Book Two - Newborn Through Age 5

Happy Birthday Baby Book TwoA New Book for Children through Age 5

Our new book actually overlaps the original Happy Birthday Baby Book from pregnancy to age 1, but continues the journey of caring for your child to age 5. You can read it online below or order your book here to be sent to your house for free.

Book Two guides you through all aspects of child care including nutrition, good parenting, behavior, sleeping, developmental milestones, immunizations and common childhood illnesses.

We’ve also devoted material to the ever important task of taking care of yourself.

WIC

WIC is a special nutrition program for women, infants and children that:

  • Helps pregnant, postpartum and breastfeeding women, new babies and children up to age 5 get the good foods they need.
  • Provides encouragement and support for breastfeeding.
  • Provides foods such as milk, eggs, cheese, juice and cereal.
  • Gives tips on planning and eating healthy meals.

Row of four baby faces

How do I qualify?

  • Meet income guidelines. 
  • Have a nutrition risk such as anemia (low iron), poor diet or diabetes. 
  • Be pregnant and/or have children under age 5.

WIC can be a very important resource for you and your family, so make an appointment today. To find out more about WIC and the clinic nearest you in Arkansas, call 1-800-235-0002; in Tennessee, call 901-222-9750 for Shelby County information. Outside Shelby County, call 1-800-DIAL-WIC (1-800-342-5942).

Resources

 

Homecoming

Mother and small daughter with new baby

Bringing your baby home for the first time will be one of your life’s most exciting and memorable experiences. It’s also a time when you are still exhausted from delivery, and taking care of your baby and yourself may seem overwhelming. Consider some of these tips to help make homecoming more enjoyable:

  • Ask your partner, family and friends to help you limit the number of visitors.
  • Don’t be shy about asking friends and family who are ill to postpone their visits.
  • Put baby updates on your Facebook page or voice mail message. 
  • Sleep every chance you get. 
  • Let your baby set the pace. 
  • Remember that crying is your baby’s only means of communication. He is making adjustments, too.
  • Leave the housekeeping to someone else.
  • Accept that it is normal to be emotional. If you feel stressed, ask for help. Remember that the relaxation techniques you learned in childbirth classes aren’t just for labor. Use them in any stressful situation.

Emotions, Depression and Baby Blues

Baby blues

Woman holding baby suffering depressionThe time right after your baby’s birth is physically and emotionally challenging. Your hormones and body chemistry are a long way from normal and will be that way for a while. Add lack of sleep to the mix and it’s easy to understand why many new mothers report feeling depressed, on the verge of tears all the time and very tired. This is called baby blues. The baby blues are a well-documented, hormone-induced condition often appearing 48 to 72 hours after delivery and lasting up to two weeks. This is a temporary, short-term condition. Keep that in mind, and it may make your emotions less overwhelming. 

Helpful coping tips:

  • Ask your partner, family and friends for help with the baby’s needs.
  • Don’t hide your feelings. Talk about them with your partner, family and friends.
  • Don’t make any major life changes during pregnancy or right after giving birth.
  • Don’t try to do too much or to be perfect.
  • Make time to go out, visit friends or spend time alone with your partner.
  • Rest as much as you can. Sleep when the baby is sleeping.
  • Talk with other mothers or join a support group.

Postpartum depression

The baby blues is normal. However, if the blues don’t lift after about two weeks or get worse, you may be suffering from a more serious problem called postpartum depression. Postpartum depression is characterized by frequent crying, irritability, sleep problems, restlessness, feelings of hopelessness, feeling disconnected from life and an inability to care for the baby. This is a serious and potentially life-threatening condition that requires professional treatment. 

Mothers with postpartum depression also report:

  • Being afraid to be alone with their babies.
  • Having negative feelings toward the baby or thinking about harming the baby. Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.
  • Worrying intensely about the baby or having little interest in the baby.

If you have any of these symptoms, call your doctor right away.

Domestic Violence

Arguments are common, but violence is never OK. Still, many women experience physical or mental abuse at the hands of their boyfriends or spouses. The stress associated with having a new baby can sometimes trigger violent behavior. If your partner is physically or emotionally abusing you, know that you are not alone. The first step toward getting out of an abusive relationship is admitting that your partner or spouse is abusive. Call the National Domestic Violence hotline at 1-800-799-SAFE (7233) for help.

Ask yourself, does your partner:

  • Always put you down or make you feel bad about yourself?
  • Cause harm or pain to your body?
  • Threaten you, the baby, your other children or himself?
  • Tell you it’s your fault he hit you?
  • Promise never to hurt you again, but still does?

If any of these things is happening, you may need to seek help. It is important that you and your children are safe. Abuse can cause long-lasting physical and emotional problems for both you and your children.  Children who witness abuse are at risk of becoming violent themselves or being in a violent relationship when they get older.

 

Drug and Alcohol Abuse

Drug and alcohol abuse keeps parents from doing their number one job – providing a stable and loving environment for their child. Helping your baby feel safe and secure is critical to healthy growth and development. When alcohol or drugs prevents you from doing that, your child may have problems with his behavior or with learning.

If you or your partner has a problem with substance abuse, seek help. Talk to your doctor for advice or, in Arkansas, call the Arkansas Rehabilitation Hotline at 1-888-656-6401. In Tennessee, call the Tennessee Redline at 1-800-889-9789. Do it for your child. Do it for yourself.

Resource

 

Smoking: Quit Now, Quit for Good

When parents smoke or let others smoke around their children they put the child’s health in danger and send a message that smoking is OK.

Secondhand smoke can cause respiratory problems, ear infections and increases the risk of Sudden Infant Death Syndrome (SIDS).

The best way to protect your child is to prevent smoking in your home or car.

If you’re ready to quit smoking, call this toll-free Quit Line: 1-800-QUIT-NOW or 1-800-784-8669.

 

Your Newborn's Body

According to the American Academy of Pediatrics, you may be surprised by a few things about your newborn that are really quite normal. 

Birthmarks. These common spots and stains are usually harmless, and many eventually disappear on their own. 

Baby laying on the floorBlood. It’s not uncommon to see a tiny bit of blood in your daughter’s diaper for the first couple of weeks. The withdrawal of maternal hormones after birth causes this tiny bit of vaginal bleeding. 

Breasts. Your hormones are still in your baby’s system. These hormones may cause breast tissue to grow slightly, in both girls and boys. These baby breasts may last for a few months but then should go away. 

Cord color. Your baby’s umbilical cord stump will turn yellow and then brown or black first before falling off on its own. 

Jaundice. This is a condition that makes a newborn’s skin and the white part of the eyes look yellow. It happens because there is too much bilirubin in the baby’s blood. Bilirubin is a substance that is made when the liver breaks down old red blood cells. Jaundice is easily treated by placing the baby under a special bilirubin light for a few minutes at the hospital. If your baby is diagnosed with jaundice, he will need a follow-up exam within the first five days after birth. Call your doctor if the yellow color gets brighter after your baby is 3 days old.

Odd movements. Newborns’ bodies are ruled by reflexes. His chin, arms or legs may seem shaky, especially when crying. 

Other skin conditions. Rashes and other skin conditions are common in newborns. Typically, they will go away in a few weeks without treatment.

Rapid breathing. Your newborn’s breathing may pause for up to 10 seconds and then resume normally. This is normal. Healthy newborns average 40 breaths a minute (adults take 12 to 18). 

Soft spots. The two soft areas on your baby’s head are known as fontanels. When your child cries, they may bulge. The soft spots may pulse along with his heartbeat. 

If you think your child may be ill, or if something just doesn’t seem right, trust your instincts and call your doctor.

Handling Your Newborn

If this is your first baby, you might be a little surprised at how tiny and fragile your little one really is. Here are a few important tips for protecting your newborn: 

  • Happy couple holding a babyDon’t let anyone smoke around your baby. Secondhand smoke is dangerous.
  • Wash your hands (or use a hand sanitizer) before handling your newborn, and make sure everyone else who handles your baby also has clean hands.
  • Support your baby’s head and neck. Cradle the head when carrying your baby, and support the head when carrying the baby upright or when you lay him or her down.
  • Do not shake your newborn, and don’t let anyone else shake him. If you need to wake your infant, don’t do it by shaking. Instead, tickle your baby’s feet or blow gently on his cheek.
  • If you feel like shaking your baby out of frustration, it is okay to walk away. Place your baby in a safe place, such as the crib and spend a few minutes alone until you feel calmer.
  • Make sure your baby is securely fastened into the carrier, stroller or car seat. Limit any activity that might be rough or bouncy.
  • Your newborn is not ready for rough play, like being jiggled on the knee or strolled at more than a walking speed. 
  • Never let anyone throw your baby in the air and catch him. This can cause irreversible brain damage.

Resource

Newborn Sleep and Crying

Sleep

Newborns may sleep as much as 16 hours in a 24-hour period, usually four-and-a-half hours at a time.

Sleeping babyTo help your baby adjust to sleeping at night:

  • Be consistent in your routine. It may take several weeks for your baby’s brain to recognize the difference between night and day.
  • Keep lights dim and your voice low to reinforce the message that nighttime is for sleeping. 
  • Start a bedtime routine by reading, singing or having quiet time before putting him in bed. 
  • Resist the urge to play or talk to your baby during late-night diaper changes.

By the time your baby is 2 months old, he should be sleeping six to eight hours through the night. If your baby isn’t sleeping through the night by 4 months, talk with your doctor. 

Crying

Crying is your baby’s only real form of communication. It’s the only way he can let you know that something in his little world isn’t right. If he cries, pick him up. Newborns can’t be “spoiled” by too much attention. Answering his cries for help promptly will make him cry less. 

Within a 24-hour period, newborns usually cry for two hours or more. It’s a normal part of adjusting, and he will cry less as he gets more accustomed to the sights and sounds of his new surroundings. Of course we don’t know for certain, but it appears that babies sometimes cry as a way of releasing tension or to block out sensations that are too intense. In fact, some babies cannot fall asleep without crying.

If your baby cries more than three hours a day, at least three days a week, for at least three weeks in a row, he may have colic. Episodes of colic usually begin suddenly and for no apparent reason late in the afternoon or evening. Try the following suggestions if your baby is colicky or has afternoon crying episodes:

  • Swaddle your baby snuggly in a blanket, leaving one arm free and the other tucked inside.
  • Gently rock your baby while rubbing his head, chest or back.
  • Position your baby tummy down on your lap or upright on your shoulder or against your chest.
  • Give your baby a warm bath.
  • Play soft music or a continuous sound like the clothes dryer or a recording of the ocean.
  • Take your baby for a walk. A car ride (in a car seat) can be soothing too.
  • Offer a pacifier or your finger to suck on.
  • Turn down the lights and noise in the room.

Don’t take your baby’s crying personally. He can feel your tension and will only cry more. Visit www.cryingplan.com for more information on handling the stress of a crying baby.

Resources

Bonding With Your Newborn

Bonding is the intense attachment that develops between a parent and child. Mothers and fathers both bond with their baby. Bonding is a very powerful survival mechanism that motivates parents to protect their vulnerable newborns. Don’t worry if you don’t feel an immediate bond. You may be exhausted and worried about taking care of your newborn. These feelings are normal, especially for first-time moms.

Tips for bonding

  • Provide a warm and loving environment. Helping your baby feel safe and secure is critical to healthy growth and development. When you give your baby a lot of affection, you are telling him he is safe and protected.
  • Woman laying down with babyTalk, sing and read with your child. You could say newborns are hardwired to respond to sounds, which are the building blocks of speech and language. When you talk to your newborn, you are helping create a deep and enduring emotional connection.
  • Establish routines. Feeding and bedtime routines help create a predictable world for your baby. Routines provide a sense of comfortable sameness and stability that babies can trust and rely on. If your child feels that his world is safe, he will be able to put his energy into exploring and learning.

Resource

Dad's Role

Dad with son on porchDads and other important men like grandfathers and uncles can make profound contributions in a child’s development. When fathers with a positive attitude are affectionate, spend time with their children and are involved in their children’s daily activities, their children have fewer behavioral problems, perform better in school, are more sociable and have better self-esteem. What kind of dad will you be? Here are some things to help you get off on the right track:

  • Define your role by being a consistent partner in caring for your baby. 
  • Create unique rituals for you and your child. 
  • Make time for both work and family. 
  • Maintain a relationship with your children even if you don’t live in the same home. 
  • Communicate with your child’s caregiver. 

Grandparents' Roles

Grandmother holding a babyMany new parents are fortunate to have their own parents close by who will help take care of the baby. This is a happy time for all of you, but it may have been a long time since your mother or others have taken care of an infant. So take the time to discuss with family caregivers the information in this book about crying plans, good nutrition, tummy time, the importance of putting babies to sleep on their backs and how they should never shake your child. Encourage them to spend time each day reading, singing and talking to your baby. 

You also may want to recommend that family members order their own free copies of the Happy Birthday Baby Books at healthyfamiliesnow.net. 

Grandparents can help you by:

  • Lending emotional support and (if asked for) advice.
  • Watching for signs of the baby blues or postpartum depression.
  • Helping with housework or cooking.
  • Running errands and shopping.
  • Taking precious photos of your family. 

 

Siblings' Roles

Siblings need a lot of one-on-one attention before the new baby arrives and helping you set up the nursery is a good way to include him. Let him help pick out sheets or a special toy that is just from him. He needs to know that the baby will not be ready to play for quite a while, but there are lots of ways to be part of his new sibling’s life. He can:

  • Be your personal assistant – getting you a glass of water or something you might need for the baby.
  • Read to your baby or tell him a story.
  • Fold baby clothes.
  • Answer the phone.
  • Hold or feed the baby if he is old enough.

Resource

 

Early Learning

Dad playing with baby

Your child is born learning. Right from birth his brain is making new connections and associations, working to understand the world around him. Children learn something from everything they do or see. As your child’s first and best teacher, you can help his developing brain by:

  • Talking, singing and reading as often as possible, even to newborns.
  • Letting him see what you do for fun and at work.
  • Making special trips to parks, museums or libraries.
  • Encouraging healthy, imaginative play and playing with him.
  • Creating opportunities for fun. 

Resource

Mom, Take Care of Yourself

Woman getting check upTaking care of yourself means you’re more likely to have all the energy and enthusiasm it takes to care for your baby. Make sure you schedule an appointment to see your doctor for a “postpartum” checkup. This appointment should be between two to six weeks after your baby is born. If you have questions or problems before then, call your doctor. 

Things to talk to your doctor about:

  • Ask if you are protected against rubella. If not, get a shot to protect yourself before you leave the doctor’s office.
  • Ask about family planning. You can get pregnant again even if you are breastfeeding. Your body is not ready for another pregnancy right now. 

Postpartum care 

  • Get as much rest as possible. Sleep when the baby sleeps.
  • Follow your doctor’s instructions. When it comes to activities like climbing stairs, jogging or walking, ask your doctor what you can and cannot do for the next few weeks.
  • Sex. Doctors usually recommend that you not have sexual intercourse for four to six weeks after birth.

Postpartum discomfort may include:

Sore breasts or engorgement. Several days after delivery, your breasts may become heavy, swollen and tender. This means your breasts are overfull or engorged with milk. You also may have a low-grade fever.

To ease engorgement:

If you are breastfeeding, nurse your baby or use a breast pump to express milk. You also may want to apply cold washcloths or ice packs to your breasts, or take a warm bath or shower. Over-the-counter pain relievers may help, too.

If you’re not breastfeeding, wear a firm, supportive bra. Compressing your breasts will help stop milk production. In the meantime, don’t pump your breasts or express milk because this will signal your breast to produce more milk.

Leaky breasts. Wearing absorbent nursing pads inside your bra can help keep your clothing dry. Avoid pads that are lined or backed with plastic, which can irritate your nipples. Change pads after each feeding.

Constipation. Your first bowel movement after birth may take a couple of days. Hemorrhoids you developed during pregnancy, healing episiotomies and sore muscles may make it a painful event.

Hemorrhoids. These are veins in the anus or lower rectum that were stretched and swollen during labor and delivery. Your doctor can recommend a topical hemorrhoid medication.

Episiotomy. If the skin between your vagina and anus was cut by your doctor or if it was torn during birth, the stitches may make it painful to sit or walk for a little while. As it is healing, it may also be painful when you cough, sneeze or laugh. 

