Mayo Clinic, guide to your baby's first years. Second edition.

Written by Dr. Walter J. Cook M.D. and Dr. Kelsey M. Class M.D.

Part 1. Caring for your child.

Chapter 1. Welcome to Parenthood.

Congratulations! You are now entering one of the greatest phases of your life. Parenthood.

There is perhaps nothing in life more special than the bond that forms between a parent and a child. It's a relationship that will bring endless years of joy, laughter, admiration, and satisfaction. The time you spend raising your child will be time that you will cherish forever.

In the years to come, you'll learn more about attachment, love, and protectiveness than you ever thought possible. But be prepared that not every day in your parenthood journey will be grand and glorious. Like everything else in life, there will be ups and downs. You may find that some of the more stressful and exhausting days of being a parent will come early on when you first bring your new self-care to life.

First bring your new son or daughter home.

Bringing a baby into your house can literally turn your life upside down.

The routine you once knew, having time to yourself, getting together with friends, going out for a relaxing dinner, or spending the day indulging in your favorite hobby, has been put on hold. In its place is a reality that may feel totally foreign to you. That's because children don't arrive with instruction manuals, but parenting is somewhat of a trial by a friar experience.

If you've never had to care for a young child before, you may feel nervous, unsure of yourself, and a bit lost. That's to be expected and is perfectly normal.

Parenting 101

Many parents describe their first year with a new baby as a roller coaster ride. As one new mom put it, "One minute you're laughing and joking, the next minute you're crying, not really knowing why."

You may go from adoring your baby and marveling at tiny fingers and toes to grieving your loss of independence and worrying about your ability to care for a newborn, all in the space of a single diaper change.

Given all these changes, the first few weeks after you bring your baby home are likely to be one of the most challenging times of your life. The changes in the daily rhythms of your life can feel chaotic, but you will learn to adapt. It may take months or even more, but you'll get there in your own way, in your own time, and with your own missteps and triumphs.

Relish the time

As chaotic as it may seem, this is a special time in your life. Appreciate the joy your son or daughter brings to your life. And don't let your worries overshadow your joys.

Baby days won't last long. Step back and appreciate the moment. For all the strain associated with these first years, parenthood brings an incredible richness to daily living.

Nothing can quite compare to the joy of meeting a newborn's gaze or accompanying the wobbly first steps of a toddler.

Trust your instincts

Caring for a child may be totally new territory for you, but have confidence in yourself. You'll quickly learn the things you need to know to take great care of your child. Also, realize that you aren't expected to know it all.

It's okay to ask questions and seek guidance from friends, family, and medical professionals. If you get unsolicited advice, take the advice that fits with your parenting style and feel free to forget the rest.

Check your expectations

Many new parents start out with unrealistic expectations that life won't be much different from before. That parenting is going to be fun every minute of the day, that the new baby will mostly eat and sleep, that they'll be able to manage everything perfectly. The gap between expectations and reality can lead to stress and disappointment.

Throw out any preconceived notions about what life with a little one should be like and be realistic about the increased demands on your time.

That cute little 8-pound addition to your household can create a lot of extra work.

Be patient

For the first few weeks, your life may seem limited to round-the-clock feeding, bathing, diapering, and soothing. All on shortened amounts of sleep. You may find it difficult to fit in a shower and do a load of laundry, let alone make dinner. You may fear this is what your life is going to be like forever. It won't be.

Soon, your baby will be a toddler, and increased mobility, conversation, and independence will bring new adventures. Over time, you'll adjust to each new normal, revive old routines, and create new ones.

As your child grows older, you'll find you have a little more time for yourself.

Take care of yourself

Childhood care also extends to parents. Taking good care of your child includes taking good care of yourself. The better you feel, the better able you'll be to care for and enjoy your son or daughter.

Get as much rest as you can. Eat well and fit in some exercise. Most of all, don't be afraid to ask for help when you need it.

Cherish relationships

Children, while wonderful, can be hard on other relationships in your life. If you're starting the parenting journey with your spouse or partner, you may miss your life as just 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 partner. Take time to admire his or her relationship with your child, and you will likely find great inspiration, not only as a parent, but also as a couple.

This book

As you maneuver the ins and outs of parenting, a little guidance and reassurance can be of great help. Mayo Clinic Guide to Your Baby's First Years is designed to help you find answers to common questions during the first three years of a child's life. The book is also intended to provide you with reassurance that you're doing well and that the emotions and concerns you may be experiencing are the same as those of many other parents.

Dig in by whatever manner works best for you. You can turn the page and begin reading, or you can selectively choose those chapters or sections that are most important to you right now. Keep the book handy so that you can turn to it whenever a concern arises, or prepare yourself for the months and years ahead.

Remember that parenting is an adventure. Enjoy the journey.

Chapter 2

Baby's First Days

From the moment you first learned you would have a child, you've been eagerly anticipating the day you could hold your baby and look into his or her face. And now, that day is here. Labor and delivery, or perhaps a lengthy adoption process, is behind you. Now you can finally get to enjoy that precious little person you've been waiting so long to meet.

Sometimes the mental picture you've had of your first moments with your baby doesn't exactly match up with reality. Truth is, newly born babies tend to look a bit messy when they emerge, and you may be exhausted and overwhelmed by the birthing process. Don't worry. Give yourself a moment to take it all in.

In this chapter, you'll learn what to expect during your newborn's first few weeks of life at home, from bonding opportunities to what newborns typically look like. You'll also learn about standard examinations, procedures, and screenings, and about some of the common conditions seen in newborns.

Baby bonding

As soon as a baby is born, he or she is ready to be held, cuddled, stroked, kissed, and talked to. These everyday expressions of love and affection promote bonding to the parent. They also help a baby's brain develop. Just as an infant's body needs food to grow, his or her brain benefits from positive, emotional, physical, and intellectual.

Relationships with other people early in life have a vital influence on a child's development. Some parents feel an immediate connection with their newborn, while for others, the bond takes longer to develop. Don't worry, or feel guilty if you aren't overcome with a rush of love at the very beginning. Not every parent bonds instantly with a new baby. Your feelings will become stronger with time.

Bonding moments

During those first few weeks, most of your time with your new son or daughter is likely to be spent feeding him or her, changing diapers, and helping him or her sleep. These routine tasks present an opportunity to bond.

When babies receive warm, responsive care, they're more likely to feel safe and secure. For example, as you feed your baby and change diapers, gaze lovingly into his or her eyes, and talk gently to him or her.

Babies also have times when they're quietly alert and ready to engage and learn. These times may last only a few moments, but you'll learn to recognize them. Take advantage of your baby's alert times to get acquainted and play.

Cuddle and touch your baby

Newborns are sensitive to changes in pressure and temperature. They love to be held, rocked, caressed, cradled, snuggled, kissed, padded, stroked, massaged, and carried. Don't worry about spoiling your newborn. Respond to your child's cues and clues warmly and promptly.

Among the signals babies send are the sounds they hear, the sounds they hear, and the sounds they hear. Don't worry about spoiling your newborn. The baby's child can be daunting, discouraging, thrilling, and perplexing, all in the same hour.

In time, your skills as a parent will grow, and you will come to love this little one far more than you could have imagined.

Serve and Return

Every day, face-to-face interactions, what some experts call serve and return moments, such as when your baby looks at you and you gaze back are the best way to stimulate and build the nerve connections and pathways in your baby's brain.

Evidence suggests that these early connections help a child grow and thrive, even in the midst of stress. Talk, read, and sing to your baby. Early conversations encourage social and emotional development and provide an opportunity for closeness.

Baby's Looks

Considering what they've been through during childbirth, it's no wonder newborns don't look like those seen on television or on social media. Instead, your newborn may emerge wrinkled and ruddy.

If your baby is like most, his or her head may be a bit misshapen and larger than you expected, and the eyelids may be puffy. His or her arms and legs may be curled in, and the hands and feet may be bluish or purplish in color. He or she may be somewhat bloody and likely wet and slippery from amniotic fluid.

In addition, most babies will be born with what looks like skin lotion, called vernex. It's most noticeable under your baby's arms, behind the ears, and in the groin. Most of this vernex will be washed off during your baby's first bath.

Head

At first, your baby's head may appear flat, elongated, or crooked. This particular elongation is one of the common features of a newly born baby.

A baby's skull consists of several sections of bone that are flexibly joined so that the head shape can change to correspond to the shape of your pelvis as your baby moves through the birth canal during childbirth.

A long labor usually results in an elongated or tall skull shape at birth. The head of a breech baby may have a shorter, broader appearance. If a vacuum extractor was used to assist in the birth, your baby's head may look particularly elongated. Sometimes you can feel ridges on your baby's head where the sections of bone have overlapped.

As your baby's head shape normalizes over the first few days, these ridges will go away, and your baby's head will take on a more rounded appearance.

Fontanels

When you feel the top of your baby's head, you'll notice two soft areas. These soft spots, called fontanels, are where your baby's skull bones haven't grown together yet. The fontanel, toward the front of the scalp, is a diamond-shaped spot, roughly the size of a quarter. Though it's usually flat, it may bulge when your baby cries or strains. By the time your child is two years old, this fontanel will be filled in with hard bone.

The smaller fontanel at the back of the head is less noticeable. This fontanel is about the size of a dime, and it closes much quicker, around six weeks after birth. Some parents are anxious about touching baby's soft spots, partly because they don't like the way they feel. Don't worry, you won't hurt your baby if you do touch a fontanel.

A rounded swelling of the scalp is usually seen on the top and back of the baby's head when a baby is born head first. This puffiness disappears within a day or so.

Skin

Most babies are born with some bruising, and skin blotches and blemishes are common. Pressure from your pelvis during labor can cause a bruise on your baby's head. The bruise may be noticeable for several weeks, and you might feel a small bump that persists for several months.

You may also see scrapes or bruises on your baby's face and head if forceps were used during delivery. These bruises and blemishes generally go away within a couple of weeks.

The top layer of a newborn skin flakes off shortly after birth. You may notice plenty of dry, peeling skin the first few weeks. In general, this gets better on its own. In the meantime, apply some petroleum jelly to baby's skin.

Evidence suggests that daily moisturizing of a baby's skin during the first six months of life can help prevent the development of eczema. Petroleum jelly is generally the most cost-effective, but other emollients such as aquafore or creams such as setafil or fannacreme also work.

There are other common newborn skin conditions such as melia and baby acne.

Birthmarks.

Contrary to their name, birthmarks aren't always present at birth. Some, such as a hemangioma, develop weeks later, and though most are permanent, a few types fade as a child grows. Most birthmarks are harmless, but some may be treated for cosmetic reasons or because of rapid growth or risk of future health problems.

Salmon patch.

A salmon patch, sometimes called a stork bite, is a reddish or pink patch that's often found just above or below the hairline at the back of the neck. The medical term is "nevis simplex." Salmon patches may also be found on the eyelids, forehead, or upper lip. These marks are caused by collections of tiny blood vessels, capillaries, close to the skin.

Salmon patches on the forehead, eyelids, or between the eyes usually fade with time, though they may flare with increased blood flow to the head, such as when crying, straining, or pushing. Salmon patches on the nape of the neck may not fade, but they're often covered by hair. Salmon patches don't require any type of treatment.

Dermal melanosis.

Dermal melanosis is a typically harmless, large, blue-grey birthmark that's sometimes mistaken for a bruise. It's more common in babies of Asian, African, or Hispanic backgrounds, and typically appears on the lower back. This birthmark usually disappears later in childhood and doesn't require treatment.

Café au lait spot.

As the name implies, these birthmarks are light brown or coffee-colored. Café au lait birthmarks are very common, and they can occur anywhere on the body. They're usually permanent but don't require treatment. However, if your child has more than six Café au lait spots, ask his or her medical provider whether further evaluation might be warranted.

Hamanjioma.

Hamanjiomas are caused by an overgrowth of blood vessels in the top layers of skin, usually not present at birth. A homangioma may begin as a small, pale spot that becomes red in the center. The birthmark enlarges during the baby's first few months and appears as a bright red raised spot. It most often disappears without treatment by school age.

Large Hamanjiomas may cover an entire segment of the face or body. Some fast-growing Hamanjiomas may require laser treatment or medication. Babies with several Hamanjiomas or Hamanjiomas at certain locations may need evaluation for an underlying condition.

Congenital Nevis.

A congenital nevis is a large, dark-colored mole that typically appears on the scalp or trunk of the body. It can range in size from less than half of an inch to more than five inches across, covering large areas. Children with a large size congenital nevis are at an increased risk of developing skin cancer as adults. If your child has this type of birthmark, talk with your child's medical provider so that he or she can check for skin changes.

Port Weinstein.

A Port Weinstein is a permanent birthmark that starts out pink but turns darker red or purple as a child grows. Most often a Port Weinstein appears on the face and neck, but it can affect other areas. The involved skin may thicken and develop an irregular pebbled surface. The condition can be treated, often with laser therapy.

Facial Appearance.

When you first look at your baby, his or her nose may seem flattened. This is from pressure inside the birth canal. Within a day or two, the nose will take on a more rounded appearance. His or her cheeks may also have marks or bruises if forceps were used during the delivery. This too will improve in a short time.

Eyes.

It's perfectly normal for your newborn's eyes to be puffy. Some infants have such puffy eyes that they aren't able to open their eyes wide right away. This will improve within a day or two.

You may also notice that your baby sometimes looks cross-eyed. This too is normal, and your child will outgrow the condition within several months.

Sometimes babies are born with red spots on the whites of their eyes. These spots result from the breakage of tiny blood vessels during birth. The spots are harmless and they won't interfere with your baby's sight. They generally disappear in a week to two.

Like a newborn's hair, his or her eyes give no guarantee of their future color. Although most newborns have dark bluish-brown, blue-black, grayish-blue, or slate-colored eyes, permanent eye color may take six months or even longer to establish itself.

Hair.

Your baby may be born bald or with a full head of thick hair or almost anything in between. Don't fall in love with your baby's hair too quickly. The hair color your baby is born with isn't necessarily what he or she will have six months down the road.

Blonde newborns, for example, may become darker blonde as they get older, or their hair may develop a reddish tinge that isn't apparent at birth. You may be surprised to see that your newborn's head isn't the only place he or she has hair.

Downy, fine hair called lanugo covers a baby's body before birth and may temporarily appear on your newborn's back, shoulders, forehead, and temples.

Most of this hair is shed in the uterus before the baby is born, making lanugo especially common in premature babies. It disappears within a few weeks after birth.

First examination.

From the moment your little one is born, he or she is the focus of everyone in the room. Often, your medical team will ask you about your preferences after delivery. If your baby appears well, he or she may be placed directly on your chest and covered with a blanket.

Alternatively, the medical team may wipe your baby clean, suction his or her mouth and nose, and check his or her heart rate. Sometimes, babies need to be brought to a warmer in the delivery room for a more thorough examination right after delivery.

All newborns look somewhat bluish gray for the first several minutes, especially on their lips and tongue. Within 5 to 10 minutes, they become pinker, though baby's hands and feet may still remain bluish, which is normal.

Your baby's umbilical cord is clamped with a plastic clamp, and you or your partner may be given the option to cut it.

In the next day or two, the medical team will conduct newborn examinations, administer screening tests, and give some vaccines and preventative treatments designed for newborns.

Apgar score.

One of the first examinations of your baby will be done to determine his or her apgar score. An apgar score is basically a quick evaluation of a newborn's health, which is given at 1 minute and 5 minutes after a baby is born.

Developed in 1952 by anesthesiologist Virginia Apgar, this brief examination rates newborns on 5 criteria – color, heart rate, reflexes, muscle tone, and respiration. Each of these criteria is given an individual score of 0, 1, or 2. The scores are totaled for a maximum possible score of 10. Higher scores indicate healthier infants, but don't get too caught up in the numbers.

Your medical provider will tell you how your baby is doing, and even those babies with lower scores often turn out to be perfectly healthy.

Other checks and measurements.

Soon after birth, your newborn's weight, length, and head circumference are measured. Your baby's temperature may be taken, and breathing and heart rate measured. Usually within 12 hours after birth, a physical exam is conducted to detect any problems or abnormalities.

Your child's blood sugar, glucose, also may be checked within the first hour or two after birth. Especially if your baby is somewhat larger or smaller for his or her age, or if he or she seems overly sleepy or has trouble getting started eating. A baby whose blood sugar is too low may be more sleepy than what's usual and won't feed well. Assistance may be given to encourage eating and improve the baby's blood sugar.

Treatments and vaccinations.

The following steps are generally taken shortly after birth to prevent diseases and conditions that may occur in newborns.

Eye protection.

To prevent the possibility of infections being passed from mothers to babies, all states require that infant's eyes be protected immediately after birth.

Gonorrheal eye infections were a leading cause of blindness until early in the 20th century, when treatment of baby's eyes after birth became mandatory.

An antibiotic ointment or solution is placed onto the baby's eyes. These preparations are gentle to the eyes and cause no pain.

Vitamin K injection.

In the United States, vitamin K is routinely given to infants shortly after they're born. Vitamin K is necessary for normal blood coagulation. The body's process for stopping bleeding after a cut or bruise.

Newborns have low levels of vitamin K in their first few weeks. An injection of vitamin K can help prevent the rare possibility that a newborn would become so deficient in vitamin K that serious bleeding might develop.

This problem is not related to hemophilia.

Hepatitis B vaccination.

Babies can contract hepatitis B from their mothers during pregnancy and birth. Protection against hepatitis B begins with a vaccine given shortly after birth.

Hepatitis B is a viral infection that affects the liver. It can cause illnesses such as cirrhosis and liver failure. Or it can result in the development of liver tumors.

These conditions are more likely to develop in people who are infected with a virus as a child.

Newborn issues.

Some babies have a bit of trouble adjusting to their new world. Fortunately, most of the problems they experience in the first few days after birth are generally minor and soon resolved.

Jaundice.

More than half of all newborn babies develop jaundice, which is a yellow tinge to the skin and eyes. Signs generally develop after the first 24 hours and peak about 5 to 7 days after birth. The condition may last several weeks.

A baby develops jaundice with bilirubin, which is produced by the breakdown of red blood cells, accumulates faster than the liver can break it down and pass it from the body.

Jaundice may occur for a few reasons. Bilirubin is produced more quickly than the liver can handle. The baby's developing liver isn't able to remove bilirubin from the blood. Too much of the bilirubin is reabsorbed from the intestines before the baby gets rid of it in a bowel movement.

Treatment.

All newborns are screened for jaundice, either using a skin sensor or with laboratory testing. Mild jaundice generally doesn't require treatment, but more severe cases can require a newborn to stay longer in the hospital. Jaundice may be treated in several ways.

You may be asked to feed the baby more frequently, which increases the amount of bilirubin passed out of the body via bowel movements.

A doctor may place your baby under a bilirubin light. This treatment called phototherapy is quite common.

A special lamp helps rid the body of excess bilirubin.

Rarely, if the bilirubin level becomes extremely high, intravenous IV fluids or a specialized blood transfusion may be required.

Eating problems.

Whether you choose to breastfeed or bottle feed, during the first few days after your baby's birth, you may find it difficult to interest your newborn in eating. The first feedings can sometimes be difficult. If this is the case, you're not alone.

Remember, your baby is learning, and so are you. See the next chapter for advice on how to reduce the stress of early feedings.

If things aren't going well, or if you're concerned that your baby isn't getting enough nourishment, talk to your baby's nurse or doctor.

Some babies are slow eaters the first few days, but soon they catch on and breastfeed or bottle feed with enthusiasm.

Over the first week, a newborn may lose up to 10% of his or her birth weight, and will typically gain that weight back in the first two weeks of life.

Infection.

A newborn's immune system isn't adequately developed to fight infection. Therefore, any type of infection can be more serious for newborns than for older children or adults.

If things don't seem right, if your newborn seems too fussy or too sleepy, or if your newborn has a fever, a temperature of 100.4 Fahrenheit or higher, don't delay seeking care.

This may mean going to the emergency room if the illness occurs in the middle of the night. Serious bacterial infections, which are uncommon, can invade any organ or the blood, urine, or spinal fluid.

Prompt treatment with antibiotics is necessary, but even with early diagnosis and treatment, a newborn infection can be life-threatening. For this reason, medical providers are often quick to treat a possible or suspected infection.

Antibiotics often are given early and stopped only when an infection doesn't seem likely. Although the majority of the tests results come back showing no evidence of infection, it's better to err on the side of safety by quickly treating a baby than to risk not treating a baby with an infection soon enough.

If a mom tested positive for Group B Strepococcus near the end of her pregnancy or was diagnosed with an infection in labor, this may influence the decision to start the baby on antibiotics in the hospital.

Viral infections can occur in newborns, although they're less common than our bacterial infections. Certain newborn viral infections, such as herpes, ferracella, HIV, and cytomegalovirus, may be treated with antiviral medication.

Hernias. It's not unusual for a baby to be born with a hernia. Hernias can occur either in the groin area, inguinal hernia, or near the belly button, umbilical hernia.

Inguinal hernia. An inguinal hernia is more common in boys than in girls. An inguinal hernia is caused by a weakness in the lower abdominal wall that allows the intestines to bulge forward.

The hernia appears as a swelling in the lower abdomen or groin and is generally painless.

Sometimes the hernia is visible only when an infant is crying, coughing, or straining during a bowel movement.

An inguinal hernia may be small at first, but it tends to gradually enlarge so that an operation is eventually needed to repair the weak spot. An inguinal hernia usually won't go away by itself.

Ambilical hernia. An umbilical hernia occurs when part of the intestine protrudes through an opening in the upper abdominal muscles near the belly button. It may be especially evident when an infant cries, causing the baby's belly button to protrude.

This is a classic sign of an umbilical hernia. Most umbilical hernias close on their own by the time a baby reaches one year old, though some take longer to heal.

Ambilical hernias that don't disappear by age 4 are those that appear later in a person's life may require surgical repair to prevent complications.

Circumcision.

If you have a baby boy, one of the decisions you'll face soon after birth is whether to have him circumcised. Circumcision is an elective surgical procedure performed to remove the skin covering the tip of the penis. Knowing about the procedure's potential benefits and risks can help you make an informed decision.

Issues to consider. Although circumcision is common in the United States, it's still somewhat controversial.

According to the American Academy of Pediatrics, current evidence of the medical benefits of circumcision outweigh the risks. However, the benefits may be low for most baby boys, so it is an elective procedure. Consider your own cultural, religious and social values in making this decision.

For some people, such as those of the Jewish or Islamic faith, circumcision is a religious ritual. For others, it's a matter of personal hygiene or preventive health. Some parents choose circumcision because they don't want their son to look different from his family or peers.

As you decide what's best for you and your son, consider these potential health benefits and risks.

Benefits of circumcision.

Some research suggests that circumcision provides certain benefits. These include decreased risk of urinary tract infections. Although the risk of urinary tract infections in the first year is low, studies suggest that such infections may be up to 10 times more common in uncircumcised baby boys than in those who are circumcised.

Uncircumcised boys are also more likely to be admitted to the hospital for a severe urinary tract infection during the first three months of life than are those who are circumcised.

Decreased risk of cancer of the penis.

While this type of cancer is very rare, circumcised men show a lower incidence of cancer of the penis than do uncircumcised men. Decreased risk of some sexually transmitted infections. Studies have shown a lower risk of human immunodeficiency virus, HIV, human papillomavirus, HPV, and herpes simplex virus, HSV, infections in circumcised men. However, safe sexual practices are much more important in the prevention of sexually transmitted infections than is circumcision.

Prevention of penile problems.

Occasionally, the foreskin on an uncircumcised penis may narrow to the point where it's difficult or impossible to retract, fimosis. A narrowed foreskin can also lead to inflammation of the head of the penis, balanitis.

While circumcision can help prevent these issues, they can still occur from the remaining foreskin in some circumcised boys.

Ease of hygiene.

Circumcision makes it easy to wash the penis, but even if the foreskin is intact, it's still quite simple to keep the penis clean. Normally, the foreskin adheres to the end of the penis in a newborn, then gradually stretches back during early childhood.

Risks of circumcision.

Circumcision is generally considered a safe procedure, but there are some minor drawbacks to consider.

Risks of minor surgery.

All surgical procedures, including circumcision, carry certain risks, such as excessive bleeding and infection. There's also the possibility that the foreskin may be cut too short or too long, or that it doesn't heal properly.

Pain during the procedure.

Circumcision does cause pain. Typically, a local anesthetic is used to block the nerve sensations. Talk to your medical provider about the anesthesia process.

Cost.

Some insurers don't cover the cost of circumcision. If you're considering circumcision, check whether your insurance company will cover it.

Complicating factors.

Sometimes, circumcision may need to be postponed, such as if your baby is born prematurely, has severe jaundice, or is feeding poorly. It also may not be feasible in certain situations, such as in the rare instance when baby's urethral opening is in an abnormal position.

Hypospidias.

Other conditions that may prevent circumcision include ambiguous genitalia or a family history of bleeding disorders.

Circumcision doesn't affect fertility. There's no evidence to suggest that sexual function or satisfaction is negatively affected by circumcision.

Whatever your choice, negative outcomes are rare.

How it's done.

If you decide to have your son circumcised, his medical provider can answer questions about the procedure and help you make arrangements at your hospital or clinic.

Usually, circumcision is performed before you and your son leave the hospital. At times, it's done in an outpatient setting. The procedure itself takes about 10 minutes.

Typically, your son lies on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, a local anesthetic is injected into the base of the penis. A special clamp or plastic ring is attached to the penis, and the foreskin is cut away.

An ointment, such as petroleum jelly, is applied. This protects the penis from adhering to the diaper. If your newborn is fussy as the anesthetic wears off, hold him gently, being careful to avoid putting pressure on the penis. It usually takes about 7 to 10 days for the penis to heal.

Circumcision care.

The tip of your son's penis may seem raw for the first week after the procedure. Or a yellowish mucus or crust may form around the area. This is a normal part of healing.

A small amount of bleeding also is common the first day or two. Clean the diaper area gently, and apply a liberal amount of petroleum jelly to the end of the penis with each diaper change. This will keep the diaper from sticking while the penis heals.

If there's a bandage, change it with each diapering. At some hospitals, a plastic ring is used instead of a bandage. The ring will remain on the end of the penis until the edge of the circumcision is healed, usually within a week.

The ring will drop off on its own.

It's okay to wash the penis as it's healing.

Problems after a circumcision are rare, but call your baby's medical provider in the following situations.

• Your baby has trouble urinating 12 to 18 hours after the circumcision.

• Bleeding or redness around the tip of the penis is persistent.

• The penis tip is significantly swollen.

• A foul-smelling drainage comes from the penis tip, or there are crusted sores that contain fluid.

• The ring is still in place two weeks after the circumcision.

Screening tests

Before your baby leaves the hospital, a small amount of his or her blood will be taken and sent to the State Health Department, or a private laboratory working in collaboration with the State Laboratory. This sample, which may be taken from a vein in your baby's arm, or a tiny nick on the heel, is analyzed to detect the presence of rare but important genetic diseases.

This testing is referred to as newborn screening. The purpose of the testing is to identify babies who might be at risk of unable families to access relevant treatment and resources.

Results are generally available in one to two weeks. Occasionally, a baby needs to have the test repeated. Don't be alarmed if this happens to your newborn.

To ensure that every newborn with any of these conditions is identified, even borderline results are rechecked. Retesting is especially common for premature babies. Each state independently operates its newborn screening program, resulting in slight differences between the tests offered.

Current national recommendations include a panel of tests to check for 35 core disorders and 26 secondary disorders.

Some states check for additional diseases. You also may request a specific genetic test if you feel your child may be at risk of a certain genetic disorder.

Newborn screening

Some of the diseases that can be detected by the panel include

biotinidase deficiency.

This deficiency is caused by the lack of an enzyme called biotinidase. Signs and symptoms of the disorder include seizures, developmental delay, eczema, and hearing loss. With early diagnosis and treatment, all signs and symptoms can be prevented.

Congenital Adrenal Hyperplasia (CAH)

This group of disorders is caused by a deficiency of certain hormones. Signs and symptoms may include lethargy, vomiting, muscle weakness, and dehydration. Infants with mild forms are at risk of reproductive and growth difficulties. Severe cases can cause kidney dysfunction and even death. Lifelong hormone treatment can suppress the condition.

Congenital Hypothyroidism

About 1 in 3,000 babies has a thyroid hormone deficiency that slows growth and brain development. Left untreated, it can result in mental retardation and stunted growth. With early detection and treatment, healthy development is possible.

Cystic Fibrosis

Cystic fibrosis causes the body to produce abnormally thickened mucus secretions in the lungs and digestive system. Signs and symptoms generally include salty tasting skin, poor weight gain, and eventually persistent coughing and shortness of breath. Affected newborns can develop life-threatening lung infections and intestinal obstructions.

With early detection and treatment, infants diagnosed with cystic fibrosis now often live longer and in better health than infants diagnosed in the past.

Galactosemia

Babies born with galactosemia can't metabolize a sugar found in milk, galactos. Although newborns with this condition typically appear otherwise healthy, they may develop vomiting, diarrhea, jaundice, and liver damage within a few weeks of their first milk feedings.

Left untreated, the disorders may result in mental disabilities, blindness, growth failure, and in severe cases, death. Treatment includes eliminating milk and all other dairy products from the diet.

Homo cystinuria

Caused by an enzyme deficiency, Homo cystinuria can lead to eye problems, mental disabilities, skeletal abnormalities, and abnormal blood clotting.

With early detection and management, including a special diet and dietary supplements, growth and development should be normal.

Maple Syrup Urine Disease (MSUD)

This disorder affects the metabolism of amino acids.

Newborns with this condition typically appear healthy, but by the first week of life, they experience feeding difficulties, lethargy, and poor growth.

Left untreated, MSUD can lead to coma or death.

Medium Chain A-SOL CoA D-Hydrogenase (MCAD Deficiency)

This rare hereditary disease results from the lack of an enzyme required to convert fat to energy.

Babies with MCAD deficiency develop serious vomiting, lethargy, that can worsen into coma, seizures, liver failure, and severely low blood sugar.

With early detection and monitoring, the condition can be effectively managed.

Fenylketonuria PKU

Babies with PKU retain excessive amounts of phenylalanine, an amino acid found in the protein of almost all foods.

Without treatment, PKU can cause mental and motor disabilities, poor growth rate, and seizures.

With early detection and treatment, growth and development should be normal.

Sickle Cell Disease

This inherited disease prevents blood cells from circulating easily throughout the body.

Infants with sickle cell disease experience an increased susceptibility to infection and slow growth rates.

The disease can cause bouts of pain and damage to vital organs such as the lungs, kidneys, and brain.

With early medical treatment, the complications of sickle cell disease can be minimized.

Hearing Screening

While your baby is in the hospital, he or she may have a hearing test. Although hearing tests are not done routinely at every hospital, newborn hearing screening is becoming widely available.

The testing can detect possible hearing loss in the first days of a baby's life. If possible hearing loss is found, further tests may be done to confirm the results.

Two tests are used to screen a newborn's hearing. Both are quick, about 10 minutes, and painless, and can be done while your baby sleeps.

One test measures how the brain responds to sound. Clicks or tones are played through soft earphones into the baby's ears, while electrodes taped on the baby's head measure the brain's response.

Another test measures specific responses to sound waves that enter a baby's ear. As clicks or tones are played into a baby's ear, a probe placed inside the ear canal measures the response.

Critical Congenital Heart Defect, CCHD Screening

Before leaving the hospital, your baby will likely also be screened for any heart defects.

Ultrasounds can identify many heart defects during a pregnancy. However, some issues may be missed or cannot be detected until after a baby is born.

For this test, an oxygen sensor, pulse oximeter, is placed on your baby's hands or feet. The test is quick and does not cause discomfort to your baby.

If the oxygen levels are low or different on the right and left sides, your baby's medical provider will most likely recommend additional testing.

Chapter 3 - Feeding Your Baby

If it seems like all you do at first is feed your baby, you know what? You're right. Newborns may not eat a lot, but they eat often. And in those first few weeks with your new son or daughter, much of your life will revolve around satisfying his or her hunger.

Just when you think you have a moment to relax or perhaps fit in a shower, wouldn't you know it? Your little one wants to eat again.

At first, all of these feedings may seem exhausting, for almost every new parent, early days with a newborn, can be demanding and sometimes stressful. Both you and your baby are adapting to a new reality and that typically takes time.

Throughout this adjustment, remember that feeding your newborn is about more than just nourishment. It's a time of cuddling and closeness that helps build the connection between you and your baby.

You want to make every feeding a time to bond with your baby. Cherish this time before your baby is old enough to start feeding himself or herself. That time will come soon enough.

Breast milk or formula

Some families know right from the start what they'll feed their babies. Breast milk or formula, while others struggle.

Most child health organizations advocate breastfeeding and "breast is best" is a commonly used phrase.

There's no doubt breastfeeding is a wonderful way to nourish a newborn. Breast milk provides numerous benefits. Mayo Clinic experts agree.

However, medical providers also realize that not all women are the same and people's life situations are different.

Depending on your circumstances, certain factors may lead you to choose infant formula instead of breast milk. Or you may opt for a combination of both breast milk and formula. Some women simply aren't able to breastfeed.

If you're worried that you're not being a good mother or putting the needs of your child first if you don't breastfeed, don't. Such negative thinking isn't good for you or for your baby.

Feeding, regardless of how it's delivered, breast milk or formula, breast or bottle, promotes intimacy.

Know that both options will provide your child the nutrition he or she needs to grow and thrive.

Questions to ask

If you haven't had your baby yet and you're debating between breast milk and formula, you might consider these questions.

What does your medical provider suggest?

Your medical provider will likely be very supportive of breastfeeding unless you have specific health issues, such as a certain disease or disease treatment that make formula feeding a better choice.

Do you understand both methods?

Many women have misconceptions about breastfeeding. Learn as much as you can about feeding your baby. Seek out expert advice if needed.

Do you plan to return to work?

If so, how will that impact breastfeeding? Does your place of work have accommodations available where you can use a breast pump if that's your plan?

How does your partner feel about the decision?

The decision is ultimately yours, but it's a good idea to take your partner's feelings into consideration.

How have other mothers you trust and respect made their decisions?

If they had it to do over again, would they make the same choices?

Breastfeeding

Breastfeeding is highly encouraged by experts because it has many known health benefits for babies and moms.

The longer you breastfeed, the greater the chances that your baby will experience these benefits, and the more likely they are to last.

Benefits for babies

Breast milk provides babies with ideal nutrition. Breast milk has just the right nutrients and just the right amounts to nourish your baby completely.

It contains the fats, proteins, carbohydrates, vitamins, and minerals that a baby needs for growth, digestion, and brain development.

Breast milk is also individualized. The composition of your breast milk changes as your baby grows.

Protection against disease

Breast milk provides antibodies that help your baby's immune system fight off common childhood illnesses.

Breastfed babies may have fewer colds, ear infections, and urinary tract infections than do babies who aren't breastfed.

Breastfed babies may also have fewer problems with asthma, food allergies, and skin conditions, such as eczema. They may be less likely to experience a reduction in the number of red blood cells, anemia.

Research suggests that breastfeeding might also help to protect against sudden infant death syndrome, SIDS, and it may offer a slight reduction in the risk of childhood leukemia. Breast milk may even protect against disease long-term.

Studies suggest that adults who are breastfed as infants may have a lower risk of heart attack and stroke and may be less likely to develop diabetes.

Protection against obesity

Research indicates that babies who are breastfed are less likely to experience obesity as adults. Formula-fed infants generally have a higher calorie intake than do babies fed breast milk. And breast milk itself appears to have components that help control hunger and energy balance.

Easy digestion

Breast milk is easier for babies to digest than is formula or cow's milk.

Because breast milk doesn't remain in the stomach as long as formula does, breastfed babies spit up less. They have less gas and less constipation.

They also have less diarrhea as breast milk appears to kill some diarrhea-causing germs and helps a baby's digestive system grow and function.

Benefits for moms

For nursing mothers, the benefits include faster recovery from childbirth.

The baby's suckling triggers your body to release oxytocin, a hormone that causes the uterus to contract.

This means that the uterus returns to its pre-pregnancy size more quickly after delivery.

Suppressed ovulation

Breastfeeding delays the return of ovulation and therefore menstruation, which may help extend the time between pregnancies.

However, breastfeeding is not a guarantee against pregnancy. You can still become pregnant while breastfeeding.

Possible long-term health benefits

Breastfeeding may reduce your risk of getting breast cancer before menopause. Breastfeeding also appears to provide some protection from uterine and ovarian cancers.

Convenience

Many mothers find breastfeeding to be more convenient than bottle feeding.

It can be done anywhere, at any time, whenever your baby shows signs of hunger.

Plus, no equipment is necessary.

Breast milk is always available and at the perfect temperature.

Because you don't need to prepare a bottle and you can nurse lying down, nighttime feedings may be easier.

Cost savings

Breastfeeding can save money because you don't need to buy formula and you may not need bottles.

Challenges

Admittedly, breastfeeding can also present some challenges and inconveniences.

Drawbacks to breastfeeding for nursing moms include

Exclusive feeding duties

At first, newborns nurse every two to three hours, day and night.

That can be tiring for you and your partner may feel left out.

But you can also express milk with a breast pump if desired, which can let others take over some feedings.

Certain dietary restrictions

If you're breastfeeding, the general rule is to avoid drinking alcohol before nursing.

The alcohol level in breast milk is basically the same as in your bloodstream.

One standard drink, such as five ounces of wine or 12 ounces of beer,

takes about two to three hours to leave the bloodstream and therefore breast milk.

If you do drink alcohol, wait at least a couple of hours before breastfeeding.

Pumping and dumping, pumping after drinking alcohol and discarding the breast milk

doesn't affect the amount of alcohol in breast milk.

Blood alcohol levels will only go down with time.

Sore nipples

Some women may experience sore nipples and at times breast infections.

These may be avoided with the right positioning and technique.

A lactation consultant or your medical provider can advise you on proper positioning.

Other physical side effects

When you're lactating, your body's hormones may keep your vagina relatively dry

using a water-based lubricating jelly can help treat this problem.

It may also take time for your menstrual cycle to once again establish a regular pattern.

What goes in comes out.

While you're breastfeeding, keep in mind that the foods and other items you ingest

can be passed on to your baby through your breast milk.

A few things to remember while breastfeeding.

Avoid or limit alcohol.

If you do have an occasional drink, keep it to a minimal amount

and do it right after breastfeeding.

Limit caffeine.

Drink mainly caffeine-free beverages.

Check your medications.

Most are safe to take, but consult your baby's medical provider first.

Only rarely do the foods you eat cause your baby to be fussy or gassy.

Babies can get fussy for many reasons and they can experience gas from the air they swallow

when they cry or eat.

However, if you suspect your child may be intolerant to something you ate,

try eliminating the food for a while and see how your baby responds.

Milk production.

As an expectant mother, your milk producing mammary glands prepare for nursing

even before your baby is born.

By about the sixth month of pregnancy, your breasts are ready to produce milk.

Your milk supply gradually increases between the third and fifth days after your baby's birth.

As the milk producing glands fill with milk, your breasts will be full and sometimes tender.

They may also feel lumpy or hard, engorged.

Milk is released from the glands when your baby nurses.

The milk is propelled down milk ducts, which are located just behind the dark circle of tissue

that surrounds the nipple, areola.

The sucking action of the baby compresses the areola, forcing milk out through tiny openings in the nipple.

The baby's sucking stimulates nerve endings in the areola and nipple,

sending a message to the brain to release the hormone oxytocin.

Oxytocin acts on the milk producing glands in the breasts, causing the ejection of milk to the nursing baby.

This release is called the letdown reflex, which may be accompanied by a tingling sensation.

Although your baby's sucking is the main stimulus for the letdown reflex,

other stimuli can have the same effect.

For example, hearing a baby cry, or even thoughts of your baby, or the sounds of rippling water,

may set things in motion.

The timing of this reflex can sometimes be inconvenient if you're not ready to breastfeed at the moment.

Regardless of whether your plan is to breastfeed, your body produces milk after childbirth.

After that, your milk supply is based on demand.

If you decide not to breastfeed, your milk supply eventually goes away.

If you do breastfeed, the more frequently your breasts are emptied, the more milk they produce.

Getting started

The time to begin breastfeeding is right after your baby is born.

If possible, put baby to your breast in the delivery room.

Early skin-to-skin contact is known to improve breastfeeding outcomes.

Breastfeeding may be a natural process, but that doesn't mean it comes easily to all mothers.

Breastfeeding is a new skill for both mom and baby.

Nothing can really prepare your nipples for a nursing baby.

If this is your first child, you may feel uncertain holding your baby,

let alone putting him or her to your breast.

It may take a few attempts before you and your baby get the hang of it.

While you're in the hospital, ask a lactation consultant or nurse to assist you.

These experts can provide hands-on instruction and helpful hints.

After you leave the hospital or birthing center,

you might want to arrange for a public health nurse who is knowledgeable about infant feeding

or a certified lactation consultant to visit you for additional one-on-one instruction.

It's a good idea to take a class on breastfeeding.

Often information on breastfeeding is offered as part of childbirth classes,

or you may be able to sign up for a class.

Most hospitals and birthing centers offer classes on feeding a newborn.

Supplies to have on hand.

If possible, purchase a couple of high-quality nursing bras.

They provide important support for lactating breasts.

What distinguishes nursing bras from regular bras is that both cups open to the front,

usually with a simple maneuver that you can manage unobtrusively while you hold your baby.

You may also want nursing pads, which sit inside the bra to absorb milk that leaks from your breasts.

Options include disposable pads or washable and reusable versions.

Avoid those with plastic shields, which prevent air circulation around the nipples.

Nursing pads can be worn continuously or on occasion.

Some women don't bother with the pads, but most women find them helpful.

Get comfortable.

When it's feeding time, find a quiet location and take advantage of this time with your baby.

Get into a position that's comfortable for both you and baby.

If you're taking a seated position, it helps to sit up straight,

put a pillow behind the small of your back and one under your arms for support.

A nursing pillow that wraps around your body can also make breastfeeding more comfortable by raising your baby to your breast.

Hold your baby across your body so that he or she faces your breast with his or her mouth near your nipple.

Make sure your baby's whole body is facing you, tummy to tummy, with ear, shoulder and hip in a straight line.

Place your free hand up under your breast to support it while squeezing lightly to point the nipples straightforward.

Different women find different nursing positions most comfortable.

Experiment with the positions to see which works best for you.

A good latch.

When your baby connects or latches well to your breast, he or she can nurse effectively and your breast feels little discomfort.

To help your baby get a good latch, hold your baby close and brush your nipple against your baby's cheek to trigger the rooting reflex.

The motion your baby makes while searching for your nipple.

If your baby is hungry and interested in nursing, his or her mouth should open and he or she will turn toward your breast.

When this happens, bring your baby's mouth to your nipple.

You want your baby to receive as much nipple and areola as possible.

And your baby's lips to flare out with chin and cheeks touching your breast.

As your baby starts suckling and your nipple is being stretched in your baby's mouth, you may feel some surging sensations.

After a few suckles, those sensations should subside.

If they don't, or if you have pain, sandwich the breast more and draw baby's head in more closely.

If that doesn't produce comfort, gently remove baby from your breast, taking care to release the suction first.

To break the suction, gently insert the tip of your finger into the corner of your baby's mouth.

Slowly push your finger between your baby's gums until you feel the release.

Repeat the procedure until your baby has latched on properly.

You want there to be a firm bond of suction.

You'll know that milk is flowing and your baby is swallowing if there's a strong, steady, rhythmic motion visible in your baby's cheek.

Also, listen for the "K" sound of your baby's swallowing.

If your breast is blocking your baby's nose, elevating your baby slightly or angling the baby's head back and in may help provide a little breathing room.

If your baby attaches and sucks correctly, even if the arrangement feels awkward at first, the position is correct.

Once nursing begins, you can relax the supporting arm and pull your baby's lower body closer to you.

Feeding Positions

Cross Cradle Hold

Bring your baby across the front of your body, tummy to tummy.

Hold your baby with the arm opposite to the breast you're feeding with.

Support the back of the baby's head with your open hand.

This hold allows you especially good control as you position your baby to latch on.

With your free hand, support your breasts from the underside in a U-shaped hold to align with baby's mouth.

Cradle Hold

Cradle your baby in your arm with your baby's head resting comfortably in the crook of your elbow on the same side as the breast you're feeding with.

Your forearm supports your baby's back.

Use your free hand to support your breast.

Football Clutch Hold

In this position, you hold your baby in much the same way a running back tucks a football under his arm.

Hold your baby at your side on one arm with your elbow bent and your open hand firmly supporting your baby's head face up at the level of your breast.

Your baby's torso will rest on your forearm.

Put a pillow at your side to support your arm.

A chair with broad low arms works best.

With your free hand, support your breast from the underside in a C-shaped hold to align with baby's mouth.

Because the baby isn't positioned near the abdomen, the football hold is popular among mothers recovering from C-sections.

It's also a frequent choice of women who have large breasts or who are nursing premature or small babies.

Side Lying Hold

Although most new mothers learn to breastfeed in a sitting position, at times you may prefer to nurse while lying down.

Use the hand of your lower arm to help keep your baby's head positioned at your breast.

With your upper arm in hand, reach across your body and grasp your breast, touching your nipple to your baby's lips.

After your baby latches on firmly, you can use your lower arm to support your own head and your upper hand and arm to help support your baby.

How Often Should You Nurse?

Because breast milk is easily digested, breastfed babies usually are hungry every few hours at first.

During those early days, breastfeeding may start to feel like a marathon session.

Most newborns eat 8-12 times a day, about every 2-3 hours.

By 6-8 weeks after birth, your baby will probably begin to go longer between feedings.

During growth spurts, your baby may take more at each feeding or when a breastfeed more often.

Trust your body's ability to keep up with the increased demand.

How Long Should A Nursing Session Be?

In general, let your baby nurse as long as he or she wants.

The length of feedings may vary considerably.

However, on average, a nursing session may take about half an hour for most babies.

Offer your baby both breasts at each feeding.

Allow your baby to end the feeding on the first side.

Then, after burping your baby, offer the other side.

Alternate starting sides to equalize the stimulation each breast receives.

You want baby to finish one breast before switching to the other side

because the milk that comes first from your breast, called the floor milk, is rich in protein for growth.

But the longer your baby sucks, the more he or she gets the hind milk, which is rich in calories and fat,

and therefore helps your baby gain weight and grow.

So wait until your baby seems ready to quit before offering him or her your other breast.

Is My Baby Getting Enough?

A baby's need for frequent feeding usually isn't a sign that baby isn't getting enough.

It more likely reflects the easy digestibility of breast milk.

If your baby is satisfied after feeding and is growing, you can be confident that you're doing well.

If you're concerned that baby may not be getting enough milk, ask yourself,

Is Baby Gaining Weight?

Steady weight gain is often the most reliable sign that a baby is getting enough to eat.

Although most babies lose weight soon after birth, it's typically regained, and then some, within 10 days to 2 weeks.

Can I Hear Baby Swallowing?

Listen carefully and you'll be able to hear your baby swallowing.

Also, look for a strong, steady, rhythmic motion in your baby's lower jaw,

or even a bit of milk dribbling out of your baby's mouth.

How Do My Breasts Feel?

When your baby is latched on successfully, you'll feel a gentle pulling sensation on your breast,

rather than a pinching or biting sensation on your nipple.

Your breasts may feel firm or full before the feeding, and then softer or emptier afterward.

What About Baby's Diapers?

By the fourth day after birth, expect your baby to have 6-8 wet diapers a day.

Also expect regular bowel movements.

The stool will be dark and sticky for the first couple of days, eventually becoming seedy, loose, and golden yellow.

Does Baby Seem Healthy?

A baby who seems satisfied after feedings and is alert and active at other times is likely getting enough milk.

Also, look for a healthy skin tone.

Breast Care

As you start to breastfeed, you may experience some occasional problems.

Though these can be uncomfortable, they often go away with time, or can be easily treated.

Fullness

A few days after your baby is born, your breasts may become full, firm, and tender,

making it challenging for your baby to grasp your nipple.

This swelling, called engorgement, also causes congestion within your breasts, which makes your milk flow slower.

So even if your baby can latch on, he or she may be less than satisfied with the results.

To manage engorgement, express some milk using a breast pump, or by hand, before trying to breastfeed.

Support with one hand the breast you intend to express.

With your other hand, gently stroke your breast inward toward your areola.

Then place your thumb and forefinger at the top and bottom of the breast, just behind the areola.

As you gently compress the breast between your fingers, milk should flow or squirt out of the nipple.

Making a warm shower also may result in letdown of milk and provide some engorgement relief.

You can also use a breast pump to express some milk.

As you release your milk, you'll begin to feel your areola and nipple soften.

Once enough milk is released, your baby can comfortably latch on and nurse.

Frequent lengthy nursing sessions are the best means to avoid engorgement.

Nurse your baby regularly and try not to miss a feeding.

Wearing a nursing bra both day and night will help support engorged breasts and make you feel more comfortable.

If your breasts are sore after nursing, apply an ice pack to reduce swelling.

Some women find that a warm shower also relieves breast tenderness.

Fortunately, the period of engorgement is usually brief, lasting no more than a few days after delivery.

Nipple Discomfort

At first, you may experience some initial nipple discomfort as baby latches on, but the discomfort should subside as your baby feeds.

For some women, though, breastfeeding can be downright painful.

If so, the first step is to check that your baby is latching on correctly.

Sore or cracked nipples are usually caused by incorrect positioning and latching.

At each feeding, you want to make sure that the baby has the areola and not just the nipple in his or her mouth.

You also want to be certain that your baby's head isn't out of line with his or her body.

This position causes pulling at the nipple.

To care for your nipples, express milk onto your nipples and let them air dry after each feeding.

You don't need to wash your nipples after nursing.

There are built-in lubricants around the areola that provide a natural salve.

Soap and water with daily bathing is fine.

Afterward, let your nipples air dry.

Blocked Milk Ducks

Sometimes, milk ducks in the breast become clogged, causing milk to back up.

Blocked ducks can be felt through the skin as small, tender lumps or larger areas of hardness.

Because blocked ducks can lead to an infection, you should treat the problem right away.

The best way to open up blocked ducks is to let your baby empty the affected breast,

offering that breast first at each feeding.

If your baby doesn't empty the affected breast, express milk from it by hand or by breast pump.

It may also help to apply a warm compress before nursing and to massage the affected breast.

If the problem doesn't go away with self-treatment, call a lactation consultant or your medical provider for advice.

Breast Infection

Infection, mastitis, can occur if some milk remains in your breast after feedings.

Infection may also result when germs gain entry into your milk ducks from cracked nipples and from your baby's mouth.

These germs are not harmful to your baby. Everyone has them.

They just don't belong in your breast tissues.

Mastitis starts with flu-like signs and symptoms such as a fever, chills and body aches.

Redness, swelling and breast tenderness then follow.

If you develop such signs and symptoms, call your medical provider.

You may need antibiotics in addition to rest and more fluids.

Keep nursing if you're taking antibiotics.

Treatment for mastitis doesn't harm your baby and emptying your breast during feedings will help to prevent clogged milk ducks.

Another possible source of mastitis.

Applying cold compresses to your breasts after feedings can help soothe swelling.

Your medical provider may also recommend taking an over-the-counter pain reliever.

Support

If you're having problems breastfeeding or you're worried that baby isn't getting enough milk, ask for help.

If you sense something isn't right or if breastfeeding seems too painful, don't be afraid to contact your baby's medical provider or a lactation consultant.

Most hospitals have lactation consultants on staff who can answer your questions or help you resolve any problems you may encounter.

Breastfeeding may feel awkward at first, but you'll get the hang of it.

Friends who've breastfed may have valuable insights and provide needed support.

You might also consider seeking out a lactation consultant in your area.

Look for someone with an international board-certified lactation consultant, IBCLC, credential.

Vitamin D

Talk with your baby's medical provider about vitamin D supplements for your baby.

Breast milk likely won't provide enough vitamin D, an infant formula may not either.

Your baby needs vitamin D to absorb calcium and phosphorus.

Too little vitamin D can cause rickets, a softening and weakening of bones.

Since sun exposure, an important source of vitamin D, isn't recommended for babies younger than six months,

supplements are the best way to prevent vitamin D deficiency in infants.

The American Academy of Pediatrics recommends that babies who are breastfed or formula-fed

receive 400 international units, IU, of liquid vitamin D a day, starting in the first few days after birth.

Continue giving your baby vitamin D as long as you breastfeed.

If you're using infant formula, continue giving vitamin D supplements until your son or daughter drinks at least 32 ounces of formula a day.

As your baby gets older and you add solid foods to his or her diet, you can help your baby meet the daily vitamin D requirement

by providing foods that contain vitamin D, such as eggs and fortified foods,

although most babies won't consistently eat these foods during their first year.

After age 12 months, you can also offer whole cow's milk.

When giving your baby liquid vitamin D, make sure you don't exceed the recommended amount.

Carefully read the instructions that come with the supplement and use only the dropper that's provided.

Going back to work.

With a little planning and preparation, you can do both, breastfeed and return to work.

Some nursing mothers work from home while some arrange to have their babies brought to them for feedings or they go to their babies.

Most, though, rely on the help of a breast pump.

Using a double breast pump is the most effective way to pump.

A double breast pump requires about 15 minutes of pumping every 3 to 4 hours.

If you need to increase your milk supply, nurse and pump more often.

Some women pump primarily at home.

You might pump after the morning feeding and after the feeding when you return from work.

As long as all of your milk produced in 24 hours is removed either by your baby or from pumping, you'll maintain a good supply.

Many women also pump while at work, storing the milk and saving it for the next day.

If you're planning to pump at work, talk to your employer as early as possible.

Ask about access to a clean private space, not a bathroom, with a comfortable chair and an outlet.

You'll also need a cooler bag, refrigerator or freezer in which to store expressed milk and a place to rinse out pump parts.

For the most part, employers are becoming more aware of the needs of working mothers and are willing to work together to help new moms stay productive.

Weaning

There will come a time when it's best for baby and you to transition from the breast to a cup.

Your baby is growing up and he or she is ready to take the next big step.

Or if your child is not ready for a cup, you may need to transition your child from the breast to a bottle.

You may have mixed emotions about weaning, but you can smooth the transition by taking a gradual approach and offering plenty of love and affection.

Choose the right time and do what you can to make it a growing experience.

Timing

You may wonder when's the best time to start weaning.

There really isn't a right or wrong answer.

Experts recommend exclusively breastfeeding babies for the first six months and continuing until your baby is one year old.

Breast milk contains the right balance of nutrients for your baby and boost your baby's immune system.

Still, when to start weaning your child is a personal decision.

It's often easiest to begin weaning when your baby initiates the process, which may be sooner or later than you expect.

The process of weaning often begins naturally at six months old when solid foods are typically introduced and feeding sessions start to become less frequent.

Some children begin to gradually turn away from breast milk and seek other forms of nutrition and comfort at around age one.

When they've begun eating a wide variety of solid foods and may be able to drink from a cup, other children may not initiate weaning until their toddler years when they become less willing to sit still during breastfeeding.

You may also decide when to start the weaning process yourself. This may be more difficult than following your child's lead, but can be done with some extra care and sensitivity.

Resist comparing your situation with that of other families and consider rethinking any deadlines you may have set for weaning when you were pregnant or when your baby was a newborn.

You might consider delaying weaning if your child isn't feeling well or is teething. He or she will be more likely to handle the transition well if you're both in good health.

You might consider also postponing weaning if a major life change has occurred, such as moving to a new home or starting a new job.

You don't want to add more stress at what may already be a stressful time for you and your child.

Some research suggests that exclusive breastfeeding for at least four months may have a protective effect for children who have had a family history of food allergies.

If food allergies run in your family, talk to your child's doctor about the potential benefits of delaying weaning.

Method

When you start the weaning process, take it slow. Eliminate one breastfeeding session a day every two to three days. Slowly tapering off the number of times you breastfeed each day will cause your milk supply to gradually diminish and prevent any discomfort from engorgement.

Children tend to be more attached to the first and last feedings of the day when the need for comfort is greater. So it might be helpful to drop a midday breastfeeding session first.

You might also choose to wean your baby from breast milk during the day but continue breastfeeding at night. It's up to you and your child.

When eliminating a breastfeeding session, offer an alternate activity, such as a book, toy or other fun activity.

Depending on your approach, weaning could take days, weeks or months. Remember, however, that slower is better.

Rushing the weaning process may be upsetting for your child and cause engorgement for you.

Ongoing nutrition

If you wean your child before age one, substitute breast milk with iron-fortified formula. Ask your child's medical provider to recommend a formula.

Don't give your child cow's milk until after his or her first birthday. You can wean your child to a bottle and then a cup or if your child seems ready, directly to a cup.

If you're introducing your child to a bottle for the first time, do so at a time when your child isn't extremely hungry and may have more patience.

It also may help if a separate caregiver introduces the bottle, since some children may refuse a bottle when the opportunity to breastfeed is nearby.

Choose a bottle nipple with a slow flow at first. If you use a bottle nipple with a fast flow, your child may become frustrated with a slower flow of milk during breastfeeding or overwhelmed by the fast flow from the bottle.

Pumping breast milk

If you're returning to work or would like to share feeding duties with your partner, pumping breast milk is a useful option. It allows your baby to continue receiving your breast milk even when you're not there.

It may help to nurse exclusively during the first few weeks so that you and your baby learn how to breastfeed and so that your milk supply becomes well established.

Once you feel confident that the two of you are doing well with breastfeeding, you can begin to introduce your baby to breast milk in a bottle. However, some women begin pumping soon after birth and do just fine.

Initially, pump a few times after regular feedings to start building a small stockpile. Consider replacing one or two daytime feedings with a bottle of breast milk.

Keep in mind that the feel of a bottle nipple in a baby's mouth is different from that of your breast. The way a baby sucks from a bottle nipple also is different, so it may take some practice to make the switch.

It may also help to have someone besides you offer the bottle, since baby is likely to associate your voice and scent with breastfeeding.

Choosing a Pump

Most mothers who breastfeed find using a breast pump easier than expressing milk manually.

A lactation consultant or your baby's medical provider can help you determine what type of pump, manual or electric, is best for you and offer help and support if problems arise.

In deciding on a pump, here are some factors to consider.

How often will you use the breast pump?

If you'll be away from the baby only occasionally and your milk supply is well established, a simple hand pump may be all you need. They're small and inexpensive.

If you're returning to work full-time or planning to be away from your baby for more than a few hours a day, you may want to invest in an electric pump.

Will you need to pump as quickly as possible?

A typical pumping session lasts about 15 minutes of breast. If you'll be pumping at work or in other time crunch situations, you'll likely want an electric pump that allows you to pump both breasts at once.

How much can you afford to spend?

While manual models generally cost less than $50, electric pumps that include a carrying case and insulated section for storing milk may cost more than $200.

Some hospitals or medical supply stores rent hospital-grade breast pumps.

Health insurance plans generally cover the cost of breastfeeding support and supplies. Your insurer may specify what type of breast pump is covered.

Is the pump easy to assemble and transport?

If the breast pump is difficult to assemble, take apart or clean, it's bound to be frustrating, which may reduce your enthusiasm for pumping.

If you'll be toting the pump to work every day or traveling with the pump, look for a lightweight model.

If you'll need to pump away from a power outlet, look for pumps that can run on batteries instead of being plugged in.

Some breast pumps come in a carrying case with an insulated section for storing expressed milk.

Additionally, some electric models are quieter than are others.

If it's important to be discreet, make sure the noise level is acceptable.

Is the suction adjustable?

What's comfortable for some women may not be for others. Choose a pump that allows you to control the degree of suction.

Storing breast milk

Once you start pumping, it's important to know how to safely and properly store your expressed breast milk.

Container

Store expressed breast milk in capped glass or plastic containers that have been cleaned in a dishwasher or washed in hot soapy water and thoroughly rinsed.

Consider boiling the containers after washing them if the quality of your water supply is questionable.

If you store breast milk for three days or less, you can also use a plastic bag designed for milk collection and storage.

While economical, plastic bags aren't recommended for long-term breast milk storage because they may spill, leak, and become contaminated more easily than hard-sided containers.

Also, certain components of breast milk may adhere to the soft plastic bags during long-term breast milk storage, which could deprive your baby of essential nutrients.

Method

You can store expressed breast milk in the refrigerator or freezer using waterproof labels and ink.

Label each container with a date and time, including your baby's name if you're delivering containers to your baby's care provider.

Place the containers in the back of the refrigerator or freezer for the temperatures the coolest.

Use your earliest milk first.

To minimize waste, fill individual containers with the amount of milk your baby will need for one feeding.

Also, consider storing smaller portions, one to two ounces, for unexpected situations or delays in regular feedings.

Keep in mind that breast milk expands as it freezes, so don't fill containers to the brim.

You can add freshly expressed breast milk to refrigerated or frozen milk you expressed earlier in the same day.

However, be sure to cool the freshly expressed breast milk in the refrigerator or a cooler with ice packs for at least one hour before adding it to previously chilled milk.

