To the Woman at Target

To the Woman at Target-

I don’t know if you even remember me. Our encounter on Wednesday was very brief, and I know I thanked you repeatedly, but I wanted to take a minute to elaborate on how grateful I am.

Two weeks ago at the same checkout stand at the same Target, my son had a meltdown. Not the baby this time, but my 2 year old. It was our fault. He had been struggling with the big brother transition, threw a major fit when we were leaving, which pushed my husband and me into an argument and we ended up not leaving until an hour later than we had planned. Which meant it was lunch time, and if you’ve never encountered a hungry toddler, you are lucky.

Anyway, Eli wanted to touch the conveyer belt, but it was time to get out of the way for the next person and he lost it. He fell to the floor as though all the bones fell out of his body, he cried (not screamed). I went and grabbed him quickly and let my husband pay. I also had the baby with me, who was only a few days old and was thankfully sleeping. As all this happened, the person in line behind us got irritated. She sighed, audibly, several times. She made eye contact with me and rolled her eyes. She ended up mumbling something about people controlling their kids and then moved to a different register. Eli’s fit lasted all of 10-15 seconds before I pulled him away, but she was so obviously inconvenienced by it and I was mortified and angry.

So on Wednesday, when a similar scene started to play out, I wanted badly to run away.

You couldn’t have known how hard that day had already been. It was my very first day home with both boys without any help. Will and I had been awake for at least a part of every hour that night and we were both exhausted as a result. Eli had a sinus infection and pink eye and had woken up hysterical because he couldn’t open his eye. We had to get out of the house for an 8:45 pediatrician appointment which resulted in me carrying two crying children to the car and all of us being at the pediatrician in various parts of our pajamas, 5 minutes late.

There was no place I wanted to be less than Target, but it’s the pharmacy we use and I needed to get Eli’s eye drops asap. I almost cried when they said it would be a half an hour to get his prescriptions ready because I knew that there was no way both boys would be okay for 30 minutes. But there wasn’t much I could do. Coming back later would be even worse, and so I plopped Eli in the cart (with a cart cover, I was trying to minimize him touching anything) and put Will in his car seat in the back of the cart and we started killing time.

For 15 minutes, we were okay. And then Will lost it. He was just so tired. I tried a pacifier, I even let him suck on my finger, but nothing helped. He was beet red and wailing. I didn’t think he was hungry, but I knew we needed to sit down somewhere so I could take him out and try. So I went to the checkout area, where we met. Will was in hysterics and all the registers were full. The checker told me to go to customer service since I only had 4 items, but the line there was even longer.

As I was pulling Will out of his car seat to try to calm him down (while in line and pushing my cart), you approached me. You said that I could go in front of you. And then you helped me push my cart, unloaded my items, waited for me to pay and then reloaded them. Our encounter lasted all of 2 minutes, max. I never would’ve asked for help, but you saw me, really saw what was going on despite my attempts to seem fine, and didn’t hesitate to help. I was so worried I was inconveniencing people with my crying baby and feeling so embarrassed when you extended that kindness.

I have been told many times that it takes a village to raise children. Two weeks ago, I cried after a trip to Target because I felt so alone, as though there was no village left. But on Wednesday, which had all the makings of a terrible day, I walked out of the store feeling supported. Those two minutes of your time, the two minutes of caring you gave to me and my boys will not be forgotten. And someday, when I have my act more together and I see someone struggling, I hope to provide the same kind of help to another mother or father who is struggling.

Thank you so very much for being a part of my village.

Katie

The Transition

In the months and weeks leading up to Will’s birth, we did everything we could to help prepare Eli for the impending change. At first, he would just outright deny that there was going to be a baby. If you asked him anything about a baby or a big brother, the answer was no. Period. Even when the question was not a yes or no one.

But as time passed, he began to get a little more with the program. He would say that yes, he was going to have a little brother (he would still say no if you said baby, oddly) and yes, he was going to be a good big brother. We read a book one night where a big brother saves a little brother and it was like there was a light switch that flipped. He kept exclaiming “big brudder!” and pointing to himself and the book. We breathed a small sigh of relief that at the very least, he seemed to be understanding.

He did great the 2 days we were in the hospital, including when we Facetimed and he got to see the baby. I was hopeful that it wasn’t going to be as rough of a transition as we had imagined.

tranz1

When we got home Saturday night, he heard us open the door, yelled Mama! took one look at the baby and turned around and ran away. He wouldn’t look at me, hug me or give me the time of day. When I took the baby out of his car seat, he flipped. He repeatedly yelled “ALL DONE” over and over until I handed Will off to someone else and picked him up instead. He got a little more okay with the baby that evening and went to bed pretty easily, which was a surprise to me. Again, I thought maybe things weren’t going to be so tough.

