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Articles
Have a Happy Marriage
Playground Etiquette
How To Know If Your Baby Has a Milk Protein Allergy
Playgroup Rules of Engagement
PICKY EATERS: What Parents Should Know (Part One)
PICKY EATERS: What Parents Should Know (Part Two)
Burn Injuries
Introducing Your New Baby to Your Toddler
Be Good To Yourself
Any Means Possible: My Breastfeeding Story
The MommyDocs Five Simple Summer Safety Tips
HOW TO HAVE A HAPPY MARRIAGE WHEN YOU'RE BUSY BEING PARENTS
By Elizabeth Pantley, Author of Kid Cooperation, Perfect Parenting and Hidden Messages
ElizabethPantley.com
Is your marriage everything you ever hoped it could be? Or has it been pushed down your list of priorities since having children? Let’s face it, parenthood is a full-time job, and it dramatically changes your marriage relationship. But marriage is the foundation upon which your entire family is structured. If your marriage is strong, your whole family will be strong; your life will be more peaceful, you’ll be a better parent, and you’ll, quite simply, have more fun in your life.
Make a commitment
To create or maintain a strong marriage you will have to take the first critical step: You must be willing to put time, effort and thought into nurturing your marriage. The ideas that follow will help you follow through on this commitment and will put new life and meaning into your marriage. A wonderful thing may happen. You may fall in love with your spouse all over again. In addition, your children will greatly benefit from your stronger relationship. Children feel secure when they know that Mom and Dad love each other—particularly in today’s world, where 50 percent of marriages end in divorce; half of your children’s friends have gone, or are going through a divorce; or maybe it’s your kids who have survived a divorce and are now living in a new family arrangement. Your children need daily proof that their family life is stable and predictable. When you make a commitment to your marriage, your children will feel the difference. No, they won’t suffer from neglect! They’ll blossom when your marriage—and their homelife—is thriving.
The surprising secret is that this doesn’t have to take any extra time in your already busy schedule. Just a change in attitude plus a committed focus can yield a stronger, happier marriage.
So here’s my challenge to you. Read the following suggestions and apply them in your marriage for the next 30 days. Then evaluate your marriage. I guarantee you’ll both be happier.
Look for the good, overlook the bad
You married this person for many good reasons. Your partner has many wonderful qualities. Your first step in adding sizzle to your marriage is to look for the good and overlook the bad.
Make it a habit to ignore the little annoying things — dirty socks on the floor, a day-old coffee cup on the counter, worn out flannel pajamas, an inelegant burp at the dinner table — and choose instead to search for those things that make you smile: the way he rolls on the floor with the baby; the fact that she made your favorite cookies, the peace in knowing someone so well that you can wear your worn out flannels or burp at the table.
Give two compliments every day
Now that you’ve committed to seeing the good in your partner, it’s time to say it! This is a golden key to your mate’s heart. Our world is so full of negative input, and we so rarely get compliments from other people. When we do get a compliment, it not only makes us feel great about ourselves, it actually makes us feel great about the person giving the compliment! Think about it! When your honey says, “You’re the best. I’m so glad I married you.” It not only makes you feel loved, it makes you feel more loving.
Compliments are easy to give, take such a little bit of time, and they’re free. Compliments are powerful; you just have to make the effort to say them. Anything works: “Dinner was great, you make my favorite sauce.” “Thanks for picking up the cleaning. It was very thoughtful, you saved me a trip.” “That sweater looks great on you.”
Play nice
That may sound funny to you, but think about it. How many times do you see -- or experience -- partners treating each other in impolite, harsh ways that they’d never even treat a friend? Sometimes we take our partners for granted and unintentionally display rudeness. As the saying goes, if you have a choice between being right and being nice, just choose to be nice. Or to put this in the wise words of Bambi’s friend Thumper, the bunny rabbit – “If you can’t say somethin’ nice don’t say nothin’ at all.”
Pick your battles
How often have you heard this advice about parenting? This is great advice for child-rearing—and it’s great advice to follow in your marriage as well. In any human relationship there will be disagreement and conflict. The key here is to decide which issues are worth pursuing and which are better off ignored. By doing this, you’ll find much less negative energy between you.
From now on, anytime you feel annoyed, take a minute to examine the issue at hand, and ask yourself a few questions. “How important is this?” “Is this worth picking a fight over?” “What would be the benefit of choosing this battle versus letting it go?”
The 60 second cuddle
You can often identify a newly married couple just by how much they touch each other — holding hands, sitting close, touching arms, kissing — just as you can spot an “oldly-married” couple by how little they touch. Mothers, in particular, often have less need for physical contact with their partners because their babies and young children provide so much opportunity for touch and cuddling that day’s end finds them “touched fulfilled”.
So here’s a simple reminder: make the effort to touch your spouse more often. A pat, a hug, a kiss, a shoulder massage – the good feeling it produces for both of you far outweighs the effort.
Here’s the deal: Whenever you’ve been apart make it a rule that you will take just 60 seconds to cuddle, touch and connect. This can be addictive! If you follow this advice soon you’ll find yourselves touching each other more often, and increasing the romantic aspect of your relationship.
Spend more time talking to and listening to your partner.
I don’t mean, “Remember to pick up Jimmy’s soccer uniform.” Or “I have a PTA meeting tonight.” Rather, get into the habit of sharing your thoughts about what you read in the paper, what you watch on TV, your hopes, your dreams, your concerns. Take a special interest in those things that your spouse is interested in and ask questions. And then listen to the answers.
Spend time with your spouse
It can be very difficult for your marriage to thrive if you spend all your time being “Mommy” and “Daddy”. You need to spend regular time as “Husband” and “Wife”. This doesn’t mean you have to take a two-week vacation in Hawaii. (Although that might be nice, too!) Just take small daily snippets of time when you can enjoy uninterrupted conversation, or even just quiet companionship, without a baby on your hip, a child tugging your shirtsleeve or a teenager begging for the car keys. A daily morning walk around the block or a shared cup of tea after all the children are in bed might work wonders to re-connect you to each other. And yes, it’s quite fine to talk about your children when you’re spending your time together, because, after all, your children are one of the most important connections you have in your relationship.