For relief:

  • Apply cold packs to that area for the first 24 hours after delivery, and then use warm packs.
  • Avoid infection and promote healing by rinsing the area with warm water after you urinate or have a bowel movement. Use anesthetic sprays, creams, or pads that contain witch hazel like Tucks.
  • Sit in a sitz bath (a small basin that fits on top of the toilet) or bathtub of warm water three or four times a day. 

Urinary or fecal incontinence. This means you may accidently pass urine when you cough, laugh, or strain or find it difficult to control your bowel movements. Get those muscles back in shape by doing your Kegel exercises. If you continue having trouble controlling bowel movements, call your doctor.

Vaginal discharge. At first you may have a bloody discharge that could be heavier than your period and may contain clots. This bloody vaginal discharge will gradually fade to white or yellow and then stop completely within two months. To reduce the risk of infection, use sanitary pads rather than tampons. 

Contact your doctor if:

  • You soak a sanitary pad within an hour while lying down.
  • The discharge has a foul odor.
  • You pass thumb-sized clots.
  • You have a fever of 100.4°F or higher.

Weight. Eating healthy and getting regular exercise will help you gradually regain your pre-pregnancy figure. Do your Kegels, but wait until you have completely stopped bleeding before swimming or taking extended walks. 

Recovery from Cesarean section (C-section). If you had a C-section, it may take longer for you to recover, because surgery requires a longer healing time. 

Your doctor will tell you about things you shouldn’t do and give you directions for bathing, how to begin gentle exercises to speed recovery and how to help avoid constipation.

Family Planning

Medical experts recommend that women not have sex for at least six weeks after giving birth, and that they not become pregnant within six months. Since getting pregnant again too soon can be very dangerous, it is important to decide early which form of family planning you will use.

  • Talk to your doctor and partner about the best method of family planning for you. Is the method easy to use? Is it safe? Does it work?
  • Methods that don’t work include: Withdrawal, douching, makeshift condoms, feminine hygiene products and breastfeeding.

Resources

 

Going Back to Work

For most companies six weeks is considered the normal length of maternity leave following delivery. That may be too few for some new mothers and too much time for others. The Family and Medical Leave Act (FMLA) requires companies to allow up to 12 weeks of unpaid leave for employees (of companies with more than 50 employees) to care for a newborn or newly adopted child.

If you’re trying to decide whether you’re ready to go back to work, here are some things to think about:

  • How much support can you expect to get at home with household chores and child care? 
  • How many hours a week do you work?
  • What are the demands of your job?
  • How much flexibility do you have at work?
  • Will you be able to take rest breaks, if necessary? 
  • Who will watch your baby?

Dad feeding baby with bottleMaking the transition from home to work

Most mothers have to go back to work within six to eight weeks after the birth of a baby. Although it’s always an emotional time, there are ways to make the transition easier.

  • Create a daily routine and practice it for a few days before you actually go back to work. Allow enough time to get yourself and your baby ready so you don’t get (or stay) stressed. If you can, have your child care arrangements begin a few days early so you can emotionally prepare for your first real day away from your baby.
  • Have a backup plan for those times – and they will come, when your child care provider isn’t available or your child gets sick.
  • Get as much rest as you can so you will be able to cope with stress better. If that means letting some household chores slide, then so be it. Ask your partner to help if he doesn’t already.
  • If you’re going to continue breastfeeding, plan ahead. Buy a breast pump, and begin pumping and freezing milk two weeks before you go back to work. Frozen milk is good for at least one month in a freezer.
  • See “Storing and Preparing Expressed Breast Milk” in the “Feeding Baby” on page 51 of this book.
  • Let someone else bottle-feed your baby so he will get used to being fed by someone other than you.
  • Talk with your employer to work out a break schedule, and find a private place to pump milk. Pumping sessions will probably require 15-20 minutes, two or three times a day. You’ll also need to find a way to refrigerate the milk and get it home at the end of the day. For more on pumping milk at work, go to the La Leche League International website at www.llli.org/faq/pumpfreq.html.

Resources

 

Finding Quality Child Care

Child care worker reading to kids

Selecting a child care provider is one of the most important, emotional and difficult decisions you will make as a parent. High-quality child care and early childhood education set the stage for how well your child will learn and how he will think of himself and others.

Better Beginnings, Arkansas’s quality rating system for licensed child care facilities, will be a great resource in helping you select the best child care for your baby. In Arkansas, the Better Beginnings website at www.ARBetterBeginnings.com and in Tennessee, the Tennessee Department of Human Services website at www.parentsknowkidsgrow.org/choosingchildcare make it easy for you to:

  • Learn what to look for in a child care facility.
  • Know what questions to ask about child care.
  • Find licensed child care providers in your area using
  • a convenient online tool.
  • Compare child care providers based on their quality ratings.

Both websites provide a checklist of everything you should consider when choosing a child care provider. Print out a checklist and take it with you when you visit

a possible child care facility.

Resource

 

Taking Care of Baby

Safe sleeping and preventing Sudden Infant Death Syndrome (SIDS)

Baby asleep on backMany infant deaths involve unsafe sleeping environments and locations. Parents and caregivers may be familiar with the Back to Sleep program that instructs parents to always place infants on their backs for sleeping as a precaution against SIDS, the unexplained death of an infant in the first year of life. No one knows what causes SIDS, but there are several things you can do to reduce the risk of SIDS and other sleep-related infant deaths. There is some evidence that breastfeeding may reduce the risk of SIDS. 

Be sure people taking care of your baby:

  • Always place your baby on his back to sleep, even for naps. 
  • Place your baby on a firm mattress, such as in a safety-approved crib.
  • Remove bumper pads and soft, fluffy bedding, pillows and stuffed toys from your baby’s sleep area.
  • Make sure your baby’s head and face remain uncovered during sleep.
  • Place your baby’s crib in the same room where you sleep, but do not place your baby in the same bed with you.
  • Make sure your baby sleeps alone, not in the bed or on the sofa with other children or adults.
  • Do NOT use blankets or comforters under your baby.
  • Do NOT let your baby sleep on a waterbed, sheepskin, pillow or other soft material.
  • Do NOT let your baby get too warm during sleep.
  • Do NOT allow smoking around your baby.
  • Have people wash their hands before holding or playing with your baby. Respiratory infections increase the SIDS rate.
  • Talk to child care providers, grandparents and babysitters about the do’s and don’ts.

Tummy time

Baby laying on tummyExperts agree you should never put your baby to bed on his tummy. They also agree that supervised tummy time, beginning within the first month after birth, is important to a baby’s physical development. Strong neck and upper back muscles allow babies to control their head movements. So encourage the development of head control by giving your infant a lot of supervised time on his stomach while he’s awake. Tummy time also seems to promote a well-shaped head that has fewer flat spots. Five or ten minutes, a couple of times a day during supervised play breaks, should do it. Your lap is a good tummy time location as is any smooth, flat surface with no loose items like toys, blankets or pillows nearby that could interfere with breathing. 

Resources 

Shaken Baby Syndrome 

Tired mother with babyAnyone who has ever taken care of a fussy baby, or a baby who cries endlessly, knows how stressful this can be. Sometimes, usually out of frustration, a caregiver may shake the baby forcefully, trying to make him stop crying. This is never the right thing to do! Your baby’s tiny, fragile brain can be severely damaged. It takes only a few seconds of shaking to cause irreversible brain damage in an infant. 

Ways to cope with the stress of crying include:

  • Placing your baby in a safe place (crib, car seat), walking away and taking a few minutes to calm down. As long as your baby is safe, has eaten and has a clean diaper, it is OK to let him cry until you feel better.
  • Sit on the front porch, step into the backyard or spend some time listening to music. 
  • Call a friend or relative for help. 

Visit www.cryingplan.com for more information on shaken baby syndrome and handling the stress of a crying baby. Call 911 immediately if you think your baby has been shaken.

 

Feeding Baby

For the first six months of your baby’s life, the only nutrition he needs is breast milk or formula.

The American Academy of Pediatrics recommends breastfeeding over formula. Formula is not identical to breast milk, but formulas do provide an appropriate level of nutrition. Both approaches are safe and healthy for your baby, and each has its advantages. 

  • Newborns need to be fed every two to three hours, but a strict feeding schedule isn’t necessary. 
  • Breastfed babies need to eat more often because breast milk digests more quickly. 
  • Don’t be alarmed if you notice your baby has lost weight in the first week; most infants lose several ounces of weight during their first week, but they should be back up to their birth weight by the end of the second week. 
  • If your baby sleeps for periods longer than four hours in the first two weeks, wake him for a feeding. If your baby will not stay awake long enough to eat at least eight times per day, call your doctor.

Breastfeeding

It’s best for your baby, and it’s good for you, too. It will help get your uterus (womb) back in shape. If you need help or advice about breastfeeding, call your local WIC clinic, the Arkansas Department of Health at 1-800-445-6175 or La Leche League at 1-877-452-5324. You also can go to their website at www.llli.org.

Tips for getting breastfeeding off to a good start:

  • Woman breastfeeding babyAvoid alcohol, cigarettes and drugs. They are not healthy for you and can harm your baby when passed through your breast milk.
  • Eat a variety of healthy foods, and drink six to eight glasses of water and other liquids each day.
  • Learn about breastfeeding during pregnancy from classes, videos, books or the Internet. 
  • Breastfeed as soon as possible after delivery.
  • Ask for help to get correct positioning. Many hospitals have specialists, called lactation consultants, on staff that can help you.
  • Nurse often, at least every three hours or eight to 12 times every 24 hours.
  • Listen for swallowing sounds during the feeding to make sure everything is going down well.
  • Let your baby be the judge of when he’s had enough. He should seem satisfied and look relaxed.
  • Your baby should wet and soil at least six diapers every day.
  • The number of wet and soiled diapers should increase each day during the first week of life.
  • If you are breastfeeding, your baby needs to be seen by his pediatrician within 48 to 72 hours after you leave the hospital. During this visit, your baby will be weighed and examined, and your breastfeeding technique can be evaluated. It’s also an opportunity for you to ask questions.

For help with breastfeeding, contact your local WIC clinic, call the Arkansas Department of Health WIC Breastfeeding Helpline at 1-800-445-6175 or visit www.HealthyArkansas.com/breastfeeding.

What happens if you get sick while you’re nursing?

Most experts agree that the best thing for you and your baby is to continue nursing. Your body will produce antibodies to the bug causing your illness, and fortunately you will pass those antibodies along to your baby through your breast milk. If your baby does get sick, he will probably only get a very mild case of the illness.

Very few diseases or illnesses require breastfeeding to stop. Talk with your doctor or refer to www.familyresource.com/pregnancy/breastfeeding/when-a-nursing-mother-get...

If you’re sick, there are some over-the-counter medicines considered safe for nursing mothers and others that are not. Always ask your doctor before taking any medicine while you’re nursing. For a detailed list of over-the-counter medicines that your doctor may recommend, go to www.familyresource.com/pregnancy/breastfeeding/when-a-nursing-mother-get...

Storing and preparing expressed breast milk 

Breast milk is perfect straight from your breast, or it can be expressed and stored for later use. Follow these safe storage and preparation tips to keep your expressed milk healthy for your baby:

  • Wash your hands before expressing or handling your milk.
  • Use only clean containers to store milk. 
  • Freeze milk if you do not plan to use it within 24 hours. Frozen milk is good for at least one month in a freezer.
  • Carefully label the milk with the date and time that you expressed it. Use the oldest milk first. 
  • Freeze between 2–4 ounces of milk per container, to avoid wasting milk after you thaw it.
  • Do not refreeze your milk.
  • Do not add fresh milk to already frozen milk in a storage container.
  • Thaw milk in the refrigerator.
  • Use milk thawed in the refrigerator within 24 hours.
  • Do not save unfinished milk from a partially used bottle to use at another feeding.
  • Never use a microwave to heat bottles. Uneven heating can scald your baby, and excessive heat can destroy important proteins and vitamins in the milk. 

 

Feeding Formula

Woman feeding a baby with a bottleAll formulas manufactured in the United States must meet strict nutritional standards set by the U.S. Food and Drug Administration (FDA), so don’t be fooled into thinking that expensive, brand-name formula is any better for your baby than a generic brand. But make sure to check the expiration date on all cans and bottles of formula, and don’t use formula from leaky, dented or otherwise damaged containers. 

For more information on feeding your baby, visit www.askbaby.com, www.kidshealth.org or www.marchofdimes.com.

Bottle basics 

Baby bottles certainly have their place, even if you are breastfeeding. Moms who breastfeed often “express” their milk by pumping and then storing it in the freezer or refrigerator for times when they can’t nurse.

  • Always hold your baby when feeding.
  • Keep plenty of formula and ready-to-use bottles on hand.
  • Sterilize bottles and nipples before first use and after every use.
  • Store bottles of formula or breast milk for no more than 24–48 hours.
  • Throw away bottle contents that sit at room temperature for more than one hour to reduce the risk of infections due to salmonella or other bacteria.

Never use the microwave to warm your baby’s bottle. Dangerous “hot spots” can burn your baby.

 

Insurance for You and Your Baby

 

Medicaid

Many women in Arkansas and Tennessee, along with their babies, qualify for medical coverage under Medicaid (an insurance program funded by state and federal governments).

Medicaid covers the cost of:

  • All checkups during pregnancy and immediately afterward.
  • Baby’s delivery at the hospital. 
  • All the checkups your baby will need during his first year.

If you are an Arkansas resident already covered by Medicaid, you may need a primary care physician (PCP). To get a list of PCPs, or for more information about Medicaid, call the ConnectCare hotline at 1-800-275-1131 or go to www.seeyourdoc.org

Four different babies in a row.

ARKids First (for Arkansas residents)

ARKids First is Arkansas’s Medicaid program providing health insurance to uninsured children. The program offers two coverage options. ARKids A offers children in low-income Arkansas families a comprehensive package of benefits. ARKids B provides coverage for children in families with slightly higher incomes. You can apply for ARKids A or B through the mail or online without having to visit a Department of Human Services (DHS) office. For more information or to get an application, call 1-888-474-8275 or go to ARKidsFirst.com or access.arkansas.gov.

TennCare (for Tennessee residents)

TennCare is Tennessee’s Medicaid-managed care health insurance program. Many low-income pregnant women in Tennessee, and their babies, may qualify for TennCare. Children under age 21 may also qualify. Under TennCare, members enroll with a managed care organization (MCO). Once you are enrolled, your MCO will help you find a prenatal care provider. If you think you may qualify, contact your local health department as soon as possible for information and an application. In Shelby County, call 901-545-8722 for assistance or go to www.tn.gov/tenncare/.

Health Insurance Marketplace

Many people may qualify for affordable health care through the Health Insurance Marketplace. Financial assistance may even be available to help cover the cost. To find out if you are eligible in Arkansas, visit www.arhealthconnector.org (http://www.arhealthconnector.org) or call 855-283-3483. In Tennessee, visit https://www.healthcare.gov/marketplace/individual or call 1-800-318-2596.

Resources

 

Your Baby's Oral Health

Baby with mouth openHealthy gums (and later, teeth) are important for your baby’s overall health and development. 

  • Begin cleaning your baby’s mouth during the first few days after birth. 
  • After every feeding, wipe your baby’s gums with a clean, soft cloth or a soft infant toothbrush and water to remove plaque and milk that can harm new teeth that may be coming through.
  • Do not use fluoride toothpaste until your child is 2 to 3 years old. 

 

 

 

Taking Baby's Temperature

The most accurate way to take an infant’s temperature is to use a digital thermometer rectally or orally. Make sure you carefully read the instructions that came with your thermometer.

To take his temperature rectally, lubricate the tip of the thermometer with petroleum jelly. Place your baby on his back, lift your baby’s thighs and insert the lubricated thermometer ½ to 1 inch (1.3 to 2.5 centimeters) into the baby’s rectum. If you feel any resistance stop immediately. Hold the thermometer in place for about a minute or until the thermometer signals that it’s done. Remove the thermometer, and read the number.

If your infant is 3 months or younger and has a rectal temperature of 100.4°F or higher, call your doctor or go to the emergency room immediately.

