Category Archives: Baby Your Baby

Developmental milestones your baby should reach by 12 months old



By the time your baby is 12 months old, he or she should be able to do a variety of new things such as saying a few simple words and playing games.

Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the important milestones your child should reach by 12 months old and tools to help parents on this episode of the Baby Your Baby Podcast.

Social and Emotional

  •  Is shy or nervous with strangers
  • Cries when mom or dad leaves
  •  Has favorite things and people
  • Shows fear in some situations
  •  Hands you a book when he wants to hear a story
  •  Repeats sounds or actions to get attention
  • Puts out arm or leg to help with dressing
  •  Plays games such as “peek-a-boo” and “pat-a-cake”

Language/Communication

  • Responds to simple spoken requests
  • Uses simple gestures, like shaking head “no” or waving “bye-bye”
  •  Makes sounds with changes in tone (sounds more like speech)
  • Says “mama” and “dada” and exclamations like “uh-oh!”
  • Tries to say words you say

Cognitive (learning, thinking, problem-solving)

  • Explores things in different ways, like shaking, banging, throwing
  • Finds hidden things easily
  •  Looks at the right picture or thing when it’s named Copies gestures
  • Starts to use things correctly; for example, drinks from a cup, brushes hair
  • Bangs two things together
  •  Puts things in a container, takes things out of a container
  •  Lets things go without help
  •  Pokes with index (pointer) finger
  • Follows simple directions like “pick up the toy

Movement/Physical Development

  •  Gets to a sitting position without help
  •  Pulls up to stand, walks holding on to furniture (“cruising”)
  • May take a few steps without holding on
  • May stand alone

What do you do if your baby is not meeting these milestones?

Video resources for 12 months:

Can parents get their baby on back on track on their own, or is this something they need a professional for?

Most of the time, children get the developmental skills they need when they are given opportunities to practice. Parents play a huge role in their child’s development, and often can help their child right away. For example, if your child’s screening showed a delay in language, you help your child right away, just by practicing this area of development.

However, sometimes your child may need professional intervention. In these situations, it’s best to work with your healthcare or childcare provider to get resources or referrals to professional agencies who are trained to help your child reach their developmental milestone needs.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Developmental milestones your baby should reach by 6 months old



By the time your baby is six months old, he or she should be able to do a variety of new things such as rolling over and recognize faces.

Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the important milestones your child should reach by six months old and tools to help parents on this episode of the Baby Your Baby Podcast.

Social and emotional

  • Knows familiar faces and begins to know if someone is a stranger
  • Likes to play with others, especially parents
  •  Responds to other people’s emotions and often seems happy
  • Likes to look at self in a mirror

Language and communication

  • Responds to sounds by making sounds
  • Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
  • Responds to own name
  •  Makes sounds to show joy and displeasure
  •  Begins to say consonant sounds (jabbering with “m,” “b”)

Cognitive (learning, thinking, problem-solving)

  •  Looks around at things nearby
  • Brings things to mouth
  • Shows curiosity about things and tries to get things that are out of reach
  • Begins to pass things from one hand to the other

Movement and physical development

  • Rolls over in both directions (front to back, back to front)
  • Begins to sit without support
  •  When standing, supports weight on legs and might bounce
  •  Rocks back and forth, sometimes crawling backward before moving forward

What do you do if your baby is not meeting these milestones?

Listed below are 6 month milestone videos:

Can parents get their baby on back on track on their own, or is this something they need a professional for?

Most of the time, children get the developmental skills they need when they are given opportunities to practice. Parents play a huge role in their child’s development, and often can help their child right away. For example, if your child’s screening showed a delay in language, you help your child right away, just by practicing this area of development.

However, sometimes your child may need professional intervention. In these situations, it’s best to work with your healthcare or childcare provider to get resources or referrals to professional agencies who are trained to help your child reach their developmental milestone needs.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


The Ages and Stages Questionnaire



You may not be thinking about preparing your baby for school when he or she is still in diapers, but the Early Childhood Utah Program at the Utah Department of Health, says that making sure your baby meets developmental milestones helps get your baby ready for success throughout his or her lifetime. The Department of Health recommends a screening tool, called the Ages and Stages Questionnaire, to help parents and caregivers make sure your baby is right on track.

Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the questionnaire and how it helps parents.

What is the Ages and Stages Questionnaire?

The Ages and Stages Questionnaire (often called the ASQ) is an evidenced-based screening tool parents or caregivers use to make sure your baby is developing all of the skills needed to be on track when he or she starts school. This can let parents know where their child is at developmentally and gives parents important information to help make the best decisions for their child.

The ASQ is made up of 2 different screening tools. Each tool has about 30 questions and takes 20-30 minutes. The first screening tool helps parents understand whether or not their baby meets developmental milestones and the other looks at your baby’s social and emotional development.

The first screening tool looks at the following developmental milestones:

  • Gross motor
  •  Fine motor
  • Communication (both expressive and receptive)
  • Adaptive behaviors
  • Personal and social development

The second screening tool looks at a child’s social emotional development. Social and emotional screenings look at things that tell you whether your baby is interacting like he or she should in social situations.

The core features of emotional development include:

  • The ability to identify and understand your own feelings
  • Accurately read and comprehend others’ emotions
  • The ability to manage strong emotions and if you’re able t express them in a constructive way
  • Regulating (or controlling) your own behavior
  • Developing empathy for others
  • Establishing and maintaining relationships

What are Developmental milestones?

Developmental milestones are foundational skills your baby needs in order to do other things later in life. For example, your baby has to be able to master certain movements before he or she can walk. The American Association of Pediatrics has screening recommendations and developmental milestones for children up to 6 years old. These recommendations let parents know when their child should get screened and skills he or she should have at each age.

