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Twenty primary (baby) teeth form in early prenatal life. Shortly before
birth, the enamel of the first molars begins to form. At birth the crowns
of the primary teeth are almost completely formed. Eruption varies from
one child to another. Also, teeth erupt earlier in girls than boys, and
the lower teeth erupt before the corresponding upper teeth.
Your newborn is likely to eat about every 2 hours or about 12 times per day. Remember, each baby is different and this pattern may have irregular intervals. She will probably need nighttime feedings until about 4 months of age. During the first few months, she will gradually increase the amount she consumes and the time between feedings. Don't give cereal to help her sleep through the night.
Feed your baby when she is hungry, calm and awake; she will be ready to eat when her eyes are open wide and she begins making sucking motions. Try to feed her before she gets fussy from hunger. If she is not quite awake, give her some time to wake up first. Once the feeding starts, avoid unnecessary interruptions which may upset her.
Let her eat as much or as little as she wants. When she is full, her sucking will slow, she will release the nipple and turn away. You can offer the nipple after a few moments but if she is uninterested, respect that cue. Don't try to get her to eat more when she is full, don't try to have her finish a bottle.
Water or juice is not necessary at this age. Infants may be offered water if they are having hard, infrequent stools. The amount will vary, 2-4 ounces/day or until soft stools are achieved. Juice should not be given under 4 months of age.
This guide will help you know how much of what foods to feed your baby every day. Your baby may eat more or less than these amounts.
NO HONEY until child is older than 12 months.
Avoid foods containing peanuts until 3 years of age.
Birth to 4 months
1-2 months 5-7 servings/day 3-6 ounces/serving
2-3 months 4-7 servings/day 4-7 ounces/serving
3-4 months 4-6 servings/day 6-8 ounces/serving
4 months
5 months
6 months
7 to 8 months
9 to 12 months
Feeding your baby is still pretty easy, they still like to eat almost everything. Baby eats well with their fingers and drinks from a cup. They are often eating foods the rest of the family is eating. Be sure these foods are not too fatty or spicy, and are cut up in small pieces. Now is the time to get them off of the bottle. Ways to get rid of the bottle: Eliminate one bottle at a time, put formula or whole milk in a cup at meals, put only water in the bottle, get bottles out of sight, start a new bedtime routine.
Your child's growth is slowing down, they don't need as much food right now. Some days they will eat more than others, just make sure you are giving healthy foods.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 6 1/2 slice or 1/4 cup
Fruit 2 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 2 1 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 2-3 1-3 tablespoon, 1 egg, 1/2 cup cooked beans
Sometimes its not easy to feed this age group! Some days they may eat very little and they say "no" often to many foods. This is normal. They are not growing as fast as last year and saying "no" is a stage that will pass. Often they begin to refuse milk, try not to worry. Give other milk group foods like yogurt and cheese.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 6 1/2 slice or 1/4 - 1/2cup
Fruit 2 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 2 1 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 2 1-3 tablespoon, 1 egg, 1/2 cup cooked beans
Feeding your two year old is not always easy. Just give a little bit of food at each meal. Don't get into fights about food and don't force your child to eat. Don't give them a cookie or treat to get them to eat. Sometimes they may be too busy to stop and eat, try to have quiet activities before meals. Always try to offer at least one food the child likes and don't worry when they have food "jags" (the same food over and over). Children's likes and dislikes often change daily. Introduce new food gradually and serve with familiar foods. Set a good example yourself by eating healthy. Schedule regular meals and snacks for toddlers since they require frequent feedings to ensure adequate intake of calories and nutrients. Children very often will eat what they need.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 7 1/2 slice or 1/4 cup
Fruit 3 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 5 1/2 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 2 1 tablespoon, 1 egg, 1/2 cup cooked beans
Snacks should be like little meals for your two year old. Try cheese and crackers, yogurt and fruit, cereal and milk or a half a sandwich and juice. Protein snacks last longer. Some protein foods are: milk, cheese, yogurt, meat, chicken, dried beans, and egg. To decrease the risk of peanut allergy, the new recommendation is to avoid peanuts until three years of age.
Praise your child for successful eating. Use lowfat milk or skim milk after the second birthday unless your child needs the extra calories of whole milk. When your child is thirsty, offer water. Be patient, feedings will get a lot easier as your child gets older.
Three year olds are very busy and have their own ideas about food and eating. Three year olds are growing slowly and may not need as much food as you think they do. They may be picky eaters or refuse to eat, this is very normal at this age. Your job is to provide your child with a good variety of healthy foods at regular meals and snacks. Your child's job is to decide what and how much to eat. Don't force your child to eat, just make sure you are providing the right foods for your child to choose from.
Helpful hints: Cut meat in small pieces, mix with other foods. Give small servings. Choking can be a problem, have your child sit down to eat and avoid hard, round foods. Milk is still important, so give with meals. If your child wants to drink and not eat, give milk after the meal.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 7 1/2 slice or 1/4 cup
Fruit 3 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 5 1/2 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 2 1 tablespoon, 1 egg, 1/2 cup cooked beans
Four year olds are constantly learning. They need to be well fed to learn as much as possible. Good nutrition really does help your child learn. They need a variety of healthy foods and regular meals and snacks. Trust your child's appetite and don't let them snack right before a meal. Help them get in the habit of brushing their teeth after meals or at least rinsing with water. Most hotdogs and lunchmeat are high in fat. Read labels and buy brands that are low in fat. Freeze juice for popsicles, cut up fruit and raw vegetables and keep refrigerated for a quick and healthy snack.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 7 1/2 slice or 1/4 cup
Fruit 3 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 5 1/2 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 2 1 tablespoon, 1 egg, 1/2 cup cooked beans
Your child has grown so much in five years! They still need milk, and lowfat or skim milk is best for most children. You can also give dairy in the form of yogurt, cheese, frozen yogurt and ice milk. You should aim for 4 servings of fruit and 3 servings of vegetables every day. They should be eating three meals per day plus snacks. Encourage lots of healthy exercise.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 9 1/2 slice or 1/4 cup
Fruit 4 1/4 cup cooked, 1/2 cup raw
Vegetables 3 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 5 1/2 cup, 3/4 ounce cheese
Meat, Poultry, Fish, Eggs, Dry Beans 3 1 tablespoon, 1 egg, 1/2 cup cooked beans
Feeding Guide School Age Children (7-12years)
During the school age years, basic nutrition education concepts can be successfully introduced. Emphasis should be placed on enjoying the taste of fruits and vegetables rather than to focus on the healthful aspect of the food. During the period between 8 and 11 years, children begin making peer comparisons, including those pertaining to weight and body shape. Children often vary greatly in weight, body shape, and growth rate, and teasing of those who fall outside the perceived norms often occurs. Family, friends and television all influence a child's eating choices.
Food Daily Servings Serving Sizes
Bread, cereal, rice, pasta 4-5 1 slice, 1/2 - 1 cup
Fruit 3-4 1medium piece of fruit, 4oz. juice, 1/2 c
Vegetables 3-4 1/4 cup cooked, 1/2 cup raw
Milk, Yogurt, Cheese 3-4 (24-32 oz) 1/2 cup - 1 cup (4-8 oz )
Meat, Poultry, Fish, Eggs, Dry Beans 3-4 (6-8 oz) 2 oz.
Feeding Guide Adolescents(13-18 years)
Food habits of adolescents are characterized by:
- an increased tendency to skip meals, especially breakfast and lunch
- eating more meals outside the home
- snacking, especially candy
- consumption of fast foods
- dieting
These behavioral patterns are explained by the adolescents newly found independence and busy schedule, difficulty in accepting existing values, dissatisfaction with bodily image, search for self identification, desire for peer acceptance, and the need to conform to the adolescent lifestyle. These behaviors can result in poor nutrition for most adolescents.
In order to support the growth spurt during adolescence the body requires an increase in calories, protein, nutrients, vitamins and fat. Daily caloric requirements for a male, 11-14 years of age, is 2800 calories; a male 15-18 years is 3000 calories. Females, 11-14 years of age, is 2400 calories, females 15-18 years is 2100 calories. These requirements may need to be adjusted based on the activity level of the adolescent. These requirements are recommended averages and the particular daily demand depends on the growth phase, physical activity, metabolic rate and illness.
Protein is required during puberty. Protein can be derived from meat, milk and milk products, eggs, rice and beans.
Fats play an important role and are essential for the production of important chemicals, like hormones, which are necessary to stimulate puberty. Fats also transport vitamins A, D, E, and K into the body. Fats should comprise up to 30% of the total calories, with 10% of these total calories derived from saturated fats.
Important minerals in the diet are zinc, iron and calcium. Zinc is necessary for the normal development of the gonads (ovaries and testis), essential for healthy skin and general overall growth. The best source for zinc is animal protein. Beans and nuts also contain zinc. Iron is important for the functioning of enzymes. Boys need iron for muscle development, girls need iron to replace the monthly loss during their period. The best source for iron is red meat and vegetables. The absorption of iron is enhanced by eating a combination of foods rich in Vitamin C and iron. Calcium is another important mineral which is necessary for the skeletal system.
Vitamin needs increase during adolescent growth spurts. Some food sources for vitamins are:
Snacking is a common practice among adolescents. Skipping breakfast, snacking during the day and eating dinner at night is a typical meal pattern for adolescents. It is important when choosing snacks to select foods that are low in sugar and fat, and are high in vitamins, minerals and protein. Fruits, raw vegetables, juice, nuts, cheese and crackers, and yogurt are good snack foods. Snacks to avoid: candy, cake, potato chips, cookies and soft drinks.
Throughout our lives we need iron in our diets to prevent anemia and iron is an essential nutrient for cognitive development. In order to ensure your toddler is getting enough iron limit the amount of milk she drinks per day to 16 ounces. More than 16 ounces of milk/day can interfere with iron absorption and can fill her up so she'll eat less, preventing her from getting iron from foods. Include at least one iron rich food at each meal. Also offer fruits and vegetables that are high in Vitamin C because they help increase the absorption of iron. Examples are tomatoes, green peppers, citrus fruits, and strawberries.
Certain foods are especially good sources of iron. Red meats (such as beef, pork and lamb), fish and dark poultry are best. Some young children will only eat lunch meats, and the low fat ones are fine. Adequate iron is also found in iron enriched cereals, beans of all types, egg yolks, peanut butter, raisins, prune juice, sweet potatoes, spinach, kale and broccoli.
New Guidelines Double the Recommended Amount of Vitamin D (October 2008)
Below is a news release on a press briefing at the 2008 National Conference and Exhibition (NCE) of the American Academy of Pediatrics (AAP). Frank Greer, MD, FAAP, chairman of the AAP National Committee on Nutrition and a lead author of the AAP Clinical Report "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," will present the key recommendations in the report at 10:45 a.m. Monday, Oct. 13 in the press briefing room 307 of the Hynes Convention Center. Carol C. Wagner, MD, FAAP, a member of the AAP Section on Breastfeeding Executive Committee and co-author of the report, will be available for telephone interviews. The report is embargoed until Monday, Oct. 13 at 12:01 a.m. ET.
For Release: Monday, Oct. 13, 2008, 12:01 am ET
BOSTON - The American Academy of Pediatrics (AAP) is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," recommends all children receive 400 IU a day of vitamin D, beginning in the first few days of life. The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.
The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.
Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.
"We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits," said Frank Greer, MD, FAAP, chair of the AAP Committee on Nutrition and co-author of the report. "Supplementation is important because most children will not get enough vitamin D through diet alone."
"Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother’s milk, it is important that breastfed infants receive supplements of vitamin D," said Carol Wagner, MD, FAAP, member of the AAP Section on Breastfeeding Executive Committee and co-author of the report. "Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day."
The new recommendations include:
·
Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.·
All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.·
Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.·
Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.
Tips
to decrease fat, saturated fat and cholesterol in your diet Steam, boil or bake vegetables. Season vegetables with herbs and spices rather than sauces,
butter or margarine. Try lemon juice on salads, or use limited amounts of
oil-based salad dressing. To reduce saturated fat, use margarine instead of butter in
baked products, and when possible use oil instead of shortening. Try whole-grain flours to enhance flavors of baked goods
made with less fat and cholesterol containing products. Replace whole milk with skim milk or low-fat milk in
puddings, soups, or baked products. Substitute plain low-fat yogurt, blender whipped low fat
cottage cheese or buttermilk in recipes that call for sour cream or
mayonnaise. Choose lean cuts of meat. (Chicken, turkey, veal and
non-fatty cuts of beef. Also, fresh or frozen fish, and canned fish
packed in water. Meats and fish should be broiled or baked on a rack.) Trim off visible fat from meat before cooking. Roast, bake, broil, steam or simmer fish, poultry or meat. Remove skin from poultry before cooking. Chill meat or poultry broth until the fat becomes
solid. Spoon off the fat before using the broth. Limit the egg yolks to one per serving when making scrambled
eggs. Use additional egg whites for larger servings. Try substituting egg whites in recipes calling for
eggs. For example, use two egg whites in place of each whole egg in
muffins, cookies, and puddings.
Vegetarian diets are not harmful to children as long as careful
planning and research is done with the help of a parent. A vegetarian diet
can be nutritionally complete for people of all ages. Meatless diets have
also been recognized as having a role in disease prevention. A common mistake for young people is to miss the vegetables in
"vegetarian". Every day the diet should include a wide variety
of fruits and vegetables; whole grains; sources of protein; and low-fat dairy
products, such as cottage cheese and low-fat milk. The following four nutrients may be compromised when switching
to a vegetarian diet: Vitamin B12 - Is found only in animal products.
Those avoiding meat, dairy and eggs should look for grain or tofu products
fortified with B12. Iron - Iron is best absorbed from red meat.
However, absorption of iron from plant sources can be increased when paired with
Vitamin C. Plant sources of iron include broccoli, raisins, watermelon,
spinach, black-eyed peas, blackstrap molasses, chickpeas and pinto beans. Calcium and Vitamin D - These nutrients are necessary to
promote optimal bone growth and bone density. Preteens and teens who avoid
vitamin D-fortified dairy products may need a calcium and vitamin D supplement
to meet their needs. ~Andrew Hertz, MD
Problem
Solution Refuses
milk
Serve at room temperature. Serve with a colored straw. Cook cereals
with milk, offer cream
soups or milk based desserts. Offer milk substitutes like yogurt, cottage
or other cheese.
Or flavor milk with chocolate, strawberry, ovaltine or carnation instant
breakfast. Drinks too much
milk
Offer milk with meals only. Offer water or juice between meals, maximum of
8oz. juice per day. Refuses meat Refuses fruits or vegetables Refuses breads and
cereals
Serve cooked cereal warm, not hot. Add raisins or fresh fruit to
cereal. Offer toast instead of
bread and cut into small pieces. Eats too many
sweets
Eliminate sweets from the home completely. Offer "natural"
sweets such as fruit.
Helpful Hints to Make Meal
Times Fun
Many people do not think about food safety until a food related illness affects
them or a family member. The CDC estimates that 76 million people get
sick, more than 300,000 are hospitalized and 5000 Americans die each year from
foodborne illness. Follow these simple tips to protect you and your
family.
Clean: Wash hands and surfaces often Wash your hands
with warm water and soap for at least 20 seconds before and after handling
food, using the restroom, changing diapers and handling pets. Wash countertops
and cutting boards with hot, soapy water after preparing each food item. Rinse all fruits
and vegetables under running tap water, including those with skins that are
not eaten. Separate:
Don't Cross Contaminate Separate raw meat,
poultry, seafood and eggs from other foods in your grocery cart, grocery
bags and refrigerator. Use one cutting
board for fresh produce and a separate one for raw meat, poultry and
seafood. Never place cooked
food on a plate that previously held raw meat, poultry, seafood or eggs. Cook: Cook to
Proper Temperatures Food is safely
cooked when it reaches a high enough internal temperature to kill harmful
bacteria associated with foodborne illness. Use a probe
thermometer which measures the internal temperature of cooked food products. Cook steak
and fish to an internal temperature of at least 145 degrees. Cook ground
beef, pork and shell eggs to an internal temperature of at least
155 degrees. Cook poultry,
stuffed food products, and all exotic food products to an
internal temperature of 165 degrees. Reheat all
leftover food products to an internal temperature of 165 degrees. Chill:
Refrigerate Promptly Refrigerate foods
quickly because cold temperatures slow the growth of harmful bacteria.
