The Baby & Child Care Encyclopedia 2021

2021/2022

Kids a nd Menta l Hea lth

$11.95

Common Il lnesses a nd Pa in Ma nagement

Fam Nut ily rition

encyclopedia Prenata l 101

REVIEWED BY CANADIAN HEALTH PROFESSIONALS

Brought to you by

Bre a stf Fir a nd eedin st t g 3 Mhe ont hs

Oakville, ON

Editor-in-Chief Katie Dupuis Copyright © 2021 Jane Media Inc. The Baby & Child Care Encyclopedia is registered trademark of Jane Media Inc. All rights reserved. The use of any part of this publication, reproduced, transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise , or stored in a retrieval system without the prior written consent of the publisher – or in the case of photocopying or other reprographic copying, license from the Canadian Copyright Licensing Agency-is an infringement of the copyright law.

Printed and bound in Canada

by Dollco Printing Inc. Published in Canada by Jane Media Inc. 407 Iroquois Shore, Suite 8 Oakville, ON, L6H 1M3 Telephone: 905-334-6417 Book and cover design: Michelle Neumeyer This project has been made possible by the Government of Canada.

Art Director Michelle Neumeyer Proofreader Jen Batler Director of Sales Lori Dickson National Account Manager Lianne Warne National Account Manager Angela Breese Controller Lisa Mackay Digital Manager James Morrison Contributing Writers Cassandra Abate Erin Pepler Amy Valm Lisa van de Geyn Owner/Publisher Jane Bradley www.parentscanada.com

CHAPTER 1

PRENATAL 101 ................................................................................... 6

CHAPTER 2

BREASTFEEDING AND THE FIRST THREE MONTHS...................20

CHAPTER 3

STARTING SOLIDS AND THE TODDLER YEARS ........................36

CHAPTER 4

AN AGE-BY-AGE GUIDE TO SLEEP................................................46

CHAPTER 5

FAMILY NUTRITION.........................................................................56

CHAPTER 6

KIDS AND MENTAL HEALTH .........................................................66

CHAPTER 7

WHEN YOUR CHILD IS SICK ..........................................................74

CHAPTER 8

SAFETY AND FIRST AID .................................................................98

CHAPTER 9

MILESTONES, CHECKLISTS AND CHARTS .................................114

Don ’t wo You’ve rry. got t h is .

Welcome to the Baby & Child Care Encyclopedia.

This encyclopedia (our second edition!) was developed for parents like you. Our goal is for it to be a go-to resource, to help you feel confident while raising your kids. That’s why it’s written by top Canadian journalists, and reviewed by experts in their field who read every word in this book. You can be sure you are getting accurate, vetted and trusted information. We want nothing but the best for Canadian parents.

The result is a reputable reference tool you’ll want to keep, to consult whenever the need arises.

I would like to thank our advertising partners for their generous support. This project would not see the light of day without you, and without the support of the Canadian Periodical Fund.

This issue of the Baby & Child Care Encyclopedia is affectionately dedicated to my mom, Bettie Bradley, who is 94 and has always said that life is an adventure. She raised three kids on her own, with grace, joy and an abundance of love every single day.

The adventure continues, Mom.

Enjoy!

4

JANE BRADLEY President + Publisher Mom of two boys (now men)

Jane

BABY & CHILD CARE ENCYCLOPEDIA

Maria Robertson is CEO and founder of The New Mummy Company (newmummycompany.ca). She has more than 21 years of experience as a baby sleep coach, lactation educator, baby nurse, doula and postpartum expert.

Emma Miles is a mom, prenatal teacher, sleep trainer and newborn specialist with 10 years of experience in midwifery care and teaching. She lives in Toronto with her husband and works with The New Mummy Company.

Dr. Dina Kulik, a paediatrician and emergency medicine doctor, is the founder and medical director of kids’ health clinic Kidcrew (kidcrew.com). She lives in Toronto with her husband and four sons.

Alanna McGinn is a certified sleep expert and founder of Good Night Sleep Site (goodnightsleepsite.com), a global sleep consulting practice. Her team of sleep consultants strive to help families overcome their sleep challenges.

Adrianna Smallwood is a clinical dieititian in Newfoundland and Labrador. She specializes in fertility, pregnancy and family nutrition. As a mom of two young children, her passion is creating healthy, delicious recipes for families.

Dr. Katie Birnie is a clinical psychologist and assistant professor at the University of Calgary. She is also associate scientific director of Solutions for Kids in Pain (SKIP, kidsinpain.ca).

Alyson Schafer is one of Canada’s leading parenting authorities. She has a private practice as a family counsellor, and is also a best-selling author, sought-after speaker and well-known TV expert.

Kylee Goldman is a registered psychotherapist who works with those struggling with mental wellness and experiences of violence and trauma. She is passionate about helping people develop meaningful relationships and build resiliency.

Katie Dupuis, a veteran of the magazine industry in Canada, joined the ParentsCanada team as editor-in-chief in 2018. A mom of two girls, she is dedicated to supporting fellow parents by creating reliable, relatable content.

“

INSTEAD OF WISHING AWAY NINE MONTHS OF PREGNANCY AND COMPLAINING ABOUT THE SHADOW OVER MY FEET, I’D HAVE CHERISHED EVERY MINUTE OF IT AND REALIZED THAT THE WONDERMENT GROWING INSIDE ME WAS TO BE MY ONLY CHANCE IN LIFE TO ASSIST GOD IN A MIRACLE.

Erma Bombeck

Ma naging Morning S ickn es

ion, ur t i r t o Nu nd Y ody a e rcis nging B e x E Cha The Tr First ime ster

s

chapter 1

prenatal 101

g atin g i v Na nal load o i t o Em Over

Th Second e a nd Trimes Third ter

The moment you find out you’re expecting a baby, your whole world changes. It may come as a shock or feel like a dream come true (or both), and it’s always a big deal. You’re adding a whole new person to your family! It’s a thrilling time, and it all begins with two little lines on a test.

Pregnancy is an adventure, but it’s not without its challenges. You will experience a long list of physical and emotional changes, and it’s completely natural to have questions, concerns and even anxiety.

Some days will be filled with excitement and joy while others may be a struggle. Fortunately, at the end of the day, it’s all worth it—we promise!

Congratulations on your impending arrival. We’re here for you, to help you stay strong, healthy and happy throughout your pregnancy.

YOU JUST FOUND OUT YOU’RE PREGNANT. NOW WHAT?

As soon as you’ve received a positive on an at-home test (or even if you just suspect that you’re pregnant), it’s best to reach out to your family doctor. If your pregnancy test is inconclusive, they will confirm your pregnancy with urine and/or blood tests and provide guidance for the months ahead. If you’re unsure of when you conceived, a dating ultrasound may be recommended. They’ll also be able to recommend an OB-GYN or midwife if you haven’t already self-referred. You may see your pregnancy caregiver right away or be asked to schedule an appointment closer to the end of your first trimester.

If you aren’t already taking prenatal vitamins, start now. This pregnancy-specific supplement contains a combination of vitamins and minerals designed to optimize maternal health and prevent neural tube defects. Folic acid is especially important in the early weeks of pregnancy, and the average woman gets far less than the daily recommended requirement through food alone. In addition to taking a prenatal vitamin, you can also increase your folic acid intake by including foods like chickpeas, lentils, cooked spinach, broccoli, cabbage, greens and sunflower seeds in your diet.

You may have heard that it’s best not to share pregnancy news with friends and family until after the first 12 weeks. While this is a fairly common practice, it’s not necessary and is entirely up to you and your partner as to when you will share the news.

THE FIRST TRIMESTER

The first trimester of pregnancy can pass by with very few symptoms or be a fairly challenging time. Every woman (and every pregnancy!) is different, but it’s common to experience any or all of the following symptoms: 8

BABY & CHILD CARE ENCYCLOPEDIA

Register today for all your baby essentials.

We've got you covered from cribs to creams.

Professional Advice

Personal Shopping Appointments

babiesrus.ca

@babiesrus_canada

Curbside Pick-up

• Nausea and/or vomiting • Tender, swollen breasts • Increased urination

• Fatigue or even exhaustion (when you’re very tired for prolonged periods of time)

• Heartburn and/or constipation • Food cravings and aversions Some of these symptoms can be alleviated with simple remedies, but if you require prescription or over-the-counter medication to relieve heartburn, nausea or other symptoms, your doctor will be able to advise which medications are safe during pregnancy. (While pregnant, do not take any medication without consulting with your doctor or pharmacist.)

Also, if you’re able to rest when tired, you should—your body is going through a major transformation behind the scenes.

In addition to these physical signs of pregnancy, you may feel like you’re on an emotional rollercoaster—you’ll feel exhilaration, joy, anxiety and stress (sometimes, several of these in a single hour or day). Many expectant mothers find themselves worrying about the health of their baby, childbirth, finances or raising a child. This is totally normal, so be kind to yourself. However, if you’re experiencing intense anxiety, depression or mood swings, we recommend connecting with your care team for support.

MANAGING MORNING SICKNESS Feeling a little green? The term “morning sickness” is a misnomer because in reality, nausea and vomiting in pregnancy can be an issue at any point throughout the day. If you’re experiencing this common ailment, there are ways to minimize your symptoms.

•E at small, frequent meals rather than a few larger meals—an empty stomach can trigger or increase nausea in pregnancy.

•S tay hydrated.

•T ry sipping on smoothies. A cold drink sweetened with raspberries, strawberries and blueberries can help fight nausea and is generally easy to stomach.

•G et some rest. Nausea worsens when you are tired.

•G et plenty of fresh air.

• I dentify and avoid nausea triggers. such as specific foods or strong smells.

•C rackers to the rescue! Keep a sleeve of plain crackers, like saltines, on your nightstand and eat a couple before getting out of bed in the morning.

10 BABY & CHILD CARE ENCYCLOPEDIA

• Try natural remedies—eating ginger, sucking on sour candies, using peppermint aromatherapy or wearing a sea band all have varying degrees of success.

Pro tip: Keep snacks in your purse!

• Ask your doctor about anti-nausea medications that are approved for safe use in pregnancy. (Yes, you can take medicine for your nausea!) Be aware that most anti-nausea medications can take some time to work as they have a cumulative effect.

• Ask your doctor before taking any natural or herbal remedies.

If you are vomiting frequently and find that you don’t pee very often or your pee is very dark yellow and you cannot drink enough to correct this, please reach out to your doctor for support. You may be suffering from hyperemesis gravidarum (HG), a condition that affects approximately 1% of pregnant women and is characterized by severe nausea, vomiting and weight loss. Severe cases of HG can result in dehydration, hospitalization and other maternal complications, so it’s important to seek medical attention.

Fortunately, this condition is not an indication of issues with the baby.

THINGS TO AVOID DURING PREGNANCY —AND WHAT’S SAFE

Imagine this: You order a latte at your local cafe and hear a voice behind you chime in, “You can’t have coffee—you’re pregnant!”

If you haven’t heard this line yet, you likely will at some point in your pregnancy...but is it true? The answer is…sort of. While it’s best to limit caffeine during pregnancy, you don’t have to eliminate it completely. So yes, order that latte and enjoy every guilt-free sip; just don’t have three of them in one afternoon. Here’s a broader look at what’s safe in pregnancy and what you should avoid.

Safe

• Caffeine (in moderation)

•E xercise (we’ll get into this in more detail later on)

•D yeing your hair/eyebrows/eyelashes (avoid until after your first trimester and ensure proper ventilation; also, an organic or semi-permanent dye is best and be sure to do a skin test to avoid any allergic reactions)

•P ainting (avoid until after your first trimester, and only paint in well-ventilated spaces)

•A cupuncture or massage therapy (be sure to inform your practitioner about your pregnancy)

•S ex (unless instructed otherwise by your doctor)

Avoid • Smoking • Drinking alcohol CHAPTER 1: PRENATAL 101 11

• Cannabis

•E xcessive caffeine (stay under 200 to 300mg per day: one to two cups of coffee or two to four cups of caffeinated tea)

•E ating unpasteurized cheese, mould-ripened cheeses like brie, Camembert or blue, deli meats, liver or liver pate, undercooked eggs and raw meat, sushi and other dishes with raw fish or high mercury fish or seafood, undercooked ready meals or leftovers

•C leaning your cat’s litter box, gardening without gloves or visiting farms without livestock (this can lead to a dangerous condition called toxoplasmosis)

•U sing a hot tub (unless the water temperature is lower than 36 C) or sauna

•B reathing in mothballs or harsh chemical cleaning products

• Getting an x-ray • Using a tanning bed

• Tattoos and piercings

If you aren’t sure whether an activity or food is safe during pregnancy, please consult your OB-GYN or midwife.

Toxoplasmosis is an illness that can be transmitted by exposure to toxoplasma gondii, a parasite that is commonly found in cat feces.

While treatable in humans, toxoplasmosis can result in serious pregnancy complications, including physical disabilities, developmental delays or miscarriage.

NUTRITION, EXERCISE AND YOUR CHANGING BODY

Your body changes constantly throughout pregnancy, and this impacts every woman differently. You may feel strong, feminine and empowered, or you might not recognize yourself in the mirror. Whatever you’re feeling, it’s valid—so cut yourself some slack!

During pregnancy, it’s normal to experience stretch marks, varicose veins, pigmentation changes, blemishes and other less than desirable side effects. Moisturize daily to keep your skin well hydrated—this is helpful for reducing dry skin and minimizing blemishes. The turnover of skin cells is accelerated during pregnancy, so make sure you nourish your body to keep skin feeling its best. Coconut butter, shea butter and similar products may help minimize the appearance of stretch marks; however, stretch marks are often influenced by your genetics and 12 BABY & CHILD CARE ENCYCLOPEDIA

cannot necessarily be avoided. Varicose veins typically resolve without treatment three to six months after pregnancy.

Are You Really Eating for Two? Well, not exactly. A pregnant woman only needs about 300 extra calories a day (that’s about 80,000 calories over the course of a full-term pregnancy). We don’t recommend dieting or counting calories while pregnant, as this can be harmful—instead, focus on eating a healthy, balanced diet that represents all of the major food groups. Enjoy fresh fruits and vegetables, lean proteins, whole grains and healthy fats.

Choose your carbohydrates wisely! Balance white bread, potatoes, pasta and rice with increased amounts of colourful vegetables on your plate.

And yes, go ahead and treat yourself once in a while! Just be mindful of your sugar intake as gestational diabetes can become an issue.

Is Exercise Safe for Pregnancy?

Physical activity is also highly beneficial for pregnant women. Regular exercise can help you enjoy a physically healthy pregnancy, contribute to mental wellness and result in an easier delivery and postnatal recovery.

Walking, swimming and yoga are all safe, low-impact activities you can try or continue. Many gyms offer fitness classes tailored to pregnant women, from pilates to aerobics. If you’ve always been active, there’s no reason not to remain active while pregnant and continue with activities such as running, cycling or hiking. Avoid activities where you could fall, waisttwisting movements, jarring movements or rapid changes in direction, and contact sports. If you weren’t as active before your pregnancy, consult your healthcare provider before beginning a fitness regime.

Aim for a minimum of 30 minutes of physical activity each day, whether that’s a brisk walk or a spin class. Stop exercising if you begin feeling dizzy or lightheaded, have chest pain or heart palpitations, have sudden swelling in your hands/feet/ankles, or feel extremely hot or short of breath. Listen to your body, stay hydrated and don’t push yourself too hard.

Gestational diabetes refers to a case of diabetes that is first diagnosed during pregnancy. Like other forms of diabetes (type 2 and type 2), gestational diabetes negatively impacts your body’s ability to process glucose. This can result in high blood sugar, which affects both your own health and the health of your baby. Fortunately, gestational diabetes can often be managed through diet and typically resolves itself after pregnancy. Women who have had gestational diabetes are at higher risk of developing type 2 diabetes later in life and having newborns who may need medical care after birth to help them maintain safe glucose levels in their blood.

CHAPTER 1: PRENATAL 101 13

THE SECOND AND THIRD TRIMESTER

As you get further into your pregnancy, a number of questions may arise. Many of these queries can be categorized under things that start happening to your body and have you wondering, “Is this normal?” (More often than not, the answer is yes, and we’ve got tips to help you cope.)

Here are a few common issues in the second and third trimesters of pregnancy, and how to deal with them.

• Swollen Feet and Ankles Due to fluid retention, this is common and can be quite uncomfortable. Fortunately, there are ways to reduce the swelling. Elevate your feet whenever you can, wear supportive shoes and avoid bare feet, flip flops or high heels. Also, avoid sitting for long periods of time. If the swelling doesn’t ever abate, becomes painful or appears in one leg only, consult your healthcare provider immediately as this can be a sign of preeclampsia or a blood clot.

• Leg Cramps The cause of leg cramps are unknown but they are thought to be caused by the increased pressure of your growing uterus, possibly a deficiency in some nutrients and typically occur during your second trimester. To reduce the effect, try to include more calcium-, magnesium- and potassium-rich foods in your diet. Drink plenty of water, as dehydration could also be the cause. Avoid crossing your legs for extended periods of time, and exercise daily (if your doctor approves). Wiggle your toes and rotate your ankles when sitting for long periods of time, such as during a lengthy car ride. Avoid lying on your back, as this tends to decrease circulation in your legs and cause more cramps. For immediate relief, stretch the leg gently by straightening it, then flex your foot and pull your toes toward you.

Massage the cramp or apply heat.

• Bleeding Gums Swelling or bleeding gums may occur due to increased circulation and pregnancy hormones. This issue will typically go away once your baby has arrived. Brush and floss regularly and visit your dentist early in your pregnancy to maintain good oral health.

• Heartburn Nope, this isn’t just a first trimester thing. Heartburn can seem non-stop when you are expecting. As your uterus grows, it crowds your stomach, pushing stomach acids upwards. Your digestive system is also working slower than usual due to changing hormone levels. To manage heartburn, avoid any fried, spicy or super-rich foods, chocolate, mint, tomatoes and tomato sauce, citrus fruit, onion and carbonated drinks. Eat small, frequent meals throughout the day (this will also help with nausea).

Don’t eat too close to bedtime or before lying down. When resting, prop up your head and shoulders using extra pillows to prevent stomach acids from rising. Finally, ask your doctor or pharmacist which heartburn medications are safe during pregnancy—there are many safe options.

14 BABY & CHILD CARE ENCYCLOPEDIA

You may also experience increased skin temperature (being pregnant can make you feel like you’re in a sauna sometimes!), dry skin, increased urination due to pressure on your bladder, increased hair growth, new or continued constipation, increased vaginal discharge and hemorrhoids. Heavily pregnant women are also more prone to dizziness, nasal problems and urinary tract infections. Ahhh, the miracle of life! (Don’t worry, your baby is going to be really cute to make up for all of this.)

Braxton Hicks contractions are often referred to as “false labour” as they involve the tightening of your uterus and mimic early labour in sensation. While Braxton Hicks may be uncomfortable, they should not feel painful and will not cause your cervix to dilate the way labour contractions do. Not sure which you’re experiencing?

Try timing each episode. Braxton Hicks contractions do not follow a pattern, increase steadily in frequency or become longer in duration over time. They are felt in the belly only and can sometimes be alleviated by a change in position. Most importantly, Braxton Hicks are nothing to worry about—they’re a totally normal part of a healthy pregnancy.

DEBUNKING PREGNANCY MYTHS

You’ve probably heard a few old wives’ tales about pregnancy—you know, those time-honoured medical “facts” that are dutifully passed down from generation to generation. While people often mean well, this information isn’t always accurate. Here are a few common statements and the realities of each: IF YOU’RE CARRYING LOW, IT’S A GIRL. False: The shape of a woman’s body during pregnancy is the result of uterine and muscle tone, along with the baby’s position. Carrying “higher” or “lower” does not indicate the sex of the baby.

A HIGH HEART RATE MEASUREMENT ON A FETAL MONITOR MEANS YOUR BABY IS A GIRL. False: There is no medical research that indicates a baby with a high heart rate will be a girl. In fact, pretty much any nonanatomical prediction of sex is a myth!

SEX CAN BRING ON LABOUR. True: Sex really can help bring on baby.

Semen contains prostaglandins that can help soften your cervix and stimulate labour. However, it is not a surefire way of achieving labour and will only happen if your baby is ready to be born. Sex before 37 weeks is very safe and will not bring labour on. If you feel comfortable getting intimate with your partner, go for it!

CHAPTER 1: PRENATAL 101 15

NAVIGATING EMOTIONAL OVERLOAD

Pregnancy is an emotionally vulnerable time and even when things are going well, it can be mentally challenging. Many mothersto-be are fraught with pregnancy fears—miscarriage, fetal health complications, the pain of delivery itself or other concerns. They may be experiencing conflict with their partner, professional challenges, financial strain or other personal stresses. In some cases, everything appears “fine” on the surface, but they still feel overwhelmed with anxiety or emotion.

Women are sometimes hesitant to give voice to these feelings, particularly when they don’t want to seem as if they’re complaining or unprepared for motherhood. However, you don’t have to hide or downplay your emotions, or suffer in silence. It’s important to acknowledge that you have concerns and to speak to your healthcare team to get answers and support. It’s normal to have questions and doubts or feel overwhelmed. Talk to your partner, family and close friends or seek out a supportive group of other expectant mothers. Connect with a therapist if you think it may help. If you are experiencing significant anxiety, depression or feelings of self-harm, please seek help or contact your doctor immediately. Support is definitely available.

WHEN TO CALL YOUR DOCTOR

It can be hard to know what’s totally normal in pregnancy—especially if you’re a first-timer—and what’s worth a call to the doctor, and “go with your gut” only goes so far. The short answer is this: When in doubt, play it safe and call your OB-GYN or midwife for advice.

Do not ignore the following symptoms: • Severe cramping or abdominal pain • Vaginal bleeding or spotting • Sudden, intense headaches or blurred vision • Leaking fluid • Decrease in fetal movement in the second and third trimester • Seeing spots or “floaters” in your field of vision • Difficulty breathing or heart palpitations • A persistent itching in your hands, feet or all over your body These symptoms could be a sign of a serious medical emergency, so seek help from your healthcare team or local emergency department right away.

16 BABY & CHILD CARE ENCYCLOPEDIA

GETTING READY FOR BABY

As you reach the last few months of your pregnancy, you’ll begin to prepare for the big day. It’s best to prep relatively early, as some women will go into labour sooner than expected. Here are a few ways to get ready to welcome your new little one: Join a Prenatal Class Even if you feel confident and well-informed, a prenatal class can be helpful for both you and your partner. You’ll meet other pregnant women and expecting couples, learn breathing and relaxation techniques for delivery, discuss your pain management options and receive valuable information on baby care, growth and development, and postpartum maternal health. You may also consider a First Aid or infant CPR certification (some prenatal classes even include this as a component).

Research Maternity Leave It’s important to have a strong understanding of the time you’re entitled to take for maternity leave, as well as how much income you’ll have access to while away from work. Your partner should also look into their parental leave options in order to plan with you. You may want to start saving some money each month to compensate for any lost wages; some workplaces will top up your maternity leave pay for a period of time, but there is no requirement to do so and every employer has their own policy. Be sure to discuss your maternity leave with your boss and co-workers in order to plan a smooth transition, and establish your last working day and expected return date.

Find a Paediatrician Be sure to have a family doctor or paediatrician lined up to care for your little one before your due date. Your baby’s first visits will happen within the first days and weeks of their life, and you don’t want to be searching for a doctor while caring for a newborn.

Set Up a Nursery Your baby’s nursery might be an adorable room with all the bells and whistles or a simple crib next to your own bed—in those early days, all they need is a safe place to sleep. The rest is a matter of personal preference. You’ll just need the basics: a bassinet or crib, diapers and wipes, clothing and receiving blankets, a car seat and a stroller. If you plan on bottle feeding, whether breastmilk or formula, consider purchasing a breast pump as well as bottles and sterilizing equipment. You may want to purchase a gentle, scent-free laundry soap and baby toiletries such as shampoo, lotion and diaper cream. Other nice-to-have items include a baby carrier or wrap, a baby bathtub or seat, a play pen, a bouncy chair or other rocker, a high chair (for later on), books and infant toys.

