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UPCOMING ISSUES
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Q & A Baby & Toddler Breastfeeding Education Fitness Nutrition Pregnancy
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------ Baby & Toddler My 19-month-old daughter has started to masturbate (or at least it looks like it!). Is this normal? What should I do? Yes, masturbation is very common (and normal) in young children. As a society, we seem to have less trouble with little boys masturbating than girls. It’s really nothing to worry about. If you notice her masturbating, don’t make a big deal about it. You can just gently explain that it is something that she does in private and/or in her room. Some children will start masturbating if they have a diaper rash or irritation. If you suspect this is to be the case, check with her doctor. Dr. Cheryl Mutch, pediatrician Why is it important to fill my child’s cavities if the primary teeth are eventually going to fall out? Untreated cavities in primary teeth can lead to a host of problems. Premature loss of primary teeth resulting from tooth decay may lead to shifting or even blockage of the permanent teeth from erupting in a desirable position. Left untreated, a cavity may become abscessed or infected, posing an overall health risk to your child. Remember, prevention is the key to avoiding early childhood tooth decay. Start introducing oral hygiene to your child as early as six months of age. Encourage good oral hygiene habits by helping your child brush his teeth after every meal. If you suspect your child has a cavity, make an appointment with your family dentist. Dr. Darren Sam, dentist Some moms tell me that candy bribery worked for them when potty training their children. Should I do this with my child? Positive reinforcement is a great way of helping the process along—we all like to please our bosses (and parents)! Rather than candy, I’d suggest a gold star for each successful use of the potty/toilet. After 5 or 10 star, award a prize or treat. Let your child participate in deciding on the treat, but try to stay away from junk food if possible. Most importantly, focus on the positive; even if they aren’t 100 percent successful, focus on what they got right and stay away from punishment. Accidents are part of potty training and shouting or getting emotional will set things back. Dr. Jeremy Friedman, pediatrician How do I introduce my dog to my new baby?The earlier that you can begin to prepare your dog for the arrival of the new “pack member,” the better. Establish rules and boundaries such as making the baby’s room off-limits and practise walking your dog with an empty stroller. When you bring the baby home, introduce the baby’s scent with a blanket first, then allow the dog to “greet” the baby from a respectful distance. Praise and reward whenever the dog is calm and controlled around the baby. Lee Poizer, dog trainer My eight-week-old cries whenever I put him down. So I end up carrying him a lot. Could I be spoiling him? You can't really “spoil” a baby by giving him attention. A parent's instinct is to calm a crying baby so he will stop. That instinct is there for good reason. When a baby cries out of hunger, you feed him. When he cries because he is tired, you try to soothe him to sleep. When he cries because he is startled or afraid, you try to comfort him. If he cries when you put him down, your instinct is to pick him up. Babies are meant to be held and cuddled. When you think of the origins of the behaviour, the crying causes the parent to pick up and thereby protect the baby. I don't think you could call this spoiling. While it may not be possible to always pick up your baby when he cries, I think that whenever possible, the best thing to do is to pick him up, soothe him and enjoy him. The time will come soon enough when he will want to venture out and explore the world. You'll miss the days when a simple cuddle was all it took to make him happy. Dr. Cheryl Mutch, pediatrician I've noticed that my baby has developed a flat spot on one side of his head. Why is this happening and should I be concerned? A flat spot can occur on your baby's head if he is lying in the same position a great deal of the time. It is a condition called positional plagiocephaly and has become quite common since the "Back to Sleep" campaign (which recommends that healthy babies be placed on their backs to sleep) began in the late 1980s. It is essentially a cosmetic issue and will likely improve over time as your baby gets older and begins moving around more in his crib. It can be prevented by changing the position of the baby in the crib (i.e. every other day, place your baby in the crib so that his feet are where his head was the night before). Your baby will then likely turn his head so that he is facing the room. Occasionally, flattening of the head can occur if the baby has trouble turning his head in one direction because of a tightened neck muscle. This is called torticollis and usually resolves with physiotherapy. Another, less common reason for flattening of the head is called craniosynostosis and occurs when the skull bones fuse together too early in development. This condition is usually diagnosed with an x-ray and requires surgery. It's best to consult with your doctor if you notice flattening of your baby's head. Dr. Cheryl Mutch, pediatrician I have a two-and-a-half-year-old who on some days is a great eater and on other days, will only have milk and Cheerios. It is very inconsistent and sporadic. Should we be giving him a vitamin supplement? If so, which one? I have looked at some brands, but they all seem to contain sugar or aspartame. Also, I noticed that only the Flintstone vitamins say that they are for children aged two and up. While we would prefer that he have food over a pill, some days it's not always possible. Generally speaking, most toddlers will eat a well-balanced diet when they are offered healthy choices. Having said that, it is true that many will go on food "jags" that can last for days (sometimes even longer). You should be looking at the big picture where your two-year-old is concerned. If he eats well most days, then chances are that he is getting the nutrients that he needs (assuming he's