6 Things Every Globetrotter Parent Should Know

A couple of years back, PhD in Parenting posted on 10 Things All New Parents Should Know.  I thought her advice was really helpful and I even sent the link to a newly pregnant friend just last week.

As I pondered PhD in Parenting's post, I thought of my own globetrotter version.  People tend to rely on their relatives, friends and doctors for advice on coping with parenting questions.  Not all the information they get is accurate and some of it is harmful.  So here is my top 6 list ('cause 10 would be way too long!) of what all parents trying to raise their children in a global culture should know:

6 Things Every Globetrotter Parent Should Know:

1.  Baby care norms differ radically from one continent and even country to the next one.

Moreover, what's considered the norm where YOU live is not necessarily the objectively right way.

My favourite example:  In Canada and the States, the health industry tells us not to share a bed with our infant, because it can lead to smothering, SIDS, baby falling off the bed, etc.

Yet, here in Madagascar, most moms sleep with their baby.  They don't do cribs here.  And I don't ever hear or read about any babies dying of SIDS or getting smothered here.  Funny that.

The point is, never assume that information from doctors and well-meaning friends where you live right or even mostly right.  Indeed, there are a lot of things not right about modern conventional western parenting ideas.  Babies have not always drunk cow's milk (whether or not adapted into formula), and still don't in many places in the world.  Newborns are not wired to sleep in little cages far away from their moms, and don't in many (most) places in the world.  Most baby boys in the world do not get the tips of their penises cut off.  The list goes on...

2.  Contrary to what many "granola" mamas seems to think, Europeans are not necessarily more into "natural family living" than North Americans.  If you've ever been on the discussion forums of mothering.com, you'll know what I mean.  "I wish I lived in Europe.  The breastfeeding rate is much higher there.  And everyone gives birth with a midwife.  And you get one year's maternity leave!"

Allow me to set the record straight about Europe:

Europe is not a monolith.  When you hear granola moms going on about how much more enlightened Europeans are, they're usually talking about Scandinavians.   The Dutch and the Germans are nearly as "crunchy" but only in certain respects.  Maternity leave is only about 12 to 16 weeks long in Germany, for example.

As for the French, well, don't be surprised to see a French maman smoking and drinking during pregnancy, formula feeding by choice (40 percent do) and sending her baby to daycare at the age of three months without so much as wincing because "baby needs to learn to become autonomous".

The Italians have a higher neonatal breastfeeding rate but 90 percent have weaned by the time baby is four months old.  Italians typically start baby on solids consisting of pasta and parmesan cheese at the age of four months.

As for the midwives, they are a highly medicalized profession in Europe.  In France, they even have to attend medical school for a year.  Most European midwives will not allow you to birth in anything but the gynecological position, i.e., lying flat on your back with your legs in stirrups so that they can perform  a routine episiotomy.  You might as well have an OB.

And forget about home birth (except in the Netherlands, and the home birth rate is dropping there).  The home birth rates in European countries hover at around one percent.

3. Your child will not become confused or speech-delayed because you speak to him in another language.  I've already written about this but let me reiterate: there is no evidence whatsoever that bilingual children have a higher rate of speech/language delay or any other speech or language disorder than monolingual children.

4.  Bilingualism is not an automatic fact resulting from a parent who speaks another language.  It takes work.  Yep.  The fact that you speak English or Spanish or French does not automatically mean that your little one will grow up speaking it.  In fact, your child will need about 24 hours per week of exposure to your language in order to speak it like a native.

5.  There are NO required vaccines for international travel - other than yellow fever in some countries in central Africa.  Polio is not a required vaccine for travel in any part of the world, neither is the vaccine against typhoid, tuberculosis, or any other disease.

6.  A global child starts with the parents who have a global mindset.   Children learn from the attitudes of their parents.  Open-minded parents who are interested in learning about other cultures, who are willing to try speaking the foreign language that they're a little rusty in, and who like meeting and talking to people from other parts of the world are more likely to have children with a similar mindset.