Do not over-stuff the refrigerator. Cold air must circulate to help
keep food safe. Keeping a constant refrigerator temperature of 41
degrees F or below is one of the most effective ways to reduce the risk of
food borne illness. Refrigerate or
freeze meat, poultry, eggs and other perishables as soon as you get them
home from the store. Never let raw meat,
poultry, eggs, cooked food or cut fresh fruits or vegetables sit at room
temperature more than two hours before putting them in the refrigerator or
freezer (one hour when the temperature is above 90 degrees F) Divide large
amounts of leftovers into shallow containers for quicker cooling in the
refrigerator.
~Cuyahoga County Board of Health Obesity
is now the most common nutritional disturbance in the pediatric population in
the United States. Nearly 1 in 4 children are overweight or at risk of
becoming overweight. The prevalence of pediatric obesity has doubled for
the toddler and child and tripled for the adolescent. Only a small
percentage of childhood obesity cases, as low as 5%, are associated with a
hormonal or genetic defect. Childhood obesity typically results from a
caloric intake that consistently exceeds caloric requirements and
expenditure. The risk of recurring obesity is on-going. It is
estimated that 1/3 of obese preschoolers, 1/2 of school age children and 3/4 of
adolescents remain obese into adulthood posing additional health risks. The
adage "a pound of prevention is worth a pound of cure" describes the
most effective means of curbing the obesity epidemic. Toddlers who have
one obese parent, have a two-fold risk of becoming an overweight adult compared
to toddlers without obese parents. The primary predictor of obesity in
adulthood for children under three years of age is the parents' obesity
status. Assessments of nutrition and feeding practices, physical
activity and environmental conditions aid in the development of a plan for good
eating habits.
Parental feeding practices can influence the development of children's and
adolescents food preferences. Children consume what is familiar to them
and available to them in the feeding environment. Studies have indicated
that a minimum of five to ten exposures to a new food is needed to increase
acceptance of the item. Research has shown that parents who have problems
regulating their own eating behavior tend to try and control their child's
eating behavior more than families without obesity. They try to regulate
the child's intake and as a result the child lacks self-regulation. There
is a division of responsibility for eating between parents and children.
The parent is responsible for supplying healthy foods and a supportive eating
environment. The child's responsibility is to decide when and how much to
eat. The parent establishes daily meal and snack times and determines what
food is offered and when, allowing the child to decide whether to eat or not. Ninety-one
percent of children, ages 6-11 years, are not consuming the recommended 5
servings of fruit and vegetables per day. Adolescents consume only 28% of
their fruit and vegetable intakes. Fresh fruits and vegetables provide
variety and satiety in a nutrient dense and fiber rich package that is low in
fat and simple carbohydrates. The sooner children can become interested in
them the better. Reduction
in juice or sweetened beverage consumption will help to decrease the link to
obesity incidence. Excessive juice consumption is defined as >12 ounces
per day. The AAP offers these recommendations on the use of fruit juice: -
Fruit juice offers no nutritional benefit and should not be introduced into
diets of infants younger than six months. -
Infants should not be served juice in bottles or easily transportable cups. -
Children, ages 1-6 years, should limit their juice consumption to 4-6
ounces/day. -
Children, ages 7-18 years, should limit their juice consumption to 8-12
ounces/day. -
Children and adolescents should be encouraged to eat whole fruits to meet their
recommended fruit intake.
Physical activity behaviors may influence the development of overweight
children. Approximately half of adults in the parental age group spend no
leisure time engaged in vigorous physical activity. Increasingly, leisure
time activities are more sedentary, with television viewing, video games and
personal computing rated the most popular pastimes. The odds of being
overweight were 4.6 times greater for youth watching more than 5 hours of
television per day compared with those children viewing less than two hours.
Environment can affect the lifestyle choices made by the patient and
family. Some factors that can influence weight management outcomes include
family composition (eg. single parent households), single or dual family
incomes, family schedules, childcare arrangements, and food availability.
School environments affect food and activity choices through school lunch
programs, a la carte snack programs and opportunities for physical activity and
after school programs. An
assessment of the child's/adolescent's and parents' readiness to make lifestyle
changes is an important measure of whether the weight management program will be
successful. A family that is not ready to make lifestyle changes will not
provide a supportive environment for the child. ~Pediatric
Perspectives Newsletter (2004)
We
all LOVE them but kids really NEED them. A snack for an adult is often a
treat, but a snack for a child is important because children don't eat much at
meals. They need snacks to grow. DON'T
RUN TO THE KITCHEN EVERY HALF HOUR! Most
mothers find it easier to have a regular snack time in the middle of the
morning and afternoon. It saves a lot of trips to the kitchen. Snacks
are best about 1 to 2 hours before the next meal. If you give a snack or
drink less than an hour before a meal, it can cut your child's appetite. Sometimes
you may have to give a snack close to mealtime because your child is too
hungry to wait. Try giving part of the meal like milk, bread or a
salad. Sometimes
your child may just be thirsty-offer water. Snacks
"last" longer with some protein in them. Protein foods are
foods like milk, cheese, yogurt, meat, chicken, egg or peanut butter (if
over 3 years of age). Leftovers
make great snacks. Good
snacks are: fruits, bananas, watermelon, cantaloupe, apples,
oranges, strawberries, tomatoes and carrots. Try yogurt with fruit or
milk. Cheese toast: melt cheese on a piece of toast.
Cereals with or without milk. Crisp vegetables if your child can eat
them.
Have
at least three meals a day. Drink
milk with meals. Enjoy
family meals when possible. Chew
food well. Eat
until full, then stop eating. Eat
lots of vegetables and fruits. Snack
on healthy food not junk food. Drink
soft drinks only once in a while. Brush
teeth or rinse after eating.
The USDA has created My Pyramid just for children. You can enter your
child's age, gender and level of physical activity and a tailored plan comes
out for your child. This plan includes amounts for overall calories, fiber
and protein intake. Check it out at
www.mypyramid.gov
Formula Preparation and Storage REFRIGERATION: Prepared from Powder: Store at 35-40 degrees Fahrenheit. Keep no
longer than 24 hours after mixed. Prepared from Concentrate or Ready-to-Use: Store at 35-40
degrees Fahrenheit. Keep no longer than 48 hours after opened. ROOM TEMPERATURE: Prepared from Powder, Ready to Use or Concentrate: Keep no
longer than 2 hours. If bottle is warmed or fed from, discard after one
hour. ~American Dietetic Assn., CDC, and the Center for Food Safety
and Applied Nutrition
If you are pumping your breasts and feeding your baby breast
milk at a later time, you must follow certain guidelines on storing the milk. What type of bag or container should I use to freeze breast
milk? Many women use disposable bottle bags (made of
polyethylene). Cheaper, generic bottle bags are fine to use too.
They come in a tear off roll and can be purchased at your local pharmacy.
Brand name bags, such as Medela and Playtex, work well but are more expensive
and sometimes harder to find. When using disposable bags, double bag the milk to eliminate the
risk of contamination from nicks: Fill the bag with breast milk, tie off
the top with a freezer tie, and then place that bag in a larger storage bag. A hard sided container is best for storing milk. Options
include glass (clear or brown), clear hard plastic (polycarbonate), and frosted
hard plastic (polypropylene). These containers are more expensive than
disposable bags and take up more room in the freezer. How much should I freeze? Freeze breast milk in small amounts-2-4 ounces. These
small volumes thaw faster than larger amounts, and less is wasted if your baby
is unable to finish the milk. When filling any container with the breast milk that is to be
frozen, leave a little space at the top. Breast milk like most other
liquids, expands when it freezes. Do not add fresh, warm milk to already frozen milk. This
defrosts the previously frozen milk. How will I know if the freezer is cold enough? If the temperature is cold enough to freeze ice cream then it is
cold enough to freeze breast milk. Choose the coldest location in the
freezer to store breast milk; the back of the freezer is colder than space near
the front or in the door. Label the bag or container with the collection date and the
volume. Also, write your baby's name if a day care provider or other
caregiver will be preparing feedings for the baby. Place the newest milk
in the back of the pile in the freezer and move older milk to the front. How long can I store the milk? That depends on where the milk is stored. The table below
lists the different times by storage location. These guidelines apply to
milk for healthy infants only. Storage
Location
Temperature
Storage Time Room
Temperature
77degreesF/25degreesC 4 hours Cooler with Blue
Ice
59degreesF/15degreesC 24 hours Refrigerator (Fresh
Milk)
39degreesF/4degreesC
72 hours Refrigerator (Previously thawed milk)
39degreesF/4degreesC
24 hours Frozen
milk
4degreesF/-20degreesC Freezer inside
refrigerator
2 weeks Freezer with separate door outside
refrigerator
3-6 months Separate manual-defrost deep
freeze
6-12 months How should I defrost frozen milk? You can move it from the freezer to the refrigerator, in which
case it will thaw in 12 hours. Or, you can place it on the counter at room
temperature. Placing it in a container of tepid water or running it under
warm tap water will speed up the thawing process and also warm it up. Do
not microwave the milk! The fat in the breast milk rises to the top so it may appear
layered after it defrosts. Swirl the milk to mix it before feeding.
Breast milk may acquire a tinge of color depending on the mother's diet, but it
remains perfectly good to use. Some mothers complain that defrosted
milk smells sour, soapy, or fishy. It is not clear why this occurs, but
general agreement in the lactation community is that the milk can still be used
as long as the baby does not reject it. ~Contemporary Pediatrics
Asthma is a disease of the lungs in which there is reversible spasm of the
muscles in the small branches of the bronchial tree, causing these airway tubes
to narrow. Narrowing of the air tubes makes it difficult for air to get in
and out of the lungs. The lining of these tubes swells and mucus
production increases. This response is a result of over sensitivity or
allergy. The tendency to develop an allergic illness like asthma tends to run in
families. A severe viral infection, bronchiolitis, which affects the lungs
of babies, may produce asthma or symptoms that mimic asthma. This usually
improves after a few years. Premature babies may have lung damage that can
lead to asthma. If your child has asthma, you can help by determining what they are sensitive
to, "triggers". These allergens should be removed from your
child's environment. If removal is not possible, limiting your child's
exposure is helpful. Other situations that may make asthma worse
include: cool damp weather, emotional upset or the presence of
another illness like a cold. Some children have asthma that becomes worse
with exercise. Use of a peak flow meter is also helpful in providing an early warning of an
asthma attack. The reading on the meter will be less than expected when
the child's breathing tubes have become obstructed. You should know
your child's personal best peak flow rate. To determine this you should
have your child obtain two peak flow readings/day for an entire week when the
child is well. These readings will then be used to determine your child's
asthma zones and asthma action plan. The green
zone equals 80% of your child's best peak flow rate and indicates your child is
doing well on current medication. The yellow
zone is when your child can achieve 50% to 80% of their best peak flow
rate. This zone means an asthma attack may occur and medications may need
to be altered. In this zone you should follow your asthma action
plan. If the peak flow rate stays in the yellow zone after medication,
call the office. In the red zone, your
child is able to achieve less than 50% of their best peak flow rate. This
suggests a moderate to severe asthma attack. Start your asthma action plan
immediately and if the attack continues seek medical help
immediately. Symptoms of asthma include: Shortness of breath,
difficulty breathing, wheezing (a vibratory whistling sound), decreased peak
flow reading Treatment: The main medications used are bronchodilators
and anti-inflammatories. The bronchodilators relax the tight muscle
surrounding the air tube. They will help breathing and relieve the
attack. The anti-inflammatories treat the inflammation of the air tubes by
decreasing the swelling of the airways and by decreasing the mucus production in
the airways. Management: Most asthmatic children are controlled with a
simple medical plan (asthma action plan). Half of the children who have
asthma will outgrow it. There is no way to predict the length of time your
child will have asthma. Follow up with the doctor every 3 months and
yearly physicals, are essential to review medications and past usage.
These visits will help determine the best treatment for your child. Our
office requires 3 month follow up visits in order to get refills on medications,
so please plan accordingly. For more information on asthma, go to www.everydaykidz.com. Note: If your child is on the medication Pulmicort,
and you use the same mask to deliver the medication as you do for Albuterol or
Xopenex aerosols, you must cover the air holes on the mask. This is
recommended to prevent prolonged contact with the eyes when administering
Pulmicort. It is safe to leave the vents open with Albuterol or Xopenex.
Exercise induced asthma (EIA) is one of the most common medical conditions
affecting individuals participating in physical activities. Exercise may
be the only trigger of asthma symptoms in some patients. For most
patients, EIA should not limit participation or success in vigorous
activities. Symptoms: EIA usually occurs during or minutes after vigorous
activity, reaches its peak 5 to 10 minutes after stopping the activity, and
usually resolves in another 20 -30 minutes. EIA should be suspected in any
young person complaining of cough, shortness of breath, chest pain or tightness,
wheezing or endurance problems during or shortly after vigorous exercise.
Relief of symptoms after use of a bronchodilator helps confirm the
diagnosis. An exercise challenge can also be used to determine the
diagnosis. Treatment: Since EIA is caused by the cooling and drying of
inspired air during exercise, so any intervention (wearing ski masks or scarves,
moving practice indoors etc.) that warms or humidifies the inspired air is
helpful. Medication may also be used to relieve symptoms. The
mainstay of medication treatment is 2 puffs of a short acting beta agonist, used
as close to exercise as possible. This medication may be helpful for 2 to
3 hours. ~American Academy of Pediatrics
Numerous factors can affect any age patient's need for sleep, however unique
to childhood is the affect the child's developmental level has on sleep
habits. Sleep habits are learned behaviors and are significantly affected
by parental consistency concerning bedtime. Children need the chance to
learn how to self-soothe themselves back to sleep, beginning as early as
infancy. It can take 20-30 minutes of fussiness for the normal baby to
fall back to sleep, which can be quite frustrating to new parents. Newborns: Birth to 28 days, may sleep from 12-20 hours a
day. The average is 16 hours, divided into 3 - 4 hour naps between
feedings and 1 -2 hours of wakefulness throughout the 24 hour cycle. As
infants grow, the total time spent in sleep gradually decreases and they remain
awake for longer periods in the day and sleep longer at night. Infants: It takes infants 6-10 weeks to develop good 24
hour schedules with the longest period of sleep at night. In the first
months of life when infants normally wake up during the night to be fed, parents
should be encouraged to provide very little stimulation. One of the most
constructive ways of teaching good sleep habits is by placing infants awake in
their own crib at naptime or bedtime. The crib is the last thing infants should
remember before going to sleep...not the breast, bottle or the parent's
arms. If babies are always put in the crib sleepy they will soon learn
that the crib is the place for sleep. By 3-4 months of age, most infants
sleep 15 hours per day, six to eight hours at night and the rest divided between
three naps decreasing to two naps between 6 and 12 months of age. Toddler: One to three year olds, require an average of
12-14 hours per day. Most of this sleep occurs at night with one or two
daytime naps, commonly 1-3 hours. By 18 months most toddlers have stopped
taking a morning nap. Preschooler: Three to six year olds, sleep between 10 and
12 hours a night and the daytime nap is given up. Many young children have
difficulty going to sleep, especially after a lot of activity and stimulation
during the day. Preschoolers with their vivid imaginations, may
develop nighttime fears, such as of the dark, monsters, storms and
dogs. Providing a night light and letting the child hold a flashlight or
favorite toy, may be reassuring to promote sleep. Bedtime also commonly
becomes a time for control and exertion of independence in young children.
Attention seeking behavior, stalling and manipulative behaviors should be
ignored. It is also advised that the child not be taken into the parent's
bed or allowed to stay up past a reasonable hour. Non-stimulating rituals
are important to young children. There is no correct routine, but it
should be a period of calmness, helping make the transition to rest and sleep
easier. If possible, bedtime rituals should occur in the same order and
time. School Age: For six to twelve year olds the amount of
sleep needed decreases to approximately 10 hours per night. Later bedtimes
may now be appropriate, helping reduce resistance to going to bed. Bedtime
rituals should be continued but often can be done more independently at this
age. The struggle for authority about bedtime should be avoided.
Children as young as 7 years old can tell time, so the clock can tell them its
bedtime, not the parent. Fears continue during this period, commonly
delaying or interrupting sleep. Adult sleep patterns begin to develop,
including problems with insomnia due to stress and anxiety. Adolescence: The amount of sleep per day diminishes to
the adult level of 7 -9 hours of sleep per night.
