Archive for ‘Uncategorized’

January 20, 2020

When Should I Feed My Baby Peanut Products?

When should I feed my baby peanut products? If your family has a history of food allergies or sensitivities, this can be a nerve racking question. Experts say the prevalence of peanut allergy among children in Western countries has doubled since 2005. While fear may persuade you to delay offering peanuts to your child, research indicates this is a riskier approach.

None of us want to experience anaphylaxis. None of us want to put our children at risk. And peanuts are hard to avoid. Your grocery store, favorite restaurant, mother’s day out, daycare or school can be filled with peanut products. Peanut ingredients may be hiding in Asian dipping sauces, curry, egg rolls, spring rolls, barbecue sauce, ice cream, candy, and cookies. Discovering the presence of peanuts is not as easy as looking for the word. Peanut ingredients may go by these names: arachidic acid, arachis oil, beer nuts, peanut oil, peanut butter, peanut flour, peanut meal, peanut protein, hydrolyzed peanut protein, hydrolyzed plant protein, hydrolyzed protein, hydrolyzed vegetable protein, mandelona nuts, cacahuètes, Earth nuts, ground nuts, goober nuts, goober peanuts, mani, Nu-Nuts, oncom or onchom (Indonesia), Valencias (Valencia is a variety of the peanut plant.), and kernel paste.

With a world full of peanuts, knowing how to reduce the risk for allergy can make you rest easier for years! Children who have severe eczema and/or an egg allergy are considered at risk for peanut allergy. That doesn’t necessarily mean you shouldn’t introduce peanuts at an early age.

baby

Introducing peanuts early significantly decreases the frequency of developing a peanut allergy and modulates immune responses to peanuts in those at high risk for this allergy.

Researchers in the Learning Early About Peanut (LEAP) trial (Du Toit G, et al. N Engl J Med. 2015;372:803-813) studied 640 infants at risk for peanut allergy who were between four and 11 months at the beginning of the study. They were randomized and assigned to separate groups based on sensitivity to peanut extract determined by a skin-prick test. One group had no measurable skin response. The other group had a wheal measuring one to four millimeters in diameter. The primary outcome of the study was assessed within each group as the proportion of participants with peanut allergy at five years of age.

The results among 530 infants with a negative skin test was a prevalence of 13.7% peanut allergy at five years for those who did not consume peanuts and 1.9% prevalence for those who consumed peanuts. Among 98 infants who initially had a positive skin test, the prevalence of peanut allergy at five years was 35.3% for those who did not consume peanuts and 10.6 percent in those who consumed peanuts. From this and other immune response data collected, researchers concluded that introducing peanuts early significantly decreases the frequency of developing a peanut allergy and modulates immune responses to peanuts in those at high risk for this allergy. Another study published earlier this year confirmed these findings.

Like much medical research, this result runs contrary to common sense. It seems as if it would be best to avoid something deemed likely to harm you, but in this case the opposite is true. Exposure to peanuts seems to reduce the frequency of allergy even in those at risk.

The American Academy of Pediatrics guidelines now recommend that you put your fears aside and introduce peanuts to at risk infants as early as four to 6 months. A child with severe eczema and/or egg allergy is advised to be tested for peanut allergy prior to introduction. A positive test means your doctor should help determine whether to introduce peanuts, how much, and over what period of time. Medically supervised feeding tests may be required.

The guidelines further recommend that infants with mild to moderate eczema be introduced to peanuts around six months of age to reduce the risk of peanut allergy. If these infants have successfully tolerated other solid food(s), they may have peanuts introduced at home without a doctor’s office evaluation, although such an evaluation can be considered.

Per the current guidelines, infants without eczema or food allergy who are not at increased risk can have peanuts introduced freely into the diet together with other solid foods in accordance with family preferences and cultural practices. This was the recommendation of my grandchildren’s pediatricians.

My family has a history of food allergies, sensitivities, and celiac disease. My second grandson had mild eczema at four months and my granddaughter is primarily tube fed due to a paralyzed vocal cord and a related swallowing problem. In spite of all of this, my sons were able to introduce peanuts at home without medical supervision.

They both kept the delivery method simple-a small bit of full-strength smooth peanut butter on a spoon. Because peanut butter is thick, this even worked for my granddaughter who is at risk for aspirating thin liquid. Many healthcare providers suggest a different delivery method.

In fact, Massachusetts General Hospital instructs parents to not give plain peanut butter to any child under four. While my grandchildren have suffered no ill effects from plain peanut butter, I like the detailed instructions, safety tips, and recipes MassGeneral Hospital for Children provides. If your pediatrician does not offer detailed instructions, these are great guidelines.

