A HEALTH NEWS AND EDUCATION RESOURCE GUIDE FOR NEW AND EXPECTING PARENTS January – April 2009 Miracle Babies Inspiring Stories from the NICU Pages 4 – 5

The Midwife Experience Empowering You in Page 7 Ask the Lactation Consultant Tips for Successful Page 8 Bridging the Gap Grandparenting in the 21st Century Page 9 Baby’s Best Friend Preparing Your Pet for the New Arrival Page 12 The Terrible Twos Simple Steps for Survival Page 13 Class Locations

Poway San Marcos Volume 5 – Issue 1 Pomerado Hospital The HealthSource January – April 2009 15615 Pomerado Road 125 Vallecitos De Oro, Suite A Poway, CA 92064 San Marcos, CA 92069 Editor in Chief 858.613.4000 858.675.5376 Janet Gennoe Klitzner Pomerado Outpatient Pavilion Escondido Director of Marketing & The HealthSource Jean McLaughlin Women’s Center [email protected] Palomar Medical Center Education Classroom 555 East Valley Parkway 15611 Pomerado Road Escondido, CA 92025 Managing Editor Poway, CA 92064 760.739.3000 Tami Diamond Weigold 858.613.6110 Marketing Manager [email protected]

Off-site classes are also available for groups, businesses and other organizations Content Editors that would like instruction on a particular Mary Coalson health topic. Call 858.675.5372 for more information. Health Education Specialist The HealthSource retains the right to cancel [email protected] a community education class if minimum enrollment is not met. If you have a Tammy Chung disability, please notify us 72 hours prior to Assistant to The HealthSource the event so that we may provide reasonable accommodations. [email protected]

Contributors Gustavo Friederichsen Numbers to Know Chief Marketing & Communications Officer [email protected] Keep these important numbers handy for use in the event of an emergency. CeCe Wilkens Emergency Crisis Hotlines – 24-Hour Service Wilkens Communications Fire, Police or Emergency 911 Jennifer Decker Arevalo Poison Control 800.222.1222 PSY/MED Media California Missing Children Hotline 800.222.3463 Design/Production California Youth Crisis Hotline 800.843.5200 Chase Design Child Abuse Hotline 800.344.6000 [email protected]

Rape/Crisis Hotline 888.272.1767 Trina Hinch Marketing Project Manager Missing, Abused & Exploited Children 888.818.4673 [email protected] National Runaway Switchboard 800.786.2929 Mark Seal Vanished Children’s Alliance (VCA) 800.826.4743 Rush Press Suicide and Crisis Counseling 800.479.3339 Photography San Diego Police Department 619.531.2000 Linda O’Neill

Janet Gennoe Klitzner

Stock Images

 January – April 2009 www.pph.org Special Features

Special Features 4 – 5 Miracle Babies: Inspiring Stories from the NICU Twelve percent of all infants in the U.S. are delivered at less than 37 weeks. The Neonatal Intensive Care Units at Palomar Medical Center and Pomerado Hospital provide the latest technologies for infants requiring special care. Two families share their meaningful journeys. 7 The Midwife Experience: Empowering You in Childbirth From delivering babies and providing routine gynecologic exams to family planning and prenatal and postpartum care, the Midwifery Program at Palomar Medical Center is your partner in childbirth. 8 Ask the Lactation Consultant Lactation Consultant Shari Siladay answers common questions for new moms about breastfeeding. 9 Bridging the Gap: Grandparenting in the 21st Century Grandparents are often eager to help once baby has arrived. Learn tips to help ensure that everyone is up to date on the latest in baby care. 12 Baby’s Best Friend: Preparing Your Pet for the New Arrival Assuring that your family pet adjusts and accepts your newborn will help establish the foundation for a lifelong relationship of happiness and friendship. 13 The Terrible Twos: Simple Steps for Survival Just as you get used to reveling in all the cute milestones of your Finding a Physician toddler’s first 24 months, you are warned to beware the “terrible To select a Palomar Pomerado Health physician twos.” A few tips can help you and your toddler make the most of for your pre- and pregnancy care, or this time. to register for a PPH childbirth class, please call 14 House Calls for Baby The HealthSource at 800.628.2880. From BPA in baby bottles to vaccinations, PPH professionals answer your questions about some of today’s most popular baby topics. Education 6 Childbirth Preparation Classes PPH offers a wide variety of classes and services to help you and your partner prepare for pregnancy and delivery. Plus, our prenatal and postnatal yoga classes will help you to stay in shape, feel your best and maximize your total well-being during and after pregnancy. Stork Club Tours Call for dates, times and locations. 8 – 9 Breastfeeding Classes and Lactation Services Tours of the Birth Centers at Palomar 10 Infant- & Toddler-Care Classes Medical Center and Pomerado Hospital are available by appointment only. If you Take advantage of our special presentation infant- and toddler-care are taking a childbirth class at the Jean classes including Baby-Care Basics, Baby Sign Language, Basic McLaughlin Women’s Center or Palomar Training for Dads and more. Medical Center, there is no need to take 15 Sibling Education, Young Adult, CPR and First-Aid Classes this tour as well. Tours of the Birth Center at Palomar Medical Center are available in The HealthSource retains the right to cancel a community Spanish on the 2nd and last Wednesdays of education class if minimum enrollment is not met. If you have a each month from 7 to 8:30 p.m. disability, please notify us 72 hours prior to the event so that we FEE: Free – registration required may provide reasonable accommodations. No children please.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.  Miracle Babies: Inspiring Stories from the NICU

Born at just 33 weeks, Charlize Thompson spent 16 days in the Pomerado Hospital NICU.

