Ages & Stages

ASK A PEDIATRICIAN:

How to stay safe this FLU SEASON

What can pregnant moms do to stay safe this flu season? Are there complications if the flu is contracted during pregnancy?

• Staying healthy while pregnant includes universal masking indoors, avoiding people who are sick, good hand hygiene and making sure you’re up to date on your vaccines. Special vaccines to remember include your annual flu shot, pertussis booster and the COVID-19 vaccine. These vaccines are safe and can help to keep a pregnant mom safe during flu season. • During previous flu seasons, the flu vaccine helps to decrease a pregnant mom’s risk of respiratory infection by about one-half. It has the additional benefit of reducing a

pregnant mom’s risk of being hospitalized with the flu by about 40%. • The flu shot also helps to protect your baby after birth and through the first several months when the baby is too young to get the flu vaccine. • During pregnancy and immediately after birth, your immune system, heart and lung functions change. These changes are normal but it means that these mom’s can get severely ill (really sick) from the flu. Pregnant and postpartum moms (2 weeks after delivery) are at higher risk for being hospitalized from a flu infection. We know the flu shot helps to keep people healthy.

We have a new baby and older siblings–how do we prevent the baby from getting sick?

Congratulations on the new baby! Newborn babies need parents to keep them safe until their immune system is stronger. Full-term babies (babies born at 37 weeks or later), need extra protection during the first 1-2 months of life. (Premature babies need special protection even longer). The best way to keep your new baby safe is to avoid group gatherings, avoid sick visitors, good hand hygiene and updated vaccines for everyone in close contact with the baby.

When older siblings want to love on the baby, I recommend good hand hygiene and avoiding kissing the baby’s head. I recommend kissing the baby’s feet instead since the baby won’t be able to get their feet to their mouth. If a sibling is sick, do your best to keep them separated (I know it’s tough!). Lots of good hand washing for everyone. Encourage the sibling to cough into their elbow and lots of good hand hygiene. If the sibling is over 6 months old, then they should receive their yearly flu shot to help keep the baby safe.

Should families get the flu and COVID vaccines at the same time? Yes, you can get both vaccines at the same time. Talk to your pediatrician or primary care doctor about these immunizations. Anyone 6 months or older is eligible for the flu vaccine. Currently the Covid vaccine is available to those 12 and over.

Who is at risk this flu season? How dangerous is it?

Flu infections can be seen in healthy adults and children of all ages but we know there are certain groups and health factors that can make you more susceptible to having serious complications and a higher chance of needing to be hospitalized. Those at increased risk include children 5 years and younger, adults over 65 years old, pregnant women and residents of nursing homes or other long-term care facilities. Health factors such as lung conditions (like asthma, chronic lung disease), metabolic disorders (including diabetes), liver, kidney, neurologic and neurodevelopmental conditions, blood disorders (including sickle cell), weakened immune system and obesity can increase your risk for severe disease.

For our pediatric population (those under 18 years old), we know that children under 2 years of age have the highest number of hospitalizations and those under 6 months of age have the highest reported death rates. Luckily, flu related deaths are rare but we know that about 80% of those children who died were not fully vaccinated. (4 out of 5 children who died were not fully vaccinated)

Since Arizona is warmer than other states, does the flu season start later?

Predicting the annual flu season is very challenging. Our flu season can be earlier or later than the east coast but it is not very predictable. Past flu seasons have started as early as October or November and sometimes last until May. In Arizona, we usually see the highest number of flu cases between December and February.

The kids love to spend time with their grandparents but I know older people are more likely to have complications from COVID and the flu. Should we avoid spending time with them?