Spoiler alert here: I was wrong.

tranz2

Everyday since Will has come home has been a different struggle. There was one night where Eli just could not go to sleep. He screamed and cried and wanted to sleep with a sippy cup of milk and wanted up and hugs and it was just awful. And after an hour, my husband had to rock him to sleep. He has never been rocked to sleep a day in his life. My once easy going kid now picks every single battle known to man. WHe threw his biggest tantrum to date last week because we wanted to take him to the pool (for some one-on-one time with dad) which he very, very much wanted to do, but he wouldn’t put on his shoes and only wanted to wear my shoes, which I needed to wear. It went on for seriously like 30 minutes, if not longer. And it was so sad to watch because you knew that it wasn’t really about shoes.

tranz3

And that’s kind of how things have gone. So many fits and battles and you can just tell that he just wants order in his world again. After a month or two off, he’s back to lining up cars pretty obsessively every day, several times a day. He will only wear certain shoes, he will only eat certain foods, he will only wear certain clothes. It’s like a lot of the progress we made getting him to be less rigid in the past few months has been completely undone. He’s the most rigid he’s ever been with everything.

Logically, I know that this is a normal kind of reaction (mostly). Everything he had ever known has changed. He’s no longer the center of attention, there’s this brother he doesn’t understand, who cries a lot. His world has been rocked and is out of order. Emotionally, I feel like a monster. As if I have broken his spirit completely. I hate that he’s fighting so hard to control things because it’s such a grown up response and he’s still so little. I don’t want him to feel like he can’t rely on us to keep his life stable because that’s our job.

(We are not going to be discussing this haircut except to say that it is NOT what I requested and soooooooob.)
tranz6

There are good moments amongst the angst. He gave William a kiss on the head the other day, he told him goodnight (unprompted) another night. He asks to sit next to me, and will climb onto our laps while we have the baby at times. He plays happily for much of the day, though he’s definitely testing limits there too. It’s not all bad and I don’t want to make it seem that way, it’s just been so different and it’s challenging on a number of levels. He is still the same sweet boy he has always been, he’s just got a shorter fuse and a lot more tears.

tranz5

It’s a challenge for both of us, really. The guilt for me, of having changed his life so much. And the struggle for him, of making sense of all these changes. When I imagined this transition, I expected more tears, more clinginess, tantrums and sleep disruptions. I didn’t expect the obvious anxiety that Eli feels. I didn’t expect him to reject me as often as he does now (though I understand it). We are both learning how to make sense of things again and what our new normal is. I tell him a hundred times a day how much I love him and I hope that in the end, that will be enough to carry us both through this transition.

Not Like the Other

I can hardly believe it’s only been a week since Will arrived. It feels a bit like he’s been here forever when really, he just moved in. And from the very first moment, it was clear that this time was not going to be like the last one in a lot of ways.

(Just as a preface, a lot of the things related to Eli’s first few weeks are…not positive. That said, I would do every moment of it again in a heartbeat because it got me to where I am now. I would not change a moment if it meant that I wouldn’t have my sweet boy exactly as he is.)

The first few days after Eli was born, I barely slept. Not because Eli was fussy or difficult (he wasn’t, he was the quietest newborn on earth), but because in my mind, I thought I had to stay awake to make sure he kept breathing. I felt this overwhelming sense of terror that I would lose my baby. That something bad would happen, and the only way to prevent it was to let him sleep on me while I struggled to stay awake all night long. I was exhausted and scared all the time, but come hell or high water, I was going to keep him breathing.

As I’m sure you can imagine, it wasn’t sustainable. That combined with the stress of a non-nursing baby was about enough to send me over the edge. I was so happy to have Eli, but so scared and stressed.

On Will’s first night home, I felt a similar panic. What if he stopped breathing? What if something happened while I slept? I had only had him for 36 hours, but already he held such a huge piece of my heart that I could not imagine how I would survive without him. I spent about five minutes trying to sleep with one hand on his chest and then I realized that this wasn’t going to work- not for him, not for me.

This time, I know I can’t control my baby’s breathing. I can’t stay awake every moment. I can make good choices (sleeping on his back, with a pacifier, fan on, rooming in, etc) to reduce the known risks, but ultimately, I have to recognize I’m not in control here. I can’t will my child to breathe (no pun intended), nor can I keep him safe without sacrificing my health and sanity. And so from that first night I let go and went to sleep. Just like that.

And that’s kind of how everything has been. It seems like it should be harder to have two kids than it was to have one, but so far, it’s not. I am emotionally and psychologically in such a better place than I was 2 years ago. I was thrilled to have Eli home, and I was truly happy, but I was so burdened and scared that it doesn’t even compare to what I feel now. I am just so unbelievably happy to have both my boys. It’s kind of amazing really, this level of happiness. I’ve literally never been happier in my life.

