Download D I F Y

PATIENT EDUCATION
DO IT FOR
YOUR BABY
17-8641-1905
Table of Contents
Welcome Letter
Neonatal Abstinence Scoring (NAS) and Withdrawal
Child Protective Services (CPS)
Drug Specific Information
All about Methadone
Breastfeeding and Your Diet
Effects of Smoking, Alcohol, and Medicines on
Breastfeeding
Stress
Stress Management
Shaken Baby Syndrome
Sudden Infant Death Syndrome (SIDS)
Fetal Alcohol Syndrome (FAS)
CAMC Family Resource Center (FRC)
Community Resource List
2
3-5
6-8
9-21
22
23-25
26-29
30-34
35-37
38-41
42-44
45
46
47
1
Dear Mom and Mother-to-be,
You are receiving this booklet because you have shared some very
important information with us. You are using or have used alcohol or drugs
during your pregnancy.
This is very important information for you and your newborn or unborn
baby. Drugs are very bad for your baby and can cause serious problems during
and after delivery. There are many resources available to help you come clean
and stay clean. Do it for your baby. Participating in a rehabilitation program
can decrease the possibility of CPS placing your baby in foster care.
Drugs during pregnancy can cause the following problems with your
baby:
Parts of your baby may be abnormal or malformed.
Problems with the central nervous system
Your baby’s brain may be small.
They may not eat well.
They may be small at birth.
They may have seizures.
They may have drug withdrawal.
They may have a stroke before birth.
They may have learning and behavioral problems later in life.
Your baby may come before your due date and need to spend time in the
intensive care unit. He or she may have to be put on a ventilator. You may have
a miscarriage and lose your baby.
If you are using drugs while pregnant please tell your doctor or nurse.
Your baby will thank you. We are committed to helping you and your baby.
Let’s work together to care for you, so you can care for your baby.
2
17-8641-1905 12/09
NAS
Neonatal Abstinence Syndrome (NAS) - A group of problems that babies may
have because of a mothers drug use during pregnancy.
Possible problems before delivery Possible problems after delivery
Low Birth Weight
Decreased Sleep
Premature Birth
Crying/Agitated
Mental Retardation
Scares Easily
Learning Problems
Shaking of Arms and Legs
Behavioral Problems
Stiff Movements
Birth Defects
High Temperature/Sweating
Breathing Problems
Nasal Stuffiness, Sneezing,
Vomiting
Loose Watery Stools
Treatment:
The baby may be on medication in the hospital. The dose may be
increased or decreased based on the baby’s drug withdrawal (NAS) score.
Mom can give the baby its pacifier, swaddle the baby, touch gently, talk
softly, keep in a comfortable position, and snuggle. Decreasing the baby’s
stimulation and activity is VERY important.
Babies’ urine, stool, or cord tissue may be tested for drugs.
3
Front Page of the NAS CAMC Form this is the link…
http://camnet/departmentprintingservices/forms/17-8837.pdf
4
17-8641-1905 12/09
Page for back of NAS score sheet…here is the link
http://camnet/departmentprintingservices/forms/17-8837.pdf
5
Everyone Can Use Help at Sometime
CPS also known as Child Protective Services is a state program. They see
to it that our children are safe.
Does a CPS visit mean I am a bad parent?
No not at all. Being a parent is very hard. Part of being a good parent is
knowing when you need help. A visit from a CPS worker is the chance for
you to get help.
What do they mean by safe?
This means your child is safe from:
Abuse (Being Hurt)
Neglect (Not being taken care of)
Not at risk of being neglected or abused in the future
What signs do they look for when it comes to abuse and neglect?
Abuse
Bruises, burns, cuts, broken bones
Biting, punching, or kicking
Torture or cruel punishment
Verbally putting down the child or making them feel unloved or
scared
Not stopping others from hurting the child
Sexual Abuse
Pictures (sexual)
Sexual contact with the child’s body
Using the child for prostitution
6
17-8641-1905 12/09
Neglect
Going to school
Child care
Healthcare
Food, shelter, and being clean
Being a Parent is hard work
There are services to help you. You don’t have to do it alone. CPS can
help you with:
Housing, clothing, food, or money
Counseling to help manage stress
Drug or alcohol problems
Family violence
Job training
Legal help
Classes for parenting skills
Childcare
Alcohol and Drugs can make you lose control, but there is help. Just
ask your CPS worker.
CPS is notified anytime your infant has a positive drug screen.
You may have to go to court, but CPS does NOT take parents to court
most of the time.
You have Rights Too:
Have a lawyer. If you cannot afford an attorney the courts will
provide you with one.
Tell your side of the story.
7
If my child goes to a new home, where will they go?
It is likely your child will stay with relatives or foster parents. You can visit
unless the courts tell you that you cannot.
Can I find out who reported me?
No, it is against the law for CPS to tell you who made the report. You can
see the records CPS has on you.
These are just a few groups that can provide help. CPS can provide
you with other resources.
Client Service Hotline
1-800-642-8589
Right From The Start Program
1-800-642-8522
WIC
1-800-445-5818
WV CHIP (Insurance)
1-877-WVA-CHIP
Domestic Violence Hotline
1-800-681-8663
Alcoholic’s Anonymous
1-800-333-5051
HUD (Housing)
1-304-347-7000
Early and Periodic Screening, Diagnosis, and Treatment
1-800-642-7904
8
17-8641-1905 12/09
List of Drugs and Effects on Mom
and Baby
Never Take Any Drug Not Prescribed for You When Pregnant
or Breastfeeding!!
9
Tobacco
Other names:
Snuff
Chew Tobacco
Cigarettes
Length of Action:
Nicotine reaches the brain 7 seconds after inhaling cigarette smoke and it lasts 15
minutes to 2 hours.
Effects on the Mom:
Decreases anxiety and stress, relaxes and enhances mood.
Increases heart rate.
Decreases appetite.
Effects on the Baby:
Tobacco use and exposure to cigarette smoke during pregnancy introduces harmful
toxins and chemicals to you and your baby. Your baby is at greater risk of:
Decreased oxygen to the baby.
Growth restriction (low birth weight).
Premature birth.
Stillbirth.
Sudden Infant Death Syndrome (SIDS).
Heart problems.
Asthma and other lung problems.
Ear infections.
Behavior and learning problems.
Treatment Options:
Talk to your doctor or nurse if you want to quit. Various nicotine replacement therapies
and treatment programs are available.
It is recommended if using replacement therapies to chew nicotine gum after breastfeeding and if using a patch, to remove it at bedtime to lower the nicotine in nighttime
feedings.
Effects on Breastfeeding:
Breastfeeding IS recommended. Mothers who smoke should do so AFTER
each infant feeding.
Nicotine passes into breastmilk in the amount equal to passive (secondhand) smoking.
High levels of nicotine in your baby can cause vomiting, diarrhea, irritability (colic) and
increased heart rate. Can decrease breastmilk production.
10
17-8641-1905 12/09
Caffeine
Other names:
No-Doz
Coffee
Tea
Midol
Excedrin
Pop/Soda drinks including colas and Mountain Dew
Chocolate
Length of Action:
Each dose lasts 2-12 hours for an adult, but up to 96 hours in a newborn!
Effects on the Mom:
Restlessness
Stomach upset
Alertness
Decreased fatigue
Increases physical endurance
Increases urine output
Effects on the Baby:
Doses higher than 300mg per day (3 cups of coffee) may cause a miscarriage.
No significant effects documented unless taken regularly.
Some babies may be jittery or irritable after birth, have nausea or urinate often.
Treatment Options:
Drink caffeine free beverages.
Do not use over-the-counter drugs with caffeine in them.
Drink plenty of water, juice and milk to remain well hydrated.
Effects on Breastfeeding:
Breastfeeding IS recommended.
Minimal amounts of caffeine found in breastmilk.
May decrease infant iron levels.
Can cause increased stimulation and sleeplessness (colic).
11
Marijuana
Other names:
Cannabis
Grass
Dope
Weed
Pot
Hemp
THC
*Marijuana is usually laced with other drugs. (Rarely Pure)
—It may contain up to 400 other chemicals including other drugs and pesticides.
