When are the Europeans going to get with the program on baby shoes?

Just when the Bambino was starting to walk, we noticed that his right foot seemed stuck at two o'clock, while the left one was at twelve.  We found this to be a little disconcerting, and the Frenchman even starting talking about putting the Bambino in foot braces, eventual surgery, etc.

"But you need to get him in some real shoes!," our French friends all told us when we showed them the Bambino's pose.  This advice seemed so obvious to them that they were surprised that the Bambino, at thirteen months, was still in Robeez style slippers.  I had to explain that we Anglo-Saxons tend to view barefoot as best.

The "babies need shoes to learn to walk" theory holds tight in many European circles, despite that fact that orthopedists worldwide (including European ones) recommend barefoot or close to it.  In France, I'm convinced that holding true to the "they must wear shoes" view is a way of propping up the children's shoe industry.   And we're not just talking about any shoe.   Your typical French, Spanish or Italian shoes salesperson will recommend a shoe with a thick, stiff sole and a high ankle for your toddler, so as to "support" the foot, as if mother nature hadn't equipped small children adequately for learning to walk.

Even standard baby websites in the French language give this dated advice.  For example, Infobébés has a whole page on shoes, in which it advises to choose a shoe that is "high enough to support the ankle", that is laced rather than in velcro, and that is "not too stiff" (well, at least they got that part right).

Netenviesdebebes suggests soft-soled shoes for infants who haven't learned to walk yet but fails to consider the possibility of no shoes at all.  It goes on to say that once baby has learned how to walk,

on préférera alors des chaussures qui maintiennent le pied et la cheville : bottes, boots, bottines par exemple.

 Translation: we prefer shoes that maintain the foot and the ankle: boots or booties, for example.

Well, it took Europe about twenty years to get on the no-smoking-in-restaurants bandwagon, so I expect about the same amount of lag time for progressive thinking on baby shoes.

The ray of light: we took the Bambino to visit the chief pediatric orthopedist at Necker hospital in Paris, to have his crooked gait checked out.  The doctor said that we should just wait another year and the Bambino's foot will likely adjust to the right position all by itself.  He didn't have an opinion on any kind of particular shoe for the Bambino but he did say that barefoot was definitely best.

The BCG Vaccine - is it worth getting?

I found this box of unused vaccines against Tuburculosis (aka the BCG vaccine) sitting in our refrigerator yesterday.  In the days prior to leaving for Madagascar, the Frenchman, being French, was intent on getting the Bambino jabbed with the BCG vaccine.  I think that France is the only country that actually even recommends this vaccine anymore.  You certainly never hear about it in the UK, Canada, the States or Australia.  (Oh yeah, I think they maybe still recommend it in Romania.  And Mexico).

I managed to convince the Frenchman to give a pass on this vaccine for the Bambino, for a few reasons.  Yes, there is tuberculosis in Madagascar.  But the BCG vaccine is not known for being that effective in preventing transmission of tuberculosis. Clinical trials in the UK have shown an efficacy of about 60 to 80 percent (which is already not great for a vaccine).  The efficacy rate falls as you get closer to the equator, sometimes to zero percent effectiveness.  No one really knows why.  But according to the World Health Organization, the BCG vaccines currently in use are produced at several sites around the world and are not identical to one another.   And it is not known whether the vaccines produced at one site are more effective than the vaccines produced at other sites. 

Since 2007, a new and apparently improved BCG vaccine is being used.  I haven't seen any data to suggest that it is, indeed, any more effective than the old vaccine.  And lookie here, The World Health Organization questions the safety of the current BCG vaccine.  From the WHO site:

BCG is widely used and the safety of this vaccine has not been a serious issue until recently.  There is concern that the use of the vaccine in persons who are immune-compromised may result in an infection caused by the BCG itself.  Also, even among immune competent persons, local reactions, including ulceration at the site of vaccination may result in shedding of live organisms which could infect others who may be immune-compromised.

The other thing that bothers me about the BCG vaccine is it can result in false positives on future tubuculin skin tests - which means that if your child ever wants to, say, work in the health care industry one day, he will have to get an X-ray to prove that he or she does not have TB!  The skin test won't suffice.

And then there is the post-vaccine bump, puss and permanent scar left on your child's arm.

