Parenting & New Baby Advice Blog

At birth, babies prefer high contrast.  Black and white designs provide the most contrast.  At first, babies prefer geometric patterns with stripes and angles.  Soon they will shift their preference to circular patterns, such as bull’s eyes.

Within three weeks, the most exciting image in his visual field is the human face.  Because your hairline and your eyes offer the most contrast, he will at first concentrate his gaze between your nose and your forehead.  Between four and eight weeks, your baby may break into his first social smile while studying your face.  At three months, he will be able to distinguish your face from a stranger’s.  By rewarding you with a special smile, he lets you know that he recognizes you.  By four months, his vision has matured.  Like you, he enjoys looking at things that are colorful, novel, and in motion.

How do you know when your baby finds something visually interesting?  An alert, calm, baby will respond to a pleasing object in his visual field by brightening his face and moving his arms and legs rhythmically.  An active baby will stop moving and carefully scan the object with his eyes.  He will signal to you when an object doesn’t interest him or when he has had enough stimulation by turning away and withdrawing.

Avoid bombarding your baby with visual input during the first two months of his life.  During this time, while he’s getting settled, all stimuli should be low key.  In these first weeks he is becoming familiar with his hands and should not be exposed to a lot of jazzy stimuli that will distract him from that familiarization process.  Later, when he has begun to master basic visual skills and has gained control over his head and hand movements, he will be ready to explore his visual environment.  As always, take your cues from him.Things That Stimulate Visual Development

• Black and white geometric patterns.
• Your face.
• Toys with faces.
• Out of reach mobiles [remove them when the baby can sit to avoid entanglement].
• Mirrors [choose stainless steel mirrors he can’t break].
• Being carried about by you.
• Being placed in an infant seat [always fasten the lap belt and never leave him unattended].

Social behavior begins very early in the lives of human beings.  Infants respond to people almost from the moment of birth.  In fact, if you began the bonding process with close skin contact immediately after your baby was born; you probably felt that she was definitely aware of you, reaching out to you.  Newborns are attracted to human faces and they like the sound of human voices, especially female voices.  Soon your new baby’s eyes will follow your movements in a room, then her head will turn to watch you.  At three or four months, your baby will respond happily to smiling people, then will smile at the sight of any approaching face.  The baby will smile-you will smile-her smile will broaden.  Thus, social interaction begins; the baby has learned to get a reaction from another person.  She will even try to mimic you when you stare, stick your tongue out, or make faces.  One day, you will notice that your baby quiets if you speak or sing as you come near the crib.  It won’t be long until she will make a sound in response to your voice.

At five to eight months old, your baby will probably be learning how to be “cute,” how to get your attention by pretending to cough or doing something that has made you laugh before. She will know the difference between familiar people and strangers and may show fear of strangers.  When your baby is somewhere between the ages of eight months and a year, you’ll be getting cooperation in the singing games and finger plays with which you’ve been entertaining her.  Soon she will adore having an audience and will delight in performing the “bye-bye” ritual and any others that get attention.

Between the ages of one and three, your child will be ready to branch out socially.  Though learning to actually play with other children effectively will take a while, she will want to be around them, if only as an observer.  She will learn a great deal from this observation.

First Social Set: The Family

The immediate family-mother, father, siblings, and a care-giver, if the baby has some kind of daycare-is your baby’s first social set, a select and fortunate group.  All of you will outdo yourselves to entertain and please the baby, and your greatest thrills will come when he responds and reciprocates.  Remember, though, that the key word in all human behavior is unique.  Your baby is as different from all the other babies in the world as each snowflake is different from all others.  Antics that sent your older child or your highboy’s child into paroxysms of giggles and gurgles may very well make this baby cry and pull back.  Take your cue from your child, if he startles easily or seems frightened by your loud noises, funny faces, or sudden actions, ease up.

At about a year, your child will be extremely sociable.  He will love being part of any and every family gathering and will obviously adore everyone.  Your baby will happily go on your rounds of shopping and errands with you, pay and receive social visits with you, and thoroughly enjoy just being with you around the house.  Anything goes, in fact, as long as a family member is close at hand.

