The AAP, the American Academy of Pediatrics, has come out with an extention and more stringent guidelines for parents for the first year of life. But are they really new? What prompted the changes? Busy parents and caregivers need to know, but often don’t get past the scary headlines. It’s important to go a bit deeper and see why the changes were recommended, in order to make the best choices for each family’s situation.
 Actually, the only new guideline is that the rules should be followed for the first year, rather than the first six months. And, doctors are recommending that babies sleep in the same room as their parents for the first year. 
 “The new rules were created because pediatricians are seeing that parents aren’t actually following the old guidelines,” says Terian Gregory, a seasoned Phoenix Certified Newborn Care Specialist. “They realize that parents are sleep-deprived, not making good choices, and are too exhausted to follow the guidelines. They’re inadvertently taking less safe shortcuts,” she explains. Like taking baby to an armchair or couch and falling asleep. Taking baby into their bed to nurse, and falling asleep. A lot of parents have done it, but it’s risky. The result is that babies are not always sleeping in their own beds, cribs, or bassinets, with a firm surface, with no pillows, blankets or soft toys.”
 Pediatricians are recommending co-sleepers, bassinets attached to the parent’s bed or sleeping the baby in a crib in the parent’s bedroom.  Mom can pull baby out, nurse, and put baby back without even getting up or leaving the room. Terian explains that what is happening is that doctors are responding to what parents are actually doing. “The AAP often puts out recommendations when there are safety concerns.”

According to a recent NPR article, The updated recommendation, then, is that mothers feed their baby in bed and then place the baby on its own sleep surface afterward. If the mother falls asleep by accident, it’s not as hazardous as it would be on a couch. When she wakes again, she should immediately place the baby back in its own bed, since the risk of death increases with the duration of bed sharing.
 “I am struggling to find a concrete study,” Terian tells us, that shows that if parents are actually following the guidelines and sleeping their baby in the baby’s crib in the nursery vs. having babies sleep in parent’s bedroom actually  keeps a baby safer.” These parents are so sleep deprived they just aren’t making good choices. If the parents put a bassinet in their room, it simply makes it easier for parents to keep their baby safe.”
 “So what is the AAP really saying?” asks Terian? “They just extended the time of following their guidelines. They’re not just looking at SIDS, but all sleep related deaths. SUID (Sudden Unexpected Death) can include suffocation, aspirating on something, babies put in cribs with pillows, soft toys, or blankets, sleeping on tummies, on their sides. Parents are just not following the recommended practices.” Terian stressed that if a baby is sleeping through the night, some of these concerns may not apply.  “As a Certified Newborn Care Specialist, I prefer to be in the same room as the baby. That’s my job. I prefer working with a baby to develop positive fundamentals and begin with “sleep shaping/sleep learning” strategies within the first 12 weeks. I have clients who prefer to have the baby monitor on even though I’m in the baby’s room. In that case, I recommend them keeping the sound off.  Parents can see the baby better on a monitor from their room than I can staying in the same room as the baby. Babies make a lot of noise during the night.  They often grunt, pass gas and makes noises and then fall right back to sleep and when the baby is in the same room, parents tend to be over responsive. Therefore, the parents get less sleep because the baby’s noises are waking them.  The AAP recommends that parents do not use ‘Home Cardiorespiratory Monitors’.   It is important that parents understand that this is different than the typical baby monitors that allow them to hear or see their babies. A regular monitor with a baby in their own room, is very workable.”

 Terian continues by suggesting, “If a mom is nursing those first few weeks, and up every two to three hours for an hour each time, it makes sense to keep baby in the parent’s bedroom.”

