Mayo Clinic Guide To Your Baby's First Year - From Doctors Who Are Parents, Too! (PDFDrive)

Guide to
Your Baby’s
First Year
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PAGE104 CREDITEYEWIRE COLLECTION
Introduction
Raising a child is one of the most chal- Mayo Clinic Guide to Your Baby’s First
lenging, yet rewarding, experiences you Year is the work of a team of pediatric ex-
will ever have. There is perhaps nothing perts at Mayo Clinic who find nothing in
more special than the lifelong bond that medicine more exciting, fascinating and
forms between a parent and a child. But satisfying than caring for young children.
be prepared that as with everything else Parenthood is a personal journey.
in life, there will be ups and downs. How you deal with all of the changes that
Information from authoritative par- come with raising a child will likely re-
enting resources, such as the information flect your expectations and hopes of what
in this book, can help satisfy your need life with your newborn will be like. The
for baby-care details and provide reas- pages that follow provide information to
surances about the health of your baby help you prepare for and deal with many Meet the Editors
and your own health. of the routine events, issues and tasks of
Mayo Clinic Guide to Your Baby’s First life with a newborn. However, you are Esther H. Krych, M.D., (left) is a specialist in general pediatric care within the Depart-
Year is an easy-to-use yet comprehensive the one who makes it all happen. A posi- ment of Pediatrics, Mayo Clinic, Rochester, Minn. She is the mother of three young
how-to manual that provides answers tive attitude, a good support system and children and can relate to parenting from both a mother’s and doctor’s perspective.
and explanations to the questions and plenty of love can go a long way in mak-
concerns of new mothers and fathers. The ing the years ahead truly enjoyable. Robert V. Johnson, M.D., (center) is a specialist in the Department of Pediatrics and
book is your one-stop resource for caring A project of this scope requires the chair of the Division of Neonatology, Mayo Clinic, Rochester, Minn. He is also an as-
for a newborn. From baby-care basics to teamwork of many individuals. A special sistant professor at College of Medicine, Mayo Clinic. A father of two and grandfather
month-by-month development to com- thanks to all of the people who helped of two, Dr. Johnson has spent more than 25 years caring for newborns.
mon illnesses to health and safety, this make this book possible.
book covers it all. There’s also a wealth of Walter J. Cook, M.D., (right) is a specialist in general pediatric care within the Depart-
tips and advice for couples coping with The Editors ment of Pediatrics, Mayo Clinic, Rochester, Minn., and an assistant professor at College
the many changes to daily life that come of Medicine, Mayo Clinic. A father of three, including twins, he has cared for thousands
with parenthood. of babies in more than 20 years of pediatric practice.
4 5
How to use this book Contents
To help you easily find what you’re looking toys and games, separation anxiety,
ing for, Mayo Clinic Guide to Your Baby’s sign language, and sitting, standing and
First Year is divided into six sections. walking.
Part 1: Caring for Your Baby Part 4: Common Illnesses and Concerns
From how to feed your newborn to de- Here you’ll find helpful tips for managing
veloping a sleep schedule to comforting a conditions that commonly affect young
crying baby to clothing your young one, children, such as fever, colds, ear infec-
you’ll find basic baby-care tips in this de- tions, pink eye and others. You’ll also
tailed section. You’ll also find information learn when medication may be appropri-
on identifying your child’s temperament ate and when it may be best to avoid it.
and learning to understand his or her
specific traits. Part 5: Managing and Enjoying PART 1 Caring for Your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Parenthood
Chapter 1 Welcome to parenthood! . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Part 2: Baby’s Health and Safety For first-time parents, caring for a new-
Part 2 covers all of the key elements to born can be nerve-racking and exhaust- Parenting 101 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
keeping your child from injury and ill- ing. The information in Part 5 can help This book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ness. You’ll read about doctor checkups you get through the first year with the
and vaccinations, as well as suggestions reassurance that you’re doing well. Chapter 2 Baby’s First days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
for childproofing your home. Baby bonding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Part 6: Special Circumstances Baby’s looks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Part 3: Growth and Development Most children are born healthy, but Head t Skin t Birthmarks t Facial appearance t Hair
Month by Month sometimes problems can develop. Dis-
First examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
This section provides monthly insights eases and disorders that can affect new- Apgar scores t Other checks and measurements t Treatments
into your baby’s growth and develop- borns, and how they’re treated, are dis- and vaccinations
ment. It covers a range of topics includ- cussed here.
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Newborn issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Chapter 5 Bathing and skin care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Jaundice t Eating problems t Infection t Hernias
Bathing basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Frequency t Types of baths t When
Issues to consider t How it’s done t Circumcision care
Bath items and products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Screening tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Bath safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Bathing step by step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 3 Feeding baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Umbilical cord care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Breast vs. bottle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Circumcision care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Breast-feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Nail care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Benefits for baby t Benefits for mother t Other issues t Milk Common skin conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
production t Getting started tSupplies to have on hand t Feeding Milia t Acne t Erythema toxicum t Pustular melanosis t Cradle cap
positions t Nursing basics t Support t Vitamin D Eczema t Contact dermatitis and ‘drool rash’ t Impetigo t Thrush
A word on sunscreen
Pumping your breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Storing breast milk t Going back to work
Keeping yourself healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Chapter 6 Clothing baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Nutrition t Rest t Breast care A few shopping tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Weaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Size t Fabric t Safety t Ease t Cost
Timing t Method t Nutrition Where to start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Bottle-feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Washing baby’s clothes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Pros vs. cons t Supplies Stains t Detergents
Infant formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Types t Forms t Generic vs. brand name t Additional ingredients Chapter 7 Sleep and sleep issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Preparation t Vitamin D t Getting into position t Amount t Weaning
Sleep schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Feeding tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Daily sleep t Naps t Night vs. day t Noisy breathing
Spitting up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Reflux t What you can do t Burping positions t When it’s Adopting good sleep habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
more serious Learning to fall asleep t Sleep tips t Don’t give up
Introducing solids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 ‘Back’ to sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Getting started t Taste and texture t Know what’s off-limits SIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Making meals manageable Causes t Risk factors t Prevention t Make time for tummy time
Crib safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Chapter 4 Diapers and all that stuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 No more drop sides t Other safety precautions
Types of diapers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Disposable t Cloth Chapter 8 Comforting a crying baby . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Getting equipped. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Why babies cry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Changing station t Diapers t Wipes t Homemade baby wipes Hunger t Discomfort t Loneliness, boredom or fear t Overtiredness
Diaper pail t Ointment or overstimulation
Changing diapers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Understanding baby’s cries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
What’s normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Comforting a crying baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Urine t Stools Colic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Causes t Common signs t Diagnosis
Diaper rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Appearance t Causes t Treatment t When to seek medical treatment Managing colic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Preventing diaper rash Your feeding style t Your diet t Your lifestyle t Calming techniques
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Keeping your cool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Side effects of vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Always be gentle Weighing the risks and benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Chapter 9 Understanding your baby’s temperament . . . . . . . . . . . . . 135 Chapter 13 Child care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Your child’s traits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Getting started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Activity t Regularity t Initial approach t Adaptability t Sensitivity Child care options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Intensity t Mood tDistractibility t Persistence In-home care t Family child care t Child care centers
Your child’s behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Relative or friend
Highly active t Very curious t Persistent t Intense t Irregular t Quiet Factors to consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
and content t Easily frustrated t Slow to adapt t Distractible t Highly Expectations t Budget
sensitive
Evaluating your options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Your parenting style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Contact information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Working together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
PART 2 Baby’s Health and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Chapter 14 Traveling with baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Chapter 10 Finding the right care provider . . . . . . . . . . . . . . . . . . . . . . 145
Heading out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Getting started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Baby carriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Care provider options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Choosing a baby carrier t Baby carrier risks t Safety tips
Pediatricians t Family physicians t Nurse practitioners Strollers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Factors to consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Considerations t Safety tips
Training t Personal approach t Cost t Location, accessibility, hours Car seats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Evaluating your options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Infant-only car seat t Convertible car seat t Other considerations
A team approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Used car seats
Installing a car seat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Chapter 11 Checkups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Preemies and small babies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Checkup schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Air travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
What to expect at each visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Trip basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Measuring your baby t Head-to-toe physical exam t Nutrition
information t Sleeping status tDevelopment t Behavior Chapter 15 Home and outdoor safety . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Vaccinations t Safety
Nursery safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Questions and concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Kitchen safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Feeding safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Chapter 12 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Bathroom safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
How vaccines work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Garage and basement safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Why get vaccinated?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Front yard and backyard safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Vaccine safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 General safety tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Vaccine additives t Vaccines and autism Preventing burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Preventing falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Vaccination schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Preventing drowning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Childhood vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chickenpox t Diphtheria t German measles t Hib disease Be cautious, not panicked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Hepatitis A t Hepatitis B t Flu (influenza) t Measles t Mumps
Pneumococcal disease t Polio t Rotavirus t Tetanus tWhooping Chapter 16 Emergency care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
cough t Alternative vaccine schedules t Missing a vaccination
When to seek emergency care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
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Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Head and neck t Hands and arms t Legs
Cardiopulmonary resuscitation (CPR). . . . . . . . . . . . . . . . . . . . . . . 211 Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Vision t Hearing t Taste and smell t Toys and games
Electrical shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Animal or human bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Laying down tracks t Expanding communication
Drowning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Injury from a fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
A real charmer t Wanting attention t View timetables with caution
Swallowed poison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Inhaled poison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Poison on the skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Chapter 20 Month 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Poison in the eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Spot-check t Skin rashes t Bedtime routine
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
PART 3 Growth and Development Month by Month . . . . . . . . . . . 220
Head and back control t Rolling over t Standing t Reaching and grasping
Chapter 17 Month 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Mouthing t Hearing t Vision
Head t Skin t Umbilical cord t Breast and genitalia tLegs and feet Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Hair t Spot-check Language skills t Laughter t Toys and games
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Baby reflexes t Soothing by sucking
Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Sight t Sound t Smell t Taste t Touch Chapter 21 Month 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Communication t Toys and games Spot-check t Introducing solid foods t Is your baby ready?
Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Becoming attached t Building up a smile Rolling over t Reaching and grasping t Bouncing t Physical activity
Vision t Hearing
Chapter 18 Month 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Learning how things work t Language skills t Toys and games
Fits and stops t Spot-check
Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Growing attachment t Emerging personality
Toys and games
Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Chapter 22 Month 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Cooing and gurgling t Crying Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Spot-check t Teeth! t Caring for new teeth
Big sisters and brothers Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Tripod sitting t Toes, toes, toes! t Picking up and letting go
Chapter 19 Month 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 A lefty or a righty?
Vision t Hearing t Touch
Spot-check t Is my baby too fat?
12
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13
Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Me, myself and I t Playing becomes serious business t Babbling Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Toys and games Spot-check t Pulling to sit t Pulling to stand t Picking up, pointing
and poking
Hearing t Touch
Chapter 23 Month 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 First words t Conversation t Nonverbal communication
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 Toys and games
Sitting t Hand and finger coordination t Spot-check
Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Mimicking t Eyeing mom and dad t Sharing
The art of conversation t The art of empowerment tToys and games
Chapter 27 Month 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Stranger anxiety t Discipline in infancy Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Crawling t Standing t Cruising t Baby shoes t Finger skills
Chapter 24 Month 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Spot-check
Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Spot-check t Establishing good eating habits t Introducing a cup Vision t Hearing and listening t Touch
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Sitting up t Getting around t Hand and finger coordination Capitalizing on body language t Increasing vocabulary
Bilingual babies tToys and games
Vision t Touch Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Increased assertiveness t Newfound fears
Attaching meaning t Object permanence t Language skills
Baby sign language Chapter 28 Month 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Toys and games tSeparation anxiety t Smoothing the way
Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Spot-check t Sitting t Standing and bending t Walking t Getting up
Chapter 25 Month 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 and down stairs t Hand and finger skills
Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Looking and listening t Touch
Spot-check tCrawling t Standing t Sitting t Hand skills Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Increasingly complex thinking t Understanding t Language
Vision t Hearing t Touch t Finger foods Toys and games
Language and understanding t Toys and games Veni, vidi, vici t Tantrums t Saying no t Relating to others

Oh, the frustration tMaking life easier t Family life
PART 4 Common Illnesses and Concerns . . . . . . . . . . . . . . . . . . . 347
Infants and medications t Taking baby’s temperature t Caring for a
Chapter 26 Month 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 sick baby t Allergies tAnemia t Asthma t Bronchiolitis t Cold
Cold and cough medications t Cough tConstipation t Crossed
eyes t Croup t Diarrhea t Ear infection t Earwax blockage
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14 5"#-&0'$0/5&/5415
Fever t Febrile seizures t Fifth disease t Flu (influenza) Sharing the load . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Hand-foot-and-mouth disease t Hives t Impetigo t Insect bites and Nurturing your team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
stings t Jaundice tLazy eye t Pink eye (conjunctivitis) t Pneumonia Agreeing on child rearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Reflux t RSV tRoseola t Stomach flu (gastroenteritis) t Sty
A firm foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Sunburn t Swollen scrotum t Teary eyes t Teething t Thrush
Urinary tract infection t Vomiting t Whooping cough
Chapter 33 Single parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Hard work, added pressures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
PART 5 Managing and Enjoying Parenthood . . . . . . . . . . . . . . . . . 398
Financial and work issues t Getting it all done t Support issues
Chapter 29 Adapting to your new lifestyle . . . . . . . . . . . . . . . . . . . . . . 399 Emotional issues t Single dads
Living on less sleep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 From surviving to thriving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444

Sleep tips t When sleep becomes a struggle Rewards and strengths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Getting comfortable with chaos . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

Coping tips Chapter 34 Siblings and grandparents . . . . . . . . . . . . . . . . . . . . . . . . . 449
Adjusting to your new role . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 Siblings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449

Handling new-baby stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Introducing your new baby
Sibling reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
Teaching gentleness t Sibling safety hazards
Chapter 30 Taking care of yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Sibling rivalry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
Recovering from labor and childbirth . . . . . . . . . . . . . . . . . . . . . . . 407 Coping tips
All about the breasts t Healing down under t Return of your period
(maybe) t Preventing back pain t Bathroom woes t Hair and skin If you have multiples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
changes Grandparents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
Changing relationships t Receiving help t Conflicting opinions
Baby blues and depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 The holidays
Getting back into shape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
A healthy diet t Exercise t Strengthening your core t Kegel exercises Grandparents as child care providers . . . . . . . . . . . . . . . . . . . . . . . 457
Keep it real(istic) Education classes
Mom and dad breaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Chapter 35 Finding contentment: Home or job? . . . . . . . . . . . . . . . . . 461
Shifting friendships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Rekindling romance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Issues to consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Career consequences t Finances t Child care tStresses and
Chapter 31 Dads and partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 rewards
Shifting roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 Living with your decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463

Deciding to stay home Making the transition back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
While you’re still on leave tWhen you go back to work
Handling common concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Uncertainty about baby care t Increased financial responsibility Balancing work and home life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
Reduced attention t Support and resources t Work-life balance
Bonding with your baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 Chapter 36 When to have another child? . . . . . . . . . . . . . . . . . . . . . . . 471
Understanding your partner’s moods . . . . . . . . . . . . . . . . . . . . . . . 429 Deciding on another child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Finding time for yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430 Added responsibilities tPreferences t Family finances t Career
Rekindling romance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 Family dynamics tSocial pressures
Second pregnancy timing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Chapter 32 Parenting as a team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Health issues tFamily issues tOther issues
A new bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
New challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
16 17
PART 6 Special Circumstances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480 Genetic disorders t Problems during labor and delivery tProblems
in utero tMetabolic disorders tEnvironmental toxins
Chapter 37 Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Diagnosing a developmental delay . . . . . . . . . . . . . . . . . . . . . . . . . 521
Supporting your child’s health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481 What can be done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522
Finding a care provider tImmunizations t Medical history
Post-adoptive care tInternational adoptions
Chapter 41 Down syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
Bonding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484
Getting to know your child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Allow time for adjustment tResponding to your baby’s needs
Learn about your child tIdentify baby’s developmental stage Developing a routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Developmental milestones
Sharing your family story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Siblings and adopted children Your child’s health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Checkups and vaccinations t Growth t Hearing problems
Handling difficult remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490 Vision problems t Heart problems t Thyroid problems
Parenting is parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491 Gastrointestinal problems t Joint problems t Blood cell problems
Obstructive sleep apnea t Behavior problems
Chapter 38 Caring for multiples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 Early intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531
Physical therapy t Speech and language therapy t Occupational
Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 therapy t Other services
Breast-feeding tBottle-feeding
Developing a support system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Raising strong individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
One-on-one time tParenting strategies
Chapter 42 Other newborn conditions . . . . . . . . . . . . . . . . . . . . . . . . . .535
Logistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Buy in bulk tCheck out supply stores tJoin a parent group Blood disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Explore different options Anemia t Low blood sugar t Polycythemia
Taking care of yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 Breathing disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537

Bronchopulmonary dysplasia t Meconium aspiration t Pneumothorax
Respiratory distress syndrome t Transient tachypnea
Chapter 39 Premature baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Central nervous system disorders . . . . . . . . . . . . . . . . . . . . . . . . . 539
Why premature birth happens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 Cerebral palsy t Hydrocephalus t Spina bifida
Definitions t The NICU
Digestive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Caring for a premature newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 Esophageal atresia t Hirschsprung’s disease t Imperforate anus
Appearance t Condition and care t Medical team t Nutrition Intestinal blockage t Pyloric stenosis
Growth and development
Facial and extremity disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
Health issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507 Cleft lip and cleft palate t Clubfoot t Finger and toe deformities
Breathing concerns t Heart concerns t Brain concerns Hip dysplasia
Gastrointestinal concerns t Blood concerns t Metabolism concerns
Vision concerns t Hearing concerns t Dental concerns t SIDS Genital disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
Future issues Ambiguous genitalia t Hydrocele t Hypospadias t Undescended
testicle
Taking care of yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Bringing baby home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512 Heart disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548
Baby’s checkups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515 Aortic stenosis t Atrial septal defect t Coarctation of the aorta
Patent ductus arteriosus tPulmonary stenosis t Tetralogy of Fallot
Transposition of the great vessels t Ventricular septal defect
Chapter 40 Delayed development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Other disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
What does delayed development mean? . . . . . . . . . . . . . . . . . . . . 517 Cystic fibrosis t Intrauterine growth restriction
Development chart
How is a delay identified? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .552
Possible causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
18 19
PART 1 CHAPTER 1
Caring for your baby Welcome to

parenthood!
Congratulations! You are now entering hobby — has been put on hold. In its
one of the greatest phases of your life — place is a reality that may feel totally
parenthood. There is perhaps nothing in foreign to you. That’s because children
life more special than the bond that don’t arrive with instruction manuals,
forms between a parent and a child. It’s a and parenting is somewhat of a trial-by-
relationship that will bring endless years fire experience. If you’ve never had to
of joy, laughter, admiration and satisfac- care for a young child before, you may
tion. The time you spend raising your feel nervous, unsure of yourself and a bit
children will be time that you will cherish lost. That’s to be expected — and is per-
forever. In the years to come, you’ll learn fectly normal.
more about attachment, love and protec-
tiveness than you ever thought possible.
But be prepared that not every day in
your parenthood journey will be grand PARENTING 101
and glorious. Like everything else in life,
there will be ups and downs. You may Many parents describe their first year
find that some of the more stressful and with a new baby as a roller coaster ride.
exhausting days of being a parent will As one new mom put it, “One minute
come early on, when you first bring your you’re laughing and joking; the next
new son or daughter home. minute you’re crying, not really knowing
Bringing a baby into your house can why.” You may go from adoring your
literally turn your life upside down. The baby and marveling at tiny fingers and
routine you once knew — having time to toes to grieving your loss of indepen-
yourself, getting together with friends, dence and worrying about your ability to
going out for a relaxing dinner or spend- care for a newborn, all in the space of a
ing the day indulging in your favorite single diaper change.
CHAPTER 1: WELCOME TO PARENTHOOD! 21

Given all these changes, the first few strain associated with the first year, par- Check your expectations Many new ner. Take time to admire his or her rela-
weeks after you bring your baby home enthood brings an incredible richness to parents start out with unrealistic expec- tionship with your baby, and you will
are likely to be one of the most challeng- daily living. Nothing can quite compare tations — that life won’t be much differ- likely find great inspiration, not only as a
ing times of your life. The changes in the to the joy of seeing a newborn’s smile or ent from before, that parenting is going parent, but also as a couple.
daily rhythms of your life can feel chaotic, the wobbly first steps of a toddler. to be fun every minute of the day, that
but you will learn to adapt. It may take the new baby will mostly eat and sleep,
months or even a year, but you’ll get Trust your instincts Caring for a baby that they’ll be able to manage everything
there — in your own way, in your own may be totally new territory for you, but perfectly. The gap between expectations THIS BOOK
time, and with your own missteps and have confidence in yourself.You’ll quickly and reality can lead to stress and disap-
successes. learn the things you need to know pointment. Throw out any preconceived As you maneuver the ins and outs of par-
to take great care of your child. Also real- notions about what life with a new baby enting, a little guidance and reassurance
Relish the time As chaotic as it may ize that you aren’t expected to know it should be like, and be realistic about the can be of great help. Mayo Clinic Guide to
seem, this is a special time in your life. all. It’s OK to ask questions and seek increased demands on your time. That Your Baby’s First Year is designed to help
Appreciate the joy your new son or guidance from friends, family and medi- cute, little 8-pound addition to your you find answers to common questions
daughter brings to your life, and don’t let cal professionals. If you get unsolicited household can create a lot of extra work. during the first year of a baby’s life. The
your worries overshadow your joys. advice, take the advice that “fits” with book is also intended to provide you with
Newborn days won’t last long. Step back your parenting style and feel free to for- Be patient For the first few weeks, your reassurance that you’re doing well, and
and appreciate the moment. For all the get the rest. life may seem limited to round-the-clock that the emotions and concerns you may
feeding, bathing, diapering and soothing be experiencing are the same as those of
— all on shortened amounts of sleep. You many other first-time parents.
may find it difficult to fit in a shower and Dig in by whatever manner works
do a load of laundry, let alone make din- best for you. You can turn the page and
ner. You may fear this is what your life is begin reading, or you can selectively
going to be like forever! It won’t be. Over choose those chapters or sections that
time you’ll adjust to the new normal, re- are most important to you right now.
vive old routines and create new ones. As Keep the book handy so you can turn to
your baby gets older, you’ll find you have it whenever a concern arises or to pre-
more time for yourself. pare yourself for what may be in store in
the month ahead.
Take care of yourself Childhood care Remember that parenting is an ad-
also extends to parents. Taking good care venture; enjoy the journey!
of your baby includes taking good care of
yourself. The better you feel, the better
able you’ll be to care for and enjoy your
new son or daughter. Sneak in as much
sleep as possible, eat well and get some
exercise. Most of all, don’t be afraid to ask
for help when you need it.
Take care of your relationship

Babies, while wonderful, can be hard on
a relationship. You and your partner may
miss your life as a couple. You may also
find that you have differences of opinion
on issues related to caring for your child.
Be patient with yourself and your part-
CHAPTER 1: WELCOME TO PARENTHOOD! 23

CHAPTER 2
Baby’s first days
From the moment you first learned you tions and screenings. You’ll also learn
were pregnant, you’ve been eagerly an- about conditions often seen in newborns.
ticipating one thing: the day you could
hold your baby and look into his or her
face. And now that day is here!
Your labor and delivery — whether it BABY BONDING
was a marathon session or shockingly
short — is behind you. Now is the time As soon as babies are born, they need
to enjoy that precious little person you’ve and want you to hold, cuddle, touch, kiss,
been waiting so long to meet. talk and sing to them. These everyday ex-
The mental picture you have of your pressions of love and affection promote
baby — the product of thousands of ad- bonding. They also help your baby’s brain
vertisements and television shows — is develop. Just as an infant’s body needs
of a plump, cuddly infant announcing his food to grow, his or her brain benefits
or her arrival with a lusty cry. In reality, from positive emotional, physical and in-
the tiny person you greet may not be the tellectual experiences. Relationships with
perfect little cherub you imagined. other people early in life have a vital in-
Newly born babies generally emerge fluence on a child’s development. Some
somewhat messy looking, often with parents feel an immediate connection
misshapen heads and blemished skin. with their newborn, while for others the
Take heart, though. It won’t be long be- bond takes longer to develop. Don’t wor-
fore the baby you envisioned is the one ry or feel guilty if you aren’t overcome
you’re holding in your arms. with a rush of love at the very beginning.
In this chapter, you’ll learn about your Not every parent bonds instantly with a
newborn’s first days of life — what he or new baby. Your feelings will become
she may look like and standard examina- stronger with time.
CHAPTER 2: BABY’S FIRST DAYS 25

Bonding moments During those first dren with a sense of security. Be patient culiar elongation is one of the common about the size of a dime and it closes much
weeks, most of your time with your new with yourself in these first weeks. Caring features of a newly born baby. quicker — around six weeks after birth.
son or daughter is likely to be spent feed- for a new child can be daunting, discour- A baby’s skull consists of several sec- Some parents are anxious about
ing him or her, changing diapers, and aging, thrilling and perplexing — all in tions of bone that are flexibly joined so touching baby’s soft spots, partly because
helping him or her sleep. These routine the same hour! In time, your skills as a that the head shape can change to cor- they don’t like the way they feel. Don’t
tasks present an opportunity to bond. parent will grow, and you will come to respond to the shape of your pelvis as worry. You won’t hurt your baby if you
When babies receive warm, responsive love this little one far more than you your baby moves through the birth canal do touch a fontanel.
care, they’re more likely to feel safe and could have imagined. during childbirth. A long labor usually
secure. For example, as you feed your results in an elongated or tall skull shape Skin Most babies are born with some
baby and change diapers, gaze lovingly Don’t worry about spoiling your at birth. The head of a breech baby may bruising, and skin blotches and blemish-
into his or her eyes and talk gently to him newborn Respond to your child’s cues have a shorter, broader appearance. If a es are common.
or her. and clues. Among the signals babies send vacuum extractor was used to assist in A rounded swelling of the scalp is
Babies also have times when they’re are the sounds they make — which will the birth, your baby’s head may look par- usually seen on the top and back of the
quietly alert and ready to learn and play. be mostly fussing during the first week or ticularly elongated. baby’s head when a baby is born the usu-
These times may last only a few mo- two — the way they move, their facial ex- al way — headfirst. This puffiness of the
ments, but you’ll learn to recognize them. pressions, and the way they make or Fontanels When you feel the top of your skin disappears within a day or so.
Take advantage of your baby’s alert times avoid eye contact. Pay close attention to baby’s head, you’ll notice two soft areas. Pressure from your pelvis during la-
to get acquainted and play. your baby’s need for stimulation as well These soft spots, called fontanels, are bor can cause a bruise on your baby’s
as quiet times. where your baby’s skull bones haven’t head. The bruise may be noticeable for
Talk, read and sing to your baby Even grown together yet. several weeks, and you might feel a small
infants enjoy music and being read to. The fontanel toward the front of the bump that persists for several months.
These early “conversations” encourage scalp is a diamond-shaped spot roughly You may also see scrapes or bruises on
your baby’s language capacity and pro- BABY’S LOOKS the size of a quarter. Though it’s usually your baby’s face and head if forceps were
vide an opportunity for closeness. Babies flat, it may bulge when your baby cries or used during delivery. These bruises and
generally prefer soft, rhythmic sounds. Considering what they’ve just been strains. In seven to 19 months, this fonta- blemishes should go away within a cou-
through during labor and childbirth, it’s nel will be filled in with hard bone. The ple of weeks.
Cuddle and touch your baby Newborns no wonder newborns don’t look like the smaller fontanel at the back of the head The top layer of a newborn’s skin
are sensitive to changes in pressure and little angels seen on television. Instead, is less noticeable. Some parents don’t flakes off shortly after birth. Because of
temperature. They love to be held, rocked, your newborn may first appear wrinkled even realize it’s there. This fontanel is this, you may notice plenty of dry, peeling
caressed, cradled, snuggled, kissed, pat- and pale. If your baby is like most, his or
ted, stroked, massaged and carried. her head will be a bit misshapen and
larger than you expected, and the eyelids
Let your baby watch your face Soon af- may be puffy. His or her arms and legs
ter birth, your newborn will become ac- may be drawn, and the hands and feet
customed to seeing you and will begin to may be bluish or purplish in color. He or
focus on your face. Allow your baby to she may be somewhat bloody and likely
study your features, and provide plenty wet and slippery from amniotic fluid.
of smiles. In addition, most babies will be born
with what appears like skin lotion. Called
Play music and dance Put on some soft vernix, it’s most noticeable under your
music with a beat, hold your baby’s face baby’s arms, behind the ears and in the
close to yours, and gently sway and move groin. Most of this vernix will be washed
to the tune. off during your baby’s first bath.
© MFMER
Establish routines and rituals Repeat- Head At first, your baby’s head may ap-
ed positive experiences provide chil- pear flat, elongated or crooked. This pe- Head elongation Fontanels
26 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 27

skin the first few weeks. In general, this and they quickly dry and peel off. The Cafe au lait spot As the name implies, pebbled surface. The condition can be
“peeled” look gets better on its own. If spots may look similar to skin infections these permanent birthmarks are light treated, often with laser therapy.
the skin should crack or bleed, apply (pustules), but pustular melanosis isn’t -brown, or coffee, colored. Cafe au lait
some petroleum jelly to the area. an infection, and it disappears without birthmarks are very common, and they Facial appearance When you first
Following are other skin conditions treatment. Pustular melanosis is more can occur anywhere on the body. Usually, look at your baby, his or her nose may
common in newborns. For pictures and common in dark-complected babies. no treatment is needed. However, if your seem flattened. This is from pressure in-
more information on these conditions, child has more than six cafe au lait spots, side the birth canal. Within a day or two,
see Chapter 5. Birthmarks Contrary to their name, ask his or her care provider whether fur- the nose will take on a more normal ap-
birthmarks aren’t always present at birth. ther evaluation is warranted. pearance. His or her cheeks may also
Erythema toxicum It may sound scary, Some, such as a hemangioma, develop have marks or bruises if forceps were
but erythema toxicum is the medical weeks later. And though most are per- Hemangioma Hemangiomas are caused used during the delivery. This, too, will
term for a common newborn rash that manent, a few types fade as a child by an overgrowth of blood vessels in the improve in a short time.
typically appears within the first few days grows. Most birthmarks are harmless, top layers of skin. They appear as a bright
after birth and lasts up to two weeks. It’s but some may require treatment for cos- red, raised spot that may resemble a Eyes It’s perfectly normal for your new-
characterized by little reddish splotches metic reasons or because of rapid growth strawberry. Usually not present at birth, a born’s eyes to be puffy. Some infants
that may or may not have a white center or risk of future health problems. See hemangioma may begin as a small, pale have such puffy eyes that they aren’t able
and that come and go. The splotches pages 30 and 31 for pictures of common spot that becomes red in the center. The to open their eyes wide right away. This
tend to flare up where baby has been birthmarks. birthmark enlarges during the baby’s first will improve within a day or two.
snuggled or held. The condition causes few months and most often disappears You may also notice that your baby
no discomfort and it’s not infectious. Salmon patches Salmon patches are without treatment by school age. Large sometimes looks cross-eyed. This, too, is
sometimes affectionately called stork hemangiomas may cover an entire seg- normal, and your child will outgrow the
Milia These are tiny white spots that bites or angel kisses. They are reddish or ment of the face or body. Some fast- condition within several months.
may look like pimples, but are not. pink patches that are often found just growing hemangiomas may require laser
They’re usually located on the nose and above or below the hairline at the back of treatment or medication. Babies with
chin. Although they appear to be raised, the neck. Salmon patches may also be several hemangiomas may need evalua-
they’re nearly flat and smooth to the found on the eyelids, forehead or upper tion for an underlying condition.
touch. Milia disappear in time, and they lip. These marks are caused by collections
don’t require treatment. of tiny blood vessels (capillaries) close to Congenital nevus A congenital nevus is
the skin. Salmon patches on the fore- a large, dark-colored mole that typically
Baby acne Baby acne refers to the red head, eyelids or between the eyes usually appears on the scalp or trunk of the body.
bumps and blotches similar to teenage fade with time, though they may flare It can range in size from less than 0.4
acne that are seen on the face, neck, up- with increased blood flow to the head, inches to more than 5 inches across, cov-
per chest and back. It’s generally most such as when crying, straining or push- ering large areas. Children with a large-
noticeable the first few months and ing. Salmon patches on the nape of the sized congenital nevus are at an increased
typically disappears without treatment. neck may not fade, but they’re often cov- risk of developing skin cancer as adults. If
Having baby acne doesn’t necessarily ered by hair. Salmon patches don’t re- your child has this type of birthmark,
mean that a child will have acne later quire any type of treatment. consult your child’s care provider so that
in life. he or she can check for skin changes.
Slate gray nevus A slate gray nevus, pre-
Pustular melanosis This is another viously called a mongolian spot, is a Port-wine stain A port-wine stain is a
condition whose name may sound scary, large, blue-gray birthmark that’s some- permanent birthmark that starts out
but the rash is typically mild and it usu- times mistaken for a bruise. It’s more pink, but turns darker red or purple as a
ally disappears soon after birth. Pustular common in darker skinned babies, espe- child grows. Most often, a port-wine
melanosis is characterized by small spots cially those of Asian heritage. This birth- stain appears on the face and neck, but it
that look like small yellowish-white ses- mark may disappear later in childhood can affect other areas. The involved skin
ame seeds. The spots are present at birth, and requires no treatment. may thicken and develop an irregular,

BIRTHMARKS
Cafe au lait spot Cafe au lait spots are pigmented birthmarks that are often oval in Port-wine stain A port-wine stain is a birthmark in which swollen blood vessels create
shape. Their name is French for “milky coffee,” which refers to their light-brown color. Cafe a reddish-purplish discoloration of the skin. Early port-wine stains are usually flat and pink
au lait spots usually are present at birth, but they may develop in the first few years of a in appearance. As the child gets older, the color may deepen to a dark red or a
child’s life. purplish color.
Congenital nevus A congenital nevus is Slate gray nevus Also known as a Salmon patches Also called stork bites, Hemangioma A hemangioma is an ab-
a mole present at birth that may vary in size mongolian spot, this blue-gray birthmark is these marks are small blood vessels (capil- normal buildup of blood vessels in the
from small to large. It typically appears as sometimes mistaken for a bruise. It’s more laries) visible through the skin. Salmon skin. The marks are bright red and often
light brown- to black-colored patch. It can common in darker skinned babies, espe- patches are most common on the forehead, raised. They often appear on the neck or
occur on any part of the body. cially those of Asian heritage. eyelids, upper lip and back of the neck. facial area.

Sometimes babies are born with red can breathe properly, the nose and
spots on the whites of their eyes. These mouth are cleared of fluid as soon as the CORD BLOOD BANKING
spots result from the breakage of tiny head appears — and again immediately
blood vessels during birth. The spots are after birth. During your pregnancy, you may have heard or read about what’s called cord
harmless, and they won’t interfere with While baby’s airway is being cleared, blood banking. At this point in time, cord blood banking is not common procedure,
your baby’s sight. They generally disap- his or her heart rate and circulation can and you shouldn’t feel pressured to take part. However, if you think this is some-
pear in a week to two. be checked with a stethoscope or by feel- thing you may want to do, here’s some information to help you make a decision.
Like a newborn’s hair, his or her eyes ing the pulse in the umbilical cord. All The blood within a baby’s umbilical cord is a rich source of stem cells, the cells
give no guarantee of their future color. newborns look somewhat bluish-gray for from which all other cells are created. Cord blood banking is a procedure in which
Although most newborns have dark the first several minutes, especially on cord blood is taken from a baby’s umbilical cord shortly after delivery and pre-
bluish-brown, blue-black, grayish-blue their lips and tongue. By five to 10 min- served for possible future use in a stem cell transplant. Collecting a baby’s cord
or slate-colored eyes, permanent eye col- utes after birth they become pinker, blood poses few, if any, risks to either mother or baby. If the cord blood isn’t col-
or may take six months or even longer to though baby’s hands and feet may still lected for preservation or research, it’s simply discarded.
establish itself. remain bluish, which is normal. Your ba-
by’s umbilical cord is clamped with a Public vs. private There are two main ways to bank cord blood. The first is using
Hair Your baby may be born bald, with plastic clamp, and you or your partner a public cord blood bank. Public banks collect and store cord blood for use by any
a full head of thick hair — or almost may be given the option to cut it. individual who has a medical condition in which cord blood might provide a cure.
anything in between! Don’t fall in love In the next day or two, many things The second type is a private bank. It oversees the collection and storage of cord
with your baby’s hair too quickly. The will take place. The medical team will blood for families who are willing and able to pay for the service, and the blood is
hair color your baby is born with isn’t conduct newborn examinations, admin- saved for use by that family.
necessarily what he or she will have six ister screening tests and give some im-
months down the road. Blond newborns, munizations. Should you consider it? Donating cord blood to a public cord blood bank is a
for example, may become darker blond tremendous opportunity to help others. Cord blood transplants from unrelated
as they get older, or their hair may de- Apgar scores One of the first exam- donors can be used to treat many conditions, including leukemia and various met-
velop a reddish tinge that isn’t apparent inations of your baby will be determining abolic problems. You won’t be charged any fees to donate cord blood to a public
at birth. his or her Apgar scores. Apgar scores are bank. However, you may need to give birth at one of the limited number of hospi-
You may be surprised to see that your basically a quick evaluation of a new- tals or other facilities equipped to handle public cord blood donations.
newborn’s head isn’t the only place he born’s health, which are given at one Donating cord blood to a private facility for possible personal use is controver-
or she has hair. Downy, fine hair called minute and five minutes after a baby is sial. The cost is often considerable, and the chance that your child will use his or
lanugo covers a baby’s body before birth born. Developed in 1952 by anesthesiol- her own banked cord blood in the future is remote. Also, should your child need a
and may temporarily appear on your ogist Virginia Apgar, this brief examina- stem cell transplant, there’s no guarantee that his or her banked cord blood will
newborn’s back, shoulders, forehead and tion rates newborns on five criteria: color, remain viable or be suitable for a transplant.
temples. Most of this hair is shed in the heart rate, reflexes, muscle tone and The American Academy of Pediatrics (AAP) encourages donation to public
uterus before the baby is born, making respiration. cord blood banks but discourages private donation. In recommending against pri-
lanugo especially common in prema- Each of these criteria is given an indi- vate donation, the AAP states: “The chances of a child needing his or her own cord
ture babies. It disappears within a few vidual score of zero, 1 or 2. The scores are blood stem cells in the future are estimated to range from 1 in 1,000 to 1 in
weeks after birth. totaled for a maximum possible score of 200,000. Private cord blood banks target parents at an emotionally vulnerable time
10. Higher scores indicate healthier when the reality is most conditions that might be helped by cord blood stem cells
infants, but don’t get too caught up in the already exist in the infant’s cord blood. However, the AAP does recommend private
numbers. Your care provider will tell you cord blood banking for parents who have an older child with a condition that could
FIRST EXAMINATION how your baby is doing, and even those potentially benefit from transplantation, such as a genetic immunodeficiency.”
babies with lower scores often turn out to If you’re considering cord blood banking, talk to your care provider. He or she
From the moment your little one is born, be perfectly healthy. can help answer any questions you may have and help you better understand the
he or she is the focus of much activity. options so that you can make an informed decision.
Your care provider or a nurse will clean Other checks and measurements
his or her face. To make sure your baby Soon after birth, your newborn’s weight,

length and head circumference are newborn would become so deficient in Z Too much of the bilirubin is reabsorbed Infection A newborn’s immune system
measured. Your baby’s temperature may vitamin K that serious bleeding might from the intestines before the baby isn’t adequately developed to fight infec-
be taken, and breathing and heart rate develop. This problem is not related to gets rid of it in a bowel movement. tion. Therefore, any type of infection can
measured. Usually within 12 hours after hemophilia. be more critical for newborns than for
birth, a physical exam is conducted to de- Treatment Most newborns are screened older children or adults.
tect any problems or abnormalities. Hepatitis B vaccination Hepatitis B is a for jaundice, either by visual inspection If things don’t seem right — if your
Your child’s blood sugar (glucose) viral infection that affects the liver. It can or with laboratory testing. Mild jaundice newborn seems too fussy or too sleepy —
also may be checked within the first cause illnesses such as cirrhosis and liver generally doesn’t require treatment, but or if your newborn has a fever, don’t de-
hour or two after birth, especially if your failure, or it can result in the develop- more-severe cases can require a newborn lay seeking care. This may mean going to
baby is somewhat larger or smaller for ment of liver tumors. Adults contract to stay longer in the hospital. Jaundice the emergency room if the illness occurs
his or her age or if he or she seems overly hepatitis through sexual contact, shared may be treated in several ways: in the middle of the night.
sleepy or has trouble getting started needles or exposure to the blood of an Z You may be asked to feed the baby Serious bacterial infections, which are
eating. infected person. more frequently, which increases the uncommon, can invade any organ or
A baby whose blood sugar is too low Babies can contract hepatitis B from amount of bilirubin passed out of the the blood, urine or spinal fluid. Prompt
may be more sleepy than normal and their mothers during pregnancy and body via bowel movements. treatment with antibiotics is necessary,
won’t feed well. Assistance may be given birth. For most newborns, protection Z A doctor may place your baby under a but even with early diagnosis and treat-
to encourage eating and improve the against hepatitis B begins with a vaccine bilirubin light. This treatment, called ment, a newborn infection can be life-
baby’s blood sugar (see page 536 for given shortly after birth. phototherapy, is quite common. A threatening.
more information). special lamp helps rid the body of ex- For this reason, care providers are of-
cess bilirubin. ten quick to treat a possible or suspected
Treatments and vaccinations The Z Rarely, if the bilirubin level becomes infection. Antibiotics often are given ear-
following steps are generally taken NEWBORN ISSUES extremely high, intravenous (IV) ly and stopped only when an infection
shortly after birth to prevent disease. medications or a specialized blood doesn’t seem likely. Although the major-
Some babies have a bit of trouble adjust- transfusion may be required. ity of the test results come back showing
Eye protection To prevent the possibility ing to their new world. Fortunately, most no evidence of infection, it’s better to err
of gonorrhea being passed from mother of the problems they experience in the Eating problems Whether you choose on the side of safety by quickly treating a
to baby, all states require that infants’ first few days after birth are generally mi- to breast-feed or bottle-feed, during the baby than to risk not treating a baby with
eyes be protected from this infection im- nor and soon resolved. first few days after your baby’s birth you an infection soon enough.
mediately after birth. Gonorrheal eye in- may find it difficult to interest your new-
fections were a leading cause of blind- Jaundice More than half of all newborn born in eating. The first feedings can Hernias It’s not unusual for a baby to
ness until early in the 20th century, when babies develop jaundice, a yellow tinge to sometimes be difficult. If this is the case, be born with a hernia. Hernias can occur
treatment of babies’ eyes after birth be- the skin and eyes. Signs generally devel- you’re not alone. Remember, your baby is either in the groin area (inguinal hernia)
came mandatory. An antibiotic ointment op after the first 24 hours and peak about learning and so are his or her parents. See or near the baby’s bellybutton (umbilical
or solution is placed onto his or her eyes. five to seven days after birth. The condi- the next chapter for advice on how to re- hernia).
These preparations are gentle to the eyes tion may last several weeks. duce the stress of early feedings.
and cause no pain. A baby develops jaundice when bili- If things aren’t going well, or you’re Inguinal hernia An inguinal hernia
rubin, which is produced by the break- concerned that your baby isn’t getting may occur in boys or girls but is more
Vitamin K injection In the United down of red blood cells, accumulates enough nourishment, talk to your baby’s common in boys. An inguinal hernia is
States, vitamin K is routinely given to in- faster than his or her liver can break it nurse or care provider. Some babies are caused by a weakness in the lower ab-
fants shortly after they’re born. Vitamin K down and pass it from the body. slow eaters the first few days, but soon dominal wall that allows the intestines to
is necessary for normal blood coagula- Your baby may develop jaundice for a they catch on and breast-feed or bottle- bulge outward. The hernia appears as a
tion, the body’s process for stopping few reasons: feed with enthusiasm. swelling in the lower abdomen or groin
bleeding after a cut or bruise. Newborns Z Bilirubin is being produced more Over the first week, a newborn may and is generally painless. Sometimes the
have low levels of vitamin K in their first quickly than the liver can handle. lose about 10 percent of his or her birth hernia is visible only when an infant is
few weeks. An injection of vitamin K can Z The baby’s developing liver isn’t able weight and will gradually gain that crying, coughing or straining during a
help prevent the rare possibility that a to remove bilirubin from the blood. weight back, and more! bowel movement.

An inguinal hernia may be small at CIRCUMCISION Consider your own cultural, religious where it’s difficult or impossible to re-
first, but it tends to gradually enlarge so and social values in making this decision. tract (phimosis). Circumcision may be
that an operation is eventually needed to If you have a baby boy, one of the deci- For some people, such as those of the needed to treat the problem. A nar-
repair the weak spot. An inguinal hernia sions you’ll face soon after birth is wheth- Jewish or Islamic faith, circumcision is a rowed foreskin can also lead to in-
usually won’t go away by itself. er to have him circumcised. Circumcision religious ritual. For others, it’s a matter of flammation of the head of the penis
is an elective surgical procedure per- personal hygiene or preventive health. (balanitis).
Umbilical hernia An umbilical hernia formed to remove the skin covering the Some parents choose circumcision be- Z Ease of hygiene. Circumcision makes
occurs when part of the intestine pro- tip of the penis. Knowing about the pro- cause they don’t want their son to look it easy to wash the penis. But even if
trudes through an opening in the upper cedure’s potential benefits and risks can different from his peers. the foreskin is intact, it’s still quite sim-
abdominal muscles near the bellybutton. help you make an informed decision. As you decide what’s best for you and ple to keep the penis clean. Normally
It may be especially evident when an in- your son, consider these potential health the foreskin adheres to the end of the
fant cries, causing the baby’s bellybutton Issues to consider Although circum- benefits and risks. penis in a newborn, then gradually
to protrude. This is a classic sign of an cision is fairly common in the United stretches back during early childhood.
umbilical hernia. States, it’s still somewhat controversial. Benefits of circumcision Some research
Most umbilical hernias close on their There’s some evidence that circumcision suggests that circumcision provides cer- Risks of circumcision Circumcision is
own by baby’s first birthday, though may have medical benefits, but the pro- tain benefits. These include: generally considered a safe procedure,
some take longer to heal. Umbilical cedure also has risks. The American Z Decreased risk of urinary tract infec- and the risks related to it are minor.
hernias that don’t disappear by age 4 Academy of Pediatrics doesn’t recom- tions. Although the risk of urinary However, circumcision does have some
or those that appear later in a person’s mend routine circumcision of all male tract infections in the first year is low, risks. Possible drawbacks of the proce-
life may require surgical repair to prevent newborns, saying there isn’t enough evi- studies suggest that such infections dure include:
complications. dence of benefit. may be up to 10 times more common Z Risks of minor surgery. All surgical
in uncircumcised baby boys than in procedures, including circumcision,
those who are circumcised. Uncir- carry certain risks, such as excessive
cumcised boys are also more likely to bleeding and infection. There’s also
be admitted to the hospital for a se- the possibility that the foreskin may
vere urinary tract infection during the be cut too short or too long, or that it
first three months of life than are doesn’t heal properly.
those who are circumcised. Z Pain during the procedure. Circumci-
Z Decreased risk of cancer of the penis. sion does cause pain. Typically a local
While this type of cancer is very rare, anesthetic is used to block the nerve
circumcised men show a lower inci- sensations. Talk to your care provider
dence of cancer of the penis than do about the type of anesthesia used.
uncircumcised men. Z Cost. Some insurance companies
Z Slightly decreased risk of sexually don’t cover the cost of circumcision. If
transmitted infections. Some studies you’re considering circumcision, check
have shown a lower risk of human whether your insurance company will
immunodeficiency virus (HIV) and cover it.
human papillomavirus (HPV) infec- Z Complicating factors. Sometimes, cir-
tions in circumcised men. However, cumcision may need to be postponed,
safe sexual practices are much more such as if your baby is born prema-
© MFMER
important in the prevention of sexu- turely, has severe jaundice or is feed-

ally transmitted infections than is ing poorly. It also may not be feasible
circumcision. in certain situations, such as in the
An inguinal hernia (left) results when a portion of the small intestine protrudes through the Z Prevention of penile problems. Occa- rare instance when baby’s urethral
lower abdominal wall. With an umbilical hernia (right), the small intestine protrudes through sionally, the foreskin on an uncircum- opening is in an abnormal position
an opening in abdominal wall near the bellybutton. cised penis may narrow to the point (hypospadias). Other conditions that

may prevent circumcision include penis. It usually takes about seven to 10 Z A foul-smelling drainage comes from delay, eczema and hearing loss. With ear-
ambiguous genitalia or a family his- days for the penis to heal. the penis tip, or there are crusted ly diagnosis and treatment, all signs and
tory of bleeding disorders. sores that contain fluid. symptoms can be prevented.
Circumcision doesn’t affect fertility. Circumcision care The tip of your Z The ring is still in place two weeks
Whether it enhances or detracts from son’s penis may seem raw for the first after the circumcision. Congenital adrenal hyperplasia (CAH)
sexual pleasure for men or their partners week after the procedure. Or a yellowish This group of disorders is caused by a de-
hasn’t been proved. Whatever your mucus or crust may form around the ficiency of certain hormones. Signs and
choice, negative outcomes are rare and area. This is a normal part of healing. A symptoms may include lethargy, vomit-
mostly minor. small amount of bleeding is also com- SCREENING TESTS ing, muscle weakness and dehydration.
mon the first day or two. Infants with mild forms are at risk of re-
How it’s done If you decide to have Clean the diaper area gently, and Before your baby leaves the hospital, a productive and growth difficulties. Se-
your son circumcised, his care provider apply a dab of petroleum jelly to the end small amount of his or her blood is taken vere cases can cause kidney dysfunction
can answer questions about the proce- of the penis with each diaper change. and sent to the state health department and even death. Lifelong hormone treat-
dure and help you make arrangements at This will keep the diaper from sticking or a private laboratory working in col- ment can suppress the condition.
your hospital or clinic. Usually, circumci- while the penis heals. If there’s a ban- laboration with the state laboratory. This
sion is performed before you and your dage, change it with each diapering. sample, which may be taken from a vein Congenital hypothyroidism About 1 in
son leave the hospital. At times, it’s done At some hospitals, a plastic ring is used in your baby’s arm or a tiny nick made on 3,000 babies have a thyroid hormone de-
in an outpatient setting. The procedure instead of a bandage. The ring will re- the heel, is analyzed to detect the pres- ficiency that slows growth and brain de-
itself takes about 10 minutes. main on the end of the penis until the ence of rare but important genetic dis- velopment. Left untreated, it can result in
Typically, the baby lies on a tray edge of the circumcision has healed, usu- eases. This testing is referred to as new- mental retardation and stunted growth.
with his arms and legs restrained. After ally within a week. The ring will drop off born screening. Results are generally With early detection and treatment, nor-
the penis and surrounding area are on its own. It’s OK to wash the penis as available in one to two weeks. mal development is possible.
cleansed, a local anesthetic is injected it’s healing. See page 97 for cleansing in- Occasionally, a baby needs to have
into the base of the penis. A special clamp structions. the test repeated. Don’t be alarmed if this Cystic fibrosis Cystic fibrosis causes the
or plastic ring is attached to the penis, Problems after a circumcision are happens to your newborn. To ensure that body to produce abnormally thickened
and the foreskin is cut away. An oint- rare, but call your baby’s care provider in every newborn with any of these condi- mucous secretions in the lungs and di-
ment, such as petroleum jelly, is applied. the following situations: tions is identified, even borderline results gestive system. Signs and symptoms
This protects the penis from adhering to Z Your baby doesn’t urinate normally 12 are rechecked. Retesting is especially generally include salty-tasting skin, poor
the diaper. to 18 hours after the circumcision. common for premature babies. weight gain and, eventually, persistent
If your newborn is fussy as the anes- Z Bleeding or redness around the tip of Each state independently operates its coughing and shortness of breath. Af-
thetic wears off, hold him gently — being the penis is persistent. newborn screening program, resulting in fected newborns can develop life-threat-
careful to avoid putting pressure on the Z The penis tip is significantly swollen. slight differences between the tests of- ening lung infections and intestinal ob-
fered. The American College of Medical structions. With early detection and
Genetics recommends a panel of tests to treatment, infants diagnosed with cystic
check for about 40 targeted diseases. fibrosis often live longer and in better
Some states check for additional diseas- health than they did in past years.
es. You also may request a specific genetic
Before circumcision (left), test if you feel your child may be at risk Galactosemia Babies born with galacto-
the foreskin of the penis of a certain genetic disorder. semia can’t metabolize galactose, a sugar
extends over the end of Some of the diseases that can be de- found in milk. Although newborns with
the penis (glans). After tected by the panel include: this condition typically appear normal,
the brief operation, the they may develop vomiting, diarrhea,
glans is exposed (right). Biotinidase deficiency This deficiency is jaundice and liver damage within a few
caused by the lack of an enzyme called weeks of their first milk feedings. Un-
biotinidase. Signs and symptoms of the treated, the disorder may result in mental
© MFMER
disorder include seizures, developmental disabilities, blindness, growth failure

and, in severe cases, death. Treatment in- easily throughout the body. Infants with
cludes eliminating milk and all other sickle cell disease experience an in-
dairy (galactose) products from the diet. creased susceptibility to infection and
slow growth rates. The disease can cause
Homocystinuria Caused by an enzyme bouts of pain and damage to vital organs
deficiency, homocystinuria can lead to such as the lungs, kidneys and brain.
eye problems, mental disabilities, skeletal With early medical treatment, the com-
abnormalities and abnormal blood clot- plications of sickle cell disease can be
ting. With early detection and manage- minimized.
ment — including a special diet and di-
etary supplements — growth and Hearing screening While your baby is
development should be normal. in the hospital, he or she may have a
hearing test. Although hearing tests are
Maple syrup urine disease (MSUD) not done routinely at every hospital,
This disorder affects the metabolism of newborn hearing screening is becoming
amino acids. Newborns with this condi- widely available. The testing can detect
tion typically appear normal, but by the possible hearing loss in the first days of a
first week of life they experience feeding baby’s life. If possible hearing loss is
difficulties, lethargy and poor growth. found, further tests may be done to con-
Left untreated, MSUD can lead to coma firm the results.
or death. Two tests are used to screen a new-
born’s hearing. Both are quick (about 10
Medium-chain acyl-CoA dehydroge- minutes), painless and can be done while
nase (MCAD) deficiency This rare he- your baby sleeps. One test measures
reditary disease results from the lack of how the brain responds to sound. Clicks
an enzyme required to convert fat to en- or tones are played through soft ear-
ergy. Babies with MCAD deficiency de- phones into the baby’s ears while elec-
velop serious vomiting, lethargy that can trodes taped on the baby’s head measure
worsen into coma, seizures, liver failure the brain’s response. Another test mea-
and severely low blood sugar. With early sures specific responses to sound waves
detection and monitoring, children diag- that enter a baby’s ear. As clicks or tones
nosed with MCAD deficiency can lead are played into a baby’s ear, a probe
normal lives. placed inside the ear canal measures the
response.
Phenylketonuria (PKU) Babies with
PKU retain excessive amounts of phenyl-
alanine, an amino acid found in the pro-
tein of almost all foods. Without treat-
ment, PKU can cause mental and motor
disabilities, poor growth rate, and sei-
zures. With early detection and treat-
ment, growth and development should
be normal.
Sickle cell disease This inherited dis-

ease prevents blood cells from circulating

CHAPTER 3
Feeding baby
If it seems like all you do these days is BREAST VS. BOTTLE

feed your baby, you know what? You’re
right! Newborns may not eat a lot, but Some women know right from the start
they eat often. And in those first few what they’ll do — breast-feed or bottle-
weeks with your new son or daughter, feed — while others struggle.
your life will revolve around satisfying his Most child health organizations ad-
or her hunger. Just when you think you vocate breast-feeding, and“breast is best”
have a moment to relax or perhaps get is a commonly used phrase. There’s no
some laundry done, wouldn’t you know doubt, breast-feeding is a wonderful way
it, baby wants to eat again! to nourish a newborn — breast milk pro-
At first, all of these feedings may vides numerous benefits. Mayo Clinic ex-
seem like a real chore. For almost every perts agree.
new parent, early days with a newborn However, care providers also realize
are often demanding and exhausting. that not all women are the same, and
Both you and your baby are adapting to a people’s life situations are different. De-
new reality, and that takes time. pending on your circumstances, certain
Throughout this adjustment, remem- factors may lead you to choose infant for-
ber that feeding your newborn is about mula instead of breast milk. Or you may
more than just nourishment. It’s a time of opt for a combination of both breast milk
cuddling and closeness that helps build and formula.
the connection between you and your Some women who choose the bottle
baby. You want to make every feeding a instead of the breast are bothered by
time to bond with your baby. Cherish this their decision. They worry they’re not be-
time before your baby is old enough to ing a good mother or putting the needs
start feeding himself or herself. That time of their child first. If you’re among this
will come soon enough. group, don’t shower yourself in guilt.
CHAPTER 3: FEEDING BABY 43

Such negative thinking isn’t good for you greater the chances that your baby will Easy digestion Breast milk is easier for always available — and at the perfect
— or for your baby. experience these benefits, and the more babies to digest than is formula or cow’s temperature. Because you don’t need
Feeding, regardless of how it’s deliv- likely they are to last. milk. Because breast milk doesn’t remain to prepare a bottle and you can nurse
ered — breast milk or formula, breast or in the stomach as long as formula does, lying down, nighttime feedings may
bottle — promotes intimacy. Benefits for baby Breast milk provides breast-fed babies spit up less. They have be easier.
Know that both options will provide babies with: less gas and less constipation. They also Z Cost savings. Breast-feeding can save
your child the nutrition he or she needs have less diarrhea, because breast milk money because you don’t need to buy
to grow and thrive. Ideal nutrition Breast milk has just the appears to kill some diarrhea-causing formula, and you may not need bottles.
right nutrients, in just the right amounts, germs and helps a baby’s digestive sys- However, breast-feeding can also
Questions to ask If you haven’t had to nourish your baby completely. It con- tem grow and function. present some challenges and inconve-
your baby yet and you’re debating tains the fats, proteins, carbohydrates, niences. Drawbacks to breast-feeding for
whether to breast-feed or bottle-feed, vitamins and minerals that a baby needs Benefits for mother For mothers, the some parents include:
you might consider these questions: for growth, digestion and brain develop- benefits include: Z Exclusive feeding by mom. In the early
Z What does your care provider suggest? ment. Breast milk is also individualized; weeks, parenting can be physically
Your care provider will likely be very the composition of your breast milk Faster recovery from childbirth The ba- demanding. At first, newborns nurse
supportive of breast-feeding unless changes as your baby grows. by’s suckling triggers your body to re- every two to three hours, day and
you have specific health issues — lease oxytocin, a hormone that causes night. That can be tiring for mom, and
such as a certain disease or disease Protection against disease Research your uterus to contract. This means that dad may feel left out. Eventually, you
treatment — that make formula- shows that breast milk may help keep the uterus returns to its pre-pregnancy can express milk with a breast pump,
feeding a better choice. your baby from getting sick. Breast milk size more quickly after delivery than it which will enable your partner or
Z Do you understand both methods? provides antibodies that help your baby’s does if you use formula. others to take over some feedings. It
Many women have misconceptions immune system fight off common child- may take about a month before your
about breast-feeding. Learn as much hood illnesses. Breast-fed babies may Suppresses ovulation Breast-feeding milk production is well established so
as you can about feeding your baby. have fewer colds, ear infections and uri- delays the return of ovulation and, there- that you can use a pump to express
Seek out expert advice if needed. nary tract infections than do babies who fore, your period, which may help extend and collect breast milk.
Z Do you plan to return to work? If so, aren’t breast-fed. Breast-fed babies may the time between pregnancies. However, Z Restrictions for mom. Women who are
how will that impact breast-feeding? also have fewer problems with asthma, breast-feeding is not a guarantee against breast-feeding generally should avoid
Does your place of work have accom- food allergies and skin conditions, such pregnancy. You can still become pregnant alcohol. However, it may be OK to
modations available where you can as eczema. They may be less likely to ex- while breast-feeding. have a minimal amount occasionally.
use a breast pump, if that’s your plan? perience a reduction in the number of Alcohol can pass through breast milk
Z How does your partner feel about the red blood cells (anemia). Breast-feeding, Possible long-term health benefits to the baby.
decision? The decision is ultimately research suggests, might also help to Breast-feeding may reduce your risk of Z Sore nipples. Some women may ex-
yours, but it’s a good idea to take your protect against sudden infant death syn- getting breast cancer before menopause. perience sore nipples and, at times,
partner’s feelings into consideration. drome (SIDS), also known as crib death, Breast-feeding also appears to provide breast infections. These can often be
Z How have other mothers you trust and and it may offer a slight reduction in the some protection from uterine and ovari- avoided with proper positioning and
respect made their decisions? If they risk of childhood leukemia. Breast milk an cancers. technique. A lactation consultant or
had it to do over again, would they may even protect against disease long your care provider can advise you on
make the same choices? term. As adults, people who were breast- Other issues Beyond potential health proper positioning.
fed may have a lowered risk of heart at- benefits, other benefits of breast-feeding Z Other physical side effects. When
tack and stroke — due to lower choles- include: you’re lactating, your body’s hor-
terol levels — and may be less likely to Z Convenience. Many mothers find mones may keep your vagina rela-
BREAST-FEEDING develop diabetes. breast-feeding to be more convenient tively dry. Using a water-based lubri-
than bottle-feeding. It can be done cating jelly can help treat this problem.
Breast-feeding is highly encouraged be- Protection against obesity Studies in- anywhere, at any time, whenever your It may also take time for your men-
cause it has so many known health ben- dicate that babies who are breast-fed are baby shows signs of hunger. Plus, no strual cycle to once again establish a
efits. The longer you breast-feed, the less likely to become obese as adults. equipment is necessary. Breast milk is regular pattern.
44 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 45

can really prepare your nipples for a up for a class. Most hospitals and birth-
WHAT GOES IN, COMES OUT nursing baby. If this is your first child, you ing centers also offer classes on feeding a
may not be comfortable holding a baby newborn.
While you’re breast-feeding, keep in mind that the foods and other items you in- — let alone putting a baby to your breast.
gest can be passed on to your baby through your breast milk. It may take a few attempts before you Supplies to have on hand Purchase a
A couple of things to remember while breast-feeding: and your baby get the hang of it. couple of nursing bras. They provide im-
Z Avoid or limit alcohol. If you do have an occasional drink, keep it to a minimal The time to begin breast-feeding is portant support for lactating breasts.
amount. right after the baby is born. If possible, What distinguishes nursing bras from
Z Limit caffeine. Drink mainly decaffeinated beverages. put baby to your breast in the delivery regular bras is that both cups open to the
Z Check your medications. Most are safe to take, but consult your child’s care room. Early skin-to-skin contact has front, usually with a simple maneuver
provider first. been shown to improve breast-feeding that you can manage unobtrusively while
Only rarely do the foods you eat cause your baby to be fussy or gassy. Babies outcomes. you hold your baby.
can get fussy for many reasons, and they can experience gas from the air they swallow While you’re in the hospital, ask a lac- You’ll also need nursing pads, which
when they cry or eat. However, if you suspect your child may be intolerant to some- tation consultant or other medical staff to can absorb milk that leaks from your
thing you ate, try eliminating the food for a while and see how your baby responds. assist you. These experts can provide breasts. Slim and disposable, they can be
hands-on instruction and helpful hints. slipped between the breast and bra to
After you leave the hospital or birthing soak up milk leakage. Avoid those with
center, you might want to arrange for a plastic shields, which prevent air circula-
Milk production Early in your preg- The let-down reflex makes your milk public health nurse who is knowledge- tion around the nipples. Nursing pads
nancy, your milk-producing (mammary) available to your baby. Although your able about infant feeding to visit you for can be worn continuously or on occasion.
glands prepare for nursing. By about the baby’s sucking is the main stimulus for additional one-on-one instruction. Some women don’t bother with the pads,
sixth month of your pregnancy, your milk let-down, other stimuli may have It’s a good idea to take a class on but most women find them helpful.
breasts are ready to produce milk. the same effect. For example, your baby’s breast-feeding. Often, information on
Your milk supply gradually increases cry — or even thoughts of your baby or breast-feeding is offered as part of child- Feeding positions When it’s feeding
between the third and fifth days after the sounds of rippling water — may set birth classes, or you may be able to sign time, find a quiet location and take
your baby’s birth. As the milk-producing things in motion.
glands fill with milk, your breasts will be Regardless of whether you plan to
full and sometimes tender. They may also breast-feed, your body produces milk af-
feel lumpy or hard. ter you have a baby. If you don’t breast-
Milk is released from the glands when feed, your milk supply eventually stops. If
a baby nurses. The milk is propelled you do breast-feed, your body’s milk pro-
down milk ducts, which are located just duction is based on supply and demand.
behind the dark circle of tissue that sur- The more frequently your breasts are
rounds the nipple (areola). The sucking emptied, the more milk they produce.
action of the baby compresses the areola,
forcing milk out through tiny openings in Getting started If this is your first ex-
the nipple. perience at breast-feeding, you may be
Your baby’s sucking stimulates nerve nervous, which is normal. If it goes easily
endings in your areola and nipple, send- for you right from the first feeding, that’s
ing a message to your brain to release the wonderful. If not, be patient. Like most
hormone oxytocin. Oxytocin acts on the anything new, it often takes some prac-
milk-producing glands in your breasts, tice to get it right.
causing the ejection of milk to your nurs- Breast-feeding may be a natural pro-
© MFMER
ing baby. This release is called the let- cess, but that doesn’t mean it comes eas-
down reflex, which may be accompanied ily to all mothers. Breast-feeding is a new
by a tingling sensation. skill for both you and your baby. Nothing

advantage of this time with your baby. Support the weight of your breast in your same side as the breast you’re feeding have large breasts or who are nursing
Have a drink of water or juice at hand be- hand while squeezing lightly to point the with. Your forearm supports your baby’s premature or small babies.
cause it’s common to feel thirsty when nipple straight forward. back. Use your free hand to support your
your milk lets down. Put the phone near- Different women find different nurs- breast. Side-lying hold Although most new
by or turn it off. If you would like, place a ing positions most comfortable. Experi- mothers learn to breast-feed in a sitting
book or the TV remote control within ment with these positions to see which Football (clutch) hold In this position, position, at times you may prefer to nurse
reach. works best for you: you hold your baby in much the same while lying down. Use the hand of your
Get into a comfortable position. Both way a running back tucks a football un- lower arm to help keep your baby’s head
you and baby should be comfortable. Cross-cradle hold Bring your baby der his arm. Hold your baby at your side positioned at your breast. With your up-
Whether in your hospital bed or a chair, across the front of your body, tummy to on one arm, with your elbow bent and per arm and hand, reach across your
sit up straight. Put a pillow behind the tummy. Hold your baby with the arm op- your open hand firmly supporting your body and grasp your breast, touching
small of your back for support. If you opt posite to the breast you’re feeding with. baby’s head faceup at the level of your your nipple to your baby’s lips. After your
for a chair, choose one with low armrests, Support the back of the baby’s head with breast. Your baby’s torso will rest on your baby latches on firmly, you can use your
or place a pillow under your arms for your open hand. This hold allows you es- forearm. Put a pillow at your side to sup- lower arm to support your own head and
support. pecially good control as you position port your arm. A chair with broad, low your upper hand and arm to help sup-
Move your baby across your body so your baby to latch on. With your free arms works best. port your baby.
that he or she faces your breast, with his hand, support your breast from the un- With your free hand, support your
or her mouth near your nipple. Make derside in a U-shaped hold to align with breast from the underside in a C-shaped Nursing basics If your baby’s mouth
sure your baby’s whole body is facing you baby’s mouth. hold to align with baby’s mouth. Because doesn’t open immediately to accept your
— tummy to tummy — with ear, shoul- the baby isn’t positioned near the abdo- breast, touch the nipple to your baby’s
der and hip in a straight line. Begin by Cradle hold Cradle your baby in your men, the football hold is popular among mouth or cheek. If your baby is hungry
placing your free hand up under your arm, with your baby’s head resting com- mothers recovering from C-sections. It’s and interested in nursing, his or her
breast to support it for breast-feeding. fortably in the crook of the elbow on the also a frequent choice of women who mouth should open. As soon as your
Cross-cradle hold Cradle hold

© MFMER
© MFMER
baby’s mouth is opened wide, like a lease. Repeat this procedure until your
yawn, move his or her mouth onto your baby has latched on properly. You want Side-lying hold
breast. You want your baby to receive as there to be a firm bond of suction.
much nipple and areola as possible. It You’ll know that milk is flowing and
might take a few attempts before your your baby is swallowing if there’s a
baby opens his or her mouth wide strong, steady, rhythmic motion visible
enough to latch on properly. You can also in your baby’s cheek. If your breast is
express some milk, which may encourage blocking your baby’s nose, elevating your
baby to latch on. baby slightly, or angling the baby’s head
As your baby starts suckling and your back and in, may help provide a little
nipple is being stretched in your baby’s breathing room. If your baby attaches
mouth, you may feel some surging sen- and sucks correctly — even if the ar-
© MFMER
sations. After a few suckles, those sensa- rangement feels awkward at first — the
tions should subside a bit. If they don’t, position is correct.
sandwich the breast more and draw ba- Once nursing begins, you can relax
by’s head in more closely. the supporting arm and pull your baby’s
If that doesn’t produce comfort, gen- lower body closer to you.
tly remove baby from your breast, taking
care to release the suction first. To break Frequency Because breast milk is easily Most newborns eat eight to 12 times a tein for growth. But the longer your baby
the suction, gently insert the tip of your digested, breast-fed babies usually are day — about every two to three hours. By sucks, the more he or she gets the hind-
finger into the corner of your baby’s hungry every few hours at first. During six to eight weeks after birth, your baby milk, which is rich in calories and fat, and
mouth. Slowly push your finger between those early days, it may seem that all you will probably begin to go longer between therefore helps your baby gain weight
your baby’s gums until you feel the redo is breast-feed! feedings. During growth spurts, your and grow. So wait until your baby seems
baby may take more at each feeding or ready to quit before offering him or her
want to breast-feed more often. Trust your other breast.
your body’s ability to keep up with the
increased demand. The more often your Amount A baby’s need for frequent feed-
Football hold baby nurses, the more milk your breasts ing isn’t a sign that baby isn’t getting
produce. enough; it reflects the easy digestibility of
breast milk. If your baby is satisfied after
Length In general, let your baby nurse as feeding and is growing, you can be confi-
long as he or she wants. The length of dent that you’re doing well.
feedings may vary considerably. How- If you’re concerned that baby may not
ever, on average, most babies nurse for be getting enough milk, ask yourself
about half an hour. these questions:
Offer your baby both breasts at each Z Is baby gaining weight? Steady weight
feeding. Allow your baby to end the feed- gain is often the most reliable sign
ing on the first side. Then, after burping that a baby is getting enough to eat.
your baby, offer the other side. (See burp- Although most babies lose weight
ing positions on page 68.) Alternate soon after birth, it’s typically regained
starting sides to equalize the stimulation — and then some — within 10 days
each breast receives. to two weeks.
You want baby to finish one breast Z Can I hear baby swallowing? If you
before switching to the other side be- listen carefully, you’ll be able to hear
© MFMER
cause the milk that comes first from your your baby swallowing. Also look for a
breast, called the foremilk, is rich in pro- strong, steady, rhythmic motion in

your baby’s lower jaw. A small amount alert and active at other times is likely PUMPING YOUR BREASTS lasts about 15 minutes a breast. If
of milk may even dribble out of your getting enough milk. Also look for a you’ll be pumping at work or in other
baby’s mouth. healthy skin tone. During the first several weeks of your time-crunched situations, you may
Z How do my breasts feel? When your child’s life, it’s best to nurse exclusively to want to invest in an electric breast
baby is latched on successfully, you’ll Support If you’re having problems help you and your baby learn how to pump that allows you to pump both
feel a gentle pulling sensation on your breast-feeding, or you’re worried that breast-feed and to be sure your milk sup- breasts at once. Double breast pumps
breast — rather than a pinching or baby isn’t getting enough milk, ask for ply becomes well established. can cut pumping time in half.
biting sensation on your nipple. Your help. You know your baby best. If you Once your milk supply is established Z How much can you afford to spend?
breasts may feel firm or full before the sense something isn’t right, don’t be and you feel confident that the two of While manual models generally cost
feeding, and softer or emptier after- afraid to contact your baby’s care provid- you are doing well with breast-feeding, less than $50, electric pumps that in-
ward. er or a lactation consultant. you may give your baby an occasional clude a carrying case and insulated
Z What about baby’s diapers? By the Most hospitals have lactation consul- bottle of breast milk. This allows others, section for storing milk may cost
fourth day after birth, expect your tants on staff who can answer your ques- such as your partner or a grandparent, an more than $200. Some hospitals or
baby to have six to eight wet diapers a tions or help you resolve any problems opportunity to feed the baby. And it pro- medical supply stores rent hospital-
day. Also expect regular bowel move- you may encounter. vides you a break, if you need one. grade breast pumps, and some health
ments. The stool will be dark and Remember, however, just as your Keep in mind that the feel of a bottle insurance plans cover the cost of buy-
sticky for the first couple of days, body knows what it’s doing during preg- nipple in a baby’s mouth is different from ing or renting a breast pump.
eventually becoming seedy, loose and nancy and childbirth, your body knows that of the breast. The way a baby sucks Z Is the pump easy to assemble and
golden yellow. how to support a breast-feeding baby. from a bottle nipple also is different. So it transport? If the breast pump is diffi-
Z Does baby seem healthy? A baby who Have faith in your body’s ability to meet may take some practice for your baby to cult to assemble, take apart or clean,
seems satisfied after feedings and is your baby’s nutritional needs. be comfortable with a bottle nipple. And it’s bound to be frustrating, which
beware that he or she may be reluctant to may reduce your enthusiasm for
take a bottle from mom because baby as- pumping. If you’ll be toting the pump
sociates mother’s voice and scent with to work every day, or traveling with
VITAMIN D breast-feeding. the pump, look for a lightweight
Most breast-feeding mothers find us- model. Some breast pumps come in a
Talk with your baby’s care provider about vitamin D supplements for your baby. ing a breast pump easier than expressing carrying case with an insulated sec-
While breast milk is the best source of nutrients for babies, it likely won’t provide milk manually. A lactation consultant or tion for storing expressed milk. Also
enough vitamin D. Your baby needs vitamin D to absorb calcium and phosphorus. your baby’s care provider can help you keep noise level in mind. Some elec-
Too little vitamin D can cause rickets, a softening and weakening of bones. determine what type of pump — manual tric models are quieter than are oth-
Since sun exposure — an important source of vitamin D — isn’t recommended or electric — is best for you, and offer ers. If it’s important to be discreet,
for babies younger than 6 months, supplements are the best way to prevent vita- help and support if problems arise. make sure the pump’s noise level is
min D deficiency in infants. In deciding on a pump, here are some acceptable.
The American Academy of Pediatrics and the Institute of Medicine recommend factors to consider: Z Is the suction adjustable? What’s com-
that babies who are breast-fed receive 400 international units (IU) of liquid vitamin Z How often will you use the breast fortable for one woman may be un-
D a day — starting in the first few days after birth. Continue giving your baby vita- pump? If you’ll be away from the baby comfortable for another. Choose a
min D as long as you breast-feed. only occasionally and your milk sup- pump that allows you to control the
As your baby gets older and you add solid foods to his or her diet, you can help ply is well established, a simple hand degree of suction.
your baby meet the daily vitamin D requirement by providing foods that contain pump may be all you need. They’re
vitamin D — such as oily fish, eggs and fortified foods. Keep in mind, however, that small and inexpensive. If you’re re- Storing breast milk Once you start
most babies won’t consistently eat these foods during their first year. turning to work full time, or planning pumping, it’s important to know how to
When giving your baby liquid vitamin D, make sure you don’t exceed the rec- to be away from your baby for more safely and properly store your expressed
ommended amount. Carefully read the instructions that come with the supplement than a few hours a day, you may want breast milk.
and use only the dropper that’s provided. to invest in an electric pump.
Z Will you need to pump as quickly as Container Store expressed breast milk in
possible? A typical pumping session capped glass or plastic containers that

to ensure that the creamy portion of the refrigerator the night before you intend
GOING BACK TO WORK milk is evenly distributed. to use it. You can also gently warm the
milk by placing it under warm running
With a little planning and preparation, you can do both — breast-feed and return Expiration The length of time you can water or in a bowl of warm water. Avoid
to work. Some mothers work at home, while some arrange to have their babies safely keep expressed breast milk de- letting the water touch the mouth of the
brought to them for feedings or they go to the babies. Most mothers, though, rely pends on the storage method. container.
on the help of a breast pump. Z Milk stored at room temperature. Never thaw frozen breast milk at
You can provide your baby with bottled breast milk by expressing milk while at Freshly expressed breast milk can be room temperature, which enables bacte-
work, storing it and saving the milk for the next day. Using a double breast pump kept at room temperature — up to 77 F ria to multiply in the milk. Also, don’t
is the most effective. A double breast pump requires about 15 minutes of pumping — for six hours. If you won’t use the heat a frozen bottle on the stove or in the
every three to four hours. If you need to increase your milk supply, nurse and pump milk that quickly, store it in the refrig- microwave. These methods can create an
more often. erator or freezer. uneven distribution of heat and destroy
If you’re worried that pumping at work may pose a problem or you prefer not Z Milk stored in an insulated cooler. the milk’s antibodies. Use thawed breast
to, brainstorm ways to make it convenient. For example, pump after the morning Freshly expressed breast milk can be milk within 24 hours. Discard any re-
feeding and after the feeding when you return home. As long as all of your milk stored in an insulated cooler with ice maining milk. Don’t refreeze thawed or
produced in 24 hours is removed either by your baby or from pumping, you’ll packs for up to one day. Then use the partially thawed breast milk.
maintain a good supply. milk, or transfer the containers to the Thawed breast milk may smell differ-
There are no rules set in stone. Go with whatever works best for you. refrigerator or freezer. ent from freshly expressed milk or taste
Z Milk stored in the refrigerator. Freshly soapy due to the breakdown of milk fats,
expressed breast milk can be stored in but it’s still safe for your baby to drink.
the refrigerator at 39 F for up to eight The milk may separate, so you may need
have been cleaned in a dishwasher or To minimize waste, fill individual days. to gently swirl the thawed milk so it’s
washed in hot, soapy water and thor- containers with the amount of milk your Z Milk stored in the freezer. Breast milk mixed evenly.
oughly rinsed. Consider boiling the con- baby will need for one feeding. Also con- can be stored in a freezer compart-
tainers after washing them if the quality sider storing smaller portions — 1 to 2 ment inside the refrigerator at 5 F for
of your water supply is questionable. ounces — for unexpected situations or two weeks. If your freezer has a sepa-
If you store breast milk for three days delays in regular feedings. Keep in mind rate door and a temperature of 0 F, KEEPING YOURSELF HEALTHY
or less, you can also use a plastic bag de- that breast milk expands as it freezes, so breast milk can be stored for three to
signed for milk collection and storage. don’t fill containers to the brim. six months. If you have a deep freezer If you’re like most new mothers, your at-
While economical, plastic bags aren’t You can add freshly expressed breast that’s opened infrequently and has a tention may be focused intently on the
recommended for long-term breast milk milk to refrigerated or frozen milk you temperature of -4 F, breast milk can needs of your baby. Although this com-
storage because they may spill, leak and expressed earlier in the same day. How- be stored for six to 12 months. mitment is completely reasonable, don’t
become contaminated more easily than ever, be sure to cool the freshly expres- Generally, though, the sooner you use forget about your needs. If your baby is to
hard-sided containers. Also, certain com- sed breast milk in the refrigerator or a the milk, the better. Some research sug- thrive, he or she needs a healthy mother.
ponents of breast milk may adhere to the cooler with ice packs for at least one hour gests that the longer you store breast
soft plastic bags during long-term breast before adding it to previously chilled milk — whether in the refrigerator or in Nutrition The best approach to nutrition
milk storage, which could deprive your milk. Don’t add warm breast milk to the freezer — the greater the loss of vita- while breast-feeding isn’t unlike the best
baby of essential nutrients. frozen breast milk because it will cause min C in the milk. Other studies have approach at other times in your life: Eat
the frozen milk to partially thaw. Keep shown that refrigeration beyond two a healthy, balanced diet. There are no
Method You can store expressed breast milk expressed on different days in sepa- days may reduce the bacteria-killing special foods to avoid when you’re
milk in the refrigerator or freezer. Using rate containers. properties of breast milk, and long-term breast-feeding. (However, you may find
waterproof labels and ink, label each Be aware that during storage ex- freezer storage may lower the quality of it helpful to limit certain foods that can
container with the date and time. Place pressed breast milk will separate — caus- breast milk’s lipids. show up in breast milk if you feel your
the containers in the back of the refrig- ing thick, white cream to rise to the top of baby doesn’t tolerate them well.) In addi-
erator or freezer, where the temperature the container. Before feeding your baby, Thawing Thaw the oldest milk first. tion, drink 6 to 8 cups of fluids each day.
is the coolest. Use your earliest milk first. gently swirl the contents of the container Simply place the frozen container in the Water, milk and juice are good choices.

Small amounts of coffee, tea and soft make you feel sleepy, so try and sleep on gorged breasts and may make you feel by hand or by breast pump. It may also
drinks are fine. baby’s schedule. more comfortable. help to apply a warm compress before
As a new mother, it can be hard to Don’t be afraid to ask others to help If your breasts are sore after nursing, nursing and to massage the affected
prepare healthy meals each day. You may out with daily chores so that you can rest. apply an ice pack to reduce swelling. breast. If the problem doesn’t go away
find it easier to snack on healthy foods Young children may appreciate being Some women find that a warm shower with self-treatment, call a lactation con-
throughout the day. Partners can help able to help mother and baby by pitching relieves breast tenderness. Fortunately, sultant or your care provider for advice.
support a breast-feeding mother by in around the house. the period of engorgement is usually
bringing her refreshments while she’s brief, lasting no more than a few days fol- Breast infection Infection (mastitis) may
nursing. Breast care As you start to breast-feed, lowing delivery. be caused by a failure to empty your
you may experience some minor, occa- breasts at feedings. Germs may also gain
Rest Try to get as much rest as you can, sional problems, which often can be eas- Nipple discomfort When you first begin entry into your milk ducts from cracked
as hard as that may seem at times. You’ll ily treated. breast-feeding, you may experience some nipples and from your baby’s mouth.
feel more energetic, you’ll eat better, and initial nipple discomfort as baby latches These germs are not harmful to your
you’ll enjoy your new baby best when Fullness A few days after your baby is on, but the discomfort should subside as baby; everyone has them. They just don’t
you’re rested. Rest promotes the produc- born, your breasts may become full, firm your baby feeds. belong in your breast tissues.
tion of breast milk by enhancing the pro- and tender, making it challenging for Sore or cracked nipples are usually Mastitis starts with flu-like signs and
duction of milk-producing hormones. your baby to grasp your nipple. This caused by incorrect positioning and symptoms such as a fever, chills and body
The soothing effect of breast-feeding can swelling, called engorgement, also causes latching. At each feeding, you want to aches. Redness, swelling and breast ten-
congestion within your breasts, which make sure that the baby has the areola derness then follow. If you develop such
makes your milk flow slower. So even if and not just the nipple in his or her signs and symptoms, call your care pro-
your baby can latch on, he or she may be mouth. You also want to be certain that vider. You may need antibiotics, in addi-
less than satisfied with the results. the baby’s head isn’t out of line with his tion to rest and more fluids.
To manage engorgement, express or her body. This position causes pulling Keep nursing if you’re taking antibi-
some milk by hand before trying to at the nipple. otics. Treatment for mastitis doesn’t harm
breast-feed. Support with one hand the To care for your nipples, express milk your baby, and emptying your breasts
breast you intend to express. With your onto your nipples and let them air-dry during feedings will help to prevent
other hand, gently stroke your breast in- after each feeding. You don’t need to clogged milk ducts, another possible
ward toward your areola. Then place your wash your nipples after nursing. There source of the condition. If your breasts
thumb and forefinger at the top and bot- are built-in lubricants around the areola are really painful, hand express some
tom of the breast just behind the areola. that provide a natural salve. Soap and milk from them as you soak your breasts
As you gently compress the breast be- water with daily bathing is fine. After- in a bath of warm water.
tween your fingers, milk should flow or ward, let your nipples air-dry.
squirt out of the nipple. Taking a warm
shower may also result in let-down of Blocked milk ducts Sometimes, milk
milk and provide some engorgement re- ducts in the breast become clogged, WEANING
lief. You can also use a breast pump to causing milk to back up. Blocked ducts
express some milk. can be felt through the skin as small, ten- There will come a time when it’s best for
As you release your milk, you’ll begin der lumps or larger areas of hardness. baby and you to transition from the
to feel your areola and nipple soften. Because blocked ducts can lead to an in- breast to a cup. Your baby is growing up
Once enough milk is released, your baby fection, you should treat the problem and he or she is ready to take the next big
can comfortably latch on and nurse. Fre- right away. step. Or, if your child is not ready for a
quent, lengthy nursing sessions are the The best way to open up blocked cup, you may need to transition your
best means to avoid engorgement. ducts is to let your baby empty the af- child from the breast to a bottle.
Nurse your baby regularly and try not fected breast, offering that breast first at Breast-feeding is an intimate activity
to miss a feeding. Wearing a nursing bra each feeding. If your baby doesn’t empty for you and your child. You may have
both day and night will help support en- the affected breast, express milk from it mixed emotions about letting go. By

taking a gradual approach to weaning — ing. He or she will be more likely to han- Nutrition If you wean your child before lows them to share more easily in the
and offering plenty of love and affection dle the transition well if you’re both in age 1, substitute breast milk with iron- feeding responsibilities.
— you can help your child make a good health. fortified formula. Ask your child’s doctor Z Convenience. Some mothers feel for-
smooth transition. Weaning doesn’t have You might also consider postponing to recommend a formula. Don’t give your mula is more portable, especially on
to be difficult. Choose the right time and weaning if a major change has occurred child cow’s milk until after his or her first outings and in public places. They
do what you can to make it a growing ex- at home, such as moving to a new home birthday. You can wean your child to a don’t have to find an out-of-the-way
perience. or the addition of a new family member. bottle and then a cup or, if your child location to breast-feed.
You don’t want to add more stress at seems ready, directly to a cup. Bottle-feeding can also present some
Timing You may wonder when’s the what may already be a stressful time for If you’re introducing your child to a challenges, such as:
best time to start weaning. There really your child. bottle for the first time, do so at a time Z Time-consuming preparation. Bottles
isn’t a right or wrong answer. Some research also suggests that ex- when your child isn’t extremely hungry must be prepared and warmed for
Breast-feeding until your baby is 1 is clusive breast-feeding for at least four and may have more patience. It also may each feeding. You need a steady sup-
recommended. Breast milk contains the months may have a protective effect for help if another caregiver introduces the ply of formula. Bottles and nipples
right balance of nutrients for your baby children who have a family history of bottle, since some children may refuse a need to be washed. If you go out, you
and boosts your baby’s immune system. food allergies. If food allergies run in bottle when the breast is available. may need to take formula with you.
Still, when to start weaning your child is your family, talk to your child’s doctor Choose a bottle nipple with a slow Z Cost. Formula is costly, which is a
a personal decision. about the potential benefits of delaying flow at first. If you use a bottle nipple concern for some parents.
It’s often easiest to begin weaning weaning. with a fast flow, your child may become
when your baby initiates the process — frustrated with the slower flow of milk Supplies Make sure you have the right
which may be sooner or later than you Method When you start the weaning during breast-feeding. supplies on hand when you bring your
expect. Weaning often begins naturally at process, take it slow. Eliminate one baby home from the hospital. Staff at the
6 months, when solid foods are typically breast-feeding session a day every two to hospital or birthing center also can pro-
introduced. Some children begin to grad- three days. Slowly tapering off the num- vide bottle-feeding equipment and for-
ually turn away from breast milk and ber of times you breast-feed each day will BOTTLE-FEEDING mula the first few days after your baby’s
seek other forms of nutrition and comfort cause your milk supply to gradually di- birth and show you how to bottle-feed
at around age 1, when they’ve begun eat- minish and prevent discomfort from en- Some mothers prefer to bottle-feed their your newborn.
ing a wide variety of solid foods and may gorgement. newborn with infant formula rather than The equipment generally needed if
be able to drink from a cup. Other chil- Keep in mind that children tend to be breast-feed. This is a personal choice, and you are going to bottle-feed your son or
dren may not initiate weaning until their more attached to the first and last feed- there are a variety of reasons why new daughter includes:
toddler years, when they become less ings of the day, when the need for com- mothers opt for the bottle rather than the Z Four 4-ounce bottles (optional, but
willing to sit still during breast-feeding. fort is greater — so it might be helpful to breast. In a few cases, a mother isn’t able useful at the beginning)
You may also decide when to start the drop a midday breast-feeding session to breast-feed her child. Z Eight 8-ounce bottles
weaning process yourself. This may be first. You might also choose to wean your If you choose not to or you aren’t able Z Eight to 10 nipples, nipple rings and
more difficult than following your child’s baby from breast milk during the day but to breast-feed, be assured that your baby’s nipple caps
lead — but can be done with some extra continue breast-feeding at night. It’s up nutritional needs can be met with the use Z A measuring cup
care and sensitivity. to you and your child. When eliminating of infant formula. And your baby will still Z A bottle brush
Whenever you start weaning your a breast-feeding session, try to avoid sit- be happily bonded to you as a parent. Z Infant formula
baby from the breast, stay focused on ting in your usual breast-feeding spots In addition to buying the right equip-
your child’s needs as well as your own. with your child. Instead, offer a distrac- Pros vs. cons Parents who bottle-feed ment, consider taking a class on infant
Resist comparing your situation with that tion, such as a book, toy or fun activity. feel the main advantage of a bottle is: feeding, if you haven’t taken one already.
of other families, and consider rethinking Depending on your approach, wean- Z Flexibility. Using a bottle with for- Often, information on feeding a newborn
any deadlines you may have set for ing could take days, weeks or months. mula allows more than one person to is offered as part of childbirth classes. If
weaning when you were pregnant or Remember, however, that rushing the feed the baby. For that reason, some you’ve never bottle-fed a baby before,
when your baby was a newborn. weaning process may be upsetting for mothers feel they have more freedom taking a class will help you feel more
You might consider delaying weaning your child and cause engorgement for when they’re bottle-feeding. Partners comfortable when you bring your baby
if your child isn’t feeling well or is teeth- you. Be patient. may like bottle-feeding because it al- home.

Bottles Bottles generally come in two INFANT FORMULAS
sizes: 4 ounces and 8 ounces. They may MILK ALLERGY
be glass, plastic or plastic with a soft plas- A wide variety of infant formulas are on
tic liner. the market. The majority of them are A person of any age can have a milk allergy, but it’s more common among infants.
based on cow’s milk. However, never use A milk allergy occurs when the body’s immune system mistakenly identifies the
Nipples Many types of nipples are on the regular cow’s milk as a substitute for for- protein in milk as something the body should fight off. This starts an allergic reac-
market, which have openings sized ac- mula. Although cow’s milk is used as the tion, which can cause fussiness and digestive problems.
cording to a baby’s age: newborn, foundation for formula, the milk has Cow’s milk is the usual cause of milk allergy; however, milk from sheep, goats
3-month-old, 6-month-old, and so on. been changed dramatically to make it and water buffalo also can cause a reaction. And some children who are allergic to
The flow rate from the nipple is appropri- safe for babies. cow’s milk are allergic to soy milk, too.
ate to the baby’s age. Infant formula is treated by heat to Because most formula is derived from cow’s milk, infants who are formula-fed
It’s important that formula flows from make the protein in it more digestible. may have a higher risk of developing a milk allergy than those who are breast-fed.
the nipple at the correct speed. Milk flow More milk sugar (lactose) is added to Researchers don’t fully understand why some infants develop a milk allergy and
that’s either too fast or too slow can cause make the concentration similar to that of others don’t.
your baby to swallow too much air, lead- breast milk, and the fat (butterfat) is re- If you use formula and your son or daughter has a milk allergy, your doctor may
ing to stomach discomfort and the need moved and replaced with vegetable oils advise you to switch to another type of formula that’s less likely to cause an allergic
for frequent burping. Test the flow of the and animal fats that are more easily di- reaction.
nipple by turning the bottle upside down gested by infants. If you’re breast-feeding, restrict the amount of dairy products you consume.
and timing the drops. One drop per sec- Infant formulas contain the right The milk protein in dairy products that triggers the allergic reaction can cross into
ond is about right. amount of carbohydrates and the right your breast milk. In addition to irritability, signs and symptoms of a milk allergy may
percentages of fat and protein. The Food include loose stools (possibly containing blood), vomiting, gagging, refusal to eat,
and Drug Administration (FDA) monitors excessive crying, and skin rashes. Fortunately, most children outgrow a milk aller-
commercially prepared infant formula. gy by age 3.
Each manufacturer must test each batch
of formula to ensure it has the required
nutrients and is free of contaminants.
Infant formula is designed to be an Cow’s milk formulas Most infant for- Protein hydrolysate formulas These are
energy-dense food. More than half its mula is made with cow’s milk that’s been meant for babies who have a milk or soy
calories are from fat. Many different types altered to resemble breast milk. This allergy. Protein hydrolysate formulas are
of fatty acids make up that fat. Those that gives the formula the right balance of nu- easier to digest and less likely to cause al-
go into infant formula are specifically se- trients — and makes the formula easier lergic reactions than are other types of
lected because they’re similar to those to digest. Most babies do well on cow’s formula. They’re also called hypoaller-
found in breast milk. These fatty acids milk formula. Some babies, however — genic formulas.
help in the development of your baby’s such as those allergic to the proteins in In addition, specialized formulas are
brain and nervous system, as well as in cow’s milk — need other types of infant available for premature infants and ba-
meeting his or her energy needs. formula. bies who have specific medical conditions.
Types If you’re planning to feed your Soy-based formulas Soy-based formu- Forms Infant formulas come in three
baby infant formula, you may have many las can be useful if you want to exclude forms. The best choice depends on your
questions. Is one brand of infant formula animal proteins from your child’s diet. budget and desire for convenience:
better than another? Are generic brands Soy-based formulas may also be an op- Z Powdered formula. Powdered formula
OK? Is soy-based formula better than tion for babies who are intolerant or al- is the least expensive. Each scoop of
cow’s milk formula? lergic to cow’s milk formula or to lactose, powdered formula must be mixed
Commercial infant formulas are regu- a sugar naturally found in cow’s milk. with water.
lated by the FDA. Three major types are However, babies who are allergic to cow’s Z Concentrated liquid formula. This type
available: milk may also be allergic to soy milk. of formula also is mixed with water.

Z Ready-to-use formula. Ready-to-use DHA and ARA in infant formula can help measure, mix and store formula should After the first use, there’s no need to
formula is the most convenient type infant eyesight and brain development, be washed with hot, soapy water and sterilize your utensils. Simply wash these
of infant formula. It doesn’t need to but other research has shown no benefit. then rinsed and dried before every use. items with soap and water and allow
be mixed with water. It’s also the most In addition, in an effort to mimic the Sterilizing bottles and nipples isn’t nec- them to air-dry. To help prevent fungal
expensive option. immune benefits of breast milk, some in- essary as long as you wash and rinse growth, you might want to rinse nipples
fant formulas now include probiotics — them well. Use a bottle brush to wash daily in equal parts vinegar and water
Generic vs. brand name All infant substances that promote the presence of bottles. Brush or rub the nipples thor- and allow them to air-dry.
formulas sold in the United States — healthy bacteria in the intestines. The oughly to remove any traces of formula. Also make sure the nipples are open.
both generic and brand name — must data on probiotic-supplemented formu- Rinse well. You can also clean bottles and Hold each nipple upside down and fill it
meet the nutrient standards set by the las is limited and long-term benefits or nipples in the dishwasher. with water, then look for the water to
FDA. Although manufacturers may vary complications of the formula are un- Whether using powder formula or drip slowly out of the nipple.
in their formula recipes, the FDA requires known. liquid concentrate, always add the exact
that all formulas contain the minimum At this point, there’s insufficient evi- amount of water specified on the label. Measure the formula For ready-to-use
recommended amount — and no more dence to recommend the use of en- Measurements on bottles may be inaccu- formula, shake the container of formula
than the maximum amount — of nutri- hanced formulas. In addition, they tend rate, so pre-measure the water before well before opening it. Pour enough for-
ents that infants need. to be more expensive than regular for- adding it to the formula. Using too much mula for one feeding into a clean bottle.
mula. If you think your child might ben- or too little water isn’t good for your For liquid-concentrate formula, pour
Additional ingredients It’s important efit from formula supplemented with baby. If formula is too diluted, your baby the amount of formula for one serving
to buy iron-fortified infant formula. Your probiotics or another substance, talk to won’t get enough nutrition for his or her into a clean bottle. For powdered formula:
baby needs iron to grow and develop, es- your child’s care provider for additional growth needs and to satisfy his or her Z Use the scoop that came with the for-
pecially during infancy. If you’re not information and guidance. hunger. mula container. Make sure the scoop
breast-feeding, using iron-fortified for- Formula that’s too concentrated puts is dry.
mula is the easiest way to provide this es- Preparation Whatever type and form of strain on the baby’s digestive system and Z Determine the amount of formula
sential nutrient. formula you choose, proper preparation kidneys, and could dehydrate your baby. you want to prepare, following in-
Some infant formulas are enhanced and storage are essential, both to ensure Generally, you can store all prepared for- structions on the package. Note the
with docosahexaenoic acid (DHA) and the appropriate amount of nutrition and mula or liquid concentrate in the refrig- number of scoops you’ll need.
arachidonic acid (ARA). These are ome- to safeguard the health of your baby. erator for up to 48 hours. After that, Z Fill the scoop with powdered formula,
ga-3 fatty acids found in breast milk and Wash your hands before handling throw away all unused formula. shaving off any excess formula from
certain foods, such as fish and eggs. formula or the equipment used to pre- Follow these steps to ensure proper the top of the scoop with the flat side
Some studies suggest that including pare it. All equipment that you use to nutrition and avoid food-related illness. of a knife — not a spoon or other
curved surface.
Wash your hands Before preparing for- Z Repeat as needed, depending on how
mula, wash your hands thoroughly. Wet much formula you want to prepare.
LOOK BEFORE YOU BUY your hands with warm running water,
then rub soap on your hands vigorously Add water to liquid-concentrate or
Don’t buy or use outdated infant formu- for at least 20 seconds. powdered formula If you’re using liquid-
la. If the expiration date has passed, you concentrate or powdered formula, you’ll
can’t be sure of the formula’s quality. Prepare your utensils Sterilize new bot- also need to add water to the bottle. Fol-
While checking the expiration date, tles, nipples, caps and rings before using low the instructions on the container for
also inspect the condition of the for- them for the first time. Boil the utensils in how much water to mix with the formula,
mula container. Don’t buy or use for- water for five minutes. Use a pot that’s and then shake well. Adding too little
mula from containers with bulges, large enough to hold the utensils and water can put a burden on your baby’s
dents, leaks or rust spots. Formula in a cover them completely with water. Re- digestive system, and adding too much
damaged container may be unsafe. move the utensils from the water using a water may overly dilute the formula and
clean set of tongs. Allow the utensils to deprive your baby of important calories
air-dry. and nutrients.

You can use any type of clean water If you prepare and fill several bottles
— tap or bottled — to prepare liquid- of liquid-concentrate or powdered for- ASK ABOUT VITAMIN D
concentrate or powdered formula. Con- mula at once:
sider the amount of fluoride in the water Z Label each bottle with the date that Vitamin D supplementation isn’t just for babies who are breast-fed. Formula may
you use to prepare your baby’s formula. If the formula was prepared. not provide enough vitamin D, which is essential to help your baby absorb calcium
you use bottled water or well water, it Z Refrigerate the extra bottles until you and phosphorus — necessary for strong bones. Too little vitamin D could also
may not contain fluoride. Mention this need them — don’t freeze them. cause a softening and weakening of bone.
to your child’s care provider. Exposure Z Put the bottles toward the back of the The American Academy of Pediatrics and the Institute of Medicine recommend
to fluoride during infancy helps prevent refrigerator, where it’s coldest. that babies who are formula-fed receive 400 International Units (IU) of liquid vitamin
tooth decay during childhood and later Z Discard any prepared formula that’s D a day — starting in the first few days after birth and continuing until your son or
in life. been in the refrigerator more than 24 daughter drinks at least 32 ounces (about 1 liter) a day.
to 48 hours. As mentioned earlier, as your baby gets older and he or she starts eating solid
Warm the formula, if needed Warming If you’re unsure whether a particular foods, you can help your baby meet the daily vitamin D requirement by providing
formula isn’t necessary for nutritional container or bottle of formula is safe, foods that contain vitamin D — such as oily fish, eggs and fortified foods. How-
purposes, but your baby may prefer it throw it out. ever most babies won’t consistently eat these foods during their first year.
warm. To warm formula: Similar to medications, when giving your baby liquid vitamin D, make sure you
Z Place a filled bottle in a bowl or pan of Getting into position The first step to don’t exceed the recommended amount. Carefully read the instructions and use
hot, but not boiling, water and let it bottle-feeding is to make you and your only the dropper that’s provided.
stand for a few minutes — or warm baby comfortable. Find a quiet place
the bottle under running water. where you and your baby won’t be dis-
Z Shake the bottle after warming it. tracted.
Z Turn the bottle upside down and al- Cradle your baby in one arm, hold the ing, it may be because he or she has had In general, during the first month, ex-
low a drop or two of formula to fall on bottle with the other and settle into a enough milk, or gas has made your baby pect eight to 12 feedings in a 24-hour pe-
your wrist or the back of your hand. comfortable chair, preferably one with full. Take the bottle away, burp your baby riod — about every two to three hours.
The formula should feel lukewarm — broad, low armrests. You may want to put (see page 68), then start to feed again. You’ll know that your young one is
not hot. a pillow on your lap under the baby for Always hold your baby while feeding. getting enough formula if by the end of
Z Don’t warm bottles in the microwave. support. Pull your baby in toward you Never prop a bottle up against your in- the first week he or she has about six to
The formula may heat unevenly, cre- snugly but not too tightly, cradled in your fant. Propping may cause your baby to eight wet diapers a day. He or she may
ating hot spots that could burn your arm with his or her head raised slightly vomit and may lead to overeating. In ad- also experience one or two bowel move-
baby’s mouth. and resting in the bend of your elbow. dition, never give a bottle to your baby ments a day.
After warming, shake the bottle well This semi-upright position makes swal- when he or she is lying on his or her
and feed the formula to your baby imme- lowing much easier. back. This may increase your baby’s risk Weaning Infant formula is generally
diately. Discard any formula that remains Using the nipple of the bottle or a fin- of developing an ear infection. recommended until age 1, followed by
in the bottle after a feeding. ger of the hand holding it, gently stroke Although your baby doesn’t have whole milk until age 2 — but talk with
your baby’s cheek near the mouth, on the teeth yet, they’re forming beneath the your child’s care provider for specific
Store formula safely Store unopened side nearest you. The touch will cause gums. Don’t develop a habit of putting guidance. Reduced-fat or skim milk gen-
formula containers in a cool, dry place. your baby to turn toward you, often with your baby to bed with a bottle. Formula erally isn’t appropriate before age 2 be-
Don’t store formula containers outdoors an opened mouth. Then touch the nipple lingers in the mouth of a baby who falls cause it doesn’t have enough calories or
or in a car or garage, where temperature to your baby’s lips or the corner of the asleep while sucking a bottle. The pro- fat to promote early development.
extremes can affect the quality of the mouth. Your baby will open his or her longed contact of sugar in milk can cause
formula. mouth and gradually begin sucking. tooth decay.
If you’re using ready-to-use formula, When feeding your baby, position the
cover and refrigerate any leftover formula bottle at about a 45-degree angle. This Amount During the first few weeks, FEEDING TIPS
from a freshly opened container. Discard angle keeps the nipple full of milk. Hold your baby will likely drink about 1 to 3
any leftover formula that’s been in the re- the bottle steady as your baby feeds. If ounces per feeding. As he or she grows, As your baby matures, he or she will
frigerator more than 24 to 48 hours. your baby falls asleep while bottle-feed- the amount will gradually increase. gradually need fewer daily feedings and

eat more at each feeding. A feeding pat- hunger can be satisfied by sucking, which Babies often don’t eat at precise inter- and the stomach keeps stomach contents
tern and routine will begin to emerge af- brings food. If you don’t respond prompt- vals throughout the day. Most babies where they belong. Until this valve has
ter the first month or two. Whether you ly, your baby may become so upset that bunch (cluster) their feedings at various time to mature, spitting up may be an is-
breast-feed or bottle-feed, here are a few trying to feed at this point may prove times of the day and night. It’s common sue — especially if your baby eats too
pointers to keep in mind. more frustrating than satisfying. for a baby to eat several times within a much or too quickly.
few hours and then sleep for a few hours. Minimal spitting up doesn’t hurt. It
Feed on cue The size of your infant’s Let baby set the pace Try not to rush isn’t likely to cause coughing, choking or
stomach is very small, about the size of your baby during a feeding. He or she Stick with breast milk or formula discomfort — even during sleep. Chanc-
his or her fist, and the time it takes to be- will determine how much and how fast Don’t give your newborn water, juice or es are your baby won’t even notice the
come empty varies from one to three to eat. Many babies, like adults, prefer to other fluids. Introducing these liquids fluid dripping out of his or her mouth.
hours. Feeding on cue requires you to eat in a relaxed manner. It’s normal for an before your baby is 6 months is unneces- Spitting up tends to peak at age 4
watch for signs that a baby is ready to eat: infant to suck, pause, rest, socialize a bit sary and can interfere with his or her de- months, and most babies stop spitting up
your baby makes sucking movements and then return to feeding. Some new- sire for breast milk or formula, which by 12 months.
with his or her mouth or tongue (root- borns are speedy, efficient eaters, consis- may lead to malnourishment.
ing), sucks on his or her fist, makes small tently whizzing through feedings. Other What you can do To reduce spitting up,
sounds, and of course, cries.You will soon babies are grazers, preferring snack-sized Consider feedings a time to bond consider these tips:
be able to distinguish between cries for feedings at frequent intervals. Still others, For babies, feeding is as much a social ac-
food and those for other reasons, such as especially newborns, are snoozers. These tivity as a nutritional one. Your baby’s Keep your baby upright Position baby’s
pain, fatigue or illness. babies may take a few vigorous sucks and growth and development are based, in head higher than the rest of the body
It’s important to feed your baby blissfully doze off, then wake, feed and part, on the powerful bond that forms when feeding. Follow each feeding with
promptly when he or she signals hunger. doze again intermittently throughout a during feedings. Hold your baby close 15 to 30 minutes in a sitting position.
This helps your baby learn which kinds typical feeding session. during each feeding. Look him or her in Hold your baby in your arms, or try a
of discomfort mean hunger and that Your baby will also let you know the eye. Speak with a gentle voice. Don’t front pack, backpack or infant seat. Avoid
when he or she has had enough to eat. miss this opportunity to build your baby’s active play and infant swings while the
When your baby is satisfied, he or she sense of security, trust and comfort. food is settling.
will stop sucking, close his or her mouth
or turn away from the nipple. Baby may Try smaller, more frequent feedings
push the nipple out of his or her mouth Feeding your baby too much can contrib-
with his or her tongue, or your baby may SPITTING UP ute to spitting up. If you’re breast-feed-
arch his or her back if you try to continue ing, limit the length of each nursing ses-
feeding. If, however, your baby needs Does your baby spit up after every feed- sion. If you’re bottle-feeding, offer your
burping or is in the middle of a bowel ing? Spitting up is a rite of passage for baby slightly less than usual.
movement, his or her mind may not be many babies. Although it’s messy, you
on eating. Wait a bit, and then try offering probably don’t need to worry. Spitting up Take time to burp your baby Frequent
the breast or bottle again. rarely signifies a serious problem. As long burps during and after each feeding can
as your baby seems comfortable and is keep air from building up in your baby’s
Be flexible Don’t expect your baby to gaining weight, there’s generally little stomach. Sit your baby upright, support-
eat the same amount every day. Babies cause for concern. ing your baby’s head with one hand
vary in how much they eat, especially if If you keep a burp cloth within reach while patting his or her back with your
they’re experiencing a growth spurt. At at all times, you’re well prepared. About other hand (see page 68).
these times, your baby will need and de- half of all babies experience infant reflux
mand more milk and eat more frequent- (gastroesophageal reflux) during the first Check the nipple If you’re using a bottle,
ly. It may seem like your baby can’t get three months after birth. make sure the hole in the nipple is the
full. During these times, you may need to right size (see page 60). If it’s too large,
put your baby to your breast or offer a Reflux Normally a valve (lower esopha- the milk will flow too fast. If it’s too small,
bottle more often. geal sphincter) between the esophagus your baby might get frustrated and gulp

BURPING POSITIONS air. A nipple that’s the right size will al- INTRODUCING SOLIDS
low a few drops of milk to fall out when
you hold the bottle upside down. When a child is first born, breast milk or
formula is the only food he or she needs.
Experiment with your diet If you’re Eventually, though, your baby will begin
breast-feeding, your baby’s doctor might to develop the coordination to move sol-
suggest that you eliminate dairy products id food from the front of the mouth to the
or certain other foods from your diet. back for swallowing. At the same time,
his or her head control will improve so
Pay attention to baby’s sleep position that he or she can sit with support. These
To reduce the risk of sudden infant death are essential skills for eating solid foods.
syndrome (SIDS), it’s important to place So when are babies ready for solid
your baby to sleep on his or her back. If foods? It varies and there’s no specific
this seems to aggravate reflux, it might time you have to introduce solids. The
help to slightly elevate the head of your American Academy of Pediatrics recom-
baby’s crib — although this can be diffi- mends waiting until a child is at least 4
cult to maintain if your baby moves months old before introducing solids,
© MFMER
around in his or her sleep. Placing a baby and preferably holding off until a child is
to sleep on his or her tummy is rarely rec- closer to 6 months old. Your child’s readi-
ommended to prevent spitting up. ness and nutritional needs also are key
Lay baby facedown across your lap, and gently rub and pat baby’s back. factors to be considered.
When it’s more serious Normal spit- It’s a good idea to check with your
ting up doesn’t interfere with a baby’s child’s care provider or another member
growth or well-being. More severe spit- of the health care team before starting
ting up may indicate something more any solid foods. These individuals can
serious. Contact your baby’s doctor if give you some advice and practical tips.
your baby:
Z Isn’t gaining weight Getting started When the time is right,
Z Spits up so forcefully that stomach begin with baby cereal. One way to make
contents shoot out of his or her eating solids for the first time easier is to
mouth (vomits) give your baby a little breast milk or for-
Z Spits up green or yellow fluid mula first, then switch to very small half
Z Spits up blood or a material that looks spoonfuls of food, and finish with more
like coffee grounds breast milk or formula. This will prevent
Z Resists feedings your baby from getting frustrated when
Z Has blood in his or her stool he or she is very hungry.
Z Has other signs of illness, such as fe- Use a small spoon — one that will fit
ver, diarrhea or difficulty breathing into your baby’s mouth — and begin
These signs and symptoms might in- with very small amounts. At first, your
dicate an underlying condition. Some little one may frown, sputter and spit it
© MFMER
© MFMER
babies experience infant gastroesopha- out. This isn’t necessarily because he or

geal reflux (GER). For more information she doesn’t like it, but rather because he
on GER, see page 382. or she may not be familiar with moving
While sitting baby upright and supporting Lay baby facedown across your shoulder, Treatment depends on what’s causing the tongue backward yet.
his or her chin and back, gently rub and pat and gently rub and pat his or her back. the problem. Special feeding techniques or Expect that your baby may not eat
baby’s back. medication may be helpful. much in the beginning. Give him or her

time to get used to the experience. Some with 4 to 5 tablespoons of breast milk or
babies need practice keeping food in formula. Many parents start with rice OBESITY: PUTTING YOUR CHILD AT RISK
their mouths and swallowing. cereal. Even if the cereal barely thickens
Don’t be surprised if your baby puts the liquid, resist the temptation to serve Can starting solids too soon increase your child’s risk of obesity? According to one
his or her fingers into his or her mouth to it from a bottle. Instead, help your baby study, the answer is yes. A 2011 study published in the journal Pediatrics found
help swallow the food. He or she may sit upright, and offer the cereal with a that infants on formula who were fed solid foods before age 4 months had a
also try to bat away the spoon. Expect it small spoon once or twice a day. higher risk of becoming obese than those starting solids later.
to be a messy experience! Once your baby gets the hang of The study involved more than 840 young children, and it found that formula-
Once your little one gets used to sol- swallowing runny cereal, mix it with less fed infants who were introduced to solid food before 4 months had up to six times
ids, he or she may be ready for a few ta- liquid. For variety, you might offer single- the risk of being obese at age 3 than did infants on formula who received solids
blespoons of food a day. When your child grain oatmeal or barley cereals. Keep after 4 months.
begins eating more, add another feeding. in mind that some babies eat cereal The results were not the same for breast-fed infants. There was no association
with gusto right from the start. Others between the timing at which solid foods were started and the development of
Taste and texture Your baby’s taste are less enthusiastic. Be patient and keep obesity. Breast-feeding was linked to a more normal pattern of growth and to a
buds are continually maturing. As you trying. slower introduction of solid foods.
begin with solids, keep in mind that ba-
bies are more likely to eat foods that are Pureed meat, vegetables and fruits
bland. They also react to how food feels Once your baby masters cereal, gradually
and tastes in their mouths. introduce pureed meat, vegetables and such as soft fruits, well-cooked pasta, as the original fruit itself. If you offer juice
Introduce cereals and other solid fruits. Offer single-ingredient foods at cheese, graham crackers and ground to your baby, make sure it’s pasteurized.
foods one at a time so that your baby can first, and wait three to five days between meat. As your baby approaches his or Limit the amount your baby drinks to
get used to having a new taste, as well as each new food. If your baby has a reac- her first birthday, mashed or chopped 4 to 6 ounces a day. Too much juice may
a new texture, in his or her mouth. tion to a particular food — such as diar- versions of whatever the rest of the fam- contribute to weight problems and diar-
Start with the blandest food at each rhea, rash or vomiting — you’ll know the ily is eating will likely become your ba- rhea, as well as thwart your baby’s appe-
feeding. It may take a couple of tries for a culprit. by’s main fare. Continue to offer your tite for more nutritious solid foods. In ad-
new food to gain acceptance. child breast milk or formula with and be- dition, sipping juice throughout the day
Finely chopped finger foods At about 9 tween meals. or while falling asleep may lead to tooth
Baby cereal Mix 1 tablespoon of a months, most babies can handle small To help prevent food allergies, parents decay.
single-grain, iron-fortified baby cereal portions of finely chopped finger foods, were once told to avoid feeding young
children eggs, fish and peanut butter. To- Know what’s off-limits Don’t offer
day, however, researchers say there’s no cow’s milk, citrus, honey or corn syrup to
convincing evidence that avoiding these your child before age 1. Cow’s milk
HOMEMADE BABY FOODS foods during early childhood will help doesn’t meet an infant’s nutritional needs
prevent food allergies. — it isn’t a good source of iron and, for
If you want to give your baby fresh food, use a blender or a food processor to Still, it’s a good idea to check with infants, it can lead to iron deficiency ane-
puree the food. For softer foods, you may be able to simply mash them with a fork. your baby’s care provider if any close rel- mia. Citrus can cause a painful diaper
You can feed your baby raw bananas that have been mashed, but most other fruits atives have a food allergy. You may con- rash, and honey and corn syrup may con-
and vegetables should be cooked until they’re soft. It’s best not to add salt or sider giving your child his or her first tain spores that can cause a serious ill-
seasoning. taste of a highly allergenic food at home ness known as infant botulism.
Refrigerate any food you don’t use, and look for signs of spoilage before giving — rather than at a restaurant — with an In addition, don’t offer your baby
it to your baby. Fresh foods are not bacteria-free, so they’ll spoil more quickly than oral antihistamine available, just in case. foods that could pose a choking hazard.
food from a can or jar. Such foods include:
Talk with your child’s care provider about homemade foods you should avoid Juice You can offer mild, 100 percent fruit Z Small, slippery foods, such as whole
giving to your child before age 1. juices when your baby is 6 months or grapes, hot dogs and hard candy
older. Juice isn’t a necessary part of a ba- Z Dry foods that are hard to chew, such
by’s diet, however, and it’s not as valuable as popcorn, raw carrots and nuts

Z Sticky or tough foods, such as peanut Dish individual servings Your baby may
butter and large pieces of meat eat just a few spoonfuls of food at a time.
For babies younger than 4 months, if If you feed your baby directly from a jar
you do feed solids, it may be best to avoid or container, bacteria and saliva from the
home-prepared or canned spinach, spoon can quickly spoil any leftovers. In-
beets, turnips and collard greens. These stead, place 1 tablespoon of food in a
foods may contain high levels of nitrates, dish. The same goes for finger foods. If
potentially harmful compounds naturally your baby finishes the first serving, offer
present in these foods. another.
Make meals manageable When your Avoid power struggles If your baby
baby begins eating solid food, mealtime turns away from a certain food, don’t
is sure to become an adventure. To help push. Simply try again another time. And
make it more enjoyable — for both you again. And again. Repeated exposure can
and your baby: help ensure variety in your baby’s diet.
Stay seated At first, you may feed your Know when to call it quits When your
baby in an infant seat or propped on your baby has had enough to eat, he or she
lap. As soon as your baby can sit easily may turn away from the spoon, lean
without support, use a highchair with a backward, or refuse to open his or her
broad, stable base. Buckle the safety mouth. Don’t force extra bites. As long as
straps, and keep other children from your baby’s growth is on target, you can
climbing or hanging on to the highchair. be confident that he or she is getting
enough to eat.
Encourage exploration Your baby is
likely to play with his or her food be- Enjoy the mess Whether it be your ba-
tween bites. Although it’s messy, hands- by’s sloppy tray, gooey hands or sticky
on fun helps fuel your baby’s develop- face, you’re building the foundation for a
ment. Place a dropcloth on the floor so lifetime of healthy eating.
you won’t worry about falling food.
Encourage good habits It’s impor-
Introduce utensils Offer your baby a tant for your baby to get used to the pro-
spoon to hold while you feed him or her cess of eating — sitting up, taking food
with another spoon. As your baby’s dex- from a spoon, resting between bites and
terity improves, encourage your baby to stopping when full. These early experi-
dip the spoon in food and bring it to his ences will help your child learn good eat-
or her mouth. ing habits throughout life.
And it’s never too early to build good
Offer a cup Feeding your baby breast eating habits. As your child gets older, fo-
milk or formula from a cup at mealtime cus on eating three meals, with two to
can help pave the way for weaning from three snacks in between. Children who
a bottle. When your child reaches 9 graze, or eat constantly, may never really
months, he or she may be able to drink feel hungry. And they can develop prob-
from a cup on his or her own. You may lems from eating too much or too little.
want to begin with a nonspill cup, often In addition, feed your child a variety of
called a “sippy” cup. healthy, nutrient-rich foods.

