Important: read this first.
TOUCHPOINTS by Dr. T. Berry Brazleton
TOUCHPOINTS ANTICIPATORY GUIDANCE
- Parental exhaustion: The emotional well-being of parents is particularly vulnerable at this point. Mother may still be recovering from the birth, but both parents are likely suffering from sleep deprivation. The baby’s demands are great, but parents’ capacity to interact is not yet clearly defined. In addition, mothers may suffer from postpartum depression. The questionnaire given at this visit is used to assess postpartum depression. Despite the exhaustion and overwhelming nature of this current phase, you can establish yourselves as competent parents through a trial and error process.
- Fussiness: Between 3 and 12 weeks babies may develop fussy periods during the day. This fussiness is normal and represents the baby becoming overloaded and needing to release some of his/her tension in the late afternoon or early evening. Cycles of comforting and letting the baby cry for 1-2 minutes are worth trying.
- Thumb sucking: Thumb sucking represents the baby’s initial attempts to soothe him-/herself. The use of a pacifier serves a similar function.
- Cognitive Burst: Feeding and sleeping routines may be disrupted as the child gains more and more interest in the outside world.
- Play: Objects to manipulate become appropriate toys. Things to transfer with hands and bring to the mouth become good playthings. Face-to-face play also becomes more enjoyable.
- Work: If mother hasn’t already returned to work, this may be the time when she considers returning to work. Concerns naturally arise about adequate child care and separation from the baby. Anxiety about separating from the baby is very natural. Many mothers and fathers feel they are missing out on spending time with their child when they return to work. Babies in child care tend to save their energy for the end of the day when they return home. This may be manifested in more protests, crying, or fussiness upon returning home.
- Feeding: Expect your baby to be easily distracted during feeding times and at times feeding refusal when exciting events are occurring.
- Sleeping: Expect increased bursts of sleep at night, but be wary of light sleep periods at which your baby may not need to come fully awake.
- Play: Provide opportunities for your baby to play during daily routines. Also encourage increased interest in manipulating objects.
- Safety: As the baby begins to move around, issues of physical safety arise. Baby proofing the house will become important very soon.
- Limit-setting: The baby’s curiosity and mobility raise concerns about limit setting.
- Sleeping and feeding: Changes in sleeping and feeding patterns may occur if they haven’t already. Limit-setting around going down to sleep should begin. You can let your baby begin to feed him-/herself soft finger foods and experiment with a cup and/or spoon in the next couple of months.
- Stranger awareness: The baby will begin to become wary of anyone new.
- Separation: Separations between you and your child are likely to become increasingly difficult over the next few months.
- Feeding: The baby’s demands for control will increase. Finger feeding should be a mode of feeding with soft foods offered in between.
- Safety: By now your baby is probably very mobile and childproofing is becoming very important.
- Temper Tantrums: Tantrums can be expected in the second year of life. The best way to manage these tantrums is to first ignore the behavior while keeping the child safe. After the tantrum is over, give the child the warm support that he/she needs.
- Toilet Training: It is too soon to train but not to discuss this topic. Physically and emotionally children are usually ready between 18 months and 2 years of age.
- Aggression: Toddlers may scratch, bite, or hit especially when the exciting world is overloaded with new people and objects. These initial aggressive behaviors should be limited calmly without too much overt attention given to them.
- Parenting responsibilities: The constant demands of keeping your child physically safe are intensified by the personal demands on the part of the child to be independent. Try to remand flexible while at the same time establish control over the child’s behavior when it is truly necessary.
- Shifting attachments: The opportunity to begin playing more regularly with other children may be an appropriate channel for the child’s increased capacity for new relationships. This is a wonderful time to involve your child in playgroups if he/she is not already in a group childcare setting.
- Temper tantrums: If you have not experienced these yet, they are likely to happen in the near future. It is important to keep your child safe but try to maintain consistency in your approach. Try to ignore the behavior but provide warmth and care after the tantrum is over.
- Safety: Toddlers do not have internal controls to stop themselves from taking extreme risks. He/she is also beginning to learn standards for his/her behavior. It is important to be vigilant in guiding your toddler as he/she negotiates stairways, climbs out of cribs, and darts away as he/she walks down the street.
- Childhood: The child and parents are experiencing the dramatic transition from infancy to childhood. The willfulness, negativity, and fluctuations between dependence and independence can create difficult situations. However, the development of the child’s sense of self, social understanding, ability to use language, and more sophisticated play can be anticipated as outcomes of successful parenting.
- Toilet training: You can now look for and support signs of readiness for toilet training. The beginning steps can include talking about what wet and dry mean and focusing on the ability to undress and dress in preparation for toileting. It is appropriate to purchase a potty seat at this time.
