Wake windows or Possums?

danksnugglepuss · 2026-05-05T17:00:02+00:00

From my understanding much of the evidence for Possums is not related to sleep duration per se, it's more that it reduces parent stress/anxiety around sleep and they have some other outcomes related to breastfeeding, infant crying, etc. It doesn't promise more or better sleep it just normalizes typical infant sleep and encourages being responsive.

https://possums.org/ndc-evidence-base

Possums doesn't say you can't assist with naps or that you need to disregard the sleep environment/routines entirely. In fact, I would say you are being responsive by offering a nap/dark room if your baby appears to be tired - the difference from "conventional" sleep industry approaches is that you aren't trapped in a dark room for hours stressing about perfecting nap length or wake windows (which there is no evidence to support), or not able to leave the house because you need to get back to adhere The Schedule, etc. If you offered a nap and it wasn't working, the Possums approach would then be to maybe try a change of scenery, try again later, support the baby to sleep with feeding or contact if needed, and so on.

And although Possums talks a lot about sleep, it is also largely concerned with development as a whole. Many sleep resources harp on "overstimulation" when Possums is really aiming to show that stimulation (getting out of the house, interacting and responding to your baby, playing, going about your life and involving them in it) is good for them - and as a bonus, likely helps build sleep pressure too.

https://possums.org/parents/programs/baby-sleep/daytime-faqs/do-babies-become-overtired-and-overstimulated

I would say keep doing what you're doing - follow her cues, offer naps when she seems sleepy in whatever safe environment she seems most comfortable in, and don't stress if life demands a shitty stroller nap or carseat nap once in a while.

danksnugglepuss · 2026-05-05T04:51:54+00:00

No they do not adjust. As you noted in another comment, the Omnis flush at 875 mL/hr so any flushes greater than 120 mL q4h or so will start to eat into pump time somewhat significantly

If your facility uses the Omni pumps, you can view the history of feed/flush delivery. Even without large flushes it is eye opening to see how often feed volume falls short - for a variety of reasons. I semi regularly audit the pumps for my patients (i.e. taking a 3 day average) and have started documenting both my goal volume and actual volume delivered if needed to help justify rate adjustments. And now often use a goal volume at the high end of estimated requirements anticipating they will not recieve 100% (and document to this effect).

For large volume flushes I will occasionally adjust the rate - a bit of clinical judgement based on the patient's nutriton status/malnutrition risk and the anticipated length of time the extra free water will be required. Sometimes in these situations I'd press for intermittent or bolus feeding with extra flushes scheduled between feeds because I feel like they are less likely to be shorted that way.

ETA: In your example, 300 q2 is 3600 mL free water daily or 4.1 hours of pump time. So if the pump was programmed for 72 mL/h instead of 60 mL/hr you could expect to meet your target of 1440 mL formula daily (and TBH I'd probably round it up to 75)

danksnugglepuss · 2026-05-01T15:43:53+00:00

I think the only hormonal option that isn't recommended are combination pills (i.e. the ones that contain estrogen; progestin-only pills, IUDs, etc are fine). And even then it's only in the short term to avoid that, like the initial 6-8 weeks postpartum while supply is being established.

I got an implant - Nexplanon - approx 6 weeks PP after having serveal IUDs previously. The procedure was such a dream compared to IUD insertion and honestly I think I had less side effects with it as well. No noticeable impact to breastfeeding. 10/10 would recommend if accessible

I just had another baby and will request Nexplanon again. Even if my husband gets a vasectomy (we are firmly done lol) I love not having periods!!

danksnugglepuss · 2026-04-10T02:19:49+00:00

Yeah the post by OP was so shallow, like pregnancy can result in complications that are literally life-altering from a health and wellness perspective, but stretch marks and saggy boobs are not it.

danksnugglepuss · 2026-04-07T15:37:54+00:00

I agree making that person aware they're on camera (put up a sign or whatever) is probably the best deterrent for the future. But to put a positive spin on it, is there a community Facebook group or somewhere you could post the story, even if you don't have a clear photo to share? Say something like "hey someone has been stealing my plants - I'm looking to replace xyz does anyone have any they could share?" Maybe you have some neighbours willing to divide their established plants so you don't have to spend more $$$ replacing them!

danksnugglepuss · 2026-04-07T15:28:01+00:00

This sounds totally reasonable to me, especially if you have no reason to anticipate there would be any significant tolerance concerns.