Unfortunately, things will change.  The push toward independence you’ve read and heard about become reality, and at a point somewhere around eighteen months, your baby will appear to have outgrown any need for you.  He will barely acknowledge your presence in daily life, except to say no a great deal.  Walking, running, climbing stairs, exploring, and satisfying curiosity about everything and anything will be all engrossing.  There will be occasional reversions to the old baby ways of love and play, but in general the child of this age is concentrating so hard on self and environment that adults seem to exist for no reason other than to satisfy his desires.  The exception to this behavior will be when there’s trouble, no one but mommy or the primary, daily caregiver can handle a cut or a bruise or make a stubborn toy work the way it should.

Sociability will return in time, but by the time it does, your baby’s social set will include playmates and others outside the family.  You will never again be as all-important to your child as you were for the first year, which is as it should be.  Learning to let go is among the most important of parents’ lessons.

You should be checking your baby’s mouth on a periodic basis even before the first tooth erupts.  This will give you an idea of the normal appearance of your baby’s mouth.  Teething may be preceded by whining, crying, or drooling more than usual.  Other common signs of teething are changes in feeding habits, trouble in sleeping, and increased irritability.  If your baby’s gums are red and swollen or if you can see or feel the tip of the tooth, teething probably is causing these changes in your baby’s behavior.  However, if your baby also has a fever or a rash or is vomiting, something else may be wrong.

Your baby will have a strong urge to chew at this time and should be given a teething ring, or dry toast to chew on.  Babies will vary in their need for help at this time.  Check with your baby’s doctor or dentist before using any of the commercial preparations to ease teething discomfort.  To help soothe your baby’s gums, wipe a dampened gauze pad over them, two or three times a day.

After your baby’s teeth begin to appear, clean them daily with a dampened gauze pad or clean washcloth until your baby is old enough to begin using a toothbrush.  When your baby is one and a half to two years old, purchase a child-sized toothbrush.  At least once a day-preferably after meals-let your child “brush” her own teeth; this will consist mainly of chewing on the toothbrush.  At this age, make no attempt to try to teach your child tooth brushing techniques.  It is more important to establish a pattern of dental care, and even chewing on a toothbrush helps clean the teeth.

Never give your baby a bottle of milk, juice, or a sweetened beverage when you put her to bed, and never put honey, syrup, or another sweetening agent on your baby’s pacifier.  These practices may help comfort your baby, but they can cause severe destruction of your baby’s teeth.  Nursing decay syndrome, or nursing or nursing bottle caries [dental cavities], can result from such practices.  When your baby is awake and sucking on a bottle, the liquid is rapidly diluted with salvia and swallowed.  However, if your baby falls asleep while nursing and swallows less often, the bacteria normally present in her mouth have time to turn to sugars in these liquids into acids that attack the tooth enamel.  Sweetening agents on a pacifier also permits the sugars to remain in the mouth too long.  The teeth most severely damaged are the upper incisors, and it has been necessary to remove teeth destroyed by this type of decay in children as young as eighteen months old.

Other practices that are just as destructive are putting sugar in a piece of cloth and using this as a pacifier or using a piece of bread as a pacifier.  The starches in the bread are quickly converted to sugars in the mouth, which can then serve as a food source for decay-causing bacteria.

Dental decay is the most common diseases affecting children, and it is the most preventable.  Eating a well balanced diet low in sugars, drinking fluoridated water or using fluoride supplements, tooth brushing after meals, and visiting the dentist at recommended intervals can help prevent most caries or catch decay at an early stage.  Caries in the primary teeth must be taken care of to relieve your child’s pain and to help maintain the teeth until they are ready to be replaced by the permanent teeth.

Inflamed, bleeding gums are not normal but are a sign of dental problems.  Even a young child can have gum disease, which needs the attention of a dentist.  Dental decay in primary teeth or gum disease that is not taken care of can lead to infection or other problems that mat affect the permanent teeth,

Young children exploring their world by crawling, toddling, and attempting to stand alone may fall or bump into things that may injure their teeth and mouths.  Any mouth injury that results in excessive bleeding or a chipped, loose, or displaced tooth needs to be evaluated by a dentist.  If a tooth is knocked out, put the tooth in a cup of water and take it and your child to the dentist as soon as possible.

Thumb sucking is a natural and satisfying behavior for babies and young children.  Most children outgrow this activity by four or five years of age.  It should not be a cause for concern in young children.

As the family grapples with the serious illness and perhaps the imminent death of the baby, the infant must also cope with the consequences of their ill health. An infant’s need to be cuddled is just as great as her requirement for food. She thrives on consistent care from her parents. A baby quickly comes to know and love these special people.