not drinking too much milk and juice over solid foods). Check with your doctor if you're worried about his weight gain. If you want extra insurance for those days when he doesn't eat much, you can offer a pediatric multivitamin. The chewable vitamins have to be sweetened with something in order to make them palatable. Remember that a two-year-old is not capable of swallowing a pill whole the way an adult can. In order for him to chew it, it has to taste good, thus the added sugar or aspartame. There are liquid vitamin supplements available but they, too, are sweetened. Dr. Cheryl Mutch, pediatrician Nipple confusion is a term that is used to describe the infant who has a preference for one type of feeding over another. It is usually used to describe the infant who prefers to suck from a bottle rather than the breast. The more appropriate term would be "nipple preference." Nipple confusion can occur in the infant who receive bottle feedings soon after birth. This can occur if the mother is too sick or unable to breastfeed for other reasons. When the baby is given frequent bottle feeds, he may have a difficult time transitioning over to the breast. It seems as if some babies are more susceptible to nipple confusion than others. It's not easy to predict which babies will develop nipple confusion although it is said that babies who were deprived of oxygen during the birth process are more likely to develop it. Nipple confusion can be prevented by avoiding bottles feeds as much as possible, especially while breastfeeding is being established. Try cup, syringe or finger feeds or a supplemental nursing system if the baby is unable to feed directly from the breast. It's likely that an occasional bottle-feed will not result in nipple confusion, but one can never really know for sure. When all is said and done, bottle-feeding should be avoided in breastfed infants at least during the early weeks in order to avoid nipple confusion. Dr. Cheryl Mutch, pediatrician My 18-month-old son wriggles and screams every time I try to brush his teeth! What can I do? Brushing a toddler's teeth can be the true test of a parent. Most children don't put up much of a fuss but some absolutely hate it. Many of these children have an exaggerated gag reflex and tooth brushing can be very unpleasant for them. Having said that, brushing twice daily is what I consider to be a "non-negotiable" - almost on par with using carseats and sunblock. Start brushing your baby's gums before the first incisors appear. Once they appear, you can begin using toothpaste. The Canadian Dental Association recommends not using fluoridated toothpaste until your child can spit it out. Children under the age of six years require adult help with brushing. Start with a soft child-sized toothbrush. Smear a bit of toothpaste (about the size of half a pea) across the bristles. Toothpastes flavoured for kids are a major advance as adult tooth pastes are "too spicy" (as my three-year-old puts it) and most kids just don't like the flavour. Have your child stand in front of you, facing away from you. Tip his head back so you can see inside his mouth. Gently brush just a few teeth at a time and then give him a break, then brush a few more and give him another break until you've covered them all. Other "tricks" include giving him his own toothbrush and taking turns brushing his teeth (no toothpaste required on his brush). You can also talk to him about how you're "gonna get those sugar bugs" - a child's imagination can be a wonderful thing! Dr. Cheryl Mutch, pediatrician My one-year-old has caught a cold twice so far, and each time, his coughs sound like barking. What should I do to relieve him? Could it be croup? A barky cough in a one-year-old child could well be croup. Croup is a specific respiratory syndrome caused by certain types of cold-type viruses. It is more common during the winter months (cold and flu season). Often the child will go to bed feeling perfectly well and will awaken several hours later with a distinctive barking or "seal-like" cough and stridorous or noisy breathing.He may also have a runny nose, fever and a hoarse voice. If the cough and stridor are severe enough, you may find yourself off to the emergency room only to find that when you get there, your child seems well again. This is common. If your child is still distressed when you get to the hospital, he is likely to get a dose of a steroid medication and some inhaled epinephrine. Most children who end up in the ER with croup do not need hospital admission and are discharged within a few hours. Occasionally, if the croup is severe the child will need hospital admission and rarer still, ventilatory support. At home, if the cough is not severe and the breathing does not seem too laboured, try steaming up the bathroom or turn on a humidifier at the bedside. Taking your child outside into the cool air can help too. If he looks pale or bluish in colour, or it he seems as if he is working very hard to breathe, go to the hospital to have him checked. It's important to note that other things can cause a barky cough as well, such as asthma or an inhaled foreign body (for instance if a food particle got caught in his windpipe). Congenital differences in the windpipe and other airway infections can also cause a barky cough. If it's severe, recurrent or persistent, make sure you see a doctor Dr. Cheryl Mutch, pediatrician How old is too old to not be toilet-trained? My two-and-a-half year-old refuses to have anything to do with toilet training. How old is too old to be wearing diapers still? Happily, there’s no specific age. It sounds as if your child is not yet ready to toilet train. Be patient and back off from trying to train him until he gives you an indicator that he is ready. Look for the following signs: • he can indicate that he needs to go to the toilet If you wait until he shows at least one or two signs, toilet training will be faster and easier on both of you. Dr. Cheryl Mutch, pediatrician My baby slept through the night from six weeks of age until now. Now at seven months, she is waking twice during the night. Why? There could be a number of different reasons she is waking up. The most common reason is the development of so-called “separation anxiety.” At around six to