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About the author..... Dr Prasad received her medical degree from India and did her residencies at the Children’s Hospital of Michigan. She is board certified in Pediatrics and Emergency Medicine. She is a fellow of the American College of Emergency Physician and the American Academy of Pediatrics.

Dr. Prasad has written numerous articles on different health issues for local newsletters and newspapers. She is the author of several articles published in medical journals. Dr. Prasad received Physician’s Recognition Awards from American Medical Association in 1992, 1995 and 1997. She also received the Service of Justice and Mercy Recognition Award in 1992, and achievement award for outstanding dedication and teaching excellence in 1996, both from St. Joseph Mercy Hospital in Pontiac. Currently, she is a Senior Staff Physician affiliated with West Bloomfield center Henry Ford Hospital, St. Joseph Mercy Hospital in Pontiac and Wm. Beaumont Hospital in Royal Oak, Michigan. Dr. Prasad believes in educating the public in Preventative Medicine. She hosts a radio health talk show on WPON 1460 dealing with preventative aspects of medicine. The proceeds from this book will go to help the poor and handicapped children.

The information in this book doesn’t constitute, and is not intended as author’s medical advice or opinion. It shouldn’t be used as the primary basis for medical judgement or decision. The book is designed to provide some health information regarding growing children.


Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii A Healthy Start for your Newborn . . . . . . . . . . . . . . . . . . . . . . . . . .A1-A3 Baby’s First 48 Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B1-B13 Apgar Score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1 How do you get to know your Newborn? . . . . . . . . . . . . . . . . . . . .C2-C8 Feeding and Nutrition for your Baby . . . . . . . . . . . . . . . . . . . . . . . .D1-D3 Growth and Development of your Baby . . . . . . . . . . . . . . . . . . . . .E1-E4 Childhood Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F1-F7 How to toilet train your toddler . . . . . . . . . . . . . . . . . . . . . . . . . . . .G1 Child’s Fear and Growing Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .H1-H3 Common Childhood Illnesses and When to call your doctor . . . . .1-I15 Safety Precaution Tips during the first 2 years of Life . . . . . . . . . . .J1-J5 Medical Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .K How to avoid stings and bites . . . . . . . . . . . . . . . . . . . . . . . . .K1-K2 Sudden Death Infancy Syndrome . . . . . . . . . . . . . . . . . . . . . .K3 Child Abuse Risk Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .K4 Choking Spells, Cardio Pulminary Resuscitation . . . . . . . . . . .K5-K14


Acknowledgement I wish to express my thanks and appreciation to the following family members for providing me with their kindness, patience, and moral support while I was writing my book. My book is being dedicated to: My dear husband Dr. Bala Prasad for his kindness and support. My children Abhilasha and her husband George, Ashish and his wife Mridu, Anjali and Ashoke. My sisters Sarojini, Binodini and Kumud who had initially inspired me to write this book. This book is also being dedicated to the loving memories of my late parents Sadashiv and Saraswati Prasad, since as a little girl, I was always inspired by my father to become a doctor. Unfortunately, I lost my dad while I was only thirteen, however, with the kind support from my mother and family members, I fulfilled my dad’s wishes by becoming a doctor. To the loving memory of the late Dr. Joseph Ponka, one of my senior colleagues at Henry Ford Hospital, West Bloomfield Center, who had always appreciated my journal publications and encouraged me to write my book. I gratefully acknowledge the help and my special thanks to Editor Anil Sirvastav for offering me the opportunity to develop this book for children. His unique editorial skills and commitments to excellence are evident throughout my book and without his help I could not have published it. My deepest appreciation and thanks to transcriptionist Diane Schumacher who was always available to help with the preparation and typing. My acknowledgements with thanks to Mead Johnson for providing me some of the baby photographs, American Academy of Pediatrics for the immunization chart and the American Heart Association for the information on recent guidelines for infant cardio pulmonary resuscitation and choking spells.

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INTRODUCTION My book has been written to provide you with information and suggestions regarding how to keep your child safe and healthy with strong emphasis on growth and development of your child within the first two years of life. During my extensive, more than twenty years of clinical practice in pediatrics and emergency medicine, and also being a mother of four children, I have encountered many illnesses and accidents which could have easily been prevented by taking a few safety precaution measures. I have always believed in preventative medicine and this has inspired me to write my own book. During my clinical practice in pediatrics and while raising my own children, I realized that children need a lot of attention during all stages of growth and development. However, the first two years of life are critical for the proper growth and development of their brain and body. Considering all these facts in mind, I have included chapters on the proper medical check up and nutrition of a pregnant mother and giving a healthy start to your newborn. The following chapters of my book focus on the proper nutrition of your baby, growth and development, proper routine immunizations and some of the common childhood illnesses and how to prevent them. As an emergency room physician, I have encountered several injuries and accidents in our babies, which could have been prevented by taking safety measures. By keeping these facts in mind, I have included chapters on childhood poisoning, how to prevent falls, and how to keep your home safe for your baby with strong emphasis on how to handle minor injuries and accidents. The concluding chapters of my book focus on how to handle major emergencies and a proper way to initiate cardio pulmonary resuscitation. I have strictly followed the recent guidelines from the American Heart Association regarding basic life support and choking spells in infants. PLEASE NOTE THAT THE INFORMATION PROVIDED IN MY BOOK IS INTENDED TO COMPLIMENT AND NOT A SUBSTITUTE FOR THE ADVICE OF YOUR PEDIATRICIAN. THE AUTHOR STRONGLY SUGGESTS THAT BEFORE STARTING ANY MEDICAL TREATMENT, ALWAYS CONSULT YOUR PHYSICIAN AND IN CASE OF EMERGENCIES, ALWAYS CONTACT 911 OR POISON CONTROL FOR FURTHER ADVICE. WHILE WRITING THIS BOOK, I HAVE STRICTLY FOLLOWED THE GUIDELINES OF THE AMERICAN ACADEMY OF PEDIATRICS, WHICH IS AN ORGANIZATION OF PEDIATRICIANS, DEDICATED TO THE HEALTH, SAFETY AND WELL BEING OF INFANTS, CHILDREN, ADOLESCENTS AND YOUNG ADULTS. I hope my book will become an invaluable resource and reference guide for parents and caretakers raising their children. I strongly emphasize the facts that all babies should receive regular check-ups and proper immunizations during the first two years of life. The forth coming volume of my book will focus on some common health issues of growing children between the ages of 2 and 13 such as learning disabilities, Attention Deficit Disorder, bed wetting, hearing and speech disorders, smoking and drinking, violence prevention as well as sports related injuries and how to prevent them.

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A Healthy Start for Your Newborn Good parenting is a challenging job and having a child is the greatest gift in life that one could have. Your responsibility as a parent begins from the day you get pregnant. It is important to remember the fact that a safe and healthy pregnancy, proper antenatal care will lead to delivery of a healthy newborn. During the process of raising your child remember these C’s: Calmness, Confidence, Competence Your calmness, confidence and competence in caring for your child will help them enjoy a healthy, happy childhood and will make them learn the importance of self-care for their own children as they mature. Gifts You Can Give Your Child Love: By giving your constant, indisputable love to your child, you are helping them develop security and build self-esteem. Self-Esteem: The building blocks of self-esteem includes self-respect, confidence and belief in one’s self. Proper Discipline: By presenting your beliefs honestly, clearly and thoughtfully from the very beginning of your child’s rearing, you can help your child develop a proper discipline. Gift of Joy: All babies demonstrate their joy in life in different ways, however, you as a parent can make your baby happy and cheerful by your smile, good humor and very pleasant personality. Safe Surroundings: Always provide a safe and healthy shelter for your baby. Good Health: It is very important for a pregnant mother to take good care of her health throughout pregnancy in order to have a healthy baby. It is also important to maintain good healthy habits while avoiding the bad ones such as smoking, drinking or drug abuse. Skill and Abilities: Help your child develop proper skills and abilities by proving proper guidelines and proper toys, books, etc. As a parent, try to expose your child to the challenges that will help him/her discover his/her abilities and achieve successes at the same time protecting him/her from injuries and accidents. Recognize: Recognize your problems and get help from your friends, relatives and community if needed. Always seek medical help if you are depressed and feel lonely.

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A Healthy Start for Your Newborn

Here are a few healthy guidelines for the pregnant mother: 1. Eat a well-balanced nutritious diet with supplemental vitamins and iron throughout your pregnancy. 2. Get frequent antenatal check-ups and follow the advice of your obstetrician. 3. Avoid cigarettes, alcohol or illegal drugs throughout your pregnancy since they adversely affect fetal growth and development. 4. Avoid taking over the counter medications such as aspirin, cold medications and antihistamines since they can all harm your growing fetus. 5. Limit your caffeine intake during pregnancy.

Birth Defects There are certain illnesses during pregnancy that predisposes the infant to be born with birth defects such as German measles, chicken pox, toxoplasmosis, etc. The German measles if contacted during early months of pregnancy can cause mental retardation, heart defects, cataracts and deafness in newborns. Fortunately immunizations are available for protection against measles, mumps and Rubella. Chicken pox if contacted during late pregnancy or delivery can affect the baby. A proper immunization is available against chicken pox. Toxoplasmosis is a parasitic illness caused by contact with infected cats. If you own pets, be careful during pregnancy and have your cat checked frequently by the veterinary doctor.

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A Healthy Start for Your Newborn

Choosing Proper Hospital for Delivery If you are a high risk pregnancy, choose a hospital with Neonatal Intensive Care Units. Your obstetrician will guide you for selection of proper hospital for delivery as well as a pediatrician who will make frequent visits to check your baby while at the hospital. Pediatricians routinely examine newborns and talk with parents regarding the health issues of your newborns. During the first year of your baby’s age, the American Academy of Pediatrics guidelines for frequent child check-ups include: Check-up at 2 weeks of age 1 month 2 months 4 months 6 months 9 months 1 year 15 months 2 years This is important for assessing infant’s proper growth and development as well as proper immunizations.

