage to navigate their surroundings. They simply use alternative methods, such as scooting around on their bottoms. As long as your baby is coordinating her limbs and body, there is probably no reason for concern.

Before your baby learns to crawl, take some time to babyproof your house. Once she’s mobile, you can sit back and enjoy watching her explore her surroundings.

At least Max’s attraction to books appears to be more than just enjoyment of destruction. He seems, also, to be taking a real, independent interest in reading these days. It’s true that reading waxes and wanes in the cycle of our lives, but there’s rarely a day without reading in our household.

Until recently, Max had been a largely distracted audience. If I sat down on the floor beside him, he would crawl away to a favorite toy (or sibling) after just a page or two. Even the very best books failed to keep his attention for long.

Now, though, Max is starting to show a real interest in books, and the stories they contain. After pulling some books off the shelf, he pauses, picks one up, and flips the pages. Sometimes, he brings them over to share with me, so I can read them to him.

It’s true he may not sit still for the whole book, even if he’s picked it out. Max is an active baby! He still may return to the bookshelf mid-story to find another selection, or he may abandon reading altogether. But more and more, he does stay for the whole story—and even asks for it again. And again…

Now that he’s discovered books are for more than just play, I’m thrilled! The importance of reading to children starting in infancy can’t be overstated. I’m sure there will be days I groan at the hundredth reading of this or that title. But for now, pass the “Max books,” would you?

Parenting four children between the ages of 46 weeks and 8 years keeps Heidi Green busy! Add in husband Michael, paid work and volunteer work, and life becomes a juggling act. Check in with us every week to find out how she manages (or not), and what she learns in the process.

Because your baby may seem cranky, fussy, or out of sorts, well-meaning but inexperienced friends and relatives may suggest that “your milk isn’t rich enough,” that “you’re not making enough milk,” that “a formula supplement or solid foods are necessary,” or that “it is time to stop breastfeeding.”

In fact, just the opposite is true. It is time to breastfeed more, albeit temporarily. Your body naturally regulates the amount of milk it produces in response to your baby’s needs. The more milk your baby takes from your breasts, the more milk you make. There is no reason to worry that you can’t or won’t make enough breast milk to satisfy your growing baby. Your body will respond to your baby’s frequency days by making more milk.

Be patient during growth spurts. Resist the temptation to offer supplements. Once your body gets the message, it will ramp up its supply to meet your baby’s needs.

The types of coughs your child may experience include:

Croup
Known for its harsh, barking cough, croup is most common in children between the ages of 6 months and 3 years. It is caused by the parainfluenza virus and can begin without warning or develop gradually along with mild cold symptoms. In addition to a cough, which has been likened to the sound of a “seal barking,” symptoms of croup include labored, noisy breathing (called stridor), fever, and hoarseness. Croup is seldom serious and can usually be managed at home. Parents should, however, contact their child’s health care provider or seek immediate medical care if their child makes noisy, high-pitched breathing sounds when inhaling, begins drooling or has trouble swallowing, seems extremely irritable or extremely tired, refuses to eat or drink, struggles to breathe, or develops blue or grayish skin around the nose, mouth, or fingernails.

If your child has a croupy cough without any of the above symptoms, he will likely feel better if he breathes in moist air. As a result, the American Academy of Pediatrics (AAP) recommends that you sit with your child in a steam-filled bathroom (turn on the hot water in the shower and close the bathroom door so the steam does not escape). Your child’s breathing should improve within 15 to 20 minutes, but the barky cough may take a bit longer. If the warm steam doesn’t provide relief, take your child outside for a few minutes to breathe the cool, moist air. This, too, may help him breathe more freely. There is no evidence to show that warm or cool mist actually improves breathing, but it may temporarily make your child more comfortable.

There is no vaccine for croup. Like many viruses, it spreads when children come in contact with the virus and then touch their noses, eyes, or mouths. As a result, frequent handwashing is the best way to avoid catching croup.