STEPS
- Behavioral Consulting Services A
therapeutic socialization program for children with Autism Spectrum Disorder and
Related Developmental Disabilities. For children ages: 3 to 12
years. The
goal of STEPS Social Skills Group is to increase social skills, enhance
communication skills, and to assist in identifying positive and socially
acceptable outlets for self-stimulatory behaviors. Reciprocal interaction
skills with peers will be a primary focus, as well as conversation skills,
nonverbal communication, social engagement, awareness of social cues, joint
attention, generalized responding, eye contact, emotion identification,
tolerance, and following group instruction. Groups
are offered weekly during 6 week sessions at the North Olmsted Recreation Center
and the Strongsville United Church of Christ. Groups will begin in June
and will last throughout the summer. The cost per 6 week session is
$230.00. For more information contact Jennifer Might at 440-377-0029 or
email STEPS at admin@stepsconsulting.org.
Internet
Resources for Special Children The
following websites are just a few of the resources available to parents of
special children. These sites provide information on resources,
assistance, educational links and material, and online stores. www.geocities.com
links parents with resources and assistance www.cshn.org
center for children with special needs - provides information and educational
materials www.childrensdisabilities.info
online store with books and resources for many disabilities (ADHD, Autism,
Cerebral Palsy) to name a few
Guidelines for Successfully Parenting ADHD Children In order to effectively parent a child with ADHD, you must be an effective
manager. Your interactions should be consistent, predictable and most
importantly, understanding of the chronic difficulties your child will likely
experience. There are many resources available on the internet in dealing with
ADHD. The following books may also be beneficial: Taking Charge of
ADHD: The Complete Authoritative Guide for Parents by RA Barkley, and Your
Defiant Child: Eight Steps to Better Behavior by Russell A. Barkley,
Christine M. Benton.
Ideas for Home
Intervention For ADHD Children
ORGANIZATION AND TIME MANAGEMENT 1. Use a clear over the door shoe
holder in your room. Use it to collect the little clutter that usually
ends up on the floor, behind dressers or under the bed. You will be able
to see immediately what is in the organizer and it will make keeping your room
neater much easier. 2. Have one specific area in your
room for personal items such as cologne, perfume, makeup, deodorant, etc.
Keeping them in one area makes it easier to find them each day and get ready on
time. 3. Have a place for everything. 4. Make a schedule of your
day: what time you go to school, what time you arrive home, how long it
takes to complete your homework, household chores and work hours. This
will help you determine how much free time you have and then schedule your day
so everything can be completed. 5. Make a list of things you want to
do. When you find yourself sitting and watching TV for hours or just doing
nothing, use your list to change your time into productive time. 6. Set goals for what you want to
accomplish. Make your goals specific. It is much easier to reach a
goal when you have something specific in mind. 7. Divide your daily activities into
categories and decide on the priority of each category. Completing
homework is a priority, hanging out at the mall is not. 8. Set time limits for yourself. 9. Keep as much routine as possible
in your day. Knowing what you need to do and when you need to do it will
help you accomplish more. 10. Don't procrastinate.
Procrastination causes wasted time. 11. Take the time to complete a task
correctly the first time. Having to do your work over again can waste
time. SCHOOL 1. If you have a study hall
available, use it to take advantage of a quiet time to study and complete
homework. 2. Take notes during class.
This can help you keep focused on the material being taught. 3. Use your assignment notebook to
keep lists of things to do. Don't make lists on scraps of paper or you may
end up losing them or forgetting about them. 4. Talk to your teachers about your
ADD and how it affects your work. Ask for their assistance in areas you
are experiencing problems. They will be more willing to help if they
understand that you are trying to overcome rather than making excuses. 5. Sit in the front of the
classroom. This will help you focus on the lesson, will enable you to pay
attention and minimize distractions. 6. Be prepared. Keep a supply
of pens and small notebooks in your locker. 7. If you end up each day at home
without the books needed to complete your assignments, use different methods to
remember which books to bring home. One student wrote the class on his
hand to remember. He wrote M for math, E for english, etc. While at
his locker, he had on his hand what books he had homework in. 8. Find a partner to help you.
Find someone you trust and work well with to help you stay focused during the
day. Have a secret signal they can give you if they see you have lost your
focus. 9. Clean out your locker every
Friday. Bring home all loose papers from your locker. When you get
home you can sort through the paper to see what you need and organize the
papers. 10. Ask the school about bringing home an
extra set of books. You will never forget your books at home or school. 11. Begin each semester by filling in a
master schedule. First, fill in the things you must do and cannot
change. Then, analyze the blanks that are left to find the most effective
use for these times. 12. Make sure you eat breakfast each
morning, your day will go much better if you take the time to stop and eat. 13. Get a large calendar for your
room. Keep track of upcoming projects, tests, reports as well as other
activities. Take a few minutes each night to fill in anything new.
Take a few minutes each morning to review the calendar to see what is going on
that day. HOMEWORK SKILLS 1. Try to complete your homework in
daylight hours. Some studies indicate it takes longer to complete the same
task at nighttime. 2. Take the time to organize your
homework after it is completed. 3. Prepare yourself the night
before. Get your clothes ready and check your bookbag to make sure
everything is there. Review your calendar to see if there is anything you
forgot to do. 4. Create flashcards for yourself when
studying for a test. These allow you to break down information into small
segments and make it easier to study during odd times, such as while waiting for
the bus or for class to start. 5. Use an assignment notebook.
Don't rely on your memory to keep track of what you need to remember. 6. Create a space for yourself to
complete your homework. Keep this area as clutter free as possible and
have supplies available. 7. Use a cardboard box for all your
loose papers. When you need old papers for school you will know exactly
where to find them. 8. For long term projects, break
into small chunks and make a schedule for completing each item. Keep the
schedule on the wall in your homework area. 9. Complete the hardest homework, or
the subject you dislike the most first and get it out of the way. If you
save this for last, you could drag out the rest of your homework in order to
delay it. 10. Keep a list of classmates and their
phone numbers in your study area so that you can call if you have forgotten the
assignment or have questions about what needs to be completed. 11. Take a short break every half hour to
stretch and then get back to work. Be sure to limit your break time to 5
minutes and make sure you don't start watching TV during the break. 12. When studying for a test, read through
the summaries of sections and chapters before reading the chapter itself.
This will help you focus on the main ideas of the chapter. 13. Find out if your teachers post
assignments online so you can check homework once you are home.
ADHD Meds & Eds (message board) www.millermom.proboards107.com Adult & Young Adult ADD issues www.add.org Children and Adults with ADHD www.chadd.org Assistive Technology at Work (tools for school/work) www.idonline.org/article/11908 Resources for teens with ADHD www.add.about.com/od/forteens/web_sites_and_Resources_for_Teens.htm ADHD Books Parenting children with ADHD: 10 Lessons that Medicine Cannot Teach,
Vincent J. Monastra, PhD. Teaching Teens with ADD & ADHD, Chris A. Zeigler Dendy, MS.
Vitamin D for Breastfed Infants The American Academy of Pediatrics recommends 200 IU of Vitamin D daily, for
100% breastfed infants and for infants that are breastfed and supplemented with
less than 16 ounces of formula per day. This vitamin is essential to
reduce the child's chances of developing rickets. This vitamin can be
found in multivitamin drops for infants.
The following tips will enhance your breastfeeding experience.
Positioning Find a comfortable
position Use a pillow that
gives support and makes feeding easier. Bring baby to the
level of your breast. Bring baby to
breast not breast to baby. Have baby facing
your breast. Latch On Hold your breast in
a C-Hold (four fingers under your breast and your thumb on top). Rub your nipple
lightly across your baby's lips. This will cause your baby to open
wide. When baby is
properly latched on the breast baby's nose should be near the breast but not
pushed into the breast. Feeding Your milk should
come in on the 3rd or 4th day after delivery. Note:
At birth, baby's stomach can only comfortably hold 2 teaspoons. This
means that baby will get enough at first with only a little sucking.
By the time your baby is 7 days old, the stomach can hold 2 ounces.
Every day you will see your baby suck more at the breast. Babies usually
finish one breast in 15 to 20 minutes. Let baby finish the
first breast before offering the second breast. Remember to always
break the suction with your finger before removing baby from the breast. Feeding Frequency You should feed
every 2-3 hours during the day and every 3-4 hours at night. Total feedings
should be 8-12 feedings each 24 hours. Baby's Suck You should be able
to hear the baby swallow after your milk comes in. You should notice a
pause between swallows. You should not hear
smacking or clicking if the baby is latched on correctly. How Do You Know
Baby Has Had Enough? In the first 48
hours baby may only have 2 wet diapers and 2 stools in a 24 hour period. After 48 hours baby
should have 5-6 wet diapers with 2-4 stools each day. Baby's urine should
be clear, light yellow or golden in color. Urine should not be
dark yellow, orange or brown. This means baby is not getting enough
breast milk. Baby's Weight
Loss Weight loss is
normal during the first 3-4 days after birth. Babies should
regain their weight within 2-3 weeks of age. Once babies have
regained their birth weight, they should gain 4-8 ounces per week. Information for
Nursing Moms As a nursing
mother, you'll need to eat a balanced diet that contains 500 to 600 calories
more per day than the diet you needed before pregnancy. Nursing mothers
should drink enough to satisfy their thirst. Most foods eaten by
the nursing mother will be well tolerated by her infant. If you find
that certain foods seem to disagree with either you or your infant, avoid
them temporarily. Medications taken
by a mother can pass into her breast milk. Some medications passed
this way can be harmful to the infant. Please check with a provider
before taking any medications other than Tylenol while you are
breastfeeding.
Natural weaning begins
when you start giving your baby food. Sometimes it may be necessary to
wean for other reasons. The following are some helpful suggestions to
guide you in the weaning process. Recommendations: Weaning should be
done as slowly as possible for the health and welfare of both mother and
baby. The American Academy of Pediatrics recommends that all babies be
breastfed until 12 months of age. Supplemental foods are often started
at 4-6 months of life, but the breast milk is considered the primary source
of nutrition. When Not to Wean: If baby is sick or
in the hospital If mother is sick
or in the hospital During times of
unusual stress During a separation
due to business or vacation During the holidays Weaning Should Be
Done As Slowly As Possible Replace the same
feeding every day with a bottle or cup depending on the age of your baby.
After replacing that feeding for approximately one week, replace a second
feeding. Continue this method until baby is completely weaned.
Weaning should not start out with bedtime or naptime feedings. At four to six
months you may supplement feedings with solid foods. If you wean before
12 months of age you must use formula until your baby's first birthday. Watch for signs of
plugged ducts and mastitis Your decreasing
hormone levels may contribute to a feeling of sadness or a sense of loss. Your menstrual
periods may resume. All babies sneeze,
yawn, belch, pass gas and occasionally spit up small amounts of their feedings.
Sneezing is the way lint, mucous and curds of milk are removed from the nose.
Hiccups are spasms of the diaphragm and generally do not bother the baby.
Often, a few sucks of water or milk will bring them to a halt. The cough,
in sickness or in health, is a protective reflex which keeps the throat and
bronchial tubes clear of foreign material. Please call if the cough is
persistent. Crying is your baby's
way of saying "I'm hungry", "I'm thirsty", "My bottom is sore", "I'm too hot or
cold", "I have a stomachache", "I'm bored", or "I don't know what I want".
You will, in time, begin to interpret the meaning of these cries. Babies
can cry for an hour or more without doing themselves any harm. The old
folk song that asks "How can you have a baby with no crying?" is a good line to
remember. Some babies cry more than others and at certain times of the
day. They may be labeled as having colic. From three weeks to three
months of age, many infants have a fussy period which may last for many hours in
the evening. They pass large amounts of gas, get red in the face and pull
up their legs. Most of these babies have nothing wrong with them.
The cause of colic is not yet known, but it begins to taper off by the fourth
month. Some comforting measures you can try include offering a pacifier,
placing a warm heating pad on your infant's abdomen, holding your infant upright
against your chest or shoulder and humming and offer more frequent burping.
Sometimes simply walking with your baby in your arms, in a stroller or going for
a ride in the car may help. When all else fails, let your infant cry (for
someone else if possible) while you take a needed break.
For some babies, bath time turns out to be a battle. Eventually, all
babies find this a very enjoyable part of the day. It is probably best to
sponge bathe your infant until the navel is healed. While the cord is
still on, keep it as dry as possible to facilitate its detachment. Because
your infant's skin is dry, a bath every other day is sufficient. Mild
soap, like Dove or Neutrogena can be used everywhere.
Please do not attempt to remove ear wax from the ear canal with cotton
applicators. This frequently results in packing portions of the ear wax
deeper into the canal, making visualization of the ear drum impossible and
removal of the wax uncomfortable for your child.
Avoid the use of bubble baths and deodorant soaps. Some of these products are
extremely irritating to the skin in sensitive areas. Cradle cap, a
collection of yellow, greasy scales on the head, usually can be managed by using
a mild dandruff shampoo once or twice per week. If this condition persists
or worsens, consult your pediatrician regarding the use of additional
medication. Do not use baby oil during the first three months of life.
Your infant already has excess natural oils and these produce skin irritation
which is made worse by the addition of baby oil. A mild lotion like
Lubriderm is all that is needed.
Crying is your baby's first language. The only way they can communicate is
to cry. The sound of your baby crying can be very distressing and hard to
ignore. When your baby cries, respond. This teaches your baby trust.
It takes about a month to get to know you and trust in the care you give.
You will not spoil your baby by approaching every time a cry is heard. Cuddle Feed Pacifiers Massage Visual distractions Music Walks Position across
knee Rhythmic motion,
walking or rocking Get some fresh air Take breaks, get a
baby sitter Mechanical swing Bath Quiet time...allow
them to learn to comfort themselves Swaddle Car ride Rhythmic Noises -
Ceiling fan, washing machine, dishwasher, vacuum While infant is in
the crib, soothe by patting rhythmically and talking with a reassuring
voice. Do silly and
unexpected things Sing Change diaper Read to infant Use relaxation and
slow paced breathing
The best alternative to
human milk is commercial infant formula because it is designed to closely
approximate human milk. Formula supplies essentially the same quality and
amount of protein, fat, carbohydrate, vitamins and minerals as human milk.
Any iron-fortified milk or soy formula is satisfactory. Occasionally, an
infant seems not to tolerate the usual formulas. If your infant seems to
have difficulty with the formula you are presently using, discuss this with one
of the providers. They may recommend a formula change. It is not necessary to
sterilize nipples and bottles or to boil the water for formula preparation.
It is important to follow the directions on the formula can for proper mixing of
the formula. Ready to feed formula is convenient but more expensive.
If cost is a concern, the powdered formulas are more economical. To feed your infant,
find a comfortable sitting position with the infant cradled in your arm.
Hold the bottle so that the milk is seen in the nipple and neck of the bottle to
avoid having the infant suck a lot of air. To keep the nipple from
collapsing, take it out of your infant's mouth frequently. Nipples should
be tested regularly to avoid use of nipples with holes that are not the right
size. Holes that are too large may cause the formula to come out too
quickly. Throw these nipples away. Holes that are too small make
feedings difficult for your infant and may cause much air to be swallowed.
Enlarge the hole by passing a hot needle through the opening. There is not one
type of bottle or nipple that is clearly better for all infants. Find what
seems to satisfy your baby. Never allow your infant to take a bottle to
bed, as this may encourage cavities.
Jaundice is the yellow color seen in the skin of many newborns. It
happens when a chemical called bilirubin builds up in the baby's blood.
Everyone's blood contains bilirubin, which is removed by the liver. Before
birth, the mother's liver does this for the baby. Most babies develop
jaundice in the first few days after birth because it takes a few days for the
baby's liver to get better at removing bilirubin. The bilirubin level is
usually the highest at 3 to 5 days of life. The skin of a baby with jaundice usually appears yellow. Jaundice
usually appears first in the face and then moves to the chest, abdomen, arms and
legs as the bilirubin level increases. The whites of the eyes may also be
yellow. Jaundice may be harder to see in babies with darker skin
color. Most infants have mild jaundice that is harmless, but in unusual
situations the bilirubin level can get very high and might cause brain
damage. This is why newborns should be checked carefully for jaundice and
treated to prevent a high bilirubin level. Jaundice is more common in babies who are breastfed than babies who are
formula-fed, but this occurs mainly in infants who are not nursing well.
