Questions to ask Your Prenatal Provider

Do you ever wonder what questions you should be asking at your prenatal visits? Here are a number of topics commonly addressed during prenatal visits or that can be asked during a hospital tour. I don’t recommend bombarding your practitioner with a huge list of questions at once. Rather, refer to this list over the course of your pregnancy to ensure that your prenatal visits are covering the topics that are important to you.

Pregnancy

• What tests are planned for your pregnancy and when should these happen?

• What are the dietary guidelines for your pregnancy? What supplements should you take? What is the appropriate amount of weight gain advised?

• How much and what kinds of exercise are recommended?

• Are you at higher risk of preterm labor?

• Is perineal massage or Kegel exercises advised during the last trimester?

• Are there recommended classes for childbirth preparation, breast-feeding, and newborn care? Are certain pediatricians recommended?

• When should you begin maternity leave?

Labor

• What’s the protocol for informing the practice when you are in early labor? For what indications does your doctor or midwife want to be called? If your doctor or midwife is unavailable, who will be caring for you during labor? Who will be likely to attend your delivery?

• Will testing for Group B Strep be done during your pregnancy? Is Group B Strep standardly treated in early labor?

• Is fetal monitoring used in an intermittent or continuous fashion? Can you move around during labor? What positions can you try during labor? Is there an option to labor in warm water (shower or tub)?

• Does your health care provider use any techniques to lower your chances for having an episiotomy?

• How many people can join you in the labor room? What about if a cesarean section is required – who can stay with you?

• How much time is your doctor likely to spend with you during labor? What’s the staffing ratio of nurses to patients during active labor? Should you hire a doula or labor coach?

• What medications are available for pain relief during labor? If you choose an epidural, how long should you expect to wait after your decision until it will be administered? Is there an anesthesiologist in labor and delivery?

• Can you tour hospital? Does hospital have a sibling class? Does hospital have a neonatal intensive care unit?

Delivery

• Who should you expect to be present in the delivery room? Will there be student doctors or nurses present?

• Can you photograph or film your delivery?

• Can your husband or partner cut the umbilical cord?

• How soon can you breastfeed? What about after a cesarean section?

Post-partum

• Does your hospital allow rooming in? Will your partner be able to stay with you? How long is a typical hospital stay with a vaginal delivery or with a cesarean section?

• Is there strong hospital support for breast feeding? Is a lactation consultant available in hospital?

• Will your pediatrician see you in hospital? Should you have a car seat available for the time of discharge?

• What vitamins and supplements are advised following the delivery?

Helping stay-at-home kids adjust to daycare

Q: I am beginning a job as a guidance counselor in a public school. My children (ages 5 years, 4 years and 15 months) will need child care (outside of our home) for the first time in their lives. I have enrolled them together in a registered daycare but am very concerned about my 15-month-old who is basically non-verbal at this time, and my 4-year-old, who has always had a difficult time adjusting to new situations and people. I have checked references and called the state to research the agency, and everything checks out.

My 5-year-old will be in kindergarten for the first part of her daycare day. Also, all three of my kids will only need daycare for three days a week since my job is only part-time. I believe I will love the job, but hate the fact that I will not be home for my kids. We need the extra income right now to pay for our new mortgage. What can I do to make sure that the transition is smooth for my 15-month-old and 4-year-old?

— Submitted by Kimberly

Dr. Bettye M. Caldwell, Ph.D.

Professor of Pediatrics in Child Development and Education

A: It sounds as though you are planning well and carefully, and consequently you probably won’t have any major problems. Good advance planning solves more problems than frantic trial and error after problems develop.

In my way of thinking, it is good that you plan to work only three days a week. Part-time work is easier on the children and on you. That schedule will facilitate a good flow between the home and child care environment. Try to begin your children’s enrollment a couple of weeks before you begin your job (may not be feasible), so you can spend time with all of them in the child care setting and observe their reactions to the situation. If the 15-month-old is already securely attached to you, chances are he or she will have little trouble adapting to the new arrangement. Expect some tears for the first few days, but then leave and come back to observe inconspicuously. You may be surprised to see how quickly the tears dry up after you leave! Remind the 4-year-old that his/her brothers and sisters are near by. And ask the director of the centre to let your child call you each day during the first week or so.

Does preschool make a difference?

Dr. Kenneth N. Condrell, Ph.D.

Child Psychologist

Preschool is a milestone in a child’s life. For many families, it’s the first time a child leaves his parents for an extended period. For that reason, many parents are filled with mixed emotions about it. Consider, for example, a few of the responses I have heard from parents anticipating the big day:

“She’s not going to make it. She won’t let me out of her sight.”

“I can’t wait to send him to nursery school. He’s driving me crazy!”

“I’m feeling depressed just thinking about my last one going off to preschool.”

“My son just can’t wait to go, and I’m so excited for him.”

Some parents feel like they’re doing their children a favor by sending them to nursery school, while other feel like they’re abandoning them. Still others fear that their kids aren’t up to leaving home to, in essence, live with other people for part of the day.

Probably the biggest developmental task children face is separating from their parents and standing on their own two feet. This is an ongoing challenge that takes up a good portion of an individual’s life. Over the years I have talked to many adults still struggling to separate from their parents.