Like most expectant parents, Shannon and Steve Thompson were ecstatic “Because of what we learned, we weren’t that surprised when Charlize in anticipation of the birth of their first baby. But life threw them a curve had to learn to eat and didn’t wake or cry when she was hungry,” says ball when daughter Charlize was born prematurely at 33 weeks and had 31-year-old Steve, who is an electrical engineer. “She wasn’t able to to spend the first 16 days of her life in Pomerado Hospital’s Intermediate nurse or take a bottle at first and was nourished with a feeding tube for Level Neonatal Intensive Care Unit (NICU). almost two weeks.” The pregnancy was considered high risk because of oligohydramnios – a Skilled Staff Provides Advanced Care lack of amniotic fluid from an unknown cause. Shannon, a 34-year-old The multidisciplinary NICU teams at both Pomerado Hospital and Palomar speech-language pathologist with San Diego City Schools, spent two Medical Center include neonatologists; nurses trained in advanced life weeks in the Birth Center at Pomerado Hospital to help her daughter support; specialized respiratory-care providers; nutritionists, occupational, develop as much as possible before delivery. speech and physical therapists; lactation consultants; laboratory and “We kept hoping that I would reach 34 weeks, when babies typically radiology technicians; and maternal-child social workers. do very well as preemies,” says Shannon. “However, the fluid level kept “As a team, we depend on good communication, support, experience and dropping and it became necessary to proceed with delivery.” practice,” says David Golembeski, M.D., a board-certified neonatologist When baby Charlize was born on August 17, 2008, weighing a slight five and director of Neonatal Services for Palomar Pomerado Health (PPH). pounds, four ounces, the Thompsons had already met with Pomerado “We know that the vast majority of our babies do well with our care. Hospital’s NICU staff who prepared them for the difficulties their tiny There’s no feeling like the euphoria of a job well done.” daughter would face. Palomar Medical Center’s Level II NICU combines the latest technology “The NICU staff members were awesome and went out of their way to with a commitment to family-centered, integrative health care to meet answer our questions, especially the special needs of infants requiring intensive care. Both facilities are since we were in a daze,” says equipped with the latest technology, including Bear Cub infant respiratory Shannon. “One of the nurses visited ventilators and dual resuscitation tables and isolettes, called Giraffes. me about a week before Charlize Pomerado’s NICU treats premature infants and other newborns who do was born to tell me about the NICU not require the higher level of care available at PMC. When necessary, and how well babies do who are infants may be transferred from Pomerado to PMC’s NICU. close to 34 weeks gestation. She Even though about 12 percent of all infants in the U.S. are delivered at less also explained what to expect and than 37 weeks, according to Dr. Golembeski, only about eight percent of all that babies don’t know how to eat newborns delivered at Pomerado Hospital and PMC are born pre-term. at this age. With her help, our fears began to ease.” Twins Analy and Alan Barrera spent the first two months of their lives in Neonatologist David Golembeski, PMC’s NICU where they received round-the-clock specialized care to help M.D., examines a newborn in the NICU at Palomar Medical Center.

 January – April 2009 www.pph.org their tiny lungs and bodies grow Baby Charlize Thrives strong. When they were born prematurely last June 28, Analy The Thompson’s daughter received all of her care at Pomerado’s NICU. weighed just three pounds, one “At first we didn’t understand why we couldn’t just cuddle our baby all ounce, and Alan weighed three the time and talk to her,” says Steve. “The NICU nurses taught us about pounds, 10 ounces. conservation of energy, which meant that Charlize needed to sleep most Their parents, Juana and of the time, except for eating. We also learned about kangaroo care, a Leonidez Barrera, credit the special way of holding her with her skin touching our skin.” NICU team with giving their As the days went by, Charlize gained strength and her parents were able to hold twins a healthy start on life. her more, have her drink from a bottle and then breastfeed with Shannon. Today, the twins are thriving and eating well. At five months “It was reassuring having the nurses there and knowing that our baby was of age, they had each more on 24-hour monitoring,” says Shannon. “I was nervous taking her home at than tripled their . first because there were no monitors. It took several weeks before I stopped New father Steve Thompson enjoys some constantly watching her to see if she was breathing and doing okay.” quiet time with Charlize while feeding her. “We were happy with the care our babies received,” Juana “Thankfully, we had a lot of support from family and friends that had says. “I respect the doctors and nurses. When our children grow up, we been through similar experiences,” Shannon says. will tell them about the NICU and all about the doctors and nurses who “At three months, Charlize was growing stronger each day, weighed 12.5 helped them.” pounds and was breastfeeding 100 percent of the time,” says Shannon proudly. “Getting started was challenging, but with the help of the We know that the vast lactation consultants and encouragement from the NICU nurses at PPH, we did it!” majority of our babies do For more information about the NICU’s at Pomerado Hospital and Palomar well with our care. There’s Medical Center, visit www.pph.org.. no feeling like the euphoria Preventing of a job well done. David Golembeski, M.D. Preterm Birth Every pregnant woman should be considered at risk of preterm birth. “Our recent advancements with technology and training allows us to Around the 20th week of pregnancy, all pregnant women should successfully treat very early pre-term infants born at 28 weeks, which learn the signs and symptoms of preterm labor and what they can is 12 weeks early,” says Dr. Golembeski. “In the past, these premature do if they occur. babies would have been transferred to Rady Children’s Hospital. While Preterm birth is any birth that occurs before the 37th completed we have an outstanding partnership with Children’s Hospital, we believe week of pregnancy. it’s very important for us to be able to provide the high level of care for our patients right here in the community.” To help prevent preterm birth: “Advances in technology and nutrition have certainly made a difference • Know the warning signs of preterm labor. in outcomes,” he says. “It’s interesting to see all the changes in care • Get regular prenatal checkups. since I first trained more than 20 years ago. Now, there is more parental • Reduce stress. involvement through kangaroo holding and early breastfeeding, as well as • Don’t smoke, drink alcohol or use illegal drugs. Avoid physical and occupational therapy involvement through baby massage, secondhand smoke. music, decreased lighting, clustered care and better isolettes.” • Call your health-care provider if you feel burning or pain when you urinate. You may have an infection that can increase the risk of preterm birth.