Resource

 

When To Call Your Baby's Doctor

when to call your baby's doctorChances are you’ll be able to tell when something isn’t quite right. If you think your newborn baby needs medical attention, call his doctor. Not everything is an emergency, but there are some conditions that simply can’t wait for regular office hours:

Call your doctor immediately if your newborn baby:

  • Has a temperature above 100.4°F.
  • Has trouble breathing or is hard to waken.
  • Has blood in his vomit or stool.
  • Has yellowish skin or eyes.
  • Is having a seizure (jerking or trembling movements in infants are fairly common and are not usually seizures, but if you are concerned, consult your pediatrician).

Resource

 

Taking Care of Minor Problems

Care of umbilical cord:

  • The end of the cord will fall off a couple of weeks after birth. Until then, keep it clean and dry.
  • Keep your baby’s diaper below the cord so it stays dry.
  • In the past, parents were told to swab the base of the cord with alcohol one or two times a day. But research shows the cord heals faster when it is left alone. If you’re unsure, ask your doctor.
  • Call your baby’s doctor if the cord stump looks red or irritated, bleeds or oozes, or has a bad odor.

Care of circumcision:

  • Clean the penis gently with mild soap and water during diapering.
  • If the tip of the penis is irritated by the diaper, put a little bit of petroleum jelly on the irritated area each time you change your baby’s diaper. 
  • A circumcision should heal in 7 to 10 days.

Preventing diaper rash:

  • Change diapers often.
  • Wash your baby’s bottom with mild soap and water at each change. Avoid scented wipes and soaps.

Treating diaper rash:

  • Let your baby go without a diaper for a few hours each day (place several folded cloth diapers under him to prevent a mess), and avoid using plastic pants. 
  • Keep his skin as dry as possible.
  • Use zinc oxide or diaper rash cream on irritated areas after washing.
  • Do not use talcum powder or cornstarch on your baby’s skin.

Treating diarrhea: 

Diarrhea can be a very serious problem for newborns and infants because it can cause them to become dehydrated (lose body fluid) quickly. If your baby will nurse or take a bottle, continue feeding as usual.

Call your baby’s doctor if:

  • Your baby won’t take liquids.
  • Can’t keep them down.
  • Has a lot of diarrhea or has diarrhea for longer than 12 hours.

Treating colic:

Refer to the section on crying earlier in Newborn Sleep and Crying.

Treating a cold:

Adult colds make us feel bad for a while, but they’re no big deal. For newborns, a common cold can quickly develop into croup, pneumonia or another serious illness. If your baby is younger than 3 months, contact the doctor at the first sign of illness or before giving your child any medicine.

  • Use a suction bulb to remove mucus from your baby’s nose. Squeeze the bulb part of the syringe, then gently place the tip inside one nostril and slowly release the bulb. Suction bulbs are available at most drug stores.
  • Keep nasal passages moist by running a cool-mist humidifier in your child’s room.
  • Children age 4 and under should not take cough or cold medicines unless prescribed by their doctor.

Resource

Bathing Your Baby

Bathing your baby too often will cause dry skin. Many doctors recommend sponge baths until the umbilical cord falls off and then bathing one to three times a week with warm water and a soft cloth. 

When using a tub or sink:

  • Collect everything you may need to bathe your baby before you begin. 
  • Make sure the room is nice and warm.
  • Place a towel or large sponge under your baby to keep him from slipping from your grasp. Use only 2 or 3 inches of water. 
  • Wait until the bath water is completely ready before undressing your baby so he won’t get chilled.
  • Wash your baby’s face and eyes first before putting him in the tub to prevent eye infections. 
  • Use just a small amount of mild soap to avoid dry skin. Wash your baby’s scalp with a wet, soapy cloth. You will only need to wash your baby’s hair with shampoo once a week. 
  • Rinse your baby thoroughly with a clean, soft cloth or sponge.
  • Wrap your baby in a towel and pat him dry.
  • NEVER leave your baby alone in the sink or tub even for a second because he could drown.
  • NEVER leave your baby alone on a bathroom counter.

Healthy Hearing

The sound of your voice is comforting to your baby. Talking, singing or reading out loud to your baby will help him recognize your voice. Babies are very interested in new sounds. And just like older children, they also get used to noises quickly and can tune them out. 

Signs your baby is responding to a new sound:

  • Pauses in sucking or fussing 
  • Widening their eyes

Check with your baby’s doctor if:

  • Your baby does not respond to noises like a whistle, hand clap or horn.
  • Does not begin looking around for the source of a sound by age 3 months.

Healthy Vision

Woman holding babyYour baby’s eyes will continue growing in size through his first year. Because his eyes are not fully developed, his sight is very limited. He won’t be able to fully control his eye movements or focus clearly for a while. Most newborns are nearsighted and focus on things that are 8 to 12 inches from their faces. By giving your baby simple things to look at, you can help strengthen his eye muscles. Newborns most like seeing your face, so give your baby plenty of face time.

Check with your baby’s doctor if:

  • Your baby’s eyes increasingly cross or one eye drifts.
  • Your baby’s eyes appear cloudy or filmy.
  • Your baby’s eyes don’t seem to focus on objects near his face or they wander randomly.

Resources

 

Safe Home for Baby

 

Your baby will grow and thrive in a safe environment. It’s up to you to be prepared for emergencies and make your home safer. There are hundreds of things, big and small, that you can do to make your home safer. We’ve included additional sources at the end of this section. But for now, here are just a few to get you started.

  • In emergencies, CALL 911 first!
  • Make sure you have the phone numbers of your pediatrician, the poison control center (1-800-
  • 222-1222), your spouse or partner at work, and your ambulance service (if you don’t have 911) programmed into your phone and easily accessible.
  • Turn your water heater down to 120°F to prevent burns.
  • Make sure every area of your house has a smoke detector and a carbon monoxide detector. Check them monthly.
  • Get a baby monitor and test it before you bring your baby home.
  • Do not allow anyone to smoke in your house, your car or near your baby.
  • Check to see that no safety recalls have been issued on equipment and toys you have bought or received for your baby. Call the Consumer Product Safety Commission at 1-800-638-2772 or go to
  • www.cpsc.gov to check for a recall on your equipment.
  • Make sure cleaning supplies and other chemicals are out of reach. 

Safe baby gear 

Every year, tens of thousands of children are injured or killed by defective products. Before you use a “hand-me-down,” check with the U.S. Consumer Product Safety Commission at www.cpsc.gov/cgi-bin/prod.aspx for a list of the most important recalls and hazards.

Be sure to mail in the registration cards on all your new baby gear so the manufacturers will contact you if the product is recalled. 

 

Preventing Injury & Vehicle Safety

 

Arkansas and Tennessee have some of the highest rates of child and adolescent injury in the nation. Arkansas Children’s Hospital has made reducing the rate of childhood injury a high priority. Download the Home Safety Checklist from www.archildrens.org/ documents/ipc-homesafety.pdf or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml, and begin making your home safer as soon as possible.

Vehicle safety

Vehicle crashes are a leading cause of death in Arkansas and Tennessee for children and youth ages 1–19. Many of these deaths and injuries can be prevented. The Injury Prevention Center at Arkansas Children’s Hospital offers programs to educate parents on the importance of vehicle safety. For a detailed list of vehicle safety tips, visit www.archildrens.org and type “injury prevention” in the search window or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml. 

Car seats

Couple with child in car seat

The law requires that your baby must always ride in an approved safety seat when traveling. That means you must bring your baby home in a car safety seat that is marked “federally approved,” and the hospital will not allow you to leave without one. Ask your doctor, the hospital where you deliver or your health department about programs that loan federally approved car safety seats. 

Your baby should ride rear-facing until he is about 2 years old. When he reaches the highest weight or length allowed by the manufacturer for its infant-only seat, he should continue to ride rear-facing in a convertible seat until he outgrows the manufacturer recommendations.

To see a list of car safety seats and safety seat manufacturers, go to the American Academy of Pediatrics website at aap.org/healthtopics/carseatsafety.cfm.

Arkansas residents can visit carseatsar.org to find a certified technician who can help answer your car seat questions.

If you’re considering a used car seat for your child, make sure the car seat:

  • Comes with instructions and a label showing the manufacture date and model number.
  • Hasn’t been recalled (go to www.cpsc.gov/cgi-bin/prod.aspx).
  • Isn’t more than 6 years old.
  • Has no visible cracks 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! 

Resources

 

The Well-Child Checkup & Immunizations/Vaccinations

Unless your baby shows outward signs of illness or some other health problem, you may not know anything is wrong. Some conditions require blood tests or a doctor’s practiced eye to detect. Well-child checkups, which you should schedule, are the best way we have of finding potential problems early when they can be more easily and successfully treated. 

The well-child checkup includes:

  • Getting a health history and developmental assessment.
  • A complete physical exam.
  • Vision and hearing checkups.
  • Laboratory tests.
  • Age-appropriate immunizations.
  • Health education.
  • A dental referral.

Put your copy of the “Well-Child Checkups and Immunizations/Vaccinations” chart where you can refer to it easily. Making and keeping appointments with your child’s pediatrician will help keep your baby healthy and happy.

Immunizations/vaccinations

The Centers for Disease Control and Prevention publishes a schedule of immunizations needed by age for children from birth through age 6. Immunizations will protect your child from getting many serious illnesses (like polio, measles, mumps and others) that can cause lifelong problems. So it’s very important that your child be up to date on shots. If you have questions about which immunizations your baby received in the hospital at birth, call your doctor. Experts have studied these vaccines to ensure they are safe and effective.

Also make sure your baby gets a flu shot every year.

NOTE: If your child misses a shot, you don’t need to start over. Just go back to your child’s doctor for the next shot. The doctor will keep your child up to date on vaccines. Talk with your doctor if you have questions. Making and keeping appointments with your child’s pediatrician will help keep your baby healthy and happy.

Resource

This schedule applies to healthy children. Parents of children who are born more than two months premature, with chronic diseases (like sickle cell disease, anatomic or functional asplenia, HIV or other immunodeficiencies) or who have cochlear implants should talk to the doctor about additional needed vaccines.

For more information about diseases that can be prevented by a vaccine, call 1-800-CDC-INFO (1-800-232-4636) or visit www.cdc.gov/vaccines/spec-grps/infants/downloads/parent-ver-sch-0-6yrs.pdf.

Visit HealthyFamiliesNow.net/resources to print out a copy of this chart to hang on your refrigerator or somewhere that you can refer to it easily.

Footnotes

1. HepA vaccination is recommended for high-risk children older than 2 years. Children with certain medical conditions may also need a dose of meningococcal vaccine (MCV4) and pneumococcal vaccine (PPSV). HepA vaccination may be administered to any child older than 2 years for whom immunity is desired. See vaccine-specific recommendations at http://www.cdc.gov/vaccines/pubs/ACIP-list.htm.

2. Two doses given at least four weeks apart are recommended for children aged 6 months through 8 years of age who are getting a flu vaccine for the first time. Children who only got one dose in their first year of vaccination should get two doses the following year.

Your Baby: Months 1-3

Parenting

Newborns are hardwired to interact first with you and later with others. This emotional connection, called bonding, gives them the sense of security and confidence they need to learn about the world around them. Studies show that children who receive lots of love and attention have higher self-esteem and actually learn faster and better. So as a parent, when you shower love and affection on your infant, you’re NOT spoiling him. You are giving him a solid foundation that will benefit him throughout every stage of life. 

Everyday interactions can promote learning:

  • Love and affection build confidence and make your baby more relaxed and happy. Happy children learn more easily.
  • Providing routines and being consistent in the way you respond to your infant (or any age child) give him a sense of stability. He learns he can depend on you.
  • Opportunities for fun encourage your child’s brain to grow in new and wonderful ways. Infants, like most adults, tune out when they are forced to participate in activities or situations that bore them. Share a baby book and name the objects, play peekaboo or “this little piggy,” make faces or tickle his tummy. But remember, your baby may become bored even after only a few minutes of one activity. He’ll tell you when he’s had enough by turning his head or starting to cry.
  • Newborns love interesting sounds, and those sounds are the building blocks for talking and language. That’s why it’s so important for you to talk to your baby as often as possible. Describe everyday events like the steps of changing his diaper or cooking dinner. 
  • Don’t worry about spoiling your infant. When your baby cries, please pick him up. If he’s wet, change him. When he shows you he’s hungry, feed him. You’re teaching him that he can trust you.

Resources

Pacifiers 

Baby with pacifierSucking is one of the most natural responses your baby has, and it’s not just for eating. Sucking also is a way babies soothe themselves. After your baby is 1 month old, sucking on a pacifier between breast- and bottle feeding is perfectly all right and will not cause any harm. 

A pacifier should not be used as a way to replace or delay eating, so only give your baby a pacifier when you know he’s not hungry. If your baby is hungry, getting a pacifier instead of your breast or a bottle may cause frustration that could make feeding time unpleasant for both of you. Remember, the pacifier is for your baby’s benefit, not your convenience.

Your baby’s pacifier should be:

  • A one-piece model with a soft nipple.
  • Dishwasher-safe so you can either boil it or run it through the dishwasher. Do that frequently to reduce risk of infection. Your baby’s immune system is considered immature until around 6 months of age. 

Early learning

Learning begins at birth

Newborns may not be able to read written words, but they are learning to make associations and understand the world around them by reading signals. Newborns learn how to read signals all around them by listening to voices, watching faces and reading body language. 

  • Dad bonding with babyHearing people speaking and sounds of all kinds sets the stage for infants themselves to begin speaking and later reading. To give your infant a head start on learning:
  • Read, read, read. Make story time a regular part of your baby’s routine. Morning, afternoon and evening are all good times to read to your baby.
  • Use rhymes, games and songs. Babies respond to these almost from birth, even if they don’t know what the words mean. 
  • Talk about what’s going on. Describe objects, activities and places to your infant. 
  • Encourage baby babble. Babies experiment with language and their own voices through babble. Repeat their sounds, and turn them into real words. “Da-da-da…daddy.” “Ma-ma-ma-ma”…”mommy.” “Ba-ba-ba…ball.” 
  • Talk and touch. Pair rhymes with gentle touch, such as patting your baby’s feet with the rhythm of the rhyme, or give him a tender rub while you’re talking.  
  • See and say. Help your baby label the things he sees around him.
  • Ask questions. By saying, “What’s that?” and then naming the picture in a book, your baby learns that objects have names.  

Developmental milestones for your baby

Your baby will grow and develop at an amazing rate in his first year. Although no two babies are alike, there are certain achievements, called developmental milestones, that most babies reach by similar ages. Keep in mind that it’s not unusual for a healthy, normal baby to fall behind in some areas or race ahead in others. The milestones we present in this book are only guidelines. Your baby’s doctor will evaluate his development at each well-child visit. 

If your baby was born prematurely (before 37 weeks of pregnancy), you need to look at the milestone guidelines a little differently. Milestones are based on due date, not birth date. So if your baby was born two months early, he will most likely achieve milestones two months later than the guidelines predict.

Development

By the end of his third month, your baby should be able to:

  • Hold his head high and raise his body on his hands while lying on his stomach.
  • Keep his hands open while at rest. 
  • Play with his hands, bat at mobiles and reach for rattles. 
  • Place any object he holds directly into his mouth.
  • Show a clear preference for parents and other caregivers. He will turn toward a sound and recognize his parents’ voices.
  • Begin to learn cause and effect – he shakes a rattle, and it makes noise; you wind the mobile, and it begins to move.

Mother playing with baby

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

Most mothers say that feeding time was easiest in the first three months. Remember that feeding time is bonding time. Enjoy it. 

Baby sleeping

  • During the first three months, babies need only breast milk or iron-fortified formula unless otherwise directed by your baby’s doctor. 
  • Always hold your baby during feedings. Do not put your baby to bed with a bottle. 
  • Call the doctor if you feel your baby is not gaining enough weight. 
  • Do not use a microwave to heat formula or breastmilk. 
  • Delay the introduction of solid foods until your infant’s doctor says it’s time to do so, usually around 6 months.

Resource

Sleep

Babies should always sleep on their backs. Newborns and infants may sleep as much as 16 hours in a 24-hour period, usually for 4½ hours at a stretch. This will vary from baby to baby depending on age. 