Preschool is one step in that long parade toward independence. And when it comes to their children making such a step, parents need to realise that separation can be a two-way street. If mum or dad is not ready to separate, the child may well pick up on this reluctance and resist the whole idea of nursery school. On the other hand, mum and dad may be ready to separate, but the child, for any number of reasons, may decide he wants to stay home. Of course, there are also situations where both parent and would-be preschooler are hesitant about separating. In these situations, it’s likely that nursery school will be postponed or skipped altogether.

Should parents pass on preschool?

I don’t think so.

Some people look upon preschool as an option, or a luxury. Others think it’s unfair to send children to nursery school when they have so many years of schooling ahead of them. I have come to look upon it as a special favor parents can do for their children. A good preschool offers children many valuable experiences. It helps kids become independent. It feeds their amazing curiosity and appetite for learning. Even the best home can’t always provide the tremendous stimulation young minds need. Nursery schools also offer children a great opportunity to practice interacting with other people. The essence of life is getting along with others; you can’t develop those skills without “mixing it up” with different personalities. Last but not least, a nursery school prepares a child for kindergarten. The current kindergarten curriculum is so much more advanced than it was in previous generations that, in my opinion, the child who misses preschool enters kindergarten at a disadvantage.

For these reasons, I strongly believe in preschool. Parents do their children a valuable service when they find them a quality, affordable nursery school and then encourage them to go forth. On the long path toward independence, preschool is one important steppingstone.

How does play lead to learning?

Learning Toys

During the first year, there's no distinction between playing and learning. The more baby plays with the objects in the world, the more baby learns about them. Take shapes, for example: baby learns that some things roll, and some things don't; some things stack into neat piles, and others don't. And size: Baby learns that little things fit into big things, but that the opposite isn't true. As your baby learns more about the world, you'll find yourself feeling proud of the accomplishments you're witnessing—and your baby will start feeling accomplished, as well. This sense of achievement is crucial for baby's development, and for your own sense of pride as a parent. Parents can hold out a toy for a baby can reach for and grasp—an accomplishment in and of itself, which deserves your happy congratulations. When you give your baby a sense of recognition and approval, you will see an immediate response in the form of a smile or rapid hand motion. As you reward your baby for whatever has just been accomplished—even a simple game of peekaboo—you will be granting your child a positive self-image. With this sense of confidence and optimism, your baby will grow into a self-assured young child, capable of taking on new challenges with the blink of an eye.

For babies, play really is learning. It is through play experiences that they learn most about the world around them. And exploration is the stimulus for learning. If babies are encouraged at this age, they will become active explorers and learners throughout their childhood. Your baby learns about items by handling them, and the more things are manipulated, the more is learned. When baby wonders: 'What kind of sound will this make when I drop it in the bucket? How do these funny shapes fit together? My block tower fits better if I put the big blocks on the bottom, doesn't it?', it's baby's way of working out the answers through play.

With each new discovery, fun and learning move to a new level. When toys offer several activities with increasing challenges, babies strengthen and build new skills. These early and sometimes shaky attempts at mastering a new skill require lots of practice sessions. As every new parent will soon find out, babies can push, pull, and grab. But in the beginning, babies often can't manage small and fine motions of the wrist and fingers required for more delicate maneuvers, such as pushing a small button on a touch-tone phone. Those skills will come soon enough.

One of the most important lessons for parents to learn is this: be very careful not to expect too much, too soon—or give baby opportunities that children their age can't be expected to fulfill. If, for example, you give an infant a toy that only a toddler is expected to be able to interact with successfully, that infant will end up feeling frustrated and stymied—not inspired and accomplished. By giving baby age-appropriate toys and activity centers, you'll help your baby create that sense of learning and accomplishment from a very young age.

*Our parenting advice is given as suggestions only. We recommend you also consult your healthcare provider, and urge you to contact them immediately if your question is urgent or about a medical condition.

Toys to encourage early learning 18-24months

Counting Friends Phone

Why your child will enjoy this toy now:

When learning is presented in a way that's fun and engaging, children become more interested and more involved. Early learning toys help thinking skills develop and enhance vocabulary.

What you can do to help your child learn more:

Help your child make the connection between the simple concepts introduced in these toys — letters, numbers, shapes and colors — with familiar items in the world around them. "That's the number two. Point to your two eyes."

When you're in the car, extend the learning by playing letter or number games. Point out an object and say, "That's a red stop sign. Stop begins with the letter S. Your name, Sheela, begins with the letter S, too."

Storybook Theater for 5-6 year olds

Give your child the opportunity to act out his storybooks for you!

Learning Skills

• Cognitive/thinking skills
• Creativity/dramatic play
• Emotional expression
• Gross motor development
• Language and vocabulary development
• Self-awareness/self-esteem

Materials

• Favorite picture books
• Towel or sheet
• Floor
• Chair

Instructions

• Have your child select a few of his favorite picture books that he would like to act out.
• Spread a large towel or sheet over the floor for the stage.
• Sit in a chair and begin to read the story slowly.
• Have your child stand in the middle of the stage and act out each scene as you read it.