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Baby’s First 48 Hours It is the greatest joy for new parents to watch their baby grow and the birth of a newborn is the start of an exciting and challenging journey with new progress each day in their growth and development. Most healthy newborns are born covered with a sticky white protective coating called vernix caseosa, which is produced in the uterus by oil glands in the fetus’s skin. The head of a newborn might be swollen due to birth trauma and the face may appear wrinkled due to pressure from delivery. Once the umbilical cord is clamped and cut, the baby stops receiving oxygen from the mother, the mouth is cleaned of secretions and infants are stimulated to cry by gently patting both feet or the back while the infant is held upside down. Most healthy newborns will start crying on their own after birth with gentle stimulation. B-1


Baby’s First 48 Hours The first few minutes of life are critical to the baby’s health and the newborn Apgar Scoring System is performed to assess the cardiovascular and neurologic status of the newborn.

Apgar Scores The Apgar Scoring System helps the physician estimate your baby’s general condition at birth. This test measures your baby’s heart rate, breathing, muscle tone, reflex response and color at birth, and at 1 minute and 5 minutes after birth. Babies born prematurely or delivered by emergency C-section are more likely to have low scores than infants with normal births. These scores may reflect difficulties the baby experienced during labor or reflect problems with his heart or respiratory system. B-2


Baby’s First 48 Hours If your baby’s Apgar scores are very low, oxygen by mask is given to the baby. If the infant doesn't breathe on his own, a tube can be placed into his windpipe and fluid, glucose and medications are administered through one of the blood vessels in his umbilical cord to strengthen his heartbeat. These babies are frequently taken to a special care nursery for more intensive medical attention. A quick routine physical examination will check for signs of maturity such as well-developed breast tissue, fully formed ears with strong cartilage, well-creased soles, skin not too thin or translucent, normal genitalia and reflexes. Most babies receive Erythromycin eye ointment to both eyes to protect against exposure to gonorrhea or chlamydia during birth. A newborn also receives an injection of vitamin K, which helps establish normal blood clotting. It is an interesting fact that all newborns are surprisingly alert in the first hour of life and move their arms and legs readily while they cry. After the newborn is cleaned gently, he is wrapped in cotton sheets and might need warmers to bring his body temperature to normal.

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Baby’s First 48 Hours During the first 6 hours, newborns are allowed to nurse since early feeding encourages the baby’s sucking reflex and presents an opportunity to bond with the mother and also provides the baby with nutrition from colostrum, a thick yellow fluid from breast milk that is rich in protein and protective antibodies. Exhausted from the delivery, most babies enter a deep sleep within a couple of hours after birth. Most newborns sleep for two to three hours, wake up, cry to be fed and wet their diapers with urine and stools. For a male infant, circumcisions are usually performed during the first 48 hours after birth.

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Baby’s First 48 Hours Newborn Tests Most newborns, after being checked by their doctors, undergo the following tests: 1. Newborn blood screening test for enzyme deficiencies such as galactosemia, phenylketonurea and maple sugar urine disease since if not treated early these diseases can cause mental retardation in children and once diagnosis is made, those babies are put on special formula. 2. Blood test for hypothyroidism since if undiagnosed, the condition can cause growth and mental retardation. These infants can be treated early with thyroid replacement. 3. Blood glucose test to check for hypoglycemia if indicated because abnormally low blood sugar frequently found in infants of Diabetic mothers can be treated with glucose. B-5


Baby’s First 48 Hours 4. Blood test for Rh incompatibility especially if the mother is Rh - negative. If the mother is type O, an ABO incompatibility test (Coomb’s Test) is performed. These tests determine an incompatibility of the newborn, which causes anemia and jaundice. The newborn jaundice frequently clears up after several days under fluorescent lights. 5. Blood tests are also performed for sickle cell anemia and HIV viruses in susceptible individuals.

Caring For Your Newborn Feedings All babies, whether breast-fed or formula fed, will generally need feeding every 2 to 3 hours, will sleep, have frequent wet diapers and gain 5 to 7 ounces each week. Most babies DO NOT need extra water except when feverish or during hot weather, however, it is advisable to offer cooled boiled water once or twice a day to maintain proper hydration for your baby. Give your baby as much milk as he wants and feed him when he is hungry.

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Baby’s First 48 Hours Test Nipples Regularly While bottling feeding, the nipple holes should be the right size to help the baby suck easily. If breast-fed, the mother should properly clean nipples before nursing the baby.

Skin Care A sponge bath using lukewarm plain water with mild soap is advisable for babies unless the skin is dry and peeling then it is advisable to use a small amount of baby oil. While bathing the baby the room temperature should be 75 to 80 degrees and the water should be warm - NOT TOO HOT. B-7


Baby’s First 48 Hours Care of the Navel The umbilical cord usually drops off in 7 to 14 days after birth with a small crust of blood remaining for several days. A cotton ball moistened with rubbing alcohol should be used several times a day to clean the navel. Notify your doctor if a moist cord is accompanied by a foul odor.

Care of Circumcision No bathing is needed until complete healing has occurred. A bland ointment such as A & D or Vaseline should be applied to keep the blood crust from adhering to the diaper when it is changed. B-8


Baby’s First 48 Hours Clothing Do NOT overdress your baby since this causes skin irritation and heat rashes. A cotton shirt and diaper during the summer and knit jumpers in the winter are suggested while the infants are in the bassinet or crib. The blankets should be light and flame retardant. Protect your baby from diaper rash by frequently changing the diapers when wet.

Nursery The nursery temperature should be 70 to 75 degrees when possible. Drafts should be avoided in the room. The child’s crib should have a firm mattress covered by a plastic sheet and cotton pads. The baby should be covered gently with cotton or Dacron blankets. Most importantly, pillows should never be used. All infants should be put to sleep on their backs.

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Baby’s First 48 Hours If breast-fed, all infants should be started with TRI VISOL vitamin by dropper.

A Checklist for the Medicine Cabinet at Home Children do get sick often and parents are alarmed. However, in order to save unnecessary trips to the pediatric office or emergency room I have prepared a list of certain medications all parents should keep in their medicine cabinet. Always consult your pediatrician before giving any medicine to your child. 1. Antihistamine - helps dry up runny nose and relives swelling and itching from allergies. 2. Acetaminophen - relives pain and reduces fever, however, always follow the direction on the bottle for exact dose and amount to give to your baby. B-10


Baby’s First 48 Hours 3. Aspirin - FOR ADULTS ONLY - DO NOT give aspirin to your baby since it has been linked to a serious condition knows as “Reyes Syndrome,” which causes damage to the liver and brain. 4. Cough Decongestant - relieves nasal and bronchial congestion. 5. Cough Suppressant - relieves coughing. 6. Cough Expectorant - loosens mucus and makes it easy to cough out. 7. Ibuprofen - relieves pain and fever due to inflammation. 8. Neosporin - or any antibacterial ointment. 9. Desitin - for diaper rash. 10. Suction Bulb - for infants to clean their stuffy nose as needed. 11. Saline Nose Drops 12. Humidifiers 13. Vitamin TriVisol - is recommended for breast-fed infants. B-11


Baby’s First 48 Hours Feeding Your Newborn As a new parent, your challenges are high. You want to provide the best nutrition for your baby. According to recent guidelines from the American Academy of Pediatrics, breast-feeding is the most natural and beneficial way to feed your baby.

What Are the Advantages to Breast-Feeding? 1. It allows the physical and emotional bonding between you and your child. 2. It provides your baby with a balanced diet and helps your baby fight off certain infections. 3. It is least likely to cause allergies and is easily digested by your baby. B-12


Baby’s First 48 Hours There is no routine schedule as to when the infant should be nursed. An average infant will take 2 to 3 ounces each feeding every 2 to 3 hours and the best way to judge the adequate nutrition of your child is by counting the wet diapers in a 24-hour period. Your child should average 6 wet diapers in a 24-hour period. The first few hours after birth is a good time to begin breast-feeding. Breast milk does not begin flowing right after birth, however, initially your infant will receive colostrum, a thick yellowish fluid that contains protein and antibodies to protect him from infection. Feeding formula to your baby is another alternative if you are unable to nurse. All infant formula are good since they contain supplements with vitamins and iron. A baby will grow and develop faster during his first year than any other time in his life. The healthy growth and development of your infant depends on the proper nutrition he gets. It is important to remember that cow’s milk is not appropriate for a baby during the first year.

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How Do You Get To Know Your Newborn? The Apgar Scoring System The Apgar scoring system helps the physician estimate your baby’s general condition at birth. This test measures your baby’s heart rate, breathing, muscle tone, reflex response and color at birth, at 1 minute and at 5 minutes after birth. Babies born prematurely or delivered by emergency C-section are more likely to have low scores than infants with normal birth. These scores may reflect difficulties the baby experienced during labor or reflect problems with his heart or respiratory system. If your baby’s Apgar scores are very low, oxygen by mask is given to the baby and if the infant doesn’t breathe on his own, a tube can be placed into his windpipe and fluid, glucose and medications are administered through one of the blood vessels in his umbilical cord to strengthen his heartbeat. These babies are frequently taken to a Special Care Nursery for more intensive medical attention.

The Apgar Scoring System Score

0

1

2

Less than 100 beats More than 100 beats per minute per minute Slow, irregular weak Good, strong cry cry Some flexing of arms Active motion and legs

Heart Rate

Absent

Respiration

Absent

Muscle Tone

Limp

Reflex

Absent

Grimace

Grimace, cough or sneeze

Color

Blue or Pale

Body pink, hands and feet blue

Completely pink

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How Do You Get To Know Your Newborn? Congratulations on becoming a parent and welcome to the bundle of joy in the bassinet.

How does a newborn look? A newborn’s head seems larger in proportion to the body, it may be elongated for a week due to birth trauma, however, it will soon be round. A newborn has two soft spots “Fontanelles” on the top of their head, which permits brain growth. The eyes may be puffy and swollen for a day after birth. The baby’s face may be covered with minor pimples, milia the tiny white cyst dotting the forehead, cheeks, nose and chin which may be due to residual effects of maternal hormones. There may be some cracks, peeling skin on hands, wrist and feet due to exposure to air and will clear up soon. Breast fed infants frequently develop jaundice which is yellowing of the skin and whites of both eyes and should be brought to the attention of your pediatrician. Newborn genitals are often swollen for a week or so due to the mother’s hormones. Some infants might develop some discharge from their breast due to maternal hormones.