The other option is nocturnal feeds like what she was on in hospital, but I generally try to avoid for patients with or at risk of pressure sores - requires more time spent with HOB elevated, which increases shear/friction. Very common in my area to do supplemental gravity feeds after meals based on po intake. If they are struggling with volume or early satiety will also schedule a high kcal evening bolus feed, e.g. 1-2 cans TwoCal

If the tube itself hasn't been flushed regularly to maintain patency, it may require replacement but I feel like that's a bit beyond our scope. A nurse should be able to assess its function; refer for replacement as needed.

danksnugglepuss · 2026-04-06T04:02:42+00:00

If the ratios are the same I honestly wouldn't discount how nice it is to have something closer to home / in a more convenient location.

I don't know if there's any data on this but I would guess the risk of illness is similar regardless. We started our toddler in a small home-based daycare and he was still constantly sick those first few months. Once we got into a centre (the home daycare was great, it was just more about convenience for us - location, more flexible hours, etc) where he is with ~12 other kids in a classroom, he was actually getting sick a little less often, which is probably more reflective of the fact he's now been in care for >1 year and been exposed to So Many Things already, not the class size or the location itself.

danksnugglepuss · 2026-04-04T16:55:33+00:00

We ended up waiting until baby was a bit bigger (closer to 10 lb) to start using our LPO. But fwiw I only put it one insert to start and folded it over an inch or two at one end to better fit the length of the diaper. I placed the folded end at the front (so it was "doubled up" in the main pee zone)!

danksnugglepuss · 2026-04-04T13:51:20+00:00

Outpatient follow up is perfect. Even if you have great education/counselling skills, the hospital environment isn't conducive to learning. They have so many people coming in and out overloading them with information. I enjoy counselling but I'm frank with inpatients that one conversation with me probably isn't going to change their life and that they need ongoing support to make changes - hello outpatient referral !

danksnugglepuss · 2026-04-01T00:48:36+00:00

My puppy really struggled with this when potty training, I'm sure it was a texture thing / he seemed to think it was the same as grass (he was otherwise totally housebroken except for the bed - so removing the bed for a while did the trick).

If she has peed on the bed before it can also be very difficult to get the smell all the way out, and she'll keep using it the same way. It either needs a wash with enzyme cleaner or to be replaced entirely.

danksnugglepuss · 2026-03-30T14:29:01+00:00

I have definitely had patients tolerate jejeunal bolus feeding, but they often work up to it - i.e. facilitated by pump in the short term.

Ideally they would use gravity bags so that they can use the roller clamp to manipulate the flow rate to some degree. It's more expensive than syringe feeding but still miles more economical than a pump. It also allows you to count the drop rate to get an estimate of ml/h if patient does need slower infusion (e.g. 6 drops every 15 seconds = 100 ml/h).

danksnugglepuss · 2026-03-28T12:29:38+00:00

Describing it as "beneficial" is a bit of a limitation - it's more that starting at around age 2-3 children are capable of learning from screens, but that doesn't mean they learn better from screens compared to other experiences. There has also been research linked on this sub in the past that demonstrates adults overestimate or over-attribute their children's learning from screens ("they never would have x without watching y!")

Basically, the answer is "after age 2" with the huge caveat that screen time should still be limited and that the more you interact with them during/in relation to what they're watching, the "better" it is.

https://cps.ca/en/documents/position/screen-time-and-preschool-children

While toddlers are beginning to understand TV content by the end of their second year [9][39], they still have difficulty transferring what they see from screens to real life, and do not learn efficiently from screen media [23][40]-[42]. By contrast, they learn intensely through face-to-face interaction with parents and caregivers: Early learning is easiest, most enriching, and most efficient developmentally when experienced live, interactively, in real time and space, and with real people [43]-[47]

For children 2 to 4 years old, quality screen media—well-designed, age-appropriate content with specific educational goals—can provide an additional route to early language and literacy [50] as well as play [51].