eight months of age, most babies begin to appreciate on an emotional level when they are separated from their caregivers and may become upset if they awaken in a room by themselves. Other possibilities may be teething/sore gums, or becoming hungry if you’ve begun to introduce solid feedings and your milk supply is decreasing. If you can’t come up with a reason, it’s likely due to the separation issue. I would recommend waiting a few minutes after she wakes to see if she is able to settle herself. If it’s clear that she’s getting upset, then help her to settle again. Since she has been such a good sleeper, she’ll likely settle back into her previous habits without too much difficulty. Dr. Cheryl Mutch, pediatrician My four-year-old son still sucks his thumb. Should I be worried? Your son still sucking his thumb at the age of four is not terribly unusual. Ultimately he will be the one to decide when he’s had enough of it. You need to be careful not to let him feel too much pressure around his thumb-sucking. I’ve heard of all sorts of things parents do to try discouraging thumb-sucking from painting a bitter anti-nail biting solution on the thumb to even putting a cast on the offending digit! I would suggest that you not make a big deal over it. Have a simple talk and let him know why his thumbsucking is an issue (could be bad for his teeth/ smile). You basically need him to ‘buy in’ to wanting to quit. Gently (and repeatedly) mentioning that he’s becoming such a big boy will plant the seed in his mind that he is out-growing his habit. Suggest to him that both of you work on a secret signal that you can use when you notice him sucking. If all else fails and he’s still sucking after the age of six years, the dentist may suggest a device that sits on the palate and may discourage sucking. Dr. Cheryl Mutch, pediatrician How can I relieve my child’s diaper rash as naturally as possible?It is possible that your baby’s skin is getting irritated from the types of diapers or baby wipes you are using. Products can contain perfumes and chemicals that are harsh on baby’s sensitive skin. Try using an unscented brand of diapers or cloth diapers and switch from commercial baby wipes to cloth wipes using a mild natural soapy solution to clean your baby. Then use a mixture of one tablespoon of baking soda to one cup of water and use cotton balls to apply the solution on baby’s bum. Also during this time allow the baby’s bottom to “air out” as much as possible. Yeast infections are also a common cause of diaper rash. In this case, a probiotic would be helpful. For symptom relief, try a cream that uses natural soothing ingredients such as calendula and Dr. Agnieszka Matusik, naturopathic physician At what age is my child supposed to get her first eye exam? Does she need an early eye exam? It’s generally recommended that children have vision testing by around three years of age. Your child’s doctor can do a screening as well as baby and child check-ups and refer if necessary. One in 20 preschoolers has a vision problem and many will have no apparent symptoms. If the problem is picked up early, good vision can be preserved. If left untreated, vision problems may worsen. It’s always important to mention to your doctor if you have a family history of vision problems, or if you notice crossed or lazy eye or a drooping eyelid. Dr. Cheryl Mutch, pediatrician What are some natural ways I can help alleviate my baby’s colic? Dr. Stephanie Bonn, chiropractor ------ Breastfeeding My wife is on medication and is unable to breastfeed our newborn. We really want to give our child the benefits of breast milk though; what can we do? You can apply to the Breast Milk Bank at BC Women's and Children's Hospital. That is done through your doctor - he must refer you. Note: to donate breast milk to the bank (and they do need donations), you can call directly and make that arrangement. Call 604-875-2345, local 2282. Marina Green, lactation consultant I just started breastfeeding and find it very challenging. Where can I go for help? Most BC health units have specific programs to support new mothers and babies. Expect to hear from your community health nurse within 24 to 48 hours after leaving hospital. She will arrange to see you at home. If she has not called, contact your local health department. Check the blue pages in your phone book or the Resource Directory in Urbanbaby & Toddler magazine. If more help is needed, she will probably suggest attending the local hospital or community breastfeeding clinic. The BC Nurseline, a 24-hour, toll-free service can answer questions or refer you to resources. In the Lower Mainland call 604-215-4700; elsewhere in BC call, toll-free, 1-866-215-4700. Trained leaders from La Leche League, a volunteer support program provide telephone counselling. These experienced mothers also hold monthly group meetings filled with valuable information about parenting through breastfeeding. If your newborn is not having wet diapers and bowel movements or is too tired to feed go to your hospital emergency department. Marina Green, lactation consultant I have a four-week-old and have been breastfeeding her. Suddenly my right breast feels very hot and tender and I have a slight fever. Do I have mastitis? And what did I do to bring it on? You may have mastitis. Cracked, damaged nipples or missing feedings are the most common things that bring on mastitis. Feed your baby more frequently at the first sign of a problem. Resting, and applying heat to and massaging the breast while feeding also help. If your breast does not improve within about 24 hours, your fever continues and you feel ‘flu-ish’ your physician will prescribe an antibiotic. Any mother with a sore breast and flu symptoms should consider that she might have mastitis. It is really important to keep breastfeeding. If the breast is too sore, express or pump at least at every feeding. This will help prevent a more serious problem of a breast abscess. Marina Green, lactation consultant My baby is three months old and I am trying to express breast milk using an electric breast pump for emergencies. But all I get for two hours worth of pumping is about three ounces. Could I be doing something wrong? Pumping three ounces of milk for a three-month-old baby is great. Two things could be causing this to take so long. First: your pump. Many mothers find that inexpensive electric pumps (under about $100) that don’t cycle automatically (they have to use their finger to close a hole on the pump to create suction) work poorly. Try hand expression or a good hand pump. Secondly, you and your baby may be in one of those phases where you are ‘in synch.’ Your supply meets her demand but does not allow a lot left over to pump. Try pumping a little milk each day for a few days. Chill the milk before adding it to already cold milk. Milk can stay in the fridge for 6-8 days or much longer in the freezer. Marina Green, lactation consultant I am expecting my first child; what kind of breast pump should I buy? The best pump depends on your purpose. If your baby feeds well at the breast you may never need a pump or you can easily learn to hand express milk. Alternatively, a good hand pump can be effective. These range in price from about $30 to $80. If there is a problem with breastfeeding and you need to express milk for every feeding, then a good quality electric pump is ideal. These pumps can be purchased or rented. A good electric, self-cycling pump can save precious time and energy. Purchase prices range from about $125 to $300. Avoid cheap electric pumps (less than about $100). Pumps where you close a vent with your finger to create suction rarely work well. There is no one best pump for all. It is reasonable to wait until your baby is born to see what your needs will be. How can I relieve engorgement? I’ve just started breastfeeding and find my breasts are constantly engorged. I’ve heard you’re supposed to express some of the milk out to relieve the pressure, but I’m afraid that will just encourage my breasts to continue to engorge. Advice? You are right. Engorgement usually occurs because you are making lots of milk. Expressing regularly will increase your milk supply and continue the engorgement. Most mothers find that engorgement settles down after the first week. If your breasts are so full that it is hard to latch your baby, try letting some milk leak (perhaps in the shower or a warm bath) or express just enough to soften the breast to feed your baby. If you are uncomfortable, you could put your baby to breast more often to help relieve the engorgement or let some of the milk leak. Cold packs after feeds can help. Some mothers get engorged in the first few days because their baby is not feeding well. You will know that your baby is feeding well if she is having lots of wet diapers and bowel movements. If your baby is older than about two weeks and you are still constantly engorged, mothers often find that feeding their babies longer on the first breast before switching will help to decrease their milk supply a little and thus the engorgement. Marina Green, lactation consultant ------ Education Is there anything I can do to help my child communicate before her first birthday? Yes. During the first 12 months of a baby's life, there are several ways that parents can help encourage their child to communicate with them. A newborn baby's first attempt to communicate is through crying. Many parents can identify specific needs (comfort, hunger, pain) and emotions (happy, sad) through the different cries baby uses. Parents can help their child by using playful, warm, and natural tones. You can also encourage sound play by imitating and adding a few of your own variations. Between six and nine months of age, a child will use vowel-like and consonant-vowel sounds such as "ma" and "da" and "ba." These sound combinations will be used for personal satisfaction and for relaying information. Encourage your baby to continue making these sound combinations by: Young children understand the meanings of many words before they are able to produce these same words. Parents should talk about what is going on in their daily routines as much as possible. Talk during bath time, dressing, and meal times by using consistent language. It is important to speak slowly and use simple language during these times to allow the child time to process the information. It is through parents' actions and responses that children learn to be better communicators. Megan Kleisinger, speech-language pathologist I have a three-and-a-half year-old and he is not interested in learning to write the alphabet or numbers. I have tried to show him how to write them but he is not interested. Should I be pushing him and if so, how? Most children at three-and-a-half years of age are not developmentally ready to start writing letters and numbers. Their writing skills between ages three and four involve drawing simple shapes and pictures (e.g. apple or balls) when they are shown by an adult. At approximately age five, children will typically show more interest in tracing letters and trying to write their own name. Your son may be telling you that writing letters and numbers is too difficult for him right now. If you still have concerns regarding his pre-handwriting skills, you may want to talk to a preschool occupational therapist who specializes in fine motor development. Even though your child may not be ready to write letters and numbers, you can certainly expose him to letters and numbers through books and songs. Engage him in fun early literacy activities such as: Learning should be fun and a positive experience for your preschooler. Megan Kleisinger, speech-language pathologist My husband and I are speaking both Chinese and English to our two-year-old boy. Are we confusing him or causing him to have language problems? Bilingual language learners will follow the same pattern of speech and language development as mono-language users. Being exposed to two or more languages does not cause speech or language delays. There may be a period during which your child mixes the two languages together or becomes quiet for a short period of time. Your child may need extra time to process how to express himself. He also may have vocabulary that exists in one language but not in the other and will then use both Chinese and English in the same sentence. This is normal and should disappear as his language skills develop. In general, research in bilingualism reveals speech and language problems are less likely