New Baby Checklist • Record details about the birth in a keepsake book • Make a photo album that you can update every month • Schedule your baby’s 1st appointment with the pediatrician at 2 weeks of age • Record your baby’s height and weight on a percentile chart and update it with each checkup • Make a list of important names and numbers to keep handy • Schedule your 6 week post-partum checkup • Get a list for immunization series

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How Do You Get To Know Your Newborn? There is NO routine schedule as to when the infants should be nursed. An average infant will take 2 to 3 oz. each feeding every 2 to 3 hours and the best way to judge the adequate nutrition of your baby is by counting the wet diapers, averaging 6 wet diapers, in a 24 hour time period. The first few hours after birth is a good time to begin breast-feeding. Breast milk does not begin flowing right after birth, however, initially your infant will receive colostrum, a thick yellowish fluid that contains protein and antibodies to protect him from infection. Feeding formula to your baby is another alternative if you are unable to nurse. All infant’s formula are good since they have supplements with vitamins and iron. A baby will grow and develop faster during his first year than of any other time in his life. The healthy growth and development of your infant depends upon the proper nutrition he gets. It is important to remember that cow’s milk is not appropriate for baby during the 1st year because it has more protein and sodium that the baby needs and lacks iron, copper and vitamin C. TIPS FOR BOTTLE FEEDING • POSITION: While feeding your baby, always cradle your baby so he is semi-upright and hold the baby’s head, back and bottom with your free arm and hand. • MIXING FORMULA: Never give your baby hot or boiling liquids. Always boil and cool the water before mixing the formula. • WARMING: DO NOT heat the bottle in the microwave. Always run hot water over the bottle so the formula gets to room temperature before feeding. • Choose the right bottle with proper nipple while you are shopping for formula.

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How Do You Get To Know Your Newborn? HOW TO HOLD YOUR BABY An infant doesn’t develop neck muscle control until 2 to 3 months of age. He should be held by placing your hands behind his neck and cradle the base of his/her head in your palm. This cradle hold provides body contact and holding a baby is always a two-handed job. With your new baby lying face up, support his head and neck in the crook of your arm and hold his buttocks and back with your other hand. For your older baby, the seat hold provides a whole new outlook on things. With your baby facing away from you, place one of your arms across his chest and hold his back against your body. Use your other arm as a bench for his bottom. The hip straddle is good for carrying your toddler. Sit your baby on your hip with his legs on either side of your thigh. Bend one arm beneath your baby’s bottom and place your free hand behind his back to steady him/her.

READ YOUR BABY’S BODY LANGUAGE Babies develop ties with parents and caretakers and these ties are the foundation of all emotional, social and moral development. Babies ned lots of tender loving care, and develop social and emotion skills by doing, thinking and watching. Our role as parents is to understand their body language and act to their demands to keep them happy.

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How Do You Get To Know Your Newborn?

SLEEPY TIME ADVICE FOR PARENTS • Try putting your baby to bed when he is drowsy but slightly awake so they know they are going to bed • Always place your baby to sleep on his back to reduce the chance of Sudden Death of Infancy Syndrome • DO NOT place your baby to sleep on sofa surfaces such as waterbeds, pillows or stuffed toys • Make sure the baby is properly burped and the diaper is not soiled • You can use play lullaby tapes, sing soft music, etc. and have a night light on • During the night time, it is all right to offer your baby a bottle or water as needed but DO NOT leave the bottle in the crib • Relax and try to get some sleep yourself while your baby is resting

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How Do You Get To Know Your Newborn? THE SLEEP PATTERN OF YOUR BABY A typical newborn sleeps 16 - 18 hours a day with frequent wake-up every 2 to 4 hours to be nursed or bottle fed. Sometimes between 3 to 4 months of age babies settle into a circadian rhythm which means their sleep wake pattern will follow a cycle of 24 hours. A 6-month-old might take 2 naps and sleep 11 to 14 hours. A 1-year-old child should be able to sleep 10 to 12 hours.

FEEDING YOUR NEWBORN As a new parent, your challenges are high. You want to provide the best nutrition for your baby. According to the recent guidelines from the American Academy of Pediatrics, breast-feeding is the most natural and beneficial way to feed your baby. THE ADVANTAGES OF BREAST-FEEDING 1. It allows the physical and emotional bonding between you and your child. 2. It provides your baby a balanced diet and helps your baby fight off certain infections. 3. It is least likely to cause allergies and is easily digested by your baby.

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How Do You Get To Know Your Newborn? During the 1st two or three days after birth , all newborns sleep, cry and like to be nursed or bottle-fed very frequently. For a new parent coming home from the hospital, it can be a shock, however, it is important to remember that the baby has recovered from birth and is sensitive to his new surroundings. By rocking, swaddling or wearing your little one on your chest in a front carrier or sling, you can soothe the baby. Newborns need to be fed every two to three hours and always respond to your baby’s cries by offering breast milk or formula. A baby experiences the world by the sense of sight, hearing, smell, taste and touch. SENSE

Sight

Hearing

Smell Taste

Touch

BABY’S ACTIVITIES A newborn sees clearly at birth, however, objects farther than 10” are blurry and focus improves around 5 weeks of age. A newborn can hear from birth, will startle at sudden sounds and will always be soothed and comforted by mother’s heartbeat which she is used to hearing throughout pregnancy. A newborn has developed sense of smell and can distinguish the scent of his mother’s breast milk from another mother’s milk. A newborn has more taste buds than an adult and likes sweet milk.

HOW TO FACILITATE IMPROVING SENSES Always look into baby’s eyes as you change the diaper or feed the baby. Decorate the crib with colorful objects to stimulate your baby’s eyesight.

Talk to your baby, sing songs, while feeding the infant or changing diaper. Pause often so infant can respond with her own vocalization. Use scent as a soother for your baby. Offer your newborn breast milk or formula and start solid food after 4 months of age.

A newborn has extremely sensitive sense of touch. Always gently stroke your baby, massage face, An infant begins to explore the world through his arm, leg and back with the pads of your fingers skin and quickly learns to distinguish someone before bed time. familiar by touch. Babies are also comforted by massage.

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How Do You Get To Know Your Newborn? The following body signs are suggestive of well nourished, healthy infants: 1. EYES - Good eye contact between the baby and caretaker indicates that the baby is getting lots of love and personal attention. 2. SMILE - Babies who are well nourished and well kept will always smile at you when stimulated. 3. APPETITE - Babies who are well fed and move bowels regularly will always feel relaxed and play with crib or floor toys. 4. MUSCLE TONE - Healthy babies will always have good muscle tone. 5. VOICE - Happy babies always make sounds, vocalize a lot, babble and squeal. 6. SLEEP - Babies who are well fed and well kept will always sleep comfortably throughout the night. By understanding this simple language, you can help your baby develop proper growth and development.

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Feeding and Nutrition for Your Child

During the first 4 months of life, most babies get total nutrition, mainly from breast milk or formula feeding. According to the American Academy of Pediatrics recent guidelines, the solid food should be added to the baby’s diet between 4 to 6 months of age due to the fact that: a.) Baby’s tongue and swallowing muscles are better developed now and most babies lose the tongue thrust reflex which previously caused them to push out anything from their mouth. b.) Baby can hold their head and neck well and can be offered solid food with a spoon in a sitting position. c.) The digestive system has matured enough to handle new food. d.) The solid food provides extra calories and energies towards the rapid growth and development of your baby. e.) Your baby will sleep throughout the night after being fed solid food before bedtime.

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Feeding and Nutrition for Your Child The introduction of new foods must be performed with proper precautions over a period of several months. It is important to remember that only one solid food should be introduced at a time. Wait 3 to 4 days before adding another baby food due to the fact that: a.) The baby’s digestive system should get used to that particular food. b.) There is less chance of developing food allergies. The Rice and Barley cereals are first recommended food because it is easily digested followed by fruits and vegetables. The American Academy of Pediatrics recommends initially adding solid food twice a day to your baby’s diet, gradually increasing the frequency and by the time the baby is 7 months of age, most of them have tried cereals, basic fruits, vegetables and meat should be the last item added. It is important to remember that most infants double their birth weight by 5 months of age and triple by 1 year of age.

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Feeding and Nutrition for Your Child When to add finger foods to your baby’s diet. After the age of 7 to 8 months, most babies are ready to pick up solid food and feed themselves. By now, they have two to four teeth for biting and show signs of readiness such as sticking their hands in their food and trying to grab the spoon. At this stage, the chunkier baby foods labeled as Stage 3 or Step 3 can be added to your baby’s diet. It is important to know that you should always cut the food into very small sizes in order to prevent choking spells. What are some favorite finger foods liked by most babies at this age? Bite sized nibbles includes cereals such as Cheerios, well cooked potatoes sliced and diced, small pieces of cooked pasta, ripe bananas, tiny cubes of bread, small squares of cheeses, well cooked carrots, etc. The meat group includes meat loaf or chicken well cooked and mashed, etc. Always remember that while introducing different textures from pureed to mashed chunks, always add the food your baby liked before.

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The Developmental Milestones of Your Baby It is fun and a great joy watching your baby grow and it is important for parents to know ahead of time the wonderful changes and progress in your baby’s growth and development.

The first 2 to 4 weeks - infant: The first few weeks of a baby’s life are dominated mostly by reflexive actions such as crying when hungry or when their diaper is soiled, startles at the sound of loud noises, will turn toward the nipple to suck if gently touched on the cheek. The infant will have equal movement, palmer grasp, raise head when prone, can follow light to midline and responds to sound.

1 month old baby: Develops a strong grasping reflex and can see black and white patterns. the baby will sleep 70 to 80 percent of the time and will feed in between naps. He will have good eye contact, neck muscles are getting stronger and she/he is able to lift her/his head when prone.

2 month old baby: Will lift his head temporarily when held upright, will have a social smile and will coo back at you if talked to. Will turn head to direction of sounds, grasp rattle placed in hand, may sleep though the night and likes to be held.

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The Developmental Milestones of Your Baby 3 month old baby: Has good eye and head control, reaches for an object and hold it for a second, will be more alert to surroundings. His vision has improved to the point he can see colors clearly and will follow a slow moving object with his eyes. The baby has full neck control and will push up and hold her/his head at a 45 degree angle for a minute or two when lying on his stomach.