The warning signs of preterm labor are: • Contractions (your abdomen tightens like a fist) every 10 minutes or more often • Change in vaginal discharge (leaking fluid or bleeding from your vagina) • Pelvic pressure—the feeling that your baby is pushing down • Low, dull backache • Cramps that feel like your period • Abdominal cramps with or without diarrhea

IMPORTANT: Call your health-care provider or go to the hospital right away if you think you’re having preterm labor, or if you have At 3½ months, Charlize is growing stronger each day and enjoying any of the warning signs. life with her proud parents. Source: www.marchofdimes.com

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.  the Classes Childbirth Preparation Yoga Preparation for Childbirth Prenatal Yoga Five-Week Series Six-Week Series 6:30 – 9 p.m. 6 – 7:15 p.m. Pomerado Outpatient Pavilion (Poway) Pomerado Outpatient Pavilion (Poway) Jean McLaughlin Women’s Center, Education Classroom Jean McLaughlin Women’s Center, Education Classroom Choose one of the following five-week series: Thursdays, January 29 – March 5 or Mondays, January 12 – February 9 Thursdays, March 19 – April 23 Wednesdays, March 4 – April 1 A regular practice of yoga postures during pregnancy helps to strengthen the belly and Mondays, April 20 – May 18 back, reduce back pain, increase well-being and Palomar Medical Center (Escondido) improve physical comfort. Prenatal yoga assists Choose one of the following five-week series: in preparing for birth by working with the body and breath to help Wednesdays, January 7 – February 4 facilitate the labor process. Join Certified Childbirth Educator and Yoga Instructor Liza Janda as she guides expectant moms to Mondays, February 23 – March 23 relax and empower themselves while creating a safe, soothing and Wednesdays, April 15 – May 13 comfortable environment for baby. This class is designed for women Prepare for a safe and satisfying birth experience with this five-week in their first through third trimesters. childbirth preparation series. Small classes ensure personalized FEE: $72 / participant for six-week series instruction focusing on the signs and stages of labor, hospital procedures, medication options and Cesarean birth. A general Infant Mommy & Me Yoga overview of labor-coping techniques is provided, and newborn Six-Week Series characteristics, infant feeding and postpartum adjustments are 10:30 – 11:30 a.m. discussed. A tour of the birth center is included. Pomerado Outpatient Pavilion (Poway) FEE: $70 / mom or couple (includes childbirth manual) Jean McLaughlin Women’s Center, Education Classroom Preparation for Childbirth “In a Weekend” Mondays, February 9 - March 23 9 a.m. – 3:30 p.m. (Saturdays) (No class on February 16) Finding time to exercise after having a baby can 10 a.m. – 3:30 p.m. (Sundays) be a challenge. Mommy & Me Yoga is the perfect Pomerado Outpatient Pavilion (Poway) way to stay in shape and spend quality time with Jean McLaughlin Women’s Center, Education Classroom your child. Registered Yoga Instructor Erin Noland Choose one of the following four weekend sessions: teaches “baby-style centering,” songs for baby, January 24 – 25; February 7 – 8; and an active Hatha Yoga class incorporating poses using your March 21 – 22; April 18 – 19 baby. You’ll wind down with wonderful relaxation! Toys are provided for your baby – please bring a blanket and yoga mat. Mothers are Palomar Medical Center (Escondido) asked to wait four to six weeks after delivery before practicing yoga. Choose one of the following four weekend sessions: Check with your doctor before starting any new exercise program. January 10 – 11; February 21 – 22; Appropriate for new mothers with infants age four weeks to one year March 7 – 8; April 4 – 5 – not walking. Our weekend class includes the same information covered in our FEE: $60 / mom and baby for six-week series five-week series, but takes only two days to complete. A tour of the birth center is included. Early registration is recommended. Sweet Success! FEE: $70 / mom or couple (includes childbirth manual) Even if you’ve never had diabetes, it’s possible to develop gestational Cesarean Birth Lecture diabetes while pregnant. Palomar Pomerado Health offers Sweet Call for dates, times and locations Success, a program especially for women with gestational diabetes. Expectant parents who anticipate a Cesarean birth and choose This class is taught by diabetes educators who provide information not to enroll in a childbirth class may attend a one-hour lecture and support to help maintain a healthy pregnancy. Sweet Success about Cesarean birth that is part of our regular childbirth series. is offered weekly in both English and Spanish at Palomar Medical Information covered includes indications for a Cesarean birth, pre- Center and Pomerado Hospital. operative procedures, medications, the birthing process, and post- operative and recovery procedures. For more information on dates, times and fees, please call FEE: $10 / mom or couple 760.510.7377.

 January – April 2009 www.pph.org The Midwife Experience: Empowering You in Childbirth

One-third of the 4,200 deliveries at Palomar Medical Center (PMC) each year are attended by Certified Nurse-Midwives (CNM). In addition to delivering babies, these midwives provide a full range of health- care services, including routine gynecologic exams, family planning services, prenatal and postpartum care. Shawn Brooking, CNM, dreamed of following her grandmother’s rewarding career as an obstetrical nurse. Then she learned about midwifery during her service in the U.S. Navy. “I love the idea of being a midwife because it encompasses the entire childbearing process,” says Brooking. “It is a privilege to provide care to a pregnant woman, be with her during labor, deliver her baby and bond with her and her family members. The basis of the midwifery model of care is the empowerment of women. Midwives help women to be active participants in their own care.” Midwife Shawn Brooking offers support to new parents Sandra Campillo and Kawika Demara as they prepare for the birth of their In 1996, PMC initiated the nurse midwifery program to enhance child at Palomar Medical Center. and birthing services for underserved – low income and uninsured – women in North County. The Palomar Midwifery Service is assistant or translator is available 24/7 at PMC or each of the a collaborative effort with area community health clinics: Neighborhood clinics listed. Healthcare Escondido, Neighborhood Healthcare Pauma Valley, North County Health Services San Marcos, North County Health Services “As midwives, our philosophy centers on treating the whole person Ramona and Instituto De La Mujer in Escondido. Bilingual services and her family, focusing on education,” says Brooking.” Midwives are are provided. partners with women. We offer patients a unique perspective of both bedside nurse and midlevel provider.” All of the midwives at PMC are advanced practice registered nurses and are certified by the American College of Nurse-Midwives. Most For more information on the midwife program at Palomar Medical have also completed master’s degrees. A bilingual CNM, medical Center, please call 760.739.2400. 3JTJOH4UBST Special Gifts for a Brighter Tomorrow. Your Baby is a “Rising Star” You have been given a precious gift. Your child – a star in the eyes of anyone who looks upon this bundle of joy. If your baby was born at Pomerado Hospital or Palomar Medical Center, then you have experienced first-hand the expertise and compassion of our nurses and doctors who strive to make each little one’s entrance into this world the best it can be. What better way to commemorate the birth of your baby, and to honor our caring staff, than with a star on our Rising Stars baby wall? How to Sign-Up The Rising Stars program offers two ways to join: A silver star represents a single donation of $100 A gold star denotes a single donation of $500 Your donations are fully tax-deductible! With the birth of a new baby, everyone wants to celebrate the happy event. Anyone can enroll a newborn in the Rising Stars program, including parents, grandparents, other family members and friends. For more information, or to sign-up, please call the PPH Foundation at 760.739.2787 or visit www.pphfoundation.org.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.  Ask the Lactation Consultant Shari Silady, IBCLC, RLC Jean McLaughlin Women’s Center