When you and your spouse regularly connect in a way that nurtures your relationship, you may find a renewed love between you, as well as a refreshed vigor that will allow you to be a better, more loving parent. You owe it to yourself — and to your kids — to nurture your relationship.
So take my challenge and use these ideas for the next 30 days. And watch your marriage take on a whole new glow.
Parts of this article are excerpted with permission from books by Elizabeth Pantley:
Kid Cooperation: How to Stop Yelling, Nagging and Pleading Hidden Messages: What Our Words and Actions are Really Telling Our Children,
New Harbinger Publications, Inc. and by McGraw-Hill/Contemporary
PLAYGROUND ETIQUETTE
By Belinda M. Cermola
The author is an Etiquette and Protocol Specialist and Owner of “Common Ground Etiquette.” CommonGroundEtiqutte@yahoo.com – 703-467-7544 – Building a Community of Excellence.
When I was growing up my dad would take me to the playground every afternoon during the summer. I loved playing on the monkey bars, teeter-totter, the swing (my favorite) and the merry-go-round. I can close my eyes and see myself sometimes waiting in line to swing myself, and sometimes not wanting to give up my swing, until I heard that familiar but firm voice: “Common Bella, its time to take turns and share. Let someone else enjoy the swing.” Sounds familiar?
For a child, the playground is one of the most amazing and fun places to go to, but it can sometimes be a daunting place for parents. And why is that? Because even though there are no posted playground rules, everybody is supposed to know how to act and “play nicely” with one another, but there are parents that choose to ignore civility and controlling their children.
How can etiquette apply to the playground? It’s very simple. The playground is a great place for your child to learn how to share, get along with others, make new friends, be kind, and play in a safe manner, among other things. And I dare say, sometimes us adults, can pick a few lessons as well.
No matter how young your child is, at the playground he/she will develop social and development skills and learn to become a pleasant playmate. The following are a few suggestions to consider when at the playground:
1- Before leaving the house, make sure your child bring along the golden rule along: “Do unto others as you would have them do unto you.” Magic words are still “on” no matter what, please, excuse me, sorry, may I – yes those words. Remind them to share, take turns, and ask permission to use a toy that doesn’t belong to them.
2-Try to go to the playground when it’s not very crowded. When children have enough room to play they don’t become cranky and will fight less. Plus less time will be spent in line waiting in to use a particular equipment for play.
3-Make sure your child uses age-appropriate playground equipment. If an older child is using the same equipment and may be playing way too rough or hog the equipment, remove your child and engage him/her elsewhere. You can also say to the older child: “Tommy and I will come back once you are done playing.”
Some playground equipment are for all ages, and your child may be older than other children playing with the slide for example. If your child is running up the slide instead of using the ladder, he may hurt someone if they crash. Make sure you remind him/her to use the equipment in the proper manner it was meant to be used.
If you would like to obtain more information on playground equipment and safety for your children I recommend you to check or download the "Handbook for Playground Safety" online at http://www.cpsc.gov/cpscpub/pubs/325.pdf or obtain a free copy by writing to Consumer Product Safety Commission (CPSC), Washington, DC 20207. It contains very useful information.
4-Always supervise your child, don’t get too distracted talking to the other parents. It is your responsibility as a parent to keep an eye on them especially if there is dangerous play, grabbing, hitting, name-calling or hitting involved.
If this situation happens, take a moment to listen to your child. Children cannot always articulate their feelings when someone has hurt or injured them. Even if you cannot "right" the situation, you can always sympathize, talk, and comfort your child in private so he/she knows that their feelings have been recognized.
5- Remain firm on family rules for playing. When handling fights be calm, patient, and be ready to call numerous "time outs." If you need to remove your child from a wrong situation let them know why he/she is being punished.
If your child is being trailed by a bully do not hesitate to intervene and talk to the bully, his parent or both. Be polite but firm with a bully, they are not used to hearing a firm “No;” that goes with the parents also.
6- When you find a situation with a stubborn child impeding yours and others to play on a particular piece of equipment, it is perfectly fine to address the child and ask him kindly but firmly to cooperate with you. For example, “Tommy, there is a long line waiting to use the slide but you’re sitting at the end of it, if you don’t move you may get hurt.” Now remember, it is not your place to discipline another person’s child. If the child won’t cooperate it is OK to ask the parent to talk to him. Do not apologize for telling the other parent about their child, it is not your fault that their child is misbehaving.
In other instances, be prepared to redirect your child’s activity when finding a bully or a parent that is not ready to discipline nor teach their child to share.
Teach your child that one person's bad manners do not have to ruin a good time.
7-Never offer a snack or juice to another child without consulting or asking for their parent’s permission first. The child may be allergic to the snack or have certain dietary restrictions you are unaware of.
8-If your child is at the swing or teeter-totter and there is a line of children waiting in line, let him/her play for five or ten minutes and explain that there are other children in line waiting to play. This is a good way to teach them how to share and also a good opportunity to teach them how to take turns.
On the other hand if you are in line for more than 20 minutes, it’s okay to ask the mother “my daughter has been waiting for more than 20 minutes, is you son almost done?” Hopefully she will get the hint.
As times evolve, keep in mind that the playground will always be the place where you will see the most diverse use and diverse representation. There will always be people of different races and cultures, and new definitions of family; ultimately it all comes down to the parents to teach their children to choose civility towards others always.
See you at the playground!
HOW TO KNOW IF YOUR BABY HAS A MILK PROTEIN ALLERGY
Sona Sehgal, MD, gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at Children’s National Medical Center, offers information on how to identify infantile food allergies.
