suwaneepediatrics

Growth and Development

Your baby will grow rapidly. In general, babies double their birth weight by 4 to 6 months of age and triple their weight by one year. This growth occurs in spurts and reflects your baby’s genetic inheritance as well as personal characteristics.

You will notice that your newborn tends to keep the hands fisted and the knees tucked under his/her stomach. A baby has very little head control initially and will need support for its head and back.

It is in this early period that your baby begins to develop a special relationship with you. Babies like to be cuddled and held closely. Your baby knows that Mom and Dad provide peace and comfort. During this time, baby develops a sense of trust that his/her needs will be met. From the time of birth, your baby is able to see, and will be attracted by brightness, movement and contrast, as well as three-dimensional objects. Bright colored mobiles and pictures by the crib will attract attention. Remember that your baby will be looking up at the bottom of the mobile, so place it appropriately.

Your baby’s hearing is essentially the same as adult hearing, your baby may startle when exposed to a loud sudden noise, but will enjoy listening to the radio or your singing. Your baby will also enjoy those special times with you taking great delight when you hold, rock, sing and talk to him/her.

Behavior Issues

Normal behavior in children depends on the child's age, personality, and physical and emotional development. A child's behavior may be a problem if it doesn't match the expectations of the family or if it is disruptive. Normal, or "good" behavior is usually determined by whether it's socially, culturally and developmentally appropriate. Knowing what to expect from your child at each age will help you decide what is normal behavior.

What can I do to change my child's behavior?

Children tend to continue a behavior when it is rewarded and stop a behavior when it is ignored. Consistency in your reaction to a behavior is important because rewarding and punishing the same behavior at different times confuses your child. When your child's behavior is a problem, you have 3 choices:

• Decide that the behavior is not a problem because it's appropriate to the child's age and stage of development.
• Attempt to stop the behavior, either by ignoring it or by punishing it.
• Introduce a new behavior that you prefer and reinforce it by rewarding your child.

How do I stop misbehavior?

The best way to stop unwanted behavior is to ignore it. This way works best over a period of time. When you want the behavior to stop immediately, you can use the time-out method.

How do I use the time-out method?

Decide ahead of time the behaviors that will result in a time-out -- usually tantrums, or aggressive or dangerous behavior. Choose a time-out place that is uninteresting for the child and not frightening, such as a chair, corner or playpen. When you're away from home, consider using a car or a nearby seating area as a time-out place.

When the unacceptable behavior occurs, tell the child the behavior is unacceptable and give a warning that you will put him or her in time-out if the behavior doesn't stop. Remain calm and don't look angry. If your child goes on misbehaving, calmly take him or her to the time-out area.

If possible, keep track of how long your child's been in time-out. Set a timer so your child will know when time-out is over. Time-out should be brief -- generally 1 minute for each year of age -- and should begin immediately after reaching the time-out place or after the child calms down. You should stay within sight or earshot of the child, but don't talk to him or her. If the child leaves the time-out area, gently return him or her to the area and consider resetting the timer. When the time-out is over, let the child leave the time-out place. Don't discuss the bad behavior, but look for ways to reward and reinforce good behavior later on.

How do I encourage a new, desired behavior?

One way to encourage good behavior is to use a reward system. This way works best in children over 2 years of age. It can take up to 2 months to work. Remaining patient and keeping a diary of behavior can be helpful to parents.

Choose 1 to 2 behaviors you would like to change (such as bedtime habits, tooth brushing or picking up toys). Choose a reward your child would enjoy. Examples of good rewards are an extra bedtime story, delaying bedtime by half an hour, a preferred snack or, for older children, earning points toward a special toy, a privilege or a small amount of money.

Explain the desired behavior and the reward to the child. For example, "If you get into your pajamas and brush your teeth before this TV show is over, you can stay up a half hour later." Request the behavior only one time. If the child does what you ask, give the reward. You can help the child if necessary but don't get too involved. Because any attention from parents, even negative attention, is so rewarding to children, they may prefer to have parental attention instead of a reward at first. Transition statements, such as, "In 5 minutes, play time will be over," are helpful when you are teaching your child new behaviors.

