Everyone loves to complain about Tipat Chalav, the network of well-baby clinics run by Israel’s health ministry. Sometimes the staff gives silly suggestions, or even dangerous ones. And nothing is more upsetting to an anxious new mother than having her baby “fail” one of Tipat Chalav’s many tests.

Overall, Tipat Chalav does its job very well. It’s important for new parents to understand Tipat Chalav’s strengths and limitations.

Tipat Chalav has several key roles:

1. Weigh, measure and examine the baby. This is to ensure that  baby is getting enough to eat and has no underlying health issues. Even educated and experienced parents don’t pick up every problem. And if your baby has never been weighed, you won’t have a baseline to tell the doctor if something comes up later.
2. Give immunizations.
3. Share updated health and safety guidelines. These include vitamins, breastfeeding and bottle-feeding information, when to start solids, safety recommendations, and more. The Israel Health Ministry writes up the guidelines, many of which come via the World Health Organization. Many Tipat Chalav nurses have even taken courses in breastfeeding, but the quality of their advice varies.
4. Test the baby’s development. This includes physical and cognitive ability, communication, hearing, and eyesight.
5. Schedule regular appointments with the resident pediatrician.

In addition, Tipat Chalav provides services for women during pregnancy and in the post-partum period, including birth control.

Tipat Chalav’s goal is to prevent babies and their families from falling though the cracks. That’s why there’s one in nearly every neighborhood. In addition to spotting medical concerns, they involve social services when they suspect abuse or neglect. This is a good thing, even though it means some parents will be falsely accused.

One problem with Tipat Chalav is that the nurses administer standard tests, and they expect standard answers. If your baby starts to drop in the weight percentiles, some nurses are alarmed even when everything else is fine.

New mothers can be sensitive to the slightest criticism. If the nurse finds something “wrong” with the baby, you don’t have to act on it. But because they see so many children of the same age, they may pick up on things a mother might not notice.

If you’re not sure whether the concern is justified, you can say that you will check it out with your doctor. If you report that your doctor said the the baby is fine, there isn’t much more the nurse can say. You can also try to see a different nurse in the future.

The most important thing a Tipat Chalav nurse can do is to make parents feel good about their children. This is doubly true with mothers of new babies. I’ll never forget the time I took my son for a blood test, when he was about 11 months old. He was flirting and “joking” with the nurse. She was so enchanted she called over another nurse to see. There’s a huge difference when you walk into the clinic and are greeted by someone happy to see you and your baby, not looking down a checklist expecting to find something wrong.

Are you satisfied with your Tipat Chalav? Do they accomplish what they are supposed to, or do they just make parents overly anxious? What tips can you give to new parents?

Photo source: MollyPop

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I’m not saying that putting a baby to sleep in a crib is riskier than co-sleeping. So much depends on the situation. Also, it’s hard to gather accurate statistics, because we don’t know what percentage of children co-sleep, mainly because parents who do it are afraid to admit it. And children often alternate between cribs and their parents’ beds.

So here is the latest baby furniture news:  Cribs with drop-down sides may be outlawed by Congress.

Bobby was one of at least 32 infants and toddlers since 2000 who suffocated or were strangled in a drop-side crib, which has a side that moves up and down to allow parents to lift children from the cribs more easily than cribs with fixed sides. Drop-sides, around for decades and probably slept in by many of today’s parents, are suspected in an additional 14 infant fatalities during that time.

The Consumer Product Safety Commission, which regulates cribs, has warned about the problem. Its chairman, Inez Tenenbaum, has pledged to ban the manufacture and sale of cribs by the end of the year with a new performance standard that would make fixed-side cribs mandatory. It could be several months into 2011 before becoming effective.

Senator Kirsten Gillibrand (D-NY) is preparing a law to ban the manufacture and use of drop-side cribs.

I predict that changing crib designs will lead to fewer babies sleeping in them. It’s not easy to lift a heavy infant in and out of a crib with a high railing, especially in the middle of the night. Babies will be more likely to fall, too. Parents will be forced to buy the newest crib models, whether or not they can afford them.

I guess the next step is a law prohibiting parents from putting babies to sleep in a crib with drop-down sides, and prosecuting parents for doing so.

But who knew, all those years, that we risked our kids’ lives by having them sleep in cribs.

Photo credit: Afroswede

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1. Adult Drinking
2. Other Children in Bed
3. Baby Formula Fed
4. Sleeping on a Sofa

Watch the video to find out.

