Okay, my sewing machine has sat dormant for a week while I tried to get things together around the house. Believe me, this is not an easy task, since getting all 3 children in bed at the same time is an impossible task, rather like herding cats. But I still want to sew badly. So, next project is to clean off the dining room table where my sewing is currently done (because the boy doesn't do stairs yet and the sewing room is downstairs) so that I can get to work. First I have to finish T's shirt and pants. Then I'm going to start on Maeve's Manhattan dress. After that I will be free to get started on the new fabric that I blogged about previously.
Which brings me to 2 things: I have found a pattern that I could use to make the dresses that comes in both Maeve's and Gwyn's sizes. Of course, it's the newest Farbenmix dress, Destina. I can totally see this on Maeve with that great mix of fabrics that I got from Bunte fabrics (plus one via ebay more that's on its way). If I use this pattern I could use all of the fabrics but still make 2 distinct dresses. On the other hand, it looks less 'twirly' and full than the farbenmix Sasha, which is what I was planning to use for Gwyn's dress but which doesn't come in Maeve's size. Maeve is almost 10 and though she still likes a 'spinning dress' (her appellation) she's starting to outgrow that style and I think that the Destina pattern is a good transition from the little girl style to an older, more 'tween' style.
I hate that word, by the way. It's so vague, and lately I've seen kids as young as 7 or 8 called tweens. Sorry, tweens are the kids who have hit the double-digits but aren't in the teen numbers yet. We're talking 4th, 5th and 6th graders. And don't get me started on the lack of appropriate clothing for a 10 year-old who is tall. But I digress.
Anyway, Gwyn doesn't have much in the way of twirly dresses and she's only 3 so she's at a good age for them and I think she'd get a lot of use from the Sasha dress. The reason I was attracted to the Destina dress was that it has that curved seam detailing that the Sasha dress has. So I'm thinking that maybe instead of doing them in the same pattern, I'll do 2 different patterns and use the same mixes of fabrics. Decisions, decisions. At least I have good fabrics to work with.
Which brings me to the Bunte fabrics part of this post. Yvonne is holding a giveaway on her blog and it's a meter cut (a meter!!!) of the Love Chirp fabric by Nic at Luzia Pimpinella, also an excellent blog for inspiration. I love this little birdy fabric - it makes me so happy. I've entered the giveaway and I hope I get it but if you read this in time, you could try your luck, too.
Wednesday, May 26, 2010
Thursday, May 20, 2010
Miss-Information, or The False Equation of Breastmilk with Cavities
I'm going to interrupt the sewing posts on this blog for a rant on breastfeeding and the misperception that prolonged breastfeeding is directly linked to cavities (dental caries) in young children.
Today I was at the dentist and a dental tech came up to me and talked to me as I was waiting to schedule the next appointment for the kids, which was to include the boy. It happened that I was wearing the sling with T riding in it and she asked if he liked it and my comment was that he seems to want to be in it more since he just weaned himself. Her response to that was that it was a good thing he had, since he was now a year old.
Me: "Why's that?"
Her: "Because breast milk causes cavities because it has so much sugar in it."
I'm not going to repeat the rest of the conversation here, mostly because I don't want to bore readers but also because I want to put forth my own argument on this ridiculous perception.
There are so many logical arguments that you can make against the statement "breast milk causes cavities and shouldn't continue past a year" which require only common sense and no scientific support so I'm going to go through those before talking about what science tells us.
1. Dentists are not the same as doctors. I hate to say this because they are doctors in the sense that they have higher degrees in their area of specialization. However, they don't go through the same kind of training that pediatricians do. The American Association of Pediatrics recommends that breastfeeding is the ideal way to feed the baby for the first year and that it should continue after the first year as long as it's beneficial for mother and child. So in other words, as long as you and your baby both want to do it.
They have taken this position because dozens and dozens of studies have shown the many benefits of breastfeeding for both mother and infant. These benefits continue beyond the first year, and they seem to far outweigh any risk for dental caries that you assume by extended nursing. Since these benefits have long-lasting effects, there is evidence to suggest that it's more beneficial to risk getting cavities in your baby's baby teeth than for him or her to be at risk for obesity or other health problems because you stopped nursing after the first year. Baby teeth fall out, your body remains the same.
Additionally, the American Association of Pediatric Dentistry makes the claim that breastfeeding should "be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced". (Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, AAPD Reference Manual V31, No. 6, p. 41) This is in direct contradiction to the AAP recommendation, given that a child's first tooth could erupt as early as 3 months, thereby making the recommendation that mothers stop nursing far before the 1 year mark. Moreover, one has to draw the (obviously false) conclusion that mothers who breastfeed should stop when the child's first tooth appears and begin bottle feeding with formula when using the AAPD's logic, since their issue is with the breastmilk and not the breast itself. This is clearly a ludicrous idea but, because the AAPD approaches the problem of dental caries solely from the point of view of oral health and not from overall health, they persist in the belief that breastmilk is a direct cause of caries and that cutting it from a child's diet will prevent a huge portion of the infant population from getting cavities. Further, it doesn't seem to mesh with the idea that dentists have put forward that prolonged sucking on a more rigid object such as a bottle's nipple or pacifier will damage tooth alignment; the breast is designed with a baby's mouth in mind.
2. Babies do most of their exclusive breastfeeding prior to having teeth. Teeth which have not erupted cannot get cavities. It has been shown that babies do most of their exclusive nursing between birth and 6 months of age. On average, an infant's first tooth appears somewhere between the age of 4 and 6 months. So even if breastmilk were a direct cause of dental caries, this means that the exposure to breastmilk gets lower as the child ages, thereby lowering the risk of dental caries from it.
