Go ahead Congress, take your pick!

The Chicago Tribune (12/6/17) reports that Illinois has enough funding for its Children’s Health Insurance Program to last through September, according to the Illinois Department of Healthcare and Family Services = 250K children

The New Orleans Times-Picayune (12/6/17) reports Louisiana will exhaust funding for the state’s Children’s Health Insurance Program in mid-January if Congress does not renew federal funding. = 115K Children

The Tennessean (12/6/17) reports the “uncertain future of the Children’s Health Insurance Program, known as CHIP and called CoverKids in Tennessee, is worrying physicians and advocates as well as state officials who could be left to decide whether to use taxpayer money to continue the program if Congress fails to act. = 80K Children

The Dallas Morning News (12/6) reports Texas is considering “an accounting trick” to extend its Children’s Health Insurance Program “a few more weeks.” The Morning News says that “by not taking matching money from the federal government for kids who used to be enrolled in CHIP but are now covered by Medicaid, Texas can stretch the remaining federal funds.” State officials are exploring “contingency funding options.” The state requested an extra $90 million from the Centers for Medicare and Medicaid Services and expects an answer before Saturday

This is happening, and it doesn’t have to. So you know, the estate tax, applied to the monopoly guy/girl leaving behind > 11M to their lucky kids, generates 20B dollars and will be rescinded (at least in the house version). CHIP costs 15B, and insures 9 M kids (500K Hoosiers). For Orrin Hatch to declare “The reason CHIP’s having trouble is that we don’t have money anymore” is an insult to our decency as a society.

This is a non-partisan issue (77% of democrats and 63% of republicans support the program. I see these kids in my clinic EVERYDAY. They are good kids, that deserve the chance to succeed. Their success depends absolutely on being healthy. So I vaccinate them, screen them for developmental difficulties, check their hearing and vision, treat their illnesses, and get them into specialists when they need it. The Children’s Health Insurance Plan lets this happen.

Like early pre-K investments, an investment in children’s health pays off in many ways by not only by staving off potentially chronic illnesses down the road, but also enabling them to be productive members of our community.

It’s time to get our heads out of the sand, and realize that time is running out. Call your legislators and demand action.

-IndyPedsDoc

Rep Jim Banks Website

Senator Todd Young Website

Senator Joe Donnelly Website

 

“Congress, Do Your Job!”

 

A Call for Improving Our Healthcare System from the Peyton Manning Children’s Hospital at St. Vincent department Chairman, Dr. Alan Schwartz, MD FAAP

What is a politician?  At the most fundamental level, a politician is one who is engaged in government; usually an elected official.  A politician is someone, then, who studies and creates public policy for the betterment of society.  An honorable profession at its heart.  Where we often differ is in what society considers “betterment!”  I think we all can agree that those in government should, and for the most part do, care about the citizens they represent.  It is therefore puzzling that this pursuit of a healthcare policy for the betterment of the citizens of the United States has proven so contentious.

As a primary-care pediatrician in Indianapolis, I have the opportunity to provide health supervision to the most vulnerable yet most important citizens for the future of our community—our children.  As the chairman of the St. Vincent Hospital Department of Pediatrics, I am aware of the myriad and complex medical needs many of our children have and the barriers that exist to providing this care.  Now I am confident that our Representatives and Senators in Washington, D.C. did not set out to add to these barriers or to prevent our children from receiving the health supervision, preventative care, and medical treatments so important to their health, growth, and development, but, the political climate being what it is, that is exactly what will happen if the proposed policies of the House of Representative’s American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA) become law.

Under the current Affordable Care Act (ACA), those individuals with pre-existing medical conditions cannot be denied coverage nor can that coverage cost more.  Both the AHCA and the BCRA, while touting this same coverage, in reality allow for waivers for states which ultimately would lead to either increased patient costs for this coverage, or actual exclusion and elimination of coverage for some pre-existing conditions.  Why is this important?  Visit any major hospital Newborn Intensive Care Unit (NICU).  There you will find many “pre-existing conditions” ranging from congenital defects to pulmonary disease to extreme prematurity with resultant developmental and neurologic consequences.  Many of these medical conditions will be life-long and require ongoing evaluation and treatment.  How will these children become insured?  And at what cost, if coverage will even be available for them?  What about a child who develops asthma, cancer, or diabetes?  That is now a pre-existing condition when they become an adult.  [As an aside, I wonder how many pediatricians were consulted as the AHCA and BCRA were being developed!]