Milk protein allergies are often discovered during infancy. Many children who are intolerant to milk protein can be intolerant to soy protein as well. It is important to recognize this condition because it can contribute to symptoms like bloody stools, diarrhea, and poor growth. There are effective ways to address a milk protein allergy. The following are answers to questions parents often ask about milk protein allergies.
Can an infant develop a food allergy?
Yes, food allergies can be seen at any age. Food allergies are usually caused from proteins we consume. Because infants are mostly exposed to cow’s milk protein or soy protein through breast milk or formula, these foods are the most common culprits.
How will I know if my baby has a milk or soy allergy?
Most often the babies have mucus or streaks of blood in the stool. The baby may be completely well otherwise. Some infants can have frequent watery stools. Occasionally, a milk protein allergy can also cause vomiting, which might have streaks of blood. These infants can be irritable even though they are on medications for reflux.
When should I see a doctor about my child’s allergy?
Consider going to the doctor if the baby has blood or mucus in his or her stools, if the baby is very fussy throughout the day, or if the baby does not gain weight appropriately.
Does my baby have to go through a procedure to make the diagnosis?
Most of the time, the baby can be given a trial diet that is free of the allergy-causing protein. If this resolves the symptoms, then it serves as a method to diagnose and treat the problem.
Can my doctor confirm the diagnosis of a milk protein allergy by doing a test?
The only specific test is an endoscopy where a gastroenterologist takes a look inside the gastrointestinal system. Small tissue samples taken during the procedure might show allergic changes.
How is a milk protein allergy managed?
Because the symptoms are caused by the body’s immune system reaction to the protein in milk, the treatment involves removing milk protein from the diet.
There are several specialized formulas that are available for this. In some formulas, like Neutramigen, Alimentum or Pregestemil, the milk protein is broken into very small fragments that the immune system often does not recognize as a foreign protein.
In a small percentage of babies, these formulas may not be adequate, as their immune system is very sensitive and able to recognize even these tiny fragments of protein. In such circumstances a very special formula, like Neocate or Elecare, where the tiny fragments of milk protein are further broken down into building blocks of proteins called amino acids, might be used.
What if I want to breastfeed my baby?
Babies who are breastfed are exposed to cow’s milk protein or soy protein through the mother’s diet. Once a mother consumes foods with these proteins, they are secreted in the breast milk. Therefore, the mother would have to restrict her diet in these foods to be able to successfully continue breastfeeding her baby. It takes about two weeks of a restricted diet for a mother’s breast milk to be free of milk or soy proteins.
I am planning my second pregnancy. Is it possible that my next child could also have a milk allergy?
Milk allergies tend to run in the same family. It typically worsens with successive births.
Is there anything I can do to prevent allergies in my next child?
If the first child has a significant allergy to milk, the next child can be put on a formula with milk protein broken into small fragments. These fragments are not small enough to treat a baby who has an allergy to milk, but can be used to decrease the chance of developing an allergy. Good bacteria called probiotics, which are given to pregnant and nursing mothers or infants with other allergic conditions like eczema, have shown to be beneficial and can be considered. Probiotics are available in health food stores or pharmacies.
How long would my baby have to be on a special diet? Can he ever outgrow this allergy?
Babies are usually on milk and soy protein-restricted diet for the first year of life. Most of them usually can take milk and soy after that. However, it is recommended that such babies should not be given eggs until two years of age and nuts and fish until three years of age to prevent the development of allergies in the future.
Is it a good idea to put all babies on these special formulas?
No. Milk or soy protein allergies are seen only in a very small percentage of babies. Exposure to proteins through formula and breast milk has been shown to help in maturing the infant’s immune system, so that when he or she is exposed to a wider variety of proteins as they grow up, they are more competent to do so. If a mother’s diet is excessively restricted, it impairs the quality of the milk. Special formulas do not taste great and they tend to have a bad odor. They are also more costly than regular formulas.
Dr. Sehgal is a gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition. She sees patients at Children’s Outpatient Centers in Annapolis and Upper Marlboro. To schedule an appointment with the Division of Gastroenterology, Hepatology and Nutrition, call 202-476-3032.
Playgroup Rules of Engagement
By: Belinda Cermola
Common Ground Etiquette
commongroundetiquette@yahoo.com
In our times playgroups have become a viable resource and fantastic experience for new and veteran mommies and their children. If you are a stay-at-home mom a playgroup will help in developing your child’s social skills and offer him/her the opportunity to play with someone else other than a sibling. Being a mom is so special, that it becomes even more when you can share similar experiences with other moms like yourself. And let’s not forget the fact that it also gives you the opportunity to leave the house and interact with other adults!
When meeting with a playgroup for the first time it is important that you go with an open mind. I remember when my cousin Teresa told me she was joining a playgroup with her 10-month old child. That first day she called me and said “I have nothing in common with these women, what should I do?” Playgroups are not a system where everybody is alike, and that’s OK. So give it a try several times before you make up your mind that this group is not working for you. I am happy to inform that today my cousin is about to have her second child and can’t wait for “playgroup sessions” with the same ladies she thought she had nothing in common with.
Playgroups are a wonderful way for your child to develop social skills, it is also a way in which we get to practice ours. And it is very important that every playgroup sets ground rules to avoid problems in the future. In this way, being a new or old member, everybody knows what to expect and how to conduct themselves. These rules of engagement will also avoid friction between the moms and will help clear the air when one is at fault. Even if you have an informal or large group you should always set rules from the beginning.
Suggestions of pre-set rules:
1-It is important to meet your playgroup moms before and talk about rearing philosophies to avoid future problems. That way everyone will more or less be on the same page on what to expect of the children’s behavior.
2-Agree on number of children and age group you will allow. (If an informal group I would suggest not more than 6 for a home setting).
3-Agree on date and time every week to meet up.
4-Have a group site or roster sheet with mom/child names, birthdays, addresses, telephone and email addresses of each member.
5-Rotate hosting duties and let host mom know what her responsibilities will be: (set-up, snacks, refreshments, and clean-up). If you have a large playgroup you can divide into small groups to host “at home” play sessions according to age.