Q: How can the services of a lactation consultant help with the breastfeeding process?

A: The lactation consultant can help reinforce the information you learned in breastfeeding class, assist in making you more comfortable with the use of pillows, and help with getting Lactation Consultant Shari Silady assists new mother the baby to on correctly. Breastfeeding should never Holly Gines as she breastfeeds her newborn son. cause mom undue pain. In addition, a lactation consultant can address common questions and concerns – from what Q: How can an expectant mother prepare for successful foods to avoid to how to use a breast pump correctly. Most breastfeeding before the baby is born? importantly, the lactation consultant is your cheerleader – reinforcing that you are doing a great job in caring for your A: I recommend that any expectant mother attend a baby and providing much needed support during an often breastfeeding class before her baby arrives and join a support difficult and discouraging time. group for continued assistance once the baby is born. This can help ease any concerns you may have. It also helps to Q: When should a new mom seek the services of a lactation watch other mothers breastfeed their babies, ranging in consultant? age from newborn to toddler. Finally, there are several good breastfeeding books available – try reading a chapter a week A: There are many reasons to seek assistance from a lactation leading up to your delivery date. The free lending library at consultant. Some common concerns are sore nipples, baby the Women’s Health Connection can provide recommended not gaining adequate weight, , going back to reading materials. work, breast infection (mastitis) or thrush. We recommend contacting a lactation consultant as soon as possible. The Q: What are the most common difficulties new moms experience earlier the intervention, the faster the problem is resolved. with breastfeeding after having a baby?

A: It is common to experience sore nipples when beginning to Personal One-On-One breastfeed. It is very important that the baby is latching on Lactation correctly in order to have good milk transfer – this helps to avoid sore nipples. Placing the baby skin to skin after birth Consultation will help prepare for successful breastfeeding – enabling her To schedule your appointment, call (regular price $65) to smell the milk and to hear mom’s heartbeat as she did 858.613.6120. before she was born, causing her to be less stressed. All of New patients, valid for first one-hour visit only. this leads to a more relaxed baby and a better, deeper latch. Expires April 30, 2009.

Lactation SERVICES Jean McLaughlin Women’s Center 858.613.6120 Pomerado Outpatient Pavilion 15611 Pomerado Road, Poway, CA 92064 Palomar Pomerado Health’s certified lactation Outpatient lactation services provided by board-certified lactation consultants provide guidance to new mothers consultants; private appointments; fee for service basis who choose to breastfeed their babies. Breast pumps are also available for sale or rental through Women’s Health Connection Boutique 858.613.6110 the PPH Women’s Health Connection Boutique, Pomerado Outpatient Pavilion along with a wide variety of breastfeeding supplies 15611 Pomerado Road, Poway, CA 92064 and literature. Medela breast pumps for rental or purchase; pump kit accessories; nursing bras; breast-care products

Palomar Medical Center 760.739.2434 Pomerado Hospital 858.613.4605 The Medela Freestyle hands-free, Breastfeeding classes; consults; telephone advice warmline double electric pump is perfect for working moms. This new technology To register for a breastfeeding class, please call is now available at the PPH Women’s The HealthSource at 800.628.2880. Health Connection Boutique.

 January – April 2009 www.pph.org Breastfeeding Ask the Successful Breastfeeding Breastfeeding Support Groups Lactation Consultant 6:30 – 9 p.m. Pomerado Outpatient Pavilion (Poway) The HealthSource, San Marcos (Craven Road location) Jean McLaughlin Women’s Center, Education Classroom Thursdays, 1 – 2:30 p.m. Choose one of the following four classes: Pomerado Outpatient Pavilion (Poway) Tuesdays, January 6, February 3, March 3 or April 7 Jean McLaughlin Women’s Center, Education Classroom Palomar Medical Center (Escondido) Tuesdays and Fridays, 1 – 2:30 p.m. Choose one of the following two classes: 3rd Saturday of each month, 10:30 a.m. – Noon (for working moms) Mondays, February 9 or April 6 Meet with a certified lactation consultant and other new moms to Breastfeeding is “nature’s way” to feed a baby, but it doesn’t always share information and learn new ideas during these weekly group come naturally. Enhance your opportunity for a positive breastfeeding sessions. The Saturday class is specially designed for working experience with this informative class led by a certified lactation moms and focuses on issues unique to women returning to work. consultant. Topics include the benefits of breastfeeding, breast anatomy Breastfeeding support groups are not a substitute for the Successful and physiology, getting off to a good start, common difficulties and Breastfeeding class. Call the Women’s Health Connection at solutions, and returning to work. 858.613.6110 for more information. FEE: $25 / mom or couple FEE: Free