Medicaid snapshot

Did you know that children make up nearly 60% of Indiana’s Medicaid population?  Over 90% of eligible children are able to benefit from this Medicaid coverage. Were you aware that almost half of the pediatric patients treated at Peyton Manning Children’s Hospital at St. Vincent rely on Medicaid for their healthcare coverage?  Under the current ACA, thirty-one states (including Indiana) as well as the District of Columbia offer expanded Medicaid coverage.  In my pediatric practice, this allows hundreds of children to receive preventative healthcare, immunizations, and illness treatments; and allows tens of thousands of children to receive the specialized care that they need from the pediatric specialists in our state.  While advertising to the contrary, it turns out that both the AHCA and BCRA will ultimately reduce the effective funds available for our Medicaid recipients.  These proposed programs phase out federal funding for the Medicaid expansion thus leaving states to “pick up the tab” for this funding difference.  States’ budgets being what they are, it is unlikely that they will be able to do so.  This shortfall in funding can only lead to three outcomes: 1) Reducing the number of people who can receive Medicaid benefits; 2) Maintaining enrollment but reducing the amount of services available; or 3) Cutting payments to physicians, hospitals, and other care providers.  All of these options will lead to decreased care for the children of Indiana. [Lest anyone wonder how #3 inhibits care—Medicaid reimburses only a fraction of what Medicare might cover, and is often not even sufficient to cover costs.  Those of us who care for children on Medicaid do so because it is the right thing to do, however we cannot personally afford to subsidize the program!  If reimbursement is cut further, many physicians will have no choice but to leave the program, thus creating a gap in care for these children.]

Providing for the health of all of our citizens—children and adults—is not a Republican or Democratic issue.  It is a moral imperative that should reflect the values of our country.  There is no question that our current ACA has some shortcomings.  But recognize that much of the recent turmoil has been created by our current leadership disrupting the funding and structure of the ACA causing the very problems that they rail against!  The AHCA and the BCRA will not fix our system and in fact will only lead to more uninsured citizens and higher costs for those able to maintain healthcare coverage.  Let us work together to improve the ACA—give it a different acronym if that helps—but do not simply destroy it in the name of partisan politics.  

It is no coincidence that most major national physician associations, hospital executives, patient advocacy groups, and a large majority of American citizens oppose the AHCA and BCRA which were largely formulated without any consultation or input from those who know healthcare the best!  It is now time for all of us to let our elected officials know that we care about the health of our children, of our families, of our friends.  We will all be “patients” at some point—even those in Congress and in the White House!  We must, therefore, make sure that the healthcare system we implement strives for excellence in care for every American regardless of their economic status or existing health concerns. The health of American citizens should not be some prize won by the most “political points!”  The health of American citizens should not be sacrificed by short-sighted political promises made!  It is time for Congress to do their job and do what is right.  And with resolve but with respect, let us all encourage those who represent us to do just that.

Respectfully,

Alan L. Schwartz, M.D.,

Chairman, Department of Pediatrics

Peyton Manning Children’s Hospital at St. Vincent and

St. Vincent Women’s Hospital;

