2 replies to this topic

[Barbies are Evil]

relax, I didn't delete them all...........

Teen Pregancy Pinned Topics

Abortion Websites (Pro Life and Pro Choice)

http://www.helpingteens.org/groups/index.php?showtopic=31500

Sex and Birth Control (Very Important Read)

http://www.helpingteens.org/groups/index.p...mp;#entry201925

Teen Pregnacy Help and Options

http://www.helpingteens.org/groups/index.php?showtopic=7186

This is for Everybody (PREGNANCY SYMPTOMS)

http://www.helpingteens.org/groups/index.php?showtopic=33964

[FranklinF]

****BREAST OR BOTTLE FEEDING****

ok so both choices have advantages and disadvantages. It is really a matter of personal choice. In very few cases a mother is unable to breast feed.

Good websites for Breastfeeding are:

http://www.lalecheleague.org/
http://www.cdc.gov/breastfeeding/
http://www.4woman.gov/breastfeeding/index.cfm?page=home

Good websites for bottle feeding are:

http://www.babycenter.com/refcap/752.html
http://www.askdrsears.com/html/0/T000100.asp

Websites that debate Breast or Bottle:

http://www.kidshealth.org/parent/growth/fe...le_feeding.html

I would suggest speaking with a lactation consultant when you get to the hospital to have your baby if you are unsure. And also if you decide to breastfeed they are a wonderful resource in helping to figure out the technique.

Choosing one form of feeding over another does not make you any less of a mother. Don't allow anyone to tell you otherwise, or make you feel bad, I say this because I have friends who breastfeed and are humiliated by passers by in public, and also friends who bottle-feed and get an earful for not breastfeeding. The best thing to do is to blow them off because they don't know the reason why you chose what you chose.

added
choosing which way and other options such as how long to breast feed for should be disscussed with your pediatrician

This is again a topic of total self choice.

good websites for cloth
http://www.punkinbutt.com/cloth_diapers_101.asp
http://www.sweetcheeksdiapers.com/FAQ.html
http://www.zany-zebra.com/cloth-diapers-101.shtml

good websites for disposable
http://www.luvs.com
http://www.pampers.com
http://www.huggies.com

if you choose to go disposable sign up on the websites they send you samples and ever needed coupons.

debate Cloth or Disposable
http://www.thenewparentsguide.com/diapers.htm

my opinion.
i chose disposable, for the simple reason, i don't have a washer and dryer. i have tried Huggies and Pampers so far. My sister swears by huggies but i like pampers more. They are softer than huggies, and i found that, atleast on my kid, pampers tend to leak less. You will probably have to experiment to find which brand you like best. And ofcourse there is price to consider, Wal-mart has thier own brand that is alot more reasonably priced, I haven't tried them yet, but i am sure once we use all the diapers we received at the baby shower we will.

from http://www.aap.org/family/carseatguide.htm
i used this well because it covers all the points

Quote

Car Safety Seats: A Guide for Families
2006

Each year thousands of young children are killed or injured in car crashes. You can help
prevent this from happening to your child by always using car safety seats and seat belts correctly.
The information below explains how.

Which car safety seat is the best?

No one seat is the "best" or "safest." The best seat is the one that fits your child's size, is
correctly installed, and is used properly every time you drive. When shopping for a car
safety seat, keep the following in mind:

* Don't base your decision on price alone. Higher prices can mean added features that may or may not make the seat safer or easier to use. All car safety seats available for purchase in the United States must meet very strict safety standards established and maintained by the federal government.
* When you find a seat you like, try it out. Put your child in it and adjust the harnesses and buckles. Make sure it fits properly and securely in your car. Keep in mind that pictures or displays of car safety seats in stores may not show them being used the right way.

Important safety rules

* Always use a car safety seat. You can start with your baby's first ride home from the hospital.
* Never place a child in a rear-facing car safety seat in the front seat of a vehicle that has a passenger air bag.
* The safest place for all children to ride is in the back seat.
* Set a good example - always wear your seat belt. Help your child form a lifelong habit of buckling up.
* Remember that each car safety seat is different. Read and keep the instructions that came with your seat handy, and follow the manufacturer's instructions at all times.
* Read the owner's manual that came with your car on how to correctly install car safety seats.
* If you need help installing your car safety seat, contact a certified Child Passenger Safety (CPS) Technician. To locate and set up an appointment, call toll-free at 866/SEATCHECK (866/732-8243) or visit www.seatcheck.org.

Rear-facing seats

All infants should ride rear-facing until they have reached at least 1 year of age and weigh at least 20 pounds. That means that if your baby reaches 20 pounds before her first birthday, she should remain rear-facing until she turns 1.

There are 2 types of rear-facing seats: infant-only seats and convertible seats. Convertible seats can be used rear-facing for infants, and then converted to a forward-facing position once the child is old enough and big enough to do so safely.

Infant-only seats

* Small and have carrying handles (sometimes come as part of a stroller system).
* Have a built-in harness that covers the child's upper torso.
* Can only be used for infants from birth up to 20 to 30 pounds, depending on model.
* Many come with a detachable base, which can be left in the car. The seat clicks into and out of the base, which means you don't have to install it each time you use it.

Convertible seats (used rear-facing)

* Are used rear-facing for infants from birth to at least 1 year of age and at least 20 to 22 pounds. Can also be used forward-facing by older children.
* Have higher rear-facing weight limits than infant-only seats. These are ideal for bigger babies.
* Have the following 3 types of harnesses:
convertible seats
- 5-point harness - 5 points of attachment: 2 at the shoulders, 2 at the hips, 1 at the crotch
- Overhead shield - A padded tray-like shield that swings down over the child
- T-shield - A padded t-shaped or triangle-shaped shield attached to the shoulder straps

Features to look for in rear-facing seats

* Harness slots. Look for seats that come with more than one harness slot to give your baby room to grow. The harnesses should be in the slots at or below your baby's shoulders.
* Adjustable buckles and shields. Many rear facing seats have 2 or more buckle positions for growing babies. Many overhead shields can be adjusted as well.
* Other features. Angle indicators (built-in angle adjusters that help you get the proper recline) and head support systems are other features that can help you install the seat the right way.

forward-facing seat
Forward-facing seat

Forward-facing seats

Once your child is at least 1 year of age and at least 20 pounds, he can ride forward-facing. However, it is best for him to ride rear-facing until he reaches the highest weight or height limit allowed by the car safety seat. There are many types of seats that can be used forward-facing including convertible seats, built in seats, combination forward-facing/booster seats, and travel vests.


Convertible seats (used forward-facing)

As mentioned previously, convertible seats can also be used forward-facing by children who are at least 1 year of age and weigh at least 20 pounds. However, if you have used
your convertible seat rear-facing, you need to make the following 3 adjustments before using it forward-facing:

1. Move the shoulder straps to the slots that are at or above your child's shoulders. On many convertible seats, the top harness slots must be used when the seat is in the forward-facing position. Check the instructions to be sure.
2. Move the seat from the reclined to the upright position if required by the manufacturer of the seat.
3. Make sure the seat belt runs through the forward-facing belt path.

When converting your seat from rear-facing to forward-facing, carefully follow the car safety seat manufacturer's instructions.

Built-in seats

Built-in seats are available in some cars and vans. Weight and height limits vary. Read your vehicle owner's manual or contact the manufacturer for details about how these seats are used.

Combination forward-facing/booster seats
Some car safety seats combine the features of a forward-facing seat and a booster seat. These seats come with harness straps for children who weigh up to 40 to 65 pounds (depending on the model). Once your child reaches the weight or height limit, you can use the seat as a booster by removing the harness and using your vehicle's lap and shoulder seat belts. Keep in mind that when using the harness straps, the seat can be secured with a lap and shoulder belt or a lap-only belt. However, once you remove the harness, you must use a lap and shoulder seat belt. Children must never ride in a booster seat using a lap belt only because serious injury can result.