3. Around the same time that babies get their first tooth, solids are introduced. As the baby gets older, more and more foods are introduced and ingested and less breastmilk. The simple fact is that there are many different substances that have varying amounts of sugar in them - some more sugar than breastmilk. For example, fructose's purpse is a sweetener and it's what makes strawberries, apples, etc. taste nice. Lactose, which is found in breastmilk doesn't just have the purpose of making the milk taste good (it's in cow's milk, too, by the way) but rather it helps the baby's immature digestive system most effectively absorb calcium and other important nutrients. So to say that breastmilk is the sole cause of cavities in infants and young children is absurd because by the time they have 2 or more teeth, most of them are consuming more than breastmilk and water.
4. If extended breastfeeding really was a direct cause of dental caries, babies in Africa and in most third world countries would have extremely poor dental health. Extended breastfeeding used to be the norm everywhere in the world because there was no such thing as formula or bottles or even baby food. While the invention of formula and baby bottles was a lifesaver for children who couldn't nurse for various reasons, it completely changed the way we feed our infants and what we perceive as normal maternal-child interaction. Now only children born in Third World countries are breastfed for extended periods of time and, generally speaking, they don't seem to have an overwhelming problem with dental health and caries in their children. What's more, these are countries whose dental care is far less established than that in the US or Europe, so it would be normal for these children to have significantly poorer dental health and yet this does not seem to be the case. According to a study published in the journal Pediatrics, children in South Africa demonstrated no significant increase in risk for dental caries when extended nursing occurred:
"The American Academy of Pediatric Dentistry currently recommends weaning from bottle or breastfeeding by the age of 12 to 14 months and discourages bedtime infant feeding, especially after the eruption of the first tooth, to prevent ECC.(33) Although Roberts et al,(23) in their study of 1- to 4-year-old South African children, reported that children who were breastfed for 12 months had a lower level of caries than those bottle fed or bottle and breastfed for <12 months, the current study provides no evidence that breastfeeding for >1 year decreases or increases the risk for ECC or dfs counts. Moreover, interpretation of the results of the current study relevant to this issue is further limited in a number of ways. For example, the quantity and quality of supplemental feedings, the quantity of breastfeeding, and information about other factors, such as bedtime breastfeeding or bottle feeding, are not available from NHANES data, and, thus, it is not known how these factors might differ among those breastfed for >1 year and those breastfed for a shorter duration. Several other studies have investigated these factors; however, the results of such studies remain inconclusive.(5,6,16,34,35)"
So, the study even shows that children who were nursed for less than a year had more cavities than those who nursed for the entire first year of life. As anecdotal evidence, my oldest daughter nursed until about 1.5 months past her 2nd birthday. She has excellent oral health and has never had a cavity as of today. She will be 10 in August. So much for extended nursing causing cavities.
5. It is well-known that the main cause of dental caries is bacteria, NOT sugar. Here's where we come to the scientific part. The American Association of Pediatric Dentistry says that, "Caries results from an overgrowth of specific organisms that are part of normally-occurring human oral flora. Mutans streptococci (MS) is considered to be a principal indicator group of bacterial organisms responsible for dental caries." (Guideline on Infant Oral Health Care, rev. 2009, American Academy of Pediatric Dentistry) So clearly, pediatric dentists already know that bacteria is the true culprit when it comes to the cause of cavities. It would be fair to say that the average mother knows that pretty much everything her child touches is potentially harboring all kinds of bacteria. New mothers are admonished to wash their hands before they touch their babies, sterilize bottle nipples, clean off dropped pacifiers before allowing the child to suck on them again. However, we cannot completely sterilize our environments. Children crawl on various surfaces and touch everything within reach, putting their fingers and hands, or even the objects that they touch, in their mouths and in this way transfer myriad types of bacteria to their mouths. I submit that direct transmission of bacteria to a child's mouth is a much more common way for bacteria to be introduced and therefore a much more likely direct cause of dental caries.
So, if the AAPD is aware that the main cause of dental caries is bacteria, why aren't dentists and hygienists telling parents this and using it as a way to emphasize the importance of maintaining oral hygiene by brushing and flossing when children are very young? Instead they tell people that nursing is to blame and probably cause some mothers to stop nursing before they want to or before their child is ready.
6. People with softer tooth enamel are, in general, more susceptible to cavities. We're all unique individuals and we each have varying amounts of enamel hardness. Any good dentist can tell you that softer enamel is more susceptible to being worn down by bacteria and acids. Children with serious GERD issues often have softer enamel because of the exposure to acid due to reflux. Acid alone can cause enamel erosion and in someone whose enamel is soft to begin with, this provides an excellent opportunity for bacteria to set up house and get to work causing cavities.
7. The AAPD, in its Guideline on Infant Oral Health Care states that "Caries is a disease that is, by and large, preventable." It goes on to list things that can be done to help prevent caries, including the fact that, since it has been shown that bacterial levels in the mother's mouth can directly influence the bacterial levels in the child's mouth prenatally: "Oral hygiene: Tooth-brushing and flossing by the mother on a daily basis are important to help dislodge food and reduce bacterial plaque levels.". Presumably this is to reduce the amount of MS existent in the mother's saliva prenatally. Further, recommendations for post-partum care of infants' teeth begins with: "Oral hygiene measures should be implemented no later than the time of the eruption of the first primary tooth. Cleansing the infant's teeth as soon as they erupt with either a washcloth or soft toothbrush will help reduce bacterial colonization." It goes on to say how often children's teeth should be brushed and how much toothpaste should be used and adds that routine flossing should begin when there are 2 or more teeth adjacent to each other. (p. 96) Further, in Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, the AAPD lists preventive measures for ECC. This list consists of 5 practices that parents can follow to decrease the risk of ECC. First on the list is reducing familial levels of Mutans streptococci during the prenatal period. Oral hygiene comes in at the #3 position and includes cleaning the teeth of children who fall asleep while feeding before putting them to bed; brushing the child's teeth twice daily with fluoridated toothpaste; and flossing. Included in #3 are recommended amounts of toothpaste by age. It is not until the last practice that we see mention of 'ad libitum' nursing. Clearly, extended nursing is not nearly as big of a problem as parents are made to believe if it is last on the list.