If you are breastfeeding, you should nurse your baby 8-12 times a day for the
first few days. This will help you produce enough milk and will help to
keep the baby's bilirubin level down. Other factors that cause a greater risk for increased bilirubin levels
include: early birth (more than 2 weeks before the due date), jaundice in
the first 24 hours after birth, breastfeeding that is not going well, a lot of
bruising or bleeding under the scalp related to labor and delivery, and a parent
or sibling who had high bilirubin and received light therapy. You should contact the doctor if your baby's skin becomes more yellow, the
abdomen, arms or legs are yellow, the whites of the eyes are yellow, or if your
baby is hard to wake, fussy, or not nursing or taking formula well. Most jaundice requires no treatment. When treatment is necessary,
placing your baby, undressed, under special lights (in the hospital), will lower
the bilirubin level. Jaundice is treated at levels that are much lower
than those at which brain damage is a concern. Treatment can prevent the
harmful effects of jaundice. In breastfed infants, jaundice often lasts
for more than 2 to 3 weeks. In formula fed infants, most jaundice goes
away in 2 weeks.
At some point while your child is in diapers they will most likely develop a
diaper rash. Irritant contact diaper rash is very common. Excessive
moisture accompanied by chafing, elevated ammonia and ph levels within the
diaper, as well as skin contact with stool irritate and damage the baby's skin.
To treat a mild rash we recommend: frequent diaper changes, discontinue
the use of wipes (which can add to the irritation) and air dry whenever possible
(this allows the skin to dry and restore its natural defenses). A barrier
cream such as Desitin, Aquaphor or Diaperene can also be used. If the
diaper rash does not improve with the above treatments after 72 hours or if
there are any open areas, contact your pediatrician for further advice or
follow-up.
All
newborn babies are required by the state of Ohio to get
tested for some rare disorders before they leave the
hospital. Babies with these disorders may look
healthy at birth. Serious problems such as mental
retardation or death can be prevented if a disorder is
diagnosed right away. If the result of the test
indicates a possible problem, your physician will
contact you and a repeat test will be ordered and
information will be given to you regarding further
follow up. Most disorders are treated with
replacement hormone or drug therapy, or dietary
changes. If a disorder is confirmed through repeat
testing, your baby will be referred to a
metabolic/endocrine/genetic specialist.
Disorders
tested:
Biotinidase
Deficiency (BIO)
BIO
is an enzyme deficiency that occurs in about 1 in 60,000
newborns and can result in seizures, hearing loss and
death in severe cases. Treatment is simple and
involves daily doses of biotin.
Congenital
Adrenal Hyperplasia (CAH)
CAH
is caused by decreased or absent production of certain
adrenal hormones. The most prevalent type is
detected by newborn screening in about 1 in 15,000
newborns. Early detection can prevent death in
boys and girls and sex misassignment in girls.
Treatment involves lifelong hormone replacement therapy.
Congenital
Hypothyroidism (CH)
Inadequate
or absent production of thyroid hormone results in CH
and is present in about 1 in 3500 newborns.
Thyroid hormone replacement therapy begun by 1 month of
age can prevent mental and growth retardation.
Congenital
Toxoplasmosis (TOXO)
Infection
of the fetus with a parasite ingested by the mother
during pregnancy can result in TOXO in the
newborn. The transmission rate is about 30% and
the national incidence is approximately 1 in 10,000
newborns based on limited screening. Early
diagnosis and drug therapy reduces the risk of
blindness, mental retardation or other serious
complications.
Cystic
Fibrosis (CF)
Cystic
fibrosis (CF) is the second most common life shortening,
childhood onset, inherited disorder in the United
States. It occurs in about 1 in 4,000 U.S.
births. Cystic fibrosis is inherited when
both parents carry an altered CF gene and pass it on to
their child. A person who has one altered CF gene
is called a "carrier". Carriers usually
do not have any health problems caused by CF. When
two CF carriers have children together, each baby has a
one in four (25 percent) chance of having CF. Most
children with CF do not have a family history of the
disease.
CF
affects breathing and digestion. It causes the
body to make thick, sticky mucus that clogs the airways
of the lungs, and it can prevent the pancreas from doing
its job to help digest food. In people with CF,
the sweat glands also make very "salty" sweat.
Beginning
in the fall of 2006, newborns in the state of Ohio began
being screened for CF as part of the routine screenings
done on tiny samples of blood taken from a newborn's
heel 24-48 hours after birth. These newborn
screenings will allow for earlier treatment, although
there is no cure at the present time.
A
positive screen does not mean that an infant has
CF. This result means that the infant is at
increased risk for the disease. Further testing
must be done to properly identify and diagnose infants
with CF versus those who are simply carriers of the gene
that causes CF. This further testing is done at
the Rainbow Cystic Fibrosis Center for residents near
Cleveland. If a newborn screen is positive, the
next step is a sweat test and genetic counseling.
The sweat test will determine if a child is affected or
not. The test takes about 30 minutes. Small
areas of the baby's arms and legs are stimulated to
produce sweat, which is collected on gauze and sent to
the laboratory. Genetic counselors then meet with
the parents to discuss the results and the next steps.
This test is most accurate if done when the baby is
between 2 to 4 weeks of age.
Early
diagnosis and treatment mean that there is a better
chance that the baby with CF will grow up with fewer
complications and an improved quality of life.
Treatment includes eating a healthy, high-calorie diet
with vitamins. To breathe better, many people with
CF need help clearing mucus from their lungs each
day. Some medications can help prevent lung
infections and help with breathing.
This
new screening will provide early diagnosis and immediate
interventions to help the child live a longer, better
life.
~Michael
Konstan, MD, Rainbow Cystic Fibrosis Center
Galactosemia
(GAL)
Failure
to metabolize the milk sugar galactose results in GAL
and occurs in about 1 in 50,000 newborns. The
classical form detected by newborn screening can lead to
cataracts, liver cirrhosis, mental retardation and/or
death. Treatment is elimination of galactose from
the diet usually by substituting soy.
Homocystinuria
(HCY)
HCY
is caused by enzyme deficiency that blocks the
metabolism of an amino acid that can lead to mental
retardation, osteoporosis and other problems if left
undetected and untreated. The incidence is
approximately 1 in 350,000 U.S. newborns.
Treatment may involve dietary restrictions and
supplemental medicines.
Maple
Syrup Urine Disease (MSUD)
MSUD
is a defect in the way that the body metabolizes certain
amino acids and is present in about 1 in 200,000 U.S.
newborns. Early detection and treatment with
dietary restrictions can prevent death and severe mental
retardation. There is an increased risk in
Mennonites.
Medium
Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency
The
most common disorder in the way the body metabolizes
fatty acids is called MCAD deficiency. Undetected,
it can cause sudden death. Treatment is simple and
includes ensuring regular food intake. The
incidence from newborn screening is not yet known, but
is thought to be approximately 1 in 15,000 newborns.
Phenylketonuria
(PKU)
An
enzyme defect that prevents metabolism of phenylalanine,
an amino acid essential to brain development, is known
as PKU and occurs in approximately 1 in every 19,000
U.S. newborns. Undetected and untreated with a
special diet, PKU leads to irreversible mental
retardation. Persons of European descent are at
increased risk.
Sickle
Cell Disease (SCD)
Sickle
cell anemia is the most prevalent SCD and causes clogged
blood vessels resulting in severe pain and other severe
health problems. Other common SCDs include various
thalassemias. Newborn screening detects about 1 in
2500 newborns with SCD annually. Persons of
African or Mediterranean descent are at an increased
risk.
Other
Fatty Acid Oxidation (FAO) Disorders
Besides
MCAD deficiency, other FAO disorders may be detected
through newborn screening. They are usually
described in categories based on the length of the fatty
acid involved. Undetected and untreated they can
cause seizures, coma and even death. The incidence
of various FAO disorders are not known since it is only
recently that early detection through newborn screening
has occurred.
Organic
Acid (OA) Disorders
Organic
acidemias are a group of metabolic disorders that lead
to accumulation of organic acids in the blood and urine
and may be detected in newborn screening through
analysis of acylcarnitine profiles. Symptoms may be
diminished by restricting protein in the diet and
supplementation with vitamins and/or carnitine.
Because newborn screening for these disorders is
relatively new, the degree of occurrence in newborns is
not yet known.
Urea
Cycle Disorders (UCD)
A
UCD is a genetic disorder caused by a deficiency of one
of the enzymes responsible for removing ammonia from the
blood stream. Some UCDs may be detected as a part
of newborn screening. They are characterized by
seizures, poor muscle tone, respiratory distress, and
coma, and result in death if left undetected and
untreated. Because newborn screening for these
disorders is relatively new, the degree of occurrence in
newborns is not yet known.
Helpful Websites for New Families
www.Kidshealth.org
Parenting, growth, development and nutrition
www.linktohelp.org Search for
organizations to help you
www.helpmegrow.org Birth to 3
years: services and programs for families
www.neofathering.net and
www.fathers.com Information for
new DADS
Hives
are usually caused by an allergic reaction to medicine, food
or plants. They can also appear with illness or as a
result of stress. Hives
are generally sharply defined, slightly raised areas
surrounded by redness and are usually circular in
appearance. Hives are accompanied by intense
itching. Each eruption is transient, lasting no more
than 8 to 12 hours, but they may be replaced by new ones
in different locations. These eruptions may
appear immediately after exposure to an allergen or they may
be delayed for several days. New lesions may continue
to appear for one week. Hives
accompanied by swelling of the lips, face and/or hands may
also occur. In severe reactions children may
experience respiratory difficulty or swelling of the
throat. If your child is experiencing any facial
swelling or difficulty breathing seek medical attention
immediately!
Head
lice spend their entire lives on the human scalp, clinging to the hair while
feeding, mating, and laying eggs. They are unrelated to hygiene or living
conditions. Lice cannot jump or fly (they have no wings). Transmission is
after close physical contact-head to head. The transfer of lice from host
to an object to a new host is relatively rare. Though it is possible for
lice to be transferred from a personal item; pillow, hat, towel, brush, it would
have to be used immediately after it was used by an infested person. Lice
cannot live off the human body for more than 24 hours. Diagnosis:
The main symptom is itching. Diagnosis is confirmed by the presence of a
live, mobile louse. The louse is about the size of a sesame seed and brown
in color. Nits (eggs) are deposited on the hair shaft usually within 6mm
of the scalp. These eggs will hatch in 7-10 days. Nits can remain
stuck on the hair shaft for weeks or months after an infestation has been
treated. A positive diagnosis is based on the presence of a live louse.
If someone in the family is diagnosed with lice, the entire family should be
checked. Treatment:
Nits can be removed with a fine tooth comb. Part the hair into
small strands and comb through hair. Examine the comb for any lice.
If no live lice are found, repeat the procedure in 1-2 days. If live lice
are found the first line of therapy is over the counter pediculicides (Rid, Nix,
Lice Arrest, for example). Follow the package directions closely.
Treatment is for external use only. A second treatment should be applied
in 7-10 days, because 25-30% of lice eggs survive
treatment. In general, these preparations are safe to use.
Prescription treatment for lice is used only if infestation has not
responded to over the counter treatment. Linens,
towels, clothes worn 2 days before treatment should be washed in hot water and
dried on high heat. The room should be vacuumed or wet mopped. Dry
clean items that are not washable or seal in plastic bags for 2 weeks or place
plastic bag in the freezer for 3 days. Remember to vacuum furniture and
car seats. Soak brushes and combs in dishwashing detergent and hot water
for one hour, rinse and dry.
Molluscum is a rash caused by a
poxvirus. The rash appears as raised, round, smooth surfaced bumps on the
skin that look like thick-walled pimples. They have a waxy or skin colored
surface with a dimple in the center of the bump. They are found on just
one area of the body and usually range in size from a pinhead to 1/4 inch
across. They are not painful but are occasionally itchy. Molluscum
is transmitted through skin to skin contact with an infected person.
Molluscum is only mildly contagious, the incubation period is 4 to 8
weeks. Your child can attend child care, preschool and school without
undue concern about spread. Children 2 to 12 years are most likely to be
infected by this virus. Molluscum can spread to other parts
of the body if a child picks at a bump and then scratches elsewhere. Use
distraction to stop younger children from picking. Chewing or sucking on
molluscum can lead to similar bumps on the lips or face. If your child is
doing this, cover the molluscum with a Band-Aid. Keep your child's
fingernails cut short and wash your child's hand frequently. Most
molluscum disappear without treatment in 6 to 18 months. Molluscum can
spread rapidly and last longer in children who have atopic dermatitis. If
repeatedly picked at, molluscum can become infected with bacteria and change
into crusty sores (impetigo). Most children only develop 5 to 10
molluscum, but some acquire more. Regardless of the number, this is a
temporary condition. Because molluscum are harmless, painless,
and have a natural tendency to heal and disappear, some physicians recommend not
treating them. The treatment itself may be painful and frightening,
especially to younger children. Treatment may be unsuccessful or need to
be repeated. Treatment will be considered if your child picks at them, the
molluscum are in areas of friction (ex: the armpit), you feel they are a
cosmetic problem, or the molluscum appear to be spreading rapidly. There
is no successful home treatment for molluscum. The following techniques
must be performed in a physician's office. The molluscum can be destroyed
by freezing or burning with a mild acid. Another type of treatment
involves piercing the center of the molluscum with a needle or scalpel and
scraping out the core. Newer techniques may become available. If
the molluscum are spreading rapidly, appear infected or your child continues to
pick at them, call your physician.
Pinworm
infections are caused by a small, white intestinal worm. Pinworms live in
the rectum of humans. While an infected person sleeps, the female leaves
the intestine through the anus and deposits eggs on the surrounding skin.
The main symptoms of infection are rectal itching, disturbed sleep and
irritability. Pinworms are the most common worm infection in the United
States. School age children have the highest rate of infection. The
mode of transmission is the fecal-oral route. You can become infected
after ingesting infective pinworm eggs from contaminated surfaces or fingers. Diagnosis:
Checking the rectum at night or first thing in the morning could reveal
the presence of adult worms. These will appear as tiny white
threads. Occasionally, worms are seen in the stool of infected persons. If
you have found worms on your child call the office for treatment. Treatment:
Pinworms are treated with prescription medication which is a two dose
treatment. Close family contacts may also require treatment. To
prevent the spread of infection: change and wash your underwear each day,
change pajamas frequently, trim fingernails short, encourage good hand washing
after using the toilet, before eating and after changing diapers.
Discourage nail biting and scratching of bare anal areas, these practices help
reduce the risk of continuous self infection. After
diagnosis, linens and towels of the infected person should be washed in hot
water. Vacuuming the entire house or washing sheets everyday are probably
not necessary or effective.
Your
child is almost certain to have one nosebleed-and probably many-during there
preschool years. Some preschoolers have several a week. This is
neither abnormal or dangerous, but it is very frightening. If blood flows
down from the back of the nose into the mouth and throat, your child can swallow
a great deal of it, which in turn may cause vomiting. There
are many causes of nosebleeds, most of which aren't serious.
Beginning with the most common causes they include: Colds
and allergies. A cold or allergy causes swelling and irritation
inside the nose and can cause spontaneous bleeding. Trauma.
A child can get a nosebleed from picking his nose, or putting something into
it, or just blowing it too hard. A nosebleed can also occur if he is
hit in the nose by a ball or other object, or falls and hits his nose. Low
humidity or irritating fumes. If your house is very dry, or if you
live in a dry climate, the lining of your child's nose may dry out, making
it more likely to bleed. If he is frequently exposed to toxic fumes
(fortunately, an unusual occurrence), they may cause nosebleeds, too. Anatomical
problems. Any abnormal structure inside the nose can lead to
crusting and bleeding. Abnormal
growths. Any abnormal tissue growing in the nose may cause
bleeding. Although most of these growths, (polyps) are benign (not
cancerous), they still should be treated promptly. Abnormal
blood clotting. Anything that interferes with blood clotting can
lead to nosebleeds. Medications, even common ones, can alter the blood
clotting mechanism just enough to cause bleeding. Blood diseases, such
as hemophilia, also can provoke nosebleeds. Chronic
illness. Any child with a long-term illness, or who may require
extra oxygen or other medication that can dry out or affect the lining of
the nose, is likely to have nosebleeds. Treatment There
are many misconceptions and folktales about how to treat a nosebleed. Here
are a list of do's and don'ts: Do: Remain
calm. A nosebleed can be frightening, but it is rarely serious. Keep
your child in a sitting or standing position. Tilt his head
slightly forward. Have him gently blow his nose if he is old enough. Pinch
the lower half of your child's nose (the soft part) between your thumb
and finger and hold it firmly for a full ten minutes. If your child is
old enough, he can do this himself. Don't release the nose during
this time to see if it is still bleeding. Release
the pressure after ten minutes and wait, keeping your child quiet. If the
bleeding hasn't stopped, repeat this step. If after ten more minutes of
pressure the bleeding hasn't stopped, call your pediatrician or go to the
nearest emergency room. Don't: Panic.
