Discipline, Strong Willed Children & Temper Tantrums

There are so many behavior programs available in the market today. Most of them are very similar and work on reward and punishment principles. But what happens when you have a child that “marches to a different drummer?” What about the child that says they don’t care when everything is taken from them? This type of child operates on different principles than most other children and usually, will not do well with reward & punishment techniques.

One program that I have found extremely useful is “Smart Parenting” by Larry Koenig. The program is based on the child being in control of their own actions by using a simple chart with either a daily program or a weekly program. I recommend the weekly program for children over 10 years old and the daily program for the younger children and for those with Attention Deficit Disorder. The daily chart has nine boxes on it. The first three boxes are left blank and then the remaining boxes are filled with something that can be taken away from the child. This “something” must be something that will be able to follow through with.

You begin the program by identifying 3-5 rules you want your child to follow. Write these down in basic understandable words and post on the refrigerator. Review these rules with your child and explain to them that each time they break one of these rules, a “X” will be placed on their chart. There are three “free” boxes before the child has a consequence so there is ample warning for them. When the child breaks one of the rules, put an X on their chart in the first available box and tell them that they have just earned one X on their chart. Do the same with #2 and #3. Initially, your child will test you to see if you will follow through. Some children have been known to go through the entire chart losing all their privileges in one day. Persevere because you are sending a message that when you break the rules there is a consequence. Only work on 3-5 rules initially because you will be more successful but make sure that these are rules that you can be consistent with. The privileges that are lost are available the next day and the entire process is repeated. Be sure to rotate the privileges into different boxes each day so that different things will be lost each day. This process is similar with the weekly chart but has 7-10 boxes with privileges in them and these are lost until the beginning of the following week. The weekly plan also has three free boxes and there should be 5-10 rules that are clear, easily observed and ones that you can be consistent with.

This is an incredibly easy program. The most important things to remember are:

* be consistent, be consistent, be consistent!
* write clear, easily understandable & observable rules for behavior
* use privileges that mean something to the child
* don’t get discouraged if your child reacts to losing a privilege with “So, I don’t care about that anyway!” This is just a tactic and they really do care but are not going to let you know that.
* I recommend that you put all the children in the house on this program for consistency, even if you don’t think they need it. In the long run, it will be easier for you and those that don’t need it will succeed anyway.
* privileges do not have to be something physical…they can be a trip to the park that you were going to take and it was something you didn’t really want to do anyway, a play date, etc.
* Be careful about using privileges that affect other members in the household such as television time. Don’t use tv on your child’s chart unless you can enforce it completely!

The effects of this program on you and your child can be tremendous. You become empowered and the emotion is taken out of disciplining your child. In addition, your child is in complete control of keeping their privileges or losing them. Try this behavior program and then let me know how you are doing!

Behavior & Your 6 year old's Attitude

Does your 6 year old have an attitude? Have you ever heard of the Terrible 6's? Not frequently written about but commonly experienced behavior is the six year old and their smart alec attitude. This behavior emerges anywhere from kindergarten to 1st grade and lasts for 1-2 years. It is characterized by a "know it all" attitude, high self esteem, talking back to adults and the belief that they can do anything.

This stage of social emotional development occurs because of the tremendous growth in their abilities at this age. They are feeling very intelligent from the learning they are doing in school and the attention they receive from their teachers and other adults. They are reading, spelling and learning a lot about the world around them. They feel smart and therefore, act smart.

This stage is not really a negative time but parents do have to get a handle on the know it all attitude and the talking back. It is important to be consistent with discipline at this stage and set clear guidelines about unacceptable behavior. Your child will quickly learn that they will receive more positive attention from you if they are respectful of you and others.

How to Tell if you are Making Enough Breastmilk for your Baby

Do you have enough breast milk for your baby?

Many mothers today worry about whether they have enough milk to feed their baby. Sit back & relax because human nature designed your body to meet the needs of your baby perfectly! Where did this doubt come from? Many women feel they need to pump & measure their milk to make sure their baby gets enough. Why?