4 month old baby: The baby rolls over from his stomach to back, can fall off the changing table, can focus on distant objects, holds head high and raises body on hands when prone. The baby can follow his parents with his eyes, can laugh out loud, maintains grasp when object is put in hands, can smile, coos, laughs, squeals and gurgles.

5 month old baby: Maintains head steady when pulled to a sitting position, can roll from stomach to back, hands and eyes work together, looks and explores objects, will smile and babble to get attention, has more control of body and transfer objects from one hand to another.

6 to 7 month old baby: Will develop fine motor skills such as holding things with his fingers, may touch objects before picking them up and shows increased interest in stroking and patting. The baby will sit with support, rolls over, reach for toys, bears weight, babbles and laughs, can make sound like “ba-ba” or “ga-ga.” Opens mouth for spoon, might start teething and begins to get stubborn.

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The Developmental Milestones of Your Baby 8 month old baby: A 8 month old baby can sit freely with good head and body control begins to crawl, uses furniture to pull up to standing, pushed away things not wanted and can wave bye-bye.

9 month old baby: A 9 month old baby has good control of both hands, has several teeth, can pull up to standing, cries when separated from mother, puts things in mouth and attempts to gain attention.

10 month old baby: A 10 month old baby may walk holding onto something, can say “mama” or “dada,” shows anger or happiness, prefers some favorite toys, may develop separation anxiety.

11 month old baby: A 11 month old baby drinks from a cup, eats with fingers, enjoys games like “peek-aboo,” imitates movement of adults and older children.

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The Developmental Milestones of Your Baby 12 month old baby: A 12 month old easily crawls than walking, can walk, may try to pick up toys, shows interest in feeding self, may refuse to eat new food, shows affection to adults, favorite toys and clothes.

2 year old child: A 2 year old child can speak readily, begins playing games, is interested in other children, shows pride in their accomplishments and seeks your approval.

3 year old child: Kick a ball, open doors, build a 9 cube tower, feed himself, help in dressing, is able to count to three, will name at least one picture in an animal book, can throw a ball overhead and should be able to know his full name, age and sex.

4 year old child: Hop, jump forward, climb a ladder, peddle a tricycle, will know 3 to 4 colors, will dress and undress with supervision, is able to count to 10,m can copy circles, cross or squares, will play hide and seek and name pictures in books and play with imaginary companions.

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Childhood Immunization

A routine adequate immunization plays a major role in protecting your children against the common childhood illnesses and their spread in the community. Immunizations work by helping the body’s immune system to recognize and attack the diseases before they cause problems by stimulating the formation of antibodies in the blood. There has been a sharp decline in communicable diseases in the United States due to large-scale public health efforts with available vaccines. Proper childhood immunizations protect against Pertussis (whooping cough), Diphtheria, Tetanus, Polio, Hemophilus influenza, Measles, Mumps, Rubella and Hepatitis B. With Proper immunization to your children, since birth, these serious illnesses will be prevented in children, family and the community. The immediate goal of immunizations is the prevention of diseases in individuals or groups and the ultimate goal of immunizations is eradication of diseases in the community. Infectious diseases can be prevented by active and passive immunizations. Active immunization is achieved by stimulating the individual to develop an active immunologic defense in preparation for meeting the challenge of future exposure by injection of live and attenuated viral vaccines. Passive immunization is achieved by injecting performed human or animal antibodies in individuals already exposed to certain infectious agents such as gama globulins to protect against Hepatitis A and B. An active immunization involves the administration of all or part of a microorganism or a modified product such as toxoid to stimulate the immunologic response in the body. It is important to educate the community regarding the benefits of proper immunizations in their children for their good health.

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Immunization for Babies . . . A Guide for Parents. These are the vaccinations your baby needs!

At Birth

HepB

2 months

HepB

DTaP

PCV

Hib

Polio

4 months

HepB2

DTaP

PCV

Hib

Polio

6 months

HepB

DTaP

PCV

Hib3

Polio

Influenza

6-18 mos1

6-23 mos1

1,2

6-18 mos

12 months or older

MMR

DTaP

PCV

Hib

Chickenpox

Influenza

12-15 mos1

15-18 mos1,5

12-15 mos

12-15 mos1

12-18 mos1

6-23 mos

1

Check with your doctor or nurse to make sure your baby is receiving all vaccinations on schedule. Many times vaccines are combined to reduce the number of injections. Be sure you ask for a record card with the dates of your baby’s shots; bring this with you to every visit. Here’s a list of the diseases your baby will be protected against: HepB: Hepatitis B, a serious liver disease

PCV: Pneumococcal conjugate vaccine protects against a serious blood, lung and brain infection

DTaP: Diphtheria, tetanus (lockjaw) and pertussis (whooping cough) Influenza: a serious lung infection Hib: Haemophilus influenzae type b a serious brain, throat, and blood infection

MMR: measles, mumps, and rubella

Polio: polio a serious paralyzing disease

Chickenpox: also called varicella

Footnotes to above chart (for use by healthcare professionals): 1. This is the age range in which this vaccine should be given. 2. All babies should receive a total of at least 3 doses of HepB vaccine. Babies may receive up to 4 doses when given HepB vaccine at birth followed by combination vaccines containing HepB. The last dose of HepB vaccine should not be given before 24 weeks of age. 3. Depending on the brand of Hib vaccine used for the 1st and 2nd doses, a dose at 6 months of age may not be needed. 4. All children between the ages of 6 and 23 months should receive vaccinations for influenza in the fall of each year. First-time vaccinees should receive 2 doses, separated by at least 4 weeks. Children 2 years of age and older with certain medical conditions should be vaccinated every year. 5. DTaP may be given as early as 12 months if it has been 6 months since the previous dose and if the child might not return by 18 months of age.

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Immunization schedules using combination vaccines. Remember to assess for each antigen, including minimum age and intervals for each vaccine.

Recommended Infant Immunization Schedule 2004 Age/ Vaccine HepB DTaP Hib PCV IPV MMR VAR TIV

Birth ✔

2 Months ✔ ✔ ✔ ✔ ✔

4 Months ✔ ✔ ✔ ✔

6 Months ✔ ✔ ✔# ✔ ✔

12 Months

15 Months ✔ ✔#

✔ ✔ 6-23 months-give annually

# - If PRP-OMP (PedvaxHIB or Comvax) is administered at ages 2 and 4 months, a dose at age 6 months is not required and a booster is given at age 12-15 months. If it is necessary to change Hib vaccine type during the primary series, 3 doses of any combination of Hib vaccine are needed to complete the primary series (with a booster still needed at 12-15 months, for a total of 4 doses).

An Example Immunization Schedule using Pediarix® Pediarix® should not be administered to infants less than 6 weeks of age or children 7 years or older. Use for primary immunization series only, not booster doses. Do not use Pediarix for 4th or 5th does of DTaP or the 4th dose of IPV.

Age/ Vaccine DTaP HepB IPV Hib PCV MMR VAR TIV

Birth ✔

2 Months

4 Months

6 Months

Pediarix DTaP/HepB/ IPV

Pediarix DTaP/HepB/ IPV

Pediarix DTaP/HepB/ IPV

✔ ✔

✔ ✔

✔ ✔

12 Months

15 Months ✔

✔# ✔ ✔ ✔ 6-23 months-give annually

* If administering Pediarix® at age 4 months after birth and 2 month doses of hepatitis B vaccine (given either as a single antigen or as part of a combination vaccine), a 4th dose of hepatitis B will be needed after 24 weeks of age. # - See note under table above.

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Recommended Childhood and Adolescent Immunization Schedule, U.S., 2005 Range of Recommended Ages

Vaccine 

Age

Hepatitis B1

Birth HepB #1

1 mo

2 mo

4 mo

Catch-up Immunization

6 mo

18 mo

24 mo

4-6 yr

13-18 yr

HepB #3

DTaP

DTap

Haemophilus Influenzae Type b3

Hib

Hib

Hib

Inactivated Pollovirus

IPV

IPV

DTaP

IPV MMR #2

Varicella

PCV

PCV

PCV Influenza (Yearly)

Influenza7

Td

HepB #1

MMR #1

Varicella5

Td

DTaP

IPV

Measles, Mumps Rubella4

PCV

11-12 yr

HepB Series

DTaP

Pneumococcal6

15 mo

only if mother is HBsAg (-)

HepB #2

Diphtheria, Tetanus, Pertussis2

12 mo

Preadolescent Assessment

MMR #1

Varicella PCV PPV Influenza (Yearly)

Vaccines below this broken line are for selected populations

Hepatitis A8

Hepatitis A Series

“This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2004, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit whin indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers’ package inserts for detailed recommendations. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form can be found on the Internet at www.vaers.org or by calling (800) 822-7967.

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Childhood and Adolescent Immunization Schedule 1. Hepatitis B vaccine (HepB). All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant’s mother is HBsAg-negative. Only monovalent HepB can be used for the birth dose. Monovalent or combination vaccine containing HepB may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months. Infants born to HBsAg-positive mothers should receive HepB and 0.5 ml. Hepatitis B immune Globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1-2 months. The last dose in the vaccination series should not be administered before age 6 months. These infants should be tested for HBsAg and anti-HBs at 9-15 months of age. Infants born to mothers whose HBsAg status is unknown should receive the first dose of the HepB series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother’s HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). The second dose is recommended at age 1-2 months. The last dose in the vaccination series should not be administered before age 6 months. 2. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15-18 months. Tetanus and diphtheria toxoids (Td) is recommended at age 11-12 years if at least 5 years have elapsed since the last dose of tetanus and diphtheria toxoid-containing vaccine. Subsequent routine Td boosters are recommended every 10 years. 3. Haemophilus influenzae type b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. if PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2,4,or 6 months, but can be used as boosters following any hib vaccine.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4-6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11-2 year old visit. 5. Varicella Vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children, i.e. those who lack a reliable history of chickenpox. Susceptible persons aged ≥ 13 years should receive tow doses, given at least 4 weeks apart. 6. Pneumococcal Vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children age 2-23 months. It is also recommended for certain children age 24-59 months. Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000, 49(RR-9); 1-38. 7. Hepatitis A Vaccine. Hepatitis A vaccine is recommended for children and adolescents in selected states and regions, and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions, and high risk groups who have not been immunized against hepatitis A can begin the hepatitis A vaccination series during any visit. The two doses in the series should be administered at least 6 months apart. See MMWR 1999;489RR-12); 1-37. 8. Influenza vaccine. Influenza vaccine is recommended annually for children age ≥ 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes, and household members of persons in groups at high risk; see MMWR 2002;51(RR-3); 1-31), and can be administered to all others wishing to obtain immunity. In addition, healthy children age 6-23 months are encouraged to receive influenza vaccine if feasible because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children aged ≤ 12 years should receive vaccine in a dosage appropriate for their age (0.25 mL. if age 6-35 months or 0.5 Ml if aged ≥ 3 years). Children aged ≤ 8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks.