 So, if you’re co-sleeping, follow the recommendations. 
 If you’ve been getting up one to two times a night for 6 months or longer, parents are in survival mode, and not typically not making good choices.
 However, If your baby is sleeping through the night, or if you can safely get up during the night and put the baby in his own crib after nursing, there is not a reason not to put him in his own room.  But, if you’re sleep deprived and not making good choices, PLEASE follow the recommendations.
 “The medical community is doing their job: saving babies lives, but sometimes these headlines feed on parent’s fears. Parents and caregivers need to dig deeper, read a little more, and make the best choice for their particular family. Parents, Nannies, and Newborn Care Specialists need to assess the particular family’s environment, physical, emotional, environmental, and assess this new information, and make the best choice for their particular situation.”
 Terian concludes with, “Caregivers need to educate themselves to make the best choice for their families. For example, how does the family plan on parenting? What’s they physical layout of the house? Is baby’s room across the house or upstairs? What is Mom’s physical condition? Is there a lot of anxiety? Is she going back to work or will she be a stay at home Mom? Our goal is to empower parents and caregivers.”
 Beth Weise

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Postpartum screening for depression for new Moms is now being seen as essential by the medical community.

When I brought my second baby home, I felt overwhelmed. I had trouble connecting with him, feeling blank. One day when I ran out of fresh diapers, I felt paralyzed. This was before disposable diapers and clothes dryers and the diapers were clean, but were hanging on the clothesline in the back yard. I laid on my bed,thinking,“This is how people feel when they’re depressed.” I knew I had a choice. I could give up, or go out there- a blustery April day, and pull a diaper off the line. I got the diaper that day, but It wasn’t until two weeks later when I saw a full page picture of a baby’s heart in a Time magazine add, that the numbness melted, and thankfully, it didn’t return.

But for 9% to 10% of pregnant and postpartum Moms, it’s more serious.

The medical industry is now recommending that pregnant women and new moms need special attention in screening for depression, according to the U.S Preventive Services Task Force. This panel was appointed by the Department of Health and Human Services, and now formally supports that advice.This is a first of it’s kind  call for doctors to routinely screen women either pregnant or who have already given birth. There are extra hormones working in women during these times and a lack of sleep can trigger depression. Dr. Eleanor Martinez, M.D., told ABC7 News, “By making this recommendation we are putting it up in the front and saying, ‘Listen, this is a diagnosis. This is a disease. We need to embrace it like anything else.’”

Evidence shows that new mothers can be accurately diagnosed and successfully treated with the help of alert pediatricians, family doctors and OBGYNs. Not taking depression seriously is harmful to both mother and the baby. Research shows that untreated moms have  babies and toddlers, with sleeping problems and take longer to be comforted. Until now, depression in these new mothers  has been under recognized and under treated. A routine test can be given to the mom while she is waiting for her appointment. It will tell the doctor if she needs further screening for depression.

Treatments that work are “talk therapy” or drug therapy, or a combination on them are most successful. However, part of the problem is motivating a depressed mom to keep trying while the right treatment starts working. Plus there is a small risk of miscarriage and preterm birth leaving talk therapy as the best choice, and a nursing mom will be hesitant to take any drug.

Legislation in Congress may authorize Washington to fund screening and treatment for moms with babies one year and under, but as for now, there is none.
If you’re pregnant or a new mom the questions a doctor may ask to determine if you are at risk may be:
“Have you felt down a lot in the last few weeks?
How often have you felt tired or were unable to concentrate?”

Anyone working with a new mother, family members, friends, or a nanny should be aware of symptoms. Mild depression, anxiety and mood swings are common in new mothers and this is called Baby Blues. This is normal in new moms and usually fades away after the second week. The entire process of giving birth is exhausting, hormones are raging, sleep can be sketchy. Most moms go through this.
How is postpartum depression different?  It brings more severe emotions that don’t go away, with thoughts of suicide, or feeling like one is unable to care for the baby. The Edinburgh Postnatal Depression Scale is a set of 10 questions  to determine if  medical help is indicated.

I got a call one Sunday morning from a distraught Dad, who reported that his wife had come out of the bedroom  stating that she had thought of suicide three times that morning. The baby was 5 days old, and we were able to find a Newborn Specialist for this family for a few weeks to get up at night with the baby and do all the night feedings so the parents could get their much needed sleep.