Most likely, your child’s pediatrician will bring up this subject at a well-care visit. If your child reaches six months of age before that happens, it may be necessary for you to initiate the conversation. Just add introduction of peanuts to your list of questions to ask the doctor. It is important to check with a physician before formulating a plan.

Research is one thing, but parental protectiveness is something much stronger. While you may intellectually understand it’s important to feed your baby peanuts, you may have a real aversion to doing so, especially if you grew up in the era during which guidelines recommended waiting.

If you are afraid to feed your baby peanuts, get some backup. Ask your doctor if a clinic or local hospital offers medical supervision that you can take advantage of. Ask a trusted friend with medical training (MD, APRN, RN, EMT) if they might be willing to come to your home to supervise you. Make sure a partner or friend is home with you to watch for signs of an adverse reaction. If your partner is responsible and less averse, it may be advisable for you to turn this task over to them and remove yourself from the situation to lessen everyone’s anxiety. Sometimes the best thing we can do is rely on someone else who we trust.

When you begin to wonder “When should I give my baby peanut products?”, the answer seems to be clear–sooner is better for reducing the risk of peanut allergy.

https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/

https://kidshealth.org/en/teens/nut-allergy.html

https://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

https://pediatrics.aappublications.org/content/143/4/e20190281

https://www.massgeneral.org/children/food-allergies/introducing-peanut-products-to-your-baby.aspx

December 29, 2019

Can’t You Do Better?

“That scarf doesn’t match your sweater. Can’t you do better?” That was how our conversation began. My mother’s first cousin Colene never held back an opinion. And yet she never made you feel bad. How did she manage that?
better
This is the question I’m pondering a month after her death as we approach the new year. The day before she died, a nurse said, “I loved Colene. She was so much fun – even when she was saying she was going to kick us in the teeth!”

I can hear her saying it now. She was fun. She was feisty. She was independent. She was confident enough to take driver’s ed at the local high school when she was 70 years old. And she was successful. She got her driver’s license and drove until she was in her 90s.

My cousin Johnny has a similar gift. He served in a state legislature in the Northwest for 30 years, retiring in 2017. He is disconcertingly direct and unafraid to let you know where he stands. Unlike most politicians, with Johnny there is no spin, no hedging, and no equivocating. Rather than being reviled for this, he is admired, trusted, and respected.

Colene and Johnny were not related, but they knew and liked each other. Dinner with the two of them was an annual event not to be missed. Conversation was lively, sometimes uncomfortable, but always uplifting…always uplifting.

When I ask myself, “Can’t you do better?”, that’s what I’m asking. Is the result of my interactions uplifting? It sounds like an impossible bar, but I have two shining examples that it is not.

Both of those examples felt free to state their truth, share opinions, and be direct. And that’s what they wanted in return. They didn’t have a need for anyone else to conform to their way of thinking. In fact, they welcomed differing viewpoints. That’s what made the conversations interesting.

And perhaps it’s as simple as that. Having the courage to listen, state my truth, share my opinion, and be direct without the need to control the response may be all it takes to leave people feeling better. It certainly builds trust. It has other benefits as well.

Building Trust
I trust you more if I know you’ll level with me. When you don’t, I sense it and become wary. I don’t like feeling that way. If it happens often, I will no longer rely on you. I will feel I must guard myself.

In order to be at our best, do our best work, and thrive, it is important to have people in our lives who will level with us. I remember the poet Miller Williams saying he trusted his wife to tell him when to stop writing because a poem was finished. He relied on her for this. He believed it made his poems better. I can’t argue with that. They feel right to me.

Creating Safety
There’s another benefit to voicing how you really feel without expectation of anyone else. Doing this creates an environment of safety for others to do the same. I always felt free to tell Colene the truth, even when it was not what she wanted to hear.

Once she could not walk, she sometimes asked me if she could go home. I didn’t tell her she might someday or leave her hanging with a we’ll see. I kindly and gently told her no. If she asked why, I would remind her that she could not walk and her house was not set up for lifts and wheelchairs.

She knew all of this was true. She felt it even when she could no longer absorb the words. There was never an argument, hysterics, or whining. She asked a simple question. I gave her a simple answer and the conversation shifted to something else.

Showing Respect
Stating your truth without equivocation shows respect for yourself and also for the listener. Feeling respected builds our sense of worthiness.

Maintaining Bonds
Colene made some pretty strong stands. Many years ago, she objected to one of her relatives’ choice in spouses. On the day of his wedding, she got in the car with her father, mother, and sister to go to the ceremony. A couple of minutes later, she said, “I’m not going to this wedding. I think it’s wrong.” Her father stopped the car, let her out, and she walked home.

In many families, this boycott would have created lingering hard feelings. That was not the case. Colene and the groom remained close until he died at age 91.