6-Agree on snacks and make a list of appropriate foods and beverages. Remember to post allergies in case any of the children cannot eat certain foods. (Remember that colorful or messy foods may stain your carpet or furniture).
7-Agree on the rule that if a child is ill with a bad cold, fever, and/or diarrhea or in any other way, they should not attend to playgroup. You do not want to put other children at risk.
8-Agree on winter and summer activities, flied trips, swimming pool.
9-Ask for volunteers with activities such as storytelling, singing, arts and crafts.
10-If a mom breaks the rules or acts in a way that alienates other members, have closest mom/friend to talk to her in private and explain how the group feels in order to clear the air and keep peace. (Yes this happens more than you might think)
11-If you have child that is not walking yet, set a separate area for them to play and ask moms to keep older children separate for safety reasons.
12-Agree if you will accept or not to receive a child with their nanny in case the mom has an important appointment and can’t make it.
13-Try to plan an "Just Moms" event every once in a while to get to know the other moms in a different setting.
Common courtesies for playgroup members and other rules of engagement:
-Never arrive too early nor too late. If arriving more than fifteen minutes late please call host mom and let her know you are on your way.
-If you cannot make it, it is polite to let host mother know.
-Don’t forget to follow the host’s house rules. You will appreciate this when it’s your turn to host.
-Always offer to help when clean up time is due (even if it’s the host mom’s duty). You will appreciate when the favor is reciprocated.
- Avoid excluding other members, every member is an ambassador of the playgroup and should make everybody feel happy and comfortable.
-Its OK to put away your child’s favorite toys away before playgroup arrives. Don’t hide all the toys, and just leave the old ones, just the ones that you know your child will have problems sharing (example: nap-time teddy bear).
-Never ignore your child’s unacceptable behavior.
-Never discipline another mom’s child.
-Don’t let your child run around with food or drink in hand.
-Never take playgroup time as baby-sitting service.
-Share other local activities that the children may benefit from or post on group’s website. This may include great baby sitters references in your area.
I believe that joining a playgroup can make a difference in your “mommy” life and help you and your children get the most out of the "at-home" years. I hope you enjoy it to the max!
PICKY EATERS: What Parents Should Know (Part One)
Irene Chatoor, MD, psychiatric director of the Feeding Disorders Program at Children’s National Medical Center discusses pediatric eating disorders, how to distinguish them, and when to get help. A pioneer in her field, Dr. Chatoor was the first person to classify types of pediatric feeding disorders.
If your child is a picky eater, you are not alone. According to several national studies, 24 percent of parents are concerned that their child is a picky eater. Doctors and researchers have found that many picky eaters have sensory food aversions (SFA) that cause them to eat only certain types of food. SFA is the most common feeding disorder seen in the Feeding Disorders Program at Children’s National Medical Center.
SENSORY FOOD AVERSIONS
Children with SFA consistently refuse to eat certain foods because of taste, texture, smell, and/or appearance. This is different from children who refuse to eat a particular food one day, but eat it the next.
Food aversions are common and vary in severity – some children refuse only a few specific foods and others refuse entire food groups, such as vegetables, fruits or meats.
While SFA can affect people of all ages, it becomes evident when young children are introduced to baby and table food.
SUPER TASTERS
The sensitivity to taste, texture or the smell of foods runs in families. Just as peoples’ vision can vary, so can the ability to taste. Studies have found that in general, people fall into three groups: non-tasters, tasters and super tasters. Super tasters have the largest number of taste buds on their tongues; therefore, foods have a much stronger taste, making many foods unappealing for them and often causing SFA.
SIGNS OF SFA
Children with SFA have reactions to certain foods that can be as mild as grimacing or as severe as gagging, spitting out the food or even vomiting. After experiencing the initial reaction, children with SFA usually refuse to continue eating that particular food and can become very distressed if forced to do so.
In fact, after a bad experience, some children tend to generalize and refuse foods that look and/or smell like the aversive food. For example, children with an aversion to peas may generalize the dislike to include all green vegetables.
Many children with SFA also are reluctant to try new foods for fear of having another episode, such as gagging or vomiting. Instead, they may eat a limited number of foods that they know are safe and will not cause a reaction.
Some children are so sensitive that they will refuse to eat any foods that touch other foods on their plates, while others eat only foods of specific brand names or from a specific restaurant. For example, some children with SFA will eat only chicken nuggets if they come from a specific fast-food chain.
EFFECTS OF SFA
If a child with SFA refuses to eat foods from an entire food group, such as vegetables or meats, his or her diet may lack vitamins, minerals and/or proteins that are important for a child’s health. In addition, if children reject foods that require significant chewing, such as meats or hard vegetables, they may fall behind in oral motor development because of the lack of experience with chewing. Delayed motor development can lead to difficulty with articulation.
There also may be long-lasting implications of SFA. It can cause older children to avoid social situations, such as birthday parties, sleepovers or summer camp, that require them to eat in front of others because they are embarrassed they aren’t able to eat the same foods as their peers.
TIPS FOR PARENTS
- If your child has gagged or vomited while eating a certain food:
- Do not offer that food again.
- Continue eating the food and other foods your child may not like so that he or she can see you eating and enjoying these foods. Young children want to do what their parents are doing. However, you should not try to coax your child into eating these foods. The harder you try, the harder he or she will resist.
- Give your child foods he or she can tolerate, while still incorporating all food groups.
- If your child grimaces after eating a certain food, offer your child the food later, but do not force the issue or your child will likely become anxious.
- Children with SFA will eat foods they prefer. If your child resists eating broccoli, offer another green vegetable, such as green beans.
Remember, these tips are for children who consistently refuse to eat certain foods. Children with SFA appear anxious or fearful of the foods they dislike. This is different from children who refuse to eat a particular food one day but eat it the next day as a way to exercise control over a parent.