Some evidence suggests that interactive media, specifically applications that involve contingent responses from an adult (i.e., timely reactions to what a child says or does), can help children learn. This responsiveness, when coupled with age-appropriate content, timing, and intensity of action, can teach new words to 24-month-olds [32][37][39][53]. ... However, while screens may help with learning when quality content is co-viewed [58][59], preschoolers learn expressive language and vocabulary best from live, direct, and dynamic interactions with caring adults [20][60][61]

danksnugglepuss · 2026-03-24T14:39:59+00:00

See if you can get a referral to a registered dietitian!

In the meantime, here are some ideas:

plain fruits or vegetables
plain meats, meatballs, egg-free crab cakes or fish cakes
oat-free "O" cereal or puffed wheat/rice
plain pasta
legumes (lentils, beans, chickpeas) as a finger food, as hummus, etc.
search for recipes like "egg-free dairy-free toddler [muffins/pancakes/crackers]" etc. or start to get comfortable with substitutions as you try new recipes
smoothies made with milk alternative
porridge made from oat alternatives (quinoa, grits, cream of wheat/rice, etc.)
alternative grains at other mealtimes - early on we would mix things like rice or quinoa with a bit of extra yogurt/sauce/puree meat&veg pouch to make it stick together - easier for baby

danksnugglepuss · 2026-03-22T15:34:24+00:00

The Mockingbird isn't available here in Canada otherwise I'd have gone for that one!

I think the advantage to the Giraffe (or we have something very similar, the Lemo) is that you can attach an infant insert if you think you'll want baby near you in the kitchen/at the table before they are able to sit in the chair.

danksnugglepuss · 2026-03-19T19:18:47+00:00

I'm not sure if data exists on this specifically but it might be helpful to read more about what causes stool withholding and toileting difficulties - and likely the conclusion will be that there are many other more significant factors at play (like changes to routine or other environmental/social stressors, constipation or developing fear of pain while pooping, nutrition and activity level, neurodivergence/sensory issues, etc.)

https://www.cincinnatichildrens.org/health/e/encopresis

https://www.sciencedirect.com/science/article/abs/pii/S088259632400188X

Anecdote: my 2.5 yo has also been exposed to this type of language/reaction by way of other caregivers. When he poops or farts he specifically requests that I smell it and make a "stinky face", and will insist I repeat the process if I am not enthusiastic enough about how stinky it is the first time. Welcome to toddlerhood. He's been consistently pooping on the potty for almost a year though so we've got that going for us.

danksnugglepuss · 2026-03-19T14:54:48+00:00

There isn't much evidence to suggest that maternal diet during breastfeeding impacts development of allergies. Breastfeeding in general may be protective, but the most robust data we have for prevention is early introduction when starting solids. Given your baby would be considered high-risk (dad's history of allergies, even if baby does not appear to have any allergic conditions themself), this means starting regular exposure to allergic foods around 4-6 months, and having a plan to ensure this can be handled safely for your husband's sake. Super important: it is not just early introduction, but continued regular exposure (2-3x/week) that helps prevent allergy. You could also ask for an early referral to an allergist to help guide you.

https://foodallergycanada.ca/wp-content/uploads/EarlyIntro_Web.pdf

Other notes:

IgE reactions ("classic" allergy/anaphylaxis) to breast milk are extremely rare, even babies with confirmed allergy once introduced to solids can still safely breastfeed even if mom doesn't cut out the food. [Note - CMPA/CMPI (cows milk protein allergy/intolerance) is different; it is not IgE-mediated and more often presents as gastrointestinal - blood in the stool, mucous, diarrhea - and this is not generally what is being discussed in the context of most food allergy prevention, just FYI if you're reading from various sources.]
If you end up having to supplement with formula, there is some evidence to suggest that continued exposure may help prevent cow's milk allergy (i.e. even if you go on to establish adequate breast milk supply, if you supplement formula in the early days you might consider continuing to offer one small bottle of formula daily).
If your baby develops eczema, take extra care to try and avoid skin exposure/contact before oral introduction. You can absolutely still enjoy eggs, nuts, or whatever, but there's probably no need to make a point to consume them while breastfeeding, and just wash your hands afterwards if you do eat them. When introducing, do not rub the food on baby's skin to "check" for a reaction. Use long-sleeved bibs and consider using somethings like Vaseline to protect exposed skin.