Dry cough
When your child has a fairly nondescript cough and isn’t coughing up mucus, he likely has what’s called a dry cough. Dry coughs, according to the Centers for Disease Control and Prevention (CDC), are often associated with the flu, cold, or other viruses. In addition to a cough, your child may also complain of a sore throat or sore chest. Setting up a cool-mist humidifier in his room may help the cough and make it easier for him to breathe and sleep. If, however, the cough lasts more than three weeks, you should contact your child’s pediatrician because it could be a sign of something more serious.

Productive/wet cough
A productive or wet cough is one that produces mucus, which can be clear, white, yellowish-gray, or green in color. Most phlegmy coughs, according to the AAP, are caused by viral bronchitis—an inflammation of the large breathing tubes (called bronchi) that results in an increased production of mucus. Bronchitis often develops from the common cold or other viral infections in the upper respiratory tract. As a result, antibiotics are ineffective in treating most cough illnesses/bronchitis in a child who otherwise appears well. For coughing spasms, the AAP recommends treating wet coughs with plenty of fluids, a humidifier, and warm chicken broth or apple juice if your child is older than one year. Mothers are urged to continue breastfeeding. These coughs may linger for weeks, but as long as your child doesn’t have a fever and feels well enough to participate in activities, he may return to school.

Another common cause of a wet cough is bronchiolitis—a viral illness that causes swelling in the small breathing tubes of the lungs. Bronchiolitis can make it difficult for infants and young children to breathe and can result in them experiencing asthmatic symptoms (wheezing, labored breathing, etc.). If your child has difficulty breathing, seek immediate medical care.

Wheezing cough
A wheezing cough or wheezing while exhaling is a common sign of asthma in children. It can also be a sign of bronchiolitis, which, as described above, is a respiratory infection common in infants. Asthma symptoms can escalate quickly in babies and young children, so it is important to seek immediate medical care if your child has any difficulty breathing. To learn more about asthma, click here.

Whooping cough
Whooping Cough, also known as pertussis, causes severe coughing spells that can leave your child gasping for air. After a coughing spell (or between coughs), a child with whooping cough typically makes the familiar “whooping” sound that gives this disease its name.

Other symptoms of Whooping Cough include those associated with the common cold. In fact, someone with pertussis may experience congestion, runny nose, watery eyes, sneezing, or a mild cough and fever for one to two weeks before the severe coughing begins. Eventually, the coughing attacks may bring up thick phlegm, trigger vomiting, result in a red or blue face, or cause extreme fatigue. If your child displays any of these symptoms, you should contact his or her pediatrician immediately.

Though infants will likely be admitted to the hospital for treatment, older children can typically undergo treatment, which includes antibiotics, at home. While at home, children with Whooping Cough should rest, drink plenty of fluids, and eat small meals to prevent vomiting after coughing. They may also benefit from having a vaporizer in their rooms to assist in loosening mucus in the lungs. If left untreated, Whooping Cough can lead to pneumonia, seizures, brain damage, or death.

The bacteria that causes pertussis, Bordetella, spreads through direct contact when a child or adult comes in contact with someone who is infected with the disease. Although it isn’t 100 percent effective, the DTaP vaccine, which protects against pertussis and two other serious bacterial diseases, goes a long way toward preventing pertussis. The CDC recommends that children receive their first dose of the DTaP vaccine when they are 2 months old, and preteens, teens, and adults who were vaccinated as children should be re-vaccinated because the vaccine’s protection decreases over time.

Having trouble identifying your child’s cough? Listen here.

Katie Porterfield is a freelance writer and former magazine editor in Nashville, Tennessee. She is mom to twin boys.

However, a recent study suggests that banning junk foods from schools wouldn’t have a significant effect on students’ health.

Research
Sociologists Jennifer Van Hook and Claire Altman from Penn State University’s Population Research Institute conducted a longitudinal study to investigate the influence of what they call “competitive foods” (that is, those sold at school that compete with the lunch and breakfast programs) on children’s weight. They drew their data from a nationally representative sample known as the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999. Van Hook and Altman limited their analysis to the 19,450 children who attended school in the same county in both fifth and eighth grades, the years during which the survey collected data on competitive food sales in the schools.

