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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Modern Tribe has some great Jewish Gifts for all occasions.

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Several years ago I reviewed Hold On to Your Kids by Dr. Gordon Neufeld, a clinical psychologist specializing in attachment at all ages. Dr. Neufeld is in Israel thanks to Shoshana Hayman, Faculty Member of the Neufeld Institute and founder of the Life Center. She organized a question and answer session with Dr. Neufeld yesterday in Tel Aviv.

Below is a summary of some of the questions and answers, which reflect my understanding of Dr. Neufeld’s words. I suggest reading the book review and referring to his books and website for more information.

1. How can people who work with parents or teachers transmit the importance of attachment and connection?
   Dr. Neufeld: The best thing we can do is to help them open their eyes to the child. Once the parent or teacher can see the child from a different perspective, the relationship, and the behavior, improve. If they ask why it worked, we can explain more about the theory.
2. How can parents implement the ideas in your book? It seems too challenging for many parents.
   Dr. Neufeld: There is a difference between the book and the paradigm.  The book is written for a very specific audience, who like to read books about parenting theory. [MiI: It's fascinating, but long, and dense at times.] The paradigm, which is used during counseling, is appplicable to all.  For example, when I work with a 14-year-old new mother, who is addicted to drugs and doesn’t know who her father is, I don’t give her a copy of the book. Instead I do something that helps all new mothers—help her be aware of her baby’s whereabouts and sensitive to his cues.  Teaching parenting skills won’t help when there is no attachment. Parenting skills follow attachment, because the mother will want to learn how to meet her child’s needs. Attachment, not skills, make a mother out of a girl.
3. Will your approach work in cases of physical abuse?
   Dr. Neufeld: Yes.  If parents have good intentions, can feel remorse about what happened and want to change, my approach can help a parent see the situation and the child in a different light and learn to respond appropriately. But if there is cruelty for its own sake, or the parent is blinded to his own behaviour, we would need to add to that a more direct form of intervention to heal the parent first. But if there is cruelty for its own sake, a more direct form of intervention is required.
4. What about cases of sexual abuse within the family, say a father or older brother is abusing the child?
   Dr. Neufeld: Removing the child from the home, as a first step, as is commonly done in the US, is counterproductive.  There are two parts to the abuse, one is the physical side, and one is the emotional side, the damaged attachment. Severing the connection with the abuser means that the child has lost the only attachment he has, even though it’s toxic.  That leaves the child hopeless because grieving and healing can only be done within the context of a healthy and operating attachment.  I recommend, at the first suspicion of sexual abuse, to find a way for the child to build a healthy attachment with someone else close to the family like an aunt or a grandmother. This attachment should gradually replace the toxic attachment, until the child feels safe enough to share what has happened. [To illustrate, Dr. Neufeld leaned on one foot and then the other, to illustrate how the child transfers his connection.]  Once a healthy attachment is in place then there can be legal inervention as neccessary, and removal of the toxic parent if required.
5. What about anorexia?
   Dr. Neufeld: Anorexia is closely related to attachment. As we know, food is a symbol for love and affection. Rebuilding the attachment with the parents can be an important part of the therapy, but anorexia is a dangerous illness and hospitalization must take priority over psychological therapy.
6. Why are so few people following this approach, and what can we do to encourage more people to adopt it?
   Dr. Neufeld: The approach I use is intuitive.  There are many therapists around the world that are intuitive and use similar approaches.  The problem is that what is intuitive doesn’t have words and can’t be passed on.  I’ve created the words to make conscious of what is intuitive, to create a collective consciousness for all using this approach, so we can join together to change the way children and understood and treated.
   In the workshops and courses that I’ve given, I’ve found many people already use this approach, but they didn’t realize it. They say I’ve given them a language and terminology to teach it to others.
7. What is the main difference between your approach and the existing approaches?
   Dr. Neufeld: The existing approaches are behavioral.  They focus on form, not development.  Skinner, Adler (popular in Israel), Locke, Watson and other behaviorists all recognized the importance of self-worth and attachment. The problem with their approach is that they advocate withholding these things until the child behaves appropriately. The children have to earn their attachment thorough good behavior. But children need to be flooded with affection and attachment from the beginning. If you withhold it you might get the desired behavior but you also arrest the development of the child’s full potential.

Dr. Neufeld also spoke about therapy. Therapies that focus on fixing what is wrong with the parent harm attachment, because the parent pays attention to him or herself and has stopped paying attention to the relationship. When parents start to look at their children and connect with them, they will work on themselves at the same time. In some cases, the parents do need individual therapy before they can rebuild a strong relationship with their children.