Travel vests
If your car only has lap belts, a travel vest may be an option. These can also be used for a child who has outgrown his seat with a harness but is not yet ready for a booster seat.

Booster seats

Booster seats do not come with harness straps but are used with the lap and shoulder seat belts in your vehicle, the same way
belt-positioning booster seat
Belt-positioning booster seat
an adult rides. Your child should stay in a car safety seat with a harness as long as possible before being allowed to ride in a booster seat. You can tell when your child is ready for a booster seat when one of the following is true:

* She reaches the top weight or height allowed for her seat with a harness. (These measurements are listed on labels on the seat and are also included in the instruction booklet that is provided with the car safety seat.)
* Her shoulders are above the harness slots.
* Her ears have reached the top of the seat.

Booster seats are designed to raise your child so that the lap and shoulder seat belts fit properly. This means the lap belt lies low across your child's thighs and the shoulder belt crosses the middle of your child's chest and shoulder. Correct belt fit helps protect the stomach, spine, and head from injury in case of a crash. Both high-back and backless booster seats are available. Booster seats should be used until your child can correctly fit in lap and shoulder seat belts.

Seat belts

Your child is ready to use lap and shoulder seat belts when the belts fit properly.
This means

* The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.
* The lap belt is low and snug across the thighs, not the stomach.
* The child is tall enough to sit against the vehicle seat back with her legs bent without slouching and can stay in this position comfortably throughout the trip.

Remember, seat belts are made for adults. If the seat belt does not fit your child correctly, he should stay in a booster seat until the adult seat belts fit him correctly. This is usually when the child reaches about 4' 9" in height and is between 8 and 12 years of age.

Other points to keep in mind when using seat belts

* Never tuck the shoulder belt under the child's arm or behind the back.
* If there's only a lap belt, make sure it's snug and low on the child's thighs, not across the stomach. Try to get a lap and shoulder belt installed in your car by a dealer.
* Never allow children or anyone else to "share" seat belts. All passengers must have their own car safety seats or seat belts.

A warning about seat belt adjusters

There are products on the market that claim to make seat belts fit better. They attach to the seat belt but are not a part of the original belt. These products may actually interfere with proper lap and shoulder belt fit by causing the lap belt to ride too high on the stomach and making the shoulder belt too loose, and may even damage the seat belt itself. No federal standard ensuring the effectiveness and safety of these after-market products has been developed. In addition, most vehicle and car safety seat manufacturers do not recommend their use. Until the National Highway Traffic Safety Administration develops safety standards for these products, the American Academy of Pediatrics (AAP) recommends they not be used. As long as children are riding in the correct car safety seat for their size and age, they do not need to use any additional devices.

Installing a car safety seat

There are 2 main things to remember when installing a car safety seat.

* Your child must be buckled snugly into the seat.
* The seat must be buckled tightly into your vehicle.

Ask yourself the following questions to make sure both are done correctly. If you are not sure, check the instructions that came with your car safety seat, or contact a certified CPS Technician for help.

Is the child buckled into the car safety seat correctly?

* Are you using the correct harness slots?
* Are the harnesses snug?
* Have you placed the plastic harness clip (if your seat comes with one) at armpit level to hold the shoulder straps in place?
* Do the harness straps lie flat?
* Is your baby dressed in clothes that allow the straps to go between the legs? It's OK to adjust the straps to allow for thicker clothes, but make sure the harness still holds the child snugly. Also, remember to tighten the straps again after the thicker clothes are no longer needed.
* Is anything under your baby? Tuck blankets around your baby after adjusting the harness straps snugly. Never place them under your baby.
* Is your child slouching down or to the side? If so, pad the sides of the seat and between the crotch with rolled up diapers or blankets.

Is the car safety seat buckled into the vehicle correctly?

* Is the car safety seat facing the right direction for your child's age and weight?
* Is the seat belt routed through the correct belt path?
* Is the seat belt buckled tight? If you can move the seat more than an inch side to side or toward the front of the car, it's not tight enough.
* Is your rear-facing seat reclined enough? Your infant's head should not flop forward. If it does, tilt the car safety seat back a little. Your car safety seat may have a built-in recline adjuster for this purpose. If not, wedge firm padding, such as a rolled towel, under the base.
* Do you need a locking clip? They come with all new car safety seats. If the seat belts in your car move freely even when buckled, you need a locking clip. If you're not sure, check the manual that came with your car. Locking clips are not needed in most newer vehicles and in vehicles with LATCH. (See "Installation made safer and easier" below for more information.)
* Some lap belts (especially those found in older vehicles) need a special heavy-duty locking clip. These are only available from the vehicle manufacturer. Check the manual that came with your car for more information.

Installation made safer and easier

Child passenger safety experts have developed several ways to make car safety seat installation safer and easier, including the following:

* LATCH (Lower Anchors and Tethers for Children) is an attachment system that makes installing a car safety seat easier by eliminating the need to use seat belts to secure the car safety seat. It includes 2 sets of small bars, called anchors, located in the back seat where the cushions meet. Car safety seats that come with LATCH have a set of attachments that fasten to these vehicle anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, come with LATCH. However, unless both your vehicle and the car safety seat have this anchor system, you will still need to use seat belts to secure the car safety seat.
* A tether is a strap that attaches a car safety seat to an anchor located on the rear window ledge, the back of the vehicle seat, or on the floor or ceiling of the vehicle. Tethers give extra protection by keeping the car safety seat and the child's head from moving too far forward in a crash or sudden stop. Tethers should not be confused with LATCH attachments; the tether is a longer strap at the top of the seat and LATCH attachments are located at or near the base of the seat. All new cars, minivans, and light trucks have been required to have tether anchors since September 2000. Most new forward-facing car safety seats and a few rear-facing car safety seats come with tethers. For older car safety seats, tether kits are available. It is highly recommended that tethers be used because they greatly improve the protection of your child in the event of a crash. Check with the car safety seat manufacturer to find out how you can get a tether for your seat if yours does not have one.
* Child Passenger Safety (CPS) Technicians can help you. If you have more questions about installing your car safety seat, a certified CPS Technician may be able to help. A list of certified CPS Technicians is available by state or ZIP code on the National Highway Traffic Safety Administration (NHTSA) Web site at www.nhtsa.dot.gov/people/injury/childps/contacts/. A list of inspection stations- where you can go for help with installation-is available in both English and Spanish at www.seatcheck.org or toll-free at 866/SEATCHECK (866/732-8243). You can also get this information by calling the toll-free NHTSA Auto Safety Hot Line at 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.

Car safety seats and shopping carts
Many infant-only car safety seats lock into shopping carts, and many stores have shopping carts with built-in infant seats. This may seem safe but your baby could tip over or fall out of the cart. Thousands of children are hurt every year from falling from shopping carts or from the carts tipping over. Instead of placing your baby's car safety seat on the cart, consider using a stroller or frontpack while shopping with your baby.

Common questions about car safety seats

Q: What if my baby is born prematurely?
A: Use a car safety seat without a shield harness. Shields often are too high and too far from the body to fit correctly. A small baby's face could hit a shield in a crash. Premature infants should be observed in their car safety seats while still in the hospital
to make sure the reclined position does not cause low heart rate, low oxygen, or breathing problems. If your baby needs to lie flat during travel, use a crash-tested car bed. If possible, an adult should ride in the back seat next to your baby to watch him closely.

Q: What if my baby weighs more than 20 pounds but is not 1 year old yet?
A: Many babies reach 20 pounds well before their first birthday. However, just because your baby weighs more than 20 pounds does not make him ready to ride forward facing. Look for a convertible seat that can be used rear-facing by children who weigh more than 20 pounds.

