Category: children

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children

Plan for a Healthy Baby

You might have thought that I’m against people having children and therefore be surprised that I am writing about having children. I am definitely in favor of people having babies; my goal is for all babies to be planned, loved and healthy—and not too many!

I believe family planning should include the treatment of infertility. It was always a joy for me when a couple who had dealt with fertility issues was able to conceive. Often I was able to attend the birth of that child—a double joy!

What a child needs most is two loving parents. It appears that marriage before childbearing is no longer in style—40% of women giving birth in the USA are unmarried. However, a marriage certificate is not nearly as important as parents being in a stable relationship. Planned pregnancies are most likely to produce healthy, loved children. This column is an update on steps people can take to have a healthy child.

If the couple has been using hormonal contraception, it may be wise for them to stop and use a barrier method for a couple of months before trying to conceive. The chances of having twins may be increased if conception occurs right after stopping “the pill”.

There are several actions that people can take to improve fertility without seeing a doctor. Being overweight is a cause of female infertility, so losing weight may help. Eating well helps improve fertility for both men and women. The suggested diet includes healthy protein, whole grains, fruits and vegetables—the same as for all of us. “Fast food” seems to prolong infertility!  For men, underwear can make a difference; the “family jewels” make more sperm if they hang loose.

Grain products in the USA are now enriched with traces of folate (a B vitamin). Fewer kids are born with neural tube defects (like spina bifida) and other problems, thanks to this vitamin. It is recommended that women start taking prenatal vitamins (which contain folate) at least 1 month before trying to conceive. It is even suggested that all women of reproductive age take folate supplementation, even if they use contraception, because failures happen. Furthermore, folate may increase a woman’s fertility.

Women usually take better care of themselves when they are pregnant, knowing that a healthy mom is more likely to have a healthy baby. For instance, women often want to know how much weight they should gain. I respond that the quality of the food is as important as the pounds gained. 

In medical school I was taught that alcohol is ok for women to drink in pregnancy. More recently we have been recommending that women avoid any alcohol when pregnant—but that recommendation has changed again. It is now thought that a very small amount of alcohol is possibly safe—but total avoidance is safest.

The literature is clear on tobacco products: they are harmful in pregnancy and should be avoided completely. Marijuana use in pregnancy has not been studied very much because of its legal status. One advantage of its legalization in Colorado is that it will be possible to get better information about its safety. I hope that medical scientists are following children whose mothers used “weed” when pregnant, but we won’t know about bad effects, if any, for many years.

Here is the latest information about some other “dos and don’ts” in pregnancy. Things that seem safe include: artificial sweeteners, caffeine in low to moderate amounts, insect repellants (including DEET), hair dyes, air travel and sexual intercourse (unless advised otherwise). Dental care, including x-rays and local anesthesia, is safe and encouraged during pregnancy—but laughing gas should be avoided, especially early in pregnancy. Exercise is encouraged, although women should take extra care to avoid injury when pregnant.

It is best to avoid getting overheated in the first trimester (up to 12 weeks), so hot tubs and long, hot showers are out. Swimming is safe, but waterskiing is not. Fish are good nutrition, but fish with high levels of mercury are especially dangerous in pregnancy. The fetal nervous system is particularly vulnerable to this toxic metal. Pregnant women should pay attention to local advisories concerning fish in lakes and streams, and avoid the most toxic ocean species: swordfish, tilefish, shark and mackerel king. Some kinds of tuna are contaminated with more mercury than others.

In a world that is overpopulated our goal should be for every child to get a good start in life by being healthy and loved.

© Richard Grossman MD 2018

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Action children

End Gun Violence

“…I call on President Trump and the Republican controlled House and Senate and Executive Branch to work together, get some bills passed and stop taking money from the NRA because children are dying and so is the future of America as a result.”

David Hogg, survivor of the school shooting in Parkland, Florida last month

“To every politician who is taking donations from the NRA, shame on you.”

Emma Gonzalez, another survivor, who has more Twitter followers than the NRA

I morned the 17 people who were killed in the mass school shooting in Florida. Then I realized that I have a granddaughter who is in high school, and that her life might be in danger; this made me feel afraid and angry. Why should a 14 year old have to worry about getting shot at her school?

Every year there are more than 37,000 gun deaths in the USA, including about 22,000 suicides. 2017 was the worst so far, with 15,591 homicides. Incredibly, there were 732 children and 3234 teens who were injured or killed by guns. These are data from the Gun Violence Archives. You probably know already that the USA has many times the gun violence of any other developed country.

Why? Although mental illness is blamed frequently, it should noted that 98% of people pulling the trigger are men. Women also have mental illness, but they are much less responsible for shootings. Male aggression (!) and the easy availability of guns are contributing factors to most shootings.

Unfortunately, our government has not taken responsibility for the ease with which guns can be purchased. Indeed, in 1996 an amendment to the omnibus spending bill stated: ”…none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control….” This has effectively halted research into gun deaths.

How did this happen? Certainly the deaths of thousands of Americans is a public health crisis! The National Rifle Association wields immense power in Washington; it was they that effectively put a stop to gun injury research. The NRA has bought our senators and representatives. All told, the NRA has given Colorado Senator Cory Gardner $3,879,064, according to the New York Times. Gardner’s comment after the Las Vegas shooting was: “My family and I are praying for the families of those injured and killed….” He has not taken any substantive action to stop the shootings. The Washington Post wrote that Representative Scott Tipton has received $19,950 from the NRA.

Shootings are a terrible way to reduce our population! In my series of bad ways to decrease human numbers, this is one of the worst, since shooting victims are often young people. What can we do to reduce the slaughter? I offer several ideas.

Do you remember Gabby Giffords, the Arizona representative who was shot in the head while campaigning? Sign her pledge at: https://action.giffords.org/page/s/gabby_giffords_pledge. It says, in part, “…I will use every means available to make sure we have a different Congress, one that puts communities’ interests ahead of the gun lobby’s.”

Another idea is to require gun owners to purchase insurance, just as car owners do. Then if you, or a gun you own, shoots someone, the insurance would help with bills. The effect would be strong because insurance companies would pressure gun stores to keep guns out of the hands of the wrong people, and limit assault weapons.

Already PayPal, Square, Stripe and Apple Pay don’t allow their services to be used for the purchase of guns. Andrew Ross Sorkin suggests that all financial institutions—including banks and credit card companies—should stop doing business with retailers that sell assault weapons, high-capacity magazines and bump stocks. This would not be a cure, but it would be a step in the right direction for the sickness of shootings.

Nicholas Kristof has an excellent online essay “How to Reduce Shootings”. It is a clear statement of the problem, and includes 9 ways to approach a solution. One of them is to research “smart guns” which require a PIN or fingerprint before they can be fired.

I am pleased that teens such as David Hogg and Emma Gonzalez, both quoted above, are stepping up to be gun safety activists. Please join me on March 24th at a local March for Our Lives. Starting at 1PM we will meet at the Durango High School parking lot and march to Rotary Park.

© Richard Grossman MD, 2018