  • The risk of sudden infant death is reduced when babies sleep on their backs. Make certain that everyone who helps care for your baby understands it must be tummy to play and back to sleep.
  • By 3 months, many babies will be sleeping through the night. Having a regular bedtime routine will help your baby go to sleep and stay asleep all night long. 
  • All babies are different, so don’t worry if your baby doesn’t meet this milestone at 3 months.
  • Establish a bedtime routine by doing the same thing every night, like bathing your baby, reading him a story and then putting him to bed when he is drowsy but still awake. 
  • Avoid rocking your baby until he is asleep or holding him until he falls asleep. Your baby needs to learn to fall asleep on his own. 
  • Try to ignore squirming or whimpering. This may just be your baby’s way of getting rid of excess energy so he can relax and go to sleep. If he cries, go to him. Make sure he isn’t wet or in distress, but keep him in his quiet, dimly lit room to help him know that the dark means it’s time to sleep.

Resource

Your child’s safety begins with you 

If you haven’t made your home safer yet, get started. Refer back to the “Safe Home for Baby” chapter for details and reminders.

  • Use an infant car seat that is properly secured in the backseat at all times. It’s the law.
  • Do not leave your baby alone in a tub of water or in high places such as changing tables, even for a few seconds. 
  • Don’t allow anyone to smoke in your home or car.
  • Never shake or jiggle your baby’s head, and don’t allow anyone else to shake him. 
  • Do not use an infant walker that has wheels. They are dangerous and do not help your baby’s motor development. 

Never leave your infant or child alone in the house or car, even for a minute. In most states it is against the law to leave a child unattended in a car at any time. If something bad were to happen, you would be looking at a felony charge.

 

Your Baby: Months 4-8

Parenting 

Babies are exploring their surroundings and trying to make sense of everything around them. So now is the time to think about getting your baby a playpen and some suitable toys to keep him entertained.  

  • Since your baby is more active, spitting up is common at this age. Have a good supply of bibs. 
  • Once head control is achieved, at about 6 months, your baby will love playing gentle bouncing games. Sit him on your knees facing you, hold his hands and gently bounce him up and down while singing to him. 
  • Begin playing social games such as pat-a-cake and peekaboo.
  • Begin setting limits using distraction, reducing stimulation and establishing routines.
  • Discipline is never appropriate for babies. At this age, babies simply need your attention and affection. Your baby needs to know he can trust and depend on you. Remember, you cannot spoil your baby at this age.
  • Never yell at or spank your baby for any reason.
  • If you haven’t already, establish a bedtime routine. This will help your baby learn to go to sleep on his own.
  • Help your baby learn self-soothing techniques by providing him with the same stuffed animal, “special” blanket or favorite toy when he is fussy.

If you have gone back to work (at home or away), decide whether you’re happy with the child care arrangements you’ve made. For helpful information about finding a quality child care provider in your area go to www.ARBetterBeginnings.com in Arkansas or www.parentsknowkidsgrow.org/choosingchildcare in Tennessee.

  • Moms and their partners need to keep in touch with friends to avoid feeling isolated. That connection keeps your relationship as a couple strong and loving. Some gatherings will be child friendly; others may be for adults only. Remember that although your baby may be the center of your universe, friends may tire of only hearing about your baby. 
  • Don’t forget to have fun! Go to the park, play under a blanket, tickle and giggle together.
  • Don’t use TV as a babysitter. Experts suggest holding off on TV or videos until age 2 to make the most of real-life interactions that are so important to your baby’s development.

Early learning

Babies are born learning. Every experience they have provides new knowledge. 

  • Continue holding, cuddling, talking and singing to your baby. Rock your baby as much as you can. Every interaction stimulates brain development.
  • Read brightly colored books to your baby. A love of reading will help your child succeed at every stage of life. 

Woman reading to a baby

  • Encourage speech development by talking to your 6-month-old throughout the day. 
  • Encourage creative play with age-appropriate toys – without spending a lot of money. Babies like to bounce, swing, reach for you, pick up and drop objects, and bang things together. Plastic measuring cups, large wooden spoons, pots, pans and plastic containers make great toys and are very inexpensive.

Development

By 6 months of age, your baby should be able to:

  • Baby looking up at mobileSpeak single (hard) consonants, like “dada” (sorry mom!).
  • Roll over both ways (front to back and back to front).
  • Look for a toy dropped out of sight.
  • Hold his head up when put in a sitting position.
  • Sit with one hand on the ground for support (and will soon sit without support).
  • Grasp and mouth objects as before, but now can transfer small objects from one hand to another.
  • Rake at small objects but cannot pick them up yet because finger coordination is not precise enough.
  • Show displeasure with loss of a toy.
  • Recognize each parent and may even begin to show some stranger anxiety.
  • Attempt to feed himself.
  • Smile, laugh, squeal and imitate sounds.
  • Remain content in a playpen for a while playing with one or two toys.
  • Bear weight on his legs when held in a standing position (this will not make him bowlegged).

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

It is around this time that feeding can get challenging. Remember that your baby is interested in things going on around him, and can be distracted by sights and sounds. He may get so distracted that he can’t settle down to eat or will take a few swallows of formula or breast milk, then stop and look around. Try to keep distracting sounds and objects to a minimum. 

Introducing solid foods

Most pediatricians recommend starting solid foods at 6 months of age. If your baby sits well when supported, holds his head up and seems to be hungry, it may be time to introduce infant cereal to your baby’s diet. Begin with infant rice cereal. 

  • Mix a couple of teaspoons of cereal with breast milk or formula until it becomes a thin soup. 
  • Place the spoon about halfway back on your baby’s tongue. Since babies have a tongue reflex that causes them to push anything out of their mouths, they must learn to swallow. Spoon placement helps overcome the tongue reflex. If your baby pushes the cereal (or anything else) out, it doesn’t always mean he doesn’t like it.
  • As your baby gets the hang of eating, increase the thickness and amount of the cereal. 

Mom spoon feeding baby

Resource

Oral health 

Although newborns usually have no visible teeth, most have at least a partially developed set of baby teeth below the gums. During the first few years of life, all 20 of the baby teeth will break through the gums. These teeth usually begin appearing about six months after birth, and most children have their full set of baby teeth by age 3. As their teeth come in, some babies may become fussy, sleepless and irritable, lose their appetites or drool more than usual. 

Diarrhea, rashes and fever are not normal for a teething baby. If your infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, it’s probably not because of teething. Call your baby’s doctor.

Some babies may have sore or tender gums when teeth begin to break through. 

  • Gently rub your baby’s gums with a clean finger, a cool spoon or a wet gauze pad.
  • A clean teething ring made of hard rubber may also help. 
  • Pain relievers and many medications that you rub on the gums are not useful and can even be harmful.
  • Brush them with a soft-bristled toothbrush and a little bit of water to prevent tooth decay. 
  • Toothpaste with fluoride is not recommended until a child reaches age 2.
  • Never let your baby fall asleep with a bottle, either at nap time or at night. Milk or juice will pool around the teeth, causing decay.
  • After your child’s first tooth appears but no later than his first birthday, begin regular dental checkups.

Teething 

Baby crawling on momThe two front teeth (central incisors), either upper or lower, usually appear first, followed by the opposite front teeth. The first molars (in the upper or lower jaw) come in next, followed by the canines or eyeteeth. There is great variability in the timing of teething. If your child doesn’t show any teeth until later, don’t worry.

 

Sleep at this age

  • Encourage your baby to soothe himself by putting him to bed with a stuffed toy while he is still awake.
  • The length and/or frequency of naps may begin decreasing.
  • Your baby may begin showing signs of separation anxiety at nap time or bedtime. He loves and depends on you, and when he can’t see you, he thinks you’ve gone away. Separation anxiety will be discussed in more detail in the segment of this book titled “Months 9–12” on pages 104-105.
  • Your baby may begin waking up for short periods during the night. When this happens, check on your baby, but keep the visit brief. Avoid exciting your infant, and leave the room quickly once you feel everything is OK.

Resources

Your child’s safety begins with you 

Baby on floor chewing on toyAccidents are going to happen, but when you take the following precautions, they may happen less frequently and be less serious.

  • Remove mobiles from the crib and playpen once your child learns to stand up.
  • Keep toys with small parts out of reach. 
  • If a toy or part can fit inside a toilet paper tube, it’s too small.
  • Never give young children small balls or balloons. 
  • Look for labels on toys that give age and safety recommendations.
  • Avoid toys with strings, straps or cords longer than 7 inches.
  • Toy chests should have lids that stay open or that are very light and removable. 
  • Use only stationary play centers; they are safer than walkers with wheels.
  • Be sure equipment and toys have not been recalled for safety reasons. Call the Consumer Product Safety Commission at 1-800-638-2772 to check for a recall on your used equipment.

Resource

 

Your Baby: Months 9-12

Parenting

  • At this stage of development, parenting is about setting limits and keeping your increasingly mobile baby safe without hindering healthy exploration and learning. It’s a delicate balance. Begin setting limits by using distractions, removing the object from the baby’s sight or removing the baby from the object. Say “no” firmly, but don’t yell.
  • Never use spanking as a form of discipline. Even a “little” smack on the hand can send the wrong message, making your baby question your love for him or his safety. If you get frustrated or angry with your baby, put him in his crib or playpen for a couple of minutes until you calm down. Your baby will realize he has done something wrong. 
  • Consistent guidance is very important. The more consistent you are, the faster your baby will learn the limits you set to keep him safe.
  • Keep up a constant chatter with your 9-month-old child. Talking to him while dressing, bathing, feeding, playing, walking and driving encourages speech and language development.
  • Encourage play with age-appropriate toys. Babies like bouncing, swinging, reaching for you, picking up and dropping objects, and banging things together. Plastic measuring cups, large wooden spoons, pots, pans and plastic containers make great toys.
  • Separation anxiety may make it more difficult – and heartbreaking – for you to leave your 9-month-old with grandparents or a babysitter, but it really is important for you and your partner to have time away from the baby. You need a breather, and your baby needs the opportunity to learn that sometimes you do go away, but you always come back.

Woman consoling baby

Begin setting limits by focusing on safety

There’s a pretty simple way to know when it’s time to start setting limits. Your baby will let you know. Does your baby look to see if you are watching him? If so, he is telling you he needs to know what is okay and what isn’t. It doesn’t mean he won’t do it anyway, but he just wants to know.

  • Introduce the word “no” only for safety issues. If your child hears “no” too often, the word will not have any meaning for him. Let him know that what he is about to do (or is doing) is unsafe.
  • Distract or redirect your child from unsafe objects or activities and childproof your home.
  • Use nonverbal communication. A stern look or a “thumbs-up” can communicate a lot to your child.
  • Don’t set your child up to fail. Taking an overtired or fussy baby to the grocery store or shopping mall is asking for trouble. Plan outings for times you know your baby will be at his best, maybe mid-morning or right after nap time.
  • Create consequences that relate to the bad behavior. For example, if your child is screaming for attention, remove him from the situation until he is able to calm down. Then take him back and try it again.
  • Make consequences immediate. Threatening or delaying consequences until a later time confuses babies and young children. When too much time lapses between a behavior and its consequence, children may not know which behavior they are being punished for or what they should do next time.

Resources

Early learning

Words, sounds, storybooks, songs and nursery rhymes are the building blocks of literacy that help children learn to read and write. Even if children don’t understand what words mean, there is great value in hearing them spoken. 

  • Read or tell stories together every day, starting at birth.
  • Teach new words anytime you can. Talking to your child about what you see around you and what you are doing encourages him to speak too.
  • Add songs and rhymes into all of your routines.
  • Ask questions and watch for your child’s responses. From day one, ask your child “where” and “what” questions whenever you can.
  • Use play to introduce language. Give your child books, musical instruments and other toys. Interacting with your child in a playful way makes learning fun.

Resource

Development

By the end of 9 months, your baby should be able to:

  • Baby standing up in cribInch, crawl and otherwise get around the room. 
  • Pull up on the bed or on furniture and begin “cruising” around the room.
  • Respond to his own name.
  • Understand a few words such as “no-no” and “bye-bye.”
  • Understand certain concepts – for example, your child will retrieve a toy after he watches you put it under a blanket.
  • Sit independently.
  • Bang two toys together.
  • Play interactive games well such as peekaboo and pat-a-cake.
  • Use fingers and thumb to poke and pick up smaller and smaller objects.
  • Sleep through the night except for an occasional night wakening.

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Resource

Eating right 

You will be adding more solid foods to your baby’s diet throughout this period. Nutrition will always be a critical factor in your baby’s growth and development.

  • Couple eating breakfast with babyBreast milk or iron-fortified formula should continue to be part of your baby’s diet for the first year.
  • Feeding should be on a routine schedule that coincides with the family meal times.
  • Continue introducing new solid foods, starting with fruits, cooked yellow vegetables, cooked green vegetables and then meats. Your baby will let you know how much he wants.
  • Your baby may begin showing preferences for some foods. 
  • Encourage your baby to use a cup. Be prepared for messes. 
  • Avoid giving foods that can cause choking, such as peanuts, popcorn, hot dogs or sausages, carrot sticks, celery sticks, whole grapes, raisins, corn, whole beans, hard candy, large pieces of raw vegetables, fruit or tough meat. Learn the proper emergency procedures for choking.
  • If there is a strong family history of food allergies, limit or avoid highly allergic foods such as eggs, strawberries, chocolate and seafood until later.
  • If you are breastfeeding, continue giving supplemental Vitamin D if recommended by your baby’s doctor and fluoride supplements if your water supply is not fluoridated.

Resource

Food safety

Food-borne infectious diseases can be a concern as you add solid foods to your baby’s diet. 

Do not feed your baby:

  • Unpasteurized milk or milk products such as cheese.
  • Unpasteurized juices.
  • Raw or undercooked meat or eggs.
  • Raw shelled nuts. 
  • Seed sprouts.
  • Honey.

Weaning your baby from breast to bottle 

Because breast milk has the right balance of nutrients and boosts your baby’s immune system, experts recommend breastfeeding through the first year. You’ll have to make the decision about weaning from breast to bottle based on what’s best for you and your baby.

Weaning often happens naturally at 6 months of age when children begin gradually turning away from breast milk in favor of a wider variety of solid foods. Other children may not show that they are ready for weaning until they are too active to sit still during breastfeeding.

You may decide when it’s time. It may be more difficult than following your child’s lead, but with a little extra love, it can be done. Remember that breastfeeding isn’t just about nutrition to your child; it’s also a source of comfort and attachment.

Woman comforting babyConsider delaying weaning if:

  • Food allergies run in the family. 
  • Your baby isn’t feeling well or is teething.
  • You’re not feeling well. You and your child are more likely to handle the transition if you’re both in good physical and emotional health.
  • There are major changes going on, such as a recent move or a change in child care. 

Getting started

The key to a successful weaning (for you and your baby) is to take it slowly. Eliminate one breastfeeding session a day for several days a week. As you taper off the number of times you breastfeed, your milk supply will gradually diminish. If you begin weaning when your child is a newborn, apply ice packs to your breasts to help slow milk production.

Children associate breastfeeding with comfort. Try to figure out when your child seems to need less comforting. If it’s midday, drop the midday breastfeeding session. You might choose to wean your baby from breast milk during the day but continue breastfeeding at night. It’s up to you and your child. 

Nutrition after weaning

If you wean your child before age 1:

  • Substitute iron-fortified formula for breast milk. 
  • Ask your child’s doctor to recommend a formula. 
  • Don’t give your child cow’s milk until after his first birthday. 

Baby’s first bottle

If you’re introducing your child to a bottle for the first time:

  • Do it when your child isn’t extremely hungry. He’ll have more patience. 
  • Ask another caregiver to introduce the bottle. Some children refuse a bottle when the breast is available. 
  • Choose a “slow-flow” bottle nipple at first. The slow flow from the bottle will be more like breastfeeding.
  • Switch later to a “fast-flow” nipple if your baby becomes frustrated with the slower flow of breastfeeding and wants the bottle instead. 
  • You can wean your child to a bottle and then a cup or, if your child seems ready, go directly to a cup.

Weaning can take days, weeks or months. Avoid the urge to rush the weaning process; it could be upsetting for your child and cause your breasts to become needlessly engorged.