Safety

Make sure none of the scenes is dangerous to act out. Read slowly and provide tips to get your child started if necessary.

Prenatal Health History

Your first prenatal visit will be a chance for you to get to know your doctor or midwife, and to supply essential information that can enhance your medical care. Being prepared for this visit can be quite helpful. Bring copies of important medical records, learn about your family’s medical history, and write down pertinent details about your health.

A typical prenatal history checklist will include the following:

1. Personal medical history. Allergies, childhood illnesses, past medical conditions, chronic illnesses (such as asthma, diabetes, seizures, hypertension), and hospitalizations.

2. Surgical history. Major or minor surgical procedures, anesthetic usage, and major accidents.

3. Medication. Recently and currently used prescription and non-prescription drugs (including topical creams or lotions), herbs, homeopathic preparations, vitamins and other supplements.

4. Lifestyle. Dietary habits or restrictions, pre-pregnancy weight, recreational and sports activities.

5. Health risks. Smoking, drug or alcohol use, environmental and occupational exposures to chemicals or radiation, psychological and social stressors, past or current psychological problems including depression, history of eating disorders, history of sexual abuse or domestic violence.

6. Past obstetric history. Outcome of all prior pregnancies (including miscarriage, ectopic pregnancy, induced abortion), obstetric complications (such as preterm labor, gestational diabetes, hypertension), birth interventions (such as forceps, cesarean section, use of anesthesia), any post-partum complications (including hemorrhage or infection).

7. Past gynecologic history. Menstrual pattern, history of reproductive organ problems such as fibroids, ovarian cysts, pelvic infections, cervical dysplasia and descriptions of treatments or surgery obtained for these conditions.

8. Current pregnancy. First day of last menstrual period, date of first positive pregnancy test, symptoms during this pregnancy including uterine cramping, vaginal bleeding, vaginal discharge, infections, rashes or other illnesses.

9. Infectious disease. Includes herpes, gonorrhea, chlamydia, bacterial vaginosis, trichomonas, vaginal yeast, syphilis, hepatitis, HIV and childhood infectious diseases.

10. Genetic histories of both parents. Personal or family histories of mental retardation or developmental delay, neural tube defects, congenital abnormalities (such as cleft palate, heart defects), blood disorders (including sickle cell anemia, thalassemia), and other diseases such as cystic fibrosis, muscular dystrophy, neurofibromatosis, Huntington’s disease, PKU, and Tay-Sach’s disease. Your age and ethnic background will influence recommendations for screening tests: Tay-Sach’s for Ashkenazi Jewish or French-Canadian descent, Canavan’s disease screening for Ashkenazi Jewish descent, sickle cell screen for African or African-American heritage in either partner, and chromosomal testing if you are over 35 years old.

Providing this level of detail about yourself will guide your practitioner in your care, allowing her to provide suitable counseling and education, obtain appropriate prenatal tests, and anticipate difficulties that could arise. You’ll be giving your pregnancy the best opportunity for a healthy outcome.

Two Important Lessons

Kenneth N. Condrell, Ph.D.

Child Psychologist

There are countless lessons parents must teach their children over the years. Here are two of the most important.

Lesson One: Saying “I’m Sorry”

Over the years, I’ve counseled many children who had great difficulty making and keeping friends. One general characteristic they shared was that they did not know how to apologize. This made it impossible for them to save a friendship when they behaved poorly and hurt another child’s feelings.

As adults, we know there are times when we need to apologize to repair a relationship that has been damaged by a thoughtless comment or action. Children, however, don’t know how to do this. They need to be taught this very important social skill by their parents.

Sometimes, they’ll mumble, “I’m sorry” in a half-hearted tone of voice, but that’s not an effective apology. An effective apology must include the following:

• A show of sincerity
• A promise not to make the mistake again
• An offer to make things right
• Let’s take a look at each one of these important components of an effective apology.

Sincerity:

In order to inspire a sincere apology, parents have to remind their child how her behavior hurt another child’s feelings. Once she understands, she’s more likely to give a sincere apology.

A promise not to repeat the mistake:

The child must pledge that he will do his best not to repeat the unacceptable behavior.

An offer to make amends:

In other words, your child should ask the offended party, “How can I make it up to you?”

Children as young as 3 can learn how to apologize. It’s an important social skill all children need to learn—one that will benefit them enormously in relationships throughout their lifetimes.

Lesson 2: No Means No

Over the years, I’ve observed parents becoming increasingly reluctant to frustrate their child with a “No” or a time-out. They worry or feel guilty that they’re hurting their child’s feelings, so they back off from their “No” or the time-out the moment she cries or protests.

If you’re one of these parents, let me assure you that there isn’t any way you can get your child ready to handle life without occasionally frustrating or upsetting him.

Children are focused on having their way, even if it means being socially inappropriate or breaking their parent’s rules. As your child’s teacher, you need to point out his mistakes and scold and punish him for them. This is normal parenting.

Over the years, parenthood experts have convinced parents they must avoid making their children cry, feel frustrated or feel guilty about the way they have misbehaved. In my opinion, this kind of advice is absolute nonsense. It waters down a parent’s authority. Because of this way of thinking, today’s “No” from a parent often means “Maybe” or “Yes.”