WHEN TO ASK FOR HELP
Parents should consult their pediatrician if their child refuses to eat foods from an entire food group, such as fruits or vegetables, or if the child refuses to eat such a large number of different types of food that parents are worried he or she is not receiving enough nutrients.
TREATMENT AVAILABLE
When pediatricians refer patients to Children’s National for treatment of SFA, patients and their families are seen by the multidisciplinary Feeding Disorders Program, which consists of specialists in Gastroenterology, Nutrition, Hearing and Speech, Occupational Therapy, and Psychiatry. Children’s
Feeding Disorders team has seen patients for more than 15 years and conducted several feeding disorders studies. The team sees nearly 100 new patients annually.
In preparation for the first visit, parents are asked to keep a food diary of everything their child eats for three days. During a child’s first visit, a nurse practitioner in Gastroenterology takes a medical history and performs a physical exam and then gives the child’s food diary to a nutritionist to input into a computer program, which determines if the child is receiving adequate nutrition.
During the second visit, a psychiatrist and occupational therapist observe the child during a feeding with the primary caregiver. They observe the child’s behavior, noting whether or not the child is refusing food and if the child is staying in his or her chair, and also look to see if the child is chewing properly.
After the observation, the doctors ask the parents more questions about the child’s eating history. Then, the entire Feeding Disorders team meets with parents while the child plays. Each team member presents his or her observations and a final diagnosis and personalized treatment plans are discussed.
If you suspect your child has sensory food aversions, consult your child’s pediatrician. To contact Children’s Feeding Disorders team, please call 202-476-5960.
PICKY EATERS: What Parents Should Know (Part Two)
Irene Chatoor, MD, psychiatric director of the Feeding Disorders Program at Children’s National Medical Center discusses pediatric eating disorders, how to distinguish them, and when to get help. A pioneer in her field, Dr. Chatoor was the first person to classify types of pediatric feeding disorders.
A feeding disorder commonly seen by the Feeding Disorders Program at Children’s National Medical Center is infantile anorexia (IA), which occurs when infants or children lack an appetite and don’t want to eat food.
INFANTILE ANOREXIA
Infants or children with IA lack an appetite (“anorexia”) and do not want to be bothered with food, but would rather play. This is different from sensory food aversions (SFA), where children have a good appetite and will eat if given foods they like. IA is also different from anorexia nervosa, which causes individuals to have an intense fear of gaining weight and to purposely not eat. Children with IA don’t have a fear of eating.
They simply don’t like to eat and usually will eat only small amounts of food.
IA is the second most common feeding disorder seen by Children’s Feeding Disorders Program and it is not uncommon for patients to have a combination of IA and SFA. Those children refuse to eat certain foods and only eat small amounts of foods even when given foods they like.
SIGNS OF IA
Although some babies show signs of IA, children usually begin showing signs between 9 and 18 months of age. During this time, a child’s world expands, as he or she begins walking, talking and transitioning to spoon- and self-feeding. Overall, children with IA have problems gaining weight and growing. They show a higher level of mental, physical and emotional arousal than other children their age and have problems shifting into a lower gear to do things with a lower level of arousal, such as eating, sleeping and relaxing.
Feeding time
At feeding time, children with IA may:
• Show hardly any signs of hunger.
• Often refuse to eat any more after only eating a few bites. The few bites they do take seem just enough to take the edge off any hunger they may experience.
• Throw feeding utensils/food and frequently try to climb out of the high chair or leave the table to play.
• Be more interested in their surroundings and would rather play and interact with their caregivers than eat.
• Not want to go in their high chairs because it’s boring. In addition, even as babies, children with IA are easily distracted during feedings. For example, a baby with IA would not be able to eat in a shopping mall, or similar noisy environment.
Behavior
Typically, children with IA:
• Have a big appetite for life –they love talking, playing, etc.
• Are very bright, perceptive and curious.
• Have average or higher than average cognitive development.
• Have problems calming down at bed time and falling asleep.
• Are active, but focused, and engaged. Sometimes, the symptoms of IA can be confused with attention deficit hyperactivity disorder. The difference is that children with IA are focused on their activities.
Children with infantile anorexia would rather play than be bothered with food.
EFFECTS OF IA
If older children continue to eat small amounts, their height may be stunted. For example, a 9-year-old might be mistaken for a kindergartner. In some cases, this short stature may affect a child’s ability to play sports because he or she is too small to play with peers and coaches fear the child will be hurt. The good news is that if children begin eating adequately before the end of puberty, they can catch up in their height.
In general, IA does not affect a child’s cognitive development. Whatever little the child does eat seems to go straight to the brain/head and whatever nutrients are left over go to the rest of the body. This results in a child having a normal head on a small body.
When a child has IA, it often creates stress for the entire family. Parents worry about their child’s poor food intake and failure to grow and they try everything from distracting, bargaining and coaxing, to threatening to get a child to eat more. The conflict surrounding feeding can carry over to the rest of the interactions between the child and parents. This conflict can affect a child’s development and can bring down a child’s IQ.
WHEN TO ASK FOR HELP
Parents should consult their pediatrician if their child refuses to eat and grow properly. A pediatrician may refer a parent to a specialist if his or her child is not gaining weight and growing appropriately.
AVAILABLE TREATMENT
Children with IA need to experience both hunger and fullness. They need specific feeding guidelines so they can learn to eat until feeling full instead of eating a few bites and becoming distracted. The Feeding Disorders Program includes teaching parents to structure mealtime and to use self-calming time outs. Most of what the program teaches parents and children can be described as common sense; however, it is hard for parents and children to implement these techniques without guidance. Generally, treatment for IA is not time-consuming, but it does require real interaction between the parents and therapist. Typically, the program includes several sessions, for a total of six
to 10 hours.
