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Doctor Q&A

Rise and Shine Feature – Attachment Parenting with Dr Sears

Dr. Bill Sears is one of America’s most renowned pediatricians, father of eight children, and author of over 40 books on childcare. He is the Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr Sears Lean has a series on this blog that covers many aspects of raising healthy kids. Dr Sears shared many tips in this Singapore workshop ‘Keeping Your Child Healthy’.

Raising healthy babies and successful children with Dr Bill Sears
Attachment Parenting & Handling Gassy and High-Need Babies

Dr Sears shared in the workshop at Rise and Shine Expo ‘Attachment Parenting and Handling Gassy and High-Need Babies’ that during his first venture into parenthood, he decided to make a checklist of desired qualities in children who he helped in his practice and asked what the parents do. It turned out that the parents were practising attachment parenting!

To help us all understand what attachment parenting is, especially important given all the misinformation on what it is, Dr Sears shared the Baby B’s of Attachment Parenting:

Birth bonding – keep baby with the mother after birth

Breastfeeding – breast milk recommended for baby’s nutrition

Baby wearing – sling is preferred so that baby can be close to the parent (either dad or mom can baby wear)

Bed sharing – sleeping beside the baby has been studied to lead to better physiology, and the baby experienced more even breathing, better growth, less stress hormones, lower glucocorticoids neurotoxicity.

Believe Baby’s Cries – leaving the baby to cry it out alone leads to prolonged stress, which can damage the hippocampus. It risks neonatal glucocorticoid neurotoxicity which can carry over into adulthood. During infancy, a baby who is carried by parents cries less and has lower risk of this toxicity. Interestingly, babies who cry but do so in the arms of others do not suffer from this effect.

Beware of Baby Trainers – for the same reason above, methods that sought to train babies are to be wary of.

Balance – Dr Sears shared that babies whose parents practiced the above (as much as they can, need not be all if not possible), have been observed to have the Childhood Cs.

Childhood Cs

Caring kids – play better with other children

Compassionate

Communicative

Connected

Comfortable with intimacy – better lovers

Confident kids – as well as better behaved and more resilient, resourceful, respectiful and thoughtful

Confident parents – these children become confident parents who connect better to their children

Q&A on Co-Sleeping

I raised a question on how long the Baby Bs can be practised, in particular sleeping with the baby. Case in point – I’ve been sleeping with mine ever since she can’t be swaddled just to watch over the scratching of eczema at night. Marcie is now 4, and we are still sleeping together. Will there be any developmental issues associated with sleeping with a child, who is no longer a baby?

Dr Sears and Martha: Dr Sears and his wife Martha shared that they do not purposely shift their children (they have eight!) out of their bed or bedroom but let the transition comes naturally as an older child start to want to have their own bed/room. This has not been studied and the best arrangement is the one that works for the whole family.

Dr Sears also shared that given that working mothers had less time with their children, practising attachment parenting is even more important. And as an ending comment, Parenting is Giving our Children the Tools to Succeed in Life.

I didn’t get to have Dr Sears vet through this post before publishing, any and all mistakes mine; next week we will tackle more health issues, such as nutrition, colic and vaccinations.

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Doctor Q&A

Friday Feature – Eczema Q&A with Dr. B

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com

Q&A with Dr Christopher Bridgett on Childhood Eczema and Habitual Scratching

This was originally a series of Friday Q&As in 2012 which had since been combined into one informative post.

Bedtime Routine for Eczema Kids

Marcie Mom: I set up a bedtime routine of reading books, singing songs, turning off all the lights and playing baby christian songs. We also pray for good night’s sleep! How does routine help a child’s behaviour and how can it help the child’s eczema?

Dr B: Your routine enables learning the desired consequence – a good nights sleep – if all the pieces of the sequence follow each other frequently enough, including the consequence of falling asleep. It’s best to move on from reading, and singing songs, to turning off the lights and saying prayers only when the signs of sleep arriving soon are quite clear!

When you think the child will sleep OK without the routine, it may be tempting to make some short cuts. I suggest that this would be a mistake! If on the other hand, a child is especially fraught, and therefore wakeful, it is best to go slowly along the routine, reading more stories, singing more songs, before the lights are turned off, and good night kisses are given.

Routine usually enables most of us to cope with everyday life. Generally following an established and happy routine means less stress, and changes in routine are usually stressful. And less stress means calmer skin, and less scratching… sounds good for eczema, I think!

