Thursday, May 20, 2010

straw cups

Anyone else use straw cups with their kids? I heard that sippy cups form bad speech habits (from our speech therapist, guess she should know) so we skipped those...

The straw cups have 4 parts: cup, lid, top part of the straw (that sticks out the top, usually flexible silicone) and a short, hard plastic bottom straw.

The bottom straws keep falling out of the dishwasher basket, so we break them or lose them. I went to buy replacement straws and they were $1 each and they only sell them online so you have to pay shipping too. Not to mention that half of the cups say to use a different straw (they don't carry the right length) and cut it yourself. I thought that was absurd. $1 for a 5" piece of plastic straw I have to cut to length myself!

So... I will say up front I'm a little off...

I did some research into the material that the straws should be made out of (the answer is polypropolene) and I ordered the stuff from a supplier (mcmastercarr). For $11.50 (that includes shipping) I will have 25 feet of the stuff at my door tomorrow. Needless to say if you use straw cups and need some replacement straws just call me. I have plenty.

Monday, January 25, 2010

MSPI diet survival (desserts)

MSPI (milk and soy protein intolerance) is something that is somewhat common in babies and that is typically outgrown. Unfortunately these proteins pass from the mom to the baby when nursing, so the options are to stop breast feeding and use a super expensive formula or to go on an elimination diet.
I have been on a milk and soy free diet for 6 months now, and after a lot of label reading, here are some suggested products and recipes that keep me sane when I'm missing my favorite foods.

I make my own bread because it's good and cheap and I'm afraid of soy lecithin.
2.5 teaspoons of active dry yeast
1 cup hot water
Dissolve yeast in water and let sit for 5-10 minutes
4 tablespoons of sugar
3 cups of flour (I use 1 cup whole wheat flour and 2 cups of bread flour)
1 teaspoon salt
1/4 cup canola oil
I put it in the bread maker on the regular cycle with light crust. My husband says that when the diet is over he does not want to go back to store bread.

Things to buy at the store:
Duncan Hines makes cake mixes, icing, and brownies with no milk or soy. Yes, brownies. Not all varieties, but some. Anything that says "milk chocolate" contains milk.
My favorite thing to do with the cake mix is to make cookies. The Lemon supreme cake mix makes amazing cookies. The recipe is simple:
1 box cake mix
1/3 cup canola oil
2 eggs
Bake at 350 for 8 minutes on a greased cookie sheet or parchment paper

For milk substitution I like the coconut milk beverage made by sodeliciousdairyfree. Things like corn bread and pancakes (Bisquick is OK but Hungry Jack is not) turn out much more normal in texture than with almond breeze or rice milk.

Other products that are surprisingly milk and soy free:
Pillsbury refrigerated cookie dough: sugar cookie and peanut butter cookie
Kroger brand chocolate graham crackers
Kroger brand ginger bread cookie dough
Peter pan peanut butter does not even have soybean oil in it
Veggie Ritz crackers
most pretzels (I like Kroger brand honey wheat twists)
most potato chips (Lays are OK)
Kroger brand tortilla chips

for baby:
Gerber sweet potato puffs (but not the other flavors)
Little comforts banana puffs (but not the other flavors)

Things that caught me off guard:
tuna in spring water contains soy in most brands
tortilla chips are tricky - beware of lime flavored. Tostitos are OK in the regular version but have milk and soy in the hint of lime and baked varieties. Kirkland brand is processed in equipment that also processes milk and soy.
Earth's best cookies for infants have a "processed on" warning
regular graham crackers in every brand my store carries have either milk or soy (but not in the other flavors)

I'll add more later, but Megan is now snoring on my shoulder...

Monday, January 18, 2010

Chylothorax and breastfeeding

Our one week stay in the hospital turned into 4 weeks. The complication was chylothorax. It is something complicated that the doctors admit they don't totally understand, but basically here is what I got out of asking them about 200 times:

Fluid collects in the pleural space (the space between the lining of the lungs and the chest cavity) and restricts the space the lungs have to expand.

The lymphatic system is responsible for processing fats. (Who knew?) Our daughter was put on IV nutrition (TPN and lipids) and then had a food challenge. They used full fat breast milk for this and it was after a short time. The fat poured into her pleural space and she had to get an extra chest tube to drain it. It also caused respiratory distress. It was terrible.

Then she was put back on TPN and lipids. This time it was for a lot longer.
In the meantime I was working with lactation and nutrition to figure out what to transition her onto after the TPN and lipid phase was over.

Typically they put kids on Portagin (spelled something like that) because it is a really low fat formula. Megan is milk and soy intolerant and Portagin is milk based, so it wasn't an option. There was another formula but they weren't big fans of it (not nutritionally complete) so we started trying to make low fat breast milk.

First I changed my diet. The lymphatic system is not responsible for processing medium chain fatty acids. Breast milk is always going to be about the same percentage fat and you can't really change that, but you can change the type of fat. I avoided all meat fat and drank coconut milk. I also tried to have most of my calories come from carbohydrates.

When I pumped I would stop after the first 1/3 of my pumping time had elapsed and set the milk aside. The rest of the milk I dumped. That foremilk was stored in a hard plastic container for at least 4 hours and then I would take a 60 cc syringe and suction out the milk below the fat layer. (I got really good at making a small air bubble to use to get the fat off the tip before sucking the milk in. Also, my milk first thing in the morning I would use the first 2/3 because it was all low fat.)