You'll just scare your child. Keep in mind that the blood coming from
the nose always looks like a lot. Have
him lie down or tilt back his head. Stuff
tissues, gauze, or any other material into your child's nose to stop the
bleeding. Call
your pediatrician if you think your child has lost too much blood, the
bleeding is coming from your child's mouth or he's coughing or vomiting blood,
or if he has a lot of nosebleeds and a chronically stuffy nose. If your
child is unusually pale or sweaty, or is not responsive, take your child to the
emergency room. Prevention: If
your child gets a lot of nosebleeds, ask your pediatrician about using salt
water nose drops every day. Doing so may be helpful if you live in a dry
climate or when the furnace is on. In addition, a humidifier or vaporizer
will help maintain your home's humidity at a level high enough to prevent nasal
drying. Also tell your child not to pick his nose. If he picks it at
night or in his sleep, put him to bed wearing thin cotton gloves or socks over
his hands. ~AAP
Warts
are caused by a virus and appear as firm raised areas with a rough or horny
surface. Plantar warts are found on the soles of the feet and are usually
tender, circular lesions with a speckled core. Warts are transmitted
through direct contact but contaminated floors are often implicated. The
incubation period is about 4 months, they are communicable as long as visible
lesions persist. Plantar warts and hand warts are most often seen in young
children. Warts nearly always regress spontaneously within a period of
months. However, to decrease transmission and to treat warts for faster
resolution, it is recommended to try one of the over the counter preparations
containing salicylic acid. The over the counter freezing medication also works
well. Be careful when using to avoid applying to normal skin.
If your child has more than one wart or warts on the face or genitals, or if the
warts don't respond to over the counter treatment, referral to a dermatologist
is recommended. Consider
the following guidelines if you want to teach your baby that nighttime is a
special time for sleeping, that her crib is where she stays at night, and that
she can put herself back to sleep. It is far easier to treat sleep
problems before 6 months of age than it is to treat them later. Newborns: Place
your baby in the crib when he is drowsy but awake. This step is very
important. He must learn to put himself to sleep without you. It
often takes 20 minutes of restlessness for a baby to get to sleep. If
he is crying, rock him and cuddle him; but when he settles down, try to
place him in the crib before he falls asleep. Hold
your baby for all fussy crying during the first 3 months. Babies can't
be spoiled during the first 3 or 4 months of life. Do
not let your baby sleep for more than 3 consecutive hours during the
day. In this way, the time when your infant sleeps the longest will
occur during the night. Many newborns can sleep 5 consecutive hours
and you can teach your baby to take this longer period of sleep at night. Keep
daytime feeding intervals to at least 2 hours for newborns. More
frequent daytime feedings (such as hourly) lead to frequent awakenings for
small feedings at night. Make
middle of the night feedings brief and boring. Don't
awaken your infant to change diapers during the night. The exceptions
are: soiled diapers or if you are treating a bad diaper rash. Don't
let your baby sleep in your bed. Teach your child to prefer his own
bed. Give
the last feeding at your bedtime (10 or 11 pm). Try to keep your baby
awake for the 2 hours before this last feeding. Going to bed at the
same time every night helps your baby develop good sleeping habits. Two-Month-Old
Babies: Move
your baby's crib to a separate room. Your baby may forget that her
parents are available if she can't see them when she awakens. Try
to delay middle of the night feedings. By now, your baby should be
down to one feeding during the night. Never awaken your baby at night
for a feeding except at your bedtime. Four-Month-Old
Babies: Try
to discontinue the 2:00 am feeding before it becomes a habit. If you
do not eliminate the night feeding at this time, it will become more
difficult to stop as your child gets older. If your child cries during
the night comfort him with soothing words instead of a feeding. Don't
allow your baby to hold his bottle or take it to bed with him. A
bottle in bed leads to middle of the night crying because your baby will
inevitably reach for the bottle and find it empty on the floor. Also,
bottles in bed can lead to tooth decay. Make
any middle of the night contact brief and boring. All children have
four or five partial awakenings each night. They need to learn
how to go back to sleep on their own. Six-Month-Old
Babies: Provide
a friendly soft toy for your child to hold in her crib. At this age
children start to be anxious about separation from their parents. A
stuffed animal, doll or blanket can be a security object that will give
comfort to your child when she wakes during the night. Leave
the door open to your child's room. During
the day, respond to separation fears by holding and reassuring your child. For
middle of the night fears, make contacts prompt and reassuring. Keep
the interaction brief, do not take out of the crib, keep the light off and
don't talk too much. One
Year Old Children: Establish
a pleasant and predictable bedtime ritual. Children need a
familiar routine. Finish the bedtime ritual before your child falls
asleep. Once
put to bed, your child should stay there. Some infants have tantrums
at bedtime. You should ignore these protests and leave the room.
If he is standing up, leave him in that position. He can lie down
without your help. Encouraging him to lie down soon becomes a
game. If you respond to his protests the same way every time, he will
learn not to try to prolong bedtime. If
your child has nightmares, reassure him. Don't
worry about the amount of sleep your child is getting. The best way to
know that your child is getting enough sleep is that they are not tired
during the day. Children stop taking morning naps between 18 months
and 2 years of age and give up the afternoon nap between 3 and 6 years of
age.
These
children are over two years old and refuse to go to bed or stay in the
bedroom. They can come out of the bedroom because they no longer sleep in
a crib. These are attempts to test the limits, not fear. Your child
has found a good way to postpone bedtime and receive extra entertainment.
If given a choice, over 90% of children would stay up until their parents'
bedtime. These children often try to share the parents' bed at bedtime or
sneak into their parents' bed in the middle of the night. The following
recommendations apply to children who are manipulative at bedtime, not fearful. Start
the night with a pleasant, predictable bedtime ritual. Most
pre-bedtime rituals last about 30 minutes and include taking a bath,
brushing teeth, saying prayers, reading stories, talking about the day, and
other interactions that relax your child. Establish
a rule that your child can't leave the bedroom at night. Expect to
hear some crying or screaming. Ignore
verbal requests. All of these requests should have been dealt with
during the pre-bedtime ritual. Exception: If you child says he
needs to use the toilet, tell him to take care of it himself. If he
says his covers have fallen off, promise him you will cover him when you go
to bed. You will usually find him well covered. Close
the bedroom door for screaming. Tell him you will open it when he is
quiet. If he pounds on the door, you can open it after 1 or 2 minutes
and suggest he go back to bed. For continued screaming or pounding on
the door, reopen it approximately every 15 minutes, telling your child that
if he quiets down, the door can stay open. Never spend more than 30
seconds reassuring him. Close
the bedroom door for coming out. If he does come out, return him
immediately to bed. Tell him you will open the door when he is in
bed. CAUTION: If your child has bedtime fears, don't close
his door. Barricade
the door for repeated coming out. While this may seem extreme, it can
be critical for safety reasons for children who wander through the house at
night without an understanding of dangers (such as the stove, hot water,
electricity, knives and going outdoors). Return
him if he comes into your bed at night. Praise
appropriate sleeping behavior. Start
bedtime later if you want to minimize bedtime crying.
Nightmare
Night Terror A
scary dream followed by complete
awakening.
A partial arousal from very deep sleep. Occurs
in the second half of the
night.
Usually one to two hours after falling asleep. After
waking is fearful and
crying.
Sitting up, thrashing, crying. Fear and confusion disappear after awake. After
waking, child is reassured by your
presence.
Child is not aware of your presence. May
have trouble returning to
sleep.
Returns to sleep rapidly without fully awakening. Often
remembers the dream and talks about
it.
No memory of the dream or of yelling or thrashing.
Confidentiality in the care of Young Adolescents A Note to Parents about Confidentiality Now that your child is entering adolescence, we would like to let you know about some changes that will be taking place in our office visit routines. These changes are being made to recognize your child’s growing independence and enable us to provide the best medical care. During early adolescence, young teens and preteens are learning to think and behave like the adults that they are destined to become. With their parents’ support, they practice the skills they will need as they become increasingly independent. Taking responsibility for choices related to health and safety is an important developmental task of adolescence, which is why gradual changes are made in the structure of pediatric office visits at this time. Sometime between ages 11 and 14, your son or daughter will begin to spend part of the office visit alone When your pediatrician meets privately with your adolescent, conversations will be confidential. A teen might want to share something that they consider “private” with the doctor, and private does not necessarily imply something that you need to be concerned about. It is critical that young people in this age group have a chance to ask questions directly and have an open dialogue with a trusted physician without embarrassment or fear of blame. The exception to confidentiality would be if your pediatrician felt that there was a threat to your son or daughter’s life or that of another person, including suicidal or homicidal thoughts. This information would be shared with you immediately. Your adolescent’s need for respect, privacy, and autonomy does not lessen their need for your continued guidance and support. Your involvement in your adolescent’s development will always be extremely important. Please feel free to telephone at any time. We are always glad to hear from you Staying in Touch With Your Teen Adolescents
are notorious for not getting enough sleep. The average amount per night
is 7 to 7 1/4 hours. What they need is between 9-91/2 hours. There
are a number of reasons teenagers do not get enough sleep: Shift
in sleep schedule. After puberty, there is a biological shift in an
adolescent's internal clock of about 2 hours, meaning that a teenager who
used to fall asleep at 9:00 p.m. will now not be able to fall asleep until
11:00 p.m. It also means waking 2 hours later in the morning. Early
high school start times. This means some teenagers may have to get up
as early as 5:00 a.m. to get ready and travel to school. Social
and school obligations. Homework, sports, after-school activities and
socializing lead to late bedtimes. As
a result, most adolescents are very sleep deprived. Sleep deprivation will
impact on many aspects of your teen's functioning. Mood.
Sleep deprivation will cause your teenager to be moody, irritable and
cranky. They have difficulty regulating their mood and will often be
frustrated and upset more easily. Behavior.
Teens that are sleep deprived are more likely to engage in risk taking
behaviors such as drinking, driving too fast and engaging in other dangerous
activities. Cognitive
ability. Inadequate sleep will result in problems with attention,
memory, decision making, reaction time and creativity. Academic
performance. Studies show that teenagers who get less sleep are more
apt to get poor grades in school, fall asleep in school, and have school
tardiness/absences. Drowsy
driving. Teens are at the highest risk for falling asleep at the
wheel. Drowsy driving is most likely to occur in the middle of the
night (2:00 - 4:00 a.m.) but also in the mid-afternoon (3:00 - 4:00 p.m.) Help
your teenager get enough sleep. Maintain
a regular sleep schedule. Avoid
oversleeping on the weekends. Although catching up on some sleep on
the weekends can be helpful, sleeping in until noon on Sunday will make it
hard to get back on a school schedule that night. Take
early afternoon naps. A nap of 30-45 minutes can be beneficial. Turn
off television, radios and computers. Stimulating activities at
bedtime will cause problems falling asleep. Avoid
caffeine, smoking, alcohol and drugs. Contact
the doctor if your teen has difficulties falling asleep or staying
asleep, snores or seems excessively sleepy during the day. ~Mindell
& Owens (2003)
Too
much of a good thing can be harmful, especially when it
comes to children playing sports. As more children
and adolescents participate in organized and
recreational sports, pediatricians are seeing an
increasing number of children and adolescents with
overuse injuries caused by too much training and not
enough rest. The
AAP defines an overuse injury as a micro traumatic
injury to a bone, muscle or tendon that has been
subjected to repetitive stress without sufficient time
to heal or undergo the natural healing process.
The risks of overuse are more serious in the
pediatric/adolescent athlete because the growing bones
of the young athlete cannot handle as much stress and
the mature bones of adults. It
is recommended that young athletes limit training in one
sport to no more than five days a week, with at least
one day off from any organized physical activity.
In addition, athletes should take time off from one
sport for two to three months each year. Taking a
break from a sport allows injuries to heal and the
opportunity to work on strength training and
conditioning to reduce the risk of future
injuries. It also helps kids take a psychological
break, which is necessary to avoid burnout, or over
training syndrome. Symptoms
of burnout include chronic muscle or joint pain,
personality changes, elevated resting heart rate,
decreased sport performance, fatigue, lack of enthusiasm
about practice or competition, or difficulty completing
ordinary activities. Youth athletes need to be
educated about proper nutrition and fluids, and how to
avoid hypothermia, hyperthermia, over training, overuse
injuries and burnout. Additional recommendations
include: Weekly
training time, number of repetitions, or total
distance should not increase by more than 10%
weekly. Focus
of sports should be on fun, skill acquisition,
safety and sportsmanship. Join
only one team per season. Be
aware of risks associated with weekend tournaments
(soccer, baseball, tennis), such as heat related
illness, nutritional deficiencies, overuse injuries
and burnout. Multi-sport
athletes who use the same body parts for different
sports especially need to take a break between
seasons to avoid overuse injuries. Getting
caught up in making the professional leagues or
Olympics is unrealistic. Children and
adolescents often train year round on multiple teams
of one sport with the hope of earning a college
scholarship in that sport or becoming a professional
athlete, but less than one percent of high school
athletes make it to the professional level. Lifelong
fitness and enjoyment of physical activity should be the
overall goal of participating in athletics. ~American
Academy of Pediatrics, June, 2007
Safety for all ages
Did you know that hundreds of children younger than
1 year die every year in the United States because of injuries — most of which
could be prevented? Often, injuries happen because parents are not aware of what
their children can do. Children learn fast, and before you know it, your
child will be wiggling off a bed or reaching for your cup
of hot coffee. BE PREPARED. While siblings and pets generally mean
well, they should never be left alone with a baby. Car Injuries
Make certain that your baby's car seat is
installed correctly. Read and follow the instructions that come with the car
safety seat and the sections in the owners' manual of your car on using car
safety seats correctly. Use the car safety seat EVERY time your child is in a
car. NEVER put an infant in the front seat of a car
with a passenger air bag. Your baby may be able to crawl as early as 6
months. Use gates on stairways and close doors
to keep your baby out of rooms where he or she might get hurt.
Install operable window guards
on all windows above the first floor. If your baby gets
burned, immediately put the burned area in cold water. Keep the burned area in
cold water for a few minutes to cool it off. Then cover the burn loosely with a
dry bandage or clean cloth and call your doctor.
To protect your baby from house fires, be sure
you have a working smoke alarm on every level of your home, especially in
furnance and sleeping areas. Test the alarms every month. It is best to use
smoke alarms that use long-life batteries, but if you do not, change the
batteries at least once a year. To prevent possible suffocation and reduce the
risk of sudden infant death syndrome (SIDS), your baby
should always sleep on his or her back. NEVER put your baby on a water bed, bean
bag, or anything that is soft enough to cover the face and block air to the nose
and mouth. Plastic wrappers and
bags form a tight seal if placed over the mouth and nose and may
suffocate your child. Keep them away from your baby.
Often, accidents happen because parents are not
aware of what their children can do. Your child is a fast learner and will
suddenly be able to roll over, crawl, sit and stand. Your child may
climb before walking or walk with support months before you expect. Your
child will be able to grasp at or reach almost anything.
FALLS
Because of your child's new abilities, he or she
will fall often. Protect your child from injury.
Do not use a baby walker. Your child
will tip it over, fall out of it, fall down the stairs in it, or get to places
where hot foods or heavy objects can be pulled down on himself.
BURNS
At 6 to 12 months children grab at everything.
NEVER leave cups of hot coffee on tables or counter edges. And NEVER
carry hot liquids or food near your child or while holding your child. He
or she will get burned. Also, if your child is left to crawl or walk
around stoves, wall or floor heaters, or other hot appliances, he or she is
likely to get burned. A safe place for your child while you are cooking,
eating or unable to provide your full attention is the playpen, high chair, or
crib.
If your child does get burned, put cold water on
the burned area immediately. Then cover the burn loosely with a bandage or
clean cloth. Call your doctor for all burns.
Test the batteries in your smoke alarm every month
to be sure they work. Change the batteries yearly.
DROWNING
POISONING AND CHOKING
Your child will explore the world by putting anything and everything into his or
her mouth. NEVER leave small objects or balloons in your child's reach,
even for a moment. Don't feed your child hard pieces of food such as hot
dogs, raw carrots, or grapes. Cut all food into thin slices to prevent
choking.
Be prepared if your child starts to choke. Learn how to save the life
of a choking child. Ask your doctor to recommend the steps you need to
take.
