CHASH

Maya steals Luna bars out of my purse sometimes. Tonight, she finished one and I took the wrapper and set it down on a side table. I gave her a toy* to play with and she refused to play with the toy and started saying a word I couldn’t understand, over and over again. It sounded like: CHASH. CHASH. CHASH.

Chash.

Chash?

Chash.

I was stumped. I followed her gaze to the side table. It fell on the Luna bar wrapper.

Trash? I asked her.

YEAH! she said. I handed her the wrapper, and she ran to the trash can, then returned to watching Mother Goose rhymes.

*iphone

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Skills

This morning Maya and I did some laundry. We have to pay with these stupid cards, like in a dorm laundry room. I never know how much money is on the cards, so I grab all of them and hope they have money on them.

Maya wanted to play with the cards, so I handed her two of them and used the third one to pay. “How many cards do you have?” I asked her. “One, two!” she said. I handed her the third one. “Now how many cards do you have?” “One, two, three!” she said.

Holy crap!

She took a great 2+ hour nap today. She woke up once, picked her head up and looked around, and went right back to sleep. I love it when she does that.

Finally, just now, she spilled a little bit of water. Without me saying a word, she picked up a paper towel and wiped it up.

I am so impressed and proud of her. My girl.

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Another one

Last night Maya let dad put her to bed, and didn’t wake up until 3am. At nearly 20 months old, maybe it’s a little late to be hitting those particular milestones, but I guess it’s better late than never.

Today, we were being lazy on the couch in our pajamas. She started to get cranky and asked for “pah, pah!” Do you want to go to the park? I ask her. YEAH! she says, and hops down off the couch to go get her dada. She pulls dada over to the door and starts trying to open the door, then pauses to grab her shoes and hand them to him. We are cracking up, amazed that she’s putting it all together. When she’s finally dressed and ready to leave, dada gets the stroller, and she starts trying to climb into it, saying “up! up!”

Big change from not so long ago, when she fought and squirmed and screamed and we had to wrestle her into the stroller.

As they walk out the door, no tears. “Bye bye! MWAH! Bye bye!”

Big changes.

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Milestones

“Can you throw this away for me?” I ask, expecting her to take the paper towel and try to eat it.

Instead, she walks over to the trash can, lifts up the lid, pauses to make sure I’m watching, and throws the paper towel out.

Milestone.

Not the kind you’d read about in a child development book, I guess. But it was a big one. It wasn’t just that she threw it away — it was that cooking became a team effort. Instead of clawing at my legs and begging me to pick her up, I can give her little tasks. Throw the paper towel away. Close the refrigerator. Finely mince these onions. (Just kidding.)

Also, the kind of milestone only other parents can really appreciate / not be grossed out by: Saturday, for the first time, she announced when she had pooped. It gives me hope that our days in diapers are numbered. I mean, it’s a high number. But I’ll take what I can.

Milestone.

I am writing this because it’s almost midnight and she’s still asleep. She didn’t fall asleep until a little after 8, and it was  a hassle to get her down. But I can think of 3, maybe 4 times, when I didn’t have to put her back to sleep over and over again between her going to bed and me going to bed. It doesn’t sound that remarkable but it makes a big difference for me — not sleeping through the night, just sleeping until I’m ready to go to bed. I’ll take what I can get. And it gives me hope that things are getting better. If she can sleep for 3-4 hours 3-4 times, maybe that will turn into 5-6 hours 5-6 times, and so on.

I don’t know.

I can’t sleep.

I resubmitted my F32 application yesterday. It didn’t get scored on the first submission but the comments were good. I feel semi-optimistic about it. I feel better about the R21 that will be reviewed in February. I’m not sure why, the project just seems so good to me.

I can’t believe she’s still asleep. Any minute now…

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The toddler

Having a toddler is much more difficult than I anticipated.

Maya is a strong-willed kid. She has strong opinions about things and doesn’t appreciate not getting her way. When we go to restaurants, I see other kids sitting happily in their high chairs, eating and playing and hanging out.

