Breastfeeding Overview (original) (raw)

The decision to breastfeed or bottle-feed is yours to make. Since you are the one taking care of your baby, you must feel comfortable with the decision. Feeling you've been pressured into one or the other method only leads to discontent.

More and more mothers are deciding to breastfeed their new babies. In deciding if you will breastfeed, you must consider many facts. The more we learn about breast milk and its composition, the more we realize it is the perfect food for babies. Some research even suggests that breast milk improves a baby's intelligence and can protect a baby against certain forms of cancer. Besides the nutritional benefits, a special closeness often develops between mothers and their breast-fed babies. In this article, we will explore all aspects of breastfeeding, including:

The Benefits of Breastfeeding The reason that breastfeeding has been such an entrenched method for feeding newborns is that there are some empirical benefits to the process. On this page, we will explain the benefits of breastfeeding so that you can decide if it would be right for you. First, there are the nutritional benefits to consider. Next, there are immunologic factors to consider. Many of the mother's immunities can get passed on to the baby through the breast milk. Finally, there is a benefit to the mother from breastfeeding.
How to Breastfeed Breastfeeding might not come as naturally to some young mothers as they would have hoped. In fact, some women have a tremendous amount of trouble learning how to breastfeed. In this section, we will show you how to get the help you need to breastfeed successfully. We will also address the questions of when you should definitely not breastfeed and how long you should breastfeed. We will also explore the question of breastfeeding at work. Finally, we will look at when it is time to stop breastfeeding.
Breastfeeding and Diet You might be surprised to learn that you will require more calories when you are breast feeding than you did while you were pregnant. There are many complications to your nutritional needs while you are breastfeeding that might surprise you. Also, whatever the mother takes into her body can be passed on to the baby through the breast milk. Naturally, the nursing mother will want to be just as vigilant about what she takes into her body during this time as she was when she was carrying the baby inside her. On this page, we will help you sort all your diet concerns while nursing.
How to Bottle-Feed If you opt to bottle-feed for medical or personal reasons, we will offer you some helpful tips on this page. First, we will examine the various baby formulas that are available. With recent advancements, baby formulas are almost as fortified as breast milk. There are also soy-based formulas for babies with milk allergies and formulas with special additives for infants with health problems. Next we will discuss mixing and storing your formula. We will also look at the various bottles and nipples that are on the market. Finally, we will look at the correct way to bottle-feed your baby.
Infant Feeding Schedules and Burping Whether or not you choose to breastfeed or bottle-feed your baby, you will eventually have to decide what schedule you will feed your baby on and know a thing or two about burping your baby. We will show you the two main strategies in feeding methods -- demand and schedule feedings. We will also teach you the correct way to burp your baby.
Infant Feeding and Fathers An article on breast feeding would naturally focus on the mother, but fathers can play a vital role in feeding their baby. Fathers can bottle-feed a baby expressed milk and of course formula, but there are other ways a father can contribute. On this page, we will offer some advice to keep dads actively involved in feeding their child. There's no reason why a father has to miss out on the closeness that can develop while feeding a newborn baby.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Contents

The Benefits of Breast-feeding
How to Breast-feed
Breast-feeding and Diet
How to Bottle-feed
Infant Feeding Schedules and Burping
Infant Feeding and Fathers

The Benefits of Breast-feeding

While a new mother should not feel pressure to breastfeed or bottle-feed, there are some benefits that many people commonly associate with breastfeeding.

Nutritional Benefits

One of the most convincing arguments for breastfeeding is that human breast milk is designed for human babies, just as cow's milk is designed for calves. Even though formula companies work hard to duplicate the composition of breast milk, commercial formulas will never be identical to human breast milk.

As we learn about the nutrients in breast milk, it becomes more obvious that breast milk provides just about everything a baby needs for good growth and development. However, at four to six months, breast-fed babies require supplemental iron and vitamin D, and at six months, fluoride should be provided to your breast-fed or bottle-fed baby if there is an insufficient amount in the local water supply.

Immunologic Benefits

Every time you have an illness or receive an immunization, your body develops immunity against that illness. This means some special cells become sensitized to a particular type of virus or bacterium. The next time that particular organism invades your body, your body is prepared to fight it off. If the immunity is strong enough, you may never contract that illness again.