Install a Car Seat You’ll want to properly install your car seat well before the baby arrives (they won’t let you leave the hospital without one in CHAPTER 1: PRENATAL 101 17

some areas). You can do this yourself by carefully following instructions or you can hire a professional to install the seat for you. Some community organizations offer free car seat clinics. Check with your local municipality, to learn about options in your region.

Consider Breastfeeding Fed is best and there’s no shame in formula feeding, but there are countless benefits to breastfeeding if you choose to go this route. The act of breastfeeding your child stimulates contractions after childbirth and helps your uterus return to its original size and position. It also helps with bonding and lowers your baby’s risk of allergies, asthma and other ailments. Breast milk is great for a baby’s immune system and gives them the nutrients they require as a newborn, an infant and beyond (incredibly, your breast milk changes as your baby ages to give them what they need). Breast milk is easy to digest, so breastfed babies typically have less colic and digestive issues. Breastfeeding also lowers the risk of cancers of the breast, ovaries and uterus. Plus, it’s an environmentally-friendly and affordable way to feed your child!

Prepare for the Big Day Don’t leave details to the last minute—when contractions hit, you’ll want everything in order. Pre-register at the hospital where you plan on delivering, if you can. Plan your route to the hospital (take traffic, unexpected weather and potential construction into consideration). Decide where you will be parking your vehicle and know which doors to enter when you arrive at the hospital. Pack your hospital bag and keep a copy of your birth plan on hand. If you are planning a home birth, you should still be aware of the quickest and easiest route to the hospital and have your hospital bag packed in case of emergency.

Make sure you have a full tank of gas, too!

Sleep When You Can Pregnancy can be exhausting, but having a newborn baby at home isn’t any less tiring—catch as many zzz’s as you need before your little one makes their appearance. If you can squeeze in an afternoon nap, go for it. If you find yourself exhausted by 8:00 p.m., go to bed. Your breasts may be tender to sleep on, but a soft bra may help. Cut back on drinking fluids in the late afternoon and evening to help eliminate frequent trips to the bathroom.

Have Sex In a straightforward pregnancy with no history of medical issues, intercourse can be a part of physical intimacy with your partner right up until your water breaks. Some women experience increased sexual appetite in pregnancy, while others have decreased interest.

Changes to the body, uncomfortable pregnancy symptoms and hormone levels often affect one’s degree of sexual interest. No matter what, these feelings are normal and you should do whatever works for you and your partner.

18 BABY & CHILD CARE ENCYCLOPEDIA

WHAT TO PACK IN YOUR HOSPITAL BAG

Getting ready for baby? It’s time to pack your bag and go! (Or, you know, let it sit by the door for a few weeks.) It’s a good idea to pack two bags, one for you and one for the baby, with enough for a two- to three-night stay.

Here’s what you need to bring to the hospital: Cell phone and charger Camera and batteries or charger, if you plan on using something other than your phone Comfortable, loose clothing and pajamas Comfortable underwear and socks Nursing bras Slippers and a robe Sanitary pads, nursing pads and nipple cream Clothes and blankets for your baby Newborn diapers and wipes Toothbrush and toothpaste Lip balm, face wash and other toiletries Your favourite pillow, blanket or other comfort items A refillable water bottle Healthy snacks (you’ll be hungry after labour - trust us!)

A notebook and pen Your purse and wallet If possible, stock your kitchen with easy-to-prepare foods before your baby arrives. Homemade frozen meals are a great way to plan ahead, if you have the energy to cook. This will make things a little easier on you when you arrive home. Otherwise, takeout is fine!

CHAPTER 1: PRENATAL 101 19

“

IN GIVING BIRTH TO OUR BABIES, WE MAY FIND THAT WE GIVE BIRTH TO NEW POSSIBILITIES WITHIN OURSELVES.

Myla and Jon Kabat-Zinn

t Firs s e e Th i nu t M Five

The F 24 irst Hours

Ba b y Ba s i c s

chapter 2

breastfeeding and the first three months feeding t s a Bre s Position

How t o Form ula Fe ed

You’ve experienced pregnancy and made it through labour and delivery (phew!). And now you’re finally here: Welcome to parenthood. We know you’ll be excited and emotional while you learn what it means to be a mother or father. This is an adventure like no other, and it starts now.

If you’ve just delivered in a hospital, your room will be bustling with doctors and nurses who will examine your newborn and get you prepped for what happens next. Procedures vary by hospital, but this will give you an idea of how your first minutes, hours and days will unfold. We’ll also give you the lowdown on everything you need to know about infants, and answer some common how-to questions.

THE FIRST FIVE MINUTES

Right after delivery, the doctors, midwives and nurses on the scene will suction Baby’s nose and mouth and your newborn will breathe on his or her own. (Yes, you’ll hear those first cries.) Your partner will be asked if they would like to cut the umbilical cord, and your baby’s Apgar score will be calculated. Baby is then measured, weighed and wiped clean. As long as they are maintaining a good body temperature, you can ask to hold them skin-to-skin and get some bonding time in.

The Apgar test (which stands for appearance, pulse, grimace, activity and respiration) is based on breathing, heart rate, colour, muscle tone and reflex response one minute after birth and again at five minutes.

If your newborn has a low score (the range is one to 10; the higher the score, the better), the test will be repeated every five minutes until the numbers come up. (Don’t let a low result scare you. It’s typical for scores to rise to normal levels pretty quickly.)

THE FIRST 24 HOURS

New moms around the world are used to keeping their wee ones with them post-birth, so don’t be surprised to learn that you’ll have your baby in your room with you, regardless of if you give birth at home or in the hospital. Besides being able to fawn over your new addition, bunking with your little one lets you get used to his or her cues. Your baby will continue to be monitored (pulse and abdomen checks, etc.) and things like head and chest circumference will be measured. You’re likely to encounter Baby’s first dirty diaper (that dark, tarry poop is called meconium), and you can pick up tips from your nurse or midwife on handling the umbilical cord stump and how to properly hold, burp, bathe and swaddle your baby.

If you have a boy and have chosen to have him circumcised, the nurse can also teach you how to care for the area. When you notice the baby’s 22 BABY & CHILD CARE ENCYCLOPEDIA

hunger cues (hands to mouth, turning their heads to look for food), you can ask for a bottle of formula or get help learning to breastfeed, if you choose to. If you opt for the latter, many hospitals have lactation consultants who can tell you everything you need to know about nursing, including what to expect, different ways to hold Baby, how to determine whether they’re getting enough, etc. (You’ll read more about breastfeeding later.)

If you’ve delivered vaginally in the hospital, you’ll likely be out of the hospital between 24 and 48 hours; if you’ve had a C-section, you’re looking at a two- to four-day stay. Either way, your baby will need to undergo a few tests prior to going home, including a check for jaundice (if babies have yellowish skin they’ll be placed in an isolette—also known as an incubator—under a special phototherapy light to help) and a hearing test. Babies will also be weighed (expect a dip in weight; don’t worry, they gain it back after a few days of eating) and their heels are pricked to screen for a variety of metabolic diseases. Have someone bring in your baby’s car seat before you’re discharged—nurses will want to see you have a safe one.

AT HOME

Feeling overwhelmed? Good news—we’ve all been there.

First of all, know that there’s help available after getting home from the hospital. If you used a midwife or hired a doula for your labour and delivery, they will check in to ensure you and the baby are doing well. Public health nurses are also a great option—they’ll come to your home to assist with breastfeeding and can field any other health-related questions you have about your recovery or Baby’s growth. If you have relatives or friends nearby who offer a hand, you might really appreciate having someone you trust around so you can shower or grab a nap. And if you’re not up for guests or don’t feel you need help, that’s fine too.

BABY BASICS

If you feel like you’re examining your kiddo 24/7, don’t worry. You’ll feel better when you realize that everything is “normal” when it comes to how your baby looks, moves, sounds, eats and sleeps.

BODY

Skin When they’re fresh out of the oven, most newborns are very red because they have a red blood count that is higher than an adult’s. Babies are born covered in a white “waterproofing” substance called vernix, especially under the arms, behind the ears and in the groin area. If you spot a skin rash, like tiny white spots on the nose, or acne, rest assured it’ll disappear soon. You might also notice birthmarks—sometimes they’re found CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 23

over the eyelids or at the back of the neck. These flat, pinkish-red spots— dubbed “stork bites” often become more noticeable when Baby cries.

They’ll also disappear.

Spots that look like bruises found just above the bum are called “Mongolian spots” and they’re caused by pigment in the deep layers of the skin.

If Baby was jaundiced in the hospital, it normally takes about four days before the skin loses its yellowish tinge. That said, babies who breastfeed can look yellow for several weeks, even though they’re thriving. You shouldn’t stop breastfeeding as long as your paediatrician has checked Baby and given the all clear. Jaundice will gradually disappear.

Fontanelle The fontanelle is the soft spot on your baby’s head—it’s the space between four of the growing head bones that’s covered by a tough inner skin and is well protected. Be mindful of it but don’t be afraid of gently washing your baby’s scalp.

Eyes Yup, babies spend a lot of time asleep. Still, when they do open those peepers, parents always want to know what colour their child’s eyes are. If your babe is born with brown eyes, he or she will always have brown eyes. But infants with blue eyes may not end up being blue-eyed down the road—it can actually take up to nine months before the final colour settles in.

If you notice your baby is waking up with runny eyes, little spots of yellow pus, or with his or her eyelids stuck together, it’s likely a blocked tear duct. It’s not serious and is easily treated with antibiotic drops. The tear duct often unblocks itself. (If it doesn’t, a doctor can fix it with a very simple procedure.)

Hair Some babies are born almost bald, while others are born with lots of locks. Don’t be surprised if some falls out soon after birth; it will grow back.

Genitals BABY GIRL: There may be some mucus coming from your baby’s vagina and even blood (pseudo-menstruation). This is caused by hormone changes and is nothing to worry about.

BABY BOY: Your baby’s testicles may seem quite big, but this is completely normal. The tip of the penis is covered by foreskin designed to protect the tip of the penis. Don’t try to pull it back. When your child is older, it will loosen and it will be easy to wash underneath the foreskin.

Some parents opt to circumcise their sons, and they do so for a variety of reasons, including religious or cultural. Circumcision is a surgical procedure to remove the layer of skin (foreskin) that covers the head (glans) of the penis and part of the shaft. While it’s not medically necessary—and routine circumcisions are not currently recommended 24 BABY & CHILD CARE ENCYCLOPEDIA

by the Canadian Paediatric Society—it’s up to parents whether or not they choose to go this route. Problems after circumcision are usually minor. It’s important to keep the area as clean as possible, changing the bandage every time you change his diaper. Use petroleum jelly to keep the bandage from sticking. Get in touch with your doctor if you see more than a few drops of blood during healing (about seven to 10 days), if swelling persists after 48 hours or if he develops a fever.

Movements Your baby will sleep most of the time, but you will notice them moving around—babies stretch, sometimes tremble and often make suckling and eye movements. When babies are awake, their arms and legs will move in various directions, and they’ll grasp hold of anything placed near their hands. When tummy time is introduced, babies’ heads move from side to side. (Just be aware that neck muscles aren’t strong, and the head should be supported when Baby is lifted.) When it comes to sounds, don’t be startled by Baby’s reactions to loud noises—he or she might jerk and cry. They’ll just need a cuddle to calm down.

Reflexes Your babe is born with reflexes and these may be the most physical developments you see for a few weeks. These reflexes include sucking (they have a natural instinct to suck); rooting (the hunt for food is on—watch how Baby’s head turns when the nipple is offered); startling (when babies hear a loud noise or see a quick movement, they throw their heads back and extend their arms and legs, then draw back in); and grasping (your baby’s hand will curl into a grasp when his or her palm is touched).

Breathing You’ll start to get used to Baby’s breathing, and his or her wee sniffles, sneezes, coughs and hiccups. It’s totally normal to hear breathing that sounds irregular—sometimes slow, sometimes fast. And when babies get upset—we’re talking really upset—they’ll cry super hard and their skin might even turn blue for a few seconds. There are also abnormal things to watch out for, including constant, fast breathing or hard breathing during feeding. Call your healthcare provider if Baby’s skin looks blue or pale, or if you hear noises like grunting with breathing or wheezing coming from their chest.

HEALTH AND BEHAVIOUR

Crying You know what they say—babies do nothing but eat, sleep, poop and cry. The last one is their way of telling you what they want or feel. Maybe they’re tired or hungry? Perhaps bored or uncomfortable?

Too hot or too cold? Soon you’ll learn what all the different cries mean.

The bottom line is a crying baby demands love and attention, so don’t CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 25

hesitate to cuddle—you can’t spoil an infant. Just give into letting them feel safe, comfortable and content.

Colic First off, babies cry. All babies. There’s no skipping over the crying part. But some babies cry more than others and for longer periods of time. Those who bawl for more than three hours a day, more than three days a week, are likely to have colic. Colic goes away on its own but it can happen to the healthiest of babies between about two to five weeks— there’s really no rhyme or reason why some get it and others don’t. What’s more, medical experts aren’t even sure what causes colic—it could be anything from a food sensitivity or a digestion issue to just getting used to life outside the womb.

Colicky babies can be difficult to soothe. They have high-pitched cries, their limbs often stiffen and their backs arch. While there’s no “cure” for colic, there are ways to help. First, make sure they have a clean diaper and they’re not hungry. Start burping more during feedings. If bottlefeeding, try other types of bottles to see if Baby swallows less air or ask your healthcare provider if you should switch formula. Breastfeeding moms might want to consider cutting certain things from their diets, including caffeine, dairy, eggs and soy. Some babies calm down when rocked or when parents pace, and some find a pacifier helps.

Remember, it’s not unusual to feel anxious, panicked or frustrated if your baby won’t stop crying. If you’re alone with the baby, bring in reinforcements—your best bet is to call a family member or friend to take care of the little one and relieve you for a bit. If you don’t have anyone nearby to help, put the baby back in his or her crib, close the door and take a break. (Deep breathing or listening to music can help.) Check on him or her after 10 minutes. If you feel like hurting yourself or the baby, call 911. Never shake a baby.

Sleep Patterns Expect lots of slumber in those early weeks. Babies usually sleep for a couple hours at a time and then wake to be fed. (If your baby isn’t waking on his or her own, wake to feed after three or four hours.) Babies generally don’t sleep through the night (six to eight hours at a time) until they’re about three months old or older.

A reminder from the Canadian Paediatric Society: Babies should be put to bed (naps and for the night) on their backs, without anything in the crib with them (that means no blankets, pillows or stuffies). Sudden Infant Death Syndrome (SIDS) is much less common in babies who sleep alone in their own crib on their backs.

Common Newborn Ailments We know you’ll be keeping a close eye on Baby, so you should definitely be aware of a few very common health issues. Some babies are born with blocked tear ducts, for instance, which 26 BABY & CHILD CARE ENCYCLOPEDIA

are completely harmless. You might notice tearing or mucus in the corner of the eye, but by 14 days tear ducts usually open without treatment or intervention. Cradle cap is another one that most babies suffer from— you’ll notice a red scalp with heavy flaking that’s caused by a buildup of oil. It doesn’t look nice, but it doesn’t hurt. Simply wash his or her head with Baby shampoo often and use a soft brush to remove scales. The most common ailment is arguably diaper rash—pretty much every baby gets it, thanks to the moisture buildup under the diaper. To avoid rashes, change diapers more often and use barrier cream on the bum. If rashes persist, let your paediatrician know.

BABY AND PARENTS

Bonding Babies form very strong emotional bonds from the get-go and nurturing this bonding during the first few weeks is key. When you respond quickly to comfort his or her crying, Baby will learn to depend on you. Comforting babies is the best way to love them. Other ways to foster that bond include speaking and singing quietly to Baby, trading facial expressions and making time for skin-to-skin contact.

Baby Blues Mom, let’s be frank: Your hormones are all over the place, you’re beyond tired, you’re likely a ball of worry and you’re dealing with learning to be a parent. It’s totally normal for things to feel a little, well, out of control right now. If you’re feeling down, take heart. Feeling blue is common and doesn’t always lead to postpartum depression. Ask family and friends for help. While you’re at it, try to ease some of the pressure you’ve likely put on yourself—the less rigid you are, the better.

If you feel like your worries or feelings of sadness are progressing, call your healthcare provider—they’ll put you in touch with someone who can help.

HOW-TOS TO KNOW

Many first-time parents haven’t had experience around infants, but they learn quickly by following some of these techniques.

Holding a Newborn You’ll want to ensure your hands are clean before picking up the baby. (Their immune systems are still developing, so using soap and water or hand sanitizer is a good idea.) Keep their head and neck supported and find a comfortable position—you’ll no doubt master cradle hold and shoulder hold within the first few days. Remember to always be gentle—it’s important not to shake the baby.

Comforting and Calming The physical closeness you have with your newborn will foster your emotional connection—that’s one reason why healthcare providers suggest skin-to-skin contact just after birth.

CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 27

If you choose to breastfeed, there’s a lot of time for the nursing parent to spend fostering physical closeness, but nursing isn’t the only way to bond with or soothe a baby. You and your partner can continue to practise skin-to-skin at home while feeding, bathing or cuddling.

Little ones also respond well to singing, cooing and talking in calm voices, and they love being rocked. Infant massage is also a popular way to calm and soothe, plus experts say it can help with growth and development. (There are plenty of how-to videos online.)

Swaddling Remember the nurse in the hospital handing you your perfectly packaged baby wrapped tightly in a blanket? It turns out babies love feeling like burritos—it keeps them warm, relaxed and feeling secure. Swaddling is an art and, thankfully, it’s easy to learn.

(There are lots of videos on proper swaddling online.) Just make sure not to overheat Baby, restrict leg movement or have the swaddle blanket above the chin.

Burping This one takes some practice. Most experts suggest burping babies often—the air that they swallow while eating can make them gassy and, yes, fussy. If you’re breastfeeding, burp when you switch breasts; if you’re bottle-feeding, burp every two or three ounces. There are a few ways to get the job done, but the one most parents seem to favour is done like this: Sit Baby on your lap. Support his or her head using one hand to cradle Baby’s chin (in the palm of your hand—ensure you’re cradling the chin and not the throat) and let the heel of your hand rest on his or her chest. Gently pat his or her back using your other hand.

If you don’t get a burp after a few minutes, try a different position (like over the shoulder) and keep Baby upright.

Diapering Don’t worry if you’ve never diapered a baby—you’re about to become a pro. Whether you choose cloth or disposable, prepare for the onslaught of poop-filled diapers; you’ll be changing dirty diapers about 10 times a day for the next while. Ensure everything you need is within reach—consider using a diaper caddy that you can easily move from room to room. When your baby’s diaper is wet or soiled, lay them down on their back and take off the diaper. Gently clean the tummy and genital area with wipes or a washcloth (girls should be wiped front to back), then apply diaper ointment, petroleum jelly or barrier cream. Diapers should fit snugly around Baby’s tummy, but not too tight. Don’t forget to wash your hands before and after.

Bathing Babies don’t need daily baths. In fact, most experts say it’s better for their skin to be bathed two or three times a week. Sponge baths are preferred for the first month (until the umbilical cord stump falls off and the belly button area heals). Using warm water, a soft washcloth and 28 BABY & CHILD CARE ENCYCLOPEDIA

unscented baby soap, gently clean Baby’s eyes, nose, ears and face.

When cleaning the rest of the body, make sure to wipe in and around those super-cute creases around the neck and don’t forget to gently wash Baby’s head. It goes without saying but bears repeating: Never leave your kiddo alone in the sink or tub.

Cord Care Right after Baby is born, the umbilical cord is white, soft and like jelly. It quickly becomes dry, hard and black, and it will fall off in a week or two. You can clean the area with cotton swabs and water.

Continue until the cord is dry and healed. If the cord has an odour, yellow discharge or redness on the nearby skin, let your paediatrician know as it might be infected.

FEEDING

New parents always ask how often babies should eat. The answer?

Whenever they’re hungry. You’ll find you’re feeding on demand—that means you’re giving your babe what they need when they need it. This goes for whether you’re nursing or bottle-feeding. When your kiddo shows you those cues (fingers in the mouth, sucking noises, rooting and crying), it’s time to feed. Newborns generally eat every one to three hours. Breastfed babies vary in timing based on your milk supply, speed of letdown, how hungry they are and how fast they fall asleep, while formula-fed babies will eat two or three ounces at a time. Monitoring how much they eat is easy when you’re bottle-feeding, but it can be difficult when nursing. As long as they are wetting six diapers and pooping a couple times a day, it’s all good. If you have questions about your baby’s feeding schedule or you’re concerned about growth, your healthcare provider can help.

Breastfeeding You’ve no doubt heard breastfeeding’s many merits. Yes, what you’ve heard is true: Babies who nurse are usually less likely to get colds and flus; they’re less likely to have allergies; breastmilk is easy to digest, so babies get fewer digestive problems; it’s environmentally friendly and it’s always fresh and the right temperature. It’s also good for Mom: It helps the uterus go back to its pre-pregnancy shape quicker; it’s super convenient (no getting bottles ready or packing them up!); and it’s much cheaper than formula. What’s more, the Canadian Pediatric Society recommends that all babies be exclusively breastfed for the first six months.

All that said, we’re not going to sugar coat it—some women find breastfeeding difficult, unnatural and uncomfortable. But don’t worry, there are lots of tips and tricks to make it easier, starting with how to hold your baby while nursing.

CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 29

Lightweight & Easy Storage

5 Soothing Sounds and 8 Classical Musics

Bluetooth® Enabled to stream music

Breastfeeding Positions SIDE-LYING POSITION: Mom lies on her side, stomach to stomach with

Baby. Mom can cradle Baby with her arm, resting on the side supporting her breast properly with the other hand. Using the arm holding the baby, move the baby close enough to guide the breast to the mouth.

CRADLE: Baby is positioned across Mom’s abdomen so that the baby’s whole body faces the mother’s body and the baby’s head is supported by the mother’s arm. Baby’s lower arm is tucked around Mom’s waist.

Baby’s ear, shoulder and hip should be in a straight line.

FOOTBALL: This works well for moms who’ve had a Caesarean birth or have flat or inverted nipples, as well as for small babies. Mom sits upright with pillows at her side. She supports the back of Baby’s neck with her hand, allowing Baby’s head to tilt back a little. Holding the breast, Mom tickles Baby’s lower lip and waits for the mouth to open.

CROSS-CRADLE: Mom sits upright with good back support and a pillow in front of her. Lie Baby across Mom’s body facing. She holds her breast with one hand and supports the back of Baby’s neck and shoulders with her other hand. This position works well for babies who have difficulty with latching.

What is Colostrum This is the liquid your baby gets for the first few days, before your milk comes in. It’s rich in vitamins, protein and substances that protect Baby from germs. This liquid gold is thicker than milk and more yellow in colour. Babies often only take a little at a time so feed frequently.

Putting Baby to Breast When your baby starts to suckle, a message is sent to your brain to produce milk. The message is then sent to your breasts and hormones are released. Deep in your breast tissue are bunches of tiny, milk-making cells. These cells start to make milk.

At this point, your baby’s face should be facing your breast (not the ceiling) and the body should be in line. If you look down, his or her ears, tips of the shoulder and hip bone will be in a straight line.

The neck shouldn’t be twisted. Baby’s nose should be across from your nipple. When you are holding your baby in a firm hold, you are in control. Baby is facing your breast with his or her mouth just below your nipple. Now you have to have patience and wait for a big mouth (yawns are always good here). Sometimes, touching Baby’s lips gently with your nipple may tease the mouth open. When you see that big mouth, very quickly push your baby onto your breast, aiming upwards and backwards at the roof of their mouth. Don’t try to push your 32 BABY & CHILD CARE ENCYCLOPEDIA

nipple into the mouth, it will just get stuck at the front of the mouth and that will be painful.