Child with sippy cup

Weaning from bottle to cup 

When you think your baby may be ready to wean from a bottle to a cup:

  • Begin skipping a bottle feeding every five to seven days.
  • Put breast milk or formula in your baby’s sippy cup.
  • Put a little more breast milk or formula in your baby’s cup and a little less in his bottle each time you feed him. 
  • Put the liquids he likes best (juice, breast milk, etc.) in the sippy cup and the ones he likes least (water) in his bottle.
  • Always offer your baby the sippy cup first, not the breast or bottle unless he rejects the cup.
  • To prevent your baby from getting too attached to his bottle, don’t let him crawl, walk around or go to bed with it. Try replacing nighttime feedings with new bonding opportunities, like reading, going for a stroll or looking at the stars together.
  • Some children naturally turn away from the bottle or breast once they’re eating three solid meals most days. So if your baby continues resisting the cup, let him get comfortable with eating solid foods before you try weaning again. 

Resources

  • Mayo Clinic
  • WebMD
  • Heading Home With Your Newborn, Jennifer Shu, M.D. and Lara Jana, M.D., 2005
  • Food Fights, Jennifer Shu, M.D. and Lara Jana, M.D., 2007

Oral health 

Baby with tooth brushMany experts say children should give up the bottle completely at around age 1 and absolutely by 18 months. Studies show that when children stay on the bottle for too long, they may be at higher risk for not getting enough iron. Solid food choices offer a variety of sources for iron, which is important for development. 

  • After a meal or snack, clean your baby’s teeth using a soft cloth, gauze or brush.
  • As long as your baby is drinking from a cup, he doesn’t need a bottle. If you must give him a bottle, just put water in it.
  • At this age, nighttime feedings are not nutritionally necessary and increase the risk of tooth decay.

Sleep

Between 9 and 12 months, babies’ brains do a lot of developing while they sleep. So it’s important that your baby learns to go to sleep on his own and stay asleep. By 9 months of age, most children are sleeping through the night.   

  • Put your baby to bed while he is sleepy but still awake. This teaches him how to relax on his own and go to sleep.
  • If separation anxiety causes your baby to resist going down for a nap or at bedtime, stay in his room with him, but do not talk, and do not rock or cuddle him. Just rest your hand on him until he calms down or goes to sleep.
  • Some babies may awaken during the night for short periods. If this happens, check on your baby, but keep the visit brief. Avoid talking to him, and leave the room quickly once you feel everything is OK. Your baby needs to learn that nighttime is for sleeping.
  • Never put your baby to bed with a bottle.

Behavior

Separation anxiety 

Between 8 and 12 months of age, children often experience a period of separation anxiety where they cry or cling to you when you leave the room. Although it is extremely frustrating for parents, it represents an IMPORTANT emotional milestone. It means your child is beginning to understand that there’s only one of you, and that you still exist even when you are out of his sight. Separation anxiety usually peaks between 10 and 18 months. Most children outgrow separation anxiety by age 2.

Time has no meaning to infants and very small children, nor do they have many memories. When you leave, your child may not know when, or if, you’ll return. To ease your child’s separation anxiety:

  • Practice goodbyes. Eventually your child will learn that he can count on you to return.
  • If possible, leave when your child is fed and rested. 
  • Say goodbye and go. Encourage the caregiver to distract your child by engaging him in a new activity right away. 
  • If you’re leaving your child in a new environment, play with him for a few minutes to ease the transition. 
  • Offer your child a special blanket, stuffed animal or other comforting object to hold while you’re gone.
  • Don’t let the tears get to you; they will stop once your child is engaged in a new activity.

Remember, we want our children to be independent. If they are going to develop a healthy sense of independence, they have to go through some degree of separation anxiety. Be patient as your child learns that it’s OK to spend time away from you.

Resource

Exercise and activity   

Play is the most valuable thing your child can do.

Social benefits of play

  • Helps children form meaningful relationships
  • Teaches children communication, negotiation, cooperation and compromise
  • Helps children learn trust, friendship and love

Emotional and intellectual benefits of play

  • Helps children express feelings, develop empathy and cope with difficult situations
  • Helps children deal with emotions and feel a sense of control
  • Helps adults understand children’s feelings
  • Allows children to develop ideas and problem-solving skills
  • Fosters curiosity and creativity
  • Prepares children for school
  • Helps children make sense of the world and function successfully within it

Resource

Your child’s safety begins with you

 

As your child begins crawling and walking, the risk of getting into dangerous situations increases. Accidents can happen quickly, so be alert. Download the Home Safety Checklist from Arkansas Children’s Hospital at www.archildrens.org/documents/ipc-homesafety.pdf or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml, to see how your home measures up.

Your 1-Year-Old

Parenting 

Setting limits. Your 1-year-old is becoming increasingly mobile, so it is important that you start putting limits on his behavior. Children learn by exploration, but it has to be safe.

  • Praise your 1-year-old for good behavior.
  • Saying “no” at the appropriate time is as important for your child’s development as nutrition and love. Saying “no” in a stern, but calm voice with good eye contact is almost always effective. 
  • Discipline isn’t punishment. Discipline is setting limits that let your child know what is acceptable. 
  • Discipline should be consistent but never violent. Distraction, loving restraint, removal of the object from the toddler or the toddler from the object are all good ways to teach your child what not to do.
  • The Center for Effective Parenting offers free parenting classes in Arkansas. Visit parenting-ed.org for more details.

Television viewing

Children under 2 should not watch television. The time babies and toddlers spend awake is better spent by having direct contact and meaningful interaction with parents and other caregivers. This one-on-one contact is important for a healthy brain and the development of social, emotional and other skills. Play with your child instead of placing him in front of a television.

Separation anxiety

Your 1-year-old may cling and cry when you try to leave. This is separation anxiety, an important milestone in your baby’s development. For more on separation anxiety, refer to the section on behavior in the chapter on  Months 9–12  of this book.

Early learning

Mom reading book to childYour child’s vocabulary is growing. As he recognizes more words, his interest in books and songs will increase. Encourage this interest by reading, singing and talking to your toddler as much as possible.

  • Ask questions while looking at pictures and reading stories. Your child’s verbal and nonverbal responses will be cues you can use.
  • Get your child books with flaps and textures he can explore and carry around with him.
  • Teach new songs and add hand movements such as “pat-a-cake” and “itsy-bitsy spider.”

Development

By your baby’s first birthday, he should be able to:

  • Pull to stand, crawl rapidly, seat himself on floor, cruise on furniture or walk alone with an unsteady gait.
  • Play social games, such as pat-a-cake, peekaboo and “so big.”
  • Bang two blocks together.
  • Say one to three words in addition to “Mama and Dada.”
  • Drink from a sippy cup. Your baby should be off bottles completely by age 1.
  • Wave “bye-bye.”
  • Feed himself.
  • Point with a finger and display a precise pincher grasp when picking up small objects.
  • Understand a few simple words; love music, rhythms and rhymes.
  • Cooperate in getting dressed by holding still.

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

Your child has been growing very rapidly during his first 12 months – doubling his birth weight at 5 to 6 months and tripling it at a year. Now everything is going to ease off a bit, including your child’s appetite. Because his rate of growth is slower than in the first year, he may not be as hungry. This is not a sign of illness. It is natural and normal for this age. 

  • Milk intake decreases considerably. 
  • If you are formula feeding, your doctor might suggest switching to whole milk (some babies have harder bowel movements at first with whole milk) and limiting the amount of milk to 24 ounces or less. 
  • No more bottles! After one year, the bottle can cause damage to the teeth. 
  • If you are still breastfeeding, talk to your child’s doctor about weaning directly to a cup.
  • At this age, toddlers eat mostly table foods, but it is fine if your child still wants “baby food.”
  • Your child may still want you to feed him. If he wants to feed himself, let him. Most won’t master utensils until 18 months, but let him get used to holding a spoon. 
  • Feed your youngster three meals a day (with the family), plus a mid-morning and mid-afternoon snack.
  • Avoid foods that can cause choking, such as peanuts, popcorn, hot dogs or sausages, carrot sticks, celery sticks, whole grapes, raisins, corn, whole beans, hard candy, large pieces of raw vegetables or fruit, or tough meat.
  • Don’t ever force your child to eat. Adopt a “take it or leave it” attitude. 

Resource

Oral health

  • Begin brushing your child’s teeth with a tiny, pea-sized amount of toothpaste that does not contain fluoride.
  • Protect your toddler’s teeth by throwing away the baby bottles. Never put your baby to bed with a bottle.
  • Only give your child fluoride supplements if recommended by your child’s doctor or a pediatric dentist.
  • Your child’s first dental appointment should be no later than his first birthday. 

Resource

Sleep

Child resisting bed timeMost of your toddler’s brain activity occurs during sleep. Children age 1–2 require around 10–13 hours of sleep in a 24-hour period. Total sleep time includes naps as well as nighttime sleeping. Often the difference between happy toddlers and cranky, out-of-sorts toddlers is their sleep schedule.

  • Babies who are put to bed while they are still awake learn to calm themselves and drift off to sleep.
  • Children this age often resist going to sleep because they do not want to be separated from people and activities.
  • Some children may start to give up one of their naps, but most 1-year-olds still take two naps.
  • If your toddler wakes up during the night, check on him, but keep the visit brief. Do not take the infant into bed with you or rock him back to sleep. This way, nighttime awakening will not become a habit.

Resource

Behavior

Getting ready for potty training

At around his first birthday, your child’s behavior will let you know he recognizes what it feels like to have a full bladder or rectum. He may begin squatting or grunting when he is about to have a bowel movement (poop) or tug at his diaper when he needs to urinate (pee). Children this age don’t have the muscle development to control these functions, but you can reinforce your child’s awareness of the link by saying “Is a poop (or pee) coming?”

When your child poops or pees in his diaper:

  • Change it right away so he learns urine and poop should be removed and thrown away. 
  • Do not make negative comments about dirty, stinky diapers; otherwise your child may think he has done something wrong and try to hold his bowel movements. Instead, say positive things about how good it feels and smells to be clean and dry.
  • Your goal is to strengthen your child’s awareness of what it feels like to need to go. So when the time comes, he will see potty training as a good thing.

Motor skills necessary for potty training

Surprised childFor toddlers to be successful at potty training, other skills must also reach a certain level of maturity, usually by 18–24 months. 

  • Walking gets them to the toilet in time.
  • Hand and finger skills and coordination mean they can handle getting their training pants down in time. 
  • Mental focus means they can concentrate on activities that may keep them seated on the potty long enough to be successful.

You can encourage these developments by:

  • Teaching your child to dress and undress himself.
  • Making sure that clothing is easy to remove (opens in front, has snaps not zippers).
  • Offering him picture books or toys to play with while he’s waiting for a bowel movement to occur.
  • Praising your child when he is successful at recognizing these pre-toilet training cues. Gaining “grown-up” skills builds feelings of independence, which will make potty training a lot easier for both of you.

Child stacking cupsExercise and activity

Your child’s newfound independence also will extend to play. Let your child use toys in any way he wants instead of insisting he use them “the right way.” Toddlers need to learn how to imagine, invent and problem solve. To help with this:

  • Plan play dates, but remember that your 1-year-old is too young to be expected to share.
  • Allow time for your child to play alone. It builds confidence when he can choose and direct things. 
  • Try new ways to play games like peekaboo; bring in push-pull toys and items that stack such as boxes or cups. 
  • See if your toddler can match up spoons with other spoons, forks with other forks, etc.

Your child’s safety begins with you

Safety must be a high priority. Your oh-so-sweet newborn is now a very mobile toddler. If you haven’t made your house safer, DO IT NOW! More children die from accidents than all diseases combined. Download the Arkansas Children’s Safety Checklist from www.archildrens.org/Services/Injury-Prevention-Center/Home-Safety.aspx.

Car seat safety

  • Most states have laws requiring that toddlers and young children travel in child safety seats that are in the backseat of the car and away from active air bags. 
  • Vehicles with no backseat aren’t a good choice for traveling with children.
  • Putting a car safety seat next to a door that has a side air bag may not be appropriate. If you’re only placing one car seat in the backseat, put it in the center rather than next to a door.
  • Your baby’s car seat should remain rear-facing until age 2 or until he has reached the highest weight allowed by the manufacturer for rear-facing (usually about 35 pounds).

 

Your 2-Year-Old

Parenting

Your 2-year-old is not a baby anymore. He is confident, independent and on the move! There are exciting parenting opportunities for you to help your child thrive during this time. 

  • Reading books with pictures to your child will help build vocabulary and speed language development.
  • Arrange times for safe running and outdoor exploring.
  • Encourage imaginative play and sharing, but don’t be surprised if your 2-year-old isn’t interested in sharing his toys with you or anyone else.
  • Allow your child to play with boys and girls his age.
  • Child playing outside on toy truckLimit television viewing. The television is a poor substitute for spending time with you. When there are shows for his age, watch with your child and talk about what you are watching. Turn the TV off during meals!
  • If your child gets curious about body parts, use the correct terms for genitals (penis, testicles, vagina, labia) and answer questions as simply as possible. 
  • Your 2-year-old may have a blanket or favorite stuffed toy that he keeps with him most of the time. This is normal. Don’t make a big deal of it or try to shame him into giving it up. He will when he’s ready.
  • Keep family outings short and simple. Your 2-year old may have a short attention span, and lengthy activities can make him tired and fussy.
  • Allow your older children to have things they do not have to share with the 2-year-old.
  • If you are pregnant, ask your doctor the best way to talk to your 2-year-old about a new baby and what changes that will mean for the family.

Early learning

Language skills are front and center during your child’s second year. Even though your child may not speak until a little later, the things you do now to expand his vocabulary will make a world of difference when he does begin speaking. 

  • Teach new words every day. The more you talk to your toddler about all the things going on around you, the more words he will learn.
  • Expand your child’s language by adding descriptive words to what he says. If he says “kitty,” you can say “Yes, the kitty is little and soft.”
  • Pick books with subjects your child is interested in, such as animals, trains or a new baby.
  • When you’re reading or looking at picture books, ask your child “Where is?” and “What is?” questions such as “Where is the dog?” or “What is that?”
  • Add songs and rhymes into all of your routines.
  • Give your child crayons, chalk or other safe things he can scribble, draw or pretend to write with. Let your child imitate you as you write a letter or draw a picture.

Resource

Development

Your 2-year-old should be able to:

  • Climb up steps alone, one step at a time holding the stair rail or a parent’s hand.
  • Jump off the floor with both feet.
  • Open doors.
  • Kick a ball.
  • Wash and dry his own hands.
  • Climb on furniture.
  • Use a spoon and cup well.
  • Ask frequent questions, such as “What is that?”
  • Enjoy imitating adults.
  • Select and use a toy correctly (feed a doll, hammer pegs in a cobbler’s bench).
  • Say approximately 50 or more words (but may go through short periods of mild speech problems like stuttering).

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

Your 2-year-old may be a very picky little eater, and since he isn’t growing much during this period he may tend not to eat very much at all. DO NOT make mealtime a battle over food. Your child will only gain 3 or 4 pounds during this year. Your child should be able to name foods and tell you what he likes and doesn’t like. Let his appetite be your guide, and let him (within reason) choose what foods to eat. 

  • Your 2-year-old may want to eat the same thing day every day.
  • Don’t use bottles. 
  • Never use food as a reward (Don’t say, “Eat your dinner, and you will get dessert.”)
  • You may switch to 2% milk with your pediatrician’s approval.
  • Ask your child’s doctor if he needs to take vitamins. Continue to give fluoride supplements if the water is lacking in fluoride.
  • Make sure your child’s caregiver is following your instructions about meals and snacks.

Oral health

  • Ask your child’s doctor about when and how often to see the dentist.
  • Your 2-year-old may like to imitate a sibling or parent. Take this opportunity to teach good brushing habits. Get your child his own toothbrush, but only use a tiny amount of toothpaste that contains fluoride.
  • Second molars usually appear.

Sleep

In general, most 2-year-olds still require an afternoon nap. Silly conflicts and frustrations happen when children (or parents) are overtired. So, do yourself a favor and continue afternoon naps as long as you can if they don’t interfere with your child sleeping at night.

  • Your child should sleep in his own bed. 
  • A 2-year-old’s bedtime is usually between 7 and 8 p.m. But you may experience problems such as your child refusing to go to bed, getting out of bed and wandering around the house at night, or night terrors and bad dreams. Don’t worry. This is normal. 
  • Stalling tactics such as, “I have to go potty” or “I want a drink of water,” are common at bed and nap time. Be kind, yet firm, in the limits you set, and calmly return your child to bed even if it takes hours for him to settle down and go to sleep.
  • Bedtime routines that include reading work well to help your 2-year-old go to sleep. 