In many ways, Will and Eli (in his first few days) are very much alike. They are/were both relatively low key, but passionate when hungry. Will is a bit gassier and more prone to crying when overtired, or at least from what I can remember from Eli’s first few days. They have/had comparable reflux (I apparently only produce boys with loose esophageal sphincters), but Will, like Eli, is so much happier than many of his refluxy peers. Oh, and they’re both adorable, though they really don’t look anything alike.

It’s just that their babyhood, at least the first week, could not be more different, and it’s not because of them. It’s because of me.

Being as happy as I am this time occasionally makes me feel a little guilty for Eli because I feel like he missed out on the mother I always wanted to be, the mother he deserved. I’m comforted that he won’t remember those early days and hope that this version, this happy, calm and grateful mom, is what they will both carry with them.

There is simply no person on this earth luckier than I am. And I know it.

boys2

Our Will

After what seemed like the most impossibly long 39 weeks and 6 days, our second son was born.

William Louis was born on Friday, August 15, 2014. He was 7 pounds, 7 ounces and 19.5 inches of baby sweetness. He has dark brown (possibly curly) hair, deep blue eyes that look likely to stay blue, his dad’s nose and my long fingers and toes. He is named for my maternal grandfather who passed away in June (his name was Bill, but he was named for his father, who was William) and my husband’s maternal grandfather, Louis.

will 1

(I’m going to type out a shortish version of his birth story now, so if that’s not your thing, you may want to stop now or just scroll to the pictures. Unless you don’t like baby pictures, in which case, you’ve come to the wrong blog.)

I saw my OB on Wednesday the 13th and was elated to learn that after a week of painful but inconsistent contractions, I had dilated to 4cm (from 1) and was 50% effaced (no change). She said the baby was looooow and that with a membrane sweep, I had a high probability of going into labor in the next few days, so I happily agreed to it. She also said that if he didn’t come on his own, she would induce on Tuesday because of how far we live from the hospital and how far dilated I was. I had rough contractions all afternoon Wednesday, but they completely went away that evening. It was like deja vu since the exact same thing happened with Eli.

The next morning I woke up feeling rough. I hadn’t slept well, I was tired and just kind of all over miserable. I dropped Eli off at preschool, came home and soaked in the tub, then napped for a few hours. I woke up feeling better but not good. At around 5pm I started to notice some regularity with the contractions- they were about every 10 minutes- but were tolerable. By 8 they were every 8 minutes and hurting. I got Eli down to bed and called my sister. I told her that I fully expected this to be a false alarm but that it would be better to have her there in case we decided to go to the hospital.

And then I waited, ate some cake and kept timing. Sure enough, the contractions were getting closer and stronger. Since I was already 4cm and live 45 minutes from the hospital, my OB said to come in earlier rather than later, so at 11 on Thursday night, we headed out. The contractions seriously picked up in the car and it was feeling much less like a false alarm.

I got checked in at midnight and sent to a waiting room. Not like a nice quiet space where I could focus on not screaming in pain, but the regular L&D waiting room, which currently held 10 members of someone’s family. Apparently none of these people had ever been in labor because despite my obvious pain, they would not stop trying to engage me in conversation. I will spare you the details but I declined gummy worms (TWICE) and refrained from answering the question “what are you most looking forward to about not being pregnant” with “never seeing you guys again.” It was my own private circle of hell.

At 1:15 I made it to triage where I was still 4cm but now 80% effaced. They decided to let me labor for an hour then recheck. I’m pretty sure thats when I hit active labor. The contractions came hard every 3 minutes. After an hour, I was 6cm and got admitted. From there, I basically counted the seconds until the very handsome anesthesiologist came to make everything better. I think the epidural process started around 3:30 and shortly thereafter, things fell apart.

The anesthesiologist got the epidural on the first try, but it took a solid 15 minutes for it to get to the right side of my belly. It did eventually work and the pain relief was absolute bliss. After 10 minutes, I started to notice that Will’s heart rate was dipping on and off on the monitor, which was new. And then it just stopped. The nurse came in and started trying to find it again. First I rolled to my right side. Then to my left. She re-geled the monitor, moved it all around and…nothing. It was the longest few minutes of my entire life.

Soon the room was full of nurses and an OB who quickly broke my water and put a scalp monitor on Will, whose heart rate picked up again. I was given something to raise my blood pressure (even though it was still in my normal range) several times to help keep things where they needed to be. I also got oxygen, which had to stay on for the rest of labor. It was a total frenzy of stress and it was terrifying, but by around 5, things had settled down.

I was able to sleep from 5:30-7, which was glorious (I love epidurals so much). At 7 I woke up to more heart rate decelerations from Will, this time with each contraction. Finally, at around 8, it was decided that we couldn’t let me labor down anymore (I was fully dilated and had been for a while) and we needed to push or do a c-section.