Almost all children protest when parents teach them how to behave properly. Giving in to this protest, however, only teaches a child that a parent doesn’t mean what she says—and it’s a very poor lesson for a child to learn. In fact, there’s no better way to raise bratty children then by giving in to them and acting more like a friend than the authority in charge.

Each time your child becomes upset when she hears “No,” you need to remind yourself that this word isn’t going to harm her self-esteem or make her fall out of love with you.

Remember, teaching your child these two lessons will help her become a better friend, respect the rules and succeed in life.

*Our parenting advice is given as suggestions only. We recommend you also consult your healthcare provider, and urge you to contact them immediately if your question is urgent or about a medical condition

Helping stay-at-home kids adjust to daycare

Q: I am beginning a job as a guidance counselor in a public school. My children (ages 5 years, 4 years and 15 months) will need child care (outside of our home) for the first time in their lives. I have enrolled them together in a registered daycare but am very concerned about my 15-month-old who is basically non-verbal at this time, and my 4-year-old, who has always had a difficult time adjusting to new situations and people. I have checked references and called the state to research the agency, and everything checks out.

My 5-year-old will be in kindergarten for the first part of her daycare day. Also, all three of my kids will only need daycare for three days a week since my job is only part-time. I believe I will love the job, but hate the fact that I will not be home for my kids. We need the extra income right now to pay for our new mortgage. What can I do to make sure that the transition is smooth for my 15-month-old and 4-year-old?

— Submitted by Kimberly

Dr. Bettye M. Caldwell, Ph.D.

Professor of Pediatrics in Child Development and Education

A: It sounds as though you are planning well and carefully, and consequently you probably won’t have any major problems. Good advance planning solves more problems than frantic trial and error after problems develop.

In my way of thinking, it is good that you plan to work only three days a week. Part-time work is easier on the children and on you. That schedule will facilitate a good flow between the home and child care environment. Try to begin your children’s enrollment a couple of weeks before you begin your job (may not be feasible), so you can spend time with all of them in the child care setting and observe their reactions to the situation. If the 15-month-old is already securely attached to you, chances are he or she will have little trouble adapting to the new arrangement. Expect some tears for the first few days, but then leave and come back to observe inconspicuously. You may be surprised to see how quickly the tears dry up after you leave! Remind the 4-year-old that his/her brothers and sisters are near by. And ask the director of the centre to let your child call you each day during the first week or so.

Ride-ons for 2-3 year olds

         

 

Bounce & Ride Thomas   Barbie Trike                         Kawasaki Trike

Why your child will enjoy this toy now:

A trike helps your child learn balance, steering and how to pedal forward and backward—all good for large motor control. Alternating right, left, right, left as they learn to pedal contributes to "whole brain" development.

What you can do to help your child learn more:

• When your child first sees a ride-on, he may be very happy to just get on and off repeatedly by himself. Or, he may sit on it and push with his feet, forward and backward.
• Ride-ons are designed so a child's feet reach the ground or the pedals, and so his body weight helps push the ride-on around. Often, children don't realize their feet should go around on pedals and they want to push back and forth; it may help if you show him how it's supposed to work. Put his feet on the pedals, hold your hands on top of them and push so he feels the motion of the pedals going down and around.
• For many children, steering with handlebars seems to happen automatically—they just get it and follow their nose! Help him to learn directions by saying the words, "Now you're turning left," or, "Turn to the right."
• Children love to make use of the ride-on's little storage compartments. If his toy has one, help your 2-year-old select a "friend" to take for a ride, or pack a little snack for him to enjoy on a break.
• Children at 2 years are old enough to learn to "park" their ride-on. Give your child a "parking spot" in the shed or garage. Say, "This is your parking spot," using that term. "Just like Mommy has a parking spot for our car, this is where you park your ride-on when you're done with it."

Family Phone Book

Materials

• Scissors
• Paper
• Photos of family and friends
• Small photo album (sleeves each measuring at least 4-by-6 inches)
• Markers, crayons, or coloured pencils

Instructions

1.      Cut the paper into 4-by-6-inch rectangles.

2.      Collect photos of family and friends and insert them into the photo album, leaving one blank sleeve between each photo.

3.      Have your child write the name and telephone number of the person in the first photo on one of the rectangles.

4.      Insert the rectangle opposite the photo, next to it, or above or below it, depending on the album’s format.

5.      Repeat this process for each photo.

Shape Painting

Materials

• Liquid tempera paint(s)
• Shallow container(s)
• Paper cups, small jars, snap-together building blocks, sponges, and other objects in different geometric shapes
• Several sheets of paper

Instructions

• Pour liquid tempera paint into a shallow container. If you like, use more than one color, using one container for each color.
• Collect assorted objects in basic geometric shapes.
• Help your child dip the objects into the paint, and then press them onto the paper.
• You may wish to use one sheet of paper for each shape, or use one sheet of paper for all the shapes, each a different color.
• If possible, use each object in more than one way. For example, a cup may leave a faint outline of a circle if pressed onto the paper upside down, but its base may leave a solid circle.
• A snap-together block will leave either a row of small circles or a larger square or rectangle, depending on which side is pressed on the paper.