Length of Action:
 Complete elimination requires 3 weeks or more after a single dose!
Effects on the Mom:
Relaxation
Increased heart rate and blood pressure
Loss of concentration
Hallucinations
Blood shot eyes
Food cravings
Impairs thinking, causing confusion
Distorts perceptions and impairs coordination
Effects on the Baby:
Increased risk of infant death!
Problems with nervous system development including: Tremors, high-pitched
cry, changes in ability to respond to visual stimulation.
Growth restriction (low birth weight) and premature birth.
Increased behavioral problems—Problems with impulsive behavior and attention,
academic performance.
Decreased motor development
Effects on Breastfeeding:
IT IS NOT SAFE TO BREASTFEED!
Marijuana accumulates in the fatty tissues of the baby increasing the risk of SIDS and
impairs the baby’s ability to control its’ muscles.
Poor feeding and weight gain.
12
17-8641-1905 12/09
Alcohol
Other Names:
Ethanol
Wine
Beer
Liquor
Length of Action:
Depends on dose.
Effects on the Mom:
Slurred speech
Loss of inhibition
Relaxation
May feel good or depressed
Effects on Pregnancy:
Causes Fetal Alcohol Syndrome— which includes mental retardation, growth
restriction, central nervous system dysfunction, defects of the face, heart and other
organs and learning, behavioral and emotional problems. (See attached section on
Fetal Alcohol Syndrome)
Sleep disturbances
Miscarriage, premature birth, stillbirth and low birth weight
Small brain growth and small eyes.
Decreased motor development and poor coordination
 ―All drinks containing alcohol can hurt an unborn baby. A standard drink is
defined as .60 ounces of pure alcohol. This is equivalent to one 12-ounce beer
or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80 proof distilled
spirits (hard liquor).‖ (CDC 2006)
Effects on Breastfeeding:
Breastfeeding IS recommended. Women who drink should wait until 2
hours after each standard drink before breastfeeding.
Alcohol is freely excreted into breastmilk and changes the taste of the milk.
Baby may eat less and have poor weight gain.
Also may decrease overall milk supply.
13
Heroin (type of Opiate)
Length of Action:
Can be smoked, snorted or injected effects usually last 4-6 hours, longer if smoked.
Major withdrawal symptoms peak between 48 and 72 hours after the last dose and stop
after about a week.
Heroin rapidly crosses the placenta.
Street heroin can be mixed with toxic additives that can clog the blood vessels in the
lungs, liver, kidneys, or brain, causing permanent damage to your organs.
 If you are using Heroin you MUST contact a doctor as soon as you know you are
pregnant it is extremely important for the safety and health of you and your baby!
 ―A pregnant women who uses Heroin should not attempt to suddenly stop taking
the drug. This can put her baby at an increased risk of death.‖
(March of Dimes 2008).
Effects on the Mom:
Very Addictive!
Risk of HIV, Hepatitis B and C if injecting Heroin—You can pass this on to your baby!
At risk for fatal overdose and spontaneous abortion
Poor nutrition and inadequate prenatal care
 You should discuss treatment options with your doctor immediately!
 The March of Dimes recommends that you ―should consult a health care provider
or drug treatment center about treatment with a drug called Methadone. Although
infants born to mothers taking methadone also have withdrawal symptoms, they
can be safely treated in the nursery and generally do better than babies born to
women who continue to use heroin.‖ (March of Dimes 2008) and DHHS/NIDA
2008.
Effects on the Baby:
Increased risk of infant death!
Drug withdrawal (NAS) symptoms including: fever, jitteriness, irritability, problems
sleeping, vomiting, diarrhea, sneezing and possibly seizures.
Growth restriction (low birth weight)
Preterm birth and Stillbirth
Premature rupture of membranes (PROM)--the fluid around the baby leaks out
early which can lead to infection and poor lung development.
Increased risk of SIDS
Breathing problems
Risk of lifelong disabilities, learning and behavioral problems
Effects on Breastfeeding:
It is NOT safe to breastfeed when using Heroin in any form!
May cause tremors, vomiting, restlessness, poor feeding and infant death.
14
17-8641-1905 12/09
Other Types of Opiates
Names:
Hydrocodone including Lortab and Vicodin
Oxycodone including Percocet, Oxycontin, and Tylox
Morphine
Codeine (found in many prescription cough syrups)
Length of Action:
Depends on which drug is used and some are slow-release over 12-24 hours.
Effects on the Mom:
Relieves pain and anxiety
Drowsiness, dizziness
Mental cloudiness
Decreased or irregular breathing
Pinpoint pupils
Nausea and vomiting
Effects on the Baby:
Increased risk of infant death!
NAS symptoms including: fever, jitteriness, irritability, problems sleeping,
vomiting, diarrhea, sneezing and possibly seizures.
The baby will have decreased movement, and may have difficulty breathing after
delivery.
Increased risk of swallowing meconium (infant stool) into the baby’s lungs during
pregnancy or delivery, which leads to trouble breathing.
Trouble eating and gaining weight
Effects on Breastfeeding:
It is NOT recommended to breastfeed when using opiates! If you have
been prescribed Tylox, Lortab, etc. after delivery check with your
physician or lactation consultant first.
Small amounts present in breastmilk.
May cause tremors, vomiting, restlessness, poor feeding and infant death.
Watch for low energy, sleepiness and poor suckling which may be a sign your baby is
getting too much of the drug.
15
Benzodiazepines
Prescription names:
Diazepam (Valium)
Midazolam (Versed)
Alprazolam (Xanax)
Lorazepam (Ativan)
Tamazepam (Restoril)
Clonazepam (Klonopin)
Street names:
Roofies, Downers, Tranks
Length of Action:
Depends on which drug is used.
 You should discuss your medications with your physician before making any
changes, if you suddenly stop taking them you may have withdrawal, which may
hurt your baby.
Effects on the Mom:
Headache, impairs memory and concentration
Relieves anxiety and tension
Relaxes muscles causing poor coordination
Induces sleep
Weight loss
Weakness
Effects on the Baby:
NAS symptoms including: fever, jitteriness, irritability, problems sleeping,
vomiting, diarrhea, sneezing and possibly seizures.
Decreased muscle tone and breathing.
Trouble eating and gaining weight after birth.
Smaller head size and facial deformities such as cleft palate and cleft lip
Mental retardation
Delayed motor skills.
Effects on Breastfeeding:
May be safe to breastfeed depending on which drug is used. Check
with your physician or lactation consultant first!
Present in breastmilk, and may accumulate in the baby.
Watch for low energy, sleepiness and poor suckling which may be a sign your baby is
getting too much of the drug.
16
17-8641-1905 12/09
Amphetamines
Other names:
Methamphetamines
Ice
Crystal Meth
Speed
Crank
Whiz
Uppers
Prescription forms: Adderall, Vyvanse, Dexedrine, Dextroamphetamine
Duration of action:
Very Addictive!
Can be smoked, snorted, swallowed, injected or inhaled.
Long lasting at least 10-12 hours
Effects on the Mom:
Impairs judgment and can cause seizures
Can cause excessive bleeding at delivery
Dental problems
Decreased appetite and weight loss
Sweating, flushing, dilated pupils, blurred vision
Encourages violence
Mania, hallucinations, paranoia, and increased anxiety
Increased heart rate and blood pressure
Dizziness and decreased sleep
Effects on the Baby:
NAS symptoms including: fever, jitteriness, irritability, problems sleeping,
vomiting, diarrhea, sneezing and possibly seizures.
Decreased blood flow and oxygen supply to the baby during pregnancy.
Miscarriage, premature birth and low birth weight
Birth defects such as small heads, cleft lip/palate, and limb malformations
Risk of brain injury such as stroke
Trouble sleeping and eating
Increased risk of SIDS
Long term behavioral and learning problems
Effects on Breastfeeding:
It is NOT safe to breastfeed!!
Will pass into breastmilk.
Causes irritability in the baby.
Long-term effects are unknown.
17
Ecstasy
Name:
Methylenedioxymethamphetamine (MDMA)
 Ecstasy is a type of amphetamine and effects on mom and baby are similar to
other amphetamine use.