- Toilet training: You can continue to look for and support signs of readiness for toilet training. The beginning steps can include talking about what wet and dry mean and focusing on the ability to undress and dress in preparation for toileting. If you have not already purchased a potty seat, you can now do so.
- Emotionality: Be prepared for negativism at this age. Try to reflect the child’s feelings with words and provide firm but comforting support when the child loses control to help the child gain an understanding of his/her emotional limits.
- Aggression: Often children can become aggressive when confronted by peers who get in his/her way or want the same toy he/she does. Prepare your child for these encounters and let him/her know that you expect the behavior to be controlled.
- Responsibility: It is not too early to begin assigning the child household chores. When a sense of competence is beginning to bloom at this, these patterns of helpfulness and responsibility can begin to be established.
- Television: Children of this age are particularly vulnerable to the negative effects of television because their imagination is increasing and learning is still largely dependent upon physical activity. Try to limit the amount and type of television your child watches.
- Preschool: Parents need to find the kind of school program that best suits the needs of their child. At the age of three, emphasis should be on play as the primary means of understanding experience and the management of peer relationships.
- Sexual identity: Part of the job of a preschool child is to establish a sexual identity. Along with internal identity seeking is the active exploration of each others’ bodies. Be prepared for this and how to handle these situations.
- Mastery: This year is sometimes called the “the golden year.” Four-year-olds greet the world with open arms. They want to master the world but are still pulled by dependence on their parents. They pay increasing attention to their peers and forming strong friendships. They ask many “Why?” questions to find out about their world. Parents find themselves in new roles because they are no longer simply providing for their children.
- Transgressions: Wishes become lies. They likely say things that are untrue because they wish it to be true. These are examples of their magical thinking. Parents may feel angered or frightened by these behaviors but must realize this is a normal part of being four.
- Parental rejection: Four-year-olds may reject one parent as they try to understand each parent individually. This can be very difficult for the excluded parent unless they understand that this is predicable and enables the child to fully understand one parent at a time.
- Discipline: At this age, discipline involves teaching. Every “NO” needs a “Yes” or an explanation of why. Continue to set limits for your child and explain the reasons behind your limit setting.
- Fears: A new set of nightmares and fears may appear. Five-year-olds begin to be afraid of more intangible things such as disease or violence.
- Games: Games with rules and directions become very important. Fairness is also important at this age.
- Moral awareness: Moral begins to develop and they find themselves living with angry feelings. Five-year-olds are also able to feel empathy for others. The child becomes aware of the effect of his/her actions not only on the responses of others but also on his/her own feelings.
- Gender identity: Gender identity is at its peak. Five-year-olds have lots of questions about their bodies. They may identify with one parent over another.
- Fantasy vs. reality: Dreaming and wishing must now struggle to make way for reality. They still may play dress-up games or have imaginary playmates, but they are now able to differentiate fantasy from reality.
- Entering first grade: Starting first grade is a major step. The teacher becomes the ultimate authority on a variety of matters. The child is a member of the world outside his/her family, and parents must realize that the child no longer just belongs to them. Parents may be fearful and mourn that they should have spent more time with their child.
- Moral development: Six-year-olds love to win, which may motivate them to cheat. It doesn’t feel good because they are developing a conscience. Parents can talk with their child about how cheating will isolate him/her from others. They also have inflexible notions about right and wrong. Jealousy may be a motivation for tattling. Parents can help them consider the gray zones and the social consequences of tattling. Six-year-olds are also very egocentric. They will take something just because they want it. Parents can explain that dishonesty and stealing hurt everybody. Even if they can get away with it, it is not acceptable.
- Friendships: Belonging to the group becomes more important. Children segregate themselves into groups with their own gender. These relationships offer learning expectations and refuge from siblings. The child may distance him-/herself from parents. Parents may feel the loss.
- Goal of interdependence: The child’s explorations and independence from parents may alarm parents. However, the ultimate goal is interdependence rather than independence.
Tips for Selecting and Using Insect Repellent
Warm summer evenings. BBQs in the backyard. Softball games in the park. Mountain hikes. Mosquito bites. They all go together, but one of these is no fun and can be health risk. Zika is just the latest mosquito born illness to hit the news. Mosquito bites are also responsible for the transmission of such major health risks as yellow fever, malaria, dengue fever and encephalitis.
In parts of the world where mosquito-transmitted diseases are not common, it is the bite itself that presents the greatest difficulty. More infants and children are bitten by mosquitoes than by any other insect. These bites can make kids miserable.
Tips for Selecting and Using Insect RepellentThe Centers for Disease Control and Prevention (CDC) recommends using an insect repellent on exposed areas of skin when in an area that may have mosquitoes. I agree.
