Drinking, Breastfeeding Mothers: Where's the Line?

Stacey Anvarinia, 26, pled guilty to charges of child neglect filed earlier this year for breastfeeding her child while she was drunk.

Police had been called to her home in Grand Forks, N.D., on an unrelated domestic disturbance call, and while they were there, an intoxicated Anvarinia began to breastfeed her 6-month-old child. The officers learned from a local hospital that breastfeeding while under the influence of alcohol was not good for the child, and they charged her with neglect.

While Anvarinia's was an extreme case, the truth is that most mothers are not teetotalers, nor are they expected to be. But there are no consistent guidelines regarding alcohol consumption following pregnancy during the time when mothers may be breastfeeding.

While the ideal postpartum abstention from alcohol, since ethanol can move rapidly into the breast milk, lactation experts agree that moderate alcohol consumption by a mother does not pose major threats to an infant.

"Breastfeeding is not a prison for women," said D. Miriam Labbok, director of the Center for Infant and Young Child Feeding and Care at the University of North Carolina at Chapel Hill. "It depends how much [the mother] ingested and over how long."

Alcohol Is Easily Absorbed By Infants

Ethanol from alcoholic drinks can move quickly into breast milk from the mother's bloodstream within an hour of ingestion. Depending on the person's metabolism and how much alcohol was consumed over time, it can take two or more hours for the alcohol to leave the mother's system. If a child is breastfeeding during this time, they can receive up to about one fifth of the amount present in the blood.

"If the mom has a dose, the baby gets a dose," Labbok said. "It adds up."

Despite receiving far less concentrations than the mother, the alcohol can hit a child harder because they are smaller and their livers are not developed enough to properly metabolize the alcohol. Therefore, the compounds remain in the infant body longer.

In Anvarinia's case, breastfeeding while intoxicated turned out to be a Class C felony, in which there is a failure to provide proper parental care and control.

Moderation Is Key For Mothers

"A mother who has a glass of wine with dinner or one beer when she goes out is not an issue or a problem," said Marsha Walker, a registered nurse and a member of the board of directors for the Massachusetts Breastfeeding Coalition. "The problem is if she is an alcoholic, if she's unable to drive or care for a baby. At that point in time, she's better off waiting to breastfeed until [the alcohol] has cleared out."

Excessive alcohol, when transferred to a breastfed baby, can depress the central nervous system and cause drowsiness and deep sleep, abnormal weight gain, and, in extreme cases, retarded mental or motor development. And for the mother, intoxication can stem milk production, leaving her unable to feed a baby, if necessary.

Mothers are educated about alcohol consumption prenatally but the sources for information on booze after birth are more scattered.

"It isn't emphasized at that point in time [postpartum] and the mothers are already overwhelmed," said Walker, but pointed out that the topic can come up prenatally in breastfeeding or childbirth classes.

Preparations before having a few drinks can go a long way towards ensuring no alcohol gets into the baby's system. Lactation experts suggest pumping and freezing breast milk or having formula on hand can be useful if the mother will be drinking.

"But should she not feed if she has some drinks? No, she should feed the baby," Labbok said. "It's not called unsafe by anybody... Women around the world continue their normal lifestyles while breastfeeding."
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Anorexia and Pregnancy Don't Mix, Docs Say

While most expectant mothers marvel at the site of their growing baby bumps, Maggie Baumann says she was "horrified."


"As my stomach began to grow, I remember being in the shower and my bump was sticking out and I looked down at my body and I thought, 'I don't even want to be in this body,'" said Baumann.

Baumann, a 48-year-old mother of two, says she struggled with an eating disorder during her pregnancies, a condition sometimes referred to as "pregorexia."

"I wasn't even thinking about the baby," said Baumann of her first daughter, Christine, who is now 23. "It wasn't that I didn't want the baby, it was just that I could not stand the sight of my body."

Baumann, who lives in Laguna Niguel, Calif., told ABCNews.com that she struggled with anorexia since her high school years, but that it worsened after she got married and began having children.