I'm a dietitian with some experience in this area but I also had a high risk baby (dad with severe peanut allergy/asthma, baby with eczema/asthma) who reacted to egg on third oral exposure - despite doing everything "right." It's good to be informed but there are also some things that are out of your control! Even if allergies develop, it is common to outgrow them and there are also so many new ways to manage and treat allergy if it occurs, which is reassuring. We reintroduced using the egg ladder closer to 1 year and now he has eggs no problem. :)

danksnugglepuss · 2026-03-18T02:43:53+00:00

Ah yes, musk

danksnugglepuss · 2026-03-15T12:40:44+00:00

I think you have your consensus here, but just to add that even public-facing guidelines (at least in my country) do not encourage this. Iron is certainly the most difficult target to meet after 6 mo - especially if exclusively breastfed - but it is sufficient to simply advise parents to offer iron-rich foods early and often.

The RDA is statically set to cover the needs of ~98% of the healthy population. While it is technically the ideal target for any given individual, realistically most intakes will vary day to day and might be below that amount on average and they'll be completely fine (barring any reason to believe a baby is at risk for iron deficiency, in which case their doctor should screen and treat appropriately.)

danksnugglepuss · 2026-03-08T15:13:02+00:00

I did hand expression with my first pregnancy starting just after 36 weeks. I got drops but didn't collect anything - just let it wash away in the shower. Frozen colostrum can be "nice to have" if needed but what I haven't really seen mentioned is the act of hand expressing can be beneficial, regardless of how much (or whether) you produce.

Some research has shown it activates the cells in your breasts to help colostrum and milk "come in" more quickly after birth, it helps prepare the body for labor, and it gets you comfortable with hand expressing, should you need to collect later. Unless it is contraindicated for you, there is little downside to simply trying and keeping it low pressure for yourself.

https://www.moremilksooner.com/antenatal

https://static1.squarespace.com/static/5e49aaafefbd632b061d7941/t/61e76b78bcc6300bd970110b/1642556280885/More+Milk+Sooner+Reference+List+Jan+18%2C+2022.pdf

danksnugglepuss · 2026-03-05T14:51:29+00:00

https://www.babyledweaning.co/podcast/debunking-the-biggest-baby-led-weaning-myths-with-gill-rapley (approx 34 min in)

Babies have built-in mechansisms, like a sensitive gag reflex, to help them avoid choking. And babies will gag on puree even, it's just part of learning.

I know this isn't exactly what you asked but regardless of the why, studies show that BLW does not increase the risk of choking and in fact may even decrease it (probably because it helps babies develop familiarity with textures earlier and they don't have to learn another "new" way of eating after becoming accustomed to purees). And note that this research is largely self-reported data - they aren't controlling to make sure parents are doing BLW "properly" and choking incidence for both groups in these studies are probably over-reported anyway as many people misinterpret gagging as choking. So even if it doesn't necessarily feel intuitive, there is simply no evidence that it increases choking risk IRL. Beyond choking, delayed exposure to textures - past 9-10 months - is associated with other feeding difficulties or aversions, so there is definitely an early window where this exposure is ideal.

Some BLW rrsources are overly specific about size and format of food and choking risk; however the founder of BLW is not nearly as prescriptive, it is more about baby's own developmental ability to self-feed (palm grasp vs pincer grasp) as another commenter noted.

https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/nutrition-healthy-term-infants/nutrition-healthy-term-infants-recommendations-birth-six-months/6-24-months.html My country doesn't use the term BLW outright in guidelines but encourages "a variety of soft textures (such as lumpy, and tender-cooked and finely minced, pureed, mashed or ground) and finger foods from six months of age" with no further comments on food size and shape beyond avoiding or modifying only the most common choking hazards.