Choosing a Health Care Provider

Many of us put more research into buying a car than we do when choosing a doctor or midwife to deliver our baby. The reality is that through this decision, you’ll be choosing a partner for a remarkable journey over the next 9 months. This choice is likely to colour your experience of the pregnancy and birth. It’s best to select an experienced clinician whose values resonate with your own, who provides informative and supportive care, and who can enhance your pregnancy and birth experience.

Here are some issues to consider:

1. Where do you want to deliver? Your choices are a hospital, free-standing birthing centre or home. Make sure the provider you select has authorization to deliver at your preferred location. A hospital or birthing centre can provide you with a list of providers who are authorized to deliver at their facility.

2. Do you prefer an obstetrician, a family practitioner or a midwife to attend your delivery? The first two are physicians. A family practice doctor will be able to care for routine pregnancies and deliveries, and can provide health care for other family members as well, including your new baby. An obstetrician has specialized training in high-risk pregnancies and deliveries, and can handle unexpected complications. A midwife can provide attentive care for low-risk pregnancies, and will need the back up of a physician if complications arise.

3. Is the office friendly and convenient? Are staff members helpful and welcoming? Are waiting times in the office reasonable? Some popular doctors may have long waits for each appointment; if your own schedule is busy, you need to take this into account.

4. Does your provider work solo, or as part of a group? If you prefer a solo practitioner, what kind of coverage will you have when she is unavailable or on holiday? If you choose someone from a group practice, will you have a chance to meet the other practitioners prior to your delivery day?

5. Is your provider part of a call group – a group of clinicians who take turns doing deliveries on nights and weekends? What percentage of patients does your health care provider deliver herself?

6. Does your provider communicate well with you? Does she allow ample time for questions to be answered? Does she seem interested in you, or impersonal? Thorough or abrupt? Does she provide eye contact when she talks to you and does she help to put you at ease during exams?

7. What should you expect at the time of labor and delivery? Does your provider “labor sit”, staying with you for extended periods of time during the labor, or does she provide more intermittent contact? Does she encourage movement during labor? What strategies does she advise for pain relief during labor? How often are cesarean sections necessary? Does she have techniques to reduce the chance of episiotomy? Does she work with labor coaches or doulas? There are a variety of ways to approach these issues, and these questions will help you learn your provider’s style.

8. Does your provider encourage family involvement during prenatal visits and the delivery? If you have another child already, would he/she be welcome at prenatal visits or at the birth?

9. What are the fees charged by this provider? What percentage will be covered by your insurance plan?

To find a provider you’ll be comfortable with, ask for the recommendations of family, friends and other health care providers. Don’t hesitate to schedule interviews with a couple of clinicians to help you make your final choice. After all, you’ll be giving someone the privilege of joining your family for a very special event!

Soda for kids: bad idea?

Q: What do you think about giving kids soda? My children are 3 and 5, and my wife wants to give them soda for dinner as a reward for being really good. (She also drinks a lot of diet cola because she’s trying to lose weight). Is this okay for their health?

— Submitted by Jeffrey in Berkeley

Dr. Karen Sokal -Gutierrez, M.D., M.P.H.

Pediatrics

A: Jeffrey, it’s good that you’re concerned about your children drinking soda. In fact, children’s consumption of soda in the United States has tripled over the past 20 years. As a result, many studies have found that drinking soda regularly has negative effects on children’s health:

Tooth decay: A 12-ounce soda has the equivalent of 10 teaspoons of sugar. The sugar and acidity of soda lead to higher rates of tooth decay.

Obesity: Just as soda is loaded with sugar, it is also loaded with extra calories. A 12-ounce soda typically has 150 calories. Children who drink soda regularly consume more calories each day and have higher rates of overweight and obesity.

Weaker bones: When children drink soda, it is often instead of milk. Milk is a major source of calcium, which children need to build strong bones and teeth. Children who drink soda regularly have been found to drink less milk, have a lower intake of calcium, weaker bones and more fractures.

Caffeine effects: Caffeine is an addictive, stimulant drug that is present in colas and many other sodas. Caffeine can make children nervous and irritable, and cause headaches and sleep problems.

It’s a nice idea to have a special treat at the end of a pleasant day. But a healthy treat would be better than an unhealthy one. Particularly if there is a family history of weight problems, it would be good to get your children into healthy eating patterns from the start. In fact, since children tend to follow the lead of their parents, it would be best for the whole family to get on a healthy eating and exercise plan. Instead of drinking soda every night at dinner, you and your wife can drink water and give your children milk. Save soda for special occasions only once in a while. For an alternative evening treat, try letting them choose what music to listen to and dance to; what video to watch after dinner; whether to go for a walk around the block, play at the park or go for a bicycle ride; or which book to read before bed.

Toy suggestions for 3 – 4 year olds

Why your child will enjoy this toy now:

Toys with realistic parts give your child something to talk about and to play-act with, helping initiate early attempts at social interaction. Your child is also at a prime age for wanting to know more and translating what she learns into realism as she plays.