This system helps you avoid power struggles with your child. However, your child is not punished if he or she chooses not to behave as you ask; he or she simply does not get the reward.

What are some good ways to reward my child?

Beat the Clock (good method for a dawdling child)

• Ask the child to do a task. Set a timer. If the task is done before the timer rings, your child gets a reward. To decide the amount of time to give the child, figure out your child's "best time" to do that task and add 5 minutes.

The Good Behavior Game (good for teaching a new behavior)

• Write a short list of good behaviors on a chart and mark the chart with a star each time you see the good behavior. After your child has earned a small number of stars (depending on the child's age), give him or her a reward.

Good Marks/Bad Marks (best method for difficult, highly active children)

• In a short time (about an hour) put a mark on a chart or on your child's hand each time you see him or her performing a good behavior. For example, if you see your child playing quietly, solving a problem without fighting, picking up toys or reading a book, you would mark the chart. After a certain number of marks, give your child a reward. You can also make negative marks each time a bad behavior occurs. If you do this, only give your child a reward if there are more positive marks than negative marks.

Developing Quiet Time (often useful when you're making supper)

• Ask your child to play quietly alone or with a sibling for a short time (maybe 30 minutes). Check on your child frequently (every 2 to 5 minutes, depending on the child's age) and give a reward or a token for each few minutes they were quiet or playing well. Gradually increase the intervals (go from checking your child's behavior every 2 to 5 minutes to checking every 30 minutes), but continue to give rewards for each time period your child was quiet or played well.

What else can I do to help my child behave well?

Make a short list of important rules and go over them with your child. Avoid power struggles, no-win situations and extremes. When you think you've overreacted, it's better to use common sense to solve the problem, even if you have to be inconsistent with your reward or punishment method. Avoid doing this often as it may confuse your child.

Accept your child's basic personality, whether it's shy, social, talkative or active. Basic personality can be changed a little, but not very much. Try to avoid situations that can make your child cranky, such as becoming overly stimulated, tired or bored. Don't criticize your child in front of other people. Describe your child's behavior as bad, but don't label your child as bad. Praise your child often when he or she deserves it. Touch him or her affectionately and often. Children want and need attention from their parents.

Develop little routines and rituals, especially at bedtimes and meal times. Provide transition remarks (such as "In 5 minutes, we'll be eating dinner."). Allow your child choices whenever possible. For example, you can ask, "Do you want to wear your red pajamas or your blue pajamas to bed tonight?"

As children get older, they may enjoy becoming involved in household rule making. Don't debate the rules at the time of misbehavior, but invite your child to participate in rule making at another time.

Children who learn that bad behavior is not tolerated and that good behavior is rewarded are learning skills that will last them a lifetime.

Why shouldn't I use physical punishment?

Parents may choose to use physical punishment (such as spanking) to stop undesirable behavior. The biggest drawback to this method is that although the punishment stops the bad behavior for a while, it doesn't teach your child to change his or her behavior. Disciplining your child is really just teaching him or her to choose good behaviors. If your child doesn't know a good behavior, he or she is likely to return to the bad behavior. Physical punishment becomes less effective with time and can cause the child to behave aggressively. It can also be carried too far -- into child abuse. Other methods of punishment are preferred and should be used whenever possible.

Breast feeding and returning to work

Breastfeeding is good for you and your baby. It provides the best nutrition and protects your baby against many illnesses. According to some experts, babies should be breastfed or given only breast milk for about the first 6 months of life, and they should continue to be fed some milk until they are at least 1 year old.

Can I continue to breastfeed when I go back to work?

Yes, it is possible to continue giving your child breast milk while you work. The easiest way to do this is to make a breastfeeding plan before you go back to work. This plan can help you deal with problems that could keep you from breastfeeding your baby.

Before you go on maternity leave, or before you return to work after your baby is born, talk to your employer about your plan to breastfeed.

Also, take as much maternity leave as you can. This will allow your milk supply to become strong before you return to work.

How can I continue to breastfeed my baby when I'm at work?