When it comes to latching, you should notice his or her mouth will be filled with breast tissue so there’s no space left in the mouth. Place your nipple as far at the back of Baby’s mouth as possible. When you do this, your baby will be able to reach the part of your breast where the milk is, behind the areola (the brown part that surrounds the nipple). If you feel pain, it means Baby’s jaws are together on your nipple. If this keeps happening, expect your nipple to get super sore and possibly even bleed. It’s not easy to see what a proper latch looks like, but you can feel it. Your baby’s nose will be touching your breast and the lower jaw will be under your areola. Some mothers worry their babies aren’t able to breathe with a face full of breast, but if they have trouble breathing, they instinctively come off the breast on their own. If there’s pain, just take Baby off and try latching again. When you’re ready to switch breasts or need to take Baby off, put your (clean) finger into the side of his or her mouth to break the suction.

Is Baby Feeding Well? Once Baby is latched on, you’ll see little jaw movements. As your milk lets down, you will see the jaw rhythm change to big open-and-close movements. The movement can be seen right up to the top of the ears. As Baby swallows, you’ll hear those swallowing, gulping noises—it may be a small sound, like a soft “ka” in the back of the throat.

Later, as the milk has more volume, you can hear swallowing much more easily. You’ll also notice a pattern of suckling when he or she is feeding— suck, swallow, suck, swallow, pause, repeat. This pattern continues throughout the feed. Infants usually come off the breast by themselves or fall asleep. Now’s the time to burp Baby and move to the second breast.

Length and Frequency of Feeding Moms used to be told to time their babies at the breast. We now know that babies will tell us when they’re ready to swap. Letting babies feed at the first breast for as long as they want allows them to get lots of that high-fat milk (hindmilk). Don’t worry if Baby doesn’t feed for long when on the second breast, or if he or she doesn’t want the second breast. Start with that side next time you feed.

Breastmilk is easily digested, and new babies have small tummies. They may want to feed every 90 minutes to three hours during the day, and every three to four hours at night. The pattern will change as the weeks go by. As the baby grows, they will take more milk and last longer between feeds. The best signs to look for that babies are getting enough milk are if they’re soaking six to eight diapers a day by the second week; if they’re doing at least one big poop a day; if they appear content between feeds; and if their clothes start getting a bit snug.

CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 33

Changes in Your Milk By about the third day of nursing, your milk changes. The milk that comes in has more water than colostrum, so your breasts will feel fuller. (Feeding frequently prevents engorgement, which helps prevent that super-full feeling.) Within about two weeks, your milk changes again into mature milk and continues changing to meet the baby’s needs while you are breastfeeding.

Baby’s Growth Spurts Babies seem to want to feed more often at about three weeks and six weeks, then again at three months and six months. If you notice your baby wanting to feed more often, or being fussy around these milestones, just feed more often. Your milk supply will catch up to the demand quickly.

Breast Pain Pain in your breast tissue is likely due to a blocked duct— the result of milk left in a duct. If you feel the painful area with your fingers, you may notice a lump. Warm compresses and massage should clear it. You’ll also want to check that your positioning and latch are good when nursing.

If you see redness in your breast and start having flu-like symptoms, call your healthcare provider or lactation consultant as you may have an infection known as mastitis. Pain felt deep in the breast during let down or after a feed is often due to the muscle lining of the ducts being stretched as the milk passes through. Again, try warm compresses; this pain often goes away as time goes by.

If you feel burning or stabbing pain in the nipple or breast, thrush is likely the culprit. You might also see small white spots in your baby’s mouth—that’s because thrush is passed from Baby to Mom and Mom to Baby. You’ll need to see your doctor and get treatment for your nipples, as well as treatment for the baby.

Engorgement Engorgement usually happens around the third day. It’s normal to feel a sense of fullness in your breasts as your milk increases in volume. (There’s also extra blood and other body fluids moving into the area that adds to the fullness.) The best thing you can do is feed your baby as much as possible when engorged.

If your breasts feel really full, it may be hard for your baby to latch onto the areola. If this is the case, you can express some milk in order to soften the area around your nipples. If you can’t put your baby to breast, use an electric pump to keep your breasts soft. Pump every two to three hours and save the breastmilk for your baby.

The truth is, some moms always feel engorged, no matter what they do. It’s not super fun when your breasts become rock hard. Consider using warm compresses and gentle massaging, as well as expressing.

34 BABY & CHILD CARE ENCYCLOPEDIA

Breastmilk Storage You can keep breastmilk in the fridge for up to five days. When storing milk for freezing, it will keep well in a freezer compartment in the fridge for two weeks; in a self-contained freezer unit for up to four months; and in a deep freeze at zero degrees for six months or longer. Don’t forget to label and date all milk.

Support While many women say breastfeeding feels totally natural, other moms report feeling the opposite—it doesn’t feel easy or “normal” for many of us. If you’re having a tough time and want to keep nursing, there are plenty of ways to get help. Many communities have a support network, so you can call your local health department, La Leche League or look for a lactation consultant online.

Bottle-Feeding Infant formula is a great alternative to breastmilk for babies—it’s nutritious and babies thrive on formula, growing nice and healthy. If this is the route you choose, you’ll find that all products with the words “infant formula” on the label provide enough nutrition for your baby—today they’re made to be as close to breastmilk as possible.

How to Formula Feed Bottle-feeding can give Mom just as much bonding time as nursing, and it can also let the other parent, grandparents, etc., have that special time too.

Hold Baby close, keeping his or her back and neck straight. Baby’s head should be tipped back slightly and held higher than her body so that formula doesn’t get into her inner ear when she swallows. Brush the nipple against his or her lips or cheeks. Hold the bottle on an angle so that the nipple is always full of milk and so that Baby doesn’t suck in air.

When everything is going well, Baby will suck and swallow easily without coughing, gagging or coming off the bottle to cry. If you see any of these behaviours, stop feeding and check the nipple—milk might be pouring out too quickly or too slowly. It’s totally normal for babies to spit up a little formula during or after a feeding. Burp after feeding.

How to Know When Your Baby Has Had Enough Formula Babies will let parents know when they’re done—they simply stop feeding when they’re full. Your babe has had enough when sucking slows, when they turn their heads away or when they fall asleep. In time you’ll learn your little one’s signs and you’ll be confident knowing they have eaten enough. Throw out any formula left in the bottle within one hour after the feeding begins and don’t reheat the milk.

Storing Formula Keep prepared bottles at the back of the fridge and use them within 24 hours. Open cans of powder should be used within one month, while refrigerated cans of liquid concentrate and ready-tofeed formula need to be used within 24 hours of opening. Do not freeze any kind of formula because it changes the fat content.

CHAPTER 2: BREASTFEEDING AND THE FIRST THREE MONTHS 35

“

SILENCE IS GOLDEN. UNLESS YOU HAVE A TODDLER, AND THEN IT’S SUSPICIOUS.

Unknown

Ta ntrum r e mp Ba sics Te

Introducing Sol ids

Ta lk

chapter 3

i ng

starting solids and the toddler years y Pott ng Tra ini

Wa l ki

ng

When you’re a new parent, life comes at you fast. The age-old saying about babies goes, “The only thing you can count on is change.” Just when you’ve mastered one routine or skill, they hit a growth spurt or learn something new and you’re trying to figure out how to adjust your approach to...well, everything from sleep to feeding. And we know you probably don’t want to think about potty training, but it’ll be here before you know it! Read on for expert advice on all things toddler.

INTRODUCING SOLIDS

Offering solids for the first time might be intimidating, especially with all of the variances between children and the different feeding options available. Babies don’t necessarily hit milestones at the exact same time as their peers, and some might not take to solids as eagerly as others.

Not to worry, Moms and Dads—we’re here to support and guide you every step of the way.

HOW DO I KNOW WHEN MY BABY IS READY FOR SOLIDS? Health Canada currently recommends waiting until your baby is around six months old before introducing solid food (this includes purees).

That said, some infants are ready earlier than others, with physical and behavioural indicators happening as early as four months old. Here are some signs to look for before offering those first bites.

Your baby can hold their head up and sit up in a high chair supported by the chair’s straps.

Your baby has lost the tongue-thrust reflex (they don’t instinctively push solid foods out of their mouth with their tongue).

Your baby is putting things in their mouth and attempting to chew on them.

Your baby has figured out how to pick things up with a raking or pincer grasp (this helps enable self-feeding efforts).

Your baby seems interested in food and may try to grab what other family members are eating.

If you aren’t sure whether or not your baby is ready for solids, ask your paediatrician or family doctor for advice.

Breastmilk, formula and solid foods aren’t the only nutritional element to be thinking about in that first year or two. Many doctors recommend a daily dose of vitamin D (the recommendation is 400 IU per day up to one year and 600 IU after one year).

38 BABY & CHILD CARE ENCYCLOPEDIA

HOW DO I START FEEDING SOLID FOODS TO MY BABY? Back in the day, it was normal to start with a homemade or store-bought puree that you spoon-fed to your child. You know those adorable photos of babies trying peas or carrots for the first time? That was the standard for decades, and it’s still a perfectly acceptable method for feeding your baby.

Another option is baby-led weaning. With this approach, parents offer small amounts of solid food that have been ripped up or cut into appropriate-sized pieces. This might mean slicing blueberries in half, shredding meat, scrambling some egg yolks or offering them a steamed piece of broccoli they can gnaw on. Both puree feeding and baby-led weaning methods have benefits, so it’s really just a matter of preference.

You can also try a combination of both feeding types and see what sticks!

WHAT ARE THE FIRST FOODS I SHOULD FEED MY BABY? According to Canadian medical recommendations, it’s good to start with ironrich foods such as meat, meat alternatives (eggs, tofu, legumes) and/or ironfortified cereals (though there are many iron-rich fruit and veggie options, too).

The next step is to expand the list of fruits and vegetables in your baby’s diet.

You can offer your baby a slice of ripe pear or avocado, some apple sauce, a steamed slice of carrot or pureed squash—there are plenty of great options!

Milk to drink is typically not recommended until nine months of age or older, and some babies won’t take well to cow’s milk until closer to one year of age (it can be hard on their still-developing gut and lead to gastrointestinal symptoms). If you start your baby on cow’s milk, use 3% (homogenized) as they need the higher fat content to keep up with their speedy growth and development. That said, yogurt or cheese can be offered earlier.

Juice is not recommended for babies due to the high sugar content.

Many babies will continue to breastfeed or bottle feed while enjoying solid foods. This is normal and a great way to ensure a healthy, wellrounded diet.

Worried About Food Allergies? If they run in the family or your child has been diagnosed with eczema or asthma, you can ask your doctor about specific strategies for introducing potential allergens. As general advice, you can offer foods containing common allergens (nuts, dairy, wheat, egg, shellfish, etc) as soon as your baby is successfully eating solid foods. In fact, early introduction to these foods may reduce the risk of an allergic reaction. If your child starts to show signs of distress, such as a rash, vomiting, skin discolouration, coughing or wheezing, swelling of the mouth or weakness, call 911. This is a medical emergency.

40 BABY & CHILD CARE ENCYCLOPEDIA

HOW TO PREPARE BABY’S FIRST FOODS

Making a homemade puree is fairly straightforward if you have the time, the energy and the right tools. However, there are also plenty of wonderful store-bought options to choose from. Do whatever works best for your family. There’s no need for added pressure or guilt!

When buying premade baby food from a store, read the label and look for whole ingredients. Avoid anything with salt, added sugars (including maple syrup and honey) or artificial preservatives. If you can’t pronounce it or don’t know what it is, you probably don’t want to feed it to your baby.

If you’re going the homemade route, simply cook and blend your fruit or vegetable of choice. Steaming, roasting and boiling are all good options, and a handheld immersion blender works just as well as a large one. If you’re aiming for a thicker puree with some texture (this works well with older babies who are transitioning from puree to firmer solid foods), you can even use a fork or a potato masher.

Once your baby has gotten used to different flavours and demonstrated no allergic reaction to certain foods, you can start to create blends. (Allergic reactions are sometimes delayed, so to be extra safe, you can wait two or three days between new foods to monitor your baby’s reaction.) Just stick with pure fruit and veggies in those early months—there’s no need for any added salt or sugar.

Later on, it may be fun to add subtle flavours to appeal to your baby’s tastebuds.

HOW TO INTRODUCE NEW FOODS TO YOUR BABY Your baby might not react with delight when they try new foods—and that’s okay! It’s perfectly normal for them to make faces or even spit it out. Not only are the flavours new, but compared to breast milk or formula, the textures are a whole new world. Don’t be discouraged— keep offering small, manageable bites. If they only eat a mouthful or get a small taste, that’s totally fine.

When first introducing solids, consider nursing your baby or feeding them a bottle before offering any additional food. This way, your baby won’t be hangry and get frustrated if the solids aren’t exactly what they were after. Let them fill up a bit first in order to enjoy solids at their own pace. You won’t need to do this forever—just until they start eating an adequate amount of solids at mealtimes.

You’ll want to keep mealtime positive and productive, so avoid tricks like “landing the spoon airplane” in your baby’s mouth if your CHAPTER 3: STARTING SOLIDS AND THE TODDLER YEARS 41

baby isn’t receptive. This could have the opposite effect and create a negative association. Instead, pay attention to your baby’s cues and end mealtime when they become uninterested, displeased with a new food or frustrated. Keep it low pressure, take it day by day and enjoy.

WALKING

Most babies will walk between nine and 18 months of age, but babies don’t just wake up one morning knowing how to put one foot in front of the other. It’s a process. They will likely begin by pulling themselves to standing, and then they will start “cruising” along furniture, with their hand on something solid to steady them. (This is when baby-proofing becomes especially important—any item your little one could pull on for support needs to be tip-proof or safely secured to the wall.) From cruising, your babe will begin to take tentative steps between pieces of furniture, before progressing to independent steps.

It’s common for toddlers to take a few weeks to master one skill in the walking process before moving on to the next one, so don’t be surprised if your baby cruises for a while (it will feel like forever as you watch with bated breath for those first steps!).

Tips for Encouraging Walking •C ARRY THEM A LITTLE LESS. If they never have any motivation to walk, because you’re handling all the travel from point A to point B for them, they will be less inclined to try standing and cruising.

• L ET THEM ROAM FREE (WITH SUPERVISION!). We’ve all been there, when you just need to prep dinner or answer an email, and the activity saucer is right there. But giving kiddos time to roam means encouraging curiosity and a desire to be on the move.

• TRY A PUSH TOY. Baby walkers are now illegal in Canada (so many injuries, plus there is evidence that they actually hinder walking progress) but a push toy is a great way for your babe to feel like they have support while navigating an open area.

• SKIP THE SHOES TO START. Babies use their toes to work out the mechanics of their movements in the early days of cruising and walking. Bare feet will allow them to figure out their balance a little better.

Worried About Your Late Walker? Kids move at their own pace—in all things, forever—so the best thing you can do is be patient, especially if they are showing introductory signs of mobility, such as crawling or pulling themselves to standing. Some kids reach this milestone later than others. If you’re anxious about it, however, mention your concern to your child’s doctor.

42 BABY & CHILD CARE ENCYCLOPEDIA

TALKING

Much like taking those first steps, kids will say their first words in their own time. That first sweet, intelligible word will likely show up between nine and 12 months, with a few more words to follow in the months after.

By 18 months, most kids have 15 to 20 words, and will put together twoword sentences by age two.

While babies will utter that first “Mama,” “Dada” or “no” (a toddler favourite!) when they’re ready, there are easy, everyday ways to encourage speech:

• Talk to them! It might seem like a no-brainer, but it really is a gamechanger for motivating kids to speak. From Day One, talk to them, with eye contact, and respond to their reactions. Reacting to a smile or giggle will actually encourage further communication.

• Talk to other people in front of them. Your child will pick up communication cues from watching you speak to other people.

• Read to your child as often as possible. Stop on each page to describe the pictures.

• Name objects, body parts and things you see in nature as often as you can by pointing to the item and saying the word out loud. This repetitive habit will eventually pay off.

When a Late Talker is Cause for Concern Consult your doctor if your toddler doesn’t say any words by 18 months, does not follow commands by 18 months, does not link words for short statements and sentences by 24 months, if speech is too unclear to understand or if there is no understanding or interest in what you say.

POTTY TRAINING

It’s a milestone parents both look forward to and dread in equal measure.

On one hand, no more diapers! On the other hand, teaching a tiny human to know their body’s cues and make it to the toilet in time is a daunting task (especially if kindergarten looms large!). Here’s the lowdown.

Most toddlers are able to learn to their bladder by age two to three and control their bowels by age three to four.

Night bladder control varies, but most children are completely dry all night by age four or five.

HOW TO START POTTY TRAINING For some kids, their toilet routine interest will be piqued early—often by observing parents or older siblings using the bathroom. For others, it may be a struggle to get them motivated to try the potty.

CHAPTER 3: STARTING SOLIDS AND THE TODDLER YEARS 43

But first things first: • Involve your child in choosing the potty. Whether you’re going to use a standalone potty or an attachment for the toilet, have your child go to the store with you to pick. You can also allow them to choose their own underwear, with a favourite character or a cute pattern, to encourage potty use. (You may want to use potty training diapers to start, but the new undies may provide much-needed motivation.)

• Have your child sit on the potty whenever they show an interest. Don’t pressure them to actually try to urinate or have a bowel movement at first. They can even sit on the potty clothed or in a diaper, as it is just to help them get used to the experience.

• When you feel they are ready, establish a routine where you take your child to try to use the potty a few times a day. Time these bathroom visits with when you know they may have to go—first thing in the morning, before nap, before bed.

• Applaud all attempts to use the bathroom, even if they don’t actually do anything. Kids get a kick out of big reactions from their parents and family members!

• When your child has a bowel movement in their diaper, take them to the bathroom and empty the contents of the diaper into the toilet.

This signals your little one to know where poop should go.

As your child gets the hang of toileting—don’t be surprised if they master either peeing or pooping in the potty first, but still have trouble with the other—develop a reward system to show how proud you are of their progress. Some experts recommend against using food as a reward, suggesting parents opt for stickers or other small items instead. Often, families have a special song or book that corresponds with potty success.

Do not tease or scold your potty training toddler—even when you’re frustrated. This can give kids anxiety about using the toilet and halt progress. In the same vein, expect regressions. Changes in routine— starting or changing daycares, holidays, road trips and vacations—can set kids back and may require a little retraining.

Toilet training may take longer than you expected, so be patient.

There will be accidents even after the toddler seems to have full control. Don’t hesitate to discuss the progress with your physician.

THE “TERRIBLE TWOS” AND THE “THREENAGE YEARS”

The fabled “terrible twos” have been the stuff of parenting folklore since...we’re guessing the beginning of time. Toddlers begin to assert their independence, which can lead to moments of frustration for 44 BABY & CHILD CARE ENCYCLOPEDIA

both children and parents. This is due in large part to the fact that small children are learning self-regulation while also figuring out that they have some autonomy and can make decisions about where they go and what they do. Queue tantrums and other shows of displeasure when they either can’t manage their emotions or are exerting their new-found ability to refuse.

For some kids, the “terrible twos” never really materialize only for this behaviour to make an appearance when the child turns three. Either way, it can be a difficult time to parent.

Tips for Handling the “Terrible Twos” or the “Threenage” Years: • BE CONSISTENT WITH THE SCHEDULE AND ROUTINE. When a toddler knows what to expect, transitions between activities are that much easier.

When you have to go off-schedule, be sure to give your child lots of advance warning when you need them to change activities or leave a location.

• KEEP THE NAP. It can be tempting to drop the afternoon nap, or to just assume they will nap in the car en route to a relative’s house or the grocery store, but overtired kids are that much harder to handle (all logic and reasoning go out the window!).

• STICK TO RULES AND DISCIPLINE. Gently reminding of rules and issuing the age-appropriate disciplinary action for misbehaviour will send the message to your child that their behaviour will not be tolerated.

• LEARN THE ART OF REDIRECTION. Sometimes your child won’t know that their behaviour is out of line, and they aren’t old enough to sit through a long explanation or lecture. Quickly and efficiently correct the behaviour but also redirect their attention to focus on something else.

Temper Tantrum Basics It can be extremely frustrating to try and defuse a child in the throes of a temper tantrum—especially if you’re in public. But guess what? You don’t have to. Sitting or standing near by, you can allow your child to have their temper tantrum without reacting.

Believe it or not, chances are the tantrum will be resolved more quickly than if you try to force the tantrum to end. Then, you can scoop your child up to offer some comfort before you address why the tantrum wasn’t acceptable. Trying to scold a tantruming child is fruitless and doesn’t help to avoid the behaviour in the future.

CHAPTER 3: STARTING SOLIDS AND THE TODDLER YEARS 45

“

BEDTIME: THE PERFECT MOMENT FOR KIDS TO NEED A SNACK, FOURTEEN STORIES, A TRIP TO THE BATHROOM, A NEW NIGHTLIGHT, LESS SCRATCHY PAJAMAS AND AN ANSWER TO THE MEANING OF LIFE.

Unknown

leep S rn ns wbo e atio d N n e comm e R Sleep Stru ctu re

Comm Sle on Infa nt ep Patte r ns

chapter 4

an age-by-age guide to sleep n Todd ler Commo s Sleep Problem

When S leep W Is s to a rra nt u the a Tr es Doc ip tor

Ask any parent and they’ll be quick to tell you that sleep—or lack thereof—is often on their minds. It’s one of the most common complaints paediatricians hear. In fact, research shows that up to 50% of children experience sleep struggles at some point (which means their parents do, too!).

That isn’t to say you’ll never sleep soundly again. Having an understanding of sleep as it pertains to your child at each stage of development will help everyone get more zzz’s.

So what are sleep struggles? They can range from a baby waking for a feeding to your toddler stalling at bedtime (come on, just *one* more story!), trouble falling asleep or waking in the night due to nightmares, sleep terrors and sleepwalking.

It’s a no-brainer that sleep is important. Without it, we’re all a bit on edge. But it’s especially important for kids to get the right amount of shuteye, as lack of sleep directly affects their psychological and physical development and can lead to a host of issues affecting their daily function, focus, productivity, mood and behaviour.

Most of the time the signs are obvious, but here are some easy indicators of a poor night’s sleep: • Irritability and moodiness

• Poor concentration, attention, memory and having a tough time making a decision

• Unplanned naps or needing naps past the age of four to five years

• Needing to be woken in the morning and constant prompts to get ready

• Daytime sleepiness

• Overactivity

• Difficulty managing daytime behaviours, which could include tantrums and acting aggressive

• Poor performance at school

But it goes beyond your child and their behaviour and temperament, because having Captain Crankypants on the loose can also cause a lot of emotional unrest at home. The lack of sleep can cause huge parental distress (and disturb your own sweet slumber), which can lead to less effective parenting and strained relationships. And it doesn’t take much—even losing 30 to 60 minutes of sleep can take a toll on your child’s behaviour.

SLEEP STRUCTURE

Children get most of their deep sleep in the first third of the night. Light sleep is the most common in the last half to last third of the night which is why young children sometimes wake more as the night goes on. Periods 48 BABY & CHILD CARE ENCYCLOPEDIA

You can’t always count on sheep.

Those nights when tummy aches keep toddlers awake, moms and dads know where to turn.

Formulated with Chamomile and flavoured with Linden Flower, Kolik Sweet Dreams combines the digestive relief of Kolik with a time-tested, herbal sleep aid in every loving spoonful.

When your bedtime routine isn’t enough, Kolik Sweet Dreams takes care of the rest.

What parents trust when children fuss.

Use as directed.

www.kolikgripewater.com

of REM dreaming sleep increase as the night progresses. This is why we often wake up in the morning and can remember dreaming.

It is normal for children to partially wake about two to six times a night.

RECOMMENDED SLEEP BY AGE CHILD’S AGE

NIGHT

DAY

TOTAL*

0 to 3 months

Unpredictable

Varies widely

14 to 17 hours

3 to 12 months

11 to 12 hours

2 to 4 hours

14 to 15 hours

1 to 2 years

11 to 12 hours

1 ½ to 3 hours

11 to 14 hours

3 to 5 years

10 to 13 hours

0 to 2 hours

10 to 13 hours

6 to 12 years

9 to 11 hours

No nap

9 to 11 hours

*Children may sleep longer at night after they drop their naps.