Separations, such as hospitalizations, can be very distressing for an infant.

Parents of children of chronic diseases can sometimes arrange to care for the child at home with or without the assistance of a nurse. Should parents decide to bring their dying baby home, many communities have resources to assist them during this period [such as visiting nurses, home care nursing, and hospital care].

During necessary hospitalizations, most hospitals allow parents unrestricted visiting privileges and often provide facilities for parents to room-in with the sick infant or child. These arrangements give parents the opportunity to participate in the care of their sick baby. Caution must be exercised not to spend so much time with the ill child that the well-being of the parents and other members of the family suffer.

Things to do that can help you cope with an ill or dying baby includes the following:

• Tell the physician and other hospital staff about your needs and the particular needs of your baby.
• Provide the hospitalized baby with her favorite toys and food. Display pictures of the family where she can see them. The entire family should visit the baby as often as is feasible.
• Obtain counseling with a skilled professional.
• Read about the subject. Most bookstore and libraries have many books for all age groups about coping with the illness or death of a loved one.
• Search out support groups, which exist for many types of chronic illnesses of childhood. There are also support groups to help parents adjust to the death of an infant.
• Allow siblings to visit the sick baby in the hospital.
• Attending funeral services that are brief and not morbid will help all family members to understand and except the finality of their loss.
• Keep lines of communication open between family members. Families that can share their feelings and console each other learn that even an enormous loss can be mastered.

Your pregnancy involves very many people besides yourself and your new baby. Your family, of course, is affected. You may have a Lamaze teacher and an exercise instructor. And you will certainly have a doctor; your obstetrician is a partner in your pregnancy. He or she will have the responsibility for you and your baby’s health, so you want to be sure the doctor is qualified and competent. In addition, he or she will intimately participate in a very special event in your life-you want someone with whom you can cooperate and feel comfortable.

Finding the right obstetrician may take some work. You may need to talk to people and visit a few doctors before you are satisfied. You can get recommendations from many different sources. Friends and relatives may suggest their obstetricians. Another doctor, such as your internist, may provide a name. Maternity nurses, or obstetrical residents [doctors in training], at your local hospital often know which obstetricians in the community are good. You can ask the department of obstetrics and gynecology at the nearest university hospital for the names of graduates, or faculty members who work n your area. If these avenues fail, try contacting a childbirth education group, such as the International Childbirth Educational Association, or a local Lamaze instructor.

When you have the name of an obstetrician who sounds promising, your next step is to find more information about her. To be sure she is a competent doctor, check out her training. An obstetrician should have completed an obstetrics residency at a registered hospital and should be certified by the American Board of Obstetrics and Gynecology.

Next, find out which hospital she is affiliated with the hospital should be accredited by the Joint Commission on Accreditation of Hospitals [JCAH]. Find out whether the hospital is a teaching institution. If it is, be sure you understand how residents will participate in your delivery. The hospital should be covenant for you, and it should have the facilities you want or need for your delivery. Some hospitals have only the traditional separate labor and delivery rooms. Others have elaborate birthing centers. If you are at risk for having problems during pregnancy or delivery, the hospital should have an infant intensive care nursery.

Find out about the people the doctor works with. If she works with a group of doctors, they probably take turns being on call at night, if you go into labor on a night your doctor is not on call, will she come in or will one of her partners perform the delivery? If one of her partners may deliver your baby, you will have to be sure that you are comfortable with the other members of the group and that they have the same attitudes towards childbirth as your doctor. Otherwise, the delivery you so carefully planned may be changed at the last minute. Some obstetricians employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement.

Finally, don’t be afraid to ask about finances. Be sure your insurance will cover the doctor’s charges and find out how and when payment is expected. Find out what happens to the charges if there are any complications.

When you have collected your information, you are ready for your first meeting with the doctor. It is a good idea for Dad to accompany you so he can ask questions and form an opinion of the doctor as well. If you haven’t been seeing an internist or gynecologist regularly, it is a good idea to choose an obstetrician before you conceive; arrange a pre-pregnancy appointment to make sure there are no medical conditions that make pregnancy inadvisable at the time. If you have been receiving regular medical care, your first appointment should occur as soon as you think that you are pregnant, usually two weeks after the missed period. During the first visit the doctor will take a complete medical history including discussion of past and present illnesses and past pregnancies. A complete physical exam, not only a pelvic exam, should be done. You should have an opportunity to discuss with the doctor issues about your pregnancy and delivery. Be prepared for this part of your visit. Make a list of questions you want to ask. The obstetrician should be willing to answer any questions and discuss the type of care you will receive. She should be flexible about issues that are important to you, but if she feels that something you want will compromise your care, she should be willing to explain to you why.