Length of Action:
Lasts 7-8 hours.
Effects on the Mom:
Euphoria and changes in perception
Enhances feelings of well-being (happiness, love)
Can cause confusion, depression, sleep problems, intense fear, and anxiety
May be toxic to the central nervous system and cause short-term memory loss
Increases heart rate, blood pressure and body temperature (to dangerous levels—
called hyperthermia).
Decreased appetite.
Effects on the Baby:
NAS symptoms including: fever, jitteriness, irritability, problems sleeping,
vomiting, diarrhea, sneezing and possibly seizures.
Decreases blood flow and oxygen supply to the baby during pregnancy.
Breathing problems after delivery.
Birth defects of the heart.
Increased risk of a skeleton defect called clubfoot.
Long-term memory and learning problems
Effects on Breastfeeding:
It is NOT safe to breastfeed!
Large amounts present in breastmilk.
Causes irritability in the baby.
Long-term effects are unknown.
18
17-8641-1905 12/09
Pseudoephedrine
Other names:
Sudafed
Can also be found in combination products for the treatment of colds and allergies!
Is used in the production of Methamphetamines.
Length of action:
60 mg: Lasts 4-6 hours
120mg: Lasts 10-12 hours.
Effects on the Mom:
Increases blood pressure
Decreases sleep.
Effects on the Baby:
Decreased blood flow and oxygen supply to the baby during pregnancy.
Increased risk of birth defects including gastroschisis, which is when the
intestines or other organs develop outside the abdomen.
Treatment Options:
Consult your physician.
Avoid Sudafed, especially in the first trimester.
Use nasal sprays, and drink lots of water and juice.
Effects on Breastfeeding:
Breastfeeding IS recommended.
Small amounts present in breastmilk.
Can cause irritability and sleep problems.
19
Cocaine
Other names:
Pure form of Crack
Length of action:
Snorting Cocaine: Lasts 15-30 minutes.
Injecting Cocaine: Immediate onset and action peaks in a few minutes.
Smoking Crack: Lasts 30 minutes to 2 hours.
 Infants can test positive up to 2-4 days after exposure!
 Cocaine in any amount or form should be avoided during pregnancy!
Effects on the Mom:
Increased risk of mom dying from excessive bleeding if placenta detaches before
delivery of baby, called placental abruption!
Very Addictive!
Increased mental alertness and energy
Increased heart rate temperature, and blood pressure
Decreased appetite and need for sleep
Dilated pupils
Excited and talkative
Euphoria
Runny nose and a hole developing between the nares is common with snorting.
Can be toxic to the heart
Effects on the Baby:
Increased risk of infant death!
NAS symptoms including: fever, jitteriness, irritability, problems sleeping,
vomiting, diarrhea, sneezing and possibly seizures.
Increased risk of preterm birth, low birth weight and placental abruption.
Decreased blood flow and oxygen supply to the baby during pregnancy.
Birth defects of the brain, head (small), face, eyes, heart, intestines, genitals,
urinary tract and arms and legs can be seen.
Increased risk of SIDS.
Central nervous system problems including trouble responding to sensory
stimulation, decreased ability to learn and behavioral changes.
Lifelong disabilities including visual and hearing problems.
Increased risk of bleeding in the brain before or soon after birth.
Effects on Breastfeeding:
It is NOT safe to breastfeed!!
Cocaine IS present in breastmilk and absorbed orally by the baby.
Can cause vomiting, diarrhea, irritability, seizures, increased respiratory and heart rate,
and infant death. Long-term effects are unknown.
20
17-8641-1905 12/09
Bibliography
Dr. Huon O’Sullivan & Dr. Sam Hargreaves. Drug Misuse in Pregnancy and
Lactation. (2005) The Royal Women’s Hospital: Pharmacy Department (Australia)
see website info below.
www.wch.org.au/emplibrary/wads/drugs_in_pregnancy_and_lactation.pdf
(Document) http://www.thewomens.org.au/.
(Hospital Website)
Http://www.nida.nih.gov/MarijBroch/parentpg13-14N.html. , Marijuana: Facts
parents need to know. The National Institute on Drug Abuse (NIDA) is part of the
National Institute of Health (NIH), a component of the U.S. Department of Health
and Human Services. Last updated on April 25, 2005.
Http://www.lalecheleague.org/ba/Aug01.html. , Update: Transfer of Drugs and
Chemicals into Human Milk. La Leche League International. Last edited August 31,
2006.
Jansson, Lauren M., MD, Velez, Martha, MD, and Harrow, Cheryl, RN-BC, MS,
CRNP-F, IBCLC. (2004). Methadone Maintenance and Lactation: A review of the
Literature and Current Management Guidelines. International Lactation Consultant
Association.
American Academy of Pediatrics: Committee on Drugs. (2001). The Transfer of
Drugs and Other Chemicals Into Human Milk. PEDIATRICS Vol. 108:3, pp.776-789.
Howard, Cynthia R. MD, MPH & Lawrence, Ruth A. MD. (1998). Breast-Feeding
and Drug Exposure. Obstetrics and Gynecology Clinics. Vol. 25:1, pp. 195-217.
American Academy of Pediatrics: Lead Authors: Gartner, Lawrence M. MD &
Eidelman, Arthur I. MD. (2005) Policy Statement: Breastfeeding and the Use of Human
Milk. PEDIATRICS Vol. 115:2, pp. 496-506.
Chapter 22: Drugs, Vitamins, Vaccines and Diagnostic Tests. The
Breastfeeding Answer Book.
www.Wikipedia.com Online Free Encyclopedia–Wikipedia.
21
Methadone
What is Methadone?
 Methadone is an opioid medication that is used for pain relief. Together with
counseling and other services Methadone is used to treat people addicted to heroin
and some prescription drugs. Methadone eliminates the appetite and craving for
Heroin and blocks the euphoric effects of opioid medications, and prevents
withdrawal for 24 hours or more with each dose.
 Opioids are a group of drugs that act on the central nervous system. They include
codeine, morphine, heroin, and other drugs such as oxycodone (aka. Percocet,
Tylox), oxycontin, hydrocodone (aka. Lortab, Vicodin), and methadone.
Confidentiality.
 If you are receiving Methadone through a treatment program during pregnancy you
are protected by special Federal regulations. No one will be told you are in
treatment or what you talk about in treatment without your consent
 You will be asked many questions. It is very important that you are honest with the
counselor or caregiver about the type and amount of drugs you are using. This is
important information to provide the best care for you and your baby. The earlier
in your pregnancy you come for treatment the better.
Remember, WE ARE HERE TO HELP.
Mixing Methadone with Other Drugs Can Be Dangerous.
 Methadone interacts with many medications, which can affect the safety of you
and your baby. Be sure to discuss ALL other medications you are taking including
prescription, over-the-counter, street drugs or herbal supplements. Taking more
opioid medication than prescribed won’t get you high, but could cause you to
overdose. If you feel like your dose is not adequate you can talk to your caregiver
about adjusting the dose. Sometimes the dose has to be increased throughout the
pregnancy due to increased blood/fluid volume and increased metabolism of the
drug.
How Methadone Affects Your Baby.
 Your baby will probably have NAS withdrawal symptoms, and may require
methadone or morphine medication after delivery, which will be weaned slowly.
Breastfeeding IS recommended!
Only small amounts transfer into breastmilk regardless of the dose you are taking.
Lack of suck and swallow coordination for the baby is usually a problem and we can have
a Lactation Specialists help you.
Important Resources
Substance Abuse and Mental Health Service Administration (SAMHSA):
call the helpline: 1-800-662-HELP (4357) or online at www.samhsa.gov.
Family Resource Center at Charleston Area Medical Center, Women & Children’s
Hospital on Pennsylvania Ave
Charleston Treatment Center at 2157 Greenbrier Street, call: 1-866-575-8186 or
online at www.methadonetreatment.net.