Don't add warm breast milk to frozen breast milk because it will cause the frozen milk to partially thaw.

Keep milk expressed on different days in separate containers.

During storage, expressed breast milk will typically separate.

The thick white cream will rise to the top of the container.

Before feeding your baby, gently swirl the contents of the container to ensure that the creamy portion of the milk is evenly distributed.

The sooner you use the milk, the better.

Some research suggests that the longer you store breast milk, whether in the refrigerator or in the freezer, the greater the loss of vitamin C in the milk.

Other studies have shown that refrigeration beyond two days may reduce the bacteria-killing properties of breast milk,

and long-term freezer storage may lower the quality of breast milk's lipids.

Storing breast milk

At room temperature, fresh milk best within four hours, especially in warm temperatures, acceptable up to six hours.

For thawed, previously frozen, one to two hours.

Leftover from a feeding, used within two hours after feeding.

For insulated cooler with ice packs, fresh milk can last up to 24 hours.

Thawed, previously frozen, one to two hours.

Leftover from a feeding, used within two hours after feeding.

Breast milk stored at refrigeration, 40 degrees Fahrenheit.

Best within four days, acceptable within eight days if cleanly expressed and stored in back of refrigerator.

For thawed, previously frozen, up to 24 hours.

Leftover from a feeding, used within two hours after feeding.

For storing in the freezer, zero degrees Fahrenheit or colder, fresh is best within nine months, acceptable within 12 months if stored in back of deep freezer.

Thawed, previously frozen, never re-freeze.

Leftover from a feeding, used within two hours after feeding.

Thawing

Thaw the oldest milk first. Simply place the frozen container in the refrigerator the night before you intend to use it.

Or place the container under warm running water or in a bowl of warm water.

Avoid letting the water touch the mouth of the container.

Never thaw frozen breast milk on a counter at room temperature, which enables bacteria to multiply in the milk.

Also, don't keep a frozen bottle on the stove or in the microwave.

These methods can create an uneven distribution of heat and destroy the milk's antibodies.

Use thawed breast milk within 24 hours. Discard any remaining milk.

Don't re-freeze thawed or partially thawed breast milk.

Thawed breast milk may smell or taste different from freshly expressed milk due to the breakdown of milk fats, but it's still safe for your baby to drink.

The milk may separate, so you may need to gently swirl the thawed milk so that it's mixed evenly.

Feeding Tips

As your baby matures, he or she will gradually need fewer daily feedings and eat more at each feeding.

Soon, a feeding pattern will begin to emerge. In the meantime, whether you breastfeed or formula feed, here are a few pointers to keep in mind.

Consider feedings a time to bond.

For babies, feeding is as much a social activity as a nutritional one.

Your baby's growth and development are based in part on the powerful bond that forms during feedings.

Take the opportunity to put away your phone or tablet and turn off the television.

Hold your baby close during each feeding.

Look him or her in the eyes. Speak with a gentle voice.

Don't miss this chance to build your baby's sense of security, trust and comfort.

Feed on Q

The size of your infant's stomach is very small, about the size of his or her fist, and the time it takes to become empty varies from one to three hours.

Feeding on Q requires you to watch for signs that baby is ready to eat.

Your baby makes sucking movements with his or her mouth or tongue, rooting, sucks on his or her fist, or makes small sounds.

Crying is a late cue for hunger.

You will soon be able to distinguish between cries for food and those for other reasons, such as pain, fatigue or illness.

It's important to feed your baby promptly when he or she signals hunger.

This helps your baby learn which kinds of discomfort mean hunger, and that hunger can be satisfied by sucking, which brings food.

If you don't respond promptly, your baby may become so upset that trying to feed at this point may prove more frustrating than satisfying.

Let babies set the pace.

Avoid rushing your baby during a feeding.

Let your baby determine how much and how fast to eat.

Many babies, like adults, prefer to eat in a relaxed manner.

It's normal for an infant to suck, pause, rest, socialize a bit, and then return to feeding.

Some newborns are speedy, efficient eaters, consistently whizzing through feedings.

Other babies are grazers, preferring snack-size feedings at frequent intervals.

Your baby will let you know when he or she has had enough to eat.

When your baby is satisfied, he or she will stop sucking, close his or her mouth, or turn away from the nipple.

Baby may push the nipple out of his or her mouth with his or her tongue, or your baby may arch his or her back if you try to continue feeding.

If, however, your baby needs burping or is in the middle of a bowel movement, his or her mind may not be on eating.

Wait a bit, and then try offering the breast or bottle again.

Feeding a Sleepy Newborn

Most newborns lose weight in the first few days after birth.

Until your newborn regains this lost weight, usually within one week after birth, it's important to feed him or her frequently, even if he or she would rather drift off to sleep.

You'll no doubt have times when your baby signals that he or she is hungry, only to doze off once you begin feeding.

Try these tips to feed a sleepy baby.

Watch for and take advantage of your baby's alert stages. Feed at these times.

If your baby falls asleep while feeding, gently wake and encourage him or her to finish eating.

Give your baby a massage by walking your fingers up his or her spine.

Partially undress your baby.

Because your baby's skin is sensitive to temperature changes,

the coolness may wake him or her long enough to eat.

Stroke a circle around your baby's lips with a fingertip a few times.

Rock your baby in a sitting position.

A baby's eye is often open when he or she is positioned upright.

Once your newborn establishes a pattern of weight gain and reaches his or her original birth weight,

it's generally okay to wait for feedings until he or she wakes up.

Be Flexible

Don't expect your baby to eat the same amount every day.

Babies vary in how much they eat, especially if they are experiencing a growth spurt.

At these times, your baby will need and demand more milk and eat more frequently.

It may seem like your baby can't get full.

During these times, you may need to put your baby to your breast or offer a bottle more often.

Babies often don't eat at precise intervals throughout the day.

Most babies bunch, cluster their feedings at various times of the day and night.

It's common for a baby to eat several times within a few hours and then sleep for a few hours.

Stick with breast milk or formula

Don't give your newborn water, juice or other fluids.

Introducing these liquids before your baby is six months old is unnecessary

and can interfere with his or her desire for breast milk or formula,

which may lead to malnourishment and risk potentially dangerous electrolyte imbalances.

Consider Supplements

If you're feeding your baby iron fortified formula, he or she is likely getting the recommended amount of iron.

If you're breastfeeding your baby, start giving your baby an iron supplement at age four months.

Continue giving your baby the supplement until he or she is eating two or more servings a day of iron-rich foods,

such as fortified cereal or pureed meat.

If you offer mixed feedings, breast milk and formula, and the majority of your baby's feedings are from formula,

the supplement probably isn't necessary.

Talk to your baby's medical provider.

He or she may also recommend a fluoride supplement, depending on your water supply, and a vitamin D supplement.

Formula Feeding

Some parents prefer to feed their infant's formula rather than breast milk.

This is a personal choice, and there are many reasons why new parents opt for formula rather than breast milk.

In a few cases, breastfeeding just isn't possible.

If you choose not to or you aren't able to breastfeed,

be assured that your baby's nutritional needs can be met with the use of infant formula,

and your baby will still be happily bonded to you as a parent.

Pros and Cons

Parents who formula feed usually feel the main advantages are shared feeding duties.

Using a bottle with formula allows more than one person to feed the baby.

For that reason, some nursing mothers feel they have more freedom when they're bottle feeding.

Both parents may like bottle feeding because it allows them to share more easily in the feeding responsibilities.

Convenience

Some parents feel formula is more portable, especially on outings and in public places.

They don't have to find an out-of-the-way location to breastfeed.

Some of the challenges of formula feeding include time-consuming preparation.

Bottles must be prepared for each feeding.

You need a study supply of formula. Bottles and nipples need to be washed.

If you go out, you may need to take formula with you.

Cost

Formula is costly, which may be a concern for some parents.

The Right Supplies

Make sure you have the right supplies on hand.

Staff at the hospital or birthing center can provide bottle feeding equipment and formula the first few days after your baby's birth

and show you how to bottle feed your newborn.

You don't need a ton of equipment for formula feeding.

Generally, it's helpful to have several four-ounce bottles for the early months and several eight-ounce bottles as your baby grows and wants more at a time.

Some extra nipples, rings, and caps and a bottle brush for cleaning are also nice to have on hand.

In addition to buying the right equipment, consider taking a class on infant feeding if you haven't taken one already.

Often, information on feeding a newborn is offered as part of child birth classes.

If you've never bottle fed a baby before, taking a class will help you feel more comfortable when you bring your baby home.

Bottles

Bottles generally come in two sizes, four ounces and eight ounces.

The four-ounce bottles come in handy at the beginning when babies don't drink much more than that.

The eight-ounce bottles should carry you through to weaning once your baby reaches a year old.

Bottles may be glass, plastic, or plastic with a soft plastic liner.

Some bottles have a curved design to try to reduce the amount of air a baby swallows.

Nipples

Many types of nipples are on the market, which have openings sized according to a baby's age, newborn, three-month-old, six-month-old, and so on.

The flow rate from the nipple is appropriate to the baby's age.

It's important that formula flows from the nipple at the correct speed.

Milk flow that's either too fast or too slow can cause your baby to swallow too much air, leading to stomach discomfort and the need for frequent burping.

Test the flow of the nipple by turning the bottle upside down and timing the drops.

One drop a second is about right.

Choosing a formula

If you're planning to feed your baby infant formula, you may have many questions.

Is one brand of infant formula better than another? Are generic brands okay?

Is soy-based formula better than cow's milk formula?

A wide variety of infant formulas are on the market.

The majority of them are based on cow's milk.

However, never use regular cow's milk as a substitute for formula.

In processing formula, the milk has been changed dramatically to make it safe for babies.

This processing includes treating formula by heat to make the protein in it more digestible.

More milk sugar, lactose, is added to make the concentration similar to that of breast milk.

And the fat, butter fat, is removed and replaced with vegetable oils and animal fats that are more easily digested by infants.

Infant formulas aren't just easy to digest.

They must contain the right amounts of carbohydrates, fat, and protein to meet baby's needs.

The Food and Drug Administration, FDA, monitors commercially prepared infant formula.

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 energy-dense food. More than half its calories are made from fat.

That fat is made up of fatty acids, specifically selected because they're similar to those found in breast milk.

These fatty acids help in the development of your baby's brain and nervous system, as well as in meeting his or her energy needs.

Types.

Commercial infant formulas are regulated by the FDA. Three major types are available.

Cow's milk formulas.

Most infant formula is made with cow's milk that's been altered to resemble breast milk.

This gives the formula the right balance of nutrients and makes the formula easier to digest.

Most babies do well on cow's milk formula. Some babies, however, such as those allergic to the proteins in cow's milk, may need other types of infant formula.

Soy-based formulas.

Soy-based formulas can be useful if you want to exclude animal proteins from your child's diet.

Soy-based formulas may also be an option for babies who are intolerant or allergic to cow's milk formula or to lactose, a sugar naturally found in cow's milk.

However, babies who are allergic to cow's milk may also be allergic to soy milk.

Protein hydrolysate formulas.

These are meant for babies who have a milk or soy allergy.

Protein hydrolysate formulas are easier to digest and less likely to cause allergic reactions than are other types of formula.

They're also called hyperallergenic formulas.

In addition, you can find specialized formulas that are made for premature infants and babies who have specific medical conditions.

Forms.

Infant formulas typically come in three forms. The best choice depends on your budget and convenience needs.

Powdered formula.

Powdered formula is the least expensive. It must be mixed with water.

Concentrated liquid formula.

This type of formula also is mixed with water.

Ready-to-use formula.

Ready-to-use formula is the most convenient type of infant formula. It doesn't need to be mixed with water. It's also the most expensive option.

Generic versus brand name.

All infant formulas sold in the United States, both generic and brand name, must meet the nutrient standards set by the FDA.

Although manufacturers may vary in their formula recipes, the FDA requires that all formulas contain the minimum recommended amount.

And no more than the maximum amount of nutrients that infants need.

Additional ingredients.

It's important to buy iron-fortified infant formula. Your baby needs iron to grow and develop, especially during infancy.

For breastfeeding, using iron-fortified formula is the easiest way to provide this essential nutrient.

Some infant formulas are enhanced with doco-sehexinoic acid, DHA, and arachidonic acid, ARA.

These are essential fatty acids found in breast milk and certain foods, such as fish and eggs.

Some studies suggest that including DHA and ARA in infant formula can help infant eyesight and brain development, but other research has shown no benefit.

In addition, in an effort to mimic the immune benefits of breast milk, some infant formulas now include probiotics, substances that promote the presence of healthy bacteria in the intestines.

The data on probiotic supplemented formulas is limited, and long-term benefits or complications of the formula are unknown.

At this point, there's insufficient evidence to recommend the use of enhanced formulas.

In addition, they tend to be more expensive than regular formula.

If you think your child might benefit from formulas supplemented with probiotics or another substance, talk to your baby's medical provider for additional information and guidance.

Preparation

Whatever type and form of formula you use, proper preparation and storage are essential, both to ensure the appropriate amount of nutrition and to safeguard the health of your baby.

Wash hands and supplies.

Wash your hands before handling formula or the equipment used to prepare it.

All equipment that you use to measure, mix and store formula should be washed with hot, soapy water and then rinsed and dried before every use.

Sterilize new bottles, nipples, caps and rings before using them for the first time.

Boil the utensils in water for five minutes.

Use a pot that's large enough to hold the utensils and cover them completely with water.

Remove the utensils from the water using a clean set of tongs. Allow the utensils to air dry.

After the first use, there's no need to sterilize your utensils as long as you wash and rinse them well.

Use a bottle brush to wash bottles.

Brush or rub the nipples thoroughly to remove any traces of formula.

Rinse well. You can also clean bottles and nipples in the dishwasher.

To help prevent fungal growth, you can rinse nipples daily in equal parts vinegar and water and allow them to air dry.

Also, make sure the nipples are open.

Hold each nipple upside down and fill it with water. Then look for the water to drip slowly out of the nipple.

Mix it up.

To prepare a bottle of formula, follow carefully the instructions on the label.

For ready-to-use formula, shake the container and pour the recommended amount into the bottle.

When using powder formula or liquid concentrate, always add the exact amount of water specified on the label.

Measurements on bottles may be inaccurate, so pre-measure the water before adding it to the formula.

Using too much or too little water isn't good for your baby.

If formula is too diluted, your baby won't get enough nutrition for his or her growth needs and to satisfy his or her hunger.

Formula that's too concentrated puts strain on the baby's digestive system and kidneys and could dehydrate your baby.

You can use any type of safe drinkable water, tap or bottled, to prepare liquid concentrate or powdered formula.

If you're concerned about the safety of your tap water, bring cold tap water to a rolling boil for one minute only.

Then cool the water to room temperature for no more than 30 minutes before using it.

Warm if needed.

Warming formula isn't necessary for nutritional purposes, but your baby may prefer it warm.

To warm formula, place a filled bottle in a bowl or pan of hot but not boiling water and let it stand for a few minutes.

Or warm the bottle under running water.

Shake the bottle after warming it.

Turn the bottle upside down and allow a drop or two of formula to fall on your wrist or the back of your hand.

The formula should feel lukewarm, not hot.

Don't warm bottles in the microwave. The formula may heat unevenly, creating hotspots that could burn your baby's mouth.

Store safely.

Store unopened formula containers in a cool, dry place.

Don't store formula containers outdoors or in a car or garage, where temperature extremes can affect the quality of the formula.

If you're using ready-to-use formula, cover and refrigerate any leftover formula from a freshly opened container.

If you prepare and fill several bottles of liquid concentrate or powdered formula at once,

label each bottle with the date that the formula was prepared.

Refrigerate the extra bottles until you need them. Don't freeze them.

Put the bottles toward the back of the refrigerator where it's coldest.

Discard any prepared formula that's been in the refrigerator more than 24 to 48 hours.

Discard any formula that remains in the bottle after a feeding.

If you're unsure whether a particular container or bottle of formula is safe, throw it out.

Milk Allergy

A person of any age can have a milk allergy, but it's more common among infants.

A milk allergy occurs when the body's immune system mistakenly identifies the protein in milk as something the body should fight off.

Some infants have a severe reaction to milk, such as hives, vomiting, or trouble breathing within minutes or up to two hours of eating milk products.

These types of reactions can be life-threatening and should prompt immediate medical attention.

More commonly, babies may have milk protein intolerance, which is different from an allergic reaction, but can still cause problems such as bloody stools, diarrhea, and possibly reflux.

Avoiding milk and milk-based foods, including in your diet if you're breastfeeding, is usually enough to resolve symptoms.

Fortunately, most children outgrow milk protein intolerance by age one and milk allergy by age three.

Cow's milk is the usual cause of milk allergy. However, milk from sheep, goats, and water buffalo also can cause a reaction.

And some children who are allergic to cow's milk are allergic to soy milk, too.

Because most formula is derived from cow's milk, infants who are formula-fed may have a higher risk of developing a milk allergy than those who are breastfed.

However, the milk protein in dairy products that triggers the allergic reaction can cross into breast milk and may bother a breastfeeding baby.

Researchers don't fully understand why some infants develop a milk allergy and others don't.

If you use formula and your son or daughter has a milk allergy, your doctor may advise you to switch to another type of formula that's less likely to cause an allergic reaction.

If you're breastfeeding, restrict the amount of dairy products you consume.

Look before you buy.

Don't buy or use outdated infant formula. If the expiration date is passed, you can't be sure of the formula's quality.

While checking the expiration date, also inspect the condition of the formula container.

Don't buy or use formula from containers with bulges, dents, leaks, or rust spots.

Formula in a damaged container may be unsafe.

Burping Positions

Lay baby face down across your lap and gently rub and pat baby's back.

While sitting baby upright and supporting his or her chin and back, gently rub and pat baby's back.

Lay baby face down across your shoulder and gently rub and pat his or her back.

Getting into position

The first step to bottle feeding is to get comfortable. Find a quiet place where you and your baby can relax and not be distracted.

Cradle your baby in one arm, hold the bottle with the other, and settle into a comfortable chair, preferably one with broad, low armrests.

You may want to put a pillow on your lap under the baby for support.

Pull your baby in toward you snugly but not too tightly. Cradled in your arm with his or her head, raise slightly and resting in the bend of your elbow.

This semi-upright position makes swallowing easier.

Using the nipple of the bottle or a finger of the hand holding it, gently stroke your baby's cheek near the mouth on the side nearest you.

The touch will cause your baby to turn toward you, often with an open mouth.

Then touch the nipple to your baby's lips or the corner of the mouth. Your baby will open his or her mouth and gradually begin sucking.

When feeding your baby, position the bottle at about a 45 degree angle. This angle keeps the nipple full of milk.

Hold the body steady as your baby feeds. If your baby falls asleep while bottle feeding, it may be because he or she has had enough milk, or gas has made your baby full.

Take the bottle away, burp your baby, then start to feed again.

Always hold your baby while feeding. Never prop a bottle up against your infant.

Propping may cause your baby to vomit and may lead to overeating. In addition, never give a bottle to your baby when he or she is lying on his or her back.

This may increase your baby's risk of developing an ear infection.

Although your baby doesn't have teeth yet, they're forming beneath the gums. Avoid making a habit of putting your baby to bed with a bottle.

Formula lingers in the mouth of a baby who falls asleep while sucking a bottle. The prolonged contact of sugar in milk with teeth can cause tooth decay.

What's the right amount?

During the first few weeks, your baby will likely drink about 1 to 3 ounces at each feeding.

You'll know that your young one is getting enough formula if by the end of the first week, he or she has about 6 to 8 wet diapers a day.

He or she may also experience one or two bowel movements a day.

As he or she grows, the amount of formula your baby consumes will gradually increase.

In general, during the first month, expect 6 to 12 feedings in a 24-hour period, about every 2 to 4 hours.

By 6 months, your baby will probably consume 6 to 8 ounces at each of 4 or 5 feedings a day.

Weaning

Infant formula is generally recommended until 1 year of age, followed by whole milk until age 2.

But talk with your child's medical provider for specific guidance.

Reduced fat or skim milk generally isn't appropriate before age 2 because it doesn't have enough calories or fat to promote early development.

Experts recommend weaning your baby from a bottle to a cup by no later than 18 months.

Spitting up

Spitting up is a rite of passage for many babies. Although it's messy, you probably don't need to worry.

Spitting up rarely signifies a serious problem.

As long as your baby seems comfortable and is gaining weight, there's generally little cause for concern.

If you keep a burp cloth within reach at all times, you'll be well prepared.

Reflux

Normally a valve between the esophagus and the stomach, lower esophageal sphincter, keeps stomach contents where they belong.

Until this valve has time to mature, spitting up may be an issue, especially if your baby eats too much or too quickly.

Spitting up tends to peak at age 4 months and most babies stop spitting up by 12 months.

Minimal spitting up doesn't hurt. It isn't likely to cause coughing, choking or discomfort, even during sleep.

Chances are your baby won't even notice the fluid dripping out of his or her mouth.

What you can do to reduce spitting up, consider these tips.

Keep your baby upright.

Position baby's head higher than the rest of the body when feeding.

Follow each feeding with 15 to 30 minutes in a sitting position.

Hold your baby in your arms, or try a front pack, backpack or infant seat.

Avoid active play and infant swings while the food is settling.

Try smaller, more frequent feedings.

Feeding your baby too much at once can contribute to spitting up.

If you're breastfeeding, limit the length of each nursing session.

If you're bottle feeding, offer your baby slightly less than usual.

Take time to burp your baby.

Frequent burps during and after each feeding can keep air from building up in your baby's stomach.

Sit your baby upright, supporting your baby's head with one hand while patting his or her back with your other hand.

Babies don't burp after every feeding though, so you don't need to prolong the burping process.

Check the nipple.

If you're using a bottle, make sure the hole in the nipple is the right size.

If it's too large, the milk will flow too fast.

If it's too small, your baby might get frustrated and gulp air.

Experiment with your diet.

If you're breastfeeding, your baby's doctor might suggest that you eliminate dairy products or certain other foods from your diet.

Pay attention to baby's sleep position.

To reduce the risk of sudden infant death syndrome, SIDS, it's important to place your baby to sleep on his or her back.

Placing a baby to sleep on his or her tummy is rarely recommended to prevent spitting up.

When it's more serious, more severe spitting up may indicate something more serious.

Contact your baby's medical provider if your baby isn't gaining weight.

Spits up so forcefully that stomach contents shoot out of his or her mouth, vomits.

Spits up gray or yellow fluid, blood, or a material that looks like coffee grounds.

Exists feedings. Has blood in his or her stool. Has other signs of illness, such as fever, diarrhea, or difficulty breathing.

Some babies experience infant gastroesophageal reflux. Special feeding techniques or medication may be helpful.

Chapter 4 To Solid Foods and Beyond

When your child is first born, breast milk or formula is the only food he or she needs.

Eventually, though, your baby will begin to develop the coordination to move solid food from the front of his or her mouth to the back for swallowing.

At the same time, your baby's head control will improve and he or she will learn to sit with limited support.

These are essential skills for eating solid foods.

As you expand your child's diet to meet his or her nutritional needs, you'll also have an early opportunity to encourage healthy eating habits.

By setting up a regular schedule for meals and snacks, you'll create a predictable and comfortable routine that your child can rely on.

By making family meals a priority, even when your child is young, you'll encourage sociability and togetherness.

You can promote this further by keeping meal times relaxed and keeping cell phones, televisions, and other devices turned off during meals.

These early habits will help your child develop a lifetime appreciation for nourishing his or her body with a variety of healthy foods in the context of a safe and comforting setting.

That's what healthy eating is all about and it's never too early to start.

Starting solids

So when are babies ready for solid foods? It varies a bit based on a child's development.

Signs that your baby might be ready include being able to sit in a high chair or booster chair, hold his or her head upright, show an interest in food, and open his or her mouth for a spoon.

The American Academy of Pediatrics, AAP, recommends waiting until a child is at least four months old before introducing solid foods to complement breast milk or formula, and preferably holding off until a child is closer to six months old.

If you have questions about starting solid foods, check with your child's medical provider.

First foods

Single grain baby cereal has traditionally been used and is fortified to meet infants' nutritional needs after six months of age.

But there's no one right first food.

Peerade meats also are a good choice as they are rich in iron and zinc, essential nutrients that are present at birth, but those levels decrease steadily over the first few months.

You can also add in pureed vegetables and fruits. Pureed beans and leafy dark green vegetables contain iron, and the vitamin C in many fruits and vegetables helps iron absorption.

Formula or breast milk can be mixed in to thin the puree if needed.

Studies show that children who are introduced to vegetables and flavorful foods early on are more likely to eat those foods later in childhood.

Avoid seasoning your infant's food with added salt or sugar.

Getting started

Use a small spoon, one that will fit into your baby's mouth, and begin with very small amounts.

At first, your little one may frown, sputter, and spit it out. This isn't necessarily because he or she doesn't like it, but rather because he or she may not be familiar with moving the tongue backward yet.

Wait for your baby to open his or her mouth for the spoon. Don't force food in. If he or she repeatedly uses his or her tongue to push the spoon away, this may be an indication that your baby isn't ready for solid yet.

Don't be surprised if your baby puts fingers to mouth to help swallow the food. He or she may also try to bat away the spoon. Expect it to be a messy experience.

To prevent baby from getting frustrated when he or she is very hungry, try alternating between breast milk or formula and spoonfuls of food.

Some parents skip pureed food entirely and let baby lead the learning process by self-feeding appropriate finger foods offered by the parent.

Once your little one gets used to solids, he or she may be ready for a few tablespoons of food a day, including finger foods. By the end of the first year, most children obtain about half of their nutrition from breast milk or formula and half from complementary foods.

Taste and texture

Babies also react to how food feels and tastes in their mouths. While you don't have to follow a particular sequence of food groups, it may help to introduce different tastes and textures gradually.

Offer single ingredient foods at first and wait three to five days between each new food. If your baby has a reaction to a particular food, such as diarrhea, a rash, or vomiting, you'll know the culprit.

Spacing out new foods also gives your child a chance to get used to a new taste and texture. It often takes quite a few tries, up to 15 or more, for a new food to gain acceptance.

Pureed foods

Foods that are soft and runny may be easier for your baby to manage at first. One option is to mix one tablespoon of a single grain iron fortified baby cereal with four to five tablespoons of breast milk or formula, or add breast milk or formula to pureed meat, vegetables, or fruit to attain a similar consistency.

Though it will be quite runny, resist the urge to serve it from a bottle. As your baby learns to manage this consistency, serve foods with a thicker pureed consistency. Keep in mind that some babies eat such foods with gusto right from the start. Others are less enthusiastic. Be patient and keep trying.

Finger Foods

By about nine months, most babies can handle small portions of finger foods, such as well-steamed vegetables, soft fruits, well-cooked pasta, cheese, graham crackers, and tender meats.

As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will likely become your baby's main fare. Continue to offer your child breast milk or formula with and between meals.

Juice

Juice, while a popular beverage, is not a necessary part of a baby's diet. Whole fruits have more nutritional value than juice.

If you choose to give your child juice, be sure to use 100% fruit juice after 12 months of age and limit the amount to no more than 4 ounces a day. Too much juice may contribute to weight problems, tooth decay, and digestive issues such as diarrhea.

You also don't want juice to take the place of more nutritious solid foods, breast milk, or formula.

What's Off Limits?

Don't offer cow's milk, citrus, honey, or corn syrup to your child before he or she is 12 months old.

Cow's milk doesn't meet an infant's nutritional needs. It isn't a good source of iron, and too much can lead to iron deficiency andemia.

Citrus can cause a painful diaper rash, and honey and corn syrup may contain spores that can cause a serious illness known as infant botulism.

In addition, don't offer your child foods that could pose a choking hazard. Such foods include small, slippery foods such as whole grapes, hot dogs, or hard candy, dry foods that are hard to chew such as popcorn, raw carrots, and nuts, sticky or tough foods such as plain peanut butter, or chunks of steak.

If you haven't done so yet, consider taking an infant cardiopulmonary resuscitation CPR course. This is strongly recommended for all parents and very helpful in case of a choking episode.

Baby-Led Feeding

A growing trend in Europe, Australia, and the US is allowing children who are six months or older to feed themselves solid foods, baby-led weaning or feeding, to encourage exploration of food and to let them regulate how much food they eat.

The key part is letting babies guide the food into their own mouths. Preliminary studies conclude that this method may decrease food fussiness.

There was no difference in weight between self-fed babies and spoon-fed babies.

The main concern with babies feeding themselves is the risk of choking, but evidence suggests that self-feeding is as safe as being spoon-fed as long as appropriate precautions are taken.

To prevent choking while eating, make sure your child is seated in an upright position and is always supervised.

Don't leave your baby unattended. Offer foods that are easy to pick up and are either mashable in your baby's mouth or easy to gnaw on without breaking up into small pieces that block your child's airway.

Think steamed carrots, roasted sweet potato, or cooked chicken. Cut into pieces about the length of an adult's pinky finger.

Avoid foods that are small, coin-shaped, slippery, crunchy, sticky, or tough.

Foods for Baby

By your baby's first birthday, he or she should be able to eat most of the food served to the rest of the family.

Just make sure food isn't too hot or a choking hazard, and avoid giving foods that are heavily spiced, salted, or sweetened.

If you want to prep food for your baby, use a blender or a food processor to puree the food or cut the food into small bite-sized pieces.

For smaller foods, you may be able to simply mash them with a fork. Here are some examples of foods to try.

Apples, peeled and cut in eighths.

Orange sections, peeled and loose membrane removed.

Peaches, ripe and peeled.

Small pieces of banana.

Egg, boiled, scrambled, or poached.

Soft cheese.

Soft custards or puddings.

Yogurt.

Cooked soft carrots and other vegetables.

Well-cooked macaroni, pasta, egg noodles, and rice.

Pieces of toast or bagels.

Tender meats, fish, tuna, lamb, chicken, turkey, and some beef and pork.

Spaghetti with meat sauce.

Pancakes and waffles.

Whole grain crackers and cereals.

Introducing peanut butter, milk, and other foods.

Some foods can cause problems if they're not introduced at appropriate times.

Peanuts and other allergenic foods.

To help prevent food allergies, parents were once told to delay feeding infants eggs, fish, and peanut butter.

But today, researchers say postponing the introduction of highly allergenic foods beyond 4 to 6 months of age

hasn't been shown to prevent eczema, asthma, allergic rhinitis, or food allergy.

In fact, recent evidence suggests that introduction of peanut butter or peanut-containing foods as early as 4 months

may help prevent the development of peanut allergy.

This is especially true for babies at increased risk of peanut allergies,

such as those with eczema, an egg allergy, or a family history of food allergies.

If your baby's started eating solid foods already and hasn't shown signs of any food allergies,

you can introduce a bit of peanut butter, thinned with breast milk, formula, or pureed food.

Avoid giving thick peanut butter from the jar or whole nuts.

If your baby tolerates it, you can gradually increase the amount given.

When introducing other allergenic foods, stick to textures your baby eats and likes.

If your baby has eczema or food allergies run in your family,

talk to your baby's medical provider before introducing peanut butter.

The provider may recommend having your baby tested for peanut allergy first.

The importance of iron.

Iron is a nutrient that's essential to your child's growth and development.

Iron helps move oxygen from the lungs to the rest of the body

and helps muscles store and use oxygen.

Babies are born with iron stored in their bodies,

but a steady amount of additional iron is needed to fuel a child's rapid growth and development.

Infant formulas are fortified with iron,

but if you breastfeed your baby, start him or her on an iron supplement at four months of age.

If your baby was born early, your provider likely recommended beginning an iron supplement earlier.

As your baby grows and begins to eat other foods,

serve iron-rich foods.

When you begin serving your baby solids, typically between ages four months and six months,

feed him or her foods with added iron, such as iron-fortified baby cereal and pureed meats.

For older children, good sources of iron include red meat, chicken, fish and tofu.

Don't overdo milk.

Once your little one turns a year old and starts drinking milk,

don't allow him or her to drink more than 24 ounces of milk a day.

Too much milk can inhibit the body's absorption of iron.

Enhance iron absorption.

On the other hand, vitamin C helps promote the absorption of dietary iron.

You can help your child absorb iron by offering foods rich in vitamin C,

such as cantaloupe, strawberries, bell peppers, tomatoes and dark green vegetables.

Cow's milk.

Around your baby's first birthday, you may gradually introduce your child to whole cow's milk.

Of course, continue to breastfeed your baby as long as you wish.

Cow's milk isn't a replacement for breast milk or formula,

but as your baby gains nutrients from a wider variety of foods, dairy milk can be an important source of vitamin D,

calcium, fat and protein.

The AAP recommends that children be given whole milk until age two.

Low fat milk, such as 2%, 1% and skim, doesn't provide enough fat for your child's developing brain

and shouldn't be given until your child is two years old,

unless specifically recommended by your child's medical provider.

Alternative milks, such as soy, nut and plant-based milks, are typically fortified with vitamin D and calcium,

but most contain lower fat content than whole cow's milk.

Talk with your child's medical provider before introducing milk,

if you have questions and especially if your child was diagnosed with a milk protein intolerance or allergy.

Limit your child's milk intake to no more than 16 to 24 ounces a day.

Higher intake may crowd out other necessary foods and is associated with iron deficiency anemia.

Family Mealtimes

Mealtimes are an important part of family life.

They offer family members a chance to come together to share not just food, but companionship.

Whenever possible, have your baby eat at the same time as the rest of the family.

This helps your baby get used to the process of eating, sitting down, choosing foods to eat,

resting between bites, and stopping when full, and socializing with others.

These early experiences will help your child learn good eating habits that last a lifetime.

Research shows that families that eat together regularly tend to eat more nutritious foods

and are less likely to encounter childhood obesity or eating disorders.

Children are also more likely to have better behavior, a stronger vocabulary, and greater academic success.

Tips for Babies

To help Mealtimes be a pleasant experience for everyone, consider these suggestions.

Stay Seated

At first, you may feed your baby propped on your lap.

As soon as your baby can sit easily without support, use a high chair with a broad stable base.

Buckle the safety straps and keep other children from climbing or hanging onto the high chair.

Encourage Exploration

Your baby is likely to play with his or her food between bites.

Although it's messy, this hands-on approach helps fuel your baby's brain development, placing a drop cloth on the floor can help.

Offer your baby new foods to try.

To increase the chances of acceptance, offer one new food along with an established favorite.

Most babies can and should eat from all food groups as soon as 7 to 8 months of age.

Introduce Utencils

Offer your baby a spoon to hold while you feed him or her with another spoon.

As your baby's dexterity improves, encourage your baby to dip the spoon in food and bring it to his or her mouth.

After your baby turns a year old, his or her use of utensils will continue to develop.

Give your child the chance to practice.

Offer a Cup

Feeding your baby breast milk or formula from a cup at meal time can pave the way for weaning from a bottle.

When your child reaches 9 months, he or she may be able to drink from a cup on his or her own, but spills are likely until about 15 months or so.

You may want to begin with a non-spill cup, often called a sippy cup.

Dish Individuals' Servings

Early on, your baby may eat just a few spoonfuls of food at a time.

If you feed your baby directly from a jar or container, bacteria and saliva from the spoon can quickly spoil any leftovers.

Instead, place one tablespoon of food in a dish and refrigerate the rest.

The same goes for finger foods.

If your baby finishes the first serving, offer another.

Know when to call it quits

When your baby has had enough, he or she may turn away from the food, lean backward, or refuse to open his or her mouth.

Don't force extra bites.

As long as your baby's growth is on target, you can be confident that he or she is getting enough to eat.

When babies are allowed to decide how much food they want to eat and how fast to eat it, they become fairly adept at it,

and doing so allows them to regulate their food intake based on how hungry they are, which contributes to a healthy weight now and later.

Tips for Toddlers

As your child moves into toddlerhood, you may notice a drop in his or her appetite.

Your child may become fussy about what he or she eats, run away after a few bites, or resist coming to the table at meal times.

This is normal and frustrating.

After the first year of life, your child's growth rate slows, and he or she doesn't require as many calories.

To keep encouraging healthy eating habits in your growing child, follow these steps.

Minimize distractions

Make the most of family meal times.

Turn off TVs, phones, and other electronic devices.

This helps your toddler and everyone else focus on the meal and each other.

Even if your child isn't using words yet, he or she enjoys the back and forth communication going on and the feeling of being part of the family.

This sort of stimulation is important to your child's mental, social, and emotional development.

Keep portions small

As your child gets older, avoid giving too much at once, which can seem overwhelming.

Put a small amount about the size of your child's fist of each food group on the plate, then offer seconds if your child wants more.

Don't sweat the picky eater.

Picky eating habits are common in the toddler years and through preschool, but these behaviors generally ease with age.

You're not responsible for making your child like certain foods, but you can present multiple opportunities for your son or daughter to learn about food and to try different kinds.

Include your child in shopping for food, feeling the shape and texture of different food items, watching food being prepared, and maybe even having a taste.

Avoid power struggles

If your child turns away from a certain food, don't push. Simply try again another time.

Repeated exposure helps ensure variety in your child's diet. The harder you push, your child to eat, the less likely he or she is to comply.

Offer a selection of nutritious foods at each meal time and let your child choose what he or she wants to eat.

Focus on the positive

Praise your child's attempts at eating and trying new foods, but avoid giving undue attention when he or she doesn't eat.

Focusing on your child's positive eating behaviors and mostly ignoring other behaviors helps reinforce the positive behaviors and keeps meal times pleasant.

Avoid using food as a means of punishment or reward, such as withholding dessert or using it as a bribe, as this can set the stage for an unhealthy relationship with food and will only reinforce the idea that desserts are more desirable.

Change it up

Sometimes it's not the food a picky eater objects to so much as the presentation. Your child might object to mixing foods or having one food touch another on a plate.

If this is the case, try changing things up. For example, offer an array of bite-sized portions arranged in a row, maybe an assortment of cooked macaroni, cannellini beans, steamed broccoli florets, and soft diced peaches.

These are all nutritious and your child can pick and choose what he or she likes.

Even if they don't all get eaten, point out the color and textures of the foods.

Touching, smelling, and playing with food are all exploratory toddler behaviors that precede a willingness to accept the food.

Be patient

Often toddlers will want to eat a particular food for days, then suddenly refuse to eat the same food at all.

Don't worry too much about these food jags. Focus on providing healthy options and try to offer at least one food that your child is familiar with and likes with each meal.

Keep in mind that most children consume the right balance of nutrients over the course of the week.

A child's pickiness won't change overnight, so take small steps and make note of what works.

Infant and toddler eating behaviors

Age 7 to 12 months

Behaviors

Grasps food with hands, takes food from a spoon with lips, eats soft foods or foods with tiny lumps without gagging.

Feeding tips

Offer soft foods such as iron fortified infant cereal or pureed meat thinned with a bit of liquid.

Offer a variety of new foods one at a time.

Don't force feed.

Age 12 to 24 months

Behaviors

Self feeds finger foods, drinks from a sippy cup without help, but maybe not without spilling.

Appetite decreases as growth slows, may seem uninterested in food for periods of time, may be a cautious, curious or rebellious eater.

Feeding tips

Consider weaning from the bottle before 18 months. This avoids risk of overeating and dental decay.

Provide safe finger foods.

Offer whole milk to drink with meals.

Allow exploration of food using all the senses.

Age 24 to 36 months

Appetite is often unpredictable, may shift favorite foods without warning, may eat better than usual at one meal and nothing at the next, may struggle to eat independently.

Feeding tips

Allow and encourage self feeding, even if it takes a while.

Offer new foods repeatedly.

Offer whole milk unless otherwise specified by medical provider.

Offer water between meals and snacks.

Teething and dental care

Your baby's first teeth may erupt by 6 to 7 months. Your baby may be fussy at this time, which may interfere with eating.

Teething causes your baby's gums to swell. When your baby makes the effort to suck, more blood rushes into the already swollen gum.

This may cause your baby to squirm, whimper and refuse to eat.

You may try rubbing your baby's gum before feeding.

Once there are teeth, there's the potential for dental decay.

Dental cavities typically occur due to prolonged exposure to sugars and foods and drinks.

To reduce the risk of dental damage, avoid putting your baby to bed with a bottle of juice or milk.

Sugar from milk and juice stays in the mouth longer when a baby drinks from a bottle.

This may lead to an increase in dental cavities.

Wean your baby from a bottle by 18 months.

Limit sugary foods and drinks to mealtimes.

Avoid carbonated sugar drinks in general.

Offer water between meals for toddlers.

Clean your baby's teeth twice daily by brushing them with a small smear and a mount about the size of a grain of rice, a fluoridated toothpaste.

Chapter 5 - Diapers and all that stuff

There's a lot to look forward to in your baby's first years, but changing diapers may not be at the top of the list.

It's no small task. The average child goes through about 5,000 diaper changes before being toilet trained.

You might wonder what diapers are best, what should I do about diaper rash, and is it normal that my baby has yellow or green poop?

A bit of prep and info can help make diaper duty more pleasant and less worrisome.

Consider diaper changing as another opportunity to bond with your baby.

After all, caring for your child in this way day after day offers a moment for you and your baby to pause and connect.

Keep in mind that the routine of diaper changes will only last so long.

The next chapter has everything you need to know about toilet training.

Finding the right diaper

Several types of diapers are available, cloth or disposable, brand name or generic, and they come in many sizes and styles.

Some babies are comfortable in a lot of different types of diapers, while others need a particular kind that works just right for their body.

If your baby doesn't fit well in the diapers you have, or if he or she seems irritated by the diaper, don't be afraid to try something new.

Disposable

These diapers are commonly used and they're highly absorbent and convenient.

However, the cost of using disposable diapers adds up, especially if you have more than one baby.

The materials used in disposables usually keep your baby's skin drier for a longer period of time.

But the downside of this absorbency is it can be harder to monitor how much your baby has urinated,

which may be important to know when your baby is a newborn.

Disposables are also convenient. You throw them away after each use.

However, disposable diapers generally aren't considered biodegradable.

At best, they may degrade over a very long period.

Amount

If you use disposable diapers, you'll need 80 to 100 a week, at least during the newborn period.

Older infants typically require fewer.

If you plan to buy cloth diapers, the numbers you'll need depends on how often you plan to wash them.

Some people buy enough that they only need to be washed every third day or so,

and others buy a smaller quantity and wash daily.

Getting equipped

Diaper changes will be easier if you have everything you need on hand.

Changing station

It helps to have one or two places where you always change your baby's diaper.

This way, you can keep all your materials together and readily available in the designated location.

If you use a changing table, make sure it has a wide, sturdy base that has compartments for storing diaper supplies.

Remember to always keep one hand on your baby during changes.

Another 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.

Diapers

Keep an adequate stock of diapers on hand.

If you primarily use disposables, it may help to have some cloth diapers around in case you run out.

If you mainly use cloth, keep a stack of disposables handy for those days when you haven't had a chance to do the wash.

Wipes

You can buy pre-moistened baby wipes.

Use a moistened cloth or make your own wipes using a homemade solution.

If you use pre-moistened baby wipes, choose wipes for sensitive skin that don't contain alcohol or fragrance.

This will help prevent irritation.

It's not necessary to use wipes with every change.

Urine is rarely irritating, so if your baby has only peed,

letting the area dry or wiping it with a moist cloth may be sufficient.

Unless your package of wipes specifies that they're flushable, wipes must be thrown away.

Dry cloths

You may want to have some dry, soft cloths on hand so that after you're finished wiping your baby,

you can gently pat his or her bottom dry if you don't have time to let it air dry.

Air exposure can trigger babies to urinate, and your baby may urinate while you're changing the diaper.

If your baby is a boy, you can avoid being sprayed with urine by covering his penis loosely with a dry cloth while you clean the rest of his bottom.

Diaper pail or wet bag

Diaper pails store dirty diapers and wipes,

and wet bags are made to store dirty cloth diapers and reusable wipes before they're washed.

There are a variety of types of pails and bags available.

Look for one that's convenient, sanitary, and holds in odors.

Ointment

You don't need to apply an ointment unless your baby tends to develop diaper rashes,

but it's nice to have a product on hand so that if your baby does develop a rash,

you won't have to immediately run out to buy something.

Changing diapers

By the time your child is toilet trained, you'll be a diaper-changing pro.

In the meantime, the following steps and pointers can help make diaper-changing a successful venture for both you and baby.

Mindset

Changing diapers is an unavoidable part of parenting,

but it may help to think of this necessary task as an opportunity for closeness and communication with your baby.

Your warm words, gentle touches, and encouraging smiles help make your baby feel loved and secure,

and soon your infant will be responding with gurgles and coos.

Frequency

Because newborns urinate frequently, it's important to change your baby's diapers every two or three hours for the first few months,

especially if you use cloth diapers.

But you can wait until your baby wakes up to change a wet diaper.

Urine alone doesn't usually irritate a baby's skin.

However, the acid in a bowel movement can, so change a messy diaper as soon as your baby awakens.

Preparation

Have your wipes and a new diaper ready and within arms reach.

It may help to pull out or prepare the number of wipes you think you'll need for the job,

and open the diaper to lay it flat.

Make eye contact and tell your baby that you're going to change his or her diaper.

Lay your baby gently on his or her back.

If you change the baby anywhere but the floor, remember to keep your hand on your baby at all times.

Remove old diaper.

Unfasten the fabric fastener, tape or snaps on the diaper your baby is wearing,

and pull down the front side of the diaper.

If your baby has had a bowel movement, you can use the clean inside front of the diaper

to pull much of the stool off your baby's skin.

Set the diaper off to the side beyond your baby's reach.

Clean baby's bottom.

During the cleaning, carefully grasp and hold your baby's legs at the ankles with one hand.

Using a cloth that's been moistened with warm water or pre-moistened wipes.

Clean from baby's front to back.

Remember to check and clean out folds where hidden stool can hide.

You can place dirty wipes in the middle of the inside of the dirty diaper to keep the mess consolidated.

Changing baby girls.

Remember to wipe from the front side to the back side to avoid getting stool or more stool in the vaginal area.

Baby girls have more folds and places for poop to hide, so it's important to clean them thoroughly.

However, girls also often have a normal white discharge in the folds of the labia,

and it's not necessary to remove that.

Too much scrubbing can cause irritation.

Let dry.

When finished with the cleaning, gently pat your baby's bottom with a soft cloth

so that the skin is dry when you put the new diaper on.

Place new diaper.

As you lift your baby's legs from the ankles, slide the new diaper underneath his or her buttocks.

The side with tab should be in the back, underneath your baby.

Pull the front of the diaper up between your baby's legs,

and place it so that the front side and backside of the diaper will be at about the same level around your baby's body.

Then fasten the tape, fabric fastener, or snaps, so that the diaper fits snugly around your baby's waist.

If you're using disposable diapers, make sure that none of the elastic around the legs has folded underneath itself.

If you're using cloth, make sure the inner layer is tucked inside the outer layer.

Changing baby boys.

Baby boys can have a tendency to urinate up and out of their diapers, causing leaks and wet clothes.

As you put a new diaper on your baby boy, try positioning his penis downward to prevent these leaks.

Also, you may want to fold the diaper down and in for extra protection on his front side.

Putting on a disposable diaper.

Step 1.

When opening the diaper, make sure the tape, which is at the back of the diaper, is at the top or away from you.

Slide the diaper under your baby until the top edge, the edge with the tape, lines up with your baby's waist.

Step 2.

Bring the front of the diaper up through the legs without twisting it to one side.

Step 3.

Hold one side in position while removing the tab from the tape.

Pull the tape forward and stick it to the diaper front.

Repeat for the other side, making sure the diaper is snug around your baby's legs,

and not twisted to one side.

Step 4.

For a newborn, fold down the top of the diaper so that it won't rub against the healing umbilical cord.

Disposable diapers should fit snugly around the waist, with room enough for only one finger.

Discard old diaper.

If you're using disposables, you can roll up the dirty diaper from the front to the back with any wipes in the middle of the diaper,

and then fasten the tabs around the sides of the rolled-up diaper.

Toss the diaper in a diaper pail.

If you're using cloth diapers and cleaning them yourself, dump any stool into your toilet.

Rinse the diaper off and place it in a designated holding spot, such as a wet bag or diaper pail, until you wash your load of diapers.

Some families use diaper sprayers, which attach to the toilet that can often be purchased in a baby store or online.

Wash your hands.

When you're finished with the diaper change and baby is in a safe place, wash your hands with soap and water.

Handwashing is important.

It can prevent the spread of bacteria or yeast to other parts of your baby's body, to you or to other children.

What's Normal?

New parents often wonder what's normal when it comes to their baby's urination and bowel movements.

For newborns especially, there's a range of what's considered normal for color, consistency, and frequency.

But there also are guidelines that help you know what to expect and when there's cause for concern.

Urine.

In a healthy infant, urine is light to dark yellow in color.

Sometimes as highly concentrated urine dries on the diaper, it creates a chalky, pinkish color, which may be bestaken for blood.

This is normal and not a cause for concern.

Keep in mind that concentrated urine is different from blood in that it dries to a powder and it's not as red in color.

By the time a baby is three or four days old, he or she should have at least four to six wet diapers a day.

As your baby gets older, he or she may have a wet diaper with every feeding.

Stools.

Your baby's first soil diaper will probably occur within 48 hours of birth.

During the first few days, a newborn's stools will often be thick and sticky, a tar-like, greenish black substance called meconium.

After the meconium is passed, the color, frequency, and consistency of your baby's stools will vary depending on how your baby is fed with breast milk or formula.

Once solid foods are introduced, the frequency and consistency of stools may change also.

Color.

If you're feeding your baby breast milk, your baby's stools will likely resemble light mustard with seed-like particles.

They'll be soft and even slightly runny.

The stools of a formula-fed infant are usually tan or yellow and firmer than those of a breast-fed baby, but no firmer than peanut butter.

Occasional variations in color and consistency are normal.

Different colors may indicate how fast the stool moves through the digestive tract or what the baby ate.

The stool may be variations of the colors green, yellow, orange, or brown.

The color isn't that significant unless the stool has blood, shown as red or coal-black streaks,

or if it is a whitish-gray color instead of closer to yellow-brown.

A whitish-gray color could be a sign that the stool is lacking bilirubin products,

which are normal byproducts from the body breaking down excess red blood cells.

These very pale stools could indicate that your baby's body isn't eliminating waste properly.

If you see blood or whitish-gray stools, contact your child's medical provider.

Consistency.

Mild diarrhea is common in newborns.

The stools may be watery, frequent, and mixed with mucus.

Constipation isn't usually a problem for infants.

Babies may strain, grunt, and turn red during a bowel movement,

but this doesn't necessarily mean they're constipated.

Constipation may develop in some babies when solid foods are introduced.

Frequency.

The range of normal is quite broad and varies from one baby to another.

Babies may have a bowel movement as frequently as after every feeding,

or as infrequently as once a week, or they may have no consistent pattern.

Blood.

If your baby's stools appear to contain blood, whether you see red or coal-black coloring,

streaks, flecks, or otherwise, contact your child's medical provider and have the problem checked out.

Actual blood in stools is always a cause for concern, but don't panic.

Sometimes the problem isn't serious.

For example, newborns may have ingested some of their mother's blood during delivery,

or they may be taking it in while breastfeeding if the mother has cracked or bleeding nipples.

Flecks or streaks of blood in stools may also be a sign of an allergy to the protein in cow's milk,

which may be found in formula or breast milk.

For older babies, red or black in stools could be from certain foods,

including tomatoes, beets, spinach, cherries, and grape juice.

Diaper surprises.

You might occasionally notice a surprising, but often harmless substance in your baby's diaper.

These substances may appear as gel-like materials.

Clear or yellow tinted beads or particles may come from diaper materials

that have become overly wet with urine,

small crystals.

A newborn baby's kidneys may make clear crystals if baby is relatively dehydrated.

This can also leave a tinted orange or pink stain in the diaper.

Pink or small blood stains.

A newborn baby girl may have some pink or blood stains in her diapers in the first few weeks.

This is generally from exposure to her mother's hormones right before birth.

Diarrhea is usually a problem, and it goes away with time.

Diarrhea.

If you notice that your baby's stool becomes more watery than normal,

and you observe a gradual or sudden increase in how often or how much he or she is pooping,

contact your child's medical provider.

There are many possible causes of diarrhea.

Some foods may cause diarrhea.

Diarrhea may also be an indication of an illness.

Probiotics are a common cause.

Antibiotics wipe out both the good and bad bacteria in the gut.

If antibiotics are the culprit and your child is nine months or older,

you might consider feeding your child foods that contain probiotics such as yogurt.

Probiotics found in certain fermented foods are microorganisms that contain good bacteria.

Probiotics may help bring a healthy bacterial balance back to your child's gut and improve digestion.

Probiotics are also available as over-the-counter supplements.

However, because not a lot is known about the supplements and studies with young children are limited,

Mayo Clinic pediatricians don't routinely recommend their use.

If you have questions about probiotics, talk to your child's medical provider.

Constipation

Constipation in infants is defined by consistency of stools rather than by frequency.

A baby is constipated when bowel movements are hard and perhaps even ball-shaped.

Babies may become more prone to constipation once they start eating solid foods regularly.

If your baby's stools are hard and formed, you can offer a couple of ounces of water in a sippy cup with meals.

This water doesn't replace breast milk or formula but can help give your baby a bit of extra fluid, which can help with constipation.

Adding more fruits and vegetables to your baby's diet can also help.

Prunes, pears, and peaches are frequently used to help soften stools, either as purees or a small amount of juice.

If these changes don't lead to softer stools, talk to your baby's medical provider about other possible causes and treatments.

Diaper rash

All babies get a red or sore bottom from time to time, even with frequent diaper changes and careful cleaning.

Diaper rash is such a common condition that it happens to nearly every baby at some point.

You certainly aren't a bad parent if your baby gets a diaper rash.

Fortunately, diaper rash is usually easily treated and improves within a few days.

Appearance

Diaper rash is marked by red, puffy, and tender-looking skin in the diaper area, buttocks, thighs, and genitals.

The skin may have rashes or just look red and irritated.

Your baby may seem more uncomfortable than usual, especially during diaper changes.

Causes

Causes of diaper rash include the following.

Irritation from stool

Prolonged exposure to a soiled or damp diaper can irritate a baby's sensitive skin.

Your baby may be more prone to diaper rash if he or she has frequent bowel movements because feces are more irritating than urine.

Irritation from a new product

Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder cloth diapers can all irritate your baby's delicate skin.

Other substances that can add to the problem include ingredients found in some baby lotions, powders, and oils.

Introduction of new foods

As babies start to eat solid foods, the content of their stool changes, increasing the likelihood of diaper rash.

Changes in your baby's diet can also increase the frequency of stools, which can lead to diaper rash.

Bacterial or yeast fungal infection

The area covered by a diaper, buttocks, thighs, and genitals is especially vulnerable because it's warm and moist, making a perfect breeding ground for bacteria and yeast.

These rashes generally start hidden within the creases of the skin, and there may be red dots scattered around the edges.

Chafing or rubbing

Tight fitting diapers or clothing that rubs against the skin can lead to a rash.

Use of antibiotics

Antibiotics kill bacteria, both bad and good ones.

Without the right balance of good bacteria, yeast infections can occur.

This can happen when babies take antibiotics, or when mothers who are breastfeeding their infants take antibiotics.

Because antibiotics often cause diarrhea, this can also lead to rashes.

Treatment

The most important factor in treating diaper rash is to keep your baby's skin as clean and dry as possible.

This often means increasing diaper free time, and thoroughly but gently washing the area with water during each diaper change.

Avoid washing the affected area with soaps and disposable scented wipes.

Alcohol and perfumes in these products can irritate your baby's skin and aggravate or provoke the rash.

If the rash is severe, it might help to clean your baby's bottom with warm water from a squirt bottle instead of using a moistened cloth or wipes, so you won't have to rub the tender skin.

It's also important to allow baby's bottom to air dry completely before putting on a new diaper.

If possible, let your child go without a diaper for longer periods of time.

Avoid using plastic pants or tight fitted diaper covers.

Use larger size diapers until the rash goes away.

In addition, use a mild ointment anytime pinkness appears in the diaper area.

This can reduce friction in rubbing and block chemical irritants from stools or from diaper materials from contact with your baby's skin.

Apply the cream in a thin layer to the irritated region several times throughout the day to soothe and protect the baby's skin.

You don't have to completely remove the cream at every diaper change if the area is clean. Rubbing will only irritate the skin further.

Many effective creams contain zinc oxide, which helps soothe the skin.

Look for a cream that doesn't contain fragrance, preservatives, or other ingredients that could cause irritation or allergies, including neomyosin.

Some products are absorbed into the body through the skin, and some creams contain ingredients that can be harmful for your baby, including boric acid, camphor, phenol, benzacane, and salicylates.

Also, avoid creams that have steroids, such as hydrocortisone in them, unless your baby's medical provider specifically recommends such a product.

Creams containing steroids can be harmful, and they usually aren't necessary.

Also, don't use talcum powder or cornstarch on a baby's skin unless recommended by your baby's provider.

An infant may inhale talcum powder, which can be very irritating to a baby's lungs.

Cornstarch can contribute to a bacterial infection.

When to seek medical treatment?

Contact your baby's medical provider if the rash is accompanied by a fever.

The rash has blisters, boils, discharge, or pus-filled sores.

The rash isn't improving after two to three days of home treatment.

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.

The rash is severe.

The rash is present on skin outside the diaper area.

Preventing diaper rash.

There are a variety of steps you can take to help prevent, or at least reduce, the incidence of diaper rash.

Change your baby's diaper often, so his or her skin is not in contact with urine or stools for very long.

Let your baby's bottom air out once in a while by letting him go without a diaper for a brief period.

Avoid using super-absorbent disposable diapers, because they tend to be changed less frequently.

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 mild detergent with no fragrance, and skip fabric softeners and dryer sheets,

which can contain fragrances that irritate your baby's skin.

Double-rinse the diapers.

If you use cloth diapers, select Snap-on diaper covers, instead of those with elastic bindings, to help improve circulation.

After changing diapers, wash your hands well to prevent the spread of germs.

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 as possible as it dries up and eventually falls off.

It's also important to keep the umbilical cord stump clean and away from contact with urine and stool.

Most newborn diapers are designed with a small cutout so that the diaper sits below the cord and doesn't rub it.

If your diapers don't have this feature, fold the top down so that the diaper is positioned below the cord.

Preventing Rash.

Cloth or disposable.

When it comes to preventing diaper rash, there's no compelling evidence that cloth diapers are better than disposable diapers, or vice versa.

Though disposables may keep baby's skin slightly drier.

Because there's no one best diaper, use whatever works best for you and your baby.

If one brand of disposable diaper irritates your baby's skin, try another.

No matter whether it's cloth or disposable, try to change your baby as soon as you can after he or she soils the diaper, to keep the bottom as clean and dry as possible.

Chapter 6. Toilet Training.

Toilet training is a big milestone for kids and parents.

Many parents look forward to the day when they no longer have to deal with soil diapers and are free to leave the house without a diaper bag.

Most don't miss the expense either.

But it's important to let your child lead the way.

Learning to use the toilet is a natural part of growing up, and not much different from learning to drink from a cup, walk, talk, or any of the many other skills that infants and toddlers develop as they move toward independence.

If left to learn how to use the toilet on their own, most children would probably toilet train themselves.

As with learning to walk, it would occur in a long series of small successes, each next step occurring when the child is ready.

In fact, readiness is the key to successful toilet training.

The single most common cause of toilet training problems is that the child isn't ready.

Being ready makes toilet training easier and quicker.

Patience on the part of parents helps too.

Recognizing readiness.

Many children show signs of being ready for toilet training between ages 18 and 24 months.

However, others might not be ready until they're three years old.

There's no rush.

Rather than relying solely on your child's age or when his or her peers are being toilet trained,

look for your child to show key signs of being ready and interested in using the toilet.

Your child's readiness depends on when he or she achieves certain physical, developmental, and behavioral milestones.

It doesn't have anything to do with intelligence, will, or character.

Physical readiness.

To use the toilet successfully, a child must have voluntary control over his or her pelvic muscles.

This is something your child grows into with time.

You don't have much control over this aspect, and some kids take a little longer than others.

Signs of voluntary control usually begin to appear by 18 months or so.

Signs of physical readiness include being able to recognize the urge to urinate or have a bowel movement,

and sense this urge in time to make it to the toilet or potty chair.

Most children achieve this neurological function between 24 and 36 months.

Developmental readiness.

A number of motor, language, and social skills are important to using the toilet.

Your child may be developmentally ready if he or she is able to walk to and sit on the potty.

Stay dry for up to two hours.

Pull bottom clothes down and back up again.

Follow simple two-step instructions, such as pick up the ball and put it in the toy basket.

Communicate the need to go potty.

Behavioral readiness.

You can also look for key indications in your child's behavior, such as being able to imitate the behaviors of others, such as using the toilet,

the ability to put things where they belong, which helps with understanding that pee and poop go in the toilet,

the ability to say no, which shows a degree of independence from you,

a desire to cooperate and less of a desire to engage in power struggles,

an interest in using the potty on his or her own and in staying clean and dry.