The researchers looked at:

• children’s age and body mass index (calculated from children’s height and weight)
• competitive food sales venues at school, with data provided by school administrators
• types of competitive foods sold
• school characteristics (e.g., amenities, free and reduced-price lunch recipients, school size)
• family characteristics (e.g., parental marital status, maternal employment, family socioeconomic status, school involvement, and school choice)

Results
The researchers expected “to find a definitive connection between the sale of junk food in middle schools and weight gain among children between fifth and eighth grades,” Van Hook explains. In fact, they found no such connection. Although the percentage of overweight and obese children in the U.S. has quadrupled during the past 25 years, and the availability of junk foods in schools has increased as well, there appears to be no association between the two.

For example, 59.2 percent of fifth graders in this study attended schools where competitive foods were sold; by eighth grade, that figure rose to 86.3 percent. In spite of the significant increase in the availability of competitive foods, Van Hook and Altman found no rise in the percentage of students who were overweight or obese. In fact, the percentage of students who were overweight or obese actually decreased during this timeframe, from 39.1 percent to 35.4 percent.

According to Van Hook, these findings seem to suggest that controlling access to junk foods at school is not an effective way of reducing childhood obesity. Rather, efforts to reduce childhood obesity should focus elsewhere, such as children’s homes, families, and neighborhoods.

This research does have some limitations. First, study tools did not collect specific information about school food sales, such as locations, hours, or rules and policies. It is possible that specific types of policies (i.e., aggressive marketing, sales at events) may be associated with student weight gain. Second, this study is particular to middle school students and cannot be generalized to high school students. Third, it is a report of population-level findings; individual students may gain weight when they have the opportunity to buy competitive foods at school. Finally, this study is not a randomized controlled trial and cannot prove cause and effect.

Recommendations
Although this study fails to find a connection between junk food at schools and children’s weight gain, parents should continue to pay attention to promoting healthy eating habits at home.

Parents of young children should pay close attention to their children’s eating habits. Research supports that children “develop eating habits and tastes for certain types of foods when they are of preschool age,” Van Hook explains, “and that those habits and tastes may stay with them for their whole lives.” Many researchers believe taste develops even in infancy, through the flavors babies experience in their mother’s milk, or even during pregnancy. In other words, the die may be cast long before middle school.

As Van Hook explains, “[s]chools represent a small portion of children’s food environment.… They can get food at home, they can get food in their neighborhoods, and they can go across the street from the school to buy food. Additionally, kids are actually very busy at school… [and] have certain fixed times when they can eat.” School, then, doesn’t provide ‘a lot of opportunity for children to eat’ or ‘eat endlessly, compared to when they’re at home.’”

Parents should provide healthy snack foods at home instead of junk foods. With more free time at home—and more time to eat—children might very well be prone to eating unhealthy snacks and bigger portions if they are readily available. Make it easy for children to grab something healthy by having fruit and vegetables (carrot sticks, green peppers, apples, etc.) washed, sliced, and plated in the fridge.

And lead by example. Display healthy habits at home that the whole family can model.

“What if children…owe our constellation of traits not only to the genes we inherit at conception, and not only to the world we encounter after birth, but also to the nine eventful months in between?”

In other words, what if your life is mapped out for you before you’re even born?

She’s not talking about the general inheritance of certain traits from one’s forebears, but rather the choices a pregnant woman makes that will have specific outcomes in the child’s life for years to come.

As a science writer, Paul knows that there is a burgeoning body of research focused on the womb and what’s going on inside. The idea of “fetal origin” has been increasing in recent years, and Paul’s book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives is a fascinating look at what scientists are learning.

Paul’s gift is to translate that research into everyday language, empowering readers to make healthier choices for themselves and their children.