Dr. Neufeld concluded by saying that some people believe that God created us so we could raise children. But he sees that as a joke. Rather, God gave us children so that we, the parents, can grow up.

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Orthodox Girls and Eating Disorders

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Staff members at Renfrew, where 12 percent of the patients are Jewish, said they noticed an uptick in Orthodox clients in recent years.

The main pressure, they said, is on the Jewish mother, who is responsible for keeping a kosher kitchen (a mammoth amount of work), providing a generous Sabbath dinner and dessert for not only her household, but various guests who wander in at any point during a Friday evening.
Jewish holidays are the worst, they said, as the amounts of food required take weeks to prepare. A woman’s worth often rests on the quality of her cuisine.

Well, I may not like it but there is a lot of truth to that last line.

The Orthodox Union got so concerned with this trend that it produced a film, “Hungry to be Heard,” warning viewers to watch for signs of these afflictions, particularly among teenage girls who feel their looks aren’t good enough.
In Orthodoxy, I was told by Adrienne Ressler, one of the panelists, the Orthodox girl wants to be chosen “by the best groom and by the best groom’s family.”
“So the pressure is to be very thin.”
In some cases, the prospective groom’s family not only wants to know the girl’s dress size, but that of her mother, so they can project what the potential bride will look like in 18 years.
“Sometimes, they put a girl’s health records online,” she said. “It’s like buying a horse. I think women can be silenced in that community. The eating disorder is the red flag.”

Many factors lead to eating disorders in the Orthodox community, and most of them are universal. I think the best thing mothers can do for their daughter is to exercise and eat wisely and share why it’s important. But when women talk about diets, and complain about the way they look, their daughters (and sons) get the message.

Related: Putting Food in Perspective (at Cooking Manager)

Teens, Sex and Eating Disorders: Interview with the Therapy Doc

Photo credit:Roland

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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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Unsafe Suggestions?

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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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The other night I went to a talk at my daughter’s high school by Dr. Meyran Boniel-Nissim. Boniel-Nissim is a Haifa University researcher on teen internet usage  and its psycho-social connotations.

In the old days, teens had to get out of the house to get into trouble. Now they can do it from the comfort of their bedrooms. Parents think that as long as they know where their children are, everything is fine. But the reality is different.

Teens know more about cyber-space than adults. Only a handful of the hundred or so parents in the room had a Facebook acount. So they don’t come to us with their questions and problems. The anonymity of the net allows teens, especially girls, to try out different personalities on the anonymous net. And while teens may be reticent at home, according to Boniel-Nissim they all pour out their hearts to strangers online.

Parents don’t have a clue. In an Israeli study of 500 teens and their parents, each pair was asked about the teens’ internet behavior. 70% of teens described themselves as consumers of porn. Only a small percentage of the parents thought their children viewed porn.

Facebook is a popular site for teens. They want to appear popular, especially when they first join. So they are quick to accept friends, but they allow access to personal information. Impersonating a real-life friend by stealing a profile picture is easy too.

Some parents think they are safe because they have “friended” their children to keep an eye on their activities. But some teens have two accounts, one for show and one for their real activities.

We’ve all heard the stories of cyber-bullying and it has even led to suicide. A teen can wake up one morning to find epithets and unflattering pictures on her wall, and a friend count back at zero.

Teachers in the audience shared disturbing stories. In one case, students used a cellphone to take embarrassing pictures during gym class. Then they uploaded them to Facebook. Others made up a quiz, “Which [insert name of school] Teacher are You,” with multiple-choice questions based on  clothing and other personal quirks.

Boniel-Nissim considers cyber-violence to be equivalent to real-life abuse, and recommends reporting it to the police. Apparently it’s illegal to upload pictures without permission from the subject, and someone who refuses to take them down can be prosecuted. But that is a privacy issue, not cyber-violence. Hacking into computers, which is apparently common and easy, is also an issue of privacy and perhaps theft. It is certainly an attack and should be illegal, but I still can’t see it as the same as physical abuse.

Bullying, ostracism, embarrassing your classmates and making fun of your teachers have been with us long before the internet. It’s true that the public nature and speed of the internet take these cruel behaviors to a different level. But I am not sure what cyber-violence is, and how a judicial system could rule on it. You can’t hit someone via the internet. You can threaten someone with violence, but you can do that in the newspaper or by anonymous letter. So the same rules should apply.

I’ve asked Meyran, my newest Facebook friend, to respond with more examples. In the meantime, I’d like to hear your opinion:

• How is bullying different on the internet than in real life? At what point, if any, should it become a crime?
• Is there such a thing as cyber-violence?
• How do you help your teens to deal with all of this, if they are on the net?