• We love grandparents and they are an essential part of our village. To help protect everyone in our village and community, we have to work together. We know that adults 65 and older have a higher chance of complications from both the flu and Covid. We also know the flu and Covid vaccines can help provide protection. In Arizona, 91% of

Dr. Sarah

Bannister has

been providing care as a Pediatric Hospitalist since 2012. She completed her pediatric residency at St. Joseph’s Hospital and Medical Center in Phoenix and served as a Chief Resident at Phoenix Children’s Hospital after the programs were combined in 2011. She is board certified in General Pediatrics and Pediatric Hospital Medicine. As a Pediatric Hospitalist, she is part of a team that cares for inpatient admissions and newborns at Banner Desert and Banner Gateway Medical Centers. Dr. Bannister has served as the Chair of Pediatric Medicine at Banner Gateway and Banner Children’s at Desert in addition to the Physician lead for the Pediatric Hospitalists at Banner Children’s at Banner Desert. Currently, she is the Medical Director of Care Coordination at Banner Ocotillo Medical Center and Banner Children’s at Desert. Dr. Bannister has a deep commitment to high quality evidence-based care. She believes that advocacy, equity and excellent care is essential to the success of our patients and profession. Dr. Bannister has spent the majority of her life in Arizona and completed her undergraduate education at the University of Arizona (Go Wildcats!). She enjoys baking and spending time with her family. She has 3 active boys, a husband and 2 dogs that keep her busy.

Raising Arizona Kids partners with the Arizona Chapter of the American Academy of Pediatrics to bring evidence-based child-health information to our communities.

those 65 and over have received at least one Covid shot. Now that the flu shot is available, these two vaccines will help decrease risk of infection and spread of illness for everyone. • In addition to vaccines, it is very important to stay home when you’re sick or keep kids away from others when they are sick. This helps to prevent the spread of many viruses (not just the flu and Covid).

Handwashing is another step that helps us to prevent illness by limiting the spread of germs. • The Covid pandemic taught us how to prevent illness with multiple layers of protections - masks, social distancing, hand washing, vaccines and staying home when you’re sick. During the flu season we can use the same game plan to keep everyone healthy.

In addition to vaccines, is there anything we can do to prevent getting sick this year?

Keeping kids and adults home when you are sick, universal masking indoors, good hand hygiene and making sure you’re up to date on your vaccines is the best way to stay healthy.

Making healthy lifestyle choices - food, exercise and sleep are also important. We want to give our body the right fuel and rest so it can perform at the top of our game.

I’ve read this flu season will be worse than we’ve seen in a while, what should we expect?

Unlike last year, we expect a “normal” flu season. It’s difficult to predict the severity of the flu season but we know it is coming and we know how to prevent severe illness. We know that giving our bodies time to have proper immunity is important. It takes the flu shot at least 2 weeks to start working, so it is important to get your flu shot early. For children 6 months to 8 years old, they will need 2 flu shots (1 month apart) during their first flu shot year, so you want to make sure they have extra time to build up their immune system.

What didn’t I ask that you’d like to add?

Your pediatrician (or primary care doctor) is here to help! We want to keep you healthy and safe. Be sure to get caught up on healthy check ups and vaccines that might have been missed over the last year of craziness. Vaccines help prevent many other dangerous diseases. Your doctors are here to help you stay healthy and safe!

Finding Healing After a Miscarriage

By Monique Seleen

Monique (pictured at 16 weeks) with her husband Chris in September 2021. They are expecting a baby boy in February 2022. MY FIRST PREGNANCY ended in a

miscarriage at just shy of 7 weeks along. While I knew miscarrying was a possibility, like so many, I wasn’t prepared for it to happen to me. My husband and I went from being blissfully ignorant, excited, and envisioning our future family, to feeling completely devastated, heartbroken, and empty. While it was not an easy healing journey, here are some things I did that helped me cope with the unexpected loss we faced:

Take time off from work

Ask if your employer offers bereavement for a miscarriage—my husband’s work allowed this and we were so grateful. You’ll need the time to heal both physically and emotionally.

Reach out to others who have also experienced a miscarriage

Neither my mom nor my mother-in-law had had a miscarriage so at first I felt very alone in what I was going through. I also found that people who had never gone through it didn’t quite know what to say and often just didn’t say anything about it at all, which was actually more hurtful to me.

Eventually, though, I had several friends reach out who had been through one or even two miscarriages of their own and offered words of hope, encouragement, and understanding.

Find a maternal mental health counselor

A week or so after our miscarriage, I started searching for a counselor who was trained to help me handle the grief and

emotions I was experiencing. Fortunately, I stumbled across a wonderful therapist who specializes in maternal mental health who also focuses specifically on those experiencing a miscarriage or loss.