Children will put almost anything into their mouths, even if it doesn't taste
good. Almost anything in your house can be poisonous to your
child. Be sure to keep household products such as cleaners, chemicals, and
medicines up, up, and away, completely out of sight and reach. Never store
lye drain cleaners in you home. Use safety latches on drawers and
cupboards. Remember, your child doesn't understand or remember "No" while
exploring.
If your child does eat something that could be poisonous, call the Poison
Control Center immediately.
CAR SAFETY
Remember, the biggest threat to your child's health and life is an accident.
Did you know that injuries are the leading cause of
death of children younger than 4 years in the United States? Most of these
injuries can be prevented. Often, injuries happen because
parents are not aware of what their children can do. At this age your child can
walk, run, climb, jump, and explore
everything. Because of all the new things he or she can do, this stage is a very
dangerous time in your child's life. It is your responsibility to protect your
child from injury. Your child cannot understand danger or remember "no" while
exploring. Your child is now able to get into
and on top of everything. Be sure to keep all household products and medicines
completely out of sight and reach. Never store lye drain cleaners in your home.
Keep all products in their original containers. If your child does put something
poisonous into his or her mouth, call the Poison Help Line immediately. Attach
the Poison Help Line number (1-800-222-1222) to your phone. Do not make your
child vomit. If your child has a serious fall
or does not act normally after a fall, call your doctor. Children who are learning to walk
will grab anything to steady themselves, including hot oven doors, wall heaters,
or outdoor grills. Keep your child out of rooms where there are hot objects that
may be touched or put a barrier around them. Your child will reach for
your hot food or cup of coffee, so don't leave them within your child's reach.
NEVER carry your child and hot liquids at the same time. You can't handle
both. If your child does get burned,
immediately put cold water on the burned area. Keep the burned area in cold
water for a few minutes to cool it off. Then cover the burn loosely with a dry
bandage or clean cloth. Call your doctor for all burns. To protect your child
from hot tap water scalds, the hottest temperature at the faucet should be no
more than120°F. In many cases you can adjust your water heater. Make sure you have a working
smoke alarm on every level of your home, especially in furnace and sleeping
areas. Test the alarms every month. It is best to use smoke alarms that use
long-life batteries, but if you do not, change the batteries at least once a
year. If you have a swimming pool, fence
it on all 4 sides with a fence at least 4 feet high, and be sure the gates are
self-latching. Most children drown when they wander out of the house and fall
into a pool that is not fenced off from the house. You cannot watch your child
every minute while he or she is in the house. It only takes a moment for your
child to get out of your house and fall into your pool. Always walk behind your car
to be sure your child is not there before you back out of your driveway. You may
not see your child behind your car in the rearview mirror.
Often, injuries happen because
parents are not aware of what their children can do. Children learn fast,
and before you know it your child will be jumping, running,
riding a tricycle, and using tools. Your child is at special
risk for injuries from falls, drowning, poisons, burns, and car crashes. Your
child doesn't understand dangers or remember "no" while playing and exploring. Your child can fall off play
equipment, out of windows, down stairs, off a bike or tricycle, and off anything
that can be climbed on. Be sure the surface under play equipment is soft
enough to absorb a fall. Use safety tested mats or loose-fill materials
(shredded rubber, sand, woodchips, or bark) maintained to a depth of at least 9
inches underneath play equipment. Install the protective surface at least 6 feet
(more for swings and slides) in all directions from the equipment. Lock the doors to any dangerous
areas. Use gates on stairways and install operable window guards above
the first floor. Fence in the play yard. If your child has a serious fall or
does not act normally after a fall, call your doctor. Remember that kitchen appliances
and other hot surfaces such as irons, ovens, wall heaters, and outdoor grills
can burn your child long after you have finished using them. If your child
does get burned, immediately put cold water on the burned area. Keep the burned
area in cold water for a few minutes to cool it off. Then cover the burn loosely
with a dry bandage or clean cloth. Call your doctor for all burns. To protect
your child from tap water scalds, the hottest temperature a the faucet should be
no more than 120°F. In many cases you can adjust your hot water heater.
Make sure you have a working smoke
alarm on every level of your home, especially in furnace and sleeping areas.
Test the alarms every month. It is best to use smoke alarms with long-life
batteries, but if you do not, change the batteries at least once a year.
If your child does put something
poisonous in his or her mouth, call the Poison Help Line immediately. Attach the
Poison Help Line number (1-800-222-1222) to your phone. Do not make your child
vomit. Do not allow your child to play or
ride a tricycle in the street. Your child should play in a fenced yard or
playground. Driveways are also dangerous. Walk behind your car before you
back out of your driveway to be sure your child is not behind your car. You may
not see your child through the rear view mirror.
At age 5, your child is learning to do many
things that can cause serious injury, such as riding a bicycle or crossing a
street. Although children learn fast, they still cannot judge what is
safe. You must protect your child. You can prevent common major injuries by
taking a few simple steps. Never let your child ride a bike in the
street. Your child is too young to ride in the street safely.
Be sure that the bike your child rides is
the right size. Your child must be able to place the balls of both feet on
the ground when sitting on the seat with hands on the handlebars. Your
child's first bicycle should have coaster brakes. Five-year-olds are often
unable to use hand brakes correctly. Water Safety Do not let your child play around any water
(lake, stream, pool, or ocean) unless an adult is watching. NEVER let your
child swim in canals or any fast-moving water. Teach your child to never dive into water
unless an adult has checked the depth of the water. And when on any boat,
be sure your child is wearing a life jacket. Teach your child not to play with matches or
lighters, and keep matches and lighters out of your child's reach. Also, do
not smoke in your home. Most fires are caused by a lit cigarette that has
not been put out completely.
Firearm Hazards Would you be able to help your child in
case of an injury? Put emergency numbers by or on your phone today. Learn
first aid and CPR. Be prepared...for your child's sake! It takes time to form a safety habit.
Remind each other what it says. Make safety a big part of your lives.
Did you know that injuries are the greatest
threat to the life and health of your child? Injuries are the leading cause
of death of school-aged children. Yet you can prevent most major
injuries! At age 6, your child will become more
independent. He or she will be able to do more things that are dangerous.
Your child will try to prove that he or she is grown up. But children still
aren't good at judging sound, distance, or the speed of a moving car at this
age. Your child can learn a few simple things to do for protection, but
you must still be in charge of his or her safety. Do not smoke in your home. Most home fires
are caused by a lit cigarette that has not been put out completely.
Install smoke alarms on every level in your
house, especially in furnace and sleeping areas, and test the alarm every
month. It is best to use smoke alarms that use long-life batteries, but if
you do not, change the batteries once a year. Bike Safety And Remember Car Safety It takes time to form a
safety habit. Remind each other what it says. Make safety a big part of your
lives.
Did you know that injuries are the greatest
threat to the life and health of your child? Injuries are the cause of death
of school-aged children. Yet you can prevent most injuries!
At age 8, children are now taking off on
their own. They look to friends for approval. They try to do daring things.
They may not want to obey grown-up rules. But your child can learn safety
rules with your help and reminders. Your child now goes out more without you
and could drown, be hurt on a bike, or be hit by a car. And your child still
can be hurt or killed while riding in a car if he is not buckled by a seat
belt. Water Safety Car Safety Firearm Hazards Would you be able to hlep your child in
case of an injury? Put emergency numbers by or on your phone today. Learn
first aid and CPR. Be prepared....for your child's sake! It takes time to form a safety habit.
Remind each other what it says. Make safety a big part of your lives.
Ways to help your
infant sleep through the night No long naps in the
evening. Play with the baby
in the evening, go for a walk. Create a
routine...play, bath, eat, then sleep. Music Try not to allow
the baby to get overtired. Do not allow middle
of the night feeding to be playtime. No lights (use night light).
Little or no talking. Decrease stimulation. Do not rock until
falls asleep, needs to be able to comfort self and get to sleep on own.
Six Sleep/Awake States for Babies DEEP SLEEP -
Baby is very still and relaxed, rhythmic breathing, occasionally jerks and
makes sucking movements, rarely awakens. If you arouse the baby they
will only wake for a moment and then resume a deep sleep state. No eye
movement. When startled, no change in sleep state. LIGHT SLEEP
- Most common in newborns, eyes are closed, but they move behind their lids.
The baby moves and makes momentary crying sounds, sucks, grimaces or smiles.
They breather irregularly. The baby responds to noise and efforts to
arouse him. Startle causes change in state. May go to drowsy
state or fall back to a sleep. DROWSY -
Appears sleepy, activity level varies and may startle occasionally.
Eyes lose focus or appeared cross-eyed. Breathes irregularly and
reacts to sensory stimuli in a drowsy way. If you want the baby to
return to sleep, avoid stimulation. If you want to wake him up, talk
to him, pick him up and massage him or give him something to suck. QUIET ALERT
- It is pleasing and rewarding for parents because baby lies still and looks
calmly with bright wide eyes. Breathes with regularity and focuses
attentively on what he sees and hears. By providing something for him
to look at, listen to or suck on, you will encourage him to stay awake. ACTIVE ALERT
- The baby is readily affected by hunger, fatigue, noises and too much
handling. They cannot lie still and may be fussy. Eyes are open
and do not appear as bright and attentive as in the quiet alert state.
Breathes irregularly and makes faces. It is time to feed or comfort.
If you act immediately, you may bring him to a calmer state before he enters
the crying state. CRYING STATE
- Difficult state for every parent. Over stimulated, tired, ill,
hungry, frustrated, wet, cold, too warm, or lonely. Baby moves body
actively, opens and closes eyes, makes unhappy faces and breathes
irregularly. Sometimes crying is a release, a self-comforting
mechanism that enables him to enter another state. At other times he
needs you to feed or comfort him. Parents
role in preventing substance abuse Teens
are prone to experiment with alcohol and drugs. The best ways for parents
to prevent this substance abuse is to keep the lines of communication open and
set a good example. About 4,000 young people under the age of 21 will die
annually because of alcohol misuse alone. Parents should look to
themselves to provide a good example. Kids watch how parents handle
stress. If you need "a drink" or a pill to sleep or relax
your teen may choose those substances when they are feeling stressed.
Parents should make it clear the family does not approve of drinking or
drugs. Other things parents can do: -
Help your child build confidence and strong values and learn to cope with peer
pressure. -
Encourage healthy, creative activities. -
Get to know your child's friends and their parents. -
Keep track of your child's whereabouts and stay in touch by phone. -
Check out secretive behavior. -
Watch for signs of a drug or alcohol problem, like declining grades, missing
medication, drug paraphernalia, and new friends and clothes that seem to promote
the drug culture. Finally,
parents should have a "rescue plan" in place for their kids. If
they have had too much to drink or are with someone who is going to drive and
has been drinking or using drugs, let your children know they can call you and
you will come pick them up with no questions asked. ~American
Academy of Pediatrics April 2006
Just about everyone knows that the legal drinking age throughout the United
States is 21. But according to the National Center on Addiction and Substance
Abuse, almost 80% of high school students have tried alcohol. Experimentation
with alcohol during the teen years is common. Some reasons that teens use
alcohol and other drugs are: From a very young age, kids see advertising messages showing beautiful people
enjoying life — and alcohol. And because many parents and other adults use
alcohol socially — having beer or wine with dinner, for example — alcohol seems
harmless to many teens. If all your friends drink and you don't want to, it can be hard to say "no,
thanks." No one wants to risk feeling rejected or left out. Different strategies
for turning down alcohol work for different people. Some people find it helps to
say no without giving an explanation, others think offering their reasons works
better ("I'm not into drinking," "I have a game tomorrow," or "my uncle died
from drinking," for example). If saying no to alcohol makes you feel uncomfortable in front of people you
know, blame your parents or another adult for your refusal. Saying, "My parents
are coming to pick me up soon," "I already got in major trouble for drinking
once, I can't do it again," or "my coach would kill me," can make saying no a
bit easier for some. If you're going to a party and you know there will be alcohol, plan your
strategy in advance. You and a friend can develop a signal for when it's time to
leave, for example. You can also make sure that you have plans to do something
besides just hanging out in someone's basement drinking beer all night. Plan a
trip to the movies, the mall, a concert, or a sports event. You might also
organize your friends into a volleyball, bowling, or softball team — any
activity that gets you moving. Girls or guys who have strong self-esteem are less likely to become problem
drinkers than people with low self-esteem. When large amounts of alcohol are consumed in a short period of time,
alcohol poisoning can result. Alcohol poisoning is exactly what it
sounds like — the body has become poisoned by large amounts of alcohol. Violent
vomiting is usually the first symptom of alcohol poisoning. Extreme sleepiness,
unconsciousness, difficulty breathing, dangerously low blood sugar, seizures,
and even death may result. It takes from 30-90 minutes after you stop
drinking before you reach your highest level of intoxication. "Passing
out" from alcohol intoxication could lead to death in two ways: you may fall
into a deep sleep, vomit and choke on it because you are too intoxicated to wake
up or you fall asleep and never wake up because the alcohol concentration in
your brain is so high that your life functions are so depressed that they stop
functioning and so do you. Symptoms of an overdose reaction: What to do when someone is intoxicated: ~kidshealth.org / Bellefaire JCB
STUDY REDEFINES BINGE DRINKING FOR BOYS AND
GIRLS
The U.S. Surgeon General issued a call to action on
underage drinking in 2007, with the goals of bringing
more attention to the issue, increasing research, and
improving prevention efforts. In response, the study
“Estimated Blood Alcohol Concentrations for Child and
Adolescent Drinking and Their Implications for Screening
Instruments,” has re-examined the number of standard
drinks that constitute binge drinking in tweens and
teens. Binge drinking is defined as a pattern of
drinking that results in a blood alcohol concentration (BAC)
of .08 grams per deciliter of blood within two hours.
However, children weigh less than adults and can
therefore achieve a higher BAC than adults after
consuming the same number of drinks. The study estimated
that in a two-hour period, three or more drinks for 9-
to 13-year-old children would theoretically result in a
legally drunk BAC of .08. The same BAC level would be
reached with four or more drinks for boys and three or
more drinks for girls 14 or 15 years of age, and with
five or more drinks for boys and three or more drinks
for girls 16 or 17 years of age. This information is
important because it suggests that fewer drinks can
result in hazardous levels of alcohol impairment in
teens, especially girls, a message that is even more
important at this time of year when proms and graduation
celebrations begin taking place.
~AAP
(june09)
Hands down, teens' favorite mode of
communication is the text message. Kids 13-17 text
more than any other age group, according to a 2008
Nielsen study. When kids and teens
text, they're thinking about what to say, focusing on
what their thumbs are doing, and reading constantly
incoming messages — rather than paying attention to what
they're doing or where they're going. And that
significantly ups their risk of getting hurt and
injuring others, possibly even seriously. And it doesn't matter
if kids can practically text with their eyes closed, as
many profess they can! Even if it feels like second
nature, their brain is still focused on trying to do two
things at once — and one of them is bound to get less
attention. Texting while
driving, in particular, can turn tragic. In 2007, a
17-year-old driver and four passengers were killed in
New York when her SUV crashed, head on, into a
tractor-trailer. Though police couldn't say for sure
that it was the driver doing the texting or talking, her
phone records showed constant activity of sending and
receiving text messages and calls in the seconds and
minutes right before the crash. The friends had just
graduated from high school together less than a week
earlier. Another 17-year-old
was suspected of texting while driving when he hit and
killed a bicyclist. Driving while texting
(or DWT) is even against the law in some states
(Minnesota, Washington, New Jersey, and now Louisiana).