Clearly that statistic doesn’t mean that breastfeeding your baby is a guarantee of safe co-sleeping. But many common activities involve risk, including driving, co-sleeping and sleeping in cribs. All we can do is weigh levels of risk and choose what suits our family.

It’s not easy being a parent.

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Israeli parents and caregivers are concerned and confused about babywearing, after a US consumer advisory warned that wearing your baby in a sling can lead to suffocation. The warning followed a number of infant deaths in 2009. Could it be that baby slings are dangerous for our little ones? Should we reconsider our pro-babywearing attitude in light of those tragic incidents?

Babywearing has been practiced throughout the centuries in all cultures and is still the most common method of transporting babies in many countries. A baby’s anatomy and psyche is designed for babywearing: When picked up, newborns immediately cling to their parents’ body and calm instantly when nestled close to the heart and reassuring warmth of their mothers. For parents of high-need or colicky babies, the sling can be a lifesaver. Babywearing improves the bond between parent and child, and promotes the baby’s physical and sensual development. Babywearing is practical when it comes to public transportation, hiking, shopping or caring for several small children at the same time.

But with countless types and brands of baby carriers available on the market, parents and caregivers should be aware of essential safety rules.

The tragic infant deaths in the US were caused by improper positioning in bag-type slings, where the baby is kept in a curled cradle position bending the chin toward the chest. This position restricts the airway and slowly suffocates the baby.  (See image on left.) Although that specific type of carrier is not available in Israel, the cradle position is widely used. I’m seeing a lot of curled-up babies, especially with the most common stretchy wrap material that makes proper positioning difficult.

Therefore, I generally recommend upright tummy-to-tummy holds for newborns in a properly tightened baby wrap or ring sling. (Photo at left below) The upright position is a safer choice for several reasons: Baby’s neck is in a straight line with the body and his face rests on the wearer’s chest, with free airflow on both sides. When the wrap is tightened properly, the immature rounded spine gets maximum support and the natural “frog-leg”-position promotes the development of baby’s cartilaginous hip joints.

If parents do choose the cradle hold, for discreet breastfeeding, for example, they should always make sure the baby is positioned in a nearly horizontal position across the parent’s chest with the neck in a straight line with the body and the face free.  (See image on right.)

The baby should be worn close to the parents body and high enough for the parent to easily kiss his face.

No matter which carrier or position is used, babywearers should always be alert to baby’s movements and reactions and check frequently that no material is draped over the face.

Prior to purchasing a baby carrier I advise every parent to consult with a babywearing professional, who will help find the ideal carrier for each familiy’s individual situation and offer thorough instructions on how to use the carrier properly. Salespeople in baby stores are not usually trained in babywearing, and the number of babywearing consultants in Israel is growing. Most sell carriers themselves, but will also be happy to assist with a carrier that the family already owns.

Resources and further reading:

Official statement from Babywearing International

Sleepywrap: Useful information on positioning, baby development and more

Correct positioning in different baby carriers

Baby’s anatomy and frog-leg position

Upright vs. Cradle (Hebrew)

About the author:

Hadassa Levy is a babywearing instructor offering private and group consultations as well as a wide range of baby carriers. Her Hebrew/English website website and blog contain information, instruction videos and answers to frequently asked questions about babywearing. She lives in Modiin with her husband and daughter.

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It is important to encourage children to think about others’ feelings from a young age. However, I was dismayed by the first line of the article:

Mothers often get blamed for the way their children turn out, and a new study gives additional weight to that accusation.

Let’s stop blaming mothers, who make mistakes like everyone else. Most of the time they are acting in a way prescribed by our culture, which, the last I heard, is comprised of both sexes. Could you imagine a newspaper using similar language to introduce a study about some unknown benefit of breastfeeding?

Mothers looking to build up career skills while taking a break from the work force might enjoy this post by Trent at The Simple Dollar, listing six neglected skills that can be transferred to practically any job.

Tom Hodgkinson writes about the reaction to his article, The Idle Parent, and gives ideas of ways parents can disconnect from the outside world and connect with the family. Shabbat is mentioned.

Finally, Miriam Adahan shares techniques for dealing with children’s anger on Chabad.org.

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Squawkfox compiled a list of the best frugal advice from 41 bloggers, dividing them into categories and adding eye-catching graphics. You can see them all here.

And in the spirit of frugality, Batya at me-ander presents the “discount” edition of Haveil Havalim, the Jewish/Israel blog carnival.