They lowered my epidural (at my request) and we started pushing. After 10 minutes I wasn’t making progress despite good pushing (cervical lips will forever be my pushing downfall), so they got the vacuum set up. Basically we could only safely give him one more contraction with the decelerations before he had to come out. Thankfully and inexplicably, his heart rate stayed stable through the next 2 contractions and by that point he was nearly out, so they put the vacuum away (thank God).

At 8:37am, Will quietly entered our lives. He did wonderfully well once he was out, which was a huge relief. He is a born breastfeeder (more, probably too much more, on this later) and looks just like his dad. He loves to be snuggled and to eat for 2-3 hours at a time.

will 3

will 4

will 5

will 11

will 9

will 8

will 7

will 6

We came home Saturday night and are doing well. Eli has been…adjusting. I have video and pictures of his reaction, but those are for another time and he’s already so much happier.

will 10

We are so thrilled to have our two boys home and thriving. I can’t tell you how much I have appreciated everyone’s support and love. We are immeasurably blessed and so very grateful. There are many more adventures to come.

Trolling for Safety

Earlier this week, a post popped up on a Facebook group I belong to for child passenger safety technicians. The tech who shared the link was concerned because the post was a review of a car seat, which showed a car seat being used entirely incorrectly. The straps were positioned wrong, the chest clip was too low and worst of all, a child who could not be more than 6 months old was pictured forward facing in the seat. The review itself mostly skirted by discussing anything of substance and instead was largely focused on how pretty the colors were.

I was alarmed on a few levels. I knew that if that child was in that seat, as pictured, and in a crash, she would likely be severely injured, if not killed. It doesn’t matter how many safety features are built into a car seat, if you use it against the manual and against the law and all safety recommendations, it’s useless. I was also frustrated because I think that reviews like that make parents look stupid. I may be a car safety nut, but every parent I know cares more about how long their child will fit in a seat, how it will fit in their car, if it’s relatively straightforward to use, etc., rather than what colors it comes in. But this second issue is beside the point.

After several of us (politely) expressed our concerns to the car seat company, the review was pulled and pictures were retaken with the child rear facing. The straps were still wrong and the review at no point acknowledged that the previous picture were misleading. In fact, in the comments, the poster was endorsing forward facing children at 1 and 20 pounds, which absolutely everyone in the car seat world agrees is entirely unsafe.

Once again, some CPSTs reached out to the poster in the comments of the post. I was one of them and I can tell you that my comment was 100% polite and simply trying to explain why recommending 1 and 20 pounds was not a good idea. As she had told another CPST to “do some research” I included a few links that would be useful for her and other parents interested in the seat and in car seat safety. Not only did my comment not get published, but I’ve been blocked from the website. This blogger wants parents to do research but doesn’t want any research to be shared?

Honestly, this is part of a bigger issue I’m personally struggling with. This person is calling me a “troll” because I want to help keep children safe by providing research. My only goal in sharing what I’ve learned about car seats is to keep children safe. I have no ulterior motive. I don’t think I’m a better parent. I really just want to help change the fact that car collisions are the #1 killer of children and that 75% of car seats are being used incorrectly. I’m not afraid to be blocked by people over this, I just wish there was a better way.

How do we incite change without being blocked and being called trolls? How can we teach parents what’s best if any attempt to do so is seen as a personal affront? I’m genuinely asking because I don’t even know anymore. We have a major issue with car seat safety in this country and it seems to be more difficult than ever to help parents learn how to keep their children safe in the car.

Baby Month!

It’s August 1st, which means that I will officially be having a baby this month (trust me, if he’s over 2 weeks late, I will perform my own c-section before September rolls around). Tomorrow I hit 38 weeks, which means my due date is in 15 days. Which is bananas.

The last time I was this pregnant, I was psychologically a disaster. My OB had assured me that Eli would arrive by the end of April. When May rolled around, I lost it. I was angry and frustrated and more than anything, I was anxious to meet my son. I was experiencing the normal discomforts of late pregnancy, but nothing serious. It was a head game.

This time, it’s very much the opposite. I do want to meet this baby and I am excited beyond description for him to arrive, but I am not, at least psychologically, in a rush. I want him to stay in until he’s ready. But holy crap is this pregnancy physically a lot more awful. (Let’s be clear- none of this is atypical, none of this is worse than anyone else’s pregnancy experience. I have good perspective here, it doesn’t mean that parts of it don’t suck.)

For the past 6 weeks I’ve had pubic symphysis pain like I did not know could exist. It feels basically like someone kicked me in the crotch all day long. It’s good times. On top of that, the headaches that have been so delightfully absent since the 2nd trimester blood volume increase have come roaring back, almost daily. And, because that isn’t fun enough, I can’t feel 3 of my fingertips on my right hand, because apparently you can get carpal tunnel from pregnancy. THE MORE YOU KNOW.