You will want to talk about pregnancy and delivery. Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby’s development. Discuss with the doctor what you should eat. How many more calories will you need? How does she feel about you drinking coffee or other caffeinated beverages? What about alcohol consumption? She will probably recommend vitamins and calcium supplements. Discuss with her how much exercise you should get. Would she recommend an aerobics class? Find out what you should do if you become ill. What medicines can you take and what should you avoid? An obstetrician can monitor a pregnancy with blood tests, urine tests, ultrasound studies and amniocentesis. What does she think is appropriate for you?

There are many decisions regarding delivery that should be made beforehand. You need to decide where you want to give birth-in a regular delivery room or in a birthing center. If you want your husband or other children there, be sure your doctor agrees. If you have strong opinions about the medical treatment during labor and delivery, be sure to discuss them with your doctor. For example, some women do not want an intravenous line, anesthesia or an episiotomy [a surgical incision to enlarge the external opening to the birth canal and make delivery easier]. Fetal monitoring is another topic you wish to inquire about. You may want to find out your doctor’s opinions about inducing labor and cesareans. Ask her how many cesareans she performs. If her rate is high, try to find out why. Does she have a high risk population or is she just quick to operate?

By the time you are finished discussing all of these topics, you should have a good idea how well you like the obstetrician. Do you feel at ease with her? While you may not agree on very subject, you should feel confident that you can develop a working relationship and that you can discuss a problem and reach a compromise that will be satisfactory for both of you.

Finding an obstetrician may be easy, or it may require an extensive search. Because the doctor plays such an important role in your life at this time, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and baby delivery will be as safe and as joyful as possible.

Conception occurs two weeks after the women’s last menstrual period. The egg and the sperm fuse to produce one cell. In the first three months, or trimester, the embryo takes shape and all the organs are formed. In the last six months, the fetus grows and matures.

In the first weeks after conception, the single cell rapidly divides into many cells. A hollow ball of cells is formed and becomes attached to the womb. Some of the cells will become the placenta; the rest will become the embryo. The latter group of cells develops into a four-layered disc. Each layer will be converted into different areas of the body. The outer layer of ectoderm, for example will develop into skin, hair, nails and the nervous system. The inner layer, or endoderm, will develop into the intestines and lungs. The middle layers will develop into the heart, bones, and muscles.

By three weeks after fertilization, or about one week after the first period is missed, the embryo already is one-tenth of an inch long and has an oval shape. In the next few weeks, it becomes more curved in shape and a head and tail are discernable. The beginning of the spinal cord and brain take shape. A tubular heart begins to form. Tiny eyes can be seen. Arms and legs begin to bud.

By the fourth week after fertilization, traces of all the organs of the body are present. Bulges that become the ears and nose appear. The gut is formed from blind pouches within the embryo; these push forward, creating an opening in the head that will become the mouth. A crude face begins to take shape. At this point, the embryo is only one quarter of an inch long.

The embryo is called a fetus at the seventh or eighth week. It has grown to be the length of one inch; the head is disproportionately large because of the size of the developing brain, while the abdomen seems large because of the growing liver. Fingers and toes appear. The rudiments of all the hormone- producing glands-the pituitary, thyroid, and the adrenal glands-are present. Amazingly, the tiny heart begins to beat.

By the end of the third month, the fetus is two to three inches long and weighs less than an ounce. Nails form on the fingers and toes. The bones begin to calcify. The male or female sex organs begin to develop. The tooth buds form in the mouth. The fetus begins to make breathing movements and starts to swallow amniotic fluid. The muscles in the intestines begin to contract and relax, as if digesting food. Skeletal muscles begin to work as well, so the fetus can move to response to local pressure.

Although the organs are present by the end of the first trimester, the fetus is not yet able to live outside the mother’s body. The second trimester is devoted to primarily to maturation of the organs. By the fourth month, the fetus moves spontaneously but is too small for the mother to feel. The fetus is four to five inches long and weighs three ounces.