CHAPTER 4
Diapers and
all that stuff
There’s a lot to look forward to in your sizes and styles. Some babies are com-
baby’s first year, but changing diapers fortable and stay clean in a lot of different
isn’t exactly at the top of the list. It can types of diapers, while others need a par-
seem like a daunting task — the average ticular kind that works just right for their
child goes through about 5,000 diaper body. If your baby doesn’t fit well in the
changes before being toilet trained. You diapers you have, or if he or she seems
might wonder, what diapers are best? irritated by the diaper, don’t be afraid to
What should I do about diaper rash? try something new.
And, is it normal that my sweet little baby
has yellow or green or brown poop? Disposable These diapers are com-
A little information and preparation monly used, and they’re highly absorbent
can help make diaper duty more pleasant and convenient. However, the cost of us-
and less worrisome. You may even look ing disposable diapers adds up, especial-
upon diaper changing as another oppor- ly if you have more than one baby.
tunity to bond with your baby. After all, The materials used in disposables
caring for your child in this way, day after usually keep your baby’s skin drier for a
day, offers a time for you and your baby longer period of time. But the downside
to pause, connect and communicate. of this absorbency is it can be harder to
monitor how much your baby has uri-
nated, which may be important to know
when your baby is a newborn.
TYPES OF DIAPERS Disposables are also convenient —
you throw them away after each use.
There are several different types of dia- However, disposable diapers generally
pers — cloth or disposable, brand name aren’t considered biodegradable. At best,
or generic — and they come in many they may degrade over a very long period
CHAPTER 4: DIAPERS AND ALL THAT STUFF 75

of time. An estimated 18 billion diapers a Depending on how many diapers you size diapers that can be adjusted to fit tion. If you use pre-moistened baby
year are sent to landfills. Fortunately, buy, cloth diapers need to be washed your growing baby. wipes, choose wipes for sensitive skin
more disposable diaper companies are anywhere from a couple of times a week that don’t contain alcohol or fragrance.
making efforts to have less of a negative to daily. Some people hire a diaper- Amount If you use disposable diapers, This will help prevent irritation. It’s not
impact on the environment by using dif- washing service to drop off clean diapers you’ll need 80 to 100 a week, at least dur- necessary to use wipes with every change.
ferent materials, fewer dyes and better and pick up dirty diapers for washing. ing the newborn period. If you plan to Urine is rarely irritating, so if your baby
packaging. Some cloth diapers also come with an buy cloth diapers, the number you’ll has only peed, letting the area dry or
optional disposable insert, so you can need depends on how often you plan to wiping it with a moist cloth may be
Cloth Cloth diapers have become in- throw away the dirty part of the diaper. wash them. Some people buy enough sufficient. Remember that most pre-
creasingly common in recent years, as There are even some biodegradable dis- that they only need to be washed every moistened wipes cannot be flushed.
new brands and styles offer more effec- posable inserts that can be composted or third day or so, and others buy a smaller Unless your package of wipes specifies
tive and convenient options. Cloth may flushed down the toilet. quantity and wash daily. that they’re flushable, wipes must be
be more comfortable on your baby, and With the rise in cloth diaper use, there thrown away.
cloth diapering also saves a lot of money also are more accessories to make it eas-
over time. However, cloth diapers are ier, including sprayers that attach to your Dry cloths You may want to have some
typically less absorbent than are dispos- toilet so that you can rinse off urine and GETTING EQUIPPED dry, soft cloths on hand so that after
ables, and they require more work. stool from dirty diapers, and wet bags to you’re finished wiping your baby, you
Cloth diapers typically have two parts. contain the diapers and smell before Diaper changes will be easier if you have can gently pat his or her bottom dry if
There’s an inner layer, which is usually they’re washed. everything you need on hand. you don’t have time to let it air dry.
made from a soft cotton material, as well Air exposure can trigger babies to uri-
as an outer cover that’s made from a type Sizes Most disposable diaper packages Changing station It helps to have one nate, and your baby may urinate while
of plastic, cotton or terry cloth. Some par- are labeled with a size that corresponds or two places where you always change you’re changing the diaper. If your baby
ents like that these materials don’t con- to your baby’s weight. Though the range your baby’s diaper. This way, you can is a boy, you can avoid being sprayed
tain chemicals, materials or fragrances varies based on the brand, newborn sizes keep all your materials together and with urine by covering his penis loosely
that can irritate babies. Today’s cloth dia- typically go up to 10 pounds, and size 1 is readily available in the designated loca- with a dry cloth while you clean the rest
pers are usually fastened with snaps or for babies who weigh about 8 to 14 tion. If you use a changing table, make of his bottom.
fabric fasteners, not pins. Cloth diapers pounds. Preemie diapers are usually for sure it has a wide, sturdy base that has
typically aren’t as absorbent as dispos- babies who weigh less than 6 pounds. compartments for storing diaper sup-
ables, so they need to be changed quickly Some cloth diapers come in different plies. Remember to always keep one
after they become dirty to prevent irrita- sizes — such as newborn, small, medium hand on your baby during changes. An-
tion to your baby’s skin. or large — while other styles have one- other option is to change your baby using
a changing pad on the floor.You can store
supplies in the lower drawer of a crib or
in a nearby dresser for easy access.
SWIM DIAPERS
Diapers Keep an adequate stock of dia-
As your baby gets older, there may come a time you want to take him or her to the pers on hand. If you primarily use dis-
swimming pool. Infants in the pool with their parents often wear swim diapers or posables, it may help to have some cloth
swim pants. It’s not clear how well these products contain stools in a pool. Even if diapers around in case you run out. If you
they appear to contain everything, some contaminants and germs can leak mainly use cloth, keep a stack of dispos-
through. If your baby has diarrhea or is sick, he or she should not go into a pool. ables handy for those days when you
Doing so could contaminate the water and make other babies and children sick. If haven’t had a chance to do the wash.
your baby is healthy and you take him or her to the pool, change the swim diapers
as needed. Wipes You can buy pre-moistened baby
wipes, use a moistened cloth, or make
your own wipes using a homemade solu-
76 PART 1: CARING FOR YOUR BABY

HOMEMADE BABY WIPES Diaper pail or wet bag Diaper pails Preparation Have your wipes and a
store dirty diapers and wipes, and wet new diaper ready and within arm’s reach.
Pre-moistened baby wipes are common in the United States, but they aren’t al- bags are made to store dirty cloth diapers It may help to pull out or prepare the
ways necessary, and they’re often overused. Some pre-moistened wipes contain and reusable wipes before they’re number of wipes you think you’ll need
ingredients that can be irritating to babies’ bottoms. One way you can eliminate washed. There are a variety of types of for the job, and open the diaper to lay it
your baby’s exposure to these ingredients, and save money, is to make your own pails and bags available. Look for one flat. Make eye contact and tell your baby
baby wipes. that’s convenient, sanitary and holds in that you’re going to change his or her
There are a variety of ways to make homemade wipes, but here are some sug- odors. diaper. Lay your baby gently on his or her
gestions to get you started. After reading through the options, decide which ap- back. If you change the baby anywhere
proach you feel would work best for you. Ointment You don’t need to apply baby but the floor, remember to keep your
ointments unless your baby tends to de- hand on your baby at all times.
Wipes There are a few different options you can consider for wipes. See what you velop diaper rashes. But it’s nice to have a
like best: product on hand so that if your baby de- Remove old diaper Unfasten the fab-
Z Buy rolls of soft paper towels. Cut the rolls in half so that you have two shorter velops a rash, you won’t have to immedi- ric fastener, tape or snaps on the diaper
rolls. You’ll have a nice size for wipes. ately run out to buy something. your baby is wearing, and pull down the
Z Buy a stack of reusable wipes, which are often made of flannel or some other front side of the diaper. If your baby has
form of cotton. Or, purchase some thin baby washcloths that you will use as had a bowel movement, you can use the
wipes. clean inside front of the diaper to pull
Z Make your own reusable wipes. Purchase soft flannel, terry cloth or fleece CHANGING DIAPERS much of the stool off your baby’s skin. Set
fabric and cut it into 5-inch squares. Then sew the edges so that the fabric the diaper off to the side beyond your
won’t unravel in the wash. By the time your child is potty trained, baby’s reach.
you’ll be a diaper-changing pro. In the
Moistener There are options on what you can use. meantime, the following steps and point- Clean baby’s bottom During the
Z Water ers can help make diaper changing a suc- cleaning, carefully grasp and hold your
Z Homemade solution. Here’s one recipe: cessful venture for both you and baby. baby’s legs at the ankles with one hand.
2 tablespoons baby wash Using a cloth that’s been moistened with
2 tablespoons olive oil Mindset Changing diapers is an un- warm water or pre-moistened wipes,
2 cups water avoidable part of parenting, but it may clean from baby’s front to back. Remem-
help to think of this necessary task as an ber to check and clean out folds, where
Container Use whichever method is easiest for you. opportunity for closeness and communi- hidden stool can hide. You can place dirty
Z Round plastic storage container. Pour your homemade solution in the bottom cation with your baby. Your warm words, wipes in the middle of the inside of the
of the container. Set a half roll of paper towels inside the container and place gentle touches and encouraging smiles dirty diaper to keep the mess consolidat-
the cover on the container. The paper towels will absorb the liquid, and then help make your baby feel loved and seed. If you have a baby boy, you may want
you can tear off each sheet as you need it. cure, and soon your infant will be re- to place a loose cloth over his penis while
Z Spray bottle. Keep fresh water or your homemade solution in a spray bottle. If sponding with gurgles and coos. you’re cleaning his bottom to avoid being
you use a solution, wet down your wipes with water first, and then spray each sprayed with urine.
wipe with a couple of squirts of solution. Frequency Because newborns urinate
frequently, it’s important to change your Changing baby girls Remember to wipe
If you create your own baby-wipe solution, you may want to check with your baby’s diapers every two or three hours from the front side to the back side to
baby’s care provider to ensure the baby wash or other ingredients in the solution for the first few months. But you can wait avoid getting stool (or more stool) in the
don’t contain any potentially harmful or irritating substances. Products can be ab- until your baby wakes up to change a wet vaginal area. Baby girls have more folds
sorbed into your baby’s body through the skin, so it’s important that you’re com- diaper. Urine alone doesn’t usually irri- and places for poop to hide, so it’s impor-
fortable with all the ingredients. tate a baby’s skin. However, the acid in a tant to clean them thoroughly. However,
bowel movement can, so change a messy girls also often have a normal white dis-
diaper as soon as your baby awakens. charge in the folds of the labia, and it’s
78 PART 1: CARING FOR YOUR BABY CHAPTER 4: DIAPERS AND ALL THAT STUFF 79
back side of the diaper will be at about families use diaper sprayers, which at-
CHANGING A DISPOSABLE DIAPER the same level around your baby’s body. tach to the toilet. They can often be pur-
Then fasten the tape, fabric fastener or chased in a baby store or online.
snaps so that the diaper fits snugly
around your baby’s waist. If you’re using Wash your hands When you’re fin-
disposable diapers, make sure that none ished with the diaper change and baby is
of the elastic around the legs has folded in a safe place, wash your hands with
underneath itself. If you’re using cloth, soap and water. Hand-washing is impor-
make sure the inner layer is tucked inside tant. It can prevent the spread of bacteria
the outer layer. or yeast to other parts of your baby’s
body, to you or to other children.
Changing baby boys Baby boys can have
Step 1. When opening the diaper, make Step 2. Bring the front of the diaper up a tendency to urinate up and out of their
sure the tape, which is at the back of through the legs, without twisting it to diapers, causing leaks and wet clothes.
the diaper, is at the top, or away from one side. As you put a new diaper on your baby WHAT’S NORMAL
you. Slide the diaper under your baby boy, try positioning his penis downward
© MFMER
until the top edge (the edge with the to prevent these leaks. Also, you may New parents often wonder what’s nor-
tape) lines up with your baby’s waist. want to fold the diaper down and in for mal when it comes to their baby’s urina-
extra protection on his front side. tion and bowel movements. For new-
borns especially, there’s a range of what’s
Discard old diaper If you’re using dis- considered normal for color, consistency
posables, you can roll up the dirty diaper and frequency. But there also are guide-
from the front to the back — with any lines that help you know what to expect
wipes in the middle of the diaper — and and when there’s cause for concern.
then fasten the tabs around the sides of
the rolled up diaper. Toss the diaper in a Urine In a healthy infant, urine is light to
diaper pail. If you’re using cloth diapers dark yellow in color. Sometimes, as high-
and cleaning them yourself, dump any ly concentrated urine dries on the diaper,
stool into your toilet, rinse the diaper off it creates a chalky, pinkish color, which
Step 3. Hold one side in position while Step 4. For a newborn, fold down and place it in a designated holding spot may be mistaken for blood. This is nor-
removing the tab from the tape. Pull the the top of the diaper so that it won’t rub — such as a wet bag or diaper pail — un- mal and not a cause for concern. Keep in
tape forward and stick it to the diaper against the healing umbilical cord. Dis- til you wash your load of diapers. Some mind that concentrated urine is different
front. Repeat for the other side, making posable diapers should fit snugly
sure the diaper is snug around your around the waist, with room enough for
baby’s legs and not twisted to one side. only one finger.
THE UMBILICAL CORD
For the first few days that you’re changing your baby’s diapers, you’ll need to work
around baby’s umbilical cord stump. It’s best to expose the stump to as much air
not necessary to remove that. Too much Place new diaper As you lift your ba- as possible as it dries up and eventually falls off. It’s also important to keep the
scrubbing can cause irritation. by’s legs from the ankles, slide the new umbilical cord stump clean — from contact with urine and stool. Most newborn
diaper underneath his or her buttocks. diapers are designed with a small cutout so that the diaper sits below the cord and
Let dry When finished with the clean- The side with tabs should be in the back, doesn’t rub it. If your diapers don’t have this feature, fold the top down so that the
ing, gently pat your baby’s bottom with a underneath your baby. Pull the front of diaper is positioned below the cord.
soft cloth so that the skin is dry when you the diaper up between your baby’s legs,
put the new diaper on. and place it so that the front side and
from blood in that it dries to a powder, with seed-like particles. They’ll be soft and
and it’s not as red in color. even slightly runny. The stools of a formu- DIAPER SURPRISES
By the time a baby is 3 or 4 days old, la-fed infant are usually tan or yellow and
he or she should have at least four to six firmer than those of a breast-fed baby, but You might occasionally notice a surprising but often harmless substance in your
wet diapers a day. As your baby gets old- no firmer than peanut butter. baby’s diaper. These substances may appear as:
er, he or she may have a wet diaper with Occasional variations in color and
every feeding. consistency are normal. Different colors Gel-like materials Clear or yellow-tinted beads or particles may come from dia-
may indicate how fast the stool moves per materials that have become overly wet with urine.
Stools Your baby’s first soiled diaper, through the digestive tract or what the
which will probably occur within 48 baby ate. The stool may be variations of Small crystals A newborn baby’s kidneys may make clear crystals if baby is
hours of birth, may surprise you. During the colors green, yellow, orange or brown. relatively dehydrated. This can also leave a tinted orange or pink stain in the diaper.
these first few days, a newborn’s stools The color isn’t that significant unless
will often be thick and sticky — a tar-like, the stool has blood — shown as red or Pink or small blood stains A newborn baby girl may have some pink or blood
greenish-black substance called meconi- coal-black streaks — or if it is a whitish- stains in her diapers in the first few weeks. This is generally from exposure to her
um. After the meconium is passed, the grey color instead of closer to yellow- mother’s hormones right before birth. It isn’t usually a problem, and it goes away
color, frequency and consistency of your brown. A whitish-grey color could be a with time.
baby’s stools will vary depending on how sign that the stool is lacking bilirubin
your baby is fed — by breast or bottle. products, which are normal byproducts
from the body breaking down excess red
Color If you’re breast-feeding, your baby’s blood cells. These very pale stools could otherwise — contact your child’s care illness. And antibiotics are a common
stools will likely resemble light mustard indicate that your baby’s body isn’t elimi- provider and have the problem checked cause. Antibiotics wipe out both the good
nating waste properly. If you see blood or out. Actual blood in stools is always a and bad bacteria in the gut.
whitish-grey stools, contact your child’s cause for concern, but don’t panic; some- If antibiotics are the culprit and your
care provider. times the problem isn’t serious. child is 9 months or older, you might
For example, newborns may have in- consider feeding your child foods that
Consistency Mild diarrhea is common in gested some of their mother’s blood dur- contain probiotics, such as yogurt. Probi-
newborns. The stools may be watery, fre- ing delivery, or they may be taking it in otics, found in certain fermented foods,
quent and mixed with mucus. Constipa- while breast-feeding if the mother has are microorganisms that contain “good
tion is not usually a problem for infants. cracked or bleeding nipples. Flecks or bacteria.” Probiotics may help bring a
Babies may strain, grunt and turn red streaks of blood in stools may also be a healthy bacterial balance back to your
during a bowel movement, but this sign of an allergy to the protein in cow’s child’s gut and improve digestion.
doesn’t mean they’re constipated. A baby milk, which may be found in formula or Probiotics are also available as over-
is constipated when bowel movements breast milk. For older babies, red or black the-counter supplements. However, be-
are infrequent, hard and perhaps even in stools could be from certain foods, in- cause not a lot is known about the sup-
ball shaped. cluding tomatoes, beets, spinach, cher- plements, and studies with young
ries and grape juice. children are limited, Mayo Clinic pedia-
Frequency The range of normal is quite tricians generally don’t recommend their
broad and varies from one baby to an- Diarrhea If you notice that your baby’s use. If you have questions about probiot-
other. Babies may have a bowel move- stool becomes more watery than normal ics, talk to your child’s care provider.
ment as frequently as after every feeding and you observe a gradual or sudden in-
or as infrequently as once a week, or they crease in how often or how much he or
may have no consistent pattern. she is pooping, contact your child’s care
provider. DIAPER RASH
Blood If your baby’s stools appear to There are many possible causes of di-
contain blood — whether you see red or arrhea. Some foods may cause diarrhea. All babies get a red or sore bottom from
coal-black coloring, streaks, flecks or Diarrhea may also be an indication of an time to time, even with frequent diaper

Chafing or rubbing Tightfitting diapers Z Let your child go without a diaper for
or clothing that rubs against the skin can longer periods of time.
lead to a rash. Z Avoid using plastic pants or tight-
fitting diaper covers.
Use of antibiotics Antibiotics kill bacte- Z Use larger sized diapers until the rash
ria — both bad and good ones. Without goes away.
the right balance of good bacteria, yeast In addition, use a mild ointment any-
infections can occur. This can happen time pinkness appears in the diaper area.
when babies take antibiotics or when This can reduce friction and rubbing and
mothers who are breast-feeding their in- block chemical irritants — from stools or
fants take antibiotics. from diaper materials — from contact
with your baby’s skin.
Treatment The most important factor in Apply the cream in a thin layer to the
treating diaper rash is to keep your baby’s irritated region several times throughout
skin as clean and dry as possible. This of- the day to soothe and protect the baby’s
ten means increasing “diaper-free” time skin. You don’t have to completely re-
Diaper rash often results from prolonged contact with urine or stool. Mild cases can often and thoroughly but gently washing the move the cream at every diaper change if
be treated with over-the-counter products. Cases that are more severe may need to be area with water during each diaper the area is clean — rubbing will only ir-
treated with prescription medications. change. Avoid washing the affected area ritate the skin further.
with soaps and disposable, scented Many effective creams contain zinc
wipes. Alcohol and perfumes in these oxide, which helps sooth the skin. Look
changes and careful cleaning. Diaper Irritation from a new product Dispos- products can irritate your baby’s skin and for a cream that doesn’t contain fra-
rash is such a common condition that it able wipes, a new brand of disposable aggravate or provoke the rash. grance, preservatives or other ingredients
happens to nearly every baby at some diaper, or a detergent, bleach or fabric If the rash is severe, it might help to that could cause irritation or allergies, in-
point. You certainly aren’t a bad parent if softener used to launder cloth diapers clean your baby’s bottom with warm wa- cluding neomycin. Products that are put
your baby gets a diaper rash. Fortunately, can all irritate your baby’s delicate bot- ter from a squirt bottle instead of using a on people’s skin are absorbed into their
diaper rash is usually easily treated and tom. Other substances that can add to moistened cloth or wipes, so you won’t bodies through the skin. And some
improves within a few days. the problem include ingredients found in have to rub the tender skin. It’s also im- creams contain ingredients that can be
some baby lotions, powders and oils. portant to allow baby’s bottom to air-dry harmful for your baby, including boric
Appearance Diaper rash is marked by completely before putting on a new dia- acid, camphor, phenol, benzocaine and
red, puffy and tender-looking skin in the Introduction of new foods As babies start per. If possible: salicylates.
diaper region — buttocks, thighs and to eat solid foods, the content of their
genitals. The skin may have rashes or just stool changes, increasing the likelihood of
look red and irritated. Your baby may diaper rash. Changes in your baby’s diet
seem more uncomfortable than usual, can also increase the frequency of stools, PREVENTING RASH: CLOTH OR DISPOSABLE?
especially during diaper changes. which can lead to diaper rash.
When it comes to preventing diaper rash, there’s no compelling evidence that cloth
Causes Causes of diaper rash include Bacterial or yeast (fungal) infection diapers are better than disposable diapers or vice versa, though disposables may
the following: The area covered by a diaper — buttocks, keep baby’s skin slightly drier. Because there’s no one best diaper, use whatever
thighs and genitals — is especially vul- works best for you and your baby. If one brand of disposable diaper irritates your
Irritation from stool and urine Pro- nerable because it’s warm and moist, baby’s skin, try another.
longed exposure to feces or urine can ir- making a perfect breeding ground for No matter whether it’s cloth or disposable, always change your baby as soon
ritate a baby’s sensitive skin. Your baby bacteria and yeast. These rashes general- as you can after he or she soils the diaper, to keep the bottom as clean and dry
may be more prone to diaper rash if he or ly start within the creases of the skin, and as possible.
she has frequent bowel movements, be- there may be red dots scattered around
cause feces are more irritating than urine. the edges.
Also avoid creams that have steroids, mild detergent with no fragrance, and
such as hydrocortisone, in them, unless skip fabric softeners and dryer sheets,
your baby’s care provider specifically rec- which can contain fragrances that ir-
ommends such a product. Creams con- ritate your baby’s skin. Double-rinse
taining steroids can be harmful, and they the diapers.
usually aren’t necessary. Also, don’t use Z If you use cloth diapers, select snap-
talcum powder or cornstarch on a baby’s on plastic pants, instead of those with
skin. An infant may inhale talcum pow- elastic bindings, to improve circulation.
der, which can be very irritating to a ba- Z After changing diapers, wash your
by’s lungs. Cornstarch can contribute to a hands well. Hand-washing can pre-
bacterial infection. vent the spread of bacteria or yeast to
other parts of your baby’s body, to you
When to seek medical treatment or to other children.
Contact your baby’s care provider if:
Z The rash is accompanied by a fever.
Z The rash has blisters, boils, discharge
or pus-filled sores.
Z The rash isn’t going away or improv-
ing after two to three days of home
treatment.
Z Your baby is taking antibiotics, and
the rash is bright red with red spots
around the edges. It could be a yeast
infection, which needs additional
treatment.
Z The rash is severe.
Z The rash is present on skin outside
the diaper area.
Preventing diaper rash There are a

variety of steps you can take to help pre-
vent, or at least reduce the incidence of,
diaper rash:
Z Change your baby’s diaper often so
his or her skin is not in contact with
urine or stools for very long.
Z Let your baby’s bottom air out once in
a while by letting him go without a
diaper for a brief period.
Z Avoid using superabsorbent dispos-
able diapers, because they tend to be
changed less frequently.
Z If you’re using cloth diapers, be sure
to wash and rinse them thoroughly.
Pre-soak heavily soiled diapers, and
use hot water to wash them. Use a

CHAPTER 5
Bathing and skin care
Bathing your baby can be a sweet and fun They don’t enjoy getting undressed or
experience. Don’t worry if you feel a little the cold feeling that comes with having
awkward at first — it takes practice to get no clothes on.
the hang of cleaning a slippery and Fortunately, infants don’t need much
squirmy baby. And don’t be surprised if, bathing. It’s not until your child gets old-
at first, your son or daughter doesn’t like er and gets dirtier that baths become
being bathed. It’s a whole new experi- more of a regular ritual.
ence for him or her — and for you, too!
The tips that follow will help make Frequency During your newborn’s first
your bath-time routine safe and smooth. couple of weeks, as the umbilical cord
You’ll also learn how to identify and deal falls off and heals, one sponge bath a
with skin conditions that are common in week is probably sufficient. Check his or
a baby’s first year. Sometimes people ex- her folds — in the thighs, groin, armpits,
pect new babies to have flawless skin, but fists and double chins — to see if they
that’s rarely the case. need occasional spot cleaning in addition
to a weekly sponge bath.
Generally, babies need only one to
three baths a week in the first year.
BATHING BASICS Once your baby starts crawling around
and eating solid food, he or she might
As your child gets older, chances are he need up to three baths a week. Bathing
or she will enjoy taking a bath. Babies more frequently than that can dry out a
have fun splashing in the water and play- baby’s skin.
ing with bath toys. They’ll often jump at
the chance to suds up. Newborns, how- Types of baths A sponge bath is often
ever, often don’t like the bath experience. the gentlest and easiest way to introduce
CHAPTER 5: BATHING AND SKIN CARE 89

your new baby to bathing. A sponge BATH ITEMS AND PRODUCTS Towels Have a couple of soft, dry towels BATH SAFETY
bath basically involves using a warm on hand. Baby-sized towels are usually
washcloth to clean your baby instead A little preparation can help make baths easier to use because you don’t have to A baby’s bath time might conjure up im-
of placing him or her in a tub of water. go a lot smoother. Think about all of the deal with all the excess material as you ages of bubbles, toys and fun, but it’s also
During a sponge bath, you can keep your equipment you’ll need and have it set out wrap up your little one. a time to exercise caution. Whether your
baby covered with a dry towel so that he within arm’s reach before you suds up. baby is a newborn or a bathing veteran,
or she doesn’t get cold. As you clean a Cotton balls While bathing your new- it’s important to be attentive to things
part of baby’s body, you move a small Place for baby Some parents find born, use two damp cotton balls to wipe like water temperature — too hot can
piece of the towel aside in order to get at it easiest to bathe a newborn in a bathi- each eye from the inside to the outside burn your baby, and too cool can chill a
that area. Once finished, pat that body nette, a sink or a plastic tub lined with corner. little one. Ensure a safe, smooth bath by
part dry and cover it back up with the a clean towel. Baby baths, which are preparing the space ahead of time and
towel before moving onto another area often placed inside your tub, are com- Soft scrubber Some people like to use staying focused on the task at hand.
of the body. monly used as babies get a little older. a soft baby scrubber to wash their baby’s
Sponge baths are a good alternative Bathinettes are free-standing, portable hair. These scrubbers can be a handy ac- Preparation Prepare the bath area with
to a full bath for the first six weeks or so bath stations that allow you to stand cessory, though a washcloth will work all the items you’ll need. Place everything
after your child is born. Once the umbili- and bathe your baby inside a small tub. fine, too. within arm’s reach so that you can keep
cal cord has fallen off and the area is They’re similar to changing tables in one hand on your baby at all times.
healed, you can try moving your baby structure, and they often have compart- Moisturizer Most babies don’t need
into a full bath. ments or shelves where you can keep any moisturizer, even though their skin Temperature Take a cue from Goldi-
When you decide it’s time to try a full washcloths, soap or anything else that may be peeling and appear dry, especially locks before you place your baby into
bath, you might start out using a baby you might need. in the first few days after birth. Some bath water. Remember the temperature
bathtub, which you can set inside your moisturizers, including those with fra-
regular tub or on the floor or next to the Water Of course you’ll want warm water grance, may irritate their skin and even
sink. Put a few inches of water in the bot- — not too hot — handy for washing and cause rashes. But if needed, or if your
tom of the baby bath, test the tempera- rinsing. Most of the time, soap isn’t nec- baby’s care provider recommends it, have
ture, and then place your baby in the essary, and plain water is all that’s need- a moisturizer on hand. Look for a brand
bath and start washing. The first few ed to clean your baby. that’s fragrance-free and gentle to baby’s
baths should be especially gentle and skin.
brief. If your baby doesn’t like it, you Soap Generally, it’s best to use only wa-
might stick with sponge baths for a while ter to bathe your baby. Soap can dry your Diaper-changing equipment Keep
longer before trying a full bath again. baby’s skin or contain ingredients that diaper-changing equipment nearby in
are irritating to your little one. As your case your baby poops or pees during the
When Find a time for bathing your baby baby gets older and starts eating solid bath and so that you can put a diaper
that’s convenient for both of you. Many foods, crawling around on the ground back on before dressing him or her.
people give their baby a bath before bed- and playing outside, soap may be need-
time as a relaxing, sleep-promoting ritu- ed. If you sense that plain water won’t Clothes or pajamas Have some
al. Others prefer a time when their baby do the trick, you can use a little mild baby clothes or pajamas ready for after the
is fully awake. You’ll enjoy this time more soap or shampoo that’s free of fragrances bath to keep your baby from getting cold.
if you’re not in a hurry and aren’t likely to and deodorants, which can irritate your
be interrupted. baby’s skin. Bath toys Bath toys aren’t necessary early
You may also want to wait a bit after on — your baby will have plenty of excite-
your baby eats or drinks to give a bath in Washcloths Soft washcloths can help ment and stimulation from bathing alone.
order to allow his or her stomach to set- you gently clean out those hard-to-reach However, as your son or daughter gets
tle. Waiting briefly may also reduce the places and folds, such as your baby’s older, he or she may enjoy having a toy or
chances of your baby peeing or pooping genital area, thighs, armpits and double two in the bath to play with and keep him
during the bath. chins. or her occupied throughout the bathing.

needs to be just right. For baby’s safety, You also want to make sure that the If you forgot something you need for then pat the face dry. Wash your baby’s
you don’t want the water too hot — water heater in your house is set at no the bath, take your baby out of the bath head with water too, tipping his or her
it could hurt or even burn your baby. And higher than 120 F. This is a precautionary and take him or her with you, even if the head back or cupping your hand over his
for his or her comfort, you also don’t measure to protect your son or daughter. item is just a step away. or her forehead to keep any water or soap
want the water so cold that your baby Many water heaters are set dangerously from running into baby’s eyes. It’s not
gets chilled. Generally, a temperature higher than that, to 140 or 150 F. Just necessary to shampoo your baby’s hair
between 95 and 100 F is ideal for a three seconds of exposure to 140-degree every bath — once or twice a week is
baby’s bath. water can cause third-degree burns on BATHING STEP BY STEP plenty. If your baby seems agitated by a
Before filling up the tub or basin, test a child. wet head, save the hair wash for last. You
the water temperature with your elbow You’ll fall into a bath-time routine soon can use a soft washcloth, your fingertips
or wrist. The water should feel warm but Attentiveness It’s important to give enough, but in the meantime, here are a or a baby scrubber to wash his or her hair
not hot. Once you fill the tub or basin, your baby your full and undivided few tips on how to go about giving your and scalp.
test the temperature again — water tem- attention during baths. If the phone child a bath and making it an easy and
peratures frequently change while the rings or someone rings the doorbell, ig- enjoyable event. Wash and check folds Wash the
water is running. Never let the bath fill nore it. Babies can drown in less than an rest of your child’s body from the top
while your baby’s sitting in it. Instead, fill inch of water in an instant, so you don’t Prepare your baby Talk calmly and down, including the inside folds of skin
the tub or basin and then test the water want to be diverted from the task at encouragingly to your baby about the and the genital area. For a girl, gently
again. Once you’re confident the tem- hand. They can also roll and fall from upcoming bath. Even if your baby can’t spread the labia to carefully clean the
perature is right, place your baby in the high surfaces, or slip and hit their understand you, your tone of voice will area. For a boy, lift the scrotum to clean
tub. If you’re not sure about the tempera- heads, even when they’re seated. During be comforting, and eventually he or she underneath. If your son is uncircumcised,
ture, consider purchasing a bath ther- a bath, keep your eyes on your little one will understand what’s happening. don’t try to retract the foreskin of the pe-
mometer to help guide you. at all times. nis. Let your baby lean forward on your
Place your baby Remove your baby’s arm while you clean his or her back and
clothes and diaper. Whether you’re bottom, separating the buttocks to clean
cleaning your baby with a sponge bath or the anal area.
SAFE BABY CARE PRODUCTS a full bath, gently lower him or her into
position. Support his or her head and Pat dry Once your baby is clean and
Finding baby care products that are absolutely safe and gentle seems like it should torso to help him or her feel secure. rinsed off, carefully pick him or her up
be an easy task, but unfortunately, that’s not always the case. Baby products are and into a towel — remember he or she
generally marketed as safe, gentle, mild and natural, yet some of these products Keep hold Babies can be slippery and will be slippery! You may set a towel
may contain ingredients that can be irritating to your baby. can become suddenly squirmy, so keep a vertically over your body so that part of
Remember that whenever you put something on your baby’s skin, the ingredi- good hold on your baby during baths. It it hangs over your shoulder. Bring your
ents in the product can be absorbed into your baby’s body through the skin. Here may help to keep your dominant hand baby to your chest and then bring the
are some ways you can protect your baby from potentially harmful ingredients: free for reaching and cleaning and use bottom of the towel up and around your
Z Limit the number of products you use on your baby. the other hand to keep your baby steady baby. Another option is to spread a towel
Z Read labels to ensure you’re comfortable with all the ingredients. This method and safe. out on the floor. Place your baby on the
has its limitations, however, since most people aren’t familiar with the many towel and then wrap the towel around
names and types of chemicals. In addition, in the United States, the Food and Eyes first Use a cloth or cotton ball him or her. Gently pat your baby dry
Drug Administration doesn’t require products to list the individual ingredients dampened with water to wipe from the with a towel. Patting the skin instead of
that are used to make a fragrance, and many products just list “fragrance” as inside to the outside corner of your new- rubbing it dry will help keep your baby’s
the ingredient. born baby’s eye. Discard the used cotton skin from getting irritated.
Z Do your homework. Go online or check government and health resources to ball and use a fresh, damp cotton ball for
learn more about the ingredients in products you’re using or are considering the other eye. Diaper and clothe After you’ve dried
purchasing. baby off, place a fresh diaper on him or
Start at the top Use a soft cloth to her, and put on some clothes or pajamas
wash your baby’s face with water and to keep your child warm.
92 PART 1: CARING FOR YOUR BABY CHAPTER 5: BATHING AND SKIN CARE 93
BABY BATH
Breaking out the tub When you’re ready to give your baby a tub bath — whether you Washing baby’s back When you clean Remember the creases Pay attention
do so right from the start or you try sponge baths first — you’ll have plenty of choices. You your baby’s back and buttocks, lean him or to creases under the arms, behind the ears,
can use a free-standing plastic tub specifically designed for newborns, a plain plastic her forward on your arm. Continue to grasp around the neck and in the diaper area.
basin or a small inflatable tub that fits inside the bathtub. Lined with a towel or rubber mat, your baby under the armpit. Wash between baby’s fingers and toes.
the kitchen or bathroom sink might be another option.
Checking the water temperature You Use a secure hold A secure hold will Rinsing baby’s hair You might want to When baby cries If your baby cries in the
need only a few inches of warm water. To help your baby feel comfortable and stay try a football hold under the faucet for tub, stay calm. Clean what you can and
prevent scalding, set your water heater safe in the tub. Use one of your hands to washing hair. Support your baby’s back then wrap your baby in a towel. Wait a few
thermostat to below 120 F. Check the tem- support your baby’s head and the other to with your arm, keeping a firm hold on your days and then try again. In the meantime,
perature with your hand. hold and guide your baby’s body. baby’s head while you rinse. use sponge baths where needed.
the abdomen pushes through a hole in cised penis doesn’t need special care.
HAPPY IN THE WATER the abdominal wall when there’s pres- Wash your baby’s penis with warm water
sure. Umbilical hernias typically resolve and mild baby soap, just like you clean
A bit of water near your baby’s eyes and ears is OK — babies can blink to protect on their own and don’t need treatment. the rest of his bottom. Occasionally, a
their eyes from a little water. If you keep your baby from even the tiniest of splash- In rare cases, a baby may need surgery to small piece of foreskin remains on the
es, you may end up with a baby who is fearful of water. close the hole. Taping the bulge down or penis. If this occurs, gently pull back that
As your baby gets older, if he or she enjoys being in the bath water, give him or taping a coin over the hernia is a poten- skin to make sure the head of the penis
her some extra time to play and splash around after he or she is finished bathing. tially harmful practice and should be is clean.
This will help him or her have positive feelings about water and may help reduce avoided. For more on umbilical hernias,
anxiety about water later. see page 36. Caring for an uncircumcised penis
During your baby’s first few months,
clean his uncircumcised penis with water
and a bit of mild baby soap, just like you
UMBILICAL CORD CARE Umbilical cord problems, including CIRCUMCISION CARE would clean the rest of his bottom. You
infections, aren’t common. But have the don’t need anything else such as antisep-
After your newborn’s umbilical cord is area examined by your baby’s care pro- If your newborn boy was circumcised, the tic or cotton swabs. Don’t try to pull back
cut, all that remains is a small stump. In vider if you notice any of the following: tip of his penis may seem raw for the first or retract the foreskin. Doing so can cause
most cases, the remaining cord will dry Z The navel continues to bleed. week after the procedure. Or a yellowish tearing, pain and bleeding. The foreskin
up and fall off one to three weeks after Z The skin around the base of the cord mucus or crust may form around the will retract on its own, most likely after
birth. Until then, you want to keep the is red. area. This is a normal part of healing. A your baby is about 6 months or older.
area as clean and dry as possible. It’s a Z There’s a foul-smelling, yellowish dis- small amount of bleeding also is com- It’s important to watch your uncir-
good idea to give sponge baths rather charge from the cord. mon the first day or two. cumcised baby urinate once in a while. If
than full baths until the cord falls off and Z Your baby cries when you touch the Clean the area around the penis gen- you notice his urine stream isn’t stronger
the navel area heals. cord or the skin near the cord. tly and apply a dab of petroleum jelly to than a trickle, or if he seems uncomfort-
Traditionally, parents have been in- Z The cord hasn’t dried up or fallen off the end of the penis with each diaper able while he pees, contact your baby’s
structed to swab the cord stump with by the time the baby is 2 months old. change. This will keep the diaper from care provider. It’s possible that the hole in
rubbing alcohol. But research indicates sticking while the penis heals. If there’s a the foreskin is too small to allow a nor-
that leaving the stump alone may help Umbilical granuloma In some cases, bandage on the penis, change it with mal flow of urine.
the cord heal faster, so many hospitals the umbilical cord forms a small red mass each diapering. Because the foreskin separation can
now recommend against this practice. If of scar tissue (granuloma) that remains At some hospitals, a plastic ring is take several months or longer, check with
you’re unsure about what to do, talk to on the bellybutton even after the cord used instead of a bandage. The ring will your baby’s care provider to find out
your baby’s care provider. has fallen off. The granuloma usually remain on the end of the penis until the when the separation is complete. Once it
Exposing the cord to air and allowing drains a light yellow fluid. If you notice edge of the circumcision has healed, usu- is, you can gently retract the foreskin to
it to dry at its base will hasten its separa- these signs, contact your baby’s care pro- ally within a week. The ring will drop off clean the head of the penis. Then pull the
tion. To prevent irritation and keep the vider to discuss whether your baby needs on its own. foreskin back over the penis when you’re
navel area dry, fold the baby’s diaper be- to be examined. Typically, an umbilical Problems after a circumcision are finished.
low the stump. In warm weather, dress a granuloma resolves on its own after rare, but call your baby’s care provider if Once your baby boy is older, it’s im-
newborn in just a diaper and T-shirt to let about a week, but if it doesn’t, your ba- you notice bleeding, redness or crusted portant to teach him how to properly
air circulate and help the drying process. by’s care provider may need to remove sores containing fluid around the tip of wash his penis using these three steps:
It’s normal to see a bit of crusted dis- the tissue. the penis. Other signs to be aware of are Z Gently pull the foreskin back and
charge or dried blood until the cord falls swelling of the penis tip or a foul-smell- away from the head of the penis.
off. But if your baby’s navel looks red or Umbilical hernia If your baby’s umbili- ing drainage coming from the penis tip. Z Use warm water and soap to clean
has a foul-smelling discharge, call his or cal cord area or belly button protrudes or the head of the penis and the fold in
her care provider. When the stump falls bulges when he or she cries, strains or Washing a circumcised penis It’s the foreskin.
off, you may see a little blood, which is sits up, he or she may have an umbilical OK to gently wash the penis as it’s heal- Z Pull the foreskin back to its original
normal. hernia. In this common condition, part of ing. And once it’s healed, the circum- place over the head of the penis.
born with some bruising, and skin in the first year, but it can last a few years.
blotches and blemishes are common. Talk with your child’s care provider. The
Young infants often have dry, peeling provider may recommend treatment if he
skin, especially on their hands and feet, or she is worried about possible scarring.
for the first few weeks. Some blueness of Having acne as a baby doesn’t neces-
the hands and feet is normal and may sarily mean that your child will have acne
continue for a few weeks. Rashes also are later in life.
common. Most rashes and skin condi-
tions are treated easily or clear up on Erythema toxicum Erythema toxicum
their own. is the medical term for a skin condition
that’s typically present at birth or appears
Milia Milia is the name for tiny white within the first few days after birth. It’s
pimples or bumps that appear on the characterized by small white or yellowish
nose, chin and cheeks. Although they bumps surrounded by pink or reddish
appear to be raised, they are nearly flat skin. The condition causes no discomfort
and smooth to the touch. If your baby has and isn’t infectious. Erythema toxicum
milia, you can wash his or her face once a disappears in several days, although
day with warm water and a mild baby sometimes it flares and subsides before
soap, but avoid using lotion, oils or other completely clearing up. Treatment isn’t
© MFMER
products. It’s also important to leave the necessary.
skin alone — never scrub or pinch the
Two hints for making nail trimming easier: Wait until your baby is asleep and then work bumps. Milia disappear in time, often Pustular melanosis These small spots
together, with one person holding the baby and the other person trimming the nails. within a few weeks, and they don’t re- look like small yellowish-white sesame
quire treatment. seeds that quickly dry and peel off. They
may look similar to skin infections (pus-
NAIL CARE Z Have another person hold your baby Acne Baby acne refers to the more pro- tules), but pustular melanosis isn’t an in-
while you trim his or her nails. nounced red or white bumps and blotch- fection and disappears without treat-
Your baby’s nails are soft, but they’re Z Trim the nails straight across. es (pimples) that are seen on the face, ment. The spots are commonly seen in
sharp. A newborn can easily scratch his Don’t bite your baby’s nails as a neck, upper chest and back. Among new- the folds of the neck and on the shoul-
or her own face — or yours. To prevent method of keeping them trimmed — this borns who experience acne, the pimples ders and upper chest. They’re more com-
your baby from accidentally scratching can cause infection. are generally most noticeable within the mon in babies with darker skin.
his or her face, you will want to trim Your baby’s toenails will probably first few weeks. To care for baby acne,
or file the fingernails shortly after birth. grow much more slowly than his or her place a soft, clean receiving blanket un- Cradle cap Cradle cap refers to a scali-
Then continue to trim his or her nails a fingernails. They may need a trim only der baby ‘s head and wash his or her face ness and redness that develops on a ba-
few times a week. once or twice a month. Toenails are also gently once a day with mild baby soap. by’s scalp. It results when oil-producing
Sometimes you may be able to care- softer than fingernails, so they may ap- Avoid lotions, oils and other treatments sebaceous glands produce too much oil.
fully peel off the ends with your fingers pear to be ingrown, but unless the skin and never scrub, squeeze or pinch the af- Cradle cap is common in infants, usually
because baby nails are so soft. Don’t wor- around the nail looks red and inflamed, fected skin. The condition typically dis- beginning in the first weeks of life and
ry — you won’t rip the whole nail off. You they’re probably fine. appears without treatment within the clearing up over a period of weeks or
can also use a baby nail clippers or a first couple of months. If it doesn’t clear months. It may be mild, with flaky, dry
small scissors. Here are some tips to up after a few months, talk with your skin that looks like dandruff, or more se-
make nail trimming easier for you and child’s care provider. vere, with thick, oily, yellowish scaling or
your baby: COMMON SKIN CONDITIONS Sometimes baby acne may not devel- crusty patches.
Z Trim the nails after a bath. They’ll be op until later, occurring when babies are Shampooing with a mild baby sham-
softer, making them easier to cut. Many parents expect their newborn’s around 3 or 4 months old. In these cases, poo can help with cradle cap. Don’t be
Z Wait until your baby is asleep. skin to be flawless. But most babies are the acne usually clears up sometime with- afraid to wash your baby’s hair frequently.
SKIN CONDITIONS
Milia Many babies are born with tiny white Acne Acne typically appears as red or Pustular melanosis This condition in- Eczema Baby eczema is characterized by
bumps that appear on the nose, chin or white bumps on a baby’s forehead or volves small blisters that resemble seeds patches of red, scaly, itchy skin. Occasion-
cheeks. This condition, called milia, occurs cheeks. The condition often develops as a that dry up and peel away. The blisters ally the patches ooze and crust over. Ec-
when skin flakes become trapped near the result of exposure to maternal hormones leave behind spots, or “freckle” marks, that zema often appears at the elbows and
surface of the baby’s skin. during pregnancy. disappear in weeks to months. knees and on the cheeks.
Cradle cap Cradle cap appears as thick, Erythema toxicum The main symptom Oral thrush Oral thrush produces slightly Impetigo Impetigo starts as a red sore
yellow, crusty or greasy patches on a ba- of this condition is a rash of small, yellow- raised, creamy white, sore patches on a that ruptures, oozes for a few days and
by’s scalp. Cradle cap is common in new- to-white colored bumps (papules) sur- baby‘s mouth or tongue. The patches may then forms a honey-colored crust. Sores
borns and usually appears within the first rounded by red skin. There may be a few or spread to the gums or the back of baby’s mainly occur around the nose and mouth
few weeks after birth. several papules. mouth. and spread to other parts of the face.
This, along with soft brushing, will help Z Bathe your baby daily with a fra-
remove the scales. If the scales don’t grance-free hypoallergenic bath oil. A WORD ON SUNSCREEN
loosen easily, rub a few drops of mineral This can help moisturize your baby’s
oil onto your baby’s scalp. Let it soak into skin, in addition to help prevent skin Remember that your baby’s skin will irritating your baby’s skin and eyes, use
the scales for a few minutes, and then infections, which are more common sunburn easily. If you’re going to be a sunscreen that contains only inorgan-
brush and shampoo your baby’s hair. in babies with eczema. outside for any length of time, protect ic filters, such as zinc oxide and titani-
If you leave the oil in your baby’s hair, Z Use a fragrance-free moisturizer right your baby’s skin with clothing and a um dioxide. Avoid using products that
the scales may accumulate and worsen after patting baby dry following a cap. Keep him or her in the shade to combine sunscreen and the insect re-
cradle cap. bath. This helps lock moisture from avoid overexposure to the sun. pellent DEET, since sunscreen must be
If cradle cap persists or spreads to the bath into baby’s skin. As for sunscreen, recommenda- regularly reapplied and insect repellent
other parts your child’s body, especially Z Keep your baby from environmental tions differ for infants younger and old- typically doesn’t need to be reapplied.
in the creases at the elbow or behind the triggers for eczema, including heat er than 6 months. Consider these gen- Apply sunscreen generously, and reap-
ears, contact your baby’s care provider, and low humidity. eral guidelines from the American ply every two hours — or more often if
who may suggest a medicated shampoo Z Check your baby’s sleeping condi- Academy of Pediatrics, the Food and your baby is spending time in the water
or lotion. tions and ensure that the area is free Drug Administration and the American or is perspiring.
Cradle cap isn’t usually uncomfort- of dust and upholstery that may con- Cancer Society:
able or itchy for your baby, but some- tain dust mites. Z For babies younger than 6 months
times a yeast infection can occur in the Keep him or her out of direct sun-
affected skin. In this case, the skin will Contact dermatitis and ‘drool rash’ light. Protect your baby from sun
become very red and itchy. If you notice Contact dermatitis is a kind of skin in- exposure by dressing him or her in
this, contact your baby’s care provider. flammation that occurs when substances protective clothing, a hat with a
touching your skin cause irritation or an brim and sunglasses. If sun expo-
Eczema Eczema, also known as atopic allergic reaction. The resulting red, itchy, sure can’t be avoided, most pediat-
dermatitis, is marked by dry, itchy, scaly dry or bumpy rash isn’t contagious or ric dermatologists recommend us-
red patches of skin that are often found life-threatening, but it can be very un- ing a sunscreen. Look for one that’s
around babies’ elbows or knees. Some- comfortable. Culprits for babies could in- 100 percent zinc oxide or titanium
times the affected area is small and clude soaps, laundry detergent, rough dioxide. These are “physical block-
doesn’t bother a baby much, and treat- fabric or even your baby’s own drool ers” as opposed to “chemical
ment isn’t necessary. Many babies out- (sometimes referred to as drool rash). blockers” often found in other sun-
grow eczema. If you can identify the offending agent screens. In addition to sunburn, in-
In other cases, eczema can cover a lot and eliminate contact between it and fants don’t sweat easily. If they’re in
of skin and be extremely itchy and un- your baby, the contact dermatitis should the sun, they can easily become
comfortable. In these cases, talk with clear up. Often, using an absorbent bib overheated.
your baby’s care provider about whether and changing it frequently, as well as ap- Z For babies 6 months or older Liber-
treatment is needed. You can also try the plying a barrier cream such as petroleum ally use sunscreen. In addition,
following methods to prevent eczema jelly to the area of irritation, can help pre- avoid exposing your baby to the
from recurring: vent the rash from worsening. In the sun during peak hours — generally
Z Use fragrance-free baby soaps to wash meantime, a wet compress may help 10 a.m. to 4 p.m. — and dress your
your baby and laundry detergents that comfort your baby. Contact your child’s baby in protective clothing, a hat
are free of fragrances, dye and deodor- care provider if the rash is severe or gets with a brim and sunglasses.
ants. Even“mild”baby soaps may have worse or if your baby’s skin is oozing or The American Academy of Derma-
a small amount of fragrance that can extremely itchy. tology recommends using a broad-
irritate sensitive skin. spectrum sunscreen with a sun protec-
Z Dress your baby in soft, cotton cloth- Impetigo Impetigo is a highly conta- tion factor (SPF) of 30 or more. To avoid
ing, and avoid synthetic fabrics and gious skin infection that mainly affects
wool. infants and children. It usually appears as
red sores on the face, especially around a mouth. Women whose breasts are infect-
child’s nose and mouth. The sores may be ed with the yeast may experience the fol-
covered with a yellow-brown scab or lowing signs and symptoms:
crust, or grow into blisters and pimples Z Unusually red, sensitive or itchy nipples
and weep pus. Although impetigo com- Z Shiny or flaky skin on the areola
monly occurs when bacteria enter the Z Unusual pain during nursing or pain-
skin through cuts or insect bites, it can ful nipples between feedings
also develop in skin that’s perfectly Z Stabbing pains deep within the breast
healthy. If you’re breast-feeding an infant who
Impetigo is seldom serious, and it has oral thrush, you and your baby will
usually clears on its own in two to three do best if you’re both treated with medi-
weeks. But because impetigo can some- cation. Otherwise, you’re likely to pass
times lead to complications, your child’s the infection back and forth. Your doctor
doctor may choose to treat impetigo with may prescribe a mild antifungal medica-
an antibiotic ointment or oral antibiotics. tion for your baby and an antifungal
cream for your breasts. If your baby uses
Thrush Thrush, which is a yeast infec- a pacifier or feeds from a bottle, rinse
tion in the mouth, is a common infection nipples and pacifiers in a solution of
in babies. You may notice creamy white equal parts water and vinegar daily and
lesions on your baby’s cheeks or tongue. allow them to air-dry to prevent fungus
Sometimes thrush even spreads to the growth. Additionally, if you use a breast
top of your baby’s mouth, gums, tonsils pump, rinse any of the detachable parts
or the back of the mouth. Aside from that come in contact with your milk in a
the white patches or lesions, your baby vinegar and water solution.
may not have any noticeable signs and
symptoms. Other indications of thrush
include:
Z Pain or fussiness while eating and
drinking
Z Loss of appetite, including drinking
less milk
If your baby only has a white tongue,
it’s probably not thrush. Drinking milk
often results in a white tongue for babies
before they start eating solid foods.
Your baby’s care provider can deter-
mine if your baby has thrush by examin-
ing his or her mouth and tongue and
scraping off a sample of the white lesions
or patches. If your baby has thrush, he or
she will probably be given an anti-yeast
medicine.
Babies can pass the infection to their
mothers during breast-feeding. The in-
fection may then pass back and forth be-
tween a mother’s breasts and a baby’s
CHAPTER 5: BATHING AND SKIN CARE 105

CHAPTER 6
Clothing baby
One of the things many new parents look Size Almost all baby clothing is sized in
forward to during pregnancy and after three-month intervals. Sizes often begin
baby is born is going baby-clothes shop- with 0-3 months, followed by 3-6
ping! For years you may have walked by months, 6-9 months and 9-12 months. It
the baby section at clothing and discount would make sense that a newborn would
stores and excitedly anticipated the day wear 0-3 months. But buying for baby of-
when you would be able to purchase such ten isn’t quite that simple — as many
cute items for your son or daughter. parents who’ve had to return clothing to
While it may be hard to resist the the store can attest!
frilly dresses, designer blue jeans or min- When you’re buying clothes for your
iature sports jerseys, you want to be prac- newborn, don’t go strictly by what’s on
tical in the clothes you buy. You’ll be the label. Look at the item and see if it
changing clothes a lot (yes, they get appears to run small or about the right
dirty), and undressing and dressing may size for your child.You may find you want
not be one of your child’s favorite activi- to size up, even if it means the item may
ties. So why make it more complicated be a little big to begin with.
than you have to. Many babies fit into clothing long be-
fore what’s indicated on the label. A
newborn may wear a size 3-6 months
within a few weeks of birth. And it’s not
A FEW SHOPPING TIPS uncommon for a 4-month-old to wear a
size 6-9 months.
If you haven’t had a lot of experience in Many mothers will tell you about
outfitting a baby, here are a few sugges- waiting until baby was 6 months old to
tions you may find helpful as you shop wear the cute 6-9 month outfit, only to
for baby clothing. put it on and find out it was too small!
CHAPTER 6: CLOTHING BABY 107

Some manufacturers include tags that Safety Keep it simple. Avoid clothes
list weight and height guidelines for each with buttons, which are easily swallowed, PROTECTING BABY’S FACE
size. They may give you a better idea if and ribbons or strings, which can cause
the item will fit. choking. Don’t buy garments with draw- You may find that some baby clothing — especially outfits for newborns and young
strings, which can catch on objects and infants — have small flaps at the ends of the sleeves. The flaps are intended to
Fabric In general, look for soft, comfort- strangle a child. cover baby’s fists. This will prevent baby from accidently scratching his or her face
able clothing that’s washable. Your infant or eyes with those sharp, little fingernails.
is just as likely to appreciate clothing that Ease Because you may be changing As baby gets older and gains more control of his or her motor functions, acci-
doesn’t irritate, bind, twist or rub as you your baby’s clothing a few times a day — dental scratches become less of a concern.
are. Select sleepwear that’s labeled flame or at least changing diapers several times
resistant or flame retardant, which can be a day — make sure the outfits are un-
either a synthetic fiber or cotton treated complicated and they open easily.
with flame-retardant chemicals. Look for garments that snap or open One-piece undershirts You want the make sure you have enough to last you
Remember, babies make a mess! So down the front, have loosefitting sleeves, kind that comes between the legs, fits up between washings.
purchase clothing that’s stain-remover and are made of stretchy fabric. Avoid over the crotch and snaps in front. People
and washing-machine friendly. Also keep items with zippers. You know what it often refer to these as Onesies. Onesies, Pajamas Depending on the weather,
in mind that items made from cotton feels like to zip your own skin in a zipper! however, is a registered trademark of baby’s pajamas may be of a lighter or
may shrink a bit. You wouldn’t want to accidently do the Gerber Childrenswear. Other manufac- heavier material. During hot summer
same to your baby. turers make similar products but call months, a sleeper or gown may be all
them by a different name. baby needs while sleeping. During the
Cost Since babies outgrow clothes so One-piece undershirts can be worn colder winter months, you may want to
quickly, consider purchasing some underneath clothing or, if the weather is put baby in a heavier blanket sleeper.
clothes at thrift stores, garage sales or hot or the indoor temperature a bit warm, Blanket sleepers keep baby warm with-
from other mothers. If someone offers by themselves. They provide an easy way out the need for a comforter or blanket.
you hand-me-downs, don’t take it as an to give your baby an extra layer of Don’t purchase oversized pajamas,
insult. Hand-me-downs are a great way warmth, and they help keep your baby’s regardless of how comfortable you think
to save money that you can put to use for other clothing from rubbing up against they might look. If the garment rides up
other items you may want to purchase that new and delicate skin. on the neck and head or is too loose
for baby. You’ll go through a lot of these. Buy around the shoulders, the extra space be-
enough to last you between clothes tween the material and baby’s skin may
washings. increase the risk of suffocation. With
sleepwear, ignore the buy-big rule and
WHERE TO START One-piece outfits Footed one-piece purchase pajamas that fit snugly.
outfits go by a lot of names, including You’ll likely want at least a couple of
You can fill your baby’s closet with all stretchies, sleepers or rompers. When pajamas. Make sure the material is flame
sorts of clothes, but because babies grow your baby is young, you may find them resistant or flame retardant.
so fast, you don’t want to buy too much. quite practical. The outfits generally snap
You run the risk that your son or daugh- in front and at the crotch and are easy to Dress wear For occasions when you‘ll
ter will outgrow the clothes before he or get on and off. be taking baby out and you want more
she has a chance to wear them. It’s often A gown resembles a stretchy or sleep- dressy clothing, look for outfits that are
best to purchase a few outfits at a time er, but instead of having footed legs, it comfortable and easy to get on and off.
every few months. looks more like a sleeping bag at the bot- Two-piece outfits that snap at the
You’ll also find there are certain tom. A gown may have an open, elasti- waist help prevent the pants from falling
clothes babies seem to wear more than cized bottom. off or the top from riding up. If the outfit
others — often because of ease, comfort Again, because your newborn may has elastic at the waistline, legs or arms,
or convenience. wear one-piece outfits almost every day, make sure the elastic isn’t too tight.
CHAPTER 6: CLOTHING BABY 109

In the warm summer months, one- Shoes Many babies don’t walk until after clothes that appear durable and that are
piece outfits with short sleeves and short their first birthday, but a few young ones likely to wash well. It’s also a good idea to
pants are great day wear. get their legs under them early. If your son wash all clothes before baby wears them,
or daughter begins walking early, you may in case during handling irritating sub-
Socks As you well know, socks have a need to purchase a pair of shoes. stances got on the clothing. Here are a
tendency to fall off! Look for those that There’s nothing wrong with baby few other tips.
are most likely to stay on, but also expect walking in his or her bare feet — it’s ac-
that you will lose some along the way. tually a great way to learn. Shoes are Stains Stains are inevitable. Breast milk,
You don’t need to worry about purchas- needed at times, though, to protect ba- formula, spit-up, poop — these common
ing socks with nonskid bottoms until by’s feet, especially when outside. You offenders will more often than not wind
baby starts walking. don’t want baby stepping on something up on your baby’s clothes (and probably
sharp or in something unpleasant. yours, too!).
Winter wear During the cooler winter When shopping for shoes, look for If possible, wipe or rinse off the sub-
months, you need a winter cap to cover shoes that are low-cut with flexible, non- stance while it’s still fresh and before it
baby’s head. His or her hands should also skid soles. The upper part of the shoe sets. You might soak stained clothes with
be covered. When baby is young, you should be made from material that’s a pre-soak before you wash them. At the
may find a bunting to be convenient. breathable and lightweight. Err on the very least, blast them with a good douse
However, these sac-like outer garments side of buying shoes that are too big rather of stain remover before they’re put in the
generally aren’t recommended if baby is than ones that will soon be too small. washing machine.
in a car seat. The extra material could pre- However, you don’t want the shoes so big
vent baby from being strapped in secure- that baby has difficulty walking in them. Detergents Babies have sensitive skin,
ly. A snowsuit, which has legs, often and some babies develop skin irritation
works best. from normal laundry detergents. If you
think your baby’s skin may be sensitive
Summer hat or cap To help protect WASHING BABY’S CLOTHES to normal laundry detergent, try a deter-
baby’s skin and keep him or her from gent without colors and fragrances. This
getting too warm, use a hat or cap during After your baby arrives, it can seem as if might reduce the irritation. And don’t use
warm, summer months. A hat or cap also you do laundry all of the time. To make fabric softeners.
helps keep the sun out of baby’s eyes. the process as easy as possible, purchase You might also consider washing ba-
by’s clothes in milder detergents that
supposedly leave less residue and, there-
fore, don’t cause as much skin irritation.
DRESS FOR THE WEATHER The label on these products often indi-
cates the detergent is intended for the
New parents sometimes overdress their infants. A good rule of thumb is to dress clothing of babies and children and those
your baby in the same number of layers that you would feel comfortable wearing, who are sensitive to laundry soap resi-
and possibly one more light layer. For example, you might put baby in a diaper and due. Be warned, though, these products
undershirt, covered by a sleeper or gown, and wrapped in a receiving blanket. tend to be more expensive.
In hot weather — over 75 F — a single layer of clothing is often appropriate. Some parents run baby’s clothes
Babies don’t sweat easily and can become overheated. However, you may want through an extra rinse cycle to ensure
an additional layer if the baby is in air conditioning or near drafts. there’s no soap residue left on the cloth-
Remember that your baby’s skin will sunburn easily. If you’re going to be outing. This may not be necessary, but if you
side, keep baby out of the sun, and protect your baby’s skin with clothing and a would like, you can try it to see if it helps.
hat or cap. For more on sun protection, see page 103.

CHAPTER 7
Sleep and sleep issues
Oh, baby! There’s nothing like getting a the first month, they usually sleep and
good night’s sleep. While newborns usu- wake round-the-clock, with relatively
ally sleep about 16 hours a day, it’s fre- equal periods of sleep between feedings.
quently for only one or two hours at a In addition, newborns don’t know the
time. Your baby can thrive on that sched- difference between night and day. It
ule, but you may find it exhausting. If you takes time for them to develop circadian
haven’t had a good night’s sleep since rhythms — the sleep-wake cycles and
your baby was born, you’re not alone. other patterns that revolve on a 24-hour
Sleepless nights are a rite of passage for cycle. As a baby’s nervous system gradu-
most new parents. But don’t despair, your ally matures, so do his or her phases of
baby will learn to sleep better at night. sleep and wakefulness.
Honestly! From the time your baby is
born, you can encourage him or her to Daily sleep Although newborns don’t
adopt good sleep habits. usually sleep for more than a few hours
This chapter also discusses common at a stretch, altogether they typically
sleep-related issues such as colic and re- sleep 12 to 16 hours a day. They may stay
views prevention strategies to reduce the awake long enough to feed, or for up
risk of sudden infant death syndrome to about two hours, before falling asleep
(SIDS) and crib accidents. again. The first few days home from the
hospital don’t be surprised if you feel
exhausted. Remember, you just had a
baby, and you’re now trying to get ad-
SLEEP SCHEDULE justed to what it’s like being up with a
baby at night.
It takes a while for newborns to get on By the time your baby is 2 weeks old,
any kind of schedule for sleeping. During you’ll likely notice that the periods of
CHAPTER 7: SLEEP AND SLEEP ISSUES 113

sleeping and wakefulness are lengthen- Night vs. day Some babies clearly have ADOPTING GOOD SLEEP HABITS ing him or her and allow for time for him
ing. By age 3 to 4 months, some babies their days and nights reversed, and they or her to settle again.
sleep at least five hours at a time and sleep more in the daytime than at night. Some babies just sleep well from the If your baby wakes shortly after you
shift more of their sleep to nighttime, For parents who are sleep deprived, this start. They nap during the day and sleep put him or her to bed and isn’t wet, hun-
much to the relief of their parents! By age can be a stressful time. Generally, though, for long stretches at night, only waking gry or ill, try to be patient with the crying
6 months, nighttime stretches of nine to within a few weeks to a couple of months, for feedings. Most babies aren’t that easy. and encourage self-settling. This may re-
12 hours are possible. days and nights will become more pre- They may take only short catnaps, wake quire soliciting support from a partner,
dictable and regular. often at night and have trouble lulling family member or friend to keep you
Naps Many newborns nap frequently in One way to help speed up this transi- themselves back to sleep. from not picking baby up.
one- to two-hour spurts. As baby gets tion is to limit daytime naps to no more If your baby doesn’t sleep well, know During sleep, babies are often active,
older, nap times may lengthen and be- than three or four hours each. In addi- that with time his or her sleep will im- twitching their arms and legs, smiling,
come more predictable. With some ba- tion, during the day, have baby sleep in a prove. In addition, there are steps you sucking and generally appearing restless.
bies, though, napping remains complete- more active area of the house with the can take to help him or her sleep better And while sleeping, infants may cry and
ly random and they never fall into any lights on and where noises can be heard. and learn how to fall asleep without your move about when entering different
type of pattern. In contrast, at night, keep the bedroom assistance. sleep cycles. Parents sometimes mistake
When baby is a few months old, you dark and quiet. a baby’s stirrings as a sign of waking up,
may find he or she will fall into a three- During nighttime feedings and diaper Learning to fall asleep In the first few and they begin unnecessary feeding. In-
naps-a-day schedule: a morning nap, an changes, avoid stimulation. Keep the months, it’s common for a pattern to stead, wait a few minutes to see if your
early afternoon nap and an early evening lights low, use a soft voice, and don’t play evolve in which a baby is fed and falls baby falls back to sleep.
nap. However, this, too, varies consider- or talk with your baby. This reinforces the asleep in a parent’s arms. Many parents
ably with each baby. message that nighttime is for sleeping. enjoy this closeness and snuggling. But Sleep tips Here are some suggestions
eventually this may be the only way the to help your baby learn how to “sleep
baby is able to fall asleep. When the baby like a baby.”
wakes up in the middle of the night, he
or she can’t fall asleep again without be- Encourage activity during the day
NOISY BREATHING ing fed and held. When your baby is awake, engage him
Drooping eyelids, rubbing the eyes or her by talking, singing and playing.
The familiar phrase “sleeping like a baby,” conjures up images of a baby lying qui- and fussiness are the usual signs that a Surround your baby with light and nor-
etly and breathing ever so softly. But babies — especially newborns — often aren’t baby is tired. When you notice these mal household noises. Stimulation dur-
quiet when they sleep. signs, put your baby in his or her crib ing the day can help promote better sleep
Newborns spend about half their time in an active phase of sleep, called rapid while he or she is drowsy but still awake. at night.
eye movement (REM) sleep. During REM sleep, baby may breathe irregularly, You want to catch the signs of sleepiness
grunt, snort and twitch. During deeper sleep, called non-rapid eye movement early. The longer you wait, the more Monitor your baby’s naps Regular naps
(NREM) sleep, baby sleeps more peacefully. As babies get older, they spend overtired and fussy your baby may be- are important — but sleeping for large
more time in NREM sleep and less time in active sleep. So they generally become come, and the harder it may become for chunks of time during the day may leave
less noisy. him or her to fall asleep. If a baby can fall your baby wide awake at bedtime.
In addition, newborns are dominantly nose breathers — they breathe through asleep in bed without assistance when
their noses, not their mouths. This is so they can breathe at the same time they first laid down, it’s more likely that he or Follow a consistent bedtime routine
nurse. The slightest congestion or mucus in baby’s tiny nasal passages as air flows she will fall asleep on his or her own after Before bedtime take part in relaxing
in and out can make a lot of noise. If your baby’s breathing sounds a bit stuffy, it waking in the middle of the night. activities such as bathing, cuddling, sing-
doesn’t necessarily mean that he or she has a cold or allergies. It’s common for babies to cry when ing or reading. Soon your baby will
Noisy breathing in infants can be very worrisome for parents. Most of the time, put down for sleep, but if left alone for a associate these activities with sleep. If
the noise is normal. However, if you’re concerned that something isn’t right, con- few minutes, most will eventually quiet you play bedtime music, choose the same
tact your child’s care provider. themselves. If you leave the room for a tunes each time you put your baby in
while, your baby will probably stop cry- the crib. Avoid active play right before
ing after a short time. If not, try comfort- bedtime.
114 PART 1: CARING FOR YOUR BABY CHAPTER 7: SLEEP AND SLEEP ISSUES 115
Put your baby to bed drowsy but the trick. Another possible benefit, as
awake This will help your baby associate noted by the AAP, is that a pacifier may FEEDING A SLEEPY BABY
bed with the process of falling asleep. The reduce the risk of SIDS. Is there a down-
American Academy of Pediatrics (AAP) side to using a pacifier? Yes — if it falls You’ll no doubt have times when your baby signals that he or she is hungry, only
strongly advises that you place your baby out of your baby’s mouth during the to doze off once you begin feeding. Try these tips to feed a sleepy baby:
on his or her back at bedtime. Putting ba- night, he or she may let you know by cry- Z Watch for and take advantage of your baby’s alert stages. Feed at these times.
bies to sleep on their backs reduces the ing loudly, and this can happen multiple Z If your baby falls asleep while feeding, gently wake and encourage him or her
risk of sudden infant death syndrome times throughout the night. In addition, to finish eating.
(SIDS). SIDS prevention is discussed lat- if you’re breast-feeding, you may want to Z Give your baby a massage by walking your fingers up his or her spine.
er in this chapter. avoid pacifier use during the first month Z Partially undress your baby. Because your baby’s skin is sensitive to tempera-
until you feel comfortable you have the ture changes, the coolness may wake him or her long enough to eat.
Give your baby time to settle down process down and baby is eating well. Z Stroke a circle around your baby’s lips with a fingertip a few times.
Your baby may fuss or cry before finding Z Rock your baby in a sitting position. The baby’s eyes often open when he or
a comfortable position and falling asleep. Expect frequent stirring at night Babies she is positioned upright.
If the crying doesn’t stop, speak to your often wriggle, squirm and twitch in their
baby calmly and stroke his or her back. sleep. They can be noisy, too. Sometimes
Your reassuring presence may be all your fussing or crying is simply a sign of set-
baby needs to fall asleep. tling down. Unless you suspect that your example, as your child gets older, he or Research shows that babies who are
baby is hungry or uncomfortable, it’s OK she may experience separation anxiety, put to sleep on their stomachs are much
Consider a pacifier If your baby has to wait a few minutes to see what happens. which can affect sleep. Illness and in- more likely to die of SIDS than are babies
trouble settling down, a pacifier might do creased motor development also may placed on their backs. Infants who sleep
Keep nighttime care low-key When disrupt sleep. on their sides are also at increased risk,
your baby needs care or feeding during probably because babies in this position
the night, use dim lights, a soft voice and Don’t give up If you’re having trouble can roll onto their stomachs. Since 1992,
calm movements. This will tell your baby getting your baby to sleep, remember when the American Academy of Pediat-
that it’s time to sleep — not play. that it’s often not as easy as it may sound. rics began recommending the back-
Sometimes what you try works, some- sleeping position for infants, the inci-
Don’t bed share Many new parents are times it doesn’t, and sometimes it works dence of SIDS in the United States has
tempted to take their newborn into bed only some of the time. If you feel you declined significantly.
with them — often because they’re tired need more help, call your doctor to ask The only exceptions to the back-sleep-
and don’t want to get up, and because for suggestions. Call a friend or a family ing rule are babies who have health prob-
having baby in bed seems more conve- member and ask for help and a little re- lems that require them to sleep on their
nient. Sometimes parents bed share for lief. Just even talking about it can help — stomachs. If your baby was born with a
cultural or philosophical reasons. No you’ll know you’re not alone. birth defect, spits up often after eating, or
matter the reason, this is not a good has a breathing, lung or heart problem,
practice. It can make it harder for your talk to your baby’s care provider about the
baby to fall asleep on his or her own. In best sleeping position for your child.
addition, adult beds aren’t as safe for ba- ‘BACK’ TO SLEEP Make sure that everyone who takes
bies to sleep as are cribs. Bed sharing may care of your baby knows to place baby on
increase your baby’s risk of SIDS. Always place your baby on his or her his or her back for sleeping. That may in-
back to sleep, even for naps. This is the clude grandparents, child care providers,
Expect setbacks Once your baby begins safest sleep position for reducing the risk baby sitters, friends and others.
to sleep well during the night, don’t take of sudden infant death syndrome (SIDS). Some babies don’t like sleeping on
it as a sign that your sleep-deprived Sometimes called crib death, SIDS is the their backs at first, but they get used to it
nights are gone for good. As babies grow sudden and unexplained death of a baby quickly. Many parents worry that their
and develop, there will be setbacks. For under 1 year of age. baby will choke if he or she spits up or

vomits while sleeping on his or her back, Z Brain abnormalities. Some infants are Z Sex. Boy babies are more likely to die covered loosely with the blanket. Don’t
but doctors have found no increase in born with problems that make them of SIDS. cover your baby’s head.
choking or similar problems. more likely to die of SIDS. In many of Z Age. Infants are generally most vul-
Some babies who sleep on their backs these babies, the portion of the brain nerable during the second and third Keep baby out of your bed Baby should
may develop a flat spot on the backs of that controls breathing and arousal months of life. sleep alone. Adult beds aren’t safe for
their heads. For the most part, this will from sleep doesn’t work properly. Z Race. For reasons that aren’t well un- infants. A baby can become trapped and
go away after the baby learns to sit up. Z Low birth weight. Premature birth or derstood, black, American Indian and suffocate between the headboard slats,
You can help keep your baby’s head a being part of a multiple birth increas- Eskimo infants are more likely to de- the space between the mattress and the
normal shape by alternating the direction es the likelihood that a baby’s brain velop SIDS. bed frame, or the space between the
your baby lies in the crib — head toward hasn’t matured completely, so he or Z Family history. Babies who’ve had mattress and the wall. A baby can also
one end of the crib for a few nights and she has less reliable control over such siblings or cousins die of SIDS are at suffocate if a sleeping parent accidentally
then toward the other. This way, the baby automatic processes as breathing and higher risk of SIDS themselves. rolls over and covers the baby’s nose
won’t always sleep on the same side of his heart rate. The risk of SIDS is also affected by and mouth.
or her head. Z Respiratory infection. Many infants maternal factors associated with the
who have died of SIDS have recently pregnancy. Mothers under the age of 20, Offer a pacifier Sucking on a pacifier at
experienced a cold, which may con- who smoke cigarettes or use drugs or al- nap time and bedtime may reduce the
tribute to breathing problems. cohol, or who receive inadequate prena- risk of SIDS. One caveat — if you’re
SIDS The items in a baby’s crib and his or tal care are at increased risk of having a breast-feeding, wait to offer a pacifier
her sleeping position can combine with a baby die of SIDS. until breast-feeding is well established.
Sudden infant death syndrome (SIDS) is baby’s physical problems to increase the For some babies, this can be 3 to 4 weeks
the unexplained death, usually during risk of SIDS. Examples include: Prevention There’s no guaranteed way of age. If your baby’s not interested in the
sleep, of a seemingly healthy baby. Sud- Z Sleeping on the stomach or side. Ba- to prevent SIDS, but you can help your pacifier, try again later. If the pacifier falls
den infant death syndrome is sometimes bies who are placed on their stom- baby sleep more safely by practicing the out of your baby’s mouth while he or she
referred to as crib death because the in- achs or sides to sleep may have more following recommendations. is sleeping, don’t pop it back in.
fants often die in their cribs. difficulty breathing than those placed
Although the exact cause is still un- on their backs. Back to sleep Place your baby to sleep
known, it appears that sudden infant Z Sleeping on a soft surface. Lying face- resting on his or her back, rather than on
death syndrome may be associated with down on a fluffy comforter or a couch the stomach or side.
abnormalities in the portion of an in- or water bed can block an infant’s air-
fant’s brain that controls breathing and way. Draping a blanket over a baby’s Select bedding carefully Use a firm mat-
arousal from sleep. head also is risky. tress and avoid placing your baby on
Researchers have discovered some Z Sleeping with parents. While the risk thick, fluffy padding, such as lambskin or
factors that may put babies at extra risk of of SIDS is lowered if an infant sleeps a thick quilt. These may interfere with
sudden infant death syndrome. They’ve in the same room as his or her par- breathing if your baby’s face presses
also identified some measures you can ents, the risk increases if the baby against them. For the same reason, don’t
take to help protect your child from sud- sleeps in the same bed — partly be- leave pillows, fluffy toys or stuffed ani-
den infant death syndrome. The most cause there are more soft surfaces mals in your infant’s crib.
important is placing your baby on his or (such as a soft mattress or a water
her back to sleep. bed) to impair breathing. Blankets or Don’t overheat baby To keep your baby
pillows also can interfere with breath- warm, try a sleep sack or other sleep
Causes A combination of physical and ing or make baby overly warm. clothing that doesn’t require additional
sleep-related environmental factors can covers. If you use a blanket, make it light-
make an infant more vulnerable to SIDS. Risk factors Although sudden infant weight. Tuck the blanket securely at the
These factors may vary from child to death syndrome can strike any infant, re- foot of the crib, with just enough length
child. Physical factors associated with searchers have identified factors that may to cover your baby’s shoulders. Then
SIDS include: increase a baby’s risk. They include: place your baby in the crib, near the foot,

Make time for tummy time Just be- In addition, research suggests that No more drop sides In 2011, the Check the corner posts If your crib has
cause your baby should sleep on his or babies who spend time on their tummies Consumer Product Safety Commission corner posts or knobs, they should stand
her back doesn’t mean baby should nev- crawl on their stomachs earlier than do (CPSC) banned the manufacture and at least 16 inches above the crib’s end
er spend any time on the tummy. While babies who don’t practice tummy time. sale of drop-side cribs due to growing panels. This is so a child can’t reach the
baby is awake and being supervised, The more time babies spend on their evidence that they played a role in the top and get his or her pajamas caught. If
place him or her on the floor on his or tummies, the earlier they might begin to suffocation or strangulation deaths of the corner posts or knobs are shorter than
her tummy. Another option is to lay your roll over, crawl on their stomachs, crawl dozens of infants over the past decade. this, unscrew or saw them off so that the
baby tummy-down on your tummy or on on all fours and sit without support. The ban also includes the resale of drop- corners are no more than ¹∕16 of an inch
your lap. Make sure to make tummy time a side cribs. higher than the crib ends or side panels.
Being on the tummy is good for ba- part of your baby’s daily activities. Start Drop-side cribs — the cribs which Make sure to sand the crib corners to
bies. It prepares them for the time when by laying your newborn on his or her you probably slept in as a child — have a eliminate splinters and sharp ends.
they‘ll be able to slide on their bellies and tummy across your lap two or three times side rail that moves up and down, allow-
crawl by encouraging them to lift their a day for short periods of time. As your ing a parent to lower the side and more Check the crib’s paint If your crib is
heads and build strong head, neck and baby grows stronger, place him or her on easily lift baby from the crib. painted, make sure the paint isn’t chipped
shoulder muscles. As babies grow older a blanket on the floor and increase tum- These cribs came under scrutiny be- or peeling. This is especially important
and stronger, they’ll need more time on my time. cause of malfunctioning hardware, with older cribs that may have been coat-
their tummies to build their strength. Some babies may not like the tummy- sometimes cheaper plastics, or assembly ed with paint that contains lead — an-
Spending time on the stomach also time position at first. To help out, place problems that can cause the drop-side other reason not to use an old crib.
helps a baby’s head develop its conven- yourself or a toy on the floor for baby to rail to partially detach from the crib.
tional roundness, preventing it from be- look at or play with. It also may be a good When this happens, the drop side can Check the hardware Occasionally check
coming flat in the back. A baby’s skull is idea not to put baby on his or her tummy create a dangerous “V-like” gap between the screws and bolts in your baby’s crib to
soft and made up of several movable shortly after baby has eaten. Eventually the mattress and side rail where a baby ensure nothing is loose, missing or dam-
plates. If a baby’s head is left in the same your baby will become used to tummy can get caught and suffocate or strangle. aged. Crib hardware can loosen over
position for long periods of time, the time and enjoy play in this position. If you have a drop-side crib, or family time and may need occasional tighten-
skull may flatten. While it’s recommend- or friends offer you one of theirs, don’t ing. If anything is missing or broken,
ed that you place your baby on his or her use it. Knowing this type of crib poses a contact the manufacturer for replace-
back to sleep to reduce the risk of sudden safety risk, it’s best to avoid its use. ment parts.
infant death syndrome (SIDS), tummy CRIB SAFETY
time helps reduce the risk of flat spots. Other safety precautions In addition
An exciting time during your pregnancy to the ban on drop-side cribs, other
was shopping for all of the items you recent CPSC manufacturing regulations
would need for your new baby. Now they strengthen crib slats and mattress sup-
are being put to use! ports, improve the quality of crib hard-
In addition to being cute or decora- ware, and require more rigorous testing.
tive, your baby’s gear needs to be safe. When purchasing and using a crib,
One item for which this is especially im- follow these safety guidelines.
portant is the crib. Make sure that your
crib — the place where your baby will Check the slat spacing The crib’s slats
spend countless hours — meets all safety should be no farther apart than 2³∕8 inch-
regulations. es. This applies to bassinets, too. If you
Even if an old crib is in good shape, can fit a can of soda through the slats, the
safety standards have improved over the openings are too large. You’re more likely
years, so it’s best to buy a new crib if to find this problem in older cribs, but
you can. A crib should be the one place you can’t be too safe when it comes to
you feel comfortable leaving your child your baby, so check any crib you put him
alone. or her in.

Check the mattress supports Make sure Keep toys out of the crib Baby toys are
that the system that supports the crib mat- cute and cuddly, and it can be difficult, if
tress isn’t bent, broken or coming apart. If not impossible, to resist buying them.You
the mattress is suspended on hangers at- will likely amass numerous baby toys.
tached to hooks on the end panels, make The main rule is to use them for play un-
sure the hangers are well connected. der parent supervision and keep them
out of the crib. They can pose a small but
Check that the mattress fits The mat- nevertheless potential safety risk.
tress should fit tightly into the crib. There
shouldn’t be any cracks or openings be- Remove crib mobiles early Crib mobiles
tween the crib and the mattress because typically include string and small at-
a baby can get trapped in the smallest of tached pieces. Make sure your little one
spaces. If you can place more than two cannot reach the mobile so that he or she
fingers between the mattress and the crib can’t become entangled or pull anything
frame, the fit isn’t snug enough. off. When baby is able to push himself or
herself onto the hands and knees, the
Adjust the mattress height correctly mobile should be removed from the crib.
Most cribs have a feature that allows the
mattress to be placed at more than one
level. The higher levels make it easier to
take your infant out of the crib. However,
this can become dangerous when your
child is able to pull himself or herself to a
standing position. Before your child
reaches that stage, the mattress should
be at its lowest setting.
Don’t use a sleep positioner These are

wedge-shaped pieces of foam designed
to help babies sleep on their backs. The
American Academy of Pediatrics says the
devices haven’t been tested sufficiently to
show they’re effective or safe.
Forget the bumper pads Crib bumpers

are cute, but the American Academy of
Pediatrics recommends that you don’t
use them. According to the organization,
there’s no evidence that bumper pads or
similar products that attach to crib slats
or sides prevent injury in young infants.
However, bumper pads may increase the
risk of entrapment and suffocation. They
also need to be tied down with string,
which can be hazardous if not properly
secured.
122 PART 1: CARING FOR YOUR BABY CHAPTER 7: SLEEP AND SLEEP ISSUES 123
CHAPTER 8
Comforting a
crying baby
The dream: Your baby starts sleeping WHY BABIES CRY

through the night just a few weeks after
birth, gurgles happily while you run er- When your baby cries, he or she is gener-
rands and only fusses when hunger ally trying to tell you something. Crying
strikes. The reality: Your baby’s favorite is a baby’s way of communicating that he
playtime is after a 2 a.m. feeding, and or she is hungry, tired, uncomfortable, or
crankiness peaks whenever you’re out simply has had too much stimulation for
and about. one day. There may be times when your
Babies cry. The average newborn cries baby needs to cry it out, but, in general,
one to four hours a day — and for lots of it’s best to respond quickly to his or her
reasons. Babies cry because they’re tired, cries — especially when your child is a
hungry, lonely, too hot, too cold or simply newborn. Don’t be afraid that by doing
because it’s that time of day. All this cry- so you’ll be spoiling your baby by giving
ing can be particularly baffling for first- him or her too much attention. Just the
time parents, who might think they opposite, studies indicate that being re-
should know what their screaming bun- sponsive to a child’s needs might help
dle of joy is trying to tell them — and be him or her cry less overall and show less
able to do something, quickly! Rest as- aggressive behavior as a toddler.
sured that if you can’t figure out why
your baby is crying or how to stop the Hunger Most newborns eat every few
tears, you haven’t failed as a parent. Don’t hours round the clock and usually wake
take the tears personally. If your baby’s for feedings during the night. Quiet ba-
crying is causing you stress or anxiety, bies may squirm and root around or fuss
take a deep breath and try to relax. Ask gently when they’re hungry. More active
for help if you feel you need it, and re- babies can become almost frantic when
member this stage won’t last forever. hunger strikes. They may get so worked
CHAPTER 8: COMFORTING A CRYING BABY 125

up by the time feeding begins that they itchy clothing. Make sure the waistband Z A hungry cry might be short and low feeding. You might need to calm your
gulp air with the milk. This can cause around baby’s stomach isn’t too tight, the pitched. baby before he or she can begin feeding.
spitting up, trapped gas and more crying. collar doesn’t rub on baby’s face, the legs Z A cry of pain might be a sudden, long, To avoid this situation, try to respond to
Some babies are intensely bothered by or sleeves don’t pull when baby moves, high-pitched shriek. early signs of hunger, such as lip smack-
having air in their stomachs, while for or the material itch. For some babies, Z If your baby is making lip movements ing, rooting, facial grimaces or fussing. If
others it isn’t as much of a problem. these are no-nos. or rooting, hunger might be the your baby begins to gulp during the feed-
problem. ing, take a break. During and after each
Discomfort Just like adults, babies don’t Loneliness, boredom or fear Some- Z If your baby is rubbing his or her eyes, feeding, take time to burp your baby.
like to feel uncomfortable. A common times, babies cry simply because they’re he or she might be tired and in need
cause of baby discomfort is a wet or looking for attention — a little tender, of some sleep. Look for signs of discomfort Feel
soiled diaper. Some babies don’t mind loving care (TLC). Baby may be lonely or Z If your baby hears a loud noise and your baby’s hands and feet. If baby seems
the warm, messy feeling they’ve created. bored. Or he or she may be frightened. A begins to cry, he or she may simply too hot or too cold, add or remove a layer
Other babies can’t tolerate a soaked or baby seeking TLC will often calm down be startled. of clothing. If your baby is cold, a warm
dirty diaper, and they let you know right simply by seeing or hearing you, feeling Picking up on particular patterns can bath might help calm him or her. You
away they’re unhappy. Tummy troubles your touch or being cuddled. As you’ll help you better respond to your baby’s might also remove his or her clothing to
also are a common source of discomfort. find, babies like to be held. They like to cries. Getting to know your child’s crying see if tight elastic or irritating material
Gas or indigestion can cause babies to see and hear their parents and listen to triggers can also help you notice when might be the cause of the tears. If the cul-
cry. If your baby fusses after being fed, he the sound of their parents’ heartbeats. your baby is experiencing unusual dis- prit is air or gas, try to burp baby or gently
or she may be feeling some sort of tum- tress — crying for reasons he or she nor- massage the tummy. If your child remains
my pain. Often, after a burp or the pass- Overtiredness or overstimulation mally doesn’t. warm, check his or her temperature to
ing of gas, the crying will stop. Tempera- When a baby is overtired or overly stimu- make sure he or she isn’t running a fever.
ture also can be a source of discomfort lated, crying becomes a way to unwind or
— if baby is too hot or too cold, it can release tension. Tired babies generally Caress baby A gentle massage or light
trigger tears. So can tight, binding or fuss. And you may find that your baby COMFORTING A CRYING BABY pats on the back can often help soothe a
needs more sleep than you think. New- crying baby. You might do this while lying
borns often sleep for 16 hours a day. Too OK. So my baby is crying. Now what do baby tummy-down across your lap.
much noise, movement or visual stimu- I do? Sometimes, the cause is obvious
lation also might drive your baby to tears. and you can quickly remedy the situa-
In addition, many babies have predict- tion. In other cases, you may have to ex-
able periods of fussiness. They cry at cer- periment with a couple of calming tech-
tain periods of the day and often for no niques until you find out what your baby
apparent reason. likes — what brings comfort to him or
her. Keep in mind that babies are differ-
ent. What works for one baby doesn’t al-
ways work for another.
UNDERSTANDING BABY’S CRIES
Check baby’s diaper Do a quick exam
What many new parents find is that with of your baby’s diaper to make sure it’s
time — as they get to know their child clean and dry. A new diaper may be the
and the child’s developing personality — answer to the problem.
they come to understand what baby’s
different cries mean. With time, the same See if baby is hungry If your baby is
will be true for you. However, here are a hungry, he or she will likely stop crying
few “crying cues” that may help you if when you offer the breast or a bottle.
you can’t figure out what your little loved Keep in mind, however, that crying is a
one is trying to tell you. late sign of hunger that can interfere with
daughter fits this description, it’s possible Many other theories about what
Keep baby movin’ Babies generally Seek quiet If your baby is overly tired he or she many have colic. Colic is the makes a child more susceptible to colic
like movement. Sometimes, just that or has had too much stimulation, move term for periods of intense, inconsolable have been proposed, but none have been
feeling of motion can help soothe baby. to a calmer environment. At times, baby crying that last for three hours or more, at proved. Gas was long thought to be
You might rock baby or walk through the just needs to get away from the noise and least three days a week (sometimes every a cause because many colicky babies
house. Keeping safety precautions in commotion. day) and for at least three weeks. The cry- have gas. However, colicky babies may
mind, try placing baby in an infant swing ing episodes typically start a few weeks develop gas as a result of swallowing too
or vibrating infant seat, or experiment Let baby cry it out If you’ve tried ev- after birth and generally begin to im- much air while crying. What doctors do
with an infant sling. If the weather per- erything and your baby is still upset, con- prove by age 3 months. know is that birth order doesn’t matter
mits, head outdoors with the stroller or a sider letting your baby cry it out. While — colic doesn’t occur more often among
baby carrier. You might even want to listening to your baby wail can be ago- Causes The big question when it comes firstborns than in later children. Girls and
buckle up baby in the car seat and go for nizing, keep in mind that sometimes ba- to colic is what is it that causes an other- boys experience colic in similar numbers.
a ride in the car. bies cry to get rid of excess energy. And wise healthy child to cry so much? And And there are no lasting effects or com-
some babies can’t fall asleep without cry- the answer is, experts really don’t know. plications from the crying episodes. Ba-
Sing or play music Quietly singing or ing. Your baby might go to sleep more There are a variety of theories, and not all bies with colic grow and develop normal-
humming a song to your baby may calm quickly if he or she is left to cry for a little doctors agree about what may or may ly, and they aren’t any more likely to cry
him or her and stop the tears. You might bit. Be sure to put your baby in a safe not be potential triggers. It’s possible the when they become older infants or tod-
even play soft, soothing music. White place — such as the crib or bassinet. If cause may be a combination of factors, dlers than are infants who didn’t
noise — such as a recording of ocean you’ve fed, burped and changed your and it may differ between infants. have colic.
waves — or even the monotonous sound baby and he or she appears otherwise all
of an electric fan or vacuum cleaner in a right, it’s OK to let your baby cry for 10 or Temperament Some babies are naturally Common signs Some babies are fussy
nearby room sometimes can help a cry- 15 minutes in the crib. irritable or sensitive, which might con- but they don’t have colic. Although the
ing baby relax. Babies often like soothing, tribute to colicky behavior. behavior can vary, a baby with colic gen-
muffled sounds similar to the amniotic erally exhibits the following signs:
fluid waves or pulsing sounds they heard Immature nervous system If your baby
in the womb. COLIC has an immature nervous system, he or Predictable crying episodes A baby with
she might be unusually sensitive to stim- colic often cries about the same time
Let baby suck Offer a clean finger or All babies cry, but some cry more than ulation. These babies become overloaded every day. These crying episodes can oc-
pacifier. Sucking is a natural reflex. For others. And for a few babies, no matter by all of the sights and sounds, and they cur at any time during the day; however,
many babies, it’s a comforting, soothing what you try to do to stop the crying, aren’t able to console themselves. As a they tend to be most common in the late
activity. nothing seems to work. If your son or result, they cry and they may have diffi- afternoon or evening. The crying usually
culty sleeping. Premature babies may ex- begins suddenly and for no clear reason.
hibit their sensitiveness in the form of Your baby might have a bowel movement
fussiness rather than crying. or pass gas near the end of the colic
THE DISTRACTION TRICK episode.
Food sensitivities If you breast-feed
A common reaction to try and comfort a screaming baby is to place something in your baby, colic might be a sign that your Intense or inconsolable crying Colic
front of his or her face to try and distract baby’s attention. Don’t waste your time, baby is sensitive to certain foods in your crying is intense and often high pitched.
especially early on. Holding up a toy to distract your newborn isn’t likely to provide diet. If you feed your baby formula, colic Your baby’s face might flush, and he or
comfort. A crying baby isn’t processing new information. He or she is too busy could be an indication your baby is sensi- she is extremely difficult to comfort.
seeking attention. Offering a toy to change your baby’s focus might actually make tive to milk protein in formula.
him or her more upset. As your baby gets older, however, you might be able to Posture changes Among babies with
stop the tears by using this technique, provided it’s something baby really wants Other health problems Rarely, colic colic, during crying episodes they tend to
or likes. might be a sign that your baby has a curl up their legs and clench their fists.
health problem, such as a hernia or an You may also notice the baby has tensed
infection. abdominal muscles.
128 PART 1: CARING FOR YOUR BABY CHAPTER 8: COMFORTING A CRYING BABY 129
Diagnosis If you think your baby may Unfortunately, there are few treat- If you breast-feed, try to empty one amount of caffeine in your diet. Caffeine
have colic, it’s a good idea to consult your ment options for colic. Over-the-counter breast completely before switching sides. in your breast milk can keep your baby
child’s care provider, especially if your drugs, such as simethicone (Baby Gas-X, This will give your baby more hindmilk, awake for prolonged periods or cause
baby is inconsolable or you notice signs Mylicon), haven’t proved helpful for colic, the fattier and potentially more satisfying agitation. Some moms say avoiding gas-
of illness, such as fever, vomiting, or and other medications can have serious milk at the end of a feeding. sy or spicy foods can help — but this
changes in eating or sleeping patterns, or side effects. Some studies suggest that hasn’t been proved.
other signs or symptoms that worry you. treatment with probiotics — substances Your diet If you breast-feed and you
Your baby’s care provider can help you that help maintain the natural balance of suspect that a food or drink you consume Your lifestyle If you or your partner
tell the difference between normal tears “good” bacteria in the digestive tract — may be making your baby fussier than smoke, get serious about quitting. Re-
and something more serious. To prepare might soothe colic. However, more re- usual, avoid it for several days search suggests that exposure to cigarette
for your appointment: search is needed to determine the effects to see if it makes a difference. Consider smoke can increase your baby’s risk of
Z Track your baby’s crying episodes. Re- of probiotics on infants. In general, Mayo eliminating dairy products or other aller- colic.
cord when and how often they occur, Clinic pediatricians don’t recommend the genic foods, which can cause allergic
how long they last, and any observa- use of probiotics in infants. symptoms in breast-fed infants. Research Calming techniques For most babies
tions you’ve made about your baby’s Some parents also report trying alter- suggests that in some special cases with colic, soothing techniques can often
behavior before, during and after the native therapies, such as herbal teas, avoiding foods such as cow’s milk, eggs, help calm the child and lessen the crying
episodes. herbal remedies or glucose. Alternative peanuts, tree nuts, wheat, soy and fish — at least for a while. The trick is finding
Z Note your efforts to soothe your baby. therapies for colic haven’t proved to be for a week can reduce infant fussiness. out which techniques your son or daugh-
Jot down the methods you’ve used consistently helpful, and some might be Also, try to eliminate or reduce the ter likes. Experiment with the comforting
and the results. dangerous. Before giving your baby any
Z Record your baby’s diet and feeding medication or substance to treat colic,
schedule. What do you feed your baby consult your child’s care provider.
and how often? Does baby seem to While you might not be able to treat TUMMY HOLD
have gained or lost any weight? colic, there are things you can do to try
Your baby’s care provider may do a and soothe your baby and reduce or less- Some babies find comfort by being held on their tummies, a position sometimes
physical exam to identify any possible en the severity of the crying episodes. referred to as the colic hold or colic carry. If your baby is fussy, you might try this
causes for your baby’s distress. If your Consider these suggestions: position to see if it helps. Place baby facedown along your forearm with your arm
baby is otherwise healthy, his or her doc- firmly between his or her legs. Baby’s cheek should be resting on your palm. Hold
tor may identify the problem as colic. Lab Your feeding style Don’t overfeed your arm close to your body, using it to brace and steady your baby. Don’t let baby
tests, X-rays and other diagnostic tests your baby. Try to make it at least two to sleep in this position.
generally aren’t needed to make a diag- two-and-a-half hours between feedings.
nosis. However, in unclear cases such a During feedings, hold your baby as up-
test can help exclude other health issues. right as possible and burp him or her of-
ten to reduce air swallowing.
If you feed your baby formula, use a
curved bottle, or a bottle with a collaps-
MANAGING COLIC ible bag also might help. You might also
consider giving him or her a hypoaller-
Caring for an infant who has colic can be genic formula, such as whey hydrolysate
exhausting, confusing and stressful — formula, for one week. If your baby’s
even for experienced parents. Colic isn’t a symptoms don’t improve, continue using
result of poor parenting skills, so don’t the original formula. Avoid frequently
blame yourself for your baby’s colic. In- switching your baby’s formula. If bottle
© MFMER
stead, focus on ways to make this difficult feedings typically take less than 15 to
stage a little more bearable. Remember, 20 minutes, consider using a nipple with
this too shall pass. a smaller hole.
strategies discussed on pages 127-128 to as ocean waves or a gentle rain. Some-
see if they help. times, the tick of a clock or metronome ALWAYS BE GENTLE
Remember that babies with colic of- does the trick.
ten like motion. Anything you can do to You might also try holding your baby When your crying baby can’t be calmed, you might be tempted to try just about
keep baby moving may help. Carry baby in a position that puts slight pressure on anything to get the noise and the tears to stop. But remember the importance of
around the house in a baby sling, take his or her abdomen (see “Tummy hold” treating your baby gently. Never yell at, hit or shake your baby.
a walk with your baby, or buckle baby in on page 131). However be sure not to Newborns have weak neck muscles and often struggle to support their heads.
the car seat and go for a drive. In addi- leave your child in this position when Shaking your baby out of sheer frustration can have devastating consequences
tion, babies with colic often find certain sleeping. — including brain damage that leads to seizures, learning disabilities or mental
sounds calming. A steady background You may find you’ll have to rely on a retardation. And severe shaking can be life-threatening, or even fatal.
of soft noise or “shushing” sounds may combination of techniques to get the job If you’re worried about your ability to cope with a crying baby, contact your care
help. Turn on the kitchen or bathroom done. For example, consider giving your provider, your baby’s care provider, a local crisis intervention service or a mental
exhaust fan, run the vacuum in the next baby a pacifier, swaddling him or her, health help line for support. If you need to, take your baby somewhere where you
room, use a white noise machine or play and shushing or swinging him or her — know he or she will be safe and cared for.
music of environmental sounds, such all at once.
KEEPING YOUR COOL baby. You might even buckle the baby
into his or her car seat and take a short
Listening to a baby cry is stressful, espe- drive, provided you feel that you can con-
cially when it seems to go on for hours centrate on your driving.
on end. Even for the best of parents, cop-
ing with colic is tough. When you’re all Ask for help Let a loved one take over
tensed up over your baby’s crying, look for a while. Take advantage of baby-sit-
for ways to calm yourself. Think about ting offers from trusted friends, neigh-
the happy moments you’ll spend with bors or other close contacts. Use the time
your baby and the milestones ahead. And to take a nap or do something you enjoy.
while taking care of your baby, remember Even an hour on your own can help re-
to also take care of yourself. new your coping strength. Expressing
yourself can help, too. When you’re get-
Take a break If your baby’s cries are ting frustrated, speak up. Saying the
getting to you, slow down. Take a deep words out loud can help ease the tension.
breath and count to 10. Repeat a calm The more relaxed you are, the more able
word or phrase, such as, “Take it easy.” you’ll be to handle and cope with baby’s
Imagine yourself in a calm, relaxing place. crying spells. It’s also good for baby. Ba-
Play soothing music in the background. bies can sense when you’re tense and
In some cases, the best thing to do may stressed out.
be to put baby down in his or her crib for
a period of time while you walk into an-
other room and give yourself a break.
Get out of the house Put your baby in

the stroller or a baby carrier and take a
walk. The exertion might take your mind
off the tears — and the movement or
change of scenery might soothe your
CHAPTER 9
Understanding your
baby’s temperament
Every baby is different. Although all new For example, the same high energy that
babies like to sleep, eat and cry, if you get makes your baby so fun to play with —
a group of them together, you’ll soon pleasing — can also make for difficult
start to notice that how they sleep, eat diaper changes or wriggly feedings —
and cry can be very different from one frustrating! This can be an adjustment in
another. One baby may be content to lie and of itself.
still in his crib, sleeping or taking in his But if you keep an open mind and
surroundings with alert eyes. Another look for clues to your little one’s unique
may lie in her crib, but she constantly traits, you can learn your baby’s normal
fidgets and wiggles. behaviors and adjust your parenting style
All of these differences in normal be- to bring out the best in him or her. By
havior are part of a baby’s inborn tem- meshing your parenting techniques with
perament traits, qualities he or she ac- your baby’s specific temperament (and
quired even before birth. Many of these this may vary from child to child even
traits continue on into adulthood and within the same family), you can achieve
contribute to individual personalities. what child behavior experts call “good-
As a parent, you have the opportunity ness of fit,” where the opportunities and
to observe and discover your child’s own demands of your child’s environment fit
temperament. Is she easygoing or ultra- with his or her inherent capabilities,
sensitive? Does he voice his opinion characteristics and behavioral style.
loudly and strongly, or is he pretty happy A good fit between your child’s tem-
with whatever comes along? perament and his or her surroundings
Often babies behave in ways their makes for optimal development. It also
parents are not expecting. Depending on creates the foundation for a thoughtful,
the situation, a temperament trait can be dynamic relationship between you and
pleasing or frustrating to you as a parent. your child that can stretch and expand to
CHAPTER 9: UNDERSTANDING YOUR BABY’S TEMPERAMENT 135

meet the varying challenges of develop- As you read through the different as- On the other hand, maybe you have a Sensitivity
ment over time. pects of temperament, think about where little one who keeps you guessing when Low Variable High
your son or daughter may fall on the he or she might be tired or hungry. One
scale of each one. It can be a challenge to day, your baby is starving in the morning. Sensitivity Some babies are highly
identify temperament traits in a sleepy The next, he or she doesn’t want to nurse perceptive of their environments and
YOUR CHILD’S TRAITS newborn. But observe your baby closely, until later. Or maybe you’ve learned to respond readily to external sources of
and as the months pass you’ll better have diapers and wipes always on hand stimulation, such as lights, sounds, tastes
Psychiatrists Dr. Stella Chess and Dr. Al- identify his or her temperament. By 4 because you never know when you might or even the way clothing feels on their
exander Thomas began to explore the months, many of your child’s traits be- need them. Naps are all over the map. skin. Does your baby fuss as soon as his
idea that every child has a natural behav- come apparent. Some are usually more If your child lies somewhere in be- or her diaper is wet, or could he or she
ioral style, or temperament, as early as dominant than others. tween predictability and irregularity, note really care less about the sagging load in
the 1950s. Based on their observations, that, too. the rear? Does your tyke have a strong
Chess and Thomas recorded nine differ- Activity opinion about breast milk versus formu-
ent dimensions of temperament that de- Low Variable High Initial approach la? Does your son or daughter notice
scribe how a child behaves: activity, regu- Very Variable Very when you’re wearing glasses or have
larity, initial approach, adaptability, Activity This is your baby’s usual level cautious curious your hair cut?
sensitivity, intensity, mood, distractibility of physical motion throughout the day, Some babies are more sensitive to
and persistence. Psychiatrists today still his or her “idle speed.” It can range from Initial approach What’s your baby’s certain factors than others. Your baby
use these groupings to help parents un- low to high energy. usual first response to something new? might dislike loud noises but isn’t as
derstand their children and develop ef- Watch your baby during daily rou- Is she or he naturally curious, smiling picky when it comes to wearing a hat
fective parenting strategies that suit their tines such as feeding, diaper changing and cooing at a new person or diving or not.
child’s individual needs. and bathing. Does your baby lie or sit still right in to taste new foods? Or does he
Each trait functions as a continuum, and watch quietly? Or does he or she or she resist, hanging back a little, wait- Intensity
and traits may occur in clusters. For ex- wiggle and squirm a lot? When sleeping, ing to see what will happen next before Low Variable High
ample, some kids are naturally easy- does your child start out on one side of making his or her approach? Babies can
going. They quickly develop regular the crib and end up on the other, or does range anywhere from being very cautious Intensity Intensity refers to the energy
sleeping and eating schedules, fuss infre- he or she remain relatively still? When to very curious. Some kids are curious level of your child’s response to different
quently, smile easily and adapt well to you approach your son or daughter, does in some circumstances and cautious in situations, whether positive or negative.
new situations. Other babies are natu- she or he wave arms and legs vigorously others. Some babies seem to have strong feel-
rally more shy or slow to warm up. These or wait quietly for you? As your child gets ings on just about everything. They
babies may be less active and not too older and begins to crawl, is he or she in Adaptability squeal, laugh, scream, wail and flail. Less
intense, approach new things slowly and constant motion or content to sit and Adjusts Variable Adjusts intense babies may smile, whimper or
with caution, and have a more difficult play in one spot? easily slowly just turn away when they’ve had enough.
time transitioning from one activity to
another. Regularity Adaptability This trait concerns how Mood
Then there are children who are born Regular Variable Irregular easily your baby adapts to change and Sunny Variable Serious
to take the world head-on. They display transition. Some babies adjust easily to
fierce emotion, have tons of energy, and Regularity In infants, this refers to the switching from the crib at home to the Mood As with adults, babies can have
approach things and people with either predictability of their bodily rhythms, car seat in the van, or to changing from various emotions throughout the day.
avid curiosity or determined caution. such as when they get hungry or tired. pajamas to clothes. Others are less adapt- But in general, think about whether your
They become easily frustrated and have Can you set the clock by your baby’s nap able and need more time to adjust to a child has an overall sunny disposition or
difficulty making changes. schedule? Or maybe you can predict with new situation, particularly to something a more serious and grave outlook on the
Many children have mixed traits. a fair degree of accuracy at what time he such as a new child care center or a new world. Is your child often happy and
Their overall temperament may be mod- or she will poop tomorrow. Babies who baby sitter. Sometimes even changes in playful? Or does your little guy or gal
erate to easy, but they may score high on eat, sleep and poop on schedule have a feeding positions can cause some chil- require a bit more coaxing to smile and
intensity, activity or persistence. high degree of regularity. dren distress. have fun?
136 PART 1: CARING FOR YOUR BABY CHAPTER 9: UNDERSTANDING YOUR BABY’S TEMPERAMENT 137
Distractibility comes more mobile, watch what hap- cumstances, you can work on adjusting Persistent This trait may become more
Focused Variable Distractable pens when you start to set limits. Does your schedule, daily routine or parenting prominent as your baby nears his or her
your baby insist on trying to pull the tactics to minimize stress while still ac- first birthday. When you start to set limits
Distractibility This trait can range from cover off the electrical outlet, or can you complishing overall goals, such as safety, on what your persistent child can and
focused to distractible. Some infants re- persuade him or her to play with some- good nutrition, proper care, and warm can’t do, he or she may not comply as
main focused on an activity for some thing else fairly easily? affection and support. willingly as you’d like. Persistent children
time, despite potential distractions. This Following are some tips and tools for don’t like giving up easily, and if you
trait is often tied to others, such as activ- adapting parenting techniques to specific won’t let them climb the bookshelves or
ity and curiosity. For example, when your traits. But don’t stop here. This is just a fiddle with the electric outlet, you’re
focused baby settles down to nurse, that’s YOUR CHILD’S BEHAVIORS sampling. There are many books avail- bound to meet resistance. It’s OK to pick
all he or she is concerned about, for the able to help you explore the subject of your battles, but when it comes to safety
most part. A distractible baby, on the oth- To get a better picture of your baby’s temperament and inspire you to new and other rules you want to keep in place,
er hand, may nurse briefly, turn away to unique temperament and how it might heights of creativity. enforce the rules kindly and consistently,
look at a toy in the corner, nurse a little affect development, experts recommend and prepare to do so often! It may take a
more, then pause to listen to a truck rum- taking notes for a short period of time on Highly active Highly energetic babies while to distract them with something
ble by outside. Older focused babies may your baby’s natural behavior. For each need lots of childproofed space within else, but eventually they’ll come along.
sit and play with one toy for a while, dis- trait, write down your observations, and which to explore and move about. Try
covering all of its ins and outs, while an- then rate your baby’s behavior on the to let them roam as much as is safely
other more distractible baby may flit from continuum of that trait. For example, you possible within the house, rather than
one thing to another, unable to resist the might note that your son or daughter keeping them to a single room, crib or
urge to move and curious to investigate. whimpers when he or she is hungry, playpen. If you live in a small apartment,
turns away when full, doesn’t react much check out baby gyms or play spaces
Persistence to bright lights or loud noises, smiles where your baby can have some extra
Low Variable High when happy and is generally mild in in- room to play. Once your little mover and
tensity. On the other hand, he or she isn’t shaker learns to stand, that might be
Persistence or attention span Some keen on trying new foods, dislikes drop- all he or she wants to do for the brief
babies persist in the face of obstacles, off time at child care, cries when you run period until he or she learns to sit down.
whereas others give up more easily when too many errands at one time and is gen- In the meantime, it may be easier to
confronted with frustration. Does your erally slow to adapt to changes in envi- change diapers in a standing position or
baby persist in trying to fit the peg in the ronment and caregivers. let your baby eat while standing at a
hole, or does he or she cry for help after a Once you get a clear idea of how your low table.
few unsuccessful tries? As your baby be- child normally reacts under different cir-
Very curious If your baby loves to in-
vestigate new things and always seems
to be into everything, make this trait en-
TEMPERAMENT IN NEWBORNS joyable for both of you by ensuring your
baby has a safe space to explore. Child-
Although some parents are certain their child’s temperament hasn’t changed since proof, childproof and childproof again.
day one, it’s not always easy to distinguish your baby’s predominant traits in the If you’ve made certain there’s nothing
first several weeks of life. This is because those first three months are a big adjust- truly dangerous around, you’ll feel more
ment for every baby, and there’s so much going on that’s temporary. After the first comfortable turning your son or daugh-
three months, many babies who demanded constant care and attention settle into ter loose, and you won’t have to rely so
daily life and become much easier to manage. If your baby was born prematurely, heavily on the power of “No!” (the effect
it may take a little longer to discern his or her inborn traits. of which is unreliable when it comes to
active babies who are very focused on
their mission).

Intense You can expect strong reactions Irregular Babies who operate like clock- Easily frustrated Some babies are the kitchen while you make lunch. Keep-
from an intense child. Just don’t counter work — napping at the same time every more easily frustrated than others. They ing your routine predictable will mini-
your little one’s intensity with your own. day, getting hungry at regular hours — become quickly upset when they can’t mize anxiety and confusion in your little
When you see your child’s emotions are pretty easy to live with (except when quite grasp the peas on their tray, or a toy one’s mind.
building, stay (or at least try to act) calm your schedule has changed and your ba- foils them yet again. These babies have
and soothing in return. Turn down the by’s hasn’t). smaller reserves of energy for dealing Distractible Around 4 or 5 months, a
lights, make shushing sounds and avoid Babies who have irregular rhythms with stress and can only deal with frus- baby’s vision begins to improve substan-
overstimulation. Sometimes a bath will require a little more flexibility. Here’s tration in small bits. Mornings are usually tially. A baby that’s easily distracted may
help. Emotions can be especially volatile where the art of parenting comes into their best times, so try to reserve big ac- all of a sudden have difficulty focusing on
at the end of the day, so try to keep din- play, and you have to use knowledge of tivities for earlier in the day. As the day nursing when there are so many other
ner and bedtime routines simple and your child’s temperament combined with wears on, baby becomes emotionally interesting things to look at. If you notice
predictable. a creative flair for getting the job done. worn out, less able to deal with frustra- this happening with your infant, try turn-
Take sleep, for example. If your baby is ir- tion, and less able to entertain himself or ing the lights down when feeding so dis-
regular but adapts easily to changing cir- herself. If you can keep afternoons and tractions are less visible.
cumstances, put him or her down to evenings simple and predictable, with a The advantage of having an easily
sleep as soon as eyes start to droop. But if minimum of challenges, it will make it distractible baby is that he or she is gen-
your baby dislikes change or is slow to easier on both of you. erally easier to soothe when upset, with a
adapt, follow a steady nap and bedtime jingling set of keys or a look out the win-
schedule. Although your son or daughter Slow to adapt A baby who adjusts dow. Babies who are less distractible
may not fall asleep right away, he or she slowly to change — whether it be to aren’t necessarily in greater distress; they
has the comfort of knowing what to ex- food, schedules, people or surroundings may just need to voice their displeasure
pect and will eventually drift off when — finds comfort in rituals and routines. for a little longer.
drowsy enough. This doesn’t mean you shouldn’t expose
Even if your baby tends toward irreg- your small creature of habit to new Highly sensitive If your baby is highly
ularity, you can still coax him or her into things; it just means it make take a while perceptive of his or her surroundings, try
something of a schedule that fits with the longer for your baby to get used to them. to keep those surroundings comfortable
rest of the family. You might gradually ex- Weaning a less adaptable baby may come to minimize unnecessary stress. For ex-
tend the minutes between feedings to later than with others, and this is fine. ample, if your son or daughter is sensitive
make them more regular or keep naps to Some babies may need to wean from the to noise, avoid eating at crowded restau-
a consistent length every day. breast to a bottle first, rather than straight rants. Or cut a wide berth from the live
to a cup, for example. band at a local festival and head for calm-
Quiet and content Babies who almost It’s also important to allow time for er areas. Remove scratchy tags on shirts.
always appear content, regardless of your baby to change tracks from one ac- If your child can’t stand to wear shoes,
household chaos and hectic schedules, tivity to another, especially as he or she skip them unless absolutely necessary.
can be so easy to live with that they gets older.You may sing a special song for Even a well-intentioned bear hug may be
sometimes get lost in the shuffle. This is different activities during the day, such as too much for this little one. In general,
especially true if you have other demands a wake-up song or a bath-time song. In- avoid overstimulating your baby’s highly
on your time, such as a busy work sched- stead of scooping your baby up without attuned senses.
ule or older children who require more warning to take him or her from playtime
active management. It can be easy to put to lunch, signal to your baby what’s going
off someone who isn’t clamoring for at- to happen next. Several minutes before
tention. But check in regularly with your lunch is ready, point toward the high- YOUR PARENTING STYLE
adaptable tyke, making sure you spend chair or use sign language to help your
time with him or her and that all of his or baby understand what’s coming next. Depending on your baby’s general tem-
her needs are met. Use one activity to signal the next — for perament, you might find that parenting
example, always bring the baby to play in is easier or harder than you expected. If

your baby is naturally even-tempered, skills, try to look at him or her as a sepa-
parenting might seem to be a piece of rate individual with his or her own
cake and you might wonder why you unique perspective. This slight distance
were so worried before the baby arrived. between yourself and your child allows
You might even wonder why other par- you to look objectively at your child’s
ents seem to have such a hard time with needs and adapt your parenting style to
their children. meet those needs. Rather than trying to
A spirited child, on the other hand, change your child’s disposition, you can
may cause parents to wonder what hap- focus on creating the best possible envi-
pened along the way that produced the ronment in which your child can natu-
whirlwind that now inhabits their home. rally thrive. As a result, and with no feel-
A curious, highly active child requires ings of guilt or failure on your part, you
more time, vigilance and physical space can swap the puzzle (which may have
than a less curious or more slow-moving been beyond your child’s capability to
child. An easily frustrated infant requires begin with) for a swing or adjust your
more patience and creative thinking from schedule so that you run errands before
a parent than a child who’s more persis- you pick your baby up from child care.
tent or accepting of minor obstacles. And With a little bit of trial and error, you’ll be
a child who resists change requires more able to determine what works best for
advance planning than a child who easily both of you.
swings from one activity to another. If you have a child who requires a lot
A common cause of frustration in a of time and skill, and you start to feel
parent-child relationship is parental ex- anxious, overwhelmed or just plain ex-
pectations regarding how a child should hausted, schedule more frequent breaks
behave. Things can be especially difficult so that you can recharge yourself. You
if your temperament differs markedly might swap time off with your partner or
from your child’s. Perhaps you had envi- engage a trusted baby sitter for regular
sioned sitting quietly with your little one, hours where you’re “off the clock.” And
working on a puzzle or reading a book. if you feel you need professional help,
But what happens when your rambunc- talk to your care provider or a child men-
tious guy or gal has no patience for being tal health specialist who can help you
still and wants to be constantly on the find more effective parenting strategies.
move? Or maybe you’re outgoing and Parenting skills don’t come overnight,
love to try new things and you’re disap- and some children require more of a
pointed or even embarrassed that your learning curve than do others. But if you
baby is so cautious and reluctant. Parents can learn to step back and appreciate
often find it difficult to slow their sched- your baby’s temperament in a positive
ules to accommodate a less-flexible light, you’re more likely to feel closer to
child’s need for extra time and prepara- your child and confident in your parent-
tion. Other parents feel inadequate being role.
cause they don’t feel capable of keeping
up with their child’s demands.
How you react to your child’s tem-
perament is a key part of parenting. In-
stead of looking at your child as a direct
reflection of yourself or your parenting

PART 2 CHAPTER 10
Baby’s Health and Safety Finding the right

care provider
During your baby’s first year, you and so. If possible, you want to choose your
your baby will likely spend a lot of time baby’s care provider before your baby is
with his or her care provider. Beyond the born — such as during your third trimes-
recommended checkups every couple of ter. Settling on a care provider before
months, it’s likely your son or daughter your baby is born will make it easier for
will get his or her first illness at some you to arrange your newborn’s first
point this year. In addition, you may have checkup in the hectic first few days after
questions about newborn care or your his or her arrival. Visiting with your ba-
baby’s health and development. by’s care provider before your baby is
While finding a care provider for your born will also give you a chance to ask
baby might sound simple, it’s worth the questions, talk about any problems dur-
effort to find an individual who can best ing your pregnancy, discuss the practice’s
meet your baby’s and family’s needs. policies and fill out any necessary insur-
Determining what you’re looking for in a ance forms without the distraction of
care provider for your baby can help you having your new baby with you. It’s also
find a pediatric care professional whom comforting to know that you already
you feel comfortable with and whom you have a trusted source you can call with
can build a good relationship with as any questions you might have regarding
your child grows and matures. newborn care — and most first-time par-
ent have lots of questions!
In addition, if you choose your baby’s
care provider before your son or daugh-
GETTING STARTED ter is born and you deliver your baby at a
hospital where the care provider works,
If you haven’t already chosen a care pro- you might be able to have the care pro-
vider for your baby, now is the time to do vider examine your baby at the hospital.
CHAPTER 10: FINDING THE RIGHT CARE PROVIDER 145

Don’t worry, though, if that’s not possi- ful for you and might delay your baby’s vanced training in a specialized area of tended hours? Is it important for you to
ble.Your baby will still be seen at the hos- care. Establishing a relationship with a medicine, such as pediatrics or family be able to contact the care provider at
pital by qualified staff. care provider for your baby will also make health. After nursing school, a nurse night or on the weekends or by email?
If you don’t have a specific care pro- it easier for you to schedule regular visits practitioner must go through a formal Would you like your child’s care provider
vider in mind, start by asking for recom- and keep your child’s immunizations up education program in his or her specialty to have privileges at a particular hospital?
mendations from trusted family mem- to date. field. A pediatric nurse practitioner fo- Would you prefer that he or she have an
bers, friends or co-workers who have cuses on caring for infants, children and office that has separate waiting rooms
children. Your own care provider might teens. Family nurse practitioners often for children who are well and those who
be a good referral source, too. You may see all family members, including chil- are sick?
also be able to find information about CARE PROVIDER OPTIONS dren. Nurse practitioners typically work
care providers by calling a nearby hospi- closely with or under the supervision of
tal or other community health resources. When it comes to choosing a care pro- one or more physicians.
Keep in mind your health insurance vider for your baby, you have options. EVALUATING YOUR OPTIONS
company may require you to choose from Many types of medical personnel treat
its approved network of care providers. babies and children, including: Once you’ve thought about what you’re
Check to see if the company provides in- FACTORS TO CONSIDER looking for and have compiled the names
formation about the providers in the net- Pediatricians Many parents choose a of some possible care providers, call each
work to help you make your decision. pediatrician to be the care provider for Before you choose a care provider for provider’s office to confirm that he or she
Whatever you do, don’t put off find- their children because pediatricians spe- your baby, think about what you’re look- is accepting new patients. If necessary,
ing a care provider for your baby. Even if cialize in the care of children from infan- ing for in a care provider. For example: double-check that he or she works with
you’re about to move or change insur- cy through adolescence. After medical your insurance company. Then, ask if you
ance providers, do your best to find a care school, pediatricians go through a three- Training Would you prefer your baby to can schedule an appointment to meet or
provider as soon as possible. Waiting un- year residency program. Some pediatri- see the same care provider who takes care talk to the care provider. Try to schedule
til your baby becomes sick can be stress- cians receive further training in subspe- of the rest of your family’s health or a care
cialties such as neonatology — the care provider who specializes only in pediat-
of sick and premature newborns — or rics? Would you like a care provider who
pediatric cardiology or dermatology. If is older and may have more experience or
your baby ever needs to be treated by a an individual who is younger and also
subspecialist, his or her regular care pro- may have young children at home?
vider can provide a referral.
Personal approach What kind of par-
Family physicians Family physicians enting and child rearing philosophy
provide health care to people of all ages, would you like your baby’s care provider
including babies. They’re trained in adult to have? Are you looking for a care pro-
and pediatric medicine. A family physi- vider of a particular sex or who shares
cian can see your child from infancy all your religious background?
the way through adulthood. Family phy-
sicians take care of most medical prob- Cost Do you need to find a care provider
lems. Also, if the rest of your family sees from among your insurance company’s
the same care provider, he or she will gain list of approved care providers?
an overall health perspective of your family.
If you already have a family doctor you Location, accessibility and hours
trust, ask whether he or she will see infants. Where would you like the care provider’s
office to be located? What locations
Nurse practitioners Nurse practitio- would be most convenient for you?
ners are registered nurses who have ad- Would you prefer an office that has ex-
the visit at a time when both you and know the person and make the right de- Philosophy and style What is the care A TEAM APPROACH
your partner can attend, so you can both cision for your family. provider’s philosophy when it comes to
ask questions. Be sure to ask if the visit the use of certain medications, discipline If you’re ever unhappy with the care your
carries a charge. Training How long has the individual or other subjects you consider important? baby receives, talk to the care provider
If you’re given a recommendation by been caring for children? At what hospi- Does the care provider listen to your about your concerns. Chances are, once
a family member or friend, try to get tals does the care provider have privileg- questions and answer them? Does he or the issue is discussed, you can come to a
some basic information from him or her es? Is he or she board certified? Board she appear interested in your concerns? resolution that is mutually agreeable. If
before talking to the care provider. For certification requires the provider to un- you can’t resolve the problem, you might
example, you might ask about: dergo testing and take classes on a peri- Making your decision After meeting consider seeking another care provider
Z Bedside manner. Does the care pro- odic basis after residency to maintain his with a care provider, consider his or her for your baby.
vider interact well with both adults or her knowledge and skills. overall approach to health care and your In the coming months, your baby’s
and children? Does the friend or interactions with the staff. Most impor- care provider will play an important role.
family member’s child like the care Accessibility and hours What are the tant, would you trust this person to pro- His or her guidance can help you make
provider? office’s hours? Is the office open at night vide care for your child? Trust your in- healthy choices for your baby, as well as
Z Office atmosphere. Is the office staff and on weekends? Does the office have stincts. If you don’t feel comfortable, determine what to do if your son or
helpful? How do staff members man- an after-hours answering service? How consider another care provider. daughter has a health problem. While
age phone calls, particularly when it does the care provider handle emergen- Once you’ve selected your baby’s care you may have certain viewpoints, don’t
comes to emergencies? Is it difficult cies, including those that occur after provider, you may have a number of is- forget that your provider is trained in in-
to make an appointment when a child hours? When is the best time to call with sues to discuss. You may want to get the fant care and likely has considerable ex-
is sick? Is there generally a long office nonurgent questions? Does the office provider’s input on topics such as breast- perience. It’s important that the two of
wait before being able to see the care have guidelines for what kind of ques- feeding, circumcision or child care. If you you work together as a team to stay on
provider? tions can be resolved with a phone call feel it would be helpful, schedule an ap- top of your baby’s health.
Z Knowledge. Does the care provider and what requires a visit? Does the care pointment to discuss these issues.
seem to be up to date on current provider communicate via email? How
medical advances, and does he or she does the office handle billing, payment
offer helpful advice? and insurance claims? Is the office a
group practice? If so, will you be able to
Issues to consider When you do sit request an appointment with a specific
down to talk to a potential care provider, care provider? If you choose a care pro-
you might bring a list of questions or just vider who is part of a group practice,
have an informal chat with the provider. make sure you feel comfortable with oth-
Don’t feel embarrassed about asking er members of the practice who might
questions that might help you get to treat your baby.
KEEP MEDICAL INFORMATION HANDY
Write down key information about your baby’s care provider, such as his or her
contact information, the office’s hours and location, and any policies for making
appointments. Keep this information in a place that will be easy for you and anyone
caring for your child to access. Also, create a file or notebook or an electronic re-
cord for your baby’s medical information. Include information such as his or her
immunization record, measurements, and any prescriptions or lab test results.
148 PART 2: BABY’S HEALTH AND SAFETY

CHAPTER 11
Checkups
Frequent checkups with a care provider CHECKUP SCHEDULE

are an important part of your baby’s first
year. These checkups — often called Most newborns have their first checkups
well-baby visits — are a way for you and within 48 to 72 hours of being discharged
your baby’s care provider to keep tabs on from the hospital. This timeline is partic-
your baby’s health and development, as ularly important for breast-fed babies,
well as spot any potential problems. who need to have their feeding, weight
Well-baby visits also give you a chance to gain and skin color — in case of jaundice
discuss any questions or concerns you — evaluated. During your baby’s first
might have and get advice from a trusted year of life, he or she should see a care
source on how to provide the best possi- provider at ages:
ble care for your baby. Z 2 months
Well-baby visits sometimes aren’t easy Z 4 months
on you or your baby. Your baby might not Z 6 months
like getting undressed and measured, and Z 9 months
then there are vaccinations. Rest assured, Z 1 year
however, that visiting the care provider Your baby’s care provider may also ask
will soon become a part of your and your to see your baby more frequently. In addi-
baby’s routine and, with time, the visits tion, you can make an appointment for
will become less stressful and more enjoy- your baby to see a care provider any time
able as your baby becomes familiar with your child is sick or you’re concerned
exploring the office’s toy selection, and about his or her health and development.
you look forward to finding out just how If possible, both parents should try to
big your baby is getting.You’ll also find the attend baby’s first few checkups. This will
care provider’s guidance invaluable in the give both of you a chance to get to know
months ahead. the care provider and ask basic questions.
CHAPTER 11: CHECKUPS 151

If only one parent can attend, ask a special tape to measure your baby’s head
family member or friend to help you nav- size and an infant scale to weigh him or PREMATURE BABIES
igate these early visits. Remembering her. Keep a blanket, a fresh diaper and
your questions and listening to your care wipes handy. If your baby was born prematurely, his or her growth and development will be
provider’s advice can be difficult when Your baby’s measurements will be measured using his or her corrected age — your baby’s age in weeks minus the
you’re also trying to undress or calm a plotted on a growth chart. This will help number of weeks he or she was premature. For example, if your baby was born
fussy baby. An extra set of hands also you and your baby’s care provider see how eight weeks early, at age 6 months, or 24 weeks, your baby’s corrected age is 4
may prove useful during your first few your baby’s size compares with that of months, or 16 weeks. This adjustment will be necessary until your baby reaches
outings. other babies the same age. Try not to fixate age 2½. Vaccinations, however, will be given to your baby according to his or her
on the percentages too much, though. All chronological age.
babies grow and develop at different rates.
In addition, babies who are breast-fed
WHAT TO EXPECT AT EACH VISIT gain weight at a different rate than do ba-
bies who are formula-fed. Keep in mind out. The more information you can pro- Ears Using an instrument called an
Each care provider does things a bit dif- that a baby who’s in the 95th percentile for vide about your baby’s health, the better. otoscope, the care provider can see in
ferently, but here’s what’s generally on height and weight isn’t necessarily health- Here are the basics of what provider’s baby’s ears to check for fluid or infection
the agenda during a well-baby exam. ier than a baby who’s in the fifth percen- commonly check for during an exam: in the ears. The care provider may ob-
tile. What’s most important is steady serve your baby’s response to various
Measuring your baby Your baby’s growth from one visit to the next. If you Head Your baby’s care provider will likely sounds, including your voice. Be sure to
checkup will usually begin with mea- have questions or concerns about your check the soft spots (fontanels) on your tell the care provider if you have any con-
surements. A nurse or your baby’s care baby’s growth rate, discuss them with baby’s head. These gaps between the cerns about your son’s or daughter’s abil-
provider will measure and record your your baby’s care provider. skull bones give your baby’s brain plenty ity to hear or if there’s a history of child-
baby’s length, head circumference and of room to grow in the coming year. hood deafness in your family. Unless
weight. To get accurate measurements Head-to-toe physical exam Your They’re safe to touch and typically disap- there’s cause for concern, a formal hear-
you’ll need to take off your baby’s clothes child’s care provider will give your baby a pear within two years, when the skull ing evaluation isn’t usually needed at a
and, for his or her weight, the diaper. To thorough physical exam and check his or bones fuse together. well-baby exam.
measure your baby’s length, the nurse her reflexes and muscle tone. Be sure to The care provider may also check ba-
will lay your baby on a flat table with his mention any concerns you have or spe- by’s head for flat spots. A baby’s skull is Eyes Your baby’s care provider may use
or her legs stretched. The nurse will use a cific areas you want the doctor to check soft and made up of several movable a flashlight to catch your child’s attention
plates. If his or her head is left in the same and then track his or her eye movements.
position for long periods of time, the skull
plates might move in a way that creates a
TIPS FOR SCHEDULING APPOINTMENTS flat spot. If flat spots are a concern, con-
tinue to place your baby on his or her back
When scheduling appointments, think about what are the care provider’s busiest to sleep. However, your baby’s care pro-
times. You might have the best chance of getting in and out of the care provider’s vider may recommend alternating the di-
office quickly if you ask for the first appointment of the day or choose a time right rection your baby’s head faces in the crib,
after lunch. On the other hand, if you think you’d like to have extra time to speak giving your baby more tummy time while
with your baby’s care provider, you might ask for an appointment at the end of the he or she is awake, and limiting the
day. Also, try to avoid making appointments on Mondays and Fridays, as well as amount of time your baby spends in a car
on holidays when the care provider’s office is open. These days tend to be busier seat — unless he or she is actually riding
than others. The end of summer vacation also tends to be a busy time for care in a car. If these types of changes are
providers, since many children are required to have a physical before the start of made, the flattening typically improves in
the new school year. two to three months. Occasionally, babies
need to wear a positioning helmet to im-
prove head shape.