This morning my OB sent me over to labor and delivery to be monitored because the baby has been minimally active and my fundal height/weight aren’t increasing the way they’d like. Happily, the baby looks awesome (and he sucks his thumb!), and despite having contractions every 3-5 minutes, a cervical check showed that I am clearly not having this baby imminently. Wah wah.

In the meantime, we’re continuing to try to get Eli excited about being a big brother, which so far is not going well at all. We bought him a baby doll, hoping it would increase his interest in babies. Let’s just say, it did not. He does not want the pretend baby to touch anything of his. He does not want the pretend baby to be near him and there is absolutely zero chance that he will considering holding or intentionally touching the baby.

He did get marginally excited about the prospect of being a big brother after reading a book where the big brother saved the little brother last night (Come Out and Play Little Mouse), but that’s about it so far. I know he’ll come around, I just feel bad for the way his life is going to change, even though I know in the long term it’s going to be great.

So now we wait. And hopefully soon we’ll have more excitement to report. Let’s go August!

Why we’re Voting NO on Proposition 46

If you’re not from California, this post maybe won’t necessarily impact you directly, but it is something important enough and close enough to my heart that I’m going to post it here regardless. I will preface this with the fact that my husband is a physician in California. We’re not hiding that fact, but even if he wasn’t, we would still vote the same way.

There is a proposition on the ballot this November called Prop 46. At first glance, it has a lot of really appealing ideas. It requires mandatory drug testing of physicians and punishes those who test positive. It requires physicians to consult with a national database before prescribing controlled substances, as a way to reduce prescription drug abuse and doctor shopping. Oh and it raises medical malpractice payouts to 1.1 million (from $250,000).

Once you get past that first glance, there are huge, serious issues here.

I’m not going to argue against drug testing for physicians. That was something that was added to the front of this proposition to try to hide what this is really about. If someone wants to draw up a clean proposition for vote that isn’t written by trial lawyers trying to make a buck, I will happily support drug testing physicians. I have been drug tested as a teacher and as a physical therapist, I have absolutely zero issue with drug testing and appropriately punishing/reporting physicians. So let’s just set that aside because it’s a trojan horse.

Malpractice Cap
A little history: The current malpractice cap was created by an act known as the Medical Injury Compensation Reform Act. The idea was to put a limit on the “pain and suffering” payouts that result from medical malpractice, as a way to help prevent malpractice insurance costs from being prohibitive to practicing medicine. It doesn’t cap payouts for medical care, it simply says that beyond the amount that will be paid to cover medical costs and medical care following an event of malpractice, you can only get an additional $250,000 for the suffering the patient/family experienced.

Proposition 46 quadruples that amount to over $1 million dollars for pain and suffering alone. Proponents of prop 46 will say that this is to correct for inflation and that the cost of increased insurance for physicians won’t be passed along to consumers, but they also don’t explain how that’s possible. Probably because it’s not.

If physicians now need to carry FOUR times their current malpractice insurance, how will they pay for that insurance increase? I know popular belief is that physicians sleep on their piles of money, but I can say with great confidence that it couldn’t be farther from the truth. To answer my own question, physicians will respond to their increased insurance in 1 of 2 ways: 1. They will stop practicing (either all together or at least in California) or 2. They will be forced to charge patients more- likely by way of yearly feeds to be a patient, charging for after hours services, or refusing to see low paying insurances.

So basically you will end up paying more out of your pocket or you will need to find a new doctor (who will charge you more). But, on the off chance that you’re one of a very tiny number of people who experience medical malpractice, you can now sue the pants off your doctor. And if you’re one of the lawyers who created this proposition, you can get 4 times as rich!

CURES Database
The other major, major issue with this proposition is the forced use of the drug history database. The Controlled Substance Utilization Review and Evaluation System (CURES) is a database that is used to track prescription use. Basically pharmacists enter schedule II-IV drugs into the system with the idea being to catch patients who doctor shop for medications and to track doctors who are “overprescribing” medications. Currently only a fraction of physicians and pharmacists use this database and it is poorly funded and doesn’t work well as a result. Prop 46 would require physicians to consult CURES before prescribing any schedule II or III medications.

I’m not going to lie, I think having physicians use the CURES database is awesome. There is strong support for this and I understand why. We DO have a problem with prescription drug abuse. We do have an issue with doctor shopping. And to a lesser extent and issue with overprescription. We need to address this, but the CURES database, in it’s current form, won’t do that.

The database isn’t ready for mandatory use. In California, once a proposition passes, it has to be enacted immediately. There is absolutely no way that the day after the election every physician or pharmacist could use CURES. It would crash within the first hour. This means doctors wouldn’t be able to prescribe, pharmacists wouldn’t be able to dispense medications. The database will take months and millions of dollars to be ready for mandatory use. Where exactly is that money coming from? And in it’s current form, the CURES database isn’t protected adequately, which means your sensitive personal medical information is at risk.