They recommend screening at:

  • 6, 12, 18 and 25 months (2 years)
  • And then at and then 3, 4, and 5 years old

How often can parents use the screening tool?

Parents can screen on a regular basis with their child, any time from one month to 6 years. You can do the screening more than once because children develop at such a rapid rate.

Parents also have different needs at different stages of a child’s development. For example, you may be very comfortable and at ease about parenting your new infant but may need additional information when your child becomes a toddler and wants more independence.

Why would a parent want to use the ASQ screening tool?

  • You know your baby best.

Early Childhood Utah, healthcare providers, teachers, and ASQ recognize that you as a parent are the true expert on your child’s development. ASQ’s parent-completed screening tool uses the in-depth knowledge that families provide.

  • It’s family friendly.

Parents love being active partners in screening. The tool is easy to use and the fun learning activities are the perfect way for families to help children make developmental progress.

It is important to trust your parental instincts and to advocate for your child. If you have concerns about your child’s development, you can check with your Local Health Department, WIC offices, Early Intervention agency, Home Visiting Program, Local Medical Provider, Early Childhood Educator and Utah Department of Health.

If you feel like you need assistance, ask one of these providers for a referral.

  • Caregivers, teachers, and pediatricians also love using the screening tool. It validates parental involvement and knowledge of their child. This helps to strengthen the home to school or pediatrician relationship.

Where can I get an ASQ screening done for my child?

You can reach out to your caregiver, pediatrician, teacher, or Early Childhood Utah to help you find a resource or program in your area that uses the Ages and Stages Questionnaire.

Utah has many resources for parents who may have concerns about their child’s development:

  • Your local health department and WIC offices
  • Early Intervention agency
  • Home visiting program
  • Your pediatrician, doctor, or a local medical provider
  • An early childhood educator
  • The Utah Department of Health.

Anyone who is in early care and education, medical, or is a healthcare provider can get ASQ training for FREE:

If you are a child care provider, early care and education teacher, or a medical or health professional and are interested in using the screening tool within your program, please reach out to Carrie Martinez at the Utah Department of Health carriemartinez@utah.gov , or visit the Early Childhood Utah websitehttps://earlychildhoodutah.utah.gov/ for more information.

For more information about important developmental milestones, visit CDC’s website.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Recovering after a miscarriage



It’s an exciting time when you first get the results from a pregnancy test and find out you’re pregnant. Most pregnancies are normal, but during those first few weeks it’s not that uncommon to experience a miscarriage. Such news can be devastating.

Jade Elliott spoke with Dr. Jessica Page, a maternal fetal medicine physician with Intermountain Healthcare who specializes in managing high risk pregnancies and has researched and studied miscarriage, to answer some questions about miscarriage.

What is a miscarriage? What is the typical time frame when it occurs?

A miscarriage is the common term for an early pregnancy loss, or one that typically occurs during the first trimester at 12 weeks or earlier.

How common are miscarriages?

The percentage of pregnancies that end in miscarriage varies a bit, depending on if you’re taking into consideration women who had a positive pregnancy test, and then had pregnancy loss, it is about 10 percent. If you look at pregnancies that haven’t been confirmed by a test, that result in loss, the numbers may be as high as 30 percent.

What are the causes of miscarriage?

Generally it’s due to the genetics of the fetus. Other causes can be due to autoimmune conditions, uterine malformations or other underlying health conditions of the mother, that she may or may not be aware of.

Do women sometimes feel a miscarriage is their fault?

In the vast majority of cases, a miscarriage is not something a woman could have prevented or that could be intervened upon. You may have factors or conditions that you didn’t know about prior to attempting pregnancy. As maternal fetal medicine specialists, we work to optimize the underlying health conditions of pregnant women. If you have a chronic condition, it’s best to have a consultation with your doctor or a specialist before getting pregnant or early in your pregnancy.

Are there ways to reduce your risk of miscarriage?

There are no guarantees, but these general practices can help you have a healthier pregnancy.

  • Avoid all alcohol, tobacco products, illicit street drugs, and over-the-counter, prescriptions, and herbal remedies that haven’t been recommended by your OB provider
  • Keep your prenatal appointments with your doctor or midwife.
  • Take your prenatal vitamins.
  • Stay up to date on your immunizations

Why do some women experience more than one miscarriage and some experience none?

Most of the time we don’t know why women experience repeated miscarriages. Recurrent losses could be due to genetics or malformations or underlying health conditions. Risk factors for miscarriage include maternal age and history of prior miscarriage. In general for women aged 20-30 years the risk is about 10-15% but rises to about 20% at age 35 and 40% at age 40.

If you’ve had one miscarriage are you more likely to have another?

While one miscarriage does increase the risk of another one occurring, most women will go on to have a positive outcome. Even those women who experience multiple miscarriages that are idiopathic (or without a known cause), about 70 percent of them go on to conceive. And about 75 percent of those pregnancies result in a live birth.

What are the signs and symptoms of miscarriage?

Some miscarriages occur without any symptoms. The most common symptoms are bleeding and cramping. If you experience either of those, call your doctor.

Should you see a doctor after a miscarriage? Is treatment needed?

If you experience a miscarriage, reach out to your doctor. In some cases, the miscarriage may not have completely passed. Some women may need medications or surgery to complete the miscarriage.

How soon can you try to get pregnant again?

After you’ve talked with your doctor to address any medical needs and as soon as you and your partner feel emotionally ready, you can try to get pregnant again.

How can women recover emotionally after a miscarriage?

Even though miscarriage is common, when it happens to you, it is significant. You need to grieve that loss and reach out for social and family support. Give yourself time to go through the grieving process. Talking with other moms who have experienced miscarriage can help.

How does miscarriage affect your partner or family?