- The most effective compounds are DEET (N,N-diethyl meta-toluamide), picaridin, and oil of lemon eucalyptus (Repel) I prefer picaridin (as in Sawyer Insect Repellent) an ingredient derived from peppers that has a long history of safety and efficacy in Europe. Or the safe, non-toxic, plant-based oil of lemon eucalyptus. It does cause irritation if it gets in the eyes, but has otherwise proven safe. It has not been tested, though, on children under age 3 years. DEET-containing products should not be used on children under 2 months of age.
- Don't apply insect repellent under clothes, or too much may be absorbed. Also, avoid applying repellent to portions of the hands that are likely to come in contact with the eyes and mouth.
- 30% is the maximum concentration of DEET recommended for infants and children. Lower concentrations have not been shown to be safer.
- The concentration of an insect repellent affects how long it will last, not how effective it will be when applied.
- DEET should not be used in a product that combines an insect repellent and a sunscreen (so that the sunscreen can be reapplied as needed).
- Other ingredients, such as IR3535 (Avon-Skin-So-Soft) or combinations of plant oils (Bite Blocker Xtreme or Burt’s Bees All Natural Herbal) can prevent bites, but not as effectively as DEET, picaridin or oil of lemon eucalyptus.
Tips for Avoiding Mosquitoes
- Mosquitoes are attracted to things that remind them of nectar or mammal flesh. When outdoors, wear light clothing that covers most of the body, keeping as much skin and hair covered as practical. Avoid bright, floral colors. Khaki, beige, and olive have no particular attraction for mosquitoes.
- They are also attracted by some body odors, and for this reason they choose some individuals over others in a crowd. Avoid fragrances in soaps, shampoos, and lotions.
- Many species of mosquito prefer biting from dusk until dawn. The problem is worse when the weather is hot or humid. Avoid playing outdoors during the peak biting times in your area.
- Try to stay away from still water.
- People who are highly allergic should avoid vacationing in the Everglades.
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Pediatric Cough and Cold Medications
by Mary Elizabeth Dallas
Medical experts agree that young kids will get about 10 viral illnesses associated with colds and coughs every year. It’s safe to say that parents often feel powerless when their children are sick and would do anything to help them feel better. That may be one reason why, in the United States (U.S.) alone, there are currently 800 over-the counter (OTC), or non-prescription, cold and cough medications available for young children. But drugs and medications are not the answer for every illness. Research shows that common pediatric cold and cough products don’t alleviate children’s symptoms. Studies also show that in some cases these remedies can actually be dangerous—even deadly—when misused.
OTC cough and cold medications are widely marketed and used by parents to treat children with cold and flu-like symptoms. They are available as either single ingredients as well as combination products containing one or more of the following:
- Decongestants or nasal decongestants such as pseudoephedrine (for relief of a stuffy nose)
- Expectorants (to help loosen up mucus)
- Antihistamines (for sneezing and runny nose)
- Antitussives or cough suppressants, such as dextromethorphan (for quieting coughs)
- Analgesics (pain relievers) and anti-pyretics (fever reducers), such as acetaminophen and ibuprofen
Are they safe?
Although these products have been used for decades, there is very little research showing safety and efficacy in children. The Food and Drug Administration (FDA) first endorsed the use of pediatric OTC cold and cough medications in 1976. At the time, dosage guidelines were based on those of adults. So, children between the ages of 5 and 12 years were given half the recommended adult dose, and children ages 2 to 5 years were given a quarter of the adult dose. Meanwhile, there were no guidelines for use of these medications in children under the age of 2 years. These rules would remain in place for the next three decades until the FDA revisited the issue when the safety of treating children with OTC cough and cold medications was called into question.
In 2007, the Centers for Disease Control and Prevention (CDC) examined cough and cold medications commonly used to relieve symptoms of upper respiratory tract infection in children older than 2 years of age. The CDC found that between 2004 and 2005, an estimated 1,519 children younger than 2 years were treated in U.S. emergency rooms for adverse health problems associated with these medications.
Among the serious adverse side effects associated with OTC cough and cold medications in young children:
- Rapid heart rate
- Decreased levels of consciousness
The CDC report identified and investigated the 2005 deaths of three infants younger than 6 months of age. All three infants had high levels of pseudoephedrine in postmortem blood samples. One of the infants had received both a prescription and an OTC cough and cold combination medication. The medications were given at the same time and both contained pseudoephedrine. In all three cases, medical examiners determined the underlying cause of death was an unintentional overdose of cough and cold medications.
In 2008, the controversy surrounding the safety of these medications prompted the makers of many children’s cough and cold remedies to change their labels to include the following warnings:
“Do not give to children younger than 4 years of age.”
“Do not use antihistamine products to sedate or make a child sleepy.”
Are they effective?