to occur if both languages are introduced early (before age three) and simultaneously. It is important to be consistent in teaching your child both languages. You may want to speak Chinese to your son while your husband speaks English around the home. It is very important for each child to learn at least one language well. If neither of you speaks English well, you may want to speak your native language to him. You may want to introduce more English as he becomes more competent speaking Chinese. If your son is not developing language at an age-appropriate level in English or Chinese, you may want to visit a speech-language pathologist to ensure he does not have a language delay unrelated to being brought up bilingually. Megan Kleisinger, speech-language pathologist How can I as a new parent, with no musical background, begin to share music with my daughter? Songs, chants, movement, and instrument play can provide your baby with a variety of sensory stimulation. Babies love the sound of their parent’s voice, and I’m sure your baby will enjoy hearing you sing – singing offers your baby a rich listening experience, as the voice is full of nuance. The lyrical content of chants and songs are also supportive of language development. To add a physical dimension to your music making, dance with your baby, bounce her on your lap, or gently pat her back in rhythm to the music. Select music with a strong beat and a lively tempo. You can also include props or instruments. Picture books or song books can provide visual representation of what you are singing about. Your baby may also enjoy feeling the texture of scarves and small percussion instruments, while exploring the sounds of these instruments. Donna Chan, music educator What’s the connection between singing and language development? I have heard that singing to infants can promote language development. What is the connection between the two? Music-making offers a powerful way to bond with your child and has numerous benefits. Music and language share many of the same qualities – pitch, rhythm, timbre, and accent. Language and music is also a means of communication and expression. Babies enjoy listening to the sound of their mother’s voice. If you have ever listened to a mother talking to her infant, you have probably noticed that her tone is almost ‘sing-song.’ Babies respond to her voice because it is not only familiar, but also expressive and calming. Singing to your baby can prepare him for listening and producing the sounds of language. This is the prime time to be talking, reading, and singing to your baby. The pathways in the brain are wide open to learning new skills and your baby needs the appropriate stimulation to form strong neural connections. Another activity you may want to try is vocal play. Imitate sounds that your baby makes and engage him in a “conversation.” You are validating his vocalizations and encouraging him to produce those sounds that will eventually become his first words! If you have any further questions email me at info@staccatostudios.com. Kera Doherty, music educator I am thinking about signing my baby up for a music class but I am skeptical about starting her at such a young age. Are babies really responsive to music? Most babies enjoy the stimulation of sound and movement provided that the songs and activities are developmentally appropriate. My greatest joy in teaching infant classes is seeing those first responses. There is cooing, babbling and giggling as Mom or Dad sings or chants to baby. Research shows that babies recognize familiar melodies; with song repetition your baby may become even more responsive. There are also many physical responses. Young babies typically move their arms wildly, kick their feet, turn their head towards the sound source or smile. Babies who can sit up may bounce their torso or wiggle. If the baby is held in a standing position she may jump. Your baby may quietly observe and listen for the first few weeks of class, but as you continue to attend and share music at home, she will probably begin to vocally and/or physically respond. Questions? Email me at info@staccatostudios.com. Kera Doherty, music educator ------ Fitness I’ve heard I shouldn’t exercise on my back after 14 weeks’ gestation. Why? As your uterus grows, it becomes heavier. In fact, it becomes your largest abdominal organ. If you lie flat on your back after 14 weeks, your uterus could put too much pressure on your vena cava, which is a major blood vessel running down your back. If it is compressed, it cannot get your blood supply back from your body to your heart. This slows the flow of blood from your heart to your lungs and brain so you may feel breathless or dizzy. If this situation were prolonged, it could cause stress to the fetus. This question usually comes up when a pregnant woman wants to do abdominal curls. If you want to continue doing abdominal exercises through your pregnancy, consider trying them on an incline bench, on your side, on all fours or standing. Having a strong core is important for a comfortable pregnancy—ask a certified prenatal/postnatal fitness instructor for exercise ideas. Melanie Osmack, fitness consultant I’m 34 weeks pregnant, and have very swollen legs and ankles, making even walking difficult. What can I do to for exercise? The swelling of the feet and ankles that sometimes occurs with pregnancy can make exercise difficult. One way to maintain your fitness and reduce your swelling is to begin a swimming program. Try 20 to 30 minutes, three times per week, with a kickboard or simply ‘water running.’ It is a great way to reduce swelling and not overheat. Avoid the breaststroke in your last trimester; it can put too much strain on the pelvis. Dr. Karen Nordahl & Carl Petersen, fitness experts I am six months' pregnant and experiencing sacroiliac pain when I exercise. What can I do to keep in shape and not aggravate the pain? Unfortunately, sacroiliac pain is a common complaint during pregnancy. It occurs mainly after the 26th week when the hormone relaxin increases, causing more laxity in the joints. Your pelvis may be mal-aligned from carrying out your normal daily activities with this increased laxity. You should probably see your physician to rule out other causes of low back pain, and possibly see a physiotherapist to get some corrective exercises and stretches to help keep your pelvis neutral. As far as exercise is concerned, switch to non-weight-bearing activities like water running, swimming or recline exercise cycling. Stay away from unilateral (single leg) weight-bearing activities and minimize or stop any activity that increases the pain. Try focusing on core strength exercises for the lower abdomen and lower back to help hold your pelvis in neutral. For more information on safe exercise guidelines visit www.fittodeliver.com. Dr. Karen Nordahl & Carl Petersen, fitness experts After I had my baby a few weeks ago, I've noticed that I have very little strength in my arms and legs, as compared to my pre-pregnancy condition. I can't even open a jar! Is this normal? If you are experiencing severe fatigue or strength loss consult with your physician or see your physiotherapist to ensure that you don't have an injury. Just carrying on doing your activities of daily living will help to strengthen you gradually. However doing some simple hand and forearm strength exercises may help get your strength back. Things like wringing out a cloth or grip-squeezing exercises may help. However it is best to check with a physiotherapist to get the correct exercises for your level and condition. Dr. Karen Nordahl & Carl Petersen, fitness experts Is it too late to start trying to get in shape because I'm pregnant (about three months)? And what activity could I start with? A very good question. You are alright to start an exercise program after you get pregnant. Speak to your caregiver to ensure that you don't have any contraindications to exercise and then consult with a fitness professional that has some experience working with pregnant clients. Generally it would be wise to start with a walking program or do some cross-training, like riding an exercise bike, using elliptical trainer machine or pool running. Start easy; approximately 15 to 30 minutes to start but keeping your rate of perceived exertion between a '3' to '5' on a scale of 1 to 10. You can progress to a walk-jog program as your stamina and strength increases. Ensure you do a dynamic warm-up before starting and gentle stretching when finished. Listen to your body aches, and ensure that your pains are addressed early by a health professional. Dr. Karen Nordahl & Carl Petersen, fitness experts What can I do to get rid of my post-partum tummy? Firstly, it is difficult to spot reduce. Secondly, it depends on the cause of the bulge. If it is just lack of tone in the lower abdominal muscles, then doing core strengthening exercises like the dying bug will target the lower abdominals and obliques to improve tone and control. If the cause is excess weight retention, doing aerobic activity like stationary cycling or running to burn more calories than you consume will help the most. Carl Petersen, fitness consultant After having baby, I find the skin on my belly looks puckered and baggy. Is it going to snap back? The ‘extra’ skin on your belly is a result of the stretching that your skin underwent to accommodate your growing tummy. While you will be able to get your abs back into pre-pregnancy shape, your tummy skin may not follow suit, at least to the point where it is ‘back to normal.’ As a general rule, if the skin is a bit loose one year after birth, it is likely to stay that way. Sorry, no magic answers here...I think this is why the ‘tummy tuck’ was invented! Dr. Karen Nordahl, fitness consultant ------ Nutrition I like to use sugar substitutes like Splenda to bake. Is it okay to feed my toddler baked goods that are made with a sugar substitute? Splenda is a no-calorie sweetener. It originates from sugar, but cannot be called “natural.” When Splenda is manufactured, the chemistry of the sugar molecules is changed in a way that prevents it from being metabolized in the body the way normal sugar would be. This gives it its no-calorie properties. It has been approved as safe for use for everyone including pregnant or nursing mothers and children. I have never been a fan of sugar substitutes, even for people with diabetes. I dislike that these replacement sugars do not originate as a plant or animal, but rather, are made in a lab. Home-baked goods using whole-grain flours, fruit purées and other wholesome ingredients along with a reduced amount of normal sugar would be my preference. And, consumed in a portion-wise fashion. Patricia Chuey, nutritionist If my preschooler refuses to eat his meals consistently, should I force him to stay at the table until he’s done, or discipline him somehow? If my preschooler refuses to eat his meals consistently, should I force him to stay at the table until he’s done, or discipline him somehow? Inconsistency is normal for preschoolers. Still, setting consistent structure around meal times and expected behaviour is important in building a sense of security. To help kids come and sit at the table give them a 10-minute warning. This way they won’t be abruptly removed from playing or caught off guard. Ask the child to take their place at the table. Ask them to make an effort to try some of the food. If they are done, allow them to be excused before the rest of the family. If they come to the kitchen moments after the meal asking for food, the dinner they did not eat should be the only choice. Minimizing snacking right before meals and involving kids in meal prep can help increase their desire to come to the table and eat. Patricia Chuey, nutritionist When should I start feeding my baby solids? Most babies are ready to start solid foods at around six months of age. Until the last few years, parents were often advised to start solids between four to six months of age. Why the change? It’s basically due to the fact that breast milk is nutritionally complete except for vitamin D until around six months in the healthy full-term baby. Any solid food introduced before six months will not be nutritionally complete and will displace some of the breastmilk from baby’s diet. Babies with low birth weight, poor weight gain, or who were born prematurely need to have more individualized advice on when to introduce other feedings from their doctor. Contrary to popular belief, solid foods have not