A woman's body naturally makes colostrum that is ready for the baby, in small amounts, right after birth. Babies are not meant to eat a lot in the first few days of life and need time for their system to adapt to the outside world & therefore, a mother's breasts do not make a lot of milk in the first few days after delivery. Notice the coordination between mother and baby. By about the third day after birth, the mother's milk should start to come in...meaning that the breasts become very full & engorged (translating into very uncomfortable). Reasons that the mother's milk is delayed in coming in are: the use of anesthesia during delivery - epidural, spinal & general - a difficult delivery, delivery complications such as excessive blood loss and toxemia, existing maternal medical conditions and previous breast reduction or enhancement.

The latest I have ever seen a mother's milk come in is at 6 days post birth. You will feel much more comfortable with your ability to provide enough milk for your baby if you visit your Pediatrician every couple of days after leaving the hospital to check the baby's weight. I manage newborn babies & breastfeeding on a regular basis in our office, observing for incorrect feeding techniques that cause pain for the mother & following the baby's weight gain until they have reached their birth weight. It is RARE that a mother does not have enough milk...usually it is the mother's perception that she does not have enough milk and is not aware of how perfectly her body works. A baby will stimulate their mother to make enough milk if they are put to the breast every time they cry in the first few days.

Your baby is getting enough milk if their weight gain is at least 1/2 oz per day and your baby is wetting diapers frequently. A general rule of thumb is that a baby should have two wet diapers on day #2 of life; 3 wet diapers on day three; 4 wet diapers on day four and five wet diapers on day #5. After an infant is six days old, they should have at least, six wet diapers a day. Another sure way to tell if your baby is getting enough breast milk is if they are passing at least one stool a day and it is yellow, watery & seedy.

Try not to worry if you have enough breast milk. Let nature do what has been occurring since the beginning of time and just feed your baby!

Relax & enjoy your baby!

Baby Poop: The Visual, Scent, Frequency & Behavior of it All

Baby poop gives us a lot of information about a baby’s well being and how well feeding is going. It tells us if the baby is tolerating their food or if they are allergic to it. So it is very important for a parent to pay attention to what their baby’s stools look like.

The Visual
A newborn’s stools begin as black and slimy but quickly turn dark green and then to yellow in the first week of life. The consistency also changes to watery loose seedy or pasty. If a baby is feeling very well in the first week of life, their stool changes to yellow quickly whereas a baby not feeding well will still have green sticky stools. A breast fed baby will have very loose watery stools, the consistency of runny scrambled eggs, while a formula fed baby will have pasty stools like toothpaste. When baby food is started, the color and consistency will change again and can be orange, green, or yellow depending on what they are eating.

The Scent
Newborn baby poop does not have any smell. The scent evolves, as the baby gets older, with the growth of normal intestinal bacteria. Breast-fed baby’s stools do not smell at all while formula fed babies have some odor. Once baby food is introduced, the smell develops in earnest and disposable poop bags are definitely needed.

The Frequency of it All
Stools are very frequent in newborn babies and can occur after every feeding. This is not considered diarrhea and occurs because the baby is on a liquid diet and there is not much debris left over to form the stool material. After several weeks of life, breast-fed infant stools become less frequent because the baby is utilizing most of the nutrients and does not have much left over to stool with. It is completely normal for a 3-8 week old infant to poop only once every 6 days! On the other hand, formula fed babies may only poop once every 3-4 days and this is because the formula does not break down as quickly as breast milk into usable nutrients. Again, after baby food is introduced, the frequency and consistency of stools will change again.

Behavior associated with Pooping
Babies exhibit some really interesting behaviors when they have a bowel movement. They poop from their head to their toes! A baby needs to bear down really hard to go to the bathroom because their muscle tone is not as strong as ours. What you will see is a crinkling up of their face, their face becoming red, a firm abdomen and you will hear grunting, moaning or crying out. Some babies seem like they are having a really hard time with all the noise they make. Some babies become really upset because they don’t like the way it feels to have a bowel movement but once they have gone to the bathroom, all the noise stops and they become quiet.

These are all the normal things about baby poop. There are some abnormal signs to look for. If you notice blood, lots of mucus or white stools, definitely call your pediatrician’s office. Really foul smelling stools and extremely dry, large and hard ones would also be a sign to consult your pediatric office.