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How to Toilet Train Your Toddler

Each child is different regarding when the bladder or bowel control mechanism develops, however, the majority of children should be toilet trained between 18 months to 3 years of age, keeping in mind that boys are trained later than girls.

Here are some tips on how to toilet train your toddler: A. You may give your toddler a potty chair to sit on, first fully clothed then later on without a diaper once or twice a day after 18 months of age. B. You may need to stop for a few days then try again so the child will feel comfortable. C. Bladder control takes longer to achieve than bowel control hence training pants should be on while the toddler plays even though they are able to urinate in the potty chair. D. Staying dry at night is the last step and it is not fully accomplished by most children until 3 to 4 years of age.

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Child’s Fears and Growing Up

Fears are a normal part of the process of growing up and as a child grows and learns about the world, many experiences will make him/her confused, from birth to school age, have many new experiences which frighten them. These fears often appear when children are learning to walk, meet strangers or get involved in accidents. Some children are highly imaginative, sensitive and may adjust less quickly than others to new and potentially frightening situations.

Understanding your child’s fear is important so you can help your child learn to manage fearful feelings and situations. Here are some important tips to help your children overcome their fears. A. If a baby is scared of noise from hairdryers or vacuum cleaners, slowly and gradually introduce the noises by standing some distance away while turning on the dryer. B. Most babies are afraid of strangers by 6 months of age so try to leave your baby with familiar adults only while you are away. C. Have strangers approach slowly at first focusing their attention on a toy or some other object rather than the child.

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Child’s Fears and Growing Up

The fear of separation develops in a child around 8 months of age hence the baby may be unwilling to stay even with familiar babysitters or other relatives besides the mother. Around 15 months of age babies can show even more anxiety over separation from their parents. D. Play peek-a-boo to teach your baby that your absence is only short. E. Always tell your baby that you are leaving now and will be back soon rather than sneak out.

G. All through your baby’s early years, gradually introduce them to new places or people. H. Toddlers from 15 months to 3 years don’t manage strong feelings like anger, frustration and jealousy very well. Encourage your child to express feelings in words so the fears won’t show up in anxious activities. I. Provide calm predictable routines for your toddler at bedtime. J. Preschoolers from 3 to 5 years suffer from nightmares and fears of the dark.

F. Encourage caregivers to be sensitive to your child’s feelings about missing you and accept those feelings.

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Child’s Fears and Growing Up

Do your best to discover your child’s underlying feelings. Provide comfort and security by: A. Helping your child express his or her’s understanding and accepting negative angry feelings. B. Providing acceptable outlets for your child’s aggressive feelings by getting them involved with enjoyable activities.

E. Watching scary movies, haunted houses at Halloween can make a child afraid and have nightmares. Limiting the TV watching for less than two hours daily and avoiding programs with violence. By giving your child respect, support, comfort and having confidence in his growing abilities, you can help your child master his fears and anxieties.

C. Speaking honestly and openly about the death of a relative or pet. D. Putting on a night light at bedtime and reading them stories before bedtime.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor A few of the common illnesses during early childhood include: • Upper respiratory tract infection. • Rashes of different etiologies such as diaper rash, allergic rashes due to food allergies, contact dermatitis or rashes due to viral or bacterial diseases. • Lower respiratory tract infections such as asthma, bronchitis, sinusitis or pneumonia. • Vomiting, diarrhea or abdominal pain. • Viral versus bacterial illnesses. • Life threatening serious illnesses such as sepsis and meningitis.

When to contact your doctor Contact your pediatrician if you notice any of these symptoms in your baby: • Fever over 100.8F in an infant less than three months of age. • High fever of 102.6F in babies three months of age or older associated with or without vomiting, diarrhea, persistent cough, wheezing and difficulty in breathing. • Prolonged diarrhea more than 24 hours especially bloody stools with or without fever. • Rashes over the body with fever. • Persistent cough or cold symptoms lasting for a week or more. • Ear pain or drainage. • Cuts that might need stitches. • Any active bleeding that you are unable to control with pressure dressing. • Inability to move arm or leg especially after a fall. • Abdominal pain with vomiting. • Seizures. • Poisoning of any kind. • Difficulty in breathing. • Head injuries with loss of consciousness. • Blood in urine, lack of energy or if your child does not look good to you.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor How to Calm a Cranky Baby All babies cry due to the fact that this is the only way of communicating with parents. However, some infants cry more than others due to a condition called infant colic. Your baby would be considered colicky if he cries more than three hours a day, three or days a week, however, most colicky babies get better by three months of age. How to calm and soothe your baby • Since hunger is the most common cause of crying, offer your baby a bottle or breast milk. • Hold your baby close to your heart and rock together in a rocking chair. • Change diapers frequently and if your baby has diaper rash, apply a soothing cream and let air dry. • If you are breast-feeding, watch your diet since certain foods such as broccoli, chocolate and cauliflower might cause gas in your baby. • Check the temperature of the baby’s bottle each time you are feeding the baby and avoid frequent changes in your baby’s formula. • Offer your little one a pacifier, however, Do NOT hang it by a string around your baby’s neck. • To relieve gas pain, hold your baby over your shoulder and pat gently. • Try a warm bath to soothe your baby. • Go for a short walk outside since fresh air is always good for everybody. • Put your baby in the crib since some babies need to be left alone in a quiet room when overstimulated. • Some soothing music, sound of hairdryer or vacuum cleaner has a calming effect on babies. • DO NOT feel guilty since there is nothing much you can do and remember this stage will pass.

When to call the doctor Contact your pediatrician if: • High fever (102.6 degrees) in babies 3 months and younger. • Vomiting with or without diarrhea lasting more than 24 hours. • Rash over your baby with fever. • Persistent cough, cold, ear discharge, breathing difficulties or if your baby does not act normal. • Infant refusing to eat or drink for more than 4 meals. • Suspected poisoning, seizures, head injuries or for any abnormal symptoms.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Diaper Rash Most babies develop diaper rash due to the fact that: 1. Less frequent changing of diaper due to the negligence leads to too much contact with moisture due to urine or feces. 2. Chemical irritation of the skin due to laundry detergent, lotion or soap. 3. Food allergies and lactose milk intolerance. 4. Fungus or yeast infection.

How to handle and prevent diaper rash 1. Keep your baby’s bottom clean and dry. 2. After washing and drying your baby apply over-the-counter Desitin ointment. 3. Frequently change the wet diaper, avoid plastic pants, use mild soap and add vinegar to the rinsed water since this helps fight bacteria.

Contact your pediatrician if: 1. No improvement in diaper rash after 2 to 3 days of home treatment. 2. Diaper area covered with red or pus filled blisters which could be due to bacterial infection. 3. If baby’s foreskin becomes very red and inflamed.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Upper Respiratory Tract Infections Most of the infections during infancy and childhood are caused by viruses and DO NOT need antibiotics. Many sick children present with fever, muscle aches, congestion, running nose, diarrhea or vomiting due to flu virus that follows it’s own course. Our role as parents is to make these children comfortable by: • Control fever by alternating Tylenol with children’s Motrin at 4 to 6 hour intervals. • Encourage oral fluids since fluid prevents mucus from hardening and makes breathing easier. • Elevate the head of your child’s bed since this promotes drainage of the nose and sinuses. • Bed rest since this gives the body’s system a chance to recuperate. • Wash your and your child’s hands frequently since the largest risk factor for getting a cold or the flu is exposure in day care, play groups and school to other children carrying the virus.

You can help prevent the spread of germs by: • Frequent hand washing. • Disinfecting likely sources of germs by using disposable paper cups, Lysol spray over the countertops, washing toys frequently with disinfectant and teaching your children to cover their face while coughing or sneezing. • Deciding if a flu shot is necessary by consulting the physician.

• Getting rid of child’s allergies by: • Changing furnace filter regularly. • Use plastic cover over mattresses and pillows to stop growth of dust mites. • Using air-filters. • Avoiding getting any food your child may be allergic to. • Using humidifiers as needed. • Frequent vacuuming.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor What are some of the common childhood ailments and how to handle them? During the first two years of life most infants develop 8 to 10 episodes of the common cold each year, characterized by running nose, sneezing, cough, low-grade temperature, lack of appetite, sore throat or ear aches. Most of these conditions are viral illnesses, self limiting and are easily treated by taking a few safety precautions. During infancy and early childhood periods, chronic persistent cold in your baby might lead to serious respiratory illnesses such as broncheolitis, croup asthma or pneumonia. Bronceolitis is a viral infection of the small air passages in the lungs which get clogged with mucus secretions and the infant develops rapid breathing and wheezing. It is important to remember that all wheezes are NOT asthma and most of them could be allergy related. Pneumonia is a serious lung condition characterized by a high fever and difficult breathing in children. Frequent barky coughs in all infants could be due to croup which is a viral illness in young infants mostly during the winter.