22
17-8641-1905 12/09
Breastfeeding and Your Diet
GENERAL INFORMATION:
What is a healthy diet during breast feeding? A healthy diet during breast feeding is
one that contains a variety of foods from all the different food groups. During breast
feeding, your body needs extra calories, protein and certain vitamins and minerals. You
need extra calories because your body uses more calories (energy) during breast
feeding. Most breast feeding women need about 200-500 calories more than they
needed before being pregnant. Your dietitian or caregiver will tell you how many
calories you need. If you eat a healthy diet with the right amount of calories, you can get
the extra nutrients you need through food. Women who do not eat certain foods, or do
not eat enough calories may need a supplement (vitamin or mineral pill).
Should I limit certain foods in my diet while I am breast feeding?
Usually, you do not need to limit certain foods while you are breast feeding. Most
women find they can eat any type of food without it causing a problem for their
baby. Certain babies may be affected by foods their mother has eaten. This
usually occurs in families with a history of food allergies or sensitivities. Foods
that commonly cause problems are cow's milk, cow's milk products, fish, eggs,
peanuts, and wheat.
If your baby is sensitive, he/she may be fussy, have a skin rash, diarrhea, or
have green stools with mucus. These signs and symptoms usually appear four
hours or more after you have eaten a certain food. If you think a food is affecting
your baby, avoid eating the food. With time, your baby's signs and symptoms
should improve. You may also try eating the food again in small amounts about
two to three weeks later to see if the sensitivity has improved. Babies often
outgrow food sensitivities as they get older.
Should I take vitamins while I breast feed? You should be able to get all the nutrients
you need if you eat a variety of foods in the right amounts. Caregivers may suggest that
you take a multivitamin over the period of time that you breast feed. Ask your caregiver
if you should take a vitamin or mineral supplement. Mothers who avoid or limit certain
food groups may not be getting enough of certain vitamins or minerals. The following
are common foods that people do not eat, and ways to replace the missing vitamins or
minerals:
Dairy: Some women are lactose intolerant (cannot digest milk products) or
choose not to eat dairy (milk, cheese, yogurt, and ice cream). Because dairy
foods are rich in calcium and vitamin D, these women may not be getting enough
of these nutrients in their diet. Your body can make vitamin D after being in the
sun. However, you may need a supplement if you get very little sunlight and do
not eat dairy foods. You can get calcium from foods other than dairy. These
foods include soy beverages, tofu, orange juice, and breakfast cereals that are
fortified with calcium (have added calcium). Other foods that contain calcium are
turnip greens, mustard greens, kale, and broccoli.
Meat products and dairy: Some women choose not to eat meat products and
dairy. Meat products and dairy are rich sources of certain vitamins and minerals,
23
such as vitamin B12. Some nonmeat foods such as breakfast cereals, soymilk or
rice milk, or vegetarian burger patties are fortified with vitamin B12. However, it
may be difficult to get enough vitamin B12 in your diet. Ask your caregiver if you
need to take a vitamin or mineral supplement.
How much liquid should I drink while I am breast feeding? Women 19 years old
and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups).
Ask your caregiver how much liquid you should have each day. A good way to
remember to drink enough liquids is by drinking a glass of water, juice, or milk when you
breast feed. Some food items such as soup and fruit also add liquid to your diet. Always
drink when you are thirsty. A good way to tell if you are getting enough liquids is if your
urine is clear or light yellow. If your urine is a dark color or you are constipated you may
not be drinking enough liquids. When you have hard, dry stools that are difficult to pass,
less often than usual it is called constipation. Drink extra liquids when you exercise.
What should I avoid or limit in my diet while breast feeding?
Alcohol: Avoid drinking any drinks that contain alcohol while you breast feed.
This includes beer, "light" beer, wine, mixed drinks, and all liquids that contain
alcohol. Your milk "let-down" and milk supply may be decreased if you drink
alcohol. Alcohol can pass to your baby through your breast milk. Regular or
heavy drinking may decrease your baby's development and weight gain. Talk to
your caregiver about drinking alcohol while breast feeding.
Caffeine: Limit caffeine in your diet while breast feeding. Drinking large amounts
of caffeine may cause your baby to be fussy or have trouble sleeping. Try to limit
your intake of caffeine to 2--8 oz cups of coffee or tea daily or 3-4--12 oz cans of
soda.
Should I try to lose weight while breast feeding?
Extra weight is added during your pregnancy to store energy for making breast
milk. Breast feeding makes it easier to lose these extra pounds. Most breast
feeding mothers lose weight just by following a normal diet. Crash diets, fad
diets, and quick weight loss may be harmful to your body and may decrease your
milk supply. A safe weight loss goal is about four pounds per month. To lose
weight slowly and safely, you may try decreasing the amount of calories you eat
by a small amount. You dietitian or caregiver will tell you how many calories you
need.
Another healthy way to lose weight is to exercise. Talk to your caregiver before
starting an exercise program. Exercise at least three times a week. Do warm-up
activities before starting exercise and drink extra liquids during exercise. You
need extra liquids during exercise because your body loses water through sweat.
Where can I get more information about breast feeding? Make sure caregivers
know that breast feeding is important to you. Ask your caregiver for information about
breast feeding. Your caregiver can answer your questions about breast feeding and
give you the name of a Lactation Consultant. This person is a specially trained
caregiver who helps mothers breast feed their babies. Going to a breast feeding class
before your baby is born can also be helpful. Call your local hospital for more
24
17-8641-1905 12/09
information about breast feeding classes. Breast feeding support groups can also help
you learn about breast feeding your baby. Contact one of the following for more
information:
La Leche League International
1400 N. Meacham Rd
Schaumburg, IL60173-4808
Phone: 1-847-519-7730
Web Address: http://www.lalecheleague.org
Women, Infants and Children Program
Food and Nutrition Services
WIC Program
Supplemental Food Programs Division
Alexandria, VA22302
Phone: 1-703-305-2196
Web Address: http://www.fns.usda.gov/wic
CARE AGREEMENT:
You can talk with your caregiver about the best way for you to feed your baby. You
have the right to help plan how you are going to feed your baby. To help with this plan,
learn as much as you can about breast feeding. Talk to your caregiver if you have
questions about breast feeding.
25
Effects of Smoking, Alcohol, and Medicines on Breastfeeding
GENERAL INFORMATION:
What are the effects of nicotine on my health and the health of my breast fed
baby?
Nicotine is a chemical found in cigarettes, bidis and kreteks (imported
cigarettes), cigars, pipes, "light" cigarettes, and smokeless tobacco
(chewing tobacco and snuff). If you use nicotine, you increase your risk of
getting many types of cancers and heart disease, and many other medical
problems. These medical problems can be very serious, and can kill you.
Scientists have found that nicotine spreads throughout your body when you
smoke, and has also been found in breast milk. This means that you are
feeding your baby this harmful chemical if you use nicotine during the time
that you are breast feeding.
Cigarette smoking may reduce the amount of milk your body makes. The
fat content of your milk may also be reduced. Both of these side effects of
smoking may cause your baby to gain weight too slowly. Smoking may also
cause you to have to stop breast feeding (wean) earlier than you had
planned.
Second-hand smoke has many of the same chemicals found in cigarettes.
Exposure to second-hand smoke happens when breathing the smoke from
someone else's cigarette, or from a person near you who is breathing out
smoking a cigarette. This kind of smoke also causes cancer and places a
person at higher risk of heart disease. In young children, their risk of SIDS
(sudden infant death syndrome), pneumonia, asthma and bronchitis
increases. Their risk is even higher than that of an adult because their
lungs are not yet fully developed. An asthmatic child's condition will get
worse if he is exposed to second-hand smoke. A child may also have more
ear infections.
If I continue to use nicotine and choose to breast feed, what can I do to decrease
the harmful effects of nicotine? Make every attempt to stop using nicotine if you
plan to, or are breast feeding your baby. While working towards quitting, do the
following:
Decrease the number of cigarettes, or amount of nicotine that you use
each day. For example, the fewer cigarettes you smoke each day, the
more you decrease the health risks to you and your baby.
If you need to smoke or use nicotine, wait until after you finish a breast
feeding session. Do not use nicotine before or during a breast feeding
session. The longer you wait to breast feed since you last smoked or used
nicotine, the less nicotine your baby may be exposed to.