"I feared my pregnancy," said Baumann, who gained a normal 33 pounds during her first pregnancy. "I refused to buy maternity clothes and our neighbors didn't even know I was pregnant until the ninth month. I hid it well."

Kathleen Rasmussen, a committee chairwoman at the Institute of Medicine who said there has been virtually no research done on pregorexics, said it's not uncommon for expectant mothers to experience a range of emotions regarding their growing figure.

"Women have very different psychological reactions to pregnancy," said Rasmussen. "Some are just thrilled with their new body and the marvelous things it's doing and others are humiliated."

The Institute of Medicine recommends that women of normal weight gain 25 to 35 pounds during pregnancy, and that those mothers-to-be who are underweight when they become pregnant should gain 28 to 40 pounds.

Baumann says that it was during her second pregnancy when she gained a measly 3 pounds that she saw her anorexia worsen.

"When I got pregnant with Whitney, I was just petrified to go through the changing body thing again and was scared to lose control," said Baumann, referring to her younger daughter. "I remember that I lost my waist really quickly and thinking to myself, 'Here it goes again.'"

Pregorexia Can Hurt the Baby

Dr. Robert Zurawin, an associate professor at the department of obstetrics and gynecology at Houston's Baylor College of Medicine, said that expectant mothers' fear of gaining weight is all too common.

"Women who are pregorexic -- or don't eat when they're pregnant because they're afraid of gaining weight -- need to think about their baby," said Zurawin.

"There are so many fad diets out there with no carbs and women are so obsessed with body image that they don't want to gain weight during their pregnancy because they're afraid of not being able to lose it afterward," said Zurawin.

"Women think that if they starve themselves during pregnancy, they won't look bad when they're done," said Zurawin.

Zurawin added that maintaining a well-balanced diet -- and not exceeding your doctor's recommendations for exercise -- are important for pregnant women to keep in mind, more so than whether they fit into their favorite jeans.

"It boils down to an expectant mother putting the needs of her unborn baby first," said Zurawin.

"What we'd like women to know is that what you eat affects how well your baby grows and how healthy your baby is," echoed Rasmussen. "This is a time in your life where it's really, really important to eat appropriately."

Baumann began over-exercising to try and quell her growing belly. An hour and a half of cardio -- running, biking and even volleyball -- was typical for her up until she gave birth.

"My rigidity and control got really strong during my second pregnancy," she said. "I was so oblivious to my disorder."

According to the National Institute of Mental Health, an estimated 0.5 percent to 3.7 percent of females will suffer from anorexia during their lifetime and an estimated 1.1 percent to 4.2 percent will suffer from bulimia.

Even when Baumann almost miscarried Whitney at the beginning of her pregnancy, cutting out exercise and increasing her daily caloric intake was not an option.

Baumann said that while she always ate -- she had to in order to keep up with her exercise regimen -- she was sure she was burning more calories than she was consuming.

Believes Pregorexia Caused by Her Adoption

"Whitney is so lucky to be here and I can only say that now that I realize what I had done at the time, back then I was in such a different world," said Baumann. "You think that [nearly miscarrying your baby] would probably hit most women as a warning that they have to be careful, but for me, I just kept going on my little path."

Baumann carried Whitney to term, when she was born at just over 5 pounds. During the first few years of her life she suffered from seizures that doctors suspect were caused by poor nutrition in the womb. Later on, Whitney was diagnosed with Attention Deficit Hyperactivity Disorder, another complication Baumann wonders whether she caused by her poor pre-natal care.

According to Zurawin, Baumann's daughter could have been much worse off than she was.

"You can seriously harm your baby by dieting and over-exercising during pregnancy," he said.

"You're setting yourself up for a growth-retarded baby and down the line, a baby with psychical and mental disabilities," said Zurawin.

Soon after Baumann gave birth to her second daughter, the anorexia she didn't think could get any worse spiraled out of control.

"I would work out for at least three hours a day," said Baumann. "My feet would be bleeding as I was running but I kept going. I was like a machine.