Stress Control for Eczema Family

MarcieMom: Parents taking care of eczema children experience high stress levels, apparently as high as parents taking care of children with kidney illness. I’ve also read that stress can be passed onto babies, is there a chance that the stress that parents of newborn feel may worsen the eczema of the baby?

Without making parents even more stressed (that they are passing on the stress!), are there any tips for them to manage their own stress or to prevent stressing their child inadvertently?

Dr B: The causation of atopic eczema is multifactorial – there is no one factor, there are many, and they can be divided up into those that we have to accept, and those that we can do something about. First we need to draw up the list that applies in a particular case – stress is usually there on the list, and stress is usually a factor we can do something about!

Stress and frustration directly affects the skin – the skin is very sensitive to our emotions, and we all tend to scratch more when stressed and frustrated, and scratching soon becomes habitual – which is the cause of chronic eczema. There is no doubt that stress can be part of family life; kids become how they are through their parents, don’t they?

Marcie Mom: Most parents of eczema children have no time for themselves, let alone exercise. Obviously, we know exercise is good for us but how does exercise affect our psychological well-bring?

Dr B: Great question! We seem to live in stressful times. Under stress the body releases hormones like adrenaline, that facilitate fighting, or fleeing! In modern times we can’t do either usually, so it’s important to have a regular physical outlet. A healthy mind in a healthy body.

Marcie Mom: Also, parents of eczema child tend to have less couple time and higher stress in marriage. What simple and practical advice would you give them?

Dr B: The first step is the one you have already taken: recognize the problem. Coping always begins with confronting reality. Next how it leaves you feeling needs expression – don’t bottle it up, let it out, talk about it, understand it and think it through.

Then consider getting and accepting help – problems shared are problems halved. Experiment with new ways of doing things. Don’t take the situation for granted – there is usually a way of changing arrangements for the better. 

Steroid Side Effects

Marcie Mom: Some child’s skin turn brown where it frequently itches, being scratched and steroid creams have been applied. Some parents think it’s the steroid cream that causes the change in skin colour but I’ve read that the brown patch is caused by cells in skin (‘melanocytes’) releasing extra pigments from scratching. Which is true? Particularly it’s important to dispel any misperception of steroid when the risk of under-treatment due to steroid phobia is real.

Dr BBoth are true!

In the first case, yes steroid creams will change the colour of skin – they very slowly reduce the pigmentation, lightening the colour of the skin. The anti-inflammatory effect of the steroid reduces the activity of all skin cells, including the pigment cells – the “melanocytes”.

In the second case, cellular activity in skin is stimulated by habitual scratching, and this affects all cells, including the pigment cells – the “melanocytes”. So habitual scratching causes the skin to thicken up – lichenification – and colour up – hyperpigmentation. Both are characteristic of chronic atopic eczema.

Cradle Cap

MarcieMom: Some eczema babies also get cradle cap, and the cradle cap shampoo has to be used to massage the scalp and wash off the cradle cap. What’s the difference between cradle cap shampoo and normal baby shampoo?

Dr B: Aha! I think I can answer this… Yes, they are different. Cradle cap is seborrheic dermatitis of the new born and infants – it is usually harmless, and can clear on its own, without any special treatment. The regular baby shampoo will help reduce the rash, but specially formulated cradle cap shampoo is stronger – it may have salicylic acid in it for example. If the special shampoo is used, please make sure it is suitable for the age of the child!

Marcie Mom: I’ve also read that brushing a newborn hair helps to keep cradle cap away. Is that true? What does brushing hair do to the scalp?

Dr B: Yes, brushing the hair helps tidy things up, until the cradle capclears. With cradle cap there is excess sebum being produced. Sebum is the natural oil of the skin. Sebum is good for the skin and hair, in moderation – for example, it gives insulation against water loss. When birds preen they are spreading oil over their feathers, and that is what brushing the hair does – see how it shines! 

Swimming for Eczema Children

Marcie Mom: Some parents are very skeptical of bring their eczema child to swimming but my baby’s doctor recommended it. Just 10-15 minutes 3 times a week and wash off pool water and moisturize immediately. Will that also be your recommendation? Swimming is so fun and I hate to see eczema children being kept off it!

Dr BSwimming is fun and good exercise – it also saves lives! So it’s good to say that swimming and atopic eczema usually go together just fine. The problem is caused by the water – it washes off a layer of the skin’s protection and leaves it very porous to water loss afterwards: a thin application of moisturizer before swimming protects against this. Make sure the application is thin though – no need to prepare for cross-channel swimming – see http://www.atopicskindisease.com/articles/TopTip1

Otherwise, the chemicals in the water of a swimming pool are disinfectants – chlorine, & bromine for example – they can be good for the skin, as their antibacterial effect is anti-inflammatory. However these additives can irritate too, so your procedure is a good one!