Infant Illness: How to Keep your Baby from Getting Sick

How can you keep your baby from becoming ill? Why is it so important to protect your baby from getting sick?

Infants are born with an immune system that is fully functioning but very immature. In order to make antibodies against illness, your baby needs to come in contact with the germs and make their own antibodies...nobody else can do it for them. There are two main ways that infants are protected from illness:

• passive transfer from the mother, through the placenta, during the last 4 weeks of pregnancy gives infants 4-6 months of immunity to what their mother is immune to; for example, chickenpox
• passive transfer from the mother through breastfeeding and this continues as long as the infant receives breastmilk for things such as respiratory illness & stomach viruses

Infants can still become sick with illness that their mother is not immune to and from a really strong exposure to an illness. The most common ways a baby becomes ill is through hand-to-hand contact from their caregivers or being exposed to someone that is coughing and sneezing. Babies do not get sick from drinking breast milk from a mother who is sick because the size of the cells are too large to pass through into the breast milk. Keep in mind that we can carry illness on our hands & in our bodily secretions that we do not become sick with and can expose the baby that way.

Now that you understand how a baby becomes sick, you can understand why it is important not to take them out in public places, have young children visit and allow sick friends and relatives to visit your new baby. Steps that you can take to keep your baby from becoming sick are:

• limit the amount of visitors that come to see your new baby
• do not allow anyone to visit if they are obviously ill
• do not allow other infants & children to visit as they may carry illness
• wash your hands with antibacterial soap & ask your visitors to wash their hands
• if you become ill, wash your hands frequently, avoid coughing & sneezing near your baby, keep your hands away from your mouth and wear a mask if you can (they are available at places like Home Depot)
• if a sibling becomes ill, separate them from the baby and, if possible, have another adult take care of them. Choose someone who will not have contact with the baby. Seclude mother & baby in a bedroom away from illness and use a different bathroom from the mother
• clean surfaces frequently with an antimicrobial cleaner or wipe: countertops, faucets, sicks, toilets & toilet handles, doorknobs, telephones, kitchen utensils & plates, remote controls, car steering wheel, etc. Do not spray cleaners in the air because the baby could breathe the chemicals into their lungs.
• avoid taking your baby out into public places where there can potentially be a lot of people
• avoid taking your baby to other people's homes where there may a sick person or children
• wash your hands before touching the baby

Doing these things may not completely protect your baby from illness but will help the illness be milder. Breast feeding your infant is the single, most important way to protect them from illness.

Nursery Water...Why the Hype?

Does your baby really need nursery water? It is marketed to be good for your baby but is it really necessary? Infants do not need extra water in their diet because breast milk & formula have plenty of liquid in them. It is also not wise to give water to infants because it does not have any calories.

Nursery water is essentially steamed water with fluoride and some minerals. Infants do not need fluoride until six months old and most pediatric dentists do not recommend supplemental fluoride even then. The minerals that are added to the nursery water can be obtained through breast milk and formula and boiling the water can be done yourself. So why does your baby need nursery water? They don't. Boiled filtered water or bottled water with a low sodium content are just fine for your baby.

Beginning from birth:

• nursery water is not a necessity in your baby's diet
• infants do not need extra water in their diet because it does not have calories
• formula does not need nursery water mixed with it (see above for water recommendations)
• you can boil your own water or buy bottled water to mix with formula
• breast fed infants do not need supplemental flouride as it is bio-available in the mother's milk
• breast fed infants only need a supplemental vitamin called Trivisol (vitamins A,D & E) which are not present in mother's milk

Wait to Take Infant out in Public Part II

Most people think that once a baby gets their shots they are protected against illness and can go out in public. Wrong…. The shots that are given to infants only cover Diptheria, Tetanus, Pertussis, Haemophyllis Influenzae B, Pneumococcus, Hepatitis B, Polio, Rotavirus, etc. Still out there in your community are millions of germs just waiting for your sweet little baby.

Infants have not had the opportunity to build up immunity because you have to have an illness (or an immunization) in order to make antibodies to protect you from becoming ill. Consequently, infants become ill with just about anything they become exposed to and is usually quite significant. In some cases, infants become so ill that they need to be hospitalized. Most medical providers that work regularly with infants know how sick an infant can become and how fast it occurs. Also, infants are more susceptible to meningitis and blood infections because of their immature immune system.