It’s really unfortunate that we’ve allowed 2 very important issues- drug abuse by physicians and prescription drug abuse by patients, get thrown together with a relatively obvious ploy for more money by trial lawyers. This proposition isn’t really about patients or protecting people, it’s about money. It’s about trial lawyers getting more money from malpractice at great cost to consumers, both financially and personally. It’s going to increase healthcare costs across the state, it’s going to cause physicians to move or retire and it’s going to put sensitive medical information at risk.

It’s just not worth it. We can do better. Voting no on this proposition doesn’t mean giving up on prescription drug abuse, it means seeing this for what it is: a wolf in sheep’s clothing. Vote no on proposition 46 and tell trial lawyers that they can’t trick voters into higher medical costs that harm patients and physicians and benefit a small group lawyers.

For more information, this is the most recent Legislative Analyst’s office report. It will better explain a lot of the costs.

Also, there’s a full list of donors who gave over $50,000 towards this proposition on this website. Interestingly, all but 2 of the donors are groups of lawyers.

(Just as an FYI, I am moderating comments on this post- but not original comments. You are free to share your opinion as to why you agree or disagree with this post and I encourage you to do so. I wrote this and am prepared to handle the disagreement, however, you are not free to harass other commenters because they disagree with you.)

Let’s Talk About Car Seats: Why Extended Rear Facing is Safest

Child and adult passenger safety has evolved tremendously in the past few decades. We went from no seat belts in cars, no car seats, to car seats that sat in the front seat or didn’t buckle in, to children in the backseat and so on. And today, we have highly complicated and specialized car seats and a lot of research telling us what does and does not work in the car.

The trouble is, not everyone has evolved with the times. Just this week I saw on FB a picture of a child who was much too young to forward face and someone politely commented that the child should still be rear facing (which, we can argue the appropriateness of this another time). And then the wrath of the uneducated masses fell upon the commenter. People repeated an unbelievably large number of falsehoods about rear facing and about why it’s not safe or best and why it’s dangerous and I just felt so very disheartened. I know that as parents we want the very best for our kids, but how can we provide that when we refuse to open our minds to the latest research?

Most states have 1 of 2 laws on the books about rear facing. Either 1) children need to rear face until age 1 and (sometimes or) 20 pounds, or 2) children must be seated in properly used car seats and there is not a single car seat on the market that allows forward facing before age 1, so basically, it means no forward facing until 1. And for a long time, the best practice was at age 1 it was time to flip the seat around to face front. But we know now, without hesitation, that that is simply not what is best for kids.

To break down why this is the case, I want to start with the science behind it. The major issue with forward facing a child before at least age 2, but really before age 4, is head size. Look, my kid has a giant head, but this isn’t about that. Up until age 2, children have significantly disproportionately large heads. Even those that don’t have the percentiles of Charlie Brown.

head
(Image from: American Genetic Association – Journal of Heredity (1921) Volume 12, pg 421)

The muscles that control the head are very, very, very small, especially in comparison to the size of the head. So when forward facing in a collision, those tiny muscles are trying to control a very, very large head and they basically do a really crappy job at it. When rear facing, the child’s head and neck are supported by the seat and there is very little excursion of the neck at all. The consequence of a collision for forward facing young child is a phenomenon known as internal decapitation, where the spinal cord is severed internally and it virtually always results in death.

The other major reason that rear facing is safer, especially for younger children, is spinal maturity. The spine of a young child is made in large part of cartilage. This is why kids are so crazy flexible (okay, part of why) and it serves them well. Except in a car accident. The fact that the spine is made of cartilage and does not begin to ossify until age 4 means it’s not as solid or protective of the spinal cord as it is in older children. This image shows the difference between the vertebrae of a 1 year old and a 6 year old. The seemingly missing pieces of the 1 year old’s spine are filled in by cartilage, which is significantly more flexible and allows much more pressure and damage to occur to the spinal cord in a collision.

bones
(Image from Human Osteology, T. White, 2000.)

So there’s the science. What the research shows is that between the ages of 1 and 2, toddlers who are forward facing have a 532% greater risk of suffering a catastrophic neck injury than their rear facing peers. Five hundred and thirty two percent greater risk. This isn’t theoretical, it’s a real scientific evidence and it’s not something we can argue with. The AAP recommends that children stay rear facing until age 2 or until they reach the maximum height or weight of their rear facing seat (they mean convertible, not infant carriers). The National Highway Transportation Safety Administration says to rear face as close to age 4 as possible. It’s a far cry from 1 and 20 pounds. The science unquestionably supports it, but why aren’t more parents doing it?

