Thomas was born to Ian and Molly as a healthy boy with a
good APGAR score and no complications. They were overjoyed and brought him home
after Molly spent one day in the hospital. Friends and family came to visit,
and Molly and Ian tried to get as much rest as they could.
In general, Thomas did what most babies do for the first
several weeks – eat, sleep, and poop. Not ever having had a child before, Molly
and Ian were slightly nervous. Molly found herself quite exhausted more often
than not – it was difficult for Ian to get up with Thomas at night given his
physical challenges, and Molly did the lion’s share of the “up all night with
the baby” care. Additionally, Molly was helping Ian to get around as she always
had.
At about six months of age, Thomas developed what the
pediatrician called “colic.” He was inconsolable for hours on end, and neither
parent knew what to do. Molly would put him in his car seat and take him out to
drive around the block, and every once in a while that helped. Still, he just
cried.
* What is colic?
* Molly and Ian decide that Thomas will be breast-fed. Given
the newly established work schedule that Ian and Molly have negotiated, what
challenges does this present? What might Molly have to do in order to keep
breast milk available, and what technologies are available to aid with that
process? Is breastfeeding acceptable in public in the United States?
* What is typical in the United States with regard to
breastfeeding? How many mothers breastfeed and for how long? What
considerations do mothers and families typically make in order to decide how to
proceed? Be sure to consider that realities of social class when answering this
question: in other words, imagine a single mother with limited income, a
married couple where only one partner works, a married couple where both work
and have moderate income, etc.
* What are the developmental milestones associated with the
first year of life for the newborn? If his development is typical, what should Thomas
be doing in his first year?
* What are the recommended immunizations for newborns? What
immunizations are typically provided just after birth? Which ones in the first
year? How frequently should the newborn visit the pediatrician in terms of what
is recommended? What is the CHAT and when is it given to parents? Outline
Thomas’ first year in terms of doctor visits. Provide rough information as to
the fees associated with these visits.
DECISION POINTS :::
How long does Molly breastfeed Thomas? What considerations
go into making this decision? Consult La Leche League (on the Internet) to
learn more about breastfeeding.
How do the Mahoneys pay for the hospital stay (birth) and
the first year of shots and doctor’s visits? In other words, make a decision
about what kind of insurance they have (if any).
Colic in an infant can be described as an extreme crying lasting up to more than three hours per day. Colic can begin when a child is six to eight weeks old and will eventually go away on its own after about eight weeks. The true causes of colic are unknown but there are some that believe gas in an infant’s belly can agitate the crying and pain. Diagnosis in based off of a doctor parent questionnaire to assess the environment and symptoms your child is having such as screaming cries where the baby clenches his or her fists and their legs stick straight out and arch their backs.
ReplyDeleteMolly and Ian will incur some challenges associated with this especially if Molly returns to work part time or if the baby is left solely home with Ian. Breastfeeding is also known as milk expression. Because Molly is the sole provider for the baby in terms of feeding, Ian will need to obtain the prepackaged pumped bottles that Molly has prepared the previous day or day of for the baby to feed. It will be important to have adequate storage of the pre-pumped bottles at a quick access for Ian. When a nanny is found, the nanny will need access to the bottles also. There are many different styles of breast pumping machines depending on the desired amount of usage. According to the Indiana State Department of Health website, there are many options for mothers who choose to breastfeed. A double pump kit would be ideal for Molly so she can reduce the time spent pumping at night or in the mornings before she leaves for work. Because Molly and Thomas will be separated for several feedings a day, a few times per week, a hospital-grade electric pump would be the best choice.
ReplyDeleteAccording to the article, “ Promoting Breastfeeding Through Social Change”, authors said, “While breast-feeding is more common in the United States today than it was twenty-five years ago, the United States continues to have one of the lowest breast-feeding rates in the developed world”. Breastfeeding is becoming much more accepted in general, as it has been around for over two centuries in the United States, but has documented back to the 1500’s. However, it is not as accepted in social settings. One study who questioned over 3500 people found that only 43 agreed that women should be allowed to breast-feed in public and only 28 percent believed it was appropriate to portray a woman breast-feeding on television. It was also a surprise to find that more men were accepting of breast-feeding than woman.