NEWBORN (0 TO 2 MONTHS)

As you may have noticed, newborns tend to sleep a lot. Often, newborns will fall asleep after just one to two hours of being awake, though every baby is different. Some newborns will sleep more and wake for a short period. Others may be more wakeful and fussy, only snoozing for short snippets. Your baby will let you know which they prefers, so follow their lead.

Your feeding style can sometimes dictate sleeping patterns. When babies are breastfed, they may sleep for two- to three-hour stretches.

Bottle-fed babies average around two to five hours.

Common Newborn Sleep Patterns In the first few weeks, you may notice irregular sleeping patterns. Your baby is still getting adjusted to day and night. Because of their small stomachs, babies wake up to eat every few hours. Every baby is different but generally at the three-month mark, your baby will display a more regular sleep-wake cycle, maybe even sleeping through the night.

What is Day/Night Reversal?

It’s not uncommon for some newborns to sleep more during the day than during the night. This backwards sleeping habit is called day/night reversal and it’s usually temporary. Here’s how to help them align to your schedule and teach them that nighttime is for sleeping:

• Keep the lights dim and noise to a minimum during nighttime feedings, and use a soft voice.

• Increase your baby’s wakeful time during the day by allowing background noise; wake your baby for feedings.

50 BABY & CHILD CARE ENCYCLOPEDIA

• Expose your baby to light during the day (especially early morning natural light) and normal levels of noise.

It’s not one-size-fits-all when it comes to helping your baby’s schedule realign. Some developmental issues can also impact sleep like:

• Sleep and wakeful periods are strongly linked to hunger and feelings of fullness.

• Babies with colic, gastroesophageal reflux or milk/formula intolerances may face more sleep challenges.

Newborn Sleep Recommendations Here are a few tips to keep in mind when it comes to safe sleep for your new addition.

• Maintain a safe sleep environment.

• Develop good sleep habits. That means when you notice that your baby is drowsy, place her in the crib and see if she can fall asleep on her own. Don’t worry if she isn’t able to every time; keep trying.

• Soothe your baby when she needs you. Many paediatricians give the green light for allowing the baby to practise falling asleep on their own around four to six months of age. Before three months of age, babies should not be left to cry when put down to sleep for more than a few minutes. If your baby needs help to fall asleep you can rock, hold or feed them. Some newborns are soothed by being held; others like white noise or motion.

• Place your baby on her back to sleep for all sleep periods.

INFANTS (3 TO 12 MONTHS)

Nighttime sleep starts to consolidate at two months of age with nine to 12 hours of sleep occurring at night. The number of naps your baby needs will usually decrease from four to two, generally by the age of one.

Common Infant Sleep Patterns Infants tend to be dependent on parental help to fall asleep. You may find they go down easiest when you rock or feed them.

By the age of three to six months, most babies are capable of sleeping through the night. However, many will continue to wake due to continued nighttime feeds and things like needing a pacifier or a diaper change.

Short naps or missed naps during the day are common in infancy and are often the result of not being able to fall asleep independently.

Developmental Issues That Can Affect Infant Sleep There are a few things that can cause or worsen sleep problems at this age including:

• Greater cognitive awareness due to baby becoming more alert CHAPTER 4: AN AGE-BY-AGE GUIDE TO SLEEP 51

T o ensure a safe sleep, refer to these guidelines from Health Canada.

• Young children should sleep on a firm flat surface in a crib or bassinet for all sleep periods (e.g. car seats and infant swings should not replace the crib for sleep).

• Always place your baby on his back to sleep when placing him in his crib until 12 months of age. The “back to sleep” position is associated with a reduced risk of SIDS. • Avoid all soft and non-breathable materials in a child’s crib.

• Do not let anyone smoke near your baby, including near where your baby sleeps or spends time.

Exposure to smoke is one of the greatest risk factors for SIDS. • Co-sleeping is not recommended due to evidence linking it with accidental smothering and suffocation by parents or bedding.

Co-sleepers that are attached to a bed are not recommended due to safety concerns.

• Room-sharing (e.g. having your baby sleep in a crib next to your bed) until six months of age is associated with a reduced risk of SIDS. •A void overheating your child.

Being overheated is a risk factor for SIDS and can lead to discomfort during sleep.

• Ensure your baby’s crib meets current Health Canada regulations.

• Keep the crib away from windows, curtains, blind cords, lamps, electrical plugs and extension cords; keep out of reach of small objects.

• There appears to be an association between pacifier use at bedtime and a reduced risk of SIDS. 52 BABY & CHILD CARE ENCYCLOPEDIA

• Reaching new motor milestones like rolling and standing • Separation anxiety Infant Sleep Recommendations To ensure your baby gets a safe and comfortable sleep, try the following: • Maintain a safe sleep environment.

• Establish a bedtime and nap routine by three months and be consistent with it. Doing this will act as a cue for your baby that sleep time is approaching.

Your routine might include a bath, massage, putting on pajamas, feeding, brushing teeth and singing a song. You can employ a condensed routine for naptime, too.

• Until 12 months of age, place your baby on her back to sleep.

Once a child can move to another position on her own, it’s not necessary to reposition her throughout the night and during naps (unless there is a medical reason to do so).

• Encourage selfsoothing. Falling asleep independently is a skill and it’s important for your little one to learn it.

TODDLERS (1 TO 3 YEARS)

Welcome to the toddler phase. A lot of key development happens at this stage. Most toddlers will drop their morning nap between 12 and 24 months of age. The remaining nap should be scheduled after lunch.

One daily nap will generally extend into the preschool years.

Common Toddler Sleep Problems Many toddlers continue to be dependent on their parents to fall asleep.

Here are a few other things you may notice with your toddler: • Bedtime resistance and stalling are common. Watch for repeated requests for various things to delay bedtime, also known as“curtain calls.”

• Parental presence at bedtime and following night wakings, including co-sleeping, is a common culprit for sleep problems in toddlers.

• Many toddlers experience night wakings, often related to not falling asleep independently and/or parental contact following night wakings.

Developmental Issues That Can Impact Toddler Sleep The following can hinder your toddler’s rest:

• Ability to climb out of the crib or get out of bed.

• Growing imagination can result in fears and/or nightmares.

• Increased independence can lead to bedtime resistance and stalling.

• Separation anxiety, which peaks between 10 and 18 months, can lead to bedtime problems and night wakings.

Toddler Sleep Recommendations Use these tips to help your toddler snooze like a champ:

• Ensure your toddler falls asleep independently.

• Set limits on bedtime behaviours. Limits should be clearly communicated, consistent and enforced. Include reasonable requests in a toddler’s bedtime routine (last drink of water, hug, trip to the potty).

• Make sure that too much sleep during the day or napping too late in the day are not contributing to bedtime problems.

• Encourage the use of a security object, like a small breathable “blankie.” Providing several blankies can ensure they will be able to find one during the night.

• Maintain a regular sleep schedule and bedtime routine. This will help provide structure and predictability to your toddler’s day.

• Ensure the bedroom environment is consistent and conducive to sleep. The optimal sleep environment includes little to no light or noise and a temperature on the “cool side of comfortable.”

• If your toddler is having nighttime anxiety or nightmares, reassure them they are safe and that you are nearby.

CHAPTER 4: AN AGE-BY-AGE GUIDE TO SLEEP 53

• Wait to transition from crib to bed. If there are no safety concerns, delay the transition to a bed until age three (or even a little beyond).

• Limit pacifier use and thumb-sucking to periods of sleep.

PRESCHOOLERS (3 TO 5 YEARS)

Your preschooler’s development is probably blowing your mind at this point.

Most are ready to stop napping between ages three and four (though some nap until age five). Because of this, bedtime may need to be a bit earlier.

Common Sleep Problems for Preschoolers Resisting bedtime and not falling asleep independently usually continue to occur in up to 50% of preschoolers. This is often due to poor sleep habits and limit-testing behaviours.

• When they wake at night, this is often related to not falling asleep independently.

• Nighttime fears and nightmares are common and often reflect normal cognitive development and the growing imagination.

• Sleep terrors and sleepwalking are common behaviours that often start during preschool years.

Development Issues that Can Impact Preschooler Sleep Your little one has an active imagination and is becoming more and more independent, which can sometimes make bedtime challenging.

• Transition from crib to bed.

• Language development can lead to more limit-testing behaviours.

• Greater comprehension allows the use of a reward system (reward chart, coins for a piggy bank) for appropriate sleep behaviours.

• Growing imagination can increase nighttime fears and/or nightmares.

Sleep Recommendations for Preschoolers All is not lost when bedtime feels like a negotiation strategy gone wrong.

Try these tips:

• Ensure your child has a regular bedtime and morning wake time.

If continued napping makes a bedtime of 8:30 p.m. difficult to achieve, limit the nap to one hour, or, if necessary, eliminate the nap and move bedtime earlier.

• Maintain a bedtime routine. Lights should be low. Snacks and screen time (if applicable) should be done prior to starting a bedtime routine.

• Ensure your preschooler’s bedroom environment is comfortable, dark, quiet and cool. Use of a low-level nightlight is fine.

• Use guard rails.

54 BABY & CHILD CARE ENCYCLOPEDIA

SCHOOL-AGED CHILDREN (6 TO 12 YEARS)

Sleep is likely coming a bit easier to everyone in your house, but there are still some challenges that come with sleep for bigger kids.

Common Sleep Problems for School-Aged Kids Children in this age set may have trouble falling asleep due to general anxiety, nighttime fears, consumption of caffeine or being overstimulated before bed.

Many school-aged kids go to bed too late and don’t get enough sleep.

Sleepwalking is most prevalent between the ages of four and eight. It can include sitting up in bed, mumbling, walking around the house and urinating in places other than the bathroom. Talk to your doctor if you’re concerned, but treatment isn’t usually required.

Developmental Issues That Can Impact Your School-Aged Kid’s Sleep Bedtime is probably getting a bit easier, but with that bright, active mind comes a new set of triggers, like anxiety and the allure of screen time.

• Increasing awareness and understanding of real-life dangers may lead to an increase in nighttime fears, nightmares or anxiety.

• Increasing interest in TV, tablets and other electronics can lead to a delayed bedtime and less overall sleep.

• Greater independence including less parental supervision over enforcing appropriate bedtimes.

Sleep Recommendations for School-Aged Kids There may be more of a tug-of-war regarding negotiations and a push to stay up due to ever-expanding independence but try to do the following:

• Maintain a relaxing bedtime routine. Avoid use of screens during a bedtime routine and encourage reading before lights out.

• Keep your child’s bedroom cool, quiet and dark. Keep TV, computers and gaming systems out of the bedroom.

• Avoid caffeinated products (including soda beverages and iced tea).

When Sleep Issues Warrant a Trip to the Doctor Chat with your paediatrician if your child displays any of the following:

• Has difficulty falling or staying asleep

• Snores, especially if the snoring is loud

• Has noisy breathing or pauses in breathing during sleep

• Grinds teeth during sleep

• Has frequent nighttime fears or nightmares

• Shows signs of being overtired during the day

• Complains of leg discomfort at bedtime (this is generally growing pains)

• Frequently moves legs while trying to fall asleep or during the night

• Has unusual night wakings including sleep terrors or sleepwalking CHAPTER 4: AN AGE-BY-AGE GUIDE TO SLEEP 55

“

KIDS DON’T REMEMBER WHAT YOU TRY TO TEACH THEM. THEY REMEMBER WHAT YOU ARE.

Jim Henson

Ti ps ng a i a nd l H er for ky Eat Pic

Ea sy Mea l Idea s

chapter 5

Hea l th Ha b y its

family nutrition Iron Deficiency

Requir Getting ed fro Nutrie m F ood nts s

Introduce nourishing meals at the family table at six months of age to help develop healthy eating habits for life.

The role food plays in your life will evolve and change as your family does. When our children are babies, we spend so much time worrying about their growth and nutrition—are they getting enough at the breast?

Is it okay to supplement with formula? When should they start solids?

What should we introduce first? (For all the answers on starting solid foods with your cuties, check out the Toddler Years chapter on page 36.)

But eventually, food can be a place where the family comes together.

Once your kids are joining you at the table, mealtimes have the potential to bring joy, tradition and connection. Some of you might think, “Yes! I’ve waited forever for this!” but for others, especially those of you who didn’t grow up sitting around the table together, it might be a foreign concept.

That’s okay. Either way, you can start whatever food habits and traditions you want with your own family.

HEALTHY HABITS: START AS YOU MEAN TO GO ON

Canada’s Food Guide is an excellent place to start when it comes to encouraging good food choices. If you’re picturing the Food Guide of the ‘80s, with the four food groups pie chart, it has come a long way. When it first showed up on the scene in 1942, there were six categories, which were whittled down to four and then eventually revamped to an “eat the rainbow” concept in the early 1990s. But in January 2019, another update introduced the idea of the balanced plate.

So what does this mean? If you can picture a dinner plate, the current Canada’s Food Guide recommendations suggest aiming for filling half the plate with fruits and vegetables, a quarter with protein and a quarter with whole grain food choices. It’s that simple.

Of course not all foods are created equal, even if they fit into the balanced plate approach, so there are a few other things to consider: • Limit processed foods. This doesn’t mean you can’t keep an emergency box of chicken fingers in the freezer but cooking from base ingredients is always the healthier option. (Even if you make the exact same meal from scratch that you’d pick up at the store as a convenience food, the homemade option will be healthier.)

• Look for foods with healthier fats. You don’t need to avoid all fat— you need fat in your diet. Vitamins A, D, E and K are fat soluble and require fat to be absorbed. Just try to choose foods with healthy, unsaturated fats (avocado, fish, nuts) as opposed to saturated fats (chocolate, butter, fattier meats like bacon).

• Drink water. There’s no better choice. Even just replacing your family’s sugary drink or pop habit with water will go a long way to improving your health. (A note on milk: Many people think drinking milk is the only way to get calcium, but there are many excellent WWW.THINKBEEF.CA

food sources for this mineral. While you don’t need to completely eliminate milk by any means, check out unlockfood.ca for other sources of calcium.)

You can use the balanced eating approach with your kids from day one.

Even toddlers will understand the plate visual, and when they go to school, dividing their lunch containers in the same way will allow them to transfer their knowledge about healthy eating to their everyday habits.

(The hope is, teaching them early and reinforcing the message often will help these guidelines stick as kids grow into adulthood.)

The newest update of Canada’s Food Guide also includes non-food related messages that can be combined with the balanced plate approach to help kids learn healthy habits: • Be mindful while eating. Taking time to enjoy food and listen to your body’s cues will make eating an enjoyable part of the day, rather than just grabbing something quickly to fuel your body.

• Cook more often (and get your family involved!). Not everyone loves cooking but coming together to make family favourites will go a long way to improving your outlook on being in the kitchen.

• Eat with others. There are so many studies that suggest just sitting down to eat together is a practice that will help improve eating habits (as well as relationships!) without much other effort at all. This can be difficult for families with busy schedules, but even if you have to divide the family into a couple of sittings to fit with the week’s activities, eating with one or two others is better than eating alone.

TIPS FOR HANDLING A PICKY EATER

It’s not uncommon to find a fussy eater (or two or three!) in a family unit, and that can make meal planning and mealtimes difficult. But all is not lost. Read on for tips and tricks for how to handle a picky eater.

• Schedule meals and snacks so that when mealtime rolls around, your kids are hungry.

• Offer a wide variety of foods to your child, but without pressuring them to eat all the food, or even to take a bite. Offer foods more than once, too. It can take 15 to 20 exposures to a taste for a child to build their taste buds for a flavour.

CHAPTER 5: FAMILY NUTRITION 59

• Presentation counts. A lot of kids don’t like different foods touching each other, so you can put them separately on a plate. Or change how the food is served. With zucchini, for example, you can offer it raw, cooked, grated, cut into sticks or baked into breads or muffins.

Tell them the veggie is there, though. Hiding veggies isn’t the best way to get kids used to integrating them into their diets.

• Involve your kids as much as possible to broaden their tastes. At the grocery store, have your child pick out a new fruit or vegetable each week, and invite them into the kitchen to help prepare meals.

• Relax and leave the focus on food behind. Make meals a positive experience, a time to connect, discuss the day and not worry so much about the food.

GETTING HELP: FOOD SHOULDN’T BE A BATTLE

There may come a point where mealtimes become too much of a stressor, wearing on kids, parents and the family dynamic. This may mean you need to seek out professional help. Take a look in your area for clinicians who offer mealtime coaching as a service. This is sometimes a registered therapist and other times, it’s a registered dietitian. The idea is, they come to your home and work with your family on the relationship each family member has with mealtimes. It’s not about the food as much as it is about making the experience a positive one, so the coach will help to identify the issues and triggers and work with families to devise solutions and strategies to ease the stress. Some coaches also offer mealplanning and pantry or fridge overhauling as part of the service.

ADDRESSING IRON DEFICIENCY

Many people—both kids and adults—don’t get enough iron in their diets, which can lead to a number of unhappy health concerns (everything from extreme fatigue and weakness, to chest pain or heart palpitations in severe cases). The body absorbs two to three times more iron from animal sources, like lean beef, chicken and turkey, but plant sources like beans and lentils can also help. Children from six months on are often at risk for iron deficiency (which is why parents are advised to start the introduction of solid foods with iron-rich options); this is such a concern that a recent study from the Food Safety Authority of Ireland recommends 30 grams of lean red meat three times a week for children ages one through five. Check out our list of iron-rich foods when you’re thinking through your meals for the week, to ensure your brood is getting what they need.

There are also foods that block iron absorption, like milk and other high-calcium sources, as well as certain plant-based sources. Consider having these between meals for optimal iron absorption.

WWW.THINKBEEF.CA

GETTING REQUIRED NUTRIENTS FROM FOODS

Experts agree that getting the nutrients your body needs from your diet, rather than supplements, is best for absorption. Eating a diverse diet will go a long way to making sure you and your family are getting what everyone needs.

Here are some specific vitamins and minerals and the food items you can incorporate to make sure your diet is coming through for you: Calcium • Plain yogurt • Cheese • Milk • Fish and seafood with bones • Collard greens Potassium • Potatoes • Beans • Tomatoes and tomato-based foods • Yogurt • Bananas • Peaches • Cantaloupe

• Honeydew melon • Fish Magnesium • Pumpkin • Spinach • Artichokes • Beans • Tofu • Nuts Vitamin A • Sweet potatoes • Pumpkin • Carrots • Spinach • Turnip greens • Cantaloupe

Vitamin C • Guava • Oranges • Kiwi • Strawberries • Cantaloupe • Papaya • Pineapple • Mango • Red and green peppers • Brussels sprouts • Sweet potatoes • Cauliflower • Tomatoes and tomato-based foods

Vitamin E • Nuts and seeds • Turnip greens • Peanut butter • Spinach • Avocado Iron • Lean beef • Chicken • Turkey • Pork • Liver • Lamb • Tofu • Lentils • Beans • Whole grain and enriched bread

Eat-More-Veggies Tip

Consider growing a small container or patio garden. It’s a good way to get kids interested in food. If they plant the food and watch it grow, they’re more likely to want to try it.

CONSIDERING PLANT-BASED

A plant-forward diet is about including more plant-based foods in your everyday eating. While vegetarians (those who consume dairy products and/or eggs) or vegans (those who eat no animal products at all) would be included in this eating style, plant-forward eating doesn’t mean you need to shun meat entirely. It’s about filling your plate with more whole plant foods like whole grains, fruits, veggies, pulses, nuts and seeds.

CHAPTER 5: FAMILY NUTRITION 61

FIRST FOOD MATTERS: IRON & INFANT NEEDS After starting off with breast milk or formula, you’ll be thinking about the introduction of solid foods at about 6 months of age. Gone are the days of starting with pablum from a box – now, it’s all about starting off with a variety of wholesome, basic foods that provide the protein, vitamins and minerals your child needs.

Iron is highlighted by Health Canada1 and researchers2 as a micronutrient of signicance as it is critical to a child’s physical, neurological and motor skill development. And since baby’s iron stores at birth are diminished at about 6 months, rst foods should be iron-rich.

DID YOU KNOW? • Iron is critical during pregnancy – healthy fetal development depends on it, and a lack of iron can cause complications for expectant moms and their newborn. (If a pregnant woman is craving a steak, she should get one!)

• Adding meat to a meal helps our bodies absorb 150 x more iron from plant-based food sources • Between seven and 12 months of age, infants require 40% more iron than a grown man Here’s what the experts say When it comes to rst foods, many parents default to fruit or vegetables – however, Health Canada, Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada all agree that iron-rich meats are an ideal introductory food for infants starting at six months of age.

Food Sources of Iron: mg Iron Per Serving Beef, liver, pan-fried Beef, composite cuts Spinach, raw Cereal, hot, cream of wheat, regular, prepared Black beans Nuts, almonds, dried, unblanched, unroasted Eggs, chicken, whole, hard-cooked, boiled in shell Tofu, regular, rm or extra rm, raw Chicken, broiler, dark meat, roasted Pork, loin, tenderloin, lean, roasted Turkey, all classes, dark meat only, roasted • Animal meat is a combination of heme and non-heme iron.

• Eggs are non-heme.

• Plant foods are non-heme only.*

0 1

2

3

4

5

6

7

Nutrient values obtained from Health Canada, Canadian Nutrient File, 2015 version. Portion sizes determined from Health Canada’s 2016 Table of Reference Amounts for Food. Based on Iron Daily Value – 18mg. *https://hemochromatosishelp.com/, Prenatal Nutrition Guidelines for Health Professionals, Iron. 2009, Health Canada.

Spinach, fortied-cereals, eggs, nuts and beans, all have some iron, but beef tops the list. Not only is lean beef an excellent source of protein, the type of iron found in meat (heme-iron) is better absorbed by infants than iron from plant-based foods. Beef provides more easy-to-access iron for our bodies than turkey, chicken, pork, lamb, sh or any plant-based foods. A child has high iron needs but tummies are small, so every bite counts. Choosing foods that are nutrient-dense matters.

Baby meals made easy When it comes to bringing baby to the table, we’re not talking about going from the breast or bottle to a t-bone! But it’s not complicated to adapt your family’s favourite iron-rich meal to your infant.

Start off at six months of age by offering a purée of fully cooked ground beef or well-cooked roast. As your child gets older (nine months+) try introducing shredded or roughly chopped cuts of beef for nger food independence! When planning meals for your infant, try to include 2 to 3 iron-rich meals per day from a variety of foods. Introducing your child to a variety of tastes, textures and avours from a young age is a great way to set the foundation for healthy eating habits that last a lifetime. A balanced diet that includes fresh fruits and vegetables, whole grains, dairy and protein foods is ideal, and iron is of critical importance in those early years.

By preparing meals with baby in mind, you’ll all eat better!

JUST SCAN FOR THE RECIPE!

For more resources and grown-up/baby adapted recipes for the whole family, visit ThinkBeef.ca/nutrition/beef-for-babies.

Health Canada, Nutrition for Health Term Infants: Recommendations from Six to 24 Months, https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-terminfants-recommendations-birth-six-months/6-24-months.html 2 Iron deciency in pregnancy – Expert Review, Georgieff MK. Iron deciency in pregnancy. Am J Obstet Gynecol.

2020;S0002-9378(20)30328-8. doi:10.1016/j.ajog.2020.03.006 Link to access article: https://thinkbeef.ca/iron-duringpregnancy 1

These all offer an array of health benefits as they’re packed with a wide assortment of much-needed nutrients. They also provide an arsenal of weapons against ailments such as high blood pressure and type 2 diabetes, both of which are now affecting younger age groups—even some older children. Fibre, potassium and various phytochemicals are just a few disease-fighters found in these foods.