TIPS FOR PARENTS
• Don’t blame yourself. When a child does not eat, it is common to become worried, anxious and upset and to blame yourself because it goes to the core of parenthood. However, IA has not been shown to be a result of poor parenting. In fact, doctors have reasons to believe that IA has a genetic predisposition. For example, the Feeding Disorders Program has seen 10 pairs of twins. In the nine pairs of fraternal twins, only one twin had IA. In the one pair of identical twins, both had IA. If IA was caused by parenting, both fraternal twins would have the disorder.
• Don’t pressure your child or invent new ways to get your child to eat. Because parentsare often worried about theirchildren’s poor growth, they feelthey need to coax, distract,threaten, and entertain. Sometimes they force their children to eat. These methods may work initially, however, they are not long-term solutions. In fact, the more these behaviors go on during mealtime, the more the children become completely unaware ofhunger and their food intake becomes externally regulated by their parents. Kids also become bored with the distraction technique, and parents have to come up with moreand more creative ways to distract them.
• Don’t let your child have control. Toddlers are veryperceptive and realize theyhave enormous control becausetheir parents will do anythingto get them to eat. It is notuncommon for them to makeunreasonable requests, suchas asking for macaroni andcheese at 2 am, just because they want to test their parents. It is not healthy to have a 2 year-old “executive” in your home.
If you suspect your child has infantile anorexia, consult your child’s pediatrician. To contact Children’s Feeding Disorders Program with questions, call 202-476-5960.
BURN INJURIES
By: Lisa Ring, MSN, CPNP-AC, PC, Nurse Practitioner for Children’s Emergency Trauma and Burn Services, offers information on the most common burns and advice on how to avoid them. The Burn Clinic team at Children’s National Medical Center sees approximately 200 burn victims a year.
Burn injuries are the fifth leading case of unintentional injury related death in children. Many of these injuries occur during the colder months when families are indoors and preparing hot meals more often. Keep your children safe this winter by learning about the most common burns, how to prevent burns and how to treat them.
THE MOST COMMON BURNS
Thermal burns from heat sources are the most common burns. The two most common types of thermal burns are scald burns from hot liquid or steam, and contact burns, which are a result of touching a heat source.
SCALD BURNS
According to Safe Kids Worldwide, nearly 65 percent of burn related injuries in children under four years of age are caused by scalds. A child exposed to hot tap water at 140 degrees Fahrenheit for just three seconds can sustain a third-degree burn – an injury that typically requires skin grafts and hospitalization. More than 50 percent of patients admitted to the Children’s Burn Clinic have scald burns from water or foods. Some examples include:
• Toddlers pulling cups of hot water or coffee from counters, spilling the contents on themselves
• Children spilling instant soups or other instant meals, which are often extremely hot and can be overheated
• School-age children preparing meals on the stove or in a microwave stove, who burn themselves when they spill heated foods
• Parents spilling heated formula or breast milk on infants
CONTACT BURNS
Children’s Burn Clinic team also treats many contact burns when children touch:
• Irons (both clothing and curling)
• Stove tops
• Oven doors
• Treadmill belts
• Glass panes in front of fireplaces
• Space heaters
TIPS FOR BURN PREVENTION
In your home:
• Set your water heater at 120 degrees Fahrenheit or lower, if you are able to do so
• Use only cold water vaporizers
When cooking or preparing food in the kitchen
• Avoid holding children. In fact, try to keep young children out of the kitchen while you are cooking
• Make sure your children are not within reach when you remove food from the stove, oven, or microwave by providing a safe place, such as a playpen, highchair or playroom
• Turn pot handles in, away from the edge of the stove, and out of the reach of little ones
• Avoid setting hot foods or liquids near the edge of a counter, or within a child’s reach. (It is especially important to keep this in mind if you have a toddler. Toddlers are very curious and can’t anticipate dangerous situations.)
• Avoid letting your school-aged children boil water, either on the stove top or in the microwave, when preparing meals
• Keep hot fluids, such as coffee mugs and instant soups, out of the reach of children
• Make sure your fire extinguisher can be easily reached
In the bathroom:
• Test bath water to make sure it isn’t too hot
• Supervise your children while they are bathing
• Don’t leave curling or straightening irons within a child’s reach
WHAT TO DO IF YOUR CHILD SUFFERS A BURN
• Remove the burning source
• Get your child to safety
• Call 911 if your child has suffered a scald involving the face and chest or a flame burn
• Apply cool water if it is an external burn to stop the burning
• Don’t put anything, such as ointments or creams, on the burn – simply cover it with a clean, dry towel or cloth
• Take your child to his or her pediatrician or an Emergency Department to evaluate the burn and to obtain directions on treatment
Contact Children’s Burn Clinic by calling 202-476-2162.
Safe Kids Worldwide, founded by Martin R. Eichelberger, MD, a surgeon at Children’s National Medical Center, is a global network of organizations whose mission is to prevent accidental childhood injury.
INTRODUCING YOUR NEW BABY TO YOUR TODDLER
Children’s National Medical Center’s renowned developmental psychologist Penny Glass, PhD, offers tips to parents on how to educate your toddler about the arrival of a new baby.
New babies bring joy and happiness to families, but they also bring change. While most members of your family will adapt well to your new bundle of joy, you might have a few obstacles to overcome if you have a toddler 2 to 3 years of age in your family. To have a happy
household when your new baby arrives, try these tips on preparing your toddler for the new sibling.
Talk Openly
It’s important to talk openly about the new baby with your toddler. Make sure your child is aware that a baby is coming and explain what will happen in the months to come, from mommy’s growing stomach to the arrival of the baby. Encourage your toddler to ask questions and answer them honestly.
Don’t Ask Your Toddler to Give Up Their Crib
If your toddler is sleeping in a crib, do not ask him or her to give it up for the new baby. Your toddler has been living in his or her crib, making it a comfortable, familiar, and safe place. You may believe this is a great time for your toddler to graduate from a crib into a big bed, but in reality, this just creates chaos by upsetting your toddler and a regular bed allows your child to run around the house at will. In the end, buying a second crib will be a better decision for the family.
