Consequences of Stress on Children's Development

This week we were required to talk about a stressor that affected us during our childhood. One of the main stressors that affected me during my childhood was disease. I lost both of my grandmothers, and my father to diseases. My paternal grandmother died to cancer (colon), my maternal grandmother died to diabetes, and my father to lung cancer. These were three of the most important people in my life. The consequences of these stressors caused me to become cold, and not allow people to get too close to me. I feared that like my father and grandmothers, they would leave me as well. I didn't want to feel, and I didn't want to love. Of course, I love my mother and my family, but I feared that they too would leave and I would be heart broken again.

We were also asked to Choose a region or country in the world that you would like to know more about and/or for which you have a special affinity. Find out, and describe, the kind of stressor(s) that impact the development of children in that region/country and what is being done to minimize the harm.

“In cases like Afghanistan with a combination of conflict and prolonged drought, the coping mechanisms of children have dwindled. They are malnourished; they suffer from a variety of illnesses. If they have a bout of measles, the fatality rates will be high.” – Deputy Director, UNICEF Supply Division, Shamsul Farooq, former Senior Programme Officer in the Humanitarian Response Unit. (http://www.unicef.org/immunization/index_why.html)

Another example of how diseases effect children.

"Pneumonia, diarrhoea, malaria, measles, HIV/AIDS and malnutrition are the primary killers of children in the developing world. These children die because they are poor, they do not have access to routine immunization or health services, their diets lack sufficient vitamin A and other essential micronutrients, and they live in circumstances that allow pathogens (disease-causing organisms) to thrive.

The possibility that children will become seriously ill or die depends largely on whether their immune systems can fight off infections. Malnutrition, combined with unsanitary or crowded conditions, makes them extremely vulnerable. Measles, for instance, rarely kills in industrial countries but can cause up to 40 per cent mortality among infected children in dire and overcrowded situations which may occur following earthquakes, floods or when populations are displaced by conflict.

A variety of pathogens – bacteria, viruses and parasites – are responsible for the major childhood diseases. Bacteria causes tetanus, diphtheria, pertussis and tuberculosis. Viruses cause polio and measles. A single-celled parasite causes malaria.

Measles, a viral respiratory infection, killed over 500,000 children in 2003, more than any other vaccine-preventable disease. The measles death toll in Africa is so high – every minute one child dies – that many mothers don't give children real names until they have survived the disease. Measles weakens the immune system and renders children very susceptible to fatal complications from diarrhoea, pneumonia and malnutrition. Those that survive may suffer blindness, deafness or brain damage.

Tetanus, referred to in the Old Testament as the “seventh-day death,” killed an estimated 200,000 newborns and 30,000 mothers in 2001. The tetanus bacteria are ubiquitous – they live in soil, in animal dung and in feces. Tetanus can infect newborns if the umbilical cord is cut with unsterile instruments or the incision treated with contaminated dressings.

In acute respiratory infections such as diphtheria or pertussis, bacteria can attack the lungs or bronchial tubes, causing chronic coughs, pneumonia and breathing difficulties. Pertussis – also known as whooping cough – kills about 300,000 children a year, while a third respiratory infection, Haemophilus influenzae type b (Hib) pneumonia kills about 500,000.

“In cases like Afghanistan with a combination of conflict and prolonged drought, the coping mechanisms of children have dwindled. They are malnourished; they suffer from a variety of illnesses. If they have a bout of measles, the fatality rates will be high.” – Deputy Director, UNICEF Supply Division, Shamsul Farooq, former Senior Programme Officer in the Humanitarian Response Unit.

Polio, a viral infection of the nervous system, can cause crippling paralysis within hours. Significant progress has been made towards eradicating the disease, but it remains a serious threat to children in areas where the wild poliovirus still circulates. The number of cases worldwide dropped from 350,000 in 1988 to under 1,300 in 2004.

Haemophilus influenzae type b (Hib), prevalent mainly in developing countries, is estimated to cause approximately 3 million cases of serious disease and kills about 450,000 children every year. Most children die from pneumonia and a minority from meningitis. In developing countries about 40% of Hib meningitis cases are fatal, and 15-35% of children who survive are left with permanent disabilities. Despite gradual uptake of the Hib vaccine in developing countries, in 2001, only one in five children worldwide were immunized against Hib during the first year of life.