Vegetarian and vegan diets can be low in some essential nutrients, like iron and vitamin B12. Ask your doctor for a referral to a dietitian to make sure you’re covering all the bases for your growing kiddos.

EASY MEAL IDEAS

Most families have the best intentions when it comes to meal planning but it’s easy to find yourself in the weeds when life gets busy. Families also easily get into food ruts, where they make the same things over and over again, to the point where no one is excited to see the meal served again.

Fear not—there are a few easy ways to combat meal planning fatigue and dish boredom (and none of them involve spending hours combing Pinterest).

• Have a loose meal plan and make sure your fridge, freezer and pantry can accommodate. If your kitchen is always stocked with staples, you’ll have an idea of possible meals week over week. You can also take the “stake in the ground” approach and know exactly what’s for dinner a couple of nights a week, while letting the rest be fluid depending on how work, school and extracurriculars unfold.

• Plan for fun. Give your family something to look forward to, whether it’s Taco Tuesday or Pizza Friday. It makes at least one meal a no-brainer, and everyone is excited to come to the table.

• Build a list of family favourites. Aim to have at least ten items that you know everyone will eat (even if they only like one part of the meal!). Then go one better—brainstorm ways you can adjust the recipes to make them a little different but still palpable to the gang.

For example—does everyone love your mac and cheese recipe?

Switch up the types of cheese or consider adding veggies. Or, if stir fry is a meal planning staple, change up the protein or the sauce.

For very picky eaters, keep at least one element the same so you know there is something they will eat.

• Embrace the picnic supper. Set out plates of cheese, olives, grapes, berries, crudités, cold roasted chicken, deli meats… Everyone makes their plates to their liking! Then you know everyone has something they like from an variety of healthy options.

WWW.THINKBEEF.CA

Go Tech-Free at the Dinner Table Connection is hard when distractions are abundant. By insisting that phones and screens are turned off during meals (at least a couple of times a week!), you’re way more likely to have quality interactions with your family members.

PARENTSCANADA RECIPE FAVOURITES

If you’re looking for a little inspiration, head on over to parentscanada.com and check out our bank of recipes for everything from snacks and school lunches, to easy weeknight dinners that come together in snap. Some of our favourites include the following:

• Baked Fish and Chips

• Blueberry Oatmeal Muffins

• Broccolini Frittata with Crispy Potato Crust

• Fudgy Beet Brownies

• Gluten-free Chocolate Chip Cookies

• Kale Chips

• Muffaletta

• Olive Oil and Maple Granola

• Puffed Apple Pancake

• Roasted Chickpeas

• Sloppy Joes

• Spaghetti Squash and Meatballs

CHAPTER 5: FAMILY NUTRITION 65

“

LISTEN EARNESTLY TO ANYTHING YOUR CHILDREN WANT TO TELL YOU, NO MATTER WHAT. IF YOU DON’T LISTEN EAGERLY TO THE LITTLE STUFF WHEN THEY ARE LITTLE, THEY WON’T TELL YOU THE BIG STUFF WHEN THEY ARE BIG. BECAUSE, TO THEM, IT HAS ALWAYS BEEN BIG STUFF.

Catherine M. Wallace

g ryin r o y W xiet n A and

Sadn es Dep s a nd ressio n

Eating Di s o r d e rs

chapter 6

kids and mental health ression Agg er a nd Ang

Socia l Anxie ty

Thinking back to when you were a kid, children’s mental health likely wasn’t top of mind. It was rarely covered in books offering parenting advice. And it’s a shame—it meant a generation of parents might not have known just how important psychological well-being is to a child’s development. They probably had no idea how prevalent mental health issues were in children. Today, about 1.2 million kids and youth across Canada are affected by mental illness. And, according to the Mental Health Commission of Canada, less than 20% of these kids will receive the appropriate treatment.

Here’s the good news: Mental health issues and illnesses in children are no longer the taboo topics they were decades ago. Instead, we know kids’ brains, emotions and behaviours are just as important as what’s happening with the rest of their development.

COMMON MENTAL HEALTH CONCERNS

There are many different types of mental health concerns, but we’ve included expert information about some of the more common issues below. If you’re looking for help relating to self-harm, bipolar disorder, obsessive compulsive disorder, a specific brain disorder or substance abuse in youth, Toronto’s Hospital for Sick Children’s About Kids Health website has trusted information. Also, we’ve listed the more common symptoms and some ways parents can help their child, but if you’re concerned about any mental health issue below, speak to your child’s healthcare provider.

WORRYING AND ANXIETY

Here’s the thing: Everyone worries, even children. The Hospital for Sick Children in Toronto says anxiety disorders are the most common mental health disorder in kids, affecting 10 to 20% of children. Experts agree that not all worrying is a negative thing—anxiety can happen when our bodies and brains are trying to protect us from some type of physical or emotional danger. So it makes sense, then, that many kids are anxious about learning to ride a two-wheeler or jumping into a swimming pool. But, the problems can start when worrying takes over thoughts and interferes with the ability to live happily. When a kid’s worries start to take over their thoughts and actions, or when they stop doing things because of how big their worries are, they can become preoccupied and may not cope well with their anxiety. In these cases, anxiety can be more disruptive than helpful.

Anxiety occurs when a child is experiencing worry about everyday issues such as academic success, friendships, fitting in, health, their parents, future events and things going on in the world, for example. If they become fixated on these issues, worrying often becomes uncontrollable.

68 BABY & CHILD CARE ENCYCLOPEDIA

SYMPTOMS Physical symptoms are the most common complaint when a child has anxiety—you’ll likely hear about stomachaches, headaches or muscle pain. Sleep can be disturbed, and you might notice withdrawal from activities and other people.

HOW TO HELP There are a variety of ways to help anxious children.

Here are a few techniques to try: Exposure This form of cognitive behavioural therapy allows parents to help their children develop a tolerance to whatever’s causing stress by practising how to manage when they’re anxious. For example, kids who get worried or scared when around dogs can start by drawing pictures of dogs, looking at photos, seeing dogs in crates, being in the same room as a dog and finally petting the dog. Each stage can take as long as the child needs.

Retelling Experiences You can help your child see stressful situations from a more positive perspective. For example, a child may have anxiety about going to school alone. You might retell the story of the child’s day by acknowledging the worry but focusing on and highlighting the child’s successes, like making a new friend or going to the library to choose a new book. This can help children build confidence in their ability to overcome their anxiety.

Mindfulness Practising mindfulness with kids can help them learn how to manage their worries and anxiety. There are lots of mindfulness activities.

Try one or more of these: breathing exercises; guided body scans or imagery (you can find videos online); mindful colouring; and mindful eating. Helping children learn how to focus on the present moment and let go of their worries can be very powerful and can help them build confidence in their ability to conquer their worries at any age.

SOCIAL ANXIETY

Maybe your little one is hesitant to make new friends or doesn’t like play dates, or maybe they won’t leave your side at friends’ birthday parties.

Kids who suffer from social anxiety are so shy or fearful of social situations that it becomes difficult to talk or interact with people, to the point where it causes problems at school or in other social situations. It’s normal, and even healthy, for kids to be shy from time to time—they should be cautious around strangers or people they don’t feel comfortable with. That said, shyness becomes a problem when it impedes functioning—when kids can’t go to school, camp, play team sports, parties, etc. These kids might also have fears of being judged or criticized, which can exacerbate their symptoms of stress and anxiety.

CHAPTER 6: KIDS AND MENTAL HEALTH 69

SYMPTOMS Children often show physical symptoms, including stomachaches, headaches and faster breathing, when they’re about to enter into a social setting, such as during the morning drop-off and extracurricular activities. For example, your child might really enjoy gymnastics and is looking forward to attending a friend’s birthday party at a gym. They were excited to go last week, but on the day of the party, they suddenly complain of unexplainable pains and beg you not to go. If they are experiencing anxiety, these types of situations will occur on a regular basis, so you can track the behaviour to see if it’s becoming a pattern.

HOW TO HELP Practise separation and reunion traditions: Find a special way to say goodbye to your child in the morning before school and a way to greet her after school as a way of easing her worries. Some parents say special handshakes and hugs work great. Do it daily so it becomes a routine they count on.

Find a Transition Object Sending kids to school (or to a friend’s house, etc.) with something they can hold onto can work wonders. A stress ball, a rubber band in their pocket to tug on, a picture, a flashcard with a calming phrase or any other object can be used. Try to choose something that can fit into a pocket and is meaningful. Just give the teacher or supervising adult a heads up that they should use this special item if they seem upset or stressed.

Model Positive Self-talk Come up with a short phrase your child can repeat in their mind, like “I always try my best.” Leaving notes in their lunchboxes or overnight bags can also help. The aim is to give children the message that they’re good enough and that you’re proud of them.

This will help them feel better, even at times when they’re struggling.

SADNESS AND DEPRESSION

Take it from parents who’ve been there: It’s pretty upsetting to see a sad or depressed child. While sadness is an emotion everyone has, persistent melancholy is a warning—it can interfere with routines, interests and participation in activities, and it may be a sign of depression. Depression in children is often linked to significant life changes, such as a death in the family, moving to a new town or other significant family events like a divorce.

Genetic factors or a family history of depression can also affect them.

SYMPTOMS Parents who have kids experiencing depression may observe behavioural changes ranging from increased irritability and acting-out behaviours or tantrums, changes in eating and sleeping patterns, withdrawal from activities and social interactions, difficulty concentrating and physical symptoms like stomachaches and headaches.

70 BABY & CHILD CARE ENCYCLOPEDIA

Also, although rare, some parents might also observe kids talking about death or expressing thoughts of suicide.

HOW TO HELP Consult with your child’s doctor about treatment options. Depending on the severity and length of episodes, they might recommend psychotherapy, where kids can talk about their thoughts and feelings in a safe space and learn healthy ways for coping. Medication might also be a possible treatment option for some kids.

AGGRESSION AND ANGER

Kids exhibit signs of aggression in a different way than adults do— children often feel anger or act out aggressively because they’re frustrated and they don’t have the skills to communicate how they’re feeling. So, they often resort to physical behaviours such as hitting others and throwing objects to show they’re angry. Anger is an emotion that usually hides other feelings children have. For example, a child may be feeling very sad about the loss of a loved one, but because they don’t have the brain development pathways and the skills to express their sadness, they may show it by screaming, hitting or kicking.

HOW TO HELP Modelling is the best thing parents and caregivers can do to help children develop a language for expressing their anger in healthy ways. You can use verbal communication to help kids label how they’re feeling, and you can model healthy strategies for coping with intense emotions, such as squeezing a stress ball or drawing a picture of their feelings. Experts also say physical activity can make a huge difference to mental well-being. When active, endorphins (feel-good brain chemicals) are released, helping to improve energy level, sleep and mood. You can also look into parenting classes to learn positive discipline techniques or how to parent children with emotional dysregulation issues.

TICS

These uncontrollable and repetitive movements or sounds are quite common in kids, and the second you notice them, it’s hard not to become preoccupied with why kids have tics. Most commonly, tics are a sign of nervousness or a symptom of other underlying emotional issues the child is experiencing such as stress. Kids can feel embarrassed by their unusual behaviours and they might worry about what other kids will think about them. Most tics are temporary, and routine medical checkups can help to identify possible causes.

SYMPTOMS It can be anything, really, from blinking, head twitching, lip biting, shoulder shrugging kicking, coughing, throat clearing, sniffing, grunting and nose wrinkling, for example.

CHAPTER 6: KIDS AND MENTAL HEALTH 71

HOW TO HELP The best thing to do is something that can be hard for a parent: Don’t draw attention to it and remember—most often tics will go away over time. You can also ask your kids about their stress to try to figure out what situations are causing the unusual behaviour, then develop strategies for reducing the exposure to the situation or teaching the child other ways to cope. You can also speak to your healthcare provider if you’re worried about the behaviour, if it’s is showing up more frequently or interfering with your kid’s daily functioning.

EATING DISORDERS

It used to be that eating disorders—like anorexia nervosa and bulimia— weren’t something parents of young children had to worry about. (These illnesses were seen more in teens and young adults.) But with arguably too much exposure to social media, kids today are way more susceptible to developing a skewed sense of their bodies.

Eating disorders are almost always a symptom of an individual’s emotional pain. Eating is something that they can control, so some children may begin to restrict their eating or binge eat in order to feel a sense of control in their life and as a way to numb their emotional pain.

Expert opinion: If you suspect an eating disorder in young children, it’s best to first rule out feeding disorders to ensure there are no medical reasons why your child is not eating.

SYMPTOMS Kids might refuse to eat even when hungry. You might also notice weight loss; poor self-esteem; a focus on comparing body images; mood changes; comments about feeling “fat;” preoccupation with food (including obsessing over calories); delays in swallowing food; excessive exercise; and physical complaints like stomachaches, dry skin and irregular bowel movements.

HOW TO HELP This is something that requires the advice and help of professionals. To start, talk to your kids to let them know you can help, and to remind them it’s good to talk about their feelings and pain. You will want to seek support from your child’s doctor, as disordered eating behaviours can have lasting impacts on a child’s physical health. Your child may also need formal emotional support like psychotherapy to help them understand their emotional pain and help them learn healthier ways to cope. Often there are underlying family dynamics involved, so family counselling and support can also be beneficial.

72 BABY & CHILD CARE ENCYCLOPEDIA

RESOURCES: YOU’RE NOT ALONE

It can be very difficult and scary to realize that your child is facing a mental health challenge, and it is easy to feel helpless. But you don’t have to figure it all out on your own. The first step would be to call professionals who are already in your circle: Your child’s doctor is a good start, as is their school. Most school boards have counsellors on staff or as community partners. There may be waiting lists for programs or appointments with mental health professionals, but just start by reaching out. This will allow you to begin building a network of care providers to call on for guidance, strategies, referrals and more.

There are also many Canadian organizations to contact for further information, assistance and advice. Each individual municipality may also have regional resources as well.

• Canadian Mental Health Association cmha.ca

• Crisis Services Canada crisisservicescanada.ca

• Canadian Pediatric Society caringforkids.cps.ca

• About Kids Health from The Hospital for Sick Children aboutkidshealth.ca

• Evergreen: A Child and Youth Mental Health Framework for Canada mentalhealthcommission.ca

• Kids Help Phone kidshelpphone.ca

CHAPTER 6: KIDS AND MENTAL HEALTH 73

“

MAKING THE DECISION TO HAVE A CHILD IS MOMENTOUS. IT IS TO DECIDE FOREVER TO HAVE YOUR HEART GO WALKING AROUND OUTSIDE YOUR BODY.

Elizabeth Stone

age n a to M w Ho Fever a Symptoms a nd Signs

chapter 7

Com m Ailm on ents

when your child is sick to Give How s Medication

Com Cold a mon nd F lu Il lnes -l ike ses

“I don’t feel well!”

These words strike fear into the hearts of parents around the world. But— and this probably won’t be a surprise to you—infections and illnesses are a common part of childhood. It’s expected that healthy children will have as many as eight viral infections a year and even as many as 100 in their first 10 years of life. With this in mind, we’ve rounded up some helpful information to help you manage symptoms at home, tips for when to call the doc or seek out emergency medical care and a breakdown of some of the common illnesses your kids may face.

SYMPTOMS AND SIGNS

A symptom is what the patient notices and complains about. A sign is a physical change the doctor notes upon observation and examination.

The signs are usually of more importance than the symptoms. It is what is observed that provides the most valuable information in determining just what kind of illness is present and whether or not is might be serious.

Three changes are often the first sign that something is wrong, although it may be many hours or even days before more evidence develops.

1. Activity: One of the most common indicators that a child is unwell is when there is no interest in doing something that is usually enjoyed. Of course, a child may not feel in the mood to be active or may just be sulking, but if the change in behaviour is a sign of a potential illness, other signs will develop.

2. Appetite: A child’s appetite can vary, so a loss of interest in food is not solid evidence of ill health, but it may be one of the early warnings.

3. Attitude: In many children, this is often the most reliable indicator.

If a child who is usually cheerful and easy to get along with seems cranky for no obvious reason, something might be up.

FEVER

The presence of a fever almost always means an infection. The average fever isn’t dangerous or harmful—it’s the body’s normal reaction to the presence of foreign organisms. Parents should watch for the following complications:

• A child’s behaviour is influenced by fever. In some children, the raised temperature makes them irritable. In others, it makes them drowsy. Irritability usually comes with moderate fever of about 38.5 C (101.5 F) to 39.5 C (103 F), and drowsiness with a fever of 39.5 C or over. Individual variations do occur. But it is likely the illness causing the irritability and drowsiness, rather than the fever.

A fever in a baby under four months of age must always be regarded as potentially serious. Call your doctor.

76 BABY & CHILD CARE ENCYCLOPEDIA

HOW TO MANAGE A FEVER

A fever itself is not usually harmful. What counts is the cause. You don’t have to give your child anything for the fever just because it is there. A sick child’s fever is usually highest from about 6 p.m. until 3 a.m. If the fever is gone by the evening, your child will almost certainly not have a temperature the next day.

Indications for treating the fever:

• If the child has had a previous febrile convulsion (a seizure due to fever)

• If the fever is making the child irritable and uncomfortable If the fever makes the child sleepy and relaxed, no treatment is needed as long as they are taking adequate fluids.

What to do • Try to keep the room cool and the humidity low.

• Have a steady movement of air.

• Keep your child undressed or in very light clothing.

Remember that your child can lose heat only through the skin when the skin is hot and flushed. If your child’s body feels cool or is shivering, wrap them up in a blanket until the skin is hot again; otherwise none of these techniques will work.

CONVULSIONS DUE TO FEVER

About one child in 20 between the ages of six months and four years suffers from seizures that are triggered by fever. In most children, these seizures (called febrile seizures) don’t happen every time there is a fever. It seems to depend on a number of factors:

1. The temperature of the fever: Seizures are more common with temperatures higher than 39.5C

2. The speed with which the fever develops: A rapid rise in the child’s temperature is thought to increase the risk of seizure more than a gradual rise

3. The type of infection: Some viruses, such as roseola (baby measles), are associated with seizures more often than the common cold viruses

Most children’s seizures are of the febrile type. They usually last a few minutes and the child may be sleepy after. A child outgrows them and will not be left with any brain damage or an increased risk of seizures in later life.

MEDICATION FOR TREATING FEVERS

Ibuprofen and acetaminophen are good options for treating fevers.

Talk to your doctor about which medication to give your child. Aspirin CHAPTER 7: WHEN YOUR CHILD IS SICK 77

is no longer advisable for children’s viral illnesses because of the risk of Reye’s Syndrome.

Dosage A general dosage outline for acetaminophen is provided by the manufacturer. Paediatricians prescribe a dose of 15 milligrams of the drug for each kilogram the child weighs.

• A 10 kg baby would get 150 mg • A 15 kg 3 year old would get 225 mg Wait for one hour for the full effect. Do not repeat the dose for at least four hours. Repeat only if the indications for treating the fever have returned. If the fever persists for more than 72 hours, check with your doctor.

MEDICINE CABINET GO-TOS

To ensure you’re prepared for whatever ailments come your family’s way, keep these medications on hand.

• Acetaminophen and ibuprofen are great for fever and relief of pain.

(Ask your doctor which medication he or she recommends.)

• Syrup of ipecac induces vomiting if a child swallows pills or anything potentially poisonous. Only give syrup on the advice of a doctor.

Never administer ipecac without advice from an emergency department or poison centre. It can be harmful if the poison is an irritating substance.

• Auralgan ear drops are an effective method for relieving the pain of an inflamed ear drum, one of the most severe pains children will ever experience.

• Anti-nausea medication is useful for motion sickness.

Do not use anti-nausea medication for the vomiting of gastroenteritis unless your doctor says so. It makes some children drowsy and then it is more difficult to tell how sick the child is. As well, the child may become too sleepy to drink. Any medication can be dangerous to a child if taken in excess. Keep medications in childproof containers and store them in a safe area, locked up or out of reach.

HOW TO GIVE MEDICATIONS

Liquid Medications Most children prefer liquids in the provided dosing cup or a medicine syringe from the pharmacy. Taste the medication yourself first. Many medications, like penicillin, have an unpleasant aftertaste. Have something tasty on hand that the child likes and can pop in their mouth immediately afterwards.

78 BABY & CHILD CARE ENCYCLOPEDIA

Medications in Pill Form The easiest way to swallow a pill is to put it behind the bottom front teeth and then drink something quickly. The pill usually gets washed down with the first one or two swallows.

Ear Drops If the drops are oily, stand the bottle in warm water for a few minutes. This will make the drops flow more easily. Lie your child on their side with the infected ear up. Put the correct dosage in the dropper. Pull the ear lobe toward the back of the head until you can see directly into the ear canal. Put the end of the dropper in the opening and squeeze the bulb. Keep your child on their side for five minutes.

Eye Drops Let a drop of the medication hang down from the dropper, have the child look toward one side, and place the drop on the white of the eye in the outside corner. It will flow in easily.

Alternatively, you can have your child close their eyes, then put the drops in the inside corner of the eye. When the eyes are opened, the drops will flow in painlessly.

Eye Ointments Squeeze out a strip of the ointment about one centimetre long and let it hang down from the tube. Then pull the lower lid down and lay the strand of ointment along the inside (the red part of the lower lid). Have your child open and close the eye a few times to spread the medication.

Nose Drops Have the child lie down with his or her head back. Measure the right amount of nasal solution in the dropper. Place the dropper inside the nostril and gently squeeze the bulb. Try not to touch the lining of the nose or the child may jump or sneeze. Have him or her sniff hard a couple of times before sitting up again.

FOR INFANTS: Administer eye or nose drops when they are busy sucking or feeding.

TREATING COMMON SIGNS OF ILLNESS

Kids are prone to a few physical reactions to illness or injury, so it’s helpful to know how to handle them when they crop up, regardless of the root cause.

Rashes Most rashes are due to either skin reactions (allergies and dermatitis) or to infections in the skin. None of these skin eruptions make the child sick or cause a fever unless there are complications.

Rashes often occur in the course of viral infections. The type of rash that accompanies the fever helps your doctor recognize illnesses.

The presence of a rash with an illness does not make the illness any more serious. If the rash is itchy, applications like calamine lotion, or a bath with baking soda or a commercial baby wash can help.

CHAPTER 7: WHEN YOUR CHILD IS SICK 79

In the event that the spots look like blood under the skin and don’t blanch when you press them, the rash may be a sign of septicaemia (blood poisoning) and your child should be taken to the ER immediately.

Cough and Congestion It is common for children’s infections to involve the respiratory system. The child develops a cough that at first is dry and irritating. After a day or two, the child’s nose begins to run and the cough begins to sound loose. At this stage, many parents say the child is “congested” and worry that there is some trouble in the lungs. The most common reason for a loose, moist cough is that the mucus from the back of the child’s nose is trickling down the back of the throat to the top part of the windpipe. This happens easily when the child is lying down.

When mucus trickles down the throat to the windpipe, adults automatically clear our throats, but children clear their throats by coughing. Suppressing the cough deprives the child of a mechanism for protecting the lungs. It is wiser to make sure that the air the child breathes is well-humidified so that the phlegm doesn’t dry out and become thick and sticky (and therefore harder to expel).

Signs that suggest that the infection is affecting the lungs and that the child should be examined are: • If the cough is not accompanied by any signs of a cold.

• If the fever from the cold lasts more than three days.

• If the child seems to be breathing rapidly or seems to have difficulty breathing, especially when the child’s temperature is below 38.5 C. • If there is any suggestion that the child’s colour is changing from pink or red to mauve or blue.

• If the child looks unusually pale.

Vomiting Vomiting is usually associated with problems directly involving the stomach or bowel, but can occur in children for other reasons. Some children will vomit from high fever, and others from emotional upset.

Some children have very strong gag reflexes.

Stomach flu is a common virus infection in young children. Usually the child is listless, especially after vomiting. The vomiting is not caused by coughing, and often comes with little warning. At the beginning of a stomach flu (also known as viral gastroenteritis), the child may vomit repeatedly and be unable to keep anything down. After a delay of six to 24 hours, diarrhea usually occurs.