Car Seat Safety State law requires infants and children to be in a car seat whenever the car is moving. “My father-in-law is of the generation before car seats and couldn’t understand why we didn’t just take our daughter out of her car seat to feed her while we were driving,” says new mom, Tami Weigold. Feeding Grandparents who remember starting their child on rice cereal at one month are often surprised to learn that pediatricians today recommend that solid foods not be introduced until about six months of age. The guideline today is to add only one food at a time in order to watch for any allergic reactions. More and more new moms are breastfeeding and for longer periods of time, whereas grandmothers may have only bottle-fed. It may be helpful to explain the many benefits of , which include improving Bridging the Gap: the baby’s immune system to protect against illness, providing all of Grandparenting in the 21st Century the necessary vitamins and nutrients, and promoting better digestion and proper weight gain. Many new and expectant parents receive offers of help from family Sleep Position members including grandparents, step-grandparents and even great- grandparents. These pointers will help bridge the generation gap and ‘Back to Sleep’ is the guideline today and is credited with the sharp assure that expectant grandparents are up-to-date on guidelines. drop in Sudden Infant Death Syndrome (SIDS). Prepare “When I was growing up, moms put their babies to bed on their Jean McLaughlin Women’s Center 858.613.6120 stomachs to prevent vomiting and gagging,” says Weigold. “Now Help your parents anticipate the birth of their grandchild by asking Pomerado Outpatient Pavilion infants are supposed to sleep on their backs without any blankets, them to reminisce about their parenting experiences. Also, recommend 15611 Pomerado Road, Poway, CA 92064 stuffed animals or pillows in the crib.” that they read the pregnancy and parenting books you are reading. This Outpatient lactation services provided by board-certified lactation can lead to fruitful discussions about your plans for parenting and how Although the ‘back is best’ approach is recommended, some babies consultants; private appointments; fee for service basis guidelines have changed. may have to sleep in different positions so that their heads do not get flat. Parents are told to rotate the baby to alternate which side of the 858.613.6110 Women’s Health Connection Boutique Childproofing head is down. Exercises and even a helmet may be prescribed to help Pomerado Outpatient Pavilion correct the head shape during early development. 15611 Pomerado Road, Poway, CA 92064 Many grandparents may be unaccustomed with the concept of Medela breast pumps for rental or purchase; pump kit accessories; childproofing, having relied on playpens to keep busy babies safely Spoiling contained. Must-have childproofing tools include safety gates, cabinet nursing bras; breast-care products For many grandparents, the arrival of a grandchild brings promises of latches, outlet plugs, cordless blinds and toilet locks. Outside safety spoiling, which can be either welcomed and supportive, or detrimental Palomar Medical Center 760.739.2434 measures include a pool fence and removal of all poisonous plants. and destructive. Disrespecting parental rules and schedules, caving in Pomerado Hospital 858.613.4605 Remind grandparents to store their medications well out of reach. Breastfeeding classes; consults; telephone advice warmline to every demand, and showing favoritism is obviously a bad idea and Interests such as hunting or crafts involving sharp tools require special creates confusion in young minds. Among the best things grandparents To register for a breastfeeding class, please call steps to secure those items safely out of sight and reach. Providing a can do is to give unconditional love and spend as much time as The HealthSource at 800.628.2880. checklist for grandparents will encourage them to make their home possible with grandchildren playing games, sharing stories, cuddling safe for your baby to visit. and listening.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.  Infant and Toddler Care Childhood Ear Infections: What You Need to Know 6 – 7:30 pm The Impact of Pediatric Asthma Palomar Medical Center (Escondido) 6 – 7 p.m. Graybill Auditorium Pomerado Hospital (Poway) Monday, March 23 Conference Room E Ear infections are very common in children Tuesday, January 20 and are often the cause for frequent visits Asthma is the most common illness among to the pediatrician. Join ear, nose and children, and accounts for the majority of all throat specialist Michael Morelock, M.D., pediatric hospital visits and missed school as he discusses the risk factors, symptoms, days. Pediatrician Nathan Rendler, M.D., will prevention methods and treatment options for childhood ear discuss the social, emotional, and economic infections and fluid in the ear. impact of this illness. This interactive FEE: Free – registration required discussion will include strategies for intervention and treatment of asthma and related allergies in children. You and Your Baby: The First Year FEE: Free – registration required 6 – 7:30 p.m. Basic Training for Dads Pomerado Outpatient Pavilion (Poway) 9:30 a.m. – Noon Jean McLaughlin Women’s Center Education Classroom Pomerado Outpatient Pavilion (Poway) Wednesday, April 8 Jean McLaughlin Women’s Center The first year after your baby’s birth is a major Education Classroom period of adjustment – from sleepless nights for Saturday, March 7 mom to establishing a sleep schedule for baby; Are you a first-time “dad-to-be” in need of some from taking care of mom’s health to ensuring that all is well with basic training? Learn what to expect during the baby’s health – the adjustments are endless. Stephanie Iem, D.O., last trimester of pregnancy, birth and the first will discuss the major hurdles and provide helpful guidelines for a few weeks at home. Plus, discover practical successful, healthy and happy beginning for new mom and baby. tips on diapering, feeding and soothing the newborn. This class is FEE: Free – registration required intended for expectant fathers in the second or third trimester of their baby’s pregnancy. It is a “fathers only” class featuring special Baby-Care Basics guests – Veteran Dads (BT graduates) and their newborn babies. 12:30 – 3 p.m. Leave the class with a boost of confidence to be the best dad you can be! Pomerado Outpatient Pavilion (Poway) Jean McLaughlin Women’s Center, Education Classroom FEE: $35 / dad Saturday, April 25 Baby Sign Language Since babies don’t come with instructions, this class will provide you 9 – 11:30 a.m. with the guidance needed to experience a more confident beginning. Pomerado Outpatient Pavilion (Poway) Topics include basic physical care skills, growth and development, normal daily activities/habits, safe-proofing your home, nutritional Jean McLaughlin Women’s Center needs and management of illnesses. Education Classroom Saturday, March 14 FEE: $30 / mom or couple Starting as early as 7 months, before verbal skills are developed, your baby can begin to learn to express his or her wants or needs Stylish Slings through the art of signing. Studies have shown that signing babies may learn to speak earlier, develop larger vocabularies, have stronger 2:30 – 3:30 p.m. parent/child bonds, show more interest in books, engage in more Pomerado Outpatient Pavilion sophisticated play, have less frustration, crying and tantrums, and Jean McLaughlin Women’s Center have increased IQ scores. Education Classroom Monta Briant, a Sign2Me Certified Instructor, will teach 50 to 60 Choose one of the following four signs during the class and provide couples with a copy of her book, classes: “Baby Sign Language Basics.” Please note that this class is for Tuesdays parents and caregivers only. Space is limited so register today! January 13, February 10, March 10 FEE: $40 / couple or April 14 Step out in style and comfort for baby and mom in our newest sling – Baby K’tan. This product is great for newborns and toddlers up to 42 pounds. With eight different carry positions, you are sure to find the most comfortable way to carry For a physician referral, or to register your baby. Join Kim Paden, certified lactation consultant, as she for a class, call The HealthSource at demonstrates this new sling. 800.628.2880. FEE: Free – registration required