Q: What if my child has special health care needs?
A: Children with special health problems may need other restraint systems. Talk about this with your pediatrician. Easter Seals, Inc has car safety seat programs for children with special health care needs. More information is available from Easter Seals, Inc at 800/221-6827. You also can learn more about transporting children with special needs by calling the Automotive Safety Program at 317/274-2977 or by visiting its Web site at www.preventinjury.org. For more information and a list of car safety seats available for children with special needs, see the AAP brochure, Safe Transportation of Children With Special Needs: A Guide for Families.

Q: What if my car has air bags?
A: All new cars come equipped with air bags. When used with seat belts, air bags work very well to protect older children and adults. However, air bags are very dangerous to children riding in rear-facing car safety seats and to child passengers who are not properly positioned. If your car has a passenger air bag, infants in rear-facing seats must ride in the back seat. Even in a low-speed crash, the air bag can inflate, strike the car safety seat, and cause serious brain and neck injury and death.

Toddlers who ride in forward-facing car safety seats also are at risk from air bag injuries. All children up to age 13 years are safest in the back seat. If you must put an older child in the front seat, slide the vehicle seat back as far as it will go. Make sure your child is properly restrained for his age and size and stays in the proper position at all times. This will help prevent the air bag from striking your child.

Air bag on/off switches are available in the few cases in which an infant must ride in the front seat. Most families don't need to use the air bag on/off switch. Air bags that are turned off cannot protect other passengers riding in the front seat. Air bag on/off switches only should be used if all of the following are true:

* Your child has special heath care needs.
* Your pediatrician recommends constant supervision of your child during travel.
* No other adult can ride in the back seat with your child.

On/off switches also must be used if you have a vehicle with no back seat or a back seat that is not made for passengers.

Q: What if my car has side air bags?
A: Side air bags improve safety for adults in side impact crashes. However, children who are seated near a side air bag may be at risk for serious injury. Read your vehicle owner's manual for recommendations that apply to your vehicle.

Q: What if my car only has lap belts in the back seat?
A: Lap belts work fine with infant-only, convertible, and forward-facing car safety seats. They cannot be used with booster seats, and they are not the safest way to buckle older children. If your car only has lap belts, use a forward-facing car safety seat with a
harness and higher weight limits. Other options are

* Check with a car dealer or the manufacturer of your car to see if shoulder belts can be installed.
* Use a travel vest (some can be used with lap belts).
* Consider buying another car with lap and shoulder belts in the back seat.

Q. What if I drive more children than can be buckled safely in the back seat?
A: Avoid having to drive more children than can be buckled safely in the back seat, especially if your car has passenger air bags. However, if necessary, a child in a forward facing car safety seat with a harness may be the best choice to ride in the front seat. This is because a child who is in a booster seat or using a regular seat belt can easily move out of position and be at greater risk for injuries from the air bag.

Q: Can I use a car safety seat on an airplane?
A: The Federal Aviation Administration (FAA) and the AAP recommend that when flying, children should be securely fastened in car safety seats until 4 years of age, and then should be secured with the airplane seat belts. This will help keep them safe during takeoff and landing or in case of turbulence. Most infant, convertible, and forward-facing seats are certified to be used on airplanes. Booster seats and travel vests are not certified to be used on airplanes. Check the label on your car safety seat and call the car safety seat manufacturer before you travel to be sure your seat meets current FAA regulations.

Q: Can I use a car safety seat that was in a crash?
A: If the car safety seat was in a moderate or severe crash, it needs to be replaced. If the crash was minor, the seat does not automatically need to be replaced. A crash is considered minor if all of the following are true:

* The vehicle could be driven away from the crash.
* The vehicle door closest to the car safety seat was not damaged.
* No one in the vehicle was injured.
* The air bags did not go off.
* You can't see any damage to the car safety seat.

If you are unsure, call the manufacturer of the seat. See the resource section for manufacturer names and phone numbers.

Q: What about using a used car safety seat?
A: Avoid using used car safety seats, especially if obtained from a yard sale or secondhand (consignment) shop because there is no way to know the seat's history. Also never use a car safety seat that

* Is too old. Look on the label for the date it was made. Do not use seats that are more than 10 years old. Many manufacturers recommend that car safety seats only be used for 5 to 6 years from the date of manufacture. Check with the manufacturer to find out how long the company recommends using its seat.
* Has any visible cracks in the frame of the seat.
* Does not have a label with the date of manufacture and model number. Without these, you cannot check to see if the seat has been recalled.
* Does not come with instructions. You need them to know how to use the seat. You can get a copy of the instruction manual by contacting the manufacturer.
* Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.
* Is a shield booster. Although shield boosters are still around, the AAP recommends against their use. Major injuries have occurred to children in shield boosters. The only time shield boosters should be used is if the shield is removed and the seat is used with a lap and shoulder belt. (See "Booster seats" on page 8.)
* Was recalled. You can find out by calling the manufacturer or by contacting the following:
- Auto Safety Hot Line: Toll-free: 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.
- National Highway Traffic Safety Administration (NHTSA) www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm

If the seat has been recalled, be sure to follow the instructions to fix it or to get the parts you need. You also may get a registration card for future recall notices from the hotline.

Don't leave your child unattended in a car safety seat

Children should never be left alone in a car whether they are in their car safety seats or not. Any of the following can happen when a child is left alone in a vehicle:

* Temperatures can reach deadly levels in minutes, and the child can die of heat stroke.
* He can be strangled by power windows, sunroofs, or accessories.
* He can be taken during a car theft or kidnapped from the vehicle.
* He can knock the vehicle into gear, setting it in motion.

Don't leave your baby unattended in a car safety seat outside of the vehicle either. When your baby falls asleep in her car safety seat, it can be tempting to bring her inside and leave her alone in the seat, but this can be unsafe. Your baby can fall out of the seat, or the seat can fall over. And remember, placing the car safety seat on a shopping cart is unsafe too. The best place for your baby to sleep is on her back in a safe crib.

Always read and follow manufacturer's instructions

If you do not have the manufacturer's instructions for your car safety seat, write or call the company's customer service department. A representative will ask you for the model number, name of seat, and date of manufacture. The manufacturer's address and phone number are on the label on the seat.

All products listed on the following pages meet Federal Motor Vehicle Safety Standard 213 as of the date of publication. There may be car safety seats available that are not listed in this brochure. The following information is current as of the date of publication. Before buying a car safety seat, check the manufacturer's instructions for important safety information about proper fitting and use.

Although the American Academy of Pediatrics (AAP) is not a testing or standard-setting organization, this guide sets forth the AAP recommendations based on the peer-reviewed literature available at the time of its publication, and sets forth some of the factors that parents should consider before selecting and using a car safety seat. The appearance of the name American Academy of Pediatrics (AAP) does not constitute a guarantee or endorsement of the products listed or the claims made. Phone numbers and Web site addresses are as current as possible, but may change at any time. Prices are approximate and may vary. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Manufacturers names are boldfaced.