Resource

Behavior

Temper tantrums

Child in park with parent throwing tantrumTemper tantrums range from whining and crying to screaming, kicking, hitting and breath holding. They are a normal part of development, usually occurring between the ages of 1 and 3 (especially age 2), and they tend to taper off as children become better able to express themselves. They are equally common in boys and girls. 

Toddlers get frustrated when they can’t master a task or express themselves. Tantrums are their way of venting. If you don’t take tantrums personally, you’ll handle them much better.

Toddlers also want a sense of independence and control over their environment. They want to do things themselves (even when it may be beyond them), and they want what they want right NOW! When they can’t do it or can’t have it, the stage is set for a tantrum.

Preventing tantrums 

Make sure your child understands what you want him to do and can actually do it.

  • Keep it friendly. Use a friendly tone of voice when you ask your toddler to do something. Say “please” and “thank you,” as in, “Please stand still while I brush your hair.” Don’t yell.
  • Don’t overreact when your toddler says no, just calmly repeat your request and only say no when it matters.
  • Don’t make deals. Bribery sends the message that everything is negotiable. It’s not.
  • Offer choices, but make sure either choice works for you. “Would you like to wear this shirt or this shirt?” “Would you like to take a bath now or in 10 minutes?” “Apple or orange juice?”
  • Child misbehavingAvoid situations that may trigger tantrums. Children are more likely to act out when they’re tired, hungry, sick, or in an unfamiliar setting, so think ahead.
  • Make life fun. Your child will be more likely to do what you want if you make an activity fun.
  • Stick to your daily routine as much as possible so your child knows what to expect.
  • Keep off-limits objects out of sight and out of reach.
  • Set the stage for success. Offer toys and games for his age.
  • Talk to your child. Remind him to use words to express his feelings.

If your child has a tantrum, REMAIN CALM and try to distract him. Ignore minor displays of anger, such as crying, but if your child hits, kicks or screams for a prolonged period, remove him from the situation. Hold your child or give him time alone to cool down.

Enforcing consequences

Don’t yell and scream, just enforce consequences.

Natural consequences. These are the times when you let the situation play out so your child sees what happens when he does not behave (as long as he’s not in danger). For example, when your child throws his snack, he won’t have a snack to eat and may get hungry later.

Logical consequences. These are the times when you will need to create a consequence and follow through. For example, tell him if he doesn’t pick up his toys, you will put them away for the rest of the day. Keep the consequence near in time and relevant to the bad behavior.

Withholding privileges. This is when you tell your child that if he does not cooperate, he must give something up he likes. Your challenge is to follow through on your promise.

  • Never take away something your child truly needs, such as a meal.
  • Choose something your child values that is related to the misbehavior.
  • Withhold privileges right away. If your child misbehaves in the morning, don’t tell him he can’t watch TV that night. Too much time has passed since he acted out.

Time-out

This works well when a specific rule has been broken. It works best for children from 2 to 5 years of age but can be used throughout childhood. Follow these steps to make a time-out work.

Decide ahead of time which two or three behaviors will cause you to implement time-out. Explain this to your child.

  • Choose a time-out spot that is boring with no distractions. Bathrooms can be dangerous, and bedrooms may become playgrounds. The goal is to get the child to calm down and think about what he has done.
  • Child going to time-outGive your child one warning (unless the offense is aggression). If it happens again, send him to the time-out spot right away. Tell him what he did wrong (in just a few words and with as little emotion as possible). If your child will not go to the spot on his own, pick him up and carry him there. If he will not stay, hold him there gently but firmly. Then, without eye contact, say, “I am holding you here because you have to have a time-out.” Don’t discuss or argue. 
  • It should only take a couple of time-outs before he learns to cooperate or sit quietly rather than be held there.
  • Set a time limit. One minute for each year of your child’s age is a good one. Once your child can sit quietly, set a timer so that he will know when the time-out is over. If fussing starts, restart the timer. Wait until your child is quiet before you set the timer again.

Resume activity. When the time is up, tell him you love him and help him return to play. NO APOLOGIES, NO DISCUSSION. Time has been served.

Why spanking is NOT the best choice

The American Academy of Pediatrics does not recommend spanking. Although most Americans were spanked as children, we now know that it has several important side effects.

  • Spanking increases aggression and anger instead of teaching responsibility.
  • Parents may regret their actions later.
  • Spanking can lead to physical struggles that may harm the child.

Research has shown that children who are spanked are more likely to become adults who are depressed, use alcohol, have more anger, hit their own children, hit their spouses, and engage in crime and violence. It is clear that spanking teaches a child that causing others pain is OK if you’re frustrated or want to maintain control. It’s also unlikely a child can see the difference between getting spanked by a parent and hitting a sibling or another child when he doesn’t get what he wants.

Potty training

You cannot train children to control urine and bowel movements before they are developmentally able to. In fact, by overtraining, you may delay the process and set the stage for real problems later on.

  • If your child has a bowel movement at the same time every day, sit him on a little potty chair and tell him what to expect. 
  • If your child’s bowel movements occur at irregular times during the day, watch for a sign (like grunting or squatting) that he has to go. Then pick up your child and put him on the potty. If nothing happens in a few minutes or if your child is scared in any way, take him off the potty.

Young boy potty trainingYour child wants to control his bladder and bowel movements to please you. So praise your child when he makes it to the potty in time. When your child has an “accident,” stay calm and don’t punish; this can delay success. And don’t begin toilet training during a stressful family time. 

Your child may be ready to potty train when he wakes up from a nap with a dry diaper. Other signs are when he:

  • Has a bowel movement at the same time each day.
  • Says “pee” or “poop.” 
  • Tugs at his diaper, squats or makes a face.
  • Is able to take off his clothes. 
  • Is uncomfortable in dirty diapers and wants them changed.

It often takes three to six months for a child to:

  • Recognize when he has to go to the potty.
  • Goes to the bathroom.
  • Pulls down his pants, pees or poops in the potty.
  • Dresses himself again.

Accidents or refusing to use the potty is normal.

It helps to offer a reward for using the potty. 

  • Involve your child in changing himself when he wets or soils his diaper (and later his underwear). 
  • Talk about how great it will be when he starts wearing underwear and even have a ceremony where he throws away the last diaper. 

If your child is having a hard time learning to use the potty, develop a regular daily routine of sitting on the potty for five or ten minutes every few hours and:

  • Avoid physical punishment for not using the potty, even with an older child. 
  • Make it clear how very happy and proud you will be when your child uses the potty.

Transition to a bed

Make sure your child is ready. It takes a certain level of development to understand that the bed has imaginary boundaries that a child must learn to stay within. Although some children make the switch to a regular-sized bed earlier than others, the ideal time is around 3 years old. Your child’s size (too big for the crib), activity level (climbing out of the crib) and progress toward potty training (he needs to get out of bed to use the potty) may drive your decision to make the transition. 

You also may be expecting another baby. If this is the case, make the switch at least six to eight weeks before your due date so your toddler can be settled into his new bed before the new baby arrives. Just don’t make your toddler feel like he is being replaced. 

Adjustment

Toddler sleeping in bedTwo-year-olds have a lot of adjustments to deal with: potty training, preschool, pressures to “grow up” and possibly even a new brother or sister. Some children, especially first-born children, are very attached to the security their cribs represent and resist the new bed. Later-born children may be in a hurry to leave “the baby bed” for a “big-kid” bed. If you start the transition and find it is too much for your toddler, you always can bring the crib back, lower the mattress as much as you can and try again later. Just don’t make it seem like punishment.

To ease the transition:

  • Put your toddler’s new bed in the same place the crib used to be. 
  • Use a familiar blanket or top sheet, even if they are too small.
  • Put up a guardrail to prevent your toddler from falling out of bed, or get a bed designed specifically for toddlers (some look like cars, trains or flowers) with built-in guardrails.
  • Get your toddler excited about a “big-kid” bed. Let him pick out his own sheets or throw a “big bed” party.

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Attention deficit hyperactivity disorder (ADHD)

Words that describe ADHD (fidgety, distractible, impulsive, dramatic, defiant, super energetic, loud and stubborn) also describe a normal 2-year-old. So don’t run to a specialist if your child is a whirlwind. In fact, most experts won’t even consider diagnosing a child with ADHD until at least 5 years of age because toddlers’ brains are developing so quickly that today’s problem behaviors are really just part of a passing phase.

Autism spectrum disorder (ASD)

There’s a lot of buzz about autism spectrum disorders these days, and it has many concerned parents looking for more information. That’s especially true when a child isn’t reaching milestones for his age – those for communication and social skills in particular. Autism spectrum disorder (ASD) refers to five related developmental disorders: Autism, Asperger syndrome, childhood disintegrative disorder, Rett syndrome and “pervasive developmental disorder” (PDD).

If you see your child consistently lagging behind other children his age, watch for these “red flags,” and talk to your child’s doctor right away about having your child screened for an autism spectrum disorder (ASD).

Red flags 

  • Doesn’t respond to his name
  • Is slow to develop language skills
  • Doesn’t point or wave “bye-bye”
  • Used to say a few words or babble, but now doesn’t
  • Throws intense or violent tantrums
  • Seems to tune people out
  • Is not interested in other children
  • Doesn’t smile back at others
  • Resists changes in routine
  • Has poor eye contact
  • Doesn’t pretend or play “make-believe”

Early detection is critical

Although there is no cure, early detection can make a huge difference in the life of a child with ASD. Medication and therapy can successfully limit symptoms and help children function well in the world.

Child playing with counting toy

 

Exercise and activity

Your child is now learning to blend real-life experiences into pretend play. This isn’t just fun; it builds important skills and nurtures his imagination. This is also one of the ways children figure out the world around them. You can encourage this type of play by:

  • Helping your child create imaginative games and new ways to use toys (wooden spoons can be airplanes and Lego pieces can be people).
  • Giving your child time to play by himself. Playing alone gives a child a chance to process and understand what he has been learning all day.
  • Listening carefully when your child tells you about wild adventures.

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Your child’s safety begins with you 

Post the toll-free Poison Help number (1-800-222-1222) by every phone. Program the number in your cell phone, and be sure that caregivers and babysitters know this number. In an emergency, this number will connect you with help if your child drinks or eats something dangerous like cleaning supplies. A poison expert in your area is available 24 hours a day, seven days a week. You can find ways to protect your child at poisonhelp.hrsa.gov.

  • In the past, children were given syrup of ipecac to make them vomit if they swallowed poison. Experts now say you should NEVER make a child vomit. If you have syrup of ipecac in your home, flush it down the toilet.

If you haven’t downloaded the Arkansas Children’s Hospital’s child safety checklist do it now. Go to www.archildrens.org/Services/Injury-Prevention-Center/Home-Safety.aspx and scroll to the bottom of the page. 

  • Have a fire escape plan and practice it with your family.

 

Your 3-Year-Old

Parenting 

Discipline should be firm and consistent, but also loving and understanding. Praise your child’s good behavior and accomplishments, and if he falls short of a goal, don’t criticize or mock him. Children at this age are still very literal, so you have to say exactly what you mean. They will take you seriously, even when you’re joking. 

  • Three-year-olds like to do things for themselves.
  • Having security objects (such as a blanket or a favorite stuffed toy) is normal. Your child will give it up when he’s ready.
  • Keep family outings short and simple. 
  • If you are expecting another baby, talk to your child’s doctor about how to prepare your 3-year-old.
  • Be sure to spend time every day enjoying your child. Read, sing and play with him as often as you can.

Preschool

For working parents, child care is already part of the family routine. For stay-at-home moms, preschool a few mornings a week can be a very good option. It gives moms a break and their child an opportunity to meet new friends and prepares him for a life of learning. Whether preschool is a success or a disaster depends on your child’s maturity and the quality of the preschool.

Better Beginnings, Arkansas’s quality rating system for licensed child care facilities, will be a great resource in helping you select the best child care for your baby. The Better Beginnings website (www.ARBetterBeginnings.com) in Arkansas and www.parentsknowkidsgrow.org/choosingchildcare in Tennessee make it easy for you to:

  • Learn what to look for in a child care facility.
  • Know what questions to ask about child care.
  • Find licensed Arkansas child care providers in your area.
  • Compare child care providers based on their quality of their programs.

Both websites provide a checklist of everything you should consider when choosing a child care provider. Print out a checklist and take it with you when you visit a possible child care facility.

Early learning 

Three-year-olds are known for three things: questions, questions and more questions. Nothing is off-limits, so be prepared. Curiosity shows their desire to learn. Encourage this by:

  • Reading books to your child.
  • Making time to explore outdoors.
  • Allowing your child to play with others his age. Three-year-olds are usually very social. 
  • Accepting imaginary friends.
  • Limiting TV viewing, and watching programs for his age with your child.

Children this age begin recognizing gender differences and will correctly say “I am a girl” or “I am a boy.” When they ask questions about body parts, keep your answers simple and always use the correct terms for genitals (vagina, penis, testicles, vulva, etc.).

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Development

Your 3-year-old should be able to:

  • Boy wearing helmet playing on trikeName pictures in a book.
  • Name at least one color.
  • Know his own name, age and sex.
  • Use pronouns, like “he” or “she.”
  • Put on his own shirt (but will need help with shoes and buttons).
  • Start to ride a tricycle.
  • Jump in place and stand briefly on one foot.
  • Open doors.
  • Speak intelligibly 50% of the time. There may be temporary episodes of stuttering during this time.
  • Understand such words as “cold,” “tired” and “hungry.” Comprehends the meaning of “on” or “under” and “bigger” or “smaller.”

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

A familiar complaint from mothers of 3-year-olds is that their child will not eat. Remember, children will eat when they are hungry. If you try to force your child to eat or make a big deal about eating, you’re setting yourself and your child up for eating problems down the road.

  • Three-year-olds will have definite food preferences and are able to feed themselves.
  • Avoid choking threats like nuts, hard candy, uncut grapes, hot dogs or raw vegetables. 
  • Limit sweets and avoid junk food.
  • Eat dinner together as a family whenever possible.
  • Begin teaching proper table manners, and encourage conversation during family meals.
  • Turn the TV off during meals.
  • Make sure your child’s caregiver is following your feeding instructions.

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Little girl sucking her thumb

Oral health 

Thumb sucking

Many experts say to ignore thumb sucking in children who are preschool age or younger. Most young children stop sucking their thumbs on their own between ages 3 and 6.

Thumb sucking isn’t usually a concern until age 4 or 5, when the habit may begin affecting the roof of the mouth or how the teeth line up. If your child is a frequent thumb sucker at age 5, talk to your child in a gentle, supportive way about breaking the habit.

 

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Dad reading to sonSleep

  • An afternoon nap is usually still needed by 3-year-olds.
  • Fears of the dark, thunder, lightning, etc., are common at this age.
  • Maintain a consistent bedtime and naptime routine. Using a night light, security blanket or toy are all ways to help lessen nighttime fears.
  • Read to your child before he goes to sleep.
  • Nightmares are very scary. They can be triggered by changes or stress. Gently reassure your child and put him back to bed.

 

 

 

Behavior

Stuttering 

Stuttering is a speech disorder that involves repeating or drawing out a word, syllable or phrase, or stopping during speech and making no sound for certain syllables. Stuttering is common among young children when they’re learning to speak, and most outgrow it on their own. Stress, fatigue and excitement can make stuttering worse. For children whose stuttering is persistent, speech therapy often can help decrease stuttering.

As a parent, you can help by not making a big deal about your child’s stuttering and by providing a calm, relaxed environment at home where he feels comfortable speaking freely.

Stuttering may be accompanied by rapid eye blinks, tremors of the lips or jaw, and tension, tightness or movement of the face or upper body.

Call your child’s doctor if stuttering:

  • Lasts more than six months.
  • Becomes more frequent.
  • Occurs along with facial tension, tightness or movements.
  • Affects your child’s schoolwork or social interactions.
  • Causes emotional problems, such as fear or avoidance of situations where your child has to talk.
  • Continues beyond age 5 or first becomes noticeable when your child begins reading aloud. 

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Bed wetting 

  • Many 3-year-olds that are successfully potty trained during the day may still not stay dry at night. Remember, the age children use the bathroom by themselves varies, and it is based only on a child’s readiness to be potty trained and the positive attitude of the parents.
  • Avoid putting too many demands on your child or shaming him about wearing diapers. Instead, let your child know how proud and happy you are about any potty successes.