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1. Find a community. I looked for friends with babies as soon as mine was born. You won’t always find friends with children close to yours in age, but the community is more for you than your baby. Keep looking. If you can’t find a mother-baby group, start your own. And you don’t have to limit your circle to stay-at-home mothers, or even to mothers. Having been in school for so long we are used to having a large group of friends at our own age and stage. This is a good time to expand your horizons. You can learn a lot from the perspective of an experienced grandmother.
2. Avoid activities requiring you to be somewhere at a particular time. I chose to stay home with my kids to enjoy a relaxed lifestyle for me and my children. (We’ll leave aside the temper tantrums, breakage, and harrowing escapes.) For me this meant delaying preschool, choosing volunteer and social commitments wisely, and avoiding carpools.
3. Have a routine, but be flexible. Getting up and going to sleep at the same time is important. So is scheduling time for household chores.
4. Vary activities. Have time for quiet, play, art, music, stories, outdoor activities, etc. It’s not necessary to do every activity every day, but over time kids should have opportunity for all of these. Too many days in a row either staying home, meeting the same friends, or going on long excursions can get frazzling, too.
5. Plan the best time of day for the activities that you enjoy. It might be when the toddler naps, when two children are playing happily together, or even early in the morning while everyone is asleep. When things finally settle down after a crazy day, choose a calming activity instead of rushing to do a project. Expect to be interrupted. You will have more time at some stages than at others. The newborn and toddler stages are especially intense, but they pass and you can look forward to smoother times ahead.
6. Keep a gauge on your moods. When you feel overwhelmed get out of the house or call a friend. If you are in the middle of something important and your kids start getting out of control, stop what you are doing and focus on them for a few minutes or as long as necessary. This is not spoiling–this is attending to their genuine needs. If they feel you are available when they need you they won’t be bothering you “all the time.” If you are never available they will just work harder to get your attention, and ultimately become resistant to cooperating with you. This doesn’t mean you need to jump up to do their bidding every minute. Sometimes if you tell them that you will help them in a minute they figure out how to do things themselves.
7. Sometimes you need to invest money to stay sane. Just because you are not working doesn’t mean that you should never hire a babysitter, get cleaning help, join a parenting group, or see a private therapist—depending on your budget. If you or your kids aren’t ready for separation, inviting a young teenager to play with the kids while you are right there or in another room might be enough to give you the break you need. Sometimes what you need most is someone coherent to talk with.
8. Volunteering. Volunteering is great because you can choose what skills you want to donate  and have human interaction that is not all about your kids, with a lower level of commitment than with a paying job. And you can cite your volunteer experience on your resume later on. It is still a commitment, though, and it’s important to pick the right organization and position for your temperament and situation. I chose breastfeeding counseling because my kids are always welcome at functions, I get to connect with lots of mothers, and I can develop my knowledge base and my writing, counseling, and group-leading skills.
9. Choose activities with your child that you both love. I enjoy reading out loud to my kids, but I regularly purge our home library of books I find irritating. It doesn’t matter that your neighbor is teaching her kids fractions or to play the piano—your kids can learn baking or folk-dancing. Share your interests with your children on their level. And as you learn what they like, you will develop new interests too. You don’t have to be an expert to enjoy a wide range of activities.
10. Involve your partner as an equal. Even though you are the primary caretaker, your husband is as important a parent as you are and should be involved in long-term decisions. He also needs the opportunity to develop a relationship with each child and with the family as a whole. Nurture your own relationship as well. Contrary to conventional wisdom this doesn’t have to mean vacationing without the kids. Take the opportunities as they come and schedule them if you need to. Strive for full and open communication.
11. The identity question. One of the hardest things for me when I became a “stay-at-home mother” was the label itself, and the stereotypes that went along with it. Yet some mothers are empowered by belonging a group. Everything depends on your attitude. Do you see staying home as something negative–not earning, not developing your career? Or is it a chance to focus on nurturing and educating your children, growing both as a mother and as a person, without the pressures of pleasing a boss? Whatever you choose, it does not have to be for a lifetime.

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There is nothing especially new or radical in the guidelines, which are based on information from the World Health Organization.

The main difference is in the statement that the first taste of complementary foods may begin at four months instead of six. In other words, exclusive breastfeeding should begin from birth and continue for at least four to six months. Mothers can give tastes of solids, including meat, fruits, vegetables, and grains containing gluten, before six months. Quantities should be limited to two tablespoons a day from the mother’s finger. After six months quantities can be gradually increased but breastfeeding should continue for at least a year. Solids given before six months may have a developmental, but not a nutritional, benefit.