This is the principle behind immunizations for such diseases as mumps, measles, and pertussis (whooping cough). A vaccine contains inactivated bacteria or virus. Your body believes an infection is present, and it develops an immunity against the inactivated virus or bacteria, which also works against the active form.

When you breastfeed your new baby, much of the immunity you have developed passes on to her through the antibodies present in your breast milk. Many studies show that breast-fed babies have fewer and milder illnesses and fewer hospitalizations.

Breastfeeding is no guarantee your infant will never get sick, but it surely lowers the chances. Many mothers note that once they stop breastfeeding, their infants seem to experience more colds, runny noses, and so on. This may be due to loss of the protection the baby received from breast milk.

Benefits for the Mother

Some of the weight you put on during your pregnancy was a special type of high-energy fat. With breastfeeding, you tend to burn this extra fat first. This doesn't mean that by breastfeeding you'll lose all the weight you gained. But it helps. Breast feeding has also been shown to help protect against breast cancer and osteoporosis.

Many mothers feel they develop a certain closeness with their babies when they breastfeed. It comes from more than just holding and feeding the baby. The feeling seems to stem from the knowledge that they are truly the source of nutrition for their growing infants.

Unfortunately, the father may feel left out when the mother breastfeeds because he does not have an opportunity to feed their new baby. You can offset this problem by occasionally expressing breast milk for the father to bottle-feed the baby.

Breastfeeding is much less expensive than bottle-feeding and much more convenient-fewer bottles to sterilize, no formula to prepare, no midnight trips to the kitchen to warm up the baby's meal.

If you have decided you might want to breast feed because of the health benefits, you might still be unsure of how the process works. In the next section, we will show you how to breastfeed.

How to Breast-feed

You should discuss your decision to breastfeed with those who are important to you. It is much more difficult to succeed if your partner, parents, or children don't understand why you want to breastfeed your new baby. A young child may be concerned that his new brother or sister is actually hurting you. Your other children may become jealous of all the attention you give the new baby. Preparing them makes it easier.

Some men become jealous of a new baby, and breastfeeding may make matters worse. Discuss your decision ahead of time as one way to lessen these feelings. And be sure to make the father a participant in routine baby care.

Many misconceptions still exist about breastfeeding. Many women find it frustrating if they don't breastfeed easily and instinctively -- they don't realize they need to learn the best way to breastfeed. Years ago, women learned breast feeding techniques from their mothers, older sisters, and older women who breast-fed their children. But chances are your mother did not breastfeed you, so she can't really help you with your own breastfeeding.

Classes in breastfeeding techniques are available. Lactation consultants, breastfeeding clinics, and organizations such as La Leche League offer support and encouragement for women having problems with breastfeeding. If you should experience breastfeeding difficulties, remember that the treatment for most breastfeeding problems is to continue breastfeeding.

Getting Started

Most women now have the opportunity to breastfeed their newborns shortly after giving birth. Unless you are so exhausted from the delivery that you can't stay awake, you should try nursing your new baby as soon as possible. Often this means nursing on the delivery table.

Don't be discouraged if your baby isn't interested -- remember, she's been through a tough and tiring process, too. She may be too worn out to be interested in feeding. Don't take this as a rejection. Some women's breasts don't seem to have colostrum (the substance you feed your baby until your milk comes in) immediately after delivery; don't be discouraged-the colostrum, then the milk, will come in.

Feel free to ask questions of your doctor, obstetrics nurse, or lactation consultant about breastfeeding. Very few new mothers cannot breastfeed. Most who feel they have to discontinue just give up too soon. As mentioned earlier, the best treatment for most breastfeeding problems (for example, blocked ducts or insufficient milk supply) is to continue to breastfeed. When you start, your nipples may be a little sore, especially if you are very fair-skinned. This is natural; they aren't accustomed to this type of work and need some time to toughen up.

Allergies

It is extremely rare for a baby to be allergic to her mother's breast milk. If any family members have allergies, particularly to milk or milk products, your baby is more likely to have problems with formula than with your milk. If you suspect an allergy, consult your child's doctor. Some experts recommend that babies from families with allergies breastfeed, and that the mother avoid eating known or commonly allergenic foods while breastfeeding.

