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

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 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: 

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: (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:

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.

Virtual support group teaches moms self-care and stress management tools

Being pregnant for the first time or being a first-time mom means a woman will be making a lot of changes. You now have another person’s needs to care for and think about, besides managing your own personal needs.

It’s a big adjustment that can be even harder with the added stresses of a global pandemic.

An April 2020 study in the Journal of American Medical Association done during the COVID-19 pandemic, reports 37 percent of pregnant women reported clinically relevant symptoms of depression and 57 percent of pregnant women reported anxiety. Pre-pandemic percentages found between 10 to 25 percent of pregnant women experience anxiety or depression symptoms.

Many women find support through connecting with other moms or joining a support group. But doing that in person during the pandemic is challenging.

Jade Elliott spoke with Clare Valles, a nurse with Intermountain Healthcare who teaches a virtual Mom and Baby Group Course and support group that helps both moms to be and new moms learn tools to manage the stress that being a new parent brings, and also take time for themselves.

Who can benefit from this virtual class?

First-time moms, moms who are new to the community or who are far away from their families or network of friends will especially benefit from this class. It’s a great way to meet moms from all different backgrounds.

We’ve seen a rise nationally in postpartum depression. A better term is peripartum mood disorders, because moms can experience this not just after childbirth but during pregnancy and symptoms can manifest not only as depression, but also as anxiety.

The virtual class is taught by trained nurses and based on a national curriculum

I’ve been a nurse in labor and delivery, a clinic setting and homecare and public health for more than 20 years. The teachers are trained nurses.

Intermountain became aware of this curriculum that was developed at Northwestern University that’s evidence-based and has been proven to help improve behavioral health outcomes for new moms and their babies.

What are the benefits of doing the course virtually?

A lot of moms are working, so we’re able to tailor the class to meet during the lunch hour or in the evening. With the course being virtual, moms save time by not having to travel to the class.

And they can tune in from anywhere. During the pandemic, especially, moms need to take a break from their responsibilities and connect with other new moms who can offer support.

What does the class focus on?

  • Self-care
  • Stress management
  • Mother-baby bonding
  • Developing positive social connections

We teach moms to take care of themselves and not feel guilty to take time away from their baby if they have a trusted adult who can watch the baby. We teach them how to include Dad. We teach them to prioritize self-care. Some mom feels they have to do all the childcare and all the housework and then they go back to work and still try to do it all and that is hard.

The course teaches these skills

1. How to understand your mood and how feelings can spiral up or down

2. How to stop unhealthy thinking and turn it into healthy thinking. Look at each day and rate it. Recall positive experiences to help re-frame things.

3. How to look at your support system and manage it.

4. How to recognize that people can be supportive, not supportive or even toxic.

5. How to be empowered to set boundaries with people who are not supportive.

6. How to share examples of how you’ve met challenges and the steps you’re taking to manage them and learn what you could do better.

Participants learn to pay attention to thoughts, feelings and behaviors

The class uses cognitive behavioral therapy which is based on the relationships between a person’s thoughts, feelings and behaviors. For example, if your mood was a six on a 10-point scale. What made it that way?

Do things to help your mood spiral up. Even simple pleasant activities like taking a shower or a walk or listening to music can help.

The importance of mother-baby bonding

The class focuses on attachment theory and the importance of mother and baby bonding.

We teach parents that they are their child’s first teacher and to comfort their baby face to face, and play with their baby. It builds self-esteem in your child. Good parenting takes time. It’s easier to ignore a fussy baby or hand them your phone to keep them occupied. But that is not what they need from you.

How a group dynamic offers support

By attending the class, many women realize they’re not the only one feeling isolated or having a hard time. Seeing people’s faces and hearing others talk. And seeing other role models can help. People emerge as different people after the class. Different people resonate to different things taught in the class. We also can refer women to other community resources if needed.

How to sign up for the virtual interactive class

You can sign up online for the Intermountain Mom & Baby Group Course. It’s a six-week class and it’s available to moms ages 18 and up in the Intermountain service area. The cost is $15. Scholarships are available. Class size is kept small to encourage connections.

How to register for online childbirth education classes

Intermountain Healthcare also has a go at your own pace, online prenatal class through YoMingo, that includes four different modules on postpartum emotions, baby blues, warning signs and a resources module that lists mental health resources in Utah.

To register, go to and click on the classes and events tab and search for birth classes.

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.

How to know if your baby is seeing properly

When you have a new baby, many new moms have a lot of questions about what is normal and healthy for babies. Since babies can’t talk, you are left wondering what your baby needs and if he or she is developing properly.