Beth Weise

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SLOGGING through endless nights with a newborn baby has long been a parenting rite of passage. But for some dual-income parents, the arrival of the night nanny is making those 2 a.m. interruptions a thing of the past.
Demand for overnight nannies — also known as newborn specialists — has been growing, especially in the last five years and largely in major metropolitan areas, said Wendy Sachs, the co-president of the International Nanny Association and the founder of the Philadelphia Nanny Network. “People have moved away from the places they grew up, and they don’t have family down the street to help them out,” she said.The trend reflects changing attitudes about child care. Parents no longer see outside child care “as bad for kids or neglectful on their part — child care is seen as a necessity, not a luxury,” said Christine Carter, a sociologist who directs the Greater Good Science Center, an interdisciplinary research center at the University of California, Berkeley. “If it is good during the day, why wouldn’t it also be helpful at night?”Night nannies have evolved from an aristocratic tradition that goes back generations: the baby nurse. These were

nurses hired by wealthy families to provide round-the-clock care of infants.The more recent demand for night nannies began with care of twins and triplets, but in the last several years parents of single babies have also been seeking overnight help.
Beth Weise, founder of Caring Nannies in Scottsdale, Ariz., said her business, which opened in 1983, once served only families with multiple births or babies with health problems. Now the clients are split 50/50 between multiple and single births. The same is true for the work of Tracy Seveney, a night nanny and founder of Nocturnal Nannies in Ashland, Mass.
Agencies like hers and Ms. Weise’s have recently begun expanding the night nanny’s role to meet their clients’ needs — offering infant sleep training and parent counseling. The bulk of Nocturnal Nannies’ clients are dual-career, professional families, Ms. Seveney said, and revenue has been increasing 25 percent a year.
Anie Roche of Los Altos, Calif., hired a night nanny through Craigslist last November after she had her second child. Both Ms. Roche and her husband have high-pressure jobs: he is an executive at a semiconductor company in Silicon Valley and she is a partner at a law firm in Palo Alto.
Their nanny works from 10 p.m. until 6 a.m. six nights a week. “She swaddles the baby and sings to him and that’s the whole point for us — she has a lot more energy and patience at that point in the day than my husband or I do,” Ms. Roche said. “We are wiped out.”
Night nannies are often treated like heroes, said Barbara Kline, president of White House Nannies in Bethesda, Md. “Suddenly you have a six-pound bundle of chaos, an incredible amount of upheaval in the household, and in swoops this person who can calm the baby and get them to eat and sleep,” she said.
As might be expected, help doesn’t come cheap. A week’s worth of night-nanny services can cost well over a thousand dollars, with nannies earning about $15 to $40 an hour, depending on their experience, the number of babies and the babies’ health. Ms. Seveney says overnight nannies usually spend 6 to 10 weeks with a family with one newborn, and anywhere from two to four months for twins.
Night nannies either work on their own — like Ms. Roche’s — or through agencies that find assignments for them. The bulk of agencies charge clients a one-time placement fee, but some charge a flat rate for each night. Agencies generally require nannies to have several years of experience with newborns that are not their own children, and most require training in infant and child cardiopulmonary resuscitation.
Jena Riley, a night nanny and owner of Night Nannies for Newborns in Denver, said most of her nannies are “moms in their 30s and 40s whose husbands were home at night.” That works well for her clients, often in their 30s and 40s, too, who have lots of questions, she said, but may not feel comfortable taking advice from a 20-year-old.
WHAT can make the job tough isn’t the baby but the parents, said Jessica Muzio, 30, a night nanny with Nocturnal Nannies. Ms. Muzio has a degree in psychology and once worked with autistic children. She is pursuing a nursing degree during the day.
“Babies are babies and I’m at the point now where I can almost always soothe them,” she said. “What makes the job good or bad is the rest of the family.” Parents are usually asked to keep track of their baby’s daytime routine in order to help the nanny troubleshoot at night, but many parents don’t.
And the atmosphere in a home is potentially uncomfortable, Ms. Riley said, if the new baby is causing friction between parents trying to adjust to the change.
It can also be isolating to work alone from 9:30 at night until 6:30 in the morning. “That’s the worst thing about the job,” Ms. Muzio said.
Making a steady living is sometimes a challenge because an assignment is generally short term, and there may be a gap before the next one.
Still, Ms. Muzio relishes the work. “It’s a great job for me,” she said, “because I love babies.”

This article ran in the New York Times  April 7, 2007

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