Rotavirus, a pervasive wheel-shaped virus, is a leading cause of severe diarrhoea in infants and young children, particularly in the developing world. Currently, there is no vaccine approved for the disease, which kills 600,000 children under five each year.

Hepatitis B virus infects many infants and children – more than 2 billion people have been infected with the virus at some point, and an estimated 350 million are lifelong carriers. However, most don't develop the clinical disease until several decades later when the virus can cause inflammation of the liver and lead to cirrhosis or liver cancer.

Yellow fever, a viral disease that occurs primarily in tropical and subtropical areas of Africa and South America, kills 30,000 each year. The virus is transmitted most often through the bite of the female Aedes aegypti mosquito. Once controlled fairly well by widespread vaccination and mosquito control, the disease is making a comeback and outbreaks are becoming more frequent.

The parasitic disease malaria is responsible for a staggering number of deaths - over one million a year - the majority children under five. A child dies every 30 seconds from malaria, many in just days after infection. Pregnant women infected with malaria can give birth to underweight babies who are then vulnerable to other diseases.

Today, 90 per cent of malaria cases occur in sub-Saharan Africa. Malaria, so named by the Romans because they believed it arose from bad (mala) air (aire) floating up from nearby swamps, is in fact caused by a single-celled parasite, Plasmodium, which is transmitted by the bite of the Anopheles mosquito. Though there is no vaccine for malaria, it can be controlled with mosquito nets and insect repellant, and is often treatable with antimalarial drugs."









Ashley Wilkins-Miller

Child development in public health

Breastfeeding has always been important to me because of my experience breastfeeding both of my children. I nursed my son until he was 6 months, and I am currently nursing my 9 month old daughter. I plan on nursing her until she is one. I was also a WIC nutritionist for 2 years, so I am well aware of the benefits of breast feeding.






The World Health Organization (WHO) recommends mothers exclusively breastfeed infants for their first six months to achieve optimal growth, development and health, yet globally less than 40% of infants under six months of age are exclusively breastfed.





In an article from http://www.havingababyinchina.com/



When it comes to breastfeeding, China is a bit of a conundrum. Although statistics tell us that China has better breastfeeding rates than the US and Europe (http://www.llli.org/cbi/bfstats03.html), most people having a baby in a Chinese hospital will feel there is far less support and understanding about breastfeeding. Most mothers will experience a large amount of pressure to formula feed in the hospital. This is true for foreign mothers and even more true for Chinese.

Living in China you have probably noticed that formula marketing is rampant. Formula samples are given at prenatal checkups, free “breastfeeding classes” are held by formula companies, their posters are all over the walls of most hospitals. Dr.’s and hospital staff receive perks from formula companies for promoting their products. WHO and UNICEF’s Baby Friendly Hospital Initiative prohibits formula promotion or pressuring. There are over 6,000 Baby Friendly Hospitals in China compared to 105 in the US. Still I can personally attest to being in Baby Friendly Hospitals where I see at least 4 of the 10 requirements being routinely broken.

Perhaps one explanation for the difference seen between statistics and real experience is that the statistics are for the whole of China. If you look at the major metropolitan cities you see a much bleaker picture. For instance, in Shanghai, breastfeeing rates at 4 months are 22% compared to country side Chengde at 76%. The national target is 80%. (Sources: 1, 2, 3)

Still, the general attitude in China is pro-breastfeeding. In contrast to the West almost all Chinese women plan to breastfeed. Breastfeeding in public is much more acceptable in China than in the West. Since the 2008 formula scandal breastfeeding has been promoted. For most, formula feeding is not seen so much as a “choice” and women only plan to use it if they have to. Still with a lack of medically sound support, unethical marketing, and abundant family pressure few manage to exclusively breastfeed and wean long before they hoped to.

So if you plan to breastfeed what should you expect when having a baby in China?