8. More emphasis should be placed on bottles and sippy cups and their contents. The AAP makes the recommendation that children should not be put to bed with a bottle or sippy cup. The AAPD mentions this, too, but I feel that more emphasis needs to be given to bottles and sippy cups because, more often than not, the beverage inside is not harmless water but juice or other sugary drinks, particularly when the child is older than 12 months. This is more common in homes on the lower end of the socio-economic spectrum and most notable in homes where the average level of education is lower. I have personally seen small children eating lollipops and drinking carbonated drinks like Sprite or non-carbonated but highly-sugared drinks such as Hi-C. It is becoming more and more common to see an 18-month-old child eating a Happy Meal at McDonalds and while fast-food restaurants have made efforts to provide healthier alternatives for children (apple slices instead of fries, milk to drink) the fact of the matter is that the children most in need of the healthy options usually don't get them and they end up with the carbonated drink and the fries. Given these extenuating factors it seems ridiculous to lay the blame for ECC at the feet of breastmilk before other causes.
9. The AAPD misses the boat completely when it comes to other major causes for ECC. According to the afore-mentioned study in the journal Pediatrics, other causes for ECC include maternal smoking and ethnicity.
"Although breastfeeding was not found to be associated with either an increased or decreased risk of ECC, decreased family income and prenatal maternal smoking, both strongly associated with decreased rates of breastfeeding as demonstrated in previous studies, (12) were both found to be independently associated with an increased risk. Maternal smoking during pregnancy is well recognized to be associated with myriad negative perinatal health outcomes in children,(24–27) in addition to early termination of breastfeeding.(28,29) In this study, children whose mothers reported smoking during pregnancy were less likely to be breastfed, but maternal smoking during pregnancy also was independently associated with increased rates of ECC and higher numbers of caries in multivariable analyses that controlled for breastfeeding. It is not possible from these data to disentangle whether it is prenatal, postnatal, or both prenatal and postnatal tobacco smoke exposure that is associated with an increased risk of ECC, because women who smoke during pregnancy are likely to continue smoking postnatally. Also, whereas it is possible that maternal smoking during pregnancy may simply be a marker for a mother's unhealthy choices for diet and oral hygiene practices, the association between secondhand tobacco smoke exposure and increased risk for dental caries in children in this and previous studies (17,30,31) indicates a clear need to establish the possible causal nature of the association of exposures to maternal smoking in utero and postnatally and ECC."
Ethnicity is a prominent factor when it comes to risk for ECC, though it is unclear whether this is a genetically-linked problem or if it is simply that minorities are more likely to earn less than their white counterparts and therefore be poor. The Pediatrics study showed that:
"Consistent with previous studies, children living in poverty and Mexican American children were at significantly increased risk for both ECC and S-ECC.(13,16,32) Although it is well recognized that socioeconomic factors and ethnicity influence dietary and oral health-related behaviors, as well as access to dental care, it remains unclear why poor and Mexican American children are at increased risk for ECC. Mexican American children in this nationally representative sample were more likely to breastfeed longer (both overall and exclusively) than other ethnic/racial groups. Ramos-Gomez et al(21) found higher rates of ECC among Mexican-American rural migrant children in California, but nursing patterns, such as duration, frequency or bedtime bottle/breastfeeding were not found to be independently associated with increased rates. Interestingly, in the current study, breastfed Mexican American and breastfed poor children had higher rates of ECC than non–Mexican American children or those living at 200% of the FPL who were never breastfed. The reasons for this could not be investigated because of limitations of the data. The NHANES 1999–2002 lacks, for example, information about nursing patterns, as well as other potentially cariogenic factors that might have been associated with poverty or being Mexican American, such as the level of oral cariogenic microorganisms, frequency of carbohydrate intake, or personal oral hygiene habits. These findings do suggest, however, that breastfeeding does not eradicate the increased risk for ECC among Mexican American children and those living in poverty."
In short, the AAPD needs to re-examine its position on extended breastfeeding and place a much greater emphasis on targeting children who are more likely to develop ECC, rather than simply demonizing extended breastfeeding. Additionally, I'm fairly certain that part of this reluctance to accept extended nursing is society's overall sexualization of women's breasts and its inability to reconcile this view with the actual purpose of the breast: to feed one's children.
Today I was at the dentist and a dental tech came up to me and talked to me as I was waiting to schedule the next appointment for the kids, which was to include the boy. It happened that I was wearing the sling with T riding in it and she asked if he liked it and my comment was that he seems to want to be in it more since he just weaned himself. Her response to that was that it was a good thing he had, since he was now a year old.
Me: "Why's that?"
Her: "Because breast milk causes cavities because it has so much sugar in it."
I'm not going to repeat the rest of the conversation here, mostly because I don't want to bore readers but also because I want to put forth my own argument on this ridiculous perception.
There are so many logical arguments that you can make against the statement "breast milk causes cavities and shouldn't continue past a year" which require only common sense and no scientific support so I'm going to go through those before talking about what science tells us.
1. Dentists are not the same as doctors. I hate to say this because they are doctors in the sense that they have higher degrees in their area of specialization. However, they don't go through the same kind of training that pediatricians do. The American Association of Pediatrics recommends that breastfeeding is the ideal way to feed the baby for the first year and that it should continue after the first year as long as it's beneficial for mother and child. So in other words, as long as you and your baby both want to do it.