The other factor that does not help infants fight infection is their immune system. If an infant is born full term, they have the benefit of “placental immunity” or the passing of antibodies from the mother to the infant in the last four weeks of pregnancy. This immunity last for 4-6 months. Another way that immunity is elevated is if the infant is breast fed. Many illnesses the mother has had herself is reflected in the mother’s antibodies and therefore, transferred in the breast milk to her infant.

The lowest time in an infant’s immune system is between 6-12 months. This is both natural and normal because of the wearing off of placental immunity. This is also a time when parents begin to feel safe taking their infants out in public. So think about where you are taking your infant and decrease the risk of them becoming ill by avoiding crowded places.

Why do some Infants have "Outie" Belly Buttons?

Why do some babies have “innie” belly buttons and others have “outie” belly buttons? Is it because the Dr. pulled the cord in a certain way at delivery? Is it because that clamp they put on the umbilical cord was too tight? “Outie” belly buttons are not caused by pulling on the umbilical cord or from anything you do to it.

An “Outie” belly button is determined to be that way at approximately 6 weeks gestation when all of the abdominal contents are outside the body. While the fetus is forming, it performs some amazing and miraculous feats as it turns inside out and folds over on itself many many times. At approximately 6 weeks of pregnancy, your baby’s abdominal contents pass through the hole in the stomach we call the belly button and then, when it is ready, migrates back into the abdomen completing that part of fetal development. When the abdominal contents move back into the body sometimes a little tissue is left on the surface and becomes and “outie” belly button.

There is nothing you can do to change or get rid of an “outie” belly button and Grandma’s recommended belly band & silver dollar does not work. An “outie” belly button is a unique part of your baby’s physical makeup.

Why do some Babies have Flat Heads?

Why do some babies have flat heads? What can a parent do to prevent a flat head in their baby?

An infant’s head is very moldable until approximately 18 months old. That means that the skull bones take on the shape of what gives it the most pressure. The bones are not soft, they are moldable, or influenced by pressure over a long period of time. Babies that spend a lot of time on their back can develop a flatness on the back of their head, or on the sides of their head if they spend a lot of time on one side instead of the other. Since babies spend a lot of time laying down and do not have very good control over their head, the point of maximal pressure on a baby’s head is most likely the back part of it.

The shape of the skull does not affect brain function or future intelligence. It is purely cosmetic. However, there is an infrequent medical condition called craniosynostosis that can cause a similar problem with the head. It is a result of an early fusion of the skull bones and will interfere with brain growth. If you are concerned with the shape of your baby’s head, please make an appointment with your pediatric office.

Things you can do to prevent a flat head that results from persistent pressure:

* change your baby’s sleep position so their head does not have pressure on the flat area
* do exercises with your baby on their stomach, showing them pictures of human faces, so they will lift up on their arms & lift their head (this also strengthens the arms & shoulders)
* hold your baby upright against your chest, keeping your baby’s head away from laying on your arm
* if all else fails and the flatness is severe, there are craniofacial clinics that will fit your baby with a helmet that puts pressure of the opposite sides of the flatness and not on the flatness itself. This is something that must be prescribed by your doctor.

In the long run, unless the flatness on your baby’s head is from craniosynostosis, the shape of your baby’s head will not be noticed or be a problem when they get older when their hair is completely in & covering the area.

Why Do Babies Cry?

When babies cry, what do they want? Are they hurt? For infants, crying is a survival mechanism and a means of communication. When they cry, babies act upset with kicking their legs and flailing their arms. We have been conditioned to believe that a baby’s cry means there is something terribly wrong and can cause new parents to feel inadequate. The reasons why babies cry are:

* when they are hungry
* when they need their diaper changed
* when something is hurting
* when they are over stimulated
* when they want to be picked up
* when they sense that their parents are nervous about handling them
* when they don’t like what you just did to them
* when they are restrained, for example, in a car seat

Since babies have not learned delayed gratification (waiting for things), they can cry for a long time until they get what they want. The intensity of the cry and the length of time spent crying is dependent on your baby’s personality. Demanding babies will not take no for an answer while other babies just lay there and wait for someone to take care of them. Normal babies cry about three hours a day. If you are not sure if your baby is crying too much, keep a brief log for 48 hours of when your baby cries and for how long. It may also be helpful to log the time and amounts of your baby’s feedings and wet & stool diapers. Add up the amount of time of crying in a 24 hour period to see whether your baby is crying an appropriate amount of time. If they are crying much more than three hours in a 24 hour period, make an appointment with your Pediatrician or Nurse Practitioner as there are some more worrisome reasons that your baby could be crying so much.