Parent readiness.

Your own readiness as a parent is important, too.

Expect that toilet training will take some time and patience.

It's also likely to get a bit messy.

In general, let your child's motivation instead of your eagerness lead the process.

Avoid equating toilet training success or difficulty with your child's intelligence or stubbornness.

Also, keep in mind that accidents are inevitable and punishment has no role in the process.

Typically, punishment or criticism tends to make the process take longer.

Plan toilet training for when you or another caregiver can devote the time and energy to be consistent on a daily basis for a few months.

Setting the stage for success.

There's not much you can do as a parent to speed up your child's physical readiness for using the toilet.

However, as early as your child's first birthday,

there are some ways you can begin laying the groundwork for a successful psychological transition from diapers to the toilet.

There are several children's picture books written specifically to interest children in this natural transition.

You can read these books with your child.

There are also videos and smartphone apps designed to help your toddler get acquainted with the benefit of using the toilet.

Another way to begin building for a successful transition at this early stage is to allow toddlers to watch parents and older brothers or sisters using the toilet.

Thus, family members can be role models for a year or more before toilet training actually begins.

Active training.

When you think your child might be ready to start using the toilet, go ahead and swing into action.

There's no single best way to toilet train, but here are some general suggestions to keep in mind.

Pull out the equipment.

Consider purchasing a potty chair available at most places that sell baby supplies for the express purpose of toilet training.

A potty chair is generally easier to learn on than an over-the-toilet seat and gives your child a more secure footing and better leverage to eliminate.

In addition, your child can take ownership of the potty chair, decorating it or drawing on it to make it his or her own.

Place the potty chair in the bathroom or initially wherever your child is spending most of his or her time.

If you have multiple levels in your home, you might want to put a potty chair on each level where your child spends time.

Encourage your child to sit on the potty chair and his or her clothes to start out.

Make sure your child's feet rest on the floor or stool.

If you have the potty chair in the bathroom, take the opportunity to have your child flush the toilet so that he or she becomes accustomed to the noise and motion of the water.

Share the purpose of the potty.

Use simple terms to explain what the toilet is for to catch pee and poop, for example.

Use terms consistently and positively.

You might dump the contents of a dirty diaper into the potty chair or toilet to show its purpose or allow your child to watch you use the toilet.

Schedule potty breaks.

Have your child sit on the potty chair or toilet without a diaper for a few minutes at two hour intervals, as well as first thing in the morning and right after naps.

Boys can learn to urinate sitting down and then move to standing up after bowel training is complete.

Stay with your child and read a book together or give your child a toy to play with while he or she sits.

Allow your child to get up if he or she wants.

Even if your child simply sits there, offer praise for trying and remind your child that he or she can try again later.

To maintain consistency, consider bringing the potty chair with you on vacation or when you're away from home with your child.

Respond quickly to the potty dance.

When you notice signs that your child might need to use the toilet, such as squirming, squatting, or holding the genital area, respond quickly.

Help your child become familiar with these signals.

Stop what he or she is doing and head to the toilet.

Praise your child profusely for telling you when he or she has to go.

This will help reinforce the idea that having to go is a call to quick action.

To maximize the chances of success in getting on to the toilet in time, keep your child in loose, easy to remove clothing.

Encourage the feeling of comfort.

Some parents think that leaving a wet or soiled diaper on will help their children want to use the toilet.

But this is generally counterproductive.

You want your child to become accustomed to feeling clean and dry.

You can help by encouraging your child to come to you when wet or soiled and changing diapers as soon as needed.

At the same time, explain to your child the connection between being clean and dry and using the potty.

You can say things such as, "If you go in the potty, your diaper or pants will stay nice and dry."

Explain hygiene.

For girls, it's important to wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder.

Show your daughter how to spread her legs apart when wiping to make this task easier.

Make sure both boys and girls wash their hands after using the toilet.

Ditch the diapers.

After a couple of weeks of successful potty breaks and remaining dry during the day, your child might be ready to trade diapers for training pants or underwear.

Some experts recommend that children wear regular underwear as opposed to disposable training pants because they feel different from diapers.

However, disposable training pants are convenient, especially in childcare settings or when away from home.

Celebrate your child's transition toward big kid clothes.

If your child is unable to remain dry, it's okay to return to diapers until he or she is ready to try again.

Praise and reward.

Reward your child for listening to body signals, heading toward the bathroom and sitting on the potty.

Focus less on mistakes and more on your child's efforts, even minor ones, at using the potty.

Your happy voice, hugs, and compliments for trying will help reinforce positive steps that build toward your child's success.

Consider finding some kind of reward, such as stickers or stars, to offer as additional positive reinforcement.

Nighttime training.

Naptime and nighttime training typically takes longer to achieve.

Most children can stay dry at night between ages 5 and 7.

In the meantime, use diapers or training pants and mattress covers when your child sleeps.

When to start and when to delay training.

If possible, plan toilet training for a time that's relatively stress-free and when schedules are fairly routine.

For instance, if you live in a cold climate, you might plan for toilet training in the warmer months when layers of clothing aren't so much of an issue.

You may want to delay toilet training if you're anticipating major changes in family life, such as a move to a new home or the arrival of a new sibling.

Consider delaying training if the unexpected happens as well, such as a major illness or the death of a family member.

Do's and don'ts of toilet training.

Things to do.

Make toilet training fun for your child.

Give lots of praise and encouragement.

Let your child feel in control.

Most important, relax.

Things not to do.

Don't force your child to sit on the potty.

Don't yell at or punish your child for accidents.

Most important, don't rush the process.

Troubleshooting.

Your child will probably have numerous failures on the way to success.

That's okay. It's the nature of learning.

There's no need to scold, discipline, or shame your child for having an accident.

Provide encouragement for behaviors your child can control, such as sitting on the potty.

And don't stress about those your child can't control yet, such as voiding only in the potty.

Keep encouraging your child to repeat the learning steps you've already started.

Knowing when to stop playing and head to the toilet, undressing, sitting on the toilet, dressing and washing hands.

Maintain a positive attitude and your child will follow suit.

And don't worry too much. Your child will get there eventually.

Accidents.

Accidents will happen. No doubt about it.

Calmly help your child change clothing as soon as you can after an accident.

Keep your tone sympathetic. You might say, "You forgot this time.

Next time you'll get to the bathroom sooner. You'll get better at this."

In the meantime, be prepared.

Make a change of underwear and clothing handy, especially in the car, on an extended outing or at childcare.

In the beginning, many children will urinate or have a bowel movement right after getting off the toilet.

This can be frustrating for parents. If this happens frequently, be patient.

It takes a while to learn to relax bowel and bladder muscles on command.

You might consider holding off on toilet training a bit longer if it leads to anxiety or tension between you and your child.

Lack of interest.

If your child isn't interested in using the potty chair or toilet or isn't getting the hang of it within a few weeks, take a break.

Chances are he or she isn't ready yet.

Pushing your child when he or she isn't ready can lead to a frustrating power struggle.

Try again in a few months. Your child's job is to ultimately learn to control his or her own bladder and bowel movements.

Your job as a parent is to be patient and support your child's efforts.

Regression.

Sometimes a child will lose the willingness to use the toilet or forget certain steps after being toilet trained.

Regression, such as this, isn't uncommon, especially if there have been changes in the child's routine.

Usually it's just one more step on the way to successful toilet training.

Consistent reminders and positive reinforcement while making necessary schedule adjustments are key to keeping your child on track.

Active resistance.

Some children are more independent and prefer to do things on their own.

As they get older, they might resist micromanaging by a parent.

They may hold back bowel movements or become constipated.

They may even continue to wet and soil themselves.

If you follow the steps described earlier for several months without success and your child is approaching three years of age, bring it up with your child's medical provider.

He or she can give you guidance and check to see if there's an underlying problem.

It may be time to try something new.

Sometimes with older children who enjoy being independent, it can help to step back and let them take responsibility for using the toilet.

Let your child know that he or she is in charge now and that you will no longer remind him or her to use the toilet.

Tell your child, in the words you've chosen, that his or her body makes pee or poop every day and that these need to go in the potty.

You can say, "I'm sorry I reminded you so much and made you sit on the potty. From now on, you don't need my help. You can do it by yourself."

Stop all reminders about using the toilet.

Let your child decide when to go to the bathroom.

If your child has an accident, be gentle.

Don't punish, criticize, or ask why or how it happened.

Simply tell him or her to go clean up and change into dry clothes.

If your child asks for assistance, it's okay to help, but keep it simple and neutral.

When your child no longer gets attention for not going, he or she will eventually seek attention for using the toilet correctly.

Give your child plenty of smiles, hugs, and praise when he or she does use the toilet.

Your child will soon embrace his or her newfound skills.

If you have questions about toilet training or your child is having difficulties, talk to your child's medical provider.

Also, call if your child shows signs of constipation or pain or burning during urination.

Treating these problems can help ensure successful toilet training.

Coordinating Toilet Training and Child Care

Many kids go through toilet training while also attending childcare.

To keep the process of toilet training going smoothly, communicate closely with childcare staff.

Tell your child's caregivers about your toilet training efforts so that they can continue your efforts at childcare or preschool.

If you can use similar methods at home and at childcare, your child is less likely to become confused and more likely to succeed.

Some advantages of toilet training at a childcare center are that staff are often positioned to recognize signs of readiness and can help your child take steps to use the toilet.

Being around other kids that use the toilet also may help motivate your child to do the same.

Disadvantages may occur if the childcare center is understaffed or there's little communication between staff and parents.

Chapter 7 Baving and Skincare

Bathing your baby can be a sweet and fun experience.

Don't worry if you feel a little awkward at first. It takes practice to get the hang of cleaning a slippery and squirmy baby.

And don't be surprised if at first your son or daughter doesn't like being bathed.

It's a whole new experience for him or her. And for you too.

The tips that follow will help make your bath time routine safe and smooth.

You'll also learn how to identify and deal with skin conditions that are common in a baby's first years.

Sometimes people expect new babies to have flawless skin, but that's rarely the case.

Baving Basics

As your child gets older, chances are he or she will enjoy taking a bath.

Older babies and toddlers have fun splashing in the water and playing with bath toys.

They'll often jump at the chance to suds up.

Newborns, however, don't always enjoy the bath experience.

They may not care for getting undressed or the cold feeling that comes with having no clothes on.

Fortunately, infants don't need much bathing. It's not until your child gets older and has more chances to get dirty that baths become more of a regular ritual.

How Often

Generally, babies need only one to three baths a week in the first year, unless otherwise instructed by your baby's medical provider.

During your newborn's first couple of weeks, it's okay to give your baby a bath even while the umbilical cord is still attached.

Just avoid submersing your baby's belly in water until the cord falls off.

If the umbilical cord does get wet, dry the area thoroughly.

In between baths, check your baby's folds in the thighs, groin, armpits, fists, and double chins to see if they need occasional spot cleaning.

Once your baby starts crawling around and eating solid food, he or she might need up to three baths a week.

Sponge Bath or Full Bath

You don't have to start out with sponge baths, but they're a gentle and easy way to introduce your new baby to bathing.

It's a fine alternative to a full bath for the first six weeks or so after your child is born.

A sponge bath basically involves using a warm washcloth to clean your baby instead of placing him or her in a tub of water.

During a sponge bath, keep your baby warm by covering him or her with a dry towel.

As you clean a part of baby's body, move a piece of the towel aside in order to get to that area.

Once finished, pat that area dry and cover it back up before moving on to another area.

Don't forget to moisturize your baby's skin.

When's the best time?

Find a time for bathing your baby that's convenient for both of you.

Many people give their baby a bath before bedtime as a relaxing, sleep-promoting ritual.

Others prefer a time when their baby is fully awake.

You'll enjoy this time more if you're not in a hurry and aren't likely to be interrupted.

You may also want to wait a bit after your baby eats or drinks to give a bath in order to allow his or her stomach to settle.

Waiting briefly may also reduce the chances of your baby peeing or pooping during the bath.

Temperature

For baby's safety, you don't want the water too hot. It could hurt or even burn your baby.

And for his or her comfort, you also don't want the water so cool that your baby gets chilled.

Generally, a temperature between 95 and 100 Fahrenheit is ideal for a baby's bath.

To start, make sure your home water heater is set at no higher than 120 degrees Fahrenheit.

This will prevent too hot water temperatures.

Before filling up the tub or basin, test the water temperature with your elbow or wrist.

The water should feel warm, but not hot.

Once you fill the tub or basin, test the temperature again.

Water temperatures frequently change while the water is running.

Never let the bath fill while your baby's sitting in it.

Instead, fill the tub or basin and then test the water again.

Once you're confident the temperature is right, place your baby in the tub.

If you're not sure about the temperature, consider purchasing a bath thermometer to help guide you.

Attentiveness

It's important to give your baby your full and undivided attention during baths.

If the phone rings or someone rings the doorbell, ignore it.

Babies can drown in less than an inch of water in an instant, so you don't want to be diverted from the task at hand.

They can also roll and fall from high surfaces or slip and hit their heads, even when they're seated.

During a bath, keep your eyes on your little one at all times.

If you forgot something you need for the bath, take your baby out of the bath and take him or her with you, even if the item is just a step away.

Bathing step by step

When you decide it's time to try a full bath, you might start out using a baby bathtub, which you can set inside your regular tub or on the floor or next to the sink.

The first few baths should be especially gentle and brief.

If your baby doesn't like it, you might stick with sponge baths for a while longer before trying a full bath again.

Once your child gets older and is able to sit well on his or her own, placing him or her in a few inches of warm water right in the family bathtub works fine too.

Gather supplies

Prepare the bath area with all the items you'll need.

Typically, this involves a couple of clean, soft washcloths, a mild fragrance-free baby soap or shampoo.

This isn't essential for newborns, as plain water will do just fine, but it becomes more important as baby gets older and has more chances to get dirty.

A couple of soft, dry towels. Baby-sized ones are easy to manage.

Gentle, fragrance-free moisturizer.

A fresh diaper and pajamas or clothes.

Bath toys. These aren't necessary early on, but as your baby gets older, he or she will enjoy having a toy or two in the bathtub.

Make sure the toys stay clean and free of mildew.

Get baby ready.

Remove your baby's clothes and diaper.

Gently lower him or her into position.

Support his or her head and torso to help him or her feel secure.

Keep hold.

Babies can be slippery and can become suddenly squirmy, so keep a good hold on your baby during bath time.

It may help to keep your dominant hand free for reaching and cleaning, and use the other hand to keep your baby steady.

Eyes first.

Clean the delicate eye area first.

Use a cloth dampened with water to wipe from the inside to the outside corner of your baby's eye.

Start at the top.

Use a soft cloth to wash your baby's face with water and then pat the face dry.

Wash your baby's head with water too, tipping his or her head back or cupping your hand over his or her forehead to keep any water or soap from running into baby's eyes.

It's not necessary to shampoo your baby's hair with every bath, once or twice a week is plenty.

If your baby seems agitated by a wet head, save the hair wash for last.

You can use a soft wash cloth, your fingertips, or a baby scrubber to wash his or her hair and scalp.

Wash and check folds.

Wash the rest of your child's body from the top down, including the inside folds of skin and the genital area.

For a girl, gently spread the labia to carefully clean the area.

For a boy, lift the scrotum to clean underneath.

If your son is uncircumcised, don't try to retract the foreskin of the penis.

Let your baby lean forward on your arm while you clean his or her back and bottom, separating the buttocks to clean the anal area.

Pat dry.

Once your baby is clean and rinsed off, carefully pick him or her up and into a towel.

Remember, he or she will be slippery.

One way to get your baby dry while holding him or her is to set a towel vertically over your body so that part of it hangs over your shoulder.

Bring your baby to your chest and then bring the bottom of the towel up and around your baby.

Another option is to spread a towel out on the floor, place your baby on the towel, and then wrap the towel around him or her.

Moisturize.

Gently pat your baby dry.

Patting the skin instead of rubbing it dry will help keep your baby's skin from getting irritated.

After you've dried baby off, moisturize your baby's skin all over with a gentle, fragrance-free moisturizer or petroleum jelly.

You might find this easier to do on a changing table or bed than in the bathroom.

Some studies show that daily moisturizing can help prevent eczema, a topic dermatitis, in babies, especially those who have a family history of the condition.

Finishing touches.

Place a fresh diaper on your baby.

Add clothes or pajamas to keep your child warm.

And you're done!

Enjoy the sweetness.

Happy in the water.

A bit of water near your baby's eyes and ears is okay.

Babies can blink to protect their eyes from a little water.

If you keep your baby from even the tiniest of splashes, you may end up with a baby who is fearful of water.

As your baby gets older, if he or she enjoys being in the bathwater, give him or her some extra time to play and splash around after he or she has finished bathing.

This will help him or her have positive feelings about water and may help reduce anxiety about water later.

Ambilical cord care.

After your newborn's umbilical cord is cut, all that remains is a small stump.

In most cases, the remaining cord will dry up and fall off one to three weeks after birth.

Until then, you want to keep the belly area as clean and dry as possible.

Avoid swabbing the cord stump with rubbing alcohol or other antiseptic.

Though this practice was recommended in the past, research indicates that doing so may prolong cord separation.

Exposing the cord to air and allowing it to dry at its base will hasten its separation.

To prevent irritation and keep the navel area dry, fold the baby's diaper below the stump.

During baths, avoid submersing the belly area in water and dry the area thoroughly if it becomes wet.

In warm weather, dress a newborn ingested diaper and t-shirt to let air circulate and help the drying process.

It's normal to see a bit of crusted discharge or dried blood until the cord falls off.

But if your baby's navel looks red or has a foul-smelling discharge, call his or her medical provider.

When the stump falls off, you may see a little blood, which is normal.

Ambilical cord problems, including infections, aren't common.

But have the area examined by your baby's medical provider if you notice any of the following.

The navel continues to bleed. The skin around the base of the cord is red.

There's a foul-smelling yellowish discharge from the cord.

Your baby cries when you touch the cord or the skin near the cord.

The cord hasn't dried up or fallen off by the time the baby is two months old.

Ambilical granuloma.

In some cases, the ambilical cord forms a small red mass of scar tissue, granuloma,

that remains on the belly button even after the cord has fallen off.

The granuloma usually drains a light yellow fluid.

If you notice these signs, contact your baby's medical provider to discuss whether your baby needs to be examined.

Typically, an ambilical granuloma resolves on its own after about a week.

But if it doesn't, your baby's provider may need to remove the tissue.

Ambilical hernia.

If your baby's ambilical cord area or belly button protrudes or bulges when he or she cries,

strains or sits up, he or she may have an ambilical hernia.

In this common condition, part of the abdomen pushes through a hole in the abdominal wall

when there's pressure on the area.

Ambilical hernias typically resolve on their own and don't need treatment.

In rare cases, a baby may need surgery to close the hole.

Taping the bulge down or taping a coin over the hernia is a potentially harmful practice and should be avoided.

Circumcision care.

If your newborn boy was circumcised, the tip of his penis may seem raw for the first week after the procedure.

Or a yellowish mucus or crust may form around the area.

This is a normal part of healing.

A small amount of bleeding also is common the first day or two.

Clean the area around the penis gently and apply a liberal amount of petroleum jelly to the end of the penis with each diaper change.

This will keep the diaper from sticking while the penis heals.

If there's a bandage on the penis, change it with each diaper ring.

At some hospitals, a plastic ring is used instead of a bandage.

The ring will remain on the end of the penis until the edge of the circumcision has healed, usually within a week.

The ring will drop off on its own.

Problems after a circumcision are rare, but call your baby's medical provider if you notice bleeding, redness, or crusted sores containing fluid around the tip of the penis.

Other signs to be aware of are swelling of the penis tip or a foul-smelling drainage coming from the penis tip.

Washing a circum-sized penis.

It's okay to gently wash the penis as it's healing.

And once it's healed, the circum-sized penis doesn't need special care.

Wash your baby's penis with warm water and mild baby soap, just like you clean the rest of his bottom.

Occasionally, a small piece of foreskin remains on the penis.

If this occurs, gently pull back the skin to make sure the head of the penis is clean.

Caring for an uncircum-sized penis.

During your baby's first few months, clean his uncircum-sized penis with water and a bit of mild baby wash, just like you would clean the rest of his bottom.

You don't need to use an antiseptic or cotton swabs.

Don't try to pull back or retract the foreskin.

Doing so can cause tearing, pain, and bleeding.

The foreskin will retract on its own, a process that can take months to years.

It's important to watch your uncircum-sized baby urinate once in a while.

If you notice his urine stream isn't stronger than a trickle, or if he seems uncomfortable while he pees, contact your baby's medical provider.

It's possible that the hole in the foreskin is too small to allow a normal flow of urine.

Because of the foreskin separation can take several months or longer, check with your baby's medical provider to find out when the separation is complete.

Once it is, you can gently retract the foreskin to clean the head of the penis.

Then, pull the foreskin back over the penis when you're finished.

Once your baby boy is older, it's important to teach him how to properly wash his penis using these three steps.

Gently pull the foreskin back and away from the head of the penis.

Use warm water and soap to clean the head of the penis and the fold in the foreskin.

Pull the foreskin back to its original place over the head of the penis.

Nail care

Your baby's nails are soft, but they're sharp.

A newborn can easily scratch his or her own face, or yours.

To prevent your baby from accidentally scratching his or her face, you will want to trim or file the fingernails shortly after birth.

Then continue to trim his or her nails a few times a week.

Sometimes you may be able to carefully peel off the ends with your fingers because baby nails are so soft.

Don't worry, you won't rip the whole nail off.

You can also use a baby nail clippers or a small scissors.

Here are some tips to make nail trimming easier for you and your baby.

Trim the nails after a bath.

They'll be softer, making them easier to cut.

Wait until your baby is asleep.

Have another person hold your baby while you trim his or her nails.

Trim the nails straight across.

Don't bite your baby's nails as a method of keeping them trimmed. This can cause infection.

Your baby's toenails will probably grow much more slowly than his or her fingernails.

They may need to trim only once or twice a month.

Tone nails are also softer than fingernails, so they may appear to be ingrown,

but unless the skin around the nail looks red and inflamed, they're probably fine.

Baby's First Bath

Breaking out the tub.

When you're ready to give your baby a tub bath, whether you do so right from the start

or you try sponge baths first, you'll have plenty of choices.

You can use a freestanding plastic tub specifically designed for newborns,

a plain plastic basin, or a small inflatable tub that fits inside the bathtub.

Lined with a towel or rubber mat, the kitchen or bathroom sink might be another option.

Checking the water temperature

You need only a few inches of warm water.

To prevent scalding, set your water heater thermostat to below 120 degrees Fahrenheit.

A temperature between 95 and 100 degrees Fahrenheit is ideal.

Use a secure hold.

A secure hold will help your baby feel comfortable and stay safe in the tub.

Use one of your hands to support your baby's head and the other to wash your baby's body.

Washing Baby's Back

When you clean your baby's back and buttocks, lean him or her forward on your arm.

Continue to grasp your baby under the armpit.

Remember the creases.

Pay attention to creases under the arms, behind the ears, around the neck, and in the diaper area.

Wash between baby's fingers and toes.

Rinsing Baby's Hair

You might want to try a football hold under the faucet for washing baby's hair.

Support your baby's back with your arm, keeping a firm hold on your baby's head while you rinse.

When Baby Crys

If your baby cries in the tub, stay calm, clean what you can, and then wrap your baby in a towel.

Wait a few days and then try again.

In the meantime, use sponge baths where needed.

Common Skin Conditions

Many parents expect their newborn skin to be flawless,

but most babies are born with some bruising and skin blotches and blemishes are common.

Young infants often have dry, peeling skin, especially on their hands and feet for the first few weeks.

Some blueness of the hands and feet is normal and may continue for a few weeks.

Rashes also are common, even into the toddler years.

Most rashes and skin conditions are treated easily or clear up on their own.

Millea

Millea is the name for tiny white pimples or bumps that appear on the nose, chin, and cheeks.

Although they appear to be raised, they are nearly flat and smooth to the touch.

If your baby has millea, you can wash his or her face once a day with warm water and a mild baby soap,

but avoid using lotions, oils, or other products.

It's also important to leave the skin alone.

Never scrub or pinch the bumps.

Millea disappear in time, often within a few weeks, and they don't require treatment.

Baby acne

Baby acne, neonatal, cephalic, pustulosis, refers to small red and white bumps that are seen on the face, neck,

upper chest, and back of some newborns.

The pimples are generally most noticeable within the first few weeks after birth.

To care for baby acne, place a soft, clean, receiving blanket under baby's head,

and wash his or her face gently once a day with mild baby soap.

Avoid lotions, oils, and other treatments, and never scrub, squeeze, or pinch the affected skin.

The condition typically disappears without treatment within the first couple of months, without scarring.

If it doesn't clear up after a few months, talk with your child's medical provider.

Aritheum Toxicum

Arithema Toxicum is the medical term for a skin condition that's typically present at birth,

or appears within the first few days after birth.

It's characterized by small white or yellowish bumps, surrounded by pink or reddish skin.

The condition causes no discomfort and isn't infectious.

Arithema Toxicum disappears in several days, although sometimes it flares and subsides

before completely clearing up.

Treatment isn't necessary.

Pustular Melanosis

These small spots look like yellowish white sesame seeds that quickly dry and peel off.

They may look similar to skin infections, pustules.

But pustular melanosis isn't an infection and disappears without treatment.

The spots are commonly seen in the folds of the neck and on the shoulders and upper chest.

They're more common in babies with darker skin.

Cradlecap

Cradlecap infant subaric dermatitis.

Refers to a scaliness and redness that develops on a baby's scalp.

It results when oil-producing sebaceous glands produce too much oil.

Cradlecap is common in infants, usually beginning in the first weeks of life

and clearing up over a period of weeks or months.

It may be mild with flaky dry skin that looks like dandruff,

or more severe with thick, oily, yellowish scaling or crusty patches.

Shampooing with a mild baby shampoo can help with cradlecap.

Don't be afraid to wash your baby's hair frequently.

This, along with soft brushing, will help remove the scales.

If the scales don't loosen easily, rub a few drops of mineral oil onto your baby's scalp.

Let it soak into the scales for a few minutes, and then brush and shampoo your baby's hair.

If you leave the oil in your baby's hair, the scales may accumulate and worsen cradlecap.

If cradlecap persists or spreads to other parts of your child's body,

especially in the creases at the elbow or behind the ears,

contact your baby's medical provider, who may suggest a medicated shampoo or lotion.

Cradlecap isn't usually uncomfortable or itchy for your baby,

but sometimes a yeast infection can occur in the affected skin.

In this case, the skin will become very red and itchy.

If you notice this, mention it to your baby's medical provider.

Eczema

Eczema, also known as atopic dermatitis, is marked by dry, itchy, scaly, red patches of skin

that are often found around babies and toddlers' elbows or knees.

Sometimes the affected area is small and doesn't bother a baby much, and treatment isn't necessary.

Many children outgrow eczema.

In other cases, eczema can cover a lot of skin and can be extremely itchy and uncomfortable.

In these cases, talk with your child's medical provider about whether treatment is needed.

You can also try the following methods to prevent eczema from reoccurring.

Use fragrance-free baby soaps to wash your child and laundry detergents that are free of fragrances,

dye, and deodorants.

Even mild baby soaps may have a small amount of fragrance that can irritate sensitive skin.

Dress your little one in soft cotton clothing and avoid synthetic fabrics and wool.

Bathe your baby daily with a fragrance-free hypoallergenic bath oil.

This can help moisturize your baby's skin, in addition to helping prevent skin infections,

which are more common in children with eczema.

Use a fragrance-free moisturizer or ointment, such as petroleum jelly, right after patting baby dry following a bath.

This helps lock moisture from the bath into baby's skin.

Keep your child away from environmental triggers for eczema, including heat and low humidity.

Check your child's sleeping conditions and ensure that the area is free of dust and upholstery that may contain dust mites.

Contact dermatitis and rule rash.

Contact dermatitis is a kind of skin inflammation that occurs when substances touching your skin cause irritation or an allergic reaction.

The resulting red, itchy, dry, or bumpy rash isn't contagious or life-threatening, but it can be very uncomfortable.

Culprits for young children could include soaps, laundry detergent, rough fabric, or even your baby's own drool, sometimes referred to as drool rash.

If you can identify the offending agent and eliminate contact between it and your child, the contact dermatitis should clear up.

Often using an absorbent bib and changing it frequently, as well as applying a barrier cream such as petroleum jelly to the area of irritation, can help prevent the rash from worsening.

In the meantime, a wet compress may help comfort your baby.

Contact your child's medical provider if the rash is severe or gets worse, or if your baby's skin is oozing or extremely itchy.

Empatigo

Empatigo is a highly contagious skin infection that mainly affects infants and children.

It usually appears as red sores on the face, especially around a child's nose and mouth.

The sores may be covered with a yellow-brown scab or crust, or grow into blisters and pimples and ooze pus.

Although Empatigo commonly occurs when bacteria enter the skin through cuts or insect bites, it can also develop in healthy skin.

Because Empatigo can sometimes lead to complications, your child's medical provider may choose to treat Empatigo with an antibiotic ointment or oral antibiotics.

Safe baby care products

Finding baby care products that are absolutely safe and gentle seems like it should be an easy task, but unfortunately that's not always the case.

Baby products are generally marketed as safe, gentle, mild and natural, yet some of these products may contain ingredients that can be irritating to your baby.

Remember that whenever you put something on your baby's skin, the ingredients in the product can be absorbed into your baby's body through the skin.

Here are some ways you can protect your baby from potentially harmful ingredients.

Limit the number of products you use on your baby.

Read labels to ensure you're comfortable with all of the ingredients.

This method has its limitations.

However, since most people aren't familiar with the many names and types of chemicals, in addition in the United States, the Food and Drug Administration doesn't require products to list the individual ingredients that are used to make a fragrance, and many products just list fragrance as the ingredient.

Go online or check government and health resources to learn more about the ingredients and products you're using or are considering purchasing.

One example is www.skinsafeproducts.com, developed in conjunction with Mayo Clinic.

Chapter 8. Clothing your child

One of the things many new parents look forward to during pregnancy and after baby is born is shopping for baby clothes.

While it may be hard to resist the sparkly dresses, designer jeans, or miniature boots, they're so cute, you do want to be fairly practical in the clothes you buy.

Between diaper blowouts, messy toddler meals, and playing in parks and puddles, your child will need plenty of outfit changes these first few years, and undressing and dressing may not be one of your child's favorite activities.

So there's no need to make it more complicated than you have to.

Not to despair, though, tutus and dinosaur costumes and other such items are sure to become a fun part of your child's wardrobe.

A few shopping tips. If you haven't had a lot of experience in outfitting a baby, here are a few suggestions you may find helpful.

Size

Almost all baby clothing is sized in three-month intervals. Sizes often begin with zero to three months, followed by three to six months, six to nine months, and so forth.

Some brands have a single number, which is typically the upper end of the size range. For example, a size 18 months is comparable to a size 12 to 18 months in other brands.

But buying for baby often isn't quite that simple, as many parents who've had to return clothing to the store can attest.

When you're buying clothes for your newborn, don't go strictly by what's on the label. Look at the item and see if it appears to run small or about the right size for your child.

You may find you want to choose a larger size, even if it means the item may be a little big to begin with.

Many babies fit into clothing long before what's indicated on the label. A newborn may wear a size three to six months within a few weeks of birth, and it's not uncommon for a four-month-old to wear size six to nine months.

Many parents will tell you about waiting until their baby was six months old to wear the cute six to nine-month outfit, only to put it on and find out it was too small.

Manufacturers often include tags that list weight and height guidelines for each size. They may give you a better idea if the item will fit.

Fabric. In general, look for soft, comfortable clothing that's washable. Look for clothing that doesn't irritate, bind, twist, or rub your baby's skin.

Clothing made from 100% cotton is often recommended for children with sensitive skin, and that includes most infants.

Purchase machine washable clothing that can be pre-treated for stains. Also, keep in mind that items made from cotton may shrink a bit.

Safety. Keep it simple. Avoid clothes with buttons, which could be swallowed, and ribbons or strings, which could cause choking.

Don't buy garments with draw strings around the neck, which could catch on objects and strangle a child.

Ease. Because you may be changing your child's clothing a few times a day, or at least changing diapers several times a day, make sure the outfits are uncomplicated and they open easily.

Look for garments that snap or open down the front, have loose-spitting sleeves, and are made of stretchy fabric.

Be cautious dressing young children in clothing with zippers, which can catch skin accidentally.

Cost. Since babies outgrow clothes so quickly, consider purchasing some clothes at thrift stores, garage sales, or from other parents.

If someone offers you hand-me-downs, don't take it as an insult.

Accepting hand-me-downs can save you money that you can use for other items you may want to purchase for your child.

Wardrobe essentials. Because babies and toddlers grow so fast, you don't want to buy too much at once.

You run the risk that your son or daughter will outgrow the clothes before he or she has a chance to wear them.

It's often best to purchase a few outfits at a time every few months.

In addition, if clothing is purchased too far in advance, the seasonality and comfort of the item may not be appropriate when your child is ready to wear it.

You'll also find that there are certain clothes babies seem to wear more than others, often because of ease, comfort, or convenience.

As your child becomes more mobile, continue dressing him or her in clothes that are easy to move and play in.

Body suits. These shirts have bottom ends that extend between the legs, fit up over the crotch, and snap in front.

Body suits are especially nice for babies because the fabric doesn't ride up to expose the belly. They come in short or long sleeves.

Body suits can be worn underneath clothing or when temperatures are warm by themselves.

They provide an easy way to give your baby an extra layer of warmth, and they help keep your baby's other clothing from rubbing up against his or her new and delicate skin.

You'll go through a lot of these. Buy enough to last between clothes washings.

One Piece Outfits. One Piece Outfits go by a lot of names, including stretchies, sleepers, or rompers.

When your baby is young, you may find that One Piece Outfits are quite practical.

The outfits generally snap in front and at the crotch and are easy to get on and off. They may come with or without footies.

A gown resembles a stretchy or sleeper, but instead of having legs, it looks more like a sleeping bag at the bottom.

A gown may have an open, elasticized bottom.

Again, because your baby may wear One Piece Outfits a lot, especially in the first year, make sure you have enough to last between washings.

One Piece Outfits are great for crawling children, as loose-fitting pants can be difficult to keep in place.

Stretchy cotton leggings or more fitted pants are a popular choice too.

As your toddler begins to walk and climb, look for clothing without loose strings or decorations.

These can sometimes get caught on furniture or get pulled by other kids.

Pajamas. Depending on the weather, infant pajamas may be of a lighter or heavier material.

During hot summer months, a sleeper or gown may be all your baby needs while sleeping.

During the colder winter months, you may want to put a baby in a heavier blanket sleeper.

Blanket sleepers keep a baby warm without the need for a comforter or blanket.

You'll likely want at least a couple of pajama sets for each season.

Don't purchase oversized pajamas, regardless of how comfortable you think they might look.

If the pajama top rides up on the neck and head or is too loose around the shoulders,

the extra space between the material and baby's skin may increase the risk of suffocation.

Some pajamas are made with chemically treated fabric that make them flame resistant

and can help prevent burn injuries in the case of a fire.

If you're concerned about these chemicals in your baby's clothes, you can opt instead for snug-fitting pajamas.

The kind that taper down from the shoulders to the ends of the sleeves and from the thighs to the hems of pant legs.

Tight-fitting sleepwear is less likely to catch fire than the loose-fitting kind.

Most importantly, take appropriate fire prevention measures, such as installing smoke detectors in your home,

not smoking and not leaving an open flame unattended.

Dress clothes.

For occasions when you'll be taking your child out and you want more dressy clothing,

look for outfits that are comfortable and easy to get on and off.

Pairing a bodysuit with pants keeps the top from riding up.

If the outfit has elastic at the waistline, legs or arms make sure the elastic isn't too tight.

In the warm summer months, one-piece outfits with short sleeves and short pants are great day wear.

Socks.

As you probably well know, socks have a tendency to fall off.

Look for those that are most likely to stay on, but also expect that you will lose some along the way.

You don't need to worry about purchasing socks with non-skid bottoms until your child starts walking.

Winter gear.

During the cooler winter months, you need a winter cap to cover your baby's head.

His or her hands should also be covered.

When baby is young, you may find a bunting to be convenient.

However, these sack-like outerwear garments aren't recommended if your baby is in a car seat.

The extra material could prevent baby from being strapped in securely.

Instead, use a car seat cover or blanket to keep your child warm.

As your child becomes more mobile, he or she can continue to play outside and explore in all weather with the right gear.

A one-piece snow suit prevents snow from getting in between layers when kids fall on uneven snowy ground.

Snow pants and a warm winter jacket are an alternative, especially as children become more steady.

Outdoor winter gear isn't recommended for use in a car seat, as it can prevent your child from being securely buckled.

Depending on where you live, your child may need warm winter boots along with a winter hat and warm mittens.

Toddlers will often refuse these items as they begin to assert their independence.

Be persistent. It's important to keep your child warm in cold weather.

Summer accessories

To help protect your baby's skin and provide a bit of shade, use a broad-brimmed hat or cap during warm summer months.

A hat or cap also helps keep the sun out of your baby's eyes.

Some toddlers get a thrill out of wearing sunglasses, which can also offer eye protection.

If you purchase sunglasses for your child, make sure that they offer UV protection and will not shatter.

Try to avoid being outdoors during the hottest times of the day, typically between 10 a.m. and 4 p.m.

Keep infants out of the sun.

Babies older than six months can wear sunscreen that has an SPF of 30 or higher.

Shoes

Many babies don't walk until after their first birthday, but a few young ones get their legs under them early.

If your son or daughter begins walking early, you may need to purchase a pair of shoes.

There's nothing wrong with your child walking in his or her bare feet. It's actually a great way to learn.

Shoes are needed at times, though, to protect your child's feet from sharp objects and other unpleasant stuff, especially when outside.

When shopping for shoes, look for ones that are low-cut with flexible, non-skid soles.

The upper part of the shoe should be made from material that's breathable and lightweight.

Air on the side of buying shoes that are too big, rather than ones that will soon be too small.

However, you don't want shoes so big that your child has difficulty walking in them.

Once your toddler masters walking, he or she will definitely need shoes.

Shoes and sandals with covered toes offer the best protection for the frequent falls that will occur as your child improves his or her walking and running skills.

Dress for the weather

New parents sometimes over-dress their infants.

A good rule of thumb is to dress your baby in the same number of layers that you would feel comfortable wearing, and possibly one more light layer.

For example, you might put baby in a diaper and undershirt covered by a sleeper or gown and wrapped in a receiving blanket.

In hot weather, over 75 degrees Fahrenheit, a single layer of clothing is often appropriate.

Babies don't sweat easily and can become overheated.

However, you may want an additional layer if the baby is in air conditioning or near drafts.

Remember that your baby's skin will sunburn easily. If you're going to be outside, keep baby out of the sun and protect your baby's skin with clothing and a hat or cap.

Laundry tips

After your baby arrives, it can seem as if you do laundry all of the time.

To make the process as easy as possible, purchase clothes that appear durable and that are likely to wash well.

It's also a good idea to wash all clothes before your child wears them to get rid of any potentially irritating substances that may have gotten on the clothing.

Here are a few other tips.

Stains

Stains are inevitable.

Breast milk, formula, spit up, poop.

These common offenders will more often than not wind up on your baby's clothes and probably on yours too.

Later on, table food, dirt, paint, and ink stains also are common.

If possible, blot or rinse off the substance while it's still fresh and before it sets.

You might soak stained clothes with a pre-soak before you wash them.

At the very least, blast them with a good douse of stain remover before putting them in the washing machine.

A mixture of equal parts white vinegar and water is often easy to keep in a spray bottle to apply to fresh stains.

Detergents

Babies have sensitive skin and some babies and young children develop skin irritation from standard laundry detergents.

Even some detergents labeled for babies are scented and can be irritating to the skin.

In general, wash your child's clothes in unscented detergent.

Several brands are available, usually with free, free and clear, or unscented included in the name.

Avoid fabric softeners for the same reason, though some unscented fabric softeners are available.

Some parents run babies clothes through an extra rinse cycle to ensure there's no soap residue left on the clothing.

This may not be necessary, but if you would like, you can try it and see if it helps.

Chapter 9

Sleep and sleep issues

Oh baby, there's nothing like getting a good night's sleep.

While newborns usually sleep up to 16 hours a day, it's frequently for only one or two hours at a time.

Your baby can thrive on that schedule, but you may find it exhausting.

If you haven't had a good night's sleep since your baby was born, you're not alone.

Sleepless nights are a rite of passage for most new parents, but don't despair.

Your baby will learn to sleep better at night, honestly.

Sleep is vital to your child's growth and development.

From the time your baby is born, you can encourage him or her to adopt good sleep habits.

By the end of the first year, your baby will likely do most of his or her sleeping at night,

usually with a nap or two during the day, and these broad sleeping patterns will continue for the next few years.

In general, it's easier to prevent sleep problems than to fix them later.

No matter how old your child is, it takes calm, consistent effort and patience to help your child develop healthy sleep habits.

This chapter offers tips on sleep schedules, reviews prevention strategies to reduce the risk of sudden infant death syndrome,

SIDS, and crib accidents, and outline steps you can use to help your toddler learn to sleep independently.

Don't beat yourself up if things don't always go as planned.

Do your best and eventually everyone will be sleeping through the night.

Newborn Sleep Schedule

It takes a while for newborns to get on any kind of schedule for sleeping.

During the first month, they usually sleep and wake round the clock, with relatively equal periods of sleep between feedings.

In addition, newborns don't know the difference between night and day.

It takes time for them to develop circadian rhythms, the sleep-wake cycles, and other patterns that revolve on a 24-hour cycle.

Azure Baby's nervous system gradually matures, so do his or her phases of sleep and wakefulness.

Fits and spurts

Although newborns don't usually sleep for more than a few hours at a stretch, all together they typically sleep 12 to 16 hours a day.

They may stay awake long enough to feed, or for up to about two hours before falling asleep again.

During 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 adjusted to what it's like being up with a baby at night.

By the time your baby is two weeks old, you'll likely notice that the periods of sleeping and wakefulness are lengthening.

By age 3 to 4 months, some babies sleep at least 5 hours at a time and shift more of their sleep to nighttime, much to the relief of their parents.

By age 6 months, nighttime stretches of 9 to 12 hours are possible.

Many newborns nap frequently in 1 to 2-hour spurts.

As baby gets older, nap times may lengthen and become more predictable.

With some babies, though, napping remains random, and they never really fall into any type of pattern.

When baby is a few months old, you may find that he or she will fall into a 3 naps a day schedule,

a morning nap, an early afternoon nap, and an early evening nap.

However, this also varies considerably with each baby.

Sinking Days and Nights

Some babies clearly have their days and nights reversed, and they sleep more in the daytime than at night.

For parents who are sleep deprived, this can be a stressful time.

Generally, though, within a few weeks to a couple of months, days and nights will become more predictable and regular.

One way to help speed up this transition is to limit daytime naps to no more than 3 or 4 hours each.

In addition, during the day, have babies sleep in a more active area of the house with the lights on and where noises can be heard.

In contrast, at night, keep the bedroom dark and quiet.

During nighttime feedings and diaper changes, avoid stimulation.

Keep the lights low, use a soft voice, and don't play or talk with your baby.

This reinforces the message that nighttime is for sleeping.

Noisy Breathing

The familiar phrase "sleeping like a baby" conjures up images of a baby lying quietly and breathing ever so softly.

But babies, especially newborns, often aren't quiet when they sleep.

Newborns spend about half their time in an active phase of sleep called rapid eye movement, REM sleep.

During REM sleep, babies may breathe irregularly, grunt, snort, and twitch.

During deeper sleep, called non-rapid eye movement, N-REM sleep, babies typically sleep more peacefully.

As babies get older, they spend more time in N-REM sleep and less time in active sleep, so they generally become less noisy.

In addition, newborns are dominantly nose breathers. They breathe through their noses, not their mouths.

This is so they can breathe at the same time they nurse.

The slightest congestion or mucus in babies' tinal nasal passages, as air flows in and out, can make a lot of noise.

If your baby's breathing sounds a bit stuffy, it doesn't necessarily mean that he or she has a cold or allergies.

Noisy breathing in infants can be very worrisome for parents. Most of the time, the noise is normal.

However, if you're concerned that something isn't right, contact your child's medical provider.

Sleep Safety

Sudden infant death syndrome, SIDS, is the unexplained death usually during sleep of a seemingly healthy baby.

Although the exact cause is still unknown, it appears that sudden infant death syndrome may be associated with abnormalities in the portion of an infant's brain that controls breathing and arousal from sleep.

Other risk factors include sleeping on the stomach or side, on a soft surface, or with parents in the same sleep space.

SIDS is a scary thing to think about, but there are multiple ways to help reduce your baby's risk of SIDS and put your baby safely to sleep.

Back to sleep

Always place your baby on his or her back to sleep, even for naps. This is the safest sleep position for reducing the risk of SIDS.

Research shows that babies who are put to sleep on their stomachs are much more likely to die of SIDS than are babies placed on their backs.

Infants who sleep on their sides also are at increased risk, probably because babies in this position can roll onto their stomachs.

Since 1992, when the American Academy of Pediatrics, AAP, began recommending the back sleeping position for infants,

the incidence of SIDS in the United States has declined significantly.

The only exceptions to the back sleeping rule are babies who have health problems that require them to sleep on their stomach because the risk of death is greater if they sleep on their backs.

If your baby was born with a birth defect, spits up often after eating, or has a breathing, lung, or heart problem, talk to your baby's medical provider about the best sleeping position for your child.

Make sure that everyone who takes care of your baby knows to place baby on his or her back for sleeping.

That may include grandparents, childcare providers, babysitters, friends, and others.

Be firm in your instructions.

Placing babies on their backs to sleep is based on evidence that doing so saves infant lives.

Some babies don't like sleeping on their backs at first, but they get used to it quickly.

Many parents worry that their baby will choke if he or she spits up or vomits while sleeping on his or her back, but researchers have found no increase in choking or similar problems.

A baby who sleeps on his or her back may develop a flat spot on the back of the head.

For the most part, this will go away after the baby learns to sit up.

You can help keep your baby's head in normal shape by alternating the direction your baby lies in the crib.

Head toward one end of the crib for a few nights, and then toward the other.

This way, the baby won't always sleep on the same side of his or her head.

Once your baby can successfully roll over from back to stomach and then back again, typically around age six months,

you can let him or her sleep in the position he or she chooses.

But until your baby becomes adept at moving around, on his or her own, keep your baby's bassinet or crib free of loose bedding or stuffed animals.

This is to prevent your baby from rolling onto them and being unable to roll out.

Share the room, not the bed.

Many new parents are tempted to take their baby into bed with them.

This is often because they're tired, understandably so, and because having baby in bed seems more convenient.

And for some parents, this is what their parents and grandparents did before them.

But the truth is that bed sharing can increase the risk of harm to your baby.

Adult beds generally have softer mattresses than cribs and have lots of blankets and pillows.

Though comfortable for adults, these factors can interfere with baby's breathing or make a baby overly warm.

In addition, there's a risk of the adult inadvertently rolling over onto the baby during sleep or pushing the baby into bedding and causing suffocation.

Falling asleep with your baby on a couch or chair can be even more dangerous because of the cramped quarters.

In addition, if your child learns to sleep well in your bed, it can make transitioning to his or her own bed later more difficult and traumatic.

As your child gets older, it can be harder to break a bed sharing habit.

Instead of bed sharing, the AAP recommends room sharing during your baby's first year or at least the first six months.

The rates of SIDS and other sleep-related deaths are highest during this time.

Room sharing means your baby sleeps in your room with you but in a separate bassinet, crib, or other structure designed for infants.

Having your baby nearby can put your mind at rest and make it easier to monitor your baby.

Evidence suggests that sharing a room with your baby but not the bed can decrease your baby's risk of SIDS by as much as half.

A safe sleep environment for your baby

To keep your baby safe during sleep, follow these recommendations from the American Academy of Pediatrics.

Place your baby on his or her back to sleep every time.

Use a firm sleep surface.

Breastfeed while you can.

Share your room with your baby using separate sleep surfaces.

Remove soft objects and loose bedding from your baby's sleep area.

Consider using a pacifier during sleep time.

Avoid smoke exposure, alcohol, and illicit drug use.

Avoid overheating.

Get your baby vaccinated on schedule.

A safe sleep space.

Make sure your baby is comfortable and safe.

If you've made sure the crib and area around it are safe, you won't immediately become concerned about your baby's safety if you hear cries.

Follow these safety guidelines.

Avoid old cribs or bassinets.

Even if an old crib is in good shape, safety standards have improved over the years, so it's generally a good idea to buy a new crib if you can.

If you do use a hand-me-down crib, make sure that it meets current safety standards.

Older cribs with dropped sides, the kind that have a side rail that moves up and down, are not considered safe.

In addition, some older cribs may have been coated with lead paint, which is a health hazard.

A crib should be the one place you feel comfortable leaving your child alone.

Check the slat spacing.

The crib's slats should be no farther apart than 2-3/8 inches.

This applies to bassinets, too.

If you can fit a can of soda through the slats, the openings are too large.

You're more likely to find this problem in older cribs, but you can't be too safe when it comes to your baby, so check any crib you put him or her in.

Get the right mattress.

The surface of your baby's mattress should be firm, flat, and smooth.

Make sure the mattress fits snugly within the frame of the product it's made for, so there's no space for your baby to get trapped.

Remove extraneous items.

During the first year, or at least until your baby can easily move around the crib on his or her own,

remove any extra bedding from the sleep space, such as bumper pads, pillows, cushions, and comforters.

This prevents your baby from rolling into a potentially suffocating situation.

To keep your baby warm, try a sleep sack or other sleep clothing that doesn't require additional covers.

Save toys and stuffed animals for when your baby is awake and supervised.

Remove crib mobiles early.

Crib mobiles typically include string and small attached pieces.

Make sure your little one cannot reach the mobile so that he or she can't become entangled or pull anything off.

When your baby is able to push up onto his or her hands and knees, the mobile should be removed from the crib.

Safe swaddling.

Many young babies fall asleep and sleep better when swaddled.

If you swaddle your baby, use a breathable 100% cotton blanket or a swaddling sleep sack.

A blanket is breathable when you can hold one layer of the blanket up to your mouth and your breath can pass through the fabric.

This is the best option for a baby because the baby can still breathe if the fabric slips and covers his or her face.

Cotton also allows body heat to escape, which prevents overheating.

When swaddling your baby, make sure to allow room for the hips and legs to move freely.

If you wrap your baby too tightly around the hips and legs, it can interfere with proper growth and joint development.

Your baby's legs should be able to bend up and out.

It's time to stop swaddling when your baby first shows signs of rolling over, generally around four months.

Ideally, a baby needs to be able to control his or her arms when rolling, but the baby can't do that when he or she is swaddled.

Try a pacifier.

Sucking on a pacifier at nap time and bedtime may reduce the risk of SIDS.

One caveat. If you're breastfeeding, you may want to wait to offer a pacifier until breastfeeding is well established.

For some babies, this can be three to four weeks of age.

If your baby's not interested in the pacifier, try again later.

If the pacifier falls out of your baby's mouth while he or she is sleeping, there's no need to pop it back in.

Good sleep habits.

A question that new parents often get from friends and family is, "Is your baby sleeping through the night yet?"

But honestly, no one sleeps through the night.

Everyone experiences nighttime arousals, but most of the time, people go right back to sleep after these brief awakenings.

Babies experience the same nighttime arousals.

In the first few months, a number of biological factors impact these awakenings.

For example, new babies need to feed every few hours, including at nighttime,

because although their stomachs are tiny, they're growing fast, and they need frequent feedings to sustain their growth and development.

As babies get older, they're able to consume and retain larger amounts of calories during the day and require fewer feedings at night.

At the same time, their biological rhythms are acclimating to day and night cycles.

By four to six months, their sleep patterns are becoming more and more like those of adults.

During this process of getting used to the real world, babies are learning many things based on the repetition of patterns,

such as making connections between the sound of your voice and loving attention,

for example, or the smell of breast milk or a fresh bottle and the satisfaction of being fed.

Likewise, your baby is also developing certain associations with falling asleep.

Maybe every time you nurse your baby or give him or her a bottle, your baby falls asleep,

or you snuggle together in a chair until your baby falls asleep, or you rock your baby to sleep.

There's no denying that having your baby fall asleep on your chest can be deeply fulfilling,

but if this happens every time your child falls asleep, it can become a condition your child needs in order to fall asleep.

So, at six months, when your baby wakes at night, as any person would, he or she needs your chest to feel right about falling back to sleep.

This is referred to as a sleep association.

You can help your baby develop positive sleep associations over time that allow him or her to fall asleep without your help.

This is called self-soothing, a skill that can be especially useful in the middle of the night.

Here are steps you can take that have proved to help babies and toddlers get a good night's rest.

Develop a bedtime routine.

Bedtime routines, we can start in the early months, become very important to a child by age one.

A winding down of the day's activities signal that it's time for bed.

Your routine could include soothing activities such as having a bath, reading or making up stories, and a good night hug or kiss.

Avoid watching TV or using electronic devices with your baby before bed, as these activities can be overly stimulating.

Finish the bedtime routine before your child falls asleep. The whole process might last 20 to 45 minutes.

Establish a consistent bedtime.

The more consistent you can be when you begin and end your bedtime routine and all the steps in between, the easier it will be for you and your child.

Children thrive on structure, so it's okay to do the same thing every night.

Consider a rule for yourself and your child that your child should not leave the crib at night unless he or she needs to feed or have a diaper change.

After age two, a healthy child doesn't need to leave his or her bedroom on a typical night except to go to the bathroom.

Allow self-soothing.

Drooping eyelids, rubbing the eyes, and fussiness are the usual signs that a baby is tired.

When you notice these signs, put your baby in his or her crib while he or she is drowsy but still awake.

If your baby can fall asleep in bed without assistance when first laid down, it's more likely that he or she will fall asleep on his or her own after waking in the middle of the night.

It's common for babies to cry when put down for sleep, but if left alone for a few minutes, most will eventually quiet themselves.

If you leave the room for a while, your baby will probably stop crying after a short time.

If not, try comforting your baby and allow time for him or her to settle again.

During sleep, babies are often active, twitching their arms and legs, smiling, sucking, and generally appearing restless.

And while sleeping, infants may cry and move about when entering different sleep cycles.

Parents sometimes mistake a baby's stirrings as a sign of waking up and they begin unnecessary feeding.

Instead, wait a few moments to see if your baby settles back to sleep.

Adopt a security object

Once your child is a year old or more, he or she has likely developed enough motor skills to have a small blanket or stuffed animal nearby at night without the danger of suffocating in them.

A favorite teddy bear or other safe object can help comfort and soothe your child when you're not present.

Offer a simple, breathable blanket. Choose soft toys without decorations such as buttons or ribbons that might come off and pose a choking hazard.

Pay attention to naps

Naps are just as important to young children as a good night of sleep is.

Napping helps your baby get the total amount of sleep he or she needs and helps prevent exhaustion before bedtime.

At nap time, you can use some of the same steps you use for your bedtime routine.

For example, read a story, tuck your child in and leave the room.

Allow a few minutes for your child to settle and fall asleep.

Some babies sleep for a long time, but they take fewer naps during the day.

Other babies take more short naps during the day.

If your baby sleeps well at night, it's fine to let him or her nap for as long as desired.

If your baby isn't sleeping well at night as long as you wish, it may help to shorten the nap time.

Or if baby takes three naps a day, try to change the habit to two naps a day.

Most children between the ages of 12 and 18 months shift to taking one midday or after noon nap a day.

As early as age three years, many children drop naps entirely and most do so by age five.

Transition to separate bedrooms

As babies grow into toddlers, parents and kids often find both parties sleep better if they're in separate rooms.

If you've had your child sleeping in your bedroom for the first six months to a year,

you might be ready to transition your child to his or her own bedroom by about the first birthday.

Here are some suggestions to make this change easier.

Start with naps.

Place your child in his or her own bedroom at each nap time.

Close the child's bedroom door when you leave the room.

This keeps most household noise out of the room so that your child can sleep better.

Using a monitor can help you hear or see how your child is doing.

After a week or two of successful napping in the child's own room,

begin to put your child to bed at night in his or her bedroom.

If your child is older than a year, make it a grand occasion.

Tell the child, starting tonight, you get to stay in your own bed during the night.

You're old enough to do that now.

Kids are usually very happy to grow up.

Invite your child to help you make the bed.

Let him or her choose which blanket or stuffed animal to use on the bed.

Give a small reward if needed when a toddler or older child has stayed in his or her room overnight.

Some examples are reading a new book together, going to the park, or doing a puzzle or game together.

Try to avoid using sweets or extra treats as a reward.

Be sure to tell your child why he or she is getting the reward.

Switch from crib to bed.

It's time to switch from a crib to a bed as soon as your child learns how to climb out of a crib with the mattress at its lowest setting.

This is usually around age 2 or 3.

If you keep your child in the crib and the child falls as he or she tries to climb out, your child could get a serious injury.

Some parents choose to switch to a special toddler bed or a bed they think their child can grow into.

For example, some toddler beds are designed to adjust in length or width as your child grows.

But you also can put a mattress on the floor until you decide on a more permanent arrangement.

Troubleshooting

Establishing healthy sleeping habits for everyone in the family is often easier said than done.

All babies sleep through the night eventually, but each one reaches this milestone on his or her own time.

Try to be patient.

In the meantime, expect some trial and error and nights of interrupted sleep because of teething, illness, and other disruptions.

There are no hard and fast rules for getting your child to sleep consistently through the night, but here are some suggestions that might help.

Phasing out nighttime feedings

It's normal for young babies to wake at night to feed, but by about 6 months of age, many babies can sleep 5 to 8 hours or more without a feeding.

By this age, babies should be able to get enough calories during the day so that they don't need nighttime feedings.

If your child is 6 months old and cries one or more times a night to be fed, try these suggestions.

Try to dissociate nursing or bottle feeding from falling asleep.

You might feed your baby an hour or so before bedtime and do it in a room separate from the bedroom.

After feeding your baby, go through your regular bedtime routine, such as reading or singing at your chosen bedtime.

Do this even if it feels a little contrived.

Put your baby to bed drowsy but still awake.

If your baby needs to suck on something to help him or her go to sleep, offer a pacifier.

Increase the volume of feedings during the day and hopefully increase spacing of feeding during the day.

If your baby consumes small volumes frequently throughout the day, he or she will be used to that feeding pattern.

This may lead to your child waking up hungry during the night.

Reducing nighttime waking

If your child is older than about 6 months and repeatedly wakes during the night crying for attention,

you can help your child learn to self-soothe, but it does require patience and consistency.

If your child is sick or going through a transition, such as attending a new childcare center,

it may not be a good time to teach self-soothing.

When you're ready, here's what to do.

First, be sure your child's basic needs have been met, such as feeding, appropriate clothing,

and a dry diaper or trip to the toilet before you put him or her to bed.

Go through your usual bedtime routine.

If your child cries when you leave, wait a few minutes before you decide whether to go back into the room.

Stay out of sight, meanwhile.

If your child is still crying after several minutes, go into the room but don't turn on the lights.

Comfort your child with a soothing pat or two and a few loving words, but avoid picking him or her up.

Then say, "It's time to go to sleep now," and leave the room.

You should be in the room no more than a minute or two.

Don't be surprised if your child cries louder as you leave. This is to be expected.

Wait again, increasing the length of your weight by a few minutes before going back in.

Repeat this process, increasing the weight each time.

When your child falls asleep, make a note of the last time frame you waited before you enter the room.

For example, 10 minutes.

The next night, if your child cries, repeat the entire process.

Start with the last weight from the previous night, 10 minutes in the previous example, and go from there.

Over the next few days, repeat the process.

It may take several nights, but your child will gradually learn to self-soothe

an important and positive development that will serve your child and your family well in years to come.

Staying in bed

As your child moves into toddlerhood, he or she may have a hard time staying in bed,

even after going through your usual sleep routine.

There are just so many interesting and exciting things to do and see.

This can be especially true when your child has just learned a new skill or is at a developmental turning point.

Some toddlers get upset when it's time to sleep. They may even refuse to lie down.

Generally, it's best to ignore these protests, as well as any other questions or demands, and leave the room.

Stick to the rule that your child should stay in bed after being tucked in.

Once your child starts potty training, you can make an exception for going to the bathroom, of course.

If your child leaves the bedroom, calmly tell your child you need to go back to your own bed now.

If your child won't do as you directed, walk alongside the child with a hand placed gently on his or her shoulder.

If your child refuses to go to the bedroom, carry the child back to the room without saying anything.

Avoid showing frustration or anger. Place your child in his or her bed and walk away.

Close the door to the bedroom.

If your child doesn't know when it's morning and gets up before you do, try using a "good morning" light.

This is a night light with a timer. You can set the light to turn on to change colors when you want your child to wake.