How to ease your child’s cold symptoms 1. Encourage oral fluids since fluids help thin mucus, relieve stuffy nose and soothe sore throat. 2. Use a cool mist vaporizer in your child’s room to reduce coughing which often gets worse at night. 3. Use saline nose drops and a nasal aspirator which is a syringe that sucks mucus from the nostril to relieve stuffy noses in infants and smaller children. 4. Raise the head of the crib by keeping a pillow under the mattress to ease congestion and coughing. 5. Keep your home free of cigarette smoke and use clean humidifiers. 6. After consulting your doctor, you may use Tylenol and decongestants such as PediaCare to help with stuffy noses, allergy, flu symptoms and coughing. 7. If your baby has asthma: Eliminate the things that trigger attacks such as cigarette, cigar or pipe smoke.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor How to ease your child’s cold symptoms (continued) 8. With your pediatrician, develop a sensible plan of response for any major asthma attack to reduce the need for frequent emergency room visits. 9. If your child’s attack occurs on a sporadic basis, your pediatrician might prescribe short acting bronchodilators to open the airway which can be given by mouth or through a breathing machine. 10. Always give the medications in proper doses at regular intervals as prescribed. 11. Keep your child away from the triggering factors such as house dust, smoke, heavy pollen exposure, certain pets and certain foods that disagree with your child. For treatment of persistent cough, after consulting your pediatrician, you might choose a cough syrup appropriate for your child’s age and weight. Most cough syrups contain a combination of the following ingredients: 1. Expectorants - such as Guaifenesin. These medications thin the mucus secretion within the airway passages so they can be coughed up more easily. 2. Antihistamines - such as chlorpheniramine. These decrease the mucus swelling and secretions from the airway - if they are allergy related. 3. Decongestants - these medications such as PediaCare, pseudo ephedrine shrink the blood vessels in the walls of the breathing passages hence decrease the amount of mucus produced. 4. Cough Suppressants act by inhibiting the cough reflexes. It is important to remember that over use of these medications can cause adverse reaction to your child such as drowsiness, irritability, tremors, hallucinations or high blood pressure in older children.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Some of the common illnesses affecting babies and older children include: Sore throat Ear infection Flu symptoms Bronchitis, asthma and pneumonia Eye infections Allergies

Sore Throat The tonsils and adenoids are part of the immune system that defends the body against diseases. They consist of lymphoid tissue which produces antibodies to fight off bacteria and viruses. The tonsils lie in the back of the throat one on each side and the adenoids lie above the soft palate which is the back part of the roof of the mouth. Frequent episodes of cold and sore throat in your child could be due to acute tonsillitis which may include bacteria such as strep throat and different viruses, one of them being Epstein Barr Virus that causes infectious mononucleosis.

Abscess near the tonsils Rarely an abscess forms around the inflamed tonsils causing fever, drooling and difficulty in swallowing.

Swollen glands Often children with several episodes of tonsillitis develop swollen Lymph nodes in the neck, a condition called cervical lymphadenitis.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Symptoms of Acute Tonsillitis 1. 2. 3. 4.

Fever and sore throat. Difficulty swallowing. Earaches, headaches, generalized body aches and pains. Foul smelling breath.

The Common Treatment for Sore Throat 1. Frequent mouth rinse and gargles with saline water. 2. Alternate Tylenol with ibuprofen to relieve fever. 3. Encourage oral fluids. For persistent sore throat with fever, consult your pediatrician since streptococcal infection of the throat needs a 10-day full course antibiotics. Consult your child’s doctor if: 1. The child has trouble breathing or swallowing. 2. It hurts to talk and a small child may drool. 3. You can see swelling and white spots on the tonsils.

Eye Infections An eye infection in your child may be caused by bacteria or viruses. Call your pediatrician if: 1. Your child has a lot of redness of the white part of the eye. 2. Redness and swelling around the eyelid. 3. A yellow or green crusty discharge around the eyes. 4. Tenderness around the eye and sensitivity to light. 5. For infants less than 2 months of age with an eye infection.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Ear Infection Children are vulnerable to frequent episodes of ear infection due to the fact that: 1. Some children have minor differences in their anatomy such as short narrow Eustachian tubes which is an open airway between the middle ear and the mouth. 2. Weaknesses of their immune system leading to frequent viral and bacterial illnesses. 3. Infants are more prone to ear infections due to persistent colds, allergies, and environmental factors such as exposure to second hand cigarette smoke or exposure to frequent viral infections in childcare centers. An ear infection left untreated may lead to complications such as hearing deficit and slow language development.

Symptoms of an Ear Infection 1. 2. 3. 4.

Persistent cold symptoms with irritability and fussiness in infants. High fever, earaches with discharge. Difficulty swallowing or draining fluid from the ear. Pulling or rubbing of the ear, headaches, nausea, vomiting, loss of appetite and loss of hearing.

Keys to Prevention of Ear Infection 1. DO NOT offer the bottle in lying down position since the milk can run back up the Eustachian tube into the middle ear carrying infection with it. 2. Avoid smoking in the house; second hand smoke may cause an adverse effect. 3. To avoid allergies, vacuum frequently, change air filters and use plastic covers on mattresses and pillows to avoid exposure to dust mites. 4. If your child is on antibiotics, finish the full course of treatment and get frequent medical check ups. 5. Use protective earplugs during swimming or diving. 6. Sometimes surgical procedures such as removing the tonsils and adenoids or putting ear tubes help. 7. For chronic ear infections, it is advisable to prescribe a daily dose of antibiotics for 2 to 3 months.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Other Conditions That Mimic the Common Cold Are: Condition

Differentiating Feature

Allergic Rhinitis

Prominent itching, sneezing and nasal discharge

Foreign body in nose

Unilateral foul smelling nasal discharge

Sinusitis

Persistent nasal discharge with headache, fever, facial pain or swelling around the eyes

Streptococcal

Sore throat, fever with nasal discharge causing excoriation around the nostril

Nasopharyngitis Pertussis (whooping cough)

Sudden onset of severe or persistent cough

How to Treat the Common Cold in Your Infant • Use a cool mist vaporizer in your child’s bedroom to reduce coughing which often gets worse at night. • For your little ones, use a nasal aspirator to suck mucus from the nose after using a few drops of saline nose drops. • Nasal decongestants such as PediaCare and antihistamines like Dimetapp and Triaminic may be used in proper does after contacting your pediatrician.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor Vomiting and Diarrhea The frequent episodes of vomiting and diarrhea during infancy and early childhood are related to: 1. Feeding error and frequent formula changes 2. Food allergies and Lactose intolerance. 3. Viral illnesses. 4. Diarrhea often accompanies stomach infection, the flu, frequent cold, earaches, food allergies and teething. 5. In some cases, vomiting and diarrhea may be symptoms of serious illness such as appendicitis, intestinal obstruction or any serious bacterial illnesses.

Symptoms of Dehydration 1. 2. 3. 4. 5.

Less frequent urination, dry diapers. Dry mouth and sunken eyes. Few tears. Rapid weak pulse. Excess fussiness or overly sleepy baby.

How to Prevent Dehydration 1. 2. 3. 4.

Offer small amounts of clear liquid at frequent intervals such as Pedialyte and Coolyte popsicles. DO NOT give formula for at least 24 hours. Later start with half strength formula. For older children offer the BRAT diet. (B-Bananas, R-Rice Cereal, A-Apple Sauce, T-Toast). Sweet liquids like juices and Jell-O should be avoided since sugar aggravates diarrhea.

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Common Common Childhood Childhood Illnesses Illnesses and and Knowing Knowing When When to to Call Call the the Doctor Doctor When to Contact Your Doctor Call your pediatrician if the baby shows: 1. 2. 3. 4. 5. 6.

Signs of dehydration as mentioned above. For greenish vomits or bloody diarrhea. For severe abdominal cramps associated with bloody diarrhea which could be due to bacterial infection. Possible urinary tract infection. Pain in the right part of the abdomen with fever and vomiting which might be suggestive of appendicitis. For weakness and lethargy in your child or if the child does not look good to you.

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Common Childhood Illnesses and How to Handle Them Signs &Symptoms Hand, Foot and Mouth Disease: 1. Low grade fever, weakness and body aches. 2. Canker sore in mouth, on tongue and on soft palate. 3. Pain and difficulty swallowing. 4. Itchy rash with blisters on hands and feet. Impetigo: Rashes generally appear as blisters over face, below nostrils, on arms and legs. Later dries as crusts. May be fluid or pus filled.

Treatment at home

When to call your doctor

How to prevent

Control fever with Tylenol or Persistent high fever, vomiting, or Encourage oral fluids. Avoid Children’s Motrin. any sign of infection. citrus and spicy foods.

Keep affected area clean by using antibacterial soap. Apply antibacterial ointment locally. Frequent lukewarm baths, dress your child in long sleeved shirts and long pants while they go to school or daycare.

Avoid direct contact with other infected children. Take immediate measure when scrape or minor skin injuries happen.

Fifth disease: Bright red 1. Bed rest. 2. Plenty of fluids patches on the cheek later 3. Tylenol. 4. Apply calamine spreading to chest, trunk, lotion. buttocks and extremities accompanied by fever and cold symptoms

Encourage good hygiene among your children. Avoid contact with infected children.

Measles: Fever, cough, runny nose, pink eyes, rashes as small red bumps starting on the face and neck, then spreading over the body. Incubation period is 1 to 2 weeks.

Rest and fluid. Use cool mist humidifier. DO NOT give aspirin to your baby since it causes a serious viral condition known as Rey’s Syndrome.

Vaccines available for Measles, Mumps and Rubella.

Mumps: Low grade fever, headache, fatigue, swollen neck glands below the ear near the jaw bones on each side of the face, aches, vomiting, etc. Viral illness more common between the ages of 2 and 12 years.

1. Bed rest. 2. Fluids. 3. DO NOT give citrus or juices. 4. Apply ice pack to swollen area

Call doctor if it does not subside in 2 to 3 weeks.

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Common Childhood Illnesses and How to Handle Them Signs &Symptoms

Treatment at home

When to call your doctor

1. Limit their drink before bedtime. 2. Encourage them to empty their bladder before bedtime. 3. Avoid giving them Coke or other caffeine drinks during the night. 4. reward and praise them when they stay dry.

If a child develops a fever, difficulty urinating, blood or pus in urine or if urinary stream is weak and scanty.

Allergies and Hives: Sudden onset of itchy rash characterized by bumps and macular rashes with raised margin all over the body

Apply cool soothing lotion, corn starch soak to involved areas, give Benadryl.

Call your pediatrician for difficulty in swallowing, trouble in breathing or for any other abnormal symptoms.

Chicken Pox: An itchy rash usually starts on face later spreading to chest and trunk as red spots, later on blisters and finally dries up and scabs.The rash generally lasts over the body for seven to ten days. Eczema: An itchy, scaly or blistered rash on the body, mostly on wrist, hand, face, scalp or along creases of elbows and knee. Oozy, crusting or thickening and discoloration of affected areas. Allergic Contact Dermatitis: Pink or red rash on exposed skin, scaly or crusty lesions might appear on any part of the exposd body after contact with the irritant.