Primary-care Pediatrician

My good-bye letter to the wonderful folks at Hendricks Regional Health

To all my wonderful friends at Hendricks Regional Hospital

            It has been the utmost honor to be your pediatrician, colleague, and friend these past five years. I was pretty nervous coming out of residency, gearing up to start my first real job. I had trained, like, since I was a fetus for this moment. It was hard to believe that I was ready to shove off on my own and practice medicine. Only, I wasn’t really ready. To be honest, I faked it a lot at first, and hoped that everyone wouldn’t realize how nervous I was, or how many times I sprinted downstairs to my office to look stuff up. But I soon realized that I didn’t have to do that quite so much, because everyone around me was constantly looking out for me, and for each other. A lot of people like to ask me, as a doctor, if I am afraid of making mistakes. I’m now comfortable knowing that I am going to make mistakes, because I’m human. But the only way I might hurt someone, is by ignoring the concerns from the team around me. And it really is an amazing team. I like to picture us on a typical day as a bunch of arrows pointing in different directions, which is fine because we all had lots of responsibilities. But then…. Sh#t hits the fan. And like magic, those arrows became compass points and everyone suddenly points in the same direction, towards the same end of helping a sick mom, baby, or child. We worked together really well, especially when hierarchical titles were put on hold, and respect for each other’s talents and capabilities became the priority. Your effort and devotion you put into your work is something I will always admire, and never forget. In fact, I could never quite figure out why there was a ‘doctors’ day. I sometimes feel like we are the most spoiled profession in the world compared to the hardworking hospital staff I observed everyday.

(above: first day on the job 7/16/2012. Note all the hair. This was before kids)

           I get quite a lot of satisfaction from my patient encounters. It’s what motivates me and makes me feel whole at the end of the day. But the most enjoyment by far was being welcomed by such cheerful faces (seriously!) each and every morning. You all let me into your lives, recounting accomplishments by your family, fun stories, and even sometimes your struggles. And it was reciprocated. I’ll never forget having a tough day, walking with my head down, when I passed one of the janitors in the hall. I didn’t even see her, but as I was walking by, she said sweetly, “cheer up!” It totally shook me out of my funk, and gave me a wonderful feeling of connectedness.  These personal connections were so valuable to me, and I felt it all the time. I’ll surely miss this job, but it’s you all that I will really miss the most. 

Thank you all for everything,

Sincerely,

Tony GiaQuinta

 

 

 

 

 

 

 

 

The kids are not alright. Call your Senator.

In the next two weeks, when you hear “funding cuts” or “caps” to Medicaid during any Senate discussion or debate (if there are any), you might be tempted to shrug your shoulders because either a) you don’t understand the implications, or b) it doesn’t affect you.

Please consider this: Medicaid, among other things, is insurance for children. A lot of children. 30 million children nationwide, of which 564,000 live in Indiana, making up 60% of Indiana’s Medicaid population. To be frank, Medicaid covers children who often need care the most. It is a lifeline for working families, and is relatively cheap, accounting for only 19% of Medicaid spending.

With Medicaid expansion, we are insuring children at historic highs well over 90%. Medicaid children receive all medically necessary care, including physician and hospital visits, well-child vistis and treatment, immunizations, dental, vision, and hearing services.

Medicaid image 3

So why would anyone want to cut Medicaid? It is a political motive, not a public health strategy. Cutting Medicaid is the only way to fulfill a political narrative to financially reconcile the difficulties of promising ‘repeal and replace.’ Unfortunately, Medicaid enrollees don’t advocate for themselves. They are low-income and disabled children. This is stealing from the blind, and for a nation that so often espouses moral principles when advocating for legislative action, this should not happen.

Hoosiers have two senators. Call them! Be the squeaky wheel for children! Tell them when you hear “cuts to Medicaid” that you aren’t fooled. Tell them to protect children’s health care coverage and oppose any funding cuts or caps to Medicaid. These next two weeks may dramatically impact the lives of millions of children in this country. Time is limited. It’s go time.  

Senator Todd Young           DC: 202-224-5623      IN: 317-226-6700

Senator Joe Donnelly         DC: 202-224-4814       IN: 812-425-5813

Other Senator’s contacts found here: https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Documents/Senator%20Contact%20List.pdf

IndyPedsDoc

My testimony to the Members of the House Education Committee re: HB 1004, expanding early preK

Chairman Behning, and Members of the House Education Committee,

My name is Dr. Tony GiaQuinta. I am a pediatrician for Hendricks Regional Hospital, and the vice-president of the Indiana Chapter of the American Academy of Pediatrics, representing over 800 Hoosier pediatricians. I am very proud of these credentials, but my favorite credential, by far, is father to two beautiful children, Margaret age two, and her four-year-old brother, Henry.

I am here today on behalf of Indiana’s pediatricians because we believe that success starts early, and therefore endorse an expansion of Indiana’s high-quality, pre-K commitment.