Tell your child that he or she can get out of bed when the light changes from red to green, or when the light turns on.

If you follow these suggestions every time, after just a few days, your child soon will learn that delaying bedtime doesn't lead to more fun or extra playtime.

Lastly, being consistent doesn't mean being inflexible. If your child is sick, has had a nightmare, or is truly afraid for some reason, spend some time with your child to make sure he or she feels secure.

Make time for tummy time.

Just because your baby should sleep on his or her back doesn't mean baby should never spend any time on his or her tummy.

Being on the tummy is good for babies. It prepares them for the time when they'll be able to slide on their bellies and crawl by encouraging them to lift their heads and build strong head, neck and shoulder muscles.

As babies grow older and stronger, they'll need more time on their tummies to build their strength.

While baby is awake and being supervised, place him or her on the floor on his or her tummy. Place yourself or a toy on the floor for baby to look at or play with.

Another option is to lay your baby tummy down on your tummy or on your lap.

Chapter 10 Comforting a Crying Baby

The dream. Your baby starts sleeping through the night just a few weeks after birth, gurgles happily while you run errands and only fusses when hunger strikes.

The reality? Your baby's favorite playtime is after a 2am feeding and crankiness peaks whenever you're out and about.

Baby's Cry. The average newborn cries 1-4 hours a day and for lots of reasons. Babies cry because they're tired, hungry, lonely, too hot, too cold, or simply because it's that time of day.

All of this crying can be particularly baffling for first-time parents who often think they should know what their screaming bundle of joy is trying to tell them and be able to do something quickly.

But it's not always easy to figure out why your baby is crying and what to do about it. It takes time and experience to learn to read your baby's cues.

Don't take the tears personally. If your baby's crying is causing you stress or anxiety, take a deep breath and try to relax. Ask for help if you feel you need it.

And remember, this stage won't last forever. Crying usually peaks around 6 weeks or so and then gradually decreases. So hang in there.

Why Babies Cry. When your baby cries, it's true that he or she is generally trying to tell you something. Crying is a baby's way of communicating that he or she is hungry, tired, uncomfortable, or simply has had too much stimulation for one day.

And in general, it's best to respond quickly to your child's cries, especially when your child is a newborn. Don't be afraid that you'll spoil your baby by giving him or her too much attention. Just the opposite.

Studies indicate that being responsive to a child's needs might help him or her cry less overall and show less aggressive behavior as a toddler. Here are some of the more common reasons Babies Cry.

Hunger. Most newborns eat every few hours around the clock and usually wake for feedings during the night.

Quiet Babies may squirm and root around or fuss gently when they're hungry. More active Babies can become almost frantic when hunger strikes.

They may get so worked up by the time feeding begins that they gulp air with the milk. This can cause spitting up, trapped gas, and more crying.

Some Babies are intensely bothered by having air in their stomachs. While for others, it isn't as much of a problem.

Discomfort. Just like adults, Babies don't like to feel uncomfortable. A common cause of baby discomfort is a wet or soiled diaper.

Some Babies don't mind the warm, messy feeling they've created. Other Babies can't tolerate a soaked or dirty diaper and they let you know right away that they're unhappy.

Tummy troubles also are a common source of discomfort. Gas or indigestion can cause Babies to cry.

If your baby fusses after being fed, he or she may be feeling some sort of tummy pain. Often after a burp or the passing of gas, the crying will stop.

Temperature can be another source of discomfort. If your baby is too hot or too cold, it can trigger tears. So can tight binding or itchy clothing.

Make sure the waistband around Babies' stomach isn't too tight. The collar doesn't rub on Babies' face and the legs or sleeves don't pull when Babies moves.

Loneliness, boredom, or fear. Sometimes Babies cry because they're lonely or bored or because they're frightened.

Your baby may calm down simply by seeing or hearing you, feeling your touch, or being cuddled. As you'll find, Babies like to be held. They like to see and hear their parents and listen to the sound of their parents' heartbeats.

Over-Tiredness or Over-Stimulation

When a baby is over-tired or overly stimulated, crying becomes a way to unwind or release tension. Tired Babies generally fuss, and you may find that your baby needs more sleep than you think.

Newborns often sleep for 16 hours a day. Too much noise, movement, or visual stimulation also might drive your baby to tears.

In addition, many Babies have predictable periods of fussiness. They cry at certain periods of the day, and often for no apparent reason.

Understanding Babies' Cries

What many new parents find is that with time, as they get to know their child and the child's developing personality, they come to understand what Babies' different cries mean.

You'll likely find the same to be true for you. In the meantime, here are a few clues that may help you if you can't figure out what your little one is trying to tell you.

A hungry cry might be short and low-pitched. A cry of pain might be a sudden, long, high-pitched shriek.

If your baby is making lip movements or rooting, hunger might be the problem. If your baby is rubbing his or her eyes, he or she might be tired and in need of some sleep.

If your baby hears a loud noise and begins to cry, he or she may simply be startled.

Picking up on patterns can help you better respond to your baby. Getting to know your child's crying triggers can also help you notice when your baby is experiencing unusual distress.

Crying for reasons he or she normally doesn't.

Comforting Strategies

Okay, so your baby is crying. Now what do you do?

Sometimes the cause is obvious and you can quickly remedy the situation.

In other cases, you may have to experiment with a couple of calming techniques until you find out what your baby likes, what brings comfort to him or her.

It's often more art than science. What works for one baby doesn't always work for another.

Check Baby's Diaper

Do a quick check of your baby's diaper to make sure it's clean and dry. A new diaper may be the answer to the problem.

See if baby is hungry. If your baby is hungry, he or she will likely stop crying when you offer the breast or a bottle.

Keep in mind, however, that crying is a late sign of hunger that can interfere with feeding.

You might need to calm your baby before he or she can begin feeding.

To avoid this situation, try to respond to early signs of hunger, such as lip smacking, rooting, facial grimaces, or fussing.

If your baby begins to gulp during the feeding, take a break.

During and after each feeding, take time to burp your baby.

Look for signs of discomfort.

Feel your baby's hands and feet. If baby seems too hot or too cold, add or remove a layer of clothing.

You might also remove his or her clothing to see if tight elastic or irritating material might be the cause of the tears.

If the culprit is air or gas, try to burp baby or gently massage baby's tummy.

If your child remains warm, check his or her temperature to make sure he or she isn't running a fever.

Caress baby.

A gentle massage or light pat on the back can often help soothe a crying baby.

You might do this while lying baby tummy down across your lap.

Keep baby moving.

Babies generally like movement. Sometimes just that feeling of motion can help soothe your baby.

You might rock baby or walk through the house.

Keeping safety precautions in mind, try placing baby in an infant swing or vibrating infant seat or experiment with an infant sling.

If the weather permits, head outdoors with a stroller or a baby carrier.

You might even want to buckle up baby in the car seat and go for a ride in the car.

Sing or play music.

White noise, such as a recording of ocean waves or even the monotonous sound of an electric fan or vacuum cleaner in a nearby room, sometimes can help a crying baby relax.

Babies often like soothing muffled sounds similar to the amniotic fluid waves or pulsing sounds they heard in the womb.

Let babies suck.

Offer a clean finger or pacifier.

Sucking is a natural reflex. For many babies, it's a comforting, soothing activity.

Seek quiet.

If your baby is overly tired or has had too much stimulation, provide some quiet time by moving to a calmer environment.

At times, baby just needs to get away from the commotion.

Let baby cry.

If you've tried everything and your baby is still upset, consider just letting your baby cry while you hold him or her.

If you need a break for yourself, put your baby in a safe place, such as the crib or bassinet.

If you've fed, burped and changed your baby and he or she appears otherwise alright, it's okay to let your baby cry for 10 or 15 minutes in the crib.

The 5 S's

Pediatrician Harvey Karp has combined 5 techniques for soothing a fussy baby into what he calls the 5 S's.

Dr. Karp proposes that a baby's first 3 months are more like a fourth trimester in that replicating womb-like conditions, warm, cozy and fairly noisy, can ease a baby's transition to the big open world.

You can find detailed information in Dr. Karp's book, "The Happiest Baby on the Block," but here's a quick rundown.

One or two of these steps might do the trick, or you can try them all at once.

Swaddle

Wrap your baby snugly in a blanket, with arms tucked in straight at the sides and legs left free to move and bend.

Side or stomach position

If your baby is fussy, try holding him or her in a side or stomach position, or over your shoulder.

Don't use this position for sleeping though. Always place your baby on his or her back to sleep.

Shush

The womb is actually quite a noisy place, with the sound of blood pulsing through nearby blood vessels.

Producing a loud shushing noise, or white noise near the baby's ear, can help soothe fussiness.

Swing

Replicate the motions inside the womb by gently jiggling your baby in fast, tiny motions.

Keep your baby's head and neck supported with your motions small.

To avoid bodily harm, make sure not to shake your baby too hard.

Suck

Sucking is a relaxing activity for most babies.

Offer your baby a pacifier or a clean finger to suck on.

Collic

All babies cry, but some cry more than others.

And for a few babies, no matter what you try to do to stop the crying, nothing seems to work.

If your son or daughter fits this description, it's possible he or she may have collic.

Collic is the term for periods of intense, inconsolable crying that lasts for three hours or more, at least three days a week,

sometimes every day, and for at least three weeks.

The crying episodes typically start a few weeks after birth and generally begin to improve by age three months.

Causes

The big question when it comes to collic is what is it that causes an otherwise healthy child to cry so much?

And the answer is, experts really don't know.

There are a variety of theories and not all doctors agree about what may be potential triggers.

It's possible the cause may be a combination of factors and it may differ between infants.

Temperament

Some babies are naturally irritable or sensitive, which might contribute to collicy behavior.

Immature nervous system

If your baby has an immature nervous system, he or she might be unusually sensitive to stimulation.

These babies become overloaded by all of the sights and sounds and they aren't able to console themselves.

As a result, they cry and they may have difficulty sleeping.

Premature babies may exhibit their sensitivity in the form of fussiness rather than crying.

Food sensitivities

If you breastfeed your baby, collic might be a sign that your baby is sensitive to certain foods in your diet.

If you feed your baby formula, collic could be an indication that your baby is sensitive to milk protein and formula.

Underlying health problem

Rarely, collic might be a sign that your baby has a health problem, such as a hernia or an infection.

Many other theories about what makes a child more susceptible to collic have been proposed, but none have been proved.

Gas was long thought to be a cause because many collic-y babies have gas.

However, collic-y babies may develop gas as a result of swallowing too much air while crying.

What doctors do know is that birth order doesn't matter.

Collic doesn't occur more often among first-borns than in later children.

Girls and boys experience collic in similar numbers, and there are no lasting effects or complications from the crying episodes.

Babies with collic grow and develop normally, and they aren't any more likely to cry when they become older infants or toddlers than are infants who didn't have collic.

Common signs

Some babies are fussy when they don't have collic.

All the behavior can vary. A baby with collic generally exhibits the following signs.

Predictable crying episodes

A baby with collic often cries about the same time every day, often in the late afternoon or evening.

The crying usually begins and ends for no clear reason.

Intense or inconsolable crying

Collic crying is intense and often high-pitched. Your baby's face might flush, and he or she is extremely difficult to comfort.

Posture changes

Among babies with collic, during crying episodes, they tend to curl up their legs and clench their fists.

You may also notice that the baby has tensed abdominal muscles.

Diagnosis

If you think your baby may have collic, check in with your child's medical provider, especially if your baby is inconsolable, or you notice signs of illness, such as a fever, vomiting, or changes in eating or sleeping patterns, or other signs or symptoms that worry you.

Your baby's medical provider can help you tell the difference between normal tears and something more serious.

Tell the provider when and how often the crying episodes occur, how long they last, and any observations you've made about your baby's behavior before, during, and after the episodes.

The provider may ask about your efforts to soothe your baby, as well as your baby's diet and feeding schedule.

Your baby's medical provider may do a physical exam to identify any possible causes for your baby's distress, but other tests generally aren't necessary. If your baby is otherwise healthy, his or her doctor may identify the problem as collic.

Managing collic

Caring for an infant who has collic can be exhausting, confusing, and stressful, even for experienced parents.

Collic isn't a result of poor parenting skills, so don't blame yourself for your baby's collic. Instead, focus on ways to make this difficult stage a little more bearable. Remember, this too shall pass.

Unfortunately, there are few treatment options for collic. Over-the-counter drugs such as somethicone, mylicone-infant gas relief, little tummies gas relief, others haven't proved helpful for collic, and other medications can have serious side effects.

Some studies suggest that treatment with probiotics, substances that help maintain the natural balance of good bacteria in the digestive tract, might soothe collic.

However, more research is needed to determine the effects of probiotics on infants. Because of this, most Mayo Clinic pediatricians don't recommend the use of probiotics in infants.

Some parents also report trying alternative therapies such as herbal teas, herbal remedies, or glucose.

Alternative therapies for collic haven't proved to be consistently helpful, and some might be dangerous. Before giving your baby any medication or substance to treat collic, consult your child's medical provider.

While you might not be able to treat collic, there are things you can do to try to soothe your baby and reduce or lessen the severity of the crying episodes.

Consider these suggestions.

Your feeding style. Check that you're not overfeeding your baby. Try to wait at least two to two and a half hours between feedings.

During feedings, hold your baby as upright as possible and burp him or her often to reduce the chances of air swallowing.

If you feed your baby with a bottle, use a curved bottle. A bottle with a collapsible bag also might help.

Some bottles are especially designed to minimize the amount of air your baby takes in while feeding.

If bottle feedings typically take less than 15 to 20 minutes, consider using a nipple with a smaller hole.

If you use formula, you might consider giving your baby a hypoallergenic formula, such as whey hydrolysate formula for one week.

If your baby's symptoms don't improve, continue using the original formula. Avoid frequently switching your baby's formula.

If you breastfeed, try to empty one breast completely before switching to the other breast.

This will give your baby more hind milk, the fattier and potentially more satisfying milk at the end of a feeding.

Your diet. If you breastfeed and you suspect that a food or drink you consume may be making your baby fussier than usual, avoid it for several days to see if it makes a difference.

Consider eliminating dairy products or other allergenic foods, which can cause allergic symptoms in breastfed infants.

Research suggests that in some special cases, avoiding foods such as cow's milk, eggs, peanuts, tree nuts, wheat, soy and fish for a week can reduce infant fussiness.

Also, try to eliminate or reduce the amount of caffeine in your diet.

Caffeine in your breast milk can keep your baby awake for prolonged periods or cause agitation.

Some moms say avoiding gassy or spicy foods can help, but this hasn't been proved.

Your lifestyle. If you or your partner smoke, it's time to quit. Research suggests that exposure to cigarette smoke can increase your baby's risk of colic, in addition to other health risks for you and your baby.

Tummy Hold. Some babies find comfort by being held on their tummies, a position sometimes referred to as the colic hold or colic carry.

If your baby is fussy, you might try this position to see if it helps. Place baby face down along your forearm, with your arm firmly between his or her legs.

Baby's cheek should be resting on your palm. Hold your arm close to your body, using it to brace and steady your baby. Don't let baby sleep in this position.

Always be gentle.

When you're crying baby can't be calmed, you might be tempted to try just about anything to get the noise and the tears to stop. But remember, the importance of treating your baby gently. Never yell at, hit or shake your baby.

Newborns have weak neck muscles and often struggle to support their heads. Shaking your baby out of sheer frustration can have devastating consequences, including brain damage that leads to seizures, learning disabilities or mental retardation.

And severe shaking can be life threatening or even fatal.

If you're worried about your ability to cope with a crying baby, contact your medical provider or your baby's medical provider, a local crisis intervention service or a mental health helpline for support. If you need to, take your baby somewhere where you know he or she will be safe and cared for.

Calming techniques

For most babies with colic, soothing techniques can offer help calm the child and lessen the crying, at least for a while. The trick is finding out which techniques your son or daughter likes. Keep in mind that babies with colic often like motion. Anything you can do to keep baby moving may help.

Sit with your baby in a rocking chair. Carry baby around the house in a baby sling. Or take a walk with your baby in a stroller.

In addition, babies with colic often find certain sounds calming. A steady background of soft noise or shushing sounds may help.

Turn on the kitchen or bathroom exhaust fan. Run the vacuum in the next room. Use a white noise machine or play music of environmental sounds such as ocean waves or a gentle rain. Sometimes the tick of a clock or metronome does the trick.

Keeping your cool

Listening to a baby cry is stressful, especially when it seems to go on for hours on end. Even for the best of parents, coping with colic is tough. When you're all tensed up over your baby's crying, look for ways to calm yourself.

Think about the happy moments you'll spend with your baby and the milestones ahead. And while taking care of your baby, remember to also take care of yourself.

Take a break. If your baby's cries are getting to you, slow down. Take a deep breath and count to ten. Repeat a calm word or phrase such as "take it easy."

Imagine yourself in a calm, relaxing place. Play soothing music in the background. In some cases, the best thing to do may be to put baby down in his or her crib for a period of time while you walk into another room and give yourself a break.

Get out of the house.

Put your baby in the stroller or a baby carrier and go for a walk together. The exertion might take your mind off the tears and the movement or change of scenery might soothe your baby. You might even buckle the baby into his or her car seat and take a short drive, provided you feel that you can concentrate on your driving.

Ask for help.

Let a loved one take over for a while. Take advantage of babysitting offers from trusted friends, neighbors, or other close contacts. Use the time to take a nap or do something you enjoy. Even an hour on your own can help renew your coping strength.

Expressing yourself can help too. When you're getting frustrated, speak up. Saying the words out loud can help ease the tension.

The more relaxed you are, the more able you'll be to handle and cope with baby's crying spells. It's also good for baby. Babies can sense when you're tense and stressed out.

Don't judge yourself. Most of all, don't measure your success as a parent by how much your baby cries.

Collocic isn't a result of poor parenting and inconsolable crying isn't a sign of your baby rejecting you. You and your baby will get through this phase. Collocic typically goes away on its own by age four months.

Chapter 11 Building a Relationship

Some days, you gaze at your baby and feel a connection deeper than you ever thought possible. Other days, you stare at this little person crying inconsolably in your arms and have no idea what's wrong.

Then, there's the toddler stage. One moment, you're enjoying a book with your happy cuddly tyke. The next, he or she is staging an all-out war because it's time for bed.

When your child was born, you embarked on one of the most rewarding, challenging and complex relationships you'll ever experience.

Like any relationship, your connection is a two-way street. Your child's behavior, personality, and moods affect you just as much as yours affect your child. There are good days and bad days. After all, no child or parent is perfect.

What matters is not perfection, but a commitment to consistently engage with your child and do your best to respond to his or her needs with empathy and sensitivity.

Whether that means comforting a crying baby or calming a frustrated toddler, your attention and affection help build the strong, secure, and nurturing relationship your child needs to thrive.

Nurturing your bond

Your baby was born to bond with you. From the start, he or she has instinctively sought a connection with each cry, nuzzle, or gaze into your eyes.

As babies grow and become more interactive, they strengthen the parent-child relationship by smiling, cooing, and imitating facial expressions.

Even when your little one begins to scoot, crawl, or walk, he or she will continually loop back to you, drawing comfort from the security of your special bond.

Each time you're responsive to your baby's instinctive, connection-seeking behaviors, you're building and deepening a stable, nurturing relationship with your child.

Experts refer to this healthy child-parent bond as "secure attachment."

A securely attached child regularly seeks physical and emotional comfort from a parent and trusts that the parent will respond to his or her needs.

Benefits of a strong bond

When babies feel secure in their relationship with a parent, they start to feel secure in their relationship with their world.

This sense of security helps a child to thrive long after the first year of life.

In fact, the positive impact of a baby's connection with a parent can last well into adulthood.

That's why you can never spoil a baby with too much attention or affection.

Babies who have a secure, nurturing relationship with a parent in the first year of life may be more likely to

handle brief separations from parents more easily and with less distress,

explore their surroundings with greater confidence and experimentation,

adapt to new situations and people more easily,

tackle challenges with greater pleasure and persistence, leading to the mastering of new skills,

manage their emotions and stress more successfully in childhood and beyond,

show greater resilience in the face of obstacles,

gain a greater capacity to form close, lifelong relationships.

Connecting with your baby

Creating a secure attachment with your baby doesn't require all-consuming sacrifice,

but it does take conscious effort.

If you strive to be a responsive, dependable and nurturing presence in your baby's life,

your bond will grow naturally.

Your baby will feel safe, secure and loved knowing that he or she can count on you to offer comfort,

fill a hungry tummy or change a soggy diaper.

Here are some things you can do to keep the connection between you and your baby strong.

Respond to your baby's cries.

Babies cry to communicate their needs, not to manipulate.

There may be times when your baby needs to cry it out,

but generally, it's best to respond quickly to his or her cries if possible.

The reassuring comfort of your smell, touch and voice strengthens your baby's attachment to you.

Spoil away.

Don't be afraid that you'll be spoiling your son or daughter.

Studies show that young babies who are consistently picked up and held in response to their cries

tend to cry less by one year of age and show less aggressive behavior as adults.

What's more, soothing babies in this way can teach them to eventually soothe themselves.

Tune in to your baby's cues.

Being attuned to your baby means paying close attention to the different facial expressions,

sounds and movements that communicate his or her needs.

Learning to understand these cues and responding to them with sensitivity

helps your baby feel loved and secure.

Talk, sing and read frequently to your baby.

Coo or chatter cheerfully to your little one while changing a diaper

when he or she coos back at you, respond in kind.

Sing a silly song at bath time.

Read a book together.

These shared experiences will bring you closer and contribute to your baby's brain development.

Make time for playtime.

Playtime offers an opportunity to interact with your baby in a fun, joyful way.

Delight your baby with a game of peek-a-boo or patty cake.

Dangle objects for him or her to observe, touch or grab.

Get down on your child's level to stack toys or roll a ball back and forth.

Give plenty of physical affection.

Whether your child's a newborn or a sturdy one-year-old, he or she benefits from your touch.

Hold, cuddle, rock and massage your baby.

Not only in times of distress, but also in peaceful or playful moments.

Let your little one know how special he or she is to you.

Offer gentle guidance.

Your baby doesn't understand the concepts of right or wrong, good or bad, just yet.

He or she depends on you to teach acceptable behavior.

If your young baby yanks on a fistful of your hair, gently remove that little hand

or distract your baby with an appealing toy.

If your baby's old enough to understand language, you can explain, that hurts.

Be a dependable home base.

Once babies are mobile, they want to explore their environment.

This newfound freedom is both thrilling and overwhelming for your baby.

He or she may periodically seek eye contact with you, call out to you

or return to your side for a quick hug or cuddle.

When you're responsive to these ways of reconnecting, you're helping your child feel safe and secure.

This allows your little one to continue exploring his or her world with confidence.

Be mindful of screen use.

When interacting with your baby, try as much as possible to set aside your smartphone,

turn off the TV and minimize other distractions.

Your baby doesn't require your single-minded attention every minute of the day,

but if you're making more eye contact with your phone than with your child,

you'll both be missing out on crucial parent-infant interactions that help your baby thrive.

Setting Reasonable Expectations

Keep in mind that you won't be able to meet every one of your baby's needs perfectly or immediately.

And that shouldn't be your expectation.

You aren't harming your baby if you can't hold her while she's crying in her car seat on the drive to the playground.

You won't weaken your bond if it takes you a while to realize that he's fussing

because of a scratchy sweater instead of an empty tummy or wet diaper.

As long as you're generally responsive to your baby's needs, your baby will flourish.

Serve and Return

Your baby babbles at you.

You respond by looking into baby's eyes and imitating the sounds.

Your baby laughs with delight, causing you to giggle.

Experts sometimes call this simple back-and-forth interaction "serve and return."

And it's an important way that parents form close, nurturing relationships with their babies.

What's more, serve and return interactions provide vital support for the rapidly developing connections in a young child's brain.

These interactions can also improve the ability to control impulses, regulate emotions,

and navigate social encounters later in childhood.

Here are some serve and return behaviors you can engage in every day.

Return your baby's gaze or smile.

Mirror your baby's expressions, vocalizations, and actions.

Talk to your baby.

Describe to your baby what he or she is seeing, feeling, or doing.

Play interactive games like peek-a-boo.

Understanding temperament

To read your child's cues and know how to best respond to his or her needs,

it helps to gain a deeper understanding of your child.

Many factors shape who your child is, including genetics, your home environment, and your parenting style.

Your child's personality or temperament is another factor.

One way experts think about temperament is to break it down into nine observable traits.

These traits are acquired before birth and have to do with how a child behaves.

Temperament traits start to emerge within the first few months of life

and will continue to influence your child's behavior in the years to come.

Each trait functions as a continuum.

A child may fall on either extreme or somewhere in the middle for any given trait.

As you read through the different temperamental traits below,

think about where your son or daughter may fall on the scale of each one.

Activity

This is your baby's usual level of physical motion throughout the day.

His or her idle speed. It can range from low to high energy.

Regularity

This trait relates to the predictability of your child's bodily rhythms,

such as when he or she gets hungry or tired each day.

Some children are as predictable as a clock, while others keep you guessing.

Approach or withdrawal

When encountering something new, some children are naturally curious,

approaching a novel situation or person eagerly.

Others are more cautious, waiting to see what will happen next before making their approach.

Adaptability

How easily does your baby adapt to change and transition?

Some children adjust easily, while others are less adaptable and need more time to shift gears.

Sensitivity

Some babies are highly perceptive of their environments and respond readily to external sources of stimulation,

such as lights, sounds, tastes, or even the way clothing feels on their skin.

Others don't display such strong sensitivities, or they may be more sensitive to certain factors than others.

Intensity

Intensity refers to the energy level of your child's response to different situations, whether positive or negative.

An intense baby will squeal, laugh, scream, wail, and flail.

Less intense babies might smile, whimper, or just turn away when they've had enough.

Mood

As with adults, children can have various emotions throughout the day,

but children tend to have an overall disposition, ranging from sunny to more serious or grave.

Distractability

Some children remain focused on an activity for some time, despite potential distractions.

Other children are more easily distracted, flitting from one thing to another as they investigate their environment.

Persistence or attention span

Certain children persist in the face of obstacles, whereas others give up more easily when confronted with frustration.

For example, does your toddler persist in trying to fit the peg in the hole, or does he or she cry for help after a few unsuccessful tries?

Trait clusters

Researchers have observed that certain temperament traits tend to cluster together to form general temperament styles.

For example, some kids are naturally easygoing.

They quickly develop regular sleeping and eating schedules, fuss infrequently, smile easily, and adapt well to new situations.

Caring for these children can be smooth sailing oftentimes.

Other kids are naturally more shy or slow to warm up.

These little ones may be less active and not too intense.

Approach new things slowly and with caution, and have a harder time transitioning from one activity or person to another.

These children tend to be more serious.

Then there are children who keep you on your toes.

They display fearsome motion, may have tons of energy, and approach things and people with either avid curiosity or determined caution.

They become easily frustrated and have difficulty making changes.

Caring for these spikety children is naturally more challenging than for even tempered ones.

Many children have mixed traits.

Overall, their temperament may be moderate to easy to live with, but they may score high on intensity, activity, or persistence, for instance.

Blending temperaments

As a parent, you might find a particular temperament trait in your child to be pleasing, challenging, or somewhere in between.

A highly active child might be a blast on an outing, but nonetheless a handful for a busy parent juggling multiple responsibilities.

By keeping an open mind and staying flexible, you can engage positively with your child in ways that meet both of your needs.

Do you have an extremely focused or persistent son or daughter?

Consider working together on a fun challenge, like building a colorful block tower or completing an age-appropriate puzzle.

For a curious child who's always on the move, visit a place you personally love, such as a scenic park.

Play a simple game of hide and seek or eye spy.

Everyone has different talents and abilities.

If your partner or another caregiver naturally fits better with some aspects of your child's temperament, work as a team to help your child develop.

Getting to know your baby's temperament better can also help to alleviate some worries you may have about your parenting.

Is your baby high on the intensity and sensitivity scale?

Those long bouts of crying might be a reflection of his or her temperament rather than anything you feel you've done or failed to do.

Do you have more difficulty redirecting your son's or daughter's attention than other parents seem to?

It might just be a sign of a powerful persistence on your baby's part.

Learning the ins and outs of your baby will help to guide you in his or her first years of life and in the years to come.

You and your toddler.

The foundation of love, security and trust that you've built for your baby takes on new importance as you enter the toddler stage.

Parenting children this age is a balancing act.

Toddlers crave both a close connection with a parent and greater independence.

They're realizing that they are their own person with their own wants and needs.

And they're ready to take charge of their world.

This eagerness to strike out on their own is tempered by their limitations and the dawning awareness that life doesn't always go their way.

Toddlers can't always move as swiftly and skillfully as they'd like or clearly express their feelings or needs and words.

They also are learning to deal with limits, compromise and disappointment.

This can naturally lead to intense emotions, tantrums and misbehavior.

Children at this age benefit from a parent who understands and honors their natural desire for autonomy while also helping them learn how to cope with negative emotions, listen to directions and accept limits.

By continuing to provide a secure relationship based on love, stability and consistency, you can help your toddler manage the ups and downs of this stage of life.

Little person, big emotions.

Your toddler is putting together a puzzle but can't seem to fit in the last piece.

With each failed attempt to jam it into place, frustration mounts, like an incoming tsunami, big emotions such as anger and frustration threaten to sweep in.

Toddlers want to do so much and they want to do it all by themselves right now.

This is what they see you do every day, but they don't yet know how to do it themselves.

They also don't know how to handle intense emotions and control their impulses.

That's where you come in.

You can teach your child how to accomplish tasks and how to remain calm by word and by example.

A caring, compassionate parent can be an anchor in stormy seas.

When your child is overcome with strong feelings, your calm presence can help to bring down the intensity level and teach your child how to understand and cope with his or her emotions.

To support and soothe your child in moments of frustration, sadness or disappointment, try these techniques.

Get close. Calmly and slowly move closer to your child so that he or she knows you're there.

Being nearby reassures your child that you're present and available.

You can also say something encouraging such as, "I'm here to help."

Validate emotions.

Let your child know that you're listening and understanding what he or she is feeling.

Label your toddler's emotions. You seem frustrated that the puzzle piece won't fit.

You're not only validating your child's feelings, but teaching how to identify strong emotions.

Soothe with a calming touch.

Try rubbing your child's back, patting his or her head or offering a hug.

A parent's touch can be extremely comforting.

Offer guidance. If your child is frustrated with a specific task, gently intervene by providing some assistance.

Avoid solving the problem for your child right away.

A bit of guidance may be all that's needed for him or her to complete the task.

Or you can offer to work on the problem together.

When emotions explode into tantrums.

Sometimes your child's emotions are just too big for either of you to contain.

Despite your best efforts to understand and soothe your child.

There are times when a tantrum seems as unstoppable as a bullet train.

What's apparent to do?

First, it's important to understand that temper tantrums are a normal way toddlers express frustration with the challenges of the moment.

Your toddler might be upset about taking turns at the playground or having to share a toy.

He or she could be struggling to transition from playtime to bedtime or perhaps the culprit is hunger, tiredness or jealousy.

These everyday obstacles can be hard for a toddler to deal with at times, sparking a full-blown meltdown.

Experts recommend that parents avoid punishing a toddler's tantrum.

Instead, try these strategies to manage a child's meltdown.

Keep your cool.

If you react with anger or frustration, you'll likely escalate the current level of stress you and your toddler are experiencing.

Take some deep breaths to calm yourself.

If that doesn't work and you're at home, leave the room for a minute to gather yourself.

By staying calm, you're modeling self-control in the face of powerful emotions.

In time, your child will learn from your example and gain more control over his or her emotions too.

Try distraction.

You may be able to redirect your child's negative behavior with a positive distraction, especially with young toddlers.

Try moving your toddler to another room or a different part of the playground.

Offer a book or toy or ask your child to join you in a different game or activity.

Give your child space.

Sometimes, a child needs time to calm down.

If your toddler can't stop crying, screaming or stomping, don't continue to react to the behavior.

Doing so may only increase the intensity of the tantrum.

Instead, ignore the behavior.

If possible, place your child in a safe, quiet place.

Having quiet alone time will help your toddler cool off and learn to soothe himself or herself.

Check back with your child after several minutes or after he or she is calmed down.

Know when to step in.

If your child starts hitting, kicking or throwing things at others, stop the harmful behavior.

Move your toddler away from the situation.

Calmly acknowledge his or her feelings, but explain that the behavior is unacceptable.

It's okay to be mad, but it's not okay to hit.

Stand firm.

Avoid giving in to your toddler during a temper tantrum.

Stick to the limit or rule you have set.

If your refusal to buy your child ice cream set off the tantrum, don't appease your child by buying the ice cream.

Giving in sends the message that negative behavior works.

You'll also make it harder to enforce the rule or limit next time.

Reconnect.

Once your child's flood of emotion has passed, see if he or she is willing to accept some comfort.

A kind word and some physical affection can help your child move on.

Can tantrums be prevented?

There might be no foolproof way to prevent tantrums, but there's plenty you can do to encourage good behavior in your toddler.

Be consistent.

Establish a daily routine so that your child knows what to expect.

Stick to the routine as much as possible, including nap time and bedtime.

Set reasonable limits and follow them consistently.

Plan ahead.

Run errands when your child isn't likely to be hungry or tired.

If you're expecting to wait in line, pack a small toy or snack to occupy your child.

Pick your battles.

If you say no to everything, your child is likely to get frustrated.

Look for times when it's okay to say yes.

Offer choices when possible.

Encourage your child's independence by letting him or her pick out a pair of pajamas or a bedtime story.

Offer a choice between two options.

Do you want strawberries or blueberries?

Praise good behavior.

Provide extra attention when your child behaves well.

Give your child a hug or tell your child how proud you are when he or she follows directions or does something positive.

Great job coming right away.

I love how you're sharing with your brother.

Avoid situations likely to trigger tantrums.

Don't give your child toys that are too advanced for him or her.

If your child begs for toys or treats when you shop, steer clear of tempting areas.

If your toddler acts up in restaurants, pack a picnic or eat at home.

Save restaurants for date night.

Setting limits.

Walking, running and climbing toddlers can have a lot of fun exploring their world,

but they can also get into a lot of trouble.

Just because they can open cabinets, jump on beds and race down sidewalks doesn't mean they know how to stay safe.

Your toddler needs clear limits to keep out of danger and learn what behavior is and isn't acceptable.

Now is a good time to establish family rules.

Start with two or three core rules related to safety, such as no hitting or no jumping on furniture.

Agree on these limits with your partner ahead of time and communicate them to other caregivers.

That way, you'll be on the same page and you can enforce the rules consistently.

If you're co-parenting and your child has more than one home, it's helpful to have consistent core rules at both homes.

You'll also need to clearly express these expectations to your child so that he or she can successfully understand them.

Be prepared to repeat the rules regularly to help your child remember and act on them.

As your toddler begins to master a rule, you can add a new one to the list.

Rules that are age-appropriate, consistently enforced and balanced with warmth and affection will help your child navigate life within your family and beyond the walls of your home.

Encouraging good behavior.

Part of a toddler's job is to test the limits, including breaking rules or ignoring directions.

But don't assume that your child is being deliberately defiant when he or she disobeys you.

Toddlers aren't known for their spectacular listening skills.

They're still learning how to understand language, pay attention to what's being said, and think about their effect on others.

Positive behavior doesn't happen overnight.

It's developed through hundreds of small exchanges with your child.

These daily interactions teach him or her how to exert emotional self-control, make good choices, and behave appropriately, even when you're not around.

Whether you're reinforcing a no-hitting rule or asking your child to put away a toy,

rely on these positive techniques to communicate your expectations and encourage good behavior.

Get close.

Whenever possible, get down on your child's level and make eye contact.

A gentle hand on the back or head can set a positive caring tone.

Speak calmly.

Get your child's attention by using his or her name or a term of affection.

Keep your voice neutral when reminding your child of a rule or asking your child to do something.

Keep it simple.

Use simple, clear language and short sentences such as "Please sit down" or "It's time to get your coat."

Try to avoid negative statements such as "Don't get out of the chair."

Be patient.

It might take your toddler a moment to focus on you and process what you're saying.

Give your child time to figure it out and transition to the new behavior.

Model the behavior.

If your child doesn't respond to a request or reminder, try modeling the behavior.

Repeat your request.

Time to put away your toys.

Then put away one of the toys yourself and say your turn.

Another technique is to say "I'll show you."

Then physically guide your child in the task or expected action.

Reward with praise.

If your child does as you ask, offer warm praise.

Let your child know how much you appreciate his or her efforts.

Playing with your toddler.

Teaching your child how to manage emotions and follow rules is a lot easier when you're doing it in the context of a secure, loving relationship.

One way to keep your connection going strong is to spend one-on-one time with your son or daughter.

After all, you are your toddler's favorite playmate.

The chance to hang out with mommy or daddy is the absolute best.

Aim for five to 15 minutes of uninterrupted one-on-one playtime with your toddler each day.

You may find it works best to schedule the playtime into your daily routine, but be flexible.

Your time together will go better when your child's rested and fed, and you have the energy to devote to him or her.

Playtime with a parent has many important benefits for children.

It serves a vital role in their social, emotional, and cognitive development.

It also improves their self-control and helps them form close relationships with other children and adults in their lives.

Consider these suggestions for making the most out of playtime.

Put away devices.

Spend this special time with your child without distractions or interruptions.

Silence your phone, turn off the television, and set aside any other devices that could compete for your attention.

Let your child take the lead.

This is a time when you can focus on what your child wants to do.

Let your child set the agenda while gently discouraging activities that are aggressive, competitive, frustrating, or destructive.

Do things that allow you to be together in a relaxed and happy manner.

Show that you're fully engaged.

If your child picks up a doll and says "doll," repeat the word and build on the conversation.

"Doll," you're hugging the doll.

You can also describe your child's actions out loud as he or she plays next to you.

You're stacking red and blue blocks.

Now you're knocking them down.

Mirror your child.

Another way to connect with your child is to imitate what your child is doing.

If your child is moving a train on the tracks and making tooting sounds, grab a train and do the same.

If he or she gets up to dance to some music, mimic his or her movements.

Describe emotions.

Label the emotions you're observing with phrases like "you look happy."

You can label your feelings too.

I'm excited to play this game.

These statements can help your toddler learn to identify and express feelings.

Enjoy yourself.

Take time to notice and think about how amazing your child is.

Show your enjoyment with positive words, an enthusiastic voice, and animated facial expressions.

Take time for a hug and a kiss.

Savor these special moments together.

Postpartum depression.

Most new moms experience some form of baby blues in the first few days or weeks after childbirth.

This commonly includes mood swings, crying spells, anxiety, and difficulty sleeping.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression.

Postpartum depression isn't a character flaw or a weakness.

Sometimes it's simply a complication of giving birth.

It's possible to provide good care for a baby, even with postpartum depression.

But in some cases, postpartum depression can affect how closely a mother bonds with her baby.

If you're feeling persistently sad after your baby's birth, you may be reluctant or embarrassed to seek help from your doctor.

But prompt treatment can help you manage your symptoms and continue to build a strong relationship with your baby.

It's important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features.

Don't fade after two weeks.

Are getting worse.

Make it hard for you to care for your baby.

Make it hard to complete everyday tasks.

Include thoughts of harming yourself or your baby.

Your doctor can help you find the treatment you need to get better.

If needed, he or she may refer you to a counselor, psychiatrist, or other mental health specialist.

Part 2 - Health and Safety

Chapter 12 - Finding the Right Medical Provider

During your baby's first year, you and your baby will likely spend a lot of time with his or her medical provider.

Beyond the recommended checkups every couple of months, it's likely that your son or daughter will get his or her first illness at some point this year.

In addition, you may have questions about newborn care or your baby's health and development.

In the second and third years, you'll see your baby's medical provider less often than in the first year.

But there'll still be plenty of occasions to visit between scheduled vaccinations and well-child checkups, and the ever-present colds and other viruses children so often get.

While finding a medical provider for your baby might sound simple, it's worth the effort to find an individual who can best meet your baby's and family's needs.

Determining what you're looking for in a provider for your child can help you find a pediatric care professional, whom you feel comfortable with, and whom you can build a good relationship with as your child grows and matures.

Getting Started

If you haven't already chosen a medical provider for your baby, now is the time to do so.

If possible, you want to choose your baby's medical provider before your baby is born, such as during your third trimester.

Settling on a provider before your baby is born will make it easier for you to arrange your newborn's first checkup and the hectic first days after his or her arrival.

Visiting with your baby's provider before your baby is born will also give you a chance to ask questions, talk about any problems during your pregnancy, discuss the practices policy,

and fill out any necessary insurance forms without the distraction of having your new baby with you.

It's also comforting to know that you already have a trusted source you can call with any questions you might have regarding newborn care, and most first-time parents have lots of questions.

In addition, if you choose your baby's medical provider before your son or daughter is born and you deliver your baby at a hospital where the provider works, you might be able to have the provider examine your baby at the hospital.

Don't worry though if that's not possible, your baby will still be seen at the hospital by qualified staff.

If you don't have a specific medical provider in mind, start by asking for recommendations from trusted family members, friends, or coworkers who have children.

Your own medical provider might be a good referral source too.

You may also be able to find information about pediatric providers by calling a nearby hospital or other community health resources.

Keep in mind that your health insurance company may require you to choose from its approved network of medical providers.

Check to see if the company provides information about the providers in the network to help you make your decision.

Whatever you do, don't put off finding a medical provider for your baby.

Even if you're about to move or change insurance providers, do your best to find a medical provider as soon as possible.

Waiting until your baby becomes sick can be stressful for you and might delay your baby's care.

Establishing a relationship with a provider for your baby will also make it easier for you to schedule regular visits and keep your child's vaccinations up to date.

Medical provider options

When it comes to choosing a medical provider for your baby, you have options.

Many types of medical personnel treat babies and children, including pediatricians.

Many parents choose a pediatrician to be the medical provider for their children because pediatricians specialize in the care of children from infancy through adolescence.

After medical school, pediatricians go through a three-year residency program.

Some pediatricians receive further training in subspecialties such as the care of sick and premature newborns, neonatology, children's heart conditions, pediatric cardiology, or children's skin issues, pediatric dermatology.

If your baby ever needs to be treated by a subspecialist, his or her regular provider can provide a referral.

Family Physicians

Family physicians provide health care to people of all ages, including babies. They're trained in adult and pediatric medicine.

A family physician can see your child from infancy all the way through adulthood.

Family physicians take care of most medical problems. Also, if the rest of your family sees the same provider, he or she will gain an overall health perspective of your family.

If you already have a family doctor you trust, ask whether he or she sees infants.

Mid-level providers

Mid-level providers include nurse practitioners and physician assistants.

Nurse practitioners are registered nurses who have advanced training in a specialized area of medicine, such as pediatrics or family health.

After nursing school, a nurse practitioner must go through a formal education program in his or her specialty field.

A pediatric nurse practitioner focuses on caring for infants, children, and teens.

Family nurse practitioners often see all family members, including children.

Physician assistants are medical professionals who are trained and licensed to diagnose illness, develop and manage treatment plans, and prescribe medications.

Physician assistants work in all areas of medicine, including pediatrics and family medicine.

Nurse practitioners and physicians, assistants, often work with or under the supervision of a doctor, but may practice independently, depending on state guidelines, and may serve as your primary medical provider.

Factors to consider

Before you choose a medical provider for your child, think about what you're looking for in a provider.

For example, your needs and preferences.

Would you prefer your child to see the same medical provider who takes care of the rest of your family's health, or a provider who specializes in pediatrics?

Would you like a provider who is older and may have more experience, or an individual who is younger and also may have young children at home?

For parents who have children with complex care needs, a provider with a relevant experience in training may be the best fit.

Cost

Do you need to find a medical provider from among your insurance company's list of approved providers?

Location, accessibility, and hours.

Is the medical provider's office in a convenient location for you?

Would you prefer an office that has extended hours?

Is it important for you to be able to contact the provider at night, or on the weekends, or by email?

Would you like your child's provider to have privileges at a particular hospital?

Would you prefer that he or she have an office that has separate waiting rooms for children who are well, and those who are sick?

Evaluating your options

Once you've thought about what you're looking for, and compiled the names of some possible medical providers,

call each provider's office to confirm that he or she is accepting new patients.

If necessary, double check that he or she works with your insurance company.

This information may also be available on the provider's website.

Next, call to schedule an appointment with the provider.

Try to schedule the visit at a time when both you and your partner can attend, so you can both ask questions.

If you're given a recommendation by friends or family, you may be able to get some basic information from them before talking to the medical provider.

For example, you might ask about "Bedside manner."

Does the provider interact well with both adults and children?

Does the child of your friend or relative like the provider?

Office atmosphere

Is the office staff helpful?

How do staff members manage phone calls, particularly when it comes to emergencies?

Is it difficult to make an appointment when a child is sick?

Is there generally a long office wait before seeing the provider?

Issues to consider

During your visit with a new medical provider, bring a list of questions or just have an informal chat with the provider.

Don't feel embarrassed about asking questions that might help you get to know the person and make the right decision for your family.

Training and style

How long has the individual been caring for children?

At what hospitals does the medical provider have privileges?

Does he or she have any particular area of expertise or interest?

Does the provider listen to your questions and answer them?

Does he or she appear interested in your concerns?

Knowledge

Does the medical provider seem to know about medical advances and does he or she offer helpful advice?

Accessibility and referrals

How does the medical provider handle emergencies, including those that occur after hours?

Does the office have guidelines for what kind of questions can be resolved with a phone call or email and what requires a visit?

Is the provider part of a group practice?

If so, will you be able to request an appointment with a specific provider?

If you choose a provider who is part of a group practice, make sure you feel comfortable with other members of the practice who might treat your baby.

Ask the medical provider about his or her referral process for specialists.

Some providers may be limited to referring your child to someone who is practicing in the same health care network or at certain medical institutions.

Making your decision

After meeting with a medical provider, consider his or her overall approach to health care and your interactions with the staff.

Most important, would you trust this person to provide care for your child?

Trust your instincts.

If you don't feel comfortable, consider another provider.

Once you've selected your child's medical provider, you may have a number of issues to discuss.

You may want to get the provider's input on topics such as breastfeeding, circumcision, or childcare.

If you feel it would be helpful, schedule an appointment to discuss these issues.

A team approach

If you're ever unhappy with the care your child receives, talk to the medical provider about your concerns.

Chances are, once the issue is discussed, you can come to a resolution that is mutually agreeable.

If you can't resolve the problem, you might consider seeking another provider for your child.

In the coming months, your child's medical provider will play an important role.

His or her guidance can help you make healthy choices for your baby, as well as determine what to do if your son or daughter has a health problem.

While you may have certain viewpoints, don't forget that your provider is trained in infant care and likely has considerable experience.

It's important that the two of you work together as a team to stay on top of your child's health.

Keep medical information handy.

Write down key information about your child's medical provider, such as his or her contact information, the office's hours and locations, 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 record of your child's medical information.

Include information such as his or her vaccination record, measurements, and any prescriptions or lab test results.

Chapter 13

Checkups

Frequent checkups with a medical provider are an important part of your baby's first few years.

These checkups, often called "well child visits," are a way for you and your child's medical provider to keep tabs on your child's health and development, as well as spot any potential problems.

Well child visits also give you a chance to discuss any questions or concerns you might have, and get advice from a trusted source on how to provide the best possible care for your child.

At first, well child visits aren't always easy on you or your baby.

Your baby might not like getting undressed and measured, and then there are vaccinations.

Rest assured, however, that visiting the medical provider will soon become a part of your and your baby's routine.

And with time, the visits will become less stressful and more enjoyable, as your baby becomes familiar with exploring the office's toy selection, and you look forward to finding out just how big your baby is getting.

You'll also find the provider's guidance invaluable in the months and years ahead.

Checkup Schedule

Most newborns have their first checkups within 48 to 72 hours of being discharged from the hospital.

This timeline is particularly important for breastfed babies who need to have their feeding, weight gain, and skin color in case of jaundice evaluated.

During your baby's first two years of life, he or she should see a medical provider at ages 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months.

After age 2, most children move to a yearly exam schedule.

Some children need more frequent visits, plus you can make an appointment for your child to see a medical provider anytime your child is sick or you're concerned about his or her health and development.

If possible, both parents should try to attend baby's first few checkups together.

This will give you and your partner a chance to get to know the medical provider and ask basic questions.

If it's just you, ask a family member or friend to help you navigate these early visits.

Remembering your questions and listening to your provider's advice can be difficult when you're also trying to undress or calm a fussy baby.

An extra set of hands may also prove useful during your first few outings.

Tips for Scheduling Appointments

When scheduling appointments, consider avoiding the medical provider's busiest times.

You might have the best chance of getting in and out of the provider's office quickly if you ask for the first appointment of the day or choose a time right after lunch.

On the other hand, if you think you'd like to have extra time to speak with your child's provider, you might ask for an appointment at the end of the day.

Also, consider avoiding appointments on Mondays and Fridays as well as on holidays when the provider's office is open.

These days tend to be busier than others.

The end of summer vacation also tends to be a busy time for medical providers, since many children are required to have physicals before the start of the new school year.

What to Expect at a Well Child Visit

Early on, the medical provider is likely to pay extra attention to taking measurements of height, weight, and head circumference and doing a thorough physical exam.

Over time, as the provider gets to know you and your child, things will likely go a little faster and exams may become a little more routine.

The benefit of seeing your child's provider regularly is that each visit adds critical information to your child's health history.

Over time, you and the provider will get a good idea of your child's overall health and development.

In general, the provider will be more attentive to your child's pattern of growth over time, rather than to specific one-time measurements.

Typically, what you'll see is a smooth curve that arcs upward as the years go by.

Regularly reviewing your child's growth chart can also alert you and the provider to unexpected delays in growth or changes in weight that may suggest the need for additional monitoring.

Each medical provider does things a bit differently.

But here's what's generally on the agenda during a Well Child exam.

Body Measurements

Checkups usually begin with measurements.

During first-year visits, a nurse or your baby's medical provider will measure and record your baby's length, head circumference, and weight.

Once your child is upright and walking, height measurements generally replace length measurements, starting at age 2.

Head circumference measurements are no longer routine, but your child's provider may start measuring your child's body mass index, BMI.

This is a screening tool based on population averages that uses weight in relation to height to estimate whether body size falls into categories of underweight, overweight, or obese.

BMI for children is expressed in percentiles, also called BMI for age percentiles.

Your child's measurements will be plotted on his or her growth chart.

This will help you and the provider see how your child's size compares with that of other children the same age.

Try not to fixate on the percentages too much, though.

All kids grow and develop at different rates.

In addition, babies who take breast milk gain weight at a different rate than do babies who are formula-fed.

Keep in mind that a child who's in the 95th percentile for height and weight isn't necessarily healthier than a child who's in the 5th percentile.

What's more important is steady growth from one visit to the next.

If you have questions or concerns about your child's growth rate, discuss them with your child's provider.

Physical Exam

Your child's medical provider will give your child a thorough physical exam and check his or her reflexes and muscle tone.

Be sure to mention any concerns you have or specific areas you want the doctor to check out.

The more information you can provide about your child's health, the better.

Here are the basics of what providers commonly check for during an exam.

Head

In the beginning, your child's medical provider will likely check the soft spots, fontanelles, on your baby's head.

These gaps between the skull bones give your baby's brain plenty of room to grow in the coming months.

They're safe to touch and typically disappear within two years when the skull bones fuse together.

The medical provider may also check baby's head for flat spots.

A baby's skull is soft and made up of several movable plates.

If his or her head is left in the same position for long periods of time, the skull plates might move in a way that creates a flat spot.

If flat spots are a concern, continue to place your baby on his or her back to sleep.

However, your baby's provider may recommend alternating the direction your baby's head face is in the crib,

giving your baby more tummy time while he or she is awake,

and limiting the amount of time your baby spends in a car seat outside of the car.

If these types of changes are made, the flattening typically improves in two to three months.

Occasionally, babies need to wear a positioning helmet to improve head shape.

Ears

Using an instrument called an "audoscope," the medical provider can see in your child's ear to check for fluid or infection in the ears.

The medical provider may observe your child's response to various sounds, including your voice.

Be sure to tell the provider if you have any concerns about your son's or daughter's ability to hear,

or if there's a history of childhood deafness in your family.

Unless there's cause for concern, a formal hearing evaluation isn't usually needed at a well-child exam.

Eyes

Your child's medical provider may use a flashlight to catch your child's attention and then track his or her eye movements.

The provider may also check for blocked tear ducts and eye discharge,

and look inside your child's eyes with a lighted instrument called an "upthomoscope."

Be sure to tell the provider if you've noticed that your child is having any unusual eye movements,

especially if they continue beyond the first few months of life.

Mouth

A look inside your baby's mouth may reveal signs of oral thrush, a common and easily treated yeast infection.

The medical provider may also check your baby's mouth for signs of "tongue tie," "ankle oligosia,"

a condition that affects the tongue's range of motion and can interfere with the baby's oral development,

as well as his or her ability to breastfeed.

As your baby gets older, the medical provider may ask whether your child has started to drool more than usual,

become fussy or irritable, or lost his or her appetite.

These are often the first signs of teething.

Your child's provider will check for emerging teeth.

After teeth are up, the provider will likely discuss with you the importance of regularly cleaning your baby's new teeth to prevent decay.

Your provider may also recommend making an appointment for your baby with a pediatric or family dentist.

Skin

Various skin conditions may be identified during the exam, including birthmarks, rashes, and jaundice,

a yellowish discoloration of the skin and eyes.

Mild jaundice that develops soon after birth often disappears on its own within a week or two.

Cases that are more severe may need treatment.

Heart and lungs

Using a stethoscope, your child's medical provider can listen to your child's heart and lungs to check for abnormal heart sounds or rhythms or breathing difficulties.

Abdomen, hips, and legs

By gently pressing a child's abdomen, a medical provider can detect tenderness, enlarged organs, or an umbilical hernia,

which occurs when a bit of intestine or fatty tissue near the navel breaks through the muscular wall of the abdomen.

Most umbilical hernias heal by the toddler years without intervention.

The provider may also move your child's legs to check for dislocation or other problems with the hip joints, such as dysplasia of the hip joint.

Genitalia

Your child's medical provider will likely inspect your son's or daughter's genitalia for tenderness, lumps, or other signs of infection.

The provider may also check for an inguinal hernia, which results from a weakness in the abdominal wall.

For girls, the doctors may ask about vaginal discharge.

For boys, the provider will make sure a circumcised penis is healing well during early visits.

The provider may also check to see that both testes have descended into the scrotum and that there's no fluid-filled sac around the testes, a condition called hydrosil.

Nutrition

Your child's medical provider will likely ask you about your child's eating habits.

If you're breastfeeding, the provider may want to know how often you're feeding your baby during the day and night and whether you're having any problems.

If you're pumping, the provider may offer suggestions for managing pumping frequency and storing breast milk.

If you're formula feeding, the provider will likely want to know how often you feed and how many ounces of formula your baby takes at each feeding.

In addition, the provider may discuss with you your baby's need for vitamin D and iron supplements.

Although breast milk or formula will be the main part of your baby's diet throughout the first year,

eventually you'll want to discuss introducing your baby to solid foods.

A medical provider can offer advice on the best foods to start with, the importance of making healthy choices and how to feed your baby.

Once your baby starts eating solid foods, the provider may check to see if you're having any problems feeding your child or if your child has had any allergic reactions.

As your son or daughter gets older, discussion topics may include drinking from a sippy cup and when it's okay for your child to start to use utensils to feed himself or herself.

You might also discuss weaning your baby from the bottle by age one, when and how to start giving your baby whole cows milk, and any concerns about picky eating in your toddler.

Bowl and bladder function

In the first few visits, your child's medical provider will likely also ask how many wet diapers and bowel movements your baby produces on a daily basis.

This information offers clues to whether your baby is getting enough to eat.

As your child gets older and you move closer to toilet training, usually between ages two and three years,

your child's provider can offer advice on when might be the best time for your child to start.

The provider may also have some tips to help you and your child transition successfully from diapers to toilet.

A well child visit is also an opportunity to discuss any concerns you might have about your child's bowel functions and any irregularities, such as frequent loose stool or constipation.

Sleeping status

Your child's medical provider may ask you questions about your child's sleep habits, such as your regular bedtime routine and how many hours your child is sleeping during the day and night.

Don't hesitate to discuss any concerns you may have about your child's sleep, such as getting your baby to sleep through the night, when it's okay to drop naps,

switching your toddler from a crib to a bed, or getting your child to stay in bed.

Your child's provider may also help you figure out how to find rest for yourself, especially in the early baby months.

Development

Your child's development is important too. The medical provider will monitor your child's development in the following five main areas.

Gross motor skills

These skills, such as sitting, walking and climbing, involve the movement of large muscles.

Your child's medical provider may ask you how well your baby can control his or her head.

Is your baby attempting to roll over?

Is your baby trying to sit on his or her own?

Is your baby starting to walk or throw a ball?

Can your toddler walk up and down steps?

Fine motor skills

These skills involve the use of small muscles in the hand.

Does your baby reach for objects and bring them to his or her mouth?

Is your baby using individual fingers to pick up small objects?

Does your child use a cup?

Can your toddler draw a straight line?

Personal and social skills

These skills enable a child to interact and respond to his or her surroundings.

Your child's medical provider may ask if your baby is smiling.

Does your baby relate to you with joy and enthusiasm?

Does he or she play peek-a-boo?

Is your toddler starting to explore on his or her own or show signs of independence?

Language skills

These skills, including hearing, understanding and use of language.

The medical provider may ask if your baby turns his or her head toward voices or other sounds.

Does your baby laugh?

Is he or she responding to his or her name?

Is your toddler starting to say no or point to named objects in a book?

Cognitive skills

These skills allow a child to think, reason, solve problems and understand his or her surroundings.

Your child's medical provider might ask if your baby can bang together two cubes

or search for a toy after seeing you hide it.

Can your child point to a body part or follow simple one-step instructions?

Behavior

Your child's medical provider may ask you questions about your child's behavior

or whether your child has started throwing tantrums or misbehaving.

Explain what you've noticed so far and anything that seems out of the ordinary to you or is causing you concern.

Your child's provider can help reassure you about what's normal

and how to handle your child's budding sense of autonomy.

As your baby gets older and begins exploring everything in sight,

you may find yourself setting greater limits.

Your toddler also might get frustrated as his or her growing desire for independence

conflicts with his or her limited vocabulary and physical abilities.

Your child's provider might discuss the importance of creating a safe home environment and predictable routine,

as well as how to handle your toddler's meltdowns without having one yourself.

Vaccinations

Your baby will need a number of vaccinations during his or her first years.

The medical provider or a nurse will explain to you how to hold your baby as he or she is given each shot.

Be prepared for possible tears.

Keep in mind, however, that the pain caused by a shot is typically short-lived,

but the benefits are long-lasting.

Keeping up with vaccines, including flu shots every year,

is important throughout your child's life.

Chapter 14 provides more detailed information on the vaccinations your son or daughter will receive during the first 36 months.

Safety

Your child's medical provider may talk to you about safety issues,

such as the importance of placing your baby to sleep on his or her back

and using a rear-facing infant car seat as long as possible.

As your child becomes more mobile, the provider may give you tips for baby-proofing your home.

He or she may discuss how to prevent falls, the importance of water safety,

and how to prevent infections by washing hands.

Questions and concerns

During your son's or daughter's checkups, it's likely that you'll have questions too.

Ask away.

Nothing is impossible.

You'll have questions too.

Ask away.

Nothing is too trivial when it comes to caring for your baby or toddler.

Write down questions as they arise between appointments

so that you'll be less likely to forget them when you're at your child's checkup.

Feel free to ask your child's medical provider for advice on topics that aren't medically related to.

For example, if you're looking for childcare,

ask the provider if he or she has any advice.

Also, don't forget your own health.

If you're feeling depressed, stressed out, run down, or overwhelmed,

describe what's happening.

Your child's provider is there to help you too.

Before you leave the medical provider's office,

make sure you know when to schedule your child's next appointment.

If possible, set the next appointment before you leave the provider's office.

If you don't already know, ask how to reach your child's provider in between appointments.

You might also ask if the provider has a 24-hour nurse information service.

Knowing that help is available when you need it can offer peace of mind.

Premature Babies

If your baby was born prematurely, his or her growth and development

will be measured using his or her corrected age.

Your baby's age in weeks minus the number of weeks he or she was premature.

For example, if your baby was born eight weeks early,

at age six months or 24 weeks,

your baby's corrected age is four months or 16 weeks.

This adjustment will be necessary until your baby reaches age two or so.

Vaccinations, however, will be given to your baby according to his or her chronological age.

Failure to Thrive

Failure to thrive is a term, not a disease,

that's used to describe a baby or toddler who isn't growing or developing at an appropriate rate.

The term might be used when a child's weight or height appears below the fifth percentile on a growth chart,

or if a child's growth rate is lower than expected.

Failure to thrive can be caused by multiple issues,

such as an underlying health problem or environmental problems.