Give your child plenty of fluids, alternate Tylenol and children’s Motrin to control fever, apply calamine lotion over body to control itching.

Call your doctor for any sign of infection such as impetigo, otitis media or pneumonia.

Bed Wetting: Among children is common more in boys than girls and is due to the fact that: 1. Bladder is small. 2. Bladder’s muscles and nerves have not matured. 3. Hormone deficiency. Most children outgrow this by the age of six years.

Keep skin moist by: 1. Warm Call your doctor if you notice bath. 2. Moisturizing lotion. 3. infection. Hydrocortisone cream. 4. Wear loose comfortable cotton clothing. 5. wear soft mittens at night to avoid itching. 6. Avoid foods like chocolate and eggs that might aggravate the symptom.

Oatmeal or cornstarch bath, moisturizing and itching lotions.

Call your doctor if you notice signs of infection.

How to prevent Encourage your child to hold urine for a few minutes past the urge of urinating. Try bladder exercises.

Chicken Pox vaccine is available now for babies past 13 months of age

It usually runs in the family. However, it can be prevented by avoiding allergy, stress, sweating and chemical irritants. Avoid skin products, poison ivy, soap.

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Common Childhood Illnesses and How to Handle Them Signs &Symptoms German Measles: Fever, swollen neck glands, rash on face spreading to chest and trunk, rash appears as tiny red or pink spots or irregular blotches, painful joints in older children. Purpura: Sore throat, fever, painless purple bruise like rash all over the body.

Childhood Leukemia: General fatigue, weakness, anemia, swollen nodes, mouth sores and susceptibilty to infection. This is a serious malignant disease affecting the blood, lymphatic system and the bones. Roseola: Occurs mostly in children between 6 months and 2 years of age. High fever of 102 to 105 F lasting 2 to 3 days, cough, runny nose, temperature drops then spotty red macular rash appears on neck and body. Scarlet Fever: Fever, red throat, strawberry tongue, white coating on tonsils, swollen glands, bright red rash on face, chest, trunk, peeling off skin from arms and legs.

Treatment at home 1. Rest. 2. Fluids. Warning: Keep your child away from pregnant women.

When to call your doctor Consult pediatrician for any complicated symptom.

How to prevent Vaccine is available.

Consult your pediatrician immediately if bleeding under the skin, swollen joints and bloody urine is observed.

Call your doctor for any early symptoms and signs of malignancy and get regular medical checkups.

1. Control fever. 2. Encourage oral fluids.

Call your pediatrician for febrile seizure or any other complications.

1. Encourage oral fluids. Watch for complications and call 2. Control fever. doctor. 3. Antibiotic treatment for 10 to 15 days.

Good hygiene.

Very contagious bacterial illness caused by streptococcal bacteria. Strep throat should be treated early.

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How to Make Your Home Safe and Child Proof 1. Children’s nightclothes should be made of 100% polyester since it is flame-resistant. Cotton sleepwear is highly flammable and ignites easily. 2. In order to prevent injuries as your child starts to crawl: a. Put all potential hazards such as matches, marbles, etc. and objects with sharp edges out of the child’s reach. b. Use safety gates on all stairways to prevent falling. c. Use non-skid mats in bathtub. d. Cushion sharp furniture corners and hard surfaces. 3. In your child’s bedroom: a. Remove small objects that might cause choking hazards. b. Keep drapery and blind cords out of the child’s reach so they don’t strangle themselves. c. Remove plastic bags or materials from around the crib. d. Put plug protectors in all unused electrical outlets. 4. In the bathroom: a. Put non-skid rubber mat in the bathtub. b. Store medicines, cosmetics and detergents in locked cabinets. c. Hair dryers and curling irons should be unplugged and out of reach from children. d. Set water heater thermostat to 120 degrees F to prevent burn injury. e. Never leave your child alone in the bathtub since they can drown themselves easily. 5. In the kitchen: a. Keep detergents, dishwashing soap, sharp knives, etc. out of reach. b. While cooking, use the back burners of stove and turn pot handles towards back of stove. c. Keep all appliance cords tucked away so children can’t pull on them. d. Always keep fire extinguishers in the kitchen.

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How to Make Your Home Safe and Child Proof

6. In the family room and stairways: a. Stairs should be carpeted and protected with non-accordion style gates at top and bottom. b. DON’T let your children run in stocking feet on hardwood floors. c. The door to basement should be locked. d. Make sure all house plants are out of reach of children. e. Place barriers around the fireplace and other heat sources. f. Televisions and stereos should be properly secured. Here are some more suggested items for your home: a. All homes should be equipped with smoke and carbon monoxide detectors. b. Use electrical outlet covers and keep cords short since long telephone and drapery cords can be dangerous hazard for your child. c. Use night lights, window guards, protective corner guards, doorsteps and safety gates. d. Never leave your child unattended in the garage, basement, patio or deck. Keep your fire grill covered and away from your child’s play area. In the garage, store your lawn mower safely out of reach from children and keep gasoline cans, etc. in a safe place. Have a list of emergency telephone numbers such as police, fire department, ambulance, poison control, your pediatrician and local hospitals near your phone.

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How to Make Your Home Safe and Child Proof

Keep a first-aid kit available in your kitchen or family room. Your first-aid kit should include the following items: a. Tylenol or children's Motrin b. Adhesive and gauze bandages c. Tape d. Hydrogen peroxide for cleaning wounds e. Syrup of Ipecac to induce vomiting after contacting poison control f. Thermometers g. Calamine lotion and liquid Benadryl for insect bites h. Bee sting kit i. Sharp scissors with rounded tips j. Antibiotic ointment k. Instant activating ice pack and cotton balls l. Elastic bandage m. Nasal aspirator to remove mucus n. Tweezers for taking our splinters Making your home safe and sound is a haven of safety for your little one.

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The Safety Precaution Tips for a Toddler

Injury and accidents are the biggest threat to a child’s health. Toddlers are busy learning about themselves and their surroundings and during climbing, jumping, etc., a curious toddler subjects himself to injuries.

P O I S O N I N G

A. All medicine in the house should have child resistant safety caps on them. B. Keep all medicine, household products and cosmetics high out of reach and in locked cabinets. C. Keep the phone numbers of poison control, your pediatrician and the affiliated hospital emergency room available.

Drowning Precautions Never leave your baby unattended while in the bathtub, bucket or swimming pool even for a second.

A. Keep doors locked to any dangerous areas, use gates on stairways and window guards above the first floor. B. Don’t leave child unattended on a chair near a railing or table where the child might climb and fall. C. Bicycle riders of all ages should always wear helmets for protection. Burns can be caused by too hot tap water, hot liquids and foods, cigarette and house fires. A. Set the water heater in your home lower than 120 degrees F. B. During the cooking hours, make sure your toddler is well supervised. C. While holding your toddler, don’t try to cook or smoke. D. Install smoke and heat detectors, fire extinguisher in appropriate places in your home.

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Safety Precaution Tips During the First Two Years of Life

Choking and suffocation can occur at any age; however, it is more common in babies due to their small air passages and their tendency to put everything in their mouth. Here are a few safety guidelines:

A. Keep babies away from small, hard objects that can lodge in their windpipes such as coins, small parts of toys, foods such as hard candies, nuts or popcorn.

B. Since a baby’s small body can slip through small spaces, there are chances that the baby’s neck might get caught leading to suffocation.

C. Do not hang a pacifier on a string around the baby’s neck. D. Take precaution so the baby can’t slip between a mattress and the side of the crib or between the seat and tray of a high chair. E. DO NOT let the baby play with plastic bags since they can easily cover their face and get suffocated. F. Supervise your children while they play with balloons since pieces of broken balloons can easily be swallowed and choke the child. G. Be careful while feeding your infant while they don’t have teeth by cutting hand foods like carrots, meat pieces, etc. into small pieces. J-5


How to Avoid Stings and Bites

During spring and summer, children and adults get more involved with outdoor activities and there is a good chance of being stung by bees, wasps, hornets or yellow jackets. Reactions to such things can range from mild to a severe life threatening condition.

How to avoid stings: 1. Wear smooth textured clothing in subdued colors. Bright colors attract agitated bees. 2. Don’t go barefoot. 3. Keep collars and sleeves buttoned or closed. 4. Bees are more likely to sting in gloomy weather than on bright sunny days, so take precaution to avoid them. 5. Never strike, agitate or throw an object at a bee or wasp hive. 6. Smoke has a calming effect on bees, so beekeepers often use a smoke canister to control their activity. 7. If caught in a swarm of bees or wasps, move away with slow deliberate movement.

What to do if you are stung: 1. Apply ice or cold compress to the sting for relief of pain and swelling. 2. If stung, gently remove the stinger with tweezers. 3. Get medical help as soon as possible if you feel dizzy, faint, short of breath or break out in hives. 4. The doctor can prescribe a bee sting kit which includes Epinephrine, syringe and Benadryl to cut down allergy in blood.

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How to Avoid Stings and Bites II

What to do to relieve itching from bug bites: 1. Ice acts as a local anaesthetic to relieve itching, swelling and pain from bug bites. 2. Menthol, phenol or camphor are ingredients of itch relieving lotions that might help upon local application. 3. Oral antihistamines act as mild sedatives and relive itching. 4. If reactions to bites worsen, seek medical help immediately. 5. Use insect repellent with 10% DEET on children older than two years of age.

Precaution Against Lyme Disease: Lyme Disease is a debilitating bacterial illness that is spread by the bite of a tick.

How to protect yourself: 1. During tick season, stay out of woods and fields likely to be infested. 2. Wear light colored protective clothing, long sleeves tucked at wrist, shirts tucked at waist and pants tucked into socks. 3. Treat clothing with repellent which kills ticks on contact. 4. Inspect children when they come indoors. Do a thorough self-inspection when you come indoors. The transmission of the disease is unlikely if the tick has been attached for less than 48 hours. 5. Make sure pets are well protected with medication or tick collars and flea powders and check them daily during tick season.

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How to Reduce the Risk of Sudden Infant Death Syndrome (SIDS)

1. Sleep Position: Healthy babies Sudden Infant Death Syndrome is the leading cause of death in the United States and is defined as the sudden and unexplained death of an apparently healthy infant. There has been research done throughout the world regarding what cause it. However, even though the Etiology is still unknown, it has been postulated that certain precautions taken by the caretaker might reduce the incidence of SIDS.

should always sleep on their back when taking a nap or going to bed for the night.