Diapers and Bowel Movements

Many parents of breast-fed babies notice their babies' bowel movements are different from those of bottle-fed babies. The bowel movements are soft and yellowish. Changing the soiled diapers of a breast-fed baby may not be as unpleasant as dealing with the diapers of a bottle-fed infant. Because breast milk is so well absorbed, breast-fed infants are rarely constipated. All of this changes once a baby starts formula or solids.

Breastfeeding and Working

Some women wonder if they can continue to breastfeed once they return to work. Most women in this situation find they can, with a little planning. Remember that breastfeeding is not an all-or-nothing proposition.

The human breast makes milk on a supply and demand basis. The more milk is taken out of the breast, the more milk is made. And human breast milk production is very adaptable. Many women have no problems with breast feeding in the morning before work, when they pick up their baby in the afternoon, during the evening, and again at night.

You can also reckon with the missed feedings during the day. You can freeze breast milk for up to two weeks. You also may be able to pump your breasts at work and refrigerate the milk in a clean bottle. This pumped breast milk can be fed to your baby the next day by your babysitter so your child's diet consists solely of breast milk.

If you are to successfully combine work and breastfeeding, you must be flexible. What works for one woman may not work best for you. Experiment with your schedule and the times you feed your baby.

Stopping Breastfeeding

How long to breastfeed is an individual decision. Most women stop within the first year. Remember, even if you breastfeed for only a few months, you have given your baby that much of a head start in good nutrition and protection from some illnesses.

Sometimes a baby decides on her own when it's time to stop breastfeeding. She may lose interest in the breast or prefer solids and a cup to breast milk.

Some women breastfeed for two or more years. If this is your choice, make sure your older child gets adequate calories and nutrition from solid foods in addition to breast milk.

Because the food you eat affects the content of your breast milk, there are some dietary concerns for when you are breastfeeding. We will tell you the foods you should avoid while nursing in the next section.

Breast-feeding and Diet

You need about 500 calories a day more than your prepregnancy intake if you breastfeed your baby. These additional calories, plus the calories available from the three to seven pounds you stored in pregnancy for lactation, supply enough calories to make milk.

Once you reach three to seven pounds above your prepregnancy weight (including two to four pounds for the weight of your lactating breasts), let your weight guide you to the number of calories you should consume each day. Your activity level and the amount of milk you produce for your baby also affect your weight.

In addition to extra calories, include extra protein for milk production, more calcium- and vitamin-rich foods, and more fluids than your normal diet.

Here are some simple guidelines:

Continue to take your prenatal vitamins (unless your doctor tells you otherwise).
Eat a varied, balanced, good-quality diet.
Pay special attention to fluids; drink enough to quench your thirst. Many moms drink a tall glass of milk or water while nursing.
Avoid junk foods and empty calories.

Foods and Drugs to Avoid

Every breastfeeding mother wonders if something she ate caused fussiness, gas, diarrhea, or a rash in her baby. While you can eat most foods without problem, some foods can cause difficulty.

Cow's milk in the mother's diet may cause colicky symptoms in some babies. If this is a problem for your baby, she will draw her legs up toward her body and scream with gas pains after feeding. You can eliminate milk from your diet for four to seven days to see if the symptoms disappear. As your baby grows older, reintroduce milk into your diet because babies often outgrow this reaction to milk. If you eliminate dairy products from your diet, you need to talk with your doctor about a calcium supplement.

Other foods that may cause problems for breast-fed babies include those that contain food additives and dyes, certain gas-producing foods (such as broccoli, cabbage, and beans), eggs, nuts, tomatoes, shellfish, chocolate, corn, strawberries, citrus fruits, onion, garlic, and some spices. To decide if a particular food upsets your baby, eliminate that single food from your diet and see if the symptoms disappear.

If you consume food in very large amounts, this may cause problems for a breast-fed baby. A half gallon of apple juice or orange juice, very large amounts of fruit, a whole jar of peanuts, or any other food consumed in unusually large quantities may cause your baby to have diarrhea or gas.