The provider may also check for blocked you the importance of regularly cleaning Nutrition information Your baby’s care oping food allergies, discuss the issue
tear ducts and eye discharge and look in- your baby’s new teeth to prevent decay. provider will likely ask you about your with his or her care provider.
side your baby’s eyes with a lighted instru- baby’s eating habits. If you’re breast- As your son or daughter gets older,
ment called an ophthalmoscope. Be sure Skin Various skin conditions may be feeding, the care provider may want to discussion topics may include drinking
to tell the care provider if you’ve noticed identified during the exam, including know how often you’re feeding your from a sippy cup and when it’s OK for
that your baby is having any unusual eye birthmarks, rashes and jaundice, a yel- baby during the day and night and your child to start to use utensils to feed
movements, especially if they continue lowish discoloration of the skin and eyes. whether you’re having any problems. If himself or herself. You might also discuss
beyond the first few months. Mild jaundice that develops soon after you’re formula-feeding, the care provider weaning your baby from the bottle by
birth often disappears on its own within will want to know how many ounces of age 1 and how to start giving your baby
Mouth A look inside your baby’s mouth a week or two. Cases that are more se- formula your baby takes at each feeding. whole cow’s milk after he or she turns 1.
may reveal signs of oral thrush, a com- vere may need treatment. For more on In addition, the provider may also
mon, and easily treated, yeast infection. jaundice, see page 378. discuss with you your baby’s need for vi- Sleeping status Your child’s care pro-
The care provider might also check your tamin D and iron supplements. He or she vider may ask you questions about your
baby’s mouth for signs of tongue-tie (an- Heart and lungs Using a stethoscope, will likely also ask how many wet diapers baby’s sleep habits, such as how you put
kyloglossia), a condition that affects the your baby’s care provider can listen to and bowel movements your baby pro- your baby to sleep and how many hours he
tongue’s range of motion and can inter- your baby’s heart and lungs to check for duces on a daily basis. or she is sleeping during the day and night.
fere with a baby’s oral development as abnormal heart sounds or rhythms or Although breast milk or formula will Don’t hesitate to discuss any concerns you
well as his or her ability to breast-feed. breathing difficulties. be the main part of your baby’s diet may have about your baby’s sleep habits.
As your child gets older, the care pro- throughout the first year, there will come
vider may ask whether your baby has Abdomen, hips and legs By gently press- a time when you will want to discuss in- Development Your baby’s develop-
started to drool more than usual, become ing a child’s abdomen, a care provider troducing your baby to solid foods. A care ment is important, too. Over the course
fussy or irritable, or lost his or her appe- can detect tenderness, enlarged organs provider can offer advice on the best of your baby’s first year, the care provider
tite. These are often the first signs of or an umbilical hernia, which occurs foods to start with, the importance of will monitor your baby’s developmental
teething. Your baby’s care provider will when a bit of intestine or fatty tissue near making healthy choices and how to feed milestones in five main areas, including:
check for emerging teeth. After teeth the navel breaks through the muscular your baby. Once your baby starts eating
erupt, he or she will likely discuss with wall of the abdomen. Most umbilical her- solid foods, your child’s care provider Gross motor skills These skills, such as
nias heal without intervention by the may check to see if you’re having any sitting and walking, involve the movement
toddler years. The care provider may also problems feeding your baby or if your of large muscles. Your baby’s care provider
move your baby’s legs to check for dislo- baby has had any allergic reactions. If may ask you how well your baby can
cation or other problems with the hip you’re concerned about your baby devel- control his or her head. Is your baby
joints, such as dysplasia of the hip joint.
Genitalia Your baby’s care provider will

likely inspect your son’s or daughter’s FAILURE TO THRIVE
genitalia for tenderness, lumps or other
signs of infection. The care provider may Failure to thrive is a term — not a disease or diagnosis — that’s used to describe a
also check for an inguinal hernia, which baby or toddler who isn’t growing or developing at an appropriate rate. The term
results from a weakness in the abdominal might be used when a child’s weight or height appears below the fifth percentile on
wall. For girls, the doctor may ask about a growth chart or if a child’s growth rate is lower than expected. Failure to thrive can
vaginal discharge. For boys, the care probe caused by multiple issues, such as an underlying health problem or environmen-
vider will make sure a circumcised penis is tal problems. If your care provider is concerned about your baby’s growth and devel-
healing well during early visits. The care opment, he or she may ask you questions about your pregnancy and delivery, your
provider may also check to see that both baby’s medical and dietary history, and your family history. With early intervention,
testes have descended into the scrotum many children respond well and catch up in their growth and development.
and that there’s no fluid-filled sac around
the testes, a condition called hydrocele.
CHAPTER 11: CHECKUPS 155

attempting to roll over? Is your baby trying Cognitive skills These skills allow a
to sit on his or her own? Is he or she trying child to think, reason, solve problems KEEP A RECORD
to crawl and pull himself or herself up into and understand his or her surroundings.
a standing position? Your baby’s care provider might ask if Consider starting a file, notebook or electronic medical record for your baby’s medi-
your baby can bang together two cubes cal information, such as his or her vaccination record, measurements, and any pre-
Fine motor skills These skills involve the or search for a toy after seeing you hide scriptions or lab test results. Taking time to organize your child’s health information
use of small muscles in the hand. Does it? Development milestones are dis- will give you a chance to review any information the care provider gives you. It’s also
your baby reach for objects and bring cussed further in Part 3 of this book. a good habit to start early because when your child enters school or preschool, you
them to his or her mouth. Is your baby will likely be required to provide certain medical information. Plus, your notes about
using individual fingers to pick up small Behavior Your child’s care provider may your baby’s growth make for a cherished keepsake.
objects? Can your baby transfer objects ask you questions about your child’s be-
from hand to hand? havior. Explain what you’ve noticed so far
and anything that seems out of the ordi-
Personal and social skills These skills nary to you or is causing you concern. explain to you how to hold your by’s care provider for advice on topics that
enable a child to interact and respond to As your baby gets older and begins baby as he or she is given each shot or, aren’t medically related, too. For example,
his or her surroundings. Your baby’s care exploring everything in sight, you may in some cases, an oral solution. Be pre- if you’re looking for child care, ask the care
provider may ask if your baby is smiling. find yourself saying no quite often. Your pared for tears. Keep in mind, however, provider if he or she has any advice.
Does your baby relate to you with real baby also might get frustrated as his or that the pain caused by a shot is typically Also, don’t forget your own health. If
joy? Does he or she play peekaboo? Is her growing sense of independence con- short-lived and the benefits are long last- you’re feeling depressed, stressed out,
your baby showing stranger anxiety? flicts with his or her limited vocabulary ing. Chapter 12 provides more detailed rundown or overwhelmed, describe
and physical abilities. Your baby’s care information on the immunizations your what’s happening. Your baby’s provider is
Language skills These skills include hear- provider might discuss the importance of son or daughter will receive during the there to help you, too.
ing, understanding and use of language. providing a predictable home environ- first year. Before you leave the care provider’s
The care provider may ask if your baby ment and routine and acting calmly office, make sure you know when to
turns his or her head toward voices or when handling meltdowns. Safety Your child’s care provider may talk schedule your baby’s next appointment.
other sounds. Does your baby laugh? Is he to you about safety issues, such as the im- If possible, set the next appointment be-
or she responding to his or her name? Vaccinations Your baby will need a portance of placing your baby to sleep on fore you leave the provider’s office. If you
Does your baby appear to understand the number of vaccinations during his or her his or her back and using a rear-facing in- don’t already know, ask how to reach
word no? Is your baby babbling? first year. The care provider or a nurse will fant car seat. As your baby becomes more your child’s care provider in between ap-
mobile, the care provider may give you pointments. You might also ask if the care
tips for baby-proofing your home. He or provider has a 24-hour nurse informa-
she may discuss how to prevent falls and tion service. Knowing that help is avail-
DEVELOPMENTAL DELAYS the importance of water safety. able when you need it can offer peace
of mind.
If your baby doesn’t reach a specific milestone by an expected age, he or she may
have a developmental delay. Delays can occur in one or several areas of develop-
ment. Your baby’s care provider might ask you about factors that can contribute to QUESTIONS AND CONCERNS
a delay, such as a history of developmental delays in the family or stressful home
conditions. If your baby has a developmental delay, the care provider can recom- During your son’s or daughter’s check-
mend a type of developmental therapy that may help your baby make progress. ups, it’s likely that you’ll have questions,
Most babies are eligible to receive a wide range of therapies in their homes, often at too. Ask away! Nothing is too trivial
no cost. Early identification of a developmental delay is important because it will en- when it comes to caring for your baby.
able you to get your baby the help he or she needs as soon as possible. For more Write down questions as they arise be-
information on developmental delays, see Chapter 40. tween appointments so that you’ll be less
likely to forget them when you’re at your
baby’s checkup. Feel free to ask your ba-
156 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 11: CHECKUPS 157
CHAPTER 12
Vaccinations
Before you met your baby, did you think alike. It’s hard to see your little one cry
about his or her health? Chances are, you after receiving a series of shots. But as
did. Think back to your pregnancy — much as you want to shield your child
the things you did to keep yourself from discomfort and tears, keep in mind
healthy and to prevent problems from that the discomfort is temporary and very
occurring, so the baby inside you could minor compared with the potential dis-
grow and develop. comfort of a serious disease.
Prevention is crucial to good health. Vaccinations have saved billions of
It’s far better to prevent a disease than to lives worldwide. However, despite the
treat it. And one of the best ways to pro- availability of vaccines, many people re-
tect your family from many diseases is to main underimmunized. One reason is
get vaccinated. Immunization is the best that some people have concerns about
line of defense against diseases such as the safety and risks of vaccines. In addi-
tetanus, hepatitis, influenza and many tion, some people feel it’s dangerous to
other infections. give more than one vaccine at a time, and
Thanks to vaccines, many infectious others feel certain vaccines are no longer
diseases that were once common in the needed. These concerns are often the re-
United States are now rare or nonexis- sult of incorrect information.
tent. As a parent, you no longer have to
fear that your child will die of or become
disabled by smallpox and tetanus. And
you no longer have to keep your children HOW VACCINES WORK
away from water fountains and swim-
ming pools to avoid getting polio. Every day, the human body is threatened
Truth be told, vaccinations aren’t ex- by bacteria, viruses and other germs.
actly fun — for children and parents When a disease-causing microorganism
CHAPTER 12: VACCINATIONS 159

enters your (or your child’s) body, your the infectious germ — triggers your im- appeared in the United States can reap- Prevention (CDC) continue to monitor
immune system mounts a defense, pro- mune system’s infection-fighting ability pear quickly. The germs that cause the their safety. Furthermore, vaccines are
ducing proteins called antibodies to fight without exposure to the actual disease. diseases still exist and can be acquired subject to ongoing research, review and
off the invader. The goal of your immune When given to you before you get infect- and spread by people who aren’t protect- refinement by doctors, scientists and
system is to neutralize or destroy the for- ed, the vaccine makes your body think ed by immunization. public health officials. Those who provide
eign invader, rendering it harmless and that it’s being invaded by a specific or- As travelers unknowingly carry dis- vaccines, such as care providers and
preventing you from getting sick. ganism, and your immune system begins ease from one country to another, a new nurses, must report any side effects they
One way the body’s immune system building defenses against the organism’s outbreak may be only a plane trip away. observe to the FDA and CDC.
fights off foreign invaders is through invasion to prevent the organism from From a single entry point, an infectious The bottom line is, your child’s chanc-
what’s called post-exposure immunity. infecting you again. disease can spread quickly among un- es of being harmed by a disease are far
After you’ve been infected with a certain If you’re exposed to a disease for protected individuals. Outbreaks of greater than his or her chances of being
organism, your immune system puts into which you’ve been vaccinated, the invad- mumps and measles have repeatedly oc- harmed by a vaccine used to prevent
play a complex array of defenses to pre- ing germs are met by antibodies prepared curred in just this way in the United disease.
vent you from getting sick again from to defeat them. And vaccines can be giv- States the past few years.
that type of virus or bacterium. en without the risk of the serious effects Vaccine additives In addition to the
Another way the immune system of disease. killed or weakened microorganisms that
prevents disease is through vaccine im- Sometimes it takes several doses of a make up vaccines, small amounts of other
munity. With this method, a person vaccine for a full immune response — VACCINE SAFETY substances may be added to a vaccine to
avoids having to get infected with the or- this is the case for many childhood vac- enhance the immune response, prevent
ganism. A vaccine — which contains a cines. Some people fail to build immunity As a new parent, you might be under- contamination, and stabilize the vaccine
killed or weakened form or derivative of to the first doses of a vaccine, but they standably leery about giving your child against temperature variations and other
often respond to later doses. In addition, vaccines. You don’t want to do anything conditions. Vaccines may also contain
the immunity provided by some vaccines, to harm your child. And while you know small amounts of materials used in the
such as tetanus and pertussis, isn’t life- that vaccinations are important, you’ve manufacturing process, such as gelatin.
long. Because the immune response may also heard that they could be harmful, One additive that has received much
decrease over time, you may need an- too — possibly causing side effects. You attention is a preservative called thimer-
other dose of a vaccine (booster) to re- may worry after hearing or seeing reports osal, which is a derivative of mercury.
store or increase your immunity. And for about a severe “reaction” that occurs Thimerosal has been used in medical
some diseases, the organism evolves, and shortly after a child’s immunization visit products since the 1930s and in small
a new vaccine is needed against the new that’s said to be a side effect or complica- amounts in some vaccines to prevent
form. This is the case with the annual flu tion of the vaccine. Unfounded stories bacterial contamination. No evidence
(influenza) shot. such as these frequently circulate on the shows that children have been harmed
Internet. by its use in vaccines. Nonetheless, child-
The fact is, vaccines are extremely hood vaccines are now made without
safe. Before they can be used, they must thimerosal or with only trace amounts.
WHY GET VACCINATED? meet strict safety standards set by the
Food and Drug Administration (FDA). Vaccines and autism Many parents
Because many vaccine-preventable dis- Meeting these standards requires a have heard claims that vaccines cause
eases are now uncommon in the lengthy development process of up to autism. The most common and specific
United States, some people feel less ur- 10 years, followed by three phases of claims are that autism stems from the
gency about getting themselves or their clinical trials. These studies, unlike drug measles-mumps-rubella (MMR) vaccine
children immunized. If you wonder if studies, involve tens of thousands of or from vaccines that contain the preser-
it’s necessary to vaccinate your family individuals. vative thimerosal. Many large studies
and to keep everyone up to date with Once vaccines are licensed and made have been conducted to investigate these
vaccinations, the answer is yes. Many in- available to the general public, the FDA specific concerns, but no link has ever
fectious diseases that have virtually dis- and the Centers for Disease Control and been found between vaccines and
CHAPTER 12: VACCINATIONS 161

autism. In fact, large numbers of studies face, chest, back and other areas of the
WELL-CHILD VACCINATION SCHEDULE from around the world have shown, be- body. The spots quickly fill with a clear
yond a doubt, there is no association. fluid, rupture and turn crusty.
The following chart lists the recommended routine childhood vaccinations. Vac- Unfortunately, the claims persist, and
cine guidelines for children change fairly often as new vaccines are developed, they’ve led some parents to refuse to vac- Recommendation Children should re-
recommendations on timing and dosages are revised, and more combination vaccinate their children. ceive one dose of the chickenpox vaccine
cines are created. Check with your child’s care provider to make sure that your The causes of autism aren’t fully un- between 12 and 18 months of age.
child is up to date on his or her vaccinations. You can also view current vaccination derstood, and it’s likely that many factors
schedules from the American Academy of Pediatrics (see page 552). are involved. But scientific evidence over- Diphtheria Diphtheria is a bacterial in-
Health insurance usually covers most of the cost of vaccinations. A federal whelmingly suggests that vaccines are fection that spreads from person to per-
program called Vaccines for Children provides free vaccines to children who lack not a possible cause. son through airborne droplets. It causes a
health insurance coverage and to other specific groups of children. Ask your care Some people also worry that receiv- thick covering (membrane) to develop in
provider about it. ing too many vaccines early in life can the back of the throat and can lead to se-
overwhelm a baby’s immune system and vere breathing problems, paralysis, heart
Recommended vaccination schedule for children ages 0-18 months*
that this might somehow lead to autism. failure and death. The disease is now rare
Ages Such reasoning doesn’t fit with what we in the United States.
Vaccine Birth 1 2 4 6 12 15 18 know about the remarkable capacity of
month mos. mos. mos. mos. mos. mos. the immune system. From the moment a Recommendation The diphtheria vac-
Hepatitis B HepB HepB † HepB † child is born, his or her immune system cine typically is given in combination
begins battling microorganisms in the with the tetanus and pertussis vaccines
Rotavirus RV RV RV
form of bacteria, viruses and fungi on a (a DTaP shot). Immunization should be-
Diphtheria, DTaP DTaP DTaP DTaP‡ daily basis. A system that copes with ex- gin when a child reaches 2 months of
tetanus, posure to countless bacteria each day can age. A child should receive five shots in
pertussis easily withstand exposure to the antigens the first six years of life and continue to
Haemophilus Hib Hib Hib Hib in vaccines. receive boosters of tetanus, diphtheria
influenzae type b and pertussis (Tdap) every 10 years, be-
ginning at age 11 or 12. The Tdap vaccine,
Pneumococcal PCV PCV PCV PCV
approved in 2005, is recommended for
Inactivated IPV IPV IPV CHILDHOOD VACCINATIONS children 11 years and older instead of the
poliovirus older Td booster vaccine.
Influenza Influenza (Yearly) Fortunately, many of the most familiar
Measles- MMR diseases of childhood — measles, mumps, German measles German measles
mumps-rubella and chickenpox — can be prevented (rubella) is a contagious disease that
(MMR) through immunization. spreads through the air from people sick
with the infection. It’s typically a mild in-
Varicella Varicella
Chickenpox Chickenpox (varicella) is a fection that causes a rash and slight fever.
Hepatitis A HepA (2 doses) common childhood disease. It can also However, if a woman develops rubella
* Based on 2012 recommendations. affect adults who aren’t immune. More during pregnancy, she may have a mis-
† If monovalent HepB is used for doses after the birth dose, a dose at 4 months children in the United States die of this carriage, or the baby could be born with
is not needed. disease than of any other vaccine-pre- birth defects.
‡ The fourth dose of DTaP may be administered as early as age 12 months, ventable disease.
provided six months have elapsed since the third dose. The chickenpox virus is spread by Recommendation Usually, two doses of
Indicates an age-range when vaccination is recommended. breathing in infected droplets or by direct the combination measles-mumps-rubella
contact with fluid from the rash, which is (MMR) vaccine are given, the first at ages
Source: Centers for Disease Control and Prevention the best-known sign of the disease. The 12 to 15 months and the second at ages 4
rash begins as superficial spots on the to 6 years.
162 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 12: VACCINATIONS 163
ALTERNATIVE VACCINE SCHEDULES COMFORTING BABY DURING AND AFTER VACCINATION
Some health care professionals tout what they call alternative vaccine schedules It can be difficult to see your baby cry or be uncomfortable as a result of a vaccina-
that delay shots or space them further apart. For parents who may be skittish tion. Try to keep in mind that protecting your baby against serious disease is worth
about giving their children so many shots, the idea of the alternative schedule is to the short-term discomfort.
encourage vaccination by slowing the pace. During each injection, hold your baby close. Softly sing a familiar song or whis-
But public health officials say that these approaches leave too many kids per reassuring words. Offer a pacifier, blanket or other comfort object. Your pres-
unprotected for too long, and they aren’t backed up by science. Alternative ence and calm reassurance can help your baby feel secure.
schedules are unstudied, and they can be dangerous because of the increased Your baby may experience mild side effects from the vaccines, such as red-
risks they pose. Skipping or spacing out vaccines dramatically increases a child’s ness, pain or swelling at the injection site. Ask the doctor what to expect. To mini-
risk of illness. mize these effects, you can give your infant acetaminophen (Tylenol, others) before
If you’re concerned, the best advice is to talk with your child’s care provider to or after vaccination. Follow the label instructions for the correct dose, or ask your
make sure you are getting the correct information. child’s care provider for specific dosing instructions.
Hib disease Haemophilus influenzae Hepatitis B The hepatitis B virus can tect against strains of flu virus expected lead to an ear infection, pneumonia, sei-
type b (Hib) disease is primarily a child- cause a short-term (acute) illness marked to be in circulation during the fall and zures, brain damage and death.
hood illness, but it can also affect some by loss of appetite, fatigue, diarrhea, winter. The vaccine is generally offered
adults. It’s caused by bacteria that spread vomiting, jaundice, and pain in muscles, between September and March, which is Recommendation Typically, two doses of
from person to person through the air. joints and the abdomen. More rarely it typically the flu season. a combined measles-mumps-rubella
This infection can cause serious and po- can lead to long-term (chronic) liver (MMR) vaccination are given, beginning
tentially fatal problems, including men- damage (cirrhosis) or liver cancer. Recommendation The influenza vaccine at ages 12 to 15 months and then again at
ingitis, sepsis, severe swelling in the The virus is spread through contact is now recommended yearly for infants 4 to 6 years.
throat, and infections of the blood, joints, with the blood or other body fluids of and children, beginning at age 6 months.
bones and membranes around the heart an infected person. This can happen by Babies require two doses of the flu vac- Mumps Mumps is a childhood disease
(pericarditis). having unprotected sex, sharing needles cine the first time they’ve been vaccinat- that can also occur in adults. Mumps is
when injecting illegal drugs, or during ed for influenza. That’s because they caused by a virus that’s acquired by in-
Recommendation The Hib conjugate birth, when the virus passes from an don’t develop an adequate antibody level haling infected droplets. The disease
vaccine is given to children at ages 2 infected mother to her baby. However, the first time they get the vaccine. Anti- causes fever, headache, fatigue, and
months, 4 months, 6 months and 12 to 15 over one-third of people who have bodies help fight the virus if it enters your swollen, painful salivary glands. It can
months. The vaccine typically is given at hepatitis B in the U.S. don’t know how child’s system. However, if a flu vaccine lead to deafness, meningitis, and inflam-
the same time as other vaccines. they got it. shortage were to occur and your child mation of the testicles or ovaries, with
couldn’t get two doses of vaccine, one the possibility of sterility.
Hepatitis A Hepatitis A is a liver disease Recommendation The hepatitis B vac- dose might still offer some protection.
caused by the hepatitis A virus. It’s usu- cine is given to children in three doses Recommendation Two doses of a com-
ally spread by eating or drinking contam- — at birth, at least one month later (1 to Measles Measles (rubeola) is primarily bined measles-mumps-rubella (MMR)
inated food or water or by close personal 4 months of age) and then at 6 to 18 a childhood illness, although adults also vaccination are given, usually beginning
contact. months. are susceptible. It’s the most contagious at ages 12 to 15 months and then again at
human virus known. The measles virus is 4 to 6 years. Use of this vaccine has mark-
Recommendation The two-dose series Flu (influenza) Influenza is a viral in- transmitted through the air in droplets, edly decreased the incidence of mumps
of hepatitis A vaccine is recommended fection that sickens millions of people such as from a sneeze. in the United States.
for all children in the U.S. The first dose is each year and can cause serious compli- Signs and symptoms include rash, fe-
generally given at 12 months and the cations, especially in children and older ver, cough, sneezing, runny nose, eye ir- Pneumococcal disease Pneumococ-
second dose at 24 months. adults. Flu vaccines are designed to pro- ritation and a sore throat. Measles can cal disease is the leading cause of bacterial
meningitis and ear infections among Polio Polio is caused by a virus (poliovi-
children younger than 5 years old. It can rus) that enters the body through the MISSING A VACCINATION
also cause blood infections and pneumo- mouth. Polio affects the brain and spinal
nia. Children below the age of 2 are at cord, often resulting in paralysis or death. If your baby falls behind on his or her vaccinations, catch-up vaccination schedules
greatest risk of the most serious compli- Polio vaccination began in the U.S. in can address the problem. Make an appointment with your child’s care provider to
cations of this disease. 1955. No polio cases have been reported determine the vaccinations your baby needs and when he or she should receive
Pneumococcal disease is caused by in this country for many years, but the them.
Streptococcus pneumoniae bacteria. The disease is still common in some parts of An interruption in the schedule doesn’t require a child to start a series over or
bacteria spread from person to person the world, and the virus could be brought redo any doses. Until your child receives the entire vaccine series, he or she won’t
through physical contact or by inhaling to the United States. For that reason, get- have maximum possible protection against diseases.
droplets released into the air when a per- ting children vaccinated against polio
son with the infection coughs or sneezes. continues to be important.
Because many strains of the bacterium The vaccine, called inactivated polio
have become resistant to antibiotics, the vaccine (IPV), contains the chemically killed Rotavirus Rotavirus is the most com- (DTaP vaccine). Vaccinations typically be-
disease can be difficult to treat. virus. IPV is given by multiple injections. mon cause of severe diarrhea among in- gin when a baby reaches 2 months of age
fants and children, resulting in the hospi- and are given in a series of five shots in
Recommendation Pneumococcal conju- Recommendation IPV is given in four talization of approximately 55,000 children the first six years of life.
gate vaccine (PCV) can help prevent seri- doses, at ages 2 months, 4 months, 6 to yearly in the U.S. Almost all children are Starting at age 11, people should con-
ous pneumococcal disease. It can also 18 months and at about age 5 years. This infected with rotavirus before their fifth tinue to be immunized every 10 years
prevent one cause of ear infections. The last vaccination is a booster dose. Con- birthday. The infection is often accompa- with the adult forms of the vaccine.
vaccine is given to all children in four trary to the fears of some people, the nied by vomiting and fever.
doses between ages 2 and 15 months. shots can’t cause polio. Whooping cough Whopping cough
Recommendation Rotavirus vaccine is (pertussis) is a disease that causes severe
an oral (swallowed) vaccine, not a shot. coughing spells, making it hard for in-
The vaccine won’t prevent diarrhea or fants and toddlers to eat, drink or even
WHY SO MANY SO SOON? vomiting caused by other germs, but it’s
very good at preventing diarrhea and
Newborns need multiple vaccines because infectious diseases can cause more vomiting caused by rotavirus.
serious problems in infants than in older children. There are two brands of rotavirus vac-
While a mother’s antibodies help protect newborns from many diseases, this cine. A baby should get either two or
immunity may begin to disappear as quickly as one month after birth. In addition, three doses, depending on which brand
children don’t receive maternal immunity from certain diseases, such as whooping is used. The first dose is given at 2
cough. If a child isn’t vaccinated quickly and is exposed to a disease, he or she months, the second at 4 months and the
may become sick and spread the illness. third dose, if needed, at 6 months.
Research shows that it’s safe for infants and young children to receive multiple
vaccines at the same time, as recommended by the Centers for Disease Control Tetanus Tetanus causes painful tighten-
and Prevention. In addition, giving several vaccinations at once means fewer office ing of the muscles, usually all over the
visits, which saves time and money for parents and may be less traumatic for body. It can be difficult to open your
the child. mouth (lockjaw) or swallow. Tetanus isn’t
Remember, newborns and young children can be exposed to diseases from a contagious disease. The tetanus bacte-
family members, care providers and other close contacts, as well as during routine ria enter the body through deep or dirty
outings — such as trips to the grocery store. Vaccines can often be given even if cuts or wounds.
your child has a mild illness, such as a cold, earache or mild fever. It’s important to
keep your child’s vaccination status up to date. Recommendation The tetanus vaccine
typically is given in combination with
those for diphtheria and pertussis

breathe. The word pertussis is from the nus and pertussis. It’s given as a series SIDE EFFECTS OF VACCINES When to avoid vaccination In a few
Latin word for “cough.” These coughing of five shots beginning when the infant circumstances, immunization should be
spells can last for weeks and can lead to is 2 months old and continuing to be- Although vaccines are considered very postponed or avoided. Talk to your child’s
pneumonia, seizures, brain damage and tween ages 4 and 6. The DTaP vaccine is safe, like all medications they aren’t com- care provider if you question whether
death. Severe whooping cough primarily a better tolerated version of an older vac- pletely free of side effects. Most side ef- your baby should be vaccinated.
occurs in children younger than 2 years cine called DTP. The “a” stands for acel- fects are minor and temporary. Your child Immunization may be inappropriate
and is contracted by inhaling infected lular, meaning that only specific parts might experience a sore arm, a mild fever if a child has:
droplets, often coughed into the air from of the pertussis bacteria are used in the or swelling at the injection site. Serious Z Had a serious or life-threatening
an adult with a mild case of the disease. vaccine. reactions, such as a seizure or high fever, reaction to a previous dose of that
At age 11, a form of the vaccine for are very rare. vaccine
Recommendation The DTaP vaccination adolescents and adults, called Tdap, is According to the Centers for Disease Z A known, significant allergy to a vac-
combines vaccines for diphtheria, teta- recommended. Control and Prevention (CDC), serious cine component, such as chicken eggs
side effects occur on the order of 1 per or gelatin
thousand to 1 per million of doses. The Z A medical condition, such as AIDS
risk of death from a vaccine is so slight or cancer, that’s compromised the
VACCINATIONS FOR that it can’t be accurately determined. child’s immune system and could al-
PRETERM BABIES When any serious reactions are reported, low a live virus vaccine to cause
they receive careful scrutiny from the Food illness
If your baby was born early or with a and Drug Administration and the CDC. Immunization may need to be de-
low birth weight, you might be con- Some vaccines are blamed for chronic layed if a child has:
cerned about having your baby immu- illnesses, such as autism or diabetes. (See Z A moderate to severe illness
nized at the standard schedule. How- page 161 for more on the issue of autism Z Taken steroid medications in the last
ever, it’s recommended that even and vaccines.) However, decades of vac- three months
premature babies should be given the cine use in the United States provides Z Received a transfusion of blood or
routinely recommended vaccinations at no credible evidence that vaccines cause plasma or been given blood products
the normal times. these illnesses. Researchers have, on oc- within the past year
Keep in mind that premature babies casion, reported a link between vaccine Immunization shouldn’t be delayed
have a greater chance of having dis- use and chronic illness. But when other because your baby has a minor illness,
ease-related problems, putting them at researchers have tried to duplicate those such as a common cold, an ear infection
particular risk if they acquire a prevent- results — a test of good scientific re- or mild diarrhea. The vaccine will still be
able infection. All of the vaccines that search — they haven’t been able to pro- effective, and it won’t make your child
are currently available are safe for pre- duce the same findings. sicker.
mature and low birth weight babies,
and pose the same risk of side effects.
There is only one exception to this:
the hepatitis B vaccine that is given
soon after birth. For an infant that SIGNS OF A SEVERE REACTION
weighs less than 2.2 pounds at birth,
your pediatrician may advise to delay After vaccination, watch for any unusual conditions, such as a serious allergic re-
the timetable for this particular vaccine action, high fever or behavior changes. Signs and symptoms of a serious allergic
until the baby is older. But stable pre- reaction include difficulty breathing, hoarseness or wheezing, hives, paleness,
mature babies weighing more than 2.2 weakness, a fast heartbeat, dizziness, and swelling of the throat. Severe reactions
pounds may be given the first hepatitis are rare, but if you think that your baby may be experiencing one, call your child’s
B vaccine as scheduled. care provider or go to an emergency department immediately.
WEIGHING THE
RISKS AND BENEFITS
The consequences of acquiring a disease

that can be prevented by immunization
are far greater than the extremely rare
risk of a serious side effect that may result
from vaccine use. For example, if your
child gets mumps, the risk of him or her
developing encephalitis, a brain inflam-
mation that can cause permanent, seri-
ous brain damage, is 1 in 300. For mea-
sles, the risk is 1 in 2,000. In contrast, the
risk of contracting encephalitis from the
mumps and measles vaccines is less than
1 in 1 million.
If a child gets serious Hib disease, the
chances of death are 1 in 20. The vaccine
for Hib disease, meanwhile, hasn’t been
associated with any serious adverse reac-
tions and is highly effective.
Most childhood vaccines are effective
in 85 to 99 percent or more of children
who receive them. For example, a full se-
ries of measles vaccine protects 99 out of
100 children from measles, and a polio
vaccine series protects 99 out of 100 chil-
dren from polio.
CHAPTER 13
Child care
When you first bring your baby home GETTING STARTED

from the hospital, it might be hard to
imagine trusting anyone else to take care Whether you plan to work after your
of him or her. You might have a difficult baby is born or just need some help a few
time feeling comfortable taking your days a week, it’s never too early to start
baby with as you run errands, let alone thinking about child care arrangements.
picturing yourself dropping him or her Even if you’re not sure about your plans,
off at a child care center. But for many start exploring and researching your op-
families, child care — whether in the tions early. You might want to visit mul-
form of a nanny, family member or a tiple child care centers to find the right
child care center — is a necessity. So how one for your baby — and many child care
do you find child care that will promote centers have long waiting lists. If you’re
your baby’s health, safety and develop- looking for in-home care, you might
ment but won’t completely empty your need time to find a child care agency, in-
bank account? terview caregivers, and set up health in-
To begin with, determine how much surance or workers’ compensation for
you can afford to spend on child care, your child’s caregiver.
and identify your expectations — what’s Before you return to work, you might
important to your family when it comes want to have your child spend time at a
to child care. Then begin researching the child care center or with a child care pro-
available options in your area as soon as vider to see how your baby handles the
possible. Before your visits, make sure situation and whether the arrangement
you know how to identify quality child works for your family.
care providers. When you begin to look for child care,
start by asking your friends, neighbors
and co-workers for recommendations.
CHAPTER 13: CHILD CARE 173

You might ask your baby’s care provider tages of an in-home arrangement are groups of children, sometimes in addi- such as Head Start. Some child care pro-
for advice. Child care agencies or referral that your child will receive individual at- tion to caring for their own children. Typ- grams also have religious affiliations or
services are great resources, too. Your local tention, and he or she won’t be exposed ically, family child care centers provide income eligibility requirements.
child care resource and referral agency can to other children’s illnesses or bad be- care for children of mixed ages. Small
tell you about licensing requirements in havior. Plus, you won’t need backup care programs provide care for up to six chil- Pros Child care centers offer many ad-
your area, how to get information about if your baby becomes ill. You won’t need dren at one time, while large programs vantages. They’re generally required to
complaints or licensing violations, and to worry about transportation for your are for seven to 12 children. meet state or local standards. Many have
whether your family qualifies for financial baby unless you want your child care structured programs designed to meet
assistance. If you’re still having trouble provider to take your baby somewhere. Pros One of the main attractions of family the needs of children at different age lev-
finding information, consider contacting An in-home caregiver also might be able child care is that it allows your baby to be els. Child care centers often have high
placement services at local colleges for the to help with light housework or prepar- in a homelike setting with other children. education requirements for staff. And
names of child development or early edu- ing meals during your baby’s naps. In addition, family child care is often less because most centers have several care-
cation students who baby-sit. You might If you use an agency to find a child expensive than care provided by an in- givers, you likely won’t need backup care
also find the names of potential sitters in care provider, you’ll have the comfort of home caregiver or a child care center. if a child care provider becomes sick. In
community newspapers or on church or knowing that someone has already Homes that offer child care usually have addition, child care centers provide op-
community bulletin boards. checked the backgrounds and references to meet state or local safety and cleanli- portunities for socialization with other
of potential candidates. If you have more ness standards. Some facilities might be children. Some centers might allow you
than one child, the cost of in-home care able to cater to your baby’s and family’s to enroll your baby for less than a full
might not be significantly more expen- specific needs, providing care for children week if you work part time or provide ex-
CHILD CARE OPTIONS sive than other care options. with special needs or extended hours. tended hours. Some child care centers
also allow you to check in on your baby
Child care options vary. Generally, though, Cons This type of care isn’t well regulated Cons The quality can vary widely. While
child care options include the following and is typically more expensive than oth- many family child care providers under-
settings. er options. If you use an agency to find a go background checks and participate in
child care provider, you’ll likely have to ongoing training, not all may be required
In-home care Under this arrangement, pay a hefty fee. Your caregiver might have to do so. Unless the facility has an online
a caregiver comes to your home to pro- minimal training in child development, surveillance system, you won’t be able to
vide child care. The person might live first aid or CPR. As an employer of a child see what your baby is doing in your ab-
with you or come to your home each day, care provider, you also might have cer- sence. You may have to drop off and pick
depending on the agreement you have tain legal and financial obligations, such up your baby at the family child care at
worked out. Some examples of in-home as meeting minimum wage and tax-re- specified times.
caregivers include relatives, nannies and porting requirements or providing health
au pairs. Au pairs are people who typi- insurance. Some people also feel uncom- Child care centers Child care centers,
cally come to the United States on a stu- fortable having another person spending also called day care centers, child devel-
dent visa and provide child care in ex- time in or living in their home. There opment centers, or sometimes preschool
change for room and board and a small might not be as much opportunity for or pre-kindergarten programs, are orga-
salary. your baby to socialize with other chil- nized facilities with staff members who
dren. When your child care provider be- are trained to care for groups of children.
Pros One of the big advantages of this comes sick or goes on vacation, you’ll In these settings, care typically is provid-
type of arrangement is that your baby can need to find back-up care. Unless you set ed in a building — rather than a home
stay at home. You don’t have to be bun- up a home surveillance system, you won’t — with separate classrooms for children
dling up your baby early in the morning be able to observe what happens to your of different ages. Programs can be large
to drop him or her off on your way to baby in your absence. or small, based on their maximum capac-
work. In addition, you set your own stan- ity. A child care center can be part of a
dards, and you might have more flexibil- Family child care Many people pro- chain, independent for profit, nonprofit,
ity with your work hours. Other advan- vide child care in their homes for small state-funded or part of a federal program,
174 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 13: CHILD CARE 175
during the day via secure online surveil- ified times. Some centers charge fees if
lance systems. you don’t pick up your baby on time. CARE FOR BABIES WITH SPECIAL NEEDS
Cons Some of the drawbacks of larger Relative or friend Many people rely on If your baby has a developmental disability or chronic illness, finding quality child
facilities are that they might have long relatives or friends to provide part-time care is more important than ever. The best programs encourage normal activities
waiting lists for admission, and spending or full-time care for their children. While and also meet each child’s special needs. To find a child care program for your
time with other children can increase having someone you know and trust take baby, consult your baby’s care provider or your state’s department of health or
your baby’s risk of getting sick. Because care of your child is comforting, there are education. Your baby’s care provider can also help you determine what kind of
of this, some child care centers might not advantages and disadvantages to this care will best address your baby’s needs. Look for a program that meets the basic
let you bring your child to the center if he type of arrangement, too. requirements you’d want in a child care program. In addition, look for:
or she is mildly ill. Child care centers also
can be expensive, depending on the ser- Pros Chances are your baby will receive Specialized staffing and equipment Has the program’s staff been trained to
vices offered. Regulations also vary. If the plenty of individual attention. You might meet your baby’s specific needs and recognize when your baby might need med-
program is large or the ratio of care pro- even be able to have your relative or friend ical attention? Does the program have a medical consultant who is involved in the
viders to children is low, your child might care for your baby in your own home so program’s development? What kind of specialized equipment does the program
not receive a lot of individual attention. you don’t need to worry about transporta- provide, and is it in working condition? Has the staff been trained to use it? Does
You may have to drop off and pick up tion. Your baby won’t be exposed to other the program tailor emergency plans to the needs of its children?
your baby at the child care center at spec- children’s illnesses or bad behavior, and
you won’t need backup care if your baby Confidence-building activities What kinds of activities will your baby be able
becomes ill. This type of arrangement also to participate in? Does the program include children who don’t have special
might give you some flexibility with your needs? Programs that contain children who have different levels of ability can help
work hours. It’s also possible, depending encourage social confidence and sensitivity.
on the agreement you work out, that you
might not need to pay your friend or rela-
tive for child care services, or you can pay at
a discounted rate. ily and what you can afford. Understand- ing the day? What kind of backup ar-
ing your priorities will help you figure out rangements can you make if your child or
Cons Your friend or relative might not what questions to ask as you start evalu- an at-home care provider becomes sick?
have any training in CPR or other emer- ating your options. Do you want your child to be exposed to
gency care. The main drawback of having a specific language?
a family member or friend provide care is Expectations Think about your fami-
that it can cause tension. You might not ly’s needs and what’s most important to Budget Think about how much money
feel comfortable talking to a family mem- you in a child care provider. How many you can afford to spend on child care and
ber or friend if you have differing opin- days and hours a week do you expect how different types of child care will af-
ions about how he or she cares for your your child to need care? What kind of fect your budget. Are you eligible for any
child. Your relative or friend might also disciplinary techniques do you want state subsidies or assistance from your
offer unwanted parenting advice. your child care provider to use? If you’re employer, such as employer discounts or
considering hiring a nanny, do you want dependent care spending accounts? If
him or her to be able to drive and do you’re considering in-home care, are you
light housework? If you’re considering prepared to pay any necessary state taxes
FACTORS TO CONSIDER out-of-home care, how far away from and the cost of backup care during your
your home or place of work would you child care provider’s vacation and sick
Before you begin looking at facilities or like your child to be? How will you han- days? If you’re concerned about the ex-
interviewing child care providers, take dle transportation to and from the child pense of child care, could you or your
some time to think about what kind of care center or access to transportation partner adjust work hours or schedules
child care might work best for your fam- your caregiver and child might need dur- to reduce your need for child care?
CHAPTER 13: CHILD CARE 177

EVALUATING YOUR OPTIONS or she typically use? What kind of hours
can he or she work? What kind of salary HANDLING THE SEPARATION
Once you’ve thought about what kind does the child care provider expect? Does
of child care will work best for your he or she need health insurance? Does Babies up to age 7 months often adjust well to being taken care of by a new child
family, compile a list of potential caregiv- he or she have CPR and first-aid training? care provider. Older babies, however, might have a harder time with the transition.
ers or facilities in your area. Next, call or Between age 7 months and one year, babies begin to develop stranger anxiety.
visit the caregivers or facilities. During Family child care Look for a facility They might need extra time and help getting used to a new child care provider and
your visit, pay special attention to the that’s certified, licensed and provides a setting. If possible, arrange for an in-home care provider to spend time with your
way staff members treat the children. Af- safe environment for children. Ask about baby while you’re at home. Or take your baby to visit the family child care or child
ter the tour, be prepared with a list of how many child care providers are on care center before he or she begins attending it. Stay nearby while your child plays,
questions. If you’re evaluating several staff and if they have undergone back- and steadily increase the length of your visits. When you begin dropping your child
different settings or child care providers, ground checks. Request references. Ask off at the program, create a goodbye ritual, and let him or her bring a reminder of
consider taking notes and recording your about the provider’s training, how many home, such as a stuffed animal or picture of you, to the program. Always say
first impressions. children are enrolled and about the facil- goodbye to your baby before leaving. If your baby shows persistent fear about
ity’s hours. Discuss the facility’s approach being left alone with a caregiver, talk to your baby’s care provider.
In-home care When looking for some- to child rearing. How many child care Separation is sometimes harder for the parents than the baby. Checking in
one to come into your home to care for providers are currently certified in CPR regularly with your child care provider to see how your baby is doing might help
your baby, checking references is crucial. and have first-aid training? Who lives in reassure you. Talk to friends and family who’ve been through it before. Carrying a
Talk to several of the child care provider’s and visits the home? What are their picture of your baby with you might help, too.
previous employers and ask questions backgrounds, and how might they inter-
about his or her strengths and weakness- act with your child? How does the facility
es, as well as any problems or concerns plan to deal with emergencies? What
the employer might have had. Do a back- safety measures are in place? Are there program’s practices. Many child care cen- child was in the program in the past year.
ground check. Search for information daily activities for the children? Find out ters provide pamphlets or have websites Be sure to search for information online
about the person online via a search en- what happens if the care provider be- that will answer your questions. You can about the program and its child care pro-
gine or social networking site. Ask about comes ill and if he or she closes for vaca- also speak to the program’s director. viders, too.
the child care provider’s approach to tions. How much does the program cost? Consider asking about:
child rearing. What will the care provider Adult-to-child ratios Ask about the
do if your baby won’t stop crying? What Child care center When evaluating Credentials and staff qualifications ratio of adults to children. The fewer the
kind of disciplinary techniques does he child care centers find out about each Make sure the program is licensed and children for each adult, the better the child
has a recent health certificate. Programs care experience may be for your son or
that are accredited have met voluntary daughter. For infants, look for an adult-to-
standards for child care that are higher child ratio of 1-to-3 or 1-to-4. Also, look
SICK CARE than most state licensing requirements. for a group size that’s no larger than six to
The National Association for the Educa- eight infants or six to 12 young toddlers.
When your baby becomes ill and you need backup care, you might have options tion of Young Children and the National Keep in mind that infants and young tod-
beyond staying home to care for him or her. Some child care centers or family child Association for Family Child Care are the dlers do better in smaller groups.
care programs offer care for sick children in a segregated area. Your community two largest organizations that accredit
might also have child care centers or family child care programs that specialize in child care programs. Staff should have Health and sanitation practices Ask
providing care only for sick children. Some employers also provide sick care for training in early child development, CPR whether the program requires children
their employees’ children. Investigate your options before your baby becomes ill. and first aid. References should be avail- and staff to have standard vaccinations
When looking for this type of care, ask about how much individual care your baby able upon request. Ask if there are fre- and regular checkups. Is the staff prohib-
will receive, how the facility and equipment are cleaned, and whether the facility quent staff changes, since high staff turn- ited from smoking inside and outside of
has a care provider on call. over might be a sign of a problem, and the building? What happens if your baby
changing care providers can be hard on a becomes ill during the day? Are parents
child. Talk to at least one parent whose notified when a child or staff member
contracts a communicable disease, such are parents notified of weather cancella- vider you hire or the child care providers might help eliminate some confusion.
as chickenpox? When should you keep tions? Do parents need to provide any at the center your baby attends. Pay close For instance, if you’re unaware that
your sick baby home? How are medica- supplies? Can you drop in and visit your attention to your baby, his or her adjust- your baby skipped his or her afternoon
tions and first aid administered? How baby during the day? How can parents ment, and the way he or she interacts snack, you might be bewildered when he
often are a baby’s diapers changed? Are contact staff? with the child care provider or providers. or she has a total meltdown due to hun-
diapering areas and toys regularly Establishing a good relationship with ger just before dinner. Some child care
cleaned and sanitized? Do staff members your baby’s care provider benefits every- centers provide daily logs with this infor-
regularly wash their hands? How are ba- one involved. You may worry that your mation. You can also ask your baby’s care
bies put to sleep? How regularly is bed- CONTACT INFORMATION child will come to love his or her provider provider to create a daily log for you.
ding cleaned? as much as you. Remember, no one can Beyond going over your baby’s daily
Whenever you leave your baby with a replace you in your child’s heart. activities, make time occasionally to have
Safety and security What kind of secu- child care provider or a sitter, make sure Showing your baby’s child care pro- longer talks about your baby’s changing
rity system does the facility have to en- you’ve provided a list of important con- vider warmth and courtesy will make needs and how to meet them. This will
sure that strangers don’t enter the build- tact information, including your phone him or her, as well as your baby, comfort- also give you and your baby’s care pro-
ing? What happens if a child becomes number and how to reach you at all able. This will also make it easier for you vider a chance to discuss any other issues
injured or lost? Are outdoor play areas times. Also, provide the phone numbers and your baby’s care provider to commu- or concerns. Be sure to listen to your
secured? Do outdoor play areas have of any other close family members or nicate. Be sure to set aside a few extra child care provider’s thoughts on each
sturdy structures and safe surfaces? What friends who can be contacted in the event minutes when you leave your baby with topic and, if possible, work together to
kind of security measures are taken dur- of a problem. Explain what you want the care provider and when you return to come up with solutions. If you’re happy
ing field trips? How are children trans- your baby’s care provider to do in the discuss any relevant issues. If your baby with your baby’s care, don’t forget to
ported? What is the program’s emergen- case of an emergency. didn’t sleep much the previous night, is mention it, too. Showing appreciation for
cy evacuation plan? How are other If you’re leaving your baby with a teething or there’s another matter that your baby’s caregiver can help strength-
emergencies handled? child care provider in your home, show might affect his or her behavior that day, en your relationship.
the child care provider the locations of let your baby’s care provider know. If Finding good child care can be a
Daily activities Ask what your child’s all exits, the smoke detector, fire extin- your baby is taking any medications, ex- stressful process. By considering your
daily routine would be like. Is there a mix guisher and the poison control telephone plain what the medication is for and pro- family’s needs at the outset and thor-
of group play and individual attention? Is number. Make sure that anyone who vide written instructions detailing how it oughly researching your options, you’ll
there a balance between physical activity provides care for your baby understands needs to be stored and administered and save time and energy. Carefully review-
and quiet time? Is there time for free the importance of putting your baby to what side effects might occur. If there are ing each candidate’s background and
play? Are there activities appropriate for sleep on his or her back. If the child care certain activities you’d like your baby’s evaluating different child care settings
different age levels? Do care providers provider will be driving your child any- care provider to do with your baby, or if will help you feel more comfortable with
read to the children? Are meals and where, make sue he or she knows how to you don’t want your baby to watch any your decision and ease your concerns
snacks provided? If so, what kinds? What properly use car seats. TV, discuss it with the child care provider. about spending time apart from your
are the program’s overall goals? Is paren- It’s also a good idea to write down When you return, you’ll want to find baby.
tal involvement expected or encouraged? your address and your child’s full name out what happened with your baby that
and birth date in the event of accident. day. How much did he or she drink and
Additional details What is the pro- The stress of an emergency may make it eat and at what times? How many dia-
gram’s admissions policy? What kind of difficult for a child care provider or sitter pers did he or she wet and soil? What
information will you need to provide? If to remember those details. activities did he or she do? How many
the program has a waiting list, how long naps did he or she have, and how long
is it, and how does it work? What are the were they? Did your child achieve any
program’s hours of operation and cost? new milestones or display any behavior
Can you pay in installments? Will you WORKING TOGETHER that’s of concern? Are you running low
need to pay if your baby is absent for a on any necessary baby supplies? Going
vacation? What is the policy for with- In the coming weeks, carefully monitor over these topics regularly will help en-
drawing a child from the program? How the performance of the child care pro- sure consistency in your baby’s care and
CHAPTER 14
Traveling with baby
Whether you’re bringing your baby HEADING OUT

home from the hospital, taking him or
her for a stroll around the block, or going You and your baby are both likely to ben-
on your first family flight together — you efit from getting out of your home. As
and your baby are likely to do some trav- early as your baby’s first month, you
eling in the months ahead. might consider taking him or her out for
As you might have guessed, traveling walks. While you may feel nervous about
anywhere with a baby takes some plan- leaving the comfort of your home as you
ning. Your baby may never have a leaky learn to care for your baby, fresh air and a
diaper, spit up all over, or stray from his change of scenery may lift your spirits.
or her eating schedule when you’re at Taking small trips with your baby now
home, but it always seems to happen will also help you gain confidence and
when you’re out and about. help you prepare for bigger adventures
It’s a good idea to be prepared for later on.
anything when you’re traveling with your Remember, if you’ve been up all night
child. In addition to knowing what to with your baby, your baby is having a
bring with you to meet your baby’s needs fussy day or you can’t face figuring out
while you’re away from home, you’ll have how to work the stroller yet, that outing
to figure out which modes of transporta- you planned can always wait until to-
tion work best and how to use them safe- morrow. There’s no gold medal for the
ly. You probably have more options than new mom who gets out of the house first.
you might realize. Take your time and head out with your
Before you hit the road, find out what baby when you feel ready. To help ensure
you need to know about traveling with a a successful outing, consider the follow-
child, and then have fun! ing tips.
CHAPTER 14: TRAVELING WITH BABY 183

Limit contact When you first take your Keep baby equipment cool Avoid Z Look at the construction. Will the car- Z Be careful when bending. Bend at the
newborn out, consider avoiding places letting your baby’s car seat or stroller sit rier provide adequate support for knees, rather than at the waist, when
where he or she will come into close con- uncovered in the sun for long periods of your baby’s head and neck? Is the picking something up. This will help
tact with a lot of people and, as a result, time before using them. Plastic and metal material sturdy? If you’re looking for a keep your baby settled securely in the
germs. Or head to a destination when it’s parts may become hot enough to burn backpack with an aluminum frame, is carrier.
least likely to be crowded. your child. it padded to protect your baby if he or Z Keep up with maintenance. Keep an
she bumps against it? eye out for wear and tear. Repair any
Check the weather report If possi- Be prepared Don’t leave your home Z Try it out. Is the carrier comfortable rips or tears in the carrier’s seams and
ble, avoid going out with your baby in without diaper supplies, a change of for you and your baby? If you plan to fasteners. Also, check the Consumer
cold and rainy weather — especially early clothes for your baby and, if you’re bot- use the carrier for a while, consider Product Safety Commission’s website
on. If you do head out, bundle your baby tle-feeding, food for your baby — just in how the straps will feel when your to make sure the carrier hasn’t been
and cover his or her head and ears in a case. If you’re nervous, ask a family mem- baby grows, gains weight and be- recalled (see page 553).
warm hat. ber or friend to go with you on your first comes more restless. Z Keep your baby’s airway unobstruct-
few outings. ed. If you use a baby sling, make sure
Dress for the weather Young babies Baby carrier risks When used incor- your baby’s face isn’t covered by the
have trouble regulating their body tem- rectly, a baby sling can pose a suffocation sling and is visible to you at all times.
peratures when exposed to extreme heat hazard to an infant younger than age 4 Check your baby frequently to make
or cold. As a rule, dress your baby in one BABY CARRIERS months. Babies have weak neck muscles sure he or she is in a safe position.
more layer than you’re wearing. Infants and can’t control their heads during the Z Be careful after breast-feeding. If you
should wear hats when it’s cold because One of the most convenient and intimate first few months after birth. If the baby breast-feed your baby in a baby sling,
they can lose a large amount of heat from ways to carry your baby around is in a sling’s fabric presses against a baby’s nose
their exposed heads. If you’re unsure baby carrier. If you’re considering pur- and mouth, he or she may not be able to
about your baby’s temperature, check her chasing a baby carrier, you’ve got op- breathe. This can quickly lead to suffoca-
hands, feet and the skin on her chest tions, including: tion. In addition, a baby sling can keep a
while you’re out.Your baby’s chest should Z Backpack or front pack. This device baby in a curled position — bending the
feel warm, while her hands and feet allows you to carry your baby in an chin to the chest. This position can restrict
should feel slightly cooler than her body. upright position on your back or the baby’s airways and limit his or her ox-
If your baby feels cold, unwrap him or against your chest. ygen supply. In turn, this can prevent a
her and hold him or her close to your Z Baby sling. This is a one-shouldered baby from being able to cry for help.
body. Feeding your baby something warm baby carrier made of soft fabric. A baby is at higher risk of suffocating
also might help. Dressing your baby in in a baby sling if he or she:
layers and bringing extra layers will help Choosing a baby carrier Not all baby Z Was born premature or with a low
you adapt if the weather changes. carriers are created equal. Some carriers birth weight (less than 5 pounds, 8
aren’t appropriate for certain babies. ounces)
Provide sun protection Babies have Others are quickly outgrown. When Z Is a twin
sensitive skin. If your baby is younger looking for a carrier: Z Has breathing problems, such as a cold
than 6 months, keep him or her out of Z Find the appropriate size for your If your baby meets one of these con-
direct sunlight for long periods of time. baby. The carrier’s leg holes should ditions, don’t use a baby sling until
Protect your baby from sun exposure by be small enough so that your baby you talk to your baby’s care provider. In
dressing him or her in lightweight, light- can’t fall through them. Keep in mind addition, if your baby was born prema-
colored protective clothing and a hat that some models aren’t appropriate turely or has respiratory problems, don’t
with a brim. If adequate clothing and for newborns. use an upright positioning device until
shade aren’t available, apply sunscreen Z Check the weight minimum and limit. you talk to your baby’s care provider.
on exposed areas of your baby’s skin. For Different models have different
more information on babies and sun- weight limits. Consider how long Safety tips When using any baby car-
screen, see page 103) you’d like to use it. rier, take the following precautions:

aren’t appropriate for a baby until age 5 Z Buckle up. Always buckle your child’s
SHOPPING CART SAFETY or 6 months. harness and seat belt when taking
him or her for a stroller ride.
Shopping carts are more dangerous than they might appear. They can easily tip Do you need a travel system? Z Be careful with toys. If you hang toys
over when a child is in the shopping cart seat or basket. A child could also fall out If so, you might look for a stroller that from a stroller bumper bar to keep
of the shopping cart seat if he or she isn’t properly buckled in. If possible, look for can hold your baby’s car seat. Some car your baby entertained, make sure that
an alternative to placing your child in the shopping cart. If you must place your seats and strollers come in matching the toys are securely fastened.
child in the cart, make sure he or she is buckled into the seat — and never leave sets, while others require you to buy sep- Z Properly store belongings. Don’t hang
him or her unattended. Don’t allow your child to ride in the basket or ride on the arate attachments that allow the strollers a bag from the stroller’s handle bar,
outside of the cart. to be used with certain car seats. Once which can make a stroller tip over.
you strap your baby into his or her car Place items in the stroller basket.
seat, these kinds of strollers will allow
you to easily move your baby between
make sure you change your baby’s Where and how will you use it? the stroller and car. This type of stroller
position afterward so his or her head If you live in or near a city, you’ll need can also be helpful in an airport, if you CAR SEATS
is facing up and is clear of the baby to be able to maneuver your stroller plan to take your baby’s car seat on
sling and your body. along crowded sidewalks and down nar- the plane. Whenever you travel by car with your
row store aisles. You also might need to baby, a car seat is a must. Not only are car
be able to collapse your stroller in a pinch What kinds of accessories are seats required by law in every state, but
to get on a bus or down stairs to the sub- available? You might consider whether they’re essential for your child’s safety.
STROLLERS way. Suburban parents, on the other you’ll want features or accessories for Traveling with your baby in your lap
hand, might want to look for a stroller your stroller, such as a basket, rain cover, could put him or her at risk of serious in-
If you’re like most parents, you’ll want to that fits into their trunk. If you have twins a stroller blanket, a sun shade or parasol, jury in case of an accident. Find out how
get at least one stroller for your baby. But or an older child, you might consider get- or a cup holder. Some accessories aren’t to choose the right car seat for your child
what’s the best stroller for your baby, fam- ting a double stroller or a stroller with available for certain strollers. and use it safely.
ily and lifestyle? When looking for a stroll- an attachment that allows your older The best time to get a car seat for your
er for your baby, consider the following: child to stand or sit in the rear. Frequent Other features Strollers with wide baby is during your pregnancy, so you’ll
travelers might also want a collapsible bases are less likely to tip over. Many be able to install the car seat in your car
umbrella stroller — either in addition to strollers have brakes that lock two wheels — which might be a more complicated
or as their primary stroller. Plan to take — a special safety feature. If you’re look- process than you realize — and have it
your baby along on your runs? You might ing for a double stroller, choose one with ready for your baby’s trip home from the
look for a jogging stroller, too. one footrest that extends across both sit- hospital. When choosing a car seat, you’ll
ting areas — since small feet can get have lots of options. Don’t assume that
Is it appropriate for a newborn? trapped in between separate footrests. the pricier models are best. Instead, look
If you plan to use a stroller while your Always read the stroller manufacturer’s for a car seat that will keep your baby safe
baby is a newborn, you’ll need to make weight guidelines, especially when look- and best serve your family’s needs. First,
sure that the stroller offers enough of a ing for a stroller with an area for an older decide if you want an infant-only car seat
recline — since newborns can’t sit up or child to sit or stand. or a convertible car seat. You might also
hold up their heads. Some strollers fully check with the store to see if they will let
recline or come with bassinet attach- Safety tips Once you find the right you try out the car seat before you pur-
ments. Strollers that can be used in com- stroller, follow these safety tips, and re- chase it.
bination with an infant-only car seat are member to never leave your child unat- If you have two cars, you might con-
also a good choice. However, most um- tended in his or her stroller: sider buying two car seats or, for an in-
brella strollers typically don’t provide ad- Z Take caution when folding. Always fant-only car seat, two bases. Otherwise,
equate head and back support for young make sure the stroller is locked open be sure to always move the car seat to the
babies. In addition, most jogging strollers before you put your child in it. car in which your child will be traveling.

Infant-only car seat Infant-only car typically has a higher rear-facing weight
seats are for babies who weigh up to 22 and height limit than an infant-only seat. IS YOUR CAR SEAT TOO OLD?
to 32 pounds, depending on the model. This type of car seat typically has a five-
They come with five-point or three-point point harness or an overhead shield — a Yes, car seats do expire — typically after six years. The expiration date is usually
harnesses and can only be used in the padded guard that can be pulled down stamped in the plastic on the bottom of the seat. With time, pieces of the car seat
rear-facing position. This type of car seat around the child. When your child reach- may become worn, jeopardizing the seat’s ability to keep your baby safe in a
typically has a handle and can be snapped es 2 years of age or the rear-facing weight crash. As technology improves, safety recommendations may also change, but for
in and out of a base in your car. This or height limit of the convertible seat, now, the six-year time frame does matter.
allows you to strap your baby into the car you can begin to face the seat forward.
seat inside your home and then simply
lock the car seat into the base. You Other considerations Once you
can also use this type of seat without a know what type of car seat you want, Used car seats If you’re considering If you don’t know the car seat’s his-
base, which might make traveling a little look for a model that will fit into your car. borrowing or buying a used car seat, tory, don’t use it. If the car seat has been
easier. Some models can also be snap- Also, look for a model with a cover that’s make sure the car seat is safe. Look for recalled, be sure to find and follow in-
ped in and out of a stroller base. When easy to clean — in case your child spits these things: structions for how to fix it or get the nec-
your baby reaches the maximum weight up, vomits or spills food in the car seat at Z Comes with instructions and a label essary new parts.
or height allowed for an infant-only car some point. No matter what kind of car showing the manufacture date and
seat, you’ll need to purchase a convert- seat you choose, make sure the label says model number
ible car seat. that it meets all federal safety standards. Z Hasn’t been recalled
Register your car seat online or by filling Z Isn’t more than six years old INSTALLING A CAR SEAT
Convertible car seat You can also out the manufacturer’s product registra- Z Has no visible damage or missing parts
start with a convertible seat, which can tion card so you can be notified in the Z Has never been in a moderate or Properly installing a car seat and correct-
be used rear-facing or forward-facing and event of a recall. severe crash ly buckling your child into it before the
© MFMER
© MFMER
Infant-only seat Convertible seat
188 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 14: TRAVELING WITH BABY 189
start of every car ride, is crucial. Before tion, use the harness slots described in the
you install the car seat, read the manu- instruction manual, usually those at or be- RENTALS, TAXIS, TRAINS AND MORE
facturer’s instructions and the section on low the child’s shoulders. Also, place the
car seats in your vehicle’s owner manual. harness or chest clip even with your child’s Follow the same car safety rules, whether you’re traveling in your own car, a rental
To install an infant-only car seat, armpits — not the abdomen or neck. car, a taxi, train or any other vehicle. Plan to bring your baby’s car seat with you on
you’ll use a back seat seat belt or a car Make sure the straps and harness lie flat any trip in which you might be riding in a vehicle or renting a car from a rental car
seat latch. To install a convertible car seat, against your child’s chest and over his or company. If you’re using an infant-only car seat that has a base, determine if you’re
you can use a back seat seat belt or, in her hips with no slack. If your car seat has going to bring the base with you. If not, make sure you know how to install the car
vehicles made after 2002, a Lower An- a carrying handle, position it according to seat in a vehicle without the base.
chors and Tethers for Children (LATCH) the manufacturer’s instructions.
restraint system. In the LATCH system, After you install the car seat, consider
lower anchors secure the car seat to the having a certified child passenger safety
vehicle. However, the tether — a strap technician check your handiwork at a lo- your newborn. If necessary, place a rolled dren may even try to climb out of a car seat.
that hooks to the top of the seat and at- cal car seat clinic or inspection event. You washcloth between the crotch strap and If your child begins to put up a fight about
taches to an anchor in the vehicle to pro- can also check with the National High- your baby to prevent slouching. Don’t sitting in a car seat, be stern. Tell your
vide stability — is only used on forward- way Traffic Safety Administration for help use any additional products unless they child that he or she must stay in the car
facing seats. Make sure the seat is facing finding a car seat inspection station. Be- came with the car seat or from the seat during travel and that you won’t get
the correct direction and it’s tightly se- fore each trip you take, check that the car manufacturer. going unless everyone is securely buckled
cured — allowing no more than one inch seat is installed tightly. Resist the urge to place your child’s up. Try to remain calm and remember
of movement from side to side or front to In the rear-facing position, recline the car seat in the forward-facing position that this is likely a passing phase. To keep
back when it’s grasped at the bottom car seat according to the manufacturer’s just so you can see his or her smile in your child entertained during travel, talk,
near the attachment points. If necessary, instructions so that your child’s head your rearview mirror. Riding rear facing is play music or sing songs together.
use a locking clip to secure the position doesn’t flop forward. Many seats include recommended until a child reaches age 2
of the seat belt holding the car seat in angle indicators or adjusters. You can or the highest weight — typically at least
place. All new car seats come with lock- also place a tightly rolled towel under 35 pounds — or height allowed by the
ing clips. the seat’s front edge to achieve the cor- car seat manufacturer. If you want to
If you’re using an infant-only seat or a rect angle. To prevent slouching, place know what’s happening with your baby,
convertible seat in the rear-facing posi- tightly rolled baby blankets alongside have someone sit in the back seat next to
your baby or pull over to check on your
baby. Back seat mirrors, while helpful,
can be distracting to drivers.
SLEEPING IN A CAR SEAT Remember, never leave your baby
alone in a car. Babies can quickly become
A car seat is designed to protect your child during travel. It’s not for use as a re- overheated, cold or frightened, and a
placement crib in your home. Limited research suggests that sitting upright in a car baby alone in a car could easily be ab-
seat might compress a newborn’s chest and lead to lower oxygen levels. Even ducted. Even though it might be hard to
mild airway obstruction can impair a child’s development. imagine forgetting your child and leaving
Sitting or sleeping in a car seat for lengthy periods can also contribute to the him or her in the back of the car, it can
development of a flat spot on the back of your baby’s head and worsen reflux, a happen. To remind yourself of your pre-
condition that causes a baby to spit up. In addition, a child can easily be injured by cious cargo, place your purse or wallet on
falling out of an improperly used car seat or while sitting in a car seat that falls from the floor of the back seat whenever your
an elevated surface, such as a table or counter. baby rides in the car with you so you’ll
While it’s essential your child be in a car seat during car travel, don’t let your child have an extra reason to check the back
sleep or relax in the car seat for long periods of time out of the car. seat before leaving the car.
As your baby gets older, he or she may
not enjoy riding in a car seat. Some chil-

AIR TRAVEL his or her own seat. The best way to en-
MOTION SICKNESS sure your child has a seat is to buy one.
Your first flight with your baby will likely When booking your flights, check if there
Any type of transportation can cause motion sickness, a feeling of uneasiness that be a lot different than your previous are any discounts for infant children.
might cause your child to develop a cold sweat, feel dizzy or vomit. While children flights. Instead of worrying about wheth- Keep in mind that car seats must be se-
ages 2 to 12 are particularly susceptible to motion sickness, the problem doesn’t er you have enough reading material, cured in a window seat so other passen-
seem to affect most infants and toddlers. If your baby experiences motion sickness, you may now be worried that your baby gers will be able to exit the row.
talk to your child’s care provider for advice. Keep in mind that medications typically will scream the entire flight. While there’s If you don’t want to buy a seat for
used to treat motion sickness aren’t recommended for children under age 2. no telling how your baby will react to his your baby, try to take a flight in which
or her first time on an airplane, careful empty seats are likely to be available. Or,
planning can go a long way toward calm- if you’re traveling with another person,
ing you and your baby’s nerves. try booking the aisle and window seats
Car seat and air bag safety The before he or she is discharged from the — which might give you a better shot at
safest place for your child’s car seat is the hospital. If this is the case, you’ll need to Identification Depending on your des- an empty middle seat. You can also ask
back seat, away from active air bags. If bring your baby’s car seat to the hospital. tination, your baby might need a pass- about open seats when you board the
the car seat is placed in the front seat and Your baby will be placed in it and have port. If you know you’ll be traveling out- plane — in case one can be assigned to
an air bag inflates, it could hit the back of his or her vital signs recorded for a cer- side of the country with your baby in the your infant.
a rear-facing car seat — right where your tain period of time. This is because sitting future, consider applying as soon as pos- If you don’t bring a car seat for your
child’s head is — and cause a serious or semireclined in a car seat can increase sible. The application process can typi- child on the plane, ask the flight atten-
fatal injury. A child who rides in a for- the risk of breathing problems or a slow cally be expedited for a fee. dant for instructions on how to hold your
ward-facing car seat could also be heartbeat. If your baby has a health prob- baby during takeoff and landing. If you
harmed by an air bag. lem that requires him or her to lie flat, Seat safety Although airlines typically sit in an aisle seat with your baby, be sure
If it’s necessary for a child to travel in a vehicle bed may be recommended. allow infants to ride on a caregiver’s lap to protect your baby’s head, hands and
a vehicle with only one row of seats, de- Look for a vehicle bed that’s been crash during flight, the Federal Aviation Ad- feet from getting bumped by service carts
activate the front air bags or install a tested. Position the bed lengthwise in the ministration recommends that infants or other passengers.
power switch to prevent air bag deploy- back seat so that your baby’s head will be ride in properly secured safety seats. Many traveling families seek out the
ment during a crash. Otherwise, air bag in the center of the car. Always use the Most infant car seats are certified for air bulkhead of the plane, which offers extra
power switches should only be used if buckle and harness to secure your baby travel. In order for your baby to travel in a space. Others prefer the back of the
your child has certain health problems, in the bed. car seat on the plane, your child will need plane, which is typically noisy enough to
his or her care provider recommends When you have the OK to use a car
constant supervision of your child during seat, you may need an infant-only car
travel, and no other adult is available to seat to accommodate your small baby.
ride in the back seat with your child. Use it only during travel, and don’t let IS IT SAFE FOR YOUR BABY TO FLY?
If you’re placing only one car seat in your child sleep in it outside of the car. If
the back seat, install it in the center of the you use a convertible car seat for a small Generally, age doesn’t affect an infant’s ability to handle air travel. While it’s always a
seat — if possible — rather than next to a infant, make sure you use a model with a good idea to avoid enclosed, crowded spaces when you have a newborn, most
door to minimize the risk of injury in case five-point harness, rather than an over- healthy term babies are OK to fly at age 1 to 2 weeks. If your baby was born prema-
of a crash. head shield. During an accident a baby’s turely or has a history of lung disease, however, consider talking to your baby’s care
head could hit the shield. provider before flying with your baby. Because your baby’s lungs might be sensitive
If your baby needs to travel with de- to the effects of the changes in altitude, the care provider might recommend post-
vices such as an oxygen tank, secure them poning air travel until age 1 or later. If your baby has an underlying respiratory condi-
PREEMIES AND SMALL BABIES in the vehicle so they don’t become flying tion, his or her care provider might recommend supplemental oxygen.
objects in case of a sudden stop or acci- Ear infections and ear tubes aren’t thought to pose problems during air travel.
If your baby is born prematurely or at a dent. You might try placing the equipment However, if your baby is ill you might want to consider postponing the flight.
low birth weight, he or she might need to on the floor and surrounding it with pil-
be monitored while sitting in a car seat lows or buckling it in with a seat belt.
192 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 14: TRAVELING WITH BABY 193
drown out crying and may even lull a Boarding Many airlines allow families Giving your baby a sedating over-the- you’re breast-feeding, a blanket or nurs-
baby to sleep. Do what makes the most to board the plane first. This might be a counter medication to make him or her ing cover might come in handy. If your
sense to you. good option if you have a lot of baggage. sleep during the flight isn’t recommend- baby uses a pacifier, bring at least one.
However, some families prefer sending ed. The medication could end up produc- It’s always smart to pack an extra
Getting through the airport If you one parent ahead with the bags, while ing the opposite effect. change of clothes — or two — for your
plan to bring a car seat on the plane, a the other boards last with the baby to If your baby does cry during the flight, baby and an extra shirt for yourself in the
stroller that allows you to attach the car minimize the amount of time spent stuck do your best to figure out what’s wrong diaper bag, just in case. You might also
seat to it is a smart investment. You’ll on the plane. — just as you would at home — and try bring disposable bags for dirty diapers, in
be able to wheel your child in his or her to stay calm. Chances are that many pas- case you don’t have immediate access to
car seat until you board the plane, at Keeping baby happy Dress your baby sengers on the plane have been in your a garbage can during travel, and travel-
which point you can collapse the stroller in comfortable, easy-to-remove layers. situation before and likely sympathize. size hand sanitizer.
base and check it at the gate. You will, This will help you keep him or her warm When packing your baby’s clothes for
however, have to take your baby out of a or cool enough and make diaper and the trip, think about the weather you’re
car seat to go through the metal detector. clothing changes easy. Sucking on a pac- likely to encounter, how many outfit
While the Transportation Security ifier or bottle might ease discomfort dur- TRIP BASICS changes your baby typically needs in a
Administration limits the amount of flu- ing takeoff and landing, since babies day, and whether you’ll have access to a
ids you can bring on a plane, exceptions can’t intentionally “pop” their ears by Taking your baby on a trip — particularly washer and dryer. You might bring along
are made for baby-related items, such as swallowing or yawning to relieve ear those involving flights, overnight stays a few familiar items, such as small toys or
medications, formula, baby food, juice pain caused by air pressure changes. and different time zones — requires a white noise machine, to help your child
and breast milk. Be sure to notify security Breast-feeding your baby — when it’s some planning. When you schedule your feel comfortable in the new environment.
officials about what you’re carrying and safe to do so — also can help. trip, think about your baby’s normal rou- If you’ll be staying at a hotel, call ahead
expect it to be inspected. Also, let security Take occasional breaks to walk up and tine and what you can do during your and see if you can reserve a crib for your
officials know if your baby is using or has down the aisle — as long as the crew ap- travels and trip to accommodate his or room. Otherwise, you’ll need to bring a
any special medical devices. proves moving throughout the cabin. her daily needs. collapsible crib with you. In addition to
the bottle supplies you bring with you on
Minding your baby’s internal clock the plane, consider what kind of steriliz-
If your baby is an early riser, consider ing or cleaning equipment you might
booking an early morning flight and need to bring for the rest of your trip.
scheduling morning activities during Traveling with a baby takes some
your trip. Think about what times your planning and — often — a lot of luggage.
baby typically naps and eats and how Think about what your baby might need,
you’ll be able to keep his or her schedule and do your best to prepare for the worst.
intact while away. Keep in mind that if And don’t forget to enjoy your trip!
you cross time zones during your trip, it
might take your baby a few days to adjust
to new sleeping and eating schedules.
Gathering essentials Start by packing

your baby’s diaper bag, which you’ll need
to keep with you at all times. Fill it with
diapers, wipes, diaper ointment and a
changing pad. If you feed your baby for-
mula, make sure you have formula, bot-
tles and nipples. Bring enough formula to
cover your travel time and well beyond,
just in case you encounter delays. If

CHAPTER 15
Home and
outdoor safety
As your baby becomes more mobile, ex- you don’t childproof every room in your
ploration will become the name of the home, you’ll need to take extra vigilance
game. Rocking, rolling and sitting will to keep your child away from those areas.
give way to crawling, climbing and cruis- Remember, however, that as your child
ing along the furniture. Your baby’s budgets older, it will become harder to ex-
ding curiosity and inexperience, howev- clude him or her from certain areas of
er, can prove to be a dangerous mix. the house.
Power cords, dresser drawers, kitchen
cabinets, dish soap and the toilet are just
a few household items that your baby
might touch, grab or try to climb onto in NURSERY SAFETY
the coming months. Small toys, hot
drinks, slippery surfaces and furniture Your son or daughter will spend a lot of
with sharp edges can also pose hazards time in the nursery. To help keep him or
for your little explorer. While trying to her safe while in the room, here are some
prevent injuries, you can take lots of steps helpful tips:
to safeguard your home and keep your
baby safe outdoors. Use safety straps Always use the
To get started childproofing your safety strap on your baby’s changing ta-
home, consider your family’s lifestyle and ble and never leave a baby alone on the
the layout of your home. Think about changing table. Even at young ages ba-
which rooms your baby will spend time bies can move suddenly and flip over the
in and what dangers each room poses. edge of a high surface. Look for a chang-
Sit on the floor in each room to get an ing table with a guardrail and keep dia-
idea of what might catch your baby’s at- pering supplies within your reach but
tention or be within your baby’s reach. If beyond your child’s reach.
CHAPTER 15: HOME AND OUTDOOR SAFETY 197

Safely store disposable diapers If Reduce water temperature Set the
SAFE TOYS you use disposable diapers, keep them thermostat on your hot water heater to
out of your baby’s reach and cover them below 120 F. If you bathe your baby in the
Babies love to play with toys, but you want to make sure the toys around them with clothing when he or she is wearing kitchen sink, never run the dishwasher at
don’t pose any dangers. them. A child can suffocate if he or she the same time — in case hot water from
tears off pieces of the plastic liner and the dishwasher backs up into the sink.
Choose toys carefully Don’t let your Avoid baby walkers A young child eats them. Don’t run the faucet while your baby is in
baby play with balloons, marbles, may fall out of the walker or fall down the sink.
coins, toys that contain small parts or the stairs while using a walker. The Avoid powders Baby powders contain-
other small items. Balloons, in particu- American Academy of Pediatrics has ing talcum can harm your baby’s lungs if Safely store hazardous objects
lar, pose a major choking hazard when called for a ban on the manufacture they’re inhaled. and substances Keep sharp instru-
uninflated and broken. Avoid projectile and sale of baby walkers with wheels. ments in a drawer with a latch or a locked
toys, extremely loud toys and toys with Take crib precautions Keep your ba- cabinet. Make sure appliances are un-
cords, long strings and small magnets. by’s crib free of small objects. Always put plugged and out of your child’s reach.
Remove plastic wrapping and stickers your baby to sleep on his or her back and Don’t allow electrical cords to dangle
from new toys, and make sure any not on a soft comforter or pillow. Don’t where your child could tug on them.
decorations or small parts — such as allow your baby to sleep with loose blan- Keep hazardous substances out of sight,
eyes, wheels or buttons — are tightly kets. For more information on crib safety, out of reach and — whenever possible —
fastened to the toy. Regularly check see page 120. in a high cabinet that locks automatically
your baby’s toys for small parts that every time you close it. Hazardous sub-
could come loose, sharp edges and Watch toy box lids If you use a toy stances in the kitchen might include
mechanical parts that could trap a box, look for one with no top, a light- dishwasher soap, cleaning products, vita-
child’s finger, hair or clothes. weight lid, or sliding doors or panels. If mins and alcohol.
you have a toy box with a hinged lid,
Safely store toys with small pieces make sure it has lid support for any angle Avoid hot spills Don’t cook, drink or
If you have an older child, you likely have to which it’s opened. In addition, look for carry hot beverages or soup while hold-
toys in your home with small pieces that a toy box with ventilation holes, in case ing a child. Know where your child is
your baby could easily choke on or your child gets trapped inside it. Don’t when you’re walking with a hot liquid so
swallow. Gather up games and toys that block ventilation holes by storing the toy you don’t trip over him or her. Keep hot
have small parts, and do your best to box against the wall. Rounded edges are foods and liquids away from table and
keep them out of your baby’s reach. also a plus. counter edges. Don’t use tablecloths,
When your older child wants to play with placemats or runners, which young chil-
these kinds of toys, make sure he or she dren can pull down. When you’re using
plays with them in an enclosed area and the stove, use the back burners and turn
picks up all of the pieces afterward. KITCHEN SAFETY the handles of your pots and pans in-
ward. Don’t leave food cooking on the
Take care with electronics Don’t al- The kitchen can be an especially danger- stove unattended.
low small children to play with toys that ous place for a baby. When you need to
need to be plugged into electrical out- spend time in the kitchen, consider plac- Safeguard your oven Try to block ac-
lets. Make sure battery covers are se- ing your baby in a high chair with a few cess to the oven. Place tape on the floor
curely fastened. If the toy contains a toys to play with. Or fill a kitchen cabinet around the oven and call it a “no-kid”
button battery, make sure your child with safe items for your baby to play with zone. Never leave the oven door open. If
cannot access the battery. — such as plastic bowls and cups. You you have a gas stove, turn your dials to
might place your child in a playpen in an the off positions and — if possible — re-
adjoining room where you can see him or move them when you’re not cooking.
her. Also take steps to prevent accidents. Otherwise, use knob covers.
198 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 15: HOME AND OUTDOOR SAFETY 199
Look around Watch out for other situa- temperature of the food. Never warm formation about how to respond if your might include nail polish remover,
tions that could be hazardous. your baby’s formula or milk in the micro- baby chokes, see page 210. mouthwash, medications and bathroom
Z Put away small refrigerator magnets. wave. Food or liquids warmed in a micro- cleaners. Dispose of unused, unneeded
A baby could choke on or swallow wave may heat unevenly. For more infor- or expired medicines.
them. mation about feeding your baby, see
Z Address slippery or uneven surfaces Chapter 3. BATHROOM SAFETY Address slippery or uneven sur-
and clean spills quickly. faces Use a rubber pad or slip resistant
Z Keep a fire extinguisher handy. Choking prevention Choking is a The easiest way to avoid bathroom inju- stickers in the bathtub to help prevent
common cause of injury and death ries is to make sure your baby can’t ac- slipping. Place a bath mat with a non-
among young children, primarily be- cess bathrooms in your home without an skid bottom on the bathroom floor. Clean
cause their small airways are easily ob- adult. Consider taking these precautions: spills quickly.
FEEDING SAFETY structed. It takes time for babies to mas-
ter the ability to chew and swallow food, Keep the bathroom door closed
Feeding your baby is often a messy expe- and babies may not be able to cough Bathrooms can be dangerous for many
rience, but you don’t want it to be a dan- forcefully enough to dislodge an airway reasons. The best way to avoid accidents GARAGE AND
gerous one. If you use a high chair during obstruction. is to keep young children out. Install a BASEMENT SAFETY
feedings, always use the chair’s safety Sometimes health conditions in- safety latch or doorknob cover on the
straps to buckle your child in. And before crease the risk of choking as well. Chil- outside of the door. It’s also a good idea Accidents and injuries can also happen
you feed your child, always check the dren who have swallowing disorders, to install childproof locks on toilet lids. in areas where kids don’t spend a lot
neuromuscular disorders, developmental of time. Don’t forget to childproof areas
delays and traumatic brain injury, for Reduce water temperature Make of the house such as the garage and
example, have a higher risk of choking sure the thermostat on your hot water basement.
than do other children. To prevent infant heater is set below 120 F. Don’t run the
choking: faucet while your baby is in the tub. In- Safely store hazardous objects
Z Don’t introduce solids too soon. Giv- stead, fill it and test the water tempera- and substances Keep them in a cabi-
ing your baby solid foods before he or ture before placing your baby in the wa- net that locks automatically every time
she has the motor skills to swallow ter. Consider installing anti-scald devices you close it. Hazardous substances in the
them may lead to infant choking. Wait on bathtub faucets and shower heads. garage or basement might include clean-
until your baby is at least 4 months ing products, windshield washer fluid,
old, preferably 6 months old, to intro- Supervise bath time Never leave a paint and paint thinner. Always unplug
duce pureed solid foods. child alone or in the care of another child and store tools after using them. If you
Z Stay away from high-risk foods. Don’t in the bathtub. A child can drown in just have an unused refrigerator or freezer,
give babies or young children small, a few inches of water. Drain water from remove the door so that a child can’t be-
slippery foods, such as whole grapes the tub immediately after use. Remem- come trapped inside.
and hot dogs; dry foods that are hard ber, infant bath seats or supporting rings
to chew, such as popcorn and raw aren’t a substitute for adult supervision. Don’t allow your child to play near
carrots; or sticky or tough foods, such the garage It might be difficult for a
as peanut butter, marshmallows and Safely store hazardous objects driver to see a small child. Automatic ga-
large pieces of meat. and substances Make sure electrical rage doors can pose a danger for chil-
Z Supervise mealtime. Don’t allow your appliances, such as hair dryers, are un- dren. Always keep the garage opener out
child to play, walk, run or lie down plugged and out of your child’s reach. of reach.
while eating. Don’t allow electrical cords to dangle
Keep in mind that as babies explore where your child could tug on them. Carefully store ladders Put ladders
their environments, they also commonly Keep substances in a cabinet that locks away after each use, and anything else
put objects into their mouths — which automatically every time you close it. that a young child could climb up on. Al-
can easily lead to infant choking. For in- Hazardous substances in the bathroom ways store a ladder on its side.

FRONT YARD AND Injuries typically occur when a child tries Keep cords out of reach Keep tele- Z Watch where you park. If you park in
BACKYARD SAFETY to climb onto, falls against or uses the phone, computer and window-blind direct sunlight, cover the car seat with
furniture to stand up. Be sure to anchor cords tied up and inaccessible — espe- a towel or blanket. Before putting
To protect children from outdoor hazards: TV stands, shelves, bookcases, dressers, cially near your baby’s crib. Safety tassels your child in the car seat, check the
Z Set boundaries. If your backyard desks, chests and ranges to the floor or and inner cord stops for window blinds temperature of the seat and buckles.
doesn’t have a fence, make sure you attach them to a wall. Free-standing and draperies can help prevent strangu- Z Lock up matches and lighters. Store
keep your child within the areas stoves or ranges can be installed with lation. When buying new window cover- matches, lighters and flammable liq-
where he or she should play. Don’t let anti-tip devices. Move floor lamps be- ings, be sure to ask about safety features. uids in a locked cabinet or drawer.
your child play unattended. hind other furniture. Z Choose a cool-mist humidifier. Steam
Z Check for dangerous plants. If you’re Watch out for liquid containers vaporizers can burn a child.
not sure about the plants in your yard, Use door knob covers, locks and Keep your child away from fish tanks and Z Unplug irons. Store items designed to
contact your regional poison control stops Door knob covers and door locks coolers. Empty buckets and other con- get hot, such as irons, blow dryers and
center for advice. If you have poison- can help prevent your child from enter- tainers immediately after use. Don’t leave hair straighteners, unplugged and out
ous plants in your yard, remove them. ing a room where he or she might en- them outside, where they may accumu- of reach.
Z Be cautious when using pesticides and counter hazards. Look for a door knob late water. Z Practice fire safety. Install smoke
herbicides. Wait at least 48 hours be- cover that’s sturdy but can be used easily alarms on every level of your home,
fore allowing your child to play in an by adults, in case of an emergency. Make Avoid certain houseplants Some and regularly maintain all alarms in
area that’s been treated. sure any locks you use on a door can be plants can be hazardous to children. your home. Keep extinguishers near
Z Keep children away from power mow- unlocked from the outside. Consider Contact your regional poison control places where a fire might start.
ers. Mowers may throw yard debris temporarily removing swinging doors center for information and advice.
with enough force to injure a child. and folding doors or keep your child
Keep your child away when mowing. away from them. Safely store firearms If possible,
Also don’t allow your child to ride on don’t keep firearms in your home or in an PREVENTING FALLS
a riding mower. Keep hazardous objects out of area where your child plays. If you do
Z Watch grills and fire pits. Don’t allow reach Common household items that keep firearms in your home, keep the un- There’s plenty you can do to prevent falls.
children to play near these potential may pose a choking hazard include safe- loaded gun and ammunition in separate Follow these simple tips:
hazards. If you have a grill, screen it so ty pins, coins, pen or marker caps, locked cabinets.
your child can’t touch it. Make sure buttons, small batteries, baby powder Beware of heights Never leave a
charcoal is cold before you dump it. and bottle tops. Always safely store all baby alone on a piece of furniture. Al-
potentially poisonous substances in a ways use the safety strap on strollers and
high, locked cabinet. Always keep prod- PREVENTING BURNS other infant seats. Don’t allow a young
ucts in the original containers, which child to play alone on a high porch, deck
GENERAL SAFETY TIPS might contain important safety informa- Children get burned because they don’t or balcony.
tion. Don’t allow your baby to play with know certain objects may be hot. To pre-
To reduce the risk of injury in other areas plastic bags or to play on waterbeds. vent burns, follow these burn-safety tips: Install safety gates Block a child’s ac-
in and outside of your home: Consider placing your trash can in a Z Establish ‘no’ zones. Block access to cess to stairs or doorways with safety
locked cabinet or getting a childproof the fireplace, fire pit or grill, so a child gates. Look for a safety gate that a child
Use furniture bumpers Cover sharp lock for it, in case you throw out poten- can’t get near it. can’t easily dislodge but that adults will
furniture and fireplace corners with cor- tially hazardous items. Z Use space heaters with care. Make be able to easily open and close. If you’re
ner or edge bumpers, just in case your sure a child can’t get near a space putting a safety gate at the top of a stair-
child falls. Consider moving items with Address outlets and electrical heater. Also keep the heater at least case, attach it to the wall. Avoid accordi-
sharp edges out of high-traffic areas cords Place plastic plugs that don’t pose three feet away from bedding, drapes, on gates with large openings, which can
while your child is learning to walk. a choking hazard in electrical outlets, or furniture and other flammable mate- trap a child’s neck.
cover them with plates. Keep electrical rials. Never leave a space heater on
Secure furniture Furniture, such as cords and wires out of the way so chil- when you go to sleep or place a space Lock windows and secure screens
TVs, can tip over and crush a young child. dren don’t chew on them or grab them. heater near someone who’s sleeping. A young child may squeeze through a
window opened as little as 5 inches. Lim- could climb on near a window. When PREVENTING DROWNING Install alarms If your house serves as
it window openings to 4 inches or less. opening windows for ventilation, open part of your pool or hot tub enclosure,
Although all windows that open should windows from the top. Swimming pools and hot tubs are very protect any doors leading to the pool or
have guards or screens, screens often dangerous to young children. Multiple hot tub area with an alarm. Add an un-
aren’t strong enough to keep a child in- Use night lights Consider using them layers of protection can help ensure water derwater alarm that sounds when some-
side. Discourage play near windows and in your child’s bedroom, the bathroom safety and prevent drowning in a home thing hits the water. Make sure you can
patio doors. Don’t place anything a child and hallways to prevent falls at night. pool or hot tub. If you have a pool or hot hear the alarm inside the house.
tub, consider these general safety tips:
Block pool and hot tub access If
Fence it in Surround your pool or hot your house serves as part of your pool
AVOIDING LEAD POISONING tub with a fence that’s at least 4 feet tall. enclosure, use a power safety cover to
Make sure slatted fences and openings block access when the pool isn’t in use.
Lead is a metal that’s found in many places — including old homes, drinking water under fences have no gaps wider than Always secure a cover on a hot tub when
and children’s products — and it can be hard to detect. Children are at especially 4 inches, so kids can’t squeeze through. it isn’t in use. Sliding glass doors that
high risk of lead exposure because they tend to put their hands and objects in their Install self-closing and self-latching need to be locked after each use aren’t ef-
mouths, and their growing bodies readily absorb lead. Even children who seem gates with latches that are beyond a fective pool or hot tub barriers. Remove
healthy might have high levels of lead in their bodies. If you suspect that your home child’s reach. Make sure the gate opens above-ground pool steps or ladders or
contains lead hazards, you can take simple measures to minimize your child’s risk away from the pool or spa. Check the lock them behind a fence when the pool
of exposure. gate frequently to make sure it’s in work- isn’t in use. In addition, empty inflatable
If you think your child has been exposed to lead, ask your child’s care provider ing order. pools after each use.
about a blood test to check for lead.
Check your home Homes built before 1978 are most likely to contain lead. Pro-
fessional cleaning, proper paint stabilization techniques and repairs done by a SAFETY AROUND PETS
certified contractor can reduce lead exposure. Before you buy a home, have it in-
spected for lead. To prevent your child from being bitten or injured, follow some basic animal
precautions.
Keep children out of potentially contaminated areas Don’t allow your
child near old windows, old porches or areas with chipping or peeling paint. If your Z Never leave your child alone with a pet. Your child might inadvertently provoke an
home contains chipping or peeling paint, clean up chips immediately and cover animal to bite him or her through roughhousing, teasing or mistreatment.
peeling patches with duct tape or contact paper until the paint can be removed. Z Teach appropriate behavior. Don’t allow your child to tease pets. Never let your
child pull an animal’s tail or take away its toys or food. Don’t let your child put
Filter your water Ion-exchange filters, reverse-osmosis filters and distillation can his or her face close to a pet.
effectively remove lead from water. If you don’t use a filter and live in an older Z Get your pets vaccinated. Make sure your pets are fully immunized, including
home, run cold tap water for at least a minute before using it. Use cold, flushed tap against rabies.
water for cooking, drinking or making baby formula. Z Be cautious around new animals. Don’t allow your child to approach unfamiliar
animals.
Avoid certain products and toys Lead may be found in children’s jewelry or Z Show your child how to greet animals. For example, show your child how to let
products made of vinyl or plastic, such as bibs, backpacks, car seats and lunch a dog sniff him or her and then slowly extend his or her hand to pet the dog.
boxes. A child can absorb lead found in these products by mouthing or chewing Z Think twice about petting zoos. Young children are at higher risk of contracting
on them or can inhale lead if the product is burned, damaged or deteriorating. an infection through contact with cattle, sheep, goats and other domestic and
Avoid buying old toys or nonbranded toys from discount shops or private vendors, wild animals. If you choose to take your child to a petting zoo or other venue
unless you can be sure that the toys have been produced without lead or other where animals might be present, be sure to wash your child’s hands if they
harmful substances. Don’t give costume jewelry to young children. become dirty in an animal’s area and after leaving the animal’s area.
Use life preservers Young children at his or her grandparents’ homes, you
should always wear life preservers when might consider asking them to do some
in a watercraft. Don’t use inflatable toys childproofing, too. The most important
to keep your child afloat, since they can safeguard, though, is adult supervision.
deflate suddenly or your child might slip
out of them. Even if your child is wearing
a life preserver, you always need to keep
an eye on him or her while in the water.
Beware of drains Don’t allow children

to play near or sit on a pool or hot tub
drain. Body parts and hair may become
entrapped by the strong suction. Use
drain covers, and consider installing
multiple drains to reduce the suction.
Keep your eyes peeled Never leave

children unsupervised in a pool or near a
pool or hot tub. An adult — preferably
one who knows cardiopulmonary resus-
citation (CPR) — should always provide
supervision. Don’t multitask while watch-
ing children in or near water.
Keep emergency equipment handy

Keep pool safety equipment beside the
pool. Make sure you always have a phone
in the pool area.
BE CAUTIOUS, NOT PANICKED
It might seem as if everything in your

home and yard poses a potential threat
to your baby. Don’t panic! You can do
plenty to childproof your home in a sin-
gle afternoon or evening. As your baby
gets older, continue to stay on the look-
out for new hazards. Go through your
home from top to bottom every few
months to make sure you’re doing every-
thing you can to keep your child safe. Be
alert when visiting new places and
friends’ or family members’ homes. If
your child is going to spend a lot of time

CHAPTER 16
Emergency care
Every parent wants a healthy baby, but Z A sudden lack of energy or an inabil-
occasional accidents or injuries can hap- ity to move
pen. Even parents who have plenty of Z Large cuts or burns
experience with babies can occasionally Z Neck stiffness
have a tough time distinguishing normal Z Blood in the urine, bloody diarrhea or
illnesses from more serious problems. persistent diarrhea
You can prepare for emergencies by Z Skin or lips that look blue, purple
asking your baby’s care provider during a or gray
scheduled checkup what to do and where In case of an emergency, call 911 or
to go if your baby needs emergency care. your local emergency care number im-
It also is important to learn basic first aid, mediately. If it’s not possible to call for
including CPR, and to keep emergency emergency assistance, take your child to
phone numbers handy. the nearest emergency facility. In case of
possible poisoning, call the Poison Help
hotline at 800-222-1222. Have this num-
ber by your telephone.
WHEN TO SEEK
EMERGENCY CARE
Seek immediate care for: BLEEDING

Z Bleeding that can’t be stopped
Z Poisoning You generally can judge the seriousness
Z Seizures of the bleeding by the rate of blood loss.
Z Trouble breathing Serious bleeding comes from injured ar-
Z Head injuries teries. Slower bleeding — a steady, slow
Z Unresponsiveness flow of dark red blood — generally comes
CHAPTER 16: EMERGENCY CARE 209

from injuries to veins or the body’s small- CHOKING 2. Thump the infant gently but firmly. Do the child is breathing again, he or she
er blood vessels (capillaries). Bleeding this five times on the middle of the back continues coughing or choking, it may
can be the result of a cut, puncture or Most of the time when something blocks using the heel of your hand. The combi- mean that something is still interfering
abrasion. your baby’s throat, he or she will instinc- nation of gravity and thumps to the back with his or her breathing. In either situa-
tively cough, gasp or gag until the object should release the blocking object. tion, have your child examined by medi-
How serious is it? The rate of blood clears his or her windpipe. Usually chil- 3. Hold the infant faceup on your fore- cal personnel to ensure everything is OK.
loss is a good indicator of the severity. dren will breathe on their own, and you arm, with the head tilted downward. Do
Remember, because babies have a much don’t need to interfere. But if your baby this if the previous steps don’t work. Us-
smaller volume of blood, they can’t afford cannot make sounds, stops breathing and ing two fingers placed at the center of the
to lose as much blood as an older child or turns blue, you must act immediately. infant’s breastbone, give five quick chest CARDIOPULMONARY
adult. Serious injuries that result in Anytime a baby inhales anything other compressions. If the infant is too large, RESUSCITATION (CPR)
bleeding from the arteries can cause than air, he or she will choke. Babies most lay him or her facedown on your lap with
death in minutes if untreated. commonly choke on toys with small parts the head lower than the rest of the body. It’s a good idea for all parents, and for
or foods that “go down the wrong way.” 4. Repeat the thumps to the back and anyone who provides child care, to take a
What you can do If the bleeding is seri- Keep from baby’s reach anything that he the chest thrusts. Do this if the child’s certified course in infant cardiopulmo-
ous and it doesn’t stop on its own or if the or she can choke on, such as hot dogs, breathing doesn’t resume. Call for emer- nary resuscitation (CPR). You can contact
cut or puncture is large or deep or has whole grapes and any small food that may gency medical help. your local American Red Cross or Ameri-
rough edges, apply pressure directly to the obstruct his or her breathing. Coins and 5. Begin infant CPR. As soon as the ob- can Heart Association chapter to sign up
injury with a sterile gauze pad or clean small batteries also are commonly swal- struction is relieved, the child will breathe for a course.
cloth. Keep pressure on the wound until lowed and can obstruct baby’s airway. spontaneously or you’ll need to begin CPR. You may need to give a baby CPR if he
the bleeding stops. In most cases, you can If the child resumes breathing within or she experiences the following:
stop bleeding with direct, firm pressure to How serious is it? When your baby’s a minute or two, he or she probably won’t Z Has no pulse or heartbeat
the wound. Follow these steps: airway is blocked and he or she cannot suffer any long-term ill effects. If, after Z Has blue lips or skin
1. Remain calm. This can be difficult, but clear it, the situation is life-threatening.
it’s important. You must deal with it immediately. The
2. Immediately apply steady, firm pres- longer your baby is deprived of oxygen,
sure to the wound with a sterile gauze the greater the risk of permanent brain
pad, clean cloth or your hand until the damage or death. If you cannot clear the
bleeding stops. Don’t attempt to clean airway, ask someone to call for emergen-
the wound first or remove any embedded cy help.
objects.
3. When the bleeding stops, cover the What you can do If your child is
wound with a tight dressing and tape the coughing, let him or her cough until the
area securely. If the bleeding continues windpipe is clear. If you can see some-
and seeps through the dressing, place thing that’s blocking the throat, carefully
more absorbent material over the first pinch and grab the object to remove the
dressing. blockage. You don’t want to push the
4. If possible, elevate the bleeding area. object farther back. If nothing is visible,
5. If the bleeding continues, apply pres- don’t stick your fingers in his or her
sure to the major vessel that delivers throat. Again, you don’t want to cause
blood to the area. the object to become more deeply
6. If the bleeding doesn’t stop, despite lodged. To clear the airway of a choking
these measures, call 911 or your local infant:
© MFMER
emergency number. If this isn’t possible, 1. Assume a seated position. Hold the
take your child immediately to the near- infant facedown on your forearm, which
est emergency department. is resting on your thigh. A gentle thump on the back can help clear the airway of a choking infant.
210 PART 2: BABY’S HEALTH AND SAFETY CHAPTER 16: EMERGENCY CARE 211
Z Has difficulty breathing or stops gers of one hand just below this line, in breathe into the baby’s mouth one time, First-degree burns They cause redness
breathing entirely the center of the chest. taking one second for the breath. Give a and slight swelling of the skin. These are
Z Is unresponsive 3. Gently compress the chest about 1½ deep enough breath to cause baby’s chest the most mild and affect only the outer
Chances for saving your baby’s life or inches. to rise gently. If it does, give a second res- layer of skin.
avoiding permanent injury increase dra- 4. Count aloud as you pump at a rate of cue breath. If the chest does not rise, re-
matically the sooner you start CPR. about 100 compressions a minute. peat the head-tilt and chin-lift maneu- Second-degree burns They generally
vers and then give the second breath. cause blistering, intense reddening, and
What you can do The procedure for Airway: Clear the airway 3. If the baby’s chest still doesn’t rise, moderate to severe swelling and pain. The
giving CPR to an infant is similar to the 1. After 30 chest compressions, gently examine the mouth to make sure no for- top layer of skin has been burned through,
one used for adults. Loudly call out the tip baby’s head back (head-tilt maneu- eign material is inside. If an object is and the second layer also is damaged.
child’s name and stroke or gently tap the ver) by lifting the chin (chin-lift maneu- seen, sweep it out with your finger. If the
child’s shoulder. Don’t shake the child. ver) with one hand and pushing down airway seems blocked, perform first aid Third-degree burns They’re the most se-
If you’re the only rescuer and CPR is on the forehead with the other hand. for a choking baby. vere. Third-degree burns appear white or
needed, do CPR for two minutes — 2. In no more than 10 seconds, put your 4. Give two breaths after every 30 chest charred and involve all the layers of the
about five cycles — before calling 911 or ear near the baby’s mouth and check for compressions. skin. There may be little pain with these
your local emergency number. If another breathing: Look for chest motion, listen 5. Perform CPR for about two minutes burns because of substantial nerve damage.
person is available, have that person call for breath sounds, and feel for breath on before calling for help unless someone
for help immediately while you attend to your cheek and ear. else can make the call while you attend What you can do For minor burns,
the baby. to the baby. take the following action:
Breathing: Breathe for the infant 6. Continue CPR until you see signs of
Circulation: Restore blood circulation 1. Cover the baby’s mouth and nose with life or until medical personnel arrive. Cool the burn Hold the burned area un-
1. Place the baby on his or her back on a your mouth. der cool (not cold) running water for 10
firm, flat surface, such as a table. The floor 2. Prepare to give the baby two rescue or 15 minutes or until the pain subsides.
or ground also will do. breaths. Use the strength of your cheeks If this is impractical, immerse the burn in
2. Imagine a horizontal line drawn be- to deliver gentle puffs of air (instead of BURNS cool water or cool it with cold compress-
tween the baby’s nipples. Place two fin- deep breaths from your lungs) to slowly es. Cooling the burn reduces swelling by
Burns can range in severity from minor conducting heat away from the skin.
problems to life-threatening emergen- Don’t put ice on the burn.
Before giving CPR to an infant, tilt the cies. They occur most often on a child’s
child’s head back to open the airway. If hands or face. Burns may result from fire, Apply antibiotic ointment After cooling
you see an object in the infant’s mouth, the sun (sunburn is discussed on page the burn for comfort and cleaning, cover
try to pick it out without pushing the ob- 388), heated objects, hot fluids, electricity the burn with antibiotic ointment. This
ject farther back in the airway. or chemicals. will prevent bandages or dressings from
Common sources of burns in infants adhering to the burn.
are hot liquids (such as coffee or tea),
bottles that have been heated in a micro- Cover the burn with a sterile gauze
wave, stoves and cigarettes. Some burns bandage Keeping the burn clean and
result from water heater temperatures covered provides comfort by keeping air
that are excessively high (more than 120 off the injury, and it reduces the risk of
F). You also want to be cautious about a infection. Don’t use fluffy cotton, or other
baby’s clothing catching fire from a spark material that may get lint in the wound.
© MFMER
or ashes. Wrap the gauze loosely to avoid putting

pressure on burned skin.
During infant CPR, alternate compression of the infant’s chest with gentle breaths from How serious is it? Burns can range
your mouth. When breathing for the infant, you want to cover the infant’s mouth and nose from mild to serious and are classified ac- Give acetaminophen Talk to your baby’s
with your mouth. cording to their severity: care provider if you have concerns about
using medication. Refer to dosage in- be obvious, but it may be present. A less bruises and not dangerous. However, DROWNING
structions on the bottle. severe shock may burn your baby’s human bites can lead to infection if they
Minor burns usually heal without fur- mouth or skin. break the skin. Infants can drown in very shallow water.
ther treatment, but watch for signs of in- Never leave your baby alone in the bath-
fection, such as increased pain, redness, How serious is it? Depending on the How serious is it? An animal bite can tub, even briefly. If a phone call, doorbell
fever, swelling or oozing. If infection de- voltage and the length of the contact cause serious wounds — especially to the or something else interrupts your baby’s
velops, seek medical help. with electrical current, an electrical shock face — as well as considerable emotional bath, either ignore the interruption or
For major burns — third-degree burns may range from mildly uncomfortable to trauma. You should consider any animal bring the baby with you, wrapped in a
or second-degree burns that involve a causing serious injury or death. or human bite that breaks the skin to be towel. Keep the toilet lid and bathroom
large area of skin — call 911 or your local a serious injury. Fortunately, cases of ra- door closed. Fence swimming pools with
emergency number. Until an emergency What you can do If you see that bies are uncommon today; still, any ani- automatic latching gates, and constantly
unit arrives, follow these steps: your child is in contact with electricity, mal bite caused by a dog, cat, skunk, rac- supervise your infant when near lakes,
Z Don’t immerse large severe burns in attempt first to disconnect the source. If coon, fox or bat should be evaluated for pools or rivers. Toddlers have even
cold water. Doing so could cause a you cannot disconnect the source, at- rabies risk. Bites by rabbits, gerbils and drowned after falling into buckets used
drop in body temperature (hypother- tempt to move your child away from the hamsters generally are harmless and for cleaning.
mia) and deterioration of blood pres- electricity. Don’t attempt to handle a live only require local wound care.
sure and circulation (shock). wire with your bare hands; use an object What you can do If your child has
Z Check for signs of circulation (breath- made of plastic or wood that won’t con- What you can do If your child is bitten, been submerged in water long enough
ing, coughing or movement). If there duct electricity. follow these guidelines: and isn’t breathing or has breathing
is no breathing or other sign of circu- As soon as your baby is away from the difficulty, has blueness of the skin, is un-
lation, begin CPR. source of electricity, check his or her breath- For minor wounds If the bite barely conscious or has a decreased level of
Z Cover the area of the burn. Use a cool, ing and heart rate. If either is stopped or breaks the skin and there’s no danger of
moist, sterile bandage; clean, moist erratic, or if your child is unconscious, be- rabies, treat it as a minor wound. Wash
cloth; or moist towels. gin CPR and call or have someone else the wound thoroughly with soap and
Z Elevate the burned body part or parts. call for emergency help. If your baby is water. Apply an antibiotic cream or oint-
Raise the area above heart level, if conscious, look for evidence of burns and ment to prevent infection and cover the
possible. notify your child’s care provider. bite with a clean bandage. If the bite
You can prevent accidental electrical breaks the skin, contact your child’s care
shocks by using safety plugs in all electri- provider to see if your child should re-
cal outlets. In addition, avoid stringing ceive medical evaluation and treatment
ELECTRICAL SHOCK long extension cords where a baby can with antibiotics.
reach them.
The most common ways that infants re- For deep wounds If the bite creates a
ceive electrical shocks are by biting into deep puncture of the skin or the skin is
electrical cords or by poking metal ob- badly torn and bleeding, apply pressure
jects or their fingers into unprotected ANIMAL OR HUMAN BITES with a clean, dry cloth to stop the bleed-
outlets. Holiday decorations provide an- ing. See your child’s care provider or go
other source of possible injury, when If your baby is bitten, try to discover the to your local emergency department. If
electrical cords and light bulbs are often source of the bite as quickly as you can. you suspect the bite was caused by an
within a baby’s reach. Household pets are the cause of most animal that might carry rabies, seek
An electrical injury often results in animal bites. Although pet dogs are more medical assistance immediately.
only minor or local injury at the point of likely to bite than are cats, cat bites are Also seek medical assistance if you
contact, similar to a burn. An electrical more likely to become infected. Bites see any signs of infection: pus draining
shock may cause your baby to stop from some wild animals are dangerous from the wound, increasing redness and
breathing and may stop the heart’s because of the possibility of rabies. Most swelling several days after the bite, or red
beating. Internal organ damage may not human bites that children get are only streaks coming from the wound.
consciousness, call for emergency help or Z A seizure amount ingested and any physical beled. Be sure to check the label on med-
have someone call for you. If your baby Z Loss of consciousness changes you detect. icine bottles each time you give a medi-
has no pulse or isn’t breathing, begin If your baby stops breathing or if you cation, especially in the middle of the
CPR immediately (see page 211). Con- cannot detect a heartbeat, begin CPR im- How serious is it? Substances vary night, to confirm that it’s the proper
tinue CPR until medical help arrives. mediately (see page 211). widely in the seriousness of their effects medicine and that you’re giving the
and the amount required to do harm. Re- proper dosage.
member, though, that a small amount of
some products or medications can be
INJURY FROM A FALL SWALLOWED POISON much more damaging to an infant than it
would be to an adult. If you have any INHALED POISON
Infants can fall for many reasons. Falls Almost any nonfood substance is poi- questions about whether a substance
tend to occur when a baby is able to roll sonous if taken in large doses. Babies ex- may be toxic, call the Poison Help hotline Inhaling poisonous substances can cause
or to tip an infant seat or walker more plore by putting things in their mouths. for advice. various reactions, including nausea and
easily than a person realizes, or when he Toxicity of substances varies greatly, and vomiting, loss of or decreased conscious-
or she begins to crawl or walk. with immediate treatment most children What you can do Call the Poison Help ness, headache, breathing difficulties,
aren’t permanently harmed from poisons hotline (800-222-1222) if you suspect coughing, or lethargy. Your baby’s reac-
How serious is it? If your baby cries they swallow. that your child has swallowed a poison. If tion will vary, depending on the amount
immediately after receiving an impact to Always keep the Poison Help hotline your child is in obvious distress (uncon- of exposure and the substance inhaled.
his or her head and remains alert, chanc- number nearby (800-222-1222), and be scious, hallucinating, convulsing, experi- Numerous substances are toxic when
es are the fall didn’t cause serious injury. sure to tell anyone who takes care of your encing breathing difficulties), call 911 or inhaled. They include carbon monoxide,
Falls can be serious, but babies’ soft bones child where the number is. If you have a your local emergency number immedi-
don’t fracture as easily as those of older cell phone, keep the Poison Help hotline ately. Have the container in front of you
children. Important factors that can affect number in your phone. when you call so that you can tell emer-
the seriousness of a fall are the force and Some common items you keep gency personnel what substance caused
distance of the fall and the surface onto around your house can be quite danger- the problem. If you need to go to the
which your baby has fallen. ous to an infant: plants, medications (in- emergency department, bring the prod-
cluding acetaminophen and aspirin), al- uct or container with you if possible.
What you can do Use ice to control cohol, mouthwashes that contain alcohol, Don’t give anything by mouth until
swelling, but be careful not to freeze the automatic dishwasher detergents, pesti- you’ve received advice from the Poison
baby’s skin. In case of a head injury, ob- cides, antifreeze and cleaning substances Help hotline. Depending on several fac-
serve your baby carefully for 24 hours for that contain lye. Personal care products, tors, the medical staff might or might not
any behavior changes. If the injured body cleaning substances and plants are the want your baby to vomit. Seek advice
part looks abnormal, or if your baby can- cause in about one-third of poison cases. from the Poison Help hotline or emer-
not move it, seek immediate care. Also Suspect poisoning if you find your in- gency personnel before you attempt to
seek immediate care if you notice any of fant with an open or empty container of induce vomiting because doing so can
the following signs: a toxic substance. Look for behavior dif- cause more damage in some instances.
Z An inability to crawl or walk, if he or ferences; burns or redness of the lips,
she was able to do so before the injury mouth or hands; unexplained vomiting; Prevention Any medication and many
Z Persistent irritability, possibly indicat- breath that smells like chemicals; breath- products in your house can be harmful to
ing a severe headache ing difficulties or convulsions. your child. If you don’t need the medica-
Z Blood or watery fluid discharge from If you suspect that your infant has tion or product in your house, remove it
the ears or nose swallowed a poison, remove your baby to avoid accidental ingestion. Be espe-
Z Persistent vomiting from the source of the poison and call the cially cautious when visiting grandpar-
Call 911 if your child experiences: Poison Help hotline immediately. Be pre- ents or“nonchildproofed”homes. Be sure
Z Breathing irregularity pared to read the labels on the container, that all substances are in their proper,
Z Lethargy or excessive sleepiness and to describe the substance and child-resistant containers and clearly la-
smoke and fumes from fires, propellants, reach. To confirm a method of treatment,
gasoline, kerosene, turpentine, furniture check with the Poison Help hotline (800-
polish, charcoal, cigarette lighter fluid, 222-1222) if your baby comes into con-
glue, paint remover, and lamp oil. tact with a poison.
It can be dangerous for your baby to If your baby is experiencing obvious
inhale toxic substances. You need to act distress — unconsciousness, lethargy,
quickly when you suspect that your baby hallucinations, convulsions, or breathing
has inhaled a dangerous substance. difficulties — call 911 immediately.
What you can do It’s not a good idea to

use aerosol products near your baby, be-
cause babies can react more severely to a POISON IN THE EYE
small amount of inhaled poison. Never
run your car in a closed garage, and be Poison can get in a baby’s eye when a
sure to maintain coal, wood or kerosene liquid splashes into it. Many substances
stoves regularly. If you smell a strong gas can damage your baby’s eyes, but your
odor, turn off the gas burner or oven, leave infant will not be able to tell you about
your house immediately and call the gas the problem. Therefore, it’s important
company. Avoid breathing the fumes that you be alert to possible situations
yourself, and get your baby to a well-ven- in which this can happen. Acting quickly
tilated area. Check your baby’s breathing could make the difference between a
and pulse, and if necessary begin CPR. temporary problem and a long-term
Call 911 or your local emergency disability.
number immediately if your baby is in
obvious distress — having difficulty What you can do Use a large glass
breathing, showing a decreased level of or pitcher filled with cool tap water to
consciousness or lethargy, is without a flood your baby’s eye for 10 to 20 min-
heartbeat or is convulsing. utes. Try to get your baby to blink fre-
quently as you flood the area. Keep the
baby’s hands out of his or her eyes. You
may need to wrap him or her with a bed
POISON ON THE SKIN sheet to keep his or her hands out of the
affected eye. Get another adult to help
If you suspect that a poison has come you, if possible.
into contact with your baby’s skin, look Call the Poison Help hotline (800-
around nearby your child for some evi- 222-1222) if you’re unsure whether the
dence of the poison. Spilled household liquid that splashed in your baby’s eye is
cleaners would probably leave a baby’s poisonous or if you are unsure whether
skin looking red and irritated. The chem- to seek emergency treatment.
icals in many household cleaning sub-
stances, especially oven and drain clean-
ers, are caustic and can easily damage
your baby’s skin.
What you can do Keep all cleaning so-

lutions in a childproof cabinet out of
CHAPTER 16: EMERGENCY CARE 219

PART 3 CHAPTER 17
Growth and Development Month 1

Month by Month
The first month of your baby’s life can BABY’S GROWTH AND
feel like a whirlwind — coming home APPEARANCE
from the hospital, getting your baby situ-
ated in your home, becoming accus- During the first few days of life, your
tomed to the rhythms of parenting, recu- newborn loses the excess body fluid he or
perating from childbirth. There’s a lot she was born with, which means that by
going on! the time you go home your baby will
At the same time, being with a new- weigh slightly less than at birth. But no
born can make you feel like time has worries, most babies will quickly gain
slowed down to a crawl. After all, new- this weight back, and in about 10 days to
borns spend most of their time sleeping two weeks, your baby will once again be
and eating, with a diaper change and a at his or her birth weight. And growth
crying spell here and there. The most ex- certainly won’t stop there. Most babies
citing times may be when your child’s grow rapidly in their first few weeks. By
eyes are open for a few minutes and you the end of the first month, your baby is
can interact for a short while. Even then, likely to weigh around 10 pounds. Your
you may wonder, should my baby be baby’s height will also lengthen by 1½ to
moving more? Is he or she getting 2 inches.
enough to eat? Many people envision newborns as
But that’s what the first month is all cute, round and smooth-skinned, but
about, slowing down enough to rest, re- that’s not always the case. If your little
cover and get to know each other. By the guy or gal doesn’t look exactly like the
end of the first month, you’ll be surprised glowing pictures you’ve seen of new-
at the changes that have occurred in your borns — those babies are probably 2 or 3
little one and the jump in your own self- months old already — don’t be discour-
confidence as a parent. aged. Passing through the birth canal
CHAPTER 17: MONTH 1 221

Both the brain and the skull grow incred- Your newborn’s skin may also look
DID YOU KNOW? ibly fast in the first few months. In the slightly mottled, with some patches look-
beginning, the average newborn’s head ing paler or darker than others, especially
Babies usually have a couple of growth spurts within the first month or two, gener- measures about 13¾ inches around and near the hands and feet.Your baby’s hands
ally around 7 to 10 days and at 3 to 6 weeks of age. During a growth spurt, your grows to about 15 inches by the end of and feet may also be colder than the rest
baby may want to eat more often, so don’t be surprised if your baby seems to the first month. At birth, baby’s brain ac- of his or her body, and may appear a little
have gone on a feeding frenzy. Hang in there. The frequency of feedings will soon counts for about 20 percent of his or her blue or purple, but if you reposition your
even out again. body weight. By adulthood, this percent- baby or move your baby’s arms and legs a
age decreases to about 2 percent. little, they should regain normal color.
At the top of your baby’s head, you’ll In some cases, your baby’s complex-
notice two soft areas where the skull ion may remind you more of an adoles-
isn’t an easy journey, and it takes a while leave your newborn’s head looking bones haven’t yet grown together (see cent’s than a newborn’s, due to the ap-
for baby’s skin to adjust to the outside slightly elongated or cone shaped at page 27). These soft spots, called fonta- pearance of tiny white pimples. The white
world. Most newborn appearance issues birth. Don’t worry though, your baby’s nels, allow a baby’s relatively large head pimples are harmless spots known as
pass quickly. To help you gauge what’s nor- head should round out in a few days. Ba- to move down the narrow birth canal. milia (see page 100). Later, your newborn
mal, here are some brief descriptions of bies born buttocks or feet first or by C- They also accommodate a baby’s rapidly may even develop newborn acne, charac-
how a typical newborn is likely to appear. section are more likely to have round growing brain. You may notice slight terized by small red bumps on his or her
heads at birth. Pressure on your baby’s bulging from these spots when your baby face (see page 100).
Head Forging headfirst through the face may leave your newborn’s eyelids cries or strains. Many newborns have birthmarks. You
birth canal can put a lot of pressure on a puffy or swollen. may notice reddish or pink patches above
baby! Literally, pressure from the tight The size of your baby’s head is impor- Skin A newborn’s skin can cause consid- the hairline at the back of the neck, on the
birth canal can cause the bones in your tant because the growth rate of your ba- erable distress to new parents. It’s just eyelids or between your newborn’s eyes.
baby’s skull to shift and overlap. This can by’s head reflects the growth of the brain. more blotchy, flaky, pimply and wrinkled These marks — nicknamed salmon
than they expected. But most of the time, patches or stork bites — are caused by
this is completely normal. For example, collections of blood vessels close to the
Month 1 switching from the moist environment of skin (see page 31). Darker skinned babies
35 the womb to the relatively dry air outside are sometimes born with a large, flat, blu-
of it can cause the top layer of your baby’s ish-gray mark on the buttocks or lower
skin to flake off shortly after birth. You back. This type of mark is commonly
may notice plenty of dry, peeling skin for called a mongolian spot or slate gray ne-
30 the first few weeks. vus (see page 30).
Length 25 INFANT JAUNDICE

(inches)
It’s not uncommon for a healthy newborn to have a yellow color to his or her skin
and eyes. This is called jaundice and occurs when the baby’s blood contains an
20 Average girl
(50 percentile)
Average boy
(50 percentile) excess of bilirubin, a yellow-colored pigment of red blood cells.
Jaundice typically develops because a baby’s liver isn’t mature enough to
21 in. 21.5 in.
9 lbs. 9.5 lbs. properly get rid of bilirubin in the bloodstream. Mild infant jaundice is harmless and
usually resolves on its own within a few weeks. If your baby’s jaundice doesn’t go
15 away after a couple of weeks or gets worse, contact your care provider promptly.
You can find out more about infant jaundice on page 378.
5 10 15 20
© MFMER
Weight (pounds)
222 PART 3: GROWTH AND DEVELOPMENT MONTH BY MONTH CHAPTER 17: MONTH 1 223
Umbilical cord The stump of a new- the cramped quarters of the womb. As
born’s umbilical cord is usually yellowish long as your newborn’s legs and feet are SOOTHING BY SUCKING ins and outs of nursing. Also, choose a
green at birth. If the stump is treated with flexible and can easily be moved about, pacifier that’s made of one piece to
an antiseptic solution called triple dye, it there’s no need for concern. These curves Most babies have a strong sucking re- avoid any choking hazards, and that’s
may look blue. As the stump dries out typically straighten on their own as your flex. Beyond nutrition, sucking often dishwasher safe for ease of cleaning.
and eventually falls off — usually within baby becomes more mobile. When a has a soothing, calming effect. That’s It helps to have several identical pacifi-
two to three weeks after birth — it’ll child is born, part of a newborn checkup where a pacifier can come in handy. ers handy, so you’re not searching for
change in color from yellowish green to includes an evaluation of a baby’s hips, Some babies are interested in paci- the lone favorite in a desperate time of
brown to black. In the meantime, keep legs and feet. fiers; others aren’t. If your baby isn’t en- need. Also make sure to replace paci-
the stump clean and dry. thralled at first, you can try invoking your fiers that have worn or cracked nipples,
Hair Don’t be alarmed if that great head baby’s natural sucking reflex by gently as the nipples can tear off and pose a
Breasts and genitalia Before birth, of hair your baby was born with falls out stroking the side of your baby’s mouth choking hazard.
the mother’s hormones pass through the within the first few weeks. Almost all while holding the pacifier in his or her Most kids stop using pacifiers on
baby’s system. This may lead to swollen newborns lose at least some of their baby mouth until the sucking gets going. their own between ages 2 and 4.
breasts at birth — for both boys and girls. hair. It will grow back in a few months. If a pacifier seems to help your
Newborn girls may have a swollen Plenty of babies also develop temporary baby, feel free to use it. The American
vulva and light mucus-like or bloody bald spots on the back of the head from Academy of Pediatrics gives pacifiers
vaginal discharge. The swelling typically regular contact with the crib mattress or the go-ahead for soothing between
disappears within two to four weeks. Nor- other sleeping surface. Once your child feedings and helping baby fall asleep.
mal vaginal discharge may last only sev- starts rolling over and moving around, this Pacifiers used during sleep may even
eral days. won’t be a problem anymore. help reduce the risk of sudden infant
For some newborn boys, fluid can ac- Some newborns are covered by fine, death syndrome (SIDS). The downside
cumulate around a testicle. This swelling, downy hair at birth — known as lanugo is that you may be woken up more of-
known as a hydrocele, usually disappears — especially on the back, shoulders, fore- ten during the night to retrieve a lost
within a few months. Frequent erections head and temples. Tiny hairs may also ap- pacifier.
are common, too. pear on your newborn’s ears or in other In the beginning, be sure that paci-
spots. Lanugo is most common in prema- fier use doesn’t interfere with your
Legs and feet A newborn’s legs and ture babies. It typically wears off from nor- breast-feeding routine, especially while
feet often look bowed or bent, thanks to mal friction within several weeks. you and your baby are still learning the
SPOT-CHECK: WHAT’S GOING ON THIS MONTH BABY’S MOVEMENT brain must send messages via nerve cells
to his or her muscles with specific instruc-
Here’s a snapshot of what your baby’s basic care looks like in the first month. In this first month, your baby doesn’t tions for movement. In the first few weeks
have a whole lot of control over his or her of life, brain and nerve cells are rapidly de-
Eating Baby will need breast milk or formula generally every two to three hours, movements, which are likely to be jerky veloping, but they haven’t achieved fluid
although the frequency at first can be pretty variable. The goal is a minimum of and quivering. Your baby may also startle communication yet.
eight to 12 feedings a day to make sure your newborn is getting enough to eat. easily and even cry at sudden movements Over time, the maturation of your
(Chapter 3 discusses nutrition in more detail.) or loud noises. Holding your baby close child’s nervous system will allow your
or swaddling him or her will help bring baby to gain control over different parts of
Sleeping Expect your newborn to sleep about 16 hours a day, in one- to three-hour comfort. his or her body. This follows an orderly se-
spurts, fairly evenly distributed throughout the day and night. Place your baby on his Because your newborn’s brain and quence from head to toe, so your baby’s
or her back to sleep to decrease the risk of sudden infant death syndrome (SIDS). nervous system are still immature, move- first major milestone is gaining head con-
ments are largely reflexive, or involuntary. trol, followed later by sitting, crawling and
In order to move purposefully, your baby’s walking. By the end of the first month,
your baby’s neck muscles will have devel- So don’t get discouraged if you and your BABY’S SENSORY react to different sounds. As with your
oped considerably. When lying facedown, baby don’t seem to nail breast-feeding at DEVELOPMENT baby’s visual preference for the human
your baby may lift up his or her head and first pass. Give yourselves a little time to face, your baby favors the sound of hu-
turn it from side to side. practice and adjust. From the get-go, your baby arrives with man voices, reacting especially to high-
In the first few weeks, your baby’s all five senses intact. Not only does your pitched voices, such as the mother’s. It’s
hands are apt to be curled up into tight Grasp reflex Placing your finger in your baby use his or her senses to learn about possible that your baby may even recog-
little fists much of the time. By the end of newborn’s palm causes your baby to the surrounding environment, he or she nize your voice from having heard it in
the first month, you may catch your baby grasp your finger, and you’ll find that if also uses them to form emotional attach- utero and will turn his or her head to-
trying to bring those fists toward his or her you try to remove your finger, he or she ments with you and others. By identify- ward the sound of your voice from the
face for closer inspection. Over time, your will grasp it even tighter. A similar reac- ing your face, your smell and the sound beginning.
baby’s hands will relax and spread wide, tion occurs if you stroke the sole of your of your voice, your baby establishes a Some babies are more sensitive to
allowing him or her to use them more baby’s foot. These reflexes generally dis- connection with you. noise than others. Too much noise, for
deliberately. appear by 2 to 3 months of age. In addition, your baby rapidly begins example, and your baby may start to cry.
using multiple sensory skills to explore In general, low, rhythmic tones are most
Baby reflexes From birth, your baby Startle reflex If your newborn hears a and interact with you. For example, your likely to soothe your baby.
comes hard-wired with a number of auto- loud noise, he or she will react by throw- baby will quickly connect the sight of the
matic responses (reflexes), some of which ing out his or her arms and legs and then breast or bottle with a particular scent, all Smell Your baby already has a keen
are focused on surviving his or her entry drawing in his or her arms. This reaction of which equals food! sense of smell and quickly becomes able
into the big, new world. These include: is also known as the Moro reflex. Anoth- In the first month, this is how your to discern his or her mother’s breast milk
er time it occurs is if your baby’s head baby is likely to perceive the world: from other mothers’ breast milk. Other
Rooting reflex If you stroke your baby’s suddenly falls back. Doctors may check smells new babies seem to like include
cheek or the corner of his or her mouth, this reflex to make sure your baby’s de- Sight At birth, your baby is fairly near- sweet or fruity smells, such as vanilla, ba-
your baby will turn toward your hand velopment is healthy. The startle reflex sighted, with the ability to focus on ob- nana and sugar. Harsh or acidic smells,
and move his or her tongue in that direc- usually disappears by about 2 to 4 months jects that are roughly eight to 12 inches such as alcohol or vinegar, are likely to
tion. This helps your baby find the nipple of age. away. Coincidentally, this is just about meet with wrinkled noses.
of the breast or bottle and initiate feed- the distance between your baby’s eyes
ing. This reflex usually disappears around Tonic neck reflex This reflex occurs when and your face when you’re nursing or Taste As a newborn, your baby has more
4 months of age. your baby turns his or her head to the holding him or her. Thus, from early on, taste buds than does an adult. Therefore,
side. Simultaneously, his or her arm and your baby is able to gaze at your face and your little one can be fairly picky about
Sucking reflex This reflex is present even leg on the same side will extend out, quickly learns to recognize it. In fact, at different taste sensations, including the
in utero, and you may have even seen while the opposing arm and leg flex, giv- this stage, your baby prefers the human temperature of his or her breast milk or
your baby sucking his or her thumb during your baby the look of a fencer. It’s face to any other patterns. formula. Most babies also prefer sweet
ing an ultrasound examination. After your a fairly subtle reflex though, so don’t Right after birth, your baby is very tastes to sour ones.
baby is born, placing a nipple in his or her worry if you don’t notice it every time. sensitive to bright light and is likely to
mouth will cause your baby to automati- The tonic neck reflex disappears around close his or her eyes tightly to keep the Touch New babies have a fully devel-
cally begin sucking. At first he or she 4 to 7 months. light out. Over the next few weeks, oped sense of touch, as well. For exam-
squeezes the area around the nipple be- though, your newborn’s vision will de- ple, they prefer soft, smooth surfaces to
tween the tongue and palate to force out Stepping reflex If you hold your newborn velop enough so that he or she can see a coarse or scratchy ones. And they can feel
the milk. Next, your baby moves his or her upright and let his or her feet touch a flat widening range of lights and darks. The pain at the prick of a needle. Most impor-
tongue toward the end of the nipple to surface, your baby will pick up one foot higher the contrast in a pattern, the more tantly, they respond to the way they’re
move the milk into his or her mouth. The and then the other, as if walking. Of likely it is to catch your child’s attention touched. In essence, this is the first form
American Academy of Pediatrics reminds course, your baby’s not ready to walk yet, during this first month. of communication between you and your
parents that even though this rhythmic and this reflex will disappear around 2 baby. Gentle handling, snuggling and
sucking is a reflexive action, it generally months, but it will become a controlled Sound Your baby’s hearing is fully ma- holding are not only soothing to your
takes a bit of practice for your baby to turn skill by the time he or she is walking, ture at birth, but it takes a little while for baby but a sign of your love and affection,
the reflex into an effective voluntary skill. usually around a year or so of age. your baby to learn how to recognize and as well.
BABY’S MENTAL DEVELOPMENT brain cells rapidly start making connec- also set the foundation for communica- drive to respond when a baby cries, mak-
tions called synapses. These connections tion and the interpersonal skills your ing this form of communication between
Your baby’s brain has been on a develop- create pathways between brain cells that, child will use when relating to others. you and your baby fairly innate. Re-
ment fast track — generating new brain when reiterated through day-to-day ex- Remember, it’s never too early to set sponding warmly to your baby’s cries
cells (neurons) at a rate of 250,000 a min- periences and activities, form the basis the foundation for essential skills such as helps your baby feel safe and secure in
ute — ever since the early days of your for knowledge and thought and for skills language. It may still be a number of his or her new environment.
pregnancy. By the time your baby is born, such as remembering, analyzing and months yet before your newborn will be Lots of crying can be hard to take, of
he or she has virtually all of the brain problem solving. For example, repeated talking, but he or she is already forming course. If you’ve run through your mental
cells that he or she will use in a lifetime. interaction with you as a loving and at- necessary connections for language de- checklist and your baby is dry, full, com-
But having all of these brain cells is tentive caregiver will soon establish your velopment. You can further encourage fortable and snug, then maybe he or she
just the beginning. As your baby is ex- image as a symbol of safety and security such development by speaking and read- just needs comforting for a bit. Or your
posed to a whole new world, his or her in your baby’s mind. These connections ing to your child. And it doesn’t have to baby may need some downtime without
be a children’s book. Read your own any stimulation, even if he or she does
pleasure book out loud, or your email or cry for a few minutes. Sometimes you
the newspaper out loud. may not know why your baby is crying,
TOYS AND GAMES Your baby’s environment has a tre- and that’s OK, too. If your baby cries a
mendous impact on how his or her brain lot, it’s OK for you to take a break. Let
During the first month, your baby doesn’t need a lot of toys to be entertained — develops. While your baby’s genetic your partner take over for a while, or lay
there are so many other things to take in. Still, you can provide different things for makeup and physical development pro- your baby in a safe place for a few min-
your baby to look at and listen to, which will help his or her brain cells develop vide the essential“nature”ingredients, you utes of alone time. Crying usually in-
more and better connections. Generally, the best time to play with your new baby provide the “nurture” components. You’ll creases over the first few weeks, peaking
is when he or she is quiet and alert. get lots more information in the following at about three hours a day at 6 weeks of
chapters on how you can create the best age and gradually decreasing to about an
Chit chat Since your face is one of your baby’s favorite things to look at, why not environment for your child’s mental hour a day at 3 months old. Chapter 8
make it available? Position yourselves face to face and have a conversation. Talk growth and development. But the one discusses crying in more detail.
to your baby about your day and what you’re planning for dinner. Make faces, thing that is essential to know, especially
smile and sing to him or her. now in the first month, is that all children
thrive in an environment of love and at-
Listen to music Play soft music while your baby lies in a crib or swing and you tention, no matter how old they are.
fold laundry or take care of some other chore.
Communication Of course you knew
Provide a view During the first few weeks to months, your baby’s neck muscles your baby wouldn’t be able to talk for
are still developing. But your baby can look from side to side. Securely install an quite some time, but who knew it would
unbreakable mirror on the inside of your baby’s crib or hang a picture with bold, be such an adjustment to stare at your
graphic lines near the changing table at baby’s eye level. newborn and realize you were temporar-
ily going to have to rely on something
Read a book Although your baby isn’t old enough to understand or interact with other than words to communicate?
a book yet, it’s never too early to start reading together. Your baby will enjoy the You’ll quickly discover, however, that
rhythmic sound of your voice as you read, whether it be Dr. Seuss' Hop on Pop or your baby has a few different ways of
your usual news source. communicating during this first month.
Get some tummy time Place your baby on his or her tummy for a short time Crying This is the only way your baby
while he or she is awake. This will encourage your baby to hold his or her head up can verbalize his or her needs and feel-
and strengthen those neck muscles. ings. All babies can and should cry, be-
cause this helps them receive the care
they need. Adults, in turn, have a strong
Body language During these first few
weeks, your baby also communicates
through body language. For example,
they are able to receive information from
you and interpret the nonverbal signals
you send, such as the expression on your
1ST MONTH MILESTONES
when awake and alert, your baby may face and the way you hold your baby. In this first month, new babies are usually working on the following skills:
make eye contact with you and carefully Z Turning head from side to side
scan your face. Or if your baby thinks Z Lifting head for a second while lying on belly
there’s simply too much going on at the Z Bringing fists in toward face
moment, your baby may react by turning BABY’S SOCIAL DEVELOPMENT Z Scoping out human faces and maybe high-contrast patterns
away from the source of stimulus, closing Z Visually tracking moving objects that are in close range (eyes may cross at this
his or her eyes or becoming irritable. The main social event on your baby’s calen- age as eye muscles are still developing)
Although new babies aren’t capable dar this first month is getting to know you. Z Perhaps turning head toward familiar voices and sounds
of responding in so many vocal ways yet, While you’re occupied trying to figure out
your baby, your baby is busy using all his or proach of love and gentle care that
STATES OF CONSCIOUSNESS her senses to become acquainted with you communicates safety to your child.
— how you smell, sound, look and feel. For some people, bonding comes more
Scientists have observed, and you will too, that new babies fluctuate between dif- easily than for others. If you don’t feel im-
ferent states of consciousness throughout the day. Some of these states are dur- Becoming attached Babies are pretty mediate attachment to your baby on day
ing sleep, and some occur while your baby is awake. There’s no need to memorize amazing self-functioning packages when one, don’t worry too much. After all, this is
them, but understanding the different states of consciousness may help you better they arrive, but they still depend on their a new person in your life, no matter how
understand your baby’s moods. environment for survival. Every time you little. As you spend time together and get
Z Deep sleep. During the deep sleep state, your baby sleeps quietly and does feed your baby, change your baby’s dia- to know each other’s traits and character-
not move. per, respond to your baby’s cries or sim- istics, you’ll develop a unique relationship
Z Active or light sleep. In this state, your baby moves while sleeping, and may be ply hold your baby close, you’re estab- that will only be strengthened in the
startled or wakened by loud noises. lishing a pattern of consistent availability months and years ahead. In addition, many
Z Drowsiness. Drowsiness may occur before or after a sleep state. You’ll notice to your baby’s needs. This creates a bond new mothers have a mild case of the blues
your baby’s eyes become a little droopy, and he or she may yawn or stretch. of trust and confidence between the two after childbirth, not to mention fatigue
Keep this one in mind for when you want to put your baby down to sleep on of you. This bond is the primary building and soreness. If you don’t start feeling bet-
his or her own. block for your child’s early social devel- ter and more involved in your parenting
Z Quiet alert. In this state, your baby looks bright-eyed and bushy-tailed, but his opment. It’s also your baby’s template for role after a few weeks, talk to your care
or her body is quiet. later interactions with the world at large. provider about getting treatment.
Z Active alert. During active alert, your baby is wide-eyed and moving actively. He As a primary caregiver, you become your
or she may be busy entertaining himself or herself. child’s “home base,” to which he or she Building up to smile Smiles actually
Z Crying. This state of consciousness is not hard to recognize because of the will repeatedly return over the years for take a while to develop, but you may no-
wails coming from your baby’s mouth. When your baby is crying, he or she also comfort, help and sustenance. tice over the course of this first month
tends to flail or thrash about. For many women, breast-feeding is a that your baby sometimes smiles during
natural way of bonding with a newborn sleep or after a feeding. Around 4 weeks
The best time to interact with your baby usually is during the quiet alert state. In because it covers many of the baby’s or so, your baby’s smile may evolve a lit-
this state, he or she is most likely to be receptive to play and outside stimulation. Be needs at once — food, warmth, comfort tle further, involving the eyes more, and
warned, though, that new babies tend to cycle through states of consciousness and security all rolled into one. But don’t come several seconds after hearing your
fairly quickly. So don’t be surprised if a toy elicits attention for a short while and then worry if you’re not breast-feeding. You voice or feeling your touch. Next month,
quickly becomes a source of irritation when your baby starts crying. Just move on to can still connect with your baby when you can look forward to full-blown hap-
what your child wants next, which is probably comforting. you’re feeding your baby a bottle or do- py smiles involving the whole face that
ing any of the other myriad activities income in response to your own smiles.
volved in baby care. It’s your general ap-
CHAPTER 18
Month 2
By the beginning of your baby’s second BABY’S GROWTH AND

month, you’re probably starting to get a APPEARANCE
handle on having a new baby in the
house. You’re more adept at basic care- During the second month of life, your baby
giving activities, such as changing dia- keeps growing at about the same rate as he
pers or fixing bottles, and you’ve almost or she did during the first few weeks —
gotten your swaddle technique down. If gaining about 5 to 7 ounces a week and
you’re breast-feeding, you’ve probably growing about ½ inch a month. Your baby
started ironing out some of the kinks, is starting to fill out — cheeks are getting
and you and your baby are feeling a lot chubbier and arms and legs fuller!
more confident in your techniques. The head and brain are still growing
During month two, you’ll still be per- rapidly so that head circumference in-
fecting a lot of these activities, but you’ll creases by about ½ inch a month, as well.
also see your baby’s personality begin to It’s normal for your baby’s head to be
emerge. Your diligent efforts are more apt proportionally larger than the rest of his
to be noticed by your little tyke, and you’ll or her body at this point — it’s still grow-
likely be rewarded with the beginnings of ing faster than anything else. The soft
true interactive smiles. What’s nice about spot on your baby’s head is still open, but
month two is that the cogs of family life toward the end of this month and into
are slowly sliding into place and yet the the third month, it should start to be-
excitement of it all is still bright. come more firm and closed.