A miscarriage can place stress on your partner and the rest of your family as well. Each person may feel a sense of emotional loss. Families should offer support and help each other through the loss and not place blame. Sometimes your partner may feel powerless. But tell them that just their companionship and emotional support is key. Be mindful of the emotions or anxiety that can occur as you approach the anniversary of a previous loss or a new pregnancy. Talk to your doctor about your history and your loss, so he or she can closely monitor your subsequent pregnancy.

How might the COVID-19 pandemic magnify some of the feelings experienced after miscarriage?

We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. Utilize resources around you and those in your household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.

You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.

What type of behavioral health resources are available?

Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.

This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.

Intermountain Walk-In Behavioral Health Access Centers

Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.

https://intermountainhealthcare.org/services/behavioral-health/access-centers/locations/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Stillbirths and coping with late pregnancy loss



Losing a baby late in your pregnancy is devastating. Understanding why fetal demise sometimes occurs is a complex topic that continues to be studied.

Jade Elliott spoke with  Dr. Jessica Page, a maternal fetal medicine specialist with Intermountain Healthcare who cares for patients with high risk pregnancies and has studied stillbirths, to discuss what we do and don’t know about stillbirths.

What is a stillbirth? How is it different from a miscarriage?

Stillbirth is defined as fetal death at or after 20 weeks of gestation. Miscarriages refer to pregnancy at 12 weeks or earlier. Early fetal losses (those between 13 and 19 weeks) are sometimes managed similarly to stillbirths.

How common are stillbirths?

Stillbirths are less common than miscarriage. In the U.S., stillbirths happen in about 6 per 1000 pregnancies. It doesn’t sound like a lot, but each loss is devastating, and it happens more often than it should. In the U.S. we continue to study the issue, learn more and work to improve.

What causes stillbirth?

It’s often hard to know the precise cause, as there can sometimes be more than one potential condition and it can be difficult to assign causality. One of the most common potential causes of stillbirth is placental insufficiency. This refers to situations in which the placenta doesn’t work well to provide the fetus with blood and oxygen. This can be due to maternal medical conditions, disruptions such as placental abruption or umbilical cord occlusion. Sometimes preterm labor prior to fetal viability (about 24 weeks) occurs and leads to stillbirth.

What tests can help determine the cause of the stillbirth and why are they important for women and their families?

Identifying a potential cause of death after a stillbirth can help families achieve emotional closure, and can help providers better manage that woman’s future pregnancies. Additionally, better identification of potential causes of death improves our ability to prevent and better understand stillbirth.

As OB providers it is important for us to deliver compassionate and clear information about what tests are most likely to identify a potential cause of death. Families often need time to consider their options and it is helpful to given them multiple chances to ask questions and process the information.

Types of exams and tests

The most useful tests for identifying a potential cause of death are fetal autopsy and placental pathology. Fetal autopsy is an exam of the baby. This can be a difficult topic for patients emotionally and it is important for providers to explain the options and high yield of this exam. The patient can spend as much time as desired with the baby prior to the exam and following the exam, and the incisions are easily hidden with normal baby clothes. This gives families the option to have funeral services or other memorials as desired. There are also options for less invasive exams which may include an external exam only or imaging with MRI. Autopsy can identify fetal anatomic abnormalities, evidence of infection or other pathologic processes leading to the death.

Placental pathology is a detailed microscopic examination of the placenta and umbilical cord. This is very useful for understanding if placental abnormalities or damage led to the stillbirth.

We also recommend genetic evaluation and testing for antiphospholipid syndrome in cases of stillbirth. If abnormal results are found, this may affect management of future pregnancies.

How do these tests help aid in research and help other women?

Understanding causes of stillbirths enables us to better identify targets for prevention of stillbirth and to characterize those pregnancies at the highest risk.

Why are stillbirths especially difficult emotionally?

Pregnancy loss at any point is difficult, but particularly as pregnancy progresses it can be emotionally devastating. It’s important to take time and space for families to grieve. Creating mementoes are helpful for many families as they navigate this grieving process.

How do labor and delivery nurses, OBs and midwives help provide comfort to mothers who experience a stillbirth?

Labor and delivery staff are experienced in all aspects of childbirth, from the joys in celebrating a new birth to comforting those who experience loss. A lot of it is meeting the patient where she and her partner are at that moment and providing the emotional support they need during their grief process. During a difficult time such as this, it’s common not to internalize all the information and details. Giving patients time and opportunity to ask questions and to acknowledge the loss of their child is especially important.

What are Cuddle Cots and how do they help families spend more time with their baby?

Many Intermountain hospitals have Cuddle Cots available, which are basically a special bassinet that provides some refrigeration for a baby who has passed away, which allows the family to spend more time with the baby they’ve lost, before rigor mortis or stiffness of the body sets in. Often they are donated by another family who has experienced a loss. We give patients as long as they want with the baby. We don’t limit that at all. Having the mementoes and support from other moms is also really helpful.

What else should women know about stillbirths?

While rare, it affects more families than you think. It’s important to recognize the role of that child in that family’s life. Just acknowledging the baby and supporting the family and listening without making judgments or commentary are what are often most helpful.

How might the COVID-19 pandemic magnify some of the feelings experienced after a stillbirth?

We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. I tell patients to utilize the resources around them and those in their household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.

You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.

During the pandemic the numbers of support people allowed in the hospital may be limited. The hospital staff also provides experienced support. Some families may connect virtually with those not present and staff can assist.

What type of behavioral health resources are available?

Intermountain’s Angel Watch Program offers support for women experiencing pregnancy loss.