 Dora's Kitchen Set                                                       Medical Kit

What you can do to help your child learn more:

Perhaps your child has a play kitchen. Ask her: "What will you make for lunch?" "What will you put into your soup?" "Do you have to go grocery shopping first?" She's interested in the details, so help her pretend to measure, mix and pour.

If your child's interested in a particular occupation or theme, feed her curiosity with details to answer those "what" and "why" questions, preparing her for richer, more creative play. Visit the library for books on the topic of interest. Go online and research together. Attend a shows or demonstrations at local grocery stores, home and garden centers, or fair grounds.

When you and your child put your imaginations together, you'll be amazed at how much more realistic and fun your play will become. If your toy is a medical kit, designate an area of your house as the doctor's office or hospital. Make a sign for the door, "The doctor is in." Gather willing patients (dolls and stuffed animals are always in need of a check-up). Put magazines and a chair in your waiting room, and a play phone for the receptionist. Locate a little tablet of paper so your "doctor" can write prescriptions.

If your child needs a few play prompts to get the idea, be the receptionist or nurse and suggest "problems" for her to solve. "Mrs. Johnson isn't feeling well. Can you see her right away?"

Take turns being doctor and patient with your child, and listen carefully to what she says in each role. You'll gain new insight, and she'll gain new confidence!

Point things out on a real trip to the doctor's office—the stethoscope, the otoscope, the blood pressure cuff. When you get home, you can use your child's toy medical kit to further explain what the instruments are used for.

Toilet Training

Dr. Karen Sokal-Gutierrez, M.D., M.P.H.

Pediatrics

'mummy, Daddy—I went poopy in the potty!' Do you long to hear those precious words from your child? Some children and parents breeze effortlessly through toilet training while others experience more difficulty. When you think your child might be ready for toilet training, take a deep breath and muster up all the determination and patience you have to work on it for several months. And consider the following tips to help make toilet training easier for you and your child:

Know when your child is ready

Using the toilet is an important developmental step for your child. But your child's unique development and temperament will determine when she's ready and how she'll get through the process. To paraphrase a common saying, 'You can lead a child to the toilet, but you can't make him do it.'

Most children show signs they are physically and emotionally ready to use the toilet between 1 ½ and 3 years of age, although some may be ready earlier and some aren't ready until later. Girls are usually ready a little earlier than boys. Your child needs to have awareness and control of his urination and bowel movements, and needs to be willing to try using the potty. Look for these signs that your child is ready:

His bowel movements are regular and predictable.

Her nappys are dry for at least two hours during the day or dry after naps.

Precious Planet Froggy Potty

His facial expression or posture indicates when he is ready to urinate or have a bowel movement.

She seems uncomfortable in soiled nappys and fusses or asks to be changed.

He can walk to the bathroom, help undress himself, and follow simple instructions.

She asks to use the potty, toilet, or wear 'big girl' underwear.

Make sure the timing is right in other ways, too. Many parents favor toilet training in the summertime when children wear fewer clothes and it's easier to undress to use the toilet. It's also a good idea to plan toilet training when there are no other major changes in the family such as moving, the birth of a sibling, changes in childcare, a family holiday, or divorce.

Help your child learn to use the toilet

When you think your child is ready, cheerfully encourage this step to be a 'big boy' or 'big girl.' But don't pressure your child—let him know it's his decision and you're there to help. Ask his other caregivers (e.g., babysitters, relatives, childcare providers, and teachers) to follow the same approach. Be patient…you can expect the toilet training process to take from three-six months.

Be sure your child understands what you want her to do. Let her watch you, her older siblings, or her playmates go to the bathroom. It's helpful for mothers or sisters to show little girls, and fathers or brothers to show little boys what to do. Decide what words you'll use to descote your child's body parts, urine, and stool. It's best to use the correct terms (e.g., 'penis') or common terms (e.g., 'pee' and 'poop') to help avoid confusion. Show him that urine and stool go in the toilet, and let him help flush. Avoid branding them as 'dirty' or 'bad,' so there's no shame about going to the bathroom.

Royal Stepstool Potty

Go to the library or bookstore and get a children's book about toilet training to read together. Dress your child in loose pants that are easy to pull down and pull up, not overalls or shirts that snap at the crotch. Some parents find it easier to use pull-up nappys or training pants during this time.

Get a comfortable potty chair or use a toilet seat adapter and step stool. Some children fear falling into the toilet, and feel more comfortable on a low potty chair with their feet on the floor. 

Introduce your child to the potty and allow her to sit on it with her clothes on a few times. Then encourage her to sit on the potty with her pants and nappy off. For boys, you can either start them urinating sitting on the potty or standing up. Have your child sit on the potty at the same time each day so it becomes routine. Try times when she regularly urinates or has a bowel movement, such as after breakfast and other meals, or after drinking; encourage her to try at other key times as well, such as before and after a nap, before her bath, and before bed. Try to catch her when you see signs that she needs to urinate or have a bowel movement. In all, ask her every couple of hours to sit on the potty.