"I lived by the beach and couldn't stop and look at the waves," she said. "I wouldn't let myself. I was this machine and I had to complete the task.

"Or if my family went to church, they would go in the car and I'd run, then I'd stand at the back all sweaty, and to me, that was not abnormal," she said.

Finally suffering from chest pain, Baumann went to the emergency room and after doctors told her that her organs were failing, checked into an in-patient treatment center in Arizona.

"I weighed about 111 pounds," said Baumann, who is 5' 8". "For me, I thought I weighed so much. My husband said I looked like a skeleton."

After more than 10 years of therapy, Baumann has now faced how her adoption at just 6 months old and the abortion she had in her early 20s may have contributed to her anorexia. Baumann's birth mother, who is deceased, also struggled with an eating disorder.

Today, Baumann maintains a healthy weight and lifestyle and is proud that both her daughters live similarly healthy lives.

"It was never my intent to hurt my babies," said Baumann. "I forgive myself for what I did, but I'll never forget what I did."
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Mom's Exercise Helps Baby's Heart

It's natural that a woman might be skeptical about exercising while she's pregnant. So many changes are occurring in her body, it makes sense to have second thoughts about whether exercise might harm her or her unborn child.

But it turns out that a thoughtful exercise program is good for both mother and child, according to medical experts.

"We know that women who exercise during pregnancy have less chance of developing certain conditions like gestational diabetes," said Dr. Raul Artal, chairman of obstetrics, gynecology and women's health for the Saint Louis University School of Medicine. "Not only that, exercise maintains musculoskeletal fitness. Women can cope with the anatomical and physiological changes of pregnancy better when they're in good shape. They also tolerate labor better and recover more quickly from delivery."

The baby also benefits. One study found that when an expectant mother works out, her fetus reaps cardiac benefits in the form of lower fetal heart rates.

The American College of Obstetricians and Gynecologists recommends that pregnant women do at least 30 minutes of moderate exercise a day most days of the week. First, though, all women should consult a doctor to make sure it's OK.

When choosing what sort of exercise to pursue, a woman should take into account the shape she was in before becoming pregnant, said Dr. Thomas Wang, a family practitioner for Kaiser Permanente in San Diego.

"A lot of things depend on the level of fitness they had before," Wang said. A mom-to-be should pursue activities that will provide a good level of exertion without testing the limits of her body's current conditioning. If she's just starting a fitness program to improve her health during pregnancy, she should start out slowly and be careful not to overexert herself.

But there are certain activities that should at least be undertaken with caution, if not avoided altogether. Pregnant women, for instance, should not go scuba diving, as that activity exposes the fetus to a risk of developing decompression sickness, also known as the bends.

Women also should think twice before engaging in activities where the risk of falling is higher, such as gymnastics, horseback riding, downhill skiing and high-intensity racquet sports. And they should avoid contact sports such as ice hockey, soccer and basketball.

"Anything that involves impact or the chance of abdominal trauma, they should try to avoid," Wang explained.

Exercise that's perfectly safe for expectant mothers includes Kegel exercises, swimming, walking, light dancing and yoga. Riding a stationary bicycle or working out on aerobic gym equipment -- elliptical or stair-climbing machines, for instance -- is also fairly safe, as long as care is taken to prevent a fall.

Most pregnant women also can take part in jogging, running and aerobics, especially if those were exercises they regularly performed before pregnancy.

Pregnant women who are doing weight training should emphasize improving their muscle tone, particularly in the upper body and abdominal area, according to the American Pregnancy Association. They should avoid lifting weights above their heads and performing exercises that strain the lower back muscles.

"There have been some studies that show heavy lifting causes a temporary drop in the baby's heart rate," Wang said. "It usually corrects pretty quickly, but they might want to be careful."

Other things to keep in mind if exercising while pregnant:

* Avoid exercising to the point of exhaustion or breathlessness, as that could affect the oxygen supply to the fetus.

* Avoid overheating, which can affect the baby's development. Don't exercise in hot weather.

* During the second and third trimesters, avoid exercise that involves lying flat on your back as this decreases blood flow to the womb.