26
17-8641-1905 12/09
Never smoke near your baby. If you need to smoke, only smoke outside
your home. Never smoke in the car when your baby is with you. Do not
expose your baby to secondhand smoke.
Talk to your caregiver about how to stop smoking. For more information
call:
o
Smokefree.gov
Phone: 1-800-784-8669
Web Address: www.smokefree.gov
o
American Lung Association
61 Broadway, 6th floor
New York City, NY10006
Phone: 1-800-586-4872
Web Address: http://www.lungusa.org
Can I breast feed my baby and drink alcohol? You should avoid drinking any drinks
that contain alcohol while you breast feed. This includes beer, "light" beer, wine, mixed
drinks, and all liquids that contain alcohol. Alcohol affects the central nervous system of
both you and your baby. Your milk "let-down" and milk supply may be decreased if you
drink alcohol. Drinking alcohol can change the flavor of your milk. Your baby's ability to
suckle may change. He may suck too often, and get less milk. All of these things
together could cause a health risk for your baby if you drink alcohol.
Is it possible to have a drink of alcohol once in a while if I am breast feeding my
baby? Ask your caregiver if you should drink alcohol while breast feeding, and
consider the following:
When you take a drink of alcohol is important. The alcohol in your breast
milk is at its highest within 30 to 60 minutes if you drink with an empty
stomach. The alcohol in your breast milk is at its highest within 60 to 90
minutes if you drink while eating. Wait at least two hours for every drink
consumed before putting your baby to the breast.
Some people think that pumping your breasts and throwing away the milk
makes the alcohol disappear from your breast milk faster. This is not true
and is not necessary. But, you can pump so you are more comfortable or to
keep up your milk supply while your wait for the alcohol to leave your
breast milk.
Try drinking "nonalcoholic" beer instead of regular beer if you drink beer to
help increase your milk supply. Also, try nonalcoholic beer if you are trying
to relax so your milk will let-down.
Other things like how much you weigh and your baby's age are also
important.
27
Can I take medicine while I breast feed?
Some medicines are prescribed (given to you) by a medical caregiver. You
can buy others without a prescription. These are called "over-the-counter"
medicines. Almost all medicines pass through your breast milk. But, only a
small number of medicines have been fully studied in breast feeding
women. This means that caregivers do not know how they will affect your
baby.
Breast milk gives your baby the most effective immunity (protection)
against disease for his first year of life. The benefits of breast feeding are
very great. Most of the time a medicine can be chosen that works well for
you while still being safe for your baby. Talk with your caregiver before you
take any medicine, whether it you get it with a prescription or over-thecounter.
What should I do if I need to use medicine while I am breast feeding? Always talk
to both your caregiver and your baby's caregiver about any type of medicine you need.
Caregivers think about several things before telling you whether it is OK to use the
medicine. They know how long it takes the medicine to reach the highest level in your
bloodstream (the medicine's "peak"). Caregivers also know the half-life of the medicine,
or when half of the medicine is gone from your blood.
Carefully watch your milk supply if you have to take antihistamines. These
are found in allergy, cold, and cough medicines and can cause you to
become dehydrated. Dehydration means not having enough fluid in your
body, which could decrease your milk supply. Watch your milk supply
carefully if you are taking birth control pills that are made with estrogen.
Your caregiver will work with you to choose the best medicine for you and
your baby.
If you have to take medicine, breast feed your baby first, and then
immediately take your medicine. This gives your body time to get rid of as
much medicine as possible before your baby's next feeding.
Street drugs are very harmful to your breast fed baby. Never use street
drugs when you are breast feeding, or if you are pregnant.
Can my baby's caregiver help me if I have breast feeding questions or problems?
Ask for information about breast feeding, and make sure caregivers know that breast
feeding is important to you. Ask your caregiver for the name of a Lactation Consultant.
This person is specially trained to help women breast feed their babies. Ask caregivers
about a breast feeding class before your baby is born, or call your hospital for more
information. Breast feeding support groups can also help you learn about breast
feeding your baby. Call or write one of the following for more information.
28
17-8641-1905 12/09
La Leche League International
1400 N. Meacham Rd
Schaumburg, IL60173-4808
Phone: 1-847-519-7730
Web Address: http://www.lalecheleague.org
Human Milk Banking Association of North America
1500 Sunday Dr., Suite 102
Raleigh, NC27607
Phone: 1-919-861-4530
Web Address: http://www.hmbana.org
Women, Infants and Children Program
Food and Nutrition Services
WIC Program
Supplemental Food Programs Division
Alexandria, VA22302
Phone: 1-703-305-2196
Web Address: http://www.fns.usda.gov/wic
CARE AGREEMENT:
You have the right to help plan your baby's care. To help with this plan, you must learn
about your baby's diet. You can then discuss treatment options with your baby's
caregivers. Work with them to decide what care may be used to treat your baby.
© 1974-2009 Thomson Reuters. All rights reserved.
29
Stress
GENERAL INFORMATION:
What is stress? Stress is a feeling of tension or strain that can be caused by many
different things. Stress is a normal part of life, and sometimes it can be good for you.
For example, the stress of having a deadline at work can encourage you to work hard
and succeed. However, too much stress can make you feel bad and increase your
chance of getting sick. The amount of stress that is "too much" is different for each
person. Learning to control and cope with stress will help you live a happier and
healthier life.
What causes stress? You may feel stress because of changes in your life. The loss of
a loved one or your job can cause you to feel very stressed. You may have stress
because of a happy event, such as having a baby or buying a house. Health problems
or having chronic (long-term) pain can also increase your stress. Becoming overloaded
with things you have to do every day can cause stress. What causes one person to feel
stressed may not cause stress in someone else.
What are some problems caused by having too much stress? Too much stress can
cause many physical (body) or emotional (mood) changes. The problems caused by too
much stress are different from person to person. It is important to tell your caregiver
about any new physical symptoms you have. Your caregiver may need to check you for
other health problems that can be mistaken for stress. Some common effects of stress
include:
Feeling anxious. You may feel "uptight" or tense. You may feel like your mind is
always racing with thoughts. You may become more forgetful or have trouble
concentrating (staying focused on a task).
Mood changes. Your mood may change often and suddenly, for little or no
reason. You may be happy one minute, and mad or sad the next. You may get
frustrated a lot more than usual. You may feel angry or depressed (very sad) and
not know why.
Substance abuse. You may find yourself drinking more alcoholic beverages
(drinks) to try and decrease your stress. You may be smoking more cigarettes or
drugs, or taking other street drugs. You may be taking too many prescription or
over-the-counter drugs, or use them too often. You may be drinking alcohol
when taking other medicines. Substance abuse is dangerous and leads to even
more stress in life. Abusing alcohol or medicines, even over-the-counter
medicines, may cause serious health problems. It may even kill you.
Physical symptoms. Sometimes stress causes symptoms that can look or feel
like a disease or illness. Some physical symptoms of having too much stress
may include:
30
17-8641-1905 12/09
o
Breathing problems. You may breathe too fast, or feel like you are not
getting enough air. You may even feel faint or dizzy.
o
Chest pain or heartburn (a burning sensation in your chest).
o
Changes in your ability or desire to have sexual intercourse (sex).
o
Diarrhea (loose BMs) or constipation (hard, small BMs that are difficult to
pass or that occur less often).
o
Hand tremors (shaking), or hands that are sweaty or cold.
o
Headaches, backaches, or stiffness in your neck, shoulders, or other
muscles.
o
Heart palpitations (feeling like your heart is beating harder or faster than
usual).
o
Monthly period changes in women.
o
Sleeping problems, or feeling tired even after a good night's sleep.
o
Unexplained skin rashes or hives.
o
Upset stomach, abdominal (belly) pain, or increased gas.
o
Weight gain, weight loss, or poor appetite (not feeling like eating).
Worsening of other health problems. Most diseases and health conditions can
become worse if you have too much stress. Stress can cause your blood pressure to
increase, which is a risk to your health. If you are diabetic you may have more
blood sugar problems during times of stress. If you have heart problems, you may
have more chest pain than usual. It is important to call your caregiver if you feel
that stress is affecting your health.
How can I deal with the stress in my life?