2. Temperature: Do not overdress your baby and keep the room temperature very comfortable. Do not make the room too warm.

3. Bedding: The baby should sleep in a firm mattress. Soft materials like quilts, stuffed animals, fluffy blankets, pillows and sheepskins should not be used in the crib.


The Child Abuse Risk Factors

A. Families where parents were abused as children. B. Families with previous child fatality. C. Parents with drug and alcohol abuse. D. Families headed by teen parents. E. Single parent families. F. Low income families. G. Children with disabilities. H. Children with a history of numerous caretakers. I. Children who change residences often. J. Families with spousal abuse.

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Choking Spells and Cardio Pulmonary Resuscitation One-Rescuer CPR: Child (1 to 8 years) CPR performed on young children is similar to CPR for adults and older children except for four differences. 1. If the rescuer has no help, give 1 minute of CPR before activating the EMS system. 2. Press the heel of one hand over the lower half of the sternum between the nipple line and the bottom of the sternum. Compress with one hand rather than both hands. 3. Depress the sternum one-third to one half the depth of the chest (about 1 to 1 1/2 inches). 4. Provide 100 compressions per minute, giving 1 rescue breath for every five chest compressions.

REMEMBER THAT THE NUMBERS USED IN THIS SECTION ARE ONLY BROAD GUIDELINES. Airway 1. Assessment: Determine unresponsiveness. Tap or gently shake shoulder and shout “Are you OK?” 2. Call out “Help!” 3. Position the victim on his or her back, taking care to support the head and neck in case of injury. 4. Open the airway, using head tilt-chin lift. K-5


Choking Spells and Cardio Pulmonary Resuscitation Breathing 5. Assessment: Determine breathlessness. With your ear over the child’s mouth, look at the chest and look, listen, and feel for breath while keeping the airway open. 6. If the victim is not breathing, give 2 rescue breaths, mouth to mouth (1 to 1 1/2 seconds per breath). The chest should rise with each breath, then fall.

Circulation 7. Assessment: Determine pulselessness. Using two or three fingers, feel for the carotid pulse with one hand while maintaining head tilt with the other. 8. begin chest compressions. Find proper hand position as in adults. Compress the lower part of the sternum, above the bottom of the sternum and below the nipple line, approximately one third to one half the depth of the chest (this will be approximately 1 to 1 1/2 inches, although these measurements are not precise). Use only the heel of one hand. Compress the chest 100 times per minute, giving 1 rescue breath for every 5 compressions. 9. Do 20 cycles of compressions and rescue breaths. 10. Activate the EMS system. Call 911. (Call fast!)

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Choking Spells and Cardio Pulmonary Resuscitation 11. Check pulse. 12. If no pulse, continue compressions and rescue breaths. 13. Check the pulse every few minutes. 14. If the pulse returns, check for spontaneous breathing. If there is no breathing, give 1 rescue breath every 3 seconds (20 rescue breaths per minute) and monitor the pulse, If the victim is breathing, place in the recovery position, maintain an open airway and monitor breathing and pulse.

Obstructed Airway: Child (1 to 8 years) Perform first aid for choking in children 1 to 8 years old just as you would for adults and older children, except do not perform blind finger sweeps. Instead, perform the tongue-jaw lift, look down into airway, and use your finger to sweep the foreign body out only if you can actually see it.

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Choking Spells and Cardio Pulmonary Resuscitation One-Rescuer CPR: Infant (less than 1 year) CPR in infants must be performed with special consideration for size and vulnerabilities. For this reason there are several differences in CPR and first aid for choking in infants.

Airway 1. Assessment: Determine unresponsiveness. Tap or gently shake the shoulder. 2. Call out “Help!” 3. Position the infant on his/her back on a firm surface, supporting the head and neck if turning is necessary. 4. Open the airway using head tilt-chin lift. Take care not to tilt the head too far back.

Breathing 5. Assessment: Determine breathlessness. While maintaining an open airway, place your ear over the infant’s mouth and look at the chest movement, listen for breathing and feel for breaths on your ear. If the victim is breathing and there is no evidence of trauma, place the victim in the recovery position. K-8


Choking Spells and Cardio Pulmonary Resuscitation 6. If the victim is not breathing, give 2 gentle breaths, with your mouth covering the infant’s mouth and nose, while maintaining an open airway. Observe the rise and fall of the chest. Each breath should be provided for 1 to 1 1/2 seconds.

Circulation 7. Assessment: Determine pulselessness. Feel for the brachial pulse on the inside of the upper arm with two fingers of one hand while maintaining head tilt with the other hand. 8. Begin chest compressions. Imagine a line drawn between the nipples, and place your index finger below that line in the center of the chest. Place the middle and ring fingers next to the index finger. Use the middle and ring (third and fourth) fingers to compress the sternum at that point. Because of wide variations in the relative sizes of rescuers’ hands and infants’ chest, these instructions are only guidelines. After finding the position for compressions, make sure that you do not compress over the xiphoid process. Compress the sternum approximately one third to one half the depth of the chest (about 1/2 to 1 inch) at least 100 times per minute. Give 1 rescue breath for every 5 compressions.

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Choking Spells and Cardio Pulmonary Resuscitation 9. Do 20 cycles of compressions and rescue breaths. 10. Activate the EMS system. Call 911. (Call fast!) 11. Check the brachial pulse. 12. If no pulse, continue compressions and rescue breaths. 13. Feel for the pulse every few minutes. 14. If the pulse returns, check for spontaneous breathing. If there is no breathing, give 1 rescue breath every 3 seconds (20 rescue breaths per minute) and monitor the pulse. If there is breathing, place in the recovery position, maintain an open airway, and monitor breathing and pulse.

Obstructed Airway: Conscious Infant (less than 1 year) Do not perform this procedure on a conscious infant unless complete airway obstruction is present (serious breathing difficulty, ineffective cough, no strong cry) and is due to a witnessed or strongly suspected obstruction by a foreign object. If obstruction is caused by swelling due to infection, the infant should be rushed to the nearest advanced life support facility, and maneuvers to clear the airway should not be performed. When respiratory distress is present, the infant should be allowed to find and maintain the position that he finds the most comfortable.

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Choking Spells and Cardio Pulmonary Resuscitation 1. Assessment: Determine airway obstruction. Observe breathing difficulties, ineffective cough, weak (or absent) cry, dusky color. 2. Place infant face down over one arm and deliver up to 5 back blows. Supporting the head and neck with one hand, place the infant face down, head lower than trunk, over the forearm supported on your thigh. Deliver up to 5 back blows forcefully between the shoulder blades with the heel of one hand. 3. Turn infant face up, supported on your arm, and deliver up to 5 chest thrusts in the midsternal area. After supporting the head, sandwich the infant between your hands and arms and turn on his back, head lower than trunk. Deliver up to 5 thrusts in the midsternal region, using the same landmarks as those for chest compressions. Deliver chest thrusts more slowly than when doing chest compressions 4. Repeat steps 2 and 3 until either the foreign object is expelled or the infant becomes unconscious.

If the Infant Becomes Unconscious 5. Call out “Help!� If someone comes, that person should activate the EMS system. Position infant on back. 6. Perform tongue-jaw lift. Do not perform a blind finger sweep; remove foreign body only if you can see it.

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Choking Spells and Cardio Pulmonary Resuscitation 7. Try to give rescue breaths. Open airway with head tilt-chin lift and try to give breaths. 8. Try again to give rescue breaths. Reposition the head and try to give rescue breaths. 9. Deliver up to 5 back blows. 10. Deliver up to 5 chest thrusts. 11. Perform tongue-jaw lift and remove foreign body if you see one. 12. Try to give rescue breaths, while maintaining an open airway with head tilt-chin lift. 13. Repeat steps 8 through 12 until successful. 14. If you are alone and your efforts are unsuccessful, activate the EMS system after about 1 minute of efforts to clear airway. 15. When obstruction is removed, check for breathing and pulse. 16. If there is breathing, place in the recovery position and monitor breathing and pulse while maintaining an open airway. If there is no breathing, give 20 rescue breaths per minute and monitor the pulse. 17. If no pulse , give 2 breaths and start cycles of compressions and breaths. If there is a pulse, open the airway and check for breathing.

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Choking Spells and Cardio Pulmonary Resuscitation Obstructed Airway: Unconscious Infant (less than 1 year) 1. Assessment: Determine unresponsiveness by tapping or gently shaking the shoulder. 2. Call out “Help!� 3. Position the infant. Turn on back, if necessary, on a firm, hard surface while supporting the head and neck. 4. Open the airway. Use head tilt-chin lift but take care not to tilt the head too far back. 5. Assessment: Determine breathlessness. Maintaining an open airway, place your ear over the infants mouth and look at chest for breathing movement, listen for breathing sounds, and feel for breaths on your ear. 6. Try to give rescue breaths. Use a mouth-over-mouth-and-nose seal. 7. Try again to give rescue breaths. Reposition head and check mouth-over-mouthand-nose seal. 8. Activate the EMS system. If someone else is there, that person should activate the EMS system. 9. Deliver up to 5 back blows. 10. Deliver up to 5 chest thrusts. 11. Perform tongue-jaw lift and remove foreign object if you see one.

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Choking Spells and Cardio Pulmonary Resuscitation 12. Try to give rescue breaths. If unsuccessful, reposition heads and try again. 13. Repeat steps 9 through 12 until successful. 14. If you are alone and your efforts are unsuccessful, activate the EMS system after about 1 minute of efforts to clear airway. 15. When obstruction is removed, check for breathing and pulse. 16. If there is breathing, place in the recovery position and monitor breathing and pulse while maintaining an open airway. If there is no breathing, give 20 rescue breaths per minute and monitor pulse. 17. If no pulse, give 2 breaths and start cycles of compressions and breaths. If there is a pulse, open the airway and check for breathing.

ALWAYS remember to keep a list of emergency numbers by your phone: Emergency Medical - 911 Fire Department Police Your Pediatricians Office Poison Control K-14

How to Keep Your Child Safe and Healthy  

A book on child care and safety by Dr Niru Prasad

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