Things To Do When the New Baby Arrives

     The August issue of Pediatric News has an excellent article by Barbara Howard M.D., assistant professor of pediatrics at Johns Hopkins. The article discusses things that new parents (and parents-to-be) need to discuss.

     The newborn period is a time of stress and also a time of huge changes. How a couple interacts during this period can have long-term effects on their relationship. Difficulties that arise when a new baby enters a family can have both positive and negative effects on the marriage that can last for years.

     Mothers need to feel that the father of the baby is a true partner. He needs to be sympathetic to the fear and pain she endured in labor and delivery and also to the complete exhaustion she will be dealing with in the first weeks at home.  Fathers need to listen closely to their partner and remember how important it is to ask up front, “what can I do for you”.  A loving husband may bring home flowers and then be hurt when the wife is bothered by the smell and actually wanted him to give her a foot rub.

     Fathers and mothers both have to realize that their relationship has changed in a very fundamental way now that a new person has been introduced into it. Things are never going back to the way they were. It is important that parents have honest discussions about their sexual relationship, breast/bottle feeding, how to handle sleep problems, how to handle relatives who want to visit and how to share the everyday workload. Parents need to be absolutely open about both their emotions and their beliefs. If there are differences in religious or cultural beliefs, these also need to be discussed. If the parents are able to engage in this kind of discussion early, they will probably be able to continue as the child grows older and issues like discipline, feeding, and school arise.

     For second-time parents, Dr. Howard also recommends being realistic and honest with the baby’s older siblings. Parents should avoid the “you’ll have a new brother to play with” attitude because babies aren’t much fun for a long time and all the sibling will see is how much the baby takes away time that they used to have with the parent. They’ll see how, when the baby screams and cries, the parents drop whatever they were doing and go to interact with the baby, so, the logical conclusion is that if they act the same way, the parent will spend more time with them. Potty-trained siblings may want to be in diapers again. Parents can ease the situation by allowing the sibling to openly express any feelings they have – especially the negative ones – and by making special one-on-one time every day with the sibling that cannot be interrupted by the baby.

Sleep Habits At All Ages

     One of the most common problems encountered by parents of children of any age are sleep problems. Questions about sleep patterns are some of parents most frequently asked questions.

     Sleep affects almost every aspect of our lives - not only our energy level and ability to concentrate, but even our basic physical health, immune system function and metabolism. If a child has sleep problems, the entire family can be affected.

     As every parent knows, newborn infants have very erratic sleep patterns. Up until a year of age, infants can need up to 18 hours of sleep daily, but that often comes in 3 hour bursts. Another problem with infants is that they can go from being happy to being miserably tired in less than a minute. Determining whether an infant is crying because he is hungry, wet or tired can be often be difficult for parents because each seems to come on instantaneously. Sometimes, the infant will give a clue with the rubbing of the eyes or ears, but most of the time a parent simply has to go through the list: first, check to be sure he is dry (and remember, sometimes even a small spot of wet will set an infant off); if not wet, try to feed – if the infant stops crying and starts eating, he was probably hungry. If the infant isn’t wet and refuses food, he is probably tired. Rock him, hold him and read to him for a short time and then put him in his crib and leave – even when the crying starts up again. If he is tired, he’ll cry for a while and then go to sleep. Remember infants often wake themselves up in REM dream sleep, so no matter when he wakes up, if he is crying inconsolably, go through the same list again. He might have woken himself up 2 hours into a 3 hour nap and what he actually needs is to go back to sleep for awhile. 

     As children get older, parents can establish and maintain good sleep habits. Co-sleeping in the parent’s bed should always be avoided. Co-sleeping with infants is dangerous and co-sleeping with older children it a difficult habit to change and results in neither the child nor the parent getting adequate sleep. Maintain the last hour before bedtime/lights out as a quiet time for reading together, baths, talking about the day and making plans for tomorrow. Most experts still recommend no “screen time” during this hour before bed – TV, computers, electronic games or phones. For parents who are both working and feeling like they don’t have enough time with their kids, this hour may end up being the best quality time of the day.

