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Monthly Archives: September 2012

Childhood Stressors

Blue. Not breathing. No heartbeat. In this moment, chaos ruled. When my son, Ephraim, was born, he had 0 APGAR scores, which basically meant he was dead. After given 2-3 minutes of CPR, he was revived, but only left to fight a long road ahead. He spent the next three weeks in the NICU, relearning many characteristics that typical newborns have naturally. Around a month old, he was diagnosed with cerebral palsy. From the moment Ephraim entered this world, he has only known chaos, which has presented numerous stressors on his young life.

While I can focus on several different areas that have affected Ephraim’s life cognitively, physically, and socially, I have choosen to focus on a large struggle and stressor on him: eating!

When Ephraim was born, he was unable to handle breast feeding initially. He was placed on nutrients through an IV that went into his belly. Around two weeks old, we began a trial process of starting him on a bottle. While he took it with some ease, he still had a lot left over in his belly. Therefore, he was put on an NG feeding tube until he could master the bottle.

When he came home, he was reluctant to accept a bottle. When he did take a bottle or breastfed, he would be slow to latch on and fed very slow. This began to place a stress on him, as he grew to dislike feeding. When he would see a bottle, his entire body would tense up and his head would turn away. Not only was this a stressor for him, but I began to dread feeding times as well. With both of us frustrated and stressed, feeding times became overwhelming at times.

Around six months old, Ephraim was barely accepting a bottle. It would take over an hour to feed him eight ounces of formula. When we got to the point where very few people had the patiences to feed him, it was time to consult a specialist. Upon our first trip to the GI doctor, Ephraim was immediately placed on a new formula for babies with sensitive tummies. When I switched bottles and placed him on the new formula, I began to see a small improvement. Feeding was still a major stressor in his lifes, but we were actively seeking outside support and professional advice to help this become less stressful.

Unfortunately, his story doesn’t end here. While eating was a slow process, he then began to have severe acid reflux, which resulted in spitting up or throwing up almost daily. Around his first birthday, he was lower on the charts for weight gain. Therefore, he was placed on a higher caloric formula to help him gain a few more ounces. However, over the next year, his eating continued to decreased. Despite changing bottles numerous times, offering sippy cups, and introducing solid foods, he still threw up daily. This was becoming such a huge stressor on his life that eating was now beginning to take place while he was asleep. (He would suck the bottle while he was half asleep.) However, this didn’t always work, as he would sometimes wake up coughing, covering himself and me in a bath of formula up-chuck. He was so stressed out over his inability to eat properly that he turned his head away everytime the bottle was presented. If he were to take anything by mouth, he would get so upset that it would often be thrown up. Eating was a huge stressor in Ephraim’s life that didn’t seem to be getting any better.

About two weeks to his second birthday, eating was taking a negative toll on his body. He spent almost half of his day trying to eat, but barely took about 12 ounces in. He finally got to the point where he refused all food and liquids. This stressor on his life had now entered significant chaos, and outside intervention was required.

Upon hearing that he had been taking in very little nutrition, his GI doctor and rehab doctor decided it was best to admit him to an inpatient facility for intense feeding therapy. When he was admited on October 19, he barely accepted a 4 oz jar of baby food a day and was not taking in any liquids. His weight was barely hanging in there at 26 pounds (just about three times his birth weight at his second birthday.) He spent the next three months working every day with multiple therapists on learning how to eat. He learned how to accept food from a spoon, and then he began to increase his food volume very slowly. He also began to work on oral motor skills and started to accept some textured foods. By January, about three months into this intensive hospital stay, he was successfully eating about 10-12 ounces of pureed food for each meal, meeting his daily calorie intake. Eating became much less stressful for him, and he came to enjoy sitting down for a meal with someone.