been shown to help a baby to sleep through the night any sooner. Your baby is probably ready for solids when he can turn his head independently, shows an interest in table food, can move solids from the tip of his tongue to the back without spitting it back out, and is around 6 months of age.The baby may also seem less satisfied after a breastfeeding than he had in the past. Waiting much longer than six months of age to introduce solid foods may result in nutritional deficiencies. Dr. Cheryl Mutch, pediatrician I’m having trouble getting my toddler to drink milk. How much milk does he really need? Toddlers - aged one to five, need four kid-friendly servings of milk or milk products per day. A kid-friendly serving is just four ounces or 1/2 a cup. Remember that yogurt and cheese also count in this group. Often parents give their kids too much milk. Ensure milk is not replacing appetite for a variety of foods from all food groups.] Patricia Chuey, nutritionist I've heard that you shouldn't feed your baby sweet foods before savoury at any one meal. Why? It is generally thought that when beginning to introduce the family of fruits and vegetables to your baby, vegetables come first. With fruits being sweeter than vegetables, if fruit were introduced first, baby may get used to this taste and then reject the blander tasting vegetables. On an individual meal basis, the same could happen. Just as for adults, if dessert or sweet foods were eaten first, appetite for the other perhaps more nutritious foods in the meal may be reduced. So save the sweets, especially those with added sugar, for the end of the meal. If possible, avoid training your little one to think of sweets and desserts as a "reward" for eating their vegetables! Keep in mind that desire for sweet or salty foods is learned, rather than inherent. The less sugary and salty foods fed to your baby, the healthier. Patricia Chuey, nutritionist I am pregnant and lactose-intolerant. How do I get calcium? Approximately 1,000 to 1,200 mg/day of calcium are recommended to support a healthy pregnancy. The non-dairy foods offering the most calcium include: Should you have trouble getting enough calcium from foods, consider taking a calcium-vitamin D supplement to help make up the difference. Since you are not using dairy foods, ensure you are getting enough total protein from lean meats, eggs, beans, soy foods and nuts. Patricia Chuey, nutritionist How much juice should my toddler be drink per day? For children and adults, whole fruit is a better choice than juice. Fruit provides all of the nutrients along with fibre and more staying power than juice. Nutrition experts suggest children not be given juice until they can drink from a cup. Due to the sweetness, even with 100 percent real fruit juice, sipping on a bottle of juice is not advisable for dental health. When child can drink from a cup, just four to eight ounces (1/2 to 1 cup) is ample juice for one day. The only exception may be for a child who struggles to get enough calories and is underweight. Sipping juice can also reduce appetite for food when meal time comes. Patricia Chuey, registered dietitian I put ketchup on my toddler’s vegetables one time so she would want to eat her vegetables more. Now, she won’t eat them without ketchup. Is ketchup really bad for my child? If a small amount of ketchup (say, 1 teaspoon) is needed to help get a good serving of vegetables down, its not a big concern. If a large amount of ketchup (say 1 tablespoon or more) is needed to get a small amount of vegetables down, it is more of a concern. Ketchup is quite salty and has sugar added. If your child is in a ketchup phase and wants it regularly, consider buying an organic ketchup and/or one with less sugar and salt added. You could try substituting tomato purée or tomato sauce, as this would actually count towards their vegetable intake. Since most kids love the process of dipping, try using plain or flavoured yogurts, cheese sauce, cream corn or a natural salsa as other, more nutritious dip options. Patricia Chuey, registered dietitian Why do I have to feed my 12-month-old son full-fat milk and when can I start him on 2%? Is it okay to put him on 1% or skim? Higher fat cow’s milk (whole/homogenized milk) is recommended as the initial milk of choice for children upon weaning from breast or bottle after 10 to 12 months of age, once baby is eating a good variety of foods. If breastfeeding is continued, whole milk can be used along with breast milk if needed. Whole milk should be continued until two years of age, after which point the child can be given any milk the family uses – whether skim, 1%, 2% cow’s milk or a fortified soy milk beverage. Lower fat milks are not recommended before two years of age as the protein-carbohydrate-fat ratio makes it hard for a young stomach to digest. The additional fat and calories in whole milk also help provide reliable energy and nutrients at a time when children are just starting to eat a variety of foods and may be inconsistent in their food intake. For families whose two-year-old is underweight and/or who follow a very low-fat diet, continuing with whole milk beyond two years is acceptable. In any case, four half-cup servings of milk per day are adequate. Patricia Chuey, registered dietitian -------- Pregnancy Are ultrasounds harmful to my unborn baby? I will assume you mean diagnostic ultrasound versus therapeutic ultrasound used for sore muscles or joints. Diagnostic ultrasound has not been found to be harmful for your unborn baby. It should be used in the safest way—only when the information it provides outweighs any potential risk. Since its development in the 1960s by an obstetrician/gynecologist, no harmful effects have been identified with present diagnostic use. Ultrasound can be an important assistant for safe care and delivery, for you and your baby. Dr. Lynn Simpson, obstetrician What does a contraction feel like? Contractions vary in each woman and at different stages of labour. In my experience as an obstetrician, there are painless contractions—I can feel tightenings, but the woman is not even aware she is contracting. Contractions have been described as menstrual cramps and also as a force tearing the woman’s body apart. In early labour, in most