     After elementary school, the child needs to start to assume more control over his own bedtime routine. If parents have established good sleep habits since day one, this transition will be easier. Homework should be done early in the evening and the last hour before bed should still be quieter and more “screen-free”. Even though it is impossible to stop late-night phone calls and computer use, parents need to continue to encourage good sleep patterns.

What Is Causing My Child's Diarrhea?

     Diarrhea is a common problem in children and it is helpful for parents to have some general rules of thumb that can identify what might be causing the diarrhea. Doctors divide diarrhea into three groups: acute (which lasts for 1-2 weeks), persistent (which lasts for 2weeks to one month) and chronic (which lasts for over a month). Of course, when your child has diarrhea, it is impossible to know how long the diarrhea is going to last unless you have a crystal ball but the categories can still be helpful.

     Viral infection causes the most common form of diarrhea: acute diarrhea. This often begins with fever and vomiting for 24 -48 hours and then the child has diarrhea for a week or two. At first, the stools may be very frequent and the child may feel very ill. The greatest risk with this form of diarrhea is dehydration and the only treatment is to give lots of water and electrolytes to keep the child hydrated. This means small sips frequently of a rehydrating solution: a mixture of water, sugar and salts. After a few days the frequency of the stools will slow down, but they may stay liquid for 2 weeks. If the symptoms are more dramatic or there is blood in the stool, a bacteria such as E. coli could be the cause of the diarrhea and the child’s caregiver should be consulted.

     Persistent diarrhea usually doesn’t come on as dramatically as acute diarrhea. The child may have cramping and a few loose stools but continues to have them longer than 2 weeks. This type of diarrhea is most commonly caused by an infection with a small organism called a protozoan parasite. The most common ones are Giardia and Cryptosporidium. These parasites are usually in water and the child becomes infected by drinking the water. Giardia is common in small, natural sources of water such as streams and ponds and wells. Cryptosporidium can survive up to 10 days in chlorinated water, so it is commonly found in swimming pools. Cryptosporidium is also sometimes acquired in petting zoos (so, good hand-washing should always be the rule after being in a petting zoo). With these infections, the child is not terribly sick, but he may have cramping. The stools are not frequent, but they are persistently liquid. Protozoan parasite infections can be difficult to diagnose. Even though there may be many eggs in the child’s stools, they may be difficult to find in a stool sample. There are medications that can kill the parasite and treat the diarrhea.

     If the child’s diarrhea lasts for longer than a month, or if it seems to come and go for longer than a month, it is chronic diarrhea. Strangely enough, one of the most common causes of chronic diarrhea is constipation. The child has recurrent abdominal cramps – especially after meals. Some stools are large and hard but others are explosive and liquid. A simple X-ray of the abdomen will show whether too much stool is the cause of the problem. Other causes of chronic diarrhea are: gluten intolerance, food (especially milk) allergy, lactose intolerance and any of the many forms of inflammatory bowel disease. This kind of diarrhea needs a full work-up by the child’s caregiver. 

Cutting The Umbilical Cord

     For a long time, Nurse Practitioners and Midwives have tried to convince medical doctors to delay cutting the umbilical cord after birth. Historically, the umbilical cord was not cut immediately after birth and in most third world countries cutting the umbilical cord is also delayed for over 1-2 minutes after birth. In contrast, in this country the umbilical cord is usually cut 10 to 15 seconds after birth.

     Not clamping the cord results in the infant getting extra blood that is pumped out of the placenta after birth. Medical doctors have believed that this extra blood was harmful to the infant because it caused the infant to have too much blood and it also increased the risk of jaundice in the first few days of life. Midwives have held that humans have always waited to clamp the cord because the extra blood is helpful to the baby.