If possible, find a caregiver who is close enough to your workplace that you can provide at least 1 feeding for your baby during your workday. On-site (at your workplace) daycare might be available to you, or the baby's caregiver might bring your baby to you for 1 or more feedings.

What if I decide to pump my breasts?

If having your baby nearby during your workday is not possible, you may decide to pump your breasts. You will need to make a breast pumping schedule. Talk to your employer and answer the following questions:

• How often can you pump your breasts? At what times?
• Where can you pump? Will this area have electricity and privacy?
• What changes might have to be made in your work schedule to allow you to pump your breasts?

A checklist (see the box below) can help you be sure that you have everything you need for pumping your breasts at work.

Whenever you are with your baby, you can still breastfeed. When you're at work, your baby's caregiver can use a bottle to feed your baby the breast milk you pump. However, be careful not to feed your baby from a bottle too early. If you use a bottle too early, your baby may not breastfeed as well. This problem is called "nipple confusion." It is best to avoid bottles and pacifiers until your baby is 4 to 6 weeks old and has learned how to breastfeed well.

What you need to pump your breasts at work

• Breast pump, plus electrical adapter if needed. Extra batteries if you are using a battery-powered pump.
• A small cooler, plus ice, if a refrigerator is not available for storing your milk at work. If you forget the cooler, breast milk can be stored at room temperature for 4 to 8 hours.
• Enough milk storage containers for the number of pumping sessions you will need during your workday.
• An extra shirt, sweater or vest to wear in case your breasts leak. It is a good idea to wear shirts with patterns on them because milk is harder to see on patterned material.
• Clothing that makes it easy to get to your breasts. Your clothing should open in the front.
• A shawl or small blanket for privacy if you need to pump in a common area.
• A water bottle and healthy snacks. Women who are breastfeeding need extra calories.
• A pillow for supporting your arm while you pump your breasts. This may make pumping more comfortable.
• A "do not disturb" sign if you are pumping in a shared space.

Optional

• A portable radio or tape or CD player (plus your favorite music), an entertaining book or a magazine. If you are relaxed, your breasts will release milk more easily (the "let-down reflex") and you will be able to pump your breasts better.
• A picture of your baby or an item of your baby's clothing. Thinking about your baby can stimulate the let-down reflex.

Where can I pump when I'm at work?

A "pumping room" (also called a "lactation room") can be created in any area that provides privacy. The area should contain a chair and working electrical outlets. A sink is helpful for cleaning up after you pump your breasts. If your workplace has a refrigerator, you can use it to store your. Otherwise, you could bring a small cooler with ice and use that to store the milk

What if I can't pump at work and I can't go home to breastfeed?

If you cannot pump at work, you can still breastfeed whenever you are with your baby. The caregiver can feed your baby formula when not enough of your milk is available.

If you don't pump, your breasts will stop making milk during your workday. For the first few days, your breasts may become overly full and leak. You can use nursing pads (breast shells) in your bra to catch leaking milk. Crossing your arms over your breast and applying firm pressure can stop the leaking. If your breasts become very uncomfortable, you can go the bathroom and pump (either with your hands or with a breast pump) just enough milk to feel better.

Who can I talk to when I have questions about breastfeeding and working?

Talk to your doctor, or ask a friend or family member who has breastfed while working outside the home.

Local breastfeeding support groups or breastfeeding-related Web sites are also good sources of information

Bronchiolitis

Bronchiolitis (say: "bronk-ee-oh-lie-tus") is a lung infection that can be caused by several kinds of viruses. Children under age 2 get this illness in the winter and the early spring. Most children are sick for about a week and then get well.

What are the symptoms of bronchiolitis?

Your child will probably have a runny nose and a slight fever for 2 to 3 days. Then your child may begin to cough, breathe fast and wheeze (make a high-pitched whistling sound when breathing) for another 2 or 3 days.

What can I do for my child?