Hospital Stay – Do not expect hospital breastfeeding support

Those foreign mothers I’ve talked to who had babies at international hospitals report receiving help with breastfeeding and less pressure to formula feed. I can’t say the same of Chinese hospitals. Of course you might get lucky and discover a local hospital that is supportive of breastfeeding! If so, use the forum on this website to promote that hospital! In any case, it is best to prepare yourself with information so you can combat any poor advice. Here are some issues to be prepared for:

Colostrum: There is a lack of understanding in Chinese hospitals when it comes to colostrum (the special breastmilk produced the first 3-4 days). Colostrum is often ignored, babies are given formula and water, and breastfeeding is started once milk comes in (day 3-5). This is unfortunate as colostrum is of paramount importance to infants. It seals the gut to protect against pathogens, colonizes the GI tract with friendly bacteria and enzymes, and it has a laxative effect that helps prevent jaundice. Because colostrum may not be abundant and looks different than mature breastmilk (and very different from formula) many doubt it’s ability to nourish a newborn. Research (and all of human history) shows that colostrum is the perfect amount for the newborns tiny stomach and is essential to infant health. No supplements of water or formula should be given unless medically indicated. Understanding colostrum and it’s transition to mature breastmilk will help you feel confident exclusively breastfeeding. See the World Health Organization’s website for more info on why exclusive breastfeeding is so important: http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
Water: Chinese see breastmilk as food not drink. 吃奶 means “eat milk.” This idea along with some Chinese medicine has lead to the belief that all babies, even right after birth, need to be supplemented with water. You will probably be instructed to give your baby water. Knowing that breastmilk has water in it and knowing the risks of giving water can be helpful. Giving water to newborns worsens jaundice, makes infants more susceptible to infection and allergies, brings imbalance to blood sugar, leads to reduced caloric intake, and lowers milk supply. There is really never a medically indicated reason to do it. Every major health organization advises against any supplements (water, food, formula) until around the baby’s 6th month of life.
Breast Massage: This is actually big business in China! Expect to have at least one visit a day from a breast massage therapist hoping to be hired. Usually they just give you their card and move along but I have observed that they can be very persistent. Even freely squeezing your breasts (without asking!) and telling you you don’t have enough milk. Although breast massage can be useful it is something any mother can learn to do herself. These services are usually offered to fix two problems, engorgement and low milk supply. Both of these problems are usually due to infrequent feeding and both can be fixed by increasing breastfeeding frequency.
Getting Enough Milk?: In China being told your baby isn’t eating enough is common. When your baby is first born breastfeeding VERY frequently is normal. 10-12 times in 24 hours or more. As your milk comes in and your baby’s stomach grows time between feedings will lengthen. Just because your baby seems to want to constantly be at the breast it doesn’t mean you don’t have enough milk for him. It’s helpful to know accurate ways to asses adequate intake. You can know how much is going in by how much is coming out! Take this chart with you to the hospital for reference.
* Day One: 1 wet, 1+ meconium (dark tarry) stool
* Day Two: 2-3 wet, 1+ meconium stools
* Day Three: 4-6 wet, transitional stools
* Day Four: 4-6 wet, transitional stools
* Day Five: 6+ wet, 3-4 yellow stools

(Taken from “Core Curiculum for Lactation Consultant Practice, 2nd Edition,” Mannel, Martens, and Walker)