Our organization’s support is limited to funding pre-K. We are not here to either endorse, nor criticize, the school choice issue, which as been attached to this bill, as those are two separate issues. We would prefer pre-K be allowed to stand on its own sot that all sides can get behind this important movement.

You may be wondering why Indiana’s pediatricians would endorse an education bill.

Well, to begin, I’d like to share something neat my 4 year old did yesterday.

I was grocery shopping with my kids, and had somehow (some might say, miraculously), checked off everything on my wife Sarah’s grocery list. I had made it to the finish line, including the gauntlet of gum and candy at the register, when Henry asks the cashier for a sticker. She smiled, and gave Henry two. Well, Margaret saw that and just about flipped her lid. But then, something amazing happened: He put one sticker on his shirt, and took the other, and held it out to Margaret, to….share?

Wait. Is he sharing? Oh sweet Moses. This was it. Time slowed down as he held it out to her. A chorus of ‘alleluia’ started playing in my head. Never again would they fight, bicker, or taunt!

Well, it was a nice moment, but instead of handing it to her, he planted it square on her face. ‘A’ for effort… the execution needs some tinkering.  Thankfully, that was good enough for Margaret (and good enough for me, too) .

Why was this moment so significant, you might ask? Sure, as a dad, wanting your child to be a kind and sharing is something any parent strives for.

But as a pediatrician, I know that watching Henry offer that sticker for his sister, instead of himself, is a sign of a healthy brain developing and maturing.

The truth is, Indiana’s pediatricians know that house bill 1004 is so much more than an education bill. It is a bill that can protect and nurture Indiana’s most vulnerable brains.

You see, brain plasticity, or the ability of the brain to rewire itself in response to changes in the environment, declines with age. In fact, by age five, the vast majority of a child’s brain capacity is already developed. This creates a real, ‘make it or break’ timeframe when areas of the brain supporting memory and learning, can inextricably connect to the areas supporting social, emotional, and language development. If these connections are not formed by Kindergarten, they likely never will.

Conversely, when the environment fosters interactions that are sensitive and responsive to the child’s needs, neuronal connections are formed and reinforced that help the brain mature, and allow the child to succeed.  

Unfortunately, there is a large population of Hoosier children that are at grave risk of missing this important opportunity forever.  Specifically, this applies to 27,000 low-income four-year old Hoosier children that are at increased risk of suffering from toxic stress.  Toxic stress is the physiologic maladaptation of the brain and body to poverty and violence. Young brains exposed to toxic stress are unable to form the healthy connections between important brain structures. This disrupted brain architecture has significant adverse effects on physical and social emotional health across the lifespan.

High quality Pre K, however, rescues children from toxic stress by providing a secure, nurturing environment, strengthening healthy neural connections and setting a strong foundation for learning and adult success.

It is without surprise, therefore, that high quality preschool is associated with greater academic success, higher high school graduation rates, increased years of education completed, higher earnings, reduced juvenile crime, decreased adolescent pregnancy rates, decreased need for future special education services, and in sum a significant rate of return on investment.

Henry is lucky. He is in a high quality pre-K program, and the only stress he faces is getting his shoes on the right feet. Every day comes home from school with a full belly, and a brain further exposed to positive, stable, and nurturing influences that reinforce integral connections in his brain. He has every opportunity to succeed.

For 27,000 low-income four-year olds Hoosier Children, their toxic stresses and adverse experiences may see the window of their brain’s development, and window of opportunity for success, closed forever.  

Indiana’s pediatricians recognize that we are critical partners in this effort to keep children on the right track, and that partnership includes calling on our state leaders to recognize the importance of pre-K and sufficiently fund it to increase access. On behalf of Indiana’s pediatricians, we hope that HB 1006 is the feel good, everyone wins success story of this legislative session. By investing in high-quality pre-K and fulfilling a young child’s developmental needs, the long term benefits are realized not only by the child, but their children, their community, and our commonwealth.

#BanTheBumper

If there were no automobiles, children would never die from car accidents. Right.