Once the safety of OTC pediatric medications was called into question, researchers also began to examine their efficacy in children. In 2009, research conducted by BC Children’s Hospital in Vancouver revealed that not only are OTC cough and cold medications potentially harmful, they offer no benefit to children younger than 5 years of age.
The research cited the U.S. National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance program, which reported that pediatric OTC cold and cough medications were responsible for 7,091 visits to emergency departments by children under the age of 12 years in 2004. Of these cases, 25 percent were the result of properly administered medications with undesired outcomes. While children ages 2 to 5 years represented the largest group in this study, children younger than 2 years had the highest rate of adverse reactions.
Still, the researchers noted, every week 10 percent of American children will use OTC cough and cold medications. Children ages 2 to 5 years are the most common users of such remedies, followed by children younger than 2 years of age.
Experts at John Hopkins weighed in on the debate in 2010. Their published commentary argued the serious adverse effects associated with pediatric OTC cold and cough medications were largely caused by inappropriate use by caregivers. A 2009 study published in Pediatrics underscored this view, revealing that caregivers often misunderstand the directions on OTC pediatric cough and cold products, which can have potentially dangerous consequences.
The study, which examined the behavior of 182 caregivers, found that when examining the front of a product’s label, 86 percent of the time parents thought these products were appropriate for use in children younger than 2 years of age. More than half of the time, parents also stated they would give these OTC products to a 13-month-old child with cold symptoms.
The products’ packaging had a big influence on parents in the study. For example, labels which read “infant,” or included graphics of infants, teddy bears, or droppers tended to sway parents’ decision to administer the medication to young children. On the other hand, dosing directions influenced caregivers only 47 percent of the time.
“A viral infection will run its course. There is no cure. Cough and cold remedies provide only symptomatic relief. Unfortunately, the benefit of symptomatic relief may not outweigh the potential risks associated with OTC combination medications. For the most part, coughing and a runny nose seem to bother the caregivers more than the child,” according to board-certified pediatrician and neonatologist, Dr. Angela McGovern, M.D.
Keeping your child safe
Facing increased scrutiny, the FDA has re-issued it’s warning that pediatric OTC cough and cold medications should not be used for infants and children under 2 years of age due to the serious and potentially life-threatening side effects. The agency however, says it is still reviewing the use of these products among children ages 2 to 11 years.
In the meantime, the Consumer Healthcare Products Association (CHPA) advises parents who decide to use pediatric OTC cough and cold medications to take the following steps to ensure the safety of their children:
- Read the labels of the medications you are administering to your child, particularly the “active ingredients” section.
- Do not give your child two different medications with the same active ingredient(s).
- Choose a medication that is appropriate for the symptoms the child is exhibiting.
- Do not give the medication any longer than is recommended.
- Do not give the medication more often than is recommended. (Don’t’ give more medicine than directed because you think the child seems more sick than in the past.)
- Measure exactly—never guess or estimate the amount of medicine.
- Use the measuring device that is given with the medication package, or those made specially for measuring drugs. (A kitchen teaspoon is not an accurate measure.)
- Do not give children adult-strength medications (even in lower dose).
- Never give aspirin containing products for viral infections such as cold, flu, or chicken pox because of possible association with the rare condition called Reye’s syndrome.
- Choose OTC cough and cold medicines with childproof safety caps, when available, and store the medicines out of reach of children.
- Do not use these products to sedate children or help them sleep.
- Call your physician, pharmacist, or other health care professional with any questions about using OTC cold and cough medications in children 2 years of age and older.
- Be sure to inform your child’s pediatrician of all the OTC, prescription medications, and other dietary supplements your child is taking to avoid harmful interactions or overdosing.
Given the fact that the health risks associated with pediatric OTC cold and cough medications appear to outweigh their intended benefits, a growing number of parents may decide not to give them to their young children. In these cases, parents can rest assured, most of the time a cold will go away on its own in about a week. In the meantime, there are other ways parents can help make their child feel more comfortable, including:
- Offering plenty of clear fluids (including breast milk) to help loosen mucus and keep children hydrated.
- Using saline nasal drops and a nasal aspirator in children at least 12 weeks old to help clear out mucus.
- Use a cool-mist humidifier to moisten the air and make breathing easier. (Make sure to clean the humidifier according to the manufacturer’s instructions.)
- If a child has a fever, acetaminophen or ibuprofen may help.
- Encourage rest.
- Consult a pediatrician if symptoms persist for more than two weeks, get worse, or if new symptoms appear.
Mary Elizabeth Dallas is a NY–based journalist with more than 15 years of experience, including CNN and ABC News. She is also relishing her newest challenge… motherhood. Today, she is using her experience to help inform parents on the key challenges and issues they face every day.
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