Women experiencing stillbirth can reach out to Intermountain’s Angel Watch program that offers support for women experiencing fetal demise. The program is staffed by master’s level social workers, nurses, bereavement specialists and chaplains who are available on-call to provide counseling specific to this type of loss, through in-home or virtual visits. The service is free and available to anyone, not just Intermountain patients. For more information call, 801-698-4486 or visit:  https://intermountainhealthcare.org/services/women-newborn/resources/angel-watch/

To listen to the Baby Your Baby Podcast about the Angel Watch Program, click here.

Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.

This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.

Intermountain Walk-In Behavioral Health Access Centers

If depression or anxiety persists and you don’t have a mental health provider there are some walk in services available.

Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.

https://intermountainhealthcare.org/services/behavioral-health/access-centers/locations/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Managing chronic conditions during pregnancy



What if you have diabetes or high blood pressure or an autoimmune disease like lupus or rheumatoid arthritis and you want to get pregnant? Or what if you become pregnant and have one of those chronic conditions?

If so, you probably have lots of questions. Jade Elliott spoke with  Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who manages high-risk pregnancies, to discuss chronic conditions.

How common are chronic conditions among pregnant women?

The most common chronic conditions among American women are overweight/obesity (>50%), pregestational (type 1 or 2) diabetes (1-2%), high blood pressure (1-1.5%), and, less commonly, autoimmune diseases like lupus or rheumatoid arthritis.

What should women who have a chronic condition know and do before they get pregnant?

If you have a chronic condition, including obesity it’s best to get a pre-pregnancy consultation with a maternal fetal medicine specialist if you want to get pregnant. If you’re already pregnant and have a chronic condition, see a specialist as early as possible in your pregnancy, since that will lead to better outcomes for you and your baby.

How can maternal fetal medicine specialists help pregnant women who have these conditions?

Women with medical conditions that put them at increased pregnancy risks usually are managed by both high-risk pregnancy specialists and their regular obstetric provider. Every woman and every pregnancy is different. Sometimes a pregnant patient will see her high-risk obstetrician just once during a pregnancy, to design a management plan for monitoring her and her fetus. Other times she will be co-managed, which means she’ll see both her high-risk and regular provider throughout her whole pregnancy, for instance if she needs specialized tests like Doppler ultrasound or interventions like in-utero surgery.

Can chronic conditions affect your pregnancy or the baby?

Yes. It depends on the type of chronic condition. That’s why it’s so important to see a maternal fetal medicine specialist.

Why is it important to manage diabetes during pregnancy?

Having diabetes during pregnancy can lead to increased risks or complications for the mom or baby. When moms have diabetes, their babies are more likely to have a larger than normal birthweight, which can lead to delivery complications. Their babies are also at increased risk for birth defects, stillbirths, respiratory distress and low blood sugar.

For pregnant moms, most complications occur in women who have diabetes before they are pregnant. Pregnant women with diabetes are at increased risk for high blood pressure or preeclampsia, as well as preterm birth, cesarean delivery and other problems.

What are the signs of diabetes?

  •  Excessive thirst.
  • Frequent urination.
  • Extreme hunger.
  • Unexplained weight loss.
  •  Fatigue.
  •  Irritability.
  • Blurred vision.
  •  Presence of ketones in the urine (can be detected through lab tests)

What’s the difference between Type 1 and Type 2 diabetes and gestational diabetes?

They are different in terms of risk factors and onset. Type 1 or 2 diabetes is pregestational, or diabetes that exists before pregnancy. Pregnancy can complicate diabetes in these women, and outcomes are closely tied to degree of glucose control during pregnancy.

Gestational diabetes is defined as a new onset of diabetes that occurs during pregnancy. However, some women diagnosed with gestational diabetes actually have undiagnosed pre-gestational type 2 diabetes. Like type 1 and type 2 diabetes, outcomes are closely tied to the degree of glucose control. This is part of why it’s important to learn what is in your genes and understand your health before you get pregnant.

Why is it important to manage high blood pressure during pregnancy?

Complications can include:

  • Preeclampsia, when high blood pressure can lead to organ damage in the mother.
  • A stroke due to very high blood pressure.
  • Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight or premature birth.

Why does obesity add risk to your pregnancy?

Obesity is defined as a body mass index (BMI) over 30, and BMI over 40 in particular, poses risk to a pregnancy. Fetal complications include a higher chance of miscarriage, birth defects, abnormal fetal growth (usually overgrowth), abnormal fluid (usually too much fluid), and rarely, stillbirth. Preterm birth is more likely in obese women, either spontaneously or medically-indicated because of maternal complications such as gestational hypertension or preeclampsia, or gestational diabetes with poor glucose control.

What advice would you give to women who are obese and either want to get pregnant or are already pregnant?

A good diet and exercise plan are always key elements to a healthy pregnancy. Before pregnancy, obese women can optimize their pregnancy outcomes by losing weight to reach an ideal body weight. Obese pregnant women can also optimize outcomes by following a healthy diet and exercise plan. Although we typically associate healthy pregnancy with weight gain, depending on a patient’s BMI, it may be best for her to gain little weight.

Why is it important to manage your autoimmune disease during pregnancy?

Most of the time, women with autoimmune disorders can expect a normal pregnancy. However, some serious problems like fetal growth restriction or even stillbirth can occur, depending upon a patient’s exact diagnosis and disease control. Also, sometimes medications have to be adjusted before pregnancy if they aren’t safe for the fetus. Patients with well-controlled disease before pregnancy do best during pregnancy. So, it’s important to have a plan, ideally before pregnancy.

Are there some chronic conditions, where women actually feel better when they’re pregnant than when they’re not?

About one third of patients with autoimmune diseases report feeling better while pregnant, and one third report no change and another third feel worse or have a first episode during pregnancy. This is probably because of the natural steroid production that occurs during pregnancy.