By the fifth month, however, the baby is six inches long and weighs one half pound, and is strong enough to make his presence felt. The mother’s perception of the baby’s movement is known as quickening. In the fifth or sixth month, the body becomes covered in fine hair, or lanugo and coarse hair appears on the head.

The baby is fully developed by the beginning of the third trimester. The last three months, therefore, are devoted to growth. The baby is about ten inches long and weighs one to two pounds by the seventh month. The skin is red, wrinkled and thin. It becomes covered in vernix, a thick, whit, sticky material composed of skin cells, ` and oily skin secretions. If the baby were born at this time, he would have a fifty percent chance of survival, provided he received appropriate medical care. Babies born this early can respond to taste, light, and sound.

If the baby is born in the eighth month of gestation, his chance of survival increases to ninety percent. By this time, he is ten to twelve inches long and weighs three to four pounds.

The final preparations for independent existence occur during the ninth month. Surfactant, a substance that lines the lungs and allows them to expand easily, develops. Fat is stored, and its deposition under the skin smoothes out the wrinkles. Much of the lanugo disappears.

By the final month of pregnancy, the fetus is usually fourteen to sixteen inches long and weighs seven to eight pounds. He is large and strong enough for the next step-birth and independent life. That one cell has come a long way, from embryo, to fetus, to newborn baby.

You’ve made the decision to have a baby. Your menstrual period is late. Should you be elated or is cautious optimism in order? You may suspect you are pregnant by the way you feel, or your doctor may suspect it by findings on a physical exam. But symptoms and signs are just suggestive-the possibility that you are pregnant should be confirmed by a urine or blood test. If the result of one of these tests is positive, you can start rejoicing.

In the first few weeks after conceiving, you may notice changes in your body and in the way you feel. A late menstrual period is often the first hint you are pregnant. However many other conditions, from stress to infections, can delay the onset of menses, so a late period is not a reliable sign until at least two weeks after the expected date. On the other hand, you can have spotting while pregnant, so the presence of some bleeding doesn’t eliminate the possibility.

You may notice some fatigue in the first weeks. You may experience nausea or vomiting, especially in the morning, a week or two after your missed period. Your breasts may have some tingling or tenderness and may even enlarge. The areolae [the area around the nipples] may darken. If you have been having trouble getting pregnant and are recording your basal body temperature, you may find that your temperature continues to be elevated. Just as with a late period, all of these signs and symptoms, if they occur at all, can be contributed to other causes. By themselves, they do not prove, just suggest, that you are pregnant.

If you go to see your doctor when your period is two weeks late, he may find physical changes that suggests you are pregnant. Your vagina and cervix may be blue to a purplish color because of increased blood flow. This is known as Chadwick’s sign. The uterus may feel softer, larger, and rounder. Your doctor may be able to feel intermittent contractions called Braxton-Hicks contractions, even though you may not recognize them.

Many women know they are pregnant before they see their obstetrician, however, because they run a pregnancy test themselves at home. Non-prescription home pregnancy tests are available in any pharmacy and cost about ten dollars. These tests are designed to detect the presence in the urine of the human chorionic gonadotropin [HCG], a hormone produced by the embryo shortly after fertilization.

Home pregnancy tests on the market today vary in sensitivity. Some can detect HCG one day after the missed period. Others require one to two weeks. Some tests must be done on a urine test obtained in the morning, when the concentrations of HCG are the highest; others can be performed on any urine specimen. Some react within ten minutes, but others require one to two hours. No matter which test you use, if the directions are followed carefully, the results are ninety to ninety-five percent accurate.

The tests are easy to perform. You add a few drops of urine to a test tube containing a protein, called an antibody that reacts specifically with HCG. If you are pregnant and HCG is present in the urine, it will bind to the antibody, forming a complex. If you are not pregnant and no HCG is present, the antibody will remain free in the solution. Different chemical reactions are used in the different test kits to indicate whether a complex or a free antibody is present. Positive tests are usually indicated either by a formation of a circle at the bottom of the tube or by a color change in the solution.