Calm Your Crying Baby

There are many calming techniques for infants. Finding the right techniques for your baby depends on their unique personality and needs. Most importantly, babies can sense when there parents are nervous and unsure of themselves and react with fussiness. If you are not comfortable then they most certainly won’t feel comfortable! Relax…and enjoy this time with your baby.

Babies have a reflex with their arms called the Moro reflex in which they fling their arms out. All babies have this reflex with some being stronger than others. This reflex is active until four months old when it disappears. Many babies have repeated Moro reflex movements, which is involuntary movement. These movements can wake a baby from a deep sleep or prevent them from feeling comfortable laying down on their own. The way to intervene would be to swaddle your baby. Use a “stretchy” blanket for better results & place it in a diamond shape, folding one of the corners down slightly. Place your baby’s head at the folded down part of the blanket. Straighten your baby’s arms so they are each laying against their side and wrap one side corner of the blanket over baby and under the arm on the other side. Do the same for the other side and then fold up the bottom. Many babies will be calm and relaxed wrapped up like this.

Another thing that will calm infants is sucking, which not only fulfills a functional nutritional need but also fulfills the need to feel comfortable and “organized.” Give your fussy baby a pacifier and let them suck on it when you are not feeding them. Keep in mind that infants cannot always hold the pacifier in their mouths and will push it out. This is due to the tongue thrust that is needed at this age for feeding. So, if your baby spits the pacifier out it many not necessarily mean that they didn’t want it. Put it right back in for them! Sucking is very calming for many infants.

Many infants respond to motion as a calming technique. A swing, rocking chair, car ride or infant seat on top of the clothes washer (of course, with you there & them buckled in) calm many babies. These repeated motions “rock” the baby and distract them away from what they were upset about.

Crossed Eyes in Babies

If your baby is younger than 6 months and you have noticed that their eyes are crossed sometimes, relax. Most babies do not use both of their eyes together until about six months old. It is completely normal for a baby to have one eye that goes off to the side or turn inward up to the age of six months because the brain is not programmed for binocular vision. The brain tells the eyes to work together around this age and this is when vision improves dramatically for infants. This usually occurs intermittently.

Some babies do have a condition called esotropia (eyes turning inward) or exotropia (eyes turning outward). This is caused by a problem with the eye muscles and must be corrected surgically if the vision is to develop normally. Most babies with these types of eye problems have it persistently instead of intermittently and need to be treated by a pediatric opthamologist.

Babies Can See??

Newborn babies can see at birth. They cannot see very clearly but they can see. Their vision is approximately 20/200 which allows them to see outlines and high contrast. They see most clearly, ironically, from the mother’s breast to her eyes, about 12 inches. This helps the baby bond with their mother and other caregivers.

Babies are attracted to human faces, black and white and highly patterned things. When babies look at you, they seem to look above your eyes at your forehead but what they are really doing is looking at the contrast of your forehead and your hairline. Eye contact and smiling will come later.

Play some vision games with your baby. Get a few magazines that have pictures with faces on them that are at least 6 inches tall. Lay your baby on their back and hold the picture about 6-8 inches from the baby’s eyes. What you will see is the baby opening their eyes wide as they look at the picture and becoming really still. Their attention span is not very long, usually 30 seconds, but they can go longer if they are really interested. Change pictures to keep your baby interested and include pictures that include different facial expressions, those wearing glasses and faces of people with different ethnicity. Babies are attracted to all of these differences!

Infant Belly Button Go Away!

Most new parents can't wait for their baby's umbilical cord to fall off. Parents are afraid to touch it, move it & clean it. You can make the cord fall off sooner if you follow these suggestions.