Breastfeeding Issues after Discharge

Well Baby Checks: Unless you’re going through an International style clinic or hospital you may not have scheduled well baby checks. Well baby checks are important to the breastfeeding mother because your baby can be weighed, measured, and you can be assured that he/she is getting enough milk. Also most serious cases of jaundice present AFTER discharge. Especially if your baby still appears jaundice after you leave the hospital schedule a check up soon. One of the easiest solutions parents have found is to look online to find the normal schedule for check-ups and vaccines from their country and try their best to follow it.
Growth Charts: In China there is an outdated growth chart in use in most hospitals and clinics. In the West there is a slow transition to using growth charts based on breastfed babies instead of formula fed babies. The WHO chart is the one to use for breastfed or mostly breastfed babies http://www.who.int/childgrowth/standards/en/. Take it with you whenever your baby will be weighed and measured. Many mothers have been told to wean or supplement with formula because their baby is in the lower percentile on a faulty chart. Whatever you hear at a check up you can take home and look up. Some families have found it useful to purchase a digital baby scale so they can keep track of weight themselves. Scales in hospitals also seem to vary greatly so it’s good to use the same one consistently.
Nutrients: Breastfed babies often have lower iron levels and I’ve heard of many mothers being told their babies are anemic. Breastmilk iron is unique and is extremely well absorbed. 50%-70% compared to 1%-12% in formula. So breastfed babies who may test low in blood iron levels may be thriving just fine. Anemia is a serious condition so don’t take it lightly. But do consider a second opinion, preferably from a pediatrician who is familiar with breastfed babies. Research has shown that babies who are exclusively breastfed for the first 6-7 months are at a lower risk of becoming anemic than formula fed babies. (Pisacane in 1995) Breastfed babies are often also told they are calcium deficient. This again is based on the high levels of calcium in formula that are not bioavailable to the baby. Always take your baby’s blood work home and do a little research for yourself before you get scared by statements like “you’re milk is bad quality” (very unlikely), “your baby is deficient in ______”, or “your baby is underweight.” Chart of normal iron levels: http://www.kellymom.com/nutrition/vitamins/iron.html#lowiron Iron rich foods for babies starting solids: http://www.llli.org/faq/firstfoods.html
*“Stop Breastfeeding”: Of the many breastfeeding mothers, foreign and Chinese, I interact with here in China almost all have been told to “stop breastfeeding” at least once by a well meaning health professional. Unfortunately, weaning is often advised here with problems such as mastitis, slow weight gain, sore nipples, or even a cold. In all of these situations abrupt weaning will only cause many more problems for both mom and baby. That being said don’t just “tough out” breastfeeding difficulties! Get good support and help.

Milk Increasing Foods: The Chinese have many traditional galactogogues (food or herbs that increase milk supply). Soup, especially fish soup, is said to increase milk supply. Scientifically, we know that breastmilk production is regulated by a “supply and demand” system. No amount of special food will be able to save the milk supply of a mother who is not allowing her baby to drive her supply by frequent breastfeeding. That being said some Chinese galactogogues may have a cause a slight rise in prolactin (milk making hormone) levels. Fish soup is a great source of calcium, important for a culture that doesn’t consume much dairy. Except for anything typically high in toxins (like shellfish), there’s no reason not to try the “more milk” foods your ayi makes for you!
Resources and Support for the Breastfeeding Family

Lactation Consultants: In China there is no real concept of lactation consultant practice. This is not true of other Asian nations. South Korea has a very large number of International Board Certified Lactation Consultants (IBCLCs) as do Japan and Thailand. Lactation Consultants hold an official certification and are often employed by hospitals or pediatric offices in developed nations. In China, advice about breastfeeding is left to nurses (who usually have very little training), Yue Zao (the ayis hired to help a mother during her “sit month”), breast massage therapists, and mostly family members. Contacting a lactation consultant in your home country by phone or email may be possible. There are a few in China who are understandably overworked.
Support Groups: La Leche League International is active in China with Leaders in the following cities: Shanghai, Beijing, Hong Kong, Qingdao, Kunming, and Suzhou. La Leche League groups are fun to attend and are a great place to find support and encouragement. If you wish to know about a La Leche League group in your area see www.muruhui.org. This site is in Chinese. You may contact me if you cannot find the information you are looking for there. No LLL group in your area? Start your own support group! Just get together with some other moms and start sharing what you’re learning. As all of us expats know, friendship and encouragement are important ways to avoid feeling alone.




This has impacted my current life because it is my life. I have seen the benefits and I am TOTALLY for it.






Ashley Wilkins-Miller

EDUC-6160: Birthing Experiences

Hello All and welcome to my blog!

In our EDUC 6160 course, week 1, we were to answer these questions:
•Write about a personal birthing experience. It can be your own birth, your child's birth, or one you took part in. What do you remember about the event? Why did you choose this example? What are your thoughts regarding birth and its impact on child development?
•Choose a region of the world or a country, other than the U.S., and find out how births happen there. Write about what you learned, and the differences and similarities with your experience (in the personal example you provided). What additional insights, if any, about the impact of the birthing experience on development, did you gain from this comparison?