In the past, breastfeeding mothers were encouraged to drink beer to aid milk production. We now know beer does not increase milk production. We also know beer and other alcoholic beverages readily enter the breast milk in about the same concentration as your blood alcohol level. Since no safe level of alcohol has been established for the breast-fed baby, it is wise to strictly limit your alcohol intake or not drink at all. In addition, alcohol can inhibit letdown (the release of milk from the milk-producing sacs within the breasts to the milk ducts), so your baby does not get the milk he needs.

Cigarette smoking and breastfeeding are not compatible. Heavy cigarette smoking may reduce milk production; increase the incidence of nausea, colicky symptoms, and diarrhea in the baby; and decrease the vitamin C content of the milk. Smoking near the baby increases his risk of many respiratory ailments, including pneumonia, bronchitis, and asthma. As in pregnancy, the best advice is to quit.

Caffeine passes into breast milk and may cause your baby to have an upset stomach and be irritable. If you suspect caffeine affects your baby, eliminate coffee, tea, cola, chocolate, and other caffeine-containing products from your diet (or switch to decaffeinated products) to see if the symptoms disappear.

Do not take any vitamin supplements or herbs other than your prenatal vitamins without consulting your doctor or a registered dietitian first.

Almost every drug or medication makes its way into breast milk. Some medications appear to have no harmful effects on your baby, while others are most certainly not safe. Talk with your pharmacist or your child's doctor before you take any prescribed or over-the-counter medications-be sure the medications pose no problems for your baby.

If you need to take any drugs, particularly on a regular basis, discuss this with your doctor. You may have to stop breastfeeding until all the drug has passed out of your system.

There are some cases where a mother will not be able to breastfeed. Modern formulas have come a long way toward reproducing the benefits of breast milk. In the next section, we will show you how to bottle-feed.

How to Bottle-feed

Mothers have fed their babies formulas for years. In the past, evaporated milk was the main component of formula. Doctors would recommend various additions to it in an attempt to make the formula more complete.

Many different types of baby formula are available. Formula manufacturers continually improve their products, trying to make them closer to breast milk. A number of special formulas are also available for babies with certain health problems.

Most formulas use nonfat cow's milk as their base and source of protein. Many different fat sources are used: Soy, coconut, and corn are the most common. Various vitamins, minerals, and trace elements are also added. There is, however, no way to duplicate the antibodies found in breast milk.

For babies with a milk allergy or intolerance, formulas are available with soy protein in place of nonfat cow's milk as the main source of protein.

Babies with digestive problems or acute, severe diarrhea often need formulas that are very easy to digest and absorb. These formulas use casein as their protein source. They are usually used for only a few days, until the baby recovers from the diarrhea.

Selecting a Formula

All the milk-based formulas currently available are similar in composition and nutrient value, with only minor differences between them. Despite this, some babies seem to do better on one milk-based formula than on another. If your baby has gas, vomiting, or bowel problems with one formula, consult your doctor regarding a possible change in formula.

Most formulas are available either with or without supplemental iron. The iron is necessary to prevent iron deficiency. The American Academy of Pediatrics recommends iron-supplemented formulas only.

Through television and print advertising, formula manufacturers encourage use of their brand of formula. The American Academy of Pediatrics opposes this type of advertising because your doctor is best suited to help you decide which formula is best for your baby if you do not breastfeed.

Formulas come in three forms: ready-to-feed, concentrate, and powder. All three forms contain the same protein, fats, and other nutrients. The type you select is a matter of price and convenience. The most convenient, but most expensive, is the ready-to-feed in individual baby bottles or quart cans. The powder and concentrate are less expensive but can be more of a hassle to use.

The only difference between the three forms of formula is the water you need to add to the concentrate and powder forms. If your water contains fluoride, then you may not need to give your infant a fluoride supplement. If you use a ready-to-feed, then your baby may need the additional fluoride.

Bottles, Nipples, and More

Using formula means you need bottles, nipples, and other paraphernalia. There's really little difference between plastic and glass bottles except glass bottles break more easily. The size you select is a matter of convenience. And some parents find special bottle/liner systems handy.