• be aggressive in cleaning the umbilical cord with alcohol by using several of the alcohol pads at a time or with a cotton ball & rubbing alcohol (using a qtip or gingerly wiping only the top part of the cord will not do anything!)
• being aggressive in cleaning the cord means pulling the cord up and exposing the moist tissue at the base where it connects to the body and dripping alcohol into that area
• clean the umbilical cord with alcohol every single diaper change
• fold the diaper under and below the umbilical cord so it will not get wet from urine
• wait to put your baby in bath water until after the cord falls off and these is not any discharge from the umbilical area for 4-5 days
• do not cover the umbilical area as it will retain moisture

The purpose of using rubbing alcohol is to dry out the cord and to prevent infection. If your baby's umbilical cord has not fallen off by three weeks old, make an appointment to see your pediatric office.

Breast-feeding - A Story of Supply & Demand

Did you know that breastfeeding works on the law of supply & demand? Your baby tells your body exactly what they need…try not to interfere with this process. There are several different ways a baby communicates to their mother that they need more milk. First, by being insatiably hungry for 2-3 days, a baby tells it’s mother that they need to eat constantly & this increased feeding sends a relay to the mother’s brain to increase the milk supply. Secondly, if babies need more milk and they are not getting it at the feeding, they will attempt to eat more frequently. Sometimes, well meaning mothers begin to feel as if they are not making enough milk for their baby and begin to supplement with formula. What actually is happening though, is that human nature is just trying to regulate things on it’s own. The best thing you can do is allow your baby to eat more frequently and 2-3 days later they will settle back into a routine with your breasts making enough milk to their increased needs.

Did you know that your breasts are on a 24-hour clock? Your breasts “know” what times of day your baby feeds and automatically makes milk for that time. Your body also knows if you miss a feeding and will not make as much milk the next day at that specific time. Consistency is important, especially if you have a hectic or irregular schedule. Mothers that are trying to balance home & work are especially impacted by this. An example will help to explain this better. If you wanted to only breastfeed at 1pm every day, your breasts would learn not to fill up except for that time of day! Isn’t that amazing?

Wait to Take Baby Out in Public

Many new parents have misperceptions of when they can safely take their newborn infant out in public. It is a commonly held belief that once the infant has received their first set of shots that they are protected and can go out in public. Unfortunately, this is not true.

Infants are born with an immune system that is unexperienced to illness. Their system relies on immunity from their mother for the first 4-6 months of life but only if the infant was born after 36-37 weeks. This kind of immunity is called “passive placental immunity” and helps the infant to only fight illness that the mother has developed immunity to such as a recent cold or chicken pox. Infants that are breast fed receive additional immunity from their mother’s milk that continues as long as breast feeding is continued. Even in a perfect world, an infant can become sick from being exposed to someone who is ill. A bad cold for an adult or young child is a bad cold…but this could result in a serious infection for an infant that requires hospitalization.

Infants receive their first set of vaccines at age 2 months. The severe diseases they are immunized against include diptheria, pertussis, tetanus, haemophillis influenza B, pneumococcus, polio, hepatitis B and rotovirus. These are only some of the illness that infants can contract but are among the most severe. Other illnesses, both bacterial and viral, can cause several illness in infants. One example is bronchiolitis that is caused by a respiratory virus that attacks the lower respiratory tract in infants causing severe asthma-like symptoms. Hospitalization may be required to help the infant breathe properly and to get enough oxygen. So having immunizations is not the answer to keeping your infant completely healthy.

Protecting your infant from illness should be a high priority for new parents. Here are several tips for preventing illness:

• limit visitors & only to those that are not sick
• prevent children from touching the baby & definitely do not allow them near the baby if they are coughing or sneezing
• do not allow too many people to hold the baby
• do not take your infant out in public places where there could be a lot of people
• it is ok to take your baby for a car ride or out in the stroller for a walk
• wash your hands with antibacterial soap & ask visitors to do the same
• breastfeed your baby to provide them with passive immunity
• if you have another child who is sick, ask family members to take them for you or isolate mother and baby in the bedroom and have dad take care of the sick child

Do not be persuaded by assertive relatives and friends to be near your infant if they are sick. Remember, you are the ones that will have to deal with a sick baby and possible hospitalization.