Her opinions were well-thought and her sentiments so sincere, you knew she wasn’t condemning you when she disagreed. She was just following her heart and her conscience. This is another characteristic she shared with Johnny and there’s something disarming about it that maintains bonds rather than threatening them.

Living Fully
If I am always holding back, I cannot live fully. It may be tempting to believe that I can garner favor or earn love by syncing my responses with those whose love or admiration I desire. If you have tried that approach, you know as well as I do that it never works that way. Ultimately, those who appreciate me will appreciate me and those who don’t, won’t.

Holding back my truth may sometimes help me avoid embarrassment, shame, humiliation, and feeling alone in a particular moment, but over time it diminishes my spirit and damages my soul. That’s a huge price to pay for momentary comfort. And it may mean that I will miss out on supportive friendships I wouldn’t otherwise have a chance to cultivate.

As I process my grief over losing Colene, I often repeat the question — can’t I do better? Of course I can. And I intend to. That still doesn’t mean she’d approve of my scarf choice.

https://www.marcandangel.com/2010/04/12/3-communication-tips-for-building-stronger-relationships/

https://my.fearlessliving.org/its-all-about-r-i-s-k-2/

http://www.cooking2thrive.com/blog/leave-the-past-behind/

November 11, 2019

Finding Peace in Every Day

Peace and healing go hand in hand. In war torn countries, health initiatives can be used for peace building. In our homes, something similar can happen when we make healing a priority.

Times of illness or recovery can put a strain on families. Exhaustion, shock, sadness, pain, and discomfort make it difficult to be at our best. But finding peace in every day can help create an environment that encourages healing.

After six months of improving health, we recently learned that my 18-month-old granddaughter has developed a quick growing muscle that is obstructing the flow of blood from her aorta. Removal and repair will require another open-heart surgery (her third). If we’re lucky, this will take place in about six months. If she gets sick this cold and flu season, the surgery may need to happen sooner. It will be more difficult than her previous surgeries and will threaten the still fragile heart repairs made last year.

From April 2018 to April 2019, she was hospitalized six times for an amount of time equaling six months. At the time, she had one sibling. Next time around, she’ll have two and one will be a newborn. That means it will take all of us to keep things going. We know what it’s like. We just lived through a similar year.

After trying unsuccessfully to hold onto some semblance of my previous normal, gone are my plans to move to another state. Gone are vacations. I just managed a trip to see my other new grandson, but lying on the beach, a cruise, the NCAA tournament, or a week at a spa are beyond reach for now.

Letting go of some positive activities has been a necessity. I prioritize getting enough sleep, eating reasonably well, working out 150 minutes per week, and grouping work into efficient batches. Most weeks meeting these goals plus family care duties puts me at capacity.

With waves of added responsibility arriving over the past three years, I am beginning to recognize new effects of the relentlessness. I’ve noticed when I feel any slight hint of relaxing into the warm feeling of a beautiful day or happy anticipation of the future, I immediately tamp it down. Then I feel sad, perhaps from a sense of loss.

At this point I’m not able to slow the process down enough to figure out the exact order in which the emotions arrive. Do I feel sad and that makes me pull back happiness, or do I feel happy and that triggers the sadness of loss? I don’t know. Maybe I don’t need to. I’m aware of the problem and sometimes that’s all that’s needed to find a solution.
sink
What remains when life gets tough are the everyday tasks-finding food, taking a shower, throwing out the trash, putting gas in the car, and choosing clothes to wear. In fact, the US Department of Labor Bureau of Labor and Statistics shows that most of our time outside of work and sleep is spent on everyday tasks.

It’s so easy to dread doing the laundry or the dishes or mowing the lawn, especially when we’re exhausted and stressed. And yet those tasks remain. Even if we hire someone to cook, clean, and mow, we still must bathe ourselves and brush our teeth occasionally.

Logic tells me that when most of the time available is filled with the tasks of everyday living, then that is the place in which I must find peace. I’m not exactly there yet, but I can visualize it-relaxing into the comfort of routine, not wondering what to do next, relying on muscle memory and allowing the mind to drift and quiet.

If you’re concerned that your mind will twist with worry instead, you have not yet experienced the state I’m describing. Neither had I prior to the past year. There is a point at which all energy has been harnessed to deal with the decisions and tasks of a given moment. In other words, the present is too absorbing to allow for speculation.

I wish you the chance to avoid reaching this point in your lifetime, but for some it will be unavoidable. According to the Centers for Disease Control, approximately 16,000 infants per year have surgery for congenital heart defects and an estimated 80,000 to 85,000 aortic valve replacements are done on aortic stenosis patients in the US each year.

As I embark upon this next difficult journey through childcare and family support, here is how I will seek peace in every day:

I will create a list for my day of things I hope to do. I will set the intention to feel good about any and everything I accomplish. If I don’t get to something, I will move it to tomorrow’s list, next week’s list, or let it go.