Practice Having Mommy Go Away
Toddlers are usually most distressed by their mommy going away overnight. Having brief opportunities for mom to go away before the baby arrives is great practice for the big day. Choose a caregiver who will stay with your child when the baby is born and have him or her spend time with your child several times before the baby is born. Establish a routine with the caregiver and plan to have mom go away overnight at least once before the baby is born, so your toddler is familiar with the caregiver and the routine.
Write a Story Book
Writing a story book is a great way for you to explain to your toddler what will happen when the new baby comes. There are many web sites that allow you to create unique stories with your child’s name and his or her personal photos. In the story, explain exactly what will happen when the baby comes. Tell your child who will take care of him or her, where mommy will go, when your toddler can visit mommy and the new baby in the hospital, and what will happen when the baby returns home. If you can’t make a book, there are similar themed stories at bookstores.
Keep Your Toddler’s Routine
When the new baby arrives, try to keep your toddler’s routine the same. This means your child should still wake up and go to sleep at the same time, in addition to following his or her normal daily schedule. If your toddler goes to pre-school or day care, make sure he or she attends as usual. Visits to the hospital should be fit into the normal routine, to avoid taking your toddler away from pre-school to see the new baby.
Act as if the New Baby is a Gift
Often times, parents act guilty and apologetic toward older siblings, as if they’ve done something wrong to the child by having a new baby. Instead, act as if you’ve given your toddler a wonderful gift, the best gift in the world — a sibling. “You’re special and I love you,” you can say to your child, or you can say, “The best thing I could give you is a new sister or brother.” Your toddler will pick up on this positive attitude.
Avoid Spoiling Older Siblings
Remember, a new sibling is the greatest gift you can give your toddler. Do not turn the arrival of your new baby into a holiday for your toddler. Instead, stash books away before the baby is born and give one to your toddler if a gift is absolutely needed. To avoid needing gifts to make toddlers happy, try not to open baby gifts in front of them.
Invite Toddler to Join Baby’s Meal Times
When feeding the baby, offer a small meal, like a quarter of a sandwich and milk to your toddler. Do this every time you feed the baby and make sure you give your toddler small meals, not snacks. Invite your toddler to join you and the baby for this meal, just like you would invite your toddler to share in a meal with guests.
Make Older Siblings Feel Loved
Toddlers sometimes view love like a cookie. Before their sibling arrived, they had the whole cookie, or all of their parents’ love. Now, they feel they have to share the cookie with their new sibling. Explain to your toddler that love is not like a cookie. You can tell your toddler, “Mommy and daddy’s hearts just get bigger.”
Handle Little Helpers
Older siblings often want to help with the new baby. While it’s great to have a helpful toddler, they simply can’t help with everything. Instead of telling eager toddlers what they cannot help with, explain to them what they can do. Making a book is helpful in showing toddlers what they can do. Some suggestions for this “What Big Brothers and Sisters Can Do” book include:
• Bring diapers when the baby needs changing.
• Keep family members and guests from making too much noise while the baby is sleeping.
• Kiss baby’s toes. (This keeps the toddler away from the baby’s face.)
• Wash your hands to keep germs away from the baby. If your toddler asks you if he or she can do something with the baby, consult with the book to see what it says.
Dr. Glass is a developmental psychologist and director of Children’s National Medical Center’s Child Development Program. To contact The Division of Psychology, call 202-476-5995.
Be Good To Yourself
Sometimes I just can’t think anymore. My brain is tired, while my body is wide awake. Do you ever feel like that? I want to do something mindless, yet rewarding. Some people do a crossword puzzle or read a book. For some it’s watching tv or a video. Sometimes I fold laundry. It’s very satisfying to me to fold a pile of clean laundry and stack it neatly in a basket. But my favorite way to do something mindless yet rewarding is to organize something. Can you relate to that? I’ll line up all the books on a shelf in size order or alphabetically. Or I’ll go through the loose playing cards that have gotten all shuffled up and separate out
the full decks, getting rid of the decks missing cards. It’s so relaxing for me to take the junk drawer in the kitchen and dump it out on the counter. I start by wiping out the drawer so I can begin again with a clean, empty space. Then I get various kinds of dividers. They might be boxes that checks come in or the microwavable trays from Stouffers small lasagna. I even might use the icing cup that comes with Pillsbury sweet rolls or a plastic film canister. And Wow! I find such treasures. It’s fun to sort through it, throw away the trash and then put it all back in a neat, orderly way. It’s a thing of beauty to look at. I can see what’s actually in the drawer and I can find it when I need it. Ahhh. To me, it’s as good as spending a few hours at the spa. Give yourself a pat on the back for being good to you. Til next time. Ritzya, The Organization Queen
Any Means Possible: My Breastfeeding Story
By Tina M. Kinney Home Staging Consultant, ASP
Elegant Home Styling
Serving Northern Virginia 703-304-6201
eleganthomestyling@yahoo.com
www.eleganthomestyling.com
www.stagedhomes.com
When I was little, my mother told me that she breastfed me for so long that when she weaned me, she had to put ginger on her nipples. There is a running rumor in my family that I was breastfed till I was 4 years old. But according to my mom, I was breastfed till about 18 months old.
When I became pregnant with my baby, I always knew that I would breastfeed her. While at a government job years ago, I evaluated the Women, Infants and Children (WIC) program and became the resident breastfeeding expert. This solidified my belief that breastfeeding was best for my baby.
I knew that there were potential problems. I had family members who experienced bleeding nipples because of breastfeeding. I prayed I wouldn’t have that problem. But I ended up having lots of other problems.
My baby Lily was born in September 14, 2006. She was 11 days early. She was a surprise frank breech. But she was born a healthy baby and that’s all I could ask for. As soon as I was able, I breastfed her. It hurt the very first time. My milk had not come in but I had colostrum. Friends and family told me it would hurt the first week but that it would get better when I got used to it. After several days at the hospital, we went home. I already had not gotten a lot of sleep because of the all-night feedings and I was still recovering from the c-section. Breastfeeding really hurt. By the time she was six days old, I was ready to quit. It hurt too much.