That’s why taking your baby to all of their well-child check-ups with their pediatrician is so important.

Jade Elliott spoke with Dr. Jenna Whitman, a pediatrician with Intermountain Healthcare, about how going to those check-ups can help you get your questions answered and how to know if your baby is seeing properly.

How pediatricians are keeping children and parents safe from viruses when they come in for a well-check

Medical providers for children around the state of Utah have largely adopted practices suggested by the American Academy of Pediatrics that minimize risk of COVID-19 exposure and allow for the delivery of services to newborns and young children.

According to the Centers for Disease Control, these strategies include ways to separate children who are sick from children who come for well-child checkups such as:

• Scheduling well visits in the morning and sick visits in the afternoon.

• Separating patients spatially, such as by placing patients with sick visits in different areas of the clinic or another location from patients with well visits.

Many clinics are using other innovative strategies as well, such as check-ins from cars and expedited rooming, avoiding waiting rooms altogether. Ask your provider about the precautions they’re taking.

Well-check visits are just as important for healthy children as for sick children

At each check up your child’s doctor will cover many things including:

• Immunizations. Your child will receive immunizations recommended by your doctor and according to a suggested schedule for babies and children to help prevent common childhood diseases.

• Flu shots are recommended annually for healthy children over age six months. With all the uncertainties surrounding the current COVID pandemic, keeping children healthy by getting their flu shots has never been more important. Many parents focus on getting the immunizations required for day care or school. But, don’t forget to come back after school starts for a flu shot. Typically, they’re available by October.

• Tips for nutrition, child safety and how to keep your child healthy.

• Tracking growth and development. You can discuss your child’s physical growth and also if they’re reaching developmental milestones. You’ll also go over what social behaviors and learning to expect at every age.

• New health concerns. Your child’s check up is an excellent time to bring up any new concerns you may have about how your child.

Regular visits help create strong, trustworthy life-long relationships among pediatrician, parent and child.

How Babies See

Babies learn to see over a period of time, much like they learn to walk and talk. They are not born with all the visual abilities they need in life. The ability to focus their eyes, move them accurately, and use them together as a team must be learned. Your child’s pediatrician will follow your baby’s visual development periodically and make sure that they are meeting vision milestones at an appropriate age.

What to watch for at home to know if your baby is seeing properly

Birth to 2 months: your baby’s eyes are not well coordinated yet. They may appear to wander or to be crossed occasionally. This is usually normal. However, if one eye appears to turn in or out constantly, an evaluation is recommended. This may be a sign of a “lazy eye” and should be evaluated by your child pediatrician. During this period, babies see only what is about 8-10 inches in front of them and only black and white.

By 3 month of age: Babies should begin to follow moving objects with their eyes and reach for things.

By 6 months of age: Baby’s control of eye movements and eye-body coordination skills continue to improve. Color vision also develops by this age.

By 1-2 Years: By two years of age, a child’s eye-hand coordination and depth perception should be well developed.

What parents can do to help with visual development

Birth to 4 months

• Use a nightlight or other dim lamp in the baby’s room.

• Change the crib’s position frequently and change the child’s position in it.

• Keep your face or toys within the baby’s focus, about eight to twelve inches.

• Talk to the baby while walking around the room.

• Alternate right and left sides with each feeding.

5 to 8 months

• Hang a mobile or various objects across the crib for the baby to grab, pull and kick.

• Give the baby plenty of time to play and explore on the floor.

• Provide plastic or wooden blocks that can be held in the hands.

• Play patty cake and other games, moving baby’s hands while saying the words aloud.

9 to 12 months

• Play hide and seek games to help the baby develop visual memory.

• Name objects when talking to encourage the baby’s word association and vocabulary

• Encourage crawling and creeping.

1 to 2 years

• Roll a ball back and forth to help the child track objects visually.

• Give the child building blocks and balls of all shapes and sizes to play with to boost fine motor skills and small muscle development.

• Read or tell stories to encourage visualization and pave the way for learning and reading.

When your baby might need to see a vision specialist

There are many reasons your child’s pediatrician might send you to see an ophthalmologist. A few common concerns that might lead to a referral are:

  • An excessive amount of tears coming from the eye(s) may indicate blocked tear ducts.
  • Constant eye turning may signal a problem with eye muscle control.
  • Sensitivity to light may indicate an elevated pressure in the eye.
  •  The appearance of a white pupil could indicate the presence of eye cancer.

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.