And many more are trying to put the same kind of
regulations into action. A growing number of
states don't allow drivers to talk on their
cell phones either. Although some laws apply to all
drivers, other states' legislation are specifically
devoted to young people, especially inexperienced
drivers and those with learning permits. Still, a summer 2007
survey, conducted by AAA and Seventeen
magazine, found that nearly half of the more than 1,000
16- and 17-year-olds interviewed said that they text
during driving. And a little more than half admitted to
using a cell phone while behind the wheel. Another survey that
same summer by Students Against Destructive Decisions (SADD)
showed that almost 40% of the nearly 1,000 guys and
girls with licenses polled considered driving while
texting to be "extremely" or "very" distracting. Love it or hate it,
texting is a major part of life for many people today,
especially teens. They're often compelled to stay
connected and in touch from sunup to sundown. As attached to their
communication technologies as they might be, you can
help educate your kids about when it's appropriate and,
especially, safe to use them. Because not only can it be
dangerous for kids (or anyone) to partake in texting
while in motion, texting at all times can be downright
disruptive and distracting. To help teens keep
their texting in perspective: Emphasize that
there's a time and place for texting. When teens are
in a texting "conversation" and feel compelled to
read responses and answer right away that diverts
their attention and prevents them from focusing. Create and
enforce family rules about texting, as well as cell
phone use overall. Put your foot down and prohibit
talking on the phone or texting while: Tell them that if
they need to text right away, to first pull off the
road, stop jogging, etc., to do it and then resume
the sport or activity. Even better, they should wait
until they're done to text. Encourage teens
to keep both hands on the wheel when driving and
skip distractions like eating, reaching for things,
switching CDs, changing radio stations, fiddling
with portable music players, whooping it up with
lots of friends, and applying makeup, says SADD. Find out about
your state's young-driver laws (visit The Governors
Highway Safety Association's website at
www.statehighwaysafety.org), like whether text and
cell phone restrictions exist and when teens are
permitted on the road (many states have curfews for
teen drivers). Recommend
ignoring calls or texts (or turning off their phone
altogether) while they're involved in anything that
requires their full attention, says ACEP. Tell kids to keep
their cell phones in easily accessible places like a
specific pouch or pocket in their backpack or purse
(so they won't have to stop what they're doing to
search for it). Encourage kids to
pick up the phone and talk instead of using texting
as their main source of communication. Messages can
be misunderstood (just like email) Sometimes it's
better to just have a real live conversation. Be a good role
model — don't text or talk on your cell when you
should really be focusing your attention elsewhere
(like on chauffeuring your kids around town). While
you're at it, model other safe driver behaviors like
following the speed limit and rules of the road,
nixing road rage, and always wearing your seatbelt. Bottom line: Teach
your kids the importance of texting in moderation and to
never put their thumbs into action when it places them
or other people at risk. ~kidshealth.org,
august 2008
Sexting is the teen trend
of sending sexual/nude images of oneself via the cell
phone. Some teens think this behavior is "fun and
games", but in reality it is illegal. Currently
teens could be charged with a felony and labeled as
sexual offenders. Two Ohio lawmakers want to make
sure teens are not labeled felons and sex offenders.
They are proposing legislation that would make sending,
receiving and viewing electronically transmitted nude
pictures of juveniles by juveniles a misdemeanor.
If the new law is passed,
juveniles would more likely face probation or be placed
in an educational program. A judge could still
sentence them to a short stint in a local juvenile
facility but they would not be labeled as a sex
offender.
Sexting may be more
prevalent than parents are aware based on the online
survey conducted by the National Campaign.org.:
39% of teens have sent
or posted sexually suggestive emails or text
messages
20% of teens have sent
or posted nude or semi-nude images of themselves
25% of teen girls and
33% of teen boys say they have nude or semi-nude
images, originally meant for someone else, shared
with them
22% of teens say that
they are personally more forward and aggressive
using sexually suggestive words and images when they
text
40% of teen girls say
"they sent the pictures as a joke"
51% of teen girls who
sent sexually suggestive messages or pictures say
they did it because "they felt pressure from a guy"
18% of teen boys cited
pressure from their female counterparts
66% of teen girls and
60% of teen boys who have sent sexually suggestive
content did it to be "fun or flirtatious"
~excerpt from The Cleveland
Plain Dealer
A recent survey of about 2,000 teens ages 12 through 17, found that teens
watching television shows with sexual content were twice as likely as their
peers to be involved in a teen pregnancy in the following three years.
Parents should be aware of the shows their teens are watching and watch with
them. Watching with your teen can create opportunities to talk about sex,
its emotional and physical consequences and the risks and responsibilities
associated with it. Common Sense Media (commonsensemedia.org) is one
website that monitors television shows content.
Almost
all teenagers get acne at one time or another. You haven't done anything
to cause your acne and its not your fault if you have it. Pimples are
caused when oil ducts in the skin get plugged and then build up, causing redness
and swelling. Although there are many myths about acne, the following are the
three main causes of acne. 1. Hormones When
you begin puberty, certain hormones, called androgens, increase in both males
and females. These hormones trigger oil ducts on the face, back and upper
chest to begin producing oil. This can cause acne in some people. 2. Heredity If
other members of your family had acne as teenagers, there may be a chance that
you've inherited the tendency toward getting acne as well. 3. Plugged
oil ducts If you
are prone to acne, the cells that line the oil ducts in your skin tend to get
larger and produce more oil and the ducts get plugged. This traps the oil
and leads to the formation of blackheads or whiteheads and the plugged ducts
allow germs in the skin to multiply and produce chemicals that cause redness and
swelling. That is why simple blackheads and whiteheads may turn red and
bumpy and turn into the pimples of acne. There
is not much you can do about heredity, so your best control efforts are those
that keep the oil ducts unplugged. What
doesn't cause acne? If you
have acne, there are some things that can make it worse. To keep acne
under control, try to avoid the following: 1. Use topical benzoyl peroxide lotion or gel 2. If you don't see results, consult your pediatrician 3. What about the "miracle drug" Accutane? If you are experiencing acne problems, remember that your pediatrician can
help you. And as you begin treatment, keep these helpful tips in mind:
A Word About ... Acne and Birth Control Pills
In 1996, the Food and Drug Administration (FDA) approved a low-dose birth
control pill to be used as an effective treatment for acne in women over 15
years of age. Research has shown that certain birth control pills lower the
levels of hormones that cause acne.
However, taking birth control pills along with other medications for the
prevention of acne may reduce the effectiveness of both medications. If you are
taking birth control pills, talk to your pediatrician about their effect on
acne.
Finally, many people don't understand acne and may say hurtful things about
it. Although acne may bother you, keep in mind it's only temporary. With
present-day treatment, it usually can be controlled. ~American Academy of Pediatrics
Growth
and Development 0 to 3 months
Developmental Milestones
Birth to 3months Children develop at their own pace, so it's impossible to tell exactly when
yours will learn a given skill. The developmental milestones below will give you
a general idea of the changes you can expect as your child gets older, but don't
be alarmed if your child takes a slightly different course.
Social and Emotional
Movement
Vision
Hearing and Speech
Developmental
Health Watch ~CDC/AAP
Developmental Milestones 4 to 7 months Children develop at their own pace, so it's impossible to tell exactly when
yours will learn a given skill. The developmental milestones below will give you
a general idea of the changes you can expect as your child gets older, but don't
be alarmed if your child takes a slightly different course.
Social and Emotional
Cognitive
Language
Movement
Vision
Developmental Health Watch
Growth and Development 8 to 12
months Developmental Milestones 8 to 12 months Children develop at their own pace, so it's impossible to tell exactly when
yours will learn a given skill. The developmental milestones below will give you
a general idea of the changes you can expect as your child gets older, but don't
be alarmed if your child takes a slightly different course. Social and Emotional Cognitive Language Movement Hand and Finger Skills
Developmental Health Watch
Growth and Development 13 to 24
months Developmental Milestones 13-24
months Children develop at their own pace, so it's impossible to tell exactly when
yours will learn a given skill. The developmental milestones below will give you
a general idea of the changes you can expect as your child gets older, but don't
be alarmed if your child takes a slightly different course.
Social
Emotional
Cognitive
Language
Movement
Hand and Finger Skills
Developmental Health Watch Alert your child's doctor or nurse if your child displays
any of the following signs of possible developmental delay for this age range.
Growth and Development 3 years
Developmental Milestones
3years Children develop at their own pace, so it's impossible to tell exactly when
yours will learn a given skill. The developmental milestones below will give you
a general idea of the changes you can expect as your child gets older, but don't
be alarmed if your child takes a slightly different course.
Social
Emotional
Cognitive
Language
Movement
Hand and Finger Skills
Developmental Health Watch
Growth
and Development 4 Years Developmental Milestones 4 years Children develop at their own pace, so it's
impossible to tell exactly when yours will learn a given skill. The
developmental milestones below will give you a general idea of the changes you
can expect as your child gets older, but don't be alarmed if your child takes a
slightly different course.
Social
Emotional
Cognitive
Language
Movement
Hand and Finger Skills
Developmental Health Watch Developmental Milestones by 5
years Children develop at their own pace, so it's
impossible to tell exactly when yours will learn a given skill. The
developmental milestones below will give you a general idea of the changes you
can expect as your child gets older, but don't be alarmed if your child takes a
slightly different course.
Social
Emotional Milestones
Cognitive Milestones
Language
Movement
Hand and Finger Skills
Developmental Health Watch Middle Childhood 6-8 years
Developmental Milestones Middle childhood
brings many changes to a child’s life. By this time, children can dress
themselves, catch a ball more easily with only their hands, and tie
their shoes. Developing independence from family becomes more important
now. Events such as starting school bring children this age into regular
contact with the larger world. Friendships become more and more
important. Physical, social, and mental skills develop rapidly at this
time. This is a critical time for children to develop confidence in all
areas of life, such as through friends, schoolwork, and sports.
§
More independence from parents and family.
§
Stronger sense of right and wrong.
§
Beginning awareness of the future.
§
Growing understanding about one’s place in
the world.
§
More attention to friendships and teamwork.
§
Growing desire to be liked and accepted by
friends. Mental/Cognitive Changes
§
Rapid development of mental skills.
§
Greater ability to describe experiences and
talk about thoughts and feelings.
§
Less focus on one’s self and more concern
for others. (Adapted with permission from
Bright Futures: Green M, Palfrey JS, editors. Bright Futures Family
Tip Sheets: Middle childhood. Arlington (VA): National Center for
Education in Maternal and Child Health; 2001)
For more information, visit the American Academy of
Pediatrics Developmental Stages website. Positive Parenting
Child Safety First
§
Protect your child properly in the car.
§
Teach your child to watch traffic and how to be safe when walking
to school, riding a bike, and playing outside.
§
Make sure your child understands water safety, and always
supervise her when she’s swimming or playing near water.
§
Supervise your child when he’s engaged in risky activities, such
as climbing.
§
Talk with your child about how to ask for help when she needs it.
§
Keep potentially harmful household products, tools, equipment, and
firearms out of your child’s reach Middle Childhood 9-11 years
Your child’s growing independence from the family and
interest in friends might be obvious by now. Healthy friendships are
very important to your child’s development, but peer pressure can become
strong during this time. Children who feel good about themselves are
more able to resist negative peer pressure and make better choices for
themselves. This is an important time for children to gain a sense of
responsibility along with their growing independence. Also, physical
changes of puberty might be showing by now, especially for girls.
Another big change children need to prepare for during this time is
starting middle or junior high school. (Adapted with permission from
Bright Futures: Green M, Palfrey JS, editors. Bright Futures Family
Tip Sheets: Middle childhood. Arlington (VA): National Center for
Education in Maternal and Child Health; 2001)
For more information, visit the American Academy of Pediatrics
Developmental Stages website. Positive Parenting You can help your child become independent, while building his or her sense
of responsibility and self-confidence at the same time. Here are some
suggestions: Child Safety First More independence and less adult supervision can put children at risk for
injuries from falls and other accidents. Motor vehicle crashes are the most
common cause of death from unintentional injury among children of this age. Early Adolescence 12-14 years
Early adolescence is a time of many physical, mental, emotional, and
social changes. Hormones change as
puberty begins. Boys grow facial and pubic hair and their voices
deepen. Girls grow pubic hair and breasts, and start menstruating. They
might be worried about these changes and how they are looked at by
others. This will also be a time when your teenager might face peer
pressure to use
alcohol, tobacco products, and drugs, and to have
sex. Other challenges can be
eating disorders,
depression, and
family problems. At this age, teens make more
of their own choices about friends, sports, studying, and
school. They become more independent, with their own personality
and interests. Some changes younger teens go through are: Emotional/Social Changes
·
More concern about body image,
looks, and clothes.
·
Focus on self, going back and forth
between high expectations and lack of confidence.
·
Moodiness
·
More interest in and influence by
peer group.
·
Less affection shown toward
parents. May sometimes seem rude or short-tempered.
·
Anxiety from more challenging
school work.
·
Eating problems sometimes start at
this age. For information on healthy eating and exercise for
children and teenagers, visit
http://kidshealth.org/teen/food_fitness/. Mental/Cognitive Changes
·
More ability for complex thought.
·
Better able to express feelings through
talking.
·
A stronger sense of right and wrong.
·
Many teens sometimes feel sad or depressed.
Depression can lead to poor grades at school, alcohol or drug use,
unsafe sex, and other problems. For more information on adolescent
mental health, visit
http://www.nimh.nih.gov/healthinformation/depchildmenu.cfm.
(Adapted with permission from
Bright Futures: Green M, Palfrey JS, editors. Bright Futures Family
Tip Sheets: Early Adolescence. Arlington (VA): National Center for
Education in Maternal and Child Health, 2001. Other sources:
American Academy of Child and Family Psychiatry and the
American Academy of Pediatrics.) Positive Parenting Trust is important for teenagers. Even as she develops independence, she will
need to know she has your support. At the same time, she will need you to
respect her need for privacy. Safety First Motor vehicle crashes are the leading cause of death among 12 to 14 year
olds. Injuries from sports and other activities are also common.
Emotional/Social Changes Mental/Cognitive Changes (Adapted with permission from Bright Futures:
Green M, Palfrey JS, editors. Bright Futures Family Tip Sheets: Early
Adolescence. Arlington (VA): National Center for Education in Maternal and Child
Health, 2001. Other sources: American Academy of Child and Family Psychiatry and
the American Academy of Pediatrics) Positive Parenting Tips for Healthy Child
Development Safety First Motor vehicle accidents are the leading cause of death from unintentional
injury among teenagers, yet few teenagers take measures to reduce their risk of
injury. Unintentional injuries resulting from participation in sports and other
activities are also common.
Parents often ask how to get rid of them--you don't have to do anything. You can
consider your baby's hiccups as just another newborn reflex that will gradually
become less frequent and eventually go away.
with the pediatrician. The first part of your visit will not change; pediatrician, parent, and child will continue to meet together and talk about anything that any of us might want to discuss. After this initial conversation, the pediatrician will spend some one-on-one time with your child to talk privately and to complete the physical examination. (Your teen or the physician may request your presence during the physical examination.)
Home life changes as children begin to enter adolescence. Wise parents work to keep the lines of
communication open. Look for opportunities to get your teen talking. What kinds of things are on most
young adolescents’ minds?
• Physical and emotional changes of puberty.
Does your adolescent understand what to expect?
Do they know that it’s perfectly normal to be the first or last of their peers to begin to menstruate
or to find that their voice has “changed”?
• Diet and exercise. Does your adolescent appreciate the benefits of exercise? Have you
taught him or her to take a mental inventory when they’re feeling low, to ask themselves how
much they’ve slept, how well they’ve eaten, how recently they’ve had a good workout?
• Sex and sexuality. Parents who talk to their children and teens about dating and sexual decision
making encourage healthier attitudes and safer choices.
• Need for privacy. If you’ve noticed your teen needs more time alone, let him or her know that
they’re missed in the TV room! Their need for privacy is normal; don’t take it personally. Just
keep asking (and monitoring for opportunities to draw them out).
• Alcohol and drugs. Don’t let this be the elephant in the room! Talk about what to do if someone
asks them to try alcohol or drugs. Tell them early and often that you will pick them up at any time,
no questions asked. And make sure your home is a safe place for friends to gather.
• Tell them you love them. Your adolescent may be stressed, but you will miss his or her passion
and they’ll be gone before you know it. Hug them, love them, and remember, “This too shall
pass.”
Car crashes are a great threat to your child's life and health. Most
injuries and deaths from car crashes can be prevented by the use of car
safety seats. Your child, besides being much safer in a car safety seat, will
behave better, so you can pay attention to your driving. Make your newborn's
first ride home from the hospital a safe one — in a car safety seat. Your infant
should ride in the back seat in a rear-facing car seat.
Falls
Babies wiggle and move and push against things with their
feet soon after they are born. Even these very first movements can result in a
fall. As your baby grows and is able to roll over, he or she may fall off of
things unless protected. Do not leave your baby alone
on changing tables, beds, sofas, or chairs. Put
your baby in a safe place such as a crib or playpen when you cannot
hold him. Many children can wiggle out of infant seats. Beware of leaving
them on a counter or in a seat.
If your child has a
serious fall or does not act normally after a fall, call your doctor.
Burns
At 3 to 5 months, babies will wave their fists and grab at things.