We usually get a minute or two in a high chair, before she starts screaming and thrashing and trying to kick herself over. She wants to walk around restaurants, climb up and down any stairs she sees, and generally find the most dangerous thing she can do and try to do it over and over again.

When I try to stop her, she screams at the top of her lungs and throws herself to the floor.

Even at home, sometimes she just throws herself on the floor and screams for no apparent reason. And by sometimes, I mean a couple times an hour, every hour, pretty much.

It makes me wonder if I am doing a bad job. Maybe I’m too permissive, maybe I don’t give her enough attention, maybe I give her too much attention? Who knows.

But she is also so smart. She amazes me. At 15 months, she says and understands:

  • mama
  • dada
  • nana
  • hi
  • bye bye
  • milk
  • apple
  • berries
  • toes
  • eye
  • nose
  • mouth
  • more
  • done
  • water / agua (uses both)
  • book
  • “animal” (the name of her animal book)
  • up
  • ball
  • no
  • shoes

There may be some others I’m forgetting. “Shoes” really impressed me because she recognizes all shoes as shoes, even shoes that she’s never seen before (like shoes in a store).

She understands a lot more than that, too. She understands simple commands like “put this away,” “give me a kiss,” and “close the door.”

This morning, she surprised me by knocking on a closed door. I think she must have picked it up at daycare; I’ve never shown her how to knock on a door.

She also has a sense of humor, which I didn’t expect at this age. For instance, we were playing in a pool, and she would climb out of the pool then jump in. After doing this over and over, she faked us out — she started walking toward the edge like she was going to jump in, and then when we were ready to catch her, she turned around and walked away and laughed hysterically. She does it in the bath tub too. When I lean down to take her out, she reaches up like she’s going to grab on for me to lift her out, and then she flings herself into the water and splashes and laughs.

She is a tough toddler. But she cracks me up. I hope she is always a strong advocate for herself, and she always fights for what she wants.

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Gut microbiota and c-sections

Mounting evidence shows that the bacterial population of infants’ digestive system, known as gut microbiota, can be influenced by c-sections and formula use. It can no longer be disputed that c-section and formula feeding are both associated with changes to infant microbiota.

I had a c-section. I fed my daughter formula sometimes. So, this made me wonder: Does it matter? What are the consequences of having a different microbiome? This post will focus on c-sections, with one on formula to follow. This is not a formal review or meta-analysis, just my interpretation of a brief review of the literature.

Babies delivered by c-section have different microbiomes than babies delivered vaginally

A 1987 study (1) was the first to show that babies born by c-section have different microbiota than babies born vaginally, measured by the bacteria found in fecal samples shortly after birth. Importantly, there are millions, possibly billions, of different species of bacteria. This initial study found decreased numbers of Bacteroides fragilis (B. fragilis) in babies born by c-section. Follow-up studies found:

  • At 1 month of age, no differences in Bacteroides, but higher numbers of bifidobacteria in vaginally-delivered babies. The same study found no differences in microbiomes at 6 months. (5)
  • At 6 weeks of age, higher numbers of Bacteroides in vaginally-delivered babies (7)
  • At 4 months of age, higher numbers of Shigella and Bacteroides in vaginally-delivered babies (4).
  • At 6 months of age, higher numbers of Bacteroides in vaginally-delivered babies (2).
  • At 7 years of age, higher numbers of C. difficile in vaginally-delivered babies (3)
  • At 7 years age, lower numbers of C. difficile in vaginally-delivered babies (6)

Given that differences in C. difficile were not detected in the studies of younger children, and the existing findings are contradictory, I think it is safe to say that differences in C. difficile are better explained by data artifacts than by mode of delivery. However, the Bacteroides findings have been robustly replicated and seem to hold.

So that brings to mind two questions:

1. How long does this effect persist?

I can’t find any direct investigations of the effect of mode of delivery on microbiota after weaning(except the 2 studies I cited above that are contradictory and do not find differences in Bacteroides), let alone into adulthood. So, the best evidence has to come from a general understanding of the evolution of the microbiome across the lifetime. Is the microbiome stable, persistent, unchanging? Or does it evolve as we go through our lives?