Infant-only seats
Name Harness Type Rear-Facing
Weight Limits Height Limits Price
Baby Trend Latch-Loc
Adjustable Back 5-point 5-22 pounds 28 1/2" $80
Britax Baby Safe 5-point 4-22 pounds 30" $299.00
Britax Companion 5-point 4-22 pounds 30" $169.99
Chicco Key Fit Infant Car Seat 5-point 4-22 pounds 30" $140
COMBI Centre/ST/DX/EX 5-point 5-22 pounds 29" $89-$99
COMBI Connection 5-point 5-22 pounds 29" $199.99
COMBI Tyro Infant Car Seat 5-point 22 pounds 29" $129-$149
Compass Baby I400 LP Infant Car Seat 5-point 4-22 pounds 30" $100-140
Cosco Arriva 5-point 5-22 pounds 29" $40
Eddie Bauer Infant Car Seat 5-point 5-22 pounds 29" $90-$100
Eddie Bauer Comfort Infant Car Seat 5-point 5-22 pounds 29" $100
Evenflo Discovery 3-point 5-22 pounds 28" $50-$60
Evenflo Embrace 5-point 5-22 pounds 28" $60-$90
Graco Infant Safe Seat 5-point 5-30 pounds 32" $129-$169
Graco SnugRide 3-point
5-point 5-22 pounds 29" $69-$120
Peg Perego Primo Viaggio 5-point 22 pounds 30" $179-$199
Safety 1st Designer 22 5-point 5-22 pounds 29" $60-$80
Safety 1st First Ride DX 5-point 5-22 pounds 29" $50
Safety 1st Starter 5-point 5-22 pounds 29" $60

Convertible seats
Name Harness Type Rear-Facing
Weight Limits/
Height Limits Forward-Facing
Weight Limits/
Height Limits Price
Britax Boulevard 5-point 5-33 pounds 20-65 pounds
27" - 49" $289.99
Britax Decathlon 5-point 5-33 pounds 20-65 pounds
27" - 49" $269.99
Britax Roundabout with Latch 5-point 5-33 pounds 20-40 pounds
27"-40" $199.99
Britax Marathon 5-point 5-33 pounds 20-65 pounds
27"-49" $249.99
COMBI Avatar 5-point 5-30 pounds 20-40 pounds $179-$199
Cosco Alpha Omega
(rear-facing, forward-facing, or booster) 5-point
5-35 pounds
and 36" 22-40 pounds and 43" with harness;
40-80 pounds and 52" as booster $140

Cosco Alpha Omega Elite
(rear-facing, forward-facing, or booster)
5-point 5-35 pounds and 36" 20-40 pounds and 40" with harness;
30-100 pounds and 52" as booster $150-$160
Cosco Scenera/DX 5-point
Overhead shield 5-35 pounds and 36" 22-40 pounds and 43" $50-$70
Cosco Touriva/Regal Ride 5-point
5-35 pounds and 36" 22-40 pounds and 43" $40-$70
Eddie Bauer 3-in-1 (rear-facing, forward-facing, or booster) 5-point 5-35 pounds and 36" 22-40 pounds and 43" with harness;
40-80 pounds and 52" as booster $170
Eddie Bauer Deluxe 3-in-1 Convertible Car Seat (rear-facing, forward-facing, or booster) 5-point
Overhead shield 5-35 pounds and 36" 20-40 pounds and 40" with harness
30-100 pounds and 52"as booster $170-$180
Evenflo Titan 5 5-point
5-30 pounds 20-40 pounds $60-$70
Evenflo Tribute 5/DLX 5-point
Overhead shield 5-30 pounds 20-40 pounds $50-$60
Evenflo Triumph 5/DLX 5-point 5-30 pounds 20-40 pounds $120-$140
Graco ComfortSport 5-point
30 pounds 20-40 pounds and 40" $69-$120
Lenox TattleTale Smart Child Seat 5-point

5-33 pounds
19"-32"
20-40 pounds and 29"-40" $209-$259
Safety 1st Enspira (rear-facing, forward-facing, or booster) 5-point
5-35 pounds 36" 22-40 pounds and 43" with harness
40-80 pounds and 52" as booster $100
Safety 1st Intera 5-point 5-35 pounds 36" 22-40 pounds and 43" with harness
40-100 pounds and 57" as booster $140
Sunshine Kids Radian Car Seat 5-point 5-33 pounds 65 pounds and 49" $199
Tripleplay Products Sit n' Stroll 5-point 5-30 pounds 20-40 pounds $200

Combination seats
(Can be used with 5-point harness or as belt-positioning booster.)
Name Weight Limits/
Height Limits
With Harness Weight Limits/
Height Limits as
Belt Positioner Price
Cosco High Back Booster 22-40 pounds
43" 40-80 pounds
52" $50
Cosco Summit 22-40 pounds
43" 40-100 pounds
52" $90-$100
Cosco Ventura DX 22-40 pounds
43" 40-80 pounds
52" $60
Eddie Bauer Comfort High Back Booster, Deluxe 22-40 pounds
43" 40-100 pounds
52" $80-$120
Eddie Bauer High Back Booster 22-40 pounds
43" 40-80 pounds
52" $80
Evenflo Express, Chase, Traditions, Vision 20-40 pounds 30-100 pounds
54" $50-$70
Evenflo Generations, Bolero 20-40 pounds 30-100 pounds
57" $70-$100
Graco Platinum/Treasured/Ultra CarGo 20-40 pounds
27"-43" 30-100 pounds
35"-54" $69-$99
Lenox TattleTale Smart Child seat 20-40 pounds
29"-40" 40-80 pounds
35"-57" $259
Recaro Young Sport 18-40 pounds
27"-40" 30-80 pounds
37"-59" $249
Safety 1st Apex 65 20-65 pounds
52" 40-100 pounds
57" $130
Safety 1st Vantage Point, Surveyor 22-40 pounds
43" 40-100 pounds
52" $70-$80

Forward-facing seats/restraints
Name Harness Type Weight Limits Height Limits Price
Britax Regent 5-point 22-80 pounds 19"-53" $239.99
Graco Toddler Safe Seat 5-point 20-40 pounds 27"-43" $129-$169
SafeGuard Child Seat 5-point 22-65 pounds 57" $429

Booster seats
Name Type Weight Limits Height Limits
(when available) Price
Baby Trend Recaro High back 30-80 pounds 37"-59" $349
Britax Bodyguard High back 40-100 pounds 43"-60" $129.99
Britax Parkway Booster High back 30-100 pounds 38"-60" $99.99
Britax Starriser Comfy High back 30-80 pounds 33"-53" $89.99
COMBI Dakota Backless 33-100 pounds 33"-57" $39-$59
COMBI Kobuk High back 33-100 pounds 33"-57" $79-$89
Compass Baby B500LP Folding Booster Car Seat High back 30-100 pounds 38"-57" $75-$90
Cosco High Rise, Ambassador Backless 30-100 pounds 57" $15-$20
Cosco Protek High back
Backless 30-100 pounds 57" $30-$40
Cosco Select Ride High back 40-80 pounds 52" $30
Cosco Traveler High back 30-80 pounds 52" $20
Cosco Voyager High back 40-80 pounds 52" $20-$25
Evenflo Big Kid Deluxe/LX, Everest High back
Backless 30-100 pounds
40-100 pounds 57" $40-$80
Evenflo Big Kid No Back Backless 40-100 pounds 57" $15
Evenflo Sightseer/Barbie/Hot Wheels High back 30-100 pounds 37"-54" $30-$40
Graco My CarGo High back 30-100 pounds 35"-54" $40
Graco TurboBooster High back
Backless 30-100 pounds
40-100 pounds 38"-57"
40"-57" $50-$80
$20
LaRoche Grizzly Bear Booster High back 40-100 pounds 36"-57" $119
LaRoche Polar Bear Booster High back 30-100 pounds 33"-57" $129
LaRoche Teddy Bear Booster High back 30-80 pounds 33"-54" $109
Recaro Start High back 30-80 pounds 59" $349
Recaro Young Style High back 30-80 pounds 59" $149
Safety Angel Ride Ryte High back
Backless 30-100 pounds
40-100 pounds 33"-54" $70-$75
$45-$48

Travel vests
Name Weight Limits/Age Limits Price
E-Z-On Vest 20-168 pounds $120
E-Z-On Modified Vest 20-100 pounds
2-12 years of age $120-$140
E-Z-On 86Y Harness 66-168 pounds $60-$80
E-Z-On Kid Y Harness
(must be used with the Ride Ryte booster) 30-80 pounds $48-$52
RideSafer Travel Vest 35-60 pounds small vest (3-6 years)
50-80 pounds large vest (5-9 years) $99.99
Safety 1st Tote 'n Go DX 25-40 pounds with harness $20

Built-in (integrated) seats
Built-in or integrated child safety seats are available on selected models from some motor vehicle manufacturers. Check with the manufacturers for specifics.