If your child's medical provider is concerned about your baby's growth and development,

he or she may ask you questions about your pregnancy and delivery,

your baby's medical and dietary history, and your family history.

With early intervention, many children respond well and catch up in their growth and development.

Failure to thrive

Keep a record

Consider starting a file, notebook, or electronic medical record for your child's medical information,

such as his or her vaccination record, measurements, and any prescriptions or lab test results.

Taking time to organize your child's health history will give you a chance to review any information the medical provider gives you.

It's also a good habit to start early because when your child enters preschool or kindergarten,

you'll likely be required to provide certain medical details.

Plus, your notes about your baby's growth make for a cherished keepsake.

Developmental delays

If your child 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 development.

Your child's medical provider might recommend certain tests to check for underlying problems.

You may also meet with a specialist, such as a developmental pediatrician.

If your baby or toddler has a developmental delay,

the provider can recommend a type of developmental therapy that may help your child make progress.

Most children are eligible to receive a wide range of therapies in their homes, often at no cost.

Early identification of a developmental delay is important because it will enable you to get your child the help he or she needs as soon as possible.

For more information on developmental delays, see Chapter 44.

Chapter 14

Vaccinations

Before you met your baby, did you think about his or her health? Chances are, you did.

Think back to your pregnancy, the things you did to keep yourself healthy, and to prevent problems from occurring,

so the baby inside you could grow and develop.

Prevention is crucial to good health.

It's far better to prevent a disease than to treat it.

And one of the best ways to protect your family from many diseases is to get vaccinated.

Immunization is the best line of defense against diseases such as tetanus, hepatitis, influenza, and many other infections.

Thanks to vaccines, many infectious diseases that were once common in the United States are now rare or nonexistent.

As a parent, you no longer have to fear that your child will die of or become disabled by smallpox or tetanus,

and you no longer have to keep your children away from water fountains and swimming pools to avoid getting polio.

Truth be told, vaccinations aren't exactly fun for children or parents.

It's hard to see your little one cry after receiving a series of shots, but as much as you want to shield your child from discomfort and tears,

keep in mind that the discomfort is temporary and very minor compared with a potential discomfort and harm of a serious illness.

Vaccinations prevent millions of deaths worldwide each year.

However, despite the availability of vaccines, many people remain under-immunized.

One reason is that some people have concerns about the safety and risks of vaccines.

In addition, some people feel it's dangerous to give more than one vaccine at a time,

and others feel certain vaccines are no longer needed.

These concerns are often the result of incorrect information.

How Vaccines Work

Every day, the human body is exposed to bacteria, viruses, and other germs.

When a disease-causing microorganism enters your or your child's body, your immune system mounts a defense,

producing proteins called antibodies to fight off the harmful germ.

The goal of your immune system is to neutralize or destroy the germ, rendering it harmless and preventing you from getting sick.

One way the body's immune system fights off harmful germs is through what's called "post-exposure immunity."

After you've been infected with a certain organism, your immune system puts into play a complex array of defenses

to prevent you from getting sick again, from that type of virus or bacterium.

Another way to get the immune system to fight bad germs is through vaccines.

With this method, a person becomes immune without getting sick.

A vaccine contains just enough of a killed or weakened form or derivative of the infectious germ

to trigger your immune system's infection-fighting ability, but without the harmful effects of a full-blown infection.

When given to you before you get infected, the vaccine makes your body think that it's being invaded by a specific organism.

Your immune system begins building defenses against that organism.

If you're exposed to a disease for which you've been vaccinated, the invading germs are met by antibodies prepared to defeat them,

and vaccines can be given without the risk of the serious effects of disease.

Sometimes it takes several doses of a vaccine for a full immune response.

This is the case for many childhood vaccines.

Some people fail to build immunity to the first doses of a vaccine, but they often respond to later doses.

In addition, the immunity provided by some vaccines, such as tetanus and pertussis, isn't lifelong.

Because the immune response may decrease over time, you may need another dose of a vaccine, booster, to restore or increase your immunity.

And for some diseases, the organism evolves and a new vaccine is needed against the new form.

This is the case with the annual flu influenza shot.

Why get vaccinated?

Because many vaccine-preventable diseases are now uncommon in the United States.

Some people feel less urgency about getting themselves or their children immunized.

If you wonder if it's necessary to vaccinate your family and to keep everyone up to date with vaccinations, the answer is yes.

Many infectious diseases that have virtually disappeared in the United States can reappear quickly.

The germs that cause the diseases still exist and can be acquired and spread by people who aren't protected by immunization.

As travelers unknowingly carry disease from one country to another, a new outbreak may only be a plane trip away.

From a single entry point, an infectious disease can spread quickly among unprotected individuals.

Outbreaks of mumps and measles have repeatedly occurred in just this way in the United States in the past few years.

Vaccine Safety

As a new parent, you might have some misgivings about giving your child vaccines.

You don't want to do anything to harm your child.

And while you know that vaccinations are important, you've also heard that they could be harmful too, possibly causing side effects.

You may worry after hearing or seeing reports about a severe reaction that occurs shortly after a child's vaccination visit

that's said to be a side effect or a complication of the vaccine.

But you may also have some more profounded stories such as these frequently circulate on the Internet.

The fact is, vaccines are extremely safe.

Before they can be used, they must meet strict safety standards set by the Food and Drug Administration, FDA.

Meeting these standards requires a lengthy development process lasting 10 to 14 years from exploratory work in laboratories

and in the field of vaccines, all before being licensed.

These studies, unlike drug studies, involve tens of thousands of individuals.

Once vaccines are licensed and made available to the general public, the FDA and the Centers for Disease Control and Prevention, CDC,

continue to monitor their safety.

Furthermore, vaccines are subject to ongoing research, review, and refinement by doctors, specialists, and public health officials.

Those who provide vaccines, such as medical providers and nurses, must report any side effects they observe to the FDA and CDC.

The bottom line is, your child's chances of being harmed by an infectious illness are far greater than his or her chances of being harmed by a vaccine used to prevent that disease.

Vaccine Additives

In addition to the killed or weakened microorganisms that make up vaccines, small amounts of other substances may be added to a vaccine

to enhance the immune response, prevent contamination, and stabilize the vaccine against temperature variations and other conditions.

Vaccines may also contain small amounts of materials used in the manufacturing process, such as gelatin.

One additive that has received much attention is a preservative called thimerosal, which is a derivative of mercury.

Thimerosal has been used in medical products since the 1930s and in small amounts in some vaccines to prevent bacterial contamination.

No evidence shows that children have been harmed by its use in vaccines.

Nonetheless, childhood vaccines are now made without thimerosal or with only trace amounts.

Vaccines and Autism

Many parents have heard claims that vaccines cause autism.

The most common and specific claims that are that autism stems from the measles, mumps, and rubella, MMR vaccine, or from vaccines that contain the preservative thimerosal.

Studies conducted around the world have shown without a doubt that the MMR vaccine doesn't cause autism.

In the meantime, researchers have learned a great deal about autism itself.

For example, it's now known that the signs of autism appear well before the timing of the MMR vaccine, and several causes of autism have been identified.

Some are genetic in nature, others act early on in pregnancy.

Unfortunately, the claims about autism and the MMR vaccine persist, and they've led some parents to refuse to vaccinate their children.

Some people also worry that receiving too many vaccines early in life can overwhelm a baby's immune system and that this might somehow harm the baby.

Such reasoning doesn't fit with what we know about the remarkable capacity of the immune system.

From the moment a child is born, his or her immune system begins battling microorganisms in the form of bacteria, viruses, and fungi on a daily basis.

A system that effectively copes with exposure to countless everyday bacteria can easily withstand exposure to the antigens in vaccines.

Childhood vaccinations

Fortunately, many of the most familiar diseases of childhood, chickenpox, measles, and mumps, can be prevented through vaccination.

Chickenpox

Chickenpox, varicella, is a common childhood disease. It can also affect adults who aren't immune.

Furthermore, chickenpox can lead to reoccurrences of viral inflammation later in life called shingles, herpes zoster.

The chickenpox virus is spread by breathing in affected droplets from the air or by direct contact with fluid from the rash, which is the best known sign of the disease.

The rash begins as superficial spots on the face, chest, back, and other areas of the body.

The spots quickly fill with a clear fluid, rupture, and turn crusty.

Recommendation

Children should receive one dose of the chickenpox, varicella vaccine, between 12 and 15 months of age, and a second dose between 4 and 6 years of age.

Diphtheria

Diphtheria is a bacterial infection that spreads from person to person through airborne droplets.

It causes a thick covering, membrane, to develop in the back of the throat, and can lead to severe breathing problems, paralysis, heart failure, and death.

The disease is now rare in the United States.

Recommendation

The diphtheria vaccine typically is given in combination with the tetanus and pertussis vaccines.

A D-tap shot.

Vaccination should begin when a child reaches two months of age.

A child should receive five shots in the first six years of life.

A booster shot of tetanus, diphtheria, and pertussis, T-dap, at age 11 or 12, and then a tetanus and diphtheria, TD booster, every 10 years after.

German measles

German measles, rubella, is a contagious disease that spreads through the air from people sick with the infection.

It's typically a mild infection that causes a rash and slight fever.

However, women who develop rubella during pregnancy may have miscarriages, or the babies could be born with birth defects.

Recommendations

Two doses of the combination measles, mumps, and rubella, MMR, vaccine, are given.

The first at ages 12 to 15 months, and the second at four to six years.

Hib disease

Homophilus influenzae, type B. Hib disease is primarily a childhood illness, but it can also affect some adults.

It's caused by bacteria that spread from person to person through the air.

This infection can cause serious and potentially fatal problems, including meningitis, sepsis, severe swelling in the throat,

and infections of the blood, joints, bones, and membranes around the heart, pericarditis.

Recommendation

The Hib vaccine is given to children at ages two months, four months, six months, and 12 to 15 months.

Hepatitis A

Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus.

The virus is found in an infected person's stool.

It's usually spread by eating or drinking contaminated food or water, or by close personal contact.

Recommendation

The two-dose series of hepatitis A vaccine is recommended for all children in the U.S.

The first dose is generally given at 12 to 23 months, and the second dose, six to 18 months later.

Hepatitis B

The hepatitis B virus can cause a short-term acute illness marked by loss of appetite, fatigue, diarrhea, vomiting, jaundice, and pain in muscles, joints, and the abdomen.

More rarely, it can lead to long-term chronic liver damage, cirrhosis, or liver cancer.

The virus is spread through contact with the blood or other body fluids of an infected person.

This can happen by sharing personal items such as toothbrushes or razors, or having unprotected sex.

It can also happen during birth when the virus passes from an infected mother to her baby.

Recommendation

The hepatitis B vaccine is given to children in three doses, at birth, at least one month later, one to two months of age, and then at six to 18 months.

Most people who are vaccinated with hepatitis B vaccine are immune for life.

Flu Influenza

Influenza is a viral infection that sickenes millions of people each year and can cause serious complications, especially in children and older adults.

Flu vaccines are designed to protect against strains of flu virus expected to be in circulation during the fall and winter of that year.

Flu season varies across the US. It s best to get vaccinated by the end of October so that you and your child receive protection before the start of the flu season.

Recommendation

The influenza vaccine is recommended yearly for infants and children, beginning at age six months.

Children require two doses of the flu vaccine the first time they receive it. That s because they don t develop an adequate antibody level the first time they get the vaccine.

Antibodies help fight the virus if it enters your child s system.

Measles

Rubiola is primarily a childhood illness, although adults also are susceptible. It s the most contagious human virus known.

The measles virus is transmitted through the air in droplets, such as from a sneeze.

Signs and symptoms include rash, fever, cough, sneezing, runny nose, eye irritation, and a sore throat.

Measles can lead to an ear infection, pneumonia, seizures, brain damage, and even death.

Recommendation

Typically, two doses of a combined measles, mumps, and rubella, MMR vaccine, are given, beginning at ages 12 to 15 months, and then again at four to six years.

Mumps

Mumps is a childhood disease that can also occur in adults. Mumps is caused by a virus that s acquired by inhaling infected droplets.

Mumps can lead to a disease that can cause a fever, headache, fatigue, and swollen, painful salivary glands.

It can lead to deafness, meningitis, and inflammation of the testicles or ovaries, with the possibility of sterility.

Recommendation

Usually, two doses of a combined measles, mumps, and rubella, MMR vaccine, are given, usually beginning at ages 12 to 15 months, and then again at four to six years.

Use of this vaccine has markedly decreased the incidence of mumps in the United States.

Pneumococcal disease

Pneumococcal disease is the leading cause of bacterial meningitis and ear infections among children younger than five years old.

Children under the age of two are at the greatest risk of the most serious complications of this disease.

Pneumococcal disease is caused by streptococcus, pneumonia bacteria.

The bacteria spread from person to person through physical contact, or by inhaling droplets released into the air when a person with the infection coughs or sneezes.

Because many strains of the bacterium have become resistant to antibiotics, the disease can be difficult to treat.

Recommendation

Pneumococcal conjugate vaccine, PCV, can help prevent serious pneumococcal disease.

It can also prevent one cause of ear infections.

The vaccine is given in four doses between ages two and 15 months.

Polio

Polio is caused by a virus, polio virus, that enters the body through the mouth.

Polio affects the brain and spinal cord and can result in paralysis or death.

Polio vaccination began in the US in 1955.

No polio cases have been reported in this country for many years, but the disease still occurs in some parts of the world.

Because the virus could be brought to the US through travelers, getting vaccinated against polio continues to be critical.

The vaccine, called inactivated polio virus, IPV, contains the chemically killed virus.

IPV is given by multiple injections.

Recommendation

IPV is given in four doses at ages two months, four months, six to 18 months, and at four to six years.

This last vaccination is a booster dose.

Contrary to the fears of some people, the shots can't cause polio.

Rodovirus

Rodovirus is a common cause of severe diarrhea among infants and children.

Almost all children are infected with Rodovirus before their fifth birthday.

The infection is often accompanied by vomiting and fever.

It can cause severe dehydration, especially in infants and toddlers.

Recommendation

Rodovirus vaccine is swallowed, oral, vaccine medication, not a shot.

The vaccine is very good at preventing diarrhea and vomiting, caused by Rodovirus.

Since the vaccine was introduced, it has significantly decreased the number of Rodovirus infections in young children.

It won't prevent diarrhea or vomiting caused by other germs, however.

There are two brands of Rodovirus vaccine.

A baby should get either two or three doses, depending on which brand is used.

The first dose is given at two months, the second at four months, and the third dose if needed at six months.

Tetanus

Tetanus causes painful tightening of the muscles, usually all over the body.

It can be difficult to open your mouth, lock jaw, or swallow.

Tetanus isn't a contagious disease.

The tetanus bacteria enter the body through deep or dirty cuts or wounds.

Recommendation

The tetanus vaccine typically is given in combination with those for diphtheria and pertussis, DTAP vaccine.

Immunization is acquired through a series of five shots, beginning when the infant is two months old and continuing to between ages four and six.

During age eleven, people should boost their immunization every ten years with the adult form of the vaccine.

Whooping cough

Whooping cough, pertussis, is a disease that causes severe coughing spells, making it hard for infants and toddlers to eat, drink, or even breathe.

The word pertussis is from the Latin word for cough.

It can cause severe coughing spells, can last for weeks, and can lead to pneumonia, seizures, brain damage, and death.

Severe whooping cough primarily occurs in children younger than two years and is contracted by inhaling infected droplets, often coughed into the air from an adult with a mild case of the disease.

Recommendation

The DTAP vaccine is a better-tolerated version of an older vaccine called DTP.

The A in DTAP stands for Accelular, meaning that only specific parts of the pertussis vaccine are used in the vaccine.

An adult form of the vaccine, called TDAP, is recommended starting at age eleven.

Side effects of vaccines

Although vaccines are considered very safe, like all medications, they aren't completely safe.

Although vaccines are considered very safe, like all medications, they aren't completely free of side effects.

Most side effects are minor and temporary.

Your child might experience soreness or swelling at the injection site or a mild fever.

Serious reactions such as a seizure or high fever are very rare.

According to the Centers for Disease Control and Prevention, CDC, serious side effects occur on the order of one per thousand to one per million of doses.

The risk of death from a vaccine is so slight that it can't be accurately determined.

When any serious reactions are reported, they undergo careful review by the Food and Drug Administration and the CDC.

Some vaccines are blamed for chronic illnesses such as autism or diabetes.

However, decades of vaccine use in the United States show no credible evidence that vaccines cause these illnesses.

Researchers have, on occasion, reported a link between vaccine use and chronic illness.

But when other researchers have tried to duplicate those results, a test of good scientific research, they haven't been able to produce the same findings.

When to avoid vaccination?

In a few circumstances, vaccination should be postponed or avoided.

Talk to your child's medical provider if you question whether your baby should be vaccinated.

Vaccination may be inappropriate if a child has had a serious or life-threatening reaction to a previous dose of that vaccine.

A known significant allergy to a vaccine component such as gelatin.

A medical condition such as AIDS or cancer that has compromised the child's immune system and could allow a live virus vaccine to cause illness.

Immunization may need to be delayed if a child has a moderate to severe illness.

Taken steroid medications in the last three months, received a transfusion of blood or plasma or been given blood products within the past year,

vaccination shouldn't be delayed because your baby has a minor illness such as a common cold, an ear infection or mild diarrhea.

The vaccine will still be effective and it won't make your child sicker.

Weighing the risks and benefits

The consequences of acquiring a disease that can be prevented by vaccination are far greater than the extremely rare risk of a serious side effect resulting from vaccine use.

For example, if your child gets mumps, the risk of him or her developing encephalitis is 1 in 300.

For measles, the risk is 1 in 2000.

Encephalitis is a brain inflammation that can cause permanent, serious brain damage.

In contrast, the risk of contracting encephalitis from the mumps and measles vaccines is virtually non-existent.

If a child gets serious hip disease, the chances of death are 1 in 20.

The vaccine for hip disease, meanwhile, hasn't been associated with any serious adverse reactions and is highly effective.

Most childhood vaccines are effective in 85 to 99% or more of children who receive them.

For example, a full series of measles vaccine protects 99 out of 100 children from measles, and a polio vaccine series protects 99 out of 100 children from polio.

Alternative vaccine schedules

Some people tout when they call alternative vaccine schedules that delay shots or space them further apart.

For parents who may be skittish about giving their children so many shots, the idea of the alternative schedule is to separate out the vaccines and give them over a longer period of time.

But health experts, including those at Mayo Clinic, say that these approaches leave too many kids unprotected for too long, and they aren't backed up by science.

Alternative schedules are unstudied, and they can be dangerous because of the increased risks they pose.

Skipping or spacing out vaccines dramatically increases a child's risk of illness.

If you're concerned, the best advice is to talk with your child's medical provider to make sure that you're getting the correct information.

Comforting baby during and after vaccination

It can be difficult to see your baby cry or be uncomfortable as a result of a vaccination.

Try to keep in mind that protecting your baby against serious disease is worth a short-term discomfort.

During each injection, hold your baby close.

Offer a pacifier, blanket, or other comfort object.

Your calm presence can help your baby feel secure.

Your baby may experience mild side effects from the vaccines, such as redness, pain, or swelling at the injection site.

Ask the doctor what to expect.

If your baby develops discomfort from fever or soreness at the injection site, you may give your baby acetaminophen, Tylenol, others.

If your child is six months or older, you can use ibuprofen, Advil, Motrin, others.

Follow the label instructions for the correct dose.

Missing a vaccination

If your baby falls behind on his or her vaccinations, catch-up vaccination schedules can address the problem.

Make an appointment with your child's medical provider to determine the vaccinations your baby needs and when he or she should receive them.

An interruption in the schedule doesn't require a child to start a series over or redo any doses.

But until your child receives the entire vaccine series, he or she won't have maximum possible protection against diseases.

Why so many so soon?

Newborns need multiple vaccines because infectious diseases can cause more serious problems in infants than in older children.

While a mother's antibodies help protect newborns from many diseases,

this immunity may begin to disappear as quickly as one month after birth.

In addition, children don't receive maternal immunity from certain diseases such as whooping cough.

If a child isn't vaccinated quickly and is exposed to a disease, he or she may become sick and spread the illness.

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 and Prevention.

In addition, giving several vaccinations at once means fewer office visits, which saves time and money for parents and may be less traumatic for the child.

Remember, newborns and young children can be exposed to diseases from family members,

childcare providers, and other close contacts, as well as during routine outings such as trips to the grocery store.

Vaccines can often be given even if 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.

Vaccinations for preterm babies

If your baby was born early or with a low birth weight, you might be concerned about having your baby vaccinated at the standard schedule.

However, it's recommended that even premature babies should be given the routinely recommended vaccinations at the normal times.

Keep in mind that premature babies have a greater chance of having disease-related problems, putting them at particular risk if they acquire a preventable infection.

All of the vaccines that are currently available are safe for premature babies and those with low birth weight 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 weighs less than 2.2 pounds at birth, your medical provider may need to give your baby a fourth dose in the first six months

or, depending on your prenatal testing, delay the first dose for one month or until hospital discharge.

Signs of a severe reaction

After vaccination, watch for any unusual conditions, such as a serious allergic reaction, very high fever, 104.8 Fahrenheit, or unusual behavior.

Signs and symptoms of a serious allergic reaction include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat, dizziness, and swelling of the throat.

Severe reactions are rare, but if you think that your baby may be experiencing one, call your child's medical provider or go to an emergency department immediately.

Chapter 15. Childcare

When you first bring your baby home from the hospital, it might be hard to imagine trusting anyone else to take care of him or her.

You might have a difficult time feeling comfortable taking your baby with you as you run errands, let alone picturing yourself dropping him or her off at a childcare center.

But for many families, childcare is a necessity at some point, whether in the form of the occasional babysitter, full-time nanny, childcare center, or other option.

So how do you find childcare that will promote your baby's health, safety, and development, but won't completely empty your bank account?

To begin, determine how much you can afford to spend on childcare, and identify your needs and expectations.

What's important to your family when it comes to childcare? Then begin looking around at the available options in your area, usually the sooner, the better.

To make the most of your visits, make sure you know how to identify quality childcare providers.

Getting started.

Whether you need full-time childcare after your baby is born, or just need some help a few days a week, it's never too early to start thinking about childcare arrangements.

Even if you're not sure about your plans, begin exploring and researching your options early.

Start by asking your friends, coworkers, or your child's medical provider for recommendations.

Your local childcare resource and referral agency can be a great source of information too.

It can provide resources about licensing requirements, and also assess whether your family may qualify for financial assistance.

You might want to visit multiple childcare centers to find the right one for your child, and many childcare centers have long waiting lists.

If you're looking for in-home care, you might need time to find a childcare agency, interview caregivers, and set up health insurance or workers' compensation for your child's caregiver.

Before you return to work, you might want to have your child spend time at a childcare center or with a childcare provider to see how he or she handles the situation, and whether or not the arrangement works for your family.

Childcare options. There are a variety of childcare options. Generally, they tend to include the following arrangements.

In-home care. Under this arrangement, a caregiver comes to your home to provide childcare. The person might live with you or come to your home each day, depending on the agreement you have worked out.

Some examples of in-home caregivers include babysitters, nannies, and au pairs.

Au pairs are typically people who come to the United States on a student visa and provide childcare in exchange for room and board and a small salary.

Pros. One of the big advantages of this type of arrangement is that your baby can stay at home.

You don't have to be bundling up your baby early in the morning to drop him or her off on your way to work.

In addition, you set your own standards and you might have more flexibility with your work hours.

Other advantages of an in-home arrangement are that your child will receive individual attention and he or she won't be exposed to other children's illnesses or poor behaviors.

Plus, you likely won't need backup care if your baby becomes ill. You won't need to worry about transportation for your baby unless you want your childcare provider to take your baby somewhere.

An in-home caregiver also might be able to help with light housework or preparing meals during your baby's naps.

If you use an agency to find a childcare provider, you may have the comfort of knowing that someone has already checked the backgrounds and references of potential candidates.

If you have more than one child, the cost of in-home care might not be significantly more expensive than other care options.

Cons.

This type of care isn't well regulated and is typically more expensive than other options.

If you use an agency to find a childcare provider, you'll likely have to pay a hefty fee.

Your caregiver might have minimal training in child development, first aid or CPR.

As an employer of a childcare provider, you might also have certain legal and financial obligations, such as meeting minimum wage and tax reporting requirements or providing health insurance.

Some people also feel uncomfortable having a caregiver spending time in or living in their homes.

There might not be as much opportunity for your baby to socialize with other children, which becomes increasingly important as your baby develops into a toddler.

You may need to provide your child's caregiver with an allowance or gas and activities you'd like your child to be involved in.

And when your childcare provider becomes sick or goes on vacation, you'll need to find backup care.

Family childcare.

Many people provide childcare in their homes for small groups of children, sometimes in addition to caring for their own children.

Typically, family childcare centers provide care for children of mixed ages.

Small programs provide care for up to six children at one time.

While large programs are for seven to twelve children.

Pros.

One of the main attractions of family childcare is that it allows your baby to be in a home-like setting with other children.

In addition, family childcare is often less expensive than care provided by an in-home caregiver or a childcare center.

Homes that offer childcare usually have to meet state or local safety and cleanliness standards.

Some places might be able to cater to your baby's and family's specific needs, providing care for your children with special needs or extended hours.

Cons.

The quality can vary widely, while many family childcare providers undergo background checks and participate in ongoing training.

Not all may be required to do so.

Family homes may not have the same facility resources as larger childcare centers.

You may have to drop off and pick up your baby at the home at specified times.

Childcare centers.

Childcare centers also called daycare centers, child development centers, or sometimes preschool or pre-kindergarten programs.

Our organized facilities with staff members who are trained to care for groups of children.

In these settings, care typically is provided in a building rather than a home, with separate classrooms for children of different ages.

Programs can be large or small, based on their maximum capacity.

A childcare center can be part of a chain, independent for profit, non-profit, state-funded, or part of a federal program, such as Head Start.

Some childcare programs also have religious affiliations or income eligibility requirements.

Pros.

Childcare centers offer many advantages.

They're generally required to meet state or local standards.

Many have structured programs designed to meet the needs of children at different age levels.

Childcare centers often have high education requirements for staff, and because most centers have several caregivers, you likely won't need backup care if a childcare provider becomes sick.

In addition, childcare centers provide opportunities for socialization with other children.

Some centers might provide extended hours or allow you to enroll your baby for less than a full week if you work part-time.

Some childcare centers also allow you to check in on your baby during the day via secure online video systems.

Cons.

A drawback of larger facilities is that they might have long waiting lists for admission.

Also, spending time with other children can increase your baby's risk of getting sick.

Because of this, some childcare centers might not let you bring your child to the center if he or she is mildly ill.

Childcare centers can also be expensive, depending on the services offered.

Regulations also vary.

If the program is large or the ratio of care providers to children is low, your child might not receive a lot of individual attention.

You may have to drop off and pick up your baby at the childcare center at specified times.

Some centers charge fees if you don't pick up your baby on time.

Relative or friend.

Many people rely on relatives or friends to provide part-time or full-time care for their children.

While having someone you know and trust take care of your child is comforting, there are advantages and disadvantages to this type of arrangement too.

Pros.

Chances are your baby will receive plenty of individual attention.

You might even be able to have your relative or friend care for your baby in your own home, so you don't need to worry about transportation.

Your baby won't be exposed to other children's illnesses or misbehaviors, and you may not need backup care if your baby becomes ill.

This type of arrangement might also give you some flexibility with your work hours.

It's also possible, depending on the agreement you work out, that you might not need to pay your friend or relative for childcare services, or you can pay at a discounted rate.

Cons.

Your friend or relative might not have any training in CPR or other emergency care.

If you pay your friend or relative and they provide care in your home, you'll want to check out your local employment laws to make sure you meet requirements for matters such as tax withholding, health insurance, and workers' compensation.

Sometimes the main drawback of having a family member or friend provide care is that it can cause tension.

You might not feel comfortable talking to your relative or friend if you have differing opinions about how he or she cares for your child.

Your relative or friend might also offer unwanted parenting advice.

Factors to consider

Before you begin looking at facilities or interviewing care providers, take some time to think about what kind of childcare might work best for your family.

Knowing your priorities will help you in the process.

Expectations

Think about your family's needs and what's most important to you in a childcare provider.

Here are some questions to ask yourself.

How many days and hours a week do you expect your child to need care?

How do you want your childcare provider to approach misbehavior in your child?

If you're considering hiring a nanny, do you want him or her to be able to drive and do lighthouse work?

If you're considering out of home care, how far away from your home or place of work would you like your child to be?

How will you handle transportation to and from the childcare center?

Or access to transportation your caregiver and child might need during the day?

What kind of backup arrangements can you make if your child or care provider becomes sick?

Do you want your child to be exposed to a specific language?

How much free playtime will your child have?

How much time outdoors?

Budget

Think about how much money you can afford to spend on childcare and how different types of childcare will affect your budget.

Are you eligible for any state subsidies or assistance from your employer, such as employee discounts or dependent care spending accounts?

If you're considering in home care, are you prepared to pay any necessary state taxes and the cost of backup care during your childcare provider's vacation and sick days?

If you're concerned about the expense of childcare, could you or your partner adjust work hours or schedules to reduce your need for childcare?

Evaluating your options

Once you've thought about what kind of childcare will work best for your family, compile a list of potential caregivers or facilities in your area.

Next, call, interview or visit the caregivers or facilities.

During your visit, pay special attention to the way staff members treat the children.

After a tour, be prepared with a list of questions.

If you're evaluating several different settings or childcare providers, consider taking notes.

In home care

When looking for someone to come into your home to care for your baby, checking references is crucial, especially if vetting by an agency hasn't already occurred.

Talk to several of the childcare providers' previous employers and ask questions about his or her strengths and weaknesses, as well as any problems or concerns the employer might have had.

Do a background check.

Search for information about the person online via a search engine or social networking sites.

Ask about the care provider's approach to childcare.

What will the care provider do if your baby won't stop crying?

How will the care provider manage tantrums?

What kind of hours can he or she work?

What kind of salary does the childcare provider expect?

Does he or she need health insurance?

Does he or she have CPR and first aid training?

Family childcare

Look for a facility that's certified and licensed and provides a safe environment for children.

Ask about how many childcare providers are on staff and if they have undergone background checks.

Request references.

Ask about the provider's training, how many children are enrolled and the facility's hours.

Discuss the facility's approach to child rearing.

How many childcare providers are currently certified in CPR and have first aid training?

Who lives in and visits the home?

What are their backgrounds and how might they interact with your child?

How does the staff plan to deal with emergencies?

What safety measures are in place?

Are there daily activities for the children?

Find out what happens if the care provider becomes ill and if he or she goes on vacation.

How much does the program cost?

Childcare center

When evaluating childcare centers,

find out about each program's practices.

Many childcare centers provide pamphlets or have websites that will answer your questions.

You can also speak to the program's director.

Consider asking about credentials and staff qualifications.

Make sure the program is licensed and has a recent inspection certificate.

Programs that are accredited have met voluntary standards for childcare that go beyond most state licensing requirements.

The National Association for the Education of Young Children and the National Association for Family Childcare

are the two largest organizations that accredit childcare programs.

Staff should have training in early child development, CPR and first aid.

References should be available upon request.

Ask if there are frequent staff changes since high staff turnover might be a sign of a problem

and changing care providers can be hard on a child.

If possible, talk to at least one parent whose child was in the program in the past year.

Adult to child ratios

Ask about the ratio of adults to children.

The fewer the children for each adult, the better the childcare experience may be for your son or daughter.

For infants, look for an adult to child ratio of 1 to 3 or 1 to 4.

Also, look for a group size that's no larger than 6 to 8 infants or 6 to 12 toddlers.

Keep in mind that infants and young toddlers do better in smaller groups.

Health and Sanitation Practices

Ask whether the program requires children and staff to have standard vaccinations and regular checkups.

Is the staff prohibited from smoking inside and outside the building?

What happens if your baby becomes ill during the day?

Are parents notified when a child or staff member contracts a communicable disease such as chickenpox?

When should you keep your sick child home?

How are medications and first aid administered?

How often are a baby's diapers changed?

Are diapering areas and toys cleaned and sanitized on a regular basis?

Do staff members regularly wash their hands?

How are babies put to sleep?

How regularly is bedding cleaned?

Safety and Security

Ask what kind of security system the facility has to ensure that strangers don't enter the building.

What happens if a child becomes injured or lost?

Are outdoor play areas secured?

Do outdoor play areas have sturdy structures and safe surfaces?

What kind of security measures are taken during field trips?

How are children transported?

What is the program's emergency evacuation plan?

How are other emergencies handled?

Daily activities

Ask what your child's daily routine would be like.

Is there a mix of group play and individual attention?

Is there a balance between physical activity and quiet time?

Is there time for free play?

Are there activities appropriate for different age levels?

Do care providers read to the children?

Are meals and snacks provided?

If so, what kinds?

What are the program's overall goals?

Is parental involvement expected or encouraged?

Additional Details

What is the program's admissions policy?

What kind of information will you need to provide?

If the program has a waiting list, how long is it and how does it work?

What are the program's hours of operation and cost?

Can you pay in installments?

Will you need to pay if your child is absent for a vacation?

What is the policy for withdrawing a child from the program?

How are parents notified of weather cancellations?

Do parents need to provide any supplies?

Can you drop in and visit your child during the day?

Preschool

Some preschools begin enrollment at two years, while others require children to be at least three.

Think about whether this is something that might be a good fit for your child.

This will depend on your child's personality and needs, as well as the resources in your community.

At this age, preschool curriculums are almost entirely play-based.

But ideally, preschool teachers encourage expanded thinking and language skills

through frequent conversation with your child, reading, and use of new words to expand vocabulary.

Contact information

Whenever you leave your child with a childcare provider or a sitter,

make sure you've provided a list of important contact information,

including your phone number and how to reach you at all times.

Also, provide the phone numbers of any other close family members or friends who can be contacted in the event of a problem.

Explain what you want your child's care provider to do in the case of an emergency.

If you're leaving your child with a care provider in your home,

show the care provider the locations of all exits, the smoke detector, the fire extinguisher, and the poison control hotline number.

Make sure that anyone who provides care for your baby understands the importance of putting your baby to sleep on his or her back.

If the care provider will be driving your child anywhere, make sure he or she knows how to properly use car seats.

It's also a good idea to write down your address and your child's full name and birth date in the event of an accident.

The stress of an emergency may make it difficult for a childcare provider or sitter to remember those details.

Working Together

In the coming weeks, monitor the performance of the childcare provider you hire or the childcare providers at the center your child attends.

Pay close attention to your child, his or her adjustment, and the way he or she interacts with the care provider or providers.

Establishing a good relationship with your child's care provider benefits everyone involved.

You may worry that your child will come to love a care provider as much as your child loves you or more.

Remember, no one can replace you in your child's heart.

Showing your child's care provider warmth and courtesy will make him or her as well as your child comfortable.

This will also make it easier for you and your child's care provider to communicate.

Be sure to set aside a few extra minutes to discuss any relevant issues when you leave your child with a care provider and when you return.

If your child didn't sleep much the previous night, is teething, or has another issue that might affect his or her behavior that day, let your child care provider know.

If your child is taking any medications, explain what the medication is for, and provide written instructions detailing how it needs to be stored and administered, and what side effects might occur.

If there are certain activities you'd like your child's care provider to do with your child, or not do, such as watch TV, talk with the care provider.

When you return, you'll want to find out what happened with your child that day. How much did he or she drink and eat, and at what times?

How many diapers did he or she wet in soil? What activities did he or she do?

How many naps did he or she have, and how long were they?

Did your child achieve any new milestones, or display any behavior that's of concern?

Are any necessary baby supplies running low?

Going over these topics regularly will help ensure consistency in your child's care, and might help eliminate some confusion.

For instance, if you're unaware that your child skipped his or her afternoon snack, you might be bewildered when he or she has a total meltdown due to hunger just before dinner.

Some child care centers provide daily logs with this information. You can also ask your child's care provider to create a daily log for you.

Beyond going over your child's daily activities, make time occasionally to have longer talks about your child's changing needs and how to meet them.

This will also give you and your child's care provider a chance to discuss any other issues or concerns.

Be sure to listen to your child care provider's thoughts on each topic, and if possible, work together to come up with solutions.

If you're happy with your child's care, don't forget to mention it too. Showing appreciation for your child's caregiver can help strengthen your relationship.

Finding good child care can be a stressful process. By considering your family's needs at the outset and thoroughly researching your options, you'll save time and energy.

Carefully reviewing each candidate's background and evaluating different child care settings will help you feel more comfortable with your decision and ease your concerns about spending time apart from your child.

Care for children with special needs

If your child has a developmental disability or chronic illness, finding quality child care may require additional considerations.

The best programs encourage regular activities and also meet each child's special needs.

To find a child care program for your son or daughter, ask your child's medical provider or your state's Department of Health or Education.

Your child's provider can also help you determine what kind of care will best address your child's needs.

Look for a program that meets the basic requirements you'll want in a child care program. In addition, look for Specialized Staffing and Equipment.

Has the program staff been trained to meet your child's specific needs and recognize when your child might need medical attention?

Does the program have a medical consultant who is involved in the program's development?

What kind of specialized equipment does the program provide? And is it in working condition?

Has the staff been trained to use it?

Does the program tailor emergency plans to the needs of its children?

Confidence-building activities

What kinds of activities will your child be able to participate in?

Does the program include children who don't have special needs?

Programs that care for children who have different levels of ability can help encourage social confidence and sensitivity.

Handling the separation

Babies up to age 7 months often adjust well to being taken care of by a new child care provider.

Older babies and toddlers, however, might have a harder time with the transition.

Between ages 7 and 12 months, babies begin to develop stranger anxiety.

They might need extra time and help getting used to a new child care provider and setting.

If possible, arrange for an in-home care provider to spend time with your child while you're at home.

Or take your child to visit the Family Child Care Center or Child Care Center before he or she begins attending it.

Stay nearby while your child plays and steadily increase the length of your visits.

When you begin dropping your child off at the program, create a goodbye ritual and let him or her bring a reminder of home,

such as a stuffed animal or picture of you, to the program.

Always say goodbye to your child before leaving.

If your child shows persistent fear about being left alone with a caregiver, talk to your child's care provider.

Separation is sometimes harder for the parents than the child.

Checking in regularly with your child care provider to see how your child is doing might help reassure you.

The care provider may be able to send you pictures and updates throughout the day.

Talk to friends and family who've been through it before.

Sick care

When your child becomes ill and you need backup care, you might have options beyond staying home to care for him or her.

Some child care centers or family child care programs offer care for sick children in a segregated area.

Your community also might have child care centers or family child care programs that specialize in providing care only for sick children.

Some employers also provide sick care for their employees' children.

Investigate your options before your child becomes ill.

When looking for this type of care, ask about how much individual care your child will receive, how the facility and equipment are cleaned,

and whether the facility has a medical provider on call.

Chapter 16 Traveling with a Little One

Whether you're bringing your baby home from the hospital, taking your child for a stroll around the block, or going on your first family flight together,

you and your child are likely to do some traveling in the months and years ahead.

As you might have guessed, traveling anywhere with a child takes some planning.

Your child may never have a leaky diaper, spit up all over, or stray from mealtime when you're at home, but it always seems to happen when you're out and about.

Add in toilet training days and you're bound to need supplies on the go.

It's a good idea to be prepared for anything when you're traveling with your child.

In addition to knowing what to bring with you to meet your child's needs while you're away from home,

you'll have to figure out which modes of transportation work best and how to use them safely.

You probably have more options than you might realize.

Before you hit the road, find out what you need to know about traveling with a baby or a toddler, and then have fun.

Heading out

You and your baby are both likely to benefit from getting out of your home.

While you may feel nervous at first about leaving the comfort of your home as you learn to care for your baby,

fresh air and a change of scenery may lift your spirits.

Taking small trips to uncrowded places with your baby now will also help you gain confidence and help you prepare for bigger adventures later on.

But at the same time, if you've been up all night with your baby, your baby is having a fussy day,

you can't face figuring out how to work the stroller yet, or you're just plain tired,

that outing you planned can always wait until tomorrow.

There's no gold medal for the new parent who gets out of the house first.

Take your time and head out with your baby when you feel ready.

To help ensure a successful outing, consider the following tips.

Limit contact

When you first take your newborn out, consider avoiding places where he or she will come into close contact with a lot of people and, as a result, germs.

Or head to a destination when it's least likely to be crowded.

Dress for the weather

Young babies have trouble regulating their body temperatures when exposed to extreme heat or cold.

As a rule, dress your baby in one more layer than you're wearing.

Infants should wear hats when it's cold because they can lose a large amount of heat from their exposed heads.

If you're unsure about your baby's temperature, check his or her hands, feet, and the skin on the chest while you're out.

Your baby's chest should feel warm while the hands and feet should feel slightly cooler than the body.

If your baby feels cold, remove the outer clothing layer and hold him or her close to your body.

Feeding your baby something warm also might help.

Dressing your baby in layers and bringing extra layers will help you adapt if the weather changes.

See Chapter 8 for more on clothing your child.

Provide sun protection

Babies have sensitive skin.

If your baby is younger than six months, avoid exposing him or her to direct sunlight for long periods of time.

Protect your child from sun exposure by dressing him or her in lightweight, light-colored protective clothing and a hat with a brim.

Apply sunscreen on exposed areas of your child's skin, remembering to reapply as needed.

Keep child equipment cool.

Avoid letting your child's car seat or stroller sit uncovered in the sun for long periods of time before using them.

Plastic and metal parts may become hot enough to burn your child or yourself.

Be prepared.

Take along diaper supplies, a change of clothes for your child and maybe even yourself, and food for your baby just in case.

Bring a water bottle for yourself and for a child old enough to drink water, especially in warm weather.

If you're nervous, ask a family member or friend to go with you on your first few outings.

As your child gets older, a favorite toy or book in the diaper bag often comes in handy.

Baby Carriers

One of the most convenient and intimate ways to carry your baby around is in a baby carrier.

These carriers can be used around the house, on a hike, or about town.

If you're considering purchasing a baby carrier, you've got options, including backpack or front pack.

This device allows you to carry your baby in an upright position on your back or against your chest.

Baby Sling

This is a baby carrier made of soft fabric that you wrap around your body, often over your shoulders or around your torso.

Choosing a Baby Carrier

Not all baby carriers are created equal. Some carriers aren't appropriate for certain babies. Others are quickly outgrown.

When looking for a carrier, find the appropriate size for your baby.

The carrier's leg holes should be small enough so that your baby can't fall through them.

Some carriers can be adjusted to fit as your child gets older.

Check the weight minimum and maximum.

Different models have different weight limits.

Keep in mind that some models aren't appropriate for newborns. Also consider how long you'd like to use it.

Look at the construction.

Will the carrier provide adequate support for your baby's head and neck? Is the material sturdy?

If you're looking for a hiking backpack with an aluminum frame, is it padded to protect your baby if he or she bumps against it?

Try it out.

Is the carrier comfortable for you and your baby?

If you plan to use the carrier for a while, consider how the straps will feel when your baby grows, gains weight, and becomes more restless.

Baby Carrier Risks

When used incorrectly, a baby sling can pose a suffocation hazard to an infant younger than four months.

Babies have weak neck muscles and can't control their heads during the first few months after birth.

If the fabric of the baby sling presses against the baby's nose and mouth, he or she may not be able to breathe.

This can quickly lead to suffocation.

In addition, a baby sling can keep a baby in a curled position, bending the chin to the chest.

This position can restrict the baby's airways and limit his or her oxygen supply.

In turn, this can prevent a baby from being able to cry for help.

If your baby was born prematurely or has respiratory problems, don't use an upright positioning device until you talk to your baby's medical provider.

Safety Tips

When using any baby carrier, take the following precautions.

Be careful when bending.

Bend at the knees rather than at the waist when picking something up.

This will help keep your baby settled securely in the carrier and protect your back.

Keep Up with Maintenance

Keep an eye out for wear and tear.

Repair any rips or tears in the carrier's seams and fasteners.

Also, check the Consumer Product Safety Commission's website to make sure the carrier hasn't been recalled.

Keep Your Baby's Airway Clear

If you use a baby sling, make sure your baby's face isn't covered by the sling and is visible to you at all times.

Check your baby frequently to make sure he or she is in a safe position.

If you breastfeed your baby in a baby sling, make sure you change your baby's position afterward so his or her head is facing up and is clear of the baby's sling and your body.

Shopping Cart Safety

Grocery shopping with a baby or toddler can be an adventure, to say the least.

While your baby is young, it may be less stressful to shop online.

But a quick run on the way home from work and childcare is bound to happen.

Be sure to take proper precautions with shopping carts.

They can easily tip over when a child is in the shopping cart seat or basket.

A child could also fall out of the shopping cart seat if he or she isn't properly buckled in.

If possible, look for an alternative to placing your child in the shopping cart.

Avoid placing an infant carrier on top of the cart.

Consider using a front-pack carrier instead.

If you must place your child in the cart, make sure he or she is buckled into the seat.

Look for carts that have kid seats closer to the ground, such as the model car carts.

Don't allow your child to ride in the basket or ride on the outside of the cart.

Strollers

If you're like most parents, you'll want to get at least one stroller for your child.

But what's the best stroller for your baby, family and lifestyle?

When looking for a stroller for your baby, consider the following.

Where and how will you use it?

If you live in or near a city, you'll need to be able to maneuver your stroller along crowded sidewalks and down narrow store aisles.

You might also need to be able to collapse your stroller in a pinch to get on a bus or downstairs to the subway.

Suburban parents, on the other hand, might want to look for a stroller that fits into their car trunks.

If you have twins or an older child, you might consider getting a double stroller

or a stroller with an attachment that allows your older child to stand or sit in the rear.

Frequent travelers might also want a collapsible umbrella stroller, either in addition to or as the primary stroller.

Plan to take your baby along on your runs? You might look for a jogging stroller too.

Is it appropriate for a newborn?

If you plan to use a stroller while your baby is a newborn, you'll need to make sure that the stroller offers enough of a recline.

Since newborns can't sit up and hold up their heads, some strollers fully recline or come with bassinet attachments.

Strollers that can be used in combination with an infant-only car seat are also a good choice.

However, most umbrella strollers typically don't provide adequate head and back support for young babies.

In addition, most jogging strollers aren't appropriate for a baby until age 5 or 6 months.

Do you need a travel system?

If so, you might look for a stroller that can hold your baby's car seat.

Some car seats and strollers come in matching sets, while others require you to buy separate attachments

that allow the strollers to be used with certain car seats.

Once you strap your baby into his or her car seat, these kinds of strollers will allow you to easily move your baby between the stroller and the car.

This type of stroller can also be helpful in an airport if you plan to take your baby's car seat on the plane.

What kinds of accessories are available?

You might consider whether you'll want features or accessories for your stroller,

such as a basket, a rain cover, a stroller blanket, a sunshade or parasol, or a cup holder.

Some accessories aren't available for certain strollers.

Other features.

Strollers with wide bases are less likely to tip over.

Look for a stroller with practical brakes that you can lock easily when a stroller is stationary.

Avoid strollers with hinges or latches that might readily pinch or damage a child's fingers.

Always read the stroller manufacturer's weight guidelines,

especially when looking for a stroller with an area for an older child to sit or stand.

Safety Tips

Once you find the right stroller, follow these safety tips,

and remember to never leave your child unattended in his or her stroller.

Take caution when folding.

Always make sure the stroller is locked open before you put your child in it.

Buckle Up

Always buckle your child's safety harness when taking him or her for a stroller ride.

Make sure your child can't unfasten the safety harness or slide out from underneath it.

Most stroller-related injuries occur when a child falls out of the stroller.

Be careful with toys.

If you hang toys from a stroller bumper bar to keep your baby entertained,

make sure that the toys are securely fastened.

Properly Store Belongings

Don't hang a bag from the stroller's handlebar, which can make a stroller tip over.

Place items in the stroller basket.

Car Seats

Whenever you travel by car with your baby, a car seat is a must.

Not only are car seats required by law in every state,

but they're essential for your child's safety.

Traveling with your baby in your lap could put him or her at risk of serious injury in case of an accident.

The best time to get a car seat for your baby is during your pregnancy.

So you'll be able to install the car seat in your car,

which might be a more complicated process than you realize,

and have it ready for your baby's trip home from the hospital.

A Good Fit

When choosing a car seat, you'll have lots of options.

Don't assume that the pricier models are best.

Instead, look for a car seat that will keep your baby safe and best serve your family's needs.

Keep these important points in mind.

Maintain the right fit.

Make sure the car seat fits your child's current size and age.

Also make sure the car seat fits your vehicle.

You'll want the car seat installed and used correctly every time.

Follow Height and Weight Limits.

Carefully adhere to your car seat manufacturer's guidelines on height and weight limits.

Follow your vehicle's owner manual on installing the car seat using the seat belt

or lower anchors in a tether if available.

Maximize Safety

The American Academy of Pediatrics, AAP, and National Highway Traffic Safety Administration,

N-H-T-S-A, recommend that all infants and toddlers ride in a rear-facing car seat as long as possible,

until they've reached the maximum height or weight limit allowed by the specific car seat manufacturer.

In a car crash, a rear-facing seat helps cradle and protect your child's delicate neck and spinal cord.

Once your child outgrows the rear-facing limits, switch him or her to a forward-facing car seat

with a harness for as long as possible, up to the manufacturer's allowed height and weight limits.

Types of Car Seats

Several types of car seats can accommodate the needs of babies and toddlers.

Infant-Only Car Seat

An infant-only car seat is made specifically for newborns and small babies.

It comes with a five-point harness and can only be used in the rear-facing position.

It typically has a handle and can be snapped in and out of a base in your car.

This allows you to carry the car seat with you wherever you go.

Just lock the car seat in place when in the car.

Some models also snap into a stroller base.

When your baby reaches the maximum weight or height allowed for in an infant-only car seat,

you'll need to move your child to a rear-facing convertible or all-in-one car seat.

Convertible Car Seat

A convertible seat can be used rear-facing or forward-facing

and typically has a higher rear-facing weight and height limit than an infant-only seat.

This type of car seat also has a five-point harness.

When your child reaches the rear-facing weight or height limit

recommended by the manufacturer of the convertible seat,

you can begin to face the seat forward, all-in-one car seat.

This seat can be used rear-facing, forward-facing, or as a booster seat.

As such, you can use it through preschool and beyond.

Just be sure not to switch positions too early

before your child has reached the maximum height and weight limits.

Other Considerations

If you have two cars, you might consider buying two car seats

or for an infant-only car seat.

Two Bases

Otherwise, be sure to always move the car seat to the car in which your child will be traveling.

Also, look for a model with a cover that's easy to clean

in case your child spits up, vomits, or spills food in the car seat at some point.

No matter what kind of car seat you choose,

make sure the label says that it meets all federal safety standards.

Register your car seat online

or by filling out the manufacturer's product registration card

so that you can be notified of any recalls.

Used Car Seats

If you're considering borrowing or buying a used car seat,

make sure the car seat is safe.

Look for a car seat that comes with instructions

and a label showing the manufacturer date and model number.

Hasn't been recalled.

Is it expired or more than six years old?

The expiration date is usually stamped in the plastic on the bottom of the seat.

Has no visible damage or missing parts?

Has never been in a moderate or severe crash?

If you don't know the car seat's history, don't use it.

If the car seat has been recalled,

be sure to find and follow instructions for how to fix it

or get the necessary new parts.

Safe Car Seat Use

Choosing the correct car seat is important,

but it's equally important to install and use car seats appropriately.

Here are some tips to getting it right.

Back seat is best.

The safest place for your child's car seat is the back seat,

away from active airbags.

If the car seat is placed in the front seat and an airbag inflates,

it could hit the back of a rear-facing car seat right where your child's head is

and cause a serious or fatal injury.

A child who rides in a forward-facing car seat could also be harmed by an airbag.

If it's necessary for a child to travel in a vehicle with only one row of seats,

deactivate the front airbags

or have a power switch installed to prevent airbag deployment during a crash.

Otherwise, airbag power switches should only be used if your child has certain health problems

and his or her medical provider recommends it.

If you're placing only one car seat in the back seat,

install it in the center of the seat if possible,

rather than next to a door to minimize the risk of injury in case of a crash.

Installing and Buckling

Properly installing a car seat and correctly buckling your child into it

before the start of every car ride is crucial.

Before you install the car seat,

read the manufacturer's instructions and the section on car seats in your vehicle's owner manual.

Make sure the seat is tightly secured,

allowing no more than one inch of movement from side to side or front to back

when grasped at the bottom near the attachment points

and facing the correct direction.

Rear Facing

If you're using an infant-only seat or a convertible seat in the rear-facing position,

keep these tips in mind.

Use the harness slots described in the car seat's instruction manual.

Usually those at or below the child's shoulders.

Place the harness straps over your child's shoulders.

Buckle the harness straps and chest clip with the chest clip even with your child's armpits.

Make sure the straps and clip lie flat against your child's chest

and over his or her hips with no slack.

Most car seats include head positioning accessories to prevent slouching.

In the rear-facing position,

recline the car seat based on the manufacturer's instructions

so that your child's head doesn't flop forward.

Babies must ride semi-reclined to keep their airways open.

Many seats include angle indicators or adjusters to guide you.

Keep in mind that as your child grows, you might need to adjust the angle.

Forward Facing

Resist the urge to place your child's car seat in the forward-facing position

just so that you can see his or her face in your rear-view mirror.

Although it's natural to want to interact with your child during a trip,

remember that your child's safety is of ultimate importance.

Riding rear-facing is recommended until a child reaches the highest weight or height

allowed by the car seat manufacturer.

When your child reaches the weight or height limit of the convertible seat,

you can face the seat forward.

When you make the switch,

install the car seat in the back seat according to the manufacturer's instructions.

Using either the seat belt or lower anchors and tethers for children.

Latch System

Use the tether strap, a strap that hooks to the top of the seat

and attaches to an anchor in the vehicle for extra stability.

Adjust the harness straps so that they're at or above your child's shoulders and fit snugly.

After you install the car seat, consider having a certified child passenger safety technician

check your handiwork at a local car seat clinic or inspection event.

Before each trip you take, check that the car seat is installed tightly.

The NHTSA's website is an excellent source for helping choosing an appropriate car seat.

It also provides information on finding a car seat inspection station

and other car seat safety information, including video demonstrations.

Remove Heavy Outerwear

Bulkie coats and blankets can prevent harness straps from snugly securing your child.

Buckle the harness, then place a coat or blanket over the harness to keep your child warm.

Stay Together

Remember, never leave a child alone in a car.

Children can quickly become overheated, cold or frightened.

Even though it might be hard to imagine forgetting your child and leaving him or her in the back of the car, it can happen.

To remind yourself of your precious cargo, place your cell phone or bag in the back

whenever your child rides in the car with you so that you'll have an extra reason to check the back seat before leaving the car.

Be a Force of Nature

As your child gets older, he or she may protest riding in a car seat.

Don't be afraid to draw the line when it comes to your child's safety.

Help your child understand that riding in a car seat is non-negotiable

and that even grown-ups must wear seat belts to stay safe.

To keep your child entertained during travel, bring a favorite toy or book along.

You can also talk, play music or sing songs together.

Premies and Small Babies

If your baby is born prematurely or at a low birth weight, he or she might need to be monitored while sitting in a car seat before being discharged from the hospital.

This is because sitting semi-reclined in a car seat can increase the risk of breathing problems or a slow heartbeat.

To make sure your baby is safe in a car seat, you'll need to bring your baby's car seat to the hospital prior to discharge.

Your baby will be placed in the seat and have his or her vital signs recorded for a certain period of time.

If your baby has a health problem that requires him or her to lie flat, a vehicle bed may be recommended.

Look for a vehicle bed that's been crash tested. Position the bed lengthwise in the back seat so that your baby's head will be in the center of the car.

Always use the buckle and harness to secure your baby in the bed.

When you have the OK to use a car seat, you may need an infant-only car seat to accommodate your small baby.

Use it only during travel and don't let your child sleep in it outside of the car.

If your baby needs to travel with devices such as an oxygen tank, secure them in the vehicle so that they don't become flying objects in case of a sudden stop or accident.

Is your car seat too old?

Yes, car seats do expire typically after six years.

The expiration date is usually stamped in the plastic on the bottom of the seat.

With time, pieces of the car seat may become worn, jeopardizing the seat's ability to keep your baby safe in a crash.

As technology improves, safety recommendations may also change, but for now, the six-year timeframe does matter.

Sleeping in a car seat

A car seat is designed to protect your child during travel. It's not for use as a replacement crib in your home.

Limited research suggests that sitting upright in a car seat might compress a newborn's chest and lead to lower oxygen levels.

Even mild airway obstruction can impair a child's development.

Sitting or sleeping in a car seat for lengthy periods can also contribute to the development of a flat spot on the back of your baby's head

and worsen reflux, a condition that causes a baby to spit up.

In addition, a child can easily be injured by falling out of an improperly used car seat

or while sitting in a car seat that falls from an elevated surface, such as a table or counter.

While it's essential that your child be in a car seat during car travel,

don't let your child sleep or relax in the car seat for long periods of time out of the car.

Rentals, Taxis, Trains and More

Follow the same car safety rules, whether you're traveling in your own car, a rental car, a rideshare, taxi, train, or any other vehicle.

Plan to bring your baby's car seat with you on any trip in which you might be riding in a vehicle or renting a car from a rental car company.

If you're using an infant-only car seat that has a base, determine if you're going to bring the base with you.

If not, make sure you know how to install the car seat in a vehicle without the base.

Air travel

Your first flight with your child will likely be a lot different from your previous flights.

Instead of worrying about whether you have enough reading material, you may now be worried about entertaining your baby or toddler.

While there's no telling how your baby will react to his or her first time on an airplane,

careful planning can go a long way toward calming you and your child's nerves.

Identification

For domestic travel, consider bringing a copy of your child's birth certificate with you.

If leaving the country, your child will need a passport.

If you know you'll be traveling outside of the country with your child in the future, consider applying as soon as possible.

The application process can typically be expedited for a fee.

Seat Safety

Although airlines typically allow infants to ride on a caregiver's lap during flight,

the Federal Aviation Administration recommends that infants ride in properly secured safety seats.

Most infant car seats are certified for air travel.

In order for your little one to travel in a car seat on the plane, your child will need his or her own seat.

Though airlines typically will let you use an empty seat if available, the only way to guarantee a seat for your child is to purchase a ticket.

When booking your flights, check if there are any discounts for infant children.

Keep in mind that car seats must be secured in a window seat so other passengers will be able to exit the row.

If you don't bring a car seat for your child on the plane, ask the flight attendant for instructions on how to hold your child during takeoff and landing.

If you sit in an aisle seat with your child, be sure to protect your child's head, hands, and feet from getting bumped by service carts or other passengers.

Many traveling families seek out the bulkhead of the plane, which offers extra space.

Others prefer the back of the plane, which is typically noisy enough to drown out crying and may even lull a baby to sleep.

Do what makes the most sense to you.

Getting through the airport

If you plan to bring a car seat on the plane, a stroller that allows you to attach the car seat to it is a smart investment.

You'll be able to wheel your child and his or her car seat until you board the plane,

at which point you can collapse the stroller base and check it at the gate.

You will, however, have to take your child out of a car seat and carry him or her through security while the stroller is screened.

While the Transportation Security Administration limits the amount of fluids you can bring on a plane,

exceptions are made for baby-related items, such as medications, formula, baby food, and breast milk.

Be sure to notify security officials about what you're carrying and expect it to be inspected.

Also, let security officials know if your child is using or has any special medical devices.

Boarding

Many airlines offer families priority boarding.

However, some families prefer to board last to minimize the amount of time spent on the plane.

Keeping Baby Happy

Dress your child in comfortable, easy-to-remove layers.

This will help you keep him or her warm or cool enough and make diaper and clothing changes easy.

Nursing or sucking on a pacifier or bottle might ease discomfort during takeoff and landing,

since babies can't intentionally pop their ears by swallowing or yawning to relieve ear pain caused by air pressure changes.

A sippy cup of water can help a toddler with the same issue.

If your child is restless, consider taking an occasional break to walk up and down the aisle,

as long as the crew approves moving throughout the cabin.

Although parents often joke about giving a child a sedating over-the-counter medication to induce sleep during the flight,

this isn't recommended.

In some cases, the medication could end up producing the opposite effect and make your child agitated.

If your child does cry during the flight, do your best to figure out what's wrong, just as you would at home, and try to stay calm.

Chances are that many passengers on the plane have been in your situation before and likely sympathize.

Is it safe for your baby to fly?

Generally, age doesn't affect an infant's ability to handle air travel.

While it's always a good idea to avoid enclosed, crowded spaces when you have a newborn,

most healthy term babies are okay to fly at age one week to two weeks.

If your baby was born prematurely or has a history of lung disease, however,

talk to your baby's medical provider before flying with your baby.

Because your baby's lungs might be sensitive to the effects of the changes in altitude,

the provider might recommend postponing air travel until later.