After his discharge in January, Ephraim suffered with a small bout of acid reflux. With a change in medication, he resumed his new eating skills. I came to love feeding Ephraim. Rather than turning away and refusing food, he actually opened his mouth and accepted his food. His weight, however,, began to drop which became disconcering. Although his eating was not as much of a stressor anymore, he has lost 2 pounds. His GI doctor became increasingly alarmed that he was actually declining on the progress chart, rather than climbing the chart with his age range. He was then placed on a caloric powder substance to increase the amount of calories he recevies a day. Fortunately, he has managed to gain about a pound and a half over a few months. With the intense therapy that he continues to receive as an outpatient and his calorie additive, eating for Ephraim has now become successful and pleasent.

Since eating was a huge stressor for Ephraim, causing major chaos in his life, he now struggled to eat any textured foods. He will refuse lumpy or grainy foods. He will not accept any liquids from a cup or bottle, but rather takes it thickened by a spoon. He received feeding therapy twice a week to help him grow more tolerate of textured foods and accept some liquid from a cup. To help him cope with this stressor, he has adapted to accepting all foods by spoon. Since feeding was so traumatic for Ephraim during the first two years of life he has become resistant with any textures or cups. While I continue to actively pursue additional resources to help Ephraim get over this stressor, I suspect that he will struggle with feeding issues for a good majority of his childhood.

Malnutrition is a huge stressor in the development in the lifes of children in Africa. Malnutrition is a result from poor food absorption or intake. Malnutrition can stem from the poverty rates, the economic situation in Africa, and even the climate change (http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm). 1 in 5 children in Africa will suffer from chronic malnutrition, while 1 in 10 will have severe malnutrition. As many as 50 % of the children have lack of calcium, iron, and zinc. 1 in 5 children in Africa have stunted physical growth as a result from undernutrition (http://food4africa.org/).

When malnutrition occurs in a child, their development is is profoundly affected. They may struggle with more sicknesses during the year, significant increasing major disease symptoms. They can have issues with paying attentiion and retaining information. Malnutrition can cause delayed or issues in physical growth and has even resulted in death (http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm). When children don’t receive the nutrition they need, their overal physical, cognitive, and mental development are negatively impacted, rendering them helpless in this situation.

However, there are numerous efforts working to help reduce hunger and malnutrition among children in Africa. The SUN (Scaling Up Nutrition) Movement, which includes about 30 countries, is working to improve the nutrition for everyone, especially children and women. This program is working directly with the people by trying to support breastfeeding and increasing vitamin suppliments among children. In addition, they are taking indirect methods, like increasing farming practices, to help reduce malnutrition. Countless people and government agencies, including UN representatives, Head of States, and politicans are working together to fight against malnutrition and to help increase the lives of children and adults http://allafrica.com/stories/201209281286.html).

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Posted by on September 29, 2012 in Childhood Stressors, Week 4

 

Child Development and Public Health: Immunizations

When researching the different ways public health affects childhood development, I chose to specifically focus on immunizations. I find immunizations to be crucial for proper and healthy development of a child. If a child is exposed to a harmful disease that could leave lifelong complications, his development could be largely impacted. With the simple routine measures of immunizations, we are actually helping to promote healthy development. In addition, I also find immunizations to be imperative for children with special needs. Whether the special needs are mild or severe, if a child catches a disease, like whooping cough, it could be deadly. By ensuring that these special children as vaccinated, we could be preventing death for them. Finally, this topic is meanigful to me, because I am a mother. Since my son has received all of his vaccines, I don’t have to fear contagious diseases. However, I couldn’t imagine watching my son enduring a painful disease, knowing that it could have been prevented through a vaccine. Knowing that immunizations are available is meaningful to me because it provides ways that I can take to make sure my son is protected and has the best chance of development that won’t be affected by contagious or deadly diseases. This is also meaningful to me as a professional because I can educate parents about the important need to vaccinate and advocate for children to receive all childhood immunizations. Through knowing this knowledge about immunizations, I feel like I have found my voice to ensure that all children are receiving these life-saving vaccines to help them reach their fullest potential.