The following are some ways for you to decrease your stress.
31
o
Learn what causes you stress. Take a close look at what makes you
feel stressed. Stay away from stressful things whenever possible. Do not
worry about things you cannot control, such as traffic or the weather.
o
Plan quiet time. Take at least 30 minutes a day to be by yourself. Use
this time to do something you enjoy. For example, you can wake up
before other household members and read the paper. In the evening, you
can relax in a warm bath. Even sitting quietly and daydreaming can give
you a much-needed break.
o
Share your workload. Insist that household members help with chores.
Be realistic about how much you can get done by yourself.
o
Learn to put your needs first sometimes. It is OK to say "no" when
people demand your time or attention. Ask yourself, "Do I need to pay
attention to this person right now? Can it wait for a time that is better for
me?"
o
Manage tasks. Set realistic goals for yourself. You may find it helps to
make a list of things you need to get done. Then do the most important
things first. Slow down and focus on one task at a time. Having a clean
home or work area may help you feel less stress as you do your work.
Not all stress can be avoided. The best way to deal with stress that you cannot
avoid is to change how you react to it. The following are some things you can do
to cope with stress.
o
Live a healthy lifestyle.
Change your diet. Eat healthy foods from all of the five food groups:
fruits, vegetables, breads, dairy products, meat and fish. Eating healthy
foods may help you feel better and have more energy. You may feel
better and sleep better if you avoid foods and drinks that have caffeine.
Examples of things that have caffeine include coffee, some teas, colas,
and chocolate. Ask your caregiver for more information about planning a
healthy diet.
Take time to exercise. Begin a regular exercise program to decrease
tension and feelings of stress. Something as simple as walking 20
minutes a day, three to four days a week can help. Exercising also makes
the heart stronger, lowers blood pressure, and keeps you healthy. Talk to
your caregiver before you start exercising. Together you can plan the best
exercise program for you.
32
17-8641-1905 12/09
Do not drink alcohol or overuse over-the-counter or prescription medicines.
Drinking alcohol can cause sleep problems, depressed feelings, and increases
stress. Taking too much medicine, even if it is over-the-counter medicine, can
cause serious health problems.
o
Have a positive attitude. Try to stop yourself when you think negative,
angry, or discouraging thoughts. If you have problems controlling negative
thoughts, tell your caregiver. A counselor can teach you ways to think
more positively.
o
Learn relaxation techniques. Learn new ways to relax, such as
meditation (med-i-TAY-shun), listening to music, or biofeedback. Ask your
caregiver for more information about any of these.
o
Pay attention to your breathing. When you are tense, you may take
shallow breaths or hold your breath without knowing it. It may help to do
deep breathing during times of increased stress. To do this, sit up straight
and take a slow, deep breath in through your nose. Then, breathe out
slowly through your mouth. Take twice as long to breathe out as you do
when you breathe in. Repeat this a few times until you feel calmer or more
focused.
o
Relax your muscles. Stress often causes muscle tightness, especially in
the shoulders and the neck. Simple exercises can help relieve this
tension. Tighten and relax the muscles of one body area at a time. Shrug
your shoulders up to your ears. Try to tighten your muscles as much as
possible while you do this. Then, completely relax your shoulders. Do this
a few times, and then move on to another area of the body. Also, stand up
and stretch at least once an hour as you do your daily work. Ask your
caregiver for more information about muscle relaxation exercises.
o
Talk it out. No one can handle stress by themselves all of the time. Talk
to someone about things that upset you. This person can be a trusted
friend, a family member, or a caregiver. Tell your caregiver if you are
having trouble coping with stress. Join a support group if you have a major
health problem that is causing you stress.
o
Above all, listen to your body. If you are feeling the effects of stress, talk
to your caregiver. This is especially important if you have other health
problems.
33
For more information: For more information about coping with stress, contact the
following organizations:
National Institute of Mental Health (NIMH), Public Information & Communication
Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD20892-9663
Phone: 1-301-443-4513
Phone: 1-866-615-6464
Web Address: http://www.nimh.nih.gov/
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, VA22209
Phone: 1-703-907
Web Address: http://www.psych.org
CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about
your health condition and how it may be treated. You can then discuss treatment
options with your caregivers. Work with them to decide what care may be used to treat
you. You always have the right to refuse treatment.
© 1974-2009 Thomson Reuters. All rights reserved.
34
17-8641-1905 12/09
Stress Management
17-8641-0229 Page 1 of 5 Rev. 8-06
Stress is your body’s response to demanding situations. You experience stress
whenever you are faced with an event or situation that you think is challenging your
ability to cope.
Stress is a natural and normal part of life but when stress is prolonged, it can have a
negative effect on our bodies and our minds.
Signs and symptoms of stress range from mild to extreme- from simply feeling tired at
the end of the day to having a heart attack. You need to be aware of the symptoms of
stress so you can manage stress and bring back balance in your life.
Do you experience any of these symptoms?
__appetite change
__forgetfulness
__headaches
__dull senses
__tension
__poor concentration
__fatigue
__low productivity
__insomnia
__negative attitude
__weight change
__confusion
__muscle aches
__lethargy
__digestive upsets
__whirling mind
__pounding heart
__no new ideas
__rash
__boredom
__restlessness
__spacing out
__finger drumming
__apathy
__increased alcohol, drug, tobacco use
__looking for magic
__decreased concentration
__increased perspiration
__difficulty maintaining weight
__hands/feet usually cool
__anxiety
__isolation
__frustration
__intolerance
__the ―blues‖
__resentment
__mood swings
__loneliness
__bad temper
__hiding
__nightmares
__clamming up
__crying spells
__lowered sex drive
__‖no one cares‖
__nagging
__depression
__distrust
__worrying
__fewer contacts with friends
__easily discouraged
__lack of intimacy
__little joy
__using people
__emptiness
__needing to ―prove‖ self
__loss of meaning
__dizziness when standing up
__abnormal bowel/bladder function
35
Stress Management
17-8641-0229 Page 2 of 5 Rev. 8-06
Choices in dealing with Stress
Remove yourself from the situation.
This choice does not solve the problem but only allows escape or avoidance
which can be a good choice in some but not all situations
Remove stressors
This choice is not helpful in all situations since some people are not ready to get
a divorce, quit job, etc. Learn healthy techniques to deal with the effects of stress
to prevent exhaustion
Increase awareness of negative thinking
been treated unfairly in the past is all the more reason to treat myself fairly in the
present‖.
This choice creates a balance in your life by developing good sleeping habits,
eating properly, exercising regularly, and learning relaxation techniques.
Stress Management
There are healthy approaches for managing too much stress. These include problem
solving, assertiveness, and time management.
Problem solving
blem issue
Think about each solution, considering the needs of those affected
Select the best option and begin to make changes
Assertiveness
Act in your own best interest
Stand up for yourself, expressing yourself honestly and appropriately
Exercise your own rights while respecting the ideas of the other person until
different viewpoints are understood
Time Management
Decide which tasks are most important
Allow a reasonable amount of time to complete all tasks
Ask people for help when possible.
Proven Stress Reducers
Get up fifteen minutes earlier in the morning. This will help prevent stress from
morning mishaps that are sure to happen.
Prepare for the morning the evening before. Set the breakfast table. Make
lunches. Put out the clothes you plan to wear.
Don’t rely on your memory. Write down appointment times, when to pick up the
laundry, when library books are due, etc.
Do nothing you have to lie about later.
Make copies of all keys. Bury a house key in secret spot in the garden. Carry a
duplicate car key in your wallet, apart from your key ring.
36
17-8641-1905 12/09
Don’t put things off. Whatever you want to do tomorrow, do today; whatever you
want to do today, do it now.
Don’t put up with something that doesn’t work right. If your alarm clock, wallet,
shoelaces, windshield wipers-whatever-are a constant aggravation, get them
fixed or get new ones.
Allow 15 minutes of extra time to get to appointments.
Eliminate or restrict the amount of caffeine in your diet.
Relax your standards. The world will not end if the grass doesn’t get mowed this
weekend.
Taking a few moments to repeat back directions/instructions can save your
hours.