But we need cars. They take us to cool and important places, like your Pediatrician’s office, or work, respectively. Therefore, we accept the risk of putting our children into cars, and do our best to make them as safe as possible. Carseats, anti-lock brakes, air bags, speed limits, rules of the road, etc.

If there were no crib bumpers, infants would never die from crib bumpers. Also right.

However, we don’t need crib bumpers. At all. Ever. They are seriously pointless, and worse, they can be deadly.

An article published by the Journal of Pediatrics this past year found that 23 infants were killed by crib bumpers from 2006-2012. Notice I didn’t say “only” 23 infants. These deaths are entirely preventable, making one such death needless and tragic.

So why are they still found in cribs?

Well, Pottery Barn Kids makes us think we need them; why else would they display them in their stores?

sketch-1

 

Pintrest makes us think we need them; how else can that barren crib look cute and cuddly?

crib-bumper

 

I’ll grant even common sense might make us think we need them, to prevent limb entrapment, or banging a vulnerable head against a hard rail.

Ultimately, all of these considerations are misleading.

Proposed benefits of crib bumpers include preventing entrapment of head, neck, or limbs between the crib rails, or preventing head trauma. Fortunately, the width of the rails, or ‘slats’ are regulated to be less than the width of a soda can. Limb entrapment does occur, but is not prevented entirely by crib bumpers. More importantly, limb entrapment is not a serious or deadly injury. There was one case of an infant hitting his head on a crib rail, causing a bruise. We (and your infant) can live with that.

We (and your infant) can also live with a plain, boring, nothing-but-baby, crib.

Pediatricians have advocated strongly against their use, and all soft bedding, as part of a comprehensive safe sleep policy statement issued in 2008, and reiterated in 2011. I personally don’t let a family leave my newborn nursery without explaining the safest possible sleep environment, ie, the lowest risk of sudden unexpected infant death. I tell parents to remember your ABC’s of safe sleep: Place infants Alone, on the Backs, and in their own crib. No bumpers. No stuffed animals. Make pinterest scoff in pity and disapproval. Your baby is sleeping safe tonight!

But it’s not enough, clearly. In this recent article published last month in Pediatrics, investigators got sneaky and filmed parents and their infant’s sleep environment. I’m not kidding. 91% had the stuff I just talked about in their sleep environments (bedding, bumper pads, pillows etc).

Sigh.

If only we treated crib bumpers like we do other things that are completely unnecessary and dangerous. Like, nuclear waste. You can’t buy that stuff because its dangerous, and unless powering your 1985 DeLorean for time-travel purposes, is completely unnecessary to possess. It’s probably illegal. Wait. Yes! That’s it! What if a crib bumper, which is clearly a hazardous, unnecessary material, were illegal to sell? Impossible? Wrong.

Maryland’s state department of health did just that, and in two short years from conception to action, passed a regulation banning the sale of baby bumper pads. You can read more here.

The INAAP Perinatal and Infant Mortality Committee believes Indiana should follow suit. On Monday, October 17th we will be advocating  “Ban the Bumper” day. On this day we invite everyone to share our messages through your Twitter and Facebook social media accounts, using #BanTheBumper.

Messages to share (cut and paste away!) include:

  • Crib bumper deaths are needless, tragic, and 100% preventable! #BanTheBumper #LaborOfLove16
  • 23 infants died because of crib bumpers from 2006-2012. We can put an end to this! #BanTheBumper #LaborOfLove16
  • Indiana ranks 45/50 in perinatal mortality. Let’s do everything possible to save these lives! #BanTheBumper #LaborOfLove16
  • A baby should be the only cute object in a crib #BanTheBumper #LaborOfLove16
  • Boring crib = safe sleep #BoringIsBest #BanTheBumper #LaborOfLove16
  • Your baby can live with a boring crib without crib bumpers! #BanTheBumper #BoringIsBest #LaborOfLove16

This date coincides with the Indiana department of health sponsored infant mortality summit, “Labor of Love,” where I will be presenting the dangers of crib bumpers, and advocating their removal from infant stores. And by all means, if you are driving by an infant supply store, or perusing Pinterest, and see these deadly, unnecessary objects in cribs, let them know they are endorsing a real threat to infant safety.