If your baby has an underlying respiratory condition, his or her provider might recommend supplemental oxygen.

Ear infections in ear tubes aren't thought to pose problems during air travel.

However, if your baby is ill, you might want to consider postponing the flight.

Plan for success.

Taking your child on a trip, particularly those involving flights, overnight stays, and different time zones,

requires some planning ahead.

When you schedule your trip, think about your child's normal routine and what you can do during your travels

to accommodate his or her daily needs.

Minding your child's internal clock.

If your child is an early riser, consider booking an early morning flight

and scheduling morning activities during your trip.

Think about what times your child typically naps and eats

and how you'll be able to keep his or her schedule intact while away.

Keep in mind that if you cross time zones during your trip,

it might take your child a few days to adjust to new sleeping and eating schedules.

Gathering Essentials

If your child is still in diapers, start by packing your diaper bag

because you'll need it with you at all times.

Fill it with diapers, wipes, diaper ointment, and a changing pad.

If you feed your baby with a bottle, make sure you have bottles, nipples, and formula,

or properly stored breast milk.

Bring enough to cover your travel time and well beyond, just in case you encounter delays.

With your breastfeeding, a blanket or nursing cover might come in handy.

If your baby uses a pacifier, bring at least one.

Bring all medications on board with you.

For older toddlers, bring easy snacks and a sippy cup that you can fill with water,

small toys, books, crayons, and paper.

Or a tablet loaded with a few select games or videos

can help you entertain your child while at the airport and on board.

It's always smart to pack an extra change of clothes, or two,

for your baby and yourself in your carry-on, just in case.

You might also bring hand sanitizer and disposable bags for dirty clothes.

For your stay

When packing your child's clothes for the trip, think about the weather you're likely to encounter,

how many outfit changes your child typically needs in a day,

and whether you'll have access to a washer and dryer.

You might bring along a few familiar items, such as small toys, books, or a white noise machine,

to help your child feel comfortable in the new environment.

If you'll be staying at a hotel, call ahead and see if you can reserve a crib for your room.

Otherwise, you'll need to bring a collapsible crib with you,

or arrange to rent or borrow one during your stay.

In addition to the bottle supplies you bring with you on the plane,

consider what kind of sterilizing or pumping equipment you might need to bring for the rest of your trip.

Traveling with a little one takes some thought, and often a lot of luggage.

Think about what your child might need, and do your best to prepare for the worst.

And don't forget to enjoy your trip.

Chapter 17 - Home and Outdoor Safety

As your baby becomes more mobile, exploration will become the name of the game.

Rocking, rolling, and sitting will give way to crawling, climbing, and cruising along the furniture.

And then walking and running.

Your child's budding curiosity and inexperience, however, can prove to be a dangerous mix.

Power cords, dresser drawers, kitchen cabinets, dish soap, and the toilet are just a few household items

that your child might touch, grab, or try to climb onto in the coming months.

Small toys, hot drinks, slippery surfaces, and furniture with sharp edges

also can pose hazards for your little explorer.

While trying to prevent injuries, you can take lots of steps to safeguard your home

and keep your child safe outdoors.

To get started child-proofing your home, consider your family's lifestyle and the layout of your home.

Think about which rooms your child will spend time in and what dangers each room poses.

Sit on the floor in each room to get an idea of what might catch your child's attention

or be within your child's reach.

If you don't child-proof every room in your home, you'll need to take extra vigilance

to keep your child away from those areas.

As your child gets older, reassess each room and your child-proofing measures

to make sure they still meet your needs.

Nursery Safety

Your son or daughter will spend a lot of time in the nursery

to help keep him or her safe while in the room.

Here are some helpful tips.

Use safety straps.

Always use the safety strap on your baby's changing table

and never leave a baby alone on the changing table.

Even at young ages, babies can move suddenly and flip over the edge of a high surface.

Look for a changing table with a guardrail

and keep diapering supplies within your reach but beyond your child's reach.

Safely Store Disposable Diapers

If you use disposable diapers, keep them out of your child's reach

and cover them with clothing when he or she is wearing them.

A child can suffocate if he or she tears off pieces of the plastic liner and eats them.

Avoid Powders

Powders such as talcum powder or cornstarch contain fine particles

that can damage your child's lungs if they're inhaled.

Take Crib Precautions

It's important to keep your baby's crib free of loose items,

especially during the first year or at least until your baby can move easily around the crib.

This helps avoid a risk of suffocation.

Put your baby to sleep on his or her back on a firm mattress

and not on a soft comforter or pillow.

Don't allow your baby to sleep with loose blankets.

Watch Toy Box Lids

If you use a toy box, look for one with no top, a lightweight lid, or sliding doors or panels.

If you have a toy box with a hinged lid, make sure it has lid support for any angle to which it's opened.

In addition, look for a toy box with ventilation holes in case your child gets trapped inside it.

Don't block ventilation holes by storing the toy box against the wall.

Rounded edges are also a plus.

Kitchen Safety

The kitchen is often the center of the home.

Most parents spend a good amount of time there, and it can be a fun place to do activities with your child.

Kitchen also can pose a number of hazards.

Take these steps to prevent accidents.

Find a safe spot for your child.

When you need to spend time in the kitchen, consider placing your baby in a high chair with a few toys on the tray.

For a toddler, fill a low kitchen cabinet with safe items to play with, such as plastic bowls and cups.

You might place your child in a playpin in an adjoining room, or you can see him or her.

Reduce Water Temperature

Set the thermostat on your water heater to below 120 degrees Fahrenheit.

If you bathe your baby in the kitchen sink, never run the dishwasher at the same time,

in case hot water from the dishwasher backs up into the sink.

Don't run the faucet while your baby is in the sink.

Safely store hazardous items.

Keep sharp instruments in a drawer with a latch or a locked cabinet.

Make sure appliances are unplugged and out of your child's reach.

Don't allow electrical cords to dangle where your child could tug on them.

Keep hazardous substances out of sight, out of reach, and whenever possible,

in a high cabinet that locks automatically every time you close it.

Hazardous substances in the kitchen might include dishwasher soap, cleaning products, vitamins, and alcohol.

Avoid Hot Spills

Don't cook, drink, or carry hot beverages or soup while holding a child.

Know where your child is when you're walking with a hot liquid so that you don't trip over him or her.

Keep hot foods and liquids away from table and counter edges.

Don't use tablecloths, placemats, or runners, which young children can pull down.

When you're using the stove, use the back burners and turn the handles of your pots and pans inward.

Don't leave food cooking on the stove unattended.

Safeguard your oven.

Try to block access to the oven.

Place tape on the floor around the oven and call it a "no kid zone."

Never leave the oven door open.

If you have a gas stove, turn each dial to the off position, and if possible, remove the dials when you're not cooking.

Otherwise, use knob covers.

Look around.

Watch out for other situations that could be hazardous.

Put away small refrigerator magnets.

A young child could choke on or swallow them.

Address slippery or uneven surfaces and clean spills quickly.

Keep a fire extinguisher handy.

Feeding safety.

Feeding your child is often a messy experience, but you don't want it to be a dangerous one.

If you use a high chair during feedings, always use the chair's safety straps to buckle your child in.

And before you feed your child, always check the temperature of the food.

Never warm your baby's formula or milk in the microwave.

Food or liquids warmed in a microwave may heat unevenly.

For more information about feeding your child, see chapters 3 and 4.

Choking prevention.

Choking is a common cause of injury and death among young children, primarily because their small airways are easily affected.

It takes time to master the ability to chew and swallow food, and babies and even toddlers may not be able to cough forcefully enough to dislodge an airway obstruction.

Sometimes, health conditions increase the risk of choking as well.

Children who have swallowing disorders, neuromuscular disorders, developmental delays, or a traumatic brain injury, for example,

have a higher risk of choking than do other children.

To prevent choking, don't introduce solids too soon.

Giving your baby solid foods before he or she has the motor skills to swallow them may lead to infant choking.

Wait until your baby is at least four months old, preferably six months old, to introduce pure-aged solid foods.

Stay away from high-risk foods.

Don't give babies or young children small, slippery foods, such as whole grapes and hot dogs,

dry foods that are hard to chew, such as popcorn and raw carrots,

or sticky or tough foods, such as peanut butter, marshmallows, and chunks of steak.

Supervised Mealtime

Don't allow your child to play, walk, run, or lie down while eating.

Keep in mind that as young children explore their environments, they also commonly put objects into their mouths, which can easily lead to choking.

Bathroom Safety

The easiest way to avoid bathroom injuries is to make sure your child can't access bathrooms in your home without an adult.

Consider these precautions around the bathroom.

Keep the bathroom door closed.

Bathrooms can be dangerous for many reasons.

The best way to avoid accidents is to keep young children out.

Install a safety latch or doorknob cover on the outside of the door.

Keep the toilet seat down after use.

It's also a good idea to install child-proof locks on toilet lids.

Reduce Water Temperature

Make sure that the thermostat on your water heater is set below 120 degrees Fahrenheit.

Don't run the faucet while your child is in the tub.

Instead, fill it and test the water temperature with your wrist or elbow before placing your child in the water.

Consider installing anti-scall devices on bathtub faucets and shower heads.

Supervise Bath Time

Never leave a child alone or in the care of another child in the bathtub.

A child can drown in just a few inches of water.

Drain water from the tub immediately after use.

Remember, infant bath seats or supporting rings aren't a substitute for adult supervision.

Safely Store Hazardous Objects and Substances

Make sure electrical appliances such as hairdryers are unplugged and out of your child's reach.

Don't allow electrical cords to dangle where your child could tug on them.

Keep substances in a cabinet that locks automatically every time you close it.

Hazardous substances in the bathroom might include nail polish remover, mouthwash, medications and bathroom cleaners.

Dispose of unused, unneeded or expired medicines.

Address Slippery Surfaces

Use a rubber pad or slip-resistant stickers in the bathtub to help prevent slipping.

Place a bath mat with a non-skid bottom on the bathroom floor.

Clean Spills Quickly

Garage and Basement Safety

Accidents and injuries can also happen in areas where kids don't spend a lot of time.

Don't forget to child-proof areas of the house, such as the garage and basement.

Safely Store Hazardous Objects and Substances

Keep them in a cabinet that locks automatically every time you close it.

Hazardous substances in the garage or basement might include cleaning products, windshield washer fluid, paint and paint thinner.

Always unplug and store tools after using them.

If you have an unused refrigerator or freezer, remove the door so that a child can't become trapped inside.

Don't allow your child to play near the garage.

It might be difficult for a driver to see a small child.

Automatic garage doors can pose a danger for children.

Always keep the garage opener out of reach.

Carefully Store Ladders

Put ladders away after each use and anything else that a young child could climb on.

Always store a ladder on its side.

Front Yard and Backyard Safety

To protect children from outdoor hazards, set boundaries.

If your backyard doesn't have a fence, make sure you keep your child within a safe area.

Don't let your child play unattended.

Check for dangerous plants.

If you're not sure about the plants in your yard, contact your Regional Poison Control Center for advice.

If you have poisonous plants in your yard, remove them.

Be cautious with pesticides and herbicides.

Wait at least 48 hours before allowing your child to play in an area that's been treated.

Keep Children Away from Power Mowers

Mowers may throw yard debris with enough force to injure a child.

Keep your child away when mowing.

Also, don't allow your child to ride on a riding mower.

Safeguard Grills and Firepits

Don't allow children to play near those potential hazards.

If you have a grill, screen it so your child can't touch it.

Make sure charcoal is cold before you dump it.

General Safety Tips

To reduce the risk of injury in other areas in and outside of your home,

consider the following suggestions.

Keep in mind that, especially as toddlers grow,

barriers aren't a replacement for adequate supervision.

Use Furniture Bumpers

Cover sharp furniture and fireplace corners with corner or edge bumpers

just in case your child falls.

Consider removing items with sharp edges from high traffic areas

while your child is learning to walk.

Secure Furniture

Pieces of furniture can tip over and crush a young child.

Injuries typically occur when a child tries to climb onto, falls against,

or uses the furniture to stand up.

Be sure to anchor TV stands, shelves, bookcases, dressers,

desks, chests, and ranges to the floor, or attach them to a wall.

Freestanding stoves or ranges can be installed with anti-tip devices.

Move floor lamps behind other furniture.

Use door knob covers, locks, and stops.

Door knob covers and door locks can help prevent your child from entering a room

where he or she might encounter hazards.

Look for a door knob cover that's sturdy but can be used easily by adults

in case of an emergency.

Make sure any locks you use on a door can be unlocked from the outside.

Consider temporarily removing swinging doors and folding doors

or keep your child away from them.

Keep hazardous objects out of reach.

Common household items that may pose a choking hazard include safety pins,

coins, pen or marker caps, buttons, small batteries, baby powder, and bottle tops.

Always safely store all potentially poisonous substances in a high locked cabinet.

Always keep products in the original containers,

which might contain important safety information.

Don't allow your child to play with plastic bags or to play around recycling bins.

Consider placing your trash can in a locked cabinet or getting a child-proof lock for it

in case you throw out potentially hazardous items.

Address outlets and electrical cords.

Insert plastic plugs.

Make sure they don't become choking hazards into electrical outlets or cover them with plates.

Keep electrical cords including cell phone chargers and other electronic cables

out of the way so that children don't chew on them or grab them.

Keep cords out of reach.

Keep electronic device, lamp and window blind cords secured and inaccessible,

especially near your baby's crib.

Safety tassels and inner cord stops for window blinds and draperies can help prevent strangulation.

When buying new window coverings, be sure to ask about safety features.

Watch out for liquid containers.

Keep your child away from fish tanks and coolers.

Empty buckets and other containers immediately after use.

Don't leave them outside where they may accumulate water and create a drowning hazard.

Avoid certain house plants.

Some plants, poinsettias, English ivy and peace lilies for example, can be hazardous to children.

Contact your regional poison control center for information and advice.

Safely store firearms.

If possible, don't keep firearms in your home or in an area where your child plays.

If you do keep firearms in your home, keep the unloaded gun and ammunition in separate locked cabinets.

Preventing burns.

Children get burned because they don't know certain objects may be hot.

To prevent burns, follow these burn safety tips.

Establish no zones.

Block access to the fireplace, fire pit or grill so a child can't get near it.

Use space heaters with care.

Make sure a child can't get near a space heater.

Also, keep the heater at least three feet away from bedding, drapes, furniture and other flammable materials.

Never leave a space heater on when you go to sleep or place a space heater near someone who's sleeping.

Watch where you park.

If you park in direct sunlight, cover the car seat with a towel or blanket.

Before putting your child in the car seat, check the temperature of the seat and buckles.

Lock up matches and lighters.

Store matches, lighters and flammable liquids in a locked cabinet or drawer.

Choose a cool mist humidifier.

Steam vaporizers can burn a child.

Unplug irons.

Store items designed to get hot, such as clothing irons, blow dryers and hair dryers, unplugged and out of reach.

Practice fire safety.

Install smoke alarms on every level of your home and regularly maintain all alarms in your home.

Keep extinguishers near places where a fire might start.

Preventing Falls

There's plenty you can do to prevent falls.

Follow these simple tips.

Beware of heights.

Never leave a small child alone on a piece of furniture.

Always use the safety strap on strollers and other infant seats.

Don't allow a young child to play alone on a high porch, deck or balcony.

As your baby grows, provide safe places for him or her to climb.

Stairways are of particular interest to young kids.

Under your close supervision, teach your child how to safely go up and come back down the steps.

Install safety gates.

Block a child's access to stairs or doorways you don't want your child to use with safety gates.

Look for a safety gate that a child can't easily dislodge, but that adults will be able to easily open and close.

If you're putting a safety gate at the top of a staircase, attach it to the wall.

Avoid accordion gates with large openings, which can trap a child's neck, leg or other body part.

Lock windows and secure screens.

A young child may squeeze through a window opened as little as 5 inches.

Limit window openings to 4 inches or less.

Although all windows that open should have guards or screens, screens often aren't enough to keep a child inside.

Discourage young children from playing near windows and patio doors.

Don't place anything a child could climb on near a window.

When opening windows for ventilation, open windows from the top.

Use nightlights.

Consider using them in your child's bedroom, the bathroom and hallways to prevent falls at night.

Nightlights can be especially helpful for toddlers who are learning to use the toilet or dealing with nighttime fears.

Preventing drowning.

Swimming pools, hot tubs, ponds and other bodies of water are very dangerous to young children.

Buckets of water, toilets and fish tanks also can be hazardous if kids climb in head first and are unable to get back out.

Close supervision of a child around water is imperative.

Multiple layers of protection can help ensure water safety and prevent drowning.

If you have a pool or hot tub, consider these general safety tips.

Fence it in.

Surround your pool or hot tub with a fence that's at least 4 feet tall.

Make sure slatted fences and openings under fences have no gaps wider than 4 inches so kids can't squeeze through.

Install self-closing and self-latching gates with latches that are beyond a child's reach.

Make sure the gate opens away from the pool or spa.

Check the gate frequently to make sure it's in working order.

Install alarms.

If your house serves as part of your pool or hot tub enclosure, outfit any doors leading to the pool or hot tub area with an alarm.

Consider adding an underwater alarm that sounds when something hits the water.

Make sure you can hear the alarm inside the house.

Block pool and hot tub access.

If your house serves as part of your pool enclosure, use a power safety cover to block access when the pool isn't in use.

Always secure a cover on a hot tub when it isn't in use.

Sliding glass doors that need to be locked after each use aren't effective pool or hot tub barriers.

Remove above-ground pool steps or ladders or lock them behind a fence when the pool isn't in use.

In addition, empty inflatable pools after each use.

Use life preservers.

Young children should always wear life preservers when in a watercraft.

Don't use inflatable toys to keep your child afloat since they can deflate suddenly or your child might slip out of them.

Even if your child is wearing a life preserver, you always need to keep a hand 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 or around a pool, pond, or other body of water.

An adult, preferably one who knows cardiopulmonary resuscitation (CPR) should always provide supervision.

Don't use multi-task while watching 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 in case of an emergency.

Be cautious, not panicked.

It might seem as if everything in your home and yard poses a potential threat to your baby, but don't panic.

You can do plenty to child-proof your home in a single afternoon or evening.

As your baby gets older, continue to stay on the lookout for new hazards.

Go through your home from top to bottom every few months to make sure you're doing everything 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 at his or her grandparents' homes, you might consider asking them to do some child-proofing too.

The most important safeguard, though, is adult supervision.

Safe toys.

Babies and toddlers love to play with toys, but you want to make sure the toys around them don't pose any hazards.

Choose toys carefully.

Don't let your baby play with balloons, marbles, coins, toys that contain small parts, or other small items.

Balloons in particular pose a major choking hazard when uninflated and broken.

Avoid projectile toys, extremely loud toys, and toys with cords, long strings, and small magnets.

Remove plastic wrapping and stickers from new toys, and make sure any decorations or small parts, such as eyes, wheels, or buttons, are tightly fastened to the toy.

Regularly check your child's toys for small parts that could come loose, sharp edges, and mechanical parts that could trap a child's finger, hair, or clothes.

Safely store toys with small pieces.

If you have an older child, you likely have toys in your home with small pieces that your baby could easily choke on or swallow.

Gather up games and toys that have small parts, and do your best to keep them out of your baby's reach.

When your older child wants to play with these kinds of toys, make sure he or she plays with them in a designated area and picks up all the pieces afterward.

Take care with electronic toys.

Don't allow small children to play with toys that need to be plugged into electrical outlets.

Make sure battery covers are securely fastened.

If the toy contains a button battery, make sure your child cannot access the battery.

Avoid baby walkers.

A young child may fall out of the walker or fall down the stairs while using a walker.

The American Academy of Pediatrics has called for a ban on the manufacture and sale of baby walkers with wheels.

Avoiding lead poisoning.

Lead is a metal that's found in many places, including old homes, drinking water, and children's products, and it can be hard to detect.

Children are at especially high risk of lead exposure because they tend to put their hands and objects in their mouths, and their growing bodies readily absorb lead.

Even children who seem healthy might have high levels of lead in their bodies.

If you suspect that your home contains lead hazards, you can take simple measures to minimize your child's risk of exposure.

If you think your child has been exposed to lead, ask your child's medical provider about a blood test to check for lead.

Check your home.

Homes built before 1978 are most likely to contain lead.

Professional cleaning, proper paint stabilization techniques, and repairs done by a certified contractor can reduce lead exposure.

Before you buy a home, have it inspected for lead.

Keep out of potentially contaminated areas.

Don't allow your child near old windows, old porches, or areas with chipping or peeling paint.

If your home contains chipping or peeling paint, clean up chips immediately and cover peeling patches with duct tape or contact paper until the paint can be removed.

Filter your water.

Ion exchange filters, reverse osmosis filters, and distillation can effectively remove lead from water.

If you don't use a filter and live in an older home, run cold tap water for at least a minute before using it.

Use cold, flush tap water for cooking, drinking, or making baby formula.

Avoid certain products and toys.

Lead may be found in children's jewelry or products made of vinyl or plastic such as bibs, backpacks, car seats, and lunchboxes.

A child can absorb lead found in these products by mouthing or chewing on them, or can inhale lead if the product is burned, damaged, or deteriorating.

Avoid buying old toys or non-branded toys from discount shops or private vendors, unless you can be sure that the toys have been produced without lead or other harmful substances.

Don't give costume jewelry to young children.

Safety around pets.

To prevent your child from being bitten or injured, follow some basic animal precautions.

Never leave your child alone with a pet.

Your child may inadvertently provoke an animal to bite him or her through rough housing, teasing, mistreatment, or just curiosity.

Teach appropriate behavior.

Don't allow your child to tease pets.

Never let your child pull on an animal's tail or take away its toys or food.

Don't let your child put his or her face close to a pet.

Get your pets vaccinated.

Make sure your pets are fully immunized, including against rabies.

Be cautious around new animals.

Don't allow your child to approach unfamiliar animals without permission and guidance from the pet owner.

Show your child how to greet animals.

For example, show your child how to let a dog sniff him or her, and then slowly extend his or her hand to pet the dog.

Think twice about petting zoos.

Young children are at higher risk of contracting an infection through contact with cattle, sheep, goats, and other domestic and wild animals.

If you choose to take your child to a petting zoo or other venue where animals might be present, be sure to wash your child's hands if they become dirty in an animal's area and after leaving the animal's area.

Chapter 18. Emergency care.

Every parent wants a healthy child, but occasionally accidents or injuries can happen.

Even parents who have plenty of experience with children can occasionally have a tough time distinguishing routine illnesses from more serious problems.

You can prepare for emergencies by asking your child's medical provider during a scheduled checkup what to do and where to go if your child needs emergency care.

It also is important to learn basic first aid, including CPR, and to keep emergency phone numbers handy.

When to seek emergency care.

Seek immediate care for bleeding that can't be stopped, poisoning, seizures, trouble breathing, severe head injury, unresponsiveness, a sudden lack of energy or an inability to move, large cuts or burns,

neck stiffness with fever, persistent crying or lethargy, persistent blood in the urine, bloody diarrhea,

or persistent diarrhea, skin or lips that look blue or gray.

In case of an emergency, call 911 or your local emergency care number immediately.

If it's not possible to call for emergency assistance, take your child to the nearest emergency facility.

In case of possible poisoning, call the Poison Help hotline at 800-222-1222 in the United States.

Have this number by your telephone. You can also use the online tool at www.poisonhelp.org.

Bleeding

You generally can judge the seriousness of bleeding by the rate of blood loss. Rapid blood loss from injured arteries is serious.

Slower bleeding, a steady trickle of dark red blood, generally comes from injuries to veins or the body's smaller blood vessels, capillaries.

Bleeding can be the result of a cut, puncture or abrasion.

How serious is it?

The rate of blood loss is a good indicator of the severity.

Remember, because babies have a much smaller volume of blood, they can't afford to lose as much blood as an older child or adult.

Serious injuries that result in bleeding from the arteries can cause death in minutes if untreated.

What you can do

If the bleeding is serious and it doesn't stop on its own, or if the cut or puncture is large or deep or has rough edges, apply pressure directly to the injury with a sterile gauze pad or clean cloth.

Keep pressure on the wound until the bleeding stops. In most cases, you can stop bleeding with direct, firm pressure to the wound.

Follow these steps.

Remain calm.

This can be difficult, but it's important.

Immediately apply steady, firm pressure to the wound with a sterile gauze pad, clean cloth or your hand until the bleeding stops.

Don't attempt to clean the wound first or remove any embedded objects.

When the bleeding stops, keep a bandage or cloth in place over the wound by taping, tying or wrapping it securely.

If blood seeps through the dressing, place more absorbent material over the first dressing.

If possible, elevate the wounded area.

If the bleeding continues, call 911 or your local emergency number.

If this is impossible, take your child immediately to the nearest emergency department.

In the meantime, maintain pressure on the wound and apply pressure to the nearest major artery above the wound.

Choking.

Most of the time when something blocks your child's throat, he or she will instinctively cough, gasp or gag until the object clears his or her windpipe.

Usually children will breathe on their own and you don't need to interfere.

But if your child cannot make sounds, stops breathing or turns blue, you must act immediately.

Babies and toddlers most commonly choke on small objects or foods that go down the wrong way.

Keep from a young child's reach anything that he or she can choke on, such as nuts, whole grapes, hot dogs and any small toy parts or objects that can obstruct a child's airway.

How serious is it?

When your child's airway is blocked and he or she cannot clear it, the situation is life-threatening.

The longer your child is deprived of oxygen, the greater the risk of permanent brain damage or death.

If you cannot clear the airway, call 911 or emergency medical help or ask someone else to call.

What you can do.

If your child is coughing, let him or her cough until the windpipe is clear.

If your child can't make sounds, stops breathing or turns blue, act immediately.

Look into your child's mouth.

If you can see something that's blocking the throat, carefully pinch and grab the object to remove the blockage.

If nothing is visible, don't stick your fingers into your child's throat.

You don't want to push the object farther back and have it become more deeply lodged in your child's airway.

For infants.

To clear the airway of a choking infant.

Number one.

Assume a seated position.

Hold the infant face down on your forearm, which is resting on your thigh.

Support the infant's head and neck with your hand and place the head lower than the trunk.

Number two.

Thump the infant gently but firmly five times on the middle of the back using the heel of your hand.

The combination of gravity and thumps to the back should release the blocking object.

Keep your fingers pointed up to avoid hitting the infant in the back of the head.

Number three.

If the previous steps don't work, hold the infant face up on your forearm with the head tilted downward.

Using two fingers placed at the center of the infant's breastbone, give five quick chest compressions.

Press down one and a half inches and let the chest rise in between each compression.

Number four.

If breathing doesn't resume, repeat the back blows and chest thrusts and call 911 or emergency medical help.

Number five.

Begin CPR.

If these techniques open the airway, but the infant doesn't resume breathing, call 911 or emergency medical help.

For toddlers, to help a child over age one who's choking.

Number one.

Stand or kneel behind your child.

Place one arm across your child's chest for support.

Bend your child over at the waist so that the upper body is parallel with the ground.

Deliver five back blows between the child's shoulder blades with the heel of your hand.

Number two.

Perform five abdominal thrusts, Heimlich maneuver.

Make a fist with one hand and position it slightly above your child's navel.

Grasp your fist with your other hand and press hard into your child's abdomen with a quick upward thrust as if trying to lift the child up.

Number three.

Do this until the blockage is dislodged.

If your baby or toddler becomes unconscious, lay your child down on his or her back and begin CPR or call 911 or emergency medical help.

If you're alone, attempt CPR for two minutes and then call 911.

If someone is with you, have that person call for help while you continue to administer CPR.

Continue doing CPR until your child starts coughing, crying or speaking.

If your child resumes breathing within a minute or two, he or she will most likely not experience any long-term effects.

After your child is breathing again, look for continued coughing or choking.

This may mean that something is still preventing him or her from breathing properly.

Call 911 or local emergency services.

Cardiopulmonary resuscitation, CPR.

Cardiopulmonary resuscitation, CPR, is most effective when delivered by a person who's trained in CPR.

It's a good idea for all parents and for anyone who provides childcare to take a certified course in an infant CPR.

You can contact your local American Red Cross or American Heart Association chapter to sign up for a course.

You may need to give a child CPR if he or she experiences the following.

Has no pulse or heartbeat.

Has blue lips or skin.

Has difficulty breathing or stops breathing entirely.

Is unresponsive.

The sooner you start CPR, the greater the chances of saving your child's life or avoiding permanent injury.

What you can do.

The procedure for giving CPR to a child is similar to the one used for adults.

Loudly call out the child's name and stroke or gently tap the child's shoulder.

Don't shake the child.

If you're alone and you didn't see the child collapse and you can't find a pulse,

provide CPR for two minutes, about five cycles, before calling 911 or your local emergency number.

If you see the child collapse and CPR is needed, call 911 immediately and then begin CPR as quickly as possible.

If another person is available, have that person call for help immediately while you attend to the child.

Circulation.

Restore blood circulation.

Number one, place the child on his or her back on a firm flat surface such as a table.

The floor or ground also will do.

Number two, imagine a horizontal line drawn between the child's nipples.

Place two fingers of one hand or if the child is over a year old, the heel of your hand just below this line in the center of the chest.

Number three, gently compress the chest about one and a half inches or one-third the depth of the chest.

Number four, count aloud as you perform 30 compressions pumping at a rate of about 100 to 120 compressions a minute.

Airway.

Clear the airway.

Number one, after 30 chest compressions, gently tip your child's head back, head tilt maneuver, by lifting the chin, chin lift maneuver, with one hand and pushing down on the forehead with the other hand.

Breathing.

Breathe for the child.

Number one, cover the child's mouth and nose with your mouth.

Number two, prepare to give the child two rescue breaths.

Use the strength of your cheeks to deliver gentle puffs of air instead of deep breaths from your lungs.

To slowly breathe into the child's mouth one time, taking one second for the breath.

Give a deep enough breath to cause the child's chest to rise gently.

If it does, give a second rescue breath.

If the chest does not rise, repeat the head tilt and chin lift maneuvers, and then give the second breath.

Number three, if the child's chest still doesn't rise, resume chest compressions, and after 30 examine the mouth to make sure no foreign material is inside.

If an object is seen, pinch it out with your finger and then give two breaths.

If the airway seems blocked, perform first aid for a choking baby or toddler.

Number four, give two breaths after every 30 chest compressions.

Number five, perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the child.

Number six, continue CPR until you see signs of life or until medical personnel arrive.

Number seven, if you're unable or unwilling to perform the rescue breathing portion of CPR, continue chest compressions until there are signs of movement or until medical personnel take over.

Number eight, if you have someone who can help you perform CPR, have one person perform chest compressions while the other performs rescue breaths.

Perform 15 compressions followed by two breaths.

Repeat this cycle 10 times before switching roles.

Burns.

Burns can range in severity from minor problems to life-threatening emergencies.

They occur most often on a child's hands or face.

Burns may result from fire, the sun, heated objects, hot fluids, electricity, or chemicals.

Common sources of burns in infants are hot liquids such as coffee or tea, bottles that have been heated in a microwave, stoves, fireplaces, and cigarettes.

Some burns result from water heater temperatures that are excessively high, more than 120 degrees Fahrenheit.

Be cautious about a child's clothing catching fire from a spark or ashes.

How serious is it?

Burns can range from mild to serious and are classified according to their severity, which consists of three categories.

Superficial burns.

They cause redness and slight swelling of the skin.

These are the most mild and affect only the outer layer of skin.

Superficial partial thickness and deep partial thickness burns.

They generally cause blistering, intense reddening, and moderate to severe swelling and pain.

The top layer of skin has been burned through and the second layer also is damaged.

Full thickness burns.

Full thickness burns appear white or charred and involve all the layers of the skin.

There may be little pain with these burns because of substantial nerve damage.

What you can do.

Minor burns can often be taken care of at home.

Major burns require emergency treatment.

Minor burns.

For minor burns, take the following steps.

Remove any constricting items.

Since burned areas can swell, take off any jewelry, belts, and similar items.

Try to do this quickly and with care.

Hold the burned area under cool, not cold running water for 10 or 15 minutes or until the pain subsides.

If this is impractical, immerse the burn in cool water or use cool compresses.

Cooling the burn reduces swelling by conducting heat away from the skin.

Don't put ice on the burn.

After cooling the burn for comfort and cleaning, cover the burn with antibiotic ointment.

This will prevent bandages or dressings from adhering to the burn.

Cover the burn with a sterile gauze bandage.

Keeping the burn clean and covered provides comfort by keeping air off the injury

and it reduces the risk of infection.

Don't use fluffy cotton or other material that may get lint in the wound.

Wrap the gauze loosely to avoid putting pressure on burned skin.

To ease pain, you can give your child an appropriate dose of acetaminophen or ibuprofen,

refer to dosage instructions on the bottle.

Talk to your child's medical provider if you have concerns.

Minor burns usually heal without further treatment,

but watch for signs of infection such as increased pain, redness, fever, swelling, or oozing.

If infection develops, seek medical help.

Major burns.

For full thickness burns or superficial partial thickness and deep partial thickness burns

that involve a large area of skin, call 911 or your local emergency number.

Until an emergency unit arrives, follow these steps.

Don't immerse large severe burns in cold water.

Doing so could cause a drop in body temperature, hypothermia,

and deterioration of blood pressure and circulation.

Shock.

Check for signs of circulation, breathing, coughing, or movement.

If there is no breathing or other sign of circulation, begin CPR.

Cover the area of the burn.

Use a cool, moist, sterile bandage, clean, moist cloth, or moist towels.

Elevate the burned body part or parts above heart level if possible.

Remove jewelry, belts, or other constricting items.

Burned areas can swell rapidly, and these items can quickly become restrictive.

Electrical shock.

The most common ways that infants and young children receive electrical shocks

are by biting into electrical cords, or by poking metal objects, or their fingers, into unprotected outlets.

Holiday decorations provide another source of possible injury.

When electrical cords and light bulbs are often within a child's reach,

an electrical injury often results in only minor or local injury at the point of contact, similar to a burn.

For example, a less severe shock may burn your child's mouth or skin.

However, a stronger electrical shock may cause your child to stop breathing and may stop the heart beating.

Internal organ damage may not be obvious, but it may be present.

How serious is it?

Depending on the voltage and the length of the contact with electrical current,

an electrical shock may range from being mildly uncomfortable to causing serious injury or death.

What you can do.

If you see that your child is in contact with electricity, attempt first to disconnect the source.

If you cannot disconnect the source, attempt to move your child away from the electricity.

Don't attempt to handle a live wire with your bare hands.

Use an object made of plastic or wood that won't conduct electricity.

As soon as your child is away from the source of electricity, check his or her breathing and heart rate.

If either is stopped or erratic, or if you see your child is unconscious, begin CPR

and call or have someone else call for emergency help.

If your child is conscious, look for evidence of burns and notify your child's medical provider.

You can prevent accidental electrical shocks by child-proofing your home and using safety plugs in all electrical outlets.

In addition, avoid stringing long extension cords or electric lights where your child can reach them.

Animal or human bites.

If your child is bitten, try to discover the source of the bite as quickly as you can.

Household pets are the cause of most animal bites.

Although pet dogs are more likely to bite than our cats, cat bites are more likely to become infected.

Bites from some wild animals are dangerous because of the possibility of rabies.

Most human bites that children get are only bruises and not dangerous.

However, human bites can lead to infection if they break the skin.

How serious is it?

An animal bite can cause serious wounds, especially to the face, as well as considerable emotional trauma.

You should consider any animal or human bite that breaks the skin to be a serious injury.

Fortunately, cases of rabies are uncommon today.

Still, any animal bite caused by a dog, cat, skunk, raccoon, fox or bat should be evaluated for rabies' risk.

Bites by rabbits, gerbils and hamsters generally are harmless and only require local wound care.

What you can do.

If your child is bitten, follow these guidelines.

For minor wounds, if the bite barely breaks the skin and there's no danger of rabies, treat it as a minor wound.

Wash the wound thoroughly with soap and water.

Apply an antibiotic cream or ointment to prevent infection and cover the bite with a clean bandage.

If the bite breaks the skin, contact your child's medical provider to see if your child should receive medical evaluation and treatment with antibiotics.

For deep wounds, if the bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean dry cloth to stop the bleeding.

See your child's medical provider or go to your local emergency department.

If you're concerned about the possibility of rabies, tell your child's provider.

He or she may administer a series of shots to prevent rabies' infection.

Also seek medical assistance if you see any signs of infection,

pus straining from the wound, increased redness and swelling several days after the bite, or red streaks extending from the wound.

Drowning

Infants and toddlers can drown in very shallow water.

Never leave your child alone in the bathtub, even briefly.

If a phone call, doorbell, or something else interrupts your child's bath, either ignore the interruption or bring the child with you wrapped in a towel.

Keep the toilet lid and bathroom door closed.

Fend swimming pools with automatic latching gates and constantly supervise your infant when near lakes, pools, or rivers.

Toddlers have even drowned after falling into buckets used for cleaning.

What you can do

If your child has been submerged in water and isn't breathing or has breathing difficulty, has blue skin, is unconscious, or has a decreased level of consciousness,

call for emergency help or have someone call for you.

If your child has no pulse or isn't breathing, begin CPR immediately.

Continue CPR until medical help arrives.

Injury from a fall

Infants can fall for many reasons.

Falls tend to occur when a baby is able to roll or to tip an infant seat, often more easily than a person realizes, or when he or she begins to crawl or walk.

How serious is it?

If your child cries immediately after receiving an impact to his or her head and remains alert, chances are the fall didn't cause serious injury.

Falls can be serious, but babies and toddlers soft bones don't fracture as easily as those of older children.

Important factors that can affect the seriousness of a fall are the force and distance of the fall and the surface onto which your child has fallen.

What you can do?

Use ice to control swelling, but be careful not to freeze your child's skin.

In case of a head injury, observe your child carefully for 24 hours for any behavior changes.

If the injured body part looks abnormal, or if your child cannot move it, seek immediate care.

Also seek immediate care if you notice any of the following signs. An inability to crawl or walk if he or she was able to do so before the injury.

Persistent irritability, possibly indicating a severe headache. Blood or watery fluid discharge from the ears or nose.

Persistent vomiting.

Call 911 or emergency help if your child experiences breathing irregularity, lethargy or excessive sleepiness, a seizure, loss of consciousness.

If your child stops breathing or if you can't detect a heart rate, begin CPR immediately and call 911.

Swallowed poison. Almost any non-food substance is poisonous if taken in large doses.

Babies and toddlers explore by putting things in their mouths. Toxicity of substances varies greatly, and with immediate treatment, most children aren't permanently harmed from poisons they swallow.

In the US, keep the poison help hotline number 800-222-1222 nearby, and be sure to tell anyone who takes care of your child where the number is.

Also, keep the hotline number in your cell phone.

Some common items you might keep around your house can be quite dangerous to an infant or toddler.

These include plants, medications, including pain relievers and aspirin, alcohol, mouth washes that contain alcohol, automatic dishwasher detergents, pesticides, anifrease, and cleaning substances.

Suspect poisoning if you find your child with an open or empty container of a toxic substance.

Look for behavior differences, burns or redness of the lips, mouth or hands, unexplained vomiting, breath that smells like chemicals, breathing difficulties, or convulsions.

How serious is it?

Substances vary widely in the seriousness of their effects and the amount required to do harm.

Remember, though, that a small amount of some products or medications can be much more damaging to an infant or toddler than it would be to an adult.

If you have questions about whether a substance may be toxic, call the poison help hotline for advice.

What you can do.

If you think that your child may have swallowed a poison,

move your child from the source of the poison and immediately call poison help at 800-222-1222 in the US.

Be prepared to relate as many details as possible.

The operator may ask you to read the labels on the container and to describe the substance in a mount ingested and when and how your child came into contact with it.

Describe any physical changes you detect in your child.

If your child is in obvious distress, unconscious, hallucinating, convulsing, experiencing breathing difficulties, call 911 or your local emergency number immediately.

If possible, have the container in front of you when you call so that you can tell emergency personnel what substance caused the problem.

If you need to go to the emergency department, bring the product or container with you or take a picture of it, including a close-up of the label.

Don't give anything by mouth until you've received advice from the poison help hotline.

Inducing vomiting in your child isn't recommended as it can cause more damage in some instances.

If your child is vomiting, turn his or her head to the side or forward if your child is upright to prevent choking.

Prevention.

Any medication and many products in your house can be harmful to your child.

If you don't need the medication or product in your house, remove it to avoid accidental ingestion.

Be especially cautious when visiting grandparents or non-child-proofed homes.

Be sure that all substances are in their proper, child-resistant containers and clearly labeled.

Be sure to check the label on medicine bottles each time you give a medication, especially in the middle of the night, to confirm that it's the proper medicine and that you're giving the proper dose.

Inhaled poison.

Inhaling poisoned substances can cause various reactions, including nausea and vomiting, loss of or decreased consciousness, headache, breathing difficulties, coughing, or lethargy.

Your child's reaction will vary depending on the amount of exposure and the substance inhaled.

Numerous substances are toxic when inhaled.

They include carbon monoxide, smoke and fumes from fires, propellants, gasoline, kerosene, turpentine, furniture polish, charcoal, cigarette lighter fluid, glue, paint remover, and lamp oil.

It can be dangerous for your child to inhale toxic substances.

Act quickly when you suspect that your child has inhaled a dangerous substance.

What you can do.

Avoid using aerosol products near your child because young children can react more severely to a small amount of inhaled poison.

Never run your car in a closed garage and be sure to maintain coal, wood, or kerosene stoves regularly.

If you smell a strong natural gas odor, turn off the gas burner or oven.

Leave your house immediately and call the gas company.

Avoid breathing the fumes yourself and get your child to a well-ventilated area.

Check your child's breathing and pulse and if needed, begin CPR.

Call 911 or your local emergency number immediately if your child is in obvious distress.

Having difficulty breathing or showing lethargy or a decreased level of consciousness is without a heartbeat or is convulsing.

Poison on the skin.

If you suspect that a poison has come into contact with your child's skin, look around nearby your child for some evidence of the poison.

Spilled household cleaners would probably leave a young child's skin looking red and irritated.

The chemicals in many household cleaning substances, especially oven and drain cleaners, are caustic and can easily damage your child's skin.

What you can do.

Keep all cleaning solutions in a child-proof cabinet out of reach.

If your child comes into contact with a poison, check with the Poison Help hotline at 800-222-1222 in the U.S. to confirm a method of treatment.

If your child is experiencing obvious distress, unconsciousness, lethargy, hallucinations, convulsions or breathing difficulties, call 911 or local emergency services immediately.

Poison in the eye.

Poison can get in a child's eye when a liquid splashes into it.

Many substances can damage your child's eyes, but your infant or toddler may not be able to tell you about the problem.

Therefore, it's important that you be alert to possible situations in which this can happen.

Acting quickly could make the difference between a temporary problem and a long-term disability.

What you can do.

Use a large glass or pitcher filled with cool tap water to flood your child's eye for 10-20 minutes.

Try to get your child to blink frequently as you flood the area.

Keep the child's hands out of his or her eyes.

You may need to wrap him or her in a bedsheet or large towel to keep his or her hands out of the affected eye.

Get another adult to help you if possible.

Call the Poison Health hotline at 800-222-1222 in the U.S.

if you're unsure whether the liquid that splashed in your child's eye is poisonous,

or if you're unsure whether to seek emergency help.

Part 3 Growth and Development

Chapter 19, Month 1

The first month of your baby's life can feel like a whirlwind.

Coming home from the hospital, getting your baby situated in your home,

becoming accustomed to the rhythms of parenting, recuperating from childbirth, and so much more.

There's a lot going on.

At the same time, being with a newborn can make you feel like time has slowed down to a crawl.

After all, newborns spend most of their time sleeping and eating,

with a diaper change and a crying spell here and there.

The most exciting times may be when your child's eyes are open for a few minutes,

and you can interact for a short while.

Even then, you may wonder, "Should my baby be moving more?

Is he or she getting enough to eat?"

But that's what the first month is all about.

Slowing down enough to rest, recover, and get to know each other.

By the end of the first month,

you'll be surprised at the changes that have occurred in your little one,

and the jump in your own self-confidence as a parent.

Baby's Growth and Appearance

During the first few days of life,

your newborn loses the excess body fluid he or she was born with,

which means that by the time you go home,

your baby will weigh slightly less than at birth.

But no worries, most babies will quickly gain this weight back.

And in about 10 days to 2 weeks,

your baby will once again be at his or her birth weight.

And growth certainly won't stop there.

Most babies grow rapidly in their first few weeks.

By the end of the first month,

your baby is likely to weigh around 10 pounds.

Your baby's length will increase by 1.5 to 2 inches.

Many people envision newborns as cute, round, and smooth-skinned.

But that's not always the case.

If your little guy or gal doesn't look exactly like glowing pictures

you've seen of newborns,

those babies are probably 2 or 3 months old already.

Don't be discouraged.

Passing through the birth canal isn't an easy journey,

and it takes a while for baby's skin to adjust to the outside world.

Most newborn appearance issues pass quickly.

To help you gauge what's normal,

here are some brief descriptions

of how a typical newborn is likely to appear.

Head.

Forging head-first through the birth canal

can put a lot of pressure on a baby.

Literally, pressure from the tight birth canal

can cause the bones in your baby's body to grow.

This can leave your newborn's head looking slightly elongated

or cone-shaped at birth.

Don't worry, though.

Your baby's head should round out in a few days.

Babies born buttocks or feet-first, or by c-section,

are more likely to have round heads at birth.

Pressure on your baby's face

may leave your newborn's eyelids puffy or swollen.

The size of your baby's head

can be a little bit bigger than the size of your baby's head.

The size of your baby's head is important

because the growth rate of your baby's head

reflects the growth of the brain.

Both the brain and the skull grow incredibly fast

in the first few months.

In the beginning, the average newborn's head

measures about 13 and 3/4 inches around

and grows to about 15 inches by the end of the first month.

At birth, baby's brain accounts for about 20%

of his or her body weight.

By adulthood, this percentage decreases to about 2%.

At the top of your baby's head,

you'll notice two soft areas

where the skull bones haven't yet grown together.

These soft spots, called fontanelles,

allow a baby's relatively large head

to move down the narrow birth canal.

They also accommodate a baby's rapidly growing brain.

You may notice slight bulging from these spots

when your baby cries or strains.

A newborn's skin can cause considerable distress

to new parents.

It's just more blotchy, flaky, pimply,

and wrinkled than they expected.

But most of the time, this is completely normal.

For example, switching from the moist environment of the womb

to the relatively dry air outside of it

can cause the top layer of your baby's skin

to flake off shortly after birth.

You may notice plenty of dry, peeling skin

for the first few weeks.

Your baby's skin may also look slightly modelled,

with some patches looking paler or darker than others,

especially near the hands and feet.

Your baby's hands and feet may also be colder

than the rest of his or her body

and may appear a little blue or purple.

If you position your baby or move your baby's arms and legs a little,

they should regain normal colour.

In some cases, your baby's complexion may remind you

more of an adolescence than a newborn's.

Due to the appearance of tiny white pimples,

the white pimples are harmless spots known as milia.

Later, your newborn may even develop newborn acne,

characterized by small red bumps on his or her face,

a normal, harmless rash called erythema toxicum.

Often appears in the first few days of life as well.

Many newborns have birthmarks.

You may notice reddish or pink patches above the hairline

at the back of the neck, on the eyelids,

or between your newborn's eyes.

These marks, nicknamed salmon patches or stork bites,

are caused by collections of blood vessels close to the skin.

Sometimes, babies are born with a large, flat, blueish grey mark

on the buttocks or lower back.

This type of birthmark is called dermal melanosis.

Ambilical cord.

The stump of newborn's umbilical cord is usually yellowish-green at birth.

As the stump dries out and eventually falls off,

usually within two to three weeks after birth,

it'll change in colour from yellowish-green to brown to black.

In the meantime, keep the stump clean and dry.

Make sure it is outside of the diaper.

Stick to sponge baths until it falls off.

When it does fall off, there may be a few drops of blood,

similar to a healing scab, but this should stop quickly.

Don't pull on the cord to help it separate faster.

Breasts and genitalia.

Before birth, the mother's hormones pass through the baby's system.

This may lead to swollen breasts at birth for both boys and girls.

Newborn girls may have a swollen vulva and light mucus-like or bloody vaginal discharge.

The swelling typically disappears within two to four weeks.

Vaginal discharge may last for several days.

For some newborn boys, fluid can accumulate around a testicle.

This swelling, known as hydracell, usually disappears within a few months.

Frequent erections are common too.

Legs and feet.

A newborn's legs and feet often look bowed or bent thanks to the cramped quarters of the womb.

As long as your newborn's legs and feet are flexible and can easily be moved about,

there's no need for concern.

These curves typically straighten out on their own as your baby becomes more mobile.

When a child is born, part of a newborn checkup includes an evaluation of a baby's hips, legs, and feet.

Hair.

Don't be alarmed if that great head of hair your baby was born with falls out within the first few weeks.

Almost all newborns lose at least some of their baby hair.

It will grow back in a few months.

Plenty of babies also develop temporary bald spots on the back of the head,

from regular contact with the crib mattress or other sleeping surface.

Once your child starts rolling over and moving around, this won't be a problem anymore.

Some newborns are covered by fine, downy hair at birth, known as lanuga,

especially on the back, shoulders, forehead, and temples.

Tiny hairs may also appear on your newborn's ears or in other spots.

Lanugo is most common in premature babies.

It typically wears off from normal friction within several weeks.

Baby's movement.

In this first month, your baby doesn't have a whole lot of control over his or her movements,

which are likely to be jerky and quivering.

Your baby may also startle easily and even cry at sudden movements or loud noises.

Swaddling or holding your baby close will help bring comfort.

Because your newborn's brain and nervous system are still immature,

movements are largely involuntary or reactive.

In order to move purposely, your baby's brain must send messages via nerve cells

to his or her muscles with specific instructions for movement.

In the first few weeks of life, brain and nerve cells are rapidly developing,

but they haven't achieved fluid communication yet.

Over time, the maturation of your child's nervous system

will allow your baby to gain control over different parts of his or her body.

This follows an orderly sequence from head to toe.

So your baby's first major milestone is gaining head control,

followed later by sitting, crawling, and walking.

By the end of the first month, your baby's neck muscles will have developed considerably.

When lying face down, your baby may lift up his or her head and turn it from side to side.

In the first few weeks, your baby's hands are apt to be curled up into tight little fists much of the time.

By the end of the first month, you may catch your baby trying to bring those fists

toward his or her face for closer inspection.

Over time, your baby's hands will relax and spread wide,

allowing him or her to use them more deliberately.

Baby Reflexes

From birth, your baby comes hardwired with a number of automatic responses.

Reflexes

Some of these reflexes help your baby survive his or her entry into the big new world.

Automatic reflexes your baby is born with include

Routing Reflex

If you stroke your baby's cheek or the corner of his or her mouth,

your baby will turn toward your hand and move his or her tongue in that direction.

This helps your baby find the nipple of the breast or bottle and initiate feeding.

This reflex usually disappears around four months of age.

Sucking Reflex

This reflex is present even in utero,

and you may have even seen your baby sucking his or her thumb during an ultrasound examination.

After your baby is born, placing a nipple in his or her mouth will cause your baby to automatically begin sucking.

At first, he or she squeezes the area around the nipple between the tongue and palate to force out the milk.

Next, your baby moves his or her tongue toward the end of the nipple to move the milk into his or her mouth.

The American Academy of Pediatrics reminds parents that even though this rhythmic sucking is a reflective action,

it generally takes a bit of practice for your baby to turn the reflex into an effective voluntary skill.

So don't get discouraged if you or your baby don't seem to nail breastfeeding at first pass.

Give yourself a little time to practice and adjust.

Grasp Reflex

Placing your finger in your newborn's palm causes your baby to grasp your finger,

and you'll find that if you try to remove your finger, he or she will grasp it even tighter.

A similar reaction occurs if you stroke the sole of your baby's foot.

These reflexes generally disappear by 2 to 3 months of age.

Startle Reflex

If your newborn hears a loud noise, he or she will react by throwing out his or her arms and legs,

and then drawing in his or her arms.

This reaction is also known as the Moro Reflex.

Another time it occurs is if your baby's head suddenly falls back.

Doctors may check this reflex to make sure your baby's development is healthy.

This startle reflex usually disappears by about 2 to 4 months of age.

Tonic Neck Reflex

This reflex occurs when your baby turns his or her head to the side.

Simultaneously, his or her arm and leg on the same side will extend out,

while the opposing arm and leg flex, giving your baby the look of a fencer.

It's a fairly subtle reflex though, so don't worry if you don't notice it every time.

The Tonic Neck Reflex disappears around 4 to 7 months.

Stepping Reflex

If you hold your newborn upright and let his or her feet touch a flat surface,

your baby will pick up one foot and then the other, as if walking.

Of course, your baby's not ready to walk yet, and this reflex will disappear around 2 months.

It will become a controlled skill by the time he or she is walking, usually around a year or so of age.

Baby's Sensory Development

From the get-go, your baby arrives with all 5 senses intact.

Not only does your baby use his or her senses to learn about the surrounding environment,

he or she also uses them to form emotional attachments with you and others.

By identifying your face, your smell, and the sound of your voice, your baby establishes a connection with you.

In addition, your baby rapidly begins using multiple sensory skills to explore and interact with you.

For example, your baby will quickly connect the site of the breast or bottle with a particular scent,

all of which equals food.

In the first month, this is how your baby is likely to perceive the world.

Sight

At birth, your baby is fairly near-sighted, with the ability to focus on objects that are roughly 8 to 12 inches away.

Coincidentally, this is just about the distance between your baby's eyes and your face when you're nursing or holding him or her.

Thus, from early on, your baby is able to gaze at your face and quickly learns to recognize it.

In fact, at this stage, your baby prefers the human face to any other patterns.

This is an early opportunity for bonding with your baby.

Make eye contact while feeding your baby or changing diapers.

Right after birth, your baby is very sensitive to bright light and is likely to close his or her eyes tightly to keep the light out.

Over the next few weeks, though, your newborn's vision will develop enough so that he or she can see a widening range of lights and darks.

The higher the contrast in pattern, the more likely it is to catch her child's attention during this first month.

Sound

Your baby's hearing is fully mature at birth, but it takes a little while for your baby to learn how to recognize and react to different sounds.

As if with your baby's visual preference for the human face, your baby favors the sound of human voices, reacting especially to high-pitched voices.

It's possible that your baby may even recognize your voice from having heard it in utero and will turn his or her head toward the sound of your voice from the beginning.

Talk and sing to your baby.

Some babies are more sensitive to noise than others.

Too much noise, for example, and your baby may start to cry.

In general, low-rhythmic tones are most likely to soothe your baby.

Smell

Your baby already has a keen sense of smell and quickly becomes able to discern his or her mother's breast milk from other mother's breast milk.

Other smells new babies seem to like include sweet or fruity smells such as vanilla and banana.

Taste

As a newborn, your baby has more taste buds than does an adult.

Therefore, your little one can be fairly picky about different taste sensations, including the temperature of his or her breast milk or formula.

Most babies also prefer sweet taste to sour ones.

Touch

New babies have a fully developed sense of touch as well.

For example, they prefer soft, smooth surfaces to coarse or scratchy ones, and they can feel pain at the prick of a needle.

Most importantly, they respond to the way they're touched.

In essence, this is the first form of communication between you and your baby.

Gentle handling, snuggling, and holding are not only soothing to your baby, but a sign of your love and affection as well.

Babies' Mental Development

Your baby's brain has been on a development fast track, generating new brain cells, neurons, at a rate of 250,000 a minute, ever since the early days of your pregnancy.

By the time your baby is born, he or she has virtually all of the brain cells that he or she will use in a lifetime.

But having all of these brain cells is just the beginning.

As your baby is exposed to a whole new world, his or her brain cells rapidly start making connections called synapses.

These connections create pathways between brain cells that when reiterated through day-to-day experiences and activities, form the basis for knowledge and thought, and for skills such as remembering, analyzing, and problem solving.

These connections also set the foundation for communication and the interpersonal skills your child will use when relating to others.

Remember, it's never too early to set the foundation for essential skills such as language.

It may still be a number of months yet before your newborn will be talking, but he or she is already forming necessary connections for language development.

You can encourage such development by talking and reading to your child.

Provide plenty of face-to-face time when your baby is awake and alert.

Your baby's environment has a tremendous impact on how his or her brain develops.

While your baby's genetic makeup and physical development provide the essential nature ingredients, you provide the nurture components.

You'll read more in the following chapters on how you can create the best environment for your child's mental growth and development.

But the one thing that is essential to know, especially now in the first month, is that all children thrive in an environment of consistent warmth and positive attention, no matter how old they are.

Communication.

Of course, you knew your baby wouldn't be able to talk for quite some time, but who knew it would be such an adjustment to stare at your newborn and realize you were temporarily going to have to rely on something other than words to communicate?

You'll quickly discover, however, that your baby has a few different ways of communicating during this first month.

Crying.

This is the only way your baby can verbalize his or her needs and feelings.

All babies can and should cry because this helps them receive the care they need.

Adults, in turn, have a strong drive to respond when a baby cries, making this form of communication between you and your baby fairly innate.

Responding warmly to your baby's cries helps your baby feel safe and secure in his or her new environment, as well as develop a secure attachment to you.

Lots of crying can be hard to take, of course.

If you've run through your mental checklist and your baby is dry, full, comfortable, and snug, then maybe he or she just needs comforting for a bit.

Or your baby may need some downtime without any stimulation, even if he or she does cry for a few minutes.

Sometimes you may not know why your baby is crying, and that's okay too.

Keep in mind that young babies don't cry to manipulate their parents or make them do things.

They generally cry to communicate their needs, whether it's hunger, discomfort, or over-stimulation.

If your baby cries a lot, it's okay for you to take a break, let your partner take over for a while, or lay your baby in a safe place for a few minutes of alone time.

Your baby may need a bit of downtime.

Crying usually increases over the first few weeks, peaking at about three hours a day at six weeks of age, and gradually decreasing to about an hour a day at three months old.

See Chapter 10.

Body Language

During these first few weeks, your baby also communicates through body language.

For example, when awake and alert, your baby may make eye contact with you and carefully scan your face.

Or if your baby thinks there's simply too much going on at the moment, your baby may react by turning away from the source of the stimulus, closing his or her eyes, or becoming irritable.

Although new babies aren't capable of responding in so many vocal ways yet, they're able to receive information and interpret nonverbal signals.

Your baby can read signals you send, such as the expression on your face and the way you hold him or her.

Baby Social Development

The main social event on your baby's calendar this first month is getting to know you.

While you're occupied trying to figure out your baby, your baby is busy using all his or her senses to become acquainted with you, how you smell, sound, look, and feel.

Becoming Attached

Baby's bodies are pretty amazing self-functioning packages when they arrive, but babies still depend on their environment for survival.

Every time you feed your baby, change your baby's diaper, respond to your baby's cries, or simply hold your baby close, you're establishing a pattern of consistent availability to your baby's needs.

This creates a bond of trust and confidence between the two of you.

This bond is the primary building block for your child's early social and emotional development.

It's also your baby's template for future relationships.

As a primary caregiver, you become your child's home base, to which he or she will repeatedly return over the years for comfort, health, and support.

For many women, breastfeeding is a natural way of bonding with the newborn because it covers many of the baby's needs at once.

Food, warmth, comfort, and security all rolled into one.

But breastfeeding is only one way to bond.

You can also connect with your baby when you're feeding your baby a bottle or doing any of the other myriad activities involved in your baby care.

It's your general approach of love and gentle care that communicates safety to your child.

For some people, bonding comes more easily than for others.

If you don't feel immediate attachment to your baby on day one, don't worry too much.

After all, this is a new person in your life, no matter how little.

As you spend time together and get to know each other's traits and characteristics, you'll develop a unique relationship that will only be strengthened in the months and years ahead.

In addition, many new mothers have a mild case of the blues after childbirth, not to mention fatigue and soreness.

If you don't start feeling better and more involved in your parenting role after a few weeks, talk to your medical provider.

He or she will help you sort things out and get the right treatment.

Building up to smile.

Smiles actually take a while to develop, but you may notice over the course of this first month that your baby sometimes smiles during sleep or after a feeding.

Around four weeks or so, your baby's smile may evolve a little further, involving the eyes more and comes several seconds after hearing your voice or feeling your touch.

Next month, you can look forward to full-blown happy smiles involving the whole face that come in response to your own smiles.

Did you know?

Babies usually have a couple of growth spurts within the first month or two, generally around seven to ten days and at three to six weeks of age.

During a growth spurt, your baby may want to eat more often, so don't be surprised if your baby seems to have gone on a feeding frenzy.

Hang in there. The frequency of feedings will soon even out again.

Infant jaundice.

It's not uncommon for a healthy newborn to develop a yellow color to his or her skin and eyes in the first few days of life.

Jaundice.

This occurs when the baby's blood contains too much of a yellow-colored substance formed during the normal breakdown of red blood cells, bilirubin.

