Parenting & New Baby Advice Blog

Archive for December, 2007

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.