Keep in mind that healthy infants Fits and stops Just when your baby is
come in a range of sizes. Although it’s easy finally sleeping for several nighttime SPOT-CHECK: WHAT’S GOING ON THIS MONTH
to cite generalizations, such as the figures hours at a stretch, he or she seems to
just listed, it’s difficult to predict your revert to waking up every two hours Here’s a snapshot of what your baby’s basic care looks like in the second month.
baby’s exact growth. Your care provider again. What’s going on? Nothing out of
will monitor your son’s or daughter’s the ordinary, probably. The fact is that in- Eating Feed your child with breast milk or formula exclusively. Breast-fed babies
growth at each well-child visit. Where fant growth and development occurs in are still likely to want to eat every two to three hours. As the second month pro-
your child’s numbers fall on the growth fits and stops. Sometimes it may even gresses, however, your baby’s stomach capacity grows, and he or she may take in
chart or how they compare with other ba- seem that your baby is forgetting recently more milk at a feeding. This may lead to a dropped nighttime feeding and hopefully
bies’ numbers isn’t nearly as important as learned behaviors. Usually this pause more sleep! Formula takes longer to pass through the stomach, so formula-fed
whether your baby is maintaining his or precedes a new leap forward. For exam- babies are more likely to eat every three to four hours. Within a month or two,
her own steady growth curve. ple, your baby may be subtly working out though, the difference in nighttime feedings between breast-fed and formula-fed
Baby skin issues start looking a little the maneuvering necessary to roll over, babies tends to even out.
better. Any jaundice should be mostly but until he or she masters the right tech-
gone by the second month. If not, contact niques, your infant may not fall or stay Sleeping Your child may sleep between 15 and 16 hours a day. As your baby’s
your care provider. Other newborn skin asleep as he or she once did. nervous system matures and stomach capacity increases, more of these sleep
conditions, such as the little white pim- hours will be consolidated into nighttime hours. At 2 months, your baby may be
ples known as milia, are largely disap- sleeping for five to six hours at a stretch at night. Always place your baby on his or
pearing, although newborn acne may her back to sleep to decrease the risk of sudden infant death syndrome (SIDS).
stick around for another month or two. If BABY’S MOVEMENT
your baby has acne, gently cleanse your
baby’s face with baby soap several times a Most of your baby’s movements are still
week, and stay away from lotions and oils. jerky and involuntary (reflexive) at this
point. But as the month progresses, these your baby can keep his or her head cen-
Month 2 newborn reflexes will begin to give way tered and look straight up — a handy
35 to more purposeful movements. While skill for watching mobiles!
this is occurring, your baby may seem less At this age, most babies aren’t ready
active for a short period until he or she be- to roll from front or side to back yet —
gins to get the hang of major muscle coor- that generally happens around 3 to 4
30 dination. Your little son or daughter is months of age. But you cannot be certain
practicing new positions by stretching, that your baby will stay in one place ei-
moving and watching. ther. Babies this young can use their feet
Your baby’s neck muscles are getting to push off surfaces and scoot around.
Length 25 stronger, too. When pulling your baby And even though they’re just learning
(inches) gently to a sitting position, you’ll notice controlled maneuvers, they can unex-
that his or her head still lags behind a pectedly flip themselves over by sudden,
bit. But when upright, your baby can startled movements. Don’t leave your
20 Average girl
(50 percentile)
Average boy
(50 percentile) probably hold his or head steady for a baby unattended on the changing table
few seconds, although not much longer. or other elevated surface, and take prop-
22.5 in. 23 in.
10.5 lbs. 11.5 lbs. Continue to support your baby’s head er precautions to securely strap your baby
when holding or carrying your baby. in while on a changing table.
15 When lying belly-side down, your baby Toward the end of the second month,
may raise his or head to look straight your baby may also start to become aware
5 10 15 20
© MFMER
ahead for a few moments, rather than of his or her hands and fingers and try to
Weight (pounds) just side to side. Lying on his or her back, bring them together to play with them.
BABY’S SENSORY ing language as “receptive” and outgoing
TOYS AND GAMES DEVELOPMENT speech as “expressive” language. Recep-
tive language, where your baby listens
During the second month, your baby Set up a mobile Your baby is better During the second month, your baby’s and absorbs speech and sounds around
will gradually be awake for longer peri- able to hold his or her head steady eyes are getting better at moving and fo- him or her, almost always precedes ex-
ods of time and have more quiet alert enough to look straight up while lying on cusing on objects at the same time, mak- pressive language, which is when your
times. You can take advantage of these his or her back. Mobiles can become ing it easier for your child to visually track baby starts to vocalize his or her own
times by providing stimuli that encour- particularly fascinating. When choosing moving objects. Your baby’s brain isn’t thoughts. In general, children understand
age your child’s development. a mobile, look at it from your baby’s per- mature enough to speedily process visual language much earlier than they are able
But let your baby guide playtime. spective. Keep in mind a child’s prefer- information, but he or she can track a toy to clearly use it themselves. For example,
Watch for clues that he or she is tired or ence for simple shapes, high contrast moving in front of him or her if it’s mov- your baby will understand the meaning of
overstimulated, such as turning away, and bright objects. Some models will ing very slowly. Although your baby is still the words “Come to mama” months be-
closing his or her eyes, or becoming ir- even twirl around to music, engaging likely to prefer the sight of human faces, fore he or she can articulate them.
ritable. Also, keep in mind your baby’s both your baby’s eyes and ears. Be sure he or she will also enjoy patterns that are
physical limitations. During physical all items are secured completely and more complex and colorful than simple Cooing and gurgling One of the most
play, be gentle and careful not to shake placed out of baby’s reach. black-and-white checkerboard images. gratifying developments for parents this
your baby or toss him or her in the air. When you talk to your baby, you’ll month — generally around 6 to 8 weeks
These activities can cause severe injury Introduce color As your child’s vision find that he or she is actively listening of age — is their babies’ first attempts
to your baby’s eyes, neck and brain. improves, he or she will become more and watching the movements of your lips at expressive language. These are typically
Here are a few suggestions for appreciative of bold, vivid colors in ad- with interest as you speak. In return, your soft, single-vowel sounds that sound like
playtime with your 1- to 2-month-old. dition to high-contrast patterns. Visit baby may move arms and legs excitedly or “ooohs” and “aaahs,” or like cooing. As
your local library to borrow books con- try to make his or her own vocalizations. opposed to crying and grunting, which
Keep up tummy time Regularly taining brightly colored art or photo- emanate from the chest, cooing and gur-
placing your baby on his or her belly for graphs. Or arrange a still life of bright gling sounds come from your baby’s lar-
a short time while he or she is awake oranges, tomatoes and asparagus for ynx. Cooing also involves using different
helps develop neck muscles and in- your baby to contemplate. BABY’S MENTAL DEVELOPMENT mouth muscles than does crying. Eventu-
crease head control. You can share in ally your baby will begin to use his or her
tummy-time fun by lying on the floor Encourage familiarity Try reading So far, your baby has been taking in a lot tongue and then lips to make more pre-
facing your baby and talking to him or the same story several nights in a row of information, but by now he or she may cise vocalizations. This pattern of language
her. Your baby will work neck and arm to your baby, and see if he or she starts be ready for some outward expression, as development — starting from the center
muscles to lift up and be face to face to show signs of recognition. Or play a well. Child psychologists refer to incom- and moving outward — mirrors your
with you. You can also encourage your favorite song several times during the
child to work those muscles by putting week and see how your baby reacts
toys just within his or her reach. after hearing it multiple times.
OUT OF SIGHT, OUT OF MIND
At this age, your baby’s young mind has yet to grasp the concept that things con-
tinue to exist even if they’re out of sight. For example, if a dog wanders into your
2-month-old’s field of vision and then out again, your baby may stare for a few sec-
onds at the spot where the dog was, not understanding that although the dog isn’t
visible it still exists. In other words, once something is out of sight, it’s also out of your
baby’s mind. It isn’t until later during the first year — around 8 months or so — that
your baby will understand that even if you hide your face behind a blanket, you are
still there. Up until that point, peek-a-boo games can be pretty exciting!
baby’s motor development (fine-tuning to calm a crying baby, especially if your
movement from arms to hands to fingers). baby is just letting off steam. Avoid the BIG SISTERS AND BROTHERS
Cooing is a way for your baby to express temptation to perceive your baby’s crying
happiness and contentment. Your baby as a rejection of your efforts or to feel as if Having a new baby in the house brings a special excitement for families that al-
may coo and gurgle for self-entertainment, you’re a failure at this parenting business. ready have kids. Although caring for other children as well as a newborn can be
but he or she may also do it to attract your Babies cry; that’s what they do. And challenging, you’ll also have the rich experience of watching the relationships of
attention. If your baby coos at you and you eventually, your baby will fall asleep or your children grow as brothers and sisters.
talk back, your baby quickly discovers that his or her mood will change. By the time Generally, children are quite excited at the prospect of having a real, live baby
this is a two-way game. By talking back, your baby is 3 or 4 months old, the in the house. But what they may not realize is that they’ll need to share you, their
you reinforce the notion that communica- amount of time he or she spends crying parent, with another person. Sometimes this can lead to older children acting out
tion is important and, furthermore, that it will have decreased substantially. in order to garner more attention, or even lashing out at the baby. With time,
can be a source of great delight. If your baby’s crying is accompanied though, most children learn to adjust to the household reorganization and find their
by other symptoms, or you feel the length own special niche. You can help them with this by doing the following:
Crying at its peak Your baby still relies or intensity of your baby’s crying is un-
heavily on crying to convey his or her usual, trust your intuition and call your Postpone major changes During the weeks following your baby’s arrival, try to
needs and moods. In fact — brace your- care provider. For more on how to com- avoid any drastic changes in older children’s routines. This may mean waiting a
self — crying tends to reach a peak of fort a crying infant, read Chapter 8. while to potty train, switch from a crib to a bed or move to another home.
about three hours a day right around 6 to
8 weeks of age. This is normal. A lot of Let each child set the pace Despite being raised in the same family, each child
babies develop a period of fussiness and can react differently to a new baby. Responses may vary from excited giggles to
prolonged crying at the end of the day, BABY’S SOCIAL DEVELOPMENT hyperactivity to lack of interest. Sometimes a child’s reaction is delayed for weeks.
perhaps as a way of releasing pent-up Allow your children to become accustomed to the baby in their own time.
stress (not unlike adults, if you think During the second month, your baby still
about it). spends a lot of time sleeping and the in- Set clear expectations Let your older children know what is appropriate behav-
If you’ve already accounted for all of teraction you experience with your baby ior around the baby. For example, let your child know it’s never OK to pick up the
your baby’s needs, listening to your baby is still fairly limited. But at the same time, baby without permission, but that it is OK to sit next to the baby and talk nicely to
cry can be difficult. A parent often feels your baby is making definite strides in his him or her.
frustrated with his or her parenting skills or her social graces. By the age of 1 month,
at this point. But it’s not always possible your baby is learning to recognize you, Offer sincere praise When you find your older child behaving well, be sure to
acknowledge it. Commend your child for speaking gently to the baby or playing
nicely. This kind of positive reinforcement shows your child that you still value his
or her presence, and you appreciate his or her contributions to the family.
SPOIL AWAY
Make time for older kids Sisters and brothers of babies need lots of personal
Don’t worry about spoiling your baby during the early months of his or her life. Ad- attention, too. Make plans to leave the baby with your partner or a reliable sitter,
dressing your child’s physical needs and desire for attention helps establish a pattern and spend some undivided time with your older children.
of consistent and predictable loving care in your son’s or daughter’s mind. If your
baby knows that he or she can expect physical and emotional comfort from you, this Be patient and positive Some children start to regress after a new baby arrives,
allows your baby to establish his or her own emotional comfort level. In other words, going back to trying on diapers, sucking a thumb or talking baby talk. This isn’t
your baby is learning to feel safe and secure and to trust you and him- or herself. In uncommon. Be patient during this period of adjustment. Treat regression in a mat-
addition, when you soothe your baby during a crying spell, you’re teaching your child ter-of-fact way. For example, “I see you wet your bed this morning. I’ll change the
how to regulate his or her emotions even in times of intense emotion or stress. sheets as soon as I can.” These simple sentences state the problem and offer a
So pick your baby up as often as you like, and hold your baby as much as you ready solution.
want. It’s good for both of you!
2ND MONTH MILESTONES
During the second month, your baby is busy:
Z Working on lifting up shoulders while lying on belly
Z Holding head steady while sitting
Z Becoming aware of own fingers
Z Relinquishing grasp reflex
Z Straightening out legs and strengthening kicks
Z Focusing on objects moving across field of vision
Z Cooing and making sounds
Z Recognizing parents’ faces, being reassured by parents’ touch
Z Learning to smile in response to parents’ smiles
Z Learning to smile spontaneously to express happiness or contentment
perhaps reacting with a jerky arm wave amount of control over what’s happen-
or a few bobs of the head at the sight of ing. This initial awareness is the begin-
you. By six weeks, many babies start to ning of your baby’s ability to distinguish
smile in response to a parent’s smile. Af- between him- or herself and others.
ter weeks revolving around feeding, dia- Baby smiles can also be spontaneous
per-changing and trying to catch some expressions of happiness or contentment
sleep, seeing your baby smile back at you even at this stage. For example, your son
can be very rewarding. or daughter is starting to recognize cer-
By reacting to your baby’s smiles with tain objects by sight, such as a bottle or
your own show of delight, your baby bathtub, and he or she may smile or coo
learns that his or her actions have an im- excitedly in anticipation of what’s to
pact, and that he or she has a certain come.

CHAPTER 19
Month 3
While a solid block of sleep may still during the first six months of life. Head
seem elusive at your house by the third circumference increases by about ½ inch
month, your son’s or daughter’s range of a month during this time, as well.
motor control, mental engagement and If you’re worried that your baby seems
social interaction is widening dramati- too thin or too chubby, be careful not to
cally. The confluence of a number of fac- judge by appearance alone. Since infants
tors affecting your baby’s growth and tend to carry different amounts of weight at
development — maturation of the ner- different stages of development, making
vous system, development of the senses, judgments about baby fat on the basis of
reinforcement of the memory pathways appearance alone isn’t reliable or effective.
in the brain, increase in the range of Instead, talk to your baby’s care provider
emotions — all contribute to your baby’s about your concerns. He or she will plot
burgeoning interest in his or her family your baby’s growth on charts that show
and the world around him or her. measurements for height, weight and head
circumference.You can use the charts your-
self to compare your baby’s growth with
that of other infants of the same sex and
BABY’S GROWTH AND age. What really matters, however, is the
APPEARANCE trend revealed on growth charts — not any
particular percentile. Your baby’s care pro-
In the third month, the rate at which your vider will look mainly for predictable
baby gains weight and grows in length changes in weight over time.
should continue at a good clip and If you’re following your baby’s hunger
roughly match last month’s rate. Most cues for feeding and his or her growth is
babies gain between 1 and 1¾ pounds progressing steadily, there’s generally no
and lengthen by about ½ inch a month reason to worry about your baby’s size.

Is my baby too fat? Babies need a diet ple, some studies have linked rapid
high in fat to support growth during in- weight gain in the first year of life to obe- SPOT-CHECK: WHAT’S GOING ON THIS MONTH
fancy. In addition, a diet high in fat helps sity later on in life. Excess baby fat may
to build a thick casing (myelin sheath) also have more immediate consequenc- Here’s a snapshot of what your baby’s basic care looks like in the third month.
around nerve fibers in the brain and spi- es, such as delaying the development of
nal cord. This sheath offers “insulation” crawling and walking. Eating Breast milk or formula exclusively. Longer stretches of sleep at night may
for nerve fibers and helps ensure that The first year of life is no time to put mean more frequent feedings during the day. But through this month and the next,
nerve impulses are sent efficiently. your baby on a diet or restrict calories, you can expect your baby to gradually take in more milk at a single feeding, perhaps
Even if you think your baby is a little unless your baby’s care provider has giv- resulting in fewer feedings throughout the day. Between 2 and 4 months of age, the
too chubby, bear in mind that most kids en you specific feeding instructions. Your average baby eats around 2 ounces per pound of body weight every 24 hours.
grow out of their baby fat in a few quick baby needs adequate nutrition to devel-
years as their bodies start to stretch out. op properly. Steps that may help prevent Sleeping About 15 hours a day. By about 3 months old, many babies sleep for a
In a few cases, it’s possible that too much excess baby fat include: solid six to eight hours during the night. Still, this doesn’t always coincide with your
baby fat might be problematic. If you’re own block of six to eight hours of sleep. Expect to be up once or twice during the
concerned about your child’s weight, talk Breast-feed for as long as possible night, especially if your baby has a growth spurt and needs more frequent feedings.
with your infant’s care provider. He or Several studies have shown a connection
she can best determine whether your between breast-feeding and reduced
baby’s growth poses any problems. childhood obesity. The mechanisms for
Many health care providers and med- this link aren’t clear, but it may have to do
ical researchers are concerned about the with the ability of breast-fed babies to baby’s cues that he or she is full. Don’t world. Added muscle strength gives your
rise in childhood obesity. Some evidence self-regulate their intake of milk. In other make your baby finish a bottle just be- baby new vantage points from which to
suggests that this problem may arise ear- words, baby decides when to stop eating. cause the milk is there. peer at the world. As your baby becomes
lier than previously believed. For exam- If you’re bottle-feeding, try to follow your more and more purposeful in his or her
Avoid juice Don’t give your child juice movements, you’ll notice those newborn
until he or she is older than 6 months reflexes fade.
Month 3 (and even then, you don’t have to). Of-
35 fering juice before this age may displace Head and neck Lying belly-side down,
regular breast milk or formula feeding, babies this age can usually lift up head
which can leave your baby deprived of and shoulders. Some infants may even
necessary nutrients. If you choose to offer extend their arms and rest on their el-
30 juice after your baby is 6 months old, bows. This gives them even more support
serve it in a cup rather than a bottle, and for looking around. In turn, looking up-
limit it to no more than 4 ounces a day. ward and sideways while on his or her
tummy further increases your baby’s
Length 25 Don’t use food as a pacifier If you’ve neck strength and head control.
(inches) just fed your baby and he or she still Increased head control means that
seems fussy, try other methods of dis- your baby’s head lags less when you pull
tracting him or her before resorting to him or her into a sitting position. Also,
20 Average girl
(50 percentile)
Average boy
(50 percentile) another feeding to quiet baby down. when you support your baby seated on
your lap, your baby can hold his or her
23.25 in. 24 in.
12 lbs. 13 lbs. head up for longer periods of time in-
stead of just a few seconds. In the third
15 BABY’S MOVEMENT month, you’ll notice your baby’s back still
rounds forward. But as your child’s move-
5 10 15 20
© MFMER
By the third month, most babies are be- ment (motor) skills develop, the muscles
Weight (pounds) ginning to move around to explore the in the upper and then lower back will
strengthen, as well. Strong back muscles able to pick a toy up and set it down BABY’S SENSORY refer your child to an eye specialist to as-
act as a balance and brace for your baby’s again, solidifying basic fine motor skills. DEVELOPMENT sure that, if needed, steps are taken to
body so that he or she can eventually sit At the same time, your child may start correct the vision problem.
straight unsupported, crawl, stand and reaching for objects by swiping or batting Although the development of your baby’s
then walk. at them with broad arm movements and senses isn’t as easy to observe as the de- Hearing Your baby’s hearing contributes
clenched fists. As your child’s hands be- velopment of motor skills and coordina- to a growing sense of familiarity and
Hands and arms Around this time, ba- come more open, he or she will have bet- tion, one is essential for the other. Even comfort with the world around him or
bies often become fascinated with their ter luck hitting the intended target. though your baby can’t tell you what he or her. Around the third month, your baby
hands. In fact, a favorite pastime for your she is experiencing, playing with and may quiet when he or she hears your
baby this month is likely to be watching Legs Your baby’s legs are becoming im- watching your baby will help you know voice or get excited when he or she hears
his or her hands, bringing them together pressively strong, and he or she is likely how well your child sees and hears. siblings or a favorite song.
at eye level and trying to bring them to to experiment with flexing his or her legs
his or her mouth. and knees at will. Some babies, especially Vision Your son’s or daughter’s sight Taste and smell Toward the end of this
You may also notice your child’s when they’re excited, may even kick hard is maturing rapidly. In the next few month, your baby is starting to distin-
hands begin to uncurl from their previ- enough to flip themselves over. In prepa- months, he or she will begin to view the guish between different tastes, such as
ous clenched fist position. At this age, ration for purposely rolling over, your world in much the same way as you do. breast milk versus formula or a new
babies begin to experiment with opening baby may start rocking back and forth. In By 2 or 3 months, your baby’s ability to brand of formula. Your baby also is likely
and shutting their hands and spreading fact, by 3 months of age, many babies simultaneously turn both eyes inward to to favor certain smells or be turned off by
their fingers wide to test and inspect start to roll from their backs onto their focus on a close object (convergence) is other smells. These factors can some-
them.Your son or daughter may also start sides and then onto their backs again. developing steadily. Convergence allows times affect feeding preferences, depend-
to grip objects intentionally rather than Because your baby is more mobile, al- the baby to focus on and play with his or ing on your baby’s temperament. For ex-
reflexively, but then have a hard time let- ways take proper precautions to prevent her hands. At the same time, your baby is ample, if your baby is very sensitive to
ting go. The next step will be to gain him or her from wiggling off of a chang- learning to focus on distant objects by si- odors and finds a smell unpleasant, he or
enough finger dexterity to hold on to a ing table or flipping out of a car seat. multaneously turning both eyes outward she may not want to eat while the smell
toy, and then transfer it from one hand to Strap your baby in and stay nearby to (divergence). is present.
the other. Eventually, he or she will be avoid any accidents. As your child’s vision matures and fo-
cus improves, he or she will be able to no-
tice details of a pattern and to tell whether
there is more than one object in a picture.
HOLD OFF ON THE SOLIDS As distance vision improves, you may
catch your baby studying you across the
For the first six months, breast milk or formula is generally the only food your baby needs. room or gazing intently at a ceiling fan.
Its liquid form perfectly matches your baby’s eating skills, habits and digestive abilities. Your baby is also getting better at distin-
Before age 4 to 6 months, your baby isn’t developmentally ready for solid guishing between colors and may be par-
foods. At this stage, your baby still manages milk or formula by moving it from the ticularly attracted to primary colors.
front to the back of the mouth by sucking, then swallowing. This sucking reflex is Around this time, your baby also
aided by the tongue-protrusion reflex, in which the tongue pushes forward to help learns a skill that encompasses both sen-
the baby suck. This reflex is still strong during this month and next, which means sory and social development. Your baby
that it’s difficult for a baby to manage solid foods. Babies at this age tend to push will look at your eyes and then turn to
out cereals or solid foods rather than swallow them, which can make spoon-feed- discover what it is that you’re looking at.
ing a frustrating experience for you and baby. This is called shared attention.
Signs that your baby may be ready for solid foods include good head and neck During the third month, if you still
control and being able to sit supported, skills that usually come a bit later. Chapter see your baby’s eyes crossing or you no-
3 discusses the introduction of solid foods in detail. tice there seems to be a lag in one eye, let
your baby’s care provider know. If it hap-
pens consistently, the care provider may
246 PART 3: GROWTH AND DEVELOPMENT MONTH BY MONTH

BABY’S MENTAL DEVELOPMENT Expanding communication At the
TOYS AND GAMES same time, your baby is building an in-
As the nerve cells in your baby’s brain creasing repertoire of sounds and ges-
mature, connect with other brain cells tures as means of communication —
As your baby becomes more interactive, it becomes even more fun to play to- and become insulated with fatty myelin, squealing, growling, blowing raspberries,
gether, especially when your baby discovers the ability to laugh sometime during your baby’s brain is able to assert greater and experimenting with consonant
this month or next. control over the rest of his or her body. sounds.
Around this time, your baby may also become more interested in objects or You can see this when you observe your As your baby approaches 3 and 4
toys that he or she can touch or hold. Choose ones that are lightweight, easy to baby making purposeful movements, months of age, he or she may initiate
grasp, drool-resistant, too big to swallow and that don’t have sharp edges. Some such as bringing a hand up for inspection “conversations” with you by smiling,
examples include board books, soft blocks, wooden and plastic spoons, measur- or reaching out for a toy. cooing or squealing. Acknowledging
ing cups, empty containers, rattles, balls and squeeze toys. As long as the toys To execute these intentional motor your baby’s overtures is sure to delight.
are safe, let your creativity flow. (Avoid shiny plastic wrap or plastic bags, though, skills requires subtle complexities in Repeat the sounds your baby makes so
which can easily cover your baby’s mouth and nose and cause suffocation.) thinking, reasoning and planning skills: he or she knows you’re listening. Also,
Here are some other ideas for fun and games in the third month: Z Interest. What is that thing mom is talk back to your baby in “parentese” —
dangling in front of me? use real words pronounced correctly and
Get rolling To help your baby practice his or her rolling skills, lie side by side with Z Speculation. What happens if I try to clearly but at a high pitch and with exag-
your baby and encourage him or her to roll toward you. Your baby will try to do this touch it? gerated tones. This helps your baby learn
with his or her whole body, which essentially means rolling over. In the beginning, Z Trial and error. Moving my arm this
babies usually find it easier to roll from back to side and then back again. Con- way seems to work better than mov-
gratulate your child when he or she manages a roll. There’s no need to push or ing it that way.
pull, though, as your child will perfect this skill in his or her own good time. If your baby succeeds in making the
toy rattle or make noise, for example, fur-
Touch and feel As your baby’s hands gradually open up, try placing different ther information processing and analysis
textures in his or her palm — soft, smooth, fuzzy, bumpy. See what textures your is required. What was that noise? How did
baby likes most. it happen? Can I make it happen again?
Get a grip Place a toy or object in your son’s or daughter’s hand. Let him or her Laying down tracks Repetition of ex-
hold it, feel it and move it. Also, try this with objects that rattle, squeak or make perience is how memories are created in
noise. Share in your baby’s surprise when he or she succeeds in producing sound. an infant’s brain. Over time, your consis-
tent response to your baby’s needs —
Set up batting practice Place your baby on an infant floor gym or play mat — feeding, cuddling, bathing, soothing, car-
the kind that usually has brightly colored, different-shaped objects dangling from rying — lays down pathways among
it. Your baby can practice reaching and batting at the toys, as well as discover your baby’s brain cells that become rein-
different shapes and textures. Another way to encourage reaching and grasping is forced and streamlined every time you
to place your baby in an infant seat and offer items that are in front, just above or respond in a similar manner.
below, or just to the side of your baby’s eye level. These games also help your By the third month, these memory
baby develop depth perception and hand-eye coordination. pathways are becoming more clearly de-
fined, and your baby is starting to have a
Get giggling Almost all little tykes love gentle tickling, especially if you deliver it better understanding of the connection
with laughter and exaggerated facial expressions. Or try blowing a raspberry on between his or her behavior and your
your baby’s belly. Your baby may register surprise at first, but eventually these reactions. For example, your baby has
activities are sure to generate not just chuckles but deep-down belly laughs. figured out that by crying, he or she can
get your attention fairly quickly, or that
by smiling he or she is likely to get a
smile in response.

RETURNING TO WORK VIEW TIMETABLES WITH CAUTION
Around this time, many working mothers are preparing to end their maternity leave Don’t worry if your baby doesn’t follow the exact timetable of development mile-
and return to work. It’s certainly not easy to leave a new little one in the care of some- stones outlined in these chapters. In some cases, your baby’s development may be
one else, even if temporarily, and especially after spending so much time together. well into the next chapter; in other cases the last chapter may be more appropriate.
In the meantime, though, nothing can change the fact that you are now a mom All babies go through the same progression of milestones, but each baby reaches
and you have a baby who thinks the world of you. To make the transition to a new them at his or her own individual pace (even babies with developmental disabilities).
schedule and routine a little smoother, try some of these suggestions: The timing of social development is likely to be even more variable than other aspects
of development.
Let go of the guilt Returning to work after having a baby leaves many new moth-
ers feeling particularly torn. But working outside the home doesn’t make you a bad
mother — and it’s OK to look forward to the challenges and interactions of your job.
Talk to your boss If you’re interested, you might ask about flexible hours, tele- the sounds of your language. Most par- vigorously with those around him or her.
commuting or working part time. ents naturally use parentese when they Some babies even start to giggle or laugh
talk to babies. So don’t be embarrassed; in response to facial and vocal expres-
Plan for feeding changes If you’re breast-feeding and plan to continue doing go ahead! Your baby will love it. sions or in response to touch. In general,
so after returning to work, ask your employer about a clean, private room for Once you’ve said your piece, pause to laughter usually comes about a month
breast pumping. About two weeks before returning to work, change your nursing allow your baby to respond with a look, after social smiling and is a great addition
schedule at home so you’re pumping during the day and nursing before and after wiggle or sound. This will help him or her to your relationship!
your upcoming work hours. Have someone else feed your baby a bottle of stored learn the rhythm and timing of effective
breast milk to help your baby adapt. communication.
Start short If you can, go back to work late in the week. That’ll make your first
week back to work go by more quickly.
BABY’S SOCIAL DEVELOPMENT
Get organized Sketch out a daily to-do list. Identify what you need to do, what
can wait — and what you can skip entirely. It doesn’t take long for parents and fam-
ily to become the most important people
Stay connected Call your baby’s caregiver to find out how your baby is doing. in an infant’s life. Your baby’s world is
Some caregivers may be willing to email you a photo of your baby during the day. centered entirely around you. He or she
Place a favorite picture of your child on your desk or in your work area. is involved in your everyday lives, watch-
ing, listening and picking up clues on
Make backup plans Know what you’ll do if your baby is sick or your baby’s how humans interact. And your family
caregiver is unavailable on a workday — whether it’s taking the day off yourself or will be the first people with whom your
calling a friend or loved one to care for your baby. baby interacts.
Above all, maintain a positive attitude. Tell your baby how excited you are to A real charmer Around this time, your
see him or her at the end of the day. He or she may not understand your words but baby is not only pleased with your atten-
will pick up on your emotions. tion but is starting to discover his or her
(If you’re not entirely sure you want to go back to work or are still looking for own powers of attraction. With a smile or
appropriate child care, turn to Chapters 13 and 35, which have more information a squeal of excitement, your baby knows
about child care and balancing work and parenting.) he or she can draw you out to respond
in kind. Your baby is able to make and
maintain eye contact, and interact more
At this stage, your baby has yet to de-
velop anxiety about meeting strangers
and may even be fairly outgoing and
Wanting attention During this month,
you may also notice that your child cries
not just to express a need or feeling, but
3RD MONTH MILESTONES
happy to meet other people. This may be in order to get your attention. In the During the third month, your baby is busy:
an opportune time to introduce your coming weeks, crying in general will de- Z Raising head and chest to look around while lying on belly
baby to the concept of staying with crease (thankfully), but it’s likely to be- Z Working on supporting upper body with arms while lying on belly
grandparents or a trusted baby sitter for a come more purposeful and directed at Z Holding head steady for longer periods while sitting
few hours while you are gone. In a few bringing you back to your baby’s side. Z Playing with hands at eye level
months, your baby may not be so keen to Continuing to respond quickly (or, as Z Trying to bring hands to mouth
be separated from you. But if he or she quickly as possible) and warmly, even if Z Swiping at dangling objects
has been accustomed to the idea that al- just by calling out to your child, will help Z Opening and closing hands, stretching fingers wide
though you may go away for a short reassure him or her that you’re still there. Z Holding toys briefly
while, you always come back, this may This continued responsiveness helps to Z Stretching and kicking legs
make it a little easier when it is necessary cement the trust and sense of security Z Developing distance vision
for you to temporarily leave your child in your baby feels in you. Z Recognizing familiar people and objects from a distance
the care of another. Z Using eyes and hands in coordination
Z Distinguishing between different colors, tastes and smells
Z Increasing repertoire of sounds to include squealing, growling, consonant
sounds and maybe even giggling
Z Turning head toward sound
Z Making eye contact
Z Enjoying family and familiar faces, maybe even new people
Z Using expanding communication skills to express emerging emotions
Z Imitating some sounds, movements and facial expressions
Z Learning to self-entertain
CHAPTER 20
Month 4
Before you delve into month four, pat ting much better at understanding him
yourself on the back. You’ve made it or her. In other words, the bond between
through the first few months of parent- the two of you is truly blossoming!
hood, quite possibly one of the biggest Take advantage of this time to enjoy
transitions of your adult life. At this age, each other’s company and revel in the
most babies have begun to adjust to life in little things — a giggle and a smile, a
this brave new world. They’ve also become splash in the tub, or a bug on a window.
much more secure in their relationship with Who knew life could be so exciting?
their parents and their own abilities to
adapt and react to their environment.
New families often find the next few
months to be a joyous time. You’ve prob- BABY’S GROWTH AND
ably settled into a familiar routine and APPEARANCE
eating and sleeping schedules have be-
come fairly regular. The amount of time Between 3 and 4 months your baby’s growth
your baby spends fussing is probably on rate is likely to slow a little, although you
the decline. Your baby’s brain and ner- can still expect your baby to gain between
vous system have matured enough that ¾ and 1½ pounds over the course of the
he or she is ready to become much more month and grow about ½ inch in length.
interactive with family and friends, while Some babies may have doubled their
continuing to explore new sights and weight by the end of the fourth month.
sounds. Newborn reflexes are fading and Head circumference increases by about ½
your little one is starting to move and do inch, as well. You’ll be able to compare
things by design now. In addition, your notes with your baby’s care provider at
infant is getting much better at convey- the 4-month well-child visit. Keep in
ing emotions and desires, and you’re get- mind your baby’s individual growth rate.

Skin rashes You’re getting ready to than proper skin care and perhaps a mild
change your baby’s diaper, and there, cortisone cream, as indicated by your SPOT-CHECK: WHAT’S GOING ON THIS MONTH
right there, under your baby’s Onesie is a child’s care provider.
bright red rash. Alarm bells go off and Some general rules of thumb for baby Here’s a snapshot of what your baby’s basic care looks like in the fourth month.
you rush to the phone to call your care skin include avoiding long, hot baths and
provider. This happens to just about ev- staying away from any substances or tex- Eating Feed breast milk or formula exclusively. During this month, the number of
ery parent. And while you should always tiles that seem to cause a reaction. Using daytime feedings generally decreases to about four or five, but a midmonth growth
call your baby’s care provider if you no- gentle moisturizers can help soothe the spurt may lead to more frequent feedings for a few days. Although it may be
tice something unusual or are concerned skin. You can read more about common tempting to get your baby started on cereal or other solid foods during this month
about your baby’s health, you should also skin rashes in Chapter 5. — especially if you’ve heard the rumor that it might help your baby sleep better (a
know that most skin rashes in infants are theory that has yet to be proved) — hold off a little bit longer until your baby shows
common and usually not serious. If the Bedtime routine It’s probably a safe clear signs that he or she is physically ready for solids.
rash occurs along with a fever, call your bet that almost all new parents are hop-
care provider promptly. ing to find somewhere — in the pages of Sleeping Expect your child to sleep about 15 hours a day, including more predict-
Rashes in babies often result from a book, in advice from a friend or on a able nighttime hours of sleep — generally six to eight hours, although every baby is
skin irritants, such as soap or scratchy website — the simple secret to getting different. By 4 months old, your baby may awaken only once or twice during the
fabric, or an underlying viral infection, their kids to sleep. Alas, there is no silver night. Around this age, babies become more active sleepers, making noise, scooting
such as a parvovirus infection or roseola. bullet. Your child’s sleeping habits de- around and often waking their parents. If your baby has been sharing your room, this
Because rashes are so visible, they’re a pend on a number of factors, including may be a time to consider moving him or her to his or her own room.
common cause of concern for new par- his or her age, the length of time he or By this time, your baby may also have settled into two to three daytime naps,
ents. Most of the time, though, rashes she can go without feeding, and his or lasting about an hour or two each (hopefully, long enough to give you some time
aren’t a sign of a serious problem and her personality. Some babies snuggle to yourself!).
may not even require treatment other down without a peep and waken briefly
Month 4 for feedings. Others cry every time you the two of you together. Two, if your son
35 put them in the crib and have a hard time or daughter isn’t keen on self-soothing at
lulling themselves to sleep. first, hang in there. It can be tough ini-
During the first few months of your tially, but one thing is for sure: This phase
baby’s life, it’s important to respond to won’t last forever, and if you establish
30 your baby’s cries and provide enough consistent bedtime practices, your child
soothing to optimize sleep. But around eventually will be “sleeping like a baby.”
the third and fourth month, you can start (Oh, the irony.)
taking steps to help your child fall asleep For tips on how to help your little one
Length 25 on his or her own, an important skill that sleep well, see Chapter 7.
(inches) every child must eventually learn.
Parents at this stage often worry about
letting their babies “cry it out.” There is
20 Average girl
(50 percentile)
Average boy
(50 percentile) plenty of advice out there on the “best” BABY’S MOVEMENT
way to get your baby to sleep. See what
24.25 in. 25 in.
13.5 lbs. 14.5 lbs. method works best for you. In the mean- Around the fourth or fifth month, the
time, there are a couple of things to keep newborn reflex that makes your child
15 in mind. One, a little bit of crying won’t look like a baby fencer — when your ba-
harm your baby, and it won’t affect his by’s head turns in one direction, the arm
5 10 15 20
© MFMER
or her attachment to you. Your overall on that side straightens and the other
Weight (pounds) approach of loving care is what bonds arm bends over the head (tonic neck
reflex) — begins to fade. This clears the Head and back control As your ba- Some roll one way; others another. infant trampoline as your baby learns to
way for further development of your by’s 4-month birthday approaches, he or Whether your baby is rolling or not, and bounce vigorously in that position. Stand-
baby’s gross motor skills — skills that she is achieving good control of the head which way, isn’t as important as whether ing and bouncing while well supported
involve his or her large muscles. At this and neck. Full head control is an impor- he or she shows interest in moving from won’t hurt your baby’s legs or hips, but
stage, babies often seem “fidgety,” but tant milestone that’s essential for other one spot to another. will give them (and you) a good workout.
they’re really exploring purposeful coor- motor skills, including sitting, crawling Don’t wait to discover your baby’s Just make sure you’re not trying to hold a
dination of their large muscle groups to and walking. ability to roll when he or she ends up on hot cup of coffee or tea at the same time.
move around. While lying down, your baby is apt to the floor from having rolled off the couch If your baby doesn’t push off with his
At 4 months, most babies are exercis- lift the head and shoulders to look or bed. Take precautions not to leave your or her feet right away at age 4 months,
ing their arm muscles by pushing up with straight ahead while resting on his or her baby unprotected on elevated surfaces. don’t fret. If your child still doesn’t do this
their elbows or hands when on their hands and arms (a favorite portrait pose at 6 months, you might mention it to
tummies. These mini-pushups give your of photographers, and who can blame Standing By the end of the fourth your child’s care provider, so that he or
baby a new vantage point and help them? It’s downright cute). month, most babies can, with a little help, she can determine if further investigation
strengthen muscles necessary for rolling. When pulled up to a sitting position, bear their own weight on their legs. If you is necessary.
Some babies may even use this new- about half of 4-month-old babies are hold your baby upright, he or she will like-
found arm power to scoot around in a able to keep their heads in line with their ly push down with his or her feet. In fact, Reaching and grasping During this
circle or even move a few inches forward bodies. In fact, your baby may even lift you may start to feel as if your lap is an month, your baby is likely to be busy
or backward. his or her head to try to “help” him- or
At the same time, your baby’s fine mo- herself sit up. By the middle of this
tor skills — skills that generally involve the month, most babies can keep their heads
hands and fingers — are being refined. steady when held in a sitting position. KEEPING PLAYTIME SAFE
While sitting, your baby’s back muscles
are working on keeping the spine straight, Your baby might not be crawling yet, but it’s around this time that babies start put-
reducing the hunched appearance. ting whatever (literally) they can in their mouths. Take advantage of this limited
period of immobility to make sure the spaces you use to play with your baby are
Rolling over On average, this is the free of any potential hazards. Get into the habit of doing a “baby-level” safety
month that babies really get rolling. check each time you put your baby down on the floor to play. Get down on your
Some may have started rolling even ear- hands and knees, at your baby’s level, and look for these items:
lier. But don’t worry if your baby isn’t Z Small objects your baby could accidentally swallow, such as coins, button bat-
there yet by age 4 months.You’ll probably teries, magnets, paper clips, or small pieces of food or candy
notice some rolling attempts in the near Z Toys with small parts
future. A few babies even skip this mile- Z Balloons
stone altogether. Z Uncovered electrical outlets
Rolling from front to back, which re- Z Pulls for window blinds, in which your baby could get entangled
quires only a shift in gravity, is generally Z Electrical cords to irons, lamps or other appliances that could fall if the baby
easier than rolling from back to front. tugs on the cord
This is why many babies roll from front to Z Plastic bags or wrappings that could suffocate your baby
back first. Giving your baby a little floor Z Newspapers and magazines
space and plenty of tummy time while he Z A pet’s toys or treats
or she is awake will provide him or her Z Houseplants
with opportunities for practice. These safety searches also can become fun and helpful activities for older
Rolling from back to front, which siblings to get involved in. Help them understand the things that can be harmful to
tends to occur a little later, requires more a baby. This will increase their awareness about the hazards of leaving toys and
complex maneuvering, such as rocking, objects around the play area.
arching the back, and twisting the legs to
flip over. Each baby is different, though.

waving his or her arms about, batting at manually investigate an object, but BABY’S MENTAL DEVELOPMENT tone of their voices. Although words are
nearby objects and trying to reach them. tongue and lips are perfect! And if your still a jumble by 4 months, your baby is
If you present your baby with a rattle or baby can’t bring the object of interest to Brain activity during these early months familiar with many of the sounds you
similar toy, he or she is likely to grasp it, his or her mouth, he or she will likely is at one of the highest peaks in a per- make and may begin to experiment with
shake it and maybe even bring it to his or bring mouth to object by bending down son’s lifetime. And as your baby becomes making some of these sounds on his or
her mouth. to suck on it. more mobile, you can really observe his her own.
You may notice that sometimes your You can spend a lot of time discourag- or her curiosity begin to emerge. Every-
baby intentionally looks at and reaches ing your son or daughter from putting thing is an object of interest, and your Laughter During this month, your baby
for an object. Other times, your baby’s things in his or her mouth, or you can baby uses all of his or her powers — probably laughs out loud frequently.
hand may touch something and instinc- stockpile a variety of safe toys with inter- looking, touching, smelling, chewing — Laughter evolves out of cooing and gur-
tively grab it, and your baby may seem esting textures that will further pique to discover and explore whatever’s near- gling and usually comes about a month
surprised or intrigued by what has unex- your child’s curiosity and encourage oral by, including his or her own hands, after your baby’s first real smile.
pectedly appeared in his or her hand. exploration. cheeks, legs and other body parts. At first, the laugh tends to come in re-
This change from grasping as a reflex to If your baby reaches for something sponse to something — a laugh from
reaching for things voluntarily is gradual. dangerous, your best bet is to quickly re- Language skills Since birth, your baby you, a funny face or a tickle of the belly.
move it from sight and distract your baby has been building language skills by lis- Your baby may also laugh to get your at-
with a more appropriate toy. At this age, tening to others and by picking up com- tention or just for the experience of mak-
your baby doesn’t understand that some- munication clues from the inflection and ing noise. In the coming months, though,
BABY’S SENSORY thing may be harmful and is only inter-
DEVELOPMENT ested in its appearance. This is why it’s
especially important to safeguard your
Throughout these months and until your baby’s play area and remove any poten- LAUGHTER AS A LIFE SKILL
baby’s sixth month, your child will do a tial hazards.
lot of exploring by touching, feeling and Encouraging laughter and humor in your household can have benefits for both you
mouthing whatever comes across his or Hearing Listening is another way of ex- and your family. Laughter can be a:
her grasp. Combined with hearing and ploring an environment. By the fourth
seeing, these sensory skills promote the month, your baby may not only quiet at Bonding agent When people laugh together, they bond together over the shared
development of your child’s motor, men- the sound of your voice but turn his or experience and emotion. Laughing with your baby helps you become closer.
tal and social skills. her head toward you, as well. He or she
Seeing an object encourages your may also turn his or her eyes toward a Stress reliever When the house is a mess, your clothes smell like spit-up and
baby to reach for it. Grasping and touch- specific sound, for example, a rattling dinner is mediocre at best, balancing it all with a good laugh can diffuse the stress
ing the object helps your infant become sound or the sudden onset of music, to you might be feeling and unconsciously passing on to your children. Even babies
familiar with it. Shaking it and hearing it find out where the sound is coming from. sense when their caregivers are stressed and tend to reflect these emotions. So
make noise helps your child learn about instead of rushing to load the dishwasher or check your work email, take a few
cause and effect. Listening to you re- Vision By 4 months, many babies have minutes to giggle and laugh with your baby after a long day. It’ll make you and your
spond to his or her accomplishment aids improved visual tracking abilities and can child feel better.
in his or her language development and watch a brightly colored object as it
social interaction. You can see how vari- moves in a slow arc overhead. You might Immune system booster Evidence suggests that a good belly laugh can actu-
ous aspects of development form a com- also notice your baby focusing on very ally increase immune system cells that fight viral illnesses and various cancers.
plex interplay that contributes to your small objects, such as a piece of yarn or a
child’s overall growth as a person. crumb, and regarding things in the dis- Resilience maker If you habitually show your children that you can still laugh,
tance with great interest, such as a tree despite life’s curveballs and momentary imperfections, you’re ultimately teaching
Mouthing At this stage, your baby’s outside the window. Improving hand- them about resilience and the ability to withstand distress, a skill that will serve
mouth is more sensitive to an object’s eye coordination — being able to both them well throughout life.
characteristics than are his or her fingers. see and reach for an object — further en-
Your baby also lacks the dexterity to courages his or her exploration instincts.
you’ll notice the beginnings of a sense of
humor. For example, something out of
the ordinary or unusual may strike your During the fourth month, your child’s so-
4TH MONTH MILESTONES
baby’s funny bone. Older siblings especial world is continuing to broaden, as is During the fourth month, your baby is busy:
cially are likely to induce laughter from his or her ability to function within it and Z Pushing up on elbows and hands to look around when lying on belly
a baby. relate to you and others. By now, your Z Sitting supported with head steady
Z Practicing moves that enable rolling over
Z Bearing weight on legs, bouncing with arms supported
Z Grasping and shaking toys, practicing letting go
TOYS AND GAMES ing on to, shaking and manipulating. Z Bringing hands to mouth, exploring items with mouth
Make sure the toys you choose have no Z Studying small items
Promote your baby’s motor develop- small parts that can come off and pose a Z Gazing at things in the distance
ment, pique his or her curiosity, and choking hazard to your baby. Z Looking for the source of a sound
encourage exploration of the world Z Becoming more communicative with body language and vocalizations
around him or her with some of these Play mimicking games Starting Z Laughing
activities and toys: around this age, your baby is becom- Z Imitating language sounds
ing intent on studying the sounds you Z Engaging in back-and-forth “conversations” with you
Practice sitting Once your baby can make and trying to produce his or her Z Enjoying playing with others, capturing attention
hold his or her head up fairly well, try sit- own versions. Take the time to listen to
ting your infant up in a baby seat or your baby’s vocalizations, then try to
against cushions for support. This will imitate his or her sounds. Talk back to
improve your baby’s sense of balance your baby, enunciating slowly and baby likely is starting to show clear signs Distractions As your baby nears 4
and help strengthen back muscles. Sit clearly, and allow him or her time to try of recognizing you and other members of months old, feeding times become less
face to face and play singing and clap- to make the same sounds. If you speak your family. He or she will love spending frequent, and his or her attention is drawn
ping games together. You can also set a second language, use it with your time with you and others. If you have an- to other people and activities during
him or her up against the curve of your child. Mimic facial expressions and other child, that older brother or sister feeding. Your baby may move around or
own body while you lie on the floor. laughter, too. This encourages your may be your baby’s most popular play- stop feeding to play or “talk” to you. This
Don’t expect the sitting to last too long baby’s language skills and social inter- time friend. Children can easily make a distraction isn’t a sign that your baby is
at this point, though. After your baby actions. baby smile and laugh. rejecting breast-feeding or is bored with
topples over a few times or tires of sit- For siblings, this is a “honeymoon” formula. An easily distracted baby is nor-
ting, switch to a different activity, such Enjoy bath time As it becomes easi- time. By 3 or 4 months, the baby is old mal as the baby discovers and explores
as belly play or reading a book together. er for babies to sit when supported, enough to thrill an older brother or sister the world. Your baby may discover that
parents often turn bath time into play- with smiles and giggles but still too feeding time can be more than a time to
Choose toys that stimulate the time, sometimes even getting into the young to be “trouble,” getting into toys eat; it’s also a time to socialize, experi-
senses Keeping in mind your baby’s tub with their babies. The weightless- and interrupting playtimes. ment and assert a little independence.
penchant for mouthing at this age, ness of the warm water and the free- At this age, your baby has yet to de- As much as you want your child to
choose toys that won’t be harmed by a dom from restrictive diapers and cloth- velop stranger anxiety and is likely to en- learn through exploration and interac-
little dampness or chewing. Soft books ing all make for a great sensory joy meeting new people, smiling, wrig- tion, it can be frustrating to try to feed a
with textured corners and squeaky pag- experience. However, remember that gling and laughing with anyone who will distracted baby. You might want to try a
es are both fun and practical. Other ideas bubble bath and soap can be irritating respond. This is a comfortable time for quiet, uninterrupted feeding place, but
include a bumpy teething ring, a ring of to a baby’s eyes, skin and genitals. And most parents. The baby is big enough acknowledge that everything is new and
big plastic keys, measuring cups or soft keep a close eye and good grip on that you’re not overly concerned about worthy of exploration to your baby. You
blocks. Also, look for toys or everyday your baby. The water makes your wig- safe handling, and you know the baby is may find that your baby’s early morning
objects that your baby can practice hold- gly, active baby extra slippery. comfortable with someone else. At this feeding — when your baby is still sleepy
age, you can easily share the fun of your and the room is dark — may be the best
baby with others. feeding of the day.
CHAPTER 21
Month 5
Many parents eagerly look forward to ing from happy to grumpy, and solidly
this month because it means you can fi- establishing his or her place in the family.
nally start introducing your baby to foods
other than breast milk or formula. Food is
a big part of human culture, and it plays a
role not only in survival, but also in soci- BABY’S GROWTH AND
etal traditions and pastimes. So it’s natu- APPEARANCE
ral for parents to want to share the joy of
eating favorite foods with their children. Between 4 and 5 months old your baby’s
It’s also another step toward integration growth rate is likely to match last
into the family when baby gets to join the month’s, which is a little slower than the
others at the dining table. first three months, but not by much. Most
As much as you may be excited to babies gain anywhere from just shy of
embark on culinary adventures with your 1 pound to 1½ pounds or more. Length
baby, keep in mind your baby’s stage of and head circumference both increase by
growth and development. In this chapter about ½ inch during this month.
you’ll read about signs that indicate that
your baby is ready for solid foods, as well Introducing solid foods Between
as tips on a successful introduction. You this month and next, your baby will
can read a more in-depth discussion of begin to develop the coordination to
infant nutrition in Chapter 3. move solid food from the front of the
During the fifth month your baby mouth to the back for swallowing. At
gains increasing control over his or her the same time, your baby’s head control
body, enthusiastically exploring each will improve, and he or she will learn to
newfound function. He or she also is con- sit with support — essential skills for eat-
tinuing to discover new emotions, ranging solid foods.

Breast milk or formula is all your little sure whether your baby is ready for sol-
tyke needs in the first four to six months ids, ask yourself these questions: SPOT-CHECK: WHAT’S GOING ON THIS MONTH
of life to grow and develop properly. But Z Can your baby hold his or her head in
eventually additional nutrition is neces- a steady, upright position? Here’s a snapshot of what your baby’s basic care looks like in the fifth month.
sary so that your baby can continue to Z Can your baby sit well with support?
thrive. After 6 months of age, for exam- Z Is your baby interested in what you’re Eating Breast milk or formula still plays the central role in your little one’s nutrition,
ple, breast milk alone generally isn’t eating, perhaps eyeing your breakfast although some parents begin to introduce solid foods during this month. Be sure
enough to provide your baby with the toast or opening his or her mouth if your baby is developmentally ready for solid foods before starting them, such as
amount of energy, protein, iron, zinc and you offer a spoon? being able to swallow, hold his or her head steady and sit with support.
other vitamins he or she requires. If you answer yes to these questions
and you have the OK from your child’s Sleeping Your baby is more likely to sleep six to eight hours at night with no inter-
Is your baby ready? Sometime be- doctor or dietitian, you can begin supple- ruption. Some babies still wake up once or twice during the night for a feeding. Total
tween ages 4 and 6 months, most babies menting your baby’s liquid diet. Read sleep may add up to between 14 and 15 hours in a 24-hour period, including a
are ready to begin eating solid foods as a more about what to serve when and couple of daytime naps, usually one in the morning and one in the afternoon. Some
complement to breast-feeding or formula- which foods to avoid in Chapter 3. babies may need a third nap late in the afternoon.
feeding. But age should not be the only
determining factor. You want to make Tips for a successful meal Once
sure your child is both physically and so- your baby starts eating foods besides
cially ready. And you shouldn’t feel pres- breast milk or formula, feedings are likely tions for when your little one reaches Use a spoon The American Academy of
sured to begin solids. The American to become a lot more interactive, and that point that he or she is ready to try Pediatrics recommends always using a
Academy of Pediatrics prefers that par- most probably, a lot messier! But that’s solids: spoon when feeding your baby comple-
ents wait until a child is 6 months old to OK. It’s all part of the process of explor- mentary foods. A small espresso spoon
introduce solids, if possible. If you’re not ing new things. Here are some sugges- Pick a happy time For your first try, or a rubber-coated baby spoon usually
choose a time when your baby’s most works well. Eating off a spoon helps your
likely to be open to adventure, such as baby learn to swallow without sucking,
Month 5 when he or she is alert, dry, comfortable and allows your baby to learn the process
35 and not starving. If your baby’s very hun- of eating in the same way the rest of the
gry, you might want to start off with a family does. Avoid giving your child ce-
little breast milk or formula first and then real in a bottle, which may encourage ex-
switch to solids. cessive calorie intake.
30
Set your expectations Remind yourself Start small For your baby’s first meal,
that the goal of these first meals is to in- start out with just a couple of spoonfuls
troduce your baby to the experience of of food in a bowl. Thin the complemen-
Length 25 food, rather than meeting your child’s tary food with breast milk or formula un-
(inches) nutritional needs. In fact, it will likely be til it’s the consistency of heavy cream, to
several weeks before the amount of food help ease the transition from bottle to
that actually gets into your baby’s belly is spoon. Over the next few meals, you can
20 Average girl
(50 percentile)
Average boy
(50 percentile) contributing to his or her overall nutrition- gradually make the consistency thicker
al requirements. as your baby becomes accustomed to
25 in. 25.5 in.
14.5 lbs. 16 lbs. swallowing solid foods.
Sit up At first, try feeding your baby
15 propped up in your lap or in an infant car Be patient Although some babies seem
seat. When your baby can sit without thrilled with their first bowl of cereal,
5 10 15 20
© MFMER
support, you can move him or her to a others may not be convinced of its joys
Weight (pounds) highchair. the first time around. If your baby flat out
refuses the first feeding, don’t give up strengthen neck muscles and develop the
GETTING YOUR KIDS TO LIKE FRUITS AND VEGETABLES hope. Put the box of cereal away for a head control necessary for sitting up.
couple of weeks and then try again. Fo-
A common battle parents face as their kids begin to eat solid foods is getting them cus on enjoying the meal rather than get- Rolling over At this point, most babies
to eat their fruits and vegetables! Scientists are finding that part of the solution to ting your baby to eat solid foods by a cer- are making progress in their attempts to
this dilemma may very well go back to the mother’s own eating habits, perhaps tain date. He or she will have plenty of roll over, too. By the end of this month,
even before your baby is born. time to warm up to the spoon as another some babies can even roll both ways
Since a number of food flavors are transmitted via amniotic fluid or breast milk vehicle for gastronomic delights. without help. Once babies learn to roll
to a baby, what the mom eats affects the baby’s early experiences with flavor. from front to back and back to front
Some evidence suggests that the more often a baby experiences a particular The scoop on poop Once you start again, they may start out sleeping on
flavor — such as carrots, for example — during pregnancy or breast-feeding, the feeding your baby solid foods, you’ll like- their backs just the way you laid them,
more accepting the baby is likely to be of that taste when he or she begins eating ly notice a difference in the texture, color but then flip over in the middle of the
solid foods. And because breast-feeding offers a child a greater variety of flavor and smell of your baby’s stools. Solid night. If this happens, don’t feel com-
experiences due to a mother’s varying diet, breast-fed infants seem less picky and foods make for more solid stools. Foods pelled to flip him or her back again. The
more willing to try new foods. such as peas, blueberries and beets can risk of SIDS begins to decrease once your
Another finding suggests that flavor learning after the introduction of solid make noticeable differences in the color baby gains head and neck control and is
foods is based on repeated exposure to new foods. One study, for example, found of stool, as well. Last but not least, get able to roll over.
that the first time a group of babies tasted green beans, many squinted, raised ready for stinky stools. The added sugars
brows or upper lips, or wrinkled noses. But after repeated offerings of green beans, and fats in solid foods can lead to a stron- Reaching and grasping During the
expressions of surprise or distaste were fewer, and willingness to eat the vegeta- ger odor. fifth month, you may notice your baby
bles was greater, especially if the green beans were followed by a sweet-tasting start working for a toy or other object. At
fruit, such as peaches. first, this may mean that he or she reach-
This type of research is ongoing, but in the meantime, it doesn’t hurt to eat well es out for a toy but may not be able to
yourself and keep setting the good stuff out there. Chances are good that eventu- BABY’S MOVEMENT grasp it at first try. At 4 months of age,
ally your kids will enjoy it for themselves, and not just because you said so. your baby still manipulates objects by
Between 4 and 5 months old, most ba- batting at them. But eventually he or she
bies achieve the first big milestone — may try to pick up a larger object by
good head control. By the end of this pressing it with the palm of the hand and
month, your baby is likely able to hold curling the fingers around the ob-
his or her head up steadily while sitting. ject. When your baby does get a hold of
He or she is also learning to turn the a toy, he or she may grasp it with both
head from side to side, making it easier to hands and have fun shaking it around.
track moving objects and place different Dangling toys are still a source of enter-
sounds and voices. tainment at this age and help your child
Once your baby has full head control, further develop his or her hand-eye
he or she has the skills necessary to move coordination.
on to sitting. And just in time, too. As
your baby gets older, he or she may be- Bouncing Your 4-month-old most likely
come increasingly less satisfied with ly- gets great joy out of being upright and
ing either faceup or facedown and will “standing” on your lap, and perhaps
probably want to spend more time up- bouncing. All the bouncing your baby
right. During this month and next, your does is a part of normal development
baby is working toward sitting up with- and isn’t harmful to the baby’s hips, legs
out help. Playing facedown on the floor or feet. By about 5 months, you will no-
and lifting the head and chest to see toys tice your baby can probably bear full
are good exercises to help your baby body weight on his or her legs. Standing
alone and walking are still a long way off, use them, potentially causing injuries or Vision Earlier, your baby was learning to skills increase, you can observe your in-
but you can see how the small stages of unintentional harm (think “Mom, look distinguish between similar bold colors. fant begin to apply the knowledge stored
development are preparing your baby for how fast Sammy can go in the swing!”). Improved visual awareness during this in his or her memory.
greater mobility. The American Academy of Pediatrics month and the next helps your baby dis- This is evident in the way your baby
(AAP) advises specifically against using cern more subtle shades of color, such as reacts to seeing you or to certain daily
Encouraging physical activity Take mobile walkers. These devices generally soft pastels, although bold colors may routines, such as a feeding or a bath. If
a look around your local baby supply have a cloth seat set in a frame with still be favorites. Improved visual track- you sit in your favorite chair for breast-
store, and you’ll see an amazing range of wheels that allows the baby to move ing and coordination also helps your feeding or a bottle, you may notice your
infant equipment — swings, playpens, around the room even though he or she baby become more adept at reaching and baby quickly settles in with you and may
infant seats, stationary activity centers, might not be able to crawl or walk yet. A grabbing larger objects and toys. Small make noises or kick in anticipation of
walkers, baby gyms, bouncy chairs — oh number of studies have shown that these objects are definitely catching his or her what he or she knows is coming. And if
my! And with your baby learning so devices can make a baby more prone to attention at this point, but he or she for some reason, what’s expected isn’t
many new skills, it’s tempting to try to injury, such as falling down steps or doesn’t yet have the dexterity to pick forthcoming, you may hear a squawk or
physically help him or her along with the reaching for dangerous objects. Even un- these up. two of displeasure.
latest gadget. Quite a lot of infant equip- der supervision, the AAP contends that Babies at this age are also starting to
ment is marketed with the idea of help- walkers are simply too fast for a parent to discriminate between the different emo-
ing your baby reach a new milestone, reach before an accident happens. Other tions they see in others — such as joy,
such as sitting or walking. experts have cautioned against the use of fear or sadness — and to make similar
Truth? What infants need more than door jumpers — seats that hang from a responses.
anything to develop their motor skills is door frame — as well. If you need a place
freedom of movement in a safe space for your baby to safely amuse himself or Hearing Between 4 and 5 months, about
that allows them to explore their sur- herself for a few minutes, consider a sta- half of all babies turn their heads toward
roundings and to practice their budding tionary activity center or playpen instead. a voice. Most babies at this age will turn
skills under the watchful eye of a nearby A highchair also can serve this function, toward a rattling sound to investigate its
caregiver. Warm interaction with a sup- once your baby is able to sit in it safely. source. At this age, babies also learn to
portive caregiver during playtime also is Keep in mind that if your baby has a distinguish emotions by tone of voice.
important. developmental disability, his or her care If by this month your baby doesn’t re-
Does that mean you have to be con- provider may in fact recommend certain spond to sounds, talk to his or her care
stantly down on the floor with baby? Not pieces of equipment to help your baby sit provider. Although newborns are gener-
always. Certain pieces of baby gear can with support or move with help. ally checked right after birth for hearing
definitely come in handy, such as a sta- loss, your observations at home are key
tionary activity center where your baby to identifying the need for further testing.
can sit and bounce or play with attached
toys, or a molded seat that helps your BABY’S SENSORY
baby sit up. Swings and playpens also DEVELOPMENT
can be essential, at times. But keep in BABY’S MENTAL DEVELOPMENT
mind that these items are mostly for your During this month, mouthing becomes
convenience, allowing time for you to an even more important avenue of explo- As the brain develops, and more and
move about unrestricted, to do some ration for your young child. Keep offering more connections are made between
chores, say, or eat breakfast. Try to limit him or her safe toys and everyday objects brain nerve cells, your baby’s memory of
the amount of time your child spends in to practice the art of picking things up faces, sounds, places and event patterns
these devices, as extended movement re- and bringing them to the mouth. This increases. Although your baby has been
striction in turn may limit your child. Be helps your baby develop sensory and absorbing information about the sur-
sure to supervise older siblings around motor skills. At the same time, keep a rounding world since birth, he or she has
these devices, too, as they may become sharp eye out for anything that might be had only limited ability to respond to this
overenthusiastic in “helping” the baby a choking or poison hazard for your baby. new knowledge. But as his or her motor

Learning how things work At the he or she bangs a toy on the table, it
same time, your baby’s curiosity and at- makes noise. When he or she giggles, TOYS AND GAMES
tention span are increasing. This allows siblings giggle, too. Like a scientist, your
him or her to spend more time examin- baby may test different actions over and At this young age, babies are interested in very simple objects and toys. They also
ing things and observing how things over to see if they always get the same don’t need a heap of toys to stay occupied. In fact, too many toys or too much activ-
work. This natural curiosity also drives effect. And, like a successful scientist, ity can overwhelm your baby and lead to tears. Limit toys to just a few at a time. That
your baby to start to work for objects that your baby will be proud every time the way your baby can take the time to study each one and see what it can do. Toys and
are out of reach. Even if he or she can’t response is the one expected. You’ll ap- games your baby may enjoy during this month include:
quite get to a toy yet, you can see the focus preciate your baby’s smiles and squeals
and concentration in your child’s eyes. of accomplishment and self-confidence. Toys that make noise By now, your baby is starting to play purposefully with
During this month, your baby is also rattles and toys that squeak or make noise. Offer him or her toys that make noise
learning more about cause and effect. Language skills Your 5-month-old may to enhance his or her discovery of cause and effect as he or she bangs and rattles
When he or she cries, you come. When have already started imitating some of the about. Infants also seem to derive great joy from pressing buttons that make things
speech sounds you make, even though it happen, such as on a pop-up toy or a baby phone.
will be a few more months before he or
she understands how these sounds work Music to bounce, sway or swing to Music can help express emotions and
together to communicate. During this thoughts when the words aren’t quite there yet. Most babies love music and will
month and the next, your baby is likely move along to a rhythm they find catchy. Make a playlist of your favorite kid-
to pick up on a single sound — such as friendly (but not necessarily “kiddy”) songs, and play them for your baby. Better
“ah”or“oh”— and repeat it over and over, yet, pick your baby up and sing and dance around the room together in accompa-
and then a few days later discover a new niment to the music.
sound and practice it repeatedly. Babies
seem to enjoy playing with a new sound The company of a mirror Place an unbreakable mirror in front of your baby and
as much as they delight in playing with a watch as he or she and “the other baby” get acquainted. At this age, your baby
favorite toy. Pretty soon, he or she will be probably won’t know that it’s his or her own reflection, but will have fun watching
babbling away at you, excited to hear his or her antics, regardless of perception.
sounds emanating not just from others,
but from his or her own mouth. Stuff to reach for While your son or
daughter is lying prone on the floor or sitting
upright, place a couple of bright toys or
objects just out of his or her reach. This
BABY’S SOCIAL DEVELOPMENT will encourage your child to practice
reaching skills and improve his or her
At this age, your baby is quickly figuring hand-eye coordination.
out how to express a variety of emotions
through facial expression, vocalizations
and body language. For example, he or
she now uses laughter to express happi-
ness and excitement. At the same time,
your baby may start to show dislikes,
making a face or turning away from
things he or she doesn’t care for. You may
notice this latter type of reaction more as
you introduce new foods to your child or
you start to set limits to your child’s ac-
tions for safety’s sake.

Growing attachment By the fifth
month, your baby is establishing a solid
place in the family structure and clearly
knows who his or her loved ones are. During the fifth month, your baby is busy:
Your baby feels comfortable with the Z Perfecting mini-pushups while lying on belly
family routine and indeed expects it. Z Sitting balanced by hands on floor in front (tripod style)
Spending time with you is still his or her Z Bearing weight on legs
favorite activity. In fact, this closer sense Z Rolling over from front to back, maybe even back to front
of attachment to you and other family Z Working to get to a toy
members may lead your baby to feel up- Z Grasping with both hands
set and display unhappiness when you Z Exploring with mouth
stop playing a game or leave the room. Z Studying small objects
He or she may even need a little extra Z Locating sounds and voices by turning head
reassurance that you’re still available — Z Imitating speech sounds
perhaps by talking to him or her or sing- Z Repeating single sounds
ing a song — and will return as soon Z Laughing, squealing
as possible. Z Expressing dislikes, making faces
This narrowing focus of attachment Z Enjoying playing with others, crying when playing stops
goes hand in hand with a gradual real-
ization that some people are strangers.
Although your baby likely still has an ac-
cepting, welcoming response to unfamil- diaper changes or wriggly feedings — fant and adjust your parenting style to
iar people, in the months ahead, you’ll frustrating! bring out the best in him or her. How you
notice that he or she is becoming in- Generally, your baby’s natural traits interact with your baby now can set the
creasingly picky about the company he or can’t be changed — it would be like try- stage for your relationship throughout
she keeps. ing to change his or her personality. But childhood, adolescence and even adult-
by learning your baby’s normal behaviors hood. You can read more about tempera-
Emerging personality As your baby and understanding his or her temperament in Chapter 9.
matures, his or her personality traits will ment, you can better appreciate your in-
rapidly become more apparent. Is your
baby bouncy and full of energy? Or per-
haps more quiet and cautious? Is he or
she easily frustrated when a goal can’t be
obtained? Or is your infant persistent to
the point where you might call it stub-
bornness? Does your baby adjust easily
to new environments, or does he or she
take a while to warm up?
Everyone is born with certain behav-
ioral characteristics that form his or her
basic temperament. Depending on the
situation, a temperamental trait can be
pleasing or frustrating to you as a parent.
For example, the same high energy that
makes your baby so fun to play with —
pleasing — can also make for difficult
CHAPTER 22
Month 6
As you approach your baby’s half-year weight. Your baby’s growth rate this
mark, think about how far you’ve both month is likely to be similar to last
come. By now, that little person in the nurs- month’s — weight gain of 1 to 1½ pounds
ery is no longer a baby, but a world-class or more and an increase in length and
explorer. And you have become an ever- head circumference by about ½ inch. But
more-confident parent, familiar with the don’t be surprised if the growth rate
rhythms of baby care and more secure in starts to slow down in a few weeks. Most
your ability to meet upcoming challenges. babies grow a little more slowly during
During this month, your baby is be- months seven through 12 than they did
coming more adept with his or her hands in the first six months.
and may even start to sit unsupported by
the end of the month. Each aspect of Teeth! Drooling, crankiness and tears —
your baby’s motor and sensory develop- could it be baby teeth coming in? Al-
ment gives your baby new tools to ex- though timing varies widely, most babies
plore the world and expand his or her begin teething by about age 6 months.
mental and social development. This is a The two bottom front teeth (lower cen-
fun time as your baby babbles and laughs, tral incisors) are usually the first to ap-
excited to be part of his or her family. pear, followed by the two top front teeth
(upper central incisors).
Classic signs and symptoms of teeth-
ing often include:
BABY’S GROWTH AND Z Drooling, which may begin about two
APPEARANCE months before the first tooth appears
Z Irritability or crankiness
By the time the sixth month rolls around, Z Swollen gums
many babies have doubled their birth Z Chewing on solid objects

Many parents suspect that teething fill it with water. Prolonged contact with
causes fever and diarrhea, but research- sugar from formula, milk or juice may SPOT-CHECK: WHAT’S GOING ON THIS MONTH
ers say this isn’t true. Teething may cause cause tooth decay.
signs and symptoms in the mouth and Here’s a snapshot of what your baby’s basic care looks like in the sixth month.
gums, but it doesn’t cause problems else- Keep it cool A cold washcloth or chilled
where in the body. If your baby develops teething ring can be soothing. Don’t give Eating Breast milk or formula still plays the central role in baby’s nutrition, al-
a fever, seems particularly uncomfort- your baby a frozen teething ring, howev- though most parents will begin to introduce solid foods by the end of this month.
able, or has other signs or symptoms of er. Contact with extreme cold may hurt, Be sure to feed your baby in a seated position, and avoid hard, chewy or round
illness, contact your child’s provider. doing your baby more harm than good. If pieces of food that could potentially seal off your baby’s airway.
Otherwise, teething can usually be han- your baby’s eating solid foods, offer cold
dled at home. items such as applesauce or yogurt. Sleeping Your baby is more likely to sleep six to eight hours at night without inter-
If your teething baby seems uncom- ruption. Some babies still wake up once or twice during the night for a feeding. Total
fortable, consider these simple tips: Dry the drool Excessive drooling is part sleep may add up to between 14 and 15 hours in a 24-hour period, including a
of the teething process. To prevent skin ir- couple of daytime naps, usually one in the morning and one in the afternoon. Some
Rub your baby’s gums Use a clean fin- ritation, keep a clean cloth handy to dry babies may need a third nap late in the afternoon.
ger, moistened gauze pad or damp wash- your baby’s chin. Saliva is used in the di-
cloth to massage your baby’s gums. The gestion of food, so isn’t it interesting that
pressure can ease your baby’s discomfort. the body knows to produce more saliva at
the time when infants begin solid foods. Motrin, others) may help. Don’t give your Association and the American Academy
Offer a teething ring Try one made of baby products that contain aspirin, how- of Pediatric Dentistry recommend sched-
firm rubber. The liquid-filled variety may Try an over-the-counter remedy If your ever, and be cautious about teething uling a child’s first dental visit after the
break under the pressure of your baby’s baby is especially cranky, acetaminophen medications that can be rubbed directly first tooth erupts and no later than his or
chewing. If a bottle seems to do the trick, (Tylenol, others) or ibuprofen (Advil, on a baby’s gums. The medication may be her first birthday. Your baby’s teeth and
washed away by your baby’s saliva before gums will also be examined at well-baby
it has the chance to do any good — and checkups. Regular childhood dental care
Month 6 too much of the medication may numb helps set the stage for a lifetime of
35 your baby’s throat, which may interfere healthy teeth and gums.
with his or her normal gag reflex.
Caring for new teeth Ideally, you’ve

30 been running a clean, damp washcloth BABY’S MOVEMENT
over your baby’s gums every day. If not,
now’s a great time to start. The washcloth By 5 or 6 months old, most babies have
can keep bacteria from building up in achieved pretty good head control and
Length 25 your baby’s mouth. When your baby’s are rolling over both ways. By now, they
(inches) first teeth appear, switch to a small, soft- may be ready to move on to learning how
bristled toothbrush. There’s no need to to sit without help. By 7 months or so,
use toothpaste. Water is all you need un- most babies have learned to sit indepen-
20 Average girl
(50 percentile)
Average boy
(50 percentile) til your child learns to spit — about age 2. dently, but some may wait until 9 months
If you have well water or you use bottled to do so, which is within the range of
25.75 in. 26.5 in.
16 lbs. 17 lbs. water in your home, your baby may not normal.
be getting necessary fluoride for healthy At the same time, baby’s hand control
15 tooth development. Discuss this issue skills are rapidly improving, allowing
with your child’s care provider. your child even more flexibility in explor-
5 10 15 20
© MFMER
It’s also time to think about regular ing his or her surroundings, and even
Weight (pounds) dental checkups. The American Dental other parts of his or her body.
Tripod sitting Your baby’s first attempts with the help of incredibly flexible limbs
at sitting will probably be very entertain- — your baby is likely to bring toes to A LEFTY OR A RIGHTY?
ing. At first, he or she will sit hunched mouth for a good sucking.
over, balancing on arms extended to the At this age, it’s too early to tell whether your baby is left-handed or right-handed.
front. Experts call this the “tripod sitting” Picking up and letting go By age 5 or For now, babies may seem to favor one hand for a while, then switch and use the
stage. Almost anything will topple a baby 6 months, your baby’s hand control is other hand more often. A 1-year-old may use both hands equally. By 18 months to
in this position — leaning a little to one good enough that he or she can reach for 2 years, toddlers start to show a preference for which hand they use. Still, true
side, a distraction that makes the baby a desired object using a rake-like motion handedness isn’t usually determined until a child is about 3 years old.
look in another direction or any attempt and grasp it. After learning to grab a toy, Handedness develops naturally, although scientists still aren’t sure what role
to shift weight. your baby will practice moving things genes play in it. Children with left-handed parents have an increased chance of
This hunched-over sitting takes all of from hand to mouth, using both touch- being left-handed, but the inheritance pattern isn’t clear-cut.
your baby’s energy. He or she probably ing and tasting to explore the toy. You If you do notice when your child is an infant that he or she favors one hand over
can’t do much else but hold his or her may even see your baby repeating the the other, let your care provider know. Sometimes, further investigation is neces-
head up without falling over. In a few hand to mouth to hand movement, tak- sary to make sure that both hands do, in fact, work equally well.
weeks, his or her balance will improve. ing the object out of his or her mouth
with alternating hands. By 6 months,
Toes, toes, toes! If your baby hasn’t your baby may learn to move something
discovered his or her toes yet, he or she is directly from one hand to the other. BABY’S SENSORY ages and observe them studiously. You
likely to do so this month. When fingers Your baby will soon discover that let- DEVELOPMENT might notice this increased visual curios-
don’t seem so novel any more, baby may ting go of something is as much fun as ity when your baby picks up a toy and
catch sight of those wiggly things at the picking it up. At first, letting go is almost Although your baby’s senses will contin- examines it, although eventually it’s like-
end of his or her feet and bring them up accidental. As soon as your baby learns to ue to mature throughout early childhood, ly to end up in his or her mouth for a
for investigation. At first, your baby may hold something, he or she will also drop they’re now almost as fully developed as truly thorough examination. Looking at
explore those little toes just by grabbing it. But over the next few months, he or those of an adult. Your baby sees and picture books together is great fun at this
and feeling them. But sooner or later — she will begin to let go more purposeful- hears the world almost as clearly as you age, as are sturdy board books that pro-
ly. By the end of your baby’s first year, he do, and this ability allows the two of you vide visual interest as well as something
or she will have acquired other means of to understand and share many of the for your baby to practice manipulating
getting rid of unwanted objects, such as same experiences. with his or her hands.
throwing them or pressing them down
on a surface. Vision By 6 months of age, your baby Hearing By the end of this month, most
At this age, babies still use their whole has more clearly focused vision and can babies respond readily to sound and turn
hands to pick things up. When babies are probably track the course of a falling toy their heads quickly toward the direction
relaxed, their hands are open; by now, or other object quite smoothly. Ongoing of a voice or other noise. With improving
they’ve outgrown the closed-fist pose of development of your baby’s visual sys- memory and increasing exposure, they
younger babies.You can see the slow pro- tem allows for greater depth perception. may even be able to distinguish between
gression from that tight-fisted infant to a And now that your baby is sitting upright male and female voices.
more mobile and coordinated baby. Right more often, he or she can gaze across at
now, your baby is just beginning to use you and at other things, rather than just Touch In addition to exploring his or
hands for small tasks. And it’s hard work! look up. Both of these skills — increased her environment, your baby is discover-
Watching your baby, you can probably depth perception and the ability to look ing all sorts of new things about himself
see the amount of effort that goes into across — come in handy, such as when or herself. By touching his or her cheeks,
this kind of “play.” When your baby baby is learning to eat solid foods, and nose, toes and genitals, your baby is be-
reaches for an object, his or her other you’re aiming a spoon full of cereal at his coming familiar with the shapes and
hand may mirror the movement of the or her mouth. contours of his or her body. Baby also
reaching hand. Both hands may close as During this month, your baby is also continues to explore new textures and
one hand reaches for and grasps a toy. able to take in more complex visual im- shapes.

BABY’S MENTAL DEVELOPMENT Sensations associated with self are
easier to reproduce with regularity than TOYS AND GAMES
Between 5 and 6 months, your baby is sensations associated with others. Every
working out some of the first inklings of time your baby kicks, he or she can see Now that your baby is becoming more comfortable sitting upright, he or she has a
his or her own identity, what it feels like his or her legs move. But every time he or whole new vantage point from which to watch, play and interact with the world.
to be a separate person with individual she cries, the sight of you may or may not And as baby’s sensory and motor skills continue to develop, he or she will become
powers of action and reaction. In parallel appear immediately. much more interested in anything that provides additional opportunities for adven-
with these discoveries, your baby is un- ture and discovery.
covering the possibilities that exist for Playing becomes serious business
interaction with others. At the same time, playing rises to a new Colorful books and magazines ably best to keep them to under an hour
As your baby’s memory expands, he level. Toys that stimulate the senses and Your baby’s vision is such that now he or or two to match your baby’s finite stam-
or she can start to roughly catalogue his simple games, such as peek-a-boo or she is able to focus on an entire pattern ina and short attention span.
or her experiences — the kitchen floor is mimicking games, become the tools and and distinguish a range of colors. Read-
hard, daddy’s beard is prickly, this toy is experiments of your small scientist. Even ing colorful board books together be- Bouncy lap games Good head con-
fun to gum, the music comes from there, the process of getting your attention re- comes especially fun at this age. Simple trol also allows for slightly more physical
and so forth. quires a certain amount of strategy and texts allow you to repeat sounds that games. Almost all babies seem to love
can become a game for baby. your baby can try to repeat. Don’t be bouncing around on a grown-up’s lap.
Me, myself and I Combining sensory, Again, you don’t need expensive toys offended if baby decides to take over, Have your baby sit on your lap facing
motor and mental skills, your baby be- to stimulate your child’s mind and sens- though, turning the pages or flipping you, hold his or her hands, and bounce
gins to realize that moving certain mus- es. Common household items with dif- back to the cover every time you try to him or her gently on your knees while
cles always produces physical sensations ferent shapes and textures — such as read the next page. At this age, the main singing a song. If you don’t know any
that correspond with specific visual re- cardboard boxes, egg cartons, lids, paper idea isn’t to understand the story line such songs, ask your parents or grand-
sults. For example, baby’s effort to kick towel rolls, spoons, tea towels, nesting but to make sounds, look at pictures parents. They’ll probably remember
his or her legs is always accompanied by bowls, home-made noisemakers (think and chew on the covers. Old magazines some, and it will be fun to hear what
the sight of these legs moving. tightly capped clear containers filled with that you don’t mind being torn up can they sang to you at one point. Or try
also be fun to look at; just make sure the looking up nursery songs and rhymes.
baby doesn’t eat the pages. Here’s a classic to get you started:
Short trips Once your baby is able to Pat-a-cake, pat-a-cake, baker’s man,
sit up in a stroller, walks around the Bake me a cake as fast as you can.
neighborhood or the park take on a Roll it, and prick it, and mark it with a B
whole new dimension. Now your baby And put it in the oven for Baby and me!
can see most of the things you see and
will enjoy the sight of a passing dog or a Reach! Once baby is able to raise his
squirrel hopping to the nearest tree. or her body up on straight arms while
With a turn of the head, your baby can lying belly down on the floor, you can
locate different sounds, too, such as the start encouraging him or her to reach
honk of a goose or the sounds of chil- out with one arm for a toy just ahead.
dren playing. If it’s nice out, place your Eventually, your baby will lean on one
baby on a patch of grass and let him or arm and reach for toys with other. This
her feel the differing textures. Trips to the act of reaching forward is generally the
zoo or your local library also become first step toward crawling. Rolling balls
more entertaining at this age, but don’t or other toys also provide an incentive
expect them to last too long — it’s prob- for chasing.

rice) — offer plenty of opportunities for
sensory exploration and discovery.
Peekaboo is still fairly magical be-
Much of your baby’s “talking” may
seem more like sound effects than bab-
bling. Squeals, sliding pitches and bub-
cause your 5- to 6-month-old hasn’t bling sounds are all common for babies at During the sixth month, your baby is busy:
quite grasped the concept that you’re still this age. Giggles and laughter are favorite Z Maintaining good head control
there behind the blanket even though he sounds for both babies and parents. Z Rolling both ways
or she can’t see you (object permanence). Z Working toward sitting independently
Your little one may, however, look for a Z “Raking” small objects toward self
dropped toy but give up quickly if it’s not Z Picking up toys with both hands
in sight. Mimicking games become more BABY’S SOCIAL DEVELOPMENT Z Bringing toys to mouth
important as your baby strives to match Z Exploring with mouth
your facial expressions and imitate the This is a fun age to socialize and play Z Learning to self-feed
sounds and cadences of your voice. with your baby. Adults have the remark- Z Perhaps transferring an object from one hand to the other
able ability to express almost any emo- Z Repeating single syllables, maybe even combining sounds
Babbling Babbling usually begins with tion through facial expression, and ba- Z Giggling, laughing
babies trying out vowel sounds, some- bies love to watch and try to imitate these Z Exploring own body
thing you may have already noticed your expressions. Sharing emotional states Z Differentiating between self and others
baby doing. A few weeks later, baby may with someone else is vital for social de- Z Enjoying simple games
start to add in consonant sounds. By 6 velopment and is one of the basic foun- Z Looking briefly for dropped toy
months, about half of all babies babble by dations for communication. Z Mimicking and sharing your emotions
repeating one syllable over and over, Don’t be discouraged if playing with
such as mah or bah. Some babies may your baby seems uncomfortable at first.
even have started adding more than one Remember, it’s been a few years since
syllable to their babbling. You may hear you spent your evenings on the floor with them. Then join in. Soon you’ll Don’t be surprised if you feel your
your baby practice one kind of sound, with rattles and a box of blocks. Watch know what games and toys make play- baby needs even more attention now than
then move on to something else and not the “expert,” observing which toys your time fun for your baby.Your baby will give in the newborn days.Your baby wants and
repeat the sound for several days. baby is drawn to and what he or she does you the kind of immediate response — needs stimulation, especially from you.
giggles, turn-taking, smiles — that make Left alone in a playpen, crib or infant seat,
playtime rewarding for both of you. he or she is apt to become bored. But life
Your baby will let you know if play- doesn’t have to be all games and playtime.
PLAYING WITH SIBLINGS time is too intense or has gone on too You can meet many of your baby’s social
long. Watch for clues that he or she is needs by including him or her in your
An older brother or sister can get a lot of enjoyment out of a 5- to 6-month-old overstimulated, such as turning away or daily tasks or just by positioning baby
baby. By six months, the baby has moved beyond face-to-face interaction and becoming grouchy or tense. where he or she can watch you at work.
may even play with toys offered by an older child. Your baby can probably entice a
bigger brother or sister into picking up dropped toys or playing passing games.
At this age, it’s important that your baby have personal toys separate from an
older sibling’s toys. Illnesses can be easily spread from one child to another through
shared toys. Keep the baby’s toys clean. Plastic toys should be washed often, and
fuzzy toys that aren’t as easily washed should be reserved just for the baby’s play.
Babies love older kids mostly because they’re fun to watch. Although babies
will play some turn-taking games, they delight in being an audience and respond-
ing to what older children do. For safety reasons, always supervise playtime be-
tween your baby and an older child.
CHAPTER 23
Month 7
The next few months are a time of grow- she will latch on to nearby items to help
ing independence for your little one. This himself or herself along or even up. Re-
can be both exhilarating and frightening moving treasured or breakable items and
for an infant. You may find your baby vig- creating a safe environment will give
orously venturing into new things, but your baby the freedom and confidence to
afraid to be too far away from the security explore and learn. At this age, it’s gener-
of what he or she already knows — you. ally easier to modify the environment
By sharing in your child’s curiosity while than to teach a child not to touch.
still providing lots of affection and com-
fort, you can help your baby become
more confident and competent in his or
her evolving skills. BABY’S GROWTH AND
From month seven on, mobility starts APPEARANCE
to take off. Day by day, your baby will
build on existing motor skills, such as During these past months, your baby’s
reaching, rolling over and sitting, and growth rate was on fast forward. Once
move on to new ones, such as crawling your baby reaches 6 months, though,
and standing (some faster than others). you’ll find that growth tends to slow a
Since you can’t predict when your bit. Previously, your baby was likely to
baby will make his or her first move gain over a pound a month. Now, his or
across the floor, now is a good time to re- her weight increase is more likely to be
view your home safety. (See Chapter 15 just under a pound each month, and his
for more information on childproofing or her increase in length around ³∕8 inch
your house.) Keep an eye out for dan- or less. You can also expect the growth of
gling cords and unsteady furniture. As your son’s or daughter’s head to begin to
your baby’s mobility progresses, he or slow, too.

From here on out, your child will con- Sitting At 6 months, many babies sit up SPOT-CHECK: WHAT’S GOING ON THIS MONTH
tinue to grow steadily, with additional with help or sit alone by leaning forward,
growth spurts here and there. But he or hands to the floor. Over the next few Here’s a snapshot of what your baby’s basic care looks like in the seventh month.
she will never grow quite as fast as in weeks, your baby is perfecting the art of
those first six months. sitting — keeping the head steady and Eating Breast milk or formula is still part of your baby’s diet, but by this time you
back straight to maintain balance. By 7 may be introducing additional foods. If you introduce one new food at a time at
months, your baby may be sitting alone first, you’ll have the advantage of knowing whether a particular food is likely to
with no support, even working to put cause a reaction of some sort, such as diarrhea, rash or vomiting. If your baby
BABY’S MOVEMENT arms to the side to keep from toppling does have such a response to a food, avoid it until you talk to your baby’s care
over. By his or her ninth month, your provider about it. See Chapter 3 for more on introducing new foods.
When your baby was younger, indica- baby may be steady and strong enough
tions of developing motor skills were to play for longer periods while seated on Sleeping Baby is more likely to sleep six to eight hours at night with no interruption.
subtle, with some so basic as to go almost the floor, even pivoting and reaching to Some babies still wake up once or twice during the night for a feeding, although
unnoticed. Fidgeting, for example, is a get to different toys. they’re unlikely to need middle-of-the-night feedings by this age. Total sleep may
normal phase of growth and develop- add up to between 14 and 15 hours in a 24-hour period, including a couple of day-
ment, but it isn’t nearly as exciting as the Hand and finger coordination At 6 time naps, usually one in the morning and one in the afternoon. Some babies may
motor skills that are now blossoming. months, babies have very clumsy hand need a third nap late in the afternoon. As your baby becomes more curious and
Between now and baby’s first birthday, movements and pick up objects by press- mobile, it may be harder to settle down to sleep at night. Establishing and maintain-
noticeable changes take place that trans- ing all their fingers against their thumbs ing a consistent, relaxing bedtime routine — such as having a bath, reading books
form your son or daughter from a totally (“mitten grasp”). But between now and together or singing a quiet song — can be a great help in getting your child used to
dependent infant to a trundling indepen- the ninth month, most babies will learn the idea of going to sleep at nighttime.
dent toddler. to use a more refined “pincer” grasp, us-
Month 7 ing the thumb and index finger to pick up BABY’S SENSORY
35 small objects. DEVELOPMENT
The graduation from a mitten grasp
to a pincer grasp is gradual. First, you By 7 months, your baby’s eyesight is
may notice your child using a cross be- nearly mature. His or her distance vision
30 tween the two, picking up objects with is continuing to improve so that faraway
the thumb, index and middle fingers. You people and objects appear clearer and
may also see baby resting his or her arm more distinct. Your baby is also able to
and hand on a surface to steady the hand track faster movements with his or her
Length 25 and pick up a small object. eyes and follow moving objects closely.
(inches) At the same time, your baby is also In fact, if you roll a ball to your baby, he or
getting better at transferring an object she can monitor its path and probably
from one hand to the other, turning it put a hand out to it as it gets near.
20 Average girl
(50 percentile)
Average boy
(50 percentile) around and upside down, holding it this By age 6 or 7 months, your baby’s
way and that, and getting to know how it hearing is almost fully developed. He or
26.5 in. 27 in.
17 lbs. 18.5 lbs. feels. About half of babies this age gain she also is becoming more selective
the ability to hold an object in each hand. about the sounds he or she reacts to. For
15 Eventually, they’ll delight in banging ob- example, your baby at this age can quick-
jects against each other, but for now your ly and accurately locate you when you
5 10 15 20
© MFMER
baby may simply enjoy banging objects speak. He or she also may stop to listen
Weight (pounds) against a leg or table. to quieter sounds.
ENTER FLUFFY TOYS AND GAMES
One thing that might help your baby As your baby becomes more interested in interacting with the outside world, give
negotiate transitions, such as going to him or her new opportunities to do so.
bed or to child care, is to carry along a
favorite stuffed animal, blanket or even Introduce the high chair By this together for some time yet, at this age,
book. Having a loved object to hang on month, your baby is likely to sit well babies will play side by side. Also,
to while venturing into uncharted terri- supported. Putting him or her in a high they’re intrigued by others who are
tory can make your little one feel more chair can be a great way to include similar in size and deed. Exposure to
secure and confident, and help him or baby in family mealtimes. It can also be other children can help expand your
her become more independent. an interesting new vantage point for baby’s social horizon. But be sensitive
your baby to sit and watch daily house- to when your baby has had enough
hold activities and play with small toys “socializing.”
on the high chair tray (he or she can
Watch to see if your baby turns to- The art of conversation In addition start working on thumb-finger coordi- Check out activities at your local
ward a sound, even if the sound comes to imitating sounds and even combina- nation). Choose a high chair that has a library Libraries often have special ac-
from outside his or her line of vision. If tions of sounds, your baby may also be- comfortable seat and straps to keep tivities for infants, such as story time.
you notice that he or she doesn’t respond gin to follow your pattern of speech — your baby safely positioned. A detach- Often a staff member will read a book
to surrounding sounds, talk to your ba- pausing between “sentences” or ending a able tray that you can take to the sink aloud and include activities, such as
by’s care provider. If there’s a problem string of sounds with an upward inflec- to wash is convenient. Experienced singing silly songs and interacting with
with your baby’s hearing, it’s better to tion, as if posing a question. You can help parents may advise removable wash- puppet shows. Many libraries also have
identify it sooner rather than later. Un- your baby practice the art of conversation able parts in general, as high chairs in- play areas designed especially for
treated, hearing loss can interfere with by talking to him or her and acknowl- variably become a backdrop for bits of younger children. This may also be a
other aspects of development, such as edging his or her efforts with your own cereal, splattered applesauce and good place to meet other parents and
language and social development. warm responses. mashed up yams. Hosing off the entire children. Plus, having all those books to
An infant’s understanding of words apparatus in the backyard or shower look at can’t hurt, right?
is far ahead of his or her ability to use isn’t unheard of.
them. At this age, your baby understands
BABY’S MENTAL DEVELOPMENT the meaning of what you say by listening Provide warm-up time If baby is shy
to your tone of voice. Even the word or cautious, offer him or her plenty of
During month seven, your baby continues no (which you may find yourself using time to warm up to a new situation or
to pick up on language skills from listen- more and more often as your baby starts activity. Allow your child to sit and ob-
ing to you and others speak. Before, your to push against the limits you’ve estab- serve on the sidelines for a while. This
son or daughter may have focused on lished) is understood by your inflection will give him or her time to assess the
imitating specific sounds, such as mmm or and tone and not necessarily by the situation and approach it on his or her
bbbb. In these next few weeks, you may word itself. own terms. Once your baby feels se-
notice him or her start to combine differ- The more you talk to your son or cure, he or she will become more in-
ent sounds together, such as consonants daughter — whether it’s while you’re volved in what’s going on.
and vowels. Around 6 or 7 months, your driving around town, doing chores
baby may make sounds such as dadada around the house, or changing or feeding Make new friends If you haven’t al-
and mamama. As tempting as it may be to him or her — the more your little one ready done so, now might be a good
think your baby is referring to you when learns about all facets of communication, time to introduce your baby to other
saying these sounds, it will likely be sev- including sounds, inflections, tone of children. Although they likely won’t play
eral weeks still before he or she is able to voice, as well as facial expression and
attach names to people. body language.
The art of empowerment As your By helping him or her feel secure — BABY’S SOCIAL DEVELOPMENT your child become a secure, independent
baby’s understanding of his or her own creating a safe environment to explore and well-adjusted adult who is able to
power to make things happen grows, you and practice, offering warm praise and Between 6 and 7 months old, your baby successfully navigate almost any social
can see how he or she begins to test the support, setting firm yet practical limits is becoming quite the expert at nonverbal environment. You can start this process
limits of what he or she can achieve. How — you can encourage experimentation communication, expressing his or her early on by establishing a trusting rela-
far can I push this train over the edge of and promote competence. In this type of emotions through laughing, crying, tionship between you and your child and
my tray before it falls out of sight? Does setting, your baby learns to tackle chal- shrieking, squealing and cooing. setting simple, consistent limits.
mommy bring it back intact every time? lenges with enthusiasm, adding skill
How much can I kick during a diaper upon skill. Stranger anxiety Even as your infant Create a foundation of trust During
change before I receive a frown? While finding the energy to repeat becomes more expressive around you, he your baby’s first year, you can set the
Amid all of this experimentation, you the same game or story over and over or she may begin to show the first signs foundation for a pattern of parent-child
will find that your son or daughter is like- again may drive you crazy at times, re- of reticence around strangers. Your child interaction that will serve you well in
ly to waver between feeling confident member the process of repetition is key has come to associate you with his or her later, potentially more trying times. This
and exuberant, and needy and cautious. to your baby’s learning. own well-being and is increasingly reluc- is done in the way you nurture and react
tant to let you go. He or she is also be- to your infant, including simple things
coming keenly aware of who is familiar such as following a consistent schedule,
and who isn’t. By 8 or 9 months, your attending to your baby’s needs promptly
BABY EINSTEIN: HELP OR HYPE? baby may openly reject strangers, cling- and spending time bonding as a family.
ing to you and even crying if unknown
Chances are if you’re an American parent of a young child, at some point you’ve people come too close.
found yourself holding a DVD intended to improve your baby’s intelligence and This is a normal phase of develop-
wondered if it could help promote junior’s brain cell connections. ment and is a sign of the strong bond
Turns out human interaction still is likely to trump anything on a screen. While your baby has developed with you. Shy-
such DVDs might catch your baby’s attention, the screen time probably won’t con- ness toward strangers can last months
tribute to his or her development. In fact, an infant can learn just as much — if not and even years, depending on your
more — by interacting with you or other caregivers. child’s temperament. Some children are
Research examining the specific effects of baby DVDs and other infant program- naturally more shy than are others.
ming is limited. In a 2007 study, children ages 8 months to 16 months who were
exposed to baby DVDs scored lower on a language development test than did ba- Discipline in infancy Discipline is a
bies who had no screen time. A 2009 study of children ages 2 months to 4 years concern that arises in every parent’s mind
showed that turning on the television reduced verbal interaction between parents at some point, perhaps even before a
and children — which may delay language development. In addition, a 2010 study baby is born. You may have definite ideas
found no evidence that children ages 1 to 2 learned words highlighted in a Baby about guiding your child’s behavior, or
Einstein DVD. In contrast, research has shown that regularly reading to young chil- you may not. It can be a fuzzy topic, es-
dren boosts language ability for both babies and toddlers. pecially if you have little previous experi-
Many pediatricians discourage screen time for children younger than age 2. In- ence. During the first six months, dis-
stead of relying on Baby Einstein DVDs, concentrate on proven ways to promote tracting your baby from unwanted
infant development — such as talking, playing, singing and reading to your baby. behavior is usually enough to stop it. But
Even if your baby doesn’t understand what you’re saying, or grasp the plot of a by the time your baby reaches the sev-
story, he or she will soak in your words and revel in your attention. These simple enth month, you may need to start set-
activities form the foundation for speech and thought. ting additional limits.
That being said, all DVDs aren’t necessarily off-limits. If your family enjoys this Keep in mind that true discipline —
kind of programming, make conscious decisions about how to use it. Turn it on only throughout the childhood years — is
occasionally — and encourage interaction by watching the programming together. positive in its approach, with the ultimate
goal of teaching rather than simply pun-
ishing. Your goal as a parent is to help

As your baby gets a little older and
more independent, he or she will likely
start testing the boundaries you’ve care-
fully created. This is not “misbehaving” During the seventh month, your baby is busy:
— it’s how a baby explores the world. If Z Learning to sit unsupported
you manage that exploration safely, you Z Sitting and looking around
can prepare the way for your child to be- Z Perhaps supporting self in a crawling position, while reaching out with one hand
come a happy, competent and confident Z Using hands to rake up small objects
member of your family and, ultimately, of Z Getting better use of thumb and fingers
society at large. Z Transferring objects from one hand to the other
Z Visually tracking rapid movements
Be gentle yet firm By this time, your Z Readily responding to sounds
child’s needs and wants have already Z Looking for sounds outside of field of vision
started to separate. For example, your Z Starting to look for dropped toys
son or daughter might prefer to fall Z Combining different sounds together
asleep in your arms, but he or she doesn’t Z Imitating patterns of speech
need to sleep in your arms. Now or even Z Distinguishing strangers from loved ones
earlier, start teaching your baby to fall Z Starting to test limits and boundaries
asleep on his or her own, in his or her
own crib. Helping your baby learn to self-
soothe is a first step toward indepen-
dence and will make bedtime much eas- Be proactive Once your baby is crawling What to avoid Day-to-day management
ier in the future. In addition, it’s likely — then walking — your baby thinks ev- of an active, curious child can be frustrating
that your baby will get better rest this erything in the house is there for him or at times. If you lose your patience with your
way, and so will you. her to touch, pull, mouth, open and, in infant, give the baby to a partner or set the
Likewise, at this age your baby’s sense general, spread around the room. This is baby in his or her crib and take a break to
of curiosity and touch has kicked into a normal and expected behavior. Take a cool off. Never shake your baby. If you’re
higher gear. As your baby discovers the proactive approach and prevent prob- struggling with your child’s behavior or
use of his or her hands, those hands will lems before they happen. Set up bound- how to handle your frustrations, talk to
grab keys, hair, earrings, a nose — any- aries by childproofing your house. Gates, your child’s care provider. If your child
thing within reach. He or she will judge cabinet locks and outlet covers can help has a physical or developmental disabili-
what’s OK by your reaction. Use your you establish a positive learning environ- ty, managing behavior can be even more
tone of voice and facial expressions to ex- ment for your baby and you won’t have challenging. You may need more intense
press disapproval. If baby pinches your to constantly say “No.” strategies, so don’t be afraid to ask for help.
nose and it hurts, make a funny face or
set your baby down and say “No,” or
“Ouch.” Your baby can’t control the
impulse to touch and grab, so gently
guide him or her to what is acceptable.
Being consistent and firm in your lim-
its will make it easier for your child to
remember what’s OK and what’s not. Es-
tablishing your authority now — show-
ing that you have the final say — will
make your life and your baby’s life easier
as he or she grows up.

CHAPTER 24
Month 8
By month eight, most of your baby’s new- pecially apparent in your infant’s social
born reflexes have faded away and are preferences, as he or she becomes in-
now replaced by intentional, purposeful creasingly aware of the difference be-
movements. This is a result of your baby’s tween familiar and unfamiliar people.
maturing nervous system. As more and Your child’s conceptualization of ob-
more nerve endings become encased in ject permanence is setting in, as well. He
protective sheaths (myelin sheaths), the or she is starting to realize that although
nerves become more efficient at carrying people and things may temporarily dis-
messages from the brain to muscles, mak- appear from his or her line of vision, that
ing your baby’s movements increasingly doesn’t mean they’re gone forever. This
“smarter” and more refined. realization tends to coincide with a reluc-
At the same time, your 7- to 8-month- tance to be separated from you, making
old’s brain is developing the ability to at- transitions to child care and baby sitters a
tach meaning to different sounds and little more challenging for a while.
gestures. For example, he or she may
quiet at the sound of his or her own
name. Or if you have a dog in the house
and the dog’s name is often repeated in BABY’S GROWTH AND
conjunction with its appearance on the APPEARANCE
scene, your baby may begin to associate
the dog with the dog’s name. During this time, your baby is growing
Your child’s thinking processes are steadily but probably at a slightly slower
becoming ever more complex, and you rate than in previous months. The aver-
can see this by the way he or she begins age baby at this age tends to gain just un-
to indicate likes and dislikes, and be fair- der a pound over the course of the month
ly emphatic about them. This may be es- and grow about ³∕8 of an inch in length.

Your baby’s head circumference is still in- Offer a wide variety of foods You still
creasing but only slightly compared with want to introduce new foods one at a SPOT-CHECK: WHAT’S GOING ON THIS MONTH
early months. time, but that doesn’t mean you have to
As long as your baby is following a stick to a single food for weeks on end. If Here’s a snapshot of what your baby’s basic care looks like in the eighth month.
steady growth curve based on measure- your baby does well with pureed yams,
ments by your baby’s care provider, try some ground chicken after a few days. Eating As you begin altering your child’s diet to add cereal and other foods, you
there’s no need to be overly concerned Or after a successful course of mashed may wonder whether breast milk or formula still plays an important role in your
about specific numbers. At this stage, peas, provide a dessert of mashed bananas. baby’s diet. Even though solid foods are beginning to replace some of your baby’s
your baby’s nutritional intake is starting feedings, they can’t efficiently replace the balance of nutrients that breast milk or
to become a little more varied. But keep Include a good balance of foods Priori- formula provides. Breast milk is designed to be a perfect food for your baby
in mind that he or she still needs a prop- tize fruits, vegetables, lean meats and through the baby’s first year and beyond.
er balance of fats, carbohydrates and pro- healthy carbohydrates over processed Many parents wonder whether their babies can drink whole milk at this age. It’s
tein. Be sure to discuss your baby’s diet foods and baked goods. Instead of a cut-up best for your baby to have breast milk or formula for the first year. Your baby’s
with his or her care provider, who can hot dog, for example, offer bits of turkey. Or delicate digestive system isn’t able to adequately handle the type and concentra-
help you decide how to best meet your instead of a soft cookie, offer pureed peach- tion of selected nutrients found in cow’s milk. And cow’s milk is lower in iron and
child’s nutritional needs. es. Minimize salt and offer sweets in mod- vitamins C and E than is breast milk or formula.
eration. Examples of not-so-obvious
Establishing good eating habits As salt-rich foods include processed cheese, Sleeping Most babies are able to sleep well through the night — between 10 to 12
you introduce new foods to your son or cottage cheese, canned vegetables and hours — around age 8 months, to the relief of their weary parents. Total sleep for
daughter, take the opportunity to estab- soups, and instant puddings. baby may add up to about 14 hours in a 24-hour period, including a couple of day-
lish good eating habits right away. Here time naps, usually one in the morning and one in the afternoon.
are some tips to help your baby develop Avoid overfeeding Watch your baby for But beware: New skills such as pulling up to stand and cruising are near if not
healthy eating patterns: cues to know when he or she is full. already learned, and your baby may waken during the night and want to practice.
If he or she can’t quite return to a sleeping position on his or her own, your help
may be needed.
Month 8 In addition, if your baby gets anxious when separated from you during the day,
35 that anxiety will likely be compounded at bedtime and in the middle of the night.
You’re caught in the dilemma of wanting to reassure your child and also wanting
your baby to learn good sleep habits. For more information about helping your son
or daughter develop good habits, see Chapter 7.
30
While you control what your baby eats, idea of using a cup. But at this age, your
Length 25 let your baby determine how much. baby will probably bang, drop and dump
(inches) the cup more than drink from it. It will
Enjoy food for its nutrition But avoid probably be another few months before
using it as a reward or as a comfort item. he or she is using it properly.
20 Average girl
(50 percentile)
Average boy
(50 percentile) Instead, reward and comfort your baby Even if your baby uses a cup at meal-
with hugs, kisses and attention. times, you may decide to continue breast-
27 in. 27.5 in.
18 lbs. 19.5 lbs. feeding or using a bottle for supplemen-
Introducing a cup You can give your tal feedings, simply because baby can’t
15 baby a cup as soon as he or she starts eat- get much out of the cup just yet. Feeding
ing solid foods. A two-handled cup is your baby breast milk or formula from a
5 10 15 20 usually easy for baby to grasp. This will cup at mealtime may help pave the way
© MFMER
Weight (pounds) help your child become familiar with the for weaning when you’re ready.
BABY’S MOVEMENT Getting around After your baby learns BABY’S SENSORY are actually still there even if hidden from
to sit up without much effort, you’ll no- DEVELOPMENT view.Your child’s brain is starting to make
Your child’s rapid development during tice other movements that are predeces- connections between what is seen and
these months can be astonishing. In just sors to crawling — rolling, twisting, During this month, your baby’s senses unseen and draw conclusions from re-
a few weeks, he or she may go from bare- crouching, and rocking back and forth on continue to contribute lots of informa- peated experiences. Although it will be
ly sitting up without your help to bustling the knees. In fact, it will be hard for your tion to his or her brain. This stimulates awhile before your child can actively for-
around the room by scooting, crawling baby to be still for long. If lying tummy- the development of other skills, such as mulate and express symbolic thought —
and cruising. down, he or she will push up on hands reaching and crawling, and drawing con- such as pretend play, which usually de-
and arms to look around. Lying faceup clusions about spatial relationships. velops in the second year — the very first
Sitting up By 8 months, your baby is lit- is an incentive to kick and grab for toes. formations of abstract thought are
erally sitting pretty and is steadier than Your baby can now also flip around at Vision Your son’s or daughter’s vision is emerging.
ever on his or her bottom. His or her will. Some babies even roll repeatedly now almost adult-like in clarity and
sense of balance is improving, and he or as a means of getting from one place to depth perception. By 8 months, most ba- Attaching meaning By 8 months or
she will be able to sit up unsupported for another. bies’ vision is 20/40. Although he or she so, you may notice your child quiet or
longer periods of time without falling Because your youngster is getting so still sees things close up better than far perk up at the sound of his or her name,
over. Your baby may even start to reach mobile, it’s important to take appropriate away, your baby’s vision should be clear or even turn toward you when you say it.
with his or her arms while sitting to try to safety precautions, such as swapping the enough to recognize people and objects He or she doesn’t fully understand at this
grasp nearby toys. These exercises will changing table for the floor or bed to across the room. Increased depth percep- point that this word refers to himself or
help further strengthen your baby’s core change diapers and installing safety gates tion helps your baby accurately reach for herself, but your baby is becoming famil-
muscles, which are important for stand- at the top and bottom of stairs to avoid objects and judge distances correctly iar with hearing that word when you ac-
ing, walking and any kind of forward- an accidental, and potentially serious, when moving forward. tively seek a face-to-face connection
propelling movement. tumble. (See more about making your with him or her.
home safe in Chapter 15.) Touch Between 7 and 8 months old, Other words are starting to become
your budding physicist is learning rapidly significant, too. You’ll probably notice
Hand and finger coordination Once about the way matter takes up space, that your baby is gaining a better under-
your baby is able to sit well, he or she is how different surfaces feel and how standing of the word no. He or she
also able to maintain upper torso balance they’re related. For example, he or she may hesitate when he or she hears the
while coordinating simultaneous move- may start to realize that balls are round word, especially when it’s delivered with
ments of arms and hands. Most babies and roll, boxes have flat surfaces, and a sharp inflection. At this age, baby be-
this age are able to hold a toy in each some toys have a top and a bottom part. gins to associate words with specific ob-
hand. Eventually they’ll develop enough Objects with tags, handles and parts that jects and actions, including gestures (see
coordination to bring both hands inward can be manipulated are especially in- “Baby sign language” on page 296).
and bang the toys against each other. triguing at this point. About half the babies at this age begin to
During this month, your baby proba- wave bye-bye.
bly still uses a raking motion to bring
small objects closer. But he or she is also Object permanence Previously, if
working on coordinating the thumb and BABY’S MENTAL DEVELOPMENT your baby dropped something, he or she
first or second finger to pick up small ob- likely thought it was gone entirely and
jects (pincer grasp). Baby will practice Around this time, your son or daughter is made no effort to look for it. Now he or
this technique until he or she achieves beginning to understand that certain she is starting to realize that, in fact, it
such a grasp. This usually happens by his things have meaning beyond the imme- may still be there and will look for a hid-
or her first birthday. diate sensory experience. For example, den toy. Games of peekaboo take on a
Your baby is also learning to let go of words and gestures, besides being seen new significance as your baby realizes
items at will. This is evident by his or her and heard, can convey messages. And that if he or she pulls the blanket away
enthusiasm for dropping and throwing things your baby once thought were — Aha! Mom is still there! And now that
things. there and then gone when out of sight baby knows you’re still around even if

you leave the room, he or she may make jabberwocky, encouraging him or her to
more of a fuss to get you to come back. communicate verbally as well as non- TOYS AND GAMES
verbally.
Language skills By this time, your
baby is likely becoming a proficient bab- Around this age, most babies enjoy toys they can bang, poke, twist, squeeze, drop,
bler, repeating not just single sounds but shake, open, close, empty and fill. Toys should be lightweight with no sharp edges.
combining syllables, such as bah-dah. BABY’S SOCIAL DEVELOPMENT Remember that all toys will end up in your baby’s mouth, so don’t give your baby
Some babies are very expressive and jab- toys with small parts.
ber away like an excited squirrel. Others As your baby learns new skills and be- For the most part, your child’s playtime will center around playing on the floor,
are a little quieter and may listen more comes more mobile, he or she is torn working on crawling, sitting and standing. You can encourage these skills by put-
than chatter. But this doesn’t mean between two desires: to be with you and ting a toy just beyond your baby’s reach and encouraging the baby to move to-
they’re not absorbing what’s being said to experience some independence. You ward it. Other playtime ideas include:
around them. Be sure to talk to your little may notice this struggle surface in many
shy guy as much as you might to a little situations as your baby searches for both Peekaboo As mentioned previously, games of peekaboo take on a new dimen-
sion around the time your baby develops a sense of object permanence. He or she
will enjoy games in which objects and people “disappear” and your baby finds
them again. Use a small blanket to cover toys, and let your baby uncover and
BABY SIGN LANGUAGE discover them. Your baby may even cover them up again only to rediscover them.
By age 8 months or so, many infants begin to know what they want, need and feel, Mirror games Your little one is starting to learn the concept of three-dimensional
but they don’t necessarily have the verbal skills to express themselves. Baby sign space. Contrast two-dimensional images with three-dimensional ones by playing
language allows children to use their hands to bridge the communication gap. games in the mirror. If your son or daughter is looking in a mirror and you sud-
Slightly older children who have developmental delays may benefit, too. Limited denly appear in the mirror too, he or she is likely to turn around and look for you
research suggests that using baby sign language may improve a child’s ability to instead of believing you’re in the mirror itself.
communicate and ease frustration, particularly between ages 8 months and 2
years. Teaching and practicing baby sign language also can be fun and give you Buckets of stuff Your baby is also learning how things relate to one another.
and your child an opportunity to bond. Infants at this age start to understand that smaller objects fit inside bigger ones.
At the same time, don’t neglect your baby’s verbal skills. Continue to talk to Stacking toys starts to appeal at this age. Games in which toys can be put into a
your child, and encourage him or her to use spoken words (or what may only container and dumped back out again are popular, as well. For a quick and easy
sound like words in the beginning) to express himself or herself. version, fill a plastic mixing bowl with odds and ends from the kitchen — measuring
A variety of books, websites, community classes and other sources are avail- spoons, plastic lids, small containers, empty baby bottles — and let your baby sort
able to help you learn baby sign language. You can also use variations of American through it, dump it out and put it all back in again.
Sign Language. Start with signs to describe routine requests, activities and objects
in your child’s life — such as more, drink, eat, mother and father. Book of animals As your baby begins to understand
To get the most out of your baby sign language experience, keep these tips in mind: that things have names and labels attached to them,
Z Set realistic expectations. Feel free to start signing with your child at any age introduce him or her to a book with simple pictures of
— but remember that most children aren’t able to communicate with baby sign various animals and their names. You can read it to-
language until about 8 or 9 months. gether. As you point to the picture and name the animal,
Z Stay patient. Don’t get upset if your child uses signs incorrectly or doesn’t start your baby will eventually start to associate the name with
using them right away. The goal is improved communication and reduced frus- the animal. In time, you can introduce animal sounds, too.
tration — not perfection. For a more lyrical version, read Brown Bear, Brown Bear,
Z Be consistent. Repetition is the best way to ensure your child’s success in us- What Do You See?, by Bill Martin Jr., and Eric Carle, which
ing baby sign language. Encourage your child’s other caregivers to use the contains rhythmic prose and colorful illustrations that are a
same signs, too. favorite of children and parents alike.

predictability and adventure. Living with
this new assertiveness may take a bit of
adjustment for all parties involved. But
baby, whether it be for a few hours or a
few minutes. He or she may become
more clingy — not wanting to let you out
understanding it as a normal phase of of sight — and may grasp or cry if you During the eighth month, your baby is busy:
development helps most parents take the manage to break away. Your baby may Z Sitting up straight and looking around
new challenges in stride. even begin to prefer the parent he or she Z Supporting self in a crawling position, while reaching out with one hand
spends the most time with. Both parents Z Rocking back and forth on all fours, rolling over repeatedly, scooting on bot-
Separation anxiety At 8 months, most should understand that this situation is tom, or expressing some form of desire to move around
babies are clearly attached to the parent normal and will diminish with time. Z Using hands to rake up small objects
providing most of his or her care. Your Every baby goes through a stage of Z Getting better use of thumb and fingers
baby may seem most assertive when you “separation anxiety,” which often begins Z Transferring objects from one hand to the other
make any attempt to separate from the around this age, peaks between 10 and Z Using touch to learn about the physical properties of different objects
Z Looking for you or dropped toys (establishing object permanence)
Z Attaching meaning to words and gestures, such as “no” and a farewell wave
Z Combining different sounds together
ENJOYING A RELAXING NIGHT OUT Z Distinguishing strangers from loved ones
Z Cementing the parent-child bond
Because babies react so strongly to separation from their parents, parents are Z Starting to test limits and boundaries
often reluctant to leave their babies with baby sitters. You might even wonder if a
night out is worth the heartbreak your baby seems to endure when left with a sitter.
You can help yourself and your baby through this stage by taking these steps:
18 months, and gradually fades as the ety as a normal phase and helping to cre-
Practice Take advantage of occasions at home to leave your baby alone for a few second birthday approaches. Some ba- ate a time of adjustment and transition.
minutes (in a safe zone, of course) while he or she plays. If your baby becomes bies pass through this phase fairly quick- If someone approaches your baby
upset at your absence, call out to him or her, but wait a few seconds before com- ly, but others remain reluctant to part for quickly, eagerly trying to engage the
ing back. Eventually, your baby will learn that it’s OK to be away from you and that quite some time. baby, the baby will probably cling to you
you always do come back. Part of your baby’s frustration stems even more tightly. Encourage others to
from not having the motor skills to follow spend some time just talking with you
Get acquainted If a baby sitter is new, take some time to let your baby become you or keep up with you, coupled with the while you let your baby watch and listen.
acquainted with him or her. Hold your baby on your lap while you and the baby budding realization that you’re still there Your baby may eventually open up and
sitter talk, and then gradually engage the baby in the conversation. Once your even if baby can’t see you. The positive jabber or want to play.
baby seems comfortable with the sitter’s presence, put your baby on the floor with side of this development is that your baby Peekaboo can be an icebreaker at this
a favorite toy and the baby sitter, and let them get to know each other. Once you’re has clearly established a strong bond with age because this game is so tempting for
comfortable with your baby sitter and you feel assured your baby is getting loving, you and wants to make sure you stick most babies. But don’t be surprised if
qualified and competent care, you will be less bothered if your baby should cry around for the long haul. Eventually, as your baby will play this game only when
when you leave. your baby realizes that you’re a perma- you’re close by. Assure others that your
nent part of his or her life, despite tempo- baby will outgrow this exclusivity.
Say goodbye When you’re ready to leave, tell your baby goodbye and provide rary separations, this anxiety will ease.
reassurance of your eventual return. Although it’s tempting to just sneak out when
baby is preoccupied with something else, this approach won’t help your baby Smoothing the way This strong at-
overcome this anxiety (instead, he or she may become more clingy, never sure tachment to the primary caregiver can
when you might leave). At the same time, there’s no need to prolong the farewell. result in a seeming dislike for everyone
Have a distraction ready to go — a bath or new toy — and a few minutes after your else, which can be crushing to grandpar-
departure, your baby’s short attention span will be directed elsewhere. ents, other relatives and friends who feel
close to the baby. You can ease feelings of
rejection by explaining separation anxi-
CHAPTER 25
Month 9
Your baby has a lot going on these days. By now, your baby may have a nice
And get ready for a big change! During head of hair. And now that he or she can
the ninth month is when most babies learn flip and turn at will, bald patches are a
to crawl, and once your baby is on the thing of the past. At 9 months old, most
move, life changes forever. No longer is babies still look like pudgy little butter-
your baby content to stay in one spot. There balls. But within a few short months of
are so many places to go, so many things to growing, walking and running, your baby
see, so much stuff to get into! Daily life will stretch out into a full-blown toddler.
with an emerging toddler can be a chal-
lenge. But it’s also a happy time of having
fun and discovering new skills. With a
little bit of prep work, you and baby will BABY’S MOVEMENT
be all set to enjoy life on the go.
It’s around this time that many babies
catapult forward to a new level of mobil-
ity and independence. All that wiggling
BABY’S GROWTH AND and fidgeting, rocking and rolling is pay-
APPEARANCE ing off. Your baby is up and moving!
During this month, your baby is growing Crawling Crawling uses the complex
steadily at about the same rate as the give-and-take movements of all four
previous month. The average baby at this limbs that are necessary for walking later.
age tends to gain just under a pound a It takes some time to understand how to
month, and grow about ³∕8 of an inch in make those little arms and legs work to-
length. Your baby’s head circumference is gether. The average age an infant starts to
still increasing slightly every month. crawl is 9 months.