Luckily the Birthing Inn at
Loudoun Hospital has drop in lactation classes so I decided to attend. They determined that Lily was not latching on right. In fact, she had a high upper palette (the upper inner area of the mouth) and the lactation consultant theorized that she sucked while she was in the womb. She was doing the same thing now but she was doing it so hard her mouth was like a little vacuum. In fact the lactation consultant exclaimed, “She’s sucking the crap out of my finger. How did you put up with this for six days?!” We came up with a plan of action. I would pump my breast milk and my husband and I would train Lily to suck correctly by feeding her breast milk with a syringe and letting her suck on our finger. We did this for a full week and by the end we were really exhausted. I tried to breastfeed her after the week of “training” and it still hurt so I decided to try to pump exclusively. However, her appetite really increased and I could not keep up with her appetite by just pumping. I was frustrated. It was extremely hard to breastfeed because it hurt. And I thought it was Lily still not latching on right. I was trying hard not to resent her. I didn’t want to be mad at my baby for causing me pain. I did some research on high upper palettes and incorrect latching and learned that most babies grew out of this. So I knew that she may stop and I could try breastfeeding again later. In the meantime, I started feeding her formula because she was hungry. I was heartbroken about this because I really wanted to exclusively breastfeed her. However, I knew that she needed food, regardless whether it came from me or from formula. After two months of pumping I got really sick of it and tried breastfeeding again and it worked out well. My milk supply was down because I was just pumping so I made plans to gradually increase breastfeeding. I still lacked confidence that I could exclusively breastfeed her because of her hearty appetite. In the end I ended up breastfeeding 2/3 of the time and formula feeding 1/3 of the time. Around Thanksgiving 2006, when Lily was almost three months, I really started hurting again. I was thinking of quitting again. I decided to see the lactation consultants at the Birthing Inn. They observed Lily latching on and she seemed to be doing everything right. When they took a look at me my nipples were bright red and sore. They started throwing around ideas and even called my midwife to look at me. They encouraged me to do a little research on Raynaud’s phenomenon, which is vasospasm of the extremities, usually of the hands and feet. Vasospasm is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. When nipple vasospasm is caused by Raynaud’s Phenomenon (Raynaud’s of the nipple), the nipple turns white, then there is usually a noticeable color change - from white to blue to red - as blood flow returns. In summary, I had almost all symptoms of Raynaud’s. Once it was determined that I had Raynaud’s, my midwife prescribed me blood pressure medication to alleviate the pain. It took about two weeks to take effect but it did make me feel better. It did not ever get rid of the pain 100%. I decided my next goal would be to breastfeed till Lily was six months old. Cold exacerbates vasospasm so when it got really cold outside my pain got worse. When it became unbearable I went back to pumping until I felt better. When Lily was almost six months old, I started making plans to wean her. But I surprised myself by feeling very emotional about it and not feeling ready. I waited another two weeks and started to wean her again. I felt much better on my second attempt. In the end, I am happy I was able to breastfeed my baby. I know my stubborn refusal to give up and my tolerance for pain kept me at it. I am not sure that I will breastfeed my next baby, but now I know what to do if I experience breastfeeding pain again. I wanted to share my story with other mothers in case they ever have similar breastfeeding problems. There are answers out there. Don’t give up!
"The MommyDocs Five Simple Summer Safety Tips"
Written by The Mommy Docs brought to you by Clorox
www.mommydocs.com
Reprinted With Permission
Five Simple Summer Safety Tips from the MommyDocs
- Have a Sun Protection Strategy: The American Academy of Pediatrics recommends sunscreen with a minimum Sun Protection Factor (SPF) of 15. Look for products that provide "broad spectrum" coverage to protect against both UVA and UVB rays. Use this sunscreen routine with your child--daily application 30 minutes before going outside and reapplication every 2 hours (or sooner if swimming, toweling off, or sweating). Creating a routine will establish good habits for the future. In addition, don't forget a wide brim hat, sunglasses with 99-100% UVA/UVB protection, and sun protective clothing.
- Keep Pests off Your Little One: In the summer, many insects can bite or sting your child. For pesky mosquitoes and ticks, consider a DEET containing insect repellant. Apply sparingly to exposed skin (avoid backs of hands and around the eyes and mouth) and/or to clothing once a day. As the percentage of DEET goes up, the duration of action increases. To prevent unnecessary exposure, always use the lowest percentage that will last for the planned length of time spent outdoors. Never go above 30% or use on children under 2 months old.
- Keep the Pool Cool and Clean: Small yard pools provide a great way for kids to have fun and cool down when the temperature rises, but they can also harbor germs, such as bacteria. To keep the pool free from unwanted "swimmers," after each use disinfect it with bleach by cleaning with a solution of ¾ cup regular bleach to one gallon of water, then rinse well and dry thoroughly. Safety must: Always supervise children regardless of age when they are around any water; whether it's a bucket, a small backyard plastic pool, or the local community pool.
- High Heat Means Hydrate: Excessive heat exposure may cause your child to experience a heat-related illness such as heat cramps, heat exhaustion, or even heat stroke. How to prevent this: take breaks in the shade, avoid playing outside during peak sun exposure hours, and drink, drink, drink! Make sure your child is taking in plenty of fluids before he become thirsty.
- Rid Rashes and Relieve Itchies: Running through the yard in bare feet, taking a nature walk on a trail, and picnicing in the park are some of the joys of warmer weather. But all of this outdoor activity can expose your child to a host of plants including those which cause poison ivy, poison oak or poison sumac. If an allergic reaction occurs, ask the pediatrician about an oral antihistamine and/or a topical skin care product such as a steroid cream or calamine. If the rash is extensive, looks infected, or is not getting better, call your doctor right away.
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