Nipples come in many different sizes and shapes. Some makers of nipples claim theirs are "more like mother" because of their shape. What's really important is not what the nipple looks like in the package but how it works when your baby sucks on it. If you find a nipple that meets your baby's needs, stick with it.

If your water supply is safe and clean, you do not need to sterilize or boil bottles and nipples. Clean them with hot, soapy water and then rinse and thoroughly dry them. Some parents put the bottles in the dishwasher.

Mixing and Storing Formula

With the concentrated and powdered formulas, you must add water before you use them. Except when told otherwise by your doctor, never add more water than the instructions say. Over-diluting formula on a regular basis leads to malnutrition.

Again, if your water supply is clean and safe, you don't need to boil the water before you add it to the formula. As a general rule of thumb, if you can drink the water without problems, so can your baby. If you have concerns regarding water quality, check with your local water or health department, or discuss your concerns with your baby's doctor.

If you mix one bottle of formula at a time, you can just add cold tap water to the powder, mix it well, and feed your baby. In areas with fluoride in the water, you won't need to give your baby supplemental fluoride. Avoid using hot tap water -- any lead in the plumbing is more likely to leach into hot water.

You can safely refrigerate mixed or open formula for 24 hours. When you travel, the most convenient form of formula is the powdered type. You simply add water, and you're ready to feed your baby. You should be extremely cautious, however, if there is any question about water quality.

Bottle-Feeding a Baby

It isn't necessary to warm bottles of formula. Some babies will take the formula straight from the refrigerator. Obviously, giving a cool bottle of formula is a lot quicker and easier than trying to warm up a bottle when your baby is screaming. If you wish to warm the bottle, just hold it under hot running tap water. Then, shake it well to mix the formula, and test the formula to be sure it isn't too hot for the baby. Do not heat your baby's formula in a microwave oven. This method has too many potential dangers.

When you feed your baby, always hold your baby and the bottle -- never prop the bottle. Your baby shouldn't lie down and feed. He should always be semi-upright or sitting up. Bottle propping causes four problems-increased ear infections, increased cavities, feeding longer than necessary, and decreased emotional and physical satisfaction from being held.

The nipple hole should be large enough that the formula drips out at a steady pace of two drops per second. A flow that's too slow may increase the amount of air your baby swallows. If the flow is too fast, he may choke.

Regardless of whether you breastfeed or bottle-feed you will have to develop a feeding schedule for your baby. We will cover this in the next section.

Infant Feeding Schedules and Burping

No matter how you feed your baby there are additional considerations you will have to take into account. In this section, we will review feeding schedules and burping.

Demand Versus Scheduled Feedings

There is no consensus regarding which feeding method is best -- feeding at the child's demand or according to a schedule. If your schedule is flexible and you are willing to feed your baby frequently, demand-feeding may be best. You feed the baby whenever he seems hungry. A potential problem is that your baby may get used to taking only small amounts of formula or milk frequently, so you spend a lot of time feeding him. Using a regular schedule may be easier -- since you know what times he will eat, you can organize your day around this schedule, and he can become accustomed to the schedule.

Whichever method you use, it's important not to overfeed your baby. Once he loses interest in the bottle or breast, stop. Don't try to coax him into taking more. An infant generally doesn't need more than one quart of formula a day. Most breast-fed babies consume the majority of milk from a feeding in five minutes on each breast. Any sucking after that is usually for comfort.

Burping

Babies generally swallow some air as they feed, although breast-fed babies tend to swallow less air than bottle-fed babies. To minimize the amount a bottle-fed baby swallows, try to always keep the nipple full of formula as you feed. Regardless of the method of feeding, an air bubble may accumulate and make your baby uncomfortable. To prevent that distress, you should burp her at the conclusion of each feeding; you may also want to burp her at the midpoint of the feeding to prevent the buildup of too large a bubble.

There are a number of common positions to burp a baby, and no one of them is the right one. You will eventually find the one that is most effective for your baby, although on some occasions, you may have to run through the whole repertoire of burping positions until you get results.

These positions generally have in common putting some slight pressure on the baby's abdomen -- by placing her against your shoulder so she faces backward; by sitting her on your lap, resting her midsection on your forearm or hand; or by laying her face down across your lap and then gently rubbing or patting the middle of her back. Remember to protect the area beneath her mouth with a cloth because she is quite likely to bring up some milk with the gas bubble; this is usually only a small amount and does not indicate a feeding problem.