There are several reasons for the change:

1. Recent studies have shown that the increase in celiac disease—sensitivity to gluten as found in wheat, barley, and oats—is related to too-early or too-late  introduction of gluten in the baby’s diet. For lowest risk, babies should be exposed to gluten between 4 and 7 months.
2. Research on celiac disease also shows lowered risk to babies exposed to gluten while their mothers are still breastfeeding. Since more mothers are nursing at four months than at six, the guidelines may ensure that more babies will be exposed to gluten during the breastfeeding stage.
3. Research on allergies has not shown a benefit to delaying solids for longer than four months, even in children with a family history of allergies. Relatively early exposure may actually reduce risk.
4. Introduction of large quantities of solids at an early age can negatively affect breastfeeding and lead to lower weight gain, but small quantities (1 to 2 tablespoons after four months) do not harm babies developmentally nor do they impact long-term breastfeeding.
5. This was not in the report, but there is concern that formula-fed babies could also benefit from earlier introduction of solid foods. Several years ago, three Israeli babies died and many were brain-damaged because of lack of Vitamin B1 in one type of Remedia brand soy formula. Since then the health ministry is concerned about the lack of variety in the diets of formula-fed babies. The babies on the Remedia formula that received even one dose of Vitamin B1 from another source, whether it was nursing or Bamba, survived.

It is not necessary or required to start solids before six months, but according to new research it may not be wise to delay much longer than six or seven months. I know many babies are not interested until long after that age, and if that is the case with your baby I would not be overly concerned. We are talking about statistical lowering of risk, and genetic components are more significant.

There is a risk that mothers will misunderstand, like the press did, and think that nursing after four months isn’t important. On the other hand, exclusive breastfeeding for four months instead of six may be easier for some mothers to “swallow,” especially since most mothers return to work at around four months. It may seem like a more attainable goal. Relaxing the restrictions on complementary foods reduces pressure on working and pumping mothers, who can relax knowing that the babysitter can give some solids if there isn’t enough pumped milk available. It also gives mothers less reason to supplement with bottles of formula, which is more likely to lead to early weaning.

At any rate, the ministry should be more concerned with the bottles given to 70% of the babies in the hospital (They do address this in the guidelines, but not strongly enough.) Most babies in Israel have been exposed to formula long before they reach four months of age.

Click to read more posts on breastfeeding at A Mother in Israel.

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In this week’s newspaper Makor Rishon, Yifat Erlich interviews couples in the national religious community who underwent abortions because of health problems with the fetus. Afraid of criticism from their close-knit communities, many ended up alone during this traumatic period.

More from the article:

• Two medical clinics in Jerusalem treating risky pregnancies each reported that 70% of pregnant women in the national religious community undergo testing for Down’s Syndrome. (I presume this referred to blood tests and follow-up amniocentesis when indicated.) In 90% of the cases where Down Syndrome is detected, the couple decides to terminate the pregnancy. One of the doctors interviewed said that this statistic is not new, but people have begun talking about it. A higher number of abortions are being performed only because of more accurate testing.
• Ten years ago, Rabbi Shlomo Aviner wrote an article encouraging older women (over 37) to become pregnant, and promised to “stand beside them” if a deformity would be discovered. This was understood to mean that in theory, he would rule to allow abortion in the case of Down Syndrome. Obstetricians hung the article in their offices and called the resulting babies “Aviner’s children.”
  In the Makor Rishon article Rabbi Aviner is quoted as saying that if the parents would not be able to cope, for instance if there are already many children, he would permit an abortion of a baby with Down Syndrome. In the case of CMV where it is not clear whether the baby has been affected, he leaves the decision up to the parents.

I am not sure that knowing that a rabbi might allow an abortion helps parents who end up in that place. Having to deal with the devastating news and make such a difficult decision—because you can never be certain how you will feel when it is real—is still a deterrent to pregnancy for older women. Also, pregnancy at a later age is riskier for the mother and should not be taken lightly.  But Rabbi Aviner believes that the risk of one terminated pregnancy should not prevent two hundred healthy babies from being born.

The relatively liberal attitude in the national religious community toward termination of abnormal pregnancies reflects the overall Israeli attitude toward prenatal testing. Israel’s mothers undergo more prenatal testing, including multiple ultrasounds and state-of-the-art tests paid for by the government, than those of any other country. A doctor quoted in the article said that Israel has the world’s highest termination rates because of fetal defects.

The religious internet site Kipah has a new forum for support after pregnancy loss.

Updates:

• Here is a link to the text of the article, posted on the Kipah forum. Thank you to commenter Keren.

• Commenter Annie pointed out that according to this Ynet article, Israel’s overall abortion rate is lower than that of most countries in Europe, and dropping.

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