At first, a baby’s arms are stronger furniture for support. When your child
than the legs, which makes for some fun- realizes how much fun standing is, he or SPOT-CHECK: WHAT’S GOING ON THIS MONTH
ny crawling variations. Many babies be- she will probably start figuring out how
gin crawling by using just their arms, to pull up to a standing position without Here’s a snapshot of what your baby’s basic care looks like in the ninth month.
scooting across the floor like a soldier in your help.
training. Others may find themselves up By 8 months, most babies can stand Eating During this month, you may start introducing to your baby slightly coarser
on their knees, give their arms a good up with support. At 9 months, more than foods that require more chewing. You might also notice that your baby’s more in-
push and begin moving backward. half of all babies can pull themselves into terested in the food on your plate than on his or her own. During the next few
Eventually, most babies will become a standing position, and some may even months, you can work your way toward feeding baby what the rest of the family is
experts at using their legs and arms si- begin “cruising” around the room, hold- having. At first, you might try overcooking or finely chopping the food. Some par-
multaneously when they crawl.You might ing on to furniture for support. ents use a baby-food grinder to get the food to the right textures.
look away for a minute, then look back At first, your baby may not know how Breast milk and formula may start to take on a more supplemental role, but are
and wonder,“Where did my baby go?” to sit down from a standing position and, still irreplaceable sources of nutrition. If you wean your baby from breast-feeding
If your baby isn’t interested in crawl- instead, may just fall on his or her bot- before his or her first birthday, replace the breast milk with iron-fortified formula.
ing, or crawls just for a short time before tom. Soon he or she will learn how to Your baby isn’t ready for whole milk until that time.
moving on to something else, remember lower himself or herself down without
that moving is the goal. How your baby falling. You can show your baby how to Sleeping By 9 months, your baby has probably settled into a regular napping and
moves isn’t as important as the fact that do this by gently helping him or her bend sleeping schedule. He or she may take two naps a day and sleep as long as 12
he or she is interested in getting around. at the knees and then squat down to a hours at night without waking to feed. But even if your baby has been a good
sitting position. sleeper up until now, you may face some new sleep challenges during this month
Standing At 8 or 9 months, if you stand and the next few months.
your baby up next to the sofa, baby will Sitting By now your son or daughter is When your baby is learning to crawl and pull up to a standing position, he or
probably be able to stand there, using the likely a proficient sitter. Indeed, at this she will probably work vigorously on these skills all day. During brief awakenings in
the night, baby may automatically start practicing crawling and standing. But early
on, your baby knows how to do only half a skill and may get in the frustrating posi-
Month 9 tion of being able to stand up but not get down again. Even after baby learns how
35 to get out of these situations, the physical activity may be enough to make it hard
to get back to sleep.
Your baby may let you know — loudly — how frustrating this situation is. At this
age, he or she can shake the crib and may cry or scream to get your attention.
30 Double-check the safety of your baby’s crib and make sure there’s nothing in the
crib that your baby could stand on. Once the novelty of your baby’s new skills wear
off, he or she is likely to start sleeping better.
Length 25
(inches)
age, babies love to sit and play and may As a result of your child’s improved
do so for extended periods of time. From stability and balance, he or she can now
20 Average girl
(50 percentile)
Average boy
(50 percentile) a seated position, your baby has a wider sit unsupported and turn his or her head
vantage point from which to observe and to look at things. He or she may even
27.5 in. 28 in.
19 lbs. 20.5 lbs. interact with the world and delights in twist his or her torso to peer around —
taking full control of his or her view. Be- although leaning sideways may not be
15 tween ages 8 and 9 months, your child is possible quite yet.
learning to point to desired objects and
5 10 15 20 lean forward while sitting to reach to- Hand skills Baby is working steadily on
© MFMER
Weight (pounds) ward you or an interesting toy. his or her thumb-finger (pincer) grasp.
With the pincer grasp, your baby can — ing at different objects and naming them, Vision Your baby’s visual acuity is con- heights and a well-timed, more cautious
and probably will — pick up objects as or playing clapping games. stantly improving, and he or she can see approach to obstacles.
small as a piece of lint. Self-feeding also A common milestone achieved dur- things clearly from across the room. At
is likely to become a popular activity during this month is the ability to bang toys this age, your baby is quick to recognize Hearing Your son or daughter now rec-
ing this month, if it hasn’t already. And by together. This is no mean feat, as working familiar faces and objects. He or she may ognizes sound without difficulty and
now, your baby may have learned to hold both arms simultaneously in this fashion adjust his or her position to get a better probably responds to his or her own
a cup or bottle and drink independently. requires an infant to sit upright steadily look at something and is more likely to name. He or she may respond to other
Because almost everything your baby without support and display a fair look for a hidden toy. familiar words, as well, such as bottle,
touches goes directly into the mouth for amount of balance. Crawling and moving about helps de- mama, dada and no.
further exploration, be sure to remove velop your baby’s depth perception, as he
anything from baby’s reach that could or she studies one hand moving forward Touch Baby is learning how to wrap his
cause choking. and then the next, over the varying or her hands around a cup or bottle, how
Your baby is also learning to move his BABY’S SENSORY ground beneath. Better depth perception to pick up a spoon and how to handle
or her fingers individually, so that he or DEVELOPMENT leads to an increased awareness of different toys appropriately.
she can soon hold a string between fin-
ger and thumb and pull a toy along. Let- By 8 to 9 months, your child’s sensory
ting go voluntarily is becoming easier, skills are fairly evolved and a great help
allowing baby to set one thing down in in practicing his or her new motor, men- FINGER FOODS FOR LITTLE ONES
order to pick up another. Other impres- tal and social skills. Combined with your
sive hand skills your child may develop child’s expanding memory skills and un- As your baby develops a better pincer Z Well-cooked diced vegetables (yams,
during this month include pointing to- derstanding of object permanence, his or grasp and more advanced chewing potatoes, carrots, green beans)
ward things he or she wants, clapping, her sensory abilities make for easy recog- skills, you can start offering finger Z Soft ripe fruits, cut up into small
and waving goodbye. These are also nition of recurring sights, sounds and foods. Self-feeding can be great enter- pieces (berries, mangos, peaches,
forms of communication. Encourage patterns. They’re helping your young one tainment. What could be more fun than bananas)
your child’s development in this area by in gaining knowledge of the general or- exploring things that actually are sup- Z Whole-grain breakfast cereals
using these skills yourself, such as point- der of things. posed to go in the mouth (although (without nuts or chunks)
they often end up on the floor)? And it Z Teething biscuits or crackers
helps foster your child’s sense of inde- Z Cut-up, well-cooked pasta
pendence and ability to accomplish a
BATTLE OF THE SPOONS task on his or her own.
Parents were once told to avoid
Some babies are determined to eat without help — or at least play with eating feeding young children eggs, fish and
utensils without your interference. Every time you try to slide that spoon in with peanut butter. Today, however, re-
some food, up comes the little hand to grab it, and splat goes the food. How to get searchers say there’s no convincing
your baby to eat? evidence that avoiding these foods
If this is the case, provide different ways for your baby to get food and entertain during early childhood will help prevent
himself or herself at the same time. Put some finger foods on the baby’s tray. Give food allergies. Do keep in mind, how-
baby his or her own spoon and use a spoon yourself. You may need to be persis- ever, your baby’s ability to handle tex-
tent in finding opportunities to get some food into the baby’s mouth. tures and foods of various sizes. Soft
You can try to teach your baby to eat with a spoon, but if you’re not successful, and mushy is the way to go. Small,
let your baby eat with hands and fingers. For now, these handy utensils are gener- hard, round or chewy bits of food can
ally faster. be choking hazards. Here are some
If your baby truly isn’t doing any eating, only playing, he or she probably isn’t suggestions for finger foods to get you
hungry at the moment. You can call it quits for this particular meal and try again later. started:
BABY’S MENTAL DEVELOPMENT the time being, you might also spend a
little extra time on the floor each day with TOYS AND GAMES
By 9 months, your infant is sophisticated your youngster to bridge the gap until he
enough to be bored. (So quickly does it set or she is better able to self-entertain. Physical games are fun at this stage of ies but goodies, such as “Old McDon-
in!) This is because his or her memory is your baby’s development and can help ald” and “Little Miss Muffet.” If you find
developing and what was once new and Language and understanding About him or her hone new motor skills. At the yourself a little rusty on some of these,
interesting isn’t so much anymore. Baby is 3 out of 4 infants are jabbering away by same time, your child’s communication you can look them up on the Internet or
on the hunt for new stimulation and is age 8 months or so. Most are starting to and language skills are rapidly progress- borrow a book from the library. In fact,
gung-ho to try out new games and skills. combine syllables and vocalize in strings ing, so include games that stimulate his chances are, there’s a mobile app out
This is certainly a fun age, but it can also of sounds pulled together. By 9 months, or her mind, too. Try some of these. there to help you learn some rhymes on
be frustrating for baby and parents alike you may even notice your baby start to the go, whether in a crowded restaurant
if baby moves quickly from one thing to use the words mama and dada to refer Indoor gym Once your baby learns to or on a long drive home.
the next, leaving little time for mom or specifically to you. crawl, getting through, in and around
dad to get other things done. Don’t fret Your child’s understanding of lan- things is a great source of entertain-
too much, though. As your child devel- guage is increasing, as well, even more ment. Create your own gym with stuff
ops further and becomes more mobile rapidly than his or her vocal expressions. you already have on hand:
and independent, he or she will be more By now, baby likely understands the Z Drape a blanket or a sheet over a
capable of creating his or her own fun. In meaning of a number of words, including table to make a tunnel. Place an
the meantime, swap out some of your his or her own name, as mentioned pre- unbreakable mirror inside for a vi-
child’s simpler toys for more complex viously. He or she is also starting to un- sual surprise.
ones (but still age-appropriate), or fill a derstand simple games and rhymes and Z Create an obstacle course with pil-
basket with board books that your child will laugh and giggle at appropriate parts. lows, laundry baskets and rolled-up
can easily access on his or her own. For For example, about half of babies can towels.
Z Use yourself. Lie down with an in-
teresting toy in front of you and
GET READY baby behind you. Encourage your
baby to climb over your legs to get it.
It’s tempting to think that as your baby gets older, he or she will require less time
and attention. But once your son or daughter is on the move, he or she actually Walk together Your baby may not be
requires more supervision. Before, your baby would wait for you to come. Now walking independently just yet. But you
that he or she is mobile, he or she can come to you. You are still your child’s pri- can get him or her acquainted with the
mary object of love and favorite companion, and there is so much your baby wants necessary leg movements by holding
to share as he or she scoots around and explores. his or her hands and helping your child
Very active or very curious babies may need especially careful supervision. take small steps forward.
Once they discover their ability to move, they are off and into everything, touching,
pulling, tasting, testing. Babies on the go need your presence to ensure that heads Clapping games To help your baby
don’t get bonked, fingers don’t get pinched, small objects don’t get swallowed practice arm coordination and build bal-
and prized possessions remain intact. ance skills, teach him or her clapping
This period of intense supervision generally lasts until about 3 years of age, games, such as patty-cake or Miss
when children are more accustomed to limits and spend more time playing alone Mary Mack.
or with friends. If you think you’ll never make it to 3 years, take heart, you will. This
is a time-intensive period of parenting, but it’s also one of great joy as you watch Nursery rhymes Never underestimate
your child grow and develop into a walking, talking toddler with some very definite the power of a few silly rhymes to make
opinions of his or her own. your child laugh. There are plenty of old-
play clapping games, such as patty-cake,
by 9 months.
As the understanding of object per-
you know just how he or she feels about
these new restrictions, too. At this point,
your child has clear likes and dislikes and
manence becomes more established in will communicate them through body During the ninth month, your baby is busy:
your baby’s mind, he or she will persist language — pointing, clapping, making Z Learning to crawl
longer in searching for something he or faces, stiffening or arching his or her back Z Standing with support
she knows is there, such as a key you’ve — and vocalizations such as squealing, Z Working on pulling up to stand
folded in your hand. Object permanence howling and jabbering. Z Using thumb and first finger together (pincer grasp)
also helps your baby understand the To a parent, this period can be frus- Z Banging toys together
physical nature of the world, such as the trating, as well. The orderly routine you Z Learning to let go voluntarily
ability of balls to roll, and its social na- finally seemed able to carve out is now Z Learning to point, clap and wave goodbye
ture. When your baby waves bye-bye as being completely turned on its head. Turn Z Feeding self
you walk out the door, he or she ac- your back for a moment, and the basket Z Recognizing and responding to familiar words
knowledges you’re leaving but also is of folded laundry that you had set on the Z Babbling, stringing syllables together
coming to expect that you’ll be back. floor (in blissful ignorance) is now strewn Z Working on verbalizing familiar words
around the dining area. The mail littering Z Holding toys and objects appropriately
the coffee table and living room floor is a Z Banging, shaking, dropping toys
shocking discovery that your child can Z Looking for toys that have dropped out of sight
BABY’S SOCIAL DEVELOPMENT now pull to stand. Z Testing limits and observing parental reactions
Also, it can be difficult to move from Z Avoiding strangers yet interacting more with family
Once your baby starts to crawl and move being the nurturing parent to being the
around, limits begin to play a larger role limit setter, as well, and having to deny
in both baby’s life and yours. Before, some of your child’s wishes.
there wasn’t much your baby could do Offer safe opportunities for exploration Mom or Dad. It’s difficult to give your
without your help. Now that he or she Making life easier Neither you nor Think about ways you can let your child baby that attention and get anything else
can crawl and climb and discover with- your baby will be happy in a home in explore without getting into trouble. accomplished. Fill a small basket with
out you, there are bound to be necessary which you must constantly keep a close Some parents reserve a low kitchen cabi- toys for each room of the house; then
limits — “No, you can’t climb the book- watch and remind baby to keep away net for items the baby can safely get into. take the baby with you as you go from
shelf,” or “No, don’t pull the cat’s tail.” from dangerous situations and objects. Or set up an“activity center”with pillows room to room, and let your baby play
So many things around the house are to climb and empty boxes to investigate. while you work.
Oh, the frustration This can be an ad- tempting, and it’s unreasonable to expect If the weather is nice, a small pop up tent
justment for children and parents alike. much self-control from your child at this in the yard can provide lots of fun. Family life Although your baby may not
Not having been stopped from doing age. Instead, try these strategies: feel comfortable around strangers, he or
much before, a 9-month-old is under- Provide comfort but stay firm When she loves to be around you and the rest of
standably confused and frustrated when Childproof regularly Maintaining a safe your child is frustrated, provide some the family. Your baby may show affection
all of a sudden Mom and Dad are shout- space for your child to explore on his or help and comfort but realize that over- by patting you on the back or even start
ing “No!” when he or she reaches for her own will make things easier for all coming frustration is a skill he or she will imitating fond gestures such as hugs and
an interesting electric cord, or they make parties involved. Soon after babies learn need to develop. Distraction or redirec- kisses. He or she definitely wants to be a
unhappy faces when an innocent roll of to crawl, they can also climb stairs. Keep tion from a forbidden object or activity part of the family commotion.
toilet paper is torn apart. Your child has gates at the top and bottom of stairs and usually works well. Kids need consisten- Big brothers and sisters still love the
no way to differentiate between what’s use them properly. Make sure heavy cy, however, so stay firm with the safety baby and want to play, but the initial en-
safe and what’s not, and won’t really un- bookcases and TV stands are securely an- limits you’ve set. chantment may largely be over, especial-
derstand the reasons behind your rules chored to the wall so that curious climb- ly once baby can scoot around and get
until much later, around age 4 or 5 years. ers can’t pull them down. Pad coffee table Keep your baby busy Most 9-month- into a sibling’s toys. Try to encourage a
With his or her increased capability corners, and remove dangerous items olds are active and need a lot of stimula- spirit of cooperation with an older child.
for expression, your infant is likely to let from the reach of little fingers. tion, but they don’t like to be apart from
CHAPTER 26
Month 10
Many of the motor skills your baby has BABY’S GROWTH AND
been working on since birth are starting APPEARANCE
to come together this month. These basic
skills enable his or her transition from Baby is growing at much the same rate
infancy into toddlerhood. From this point as last month — gaining just under a
forward, your child is moving steadily pound a month, and growing about ³∕8 of
toward an upright view of the world. And an inch in length. Your baby’s head cir-
even though he or she may still only cumference is still increasing slightly ev-
see knees and legs and the lower half ery month.
of the world for a while, his or her ability When your baby first starts to stand
to maneuver about is a very exciting and then walk, you might notice that his
development. or her legs appear slightly bowed. This is
During month 10, many babies prac- normal. In most babies, legs become
tice pulling themselves up to stand with straighter within the next year or so.
the help of furniture or a parent’s leg. By
the end of the month, some babies are
even able to stand on their own for a few
seconds. BABY’S MOVEMENT
Babies also start to be big copycats
around this time, which can provide for By month 10, you can really start to see
some enjoyable and laughable moments. how your baby’s early motor accomplish-
Copying the facial expressions, gestures ments are building on each other. Good
and vocalizations of adults and older head control, along with strong muscles
children is one of the primary ways a conditioned by months of pushing up,
baby learns how to fit into the family and looking around, wriggling and rolling, al-
society at large. low your baby to become proficient at

more advanced motor skills, such as Pulling to stand Although baby prob-
crawling, standing and walking. ably still needs support while standing, SPOT-CHECK: WHAT’S GOING ON THIS MONTH
Most babies can now sit unsupported he or she is working steadily at pulling
with a straight back for an indefinite pe- himself or herself up to stand. He or she Here’s a snapshot of what your baby’s basic care looks like in the tenth month.
riod. For baby, this is a comfortable posi- might do this by grasping whatever sup-
tion from which to play and engage the port is handy, such as the rails of the crib, Eating During this month, your baby may start eating more of the same foods that
world. In a matter of weeks, your baby is your pant leg or even a patient dog’s tail. the rest of the family is eating. Be sure the food you give to your baby is of the size and
becoming an efficient crawler, moving Since your baby doesn’t know the differ- texture that he or she can handle. Overcooked or finely chopped foods are still the way
with singular ambition from one place to ence between what’s safe to climb and to go, or you can use a baby-food grinder to get the food to the right textures.
another. And he or she can bear weight what’s not, it’s important to keep safety a Breast milk and formula start to take on a more supplemental role, but are still
on his or her legs, holding on to some- priority. Empty the crib of things your irreplaceable sources of nutrition. If you’ve decided to wean your baby from breast-
thing to stand upright. Refinements of baby might use to climb too high and un- feeding, replace the breast milk with iron-fortified formula. Your baby isn’t ready for
these basic skills accumulate this month. intentionally pitch forward out of the whole milk until after his or her first birthday.
crib. Also, keep heavy bookshelves and
Pulling to sit By the end of month 10, cabinets anchored to the wall so that Sleeping By 10 months, you and your baby have developed a regular napping and
most babies have learned how to pull baby doesn’t accidentally pull down an sleeping schedule. The general expectation is that most 9- to 10-month-olds take
themselves into a sitting position — unsteady structure. two naps a day and sleep as long as 12 hours at night without waking to feed. But
bringing the torso up from lying down, then again, it’s common for babies practicing new skills, such as crawling and stand-
flopping over from crawling, or squatting Picking up, pointing and poking By ing, to wake up at night and pull themselves into positions they need help getting out
down from a supported standing posi- month 10, most babies are refining their of. Even after baby learns how to get out of these situations, the physical activity may
tion. Being able to switch positions at will heavy-handed grasp of small objects and be enough to make it hard to get back to sleep.
gives your child a little taste of the mobile graduating to a more delicate thumb- If your baby is safe and dry, it’s OK to let him or her settle back to sleep on his
freedom and independence ahead. finger grasp. As well as manipulating or her own (which might involve some fussing and crying). Once your baby’s new
skills become routine, he or she is likely to start sleeping better.
Month 10
35
items with a greater degree of accuracy, BABY’S SENSORY
babies are also getting better at releasing DEVELOPMENT
things at will. Letting go at this age (and
30 for a while to come), however, tends to As your child approaches the end of his
mean throwing a toy aside rather than or her first year, he or she is becoming
gently laying it down. skilled at using his or her senses to learn
Your little one has also discovered the and explore.
Length 25 power of the index finger, using it to
(inches) point, prod and poke at items of interest Hearing By 10 months, your baby rec-
(yourself included). Picture books are ognizes sounds without difficulty, such
great for practicing pointing and learning as the sound of his or her name, familiar
20 Average girl
(50 percentile)
Average boy
(50 percentile) the names of things. Use the same words songs and words, and even the doorbell.
each time for each picture, and your son Your son or daughter is also becom-
28 in. 28.5 in.
19.5 lbs. 21.5 lbs. or daughter will soon start helping you ing more selective as to what sounds he
out. Some books feature different tex- or she listens to. For example, he or she
15 tures, such as furry or rough patches, or can listen to other people talking and pay
foldout flaps, which make them doubly attention to conversations without being
5 10 15 20
© MFMER
interesting for baby. distracted by other noises.

Weight (pounds)
PREPARE FOR SOME BUMPS TOYS AND GAMES
As your baby starts to stand and move around on two feet, falls and short tumbles
naturally become more frequent. This isn’t really a big deal, as your baby doesn’t Go for toys and games that help enrich your child’s growing awareness of the way
have very far to fall and is unlikely to get hurt landing on his or her bottom. things work, from toys that stimulate exploration of different functions to ones that
Often, when your baby falls, he or she will look at you first to gauge your reac- allow baby to mimic grown-up behaviors. Games made up of simple actions can
tion before committing to his or her own. Among childhood experts, this is called be fun, and silly songs with accompanying gestures are sure to be a hit.
social referencing. Babies will look to trusted adults for emotional guidance before
proceeding with a novel experience. Busy toys With your child’s growing dexterity, he or she may enjoy toys that fea-
You can help your child understand that a minor tumble is no obstacle to get- ture multiple functions, such as pushing buttons, opening drawers, making noises
ting back up by treating it matter-of-factly and offering cheerful reassurance. Some and lifting lids. Stacking toys and nesting toys are fun for baby to assemble and
babies will cry no matter what. But if you offer loving encouragement accompanied disassemble.
by positive facial expressions, your baby will quickly learn to shrug off such small
setbacks. Mimic Offer your child toys that resemble adult accessories, such as a toy phone,
At the same time, be sure to provide a forgiving environment for your baby to plastic keys, a comb, toothbrush or teacup. See what your child does with them.
knock about in. For example, pad sharp coffee table corners and keep loose cords Or make a silly face or gesture and encourage your child to imitate you. Wait to see
out of sight and reach to avoid accidents. if he or she makes a funny face or odd gesture at you. Return the favor and imitate
him or her.
Give and take Nine- to 10-month-olds often enjoy simple games that involve
Touch With the expansion of your baby’s really start to blossom. Not only is your passing an object or toy back-and-forth between you and him or her. Offer your
mental and fine motor skills — such as baby’s comprehension of what’s being child a ball. Once he or she grasps it, ask for it back. This may sound a bit tedious
increased memory and individual finger said expanding, he or she may also be on to an adult, but your baby loves it, and it helps him or her learn the concept of
skills — he or she now enjoys more con- the way to saying his or her first words. game play and following simple instructions.
trol over his or her exploratory activities. First words are cause for excitement, and
Some things are even starting to become deservedly so. There’s so much to say! Silly songs Babies at this age delight in silly songs
routine. By now, for example, your child Your child’s ability to think as a sepa- that have accompanying hand gestures. These help
knows that a maraca is to be shaken, a rate individual is becoming more sophis- stimulate not only the funny bone, but hand-eye co-
cup goes to the mouth, buttons are ticated, and you may see clues of this ex- ordination and fine motor skills, as well. “Itsy, Bitsy
pushed and a favorite doll is gently pat- pressed through your baby’s nonverbal Spider,” “I’m a Little Teapot” and “This Little Piggy”
ted (just like Mommy does it). communication, as well. will never go out of style with this crowd.
Your baby also enjoys self-feeding.
And even though it’s bound to be messy, First words During this month, many
it’s important to let him or her practice, new parents start to hear baby sounds
as this is the only way your baby will get bound to warm their hearts. About half
better at it. To make cleanup a little easier, of babies use dada and mama to refer
consider spreading a splat mat or news- specifically to father and mother at this
papers under your baby’s highchair. point. A few babies even start to use one
other word in addition to dada and mama,
such as baba for bottle or mok for milk.
These words are often hard to under-
BABY’S MENTAL DEVELOPMENT stand at first, and it may be a while before
you figure out your son or daughter is
It’s during the last quarter of your baby’s saying something meaningful. In gener-
first year that his or her language skills al, a word at this age is any sound used
consistently to refer to the same person, also developing thinking skills sophisti-
A TWO-WAY STREET object or event. cated enough to communicate those
When opportunity presents itself, you wants and devise ways to achieve them.
Multiple studies have shown that a child’s mental development and grasp of lan- can reinforce the correct way to say the
guage, specifically, are strongly associated with the amount of language a child is words your baby is learning. For example, Simon says Along with simple expres-
exposed to in the first three years of life. The greater variety of adult words an infant readily acknowledge your child’s request sions of his or her own thoughts, your
or toddler hears early on, the greater his or her language skills tend to be in the for a baba, and then say the correct word, son or daughter is beginning to under-
preschool years. bottle, when offering it back to him or her. stand brief requests of action from you.
Because of this strong association, parents are often encouraged to expose Eventually, your child’s language skills He or she may do what you ask if you use
their children to as much language as possible, through reading, storytelling or will develop enough for him or her to use hand gestures with your request, and it
even just narrating the day’s activities. the correct version. involves some sort of interaction with
One study in particular, published in the journal Pediatrics, sought to expand you. If you ask your child for one of his
on the kind of adult language exposure that might be most beneficial to a young Conversation As a result of listening to or her crackers and hold out your hand,
child. If simply hearing adult vocabulary is the only requirement for child language you talk, your child’s own babbling will indicating what you want, he or she may
acquisition, then you could reasonably assume that turning on the TV would help start to sound more like the ups and comply.
your baby develop his or her language skills. But evidence indicates that heavy downs of a real conversation. Even if
TV exposure tends to have a negative impact on a child’s language, reading and most of it makes no sense, join in the
math skills. conversation and repeat your baby’s
To conduct their research, the authors of the Pediatrics study fitted each par- sounds back to him or her. Try to discern
ticipant in the study, ranging in age from 2 to 48 months, with a digital recorder any words that might be popping up in
worn throughout the day. Using special software, the investigators differentiated the middle of all the jabbering. Respond
between three types of speech that a child might hear: adult speech, television positively to your baby’s talking, and
and adult-child conversations. During the study, the children’s language develop- pause at times to encourage a rhythm
ment was assessed several times by a speech-language pathologist. like that of real conversation. Your baby
When evaluated alone, adult speech had a positive impact on language devel- will be delighted that you’re interested
opment and TV had a negative impact, as you might expect. But when all three and paying attention.
types of verbal input were evaluated simultaneously, only adult-child conversations
continued to have a significant effect on a child’s language skills. Nonverbal communication Although
This suggests that more important than merely hearing adult vocabulary is your baby still has few words with which
hearing adult speech that elicits a child’s response. More conversations with you, to express himself or herself, this won’t
for example, means more opportunities for your child to practice verbalizing and stop him or her from communicating
conversing. It also means more chances for your child to learn as you correct his with you. Now that your baby is starting
or her mistakes. From a parent’s perspective, frequent back-and-forths with your to discover personal likes or dislikes, he
child helps keep you in tune with your child’s evolving abilities. This awareness or she will communicate wants and de-
helps you calibrate your speech so that it’s neither too simplistic nor too difficult for sires through pointing, shaking his or her
your child. head no, reaching and making sounds,
Granted, when your child’s vocabulary consists of one word, having a full- and pulling or holding arms out to be
blown conversation may seem a little hard. But as you’ve probably noticed, com- picked up.
municating with your child need not always involve words. Teaching your child that Not only does this nonverbal com-
conversation is a two-way street can be done with facial expressions, sounds and munication show that your child is trying
gestures. Doing this will set the foundation for further language skills as your child’s to relay ideas to you, but also indicates an
vocabulary expands. increase in your child’s self-perception.
Bottom line: Keep on reading and talking to your child, but be sure to include He or she is now able to formulate
some “conversation” time, as well! thoughts related distinctly to himself or
herself, apart from others, and to his or
her own personal desires. Your child is

As your child’s skills and independence

the remote control, for example, you
might find him or her pointing it at the
TV. Or if baby’s older brother blows a
increase, he or she will still look to you raspberry, the baby will try to do it, too (a During the tenth month, your baby is busy:
for safety and security. Even if you have scenario that all too often unfolds at the Z Mastering crawling
officially “bonded” at this point, hugs, dinner table when you’re engaged in the Z Standing with support
kisses and warm affection are still vital to serious business of trying to eat a meal). Z Pulling up to stand
expanding on the trust your baby has After a meal, your baby may try to wipe Z Maybe standing alone for a few seconds
placed in you. Giggles and laughter and your hands and face. Z Using thumb and first finger together (pincer grasp)
quiet times together deepen your rela- Babies also like to initiate copycat Z Manipulating toys appropriately
tionship and further cement the bond games, making a sound or gesture and Z Learning to let go voluntarily
you have. looking to see whether you will do the Z Using gestures to communicate, such as shaking his or her head for no
Since birth, your baby has been learn- same thing back. Z Feeding self
ing through listening to and watching Mimicking is an important way of Z Recognizing and responding to familiar words
you. In earlier months, it may have felt learning essential skills. Even adults Z Babbling, stringing syllables together
like your baby wasn’t paying much atten- make use of this form of social learning Z Saying mama and dada
tion to your day-to-day activities. But when they are confronted with new cul- Z Verbalizing other familiar words
soon you’ll notice you have a “mini-me” tural situations. Your actions and behav- Z Looking for hidden toys
at your heels, imitating many of the ac- iors as a parent can be powerful teaching Z Imitating the activities of adults and older kids
tivities you thought had gone unnoticed. tools for your child. For example, if you Z Testing limits and observing parental reactions
consistently use the words “please” and Z Avoiding strangers yet interacting more with family
Mimicking Around this age, babies like “thank you,” and you always treat your
to mimic the gestures, facial expressions spouse or partner with kindness and re-
and some of the sounds made by adults spect, you’ll find your child eventually
and older kids. If your baby gets ahold of doing the same. Eyeing mom and dad By 9 to 10 feel as loved as possible. Take breaks
months, your child’s awareness of strang- when you need to. As your child becomes
ers is obvious. Although he or she may be more secure in his or her independence,
affectionate and playful around you, the emotions will become more stable.
SHARING same is generally not true for strangers
and even relatives or baby sitters. In ad-
Between months 10 and 12, babies love to be with other babies and watch them dition, separation anxiety tends to peak
play. But they’re still not capable of playing with each other. Interactive play usu- sometime between 10 and 18 months.
ally doesn’t take place until around 2 to 3 years of age. While playing, your baby may repeatedly
What babies are capable of right now is taking an interest in another child’s toy. look for you in a room to make sure
This can lead to some tussles over toys and other playthings. It would be nice if you’re still there. This makes it hard to
babies had an innate ability to share and be polite, but at this stage it’s all about leave your baby with other caregivers
them and what they want. In general, kids don’t understand the concept of sharing without some emotional stress.
or taking turns until the age of 3 or so. And even when they do understand the As you probably realize, this is a sign
concept, they may not always put it into practice. that your child is strongly attached to
If conflict arises around a toy or other object, your best bet is to distract your you. It can be amazing to realize how
baby with something else. Aided by his or her short attention span, it’s fairly easy much this little one loves and depends
to engage your baby in a different activity, making the sharing issue a moot point. on you, but at times your baby’s needi-
Eventually, you can start showing your child how to share with someone else. For ness can make you feel suffocated and
now, though, the lesson is likely to be lost on your baby (especially if it’s a long- guilty when you need to leave. This is
winded one). normal. Bear with your tiny guy or gal for
a little while, and try to make him or her

CHAPTER 27
Month 11
Wow. It may seem like just yesterday that BABY’S GROWTH AND
you brought your baby home from the APPEARANCE
hospital. But here he or she is, fast closing
in on the end of his or her first year. So As your child heads into toddlerhood,
much has happened since birth that those you can expect his or her growth rate to
early months may now start to seem like a begin to slow down quite a bit compared
blur. And in the eagerness to celebrate with the first year, which is the period of
your baby’s first birthday, month 11 might most rapid growth a person experiences
feel like it gets a little lost in the shuffle. in a lifetime.
But there’s plenty going on. Your little For example, during baby’s second
tyke is headed toward an upright view of year, he or she is likely to gain about half
the world, which allows him or her to see the amount in a month that he or she
so much more. This vantage point also gained in months six through 12. Growth
places more toys and other objects within height slows down considerably, too,
in easy reach.Your baby will start inching, from about a 10-inch growth spurt in the
or cruising, along furniture to get to first year to about 5 inches in the second
things and places. These are the first year. Head growth also is much slower in
steps toward walking without help. the second year, totaling about 1 inch for
Your son or daughter can also see the whole year.
clearly and is learning to listen and look For month 11, however, your son’s or
at the same time — a big step forward in daughter’s growth rate will likely be the
the ability to focus and concentrate. His same as last month’s. Keep in mind,
or her language skills are building as though, that babies tend to grow in fits
understanding increases, and he or she and starts, so don’t be surprised if a peri-
starts using meaningful “words” to indi- od of very little growth is followed by a
cate people, places and things. big growth spurt.

BABY’S MOVEMENT by’s depth judgment improves, his or her
movements become more controlled, and SPOT-CHECK: WHAT’S GOING ON THIS MONTH
On average, month 11 is when many ba- he or she may become more cautious
bies start “cruising,” shuffling alongside about heading down a slight slope or up a Here’s a snapshot of what your baby’s basic care looks like in the eleventh month.
furniture, going from one piece to anoth- gradual incline.
er as they make their way around the If your baby has started cruising, he or Eating During this month, your baby is probably eating many of the same foods
room. It doesn’t take long for a baby to she will drop down to crawl if there’s that the rest of the family is eating. Be sure the food you give to your baby is of the
become quite good at this method of nothing to hold on to. And many babies size and texture that he or she can handle. Overcooked or finely chopped foods
traveling. Although walking without help continue to crawl even after they start are still appropriate, as are small chunks of foods that are easy to chew and swal-
is just a few steps away, crawling still walking. Kids are fairly efficient crea- low. Breast milk and formula take on a more supplemental role, but are still neces-
rules for most babies, affording the most tures, though. Once walking becomes sary sources of nutrition.
efficient way of getting from point A to the fastest way to get around, they’ll stick
point B. mostly to walking. Sleeping Most 10- to 11-month-olds sleep as long as 10 to 12 hours at night and
take a couple of naps during the day. A few babies may start giving up their morning
Crawling With added experience, your Standing Your baby is getting pretty naps during this month. If that’s the case for your baby, try starting the afternoon nap
baby is getting faster and more confident good at standing, too. Most babies this a little earlier and make bedtime a little earlier, as well. This will help avoid overtired-
at crawling (whatever his or her tech- age can stand with support, such as while ness. Pay attention to your child’s cues, too, and adjust his or her sleeping schedule
nique might be). Crawling around helps holding your hand, for at least a couple of to accommodate his or her need for sleep.
develop your child’s ability to absorb seconds. Some babies even start to stand
slightly differing views from both eyes, so alone for a brief second or two.
that his or her brain can see with three- Around 11 months, the average baby
dimensional capability. This ability pro- is also able to maneuver himself or her- ing position without just falling on his or ther away, such as from couch directly to
vides new depth perception. As your ba- self into a sitting position from a stand- her bottom. He or she will probably need chair if it’s close enough. You might even
to hold on to furniture or your leg, for ex- catch your son or daughter taking a few
ample, for support while doing this. quick steps unaided.
Month 11
35 Cruising Some babies walk sooner than Finger skills Passing objects back-and-
do others, and a few babies will start to forth is a fun game for baby, giving him
take their first independent steps during or her lots of practice in using the thumb-
this month. However, most continue to finger grasp and in deliberately letting
30 rely on nearby furniture to support their go. Your baby also enjoys pointing at
movements. You’ll see your baby slide his things he or she finds interesting.
or her hands along a piece of furniture, Your child’s improved depth perception
taking small sideways steps to get helps him or her realize that an empty cup
Length 25 around. Every so often, he or she may has space inside of it and that, amazingly
(inches) pause to examine a toy or a scratch in the enough, things can be put into the cup.
wood, or to bang vigorously and happily By the end of month 11, about half of ba-
on the coffee table. bies are adept at putting things in a con-
20 Average girl
(50 percentile)
Average boy
(50 percentile) At first, your son or daughter will tainer. The new big attraction will be
likely keep one arm on one piece of fur- dumping everything out of a basket or
28.5 in. 29.25 in.
20 lbs. 22.5 lbs. niture and reach out with the other arm a bucket and then putting the things back
to secure himself or herself to the next in again.
15 piece — from couch to coffee table to Having greater depth perception also
chair, for example. Gradually, he or she makes it possible for your son or daugh-
5 10 15 20
© MFMER
will become confident enough to move ter to take part in simple ball games, such
Weight (pounds) between pieces that are farther and far- as rolling a ball back-and-forth.
BABY’S SENSORY Hearing and listening Your baby’s
DEVELOPMENT hearing and listening abilities — along GETTING YOUR CHILD TO LISTEN
with an increasing ability to focus his or
By month 11, your child’s sensory abili- her attention — are improving to the During this past year, you’ve had the luxury of being the center of your baby’s
ties are running in practically full gear. point where he or she is starting to listen universe. It’s likely that every time your little guy or gal hears your voice, his or her
and look at the same time. These skills ears perk right up, and he or she turns to you with full attention.
Vision Although your baby is still near- help your child pull in valuable informa- But as your child gets older and interested in more and more things, you might
sighted, he or she can see as clearly as you tion about the surrounding world. find that it gets a little harder to capture and keep his or her attention (see your
can, recognizing familiar faces from 20 older kids, or consult any parent of an older child for expert testimony). To get
feet away. Your little tyke has become a Touch During this month, your child is good at commanding your child’s attention in the face of outside forces — such as
keen observer, watching the movements learning about concepts such as behind TV, candy aisles, warring siblings, and other various and sundry onslaughts — re-
of others with interest. He or she can visu- and inside, which is one of the reasons quires a bit of practice. If you start working on your skills now, you’ll be one step
ally track moving objects with no prob- why taking inventory of a purse or bag ahead in helping your child become a better listener, and in making yourself heard:
lems. And now that your baby knows that becomes so much fun at this point. Your Z Eliminate background noise. It’s hard for your little one to concentrate if there
things continue to exist even when out of child will probably also delight in poking are a lot of other sounds swirling around.
sight, he or she is able to look in the right his or her fingers into holes, tearing up Z Go to your child. Don’t shout from across the room. Stop what you’re doing
places for playthings and objects that have paper, or putting his or her fingers into and go directly to your child. Your child is more likely to hear, understand and
dropped or rolled out of sight. something wet or gooey. respond if you are right in front of him.
Z Get down to his or her level. Being face to face helps your child focus his or her
attention on you.
Z Say his or her name. Do this clearly and loudly. Then pause before continuing
SHOES: DOES YOUR BABY NEED THEM? to allow your son or daughter time to shift his or her attention away from cur-
rent activities to you.
When their babies start standing and feet or help baby walk more easily. On Z Maintain eye contact. This helps your child stay focused and increases his or
cruising, many parents wonder whether the contrary, your baby may benefit from her concentration on what you’re saying.
shoes are necessary. At this age, your being barefoot to get a “feel for the road”
baby doesn’t need shoes for standing when learning to walk.
or walking. You might put shoes on your If you do buy shoes for your baby,
baby because they look cute, to keep make sure they’re comfortable and BABY’S MENTAL DEVELOPMENT astically in response. While the two of
the baby’s feet warm or to protect the have nonskid soles to avoid slips. You you are communicating, use signs or
bottoms of the feet. But your baby should be able to feel a space as wide Your little one’s receptive language skills, hand motions. Doing so will help your
doesn’t need shoes for any other rea- as your index finger between your ba- what he or she understands, are still way youngster communicate his or her im-
son and is probably growing so fast that by’s big toes and the tips of the shoes. ahead of his or her expressive language mediate needs (and minimize frustra-
buying shoes seems impractical. Shoes should also be wide enough skills, what he or she can say. Around this tion) while learning verbal expression.
You may think your baby’s feet look across the front to allow your baby’s age, your baby is becoming adept at us-
flat and seem to be supported by un- toes to wiggle. ing body signals to communicate, such as Increasing vocabulary About half of
stable ankles. This is normal. All babies nodding, waving goodbye, pointing, and infants have learned their first words by
have chubby, thick feet with a fat pad shaking his or her head for no. But if you the end of their first year, but it’s not un-
that hides their arches. And they are pay careful attention, you may notice that usual for some to wait until their second
generally unsteady on their feet. They amid all of the babbling, your baby con- birthday to really start talking. Boys usu-
are just learning to walk, after all. But stantly uses particular sounds (“words”) ally say their first words later than do
putting your baby in shoes with special for certain things. girls. Other factors affect language devel-
arches, inserts, high backs or rein- opment, such as whether your child has a
forced heels won’t change your baby’s Capitalizing on body language If cautious temperament or is the youngest
you say,“It’s time for breakfast!” your son child in a large family. If there’s no need
or daughter may smile and nod enthusi- for your baby to talk, he or she may not
view it as a necessary skill just yet. Also, word, incorporate it into your conversa-
babies tend to work separately on differ- tions. Use it in ways that are easy for your TOYS AND GAMES
ent skill sets. If your toddler is working child to understand. Take the words
hard at walking, he or she may not have mama and dada, for example, which are
any energy left to work on talking. Once typically some of the first words a child This is often a good month to introduce toys that complement your toddler’s growing
an active toddler is walking well, he or learns. Hang around parents of young skills, such as cruising, walking or sorting through objects.
she is more likely to devote attention to children for any length of time and you’ll
learning words. hear them frequently referring to them- Push toys These are toys your child can push around while standing upright, such
Once first words arrive, vocabulary selves in the third person. “Do you want as a toy grocery cart or stroller. Such a toy can help your child practice walking while
can increase fairly rapidly in the months mama to help you?” “Can dada put you still offering some support. Stay close, though, to offer a hand when your child gets
following. The best way to help your child in the swing?” Doing this accomplishes tired of pushing.
increase his or her vocabulary is to talk several things: It reinforces who mama
with him or her. You want your child to and dada are, places the words in a con- Fill a basket Place a variety of small, nonhazardous objects in a basket or plastic
not only hear words, but hear them as text that’s easy for the child to under- bowl. Let your child sort through the items, dump them out and put them back in
part of an interaction with others. Once stand and helps the child learn to vocal- again. You’ll be surprised at how entertaining this can be for your little one.
you hear your child working on a new ize them.
Play catch Although your son or daughter can’t catch a ball in midair yet, he or she
will have fun corralling a ball that’s rolled in his or her direction.
BILINGUAL BABIES Godzilla Give your child a chance to unleash some energy and laugh in the process
by building a tower of soft blocks for your child to knock down. In a few months, he
If you speak a second (or third) language, feel free to use it with your baby. The rule or she will have the skills to build a tower himself or herself, just to knock it down
of thumb is that the younger a person is when exposed to a different language, the again, of course.
less difficulty he or she will have in acquiring it. Giving your child the gift of a second
language is a gift he or she can use throughout life. Create an exploration zone To build on your child’s ability to pull up to stand and
Some parents are concerned that their child will become confused if presented cruise, place some interesting objects on a low table that will attract his or her atten-
with two languages at the same time. But there is little evidence to support this tion. This will give your child extra motivation to stand and move around while hold-
concern. In fact, research suggests that the human brain is adaptable enough to ing on to the table.
learn two languages simultaneously just as well as one. Consider also the millions
of families around the world who speak more than one language at home and in
their communities.
Although bilingual kids may mix words from different languages or attach verb
endings from one language to words in another, research shows that eventually
they sort it out. If they consistently use one language over another, that language
may become the dominant one — for example, if English and French are both
spoken at home but English is used everywhere else, English is likely to become
the dominant language. Nonetheless, the child can still become proficient in French
if he or she uses it often enough.
Even if your partner doesn’t share your second language, you can still expose
your baby to it by using it to narrate your day, read books in that language or have
the same kinds of “conversations” with your baby that you would have in your fam-
ily’s primary language. You might feel funny at first, but it will be worth it when you
hear your child say his or her first words in English and in Vietnamese or Spanish
or Russian.
When your baby was born, he or she had

try to copy you while watching his or her
own reflection.
As your child’s self-concept grows, it
no sense of himself or herself as a sepa- affects the way he or she interacts with During the eleventh month, your baby is busy:
rate entity from you or the rest of the the world. You may notice a growing self- Z Mastering crawling
world. But from about 8 months or so, confidence, as well as a newfound wari- Z Standing with support
your child starts to figure out that, “Hey, ness of things that may previously have Z Pulling up to stand
I’m Sam. I have my own face, hands, fin- had little to no effect on your child. Z Maybe standing alone for a few seconds or even taking a few steps
gers and toes. I can wiggle my body when Z Holding on to furniture to walk around (cruising)
I want, and when my dad makes a funny Increased assertiveness The more Z Using thumb and first finger together (pincer grasp)
face, I can make it myself!” practiced your son or daughter becomes Z Manipulating toys appropriately
You might notice this when you and at new skills, the more assertive he or she Z Learning to let go voluntarily
your child are in front of a mirror. Before, is likely to become. This growing inde- Z Using gestures to communicate
your baby may have thought the image pendence is good and a sign of healthy Z Feeding self
in the mirror was a different baby alto- development, but it raises the potential Z Recognizing and responding to familiar words
gether. Now your child is starting to rec- Z Babbling, stringing syllables together
ognize that it’s his or her own image and Z Saying mama and dada
may touch his or her nose or pull a strand Z Verbalizing other familiar words
of hair to confirm the physical feeling Z Looking for hidden toys
with the actions in the mirror. When you Z Imitating the activities of adults and older kids
make a face in the mirror, your baby may Z Testing limits and observing parental reactions
Z Becoming more assertive
Z Avoiding strangers yet interacting more with family
for the first power struggles between you Newfound fears As your baby’s brain
and your child (see Chapter 26). Your continues to develop, so does his or her
child’s discovery of his or her own will perception of danger and sense of fear.
may make him or her more likely to re- This is a primal step in the development
fuse certain foods, demand more privi- of a child’s judgment and ability to recog-
leges or protest your restrictions more nize unsafe situations. Things that may
loudly. not have bothered your child before, such
Your baby’s personality starts to shine as the dark, thunder or loud noises, may
through more clearly when he or she can now become scary and provoke intense
assert both likes and dislikes. For exam- feelings of fear. At this point, it’s easier to
ple, you can now see evidence of your remove or minimize the sources of fear
child’s amazing persistence when he or than to attempt to rationalize them. For
she insists on finding that hidden object. example, you might install a night light in
Or when your son or daughter crawls off your child’s room or leave a closet light
to play alone for a while after being sur- on at night. If a scary something is im-
rounded by other people, you realize that possible to avoid, stay close and calm.
he or she may need some downtime to Eventually, based on your reaction and
recharge his or her batteries before inter- comfort, he or she will learn there’s noth-
acting with people again. ing to be afraid of in these situations.

CHAPTER 28
Month 12
This month marks the end of your baby’s your little one makes the transition from
first year. Your son or daughter has infant to toddler, your in-depth knowl-
changed dramatically the past 12 months. edge of your child will help you provide
During those first days and weeks, you the challenges, support and assurance he
may have wondered if you would ever or she needs.
understand each other and work as a
team. Now you can read your baby’s
moods and cues and respond with ex-
actly what he or she needs.Your baby also BABY’S GROWTH AND
understands you and your partner and APPEARANCE
knows how to thrill you, make you smile
and even exasperate you. What a difference 12 months can make!
You’ve changed, too. While your baby For most babies, their birth weight has
has become more independent and com- tripled by the end of their first year. So if
municative, you’ve become a more confi- your baby weighed 7.5 pounds at birth,
dent and interactive parent. Congratula- he or she is likely to be between 21 and
tions! It’s not easy becoming a parent, 23 pounds now.
but it’s definitely doable. And although During the first year, most babies
this is the last month of year one, it’s re- grow about 10 inches from birth. The av-
ally only the beginning of many adven- erage baby is now between 28 and 32
tures to come. inches tall. The typical head size at 12
The confidence you’ve developed and months is about 18 inches, up 4 inches
your ability to understand and commu- from a newborn size of approximately 14
nicate with your baby are your best tools inches. Some babies may have only one
in the months ahead. No one knows your tooth at this stage; others may have up to
son or daughter as well as you do. As 12 or more.

Childhood experts and care providers BABY’S MOVEMENT
use a baby’s first birthday as a natural SPOT-CHECK: WHAT’S GOING ON THIS MONTH
benchmark for many milestones, but Your son or daughter has learned so
keep in mind that all babies will continue much in the past year. In a matter of Here’s a snapshot of what your baby’s basic care looks like in the twelfth month.
to grow and develop at their own unique months, he or she has gone from strug-
rates. What’s important is not that your gling to hold up his or her head to learn- Eating By now, your baby’s diet probably includes foods with various textures and
baby’s height and weight numbers match ing how to sit, crawl, cruise and maybe flavors. But the amount your baby eats at a meal may seem very small. Many par-
up with national averages, but that he or even walk, all on his or her own. Where ents become concerned that their babies aren’t getting enough. Keep in mind that
she is following his or her own steady once your child was able only to bat at portions for an 11- to 12-month-old are pretty small compared with an adult’s,
growth curve. large objects with closed fists, he or she perhaps ¼ cup from each food group. And as babies transition into the second
In the same way, the normal range for can now pick up an item as small as a year, their appetite tends to drop and becomes more erratic. Altogether, this might
many developmental milestones is quite crumb. This is all a result of the rapid de- translate into a meal of a few tablespoons of cooked carrots, two bites of rice, a
wide, so don’t be concerned if your baby velopment of your baby’s nervous sys- taste of meat and several bites of pears. Focus on your baby’s signs of hunger and
isn’t walking or talking yet, or is still very tem, which is now a much more efficient thirst rather than how much is left on the plate. Allow him or her to stop eating
leery of strangers. The first birthday is conductor of messages from brain to when he or she is full, rather than coaxing or playing tricks to get more food in. If
magical only in the sense that loved ones muscles and vice versa. you make a healthy selection of foods available, your child won’t starve or lose
make it so in celebration of reaching that significant weight.
one-year milestone. However, in terms Sitting Not only can your baby sit for in- Keep giving your baby breast milk or formula. Both are important sources of
of measuring development, it’s much less definite periods of time without toppling nutrition. If you’ve decided to wean your baby from breast-feeding, replace the
significant. Your baby will begin doing all over, he or she can pivot while seated to breast milk with iron-fortified formula. After the first birthday, you can gradually
of the things he or she is supposed to, reach a toy or to turn toward you. He or transition your baby to drinking whole milk.
whether it be a few months before or a she can also easily get in and out of a sit-
few months after the big birthday bash. ting position at will. Sleeping Most 11- to 12-month-olds sleep as long as 10 to 12 hours at night and
take a couple of naps during the day. Most babies still need two naps a day, but
some start giving up their morning naps around this time. If that’s the case for your
Month 12 baby, try starting the afternoon nap a little earlier and make bedtime a little earlier, as
35 well. This will help avoid overtiredness. Pay attention to your child’s cues, too, and
adjust his or her sleeping schedule to accommodate his or her need for sleep.
By 11 to 12 months, most babies don’t need nighttime feedings anymore.
Nursing or taking a bottle is likely to be for reasons of comfort, not calories. If your
30 baby is still waking up for feedings and you want to work toward sleeping through
the night, try gradually shorter nursing sessions or smaller bottles. Eventually you
can cut down to none at all. Also look at your child’s bedtime routine. Place your
child in bed while tired but still awake so that he or she learns how to put himself
Length 25 or herself to sleep.
(inches)
20 Average girl
(50 percentile)
Average boy
(50 percentile)
29 in. 29.5 in.

21 lbs. 23 lbs.
15
5 10 15 20
© MFMER
Weight (pounds)
Standing and bending During this away with your arms out, and encourage
month, about half of babies gain enough him or her to walk toward you. Pretty SAFETY CHECK
balance to stand alone for a few seconds soon, look out — there goes your tod-
or even longer. This opens up a whole dler! First steps are always exciting. It’s Every step your baby takes toward more independence and mobility is thrilling, but
new level of vision and reach for your good to stand back and let your baby it also means an increased risk of injury. As your baby learns to stand, cruise and
baby, as he or she can now play with toys practice, but continue to stay close, as it walk, the risk of injury increases. Being aware of your baby’s ability to move farther
above ground. At the same time, about takes awhile to get the hang of walking and faster is the first step in reducing this risk. It may seem surprising that your
25 percent of infants are learning to stoop without help. baby can get into something that a week earlier was out of reach.
down while standing to recover an item Don’t fret if your baby doesn’t seem to Take time out every few days to get down to the baby’s level and look around
from the floor. be interested in walking just yet. A few each room. What new temptations do you see?
babies start walking as early as 9 months, Injuries are most common at times when the family is occupied, such as din-
Walking Between months 11 and 12, but others wait until 17 months to take nertime. Your baby is active and impulsive. When you’re busy and stressed, it’s
about 1 out of 4 babies learns to walk the plunge. Both are perfectly normal. easy to lose sight of the baby for just a second. Unfortunately, babies at this age
well. Walking is a complex activity that don’t know how to adjust their need for attention and exploration just because
requires coordination, balance and a Getting up and down stairs Even you’re stressed. Sharing mealtime duties with another family member may allow
good dose of confidence. A key stage in before a baby starts walking well, he or one person to play with or feed the baby while the other tends to the rest of the
learning how to walk independently is she will likely figure out how to get up a family’s needs.
learning to lift first one foot and then the set of stairs, which involves a mix of For more information on childproofing your home, see Chapter 15.
other so that the baby is briefly standing crawling and walking maneuvers. In a
on one leg. Your baby practices doing this few weeks, usually sometime between 12
while cruising around holding on to fur- and 15 months, children learn to go
niture for support. down the stairs, too, most often by slid- Hand and finger skills Your son’s or take it. He or she is also getting better at
When your baby first shows an inter- ing down feet first on his or her tummy. daughter’s refined pincer grasp at 12 using a spoon and has probably discov-
est in taking steps, walk with your baby, Getting up and down stairs is an im- months allows him or her to pick objects ered that spoons make good toys (espe-
holding his or her hands, praising his or portant skill to learn, but you’ll want to up with ease. When reading a book to- cially if they’re filled with food).
her efforts to move forward. Once baby be close by whenever your child is work- gether, your child can turn the pages with
signals that he or she is ready to walk ing on them, to catch any slips and avoid a little bit of help. Later, he or she will use
alone, crouch down a short distance tumbles that are bound to happen. these same skills to learn to draw, paint,
write, and work buttons and zippers. BABY’S SENSORY
Most babies can hold an object in DEVELOPMENT
each hand by this age and enjoy banging
IT’S A PARTY! them together. Your baby may even have By the end of the first year, your child’s
figured out how to hold two objects in senses are working together in a coordi-
At the end of this year, the whole family deserves a party — perhaps for the family one hand and how to put them into a nated fashion to make your child aware
more so than baby, who likely won’t grasp the significance of the event until around container. He or she may also throw toys of the outside world. And as he or she
age 3. In any case, it’s a traditional time to celebrate, and why not? For many to the side when they lose appeal or to becomes used to routine sights and
families, the baby’s first birthday marks the end of a period of labor-intensive par- pick up something more interesting. But sounds around the house, your son or
enting. There’s more to come, sure, but colicky evenings, breast-feeding struggles your fickle juggler won’t have much con- daughter learns to filter out distractions
and chronic sleep deprivation are now largely behind you. It’s time for cake! trol over where he or she can throw. and better focus on things of interest,
While it’s tempting to invite everyone you know to such a grand occasion, for Between 11 and 12 months old, many such as eating a meal or listening to a fa-
baby’s sake you might consider having a small party with immediate family. At 1 infants are getting a better grasp of their vorite story.
year of age, your baby may not enjoy a large, noisy gathering of friends and neigh- eating and drinking utensils, both liter-
bors. Even if your little one is the gregarious type, you might still want to limit the ally and figuratively. Your baby may know Looking and listening Your baby’s
duration of the party to an hour or so, to avoid any baby-related meltdowns. how to pick up a cup and drink from it hearing is sharper now, and he or she lis-
but may not be able to set it down just tens with greater attention. In fact, he or
yet, and will probably drop it if you don’t she can look and listen at the same time,
making reading books together that much BABY’S MENTAL DEVELOPMENT
more enjoyable. If you think your baby TOYS AND GAMES
isn’t hearing well, talk to your baby’s care Brain imaging studies of sleeping infants
provider about a hearing assessment. between 0 and 2 years of age reveal that Through the end of the first year and baby along so that he or she can ben-
the total volume of a baby’s brain in- beyond, your baby will still enjoy toys efit from the space, too.
Touch Even though your little guy or gal creases by over 100 percent during the and games that use and build new mo-
is benefiting from integrated sensory in- first year of life. Pretty amazing, isn’t it? tor skills. Games that involve picking up Walk together Practice walking to-
put, he or she still enjoys singular sensa- No wonder their head size grows so and dropping objects will likely be en- gether with your baby by holding
tions, such as feeling different textures or much — it has to accommodate all of tertaining. At 12 months, your baby’s hands. Gradually, he or she will move
pouring water from one container into that growth in gray and white matter. play may range from exercising large to holding one hand only and then just
another. For some adventure as your The older your baby gets, the greater muscles to working and mastering fine a finger. Soon, you’ll be able to take a
baby learns to walk, let him or her tread the myelinization of your baby’s nerves motor skills. He or she will likely think step back and let your baby walk to-
barefoot on different surfaces, such as on — the process whereby nerves become it’s fun to push, throw and knock down ward you. Let your baby try out differ-
soft grass or in a puddle of water. Your encased in a fatty sheath called myelin, everything. ent surfaces, too, such as warm sand,
baby also enjoys human touch and loves which makes them stronger and more When walking down the toy aisle of soft grass or a wet puddle.
to return hugs and kisses, although not efficient messengers. This myelinization your local retail store, it may be easy to
always on demand. helps to bring more and more areas of get carried away because there’s so Crayons Some babies start to scrib-
Even at 1 year, your baby still explores the brain into use. much to choose from. When purchas- ble around 12 months or so. Give your
using fingers and mouth together. Anything Some areas of the brain don’t mature ing a toy for your child, keep in mind child a crayon and a piece of paper and
your baby picks up will be taste tested. until much later, such as a part known as the fun factor. Toys can certainly be see what happens. Show him or her
the reticular formation, which helps you educational, but try to stick with somehow it works and see what your child
maintain attention. This area doesn’t be- thing appropriate for your child’s level does. He or she may be delighted at
come fully myelinated until puberty or of development. If a toy or game is too the results, and so will you.
later. The frontal lobes, responsible for difficult for your child to comprehend,
executive thinking and judgment, don’t he or she will quickly lose interest. And Pull toys With your son’s or daughter’s
become fully myelinated until adulthood while toy manufacturers may think of increased dexterity, he or she can pull a
(and you thought impulsive teenagers their products as the perfect develop- toy along if it has a string or ribbon at-
were just out to give a parent gray hair). ment aid, there’s nothing that beats in- tached. Pulling a toy can be just as fun
teraction with you when it comes to as pushing one around.
Increasingly complex thinking By helping your baby grow and learn.
age 1, your baby is starting to gain control A 1-year-old is still entertained by Water toys A book in the bath? Little
of the limbic system — the area of the simple things. Here are some ideas to ones love sitting in the tub and flipping
brain responsible for emotions, appetites get you started. through a waterproof picture book.
and basic urges, but also information Your little guy or gal might also enjoy
processing and directing incoming infor- Find open space Often the best bathtub paints and crayons that rinse
mation from the outside world to the ap- thing you can do for your baby when right off with the bath water. Water is
propriate areas of the brain. Thus, a he or she is learning how to crawl and fascinating to kids, and many will be
1-year-old’s thinking gains in complexity walk is to give him or her plenty of content to simply pour it from one cup
and starts to contain longer chains of space to move around in. This could be to another. Just be sure to always su-
thoughts. If you offer two toys to a 1-year- at a park if the weather is nice or at a pervise your child around water to
old, for example, he or she will likely make community recreation center or kids’ avoid any possibility of drowning. Re-
a choice between the two rather than try- gym. If you have older children who are member, if the phone rings or the door-
ing to grab both. Or if your baby sees a toy taking a class in a gym or other open bell sounds, don’t leave your baby in
with a blanket on it, he or she may employ area, such as ballet or karate, take your the bathtub alone.
knowledge of cause and effect to pull the
blanket to get to the toy.

Understanding The part of the brain in-
volved with understanding is maturing as
well. By the end of the first year, babies are Your baby may be on the road toward in-
beginning to respond to one-step com- dependence but still has lots to learn. During the twelfth month, your baby is busy:
mands. For example, your child may hold Some of the fear that accompanies that Z Standing alone
on to you on request when you pull his or early independence is starting to fade as Z Cruising
her pants up to get dressed. Or your baby your baby becomes more sure of his or Z Maybe taking first steps
may give you a kiss when you ask. her place in the family. However, you and Z Using pincer grasp accurately
Your son or daughter may also show other family members will be the ones Z Manipulating toys appropriately
understanding of simple questions, such your baby relies on for safety and security. Z Feeding self
as “Where’s daddy?” or “Is that a puppy?” Z Learning to let go voluntarily
when pointing at a picture of a puppy in Veni, vidi, vici Your baby is starting to Z Looking and listening simultaneously
a familiar book. take up Julius Caesar’s famous motto, “I Z Increasing attention span
came, I saw, I conquered.” Everything is Z Using gestures to communicate
Language Speaking comes slower than up for mastery. Early signs of your baby’s Z Recognizing and responding to familiar words
understanding, and it won’t be until the drive for independence include self-feed- Z Increasing vocabulary
second or third year that your child’s vo- ing, drinking from a cup and being able to Z Responding to one-step commands and simple questions
cabulary begins to expand dramatically. move about on his or her own. For most Z Imitating the activities of adults and older kids
And it may take even longer for people youngsters, the thrilling part of learning to Z Testing limits and expressing frustration
outside of the family to understand what walk is gaining more control over the Z Still being wary of strangers but very affectionate with family
your child is saying. world. The world is no longer limited to
Still, the beginnings of speech are at what comes to them; now they can go out
hand. More than half of babies know at and conquer it. This independence can be
least one word by the age of 1 in addition both exciting and intimidating. soothing, your best bet may be to head for object remains in the room, expect that
to mama and dada, such as uh-oh. Some a nap rather than repeated attempts at your child will likely go right back to
may even know two or three words. Con- Tantrums Although tantrums become discipline. Your baby may need to “vent” a what you just said no to. Try hard to re-
tinue to encourage your baby’s explora- more common during a child’s second little before actually falling asleep. serve no for those things that can harm
tion of words by listening intently and re- year, you may be noticing the first signs your baby. (Easier said than done!) You
sponding to the baby’s jabbering. Repeat of your baby’s temper. Your 1-year-old Saying no By now, your son or daughter can also teach your baby the meanings of
new words your baby is learning, and ver- may get upset when something is taken understands what you mean when you “be gentle” and “be soft” for situations
bally name gestures that he or she already away or when he or she doesn’t get what say the word no. It’s just that everything that require caution, such as playing with
uses for communication. he or she wants. As your baby’s drive for in your home is so fascinating — includ- a friend or the family pet.
If you’re concerned about your child’s independence and mastery run up ing pot handles, fireplaces, holiday deco-
speech development, try to discover what against his or her still-limited abilities rations, the way the water swirls in the Relating to others Most babies this
he or she is channeling his or her ener- and your parental limits, he or she may toilet and your pet’s whiskers, tail and age are very affectionate with family
gies toward. Perhaps your son or daugh- feel frustrated and mad. Some babies ex- food. His or her desire to explore is stron- members and enjoy snuggling and cud-
ter is spending more time standing, press these feelings more loudly and in- ger than the desire to listen to your warn- dling up for lap time. But don’t be sur-
cruising and walking. Eventually, once tensely than do others, depending on ings. This isn’t a sign of defiance, just prised if your baby’s wariness of strang-
these skills are mastered, speaking will their personalities (see Chapter 9 for more your baby’s natural, irrepressible craving ers continues through these months.
become a priority. Allow your baby to on a baby’s temperament). to explore. Many babies have a fear of strangers past
learn these skills within his or her own When you see your child becoming As much as possible, remove valuable their first birthdays. Others have shorter
time frame. irritable, more often than not it’s a sign or dangerous objects that tempt your stages, and many even have on-and-off
You should also know that how well that he or she is tired or hungry. This is baby. For the remaining objects, keep a periods of stranger anxiety.
your baby understands language is a bet- true even for older children and adults. If close watch and be prepared to move
ter measure of language development than your baby is out of sorts or seems in- your persistent baby away from danger-
are the words he or she is able to say. creasingly resistant to your efforts at ous objects or offer a distraction. If the
PART 4
Common Illnesses
and Concerns
Among the many challenges you face as help. You know your child better than
a parent is caring for your baby during ill- anyone else — including details about
nesses or medical emergencies. This can his or her current and previous illnesses.
be scary, but thank goodness true medi- You will notice, for example, if your little
cal emergencies in infants are fairly rare. one is suddenly more fussy than usual, or
And because your son or daughter can’t has changed eating or sleeping patterns.
verbally tell you when something hurts, You’ll also be able to tell if your baby is
it’s sometimes difficult to sort out more less active or clinging to you more.
serious illnesses from those that are com- You are an important member of the
mon and easily managed at home. team that cares for your sick child. In
Illnesses in general are more frequent most cases, you will determine when you
in the first year of life, simply because your can handle an illness at home or when
new baby is small and still developing in it’s time to call your baby’s care provider
many ways. He or she also is confronting or visit an emergency department. You
a whole new environment filled with all can help your care provider determine if
kinds of elements that weren’t present in a problem is present when things just
the uterus, including people, pets and don’t seem right with your son or daugh-
germs. But as your baby matures and his ter. You also play a key role in caring for
or her immune system becomes stronger your sick infant: knowing when to give
and better adapted to the environment, medication, understanding what chang-
illnesses will become less frequent. es to watch for and foods to avoid, and
As you get to know your son or determining when your baby can return
daughter better, it will become easier for to child care. Remember, parents’ in-
you to know when your child has a mi- stincts about sick children are usually
nor illness and when you need medical very good — trust yours.
PART 4: COMMON ILLNESSES AND CONCERNS 347

INFANTS AND MEDICATIONS Cough and congestion When your Avoid aspirin Aspirin is not approved for How to give medicine When your
baby is coughing or congested, it’s tempt- children under 2. And it’s generally not rec- child does need to take a medicine, here
A question new parents often have when ing to pick up one of the many cough and ommended for children under age 18 be- are some tips to make the job easier:
faced with a sick baby is whether it’s OK cold medications available at your local cause of its association with a serious ill- Z A baby is usually more willing to take
to give medication. When you have a drugstore, but research indicates that ness called Reye’s syndrome, which can medicine by mouth before a feeding.
headache, for example, the easiest and these aren’t very effective in curing in- damage the brain and liver. The risk is Z Place a small amount of medicine in-
most effective solution is to take a pain fants’ and toddlers’ colds. The Food and mostly associated with using aspirin to side the baby’s cheek, where it’s not
reliever. But what about for a baby? Drug Administration also warns that treat symptoms of a viral illness, such as as easy to spit out.
When it comes to medications, they can have rare but serious side effects the flu or chickenpox. But since it’s not al- Z Don’t refill bottles or use measured
whether for adults or children, the bene- (see “Cough and cold medications” on ways easy to accurately distinguish be- droppers for anything other than the
fits of the medication must always be page 361). A safer and more effective al- tween a viral and a nonviral type of illness, original medicine.
weighed against the risks. While some ternative for a stuffy nose may be to use experts recommend avoiding aspirin alto- Z Avoid chewable medications in ba-
medications certainly can play a role in saline nasal drops to thin the mucus (see gether in children under 18, unless spe- bies younger than age 2.
helping infants and children get better, “Cold” on page 359) or a suction bulb to cifically prescribed by a care provider. Z Follow the directions of your baby’s
many others do not. Plus, almost all remove secretions from your baby’s nose. If you have any questions about giv- care provider for continuing to use a
drugs have potential side effects. So it’s ing your baby a medication, call your ba- medication, even if it doesn’t taste
important to choose wisely when and Precautions When giving your baby by’s care provider. This will help you good or your baby’s symptoms are
what type of medication to give. medicine, follow these precautions: avoid unnecessary risks. If your baby getting better. A course of antibiotics,
The general approach to over-the- vomits or develops a rash after taking a for example, needs to be taken in full
counter medications in an otherwise Give the right dose Infant medicines medicine, call the care provider promptly. for it to work as it should.
healthy baby is that they’re rarely need- usually come in liquid form but in differ-
ed. If you do use nonprescription medi- ent strengths based on the individual
cations, use only those that are designed medicine. Use only the dispenser that
for infants. Use them only when neces- came with the medication, and follow
sary and as indicated by your baby’s the directions on the label carefully so
care provider. that you give your baby the right dose.
Often, for children under 2, the medicine
Fever and pain Call your baby’s care label will tell you to ask your care pro-
provider right away if your baby is under vider for instructions on dosing (see also
3 months of age and has a rectal temper- the dosage charts for acetaminophen
ature of 100.4 F or higher. If your child has and ibuprofen on page 370). If you know
a fever and isn’t uncomfortable, medica- your child’s weight, use that as a guide.
tion isn’t necessary. If your child has a fe-
ver and is uncomfortable, acetaminophen Avoid overdosing Avoid giving your
(Tylenol, others) is generally considered baby multiple medicines with the same
safe for babies under 6 months of age. In active ingredient at the same time, such
addition to helping with fever discomfort, as a pain reliever and a decongestant,
acetaminophen can help relieve pain, which can lead to an accidental overdose.
such as soreness after shots and painful Some parents alternate between pain re-
earaches. Ibuprofen (Advil, Motrin, oth- lievers such as acetaminophen and ibu-
ers), another pain reliever, is safe for ba- profen, but be cautious about doing this.
bies older than 6 months, although it can Each medicine requires a specific interval
aggravate illnesses affecting the digestive between doses (see the dosage charts on
tract. Ask a care provider before giving page 370). Trying to keep the two straight
medication to a child with a chronic ill- may become confusing, and you may un-
ness, such as kidney disease or asthma. intentionally overdose your baby.
348 PART 4: COMMON ILLNESSES AND CONCERNS

TAKING BABY’S TEMPERATURE to measure the temperature inside the With armpit (axillary) temperatures, it more easily use a digital ear thermome-
ear canal. Other options include a digital can sometimes be difficult to get an ac- ter, since a toddler’s ears are usually large
If your child feels warm or seems under pacifier thermometer and temporal ar- curate reading. Temperatures measured enough. Plus, it’s more difficult to obtain
the weather, it’s probably time to take his tery thermometer — which uses an infra- with a pacifier thermometer are consid- a rectal temperature at this age. Carefully
or her temperature. Sounds simple red scanner to measure the temperature ered the least accurate. The reliability of follow the instructions that came with
enough — but if you’re new to it, you of the temporal artery in the forehead. temporal artery thermometers hasn’t yet your thermometer. You can also use a reg-
may have questions. Which type of ther- If you want to get a single thermom- been verified. ular digital thermometer to take a rectal
mometer is best? Are thermometer eter for the entire family, a regular digital Whatever the method, make sure you temperature or an armpit temperature. To
guidelines different for babies and older thermometer is probably best. However, carefully read the instructions that came take an armpit temperature, first turn on
children? Here’s what you need to know if you plan to use the digital thermome- with your thermometer. After each use, the digital thermometer. When you place
to take your child’s temperature. ter to take a rectal temperature, get two clean the tip of the thermometer with the thermometer under your child’s arm-
digital thermometers and label one for rubbing alcohol or soap and lukewarm pit, make sure it touches skin — not cloth-
Thermometer options A glass mer- oral use and one for rectal use. Don’t use water. For safety — and to make sure the ing. Hold the thermometer tightly in place
cury thermometer was once a staple in the same thermometer in both places. thermometer stays in place — never for about a minute or until the thermom-
most medicine cabinets. Today, digital leave your child unattended while you’re eter signals that it’s done. Remove the
thermometers are recommended instead Accounting for accuracy The most taking his or her temperature. thermometer and read the number.
of mercury thermometers, which can accurate way to take a child’s tempera-
break and allow mercury to vaporize and ture is to use a digital thermometer rec- Age matters The best type of ther- 4 years and older By age 4, most kids can
be inhaled. tally or orally. Rectal temperatures pro- mometer — or the best place to insert the hold a digital thermometer under the
Regular digital thermometers, which vide the best readings for infants. Ear thermometer, in some cases — depends tongue for the short time it takes to get a
use electronic heat sensors to record thermometers are another option for on your child’s age. temperature reading. Turn on the digital
body temperature, can be used in the older babies and children. However, ear- thermometer. Place the tip of the ther-
mouth, armpit or rectum. Digital ear wax or a small, curved ear canal can in- Birth to 3 months For newborns, use a mometer under your child’s tongue, and
thermometers, also called tympanic ther- terfere with the accuracy of a tempera- regular digital thermometer to take a rec- ask your child to keep his or her lips
mometers, use infrared energy detection ture taken with an ear thermometer. tal temperature. Turn on the digital ther- closed. Remove the thermometer when it
mometer and lubricate the tip of the signals that it’s done and read the num-
thermometer with petroleum jelly. Lay ber. If your child has been eating or
your baby on his or her back, lift your drinking, wait at least 15 minutes to take
baby’s thighs, and gently insert the lubri- his or her temperature by mouth. If your
cated thermometer half an inch into your child is too congested to breathe through
baby’s rectum. Insert the thermometer his or her nose, you may need to take an
slowly, and stop if you feel any resistance. armpit or rectal temperature — or use a
Hold the thermometer in place for about digital ear thermometer.
30 seconds or until the thermometer sig-
nals that it’s done. Remove the ther-
mometer and read the number. Call your
baby’s care provider right away if your CARING FOR A SICK BABY
child is under 3 months of age and has a
temperature of 100.4 F or higher. Many common childhood illnesses can
be treated at home. If you have any ques-
3 months to 4 years For older infants tions, seek the help and advice of your
and toddlers, continue to use a rectal baby’s care provider. When you have a
thermometer as long as you are able to. sick baby at home, a little extra loving
Ear thermometers are often too big for an care is always in order. To help your child
© MFMER
older baby’s small ear canals and are like- recover quickly and fully, there are some
Taking a baby’s temperature rectally ly to be inaccurate. For toddlers, you can simple steps you can follow.
350 PART 4: COMMON ILLNESSES AND CONCERNS PART 4: COMMON ILLNESSES AND CONCERNS 351
Encourage rest Make sure your baby ers) to relieve the discomfort. Ibuprofen
has plenty of opportunity to rest. Getting (Advil, Motrin, others) should only be
enough sleep will help ease crankiness given to babies older than 6 months. Fol-
and smooth over irritability and discom- low the directions on the label, the dos-
fort. Take the opportunity to snuggle up age charts on page 370, or the advice of
and relax together. A mild illness is often your child’s care provider. Be sure to wait
just the excuse you need to pause the for the appropriate amount of time be-
family’s hectic schedule and spend qual- fore giving your baby another dose. If
ity time with your baby. your child’s care provider has prescribed
antibiotics or another medication, follow
Offer plenty of fluids One of the big- the instructions exactly to maximize the
gest risks associated with infections and drug’s benefits and reduce possible risks.
other common childhood illnesses is de-
hydration. Dehydration occurs when Contact your baby’s care provider
your baby loses more fluids than he or When dealing with a sick child, trust your
she is taking in — because of vomiting, intuition as a parent. If you feel like you
diarrhea, difficulty feeding, or just the in- should call your baby’s care provider —
creased demands on your baby’s metab- call. Describe what’s worrying you and
olism. If your baby is having difficulty what you’ve tried so far. A phone call to a
eating or keeping fluids down, offer care provider often can solve a lot of
small, frequent sips of breast milk, for- problems and give you reassurance that
mula, water or oral rehydration solution the steps you’ve already taken are the
(see “Vomiting” on page 395 for more de- right ones. If you feel like you should
tails on getting your baby to take in have your child seen in either the doc-
enough fluids). Older babies may enjoy tor’s office or the emergency department
sucking on an ice pop or crushed ice. — go in.
Make your baby comfortable If your Prevent the spread of germs Young
baby is congested, adding extra moisture babies are especially vulnerable to virus-
to the air by running a humidifier or va- es and bacteria. Take common sense
porizer may help soothe your baby’s steps to keep germs from spreading.
nose. Or have your child breathe the Sneeze or cough into a clean tissue or
warm, moist air in a steamy bathroom. into your elbow if tissues are unavailable.
Saline drops into the nose can help with Toss used tissues promptly. Don’t share
congestion. If your baby’s room feels hot eating and drinking utensils. Keep sur-
and stuffy, circulate the air with a fan. faces clean, including pacifiers and toys
Also make sure your child isn’t dressed that your baby likes to chew on. Avoid
too warmly. people who are sick, and stay away from
crowded areas in the fall and winter,
Use medications wisely If your baby when more people are indoors and the
is more than 3 months old and has a fe- chances of infection are higher. Above all,
ver but is eating and sleeping well and wash your hands frequently and thor-
playing normally, medication may not be oughly and make sure other family
necessary. But if your son or daughter is members do the same. You may want to
fussy and uncomfortable, it’s fine to give keep bottles of hand sanitizer in various
him or her acetaminophen (Tylenol, oth- places around the house.
A TO Z ILLNESS GUIDE egg whites, nuts, fish and shellfish, If your baby has allergy signs or ANEMIA
wheat, soy and corn. symptoms such as a constant runny nose,
Following are some illnesses most com- Food allergies are sometimes con- chronic cough or dry, itchy skin, make an Anemia is a condition in which blood
mon to newborns and young children fused with an intolerance or sensitivity to appointment with his or her care pro- lacks a sufficient number of healthy red
and tips on how to treat them. certain foods. Intolerance of a certain vider to discuss what’s causing it and to blood cells. Red blood cells carry oxygen
food can cause digestive problems — learn how to treat it. to the brain and other organs and tissues,
such as stomachache, gas and diarrhea providing energy and giving skin a
— but isn’t related to the immune sys- What you can do The best way to pre- healthy color. They’re also essential to a
ALLERGIES tem. For example, some babies don’t vent any allergy is to avoid the substance child’s growth and development.
have enough of the enzyme required to that’s triggering the reaction. If you’re in The most common cause of anemia in
Allergies occur when your body’s natural digest milk sugar (lactose), making them the midst of introducing new foods to infants is a lack of iron (iron deficiency).
defense system incorrectly identifies a lactose intolerant. Also, sometimes the your child, and he or she shows signs of a Iron is necessary for the creation of he-
harmless substance as harmful. The body acid found in certain foods, such as to- possible food allergy, your child’s care moglobin, the substance that enables red
then overreacts in an attempt to protect matoes or oranges, can cause a red rash provider may advise going back to foods blood cells to deliver oxygen to the body.
itself, and the result is an allergic reac- around the mouth that parents mistake you know are safe and holding off on In full-term infants, iron deficiency usu-
tion. A tendency to develop allergies is for allergies. new foods for a week or two. Then intro- ally results from a lack of iron in the ba-
usually inherited. duce new foods one at a time, so you can by’s diet. Babies who drink cow’s milk
As with adults, infants can develop an How serious is it? Most of the time, monitor which food might be causing too early, for instance, miss out on iron
allergic reaction when they eat, breathe allergies are annoying but not serious. In problems. If necessary, your child’s care because cow’s milk is a poor source of
in or touch something that offends their a few cases, though, an allergic reaction provider may refer you to an allergy spe- iron. Iron deficiency can also occur as a
immune systems. Certain drugs (most can be life-threatening and require emer- cialist who can conduct special tests to result of premature birth or excessive
commonly penicillin) and stings and gency treatment (anaphylaxis). Signs and identify potential allergens. blood loss.
bites from insects and other animals also symptoms to watch out for include: If your baby has irritated skin, use Most full-term babies are born with a
can cause an allergic reaction. Z Difficulty breathing lukewarm water and gentle, fragrance- supply of iron that lasts about four
Z Facial swelling free soaps for baths. Apply fragrance-free months. After that, the supply diminish-
How to recognize it Allergies often Z Bluish skin color skin moisturizer frequently, especially es and needs to be supplemented with
cause signs and symptoms such as: Z Loss of consciousness right after a bath to lock in moisture. other sources of iron, such as food, infant
Z Runny nose with a thin, clear discharge Avoid clothing that’s rough, scratchy, formula or an iron supplement.
Z Itchy, watery or swollen eyes When to call If your baby has symp- woolen or too tight. To relieve severe
Z Sneezing toms of anaphylaxis, call 911 or your local itching or oozing, apply a wet, lukewarm How to recognize it Signs and symp-
Z Itchy skin emergency number. After emergency washcloth or compress to the irritated toms of anemia aren’t always easy to rec-
Z Rash treatment, see your child’s care provider skin. Your child’s care provider may also ognize. Often, babies are diagnosed with
Z Hives to determine what caused the reaction recommend using an over-the-counter anemia as a result of a blood test done for
Z Swelling and to figure out how to avoid another hydrocortisone cream or prescription a separate reason. In general, though, a
Z Cough, wheezing or shortness of breath one. Doctors will often prescribe an ointment to treat dry, itchy skin. baby with iron deficiency anemia may:
Food allergies can create the above emergency injectable medication (EpiPen Respiratory allergies — to dust, pol- Z Appear pale or ashen
symptoms, as well as diarrhea and vom- or Twinject) that you can keep with you at len, mold or other allergens in the envi- Z Tire easily
iting. Almost any food can cause an al- all times. This medication provides your ronment — are fairly uncommon under Z Be persistently irritable
lergic reaction, but most reactions are child relief until you are able to reach the the age of 2. But if you think your baby is Z Have a poor appetite
caused by only a few foods: cow’s milk, emergency department. allergic to any of these substances, try to
keep your home environment as free How serious is it? If untreated, iron
from them as possible. You can purchase deficiency in children can cause delays in
dust mite-proof covers for mattresses normal growth and development. Some
and pillows. Washing sheets and blan- studies show a long-term association be-
kets in hot water every week or two tween iron deficiency anemia in infancy
helps, too. and later deficits in intellectual capacity.

Don’t try to treat your child on your solid foods. If you’re breast-feeding ex- similar to those caused by asthma. If your work by opening up the airways and
own. Always talk to your child’s care pro- clusively beyond age 4 months, talk to child has repeated episodes of wheezing, making breathing easier right away.
vider before giving your baby any type of your child’s care provider about giving your care provider is likely to consider Controller medications are used every-
vitamins or supplements. your baby an iron supplement. asthma as a possible underlying problem. day by children who have been diag-
Asthma is more common in children nosed with asthma and have regular
When to call If your baby seems un- Use iron-fortified formula If your baby who have a family history of asthma, al- symptoms.
usually pale, tired, irritable or uninter- drinks formula, make sure it has iron lergies or eczema. If your baby has symptoms of asthma,
ested in eating, or if you’re concerned added (4 to 12 milligrams of iron per li- your child’s care provider may use a wait-
about the amount of iron in your baby’s ter). Most standard formulas on the U.S. How to recognize it Wheezing — and-see approach before prescribing
diet, talk to your baby’s care provider. In market contain iron. a high-pitched whistling sound pro- medications, depending on the severity
most cases, a simple blood test is all that’s duced when your child breathes out of symptoms. If your baby has severe
needed to diagnose anemia. Offer a balanced diet As your son or (exhales) — is generally the first sign to wheezing episodes, a care provider may
If your baby has iron deficiency ane- daughter gets older, you can include raise a parent’s suspicion of asthma. Oth- prescribe a quick-relief medication to
mia, his or her care provider will likely rec- iron-rich foods in his or her diet, such as er signs and symptoms include a cough help ease your baby’s symptoms. This
ommend iron supplements, usually in a pureed meat, egg yolks, green beans, that gets worse at night, tightness in the medication comes in the form of an in-
liquid form for infants. Generally, you ad- peas, squash, spinach, sweet potatoes, chest and shortness of breath. With asth- haler. Medical staff can show you how to
minister the supplements for about seven tuna, ripe apricots and stewed prunes. ma, wheezing or coughing episodes tend use a spacer, a plastic tube — usually
to nine weeks until your baby’s iron sup- to recur. with a mask attached — that makes it
ply is at a healthy level. Iron medications Enhance iron absorption Offer your While wheezing is most commonly easier to deliver the medication to your
can change your baby’s stool to a dark baby foods rich in vitamin C, which helps associated with asthma, not all children baby. You may also use a nebulizer, a ma-
color, so don’t be concerned if this hap- the body to absorb iron. Examples of vi- with asthma wheeze. Some kids may chine that turns liquid medication into
pens. Once your child’s iron levels are tamin C-rich foods include strawberries, have only one sign or symptom, such as a fine droplets, to deliver the medication to
back to normal, you’ll want to make sure cantaloupe, kiwi, raspberries, broccoli, lingering cough or chest congestion. your infant’s lungs. Sometimes, an oral
he or she continues to get enough dietary tomatoes, potatoes and cauliflower. medication may be prescribed. Asthma
iron, through food or supplements. How serious is it? Asthma signs and medications are very safe. All medica-
It’s possible to overdose on iron sup- symptoms vary from child to child and tions carry risks if used inappropriately,
plements — too much iron is poisonous may get worse or better over time. Some but when asthma medications are used
— so be sure to give any supplements to ASTHMA kids outgrow recurrent wheezing when correctly, their benefits far outweigh the
your child exactly as the care provider rec- they reach 5 or 6 years old. For others, small risks.
ommends. Also, keep this and any other In some people, the lungs and airways wheezing episodes may stop and then Asthma medications can sometimes
medications away from small children. become easily inflamed — more easily recur again later in life. Still others have be difficult to remember to use because
than in other people — when exposed to chronic, persistent wheezing that re- when your child’s asthma is well con-
What you can do Iron deficiency ane- certain conditions called triggers. The in- quires daily management. trolled, he or she has no symptoms. As a
mia can be prevented by making sure flammation constricts the airways and parent, it may not seem necessary to give
your baby gets an adequate supply of leads to difficulty breathing. This is re- When to call Seek immediate medical your child a medication if he or she isn’t
iron in his or her diet. Here are some ferred to as asthma, or an older term, re- care if your baby has severe trouble ill. But it’s very important not to stop the
simple steps you can take: active airway disease. In young children, breathing, or his or her mouth or finger- medication. Left untreated or under-
the first sign of asthma may be wheezing tips are turning dusky or blue. treated, childhood asthma can lead to
Wait on cow’s milk Don’t give your that’s triggered by a cold, goes away and Make an appointment right away permanent lung changes that can result
baby cow’s milk until he or she is at least then recurs with the next cold. with your child’s care provider if you no- in poor lung function in adulthood.
1 year old. Until then, give your baby Asthma can be difficult to diagnose, tice a fever with persistent coughing or If your son’s or daughter’s wheezing
breast milk or formula. especially in younger kids because it’s wheezing, or if your child has difficulty persists over time, his or her care provid-
hard to get accurate results on lung func- sleeping or eating because of wheezing, er will likely recommend a full evaluation
Introduce iron at the right time If you’re tion tests. Also, a number of childhood coughing or troubled breathing. for asthma. If your child does have asth-
breast-feeding, give your baby iron-forti- conditions — bronchiolitis and pneumo- Asthma is treated with prescription ma, you and the care provider can create
fied cereal when you start to introduce nia as examples — can have symptoms medications. Quick-relief medications a comprehensive treatment plan that
best controls your child’s symptoms and cough. Over several days, the cough be- Also, call your child’s care provider Colds are most commonly spread
helps to prevent severe attacks. comes more pronounced and you may without delay if you suspect bronchiolitis when someone who is sick coughs,
hear your baby wheezing. Babies are and your baby was born prematurely or sneezes or talks, spraying virus-carrying
What you can do Keep track of your nose breathers, and when too much mu- has an underlying health problem. droplets into the air that others inhale.
child’s wheezing episodes, preferably in a cus is stuffing a baby’s nose or trickling If the severity of your child’s symp- Colds can also be spread through hand-
journal if you can, and don’t be afraid to down his or her throat, sucking and toms require a hospital stay, your child to-hand contact. Some viruses can live
call your care provider when symptoms swallowing become more difficult. Be- will likely receive humidified oxygen to on surfaces for a few hours, so contami-
warrant it. If you’re not sure when you cause of this, he or she may not be inter- maintain sufficient oxygen in the blood, nated toys may be another source of
should call, ask your child’s care provider ested in eating. and perhaps fluids through a vein (intra- infection.
to tell you. venously) to prevent dehydration. Once your baby has been infected by
If you notice that certain things tend to How serious is it? Even if your baby is a virus, he or she generally becomes im-
trigger your baby’s wheezing, such as dust otherwise healthy, symptoms of bronchiol- What you can do You can treat most mune to that specific virus. But because
or pollen, try your best to avoid them. Clean itis may range from mild to severe. Wheez- cases of mild bronchiolitis at home with there are so many viruses that cause
regularly to eliminate dust, and use air con- ing typically lasts for a week to a month or self-care steps. Treat the cold symptoms colds, your baby may experience several
ditioning during pollen season to keep out more and then goes away on its own. with a humidifier and perhaps saline colds a year and many throughout his or
airborne allergens. If your baby’s wheezing In some cases, especially if your child nasal drops if your baby is very congested her lifetime.
is worsened by cold air, bundle your baby has an underlying health problem or is a (see more tips on relieving cold symp-
in a blanket to keep the air around his or significantly premature newborn, bron- toms under “Cold”). Encourage plenty How to recognize it When your baby
her face warm and moist. Not all studies chiolitis can become very severe and re- of fluids; breathing difficulties often has a cold, he or she will likely develop
show that allergen-avoidance measures quire hospitalization. cause your baby to eat or drink less and a congested or runny nose. Nasal dis-
are effective in controlling asthma, though, During the illness, it’s important to more slowly. charge is typically clear at first, then turns
so don’t feel like you need to surround your encourage babies to drink frequently. Wash your hands frequently to pre- yellow, thicker and even green. After a
baby in a protective bubble at all times. Those who don’t get enough fluids be- vent the spread of viruses. When your few days, the discharge again becomes
come at risk of dehydration, which itself baby is a newborn, avoid this and other clear and runny.
can be serious. infections as you much as you can by Colds may produce a low fever —
avoiding close contact with children or around 100 F — in your baby for the first
BRONCHIOLITIS When to call If your baby’s symptoms adults who have any type of respiratory few days. Your baby may also sneeze and
are severe — such as marked difficulty infections — even if the symptoms seem have a cough, a hoarse voice or red eyes.
Bronchiolitis is a common lung infection breathing or skin that’s turning blue from mild. Some colds seem to settle mainly in a
in babies. It’s caused by a virus, often the lack of oxygen (especially around the baby’s nose, and others settle in the
respiratory syncytial virus (RSV). In mouth and fingertips)— call 911 or your chest. If your infant seems to have a lot of
adults, RSV infection typically causes local emergency number . sneezing or snorting and is frequently
only mild upper respiratory tract symp- Call your child’s care provider right COLD congested, he or she may not always
toms. In infants, however, the infection away (or seek urgent care if after office have a cold. Because babies’ nasal pas-
sometimes spreads to the smallest of the hours) if your baby: Babies are especially susceptible to the sages are quite small, it doesn’t take
lungs’ airways (bronchioles), leading to Z Is making a high-pitched, whistling common cold — a viral infection of the much mucus to cause congestion. Con-
inflamed, narrowed airways (bronchiol- sound (wheezing) each time he or nose and throat — in part because they’re gestion may also result from dry air or
itis). RSV infection is very contagious and she breathes out often around other children with colds. from irritants such as cigarette smoke.
is most common during the winter Z Is having difficulty sucking or swal- In fact, within the first year of life, most
months. Other less common viral causes lowing babies have seven to 12 colds. Colds gen- How serious is it? Colds are mostly
of bronchiolitis include influenza, para- Z Develops signs of dehydration (infre- erally last a week or two, but occasionally a nuisance and usually don’t require a
influenza, measles and adenovirus. quent urination, dry mouth, crying they persist longer. Sometimes visit to a care provider. If your baby has a
without tears, taking less fluid) it may seem as if your baby has a runny cold with no complications, it should re-
How to recognize it Bronchiolitis typ- Z Is under 3 months old and has a fever, nose all winter! This is especially true if solve within about 10 to 14 days.
ically starts out like the common cold or has a fever that lasts more than a child has older siblings or he or she at- Keep an eye on your baby’s symp-
with a runny nose, mild fever and a three days tends child care. toms, though, because sometimes colds
can progress into more serious problems, kill bacteria but don’t work against
especially in smaller or younger infants. viruses. Over-the-counter medications COUGH AND COLD MEDICATIONS
If your baby’s symptoms seem to be should generally be avoided in infants.
worsening, call your child’s care provider However, fever-reducing medications The Food and Drug Administration (FDA) strongly recommends against giving
promptly. may be used — provided you carefully over-the-counter (OTC) cough and cold medicines to children younger than age 2.
follow dosing directions — if fever is Over-the-counter cough and cold medicines don’t effectively treat the underlying
When to call If your baby is younger making your child uncomfortable (see cause of a child’s cold and won’t cure a child’s cold or make it go away any
than 2 to 3 months of age, call the care “Fever” on page 369). Ibuprofen (Advil, sooner. These medications also have potential side effects, including rapid heart
provider early in the illness. For new- Motrin, others) is OK, but only if your rate and convulsions.
borns, a common cold can quickly de- child is age 6 months or older. Cough In June 2008, the Consumer Healthcare Products Association voluntarily mod-
velop into croup, pneumonia or another and cold medications are not safe for in- ified consumer product labels on OTC cough and cold medicines to state “do not
more serious illness. Even without such fants and young children. use” in children under 4 years of age. Many companies have stopped manufactur-
complications, a stuffy nose can make it In the meantime, consider these sug- ing these products for young children.
difficult for your baby to nurse or drink gestions for easing your baby’s symp- FDA experts are studying the safety of cough and cold medicines for children
from a bottle. This can lead to dehydra- toms and making him or her more com- older than age 2. In the meantime, remember that cough and cold medicines
tion. As your baby gets older, his or her fortable: won’t make a cold go away any sooner — and side effects are still possible. If you
care provider can guide you on when give cough or cold medicines to an older child, carefully follow the label directions.
your baby needs to be seen by a doctor Offer plenty of fluids Liquids are impor- Don’t give your child two medicines with the same active ingredient, such as an
and when you can treat a cold at home. tant to avoid dehydration. Encourage antihistamine, decongestant or pain reliever. Too much of a single ingredient could
If your baby is under 3 months and your baby to take in his or her normal lead to an accidental overdose.
has a temperature of 100.4 F or higher, amount of fluids. Extra fluids aren’t nec-
contact your child’s care provider right essary. If you’re breast-feeding your baby,
away. If your baby is 3 months or older, keep it up.
call your care provider if he or she:
Z Has a temperature that lasts more Thin the mucus If your baby’s nasal dis-
than three days charge is thick, saline nose drops or salt-
Z Seems to have ear pain water nasal sprays may help loosen the
Z Has red eyes or develops yellow eye mucus. Saline nose drops and sprays are
discharge made with the optimal amount of salt
Z Has a cough for longer than three and water. They’re inexpensive and avail-
weeks able without a prescription. To help your
Z Has thick, green nasal discharge for son or daughter eat better, place a couple
more than two weeks of drops in each nostril 15 to 20 minutes
Z Experiences signs or symptoms that before a feeding. This can be followed by
worry you suction with a nose bulb, if desired.
Seek medical help immediately if
your baby: Suction your baby’s nose You can use a
Z Refuses to nurse or accept fluids rubber-bulb syringe to suction mucus
Z Coughs hard enough to cause persis- from your baby’s nasal passages, but
tent vomiting or changes in skin color sometimes it’s more trouble than it’s
Z Coughs up blood-tinged sputum worth. Suctioning usually works best in
Z Has difficulty breathing or is bluish infants under 6 months of age or babies
around the lips and mouth who don’t mind it. Squeeze the bulb sy-
ringe to expel the air. Then gently insert
What you can do Unfortunately, there’s the tip of the bulb into your baby’s nos-
no cure for the common cold. Antibiotics tril, pointing toward the back and side of
the nose. Slowly release the bulb, holding Use tissues Teach everyone in the house- Z Is younger than 2 months and devel- How to recognize it Constipation may
it in place while it suctions the mucus hold to cough or sneeze into a tissue — ops a cough be a problem if your baby:
from your baby’s nose. Remove the sy- and then toss it. If you can’t reach a tissue Z Is younger than 3 months and has a Z Is a newborn and hasn’t passed his or
ringe from your baby’s nostril, and empty in time, cough or sneeze into the crook of rectal temperature of 100.4 F or higher her first meconium stool one to two
the contents onto a tissue by squeezing your arm. Z Develops a cough with fever days after birth
the bulb rapidly while holding the tip Z Has a cough that lasts longer than Z Has painful bowel movements (baby
down. Repeat as often as needed for each one week grunts and grimaces or shows dis-
nostril. Clean the bulb syringe with soap Z Seems to be in pain comfort, fussiness) with stools that
and water. COUGH Call 911 or your local emergency are hard and dry
number if your baby: Z Has streaks of blood in or on his or
Moisten the air Running a cool-mist hu- Cough is common in infants and tod- Z Begins turning blue her stools
midifier in your baby’s room can help im- dlers. It’s also a common cause of anxiety Z Has problems swallowing or difficulty Z Appears to have abdominal pain that
prove a runny nose and nasal congestion. in parents. Your baby usually coughs be- making sounds seems to be relieved after a large
Aim the mist away from your baby’s crib cause something is irritating his or her air Z Stops breathing bowel movement
to keep the bedding from becoming passages. A baby’s cough most often is
damp. To prevent mold growth, change caused by a cold or other upper respira- What you can do You may be able to How serious is it? Most infant consti-
the water daily and follow the manufac- tory tract illness. But it can also result ease your baby’s cough by providing pation is mild, a result of a change in the
turer’s instructions for cleaning the unit. from the irritation caused by an aspirated extra fluids and adding moisture to the baby’s diet, and resolves within a short
It might also help to sit with your baby in chunk of food, a toy or other small object air with a humidifier. If your baby’s cough time. Constipation often causes more
a steamy bathroom for a few minutes be- that has“gone down the wrong pipe”and is interfering considerably with eating distress for the parents than the child. It
fore bedtime. We do not recommend the settled in an airway. A chronic cough and sleeping, check with your baby’s care can usually be managed by providing ex-
use of hot steam vaporizers because that’s triggered by exercise, cold air, sleep provider. Cough medicines aren’t recom- tra fluids and more high-fiber foods.
there have been reports of burns to in- or allergens may be a sign of asthma. mended for children under age 2 because
fants and children from their use. of potential side effects and because When to call Call your baby’s care pro-
To prevent colds in the first place, use How to recognize it Coughs may vary they’re generally not very effective in this vider if your baby seems chronically con-
common sense and plenty of soap and according to the part of the respiratory age group (see “Cough and cold medica- stipated or if your efforts at home aren’t
water. tract affected. An irritation near the vocal tions” on page 361). providing any relief. Don’t give laxatives,
cords may cause a barking, croupy cough, enemas or medication without consult-
Avoid sick people Keep your baby away and an irritation of your baby’s trachea ing your care provider first.
from anyone who’s sick, especially dur- may cause a raspy cough. Allergies or
ing the first few days of an illness. Re- asthma may cause a dry, unproductive CONSTIPATION What you can do Although many cas-
mind family and friends that the most cough that often occurs during the night. es of constipation can be traced to diet,
loving thing they can do when sick is to Pneumonia may cause your baby to have Parents sometimes worry that their child breast-fed babies are seldom constipated
stay away from a new baby. If possible, a deep chest cough that occurs both day is constipated because several days go by
avoid public transportation and public and night. Babies with pneumonia usu- without a bowel movement. But it’s not
gatherings with your newborn. ally have a fever and look sick. unusual for an infant who is exclusively
breast-fed to go for several days — even
Keep hands clean Wash your hands be- How serious is it? Your baby’s cough, up to a week — without a bowel move-
fore feeding or caring for your baby. Use by itself, is usually bothersome but not ment. Constipation refers to dry, hard
hand gels, wipes or soap and water. serious. The seriousness of the cough de- stools that are difficult to pass. As long as
pends on the condition that causes it. the stool is soft and easily passed, consti-
Don’t share Don’t share bottles, utensils Treating the underlying problem usually pation likely isn’t a problem.
or sippy cups. If your baby attends a child helps the cough. Constipation tends to be more com-
care facility, make sure his or her items mon in toddlers who are potty training
are clearly labeled. Clean your baby’s toys When to call Contact your child’s care than in infants.
and pacifiers often. provider promptly if your baby:

from changes in the mother’s diet. If a typically gets worse if left untreated. At CROUP struggling to breathe, dial 911 or your lo-
change of diet seemed to start the prob- first, a misaligned eye can lead to double cal emergency number.
lem, it will likely improve with time. Of- vision. But eventually the brain will learn The most common characteristic of Call immediately or seek medical care
fer plenty of fluids. Ask your child’s care to ignore the image from the turned eye, croup, a viral infection of the upper respi- if your baby:
provider about giving your baby small and the eye may become “lazy” (amblyo- ratory tract, is a harsh, repetitive cough Z Makes noisy, high-pitched breathing
amounts of prune juice. If your baby is pic). This may result in permanently re- that’s often likened to a seal barking. Be- sounds when inhaling (stridor)
eating solid foods, add high-fiber foods duced vision. cause the cough is so harsh, it can be Z Begins drooling or has difficulty
— such as prunes, apricots, plums, peas scary for children and their parents. But swallowing
and beans — to his or her diet. When to call If by 4 months of age your croup usually isn’t serious, and most cas- Z Seems agitated or extremely irritable
baby’s eyes appear crossed, even if only es can be treated at home. Z Becomes unusually sleepy or lethargic
sometimes, make an appointment with The barking cough of croup is the re- Z Has a fever of 103.5 F or higher
your baby’s care provider. He or she may sult of inflammation around the vocal Call as soon as you’re able if you’re
CROSSED EYES refer you to a pediatric eye doctor for an cords and windpipe. When the cough re- concerned that your baby:
evaluation. It’s important to get an accu- flex forces air through this narrowed pas- Z Can’t sleep, and your efforts won’t
Crossed eyes (strabismus) is one of the rate diagnosis as soon as possible. The sage, the vocal cords vibrate with a bark- settle him or her
most common eye problems in babies. It earlier treatment is started, the better the ing noise. Because young children have Z Is getting worse night after night, de-
occurs as a result of an imbalance in the outcome for your child. small airways to begin with, they tend to spite home treatment
muscles controlling the eye. Rarely, a baby’s eyes may suddenly have more marked symptoms. Z Isn’t taking fluids well for 24 hours
It’s normal for a newborn’s eyes to become misaligned after having been As with a cold, croup is contagious
wander or appear cross-eyed because his straight. If this happens, call your child’s until the fever is gone, or a few days into What you can do While your baby’s
or her brain cells haven’t yet learned how care provider right away, as it may signal the illness. The virus is passed by respira- sick, try to keep him or her as comfort-
to control eye movements. But by 4 a more serious problem. tory secretions or droplets in the air. able as possible:
months of age your baby’s nervous sys- To treat strabismus, your child’s eye
tem should be developed enough that doctor may recommend prescription How to recognize it The classic sign Stay calm Comfort or distract your child
his or her eyes work together to focus on eyeglasses, eyedrops or surgery on the of croup is a loud, harsh, barking cough — cuddle him or her, read a book, or play
the same point at the same time. If they eye muscle. Surgery is usually reserved — which often comes in bursts at night. a quiet game. Crying makes breathing
continue to cross or wander, then it’s for when other treatments aren’t work- Your child’s breathing may be labored or more difficult.
time to see your baby’s care provider. ing. It’s safe and effective, but a second noisy. Other cold-like symptoms — such
procedure is sometimes required to get as a runny nose, fever and a hoarse voice Moisten the air Use a cool-air humidifi-
How to recognize it You may notice the eyes exactly aligned. — are common, too. er in your child’s bedroom or have your
one of your baby’s eyes turns in, out, up child breathe the warm, moist air in a
or down. This misalignment of the eyes What you can do You can’t treat stra- How serious is it? Most cases of croup steamy bathroom. Although researchers
may be present all the time, or it may bismus at home, but you can monitor are mild, and your baby likely won’t need have questioned the benefits of humidity
come and go. your child’s eyes during the early months. to see a care provider unless symptoms are as part of emergency treatment for croup,
Some babies have what’s referred to Request an evaluation as soon you sus- severe. Croup generally lasts three to seven moist air seems to help children breathe
as false strabismus (pseudostrabismus). pect any problems with the alignment of days (plan on at least a couple of “bad” easier — especially when croup is mild.
Although their eyes are perfectly aligned, your son’s or daughter’s eyes. If your nights) and then resolves on its own.
they appear cross-eyed because of the child requires treatment, do your best to Rarely, the airway swells enough to Get cool Sometimes breathing fresh,
way their face is shaped. They might have make sure your child complies by wear- interfere with breathing, warranting a cool air helps (although if your child is
extra skin around the inner folds of the ing his or her glasses or by administering trip to an urgent care clinic or emergency wheezing, cold air may make the wheez-
eyes or a wide bridge of the nose. As your eyedrops exactly as your doctor recom- department. Pneumonia is a rare but po- ing worse). If it’s cool outdoors, wrap
child gets older, the appearance of being mends. If necessary, surgery is usually tentially serious complication. your child in a blanket and walk outside
cross-eyed should fade. performed between 6 and 18 months of for a few minutes.
age. An eye surgeon will help you learn When to call If your baby’s skin is turn-
How serious is it? A child can’t out- exactly what you need to know about the ing blue or grayish around the nose, Hold your child in an upright position
grow true strabismus, and the condition procedure. mouth or fingernails, or he or she is Sitting upright can help make breathing
easier. Hold your child on your lap, or blood in their stool, caused by skin irrita- these drinks don’t have the proper Z Ear pain, especially when lying down
place your child in a favorite chair or in- tion from frequent passing of stool or by amounts of sodium and other electro- Z Difficulty sleeping
fant seat. irritation of the intestinal lining. lytes to replace those lost in stool. Z Unusual crying or fussiness
If your baby has mild diarrhea and is Z Difficulty hearing or responding to
Offer fluids For babies, breast milk or How serious is it? Dehydration is the hungry, there’s no need to restrict his or sounds
formula is fine. For older children, soup main complication that can result from her diet. Continue breast-feeding nor- Z Drainage of fluid from the ear
or frozen ice pops may be soothing. your baby’s diarrhea, especially if your mally and give a rehydration solution Z Loss of appetite
baby has also been vomiting. Your baby only if your child’s care provider recom- Z Tugging or pulling at an ear
Encourage rest Sleep can help your child has a much smaller reserve of fluids than mends it.
fight the infection. you do because his or her body’s volume When the diarrhea improves, if your How serious is it? Symptoms of ear
is much less. Milk or lactose intolerance baby is eating solid foods, offer bland infections usually improve within the
can cause explosive diarrhea that persists foods such as rice cereal, oatmeal, banan- first couple of days, and most infections
for more than two weeks. as, potatoes, applesauce and carrots. Of- clear up on their own within one to two
DIARRHEA fer frequent, small feedings rather than weeks without any treatment.
When to call Contact your child’s care large feedings. Aim to get your baby back Long-term problems related to
Diarrhea is a common concern for new provider immediately if your child: to his or her normal diet within a few chronic ear infections — persistent fluids
parents. Since bowel movement patterns Z Passes more than eight diarrheal days to ensure adequate nutrition. in the middle ear, persistent infections or
can vary widely among young infants — stools in eight hours or has blood in If diarrhea is persistent, your child’s care frequent infections — can cause hearing
from a single bowel movement once a the stool provider may recommend a lactose-free problems and other serious complica-
week or so to over 10 a day, especially in Z Seems to have abdominal pain, a fe- diet to see if it helps improve symptoms. tions. So it’s important to bring ear infec-
breast-fed babies — it can be tricky to tell ver of more than 102 F (a fever of tions, especially recurring ones, to the
when diarrhea is a problem. A “blowout” more than 100.4 F for a child less than attention of your child’s care provider.
every so often is nothing to worry about, 3 months old) or other obvious signs
but if you notice stools that are more fre- of illness EAR INFECTION
quent than usual and have a watery con- Z Can’t keep any fluids down
sistency, your baby may have diarrhea. Z Shows signs of dehydration — re- An ear infection (acute otitis media) is a
Diarrhea is most often caused by an duced urination, no tears when cry- common reason children visit their care
infection of your baby’s stomach and in- ing, dry mouth, or sunken eyes or providers. An ear infection is caused by a
testines (gastroenteritis), usually by a vi- fontanels (the soft spots in the head) bacteria or virus that affects the middle ear,
rus. Sometimes bacteria or parasites may Z Seems unusually sleepy or noticeably the air-filled space behind the eardrum
cause diarrhea. Although your baby will less active than usual that contains the tiny vibrating bones of the
seldom have diarrhea from a specific food If your baby has mild diarrhea for ear. Children are more likely than are adults
allergy, it can be caused by certain dietary more than a week and you’re concerned, to get ear infections.
factors, such as increased juice intake, lac- you might also contact your child’s care Ear infections often occur after a cold
tose intolerance or the addition of new provider. or other respiratory infection. These ill-
foods. Antibiotics also may cause diarrhea. nesses set the stage for inflammation and
What you can do To avoid dehydra- buildup of fluids in the middle ear.
How to recognize it If you’re changing tion, offer your baby liquid that’s easily Ear infections often clear up on their
more dirty diapers than usual and the absorbed. For moderate to severe diar- own. For infants, or in severe cases, how-
contents are consistently thin and wa- rhea, your baby’s care provider may sug- ever, your child’s care provider may rec-
tery, your baby likely has diarrhea. Diar- gest an oral rehydration solution (Pedia- ommend antibiotic medications.
rhea caused by an infection may also be lyte, others) to replace fluid lost in the
accompanied by vomiting and fever. Bac- baby’s stool. For severe diarrhea, don’t How to recognize it Infants with an
terial infections may cause blood in the give your baby liquids high in sugar, such ear infection usually develop the infec-
stool and abdominal pain, as well. Occa- as fruit juice, or salty broths or liquids tion after an upper respiratory tract infec-
sionally, babies have small streaks of very low in salt, such as water or tea; tion. Signs and symptoms may include:

When to call Contact your baby’s care EARWAX BLOCKAGE called a curet or by using suction while in- 350). Although laying your hand or your
provider if: specting the ear. He or she may also flush cheek on your baby’s forehead may give
Z Symptoms last for more than a day Earwax blockage occurs when earwax out the wax using a water pick or a rub- you a suspicion of fever, it won’t tell you
Z Ear pain is severe (cerumen) accumulates in the ear or be- ber-bulb syringe filled with warm water. the difference between 99 F and 101 F.
Z Your infant or toddler is sleepless or comes too hard to wash away naturally. A rectal temperature of 100.4 F is gen-
irritable after a cold or other upper re- Earwax is a helpful and natural part of What you can do Avoid cleaning your erally considered the upper range of nor-
spiratory infection the body’s defenses. It protects the ear baby’s ears with cotton swabs, your fin- mal. Anything higher constitutes a fever.
Z You observe a discharge of fluid, pus canal by trapping dirt and slowing the ger or anything else. If your child doesn’t
or bloody discharge from the ear growth of bacteria. Normally, it will dry have any tubes or holes in his or her ear- How serious is it? A fever itself isn’t
In babies, most ear infections are up and tumble out of the ear on its own. drum, his or her care provider may rec- harmful. Any potential harm would come
treated with antibiotics. Among older But occasionally, wax buildup occurs, ommend eardrops to soften the wax. Ask from the infection that’s causing the fe-
children, a doctor may wait to see if the perhaps because of a narrower than usu- the provider to show you how to gently ver. Usually, when a baby has a fever, he
condition improves on its own before al ear canal, an excess production of ear- irrigate the outer ear with warm water or she is fighting an infection; fever is a
prescribing antibiotics. Your child’s care wax or even well-meaning attempts to and a rubber-bulb syringe to wash out sign of the immune system at work.
provider may also recommend numbing clean out the ear, which can push the wax the softened wax. In young infants, however, an infec-
drops or an infant pain reliever to ease further into the ear and cause a blockage. tion signaled by a fever can quickly be-
your baby’s ear pain. come serious. Their immune systems are
Ear tubes — tiny tubes that are surgically How to recognize it Although it may not yet up to the task of fighting off bac-
placed in a hole through the eardrum to help not be easy to identify in your child, signs FEVER teria and other germs, making them par-
ventilate the middle ear and prevent the and symptoms of earwax blockage are ticularly vulnerable to infection that can
accumulation of more fluids — are usually re- likely to resemble some of those related Normal temperatures vary for different easily spread throughout the body.
served for children who have recurrent ear to an ear infection. Your baby may pull or people. Your newborn’s temperature will
infections and persistent fluid behind the tug at his or her ear, cough, or be unusu- change up and down by about 1 degree When to call Call your baby’s care pro-
eardrum, along with hearing problems. ally fussy or irritable. You may also notice throughout the day. It’s usually lowest in vider right away if your baby is under
that your baby doesn’t hear quite as well the morning and highest late in the after- 3 months of age and has a rectal tem-
What you can do Placing a warm (not or doesn’t respond to sounds. noon. In general, infants and young chil- perature of 100.4 F or higher. This is im-
hot), moist washcloth over the affected dren have a higher normal body temper- portant because your baby’s immune
ear may lessen pain. If your child’s care How serious is it? A buildup of earwax ature than do older children and adults. system is still developing and may not be
provider recommends a pain reliever or is unlikely to cause serious problems, unless When faced with an infection or other able to fight off an infection as well as
numbing drops, use them exactly as the you try to dig it out yourself. Trying to re- illness, however, your baby’s central ner- an older baby. So call, even if you’re feel-
care provider instructs. To administer the move earwax with a cotton swab or other vous system cranks up his or her internal ing reluctant to bother your baby’s care
drops, warm the bottle first in warm wa- instrument may push the wax further into “thermostat” to help fight the infection. provider.
ter, then put the recommended dose in your baby’s ear and cause serious damage This results in a fever. In newborns and Call if your baby is between 3 and 12
your baby’s ear while he or she lies flat to the lining of the ear canal or eardrum. infants less than 3 months of age, a fever months old and doesn’t respond to acet-
with the infected ear facing up. warrants an immediate call to your ba- aminophen or shows other signs of ill-
To reduce your baby’s risk of ear in- When to call Make an appointment to by’s care provider. In older infants and ness, such as:
fections, practice good infection preven- have your baby’s ears checked out if he or children, the need for medical evaluation Z An unexplained rash
tion skills by washing hands frequently, she is tugging at his or her ears, you notice of a fever depends more on how your Z Repeated vomiting or diarrhea
not sharing eating and drinking utensils, hearing problems, or you see a lot of waxy child is behaving and whether there are Z Unusual fussiness or irritability
and avoiding contact with others who are discharge coming out of your child’s ears. other accompanying signs or symptoms Z Coughing
sick. Secondhand smoke also can con- Your child’s care provider can determine of illness. Z Refusal to eat or drink
tribute to frequent ear infections. In addi- if there’s an excess of earwax by looking Z Dehydration — reduced urination,
tion, hold your baby upright when feed- in your child’s ear with an otoscope, a How to recognize it If your baby feels dry mouth, crying without tears,
ing him or her a bottle, to avoid blocking special instrument that lights and magnifies unusually warm to you, take his or her sunken eyes and fontanels (the soft
the passage between the middle ear and the eardrum. A care provider can often temperature with a thermometer (see spots in the head)
throat (eustachian tube). remove excess wax using a small instrument “Taking baby’s temperature” on page Z Lethargy and unresponsiveness
If your baby seems feverish after Most of the time, mild fevers don’t
spending time in an overheated area, need treatment and resolve along with FEBRILE SEIZURES
such as on a hot beach or in a hot car, the associated cold or other infection that
seek medical help immediately. Over- brought it on. In the meantime, you can: Some babies experience convulsions as a result of a rapid rise or fall in body tem-
heating (heatstroke) is an emergency and perature, often from an infection. Watching your baby have a febrile seizure can be
needs to be treated quickly. Provide plenty of fluids Continue breast- alarming, but the good news is that it’s usually harmless and typically doesn’t indi-
feeding or formula-feeding as usual. Fro- cate a long-term or ongoing problem. Studies suggest there also isn’t much that
What you can do If your baby has a zen ice pops work well in older infants. If can be done to prevent a febrile seizure.
fever, monitor his or her behavior closely. your baby is eating solid foods, let him or You can tell your baby is having a febrile seizure if he or she has repeated rhyth-
Look for other signs or symptoms of ill- her decide whether and how much to eat. mic jerking of both arms and legs and is not responsive to you or aware of his or
ness, such as loss of appetite, vomiting, If you’re concerned that your baby is gether surroundings. (Occasional odd twitchy or jerky movements are common, es-
irritability or unusual sleepiness. Call ting dehydrated, offer a commercially pre- pecially in sleepy infants — these are not seizures.)
your baby’s care provider if you have any pared oral rehydrating solution (Pedialyte, Most of the time, a febrile seizure occurs the first day of an illness, sometimes
concerns. others). even before parents realize that their child is ill.
If your child has a febrile seizure, stay calm and follow these tips to help your
child during the seizure:
FEVER AND PAIN RELIEVERS: RECOMMENDED DOSAGES Z Place your child on his or her side, somewhere where he or she won’t fall.
Z Stay close to watch and comfort your child.
Acetaminophen dosages (every 4 hours)* Z Remove any hard or sharp objects near your child.
Child’s weight: 6 to 11 lbs. Child’s weight: 12 to 17 lbs. Z Loosen any tight or restrictive clothing.
Dose: 40 mg Dose: 80 mg Z Don’t restrain your child or interfere with your child’s movements.
Infant drops: ½ dropper (0.4 mL) Infant drops: 1 dropper (0.8 mL) Z Don’t attempt to put anything in your child’s mouth.
Infant liquid: 1.25 mL in syringe Infant liquid: 2.5 mL in syringe Have a first-time febrile seizure evaluated by your child’s care provider as soon
Children’s liquid: ½ tsp. (2.5 mL in cup) as possible, even if it lasts only a few seconds. If the seizure ends quickly, call the
care provider as soon as it’s over and ask when and where your child can be ex-
Child’s weight: 18 to 23 lbs. Child’s weight: 24 to 35 lbs.
amined. If the seizure lasts longer than five minutes or is accompanied by vomiting,
Dose: 120 mg Dose: 160 mg
a stiff neck, problems with breathing or extreme sleepiness, call for an ambulance
Infant drops: 1½ droppers (1.2 mL) Infant drops: 2 droppers (1.6 mL)
to take your child to the emergency department.
Infant liquid: 3.75 mL in syringe Infant liquid: 5 mL in syringe
By staying calm, observing your child and knowing when to call for medical
Children’s liquid: ¾ tsp. (3.75 mL in cup) Children’s liquid: 1 tsp. (5 mL in cup)
help, you’re doing everything that’s needed to take care of your child.
Ibuprofen dosages (every 6-8 hours)