It is important to avoid dehydration. For most children who are healthy and well-nourished before the flu starts, the risk of serious dehydration depends on excessive loss of fluid rather than a failure to take in fluids. Any healthy child, even a baby, can safely go for up to 12 hours or more without drinking much, as long as there are no fluids 80 BABY & CHILD CARE ENCYCLOPEDIA

lost by vomiting, diarrhea or very heavy and continuous sweating. A child with gastroenteritis usually can’t keep very much down for the first 12 hours or so, but keep offering frequent small sips of flat ginger ale or diluted apple juice—start with a tablespoon every 15 minutes, then gradually increase the amount as tolerated. Paediatricians often recommend rehydration fluid for children. Things can change quickly with stomach flu, so if your child continues to have vomiting or loose bowel movements after a couple of days, check with your healthcare provider.

COMMON AILMENTS: A QUICK REFERENCE GUIDE ABDOMINAL PAIN, ACUTE Abdominal pain may be the symptom of a number of ailments from childhood diseases, internal disorders or simply the result of overeating or eating the wrong foods. Other causes would include a twisted digestive organ, stomach ulcer, twisted testicle, viral or bacterial diarrhea or food poisoning, pneumonia, hepatitis, chronic constipation and even pain associated with emotions, such as high levels of worry.

Diagnosis: Diagnosis will vary according to the location of the pain, when it began, how long it has lasted, the age and sex of the child and whether there are other symptoms such as changes in bowel movements or urination, fever, nausea or vomiting.

Home Treatment: If you suspect constipation, avoid use of laxatives.

Give plenty of fluids, fresh fruits and vegetables. Encourage your child to sit on the toilet regularly following meals, to increase opportunities for bowel movements to occur.

Emergency Treatment: A physician should see your child if there is severe pain—especially if there is vomiting. If a physician is unavailable, go directly to a hospital emergency room.

ALLERGIES An allergy is present when your child’s body overreacts to one or many things, including things that are eaten, breathed, touched or injected (such as medications). The most common childhood reactions are to foods, house dust, certain pollens, poison ivy, oak and sumac, stinging insects and some medications, such as antibiotics. Asthma often has an allergic component.

Symptoms: Swelling of the lips and mouth, hives, wheezing and even shock are some of the more severe symptoms. The shock reaction (called anaphylaxis) may be fatal. A reaction to stinging insects includes swelling and itching at the site of the sting, but if the reaction is severe it can CHAPTER 7: WHEN YOUR CHILD IS SICK 81

cause anaphylaxis. Whatever symptoms are evident in a small child may change as the child grows older.

Medical Treatment: The symptoms of most allergic reactions can be reduced or eliminated with proper treatment—your doctor may prescribe an antihistamine, or a desensitization program. It is a medical emergency if a child has associated breathing difficulty.

ALLERGIES, FOOD Food allergies aren’t as common in children as you’d think. Still, the most allergenic food is the peanut, and in infants, it’s eggs and milk products.

Symptoms can involve swelling of the mouth, hives, a stuffy nose and difficulty breathing or swallowing.

Symptoms: Usually appear within a few minutes to an hour after eating. Some food allergies may result in vomiting, diarrhea, abdominal pain and bloating.

Home Treatment: If you know what caused the allergic reaction, remove the food from your child’s diet. Give plenty of clear liquids if he or she has lost fluids through vomiting or diarrhea. If the reaction includes itching from hives, try antihistamines, calamine lotion, decongestants and cool compresses.

Medical Treatment: If asthma results, a physician can prescribe medication to help breathing difficulties. Children often outgrow food allergies by age two or three.

If the child shows signs of shock (rapid pulse, fast shallow breaths, dizziness or fainting, clammy skin, thirst or anaphylaxis) get medical attention immediately. Epinephrine may be administered to control a severe allergic reaction. A kit may also be prescribed for home use.

APPENDICITIS Appendicitis is uncommon in children younger than five. However, diagnosing appendicitis is difficult, so doctors take prompt action.

Symptoms/Action: Consult your healthcare provider or take your child to an emergency room if he or she complains of pain, tenderness or cramps in the stomach around the navel or lower right side of the abdomen for three hours or more.

Medical Treatment: If it’s appendicitis, an appendectomy may be required following the diagnosis.

ASTHMA Wheezing and difficulty in breathing in children is usually an indicator of asthma, but a doctor will check for alternate reasons. A viral infection, may precipitate an attack. Many children outgrow asthma.

82 BABY & CHILD CARE ENCYCLOPEDIA

Medical Treatment: Mild asthma attacks may be treated with a prescription medication that relaxes smooth muscles in the breathing tubes. Medication usually continues for two to seven days after the wheezing has stopped. A child with severe asthma may require hospitalization.

BITES AND STINGS (See First Aid chapter) BLEEDING (See First Aid chapter) BLISTERS These are raised, red bumps filled with an almost-clear fluid that forms when skin is damaged by being rubbed or injured. A blister can also result from an allergic reaction to plants or insects. The blister won’t disappear until the skin underneath the blister has healed.

Home Treatment: Protect the area with a bandage or gauze to prevent infections. Don’t break a blister, but if the blister should be accidentally broken, wash with soap and water, apply a mild antibiotic ointment (a prescription medication isn’t required) and cover.

Infection may result if a blister breaks. Red streaks that spread or redness at the base of the blister indicate infection and a physician should be seen.

BLOOD (IN STOOL OR VOMIT) Symptoms: Vomiting a large amount of blood usually suggests that the bleeding originates in the esophagus or stomach. Blood in the stool is a sign that bleeding originates in the intestines. A black stool may also indicate internal bleeding. Significant blood loss can lead to shock.

Medical Treatment: If there is a large amount of blood in vomit or rectal bleeding, get medical attention immediately. For massive bleeding, intravenous fluids and salts may be given to combat dehydration and shock. A blood transfusion may be started. Specific treatment depends on the cause. Comfort and reassure the child, who will be frightened.

Fear and anxiety can complicate the problem.

BLOOD (IN THE URINE) Blood in the urine may be due to bladder infections, inflammation or kidney disease. It can indicate serious conditions, so get an immediate medical evaluation. Sometimes coloured foods, such as beets or red dyes, can cause red urine. All children with blood in the urine should be seen by a physician.

BREATHING (RESCUE BREATHING, CHOKING, HYPERVENTILATION) (See First Aid chapter) BROKEN BONES (See First Aid chapter) BURNS (See First Aid chapter) CHAPTER 7: WHEN YOUR CHILD IS SICK 83

CHICKEN POX Chicken pox (varicella) is a viral infection. It is common in childhood in children who haven’t been vaccinated against it, and the infection is usually mild. Chicken pox usually begins with a fever, followed by a rash after one or two days. The rash usually starts as red spots, and then turns into blisters filled with fluid. Within a few days, crusts form over the blisters. New spots may also appear over the following days. The rash may be very itchy. If your child gets chicken pox, they should develop immunity and will likely not get the infection again.

Treatment: You can try to control your child’s fever by giving him acetaminophen. Do not give your child aspirin or any products that contain aspirin. Aspirin increases the risk of getting Reye’s Syndrome, a severe illness that can damage the liver and the brain. Treat the itchy rash with calamine lotion and/or baking soda baths.

Transmission/Prevention: The virus that causes chicken pox spreads through the air, or spreads through direct contact with the blister(s) of an infected person. Chicken pox is infectious five days after the rash first appears, or until a crust has formed over the last blister. If your child isn’t vaccinated and has been around another child who has chicken pox, watch them for signs of the infection over the following two weeks.

If your child gets chicken pox and attends a daycare centre or school, it is important to tell the centre staff or teacher.

COMMON COLD AND FLU-LIKE ILLNESSES Symptoms of a common cold or head cold are usually a stuffed-up nose, lessened appetite, headache and mild fatigue. A sore throat or mild cough are somewhat common. Sometimes there is a mild fever. With a flu, symptoms are more severe, and may include fever, cough, fatigue and achiness. There may also be a sore throat, hoarseness and the swollen glands in the neck. Loss of appetite, vomiting and diarrhea are also common with flu-like illnesses.

The common cold is actually caused by a virus that can infect the nose and throat. Flu-like illnesses are also often caused by a virus and usually infects the head and chest.

Treatment: Give your child plenty of fluids and urge him to rest. You can give your child acetaminophen for pain, aches or a fever higher than 38.5. Do not give your child Aspirin or products containing Aspirin because of the risk of Reye’s Syndrome. If your child has a dry, hacking cough and is older than age six, you can give your child a cough syrup that contains dextromethorphan (DM).

Contact your physician if your child shows any of the following signs: earache, fever higher than 39C (102F), excessive sleepiness, 84 BABY & CHILD CARE ENCYCLOPEDIA

excessive crankiness or fussiness, skin rash, rapid breathing or difficulty in breathing. Common colds usually get better after five to seven days. Bad colds or flu-like illnesses may take a few days longer. A cough can linger for a few weeks. If your baby has breathing trouble, fever, poor appetite, or vomiting, make sure they are checked by their doctor. Sometimes a cold can lead to complications such as a middle ear infection, in which case your child needs to see a doctor. Signs of an ear infection are a high fever, earache, vomiting, irritability and especially pus draining from the ear. Your child should also see a doctor if they get an eye infection with a cold, a symptom of which is dried yellow pus in and around the eye.

Transmission/Prevention: The virus is carried in the saliva and nasal secretions and spreads through the air when people cough, sneeze or blow their noses. Teach your child to cover their mouth and nose when sneezing or coughing.

COLD SORES (ORAL HERPES, FEVER BLISTERS) These are clusters of painful bumps or blisters on one side of the outer lip.

Kids usually get infected by coming in contact with the open lesions or saliva of someone who’s infected. (If adults around your child are prone to cold sores, they should avoid close contact when experiencing a flare up.) With the first infection these blisters also appear inside the mouth (stomatitis) and are confused with canker sores. However, they are very painful and are associated with fever. The infections usually start before age four. Cold sores (oral herpes) are associated with the herpes simplex virus, type 1.

Symptoms/Treatment: The blisters on the lip rupture, scab over and dry up in 10 to 14 days. They do not cause scars. After the blister heals, the virus is dormant and then, at a later time, can become active again. Cold sores heal by themselves and although they are a nuisance, they are not serious.

Home treatment: Warn your child not to touch the blisters or pick at the resulting scabs. Phenol and camphor may give some relief if the blisters are sore, and may also prevent bleeding of the scabs. Apply at the first sign of a cold sore.

CHOKING (See First Aid chapter) CROUP Croup often begins like a common cold. Later, there is fever, cough and difficulty breathing. The lining of the throat and larynx gets red and swollen, and a barking cough develops. The voice gets hoarse and breathing can get rapid and noisy. Croup usually sounds worse than it is.

Cause: Croup is a viral infection of the throat and vocal cords (larynx). In an older child or adult it is call laryngitis.

CHAPTER 7: WHEN YOUR CHILD IS SICK 85

Treatment: Croup is a viral infection so antibiotics, which are used to treat bacterial infections, do not help. Call your child’s doctor right away if he gets a fever higher than 39C (102F), has rapid or difficult breathing, has a severe sore throat, starts to drool or has more drool or if he refuses to swallow or is uncomfortable when lying down.

Transmission/Prevention: As with a cold, the virus is carried in the saliva and nasal secretions and spreads through the air when people cough, sneeze or blow their noses.

DEHYDRATION This is an excessive loss of body fluids, and it can develop very rapidly among newborns and infants who are vomiting or have diarrhea. Notice if your child: has not urinated in more than eight hours; if there are no tears when crying; if the mouth is dry; if there is decreased quantity or frequency in urinating if the pulse is rapid; if the eyes seem to be sunken; and if your child is lethargic.

Home Treatment: Encourage him or her to drink water, fruit juices or soft drinks such as ginger ale. Don’t offer salty liquids such as broth. If the child is nauseous and can’t tolerate drinks, try offering chips of ice or frozen juice.

Medical Treatment: If hospitalization is necessary, the child may be given fluids and nutrients intravenously.

DIARRHEA/DEHYDRATION Diarrhea is most often caused by a virus. Sometimes it is caused by bacteria.

Your child has diarrhea if he is having more bowel movements than usual and his stools are loose and watery. Your child may also have a fever, nausea, vomiting, pains in the stomach, cramps, blood and/or mucus in the stool and may not want to eat. Diarrhea can be dangerous if it causes dehydration.

Signs of dehydration are less urination, lack of tears, dry skin, mouth and tongue, sunken eyes and a sunken fontanelle in babies. Dehydration can be very dangerous, especially for babies and young children.

Treatment: At the start of diarrhea in your baby, continue breastfeeding on demand. If you do not breastfeed, continue to offer your baby food and drink. Whether you breastfeed or not, offer oral rehydration solution (ORS) following this schedule.

For the first six hours:

• For a child less than six months old, give 30 to 90 ml of ORS every hour.

• For a child six to 24 months old, give 90 to 125 ml of ORS every hour.

• For a child over two years old, give 125 to 250 ml ORS every hour.

If your child vomits in addition to having diarrhea, you may need to stop food and drink. Continue to give ORS. Give your child 15 ml (1 tbsp) 86 BABY & CHILD CARE ENCYCLOPEDIA

every 10 to 15 minutes until the vomiting stops. Then go back to the schedule above. If vomiting doesn’t stop after four to six hours, take your child to the hospital.

• From six to 24 hours, keep giving ORS until the diarrhea happens less often. When the vomiting happens less often, have your child drink small amounts of milk or formula often.

• After 24 to 48 hours, most children can eat and drink normally. It can take seven to 10 days for stools to return to the normal form.

Transmission/Prevention: The germs that cause diarrhea are spread easily from person to person, especially among children who haven’t learned to use the toilet. Wash your hands and your child’s hands well after changing a diaper and going to the toilet and before preparing food and eating.

Call your child’s doctor if he has diarrhea and is younger than six months, if he has bloody or black stools, if he is still vomiting after four to six hours, if he has a temperature greater than 38.5C (101.5 F) or if he has signs of dehydration.

DIZZINESS (VERTIGO) This involves a feeling of the world spinning—a sensation that indicates the balancing mechanism of the inner ear is disturbed. The feeling can be momentary, but if it persists, nausea and vomiting are likely. A few children experience dizziness during their early years but it usually isn’t a cause for concern. Some children experience dizziness in the car.

Home Treatment: Most dizziness will pass quickly, especially if the child has been spinning during play. If it persists for more than a few minutes, ask your child about other symptoms.

Medical Treatment: See a doctor if there is earache, buzzing in the ears, headache, fever or if the child is unable to stand or walk.

EAR INFECTION The peak ages for earaches are six months to two years, but they continue to be a problem until children are eight or 10 and usually cause both pain and fever. An ear infection can be in the external ear, the middle ear or the inner ear. Young children are most affected by middle ear infections—it’s the most common early childhood problem next to colds. An external ear infection (often called swimmer’s ear) can ache, be tender and red, swell and have a discharge of pus that has an unpleasant odour. Itching and discomfort can last for a few days, even after treatment has started.

Home Treatment: Don’t use folk remedies, such as warmed oil dropped in the ear, and don’t plug the ear canal with cotton. To relieve pain, CHAPTER 7: WHEN YOUR CHILD IS SICK 87

put an ice bag or ice in a washcloth over the ear for 15 minutes. Cold provides better relief than warmth. Don’t allow water near the ear. If the pain is from water in the ears, get the child to lie with the affected ear downward so the water can drain.

Medical Treatment (External Ear): The physician will clean the ear canal and prescribe ear drops with antibiotics and cortisone.

Medical treatment (Middle Ear Infection): Antibiotics are generally indicated to combat infection. Sometimes a small incision is made in the eardrum to admit a tube that allows fluid to drain from the middle ear.

This is generally done if a child has multiple ear infections.

Medical Treatment (Inner Ear): Your healthcare provider will drain the accumulated fluid from the inner ear and start antibiotic therapy. Surgery is sometimes necessary.

ECZEMA Eczema is a skin eruption that, in infants, usually starts on the cheeks and is red and oozing. Thickening of the skin will occur in older children if the eczema is long-term. It is not contagious. Infantile eczema tends to run in families. Usually a close relation to the child is susceptible to eczema or some other allergic complaint, such as hay fever or asthma.

Eczema usually starts in infants two to three months old and often clears when a child is between three to five years old. It may be associated with other allergic conditions such as hay fever. You will notice it first on your infant’s cheeks, but it will probably spread to the rest of the face, the neck, the wrists and the hands. Because it is so itchy, the child will rub against blankets and try to scratch. Then there will be oozing, followed by crusting and scaling. It may become infected.

Home Treatment: If a child scratches, eczema is very difficult to control.

Apply cool, moist compresses to calm the itch. Keep your child’s fingernails as short as possible. Avoid harsh soaps and detergents. Let the child soak in warm water to relieve the dryness, but after bathing coat the skin in oil to seal in moisture. Avoid rough or scratchy clothes.

If the cause is food-related, it can be treated by eliminating specific foods. These triggers may include milk products, eggs, tropical fruits, fish, shellfish, wheat flour products and chocolate. After the eczema has cleared up introduced these foods one at a time, a week apart, so that the problem food can be identified. If you’re having trouble get a handle on your child’s eczema, make an appointment with their doctor.

Medical Treatment: A hydrocortisone ointment may be prescribed to help reduce inflammation. (A mild hydrocortisone would be used for infantile eczema.)

88 BABY & CHILD CARE ENCYCLOPEDIA

EYE INJURIES Eye injuries can be caused by a piece of matter in the eye or under the eyelid; a sharp object puncturing the eye or eyelid; a blow to the eye; burns sustained from being exposed to chemical substances (cleaning agents, firecrackers); or overexposure to the sun.

Home Treatment: Blinking can usually force dust out of the eye. If you can see the culprit, moisten a cotton swab and gently flick it out, or flush the eye thoroughly with running water for at least 15 minutes. If the injury is from an explosive substance, if the eye has been penetrated or if it has come into contact with a chemical substance, do not wash out the eye.

Call your healthcare provider for actions to take.

Emergency Treatment: If the foreign matter is embedded, don’t try to remove it. Go to an emergency room. After the object is removed, the physician may prescribe antibiotic ointment and pain relievers if the cornea is scratched. If the cornea has been burned by ultraviolet light, both eyes should be kept closed until healing occurs (one or two days). A cut in the eyeball may require surgery. Teach your child to wear protective eye goggles when working with tools or chemistry sets. It should become an automatic habit.

GIARDIA Giardia is a parasite that causes a bowel infection. It is common in children in childcare centres, especially if there are children in diapers. Some children have no symptoms. Others have diarrhea, bowel movements with a very bad smell, stomach cramps, gas, loss of appetite and weight.

Treatment: There are medications to treat giardia. A doctor may have to take three stool samples on three days to confirm the diagnosis.

Transmission/Prevention: Giardia may spread on the hands of someone who has changed a diaper or used a toilet. The spread can be prevented by careful hand-washing after changing the diaper or going to the toilet, and before preparing food and eating.

If your child has been diagnosed with giardia and is ill, he should not attend daycare or school until the diarrhea has stopped.

GROWING PAINS We say “growing pains,” but these aches aren’t really caused by growth.

Instead, these are normal aches and pains in limbs and joints, and they are experienced by most children ages 3 to 12, at some point. Luckily, these pains are both temporary and harmless. The pains most often are felt in the child’s calves, thighs and feet, and they’re more likely to occur when kids are at rest and at night. The cause is unknown, although it seems to have a family tendency.

CHAPTER 7: WHEN YOUR CHILD IS SICK 89

Home Treatment: A warm bath may help, as well as gently massaging and stretching the sore muscles. There is no need to stop regular activities.

Medical Treatment: If there is persistent pain that does not improve after a couple of days, if it gets worse or if there is a limp, joint swelling or fever, you should contact your healthcare provider.

HAND, FOOT AND MOUTH DISEASE This infection is found in saliva and can cause fever, headache, sore throat, loss of appetite, lack of energy, a skin rash and small, painful ulcers in the mouth. The rash usually appears on the hands and feet, but may also be on other parts of the body.

Treatment: If symptoms appear, call your doctor to confirm the diagnosis. There’s no treatment; the infection will go away after seven to 10 days. Outbreaks are more common in the summer and fall.

Transmission/Prevention: It spreads from person to person through the air or by touch. The incubation period is about 10 to 14 days. Children may remain infectious for one to two weeks.

HEADACHE Most headaches are of short duration and don’t require treatment.

They’re almost as common in children as they are in adults. There may be numerous causes such as a blow to the head, a viral illness, a high fever, hunger, tension or stress. Broadly speaking, there are three types of headaches: migraine, disease or injury-related and tension.

Home Treatment: Let your child relax in a dimly lit room. Encourage other relaxation strategies, like taking deep breaths or imagery. Offer a few snacks.

A cool washcloth on the forehead may help, too. You can also give a painrelieving medicine such as children’s acetaminophen or children’s ibuprofen.

Encourage your child to get back to regular activities as soon as they’re able.

Medical Treatment: If headaches are diagnosed as migraines, your healthcare provider may suggest regular medication that may prevent attacks.

Emergency Treatment: Treat a headache as an emergency if the pain is so severe that it interferes with normal activity for more than an hour; the pain is accompanied by fever, vomiting and a stiff neck; or if he or she is confused, disoriented or delirious.

HIVES This is a general term for an allergic skin reaction that affects children who are allergic to specific substances. In some cases, the cause of hives is never found.

Acute hives may appear on a child face and chest or anywhere on the body. They are very itchy and may erupt suddenly after a bee sting or 90 BABY & CHILD CARE ENCYCLOPEDIA

specific foods. Hives generally disappear in a few days without receiving treatment. Cold hives are exactly what the name implies: a reaction to cold air, cold water and cold drinks. They are itchy and painful.

Home Treatment: Itching and pain may be relieved with calamine lotion or by soaking the affected skin in cool water with two tablespoons of sodium bicarbonate.

Medical Treatment: An oral antihistamine may be prescribed. If hives are associated with difficulty in breathing or wheezing, medical help should be sought immediately.

HYPERVENTILATION (See First Aid chapter) INFLUENZA The flu is a viral infection of the nose, throat, trachea and bronchi. Every autumn and winter you can bet on a widespread epidemic of whichever bug is present. There are many types of viruses and they change constantly, so it is possible to have influenza annually.

Symptoms: Primary symptoms are stuffy nose, sore throat and nagging cough, as well as muscle pain, headache, fever and chills that are usually identified with the common cold. Because it is so widespread, healthcare providers can readily identify the symptoms.

Home Treatment: Influenza is almost always treated at home, but not with antibiotics, because it is a viral infection. It can sometimes develop into a bacterial infection (pneumonia), at which time antibiotics will be required.

Kids with the flu need plenty of bed rest and lots of fluids.

Acetaminophen or ibuprofen help reduce muscle aches and fever.

LARYNGITIS Laryngitis in infants is often called croup and may be associated with a hoarse cry and breathing difficulties. In older children, breathing problems are unusual, because the airway is much bigger. Their hoarseness is caused by a cold or overuse of the vocal cords through shouting or screaming, which cause an inflammation of the voice box (larynx). An older child with laryngitis may not be able to speak above a whisper and may have a dry cough and a scratchy and sore throat.

Home Treatment: Have your child gargle with warm saltwater or suck on a hard candy several times a day. Younger children can sip warm liquid, like apple juice. Encourage the child to talk as little as possible for a few days. If he or she has a fever, offer acetaminophen or ibuprofen. You can also put a cool-mist humidifier in the bedroom.

Medical Treatment: Call your healthcare provider if the hoarseness is CHAPTER 7: WHEN YOUR CHILD IS SICK 91

present for more than two weeks or if the hoarseness gets worse. If there is difficulty in breathing or a high fever develops, call a physician immediately.

NOSE BLEEDS Nosebleeds are common in childhood and almost never dangerous. The actual blood loss is usually insignificant. You can blame a blow to the nose, scratching or blowing the nose very hard, hay fever, other allergies and colds. A nosebleed can also result from bleeding disorders like hemophilia.