Say ―NO‖ Saying no to extra projects or invitations takes practice.
Simplify, simplify, simplify.
Make friends with non-worriers. Chronic worrywarts are contagious.
Take many stretch breaks when you sit a lot.
Get enough sleep. Set your alarm for bedtime.
Check your body for stress signs. If your stomach muscles are knotted and your
breathing is shallow, relax your muscles and take some deep, slow breaths.
Write your thoughts and feelings down on paper. It can help you clarify your
thoughts.
Visualize success before any experience you fear. Take time to go over every
part of the event in your mind. Imagine how great you will look, and how well you
will present yourself.
Talk about your problems with a friend. It helps to relieve confusion.
Everyday, do something your really enjoy.
Take a bath or shower to relieve tension.
Do a favor for someone every day. Doing things for others can make you feel
good about yourself.
Focus on understanding, rather than being understood, on loving rather than
being loved.
Take more time between tasks to relax. Schedule your day so you don’t get
overwhelmed with trying, to do too much.
Be flexible. Some things are not worth perfection.
Change pace on weekends. If your week was slow, be active. If you felt nothing
was accomplished during the week, do a weekend project.
Do one thing at a time. When you are working on one thing, don’t think about
everything else you have to do.
Allow time every day for privacy, quiet and thinking.
Do unpleasant tasks early and enjoy the rest of the day.
Delegate responsibility to capable people.
Count to 1,000 instead of 10, before you say something that could make matters
worse.
Forgive people and events. Accept that we live in an imperfect world.
Find the positive in people and situations. For every one thing that goes wrong,
there are probably 10 or 50 blessings.
Always have a back up plan and accept things you cannot change.
Organize. A place for everything and everything in its place. Losing things is
stressful.
37
Shaken Baby Syndrome
GENERAL INFORMATION:
What is shaken baby syndrome? Shaken baby syndrome (SIN-drohm), or SBS,
occurs when a baby develops brain injury as a result of physical abuse. This happens
when a baby is grasped and shaken violently. A baby still has weak neck muscles and
a large, heavy head. This makes it hard for him to control his head when he is shaken
forcefully. Babies also have more fluid surrounding their brain. Intense shaking throws
their brain back and forth inside the skull, and may cause it to bruise, swell, and bleed.
This may lead to permanent, severe brain damage and even death.
Shaken baby injuries usually occur in children younger than two years of age.
Sometimes, although rarely, it also happens to children up to five years of age.
Men more than women are likely to shake a baby. The men are usually the
baby's father or the mother's boyfriend. The women are mostly baby-sitters or
child care providers. Shaking a child is a serious type of physical child
abuse. Shaken baby syndrome may be a serious condition needing life-long
medical treatments.
What causes shaken baby syndrome? The sudden forward and backward
movements of a baby's head cause shaken baby syndrome. This occurs when a baby
is forcefully and repeatedly shaken, or thrown down. Intense shaking throws the brain
into different places inside the skull, tearing brain tissues and blood vessels. Injury to
the brain then causes it to swell. Bleeding in the back of the eyes due to brain swelling
is common. Many things may increase the chances of shaking a baby. Persons caring
for a baby may get frustrated, frightened, or angry due to the baby's uncontrolled crying.
They may shake the baby out of frustration, in a desire to stop the baby from crying.
What are the signs and symptoms of shaken baby syndrome? There may be few or
no signs of injury in shaken baby syndrome. Symptoms may vary from mild to severe.
These depend on how strong and how often the baby was shaken. Your baby may
have any of the following symptoms:
Mild to moderate:
38
o
Fussiness or uncontrolled crying.
o
Low body temperature.
o
Poor feeding or vomiting (throwing up).
o
Sleepiness or difficulty in waking your baby up.
o
Weakness or limp arms and legs.
17-8641-1905 12/09
Severe:
o
Blood or blood spots in the eyes.
o
Bulging or full fontanels (soft spot on the head).
o
Coma (loss of consciousness).
o
Fractures (break in the bones).
o
Pale or bluish skin.
o
Seizures (convulsions).
o
Trouble or decreased breathing.
How is shaken baby syndrome diagnosed? Caregivers often look for particular
injuries to diagnose SBS. These may include bleeding in the brain and eyes, and
fractures of the ribs and bones. Your baby may have any of the following tests to look
for these injuries:
CT scan: This is also called a CAT scan. A special x-ray machine uses a
computer to take pictures of your child's body. It may be used to look at
your child's bones, muscles, brain, body organs, and blood vessels. Your
child may be given dye by mouth or in an IV before the pictures are taken.
The dye may help your child's caregiver see the pictures better. People
who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be
allergic to some dyes. Tell the caregiver if your child is allergic to shellfish,
or has other allergies or medical conditions.
Lumbar puncture: This procedure may also be called a spinal tap. A small
needle is placed into your child's lower back. Fluid will be removed from
around your child's spinal cord and sent to the lab for tests. The test is
done to check for bleeding around your child's brain and spinal cord, and
for infection. This procedure may also be done to take pressure off your
child's brain and spinal cord, or to give medicine. Your child may need to
be held in place so that he does not move during the procedure.
MRI: This test is called magnetic resonance imaging. During the MRI, 3-D
(three-dimensional) pictures are taken of your child's body. An MRI may be
used to look at your child's brain, muscles, joints, bones, or blood vessels.
Your child will need to lie still during his MRI. Never enter the MRI room
with an oxygen tank, wrist watch, or any other metal objects. This can
cause serious injury.
39
Ophthalmoscopy: This is also called fundoscopy. This test allows
caregivers to see the back of the eye using an ophthalmoscope. An
ophthalmoscope is a magnifying instrument with a light. Caregivers may
use eye drops to dilate (open) the pupil (the dark center part of the eye).
This helps caregivers see the back of your baby's eyes clearly.
How is shaken baby syndrome treated? Your baby's brain injuries may be lifethreatening. He may need to stay in the hospital for treatments. Intravenous (IV) fluids
may be given to control his body fluids and salts. A tube may be inserted into his
stomach to empty the stomach or to get food into your baby's stomach.
A tube attached to a ventilator (breathing machine) may be used if your baby has
trouble breathing. Medicines to decrease brain swelling and prevent seizures may
be given. Shunt placements and surgery may be done in severe cases of brain
injury. Ask your caregivers for more information about the different treatments
that may be done to your baby.
What can I do to prevent shaken baby syndrome? Ask your baby's caregiver for
more information on the normal growth and development of babies. This will help you
better understand what your baby or child is trying to tell you.
Crying is normal for a child. Babies do not cry to bother or get their parents
or childcare provider mad. A baby cries for many reasons. He may be
hungry, needs to have a diaper changed, or may be too cold or hot.
Sometimes he cries just because he wants to be held. Crying may also be
a way for your baby to release stress or tension. Crying may also tell you
that your baby is hurt or sick.
Decide carefully who can care for your child. Teach everyone who cares for
your baby, including baby-sitters, about the dangers of shaking a child.
Make sure they understand how babies normally act, and how they grow
both mentally and physically.
It is normal to feel upset and angry when your baby cries and cannot be
consoled. Learning how to handle these feelings is important. Planning
ahead may help you avoid hurting your baby. Call a friend or family
member when you feel you are upset with your child. Post hotline numbers
where you can see them and use them. Do the following if your baby is
crying hard and cannot be consoled:
o
40
Stop: Put the baby in a safe place and leave the room. Do not touch
the baby if you are very upset or angry.
17-8641-1905 12/09
o
Calm down: Play some soft music. When you get upset, call hotline
numbers, a friend or another family member for advice and support.
Take a shower, read a book, or think about something nice that
happened in the past. Try counting to 10 and take a deep breath.
o
Try again: When you have calmed down, go back to your baby and
try again to help him stop crying. Try putting the baby in a carrier, or
take the baby for a walk in a stroller. You may also try and comfort
him with his blanket.
Where can I get support and more information? You may feel scared, confused,
guilty, and anxious because your baby has SBS. You may blame yourself and think you
have done something wrong. These feelings are common. Talk to your caregivers,
family, or friends about your feelings. You may also want to join a support group for
shaken baby syndrome. Such a group can help you find community education and
resources.