Child’s weight: 12 to 17 lbs.† Child’s weight: 18 to 23 lbs.
Dose: 50 mg Dose: 75 mg Encourage adequate rest Provide extra Use medication for discomfort If your
Infant drops: 1 dropper (1.25 mL) Infant drops: 1½ dropper (1.875 mL) opportunities for rest and quiet play until baby seems uncomfortable and weighs 6
Child’s weight: 24 to 35 lbs. the fever is improved or over. pounds or more, you can give him or her
Children’s liquid: 1 tsp. (100 mg per tsp. dose/5 mL in cup) acetaminophen (Tylenol, others). If your
Chewable tablets: 2 tablets (50 mg per tablet/100 mg total) Keep cool If your baby seems hot, keep child is 6 months or older, ibuprofen
Junior strength caplet or chewable tablet: 1 tablet (100 mg per tablet) his or her room comfortably cool and (Advil, Motrin, others) is OK. Read the
dress him or her lightly. label carefully for proper dosage (or see
*The U.S. Food and Drug Administration was expected to publish updated guidelines in the opposite page). Don’t use aspirin to
2012 on acetaminophen use in children, which could change these recommended Try a sponge bath Your son or daughter treat a fever in anyone age 18 years or
dosages. Check with your child’s care provider for the latest information. may enjoy a sponge bath with lukewarm younger, as it can cause a rare but serious
(not cold) water. Don’t put rubbing alco- disorder called Reye’s syndrome. Keep in
†For hol in the bath or rub your baby with it mind that it’s generally not a good idea to
a child younger than 6 months, ask his or her care provider before giving ibuprofen.
— doing so is not safe. give fever-reducing medication for more
than three days without consulting your ticularly in the first trimester. If a woman and Prevention now recommend annual vaccine, you’re less likely to get the flu
child’s care provider. develops a parvovirus infection during flu vaccination for all Americans over the and pass it to each other. If your baby is
pregnancy, her baby may be affected. age of 6 months. It’s typically available as under 6 months of age, it’s especially im-
an injection or as a nasal spray. However, at portant to take common-sense precau-
When to call Rashes aren’t always easy this time, the nasal spray is only available tions against infections:
FIFTH DISEASE to diagnose at home, so if you suspect for children who are at least 2 years old. Z Wash your hands frequently.
fifth disease in your child, it’s best to call Z Keep heavily-used surfaces clean.
Fifth disease is a highly contagious and your baby’s care provider to make sure How to recognize it Having the flu Z Cough or sneeze into a tissue or the
common childhood ailment caused by it’s not a sign of a different illness that may usually causes: crook of your elbow (discard used tis-
the parvovirus — you may also hear it require treatment. Also, call the care pro- Z A sudden onset of fever, typically sues promptly).
referred to as parvovirus infection or vider if your baby has a fifth disease-like more than 101 F, although not every- Z Don’t share eating or drinking uten-
slapped-cheek disease because of the rash and another condition such as sickle one gets a fever sils or toothbrushes.
rosy rash that appears on the cheeks. In cell anemia or a weak immune system. Z Chills Z Avoid cross-contamination between
most children, the infection is mild and Z Achy muscles sick family members by not kissing
requires little treatment. What you can do Make sure you or Z Extreme tiredness each other on the hands or mouth.
your child gets plenty of rest and drinks Z Dry cough Z Avoid people who have the flu.
How to recognize it You may suspect lots of fluids. You can use acetaminophen Z Avoid crowds at peak flu season,
that your baby has fifth disease if he or (Tylenol, others) to relieve fever or minor How serious is it? Influenza can be a where the chances of coming into con-
she develops bright red, warm, raised aches and pains (see“Fever”on page 369). serious illness for your otherwise healthy tact with influenza viruses are greater.
patches on both cheeks. During the next It’s not always practical or necessary baby, although most babies recover with- If your child does develop influenza,
few days, a baby with fifth disease will to isolate a child with fifth disease. You out major problems. The main complica- encourage plenty of rest, fluids and hugs.
develop a pink, lacy, slightly raised rash won’t know your son or daughter has tions of influenza are ear infections and If your baby seems fussy and uncomfort-
on the arms, trunk, thighs and buttocks. parvovirus infection until the rash ap- pneumonia; both require treatment from able, acetaminophen can help ease aches
Generally, the rash occurs near the pears, and by that time, he or she is no your baby’s care provider. Children with and pains, as well as reduce fever (see the
end of the illness when the child is no longer contagious. underlying health problems are at great- medication chart on page 370). Don’t
longer contagious. Some children devel- er risk of complications. give aspirin, which can cause serious side
op mild cold-like symptoms before the Influenza infections are contagious a effects in young people who have a viral
rash, such as sore throat, mild fever, day or so before your child becomes sick infection.
headache and fatigue. Itchiness also may FLU (INFLUENZA) and while he or she is sick. Sometimes adding extra moisture to
be an early symptom. the air makes it easier for your baby to
It’s possible to mistake the rash for Influenza, routinely known as the flu, is a When to call Children under age 2 are breathe. Keep your baby home from his
other viral rashes or a medicine-related common fall and wintertime viral illness at higher risk for complications from the or her child care center at least 24 hours
rash. The rash may come and go for up to that affects the upper respiratory system. flu. Call your baby’s care provider for ad- after the fever has passed.
three weeks, becoming more visible It’s often confused with the common vice if you notice flu-like symptoms. Call
when your baby is exposed to extreme cold, although the flu usually leaves your right away if you suspect your baby is de-
temperatures or spends time in the sun. child feeling more achy and miserable veloping complications or if coughing or
than does a cold. fever persists. If your baby has flu-like HAND-FOOT-AND-
How serious is it? Generally, infants Several types of viruses can cause influ- symptoms and trouble breathing, seek MOUTH DISEASE
feel fairly well when they have fifth dis- enza (A and B are the most common), with medical care immediately. If you know
ease. For most, it’s a mild illness unless each type having several strains. Influenza your infant has been exposed to influen- Hand-foot-and-mouth disease — a mild,
your baby has sickle cell anemia or a viruses are constantly changing, with new za, contact your child’s care provider. contagious viral infection common in
weak immune system, in which case it strains appearing regularly. This is why it’s young children — is characterized by
may cause more serious problems. important to receive an annual flu vaccine What you can do The best way to pre- sores in the mouth and a rash on the
Parvovirus can be a concern for preg- — each year’s vaccine is developed to prevent the flu is to receive the flu vaccine, hands and feet. Hand-foot-and-mouth
nant women, though, so keep a sick baby vent the three most likely strains to appear available to everyone 6 months of age or disease is most commonly caused by a
away from anyone who’s pregnant, par- that year. The Centers for Disease Control older. If your whole family receives the coxsackievirus.
Hand-foot-and-mouth disease isn’t comfort from fever or aches and pains (see When to call If your baby develops IMPETIGO
related to foot-and-mouth disease (some- “Infants and medications”on page 348). hives, ask his or her care provider about
times called hoof-and-mouth disease), If your baby is eating solid foods, keep the proper treatment. Call your baby’s Impetigo usually appears as red sores on
which is an infectious viral disease found in mind that certain foods may irritate care provider right away if your infant: the face, especially around a child’s nose
in farm animals. You can’t contract hand- blisters on the tongue or in the mouth or Z Has difficulty breathing or swallow- and mouth (see the photo on page 101).
foot-and-mouth disease from pets or throat. You can help make blister sore- ing or develops a swollen tongue It’s a highly contagious skin infection
other animals, and you can’t transmit it ness less bothersome and eating more Z Develops hives while taking medica- that’s more common in infants and chil-
to them. tolerable by: tion (discontinue the medication until dren than in adults. Although it common-
Once your child is exposed to the vi- Z Offering frequent feedings of breast you’ve talked with your child’s care ly occurs when bacteria enter the skin
rus that caused the hand-foot-and-mouth milk or formula. Drinking is more im- provider) through cuts or insect bites, it can also de-
disease, he or she will build up immunity portant than eating solids. Z Seems to have soreness in his or her velop in skin that’s perfectly healthy.
to it in the future. Z Offering a small amount of sherbet to joints Keeping the skin clean is the best way
soothe the throat. Z Has hives for more than a few days to prevent infection. Treat cuts, scrapes, in-
How to recognize it A fever is often Z Avoiding acidic foods and beverages, sect bites and other wounds right away by
the first sign of hand-foot-and-mouth such as citrus fruits and fruit drinks What you can do Babies with hives of- washing the affected areas and applying
disease, followed by a sore throat, irrita- Z Offering soft foods that don’t require ten look much worse than they feel. To antibiotic ointment to prevent infection.
bility and sometimes a poor appetite. much chewing keep your baby as comfortable as possi-
One or two days after the fever begins, ble, administer an antihistamine as indi- How to recognize it Your child might
painful sores may develop in the mouth cated by your baby’s care provider. Keep have impetigo if you notice:
or throat. A rash on the hands and feet your baby dressed in light clothing and Z Red sores that quickly rupture, ooze
and possibly on the buttocks can follow HIVES avoid bathing him or her in hot water. for a few days and then form a yel-
within one or two days. Lukewarm water is less likely to exacer- lowish-brown crust
Hives is the name for an allergic reaction bate itching. Trim your baby’s fingernails Z Itching
How serious is it? Hand-foot-and- that produces patches of red, raised, itchy to avoid scratching. Z Painless, fluid-filled blisters, usually
mouth disease is usually a minor illness skin. Often there’s no clear explanation If you notice a pattern to the appear- on the trunk, arms and legs (These are
causing only a few days of fever and rela- for what triggers hives, but viral infec- ance of hives on your baby, try to deter- more common in children under 2.)
tively mild signs and symptoms. tions are a common cause. Hives can also mine what may be triggering it. Avoiding Z Painful fluid- or pus-filled sores that
The sores in the mouth and throat occur as an allergic reaction to a food, the trigger will help prevent a recurrence turn into deep ulcers (This is the more
can make swallowing painful and diffi- drug or insect bite. of hives. serious form.)
cult for your baby, however, increasing
his or her risk of dehydration. Watch close- How to recognize it Hives is charac-
ly to make sure your child frequently sips terized by splotchy, red, raised areas of
fluid during the course of the illness. skin, often with pale centers. The rash
Infected people are most contagious itches and can become uncomfortable.
during the first week of illness. Hives can appear all over your baby’s
body or be concentrated in one area. The
When to call Contact your baby’s care rash is irregularly shaped and may change
provider if mouth sores or a sore throat locations. Some areas may enlarge and
keep your child from drinking fluids. Call merge into each other. Hives may come
also if after a few days, your child’s signs and go for a few days or a few weeks.
and symptoms worsen.
How serious is it? Hives usually isn’t
What you can do As with most viral ill- serious unless your child also develops
nesses, there’s not much you can do but difficulty breathing or swallowing, a sign
encourage plenty of fluids and plenty of of swelling around the throat area and
rest. Acetaminophen can help relieve dis- windpipe. This photo shows an infant with hives, characterized by patches of red, raised skin.
How serious is it? Impetigo is seldom Z Cut an infected child’s nails short to How serious is it? Most children will Z Avoid areas where insects are com-
serious and usually clears on its own in prevent scratching and spreading the have only a mild reaction to bites and monly found, such as garbage cans,
two to three weeks. But because impeti- infection. Applying a nonstick dress- stings. But a few children are more sensi- stagnant water (breeding ground for
go can sometimes lead to more severe ing to the infected area can help, too. tive than are others to insect venom, es- mosquitoes) and blooming flowers.
infection, your child’s doctor may choose Z Avoid touching the sores as much as pecially from stinging insects, and can Z Don’t use strong perfumes or scented
to treat impetigo with an antibiotic oint- possible until they heal. have a severe allergic reaction (anaphy- soaps and lotions on yourself or your
ment or oral antibiotics. Z Wash your baby’s clothes, blankets, laxis) that requires emergency treatment. baby.
washcloths and towels every day, and Z Cover all picnic food, and seal picnic
When to call If you suspect that you don’t share them with anyone else in When to call Call your baby’s care pro- garbage in plastic bags.
or your child has impetigo, ask your your family. vider immediately if your child: Z Keep garbage cans securely covered.
child’s care provider for advice on treat- Z Wear gloves when applying any anti- Z Has difficulty breathing Z Don’t allow pools of stagnant water
ment. Sometimes he or she may choose biotic ointment and wash your hands Z Vomits in your backyard.
to treat minor cases of impetigo with thoroughly afterward. Z Shows signs of shock (rapid breath- DEET is the most widely used chemi-
only hygienic measures. Keeping the Your son or daughter can usually re- ing, dizziness, clammy skin) cal found in insect repellents. Products
skin clean can help mild infections heal turn to child care after his or her care pro- Z Has received multiple stings that contain DEET are not recommended
on their own. vider says he or she is no longer conta- Z Develops extreme facial swelling, or for babies under 2 months old. In older
In other cases, your child’s care pro- gious — often within 48 to 72 hours of hives all over the body or in an area infants, the maximum concentration of
vider may recommend an antibiotic oint- starting antibiotic therapy. separate from the sting itself DEET in the product should not exceed
ment to apply to the affected areas. Z Has increased swelling and redness 30 percent.
If your child is uncomfortable, or the around the sting or bite after the first The American Academy of Pediatrics
sores are oozing or widespread, make an six to eight hours (AAP) recommends applying DEET only
appointment to have the sores examined. INSECT BITES AND STINGS once a day and washing it off at the end
Severe or widespread cases may be treat- What you can do If a stinger is notice- of the day to avoid toxicity. The higher
ed with oral antibiotics taken by mouth. Bites from bees, wasps, hornets, yellow able, remove it from your baby’s skin as the concentration of DEET in a product,
Be sure you child finishes the entire jackets and fire ants are typically the soon as possible. Use a fingernail, credit the longer the protective time it supplies.
course of medication, even if the sores most troublesome. Bites from mosqui- card or other thin dull edge to scrape the The AAP recommends using the lowest
are healed. This helps prevent the infec- toes, ticks, biting flies and some spiders stinger away. Avoid pinching or squeez- effective concentration for the amount of
tion from recurring and makes antibiotic also can cause reactions, but these are ing the stinger, as this may release more
resistance less likely. generally milder. venom into the skin.
Once the stinger is gone, apply a cool
What you can do For minor infections How to recognize it Bites and stings washcloth or ice pack to relieve pain and
that haven’t spread to other areas, try the may come from: swelling. Cool compresses can also help
following: Z Bees, yellow jackets and hornets. In relieve itching associated with mosqui-
Z Soak the affected areas of skin with a most children, stings cause initial toes, flies, ants and other insect bites.
vinegar solution — 1 tablespoon (½ pain and become red and swollen Ask your baby’s care provider about
ounce) of white vinegar to 1 pint (16 within the first several hours. But in a applying ointments or creams to relieve
ounces) of water — for 20 minutes. few kids, stings can cause severe itching, such as calamine lotion, hydro-
This makes it easier to gently remove symptoms, including vomiting, diar- cortisone cream or baking soda paste. If
the scabs. rhea, dizziness and sometimes trou- itching is severe, your child’s care pro-
Z After washing the area, apply an over- ble breathing. vider may recommend giving your baby
the-counter antibiotic ointment three Z Mosquitoes. Usually the site simply an oral antihistamine.
times daily. Wash the skin before each itches and swells. To decrease the likelihood of experi-
application, and pat it dry. Z Deerflies, horseflies, fire ants, harvest- encing insect bites:
To help keep the infection from spread- er ants, beetles and centipedes. These Z Cover your baby’s skin with light-
ing to others: may cause painful red bumps that weight clothing when you take him
Z Wash your hands frequently. may blister. or her outdoors.

time your child spends outside. Products isn’t mature enough to filter out bilirubin, Your baby should be checked for jaun- LAZY EYE
with 4.75 percent DEET afford about an a yellow-colored pigment of red blood dice when he or she is between 3 and 7
hour and a half of protection. A 20 per- cells, from the bloodstream. days old, when bilirubin levels usually Lazy eye (amblyopia) develops when
cent DEET product provides about four peak. If your baby is discharged earlier nerve pathways between the brain and
hours of protection. How to recognize it The main signs of than 72 hours following birth, schedule a the eye aren’t properly stimulated. This
To apply repellent to your baby, put it newborn jaundice are yellowing of the follow-up appointment with your baby’s can lead to a condition in which the brain
on your hands first and then rub it on skin and eyes. These usually appear be- care provider to check for jaundice within favors one eye, usually due to poor vision
your baby’s skin. Avoid your baby’s tween the second and fourth day after two days of discharge. in the other eye. The weaker eye tends not
hands, which he or she is likely to put in birth. You’ll usually notice jaundice first The following signs or symptoms may to track with the stronger eye, commonly
his or her mouth. in your baby’s face. If the condition pro- indicate severe jaundice or complications referred to as “wandering.” Eventually,
There are alternatives to DEET prod- gresses, you may notice the yellow color from jaundice. Call your doctor if: the brain may ignore the signals received
ucts. Picaridin in 5 to 10 percent concen- in his or her eyes and on the chest, abdo- Z Your baby’s skin looks yellow on the from the weaker — or lazy — eye.
trations is safe for young children. Oil of men, arms and legs. chest, abdomen, arms or legs. Treatments such as corrective eye-
lemon eucalyptus is a plant-based repel- The best way to check for newborn Z The whites of your baby’s eyes look wear or eye patches can often correct lazy
lent, but it’s not recommended for chil- jaundice is to press your finger gently on yellow. eye. Sometimes, lazy eye requires surgi-
dren under 3 years of age. your baby’s forehead or nose. If the skin Z Your baby seems listless, sick or diffi- cal treatment.
looks yellow where you pressed, it’s like- cult to wake.
ly your baby has jaundice. If your baby Z Your baby isn’t gaining weight or is How to recognize it Lazy eye usually
doesn’t have jaundice, the skin color feeding poorly. affects just one eye, but it may affect both
JAUNDICE should simply look slightly lighter than Z Your baby makes high-pitched cries. eyes. With lazy eye, there’s no apparent
its normal color for a moment. Z Your baby develops any other signs or damage or abnormality to the eye. Signs
Jaundice is a yellow discoloration of a It’s best to examine your baby in good symptoms that concern you. and symptoms to look for include:
newborn baby’s skin and eyes. Newborn lighting conditions, preferably in natural Z Diagnosed jaundice lasts more than Z An eye that wanders inward or outward
jaundice is a common condition, particu- daylight. three weeks. Z Eyes that may not appear to work
larly in babies born before 38 weeks ges- together
tation (preterm babies) and breast-fed How serious is it? Mild newborn What you can do Feeding more fre- Z Poor depth perception
babies. It develops when a baby’s liver jaundice often disappears on its own quently will provide your baby with more
within two or three weeks. If your baby milk and cause more bowel movements, How serious is it? Left untreated, lazy
has moderate or severe jaundice, he or increasing the amount of bilirubin elimi- eye can cause permanent vision loss. In
she may need to stay longer in the new- nated in your baby’s stool. Breast-fed in- fact, lazy eye is the most common cause
born nursery or be readmitted to the fants should have eight to 12 feedings a of single-eye vision impairment in young
hospital for phototherapy. This is a spe- day for the first several days of life. For- and middle-aged adults, according to the
cial blue light that helps the body clear mula-fed infants usually should have 1 to National Eye Institute.
the bilirubin. 2 ounces of formula every two to three Depending on the cause and the de-
Although complications are rare, se- hours for the first week. gree to which your child’s vision is af-
vere infant jaundice can lead to cerebral If your baby is having trouble breast- fected, treatment options may include:
palsy, deafness and brain damage. feeding, is losing weight or is dehydrated,
your baby’s care provider may suggest Corrective eyewear If a condition such
When to call Most hospitals have a giving your baby infant formula or ex- as nearsightedness, farsightedness or
policy of checking babies regularly for pressed milk in addition to his or her astigmatism is contributing to lazy eye,
jaundice while they are hospitalized and breast-feedings. In some cases, a care an eye doctor will likely prescribe correc-
before they’re discharged. The American provider may recommend only infant tive glasses or contact lenses. Sometimes
Academy of Pediatrics recommends that formula for a couple of days and then re- corrective eyewear is all that’s needed.
your newborn be examined for jaundice suming breast-feeding.
whenever a routine medical check is Ask your baby’s care provider what Eye patches To stimulate vision in the
done. feeding options are right for your baby. weaker eye, a doctor may recommend

that your child wear an eye patch over PINK EYE (CONJUNCTIVITIS) What you can do Wash the outside of Applying the drops or ointment in
the stronger eye — possibly for two or more your baby’s eyelid, using clean cotton your baby’s eye is sometimes easier with
hours a day, depending on the severity of Pink eye is an inflammation or infection balls (a new one for each eye) and warm two people. Wash your hands before ap-
the condition. This helps the part of the of the transparent membrane (conjunc- water. Or you can use a washcloth and plying ointment or drops. (The other per-
brain that manages vision develop more tiva) that lines your eyelid and part of warm water. Wipe from the inner to the son should do the same.) To prevent con-
completely. your eyeball. It’s frequently caused by a outer part of the eye to prevent spreading tamination of the medication, don’t let
bacterial or viral infection (usually the infection to the uninfected eye. Because the applicator tip touch any surface, in-
Eyedrops A daily or twice-weekly drop same virus that causes the common pink eye is usually contagious, you and cluding the baby’s eye. When you finish,
of a medication that temporarily blurs vi- cold), but it can also result from allergies. others who care for your child should wipe the tip of the tube with a clean tis-
sion in the stronger eye is used to en- take precautions to avoid spreading it. A sue and tightly close it. Wash your hands
courage use of the weaker eye. It offers How to recognize it You might sus- baby with pink eye should have his or her after touching your baby’s eyes.
an alternative to wearing a patch. pect that your baby has pink eye if you own towel and washcloth, both at home To administer medication, follow
notice that the white part of the eye and and away. Wash your hands carefully af- these tips:
Surgery If your child has crossed or out- the eyelid are reddened in one or both ter you come into contact with secretions
wardly deviating eyes (strabismus), the eyes. Pink eye can also cause mucus, or from your child’s eyes. Eyedrops Lay your baby on his or her
eye muscles may benefit from surgical “matter,” to form in your baby’s eye, In case of a bacterial infection, your back. Gently pull the lower eyelid down
repair. Droopy eyelids or cataracts also varying from thin and watery to thick child’s care provider may recommend to form a little pouch, and place the drops
may need surgical intervention. and yellowish green. Bacterial infections antibiotic drops or ointment. Some par- in the pouch. The drops will disperse over
For most children with lazy eye, prop- are more likely to cause thick, green ents find ointment easier to use than the eye as your baby blinks.
er treatment improves vision within weeks discharge. eyedrops, although ointment can blur
to several months — and the earlier treat- If your baby has pink eye, you may your child’s vision for up to 20 minutes or Ointment Pull your baby’s lower eyelid
ment begins, the better. Although re- find his or her eyelids stuck together on so after application. In either case, the away from the affected eye to form a
search suggests that the treatment win- awakening, requiring you to wash them discharge should improve within the first pouch. Unless your child’s care provider
dow extends through at least age 17, clean. Also suspect pink eye if your baby two days or so, although the redness may tells you otherwise, squeeze a thin strip
results are better when treatment begins experiences discomfort with exposure to persist a few days more. Follow the in- of ointment into the pouch. Release your
in early childhood. bright lights, or if he or she does a lot structions of your child’s care provider child’s lower eyelid, and then ease the
of blinking. and use the antibiotics until the prescrip- upper eyelid down to cover your baby’s
When to call If you notice your child’s tion runs out to prevent recurrence of the eye. Hold the lid closed for just a moment
eye wandering at any time beyond the How serious is it? Pink eye generally infection. or two.
first few weeks of life, consult your child’s lasts about as long as a cold, usually a
care provider for an evaluation. Depend- week or so, but sometimes up to two or
ing on the circumstances, he or she may three weeks. If infectious, pink eye is
refer your child to a doctor who special- contagious by contact.
izes in eye conditions (ophthalmologist Viral infections just need time to run
or optometrist). their course; bacterial infections may be
treated with antibiotic drops. If pink eye
What you can do There’s really noth- is due to allergies, your care provider may
ing you can do at home to treat lazy eye. recommend specific eyedrops for people
However, you can monitor your child’s with allergies.
eyes closely in the first few months of life
to make sure they are in proper align- When to call Make a call if your baby:
ment and to make sure your baby’s vision Z Develops a red and swollen eyelid
seems to be consistently improving. The Z Develops a fever or starts acting ill
sooner treatment for lazy eye begins, Z Has the symptoms of an ear infection
generally the better the outcome for your Z Doesn’t seem to improve after start-
child. ing treatment
PNEUMONIA bacterial pneumonia. Be sure to give your may sometimes flow up the esophagus hand until your baby outgrows the condi-
baby the full course of medication pre- and out of your baby’s mouth. Some- tion. To minimize reflux in the meantime:
Babies who get pneumonia are usually ill scribed, even if he or she starts to feel times air bubbles in the esophagus may
first with a viral upper respiratory tract better. This helps reduce recurrence of push liquid out of your baby’s mouth. In Try smaller, more frequent feedings
infection, such as a cold. Some viral in- the infection and minimizes the chances other cases, your baby may simply drink Feed your baby slightly less than usual if
fections can the affect the lungs, resulting that the bacteria will become resistant to too much, too fast. you’re bottle-feeding, or cut back a little
in viral pneumonia. Pneumonia can also the drug. on the amount of time you breast-feed.
stem from a bacterial infection, perhaps Viral pneumonia typically doesn’t re- How to recognize it Although infant
after a cold. In children under 2 years of quire anything other than home treatment. GER most often occurs after a feeding, Take time to burp your baby Frequent
age, bacterial pneumonia is less common Encourage quiet activities so that your baby your baby also may spit up when he or burps during and after each feeding can
than the viral kind. Bacterial pneumonia gets plenty of rest. Your baby may need she coughs, cries or strains. You may also keep air from building up in your baby’s
may be helped by antibiotics. extra holding and cuddling. He or she notice your baby becomes more irritable stomach. Sit your baby upright, support-
also needs plenty of fluids. Coughing is during or after feedings, or coughs, ing his or her head with your hand, and
How to recognize it Pneumonia is usually beneficial for babies with pneumo- wheezes or cries when you lay him or rub his or her back. Avoid burping your
usually worse than a bad cold. A baby nia because it helps to clear the mucus and her on his or her back, especially after baby over your shoulder, which puts
with pneumonia may cough and have secretions associated with the infection. feeding. pressure on your baby’s abdomen.
difficulty breathing. Breathing may be- You can help prevent your baby from
come fast and labored. You might notice developing pneumonia in many cases by How serious is it? Infant GER typi- Check the nipple If you’re using a bottle,
that your baby’s lips or nails have a bluish making sure your son or daughter is up cally resolves on its own when your baby make sure the hole in the nipple is the
tint. Your baby may also appear pale, de- to date with his or her immunizations — is around 12 to 18 months old. Unless right size. If it’s too large, the milk will
velop a fever, lose his or her appetite, and especially against pneumococcal infec- severe — gastroesophageal reflux disease flow too fast. If it’s too small, your baby
become either more listless or fussier tions (pneumococcal conjugate, or (GERD) is a severe version of reflux that may get frustrated and gulp air. A nipple
than usual. PCV13), a bacterial cause of pneumonia, can cause pain, vomiting and poor weight hole that’s the right size will allow a few
Haemophilus influenzae type b (Hib), vari- gain — infant GER doesn’t interfere with drops of milk to fall out when you hold
How serious is it? In the past, pneu- cella and the seasonal flu. a baby’s growth or well-being. the bottle upside down.
monia could be a dangerous illness. Now,
most babies recover well if they receive When to call Call your child’s care pro-
prompt medical attention. vider if your baby:
REFLUX Z Isn’t gaining weight
When to call Call immediately if you Z Spits up forcefully, causing stomach
suspect that your baby may have pneu- Spitting up is common in new babies, oc- contents to shoot out of his or her
monia or your baby is less than 3 months curring in about half of newborns under mouth
old and has a rectal temperature of 100.4 age 3 months. Normally, the condition Z Spits up green fluid (Call immediately
F or higher. Be sure to check back with goes away after the first few months. But if this happens.)
your care provider if: in some babies, spitting up continues Z Spits up blood or a material that looks
Z Your baby’s fever continues more throughout the first year or so. The medi- like coffee grounds
than two or three days, despite taking cal term for this condition is gastro- Z Resists feedings
an antibiotic esophageal reflux, or GER. Z Has blood in his or her stool
Z Your baby has difficulty breathing The causes of infant GER are gener- Z Has other signs of illness, such as fe-
ally simple. Normally, the ring of muscle ver, diarrhea or difficulty breathing
What you can do If your child’s care between the esophagus and the stomach Z Begins persistent vomiting at age 6
provider suspects bacterial pneumonia, (lower esophageal sphincter) relaxes and months or older
he or she may prescribe a course of anti- opens only when you swallow. Other-
biotics for your baby. Antibiotics don’t wise, it’s tightly closed — keeping stom- What you can do Infant GER is usually
help viral infections, but sometimes it’s ach contents where they belong. Until little cause for concern, but you may have
difficult to distinguish between viral and this muscle matures, stomach contents to keep an extra supply of spit-up cloths on

Thicken the formula or breast milk If wheezing and breathing fast. Ear infec- the air moist with a humidifier also may patches, mainly on the baby’s trunk. Al-
your baby’s care provider approves, add a tions are occasionally associated with help ease congestion. Have your child though not itchy or uncomfortable, the
small amount of rice cereal to your baby’s RSV infections. drink plenty of fluids to prevent dehydra- rash can last from several hours to sev-
formula or expressed breast milk. You In babies who are only a few weeks tion. Continue breast-feeding or bottle- eral days before fading.
may need to enlarge the hole in the nip- old, infection with RSV may cause more feeding your infant as you would nor-
ple to make sure your baby can drink the general symptoms, such as coughing, mally. Wash hands frequently and avoid How serious is it? Roseola typically
thickened liquid. wheezing, extreme tiredness, irritability sharing eating and drinking utensils to isn’t serious. If your baby is otherwise
and poor feeding. prevent spreading the infection. healthy, he or she will most likely recover
Make a change Occasionally, some ba- The medication palivizumab (Synag- quickly and completely. Treatment in-
bies develop an allergy to cow’s milk pro- How serious is it? RSV can be very se- is) can help protect children under age 2 cludes rest, fluids and, if your child is un-
tein. If you are breast-feeding, that means rious. However, babies who are other- who are at high risk of serious complica- comfortable, medications to reduce fever.
you may have to eliminate milk products wise healthy generally recover from the tions from RSV, such as premature babies
from your diet. If you are formula-feed- illness in one to two weeks without the or those who have an underlying lung or When to call Call your child’s care pro-
ing your baby, your child’s care provider need for medical treatment. heart problem. The medicine is started vider if your baby is under 3 months old
may suggest switching to a different for- Babies who are finding it difficult to prior to the RSV peak season. If you think and has a rectal temperature of 100.4 F or
mula that doesn’t contain cow’s milk. breathe may need to stay at a hospital to your baby may qualify for this treatment, higher. The care provider may want to ex-
receive supportive care, such as supple- talk to your child’s care provider. The amine your child to rule out more serious
mental oxygen and suctioning of mucus medication isn’t helpful in treating RSV causes of fever. Also call if the fever lasts
from their airways. Even among babies infection once it has developed. more than seven days, or if the rash
RSV who need to be hospitalized, most have a doesn’t improve after three days.
full recovery within a few weeks.
Respiratory syncytial virus (RSV) is a vi- What you can do Like most viral ill-
rus that can cause infections of the upper When to call Call your baby’s care pro- ROSEOLA nesses, roseola needs to run its course.
respiratory tract, such as a cold, or the vider right away if your child: Encourage plenty of rest and plenty of
lower respiratory tract, such as bronchi- Z Is less than 2 months old and you Roseola is a generally mild infection that fluids. A lukewarm sponge bath or a cool
olitis and pneumonia. It’s so common suspect an infection typically affects children by age 2. It’s ex-
that most children get RSV before age 2. Z Is struggling to breathe tremely common — most children have
Reinfections with RSV are common, but Z Runs a high fever, or a fever of 100.4 been infected with roseola by the time
a child gets older, symptoms usually be- or above if your baby is less than 3 they enter kindergarten.
come less severe. months old Two common strains of herpes virus-
In many cases, the symptoms of an Z Turns blue, particularly on the lips es cause roseola (but not the same ones
RSV infection resolve on their own. Self- and in the nail beds that cause sexually transmitted herpes).
care measures are usually all that’s need- Z Shows signs of dehydration (dry mouth, The condition typically causes several
ed to relieve any discomfort. reduced urination, sunken eyes and fon- days of fever, followed by a rash.
But in a few cases, the infection can be tenels, extreme fussiness or sleepiness)
severe enough to require a stay at the hos- Z Breathing or poor eating seems to be How to recognize it Roseola typically
pital. Premature babies and infants with getting worse starts with a sudden, high fever — often
underlying health conditions are at great- greater than 103 F. Some children have a
er risk of severe illness. What you can do Mild symptoms can slightly sore throat, runny nose or cough
be treated at home, although you should along with or preceding the fever. Your
How to recognize it Initially, infection be ready to call your child’s care provider child may also develop swollen lymph
with RSV may cause a runny nose, de- promptly if symptoms worsen. If your nodes in his or her neck along with the
crease in appetite and perhaps a fever. child is more than 3 months old and has fever. The fever lasts for three to five days.
Over the next few days, the infection may a fever and is uncomfortable, you can Once the fever subsides, a rash typi-
spread to the lower airways and lungs give him or her acetaminophen (Tylenol, cally appears — but not always. The rash
and your baby may start coughing, others). Keeping your child upright and consists of many small pink spots or

washcloth applied to your child’s head Z Watery, usually nonbloody diarrhea Z Has bloody diarrhea by’s already-prepared formula. After 15
can soothe the discomfort of a fever. — bloody diarrhea usually means a Z Has vomiting that lasts more than to 30 minutes, if the liquid stays down, of-
Once the fever subsides, your child different, more severe infection several hours fer it again. If you’re concerned about pos-
should feel better soon. Most children re- Z Abdominal cramps and pain Z Hasn’t had a wet diaper in six to 12 sible dehydration, ask your child’s care
cover fully from roseola within a week of Z Vomiting hours and can’t keep fluids down provider about giving your baby a small
the onset of the fever. The rash should Z Loss of appetite Z Has a sunken fontanel — the soft amount of an oral rehydration solution.
fade on its own in a short time. Z Irritability spot on the top of your baby’s head If your baby is eating solids, these
If the fever is making your baby un- Z Low-grade fever Z Has a dry mouth or cries without tears suggestions may help ease your baby’s
comfortable, you can give him or her ac- Depending on the cause, viral gastro- Z Is unusually sleepy, drowsy or un- discomfort and avoid complications:
etaminophen (Tylenol, others). Once enteritis symptoms may appear within one responsive
your child is older than 6 months, you to three days after your baby is infected and Help your child rehydrate Give your
can give him or her ibuprofen (Advil, can range from mild to severe. Symptoms What you can do When your baby has child an oral rehydration solution (Pedia-
Motrin, others). See page 370 for more usually last just a day or two, but occasion- an intestinal infection, the most impor- lyte, others). Don’t give him or her only
on fever medications. However, don’t ally they may persist as long as 10 days. tant goal is to replace lost fluids and salts. water. In children with gastroenteritis,
give aspirin to a child who has a viral ill- After vomiting or a bout of diarrhea, let water isn’t absorbed well and it won’t ad-
ness because aspirin has been associated How serious is it? A bout of viral gas- your baby’s stomach rest for 30 to 60 equately replace lost electrolytes. You can
with the development of Reye’s syn- troenteritis usually resolves on its own minutes, then offer small amounts of liq- find oral rehydration solutions in most
drome, which can be serious. within a week or two (although it can of- uid, 1 to 2 teaspoonfuls at a time. If you’re grocery stores. Talk to your care provider
If your child is sick with roseola, keep ten include a miserable few days). Antibi- breast-feeding, offer just one breast and if you have questions about how to use
him or her home and away from other otics offer no help for viral infections. let your baby nurse for five minutes. If them. Avoid giving your child apple juice
children until the fever has broken. The main complication of viral gas- you’re bottle-feeding, offer small amounts for rehydration because it can make diar-
troenteritis is dehydration. If your baby of regular formula. Don’t dilute your ba- rhea worse.
can’t take in enough fluids — through
breast milk, formula or an oral rehydra-
STOMACH FLU tion solution — to replace the fluids be-
(GASTROENTERITIS) ing lost through diarrhea or vomiting, he
or she will become dehydrated and may
Although it’s commonly called stomach need to go to a hospital to receive fluids
flu, gastroenteritis isn’t the same as influ- through a vein (intravenously).
enza. Influenza affects your baby’s respi- If your baby has severe or prolonged
ratory system — nose, throat and lungs. diarrhea, especially if accompanied by
Gastroenteritis, on the other hand, at- vomiting, watch carefully for signs of de-
tacks the intestines. hydration — extreme thirst, dry mouth,
The rotavirus and noroviruses are two crying without tears and reduced urina-
common causes of gastroenteritis. Babies tion compared to your baby’s usual out-
usually become infected when they put put. Babies who are dehydrated usually
their fingers or other objects contami- will change from fussy to quiet to lethar-
nated with a virus into their mouths. gic. Call your care provider promptly if
A vaccine against rotaviral gastroenteri- you notice signs of dehydration.
tis is available in some countries, including
the United States, and appears to be effec- When to call Call your child’s care pro-
tive in preventing severe symptoms. vider right away if your child:
Z Has a fever that is high for his or her
How to recognize it Gastroenteritis age
typically causes signs and symptoms Z Seems lethargic or very irritable
such as: Z Is in a lot of discomfort or pain

Return to a normal diet slowly Drink- baby’s eyelid may also be swollen and the want to minimize the fun your child has This precaution includes cloudy days,
ing is more important than eating. When eye may be teary. outdoors, it’s important to be sun smart. when the clouds don’t block but simply
your child seems ready to eat, there’s You can help prevent sun damage by set- scatter UV rays. You can also protect your
generally no need to restrict his or her How serious is it Most sties are harm- ting up in shady areas (or using an um- baby by routinely dressing him or her in
diet, but bland foods — such as toast, less and don’t require treatment. A sty brella), using sunscreen appropriately, a hat for outings during the middle of the
rice, bananas and potatoes — are usually typically resolves on its own in a few days and dressing your child in hats and light, day. If you can’t avoid sun exposure, use
easier to digest. to a week. protective clothing. sunscreen just on areas of the body that
will be exposed, such as the face and
Avoid certain foods Don’t give your When to call Contact your baby’s care How to recognize it You may not real- backs of the hands.
child dairy products and sugary foods. provider if the sty doesn’t go away in a ize that your baby has sunburn because
These can make diarrhea worse. week, or the redness and swelling extend the pain and redness may not appear for In babies older than 6 months Apply a
beyond your baby’s eyelid, involving his several hours. Sunburn may cause red, broad-spectrum sunscreen, which pro-
Make sure your child rests The illness or her cheek or other parts of the face. tender, swollen or blistered skin that is tects against UVA and UVB rays, 30 min-
and dehydration may have made your For a sty that persists, your care pro- usually hot to the touch. utes before going outside. Use a sun-
child weak and tired. vider may recommend antibiotic oint- screen with a sun protection factor (SPF)
ment or drops to help clear the infection. How serious is it? It’s a good idea to of at least 30. Don’t forget the back of the
Don’t give children aspirin It may be cautious about the possibility of your neck, ears, nose, lips and tops of the feet.
cause Reye’s syndrome, a rare, potential- What you can do Don’t try to pop the baby sunburning. Babies can develop Reapply it every two hours or after the
ly fatal disease. Also don’t give your child sty or squeeze the pus from a sty, and blisters, fever, chills and nausea with sun baby has played in the water, even if the
over-the-counter anti-diarrheal medica- keep your baby’s face and hands clean. exposure that may not affect an older sunscreen is waterproof. If you think
tions such as Imodium, unless advised to To relieve discomfort, apply warm com- person. your baby might have sensitive skin, do a
do so by your child’s care provider. They presses to your baby’s eyelid. Run warm patch test. Apply a small amount of sun-
can make it more difficult for your child’s water over a clean washcloth. Wring out When to call Contact your baby’s care screen to your baby’s forearm and watch
body to eliminate the virus. the washcloth and place it over the closed provider if the sunburn blisters or if your for the next 48 hours for any reaction. If
eye. Re-wet the washcloth when it loses baby begins vomiting or acts ill. your baby is sensitive to one sunscreen,
heat. Continue this for five or 10 minutes. try a sunscreen without chemical sun-
Applying a warm compress several times What you can do Treat sunburn by block components — one with only zinc
STY each day may encourage the sty to drain gently applying cool compresses every oxide or titanium dioxide.
more quickly. few hours, taking care not to allow your If at any time you notice your baby
If you notice a red, painful-looking lump baby to become chilled. Encourage plen- turning pink, take him or her out of the
appear fairly rapidly near the edge of your ty of fluids. Give your baby acetamino- sun. Pink now can mean red and sun-
baby’s eyelid, he or she may have a bacte- phen (Tylenol, others) to relieve the pain. burned later.
rial eyelid infection called a sty. A sty may SUNBURN Avoid using anesthetic lotions or sprays
develop when your baby rubs or scratches on a baby’s skin. Some sting, and a baby’s
his or her eyes with dirty hands or finger- Your baby’s skin is quite thin and suscep- skin may react to anesthetic sprays. Ben-
nails, transferring bacteria to the eyelids. tible to sunburn, even with only 10 to 15 zocaine in particular can have rare but SWOLLEN SCROTUM
In most cases, a sty will disappear on minutes of exposure, and even on a serious side effects in children under age (FROM A HYDROCELE)
its own in a few days to a week. In the cloudy or cool day. It’s not the visible 2. Don’t use it without the advice of your
meantime, you may be able to relieve the light or the heat from the sun that burns baby’s care provider. A hydrocele is an accumulation of fluid in
pain or discomfort of a sty by applying a but the invisible ultraviolet (UV) light. It’s also important that you take steps the pouch that holds the testicles (scro-
warm washcloth to the eyelid. The lighter the color of your baby’s skin, to prevent sunburn: tum), making the scrotum look swollen
the more sensitive it is to UV rays, but and large on one side. This condition is
How to recognize it A red lump on that doesn’t mean darker skin is immune In babies under 6 months Keep your not uncommon in newborn boys. Before
your baby’s eyelid that looks similar to a from sun damage. baby out of direct sunlight as much as birth, your baby’s testicles develop in his
boil or a pimple is usually an indication Most sun damage occurs in the child- possible, especially between 10 a.m. and abdomen and move through a passage
of a sty. A sty often contains pus. Your hood years. While you certainly don’t 3 p.m., when the sun’s rays are strongest. into the scrotum. When the opening to
the abdomen doesn’t fully close, fluid What you can do If you suspect that When to call Call your baby’s care pro- Many parents suspect that teething
that is normally in the abdomen can pass your baby has a hydrocele, share your vider if your baby’s eye is red or swollen causes fever and diarrhea, but research-
into the scrotum and cause swelling. concerns with your baby’s care provider or looks infected. ers say this isn’t true. Teething may cause
A hydrocele is usually painless. By the and watch for any change in your baby’s signs and symptoms in the mouth and
time a baby is a year old, the fluid typi- condition. What you can do Your child’s care pro- gums, but it doesn’t cause problems else-
cally has been absorbed and the hydro- vider may show you how to massage the where in the body.
cele goes away on its own. lower inner corner of your baby’s eye,
where the tears collect (lacrimal sac). Use How serious is it? Teething is a nor-
How to recognize it You may notice TEARY EYES a cotton-tipped swab or clean finger to mal and healthy process in your baby’s
that your baby boy’s scrotum seems gently press upward from the inner cor- development. But where there are teeth,
swollen on one side. It may seem more Teary, or watery, eyes in a newborn are ner. This may or may not help open the there’s the possibility for tooth decay.
swollen when he is crying or active and usually caused by a blocked tear duct. duct, but it can help empty out the lacri- When your baby’s first teeth appear,
less when he is lying down. Normally, tear fluid flows down the sur- mal sac of stagnant fluid. brush them with a small, soft-bristled
face of the eye to lubricate and protect Use moist compresses to wipe away toothbrush and some water, or wipe
How serious is it? Generally, a hydro- the eye. It then drains through a system the fluids from your baby’s eyes. Keeping them with a cloth. Some parents find it
cele isn’t serious and doesn’t cause your of holes and canals into the nose, where your baby’s face and hands clean will easier to use a soft finger toothbrush that
baby any discomfort. It usually goes away the fluid evaporates or is reabsorbed. This help prevent infections. fits over the parent’s finger. There’s no
without treatment by the time your baby system typically takes time to fully de- need to use toothpaste until your child
is a year old. However, if the area be- velop. Babies under 8 months of age pro- learns to spit — about age 2.
comes very large and tender, part of the duce enough tear fluid to coat the eye, The American Dental Association and
intestine may have moved into the scro- but not necessarily to cry “real tears.” TEETHING the American Academy of Pediatric Den-
tum, causing an inguinal hernia. In this Quite a few babies have a blocked tistry recommend scheduling a child’s
case, surgery may be required to move tear duct at birth. Often, a thin tissue Your baby may have a first tooth by 6 first dental visit after the first tooth
the intestine back into the abdominal membrane remains over the opening months or may not begin teething until erupts, and no later than his or her first
cavity and close the opening between the (duct) that empties into the nose. This much later. Often the two bottom center birthday. Your baby’s teeth and gums will
abdomen and the scrotum. blockage causes tear fluid to well up in teeth (incisors) appear first, but not al- also be examined at well-baby checkups.
your baby’s eyes, leaving them watery. ways. When they’ve both come in, a tooth Getting in the habit of good dental care
When to call If your baby develops a may appear on the top. Your baby will now will serve your child’s teeth and
sudden, painful swelling of the scrotum, How to recognize it One or both of probably get four top teeth before a mouth well in later years.
call your child’s care provider immedi- your baby’s eyes may appear to be con- matching set of four is completed on the
ately. Most causes of such symptoms are tinuously watery, with tears occasionally bottom. When to call Contact your baby’s care
benign, but if the testicle twists on the running down the cheeks, even though Your infant’s baby (deciduous) teeth provider if your baby develops a fever,
cord (testicular torsion) the blood supply he or she isn’t crying. Usually, the eye were formed during pregnancy. As these seems particularly uncomfortable, or has
to the testis can be cut off. This requires isn’t red or swollen, unless it becomes teeth come in, your baby’s body will be- other signs or symptoms of illness — in-
immediate surgery. If your baby’s care infected. gin preparing adult teeth to take their cluding fever or diarrhea.
provider did not notice your baby’s hy- place in a few years.
drocele when your baby was born, men- How serious is it? A blocked tear duct What you can do Sometimes you may
tion it at your baby’s next well-child visit. generally isn’t serious, and most of the How to recognize it Drooling is a clas- not even notice your baby is teething un-
Your child’s care provider will likely con- time resolves by about 6 to 9 months of sic sign of teething. However, it may take til you see the new tooth! But if teething
tinue to examine it regularly for changes. age. Because the tear fluid isn’t draining about two months after the drooling is making your baby uncomfortable:
In the meantime, call your care pro- as it should, however, infections (pink starts before the first tooth pops up. For
vider promptly if your baby shows eye, or conjunctivitis) are slightly more some babies, teething causes pain or dis- Rub your baby’s gums Use a clean fin-
marked tenderness in the scrotum, or common when a tear duct is blocked. In comfort. So your baby might be more ir- ger, moistened gauze pad or damp wash-
starts vomiting or showing signs of nau- the morning, your baby’s eyes may be ritable or crankier than usual. You might cloth to gently massage your baby’s
sea for no apparent reason. crusted over with dried up discharge. also notice swollen gums and a drive to gums. The pressure may help ease your
chew on solid objects. baby’s discomfort.
390 PART 4: COMMON ILLNESSES AND CONCERNS PART 4 COMMON ILLNESSES AND CONCERNS 391
Offer something to chew on Try a teeth- THRUSH
ing ring. Some are made from firm rubber
and others plastic with liquid inside. Keep Thrush is the name for a fungal infection
in mind the liquid-filled variety may that can occur in your baby’s mouth. It’s
break under the pressure of your baby’s caused by the same fungus that causes
chewing. If your baby is eating solid yeast infections, Candida albicans. This fun-
foods, you can try a homemade teething gus is normally found in the mouth, skin
ring such as a frozen bagel. (Make sure and other mucous membranes. If the
you offer a frozen food that will turn soft mouth’s natural bacterial balance is upset
so that baby can swallow any pieces that — typically by medications or an illness —
might break loose.) A pacifier may help. an overgrowth of candida may result, pro-
If a bottle seems to do the trick, fill it ducing thrush.
with water. Prolonged contact with sugar
from formula, milk or juice may cause How to recognize it When your baby
tooth decay. has thrush, it looks like he or she has
patches of milk on the inside of the
Keep it cool A cold washcloth or chilled cheeks and on the tongue that won’t
teething ring can be soothing. Be careful wash off (see the photo on page 101).
when giving your baby something fro- Occasionally, thrush causes discomfort
zen, however. Contact with extreme cold and your baby may have trouble feeding
may hurt the gums. If your baby’s eating or be fussy and irritable.
solid foods, offer cold items such as ap- If your baby’s tongue looks white all
plesauce or yogurt. over but there are no white patches in-
side the lips or cheeks, this is probably
Dry the drool Excessive drooling is part not thrush. Milk can make your baby’s
of the teething process. To prevent skin tongue have a white coating.
irritation, keep a clean cloth handy to dry
your baby’s chin. You might also make How serious is it? Thrush can be pain-
sure your baby sleeps on an absorbent ful in severe cases, but it doesn’t gener-
sheet. ally cause discomfort or serious prob-
lems. It can lead to a diaper rash in your
Try an over-the-counter remedy If your baby as the yeast travels through the ba-
baby is especially cranky, acetaminophen by’s gastrointestinal tract.
(Tylenol, others), or ibuprofen (Advil, Infants can pass the infection to their
Motrin, others) if your baby is more than 6 mothers during breast-feeding. The in-
months old, may help reduce gum irrita- fection may then pass back and forth be-
tion and discomfort. Don’t give your baby tween mother’s breasts and baby’s
products that contain aspirin, however, and mouth. Women whose breasts are infect-
be cautious about teething medications ed with candida may experience the fol-
that can be rubbed directly on a baby’s lowing signs and symptoms:
gums. Avoid teething medications that Z Unusually red, sensitive or itchy nipples
contain benzocaine. Benzocaine has been Z Shiny or flaky skin on the darker, cir-
linked to a rare but serious and sometimes cular area around the nipple (areola)
deadly condition that decreases the Z Unusual pain during nursing or pain-
amount of oxygen that the blood can carry, ful nipples between feedings
especially in children under 2 years of age. Z Stabbing pains deep within the breast

When to call If you notice white patch- The urethra, the tube that carries urine the infection from coming back. After When to call If your baby is very young
es inside your baby’s mouth, call your out of the bladder, is shorter in girls than treatment is over, the care provider may — between 2 and 6 weeks — and vomits
baby’s care provider during office hours. in boys, making it easier for bacteria to request another urine sample to make forcefully within 30 minutes after every
Check back with the care provider if your travel to the bladder. When bacteria enter sure the bacteria have been eliminated. feeding for six to 12 hours, call your ba-
baby’s mouth becomes increasingly coat- the bladder or kidneys, an infection may An ultrasound of the kidneys may be by’s care provider right away. This may be
ed and causes discomfort, or if your baby result. Most often, the bacteria come performed if the care provider wants to a sign of a stomach disorder called py-
has difficulty swallowing. from stool and the anal area. rule out a urinary system abnormality. loric stenosis, a narrowing of the stom-
ach’s outlet into the intestines that pre-
What you can do Your child’s care pro- How to recognize it In babies younger vents food from passing (see page 543).
vider may prescribe a liquid antifungal than 2 years old, a urinary tract infection This requires prompt attention (occa-
medication for your baby, which you ap- can be hard to discern. Often the only VOMITING sionally surgery) so that your baby can
ply to the patches of thrush in the mouth. sign is a fever with no apparent cause, get the nutrition he or she needs to grow.
If your baby is having recurring infec- one that’s not explained by an upper re- In the first few months of life, it’s com- Also, call immediately if your baby seems
tions, it’s probably a good idea to replace spiratory infection or diarrhea. Less common for babies to spit up or easily regur- to be getting more ill, you’re concerned
your baby’s pacifiers and bottle nipples, mon signs and symptoms of a urinary gitate their food from time to time. Vom- about possible poisoning, or he or she expe-
which could be harboring the fungus. tract infection are irritability, poor feed- iting is different. It’s the forceful ejection riences any of these signs or symptoms:
If you’re breast-feeding an infant who ing and not gaining weight properly. of a large portion of the stomach’s con- Z Blood or green matter (bile) in the vomit
has oral thrush, you and your baby will do tents through the mouth and sometimes Z Vomiting for more than 12 hours in
best if you’re both treated. Otherwise, you’re How serious is it? Urinary tract infec- even the nose. Because your baby won’t newborns, 24 hours in older infants
likely to pass the infection back and forth. tions require prompt treatment. Left un- understand what is happening, vomiting Z Forceful, repeated vomiting
Z Your doctor may prescribe a mild an- treated, the infection can cause perma- can be a frightening experience for him Z Dehydration — no wet diapers in
tifungal medication for your baby and nent damage to the kidneys. or her. And as a parent, it can be very eight hours, dry mouth, no tears (al-
an antifungal cream for your breasts. stressful when your baby begins to vomit though newborns don’t usually show
You can also use a nonprescription When to call Call anytime your baby without warning. tears), sunken soft spots (fontanels)
antifungal cream, such as clotrima- has an unexplained fever that persists for Most vomiting in infancy is caused by in the head
zole (Lotrimin). Apply it four times a more than 24 hours, especially when the viral infections that affect the stomach Z Unusually sleepy or unresponsive
day after feedings. temperature is greater than 102.2 F. Call and intestines (gastroenteritis). Your Z Inability to keep liquids down
Z If you use a breast pump, rinse all the your child’s care provider right away if your baby also may have fever and diarrhea. Z Seems to have persistent abdominal pain
detachable parts in a vinegar and wa- child is under 3 months of age and has a
ter solution. rectal temperature of 100.4 or higher. How to recognize it Normal infant What you can do To prevent dehydra-
Z If you develop a fungal infection on spit-up seems to dribble out of your ba- tion in your baby:
your breasts, using pads will help pre- What you can do? Be alert to unex- by’s mouth without much ado. Vomit, on
vent the fungus from spreading to plained, persistent fevers in your child, the other hand, comes out like a projec- Wait a little after a vomiting episode
your clothes. Look for pads that don’t and don’t be afraid to call you child’s care tile, fast and furious. Generally, there’s After your baby vomits, let the stomach
have a plastic barrier, which can en- provider when necessary. A care provider more of it, too, compared with spit-up. settle for a while. Wait 30 to 60 minutes
courage the growth of candida. If can diagnose a urinary tract infection before offering more fluids. Sleep may
you’re not using disposable pads, with a urine sample. In infants, a urine How serious is it? Most of the time, help ease your baby’s nausea.
wash the nursing pads and your bras sample is usually obtained by briefly in- vomiting is due to a viral infection and
in hot water with bleach. serting a catheter into the urethra to stops on its own within 12 to 24 hours. Offer small amounts of liquid Start out
withdraw a small amount of urine. The greatest risk your baby faces from with a teaspoon or two. Breast-fed babies
If your baby has a urinary tract infec- vomiting is dehydration from losing too usually tolerate breast milk fairly well and
tion, his or her care provider will pre- many bodily fluids. digest it quickly. Offer just one breast and
URINARY TRACT INFECTION scribe a course of antibiotics, which may In a few cases, vomiting can be a nurse for only five minutes. Small amounts
last up to two weeks. Make sure to give symptom of a more serious problem, of regular formula for bottle-fed babies
Urinary tract infections are fairly com- your child the whole prescription, even such as an intestinal obstruction, stom- are OK, too. After 15 to 30 minutes, if the
mon in young children, especially girls. after the fever goes away. This will keep ach disorder or infection. liquid stays down, offer it again.
Offer an oral rehydration solution If son to person through airborne droplets How to recognize it At first, it may Z Has severe coughing fits
your baby continues to vomit, switch to from coughing or sneezing. seem as if your baby has a mild upper re- Z Has spells of difficulty breathing,
feeding a teaspoon or two of oral rehydra- A vaccine against whooping cough is spiratory tract infection — a runny nose, turning blue or gagging
tion solution (Pedialyte, others). Gradually part of your baby’s recommended immu- congestion and cough, but no fever. Only Z Has had a bad cough for more than
increase the volume as your baby toler- nizations, usually given as a series of five the cough worsens throughout the first five to seven days
ates it. If your baby can’t keep anything injections at 2 months, 4 months, 6 week, until he or she experiences exhaust- Z Vomits after a coughing fit, eats poor-
down, call your child’s care provider. months, 12 to 18 months and 4 to 6 years. ing coughing fits consisting of 10 to 30 ly or seems ill
Because babies under 6 months haven’t forceful, abrupt coughs, sometimes fol-
Gradually return to normal diet After been fully vaccinated, they’re at greater lowed by a “whoop” sound as your baby What you can do If you’re caring for
eight hours without vomiting, gradually risk of getting the infection and of devel- inhales forcefully. Many babies don’t de- your baby at home, these steps may help
return to normal breast- or formula- oping significant complications. How- velop the whoop sound. Some vomit after your son or daughter feel better while re-
feeding amounts. If your baby is eating ever, being up to date on vaccinations a coughing fit. covering:
solids, you might want to start out with usually makes symptoms less likely to be In infants under 3 months of age, the
easily digested foods, such as baby cereal, severe. initial phase of mild symptoms may not Encourage plenty of rest A cool, quiet
bananas, crackers, toast or plain pasta. The protection offered by the vaccine always be obvious. The first sign of and dark bedroom may help your child
wears off after several years, meaning whooping cough may be a sudden fit of relax and rest better.
that teens and adults who haven’t up- coughing or difficulty breathing. In be-
dated their vaccinations may become in- tween episodes of coughing or trouble Offer plenty of fluids Water, juice and
WHOOPING COUGH fected and pass it on to infants and young breathing, the baby may appear well. soups are good choices. If your baby is
children. Because of this, it’s now recom- having trouble consuming enough fluids,
Whooping cough (pertussis) is a highly mended that adolescents and adults How serious is it? In infants — espe- offer small amounts of an oral rehydrat-
contagious bacterial infection of the re- receive a vaccine booster shot for whoop- cially those under 6 months of age — ing solution (Pedialyte, others).
spiratory tract. It’s transmitted from pering cough. complications from whooping cough are
more severe than in older children and Offer smaller meals To avoid vomiting
adults, and may include ear infections, after coughing, give your baby smaller,
pneumonia, respiratory failure and sei- more-frequent feedings.
zures. Complications such as pneumonia
can be life-threatening in new babies. Vaporize the room Use a mist vaporizer
Young infants diagnosed with whoop- to help soothe irritated lungs and to help
ing cough are often kept at a hospital to loosen respiratory secretions. If you use a
receive supportive care and to be closely vaporizer, follow directions for keeping it
monitored for potentially serious compli- clean. If you don’t have a vaporizer, sit-
cations. If your baby is older and has mild ting in a warm bathroom with the show-
symptoms, hospitalization may not be er turned on can also temporarily help
necessary. Antibiotics, when given early clear the lungs and ease breathing.
in the illness, may help shorten the dura-
tion of symptoms and can decrease the Clean the air Keep your home free of ir-
chances of transmitting the infection to ritants that can trigger coughing spells,
others. such as tobacco smoke and fumes from
fireplaces.
When to call Contact your child’s care
provider right away if your baby: Prevent transmission Cover your cough
Z Is under 6 months old or hasn’t been and wash your hands often; keep your
fully immunized, and has been ex- baby away from others. Ask your family’s
posed to someone with a chronic care provider about getting your whole
cough or whooping cough family’s immunizations up to date.

PART 5 CHAPTER 29
Managing and Adapting to

Enjoying Parenthood your new lifestyle
It’s not just baby’s first year — it’s also the most challenging times of your life.
mommy’s and daddy’s first year with this The changes in the daily rhythms of your
new little person. Adding a baby to your life may feel chaotic and foreign. A few
family brings some of the most profound practical strategies can help you adapt. It
changes you’ll ever experience, from the may take months or even a year, but
mundane (diapers) to the magical (the you’ll get there.
first smile). No matter how many baby-
care websites or books you’ve perused, or
how meticulous you’ve been in getting
everything in place, nothing can fully LIVING ON LESS SLEEP
prepare you for the first weeks and
months after your baby’s birth. If there’s any issue to which all parents
This time can be exciting — and over- can nod their heads and say, “I’ve been
whelming. You’re dealing with many dif- there,” it’s the fatigue that comes with
ferent physical, social and emotional is- having a baby. You’re up at all hours feed-
sues all at once. You’re recovering from ing, diapering and otherwise tending to
pregnancy and childbirth, trying to get a your newborn, who needs time to devel-
handle on your baby’s needs and habits, op regular sleep-wake cycles. Parents’ sleep
and adjusting to a new role and identity. is often disturbed for weeks, if not years,
Relationships with your partner, family after a baby’s birth. Lack of sleep not only
and friends are shifting. And round-the- can leave you exhausted, but also can
clock newborn care can turn your life up- make you irritable and less able to focus,
side down, making even simple tasks remember details and solve problems.
such as showering a challenge. But seasoned parents will also tell you
The first few weeks after you bring that it gets better. By age 3 months, many
your baby home are likely to be some of babies can sleep at least five hours at a
CHAPTER 29: ADAPTING TO YOUR NEW LIFESTYLE 399

stretch. By 6 months, many infants sleep care for the baby while you excuse your-
through the night, and 70 to 80 percent self for some much needed rest. Allow A HOUSE BECOMES A HOME
of babies are doing so by 9 months. In the them to help with cooking and cleaning.
meantime, hang in there — and try to Children’s book writer Christopher Harder describes the way his house changed
sneak in as much sleep as possible. Avoid bed sharing during sleep It’s after he and his wife had a child:
While there’s no magical formula for OK to bring your baby into your bed for We had renovated the house by getting rid of our dining room, living room and
getting enough sleep, here are some tips nursing or comforting, but return your den and replacing them with one, house-sized playroom. We had scarred the new
that may help. baby to the crib or bassinet when you and furniture, stained baseboards and repainted walls. ... Half our books were in the
your baby are ready to go back to sleep. attic. The hardwood floors had skid marks. ... And it felt like home.
Sleep when your baby sleeps While
this is one of the common pieces of ad- Share nighttime duties Work out a
vice, it’s not always so easy to follow. schedule with your partner that allows
Some babies doze off for just 15 or 20 both of you to rest and care for the baby.
minutes at a time, and you may need to If you’re breast-feeding, perhaps your
seize that time to shower, eat a meal or partner can bring you the baby and han-
just go to the bathroom. dle nighttime diaper changes. If you’re
Still, even an hour or two of extra using a bottle, take turns feeding the
sleep can make a big difference, so make baby. You could also split the night into
it a priority. Turn off the ringer on your two shifts or trade nights to be on duty.
cellphone and your house phone, hide
the laundry basket, and ignore the dishes Wait a few minutes Sometimes mid-
in the kitchen sink. Your chores can wait. dle-of-the-night fussing or crying is sim-
ply a sign that your baby is settling down. Go easy on yourself If you’re not get- might miss your former carefree life, a
Set aside your social graces When Unless you suspect that your baby is ting enough sleep, you may feel cranky predictable schedule and control over
close friends and loved ones visit, don’t hungry or uncomfortable, wait a few and in a fog. Try not to beat yourself up your time. Maybe you long for the com-
worry about entertaining them. Let them minutes before responding. about it. Set aside complicated tasks, fort of your old routines, like a quiet morn-
such as preparing elaborate meals, bal- ing cup of coffee, a structured workday,
ancing your budget and operating heavy weekly get-togethers with friends or
machinery, for a time when you’re feeling movie night with your partner.
WHEN SLEEP BECOMES A STRUGGLE more rested. Over time, you’ll adjust to the new
normal, revive old routines and create
The rigors of caring for a newborn may leave you so exhausted that you feel you new ones. In the meantime, you can
could fall asleep anytime, anywhere — but that’s not always the case. Some new bring some order to the chaos — and
parents experience insomnia. GETTING COMFORTABLE learn to embrace it.
Prolonged sleep deprivation can set the stage for depression and other health WITH CHAOS
problems. If you’re having problems sleeping even when you have the opportunity, Check your expectations Many new
try these suggestions. In the first weeks after you bring home parents start out with unrealistic expec-
Z Make sure your environment is suited for sleep. Turn off the TV and keep the your baby, you might feel like you’re in a tations — that life won’t be much differ-
room cool and dark. fog. With the baby’s constant need for ent from before. The gap between expec-
Z Avoid nicotine, caffeine and alcohol late in the day or at night. care and attention, your day-to-day rou- tations and reality can lead to stress and
Z If you don’t nod off within 30 minutes, get up and do something else. When tine goes out the window. On top of feed- disappointment, or even a feeling that
you begin to feel drowsy, try going back to bed. ings, diaper changes and crying spells, something’s wrong with you. Throw out
If you think you have a sleep problem, consult your care provider. Identifying parents must find time to do household any preconceived notions about what life
and treating any underlying conditions can help you get the rest you need. chores and other daily activities. with a new baby should be like, and be
Although your days will likely include realistic about the increased demands
moments of awe and enjoyment, you still you face.
400 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 29: ADAPTING TO YOUR NEW LIFESTYLE 401
Go with the flow It’s never too early to Z Use disposable plates and utensils when ADJUSTING TO YOUR NEW ROLE Believe in yourself Parenting brings a
establish a routine — but let your new- you don’t have time to do dishes. seemingly endless array of decisions.
born set the pace. Allow plenty of time Z Pare down your baby equipment. You Taking care of a new baby is an awesome Where will baby sleep? Cloth or dispos-
each day for nursing sessions, naps and don’t need every gadget on the market. responsibility — both in the sense of able diapers? Should you circumcise your
crying spells. Keep scheduled activities to Z Set up a baby-care station with every- “amazing” and of “what am I doing?” son? Ultimately, you’ll have to trust that
a minimum. When you need to head out, thing you need in one place. Infants depend utterly on their parents to you do know what’s best for you and
give yourself extra time to pack your sup- Z Keep cleaning supplies where you meet all their physical and emotional your family. Each parent and each baby is
plies and change the inevitable out-the- use them, such as in the bathroom. needs. Even if you’ve dreamed about be- an individual, so there’s no one right an-
door dirty diaper. Z Get a new haircut if your hair routine ing a parent since you were a kid, the re- swer for every situation. Your parenting is
takes too much time. alities of dressing, feeding, bathing and now and always will be a work in prog-
Relax your standards Learn to live performing the many other child care ress. You’ll learn as you go, and you’ll
with a messier house. Every room doesn’t Stock up Buy a month’s supply of toilet routines take time to learn. Along with learn from your inevitable mistakes.
have to be perfect. Hide the broom and paper, diapers and other essential house- the joy, excitement and fulfillment par-
vacuum and leave dust bunnies where hold items. Accept pre-made meals from enthood brings, don’t be surprised to ex- Let go of being perfect These days,
they lie. Store clean clothes in the laun- friends and family. Prepare double din- perience doubts and uncertainties in moms and dads experience a new level of
dry basket until you need them — or in ner portions and freeze the leftovers, or your new role. anxiety as parenting has become a verb
stacks on the floor, for that matter. Clean buy healthy heat-and-serve options. Feelings of incompetence are normal. and often feels like a competition. You
the bathroom with a fresh diaper wipe. Like many new parents, you may be go- may find yourself seeking the “best” way
Establish visiting rules Friends and ing from a working life where you feel to care for your child or painstakingly fol-
Simplify and streamline Find ways to loved ones may seem to come out of the confident and successful to a job for lowing a nurse’s or doctor’s example. This
make life easier by cutting back on cooking, woodwork to admire your newborn. Let which you lack experience and won’t get can be frustrating and overwhelming. In-
cleaning and other household routines: them know which days work best and instructions or feedback from your new stead, remember that you know your
Z Serve cold cereal and peanut butter how much time you have for a visit. Insist “boss.” You’re acquiring a whole new baby better than anyone else, and you and
toast for dinner when you’re too tired that visitors wash their hands before skill set at a rapid pace. Although the your partner love your baby like no one
to prepare a more traditional meal. holding the baby, and ask anyone who’s “maternal instinct” is supposed to kick else can. Because of this, you will always
Z Get takeout food when your budget ill to stay home. in, new mothers (and fathers) don’t auto- have your child’s best interests at heart. In
allows it. matically know exactly what their babies the end, that’s what matters the most.
Accept help When people ask if there’s need. You may feel anxious, helpless or
anything they can do, give them a job. It powerless as you try to figure out why Tune in to your baby Your baby will
can be as simple as watching the baby your baby is crying or not sleeping. also help build your confidence. As you
while you take an unhurried shower and Should you feed her, entertain her, or just respond to his needs, you receive in re-
wash your hair. If you have other chil- let her take in the new surroundings? turn a response — a contented gaze, a
dren, let someone take them for a few If you’re wondering how you’ll han- grasp of your finger or a fleeting smile.
hours or the whole day so you can have dle one of life’s biggest responsibilities, Spending time alone with your baby,
some alone time with the new baby. And take a deep breath and relax. Becoming a away from distractions, can be ideal for
never refuse a meal you don’t have to parent is a process. It doesn’t happen fostering this relationship. Bonding with
cook. If someone is staying with you, let overnight. As you gain experience, you’ll your baby and learning his or her habits
that person wait on you. You deserve it learn to read your baby’s cues and begin and rhythms takes time.
and need it, and it will probably make to master the tasks of baby care. In turn,
your guest feel special as well. your sense of competence and satisfac- Take advice with a grain of salt
tion will increase. As one mom remarked Chances are, you’re sure to face an on-
Keep your perspective The newborn six weeks after giving birth, “I know how slaught of often-conflicting advice from
days won’t last long. Before you know it, to put him back down to sleep. And I can friends, family and even strangers on the
your infant will be a toddler, walking and tell if he’s hungry when he’s crying or he’s street. You’ll hear about the “right” way to
talking. Try to step back and appreciate just tired. ... I have my little tricks now that do everything, from feeding and clothing
the moment, even amid the chaos. I feel like I know him a little more.” your baby to burping and diapering. And
CHAPTER 29: ADAPTING TO YOUR NEW LIFESTYLE 403

if your mother, mother-in-law or another with your partner and for yourself, and (at
experienced adult is on hand, you may least a temporary) loss of sexual activity. SUPPORT COMES IN MANY FORMS
feel as if you’re constantly being evaluat- Realistically, you won’t be able to
ed on your baby-care skills. Such advice avoid stress altogether during your ba- What kind of support do you need? Here are some examples of emotional and
and help from others may heighten your by’s first year. But you may be able to hands-on help that you may find beneficial as you enter the world of parenthood:
feelings of inadequacy or undermine keep from becoming overwhelmed by Z Expressions of love, caring, concern and trust
your confidence. Support from others can taking steps to minimize it. Z Reassurances about your parenting capabilities
be wonderful, but be specific about what Z An atmosphere of understanding
you want, such as reassurance or sugges- Drink fluids and eat well Keep a bot- Z Listening and encouragement
tions for a particular question you have. tle or glass of water and nutritious snacks Z Companionship
Learn to take advice with a grain of salt handy. If you can afford it, buy prepared Z Help with household chores, especially providing and preparing meals, clean-
— you’re the expert on your baby. foods or takeout, but try to avoid fried ing and laundry
fast foods. Spend some time each eve- Z Help with baby care, especially in the days immediately after your baby is born
Seek out other new parents Talking ning stocking your refrigerator with indi- Z Sharing experiences and information
with other new parents can help you re- vidual servings of healthy foods and cold Z Help in getting answers to questions you may have
alize you’re not alone — they’re in the drinks. Sandwiches make an easy one- In accepting help, it’s wise to establish boundaries. Graciously specify the kind
same boat and can offer support and em- handed meal. Do whatever you can to of help you’ll need and discuss what you may want to do yourself. For example,
pathy rather than advice. Consider join- make mealtime easier, including accept- you can say, “I would like to be alone with my baby during feedings. Perhaps you
ing a new moms or new parents group, ing people’s offers of meals and cooking. could straighten up the house at that time and help get dinner on the table.” If your
which may be organized by a hospital, guests overstay their welcome, you or your partner should not be afraid to politely
place of worship, community center or Get some exercise Exercise is a great ask them to leave.
school district. You can also reach out to stressbuster. Walk your baby in the stroll-
other new moms or dads through online er outside or at the mall or a gym. Join a
support groups or at the neighborhood parent-baby exercise class. Carry baby
park. By sharing honest stories, laughing while you garden or hike. See Chapter 30 with a fussy newborn, take the baby out mation about postpartum depression.)
and maybe even crying together, you’ll for more on exercise. for a walk. Bring your baby to the office Feeling overwhelmed or stressed doesn’t
not only realize that you’re all dealing for a meet and greet. If you can, have make you a bad parent. Learning to han-
with similar issues, but you might also Build a network of social support your partner, a friend or someone else dle the new stress in your life can help you
form strong, lasting friendships. Social support is one of the most impor- you trust stay with the baby so that you enjoy the riches parenting has to offer.
Over time, you’ll become confident of tant buffers against stress. Both women can get out by yourself.
your abilities to recognize and meet your and men need a support network during
baby’s needs. As your doubts diminish and their baby’s first year. Seek out friends and Nurture your other relationships
your confidence grows, you’ll carry your family who can give you encouragement Your newborn needs your love and atten- LONG DAYS, SHORT YEARS
new responsibility with grace and ease. and practical help. Your support network tion, but you won’t let your baby down by
may include your partner, friends, parents, spending time with others. If you have Despite the ups and downs of the first
siblings, a lactation consultant, doula, co- other children, set aside one-on-one year, chances are your sense of accom-
workers, neighbors or visiting nurses. Find time with each of them. Schedule dates plishment and joy will make up for the
HANDLING NEW-BABY STRESS ways to connect with other parents in with your partner. Meet a friend for lunch long days and nights, the fatigue and the
your neighborhood or community. Hav- or a movie. worries. As your baby grows and chang-
Your bundle of joy also brings a bundle of ing friends who can really relate makes es, you’ll grow and change, too. You’ll
stress, which goes hand in hand with a your journey easier and more fun. Know when to seek additional help create new routines, discover your par-
major life change. Besides the disrupted Parenting is a challenge, even on a good enting quirks and learn from missteps.
sleep, new responsibilities and changes in Get out of the house The change in day. If you’re depressed or having trouble You may even discover a new sense of
your lifestyle, other sources of stress in- routine during maternity leave can be es- adjusting to life with a newborn, consult meaning in life, greater self-esteem and a
clude financial strain, hormonal fluctua- pecially hard on women who are used to your care provider or a mental health pro- deeper connection to your family and
tions, changes in your identity, less time going to work. If you’re going stir-crazy fessional. (See Chapter 30 for more infor- community.
404 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 29: ADAPTING TO YOUR NEW LIFESTYLE 405
CHAPTER 30
Taking care of yourself
After months of anticipation and the rig- RECOVERING FROM LABOR

ors of labor and delivery, your attention AND CHILDBIRTH
shifts to caring for your new baby — but
you also need to take care of yourself. In The early weeks after labor and delivery
many cultures throughout the world, can be exhausting, and you may experi-
postpartum customs hold that new ence a wide range of aches and pains.
mothers recuperate by resting — often Will your body ever get back to normal?
for a month or longer — eating (or not Realistically, you’re not going to
eating) certain foods and being pam- bounce back right away. It takes time to
pered by family members. You probably recover from the dramatic changes that
won’t have someone bringing you chick- took place over the previous nine months.
en soup while you lounge around for 40 Gradually, however, you’ll start to feel
days, but it’s important to restore your better and get back in shape. If you had a
strength and nurture yourself. cesarean delivery, you can expect a few
Personal care after labor and delivery additional discomforts and precautions
may involve managing a C-section during the postpartum period.
wound or vaginal tear, sore breasts, uri- Pain and fatigue are the most com-
nation problems, hair loss, and more. But mon complaints after delivery, whether
recovery extends beyond your physical vaginal or cesarean. After your baby’s
health. It also includes your mental well- birth, your uterus begins shrinking back
being — dealing with mood swings, irri- to its normal size. You may feel contrac-
tability, sadness and anxiety. And it en- tions — called afterpains — for a few
compasses your emotional health, from days after delivery. During the first weeks
your need for personal time and interests of caring for your newborn, you may also
to shifting friendships and the gradual feel profoundly tired. After the demands
return of romance. of labor, you’re hit with round-the-clock
CHAPTER 30: TAKING CARE OF YOURSELF 407

infant care and night after night of inter- with plastic, which can irritate your Z Take the sting out of urination. Squat Return of your period (maybe)
rupted sleep. The energy required for nipples. Change wet pads. rather than sit to use the toilet. Pour Women who aren’t breast-feeding can
breast-feeding and carrying around a Z Don’t pump to prevent leaking. This warm water over your vulva as you’re expect their menstrual cycle to start up
baby can add to your exhaustion. Over may prompt more milk production. urinating. again six to eight weeks after the birth, or
time, your fatigue should lessen as your Z Help ease engorged breasts. Express a Z Prevent pain and stretching during sooner. If you’re breast-feeding, your pe-
body adjusts to the rhythms of mother- little milk, either manually or by feed- bowel movements. Hold a clean pad riods may not start again for months, or
hood, you gain experience in dealing ing your baby. If you’re not breast- firmly against the wound and press even until your baby is fully weaned.
with your baby and the baby sleeps feeding, avoid pumping or massaging upward while you bear down. This will Before your first period returns, your
through the night. your breasts, as this encourages milk help relieve pressure on the wound. ovaries may release an egg. That means
Beyond the first few weeks of physical production. Z Sit down carefully. To keep your bot- you could get pregnant again, even if
recovery, you may continue to experience Z Soothe sore or engorged breasts. Apply tom from stretching, squeeze your but- you’re breast-feeding. Unless you want
various changes. While not always dis- cold washcloths or ice packs to the tocks together as you sit down. If sitting another baby right away, use birth con-
cussed openly, these issues are common. breasts, or take a warm bath or show- is uncomfortable, use a doughnut- trol as soon as you resume having sex.
er. Over-the-counter pain relievers shaped pillow to ease the pressure.
All about the breasts Your breasts may help, too. Z Do your Kegels. These exercises help Bathroom woes A leak when you
may remain enlarged for a while after Z Take a break. If a nipple becomes tone the pelvic floor muscles. (See cough or laugh. Hemorrhoids. Bowel
your baby’s birth. If you’re not nursing, cracked, you may need to keep your page 418 for instructions.) troubles. After you give birth, you may
they may be engorged — heavy, swollen baby off that breast for a few days and Z Look for signs of infection. If the pain find that going to the bathroom isn’t the
and tender — and hard until you’re no express milk to avoid engorgement. intensifies, or the wound becomes simple act it once was.
longer producing milk. Even if you’re Z Try to clear a blocked duct. Start feed- hot, swollen and painful or produces
breast-feeding, your breasts may at times ings with the affected breast and gen- a pus-like discharge, contact your Urination problems Soon after delivery,
overfill and become engorged. Engorge- tly massage it while feeding. care provider. the tissues surrounding your bladder and
ment usually lasts less than three days,
but it can be uncomfortable. Healing down under You’ll have vagi-
When you begin breast-feeding, your nal discharge (lochia) for up to six weeks
nipples may feel sore or tender. In the after delivery. Expect a bright red, heavy PREVENTING BACK PAIN
early weeks of breast-feeding, a milk flow of blood for the first few days. The
duct may become blocked. Your breast discharge will gradually taper off, chang- Back pain is common during pregnancy. It typically gets better within a few weeks
may feel tender and lumpy, and the skin ing from pink or brown to yellow or white. of delivery, but lifting and carrying a growing baby all day can bring back your
may be red. Leaky breasts are another To reduce the risk of infection or injury, backaches.
common problem. You might find your- use sanitary pads rather than tampons. To help prevent back pain or injury, try these tips:
self leaking when you think or talk about If you had an episiotomy or vaginal Z Begin exercising soon after delivery to restore muscle tone to your abdomen
your baby, hear a baby cry, or go for a tear during delivery, the wound may hurt and back. Do stretching exercises on the floor to restore hip and back flexibility.
long stretch between feedings. for a few weeks — especially when you Z Practice good posture. Stand up straight when holding your baby. While nursing,
To keep your breasts comfortable: walk or sit. Extensive tears may take lon- sit in an upright chair and bring baby to your breast, rather than bending over.
Z Seek support. Wear a good-quality, ger to heal. In the meantime, to help pro- Z Carry your baby in a front pack when you’re walking. Don’t carry a child on
well-fitting bra. mote healing: your hip, as this overloads your back muscles.
Z Keep your breasts clean and dry. Let Z Soothe the wound. Use an ice pack, or Z Try not to lift anything heavier than your baby for a while.
your nipples air-dry between feed- wrap ice in a washcloth. Chilled witch Z When you pick up your baby, keep him or her close to your chest. Avoid twist-
ings, and go topless occasionally, es- hazel pads — available in most phar- ing your body or stretching out your arms to lift him.
pecially when resting. macies — may help, too. Z When picking up baby from the floor, bend at your knees, squat down and lift
Z Wear nursing pads. You can’t do any- Z Keep the wound clean. Use a squirt with your legs.
thing to stop your breasts from leak- bottle filled with water to rinse the Z Be careful when bending over the crib side and lifting your baby out. If it is safe
ing, but wearing nursing pads inside tissue between the vaginal opening for baby, raise the crib mattress so you don’t have to reach down so far.
your bra can help keep your shirt dry. and anus (perineum) after using the
Avoid pads that are lined or backed toilet. Soak in a warm tub.
408 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 30: TAKING CARE OF YOURSELF 409
urethra are swollen and bruised, which can time, wear sanitary pads and do frequent swollen veins in the anus or lower rectum. BABY BLUES AND DEPRESSION
lead to difficulty urinating. Fearing the Kegel exercises. If urinary problems don’t You may develop hemorrhoids during preg-
sting of urine on the tender perineal area go away, talk to your care provider. nancy or discover them after giving birth. You’re marveling at the miracle of the
can produce the same effect. Difficulty uri- To ease discomfort while hemor- newborn in your arms and falling in love
nating usually resolves on its own within Bowel movements You may not have a rhoids heal, soak in a warm tub and ap- with this new person in your life. At the
about a week. To encourage urination: bowel movement for a few days after de- ply chilled witch hazel pads to the af- same time, you might find yourself sit-
Z Contract and release your pelvic mus- livery. Your abdominal muscles are re- fected area. Your care provider may ting on the couch in the middle of the
cles while sitting on the toilet. laxed and stretched, which can slow the recommend a topical hemorrhoid medi- afternoon, still in your pajamas and
Z Drink plenty of fluids. passage of feces through your bowels. cation as well. needing a shampoo. You see dishes in the
Z Try taking a warm bath. This slowing can lead to constipation. In Avoiding constipation and straining sink, dirty laundry overflowing the ham-
Z Soak your hands in cold running wa- addition, you may find yourself avoiding can help prevent hemorrhoids. To keep pers and dust bunnies lurking under the
ter, or run the tap while you’re in the bowel movements out of fear of hurting your stools soft and regular: furniture. The tears flow as you wonder
bathroom. your perineum or aggravating the pain of Z Eat foods high in fiber, including when you’ll get more than an hour and a
Z Spray warm water across your vulva hemorrhoids. fruits, vegetables and whole grains. half of sleep at a time. Perhaps you’re re-
with a squeeze bottle. Some new moms have trouble con- Z Drink plenty of water. sentful of your partner, who’s out in the
A potentially longer term issue is trolling bowel movements (fecal inconti- Z Remain as physically active as possible. world with other adults.
leaking urine (urinary incontinence). nence) — especially if they had an un- Z If your stools remain hard, ask your Childbirth triggers a jumble of pow-
Pregnancy and birth stretch the connec- usually long labor. Frequent Kegel care provider about a stool softener or erful emotions, from excitement and joy
tive tissue at the base of the bladder, exercises can help. If you have persistent fiber laxative. to fear and anxiety. Mood swings, irrita-
which can damage nerves and muscles in trouble controlling bowel movements, bility and sadness are common. Most
the bladder or urethra. As a result, you consult your care provider. Hair and skin changes During pregnan- new moms experience what’s called the
may leak urine when you cough, strain or cy, elevated hormone levels put normal baby blues — feeling stressed, anxious or
laugh. This problem usually improves Hemorrhoids Pain during a bowel move- hair loss on hold. The result is often an upset, angry with their partner, the new
within three months, but for some wom- ment and swelling near your anus may extra-lush head of hair — but now it’s baby or their other children. You may cry
en, incontinence persists. In the mean- indicate hemorrhoids — stretched and payback time. After delivery, your body for no clear reason, have trouble eating,
sheds the excess hair all at once. Don’t sleeping and making decisions, and
worry — the hair loss is temporary, and question whether you can handle caring
by the time your baby is 6 months old, for your baby. The baby blues usually set
WHEN TO CALL YOUR CARE PROVIDER your hair will probably be back to nor- in two or three days after the birth and
mal. In the meantime, shampoo only last from a few hours to a week or so.
If you have concerns about your postpartum recovery, talk with your care provider. when necessary, use a conditioner and
Also call your provider if you: find a hairstyle that’s easy to maintain.
Z Have a fever or your abdomen is tender to the touch As for your skin, you may see small red
Z Are soaking a sanitary pad every hour for more than a few hours spots on your face after giving birth,
Z Feel dizzy caused by small blood vessels breaking
Z Have a foul-smelling vaginal discharge during the pushing stage of labor. The
Z Notice your blood flow suddenly becomes bright red again after fading in color spots usually disappear in about a week.
Z Experience new or worsening perineal pain Most women get some degree of the
Z Have symptoms of a urinary tract infection, such as pain or burning when uri- dreaded stretch marks, especially on the
nating, a feeling of being unable to empty your bladder completely, or an un- abdomen, breasts, buttocks and thighs.
usually frequent urge to urinate Unfortunately, the marks won’t disappear
Z Have breast pain and feel sick or have a fever after delivery, but eventually they’ll fade
Z Notice your legs become swollen or painful from reddish purple to silver or white. Any
Z Feel hopeless or sad much of the time skin that darkened during pregnancy —
such as the line down your abdomen (lin-
ea nigra) — may slowly fade as well.
410 PART 5: MANAGING AND ENJOYING PARENTHOOD

You can beat the blues more quickly if they tend to get worse, rather than better. Z Having a challenging baby or a baby GETTING BACK INTO SHAPE
you get as much rest as you can, even if PPD may eventually interfere with your with special needs
that means asking for more help with the ability to care for and enjoy your baby Z Other major stresses in life, such as There’s nothing like looking in the mirror
baby. Eat a healthy diet and get some ex- and handle other daily tasks. the death of a loved one after you give birth and realizing you still
ercise. And try to talk openly about your The abrupt drop in levels of estrogen Some men also experience symptoms look like you’re pregnant. Don’t worry.
feelings, particularly with your partner. If and progesterone after childbirth, com- of depression after their babies are born. This is perfectly normal. Unless you’re a
these measures don’t help, you may have pounded by lack of sleep, may trigger the Men whose partners have postpartum Hollywood celebrity, you’re not going to
a more severe form of depression. baby blues and contribute to postpartum depression may be more likely to have slip back into your skinny jeans two
About 10 to 20 percent of new moth- depression. Other factors that may play a depression themselves. weeks after having a baby.
ers experience a more serious, long-last- role include: Don’t feel ashamed or guilty if you Most women lose more than 10
ing depression, called postpartum de- Z Stress from changes in your work and experience postpartum depression. It can pounds during birth, including the
pression (PPD). Postpartum depression home routines happen to anyone — it doesn’t mean weight of the baby, placenta and amni-
may appear to be the baby blues at first, Z Poor emotional and social support you’re a bad mother or father. One moth- otic fluid. Within the next few weeks,
because they share some of the same Z Physical changes after pregnancy er recalls, “After I had my daughter, I felt you’ll likely also drop additional pounds
symptoms. How do you know if it’s PPD? Z Financial or work problems miserable. It started when she was a as you shed retained fluids. After that,
One clue is the length of time you’ve Z Unrealistic expectations about parenting week old and all I could do was cry. I felt weight loss is likely to slow down — and
been feeling down. The mood swings, Z Doubts about your ability to be a like a horrible mom and wife but was the fat stored during pregnancy won’t
anxiety and irritability of baby blues tend good parent ashamed to be put on any medicine. It disappear on its own.
to last a few days to a week or two. Post- Z Changes in your identity and rela- took me eight weeks of crying before I To return to your pre-pregnancy
partum depression is more severe and tionships asked for help.” weight, you’ll need a commitment to eat-
long lasting. Symptoms may begin at any Z Letdown after the excitement of giv- Some people don’t tell anyone about ing healthy foods and fitting in physical
time during your baby’s first year, and ing birth their symptoms because they feel embar- activity — as well as plenty of patience.
rassed or guilty about feeling depressed By maintaining a healthy-eating plan
at a time when they’re supposed to be and exercising regularly, you can expect
happy. But prompt treatment is impor- to gradually lose weight. Sleep counts in
SIGNS OF POSTPARTUM DEPRESSION tant. Left untreated, postpartum depres- your weight-loss plan, too. When you’re
sion can last for months and make it hard exhausted, it’s harder to make smart
If you experience any of these signs or symptoms, make an appointment with your for you to take care of your baby and choices about food and exercise.
care provider right away. Don’t wait until your next postpartum visit. bond with him or her. A number of effec- This effort is worth more than fitting
Z Baby blues that last more than about a week tive treatments can help you cope and into your favorite pants again. The excess
Z Changes in appetite or sleep find the joy in life again. pounds you shed now can help promote
Z Intense irritability and anger, or severe mood swings
Z Overwhelming fatigue
Z Persistent sadness, depression and crying
Z Headaches, chest pains, heart palpitations (the heart beats fast and feels like
it’s skipping beats) numbness, or fast, shallow breathing
Z Trouble focusing, remembering or making decisions
Z Excessive worry about the baby
Z Difficulty bonding with the baby
Z Overwhelming feelings of hopelessness, worthlessness, shame or guilt
Z Lack of joy in life
Z Withdrawal from family and friends
Z Thoughts of harming yourself or the baby
Call for immediate help if you have thoughts of harming yourself or your baby.

a lifetime of good health. Keep in mind Avoid temptation Surround yourself Get comfortable If you’re breast-feed- breast milk, producing a sour taste baby
that women who haven’t lost their preg- with healthy foods. If junk food poses too ing, feed your baby right before you exer- might not like. If you’re breast-feeding,
nancy weight by six months after the much temptation, don’t buy it. Keep it cise. Wear a supportive bra and comfort- you can prevent this potential problem
birth usually end up heavier for the long out of the house. able clothing. by sticking to moderate physical activity
term. In one study, they were 13 pounds and drinking plenty of fluids during and
heavier eight to 10 years later. By 15 Eat smaller portions You may want to Go for a walk Walking is a great way to after your workout. If vigorous activity is
years, these moms faced a high risk of trade the traditional three meals for get back in shape. You can walk almost a priority during the first few months of
developing heart disease and other obe- smaller, more frequent meals. But don’t anywhere at any time, and the only breast-feeding, consider feeding your
sity-related health problems. Women skip meals or limit the amount of fruits equipment you need is a pair of comfort- baby or pumping before your workout —
who exercised during those first six and vegetables in your diet. You’ll miss able shoes. You can go by yourself, with which can also help you stay comfortable
months were less likely to be obese 15 vital nutrients. your baby, and with your partner or a while you’re exercising. Another option is
years later compared with women who friend. Brisk walks will prepare you for to discard milk produced 30 minutes af-
weren’t active. Eat only when you’re hungry If you’re more vigorous activities when you’re ter vigorous exercise.
anxious or nervous, or if you simply think ready for them.
A healthy diet It might seem counter- it’s time to eat, find a way to distract Exercise safely Remember to drink
intuitive, but to take off those excess yourself. Take your baby for a walk, call a Start slowly and build up Begin with plenty of water before, during and after
pounds, it’s important to eat regular meals friend or read a favorite magazine. Also light aerobic activity, such as walking, each workout. Stop exercising immedi-
after your baby is born. Even though you keep in mind that fatigue can masquer- stationary cycling or swimming. Exercise ately if you experience pain, dizziness,
might be busier and more tired than you ade as hunger. a few times a day in brief sessions rather shortness of breath or a sudden increase
bargained for, be careful to eat healthy than for one long period. As your stami- in vaginal bleeding. These may be signs
meals and snacks. It’s also important to Exercise Daily exercise can help you re- na improves, gradually increase the that you’re overdoing it.
make conscious choices about what — cover from labor and delivery, restore length and intensity of your workouts.
and how much — you eat. Compared your strength and get your body back to Stick with it Even after you lose your
with women without children, mothers its pre-pregnancy shape. It can boost Include your baby If you have trouble pregnancy weight, exercise brings many
consume more sugar-sweetened bever- your energy level and cardiovascular fit- finding time to exercise, include your physical and mental health benefits.
ages, calories and saturated fat. ness and help prevent backaches. Physi- baby in your routine. Take your baby for a
Good nutrition not only is important cal activity also brings important psycho- daily walk in a stroller or baby carrier. If
to your well-being, but also benefits your logical benefits. It improves your sense of you prefer to jog, use a jogging stroller
baby if you’re breast-feeding. Instead of well-being and your ability to cope with designed for infants. Lay your baby next
cutting back significantly on how much the stresses of being a new parent. It also to you while you stretch on the floor.
you eat, skipping meals or going on a fad helps prevent and promote recovery from
diet, choose healthy foods. Making wise postpartum depression. Target your abs Losing abdominal fat
choices can promote weight loss while If you exercised during pregnancy takes dietary changes and aerobic exer-
keeping you and your baby in good and had an uncomplicated vaginal deliv- cise, but abdominal crunches and other
health. ery, it’s generally safe to begin exercising ab exercises can help tone your abdomi-
within days of delivery — or as soon as nal muscles (see “Strengthening your
Focus on fruits, vegetables, whole you feel ready. If you had a C-section or a core” on page 416).
grains Foods high in fiber — such as complicated birth, talk to your care pro-
fruits, vegetables and whole grains — vider about when to start an exercise Make it social Invite other new moms to
provide you with many important nutri- program. join you for a daily walk, or join a post-
ents while helping you feel full longer. It might seem crazy to expect to fit in partum exercise class at a local fitness
Other nutrient-rich choices include low- exercise when you can’t even find time club, community center or hospital.
fat dairy products, such as skim milk, yo- for sleep — but every bit helps. You might
gurt and low-fat cheeses. Skinless poul- be surprised by how much better you feel Breast-feed or pump before a vigorous
try, most fish, beans, and lean cuts of beef after a 10-minute walk. Here are some workout High-intensity physical activity
and pork are good sources of protein. tips to get you started. may cause lactic acid to accumulate in

Head Lifts Head lifts can progress
to shoulder lifts and curl-ups, all of
STRENGTHENING YOUR CORE
which strengthen the abdomen.
When you can do 10 head lifts at a
Exercises to tone and strengthen your abdominal and pelvic floor muscles can be benefi-
time, proceed to shoulder lifts.
cial after giving birth. They restore abdominal strength, tone and flatten the abdomen and
1. Lie on your back with your knees
help you maintain good posture. It’s also important to strengthen your back. If you have
bent, your feet flat on the floor,
the time and with your care provider’s OK, try these exercises.
and your arms along your sides.
Inhale.
Exercises printed with permission. © 2009 The American College of Obstetricians and Gynecologists.
2. Exhale slowly as you lift your
head off the floor.
3. Inhale as you lower your head.
Leg Slides They tone the abdo- Shoulder Lifts When you can do
men and legs. This exercise does 10 shoulder lifts at a time, proceed
not put much strain on your incision to curl-ups.
if you’ve had a cesarean birth. 1. Lie on your back with your knees
1. Lie flat on your back and bend bent, feet flat on the floor, and
your knees slightly. arms along your sides. Inhale.
2. Inhale. Slide your right leg from a 2. Exhale slowly and lift your head
bent to a straight position. Ex- and shoulders off the floor.
hale, and bend it back again. Reach with your arms so you do
3. Keep both feet relaxed on the not use them for support.
floor. 3. Inhale as you lower your shoul-
4. Repeat with left leg. ders to the floor.
Kneeling Pelvic Tilt This exercise Curl-ups

also strengthens your abdominal 1. Lie on your back with your knees
muscles. bent and your feet flat on the
1. Kneel on your hands and knees floor.
with your back straight. Inhale. 2. Exhale. Reach with your arms,
2. Exhale and pull your buttocks and slowly raise up halfway be-
forward, rotating the pubic bone tween your knees and the floor.
upward. 3. Inhale as you lower yourself to
3. Hold for 3 seconds. Repeat five the floor.
times.
© MFMER
© MFMER
416 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 30: TAKING CARE OF YOURSELF 417
Kegel exercises These exercises also MOM AND DAD BREAKS Take your son or daughter out for a SHIFTING FRIENDSHIPS
tone your pelvic floor muscles and can walk, or find someone to watch the baby
help control bladder leaks, heal your During the first weeks at home with a for a few hours while you get out. Con- Along with all the other changes in your
perineum and tighten your vagina. Tight- newborn, simply finding a few minutes a sider swapping child care with other new life, expect some transformations in your
en (contract) the muscle that you use to day to attend to basic hygiene — bathing, moms or joining a child care cooperative. friendships after you have a baby. You
stop your urine flow. Hold the contracted showering, getting dressed — can be If possible, plan a regular activity outside might miss your friends and still need
muscle for up to 10 seconds and then re- challenge enough. Part of the stress of the house, such as a yoga class or book them as much as ever, but you won’t
lease. Repeat the exercise 10 times. Do early parenting comes from the nearly group. have as much time and energy to devote
Kegels at least three times a day. You can constant demands on your energy and to them. You can’t pop out for coffee or a
do them while standing, sitting or lying resources. But burning yourself out won’t Pamper yourself Make an arrange- walk without some planning, and con-
down — even while breast-feeding. help you or your baby. You’ll be better ment with your partner, a friend or a rela- certs or movies, parties, and late dinners
able to meet these demands if you ar- tive to watch the baby while you have may be a thing of the past (at least for
Keep it real(istic) Through diet and range to have at least a few hours to lunch with a friend or go on a special now). The baby’s wail can bring phone
exercise, you can lose up to 1 pound a yourself every week. Taking occasional outing. Schedule a manicure, massage or conversations to an abrupt end.
week. It may take six months or longer to breaks from your parenting role is good. facial, or take advantage of a free make- As you’re adapting to your new iden-
return to your pre-pregnancy weight — Doing so can reduce stress, help you feel over at a local department store. If you tity and lifestyle, it might take a while to
and even then, your weight may be dis- more in control and give you a sense of can’t get away, treat yourself to a sooth- sort out how your friendships fit in. Stay-
tributed differently from how it was be- return to your normal self. ing, scented bath, or shut the door to ing connected to friends who don’t have
fore you became pregnant. Be gentle your bedroom, light a candle and listen kids requires patience and understand-
with yourself as you accept the changes Look good, feel good Yes, there will to some music. ing on both sides. Some friendships may
in your body. Above all, take pride in your be days when you’re still not showered drift or fall away, while others form new
healthy lifestyle. Being physically active or dressed at 3 o’clock in the afternoon, Hang on to your own interests Of patterns.
will help you set a positive example for and that’s OK. But getting dressed and course, your baby may be your No. 1 in- This is also a time when you’ll make
your child in the years to come. cleaned up will make you feel like a regu- terest right now, but try to find time to new friends with other parents who can
lar adult again. Figure out which groom- pursue other activities or hobbies you relate to the sleepless nights, spit-up and
ing routines make you feel good and enjoy. Go for a walk, read a book, write, diapers. “Truly, there was no comfort to
which are too time-consuming. If drying draw or listen to music. me like fearfully asking, ‘Does your baby
your hair takes half an hour, consider a do this?’ and getting knowing nods in re-
shorter cut. Keep the routines you prize Share your feelings Talk about your sponse,” says one mom. Another mom
most, such as putting on lipstick. Keep feelings with someone you trust. Be open appreciated connecting with other wom-
your beauty and grooming supplies in about your feelings of anger, frustration en in a lactation group: “It was just nice
one convenient place. and sadness. Be sure to keep communi- to get advice from other moms, or just to
cating with your partner. say, ‘Oh yeah. I’ve been there.’ … Some-
Get out of the house Being house- times you’d hear a worse story than
bound with a crying newborn day after Let go of guilt Many moms say they yours, like, ‘Oh, your child got up nine
day can make anyone stir-crazy. A little feel guilty about taking a time-out from times last night! Mine got up only three
fresh air or a change of scenery can go a baby and household duties. By nurturing times. That makes me feel better!’”
long way in renewing your energy. As yourself, however, you’re helping your- The support of friends can help you
parenting columnist Lisa Belkin writes, self be a better parent. avoid isolation and help beat the blues.
“The lightness. The freedom. The awe To help keep friendships strong through
that the world is still here, just the way Cut yourself some slack If you this time of transition, try these tips.
you left it. The return of a previous ver- haven’t checked off everything on your
sion of yourself. It’s the way I felt when to-do list, be realistic about what you can Let your friends know you care You
each of my boys were newborns, and accomplish in one day. Cut down on might not be able to go out for a weekly
I left the house alone for the first few some of the less important “shoulds” to dinner like you used to, but reassure your
times.” make time for some wants. friend you still want her to be part of your
CHAPTER 30: TAKING CARE OF YOURSELF 419

life. Even if you have just five minutes, REKINDLING ROMANCE occasional soaks in the tub. Rekindle the share your concerns with your partner.
call or text a friend to say hello. spark that brought you together in the Also talk about your feelings about your
Sex after pregnancy happens. Honestly. first place. (For more ideas on nurturing new roles as parents.
Connect with other parents Make But it might not happen very soon, or your relationship, see Chapter 32.)
friends with other parents. Keep in touch very often — romance usually isn’t a pri- Most sexual problems that women Focus on the moment For most
with the people you met at prenatal class, ority for new parents. Many factors con- experience after pregnancy resolve with- women, sexual response requires the en-
take a parenting class or join a parenting tribute to a decrease in sexual activity in in a year. In the meantime, concentrate tire brain. Keep your mind on yourself
group. You may find parenting resources the first year after childbirth. These in- on promoting your physical and mental and your partner — not the diapers,
and groups at local schools, child care clude vaginal soreness, exhaustion, post- health, be patient and ease back into in- laundry and other household chores.
centers, community centers, health clin- partum blues, an unpredictable schedule, timacy and sex.
ics, hospitals or houses of worship. changes in libido and body image, and Make love when you have the energy
the adjustment of going from partners to Take it slow Start with cuddling, kiss- If you’re too tired to have sex at bedtime,
Avoid the ‘child vs. childless’ battle parents. Your bedroom may have turned ing or massage. Gradually build the in- say so. Consider making love early in the
Many people without kids say their par- into a nursery, pumping station and dia- tensity of stimulation. If vaginal dryness morning or while your baby naps.
ent friends treat them like they just don’t per storage center — not exactly condu- is a problem, use a lubricating cream or
get it. While your friends might not know cive to romance. gel. Try different positions to take pres- Get help if problems persist If
exactly what you’re going through, that Some women feel ready to resume sure off any sore areas and control pene- months go by and you’re still not inter-
doesn’t mean they can’t empathize with sex within a few weeks of giving birth, tration. Tell your partner what feels good ested in sex, your mood is consistently
you or don’t care about your baby. while others need a few months or longer. — and what doesn’t. low or you find little joy in life, contact
In surveys of new parents, most say they’re your care provider. Postpartum depression
Spend time together in ways that having sex by six weeks after the baby is Share your feelings If you’re not feel- can sap your sexuality. Also consult your
work for everyone Explain your new born — and most also say that sleep is ing sexy or you’re afraid sex will hurt, provider if sex continues to be painful.
realities to your friends — you need to be more important than sex, and they’re not
home by 6:30, for example, or might have having sex as often as they did before.
to cancel at the last minute. Maybe you can Whether you give birth vaginally or
put your baby in a backpack and go hiking, by C-section, your body will need time to
or walk together while you push the stroll- heal. Many care providers recommend
er. (Your baby is more portable now than he waiting six weeks before having sex. This
or she ever will be again!) If you’re craving allows time for the cervix to close, post-
some one-on-one time to catch up, find a partum bleeding to stop and any tears or
time when you can get out by yourself. repaired lacerations to heal. After a vagi-
nal delivery, decreased muscle tone in
Be a friend as well as a mom Your the vagina may reduce pleasurable fric-
focus these days might be almost exclu- tion during sex — which can influence
sively on your little one, but friendship is arousal. This is usually temporary. Due to
built on mutual empathy, listening, laugh- hormonal changes, your vagina may be
ing together and sharing interests. Even dry and tender, especially if you’re breast-
other moms might want to talk about feeding. If this is bothersome, talk to your
something other than parenting. Take an care provider about estrogen cream to al-
interest in your friend’s life, and make sure leviate some of the dryness.
you’re listening and giving to her. Until you’re ready to have sex, you can
maintain intimacy in other ways. Spend
Talk it out If you’re feeling tension in a time together without the baby, even if it’s
friendship after bringing baby into the just a few minutes in the morning and af-
picture, have an honest conversation ter the baby goes to sleep at night. Share
about the changes you perceive. short phone calls throughout the day or

CHAPTER 31
Dads and partners
Nature consigns dads and partners to a Few first-time parents — men or

supporting role during pregnancy and la- women — feel fully prepared for the mix-
bor. Not so after the baby arrives. Then ture of emotions ahead. Sometimes new
parenting becomes a gender-neutral ac- parents are amazed at the intensity of
tivity — dads and partners can (and do) their feelings for their new son or daugh-
take on just about any baby-care task ex- ter and the extraordinary sense of close-
cept breast-feeding. These days, fathers ness they feel to their partner and the
spend twice as much time performing baby. Such feelings are important buffers
child care each day compared with dads in the hectic days ahead, when infants
in 1985 and nearly three times as much cry frequently and fatigued mothers may
as dads did in 1965. have trouble coping.
Still, many dads and partners feel un- Later, perhaps on your child’s first
certain about their new roles and respon- birthday, you may look back and realize
sibilities. Becoming a parent is a momen- that, for all the strain associated with
tous transition for both parents. While pregnancy and that first year, parenthood
you didn’t go through the physical brings an incredible richness to daily
changes of pregnancy and labor, you may living — a bond that’s so unique and
be experiencing your own dizzying mix rewarding.
of feelings, from doubts about whether Nothing can quite compare to the joy
you can diaper a baby to a surge of love of seeing a newborn’s smile or to the ex-
and pride. You’re trying to be supportive citement of watching the wobbly first
of your partner while figuring out who steps of a toddler. “You know those mo-
you’re going to be as a dad. Work and fi- ments of him giggling and falling asleep
nancial pressures also may loom large. on your shoulder,” says one new father.
This can be a rewarding, yet stressful, time. “Those things are just priceless.”
CHAPTER 31: DADS AND PARTNERS 423

SHIFTING ROLES there for their kids physically and emo-
tionally. One new father explains:“I’d like DECIDING TO STAY HOME
Just a few decades ago, fathers were not to be close to our son. … and I’d like to do
expected to play much of a role in family the things that maybe weren’t typical of a If you’re a stay-at-home dad, you’re in the minority — just 3 percent of parents
life. Dads were viewed mainly as bread- father before — feedings, changing dia- who care for their kids full-time are dads. You might also be the envy of other dads.
winners. That meant long hours at work, pers, holding him, getting him to relax Although very few fathers stay home full time to raise children, more than half said
which was a man’s first priority. Moms, before bed, walking with him in the mid- they would consider this option if they could, according to one study.
as “homemakers,” assumed most or all of dle of the night.” For most parents, regardless of gender, staying home with the baby isn’t an
the responsibility of raising the children. Men’s shifting roles have led to new option, since both incomes are needed. Even if it’s financially feasible, other barri-
Today, the traditional family structure options and opportunities, as well as ers might keep a man from staying at home. Deeply rooted cultural beliefs can
— where one parent works and the other conflicts and challenges. For some men, make men uncomfortable with the role of primary caregiver. You may feel less
stays home to care for the kids and do the shared parenting is better than “allowing “manly” or tough if you stay home with the kids.
housework — is the exception. It’s been work to take over every nook and cranny Stay-at-home dads may also face criticism from family members. One father
replaced largely by dual-earner couples of your life,” as one dad puts it. For oth- notes, “I am copping a lot of flak for choosing to be a stay-at-home dad. Espe-
and single-parent households. As wom- ers, taking care of the children provides a cially from my own parents. … They feel that (my wife) needs to bond with the baby
en spend more time at work, they expect sense of purpose and structure during more than I do, and they think the baby will get confused.”
more help at home, and men and women times of unemployment. Many dads are At the other extreme, some stay-at-home dads find themselves the subject of
are increasingly sharing child-raising re- working to find a balance between their too much attention — almost glorified — when they’re out and about with baby.
sponsibilities. breadwinner and caregiver roles. “Man- Notes one such dad, “We don’t need special treatment and certainly don’t want it.
It’s not just external influences lead- liness means facing the challenges and We’re parents, just like all of those moms. All we care about is doing what’s best
ing men to be more involved with their fears of parenting, acquiring the skills, for our kids.”
families. Most dads today want to fully taking responsibility, having fun, learn- If you do decide to become a pioneer and stay home with your baby, consider
embrace their roles as fathers — being a ing to love and be loved,” says one father. the trade-offs you’ll face. You need to balance your parenting goals with your ca-
“good father” means caregiving as much “It’s about being your own man, instead reer goals, taking into account what you might be giving up in terms of retirement
as being a breadwinner. Dads want to be of just being your job.” benefits and possible promotions, skills or opportunities related to work.
HANDLING COMMON Uncertainty about baby care The

CONCERNS ability to care for children may seem to
come naturally to some people, but most
For both dads and moms, the first weeks parents learn on the job. Feeling unsure
home with baby can be overwhelming, or anxious about how to handle a baby,
especially if being at home is new to you. especially in the first weeks, is normal.
On top of feedings, diaper changes and Women don’t know instinctively what to
crying spells, you must find time to do do either, but they often spend more time
household chores and other daily activi- with the baby in the first months. If you
ties. If you’re used to a carefree, indepen- have to go back to work while your part-
dent lifestyle, you may have trouble ac- ner stays home, you miss out on that full-
cepting your new responsibilities. Sleep immersion experience of caring for your
deprivation can take a toll on your ability infant.
to cope. During this time of transition, The best way to master the tasks of car-
you may feel surprised, amazed, con- ing for a baby is to jump in and do them.
fused, stressed — or all of the above. Get involved — do whatever you can,
Many dads and partners experience whenever you can. With time and practice,
some common challenges and concerns. you’ll recognize your baby’s needs and

no easy answers, talk together about side the home. Both roles are seen as le-
WHAT DADS DO family finances. Work out a plan you and gitimate. But workplaces tend to be less
your partner both feel good about. Talk- accepting of men who make family a top
As a father, or a partner, you play a key role in your baby’s healthy development. ing with other couples facing similar is- priority, and many dads face challenges in
Positive interactions and shared activities between infants and dads enhance chil- sues or meeting with a financial adviser balancing the competing demands of
dren’s mental development and improve their social and emotional outcomes. may also be useful. work and family.
Even when mothers and fathers share equally in the parenting duties, dads bring While many men say they’d like to
their own style to the venture. While mothers often can calm an upset baby more Reduced attention Some dads fear spend more time at home after the baby’s
easily, fathers tend to play with their children more. The games men traditionally that their partners will focus all of their birth, few actually take significant time
play — vigorous, active games — help babies develop physically as well as intel- attention and affection on the baby now. off, perhaps because of limited paternity
lectually. Fathers do well in a teaching or coaching role, setting goal-oriented tasks The fear has roots in reality. After the leave. It can be difficult to return to work
for their children. birth, babies and moms usually do get so soon, however.You may feel like you’re
Being actively involved with your infant not only benefits your baby, but also most of the attention from family and missing out, feel bad about leaving your
enhances your own well-being. Dads who spend time with their infants and chil- friends — and you will have to share your partner on her own and feel squeezed for
dren report an increased sense of competence, greater satisfaction with parenting, partner’s affections and attention with time to spend with your newborn.
and a newfound sense of maturity, personal growth and responsibility. As one dad this new member of the family. Try not to Many dads and partners say that
reflects, “Taking care of my children is the toughest challenge I ever faced, but fac- take feelings of exclusion personally. Talk while their responsibilities at home have
ing it strengthened me and enlarged my life.” with your partner about how you feel, increased, their job expectations and
and spend some time alone with her. hours stay the same. Other challenges
include demanding workloads, long
Support and resources Some new workdays and lack of flexibility. Some
acquire the skills to feed, diaper, hold, dress, Get information If you don’t know fathers have dads who weren’t around dads say they welcome a more balanced
bathe and soothe him or her. something, ask questions or learn from during their growing-up years or who approach to life — that they don’t want
other parents, books, websites and pro- weren’t the best role models. In this case, to think about work 24/7. Others worry
Consider taking parental leave The fessionals. you may have to sort through conflicting
more time you can spend with your baby, feelings about fatherhood and find other
the more competent and effective you’ll Trust your instincts You’ll get to know models of a “good father.” Some men say
feel (and be) as a caregiver. If your com- your baby and learn what’s normal for they’re motivated to be a different kind of
pany doesn’t offer paid parental leave, him or her and what’s not. father than they had: “I wish that he
find out if you can take some time off could have been a listener, instead of a
without pay. Increased financial responsibility lecturer,” says one new dad. “I want to be
The cost of your baby’s delivery, health able to understand my child’s experience.”
Take turns caring for the baby Switch care, diapers, clothing and furniture can While many new moms rely on their
off with your partner in feeding and add up quickly. Moving to a bigger home own mothers for support, men don’t of-
changing duties and putting your baby to or paying someone to take care of your ten turn to their fathers for support. In
sleep. If your partner is breast-feeding baby while the both of you work can in- general, new fathers often lack support
and planning to return to work, she may crease the financial strain. Finances also networks, and they have access to fewer
want to pump and store her breast milk. can become an increased concern if one parenting resources, including education,
You can help out by bottle-feeding the of you takes unpaid leave or quits work discussion groups and play groups. For
stored milk. When your baby cries at to take care of the baby. suggestions on how to build or boost
night, take turns responding to baby. If you’re the family’s main financial your support network, see page 404.
provider, you’re probably nervous about
Go along to doctor’s appointments the bump in expenses. But burying your- Work-family balance This is no longer
You’ll learn more about how your baby is self in work can keep you from providing just a women’s issue. After decades of so-
doing and will hear firsthand suggestions the physical and emotional support your cial and demographic changes, mothers
from the doctor. partner and baby need. While there are can choose to stay at home or work out-
426 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 31: DADS AND PARTNERS 427
about losing ground or status at work be- Z Snuggle baby under your chin. Be patient It takes time for your part-
cause they’re less able to dedicate time to Z Lay your naked or diapered baby on ner to recover physically and emotionally
their jobs. your bare chest for skin-to-skin con- from pregnancy while caring for an in-
Like women, men are realizing it’s tact. Turn your baby’s head to the side fant. Be patient with her, and ask for her
difficult if not impossible to have it all — so he or she can hear your heartbeat. patience with you, too. This is a new ex-
to be an ideal worker and parent at the Z Wear your baby in a carrier, and keep perience for both of you.
same time. Combining work and family him or her close to you all day. One of your most important jobs is to
requires some flexibility, as well as a sup- Z Give your baby a bath. provide support and help create a nur-
portive boss and work culture. It might Z As your baby grows, keep holding turing environment for her. Here are
also mean redefining what “success” and hugging him or her. some ideas about how to do that.
looks like and making tough choices. Z Play with the baby. Face-to-face play
helps focus your baby’s attention and Don’t wait for requests or orders Look
provides the first lessons in the shar- for household and baby-care tasks you
ing of expression and emotions. can help with without your partner hav-
BONDING WITH YOUR BABY Z Don’t expect to feel like a dad from ing to tell you.
the moment your child is born. Allow
The powerful and personal experience of your love and commitment to grow Let your partner sleep Arrange for a
pregnancy, labor and birth gives a wom- over time. block of time for her to sleep. Let her take
an a head start on intimacy with her a nap during the day or cover the night
baby. Fathers and partners have to get to feedings.
know this tiny new person.
For some, the emotional attachment UNDERSTANDING YOUR Give her time to herself This is especial-
starts directly after the birth. Many dads PARTNER’S MOODS ly important if she’s home all day with
and partners find that bonding happens the baby. Allow and encourage her to
gradually and may begin with a mix of After childbirth, along with the physical take quiet breaks by herself, get out with
positive and negative feelings. After changes your partner is experiencing, she a friend, exercise or just run errands by
you’ve changed a few diapers and may seem to be on an emotional roller herself.
hummed and rocked your child to sleep a coaster — and taking you along for the
few times, you may sense a warmth of ride. One minute she’s beaming with joy, Give her time to exercise Support your
feeling you didn’t notice in the delivery and the next she’s crying. Mood swings partner in getting some form of exercise
room. A smile, a tiny hand grasping your are common, and most new moms expe- most days and in getting out of the
fingers, the first unsteady steps and the rience the baby blues, triggered in part by house.
first da da can work wonders. major hormonal shifts after birth. Symp-
Take time to connect physically and toms include tearfulness, anxiety and ir- Expect times when she’s moody It can
emotionally with your baby. It will hap- ritability. Your partner may have trouble be upsetting or frustrating to deal with
pen naturally as you’re doing the many eating or sleeping, and she might be- your partner’s emotional swings, but re-
baby-care tasks. Here are some other come angry or upset with you or the new member that the baby blues are tempo-
techniques to promote bonding: baby. The baby blues usually pass within rary. Try not to take it personally. At the
Z Hold your baby close and gaze into a week or two. same time, you can set limits — it’s not
his or her eyes. A more serious issue is postpartum fair for her to use you as an emotional
Z Talk or coo to your baby, stroke his or depression, which lasts longer and in- punching bag.
her skin, and rock your child. cludes more severe symptoms. Because
Z Sing or hum a favorite song or lullaby you know your partner better than any- Watch for postpartum depression Signs
at bedtime. one else, you’re in the best position to and symptoms include anxiety, lack of
Z Lie on your side with your baby next notice changes in mood and behavior confidence and frequent crying spells
to you, facing you. that might indicate a problem. (see page 411 for a list of symptoms). If
428 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 31: DADS AND PARTNERS 429
you believe your partner may have a mood FINDING TIME FOR YOURSELF portant to take care of yourself so you have REKINDLING ROMANCE
disorder, make an appointment to see the reserves you need to be there for your
your care provider together. During this time of transition — when partner and baby. Try these tips to cultivate While resuming your sex life might be
you’re embarking on a great new journey support and carve out time for yourself: your No. 1 priority, your partner needs
Be a good listener Whether your partner and your life is turned upside down — time to rest, recover and get used to the
just wants to talk about how she’s feeling you also need support and time for your- Take some time for yourself Even if new normal before she’ll be ready. Your
or needs to vent, give her your undivided self. But those are just the things many it’s just a couple of hours a week, doing sex life might disappear for a time. How
attention. If she’s experiencing the blues dads and partners say they lack. In stud- something you enjoy — watching a game long? On average, six weeks.
or depression, avoid giving advice, such ies of new fathers, many report having on TV, running or biking, playing golf, or Just because sex is off-limits tempo-
as, “Just think positive” or “You can snap few support systems beyond their part- getting together with a friend — will help rarily doesn’t mean you and your partner
out of it.” ners. Parenting resources, such as classes, you deal with the new stresses in your life. can’t be affectionate — and yes, roman-
play groups and support or discussion Don’t cut yourself off from your friends tic. Schedule private times together, per-
Pamper your partner Serve her break- groups, are often more geared to moms and family or adult activities and fun. haps a weekly lunch or dinner date. If
fast in bed on occasion or give her a mas- than dads, especially for those who can’t your budget doesn’t allow dining out, do
sage. Make time for her to enjoy a long take time off during the day. Men may Ask for help and encouragement Let something special at home — have din-
soak in the bath. also perceive a lack of support at work. your partner know if you need some time ner by candlelight, or enjoy breakfast in
You may not be able to take time off or for yourself or you could use some reas- bed. Cuddle and kiss. Let your partner
Let her know it’s OK not to be perfect work a more flexible schedule. surance that you’re doing OK as a dad. know you find her as attractive as ever.
Encourage her to lower her expectations Finding time for yourself can also be Instead of pressing your partner to
about keeping up the house and other very challenging. As fathers are spending Get guidance, if you need it No one have sexual intercourse, let her decide
daily responsibilities. If she’s bothered by more time with their children and on is born an expert on bringing up a baby. when the time is right. Go slowly, and
a messy house, if you are able to, hire housework, they’re sacrificing their per- Read books and websites about parent- encourage your partner to share her feel-
someone to come in and clean. sonal time, interests and hobbies. It’s im- ing and infant development, and don’t be ings and concerns with you. When you
afraid to ask your care provider, family begin having intercourse, make sure to
members or other parents for tips. use birth control if you don’t want an-
other pregnancy right away.
Reach out to other parents, espe- Eventually you’ll settle into a new
cially other partners Support, infor- routine, and you’ll have some time for
mation and encouragement from others yourselves again. But even then, most
who are going through the same experi- couples don’t have sex as often as they
ence can help you with practical issues did before baby. Many factors can affect
and build your confidence. In turn, this your partner’s (and your) desire for sex,
strengthens your bond with your baby. including fatigue, stress, lack of time for
Consider joining a parent-child class or a yourselves and emotional swings. Make
dad-baby play group. If you can’t find an effort to stay connected as a couple,
one in your area, you could form a group which will help your romantic and sexual
yourself or join an online community. life. (See Chapter 32 for more ideas about
Many websites by and for dads offer sup- maintaining a healthy relationship with
port, a sense of community and resources. your partner.)
Eat well and try to get enough

sleep While you may not be getting sev-
en or eight hours of uninterrupted sleep,
you can make up some of the deficit by
taking naps or going to bed earlier than
usual.

