Rapid-Fire Reader Questions

Allowance follow-up, vaginal seeding, picky eaters, and more

Time for another edition. We’re covering a lot of ground here, so hopefully there’s something relevant to you!

What did you decide about the allowance?

That newsletter garnered a huge amount of response and advice, much of which was so thoughtful and great. Before I tell you what we did, let me pass along two pieces of that advice. First, tons of people recommended the book The Opposite of Spoiled, which I have now read and is excellent. Second, many people suggested the app RoosterMoney if you want a way to keep track of things.

Here is how it went down in our house. I sent Jesse a bullet-point version of the newsletter and we had a brief discussion and decided, yes, it was a good idea. The kids now each get $3 a week, of which a percentage not less than 10% must be allocated to charity for end-of-year donation. Their funds are recorded in a Google Sheet that is shared with them (though they do not have edit access, haha), and purchases must be approved by me.  

There you go! So far no one has bought anything, but we did get some good math calculations out of it. 

Is vaginal seeding worth doing?

For those of you who are scratching your heads: vaginal seeding refers to a practice of using a swab or gauze to transfer some vaginal fluids to the skin of a baby born by C-section. 

Why would one do this?

It has been noted in the data that infants born via C-section are at higher risk for several conditions (example: asthma). There is speculation that this could be a result of more limited exposure to the maternal microbiome through vaginal birth. This, in turn, has led to the idea that we should “seed” infants with the maternal microbiome through wiping them.

This practice is extremely controversial and has no particular evidence base one way or the other. It is seemingly true that there are some differences in infant bacteria after birth depending on delivery mode, although it isn’t clear (see, e.g., this careful study) that the difference persists very long. A review article finds evidence of variation in infant gut bacteria in the first months of life but not persisting to the 6- to 12-month period.

Even if we did observe variation in gut bacteria, linking that directly to health is difficult. Our understanding of the microbiome is quite poor, so while it seems clear it is in some way important, it’s not at all obvious how vaginal seeding would matter. I will say it is also unclear to me how much we should believe in a link between C-section and these health outcomes, given the many other differences across groups. 

On the flip side, there are concerns that vaginal seeding could be unsafe for infants, since we do not generally like to just do stuff to newborns if we are not sure it is a good idea. It’s a little ambiguous what exactly the safety concerns are, but infection or other negative reactions are the primary issues. 

The American College of Obstetricians and Gynecologists’ guidance says that clinicians should not do this outside of an approved clinical trial. A few trials are underway. Even if they do show some effects, it is hard to imagine they will be very significant. In the end it does not seem worth it to push, even if you think your OB would be responsive. 

Is Zika something we still have to worry about?

Not right now, no. Zika is a virus that ebbs and flows; there was a significant outbreak in 2015, and pregnant women were cautioned against travel to many places in the Caribbean and even parts of the U.S. However, the virus diminished and has not returned. The CDC’s Zika map has no areas of caution. And the U.S. has recorded no Zika cases since 2019. 

(I actually wrote about it in my first full newsletter; if anything, the data has gotten more reassuring since then.) So, for the moment, please remove this from your worry list.  

Should I give my picky eater multivitamins?

I am a vitamin skeptic. I’ve written about it before, and it’s a topic of some of my research. Most of my complaints relate to the claim that, as adults, vitamins can make us healthier. This has very little support in the data. People who take vitamins typically also undertake all kinds of other healthy behaviors, and it’s extremely difficult to separate the vitamins from everything else.  

I could go on at length about this, but it’s a bit tangential, so I’ll hold back.

On the particular question of a picky kid, the answer is likely no, unless your kid eats an extremely restrictive diet. People do need some amount of many vitamins. For example, if you do not have enough vitamin C, you get scurvy. Scurvy is terrible (as you would know if you read as many books about Arctic exploration as I do), and if your child’s diet is so restricted that they aren’t getting enough vitamin C, you should supplement. But the thing is that vitamin C is in a ton of different foods — meat, tomato sauce, strawberries, broccoli, potatoes. Lemonade! A similar message goes for other vitamins. And you don’t need an infinite amount of these, so it isn’t a case of more is better.

Bottom line: If what you mean by picky is your kid will literally only eat white bread, you might need to supplement. But if you mean they do not seem adventurous, multivitamins are unnecessary.

How worried should I be about febrile seizures happening?

“Febrile seizures” are seizures that happen in infants and young children as a result of a high fever.

There are two ways I can read your question. The first is how likely they are. To which the answer is: moderately. Between 2% and 4% of children will have one; they typically occur between the ages of 6 months and 5 years, with a peak between 12 and 18 months. 

You could also be asking how worried, if they happen, you should be about long-term consequences. The vast majority of febrile seizures are “simple,” defined as lasting less than 10 or 15 minutes (there is variation in the proposed cutoff) and not occurring repeatedly within 24 hours. These seizures are extremely likely to be benign; they do re-occur for a proportion of kids but are not associated with significant elevation in risks for long-term seizure disorders like epilepsy.

A “complex” febrile seizure episode involves recurrence within 24 hours, a long duration, and often some asymmetry in the focus of the seizure. These will need more significant follow-up and could be a sign of something else going on. Again, this is a very small share of seizures, which, again, happen in only 2% to 4% of children. So it’s overall quite a small risk. 

It goes without saying that if your child does have a febrile seizure, even one that seems simple, you should involve your pediatrician.

“How worried” is always a complicated question. Having the facts may put you more in control. 

Family Firm follow-up:

Do your kids actually look at their schedule every day/night? How specific are you on the schedule for how they use their time during the week? What do you say to your kids to remind them of their responsibilities? 

Interesting question, and probably most relevant to the older kid, who is supposed to maintain her own schedule. The younger one gets a lot of “scaffolding” in terms of his schedule, which anyway is … limited.

For the bigger one, we write down schedules at the start of the school year, and my sense is for a while early on she did refer to it somewhat frequently. At this point, it’s pretty dialed-in. The way I think about the specificity is the following: We worked out a schedule that was very specific, to make sure we are clear on what needs to be done and that there is sufficient time to do it. But within this, as things evolve, there is some flexibility.

Example: The schedule has violin practice happening before dinner, but she often moves it to after dinner for various reasons I do not completely understand. As long as it happens, I try not to get too involved. 

We do not do that much reminding, since they basically know what to do. The one place we do a tremendous amount of reminding, though, is in the space of what to bring to school. There are checklists by the door that Jesse keeps updated for different seasons. We force the kids to check them every morning (or rather, Jesse does, since I’m terrible at this). In the absence of the checklists, we would very, very frequently forget things.

Did you miss it?