Flu and pregnancy

When you’re pregnant, you’re more at risk for getting the flu. And the flu can have serious effects on both mom and baby.

Jade Elliott spoke with  Celeste Thomas, a certified nurse midwife with Intermountain Healthcare, about the risks for pregnant women during flu season and how you can protect yourself on this episode of the Baby Your Baby Podcast.

Why pregnant women are more susceptible to the flu

When you’re pregnant, changes occur in your immune system and it is naturally suppressed, making you more susceptible to the flu. Also, your lung capacity decreases and heart rate increases, during pregnancy, putting additional stress on the heart and lungs.

All three of these things make pregnant women (and women up to two weeks postpartum)

more prone to severe illness or hospitalization from the flu.

Why the flu can be serious for pregnant women and their unborn baby

Pregnant women who have the flu are:

  • More likely to be hospitalized
  •  At higher risk of pregnancy complications, such as preterm labor and preterm birth.
  • At risk of having a baby with neural tube birth defects or other adverse outcomes due to fever.

Flu vaccines are safe and recommended for pregnant women

Getting a flu vaccine is the first and most important step in protecting against flu and helps protect both the mother and her baby from the flu. The vaccine protects babies from the flu for the first several months after their birth because the mom passes antibodies onto the developing baby. Once babies are six months or older, they can get their own vaccine.

Flu shots have been given to millions of pregnant women over many years with a good safety record. There is a lot of evidence that flu vaccines can be given safely during pregnancy. Pregnant women can get vaccinated during any trimester of their pregnancy. Getting a flu shot at the beginning of flu season (October) is recommended. It takes about two weeks for the body to build up protective antibodies after you get the flu shot.

Pregnant women should not get the nasal spray flu vaccine, as it contains a live strain of the virus.

Vaccination has been shown to reduce the risk of flu-associated acute respiratory infection in pregnant women by up to one-half. A 2018 study showed that getting a flu shot reduced a pregnant woman’s risk of being hospitalized with flu by an average of 40 percent.

What else can I do to stop the spread of disease?

The same prevention methods work for flu or COVID-19

  • Get a seasonal flu vaccine. Everyone in the family (over the age of 6 months) should get a vaccine, and so should anyone who cares for your baby.
  •  Wear a mask, being sure it covers your nose and mouth snuggly.
  • Wash your hands often and well, and have children do the same.
  •  If you’re sick, stay home from school or work.
  • Avoid close contact with people who are sick, if possible.
  • Cover your sneezes and coughs.
  • Use a tissue once, then throw it away and wash your hands.

Signs and symptoms of the flu

Seasonal flu symptoms usually come on fast, causing chills, fever, muscle aches, tiredness, dry cough, and sore throat. Occasionally, seasonal flu will cause a runny or stuffy nose or, in young children, nausea, vomiting, and diarrhea.

How influenza spreads

The flu virus prefers air travel, catching rides on the tiny droplets that fly out when someone sneezes or coughs. However, it can also stick around on surfaces for a while. If you touch something that was recently contaminated and then touch your mouth or nose, you can get infected, too. It is important to note you can spread the virus before you show signs of illness.

What if I get the flu during pregnancy?

If you begin feeling ill with any of the symptoms of the flu, or feel you may have it, contact your doctor immediately. Your doctor can prescribe you safe antiviral medications to treat the flu. Taking antiviral medications as soon as you find out you are sick can reduce the amount of time you are sick. Other steps to treat the flu include getting plenty of rest and drinking plenty of fluids. Talk with your doctor before taking any over the counter medications for the flu.

For more information

Ask your doctor about getting a flu vaccine. Or for locations to receive the flu vaccine, go to

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.

Take 2 Podcast: Vote-by-mail ballots are out, Amendment G and dueling town halls

The Take 2 Podcast regulars were all back in the KUTV studios today with Heidi Hatch hosting Democrat and former lawmaker Jim Dabakis and Republican and former Speaker of the House Greg Hughes to discus a variety of topics less than three weeks before the 2020 election.

Long a vote-by-mail state, ballots started arriving in the mail for many Utahns, with only 18 more days before Election Day.

The pair also discussed Amendment G on the ballot and education funding with each having a view on how to vote on the issue.

President Donald Trump and candidate Joe Biden each had a town hall meeting last night, dueling on different channels. Instead of the scheduled debate, Trump was on NBC while Biden was on ABC, making their case to voters. Who won?

And what did Hughes and Dabakis have to say after Twitter and Facebook did allow a New York Post article on its platforms.  Who should control what the public sees and hears?