Though that might seem like a lot of cautions for something that's supposed to be safe, doctors insist that women can and should engage in a well-thought-out fitness program during their pregnancy.

"By and large, if there are no medical complications of pregnancy, women can continue engaging in the same type of activities," Artal said. "Women should be encouraged to continue living an active lifestyle."
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Epilepsy Drug Impairs Baby's Intelligence

WEDNESDAY, April 15 (HealthDay News) -- When a pregnant woman takes the epilepsy medication valproate, her child's intelligence may be lowered for at least three years, and possibly beyond, a new study suggests.
Reporting in the April 16 issue of the New England Journal of Medicine, researchers found that when tested at age 3, children who were exposed to valproate in the womb had IQ scores up to nine points lower than children exposed to other epilepsy medications in utero.

The problem is, many women with epilepsy can only get good control of their seizures with valproate.

"We're not saying never use valproate, but try other drugs first," said the study's lead author, Dr. Kimford Meador, a professor of neurology at Emory University School of Medicine in Atlanta. "We don't think that valproate should be used as a first choice for any woman of childbearing age. Other drugs should be used first."

Meador said the recommendation pertains to all women of childbearing age, not just pregnant women, because more than half of all pregnancies are unplanned, and any damage that may occur to the baby may occur before a woman even realizes that she's pregnant. Additionally, the drug has been shown to cause congenital birth defects in about 10 percent of children exposed to it in the womb, according to Meador.

For women currently taking valproate, sold under the brand name Depakote, Meador emphasized that no one should stop taking epilepsy medication abruptly, because this could result in seizures.

"Don't stop taking any medications without talking to your doctor," Meador stressed. "But, if you're on this medication, ask your doctor about it."

While the majority of children born to women with epilepsy are normal, animal studies have suggested that exposure to epilepsy medications might be associated with "cognitive and behavioral difficulties," according to background information in the study.

To assess what effects these medications might have on babies, the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study was begun. The study includes 309 children from 25 epilepsy centers in the United Kingdom and the United States. All of the children's mothers were taking one of four epilepsy medications during pregnancy, including valproate, carbamazapine, lamotrigine and phenytoin.

The researchers plan to assess the children periodically until they're 6 years old. The current report focuses on outcomes when the children were 3 years old.

After compensating for other factors that might influence a child's intelligence -- such as maternal IQ, maternal age, the dose of anti-epileptic medication, gestational age at birth and the mother's intake of folic acid -- the researchers found that children exposed to valproate during pregnancy had significantly lower IQ scores than the children exposed to the other medications.

The average IQ for children exposed in the womb to lamotrigine was 101, for phenytoin it was 99, and for carbamazepine it was 98. Children exposed to valproate in the womb scored an average of 92 on the IQ test, according to the study.

The researchers also found that the drug's effect on IQ was "dose-dependent," meaning that the higher the dose of medication, the more effect on the child's intelligence.

Meador said the researchers suspect that the medication may cause a loss of brain cells in the baby, like fetal alcohol syndrome does.

"The take-away message from this study is that the danger of neurocognitive impairment is real with the use of valproic acid (valproate)," said Dr. Inna Vaisleib, a pediatric neurologist and epileptologist at Children's Hospital of Pittsburgh.

"Not using valproic acid in women of childbearing age is a good idea, as approximately half of all pregnancies are unplanned," she said, adding that "epilepsy is common, and about one in 200 pregnant women are receiving anti-epileptic drugs."

Vaisleib cautioned strongly against stopping any medications without first consulting a neurologist, because seizures can also be damaging to a growing fetus, as well as to the expectant mother.
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Does Your Baby's Bottle Make Her Thighs Look Fat?

While excess weight can be a problem in some babies, perdiatric nutritionists say parents should not put these infants on diets.


For so long, the main nutrition concern regarding infants has been that they obtain enough nutrients and calories to support good growth and development. Well, America got the memo, at least about the calories.