Yes—there are choices. While Paul writes about the influences outside of the womb that affect the baby within, including exercise, depression, chemical exposure, stress levels, even catastrophic world events. Some of these influences are obviously not within our control, but others are. And Paul’s book is hardly a doomsday scenario; rather, she encourages women to focus on the positive influences they can have on their babies during pregnancy. Paul doesn’t just preach these changes in habit, but instead she makes changes throughout her own pregnancy, generously sharing her personal experiences with the reader in an effort to lead by example.

While the whole book is a fascinating blend of sound medical research and personal experience, I found the sections on mood and diet—two things with which every pregnant woman is well acquainted—most intriguing.

Emotions
It’s easy to accept that a pregnant woman should eat well and exercise. Some people might have a harder time believing that an expectant mother’s mental state could have a very real affect on her fetus. After all, we’ve long rejected the sweeping “insanity of pregnancy” diagnosis given to emotion-charged, pregnant women in the 19th century, just as current thinking rejects the notion that a woman’s desire to be pregnant is the same thing as wanting to have a penis (a Freudian theory). However, current research recalls “maternal impressions,” a popular 18th century belief that specific acts or thoughts of the mother would physically manifest in the child. While today’s science is not saying exactly the same thing, recent studies show that a woman’s emotional state “can influence the fetus’ developing brain and nervous system, potentially shaping the way the offspring will experience and manage its own emotions—a kind of material impressions redux,” writes Paul.

Researchers are still trying to find out whether a mother’s mood can be transmitted to the fetus, how that might happen, and how those moods might affect fetal development. One study of depressed women found that an increase in maternal heart rate, blood pressure, and respiration, caused an increase in fetal heart rate as well. Whether the cause is genetics or related to the mother’s nervous system, the result is also apparent after birth. As Paul writes, research shows that children of depressed mothers are more reactive to stress, more irritable and harder to soothe, have more sleeping problems and higher levels of cortisol (a stress hormone) in their blood.

Diet
Two-thirds of American women of childbearing age are overweight. One in five who give birth is obese. Paul quotes a 2009 study that found 73 percent of American women failed to follow weight gain guidelines during pregnancy, with most overweight women gaining too much weight. More recent studies show that overweight and obese women are more likely to have children with birth defects (which can occur at conception or in early pregnancy) and children who are overweight.

One is tempted to say that “intergenerational transmission of obesity” is environmental given that kids will eat what their parents eat. But Paul shares a study that looked at siblings who were born after mothers had successful anti-obesity surgery. These children were 52 percent less likely to be obese compared to their siblings who were born to the same mother when she was obese. These children shared the same mother, but completely different intrauterine environments. (If you’re interested to learn more about how genetics, environment, and maternal choices play a role in a child’s risk for obesity, read this.)

Getting personal
Readers who’ve gone through a pregnancy will feel a certain kinship as Paul offers candid and engaging glimpses of her pregnancy and everyday life with her husband and older son. She has a knack for taking broader issues and making them personal and interesting. When she writes about pregnant women and diets, for example, she examines the way Americans view and experience food in general before recounting her own quest for healthier eating, including the details of a particular grocery run. When she writes about babies forming their dietary preferences while still in the womb, tasting their mothers’ food via amniotic fluid, she considers her own unborn child.

“As I dig into my Penang curry with chicken and green beans, I’m thinking not about calorie counts or nutrient quotas, but about the distinctive diet to which my future child is already being exposed: the exuberantly polyglot menu of a twenty-first century Manhattan dweller with a world of tastes—Indian, Mexican, Chinese, Italian-American pizzeria—just down the block,” she writes.

There’s certain anticipation as you near the last chapter, “Nine Months.” The whole book has led up to this moment, the birth of her child, and because of Paul’s engaging writing, you feel like you are about to witness your friend’s birth. Yet, it is the one time when Paul fails to share a complete picture of her experience. She writes about how modern doctors try to manage all aspects of pregnancy and childbirth; how interventions change the actual length of pregnancy; how the cesarean section (c-section) rate in the U.S. continues to grow.  “Women undergoing a scheduled c-section, like me, may know their future child’s birthday months in advance,” writes Paul, leaving one to wonder why she’s having a c-section. In fact, by the end of a book filled with introspection, the absence of explanation is jarring.