Meyran is skeptical about internet filters because they can’t block one-on-one interaction, which is the main source of the difficulties.

Whether our kids are on the internet or not, there is only so much we can protect them. With teens there’s no substitute for communication, awareness, education, and setting limits.

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Toy Warning

I was curious since most warnings are for children under the age of 3, because of small parts. So I was surprised when my daughter (just short of 6!) opened this fearful object (wrapped in plastic with the warning repeated):

The Dangerous Object

It’s a simple cardboard card. Oh, wait, it’s coated with some kind of shiny veneer. It seems to me that potato chips are more of a choking hazard than this toy.

More ridiculous labelling: Imaginary Ingredients

An Explosive Purim

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Over the years I’ve encountered many toddlers who did not eat or gain as much as they were supposed to. Before getting concerned, ask the following questions:

1. Is the child really underweight? As Ingathered learned, older growth charts are based on bottle-fed babies. Breastfed babies are expected to gain 2.5 times their birth weight by a year, not triple like some charts indicate. Children at the 5th percentile are generally not underweight, just small compared to all healthy children their age.
2. How much is the toddler really eating? Toddlers have small stomachs. Breastmilk and formula are high in calories and may not leave room for much more. Growth slows down in the second year so a toddler may eat less than a younger baby. And parents who record what a child consumes throughout the day are often surprised by how much is eaten. Toddlers are known for having irregular appetites.
3. What do the parents look like? Babies follow two distinct growth patterns. For the first six months or so, they follow the growth curve of their birth weight.  So babies born large continue to measure at a high percentile. Between 6 and 12 months, babies switch to a curve closer to that of their parents. Sometimes a drastic drop in percentile can be a normal leveling-out to match a genetic growth pattern. I learned this when my daughter dropped from the 90th percentile for height to below the lowest line on the chart, holding that position for many years. I remember being very short as a child as well.
4. Is the baby happy, healthy and developing normally? Look at the whole picture, not just numbers. An active and good-natured baby is a strong indicator for overall health.
5. Is the child gaining slowly, or is he failing to thrive (FTT)? It’s important to know the difference.  Slow gainers stay on a curve, while FTT babies gain erratically or lose. Slow gainers have good skin and muscle tone, are active and alert, and meet developmental milestones. A good doctor can tell the difference.
6. Are scales accurate? Always use the same scale from one weighing to the next, as differences can be significant.

A word about breastfeeding toddlers: I don’t believe in delaying  solids much past six months, but a small number of breastfeeding babies are satisfied with breastmilk alone for a year or more.  If the child is happy, healthy, and gaining weight, there is no reason for concern. In fact, starting solids too early can lead to poor weight gain.

Dr. Jack Newman tells of a child who ate only jello and breastmilk. The mother was told to wean so the child would eat more solids. After weaning the child refused everything but jello. Breastmilk is high in calories and has antibodies to fight illness. Weaning will not help a toddler gain weight.

I believe we have to trust our children, and our instincts. A healthy child will eat as much as he or she needs. A child who doesn’t is sending some kind of message.  I have known many children who did not eat as much as their parents or health providers thought they should. They outgrew it.

Sometimes, even after the issues above are resolved, there is still concern. Reasons for poor appetite, rejection of solids and low weight gain include allergies, reflux, celiac, abuse, sensory issues, anemia, and illnesses such as cancer or cystic fibrosis.

An excellent and humorous resource is Dr. Carlos Gonzalez’ book, My Child Won’t Eat.

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The premise of her book and blog is that parents stifle their kids when they worry about things that are unlikely to happen, like molestation and kidnapping. By teaching them to be scared of strangers and chauffeuring them everywhere, we deny them the chance to learn life skills and solve problems. There are health implications too: Kids don’t get enough exercise.

I grew up as a “free-range” kid, walking alone to school from the time I turned five. My own kids ride public buses from about 9 and the older ones started walking to school in first grade. But over the years I have become more cautious about walking to school. This is partly because of warnings and partly because of scary things that happened to people I know.

I trust my kids to get to school on their own, although I am still nervous about intersections without traffic lights. Last week I decided to let my first and third-graders walk the three blocks to school on their own, after crossing the busiest intersection with them. They have to cross one dead-end street and another manned by crossing guards. Other than my son complaining that his sister walks too slowly, they were comfortable with the idea.

The commenters on Skenazy’s blog talk about how hard it is to be a “free-ranger” when you are the only one. When I spoke to a mother from my son’s class about having the two third-graders walk home together on the days they finish late, she agreed in theory. “After the winter,” she promised. In the meantime I’m hesitant to let my son walk by himself because the streets are deserted at that hour.

When do you let your kids walk to school alone?

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