CHAPTER 32
Parenting as a team
As new parents, you’re busy keeping relationship. What makes the difference?
baby fed, diapered, clean, safe, loved and Creating practical strategies to share de-
nurtured. But parenting also entails get- cisions, responsibilities and rewards.
ting dinner on the table, doing laundry, Staying alert to potential pitfalls. Re-
keeping up with housework and earning maining committed to preserving a deep
money to support the family. Along with connection with your partner. The goal is
sharing the joys and pleasures of parent- to work as a team.
hood, you and your partner must also As you and your partner develop
juggle a never-ending, round-the-clock complementary roles and support, you
set of tasks and responsibilities. The may be surprised at the strengths you
stepped-up demands of life with a baby uncover. And the stronger your bond is,
require you to negotiate new arrange- the more effective you’ll be as parents. A
ments for dividing up duties. At the same supportive, mutually satisfying relation-
time, your relationship as a couple is ship serves as the foundation for a
changing as your focus shifts to the baby healthy, happy family.
and you have less time and energy for
each other.
These stresses can set the stage for
strife and ambivalence. About half of A NEW BOND
couples say they’re less satisfied in their
relationship after having a baby. That’s a Many couples say that having a child
discouraging statistic — but the arrival of brought them closer than ever, and it
your baby doesn’t have to lead to a de- gave them a new and powerful point of
cline in the quality of your relationship. connection. Watching your partner cud-
Many new parents adapt to family life dle with the baby, lying next to one an-
while maintaining a positive view of their other with the baby nestled between you,
CHAPTER 32: PARENTING AS A TEAM 433

joining hands with your baby as he or she NEW CHALLENGES
takes those first wobbly steps — sharing ADDED STRESSES
moments such as these bonds you and The rewarding moments are interspersed
your partner in new ways. with the day-to-day stresses of child care Some couples may be more prone than others to relationship problems after the
Many people also appreciate feeling and housework. The first year or so of birth of a baby. You may be more at risk of stress during this transition if you:
like a family or a “complete package.” parenthood is especially hard on a cou- Z Are young
You and your partner may feel a sense of ple’s relationship. No matter how well Z Are unmarried
achievement and fulfillment, especially if you got along before the baby arrived, Z Haven’t been in the relationship for very long
you’ve both longed for a baby or your you may find yourselves disagreeing and Z Have an unplanned or unwanted pregnancy
journey to parenthood included a few becoming annoyed with each other now. Z Are experiencing depression or another mental health disorder
bumps in the road. A baby can be a pow- As one new mom says,“We bickered. We Z Are going through other stressful life events
erful symbol of your love and commit- said crazy things to each other that we Z Grew up with parents who had a poor relationship
ment. And then there’s the fun and hu- never did before.” Z Had a poor relationship with your parents during your childhood
mor you enjoy together, from the silly Part of the problem in the first year is Z Have an infant with a difficult temperament
stuff you do to entertain your baby to the the unique demands of caring for an in- If you’re dealing with one or more of these issues, the first step is to be aware
sight of him or her covered in peas or fant, including the lack of a regular of the risk, and take steps proactively to bolster your relationship. Seek support
carrots as you start solid foods. You can schedule, the crying and the nighttime from family, friends or a counselor if you’re struggling.
even bond over your tales from the trench- feedings. Infant care adds an estimated
es, such as surviving a week of the flu. 35 to 40 hours of work each week to the
average couple’s household. Many cou-
ples say they didn’t realize how difficult time, energy and attention to devote to parenting and their relationship. In dual-
and time-consuming caring for a baby your partner. Even your identity as a cou- earner couples, balancing the competing
would be. In addition, disagreements ple may seem threatened at first. “It was demands can cause confusion and con-
that might have lived in the background always about the baby,” notes one mom. flict. Even when men and women aspire
— about life goals, for example, or how You may feel less like a couple and more to share equally in caring for their chil-
to handle finances — may be brought to like business partners checking items off dren and their home, women often spend
the forefront. your endless to-do list. more time with the household chores
Other issues also may put a strain on and men put in more hours at their jobs.
your relationship. Fatigue and exhaustion Lack of sleep
adds to couples’ stress. Sleep deprivation
Division of labor Along with sex and can make you irritable toward your part-
money, the issue of “who does what” is ner while dampening positive feelings. SHARING THE LOAD
one of the most common arguments You might find it harder to convey your
among couples. How partners divide needs and goals and to consider your Who will do the baby’s bath? Who’s re-
their responsibilities both inside and out- partner’s point of view, two skills needed sponsible for planning meals, buying the
side the home is an ongoing source of for healthy communication. groceries and cooking? Will you or your
discussion and debate, not only in indi- partner be the one to work more hours or
vidual couples but also in books, blogs Decline in disposable income The spend more time at home with the baby?
and articles about parenting. financial squeeze of increased costs, As the saying goes,“The devil is in the
along with a possible dip in income if one details.” Working out the nitty-gritty of
Less time as a couple After your parent reduces work hours, can leave you the day-to-day duties causes many of the
baby arrives, your couple time may seem with little money to spend on a baby sit- conflicts among parents. Before child-
to vanish overnight. Gone are the lei- ter or outings as a couple. birth, most parents-to-be share the ideal
surely meals, evenings snuggling in front of participating equally in family life,
of the TV and impromptu nights out. Changing roles Most parents struggle household management and child rear-
Now that you’re a family, you have less with the competing demands of work, ing. After childbirth, traditional gender

patterns often assert themselves. Al- Check your assumptions Sometimes hiring someone to help with the house- challenging and your relationship re-
though men and women have similar what seems like a choice is actually influ- work or yardwork. But be clear whose requires maintenance.
workloads overall, fathers spend more enced by social or gender norms. For ex- sponsibility it is to make those arrange-
time doing paid work, while mothers put ample, many people (and employers) as- ments. Join a baby-sitting co-op, if one Encourage each other Both of you
in more hours on the home front. The sume that a woman will take more time exists in your area, or start one yourself. need support and encouragement during
difference between expectations and re- off work after the baby’s birth than a man this stressful year. Be sure to talk about
ality can come as a surprise and disap- will. In one study, both spouses viewed what’s positive as well as what’s more
pointment to both partners. the wife’s job as more flexible than the difficult. Tell your partner what you need
To avoid this scenario, jointly work man’s, even if they had the same job! NURTURING YOUR TEAM to feel supported, and do the same for
out a division of labor that distributes the him or her. Discuss how well your needs
stresses — and the rewards — of parent- Stay flexible about how things get To parent together as a team, you have to are being met.
hood. It’s not that you have to split all the done Your partner won’t do chores and nurture your couple relationship as well
responsibilities of life 50-50, but you baby care the same way you do. Agree that as your baby. You and your partner de- Be courteous and considerate
want to come up with a plan that you can it’s OK for each of you to have different pend on each other for support, both When you’re feeling depleted or over-
both embrace — one that allows you to ways of doing things, as long as you’re physically and emotionally. By tending to whelmed, you’re more prone to lash out
work as a team in caring for your baby providing consistency for your baby. your relationship, you’ll feel more satis- at your partner and to be less forgiving.
and sharing decisions and tasks. fied as a couple. In turn, this improves Try not to let courtesy and caring go by
How much responsibility should you Avoid scorekeeping You and your your parenting ability. Studies show that the wayside. Cut yourself and your part-
each take on? Negotiate. Make a list and partner are on the same team — you couples who experience ongoing conflict ner some slack by not overreacting if one
talk about what you can do, want to do don’t need to keep score. Instead of tak- are less responsive and sensitive to their of you is irritable. Try to see situations
and are good at. Structure the arrange- ing a tedious inventory of everything infants in their first year of life. Negativity from your partner’s point of view.
ment as an experiment, and tweak it as your partner is (or isn’t) doing, trust that in a couple’s relationship expands to
you go. Keep communicating about you’re both committed to your family’s family interactions. Be adventurous Plan something small
what’s working and what’s not. One dad success. Work together to solve prob- On the other hand, supportive, mutu- but special for your family each month,
comments, “It’s a lot of give and take. In lems, and don’t complain about who has ally satisfying couple relationships en- and look forward to it together.
the morning I wake (the baby) up, get her the short end of the stick. Pitting your- hance the well-being of the whole family.
dressed, and I get her out the door. (My selves against each other — or men vs. Making a special effort to see yourself
wife) picks her up, she takes care of her women — shortchanges everyone. not just as a mother or father, but as a
while she’s cooking, And when I get partner, is good for both of you — and
home we feed her together. ... Then my Watch out for gatekeeping Does this your baby. Here are some other ways you
wife takes care of her while I do the dish- sound familiar? Dad dresses the kids can nurture your team:
es and then we play for a while. I put her wrong, leaves the house a mess or can’t
to bed.” soothe a crying baby. You may be falling Communicate openly Discuss issues
into the trap of thinking only mom and difficult situations as they arise. Ex-
Acknowledge you may have different knows how to do things the “right” way. press your feelings, and be specific and
priorities Discuss what matters most to This phenomenon, known as “gatekeep- honest about your concerns. Don’t use
each of you in terms of your baby, your ing,” happens when a mother assumes this as an opportunity to blame or criti-
career, your free time and the household the major responsibility for child rearing cize your partner. Make sure you both
chores. You and your partner aren’t going or criticizes a father’s parenting efforts. have time to talk.
to agree on everything — and you prob- Moms can positively influence their part-
ably won’t find a perfect balance. Be will- ners’ involvement by encouraging their Set realistic expectations Couples
ing to negotiate some compromises. efforts and ensuring they have opportu- do better when they share realistic ex-
When you’re dividing up household nities to gain experience. pectations about their relationship and
chores, take into account your prefer- parenting. Discuss what you expect of
ences and strengths and the most effi- Consider alternatives to dividing each other and your family life. Acknowl-
cient use of your time. the work If you can afford it, think about edge that the first years of parenting are

AGREEING ON CHILD REARING they’ll reveal unbridgeable differences or
start major conflicts. But confiding what
From infancy on, child rearing brings you hope will happen and what you’re
countless decisions about a range of is- concerned about strengthens the bond
sues — rules and expectations, discipline, between you.
structure and routines, time with grand-
parents, and exposure to TV and other
media, to name a few. Granted, during
baby’s first year, discipline won’t be a ma- A FIRM FOUNDATION
jor issue, but by the time he or she is a
toddler, you’ll be dealing with misbehav- Your relationship with your partner
ior as your child tests the limits. Will you serves as the foundation for your family.
and your partner agree on what those You make your foundation stronger by
limits are and how to enforce them? engaging with each other with respect
New parents tend to emulate their and mutual appreciation, sharing tasks
own parents in their child-raising beliefs and responsibilities, and regularly tend-
and behavior — though some people ing to your relationship. Parents in satis-
make a point of doing the opposite of fying relationships report feeling more
what their parents did. What’s important confident in their parenting and more
is for you and your partner to discuss resilient in the face of challenges. They’re
your parenting beliefs and come to less worried and stressed.
agreement on the strategies you’ll use. Your parenting patterns are the least
For example, what type of consequences stable during your baby’s first year. Over
will you set when your toddler breaks a time, you’ll establish patterns that work
rule? How will you handle tantrums or for you, and the stress on your relation-
requests to sleep in your bed? How will ship will ease. Practice does makes per-
you encourage cooperation? fect — handling the challenges of this
You and your partner may not agree year together will help you and your
on everything. Acknowledge any differ- partner weather future stresses better.
ences, and develop compromises that al- By approaching parenting as a unified
low you to maintain a united front. Make team, you create an optimal environment
sure you and your partner (and other for your baby to grow up in and form a
adults who care for your child) observe secure attachment to you. You’ll set the
the same rules and discipline guidelines. tone for an affectionate, communicative
This reduces your child’s confusion and family life. For all the challenges raising
need to test you. Work together to pro- your child brings, you and your partner
vide love, attention, praise, encourage- are also in for a lot of fun, love, surprises
ment and a degree of routine. and deep satisfaction.
Both you and your partner come to
parenthood with inner visions of what
you hope it will be. To build a life that sat-
isfies both of you and nurtures your child,
share your core values and choose goals
that matter to both of you. Some partners
don’t want to discuss their hopes and
anxieties because they’re afraid that

CHAPTER 33
Single parenting
If you’re raising your baby on your own, tending to your own needs and happi-
you’re not alone. Single-parent families ness as well.
are more common than ever — more One of the keys to raising a baby on
than one-fourth of children in the United your own is to develop a solid support
States live with one parent, according to network. Other strategies also can help
the U. S. Census Bureau. you manage the challenges that come
The pathways to becoming a single with the territory.
parent range from divorce or the breakup
of a relationship to unplanned pregnancy
to the choice to go it alone. Despite the
large number and variety of one-parent HARD WORK, ADDED PRESSURE
families, stereotypes persist — such as
the struggling “welfare mom.” Today’s All new parents face many of the same
reality, however, is far more complex. For challenges in taking care of a baby and
one thing, about 1 in 5 single parents is raising a child. But parenting without a
a father. partner puts more pressure on you. Along
Parenting without a partner brings with handling the day-to-day duties and
special challenges. The responsibility for decisions, it’s up to you to support your
all aspects of day-to-day child care may family. One woman who chose to be-
fall squarely on your shoulders. Juggling come a single parent felt panicked after
work and child care can be financially she came down with a severe bout of flu:
difficult and socially isolating. But single “What if anything happens to me?” An-
parenting can also be rewarding, and it other single mom worried, “What hap-
can result in an especially strong bond pens if (my baby) gets sick, and I have to
between you and your child. Yes, you go to work? Will I lose my job because
can raise a healthy, happy child while I’m on my own?”
CHAPTER 33: SINGLE PARENTING 441

Many single parents can relate to Prepare for emergencies Even if money Support issues In the first weeks and es of single parenting can be as difficult
these fears. You may face several specific is tight, try to build up an emergency months after having a baby, you’re likely as the practical ones. You may feel differ-
challenges as you adjust to your new role fund. Ideally, you’d have enough to cover feeling more physically and emotionally ent from traditional families or be envi-
and raise your baby. several months’ expenses. vulnerable. ous of the support couples get from each
As a single parent, it’s important to other. You might feel guilty about raising
Financial and work issues Single Find out if you qualify for assistance reach out for support — see the sugges- a child without another parent. If your
parents often are the sole provider for Public programs such as food stamps and tions on page 444. Being a single parent in relationship with the other parent has
their families. This makes it harder to subsidized child care and housing can itself doesn’t increase your risk of depres- ended, you may be grieving the loss of
earn enough money to meet your basic help you stay afloat if you’re having trou- sion or other mental health problems, but your partner, as well as your dreams and
needs, and you may lack a safety net for ble making ends meet. In addition to fed- single parents are more likely to have visions of how your life would be as you
emergencies. As a result, single parents eral benefits, state governments, private other risk factors for depression, such as raised your child together.
— especially mothers — tend to have foundations and faith-based organiza- financial hardship and unemployment. Acknowledge your feelings and
fewer financial resources. Compared tions also offer grants, scholarships and Keep in mind that having a partner mourn the losses. Recognize that it can
with single mothers, single fathers do other assistance. doesn’t help much if your partner isn’t take months or even years to resolve the
better financially, but they earn less mon- supportive. A relationship with an unsup- emotional fallout of separation or di-
ey on average than do married fathers. Check into employment resources If you portive partner may be worse for your vorce. The first two years after the break-
Single mothers also confront more need help with finding a job (or getting a mental health than is single parenting. up are generally the hardest. As you ac-
challenges in finding and keeping jobs. better job), contact your state employ- cept your new reality and your feelings,
To juggle their work and caregiving roles, ment office. Emotional struggles Many single you can begin to move on and create new
single parents may have to reduce their parents say that the emotional challeng- dreams.
work hours, turn down promotions or Consider getting more education or
take less demanding jobs. Single parents training Getting a high school diploma,
in rural areas may lack public transporta- college education or special training can
tion, employment opportunities, family boost your chances of finding a job. SINGLE DADS play groups and books are geared to-
support programs and subsidized child ward women. As a single father, you
care centers. Getting it all done As described in One of the first hurdles single fathers might feel like you stick out at the play-
As a single parent, you may have to Chapter 32, one of the biggest issues new must face is their invisibility in society. ground. You might not appreciate the
find ways to do more with less and be- parents must contend with is how to di- When people hear “single parent,” they unsolicited advice you get. Eventually
come a careful planner. These sugges- vide the endless tasks and responsibili- usually think of a mother. But in the you’re likely to meet other men in the
tions may help. ties of life with a baby. If you’re flying United States, more than 2 million fa- same situation. And if you don’t, make
solo, you don’t have the luxury of this thers are raising kids on their own. an effort to seek out — or create — a
Assess your financial situation Figure debate. You bear the burden of child care Most became single parents as a result support group in your community.
out your income and expenses so that and housework, including the logistics, of divorce, separation or out-of-wed-
you can budget your money. Will you re- organizing and planning. As one single lock birth.
ceive child support? Pay for child care? mother writes, “There is a constancy of In general, single fathers have high-
How many hours will you work? Now parenting on your own that you don’t un- er economic status, work satisfaction
that you have a baby, your expenses will derstand until you’ve had to do it. Noth- and level of education compared with
likely increase, and your income may de- ing ever stops. The minute you wake up in single mothers. Perhaps because of
crease if you’ve reduced your work hours. the morning, you hit the ground running, this, single dads’ overall well-being
You may need to adjust your budget. and needs don’t stop until you pass out. tends to be higher as well.
That’s when things go right.” But single dads face other issues.
Cut down on spending Figure out where On the other hand, since division of Finding support and a peer group for
you can make cuts. Decide which items labor is a main source of conflict among single dads can be more difficult . Many
are most important. Take advantage of couples with children, you don’t have to parenting classes, support groups,
free or low-cost activities, and eat out worry about fighting over who will take
less often. out the garbage or change a diaper!
442 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 33: SINGLE PARENTING 443
FROM SURVIVING TO THRIVING Seek and accept support Probably one you know and trust and who has regular sleep habits, and the feeding
the most important thing you can do as a some experience with babies. schedule might vary from one day to the
As a single parent, some days it may feel single parent is to develop a strong sup- To learn about financial assistance for next. As your baby gets older, create a
like you’re doing all you can just to sur- port network. Practical and emotional child care in your area, contact your local regular schedule for meals, naps and
vive. It will get better. As one mother support from others not only can help child care resource and referral (CCR&R) bedtime. If you’re having trouble estab-
says, ”I learned that regardless of wheth- you handle your responsibilities but also agency. The agency can help you find out lishing daily routines, figure out what’s in
er or not this is the life I planned, this is boost your well-being. Asking for help if you qualify for free or subsidized child your way and brainstorm solutions. You
my life and I need to embrace it. I love can be hard on your pride, since many care. Links to state CCR&R agencies are can also seek assistance from your child’s
being a mom and wouldn’t trade it for people are brought up to believe they available through the National Child care provider.
the world. My son makes all of the diffi- should and must do everything by them- Care Information and Technical Assis-
cult times worthwhile.” selves. But it’s better to lean on others a tance Center or Child Care Aware (see Take care of yourself To help keep
Several strategies have been shown to little than to become so overwhelmed, “Additional Resources,” beginning on stress at bay, include physical activity in
improve outcomes for single-parent depressed or stressed that you can’t par- page 552). The federally funded Early your daily routine, eat a healthy diet and
families. With these in mind, you can cre- ent effectively. Head Start serves infants and toddlers in get plenty of sleep. Make sure you get
ate an environment that helps you and Many single moms say their own low-income families. Local government, some “me time” regularly. Time away
your baby thrive and grow. mothers are their best source of both United Way agencies and other commu- from your baby will help replenish your
practical and emotional support. You can nity or faith-based organizations some- energy and spirit, helping you to be a
also turn to other trusted family mem- times provide child care scholarships. better parent. Even taking 15 or 20 min-
bers, friends or co-workers. Ask for what Some employers may provide scholar- utes to relax can be helpful.
you need, whether it’s someone to baby- ships or discounts. Of course, this is all easier said than
sit while you run errands, a friend to call done. Here are some tips:
when you need to talk or someone who’s Aim for a stable family life Changes Z Arrange for a baby sitter for a few
willing to provide backup child care if in family structure, such as one parent hours once a week so you can get out
your baby is sick or your regular arrange- leaving or a new adult entering the fam- of the house and do something you
ment falls through. ily, can be hard on kids. Try to ensure like, either by yourself or with friends.
If you don’t have family members or consistency in your family and your ba- Z Find a gym with free child care.
friends who can help, look for a support by’s caretakers and, if possible, keep Z Take naps when you can.
group for single parents, or seek social moves and major changes to a minimum. Z Read or walk on your lunch break.
services. Faith communities can be help- Z Take a bath or read a magazine after
ful resources, too. A support group, Create routines Family routines — baby is in bed.
whether in person or online, offers a such as regular bedtimes, mealtimes, Z Get up a little early to enjoy a quiet
great opportunity to share feelings and naps and reading — promote good cup of coffee, write in a journal or do
get advice. health and cognitive development in some yoga stretches.
children. A lack of bedtime and mealtime Z Reduce stress with relaxation tech-
Find quality child care Good child routines, for example, increases the risk niques.
care is crucial for your baby’s well-being that children will have sleep problems, eat Z Let go of guilt about taking time for
and your peace of mind. If you need reg- a less healthy diet and become overweight. yourself.
ular child care, look for a qualified care- Single-parent families are less likely Z Accept your limits, and don’t be too
giver who can provide stimulation in a to keep daily routines for young children hard on yourself.
safe environment. (See Chapter 13 for than are two-parent families. Some of
more information.) Many single parents the reasons include time constraints, fi- Prioritize family time Throughout
say they view their child care provider as nancial pressure, fatigue and lack of sup- your child’s life, and particularly in the
a valued partner in raising their child. port. Do the best you can to establish early years, time with parents is impor-
Be careful about asking a new friend routines. tant to health and development. Single
or partner to watch your baby. Anyone During your baby’s first months, parenting can put the squeeze on your
who cares for your baby should be some- you’re still helping him or her develop time with your baby. Make it a priority —
CHAPTER 33: SINGLE PARENTING 445

even if it means having a messier house “Give yourself a pat on the back daily.
or not getting something else done that What worked out well and what made
day. Set aside time each day to cuddle, you smile today? There is no question
play with or simply hold your baby. Find that being a new single mom is one of
out if you can modify your work schedule the hardest challenges life will throw
to have more time with your baby. your way, but you will get through it and
it will get better.”
Get organized Being organized can If you’re feeling down much of the
help reduce stress. Try these tips: time or find yourself stuck in a pattern of
Z Stock up on basic household supplies, negative thinking, talk to your doctor or
such as toilet paper and diapers, as well consult a counselor or psychologist.
as easy-to-prepare foods and meals
that can be frozen and reheated.
Z Eliminate clutter.
Z Plan your week on a calendar. REWARDS AND STRENGTHS
Z Develop a list of timesavers.
Z Keep a list of baby sitters. Despite the difficulties, being a single
Z Set goals. Figure out what’s most im- parent also brings rewards, including a
portant for your baby’s needs and strong parent-child bond. In this rela-
your needs, and focus on those. tionship, the parent and child depend on
each other, and they may become more
Provide opposite-sex role models communicative and supportive. Over
Children benefit from interactions with time, you may create special routines and
both women and men. If your baby’s oth- rituals together or discover places you
er parent isn’t involved, create opportu- like to go and things you like to do.
nities for the baby to interact with an Children growing up in single-parent
opposite-sex adult who can be a positive families often learn to take on more re-
role model. It doesn’t have to be a ro- sponsibility at home and develop self-
mantic partner. If you’re a single mother, reliance. As for the parents, many say
spend time with a responsible, positive they find a strength they never knew they
male family member or trusted friend. had. Some also appreciate the freedom to
Involve the men in your life in family rit- make child-rearing decisions on their
uals, such as holidays and birthdays. own, without constant negotiation and
compromise. You may find yourself with
Stay positive Make a conscious deci- a welcome clarity about what’s important
sion to focus on the positive and not and learn to let go of what’s not. As a
dwell on the negative aspects of single single parent, you can take pride in your
parenthood. Try to keep your sense of accomplishments and feel good about
humor when dealing with everyday chal- what you’re giving your baby.
lenges, and don’t forget to have fun. Take At first, you might feel overwhelmed
a break from the routine and plan a fun and sad about being a single parent.
activity you can do with your baby, such Overcoming such feelings can foster a
as a hike in the park, trip to the zoo or sense of inner strength. As one mom
picnic with friends. comments, “I have done things I never
One single mother advises recogniz- thought I was capable of all by myself. I
ing your accomplishments and blessings: am in control of my own happiness.”
446 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 33: SINGLE PARENTING 447
CHAPTER 34
Siblings and
grandparents
Bringing home a new baby can be an ex- and understand how you can help your
citing experience for your family. If you older child or children, as well as your
already have a child or children, your parents, adjust to their new roles.
baby is a new sibling. He or she will like-
ly become someone your older child or
children will play with, laugh with and
share a lifelong relationship with. If this SIBLINGS
is your first baby, your parents might be
more eager than you expected to dote on The experience of bringing a newborn
and help care for your newborn. You and home is a little different the second time
your partner might also begin to view around. With your first child, you were
your parents and your relationships with probably focused on recovering from
them differently. childbirth and figuring out how to care
Bringing a newborn home can also for a baby. With the second — or third or
require some adjustments within a fami- fourth — baby, you’re more likely won-
ly. Babies need a lot of attention — which dering how your older child or children
can cut into the amount of time you are going to react to having a new sibling
spend with your older child or children and how you’re going to juggle and meet
and cause jealousy. Grandparents, on the all of their needs. Help set the tone for
other hand, may be so excited about your your children’s early interactions by pre-
new baby that they unknowingly over- paring your older child or children for
step certain boundaries, such as by giving what’s ahead.
unwanted parenting advice.
Don’t underestimate the impact your Introducing your new baby You’ve
tiny newborn might have on your family. probably been talking to your older child
Consider your personal family dynamics, for a while now about the arrival of your
CHAPTER 34: SIBLINGS AND GRANDPARENTS 449

new baby. Perhaps your child has asked care during your time in the hospital, and your family and looking at picture books plenty of individual attention from you
questions about your growing stomach, explain the details to him or her. about babies and families. and other family members once your
gone with you to prenatal checkups or When the new baby arrives, have baby arrives. Grandparents can be par-
helped you set up the nursery. Or maybe your partner or a family member bring Children ages 2 to 4 Children at this ticularly helpful during this time. Watch-
your child attended a sibling preparation your child to the hospital for a brief visit age may feel uncomfortable sharing your ing mom and dad coo over a new baby
class at your hospital. But it may still be to meet your newborn. This is a great way attention with a newborn. Explain to can be difficult for an older child to
difficult to know how your child will re- for your child to meet the new baby and your child that the baby will need lots of watch. If you’re taking lots of pictures or
act to an addition to the family and the spend some time with you. Be sure to al- attention. And encourage your child’s in- videos, be sure to include your older
changes a new baby will bring. low another family member to hold the volvement by taking him or her shopping child, too. Take some pictures or videos of
While older children are typically baby for a while, so that you can give for baby items. Read to your child about him or her alone, as well as with the new
eager to meet a new sibling, young chil- your older child plenty of cuddles. Con- babies, brothers and sisters. Give your baby. Consider having a few small gifts
dren may be confused or upset and sider giving your older child a gift that’s child a doll so that he or she can practice on hand to give to your older child, in
have a hard time adjusting — especially from the baby — such as a T-shirt that taking care of it. Look at your child’s baby case friends visit with gifts for the new
as the new baby sleeps less and begins to says big brother or big sister — or taking pictures together. Tell him or her the story baby. During your newborn’s feedings,
demand more of your attention. Explain your child someplace new or special to of his or her birth. try to make your older child feel included
to your older child that your newborn celebrate the new baby’s arrival. If possible, complete your child’s toi- by reading stories together. Reassure
will probably cry, sleep and eat most of let training before the baby is born. Oth- your older child that you love him or her
the time. The baby won’t be a playmate erwise, wait until a few months after you and your new baby. And remind your
right away. bring your baby home to start the pro- older child that he or she has an impor-
To minimize the stress your child SIBLING REACTIONS cess. Keep in mind that siblings some- tant role to play now, too — that of big
might experience once the new baby times regress after the arrival of a new brother or big sister.
comes, think ahead. If your child will Your older child’s age and development baby — such as by having toilet training
need to change rooms or move out of the will affect how he or she reacts to having accidents, drinking from a bottle or ask-
crib so that your new baby can use it, do a new sibling. ing to be carried to bed — to get your at-
this before the new baby is born. It will tention. There’s no need to punish this
give your older child a chance to get used Children under age 2 Young children type of behavior. Instead, give your child
to the new setup before dealing with the likely won’t understand yet what it plenty of love and assurance. Don’t for-
other changes associated with the new means to have a new sibling. Try talking get to praise your child when he or she
baby’s arrival. Arrange for your child’s to your child about the new addition to demonstrates good behavior.
School-age children Children ages 5

and older may feel jealous of how much
WHEN YOUR NEWBORN IS SICK attention the new baby gets. Try talking
to your child about your newborn’s
If your new baby has health problems, try to answer your older children’s questions needs. Encourage your child to get in-
about the new baby simply. You might explain that their baby sister or brother is volved by helping to decorate the baby’s
sick, and you’re worried. Reassure your children that the baby’s illness isn’t their room with handmade artwork and par-
fault. If your baby needs to stay in the hospital after he or she is born, ask about ticipate in taking care of the baby. Be sure
the sibling visitation policy. You might also take pictures of the baby and show to explain the importance of being gentle
them to your older children. with the new baby. Point out to your child
Keep in mind that even if you don’t talk to your older children about the baby’s the advantages of being older, such as
illness, they will sense that something is wrong and may act out to get your atten- being able to go to bed later or play with
tion. Rather than keeping them in the dark, give your older children some basic in- certain toys.
formation about the situation, and do your best to show that you are there for them.
All children Regardless of your older
child’s age, make sure that he or she gets

TEACHING GENTLENESS SIBLING SAFETY HAZARDS
Sometimes older children, stressed by the changes happening around them, take If you have an older child, you probably have toys in your home with small pieces
out their frustrations on a new baby. If your older child tries to pull your baby’s hair, that an exploring baby could easily choke on or swallow. Be sure to round up
take away the baby’s bottle or harm the baby in any way, it’s time for a serious talk. games and toys that have small parts, and keep them out of your baby’s reach.
Sit your child down and calmly explain that you still love him or her but that he or When your older child wants to play with these kinds of toys, keep the toys in an
she isn’t allowed to hurt the baby. In addition, make an effort to give your older enclosed area. This will give your older child a chance to play without fearing the
child some extra attention, and include him or her in activities that involve the baby, intrusion of little hands. Encouraging your children to play separately with their own
such as singing, bathing or changing diapers, to encourage positive interaction toys may also help you sidestep a few battles — especially if your older child is
between the siblings. Keep in mind that, for safety reasons, you shouldn’t leave younger than age 3 and isn’t eager to share his or her things. For more information
your newborn alone with a child who is younger than age 12. on child-proofing your home, see Chapter 15.
SIBLING RIVALRY For example, younger children might be as a parent to encourage healthy sibling Listen to your children Being a sib-
more likely to fight physically, while old- relationships now and as your children ling can be frustrating. Let your children
Right now, sibling rivalry may not be a er children might argue instead. get older. Consider these tips: vent their negative feelings about each
concern, but it can become an issue as Children who have less than a two- other, and listen. Respond by showing
your child gets older and competes with year age difference might battle each oth- Respect each child’s unique needs your child that you understand what he
other children for parents’ love and reer more than children who have bigger Treating your children uniformly isn’t al- or she is feeling. If your child is old
spect. Signs of sibling rivalry might in- age gaps between them. Although chil- ways practical — and the harder you try, enough, you can ask him or her to help
clude hitting, name-calling, bickering and dren of the same sex might share more of the more your children may look for in devising an acceptable solution to
regressive behavior. This kind of behavior the same interests, they might also be signs of unfairness. Instead, focus on try- whatever is bothering him or her. If you
is common after the birth of a new baby more likely to compete against each other. ing to meet each child’s unique needs. have siblings, share stories of conflicts
— but it can also happen anytime one Middle children might feel less secure and you had with your brother or sister
child in the family receives extra attention. be more likely to seek affection because Avoid comparisons Comparing your when you were a child. Holding regular
While sibling rivalry is a natural part they may believe they don’t get the same children’s abilities can cause them to feel family meetings can give your children a
of growing up, many factors can affect privileges or attention as the oldest or hurt and insecure. While it’s natural to chance to talk about and work out sib-
how well your children might get along youngest child in the family. notice your children’s differences, try to ling issues, too.
with each other, including their sex, ages Although all siblings are bound to avoid discussing them out loud in front
and personalities, as well as the size of fight, tease and tattle on one another at of your children. When praising one of Don’t take sides Try to avoid being
your family and each child’s position in it. some point, there are things you can do your children, stick to describing his or drawn into your children’s battles, unless
her action or accomplishment — rather violence is involved or one of your chil-
than comparing it with how his or her dren could get injured. Encourage your
sibling does it. children to settle their own differences.
While you may need to help younger chil-
Set the ground rules Make sure your dren resolve disputes, you can still refrain
children understand what you consider from taking sides. In addition, avoid using
acceptable and unacceptable behavior derogatory nicknames for your children
when it comes to interacting with each that might perpetuate sibling rivalry.
other, as well as the consequences of
their misbehavior. Consistently follow Give praise When you see your chil-
through with discipline, such as a time- dren playing well together or working as
out or loss of certain privileges, when a team, compliment them. A little praise
your children break the rules. and encouragement can go a long way.
CHAPTER 34: SIBLINGS AND GRANDPARENTS 453

advice, discuss some of the ups and needs with your parents before the baby
MANAGING SIBLINGS DURING BREAST-FEEDING downs they experienced as new parents is born. Would you and your partner like
and reassure you that you’ll be able to to spend a few days on your own with
If you’re breast-feeding your newborn, you may wonder how your older child will handle your new role. your new baby before relatives visit? Or
react to your nursing sessions — or how to keep your older child busy while you Typically, the birth of a new baby would you prefer to have relatives come
nurse. Try not to worry. Your child will likely express curiosity and may hover upon brings families closer together, giving to help you early on, go with you to your
first seeing you breast-feed. Simply explain what you’re doing, and try to answer new parents and their parents a chance baby’s first doctor’s appointment or assist
any questions your child might have. If you breast-fed your older child, explain to renew and strengthen their bonds. But with caring for your other children?
that you did the same thing for him or her when he or she was a baby. To keep your the shift in your role and your parents’ Would you like to have your parents and
child entertained while you nurse, consider setting out a couple of toys or a roles may not always go as smoothly as in-laws visit at different times so that
workbook nearby beforehand. You might also play music or audio versions of you might hope. You and your parents each set of grandparents can have time
children’s books. might unknowingly have different un- with the baby?
derstandings and expectations of your Tell your parents what they can do to
new roles. Make an effort to talk to your be most helpful — household chores in-
parents about how you feel about be- cluded. This may help prevent misunder-
IF YOU HAVE MULTIPLES GRANDPARENTS coming a parent and your parents be- standings and tension, as well as help
coming grandparents — and be sure to you make the most of your parents’ de-
Sibling rivalry often isn’t an issue for Grandparents can play a major role in listen to their feelings on the subject, too. sire to be there for you.
multiples. While the children may com- your newly expanded family.Your parents Like it or not, your parents might go a
pete against each other, multiples typi- (yours and your partner’s) will likely give Receiving help As you navigate the little overboard on the baby gifts. While
cally also depend on each other and de- you and your partner emotional support early stages of parenthood, your parents you might not be able to stop your eager
velop close relationships early on. and encouragement, and calm your will likely want to provide help and sup- parents from buying the baby gifts, be
However, they may have problems main- nerves as you figure out life with a new- port. Sometimes, however, the support sure to tell your parents what the baby
taining their individuality. For example, born. They may share their experiences you get isn’t the support you need. For needs. Also, remind your parents that
twins are often treated as a unit, rather as well as helpful tips. They’ll likely be example, excited new grandparents what your baby really needs isn’t a toy or
than two children with unique personali- great baby sitters and helpful in a pinch. might want to come to stay for a few days treat, but to spend quality time with his
ties. As a result, twins are often dressed Grandparents can serve as role models once the baby is born. While some new or her grandparents. Doing an activity
alike and given the same toys. If you have for the kinds of parents you want to be- moms and dads might find this helpful, together, such as taking a walk in the
multiples, pay attention to their different come. And, best of all, they can provide others — as they learn the ropes of caring park, can be a fun way for grandparents
needs and try to foster individuality. your child with a special kind of love and for a new baby — might find the pres- and new babies to begin bonding.
Multiples can also cause other chil- affection. ence of relatives stressful. And don’t forget that as much as your
dren in the family to feel left out or jeal- Think about what might work best for parents want to help you during this
ous — since they are not part of this Changing relationships Pregnancy you and your family, and discuss your time, they likely also want to spend some
unique relationship. If you have multiple and the birth of a baby often cause new
babies and an older child, be sure to parents to re-examine their relationships
spend plenty of special one-on-one time with their own parents. As you prepare
with your older child. Also, encourage for your future as parents, it’s only natu- GIVING GRANDPARENTS TIME
your multiples to play separately with ral that you and your partner think about
other children. For example, arrange a the ways in which you were raised and Sometimes, new grandparents aren’t quite ready for their new role. They may still
play date for one of your twins while what you would like to carry forward have career aspirations and life plans, and the idea of being grandparents may
the other twin plays with a sibling. Your from the past or would like to change. In make them feel old. If your parents are struggling with becoming grandparents,
multiples may resist separation, but be- the process, you might find that you have give them an honorable “out.” Don’t bathe them with all of the grandparent lan-
ing able to be apart is a skill your children questions for your parents about how guage or expect them to perform the traditional grandparent duties or tasks. With
will benefit from as they get older. For they handled becoming a mom or dad time, things may change, but until your parents are ready, take it slow.
more information on multiples, see and why they made certain decisions.
Chapter 38. Your parents will likely be able to share
454 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 34: SIBLINGS AND GRANDPARENTS 455
LETTING GO OF THE PAST NAME PREFERENCES
If you and your parents aren’t close or have a difficult relationship, the birth of your Your parents may have their own ideas about what they would like to be called
baby might serve as motivation to work through your problems — especially if you — beyond Grandma or Grandpa. For some grandparents, these traditional titles
want your parents and your child to have a strong connection. During your preg- just don’t jibe with the way they see themselves. Consider talking to your parents
nancy or after your baby is born, consider making an effort to work on your rela- about what names they might have in mind for themselves. Some grandparents
tionship with your parents. In addition, remember that your child will have a sepa- wish to be called what they called their grandparents. Others prefer first names,
rate and different relationship with your parents than you do. When couples nicknames or terms that reflect their ethnicity. Remind your parents, however, that
divorce, the grandparents on both sides of the family will still want to spend time when your baby begins to talk, he or she might come up with some names of his
with him or her. or her own.
time cuddling with your baby and getting in-laws that what you could really use is When making requests for help in taking GRANDPARENTS AS
to know him or her. This is especially support or help around the house, not care of your child, be sure to keep in CHILD CARE PROVIDERS
important if your parents don’t live near- unsolicited advice. You and your partner mind your parents’ ages, abilities and any
by or won’t be able to visit your baby fre- have the final say over the way your child other limitations. To avoid unnecessary Some couples rely on grandparents to
quently. Offer your parents as much time is raised and the rules in your house. misunderstandings or resentment, ask provide part-time or full-time care for
with the baby as you’re comfortable giv- However, try not to dwell on these issues. your parents what they can handle and if their children. Having someone you
ing them. If you’re bottle-feeding or Keep in mind that your parents are prob- you’re expecting too much from them. know and trust take care of your child
you’re breast-feeding and already pump- ably trying to help and may be struggling can be comforting. Grandparents are of-
ing, consider letting your parents feed with the transition from being your par- The holidays Your baby’s first holidays ten flexible with their hours, may be able
the baby. Remember, this is a precious ent to being a parent and a new grand- and birthdays will likely be important to watch your child in your home and
and exciting time for your parents, too. parent. And expect that if your parents events that his or her grandparents will
baby-sit your child, they will likely han- want to help celebrate. But while big
Conflicting opinions You and your dle things slightly differently than you family parties can be fun, they’re not al-
partner likely have some ideas about would. These little differences may even ways possible. Chances are that you’ll
how you plan to care for your baby — help your child learn how to be flexible. end up alternating holidays with differ-
and they might be different from your In addition, just as you and your part- ent grandparents. Or perhaps you’ll have
parents’ ideas. For example, while your ner have your own thoughts about what two celebrations, one with each set of
parents might have fed you formula, you kinds of parents you’d like to be, your grandparents, on different days.
might plan to breast-feed. One of your parents might have thoughts about what Either way, if holidays are particularly
parents might have stayed home to take kinds of grandparents they’d like to be. important to your parents, talk to them
care of you, while you and your partner Some grandparents aren’t comfortable ahead of time about your plans and your
both plan to continue working. As your baby-sitting and prefer a formal relation- desire to make sure everyone feels in-
baby gets older, you and your parents ship with their grandchildren. Others are cluded in your child’s big days. If your
may also have different opinions about playful and enjoy engaging their grandparents are having a hard time under-
the toys your child should play with — children in activities. And still others standing the situation, explain that alter-
wood or plastic? — or the amount of want to be a part of their grandchildren’s nating holidays will allow each set of
television he or she should be allowed to daily lives, serving as surrogate parents. grandparents to spend more quality time
watch. This can be tricky territory. Consider talking to your parents about with your child in a more relaxed setting.
If your and your parents’ parenting what kinds of roles they’d like to play in You might also encourage your parents to
styles differ, it might be difficult for your your child’s life. Do they want to baby-sit? focus on new or different traditions, such
parents to keep their opinions to them- How available do they plan to be? Are as taking your child out for his or her
selves. Consider telling your parents or they willing to help out in case of a crisis? half-birthday.

may not ask for payment. However, topics. Make sure your parents are aware
GRANDPARENTING FROM A DISTANCE grandparents might not have any train- of all safety precautions discussed in
ing in car seat use, CPR or other emer- Chapters 14-16. If your baby is going to
If your parents don’t live nearby, they might miss out on your baby’s first smile, gency care. These types of arrangements be at their house, the house needs to be
giggle or attempts at rolling over. Consider helping your parents keep in touch with can also cause tension, especially if you childproofed. It’s also important that they
your baby through regular phone calls, video phone chats — perhaps at the same don’t feel comfortable telling your parents not leave medications and other danger-
time each week — or by frequently sending videos or pictures. While it might still how you want your child cared for or if you ous items within a child’s reach, and that
be awhile before your baby can talk much, he or she will likely enjoy listening to don’t want unsolicited parenting advice. they take precautions around hot liquids
your parents’ voices and grabbing the phone or computer. If your parents aren’t up Think about the pros and cons before and other items that could lead to a burn.
on current technology, regularly mailing printed pictures might be your best option. asking your parents to provide regular These are just some of the safety issues
To help your baby get to know your parents and other family members, make a child care. If you decide to go that route, that need to be addressed.
photo album with their pictures, and look at it with your baby during playtime or ask them to take a CPR class. Be sure to
before bed. Be sure to tell your baby the names of the people in the photos. discuss the details, and come to an agree- Car seats Make sure your parents pur-
ment beforehand about how the ar- chase a reliable car seat and know how to
rangement will work. For more informa- use it properly when transporting your
tion on child care, see Chapter 13. baby. Explain the importance of having
If your parents will be watching your your baby ride rear-facing until he or she
child in their home, consider asking them reaches age 2 or the highest weight —
to purchase their own crib or highchair typically at least 35 pounds — or height
— or offer to get one for them. This will allowed by the car seat manufacturer. For
make meals and naps easier on your more information about car seat safety,
baby, as well as your parents. You might see Chapter 14.
also consider asking your parents to buy
their own stroller, car seat and basic medi- Sleep positions Insist that your par-
cations, such as for a fever or diaper rash. ents put your baby to sleep resting on his
If it’s been awhile since your parents or her back, rather than on the stomach
took care of a baby, they might need a re- or side, until your baby can roll over both
fresher on the basics — especially in areas ways without help. Make sure your baby
where the rules have changed over the is put to sleep on a firm mattress in a crib.
years, such as in car seat safety and baby- Remind your parents that adult beds
sleeping positions. Before you leave your aren’t safe for infants. For more informa-
child in your parents’ care, discuss safety tion about sleep safety, see Chapter 7.
EDUCATION CLASSES
Many hospitals, birth centers, senior centers, churches and community colleges
offer classes for grandparents. These classes may serve as refreshers on baby
care and changes in maternity care. They might also touch on how to deal with role
changes, parents’ goals and expectations, what it’s like to grow up today, and any
other concerns new grandparents might have. If your parents or in-laws are inter-
ested in taking a class, start by inquiring at your hospital or birthing center. If they
live far away, suggest that they contact a local hospital for information.
458 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 34: SIBLINGS AND GRANDPARENTS 459
CHAPTER 35
Finding contentment:
Home or job?
It is perhaps one of the most difficult de- tween competing roles, expectations and
cisions new parents face — staying at responsibilities. The bottom line is, what-
home with a newborn or returning to a ever choice you make, it will be the right
job. For many couples, juggling parent- one for you and your family. There’s no
hood and a job has become the norm. right or wrong decision, but there’s prob-
More than half of U.S. mothers with in- ably one that’s best for you. And what
fants under a year old work outside the works now might not be the best solu-
home, most of them in full-time jobs. tion later.
And as their children get older, the ma- If you decide to return to your job,
jority of moms hold a paying job. know that quality child care is available
Almost all parents try to balance their for your son or daughter, and there are
family and career roles. Women with steps you can take to make the transition
children may move in and out of the paid back to work easier for you and everyone
workforce at different points, shift ca- involved.
reers or start their own business. They
may work part-time or work from home.
Sometimes dad chooses to stay home or
change careers to help with child care. ISSUES TO CONSIDER
It’s up to you to decide if, when and
how you go back to work after having a As you navigate the work-life balance of
baby. And it may take some time to make a new parent, there are a number of is-
this decision. You may appreciate the sues to weigh. If you are struggling over
sense of identity and accomplishment whether to stay home with your child or
you get from work, but at the same time return to your job, consider your personal
you feel a strong emotional pull to be needs as well as those of your baby and
with your baby. You might feel torn be- family.
CHAPTER 35: FINDING CONTENTMENT: HOME OR JOB? 461

Career consequences If you’ve If, on the other hand, you or your with confidence, knowing that your child breaks away from your baby to do some of
worked hard to attain a certain position, partner makes enough income to sustain is in good hands. By building a good rela- the things you enjoy. Some parents also
or your occupation is very meaningful to the family, you may choose to stay at tionship and communicating effectively experience stress because they no longer
you, you may not want to give it up. In home or take on a part-time job or a job with your baby’s caregivers, you may feel the sense of accomplishment they
fact, having a career that you genuinely that you can do from home. come to view them as valued partners in used to get from earning money or per-
love can be a positive influence and in- Carefully review your finances before helping your baby thrive. forming well at their job. The job of par-
spiration for your children. Other reasons making a decision. Consider not only enting doesn’t come with objective mea-
you may want to keep working include your and your partner’s salaries but also Stresses and rewards No matter sures of success. However, many parents
the intellectual challenge, adult interac- the cost of having two people working — what choice you make, you can be sure it will say it is the most rewarding job of all!
tion and sense of accomplishment you including child care, commuting, parking will bring some stresses — and its own
may get from working outside the home. and clothing. For some parents, child rewards. Juggling parenting and working
Your decision about whether to return care would cost more than they could outside the home takes a lot of energy
to your job may be influenced by your earn by working. On the other hand, and can lead to burnout, especially if you LIVING WITH YOUR DECISION
employer’s policies and culture. Family- some couples are nervous about living on work long hours, spend time commuting,
friendly benefits may include flexible a single paycheck in tough economic work nights or weekends, or travel a lot Remember, the decision you make now
work schedules, part-time work, child times. If you prefer to stay home, can you for work. Among two-career couples, doesn’t have to last until the day your
care referrals or on-site child care, and cut enough expenses to make up for your parents need to share household and child enters kindergarten. Many parents
parental leave. Practical matters, such as lost income and still have a cushion? child care responsibilities, which can lead make adjustments to their work or child
your commute, also can be a deal breaker. Another financial issue to consider is to resentment and conflicts. care arrangements during their baby’s
Nevertheless, many working parents, the longer term impact of staying at Staying at home comes with its own first few years.
especially moms, also contend with feel- home. Will you be able to save money for stresses. Taking care of a baby 24/7 is ex- You may not know how you’re going
ings of guilt. You may feel guilty about your child’s college education or your hausting, especially if you don’t get many to feel about your decision until you’ve
leaving your baby in someone else’s care retirement?
or not spending enough time with him or
her. You may feel guilty for wanting to Child care Another important factor
keep your career. that can influence the decision of wheth- EFFECTS ON YOUR CHILD
To the contrary, some stay-at-home er to remain at home or return to a job is
parents struggle with feeling lonely and child care. Many options are available, Opinions on whether child care is good for kids can run strong. Some people insist
isolated. An infant doesn’t provide the each with pros and cons. that to be a good parent, you have to be home with your child. Research doesn’t
kind of companionship they may have You want your baby to be cared for in bear this out, however. There’s no evidence children are harmed when their par-
expected. Some parents who leave a job a safe, healthy environment by support- ents work, and good-quality, stimulating and nurturing child care offers some ben-
to stay at home with a child also experi- ive, affectionate adults who help your efits. Spending time in child care can improve school readiness, language devel-
ence a mini identity crisis — feelings child learn and interact. The more reli- opment, independence, social competence and peer interaction skills.
of personal loss. This can come as a sur- able, dependable and attentive to your The most influential factor in parenting is not the sheer quantity of time you
prise to a parent who was looking for- child’s needs your care provider is, the spend with your child but that you have a loving, nurturing relationship. Studies
ward to a new stay-at-home routine. more you’ll be able to focus on work. As have found no difference between working mothers and stay-at-home mothers in
None of this is out of the ordinary. one new mother says,“If you find a good the quality of mother-child interactions or their influence on children. And on aver-
These are all normal feelings. place where you know the child is well age, working moms spend only about 10 hours a week less caring for their chil-
looked after, then you are comfortable at dren compared with at-home moms. What’s important is that when you’re with
Finances If you’re the sole provider for work. If not, it’s unbearable, and you your child — whether you’re a stay-at-home parent or you work outside the home
your family, or your partner’s income can’t concentrate on anything.” For more — the time you spend together is quality time.
doesn’t cover your expenses, you may not information on child care and issues to Whatever your choice, if you feel happy and fulfilled, your child will enjoy the
have the option of staying at home. Al- consider as you look for child care, see happiness as well. If you resent your current arrangement or feel cheated by it,
though money isn’t everything, you do Chapter 13. you’ll likely pass on these feelings to your child.
need enough to provide basic care for Once you’ve found child care you feel
your family. comfortable with, you can return to work
462 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 35: FINDING CONTENTMENT: HOME OR JOB? 463
lived with it for a while. If you go back to MAKING THE TRANSITION BACK then take some time to run errands or with someone else. You may be anxious
your full-time job and find yourself mis- have a little time to yourself. that the baby will bond more with the
erable, you could cut back on your hours, If you’ve decided to return to your job, caregiver than with you, or that you’ll
take an extended leave or step away for a take some time and consider when Prepare to continue breast-feeding If miss an important milestone. But don’t
while. If you decide to stay home and would be the best time to go back. Al- you plan to continue breast-feeding after worry, you’ll still have time to spend with
find the financial strain too stressful, or though there’s no perfect time frame, ex- returning to work, tell your employer that your child. Working outside the home
miss the camaraderie or your career, you perts suggest spending three to four you’ll need to take breaks throughout the doesn’t make you a bad mother — and
may choose to go back to work. One months at home with your baby, if you day to pump. Ask about a clean, private it’s OK to look forward to the challenges
mom who cut her maternity leave short are able to do so. That gives you time to room with an outlet for breast pumping. and interactions of your job. Remind
notes, “I was getting bored at home and settle into a schedule, bond emotionally Consider buying or renting an electric yourself that you’re doing what’s best for
needed the structure in my life of return- and learn to care for your child. Fatigue pump that allows you to pump both you and your family.
ing to work. I wasn’t happy and was driv- is a big factor for both parents during breasts at once.
ing my husband crazy.” Another mom those first few months. Three to four About two weeks before returning to Provide continuity of care Develop a
had the opposite experience: “I thought months at home gives you plenty of time work, adjust your breast-feeding sched- good relationship with your baby’s care-
I’ll just take 2 months off and I’ll go back to rest and recover. ule so that you’re pumping two or three giver. Spend time talking to him or her
to work. But having my daughter totally The standard 12-week maternity times during the day and nursing before when you drop off or pick up your baby.
changed me.” leave passes quickly, and many women and after your upcoming work hours. Share family stresses — both good and
dread the day it will end.You may not feel Have someone else feed your baby a bot- bad — that might affect your baby. Before
ready. With some planning, you can ease tle of stored breast milk to help your baby you take your baby home, ask about any
your transition back to work — and stay adapt. If you’re lucky enough to have on- important events that occurred in your
connected to your baby. site or nearby child care, consider breast- absence, such as a change in bowel
feeding your baby during the workday. movements or eating patterns or a new
While you’re still on leave You can way of playing. Take time to periodically
help your return to work be successful by Plan ahead Write a list of everything discuss your baby’s progress and any
following these basic steps: you’ll need to pack for your new routine problems or concerns.
— such as a breast pump, diaper bag, extra
Talk to your employer Clarify your job diapers — and figure out how much time Stay connected Consider a daily phone
duties and schedule so that you’ll know you’ll need to get ready in the morning. call or text message to your baby’s caregiver
what’s expected of you after your mater- to find out how he or she is doing. Place a
nity leave. You might ask about flexible When you go back to work Expect favorite photo of your baby on your desk or
hours, telework or working part-time. ups and downs as you become more ad- in your work area. Set aside time after work
ept at managing multiple demands. The to reconnect with your baby.
Set a return-to-work date Try to avoid first day can be especially emotional.
going back to work at a time when you’re One mom recalls, “I’ll never forget the Make backup plans Know what you’ll
going through other stressful life events first day we picked (our baby) up from do if your baby is sick or your baby’s care-
or major changes, such as moving or an her baby sitter’s house, and I got her giver is unavailable on a workday. Op-
illness or death in the family. If you can, home and changed her little diaper and tions might include taking the day off
go back to work later in the week. This started crying because she was wearing a yourself, asking your partner to take the
will make your first week back to work a diaper that I didn’t put on her! But it gets day off, or calling a friend or loved one to
short one. easier.” Allow for some tears that first care for your baby.
day! Here are some other tips to help
Try a trial run with child care Consider smooth the transition: Get plenty of rest The first few weeks
having your baby stay with his or her back will no doubt be emotionally and
caregiver for part of the day just before Let go of the guilt Often when mothers physically draining. Go to bed as early as
the end of your maternity leave. You can first return to work after their baby is you can, and ask your partner to help
stay there awhile to help the baby adjust, born, they feel guilty for leaving the child with night feedings.

Continue to breast-feed If you’re breast- vere anxiety, consider talking to a coun- role. They take on the bulk of the respon- Just as important as a company with
feeding, bring your breast pump, con- selor or joining a support group. Give sibility for running the household, raising family-friendly policies is having a sup-
tainers for expressed milk, an insulated yourself a time frame for re-evaluating children and having careers. They’re portive boss. One mom notes that her
bag and ice packs to work. Keep a stash your decision, such as two months. more likely to be the ones to get the baby supervisor at the time of the birth of her
of breast pads and extra blouses handy, Give yourself some time to adjust to ready in the morning, pick him or her up first child was a woman who’d raised two
in case your breasts leak. If finding time your new circumstances, and maintain a at the end of the day and stay home if the children by herself: “She was supportive
to pump is a concern, consider alterna- positive attitude. Being separated from baby is sick or child care isn’t available. in allowing me to work part time and
tives — pumping during your breaks or your baby all day is probably harder on Working moms soon realize that they sometimes from home. This made breast-
working from home to make up for the you than on your baby. Tell your baby can’t do everything perfectly — and that feeding and logistics much easier.”
lost hours, for example. If you can’t ex- how excited you are to see him or her at “having it all” often means sacrificing If your work setting doesn’t give you
press milk at work, breast-feed your baby the end of the day. Your baby might not something. As one mom says,“I’ve opted time to be a parent, consider working less
or pump just before you go to work and understand your words, but will pick up not to take promotions because they — or somewhere else.
as soon as you return home. You could on your emotions. would have involved more time commit-
also pump between feedings on your ment than I felt comfortable giving while Get organized Make a daily to-do list.
days off for extra breast milk to be used being a mother to my children.” In some Divide the list into tasks for work and
while you’re working. cases, working moms feel like they’re not tasks for home, or tasks for you and tasks
BALANCING WORK doing very well in either role. Others fol- for your partner. Identify what you need
Network with other working parents AND HOME LIFE low the mantra that you can have it all, to do, what can wait — and what you can
Even if it feels like you have no spare mo- just not all at once. skip entirely. Organization can help you
ment in the day, reach out to other moms Achieving balance between work and Despite the challenges, it is possible get more work done in less time.
in the same position. You can trade tips home is the holy grail for working par- to manage and even thrive with the jug-
and gain support. Have lunch with a co- ents. Difficulty finding this balance is a gling routine. Here are some suggestions
worker who’s also a parent, or organize a perennial topic of discussion in the me- for creating balance.
moms’ night out. dia and one of the top reasons people
seek counseling or psychotherapy. Embrace ‘good enough’ If you’ve
Re-evaluate your decision if you need Both moms and dads struggle with always set high standards for yourself,
to If your transition is much tougher than work-life balance, but mothers tend to this is the time to let go of perfectionism.
you expected, or you’re experiencing se- identify much more with their family Balance requires being good enough
rather than perfect. Your home might not
be as tidy and organized as it was before
you had a child. You might not have time
STAYING CONNECTED AT HOME to cook meals from scratch anymore.
Maybe you can’t work the long days as
Women who leave the paid workforce to care for children often find re-entry chal- you used to — and get as much done. Fo-
lenging, as office technology, jobs and workplace norms change. If you’re staying cus on the positive aspects of your situa-
home for an extended time, you can take steps to stay connected to the work tion, and let go of guilt about what you’re
world and avoid the insecurity that can follow the post-Mommy years. doing or not doing.
Z Keep up your networks. Maintain personal and business contacts. Have lunch
with former colleagues, keep in touch through social media or email, or attend Find the right fit for work You’re
networking events. more likely to create work-life balance if
Z Stay abreast of industry trends. Read trade magazines, check out industry you work for an organization that’s sup-
websites or subscribe to e-newsletters in your field. portive of parents. Flexibility is on top of
Z Consider doing some work on the side. If you can take on an occasional proj- women’s wish lists when choosing an or-
ect or even some part-time work, you can keep your foot in the door. ganization. Control over your schedule
can buffer work-life conflicts and reduce
the chance of negative health outcomes.

Seek support Don’t try to do every- Nurture your own well-being Cut
thing yourself. Accept help from your down on unnecessary commitments.
partner, loved ones, friends and co- Exercise and move your body. If you feel
workers. Speak up if you’re feeling guilty, as if going to the gym takes away from
sad or overwhelmed. If you can afford it, time with your baby, go for a walk with
consider paying for weekly or biweekly your baby in the stroller, or try for some
housekeeping to buy yourself extra time active play together. Relax in the tub
for your family or yourself. Keep up your after you put baby to bed, or unwind
friendships, whether it’s for a girls’ night with a book or some favorite music. Pick
out or someone you can call to talk with a reasonable bedtime and stick with it.
or to ask for baby-sitting help. On your days off, sleep when your baby
sleeps.
Share more of the load with your
partner Ask your partner to split more
of the responsibilities with you. Maybe
you can work different schedules so that
you can have your baby in child care for
fewer hours. (See Chapter 32 for more on
this topic.)
Recognize the issue is bigger than

you It can be helpful to put your strug-
gles into context.You’re not alone in find-
ing it tough to balance work and family,
and if you sometimes feel like you’re los-
ing the battle, it’s not because you’re in-
efficient or unmotivated. The traditional
model of career success in the United
States poses challenges for working fam-
ilies, and the global economic downturn
has increased the pressures to perform.
Media messages that pit working moms
against stay-at-home-moms add to the
problem.
Keep your career options open

Creating a sense of independence from a
specific employer or career can give you
the freedom to move between positions
and companies, and possibly take some
time off or consider starting your own
business. Maintain your personal and
professional networks and contacts, and
build a strong reputation in your field.

CHAPTER 36
When to have
another child
As your baby approaches toddlerhood, tors to weigh when planning your next
family, friends and perfect strangers start pregnancy.
asking the inevitable question — are you As you and your partner consider the
going to have another child? (Often it’s possibility of having another child, ap-
“when” and not “if.”) And the question proach each other with compassion, re-
may be foremost on your mind as well. spect and a willingness to listen. Talk about
Like other parenting decisions, figur- the issues with an eye toward strengthen-
ing out how many children you want is a ing your relationship and your family.
personal process, though you may re-
ceive plenty of advice and opinions. De-
ciding whether or not to have another
child is one of the most important deci- DECIDING ON ANOTHER CHILD
sions you’ll make for your family, and it
may be even harder than deciding to Maybe you’ve always dreamed of having
have the first one. It’s normal to worry three kids, each spaced three years apart.
about how another child will affect your Or you’re agonizing over whether you
family, relationships, lifestyle, finances can really handle another baby. Whatever
and work and to wonder if you’re making your hopes, fears and dreams, there are a
the right choice. number of issues to consider as you think
If you think you want another child, about expanding your family.
when might be the best time? Again,
only you and your partner can answer Added responsibilities Caring for a
that question. Pregnancy spacing affects growing family can be physically, men-
how close your children are in age and tally and emotionally taxing, despite its
may have an impact on your health and many rewards. Most parents say that
your baby’s health. There are many fac- adding a second child more than doubles
CHAPTER 36: WHEN TO HAVE ANOTHER CHILD 471

the work. You need plenty of time and Your partner’s preferences Some- extra money in the budget before you child will change the dynamic and logis-
energy to care for an infant, while your times one partner is ready for another conceive another child. Think about what tics of your family life. However, most
older child also needs your attention. baby and the other isn’t. It’s important to your financial picture will look like with a parents say that soon after the arrival of
With two kids, your life will be more hec- understand each other’s concerns. Sit new baby. Will you or your partner need the second baby, they can’t imagine life
tic — and your house will no doubt be down together and talk about your points to reduce your work hours or stay home without him or her.
messier. But you’ll also find that you of view and your differences. What does to care for your children? Can you afford
grow to meet the challenges. having a second child mean for each of to pay for the new baby’s child care if you Sharing the love Probably most par-
“I felt like my life as a parent finally you? What are your goals and dreams? keep your job? Are you willing to sacri- ents have wondered how they could pos-
had a rhythm to it (he finally slept at Explore ways to resolve concerns and fice certain things in order to cover baby sibly love the second child as much as
night, I didn’t need to lug around all the conflicts. If your partner is worried that costs? Will you have enough money to save they love their first. You may worry that
baby paraphernalia anymore, etc.) and I your relationship will suffer, make spe- for college tuition? If you’re living paycheck you’ll lose your special relationship with
wasn’t sure how I’d do once a second cific plans for keeping date night alive. to paycheck or fear a layoff, you may decide your first child and shortchange the sec-
child came along,”writes one mom.“Tak- Work together to come up with ways to to hold off on having the next baby. ond child by having to share your atten-
ing care of the needs of two little people lessen the financial burden. In the longer term, having babies tion and time. It’s common to worry that
can definitely be more stressful, but you Both of you need to be on board with close together frees you from child care the second child will feel less wanted and
get progressively more creative to get ev- the decision. If you remain at odds, per- costs sooner. On the flip side, spacing loved and that the first one will feel re-
erything done.” With a second baby, haps you can agree to revisit the issue in children further apart can give you more sentful. Rest assured that your relation-
you’ll realize how much you learned the a year or two. It might also be helpful to time to recover from the financial impact ship with each child will be unique, like
first time around. You’ll have increased talk to other couples who’ve been in the of pregnancy and early child care. the children themselves, and that you’ll
confidence in your abilities and knowl- same position or to consult a marriage have plenty of love to go around.
edge, and you’ll find it easier to handle and family therapist. Impact on your career It might be As writer Lisa Belkin notes,“I remem-
things that might have seemed daunting harder to juggle your job and child care ber, with Polaroid clarity, the moment I
the first time around, such as breast- Family finances A new child adds to responsibilities when you add another said goodbye to Evan as I left for the hos-
feeding and taking care of a sick baby. your family’s expenses. You’ll want some baby to the mix. Will you be able to keep pital to deliver Alex. I had the over-
up with your job after the next baby? Is it whelming feeling that I was about to ruin
important for you to reach another level his life. I tried to remember what I try to
in your career path before you take on remember in all tough parenting situa-
pregnancy, childbirth and caring for an tions — that I am giving them some-
infant again? Then again, it might be eas- thing, not taking it away. … And when I
ier to focus on your career later if your brought home a baby brother, I gave each
kids are in school at the same time. of them proof that neither of them was
alone in the world, and that neither was
Family dynamics Many people have the center of the universe.”
more than one child because they don’t
want their firstborn to be an only child. Social pressures Although one-child
Providing a sibling for your child may be families are increasingly common, cou-
part of your motivation, but it’s impor- ples still face cultural and family pressure
tant to want to raise another baby just for to have a second child. If your friends are
him- or herself. You can’t predict how all having a second or third child, you
well siblings will get along, and there are may feel left out. You may feel the pres-
pros and cons to having siblings or not. sure from your partner or feel guilty if he
(See“Deciding one is enough,” page 474.) or she wants another baby and you don’t.
Another common concern is that Be honest with yourself about what’s
you’ll disrupt the smoothly functioning, right for you. Parenting another child is a
happy family you’ve created. Change of big responsibility to take on because
any sort can bring up fears, and a second someone else thinks it’s a good idea.

Having more children than you want or even if you’re breast-feeding. If you and SECOND PREGNANCY TIMING risk of uterine rupture if you decide to try
can manage can increase the risk of poor your partner agree that your family is a vaginal birth.
parenting. complete, you can stick with your present Once you’ve said yes to another baby, the Limited research suggests that a
form of birth control or switch to some- next decision is when to start trying. pregnancy within 12 months of giving
Thinking in reverse If you’re having thing long lasting, such as an IUD or im- There’s no perfect time to have another birth is also associated with an increased
trouble making a decision about having plantable rod. You might also opt for baby, and if you wait until the circum- risk of placental problems. One study re-
another child, you might try turning the something permanent, such as a vasec- stances are just right, you might never do ported a link between pregnancy inter-
question on its head. How would you feel tomy or tubal ligation. Remember that a it. Even with careful planning, you can’t vals of less than 12 months and an in-
if you were told you couldn’t have an- decision as big as this one takes time and always control when conception hap- creased risk of autism in second-born
other child? Your sadness or your relief thought. Do your research and discuss pens. You might get pregnant sooner children.
may give you insight into what you really any concerns with your health care pro- than you thought or long after you hoped It’s possible that behavioral risk fac-
want. vider. Make sure you have the informa- you would. In the end, pregnancy spac- tors, such as smoking, substance abuse or
Until you make a decision about tion you need — and the time you need ing is often based on a combination of lack of prenatal care, as well as stress and
when to have another child, be sure to to process it — before going through personal preference and luck. poverty, are more common in women
use a reliable method of birth control — with a permanent plan. You can make an informed decision who have closely spaced pregnancies.
about when to grow your family by un- These risk factors — rather than the short
derstanding the health issues associated interval itself — might explain the link
with timing your pregnancies too close between closely spaced pregnancies and
DECIDING ONE IS ENOUGH together or too far apart, as well as the health problems for mothers and babies.
advantages and disadvantages of differ-
The number of families with one child has nearly doubled since the 1960s, as more ent pregnancy intervals for parents and Long interval between pregnancies
people are starting families later in life and facing financial pressures. But negative children. Spacing pregnancies many years apart
stereotypes about only children — that they’re spoiled, selfish, lonely and bossy also may pose some health concerns for
— still persist. Such beliefs may prompt couples to have more than one child. Health issues Some studies show that mothers and babies. A pregnancy five
Years of studies in several countries have found no evidence to support these spacing pregnancies too close together or years or more after giving birth is associ-
stereotypes. Only children are no different from their peers in terms of character, too far apart can pose health risks for ated with an increased risk of:
sociability, adjustment or personal control. One way they are different is that they both mother and baby. Z High blood pressure and excess pro-
score consistently higher in intelligence and motivation compared with children tein in your urine after 20 weeks of
with siblings. Interestingly, some research suggests that parents of only children Short interval between pregnancies pregnancy (preeclampsia)
are happier than are parents with more than one child. When you have just one Closely spaced pregnancies may not give Z Slow or difficult labor or delivery
child, you spend a lot of time with that child, which can make for a close relation- a mother enough time to recover from Z Preterm birth
ship. However, parents with multiple children also are close to their children. the physical stress of one pregnancy be- Z Low birth weight
If you’re struggling with the idea that a childhood without siblings will damage fore moving on to the next. It can take a Z Small size for gestational age
or shortchange your child, you can let go of that fear. Yes, having brothers and year or longer to develop stores of essen- It’s not clear why long pregnancy in-
sisters can be a positive experience and help kids learn skills such as dealing with tial nutrients that may have been deplet- tervals are linked to these potential prob-
conflict. As a parent of a singleton, you’ll want to make an effort to give your child ed during pregnancy and breast-feeding. lems. Researchers speculate that women
opportunities to interact with other children. If you become pregnant before replacing who wait five years or more to have an-
What’s most important is to know what’s right for you and your partner. “I am those stores, it could affect your health or other baby may lose some of the protec-
being honest with myself when I admit that I will be a much happier and better your baby’s health. tive effects generated by the first preg-
parent to one child than more,” says one mother. “Some people thrive in busy, Getting pregnant within 18 months nancy. Maternal age or factors such as
spirited environment. ... I fall apart. I think the worst thing about deciding to have of giving birth may slightly increase the maternal illnesses also may play a role.
an only child is dealing with my own feelings of needing validation.” Another says, risk of low birth weight, small size for To reduce the risk of pregnancy com-
“By having a second child, we would stretch ourselves way too thin mentally, emo- gestational age and preterm birth. If you plications and other health problems,
tionally, financially, physically, and we know we would end up in pure misery.” had a cesarean birth and allow for less wait at least 12 months before getting
than an 18-month interval before your pregnant again. An ideal interval might
next child is born, you may increase your be to wait at least 18 to 24 months but no
474 PART 5: MANAGING AND ENJOYING PARENTHOOD CHAPTER 36: WHEN TO HAVE ANOTHER CHILD 475
more than five years before attempting You might have a similar fantasy of Z You condense the time when you’re Z Your first child will have the opportu-
your next pregnancy. how far apart in age you’d like your chil- dealing with carrying, feeding, diaper nity to be the baby of the family with-
If you do get pregnant while breast- dren to be. Is there an ideal spacing be- changing, sleep deprivation and toilet out any competition.
feeding and decide not to wean your tween children for their sake and yours? teaching. Also, you may not need to Z When the new baby arrives, the older
baby, you’ll need to take extra care with Probably not. Many families settle on an childproof your home as many times sibling will be more likely to play on
your diet. You may want to meet with a interval of two to three years, but various as you would if you had your children his or her own at times, giving you
dietitian to be sure you’re meeting your types of spacing all have advantages and further apart. some one-on-one time with the baby.
nutritional needs. disadvantages. Z You can double up on some tasks, Z Your children will still be close enough
such as reading to your older child in age to bond easily.
Family issues As a child, Mary M. 1 to 2 years apart Having children one while nursing the baby or having Z You’re only paying for diapers for one.
Murry, a certified nurse-midwife at Mayo to two years apart can be the ultimate them nap at the same time. Some baby supplies, such as a crib or
Clinic, pictured herself married to a hand- test of your endurance. But that doesn’t Z Your first child may have an easier stroller, can be recycled.
some pop singer:“We’d have four children, mean it can’t work. time adjusting to a sibling and will Z Your body has time to restore its nutri-
two boys and two girls with two years be- barely remember what life was like tional supply to prepare for the next
tween each child. ... I’m not sure why two Advantages Some of the benefits are: without him or her. pregnancy.
years between children seemed like the Z Your children will be close in age as Z You’ve fine-tuned your parenting
perfect pregnancy spacing in my 9-year- they grow up. They may share many Disadvantages Some of the possible skills, but it hasn’t been so long that
old imagination. As an adult who started of the same interests and activities, drawbacks are: they’re rusty.
having children a little later in life, two making it easier to juggle family Z Caring for two in diapers is likely to
years seemed too long between babies — schedules. Parents often hope that leave you exhausted much of the time Disadvantages Some of the possible
yet my second and third children are two siblings close in age will be close and with little personal space for a drawbacks are:
and a half years apart.” companions and play together. few years. Tantrums, dirty diapers and Z Your first child may feel jealous of the
potty accidents times two can feel like new baby. It’s not uncommon for 3-
constant chaos. and 4-year-olds to revert to baby-like
Z Stress and fatigue can take their toll behavior when faced with having to
on your marriage. You and your part- compete for a parent’s attention. This
ner will need to work as a team to usually goes away with time, though.
meet the challenges ahead. And you’ll Z Rivalry issues regarding toys and ac-
need to set aside some quality time tivities may occur as the baby gets
for each other. older and starts getting around on his
Z Supplies for two infants can be costly. or her own.
Z Sibling rivalry may be a problem as Z Your older child may be outgrowing
your children grow up. his or her naps just as your baby is
settling into a regular nap schedule.
2 to 5 years apart A spacing of two to Z The further apart your children are,
five years is what most experts recom- the more different each child’s activi-
mend. Your first child is a little more in- ties are. Coordinating schedules may
dependent, and you and your partner require considerable organization and
have had some time to regain strength planning and can be stressful.
and energy.
5 years or more apart Some parents
Advantages Some of the benefits are: liken having kids who are five years or
Z During the interval between preg- more apart to having an only child twice.
nancies, you’ll have time to bond with
your first child and give him or her Advantages Some of the benefits are:
your undivided attention. Z You get a big break between babies.

This may give you some time to go Other issues Other factors also can in-
back to doing things you enjoyed be- fluence the time of a second baby.
fore having an infant, such as going Z Your age. Couples who start a family
out for dinner or a movie or taking when they are older sometimes must
adventurous vacations. It may also race against the biological clock. If
give you a chance to refocus on your you’re a woman in your late 30s and
career or your marriage. Waiting five you would like two more kids, you
years or more can also give you a fi- may not have the luxury of spacing
nancial break and allow you to save your children three years apart.
money for the next baby. Z Your fertility. If it took you a long time
Z Each child gets plenty of individual to conceive the first time, or you used
attention in infancy and beyond. fertility procedures, you may not want
Z You get to enjoy and focus on specific to wait long before trying to conceive
stages of growth and development again.
with each child. Z How many children you want. If you
Z Because of the difference in age, sib- would like to have a large family, you
ling rivalry tends to be less intense. may need to space your children clos-
Instead, your younger child may reer together.
gard his or her older sibling as more Most important, listen to what your
of a hero, while the older child may heart says. Whatever the pros and cons of
assume a more protective or guardian- various pregnancy intervals, if you and
like role. Depending on the age of your partner both want another baby,
your first child, you may even have a this might be just the right time.
built-in baby sitter.
Disadvantages Some of the possible

drawbacks are:
Z After several years of being out of
baby mode, you may have a hard time
getting back into it. You tend to forget
how much work caring for an infant
can be and how exhausted you be-
come at the end of the day.
Z It may be a challenge to keep up with
your older children while caring for a
baby.
Z You’ll probably need new baby gear,
because your car seat and stroller will
likely be out of date.
Z Schedules in your household may
vary widely. It can be stressful to keep
them all coordinated.
Z Due to the age difference, your chil-
dren may not share many of the same
interests. They may not be as close as
children who are more similar in age.

PART 6 CHAPTER 37
Special Circumstances Adoption
One of the most deliberate ways of be- may have no control over the prenatal
coming a parent is through adoption. and postnatal care of the child you adopt,
Adoption is an active process, often in- you may have some unique concerns.
volving a great deal of paperwork to be This chapter offers basic advice on adop-
filled out, personal information to be tion and addresses medical and emo-
shared, home studies to complete and tional issues that may be on your mind.
agency fees to work into the budget. And
unlike a nine-month pregnancy, adopt-
ing a child can take anywhere from sev-
eral months to several years. The wait can SUPPORTING YOUR
be difficult, and adoptions can some- CHILD’S HEALTH
times fall through.
Prospective parents, whether through Like any parent, one of your jobs is to
adoption or surrogacy, are often required keep your child as healthy as possible.
to undergo a level of introspection and Since you may not know ahead of time
outside scrutiny that can be considerably what your child’s health status or medi-
greater than for others making the tran- cal history is, you may need to take a few
sition into parenting. In short, those who extra steps to ensure your child gets on
undertake adoption are some of the best the right track.
prepared parents around! This can be a
great strength when it comes to facing Find a care provider The best time to
the challenges and opportunities ahead. choose a care provider is before your
Most of what you need to know about child arrives, if at all possible. Although
caring for a baby is already in this book: many professionals who care for chil-
All babies require love, nurturing, guid- dren’s health have experience with adop-
ance and medical care. But because you tion, you may need to shop around a bit
CHAPTER 37: ADOPTION 481

before you find one that suits your needs. history in writing from the birth parents
Talk to other parents who have adopted or adoption agency. There might not be INTERNATIONAL ADOPTIONS
and ask for recommendations. Call a few much information, but it will be easier to
of those care providers to say you’re track down now rather than years later. Immigration laws in the United States require that all immigrants seeking perma-
planning to adopt, and ask if there’s any It’s especially important to gain full nent residence in the U.S. show proof of having received the vaccines recom-
specific medical information you should disclosure from the agency before you mended by the Advisory Committee on Immunization Practices (ACIP). Interna-
request from the agency concerning your adopt, to have a more accurate represen- tionally adopted children under 10 years of age are exempted from this law,
child. If you’ll be adopting international- tation of any medical conditions your however, as long as the parents sign a waiver declaring their intention to comply
ly, ask care providers if they’ve had expe- child may have. This is where having a with immunization requirements within 30 days of the child’s arrival in the U.S. Over
rience with international adoptions. care provider for your child already se- 90 percent of children adopted from abroad need catch-up immunizations when
If possible, schedule a pre-adoption lected may come in handy. He or she may they arrive.
visit with the care provider you prefer. be able to help you make sense of medi- Certain countries also have high rates of infectious diseases or parasites that
Most providers appreciate the opportu- cal reports you obtain, explain the impli- prompt testing and treatment, if necessary, both for the care of the child and pro-
nity to meet parents before the child ar- cations of a medical condition, or alert tection of the rest of the family. In addition to a complete physical examination (in-
rives so that they can discuss issues such you to what might be missing from the cluding vision and hearing screenings), your child’s care provider may recommend
as sleeping, eating, making the house records. screening for the following:
childproof, immunizations and any perti- Z Hepatitis B Z High lead levels in the blood
nent medical concerns. They can also dis- Get post-adoptive care If your baby Z Syphilis Depending on your child’s country
cuss with you general developmental has a known medical condition or arrives Z HIV of origin, the care provider may also
expectations based on the age your child ill, you may need to visit your child’s care Z Intestinal parasites recommend testing for:
will be on arrival. provider soon after arrival. But if your Z Tuberculosis Z Hepatitis A
Some international adoption clinics baby appears healthy when he or she Z Anemia and blood disorders Z Hepatitis C
offer physician services, such as review- joins your family, you might wait a cou- Z Vitamin and mineral deficiencies Z Chagas’ disease
ing a child’s medical information before a ple of weeks or even a month. This gives Z Thyroid disorders Z Malaria
prospective parent accepts a referral, the child a chance to adjust and the par- Treatment exists for many of these conditions. The sooner a health concern is
travel consultations for parents traveling ents a chance to get to know the new ar- detected, the more effectively it can be treated.
abroad to pick up their child, and post- rival so they can better answer a care pro-
adoption checkups. vider’s questions about their child’s
“usual” behavior. If your baby is an open-
Update family immunizations Adults adoption newborn, you may just need to mend certain screening tests and immu- your child’s blood before recommending
and children who will be in close contact follow the same well-child schedule as nizations, depending on your child’s certain vaccines to see if he or she has al-
with the child being adopted may need any new baby. (For more information on country of origin. ready had certain infections.
to catch up on immunizations, including routine medical care, see Chapters 11 At the first appointment, your son’s or A few children have no official birth
vaccines against measles, hepatitis A and and 12.) First-time parents, especially if daughter’s care provider will review the date. Determining their age can be diffi-
B, tetanus, diphtheria, and pertussis. If they did not have a pre-placement visit, child’s immunizations and perform any cult if their growth is delayed because of
you’re traveling to a different country to may want to consult their child’s care age-appropriate screening tests, as well prematurity, problems at birth, malnutri-
receive your child, your care provider can provider sooner if they need information as any further tests indicated by the ex- tion or neglect. Your doctor will try to
also give you advice on travel safety and and support. amination. If your child has no written make an educated guess based on the
any necessary vaccines or medications For children arriving from overseas, record of immunizations or has missing information available.
you’ll need to receive before or during the Centers for Disease Control and Pre- or ineffective vaccines, the care provider After your child’s first medical exami-
your trip, depending on your child’s vention recommends a medical exami- may recommend starting a new sched- nation, it’s important to follow the sched-
country of origin. nation within two weeks of arrival in the ule. The risk of side effects from repeating ule of examinations and immunizations
United States, or sooner if your child has a vaccine is lower than the risk of getting recommended by your care provider.
Try to track down a medical history a fever, anorexia, vomiting or diarrhea. In an infection. If your child is older than 6
If possible, try to acquire any medical, ge- addition to a comprehensive exam, your months, his or her care provider may rec- Give it time It’s not uncommon for
netic and social records of your child’s child’s care provider may also recom- ommend checking antibody levels in children adopted internationally to show
482 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 37: ADOPTION 483

delays in development when they arrive. dent and comfortable with each other Respond to your baby’s needs Be Learn about your child Inquire about
But most are able to catch up within the and in the way you interact. quick to find out why he or she is crying. the child’s environment and routine before
first 12 months of arrival, after being on a The same activities can foster the at- Tending promptly to your child in the first he or she enters your family so you can
nutritious diet coupled with a stimulat- tachment process for both biological and few months won’t spoil the child but will help smooth the transition. For instance:
ing, nurturing environment. For example, adoptive parents: holding your baby provide reassurance and comfort. Even- Z A child who shared a crib or a mat
a baby who may not have had the oppor- close, cuddling, feeding, laughing, sere- tually, your son or daughter will become with other children or family mem-
tunity to learn to crawl because of his or nading, playing games, going through more secure in his or her role in the fam- bers may be frightened at night in a
her previous conditions may quickly the daily activities of living. ily and less clingy or demanding. In fact, room by him- or herself. You may
learn to do so by being placed on a blan- this is common advice for every parent. want to bring the child into your bed-
ket on the floor and given the incentive Allow time for adjustment Parents Also investigate if your child doesn’t room and keep his or her crib in your
of a toy just out of reach. who adopt have sometimes waited so yet signal his or her discomfort. Children room for a while until he or she gets
very long for a baby that they cannot wait who have spent time in an institution or used to her new environment and has
Get support If you’re adopting an older to smother the child with love and atten- have been neglected may internalize had time to adjust. After a while, the
child, especially one who has had a diffi- tion. Depending on your child’s age, he feelings of abandonment and insecurity child likely will establish more inde-
cult past, or a child with special needs, or she may have just been separated from by withdrawing from others and failing pendence and be able to sleep on his
your child’s care provider may refer you everything that was familiar and needs to make their needs known. Keeping a or her own. You might also consider
to a counselor or mental health care time to warm up to you and take in a new quiet eye on your child and maintaining a giving your child a soft blanket or
provider who has experience with adop- environment. regular schedule for meals, naps and bed- stuffed animal. Having a loved object
tion. Such a therapist can help ease the Holding children close is important time will help promote health and provide to hang on to while everything seems
transition for the whole family and pro- because it helps them get accustomed to a sense of security and well-being. to be in transition may help your son
vide help in working through issues of your scent, to hear your heartbeat and to
loss and change. Support groups for fam- feel your body warmth. But pay attention
ilies created through adoption also can to their signals. Some children prefer to
be helpful. be held more than others do.
In general, the best way to nurture a
healthy attachment to your child is by
observing closely what he or she needs
BONDING and determining how best to make your
son or daughter feel supported, safe and
Some parents bond immediately with loved in any situation. This may call for
their baby the first time they meet their different strategies in a young infant
son or daughter. It seems as if the family when compared with an older child.
they’ve established was always meant to Older children are more likely to have
be. But for others it takes a little longer. difficulties with attachment, and parents
Don’t fret too much if the first time you of these children may wish to connect
meet your baby, both you and your child with specialists in post-adoption services
feel more bewildered than besotted. As either through their adoption agency or
with any relationship, it takes time and through their primary care provider.
commitment to establish a deep, solid
connection. Talk, sing and read to your baby
The longer you’re there to provide These activities allow the child to get
consistent, loving care, the more your son used to the sound of your voice. This is
or daughter will realize that you’re in this especially important for children who
for the long haul and that he or she is come from another country because it
safe and secure. With time and consistent helps them get acquainted with the nat-
effort, you both will become more confi- ural rhythms of a new language.
484 PART 6: SPECIAL CIRCUMSTANCES

or daughter feel more secure and she may have already learned certain cul-
eventually, more independent. tural behaviors. For instance, a child from BREAST-FEEDING AN ADOPTED BABY
Z A child who was carried everywhere a country where passivity is encouraged
on the back of his or her caregiver, as may appear unresponsive. Many adoptive mothers are surprised to learn that nursing their babies may be an
is the custom in some countries, may If you’re adopting a child of 12 months option for them. Because lactation, or the production of breast milk, can some-
feel right at home if you put him or or older, it may take more time and un- times be induced (with a combination of pumping and nipple stimulation), a wom-
her in a back carrier. Even a child who derstanding to get acquainted and de- an might be able to breast-feed without ever having been pregnant.
isn’t used to it may enjoy the security velop mutual trust. You may find reassur- Adoptive mothers who seek to nurse young infants usually do so to enhance
of being carried close to you in a front ance in reading about parenting, talking their relationships with their children. Although most adoptive mothers can’t pro-
or back baby carrier. to someone from the adoption agency or duce all the milk their infants need, even limited breast-feeding allows them the
Z A baby who is used to falling asleep a counselor familiar with the adoption opportunity for physical and emotional attachment with their babies.
with the room light on may be ex- process, and in doing what you can to When the baby’s arrival can be anticipated, some women try to establish a milk
tremely attached to that simple rou- help your child feel loved, secure and supply in advance by using an electric breast pump at regular intervals.
tine. Be sensitive to any behaviors wanted. Eventually, the majority of chil- Others wait until the baby arrives, because the baby’s sucking will stimulate
that seem important to your child, dren — especially those who arrive most lactation better than any pump on the market. These mothers use a supplemental
and allow some time before gradually needy — make great gains in their social nursing device that allows infants to receive formula through a soft tube inserted in
trying to change habits. and behavioral skills, a testament to the their mouths while nursing. Even after their milk comes in, many mothers continue to
Z A child who comes from little means resilience of human nature. use supplemental nursing devices if they need to increase their breast milk volume.
may experience sensory overload with Babies are usually more willing to breast-feed if they are younger than 8 weeks
a nursery full of toys, unable to decide Take care of yourself It’s tempting to of age, but some adoptive mothers have reported success with older infants, too.
what to play with first. Introduce one let everything else fall by the wayside — If you try breast-feeding but aren’t able to produce milk, don’t be anxious. There
toy at a time, as the child is ready. including yourself — when focusing on are plenty of other ways to foster attachment with your baby, including holding your
your newest family member. But allow- baby close with skin-to-skin contact during feedings, and at other times, too.
Identify baby’s developmental stage ing yourself to become sleep deprived, If you think you might like to nurse your adopted infant, discuss the advantag-
On joining your family, your child’s de- worn down and stressed out isn’t helpful es, disadvantages and techniques with your doctor or a lactation consultant weeks
velopmental stage can affect how he or to anyone and may in fact undermine the or even months before you anticipate your child’s arrival. There may be a lactation
she interacts with you. For instance, in attachment process. consultant on staff at your hospital, or you may contact the International Lactation
the first four months, babies cry mostly Like any new parent, it’s not uncom- Consultant Association or La Leche League International. See page 552 for con-
when they need something and they’ll mon to feel overwhelmed when faced tact information.
bond most easily with the person who with the intense demands of parenting.
responds to their cries. Later, they begin Accept help from family members and
learning cause and effect and may cry friends with housecleaning and other
just to see what happens. This behavior chores, spend some time on your own, party who has seen and talked to other SHARING YOUR FAMILY STORY
could frustrate parents meeting their get some exercise (even if it is just a walk adoptive families, and can help them
child for the first time at this stage. At around the block) and eat regular, healthy work through the necessary steps to A renewed focus on an adoptive child’s
around nine months, separation anxiety meals. If you take care of yourself, you’ll achieve mental and emotional wellness well-being has paved the way for in-
can be very intense for a child who’s been be better equipped to care for your new and to bond as a family. creased openness when it comes to telling
attached to another caregiver. son or daughter and your family. If you’re feeling discouraged or lost, the adoption story. More adoptions are
Read through the chapters in Part 3 of or if your child exhibits behavior prob- now carried through as open adoptions,
this book that correspond to your baby’s Get help when needed All children lems or doesn’t seem to be building a re- where the birth parents are in contact
developmental stage.You’ll find that some are individuals with definite likes, dis- lationship with you, seek professional with the adoptive family during the adop-
of your child’s behavior is indicative of the likes and inborn personality traits. Some help. Your child’s care provider, adoption tion process and possibly beyond. This
developmental phase he or she is in rath- adjust quickly and respond with joy to agency, a social worker or mental health avoids the scenario of previous genera-
er than of his or her personality. their new families, but others might have professional may be able to help you un- tions when parents didn’t always tell their
If you’re adopting a child who’s 6 a difficult adjustment period. Many fami- derstand and resolve the challenges children they were adopted. The news
months or older, keep in mind that he or lies benefit from talking to an outside you’re facing. might be revealed by a relative or come as

a surprise later on, leaving the children Experts agree that if parents demonstrate
feeling puzzled, angry or betrayed. they are comfortable talking about adop- SIBLINGS AND ADOPTED CHILDREN
But even with open adoptions, it’s not tion as a positive, normal experience,
always easy for a child to understand the re- their children will be much more likely to If you have other children in addition to vival behaviors, such as hoarding food
lationship between the two sets of parents. feel comfortable with it themselves. They your adopted child, you’ll probably face or sleeping with the back against a
While it’s best not to keep the adoption a will also be more willing to share their some of the same issues as any parent wall. Other siblings may perceive this
secret, you also don’t want to overwhelm questions and concerns about adoption has when introducing a sibling to broth- as “weird.” But it’s important to realize
your child with information. Right now as issues arise. ers and sisters (see Chapter 34). that these behaviors are likely there for
your adoptive son or daughter may be Help your other children with the a reason. Over time, as your new child
too little to understand, but when he or Use books Even before your child is old transition by including them in plans for continues to receive consistent, loving
she is older and the time is right, look for enough to ask questions, you can begin the new baby’s arrival, welcoming him care, these behaviors are likely to fade.
natural opportunities to weave your fam- to introduce age-appropriate books that or her home and in daily caregiving ac- In the meantime, encourage your chil-
ily’s story into your daily life. If you start explain adoption through simple con- tivities. Children typically love babies dren to focus on the positive aspects of
early and simply, the transition to more cepts and words. and will be thrilled to help out. Even after their relationship with the new brother
complex discussions down the road may the novelty wears off, big brothers and or sister. Younger children, for example,
be that much smoother. Keep in mind Tell your story Many experts recom- sisters still continue to bond with the are usually easily distracted by a new
that this is your own family story; how mend that parents develop their own baby, even when conflicts arise. Also, try topic of conversation or by the sugges-
you share it with others outside of your story of how their family was created and to find some time to spend with each tion of a game. Older children may be
immediate family is up to you. tell it to children from the very beginning. child individually, even if it means run- able to better understand the possible
Children won’t understand everything at ning a quick errand together or snug- reasons for unusual behaviors and may
Be positive Start by making sure your first, but the words and phrases will be- gling for a few minutes before bedtime. be able to help you in providing consis-
own attitude toward adoption is positive. come a natural part of their vocabulary. The younger the siblings and the tent support to their sibling.
adopted child, the more likely they are Sibling relationships can be a life-
to bond with little trouble. Most children long gift, continuing to be a source of
under the age of 4 generally don’t no- strength even after parents are gone.
ONE MOM’S STORY tice differences among themselves and Look for opportunities to promote
like to hear the adoption story. Older bonding between all of your children. If
We have a fairly open relationship with my 4-year-old daughter’s birth mother. My children are more likely to ask ques- you have doubts or questions, or you
daughter knows her birth mother’s name and a picture of the two of them hangs tions and feel some differences. feel your family needs help in bonding
above her bed. Her birth mother and I exchange emails and pictures, and we all talk In some cases, an older adopted together, talk to someone who is
on the phone on holidays and birthdays. When my daughter and I discuss our fam- child may have developed certain be- knowledgeable in the matter. This may
ily story, it goes something like this. haviors before joining a permanent be someone from your adoption agen-
family that persist for weeks or months cy, your primary care provider, a social
“I feel so lucky that your birth mom (we use her first name) chose me to be your after adoption. This might include sur- worker, or a family counselor or therapist.
mommy! I remember the day that you were born ... when I first held you, I couldn’t
believe how small you were! I’d been waiting for you and seeing you made me
smile so big. You had tiny little fingers, and you wrapped them around my little
finger right away — I think maybe that’s why we like to hold hands today. Your birth
mom and I took turns holding you and feeding you. We talked about how cute you
were and about what we hoped you’d do when you got older. We both want you
to be happy and to do good in school and be nice to your friends. We want you to
have lots of adventures and to go to college when you’re bigger. Most importantly,
we want you to know that you’re loved. You grew in your birth mom’s tummy and
you grew in my heart and that means that you get two people to love you.”

And all children love hearing stories Use positive language Let your lan- your child’s benefit than to educate the through adoption are keenly aware of
about themselves. guage reflect your own positive values person asking the question or making their parental responsibilities. Together,
Use the story to introduce your child’s toward adoption. Be open and honest the comment. you and your child make a family, a fam-
birth parents in an understanding way, about the adoption, but don’t use it as Here are some responses suggested ily that more often than not is abundant-
explain why you chose adoption to build a label. Say my child and not my adopted by adoptive parents to frequently asked ly prepared for the adventures ahead.
your family, and give your child a sense child. Phrases such as“given up for adop- questions:
of personal history and belonging. Any tion” may leave children feeling there Z Who are his real parents? We are —
details you can add to such a story about was something wrong with them that we’re not imaginary. We are the ones
the joy of your first encounter will make made their parents give them away. In- who do the parenting. (Information
it more delightful to your child. stead, talk about the decision made by about the birth parents is the child’s
Creating a “life book” for your child is the birth parents to “make an adoption to give.)
another way to celebrate the unique way plan” or “arrange for an adoption” so that Z Are they really brother and sister? Yes,
he or she joined your family. Save any their child could be well cared for. they have the same parents. (Whether
mementos such as letters, toys, hospital or not they are biologically related is
name tags or documents that came with Celebrate your family Some families also the child’s information.)
your child at the time of placement; they make a tradition of doing something Z I don’t know how any mother could
can serve as a source of “roots” later. In- special on the day their family was cre- give up her child. The decision to
clude pictures, too. Save any information ated, such as having a family anniversary place a child for adoption is a painful,
or mementos that are directly from your party or doing something special for the difficult decision for any woman, but
child’s birth parents, no matter how small birth parents. This is a great way to get it’s always made in the best interests
they may appear to be. Even a slip of pa- your other children involved, as well. of the child. It’s not because a birth
per with the birth parent’s handwriting mother doesn’t care, but because she
may ultimately become a treasured pos- Seek out other families like yours and the birth father could not care for
session for your child. If your child is Look to make connections with other any child at that time in their lives.
from another country, pictures, trinkets families that have been touched by adop- Z Too bad you couldn’t experience preg-
and other mementos from your trip there tion — both the children and the parents nancy. You don’t get to experience
can provide a sense of background. will find this type of peer group helpful. everything in life. I may never get to
Transracially adopted children will get Africa either. But my adoption experi-
Tell the truth Be factual about your the added benefit of spending time with ence has been wonderful, and I
child’s story, while keeping in mind children — and other families — who re- wouldn’t trade it for anything.
what’s age appropriate. It’s important not semble them.
to embellish or add details that you don’t
know to be true. You may be uncomfort-
able with the fact that there are holes in PARENTING IS PARENTING
the story, and you may wish you knew all HANDLING DIFFICULT REMARKS
of the answers. Your child may ultimately Becoming a parent opens up opportuni-
grieve the loss of those details, too. How- At one time or another, parents and chil- ties for amazing fulfillment and incredi-
ever, it’s healthier to acknowledge the dren may be faced with ignorant or even ble challenges, no matter how you come
missing information and deal with the hurtful remarks from others. It isn’t al- into that role.
ramifications of not knowing than it is to ways easy to speak up when someone In the end, parenting is parenting. In
make up details that you don’t know to says something naive or offensive, but it order to move successfully from depen-
be true. And don’t feel the need to share is important to keep your child’s well- dent infant to independent adult, every
all of the information with your child being in mind. You don’t have to answer child requires consistent, loving care in a
right away; there may be some details every question, and you don’t have to let warm and nurturing environment. Pro-
that are better saved until your child is everyone know you adopted your child. viding this to your child makes you a par-
mature enough to handle them. Instead, your response may be more for ent, and research indicates that parents

CHAPTER 38
Caring for multiples
Congratulations on not one but two FEEDING

(or more) babies! Your first year together
will likely be a busy one, filled with chaos Mothers of multiples report that one of
and, yes, delight. Like any new parent, the most stressful aspects of being a new
there may be times when you wonder if mom involves feeding their children.
you’ll ever make it through and times Newborns and young infants need to eat
when you feel that it’s all more than frequently — generally between eight
worth the effort. and 12 times a day. When you’re feeding
Raising multiples, especially in the more than one child that many times,
early months, can seem truly overwhelm- you may feel as if all you do is sleep, eat
ing, simply because of the extra logistical and feed your babies. Even bottle-feed-
and physical demands involved. Daily ing, which many assume would be the
parenting tasks may be doubled or tri- most efficient method, takes a surprising
pled, and the amount of time left to your- amount of time and technique — not to
self may very well be miniscule. But most mention a lot of bottles that require
parents of multiples are able to rise to the washing and storing!
occasion and find inner reserves of ener- Feeding your infants may seem to be
gy and strength they never imagined an insurmountable task at times but there
they had. are a couple things to keep in mind:
You already have plenty of helpful in- Regardless of which method you
formation in other sections of this book. choose to feed your babies — breast-
This chapter aims to give you some prac- feeding or formula-feeding — a source of
tical tips on caring for multiple infants support and help is invaluable. This may
and finding time to care for yourself. If come through your partner, grandpar-
your babies were born prematurely, you ents, support groups or a hired caregiver.
may also find Chapter 39 to be helpful. No one says you must do this alone.
CHAPTER 38: CARING FOR MULTIPLES 493

This stage doesn’t last forever (even recover from childbirth, get the hang of one of your babies has an easier time helps establish and maintain your milk
though it may feel that way). As one ex- breast-feeding and spend time with each latching onto your breast or staying supply, any amount of breast milk you
perienced mother said, “The days are infant. You can find out more about latched, place him or her in the cradle can give to your children is beneficial.
long but the years are short.” In a few breast-feeding basics in Chapter 3. position. To use the double cradle Many moms find that a combination
months, as your children begin eating position, you place both of your ba- of breast- and bottle-feeding works well
other foods and become more indepen- Simultaneous breast-feeding Many moth- bies in the cradle position in front of because it allows them to breast-feed
dent, the demands placed on you will be- ers find that once their milk supply is es- you. Position your babies so that their their babies but also share the job of
come less intense. tablished and breast-feeding is going legs overlap and make an X across feeding with a partner or other caregiv-
A quick note: Don’t let others pres- well for all involved, they’re able to feed your lap. ers. For example, you might breast-feed
sure you into one form of feeding or an- their babies simultaneously. This may or Rather than assign one baby to each one baby while your partner bottle-feeds
other. This is a personal decision between may not be for you, but it’s worth a try breast, try to alternate them. This way, if the other one, then swap at the next
you and your partner, based on sound because it can save time and energy. As one infant sucks less vigorously, the oth- feeding. Or your partner might take over
advice from your children’s care provider with feeding one baby, be sure to get er may make up the demand and balance a double bottle-feeding session while
or another specialist. The most important comfortable. Use pillows to support out the supply in each breast. If you have you get some rest. Ideally, you want to
thing is that your children grow and yourself and your infants. Some manu- three or more babies, use a rotation sys- establish a milk supply before supple-
thrive, and that you and your partner are facturers make breast-feeding pillows tem so that each one gets milk from both menting regularly with formula.
able to enjoy the process (at least some of designed specifically for multiples. breasts. For example, if you have triplets, Some mothers of triplets prefer to set
the time). Here are some commonly used posi- you might breast-feed one on each breast up a rotation where they breast-feed two
tions for breast-feeding twins: simultaneously and then the third on infants supported by pillows while bot-
Breast-feeding Most experts agree Z Double clutch or double football hold. both breasts. At the next feeding, rotate tle-feeding the third sitting in an elevat-
that breast milk is the ideal source of nu- In this position, you hold each baby in their positions. ed infant seat. This is usually easier when
trition for infants. Breast milk’s nutrition- a clutch or football hold. Place a pil- babies are a little older and can hold up
al value is also one of the biggest reasons low on each side of your body. You Combined breast- and bottle-feeding their heads well.
that mothers of multiples seek to breast- might also want to place another pil- Breast-feeding doesn’t have to be all or If you give your babies formula, keep
feed. While it takes a certain amount of low on your lap. Place each baby on a nothing. While frequent breast-feeding in mind that your milk production might
dedication, it is possible to do, as shown pillow beside your body — almost
by so many mothers who have success- under your arm — so that the babies’
fully breast-fed multiples. Some mothers legs point toward the back of your
even say that breast-feeding is easier and chair. Make sure each baby lies on his To breast-feed two babies at
less time-consuming, once lactation is or her back with his or her head at the once you might use the double
established, than is bottle-feeding. And level of your nipple. Place the palm of clutch or double football hold
research studies indicate that most wom- one hand at the base of each baby’s position. In this position, you
en will generally produce as much milk head to provide support. Alternative- hold each baby in a clutch or
as is demanded, so it’s possible to pro- ly, you can place both babies — head football hold under your arms.
duce enough milk for multiple children. to head — on pillows directly in front Make sure each baby lies on
If you decide to breast-feed, it’s help- of you. Be sure to keep your babies’ his or her back with his or her
ful to find a mentor who can give you in- bodies turned toward you, rather than head at the level of your nipple.
sights and tips. This may be an experi- facing up. Use the palms of your Place the palm of one hand at
enced mother of multiples, care provider hands to provide support for each the base of each baby’s head
or lactation consultant. Support groups baby’s head. to provide support.
for parents of multiples, such as the Z Cradle-clutch combination. In this
Mothers of Twins Clubs (see page 553), position, you hold one baby in the
are another way to meet experienced cradle position — with his or her
mothers and fathers of multiples. head on your forearm and his or her
© MFMER
At first, most women breast-feed one whole body facing yours — and the
infant at a time. This allows you time to other baby in the clutch position. If
494 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 38: CARING FOR MULTIPLES 495
begin to decrease if you breast-feed or the babies’ needs — getting adequate lap. Hold one bottle with your right tween babies that are breast-fed or bot-
pump less than eight to 10 times within nutrition and avoiding dehydration are hand and lean the other bottle against tle-fed. If you have any questions or con-
24 hours. the ultimate goals. your chest. cerns, don’t hesitate to ask your babies’
As with breast-feeding, it may be best Z Cradle one infant in your left arm and care provider.
Pumping If one or both of your babies to start out feeding one infant at a time. curl your left wrist and hand around
are preemies or require an extended stay Chapter 3 will tell you what you need to the baby to offer this baby’s bottle.
at the hospital, you can still establish a know about bottle-feeding basics. Once Support the other baby’s head in your
milk supply by renting a hospital-grade your babies are feeding well, you can lap with his or her feet extended away RAISING STRONG INDIVIDUALS
breast pump and pumping milk until save time and bottle-feed simultaneously from you and offer this baby’s bottle
you’re able to nurse. A breast pump may with the right techniques. One thing to with your right hand. Multiples are born with a strong connec-
also be beneficial if you have one baby at avoid is propping up bottles and leaving Z Lean back in an armchair or against tion with each other. They have similar
home and one at the hospital, or one or a baby unattended, as this can increase pillows and put both babies on your genetic material, they’re usually deliv-
both babies have difficulty latching on or the risk of aspiration and choking. lap facing away from you with their ered within minutes of each other, and
sucking. Pumping is also helpful if you Two pediatricians who are also moth- heads supported against your chest. they go through each phase of develop-
need to return to work but would like to ers of twins offer some different ways to Offer a bottle from each hand. ment around the same time. They come
continue feeding your babies breast milk. bottle-feed twins simultaneously: Z Place one baby in an elevated infant into the world with a ready-made com-
See Chapter 3 for how-to’s on pumping. Z Sit on the floor with your legs extend- seat next to you on the floor and hold panion and playmate at hand. They’re
ed in a V shape. Place the babies be- the other baby in your lap. Offer a likely to share bedrooms, toys and even
Bottle-feeding Parents decide to feed tween your knees with their feet to- bottle from each hand. attention from others.
their babies formula for a variety of rea- ward you and heads propped on a Z Use two infant seats and sit between
sons — illness on the part of the mother pillow. Hold a bottle in each hand and them on the floor. Offer a bottle from
or one of the babies, difficulty sustaining use your thighs as armrests. each hand.
an adequate milk supply, the ability of Z Sit in a comfortable armchair with
both parents to feed rather than just the your left elbow propped on the arm- Are my babies getting enough? If
mother, or simply the convenience of rest. Hold both babies with their your babies are growing adequately, then
having as much as you need whenever heads resting against your left arm they’re getting enough milk. Your babies’
you need it. Ultimately, it comes down to and their bodies supported in your care provider may recommend some ex-
tra office visits to make sure each is gain-
ing weight properly. You may also con-
sider renting a scale, such as a baby scale,
TIPS TO OPTIMIZE MILK PRODUCTION for the first month to monitor each baby’s
weight gain. Knowing your babies are
Taking care of your body will help you make the most of breast-feeding: getting enough to eat and they’re gaining
Z Rest when you can. Although a solid night’s sleep may be a thing of the past, weight properly may help you feel more
take every chance you get to rest. Extreme fatigue can interfere with breast confident in breast-feeding. As a general
milk production. rule, after the first week of life, weight
Z Eat a healthy and adequate diet. Avoid dieting while breast-feeding, which in gain should be ½ to 1 ounce a day.
itself burns calories. Eat a well-balanced diet with plenty of liquids. During the first few weeks, you might
Z Continue taking prenatal vitamins. Your prenatal vitamins provide nutrients that find it helpful to maintain a daily chart to
may be missing from your daily diet. record feedings, wet diapers and bowel
Z Drink plenty of fluids. Although extra intake of fluids hasn’t been proved to in- movements. In general, a baby who’s
crease milk production, nursing does tend to make you thirsty. Have a glass of getting adequate nutrition will eat eight
water or juice before you sit down to nurse and keep water handy while nurs- to 12 times a day, produce at least four to
ing. Some nursing pillows even have pockets for just such a purpose. six wet diapers (and at least one that’s re-
ally soaked) and one bowel movement a
day. There may be slight differences be-
496 PART 6: SPECIAL CIRCUMSTANCES

When you have twins or other sets of study attempting to find out why con- ples are permanently disadvantaged, and wipes in large volumes and at a dis-
multiples, it can be easy to slide into a cluded that one of the reasons for this they do illustrate the value of spending count. Another option is to purchase
mode where you treat them as a pair or delay may have to do with the level of interactive one-on-one time with each bulk items online and have them deliv-
a set. For example, you may dress them parent-child interaction. Mothers of child when possible. ered right to your door. Some retail web-
alike or others may refer to them as “the twins were less likely to engage each sites have special membership programs
twins.” This isn’t necessarily harmful child in back-and-forth “conversations” Parenting strategies Another reason for parents, such as Amazon Mom, that
but it can sometimes get in the way of and less likely to report regular book to look at each child as an individual — allow parents to access baby and toddler
each child’s ability to develop separately. sharing — looking at books together and one who just happened to be born at the items at a discount.
Also, if you treat your multiples as alike talking about pictures or pointing at same time as his or her sibling — is that
in every way, you may be missing out on them and investigating the story further. you can learn to recognize different tem- Check out supply stores Preschool
some effective parenting strategies. This seems fairly natural, as mothers peramental qualities in each one. Espe- and child care supply stores carry equip-
of twins tend to have more demands cially as your children get older, you can ment that’s specifically designed for han-
One-on-one time Research shows placed on them on a day-to-day basis use your understanding of their different dling multiple children of the same age at
that, overall, multiples grow and develop than do mothers of singletons, who may temperaments to target your parenting once. Some examples include feeding
in much the same way as single-born have more time to actively engage with strategies more effectively. tables with multiple seats built in, diaper
children — unless they were born pre- their child. Although the study was lim- For example, you may notice that one storage units, activity tables built to ac-
maturely, in which case prematurity may ited to studying mother-child interaction, child is more flexible when it comes to commodate multiple children and stack-
impact growth and development. in real life fathers and other caregivers transitioning from one activity to another, able toddler chairs. Plus, these items are
Some studies indicate that children can also play major roles in a child’s daily but the other may need ample warning generally built to withstand a fair amount
who are multiples tend to display a slight care. In the long run, being a twin doesn’t that a change is coming. Knowing this of use.
delay in language development com- appear to affect academic performance difference between the two may help you
pared to singletons. This delay can be a once children reach school age. So while smooth your day and avoid meltdowns. Join a parent group Groups for par-
common concern among parents. One studies like these don’t mean that multi- (See Chapter 9 for a more in-depth dis- ents of multiples not only provide regular
cussion of temperament.) However, as gatherings and emotional support, mem-
you come to recognize their differences, bers of the group also may hold resale
try to avoid labeling your twins, such as events where families can buy and sell
referring to one of them as the“quiet one” gently used baby equipment.
and the other as the “outgoing one.”
Explore different options Assessing
your needs and knowing what’s available
is helpful when it comes to equipment:
LOGISTICS
Gates and locks Thoroughly childproof-
In addition to the physical demands of ing your home — placing gates in bath-
raising multiples, there are logistical room and kitchen doorways and in front
challenges, as well. You don’t just need of stairs, putting childproof locks on cabi-
one crib, stroller, highchair and car seat. net doors — allows you to rest more easily
You need two or more. Here are some when you’re busy with one toddler and
practical tips that may help you save don’t have a hand on the other.
money and get the job done.
Strollers Double strollers for twins come
Buy in bulk If you’re near a warehouse in a few variations. Side-by-side ones are
club that sells items in bulk, such as a nice for walks in the park and jogging
Costco, BJ’s or Sam’s Club, it may be with your infants. Front-to-back models
worth considering a membership. These are easier to navigate in and out of door-
places offer formula, baby food, diapers ways and in tight spaces. You can also
clamp two lightweight umbrella strollers to accomplish the daily tasks required to Get help and support Getting help eventually contribute to society in their
together to make a double stroller. care for your children. can make a big difference. Some families own right.
Keeping in mind that the demands of hire help, some rely on extended family,
Harnesses Once your children start early parenthood are exponentially in- and some get help from friends, neigh- Take time for yourself The stresses
walking, you might consider purchasing creased for parents of multiples and the bors, their church or other organizations. and demands of early parenting can take
child harnesses. These devices allow a fact that real life rarely falls together as Also consider attending a local sup- a toll on marriage and relationships. It’s
child to walk independently and still be neatly as advice found in a book, here are port group for parents of twins or other important to remain flexible about your
within reach. Harnesses can be especially some suggestions that might help make multiples. You’ll likely get many invalu- changing roles in the family and main-
helpful in crowded areas. life a little easier: able ideas and practical suggestions from tain open communication so that each
All the equipment and supplies you other parents. Online communities dedi- knows what the other is thinking.
acquire may seem to overwhelm your Get enough rest When others tell you cated to supporting parents of multiples In addition to taking time for yourself,
house, car and everything else in the first to get more sleep, it may feel like a joke at are another option. take periodic breaks with your partner to
year. But as your children get older, you’ll times. How, you ask? Two nurses con- nurture and sustain your relationship.
find that some things are no longer nec- ducted a survey of mothers and fathers of Let go of guilt After experiencing in- This doesn’t have to be anything compli-
essary, such as infant swings, playpens twins, published in Applied Nursing Re- fertility and then having multiples, some cated — it might be as simple as watch-
and eventually highchairs and cribs. search, to see if they could find any con- parents feel guilty when they become ing a favorite TV show together or mak-
Hang in there! sistent answers to this dilemma. Their stressed or exhausted by the demands of ing a decent dinner for yourselves after
question was simple: What strategies did caregiving. They may believe that they the kids are in bed. Look for ways to sup-
parents of twins employ to obtain sleep should only have feelings of happiness port each other as new parents and com-
in the first six months after taking their and joy after finally achieving their wish pliment one another on a job well done.
TAKING CARE OF YOURSELF babies home? for children. Read Part 5 of this book, if you haven’t
Although no single answer emerged This is a false and unrealistic proposi- already, which has several chapters on
During your first year together with your as completely effective, common strate- tion. There’s no doubt that having chil- managing and enjoying parenthood.
little ones, you’re likely to find yourself so gies employed by the parents included: dren when you may have felt you couldn’t
immersed in caring for them that a life Z Assigning shifts or taking turns with is a great source of pleasure. But this
apart may seem almost surreal. Although nighttime caregiving doesn’t mean you won’t feel tired, out of
this may come as small comfort, rest as- Z Getting help from relatives sorts and wondering at times what you’ve
sured that your parenting job will be- Z Sleeping while the babies slept, al- gotten yourself into. These are normal
come less labor intensive and easier to though some parents reported taking feelings for any parent.
manage as time goes by. advantage of this time to complete Parents of multiples sometimes feel as
In the meantime, it’s important to other tasks if they should be able to bear the full load
carve out time for yourself. Extreme fa- Z Getting the twins on the same sleep- of caregiving because“they got what they
tigue and lack of personal time can un- ing and eating schedules were asking for.” This is an emotional
derstandably lead to depression and iso- Z Using white noise and dimming the trap to avoid. Accepting help doesn’t
lation. If you feel overwhelmed or unable lights to help the babies sleep make you a bad parent. In fact, as dem-
to enjoy your babies, it’s important to During the first few weeks, it will like- onstrated earlier, it can help you be a bet-
seek professional help from your chil- ly be difficult to get enough sleep as ev- ter one.
dren’s care provider, a counselor, thera- eryone adjusts to the transition. But
pist or other mental health professional eventually, you’ll develop a routine and Take outside attention in stride
— someone who can help you get back your days and nights will even out a bit. If Twins, triplets and greater numbers of
on track. you have difficulties or concerns about multiples frequently attract attention in
Taking care of yourself may seem like getting enough sleep or getting your public, which can be positive or negative.
it should come last on your to-do list, but children to sleep, talk to your children’s Regardless of what others say about you
in fact it is the first step toward taking care provider. He or she may be better or your family, remember to keep your
care of your family. If your energy supply situated to assess your needs and give eye on the prize — raising happy, healthy
is depleted, it will be much harder for you you specific advice. and well-adjusted children who will
CHAPTER 39
Premature baby
Every parent dreams of having a healthy, WHY PREMATURE

full-term baby. Unfortunately, that dream BIRTH HAPPENS
isn’t always the reality. Although most
babies are born full term and free of Many factors can increase the risk of pre-
medical problems, some are born too mature birth. A multiple pregnancy is
early. A premature (preterm) birth — a one cause. Chronic conditions experi-
birth that occurs before 37 weeks of enced by a pregnant mother, such as dia-
pregnancy — gives a baby less time to de- betes, high blood pressure, and heart and
velop and mature in the womb. As a re- kidney disease, also can lead to premature
sult, premature babies may need special- birth. However, the specific cause of a pre-
ized treatment in the neonatal intensive mature birth often isn’t clear. And a pre-
care unit (NICU). Sometimes, even after a mature birth can happen to anyone, in-
premature baby leaves the hospital, he or cluding women who have no risk factors.
she may continue to need medical care. As the parent of a premature newborn,
If your baby was born prematurely, you might feel that you did something to
the miracle of birth might be overshad- cause the preterm birth or that you could
owed by concern about his or her health have done more to prevent it. Mothers es-
and the possible long-term effects. How- pecially might think about how they might
ever, there’s much you can do to take care have changed the outcome by making dif-
of your premature baby — and yourself ferent decisions during pregnancy. Try to
— as you look toward the future. Under- let go of any feelings of guilt about your
stand what to expect after your prema- baby’s premature birth by talking about
ture baby is born, the health problems them with your baby’s care providers and
that premature babies sometimes face, your partner, who might be able to pro-
and how to cope and care for your pre- vide comfort. Focus your energy on car-
mature baby. ing for and getting to know your child.
CHAPTER 39: PREMATURE BABY 503

Definitions If your baby was born pre- Z Extremely low birth weight. A baby
maturely, you’re not alone. It’s estimated who is born weighing less than 2 THE NICU TEAM
that premature births occur in about 13 pounds, 3 ounces
percent of pregnancies in the United In the NICU, your baby may be cared for by many specialists and other health care
States and that nearly 60 percent of mul- The NICU Your first close-up look at professionals. The team attending your baby may include:
tiple deliveries result in premature births. your premature baby might be in the Z Neonatal nurse. A neonatal nurse is a registered nurse who has special training
While all babies born before 37 weeks’ hospital neonatal intensive care unit in caring for premature and high-risk newborns.
gestation are considered preterm, there (NICU), which is designed to provide Z Neonatal nurse practitioner. An experienced neonatal nurse who has complet-
are a few specific types of preterm birth, round-the-clock care for premature ba- ed additional training in the treatment of newborns, particularly babies in NICU.
including: bies as well as full-term babies who de- Z Neonatologist. A neonatologist is a pediatrician who specializes in the diagno-
Z Late preterm. A baby who is born at velop problems after birth. You’ll proba- sis and treatment of newborn health problems.
34 through 36 weeks of pregnancy bly be amazed, overwhelmed — and Z Pediatrician. A pediatrician is a doctor who specializes in treating children from
Z Moderately preterm. A baby who is perhaps a little shocked — by this first birth through adolescence.
born at 32 to 34 weeks of pregnancy look at your newborn. Z Pediatric resident. A pediatric resident is a doctor who is receiving specialized
Z Very preterm. A baby who is born at Your son or daughter may be in an training in treating children.
less than 32 weeks of pregnancy enclosed incubator. An incubator pro- Z Respiratory therapist. A respiratory therapist or respiratory care practitioner as-
Z Extremely preterm. A baby who is born vides warmth, which is important be- sesses respiratory problems in newborns and manages respiratory equipment.
at or before 25 weeks of pregnancy cause premature babies have less protec- Z Pediatric surgeon. A pediatric surgeon specializes in performing surgery for
Z Low birth weight. A baby who is born tive body fat than do full-term babies and newborns and children.
weighing less than 5 pounds, 8 ounces may get cold in normal room tempera- Keep in mind that your baby’s medical team may also call on other specialists
Z Very low birth weight. A baby who is tures. The unit may have a round port- for help in providing care for your child.
born weighing less than 3 pounds, 5 hole through which you and the NICU
ounces staff can reach in and touch your little
one. You may also notice an array of
tubes, catheters and electrical leads taped CARING FOR A common in full-term babies, and his or
to your baby. For example, he or she may PREMATURE NEWBORN her skin may look thin, fragile and trans-
be placed on a cardiorespiratory monitor, parent. These characteristics will be easy
which tracks his or her heart rate and rate A premature newborn may require some to see because most premature babies
of breathing. Seeing this equipment may special care. The medical team caring for aren’t dressed or wrapped in blankets.
be intimidating. It’s important to remem- your baby will do everything they can to This is so nursery staff can closely ob-
ber that these are tools to help keep your help your baby thrive. Keep in mind that serve a preemie’s breathing and general
baby healthy and inform the medical your role as a parent is essential, too. appearance. The medical team will likely
staff about your baby’s condition. Consider ways to get involved in your treat your baby’s skin with care, avoiding
In the NICU, your baby will receive baby’s care and begin bonding with your lotions and ointments and using special
specialized care, including a feeding plan newborn. tape that’s gentle to the skin.
tailored to his or her needs. Some prema- Your son or daughter has a lot of
ture babies may initially need to have flu- Appearance A premature baby may growing to do in the coming weeks. In
ids given to them intravenously or look a little different than a full-term time, he or she will begin to look more
through a feeding tube that passes baby. The earlier a baby is born, the like a full-term baby.
through the mouth or nose into the stom- smaller he or she may be and the larger
ach. If you plan to breast-feed but your his or her head will be in relation to the Condition and care Uncertainty can
baby is unable to nurse at first, you can rest of the body. Your baby’s features may be frightening — as can seeing and hear-
pump your breast milk.Your milk can then appear sharper and less rounded than do ing monitors, respirators and other types
be given to your baby via a feeding tube or a full-term baby’s. of equipment in the NICU. Ask questions
bottle. The antibodies in breast milk are A preemie’s skin may be covered with about your baby’s condition and care or
especially important for preemies. more fine body hair (lanugo) than is write them down and seek answers

when you’re ready. Read material pro- not be able to feed from your breast or a
vided by the hospital, or do your own re- bottle at first, breast milk can be given in TRANSPORTNG YOUR CHILD
search. If you would prefer to be present other ways — or frozen for later use. Be-
during a procedure, let the NICU team gin pumping as soon after birth as pos- In some cases, a premature baby might need to be transported to a hospital that
know. If necessary, make an appointment sible. Aim to pump at least six to eight can provide specialized care. A member of your baby’s medical team will explain
to discuss your baby’s progress. The more times a day, round-the-clock. Keep in the situation to you and make the arrangements. Depending on your baby’s health
you know, the better you’ll be able to han- mind that it will take time to establish and the travel distance involved, he or she might be transported by ambulance,
dle the situation. In addition, if you’re con- your milk supply but that every drop of helicopter or aircraft. A transport team from one of the hospitals will accompany
cerned about changes in your preemie’s breast milk is precious to your baby, your baby on the trip. He or she will likely travel inside a transport incubator, which
condition, talk to your child’s caregivers. whose first feedings will be small any- will provide warmth and allow him or her to receive any needed medical attention.
way. Give the milk in a container — Being separated from your baby can be stressful and pose some challenges.
Medical team You may see a dizzying clearly labeled with your baby’s name Be sure to ask how you will be able to check on your child’s condition once he or
number of medical professionals provid- and the date and time you pumped — to she has been transported. If your baby is moved to a hospital that’s far away, con-
ing care for your baby. Until you become one of your baby’s nurses, who can re- sider asking a hospital discharge planner or social worker to help you find afford-
familiar with staff rotations, introduce frigerate or freeze it and use it as your able nearby lodging so you can spend time with your baby. Ask your baby’s med-
yourself every time you see a new face baby needs it. ical team about when your son or daughter might be able to return to a hospital
and ask what his or her role is in caring When your baby is able to nurse, keep near your home.
for your son or daughter. in mind that he or she might need more
time getting used to the process than
Nutrition Breast milk contains proteins does a full-term baby. Give yourself and
that help fight infection and promote your baby time to learn and ask for help Growth and development Become NICU nurse can help with these activi-
growth. Although your preemie might from the NICU team when you need it. physically involved with your baby as ties and teach you how to deal with
early as possible. Loving care is impor- equipment such as breathing tubes, in-
tant to your baby’s growth and develop- travenous tubes or monitor wiring.
ment. Gentle contact with your prema- Don’t hesitate to ask the NICU staff
DONOR BREAST MILK ture baby can help him or her thrive. how you can become more involved in
For extremely premature babies, ask your baby’s care. Being hands-on with
For premature babies whose mothers are unable to provide breast milk, it may be the NICU nurses for the most helpful your baby can give you confidence as a
possible for the NICU to arrange for donated breast milk as a source of nutrition. ways to comfort your baby. Even before a new parent, as well as make the transi-
The source of donated breast milk in a NICU is taken very seriously, with the milk baby is healthy enough to be held, you tion home a little easier when your child
generally coming from established milk banks. Donor breast milk is not always may be able to comfort him or her with a is ready to leave the hospital. While this
feasible, partly due to the expense of ensuring a safe supply. steady, calm touch. For the youngest ba- may not be the way you imagined your
bies, patting or stroking may be over- baby’s first days or weeks, your time with
whelming at first. Speak to your baby in him or her is special. Focus on enjoying
loving tones or quietly hum a lullaby. your firsts together, such as the first time
Reading to your baby also can help you you feed your baby or bathe him or her,
feel closer to him or her. and your baby’s progress.
NICU nurses can help you hold your
baby to allow skin-to-skin contact by
placing the baby on your bare chest, cov-
ered loosely with a blanket. This type of HEALTH ISSUES
contact, sometimes called kangaroo care,
can be a powerful way for you to bond Due to medical progress, the outlook for
with your baby. Eventually, you’ll become premature newborns is much more
very comfortable in feeding, changing, hopeful than it was years ago. In fact, in-
bathing and soothing your little one. A fants born at 24 weeks currently have a
506 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 39: PREMATURE BABY 507

survival rate of 40 to 60 percent. A pre- ence are patent ductus arteriosus (PDA) breast milk have a much lower risk of de- contains an excess of bilirubin, a yellow-
mature baby who is born after 28 weeks and low blood pressure (hypotension). veloping NEC. Antibiotics, intravenous colored pigment of red blood cells. Jaun-
of pregnancy and weighs more than 2 PDA, which tends to affect babies born feedings and resting the intestine by dice is common in babies born before
pounds, 3 ounces has nearly a full chance before 30 weeks or weighing less than 2 withholding feedings for a short period 38 weeks. Most babies who need treat-
of survival. pounds, 3 ounces, is a passage between helps most babies recover from NEC, al- ment respond well to light therapy (pho-
While not all premature babies expe- two major blood vessels leading from the though surgery is sometimes needed. totherapy). Although complications are
rience complications, being born too early heart (see page 548). While this passage Infant gastroesophageal reflux (GER), rare, all newborns are assessed for jaun-
can cause short-term and long-term often closes on its own, left untreated it a condition that occurs when stomach dice during the first weeks of life. This is
health problems for babies. Generally, the can cause too much blood to flow acid or bile flows back into the food pipe because severe infant jaundice can cause
earlier a baby is born, the higher the risk. through the lungs and cause heart failure (esophagus), also is common in prema- permanent deafness and brain damage.
Birth weight plays an important role, too. as well as other complications. Small ture babies. It can cause a baby to vomit For more information on jaundice, see
Some problems may be apparent at birth, premature babies who have a PDA may multiple times a day and disrupt weight page 378.
while others may not develop for weeks or need to have their fluids limited and be gain. Most babies outgrow the condition
months. Complications of premature birth given intravenous medication. In some as they reach their original due date. Fre- Metabolic concerns Premature ba-
may include the following. cases, surgery is needed to close the pas- quent feedings in small amounts can bies often have problems with their me-
sage. If your baby needs treatment for help alleviate the condition. For more in- tabolism. Some preemies may develop a
Breathing concerns A premature baby low blood pressure, he or she may be formation on reflux, see page 382. low level of blood sugar (glucose), called
may have trouble breathing due to an given additional fluid or intravenous Preemies are also at risk of hernias, hypoglycemia (see page 536). This can
immature respiratory system. In some medication. when a loop of intestine pushes through happen because preemies typically have
cases, breathing difficulties can prevent a weakened muscle or an unusual open- smaller stores of glycogen (stored glu-
other immature organs in the body from Brain concerns Babies born before 28 ing inside the body. While most umbilical cose) than do full-term babies and be-
receiving enough oxygen. If the baby’s weeks or weighing less than 2 pounds, 10 hernias heal without intervention by the cause preemies’ immature livers have
lungs lack surfactant — a substance that ounces are at risk of bleeding inside the toddler years, inguinal hernias may re- trouble producing glucose. Medications
allows the lungs to remain expanded — brain, known as a germinal matrix or an quire surgery. For more information on given during pregnancy to help control a
he or she may develop respiratory dis- intraventricular hemorrhage. Most hem- hernias, see page 35. mother’s high blood pressure can some-
tress syndrome, or RDS, (see page 538). orrhages are mild and resolve with little times contribute to hypoglycemia in a
This condition primarily affects infants short-term impact. Some babies may Blood concerns Preemies are at risk of preemie. If your baby is at risk of hypo-
born before 35 weeks. Preemies, espe- eventually develop fluid accumulation in blood problems such as anemia and glycemia, he or she may have a drop of
cially those born between 23 and 32 the brain (hydrocephalus) or neurologi- jaundice. Anemia is a common condition blood drawn from his or her finger, heel
weeks, may also develop chronic lung cal problems, such as cerebral palsy — a in which the body doesn’t make enough or toe and tested. Treatment usually con-
disease known as bronchopulmonary disorder of movement, muscle tone or red blood cells. While all newborns expe- sists of feeding the baby breast milk or
dysplasia, or BPD, (see page 537). In ad- posture — or learning disabilities. Pree- rience a slow drop in red blood cell count formula, or giving the baby dextrose
dition, most preemies younger than 34 mies who develop hydrocephalus may during the first months of life, the de- (sugar) intravenously.
weeks experience prolonged pauses in need surgery. If your baby has abnormal crease may be greater in preemies. More
their breathing, known as apnea. muscle tone, he or she may need to work severe anemia may occur if your baby has Vision concerns Preemies born before
To detect and treat breathing prob- with a physical therapist. a lot of blood taken for lab tests. Infants 30 weeks may develop retinopathy of
lems, your baby’s medical team may moni- who have no symptoms may not need prematurity (ROP), a condition that de-
tor your preemie’s breathing and heart rate. Gastrointestinal concerns Preemies treatment. However, babies who experi- velops when blood vessels swell and
If your baby has breathing problems, he or are likely to have immature gastrointesti- ence symptoms — such as low blood overgrow in the light-sensitive layer of
she may be given oxygen or support nal systems. The earlier a baby is born, pressure, a fast heart rate, weak pulse, nerves at the back of the eye (retina).
through a ventilator or a breathing assis- the greater his or her risk is of developing pale color and breathing problems — Sometimes the abnormal retinal vessels
tance technique called continuous positive necrotizing enterocolitis (NEC). This may need blood transfusions. For more leak, eventually scarring the retina and
airway pressure (CPAP). condition, in which the cells lining the information on anemia, see page 535. pulling it out of position. When the retina
bowel wall are injured, primarily occurs Neonatal jaundice is a yellow discol- is pulled away from the back of the eye
Heart concerns The most common in premature babies after they start feed- oration in a newborn baby’s skin and it’s called retinal detachment, a condition
heart problems premature babies experi- ing. Premature babies who receive only eyes that occurs because the baby’s blood that can impair vision and cause blind-

ness. In most cases, retinopathy of pre- up testing with a specialist. Early diagno-
maturity resolves by itself with no persis is crucial. The sooner treatment begins INTERMEDIATE CARE
manent damage. If the disease is severe, the better your child’s chances are of de-
laser treatment may be needed. veloping age-appropriate language and While some babies go home after spending time in the neonatal intensive care unit
Premature babies are also at risk of communication skills. (NICU), many are transferred to a unit that provides intermediate care before dis-
developing other vision problems, such charge. This unit, which may be located within the NICU or nearby, typically pro-
as misalignment of the eyes (strabismus) Dental concerns Preemies who have vides care for babies who need less intensive care and monitoring. Be sure to talk
or nearsightedness (myopia). been critically ill are at increased risk of to your baby’s care providers about the type of treatment he or she will receive in
If your baby is born before 30 weeks developing dental problems, such as de- the new unit and how you can be involved.
or weighs less than 3 pounds, 5 ounces, layed tooth eruption, tooth discoloration
an ophthalmologist will likely examine and improperly aligned teeth.
your baby’s eyes, beginning when he or
she is about 4 to 6 weeks old. Generally, SIDS Premature babies are at increased perience developmental delays, learning take the best care of your new son or
preemies need eye exams every couple of risk of sudden infant death syndrome disabilities, difficulty smoothly control- daughter.
weeks or so until the retina has fully de- (SIDS). When your baby is home from ling their muscles, and behavioral, psy-
veloped. Regardless of whether your the hospital, always place your baby on chological or other chronic health prob- Allow time to heal You might need
child has ROP, your baby’s care provider his or her back to sleep. In the NICU, ba- lems. Preterm babies who have a very more time to recover from the rigors of
may recommend that your son or daugh- bies may be placed on their stomachs if low birth weight also may be at increased childbirth than you imagined. Be sure to
ter be periodically examined by an oph- they have respiratory problems or on risk of autism. Research suggests that eat a healthy diet and get as much rest as
thalmologist during the preschool years. their sides if they have infant gastro- some premature babies, especially those you can. When your care provider gives
esophageal reflux (GER). In these cases, with severe intrauterine growth restric- you the OK, you can start exercising.
Hearing concerns Premature babies the medical team will begin placing the tion (IUGR), may face an increased risk
are at increased risk of some degree of baby on his or her back prior to discharge. of type 2 diabetes and high blood pres- Acknowledge your emotions Expect
hearing loss. Your baby will likely be giv- For more information on SIDS, see page sure as adults. to feel joy, anger, fear, powerlessness and
en a newborn hearing screening before 118. Take heart. It’s normal to be con- a sense of loss. Some parents report feel-
he or she reaches a corrected age of 1 cerned about your baby’s health, espe- ing strange about getting to know their
month (see “Corrected age” below) or Future issues For some premature ba- cially if he or she has spent time in the newborns in the busy NICU. You might
before being discharged from the NICU. bies, difficulties may not appear until NICU. But most babies who spend time celebrate successes one day, only to ex-
If your preemie has abnormal screening later in childhood or even adulthood. in the NICU don’t have significant dis- perience setbacks the next. Give yourself
results, he or she will likely have follow- Children who were born premature ex- abilities. And many premature babies permission to take it one day at a time.
catch up and develop into normal healthy Remember that you and your partner
children. Keep in mind that the way you might react to stress and anxiety differ-
and your family care for, interact with ently, but you both want what’s best for
CORRECTED AGE and stimulate your baby in the coming your baby. Keep talking and supporting
months also can have a major impact on each other during this stressful time.
A premature child’s growth and development is typically measured using his or her his or her development.
“corrected age” — your baby’s age in weeks (chronological age) minus the number Take a break If you leave the hospital
of weeks he or she was premature. before your baby, use your time at home
For example, if your baby was born eight weeks early (at 32 weeks), when your to prepare for his or her arrival and get
child is 6 months old, his or her corrected age is actually 4 months (6 months mi- TAKING CARE OF YOURSELF some rest. Your baby needs you, but it’s
nus eight weeks). For a baby born at 24 weeks (16 weeks or 4 months early), when important to balance time at the hospital
the child is 6 months old, the baby’s corrected age is 2 months (6 months minus At this point in time, all of your attention with time for yourself and your family.
4 months early). This adjustment is helpful to have the fairest comparison of a may be concentrated on your child, and
premature baby’s development, until the child reaches about 2½ years old. helping him or her to thrive. But remem- Be honest with siblings If you have
ber that you have special needs, too. Tak- other children, try to answer their ques-
ing good care of yourself will help you tions about the new baby simply. You

might explain that their baby sister or BRINGING BABY HOME
brother is sick and you’re worried. Reas- REHOSPITALIZATION
sure your children that the baby’s illness As your son’s or daughter’s condition be-
isn’t their fault. Ask if you can bring your gins to improve, you may wonder when Premature babies’ health problems can sometimes make it necessary for them to
other children to the NICU to visit your you finally can bring him or her home. be readmitted to the hospital. Research suggests that 15 percent of babies who
baby. If your children aren’t able to see the The criteria vary, but generally hospital are born before 36 weeks and go home need to be rehospitalized at least once
baby in the NICU, show them pictures. staff will consider allowing you to take during their first year. Common causes of rehospitalization include infections, re-
your baby home when he or she: spiratory problems, feeding problems and surgical complications.
Seek and accept help Allow friends Z Can breathe without support If your preemie needs to go back to the hospital for treatment, try not to get
and loved ones to care for older children, Z Has a stable heart rate discouraged or blame yourself. You may want to reconnect with some of the sup-
prepare food, clean the house or run er- Z Is able to maintain a stable body tem- port personnel who helped you through the last hospital stay. For longer hospital
rands. Let them know what would be perature stays or more frequent rehospitalizations, some families find it helpful to blog their
most helpful. Surround yourself with un- Z Can breast- or bottle-feed baby’s progress online so that they don’t have to continuously call family members
derstanding friends and loved ones. Talk Z Is gaining weight steadily and well-wishers with updates. Ask the hospital medical team any questions you
with other NICU parents. Consider join- In some cases, a child may be allowed might have about your baby’s condition and find out what you need to know to
ing a local support group for parents of to go home before meeting one of these care for him or her in the future.
preemies, or check out online communi- requirements — as long as the baby’s
ties. Seek professional help if you’re feel- medical team and family create and agree
ing depressed or you’re struggling to on a plan for home care and monitoring.
cope with your new responsibilities. When it’s time to bring your baby team can inform him or her about your OK to use a car seat, use it only during
home, you might feel relieved, excited — baby’s medical condition. Discuss symp- travel. If your baby has a health problem
and anxious. After days, weeks or months toms — such as infant breathing or feed- that requires him or her to lie flat, a car
in the hospital, it can be daunting to ing problems — that might necessitate a bed may be recommended. Talk with
leave the support of the medical team call to your baby’s care provider. Note your baby’s care providers if you may
behind. As you spend more time with your baby’s need for follow-up visits or need to take an airplane flight with your
your baby, you’ll better understand how referrals, and find out whom to call if you newborn. Your son’s or daughter’s lungs
to meet his or her needs and your rela- have questions or concerns. may be sensitive to the effects of altitude
tionship will grow stronger. In the mean- changes during flight. Also don’t place
time, consider ways to prepare for your Discuss feedings Ask the medical your preemie in an infant sling, backpack
child’s hospital discharge. team about your baby’s need for supple- or other upright positioning devices until
mentation in the form of breast milk for- you talk to your baby’s care provider.
Understand care requirements Be- tifiers or preterm infant formula. Keep in These devices may make it harder for
fore you leave the hospital, take a course mind that premature babies usually eat him or her to breathe. For more informa-
in infant CPR. Ask your baby’s medical smaller amounts and may need to be fed tion on traveling with your baby, see
team any questions you might have and more often than full-term babies. Pree- Chapter 14.
take notes. Make sure you’re comfortable mies also tend to be sleepier than full-
caring for your baby, especially if you’ll term babies and sleep through feedings. Protect against illness Premature
need to administer medications, use spe- Find out how much and how often your babies are more susceptible than are oth-
cial equipment, or give your baby supple- baby should be eating. er newborns to serious infections. Try to
mental oxygen or other treatments. Ask if minimize your preemie’s exposure to
any members of the hospital medical Make travel arrangements Because crowded places and make sure people
team do home visits, which can be help- sitting semireclined in a car seat can in- who come into contact with your child
ful during your baby’s first week home. crease the risk of breathing problems or a washes their hands first. Babies at high
You’ll likely be asked to provide contact slow heartbeat, your baby might need to risk of developing respiratory complica-
information for your baby’s care provider be monitored in his or her car seat before tions, such as babies who require oxygen
so that a member of the hospital medical hospital discharge. When you have the at home, should minimize the number of

VULNERABLE CHILD SYNDROME
When a premature baby requires intensive care in the hospital, it can be a trau-
matic experience. As a result, parents may become excessively concerned about
their child’s health and development or become excessively overprotective, a con-
dition called vulnerable child syndrome. Signs of vulnerable child syndrome might
include repeatedly taking a child to the care provider for treatment of minor symp-
toms, underestimating a child’s abilities or having trouble setting appropriate limits
for a child. Overprotective behavior can affect a child’s development, prolong
separation anxiety and cause behavioral problems.
If you’re feeling overwhelmed by your baby’s premature birth, talk to your care
provider or lean on family and friends for support. Finding ways to process your
baby’s premature birth and deal with your stress now might have a positive impact
on your relationship with your child down the road.
young children they encounter. During It’s recommended that immuniza-

the child’s first year, or at least first winter, tions be given to medically stable prema-
it may be best to avoid child care centers. ture babies according to their chronolog-
ical age. Work with your baby’s care
provider to stay on top of your baby’s
need for immunizations. Your care pro-
BABY’S CHECKUPS vider may also monitor your baby for de-
velopmental delays and disabilities in the
Depending on your baby’s age, weight coming months. Babies who are identi-
and health, you’ll likely need to schedule fied as at risk may receive further evalua-
his or her first visit to the care provider tion and be referred to early intervention
within several days after his or her hospi- services, such as physical therapy therapy
tal discharge. The care provider may re- for infants.
view your baby’s treatment in the NICU, Work with your baby’s care providers
current medications and treatments. In to understand any health problems your
addition, the care provider will likely dis- baby might experience and what you can
cuss your son’s or daughter’s growth, nu- do to promote your preemie’s health and
trition, immunizations and specific med- well-being.
ical problems and evaluate your baby’s
progress since leaving the hospital. Be
sure to tell the care provider about any
concerns you might have. In addition,
discuss your baby’s need for future ap-
pointments with the care provider and
any specialists. Your preemie may initially
need to see his or her care provider every
week or two to have his or her growth
and care monitored.