Now there's an epidemic of obesity, and it seems to appear earlier and earlier in life. This study found that 7.5 percent of 3-year-olds were obese. That's about one in 13 toddlers, and that's 50 percent more than the one in 20 you'd otherwise expect. Of course, there really shouldn't be any obese 3-year-olds.

The cause: Nature? Nurture? Not enough recess?

OK, disregard the recess comment. Actually, this study didn't look at reasons for the obesity, only that it happened.

The researchers do pose some possible explanations, however, and I can concur, based on 25 years of clinical practice with parents and children:

Overfeeding. Think about it. You have 6 ounces of formula in the bottle, and your baby wants only 4 ounces. You pester him into taking the other 2 ounces so that you don't have to throw it away. All fine and well, but you're also overriding his internal cues that have told him he's had enough.

Not sensing when your baby has had enough. Feeding babies is one of the most enjoyable things parents can do. You feel as if you're doing your job when your baby takes his bottle and you like feeding him, but when he starts refusing the bottle, you need to learn when to reel it in and not push the issue.

Reinforcing oral fixations. The study didn't look at this, but I see it all the time. Too many parents stick a bottle, a snack or a pacifier into a baby's mouth every time he opens his mouth. It stops him from crying or fidgeting, but it also reinforces the idea that all comfort comes from eating, suckling and anything oral.

Early introduction of solids. The study didn't find an association here, but the researchers didn't probe too deeply either. Babies aren't little adults, and giving solids too early can add unnecessary calories to their diet. Even if your baby can tolerate solids, that doesn't mean he's ready for them.

Low-Carb, or Low-Fat Formula?

Whoa! Neither. I'm a little concerned that a hypervigilant parent who may have the best of intentions starts getting obsessed about his baby's weight. Here's a starting point for figuring your baby's formula needs:

Take your baby's weight in pounds;

Multiply that weight by 2.5 to 2.7;

The result is the number of ounces your baby will probably need in a day.

So, if your baby is 10 pounds, she'll need about 25 to 27 ounces of formula per day. Some babies can grow nicely on a little less, but others will need a little more.

What do you do if your baby is chunky? There's a reason there is no low-calorie baby formula -- babies shouldn't need it. Babies and toddlers have a higher need for fat until they're about 2 years old.

If your infant is overweight, don't put her on a diet; just feed her like her age. Use the math above as a starting point. Definitely check with your pediatrician however, before doing anything. Don't even consider adding extra water to the full-strength formula without clear instructions from your pediatrician, and no fat-free or low-fat milk for toddlers.

When it comes to obesity in infants, it's all about prevention. Here are some tips to get things started:

Ask your baby's pediatrician if his weight is good and if it's correct for his height. It's all about proportion here, not just the pounds.

Give the right amount of formula for your baby's weight.

Hold pacifier use to a bare minimum -- like when it's 2 a.m. and you're ready to scream. Other than that, it's not a good thing. Just ask a speech pathologist -- too much pacifier use can interfere with making sounds and forming words. Keep that cork out of their mouths

Wait until your baby is at least 4 months before considering introducing solids. Wait until he's 5 or even 6 months if you can. Babies have a lifetime of eating ahead, and it will be worth the wait.

Learn to recognize when your baby has had enough, and then honor that. It's the beginning of great communication. Read More...

Rocket Fuel Chemical Found in Baby Formula

When a parent puts a bottle of baby formula to a child's lips, the parent might not know exactly what ingredients are in that thick, nutritionally packed mix. But rocket fuel? That's not an ingredient many expect to find.

A study by government researchers released Thursday tested 15 different brands of formula and found a chemical -- also found in rocket fuel -- contaminating every single one.

While the levels of the chemical, perchlorate, have been deemed safe by the Environmental Protection Agency, some worry public health is at risk.

Scientists at the Centers for Disease Control and Prevention tested the formula for the presence of perchlorate, a chemical used as the main ingredient in solid rocket fuel. It's a worry because perchlorate can interfere with the production of thyroid hormones by inhibiting the absorption of iodine.