10 January – April 2009 www.pph.org Pomerado Outpatient Pavilion Jean McLaughlinKimberly Women’s CenterPaden, IBCLC 15611 Pomerado RoadWomen's Poway, CA Health 92064 Coordinator P: 858.613.6110 858.613.6110 Pomerado Outpatient Pavilion F: 858.613.6165 www.pph.org/women Jean McLaughlin Women's Center Orange: pantone 144 c E: [email protected] 15611 PomeradoHours Road, Suite 100 Monday – Friday Saturday W: www.pph.org/women Poway, CA 92064 10 a.m. – 6 p.m. 10 a.m. – 2 p.m.

At the Women’s Health Connection Boutique, our goal is to provide the very best products, services and information to every woman embracing the joys of motherhood. Our friendly and knowledgeable Boutique staff specialize in pregnancy health and is committed to providing the support and encouragement needed for a positive breastfeeding experience.

The mission ofChoose Palomar from Pomerado our extensiveHealth is line of products, including:

to heal,• comfortMedela ®and Breast promote Pumps health for inSale the communities we• serve.Nursing Covers andPink: Burp Cloths pantone or Rental • Maternity and Postpartumrubine Undergarments red c • Breast Pump Accessories and Replacement • Baby Skin and Hair Care Parts • Colic and Gas Soothers • Breastfeeding Accessories • Herbal Supplements • Breast Milk Storage • Slings and Baby Carriers • Breast Cream and Pads • Diaper Bags • Nursing Pillows • Gift Cards • Nursing Bras and Tanks • Gift Registry

Visit us at our new location in the Jean McLaughlin Women’s Center located on the first floor of the Pomerado Outpatient Pavilion. For more information, call858.613.6110 .

$10 OFF any purchase of $100 or more FREE NURSING BRA $25 OFF any purchase of $200 or more with breast pump purchase Visit the Women’s Health Connection Boutique and take $10 Make the experience of breastfeeding your baby easy and OFF any purchase of $100 or $25 OFF any purchase of $200 comfortable with our extensive line of Medela® breastfeeding or more. Choose from a variety of breast pumps, breastfeeding products. Visit the Women’s Health Connection Boutique and accessories and nursing bras, as well as wigs, hats, scarves and receive a free Medela® Comfort Bra with the purchase of a breast prostheses for women recovering from cancer. double electric breast pump. Call 858.613.6110 for details. Call 858.613.6110 for details.

Offer not valid for pump rentals, with any other discount, or for previous purchases. Offer not valid for pump rentals, with any other discount, or for previous purchases. Limit one coupon per person. Coupon must be presented at time of purchase. Expires Limit one coupon per person. Coupon must be presented at time of purchase. Expires 4/30/09 BS109 4/30/09 BS209

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 11 Baby’s Best Friend Preparing Your Pet for the New Arrival

Assuring that your family pet Once baby is born: adjusts and accepts your newborn • Before leaving the hospital, have someone bring home an item that will help establish the foundation your baby has worn to expose your pet to the new scent of baby. for a lifelong relationship of • When coming home with baby, remember that your pet has missed happiness and friendship. The you. Have someone else bring the baby into the home, so that you Humane Society of the United States recommends starting preparations can give some special undivided attention to your pet for a few months before your due date. minutes. Schedule a routine vet exam, get required vaccinations • Have someone with you when you are ready to introduce your pet and and trim your pet’s nails well in advance of your delivery. infant. Use a leash to restrain your pet as needed. Be sure your pet is calm and allow him to look at and smell, but not lick the baby. Remember that spayed or neutered pets are generally calmer. • Most importantly, supervise all interactions between your pet and new baby. If you see any signs of aggression, like biting, growling or • Let your pet investigate the nursery and become accustomed to the soiling accidents, calmly separate the two. Always try to redirect bad furnishings and smells. However, don’t allow pets in the crib or on behavior and reward good behavior. the changing table. • If your baby is scratched by the pet, wash the skin thoroughly with • Use a swaddled doll to familiarize your pet to what the baby will be mild soap and water. Call your pediatrician to see if additional care is like. The goal is to assure that your pet follows commands and does needed. not jump on you or the baby. If necessary, attend an obedience school for further training. • Ask friends and family members to introduce their infants or small children to your pet to help socialize your pet to youngsters and Avoid Nontraditional Pets their unpredictable movements. Many nontraditional pets can spread disease and infection, like rabies • Start spending less time with your pet now, so he won’t feel ignored or salmonella. They can also cause injury and trigger allergies. These are when the baby arrives. among the pets to avoid in homes with young children: • Adjust walking and feeding routines to better fit in with your new • Rodents (mice, rats, hamsters, gerbils, guinea pigs, chinchillas, baby schedule. gophers, lemmings, squirrels, chipmunks, prairie dogs, hedgehogs) • Create a pet only zone in your home – like a cozy chair or sleeping bed – that is off-limits to the baby. • Reptiles (turtles, lizards, iguanas, snakes, alligators) • Amphibians (frogs, toads, newts, salamanders) • Fish Dogs • Baby poultry (chicks, ducklings) • Wildlife mammals (bats, raccoons, foxes, coyotes, rabbits, hares, Rule! pikas) • 44.8 million US households • Weasels (ferrets, minks, sables, skunks) own DOGS • Exotic animals (monkeys, zebras, psittacine birds, spiders) • 38.4 million own CATS Source: American Academy of Pediatrics Source: American Pet Products Manufacturers Association