I hope you will join with INAAP as we encourage everyone to #BanTheBumper.

Tony GiaQuinta, MD FAAP

@IndyPedsDoc

Zika, Chikungunya, and Aedes Mosquitos. Oh My!

Until our honorable elected officials stop their political posturing and decide Zika is real bad and needs real attention, here are some tips to protect yourself and your kids from mosquitoes.

There are three basic strategies:

  1. Whenever outside, constantly scan your arms, legs, and all other exposed skin areas waiting for a mosquito to land. Quickly smack that son-of-a-gun into a unrecognizable insect paste. Make sure someone is constantly scanning your neck and other hard to reach areas, also ready to deliver a nice whack.
  2.  Never ever ever go outside this summer. There are plenty of great HBO series to get caught up on anyways.
  3.  Use a safe, effective insect repellent.

This doc wants you to go with #3.

#1 sounds exhausting and might start a fight. #2 would worsen our obesity epidemic, and kids aren’t mature enough for the suggestive adult content of some HBO series (I’m looking at you, Game of Thrones). No, kids really do need to spend time outside this summer, and you do, too.  Here’s how to do so safely.

Kinds-of-Insect-Repellent

Honestly, just remember to use a repellent with DEET in it. Or N,N-diethyl-meta-toluamide as I like to call it. Yeah, I know it’s a chemical made up of big chemically words, and I have no idea if it is gluten free or not. But it is the most widely used ingredient and has the most data on safety and efficacy.

Word on the street is there is no evidence that concentrations above 50% increase efficacy, so you can stick your nose up at that marketing ploy. My academy (The American Academy of Pediatrics) recommends using products containing up to 30% DEET for children.

Couple of considerations:

  1. Don’t use on babies less than 2 months old, use mosquito netting instead.
  2. Don’t use repellents under clothes
  3. Don’t use products that use both sunscreen and repellent, because sunscreen needs to be applied more frequently.

Pregnant? You’re good. They’ve studied DEET during 2nd/3rd trimesters of pregnancy, and didn’t see any adverse effects to the fetus.

Other options include:

  1. IR3535 – concentrations between 7.5%-20% are safe and effective.
  2. Picaridin – odorless, doesn’t damage clothing, no reports of toxicity. Use up to 10%
  3. Essential oils – Safe to use, doesn’t work as well. Zika!
  4. Citronella – Works well, doesn’t last as long

More info here!

That should do it. Enjoy being outdoors this summer! If you have time, contact your honorable congressman or congresswomen and let them your future children shouldn’t be a political pawn vs Zika. Here is the letter my academy wrote, for example.

– IndyPedsDoc

 

Breastfeeding for guys. I get it. You don’t have boobs. You can still help.

O.K. Dads here the deal: It’s 2AM, you have your new 2 day old baby at home for the first time, you’ve had 2 hours of sleep in the past 2 days, your kiddo isn’t latching on 2 mom well, tears of frustration are starting to well-up in her eyes and you have 2 seconds to figure out what to do before Mom, baby, and you start to lose it…. what do you do??

Terrifying? Yup. Been there… but don’t panic. If you weren’t trained for this before, I’ll help walk you through it.

Through my own trial and error, and pumping my wife for feedback, I have compiled a couple helpful tips of do’s and don’t that will help you breastfeed.

Tip 1: Consider breastfeeding a team sport with the mentality that you are both breastfeeding.

My wife really found it helpful for me to just be there, as an extension of her. Breastfeeding put an enormous amount of pressure on my wife. After all, breastfeeding is supposed to be natural and the best form of nutrition for your baby… to not succeed gave her feelings of not only failure as a mother, but also that the baby isn’t getting what’s best. Breastfeeding can be a very onerous responsibility, with the pressure of letting the three of you down. The more you make the act of breastfeeding seem like a team sport, the less guilt and burden she will feel when things don’t go so well (which usually is bound to happen). Hopefully you have some paternity time off that first week. I really do suggest waking up for those first few breastfeeds with your wife until things start going smoothly. Now, the question becomes, what to do while she is breastfeeding?

Tip 2: Make like Jeeves and wait.