Jaundice typically develops because a baby's liver isn't mature enough to properly get rid of bilirubin in the bloodstream.

The mild infant jaundice is harmless and usually resolves on its own within a few weeks.

If your baby's jaundice doesn't go away after a couple of weeks or gets worse, contact your baby's medical provider promptly.

Soothing by sucking.

Most babies have a strong sucking reflex.

Beyond nutrition, sucking often has a soothing, calming effect.

That's where a pacifier can come in handy.

Some babies are interested in pacifiers, others aren't.

If your baby isn't enthralled at first, you can try invoking your baby's natural sucking reflex by gently stroking the side of your baby's mouth while holding the pacifier in his or her mouth until the sucking gets going.

If a pacifier seems to help your baby, feel free to use it.

The American Academy of Pediatrics gives pacifiers the go-ahead for soothing between feedings and helping baby fall asleep.

Pacifiers used during sleep may even help reduce the risk of sudden infant death syndrome, SIDS.

The downside is that you may be woken up more often during the night to retrieve a lost pacifier.

In the beginning, be sure that pacifier use doesn't interfere with your breastfeeding routine,

especially while you and your baby are still learning the ins and outs of nursing.

Choose a pacifier that's made of one piece to avoid any choky hazards, and that's dishwasher safe for ease of cleaning.

It helps to have several identical pacifiers handy, so you're not searching for the lone favorite in a desperate time of need.

Also, make sure to replace pacifiers that have worn or cracked nipples, as the nipples can tear off and pose a choking hazard.

You may wish to eliminate a pacifier by 18 months, but most kids stop using pacifiers on their own between ages 2 and 4.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the first month.

Eating. Baby will need breast milk or formula, generally every 2 to 3 hours, although the frequency at first can be pretty variable.

The goal is a minimum of 8 to 12 feedings a day to make sure your newborn is getting enough to eat.

Chapter 3 discusses nutrition in more detail.

Sleeping. Expect your newborn to sleep about 16 hours a day in 1 to 3 hour spurts.

Fairly evenly distributed throughout the day and night.

Place your baby on his or her back to sleep to decrease the risk of sudden infant death syndrome.

SIDS.

Toys and Games.

During the first month, your baby doesn't need a lot of toys to be entertained. There are so many other things to take in.

Still, you can provide different things for your baby to look at and listen to, which will help his or her brain cells develop more and better connections.

Chit Chat.

Since your face is one of your baby's favorite things to look at, why not make it available?

Position yourself to be face to face and have a conversation.

Talk to your baby about your day and what you're planning for dinner.

Make faces, smile, and sing to him or her.

Eye contact is important, so try to minimize distractions such as TV or phones.

Listen to music.

Play soft music while your baby lies in a crib or swing and you fold laundry or take care of some other chore.

Provide a view.

During the first few weeks to months, your baby's neck muscles are still developing, but your baby can look from side to side.

Hang a picture with bold graphic lines near the changing table at baby's eye level.

Read a book.

Although your baby isn't ready to interact with a book yet, it's never too early to start reading together.

Your baby will enjoy the rhythmic sound of your voice as you read, whether it's Dr. Seuss, Hop on Pop, or your usual news source.

Get some tummy time.

Place your baby on his or her tummy for a short time while he or she is awake.

This will encourage your baby to hold his or her head up and strengthen those neck muscles.

Some babies cry at first with tummy time.

Stick with it.

Try lying next to your baby or placing a mirror or toys on either side of your baby's head.

First month milestones.

In this first month, new babies are usually working on the following skills.

Turning head from side to side.

Lifting head for a second while lying on belly.

Bringing fists in toward face.

Checking out human faces and maybe high contrast patterns.

Visually tracking moving objects that are in close range.

Eyes may cross at this age as eye muscles are still developing.

Perhaps turning head toward familiar voices and sounds.

States of consciousness.

Scientists have observed, and you will too, that new babies fluctuate between different states of consciousness throughout the day.

Some of these states are during sleep and some occur while your baby is awake.

There's no need to memorize them, but understanding the different states of consciousness may help you better understand your baby's moods.

Deep sleep.

During the deep sleep state, your baby sleeps quietly and does not move.

Active or light sleep.

In this state, your baby moves while sleeping and may be startled or wakened by loud noises.

Drowsiness.

Drowsiness may occur before or after a sleep state.

You'll notice your baby's eyes become a little droopy and he or she may yawn or stretch.

Keep this one in mind for when you want to put your baby down to sleep on his or her own.

Quiet alert.

In this state, your baby looks bright-eyed and bushy-tailed, but his or her body is quiet.

Active alert.

During active alert, your baby is wide-eyed and moving actively.

He or she may be busy entertaining himself or herself.

Crying.

This state of consciousness is not hard to recognize because of the whales coming from your baby's mouth.

When your baby is crying, he or she also tends to flail or thrash about.

The best time to talk and play with your baby usually is during the quiet alert state.

In this state, he or she is most likely to be receptive to play and outside stimulation.

Be warned, though, that new babies tend to cycle through states of consciousness fairly quickly.

So don't be surprised if a toy elicits attention for a short while

and then quickly becomes a source of irritation when your baby starts crying.

Just move on to what your child wants next, which is probably comforting or napping.

Chapter 20

Month 2

By the beginning of your baby's second month, you're probably starting to get a handle on having a new baby in the house.

You're more adept at basic caregiving activities, such as changing diapers or fixing bottles,

and you've almost gotten your swaddle technique down.

If you're breastfeeding, you've probably started ironing out some of the kinks,

and you and your baby are feeling a lot more confident in your techniques.

During month 2, you'll still be perfecting a lot of these activities,

but you'll also see your baby's personality begin to emerge.

Your diligent efforts are more apt to be noticed by your little tyke,

and you'll likely be rewarded with the beginnings of true interactive smiles.

What's nice about month 2 is that the cogs of family life are slowly sliding into place,

and yet the excitement of it all is still bright.

Baby's Growth and Appearance

During the second month of life, your baby keeps growing at about the same rate as he or she did during the first few weeks,

gaining about 5 to 7 ounces a week and growing about half an inch a month.

Your baby is starting to fill out, cheeks are getting chubbier, and arms and legs fuller.

The head and brain are still growing rapidly, so that the head circumference increases by about half inch a month as well.

It's normal for your baby's head to be proportionally larger than the rest of his or her body at this point.

It's still growing faster than anything else.

The soft spot on your baby's head is still open,

but toward the end of this month and into the third month, it should start to become more firm and begin to close.

Keep in mind that healthy infants come in a range of sizes.

Although it's easy to cite generalizations, such as the figures just listed,

it's difficult to predict your baby's exact growth.

Your medical provider will monitor your son's or daughter's growth at each well-child visit,

where your child's numbers fall on the growth chart or how they compare with other baby's numbers,

isn't nearly as important as whether your baby is maintaining his or her own steady growth curve.

Baby's skin issues start looking a little better.

Any jaundice should be gone by the second month.

If not, contact your child's medical provider.

Other newborn skin conditions, such as the little white pimples known as milia, are largely disappearing,

although newborn acne may stick around for another month or two.

If your baby has acne, gently cleanse your baby's face with baby soap several times a week,

and stay away from lotions and oils.

Growth spurts.

Just when your baby is finally sleeping for several nighttime hours at a stretch,

he or she seems to revert to waking up every two hours again.

What's going on?

Nothing out of the ordinary, probably.

Infant growth and development occurs in spurts.

Usually a pause in learning precedes a new leap forward.

For example, your baby may be subtly working out the maneuvering necessary to roll over,

but until he or she masters the right techniques,

your infant may not fall or stay asleep as he or she once did.

Baby's movement.

Most of your baby's movements are still jerky and involuntary, reflexive at this point.

But as the month progresses, these newborn reflexes will begin to give way to more purposeful movements.

While this is occurring, your baby may seem less active for a short period

until he or she begins to get the hang of major muscle coordination.

Your little son or daughter is practicing new positions by stretching, moving, and watching.

Your baby's neck muscles are getting stronger too.

When pulling your baby gently to a sitting position, you'll notice that his or her head still lags behind a bit.

But when upright, your baby can probably hold his or her head steady for a few seconds, although not much longer.

Continue to support your baby's head when holding or carrying your baby.

When lying belly side down, your baby may raise his or her head to look straight ahead for a few moments,

rather than just side to side.

When lying on his or her back, your baby can keep his or her head centered and look straight up,

a handy skill for watching mobiles and looking up at mom and dad.

At this age, most babies aren't ready to roll from front to back or side to back yet.

That generally happens around three to four months of age.

But you cannot be certain that your baby will stay in one place either.

Babies this young can use their feet to push off surfaces and scoot around.

And even though they're just learning controlled maneuvers, they can unexpectedly flip themselves over by sudden startled movements.

Don't leave your baby unattended in a car seat, on a changing table, or other elevated surface,

and take proper precautions to securely strap your baby in while on a changing table.

Toward the end of the second month, your baby may also start to become aware of his or her hands and fingers

and try to bring them together to play with them.

Baby's Sensory Development

During the second month, your baby's eyes are getting better at moving and focusing on objects at the same time,

making it easier for your child to visually track moving objects.

Your baby's brain isn't mature enough to speedily process visual information,

but he or she can track a toy moving in front of him or her if it's moving very slowly.

Although your baby is still likely to prefer the sight of human faces,

he or she will also enjoy patterns that are more complex and colorful than simple black-and-white checkerboard images.

When you talk to your baby, you'll find that he or she is actively listening and watching the movements of your lips,

with interest as you speak.

In return, your baby may move arms and legs excitedly, or try to make his or her own vocalizations.

Baby's Mental Development

So far, your baby has been taking in a lot of information,

but by now, he or she may be ready for some outward expression as well.

Child psychologists refer to incoming language as receptive and outgoing speech as expressive language.

Receptive language, where your baby listens and absorbs speech and sounds around him or her.

Almost always precedes expressive language, which is when your baby starts to vocalize his or her own thoughts.

This is why it's so important for you to talk to your baby, even if he or she can't yet talk back.

In general, children understand language much earlier than they are able to clearly use it themselves.

For example, your baby will understand the meaning of the words "come to mama" months before he or she can articulate them.

Cooing and Gurgling

One of the most gratifying developments for parents this month, generally around 6-8 weeks of age, is their baby's first attempts at expressive language.

These are typically soft, single vowel sounds that sound like "oo's" and "ah's" or like "cooing."

As opposed to crying and grunting, which emanate from the chest, "cooing" and "gurgling" sounds come from your baby's larynx.

Cooing also involves using different mouth muscles than does crying.

Eventually, your baby will begin to use his or her tongue and then lips to make more precise vocalizations.

This pattern of language development, starting from the center and moving outward, mirrors your baby's motor development,

fine-tuning movement from arms to hands to fingers.

Cooing is a way for your baby to express happiness and contentment.

Your baby may coo and gurgle for self-entertainment, but he or she may also do it to attract your attention.

If your baby coos at you and you talk back, your baby quickly discovers that this is a two-way game.

By talking back, you reinforce the notion that communication is important and, furthermore, that it can be a source of great delight.

Crying at its peak

Your baby still relies heavily on crying to convey his or her needs and moods.

In fact, brace yourself, crying tends to reach a peak of about three hours a day right around six to eight weeks of age.

This is normal. A lot of babies develop a period of fussiness and prolonged crying at the end of the day,

perhaps as a way of releasing pent-up stress, not unlike adults if you think about it.

If you've already accounted for all of your baby's needs, listening to your baby cry can be difficult.

A parent often feels frustrated with his or her parenting skills at this point,

but it's not always possible to calm a crying baby, especially if your baby is just letting off steam.

Avoid the temptation to perceive your baby's crying as a rejection of your efforts,

or to feel as if you're a failure at this parenting business.

Babies cry. That's what they do.

And eventually, your baby will fall asleep, or his or her mood will change.

By the time your baby is three or four months old, the amount of time he or she spends crying will have decreased substantially.

If your baby's crying is accompanied by other symptoms, or you feel the length or intensity of your baby's crying is unusual,

trust your intuition, and call your child's medical provider.

For more on crying, see Chapter 10.

Baby Social Development

During the second month, your baby still spends a lot of time sleeping,

and the interaction you experience with your baby is still fairly limited.

But at the same time, your baby is making definite strides in his or her social graces.

By the age of one month, your baby is learning to recognize you,

perhaps reacting with a jerky arm wave, or a few bobs of the head at the sight of you.

By six weeks, many babies start to smile in response to a parent's smile.

After weeks revolving around feeding, diaper changing, and trying to catch some sleep,

seeing your baby smile back at you can be very rewarding.

By reacting to your baby's smiles with your own show of delight,

your baby learns that his or her actions have an impact,

and that he or she has a certain amount of control over what's happening.

The initial awareness is the beginning of your baby's ability to distinguish between himself or herself and others.

Baby's smiles can also be spontaneous expressions of happiness or contentment, even at this stage.

For example, your son or daughter is starting to recognize certain objects by sight,

such as a bottle or bathtub,

and he or she may smile or coo excitedly in anticipation of what's to come.

Spoil away.

Don't worry about spoiling your baby during the early months of his or her life.

Addressing your child's physical needs and desire for attention

helps establish a pattern of consistent and predictable loving care in your baby's mind.

This allows your baby to establish his or her own emotional comfort level.

In other words, your baby is learning to feel safe and secure and to trust you and himself or herself.

In addition, when you soothe your baby during a crying spell,

you're teaching your child how to regulate his or her emotions even in times of intense emotion or stress.

So pick your baby up as often as you like and hold your baby as much as you want.

It's good for both of you.

Spot check.

What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the second month.

Eating.

Feed your child with breast milk or formula exclusively.

Breast-fed babies are still likely to want to eat every two to three hours.

As the second month progresses, however, your baby's stomach capacity grows

and he or she may take in more milk out of feeding.

This may lead to a dropped nighttime feeding and hopefully more sleep.

The formula takes longer to pass through the stomach, so formula-fed babies are more likely to eat every three to four hours.

Within a month or two, though, the difference in nighttime feedings between breast-fed and formula-fed babies tends to even out.

Sleeping.

Your child may sleep between 15 and 16 hours a day.

As your baby's nervous system matures and stomach capacity increases, more of these sleep hours will be consolidated into nighttime hours.

At two months, your baby may be sleeping for five to six hours at a stretch at night.

Always place your baby on his or her back to sleep in a crib with no blankets, pillows, or toys to decrease the risk of sudden infant death syndrome.

SIDS.

Toys and Games.

During the second month, your baby will gradually be awake for longer periods of time and have more quiet alert times.

You can take advantage of these times by providing stimuli that encourage your child's development.

But let your baby guide playtime.

Watch for clues that he or she is tired or overstimulated, such as turning away, closing his or her eyes, or becoming irritable.

Also, keep in mind your baby's physical limitations.

During physical play, be gentle and careful not to shake your baby or toss him or her in the air.

These activities can cause severe injury to your baby's eyes, neck, and brain.

Here are a few suggestions for playtime with your one to two month old.

Keep Up Tummy Time.

Regularly placing your baby on his or her belly for a short time while he or she is awake helps develop neck muscles and increase head control.

You can share in tummy time fun by lying on the floor, facing your baby, and talking to him or her.

Your baby will work neck and arm muscles to lift up and be face to face with you.

You can also encourage your child to work those muscles by putting toys just within his or her reach.

Set Up a Mobile.

Your baby is better able to hold his or her head steady enough to look straight up while lying on his or her back.

Mobiles can become particularly fascinating.

When choosing a mobile, look at it from your baby's perspective.

Keep in mind a child's preference for simple shapes, high contrast, and bright objects.

Some models will even twirl around a music, engaging both your baby's eyes and ears.

Be sure all items are secured completely and placed out of baby's reach.

Introduce Color.

As your child's vision improves, he or she will become more appreciative of bold, vivid colors, in addition to high contrast patterns.

Visit your local library to borrow books containing brightly colored art or photographs,

or arrange a still life of bright oranges, tomatoes, and asparagus for your baby to contemplate.

Encourage Familiarity.

Try reading the same story several nights in a row to your baby, and see if he or she starts to show signs of recognition.

Or play a favorite song several times during the week, and see how your baby reacts 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 continue to exist even if they're out of sight.

For example, if a dog wanders into your two-month-old's field of vision and then out again, your baby may stare for a few seconds 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 eight 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 feel pretty magical.

Big Sisters and Brothers.

Having a new baby in the house brings a special excitement for families that already have kids,

although caring for other children as well as a newborn can be challenging.

You'll also have the rich experience of watching the relationships of your children grow as brothers and sisters.

Generally, children are quite excited at the prospect of having a real live baby in the house.

But what they may not realize is that they'll need to share you, their parent, with another person.

Sometimes, this can lead to older children acting out in order to garner more attention or even lashing out at the baby.

With time, though, most children learn to adjust to the household reorganization and find their own special niche.

You can help them with this by doing the following.

Post-Pone Major Changes.

During the weeks following your baby's arrival, try to avoid any drastic changes in older children's routines.

This may mean waiting a while to potty train, switch from a crib to a bed, or move to another home.

Let each child set the pace.

Despite being raised in the same family, each child can react differently to a new baby.

Responses may vary from excited giggles to hyperactivity to lack of interest.

Sometimes, a child's reaction is delayed for weeks.

Allow your children to become accustomed to the baby in their own time.

Set Clear Expectations.

Let your older children know what is appropriate behavior around the baby.

For example, let your child know it's never okay to pick up the baby without permission.

But that it is okay to sit next to the baby and talk nicely to him or her.

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.

Make Time for Older Kids.

Sisters and brothers of babies need lots of personal attention too.

Make plans to leave the baby with your partner or a reliable sitter

and spend some undivided time with your older children.

Be Patient and Positive.

Some children start to regress after a new baby arrives.

Going back to trying on diapers, sucking a thumb, or talking baby talk.

This isn't uncommon. Be patient during this period of adjustment.

Treat regression in a matter-of-fact way.

For example, I see you at your bed this morning. We'll change the sheets.

These simple sentences state the problem and offer a ready solution.

Second Month Milestones.

During the second month, your baby is busy working on lifting up shoulders while lying on belly,

holding heads steady while sitting, becoming aware of own fingers,

relinquishing grasp reflex, straightening out legs and strengthening kicks,

focusing on objects moving across field of vision,

cooing and making sounds, recognizing parents' faces, being reassured by parents' touch,

learning to smile in response to parents' smiles,

learning to smile spontaneously to express happiness or contentment.

Chapter 21 Month 3

While a solid block of sleep may still seem elusive at your house by the third month,

your son's or daughter's range of motor control, mental engagement, and social interaction is widening dramatically.

The confluence of a number of factors affecting your baby's growth and development,

maturation of the nervous system, development of the senses, reinforcement of the memory pathways in the brain,

expansion of the range of emotions, all contribute to your baby's burgeoning interest in his or her family and the world around him or her.

Babies Growth and Appearance.

In the third month, the rate at which your baby gains weight and grows in length should continue at a good clip and roughly match last month's rate.

Most babies gain between 1 and 1/3/4 pound and lengthen by about a half an inch a month during the first six months of life.

Head Circumference increases by about half an inch a month during this time as well.

If you're worried that your baby seems too thin or too chubby, be careful not to judge by appearance alone.

Since infants tend to carry different amounts of weight at different stages of development,

making judgments about baby fat on the basis of appearance alone isn't reliable or effective.

Instead, talk to your baby's medical provider about your concerns.

He or she will plot your baby's growth on charts that show measurements for height, weight, and head circumference.

You can use the charts yourself to compare your baby's growth with that of other infants of the same sex and age.

What really matters, however, is the trend revealed on growth charts, not any particular percentile.

Your baby's provider will look mainly for predictable changes in weight over time.

If you're following your baby's hunger cues for feeding and his or her growth is progressing steadily,

there's generally no reason to worry about your baby's size.

Baby Fat

Babies need a diet high in fat to support growing during infancy.

In addition, a diet high in fat helps to build a thick casing, myelin sheath, around nerve fibers in the brain and spinal cord.

This sheath offers installation for nerve fibers and helps ensure that nerve impulses are sent efficiently.

It's true that many medical providers and medical researchers are concerned about the rise in childhood obesity.

Some evidence suggests that this problem may arise earlier than previously believed.

For example, some studies have linked rapid weight gain in the first year of life to obesity later on in life.

Excess baby fat may also have more immediate consequences, such as delaying the development of crawling and walking.

Yet the first year of life is no time to put your baby on a diet or restrict calories unless your baby's medical provider has given you specific feeding instructions.

Your baby needs adequate nutrition to develop properly.

Steps that may help reduce the risk of later obesity include breast feed for as long as possible.

Several studies have shown a connection between breastfeeding and reduced childhood obesity.

The mechanisms for this link aren't clear, but it may have to do with the ability of breastfed babies to self-regulate their intake of milk.

In other words, baby decides when to stop eating.

If you're bottle feeding, try to follow your baby's cues that he or she is full.

Don't make your baby finish a bottle just because the milk is there.

Avoid juice.

Don't give your child juice until he or she is older than six months, and even then you don't have to.

Offering juice before this age may displace regular breast milk or formula feeding, which can leave your baby deprived of necessary nutrients.

If you choose to offer juice after your baby is six months old, serve it in a cup rather than a bottle and limit it to no more than four ounces a day.

Don't use food as a pacifier.

If you've just fed your baby and he or she still seems fussy, try other methods of distracting him or her before resorting to another feeding to quiet baby down.

Baby's movement.

By the third month, added muscle strength gives your baby new vantage points from which to peer at the world.

As your baby becomes more and more purposeful in his or her movements, you'll notice those newborn reflexes fade.

Head and neck.

Lying belly side down, baby's this age can usually lift up their heads and shoulders.

Some infants may even extend their arms and rest on their elbows.

This gives them even more support for looking around.

In turn, looking upward and sideways while on their tummies further increases neck strength and head control.

Increased head control means that your baby's head lags less when you pull him or her into a sitting position.

Also, when you support your baby seated on your lap, your baby can hold his or her head up for longer periods of time instead of just a few seconds.

In the third month, you'll notice your baby's back still rounds forward.

But as your child's movement, motor skills develop, the muscles in the upper and then lower back will strengthen as well.

Strong back muscles act as a balance and brace for your baby's body so that he or she can eventually sit straight, unsupported, crawl, stand, and then walk.

Hands and arms.

A favorite pastime for your baby this month is likely to be watching his or her hands, bringing them together at eye level and trying to bring them to his or her mouth.

You may notice that your child's hands begin to uncurl from their previous clenched fist position.

At this age, babies begin to experiment with opening and shutting their hands and spreading their fingers wide to test and inspect them.

Your son or daughter may also start to grip objects intentionally rather than reflexively, but then have a hard time letting go.

The next step will be to gain enough finger dexterity to hold onto a toy and then transfer it from one hand to the other.

Eventually, he or she will be able to pick a toy up and set it down again, solidifying basic fine motor skills.

At the same time, your child may start reaching for objects by swiping or batting at them with broad arm movements and clenched fists.

As your child's hands become more open, he or she will have better luck hitting the attended target.

Legs.

Your baby's legs are becoming impressively strong, and he or she is likely to experiment with flexing his or her legs and knees at will.

Some babies, especially when they're excited, may even kick hard enough to flip themselves over.

In preparation for purposely rolling over, your baby may start rocking back and forth.

In fact, by three months of age, many babies start to roll from their backs onto their sides and then onto their backs again.

Because your baby is more mobile, always take proper precautions to prevent him or her from wiggling off of a changing table or flipping out of a car seat.

Strap your baby in and stay nearby to avoid any accidents.

Baby's Sensory Development

Although the development of your baby's senses isn't as easy to observe as the development of motor skills and coordination, one is essential for the other.

Even though your baby can't tell what he or she is experiencing, playing with and watching your baby will help you know how well your child sees and hears.

Vision

Your baby's sight is maturing rapidly. In the next few months, he or she will begin to view the world in much the same way as you do.

By two or three months old, your baby's ability to simultaneously turn both eyes inward to focus on a close object, convergence, is developing steadily.

Convergence allows your baby to focus on and play with his or her hands. At the same time, your baby is learning to focus on distant objects by simultaneously turning both eyes outward. Divergence.

As your child's vision matures, he or she will be able to notice details of a pattern and to tell whether there is more than one object in a picture.

As distance vision improves, you may catch your baby studying you across the room or gazing intently at a ceiling fan.

Your baby is also getting better at distinguishing between colors and may especially enjoy primary colors.

Around this time, your baby also learns a skill that encompasses both sensory and social development.

Your baby will look at your eyes and then turn to discover what it is that you're looking at. This is called shared attention.

During the third month, if you still see your baby's eyes crossing or you notice there seems to be a lag in one eye, let your baby's medical provider know.

If it happens consistently, the provider may refer your child to an eye specialist so that if needed, steps are taken to correct the vision problem.

Hearing. Your baby's hearing contributes to a growing sense of familiarity and comfort with the world around him or her.

Around the third month, your baby may quiet when he or she hears your voice or get excited when he or she hears siblings or a favorite song.

Taste and smell.

Toward the end of this month, your baby is starting to distinguish between different tastes, such as breast milk versus formula or a new brand of formula.

Your baby also is likely to favor certain smells or be turned off by other smells.

These factors can sometimes affect feeding preferences depending on your baby's temperament.

For example, if your baby is very sensitive to odors and finds a smell unpleasant, he or she may not want to eat while the smell is present.

Baby's mental development.

As the nerve cells in your baby's brain mature, connect with other brain cells and become insulated with fatty myelin.

Your baby's brain is able to assert greater control over the rest of his or her body.

You can see this when you observe your baby making purposeful movements, such as bringing a hand up for inspection or reaching out for a toy.

To execute these intentional motor skills requires subtle complexities in thinking, reasoning, and planning skills.

Interest.

What is that thing dangling in front of me?

Speculation.

What happens if I try to touch it?

Trial and error.

Moving my arm this way seems to work better than moving it that way.

If your baby succeeds in making the toy rattle or make noise, for example, further information processing and analysis is required.

What was that noise?

How did it happen?

Can I make it happen again?

Laying down tracks.

Repetition of experience is how memories are created in an infant's brain.

Over time, your consistent response to your baby's needs, feeding, cuddling, bathing, soothing, carrying, lays down pathways among your baby's brain cells that become reinforced and streamlined

every time you respond in a similar manner.

By the third month, these memory pathways are becoming more clearly defined, and your baby is starting to have a better understanding of the connection between his or her behavior and your reactions.

For example, your baby has 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.

Expanding communication.

At the same time, your baby is building an increasing repertoire of sounds and gestures as means of communication, squealing, growling, blowing raspberries, and experimenting with consonant sounds.

As your baby approaches three and four months of age, he or she may initiate conversations with you by smiling, cooing, or squealing.

Acknowledging your baby's overtures is sure to delight. Repeat the sounds your baby makes, so he or she knows you're listening.

Also, talk back to your baby in parentese. Use real words, pronounce correctly and clearly, but at a high pitch and with exaggerated tones.

This helps your baby learn the sounds of your language.

Most parents naturally use parentese when they talk to babies, so don't be embarrassed. Go ahead, your baby will love it.

Once you've said your piece, pause to allow your baby to respond with a look, wiggle, or sound. This will help him or her learn the rhythm and timing of effective communication.

Baby's social development.

It doesn't take long for parents and family to become the most important people in an infant's life.

Your baby's world is centered entirely around you and your family.

He or she is involved in your everyday lives, watching, listening, and picking up clues on how humans interact.

And your family will be the first people with whom your baby interacts.

A real charmer.

Around this time, your baby is not only pleased with your attention, but is starting to discover his or her own powers of attraction.

With a smile or a squeal of excitement, your baby knows he or she can draw you out to respond in kind.

Your baby is able to make and maintain eye contact and interact more vigorously with those around him or her.

Make your attention available when your baby seeks it. Try to carve out time away from distractions, such as phones, TV, and other devices.

Some babies even start to giggle or laugh in response to facial and vocal expressions, or in response to touch.

In general, laughter usually comes a month after social smiling and is a great addition to your relationship.

At this stage, your baby has yet to develop anxiety about meeting strangers and may even be fairly outgoing and happy to meet other people.

This may be an opportune time to introduce your baby to the concept of staying with grandparents, or a babysitter for a few hours, and to develop a bond with these trusted adults.

In a few months, your baby may not be so keen to be separated from you.

But if he or she has been accustomed to the idea that although you may go away for a short while, you always come back.

This may make it a little easier when it is necessary for you to temporarily leave your child in the care of another.

Wanting attention

During this month, you may also notice that your child cries not just to express a need or a feeling, but in order to get your attention.

In the coming weeks, crying in general will decrease, thankfully, but it's likely to become more purposeful and directed at bringing you back to your baby's side.

Continue to respond quickly, or as quickly as possible, and warmly, even if just by calling out to your child.

This will help reassure your baby that you're still there.

This continued responsiveness helps to cement the trust and sense of security your baby feels in you.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the third month.

Eating

Breast milk or formula exclusively.

Longer stretches of sleep at night may mean more frequent feedings during the day,

but through this month and the next, you can expect your baby to gradually take in more milk at a single feeding,

perhaps resulting in fewer feedings throughout the day.

Between two and four months of age, the average baby eats around two ounces per day of body weight every 24 hours.

Sleeping

About 15 hours a day.

By about three months old, many babies sleep for a solid six to eight hours during the night.

Still, this doesn't always coincide with your own block of six to eight hours of sleep.

Expect to be up once or twice during the night, especially if your baby has a growth spurt and needs more frequent feedings.

Hold off on purees and solids.

For the first six months, breast milk or formula is generally the only food your baby needs.

Its liquid form perfectly matches your baby's eating skills, habits, and digestive abilities.

Before age four to six months, your baby isn't developmentally ready for purees and solid foods.

At this stage, your baby still manages milk or formula by moving it from the front to the back of the mouth by sucking, then swallowing.

This sucking reflex is aided by the tongue protrusion reflex in which the tongue pushes forward to help the baby suck.

This reflex is still strong during this month and next, which means that it's difficult for a baby to manage more solid textures.

Babies at this age tend to push out cereals or solid foods rather than swallow them, which can make spoon feeding a frustrating experience for you and baby.

Signs that your baby may be ready for solid foods include good head and neck control, being able to sit supported, and opening his or her mouth when a spoon approaches.

All skills that usually come a bit later, see chapter four for more details.

Toys and Games

As your baby becomes more interactive, it becomes even more fun to play together, especially when your baby discovers the ability to laugh sometime during this month or next.

Around this time, your baby may also become more interested in objects or toys that he or she can touch or hold.

Choose toys that are lightweight, easy to grasp, drool resistant, too big to swallow, and that don't have sharp objects.

Some examples include board books, soft blocks, wooden and plastic spoons, measuring cups, empty containers, rattles, balls, and squeeze toys.

As long as the toys are safe, let your creativity flow.

Avoid shiny plastic wrap or plastic bags though, which can easily cover your baby's mouth and nose and cause suffocation.

Here are some other ideas for fun and games in the third month.

Get rolling.

To help your baby practice his or her rolling skills, lie side by side with your baby and encourage him or her to roll toward you.

Your baby will try to do this with his or her whole body, which essentially means rolling over.

In the beginning, babies usually find it easier to roll from back to side and then back again.

Congratulate your child when he or she manages a roll.

There's no need to push or pull though, as your child will perfect this skill and his or her own good time.

Touch and feel.

As your baby's hands gradually open up, try placing different textures in his or her palm.

Soft, smooth, fuzzy, bumpy.

See what textures your baby likes most.

Get a grip.

Place a toy or object in your son's or daughter's hand.

Let him or her hold it, feel it and move it.

Also, try this with objects that rattle, squeak or make noise.

Share in your baby's surprise when he or she succeeds in producing sound.

Set up batting practice.

Place your baby on an infant floor gym or play mat,

the kind that usually has brightly colored, different shaped objects dangling from it.

Your baby can practice reaching and batting at the toys, as well as discover different shapes and textures.

Another way to encourage reaching and grasping is to place your baby in an infant seat

and offer items that are in front, just above or below, or just to the side of your baby's eye level.

These games also help your baby develop depth perception and hand-eye coordination.

Get giggling.

Almost all little kids love gentle tickling, especially if you deliver it with laughter and exaggerated facial expressions.

Or try blowing a raspberry on your baby's belly.

Your baby may register surprise at first, but eventually, these activities are sure to generate

not just chuckles, but deep down belly laughs.

View timetables with caution.

Don't worry if your baby doesn't follow the exact timetable of development milestones outlined in these chapters.

In some cases, your baby's development may be well into the next chapter.

In other cases, the last chapter may be more appropriate.

All babies go through the same progression of milestones, but each baby reaches them at his or her own individual pace.

Even babies with developmental disabilities.

The timing of social development is likely to be even more variable than other aspects of development.

Returning to work.

Around this time, many working mothers and increasingly fathers are preparing to end family leave and return to work.

It's certainly not easy to leave a new little one in the care of someone else, even if temporarily, and especially after spending so much time together.

In the meantime, though, nothing can change the fact that you are now a mom or dad and you have a baby who thinks the world of you.

To make the transition back to work a little smoother, try some of these suggestions.

Let go of the guilt.

Returning to work after having a baby often leaves many new mothers feeling particularly torn,

but working outside the home doesn't make you a bad parent,

and it's okay 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, telecommuting, or working part-time.

Plan for feeding changes.

If you're breastfeeding and plan to continue doing so after returning to work,

ask your employer about a clean private room for breast pumping.

About two weeks before returning to work, change your nursing schedule at home

so you're pumping during the day for at least one to two feedings and nursing before and after your upcoming work hours.

Have someone else feed your baby a bottle of stored breast milk to help your baby adapt.

Start short.

If you can, go back to work late in the week.

That'll make your first week back to work more manageable.

Get organized.

Sketch out a daily to-do list.

Define what you need to do, what can wait, and what you can skip entirely.

Stay connected.

Keep in touch with your baby's caregiver to see how your baby is doing.

Some caregivers may be willing to email or text you a photo or short video clip of your baby during the day.

Make backup plans.

Know what you'll do if your baby is sick or your baby's caregiver is unavailable on a workday.

Whether it's you or your partner taking the day off or calling a friend or loved one to care for your baby.

Maintain a positive attitude.

Tell your baby how excited you are to see him or her at the end of the day.

He or she may not understand your words, but will pick up on your emotions.

Third month milestones.

During the third month, your baby is busy raising head and chest to look around while lying on belly.

Working on supporting upper body with arms while lying on belly.

Holding head steady for long periods while sitting.

Playing with hands at eye level.

Trying to bring hands to mouth.

Swiping at dangling objects.

Opening and closing hands.

Stretching fingers wide.

Holding toys briefly.

Stretching and kicking legs.

Developing distance vision.

Recognizing familiar people and objects from a distance.

Using eyes and hands in coordination.

Distinguishing between different colors, tastes and smells.

Increasing repertoire of sounds to include squealing, growling, consonant sounds and maybe even giggling.

Turning head towards sound.

Making eye contact.

Enjoying family and familiar faces.

Maybe even new people.

Using expanding communication skills to express emerging emotions.

Imitating some sounds, movements and facial expressions.

Learning to self entertain.

Chapter 22. Month 4.

Before you delve into month 4, pat yourself on the back.

You've made it through the first few months of parenthood.

Quite possibly one of the biggest transitions of your adult life.

At this age, most babies have begun to adjust to life in this brave new world.

They've also become much more secure in their relationship with 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 probably settled into a familiar routine.

And eating and sleeping schedules are becoming more regular.

The amount of time your baby spends fussing is probably on the decline.

Your baby's brain and nervous system have matured enough that he or she is ready to become much more interactive with family and friends.

While continuing to explore new sights and sounds.

Newborn reflexes are fading and your little one is starting to move and do things by design now.

In addition, your infant is getting much better at conveying emotions and desires.

And you're getting much better at understanding him or her.

In other words, the bond between the two of you is truly blossoming.

Take advantage of this time to enjoy each other's company and revel in the little things.

A giggle and a smile, a splash in the tub or a bug on a window.

Who knew life could be so exciting?

Baby's growth and appearance

Between three and four months old, your baby's growth is likely to slow a little.

Although you can still expect your baby to gain between three-fourths and one-and-a-half pounds over the course of the month and grow about half an inch in length.

Some babies may have doubled their weight by the end of the fourth month.

Head circumference increases by about a half inch.

You'll be able to compare notes with your baby's medical provider at the four-month well-child visit.

Keep in mind your baby's individual growth rate.

Skin rashes

You're getting ready to change your baby's diaper, and there, right there under your baby's shirt is a bright red rash.

Alarm bells go off and you rush to the phone to call your baby's medical provider.

This happens to just about every parent.

And while you should always call your baby's provider, if you notice something unusual or are concerned about your baby's health,

you should also know that most skin rashes and infants are common and usually not serious.

If the rash occurs along with a fever, call your baby's provider promptly.

Rashes and babies often result from skin irritants, such as soap or scratchy fabric,

or an underlying viral infection, such as Parvovirus infection or Rosiola.

Because rashes are so visible, they're a common cause of concern for new parents.

Most of the time, though, rashes aren't a sign of a serious problem.

It may not even require treatment other than proper skin care and perhaps a mild cortisone cream,

as indicated by your child's medical provider.

Some general rules of thumb for baby skin, including avoiding long hot baths

and staying away from any substances or textiles that seem to cause a reaction.

Using gentle moisturizers daily can help soothe and protect the skin.

You can read more about common skin rashes in Chapter 7.

Bedtime routine

It's probably a safe bet that almost all new parents are hoping to find somewhere

in the pages of a book, in advice from a friend, or on a website,

the secret to getting their kids to sleep.

Alas, there is no simple solution.

Your child's sleeping habits depend on a number of factors, including his or her age,

the length of time he or she can go without feeding, and his or her personality.

Some babies snuggle down without a peep and waken briefly for feedings.

Others cry every time you put them in the crib and have a hard time lulling themselves to sleep.

During the first few months of your baby's life, it's important to respond to your baby's cries

and provide enough soothing to optimize sleep.

But around the third and fourth month, you can start taking steps to help your child fall asleep on his or her own.

An important skill that every child must eventually learn.

Parents at this stage often worry about letting their babies cry it out.

There is plenty of advice out there on the best way to get your baby to sleep.

See what method works best for you.

In the meantime, there are a couple of things to keep in mind.

One, a little bit of crying won't harm your baby, and it won't affect his or her attachment to you.

Your overall approach of loving care is what bonds the two of you together.

Two, if your son or daughter isn't keen on self-soothing at first, hang in there.

It can be tough initially, but one thing is for sure, this phase won't last forever.

And if you establish consistent bedtime practices, your child eventually will be sleeping like a baby.

Oh, the irony.

For tips on how to help your little one sleep well, see Chapter 9.

Babies Movement

Around the fourth or fifth month, the newborn reflex that makes your child look like a baby fencer,

when your baby's head turns in one direction, the arm on that side straightens,

and the other arm bends over the head, tonic neck reflex, begins to fade.

This clears the way for further development of your baby's gross motor skills,

skills that involve his or her large muscles.

At this stage, babies often seem fidgety, but they're really exploring purposeful coordination of their large muscle groups to move around.

At four months old, most babies are exercising their arm muscles by pushing up with their elbows or hands when on their tummies.

These mini push-ups give your baby a new vantage point and help strengthen muscles necessary for rolling.

Some babies may even use this newfound arm power to scoot around in a circle or move around a few inches.

At the same time, your baby's fine motor skills, skills that generally involve the hands and fingers,

are being refined as he or she works to improve his or her grasp.

Head and Back Control

As your baby's four-month birthday approaches, he or she is achieving good control of the head and neck.

Full head control is an important milestone that's essential for other motor skills, including sitting, crawling, and walking.

While lying down, your baby is apt to lift the head and shoulders,

to look straight ahead while resting on his or her hands and arms, a favorite portrait pose of photographers, and who can blame them? It's downright cute.

When pulled up to a sitting position, about half of four-month-old babies are able to keep their heads in line with their bodies.

In fact, your baby may even lift his or her head to try to help himself or herself sit up.

By the middle of this month, most babies can keep their head steady when held in a sitting position.

While sitting, your baby's back muscles are working on keeping the spine straight, reducing the hunched appearance.

Rolling Over

On average, this is the month that babies really get rolling. Some may have started rolling even earlier,

but don't worry if your baby isn't there yet by age four months. You'll probably notice some rolling attempts in the near future.

A few babies even skip this milestone altogether.

Rolling from front to back, which requires only a shift in gravity, is generally easier than rolling from back to front.

This is why many babies roll from front to back first.

Giving your baby a little floor space and plenty of tummy time while he or she is awake will provide him or her with opportunities for practice.

Rolling from back to front, which tends to occur a little later, requires more complex maneuvering, such as rocking, arching the back, and twisting the legs to flip over.

Each baby is different, though. Some roll one way, others another.

Whether your baby is rolling or not, and which way isn't as important as whether he or she shows interest in moving from one spot to another,

don't wait to discover your baby's ability to roll until he or she ends up on the floor from having rolled off the couch or bed.

Take precautions not to leave your baby unprotected on elevated surfaces.

Standing

By the end of the fourth month, most babies can, with a little help, bear their own weight on their legs.

If you hold your baby upright, he or she will likely push down with his or her feet.

In fact, you may start to feel as if your lap is an infant trampoline as your baby learns to bounce vigorously in that position.

Standing and bouncing while well supported won't hurt your baby's legs or hips, but will give them, and you, a good workout.

Just make sure you're not trying to hold a hot cup of coffee or tea at the same time.

If your baby doesn't push off with his or her feet right away at age four months, don't fret.

If your child still doesn't do this at six months old, you might mention it to your child's medical provider so that he or she can determine if further investigation is necessary.

Reaching and grasping

During this month, your baby is likely to be busy waving his or her arms about, batting at nearby objects and trying to reach them.

If you present your baby with a rattle or similar toy, he or she is likely to grasp it, shake it, and maybe even bring it to his or her mouth.

You may notice that sometimes your baby intentionally looks at and reaches for an object.

Other times, your baby's hand may touch something and instinctively grab it, and your baby may seem surprised or intrigued by what has unexpectedly appeared in his or her hand.

This change from grasping as a reflex to reaching for things voluntarily is gradual.

Baby's sensory development

Throughout these months and until your baby's six months, your child will do a lot of exploring by touching, feeling, and mouthing whatever comes across his or her grasp.

Combined with hearing and seeing, these sensory skills promote the development of your child's motor, mental, and social skills.

Seeing an object encourages your baby to reach for it.

Grasping and touching the object helps your infant become familiar with it.

Shaking and hearing it make noise helps your child learn about cause and effect.

Listening to you respond to his or her accomplishments, aids in his or her language development, and social interaction.

You can see how various aspects of development form a complex interplay that contributes to your child's overall growth as a person.

Mouthing

At this stage, your baby's mouth is more sensitive to an object's characteristics than our his or her fingers.

Your baby also lacks the dexterity to manually investigate an object.

But tongue and lips are perfect.

And if your baby can't bring the object of interest to his or her mouth, he or she will likely bring mouth to object by bending down to suck on it.

You can spend a lot of time discouraging your son or daughter from putting things in his or her mouth,

or you can stockpile a variety of safe toys with interesting textures that will further peak your child's curiosity and encourage oral exploration.

If your baby reaches for something dangerous, your best bet is to quickly remove it from sight and distract your baby with a more appropriate toy.

At this age, your baby doesn't understand that something may be harmful and is only interested in its appearance.

This is why it's especially important to safeguard your baby's play area and remove any potential hazards.

Hearing

Listening is another way of exploring an environment.

By the fourth month, your baby may not only quiet at the sound of your voice, but turn his or her head toward you as well.

He or she may also turn his or her eyes toward a specific sound.

For example, a rattling sound or the sudden onset of music to find out where the sound is coming from.

Vision

By four months old, many babies have improved visual tracking abilities and can watch a brightly colored object as it moves in a slow arc overhead.

You might also notice your baby focusing on very small objects such as a piece of yarn or a crumb and regarding things in the distance with great interest such as a tree outside the window.

Improving hand-eye coordination, being able to see and reach for an object further encourages his or her exploration instincts.

Baby's mental development

Brain activity during these early months is at one of the highest peaks in a person's lifetime.

And as your baby becomes more mobile, you can really observe his or her curiosity begin to emerge.

Everything is an object of interest and your baby uses all of his or her powers, looking, touching, smelling, chewing, to discover and explore whatever's nearby.

Including his or her own hands, cheeks, legs and other body parts.

Language skills

Since birth, your baby has been building language skills by listening to others and by picking up communication clues from the inflection and tone of their voices.

Although words are still a jumble by age four months, your baby is familiar with many of the sounds you make and may begin to experiment with making some of these sounds on his or her own.

Warmly encourage these baby conversations.

Talk about your surroundings and what you're doing.

Imitate your baby sounds.

These exchanges between you and your baby are key to developing the nerve cell networks that form the foundation of your baby's brain architecture.

Laughter

During this month, your baby probably laughs out loud frequently.

Laughter evolves out of cooing and gurgling and usually comes about a month after your baby's first real smile.

At first, the laugh tends to come in response to something. A laugh from you, a funny face from an older sibling.

Your baby may also laugh to get your attention or just for the experience of making noise.

In the coming months though, you'll notice the beginnings of a sense of humor.

For example, something out of the ordinary may strike your baby's funny bone.

Baby's social development

During the fourth month, your baby likely is starting to show clear signs of recognizing you and other members of your family.

If you have other children, they may be your baby's most popular playtime friends.

Children can easily make a baby smile and laugh.

For siblings, this is a honeymoon time.

The baby is old enough to thrill an older brother or sister with smiles and giggles, but still too young to be "trouble" getting into toys and interrupting play.

At this age, your baby has yet to develop stranger anxiety and is likely to enjoy meeting new people, smiling, wriggling and laughing with anyone who will respond.

This is a comfortable time for most parents.

The baby is big enough that you're not overly concerned about safe handling and you know the baby is comfortable with someone else.

At this age, it's easy to share the fun of your baby with others.

Distractions

As your baby nears four months old, feeding times become less frequent and his or her attention is drawn to other people and activities during feeding.

Your baby may move around or stop feeding to play or talk to you.

This distraction isn't a sign that your baby is rejecting breastfeeding or is bored with formula.

An easily distracted baby is normal as the baby discovers and explores the world.

Your baby may discover that feeding time can be more than a time to eat.

It's also a time to socialize, experiment and assert some independence.

As much as you want your child to learn through exploration and interaction, it can be frustrating to feed a distracted baby.

You might try a quiet uninterrupted feeding place.

Early morning feedings, when your baby is still sleepy and the room is dark, may be the best feeding of the day.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the fourth month.

Eating

Feed breast milk or formula exclusively.

During this month, the number of daytime feedings generally decreases to about four or five.

But a mid-month growth spurt may lead to more frequent feedings for a few days.

Although it may be tempting to get your baby started on cereal or other solid foods during this month,

hold off a little bit longer until your baby shows clear signs that he or she is physically ready for solids.

C Chapter 4

Sleeping

Expect your child to sleep about 15 hours a day, including more predictable nighttime hours of sleep.

Generally, six to eight hours, although every baby is different.

Around this age, babies become more active sleepers, making noise, scooting around and often waking their parents.

It's okay to give your baby a few minutes to settle back down without your help.

This allows your baby to learn to self-soothe upon waking at night.

Although your baby is moving around more, maybe even starting to roll,

it's still important to put your baby on his or her back to sleep.

By this time, your baby may also have settled into two to three daytime naps, lasting about an hour or two each.

C Chapter 9

For More on Sleep

Keeping Playtime Safe

Your baby might not be crawling yet, but it's around this time that babies start putting 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 free of any potential hazards.

Get into the habit of doing a baby-level safety check each time you put your baby down on the floor to play.

Get down on your hands and knees at your baby's level and look for these items.

Small objects your baby could accidentally swallow, such as coins, button batteries, magnets, paper clips, or small pieces of food or candy.

Toys with small parts, balloons, uncovered electrical outlets,

poles for window blinds in which your baby could get entangled,

electrical cords to irons, lamps or other appliances that could fall if the baby tugs on the cord,

plastic bags or wrappings that could suffocate your baby,

newspapers and magazines, a pet's toys or treats,

houseplants.

These safety searches can become fun and helpful activities for older siblings to get involved in.

Help them understand the things that can be harmful to a baby.

This will increase their awareness about the hazards of leaving toys and objects around the play area.

Laughter as a life skill.

Encouraging laughter and humor in your household can have benefits for both you and your family.

Laughter can be a bonding agent.

When people laugh together, they bond together over the shared experience and emotion.

Laughing with your baby helps you become closer.

Stress reliever.

When the house is a mess, your clothes smell like spit up and dinner is mediocre at best.

Balancing it all with a good laugh can diffuse the stress you might be feeling and unconsciously passing on to your children.

Even babies sense when their caregivers are stressed and tend to reflect these emotions.

So instead of rushing to load the dishwasher or check your work email,

take a few minutes to giggle and laugh with your baby after a long day.

It'll make you and your child feel better.

Immune system booster.

Evidence suggests that a good belly laugh can actually increase immune system cells that fight viral illnesses and various cancers.

Resilience maker.

If you habitually show your children that you can still laugh despite life's curveballs and momentary imperfections,

you're ultimately teaching them about resilience and the ability to withstand distress,

a skill that will serve them well throughout life.

Toys and Games.

Promote your baby's motor development, peak his or her curiosity,

and encourage exploration of the world around him or her with some of these activities and toys.

Practice sitting.

Once your baby can hold his or her head up fairly well,

try sitting your infant up in a baby seat or against cushions for support.

This will improve your baby's sense of balance and help strengthen back muscles.

Sit face to face and play singing and clapping games together.

You can also set him or her up against the curve of your own body while you lie on the floor.

Don't expect the sitting to last too long at this point though.

After your baby topples over a few times or tires of sitting, switch to a different activity,

such as belly play or reading a book together.

Choose toys that stimulate the senses.

Keeping in mind your baby's penchant for mouthing at this age,

choose toys that won't be harmed by a little dampness or chewing.

Soft books with textured corners and squeaky pages are both fun and practical.

Other ideas include a bumpy teething ring,

a ring of big plastic keys, measuring cups or soft blocks.

Also, look for toys or everyday objects that your baby can practice holding onto,

shaking and manipulating.

Make sure the toys you choose have no small parts that can come off

and pose a choking hazard to your baby.

Play mimicking games.

Starting around this age, your baby is becoming intent on studying the sounds you make

and trying to produce his or her own versions.

Take the time to listen to your baby's vocalizations, then try to imitate his or her sounds.

Talk back to your baby, speaking slowly and clearly,

and allow him or her time to try to make the same sounds.

If you speak a second language, use it with your child.

Mimic facial expressions and laughter too.

This encourages your baby's language skills and social interactions.

Enjoy bath time.

As it becomes easier for babies to sit when supported,

parents often turn bath time into play time.

The weightlessness of the warm water and the freedom from restrictive diapers and clothing

all make for a great sensory experience.

However, remember that bubble bath and soap can be irritating to a baby's eyes,

skin and genitals.

And keep a close eye and a good grip on your baby.

The water makes your wiggly, active baby extra slippery.

Never leave your baby alone in a tub.

Fourth month milestones.

During the fourth month, your baby is busy pushing up on elbows and hands

to look around when lying on belly,

sitting supported with head steady,

practicing moves that enable rolling over,

bearing weight on legs, bouncing with arms supported,

grasping and shaking toys, practicing letting go,

bringing hands to mouth, exploring items with mouth,

studying small items, gazing at things in the distance,

looking for the source of a sound,

becoming more communicative with body language and vocalizations,

laughing, imitating language sounds,

engaging in back and forth conversations with you,

enjoying playing with others, capturing attention.

Chapter 23, Month 5

Many parents eagerly look forward to this month

because it means you can finally 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 societal traditions and pastimes.

So it's natural for parents to want to share the joy

of eating favorite foods with their children.

It's also another step toward integration into the family

when baby gets to join the others at the dining table.

As much as you may be excited to embark on culinary adventures

with your baby, keep in mind your baby's stage of growth and development.

In this chapter, you'll read about signs that indicate

that your baby is ready for solid foods,

as well as tips on successful introduction.

You can read a more in-depth discussion of infant nutrition in Chapter 4.

During the fifth month, your baby gains increasing control

over his or her body, enthusiastically exploring each new found function.

He or she is also continuing to discover new emotions,

ranging from happy to grumpy,

and solidly establishing his or her place in the family.

Baby's Growth and Appearance

Between 4 and 5 months old,

your baby's growth rate is likely to match last month's,

which is a little slower than the first 3 months, but not by much.

Most babies gain anywhere from just shy of 1 pound to 1.5 pounds or more.

Length and head circumference both increase by about half an inch during this month.

Introducing Solid Foods

Between this month and next,

your baby will begin to develop the coordination to move solid food

from the front of the mouth to the back for swallowing.

At the same time, your baby's head control will improve,

and he or she will learn to sit with support,

essential skills for eating solid foods.

Breast milk or formula is enough to meet your little tykes' needs

in the first 4 to 6 months,

but eventually, additional nutrition is necessary,

so that your baby can continue to thrive.

After 6 months of age, for example,

breast milk alone generally isn't enough to provide your baby

with the amount of energy, protein, iron, zinc, and other nutrients he or she requires.

Is Your Baby Ready?

Sometime between ages 4 and 6 months,

most babies are ready to begin eating solid foods

as a complement to breastfeeding or formula feeding.

But age should not be the only determining factor.

You want to make sure your child is both physically and socially ready,

and you shouldn't feel pressure to begin solids.

The American Academy of Pediatrics

prefers that parents wait until a child is 6 months old

to introduce solids if possible.

If you're not sure whether your baby is ready for solids,

ask yourself these questions.

Can your baby hold his or her head in a steady, upright position?

Can your baby sit well with support?

Is your baby interested in what you're eating,

perhaps eyeing your breakfast toast,

or opening his or her mouth if you offer a spoon?

If you answer yes to these questions,

and you have the OK from your child's doctor or dietitian,

you can begin supplementing your baby's liquid diet.

Read more about what to serve, when, and which foods to avoid in Chapter 4.

Tips for a Successful Meal

Once your baby starts eating foods besides breast milk or formula,

feedings are likely to become a lot more interactive,

and most probably, a lot messier.

But that's OK.

It's all part of the process of exploring new things.

Here are some suggestions for when your little one reaches the point

that he or she is ready to try solids.

Pick a happy time.

For your first try, choose a time when your baby's most likely to be open to adventure,

such as when he or she is alert, dry, comfortable, and not starving.

If your baby's very hungry,

you might want to start off with a little breast milk or formula first,

and then switch to solids.

Set your expectations.

Remind yourself that the goal of these first solids

is to introduce your baby to the experience of food,

rather than to meet your child's nutritional needs.

In fact, it will likely be several weeks before the amount of food

that actually gets into your baby's belly

is contributing to his or her overall nutritional requirements.

Sit up.

At first, try feeding your baby propped up in your lap or in an infant car seat.

When your baby can sit without support, you can move him or her to a high chair.

Try a spoon.

The American Academy of Pediatrics recommends encouraging your baby

to use a spoon or fingers to self-feed.

A small espresso spoon or a rubber-coated baby spoon,

usually works well.

Eating off a spoon helps your baby learn to swallow without sucking

and allows your baby to learn the process of eating

in the same way the rest of the family eats.

Avoid giving your child cereal in a bottle,

which may encourage excessive calorie intake.

Start small.

For your baby's first meal, start out with just a couple of spoonfuls of food,

such as cooked cereal or pureed meat or vegetables in a bowl.

Thin the complimentary food with breast milk or formula

until it's the consistency of heavy cream

to help ease the transition from bottle to spoon.

Over the next few meals, you can gradually make the consistency thicker

as your baby becomes accustomed to swallowing solid foods.

Be patient.

Although some babies seem thrilled with their first bowl of "big kid" food,

others may not be convinced of its joys the first time around.

If your baby flat-out refuses the first feeding, don't give up hope.

Clear the food away and try again a few days later.

Focus on enjoying meal time rather than getting your baby

to eat solid foods by a certain date.

He or she will have plenty of time to warm up to the spoon

as another vehicle for gastronomic delights.

The Scoop on Poop

Once you start feeding your baby solid foods,

you'll likely notice a difference in the texture, color, and smell of your baby's stools.

Solid foods make for more solid stools.

Foods such as peas, blueberries, and beets

can make noticeable differences in the color of stool as well.

Last but not least, get ready for stinky stools.

The added sugars and fats in solid foods can lead to a stronger odor.

Babies Movement

Between four and five months old, most babies achieve the first big milestone,

good head control.

By the end of this month, your baby is likely to be able to hold his or her head up steadily while sitting.

He or she will also learn to turn the head from side to side,

making it easier to track moving objects and identify different sounds and voices.

Once your baby has full head control,

he or she has the skills necessary to move on to sitting and just in time too.

As your baby gets older, he or she may become increasingly less satisfied

with lying either face up or face down

and will probably want to spend more time upright.

During this month and next, your baby is working towards sitting up without help.

Playing face down on the floor and lifting the head and chest to see toys

are good exercises to help your baby strengthen neck muscles

and develop the head control necessary for sitting up.

Rolling Over

At this point, most babies are making progress in their attempts to roll over too.

By the end of this month, some babies can even roll both ways without help.

Once babies learn to roll from front to back and back to front again,

they may start out sleeping on their backs just the way they were laid,

but then flip over in the middle of the night.

If this happens with your baby, don't feel compelled to flip him or her back again.

The risk of SIDS begins to decrease once your baby gains head and neck control

and is able to roll over.

Reaching and Grasping

During the fifth month, you may notice your baby start working for a toy or other object.

At first, this may mean that he or she reaches out for a toy,

but may not be able to grasp it on the first try.

At four months of age, your baby still manipulates objects by batting at them,

but eventually, he or she may try to pick up a larger object

by pressing it with the palm of the hand and curling the fingers around the object.

When your baby does get a hold of a toy,

he or she may grasp it with both hands and have fun shaking it around.

Dangling toys are still a source of entertainment at this age

and help your child further develop his or her hand-eye coordination.

Balancing

Your four-month-old most likely gets great joy out of being upright

and standing on your lap and perhaps bouncing.

All the bouncing your baby does is a part of normal development

and isn't harmful to your baby's hips, legs, or feet.

By about five months, you will notice that your baby can probably bear full body weight on his or her legs.

Standing alone and walking are still a long way off,

but you can see how the small stages of development are preparing your baby for greater mobility.

Encouraging physical activity

Take a look around your local baby supply store

and you'll see an amazing range of infant equipment -

swings, playpins, infant seats, stationery activity centers, walkers, baby gyms, bouncing chairs, oh my!

And with your baby learning so many new skills,

it's tempting to try to physically help him or her along with the latest gadget.

Quite a lot of infant equipment is marketed with the idea of helping your baby reach a new milestone, such as sitting or walking.

Truth

What infants need more than anything to develop their motor skills

is freedom of movement in a safe space

that allows them to explore their surroundings and to practice their budding skills

under the watchful eye of a nearby caregiver.

Warm interaction with a supportive caregiver during playtime also is important.

Does that mean you have to be constantly down on the floor with baby?

Not always.

Certain pieces of baby gear can definitely come in handy,

a stationery activity center where your baby can sit and bounce or play with attached toys

or a molded seat that helps your baby sit up.

Swings and playpins also can be essential at times,

but keep in mind that these items are mostly for your convenience,

allowing time for you to move about unrestricted to do some chores, say, or eat breakfast.

Try to limit the amount of time your child spends in these devices,

as extended movement restriction, in turn, may limit your child.

Be sure to supervise older siblings around these devices too,

as they may become over-enthusiastic in helping the baby use them,

potentially causing unintentional harm.

Think, "Mom, look how fast Sammy can go in the swing."

The American Academy of Pediatrics, AAP, advises specifically against using mobile walkers.

These devices generally have a cloth seat set in a frame with wheels

that allow the baby to move around the room,

even though he or she might not be able to crawl or walk yet.

A number of studies have shown that these devices can make a baby more prone to injury,

such as falling down steps or reaching for dangerous objects.

Even under supervision, the AAP contends that walkers are simply too fast

for a parent to reach before an accident happens.

Other experts have cautioned against the use of door jumpers,

seats that hang from a door frame as well.

If you need a place for your baby to safely amuse himself or herself for a few minutes,

consider a stationary activity center or playpen instead.

A high chair also can serve this function,

once your baby is able to sit in it safely.

Keep in mind that if your baby has a developmental disability,

his or her medical provider may in fact recommend certain pieces of equipment

to help your baby sit with support or move with help.

Baby's Sensory Development

During this month, Malving becomes an even more important avenue of exploration for your young child.

Keep offering him or her safe toys and everyday objects

to practice the art of picking things up and bringing them to the mouth.

This helps your baby develop sensory and motor skills.

At the same time, keep a sharp eye out for anything that might be a choking or poison hazard for your baby.