Exercise and activity

Motor skills  

Little girl playing on slideRunning, skipping, kicking, jumping, hopping, catching and throwing are fundamental skills. Toddlers and preschoolers spend a lot of time trying to master these skills. These activities really do take some effort for children because they are learning to move in different ways without falling over. 

As infants, children relied mostly on information from their eyes and mouths; but as toddlers, they are beginning to process signals and cues from their brains and inner ears. Until they get used to it, this new focus can cause them to lose their balance. They can get overloaded with these signals while walking or running, and it takes all of their concentration just to stay upright. Putting all of their attention into balance control may also mean they don’t pay attention to the rules of the game and just run around wildly. With time, running, skipping, kicking, jumping and hopping all become easier without requiring as much concentration on staying upright. Then children can begin focusing on catching a ball and throwing it back. 

Your child’s safety begins with you  

The greatest risk to your child’s health continues to be car crashes. It is impossible for you to protect your child during an accident by just holding him, so make sure he is in the proper safety seat. Car crashes aren’t the only things that pose a danger to your child. Here are some safety tips that may be especially important now:

  • Begin teaching your child his full name, address and phone number and not to talk to strangers.
  • Insist on helmet use when you go bike riding.
  • Your child always belongs in the backseat of the car, and he should use a forward-facing car safety seat with a harness for as long as possible. When he is about age 4 – if he has outgrown the highest weight or height allowed by their car safety seat’s manufacturer – you may move him up to a booster seat held in place by a seatbelt. 
  • If your child isn’t in the car with you, always walk behind your car before backing out of the driveway.
  • Never buy a home trampoline or allow children to use home trampolines.
  • Ensure your child wears a life vest if boating.
  • Don’t allow your child to play with plastic bags or balloons because suffocation from these objects can still occur at this age.
  • Never leave a child unattended in a car or a house.
  • There is no such thing as waterproof sunscreen. So reapply sunscreen often, especially when your child comes out of the water, and avoid being in the sun between 10 a.m. and 3 p.m. when the sun is the most dangerous.

 

Your 4- to 5-Year-Old

Parenting

Children in this age group are beginning to develop important life skills. You can have a huge impact on the person your child will become just by the way you parent at this critical time. 

Set limits. When children do something that is against the rules, explain that what they did was wrong and outline what the consequence will be simply and in a few words. Consequences need to be logical, meaningful and simple. For example:

  • If your child rides a bike without a helmet, the bike is off-limits for a day or two.
  • When your child won’t share a toy, that toy can’t be used for the rest of the day.
  • If he misbehaves at the grocery store, he won’t be allowed to go next time. 

Create and keep routines. Children do best when they know what to expect.

Assign responsibility. When children do everyday household chores like putting dirty clothes in the hamper or washing machine, setting the table or feeding the dog, they are really learning how to contribute. 

Encourage your child to bathe and dress himself. 

Teach simple rules about safety with adults. You want your child to respect and trust others, but you also need to teach your child to be careful, so tell him: 

  • “If you’re not sure, ask me.”
  • “If an adult asks you to do something that you’re not sure is OK, always ask me first. I won’t get mad at you for asking.”
  • “No one should ever tell you to keep a secret from me – one that might make me mad if I found out. Adults should never expect you to do that.”
  • “No adults (except parents, doctors and nurses) should touch you where you normally wear a bathing suit.”
  • “If we get separated, find a security guard or police officer. That person will help you find me.” Point out the person who is there to help if you do become separated.

Kindergarten teacher with students

Early learning

Children entering kindergarten with a range of skills and knowledge tend to be more successful in school for years to come. You can download a list of helpful skills from the Arkansas Department of Human Services Division of Child Care and Early Childhood Education website at humanservices.arkansas.gov/dccece/classroom_docs/kric_booklet_for_parents.pdf or, in Tennessee, at www.tn.gov/education/smart/57_60_months.shtml. Although mastery of any or all of the skills identified here is not required for admission to kindergarten, they will give your child more confidence.

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Development

Your 4-year-old should be able to:

  • Speak in a way that is almost always understandable.
  • Usually count from 1 to 10.
  • Walk on tiptoes, climb a ladder and ride a tricycle.
  • Name and match three or four primary colors.
  • Know his own name.
  • Correctly use the pronoun “I.”
  • Recognize gender differences and correctly say “I am a girl” or “I am a boy.”
  • Dress and undress but may still have trouble with laces and buttons. Children this age also begin to be selective about what they wear.
  • Hold and use a pencil with good control.
  • Copy a cross, circle and possibly a square.
  • Draw a person with a face, arms and legs.
  • Engage in conversation.
  • Sing a song.
  • Talk about his day’s activities and experiences.
  • Identify emotions such as sadness, anger, anxiety and fear.
  • Enjoy the company of other children.
  • Play cooperatively and show interest in other children’s bodies.

Development

Your 5-year-old should be able to:

  • Group of 5 year old children sitting in a fieldSkip, walk on tiptoes and jump forward.
  • Throw a ball overhand.
  • Wash and dry hands and brush teeth unassisted.
  • Cut and paste.
  • Name four or five colors.
  • State his age.
  • Speak six- to eight-word sentences.
  • Tell a simple story.
  • Dress and undress without supervision.
  • Say his own phone number, address and several nursery rhymes.
  • Copy a triangle from a picture.
  • Draw a person with a head, body, arms and legs.
  • Understand right and wrong, fair and unfair.
  • Understand games that have rules.
  • Engage in make-believe and dress-up play; may pretend to be “mommy” or “daddy.”

If you’re concerned, talk to your child’s doctor. 

As a parent, you know your child best. If your child is not meeting the milestones for his age, or if you think there could be a problem with the way your child plays, learns, speaks or acts, talk to your child’s doctor and share your concerns. Don’t wait.

Eating right

Young boy eating an appleYour preschooler has probably developed a pretty good appetite. Preschoolers act out thoughts and emotions instead of using language. That’s why they seem to be in motion all the time. All this physical movement means your child will be hungrier and not so picky about the food you serve at home.

However, your child may be asking for fast food. Kids’ menus at these restaurants are seldom in line with your nutritional goals for your child. Fast foods are generally especially high in fats, salts and sugars, increasing the potential for weight gain and risk for diabetes. Find healthy alternatives to fast food.

Do children really need vitamins? No.

Nutrition experts have been saying for some time that most children do not need vitamins at all. The amount your child needs to eat to get enough vitamins and minerals from food alone is probably much smaller than you think. There are actually very few instances where a child’s diet will leave him deficient. 

Here are the facts:

  • It doesn’t take more than a very few selections from each of the basic food groups for children to get their recommended daily dose.
  • Many vitamins are stored in the body, so your child doesn’t have to eat each and every one every day.
  • Many foods these days are fortified with vitamins and minerals. Classic examples include vitamin-D fortified milk, margarine and pudding, and the calcium contained in kid-friendly foods such as orange juice, cereals, breads and even toaster waffles.

Oral health

  • Supervise brushing twice a day with a small amount of toothpaste.
  • Take your preschooler to the dentist again this year and follow up as recommended by the dentist.
  • If your child is a thumb sucker, ask the dentist how to discourage this habit. 
  • No more pacifiers by this age.
  • Give a fluoride supplement if your drinking water is not fluoridated. Ask your dentist how long to continue giving fluoride supplements.
  • Learn how to prevent dental injuries and what to do in case of a dental emergency, especially the loss or fracture of a tooth.

Breaking the thumb-sucking habit:

  • When you see your child thumb sucking, gently remind him he wanted to stop. Never make fun of your child or criticize him; that’s cruel. It also may teach him that he can “get to you” by sucking his thumb.
  • Praise your child or provide small rewards – such as an extra bedtime story or a trip to the park – when he isn’t sucking his thumb. 
  • Encourage your child to do something else, like squeeze a pillow or stuffed animal, when he feels the need to suck his thumb.

Parents sometimes try to break the habit by making their child’s thumb taste bad or putting a bandage, sock or glove on his hand. These techniques almost never work and cause undue stress to your child. 

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Sleep

Bedtime routine

Young girl sleeping in a bedPreschoolers sleep about 10 to 12 hours during each 24-hour period. A bedtime routine is a great way to ensure that your preschooler gets enough sleep and develops good sleep habits.

To establish a bedtime routine:

  • Set fixed times for going to bed, waking up and taking naps.
  • Include a winding-down period 30 minutes before bedtime.
  • Give your child a warning 30 minutes and again at 10 minutes before bedtime.
  • Keep consistent playtimes and mealtimes.
  • Make the bedroom quiet, cozy and conducive to sleeping.
  • Use the bed only for sleeping – not for playing or watching TV.
  • Limit food and drink before bedtime.
  • Tuck your child into bed snugly for a feeling of security.

A note on naps

Most preschoolers are very active and still need naps during the day. Even if your child can’t fall asleep, try to set aside some quiet time during the day for relaxing, which will be good for you, too.

The tips for establishing a bedtime routine also apply to naps. Usually, an hour is long enough to get the benefits of a good nap, but if your child has been going full tilt, he may take a longer one.

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Night terrors

Young boy having a nightmareThere is a difference between simple nightmares (when children wake up crying and afraid) and night terrors. Night terrors are when your child is in bed and appears to be awake and terrified, but he won’t respond to you because he is not awake. Night terrors are a mysterious and distressing form of sleep behavior common during the preschool and early school years. These events are much more unsettling for parents than for the child having them. Typically, the child falls asleep without difficulty but wakes up a few hours later in a state of panic and fear. He may point to imaginary objects, kick, scream, call out and be inconsolable. The only things you can really do are:

  • Hold and protect your child from hurting himself. 
  • Reassure him.
  • Keep the lights dim and speak softly. 

After 10 to 30 minutes, he’ll go back to sleep and won’t remember a thing about it in the morning.

Since some children have night terrors when they’re overtired, try putting your child to bed about 30 minutes earlier than usual and see if that helps. In any case, they’ll disappear naturally as the child grows older. It’s unusual for night terrors to happen often or over a long period of time. In cases of very frequent night terrors, talk with your child’s doctor, but the best strategy seems to be to wait them out. 

Behavior

Lying

Preschoolers (ages 3–5) live in a place somewhere between fantasy and reality. They have “real” imaginary friends, make up stories about places they have never been and hang out with superheroes. They also may have poor memories for accidents (spilled milk) or misdeeds (pinching the baby) that happened earlier in the day. In short, they do not have the ability yet to understand the difference between lying and telling the truth. 

You can teach your child the difference between lying and telling truth.

Help them learn the ground rules. At this early age, fibs and misdeeds are learning opportunities. Don’t accuse your child of a misdeed by asking “Did you do this?” It’s better to simply say what the rule is and offer a solution. “We have a rule that we only draw on paper. So let’s get some soap, and you can help clean this up.” Then you can praise your child when he cleans up the mess he obviously made. In this way, he learns what is expected of him. 

Gently help them see the difference. Creativity is in high gear during this period.

You can help nurture your child’s imagination and still teach him the importance of honesty. Gently remind children that what they are saying isn’t really true, then turn the discussion into a “what if?” For example, if your child talks about a fictitious trip to Disneyland, you can say, “Well, you know we haven’t been to Disneyland yet, but if we did go, what would you want to do?”

Pay attention. Preschoolers often stretch the truth to get your attention. 

Be positive, don’t judge. As the author of The Self-Aware Parent put it, “You have to bust out your child in a nice way.” Tell him you know it’s hard to admit doing something wrong but telling the truth is important.

Resources

  • Lies, Truths and Your Preschooler, Jennifer Soong, WebMD Feature.
  • The Self-Aware Parent, Fran Walfish, PsyD, 2009.

Resolving conflicts

Mother talking with young boyRemember that children do what they see others do. You are your child’s most important role model. Be sure that every day in every way you are showing your child a healthy way to deal with anger.

Help children understand conflict. Let them know that people get into fights when they are angry, when they get teased a lot or when they are encouraged by people around them. Remind your child that: 

  • Fights don’t solve problems – they make new ones.
  • When they get mad but don’t fight, they have really won. 
  • Sometimes, getting along with other kids is just hard. 

If your child is being bullied

Bullies target children they think are weak, shy or are smaller, and want to control them. They torment them verbally or physically, undermining confidence in the victim. The victim may not want to go to school or play outside for fear of being hurt.

Here are some things your child can do, with your help, that will make him safer:

  • Tell your child not to react to the bully, particularly by giving in to demands. Your child should try to keep calm and simply walk away.
  • If your child’s attempts at disregarding a bully’s taunts aren’t effective, he should become assertive with his harasser. While standing tall and looking his tormentor in the eyes, he should clearly and loudly make a statement like, “I’ll talk to you, but I’m not going to fight. So put your fists down now.” Drawing the attention of peers to the bullying situation can embarrass the bully. If your child isn’t used to reacting assertively, help him rehearse what he will say if he is confronted.
  • Encourage your child to form strong friendships. A youngster who has loyal friends is less likely to be singled out by a bully, or at least he’ll have some allies if he does become a target. 
  • If you suspect you child is being bullied, you need to take action to ensure your child’s safety and well-being. Talk to your child’s teacher, the principal of his school or the child care facility manager.
  • Let the school authority figure talk to the bully when he sees the inappropriate behavior taking place. This is generally a more effective approach than having you speak with the child or his parents. 

It’s normal to get mad. Anger doesn’t usually last a long time, but it is a very strong feeling when it happens. Talk to your child about what they should do when they’re angry.

When children are angry, they should:

  • Breathe deeply, count to ten or just walk away.
  • Stay alert, stand tall and keep a safe distance from the other person. 
  • Notice changes in their bodies.
  • Express their anger by putting their feelings into nice words.
  • Listen to what the other person is saying, and ask, “What does this person really want?”
  • Not hit anyone, break things or say hurtful things.
  • Blow off steam by running or exercising.
  • Think and talk. With a little guidance from you, your child can be the one to stay calm when someone tries to start a fight. 

If your child is still having trouble getting along with other kids, talk with his doctor.

Learning to read

There are a lot of tools out there (like educational television programs, games, songs, video games and DVDs) that will help your child learn to read when he’s ready. None of those tools will be as important as your attention and your involvement. 

Mother reading with child

The most successful approach to early learning: 

  • Let your child set his own pace and have fun at whatever he’s doing. 
  • Don’t drill your child on letters, numbers, colors, shapes or words. Instead, encourage his natural tendencies to explore on his own. 
  • Make learning fun. 
  • Present him with educational experiences, but make sure they are entertaining.
  • With your preschooler sitting with you, print the letters of his name on paper and say each letter as you write it. Make signs for special places, and let him decorate them. 
  • Teach your child “The Alphabet Song” and play games using the alphabet. 
  • Watch educational videos, DVDs, CDs and TV shows with your child.
  • Place alphabet magnets on your refrigerator or other safe metal surface, and encourage your child to assemble his name and make other words.

Remember that learning to read is a process. If done lovingly, it will open a world of wonder for your child that he will carry with him for the rest of his life. 

Exercise and activity

Young girl swinging on ropeChildren need exercise. Being active at least one hour a day will help your child:

  • Feel less stressed. 
  • Feel better about themselves and be more ready to learn in school. 
  • Keep a healthy weight. 
  • Build and keep healthy bones, muscles and joints. 
  • Sleep better at night. 

Children need to stay active so they keep developing their bodies and their brains. They aren’t designed to be couch potatoes. Young children should not be sitting around for long amounts of time. A good rule is no more than one hour – unless they are sleeping. And school-age children should not be sitting around for longer than two hours at a time. 

Parents need to limit TV, video games and computer time for their children. They also need to set a good example by being active themselves. Being active together can be fun for everyone. 

Playing team sports, walking or riding a bike to school, dancing, swimming, bowling or yoga are all great ways to stay in shape. 

Your child’s safety begins with you  

Family riding bikesAccidents continue to be the principal cause of death in children in this age group. As your child becomes active outside the house, you have more things to think about in keeping him safe. Download the Arkansas Children’s Hospital’s child safety checklist. Look for safety issues that might put an on-the-go preschooler or kindergartener in particular danger. Go to http://www.archildrens.org/Services/Injury-Prevention-Center/Home-Safety... and scroll to the bottom of the page. 