It is widely recommended that mothers “exclusively breastfeed” their babies for the first six months of the baby’s life because breast milk provides important nutrients that keep the baby safe from various sicknesses, and it will help the baby become a healthy child in the future. “Exclusive” means that for the first six months of a baby’s life, he or she should be receiving only “breast milk without any additional food or drink, not even water,” and “thereafter, infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond,”(Exclusive breastfeeding, 2012). In a study conducted by Kennedy-Stephenson, McDowell, and Wang (2008), United States’ breastfeeding rates have grown significantly in the time span of 13 years, (1993-2006). According to Kennedy-Stephenson et al (2008), the rate of babies who had ever been breastfed, (meaning “ever breast-fed or given breast milk”), was 60% from 1993-1994, and jumped to 77% in 2005-2006 (5). Babies from certain population groups have shown to be more or less likely to be breastfed; “Mexican-American and non-Hispanic white children were significantly more likely to have been breastfed compared with non-Hispanic black children in each birth year cohort,”(Kennedy-Stephenson et al, 2). However, non-Hispanic black babies’ rate of being breastfed still increased a lot from 1993-2006. This study also found that babies from low-income families were less likely to be breastfed. The breastfeeding rate of low income families stood at 57%, and the rate of families who were classified as being of higher income was 74% (Kennedy-Stephenson et al, 3). Next, another finding worth noting is that young mothers, (under age 20), are less likely to breastfeed their babies compared to mothers who are aged 20-29, as well as women age 30 and over. 43% of mothers under age 20 breastfed their babies, compared to 65% of 20-29 year old mothers, and finally 75% of women aged 30 and over breastfed their babies (Kennedy-Stephenson et al, 3). According to a study conducted by Dodge, Erickson, Murimi, and Pope, (2009) on mothers from central Louisiana, they found that less than “one third of U.S. infants are breastfed exclusively for six months or more,”(Abstract). Dodge et al, (2009) cite many reasons for why mothers, in and outside of Louisiana, are unable or choose not to breastfeed their infants: “lack of knowledge about the benefits of breastfeeding, embarrassment, negative perception of breastfeeding, lack of family support, and the inconvenience when returning to work or school,” as well as the infant having a father and/or physician who support and promote breastfeeding.” I recognize that the results from this study are from a small area in Louisiana, but the overall conclusions from this study can be attributed to new mothers from all over the United States. Dodge et al, (2009) said most mothers from the study wanted to breastfeed because they knew it would drastically strengthen the health of their babies, and they formed a bond with their babies while breastfeeding as well.
ReplyDeleteAlso, the majority of the women recognized that breastfeeding is better for their baby over formula. Some of the aforementioned studies and research have shown that women who receive a lower income, and also those that are younger, tend to have the lowest rates of breastfeeding. Some women may choose to use formula over breast milk because they may need to use their breastfeeding time to work at a job instead. On the other hand, women who have a supportive husband and/or a comfortable income, will probably be more likely to breastfeed their baby because they have the time and money to do so without having to worry about money issues. According to Mercer and Thulier (2009), “The latest statistics from the CDC indicated that in 2004, the rate of exclusive breastfeeding at 6 months of age was 11%, and the rate of any breastfeeding at 12 months was 20%,” and equally important is that “Research data have shown that women from lower socioeconomic groups have decreased incidence and duration of breastfeeding,” whereas “educated women breastfeed more often and for longer periods of time.” There is a program called WIC that gives free formula to mothers, and there have been some findings that suggest this action decreases the likelihood of disadvantaged women breastfeeding their babies (Mercer, et al, 2009).
ReplyDeleteBabies need a warm and caring environment during their first year of life. There are several developmental milestones that are age appropriate for each month during the first year of life. During the first month, a baby should be able to lift their head and be able to move it. They should also be able to make spastic/jerky arm movements. The baby should have the ability to bring the hand to their face. Their reflex movements should be strong, and they should have the ability to focus on objects a foot away. The baby may also have the ability to turn their head towards familiar sounds and also respond to loud noises. They should also be able to blink at bright lights. During the second month, the baby should be able to track objects with his eyes, repeat certain vowel noises, make noises other than crying, and have the ability to smile. During the third month, a baby should be able to raise their head and chest while lying on their stomach. While on their back, they should be able to kick and straighten their legs. They often open and shut their hands very fast and frequently. The baby should also be able to reach for dangling objects if visible. He should be able to grasp hand toys as well. The baby should be able to recognize familiar objects and people, even at a distance. He should begin to imitate sounds and develop a social smile. The baby should also develop hand-eye coordination. He should be kicking his legs energetically, and also hold his head up with control. By the fourth month, the baby should be able to sleep approximately six hours at night without waking. He should be able to sit with support, and also roll over on his own. The baby should be able to follow a moving object for 180 degrees. He should have the ability to babble and amuse himself with certain noises. The baby should start to explore objects with his mouth and recognize a bottle. He has the ability to communicate pain, discomfort, and fear through crying. He should also be able to respond to a rattle or bell, or other loud noises. By the end of the fifth month, the baby should begin the teething process. He has the ability to see across the room and can see small objects. He will be able to experiment with cause and effect, and can rake hands to bring toys towards him. After six months, a baby can make two- word syllables, hold a bottle, and copy some facial expressions. He can drink from a cup with help and open mouth for spoon, He should be able to reach and grab objects and sit up with minimal support. The baby should make some vowel-consonant sounds and be able to keep his head level while sitting. At month seven, a baby should distinguish emotions by tone of voice, turn in the direction of a voice, and imitate many sounds. He should also be able to play peek-a-boo, make razzing sounds, and self-feed some finger foods. At eight months, a baby should respond to his own name, have different reactions for different family members, chew on objects, and reach for utensils while being fed.