They have taken this position because dozens and dozens of studies have shown the many benefits of breastfeeding for both mother and infant. These benefits continue beyond the first year, and they seem to far outweigh any risk for dental caries that you assume by extended nursing. Since these benefits have long-lasting effects, there is evidence to suggest that it's more beneficial to risk getting cavities in your baby's baby teeth than for him or her to be at risk for obesity or other health problems because you stopped nursing after the first year. Baby teeth fall out, your body remains the same.
Additionally, the American Association of Pediatric Dentistry makes the claim that breastfeeding should "be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced". (Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, AAPD Reference Manual V31, No. 6, p. 41) This is in direct contradiction to the AAP recommendation, given that a child's first tooth could erupt as early as 3 months, thereby making the recommendation that mothers stop nursing far before the 1 year mark. Moreover, one has to draw the (obviously false) conclusion that mothers who breastfeed should stop when the child's first tooth appears and begin bottle feeding with formula when using the AAPD's logic, since their issue is with the breastmilk and not the breast itself. This is clearly a ludicrous idea but, because the AAPD approaches the problem of dental caries solely from the point of view of oral health and not from overall health, they persist in the belief that breastmilk is a direct cause of caries and that cutting it from a child's diet will prevent a huge portion of the infant population from getting cavities. Further, it doesn't seem to mesh with the idea that dentists have put forward that prolonged sucking on a more rigid object such as a bottle's nipple or pacifier will damage tooth alignment; the breast is designed with a baby's mouth in mind.
2. Babies do most of their exclusive breastfeeding prior to having teeth. Teeth which have not erupted cannot get cavities. It has been shown that babies do most of their exclusive nursing between birth and 6 months of age. On average, an infant's first tooth appears somewhere between the age of 4 and 6 months. So even if breastmilk were a direct cause of dental caries, this means that the exposure to breastmilk gets lower as the child ages, thereby lowering the risk of dental caries from it.
3. Around the same time that babies get their first tooth, solids are introduced. As the baby gets older, more and more foods are introduced and ingested and less breastmilk. The simple fact is that there are many different substances that have varying amounts of sugar in them - some more sugar than breastmilk. For example, fructose's purpse is a sweetener and it's what makes strawberries, apples, etc. taste nice. Lactose, which is found in breastmilk doesn't just have the purpose of making the milk taste good (it's in cow's milk, too, by the way) but rather it helps the baby's immature digestive system most effectively absorb calcium and other important nutrients. So to say that breastmilk is the sole cause of cavities in infants and young children is absurd because by the time they have 2 or more teeth, most of them are consuming more than breastmilk and water.
4. If extended breastfeeding really was a direct cause of dental caries, babies in Africa and in most third world countries would have extremely poor dental health. Extended breastfeeding used to be the norm everywhere in the world because there was no such thing as formula or bottles or even baby food. While the invention of formula and baby bottles was a lifesaver for children who couldn't nurse for various reasons, it completely changed the way we feed our infants and what we perceive as normal maternal-child interaction. Now only children born in Third World countries are breastfed for extended periods of time and, generally speaking, they don't seem to have an overwhelming problem with dental health and caries in their children. What's more, these are countries whose dental care is far less established than that in the US or Europe, so it would be normal for these children to have significantly poorer dental health and yet this does not seem to be the case. According to a study published in the journal Pediatrics, children in South Africa demonstrated no significant increase in risk for dental caries when extended nursing occurred:
"The American Academy of Pediatric Dentistry currently recommends weaning from bottle or breastfeeding by the age of 12 to 14 months and discourages bedtime infant feeding, especially after the eruption of the first tooth, to prevent ECC.(33) Although Roberts et al,(23) in their study of 1- to 4-year-old South African children, reported that children who were breastfed for 12 months had a lower level of caries than those bottle fed or bottle and breastfed for <12 months, the current study provides no evidence that breastfeeding for >1 year decreases or increases the risk for ECC or dfs counts. Moreover, interpretation of the results of the current study relevant to this issue is further limited in a number of ways. For example, the quantity and quality of supplemental feedings, the quantity of breastfeeding, and information about other factors, such as bedtime breastfeeding or bottle feeding, are not available from NHANES data, and, thus, it is not known how these factors might differ among those breastfed for >1 year and those breastfed for a shorter duration. Several other studies have investigated these factors; however, the results of such studies remain inconclusive.(5,6,16,34,35)"
So, the study even shows that children who were nursed for less than a year had more cavities than those who nursed for the entire first year of life. As anecdotal evidence, my oldest daughter nursed until about 1.5 months past her 2nd birthday. She has excellent oral health and has never had a cavity as of today. She will be 10 in August. So much for extended nursing causing cavities.
5. It is well-known that the main cause of dental caries is bacteria, NOT sugar. Here's where we come to the scientific part. The American Association of Pediatric Dentistry says that, "Caries results from an overgrowth of specific organisms that are part of normally-occurring human oral flora. Mutans streptococci (MS) is considered to be a principal indicator group of bacterial organisms responsible for dental caries." (Guideline on Infant Oral Health Care, rev. 2009, American Academy of Pediatric Dentistry) So clearly, pediatric dentists already know that bacteria is the true culprit when it comes to the cause of cavities. It would be fair to say that the average mother knows that pretty much everything her child touches is potentially harboring all kinds of bacteria. New mothers are admonished to wash their hands before they touch their babies, sterilize bottle nipples, clean off dropped pacifiers before allowing the child to suck on them again. However, we cannot completely sterilize our environments. Children crawl on various surfaces and touch everything within reach, putting their fingers and hands, or even the objects that they touch, in their mouths and in this way transfer myriad types of bacteria to their mouths. I submit that direct transmission of bacteria to a child's mouth is a much more common way for bacteria to be introduced and therefore a much more likely direct cause of dental caries.