Manufacturer phone numbers and Web sites
For more information on the seats listed in this guide, please contact the individual manufacturers.
Baby Trend
800/328-7363
www.babytrend.com
Britax Child Safety
888/427-4829
www.britaxusa.com
Chicco USA
www.chiccousa.com
COMBI International
800/992-6624
www.combi-intl.com
Compass Baby
888/899-BABY
www.compassbaby.com
Cosco, Inc.
800/544-1108
www.coscojuvenile.com
Eddie Bauer
800/544-1108
www.djgusa.com/eddiebauer
Evenflo Company Inc.
800/233-5921
www.evenflo.com
EZ On Products/Safety Angel
800/323-6598
www.ezonpro.com
Graco
800/345-4109
www.gracobaby.com
IMMI/SafeGuard
800/974-7798
www.safeguardseat.com
Jupiter Industries
800/465-5795
www.jupiterindustries.com
LaRoche Brothers, Inc.
978/632-8638
Lenox Juvenile Group
888/372-0622
www.smartchildseat.com
Peg Perego USA, Inc.
800/671-1701
www.pegperego.com
Recaro of North America
800-8-RECARO
www.recaro-nao.com
Safety 1st
800/544-1108
www.safety1st.com
Safe Traffic Systems, Inc
847/329-8111
www.safetrafficsystem.com
Sunshine Kids Juvenile Products
888/336-7909
www.sunshinekidsjp.com
TriplePlay Products, LLC
800/829-1625
www.tripleplayproducts.com


Although the American Academy of Pediatrics (AAP) is not a testing or standard setting organization, this guide sets forth the AAP recommendations based on the peer-reviewed literature available at the time of its publication, and sets forth some of the factors that parents should consider before selecting and using a car safety seat.
The appearance of the name American Academy of Pediatrics (AAP) does not constitute a guarantee or endorsement of the products listed or the claims made. Phone numbers and Web site addresses are as current as possible, but may change at any time.
Prices are approximate and may vary.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Photographs courtesy of the National Highway Traffic Safety Administration. [/b]

ok there are many things to discuss in this topic
Shot Schedule
remember to bring the shot record sheet they gave you in the hostpital.
http://www.cdc.gov/nip/recs/child-schedule.htm#printable

Quote

1. Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth:
• Administer monovalent HepB to all newborns prior to hospital discharge.
• If mother is HBsAg-positive, administer HepB and 0.5 mL of hepatitis B immune
globulin (HBIG) within 12 hours of birth.
• If mother's HBsAg status is unknown, administer HepB within 12 hours of birth.
Determine the HBsAg status as soon as possible and if HBsAg-positive, administer
HBIG (no later than age 1 week).
• If mother is HBsAg-negative, the birth dose can only be delayed with physician's
order and mothers' negative HBsAg laboratory report documented in the infant's
medical record.
Following the birth dose:
• The HepB series should be completed with either monovalent HepB or a combination
vaccine containing HepB. The second dose should be administered at age 1–2
months. The final dose should be administered at age ≥24 weeks. Infants born
to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg
after completion of 3 or more doses in a licensed HepB series, at age 9–18
months (generally at the next well-child visit).
4-month dose of HepB:
• It is permissible to administer 4 doses of HepB when combination vaccines are
given after the birth dose. If monovalent HepB is used for doses after the birth
dose, a dose at age 4 months is not needed.

2. Rotavirus vaccine (Rota). (Minimum age: 6 weeks)
• Administer the first dose between 6 and 12 weeks of age. Do not start the series
later than age 12 weeks.
• Administer the final dose in the series by 32 weeks of age. Do not administer a
dose later than age 32 weeks.
• There are insufficient data on safety and efficacy outside of these age ranges.

3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).
(Minimum age: 6 weeks)
• The fourth dose of DTaP may be administered as early as age 12 months, provided
6 months have elapsed since the third dose.
• Administer the final dose in the series at age 4–6 years.

4. Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks)
• If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages
2 and 4 months, a dose at age 6 months is not required.
• TriHiBit® (DTaP/Hib) combination products should not be used for primary immunization
but can be used as boosters following any Hib vaccine in ≥12 months olds.

5. Pneumococcal vaccine. (Minimum age: 6 weeks for Pneumococcal Conjugate
Vaccine (PCV); 2 years for Pneumococcal Polysaccharide Vaccine (PPV))
• Administer PCV at ages 24-59 months in certain high-risk groups. Administer
PPV to certain high-risk groups aged ≥2 years. See MMWR 2000; 49(RR-9):1-35.

6. Influenza vaccine. (Minimum age: 6 months for trivalent inactivated influenza
vaccine (TIV); 5 years for live, attenuated influenza vaccine (LAIV)
• All children aged 6–59 months and close contacts of all children aged 0–59
months are recommended to receive influenza vaccine.
• Influenza vaccine is recommended annually for children aged ≥59 months with
certain risk factors, healthcare workers, and other persons (including household
members) in close contact with persons in groups at high risk. See MMWR
2006; 55(RR-10);1-41.
• For healthy persons aged 5–49 years, LAIV may be used as an alternative to TIV.
• Children receiving TIV should receive 0.25 mL if aged 6–35 months or 0.5 mL if
aged ≥3 years.
• Children aged <9 years who are receiving influenza vaccine for the first time
should receive 2 doses (separated by ≥4 weeks for TIV and ≥6 weeks for LAIV).

7. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)
• Administer the second dose of MMR at age 4–6 years. MMR may be administered
prior to age 4–6 years, provided ≥4 weeks have elapsed since the first
dose and both doses are administered at age ≥12 months.

8. Varicella vaccine. (Minimum age: 12 months)
• Administer the second dose of varicella vaccine at age 4–6 years. Varicella
vaccine may be administered prior to age 4–6 years, provided that ≥3 months
have elapsed since the first dose and both doses are administered at age ≥12
months. If second dose was administered ≥28 days following the first dose,
the second dose does not need to be repeated.

9. Hepatitis A vaccine (HepA). (Minimum age: 12 months)
• HepA is recommended for all children at 1 year of age (i.e., 12–23 months).
The 2 doses in the series should be administered at least 6 months apart.
• Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits.
• HepA is recommended for certain other groups of children including in areas
where vaccination programs target older children. See MMWR 2006; 55(RR-7):1-23.

10. Meningococcal polysaccharide vaccine (MPSV4). (Minimum age: 2 years)
• Administer MPSV4 to children aged 2–10 years with terminal complement
deficiencies or anatomic or functional asplenia and certain other high risk
groups. See MMWR 2005;54 (RR-7):1-21.[/b]

my advice
keep a running list of questions you might have, your brain will get frazzled once you get into the doctor
if you think there may be something wrong even if it is small dont hesitate to call the,
the nurses can be a bit bitchy at times, dont take it personally they deal with lots of sick screaming kids all day

[FranklinF]

Ok In this topic we will discuss what goes on at your doctors appointments, ultrasounds, things you should look out for, and other such things.

Early Prenatal care is very important. As soon as you think you are pregnant get into a doctor if at all possible. If you are scared your parents will find out go to your regular doctor or head to a family planning clinic.

