Stranger Anxiety

It may cause you some embarrassment, but when your child screams and clings to you at the mere approach of Aunt Marge (or nearly any other unfamiliar person), he’s actually responding in a very normal way. “Stranger anxiety is nothing more than your child’s way of telling you that he prefers you over anyone else,” explains Robert Needlman, M.D., F.A.A.P., associate professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland. “Humans are born with the instinct to create strong emotional attachments to special people in their lives, and the flip side of a strong emotional attachment is some anxiety or shying away from other people.”

Your baby wants only a small circle of friends, namely mom and dad

Needlman says the “stranger danger” reaction occurs among almost all babies and often appears at around 9 to 12 months of age. There is great variability in when children begin to outgrow it, ¿is well as its sever­ity, but many begin to be more accepting at 2 '/a to 3 years old. In the meantime, patience is paramount. “The key is to know your child,” says Needlman. “If you have a very reserved child, don’t push it, but rather respect his need for some time. You might say to a well-meaning adult, ‘If you stand over there for a while and don’t talk directly to Johnny, pretty soon he’ll be more comfortable.’”

The best overall approach, he adds, is to present your child with small challenges that he can handle. “You wouldn’t take a child with severe stranger anxiety to a very boisterous party,” he says, “but you might take him to a quiet gathering of one or two friends.”

A sneaky culprit

Are you having a hard time getting your newborn to latch on? Is nursing becoming bite-your- lip painful? If so, your baby may have a condition called Ankyloglossia or tongue tie. Affecting an estimated 4.8 percent of newborns, tongue tie occurs when the frenulum, the thin piece of tissue that attaches the tongue to the floor of the mouth, is too tight, restricting the tongue’s move­ment. This can cause breastfeeding issues and poor weight gain for babies.

“Latching on to the breast requires the baby to stick his tongue out and lift it up, and tongue tie can hin­der this,” explains M. Lauren Lalakea, M.D., an otolar­yngologist and clinical associate professor (affili­ated) at Stanford University Medical Center in Palo Alto, Calif. “Babies may gum the breast and not create the suction necessary for a proper latch.” Interestingly, tongue tie does not cause problems with bottle-fed babies because the same mechanics are not required.

To check for the condition, look to see if your child’s tongue is heart- shaped when it is sticking out; also see if it is difficult to lift up or seems tight against the floor of his mouth. If you suspect he has tongue tie, see your pediatrician; it may need to be treated in a simple office procedure called a frenotomy, in which the frenulum is snipped to increase the tongue’s mobility. Beware, however, that wait­ing too long may make for a slightly more complicated procedure.

“Once a baby is 4 to 5 months old,” Lalakea says, “a frenotomy usually needs to be done in an operating room under anesthesia.” She explains that younger babies tolerate the office procedure fairly well; older ones are more cognizant and simply won’t like it.

Contraception after baby

Planning on using the same birth control as before you conceived? That may not be a smart move. According to the U.S. Centers for Disease Control and Prevention (CDC), there are potential safety issues with certain types of hormonal contraceptives—especially in the first few weeks after having a baby.

Planning on using the same birth control as before you conceived?

“One of the main concerns in the immediate postpartum period is that women are at higher risk for something called a venous throm­boembolism, or a blood clot,” says Naomi K.Tepper, M.D., M.P.H., a medical officer in the division of reproductive health at the CDC. “If these women use birth control that contains estrogen—which also raises the risk for blood clots—they’re at even higher risk.”

Avoid estrogen following delivery

In guidelines released in 2011, the CDC advises that all women avoid estrogen forms of birth control for the first 21 days after having a baby, when the risk for a blood clot is the highest. These include combined birth control pills (those that contain estrogen and progestin), the patch and the vaginal ring. Women who have risk factors for developing blood clots—a history of preeclampsia, a blood-clotting disorder or a Cesarean delivery; or being a smoker, obese or age 35 and older, to name a few— are at even higher risk and are advised not to use estrogen birth control for the first six weeks. If you are nursing, avoid estrogen birth control for the first month because it might affect your milk supply.

Your best birth control options

Contraceptives that contain only progestin are safe for all women even those who are breastfeeding in the immediate postpartum period and indefinitely, says Tepper, who helped draft the guidelines. These include progestin-only birth control pills; Depo-Provera (injections given every 12 weeks); Implanon (a small rod inserted under the skin of the arm that lasts for three years but can be removed at any time); and Mirena (a hormonal IUD that is effective for five years but also can be removed at any time). In addition, the copper IUD, which does not contain any hor­mones, is safe and lasts for 10 years.

Whatever type of contraceptive you’re considering, discuss it with your doctor or midwife, preferably while you’re still pregnant and be sure to mention any potential risk factors you may have.