Some babies don't accumulate a large bubble or aren't made uncomfortable by one, so if your baby doesn't burp after several minutes of concerted effort, there is no point in exhausting both of you in a marathon burping session.

Of course, you want to spare your baby any discomfort that might result from an air bubble, but if your burping efforts aren't successful, the worst that may happen is your baby noisily lets you know when the bubble is making her uncomfortable, at which point you can renew your burping efforts.

So far our discussion around feeding and feeding option has focused on the mother. In the next section, we will explore how fathers can contribute.

Infant Feeding and Fathers

Research has shown that fathers can influence the diets of their families in some very important ways. In one study, 89 percent of mothers served infrequently or eliminated from the family diet entirely the foods the fathers disliked.

In another study, 81 percent of mothers surveyed planned meals based on the food preferences of the fathers. As a result of such studies, nutritionists now urge fathers to recognize the important effect their food tastes have on the nutritional well-being of their families.

Your food preferences and dietary habits are the first important way you are involved in feeding. You have an essential role in achieving a nutritious, age-appropriate diet for your baby.

During pregnancy, you and the baby's mother probably discussed how to feed your baby -- by breast or bottle. If the two of you decided breastfeeding was the best choice, your unswerving support during the time your baby is breast-fed is crucial.

If you chose to bottle-feed, your acquiring knowledge about formula preparation and healthy feeding practices is necessary and valuable. Perhaps you and the baby's mother chose to breastfeed first and bottle-feed later or to combine the two feeding methods. In any case, your support and involvement with feeding your baby will help your baby and give pleasure to you.

If your baby is breast-fed, you obviously cannot directly provide milk for your baby, although you can give him bottles of expressed milk if there are times when it is inconvenient or impossible for your partner to breastfeed. There are other important ways you can be helpful during feedings. You can bring your baby to his mother for night feedings and then tuck him back in bed later. You can burp the baby after feedings and take the opportunity to enjoy the quiet but alert time he has after feeding.

Many breastfeeding mothers experience sore nipples, fatigue, and doubts about milk supply. Your encouragement and nurturing help are important. In fact, one study has demonstrated a relationship between the father's support of breastfeeding and its success or failure.

Another important way you can help is to teach other family members about breastfeeding, so they understand and support this method of feeding. In the past, less was known about the benefits of breastfeeding than is known today, and feeding practices were different.

If your baby is bottle-fed, you can help by actively sharing the feedings with his mother. Make it your responsibility to mix formula in the proper way and to ensure the feeding equipment is clean and functioning well.

Always hold your baby when you feed him. He will begin to trust that you love him and are able to satisfy his needs. To provide for normal eye muscle development, hold him sometimes in your right arm and sometimes in your left. Hold him so his head is slightly elevated. Feeding in a flat position is associated with greater risk of middle ear infections.

Discontinue feeding your baby when he indicates he is through. Burp him during and after feedings. The frequency of burping depends on how much air he seems to swallow.

Whether your baby is breast- or bottle-fed, you can help by keeping feeding times calm. Run interference with the doorbell and the telephone. Anything you do to reduce tension is beneficial.

When your baby is ready for table foods, you can be involved in many ways. You can help by making mealtimes pleasant. Tension during feedings diminishes appetite and disturbs digestion. Make an effort to indicate pleasure with the variety of foods you offer your baby even if the food does not appeal to you. As tempting as it might be, avoid using food as a reward for good behavior or a special accomplishment.

Never offer your baby junk food or alcohol. Neither is part of a nutritious diet, and each replaces the foods your baby does need for growth and health. In addition, even small amounts of alcohol can be toxic to a young child.

Your involvement with your child's mealtimes is important. You can have a significant effect on your baby's health, and your relationship benefits from the time you spend together.

The decision to breastfeed is ultimately a personal choice that the parents will make by themselves. In fact, you might find that you cannot make a final decision until you have tried breastfeeding after the delivery. Hopefully, the information in this article will help you make this choice.

About the consultant:

Alvin Eden, M.D.: Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.