So, if the AAPD is aware that the main cause of dental caries is bacteria, why aren't dentists and hygienists telling parents this and using it as a way to emphasize the importance of maintaining oral hygiene by brushing and flossing when children are very young? Instead they tell people that nursing is to blame and probably cause some mothers to stop nursing before they want to or before their child is ready.
6. People with softer tooth enamel are, in general, more susceptible to cavities. We're all unique individuals and we each have varying amounts of enamel hardness. Any good dentist can tell you that softer enamel is more susceptible to being worn down by bacteria and acids. Children with serious GERD issues often have softer enamel because of the exposure to acid due to reflux. Acid alone can cause enamel erosion and in someone whose enamel is soft to begin with, this provides an excellent opportunity for bacteria to set up house and get to work causing cavities.
7. The AAPD, in its Guideline on Infant Oral Health Care states that "Caries is a disease that is, by and large, preventable." It goes on to list things that can be done to help prevent caries, including the fact that, since it has been shown that bacterial levels in the mother's mouth can directly influence the bacterial levels in the child's mouth prenatally: "Oral hygiene: Tooth-brushing and flossing by the mother on a daily basis are important to help dislodge food and reduce bacterial plaque levels.". Presumably this is to reduce the amount of MS existent in the mother's saliva prenatally. Further, recommendations for post-partum care of infants' teeth begins with: "Oral hygiene measures should be implemented no later than the time of the eruption of the first primary tooth. Cleansing the infant's teeth as soon as they erupt with either a washcloth or soft toothbrush will help reduce bacterial colonization." It goes on to say how often children's teeth should be brushed and how much toothpaste should be used and adds that routine flossing should begin when there are 2 or more teeth adjacent to each other. (p. 96) Further, in Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, the AAPD lists preventive measures for ECC. This list consists of 5 practices that parents can follow to decrease the risk of ECC. First on the list is reducing familial levels of Mutans streptococci during the prenatal period. Oral hygiene comes in at the #3 position and includes cleaning the teeth of children who fall asleep while feeding before putting them to bed; brushing the child's teeth twice daily with fluoridated toothpaste; and flossing. Included in #3 are recommended amounts of toothpaste by age. It is not until the last practice that we see mention of 'ad libitum' nursing. Clearly, extended nursing is not nearly as big of a problem as parents are made to believe if it is last on the list.
8. More emphasis should be placed on bottles and sippy cups and their contents. The AAP makes the recommendation that children should not be put to bed with a bottle or sippy cup. The AAPD mentions this, too, but I feel that more emphasis needs to be given to bottles and sippy cups because, more often than not, the beverage inside is not harmless water but juice or other sugary drinks, particularly when the child is older than 12 months. This is more common in homes on the lower end of the socio-economic spectrum and most notable in homes where the average level of education is lower. I have personally seen small children eating lollipops and drinking carbonated drinks like Sprite or non-carbonated but highly-sugared drinks such as Hi-C. It is becoming more and more common to see an 18-month-old child eating a Happy Meal at McDonalds and while fast-food restaurants have made efforts to provide healthier alternatives for children (apple slices instead of fries, milk to drink) the fact of the matter is that the children most in need of the healthy options usually don't get them and they end up with the carbonated drink and the fries. Given these extenuating factors it seems ridiculous to lay the blame for ECC at the feet of breastmilk before other causes.
9. The AAPD misses the boat completely when it comes to other major causes for ECC. According to the afore-mentioned study in the journal Pediatrics, other causes for ECC include maternal smoking and ethnicity.
"Although breastfeeding was not found to be associated with either an increased or decreased risk of ECC, decreased family income and prenatal maternal smoking, both strongly associated with decreased rates of breastfeeding as demonstrated in previous studies, (12) were both found to be independently associated with an increased risk. Maternal smoking during pregnancy is well recognized to be associated with myriad negative perinatal health outcomes in children,(24–27) in addition to early termination of breastfeeding.(28,29) In this study, children whose mothers reported smoking during pregnancy were less likely to be breastfed, but maternal smoking during pregnancy also was independently associated with increased rates of ECC and higher numbers of caries in multivariable analyses that controlled for breastfeeding. It is not possible from these data to disentangle whether it is prenatal, postnatal, or both prenatal and postnatal tobacco smoke exposure that is associated with an increased risk of ECC, because women who smoke during pregnancy are likely to continue smoking postnatally. Also, whereas it is possible that maternal smoking during pregnancy may simply be a marker for a mother's unhealthy choices for diet and oral hygiene practices, the association between secondhand tobacco smoke exposure and increased risk for dental caries in children in this and previous studies (17,30,31) indicates a clear need to establish the possible causal nature of the association of exposures to maternal smoking in utero and postnatally and ECC."
Ethnicity is a prominent factor when it comes to risk for ECC, though it is unclear whether this is a genetically-linked problem or if it is simply that minorities are more likely to earn less than their white counterparts and therefore be poor. The Pediatrics study showed that:
"Consistent with previous studies, children living in poverty and Mexican American children were at significantly increased risk for both ECC and S-ECC.(13,16,32) Although it is well recognized that socioeconomic factors and ethnicity influence dietary and oral health-related behaviors, as well as access to dental care, it remains unclear why poor and Mexican American children are at increased risk for ECC. Mexican American children in this nationally representative sample were more likely to breastfeed longer (both overall and exclusively) than other ethnic/racial groups. Ramos-Gomez et al(21) found higher rates of ECC among Mexican-American rural migrant children in California, but nursing patterns, such as duration, frequency or bedtime bottle/breastfeeding were not found to be independently associated with increased rates. Interestingly, in the current study, breastfed Mexican American and breastfed poor children had higher rates of ECC than non–Mexican American children or those living at 200% of the FPL who were never breastfed. The reasons for this could not be investigated because of limitations of the data. The NHANES 1999–2002 lacks, for example, information about nursing patterns, as well as other potentially cariogenic factors that might have been associated with poverty or being Mexican American, such as the level of oral cariogenic microorganisms, frequency of carbohydrate intake, or personal oral hygiene habits. These findings do suggest, however, that breastfeeding does not eradicate the increased risk for ECC among Mexican American children and those living in poverty."