Home Treatment: A nosebleed usually stops by itself. If it doesn’t, have your child sit up and lean slightly forward so as not to swallow the blood.

Then squeeze his or her nose firmly between your thumb and forefinger.

Apply this pressure for a few minutes, then release. This allows the body’s clotting mechanism to go to work. After the bleeding has stopped, tell your child not to wipe or blow his or her nose and sit still for a few minutes.

If bleeding doesn’t stop after home treatment and after 20 minutes of constant pressure, consult your physician.

PINK EYE Pink eye is an infection of the covering of the eyeball, usually caused by a virus, but sometimes caused by a bacteria. It can also be caused by allergy, exposure to chemicals and other irritants around your child. There will be pus coming from the eye if the pink eye is caused by bacteria. If it is caused by a virus, the discharge will be more watery. The pus may make the eyelids stick together. There is a scratchy or painful feeling in the eyes, and the whites of the eyes turn pink or red. Your child should see a doctor if they have these symptoms.

Treatment: If caused by bacteria, it is treated with antibiotics and warm water compresses. If caused by a virus, treat with warm water compresses only.

PINWORMS Pinworms are tiny, white thread-like worms that live in the intestines. The worms crawl out of the anus at night and lay their eggs on the nearby skin. Pinworms are a nuisance, not a disease. They spread when an uninfected person picks up pinworm eggs from an infected person or their belongings. There may be no symptoms, or there may be itchiness around the anus or vagina.

Treatment: If a doctor determines that a child has pinworms, it can be treated with medication.

Transmission/Prevention: When an infected person scratches the itchy area, they get pinworms on their fingers or under their fingernails. It’s also spread when an uninfected person picks up pinworm eggs from an infected person’s belongings (eggs can live for several weeks outside the body). To prevent repeated infections, hand-washing is important.

92 BABY & CHILD CARE ENCYCLOPEDIA

PNEUMONIA AND BRONCHITIS Pneumonia is an inflammation or infection of the lungs. It can be caused by bacteria or viruses. Bronchitis is an inflammation of the bronchi— the air passages connecting the windpipe (trachea) with the lung sacs (alveoli) where oxygen is taken up by the blood. It can be caused by complications from a cough due to a severe cold. These infections are much more severe than colds. Symptoms include breathing trouble and a strong cough, which may produce yellow or green phlegm, and/or that is so severe it causes vomiting or turning red in the face. Fever may also be present.

Treatment: Your doctor will decide on a course of treatment, depending on the condition, how severe it is and what caused it.

Transmission/Prevention: With viral pneumonia, it is spread from person to person in the form of droplets expelled by an infected person when talking, coughing or sneezing, through touching infected secretions and through touching contaminated hands, objects and surfaces.

ROSEOLA Caused by a virus, the infection is rare for children younger than four months or older than four years; it’s common in children aged six to 24 months. It starts out with a fever that disappears in a few days and is replaced with a rash on the face and body. The rash has small red spots and lasts for one or two days. Most children are not very sick during the fever stage, although some children have a very high fever that causes febrile seizures (convulsions).

Treatment: Talk to your doctor if your child gets a persistent fever or feels unwell.

Transmission/Prevention: It is not known how roseola spreads from person to person. Tell your child’s daycare or school if he is diagnosed with the infection.

SINUSITIS The sinuses are a group of air-filled hollows that connect to the nasal passages. Sinusitis can be caused by colds, other viral infections, allergies, injury to the nose, infected adenoids, polyps in the nose or foreign objects in the nose. Infection of the sinus tissue is often caused by bacteria. Chronic sinusitis is also associated with the inhaling of cigarette smoke.

Symptoms: There is a sensation of pressure or pain above the eyebrow, behind the eye or over the cheekbone. The child may complain of headaches. There may be a thick nasal discharge and it may be necessary to breathe through the mouth.

CHAPTER 7: WHEN YOUR CHILD IS SICK 93

Home Treatment: It’s necessary to clear the sinuses and passageways so the fluid drains away and inflammation can be reduced. Decongestants may help. You might use a vaporizer in your child’s bedroom. See that they drink plenty of fluids. For kids who are swimmers, see that goggles and nose plugs are worn.

Medical Treatment: Antibiotics may be prescribed if the infection is bacterial. The sinus may be drained, using suction, if other treatment fails.

STREP THROAT Caused by a bacteria called streptococcus pyogenes (strep) Group A, strep throat is characterized by fever, severe sore throat, headache and stomachache. Neck glands may be swollen and tender, or sores around the nose may appear.

Treatment: See your child’s doctor for diagnosis and treatment, which will likely involve antibiotics.

Transmission/Prevention: Spread through the air when an infected person talks, coughs or sneezes. Hand-washing is important to prevent spread. Teach your child to cover his mouth when sneezing or coughing.

Your child should not go back to daycare or school until antibiotics have been taken for at least 24 hours.

STYES Styes are bacterial infections that develop when the glands along the eyelids are clogged, much like when a skin glad is clogged and a pimple forms.

Home Treatment: Place a warm, wet washcloth or cotton ball over the stye for 10 minutes, three or four times a day. This hot compress helps increase the blood flow to the area. A physician’s help shouldn’t be needed unless the styes persist. Keep the child’s towel and washcloth separate from the rest of the family (and replace with clean ones often).

See that hands are washed frequently.

VIRAL MENINGITIS This is a virus that causes swelling of the lining of the brain and is diagnosed by analyzing spinal fluid taken during a procedure called a spinal tap. The doctor will confirm whether the infection was caused by a virus or bacteria (bacterial meningitis is much more serious). Fever, headache, neck pain, or stiffness, pain when looking at bright lights, nausea, vomiting, poor appetite, tiredness and sleepiness. It may infect other parts of the body and cause skin rash, runny nose, sore throat, earache, cough, difficulty breathing and diarrhea.

If your child develops these symptoms, see your child’s doctor immediately.

94 BABY & CHILD CARE ENCYCLOPEDIA

Treatment: There is no treatment to cure viral meningitis, and children recover on their own in approximately one to two weeks. The doctor will only hospitalize your child if they are quite sick from the infection.

Transmission/prevention: The germs are in the saliva and secretions of the nose. Close contact between children is required for the spread of these germs. It occurs most often in children under two.

VACCINATION SCHEDULE

Vaccinations are scheduled differently in every province (turn the page for the cross-country table) but there is a general consensus that the standard vaccines are spread out at intervals from two months of age to age 11. Booster shots to update vaccines may occur throughout adolescence and adulthood. Keep an eye on the calendar to ensure your child’s vaccinations are up to date (especially when kids go to school—you may be asked to show proof of vaccination depending on your region). Vaccinations are a contentious topic for some families; any concerns can be discussed with your child’s doctor.

For more information, and to view and print your own copy of the Provincial and Territorial Routine and Catch-up Vaccination Schedule for Infants and Children in Canada, visit canada.ca. (You can also search “Canadian vaccination schedule” for easier access.)

CHAPTER 7: WHEN YOUR CHILD IS SICK 95

CANADA’S PROVINCIAL AND TERRITORIAL ROUTINE (AND CATCH-UP) VACCINATION SCHEDULE FOR INFANTS AND CHILDREN* This table summarizes the current routine vaccination schedule for infants and children in all provinces and territories accross Canada. Changes to this schedule are updated regularly in collaboration with the Canadian VACCINES

*

last updated: December 2020.

ABBREVIATIONS: yrs = Years (age); mos = Months (age)

Vaccine is not publicly funded in this province/territory A specific catch-up program is currently underway. A catch-up program is defined as a time-limited measure to implement a new vaccine program to a certain age cohort (e.g. an additional dose of a vaccine is recommended and a targeted program is put in place). It can also be used when a vaccine is added at a younger age (e.g. in infancy) and the existing program continues until that infancy age cohort “catches up” to the current age cohort (e.g. hepatitis b vaccine is added to the infancy program, but the school immunization program continues until those infants reach school aged immunization). With that said, a province or territory can still provide catch-up vaccine at the individual level even if there’s no specific program in place.

96 BABY & CHILD CARE ENCYCLOPEDIA

Nursing Coalition for Immunization (CNCI) and the Canadian Immunization Committee (CIC) schedules for each province or territory can be found on Canada.ca/vaccines.

PROVINCIAL AND TERRITORIAL VACCINATION SCHEDULE

If attending post-secondary school out-of territory Females only 3 Males only 4 The schedule applies to children born after June 1, 2019. Children born before this date will follow the vaccination schedule that was recommended at the time. For more information please visit https:// www.quebec.ca/en/health/advice-and-prevention/ vaccination/quebec-immunisation-program/ 5 Students are provided with a combination vaccine 1 2

that protects against hepatitis A and B A catch-up program in the 3rd year of high-school evaluates student’s vaccination history. Students will be provided any missed vaccination to protect against the following diseases: diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, varicella, meningoccal serogroup C infections, hepattis A and B, and human papilloma virus.

7 DTaP-IPV-Hib may be substituted for DTaP-IPV in times of shortage 6

CHAPTER 7: WHEN YOUR CHILD IS SICK 97

“

THE MORE PEOPLE HAVE STUDIED DIFFERENT METHODS OF BRINGING UP CHILDREN, THE MORE THEY HAVE COME TO THE CONCLUSION THAT WHAT GOOD PARENTS INSTINCTIVELY FEEL LIKE DOING FOR THEIR BABIES IS THE BEST AFTER ALL.

Dr. Benjamin Spock

ater W a nd y e Ic Sa fet Equi pm ent Sa fet y

Insect Sting

chapter 8

safety and first aid CPR g vin Gi

Bro ken Bo nes

s

Children are curious, and this curiosity often leads to injury. Parents can help protect children by creating a safe environment. You can also teach them to take responsibility for themselves so they develop their own sense of safety and self-confidence. And remember, you will be imitated, so be a positive role model.

This chapter is for reference only. It should not be considered a substitute for an up-to-date first aid or CPR training course. We recommend all parents and caregivers receive CPR training.

FIRST AID SUPPLIES

A first aid kit for home use should contain the following. Remember to check your supplies and replenish them often.

Emergency telephone numbers for EMS, the local poison control centre and personal doctors, as well as the home and workplace phone numbers of family, friends and neighbors who can help Sterile gauze pads (dressings) in small and large squares to place over wounds Adhesive tape Roller and triangular bandages to hold dressings in place or to make an arm sling Adhesive bandages in assorted sizes Scissors Tweezers Safety pins Ice bag or instant ice packs Disposable gloves, such as surgical or examination gloves (non-latex, non-vinyl) Flashlight, with extra batteries in a separate bag Antiseptic wipes, soap and hand sanitizer Pencil and pad Emergency blanket Eye patches Thermometer Barrier devices, such as pocket mask or face shield Canadian Red Cross childcare first aid and CPR manual

100 BABY & CHILD CARE ENCYCLOPEDIA

Want to test products, have access to exclusive content, contests and more?

Join our NEW Parent Panel.

Parent Panel

Being a member gives you the very best of ParentsCanada – all for FREE!

JOIN THE CLUB! As a member you will receive: • Product testing for kids and grownups (and you keep the product!)

• Webinars with top parenting experts • Exclusive access to special deals from our retailers • Contests and discounts • Downloadables like our annual Baby & Child Care Encyclopedia book • Our weekly newsletter full of great articles and parenting tips

JOIN today for a chance to WIN a $150 gift card from Toys R Us.

ParentsCanada.com/ParentPanel

EQUIPMENT SAFETY • Always follow manufacturer’s instructions for assembly, installation, use and repair.

• Consumer and Corporate Affairs Canada issues safety guidelines that govern many products for children.

Although these guidelines provide considerable protection, there is no substitute for your own careful inspection and judgment.

TOY SAFETY • Be aware of appropriate toys for each age group.

• Canadian Standards Association (CSA) and Canadian Toy Testing Council can recommend toys for various ages.

• Health Canada publishes advisories, warnings and recalls for toys.

CAR SAFETY • Make sure car seats meet federal and provincial/ territorial legislation.

• Approved child-restraint systems (car seats, booster seats) are required by law.

• Refer to Transport Canada for further information.

102 BABY & CHILD CARE ENCYCLOPEDIA

FIRE SAFETY • Ensure smoke detectors are placed in all areas required by your local fire department or other agency that regulates fire safety in your region.

• A fire escape plan should be practised several times a year.

ICE AND WATER SAFETY • Nearly all drownings of babies occur in bathtubs during a momentary absence of supervision by an adult.

Bathtubs are the secondleading location for drownings of children ages 1 to 2.

• 50% of swimming pool fatalities in residential pools are toddlers aged 1 to 4.

Almost all occur in pools with inadequate safety gates and during the absence of adult supervision • When boating, you must have correctly sized Transport Canada or Canada Coast Guard approved personal flotation devices (PFD) or life jackets on board for each person aboard.

• Ice must be at least 15 centimeters (6 inches) thick to support a person. It should be solid, clear blue and not covered in snow before being walked on.

BITES Care

1. C heck the child’s ABCs (airway, breathing, circulation) immediately.

2. C all EMS if there is severe bleeding or if the bite was caused by an unfamiliar animal.

3. I f the incident involved an animal, call your local animal control department. Give animal control the exact location of where the bite occurred.

4. I f the wound is minor, wash it with soap and water, control any bleeding and put a dressing on the wound.

5. W atch for signs of infection. You might notice swelling, redness and warmth around the wound; pain or tenderness in the area of the wound; or pus or discharge. A more serious infection may cause fever or nausea.

6. H uman bites can easily become infected. Be especially careful to wash with soap and water and follow up by seeking medical attention.

INSECT STINGS Care

1. C heck the child’s ABCs (airway, breathing, circulation) immediately.

2. Remove the stinger by scraping it away from the skin.

4. A pply a cold pack to help control swelling. Keep it on for 20 minutes every hour

3. W ash the area thoroughly with soap and water.

5. W atch for signs of an allergic reaction. You might notice rash, itching or hives (raised, itchy areas of the skin); a feeling of tightness in the chest and throat; weakness, dizziness or confusion.

If the child develops an itchy rash, apply calamine lotion and cool compresses.

TICKS Care

1. Check the child’s ABCs (airway, breathing, circulation) immediately.

2. I f the tick hasn’t started to dig into the flesh, remove it by brushing it off the skin. If it has started to dig into the flesh, grasp its head with tweezers and pull it out.

3. W hen the tick is out, wash the area with soap and water. Use an antibiotic ointment to prevent infection.

4. If you cannot remove the tick, the child needs a doctor.

CHAPTER 8: SAFETY AND FIRST AID 103

6. I f a rash or flu-like symptoms develop within a month of the tick bite, the child may have Lyme disease and requires medical attention immediately.

LYME DISEASE

Lyme disease is caused by a bite from an infected tick.

Early symptoms

• A rash in a small red area at the site of the bite that spreads up to 13 to 18 centimetres (5 to 7 inches) across.

• Fever, headache, weakness and joint and muscle pain that may feel like the flu.

Later symptoms (weeks or months after the bite) • Arthritis, numbness or a stiff neck • Memory loss • Irregular or rapid heartbeat • Problems seeing or hearing • High fever

BLEEDING, CUTS AND SCRAPES Care

1. Check the child’s ABCs (airway, breathing, circulation).

2. P ut on a pair of gloves. If gloves are not available, use another barrier between your hand and the wound. There is usually minimal bleeding with scrapes, but if there’s blood, put direct pressure on the wound until bleeding stops. If possible, have the injured child apply the direct pressure.

3. W ash the wound thoroughly with soap and water.

4. Blot the area dry with sterile gauze.

5. Cover the wound with sterile non-stick dressing.

6. W atch for signs of infection. If there is a great deal of dirt or contamination in the wound, seek medical attention.

If the blood soaks through the dressings, add more dressings on top.

If you cannot control the bleeding, make sure the person gets medical attention immediately.

CPR

The process for CPR varies depending on the age of the child. Read on for how to perform this procedure as your child ages.

104 BABY & CHILD CARE ENCYCLOPEDIA

GIVING CPR TO YOUR BABY Begin CPR immediately if your baby is unresponsive and not breathing, not responding to touch, not moving or showing signs of alertness. If you’re not alone, ask someone to call 911 and get an automated external defibrillator (if available) while doing CPR. If you’re alone and have a smartphone, put it on speaker and start CPR while calling 911. If you’re alone and don’t have access to a phone, start CPR for 2 minutes and then call 911 from a landline.

1. Begin CPR by laying your baby down on a firm, flat surface. Do not spend time trying to find a pulse. Place your 2 fingers on the breastbone, just below the nipple line. Give your baby 30 quick chest compressions (push fast), pressing hard enough so their chest moves approximately 4 centimetres (1.5 inches) down (push hard).

2.

Count out loud. You should deliver about 100 to 120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your baby’s brain and other vital organs.

3.

After the first 30 chest compressions, place the palm of your hand on your baby’s forehead. Place 2 fingers on the hard, bony tip of their chin and gently tilt their head back. This will open the airway. Pinch your child’s nose and place your mouth over their mouth and give 2 breaths. Each breath should be just enough to make your child’s chest rise and should be no more than 1 second in length. Make sure you see your child’s chest rise with each breath.

4.

Give cycles of 30 chest compressions and 2 breaths during 2 minutes and repeat until the ambulance arrives or your baby starts breathing again. Two minutes usually allow for 5 cycles of 30 chest compressions and 2 breaths. A 2-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every 2 minutes.

5. Once your baby has recovered and started breathing again on their own, your baby may vomit and find it difficult to breathe. Simply put your baby in the recovery position: Their chin should point slightly away from the chest and their face should rest on the surface on which the baby is laying. Make sure nothing is blocking or covering your baby’s mouth and nose. The recovery position will help keep your baby’s airway open.

CPR IN A CHILD (1 TO PUBERTY) Begin CPR immediately if your child is unresponsive and not breathing, not responding to touch, not moving or showing signs of alertness. If you’re not alone, ask someone to call 911 and get an automated external defibrillator (if available) while doing CPR. If you’re alone and have a CHAPTER 8: SAFETY AND FIRST AID 105

smartphone, put it on speaker and start CPR while calling 911. If you’re alone and don’t have access to a phone, start CPR for 2 minutes and then call 911 from a landline.

1.

Begin CPR by laying your child down on a firm, flat surface. Do not spend time trying to find a pulse. Place the heel of 1 or 2 hands over the lower third of your child’s breastbone and give them 30 quick chest compressions (push fast). Be sure to push hard enough so their chest moves approximately 5 centimetres (2 inches) down (push hard).

2. Count out loud. You should deliver about 100 to 120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your child’s brain and other vital organs.

3.

After the first 30 chest compressions, place the palm of your hand on your child’s forehead. Place 2 fingers on the hard, bony tip of their chin and gently tilt their neck back. This will open your child’s airway.

4. Pinch your child’s nose and place your mouth over their mouth and give 2 breaths. Each breath should be just enough to make your child’s chest rise and should be no more than 1 second in length.

Make sure you see your child’s chest rise with each breath.

5. Give cycles of 30 chest compressions and 2 breaths during 2 minutes and repeat until the ambulance arrives or your child starts breathing again. Two minutes usually allow for 5 cycles of 30 chest compressions and 2 breaths. A 2-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every 2 minutes.

6.

Once your child has recovered and started breathing again on their own, put them in the recovery position until help arrives. The recovery position will help keep your child’s airway open and prevent them from choking on their own vomit. If your child vomits, wipe it away.

Make sure nothing is blocking or covering their mouth and nose.

CHOKING BABY UNDER 1 YEAR Note If a baby is too heavy or large to support with your forearm, treat the baby as you would treat a choking child.

• If a baby is coughing or gagging, the choking is mild. Do not interfere.

• If the baby is making high-pitched noises, wheezing, can no longer make a sound or becomes too weak to cough, have someone call EMS and care for the baby.

Care

1. S andwich the baby between your forearms, supporting the head.

2. Turn the baby face-down with the head lower than the body.

106 BABY & CHILD CARE ENCYCLOPEDIA

3. Lower your forearm onto your thigh. With the heel of your hand, deliver 5 firm back blows between the shoulder blades.

4. I f the object has not been dislodged, while still supporting the head, turn the baby face-up, with your arms supported on your thigh.

5. P lace 2 fingers on the middle of the chest just below the nipple line and push hard and fast at least 4 centimeters (1.5 inches) or 1/3 to 1/2 the depth of the chest 5 times.

6. R epeat the 5 firm back blows in 5 chest thrusts until the object is coughed up, the baby starts to cry, breathe or cough, or he or she becomes unconscious.

7. Continue until EMS personnel arrive.

8. I f the baby becomes unconscious, follow the steps for unconscious choking baby below.

UNCONSCIOUS BABY (UNDER 1 YEAR) CHOKING Care

1. S tart chest compressions: • Place 2 fingers on the middle of the nipple line • Do 30 compressions. Push hard and push fast.

• Allow the chest to recoil after each compression.

2. G ive 1 rescue breath: • Tilt baby’s head and lift the chin.

• Take a normal breath.

• Cover the baby’s mouth and nose with your mouth.

•G ive 1 breath lasting 1 second, with just enough volume to make the chest start to rise.

3 If the baby’s chest does not rise after the first breath, perform the head tilt/chin lift again.

4. A ttempt to give another breath. If your breath still does not go in, go to Step 6. If your breath does go in, give a second breath.

5. W hen both breaths go in, and there is no obvious response to your breaths, start CPR sequence of 30 compressions and 2 breaths.

6. R epeat the cycle of 30 compressions, then look in the mouth: • Grasp the tongue and lower jaw and lift.

• If you do not see an object, return to Step 2.

• If you see an object, remove it. Turn the head to the side, slide your finger down the side of the cheek to the base of the tongue, and try to sweep the object out. When it is removed, return to Step 2.

CHAPTER 8: SAFETY AND FIRST AID 107

7. C ontinue CPR until: • An AED arrives • The scene becomes unsafe • You become physically unable to continue

Note After you reposition the head and attempt to give a second breath once, you do not need to repeat the repositioning step between chest compressions cycles. If there is any change in the baby’s condition during the CPR sequence, stop and check the baby’s ABCs. And if there are 2 people who can assist present, they should alternate every 5 cycles (about 2 minutes).

CHOKING CHILD (1 TO 8 YEARS) Note To determine if choking is mild or severe ask, “Are you choking?” If the child can speak, cough or breathe, it is mild choking.

Care

1. E ncourage the child to continue coughing and do not interfere. The obstruction might clear itself.

2. I f the child is unable to speak, cough or breathe, or is wheezing or making high-pitched noises, it is severe choking: •S tand (or kneel for a small child) behind the child and wrap 1 arm diagonally across the child’s chest.

• B end the child forward at the waist until the child’s upper airway is at least parallel to the ground.

• W ith the heel of your hands, deliver 5 firm back blows between the shoulder blades.

3. If the object has not been dislodged, make a fist and place it just above the child’s belly button.

• P lace your other hand over your fist and pull sharply in and up, doing 5 abdominal thrusts.

• C ontinue the cycle of 5 firm back blows and 5 abdominal thrusts until the object comes out or the child begins to breathe or cough or becomes unconscious.

4. I f the object comes out, ensure the child is able to breathe easily again.

5. Provide continual care and seek medical attention

6. If the child becomes unconscious:

• S upport the child to the ground protecting the head and placed the child on his back. Recheck the child’s ABCs. • C all EMS, get an AED and follow the steps for unconscious choking child on the next page.

Note To deliver effective back blows, you may need to stand behind and slightly to the side of the child rather than directly behind the child.

108 BABY & CHILD CARE ENCYCLOPEDIA

UNCONSCIOUS CHOKING CHILD Care 1. Start trust compressions: • P lace the heel of 1 hand on the middle of the child’s chest.

Place the other hand on top.

• D o 30 compressions.

• A llow the chest to recoil after each compression.

2. Give 1 rescue breath: • O pen the airway using the head tilt/chin lift.

• P inch the child’s nostrils closed.