Therapy can be expensive, but many health insurance plans offer it as part of your coverage if the therapist is in network.

Plan some fun things to look forward to and distract yourself

Our miscarriage happened a week before Christmas and while it definitely put a damper on our usual joyful celebrations, we were also thankful for the distraction and busyness that the holiday season provided.

Plan some fun date nights, a weekend getaway, a movie night watching your favorite comedy, or go for a walk with a friend. The more things you have on your calendar to keep yourself busy, the less time you’ll have to sit and wallow in your sadness.

Start a project

I was so looking forward to all the fun things that came with a pregnancy— designing a baby’s room, picking out a name, starting a registry, etc. So after the miscarriage, I felt even more at a loss of what to do with myself.

My husband and I decided to use that time to take an online course together about how to better handle our finances and become debt-free. That gave us something else to focus on and we felt like we were accomplishing something, too.

Use this time to tackle a home renovation, start a new hobby (learn how to sew, play an instrument, knit, crochet, learn a new language, start a blog, etc.), volunteer, or start that Etsy shop you’ve always dreamt about.

Dealing with the Anxiety of a Pregnancy after a Loss

WHILE I WRITE THIS, I am currently 17 weeks pregnant and have been experiencing firsthand the anxiety that comes with being pregnant after a loss.

Since my very first pregnancy ended in a miscarriage, all I had was a negative experience to compare it to, so naturally, I worried about the same outcome happening again.

I have been a ball of anxiety since the moment I saw those two pink lines but here are some things that have been helpful in getting me through:

Write down words of affirmation and recite them daily

I wrote down a bunch of phrases on sticky notes and stuck them in a place I would see as a daily reminder (a bathroom mirror, refrigerator, inside your closet, etc.). Some of the phrases I found helpful were: • I trust my body knows what it’s doing • It is okay to hope • Every day is one day closer • Hope does not make bad things happen • The past is not the future • This is a different experience • There is nothing I can change with worry

Stay focused on one milestone at a time

With my first pregnancy, my husband and I jumped right from a positive pregnancy test to picturing what our baby was going to look like and in doing so, it made the loss so much harder.

Instead, this time, we decided to focus on one small win at a time. We could still celebrate but were cautious not to get too far ahead of ourselves.

Focus on the facts and celebrate each small victory—a positive pregnancy test, good blood work results, your first doctor’s visit, etc. Then, stay focused on whatever the next milestone is—the first ultrasound, making it further along than you have before, the end of the first trimester, etc.

Look into midwifery care

When I had a miscarriage, the doctor’s office I was going to wasn’t particularly sensitive. I know miscarriages are common and that they probably see them all the time, but it was my first pregnancy and a devastating loss for me. Yet I felt like they were treating me like just another patient and told me to “come back in when I got another positive test”.

Because of that, I decided to switch from a regular Obstetrician to a Certified Nurse Midwife. The midwife I see does not rush me when I’m in the office, looks at my situation individually, and is available to communicate via an online portal/app, usually responding to me within a couple of hours. This has brought me so much reassurance when I’m worried and having someone understand my anxiety because of my past experience has been so wonderful.

I was 1in4

By Kate Reed Photo by Laura Liz Photography

DRIVING TO OUR 12 WEEK ULTRASOUND I was zoned out, focusing only on the road ahead of me. We drove in silence for 45 minutes. Both of us afraid to jinx it. I prepared myself for another loss. I had convinced myself that if there was nothing on the screen, I’d be ok. I was expecting it this time. We told no one except close family that we were pregnant again.

After suffering two miscarriages in the previous year, I was no stranger to the feelings of loss. We lost one right around the 6 week mark and another at 10 weeks. I had two healthy babies before so I was angry at my body for not being able to do what it was supposed to do.

I found that I didn’t like talking about it and rather internalized my grief. I pretended it didn’t bother me and that it was just ‘meant to be’. It wasn’t until multiple friends (more than I ever knew) admitted that they also had miscarriages. So why did I feel so alone?