Quote

Your First Pregnancy (from http://www.obfocus.com/prenatal/firstpreg.htm)
By M.Hellen Rodriguez,MD

SEARCH
Being pregnant for the first time can be a very exciting yet scary time in a woman’s life. There are many physical and emotional changes, which occur with pregnancy. Understanding these changes will help you and your partner prepare for the weeks and months to come and will help you differentiate what is normal and what should be a cause of concern which you should address with your physician. Table 1 lists some of the normal symptoms of pregnancy.

Dr. Rodriguez is a board-certified perinatologist and co-director of maternal-fetal medicine at the Pomona Valley Hospital Medical Center in Pomona , Calif.

Many of the changes that you will experience are triggered by hormones that nurture the baby and prepare your body for childbirth and nursing. Additionally, as your baby grows, the size of your uterus increases to about 1000 times its original size putting strain on the organs that surround the uterus, on your back muscles and causing a change in your posture.


Table1. Symptoms of Pregnancy
NORMAL

* Breast tenderness
* Constipation
* Frequent urination
* Heartburn
* Hemorrhoids
* Mood swings
* Nausea
* Stuffy nose

ABNORMAL

* Bleeding
* Headache unrelieved by analgesic.
* Painful urination
* Stomach pains
* Swelling of one leg
* Visual problems
* Weight loss

Your breasts may be one of the first indicators of your pregnancy. By 6 - 8 weeks your breasts will be noticeably larger they will continue to grow in size and weight throughout the first trimester. They are usually firm and tender and the nipples and areolas will darken. The small glands in the areola will become raised and bumpy. By 12 -14 weeks the breasts may begin producing colostrum, this fluid may leak from your breast by itself or if you massage your breasts.

Nausea and vomiting are also common findings during the first 3 months, but may occur throughout the pregnancy. Although it is referred to as morning sickness it can occur any time during the day particularly on an empty stomach. It is not unusual for a woman to loose some weight during the early part of the pregnancy but if this becomes excessive you should notify your physician.

Heartburn , indigestion and constipation are also a common finding because changes in hormones slow the movement of food through the digestive tract. During the last part of pregnancy pressure on your rectum to your uterus often worsens the constipation.

Hemorrhoids, swollen veins in the rectum, are also very common and can sometimes cause bleeding while having a bowel movement. If the bleeding is excessive notify your physician. Swollen veins (varicosities), also appear frequently in the legs but can also be found in the vulva and vagina. Varicosities can be uncomfortable but usually they are not a serious condition.

Table 2. Safe Medications For Some Common
Problems During Pregnancy
Symptom
# Heartburn
-TUMs®
# Constipation
-Metamucil® ,
-Citrucel®,
- Docusate (Colace®, Ducolax ®)
-Milk of magnesia.
# Hemorrhoids
-Tucks®
-Preparation H®
-Anusol®

Groin or lower abdominal pain is also a common finding as the round ligaments that support the uterus are stretched.

There is also a need to urinate frequently caused by the pressure of the growing uterus on the bladder. As the pregnancy continues it may also be normal to leak some urine. If you have pain when you urinate or if you often feel you need to urinate right away you should consult your physician.

The growing uterus can also put pressure on certain nerves causing numbness and tingling in the legs and toes and low back pain. This is usually not serious and will go away after the baby is born.

A certain amount of water retention manifested as swelling in the ankles is very common particularly in the third trimester. If the swelling involves your hands and face this can be a manifestation of toxemia and you should notify your doctor.

Leg cramps are also common in the third trimester particularly during sleep, these may be avoided by stretching your legs before going to bed.

False labor or Braxton-Hicks contractions can start as early as the fifth month of your pregnancy. Maintaining good hydration and emptying your bladder frequently can minimize the symptoms. If contractions become regular and last for more than one hour you should contact your physician.

Pregnancy is a time of not only physical changes but also emotional changes. Because of your increased hormone levels you may be irritable and have unpredicted mood swings. You may also feel anxious and depressed. Good nutrition with regular periods of rest and relaxation and setting special time aside for you and your partner will help your emotional as well as physical well being.


PRENATAL (BEFORE BIRTH) CARE

Early prenatal care can help keep you and your baby healthy. Your first prenatal checkup will usually be after you have missed your second period (12 to 13 weeks' pregnant).

Visits are scheduled as follows:

* Every four weeks until 28 weeks
* Every two weeks from 28 to 36 weeks
* Every week after 36 weeks

Each visit:

* Confirm your due date. Report vaginal discharge or leaking of fluid.
* Your blood pressure should be checked along with the baby's heart tones.
* Your fundal height will measured and a urine dipstick to exam for preeclampsia and infection will be performed.
* The physician will attempt to document the type of cesarean section scar where appropriate.
* Report decreased fetal movement.Ask about fetal movement Check for PIH symptoms
* Report headaches, blurred vision, rapid weight gain, and stomach pain.

You may expect a cervical check (vaginal examination) if you are being seen for preterm labor, cerclage, or complaints of uterine contractions.

Visit Screen (s)
First visit

* PAP smear, complete blood count (CBC),type and screen (T&S), urine analysis , rubella status, VDRL, HIV, Hepatitis B status, tuberculosis test (PPD), cervical cultures for gonorrhea and chlamydia.
* In additon
o If you are at risk a one hour glucose test.
o Hemoglobin electrophoresis if you are African American or Southeast Asian.

16-20 weeks

* Expanded AFP test.
* Genetic counseling and possible amniocentesis if you will be older than 34 at the time of delivery, or at at increased risk for carrying a genetic disorder (for example, cystic fibrosis, sickle cell anemia, thalassemia)
* Ultrasound as indicated.

20-24 weeks

* Fetal echo as indicated

24-28 weeks

* Repeat T&S if you are Rh negative.RhoGAM
* One hour glucose challenge test .

28-32 weeks

* CBC
* Repeat VDRL, HIV, and cervical cultures if you have risk factors.

32-36 weeks

* Fetal kick count and assessment for fetal presentation

35 to 37 weeks

* Group B strep screening cultures

36-40 weeks

* Repeat T&S if you are Rh negative and you were not given RhoGAM
* Fetal kick count and assessment for fetal presentation

*As indicated. Routine U/S is not otherwise indicated Ref BMJ 307:13-17, 1993 [/b]

Ultrasound Info from http://www.ob-ultrasound.net/

Quote

What are Obstetric Ultrasound Scans?


Obstetric Ultrasound is the use of ultrasound scans in pregnancy. Since its introduction in the late 1950’s ultrasonography has become a very useful diagnostic tool in Obstetrics.

Currently used equipments are known as real-time scanners, with which a continous picture of the moving fetus can be depicted on a monitor screen. Very high frequency sound waves of between 3.5 to 7.0 megahertz (i.e. 3.5 to 7 million cycles per second) are generally used for this purpose.

They are emitted from a transducer which is placed in contact with the maternal abdomen, and is moved to "look at" (likened to a light shined from a torch) any particular content of the uterus. Repetitive arrays of ultrasound beams scan the fetus in thin slices and are reflected back onto the same transducer.

The information obtained from different reflections are recomposed back into a picture on the monitor screen (a sonogram, or ultrasonogram). Movements such as fetal heart beat and malformations in the feus can be assessed and measurements can be made accurately on the images displayed on the screen. Such measurements form the cornerstone in the assessment of gestational age, size and growth in the fetus.

A full bladder is often required for the procedure when abdominal scanning is done in early pregnency. There may be some discomfort from pressure on the full bladder. The conducting gel is non-staining but may feel slightly cold and wet. There is no sensation at all from the ultrasound waves.

A short history of the development of ultrasound in pregnancy can be found in the History pages.