     There are two studies in the August, 2014 issue of Pediatrics, the official journal of the American Academy of Pediatrics, which go a long way to support the opinion that clamping the cord should be delayed. The first is a very complex, scientific study that measures stress in the newborn.  The researchers found that not only did the extra blood from the placenta reduce the post-delivery stress of the newborn, but it also gave some helpful elements that helped the infants deal with the stress of delivery. The second study was done in a rural Tanzania hospital and it found that, even in healthy infants who were breathing on their own after delivery, the complication rate for the infants was decreased by 20% for every 10-second delay in clamping the cord after the infant started breathing.

     The current practice in most American hospitals is that immediately after birth the cord is clamped and cut and then the infant is given to the nurse, pediatrician, or nurse practitioner who is responsible for the infant’s immediate care. The doctor who is responsible for the delivery needs to concentrate on the mother’s care. Delaying the cutting of the cord would be difficult. The second study suggested that, even if the infant wasn’t breathing at first, delaying the cutting of the cord was still beneficial. But when an infant isn’t breathing after delivery, our current way of thinking is that the infant should immediately be given respiratory support with a bag-mask respirator. Doing this at the foot of the delivery bed would mean a significant change in the procedure.

     Modern medicine improves its care by continually questioning its practices and procedures. If these studies hold to be true, it may result in changes in every delivery room in the country.

When Your Child Turns One Year Old

     Your child’s first birthday is a good time to evaluate a number of issues and, if necessary, make changes that will make the toddler years easier for both of you.

     The first change is in the bottle. After one, the only liquid that goes into the bottle is water – no formula, milk or juice. The child can still have a bottle anytime he wants, but, by only putting water in the bottle, you’ll be helping his appetite, his teeth, his weight and his health in general. In addition, your budget will be improved when you no longer have to buy formula. So, the plan for a one-year old is that he drinks regular milk at meal times, in a non-spill cup, drinks water between meals – especially in the naptime and bed time bottles – and never drinks formula or juice.

     His meal menu now is regular food – no more baby food and no special meals. You chop up whatever you are eating and then put it on the tray in front of him. It is important that you also sit down with him and eat your meal, too – kids eat better when the parent eats with them and they are more likely to try foods that they see the parent eating. No more feeding him, no more “Here comes the airplane”.  Just put it in front of him and let him go – some goes in the hair, some goes in the ears and some gets into the mouth. When more food hits the floor that hits the mouth, remove the tray – he’s done eating. If he refuses everything, think back to what he may have eaten or drunk the two hours before the meal. In most instances, refusal to eat is caused by not being hungry rather than “he doesn’t like it”. Resist the temptation to try other foods that you think he’ll like – this results in hot dogs at every meal and you teaching your baby that you’re willing to be a short-order cook.

     Stranger and separation anxiety are beginning now, so remember that “loveys” – blankets, worn stuffed animals and even special clothes – are all very important now. You may need to carry around an extra bag or two, but he needs them. Also remember how important repetition is for his security as you read the same story for the 16^th time that day. Don’t force Grandma on him if he acts frightened – he’ll warm up to her gradually in his own time.

     He can still have the pacifier, but it never leaves the crib. As soon as he wakes up, he’ll want out of the crib, but when you pick him up, leave the pacifier behind. If he wants to go back to get it, he finds that it has (amazingly) disappeared. But it will reappear again at naptime and at bedtime when he gets back into the crib. If he has been taught that he can have the pacifier all day, this habit may be a little hard to break, but don’t give up. In a very short time, he’ll go with the new program and it will save you a world of trouble.

    Keep the car seat facing the rear of the car for as long as you possibly can. It is always the safest way to transport toddlers, too.

     Don’t worry about buying expensive, hard-soled shoes. His feet will grow fine whether you put him in the shoe or the shoebox.

     Finally, remember how important time together is. You are his teacher, his role model and the source of all his love and security. Spend as much relaxed, non-structured, play time as you possibly can with him. All too soon he’ll be a teenager.