The most common concern parents state is leg injuries. Now, let me be clear: there is absolutely zero evidence of an increased risk of leg injuries from rear facing. Zero. In fact, leg injuries are the 3rd most common injury in forward facing children, but they are virtually unheard of in rear facing, even for extended rear facers with longer legs. Why? Because when forward facing, children strike the seat in front of them or the sides of the vehicle. There is much better containment when rear facing and in most crashes, the child moves towards the back of the car seat and away from vehicle seat, thus not injuring the legs (or the spine! woo!)

rear facing2

Other parents are concerned that an extended period of time with the legs in the frogged position is dangerous. Actually, the opposite of that is true. A frogged leg position is one of the best, most stable positions for the hip. When children have developmental hip dysplasia and need to have the hips stabilized that is the position they’re braced in because it helps deepen the hip socket. From a anatomical/physiological standpoint, the dangling legs that occur with forward facing are significantly worse for a child’s hips than sitting criss crossed or frogged.

The next concern is that it’s uncomfortable. I can’t speak for all children, but as the mother of an extended rear facer and the friend of many children who rear face until age 4 and sometimes beyond, it really isn’t the case. Parents want children to forward face, but most kids, especially before age 2, they have zero idea that there are any other options besides what they’re used to.

rear facing1

Eli is 26 months, his feet touch the seat in all his car seats and he’s never expressed any discomfort (and trust me, he can express it). He’s able to sleep very, very well in his car seats, which I’d argue is pretty challenging if you’re uncomfortable. Many kids who forward face have issues with the legs falling asleep and the head slumping, neither of which are an issue with rear facing.

rear facing 3
(He looks just miserable, huh?)

Another major concern is about what happens in rear ending collisions. I can see why this is a concern, unquestionably, since the back of the car will move toward the child. Rear end collisions comprise less than 20 percent of serious car accidents, so even if there was a risk to a rear facing child, it would be a rarity for it to even be an issue. Most rear ending collisions are at low speed and do not result in injuries and do not result in enough intrusion to even be a concern. However, even in higher speed rear ending collisions, a rear facing rider will be no more at risk than a forward facing back seat passenger. Their seat will move forward and they will ride into it, which moves them away from the intrusion.

The only reason for forward facing over rear facing that I have no response to is car sickness. Studies show that there’s no significant difference in car sickness in rear v. forward facing as long as the child has a clear view out a front or back window, but I know that it’s not been the case for many people. I do not recommend this, but I can absolutely understand how a child vomiting in their car seat would present a significant safety hazard (as a distraction) and may outweigh the benefits of rear facing. It’s a decision that needs to be very carefully weighed and not taken lightly.

No one here is advocating rear facing beyond the limits of a car seat, but if a child still fits within the height and weight maximum of a seat, there is no reason to turn them around and doing so immediately reduces their safety in the car. Yes, decades ago we survived without car seats and forward facing from birth, but a lot of other children haven’t. If we want to reduce the number of fatalities and catastrophic injuries from car accidents, we have to educate ourselves and educate others. We have to move forward and not take new research and recommendations as a criticism of our parenting or the choices we made before we knew better.

It is critical that we listen to the science and that once we know better, we do better. Our children look to us to keep them safe. There is no question that rear facing, until at least age 2, or if possible, age 4, is the best way to do that in the car.

Things I’ve Learned this Week

You ever have one of those weeks where you just feel like a rookie at everything you do? Because yea, this was one of those. In no particular order, things I learned this week:

1. Just because a stuffed animal tag says to hand wash doesn’t mean that hand washing will actually get the smell of vomit out of it.
2. Stuffed animals that say they must be hand washed do just fine in a washing machine.
3. The gentle cycle was not made for items covered in vomit.
4. Sometimes, toddlers throw up in their bed for no reason and then sleep in it quietly all night.
5. Toddlers are disgusting.
6. Scentsy plug ins are the greatest invention of all time.
7. If you try to remove a Scentsy from an outlet while the wax is melted, no matter how carefully you pull, you will throw hot wax all over yourself and your surroundings.
8. Seriously, no matter how carefully you do it. Trust me.
9. The group B strep test is a horrific invasion of personal space and it turns out it’s something you might forget between pregnancies.
10. My 2 year old now has the cognitive and language abilities to have an actual argument with his father.
11. He also has the persistence to win the argument.
12. If you buy your toddler cute pajamas, they will never want to take them off and might wear them to preschool pretty much every day.
13. If you put your toddler in a normal shirt and pants, ones that would be acceptable to wear to preschool the next day, to sleep in, and feel like an evil genius for thinking of this, they will ask to change out of their jammies in the morning.
14. Eli thinks flip flops are called clip clops and that is now what they are called forever and ever.
15. Toddlers can live on air and water and bananas for days at a time.
16. Items tend to cook better in the oven when you turn it on.
17. They also cook better if you don’t accidentally turn it off halfway through.
18. The timer and the oven buttons are very close together.
19. Insurance companies can limit the number of generic Zofran you can get each month, even if your doctor prescribes a normal dosage and even if you’re pregnant with persistent nausea.
20. Because apparently insurance companies know more than physicians.
21. You can eat several pints of ice cream and all kinds of terrible things when you’re 35 weeks pregnant and not gain an ounce.
22. Somehow, pieces of tile can get into your Bisquick.
23. Bisquick takes these claims SUPER seriously and will call you at 8am the morning after you submit an email.
24. They will also tell you that it’s not tile, but hardened “product.”
25. Apparently, if the “product” is left in the equipment too long, one side lacquers itself. Or you know, IT’S A PIECE OF TILE.
26. There’s something kind of sad about your toddler switching from calling you mama to calling you mommy.
27. I have the cutest toddler on earth. Okay fine, I didn’t learn that this week.