Make the potty visits last at least a few minutes to give your child a chance to relax and go to the bathroom. Talk encouragingly or read a potty book, and let him leave when he's ready. Don't expect him to do anything right away, and don't show disappointment when he doesn't go. But when he does, reward him with praise and hugs. Other rewards and incentives can also be helpful. Some parents use a calendar and give one sticker for sitting on the potty, another for pee, and another for poop.

Some children learn to urinate in the toilet first, while others learn to have a bowel movement first. Over time, teach your child to do all the steps: walking to the bathroom, pulling down her pants and nappy, sitting on the potty or toilet, urinating and/or having a bowel movement, tearing off a little toilet paper, wiping her bottom from front to back (to prevent urinary and vaginal infections in girls), throwing the toilet paper in the toilet or using water to clean, pulling up her underwear and pants, flushing the toilet, and washing her hands with soap and drying her hands.

When your child consistently goes to the bathroom in the potty or toilet, celebrate by letting him choose some big kid underwear. For many children, the chance to wear underwear is a big motivation to use the toilet. Put him in underwear during the day and take him to the bathroom frequently. You should expect that he'll have occasional accidents, though, so be prepared with extra underwear, pants, nappy wipes, and plastic bags on-hand at child care and on outings. Although you may feel disappointed or exasperated by the accidents, it's best to keep a positive attitude—over time, your child will have fewer accidents and finally be toilet trained. Try to deal with accidents in an understanding and matter-of-fact manner, and don't punish your child for them. Tell your child, 'That's okay. Next time, try to let me know when you feel you have to go so you can do it in the toilet.'

For toileting difficulties, be patient and get help. While some children go from daytime toilet training to remaining dry during naps and nighttime shortly afterwards, many continue to need a nappy at night for another six months to a year or more. In fact, it's not uncommon for children to need a nappy at night until they're 6 years or older. Delayed bladder control tends to run in families, and often one or both parents had a history of bedwetting. Help your child not feel embarrassed about it, and try to prevent bedwetting by avoiding giving your child liquids in the evening and having your child urinate right before bedtime. If you're concerned about your child's bedwetting, talk to your pediatrician: it could be a sign of a urinary tract infection, diabetes, or emotional difficulties, and your pediatrician can help determine the cause and treatment.

Little Engine* - Activity for 3-6month olds

Now that your baby can sit up with support, play a game of Little Engine and take him on a little trip. He'll enjoy the ride, the view, and the fun with you along the way. All you need is a simple cardboard box!

Learning Skills:

• Balance
• Head & neck control
• Visual tracking

Materials:

•           Cardboard box, approximately 2- by 1½-feet wide, and 1-foot tall

•           Soft blankets or towels

•           Masking or duct tape

What to do:

1. Find a box that will hold your baby while he sits up, and cut down the height of the box so your baby is supported, but can see over the top.

2. Cover the cut edges of the box with tape so the rough edges don't hurt baby.

3. Line the box with blankets or towels, to give your baby comfort and support.

4. Push your baby around the house or yard in his Little Engine.

Safety:   Be sure to push your baby slowly so he doesn't get a neck injury and isn't startled by sudden moves. Be careful to avoid steps and other uneven surfaces.

What is a cradle cap?

Q: My baby’s scalp has been crusty and flaking. My mum said it was cradle cap. What is this? Can it spread to other parts of her body?

—    Submitted by Jenna from Seattle

    

A:Karen Sokal-Gutierrez, M.D., M.P.H.

Jenna, cradle cap is a crusty, scaly scalp rash that’s very common in healthy babies. It’s thought to be caused by an overactivity of the baby’s oil glands in the scalp from the mother’s hormones passing to the baby before birth. Sometimes babies can also get this scaly skin in other places where there are oil glands, like around the ears, eyebrows, neck folds and armpits. When the rash is found in other places, it’s also known as seborrhea. But this is not a contagious condition, so you don’t have to worry about it spreading.

Cradle cap is most common in babies in the first few months of life, and it generally goes away on its own by 6 to 12 months of age. You don’t have to do anything to treat cradle cap. But if you want to try to treat it, rub a small amount of olive oil or baby oil into your baby’s scalp to help soften and loosen the scales. Then you can wash your baby’s scalp with baby shampoo and gently try to brush off the scales with a soft brush or a towel.

Your baby’s cradle cap will probably clear up in a few months. But she’s over 6 months and still has a lot of cradle cap, be sure to have the doctor check her scalp. She might recommend that you wash her hair with a medicated seborrhea shampoo that contains selenium, salicylic acid or tar. Be careful, however, because these shampoos are irritating if they get in her eyes.

If the cradle cap is very red and cracking, the doctor might recommend over-the-counter hydrocortisone cream dabbed on her scalp a couple times a day, which may help reduce the inflammation. Occasionally the doctor may determine that the scalp has a fungal or bacterial infection and prescote anti-fungal or antibiotic cream or ointment to treat it.

Maintaining your Identity after Motherhood

Kenneth N. Condrell, Ph.D.

Child Psychologist

During the 1950s my mother was a stay-at-home mom of five children. She prepared the meals, cleaned the house, did the laundry, ironed, shopped, took care of us when we were ill, helped with homework and taught us the most important life lessons. As if this were not enough, at the end of the day, when all of the kids were tucked in bed, my mom helped my father with the family business.