This first post will explain my personal experiences and another region's tradition of the "birthing experience".
I had my son in 2009 and my daughter in 2012. Both experiences were very different and had some similarities. I had my son 3 days after I graduated college. The week of my graduation was very eventful to say the least. I graduated from Winthrop University on Saturday, moved back to my home town on Sunday, and had my son on Wednesday. Whew!?! I had him two days before my due date. I went into labor at 2am. Unaware of what was going on with my body. I was unprepared and scared. I asked for EVERY DRUG I could get, I stopped dilating at 7.5 cm, and I had to have a C-Section. My recovery was terrible to say the least.
My daughter was born 3.5 years later, this time I was prepared. I opted to try a VBAC , all natural, and on my own terms. I was also fully prepared to have a C-Section if needed. My daughter was born 2 weeks early. I went to my weekly check-up to find out that I dilated to 3cm. My doctor sent me straight to the hospital. I had my music, bag, and everything ready. My husband still laughs about what he calls "Monk Music". all was well. I dilated to 9 cm without any medication, but due to a medical issue(TMI) I had to have another C-Section. Unlike the first one, I was calm, and it was a beautiful experience. My recovery was AWESOME!!!I bounced back within the first two weeks.

Here are a couple of interesting practices from different countries that I researched.












The Netherlands

Most expectant moms in Holland don't see an obstetrician, but are instead referred by their family doctor to a local midwife practice. Doctors only intervene in high-risk cases or if complications arise during delivery. Dutch women decide whether they want a home or hospital delivery. I was surprised to learn that more than half of the women at my midwife's practice deliver at home. In fact, all expectant mothers in Holland are required to pick up a kraampakket that includes all of the medical supplies necessary for a home birth. If you choose not to deliver at home, your midwife will make a house call to check on the progress of your labor and determine the ideal time for you to go to the hospital.

Even if you opt for a hospital birth, it's unlikely that you'll get an epidural. Epidurals are usually only given if it's convenient for the anesthesiologist's schedule (people often joke about the Dutch 9-to-5 epidural) or if an obstetrician determines it is necessary. Giving birth naturally remains the ideal for the vast majority of Dutch women. As my due date approached, I became more open to the idea, and in the end, no one was more surprised than I was to realize I had given birth to our son without any painkillers.

If a mother gives birth early in the day without complications, she and the baby may go home in as little as two hours. Then the unique Dutch system of kraamhulp (maternity home care) is set into motion. For seven days we had a nurse come to our home, a benefit covered by insurance. Not only did she provide medical care, but she also cleaned our apartment, cooked, and instructed us in basic parenting skills.

Local custom: Another important duty of the nurse is to manage the flow of visitors and make the traditional snack to celebrate a birth: beschuit met muisjes, which literally translates as "biscuits with mice." The "mice" are actually miniature licorice bits with blue-and-white coating for boys, pink-and-white for girls.


-Wow, I love the perks that these moms get.















Germany

As in Holland, in Germany women see midwives for their prenatal care. In fact, midwives are so respected that by law a midwife must be present at every birth, and a doctor is optional.

Malin Haugwitz, a Berlin resident who is originally from Bethesda, Maryland, says that German women focus on the event of giving birth almost more than the outcome. Following her second c-section, she heard many words of pity from friends and even from her midwife, who asked, "Do you see it as a failure?"

German women who hold full-time jobs can feel secure knowing their position will be waiting for them when and if they decide to return to work. As soon as a woman tells an employer she's pregnant, she cannot be fired. Thus, during economic downturns, being pregnant can essentially save your job. Women may stop working six weeks before their due date and are forbidden from working for eight weeks after giving birth, all with full pay. Mothers may even take up to three years of unpaid leave, the third being a floating year that can be taken at any time and by either parent.

Local custom: Another practice that Haugwitz recounts is that government offices keep a list of "accepted names" that parents must adhere to when registering the name of their child. In the case of an unusual name, they must give a compelling reason why an exception should be made. The government policy is intended to act in the best interest of the child, in an effort to thwart potential ridicule of a child with a name that's too different.


- I would LOVE to get up to three years off to take care my child with full pay, but I think some people would be in trouble with the name restriction in the states. LOL.



In the US, some women are granted 6 to 8 weeks time off to heal from their birthing experience, but I have never heard of three years on leave. That is pretty AWESOME!!!




Ashley Wilkins-Miller