Peaceful Parenting The arrival of a baby in a family is a major adjustment Six-Week Series for all family members. Creating healthy family relationships from the beginning can pave the way 6:15 - 8:15 p.m. for successful parenting. This class focuses on the Pomerado Outpatient Pavilion (Poway) positive impact that parents can have with children Jean McLaughlin Women’s Center before the age of 6. Learn about developmental Education Classroom ages and stages, communication techniques and Tuesdays, February 10 – March 24 Shelly alternative discipline methods while participating (No class on March 3) Cowper-Smith in this six-week series led by Shelly Cowper-Smith, a trained parent educator. Classes are provided by Jewish Family Service of San Diego, funded by the FIRST 5 Commission of San Diego County. Appropriate for expectant and new parents as well as grandparents of children ages birth to 5 years. No childcare is provided. FEE: Free – registration required

12 January – April 2009 www.pph.org The Terrible Twos:

Simple Steps for Survival

Just as you get used to reveling in all the cute milestones of your toddler’s first 24 months – first word, the tentative hands-free step, playful gestures – you are warned to beware the “terrible twos.” Your precocious child may even jump start this normal stage of development by starting to exhibit negative responses (“no” to every suggestion), temper tantrums and frequent mood changes anytime after his first birthday. While your child is certain to exhibit some – if not all – of those sometimes unwelcome traits as he strives to claim independence, it does not mean that this time will inevitably be terrible. A few tips can help you and your toddler make the most of this time.

Consistency Counts Prevent Problems Maintaining a regular schedule for naps, meals and bedtime is Try to avoid running errands with your toddler when it’s close to reassuring and something your toddler can depend on even as naptimes or meals. The potential for tantrums increases if your his world widens with his new interests and abilities. It’s also child is tired or hungry and can’t find a way to express his needs important to be consistent when applying rules at this age. calmly.

Positive Reinforcement Take a Time Out Since your child seeks your approval more than anything else, At this age, children can understand disciplinary actions such as reinforce good behavior with hugs and praise, and redirect bad time out. Keep it short – no more than a minute – and explain behavior. the reason for the time out calmly and confidently. If the action deserves a time out, but is worthy of a big smile, try to keep the Limit Choices smile to yourself or run the risk of sending mixed signals. Instead of asking “what do you want,” offer a choice of apples or pears for a snack. This helps your child learn to make decisions Set the Example within acceptable parameters. Remember too that your active Role-modeling starts at the top, whether it’s the company boss or youngster needs frequent healthy snacks to help keep his blood parent. Children will emulate what they see. How you react to your sugar steady. toddler’s behavior will shape how he acts in the future. Safety First Monitor Moods Now is a time of enhanced curiosity and ability, so redouble your Since every toddler has a unique temperament and may respond efforts to provide a childproof environment. Remove dangerous differently to discipline, you will have to learn which discipline items from your house or keep them off limits (baby gates) before tactics work best for your child. Listen to her words and observe an accident happens. her mannerisms.

As you use these tools to discipline your 2-year-old toddler, remember that you are teaching him how to be independent, think for himself and behave properly. Since he is just learning and developing a sense of his Mothers of own desires and individuality, be empathetic, patient and loving. Believe it or not, the “terrible twos” will pass, so enjoy this time of unfettered Twins & Triplets Club enthusiasm, imagination and irresistible charm!

Have you been blessed with multiple bundles of joy? The Mothers of Twins and Triplets Club meets monthly and provides a forum for friendship and support for families, or expecting families, with twins or triplets. Speakers and special programs help parents deal with the pressure of raising multiple-birth children. For more information, call 760.798.9678.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 13 HouseCalls For Baby Baby Bottle Blues To Vaccinate or Not to Vaccinate Should I be concerned about using baby Q: bottles with BPA? Is there a link between the MMR (measles Kimberly Paden Q: mumps rubella) vaccine and autism? Board-Certified Lactation Consultant Neil Goldfinger, M.D. Women’s Health Connection Boutique Board-Certified Pediatrician Palomar Pomerado Health Centre for Health Care

All parents want to give their newborn A: the safest start on life possible. That’s Concerned parents often ask me about why many are concerned about BPA (bisphenol A:this and I always tell them there is no good A), a chemical additive used to manufacture hard, clear plastic scientific evidence showing an association between containers, including some baby bottles, sippy cups and water the MMR vaccine and autism. Even though several online sites bottles. BPA has been used in manufacturing since the 1950’s suggest such a link, those reports are not backed by any scientific and is commonly found in a wide variety of items including food proof. I encourage parents to check credible websites that provide and beverage containers, CDs and eyeglasses. information based on scientific fact (see below). It is so common, the Centers for Disease Control estimate that When a child is diagnosed with autism, parents understandably 95 percent of the population carries measurable amounts of the want an answer as to the cause. While the cause of autism is not chemical in their blood. yet known, there is a theory gaining great acceptance that it may be related to a genetic abnormality that occurs before birth, rather Some studies have linked BPA than an environmental trigger. to prostate and breast cancers, diabetes, behavioral disorders In recent years, there has been a significant increase in the number and reproductive problems in of children identified with autism. I believe this is due to increased laboratory animals. Although the awareness by parents, teachers, the media and physicians about Food and Drug Administration social behaviors related to autism. Also, it was only about 10 years and product manufacturers are ago that definitive criteria were approved for evaluating a child’s debating potential health risks, behavior and making an accurate diagnosis of autism. Canada recently became the first For parents who are concerned about the safety of immunizations, country to ban the use of BPA. I remind them that scientists have spent decades researching The best way for parents to reduce exposing their infant to BPA is vaccine effectiveness and formulating the recommended vaccine to breastfeed and use only BPA-free plastic items or glass bottles schedule. Vaccines protect children from diseases that sometimes for storing or feeding breast milk. The Women’s Health Connection have serious complications, such as deafness, encephalitis and Boutique sells only BPA-free products, including breast milk even death. storage and feeding supplies. Also, avoid using plastic containers with the number “7” inside the recycling symbol. Instead, use Immunization Information plastics marked with “1,” “2,” “4” or “5” inside the recycling For reliable information about immunizations, symbol. Dr. Goldfinger recommends:

Allied Vaccine Group www.vaccine.org

Do you have a question Centers for Disease Control and Prevention (CDC) for House Calls? www.cdc.gov/nip Childhood Immunization Support program (CISP) www.cispimmunize.org Visit www.pph.org/housecalls to submit your inquiry CDC’s Immunization Information Hotline or to view previously posted questions and answers. 800.232.2522 or 800.232.0233 (Spanish) Selected new questions will be answered by Palomar Pomerado Health physicians in future issues of The Book: “Vaccinating Your Child: Questions and Answers for the HealthSource magazine and online. Concerned Parent” by Sharon Humiston, M.D., MPH, and Cynthia Good.

14 January – April 2009 www.pph.org CPR & First-Aid Classes Sibling Education American Heart Association Basic Life Support and Becoming a Big Brother/Big Sister HeartSaver First-Aid Courses 10 – 11:30 a.m. Courses are offered through the Palomar Pomerado Health/American Pomerado Outpatient Pavilion (Poway) Heart Association (AHA) Training Center. Onsite group training is Jean McLaughlin Women’s Center available with a minimum of six participants. The AHA strongly Education Classroom promotes knowledge and proficiency in BLS, ACLS and PALS and has developed instructional materials for this purpose. Use of Saturday, April 25 these materials in an educational course does not represent course Palomar Medical Center (Escondido) sponsorship by the AHA, and any fees charged for such a course do Saturday, February 28 not represent income to the AHA. This 90-minute class offered at the Pomerado Outpatient Pavilion Basic Life Support Courses in Poway and Palomar Medical Center in Escondido will help big brothers and sisters prepare for the new baby’s arrival. Activities Call 800.628.2880 for dates, times, locations and registration information on the following classes. include safe ways to interact with the new baby, special art projects, and diapering and feeding their “own” baby (please bring a doll or CPR for Family and Friends (Non-Certified) stuffed animal). This class is designed for children ages 3 to 5. This course teaches basic life saving techniques including how to FEE: $15 / family relieve an obstructed airway. It is suggested for the lay rescuer such as new parents, grandparents, babysitters, caregivers or anyone who is preparing to help others in distress but does not need certification. Young Adult Classes FEE: $25 / participant Babysitting Basics* HeartSaver CPR (Certified) 6 – 9 p.m. Pomerado Outpatient Pavilion (Poway) This class provides CPR certification and is designed for the layperson who may serve as a rescuer in the workplace. Jean McLaughlin Women’s Center FEE: $40 / participant Education Classroom Choose one of the following two classes: BLS for the Healthcare Provider Fridays, February 20 or April 3 This class provides CPR certification for the health-care professional, paramedic, lifeguard or nursing student. The HealthSource, San Marcos FEE: $50 / participant Friday, March 27 HeartSaver First Aid This three-hour babysitting course is designed for boys and girls ages 10 to 14. Topics covered include babysitter responsibilities, caring This four-hour class includes instruction on the general principles of for children, overview of first-aid, safety and accident prevention, first aid, as well as medical, injury and environmental emergencies. handling emergencies, playing with children, behavior management, FEE: $45 / participant and tips for a professional babysitter. Those completing the course HeartSaver AED receive a certificate of completion to present to prospective This class provides certification in Adult CPR and the use of an AED employers. (Automated External Defibrillator). Classes are offered to groups who FEE: $20 / boy or girl (includes course materials) either have or would like to purchase an AED. FEE: $50 / participant Becoming a Young Woman* HeartSaver Pediatric First Aid 7 – 8:30 p.m. The Heartsaver Pediatric First Aid program will Pomerado Outpatient Pavilion (Poway) contain information on how to manage illness, Jean McLaughlin Women’s Center injuries, blood-borne pathogens, infection Education Classroom control and asthma related emergencies. Friday, March 13 This course meets the CA requirements for The HealthSource, San Marcos First Aid, Infant/Child CPR and the use of the Friday, April 24 ARD and BBP for daycare facilities. This eight- hour class in designed for daycare providers, This informative class helps young women 10- to 12- teachers, new parents and babysitters. year-old explore the emotional and physical changes of puberty. Emphasis is placed on how each girl experiences changes in her own FEE: $70 / participant special way. Additional topics include challenges with competition and development, communicating with parents, menstruation, purchasing personal female items, cramps and other common Advanced Life menstrual discomforts, and emotional changes and hormones. Mothers are encouraged to attend and share this unique time with Support Courses their daughters. Please note there is no discussion on sex.

Palomar Pomerado Health also offers Advanced Life Support Courses FEE: $15 / daughter and mother for health-care professionals including Advanced Cardiac Life *The “Babysitting Basics” and “Becoming A Young Woman” classes Support (ACLS), Pediatric Advanced Life Support (PALS), Neonatal are available for off-site instruction upon request. Please call Resuscitation (NRP) and Pediatric Education for Prehospital 858.675.5376 for more information. Professionals (PEPP). Call 858.613.4444 for more information.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 15 PRST STD

The HealthSource U.S. POSTAGE 15255 Innovation Drive PAID San Diego, CA 92128 SAN DIEGO, CA PERMIT NO. 2838

Palomar Medical Center 555 East Valley Parkway Escondido, CA 92025 760.739.3000

Pomerado Hospital 15615 Pomerado Road Poway, CA 92064 858.613.4000

Pomerado Outpatient Pavilion (POP) Jean McLaughlin Women’s Center 15611 Pomerado Road Poway, CA 92064 858.613.6120

The HealthSource – San Marcos 125 Vallecitos de Oro, Suite A San Marcos, CA 92069

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.

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