Even though these tests are extremely sensitive, there are a few other things that, when present in the urine will cause a positive test result even though the woman is not pregnant. Luteinizing hormone [LH] is one of the hormones that regulate the menstrual cycle. It can cross-react with HCG and give a positive test result. Ordinarily, it is not present in the urine in detectable amounts. However, menopausal women have a high level of LH and can have a positive test result. Women with protein in their urine can have a similar reaction. Protein may be present because of infection or kidney disease, or because certain medications such as tranquilizers, thyroid medications, and anti seizure drugs, have been taken. More common than a false- positive test result is a false-negative one-that is, the test result is negative even though the woman is pregnant. This usually occurs when the test is done too early after the missed period, when the level of HCG is too low to be detected. Low levels of HCG may also be caused by an ectopic pregnancy [a pregnancy that develops outside the uterus], if the first test is negative and your period doesn’t start, repeat the test in five to ten days. If it is still negative, consult your doctor.

If you go to your doctor two or three weeks after your missed period, he or she will probably perform a pregnancy test on your urine that is similar to the home pregnancy tests. The “rabbit test” is no longer used because of the greater speed, convenience, and accuracy of modern tests.

If your doctor needs to know if you are pregnant at a time before the urine test can be used, or if he or she suspects a false-negative result, a blood test that is more sensitive and specific may be used. It measures a part of the HCG molecule known as the beta-subunit. Since LH doesn’t have a beta-subunit, this test can distinguish between LH and HCG because it can measure very small amounts of HCG. It can be used to diagnose pregnancy before a missed period [by seven to nine days after fertilization] or to diagnose a tubal pregnancy [one that develops in one of the fallopian tubes]. This test takes longer [twenty-four to forty-eight hours] to complete, and it is more expensive because it requires special equipment and personnel. Therefore it is not used routinely to diagnose pregnancy.

When you know for sure that you are pregnant, the next question will undoubtedly be “When will my baby be born?” Delivery usually occurs 280 days after the first day of the last menstrual period. An easier way to calculate the delivery, or due date, is to count back three months from the first day of your last period and add seven days. Most women don’t give birth on the exact date, but eighty-five percent do within two weeks of it; delivery is earlier for ten percent and later for five percent. As your pregnancy progresses, your due date can be double-checked by the timing of certain events. For example, the baby’s heart is usually heard at ten to twelve weeks. The level at which the top of the uterus can be palpitated by the doctor can also be used; at twenty-four weeks, for example, it is usually at the umbilicus [navel]. If your obstetrician performs an ultrasound study, a measurement of the baby can be taken and compared with standard tables to estimate gestational age.

Discovering you are pregnant is an exciting moment. The next nine months will be filled with excitement both for you and your family as the changes of pregnancy takes place.

Car accidents are the leading cause of death in children after the first few months of life. Of all deaths due to injury, two thirds are related to motor vehicles. In the one to four year old age group, two thirds of the children who are killed in car accidents are occupants of a car, and one third are pedestrians struck by a car. It has been estimated that eighty-five percent of those deaths and sixty-five percent of those injuries could have been prevented by the use of car seats and seat belts.

Children can be injured by cars in two major ways. Children playing on the sidewalk may be hit by a car that jumps the curb, or they may be struck if they venture into the street. But more commonly, a child is hurt in when a car in which he or she is a passenger is involved in a collision. When a car stops suddenly, the unrestrained passengers continue to move at the original speed until he hits something that stops him. This is usually the interior of the car, but may be the ground if the passenger has been ejected. Children, who are at highest risk of injury in an accident, are those who are held in an adult’s lap. Not only is the child thrown forward into the dashboard, but he is smashed from behind from the weight of the adult. Even if the passenger is belted in, it is nearly impossible to hold onto a child in a crash. For example, to hold on to a ten pound infant in a collision at thirty miles per hour requires the same amount of strength as lifting three hundred pounds one foot off the ground!

To prevent an auto injury to your child, you must address the issue of safety from the point of view of each of the ways in which injury occurs; you have to consider both pedestrian safety and auto safety.

To make sure your child isn’t struck by a car, teach her how to respect the road and to walk defensively. Teach her to play in the yard or on the sidewalk, and to stay away from the street. Try to “keep the eye out” for her. As she gets older, teach her to look both ways before crossing the road. Be sure she knows how to read traffic signals.

To keep your child safe in the car, drive carefully and defensively. Follow the rules of the road. Don’t allow your children to distract you-concentrate on driving. Avoid having any sharp or heavy objects in the car that could be flying missiles in a sudden stop of crash. But the most important precaution doesn’t concern your driving skills, but rather one simple plastic and metal device-a car seat.