CHAPTER 40
Delayed development
Throughout the first year, your baby’s your child’s care provider can take steps
care provider will monitor your son’s or to detect any possible developmental
daughter’s growth and development to problems. The earlier a problem is identi-
make sure it’s progressing steadily and it fied, the sooner you can take additional
falls within the range of normal develop- measures to help your child achieve his
ment. At each well-child visit, the care or her maximum developmental poten-
provider will likely ask you questions tial. If an underlying condition or disease
about your child, based on his or her age. is present, treatment may help prevent
They may include questions such as further problems.
whether your baby is learning to hold up
his or her head, grasp toys, roll over, coo,
laugh, walk or say mama or dada.
Sometimes, a child’s abilities will fall WHAT IS DELAYED
below the range of milestones achieved DEVELOPMENT?
by his or her peers. This isn’t always a
cause for alarm because children tend to A developmental delay is when your
develop at highly individual rates. They child doesn’t reach developmental mile-
may fall behind in one area, such as lan- stones within the same timeframe as
guage, while focusing intently on mas- other children of the same age. When a
tering another area, such as crawling or child is delayed in two or more important
walking. Soon after they acquire the skill areas of development, medical experts
they’re pursuing, they move on to achieve refer to this as global developmental de-
other milestones that have been lagging. lay. Milestones are usually grouped into
But if your child is slower to achieve these categories:
certain milestones or if you’re concerned Z Motor skills — rolling over, sitting,
about his or her development, you and picking up small objects, walking
CHAPTER 40: DELAYED DEVELOPMENT 517

Typical Speech Typical Play Typical Physical
Signs to Watch for in Physical Development*
Development* Development* Development*
Sucks and swallows well While lying on their back…

during feeding
BY 3 MONTHS
Visually tracks a moving toy

Quiets or smiles in response from side to side
to sound or voice While lying on their tummy…
Attempts to reach for a rattle
Coos or vocalizes other than held above their chest Pushes up on arms Difficulty lifting head Pushes back with head
crying Lifts and holds head up Stiff legs with little or Keeps hands fisted and
Keeps head in the middle to
Turns head toward direction watch faces or toys no movement lacks arm movement
of sound
Begins to use consonant Reaches for a nearby toy while Uses hands to
sounds in babbling, e.g. on their tummy support self in sitting
BY 6 MONTHS
“dada”
While lying on their back… Rolls from back to
Uses babbling to get attention tummy Arms held back
Transfers a toy from one hand
While standing with Rounded back Difficult to bring arms forward Stiff legs
Begins to eat cereals and to the other
pureed foods support, accepts to reach out
Unable to lift head up
Reaches both hands to play
entire weight with Arches back and stiffens legs
with feet Poor head control
legs
Increases variety of sounds In a high chair, holds and drinks Sits and reaches for
and syllable combinations in from a bottle toys without falling
Inability to
BY 9 MONTHS
babbling
Explores and examines an Moves from tummy straighten back
Looks at familiar objects and object using both hands or back into sitting
Cannot take
people when named Difficulty crawling
Turns several pages of a Creeps on hands and Uses one hand predominately weight on legs
Begins to eat junior and chunky (board) book at once knees with alternate Uses only one side of body
Rounded back
mashed table foods arm and leg to move
In simple play imitates others
movement Poor use of arms in sitting
Meaningfully uses “mama” or Finger feeds self Pulls to stand and

“dada” cruises along
Releases objects into a
BY 12 MONTHS
furniture Difficulty getting to stand Sits with weight to one side

Responds to simple container with a large opening because of stiff legs and
comands, e.g. “come here” Stands alone and Strongly flexed or stiffly
Uses thumb and pointer finger pointed toes
takes several extended arms
Produces long strings of to pick up tiny objects Only uses arms to pull
independent steps Needs to use hand to
gibberish jargoning) in social up to standing
communication maintain sitting
Begins to use an open cup
Vocabulary consists of 5-10 Stacks two objects or blocks Walks independently

words and seldom falls
BY 15 MONTHS
Helps with getting undressed Unable to take steps independently

Imitates new less familiar Squats to pick up toy
Holds and drinks from a cup Poor standing balance, falls frequently
words
Understands 50 words Walks on toes
Increases variety of coarsely

chopped table foods
*Remember to correct your child’s age for prematurity. Adapted with permission from Pathways.org, 2011. See page 553 for more information.
518 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 40: DELAYED DEVELOPMENT 519

POSSIBLE CAUSES Metabolic disorders Disorders of the
WILL MY CHILD GROW OUT OF A DEVELOPMENTAL DELAY? body’s chemistry, such as an underactive
There are many conditions that can lead thyroid, can result in impaired growth
Some premature infants appear delayed, based on their chronological age. How- to delayed development, ranging from and development and slower intellectual
ever, the apparent delay may disappear when the baby’s corrected age is taken genetic disorders to infections to toxin function. In most inherited metabolic
into account. Of the children, preterm or term, who have true developmental de- exposure. But in many cases, the cause is disorders, a single enzyme is either not
lays in the preschool years — meaning they consistently lag behind in screening hard to identify. produced by the body or is produced in a
tests — most continue to be delayed even as they grow older. This is why early nonworking form. Examples of inherited
identification is so important. If you’re waiting for your son or daughter to grow out Genetic disorders In some cases, the metabolic disorders include galactose-
of a development delay, you may be missing out on early opportunities to optimize cause is a chromosomal abnormality or mia, maple syrup urine disease and phe-
his or her potential. an inherited disorder that interferes with nylketonuria (PKU). In many states, a
normal growth and development. newborn screening will identify these
One of the most common inherited conditions (see pages 39 and 41).
disorders that causes delayed develop-
Z Language and communication — The screening tests are usually brief ment is fragile X syndrome. This disorder Environmental toxins Excessive ex-
recognizing sounds, imitating speech, and inexpensive. Your child’s care pro- is passed from parents to children and posure to lead can harm the body’s ner-
babbling, pointing vider may ask your child to play a game results from an altered gene that under- vous system. Very high levels of lead in
Z Thinking and reasoning — beginning or perform certain activities, such as produces a protein vital to brain develop- the body can lead to mental deficits.
to understand cause and effect, object playing with a doll or picking up a small ment. Because the alteration often in- However, lead poisoning is not a com-
permanence object. You may be asked to fill out a creases in severity during transmission mon cause of delayed development.
Z Personal and social skills — explor- questionnaire. Based on the screening from parent to child, the parent of an af-
ing, smiling, laughing, interacting test’s results, the care provider may rec- fected child may have no symptoms of Neglect or deprivation A baby’s brain
with others ommend a wait-and-see approach to the disease. continues to develop even after birth. In
Z Daily activities — eating, dressing give your child a little more time to de- Rett syndrome is another cause of de- cases of severe neglect or deprivation,
Part 3 of this book contains chapters velop, or he or she may refer you to a layed development that occurs more where the brain isn’t being appropriately
for each month of the first year of your childhood development expert for fur- commonly in girls. Children with Rett stimulated or nourished, delayed devel-
son’s or daughter’s life that help you un- ther evaluation. syndrome appear to develop normally opment can result.
derstand the normal range of growth and A developmental evaluation is a more until 6 to 18 months of age, when they
development. If you’re concerned that complex procedure carried out by a pro- gradually begin to lose acquired speech
your child isn’t developing as he or she fessional who is specially trained to ad- and fine motor skills.
should, talk to your child’s care provider. minister these tests. The evaluation is DIAGNOSING A
He or she can reassure you about what’s designed to identify specific develop- Problems during labor and delivery DEVELOPMENTAL DELAY
considered normal and offer advice on mental disorders that may be affecting Being born prematurely or difficulties
further testing. the child. Along with the developmental during labor that impair circulation may To try to determine what may be causing
evaluation, a medical diagnostic evalua- lead to developmental problems. More your child to lag behind in achieving de-
tion is conducted to identify any possible often, though, delayed development is velopmental milestones, your child’s care
underlying conditions that may be affect- associated with events that occur prior provider or another specialist, such as a
HOW IS A DELAY IDENTIFIED? ing development. to labor. developmental pediatrician or a child
If it’s determined that your child may neurologist or geneticist, will likely do a
Usually, a developmental problem is identi- be at high risk for a developmental disor- Problems in utero Sometimes during comprehensive physical exam. He or she
fied over time rather than at a single visit. If der, even before a disorder is diagnosed, a pregnancy, a fever or infection in the may also conduct a variety of tests. The
you or your child’s care provider have con- your child’s care provider or a specialist mother will create immune reactions that tests may include vision and hearing ex-
cerns about your child’s development, the may refer you to early intervention ser- can harm the development of the baby’s ams, genetic tests to look for a possible
care provider may conduct a developmen- vices. These services generally provide brain. Fetal exposure to alcohol or drugs genetic abnormality, imaging tests of the
tal screening test to see if your child may evaluations and other services that may during pregnancy can also damage a ba- brain to look for an abnormality or injury,
be at risk for a developmental disorder. be helpful during the diagnosis process. by’s developing nervous system. and metabolic and thyroid tests.
520 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 40: DELAYED DEVELOPMENT 521

Usually, the tests aren’t all done at known. But early identification of a prob- with you and your child, but you may GET SUPPORT
once but in a stepwise fashion. Depend- lem — whether an underlying cause is also visit a center or clinic for some parts
ing on the results of one test or examina- discovered or not — allows therapies to of your plan. Common services offered Determining whether your child has a
tion, the care provider will make recom- be provided at a time when they may be by an early intervention program include: developmental disability, and if so, what
mendations about additional testing. most helpful. Z Physical therapy to work on gross and can be done to help your child, can take
If your child is identified as having spe- fine motor skills time. It may require trips to various spe-
cial needs, he or she has access to early in- Z Speech therapy to work on language cialists, watching your child undergo dif-
tervention services. You may already have and communication skills ferent tests and waiting for results in be-
WHAT CAN BE DONE? been referred by your child’s care provider Z Occupational therapy to work on per- tween tests. It’s not always easy dealing
to your local early intervention office for an sonal and social skills with the uncertainty and anxiety that of-
A few causes of developmental delay are evaluation of developmental concerns. A Z Family training and counseling to help ten accompany this process. Your care
treatable. These include certain metabolic referral can be made at any time. Once a you work with your child at home provider or caseworker, if you’ve been
disorders that may be treated by avoiding referral is submitted, your child is assessed Z Transportation and assistive technol- assigned one by an early intervention
certain foods or substances or with vita- and a caseworker is assigned to your family ogy services if your child needs spe- program, may be able to help you navi-
min or hormone supplementation. Lead to coordinate the services that meet your cial equipment to get around gate the various procedures and coordi-
poisoning can be treated with medica- child’s specific needs. Together with the Z Nutrition counseling if your child has nate the services you need.
tions and by removing the child from fur- caseworker and therapists, you create a trouble feeding In the meantime, it’s important to get
ther lead exposure. Removal from ad- written plan called the Individualized Fam- Z Coordination of services from physi- support — not only through meeting
verse home environments and placement ily Service Plan (IFSP). This plan outlines cians and other agencies with specialists and reading information
in permanent, loving care can greatly the services your child needs and how they Early intervention programs are but also through meeting other parents
stimulate development in an abused or will be provided. funded primarily by each state but also in similar circumstances. These are the
neglected child. The earlier these services are started, receive help from the federal government people most likely to know what you’re
More often, the condition causing de- the better it is for your child. Therapists and local resources. In a few cases, a state going through, and they may be able to
velopmental delay isn’t curable or even may come directly to your home to work program will charge a small family fee. offer valuable information you can’t get
Your caseworker can discuss the cost of elsewhere, such as a great dentist for kids
these services with you and may coordi- with special needs or which kind of sippy
nate with your health insurance provider, cup works best for infants with challeng-
but your ability to pay is not a prerequi- es learning how to use a cup. And some-
site for eligibility. In general, families in- times a friendly chat with another parent
cur little to no out-of-pocket costs for about the ups and downs of your day is
these services. just what you need to feel a little more
Once your child reaches 3 years of ready to face the next day.
age, your son or daughter may be eligible Here again, your care provider or
for services available through the public caseworker may be able to connect you
school system. Most kids with special to a local parent group that fits your
needs start kindergarten on time or the needs. Or you can check online for local
following year. The vast majority attends chapters or online communities of na-
schools that serve a variety of students, tional organizations for specific disabili-
not just children with disabilities. Your ties. For information on resources, in-
child will continue to receive special ser- cluding websites, books, videos and
vices as needed throughout kindergar- other sources that may be useful to you,
ten, elementary and high school. Differ- see the Additional Resources section, be-
ent states have different policies ginning on page 552.
regarding when state-sponsored pro-
grams end. Your local resources can help
you find out what applies in your state.
CHAPTER 40: DELAYED DEVELOPMENT 523

CHAPTER 41
Down syndrome
Learning that your baby has Down syn- can extend beyond previously conceived
drome, whether before birth or after, can boundaries of what is and isn’t possible
be a defining moment in your life. Within and valuable. Many also express a greater
that moment, your expectations for your understanding of love and tolerance,
child — of identity, achievement, even even in the midst of frustration.
your basic relationship together — can This chapter will help you understand
be shattered. It’s not uncommon to react some of the basic issues you’ll face in the
with shock, anger, fear and disappoint- first year of your baby’s life, including
ment. Yet some parents report these feel- some that may affect your baby in the
ings being dramatically softened the first long term. There are many resources
time they hold their baby in their arms available for children with Down syn-
and gaze into their child’s eyes. drome and their families.
Many parents wonder whether life You may want to start with your ba-
will be more difficult having a child with by’s care provider, who may be able to
Down syndrome. Certainly, it can be, es- refer you to helpful local resources. You
pecially if related medical conditions be- can also check online for teaching hospi-
come prominent or when issues of be- tals or children’s hospitals that have a
havior and independence come up. But Down syndrome clinic or center. These
where some expectations fail, other reali- centers typically work closely with your
ties open up, often filled with surprising baby’s care provider and serve as a link to
richness. Anecdotally and in surveys, medical, educational, social and financial
parents of a child with Down syndrome support systems in your community. Par-
frequently say they now have a better ent support groups and Down syndrome
sense of how limitless life can be, how it associations are other great resources.
CHAPTER 41: DOWN SYNDROME 525

GETTING TO KNOW YOUR CHILD tween sleeping and eating and looking
around. In fact, your daily routine is likely DEVELOPMENTAL MILESTONES
Babies with Down syndrome carry extra to be similar to any other new parent,
genetic material from chromosome 21 — filled with feedings, naps, cuddling and Range for children with Typical range for
in most cases three copies of the chro- diapering. Down syndrome most children
mosome rather than the usual two cop- But there are some aspects unique to
ies. This is referred to as trisomy 21. This Down syndrome. One of the most visible Gross motor
extra genetic material directly affects of these is hypotonia. This refers to the
Sits alone 6-30 months 5-9 months
your baby’s mental and physical devel- decreased muscle tone that most babies
opment. It causes some common signs with Down syndrome have. Hypotonia Crawls 8-22 months 6-12 months
and symptoms, including: can create a number of caregiving chal- Stands 1-3¼ years 8-17 months
Z Decreased muscle tone (hypotonia) lenges, particularly when it comes to Walks alone 1-4 years 9-18 months
Z Small stature feedings. Other medical conditions your
Z Characteristic facial features such as a baby may have also can have an impact Language
flat nasal bridge and an upward slant on daily activities.
First word 1-4 years 1-3 years
to the eyes
Z Single crease in the palm Feeding Because of decreased muscle Two-word phrases 2-7½ years 15-36 months
Z Mild to moderate intellectual impairment tone in the mouth and throat area, new-
Z Slower rate of development than ba- borns with Down syndrome can have Personal and social
bies without Down syndrome difficulty sucking and may be slow in Responsive smile 1½-5 months 1-3 months
Z Cardiac abnormalities learning to breast-feed. They also tend to Finger feeds 10-24 months 7-14 months
These effects can vary widely, so no have a nonrhythmic suck and may choke
Drinks from cup 12-32 months 9-17 months
two individuals with Down syndrome or gag easily. They may arch their bodies
unassisted
are exactly alike. As with any child, your and be oversensitive to stimulation,
son or daughter will have characteristics which can distract them from feeding. If Uses spoon 13-39 months 12-20 months
that are all his or her own, as well as your baby also has a heart defect, he or Bowel control 2-7 years 16-42 months
characteristics that remind you of your- she may become worn out before taking Dresses self 3½ -8½ years 3¼-5 years
self or your partner. in enough milk. unassisted
As your child gets older, you’ll get to This doesn’t mean it isn’t possible to
know his or her unique temperament breast-feed. With time and patience, you Source: National Down Syndrome Society
and likes and dislikes. You’ll also become and your baby can successfully breast-
more familiar with the different aspects feed. In fact, breast-feeding can be ben-
of your baby’s development. It’s likely to eficial because breast milk is easy on your
be slower in some areas, such as motor baby’s digestive system. By passing on In some cases, it may be necessary to the act of feeding their child. Your child’s
skills, and may be advanced in others, your antibodies to your baby through supplement your baby’s nutrition with care provider or a member of his or her
such as social skills. Babies with Down breast milk, breast-feeding can help de- formula feedings. This is nothing to feel health care team may have recommen-
syndrome progress through the same decrease the number of upper and lower guilty about. Breast-feeding can cause dations on the best nipples or bottles to
velopmental milestones, but generally at respiratory infections your baby gets, as anxiety in any mother, but it can be espe- use to help ensure feedings go well. The
a different pace (see opposite page). well as the number of ear infections, all of cially stressful if your baby is having dif- most important thing is that your baby is
which tend to be more common in ba- ficulty with it. If anxiety over breast-feed- thriving and growing.
bies with Down syndrome. Breast-feeding is causing you to feel overwhelmed or
ing also helps develop your baby’s mouth neglect other aspects of parenting, talk to Sleeping New babies with Down syn-
DEVELOPING A ROUTINE and tongue coordination, which is help- your baby’s care provider. Some parents drome tend to be good sleepers. This can
ful for language and speech skills later prefer to feed formula exclusively be- make things a bit easier for parents, but
During the early months, your baby may on. And the time you spend together cause it frees up energy for other things letting your baby sleep for extended peri-
behave like any newborn, alternating be- may help you bond as parent and child. and allows both parents to participate in ods can interfere with your baby getting
526 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 41: DOWN SYNDROME 527

enough to eat. If your baby sleeps a lot, Your baby’s care provider, along with which facilitate the buildup of fluid. In- provider will want to monitor beginning
you might need to wake him or her every the help of other specialists, plays an im- sertion of ear tubes to ventilate the ear at birth is vision. About 60 percent of
two to three hours for a feeding to make portant role in keeping your baby as canal can help restore hearing. Hearing children with Down syndrome have eye
sure he or she is getting adequate nutri- healthy as possible. It may seem at first as loss can also be due to problems with the problems, such as crossed eyes (strabis-
tion. Watch for slight movements of your if you’re spending most of your time nerves that travel between the ear and mus), rapid involuntary eye movement
baby’s eyes or hands, which indicate he making trips between your home and the brain (sensorineural hearing loss). (nystagmus) or cataracts. These vision
or she is in a lighter phase of sleep and various medical offices. But it’s important This type of hearing loss can be treated problems are treated no differently from
may be easier to wake. You can also try to establish your baby’s health status as with hearing aids. Your baby’s hearing that of other children. Refractive prob-
undressing your baby for a diaper change early as possible to enable timely and ef- will likely be evaluated at birth, as is done lems, such as nearsightedness or far-
or holding him or her cheek to cheek. fective treatment where necessary. with almost all newborns. sightedness, also are common in children
Ask your baby’s care provider for advice if Because of the often-narrow ear ca- with Down syndrome. About half require
you have any questions about how long Checkups and vaccinations In addi- nal, and because of certain immune defi- eyeglasses between 3 and 5 years of age.
it’s OK to let your baby sleep. tion to paying special attention to health ciencies that make babies with Down
concerns associated with Down syn- syndrome more prone to respiratory ill- Heart problems Congenital heart de-
Carrying your baby When carrying drome, your baby’s care provider will nesses, ear infections are common and fects affect about 40 to 50 percent of ba-
or holding your baby, you may need to conduct regular checkups and administer can result in hearing loss. Your son or bies with Down syndrome. The most
pay extra attention to giving him or her vaccinations in much the same way as daughter’s care provider will continue to common defects result from heart tissue
proper support. Decreased muscle tone with any other child. Keeping vaccina- monitor your baby’s ear health and hear- not being fully formed, leaving a hole in
makes a baby “floppy” so that the limbs tions up to date is especially important ing regularly. It’s important to get ear in- the heart that causes problems with
and head fall sideways if not supported. since children with Down syndrome are fections treated promptly so that they blood flow. Experts recommend that all
It’s also easier for a baby with hypotonia more prone to infectious illnesses. don’t lead to hearing loss, even if your newborns with Down syndrome be eval-
to slip out of your grasp if you’re not baby passed the newborn hearing screen. uated by a pediatric cardiologist. Surgery,
watchful. Growth There are special growth charts Hearing loss in any baby can lead to a de- usually performed in the first year of life,
for children with Down syndrome, which lay in language and communication may be necessary to repair a defect.
your baby’s care provider will use to track skills, and experts suspect that hearing
your son’s or daughter’s growth com- loss in children with Down syndrome Thyroid problems Babies with Down
YOUR CHILD’S HEALTH pared with his or her peers with Down can contribute to an even greater disad- syndrome are also at risk of thyroid prob-
syndrome. In general, children with vantage in language development. lems, most commonly hypothyroidism.
Babies with Down syndrome are at in- Down syndrome have a smaller stature Hypothyroidism is a condition in which
creased risk for certain health conditions. than children without Down syndrome. Vision problems Another aspect of the thyroid gland doesn’t produce
The list of health risks may seem long, Impaired growth rate may be especially your baby’s health that his or her care enough of certain hormones that help
but keep in mind that most babies with noticeable between 6 months and 3 years
Down syndrome have only a few health of age and during puberty.
issues; some have none. Occasionally, a Monitoring your child’s growth on
baby with Down syndrome may have se- these charts will also alert your doctor to TEETHING
vere health problems. potential problems associated with
A thorough assessment of your baby’s Down syndrome, such as thyroid disease If you’re wondering when your baby’s teeth will finally come in, don’t worry. They’ll
health is vital to optimizing his or her or celiac disease, which may further im- come, but probably a bit later than is normally expected and perhaps not in the
growth and development. Any existing pair a child’s growth. same pattern as in the average infant. In some cases, a tooth may be unusually
health problems can and should be diag- shaped or missing. Since dental problems, such as enamel defects and gum dis-
nosed and treated promptly — they’re Hearing problems Up to 75 percent of ease, tend to be more common with Down syndrome, it’s important to practice
not just “part of Down syndrome” and babies with Down syndrome have some good dental hygiene with your child as soon as teeth do appear. Establish a rela-
they can greatly affect quality of life. Your degree of hearing loss. In many cases, the tionship with a dentist as soon as possible, preferably one that has experience
child’s health should be monitored regu- hearing loss is due to the accumulation of treating kids with Down syndrome.
larly throughout his or her life to address fluid in the ear canal. Babies with Down
any health concerns that may arise later. syndrome often have narrow ear canals,

control metabolism. Signs and symp- Down syndrome also increases a per- bowel function, muscle weakness, and peated stops and starts in breathing dur-
toms of hypothyroidism — such as de- son’s susceptibility to gluten allergy (ce- loss of muscle function. ing sleep. Lack of adequate rest at night
creased growth rate, increase in weight, liac disease). Between 5 and 15 percent of Many parents become especially con- can lead to daytime tiredness, excessive
dry skin, constipation and lethargy — people with Down syndrome have celiac cerned about this risk when their chil- crankiness and disruptive behavior. Ob-
can overlap with and even be masked by disease. This allergic reaction to gluten dren become older and more physically structive sleep apnea has also been asso-
those of Down syndrome. But hypothy- damages the absorbing function of the active or begin participating in sports. ciated with intellectual deficits, decreased
roidism is treatable. Hormone supple- small intestine. The body’s resultant in- The American Academy of Pediatrics rec- visual perception skills, high blood pres-
ments can minimize or eliminate the ef- ability to absorb nutrients from food ommends using X-ray examination of sure and other cardiovascular problems.
fects of an underactive thyroid. Screening leads to bloating, diarrhea and growth the cervical spine to screen for atlanto- Treatment may consist of having your
for thyroid problems is recommended at problems. If your child begins showing axial instability between 3 and 5 years of child wear a device at night that helps
birth, 6 and 12 months, and then annu- signs of abdominal pain after starting age, especially if your child is planning him or her breathe properly. Other op-
ally thereafter, as the risk of thyroid prob- solid foods, talk to your son’s or daugh- on participating in sports. tions include various surgical procedures
lems increases with age. ter’s care provider about the need to If your child has atlantoaxial instabil- that change the structure of your child’s
check for celiac disease. A gluten-free ity, this doesn’t mean it will inevitably nose, mouth or throat.
Gastrointestinal problems Some ba- diet is key to treating celiac disease. progress to spinal cord compression —
bies with Down syndrome are born with A small number of babies with Down only that the risk of such an injury is in- Behavior problems Discuss with your
a gastrointestinal blockage called a duo- syndrome are born with Hirschsprung’s creased. Treatment for atlantoaxial insta- child’s care provider at every visit your
denal atresia. This occurs when the first disease, a nerve cell malformation in the bility may consist of a neck brace to child’s behavioral and social progress.
part of the small intestine (duodenum) colon that causes problems with passing protect the spine or surgery to stabilize Autism and other behavioral problems
doesn’t develop properly, remaining stool (see page 542).Your child’s care pro- the affected vertebrae. occur with increased frequency in chil-
closed off from the stomach and blocking vider might suspect the condition if your dren with Down syndrome. Symptoms
the passage of food. Often this condition baby fails to pass stool within the first Blood cell problems Your baby’s care may first become noticeable as early as 2
is diagnosed before birth during an ultra- or second day of life. Chronic constipa- provider will likely obtain a complete or 3 years of age.
sound. Babies born with duodenal atresia tion is another clue. Hirschsprung’s dis- blood count sometime in your baby’s first
have difficulty feeding, persistent vomit- ease is often treated with surgery month to check for blood cell abnormali-
ing, and a distended abdomen. The con- to remove the abnormal portion of the ties associated with Down syndrome.
dition is corrected with surgery. colon. Abnormalities may include too many or EARLY INTERVENTION
too few white blood cells (which help
Joint problems Down syndrome is as- fight infection) or platelets (involved In addition to monitoring and managing
sociated with a certain amount of loose- with clotting), or elevated or enlarged red any health concerns your child may have,
ness in the joints and ligaments. In most blood cells. Some of these problems are you can also help optimize his or her
cases, this isn’t a problem. But about 15 temporary and resolve on their own. growth and development by becoming in-
percent of people with Down syndrome Others require treatment. volved in an early intervention program.
develop a misalignment of the first and These therapy and counseling servic-
second vertebrae in the upper spinal col- Obstructive sleep apnea Alterations es, which are available through state pro-
umn due to loose ligaments. You may in the shape and structure of the head grams, are designed to promote optimal
hear medical care providers refer to this and neck area and decreased muscle development in your son or daughter
condition as atlantoaxial instability. This tone in children with Down syndrome and help you as a family learn how to un-
instability in the upper spinal cord poses contribute to a greater risk of obstructive derstand and meet your child’s needs
a very small but serious increased risk of sleep apnea. This breathing disorder oc- during the first three years of life.
spinal cord compression that could po- curs when throat muscles intermittently The hospital where your baby was
tentially result in paralysis and loss of relax and block the airway during sleep. born or your baby’s care provider can
bodily functions. Signs and symptoms of It’s usually a more significant issue after give you a referral to your local state
atlantoaxial instability include neck pain, age 1. agency. Once a referral is submitted, your
twisting of the neck to one side, changes Signs and symptoms of sleep apnea child is assessed and a caseworker as-
in walking pattern, loss of bladder and include snoring, restless sleep, and re- signed to your family to coordinate the
CHAPTER 41: DOWN SYNDROME 531

services that meet your baby’s specific A physical therapist can also help As your baby gets older, sign lan- have a partner, develop a plan where both
needs. Together with the caseworker and prevent your baby from learning inap- guage and picture systems may serve as of you can take regular breaks to recharge
therapists, your family creates a written propriate movement patterns. For exam- important tools of communication. your batteries. Find a trusted sitter so that
plan called the Individualized Family ple, your baby may compensate for cer- you can take breaks together, too (see Part
Service Plan (IFSP) — usually within 45 tain deficits now by moving in a way that Occupational therapy An occupa- 5 of this book). If you have other children,
days of referral. can lead to orthopedic and functional tional therapist can help you and your involve them in caring for the baby and
Early intervention programs are problems later on. baby work on personal and social skills understanding the condition, but spend
funded primarily by each state, but also that will help your child operate inde- time alone with older children, as well.
receive help from the federal government Speech and language therapy A big pendently. Such skills are often learned Seek out positive reinforcement. Sup-
and local resources. In a few cases, a state challenge for any baby is learning to through play, such as holding toys, ma- port groups for parents of children with
program will charge a small family fee. communicate needs and wants. But it nipulating knobs and buttons, building Down syndrome may be invaluable. Not
Your caseworker can discuss the cost of can be even more of a challenge for ba- towers, and moving objects in and out of only will group members know what
these services with you and may coordi- bies with Down syndrome. Speech and a basket. An occupational therapist also you’re going through, but also may be
nate with your health insurance provider, language therapy during the first years of can help your child master progressive able to offer advice, recommend helpful
but your ability to pay is not a prerequi- life can help establish a stable foundation fine-motor skills such as self-feeding, resources, give you a shoulder to cry on
site for eligibility. In general, families in- upon which your baby can learn to com- scribbling and getting dressed. and laugh with you when others may fail
cur little to no out-of-pocket costs for municate effectively through nonverbal to find the humor in a situation.
these services. and verbal means. Just as with any infant, Other services Depending on your Unfortunately, society can still be fair-
The earlier these services are started, a baby with Down syndrome understands needs, your IFSP also may include ser- ly obtuse when it comes to recognizing
the better it is for your child. Frequently, language much sooner than he or she can vices such as nutrition counseling, locat- talents and abilities hidden beneath a la-
therapists come directly to your home to express it. But it may be several years being medical and dental services for your bel such as Down syndrome. It may not
work with you and your child, but you fore a child with Down syndrome can child, getting transportation or special always be easy to brush off insensitive
may also visit a center for some services. learn to use expressive language. equipment for your child, and helping comments or ill-informed reactions to
The most common services provided in Speech skills build on the same mus- you find child care, among others. The your child. But if you can be straightfor-
an early intervention program for Down cles and body systems used for breath- IFSP is designed to be tailored to your ward and honest about your child’s abili-
syndrome are as follows. ing, swallowing and eating. To prepare family, so take the time to think about ties and disabilities, you may be able to
your baby for speech, a speech and lan- what you need and be sure to communi- educate those around you and offer them
Physical therapy A big part of every guage therapist may help you and your cate this to your caseworker and medical a whole new perspective on what it
child’s development in the first year is baby work on breast-feeding or sucking team. means to have Down syndrome in the
learning to explore and interact with his skills, which can strengthen your baby’s family. And you may even be surprised at
or her environment. This early explora- jaw and facial muscles. The therapist may the kindnesses of others. If you have any
tion depends heavily on your baby’s mo- also help you and your baby work on questions or doubts about your child’s
tor skills but can be impaired by de- pre-speech skills such as: DEVELOPING A legal rights and protections, be sure to
creased muscle tone. A physical therapist Z Imitating sounds SUPPORT SYSTEM ask your caseworker, who can guide you
can show you exercises and movements Z Using social and facial cues to com- to the right answers.
that help strengthen your baby’s muscles municate (you talk and then wait You may spend much of your baby’s first For information on resources that may
so that he or she can achieve milestones while your baby reacts) year mentally organizing all of the vary- be useful to you, see the Additional Re-
such as holding up his or her head to Z Learning to listen, through music and ing issues affecting your child, sorting out sources section, beginning on page 552.
look around, pulling up to sit, rolling conversation what your child does and doesn’t need
over, and sitting up. You can read more Z Learning through touch and explor- and generally acclimating to living a life
details about growth and development in ing objects with the mouth closely connected to Down syndrome.
Part 3. (Don’t think these chapters aren’t Z Understanding object permanence During this time, it’s important to care
for you just because your baby’s develop- (an object under a blanket is still there for yourself, as well. The challenges of
ment is likely to be delayed. The informa- even if out of sight) raising a child with Down syndrome may
tion still applies even if the timetable Z Understanding cause and effect (“If I seem insurmountable at times, but you
doesn’t.) smile, Daddy smiles back”) don’t have to do it all by yourself. If you

CHAPTER 42
Other newborn
conditions
Even if you do everything right during BLOOD DISORDERS

your pregnancy, sometimes complica-
tions can occur during pregnancy and It’s not uncommon for infants to experi-
childbirth or shortly thereafter. If your ence blood-related conditions or illness-
child faces an unexpected problem, you es. Jaundice is a very common blood-re-
may be concerned, confused and even lated condition, which you can read
frightened. about on page 378. Following are other
This section describes some of the blood disorders that can affect children
conditions that can occur in newborn under a year of age.
children and how they may be treated.
Listen to the advice of your child’s care Anemia Anemia is a common blood dis-
provider and ask questions until you feel order in infants that can affect normal
you understand the complication and the growth and development. Anemia occurs
possible courses of action. Also trust that when red blood cells are broken down
your child’s care provider and the medi- too rapidly, too much blood is lost or a
cal team will do the best for your son or child’s bone marrow doesn’t produce
daughter. Keep in mind that many con- enough red blood cells.
ditions that develop in infants can be The most common type of anemia in
successfully managed. children under 2 years of age is iron defi-
If your child is healthy, there’s no ciency anemia. It results when a child
need to read this chapter. Reading about doesn’t get enough iron in his or her diet
things that don’t affect your child or that or cannot absorb iron properly. Lack of
could go wrong may worry you unneces- iron lowers the number of healthy red
sarily. However, this chapter may be blood cells needed for growth and devel-
helpful if a friend or relative has a new- opment. Red blood cells contain hemo-
born with a health concern. globin, which carries oxygen to growing
CHAPTER 42: OTHER NEWBORN CONDITIONS 535

organs and tissues. Signs of infant ane- After birth, a baby must quickly develop breast milk, formula or glucose water will blood cells and decrease blood volume,
mia can be difficult to detect until the the ability to regulate his or her own usually cause the level to return to nor- making it easier for baby’s blood to func-
condition becomes more severe. They in- blood sugar level. Most healthy babies mal. If a baby isn’t able to feed well the tion properly. Blood that’s been with-
clude paleness in your baby’s skin, lips or are able to do this because they have a first few hours after birth — perhaps be- drawn may be replaced with fluids.
nail beds. Your child may also become ir- stored form of sugar, called glycogen, in cause baby is too sleepy from low blood
ritable and fatigued and experience a loss their livers. Babies also develop the capa- sugar — he or she may be given some
of appetite. bility to generate sugar from other food glucose via a small feeding tube directly
Babies born prematurely are at risk of reserves in their bodies. These abilities into the stomach. Boosting the sugar lev- BREATHING DISORDERS
iron deficiency anemia, since babies get are important because a baby needs to el to a normal range with tube feedings
the majority of their iron stores from adapt from a continuous supply of blood can be very helpful. The lungs are one of the last organs to
their mothers during the last trimester of sugar to periodic supplies that come dur- If a newborn’s blood glucose tests fully develop during pregnancy. Most
pregnancy. Infants who drink cow’s milk ing feedings. continue to be repeatedly low, prompt newborns have no difficulty breathing,
in the first year of life (instead of breast Fortunately, most babies handle the treatment is necessary. An intravenous but occasionally breathing problems can
milk or iron-fortified formula) also are at transition well. When the changeover (IV) tube is often started to infuse glu- occur, especially if an infant is born pre-
risk of iron deficiency anemia. Cow’s doesn’t go so well, hypoglycemia may cose directly into the baby’s circulation. maturely. Following are some breathing
milk is low in the iron necessary for infant occur. Hypoglycemia is a condition in This will quickly correct the low glucose disorders that can affect infants.
growth. That’s why it’s recommended that which a person’s blood sugar is lower while the potential causes for the hypo-
you don’t give cow’s milk to your child un- than normal. Babies more likely to de- glycemia are investigated. Bronchopulmonary dysplasia Breath-
til he or she is at least a year of age. velop hypoglycemia include those born ing difficulties associated with premature
Iron deficiency anemia may also occur to mothers with diabetes, full-term ba- Polycythemia Polycythemia is a blood birth generally improve within several
in breast-fed infants who don’t eat iron- bies who are large for their gestational disorder in which your bone marrow days to weeks. Premature infants who
rich foods after age 6 months. Healthy age, full-term babies who are small for makes too many red blood cells — the still require assistance with ventilation or
newborns generally have enough iron their gestational age (intrauterine growth opposite of anemia. Polycythemia also supplemental oxygen after a month are
stores in their bodies to last for at least six restriction), and premature babies. may result in production of too many of often described as having brochnopul-
months. After that, more significant Too little blood sugar is a problem be- the other types of blood cells — white monary dysplasia.
amounts of iron are often required. cause it can impair the brain’s ability to blood cells and platelets. But it’s the ex- Bronchopulmonary dysplasia is most
function. Severe or prolonged hypogly- cess red blood cells that thicken your common in infants born early (prema-
Treatment Anemia is diagnosed with a cemia may result in seizures and serious blood and cause most of the concerns as- turely) whose lungs were not fully devel-
blood test. Treatment involves supple- brain injury. sociated with the condition. oped at birth and in infants who have
mental iron. Common sources of dietary Some babies with hypoglycemia don’t Infants at higher risk of the condition been on a breathing machine (ventilator)
iron for infants are iron-fortified formu- experience signs and symptoms or they are those who are born past term (“over- or who need supplemental oxygen for an
las and cereals. Iron may also be added to may be mild. In other instances, signs and due”), are small for their gestational age, extended period.
an infant’s diet in the form of supple- symptoms may be more severe. Some of are born to mothers with diabetes, have Signs and symptoms of bronchopul-
mental drops or powders. the more common indications of hypo- chromosomal abnormalities, have con- monary dysplasia include rapid breathing,
Don’t give your child iron supple- glycemia are jitteriness, bluish coloring tinually decreased oxygen levels, or are wheezing, coughing, and bluish lips and
ments, without first consulting with his (cyanosis), breathing problems, low body the recipient twin in a condition called fingernails (cyanosis). Brochnopulmonary
or her care provider. Too much iron can temperature, poor appetite and lethargy. twin-to-twin transfusion syndrome. dysplasia is often suspected in infants
be dangerous. A simple blood test to check blood Often, there are no symptoms, but with respiratory distress syndrome who
sugar levels can diagnose hypoglycemia. when they do occur they may include a don’t recover within the first several weeks.
Low blood sugar The human brain de- A newborn’s blood sugar level is com- reddish-purple coloring, lethargy, a poor
pends on blood sugar (glucose) as its monly measured within the first several appetite and breathing problems. Treatment Babies with bronchopulmo-
main source of fuel, so it needs a steady hours after birth to be reassured that it’s nary dysplasia need supplemental oxy-
supply. Throughout pregnancy, a baby’s in the normal range. Treatment In newborns, the condition gen for an extended period and may also
blood sugar stays at a fairly even level may resolve on its own within a few days. need medication. Most get better with
because he or she continuously receives Treatment When a baby’s blood sugar is If treatment is required, blood may be time; however, they may need to contin-
nutrition from the mother’s placenta. below normal levels, feeding him or her withdrawn to reduce the number of ue treatment for months or even years.
536 PART 6: SPECIAL CIRCUMSTANCES CHAPTER 42: OTHER NEWBORN CONDITIONS 537
Some continue to have lung problems, pressure changes may be needed to in- commonly seen in premature infants Among some babies, their skin may have
such as asthma, throughout childhood flate the lungs. whose lungs haven’t fully developed and a bluish tinge (cyanosis).
and even into adulthood. Occasionally, the lungs don’t inflate is rarely found in full-term infants. The Unlike infants with RDS, these in-
evenly, and the pressure differences can severity of RDS often correlates with the fants rarely appear severely ill and most
Meconium aspiration Meconium as- cause a condition called collapsed lung, infant’s gestational age and weight. The recover within a couple of days. Howev-
piration syndrome is a condition in which or pneumothorax. In this condition, the smaller and more premature the infant, er, rapid breathing makes it more difficult
a newborn breathes (aspirates) a mixture small air sacs within a baby’s tiny lungs the greater the chance he or she will for the babies to eat. Once their breath-
of meconium and amniotic fluid into the rupture and allow air to leak out into the have RDS. Other factors that may in- ing becomes more comfortable, babies
lungs during labor. spaces between the thin membranes lin- crease the risk are an older sibling who with TTNB are more willing to nurse or
Meconium is the first feces, or stool, ing the lungs and the inner wall of the had RDS, a mother with diabetes, a ce- take a bottle.
of a newborn. Normally, meconium isn’t chest. Pneumothorax may also cause ba- sarean delivery and a multiple pregnancy
passed until after an infant is born. In bies to have other respiratory conditions. (twins or more). Treatment Treatment may include giving
some cases, though, a baby will pass If a small amount of air leaks, the in- Most infants who develop RDS show the baby oxygen until breathing im-
stool (meconium) while still inside the fant may have shortness of breath, rapid signs of breathing problems and the proves. If the baby is breathing too fast to
uterus. Once the meconium has passed breathing or grunting, and perhaps blu- need for more oxygen at birth, or within be fed via breast or bottle, the baby might
into the surrounding amniotic fluid, the ish lips and fingernail beds (cyanosis). If a the first few hours that follow. Blood tests be given intravenous (IV) fluids or milk
baby may inhale it into the lungs, called large amount of air leaks, the infant may and an X-ray of the lungs can establish via a feeding tube passed through the
meconium aspiration. The meconium develop more severe breathing difficulty. the diagnosis. A child with RDS may be nose and into the stomach. Usually, no
can potentially obstruct the infant’s air- placed in a neonatal intensive care unit other treatment is necessary.
ways and can cause breathing difficulties Treatment Pneumothorax can be very (NICU), where his or her vital signs can
due to inflammation of the baby’s lungs. serious if a lung collapses suddenly, but be constantly monitored.
Symptoms of meconium aspiration in most cases the leakage is small and the
generally include breathing difficulty — air is reabsorbed on its own. Sometimes, Treatment Many infants with RDS re- CENTRAL NERVOUS
the infant has to work hard to breathe — no treatment is necessary. In other cases, quire help with their breathing. A breath- SYSTEM DISORDERS
and a bluish skin color (cyanosis). the infant may be given extra oxygen to ing tube attached to a ventilator may be
breathe for a period of time. In the case of inserted through the mouth into the ba- The central nervous system consists of
Treatment When a baby is born with severe pneumothorax, air that has leaked by’s trachea to assist with breathing. the brain and spinal cord. Three of the
meconium in the amniotic fluid, the first into the chest may need to be removed Some babies are helped with a tube in more common central nervous system
step is to suction the newborn’s mouth by inserting a tube into the chest wall be- the nose or a mask on the face to provide disorders seen in infants may occur dur-
after birth. Further treatment is only nec- side the lung. continuous positive airway pressure. In- ing early fetal development or shortly af-
essary if the baby isn’t active and crying fants with severe RDS may be given sur- ter birth.
immediately after delivery. A tube may be Respiratory distress syndrome Re- factant directly into their lungs. Other
placed in the infant’s trachea and suction spiratory distress syndrome (RDS) is medications may also be given to help Cerebral palsy Cerebral palsy is a dis-
applied to remove the meconium. characterized by rapid, difficult breathing improve breathing. order of movement, muscle tone or pos-
In most cases, the outlook is excellent and perhaps a bluish skin color (cyano- ture that’s caused by infection, injury or
and there are no long-term health ef- sis). The breathing sound made by a baby Transient tachypnea Transient tach- abnormal development in the immature
fects. In more severe cases, a baby may with RDS, commonly referred to as ypnea of a newborn (TTNB) is a form of brain, most often before birth. Most chil-
need antibiotics to treat possible infec- “grunting,” is often very distinctive. As respiratory distress that can occur after dren born with cerebral palsy had a
tion, specialized ventilators and other the child breathes out, he or she may an uneventful vaginal delivery or cesare- seemingly uncomplicated course of
technologies to keep the lungs inflated, make a noise that sounds like a lamb or a an birth in both premature and full-term pregnancy, labor and birth.
and oxygen to keep blood levels normal. soft cry. Babies with RDS also have to infants. TTNB is more likely to occur after In general, cerebral palsy causes im-
work harder to move air into their lungs. a rapid vaginal birth or among babies paired movement associated with exag-
Pneumothorax One of the miracles of RDS is caused by lack of a slippery, born by cesarean birth without labor. gerated reflexes or rigidity of the limbs
birth is that within a few breaths a new- protective substance called surfactant, Infants with this form of respiratory and trunk, abnormal posture, involuntary
born’s lungs inflate with air and the baby which helps the lungs inflate with air and distress often have no signs of trouble movements, unsteadiness of walking,
begins breathing. Initially, considerable keeps air sacs from collapsing. It’s most other than rapid, shallow breathing. or some combination of these. These
problems often aren’t evident until an in- severe at birth, major brain damage and is the embryonic structure that eventually supplements and fortified foods, is called
fant is 6 to 12 months old or older. Other physical disabilities are likely. In less se- develops into the baby’s brain and spinal folic acid. A folic acid deficiency before or
conditions related to abnormal brain de- vere cases, with proper treatment, it’s cord and the tissues that enclose them. in early pregnancy increases the risk of
velopment also may occur, including in- possible to have a nearly normal life span Normally, the neural tube forms early neural tube defects.
tellectual disabilities, vision and hearing and intelligence. in a pregnancy and it closes by the 28th
problems, or seizures. Premature infants are at increased day after conception. In babies with spi- Treatment Treatment of spina bifida de-
There are many possible causes of ce- risk of the condition because they’re at na bifida, a portion of the neural tube pends on the severity of the condition. It
rebral palsy. One possible cause is inade- higher risk of severe bleeding within the fails to develop or close properly, causing usually requires surgery to put the spinal
quate circulation of blood in brain tissue. brain, which can eventually lead to hy- defects in the spinal cord and in the cord and exposed tissue back in place
Abnormal brain growth and development drocephalus. Certain problems during bones of the backbone. and close the opening in the vertebrae.
early in pregnancy is increasingly recog- pregnancy also may increase an infant’s Spina bifida may occasionally cause Rarely, this surgery may be done before a
nized as a cause of cerebral palsy. Injury to risk of developing hydrocephalus, in- no symptoms or only minor physical dis- child is born while he or she is still in the
the brain during labor and delivery can cluding an infection within the uterus or abilities. More frequently, it leads to seri- womb, but it carries many risks. More
also be a cause, as well as infection or problems during fetal development, such ous physical, and sometimes mental, dis- surgeries and other forms of treatment
bleeding in or around the brain of the de- as spina bifida. In some cases, a genetic abilities. Often, the condition causes loss may also be necessary.
veloping fetus. Other factors related to abnormality may be responsible. of neurological control of the legs, blad-
pregnancy or birth associated with an in- Congenital or developmental defects der and bowel. Some infants also experi-
creased risk of cerebral palsy include pre- not apparent at birth may increase an ence accumulation of fluid in the brain
mature birth, low birth weight, breech older child’s risk of hydrocephalus. Other (hydrocephalus) or an infection in the tis- DIGESTIVE DISORDERS
birth and multiple births (twins or more). factors that increase risk include menin- sues surrounding the brain (meningitis).
gitis or bleeding in the brain. Doctors aren’t certain what causes Disorders of the digestive tract can cause
Treatment There’s no cure for cerebral spina bifida. As with many other nervous a variety of problems, including poor eat-
palsy, but in some cases surgery may help Treatment Hydrocephalus is often treat- system disorders, it appears to result ing and excessive spitting up. In other
reduce muscle spasticity and resulting ed with surgery. The most common treat- from a combination of genetic and envi- chapters in this book we discuss condi-
deformities. Physical therapy is a comment is the surgical insertion of a drain- ronmental risk factors, such as a family tions such as reflux (see page 382) and
mon component of treatment. Muscle age system, called a shunt. It consists of a history of neural tube defects or folic acid milk allergy (see page 61), which can af-
training and strengthening exercises may long flexible tube with a valve that keeps deficiency. Folate (vitamin B-9) is impor- fect newborns. Following are some less
help your child’s strength, flexibility, bal- fluid from the brain flowing in the right tant to the healthy development of a fe- common digestive disorders that can
ance, motor development and mobility. direction and at the proper rate. One end tus and can help prevent spina bifida. The cause complete or partial obstruction of
Occupational and speech therapy also of the tubing is usually placed in a fluid- synthetic form of the vitamin, found in the passage of food or stool.
may be part of the treatment program. As filled chamber in the brain, and the tub-
a child becomes older, medication may ing is then tunneled under the skin to the
also be used to help lessen muscle tight- abdomen where the excess cerebrospinal
ness and manage complications. fluid can be more easily absorbed.
If your child has hydrocephalus, his or
Hydrocephalus Hydrocephalus is an her doctor may recommend working
excessive accumulation of water in the with specialists who can evaluate your
brain due to an imbalance between the child’s developmental progress on a reg-
brain’s production of cerebrospinal fluid ular basis in order to detect any delays in
and its ability to absorb it. Untreated hy- social, intellectual, emotional or physical
drocephalus in a young infant can even- development. Effective interventions are
tually result in an extremely large head. available to help your child, if needed.
The outlook for a child with hydro-
cephalus depends on the severity of the Spina bifida Spina bifida (myelomenin-
© MFMER
condition and whether any underlying gocele) is part of a group of birth defects
disorders are present. If the condition is called neural tube defects. The neural tube Spina bifida
Esophageal atresia In an infant born Treatment Treatment generally involves also occur with a lower obstruction, but it wave-like contractions are caused by
with esophageal atresia, the tube leading surgery to remove the abnormal portion may come later. If a baby has a partial ob- stomach muscles trying to force food past
from the throat to the stomach (esopha- of the intestines. In cases where surgery struction, symptoms may not be immedi- the outlet of the pylorus.
gus) isn’t properly connected. The condi- can’t be performed right away, an open- ately apparent.
tion may be accompanied by other disor- ing on the outside of the abdomen (sto- An infant with an intestinal obstruc- Treatment Pyloric stenosis is generally
ders. It may occur with certain genetic ma) is created so that stool can pass into tion generally doesn’t have a bowel treated with surgery. During the proce-
disorders, including Down syndrome. a disposable pouch. After surgery, most movement, although baby’s first (meco- dure, the surgeon cuts and spreads apart
Signs and symptoms of esophageal children pass stool normally, but they nium) stool may pass if the obstruction is the outside layer of the thickened pylorus
atresia are typically detected soon after may need long-term follow-up for con- high in the small intestine. muscles to widen the lower stomach. For a
birth. The infant may have an unusually stipation and other problems. The condition is sometimes associat- few hours to days after surgery, intravenous
large amount of secretions coming from ed with certain genetic disorders, includ- (IV) fluids are given until the child can eat.
the mouth, or may cough, choke or turn Imperforate anus An infant with im- ing Down syndrome. The surgery doesn’t increase the risk of fu-
blue when attempting to feed. perforate anus has not formed an anal ture stomach or intestinal problems.
opening, preventing passage of stool. The Treatment Treatment depends on the
Treatment Infants with this condition re- condition may be noticeable during a type of obstruction. A complete obstruc-
quire surgery. If the underdeveloped seg- physical examination, or it may be sus- tion generally requires immediate sur-
ment is short, repair may be attempted pected when a baby fails to pass his or gery. A partial obstruction may also re- FACIAL AND EXTREMITY
immediately. If the segment is long, fur- her first stool (meconium) a few hours to quire surgery. Recovery depends on the DISORDERS
ther growth of the esophagus may be days after birth. A child with imperforate severity and location of the blockage.
necessary before doing surgery. Until anus may have other birth abnormalities. A child is sometimes born with a disor-
surgery is performed, a tube is temporar- Pyloric stenosis Pyloric stenosis is a der that’s physically apparent. On occa-
ily placed through the abdominal wall Treatment Treatment depends on the lo- condition that affects the muscles of the
into the stomach for feeding. cation of the obstruction. If the anal pylorus, which is at the lower end of the
opening is simply narrowed, an instru- stomach. The muscles of the pylorus (py-
Hirschsprung’s disease An infant ment can be used to widen (dilate) the loric sphincter) connect the stomach and
with Hirschsprung’s disease gradually opening. More typically, surgery is neces- small intestine.
develops an abnormally large (dilated) sary. Children with a less complicated In pyloric stenosis, the pyloric sphinc-
colon. The condition is due to a failure of obstruction generally do well after sur- ter becomes abnormally large, causing
the muscles of the colon to propel stool gery and develop normal bowel control. the lower stomach to narrow. The en-
through the anus. If the obstruction is more complicated, larged muscles block food from entering
Muscle contractions in the gut help the child may require a series of opera- the baby’s small intestine, typically re-
digested materials move through the in- tions and have long-term challenges sulting in excessive spitting up or forceful
testines. Nerves in between the muscle with passage of stool. (projectile) vomiting.
layers synchronize the contractions. In Signs of pyloric stenosis usually ap-
Hirschsprung’s disease, these key nerves Intestinal blockage Intestinal atresia pear within three to five weeks after
are missing from a part of the bowel. Ar- is the medical term for an obstruction birth. The condition is rare in babies older
eas without such nerves cannot push anywhere in the intestines. The obstruc- than age 3 months. Enlarged
material through. This causes a blockage tion may be complete — blocking all In addition to spitting up and vomit- pyloric
sphincter
of intestinal contents. passage of fluid and intestinal content — ing, other signs and symptoms may in-
Early signs may include a delay of or or it may be partial. clude persistent hunger — baby always
failure to pass baby’s first stool (meconi- A high obstruction just beyond the wants to eat, even after vomiting —
um). Baby may also experience vomiting outlet of the stomach or in the upper wave-like stomach contractions, dehy-
and abdominal distention. Dehydration small intestine can cause persistent vom- dration, constipation or very small stools,
and weight loss are also common. Many iting. An obstruction in the lower small and no weight gain or weight loss. Re-
© MFMER
infants with Hirschsprung’s disease have intestine or the colon may cause a swol- peated vomiting may irritate baby’s
alternating constipation and diarrhea. len (distended) abdomen. Vomiting may stomach and cause mild bleeding. The Pyloric stenosis
sion, these disorders may involve the face interaction of genetic and environmental Clubfoot Clubfoot describes a range of Treatment The goal of treatment is to re-
and the hands and feet. factors. Fetal exposure to cigarette smoke, foot abnormalities usually present at store the look and function of the foot
alcohol, certain medications, illicit drugs birth in which your baby’s foot is twisted before your child learns to walk, in hopes
Cleft lip and cleft palate Cleft lip and and certain viruses have been linked to out of shape or position. The term refers of preventing long-term disabilities. Treat-
cleft palate are among the most common the development of a cleft. In many ba- to the way the foot is positioned at a sharp ment options include stretching and cast-
birth defects. A cleft is an opening or split in bies, however, a definite cause isn’t dis- angle to the ankle, like the head of a golf ing or taping the foot. When clubfoot is
the upper lip, the roof of the mouth (palate) covered. club. Also, the calf muscles in the affected severe or it doesn’t respond to nonsurgical
or both. Cleft lip and cleft palate result leg are usually underdeveloped, and the treatments, surgery may be necessary.
when developing facial structures in an un- Treatment Surgery to correct cleft lip and affected foot may be slightly shorter than Even with treatment, clubfoot may
born baby don’t completely grow together. palate is based on your child’s particular the other foot. not be totally correctable, but most ba-
Often, a cleft — or split — in the lip or defect. Following the initial cleft repair, Clubfoot is a relatively common birth bies who are treated early grow up to
palate is diagnosed during a prenatal ul- your doctor may recommend follow-up defect and is usually an isolated problem lead normal, active lives.
trasound exam. Otherwise, it is identifi- surgeries to improve speech or improve for an otherwise healthy newborn. The
able immediately at birth. Cleft lip and the appearance of the lip and nose. Surger- disorder can be mild or severe, affecting Finger and toe deformities One of the
palate can affect one or both sides of the ies typically are performed in this order: one or both feet. Clubfoot will hinder first things parents often do after a child is
face. Clefts can appear as only a small Z Cleft lip repair. Between 10 weeks your child’s development once it’s time born is to count the fingers and toes to
notch in the lip or can extend from the lip and 3 months of age for your child to walk, so treating club- make sure they are all there. On rare occa-
through the upper gum and palate into Z Cleft palate repair. Between 6 and 18 foot soon after birth, when your new- sions, the number of fingers — or the
the bottom of the nose. Less commonly, months of age born’s bones and joints are extremely number of toes — doesn’t add up to 10.
a cleft occurs only in the muscles of the Z Follow-up surgeries. Between age 2 flexible, is generally recommended.
soft palate (submucous cleft palate), and late teen years The cause of clubfoot isn’t known; Extra fingers or toes A child may be
which are at the back of the mouth and For children with cleft palate, ear however, environmental factors may play born with one or more extra digits, such
covered by the mouth’s lining. Because tubes also may be placed during the first a role in causing clubfoot. Studies have as an extra finger or extra thumb on the
it’s hidden, this type of cleft may not be surgery to ventilate the middle ear and strongly linked clubfoot to cigarette hand or extra toes. Often, the extra digit
diagnosed until later. prevent hearing loss. Your child’s surgeon smoking during pregnancy, especially consists only of skin and soft tissue and
Researchers believe that most cases of will determine the optimal timing for all when a family history of clubfoot is al- can easily be removed. If the extra digit
cleft lip and cleft palate are caused by an needed surgeries. ready present. contains bone or cartilage, surgery may
© MFMER
© MFMER
Cleft lip (left) and cleft palate (right) Finger and toe deformities
be necessary. This may be done after the Ambiguous genitalia This term refers Hypospadias Hypospadias is a condi- Treatment The goal of treatment is to
infant is a few months old. to the uncertain appearance of a baby’s tion in which the opening of the urethra move the undescended testicle to its
external sexual features. Sometimes, a fe- is on the underside of the penis, instead proper location in the scrotum. Early
Webbed fingers or toes A child may be male with normal ovaries who’s been ex- of at the tip. The urethra is the tube treatment may lower the risk of complica-
born with one or more fingers or toes posed to an excess of male hormones in through which urine drains from the tions of an undescended testicle, such as
that are joined (“webbed”) together. the womb is born with male-like geni- bladder and exits the body. The severity the risk of infertility and testicular cancer.
Simple webbing of fingers or toes in- tals. Conversely, a male may be born with of the condition varies. In most cases, the The condition is usually corrected
volves only the skin and other soft tis- testicles but with ambiguous or com- opening of the urethra is near the head of with surgery. The surgeon carefully ma-
sues. Occasionally, webbing may involve pletely female genitals. Some newborns the penis. Less often, the opening is at nipulates the testicle into the scrotum
fused bones, nerves, blood vessels, and have both ovaries and testicles and am- midshaft or at the base of the penis. and stitches it into place. When your son
tendons. Surgery is advised if the web- biguous genitals. You may feel distressed if your son is has surgery will depend on a number of
bing causes problems with appearance, Ambiguous genitals can result from born with hypospadias. However, the factors, such as his health and how diffi-
or it impairs use of the fingers or toes. tumors, chromosome abnormalities, oth- condition is common and it doesn’t cause cult the procedure might be. Generally,
er genetic problems, and hormone ex- difficulty in caring for your infant. this type of surgery is performed after a
Hip dysplasia This condition results cesses or deficiencies. child is 3 to 6 months old and before the
from abnormal development of the hip When a newborn’s sex is in question, Treatment Treatment involves surgery to child is 15 months old.
joint. The hip is a ball-and-socket joint. only thorough testing and evaluation can reposition the urethral opening and, if
In some newborns, the socket is too shal- establish a correct diagnosis. Because necessary, straighten the shaft of the pe-
low and the ball (thighbone) may slip out ambiguous genitalia is an uncommon nis. Rarely, the repair may require two or
of the socket, either part of the way or com- and complex condition, the baby may be more surgeries. With successful treat-
pletely. Left untreated, the affected leg may referred to a medical center with doctors ment, most male infants will have nor-
turn outward or be shorter than the other who have expertise in disorders of sex mal adult sexual function.
leg. Occasionally, both hips are involved. development.
Hip dysplasia is often detected during Undescended testicle An undescend- Testicle
an initial examination at birth or in the Treatment Treatment depends on a varied testicle is a testicle that hasn’t moved
first weeks to months of life. Girls born ety of factors. It may include hormone into its proper position in the bag of skin
breech are at greater risk of hip dysplasia therapy or reconstructive surgery. hanging beneath the penis (scrotum) pri-
and may require an ultrasound of the or to the birth of a baby boy. Usually just
hips at about 6 weeks of age. Hydrocele A hydrocele is a fluid-filled one testicle is affected, but in some cases
sac surrounding a testicle that results in both testicles may be undescended. The
Treatment Hip dysplasia can be success- swelling of the scrotum, the loose bag of condition is more common among baby
fully treated. When the condition is diag- skin underneath the penis. Up to 10 per- boys born prematurely or before 37 weeks.
nosed early, a device or harness is used to cent of male infants have a hydrocele at Testicles form in the abdomen during
keep the legs apart and turned outward birth, but most hydroceles disappear fetal development. During the last couple
(frog-leg position). This device will usu- without treatment within the first year of months of normal fetal development,
ally hold the hip joint in place while the of life. the testicles gradually leave the abdo-
child grows. Children who are diagnosed men, pass through a tube-like passage-
after 6 months of age may need surgery. Treatment If the testicle can be easily way in the groin (inguinal canal) and de-
examined and the amount of fluid re- scend into the scrotum.
mains constant, treatment is generally If your son has an undescended tes-
unnecessary. Usually the fluid gets ab- ticle, that process was stopped or delayed
GENITAL DISORDERS sorbed within a year. If a hydrocele at some stage of development, and the
doesn’t disappear after a year or if it con- testicle is not where you would expect
Some birth conditions affect the genitals. tinues to enlarge, it may need to be surgi- it to be — it may still be in the abdomen.
© MFMER
These conditions are typically diagnosed cally removed. Sometimes, a hydrocele The disorder is typically detected when
on physical examination at birth. may recur. your baby is examined shortly after birth. Undescended testicle
HEART DISORDERS opening produces abnormal blood flow When the ductus arteriosus doesn’t heart defects that are present at birth.
and allows oxygen-rich and oxygen-poor close, it causes abnormal blood circula- These defects, which affect the structure
Some infants are born with a heart defect blood to mix. If the hole is large and a lot tion between the heart and lungs. Babies of the heart, cause oxygen-poor blood to
— a problem in the heart’s structure. of blood is mixed, the blood that ends up born prematurely are more at risk of pat- flow out of the heart and into the rest of
These defects range from mild to severe, being circulated through your child’s ent ductus arteriosus (PDA) than are the body.
with most cases being mild. The risk of body is not carrying as much oxygen as those born at term. Infants and children with tetralogy of
having a baby with a heart condition may normal. The condition may also cause in- When the opening is small, often there Fallot usually have bluish skin color (cya-
be higher if you have an older child who creased fluid in the lungs. Children with are no symptoms. A large opening will pro- nosis) because their blood doesn’t carry
was born with a heart defect or if other the condition often don’t experience any duce a heart murmur and may cause pul- enough oxygen. Sometimes, infants with
family members have had a baby with a signs or symptoms. monary hypertension and poor growth. tetralogy of Fallot will suddenly develop
heart defect. deep blue skin color after crying, feeding,
The precise cause of a congenital Treatment If the hole is small, no treatment Treatment Often, especially in prema- having a bowel movement, or kicking his
heart defect is often unknown. Genetic may be necessary. In more severe cases, ture infants, the ductus will close on its or her legs upon awakening. These epi-
defects and certain viral infections ob- surgery may be needed to close the hole. own within weeks. If it doesn’t, medica- sodes are called tet spells and are caused
tained during pregnancy may be possible tion or surgery may be used to close the by a rapid drop in the amount of oxygen
causes. Coarctation of the aorta In this con- opening. In older infants with a ductus in the blood.
Fortunately, with continued advances dition, there’s a narrowing (constriction) that remains open, surgery or procedures Tetralogy of Fallot is often diagnosed
in heart surgery, many heart disorders in the main artery carrying blood away done by cardiac catheterization are used during infancy or soon after. However, it
can be successfully treated. Some may from the heart to the rest of the body. The to close the opening. may not be detected until later in life, de-
even heal on their own, without surgery. heart may have to pump harder to force pending on the severity of the defects
blood through the narrowed area and Pulmonary stenosis Pulmonary ste- and symptoms.
Aortic stenosis Aortic stenosis is a blood pressure above the constricted nosis is a condition in which the flow of
narrowing of the valve through which area may be increased. blood from the heart to the lungs is Treatment All babies with tetralogy of
blood leaves the heart to enter the aorta, Initially, no symptoms may be evi- slowed by a deformed pulmonary valve, Fallot need corrective surgery. Without
the main artery carrying blood away from dent. If the constriction is significantly or a narrowing above or below the valve. treatment, your baby may not grow and
the heart. Because the valve does not interfering with blood flow, it may result Mild or moderate obstruction may cause develop properly. He or she is also at in-
fully open, blood flow from the heart is in pale skin and breathing difficulties. no symptoms. A newborn with a severe creased risk of serious complications,
decreased. obstruction may have a bluish skin color such as infective endocarditis, an inflam-
Severe stenosis, which may be ac- Treatment In more severe cases, imme- (cyanosis) and show signs of heart failure. mation of the inner lining of the heart
companied by breathing difficulties, is diate surgery may be necessary to fix the Pulmonary stenosis is often diag- caused by a bacterial infection.
usually detected in early infancy. Mild or narrowing to increase blood flow. In less nosed in childhood, sometimes soon af- With early diagnosis followed by
moderate stenosis may not produce any severe cases, surgery is still likely, but ter birth. Your baby’s care provider may appropriate treatment, most children
noticeable symptoms, but during a physi- doesn’t need to be done immediately. suspect pulmonary stenosis if he or she with tetralogy of Fallot live relatively nor-
cal examination your baby’s care provider hears a heart murmur in the upper left mal lives, though they’ll need regular
may detect a distinctive heart murmur. Patent ductus arteriosus The ductus area of the chest during a routine checkup. medical care and may have restrictions
arteriosus is a vessel that leads from the on exercise.
Treatment Surgery may be needed to pulmonary artery to the aorta while an Treatment Mild pulmonary stenosis usu-
treat severe stenosis. It may not be neces- infant is in the womb. It allows blood to ally doesn’t worsen over time, but mod- Transposition of the great vessels
sary for mild to moderate disease, but bypass the baby’s lungs by connecting erate and severe cases may get worse and This is a complex condition in which the
your baby should have periodic examina- the pulmonary arteries (which supply require surgery. Fortunately, treatment is two arteries rising from the heart — the
tions to monitor the condition to make blood to the lungs) with the aorta (which highly successful, and most infants with aorta and the pulmonary artery — are re-
sure it doesn’t worsen. supplies blood to the body). Soon after pulmonary stenosis can expect to lead versed. Because of this, blood returning
an infant is born and the lungs fill with normal lives. to the heart from the body is pumped
Atrial septal defect Atrial septal de- air, this blood vessel is no longer needed. back to the body without ever going
fect is an opening high in the heart be- It will usually close within a couple of Tetralogy of Fallot Tetralogy of Fallot through the lungs to pick up oxygen.
tween the heart’s upper chambers. The days. is the name for a combination of four Newborns with this condition are often
very dusky blue in color and require in- Treatment Many babies born with a tory system or the digestive system. The Intrauterine growth restriction A
tensive immediate medical care within small ventricular septal defect don’t ever thick and sticky mucus associated with baby who is born full term but weighs
the first hours to days after birth. need surgery to close the defect. After cystic fibrosis clogs the tubes that carry less than 5 pounds, 8 ounces is often re-
birth, your doctor may want to observe air in and out of the lungs. This can cause ferred to as being at a low birth weight.
Treatment A surgery called an arterial your baby and treat any symptoms while a persistent cough, wheezing, and re- The medical term for this condition is in-
switch procedure is used to permanently waiting to see if the defect closes on its peated lung and sinus infections. The trauterine growth restriction, or IUGR.
correct the problem; however, not all ba- own. Infants who have a ventricular sep- thick mucus can also block tubes that Intrauterine growth restriction refers
bies have anatomy suitable for this pro- tal defect that’s large or is causing signifi- carry digestive enzymes from the pan- to the poor growth of a baby while in the
cedure. The surgery switches the great cant symptoms usually require surgery. creas to the small intestine. Without mother’s womb during pregnancy. Spe-
arteries back to the normal position. Surgical treatment generally produces these digestive enzymes, the intestines cifically, it means the developing baby
Most infants who undergo arterial switch excellent long-term results. can’t fully absorb the nutrients in the weighs less than 90 percent of other ba-
don’t have symptoms after surgery and food. The result is foul-smelling and bies at the same gestational age.
live normal lives. A medical team will de- greasy stools, poor weight gain and Intrauterine growth restriction can
termine the best approach for surgery. growth, a distended abdomen from con- result from a variety of genetic, metabolic
OTHER DISORDERS stipation, and intestinal blockage, partic- and environmental influences. Congeni-
Ventricular septal defect A ventricu- ularly in newborns. tal or chromosomal abnormalities are of-
lar septal defect (VSD), also called a hole Two other disorders that can affect a Within the past decade, most states ten associated with below-normal
in the heart, is a common heart defect newborn include cystic fibrosis and intra- have begun to routinely screen newborns weight. Infections during pregnancy may
that’s present at birth. It occurs when the uterine growth restiction. for cystic fibrosis. This test checks a blood affect the weight of the developing baby.
septum, the muscular wall separating the sample for a particular component that’s A placenta that’s particularly small or
heart into left and right sides, fails to form Cystic fibrosis Cystic fibrosis is an in- commonly elevated in babies who have isn’t functioning normally also can result
fully between the lower chambers of the herited condition that affects the cells cystic fibrosis. Other tests are needed to in a growth-restricted baby.
heart during fetal development. This that produce mucus, sweat and digestive confirm the diagnosis. After birth, the growth and develop-
leaves an opening that allows mixing of juices. Normally, these secretions are thin ment of a low birth weight baby is gener-
“red” (oxygenated) blood and “blue” (de- and slippery, but in cystic fibrosis, a de- Treatment There’s no cure for cystic fibro- ally influenced by the severity and cause
oxygenated) blood. As a result, blood may fective gene causes the secretions to be- sis, but treatments can ease symptoms of the condition. Many IUGR babies see
overfill the lungs and overwork the heart. come thick and sticky. Instead of acting and reduce complications. Treatment gen- improvement in growth during the first
A baby with a small ventricular septal as a lubricant, the secretions plug up erally includes medications and therapy. months after birth. However, some ba-
defect may have no problems. A baby tubes, ducts and passageways, especially Infants with cystic fibrosis may be bies continue to experience slow growth
with a larger ventricular septal defect in the pancreas and lungs. given medications to treat infection, despite ample nutrition.
may have a bluish skin color — due to Signs and symptoms can vary from break up mucus in the lungs, and reduce
oxygen-poor blood — often most visible child to child, depending on the severity lung inflammation. A child may also re- Treatment A baby born at a low birth
in the lips and fingernails. Other signs of the disease. Even in the same child, ceive enzyme supplements with each weight may have to stay in the hospital
and symptoms may include rapid breath- symptoms may worsen or improve as meal to help his or her body absorb food. longer than normal, until he or she gains
ing, a poor appetite and failure to gain time passes. In some children, symptoms To help loosen mucus in the lungs, a sufficient weight and other problems are
weight. begin during infancy. Other children may parent or caregiver may need to thump resolved, such as jaundice or mainte-
A ventricular septal defect at birth not experience symptoms until adoles- the baby’s chest with a cupped hand. This nance of normal body temperature. Ba-
typically doesn’t cause problems in early cence or adulthood. often needs to be done a couple of times bies with IUGR may need specific nutri-
infancy. If the defect is small, symptoms One of the first signs of cystic fibrosis each day for about 30 minutes each time. tional supplements and assistance with
may not appear until later in childhood is an excessively salty taste to the skin. There are also electronic devices that can feeding until they are growing well.
— if ever. Signs and symptoms vary de- People with cystic fibrosis tend to have perform this task. A baby with IUGR may have trouble
pending on the size of the hole. The con- higher than normal amounts of salt in In the past, most children with cystic fitting safely in a car seat. Some infants
dition may be diagnosed during a regular their sweat. Parents often can taste the fibrosis died in their teens. Improved need to be transported in a crash-safe car
checkup. While listening to your baby’s salt when they kiss their child. screening and treatments now allow bed until they grow large enough for a
heart with a stethoscope, a care provider Most of the other signs and symp- many children with cystic fibrosis to live regular infant car seat.
may detect a distinctive heart murmur. toms of cystic fibrosis affect the respira- into their 50s or even longer.
Additional Resources
If you’re looking for additional information on a particular topic, you may find
the following resources helpful.
AMERICAN ACADEMY OF PEDIATRICS MAYO CLINIC HEALTH INFORMATION NATIONAL DOWN SYNDROME SOCIETY PATHWAYS.ORG
847-434-4000 www.MayoClinic.com 800-221-4602 800-955-2445
www.aap.org www.ndss.org www.pathways.org
NATIONAL CAPITAL POISON CENTER friends@pathways.org
CENTERS FOR DISEASE CONTROL AND Poison Help hotline: 800-222-1222 NATIONAL FATHERHOOD INITIATIVE
PREVENTION www.poison.org 301-948-0599 U.S. CONSUMER PRODUCT SAFETY
800-232-4636 www.fatherhood.org COMMISSION
www.cdc.gov NATIONAL CENTER FOR FATHERING 800-638-2772
800-593-3237 NATIONAL INSTITUTE OF CHILD HEALTH www.cpsc.gov
CHILD CARE AWARE www.fathers.com & HUMAN DEVELOPMENT
800-424-2246 800-370-2943 U.S. FOOD AND DRUG ADMINISTRATION
www.childcareaware.org NATIONAL CENTER ON BIRTH DEFECTS www.nichd.nih.gov 888-463-6332
AND DEVELOPMENTAL DISABILITIES www.fda.gov
INTERNATIONAL LACTATION 800-232-4636 NATIONAL ORGANIZATION OF MOTHERS
CONSULTANT ASSOCIATION www.cdc.gov/ncbddd OF TWINS CLUBS INC.
919-861-5577 248-231-4480
www.ilca.org NATIONAL DISSEMINATION CENTER www.nomotc.org
FOR CHILDREN WITH DISABILITIES
LA LECHE LEAGUE INTERNATIONAL 800-695-0285 NATIONAL WOMEN’S HEALTH INFORMATION
800-525-3243 nichcy.org/families-community/new-to- CENTER BREASTFEEDING HELPLINE
www.llli.org disability 800-994-9662
www.womenshealth.gov/breastfeeding
552 ADDITIONAL RESOURCES ADDITIONAL RESOURCES 553

laughter, 261
Index
items and products, 90–91
location, 90 moments, 26
month 4, 262 month 1, 231
A books of, 303 orientation to, 89 bottle-feeding
acne, 28, 99, 100 stuffed, 290 rinsing, 95 amount, 65
activity antibiotics, 83, 85 safety, 91–93 bottles, 60
high, 139 aortic stenosis, 548 soap, 90 breast-feeding vs., 43–44
physical, 270 Apgar scores, 32 step-by-step, 93–94 formulas, 60–65
as temperament aspect, 136 appearance, 265–269 towels, 91 multiples, 496–497
adaptability month 1, 221–224 toys, 91 nipples, 61
high, 140 month 2, 233–234 tub, 94 positions, 64–65
slow, 141 month 3, 243–245 uncircumcised penis, 97 pros versus cons, 59
as temperament aspect, 137 month 4, 255–257 washcloths, 90 supplies, 59
working with, 140, 141 month 5, 265–269 washing, 93, 95 vitamin D and, 65
adopted baby, 481–491 month 6, 277–279 water, 90 weaning, 65
adjustment time, 484 month 7, 287–288 bathroom safety, 201 bouncing, 269–270, 283
bonding with, 484–487 month 8, 297–299 baths bowel movements (mother), 410
breast-feeding, 487 month 9, 307 play, 96 breaks, mom and dad, 418–419
care provider, 481–482 month 10, 317 preparing for, 91 breast milk
developmental delays, 483–484 month 11, 327 sponge, 89–90 containers, 53–54
developmental stage, identifying, 486 month 12, 337–338 temperature, 91–92, 94 donor, 506
difficult remarks, handling, 490–491 newborns, 29–32 types of, 89–90 expiration, 55
family story sharing with, 487–489 premature babies, 505 batting, 248 mother ingestion and, 46
health support, 481–484 appointments, scheduling, 152 bed sharing, 116 optimizing production, 496
immunizations and, 482 aspirin, 349 bedding, 119 production, 46
international, 484 assertiveness, 334 bedtime sticking with, 67
learning about, 485–486 asthma, 356–357 drowsy baby at, 116 storing, 53–55
medical history, 482 atrial septal defect, 548 routine, 115, 256–257 thawing, 55
needs, responding to, 485 attachment, 274 settle down time, 116 breast pumps, 53
parent attitude toward, 488 attention, wanting, 252 See also sleep (baby) breast-feeding
parenting, 491 autism, vaccines and, 161–163 behavior adopted baby, 487
post-adoptive care, 482–483 Down syndrome baby, 531 amount, 51–52
self-care and, 486 B status, at checkup, 156 antibodies, 44
siblings and, 489 babies with special needs, 177 surprising, 135 baby mouth opening and, 49–50
support, 484 baby blues, 411–413 bending, 340 basics, 49–52
truth, telling, 490 Baby Einstein, 292 bilingual babies, 332 benefits for baby, 44–45
advice, 403–404 back pain (mother), 409 biotinidase deficiency, 39 benefits for mother, 45
air bags, 192 backyard safety, 202 birthmarks, 28–29, 31, 223 bottle-feeding versus, 43–44
air travel basement safety, 201 bites comfort, 50
airports, 194 bathing animal/human, 214–215 cradle-clutch combination, 494–495
baby happiness during, 194–195 attentiveness, 92–93 insect, 376–378 cradle hold, 48–49
boarding, 194 baby-care products, 92 bleeding, emergency care, 209–210 cross-cradle hold, 48
identification, 193 baby preparation, 93 blood digestion, 44
safety, 193 basics, 89–90 disorders, 535–537 double clutch, 494
seat safety, 194–195 circumcised penis, 97 in stools, 83 drawbacks, 45
See also traveling creases and folds, 93, 95 body language, 230 football (clutch) hold, 49, 50
allergies, 354–355 crying and, 95 bonding frequency, 50–51
ambiguous genitalia, 546 drying, 93 adopted baby, 484–487 lactation consultants, 47
anemia, 355–356, 535–536 eyes, 93 baby, 25–26 length, 51
animals frequency, 89 couples, 433–434 as long as possible, 245–246
bites, 214–215 illustrated, 94–95 dads/partners, 428–429 managing siblings during, 454
554 INDEX INDEX 555

breast-feeding continued adopted baby, 481–482 factors to consider, 176–177 one-piece outfits, 109
multiples, 494–496 bedside manner, 148 family, 174–175 one-piece undershirts, 109
positions, 47–49 budget, 147 getting started with, 173–174 pajamas, 109
pumping breasts, 53–55 choosing, 145–146, 149 grandparents as providers, 457–459 safety, 108
side-lying hold, 49, 50 contacting with sick baby, 352 in-home, 174 shopping tips, 107–108
simultaneous, 495–496 examination after birth, 145–146 in home vs. job decision, 462–463 sizes, 107–108
starting, 46–47 family physicians, 146 information after, 181 socks, 110
supplies for, 47 finding, 145–149 options, 174–180 stains, 111
support, 52 information about,, 149 providers, 180–181 summer hat/cap, 110
vitamin D and, 52 knowledge, 148 by relative or friend, 176 for traveling, 195
weaning, 57–59 nurse practitioners, 146–147 resources, 174 where to start, 108–110
when to begin, 47 office atmosphere, 148 reviewing, 181 winter wear, 110
working and, 54 options, 146–149 separation, handling, 179 clubfoot, 545
breasts pediatricians, 146 for sick children, 178 coarctation of the aorta, 548
blocked milk ducts, 57 personal approach, 147 single parents, 444–445 cognitive skills, 156
care, 56–57 philosophy and style, 149 child care centers, 175–176, 179–180 colds, 359–362
in childbirth/labor recovery, 408 recommendations, 148 child obesity, 71, 244–245 colic
fullness, 56–57 role importance, 149 child rearing, agreeing on, 439 causes, 129
infection, 57 team approach, 149 childbirth/labor recovery common signs, 129
nipple discomfort, 57 training, 147, 148 baby blues/depression, 411–413 defined, 128–130
breathing caressing, 127 back pain, 409 diagnosis, 130
in CPR, 212–213 central nervous system disorders, bathroom woes, 409–411 from food sensitivities, 129
disorders, 537–539 539–541 bowel movements, 410 from immature nervous system, 129
noisy, 114 cereal, baby, 70 breasts and, 408 managing, 130–132
bronchiolitis, 358–359 cerebral palsy, 539–540 demands and, 407–408 motion and, 132
bronchopulmonary dysplasia, 537–538 chaos, comfortability with, 401–402 hair and skin changes, 411 from temperament, 129
bumper pads, 123 checkups hemorrhoids, 410–411 tummy hold for, 131
burns, 203, 213–214 appointment scheduling, 152 period return, 409 comforting, 127–128, 165
attending, 151–152 urination problems, 409–410 communication, 229–230, 249–251, 323
C behavior, 156 vagina, 408–409 concentrated liquid formulas, 61
cafe au lait spot, 29, 30 development, 155–156 childproofing, 197, 314, 341 congenital adrenal hyperplasia (CAH), 39
calming techniques, 131–132, 133 Down syndrome baby, 528 choking, 200–201, 210–211 congenital hypothyroidism, 39
car seats, 187–192 head-to-toe physical exam, 152–154 circumcision congenital nevus, 29, 30
air bags and, 192 measurement, 152 benefits, 37 constipation, 363–364
convertible, 188, 189 medical records, 157 care, 38–39, 97 contact dermatitis, 102
expiration dates, 189 nutrition information, 155 how it’s done, 38 contact information, 180
front-facing position, 191 premature baby, 515 illustrated, 38 conversation, 290, 322
grandparents and, 459 questions and concerns, 157 issues, 36–38 convertible car seats, 188, 189
infant-only, 188, 190 safety, 157 risks, 37–38 cooing, 237–238
installing, 189–192 schedule of, 151–152 washing and, 97 cord blood banking, 33
models, 188 sleeping status, 155 clapping games, 313 core, strengthening, 415
for older children, 191 vaccinations, 156–157 cleft lip and cleft palate, 544 cotton balls, 91
preemies/small babies and, 192 visit expectations, 152–157 cloth diapers, 76, 85 coughs, 348, 361, 362–363
rear-facing position, 190–191 See also care providers clothes couples
sleeping in, 190 chickenpox vaccination, 162–163 after bathing, 91 bonding, 433–434
in travel systems, 187 child care cost, 108 challenges of, 434–435
used, 189 amount to spend determination, 173 detergents, 111 changing roles, 435
when to purchase, 187 for babies with special needs, 177 dress wear, 109–110 child-rearing agreement, 439
cardiopulmonary resuscitation. See CPR budgets, 177 dressing for weather and, 110 communication, 437
care providers contact information and, 180 ease, 108 division of labor, 434
accessibility and hours, 147, 148 expectations, 177 fabric, 108 expectations, 437
556 INDEX INDEX 557

couples continued letting, 128 discarding diaper, 81 early intervention, 531–533
less time as, 434–435 from loneliness, boredom, fear, 126 dry clothes and, 77 gastrointestinal problems, 530
nurturing, 437 newborn statistics, 125 drying, 80 getting to know, 526
parenting as, 433–439 from overstimulation/overtiredness, 126 equipment, 77–79 growth, 528
responsibilities, 436 predictable episodes, 129 frequency, 79 health, 528–531
sharing load, 435–437 quiet and, 128 gel-like materials, 83 hearing problems, 528–529
stresses, 435 reasons for, 125–126 girls, 79–80 heart problems, 529
cow’s milk formulas, 61 response to, 133 illustrated, 80 joint problems, 530–531
CPR (cardiopulmonary resuscitation) singing/music and, 128 mindset, 79 learning of, 525
airway, 212 state of consciousness, 230 new diaper placement, 80–81 milestones, 527
breathing, 212–213 cuddling, 26 ointment, 79 obstructive sleep apnea, 531
for choking, 211 cups, 73, 299 old diaper removal, 79 occupational therapy, 533
circulation, 212 curiosity, 139, 294 pink/small blood stains, 83 physical therapy, 532
defined, 211 curl-ups, 417 preparation for, 79 routine with, developing, 526–527
for drowning, 216 cystic fibrosis, 39, 550–551 process, 79–81 sleeping, 527–528
illustrated, 212 small crystals, 83 speech and language therapy, 532–533
procedure, 212–213 D station, 77 support system, developing, 533
for unconsciousness, 214 dads/partners, 423–431 surprises, 83 thyroid problems, 529–530
when to perform, 211–212 bonding, 428–429 umbilical cord stump and, 81 vision problems, 529
cradle cap, 99–102 care uncertainty, 425–426 washing up after, 81 drool rash, 102
cradle hold, 48–49 child care, 444–445 wipes, 77, 78 drop-side cribs, 121
crawling, 307–308, 328 common concerns, 425 diaper pails, 79 drowning, 205–207, 215–216
cribs financial responsibility, 426–427 diaper rash, 84–87 DTaP vaccine, 167
bedding, 119 help, asking for, 431 diapers
bumper pads, 123 partner’s moods and, 429–430 amount of, 77 E
corner posts, 121 reduced attention, 427 breast-feeding and, 52 ears
drop-side, 121 role in baby development, 426 checking when crying, 127 infection, 367–368
hardware, 121 romance, rekindling, 431 cloth, 76, 85 physical exam, 153
mattress, 119, 123 shifting roles, 424 discarding, 81 wax blockage, 368–369
paint, 121 single, 443 disposable, 75–76, 85 eating
safety, 120–123, 199 stay-at-home, 425 equipping with, 77 habits, establishing, 298–299
slat spacing, 121 support, 427, 444 sizes, 76–77 month 1, 224
sleep positioners, 123 supporting role, 423 swim, 77 month 2, 235
toys and, 123 time for yourself, 431–432 types of, 75–77 month 3, 245
cross-cradle hold, 48 work-life balance, 427–428 diarrhea, 83, 366–367 month 4, 257
croup, 365–366 dance, with baby, 26 digestive disorders, 541–543 month 5, 267
cruising, 329 delayed development, 156, 517–523 diphtheria vaccination, 163 month 6, 279
crying causes, 521 discipline, 293 month 7, 289
baby movement and, 128 defined, 517–520 discomfort month 8, 298–299
baby sucking and, 128 diagnosing, 521–522 comforting, 127 month 9, 309
caressing and, 127 identification of, 520 crying from, 125–126 month 10, 319
checking diapers and, 127–128 outgrowth of, 520 disposable diapers, 75–76, 85, 199 month 11, 329
from colic, 128–130 services offered for, 523 distractibility, 138, 141 month 12, 339
comforting, 127–128 support and, 523 distraction trick, 128 newborn problems, 35
cry types, 126–127 typical development versus, 518 distractions, 263 overfeeding, avoiding, 298–299
from discomfort, 126, 127 what can be done for, 522–523 donor breast milk, 506 eczema, 101, 102
distraction trick, 128 depression, postpartum, 412–413 Down syndrome baby, 525–533 electrical shock, 214
help, asking for, 133 development, 153, 155–156 behavioral problems, 531 emergency care, 209–219
from hunger, 125–126, 127 diaper changing blood cell problems, 531 animal/human bites, 214–215
intense/inconsolable, 129 boys, 81 carrying, 528 bleeding, 209–210
keeping your cool with, 133 cleaning baby’s bottom, 79–80 checkups, 528 burns, 213–214
558 INDEX INDEX 559

emergency care continued bottle, 59–65 cow’s milk, 61 relationships with, 454–455
choking, 210–211 breast, 44–59 digestibility, 60 role, 454
CPR, 211–213 breast versus bottle, 43–44 as energy-dense food, 60 time, giving, 455
deep wounds, 215 changes, planning for, 250 feeding with, 64–65 grasp reflex, 226
drowning, 215–216 choking prevention, 200–201 forms, 61–62 grasping, 259–260, 269
electrical shock, 214 combined breast-/bottle-feeding, generic versus name brand, 62 growth
inhaled poison, 217–219 495–496 hand-washing before preparing, 63 Down syndrome baby, 528
injuries from falls, 216 on cue, 66 ingredients, 62 month 1, 221–224
poison, 219 flexibility, 66–67 measuring, 63 month 2, 233–234
swallowed poison, 216–217 mealtime supervision, 200 outdated, 62 month 3, 243–245
when to seek, 209 multiples, 493–497 powdered, 61 month 4, 255–257
empowerment, art of, 292 pace, baby as setting, 66 preparation of, 62–64 month 5, 265–269
erythema toxicum, 28, 99, 100 positions, breast-feeding, 47–49 protein hydrolysate, 61 month 6, 277–279
esophageal atresia, 542 premature baby, 513 ready-to-use, 62 month 7, 287–288
exercise safety, 200–201 soy-based, 61 month 8, 297–299
core, strengthening, 415 sleepy baby, 117 sticking with, 67 month 9, 307
fitting into schedule, 414 solids introduction, 69–73 storing, 64 month 10, 317
Kegel, 418 spitting up and, 67–69 types of, 60–61 month 11, 327
safety, 414 style, changing, 130–131 warming, 64 month 12, 337–338
in stress release, 404 tips, 65–67 weaning from, 65 premature babies, 507
tips, 414 fever, 348, 369–372 See also bottle-feeding spurts, 222
See also childbirth/labor recovery fifth disease, 372 friendships, shifting, 419–420 gurgling, 237–238
expectations, 23, 437 finances, 462, 472–473 front yard safety, 202
eyedrops, 380, 381 fingers fruits, 70, 268 H
eyes deformities, 545–546 frustration, 141, 143, 314 hair
bathing, 93 foods, 70–71, 311 furniture bumpers, 202 changes (mother), 411
crossed, 364 skills, 329 month 1, 224
lazy, 379–380 fire safety, 203 G newborns, 32
newborns, 29–32 first days. See newborns galactosemia, 39–41 hand-foot-and-mouth disease, 373–374
physical exam, 153–154 first examination, 32–34 games. See toys and games hands
poison in, 219 flu (influenza), 164–165, 372–373 garage safety, 201 favoring, 281
protection, 34 fluids gastroesophageal reflux (GER), 69, 382 finger coordination, 288–289, 300
teary, 390–391 for colds, 360 gastrointestinal problems month 3, 246
for fever, 370 Down syndrome baby, 530 mother, washing, 362
F in stress release, 404 premature babies, 508–509 skills, month 9, 309–310
fabric, clothing, 108 fontanels, 27 genital disorders, 546–547 harnesses, 500
facial and extremity disorders, 543–546 foods genitalia, 154, 224 hats/caps, 110
failure to thrive, 155 balance of, 298 German measles vaccination, 163 head
falls finger, 311 germs, preventing spread of, 352 month 1, 222–223
injuries from, 216 fruits and vegetables, 268 giggling, 248, 251 month 2, 233–234
preparing for, 320 high-risk, avoiding, 200 gonorrhea eye infections, 34 newborns, 26–27
preventing, 203–204 new, introduction of, 84 grandparents physical exam, 153
seriousness of, 216 not using as pacifier, 245 car seats and, 459 head lifts, 417
familiarity, 236 for nutrition, 299 as child care providers, 457–459 health information, maintaining, 157
family child care, 174–175, 178 sensitivities, 129 at a distance, 458 healthy diet (mother), 414
family life, 315 variety, 298 education classes, 459 hearing
family physicians, 146 See also solid foods help, receiving, 455–456 Down syndrome baby, 528–529
fears, 126, 335 football (clutch) hold, 49, 50 holidays and, 457 month 3, 247
febrile seizures, 371 formulas letting go of the past and, 456 month 4, 260
feeding adding water to, 63–64 name preferences, 457 month 5, 271
as bonding times, 67 concentrated liquid, 61 opinions, conflicting, 456–457 month 6, 281
560 INDEX INDEX 561

hearing continued frequency, 347 K infants and, 348–349
month 9, 311 hand-foot-and-mouth disease, Kegel exercises, 418 precautions, 348–349
month 10, 319 373–374 kitchen safety, 199–200 using wisely, 352
month 11, 330 hives, 374–375 kneeling pelvic tilt, 416 medium-chain acyl-CoA dehydrog-
premature babies, 510 impetigo, 375–376 enase (MCAD) deficiency, 41
screening, 41 insect bites and stings, 376–378 L memory pathways, 249
heart jaundice, 378–379 language skills mental development
disorders, 548–550 lazy eye, 379–380 bilingual babies, 332 month 1, 228–230
physical exam, 154 medications and, 348–349 at checkup, 156 month 2, 237-238
heights, awareness of, 203 pink eye (conjunctivitis), 380–381 exposure to language and, 322 month 3, 249–251
hemangioma, 29, 31 pneumonia, 382 month 4, 261 month 4, 261–262
hemorrhoids (mother), 410–411 reflux, 382–384 month 5, 272 month 5, 271–272
hepatitis A vaccination, 164 roseola, 385–386 month 8, 302 month 6, 282–284
hepatitis B vaccination, 34, 164 RSV (respiratory syncytial virus), month 9, 312–314 month 7, 290–292
hernias, 35–36, 96–97 384–385 month 12, 344 month 8, 301–302
Hib disease, 164 stomach flu (gastroenteritis), language therapy, Down syndrome month 9, 312–314
high chair, 291 386–388 baby, 532–533 month 10, 320–322
hip dysplasia, 546 sty, 388 laughter, 251, 261–262 month 11, 331-332
Hirschsprung’s disease, 542 sunburn, 388–389 lazy eye, 379–380 month 12, 342–344
hives, 374–375 swollen scrotum (from a hydrocele), lead poisoning prevention, 204 milestones
home versus job decision, 461–469 389–390 leg slides, 416 Down syndrome baby, 527
career consequences, 462 teary eyes, 390–391 legs and feet, 224, 246 month 1, 231
child care, 462–463 teething, 391–392 limits, consistent and firm in, 294 month 2, 241
finances, 462 thrush, 392–393 listening, 330, 331, 341–342 month 3, 253
issues, 461–463 urinary tract infection, 394–395 low blood sugar, 536–537 month 4, 263
living with, 463–464 vomiting, 395–396 lungs, physical exam, 154 month 5, 275
re-evaluating, 466 whooping cough, 396–397 month 6, 285
stresses and rewards, 463 See also newborn conditions M month 7, 295
homocystinuria, 41 immune system, functioning of, 160 maple syrup urine disease (MSUD), 41 month 8, 305
hunger, 125–126, 127 imperforate anus, 542 meals month 9, 315
hydrocele, 389–390, 546 impetigo, 101, 102–104, 375–376 expectations, 267 month 10, 325
hydrocephalus, 540 inactivated polio vaccine (IPV), 166 exploration, 73 month 11, 335
hypospadias, 547 infant jaundice, 223 happy time, 267 month 12, 345
infant-only car seats, 190 managing, 73 milia, 28, 99, 100
I infection, in newborns, 35 patience, 267–268 milk ducts, blocked, 57
illnesses/conditions inguinal hernias, 35–36 spoon use, 267 mimicking
allergies, 354–355 inhaled poison, 217–219 success tips, 266–268 games, 262
anemia, 355–356 in-home child care, 174, 178 See also foods; solid foods month 10, 324
asthma, 356–358 insect bites and stings, 376–378 measles vaccination, 165 toys, 321
bronchiolitis, 358–359 instincts, trusting, 22 measurements mirrors, 273, 303
caring for, 351–353 intensity, 137, 140 at checkup, 152 mobile walkers, advice against, 270
cold, 359–362 international adoptions, 483 first examination, 32–34 mobiles, 123, 236
constipation, 363–364 intestinal blockage, 542–543 premature babies, 153 moisturizers, 91
cough, 362–363 intimacy, maintaining, 420–421 meat, pureed, 70 month 1
crossed eyes, 364 intrauterine growth restriction (IUGR), meconium aspiration, 537–538 appearance, 221–224
croup, 365–366 511, 551 medical records, 157 body language, 230
diarrhea, 366–367 irregular body rhythms, 140 medications bonding, 231
ear infection, 367–368 cough and congestion, 348, 361 breasts and genitalia, 224
earwax blockage, 368–369 J dosing, 348 communication, 229–230
fever, 369–372 jaundice, 34, 223, 378–379 fever and pain, 348 crying, 229
flu (influenza), 372–373 juices, 71, 245 giving, 349 eating, 224
562 INDEX INDEX 563

month 1 continued month 4 movement, 279–280 eating, 309
growth, 221–224 appearance, 255–257 picking up and letting go, 280 growth, 307
hair, 224 bedtime routine, 256–257 playing, 282–284 hand skills, 309–310
head, 222–223 crying, 257 sensory development, 281 language and understanding, 312–314
legs and feet, 224 distractions, 263 size/weight chart, 278 mental development, 312–314
mental development, 228–230 eating, 257 sleeping, 279 milestones, 315
milestones, 231 growth, 255–257 social development, 284–285 movement, 307–310
movement, 225–226 head and back control, 258 teeth, 277–279 sensory development, 310–311
reflexes, 226 language skills, 261 toe discovery, 280 sitting, 308–309
sensory development, 227 laughing, 261–262 toys and games, 283 size/weight chart, 308
size/weight chart, 222 mental development, 261–262 tripod sitting, 280 sleeping, 309
skin, 223 milestones, 263 month 7 social development, 314–315
sleeping, 224 movement, 257–260 appearance, 287–288 standing, 308
smiles, 231 reaching and grasping, 259–260 conversation, 290 toys and games, 313
social development, 230–231 rolling over, 258–259 eating, 289 month 10
toys and games, 228 sensory development, 260 empowerment, 292 appearance, 317
umbilical cord, 224 size/weight chart, 256 growth, 287–288 conversation, 322
month 2 sleeping, 257 hand and finger coordination, 288–289 eating, 319
appearance, 233–234 social development, 262–263 mental development, 290–292 eyeing mom and dad, 325
cooing and gurgling, 237–238 standing, 259 milestones, 295 first words, 320–322
crying, 238 stranger anxiety, 263 movement, 288–289 growth, 317
eating, 235 toys and games, 262 sensory development, 289–290 mental development, 320–322
fits and stops, 234 month 5 sitting, 288 milestones, 325
growth, 233–234 appearance, 265–269 size/weight chart, 288 mimicking, 324
mental development, 237–238 attachment, 274 sleeping, 289 movement, 317–319
milestones, 241 bouncing, 269–270 social development, 293–295 nonverbal communication, 322
movement, 234–235 eating, 267 stranger anxiety, 293 picking up, pointing, poking, 318–319
sensory development, 237 growth, 265–269 toys and games, 291 pulling to sit, 318
size/weight chart, 234 language skills, 272 month 8 pulling to stand, 318
sleeping, 235 learning how things work, 272 appearance, 297–299 sensory development, 319–320
smiles, 241 mental development, 271–272 attaching meaning, 301 sharing, 324
social development, 239–241 milestones, 275 baby sign language, 302 size/weight chart, 318
toys and games, 236 movement, 269–270 eating, 298–299 sleeping, 319
month 3 personality, 274–275 getting around, 300 social development, 324–325
appearance, 243–245 physical activity encouragement, 270 growth, 297–299 toys and games, 321
attention, desire for, 252 reaching and grasping, 269 hand and finger coordination, 300 month 11
communication, 249–251 rolling over, 269 language skills, 302 appearance, 327
eating, 245 sensory development, 270–271 mental development, 301–302 assertiveness, 334
giggling/laughing, 251 size/weight chart, 266 milestones, 305 crawling, 328
growth, 243–245 sleeping, 267 movement, 300 cruising, 329
hands and arms, 246 social development, 272–275 object permanence, 301 eating, 329
legs and feet, 246 solid food introduction, 265–269 sensory development, 301 fears, 335
memory pathways, 249 toys and games, 273 separation anxiety, 304–305 finger skills, 329
mental development, 249–251 month 6 sitting, 300 growth, 327
milestones, 253 appearance, 277–279 size/weight chart, 298 milestones, 335
movement, 245–246 babbling, 284 sleeping, 299 movement, 328–329
sensory development, 247 eating, 279 social development, 302–305 sensory development, 330–332
size/weight chart, 244 growth, 277–279 toys and games, 303 size/weight chart, 328
sleeping, 245 hands, favoring, 281 month 9 sleeping, 329
social development, 251–252 mental development, 282–284 appearance, 307 social development, 332–335
toys and games, 248 milestones, 285 crawling, 307–308 standing, 328–329
564 INDEX INDEX 565

month 11 continued month 10, 317–319 nonverbal communication, 323 physical activity, 270
toys and games, 333 month 11, 328–329 nurse practitioners, 146–147 physical development, 419, 518
vocabulary, 331–332 month 12, 338–341 nursery rhymes, 313 physical exams, 153–154
month 12 multiples, 496 nursery safety, 197–199 physical therapy, Down syndrome baby, 532
appearance, 337–338 bottle-feeding, 496–497 nursing. See breast-feeding picking up, 280, 318–319
eating, 339 breast-feeding, 494–496 nurturing, 437 pink eye (conjunctivitis), 380–381
growth, 337–338 bulk buying for, 499 nutrition play development, typical, 518
hand and finger skills, 341 caring for, 493–501 information at checkup, 155 playing, 282–284
language skills, 344 combined breast-/bottle-feeding, mother, 55–56 playtime safety, 259
mental development, 342–344 495–496 premature baby, 506 pneumococcal disease vaccination,
milestones, 345 help and support with, 501 weaning and, 59 165–166
movement, 338–341 logistics, 499–500 pneumonia, 382
relationship with others, 345 one-on-one time, 498–499 O pneumothorax, 538
saying no, 345 overwhelming demand of, 493 occupational therapy, Down syndrome pointing, 318–319
sensory development, 341–342 parenting strategies, 499 baby, 533 poison
sitting, 338 raising, as strong individuals, 497–499 ointment, 79, 85, 381 in eyes, 219
size/weight chart, 338 rest and, 500 opposite-sex role models, 447 inhaled, 217–219
sleeping, 339 self-care with, 500–501 outlets/electrical cord safety, 202 on skin, 219
social development, 344–345 siblings and, 454 overfeeding, avoiding, 298–299 swallowed, 216–217
stairs, 340 mumps vaccination, 165 overstimulation/overtiredness, crying Poison Help hotline, 216, 217, 219
standing and bending, 340 music, 26, 128, 273 from, 126 poking, 318–319
tantrums, 344–345 polio vaccination, 166
N P
thinking complexity, 342 polycythemia, 537
nail care, 98 pacifiers, 116, 119, 225
toys and games, 343 pool safety, 205–207
naps, 114, 115 pain relievers, 370
understanding, 344 port-wine stain, 29, 31
neonatal intensive care unit (NICU), pajamas, 109
walking, 340 postpartum depression, 412–413
503, 504–505, 511 parenting
mood, 137 powdered formulas, 61
newborn conditions adopted baby, 491
mothers premature babies, 503–515
blood disorders, 535–537 as adventure, 23
diet, changing, 131 appearance, 505
breathing disorders, 537–539 chaos and, 401–402
giving time to, 429 blood concerns, 509
central nervous system disorders, enjoying, 399–405
health, 56–57, 431 brain concerns, 508
539–541 foundation as a couple, 439
moods, dad’s/partner’s understanding breathing concerns, 508
digestive disorders, 541–543 multiples, 499
of, 429–430 bringing home, 512–515
disorders, other, 550–551 new-baby stress, 404–405
pampering, 430 car seats and, 192
facial and extremity disorders, 543–546 role adjustment, 403–404
See also self-care care requirements, 512–513
genital disorders, 546–547 single, 441–447
motion caring for, 505–507
heart disorders, 548–550 skill development, 143
colic and, 132 checkups, 515
newborns sleep and, 399–401
sickness, 192 condition and care, 505–506
birthmarks, 223 support, 404, 405
motor skills, 155–156 corrected age, 510
bonding, 25–26 as team, 433–439
mouth, physical exam, 154 definitions, 504
circumcision, 36–39 temperament and, 141–143
mouthing, 260 dental concerns, 510
first examination, 32–34 welcome to, 21–23
movement development, 153
issues, 34–35 parents, connecting with, 404, 420
in comforting, 128 feedings, 513
looks, 26–32 patent ductus arteriosus, 548–549
month 1, 225–226 future issues, 510–511
screening tests, 39–41 patience, fostering, 23
month 3, 245–246 gastrointestinal concerns, 508–509
strollers and, 186–187 pediatricians, 146
month 4, 257–260 growth and development, 507
temperament in, 138 peekaboo, 284, 303
month 5, 269–270 health issues, 507–511
vaccinations, 166 persistence, 138, 139
month 6, 279–280 hearing concerns, 510–511
night lights, 204 personality, emerging, 274–275
month 7, 288–289 heart concerns, 508
nipples, bottle-feeding, 60 pets, safety around, 205
month 8, 300 help with, 512
no, saying, 345 phenylketonuria (PKU), 41
month 9, 307–310 illness, protecting against, 513–515
566 INDEX INDEX 567

premature babies continued S short interval between pregnancies, 475 introducing your new baby, 449–450
intermediate care, 511 safety, 197–207 social pressures, 473–474 listening to, 453
measurement, 153 air travel, 193 thinking in reverse, 474 multiples and, 454
medical team for, 506 airplane seat, 193–194 timing, 475–476 reactions, 450–452
metabolic concerns, 509 baby carrier, 185–186 two to five years apart, 477 rivalry, 452–453
NICU, 503, 504, 505 basement, 201 when to have, 471–479 safety hazards, 453
nutrition, 506 bathroom, 201 self-care, 407–421 school-age, 451
reasons for, 503–504 burn prevention, 203 adopted baby and, 487 sick newborns and, 450
rehospitalization, 513 caution and, 207 breaks, 418–419 sick babies
self-care, 511–512 child care centers, 180 care provider, calling, 410 caring for, 347, 351–353
separation from, 507 childproofing and, 197 childbirth/labor recovery, 407–411 child care and, 178
siblings and, 511–512 clothing, 108 exercise, 414–418 comforting, 352
SIDS, 510 crib, 120–123, 199 friendships and, 419–420 fluids, 352
transporting, 507, 513 exercise, 414 getting back into shape, 413–418 rest, 352
vaccinations, 168 exploration, 315 healthy diet, 414 siblings and, 450
vision concerns, 509–510 fall prevention, 203–204 importance of, 23 temperature, taking, 350–351
vulnerable child syndrome, 515 feeding, 200–201 with multiples, 500–501, 511–512 sickle cell disease, 41
probiotics, 83 fire, 203 out of the house, 418–419 side-lying hold, 49, 50
protein hydrolysate formulas, 61 front yard/backyard, 202 pampering, 419 SIDS. See sudden infant death syndrome
pulmonary stenosis, 549 garage, 201 romance, 420–421 sign language, baby, 302
pumping breasts, 53–55, 496 hazardous objects/substances, 199, 201 single parents, 445 silly songs, 321
push toys, 333 kitchen, 199–200 weight return, 413 singing, to baby, 26, 128, 484
pustular melanosis, 28, 99, 101 lead poisoning prevention, 204 sensitivity, 137, 141 single parents, 441–447
pyloric stenosis, 543 nursery, 197–199 sensory development challenges of, 441
pet, 205 month 1, 227 dads, 443
Q playtime, 259 month 2, 237 emotional struggles, 443
quietness, 128, 140 shopping cart, 186 month 3, 247 family life stability, 445
status, at checkup, 157 month 4, 260 family time priority, 445–446
R financial issues, 442
straps, 197 month 5, 270–271
rapid eye movement (REM), 114
stroller, 187 month 6, 281 opposite-sex role models, 447
rashes, 256
tips, 202–203 month 7, 289–290 organization, 447
RDS (respiratory distress syndrome),
toy, 198 month 8, 301 pathways to becoming, 441
538–539
vaccine, 161–163 month 9, 310–311 positive attitude, 447
reaching, 259–260, 269, 283
water, 205–207 month 10, 319-320 rewards and strengths, 447
reading, to baby, 26
salmon patches, 28, 31 month 11, 330–332 routines, 445
ready-to-use formulas, 62
scheduling appointments, 152 month 12, 341–342 self-care, 445
reflexes, 226
screening tests, 39–41 separation, child care, 179 support issues, 443
reflux, 67, 382–384
second child separation anxiety, 8, 304–305 work and pressure of, 441–443
regularity, 136–137
career impact, 473 sex, having, 420, 421 work issues, 442
relative/friend child care, 176
deciding on, 471–474 sharing, 324 sitting
respiratory distress syndrome (RDS),
family dynamics, 473 shoes, 330 month 7, 288
538–539
family issues, 476–479 shopping cart safety, 186 month 8, 300
rest, mother, 56
finances and, 472–473 shoulder lifts, 417 month 9, 308–309
rolling, 248, 258–259, 269
five years or more apart, 477–478 siblings month 12, 338
romance, rekindling, 420–421, 431
health issues and, 475–476 adopted baby and, 489 pulling for, 318
rooting reflex, 226
long interval between pregnancies, age 2 and under, 450–451 size/weight charts
roseola, 385–386
475–476 ages 2 to 4, 451 month 1, 222
rotavirus vaccination, 167
mother age and, 479 all children, 451 month 2, 234
routines, 445
one to two years apart, 476–477 comparisons, avoiding, 453 month 3, 244
RSV (respiratory syncytial virus),
partner preferences, 472 gentleness, teaching, 452 month 4, 256
384–385
responsibilities, 471–472 ground rules, 453 month 5, 266
568 INDEX INDEX 569

size/weight charts continued month 11, 329 not introducing too soon, 200 T
month 6, 278 month 12, 339 off-limits, 71–72 tantrums, 344–345
month 7, 288 naps, 114, 115 pureed meat, vegetables and fruits, 70 taste, 227, 247
month 8, 298 night versus day, 114 stools and, 269 teary eyes, 390–391
month 9, 308 noisy breathing, 114 taste and texture, 70–71 teeth
month 10, 318 overheating baby and, 119 soy-based formulas, 61 caring for, 279
month 11, 328 pacifiers, 116 speech development, typical, 518 first, 391
month 12, 338 position, 117–118, 459 spina bifida, 540–541 formation, 391
skin rapid eye movement (REM), 114 spitting up, 67–69 month 6, 277–279
changes (mother), 411 schedule, 113–114 spoiling, 26, 238 teething
month 1, 223 setbacks, 116–117 sponge baths, 89–90 recognizing, 391
month 2, 234 settle down time, 116 spoons, 267, 310 seriousness of, 391
newborns, 27–28 states of consciousness, 230 stairs, getting up/down, 340 signs and symptoms, 277–278
physical exam, 154 status, at checkup, 155 standing, 259, 308, 318, 328–329, 340 tips for soothing, 278–279, 391–392
poison on, 219 sudden infant death syndrome (SIDS) startle reflex, 226 See also illnesses/conditions
sunscreen, 103 and, 117–118 states of consciousness, 230 temperament
skin conditions tips, 115–117 stay-at-home dads (SAHDs), 425 activity, 136, 139
acne, 99, 100 trouble, 117 stepping reflex, 226 adaptability, 137, 140
common, 98–105 sleep (parents), 399–401 sties, 388 as colic cause, 129
contact dermatitis, 102 sleep positioners, 123 stimulation, 285, 315 curiosity, 139
cradle cap, 99–102 sleepy baby, feeding, 117 stomach flu (gastroenteritis), 386–388 distractibility, 138, 141
eczema, 101, 102 smell, 227, 247 stools, 82–84, 269 frustration, 140
erythema toxicum, 99, 100 smiles, 231, 241 stranger anxiety, 263, 293 inborn traits, 136–138
impetigo, 101, 102–104 soap, 90 stress, handling, 404–405 initial approach, 137
milia, 99, 100 social development strollers, 187 intensity, 137, 140
pustular melanosis, 99, 101 month 1, 230–231 accessories, 187 interaction with, 143
rashes, 256 month 2, 239–241 double, 499–500 irregular body rhythms, 140
thrush, 101, 105 month 3, 251–252 newborns and, 186–187 mood, 137
slate gray nevus, 28, 30 month 4, 262–263 safety tips, 187 in newborns, 138
sleep (baby), 113–123 month 5, 272–275 short trips, 283 parenting and, 141–143
activity during the day and, 115 month 6, 284–285 in travel system, 187 persistence, 138, 139
“back” to, 117–118 month 7, 293–295 use of, 186 quiet, 140
bed share and, 116 month 8, 302–305 stuffed animals, 290 regularity, 136–137
bedtime routine, 115 month 9, 314–315 suckling, 225, 226 sensitivity, 137, 141
in car seats, 190 month 10, 324–325 sudden infant death syndrome (SIDS), surroundings and, 135–136
daily, 113–114 month 11, 332–335 117–119, 510 understanding, 135–143
Down syndrome baby, 527–528 month 12, 344–345 sun, 103, 184 working with, 138–141
falling asleep, 115 social skills, 156 sunburn, 388–389 temperature, taking, 350–351
frequency of stirrings, 116 socks, 110 sunscreen, 103 tetanus vaccination, 167
going to bed drowsy, 116 soft scrubbers, 91 supervision, 312 tetralogy of Fallot, 549
good habits, 115–117 solid foods support thermometers, 350
month 1, 224 baby cereal, 70 adopted baby, 481–484 thrush, 101, 105, 392–394
month 2, 235 baby readiness for, 266 breast-feeding, 52 time, relishing, 22
month 3, 245 child obesity and, 71 dads/partners, 427, 444 timetables, caution, 251
month 4, 257 finger food, 70–71 delayed development baby, 523 toes
month 5, 267 getting started with, 69–70 Down syndrome baby, 533 deformities, 545–546
month 6, 279 holding off of, 246 multiples, 501 discovery of, 280
month 7, 289 homemade, 70 parenting, 404, 405 tonic neck reflex, 226
month 8, 299 introducing, 69–73, 265–266 work and, 469 touch
month 9, 309 juice, 71 swallowed poison, 216–217 month 1, 227
month 10, 319 meal management, 73 swim diapers, 76 month 6, 281
570 INDEX INDEX 571

touch continued in diaper changing, 81 when to avoid, 169 home connection, 466
month 8, 301 exposing to air, 96 whooping cough, 167–168 home life balance, 466–469
month 9, 311 month 1, 224 vaginal recovery, 408–409 parent networking, 466
month 10, 320 problems, 96–97 vegetables, 70, 268 planning return to, 250, 464–465
month 11, 330 umbilical granuloma, 96 ventricular septal defect, 550 right fit for, 468
month 12, 342 umbilical hernia, 36, 96–97 vision self-nurture and, 469
towels, 91 uncircumcised penis, caring for, 97 Down syndrome baby, 529 support and, 469
toys and games undershirts, one-piece, 109 month 1, 227 transition back to, 464–466
cribs and, 123 understanding, 344 month 3, 247 ups and downs, 465–466
month 1, 228 undescended testicle, 547 month 4, 260 See also home versus job decision
month 2, 236 urinary tract infection, 394–395 month 5, 271
month 3, 248 urination month 6, 281
month 4, 262 irritation from, 84 month 8, 301
month 5, 273 normal, 81–82 month 9, 311
month 6, 283 problems (mother), 409–410 month 11, 330
month 7, 291 used car seats, 189 premature baby, 509–510
month 8, 303 visiting rules, 402
month 9, 313 V vitamin D, 52, 65
month 10, 321 vaccinations (vaccines), 159–171 vitamin K injection, 34
month 11, 333 additives, 161 vocabulary, 331–332
month 12, 343 alternative schedules, 164 vomiting, 395–396
safe, 198 autism and, 161–163
selecting, 198 benefits of, 159 W
water, 343 at checkup, 156–157 walking
transient tachypnea, 539 chickenpox, 163 interest in, 340
transposition of the great vessels, childhood, 163–168 together, 313, 343
549–550 comforting during/after, 165 washcloths, 90
traveling diphtheria, 162–163 water
air, 193–194 first examination, 34 safety, 205–207
with baby, 183–195 flu, 164–165 temperature, 199, 201
with baby carriers, 184–186 German measles, 163 toys, 343
with car seats, 187–192 hepatitis A, 164 weaning
dressing for weather, 184 hepatitis B, 34, 164 from formula, 65
essentials, 195 Hib disease, 164 gradual approach to, 57–58
heading out, 183–184 how they work, 159–160 methods, 58
internal clock and, 195 immune response, 160 nutrition and, 59
motion sickness, 192 measles, 165 timing, 58
with preemies and small babies, 192 missing, 167 See also breast-feeding
preparation for, 183, 184 mumps, 165 weather, 110, 184
with strollers, 186–187 newborns, 166 weight gain, breast-feeding amount
sun protection, 184 pneumococcal disease, 165–166 and, 51
trip basics, 195 polio, 166 well-child vaccination schedule, 162
weather and, 184 preterm babies, 168 whooping cough, 167–168, 396–397
tripod sitting, 280 reasons for getting, 160–161 winter wear, 110
trust, 293–294 risks versus benefits, 171 wipes, 77, 78
tummy hold, 131 rotavirus, 167 words, first, 320–322
tummy time, 120, 228, 236 safety, 161–163 work
severe reaction, 169 balance (dads/partners), 427–428
U side effects, 169 breast-feeding and, 466
umbilical cord tetanus, 167 career options, 469
care, 96–97 well-child schedule, 162 continuity of care, 465
572 INDEX INDEX 573

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Mayo Clinic Guide To Your Baby's First Year - From Doctors Who Are Parents, Too! (PDFDrive)

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Introducing solids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 ‘Back’ to sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Baby’s mental development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Baby’s movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Baby’s growth and appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Baby’s sensory development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

Baby’s social development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314

Living on less sleep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 From surviving to thriving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444

Getting comfortable with chaos . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

Adjusting to your new role . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 Siblings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449

Shifting roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 Living with your decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463

Taking care of yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 Breathing disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537

Caring for your baby Welcome to

CHAPTER 1: WELCOME TO PARENTHOOD! 21

Take care of your relationship

CHAPTER 1: WELCOME TO PARENTHOOD! 23

Baby’s ﬁrst days

CHAPTER 2: BABY’S FIRST DAYS 25

26 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 27

28 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 29

30 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 31

32 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 33

34 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 35

important in the prevention of sexu- turely, has severe jaundice or is feed-

36 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 37

disorder include seizures, developmental disabilities, blindness, growth failure

38 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 39

Sickle cell disease This inherited dis-

40 PART 1: CARING FOR YOUR BABY CHAPTER 2: BABY’S FIRST DAYS 41

If it seems like all you do these days is BREAST VS. BOTTLE

CHAPTER 3: FEEDING BABY 43

44 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 45

46 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 47

Cross-cradle hold Cradle hold

50 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 51

52 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 53

54 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 55

56 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 57

58 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 59

CHAPTER 3: FEEDING BABY 61

62 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 63

64 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 65

CHAPTER 3: FEEDING BABY 67

babies experience infant gastroesopha- out. This isn’t necessarily because he or

68 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 69

70 PART 1: CARING FOR YOUR BABY CHAPTER 3: FEEDING BABY 71

CHAPTER 3: FEEDING BABY 73

CHAPTER 4: DIAPERS AND ALL THAT STUFF 75

76 PART 1: CARING FOR YOUR BABY

CHAPTER 4: DIAPERS AND ALL THAT STUFF 83

Preventing diaper rash There are a

CHAPTER 4: DIAPERS AND ALL THAT STUFF 87

Bathing and skin care

CHAPTER 5: BATHING AND SKIN CARE 89

90 PART 1: CARING FOR YOUR BABY

CHAPTER 5: BATHING AND SKIN CARE 105

CHAPTER 6: CLOTHING BABY 107

CHAPTER 6: CLOTHING BABY 109

110 PART 1: CARING FOR YOUR BABY

Sleep and sleep issues

CHAPTER 7: SLEEP AND SLEEP ISSUES 113

CHAPTER 7: SLEEP AND SLEEP ISSUES 117

118 PART 1: CARING FOR YOUR BABY

CHAPTER 7: SLEEP AND SLEEP ISSUES 121