In short, the AAPD needs to re-examine its position on extended breastfeeding and place a much greater emphasis on targeting children who are more likely to develop ECC, rather than simply demonizing extended breastfeeding. Additionally, I'm fairly certain that part of this reluctance to accept extended nursing is society's overall sexualization of women's breasts and its inability to reconcile this view with the actual purpose of the breast: to feed one's children.
Sunday, May 16, 2010
Sew much for that!
My machine is still not working right so I haven't gotten as much done as I'd like. In fact, I scrapped everything that I was doing 2 weeks ago and haven't done anything except hem little man's shirt. I can do that because my beloved Singer Featherweight works. What I can't do is anything other than a straight stitch. So nothing that needs buttonholes. At least, not right now. I desperately want to get up early in the morning so that I can get it over to the repair guy - not the one I took it to last time, thanks very much. But the best laid plans and all that.....
On the brighter side, I ended up ordering the fabric I was coveting in the last post and am drooling over it, though I'm a tad disappointed in the delft print, as it clearly is flawed. You can't really tell if you're not looking at it closely, but under scrutiny it's clear that the printing is a bit off. I can't describe how, so I'll try to get a picture of it this week and add it here. On the whole, though, I'm pleased with it. I also scored some cute knit fabric for the boy that has surfboards on it. That came from ebay. These dresses are not at the top of the list right now, since the queue is being held up by little man's shirt and pants. Thank god I had already done the buttonholes before the machine went south on me. Now all I have to do is hem the sleeves and then I can work on the pants, which won't need buttonholes right away. Then I can start on the Manhattan dress from everybody's favorite book. And at some point I need to sneak in a gift for a friend's baby and finish the boy's quilt, since he is 1 year old now. So much to sew, so little time.
On the brighter side, I ended up ordering the fabric I was coveting in the last post and am drooling over it, though I'm a tad disappointed in the delft print, as it clearly is flawed. You can't really tell if you're not looking at it closely, but under scrutiny it's clear that the printing is a bit off. I can't describe how, so I'll try to get a picture of it this week and add it here. On the whole, though, I'm pleased with it. I also scored some cute knit fabric for the boy that has surfboards on it. That came from ebay. These dresses are not at the top of the list right now, since the queue is being held up by little man's shirt and pants. Thank god I had already done the buttonholes before the machine went south on me. Now all I have to do is hem the sleeves and then I can work on the pants, which won't need buttonholes right away. Then I can start on the Manhattan dress from everybody's favorite book. And at some point I need to sneak in a gift for a friend's baby and finish the boy's quilt, since he is 1 year old now. So much to sew, so little time.
Friday, April 30, 2010
I'm obsessed
with this fabric. I'm also in love with this one, as well as its sister. I must have them. I really want to make matching dresses for the girls but the pattern I want to use doesn't go up to Maeve's size. Scott calls her his weed because she grows so fast. This morning she put on a dress I bought for her last year and it will definitely be too short or too tight by the time summer really is in full swing, so I can justify a new dress for her. And I justify a new one for Gwyn because she never really gets anything new unless I make it, since I saved all of Maeve's clothes from when she was little. Just call me Miss Thrifty.
Anyway, I'm leaning towards the Farbenmix Sasha dress pattern because I think it will really be a great way to showcase that delft patterned fabric. And I already own it, so that means no buying a new pattern and waiting for it to get here; I can trace it tonight if I want to. I've only sewn it once, for Maeve but it turned out so lovely. Actually, it was the first Farbenmix pattern I used and it was before I had my serger, so everything is zigzagged on the edges. Here's a picture of it:
And here's the back view:
A quick note about this pattern and Farbenmix patterns in general: I made this dress back in the spring of 2008, when Maeve was finishing 2nd grade. This dress is just now getting to be too small for her and she's about to finish up 4th grade. So, when they say that Farbenmix patterns are designed to grow with the child, they aren't kidding. This is the biggest size - a 134/140 and Maeve wears a 140 or 146, depending on the ease of the garment. She really needs the 146 in pants for length because she has such long legs.
Anyway, I want to use the delft fabric for the top and bottom tiers, with the red floral print in the middle and the blue floral print for the bodice; maybe with red straps - I'm not sure, though. I think it would be adorable on Gwyn. Of course, I might have to make a cute t-shirt to go with it, but that's what Ottobre is for, right? I think the Puffis shirt from 3/2008 would be cute with it. The question is, what pattern do I use for Maeve's dress? I was thinking of Abacadabra #64, since I already have that one, too. Plus, it has the tiered skirt and that's similar to the Farbenmix Sasha. I've done the Abacadabra one for Maeve already - not sure if I have it traced in the right size, but I might and that would make things go even easier. Here's the version I made previously:
The only problem with this pattern is that the straps are ruffles that have elastic in them to make them stretch. This in itself isn't that big of a problem; what is a problem is the fact that the ruffles extend into these trailing streamers which are simply gathered and stitched to hold the gathers. That may not seem like a problem, but it does mean that if your child sits on the streamer end and then shifts her weight (as mine did) suddenly, the stitching can rip out rather easily. Now, I have to say that I haven't tried stitching the streamer parts with a zig-zag stitch, which would probably give it the strength it needs; I only used a straight stitch. However, I'm still thinking of altering this to either not have the streamers - which I really don't want to do since they're what makes the dress so darn cute - or to make them with elastic down the entire length of the ruffle, so that the lack of stretch is virtually eliminated.