Vision

Earlier, your baby was learning to distinguish between similar bold colors.

Improved visual awareness during this month.

And the next, helps your baby discern more subtle shades of color, such as soft pastels,

although bold colors may still be favorites.

Improved visual tracking and coordination also help your baby become more adept at reaching and grabbing larger objects and toys.

Small objects are definitely catching his or her attention at this point,

but he or she doesn't yet have the dexterity to pick these up.

Babies at this age are also starting to discriminate between the different emotions they see in others,

such as joy, fear, or sadness, and to make similar responses.

Hearing

Between four and five months, about half of all babies turn their heads toward a voice.

Most babies at this age will turn toward a rattling sound to investigate its source.

At this age, babies also learn to distinguish emotions by tone of voice.

If by this month your baby doesn't respond to sounds, talk to his or her medical provider.

Although newborns are generally checked right after birth for hearing loss,

your observations at home are key to identifying the need for further testing.

Babies' Mental Development

As the brain develops and more and more connections are made between brain nerve cells,

your baby's memory of faces, sounds, places, and event patterns increases.

Although your baby has been absorbing information about the surrounding world since birth,

he or she has had only limited ability to respond to this new knowledge.

But as his or her motor skills increase, you can observe your infant begin to apply the knowledge stored in his or her memory.

This is evident in the way your baby reacts to seeing you or to certain daily routines,

such as a feeding or a bath.

If you sit in your favorite chair for breastfeeding or a bottle,

you may notice that your baby quickly settles in with you

and may make noises or kick in anticipation of what he or she knows is coming.

And if for some reason what's expected isn't forthcoming,

you may hear a squawk or two of displeasure.

Learning How Things Work

At the same time, your baby's curiosity and attention span are increasing.

This allows him or her to spend more time examining things and observing how things work.

This natural curiosity also drives your baby to start to work for objects that are out of reach,

even if he or she can't quite get to a toy yet.

You can see the focus and concentration in your child's eyes.

During this month, your baby is also learning more about cause and effect.

When he or she cries, you come.

When he or she bangs a toy on the table, it makes noise.

When he or she giggles, siblings giggle too.

Like a scientist, your baby may test different actions over and over

to see if they always get the same effect.

And, like a successful scientist, your baby will be proud every time the response is the one expected.

You'll appreciate your baby's smiles and squeals of accomplishment and self-confidence.

Language Skills

Your five-month-old may have already started imitating some of the speech sounds you make,

even though it will be a few more months before he or she understands how these sounds work together to communicate.

During this month and the next, your baby is likely to pick up on a single sound, such as "a" or "o",

and repeat it over and over.

And then a few days later, discover a new sound and practice it repeatedly.

Babies seem to enjoy playing with a new sound, as much as they delight in playing with a favorite toy.

Pretty soon, your baby will be babbling away at you, excited to hear sounds emanating not just from others,

but from his or her own mouth.

Continue talking to your baby every chance you get.

Regular face-to-face interaction with your baby is a key building block for mental, emotional, and social development.

When you respond positively to your baby's bids for interaction,

you're teaching him or her how relationships work, and solidifying the secure attachment your baby has to you.

Baby Social Development

At this age, your baby is quickly figuring 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 happiness 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 actions for safety's sake.

Growing Attachment

In the fifth month, your baby is establishing a solid place in the family structure

and clearly knows who his or her loved ones are.

Your baby feels comfortable with the family routine, and indeed expects it.

Spending time with you is still his or her favorite activity.

In fact, this closer sense of attachment to you and other family members

makes your baby feel upset and display unhappiness when you stop playing a game or leave the room.

He or she may even need a little extra reassurance that you're still available,

perhaps by talking to him or her or singing a song, and will return as soon as possible.

This narrowing focus of attachment goes hand in hand with a gradual realization that some people are strangers.

Although your baby likely still has an accepting, welcoming response to unfamiliar people,

in the months ahead, you'll notice that he or she is becoming increasingly picky about the company he or she wants to keep.

Emerging Personality

As your baby matures, his or her personality traits will rapidly become more apparent.

Is your baby bouncy and full of energy? Or perhaps 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 stubbornness?

Does your baby adjust easily to new environments? Or does he or she take a while to warm up?

Everyone is born with certain behavioral 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 diaper changes or wriggly feedings, frustrating.

Generally, your baby's natural traits can't be changed.

It would be like trying to change his or her personality,

but by learning your baby's normal behaviors and understanding his or her temperament,

you can better appreciate your infant and adjust your parenting style to bring out the best in him or her.

How you interact with your baby now can set the stage for your relationship throughout childhood, adolescence, and even adulthood.

You can read more about temperament in Chapter 11.

Spot check! What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the fifth month.

Eating. Breast milk or formula still plays the central role in your little one's nutrition,

although some parents begin to introduce solid foods during this month.

Be sure your baby is developmentally ready for solid foods before starting them,

such as being able to swallow, hold his or her head steady, and sit with support.

Sleeping. Your baby is more likely to sleep 6-8 hours a night with no interruption.

Some babies still wake up once or twice during the night for a feeding.

Total sleep may add up to between 14 and 15 hours in a 24-hour period,

including a couple of daytime naps, usually one in the morning and one in the afternoon.

Some babies may need a third nap late in the afternoon.

Getting kids to like fruits and vegetables.

A common battle parents face as their kids begin to eat solid foods is getting them to eat their fruits and vegetables.

Scientists are finding that part of the solution to this dilemma may very well go back to the mother's own eating habits,

perhaps even before a baby is born.

Since a number of food flavors are transmitted via amniotic fluid or breast milk to a baby,

what the mom eats affects the baby's early experiences with flavor.

Some evidence suggests that the more often a baby experiences a particular flavor,

such as carrots for example, during pregnancy or breastfeeding,

the more accepting the baby is likely to be of that taste when he or she begins eating solid foods,

and because breastfeeding offers a child a greater variety of flavor experiences due to a mother's varying diet,

breastfed infants seem less picky and more willing to try new foods.

Another finding suggests that flavor learning after the introduction of solid foods is based on repeated exposure to new foods.

One study, for example, found that the first time a group of babies tasted green beans,

many squinted, raised brows or upper lips, or wrinkled noses,

but after repeated offerings of green beans, expressions of surprise or distaste were fewer,

and willingness to eat the vegetables was greater, especially if the green beans were followed by a sweet tasting fruit such as peaches.

This type of research is ongoing, but in the meantime, it doesn't hurt to eat well yourself and keep setting the good stuff out there.

Chances are good that eventually your kids will enjoy it for themselves, and not just because you said so.

Toys and Games

At this young age, babies are interested in very simple objects and toys.

They also don't need a heap of toys to stay occupied.

In fact, too many toys or too much activity can overwhelm your baby and lead to tears.

Limit toys to just a few at a time.

That way, your baby can take the time to steady each one and see what it can do.

Toys and Games your baby may enjoy during this month include toys that make noise.

By now, your baby is starting to play purposefully with rattles and toys that squeak or make noise.

Offer him or her toys that make noise to enhance his or her discovery of cause and effect as he or she bangs and rattles about.

Infants also seem to derive great joy from pressing buttons that make things happen, such as on a pop-up toy or a baby phone.

Music to bounce, sway or swing to.

Music can help express emotions and thoughts when the words aren't quite there yet.

Most babies love music and will move along to a rhythm they find catchy.

Make a playlist of your favorite kid-friendly but not necessarily kid-y songs and play them for your baby.

Better yet, pick your baby up and sing and dance around the room together in accompaniment to the music.

The Company of a Mirror

Place an unbreakable mirror in front of your baby and watch as he or she and the other baby get acquainted.

At this age, your baby probably won't know that it's his or her own reflection, but will have fun watching his or her antics regardless of perception.

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 will encourage your child to practice reaching skills and improve his or her hand-eye coordination.

Fifth Month Milestones

During the fifth month, your baby is busy, perfecting mini push-ups while lying on belly,

sitting balanced by hands on floor in front, tripod style, bearing weight on legs,

rolling over from front to back, maybe even back to front,

working to get to a toy, grasping with both hands, exploring with mouth,

studying small objects, locating sounds and voices by turning head,

imitating speech sounds, repeating single sounds, laughing, squealing,

expressing dislikes, making faces, enjoying playing with others, crying when playing stops.

Chapter Twenty-Four Month Six

As you approach your baby's half-year mark, think about how far you've both come.

By now, that little person in the nursery is no longer a baby, but a world-class explorer.

And you have become an ever more confident parent, familiar with the rhythms of baby care

and more secure in your ability to meet upcoming challenges.

During this month, your baby is becoming more adept with his or her hands

and may even start to sit unsupported by the end of the month.

Each aspect of your baby's motor and sensory development

gives your baby new tools to explore the world and expand his or her mental and social development.

This is a fun time as your baby babbles and laughs excited to be a part of his or her family.

Babies' Growth and Appearance

By the time the six-month rolls around, many babies have doubled their birth weight.

Your baby's growth rate this month is likely to be similar to last month's,

weight gain of one to one and a half pounds or more,

and an increase in length and head circumference by about a half an inch.

But don't be surprised if the growth rate starts to slow down in a few weeks.

Most babies grow a little more slowly during months seven through twelve

than they did in the first six months.

Teeth

Drooling, crankiness and tears.

Could it be baby teeth coming in?

Although timing varies widely, many babies begin teething by about age six months.

The two bottom front teeth, lower central incisors, are usually the first to appear,

followed by the two top front teeth, upper central incisors.

Classic signs and symptoms of teething often include

drooling, which may begin about two months before the first tooth appears,

irritability or crankiness, swollen gums, chewing on solid objects.

Many parents suspect that teething causes fever and diarrhea,

but researchers say this isn't true.

Teething may cause signs and symptoms in the mouth and gums,

but it doesn't cause problems elsewhere in the body.

If your baby develops a fever, seems particularly uncomfortable,

or has other signs or symptoms of illness, contact your child's medical provider.

Otherwise, teething can usually be handled at home.

If your teething baby seems uncomfortable, consider these simple tips.

Rub your baby's gums.

Use a clean finger, moistened gauze pad, or damp washcloth to massage your baby's gums.

The pressure can ease your baby's discomfort.

Offer a teething ring.

Try one made of firm rubber.

The liquid filled variety may break under the pressure of your baby's chewing.

If a bottle seems to do the trick, fill it with water.

Prolonged contact with sugar from formula, milk or juice may cause tooth decay.

Keep it cool.

A cold washcloth or chilled teething ring can be soothing.

Don't give your baby a frozen teething ring, however.

Contact with extreme cold may hurt, doing your baby more harm than good.

If your baby's eating solid foods, offer cold items such as applesauce or yogurt.

Dry the drool.

Excessive drooling is part of the teething process.

To prevent skin irritation, keep a clean cloth handy to dry your baby's chin.

Saliva is used in the digestion of food, so it makes sense for the body to produce more saliva at the time when infants typically begin solid foods.

Try an over-the-counter remedy.

If teething is making your baby especially cranky, acetaminophen, Tylenol, others,

or ibuprofen, Advil, Motrin, others, if your baby's six months or older, may help.

Don't give your baby products that contain aspirin, however,

and be cautious about teething medications that can be rubbed directly on baby's gums.

The medication may be washed away by your baby's saliva before it has the chance to do any good,

and too much of the medication may numb your baby's throat,

which may interfere with his or her normal gag reflex.

Caring for new teeth.

Ideally, you've been running a clean, damp washcloth over your baby's gums every day.

If not, now's a great time to start.

The washcloth can keep bacteria from building up in your baby's mouth.

When your baby's first teeth appear, switch to a small, soft-bristled toothbrush.

Use a small smear of toothpaste about the size of a grain of rice.

If you have well water or you use bottled water in your home,

your baby may not be getting necessary fluoride for healthy tooth development.

Discuss this issue with your child's medical provider.

It's also time to think about regular dental checkups.

The American Dental Association and the American Academy of Pediatric Dentistry

recommend visiting the dentist after the first tooth erupts,

although many dentists recommend visiting by age 3 if there are no concerns.

Your baby's teeth and gums will also be examined at well baby checkups.

Regular childhood dental care helps set the stage for a lifetime of healthy teeth and gums.

Baby's movement.

By 5 or 6 months old, most babies have achieved pretty good head control

and are rolling over both ways.

By now, they may be ready to move on to learning how to sit without help.

By 7 months or so, most babies have learned to sit independently,

but some may wait until 9 months to do so, which is within the typical range.

At the same time, baby's hand control skills are rapidly improving,

allowing your child even more flexibility in exploring his or her surroundings

and even other parts of his or her body.

Tripod Sitting.

Your baby's first attempts at sitting will probably be very entertaining.

At first, he or she will sit hunched over, balancing on arms extended to the front.

Experts sometimes call this the tripod sitting stage.

Almost anything will topple a baby in this position,

leaning a little to one side,

a distraction that makes the baby look in another direction,

or any attempt to shift weight.

This hunched over sitting takes all of your baby's energy.

He or she probably can't do much else,

but hold his or her head up without falling over.

In a few weeks, though, your baby's strength and balance will improve,

and he or she will be able to sit upright.

Toes, toes, toes.

If your baby hasn't discovered his or her toes yet,

he or she is likely to do so this month.

When fingers don't seem so novel anymore,

baby may catch sight of those wiggly things at the end of his or her feet

and bring them up for investigation.

At first, your baby may explore those little toes just by grabbing and feeling them,

but sooner or later, with the help of incredibly flexible limbs,

your baby is likely to bring toes to mouth for a good sucking.

Picking up and letting go.

By age 5 or 6 months, your baby's hand control is good enough

that he or she can reach for a desired object using a rake-like motion and grasp it.

After learning to grab a toy,

your baby will practice moving things from hand to mouth,

using both touching and tasting to explore the toy.

You may even see your baby repeating the hand-to-mouth to hand movement,

taking the object out of his or her mouth with alternating hands.

By 6 months, your baby may learn to move something directly from one hand to the other.

Your baby will soon discover that letting go of something is as much fun as picking it up.

At first, letting go is almost accidental.

As soon as your baby learns to hold something, he or she will also drop it.

But over the next few months, he or she will begin to let go more purposefully.

By the end of your baby's first year, he or she will have acquired other means

of getting rid of unwanted objects, such as throwing them or pressing them down on a surface.

At this age, babies still use their whole hands to pick things up.

When babies are relaxed, their hands are open.

By now, they've outgrown the closed fist pose of younger babies.

You can see the slow progression from that tight-fisted infant to a more mobile and coordinated baby.

Right now, your baby is just beginning to use hands for small tasks, and it's hard work.

Watching your baby, you can probably see the amount of effort that goes into this kind of play.

When your baby reaches for an object, his or her other hand may mirror the movement of the reaching hand.

Both hands may close as one hand reaches for and grasps the toy.

Baby's Sensory Development

Although your baby's senses will continue to mature throughout early childhood,

they're now almost as fully developed as those of an adult.

Your baby sees and hears the world almost as clearly as you do.

And this ability allows the two of you to understand and share many of the same experiences.

Vision

By six months of age, your baby has more clearly focused vision

and can probably track the course of a falling toy or other object quite smoothly.

Ongoing development of your baby's visual system allows for greater depth perception.

And now that your baby is sitting upright more often, he or she can gaze across at you

and at other things rather than just look up.

Both of these skills, increased depth perception and the ability to look across,

come in handy such as when baby is learning to eat solid foods

and you're aiming a spoonful of cereal at his or her mouth.

During this month, your baby is also able to take in more complex visual images

and observe them studiously.

You might notice this increased visual curiosity when your baby picks up a toy and examines it.

Although eventually, it's likely to end up in his or her mouth for a truly thorough examination.

Looking at picture books together is great fun at this age,

as are sturdy board books that provide visual interest

as well as something for your baby to practice manipulating with his or her hands.

Hearing.

By the end of this month, most babies respond readily to sound

and turn their heads quickly toward the direction of a voice or other noise.

With improving memory and increasing exposure,

they may even be able to distinguish between male and female voices.

Touch.

In addition to exploring his or her environment,

your baby is discovering all sorts of new things about himself or herself.

By touching his or her own cheeks, nose, toes, and genitals,

your baby is becoming familiar with the contours and shapes of his or her body.

Baby also continues to explore textures and shapes.

Offer new surfaces and objects for your baby to touch,

such as a branch or a smooth rock.

Be aware that most objects will quickly go to your baby's mouth,

so be sure to supervise baby's tactile exploration.

Baby's mental development.

Between five and six months,

your baby is working out some of the first inklings of his or her own identity.

What it feels like to be a separate person with individual powers of action and reaction.

In parallel with these discoveries,

your baby is uncovering the possibilities that exist for interaction with others.

As your baby's memory expands,

he or she can start to roughly catalogue his or her experiences.

The kitchen floor is hard. Daddy's beard is prickly.

This toy is fun to gum.

The music comes from there and so forth.

Me, myself, and I.

Combining sensory, motor, and mental skills,

your baby begins to realize that moving certain muscles

always produces physical sensations that correspond with specific visual results.

For example, baby's effort to kick his or her legs

is always accompanied by the sight of these legs moving.

Sensations associated with self are easier to reproduce with regularity

than sensations associated with others.

Every time your baby kicks, he or she can see his or her legs move.

But every time he or she cries,

the sight of you may or may not appear immediately.

Playing becomes serious business.

At the same time, playing rises to a new level.

Toys that stimulate the senses and simple games,

such as peek-a-boo or mimicking games,

become the tools and experiments of your small adventure.

Even the process of getting your attention

requires a certain amount of strategy and can become a game for baby.

Again, you don't need expensive toys to stimulate your child's mind and senses.

Common household items with different shapes and textures,

such as cardboard boxes, egg cartons, lids, paper towel rolls,

spoons, tea towels, and nesting bowls

offer plenty of opportunities for sensory exploration and discovery.

Homemade noise makers think tightly capped containers filled with rice

are fun to shake and prod,

and a plastic lid filled with water placed on the high chair tray is sure to intrigue.

Peek-a-boo is still fairly magical

and the five to six-month-old hasn't quite grasped the concept

that you're still there behind the blanket,

even though he or she can't see you.

This memory of things, not immediately visible, is called object permanence.

Your little one may, however, look for a dropped toy,

but give up quickly if it's not in sight.

Mimicking games become more important

as your baby strives to match your facial expressions

and imitate the sounds and cadences of your voice.

Babbling

Babbling usually begins with babies trying out vowel sounds,

something you may have already noticed your baby doing.

A few weeks later, baby may start to add in consonant sounds.

By six months, about half of all babies babble

by repeating one syllable over and over, such as "ma" or "ba".

Some babies may even have started adding more than one syllable to their babbling.

You may hear your baby cheerfully practice one kind of sound,

then move on to something else

and not repeat the first sound for several days.

Much of your baby's talking may seem more like sound effects than babbling.

Squeals, sliding pitches, and bubbling sounds

are all common for babies at this age.

Giggles and laughter are favorite sounds for both babies and parents.

Baby's social development

This is a fun age to socialize and play with your baby.

Adults have the remarkable ability to show almost any emotion through facial expression,

and babies love to watch and try to imitate these expressions.

Sharing emotional states with someone else is vital

for social development and is one of the basic foundations for communication.

Don't be discouraged of playing with your baby seems uncomfortable at first.

Remember, it's been a few years since you spent your evenings on the floor

with rattles and a box of blocks.

Watch the expert observing which toys your baby is drawn to

and what he or she does with them.

Then, join in.

Soon you'll know what games and toys make playtime fun for your baby.

Your baby will give you the kind of immediate response.

Giggles, turn-taking, smiles, that make playtime rewarding for both of you.

Your baby will let you know if playtime is too intense or has gone on too long.

Watch for clues that he or she is overstimulated,

such as turning away or becoming grouchy or tense.

Don't be surprised if you feel your baby needs even more attention now

than in the newborn days.

Your baby wants and needs stimulation, especially from you.

Left alone in a playpen, crib, or infant seat, he or she is apt to become bored.

But life doesn't have to be all games and playtime.

You can meet many of your baby's social needs by including him or her

in your daily tasks, or just by positioning baby

where he or she can watch you at work.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the sixth month.

Eating.

Breast milk or formula still plays the central role in baby's nutrition,

although most parents will begin to introduce solid foods by the end of this month.

Be sure to feed your baby in a seated position and avoid hard, chewy,

or round pieces of food that could potentially seal off your baby's airway.

Sleeping.

Your baby is more likely to sleep six to eight hours at night without interruption.

Some babies still wake up once or twice during the night for a feeding.

Total sleep may add up to between 14 and 15 hours in a 24-hour period,

including a couple of daytime naps, usually one in the morning and one in the afternoon.

Some babies may need a third nap late in the afternoon.

A lefty or a righty.

At this age, it's too early to tell whether your baby is left-handed or right-handed.

For now, babies may seem to favor one hand for a while,

then switch and use the other hand more often.

A one-year-old may use both hands equally.

By 18 months to two years, toddlers start to show a preference for which hand they will use.

Still, true handedness isn't usually determined until a child is about three years old.

Handedness develops naturally.

Although scientists still aren't sure what role genes play in it,

children with left-handed parents have an increased chance of being left-handed,

but the inheritance pattern isn't clear cut.

If you do notice when your child is an infant that he or she favors one hand over the other,

let your medical provider know.

Sometimes, further investigation is necessary to make sure that both hands do, in fact, work equally well.

Toys and Games

Now that your baby is becoming more comfortable sitting upright,

he or she has a whole new vantage point from which to watch, play, and interact with the world.

As your baby's sensory and motor skills continue to develop,

he or she will become much more interested in anything that provides additional opportunities for adventure and discovery.

Colorful Books and Magazines

Your baby's vision is such that now he or she is able to focus on an entire pattern and distinguish a range of colors.

Reading colorful board books together becomes especially fun at this stage.

Simple texts allow you to repeat sounds that your baby can try to repeat.

Don't be offended if baby decides to take over, though, turning the pages or flipping back to the cover every time you try to read the next page.

At this age, the main idea isn't to understand the storyline, but to make sounds, look at pictures, and chew on the covers.

Old magazines that you don't mind being torn up can also be fun to look at.

Just make sure baby doesn't eat the pages.

Short Trips

Once your baby is able to sit up in a stroller, walks around the neighborhood or the park, take on a whole new dimension.

Now your baby can see most of the things you see and will enjoy the sight of a passing dog or a squirrel hopping to the nearest tree.

With a turn of the head, your baby can locate different sounds too, such as the honk of a goose or the sounds of children playing.

If it's nice out, place your baby on a patch of grass and let him or her feel the differing textures.

Trips to the zoo or your local library also become more entertaining at this age.

But don't expect them to last too long.

It's probably best to keep them to under an hour or two to match your baby's finite stamina and short attention span.

Bouncy Lap Games

Good head control also allows for slightly more physical games.

Almost all babies seem to love bouncing around on a grown-up's lap.

Have your baby sit on your lap facing you, hold his or her hands and bounce him or her gently on your knees while singing a song.

If you don't know any kid songs, ask your parents or grandparents.

They'll probably remember some and it will be fun to hear what they sang to you at one point.

Or try looking up nursery songs and rhymes.

Here's a classic to get you started.

Padacake, padacake, baker's man, bake me a cake as fast as you can.

Roll it and prick it and mark it with a B and put it in the oven for baby and me.

Reach

Once baby is able to raise his or her body up on straight arms while lying belly down on the floor,

you can start encouraging him or her to reach out with one arm for a toy just ahead.

Eventually, your baby will lean on one arm and reach for toys with the other.

This act of reaching forward is generally the first step toward crawling.

Rolling balls or other toys also provide an incentive for chasing.

Playing with siblings

An older brother or sister can get a lot of enjoyment out of a five to six month old baby.

By six months, the baby has moved beyond face-to-face interaction

and 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 responding to what older children do.

For safety reasons, always supervise playtime between your baby and an older child.

Six-month milestones

During the six-month, your baby is busy, maintaining good head control,

rolling both ways, working towards sitting independently, raking small objects towards self,

picking up toys with both hands, bringing toys to mouth, exploring with mouth,

learning to self-feed, perhaps transferring an object from one hand to the other,

repeating single syllables, maybe even combining sounds, giggling, laughing, exploring on body,

differentiating between self and others, enjoying simple games, looking briefly for dropped toy,

mimicking and sharing your emotions.

Chapter 25, Month 7

The next few months are a time of growing independence for your little one.

This can be both exhilarating and frightening for an infant.

You may find your baby vigorously venturing into new things,

but afraid to be too far away from the security of what he or she already knows, you.

By sharing in your child's curiosity while still providing lots of affection and comfort,

you can help your baby become more confident and competent in his or her evolving skills.

From Month 7 on, mobility starts to take off.

Day by day, your baby will build on existing motor skills, such as reaching, rolling over, and sitting,

and move on to new ones, such as crawling and standing, some faster than others.

Since you can't predict when your baby will make his or her first move across the floor,

now is a good time to review your home safety.

See Chapter 17 for more information on child-proofing your house.

Keep an eye out for dangling cords and unsteady furniture.

As your baby's mobility progresses, he or she will latch on to nearby items

to help himself or herself along or even up.

Removing treasured or breakable items and creating a safe environment

will give your baby the freedom and confidence to explore and learn.

At this age, it's generally easier to modify the environment than to teach a child not to touch.

Baby's Growth and Appearance

During these past months, your baby's growth rate was on fast forward.

Once your baby reaches six months, though, you'll find that growth tends to slow a bit.

Previously, your baby was likely to gain over a pound a month.

Now, his or her weight increase is more likely to be just under a pound each month,

and his or her increase in length around 3/8 inch or less.

You can also expect the growth of your son's or daughter's head to begin to slow too.

From here on out, your child will continue to grow steadily,

with additional growth spurts here and there,

but he or she will never quite grow as fast as in those first six months.

Baby's Movement

When your baby was younger, indications of developing motor skills were subtle,

with some so basic as to go almost unnoticed.

Fidgeting, for example, is a normal phase of growth and development,

but it isn't nearly as exciting as the motor skills that are now blossoming.

Between now and baby's first birthday,

noticeable changes take place that transform your son or daughter

from a dependent infant to a trundling, independent toddler.

Sitting

At six months, many babies sit up with help,

or sit alone by leaning forward, hands to the floor.

Over the next few weeks, your baby is perfecting the art of sitting,

keeping the head steady and back straight to maintain balance.

By seven months, your baby may be sitting alone with no support,

even working to put arms to the side to avoid toppling over.

By his or her ninth month, your baby may be steady and strong enough

to play for longer periods while seated on the floor,

even pivoting and reaching to get to different toys.

Hand and Finger Coordination

At six months, babies have very clumsy hand movements

and pick up objects by pressing all their fingers against their thumbs,

mitten grasp.

But between now and the ninth month,

most babies will learn to use a more refined pincer grasp,

using the thumb and index finger to pick up small objects.

The transition from a mitten grasp to a pincer grasp is gradual.

First, you may notice your child using a cross between the two,

picking up objects with the thumb, index and middle fingers.

You may also see baby resting his or her arm and hand on a surface

to steady the hand and pick up a small object.

At the same time, your baby is also getting better at transferring an object

from one hand to the other, turning it around and upside down,

holding it this way and that, and getting to know how it feels.

About half of babies this age

gain the ability to hold an object in each hand.

Eventually, they'll delight in banging objects against each other,

but for now, your baby may simply enjoy banging objects against a leg or table.

Baby's sensory development

By seven months, your baby's eyesight is nearly mature.

His or her distance vision is continuing to improve

so that far away people and objects appear clearer and more distinct.

Your baby is also able to track faster movements with his or her eyes

and follow moving objects closely.

In fact, if you roll a ball to your baby, he or she can monitor its path

and probably put a hand out to get it as it gets near.

By age six or seven months, your baby's hearing is almost fully developed.

He or she is also becoming more selective about the sounds he or she reacts to.

For example, your baby at this age can quickly and accurately locate you when you speak.

He or she may also stop to listen to quieter sounds.

Watch to see if your baby turns toward a sound,

even if the sound comes from outside his or her line of vision.

If you notice that he or she doesn't respond to surrounding sounds,

talk to your baby's medical provider.

If there's a problem with your baby's hearing,

it's better to identify it sooner rather than later.

Untreated hearing loss can interfere with other aspects of development,

such as language and social development.

Baby's mental development

During month seven, your baby continues to pick up on language skills

from listening to you and others speak.

Before your son or daughter may have focused on imitating specific sounds,

such as "mmm" or "buh."

In these next few weeks, you may notice him or her start to combine different sounds together,

such as consonants and vowels.

By six or seven months, your baby should make a more complex sound, such as "dada" and "mama."

As tempting as it may be to think your baby is referring to you when saying these sounds,

it will likely be several more weeks before he or she is able to attach names to people.

The art of conversation

In addition to imitating sounds and even combinations of sounds,

your baby may also begin to follow your pattern of speech,

pausing between sentences,

or ending a string of sounds with an upward inflection, as if posing a question.

It can help your baby practice the art of conversation by talking to him or her

and acknowledging his or her efforts with your own warm responses.

An infant's understanding of words is far ahead of his or her ability to use them.

At this age, your baby understands the meaning of what you say by listening to your tone of voice.

Even the word "know," which you may find yourself using more often as your baby starts to push against

what you've established, is understood by your inflection and tone,

and not necessarily by the word itself.

The more you talk to your son or daughter, whether it's while you're driving around town,

doing chores around the house, or changing or feeding him or her,

the more your little one learns about all facets of communication,

including sounds, inflections, and tone of voice,

as well as facial expression and body language.

The Science of Experimentation

As your baby's understanding of his or her own power to make things happen grows,

you can see how he or she begins to test the limits of what he or she can achieve.

How far can I push this train over the edge of my tray before it falls out of sight?

Does mommy bring it back intact every time?

How much can I kick during a diaper change before I receive a frown?

Amid all of this experimentation, you will find that your son or daughter is likely to waver between feeling confident and exuberant and needy and cautious.

By helping him or her feel secure, creating a safe environment to explore and practice,

offering warm praise and support, setting firm yet practical limits,

you can encourage experimentation and promote competence.

In this type of setting, your baby learns to tackle challenges with enthusiasm, adding skill upon skill.

Finding the energy to repeat the same game or story over and over again can be challenging at times,

but keep in mind that the process of repetition is essential to your baby's learning and mastering key skills.

Baby Social Development

Between six and seven months, your baby is becoming quite the expert at non-verbal communication,

expressing his or her emotions in a variety of ways, laughing, crying, shrieking, squealing, and cooing.

Stranger Anxiety

Even as your infant becomes more expressive around you, he or she may begin to show the first signs of reticence around strangers.

Your child has come to associate you with his or her own well-being and is increasingly reluctant to let you go.

He or she is also becoming keenly aware of who is familiar and who isn't.

By eight or nine months, your baby may openly reject strangers, clinging to you and even crying if unknown people come too close.

This is a normal phase of development and is a sign of the strong bond your baby has developed with you.

Shyness towards strangers can last months and even years depending on your child's personality.

Some children are naturally more shy than are others.

Discipline in Infancy

Discipline is a concern that arises in every parent's mind at some point, perhaps even before a baby is born.

You may have definite ideas about guiding your child's behavior, or you may not.

It can be a fuzzy topic, especially if you have little previous experience.

During the first six months, distracting your baby from unwanted behavior is usually enough to stop it.

But by the time your baby reaches the seventh month, you may need to start setting some additional limits.

Keep in mind that true discipline throughout the childhood years is positive in its approach with the ultimate goal of teaching rather than simply punishing.

Your goal as a parent is to help your child become a secure, independent and well-adjusted adult who is able to successfully navigate almost any social environment.

You can start this process early on by establishing a trusting relationship between you and your child and setting simple, consistent limits.

Create a Foundation of Trust

During your baby's first year, you can set the foundation for a pattern of parent-child interaction that will serve you well in later, potentially more trying times.

This is done in the way you nurture and react to your infant, including simple things such as following a consistent schedule, attending to your baby's needs promptly, and spending time bonding as a family.

As your baby gets a little older and more independent, he or she will likely start testing the boundaries you've carefully created.

This is not misbehaving. It's how a baby explores the world.

If you manage that exploration safely, you can prepare the way for your child to become a happy, competent and confident member of your family and ultimately of society at large.

Be gentle yet firm.

By this time, your child's needs and wants have already started to separate.

For example, your son or daughter might still like to have a nighttime feeding, but he or she probably doesn't need a midnight snack.

If you haven't yet done so, start phasing out nighttime feedings.

Establish a consistent bedtime routine that helps your baby learn to self-soothe rather than rely on you to fall asleep.

This is a first step toward independence and will make bedtime much easier in the future.

In addition, it's likely that your baby will get better rest this way, and so will you.

Likewise, at this age, your baby's sense of curiosity and touch have kicked into a higher gear.

As your baby discovers the use of his or her hands, those hands will grab keys, hair, earrings, a nose, anything within reach.

He or she will judge what's okay by your reaction.

Use your tone of voice and facial expressions to express disapproval.

If baby pinches your 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 limits will make it easier for your child to remember what's okay and what's not.

Establishing your authority now, showing that you have the final say, will make your life and your baby's life easier as he or she grows up.

Be proactive.

Once your baby is crawling, then walking, your baby thinks everything in the house is there for him or her to touch, pull, mouth, open, and in general, spread around the room.

This is normal and expected behavior.

Take a proactive approach and prevent problems before they happen.

Set up boundaries by child-proofing your house.

Gates, cabinet locks, and outlet covers can help you establish a positive learning environment for your baby, and you won't have to constantly say "no."

What to avoid.

Day-to-day management of an active, curious child can be frustrating at times.

If you lose your patience with your infant, give the baby to a partner, or set the baby in his or her crib, and take a break to cool off.

Never shake your baby.

If you're struggling with your child's behavior or how to handle your frustrations, talk to your child's medical provider.

If your child has a physical or developmental disability, managing behavior can be even more challenging.

You may need more intense strategies, so don't be afraid to ask for help.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the seventh month.

Eating. Breast milk or formula is still the primary part of your baby's diet, but by this time, you should be introducing additional foods.

Around seven months, most babies can begin the transition to soft foods, or foods with tiny lumps without gagging.

Your baby's airway is still very small, however, so avoid foods that could pose a choking hazard,

such as those that are small, round, hard, elastic, slippery, or crunchy.

C Chapter 4 for more on introducing new foods.

Sleeping.

Baby is more likely to sleep six to eight hours at night with no interruption.

Some babies still wake up once or twice during the night for a feeding,

although they're unlikely to need middle-of-the-night feedings by this age.

Total sleep may add up to between 14 and 15 hours in a 24-hour period,

including a couple of daytime naps, usually one in the morning and one in the afternoon.

Some babies may need a third nap late in the afternoon.

As your baby becomes more curious and mobile, it may be harder to settle down to sleep at night,

establishing and maintaining a consistent, relaxing bedtime routine,

such as having a bath, reading books together, or singing a quiet song,

can be a great help in getting your child used to the idea of going to sleep at night.

Toys and Games.

As your baby becomes more interested in interacting with the outside world,

give him or her new opportunities to do so.

Introduce the High Chair.

This month, your baby is likely to sit well while supported.

Putting him or her in a high chair can be a great way to include baby and family mealtimes.

It can also be an interesting new vantage point for your baby to sit and watch daily household activities,

and play with small toys on the high chair tray.

He or she can start working on thumb-finger coordination.

Choose a high chair that has a comfortable seat and straps to keep your baby safely positioned.

A detachable tray that you can take to the sink to wash is convenient.

Experienced parents may advise removable washing parts in general,

as high chairs invariably become a backdrop for bits of cereal, splattered applesauce, and mashed-up yams.

Hosing off the entire apparatus in the backyard or shower isn't unheard of.

Provide warm-up time.

If baby is shy or cautious, offer him or her plenty of time to warm up to a new situation or activity.

Allow your child to sit and observe on the sidelines for a while.

This will give him or her time to assess the situation and approach it on his or her own terms.

Once your baby feels secure, he or she will become more involved in what's going on.

Make new friends.

If you haven't already done so, now might be a good time to introduce your baby to other children.

Although they likely won't play together for some time yet,

at this age, babies will play side by side.

Also, they're intrigued by others who are similar in size and behavior.

Exposure to other children can help expand your baby's social horizon,

but be sensitive to when your baby has had enough socializing.

Check out activities at your local library.

Many libraries have special activities for infants, such as storytime.

Often a staff member will read a book aloud and include activities,

such as singing silly songs and interacting with puppet shows.

Libraries also may have play areas designed especially for younger children.

This may be a good place to meet other parents and children.

Plus, having all those books to look at can't hurt, right?

Baby Screen Time

Chances are, if you're an American parent of a young child,

at some point you've found yourself downloading an app, streaming a video,

or holding a DVD intended to improve your baby's intelligence.

You wondered if it could help promote Junior's brain cell connections.

Turns out, human interaction still is likely to trump anything on a screen.

While games or videos might catch your baby's attention,

the screen time probably won't contribute to his or her development.

In fact, research shows that an infant learns most when interacting with you or other caregivers.

Studies examining the specific effects of baby DVDs and other infant programming are limited,

and research on the impact of newer technology, such as touchscreen devices, on infants, is even more scarce.

Study results generally aren't positive.

In one study, children ages 8 months to 16 months, who were exposed to baby videos,

scored lower on the Language Development Test, then did babies who had no screen time.

Another study of children ages 2 months to 4 years,

but turning on the television reduced verbal interaction between parents and children,

which may delay language development.

In addition, studies indicate that when parents spend time on their phones,

it reduces the quantity and quality of parent and child interaction.

In contrast, research has shown that regularly reading to and interacting with young children

boosts language ability for both babies and toddlers.

Many pediatricians discourage screen time for children younger than age 2.

Instead of relying on videos or smart apps,

concentrate on proven ways to promote infant development, such as talking, playing, singing, and reading to your baby.

Even if your baby doesn't understand what you're saying or grasp the plot of a story,

he or she will soak in your words and revel in your attention.

These simple activities form the foundation for speech and thought.

Seventh Month Milestones

During the seventh month, your baby is busy, learning to sit unsupported, sitting and looking around,

perhaps getting into a crawling position while reaching out with one hand,

using hands to rake up small objects,

making better use of thumb and fingers,

transferring objects from one hand to the other,

visually tracking rapid movements,

readily responding to sounds,

looking for sounds outside of field of vision,

starting to look for drop toys,

combining different sounds together,

imitating patterns of speech,

distinguishing strangers from loved ones,

starting to test limits and boundaries.

Chapter Twenty-six Month Eight

By month eight, most of your baby's newborn reflexes have faded away

and are now replaced by intentional, purposeful movements.

This is a result of your baby's maturing nervous system.

As more and more nerve endings become encased in protective coverings,

myelin sheaths, the nerves become more efficient at carrying messages

from the brain to muscles,

making your baby's movements increasingly smarter and more refined.

At the same time, your seven to eight month old's brain is developing the ability to attach meaning

to different sounds and 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 conjunction with its appearance on the scene,

your baby may begin to associate the dog with the dog's name.

Your child's thinking processes are becoming ever more complex

and you can see this by the way he or she begins to indicate likes and dislikes

and be fairly emphatic about them.

This may be especially apparent in your infant's social preferences

as he or she becomes increasingly aware of the difference between familiar and unfamiliar people.

Your child's conceptualization of object permanence is setting in as well.

He or she is starting to realize that although people and things may temporarily disappear

from his or her line of vision, that doesn't mean they're gone forever.

This realization tends to coincide with less tolerance for being separated from you,

making transitions to childcare and babysitters a little more challenging for a while.

Babies' Growth and Appearance

During this time, your baby is growing steadily

but probably at a slightly slower rate than in previous months.

The average baby at this age tends to gain just under a pound over the course of the month

and grow about 3/8 of an inch in length.

Your baby's head circumference is still increasing

but only slightly compared with earlier months.

As long as your baby is following a steady growth curve

based on measurements by your baby's medical provider,

there's no need to be overly concerned about specific numbers.

At this stage, your baby's nutritional intake is starting to become a little more varied.

But keep in mind that he or she still needs a proper balance of fats, carbohydrates, and protein.

Be sure to discuss your baby's diet with his or her provider

who can help you decide how to best meet your child's nutritional needs.

Establishing Good Eating Habits

As you introduce new foods to your son or daughter,

take the opportunity to establish good eating habits right away.

Here are some tips to help your baby develop healthy eating patterns.

See Chapter 4

Offer a wide variety of foods.

You still want to introduce new foods one at a time

but that doesn't mean you have to stick to a single food for weeks on end.

By this age, you can experiment with a variety of foods.

If your baby does well with pureed yams,

try some ground chicken after a few days

or after a successful course of mashed peas,

provide a dessert of mashed bananas.

Include a Good Balance of Foods

Prioritize fruits, vegetables, meats, and healthy carbohydrates

over processed foods and baked goods.

Instead of a cut-up hot dog, for example,

offer bits of turkey

or instead of a soft cookie,

offer pureed peaches.

Minimize salt and offer sweet foods in moderation.

Examples of not-so-obvious salt-rich foods

include processed cheese, cold cuts, pizza, canned vegetables, beans, and soups.

Avoid overfeeding

Watch your baby for cues to know when he or she is full

While you control what and when your baby eats,

let your baby determine whether to eat each food you offer and how much.

Enjoy food for its nutrition

but avoid using it as a reward or as a comfort item.

Instead, reward and comfort your baby with hugs, kisses, and attention.

Introducing a Cup

You can give your baby a cup as soon as he or she starts eating solid foods.

A two-handled sippy cup is usually easy for baby to use.

This will help your child become familiar with the idea of using a cup.

But at this age, your baby will probably bang, drop, and dump the cup more than drink from it.

It will probably be another few months before he or she is using it properly.

Even if your baby uses a cup at mealtimes,

you may decide to continue breastfeeding or using a bottle for supplemental feedings,

simply because baby can't get much out of the cup just yet.

Feeding your baby breast milk or formula from a cup at mealtime

may help pave the way for weaning when you're ready.

Baby's Movement

Your child's rapid development during these months can be astonishing.

In just a few weeks, he or she may go from barely sitting up without your help

to bustling around the room by scooting, crawling, and cruising.

Sitting Up

By eight months, your baby is literally sitting pretty and is steadier than ever on his or her bottom.

His or her sense of balance is improving,

and he or she will be able to sit up unsupported for longer periods of time without falling over.

Your baby may even start to reach with his or her arms while sitting to try to grasp nearby toys.

These exercises will help further strengthen your baby's core muscles,

which are important for standing, walking, and any kind of forward-propelling movement.

Getting Around

After your baby learns to sit up without too much effort,

you'll notice other movements that are predecessors to crawling,

rolling, twisting, crouching, and rocking back and forth on the knees.

In fact, it will be hard for your baby to be still for long.

If lying tummy down, he or she will push up on hands and arms to look around.

Lying face up is an incentive to kick and grab for toes.

Your baby can now also flip around at will.

Some babies even roll repeatedly as a means of getting from one place to another.

Because your youngster is getting so mobile,

it's important to take appropriate safety precautions,

such as swapping the changing table for the floor or bed,

to change diapers and installing safety gates at the top and bottom of stairs

to avoid an accidental and potentially serious tumble.

See more about Making Your Home Safe in Chapter 17.

Hand and Finger Coordination

Once your baby is able to sit well,

he or she is also able to maintain upper torso balance

while coordinating simultaneous movements of arms and hands.

Most babies this age are able to hold a toy in each hand.

Eventually, they'll develop enough coordination to bring both hands inward

and bang the toys against each other.

During this month, your baby probably still uses a raking motion

to bring small objects closer.

But he or she is also working on coordinating the thumb and first or second finger

to pick up small objects, pincer grasp.

Baby will practice this technique until he or she achieves such a grasp.

This usually happens by his or her first birthday.

Your baby is also learning to let go of items at will.

This is evident by his or her enthusiasm for dropping and throwing things

again and again.

Baby's Sensory Development

During this month, your baby's senses continue to contribute

lots of information to his or her brain.

This stimulates the development of other skills,

such as reaching and crawling

and drawing conclusions about spatial relationships.

Vision

Your son's or daughter's vision is now almost adult-like in clarity and depth perception.

By eight months, most baby's vision is 20/40,

although he or she still sees things better at a close range than far away.

Your baby's vision should be clear enough to recognize people and objects across the room.

Increased depth perception helps your baby accurately reach for objects

and judge distances correctly when moving forward.

Touch

Between seven and eight months old,

your budding physicist is learning rapidly about the way matter takes up space,

how different surfaces feel, and how they're related.

For example, he or she may start to realize that balls are round and roll,

boxes have flat surfaces,

and some toys have a top and a bottom part.

Objects with tags, handles, and parts that can be manipulated

are especially intriguing at this point.

Baby's Mental Development

Around this time, your son or daughter is beginning to understand

that certain things have meaning beyond the immediate sensory experience.

For example, words and gestures, besides being seen and heard, can convey messages.

And things your baby once thought were there and then gone when out of sight

are actually still there even if hidden from view.

Your child's brain is starting to make connections between what is seen and unseen

and draw conclusions from repeated experiences.

Although it will be a while before your child can actively formulate

and express symbolic thought, such as pretend play,

which usually develops in the second year,

the very first formations of abstract thought are emerging.

Attaching Meaning

By eight months or so, you may notice your child quiet

or perk up at the sound of his or her name,

or even turn toward you when you say it.

He or she doesn't fully understand at this point

that this word refers to himself or herself,

but your baby is becoming familiar with hearing that word

when you actively seek a face-to-face connection with him or her.

Other words are starting to become significant too.

You'll probably notice that your baby is gaining a better understanding of the word "no."

He or she may hesitate when he or she hears the word,

especially when it's delivered with a sharp inflection.

At this age, baby begins to associate words with specific objects and actions,

including gestures.

About half of babies at this age begin to wave bye-bye.

Object Permanence

Previously, if your baby dropped something,

he or she likely thought it was gone entirely

and made no effort to look for it.

Now, he or she is starting to realize that, in fact,

it may still be there and will look for a hidden toy.

Games of peek-a-boo take on a new significance

as your baby realizes that if he or she pulls the blanket away,

"Aha! Dad is still there!"

And now that baby knows you're still around,

even if you leave the room,

he or she may make more of a fuss to get you to come back.

Language Skills

By this time, your baby is likely becoming a proficient babbler,

repeating not just single sounds,

but combining syllables such as "bada."

Some babies are very expressive and jabber away like excited squirrels.

Others are a little quieter and may listen more than chatter.

But this doesn't mean they're not absorbing what's being said around them.

Be sure to talk to your little shy one as much as you might to a little chatterbox,

encouraging him or her to communicate verbally as well as non-verbally.

Baby Social Development

As your baby learns new skills and becomes more mobile,

he or she is torn between two desires to be with you

and to experience some independence.

You may notice this struggle surface in many situations

as your baby searches for both predictability and adventure.

Living with this new assertiveness may take a bit of adjustment for all parties involved,

but understanding it as a normal phase of development

helps most parents take the new challenges in stride.

Separation Anxiety

At eight months, most babies are clearly attached to the parent providing most of their care.

Your baby may seem most assertive when you make any attempt to separate from him or her,

whether it be for a few hours or a few minutes.

He or she may become more clingy, not wanting to let you out of sight,

and may grasp or cry if you manage to break away.

Your baby may even begin to prefer the parent he or she spends the most time with.

Both parents should understand that this situation is normal and will diminish with time.

Every baby goes through a stage of separation anxiety,

which begins around this age, peaks between 10 and 18 months,

and gradually fades as the second birthday approaches.

Some babies pass through this phase fairly quickly,

but others remain reluctant to part for quite some time.

Part of baby's frustration stems from not having the motor skills to follow you or keep up with you,

coupled with a budding realization that you're still there even if baby can't see you.

The positive side of this development is that your baby has clearly established a strong bond with you

and wants to make sure you stick around.

Eventually, as your baby realizes that you're a permanent part of his or her life despite temporary separations,

this anxiety will ease.

Smoothing the way

This strong attachment to the primary caregiver can result in a seeming dislike for everyone else,

which can be crushing to grandparents, other relatives, and friends who feel close to the baby.

You can ease feelings of rejection by explaining separation anxiety as a normal phase

and helping to create a time of adjustment and transition.

If someone approaches your baby quickly, eagerly trying to engage the baby,

the baby will probably cling to you even more tightly.

Encourage others to spend some time just talking with you while you let your baby watch and listen.

Your baby may eventually open up and jabber or want to play.

Peek-a-boo can be an icebreaker at this age because this game is so tempting for most babies.

But don't be surprised if your baby will play this game only when you're close by.

Assure others that your baby will outgrow this exclusivity.

Spot check. What's going on this month?

Here's a snapshot of what your baby's basic care looks like in the eighth month.

Eating

As you begin altering your child's diet to add cereal and other foods,

you may wonder whether breast milk or formula still plays an important role in your baby's diet.

Even though solid foods are beginning to supplement some of your baby's feedings,

they can't completely replace the balance of nutrients that breast milk or formula provides.

Breast milk is designed to be an excellent source of nutrients for your baby

through the baby's first year and beyond.

Many parents wonder whether their babies can drink whole milk at this age.

It's best for your baby to have breast milk or formula for the first year.

Avoid cow's milk until your baby is a year old.

Your baby's delicate digestive system isn't able to adequately handle the type and concentration

of selected nutrients found in cow's milk.

And cow's milk is lower in iron and vitamins C and E than is breast milk or formula.

Sleeping

Most babies are able to sleep well through the night, between 10 to 12 hours,

around age 8 months, to the relief of their weary parents.

Total sleep for baby may add up to about 14 hours in a 24-hour period,

including a couple of daytime naps, usually one in the morning and one in the afternoon.

But beware, new skills such as pulling up to stand and cruising are near, if not already learned,

and your baby may wake in 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.

In addition, if your baby gets anxious when separated from you during the day,

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 sleep habits, see Chapter 9.

Baby Sign Language

By age 8 months or so, many infants begin to know what they want, need and feel,

but they don't necessarily have the verbal skills to express themselves.

Baby Sign Language allows children to use their hands to bridge the communication gap.

Slightly older children who have developmental delays may benefit too.

Limited research suggests that using Baby Sign Language may improve a child's ability to communicate and ease frustration,

particularly between ages 8 months and 2 years.

Teaching and practicing Baby Sign Language can also be fun and give you and your child an opportunity to bond.

At the same time, don't neglect your baby's verbal skills.

Continue to talk to your child and encourage him or her to use spoken words,

or what may only sound like words in the beginning, to express himself or herself.

Voice the meaning of a sign each time you use it.

A variety of books, websites and other resources are available to help you learn Baby Sign Language.

You can also use variations of American 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.

Keep these tips in mind.

Set realistic expectations.

Feel free to start signing with your child at any age,

but remember that most children aren't able to communicate with Sign Language until about 8 or 9 months.

Stay patient.

Don't get upset if your child uses signs incorrectly or doesn't start using them right away.

The goal is improved communication and reduced frustration, not perfection.

Be consistent.

Repetition is the best way to ensure your child's success in using Baby Sign Language.

Encourage your child's other caregivers to use the same signs too.

Toys and Games

Around this age, most babies enjoy toys they can bang, poke, twist, squeeze, drop, shake, open, close, empty and fill.

Toys should be lightweight with no sharp edges.

Remember that all toys will end up in your baby's mouth, so don't give your baby toys with small parts.

For the most part, your child's playtime will center around playing on the floor, working on crawling, sitting and standing.

You can encourage these skills by putting a toy just beyond your baby's reach and encouraging baby to move toward it.

Other playtime ideas include peekaboo.

Games of peekaboo take on a new dimension 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 discover them.

Your baby may even cover them up again only to rediscover them.

Mirror Games

Your little one is starting to learn the concept of three-dimensional space.

Contrast two-dimensional images with three-dimensional ones by playing games in the mirror.

If your son or daughter is looking in a mirror and you suddenly appear in the mirror too,

he or she is likely to turn around and look for you instead of believing you're in the mirror itself.

Buckets of Stuff

Your baby is also learning how objects relate to one another.

Infants at this age start to understand that smaller objects fit inside bigger ones.

Stacking toys appeal at this age.

Games in which toys can be put into a container and dumped back out again are popular as well.

For a quick and easy version, fill a plastic mixing bowl with odds and ends from the kitchen,

measuring spoons, plastic lids, small containers, empty baby bottles,

and let your baby sort through them, dump them out, and put them all back in again.

Book of Animals

As your baby begins to understand that things have names and labels attached to them,

introduce him or her to a book with simple pictures of various animals and their names.

You can read it together.

As you point to the picture and name the animal,

your baby will eventually start to associate the name with the animal.

In fact, you can introduce animal sounds too.

For a more lyrical version, read Brown Bear, Brown Bear, What Do You See?

by Bill Martin Jr. and Eric Carl, which contains rhythmic prose and colorful illustrations

that are favorites of children and parents alike.

Enjoying a Relaxing Night Out

Because babies react so strongly to separation from their parents,

parents are often reluctant to leave their babies with babysitters.

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.

Practice

Take advantage of occasions at home to leave your baby alone for a few minutes,

in a safe zone, of course, while he or she plays.

If your baby becomes upset at your absence, call out to him or her,

but wait a few seconds before coming back.

Eventually, your baby will learn that it's okay to be away from you and that you always do come back.

Get Acquainted

If a babysitter is new, take some time to let your baby become acquainted with him or her.

Hold your baby on your lap while you and the babysitter talk

and then gradually engage the baby in the conversation.

Once your baby seems comfortable with the sitter's presence,

put your baby on the floor with a favorite object and the babysitter,

and let them get to know each other.

Once you're comfortable with your babysitter and you feel assured your baby is getting loving,

qualified and competent care,

you will be less bothered if your baby should cry when you leave.

Say Goodbye

When you're ready to leave, tell your baby goodbye and provide 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 overcome this anxiety.

Instead, he or she may become more clingy, never sure when you might leave.

At the same time, there's no need to prolong the farewell.

Have a distraction ready to go, a bath or new toy.

In a few minutes after your departure, your baby's short attention span will be directed elsewhere.

Eighth Month Milestones

During the eighth month, your baby is busy, sitting up straight and looking around,

reaching out with one hand while in a crawling position,

rocking back and forth on all fours, rolling over repeatedly,

scooting on bottom or expressing some form of desire to move around,

using hands to rake up small objects,

getting better use of thumb and fingers,

transferring objects from one hand to the other,

using touch to learn about the physical properties of different objects,

looking for you or drop toys, establishing object permanence,

attaching meaning to words and gestures such as no or a farewell wave,

combining different sounds, distinguishing strangers from loved ones,

cementing the parent-child bond, starting to test limits and boundaries.

Chapter Twenty-Seven Month Nine

Your baby has a lot going on these days, and get ready for a big change.

During the ninth month is when most babies learn to crawl,

and once your baby is on the move, life changes forever.

No longer is your baby content to stay in one spot.

There are so many places to go, so many things to see, so much stuff to get into.

Daily life with an emerging toddler can be a challenge,

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 be all set to enjoy life on the go.

Babies' Growth and Appearance

During this month, your baby is growing steadily at about the same rate as the previous month.

The average baby at this age tends to gain just under a pound a month

and grow about 3/8 of an inch in length.

Your baby's head circumference is still increasing slightly every month.

By now, your baby may have a nice head of hair,

and now that he or she can flip and turn at will, bald patches are a thing of the past.

At 9 months old, most babies still look like little butterballs,

but within a few short months of growing, walking and running,

your baby will stretch out into a full-blown toddler.

Babies' Movement

It's around this time that many babies catapult forward to a new level of mobility and independence.

All that wiggling and fidgeting, rocking and rolling is paying off.

Your baby is up and moving.

Crawling

Crawling uses the complex give-and-take movements of all four limbs that are necessary for walking later.

It takes some time to understand how to make those little arms and legs work together.

The average age an infant starts to crawl is 9 months.

At first, a baby's arms are stronger than the legs,

which makes for some funny crawling variations.

Many babies begin crawling by using just their arms,

scooting across the floor like a soldier in training.

Others may find themselves up on their knees,

give their arms a good push and begin moving backward.

Eventually, most babies will become experts at using their legs and arms simultaneously when they crawl.

You might look away for a minute, then look back and wonder,

"Where did my baby go?"

If your baby isn't interested in crawling or crawls just for a short time before moving on to something else,

remember that moving is the goal.

How your baby moves isn't as important as the fact that he or she is interested in getting around.

Standing

At 8 or 9 months old, if you stand your baby up next to the sofa,

he or she will probably be able to stand there using the furniture for support.

When your child realizes how much fun standing is,

he or she will probably start figuring out how to pull up to a standing position without your help.

By 8 months old, most babies can stand up with support.

At age 9 months, more than half of all babies can pull themselves into a standing position,

and some may even begin cruising around the room, holding on to furniture for support.

At first, your baby may not know how to sit down from a standing position,

and instead may just fall on his or her bottom.

Soon, he or she will learn how to lower himself or herself down without falling.

You can show your baby how to do this by gently helping him or her bend at the knees

and then squat down to a sitting position.

Sitting

By now, your son or daughter is likely a proficient sitter.

Indeed, at this age, babies love to sit and play and may do so for extended periods of time.

From a seated position, your baby has a wider vantage point,

from which to observe and interact with the world and delights in taking full control of his or her view.

Between ages 8 and 9 months, your child is learning to point to desired objects

and lean forward while sitting to reach toward you or an interesting toy.

As a result of your child's improved stability and balance,

he or she can now sit unsupported and turn his or her head to look at things.

He or she may even twist his or her torso to peer around,

although leaning sideways may not be possible quite yet.

Hand Skills

Baby is working steadily on his or her thumb finger, pincer grasp.

With the pincer grasp, your baby can and probably will pick up objects as small as a piece of lint.

Self-feeding also is likely to become a popular activity during this month, if it hasn't already.

And by now, your baby may have learned to hold a cup or bottle and drink independently,

because almost everything your baby touches goes directly into the mouth for further exploration.

Be sure to remove anything from baby's reach that could cause choking.

Your baby is also learning to move his or her fingers individually,

so that he or she can soon hold a string between finger and thumb and pull a toy along.

Letting go voluntarily is becoming easier, allowing baby to set one thing down in order to pick up another.

Other impressive hand skills your child may develop during this month

include pointing toward things he or she wants, clapping and waving goodbye.

These are also forms of communication.

Encourage your child's development in this area by using these skills yourself,

such as pointing at different objects and naming them, or playing clapping games.

A common milestone achieved during this month is the ability to bang toys together.

This is no mean feat, as working both arms simultaneously in this fashion

requires an infant to sit upright, steadily, without support, and display a fair amount of balance.

Baby's Sensory Development

By age 8 to 9 months, your child's sensory skills are fairly evolved,

and a great help in practicing his or her new motor, mental, and social skills.

Combined with your child's expanding memory skills and understanding of object permanence,

his or her sensory abilities make for easy recognition of recurring sights, sounds, and patterns.

They're helping your young one in gaining knowledge of the general order of things.

Vision

Your baby's visual acuity is constantly improving, and he or she can see things clearly from across the room.

At this age, your baby is quick to recognize familiar faces and objects.

He or she may adjust his or her position to get a better look at something,

and is more likely to look for a hidden toy.

Crawling and moving about helps develop your baby's depth perception,

as he or she studies one hand moving forward and then the next over the varying ground beneath.

Better depth perception leads to an increased awareness of heights

and a better timed, more cautious approach to obstacles.

Hearing

Your son or daughter now recognizes sound without difficulty,

and probably responds to his or her own name.

Your daughter or daughter may respond to other familiar words,

as well such as bottle, mama, da-da, and no.

Touch

Your baby is learning how to wrap his or her hands around a cup or bottle,

how to pick up a spoon, and how to handle different toys appropriately.

Baby's mental development

Your baby is on the hunt for new stimulation, and is keen to try out new games and skills.

This is certainly a fun age, but it can also be frustrating for baby and parents alike

if baby moves quickly from one thing to the next, leaving you with a new life.

The baby is a little bit more mature than the baby,

but it's not a big deal.

Baby's mental development is a little bit more complex than the baby,

but it's a little bit more fun to do.

Baby's mental development is a little bit more complex than the baby,

but it's a little bit more fun to do.

Baby's mental development is a little bit more complex than the baby,

but it's a little bit more fun to do.

Baby's mental development is a little bit more complex than the baby,

or fill a basket with board books that your child can easily access on his or her own.

For the time being, you might also spend a little extra time on the floor each day with your youngster

to bridge the gap until he or she is better able to self-entertain.

Language and understanding

About three out of four infants are jabbering away by age eight months or so.

Most are starting to combine syllables and vocalize in strings of sounds pulled together.

By age nine months, you may even notice your baby start to use the words "mama" and "dada"

to refer specifically to you.

Your child's understanding of language is increasing, as well even more rapidly than his or her vocal expressions.

By now, your baby likely understands the meaning of a number of words, including his or her own name.

As mentioned previously, he or she is also starting to understand simple games and rhymes

and will laugh and giggle at appropriate parts.

For example, about half of babies can play clapping games by age nine months.