Moisturizing

MarcieMom: Moisturizing is important to maintain the skin barrier, particularly when eczema child has a weaker skin barrier that allows for more allergens to penetrate. The recommended guideline is about 500ml per week, that’s a lot and some children simply squirm when parents try to apply the moisturizer. What do you suggest parents can do to get their children to like being moisturized? Or even better, moisturize themselves!

Dr B: The use of a moisturizer – also called an emollient – is central to the care of atopic eczema.  The way it is used is very important – much more important than which one is used. Sometimes the better ones are the cheapest – and the best one is the one that is liked and used properly!

With children, as with adults, there are four key words to remember:

Thinly, Gently, Quickly and Often

and with the child it is very important to get it done quickly, and on afterwards to do something fun together, so that fun becomes the focus, not the moisturizing!

Getting the child to do their own moisturizing needs careful consideration: left to their own devices there is a good chance it will not get done properly – perhaps age and temperament come into it. 

Reactive Skin Reactive Mind?

Marcie Mom: It is mentioned in this article a comment by Sophie Worobec MD at University of Illinois that eczema children are “very bright” as the skin and the brain develop at the same time, so “very reactive skin and very reactive mind”. What do you think of this statement?

There seems to be an association between ADHD and eczema children. And have you seen more cases of ADHD for eczema patients?

Dr B: That there seems to be a close relationship between the skin and the mind is often referred to, and the development of the skin and the brain from the ectoderm of the early embryo is seen as relevant to this relationship – I sometimes say the brain can be called a specialized part of the skin!

But in reality the whole body is closely integrated. All the separate parts are interdependent through shared characteristics, and the overall function is enabled by circulating hormones and by the nervous system links between brain and body.

Both ADHD and atopic eczema are relatively common conditions. The recent reports of an association need to be treated with caution. I have no personal clinical experience of this reported association.

Tensed Baby

Marcie Mom: My baby has taken to tensing her stomach and legs in positions such as doing leg raisers or push-ups. My husband and I think it’s related to her being swaddled too much when young (we had to swaddle her due to scratching, sometimes looping a cloth around her limps cos the scratching was so bad). Do you think it is possible that she has learnt to use tensing to ease her itch and will this impact her psychologically? We certainly hope we haven’t made her gone bonkers!

Dr B: No, I do not think so! Probably what your baby is doing is “within normal limits” and is not due to swaddling, or to itching – and will have no psychological significance at all.

Marcie Mom: That’s comforting to know. Here’s another ‘crazy’ question from me. I frequently use finger food like biscuits (but only vitamin fortified, non-sugary, suitable for babies) to distract from my baby from scratching. My husband thinks I’m turning her into a glutton and soon she’ll have compulsive behaviour to keep eating. Is that true? 

Dr B: The importance of neutral/helpful alternative behaviours to scratching is fundamental to habit reversal – the new behaviour should not risk substituting a new problem for the old problem. I do not think what you describe is likely to lead to compulsive behaviour, but using eating as a habit reversal tactic does seem to encourage habitual snacking, and that may not be what you want to do?

Parental Guilt

Marcie Mom: Some parents have feedback that they feel guilty that they have either passed on the ‘bad gene’ or haven’t noticed their child scratching. What advice would you give to parents to cope with the guilt, which of course, isn’t justified!

Dr B: Both awareness of genetic inheritance, and coping with achild’s scratching are common human experiences and, as “facts of life”, need keeping in proportion. Some of us are more prone to self-blame than others. I think self-blame regarding genetic predisposition is quite unjustified. Failing to supervise a child’s scratching behaviour may be something to review. Sharing experiences in real time with others, and over the internet should be really helpful: great that you have this site!

Stop Scratching Eczema

Marcie Mom: Eczema babies seem to form a habit of scratching, mine even scratches my spouse or I when we’re beside her. How do you suggest parents can help to break the habit for your children (who can’t understand not to scratch nor appreciate the full negative effect of scratching)?

Dr B: Follow The Combined Approach to atopic eczema …. usehabit reversal behaviour modification to treat habitual scratching, together with optimal conventional treatment. To rescue a young child from chronic eczema please refer to Chapter 5 of our book“Atopic Skin Disease” – available to consult at www.atopicskindisease.com

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Support Group

Weaning off Eczema Baby from Co-Sleeping

Baby Marcie thought the cot is a fun place to walk around -> Baby Marcie found out that she’s staying in the cot for the night

 2 hours later, at 1 a.m.