Nearly all of the states and the
District of Columbia require child restraints in automobiles.
Tennessee was the first to require them, in 1977. Use of car seats in
Tennessee increased from eight to twenty-nine percent in the two and a half years after the law was enacted. The number of children killed decreased from twenty-two in 1979 to ten in 1981. While states regulate their use, the federal government regulates the construction of car seats. Child seats must meet federal standards for crash protection, standards that are based on dynamic, rather than just static, testing.

Choking is the fourth most common cause of accidental death in children. However, for children under one year, it is the most common cause, ranking above even car accidents. In one recent year alone, 440 infants under a year old choked to death.

Children choke easily. Babies put everything they come upon into their mouths. It is a way of exploring. In your baby’s opinion, everything must be tasted as well as looked at and touched. Unfortunately, infants are not well coordinated, and small pieces can work their way too far back into the mouth and then get stuck.

If something gets stuck, one of two things can happen. If the object is the right size, it can completely close off the child’s airway, causing him to be unable to speak or breathe. Unless removed quickly, the object can cause brain damage from lack of oxygen, or even death. If the object was sucked into one of the smaller airways, the child will cough, wheeze, and have trouble breathing. Often such objects must be removed surgically.

Children can choke on anything small enough. Before disposable diapers, safety pins were a major hazard. Now, pieces of toys, balloons [even uninflated ones], and coins are frequent dangers. Some foods, such as hot dogs, grapes, nuts, and hard candies, as well as vitamins and baby aspirin tablets, can cause choking.

The federal government has taken action to prevent pieces of toys from becoming the objects responsible for choking. The Consumer Product Safety Commission has mandatory safety standards, and the Toy Manufacturers of America has voluntary product standards regulating toys with small parts.

Since children choke on many things besides toys, it is your obligation to watch what your child puts in his mouth and to keep dangerous things away.

Preventing Choking

• Examine your baby’s toys and clothing for parts that could be easily pulled off and swallowed.
• Don’t allow your baby to play with coins, balloons, or other items that could easily be swallowed.
• Cut or bite your toddler’s food into bite sized pieces.
• Avoid giving a toddler such hard, smooth foods as nuts, carrots, and hard candy. Also avoid foods that may become lodged in your child’s throat, such as hotdogs, potato chips, and popcorn.
• Do not give chewable pills or vitamins to children under the age of three.
• Teach your child to chew thoroughly, and discourage talking while chewing.
• If your child does choke, don’t put your fingers in her mouth- you may push the object further in.
• Learn the Heimlich maneuver, or the back-blow/chest-thrust maneuver recommended by the American Academy of Pediatrics.

Diaper rash is the most common infant skin problem.  The rash, usually confined to the diaper area, is caused moisture, urine, stool, or irritating chemicals, usually from the diaper.  If not treated promptly and appropriately, bacteria or yeast may invade the area and start an infection.

Simple diaper rashes are red, slightly rough, and scaly.  They usually only involve the area covered by the diaper. The skin may be irritated by chemicals in disposable diapers or in the detergent used to launder cloth diapers.  Plastic or rubber pants worn over the cloth diapers sometimes affect the skin [and always hold the moisture in against the skin].

If your baby stays in wet diapers too long, microorganisms and moisture can irritate his sensitive skin, leaving a large, bright red rash.  Often you will detect an ammonia odor when changing your baby’s diapers.

Some babies are prone to getting yeast diaper rashes.  The organism that causes the rash is the same one that causes vaginal yeast infections.  The rash is usually found in the skin folds of a baby’s thighs.

Any of the above rashes may become infected with bacteria.  The rash, instead of getting better, begins to get worse.  It will become darker red, with some discharge.  Oral antibiotics may be necessary to clear up such an infection.

Other causes of diaper rash include food and drug allergies, skin infections and contagious diseases [chicken pox or measles].

Most diaper rashes are simple to treat at home.  Make sure your baby doesn’t stay in wet or soiled diapers for very long.  Change his diapers frequently.  If possible, let him go without diapers-letting his sore bottom be exposed to the air is best.  There are many different ointments that are protective.  For some babies, they help the rash clear up quickly, but for others they seem to make things worse.  Avoid airtight rubber pants.  They hold the urine and feces against the sore skin.  If you suspect an allergic rash, stop giving your child whatever you think is the problem food.

Some rashes just don’t respond to home care.  If the rash is getting much worse, if your baby is extremely uncomfortable, or if you can’t figure out what’s going on, give your doctor a call.