Put together a list of agencies, clinics, and caregiver names, addresses, and
phone numbers. List all the people who will be involved with your child's longterm care and therapy. There are also federal, state, and local support services to
help people with disabled children. Contact the following for support and more
information:
National Center on Shaken Baby Syndrome
2955 Harrison Boulevard, Suite 102
Ogden, UT84403
Phone: 1-801-627-3399
Phone: 1-888-273-0071
Web Address: http://www.dontshake.com
The Shaken Baby Alliance
4516 Boat Club Rd, Ste 114
Ft. Worth, TX76108
Phone: 1-877-636-3727
Web Address: http://www.shakenbaby.com
CARE AGREEMENT:
You have the right to help plan your baby's care. To help with this plan, you must learn
about your baby's health condition and how it may be treated. You can then discuss
treatment options with your baby's caregivers. Work with them to decide what care may
be used to treat your baby.
© 1974-2009 Thomson Reuters. All rights reserved.
41
Sudden Infant Death Syndrome
GENERAL INFORMATION:
What is sudden infant death syndrome? Sudden infant death syndrome is also
called SIDS. It is the sudden death of a baby under one year of age. The cause of
death in SIDS is unknown. The death cannot be explained even after a review of the
baby's health history, environment, and autopsy results.
What puts my baby at risk of sudden infant death syndrome? Although the cause
of SIDS is not yet clearly known, certain factors are believed to increase its risk. It
happens mostly to baby boys, 2 weeks to 6 months of age, born premature, and with
low birth weights. Your baby may also be at a higher risk of SIDS with one or more of
the following:
Sleeping in a prone (face down or lying on stomach) position.
Being around people who smoke or having a mother who smoked during or
after pregnancy.
Sleeping on fluffy or soft bedding.
Overheating or overwrapping with too much clothing.
Sharing his/her bed with others.
Poor or no prenatal care. Prenatal care is the regular healthcare visits
made throughout pregnancy.
What can I do to prevent sudden infant death syndrome? There are no exact ways
to prevent SIDS from happening. Some things may be done to decrease your baby's
risk of having SIDS. The following are ways that may help protect your baby from
SIDS:
Back to Sleep: Place your baby on his/her back every time he/she sleeps,
including naps and at night. Do this even if you think your baby sleeps
more soundly lying on his/her stomach or side. Babies who sleep on their
back are not more likely to choke. Do this unless a medical condition
requires your baby to lie in another position. Ask your baby's caregiver
which sleeping position is best for your baby.
42
17-8641-1905 12/09
You may put your baby on his stomach while he is awake with someone
watching. This is called tummy time. Tummy time helps your baby's head,
neck, and shoulder muscles get stronger. This may also prevent flat spots
from forming on your baby's head. Changing the direction your baby faces
when lying down may also help prevent flat spots.
Use a firm sleep surface: Place your baby on a firm flat surface to sleep.
Do not let him sleep on soft surfaces. These include pillows, soft
mattresses, waterbeds, quilts, sheepskins, beanbags, or other forms of
bedding. Your baby's crib should be a safety-approved crib.
Keep soft objects and loose bedding out of the sleep area: Keep your
baby's crib free from other things, such as pillows, comforters, and stuffed
toys. If bumper pads are used, they should be thin, firm, well-secured, and
not pillow-like. Use a fitted bottom sheet made for your baby's crib. The
mattress should be the correct size and against all four sides of the crib.
Keep all items away from your baby's face. If a blanket is to be used, your
baby's feet should reach the foot of the crib. The blankets can be tucked in
around the crib mattress and should reach only to the level of your baby's
chest.
43
Smoke-free environment: Do not smoke or let others smoke near you
when you are pregnant. Do not let others smoke around your baby.
Sleep in separate beds but same room: Place your baby in the same
room but not in the same bed when sleeping. Put him in a separate sleep
area, such as a bassinet, crib, or cradle. Do not let him sleep on the same
bed with other children or adults. Do not share a bed with your baby
especially if you have been drinking alcohol, taking drugs, or if you are a
smoker. Do not let him sleep on an adult's bed, sofa, or armchair. If you
need to breast feed, always put him back in his own bed when finished. At
some point you may fall asleep during breastfeeding and accidentally roll
over on your baby.
Right room temperature: Your baby should be kept warm, but not hot. Do
not over-clothe your baby. Dress him in light sleepwear and do not wrap or
cover him with too many blankets. Keep the room at a temperature that is
comfortable for an adult wearing light clothing. Your baby should not be
sweating or feel hot to the touch.
Consider using a pacifier: Use the pacifier when placing your baby down
to sleep during the first year of life. Do not put it back in your baby's mouth
once he falls asleep. If he rejects it, do not force him to take it. Do not coat
the pacifier with any sweet solution. Clean it often and replace it regularly.
If your baby breast feeds, wait until he is at least one month of age before
using the pacifier.
Breast feeding: Breast milk may help protect your baby against infections.
Infections are believed to increase the risk of SIDS.
Where can I find more information about sudden infant death syndrome?
National SIDS/Infant Death Resource Center
8280 Greensboro Dr, Ste 300
McLean, VA22102
Phone: 1-703-821-8955
Web Address: www.sidscenter.org
National Institute of Child Health and Human Development
PO Box 3006
Rockville, MD20847
Phone: 1-800-370-2943
Web Address: www.nichd.nih.gov
© 1974-2009 Thomson Reuters. All rights reserved.
44
17-8641-1905 12/09
Fetal Alcohol Syndrome (FAS)
Definition: Fetal alcohol Syndrome is a disorder describing permanent birth defects that
occur in the babies of women who drink alcohol during pregnancy.
It is not known if the amount, how often alcohol is used, or the time during the
pregnancy causes a difference in the amount of damage to the fetus.
Alcohol crosses the placenta to the baby in the womb causing:
Slow growth
Decreased weight gain
Facial abnormalities
Damage to the brain structures
Physical, mental, and behavioral problems
Fetal alcohol syndrome is the leading cause of mental retardation in the country.
The risk of brain damage exists all during pregnancy, since the brain develops during
the entire pregnancy.
Even if your child doesn’t suffer mental retardation related to alcohol exposure they are
more likely to experience a wide range of functional difficulties such as:
Learning disabilities
Clumsiness
Poor school performance
Poor balance
Problems writing or drawing
Short attention span
Impulsive behavior
Hyperactivity
45
CAMC—Family Resource Center (FRC)
Located at CAMC Women’s and Children’s Hospital
800 Pennsylvania Ave.
Charleston, WV 25302
The Family Resource Center helps people to deal with issues that hit close to home.
Our staff is trained to help you deal with:
Parenting
Relationships
Same gender concerns
Loss and crisis
Depression
Anxiety
Substance abuse issues
Adjustment to chronic illness or pain
The FRC provides a comfortable, caring and safe and environment where your
confidentiality is respected. Counseling is available for individuals, couples,
adolescents and children. For referral information, call (304) 388-2545.
Some of the services we provide include:
Psychiatric evaluations / medical interventions
Community offerings
Support groups
Childbirth classes/parenting classes
Women's Health Connection
Holistic Services - yoga and massage
In addition, we now have a new program that focus’ on the needs of pregnant women
who are dealing with issues of substance abuse.
The Family Resource Center provides individual therapy and a psycho-educational
group, which will address topics such as the disease of addiction, relapse prevention,
the 12 Steps, and delivering a healthy baby.
2545.
46
17-8641-1905 12/09
Community Resources
Alcoholics Anonymous
1-800-333-5051 or 1-304-342-4315
Narcotic Anonymous
1-304-344-4442
Al--A-Non
1-304-345-7420
Highland Hospital
1-304-926-1600
Prestera
1-800-642-3434
Family Resource Center
1-304-388-2545
Charleston Treatment Center
1-304-344-5924
Rea Of Hope Fellowship Home
1-304-344-5363
National Council on Alcoholism and Drug Dependence
1-800-622-2255
Substance Abuse Treatment Facility Locator
1-800-662-4357
WV Tobacco Quitline
1-877-966-8784
CAMC Women and Children’s Hospital
47