The CDC study found cow's milk-based formula contained more perchlorate than that made with soy or other ingredients.

The two brands with the highest levels -- more than double that of the other milk-based products -- command 87 percent of the market share for infant formula.

The report does not specify the brand names of any formula tested.

Perchlorate has been found in the water supplies of 35 states and has been detected in everything from vegetables to milk. In the case of dairy, the rocket fuel in the water flows into grass, which is eaten by cows, and is then passed along into milk.

The perchlorate was found in levels within a range that's been deemed safe by the Environmental Protection Agency.

CDC researchers write that "this is reasssuring at first glance," but add that it could be problematic because drinking water in 26 states has high perchlorate levels. So, mixing contaminated powdered milk with contaminated water in those places could result in a dangerous exposure.

"The widespread penetrance of these products, and the potential for utilization of water for reconstitution that has even minimal concentrations of perchlorate," the researchers write, "suggest that a significant number of infants consuming bovine milk-based [powdered infant formula] with lactose, will have perchlorate doses in excess of the [recommended limit]."

Advocacy Groups Says Risk Is Understated

The Environmental Working Group, an organization that advocates for stricter limits on a variety of chemicals, contends EPA's recommended limit is set "too high to protect public health" and understates the risk.

"Perchlorate contamination of drinking water is a very serious concern, particularly for infants," said Dr. Anila Jacob, an Environmental Working Group scientist.

Dr. Sheela Sathyanarayana, a pediatrician who works on environmental health issues at Seattle Children's Hospital and at the University of Washington department of pediatrics, said it's difficult to say whether this sort of exposure is dangerous.


"Considered in isolation, these perchlorate concentrations in formula are not concerning for child health," Sathyanarayana wrote in an e-mail to ABC News. "The reason that some may be concerned about health effects to children is that there are several sources of perchlorate in our environment ... and, therefore, the cumulative dose of perchlorate to an infant may be much higher than that found in the formula."

"That being said," she added, "the most well-respected studies (only a handful exist) on perchlorate contamination have not found any link between perchlorate contamination in water and health impacts in children. Therefore, we truly do not know if this kind of contamination may be leading to health problems or not."

Another professor of pediatrics, Keith-Thomas Ayoob of the Albert Einstein College of Medicine, considers the findings "disturbing" and "a wake-up call to municipalities to clean up their water supplies, if at all possible."

At her confirmation hearing in January, EPA Administrator Lisa Jackson agreed to take another look at the safety of perchlorate.

The study appeared in the March 2009 issue of the Journal of Exposure Science and Environmental Epidemiology.

The CDC study is based on a handful of samples bought in one city and includes the caveat: "The results of this study may not be relevant throughout the United States."

Still, Ayoob told ABC News, "This is a perfect example of how polluting one area of the environment can be magnified."

"It's not causing harm to the animals or most consumers, but you can see how the effect can be magnified," Ayoob said. "If we get rid of the perchlorate, then the infants, their parents, all consumers, and even the cows and the farmers will be better off and happier."

Read the Environmental Working Group's analysis of the CDC study.
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Medical Mystery: The Baby Who Wouldn't Grow

Docs Are Baffled by 14-Month-Old Baby Who Weighs Only as Much as a Newborn
Atlanta Ruzman of the U.K. said her first clue that something was wrong with her pregnancy came at seven months, when she was barely showing a bump.

"I thought that I was really small," Ruzman, 24, told ABCNews.com. "I went to my midwife and asked her if everything was OK. She measured me, and she said yes, I was quite small."

Ruzman went to the hospital, where scans confirmed that the baby growing inside her was unusually small. Fearing that the baby was not getting enough nutrition in the womb, doctors made the decision to induce labor at 36 weeks and four days.

Suraya Brown entered the world at just over two-and-a-half pounds. That was 14 months ago. But today, doctors in England are baffled by the case of Baby Suraya who, it seems, has refused to grow.

Ruzman said that even now, her daughter is barely above the weight of an average newborn at 7 pounds, 7 ounces. This is only two ounces heavier than the birthweight of her older sister, Akilah, who was born about a year prior to Suraya.