When I wash dishes, I will notice the warmth of the water, the lemony smell of the dishwashing liquid, and the green plants outside the window. I’ll feel my feet solidly planted on the floor. I’ll let thoughts and feelings flow and go.

When I do laundry, I’ll take a moment to bury my face in the warm towels from the dryer and breathe in their fresh scent.

I’ll make sure to breathe when I’m on my yoga mat and consciously relax large muscle groups in order to stretch my fascia.

When I water the plants, I will savor the smell of rosemary and mint.

I will wear clothes that feel good.

I will lean into hugs.

I will say yes to help when it’s sincerely offered.

I will absorb comfort and compliments.

I will cut short phone calls or visits that do not feel supportive and will be willing to put friendships on hold or let them go when they feel draining.

While I may not take the time to record gratitude, I will take note each time I feel grateful.

I will count progress toward a goal as accomplishment.

I will trust myself, my judgment, and my shifting priorities.

I will let myself change.

Significant life events may mean we are never again the person we once were. This can feel like loss. That loss must be grieved. But all loss is also gain of something new and different. What we make of that gain can mean peace or turmoil. I may not get there immediately, but I am committed to using hard lessons as steps on a path toward peace.

This moment is all we know we have. If this is as good as it gets, then I have to let it be good enough. I will begin with finding peace in every day and trust that peace can lead me to joy.

I wish you both peace and joy in life’s easiest and most difficult moments.

https://www.nursingcenter.com/journalarticle?Article_ID=1580903&Journal_ID=54009&Issue_ID=1580838

https://www.bls.gov/news.release/pdf/atus.pdf

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.105.592089

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October 20, 2019

A Perfect Pair

If you don’t have a recipe, how do find a perfect pair of flavors? My oldest son once called me during a layover in Vegas on his way home asking me to make Mexican lasagne for dinner. I had no idea what that was. He described it as a layered dish with lasagne noodles, meat, red sauce seasoned with a ton of spices like you’d use in tacos plus those in traditional lasagne, and cheese. I told him I’d give it a shot.

In that instance, I imagined the flavors in tacos. For that flavor profile, I chose salt, pepper, garlic, chili powder, and cumin. For the lasagne flavors, I added oregano, basil, thyme, and rosemary. I combined both of these profiles using sight, smell, and taste to judge the amount of each to add. The result turned out better than I would have guessed when he suggested it.

This request didn’t throw me because I rarely use recipes when I’m cooking for my family. So how do I know what to put in the pot? I’ve probably mentioned before that I imagine flavor combinations in my head. I do. But there are several things in play when I’m cooking.
perfect pair
For one, I use my sense of smell. If you hold your head over a pan and smell for a moment, you’ll realize you can smell salt as well as garlic, and curry powder, and basil. When the balance of the aroma is off, the taste will be as well.

I also use my eyes. If I’m adding beans to chili or cranberries to a salad, I use proportions that look pleasing. This results in a full combination of flavors in each bite.

Throwing something together often begins with inspiration or imagination. Sometimes I take a bite of something and have a sudden thought that it would pair well with X. Other times, I take the ingredients in my refrigerator and imagine different combinations of the flavors there. Sometimes I do this when I’m choosing my groceries for pickup or purchasing items at the farmers market.

Beyond my senses and imagination, I use memory. I both watched and helped my grandmother cook. I think about how she seasoned things. I also pay attention to the flavors and ingredients I can identify in restaurant dishes. And I envision combinations I’ve seen in recipes before.

Even if I can remember the general ingredients, once I get started I have to determine proportions. Knowing how something should look is helpful. If I’ve seen the consistency of pancake batter, then I can tell if there’s too much liquid or not enough.

Cooking experience is valuable as well. If you’ve baked a lot of cakes, you’ll have an idea what the ratio of flour to sugar, oil, and eggs should be. It’s probably worth noting that when you make gluten or dairy-free versions, traditional rules may not apply.

The best gluten-free sandwich bread I make has a dough that’s more like batter than dough. But once you’re practiced in these adaptations, you’ll still be able to rely on experience to help you.

If you have never cooked, or watched anyone cook, from scratch and cannot imagine flavor pairings, there’s a handy tool called The Flavor Bible that tells you what to mix and match. This comprehensive reference book of compatible flavors was named by Forbes as one of the 10 best cookbooks in the world of the past century. It also won a James Beard Book Award.

Following a specific recipe to the letter will yield a more consistent result, but using a flavor guide can introduce playfulness into your cooking. Life is made of so many repetitious chores, I like to add a sense of fun and play whenever I can. Sometimes the best way to do that is to try to find yet another perfect pair.

https://www.karenandandrew.com/books/the-flavor-bible/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”