In fact, the microbiome is flexible and adaptive, and changes dramatically over time. By adolescence (13 to 17), a child’s microbiome is no more similar to his/her mother’s than it is to his/her father’s:

“Although biological mothers are in a unique position to transmit an initial inoculum of microbes to their infants during and after birth, our analysis of mothers of teenage US twins showed that their fecal microbiota were no more similar to their children than were those of biological fathers…” (15)

Since, presumably, 0% of the fathers vaginally delivered their children, I think we can infer from this finding that by adolescence, mode of delivery no longer has a detectable effect on the microbiome.

2. Does it matter? What are the consequences of low Bacteroides numbers?

  • Obesity has been associated with a low ratio of Bacteroides to Firmicutes (11, 12)
  • Colon cancer has been associated with high Bacteroides numbers (8, 9), specifically B. fragilis (10)
  • Bacteroides can induce inflammatory bowel disease in susceptible animals (13)

(Credit to [14], review.)

So I would not be quick to say that c-sections cause obesity unless you are equally prepared to claim that vaginal delivery causes colon cancer and inflammatory bowel disease. In both cases, the data are preliminary, and that conclusion is an oversimplification of a complex, evolving system.

Additionally, consider that country of origin has a larger influence on microbiome population than does mode of delivery (7). Which country has the “best” biome? Who knows? What does that even mean? Then how can we say that a baby born by c-section has a worse biome than a vaginally-delivered baby?

Other important confounds:

As I was reading through these studies, I learned that antibiotics are given routinely before/during c-sections as preventive care. That’s what, as a reviewer, I would call a fatal confound. Are changes in Bacteroides populations due to c-sections, or due to antibiotic administration? Would we see similar microbiomes in babies delivered to mothers who had antibiotic administration for other reasons?

Conclusions

I don’t mean to suggest here that c-sections have no consequences for mother or baby, or even for the microbiome. I do think the preponderance of evidence shows that c-sections are associated with changes to the microbiome. I don’t think anyone can categorically say that the microbiome of a c-section baby is worse than the microbiome of anyone else. And if you’re really worried, there are always probiotics.

 

References

1. http://www.sciencedirect.com/science/article/pii/S0176672487802134

2. http://journals.lww.com/jpgn/Abstract/1999/01000/Fecal_Microflora_in_Healthy_Infants_Born_by.7.aspx

3. http://gut.bmj.com/content/53/9/1388.2.long

4. http://www.cmaj.ca/content/185/5/385.full

5. http://www.ncbi.nlm.nih.gov/pubmed/18025796

6. http://www.sciencedirect.com/science/article/pii/S0091674911011481

7. http://journals.lww.com/jpgn/Fulltext/2010/07000/Intestinal_Microbiota_of_6_week_old_Infants_Across.15.aspx

8. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016393

9. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2006.01494.x/full

10. http://www.nature.com/ismej/journal/v6/n2/full/ismej2011109a.html

11. http://www.nature.com/nature/journal/v444/n7122/full/4441022a.html

12. http://www.nature.com/nature/journal/v457/n7228/full/nature07540.html

13. http://www.sciencedirect.com/science/article/pii/S1931312811001314

14. http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.2012.00505.x/full

15. http://www.nature.com/nature/journal/v486/n7402/abs/nature11053.html

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This post brought to you by a good MATLAB day

After much debugging I have matlab batch processing some stuff I used to do by hand that took forever and was boring.

To my surprise, daycare is starting to grow on me. I kept Maya home on Monday because I was a little worried she was getting sick, and I didn’t have anything important on my calendar. We had a fun day together, but she was so boisterous and playful it occurred to me that she might actually have more fun during the day at daycare, with the other kids, more space to run around, and more toys.

She also has had some good dropoffs. This morning she sat contentedly in her daycare provider’s lap, and yesterday she actually reached for her.

I guess it does get easier, day by day.

Well, some things do, anyway.

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