Are there any chronic conditions where getting pregnant is not recommended?

Rarely, a high-risk obstetrician might advise against pregnancy, for instance, in women with antiphospholipid syndrome and history of recurrent blood clots, or severe pulmonary hypertension, or certain kinds of heart problems. That doesn’t happen often, but anticipating serious problems is one reason to contact your high-risk obstetrician before becoming pregnant.

Keep in mind most pregnancies and births are normal

If you have a chronic medical condition, it’s important to meet with your doctor early, ideally before you are pregnant, to develop a management plan. This helps you and your healthcare team to optimize your situation for the best possible outcome for you and your baby.

For more information

Go to https://intermountainhealthcare.org/

And search for high risk pregnancy or maternal fetal medicine.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Preventing preterm birth



Predicting when your baby will be born and whether she’ll arrive early, on time or late has been a mystery since the time of Hippocrates, the ancient Greek physician known as the father of medicine, who developed the Hippocratic Oath, still accepted by physicians today. Medical experts in 2020 are still trying to solve the mystery to predict whether the timing of your baby’s delivery will be preterm, at term or post-term.

Jade Elliott spoke with Dr. Helen Feltovich, a maternal fetal medicine OB/Gyn and associate professor at Intermountain Healthcare who manages high-risk pregnancies to  shed some light on the mystery of the possible causes of preterm birth.

What is the definition of preterm birth?

Babies born at 37 weeks or later are considered at term. For babies born before 37 weeks, the earlier they are born, the more likely they are to have health issues. So, we categorize preemies into these general categories.

Babies born between:

34-37 weeks are considered late preterm

34 or 32 weeks are considered early preterm

26-28 weeks are considered very early preterm

Does preterm birth just happen on its own or are there reasons why it would be recommended for a mom to give birth before 37 weeks?

Preterm birth can be either medically-indicated (because continuing pregnancy is not safe for the mother, baby or both) or spontaneous (labor happens on its own). Currently, at least 2/3 of preterm births are spontaneous, and, while we do know some factors increase the risk of preterm birth, most preterm births actually have no biological explanation. Unfortunately, by the time labor is happening, we have no therapies at all that can stop it.

Why is it so difficult for physicians to predict preterm birth?

While physicians have various ways to try to guess at when a baby will deliver, like how long or dilated the cervix is, none of these work well, even during labor itself, to predict when a baby will be born. Preterm birth is particularly vexing to OB/Gyn caregivers because of its potentially serious health consequences to the newborn.

What are some of the challenges in preventing preterm birth?

Preventing preterm birth is even more challenging because we have only two basic approaches, that have been around since about the 1950-1960s and they both have limits in their effectiveness. One of these approaches is progesterone (hormone) supplementation, which although it’s been tried in various formulations and doses, prevents preterm delivery less than half of the time.

The other approach is mechanical support of the cervix by cerclage (basically stitching a purse-string around the cervix), which prevents preterm birth less than half of the time.

Although these therapies don’t work all the time, they certainly work some of the time in the right patients. So, it’s very important to see a high-risk pregnancy specialist, ideally before pregnancy, to discuss which approaches might be appropriate for the next pregnancy.

This lack of overall progress seems astonishing, but it’s because preterm birth is so complex, and there are so many factors that come into play, and so many different pathways.

What are some of the possible risk factors that may lead to preterm birth?

Studies show the two strongest risk factors for preterm birth are:

  • History of PTB, and
  • Short cervix during your current pregnancy

Other risk factors include:

  • Infection or inflammation

(There are many different types of infections or causes of “sterile” or non-infectious inflammation. Some studies have shown that COVID-19 increases the risk of preterm birth).

  • Smoking or substance abuse during pregnancy
  • Short time between pregnancies (less than 18 months)
  • Expecting multiples, twins, triplets, etc. 50 percent of twins come early.
  • Vaginal bleeding
  • Abnormal shape of the uterus
  • Maternal and fetal stress (probable, difficult to measure/prove)

What about stress – how does that have an impact?

Stress is a very difficult thing to measure, because there is physiological stress, psychological stress, and a combination of the two and they do all kinds of things in a person’s body. That said, it is becoming increasingly clear that social determinants of health that are associated with both physiological and psychological stressors (like education, income level, ancestry, race or ethnicity, access to healthcare, social support, etc. can change preterm birth risk.

The COVID-19 pandemic is highlighting this, because in some countries (like the Netherlands), the rate of preterm birth has decreased among higher income women, thought perhaps due to less stress because of working from home, etc, while in the U.S. (where we do not have widespread governmental support for income maintenance, or universal healthcare), the CDC data suggests an increased risk of preterm birth. This is an extremely complex issue, which affects an extremely complex and multifactorial outcome (preterm birth), but this pandemic is showing us new ways to look at potential contributors to and solutions for preterm birth.

What kinds of symptoms of preterm labor should a woman call her doctor about?

  • Call your obstetric provider right away if you notice any of these signs or symptoms:
  • Change in type of vaginal discharge (watery, mucus, or bloody)
  • Increase in amount of discharge
  • Pelvic or lower abdominal pressure
  • Constant low, dull backache
  • Mild abdominal cramps, with or without diarrhea
  • Regular or frequent contractions or uterine tightening, often painless
  •  Ruptured membranes (your water breaks with a gush or a trickle of fluid)
  • See a specialist if you have a history of preterm birth or complications in your pregnancy

If you have had a preterm birth in the past, it’s important to see a high-risk pregnancy specialist, ideally before you become pregnant, to discuss your particular situation and the types of strategies to decrease your risk of recurrent preterm birth.

What does the future look like for preventing preterm birth?

We need to think about preterm birth not as a diagnosis, but rather one possible outcome of a variety of different causes and processes. We need to follow the successful path of our cancer colleagues.