ReplyDeleteHe should turn head away when finished eating, sit unsupported, babble enthusiastically, drop objects off high chair to test gravity, and sleep between 11 and 13 hours a night. He should also be able to take a few naps a day and have the ability to get on arms and knees in crawling position. By the end of nine months, a baby should pick up tiny objects, drop objects and then look for them, reach for toys, identify self in a mirror, and go from tummy to sitting by himself. At ten months, a baby should understand object permanence, pull to standing, get upset if a toy is removed, move objects from hand to hand, and be able to stand while holding onto someone else. After 11 months, a baby should understand what “no” means, clap hands, wave “bye-bye”, and say “ma-ma” and “da-da” discriminately. Finally at twelve months (one year) of age, the baby should have the ability to take one to two daily naps, triple birth weight, be able to put objects into containers as well as remove them, crawl well, and understand simple commands. He should be able to extend arms and legs while dressing, push, pull, and dump items, dance to music, open and close cabinet doors, voluntarily let objects go, and walk with adult help. He may form attachment to an item, test parental responses to certain behaviors, and share toys yet want them back. The baby should also be able to pull of socks, hats, etc. and understand the use of certain objects. These are all normal development milestones of typical infants in the first year, and are all behaviors that Thomas should be exhibiting
ReplyDeleteDuring the first 2 months, a newborn should receive two Hepatitis B shots. When the baby is around two months old, he should be given five different shots. First, a DTaP shot which is a vaccine that protects against diphtheria, tetanus, and pertussis (whooping cough). Then, he should be given a Hib shot which protects against Haemophilus influenzae type b, a PCV shot to protect against pneumococcal disease, a IPV shot to protect against polio and finally an RV shot that protects against infections caused by rotavirus. The baby should be given all five shots (RV, DTaP, Hib, PCV, and IPV) again at 4 months of age. Between 6-18 months of age, another Hepatitis B shot should be given as well as another IPV shot. At 6 months of age, another dose of DTap, Hib, PCV, RV should be given. A yearly influenza shot can be given as early as 6 months. According to Centers for Disease Control and Prevention, “All children ages 6 months through 18 years should receive vaccination during the influenza season each year. If this is the first time for flu vaccine, a child should receive two doses, separated by at least 4 weeks. If a child only receives one dose in the first season, he or she should receive two doses the next season.” When the baby is 12 months, an MMR shot should be given which will protect against measles, mumps, and rubella. Between the age of 12-15 months, another dose of Hib and PCV should be given. A varicella shot should be given between 12-15 months to protect against chickenpox. Between 12-23 months, 2 doses of Hepatitis A should be given at least 6 months apart from one another.
ReplyDeleteThe American Academy of Pediatrics recommends the infant see a pediatrician for a check-up at birth, two weeks, two months, four months, six months, nine months, 12 months, 15 months, 18 months, and 24 months, and annually thereafter.
The Modified Checklist for Autism in Toddlers (M-CHAT) is a screening tool used to determine the child’s risk for autism spectrum disorders. It is a 23 item questionnaire that looks at the behavior of the child. It is given to parents when the child is between 16 to 30 months old.
Since the Mahoney’s have Anthem Blue Cross and Blue Shield Insurance SmartSense plan, they will have no charge for the baby’s doctor appointments until the age of 7. This part of the plan is called “Well baby and well child care” which offers “physician services for routine physical examinations, immunizations given as standard medical practice for children, radiology and laboratory services and tests ordered in connection with a routine physical examination and screening for blood lead levels as prescribed by a physician.” (University of California Riverside).
Decision Point:
ReplyDeleteAfter researching breastfeeding extensively, Molly and Ian decide to breastfeed Thomas for 9 months. For the next three months, they breastfeed as well as bottle feed and gently wean Thomas off of breastfeeding by one year of age.
The Mahoney’s have Anthem Blue Cross and Blue Shield Insurance. They have decided to take out a separate family insurance plan called “Smartsense with Enhanced Drug Benefit.” This allows them to pay 30% or 0% coinsurance after deductible for Molly’s hospital stay with Thomas, and also allows a $35 copay for the first 3 visit per family member per year with deductible waived for the follow up doctors appointments. After 3 visits, they pay 30% or 0% coinsurance after deductible. All of this is provided to them with a monthly premium of $418.