There are some things you can do when your child has bronchiolitis:

• Have your child drink liquids. Don't worry if he or she doesn't feel like eating solid foods.
• Use a cool-mist vaporizer in the bedroom while the child is sleeping.
• Run hot water in the shower or bathtub to steam up the bathroom and sit in there with your child if he or she is coughing hard and having trouble breathing.
• Give your child acetaminophen (some brand names: Children's or Infants' Tylenol), if he or she has a fever. Don't give your child aspirin. Aspirin has been associated with Reye's syndrome, a rare disease of the brain and liver.

When should I call the doctor?

You should call your doctor if:

• Your child is vomiting and can't keep liquids down.
• Your child is breathing very fast, more than 40 breaths in 1 minute.
• Your child's skin develops a bluish color, especially around the lips or in the fingertips.
• You can see your child's skin pull in between the ribs with each breath or your child has to sit up to be able to breathe.
• Your child has had heart disease or was born prematurely. In this case, call the doctor at the first signs of this illness.

What will my doctor do for my child?

Your doctor will check your child for signs of dehydration (not enough liquids in his or her body). Your doctor will also check to see if your child is getting enough oxygen and may want to check your child for pneumonia. Sometimes, doctors give children a liquid medicine to help with the cough. Your doctor may want to see your child again in 24 hours.

If your child is really working hard to breathe, your doctor may suggest putting him or her in the hospital. Your child can get extra oxygen while in the hospital. Your child can also get extra liquids through the veins (intravenous fluids), which will help prevent dehydration.

Will my other children catch bronchiolitis?

Bronchiolitis is spread just like a cold, through close contact with saliva or mucus, but older children usually don't get as sick as younger children do.

You can help prevent spreading this disease by keeping your sick child home until the cough is almost gone. Make sure to wash your hands after you take care of your sick child to avoid spreading the virus to others

Immunization

Although the number of children fully vaccinated by the age of 1 yr has increased from 5% in 1974, when the Expanded Program on Immunization (EPI) was set up, to ~80% in the 1990s, 12 million children under the age of 5 yrs are still dying each year. Many are due to diseases that could be prevented by vaccination in principle, but for which vaccines have not yet been developed. However, 2 million deaths are due to diseases that can be prevented by the vaccines already on offer through the EPI. In 2000 approximately 875,000 children died from measles, almost 500,000 from neonatal tetanus, and 400,000 from whooping cough.

These deaths occur for two reasons — because not all existing vaccines are 100% effective and because each year ~20% of the world's children are not fully immunized in their first year of life with the EPI vaccine. Research work around the world is working to improve the effectiveness of vaccines to work on the first problem. In response to the second problem, the WHO is also working on ways of increasing coverage globally for all EPI vaccines. They have noted that many opportunities to give vaccines are not taken — the so-called 'missed opportunities'. Reduction in these missed opportunities would likely markedly improve global coverage. learn more

Shortness of Breath

When you are short of breath, you may feel like you can't catch your breath or your chest may feel tight. Sometimes the feeling is worse when you are physically active. It can be worse when you lie down flat. You may have other symptoms such as a cough, chest pains or fever. If you have any of these problems, tell your doctor.

What could be causing me to be short of breath?

Shortness of breath can be caused by many things, including the following:

• Asthma
• Emphysema (say: "em-fa-see-ma"), a lung disease that is caused by smoking
• Heart failure that causes fluid to collect in the lungs
• Panic attacks

If you are short of breath with a cough and/or fever, you may have a chest infection or pneumonia (say: "new-moan-yuh"). Less common causes of breathing problems are lung cancer, a blood clot in the lungs, air leakage around the lungs and scarring of the lung tissue.

What tests will my doctor perform?

Your doctor can help find the cause of your breathing problem by asking you questions and doing a physical exam. You doctor also may order some tests.

To find the cause of your shortness of breath, your doctor may order a chest x-ray or an electrocardiogram (also called an ECG). During this test, your doctor will have you lie down so your heart can be monitored. The ECG machine makes a picture, or tracing, that shows your heart's electrical signals. Your doctor may measure your breathing and the oxygen level in your blood. You also may need to have a blood test.

What can I do to help my breathing?

If you smoke, you need to stop. Ask your doctor for help. Also, avoid chemicals and strong smells that can bother your lungs.