Second Verse

I think I have been in a bit of denial about the impending birth of my second child. The first trimester was so long and so slow and I wanted it to go faster and now that I’m at the end, I am trying desperately to find more time. Despite the fact that I’m having another boy, things could not feel more different this time.

I’m less nervous about the birth than I was last time. That’s just a product of it no longer being an unknown. I know that it is going to hurt like hell and that epidurals are amazing. I know that the pain will be temporary and I am trying to not forget that the contractions don’t stop when the baby is born, because that made the second day kind of traumatically upsetting last time. I’m told it’s worse this time, but even that is short lived, I know.

I am much more nervous about breastfeeding, and then also less nervous about not breastfeeding. With Eli I was a disaster. He was born, they put him on my chest, he wiggled his way to my breast and then he did nothing. Did not root, did not suck, did not have any interest in any of that for anything other than a pillow. For two hours of bonding time we tried to convince him and he was not having it. The nurse tried to stimulate his rooting and sucking reflex and…nothing. He didn’t eat a thing for almost 24 hours.

I carry some guilt about this, because I was trying so hard to be relaxed and not one of those crazy new mothers that I didn’t ask for the help I needed. I just went with the, he’ll figure it out, and when he didn’t, I still tried to stay calm. I let lactation consultants discharge us when we weren’t anywhere near ready to be independent with feeding and then when it didn’t work out, I got so obsessed with succeeding on some level that I cried when I had to supplement with formula and I pumped 6-8 times a day for a year.

Let’s say that virtually none of that is going to happen this time around. I’m going to try to be relaxed, but I’m going to advocate for us. I’m not going to get caught up in the formula is evil for only my baby mindset and am going to feed my child however works best for us. I want breastfeeding to work, but not at the expense of my sanity. I lost so much time with Eli to pumping and crying and worrying and I will not do that this time.

While I was sure I was going to go early last time and was instead 6 days overdue, I still have a suspicion I won’t make it to my due date with this one. Partially it’s just a weird gut feeling, and partially it’s that I was already dilating and effacing at 26 weeks and have contracted all the live long day since then. If these contractions strengthen the uterus, mine is an absolute beast by now.

Eli was an excruciating 6 days overdue and I was awful. I was homicidal. I hated everyone and everything. I won’t do that this time. This time I will remember that Eli was only 6 pounds and 15 ounces after being overdue and it’s clear my body waited for a reason. If this baby doesn’t come early, I know it’ll be for a reason. I know my doctor will monitor me and make sure everything is safe and then I have to trust that my body knows what it’s doing.

And while all of that sounds like I have things mentally in control, that’s…not entirely true. I am terrified of the transition from 1 to 2. I feel like Eli is going to struggle and it makes me sad and scared. I’m worried I won’t be able to take care of them both alone, which I will have to do a lot of and, which is not a surprise, obviously, just a fear. I fear the sleepless nights followed by the toddler mornings. I can’t even talk about how scared I am to go back to work when this baby is only 14 weeks old (I know many people have it tougher, I just had a bit more time with Eli). For all the knowns this time, there are still so many unknowns left.

I have 5.5 weeks left until my due date and I know most of this stuff will play itself out one way or another, but I am both totally ready and not even a little bit ready. Life is crazy that way. I’m horribly uncomfortable and exhausted, but I’m also comfortable with life as I know it. And we all know that change is never a good thing. I guess unless it’s tiny and cute and a baby.

Welcome!
I'm Katie, a 30-year-old, wife, mom, former teacher-turned PT, who also had brain surgery in November of 2007. This blog chronicles my daily life, from mundane to crazy, often with far too much detail. Sit down, get comfortable and stay for a while.
Social Media Links
RSSTwitterFacebookpinterestinstagram
Email
overflowingbrain@gmail.com
Categories
Previously…
BlogHer Reviewer