Already, the child has undergone a battery of medical tests. An X-ray of the baby's bones revealed no abnormalities. Most recently, a genetic test for a form of dwarfism called Silver-Russell syndrome came back negative -- and doctors have also ruled out some other forms of dwarfism. But Ruzman said the team of physicians is still short on solid explanations.

"Every test we do keeps coming back negative," she said.

"Her case is highly unusual," consultant pediatrician Dr. Jide Menakaya, who has known Suraya since birth, told the U.K. paper the Daily Mirror on Monday. "I have certainly never seen anything like this, and I have been in pediatrics for nearly 17 years... We have run many tests but we haven't had a firm reason as to why she is not growing."

Repeated attempts to contact Menakaya directly were unsuccessful.

Dr. Ian Holzman, chief of the Division of Newborn Medicine at Mount Sinai Medical Center in New York, said it is little wonder that doctors find it a challenge to nail down a solid diagnosis.

"There can be a laundry list of conditions that might prevent growth, and it certainly looks like the doctors have looked for a number of these," said Holzman, who is not involved in the case, but who is familiar with similar cases of slow growth.

"I have cared for a child, small at birth, who grew very slowly, which we [initially] ascribed to poor nutritional intake," Holzman said. However, he added, further investigation revealed that the child had a condition known as gluten enteropathy -- and that the child began to grow once a change in diet was made.

But because there are so many potential causes for slow growth in infants, nailing down the exact cause is often a study in trial and error. Dr. Sessions Cole, director of the division of newborn medicine at the Washington University School of Medicine in St. Louis, Mo., said that any one of numerous issues could be at play in this case -- including cystic fibrosis and adrenal, intestinal, kidney or chromosome problems.

"The case ... is definitely interesting and unusual," Cole said. "I have not personally seen a child with a similar presentation."

New Symptoms Mean New Clues, New Dangers

Tiny stature is not Suraya's only symptom. Ruzman said her daughter recently began experiencing seizures, as well as extreme low blood sugar, or hypoglycemia.

"Her sugar levels at one point went below 1," she said. "In adults, that can put you in a coma."

Ruzman said that since this episode, she has laid Suraya to sleep on a special mat that monitors her breathing in case more seizures occur at night.

While terrifying for her mother, Suraya's seizures may offer more clues as to what may be behind her mysterious condition. Holzman said her hypoglycemia may point to a metabolic disorder -- though these can be difficult to diagnose.

A genetic abnormality may also be a factor. "The fact that she was small at birth suggests a genetic disease that might have a very small deletion or duplication of a part of a chromosome," Holzman said. "These can be hard to identify and require sophisticated chromosome studies."

Cole agreed that the fact that Suraya was so small at birth is an important clue.

"If this weight is correct, she was strikingly small at birth -- a condition known as intrauterine growth retardation," he said. "This observation means that the substances needed to grow in the womb were also disrupted."

He said one possibility may be a genetic defect that makes it impossible for the infant's body to respond to the hormone known as insulin, which is critical in the body's ability to properly regulate blood sugar and certain aspects of growth and development.

Baby Suraya Still Full of Surprises

Though Suraya's life has had a difficult start, Ruzman said that her tiny daughter remains cheerful.

"She's such a happy baby; she's a cheeky monkey," she said. "That child is intelligent, and she knows what's going on around her."

Suraya's parents, however, continue to worry about what the future holds for their youngest child. Ruzman said the family's medical consultant told her it could take years before doctors find an explanation for her daughter's condition -- or the answer may never come.

"All we want to know is what we will have in the future for her -- will she be in pain? What will she have to eat? Will the length of her life be different?" Ruzman said. "We just want to give her the best quality of life."

In an effort to answer these questions, doctors have now admitted Suraya to London's Great Ormond Street Hospital, where she will undergo further tests. And Wednesday, doctors will operate on Suraya to determine whether any throat abnormalities could be contributing to her condition.

Ruzman said the hunt for answers has been difficult. But she added that her tiny daughter is worth the struggle.