On the other hand, it's hard to expect a child to be interested in learning French or Spanish when the parent won't even consider watching a foreign film.

Vaccines again

Before we moved the Madagascar, under pressure from our pediatrician and the Frenchman, I allowed the Bambino to get the Hexavac shot.  This shot includes vaccines against diptheria, tetanus, pertussis, polio, hiB and hepatitis B.  The Bambino was two and a half months old!

I immediately regretted the decision.

Two days later we moved to Madagascar.  Within the week, Joshua had a horrible upper and lower respiratory infection.  That's pretty unusual for a baby less than three months old who is not in daycare and who is normally still full of antibodies from mama's placenta.  It took him two weeks to recover.

I later read that the hexavac shot had been taken off the market in Europe in 2005, ostensibly owing to the ineffectiveness of the Hepatitis B component of the shot, but more likely because some infants in Germany died after getting the hexavac shot.

I also read this 2000 study, which found that the odds of having a history of asthma was twice as great among children vaccinated with the old diptheria-tetanus-pertussis vaccine than among unvaccinated children and that the odds of having had any allergy-related respiratory symptom in the previous twelve months was 63% greater among vaccinated children than unvaccinated children.  


More recently, a study from Canada found that the risk of asthma was reduced to half in children whose first dose of DPT was delayed by more than 2 months. 

Both these studies involve the old whole cell pertussis vaccine rather than the newer acellular pertussis vaccine but is there really necessarily a difference?

The Bambino has had no shots since that hexavac shot at two and a half months.  He is now fifteen months old.  Notwithstanding the aforementioned studies, we are prepared to give him the vaccines that are mandatory in France - that is to say, a combined vaccine for diptheria, tetanus and polio  - because the Bambino will not be admitted to a French public school (be it in France or in one of the public French schools abroad) if he has not had been vaccinated against diptheria, tetanus and polio, or a note from the doctor saying he can't have it.

The problem is that the manufacturer, Sanofi Pasteur, took the DT Polio vaccine off the market in 2008 owing to "side effects". They never said what those side effects were.  I do know that the DT Polio vaccine was the only one on the market without no aluminium and no thimerosal.  We are left with the combined pentavac or hexavac shots but both contain more vaccines than the three obligatory ones.  The pentavac contains the vaccine for pertussis and hib and the hexavac has hepatitis B to boot.

So we are left in a situation where we are willing to give are son the obligatory vaccines in France but we have no way of doing this without also giving him vaccines that are not obligatory.  Keep in mind that should we choose to give our son the shots containing non-obligatory vaccines, we have no recourse against the French state should our son suffer any serious side effects from them.

Is this situation the result of joint conspiracy between the French state and drug manufacturers in order to force us to give  our children more vaccines than French law requires?  I don't know but our pediatrician has found a couple of imperfect ways around it.

One way is to have our pediatrician write a letter stating that the Bambino cannot have the DT Polio vaccination because it is no longer available on the market in France and all other shots contain vaccines that are not legally obligatory.  This would be put in the Bambino's health and eventually school records.

Alternatively, we could give the Bambino the adult booster DTP shot, called Revaxis.  This solution has the upside that, since it is a booster shot, the amount of virus in the shot is much lower than the one for children, ironically.  The downside is that the package insert stipulates not to give it to children younger than six years of age.  So if the Bambino received the Revaxis vaccine and then had a severe reaction to it, we would have no recourse against the manufacturer or the French state.

The other downside to the Revaxis shot is that it contains 350 micrograms of aluminium, about 50 micrograms more aluminium than the hexavac shot.

The Bambino is not yet in any kind of collectivity so we're holding off for now.

"But aren't you afraid he'll catch polio?" I hear you asking.  Having looked at the statistics (just check out the vaccine's package insert), I'm just as afraid of side effects from the vaccine.

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!