• T ake a normal breath.

• C over the child’s mouth with your mouth.

• G ive 1 breath lasting 1 second, with just enough volume to make the chest start to rise.

3. If the child’s chest does not rise after the first breath, perform the head tilt/chin lift again, tilting the head farther back and attempt to give another breath.

4. If your breath still does not go in, go to Step 6. If your first breath goes in, give a second breath.

5. When both breaths go in, and there is no obvious response to your 2 breaths, start the CPR sequence of 30 compressions and 2 breaths.

6. R epeat the cycle of 30 compressions, then look in the child’s mouth.

• G rasp both the tongue and lower jaw and lift.

• I f you do not see an object, return to Step 2 • I f you can see an object, remove it. Turn the head to the side, slide your finger down the inside of the cheek to the base of the tongue, and try to sweep the object out when the object is out of the child’s mouth, return to Step 2.

7.

Continue CPR until: • A n AED arrives • M ore advanced care takes over • T he scene becomes unsafe • Y ou become physically unable to continue Note: If your breath does not go in, go back to compressions. After you reposition the head and attempt to give a second breath once, you do not need to repeat the repositioning step between chest compression cycles. If there’s any change in the child’s condition during CPR, stop and check the child’s ABCs. CHAPTER 8: SAFETY AND FIRST AID 109

BROKEN BONES

Bone, muscle and joint injuries are almost always painful. Without first aid, they can lead to serious injuries and even permanent disabilities. In some cases, they can be life-threatening. Signs of a break include: • Pain • Deformity • Swelling • Bruising

• Limited use of, or an inability to move, the injured body part due to pain

• Broken bone or broken fragments sticking out of a wound • Sensation or sound of bones grading • Possible muscle cramps • Shock • The sound of a snap or a pop when the injury happened General care is the same for all bone, muscle or joint injuries. You do not need to know the specific injury.

Call EMS when:

• There is a problem with the ABCs. • The injury involves the head and or neck.

• The injury makes walking difficult.

• You suspect that there may be more than 1 injury.

• There are injuries to the thigh bone or pelvis.

• The child has an altered level of consciousness.

Though you may not need to call 911 for a potential broken bone, a hospital visit is in order. Head to the emergency room for immediate diagnosis and treatment. The ER care team will advise you on follow-up care depending on the injury.

CHEMICAL BURNS

1. Ensure the child’s ABCs are present.

• W ear protective equipment and brush off excess dry chemicals.

• F lush with large amounts of cool running water for at least 15 minutes.

• R emove any clothing covered in chemicals from the child.

2. Refer to the appropriate material safety data sheets (MSDS) or call your local poison control centre. Seek immediate medical attention.

110 BABY & CHILD CARE ENCYCLOPEDIA

HEAT BURNS

This is any burn caused by overexposure to excessive heat, such as fire, steam and sun.

Care

1. Ensure the child’s ABCs are present

3.

Depending on the severity of the burn, you will decide on the course of treatment. Mild burns cause redness and swelling and can be treated at home, with an over-thecounter pain reliever, antibiotic ointment and vigilance for signs of infections. More severe burns may require emergency attention. A second-degree burn may blister in addition to causing pain, but if it’s a small burn, it can also be treated at home. A large second-degree burn may require further medical attention. Third-degree burns always require emergency medical care, such as calling 911, as they involve all levels of skin and fat. They may even involve muscle and bone. With third-degree burns, the injured may not feel pain because the nerve endings have been destroyed.

2.

Cool the burn with running or standing water for at least 10 to 20 minutes. If the standing water becomes warm, add more cool water.

With all electrical burns, call for an ambulance and look for possible entry and exit burns that may need treatment. Carefully watch for breathing problems.

ELECTRIC SHOCK

Do not touch the child until the power has been switched off.

Care

1. Ensure the child’s ABCs are present. Electricity and lightning may affect the heart, so monitor the ABCs closely.

2. Treat the child as if he or she has a head and/or spine injury. Stabilize the child’s head and neck by placing your hands on either side of the child’s head. Gently support the child’s head in the position in which you found it until EMS personnel arrive.

3.

If the child is wearing a helmet, leave it on unless it makes it difficult for you to ensure the child’s ABCs are present.

4.

Provide continual care until EMS personnel arrive.

5. L ook for 2 burns (an entry point and an exit point). They will be open wounds that need to be treated.

CHAPTER 8: SAFETY AND FIRST AID 111

HYPERVENTILATION What to look for

• Uncontrolled gasping for air • Dizziness • Panic • Anxiety Care

1. Ensure the child’s ABCs are present.

3. P lace the child in the recovery position so that blood can start flowing to the brain and the airways stays open. Then watch the child’s breathing closely.

4. Provide continual care until EMS personnel arrive.

2. C omfort the child. Encourage the child to take long, slow breaths and holds the breaths before breathing out slowly.

INHALED POISONS What to look for

• Breathing difficulties • Irritated eyes, nose, throat • Dizziness • Vomiting • Seizures • Unusual smell in the air • Blueish colour around the mouth • Unconsciousness Care

1. Ensure child’s ABCs are present.

3. G et the child into fresh air, but do not enter the hazardous atmosphere yourself to do so. Wait for EMS in this case.

4. P rovide continual care on the advice of medical professionals.

2. Call EMS and call your local poison control centre if the child has an altered level of consciousness or has difficulty breathing.

ABSORBED POISONS What to look for • Burns • Rash • Itching, burning • Blisters 112 BABY & CHILD CARE ENCYCLOPEDIA

• Unconsciousness • Swelling • Hives (raised, itchy areas of skin) Care

1. Ensure the child’s ABCs are present.

3. S eek medical attention and provide continual care.

2. R emove the substance from the skin. Flush the skin with large amounts of water for at least 15 minutes. To prevent any further injury, make sure the water flushes away from any unaffected areas.

INGESTED POISONS What to look for

• An open container of poison nearby • Burns around the mouth • Increase production of saliva and or saliva that isn’t abnormal colour • Seizures • Abdominal cramps and vomiting • Dizziness and or drowsiness • Unconsciousness • Diarrhea • A burning sensation in the mouth, throat or stomach Care

1. Ensure the child’s ABCs are present.

2. C all your local poison control centre and take their advice.

If advised, have someone drive you and the child to the hospital. Take the container or a sample of the poison in any vomit with the child to the hospital. If the child has an altered level of consciousness or difficulty breathing, call 911.

Note Never induce vomiting if the child is unconscious, having seizures or has swallowed a corrosive or petroleum product. Give water or milk or induce vomiting only if directed to by EMS or the poison control centre.

CHAPTER 8: SAFETY AND FIRST AID 113

“

THE MORE RISKS YOU ALLOW YOUR CHILDREN TO TAKE, THE BETTER THEY LEARN TO LOOK AFTER THEMSELVES.

Roald Dahl

chool: s e Pr rs 5 Yea o t 3

Newborn Grow th

chapter 9

Th Fir e st Yea r

milestones, charts and checklists ge ool-A h c S Yea rs

K Rea inderg di n e a rt e ss Ch n ec kli st

First things first: All kids move at their own pace, and comparing your kids to others is a fast-track to Worrytown. That being said, it’s always a good idea to have a sense of the milestones on the horizon so you can reach out for help if you’re concerned (because there is absolutely no shame in asking for advice at any stage of the pregnancy and parenting journey). We’ve rounded up some of the basic milestones you’ll want to watch out for as your little one grows and changes.

THE NEWBORN YOUR NEWBORN’S GROWTH Weight Most newborns lose about one tenth of their birth weight in the first week and reach their birth weight again by the second week. After that, your baby’s weight will increase quickly.

Length Boys tend to be a little heavier and longer than girls and they grow a little faster.

Head Your baby has a diamond-shaped soft spot in the middle of their skull and a little toward the front. (The skull bones will not fuse in that spot until about six to 10 months.) If your little one was born vaginally, the skull may look misshapen at birth, but soon will have a normal shape. Any bruising or swelling that happened during birth will disappear.

Body Your baby was curled up in the womb. Their legs may appear bowed, but gradually will straighten out over the next few months.

YOUR CHILD’S DEVELOPMENT Even as newborns, the personalities of children shine through.

You will learn to “read’ and enjoy your newborn’s personality and adjust to it—just as your newborn adjusts to you. Some things to know: Your baby can see and is attracted to bright colours and patterns. Babies can hear and are interested in high-pitched sounds, but also soft voices. They are sensitive to smells, such as milk. You will start to see and gauge their reactions to all manner of stimuli.

Movements Newborns can move their arms and kick their legs— especially when they cry. If they lie on their bellies, they instinctively turn their heads to the side so they can breathe. If you put your finger in your baby’s hand, the baby will grasp the finger tight, as a reflex.

Language Newborns are visibly content when they have been fed and feel comfortable. They can make soft sounds, too—and of course they cry when they are hungry, cold, wet or experience some other discomfort.

Watch your newborn. You will learn to understand your child’s signals, which are the start of communication.

116 BABY & CHILD CARE ENCYCLOPEDIA

THIS IS

ISA EL YOUR CHILD MAY BE MISSING PROTECTION FOR MENINGITIS B* EVEN IF THEY RECEIVED A MENINGITIS VACCINE Ask your child’s doctor about meningitis B* and vaccination.

Vaccination may not fully protect all people who are vaccinated and does not treat infection or reduce the risk of complications.

Side effects and allergic reactions may occur. Ask your healthcare professional if vaccination is right for your child. *Meningococcal disease caused by Neisseria meningitidis group B strains.

Copyright 2020. Brought to you by one of Canada’s leading healthcare companies. All Rights Reserved.

04766 10/21

missingB.ca

WHO GROWTH CHARTS FOR CANADA From your baby’s first doctor’s appointment on, your child’s primary care provider will consult the WHO Standard Growth Charts to measure and track height and weight. The curve plotted helps the doctor determine if growth is happening at a consistent rate for your child.

For more on these charts, check out the Canadian Paediatric Society’s resource page at cps.ca/tools-outils/who-growth-charts.

118 BABY & CHILD CARE ENCYCLOPEDIA

THE FIRST YEAR YOUR CHILD’S GROWTH Weight A baby’s weight usually doubles by the fourth month—and then triples by the end of the first year.

Height Babies are about 70 centimetres long when they reach 12 months.

Head Their head size increases quickly due to the brain’s fast growth, which pushes the skull bones outward in order to expand.

CHAPTER 9: MILESTONES, CHARTS AND CHECKLISTS 119

This growth rate is only a guide. If parents are unusually large or small, the baby may follow their growth pattern—and if the baby was smaller at birth for any reason, growth may remain smaller or show spurts. Call your doctor if your baby does not gain weight, or appears to lose weight over a period of days.

YOUR CHILD’S DEVELOPMENT Babies progress slowly to gain control over their movements.

Neck Your baby’s muscles become progressively stronger, and they will have full control over neck and head motions by about six months.

Body Their body muscles become stronger and can control many movements.

• By three or four months, babies can roll over, belly to back.

• By four months, they can roll from back to belly.

•B y six to seven months, your baby can sit for a few moments (with legs spread apart).

•B y eight to nine months, the baby can sit steadily and change position from sitting to getting on the floor and back again.

Arms and Legs Movements become stronger and more purposeful.

•A round five months, your baby will be able to straighten their legs when they lie on their back.

•A round six months, their legs come up so far that your baby can get hold of a foot and bring it to their mouth.

•A round eight to nine months, your infant can make crawling motions to move on the floor commando-style.

•A round 10 months, arms and legs are strong enough to help your baby creep on hands and knees and pull to stand.

•A round 10 to 11 months, your baby may cruise around the crib or coffee table while holding onto it.

•A round 12 months, your baby may take their first steps.

Hands In the first 12 months, there is a fascinating progression from reflex grasping to precise reaching out and grasping actions.

•A round three to four months: Your baby will reach out to grasp a toy

•A round six months: Your little one will hold a rattle or toy and is able to pass it from one hand to another.

• Around seven months: They will try to get hold of small items.

•A round eight months: They can pick up very small items with their whole hand.

120 BABY & CHILD CARE ENCYCLOPEDIA

•A round nine months: They will pick up small items with their thumb and the rest of the hand.

•A round 11 to 12 months: They can pick up items with the tip of thumb and forefinger, called the pincer grasp.

SPEECH AND LANGUAGE Babies have an urge to make sounds and show an interest in the sounds parents or others make.

•A round one or two months: Your baby recognizes and pays special attention to your voice. As muscles of the lips, tongue and other mouth muscles develop, your baby will make more advanced sounds, cooing, squealing.

•A round two to three months: They will start to make more sounds when you talk to them. It’s like the beginning of a conversation.

•A round eight months: They start to make “Mama” and “Dada” sounds, but they don’t really make the connection between the sound and the person.

•A round nine to 10 months: They will use these sounds as special signals to call for you, or to greet people who come to see them.

•A round 12 months: Your baby will likely have other sounds that have meaning, like “ba” for bottle and “do” for dog. Just by the tone of your baby’s sounds, you will learn if they are pleased, lonely, angry or need comforting.

By 12 months, your baby understands several names of people or objects and shows understanding by looking at the person or object.

Your baby understands tone of voice, too, and will frown if your voice is louder or sharper. Consult a physician if your baby does not show interest, does not turn their head to sounds and if your baby’s own sounds do not seem to progress.

EMOTIONAL DEVELOPMENT Between the second and seventh month, your baby will connect that there are very special people in their life who are always there when needed.

Between the fourth and 12th month, your baby discovers that those special people are separate but can be communicated with through looks, touch and play. At one year, your baby is moving around, can get ahold of things, and start to communicate by changing facial expressions and making gestures and sounds.

Observe that your baby is alert, smiles, looks at and plays with you —and may show some distress when you leave (and also may “make strange” when meeting new people).

CHAPTER 9: MILESTONES, CHARTS AND CHECKLISTS 121

COGNITIVE DEVELOPMENT Babies are curious to see, hear and touch. As the months go by, their eyes follow people as they move around. Babies also learn to scan for sounds— at the beginning with eye movements and later by turning their heads.

As soon as they can grasp, they can get ahold of anything that is nearby; they will look at what they’re holding, put it in their mouth, shake it, bang it, throw it and pass it from one hand to another.

If a toy they like is hidden, they will remember and search for it where they last saw it (like toy peek-a-boo!).

They will often bang two toys together or try to fit one toy inside the other.

For more on newborn and baby development, see Chapter 2.

TODDLER: 1 TO 3 YEARS YOUR CHILD’S GROWTH Your baby’s growth rate—both height and weight—will begin to slow after the first year. Their head will reach about 90 percent of its adult size.

Their arms and legs get longer and more muscular. Their feet start to point more forward and their sweet face loses some of the baby fat.

YOUR CHILD’S DEVELOPMENT Walking Walking becomes steadier and faster with their feet closer together.

• By 24 months, they will likely run with good balance.

Climbing A toddler will start to climb stairs on all fours by around 13 months.

• By 15 months: They can climb stairs on hands and knees.

• By 15 to 18 months: They are experts at climbing on low furniture.

• By 18 months: They can walk up stairs with some assistance.

• By 21 months: They can walk down stairs if their hand is held.

•B y 24 months: They can go up and down, holding on to the railing or wall.

• By 30 to 26 months: They can negotiate stairs by alternating feet.

Other Movements Around 24 months, toddlers can jump with their feet off the floor and can kick a ball.

• By 30 months: They can jump down from a low chair or step.

• By 36 months: They can pedal a tricycle.

LANGUAGE A toddler tends to repeat words that others say, but it may take some time for them to connect the word to the meaning.

• Be aware that children understand more than they can say.

• Early in the second year, a child will understand a number of words.

122 BABY & CHILD CARE ENCYCLOPEDIA

•B y 18 months: They will understands directions such as “come here” or “give to me” (although they may frequently choose not to follow the direction).

•B y 24 months: They understand more difficult directions, such as, “Put the ball on the table” or “Give the ball to Daddy”.

• By 36 months: They will understand questions like, “What is your name?”

EMOTIONAL SKILLS In some ways, toddlers are like adolescents—going through the intense emotions of learning to be and act on their own, asserting themselves and using their own judgment in new situations. When your child ventures away from you, like walking to the other end of the room, it is an experience similar to a long trip for a grown-up.

•T oddlers are delighted and scared at the same time.

•T hey try to escape you but will look back to be sure you’re there.

•T hey want to test their own will and act contrary to your wishes.

• They have intense fits of frustration when obstacles stand in their way.

For more on toddler development, see Chapter 3.

PRESCHOOL: 3 TO 5 YEARS YOUR CHILD’S GROWTH Measure your child’s growth every six months, using your bathroom scale for weight and a tape measure for height. Ask your child to stand straight with their back against the wall. Then hold a book on top of your child’s head and make a pencil mark at the level of the lower cover of the book.

Then use the tape measure to measure their height.

Your preschooler’s appearance will change and you may have a glimpse of what your child’s face and physique will be as a grown-up.

YOUR CHILD’S DEVELOPMENT Improved balance and coordination help the preschooler try more difficult exploits: hopping, jumping, big jumps forward, balancing well on one foot, running, skipping and climbing monkey bars.

It can be a lovely keepsake of your kid’s childhood to have a place where your little one’s height is marked in your home. If you’re renting a home or want to be able to take the growth chart with you when you move, many companies make adorable charts that can be affixed to the wall and easily removed when necessary.

CHAPTER 9: MILESTONES, CHARTS AND CHECKLISTS 123

At this age, many parents introduce their preschoolers to the sports they themselves enjoy: swimming, skating, skiing, or imitating hockey and baseball motions with their parents or similarly aged friends.

Team sports can be a challenge at this age but kids can work on the individual skills they will need when they are an appropriate age to try playing on a team.

Hand to eye coordination is also progressing quickly at this age.

Preschoolers throw and bounce balls. They are likely able to string beads, cut with scissors and hold crayons with their thumb and two fingers. By now, most children are showing their hand preference very clearly. Do not attempt to change it.

LANGUAGE AND COMMUNICATION Preschoolers can produce long and complex sentences and they ask questions beyond “what.” Now it is “why,” “when,” and by the end of this period, “how.” By now, they can use past and future forms of speech. They start to give a beginning, middle and end to what they are saying. Their stories may sometimes be a mix of facts and fantasy as your child’s imagination grows.

Consult your doctor if

• Your child’s speech is unclear to you or to others.

• Your child has a small vocabulary.

• Your child does not seem to understand what you say.

• Your child is not able to form long sentences.

• Your child cannot express thoughts or feelings.

Stuttering Around four years of age, many children start to stutter. In most cases, stuttering at this age will improve. A physician only needs to be consulted if the stuttering persists for more than a couple of months and interferes with your child’s attempts to communicate.

COGNITIVE DEVELOPMENTS Your child will learn to understand and draw simple shapes, as well as learn about—and try to draw—the shape of a body and its parts.

Children learn that their names consist of sounds that can be put down on paper. They can count by rote, but they don’t really understand the meaning of numbers, such as 10 being more than five.

EMOTIONAL DEVELOPMENT By now, your child decides it is safe to be away from you for a little while.

They can tolerate separation from their parents and use other grownups, such as teachers, as substitutes for parents. They are also used to meeting and being with peers in play groups, drop-in centres, nursery schools and daycare centres.

124 BABY & CHILD CARE ENCYCLOPEDIA

The crucial factor in being ready for school is the ability to separate from parents and relate to other adults and peers. If your preschooler is secure, peer relationships will be explored that require skills like taking turns, sharing, being a leader or taking another child’s lead.

Nipissing District Developmental Screen The NDDS is often touted as the Canadian standard for milestone assurances. The NDDS is a series of checklists designed to give parents a sense of whether their child is hitting age-appropriate developmental milestones, and, should there be a concern, directing parents when to have their child seen by a paediatrician or GP. Parents can register for monthly prompts up to 30 months, and then yearly prompts up to age six, at lookseechecklist.com.

SCHOOL YEARS: 6 TO 10 YEARS YOUR CHILD’S GROWTH Boys and girls grow at about the same rate between five and 10 years old.

Girls may be a little heavier. Boys tend to be more muscular and girls tend to have slightly more fat.

YOUR CHILD’S DEVELOPMENT The motor coordination of the school-age child is fast getting to be like an adult. If children have the inclination and opportunity, they can tackle most sports and activities, such as basketball, baseball, dancing, karate or gymnastics.

Your child will gradually perfect paper and crayon or pencil skills. By now, a child can do arts and crafts with dexterity, which helps develop concentration, patience and perseverance.

LANGUAGE AND COMMUNICATION School-aged children usually have excellent memories and the capacity to absorb new information. By now, your child’s skills take a new form— written communication. Reasoning about people and events develops, as well as a need to explain what happens and why. These explanations may not always be accurate, but they are refreshingly inventive!

EMOTIONAL DEVELOPMENT School-age children enjoy one of the most stable periods of their development.

By now, your child has established self-regulation, has friends, has selected activities they enjoy and has a sense of purpose through school learning and other regular extracurriculars.

CHAPTER 9: MILESTONES, CHARTS AND CHECKLISTS 125

Let kids try a variety of activities until they really land on something they’re passionate about. Some communities have multisport or multi-activity programs that allow kids to try a number of different things over the duration of the course. These programs are great for being active and social and to home in on what your child may want to pursue more selectively.

KINDERGARTEN READINESS CHECKLIST

For some kids, school is an exciting milestone they can’t wait to experience (especially if they have older siblings, cousins or friends who go to school and rave about their teachers, the playground and more).

But for other kids, kindergarten looms large and may be a little scary.

With this in mind, we’ve rounded up some ways parents can help ensure their kids are ready for the classroom.

A Note for Parents There are academic skills you can work on at home in the months leading up to the start of kindergarten, of course, but if your child doesn’t know how to print the alphabet or recognize sight words on the first day of school, don’t panic. Work on selfregulation, instruction- and rule-following, social interactions and taking responsibility for themselves and their belongings. The ABCs and 123s come second.

LIFE SKILLS Your child knows their first and last name and can recognize it in print.

Your child is toilet-trained and can (for the most part) manage their own clothing during bathroom breaks.

Your child can identify their shoes/boots and outdoor clothing and knows how to button, buckle, zip and fasten.

Your child can open lunch containers and feed themselves.

Your child understands authority and can abide by rules with little reminding.

Your child can follow instructions and ask for help if needed.

Your child can use words like please, thank you and you’re welcome.

Your child understands and handles transitions between activities with little difficulty.

Your child tries to self-regulate and articulate their feelings in words.

Your child can play cooperatively with others (most of the time…).

Your child is excited by learning new things and accepts that they will sometimes make mistakes (and that it’s okay and even encouraged!).

126 BABY & CHILD CARE ENCYCLOPEDIA

CLASSROOM BASICS Your child can identify colours.

Your child can recognize the difference between numbers and letters.

Your child can identify how objects are the same and different.

Your child can hold a crayon or pencil correctly.

Your child can cut with scissors.

Your child can do an age-appropriate puzzle.

LITERACY BASICS Your child will sit and listen quietly to a story, following the plotline.

Your child will look at the pictures in a book independently.

Your child can put the events of a story timeline in chronological order.

Your child can explain what happens to a character and how they might feel.

Your child can draw pictures to tell a story.

Your child scribbles or imitates letters as “writing.”

Your child asks you to write notes to others and can dictate what they want to say.

NUMERACY AND MATHEMATICS BASICS Your child can make more-or-less comparisons.

Your child can count using one-to-one correspondence (points to each object as they count).

Your child can recognize and name basic shapes.

Your child is starting to notice patterns in their every day environment.

CHAPTER 9: MILESTONES, CHARTS AND CHECKLISTS 127

Parenting: Gotta Love It! Need a friend to help get you through the week?

Sign up for our weekly newsletter (delivered on Thursday nights) with helpful advice, easy recipes, contests and much more.

Plus, receive our Annual Guide for New Parents.

Visit www.parentscanada.com/newsletter

A big thank you to our major sponsors for their support of The Baby & Child Care Encyclopedia:

We would also like to thank the following partners for their added support: