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Pediatrician

What’s New Wednesday: Toddlerhood is Here!

Taking a break from her morning stroll to
splash about in a mini-river, courtesy of a
broken water line up the street.
The daddy has been insisting for many weeks now that Annabelle is a toddler despite her age since she has, in fact, been toddling for some time. Some mixture of a desire to keep things from going too quickly and a love of  accurate language made me resist the label until she was officially one, but now there is no denying it and I’m actually getting used to referring to “my toddler” in conversation. It’s hard to believe that I’m mama to someone who has had a birthday!
The biggest milestone this week was the addition of a third word to toddler Annabelle’s vocabulary. Actually, this is another area where the daddy and I lovingly disagree. He was certain that she had said “hello” a couple of weeks ago, but I assured him that he was hearing things. Because you know, I know everything and all that. Well, last night, when we were playing cracker phone (more on that later!), she held a cracker to her ear and very clearly said, “hello.” There was no mistaking it this time! Today, I am sure I heard her say it again, and also a simple “hi.” She has also signed for milk more this week, and added “bathroom” to her ASL repertoire to let me know she needed to ‘go.’
Taking a break on the curb
Imitation has most definitely begun, and Annabelle’s favorite thing to do is talk away on the phone. It’s funny, too, because neither the daddy nor I really enjoy using  the phone. I have one actual phone conversation each week, sometimes two, when my sister calls on her way home from work. The rest of the week, I am surprised to hear the phone ring. We just don’t use it much, but Annabelle has certainly picked up on the practice. When she gets ahold of the cordless phone (which has been missing a piece for months now – since the first time she got her hands on it), she holds it somewhat behind her head and walks around chatting away. Since that phone is generally hung up someplace out of her reach, however, she has taken to using any and everything as a telephone. The thermometer and a  cracker have been favorites lately, and she loves to hand the phone off to one of us to chat on as well, hence the new game, “cracker phone,” where we pass a cracker back and forth for some imaginary conversation. The very first time we noticed Annabelle “talking on the phone” was actually the day before her big birthday party, and the daddy caught a bit of it on video. Here you go:

In other news, the whole “schedule” thing is working famously at night, but naps during the day have been a challenge, so we’re working on it. I’m sure the naps will come around eventually – I’m just glad that the regular midnight bedtimes seem to be a thing of the past. Waking up to nurse every 2-3 hours is still normal, and that’s okay – especially since going back to sleep is so easy.

The big twelve month well baby check was on Monday, and went great for the most part. Annabelle weighs just over 19 pounds and is twenty eight and a half inches tall. I was thrilled that I didn’t have to smile and nod at any advice this time – there were no mentions of night weaning, rice cereal, or anything of the sort. It was downright pleasant, actually. Afterward, however, we had to go to the lab, and that was not pleasant at all. The daddy and I have noticed a bowing in Annabelle’s legs and, while I know some bowing is quite normal at her age, we were both interested to see what a trained pair of eyes thought about how normal it was in Annabelle’s case. The doctor watched Annabelle walk across the exam room and then assured me that it was simply “physiological” bowing, and was nothing out of the ordinary – just the amount that is typical of a toddler. Later on in the exam, however, the doctor noted a bit of a widening at the wrists on Annabelle’s arms, something that can be a sign of a vitamin D deficiency. She said it was minor enough that she likely would not have thought anything of it had we not mentioned the bowing, which of course can indicate rickets in extreme cases. I decided long ago, after much research, not to give Annabelle the nasty Vitamin D drops that the one-size-fits-all AAP recommendation says every breastfed baby ought to have. We do live in the tropics, after all, and our girl loves to be outside. Well, all of this information taken together led to the decision that we ought to go ahead and have some blood work done, just to put any concerns to bed. 

Checking out the eels with friends at Underwater World.

So, off to the lab we went. My poor girl had to sit in my lap while a stranger held her arm down and another drew the blood. Unfortunately, he did not get enough for all of the tests, so we only got her calcium and phosphorous levels, and we have to go back for more. This time, however, we are planning ahead and the daddy will come along so that no strangers have to hold the babe’s arms. It seems a bit unnecessary now, since her calcium levels came back fine, but we will check just in case. Really, I think I had a harder time with the whole thing than Annabelle did. The minute we were dismissed from the lab, I rushed off to the waiting room and sat down to comfort/nurse her. She latched on for about half a second and then popped off to wave and smile at the other people in the room. I guess it wasn’t such a big deal after all.

And that’s the haps for this week. Tell us, what’s news around your house? 

Labial Adhesions, Part 2

Photo Credit: Veganbaking.net on Flickr
It seems that people land on the first post I wrote about our experience with labial adhesions quite frequently. It is by far the most popular search term that brings people to this blog, and it seems that it’s a topic that isn’t discussed much, so I wanted to follow up.
See the post referenced above for an explanation of what labial adhesions are if you’re not familiar A refresher on our story: Annabelle’s adhesions were discovered at a well baby visit when she was about seven months old. Her pediatrician immediately jumped to hormones, and prescribed an estrogen cream, which I chose not to use. After several days of twice daily application of coconut oil and one day of flax oil, the adhesion cleared up.
I wanted to follow up, however, because they did readhere. I noticed this right around the time that she turned nine months old. Per the pediatrician, it is not uncommon, even when estrogen cream is used, so I stand by my decision to avoid the route of synthetic hormone treatment. I have gone back and forth when it comes to treatment, and as with many things I have a sort of internal debate on what the best route is. I question the supposed cause of labial adhesions, at least in Annabelle’s case, and I truly do not think they are a problem for her at this time, so I’m hesitant to really treat them.
Labial adhesions are thought to be caused by irritation. Doctors say that it can be something as simple as staying in wet or dirty diapers for too long, but they also show up in the aftermath of abuse. I am thankful that I have almost never had to leave Annabelle in someone else’s care. Since she is with me all the time, I can rest assured that abuse is not a factor. Irritation seems unlikely to me, too, however. Because we practice elimination communication, we very rarely use a regular, fully absorbent cloth diaper. Most of the time we use trainers that are just absorbent enough to catch the urine from one pee, but not so much so that we won’t know immediately if Annabelle is wet. When she does not use the potty, she is still changed within minutes. When I first learned of the supposed cause of labial adhesions, I had some serious mommy guilt, feeling like I had been neglecting my daughter by not keeping her clean enough. The more I think about it, however, the more it seems, for the reasons stated above, that it’s highly unlikely that anything I could have done would have prevented this from happening. With Annabelle, it just seems that she was going to have labial adhesions all along, and that she will have issues with them until she is a bit older. I am frustrated by the thought that other doctors, like ours, may be telling parents that their daughters labia adhered because they “sat in a wet diaper too long.” Anyway, as I explained in my previous post (click to read), most of the time, the condition resolves itself by sometime before puberty, if not much earlier, when the body begins to produce more estrogen.
The thing I constantly remind myself of is that, while Annabelle’s pediatrician is an expert on infants in general, I am an expert on Annabelle. I can tell when she is uncomfortable, and so far it seems that she is not. If treatment becomes necessary, I will know, and I will deal with it at that time. At this point, since she has shown no discomfort and she has had no issues with infection, I feel comfortable waiting it out. I do keep both flax oil and coconut oil on hand, and once every couple of days, or whenever I think of it, I will put a few drops of one or the other in a small bowl (identical to the one pictured above, oddly), and use that to lubricate the area. This prevents any potential irritation caused by dryness or chafing, and protects against more extensive adhesions. So far, I have seen little change and it seems that the wait and see approach is working just fine for us.

The Parent-Pediatrician Relationship

Photo Credit: dmason on flickr
Those of you who know me well know that I lean more toward natural medicine. I had a hospital birth, but I was very careful to prepare so that I could still birth unhindered, with minimal intervention. Since Annabelle was born, I have successfully treated two eye infections with breast milk alone, and having come down with strep throat myself, managed to bounce back by taking plenty of garlic and grapefruit seed extract. I avoid pharmaceutical drugs wherever I reasonably can. Still, I take Annabelle to all of the regular “well-baby” visits with the base pediatrician.
Many who take a view similar to mine when it comes to medicine choose to avoid seeing, or taking their children to an MD or a Pediatrician. Some feel that doctors are only for the sick, and don’t replace these “routine” visits with anything at all. Still others choose to see a chiropractor, or another type of practitioner. Personally, when I was single and uninsured, I saw an ND (Doctor of Naturopathic Medicine), and that would be my first choice if I had a wide variety of options. Now that I am covered by military insurance, as is Annabelle, and we’re in a location with limited options, for me the family practitioner is the best bet, and for her it’s the pediatrician. I feel fortunate that we have access to this resource, and I don’t hesitate to take advantage of it. 
While I know Annabelle best, and I pay careful attention to her growth and development, her pediatrician knows how the “average” child should be progressing at Annabelle’s age, and is aware of a wide array of potential issues that I would not know to watch out for. I have plenty of confidence in our ability to take responsibility for Annabelle’s care as parents, but I welcome the screening tool that we have in her pediatrician. I don’t see this tool as a substitute for being well-informed myself, but simply as another source of information, to be checked against the others I have access to. 
The pediatrician alerted me to the fact that Annabelle has labial adhesions and, while I chose not to take the  doctor’s advice regarding treatment, I am thankful that she took note of the condition and that I now know what to watch out for. I see the pediatrician as another resource in my journey as a new mom. 
I will admit, however, that I have found myself frustrated with this model of care on more than one occasion, and navigating the parent-pediatrician relationship has been a huge learning experience. If I were asked to advise new parents as they choose a care provider, I would certainly recommend that they look for one with whom they share some core values. I have only one option here, so I have taken what I can get, and it’s not all bad, but it’s a challenge at times!
I went to Annabelle’s four month visit happy as a lark, and about as confident as a new parent can be. I left fuming mad. I was nursing when the doctor came in to the room, and he was very good about it, gauging the situation to make sure I was comfortable with his being there, and continuing with business as usual when he realized that I was. A good sign, I thought. I got too comfortable, however, and made the mistake of indicating the fact that we coslept. He jumped in with, “Well, you do know that cosleeping increases the risk of SIDS!?” I calmly replied, “Yes, but there are those who would argue that it actually decreases the risk.” He looked at me like I had at least half a dozen heads and quickly corrected me. “No, it INcreases it.” I smiled, and waited for him to move on, since he clearly was not interested in the other side of the issue. Later, he went through the list of topics that I suppose are standard practice to cover: “Do you use a car seat in the car?” and the like. The whole thing felt patronizing, yet I know he was following the ‘standard of care.’ In any case, it all rubbed me the wrong way and I was very glad when the visit was over.
Fortunately, we won’t be seeing that particular doctor again, and since that unpleasant visit, I have learned a few things. First and foremost: I’m the mama. While the pediatrician is the expert on norms, I’m the expert on my daughter, and the one who ultimately has to live with any decisions made regarding her care. I appreciate the valuable expertise doctors can provide, but I believe that they should be my collaborators, not directors of my decisions as a parent. 
Additionally, I have learned that pediatricians are medical experts, but not all can be nutrition and parenting experts as well. Annabelle’s pediatrician suggested months ago that I night wean. If you’ve been around this space for awhile, you can probably guess that it took a great deal of restraint on my part to avoid uttering a loud, “Pffft!” at that particular recommendation. This was just one example of a suggestion offered based on norms. In the doctor’s words, “At her age, she shouldn’t need to eat during the night.” Fortunately I know my daughter, and I know that, age aside, she does need to eat during the night, so four months later, we’re still night nursing. Having read plenty on the subject of breastfeeding and infant sleep gave me the confidence necessary to quietly blow off this particular piece of advice. 
Another suggestion that was pushed, this one several times, was the introduction of rice cereal. It was implied that Annabelle would turn out horribly iron deficient without it. I knew that rice cereal is a pretty lousy choice as first foods go, so it was easy for me to disregard this advice, but with my tendency to have low iron levels, I was a bit worried about that particular issue. Not wanting to be irresponsible, I requested that Annabelle’s iron levels be checked at nine months instead of waiting until the twelve month mark, as is the standard here. You see, I was borderline anemic early in my pregnancy, and have had low iron in the past, so as Annabelle’s primary nutrition source, I wanted to ensure that she was getting enough. Her levels were perfectly normal, and at the time she was eating very little in the way of solid foods. My confidence in our feeding decisions was reinstated. 
Overall, I value the resource that we have in Annabelle’s pediatrician and I feel extremely fortunately to have such easy access to medical care. More and more every day, however, I’m finding that there is no substitute for informed parenting. 
What are your thoughts on “well-child” visits? Does your family use an MD, or do you go the alternative medicine route? What factors have you considered in making your decision? How do you navigate the parent-care provider relationship?
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