“Smoking-gun email reveals how Hunter Biden introduced Ukrainian businessman to VP dad” Should we be concerned about turning into China where information is filtered and the flow of information is controlled?

Food allergies and kids

Food allergies can cause serious and even deadly reactions in kids, so it’s important to know how to feed a child with food allergies and to prevent reactions.

Jade Elliott spoke with Dr. Thad Abbott, Intermountain Healthcare, on this episode of the Baby Your Baby Podcast about how food allergies effect kids and how to manage them while they are at school.

What Are Food Allergies?

Milk, eggs, soy, wheat, tree nuts, peanuts, fish, and shellfish are among the most common foods that cause allergies.

Food allergies can cause serious and even deadly reactions. So it’s important to know how to recognize an allergic reaction and to be prepared if one happens.

What Are the Signs & Symptoms of a Food Allergy?

With a food allergy, the body reacts as though that particular food product is harmful. As a result, the body’s immune system (which fights infection and disease) creates antibodies to fight the food allergen .

Every time the person eats (or, in some cases, handles or breathes in) the food, the body releases chemicals like histamine . This triggers allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system.

Symptoms can include:

  • wheezing
  • trouble breathing
  • coughing
  • hoarseness
  • throat tightness
  • belly pain
  • vomiting
  • diarrhea
  • itchy, watery, or swollen eyes
  • hives
  • red spots
  • swelling
  • a drop in blood pressure, causing lightheadedness or loss of consciousness (passing out)

What Are the Most Common Food Allergens?

A child could be allergic to any food, but these eight common allergens account for 90% of all reactions in kids:

  • milk
  • eggs
  • peanuts
  • soy
  • wheat
  • tree nuts (such as walnuts and cashews)
  • fish
  • shellfish (such as shrimp)

In general, most kids with food allergies outgrow them. Of those who are allergic to milk, about 80% will eventually outgrow the allergy. About two-thirds with allergies to eggs and about 80% with a wheat or soy allergy will outgrow those by the time they’re 5 years old. Other food allergies may be harder to outgrow.

What Happens in a Food Allergy Reaction?

Food allergy reactions can vary from person to person. Sometimes the same person can react differently at different times. So it’s very important to quickly identify and treat food allergy reactions.

Reactions can:

  • be very mild and only involve one part of the body, like hives on the skin
  • be more severe and involve more than one part of the body
  • happen within a few minutes or up to 2 hours after contact with the food
  • Food allergy reactions can affect any of these four areas of the body:
  • skin: itchy red bumps (hives); eczema; redness and swelling of the face or extremities; itching and swelling of the lips, tongue, or mouth (skin reactions are the most common type of reaction)
  • gastrointestinal tract: belly pain, nausea, vomiting, or diarrhea
  • respiratory system: runny or stuffy nose, sneezing, coughing, wheezing, shortness of breath
  • cardiovascular system: lightheadedness or fainting

Sometimes, an allergy can cause a severe reaction called anaphylaxis, even if a previous reaction was mild. Anaphylaxis might start with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life-threatening.

How Are Food Allergies Treated?

If your child has a food allergy, the allergist will help you create a treatment plan. Treatment usually means avoiding the allergen and all the foods that contain it.

You’ll need to read food labels so you can avoid the allergen. Makers of foods sold in the United States must state whether foods contain any of the top eight most common allergens: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, or soy.

There’s no cure for food allergies. But medicines can treat both minor and severe symptoms. Antihistamines might be used to treat symptoms such as hives, runny nose, or belly pain from an allergic reaction.

If your child has any kind of serious food allergy, the doctor will want him or her to carry an epinephrine auto-injector in case of an emergency.

An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It’s easy to use. Your doctor will show you how. Kids who are old enough can be taught how to give themselves the injection. If they carry the epinephrine, it should be nearby, not left in a locker or in the nurse’s office.

Signs and symptoms of anaphylaxis that would require epinephrine include:

  • hoarseness
  • throat feels tight
  • swelling in the mouth
  • trouble breathing
  • any symptoms from two or more body systems (skin, heart, lungs, etc.), such as hives and belly pain
  • any other combination of two or more symptoms that affect different parts of the body

Every second counts in an allergic reaction. If your child starts having serious allergic symptoms, give the epinephrine auto-injector right away. Also give it right away if the symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms can happen.

It’s also a good idea to carry an over-the-counter (OTC) antihistamine for your child, as this can help treat mild allergy symptoms. Use antihistamines after — not as a replacement for — the epinephrine shot during life-threatening reactions.

For more information, click here.

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.