NEVER carry your baby and hot liquids, such as coffee, or
foods at the same time. Your baby can get burned. You can't handle
both! To protect your child from tap water scalds, the hottest temperature at
the faucet should be no more than 120°F. In many cases you can adjust
your hot water heater.
Choking and Suffocation
Babies explore their environment by putting anything and everything into their
mouths. NEVER leave small objects in your baby's reach,
even for a moment. NEVER feed your baby hard pieces of food such as
chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn. Cut all
the foods you feed your baby into thin pieces to prevent choking.
Be prepared if your baby starts to choke. Ask your doctor
to recommend the steps you need to know. Learn how to save the life of a choking
child.
Firearm Hazards
Children in homes where guns are present are in
more danger of being shot by themselves, their friends, or family members
than of being injured by an intruder. It is best to keep all guns out of the
home. Handguns are especially dangerous. If you choose to keep a gun,
keep it unloaded and in a locked place, with the ammunition locked
separately. Ask if the homes where your child visits or is cared for have
guns and how they are stored.
Poisonings
Children continue to explore their world by
putting everything in their mouths, even if it doesn't taste good. Your
child can open doors and drawers, take things apart, and open
bottles easily now, so you must use safety caps on all medicines and
toxic household products. Keep the safety caps on at all times or
find safer substitutes to use. Contact your Poison Center for more
information.
Falls
To prevent serious falls, lock the doors to any
dangerous area. Use gates on stairways and install operable window
guards above the first floor. Remove sharp-edged furniture from
the room your child plays and sleeps in. At this age your child will walk
well and start to climb, jump, and run as well. A chair left next to a
kitchen counter, table, or window allows your child to climb to dangerously
high places. Remember, your child does not understand what is dangerous.
Burns
The kitchen is a dangerous place for your child
during meal preparation. Hot liquids, grease, and hot foods spilled on your
child will cause serious burns. A safer place for your child while
you are cooking, eating, or unable to give him your full attention is the
playpen, crib, stationary activity center, or buckled into a high chair.
It's best to keep your child out of the kitchen while cooking.
Drowning
At this age your child loves to play in water.
NEVER leave your child alone in or near a bathtub, pail of water, wading
or swimming pool, or any other water, even for a moment. Empty all
buckets after each use. Keep the bathroom doors closed. Your child can drown
in less than 2 inches of water. Knowing how to swim does NOT mean your child
is safe near or in water. Stay within an arm's length of your child around
water.
And Remember Car Safety
Car crashes are a great danger to your child's life and health.
The crushing forces to your child's brain and body in a crash or sudden
stop, even at low speeds, can cause severe injuries or death. To prevent
these injuries USE a car safety seat EVERY TIME your child rides in the
car. Your child should ride rear facing until she is at least a year old AND
weighs at least 20 pounds. It is even better for her to ride rear-facing to
the highest weight and /or height her car safety seat allows. Be sure that
the safety seat is installed correctly. Read and follow the instructions
that come with the car safety seat and the instructions for using car safety
seats in the owners' manual of your car. The safest place for all infants
and children to ride is in the back seat.
Do not leave your child alone in the car. Keep vehicles and their trunks
locked. There are dangers involved with leaving children in a car; death
from excess heat may occur very quickly in warm weather in a closed car.
Remember, the biggest threat to your child's life and health is an injury.
Did you know that injuries are the leading
cause of death of children younger than 4 years in the United States? Most
of these injuries can be prevented.
Falls
Because your child's abilities are so great
now, he or she will find an endless variety of dangerous situations at home
and in the neighborhood.
Firearm Hazards
Children in homes where guns are present are in
more danger of being shot by themselves, their friends, or family members
than of being injured by an intruder. It is best to keep all guns out of the
home. If you choose to keep a gun, keep it unloaded and in a locked place,
with ammunition locked separately. Handguns are especially dangerous.
Ask if the homes where your child visits or is cared for have guns and how
they are stored.
Burns
The kitchen can be a dangerous place for your
child, especially when you are cooking. If your child is
underfoot, hot liquids, grease, and hot foods can spill on him or her and
cause serious burns. Find something safe for your child to do while you are
cooking.
Poisonings
Your child will be able to open any
drawer and climb anywhere curiosity leads. Your child may swallow
anything he or she finds. Use only household products and medicines that
are absolutely necessary and keep them safely capped and out of sight and
reach. Keep all products in their original containers.
And Remember Car Safety
Car crashes are the greatest danger to your child's life and
health. The crushing forces to your child's brain and body in a collision or
sudden stop, even at low speeds, can cause injuries or death. To prevent
these injuries, correctly USE a car safety seat EVERY TIME your child is
in the car. If your child weighs more than the highest weight allowed by the
seat or if his or her ears come to the top of the car safety seat, use a
belt positioning booster seat.
The safest place for all children to ride is in
the back seat. In an emergency, if a child must ride in the front seat, move
the vehicle seat back as far as it can go, away from the air bag.
Remember, the biggest threat to your child's
life and health is an injury.
Did you know that injuries are the greatest
threat to the life and health of your child? Injuries are the leading cause
of death of school-age children. Yet you can prevent most major injuries!
Your child should always wear a helmet when riding a bike. Buy the helmet
when you buy the bike! Make sure your child wears a helmet every time he
or she rides. A helmet helps prevent head injuries and can save your
child's life.
Your child is in danger of being hit by a car if he or she darts out into
the street while playing. Take your child to the playground or park to play.
Show your child the curb and teach him or her to always stop at the curb
and never cross the street without a grown-up.
Now is the time to teach your child to swim. Even if your child knows how to
swim, never let him or her swim alone.
Household fires are a threat to your child's life, as well as your own.
Install smoke alarms in your house, and test the batteries every
month to make sure they work. Change the batteries once a year.
Car crashes are the greatest danger to your child's life and
health. The crushing forces to your child's brain and body in a collision or
sudden stop, even at low speeds, can cause injuries or death. To prevent
these injuries, correctly USE a car safety seat or booster seat and seat
belt EVERY TIME your child is in the car. Your child should use a car
safety seat or a booster seat until the lap belt can be worn low and flat on
the hips and the shoulder belt can be worn across the shoulder rather than
the face or neck (usually at about 80 pounds and 4 feet 9 inches tall).
The safest place for all children to ride is the back seat. Set a good
example. Make sure you and other adults buckle up, too!
Children in homes where guns are present are in more danger of being
shot by themselves, their friends, or family members than of being injured
by an intruder. Handguns are especially dangerous. It is best to keep
all guns out of the home. If you choose to keep a gun, it should be kept
unloaded and in a locked place separate from the ammunition. Ask if the
homes where your child visits or is cared for have guns and how they are
stored.
Dear Parent: Your child is old enough to start learning how to prevent
injuries.
Make an escape plan in case of fire in your home. Your fire
department can tell you how. Teach your child what to do when the smoke
alarm rings. Practice what you and your child would do if you had a fire.
Children in homes where guns are present are in more danger of being shot by
themselves, their friends, or family members than of being injured by an
intruder. It is best to keep all guns out of the home. Handguns are
especially dangerous. If you choose to keep a gun, keep it unloaded and
in a locked place, with ammunition locked separately. Ask if the homes where
your child visits or is cared for have guns and how they are stored.
Protect your child from bad head injuries or even death. Make sure
your child wears a properly fitted, approved helmet every time she rides a
bike. Never let your child ride in the street. Your child is too young
to ride in the street safely!
Never let your child play near the street. Your child may dart out into
traffic without thinking. The park or playground is the best place to play.
Begin to teach your child safe street habits. Teach your child to stop at
the curb, then look to the left, to the right, and back to the left
again. Teach your child never to cross the street without a grown-up.
Your child must now use a booster seat in the car. Always check to be
sure that he or she is correctly restrained in the booster seat before you
start the car. Your child should use a booster seat until the lap belt can
be worn low and flat on the hips and shoulder belt can be worn across the
shoulder rather than the face or neck (usually at about 4 feet 9 inches tall
and between 8 and 12 years old). The safest place for all children, even
through school age, is in the back seat of the car. Set a good example.
Make sure you and other adults buckle up, too!
Dear Parent: Your child
is old enough to learn how to prevent injuries.
Ask your doctor which sports are right for your child. Be sure your child
wears all the protective equipment made for the sport, such as shin
pads, mouth guards, wrist guards, eye protection, or helmets. Your child's
coach also should be able to help you select protective equipment.
At this age, your child is not safe alone in water, even if he or she knows
how to swim. Do not let your child play around any water (lake, stream,
pool, or ocean) unless an adult is watching. Never let your child swim in
canals or any fast-moving water. Teach your child to always enter the
water feet first.
Make sure your child always wears a helmet while riding a bike. Now
is the time to teach your child "Rules of the Road." Be sure he or she knows
the rules and can use them. Watch your child ride. See if he or she is in
control of the bike. See if your child uses good judgment. Your 8-year-old
is not old enough to ride at dusk or after dark. Make sure your child brings
the bike in when the sun starts to set.
NEVER start the car until you've checked to be sure that your child is
properly restrained in a booster seat. Your child should use a booster
seat until the lap belt can be worn low and flat on the hips and the
shoulder belt can be worn across the shoulder rather than the face or neck
(usually at about 80 pounds and about 4 feet 9 inches tall). Be sure that
you and all others in the car are buckled up, too. Install shoulder belts in
the back seat of your car if they are not already there. Serious injuries
can occur with lap belts alone. The
safest place for all children to ride is in the back seat.
It is best to keep all guns out of your home. If you choose to keep a gun,
store it unloaded and in a locked place, separate from ammunition. Ask if
the homes where your child visits or is cared for have guns and how they are
stored. Your child is at greater risk of being shot by himself, his
friends, or a family member than of being injured by an intruder.
The 411 on Texting
What This Means to You
o walking
o running (in public or on a treadmill)
o riding a bike (or a horse!)
o skateboarding
o inline skating
o walking in crowds, especially at night (they may
be at greater risk of theft or assault)
o driving any kind of vehicle (car, scooter, ATV,
motorcycle)
o operating any type of equipment or machinery (like
a lawnmower, the fries machine at work, or the gear
at the gym)
o in class, doing homework, or eating dinner with
the family
It's
important to know that there is no true cure for acne. If untreated, it can last
for many years, although acne usually clears up as you get older. The following
treatments, however, generally can keep acne under control.
Benzoyl peroxide helps kill skin bacteria, unplug the oil ducts and heal acne
pimples. It is the most effective acne treatment you can get without a doctor's
prescription. Many brands are available in different levels of strength (2.5
percent, 5 percent or 10 percent). Read the labels or ask your pediatrician or
pharmacist about it.
Your doctor can prescribe stronger treatments, if needed, and will teach you how
to use them properly. Three kinds of medications may be recommended:
Isotretinoin (Accutane) is a very strong chemical taken in pill form. It is used
only for severe cystic acne that hasn't responded to any other treatment.
Accutane must NEVER be taken just before or during pregnancy. There is a danger
of severe or even fatal deformities to unborn babies whose mothers have taken
Accutane while pregnant or who become pregnant soon after taking Accutane. You
should never have unprotected sexual intercourse while taking Accutane. Patients
who take Accutane must be carefully supervised by a doctor knowledgeable about
its usage, such as a pediatric dermatologist or other expert on treating acne.
Your pediatrician may require a negative pregnancy test and a signed consent
form before prescribing Accutane to females.
Alert your child's doctor or nurse if your child displays any of the following
signs of possible developmental delay for this age range.
Alert your child's doctor or nurse if your child displays any of the following
signs of possible developmental delay for this age range.
Alert your child's doctor or nurse if your child displays any of the following
signs of possible developmental delay for this age range.
Alert your child's doctor or nurse if your child displays any
of the following signs of possible developmental delay for this age range.
Alert your child's doctor or nurse if your child displays any of the
following signs of possible developmental delay for this age range.
Alert your child's doctor or nurse if your child displays any of the
following signs of possible developmental delay for this age range.
Here are some changes your child may go
through during middle childhood:
Emotional/Social Changes
More physical ability and more independence can put children at risk for
injuries from falls and other accidents. Motor vehicle crashes are the most
common cause of death from unintentional injury among children this age.
Developmental Milestones
During this time, your child
might:
Developmental Milestones
Middle Adolescence
(15-17 years old)
Developmental
Milestones
Middle adolescence is a time of physical, mental,
cognitive, and sexual changes for your teenager. Most girls will be
physically mature by now, and most will have completed puberty. Boys
might still be maturing physically during this time. Your teenager might
have concerns about her body size, shape, or weight. Eating disorders
can also be common, especially among females. During this phase of
development, your teenager is developing his unique personality and
opinions. Peer relationships are still important, yet your teenager will
have other interests as he develops a more clear sense of identity.
Middle adolescence is also an important time to prepare for more
independence and responsibility; many teenagers start working, and many
will be leaving home soon after high school.
Other changes you might notice in your teenager include:
With the onset of adolescence there is a rapid increase in growth...an increase in quantity, including weight, height, and secondary sex characteristics. The final 20-25% of linear growth is achieved during adolescence and up to 50% of the adult body weight is gained during this time. Sexual maturation is also achieved during this period.
Girls: The pubertal growth spurt begins as early as 9 1/2 years or as late as 14 1/2 years in girls. Females have an average increase in height of 2 to 8 inches total and normally a 15 to 55 pound increase in weight. In general the growth spurt in girls occurs 1 to 2 years earlier than boys. Breast development is typically the earliest secondary sex characteristic obvious in girls, beginning normally between the ages of 8 and 13 and ending between 13 and 18. Most girls begin to menstruate 2 years after the appearance of breast buds. The average age of onset of menarche is 12 1/2 years, but may normally range from 10 to 15 years. Although initial menstrual periods are usually scanty, irregular and not accompanied by ovulation, this is not always true.
Boys: The growth spurt in boys occurs between 10 1/2 years to as late as 16 years. On average, boys will grow more than girls, growing 4 to 12 inches and gaining 15 to 65 pounds. Testicular enlargement is usually the first pubescent change in boys, starting between 10 to 13 years and ending between 13 and 17 years. The voice begins to deepen around 13 to 14 years. The growth of pubic, facial and chest hair occurs between the ages of 12 and 16. The first ejaculations usually occur spontaneously between 11 and 13 years. Gynecomastia, breast enlargement and tenderness, occurs in 33% of boys and usually lasts no more than 2 years.
For both sexes, the gain in weight is proportionately greater than the gain in height. Therefore, the early adolescent normally appears "stocky" or "chubby". The skeletal system often grows faster than supporting muscles, which tends to cause clumsiness and poor posture.
The physical changes of adolescence have a profound impact on body image and self esteem. Teens typically measure their attractiveness by whether they are accepted or rejected by peers. Once the process of growth begins the sequence of changes is predictable. Awareness of the wide variation of normal growth and the sequence of changes is important for reassuring concerned adolescents.
Years ago, a pediatric
endocrinologist Dr. Tanner developed stages of sexual developed that are
referred to as "Tanner Stages" or Sexual Maturity Ratings (SMR). These
"stages" give physicians a way of evaluating a child's sexual
development. Parents should remember that while every child develops along the
same path to complete sexual development, they do so at different times.
The Tanner Stages were
developed by observing the pubic hair of both males and females, the male
genital area, and the female breast.
I. Girls
|
Tanner Stage |
Stage of develop |
Pubic Hair |
Breasts |
|
Stage 1 |
Early adolescence |
Preadolescent |
Preadolescent |
|
Stage 2 |
|
Sparse, straight |
small mound |
|
Stage 3 |
Middle adolescence |
Dark, curl |
bigger; no contour separation |
|
Stage 4 |
|
Coarse, curly, abundant |
Secondary mound of areola |
|
Stage 5 |
Late Adolescence |
Triangle; medial thigh |
nipple projects; areola part of breast |
I. Boys
|
Tanner Stage |
Stage of develop. |
Pubic Hair |
Penis |
Testes |
|
Stage 1 |
Early adolescence |
None |
Preadolescent |
preadolescent |
|
Stage 2 |
|
Scanty |
Slight increase |
larger |
|
Stage 3 |
Middle adolescence |
Darker, curls |
Longer |
larger |
|
Stage 4 |
|
adult, coarse, curly |
Larger |
scrotum dark |
|
Stage 5 |
Late adolescence |
adult - thighs |
Adult |
adult |
Middle Adolescence (Stages 3 and 4): acceleration of weight and growth as well as above secondary sex characteristics. Pubic hair first, then axillary, then facial hair.