My hubby was comforting Marcie, while I pretended to be dead -> Finally, out of exhaustion, everyone’s asleep

Hi! Last night was such a major milestone that I had to update you all; my baby Marcie spent the first night sleeping by herself in her cot! If you’ve seen my previous posts (here and here), you’d know that I’ve been co-sleeping with my baby. But for the past month, I’ve had a bad cough and Marcie sleeping on me made it worse. Last night, we cleared the clutter in her cot, vacuumed her mattress and resolved to regain our bodies (and sanity) at night.

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101 things that Mothers with Eczema Child do Differently

2 of the 101 things that Moms with Eczema Child do Differently – Co-Sleeping

Co-Sleeping = Sleeping Poorly Alone

When It is Bedtime

Eczema Mom is the bed, pillow and bolster for baby. Hubby has long been sleeping (gladly?) in the study room. Eczema Mom is wondering when baby will wake up scratching and how long it will take to comfort baby back to sleep… another long night with poor sleep lies ahead.

This is the second of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

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Support Group

Is Co-Sleeping good or bad for eczema baby?

Sound asleep baby

There is a whole debate out there on whether co-sleeping is good or not. Generally speaking, the ‘against-side’ has more support citing early independence for the baby. Personally, I am for co-sleeping with my baby, mainly because A LOT of scratches have been prevented as I can hold her hands anytime she scratches at night. Of course, the sacrifice is huge – lack of good sleep for me and almost no couple time with my hubby. Let’s take a closer look at the pros and cons in the context of taking care of eczema children:

For Co-Sleeping

1. Help baby sleep better. I believe this is true and especially important for an eczema baby whose itch may be preventing her from sleeping well.

2. Help build a stronger bond with parents. I think this is true too. When I was a stay at home mom and my hubby worked, after a few months, Marcie didn’t seem to get too excited when daddy came home. But if daddy co-sleep with her for two nights in a row, Marcie would display much more warmth towards daddy. For me, I just love to look at my baby’s face when she’s asleep and smelling her milk-breath!

Against Co-Sleeping

1. Risk suffocating baby. The verdict is still not out on this one. Some say the risk is higher while some say lower. My personal suggestion is to let your baby sleep alone in a very cool air-conditioned room but wrap her up to prevent scratching. When Marcie got too big to be swaddled, we tied her hands to her legs for a few nights but she couldn’t sleep well. That’s when we decided she’s big enough to not get suffocated/ crushed by us on our bed and it’s also the only way we know whether she’s scratching. Marcie started scratching ‘covertly’ at about 7 months old, when it became more difficult to know that she’s scratching as practically no sound was made. So the only way I knew was sleeping with her and detecting her scratching fingers move.

2. No good sleep for parents. That is so true especially when Marcie has eczema flare or teething which causes her body temperature to rise and somehow causes her skin to be more sensitive and itchy. For me, it’s a sacrifice I make and I compensate by sleeping earlier with Marcie.

3. Increase heat to baby. That is also true. I give off less heat compared to my hubby and I’m more aware when Marcie scratches. So I co-sleep with Marcie more often. Regarding the additional heat, you can compensate by turning the air-con cooler and dressing your baby light.

4. Make it difficult for baby to sleep if parent isn’t co-sleeping. Good news is babies adapt quickly and Marcie has no problem sleeping at infant care now. This was a great relief for me as I was worried whether Marcie could nap in school.

5. Prevent baby to be independent. No research results cast in stone for this one. Some studies now believe that making babies feel more secure will enable them to be more independent at an older age.

6. Prevent parents from their own couple time. This is true. Again we compromise by letting Marcie sleep alone first, and when she wakes up, I will then stop whatever I’m doing (usually watching dvd with my hubby) and quickly hop into the bed with her. We used to put Marcie in her cot but realise that she sleeps better on our bed.

I do take precaution though. Marcie likes to lie flat on her stomach but she has good neck muscles at an early 3 month age. She’s always in the centre of our bed, without the possibility of wedging between the wall and the bed and our bed has no bed frame that may trap her.

There’re also going to be a lot of objections from people around you if you choose to co-sleep. I think for parents with eczema children, it goes back to being confident about how you are helping your child with her eczema.

& always believe that You are the Best Parent for your eczema child