The dietitian and lactation consultants were using a hematocrit machine and spinning samples of my milk to determine the fat content. We got to the point that it was lower fat than the formula.
When she was ready to start taking her food orally we started her with this milk.

The problem was that they wanted her on this low fat diet for 6 weeks. I was dumping more than half of what I was pumping. It doesn't take any advanced math to see that there was no way I could supply what she needed if I dumped this much, so we had to find a way to make low fat milk out of all of my milk and not just the foremilk.

There is a la leche league article about this and the family use the washing machine as a centrifuge but couldn't figure out how to get the milk out once it was seperated. They ended up buying a real centrifuge to separate the milk and fat and feed their baby. After finding out that a centerfuge was going to be expensive and very tedious, I decided a better approach was to use the washing mahine and think of a way to get the milk out.

Washing machine milk centrifuge:
I took 60 cc syringes of freshly pumped milk (no need to let it sit for this, but if you do just fill the syringe with the part under the fat layer and consider it a double-skimming) and closed them with IV locking caps. (They screw on. The kind that pushes on leaked and I lost a batch of milk into the washing machine that way.) The hosptial supplied me with these.
Then I tied a cord around the syringe up by the flange (the cord I used was similar to shoelace material, the yarn broke), hung the syringe pointing down, and tied the other end of the string to the agitator in my washing machine. I ran the spin cycle (the syringe would fly outwards like the swing ride at the fair, but I tied it tight so it wasn't hitting the sides). When the cycle finished the fat would be at the top of the syringe. I took the cap off and squirted the milk out into a storage container and stopped squirting when I reached the fat layer. Tadaaa! Low fat milk! I found that I could spin 2 syringes at once with no tangling or problems. I was never brave enough to put 180 ccs of milk in at once. The creamatocrit results showed that we could make 1% milkfat and even less using this technique.

For the contact information of the nutritionist and lactation consultants at Nationwide Children's Hospital who did this with me, email me. They have more information that will be useful should you be going down the same path.

Thursday, January 14, 2010

How do you give an infant a pill?

One of the least scary things we learned before Megan was discharged from the NICU was that she had hypothyroidism. It's simple to treat, they assured us. Just give her medicine once a day and she will not have any problems as a result.

This was much easier to swallow than the heart problems. But this is the first problem that really set me on a mission. Even though it was so treatable, I next learned that the hormones from the thyroid are responsible for BRAIN DEVELOPMENT in babies! (I was thinking it was weight gain. I could live with messing up a little if it was just that, but brain development! Why did that have to be something I could actually ruin!?!)

How do you give an infant a pill?

It seemed so simple. You split it to the proper dose, crush it in a pill grinder, pour it in a little cup and add some water or breast milk... WRONG! Most of the pill is now sticking to the sides of the little cup. (This is what they did in the NICU. The endocrinologist did not agree with this method.)

So you split it, crush it, mix it in a bottle, add a little breast milk or water... WRONG! It sticks to the sides of the bottle.
Even if you use multiple washes of milk or water, it still sticks (I tried).

So I did what any reasonable mom would do, I asked her specialist what to do. He was so helpful with what I should not do. He said "You should put the crushed pill onto a teaspoon of milk or water and shove it in her mouth." This man (nice though he admittedly was) had definitely never tried this method.

I had no idea she could spit something out so quickly, so completely. Megan said that this method was WRONG! (I held a grudge against that doctor for his terrible advice and she goes to a different endocrinologist now.)

So my husband and I searched for a better idea. We didn't find anything.

Finally, by trial and error, I found the answer. Here it is:

Required tools:
Oral syringe (I recommend the Safety First syringe because it has a wide flare for the top opening.)
small cup
clean hands

1. Take the syringe apart.
2. Put your finger over the opening of the syringe (the part that goes in their mouth) and hold it tightly.
3. Pour the medicine into the syringe from the top. (Keep it upright.)
4. Gently push the stopper just a little way into the syringe.
5. Flip the syringe so the powered medicine can fall down onto the stopper. (Flick the sides if necessary, but make sure there is no more medicine against your finger.)
6. Remove your finger.
7. Keeping the syringe upright, insert the stopper slowly until it is most of the way into the syringe.
8. Suck up some liquid (breast milk was great for keeping her from spitting out the medicine because it was a familiar taste, but it did not dissolve the pill well. We switched to water once she liked water too.)
9. Put your finger firmly over the end again
10. Shake it up
11. Give it to the baby
12. Repeat 8-11 as a rinse

Some other tips:
Don't clean the pill crusher. It sounds gross, but it helps keep the dosing consistent. Just be careful to keep it in a special place out of the way of the dirt of life. When we had multiple pills to give her we used separate pill crushers for each one.

Megan went through a stage of spitting out her medicine no matter what we mixed it with. Finally we realized that she just didn't like having anything squirted into her mouth. We started leaving extra air in the syringe and letting her suck the medicine out. It worked great for her. It also taught her how to drink out of a straw at a very young age.

Welcome to my thoughts

My daughter, Megan, is now 10 months old. When she was born I started, unexpectedly, on an intense course of study to find answers to her unique set of problems. Along the way I found that though others had certainly walked the road ahead of me, I could not track down the results of their searches. Your child is not my child, so my answers will not be perfect for you. I do hope that some of my hours of reading and sleepless nights will save some other parent from having to figure something out from scratch.

I hope you laugh at me when I take myself too seriously. My journey started with my new baby girl wheeling away to the NICU...