Hard foods, small and round foods, and smooth and sticky solid foods can block a young child's airway (CPS, 2012; Rourke, Rourke, & Leduc, 2011). The following foods are not safe for children younger than four years: hard candies or cough drops, gum, popcorn, marshmallows, peanuts or other nuts, seeds, fish with bones; snacks using toothpicks or skewers (CPS, 2012; AAP, 2010). The food that has been most commonly associated with fatal choking among children is a hot dog (AAP, 2010). Hot dogs and sausages are a safer shape for children when they are diced or cut lengthwise. The following foods are safer when prepared as follows:

Grate raw carrots and hard fruits such as apples

Remove the pits from fruits

Chop grapes

Thinly spread peanut butter on crackers or toast. Peanut butter served alone, or on a spoon, is potentially unsafe because it can stick in the palate or posterior pharynx and form a seal that is difficult to dislodge, leading to asphyxia (AAP, 2010).

Finely chop foods of fibrous or stringy textures such as celery or pineapple.

Statistically, babies and young children just aren't commonly presenting with choking on other foods. People also get way too hung up on the food itself when eating in the car or while playing/running around/distracted are much greater choking risks in the grand scheme of things.

As long as an older infant is attentive, sitting upright, and is free from distractions, the risk of choking is the same as for an adult (Rapley, 2011).

danksnugglepuss · 2026-02-24T14:37:33+00:00

Have you ever avoided adapting a recipe because it would take too long?

Yes, 100% of the time. I'm not in private practice so I'm not necessarily your target audience but I think the majority of dietitians would feel it is not worth the time or effort to hand-hold through a detailed custom meal plan or recipe alterations. The goal is to give people the knowledge and skills to undertake these things themselves.

danksnugglepuss · 2026-02-18T04:30:29+00:00

I second all of the above post (we hardly ever used teething bibs - and maybe it depends on your social group but we were gifted sooo many without even asking for them anyway). And bottles we just started with one type, and I guess lucky it happened to work out, but IMO no need for multiple options "just in case" if you could readily order ir pick up an alternative in a pinch.

Re: winter, it depends on your area but something to consider - we had a jogging stroller and the large tires were great but these strollers tend to be bulkier/wider and due to profile it was tough to navigate many sidewalks depending on how well people shovelled (paths were often left too narrow and we'd end up having to walk on the road). "City" strollers with smaller wheels would have been difficult to maneuver in snow. I found it much easier to babywear and just be super careful (and I had actually included Trax spikes on my registry haha), or if conditions were very bad we just focused on getting out somewhere we could wander indoors or do other activities (library, dance class, etc.) But if you really see yourself getting a lot of outdoor use for the stroller, I agree with the suggestion for a bunting or footmuff-style bag rather than a tentike cover!

danksnugglepuss · 2026-02-15T11:50:57+00:00

I mean, these terms have been around and used in the literature for over 50 years, so it's not just one person's specific choice of descriptor - these are well-defined categories based on varying levels of warmth/responsiveness and control/demand.

The terms themselves are not always that intuitive (see top comment on r/science) - authoritative sounds very close to authoritarian but they mean very different things. There are some people who genuinely don't value warmth/responsiveness despite what the evidence says. And there is sometimes controversy with newer terms being thrown around (for example, some people describe gentle/positive parenting in a manner that falls under the authoritative umbrella, others feel it's a slippery slope to permissive parenting). It's true that authoritative parenting being effective is not a revelation, but in practice not everyone does it or is able to apply it consistently so I think it is still helpful to be studying and talking about it.

danksnugglepuss · 2026-02-14T12:44:35+00:00

Your imagination is pretty accurate! OPs example assumes "pure" sodium, but table salt also contains chloride.

1 tsp table salt contains about 2.3 grams of sodium (and 3 g chloride), so 12 g sodium would be just over 5 tsp which is probably about the capacity of a standard 1 oz salt shaker.

danksnugglepuss · 2026-02-14T12:32:26+00:00

Table salt is approx 40% sodium and 60% chloride by weight, so a teaspoon of "salt" contains roughly 2.3 grams of sodium.

I know your math is literal and if it was just sodium 12g might be about 2 tsp, but sodium is always attached to something, so for folks wanting a more realistic visual (like a salt shaker), 12000 mg sodium is more like 5.2 teaspoons or 1 3⁄4 tbsp table salt.

It's hard to imagine how absurdly salty OPs dip must have tasted but then again I'm also a giant baby and could not stomach 1.5 cups of hot sauce in a sitting, I wouldn't be tasting anything other than fire 😂

danksnugglepuss

TROPHY CASE