After comparing information of immunizations in the US and Africa, I am able to see how blessed and fortunate we are living in America. Our children have the opportunity to receive these vaccines that will help prevent major diseases and promote healthy development. So many children in Africa don’t yet have this opportunity and are unfortunately suffering from this deficit. It also encourages me to become a stronger advocate for children worldwide to receive immunization opportunities. If all children in Africa were to receive the vaccines the children in US received, we would see a lower rate in mortality and childhood diseases, with an increase in childhood lifespan.

Knowing this amount of information about immunizations impacts my work as a professional. I am know aware of the consequences that the lack of vaccines has. If I encounter a child that has these side effects, I will be able to know how to better serve him and his family. I will be able to provide appropriate resources and services for the child and family. Through working in collaboration with the family, we can ensure that the child will be encouraged to reach his fullest potential, despite from effects from a preventable disease. In addition, I also know how to better advocate about childhood immunizations. I can help parents remained informed about the importance of vaccines and arrange for assistance, if needed, to ensure their child receives all of the childhood immunizations. I could also enforce a general policy that all children within my care are up-to-date with their vaccines to make sure all children are protected. Through knowing more about immunizations, my opinion as a parent and a professional has been impacted. I am inspired to advocate for all children, irregardless of race, SES status, or ability, to receive their vaccines, so they can aim for the best in life.

 
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Posted by on September 15, 2012 in Public Health, Week 2

 

Personal Birthing Experience and Birth Customs in Germany

My Journey to a Miracle …

I was almost 42 weeks pregnant, and I desperately wanted to have my child. I had stopped working when I reached my due date, which was about two weeks prior. I spent my days lying around, feeling contractions, and waiting, waiting, waiting for my precious baby boy to arrive into the world.

Friday afternoon, October 23, rolled around. As I got up from my routine afternoon nap, I had to go to the bathroom. When I had finished, I realized that I was still “leaking.” This was finally it! I called my midwife and informed her that my water was starting to break. There was no immediate rush, as my contractions hadn’t begun yet. I leisurely took my time getting ready to go to the hospital. My mother arrived home from work around 5, and my family sat down to eat dinner. Feeling no rush, just a trickle of water every now and then, I enjoyed my last meal before I became a mother.

We finally got to the hospital around 6:30 that evening. I was checked into triage, and it was confirmed that my membranes had indeed ruptured. Everything with the baby checked out fine, and it was now time to walk, walk, walk until the contractions began. My mother, who was my birth coach, walked up and down the halls for hours, with a periodic check from the doctor. Nothing was moving or happening. The only thing to do was wait until my little boy decided he was ready to arrive.

Around midnight, I decided to try to get some sleep. Contractions hadn’t started yet, so I figured I would attempt to catch my sleep before his big arrival soon. At 2 AM, I felt a sudden sharp pain that startled me from sleep. Contractions were starting. I breathed through my first one, which lasted about 45 seconds. I didn’t think they were so bad. I was certain that I could carry out my birth plan to remain drug free.

By 5:45 that morning, my contractions were steady and strong every 2-3 minutes. As much I as tried to stay away from any medications, the pain was becoming overbearing. I was given an epidural shortly before 6 in the morning. Afterwards, I was much more comfortable and was able to rest. By midmorning, I was 6 centimeters dilated and moving steadily along. I was happy and merry, as I couldn’t feel anything below my waist. I would be told a contraction was coming or going, but my body felt nothing.

Around 1 PM, I was fully dilated. It was time to start pushing! I was so excited to meet this little boy I had been carrying for nearly 10 months. Pushing started out easily. Although I couldn’t feel anything, I would push on cue with all my might. By 4:30, the concern was starting to grow that my son wasn’t moving easily through the birthing canal. My epidural was reduced, and I was put on Pitocin to increase my contractions. Different positions were attempted to help ease my son out, but he remained stuck.

At 5:30 PM, 4 ½ hours after I started pushing and over 24 hours since my water broke, the concern was written all over everyone’s face. My unborn child was stuck on my pelvic bone and wouldn’t budge no matter how hard I tried. My epidural had since been stopped, so the pain was wrenching through my body. I was begging anyone who would listen to help get my child out.