I’m thinking that origin of ‘waiting on tables’ and thus, a ‘waiter’ probably stems from the responsibility to just stand-by, be patient, and ‘wait’ until given something to do. You don’t have breasts, so you have to find other ways to be a part of this breastfeeding team.

Here’s a couple pearls:

–          Keep a LARGE water glass full of cold water. My wife was ALWAYS thirsty, and really pretty parched for water. (I thought this was curious, so I looked it up. Guess what? Scientific article “Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation.”1 or in other words, baby sucking makes you thirsty). You will find that Mom is so focused on breastfeeding that she really can’t just press pause get things like a glass of water. In fact, with this one, don’t wait for her to ask, just keep a cold glass full by her side. She will notice and thank you.

–          She probably forgot to grab the remote control, lanolin cream, burp cloth, or tons of other little things before she sat down and got things started. Again, interrupting breastfeeding is really tricky for her. Be there to help get these things.

–          Impromptu shoulder rub. Just do it. She won’t mind.

Tip 3: You can over do it.

Yeah, I was feeling a little cocky. I went to the breastfeeding class. I followed around lactation doctors while in residency. I watched the lactation nurses work with my wife in the hospital. I’m IndyPedsDoc for crying out loud! I can be such a bonehead. Your wife does need you to be there emotionally and even physically… but she isn’t a cow that wants to be milked. Its one thing for a lactation nurse to manipulate her breast, but you are her teammate, and doing these things can make her feel as if she isn’t doing it right, and that you could do better. Leave her breasts alone unless she asks.

Tip 4: Reinforce that she is your hero

Especially during those late-night feeds when the latching isn’t going well and she asks, on the verge of tears, ‘What am I doing wrong?” or “Why isn’t he latching?” I found the best thing to do was kiss her on the forehead, maybe hand her a kleenex, and offer words of encouragement (check out my earlier blog with a note from our lacatation nurse for some easy tips that will help). You might have a tip that you remembered during your breastfeeding class, but again, don’t let her think that you could do better, or that she is doing things wrong. If things are really getting strained, it might be best to take a break and have her take a shower or nap, and call the lactation nurse in the morning. Remember: all babies are equipped with extra fluid on board until mom’s milk comes in, which means losing a little weight those first few days is normal. You can remind her that a newborn’s stomach is about the size of a big marble, so as long as the baby is peeing a few times a day, the baby is probably getting everything it needs.

Good luck Team! You are going to be great.

1) James RJ, Irons DW. Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation. , Clin Endocrinol (Oxf). 1995 Sep;43(3):277-82.

Gun Safety? Get real.

8/8/2013: My IndyStar published response to the awful news from Anderson, Indiana:

I can’t write an article every time a child is needlessly killed by a gun. If I did, I would probably have to quit my job due to the time commitment involved. Just in the last six weeks, in central Indiana, three kids have been accidentally killed. The latest fatality, however, emphasizes a point that we just can’t seem to grasp: THERE IS NO 100% SAFE WAY TO STORE A GUN.

The guns were hidden (in a closet).

The guns were locked away.

The bullets were separate from the gun.

The gun was unloaded….almost.

One bullet, unknowingly and accidentally left in the chamber, is what stands between a 13 year old honor student from going back to school today, shot yesterday by his 10 year old brother.

But we still don’t get it.

The Anderson Police department has called the case ‘a perfect storm of unlikely scenarios,’ musing that “had (the bullet) been in another chamber, it would have dry fired. The odds are just really unbelievable.” They are pleading with area residents to please keep your guns safe, even offering free gun locks.

Unbelievable odds? Nope. They are possibilities. Possibilities of your child getting killed. What a stupid game to play.

I am sick for this family. They have been given the delusion by gun advocates, and even the Anderson police department, that there is a safe way to store guns around children. There isn’t. Are there safer ways to store guns? Who cares?

Once again…

1) A gun kept in the home is 43 times more likely to kill someone known to the family than to kill someone in self defense.

2) A gun kept in the home triples the risk of homicide

3) The risk of suicide is 5 times more likely if a gun is kept in the home

Please stop kidding yourself, and each other, that there is a safe way to keep a gun in a home with children.