When I thought I was pregnant again, I hesitantly peed on that stick and when the second line appeared, I wasn’t sure if I should feel happy or anxious.

At 12 weeks, I still couldn’t hear a heartbeat on a doppler and you can’t feel the baby move so I had no idea if there was even a baby in there. Every time I went to the bathroom, I feared there would be blood.

But, there he was…happy as could be dancing on the big screen in front of me. I sobbed. I’ll admit, seeing a healthy baby on the ultrasound provided a big sense of relief but it didn’t seem to cure all my worries.

Each appointment, I mentally prepared myself to hear “I’m sorry, there’s no heartbeat”. Of course, I let out a sigh of relief after he was deemed perfectly healthy week after week.

MISCARRIAGE STOLE MY JOY. There weren’t as many blissful pregnant updates with this baby. Not nearly as many belly shots. It wasn’t that I didn’t want to celebrate him, but rather I was worried that the loss would hurt even more if I fell TOO much in love with our baby. I spent too much time researching everything that could go wrong. I didn’t even want to wash his clothes or set up his crib at first ‘just in case’. I think in many ways I was disconnected.

Maverick was born at 41 weeks in a precipitous late night labor and I think I was in shock for the first few moments until I realized he was finally here. I think my face in this photo above really encompasses that feeling.

Maverick is now 4 months old and he’s the smiliest, squishiest, and joyful baby we’ve had yet. He truly is our rainbow after the storm.

Talking to your baby’s caregiver ABOUT SAFE SLEEP

By Emily Singleton

MOST NEW PARENTS have had some training in the ABCs of safe sleep: All babies should sleep Alone on their Back and in a Crib. But what about when someone else will be caring for your baby, especially if that person is from another generation and has different ideas about baby sleep?

Here are some tips for addressing some common misconceptions to keep your baby safe while they sleep:

TUMMY SLEEPING: “But they sleep so much better on their tummy”

In the early 90s, the American Academy of Pediatrics began recommending babies be put to sleep on their backs. Since then, deaths from sudden infant death syndrome, more commonly known as SIDS, dropped from 130.3 deaths per 100,000 live births in 1990 to 35.4 deaths per 100,000 live births in 2017.

Once babies can roll over to their tummy on their own (usually around 4-6 months of age), caregivers do not need to turn the baby to their back again. The important thing is that babies start their sleep on their backs and that all caregivers follow this important safety procedure.

CRIB BUMPERS: “Won’t they get their arms stuck in the crib slats?”

Bumper pads that attach to crib slats or sides come in cute designs and are used with the idea of protecting infants from injury. However, they can actually cause serious injury and even suffocation. The best way to keep babies safe in their crib is to keep the crib bumpers out.

Grandparents and older caregivers might remember a time before crib safety was regulated and the spacing between the slats on the crib sides could have been dangerous to babies if they were too wide. Now that cribs must meet safety standards (slats can’t be more than 2-3/8 inches apart), the slats don’t pose the same dangers and the bumpers are not needed.

RICE IN THE BABY BOTTLE: “They need more than milk to keep them full and sleep through the night”

Although many swear by this practice to put their babies to sleep, several studies have shown that babies with solids added to their bottles do not sleep longer than babies who were not given solids. Further, if your baby is under 6 months old, they might even sleep worse due to reactions to the solids.

All caregivers want their babies to have a good night’s sleep. While it can be exhausting for a caregiver, it is normal for young babies to wake several times throughout the night. Adding cereal to a baby bottle can be a choking hazard and it also takes away from the amount of milk or formula in the bottle so the baby may not get enough for their growth.

For more information about safe sleep, visit safesleep.gov or you can also contact Southwest Human Development’s Birth to Five Helpline at 877-705-KIDS (5437), which offers parents, caregivers and professionals free early childhood information and advice. Specialists are available from Monday through Friday, from 8 a.m. to 8 p.m.

Emily Singleton is the senior program manager of Parent Partners Plus at Southwest Human Development. To learn more about Parent Partners Plus, visit www. parentpartnersplus.com. For more about Southwest Human Development, visit www.swhd.org