"I wouldn't change her for the world, neither would her dad," Ruzman said. "We know that this child is very special."
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Report Sheds Light on Infant Suffocation

Margaret D'Arrigo-Martin knows firsthand the pain of losing an infant.

In 2003, her baby Alexis Claire was a very healthy 6½-week-old. D'Arrigo-Martin said she would often nurse Alexis and place her in a crib next to her own bed.

On the night Alexis died, however, the infant was more fussy than usual, and D'Arrigo-Martin placed her next to her in the bed in order to comfort her. When she awoke two hours later, she was horrified to find her baby not breathing.

"If I knew I was putting her in an unsafe situation by letting her sleep next to me, I never would have done it," she said.

She performed CPR and called 911, but unfortunately, nothing could be done to bring Alexis back.

D'Arrigo-Martin knew how important it was to keep her baby on her back and keep blankets and pillows away. But she did not know that it could also be dangerous to have her baby sleeping in the bed next to her.

"If I were to do it again, I would definitely [have put her] in a bassinet next to the bed, knowing what I know now," she said.
Unfortunately, stories like D'Arrigo-Martin's are not uncommon. Infant deaths related to suffocation and strangulation in bed have quadrupled in the last two decades, researchers at the U.S. Centers for Disease Control and Prevention reported in a study published Monday in the journal Pediatrics.

However, lead study author Dr. Carrie Shapiro-Mendoza said the reported increase does not necessarily mean that more infants overall are dying. Rather, she said, medical examiners now have more information available to better classify deaths in which suffocation or strangulation has occurred.

"This provides support for child death review teams and better death scene investigations," Shapiro-Mendoza said. She added that the research suggests there needs to be more education of parents about safe sleep environments.

"Hopefully, it will reinvigorate the method of safe sleeping," she said.

Searching for an Explanation

The study looked at infant death rates between the years of 1984 and 2004 and found that deaths classified as accidental suffocation and strangulation in bed (ASSB) increased four-fold over this time period. But over the same time period, infant deaths classified as sudden infant death syndrome (SIDS) have declined. The total rate of unexplained death among infants has not changed significantly.

In the paper, ASSB includes suffocation by various means, such as when the baby's airway is blocked by soft bedding or a pillow, or if an adult rolls on top of the child. The classification of SIDS, on the other hand, indicates that there is no known cause of death after a thorough investigation.

So, why is it so important to further define the circumstances of death in these situations? Shapiro-Mendoza said that knowing what risk factors lead to ASSB and SIDS can help doctors tell new parents how to prevent these deaths from happening.

Dr. Sessions Cole, chief medical officer of St. Louis Children's Hospital, agreed.

"This will be a stimulus to get everyone to adhere to CDC recommendations for death scene investigations for children," Cole said.

But even as more information comes to light, there are still unanswered questions.

Currently, Shapiro-Mendoza said, the jury is still out on the exact risk factors for suffocation and strangulation in babies. These deaths occurred on beds, but they also occurred on cribs and sofas.

The study also finds that black male infants less than 4 months of age are most affected by ASSB, for reasons Shapiro-Mendoza said are still unclear.

Creating a Safer Sleep Space

But what is known is that parents can take steps to reduce the chance that their baby will die from suffocation or strangulation.

"We recommend room sharing instead of bed sharing," said Laura Reno, vice president of public affairs for First Candle, an organization devoted to parental education. "[Parents need to] learn how to create a safe sleep zone, making sure babies sleep in a separate space on their back, on a firm mattress, free from any soft bedding."

She added that if parents do not want to sleep too far away from their baby, they can place that safe sleep space right next to their bed.

"It will protect [the baby] and promote breastfeeding," Reno said.

Dr. Suresh Kotogal, a professor of neurology and a pediatric sleep specialist at Mayo Clinic, agreed.

"[This study] will fuel interest in this area again," Kotogal said. "[Safe] sleeping environments need to be emphasized by all primary care physicians and at the time babies [are] going home from the hospital."
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