Before the 1950s, “cancer” was considered a singular diagnosis, and treated similarly with surgery, chemotherapy and radiation, no matter where or how it occurred in the body. But today, through the use of imaging biomarkers like those identified with PET or CT scanning combined with fluid biomarkers found in blood or urine or the tumor itself, we understand that there are thousands of different types of cancers, and the approach to treating them should be individualized to a specific tumor in a specific patient at a specific point in time.

This involves understanding the internal (for example, genetic) and external (for example, environmental stressors) environment of a person. This is called precision (or personalized) medicine, and it’s why now the previously unthinkable has become true – some cancers are curable!

Could understanding a patient’s genetics and environmental factors help doctors determine what might help prevent preterm birth in a certain patient?

This is where we are slowly starting to go with preterm birth.

One of our maternal fetal medicine doctors at Intermountain, Dr. Sean Esplin, recently led a nationwide study looking at an imaging biomarker (length of cervix measured by ultrasound) and fluid biomarker (presence of fetal fibronectin in the vagina) related to preterm birth. More than 9000 women were evaluated, and the study showed that even the combination of these two biomarkers did not effectively predict preterm birth.

However, more importantly, it told us we need more, and better, imaging and fluid biomarkers to direct their therapies. What will happen from further investigations is we will have many more biomarkers so we can develop new therapies and target them to a particular person in a particular pregnancy. When we are able to do that, we will undoubtedly have the same sort of success as our oncology colleagues – and the previously unthinkable will happen – a cure!

Decades ago, nobody thought cancer would actually be curable, but today we know that several cancers are actually curable, or at least can be managed as chronic diseases. This is where we can go with the problem of preterm birth!

For more information: Go to https://intermountainhealthcare.org/ and search for high risk pregnancy or maternal fetal medicine.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Preventing tooth decay in young children



Before you know it, your baby has teeth! But it turns out that those beautiful new teeth painstakingly working their way through your baby’s gums are already at risk of tooth decay as soon as they appear. You may hear lots of advice from other parents about using bottles and sippy cups before your child can drink from a regular cup.

Jade Elliott spoke with  Dr. Hans Reinemer, a spokesperson for the American Academy of Pediatric Dentistry and a pediatric dentist from Intermountain Primary Children’s Hospital about how bottles and cups can affect your child’s teeth.

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How Can Bottles Lead to Tooth Decay?

One of the risk factors for early childhood tooth decay (sometimes called baby bottle tooth decay or nursing decay) is frequent and prolonged exposure of a baby’s teeth to liquids, such as fruit juice, milk or formula, which all contain sugar.

Tooth decay can occur when a baby is put to bed with a bottle, or allowed at-will access to a bottle or sippy cup. Infants under one should finish their naptime or bedtime bottle before going to bed. Encourage your children to drink from a cup by their first birthday.

What About Sippy Cups?

Many training cups, also called sippy or tippy cups, are available in stores. Many are no-spill cups, which are essentially baby bottles in disguise. No-spill cups include a valve beneath the spout to stop spills. However, cups with valves do not allow your child to sip. Instead the child gets liquid by sucking on the cup, much like a baby bottle. This practice defeats the purpose of using a training cup, as it prevents the child from learning to sip.

Don’t let your child carry the training cup around. Toddlers are often unsteady on their feet. They take an unnecessary risk if they try to walk and drink at the same time. Falling while drinking from a cup has the potential to injure the mouth.

A training cup should be used temporarily. Once your child has learned how to sip, the training cup has achieved its purpose. It can and should be set aside when no longer needed.

What Kind of Training Cup or Sippy Cup is Better for Your Child’s Teeth?

For sipping success, carefully choose and use a training cup. As the first birthday approaches, encourage your child to drink from a cup. As this changeover from baby bottle to training cup takes place, be very careful.

Parents should choose

  • What kind of training cup to use
  • What goes into the cup – water is best. Children can enjoy other drinks at meal times only.
  • How frequently your child sips from it. No worries it it’s water
  • To not let their child carry the cup around

Talk to your dentist for more information. If your child has not had a dental examination, schedule a well-baby checkup for his or her teeth. The American Academy of Pediatric Dentistry says that it’s beneficial for the first dental visit to occur within six months of the appearance of the first tooth, and no later than the child’s first birthday.

What Foods Can Cause Tooth Decay in Toddlers and Young Children?

Now more than ever, kids are faced with a bewildering array of food choices, especially during the pandemic when more children are home for extended periods than ever before. This makes the pantry and refrigerator available all day, which was not possible when kids were in school. What children eat and when they eat it may affect not only their general health but also their oral health. Avoid grazing!! Sugary foods and snacks should only be available during meal times.

Americans are consuming foods and drinks high in sugar and starches more often and in larger portions than ever before. It’s clear that junk foods and sugary drinks gradually have replaced nutritious beverages and foods for many people.

What Habits Can Cause Tooth Decay in Toddlers and Young Children?

Alarmingly, a steady diet of sugary foods and drinks can ruin teeth, especially among those who snack throughout the day. Common activities may contribute to the tendency toward tooth decay. These include grazing habitually on foods with minimal nutritional value, and frequently sipping on sugary drinks. When you eat sugar, you are cavity prone for about 30 minutes, so if you eat three meals a day, you are then cavity-prone for 90 minutes each day. If you snack all day, then you are cavity prone ALL DAY!! Frequent access is the main thing to consider.

When sugar is consumed over and over again in large, often hidden amounts, the harmful effect on teeth can be dramatic. Sugar on teeth provides food for bacteria, which produce acid. The acid in turn can eat away the enamel on teeth.