What she does share of the birth is, again, recognizable to any mother: “There’s a moment of stillness,” she writes. “I realize that I’m holding my breath. Then—an eruption of noise and motion. In the din there’s a sound I hear above all the others: a baby’s cry, rising in indignation.”

It’s the moment that makes all of those nine months of planning and plotting and worrying and research just slip away.

Will this book make pregnant women worry that they aren’t doing the right thing, or enough of it?

Is it just one more tome telling mamas-to-be what to do, sending them over the edge of overachieving anxiety?

No, I don’t think so. Paul’s tone is far from judgmental, and she reminds the reader of something very important: there is no “ideal pregnancy” to aspire to. She says, “There is instead a highly personal and particular shaping of the fetus for the specific world into which it will be welcomed.”

Mary Jessica Hammes is an Athens, Georgia-based writer, trapeze instructor, assistant preschool teacher, knitter, gardener, comic book enthusiast, and hula hooper. She is mom to Tommy.

Problem: Consumers reported difficulty using the Infants’ TYLENOL SimpleMeasure dosing system. SimpleMeasure includes a dosing syringe, which a parent or caregiver inserts into a protective cover, or “flow restrictor,” at the top of the bottle to measure the proper dose. In some cases, the flow restrictor was pushed into the bottle when inserting the syringe.

Action: If the flow restrictor is pushed into the bottle, parents and caregivers should not use the product.   To learn more, click here.

It has become more difficult to accomplish tasks around the house now that Max has developed a bit of separation anxiety. (I type this with one hand—in the tradition of oh-so-many mothers before me—while holding him with the other arm.)

This isn’t, actually, to imply that the newborn phase was one of hands-off parenting. Hardly. But there’s often something different in Max’s response to my absence these days, a stridency or urgency that finds him crawling after me (if on the floor) or crying in distress (if in his high chair or bed).

It’s not that I expect to be able to do big tasks without him on my lap. Trips to the laundry room or cooking a seven-course meal are the sorts of things that can’t be accomplished without one of my baby-distracting big kids around. But I would like to be able to step into the bathroom or pour a cup of coffee without Max feeling stressed out about it. These days, if he’s awake, that’s not happening.

I’d forgotten about this. Perhaps the older children weren’t quite as vocal about their separation stress, or perhaps time has dulled my memory. But the tears and the crying, the shallow breathing and vice-like clutching hands upon reuniting are a bit heartbreaking to behold.

At least I can be assured that his behavior is both developmentally appropriate and normal. A resource from the National Institutes of Health suggests separation anxiety is typical behavior that usually resolves around 2 years of age, although it may recur during times of stress. Author Elizabeth Pantley suggests that parents accept such behavior as a positive sign of the strength of the parent-child bond. Because “babies don’t know what makes people appear or disappear,” she explains, they “crave the nearness of those they love… to protect themselves from loss.”

Right now, I suppose I’d have more reason for concern if he was unfazed by separation than if he is.

Over time, I know Max will learn that all is fine even when I’m not within arm’s reach. After all, it’s not as if he’s completely incapable of being without me now. He naps—usually—apart from me. And he clearly enjoys playing by himself or with an older sibling; he just tends to prefer that I’m around, and responsive, while he does.

And that’s one of the most interesting aspects of Max’s heightened awareness of separation: it emerges at roughly the same time we see big strides in his independence. He’s springing ahead in so many ways right now—mobility, hand-eye coordination, feeding—and yet he’s still very much a mama-needing baby.

Like so many aspects of parenting, it’s a balancing act, this time of separation and of growing  independence.

Parenting four children between the ages of 45 weeks and 8 years keeps Heidi Green busy! Add in husband Michael, paid work and volunteer work, and life becomes a juggling act. Check in with us every week to find out how she manages (or not), and what she learns in the process.