My cousin Wolfgang, who happens to be a microbiologist and a travel doctor in Berlin, doesn't have a problem with the BCG vaccine per se but he does recognize its lack of effectiveness.  When I talked to him about whether to have the Bambino vaccinated, he recommended testing the Bambino for TB once a year, instead, using the tuburculin skin test.  If the test result is negative, no TB.  If the test result is positive, the child then gets an x-ray to ensure that he has simply developed immunity to TB (this is what usually happens when you are exposed to TB) and does not actually have TB.  If the child has developed TB, then the TB gets treated.   Most of the American parents that I have met here have chosen this route for their children.

Since arriving in Madagascar last July, I have surveyed lots of families of a few different nationalities about the BCG vaccine.  So far, all of the French parents that I have met have had their children vaccinated with the BCG vaccine and all but one of the non-French families have refused the BCG vaccine for their children (the one non-French vaccinated child I know was born in Mexico, where they give the BCG vaccine routinely at birth) -yet more evidence that the way you parent really is a cultural thing, even when it comes to vaccines!

Circumcision and HIV/AIDS - Is the link really that relevant?

If I see one more article suggesting that all infant boys should be circumcised so as to reduce their chances of getting HIV/AIDS, I am going to scream.  Honestly, think about this one people.  Circumcision is an excruciatingly painful procedure for most babies who undergo it (no, the EMLA cream does not work and most parents don't bother asking for the penile block).  Moreover, the procedure removes a tissue containing something like ten thousand nerve endings, reducing sexual pleasure by thirty to fifty percent. 

As for those studies that conclude that it reduces transmission of STDs such as HIV, I urge you to read more about them.  Their conclusions are of questionable value, both in terms of the sample size of the men who did end up getting HIV and in terms of their applicability to North America and Europe.

But let's just say that circumcision really will reduce your boy's chances of getting HIV in the future.  Please ask yourself this before you have anyone mutilate his penis:

Would you have your baby girl circumcised for the same reason? 

Seriously, if it could be shown that circumcising your baby daughter would reduce of her chances of getting or transmitting HIV in the future, would you have her circumcised?  Because the pain is the same or worse for a boy and, as with female circumcision, removing your son's foreskin will deprive him of a great source of pleasure in the future.

Proof that those growth charts don't mean much - they change according to country!

So, we finally got our globetrotter Bambino officially weighed.  It had been a while.  I never bother with the baby well-checks.  I would have to find a competent generalist or pediatrician here first, which I haven't succeeded in doing,** so the Bambino hadn't been weighed since our arrival in Tana at the beginning of July.

Then when we were checking in our luggage at the Morondava airport last week, the Frenchman had the brilliant idea of weighing the Bambino on the luggage scale.  It worked fairly well.  The Bambino weighed in at 9.8 kg (around 21.5 pounds?), with diaper and clothes on, so probably around 9.5 kg without.

Then yesterday, I took the Bambino to a local dermatoligist (who is a very good doctor.  I would choose her as our pediatrician if she wasn't already a dermatogist!).  The baby's arms and chest had been covered in a rash for a week and I wanted to be sure it wasn't anything more than heat rash.

"It's heat rash," she said, as she was going gaga over this beyond cute, big, bouncy, wasa baby. 

"He's so big!", she exclaimed.

"Which reminds me," I said.  "Could we get him weighed on a real baby scale?"

So the dermatologist had the baby scale brought into her office and we undressed the Bambino and put him on the scale.  Sure enough, 9.5 kg.

"Wow!  He is so big for an 8 month old baby!" the doctor exclaimed.  "Bravo!"

"Er, you think?  Because he is exactly average weight for his age on the CDC growth charts for American babies."

"Well, yes but the Americans are fat."  (She honestly said this.)

"And he is in the 75th percentile on the tableau in the French carnet de santé," I went on.

"So you see?  Even in France, he is big.  And by Malagasy standards, he is enormous!", she said.

And it's true.  Malagasy babies are tiny.  Now, part of this really is due to malnutrition, but even the well-fed ones are not that big.   Plus the Bambino really is a very tall baby.  The Malagasy tend to be on the short side.

All of which leads me to believe that those growth charts that doctors are so obsessed with don't really mean that much.  So much depends on the baby's ethnicity and genes. 

I should add that the Bambino was 4.2 kg at birth -that's around the 90th percentile on the CDC charts - so he has slipped way down in weight.  A typical pediatrician would have probably told me a long time ago to start supplementing with formula, notwithstanding that it is obvious from just looking at the baby that he is doing fine (see photo).

The Bambino was never destined to stay his birthweight percentile anyway.  We're all tall and thin in our family.

**The one generalist I have met here told me that I should be retracting my son's penis on a regular basis.  Isn't that advice from something like 30 years ago?