I wasn't going to add my 2 cents to this.   However I felt the need to 
respond to the suggestion of planting the seed to talk mom into staying home with 
baby.

My first reaction when I read the vignette was, "boy does this kid need a 
daycare transplant."   The daycare provider did not seem to be sensitive to the 
baby's cues around feeding, needing to be held.   The vignette didn't relate 
the provider to baby ratio (that could impact a lot of care decisions).

However this is a mom needing childcare for three children -- not an easy 
thing.   Some day cares do better with little babies not so great with older 
children.   This is something I experienced with my son as he became older.

Planting the seed to stay home -- may not be a realistic option for this mom. 
  Even moms on TANEF (temporary assistance to needy families -- used to be 
called Welfare in the US) are required to spend a certain number of hours 
working per week (whether it be community service, school or whatever).

As pediatrician, I had the luxury of disability insurance (and the misfortune 
of having carpal tunnel in both hands after delivery)-- I could stay at home 
for the first four month's of my son's life.   As a single parent who did not 
get any financial support from my son's father, I HAD TO WORK.     Staying at 
home for an extended period of time was not an option.   As a pediatrician, I 
was fortunate to work reduced hours (40 vs. 60-80) so that I could continue to 
pump until my son was a year.   My son continued with breastfeeding until he 
was nearly three.   He was a reverse cycle nurser so most of his feeds were 
with me at home.

Not every mom has the financial option to stay at home.   Please don't forget 
there are parents in all sorts of family situations.   Not every mom is in a 
traditional nuclear family.   All that being said, I would try to support mom 
in choosing the best situation for her and her children.

Educating daycare providers (like anyone else) can be a mixed bag.   Finding 
daycare for three children in one place can be very difficult.   I just hope 
this mother can continue to breastfeed and express for her baby as long as 
possible.   My hats are off to her as she sounds like a very committed mom.

Pierrette Mimi Poinsett, MD
Modesto CA


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