Then we grew up and, one by one, left home. For her part, my mom was lost.

When a woman becomes a mother, her life changes forever. Your children come first; they become the focal point of your life. So how do you deal with the powerful force of motherhood and still maintain your identity as a woman? Here are three suggestions.

1. Promote Independence in Your Children

When a woman becomes a mom she finds herself totally dedicated to her baby’s needs. She is there for her baby 100 percent of the time. However, many women never pass out of this stage, even when their children are mature enough to handle things for themselves. Instead of teaching their children to become independent, many mothers continue doing everything for their children.

Why? Many women argue that they can do things faster and better than their children. No doubt that’s true. But the end result is that you have turned into your kids’ slave by fostering their dependence on you.

To preserve your identity, you must avoid this trap. When your children reach the age of 3, which is typically when kids become enthusiastic about helping out, it’s time to shift gears. Stop doing everything for your children and start encouraging them to contribute, gradually increasing their responsibilities as they mature.

2. Keep the Parenting Partnership Alive

Unless you’re a single mother, you should not be raising your children without dad. Unfortunately, in our society women seem to be programmed to do everything in the family and men seem to be programmed to let women do everything. To keep her identity, a woman must be partnered with a man who shares parenting and household duties. This should be absolutely clear between a man and a woman before they become parents. To encourage this cooperation, I suggest that women leave the children with dad occasionally to do something for themselves outside the home.

Not only will a woman’s identity suffer if she doesn’t have an active parenting partner; when one person does it all, the marriage undoubtedly suffers. So many marriages fail because of a lack of cooperation between mothers and fathers in parenting and managing the family.

3. Make Your Marriage a Priority

In the “olden days” the marriage was at the center of the family rather than the children. Then modern psychologists convinced parents that their homes should be “child-centered.” I disagree with this approach; it has led to disasters in many households.

When parents make their marriage the priority, they ensure their children will grow up in a happy home. In a way, isn’t that putting your children first? A happy home is a true gift to children that they will treasure for the rest of their lives.

I hope these suggestions help you keep your life balanced and your identity as a woman intact. In a month, reread them to see how you’re faring. Good luck!

*Our parenting advice is given as suggestions only. We recommend you also consult your healthcare provider, and urge you to contact them immediately if your question is urgent or about a medical condition.

Doodle Pro Assist – 5years +

Why your child will enjoy this toy now?

With more life experiences to draw on, and a wealth of verbal and motor skills, your child will enjoy communicating and expressing himself through art, performance and photography.

What you can do to help your child learn more?

Try to make time to show a real interest in your child's creations. If you can, stop what you're doing and check it out when he says, "Hey, Mom! Look what I made!" or "Watch this dance I made up!" Set aside special time when you can focus on just him. Ask him to demonstrate his work, and praise him for his abilities.

Can he express to you why he's created a certain drawing or snapped a particular picture? Or why he thinks his music sounds a certain way? Encourage him to talk about his ideas and feelings.

If your child owns or has access to a camera, encourage her to take photos while on an outing to document the experience. If her favorite photo is digital, help her enhance it by adding special effects or a fun digital border.

Make sure your child is exposed to music and art in other parts of his life. Take a trip to a gallery or sculpture park, attend a play or symphony performance just for kids. Whatever field trip you decide on, do a little research up front to see if it's a child-friendly environment; it can help ensure the experience is a positive one for both of you

Handy Clap

Developing eye/hand coordination takes time, but if you watch your baby carefully, you'll see her beginning attempts to control those tiny hands. Fun fingerplays can help your baby work on motor skills.

Learning Skills:

• Eye/Hand co-ordination
• Motor control
• Social interaction

Materials:

•           Soft blanket or an infant seat

•           Fingerplays, songs, and rhymes

•           Your hands and baby's hands

What to do:

1. Lay your baby on a soft blanket or sit her upright in her infant seat, and sit close by so she can see you.

2. Sing or chant songs and rhymes while you play with your baby's hands and fingers. Try one of the following Handy Clap games:

Pat-A-Cake

Pat-a-cake, pat-a-cake, baker's man, (clap your baby's hands)

Bake me a cake as fast as you can; (repeat clapping)

Roll it (roll baby's hands) and pat it; (pat baby's hands)

Mark it with a B. (draw a B in the middle of baby's hand)

Put it in the oven for baby and me. (gently poke baby in the tummy)

If You're Happy

If you're happy and you know it, clap your hands. (clap baby's hands)

If you're happy and you know it, clap your hands. (clap baby's hands)

If you're happy and you know it, then your hands will surely show it. If you're happy and you know it, clap your hands. (clap baby's hands)

Whoops! Johnny!

(Start by spreading your baby's fingers open.)

Johnny (touch your baby's baby fingertip),

Johnny (touch baby's ring finger fingertip),

Johnny (touch next fingertip),

Johnny (touch next fingertip),

Whoops! Johnny! (slide your finger down in between the forefinger and the thumb, then repeat going backwards)

Whoops! Johnny! Johnny, Johnny, Johnny.

Safety:   Hold and move your baby's hands gently as you play.

What songs do you sing to your baby?