Anyway, that's what I've got in mind. And I must be obsessed because I've been thinking about it non-stop. Crazy, since I haven't even started on Maeve's Manhattan dress or finished T's spring/birthday outfit and I'm considering whipping up something fun to wear when Scott takes me to dinner next Friday.
What do you think about the pattern choices?
Anyway, I'm leaning towards the Farbenmix Sasha dress pattern because I think it will really be a great way to showcase that delft patterned fabric. And I already own it, so that means no buying a new pattern and waiting for it to get here; I can trace it tonight if I want to. I've only sewn it once, for Maeve but it turned out so lovely. Actually, it was the first Farbenmix pattern I used and it was before I had my serger, so everything is zigzagged on the edges. Here's a picture of it:
And here's the back view:
A quick note about this pattern and Farbenmix patterns in general: I made this dress back in the spring of 2008, when Maeve was finishing 2nd grade. This dress is just now getting to be too small for her and she's about to finish up 4th grade. So, when they say that Farbenmix patterns are designed to grow with the child, they aren't kidding. This is the biggest size - a 134/140 and Maeve wears a 140 or 146, depending on the ease of the garment. She really needs the 146 in pants for length because she has such long legs.
Anyway, I want to use the delft fabric for the top and bottom tiers, with the red floral print in the middle and the blue floral print for the bodice; maybe with red straps - I'm not sure, though. I think it would be adorable on Gwyn. Of course, I might have to make a cute t-shirt to go with it, but that's what Ottobre is for, right? I think the Puffis shirt from 3/2008 would be cute with it. The question is, what pattern do I use for Maeve's dress? I was thinking of Abacadabra #64, since I already have that one, too. Plus, it has the tiered skirt and that's similar to the Farbenmix Sasha. I've done the Abacadabra one for Maeve already - not sure if I have it traced in the right size, but I might and that would make things go even easier. Here's the version I made previously:
The only problem with this pattern is that the straps are ruffles that have elastic in them to make them stretch. This in itself isn't that big of a problem; what is a problem is the fact that the ruffles extend into these trailing streamers which are simply gathered and stitched to hold the gathers. That may not seem like a problem, but it does mean that if your child sits on the streamer end and then shifts her weight (as mine did) suddenly, the stitching can rip out rather easily. Now, I have to say that I haven't tried stitching the streamer parts with a zig-zag stitch, which would probably give it the strength it needs; I only used a straight stitch. However, I'm still thinking of altering this to either not have the streamers - which I really don't want to do since they're what makes the dress so darn cute - or to make them with elastic down the entire length of the ruffle, so that the lack of stretch is virtually eliminated.
Anyway, that's what I've got in mind. And I must be obsessed because I've been thinking about it non-stop. Crazy, since I haven't even started on Maeve's Manhattan dress or finished T's spring/birthday outfit and I'm considering whipping up something fun to wear when Scott takes me to dinner next Friday.
What do you think about the pattern choices?
Tuesday, April 20, 2010
Meet Rachel
So this is the "easter" dress that I promised Gwyn. It actually didn't get finished until about a week after Easter but that's okay, since we don't go to church. I was ambivalent about this mix of fabrics - they seemed good at first but after I got started I wasn't feeling that great about the number of different prints. I'm still not sure, although it does look really cute on. Much better on, in fact, than on the hanger.
The pattern is the farbenmix Rachel dress, which lends itself well to a mix of fabrics. It was actually really quick to put together, after I finished every single piece with the serger. I hate when my mommymade clothes come apart because the fabric raveled so it's worth taking the time to finish everything. It bit obsessive maybe, but worth it. I like to use embellishments but this time there was so much going on with the fabric that I just used a simple aqua satin ribbon around the sleeve cuffs and the circumference of the skirt. I think it adds that extra something while still letting the fabrics speak. And speak they do.
The main fabric is the infamous Carnival Bloom by Michael Miller. I got this about 2 years ago but wasn't sure what to do with it. I got the aqua, pink and green colorways of the brown Dumb Dot at the same time, as well as the aqua with the multi-colored dots and the brown with the multi-colored dots. Anyway, there's clearly a lot going on in terms of print. I wasn't sure if I was going to like the way this ended up because I started to see the colors as too "candy box-like" and I'd seen so much pink and brown of late - the carnival bloom in particular - that I was starting to not like it at all. But I've decided I do like it.
The only problem with using American fabrics is that they are almost universally too narrow when it comes to cutting skirt panels. With the Rachel dress this is true, even for this tiny size (98-104). The bottom ruffle onto which I've sewn the ribbon needed to be cut in 3 pieces, rather than the 2 called for. In order to avoid having seams in the front, I cut that piece as long as possible, then cut the remaining piece in 2 shorter lengths which I then seamed together. It works, and I don't think it's obvious at all.
From a design standpoint, the one thing that bothers me is the fact that I chose to do the center panels all with the brown dot. Too me it looks kind of blah and stands out too much. In retrospect I think I should have put the green and pink dot on the sides of the dress and replaced the aqua multi-dot with the brown multi dot at the center. I think that would have given a better effect. Oh well, live and learn.
Here Gwyn gives us her standard model pose, also known as the "I'm a little tea pot" pose. (Un)fortunately, this pose shows off the front panels and you can see the mass of brown polka dots that I don't like.
Friday, March 26, 2010
Sew new
How cute is this? Today I made a shirt for my little man. This is the Outo Otus shirt from the 6/2009 issue of Ottobre. Normally I don't make entire outfits as shown in the magazine, but this shirt was shown on the cutest baby and I immediately thought of my little man. The fabric is Hilco's Campan knit in a brown/red combo that I got from !st European Fabrics group on yahoo, purchased specifically for this item. Actually I really liked the brown/green version in the magazine, but I couldn't find it anywhere so I went with the brown/red.