Almost all foods have some type of sugar that cannot and should not be eliminated from our diets. Many of these foods contain important nutrients and add enjoyment to eating. But there is a risk for tooth decay from a diet high in sugars and starches. Starches can be found in everything from bread to pretzels to salad dressing, so read labels and plan carefully for a balanced, nutritious diet for you and your kids.

How to Reduce Your Child’s Risk of Tooth Decay

  • Sugary foods and drinks should be consumed with meals. Saliva production increases during meals and helps neutralize acid production and rinse food particles from the mouth.
  • Limit between-meal snacks. If kids crave a snack, offer them nutritious foods.
  • If your kids chew gum, make it sugarless – Chewing sugarless gum after eating can increase saliva flow and help wash out food and decay-producing acid.
  • Monitor beverage consumption – Instead of soft drinks all day, children should also choose water and low-fat milk.
  •  Help your children develop good brushing and flossing habits.
  • Schedule regular dental visits

For more information about pediatric dentistry visit:

https://intermountainhealthcare.org/

https://mouthmonsters.mychildrensteeth.org/ 

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Brushing your child’s teeth



It’s exciting when your baby gets a first tooth! But it’s a long and somewhat painful process before your baby has enough teeth to start really chewing food. But with that discomfort in your baby’s gums, you may wonder when it’s time to start brushing those new teeth.

Jade Elliott spoke with Dr. Hans Reinemer, a pediatric dentist with Intermountain Primary Children’s Hospital and spokesperson for the American Academy of Pediatric Dentistry to help answer all things about your baby’s teeth and their care.

When should you start brushing your child’s teeth?

Begin cleaning or brushing an infant’s teeth as soon as the teeth begin to erupt. Use an infant brush or moistened clean soft gauze to brush or wipe the teeth after feedings. One parent can hold the baby in a comfortable position, while the other parent brushes the child’s teeth.

For toddlers, let them chew on a brush during bath time. Keep your eye on your child at all times in the bathtub. This is safer than letting them walk around with a toothbrush. This gets them used to the look and feel of a brush and the chewing motion can massage the gums and erupting teeth. Parents should follow up and brush their child’s teeth to make sure every area is clean.

Tell, Show and Then Do

As children get older and understand basic instruction, use “Tell-Show-Do” when guiding the behavior of children. Pediatric dentists use this in the dental office. Parents can use the same techniques at home when it comes to teaching children to brush. Tell small children what you are going to do, show them how to do it on a stuffed animal or doll, then perform on the child.

Talk to your child about their teeth and why they need to brush them to prevent cavities and tooth decay. For older children, explain how you need to brush away the bacteria, because the bacteria produces acid. The acid in turn can eat away the enamel on teeth. For younger children, a parent can explain that there are tiny “bugs” on the teeth that make them dirty.

Take Turns

Encourage the child to try brushing first, then the parent should always get a turn. Parents should look for areas the child may be missing and help at as needed.

Give Your Child a Choice

Let your child pick out their own age appropriate toothbrush. If they like it, they will use it more. Some toothbrushes make noise, light up, play music or come in fun styles like superheroes or princesses.

Ideas to Make Brushing Fun

1. Play a game. Find ways to make it fun and reward the small child with surprises for a good efforts and consistency.

2. Put on some tunes. Teach them to brush for the length of one song.

How Long to Brush

For a toddler, the length of the ABC song may be good.

As children get older, monitor the time. Splashing a little water on the teeth for five seconds is not enough! Don’t be afraid to send them back to the sink for the appropriate length of time – two minutes.

The bottom line is, never assume any child of any age is going to do a thorough job at brushing teeth. Teach, observe, time and follow up twice daily.

How Much Toothpaste to Use?

A schmear (grain of rice) of fluoridated toothpaste is appropriate until the child can predictably rinse and spit, then progress to a pea-sized amount.

When Can Children Brush Their Teeth on Their Own?

Children may have the manual dexterity to brush on their own when they can tie their own shoes. The child may not need help anymore, but watch to monitor thoroughness.

For more information about pediatric dentistry visit:

https://intermountainhealthcare.org/

https://mouthmonsters.mychildrensteeth.org/ (The parent resource of the American Academy of Pediatric Dentistry)

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Mom shaming: Why it hurts more than it helps



By nature, motherhood is an emotional journey filled with daily choices about how to raise your kids and how you are as a mother to your children. Because we love our children, we have strong emotions about these decisions, and because these decisions have an impact on our lives and the lives of our children, we wonder if we’re doing the right thing for our child and our family. Because of this, sometimes we look at other families who are making choices that are different from our own and question if we, or they, are making the right choice, and unfortunately, that can lead to shaming other moms or being shamed by other moms.

Jade Elliott spoke with Laura Cipro, a psychiatric mental health nurse practitioner with Intermountain Healthcare who treats children and adults for both emotional needs, to talk with us about mom shaming — what it is, and how to manage it if you experience it, and how to avoid doing it yourself.

What is shame?

Shame (verb) – the act of making or causing someone to feel guilt, humiliation, or distress.

Shame (noun) – as defined famously by Brene Brown (researcher at the University of Houston, author, and podcast host) as “an intensely painful feeling or experience of believing that we are flawed and something we’ve done or failed to do makes us unworthy.”

It’s important to understand that shame is different from guilt, which is an awareness of hurt or harm caused to others). Shame is not a productive feeling and breeds insecurity and anxiety, whereas guilt can motivate change.

“Mom shaming” is criticizing a mother for her parenting choices because they differ from the choices the person shaming would make or has made.

Why is mom-shaming especially damaging?

1. It’s unfair

It doesn’t take into account that as mothers we are often not the sole caregivers for our children. Mom shaming doesn’t consider the role of fathers, other caregivers (grandparents, daycare providers, nannies, babysitters, etc). Fathers especially, don’t receive the same level of scrutiny for parenting choices that mothers face, and that is certainly a double standard.