A doctor who was on-called emerged into my birthing room and reviewed my case. While forceps were briefly mentioned, a C-section was the ultimate route decided. I was rushed into the operating room around 6 PM Saturday night. An epidural was re-administered, and I was prepped for surgery.

At 6:32 PM, my son, Ephraim Emmanuel, entered into this world. Unfortunately, due to the intense, lengthy birthing process, he was born not breathing and with no heartbeat. After he was giving 2-3 minutes of CPR, he came back to life. He was quickly put on a ventilator and moved to the NICU. My little miracle continued his fight for the next month in NICU. However, nearly a month after he was born, my Ephraim was able to come home.

Although my birthing experience was dramatic, I consider myself extremely blessed to have taken this journey that led me to a true miracle, my little Ephraim.

I chose to share this story because it is my direct, personal experience with a birth. Prior to giving birth, I read about birthing experiences and watched numerous TV shows. However, once I personally went through it, I was able to put my story into words. In addition, I like to share my story so others know that they are not alone. There were so many times when I felt like I was the only one who went through an experience like mine. However, if I can share my story and let others know that someone else understands what they are feeling, then perhaps I can make a difference. Finally, I chose to share this story because I love to show people what a true miracle looks like almost 3 years later:

When it comes birth and its impact on child development, I can personally say that the birth experience, whether it is positive or negative, highly impacts how a child will develop. With a positive birth, where a child emerges healthy and happy, her/her development is off to a good start. However, when a negative birth experience occurs, like my son’s, his development has been severely impacted. He currently suffers from brain damage on the right, left, and middle. He struggles with developmental delays and learning how to eat and speak. All of his current developmental progress can be tracked directly to his birth experience. In addition, if a child is born addicted to drugs, his/her development may have already been negatively affected. I believe, based upon personal and professional experience, a child’s birth experience may significantly impact his lifelong development.

In Germany, they believe that midwives are very important, while doctors are optional. This is similar to my story, as I had a midwife present at my delivery. However, a doctor was also there at the end of my delivery to help provide additional assistance when my son ran into troubles. Germany also places a large significance on the birthing process and sometimes views a C-Section as a failure. This is a difference with my personal experience. While I was focusing on delivering my son, I was more intently focused on actually seeing my child. When I had to have a C-Section, I didn’t see it as a failure, but rather a life-saving effort that saved my son. While Germany may see this as a failure, I see my C-Section as a success.

One of main differences between my personal birth experience and Germany birth customs is the length in maternity leave. In the US, women are given between 6-8 weeks after giving birth. This is unpaid leave, and if any additional time is needed, a job may not necessarily be saved. For me, I had to return to work about 8 weeks after my son was born. While I was still struggling with health issues and learning how to handle a son with special needs, I was forced to return to work, or my job would be given to someone else. I often wonder if I had been given a lengthy amount of maternity leave, as they do in Germany, if my health issues would be better today and if my son would have gotten even better care from the doctors.

Another small difference is that I had the freedom to choose the unique name of Ephraim for my son. If I had been living in Germany, I would have had to write to the government to get an approval for his name. I am very glad that in the US we have the ability to name our child anything we would like (well, to an extent).

After comparing my personal birth experience and the Germany birth customs, I have gained a few insights. While midwives are important in the birthing process, doctors are just as equally important. They bring a certain level of expertise and knowledge that can help save both the mother’s and child’s life if dangerous situations emerge. If both a midwife and a doctor are present at a birth, I believe that unborn babies in distress can be helped quicker, which could prevent a negative development growth.

In addition, I also gained an insight about the importance of maternity leave. Germany provides up to 3 years with job security. If women were able to relax and know that their job is secure, they will be able to focus on their newborn. If we were to increase parent bonding and interaction with newborns and children, I believe that their developmental growth will be positively impacted.

 
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Posted by on September 8, 2012 in Birth Experience, Week 1