This shirt went together pretty easily but after trying the lap-seam method that was recommended in the instructions I decided I didn't like the look and after ripping out the stitching I re-sewed the seam with the serger in the standard way, then topstitched the seam allowances toward the sleeve. The flat construction (sewing the arm and side seams all in one pass) is fast, but I'm not fond of the way the seam allowance sticks out at the cuff when done this way. I think that if I make this again (and I plan on it) I'll sew the cuffs to the sleeve in a single layer, then do the arm and side seams so that I'm able to fold the raw edge of the cuff in and then hand stitch it to the sleeve allowance, so that the underarm seam allowance is concealed within the cuff. I think this provides a much nicer finish, although that could be because I'm such a glutton for hand-sewing and finishing. I think a lot of people like the fast way, but then you run the risk of seeing the seams and to me that just screams "Poor Construction!!"
Another note about the fabrics and finishing: The binding isn't as nice as I'd like it to be. To begin with, I wanted to use brown ribbing but what I had in my stash was darker than the brown in the Campan. My husband thought the darker ribbing looked fine but to me it was off just enough to be noticeable and annoying, as opposed to noticeable and contrasty. I figured that if it wasn't going to match I'd better go farther so that it looked deliberate, instead of being a poorly matched fabric choice. Yeah, I'm anal like that. Anyway, the ribbing I went with is the same as the tan that I used in the Kaarna pants for which this shirt was made, so it was a good choice. However, this ribbing - while nice and firm and substantial in weight - has less stretch than I probably should have had. This made it difficult to fit the neckline and still have enough to adequately wrap it to the other side as described in the instructions. I made it work, but it's not pretty if you look at it from the wrong side. Also, I transposed the snap parts on one of the snaps, so that the post is on the wrong side. The snap still works fine and it's not at all noticeable when on, but it's another annoying mistake. Then too, the snaps are a red which doesn't really match with the red in the fabric, but I really had little choice. I wanted brown but they didn't have any so I had to go with red, even though it's a bit brighter than I'd like. It works.
So here he is in the entire outfit:
As mentioned in a previous post, I made the Nala combi by Farbenmix for Miss Gwyn. Finally I've got pictures to show of this one:
The second one shows how cute the leggings are. This is a really easy pattern and it went together really fast. I had some issues with it that were based on fabric and on not really taking time to translate the entire thing from German. The fabric part was due to a very small amount of the stripe: another Campan knit by Hilco that I purchased from Banberry Place about 3 years ago along with the floral. I bought 1 yard of the floral and I thought I bought a yard of the stripe, but either the fabric shrank drastically when I laundered it or there was less than a yard left when I ordered it and Corie just gave me what was left. Anyway, I had to make things work with what I had. The only problem really was that I didn't have quite enough to do the entire neck binding in 1 piece with the stripes going vertically. There's really no point in doing horizontal stripes on the binding because the effect is pretty underwhelming. I tried to rectify this by cutting 2 pieces and then sewing them together, but I ended up not being able to line up both seams in the binding with the shoulder seams. In retrospect I could have easily avoided this if I'd done the 2 binding pieces separately and then sewn the shoulder seams afterward, but hey - hindsight is always 20/20. For the record, Corie still carries the floral knit I used.
Which brings me to the other minor problem I had with the construction. Not bothering to translate the entire instructions or to really look at the sew-along, I didn't bother to slash the circles which are the ruffly cuffs. Instead I finished the edges of the circles (a bit tricky, I must say) and then applied them in the round to the legs and arms after sewing the leg and arm seams. This method works well, but is a bit more picky than I'd like if I were to make it again (she likes it so I probably will). So next time I'll do the slash to make the finishing of the cuffs easier and then sew the entire side, arm and cuff seam in one go. I let Gwyn choose where to put the Farbenmix label and she thought that was cool; it's on the left arm, near her shoulder.
Sunday, March 14, 2010
Purple Princess
Earlier in the week Miss Maeve was able to wear her tunic and leggings that I made for her SWAP, which continues to be a work in progress. I might finish by the end of this month, if I'm lucky. I really love this fabric and I have to say that it was expensive as hell. In fact, I'd only bought enough of it back in 2008 to make a blouse for her, since it was something like $32/yd! Okay, it is Liberty of London, but I don't know if I can justify paying that much. The funny thing is, it's such a sophisticated fabric for someone her age and I thought it was too pretty to pass up, even if she changed her mind. My thought was that I could use it for myself if she ended up not wanting it.
Not only did she not change her mind, but she decided that this tunic needed to be made in addition to the blouse (the one I just finished - sorry, no pics yet!). I didn't have enough fabric, so I had to search for it. The local store where I got it no longer had it. They offered to order it, but a special order was going to be more expensive, so I turned them down. After an exhausting search on the web I found it and ordered it from a place in London. It was still expensive, but this time I was paying about $27/meter, so I was getting more fabric for less money and that seemed worth it. I picked up the car-print fabric for T's birthday shirt at the same time.
Anyway, I had enough to make the blouse and the tunic, with enough left over to maybe use in a future project for someone. Plus, the solid-looking raspberry color on the placket is also used on the blouse yoke, so there's actually some kind of continuity in the SWAP. I like this tunic made in the longer dress-length - mostly because I can't stand that so many kids her age wear skirts that practically show their bums. Sorry, I like her bum to be covered, plus she has long legs and I know that come May she's going to want to wear this thing as a dress, without leggings. I may have to make a pair of bike shorts, though. For that I'll probably use the Riviera leggings pattern in Sewing Clothes Kids Love.
Last night I completed the Farbenmix Nala combi except for the waistband for Miss G; I didn't have the right elastic. Or rather, if I do, I can't find it. Anyway, I'll stop by the store on the way back from gymnastics tomorrow so I can get some, then I'll finish it and hopefully have pictures tomorrow to share. It looks super cute and she's totally excited for me to finish it.
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