Why and when is Ultrasound used in Pregnancy?


Ultrasound scan is currently considered to be a safe, non-invasive, accurate and cost-effective investigation in the fetus. It has progressively become an indispensible obstetric tool and plays an important role in the care of every pregnant woman.

The main use of ultrasonography are in the following areas:


1. Diagnosis and confirmation of early pregnancy.

The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus.


2. Vaginal bleeding in early pregnancy.

The viability of the fetus can be documented in the presence of vaginal bleeding in early pregnancy. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks. If this is observed, the probability of a continued pregnancy is better than 95 percent. Missed abortions and blighted ovum will usually give typical pictures of a deformed gestational sac and absence of fetal poles or heart beat.

Fetal heart rate tends to vary with gestational age in the very early parts of pregnancy. Normal heart rate at 6 weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140-170 bpm. At 5-8 weeks a bradycardia (less than 90 bpm) is associated with a high risk of miscarriage.

Many women do not ovulate at around day 14, so findings after a single scan should always be interpreted with caution. The diagnosis of missed abortion is usually made by serial ultrasound scans demonstrating lack of gestational development. For example, if ultrasound scan demonstrates a 7mm embryo but cannot demonstrable a clearcut heartbeat, a missed abortion may be diagnosed. In such cases, it is reasonable to repeat the ultrasound scan in 7-10 days to avoid any error.

The timing of a positive pregnancy test may also be helpful in this regard to assess the possible dates of conception. A positive pregnancy test 3 weeks previously for example, would indicate a gestational age of at least 7 weeks. Such information would be useful against the interpretation of the scans. Please read the FAQs for more comments.

In the presence of first trimester bleeding, ultrasonography is also indispensible in the early diagnosis of ectopic pregnancies and molar pregnancies.


3. Determination of gestational age and assessment of fetal size.

Fetal body measurements reflect the gestational age of the fetus. This is particularly true in early gestation. In patients with uncertain last menstrual periods, such measurements must be made as early as possible in pregnancy to arrive at a correct dating for the patient. See FAQ. In the latter part of pregnancy measuring body parameters will allow assessment of the size and growth of the fetus and will greatly assist in the diagnosis and management of intrauterine growth retardation (IUGR).

The following measurements are usually made:

a) The Crown-rump length (CRL)

This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 3-4 days of the last menstrual period. (Table) An important point to note is that when the due date has been set by an accurately measured CRL, it should not be changed by a subsequent scan. For example, if another scan done 6 or 8 weeks later says that one should have a new due date which is further away, one should not normally change the date but should rather interpret the finding as that the baby is not growing at the expected rate.

b) The Biparietal diameter (BPD)

The diameter between the 2 sides of the head. This is measured after 13 weeks. It increases from about 2.4 cm at 13 weeks to about 9.5 cm at term. Different babies of the same weight can have different head size, therefore dating in the later part of pregnancy is generally considered unreliable. (Chart and further comments) Dating using the BPD should be done as early as is feasible.

c) The Femur length (FL)

Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term. (Chart and further comments) Similar to the BPD, dating using the FL should be done as early as is feasible.

d) The Abdominal circumference (AC)

The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. (Chart and further comments) AC measurements should not be used for dating a fetus.


Other important measurements are discussed here.

The weight of the fetus at any gestation can also be estimated with great accuracy using polynomial equations containing the BPD, FL, and AC. computer softwares and lookup charts are readily available. For example, a BPD of 9.0 cm and an AC of 30.0 cm will give a weight estimate of 2.85 kg. (comments)


4. Diagnosis of fetal malformation.

Many structural abnormalities in the fetus can be reliably diagnosed by an ultrasound scan, and these can usually be made before 20 weeks. Common examples include hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops. With more recent equipment, conditions such as cleft lips/ palate and congenital cardiac abnormalities are more readily diagnosed and at an earlier gestational age. (Also see the FAQ and Anomalies pages).

First trimester ultrasonic 'soft' markers for chromosomal abnormalities such as the absence of fetal nasal bone, an increased fetal nuchal translucency (the area at the back of the neck) are now in common use to enable detection of Down syndrome fetuses.

Read also: Soft Markers - A Guide for Professionals and Ultrasonographic "soft markers" of fetal chromosomal defects.


Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy.


5. Placental localization.

Ultrasonography has become indispensible in the localization of the site of the placenta and determining its lower edges, thus making a diagnosis or an exclusion of placenta previa. Other placental abnormalities in conditions such as diabetes, fetal hydrops, Rh isoimmunization and severe intrauterine growth retardation can also be assessed.


6. Multiple pregnancies.

In this situation, ultrasonography is invaluable in determining the number of fetuses, the chorionicity, fetal presentations, evidence of growth retardation and fetal anomaly, the presence of placenta previa, and any suggestion of twin-to-twin transfusion.


7. Hydramnios and Oligohydramnios.

Excessive or decreased amount of liquor (amniotic fluid) can be clearly depicted by ultrasound. Both of these conditions can have adverse effects on the fetus. In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia. See also FAQ and comments.


8. Other areas.

Ultrasonography is of great value in other obstetric conditions such as:

a) confirmation of intrauterine death.
b) confirmation of fetal presentation in uncertain cases.
c) evaluating fetal movements, tone and breathing in the Biophysical Profile.
d) diagnosis of uterine and pelvic abnormalities during pregnancy e.g. fibromyomata and ovarian cyst.



Transvaginal Scans
With specially designed probes, ultrasound scanning can be done with the probe placed in the vagina of the patient. This method usually provides better images (and therefore more information) in patients who are obese and/ or in the early stages of pregnancy. The better images are the result of the scanhead's closer proximity to the uterus and the higher frequency used in the transducer array resulting in higher resolving power. Fetal cardiac pulsation can be clearly observed as early as 6 weeks of gestation.

Vaginal scans are also becoming indispensible in the early diagnosis of ectopic pregnancies. An increasing number of fetal abnormalities are also being diagnosed in the first trimester using the vaginal scan. Transvaginal scans are also useful in the second trimester in the diagnosis of congenital anomalies. Read one of my presentations at OBGYN.net-Ultrasound.


Doppler Ultrasound
The doppler shift principle has been used for a long time in fetal heart rate detectors. Further developments in doppler ultrasound technology in recent years have enabled a great expansion in its application in Obstetrics, particularly in the area of assessing and monitoring the well-being of the fetus, its progression in the face of intrauterine growth restriction, and the diagnosis of cardiac malformations.

Doppler ultrasound is presently most widely employed in the detection of fetal cardiac pulsations and pulsations in the various fetal blood vessels. The "Doptone" fetal pulse detector is a commonly used handheld device to detect fetal heartbeat using the same doppler principle.

Blood flow characteristics in the fetal blood vessels can be assessed with Doppler 'flow velocity waveforms'. Diminished flow, particularly in the diastolic phase of a pulse cycle is associated with compromise in the fetus. Various ratios of the systolic to diastolic flow are used as a measure of this compromise. The blood vessels commonly interrogated include the umbilical artery, the aorta, the middle cerebral arteries, the uterine arcuate arteries, and the inferior vena cava.

The use of color flow mapping can clearly depict the flow of blood in fetal blood vessels in a realtime scan, the direction of the flow being represented by different colors. Color doppler is particularly indispensible in the diagnosis of fetal cardiac and blood vessel defects, and in the assessment of the hemodynamic responses to fetal hypoxia and anemia.

A more recent development is the Power Doppler (Doppler angiography). It uses amplitude information from doppler signals rather than flow velocity information to visualize slow flow in smaller blood vessels. A color perfusion-like display of a particular organ such as the placenta overlapping on the 2-D image can be very nicely depicted. Doppler examinations can be performed abdominally and via the transvaginal route. The power emitted by a doppler device is greater than that used in a conventional 2-D scan. Its use in early pregnancy is therefore cautioned.