Mom shaming also doesn’t take into account other factors such as financial constraints and how this affects parenting choices. It doesn’t take into account that single moms carry heavier parenting burdens than those who have a partner. It also doesn’t take into account that all children are different, and one parenting style or approach will not meet the needs of or be effective for all kids.

2. It leads to unreasonably high expectations of mothers

It reinforces antiquated ideas and narratives that mothers have to be perfect and that we are defined by how we raise our children, rather than the idea that raising our children is just one part of who we are. Women are not only mothers, but employees, coworkers, friends, daughters, sisters, partners, athletes, leaders, etc. We can’t operate in all of these roles at 100 percent all the time. Social media can contribute to unrealistic expectations, when people are posting all their ideal moments, but not the true reality moments.

When mothers can’t meet these unrealistic expectations, they are set up to be disappointed, feel like failures, or become insecure about their parenting abilities. Data shows this can lead to an increase in rates of anxiety and depression in mothers.

3. Mom shaming also affects children

Mom shaming can cause the shamed mother to be insecure or anxious about their parenting abilities and choices and compensate by “over-parenting.” Over-parenting can undermine children’s confidence, independence and subsequently their ability to cope with life’s challenges. When children make their own mistakes, it’s an opportunity for them to learn from those mistakes and grow and develop their character.

Why is it unhelpful to criticize the decisions other parents make during the pandemic, when they’re faced with difficult choices about school, work and childcare?

First, I think it’s especially hard during a pandemic not to be invested in other parents’ decision making, because their choices just might directly affect you and your child’s health. However, it’s also especially not helpful during a pandemic to criticize or shame others. There are so many factors. Every family situation is multi-factorial. The pandemic adds more factors. We can’t possibly know all of the factors other parents face, so we shouldn’t judge.

We only see the tip of the iceberg of family life

I like to think of the photo of the iceberg floating in the ocean. The top 10 percent of the iceberg is visible above the water to the naked eye, but underneath the water lies the remaining 90 percent of the iceberg. This is how we should be thinking about other families. Outsiders looking in, see or know 10 percent (or less) of what is going on in that mother’s life that contributes to the choices her family makes during this pandemic. We don’t know the other 90 percent.

For example, I might not know that one of her children has an underlying health conditions, I might not know she is caring for an elderly relative, I might not know she is an essential worker, I definitely don’t know her financial situation, etc). We are all weighing the risks for our specific situations.

Don’t judge

No one should judge others for the decision they make during this pandemic in regard to childcare, education, attending public events, etc. because the factors leading to the decisions to home school, attend in-person school, get a nanny, go to daycare, skip the neighborhood birthday celebration or whatever are undoubtedly different than the factors that myself, or you, or the mother down the street evaluated in order to determine what she felt was best for her family.

We all have anxieties and the COVID-19 pandemic has added some

Also, from a mental health perspective, no one feels 100 percent confident about the decisions they’ve made. We can’t, because there’s still so much unknown about this virus. There’s still risk that we are all accepting for whatever choice our family makes, and a certain level of anxiety and fear about that risk and that decision.

In addition to all of our baseline anxieties, we now add the fear of living in a pandemic, facing rising unemployment, adjusting to a new normal for family life, work, school, etc. In my practice I see many children with online learning challenges, and motivational challenges due to the pandemic.

Studies find worsening mental health for parents and children since the pandemic

According to an American Academy of Pediatrics study about the effects of the pandemic on mental health, more than one in four parents reported worsening mental health, and one in seven reported worsening behavioral health for their children since coronavirus began to spread in March. About 10 percent reported that both parent and child were affected. Mental health decline was reported most by females and unmarried parents. Families with younger children had highest rates of declining mental and behavioral health.

A recent CDC study found that almost 41 percent of adult respondents are struggling with mental health issues stemming from the pandemic – both related to the coronavirus pandemic itself and the measures put in place to contain it, including physical distancing and stay-at-home orders.

Support other parents even when their decisions differ greatly from our own

People right now don’t need the added shame and anxiety from others criticizing and critiquing the choices we’ve made. We need to be supporting others and helping them through these difficult times.

Respect the choices they’ve made for their family and the boundaries they’ve set during the pandemic. Don’t pressure or push others outside of their comfort zone.

Communicate support for the choices other moms make

Focus on the positive and offer non-judgmental support.

Re-frame your thinking to be supportive of other moms

I think there can be a tendency to interpret differences in choices as a dig about the choice that you’ve made. Re-framing can be especially important here. Rather than seeing differences as a challenge to your choice or critique of your choice, try to see the underlying struggle that might have led this mother to her choice. For example: A mother’s decision to send her kids back to school might reflect her insecurity about her own ability to be an effective teacher. I think it’s easier to have compassion when we look at the issue this way. Also, remember that all mothers want the best for their kids and we all have this in common.

Tools moms can use if they experience mom-shaming

Use disarming statements. This is a tool I teach children to cope with bullies, and I think it applies, since people who mom shame are engaging in a type of bullying. Disarming statements are neutral responses that aim to shut down a conversation, help a person stand up for themselves, and not engage in bullying back. For example: “Thanks for sharing your opinion.” “Hmmm I’ll have to think about that.” Or “I don’t appreciate when my choices are questioned.” “I try not to comment on others’ parenting styles.”

For more information

Intermountain Healthcare has a free emotional health relief hotline available. The phone number is 833-442-2211. It’s available 7 days a week from 10 a.m. to 10 p.m. Interpretation services are available.

To find out more about Intermountain’s behavioral health resources, visit: https://intermountainhealthcare.org/services/behavioral-health/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.