  • Know where your child is at all times. Children ages 4 and 5 are too young to be roaming the neighborhood alone.
  • Trampolines are not recommended because of the risk of serious injury.
  • Insist that your home and car be smoke-free.
  • Electrical tools, firearms, matches and poisons should be locked up and kept out of reach.
  • Your child should not have unsupervised access to, or ride a bike in, the street. Supervise all street crossings.
  • Teach your child his full name, address and phone number as well as the first and last names of family members.
  • If bicycling, teach safety rules and insist he wear a helmet.
  • Continue to use a car seat or booster seat secured properly until the child weighs at least 60 pounds or his head is higher than the back of the rear seat. 
  • Always walk behind your car before backing out of the driveway.
  • Many 4- and 5-year-olds are fairly good “swimmers,” but knowing how to swim does not make your child safe around water. Make sure that your child wears a life vest if boating.
  • There’s no such thing as waterproof or sweat-proof sunscreen. Reapply sunscreen often, and teach your child the importance of using it even when you’re not around. When possible, avoid the sun between 10 a.m. and 3 p.m.
  • Advise your child to be careful around strange dogs, especially ones that are eating.
  • Teach your child not to talk to strangers or accept food from strangers. 

For more tips on keeping your child safe, download the Home Safety Checklist from www.archildrens.org/documents/ipc-homesafety.pdf or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml.

 

Preschool Health

The well-child checkup 

Making and keeping well-child checkup appointments with your child’s doctor every year will help keep your child healthy and happy.

The well-child checkup includes:

  • Getting a health history and developmental assessment.
  • A complete physical exam.
  • Vision and hearing checkups.
  • Lab tests.
  • Immunizations for his age.
  • Health education.
  • A dental referral.

Immunizations/vaccinations

At your child’s annual well-child checkup, ask what immunizations he needs and get your child a flu shot.

Click here for the “Well Child Check Up and  Immunization” chart.

Healthy hearing

Most children who are born with a hearing loss can be diagnosed through a hearing test. But in some cases, the hearing loss is caused by things like infections, trauma and damaging noise levels, and the problem doesn’t emerge until later in childhood. So it’s important to have your child’s hearing evaluated regularly as they grow.

Kids who seem to have normal hearing should continue to have their hearing tested at regular doctor’s appointments. Hearing tests are usually done at ages 4, 5, 6, 8, 10, 12, 15 and 18, and any other time if there’s a concern.

If your child seems to have trouble hearing, if speech development seems abnormal or if your child’s speech is difficult to understand, talk with your child’s doctor.

Resource

Young girl getting an eye examHealthy vision

Healthy eyes and vision are a critical part of your child’s development. His eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early.

Routine medical exams for kids’ vision include:

  • In the first year of life, all infants should be routinely screened for eye health during checkups with their doctors.
  • Around age 3, children should undergo eye health screenings and tests that measure sharpness of vision with their doctors.
  • After age 5, further routine screenings should be done at school or at the doctor’s office, or after the appearance of symptoms such as squinting or frequent headaches. (Many times, a teacher will realize the child isn’t seeing well in class.)
  • Kids who wear prescription glasses or contacts should have annual checkups to screen for vision changes.

Resource

Fever

In healthy children, fevers are usually not serious and are often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

Your child has a fever if his body temperature is above:

  • 100.4°F measured rectally (in the bottom).
  • 99.5°F measured orally (in the mouth).
  • 99°F measured under the arm.

Causes of fever

It’s important to remember that fever by itself is not an illness – it’s usually a symptom of another problem. Fever is usually due to infection, overdressing or an immunization.

  • Children at this age with temperatures at or above 102.2°F require medical attention. 

The illness is probably not serious if your child has normal skin color; is still interested in playing and is urinating and drinking well; and looks well when the temperature comes down.

Resource

When to call the doctor

In general, contact your child’s doctor if your child:

  • Isn’t urinating as often as usual.
  • Has a temperature higher than 102.2°F for one day.
  • Has a temperature higher than 100°F for more than three days.
  • Seems to have ear or sinus pain.
  • Has yellow eye discharge.
  • Has a cough for longer than one week.
  • Has thick, green nasal discharge.

Seek medical help immediately if your child:

  • Has trouble drinking.
  • Coughs hard enough to cause vomiting or changes in skin color.
  • Coughs up bloody mucus.
  • Has difficulty breathing or is bluish around the lips and mouth.

When to keep your sick child at home

Sick Child with thermometer in her mouthCheck with your child care provider for a list of their rules on when to keep sick children home, but you should probably keep a child home if he has any of the following:

  • Fever, irritability, lethargy, persistent crying or difficulty breathing.
  • An upper respiratory illness such as bronchiolitis or influenza.
  • Diarrhea that can’t be contained by diapers or by using the toilet regularly.
  • Bloody stools or stools containing mucus. (Give your doctor a call!)
  • Vomiting.
  • A rash – if it is not linked to a fever or other symptoms, he may be able to go if your daycare’s rules allow it.
  • Chicken pox – your child is no longer contagious once all the sores have dried and crusted over.
  • Impetigo during the first 24 hours of antibiotics.
  • Scabies – until it is treated with a topical insecticide as recommended by your child’s doctor or pharmacist; prior to treatment, it is contagious.
  • Bacterial conjunctivitis (pinkeye) and yellow discharge from the eye – not contagious after 24 hours of antibiotics.
  • Strep throat – is usually not contagious after 24 hours of antibiotics. Mouth sores that cause excessive drooling; wait until your doctor says they’re not infectious.
  • Head lice – your child can return to daycare after he’s been thoroughly treated.

 

Girl washing her handsGerm prevention 

Hand washing is the best way to prevent illness. Teach your child to wash his hands thoroughly. 

  • Teach everyone in the household to cough or sneeze into a tissue or the crook of their arm.
  • Avoid sharing utensils, drinking glasses, washcloths, towels and other items that may harbor germs.
  • Avoid anyone who’s sick. This is especially important during the first few days of a viral illness, when the person who’s sick may be most contagious.

 

 

Over-the-counter medicines

Pharmacist with over the counter medicineOver-the-counter (OTC) means you can buy the medicine without a prescription.

You should check with your child’s doctor or a pharmacist before giving your child any medicine, especially for the first time. Your child may or may not have side effects with any drug. Be sure to tell the doctor if your child has any side effects, throws up or gets a rash after taking a medicine. 

All OTC medicines have the same kind of label. The label gives important information about the medicine. It says what it is for, how to use it, what is in it and what to watch out for. Look on the box or bottle to:

  • Check the chart on the label to see how much medicine to give. If you know your child’s weight, use that first. If not, go by age. 
  • Check the label to make sure it is safe for infants and toddlers younger than 2 years. If you are not sure, ask your child’s doctor.

 

First aid 

Eye injuries

Any injured or painful eye should be seen by a doctor. Cover the painful or injured eye until you can get medical help. If anything is splashed in the eye, flush gently with water for at least 15 minutes. Call the Poison Center or the pediatrician for further advice. Do not touch or rub an injured eye. Do not apply medicine. Do not remove objects stuck in the eye. 

Fractures and sprains

If an injured area is painful, swollen or deformed, or if motion causes pain, call your child’s doctor or seek emergency care. Apply ice or a cold compress wrapped in thin cloth for no more than 20 minutes. 

If there is a break in the skin near the fracture or if you can see the bone, call 911 or an emergency number in your area. Then cover the area with a clean bandage. Do not move the child unless instructed to do so.

Fainting

Make sure the child is breathing. If not, call 911 and begin rescue breathing and CPR. If vomiting has occurred, turn the child onto one side to prevent choking. Elevate the feet above the level of the heart (about 12 inches). Do not give the child anything to drink.

Head injuries

Do not move a child who may have a serious head, neck and/or back injury. Call 911 or an emergency number right away if the child loses consciousness or has a convulsion (seizure).

Call the pediatrician for a child with a head injury that includes any of the following:

  • Drowsiness
  • Difficulty being awakened
  • Persistent headache or vomiting
  • Clumsiness or inability to move any body part
  • Oozing of blood or watery fluid from ears or nose
  • Abnormal speech or behavior

Poisons

If the child has been exposed to or ingested a poison, call the Poison Center at 1-800-222-1222. A poison expert in your area is available 24 hours a day, seven days a week.

  • Swallowed poisons. Do not give anything by mouth or induce vomiting. Call the Poison Center right away. Do not delay, but try to have the substance label or name available when you call.
  • Fumes, gases or smoke. Get the child into fresh air and call 911 or the fire department. If the child is not breathing, start CPR and continue until help arrives.
  • Skin exposure. If acids, lye, pesticides, chemicals, poisonous plants or any other potentially poisonous substance comes in contact with a child’s skin, eyes or hair, brush off any residual material while wearing rubber gloves, if possible. Remove contaminated clothing. Wash skin, eyes or hair with a large amount of water or mild soap and water. Do not scrub. Call the Poison Center for further advice.

If a child is unconscious, becoming drowsy, having convulsions or having trouble breathing, call 911 or an emergency number. Bring the poisonous substance (safely contained) with you to the hospital.

Nosebleeds

Keep the child in a sitting position with the head tilted slightly forward. Apply firm, steady pressure to both nostrils by squeezing them between your thumb and index finger for 10 minutes. If bleeding continues or is very heavy, call the pediatrician or seek emergency care.

Teeth

  • Baby teeth. If knocked out or broken, apply clean gauze to control bleeding and call a pediatric dentist.
  • Permanent teeth. If knocked out, call or go directly to the pediatric dentist or an emergency department. Do not touch the root of the tooth (the part that would be in the gum). If dirty, rinse gently with cold running water or milk. Do not scrub. Do not use any cleansers. Place the tooth in clean water or milk, and take it along with the child when seeking emergency care. 

Convulsions, seizures

Call 911 or an emergency number for a prolonged seizure (more than five minutes). If the child is breathing, lay him on his side to prevent choking. Make sure the child is safe from objects that could injure him. Be sure to protect his head. Do not put anything in the child’s mouth. Loosen any tight clothing, and start rescue breathing if the child is blue or not breathing. 

Stings, bites and allergies

  • Stinging insects. Remove the stinger as soon as possible. Put a cold compress on the bite to relieve the pain. If the child has trouble breathing or if fainting or extreme swelling occur, call 911 or an emergency number right away. If hives, nausea or vomiting occur, call the pediatrician. 
  • Spider bites. Call the pediatrician or Poison Center (1-800-222-1222) and describe the spider. Have the pediatrician check any bites that become infected.
  • Animal or human bites. Wash wound well with soap and water. Call the pediatrician. The child may need a tetanus or rabies shot.
  • Ticks. Use tweezers or your fingers to grasp as close as possible to the head of the tick and briskly pull the tick away from where it is attached. Put the tick in a plastic baggie, and keep the tick in the freezer until you are sure the bite is fully healed. Call the pediatrician if your child develops symptoms such as a rash or fever. Wash your hands well after handling a tick.
  • Snake bites. Take the child to an emergency department if you are unsure of the type of snake or if you are concerned that the snake may be poisonous. Keep the child at rest. Do not apply ice. Loosely splint the injured area, and keep it at rest, positioned at or slightly below the level of the heart. 
  • Allergies. Swelling, problems breathing and paleness may be signs of severe allergy. See your doctor to determine if your child has allergies. If the child has trouble breathing or if fainting or extreme swelling occur, call 911 or an emergency number right away.

Burns and scalds

First remove the child from contact with hot water or a hot object (for example, oil). If clothing is burning, smother flames and cool clothing by soaking with water. Remove clothing unless it is firmly stuck to the skin. Run tap water over burned skin until the pain eases. Do not apply ice, butter, grease, medicine or ointment.

  • Burns with blisters. Do not break the blisters. Call your pediatrician to determine how to cover the burn and to ask about burns on the face, hands, feet or genitals.
  • Large or deep burns. Call 911 or an emergency number. After stopping and cooling the burn, keep the child warm with a clean sheet or covered with a blanket until help arrives.
  • Electrical burns. Disconnect electrical power immediately, if possible. If the child is still in contact with the live electrical source, do not touch the child with bare hands. Pull the child away from the power source with an object that does not conduct electricity (such as a wooden pole) only after the power is turned off. All electrical burns need to be seen by a doctor.

Sunburn 

  • Regular sunburn. Apply cool compresses to the burned areas or bathe the child in cool water. You also can give acetaminophen to help relieve the pain. (Check the package for appropriate dosage for his age and weight.)
  • Severe sunburn. If the sunburn causes blisters, fever, chills, headache or a general feeling of illness, call your pediatrician. Severe sunburn must be treated like any other serious burn, and if it’s very extensive, hospitalization sometimes is required. 

Skin wounds

Make sure the child is up to date for tetanus vaccination. Any open wound may require a tetanus booster even when the child is currently immunized. If the child has an open wound, ask the pediatrician if the child needs a tetanus booster.

Bruises

Apply cold compresses. Call the pediatrician if the child has a crush injury, large bruises, continued pain or swelling. The pediatrician may recommend acetaminophen for pain.

Cuts

Rinse small cuts with water until clean. Use direct pressure with a clean cloth to stop bleeding. If the cut is not deep, apply an antibiotic ointment, and then cover the cut with a clean bandage. Call the pediatrician or seek emergency care for large, deep or gaping cuts. Continue direct pressure with a clean cloth until help arrives.

Scrapes

Rinse with clean, running tap water for at least five minutes. Do not use detergents, alcohol or peroxide. Apply a triple antibiotic ointment and a bandage that will not stick to the wound.

Puncture wounds

Do not remove large objects (such as a knife or stick) from a wound. Call for help (911 or an emergency number). Large objects must be removed by a doctor. Call the pediatrician for all puncture wounds. The child may need a tetanus booster.

Bleeding

Apply pressure using a gauze pad or cloth over the bleeding area. If still bleeding, add more gauze or cloth, and apply pressure. If bleeding continues, call the pediatrician or seek emergency care.

Preventing bites

Insect bites

It is impossible to prevent all insect bites, but you can minimize the number your child receives by:

  • Avoiding areas where insects nest or congregate, such as garbage cans, stagnant pools of water, uncovered food, and orchards and gardens where flowers are in bloom.
  • When you know your child will be exposed to insects, dress him in long pants and a lightweight, long-sleeved shirt.
  • Avoid clothing with bright or dark colors or flowery prints. They seem to attract insects.
  • Don’t use scented soaps, perfumes or hair sprays on your child, because they also are inviting to insects.

Insect repellents

Insect repellents come in many forms including aerosols, sprays, liquids, creams and sticks. Some are made from chemicals, and some have natural ingredients. Keep in mind that insect repellents prevent bites from biting insects but not stinging insects. Ask your doctor or pharmacist to recommend a good insect repellent for your child. 

The following types of repellents are not effective:

  • Wristbands soaked in chemical repellents
  • Garlic or vitamin B1 taken by mouth
  • Ultrasonic devices that give off sound waves designed to keep insects away
  • Backyard bug zappers (insects may actually be attracted to your yard) 

Preventing animal bite wounds 

Child walking next to a dogThere are about 4.5 million dog bites, 400,000 cat bites and 250,000 human bites reported annually. Although many bites are minor, others cause serious infections. Most bites come from domesticated animals that have been vaccinated, so the risk of rabies or other diseases is low. The greatest risk for rabies comes from wild animals such as bats, raccoons, foxes, skunks and coyotes. Rabies is a very serious viral infection that affects the central nervous system and brain, causing a high fever, swallowing difficulties, convulsions and eventually death. If your child is bitten by an animal, contact animal control officials. 

Even when rabies isn’t present, an infection can develop at the site of the bite. 

Contact your pediatrician if any of the following signs of an infection are present:

  • Pus or drainage from the bite wound
  • Swelling and tenderness in the area around the bite
  • Red streaks that extend from the bite
  • Swollen glands that occur above the bite

To prevent bites and the infections associated with them:

  • Teach your child to avoid all contact with strange animals. 
  • Never leave a young child alone with an animal. Even playful interactions can lead to an unexpected bite.
  • Teach your child to play nicely with pets and respect them while they are eating.
  • Educate your youngster never to place his face close to an animal nor to awaken a pet from sleep.
  • Teach your child not to run from a dog or make any aggressive movements but instead face the dog, allow the dog to sniff him and then back away slowly.
  • Instruct older children to recognize the signs of a potentially unsafe dog, including a rigid body, a stiff tail at half-mast, a staring expression, hysterical barking or a crouched position.