New Parents and Repetitive Strain

New Parents and Repetitive Strain
The physical stresses and strains of new parenthood are quite different than most people are exposed to in other aspects of life. There is a lot of static stress – e.g. holding positions, often against gravity and a small weight – for extended periods. This can affect all parts of the body, but especially the hands, arms, shoulders and back.

The most common repetitive strain injuries for a new parent (and I have to say especially the mother) to experience involve the wrist, hand and thumb. These are DeQuervains Tenosynovitis and Carpal Tunnel syndrome. For the mother, they may occur during pregnancy and continue on.

DeQuervains develops in the synovium of the tendon that connects the thumb extensor from the forearm to the thumb and the tendon connecting the muscle to the thumb that moves the thumb away from the palm. Pain is often felt along the thumb and into the wrist area on the thumb side.

Carpal Tunnel Syndrome develops in a similar way, with the swelling occurring in the finger flexor synovium and the median nerve being affected. There may be loss of grip strength and pain or numbness on the little finger side, sometimes to middle of the hand. Pain is generally in the wrist on the palm side.

Elbow problems may included Tennis Elbow, from the prolonged weight bearing at the elbow.

R.M. van Rijin reported in the journal Rheumatology (Associations between work-related factors and specific disorders at the elbow: a systematic literature review, Feb 17,2009) that static stress was related to lateral epicondylitis, medial epicondylitis, cubital tunnel syndrome and radial tunnel syndrome .

Radial Tunnel syndrome generally appears as stabbing or radiating pain at the back of the hand. Lateral epicondylitis creates pain on the at the outside (side away from the body) of the elbow (tennis elbow). Medial epicondylitis is similar, and involved pain on the inner side of the elbow (golfer’s elbow). Cubital tunnel syndrome has symptoms common to carpal tunnel syndrome because it involves the same nerve.

All of these tunnel related conditions will frequently respond to conservative treatment (no surgery). Surgery has been known to cause more problems as the build-up of scar tissue can also restrict tunnel space. If you have symptoms, visit your doctor.

Another common problem you may have is all of the bending over and lifting you now have to do – not to mention the holding and carrying. Frequently this is minimal muscle strain which subsides with rest and gentle stretch. Sometimes, it becomes either painful enough to be a problem or persistent enough to require attention.

Choosing a Work Area

It’s a good idea to find a surface that’s the right height for you to work at and use that for the primary part of your care. This includes changing diapers, dressing baby, bathing baby, etc. Finding or jury-rigging a proper work height is your best initial prevention for sore backs.

If you are lucky, the crib height will be a good working height. Some cribs have adjustable bed heights. While the baby is small, you can bring the mattress up to a working height. As the baby becomes more mobile and climbing out becomes an issue, you will need to lower the surface and find another spot for your care. Some cribs (such as the ones at the site below) also can convert to semi cribs, and to day-beds so that they can be used until the mattress is too short for the baby’s height.

If you are tall, the best work surface may be the kitchen counter or ‘island’ height. For others, it may be the kitchen table. Sometimes the bassinette is just the right height. If there are two parents of very different heights, you may need two separate places for care.

Working at a comfortable height will also improve your ability to maintain neutral wrist and open elbow postures while you handle and care for your baby. Amazingly, the right height will also improve your visual space, allowing you to focus more easily.

Feeding Baby

Talking, eye contact, holding and giving food are all nurturing behavior that occur during feeding and the all strengthen the parent – child bond. These are highly important to the infant’s growth.

Feeding babies has to involve static contractions for the elbows. Again, we are lucky that babies start off small and don’t begin eating more than a few ounces at a time. This give time for the parent’s body to gain strength and conditioning in the needed muscles.

Tips to minimize issues during feeding:
• Avoid tilting your hand toward the thumb or little finger.
• As much as possible, avoid prolonged wrist flexion or extension (bend towards or away from the palm).
• Every 10 minutes or less, stretch your arms out so that the elbows are extended. You can do this one at a time.
• Whether you are breast-feeding or bottle feeding, sit in a good chair that allows approximately 15° of recline – or a chair with high back and neck support with more recline. This will allow you to support a large part of the baby’s weight on your torso without stressing your back or neck.
• This is a good time to let your legs un-weight. Find a good footrest or leg rest to use (knees must be supported or flexed). This can really help if you have swollen legs or feet.
• Support your arms. Remember, the arms ARE heavy, about 7 pounds apiece. Use pillows, softly padded chair arms and small pillows, or pillows specially designed for use in feeding babies. If you use chair arms, make sure they do not result in hiking of the shoulders or movement of the arms away from the body to the side.
• Maintain your back in good, supported alignment. This will help prevent back, shoulder and neck stress.
Diapering and Dressing Baby

Although I am generally a fan of recycling and natural materials, if you have any hand, thumb, or wrist issues I recommend disposable diapers with Velcro fasteners. These require much less strength and control than safety pins. Babies are not happy if they are accidentally stuck with pins.

If you’ve browsed through a catalog of baby clothes recently, you know that there are hundreds of delightful and attractive choices. When you chose for your baby however, remember that you are choosing for yourself too. If it’s hard to get the baby into that cute outfit it’s probably not worth the price. There are many others just a cute waiting out there for you.
• Clothes that are a little loose are easier to manage than tight fitting ones. He or she will grow into them, anyway.
• Look for Velcro or loosely fitting elastic.
• Baby clothes need to unfasten at the crotch, so that diapering can occur without undressing (unless of course, there’s a big enough mess to require it).
• You may find that two piece outfits are easier to use than onesies. This is particularly true as baby grows.
Remember, you do these basic care tasks many times a day, and they need to be done every day. A few precautions can lessen the probability that you will have serious problems.

View this site for a selection of good adjustable cribs and bassinettes.

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