Doppler facilities are generally an integral part of modern ultrasound scanners. They merely would need to be switched on to function. One does not need to 'go' to another machine for the doppler investigations.


3-D and 4-D Ultrasound
3-D ultrasound can furnish us with a 3 dimensional image of what we are scanning. The transducer takes a series of images, thin slices, of the subject, and the computer processes these images and presents them as a 3 dimensional image. Using computer controls, the operator can obtain views that might not be available using ordinary 2-D ultrasound scan. 3-dimensional ultrasound is quickly moving out of the research and development stages and is now widely employed in a clinical setting. It too, is very much in the News. Faster and more advanced commercial models are coming into the market. The scans requires special probes and software to accumulate and render the images, and the rendering time has been reduced from minutes to fractions of a seconds.

A good 3-D image is often very impressive to the parents. Further 2-D scans may be extracted from 3-D blocks of scanned information. Volumetric measurements are more accurate and both doctors and parents can better appreciate a certain abnormality or the absence of a certain abnormality in a 3-D scan than a 2-D one and there is the possibility of increasing psychological bonding between the parents and the baby.

An increasing volume of literature is accumulating on the usefulness of 3-D scans and the diagnosis of congenital anomalies could receive revived attention. Present evidence has already suggested that smaller defects such as spina bifida, cleft lips/palate, and polydactyl may be more lucidly demonstrated. Other more subtle features such as low-set ears, facial dysmorphia or clubbing of feet can be better assessed, leading to more effective diagnosis of chromosomal abnormalities. The study of fetal cardiac malformations is also receiving attention. The ability to obtain a good 3-D picture is nevertheless still very much dependent on operator skill, the amount of liquor (amniotic fluid) around the fetus, its position and the degree of maternal obesity, so that a good image is not always readily obtainable.

More recently, 4-D or dynamic 3-D scanners are in the market and the attraction of being able to look at the face and movements of your baby before birth was also enthusiastically reported in parenting and health magazines. This is thought to have an important catalytic effect for mothers to bond to their babies before birth. What are known as 're-assurance scans' and the rather misnamed 'entertainment scans' have quickly become popular.

Most experts do not consider that 3-D and 4-D ultrasound will be a mandatory evolution of our conventional 2-D scans, rather it is an additional piece of tool like doppler ultrasound. Most diagnosis will still be made with the 2-D scans. 3-D ultrasound appears to have great potential in research and in the study of fetal embryology. Whether 3-D ultrasound will provide unique information or merely supplemental information to the conventional 2-D scans will remain to be seen.

Click here for some good sample images courtesy of Dr. Bernard Benoit. Visit the GE 4D site for more pictures and information. Dr. Najeeb Layyous's 3-D and 4-D website also has many more pictures and clips. Read also the FAQ page.

A short history of the development of 3-D ultrasound in pregnancy can be found in the History pages.



The Schedule
There is no hard and fast rule as to the number of scans a woman should have during her pregnancy. A scan is ordered when an abnormality is suspected on clinical grounds. Otherwise a scan is generally booked at about 7 weeks to confirm pregnancy, exclude ectopic or molar pregnancies, confirm cardiac pulsation and measure the crown-rump length for dating.

A second scan is performed at 18 to 20 weeks mainly to look for congenital malformations, when the fetus is large enough for an accurate survey of the fetal anatomy. multiple pregnancies can be firmly diagnosed and dates and growth can also be assessed. Placental position is also determined. Further scans may be necessary if abnormalities are suspected.

Many centers are now performing an earlier screening scan at around 11-14 weeks to measure the fetal nuchal translucency and to evaluate the fetal nasal bone (and more recently, to detect tricuspid regurgitation) to aid in the diagnosis of Down Syndrome. Some centers will do blood test biochemical screening at the same visit.

Further scans may sometimes be done at around 32 weeks or later to evaluate fetal size (to estimate the fetal weight) and assess fetal growth. Or to follow up on possible abnormalities seen at an earlier scan. Placental position is further verified. The most common reason for having more scans in the later part of pregnancy is fetal growth retardation. Doppler scans may also be necessary in that situation.

The total number of scans will vary depending on whether a previous scan has detected certain abnormalities that require follow-up assessment. What is often referred to as a Level II scan merely indicates a "targeted" examination where it is done when an indication is present or when an abnormality is suspected in a previous examination. In fact professional bodies such as the American Institute of Ultrasound in Medicine does not endorse or encourage the use of these terms. A more "thorough" examination is usually done at an a perinatal center or specialised clinic where more expertise and better equipments may be present.

One should not dwell too much on the definitions or guidelines for a level II ultrasound scan. The prenatal sonologist should always try very hard to look for and assess any abnormality that may be present in the fetus. It is not very meaningful to be talking about level III or even level IV scans.

That a pregnancy should be scanned at 18 to 20 weeks as a rule is gradually becoming a matter of routine practice. Please go to the FAQ page and News page for other discussions. A rather thorough discussion paper on Ultrasound screening in pregnancy can be found here. Read also the RCOG's paper on routine screening in pregnancy.



What about Safety?
It has been over 40 years since ultrasound was first used on pregnant women. Unlike X-rays, ionizing irradiation is not present and embryotoxic effects associated with such irradiation should not be relevant. The use of high intensity ultrasound is associated with the effects of "cavitation" and "heating" which can be present with prolonged insonation in laboratory situations.

Although certain harmful effects in cells are observed in a laboratory setting, abnormalities in embryos and offsprings of animals and humans have not been unequivocally demonstrated in the large amount of studies that have so far appeared in the medical literature purporting to the use of diagnostic ultrasound in the clinical setting. Apparent ill-effects such as low birthweight, speech and hearing problems, brain damage and non-right-handedness reported in small studies have not been confirmed or substantiated in larger studies from Europe. The complexity of some of the studies have made the observations difficult to interpret. Every now and then ill effects of ultrasound on the fetus appears as a news item in papers and magazines. Continuous vigilance is necessary particularly in areas of concern such as the use of pulsed Doppler in the first trimester.

The greatest risks arising from the use of ultrasound are the possible over- and under- diagnosis brought about by inadequately trained staff, often working in relative isolation and using poor equipment.

A discussion on the various possible effects of ultrasound on the human fetus can be found here. Ultrasound scans should best be performed when there is a clear indication to do so. When there is, safety considerations should not be an issue to prevent its prudent use.

It should be bornt in mind that prenatal ultrasound cannot diagnose all malformations and problems of an unborn baby (reported figures range from 40 to 98 percent), so one should never interpret a normal scan report as a guarantee that the baby will be completely normal. Some abnormalities are very difficult to find or to be absolutely certain about.

Some conditions, like for example hydrocephalus, may not have been obvious at the time of the earlier scan. The position of the baby in the uterus has a great deal to do with how well one sees certain organs such as the heart, face and spine. Sometimes a repeat examination has to be scheduled the following day, in the hopes the baby has moved.

Images tend also to be strikingly clear in skinny patients with lots of amniotic fluid, and frustratingly fuzzy in obese women, particularly if there is not much amniotic fluid as in cases of growth restriction. As in almost every endeavor, there is also a wide difference in the skill, training, talent, and interest of the sonographer or sonologists. The improvements in equipment has also lead to the earlier detection of abnormal structures in the fetus bringing along with it "false positives" and "difficult-to-be-sure-what-will-happen" diagnosis that could generate huge amount of undue anxiety in patients. [/b]

also when i went to get my first ultrasounds, they tell you to drink water before hand so your bladder is full, it makes the baby show up better on the scans when they are smaller, your doctor will tell you how much to drink.