women, contractions start in the lower back or lower abdomen as menstrual-like cramps, and, as the labour progresses, become much more painful. Contractions come and go (usually lasting one minute or less), and crescendo and decrescendo. There are ways to control the pain if it is too severe. Dr. Lynn Simpson, obstetrician I’m pregnant and I’ve heard that I should steer clear of cats. Why? The concern is Toxoplasmosis – an infection from a common parasite (Toxoplasma Gondii). You can get a blood test to see if you are immune. Cats can get infected and pass it through their feces. If you are not immune, you should avoid changing the kitty litter, which should be changed every day (fresh cat poop is not infectious). You do not need to “steer clear” of cats. You can also come into contact with this parasite in undercooked meat (always cook to at least 160ºF to be safe) or unwashed fruit or vegetables. Wash your hands when handling cats, raw meat or fruits and vegetables. For more information visit www.motherisk.com and search for Toxoplasmosis. Dr. Lynn Simpson, obstetrician & gynecologist I’ve heard that monitoring your baby’s movements may help prevent stillbirth. How? Every year, stillbirth claims the lives of approximately 26,000 babies – 70 per day – 10 times that of Sudden Infant Death Syndrome (SIDS) in the United States, according to the National Institutes of Health. Research shows that fetal movement is a good indicator of your baby’s well-being. Significant changes in the fetal movement pattern may help identify problems with your pregnancy before the baby’s heart rate is affected. Once the heart beat stops, it is too late. Setting aside time once a day when your baby is most active to count kicks, turns, swishes, rolls, and jabs may help identify potential problems and could help prevent stillbirth. Doing a daily kick count not only helps you feel confident about your baby’s health, but also gives helpful information to your obstetrical provider. If the information suggests that there may be a problem, this does not necessarily mean that your baby is in trouble. It just means that you may need further care and more tests. For the latest on the kick count method and stillbirth prevention, visit the Health Care Professionals section at www.babykickalliance.com. Dr. Diep Nguyen, obstetrician & gynecologist Are there certain household cleaners and chores that I should avoid when pregnant? I feel that any woman whose body is busy developing a baby should be exempt from any chores that she does not feel comfortable doing. I know, I know, that is not realistic in this world. It is best when using any cleaners to use rubber gloves and make sure you are in a well-ventilated area. It is also important not to mix cleaners together. Avoid extended exposure to organic solvents (e.g. gasoline, spot remover, lighter fluid, glue, paint). It is best to stay off ladders when in the second and third trimesters. To be safe, always talk to your doctor if you have any concerns. Dr. Lynn Simpson, obstetrician & gynecologist I'd like to know the sex of my baby. How accurate is the ultrasound in identifying the gender? I have it from reliable sources that an ultrasound after 20 weeks gestation is more than 99 percent accurate in identifying the baby’s sex. It is less accurate if the baby is in a breech position or the amniotic fluid is low. However, remember it is not 100 percent. Recently, I had a patient who had two ultrasounds around the same time (19 weeks) at two different ultrasound offices and one said definitely a girl and the other said definitely a boy! So, we will wait for the old-fashioned way to find out – look at the time of birth. Dr. Lynn Simpson, obstetrician & gynecologist I'm 32 weeks pregnant and experiencing high blood pressure, so my doctor has put me on bed rest. But what does that mean exactly? Bed rest means being a princess. It means resting at home and not doing things like laundry, shopping and cleaning. But you can sit up for meals, have a shower etc. And when you are resting, you lie on your side. Lying on your side will increase the blood flow to the baby - more food and more oxygen. The doctor has put you on bed rest because he is concerned. Your elevated blood pressure can be the result of a hectic lifestyle, and by resting, your blood pressure may go down to normal. If that happens, then you know that you must slow down and continue to be watched closely. If your blood pressure does not decrease by resting, then it may be a more serious problem - gestational hypertension. With elevated blood pressure, the vessels in the placenta can respond by becoming narrow and limiting the blood flow to the baby. By resting, you may be able to reduce this effect. Resting, especially on your side, is a way to increase the blood flow and thus the oxygen and nutrients to the baby. You must be watched carefully if you have persistently elevated blood pressure - which means frequent visits to your doctor or hospitalization. Dr. Lynn Simpson, obstetrician & gynecologist My hair has been falling out since my baby was born. Will it grow back? Why is this happening? While you are pregnant and in the postpartum period (i.e. after delivery), many hormone changes can affect hair growth. Usually, the whole hair cycle speeds up, so while it seems that more hair is falling out, there is also more new hair growing. Eventually things even out and your hair will return to normal. If it becomes and remains noticeably thinner, you should see your doctor. Dr. Lynn Simpson, obstetrician & gynecologist My wife and I welcomed our new son to the world a few weeks ago. But I feel very jealous of the baby and all the time he is spending with my wife. Is this normal? What should I do? A fleeting feeling of jealousy can be normal. Suddenly your partner (wife) is busy with this new person who seems to have priority. She may be feeling a bit of jealousy too - that you don't have to get up "X" number of times each night to breastfeed. However when I hear "very jealous," I am concerned. If this feeling is persistent and affecting your relationship with your wife or your son, then it is not "normal." You should see your doctor or counselor. Dr. Lynn Simpson, obstetrician & gynecologist I'm eight months pregnant, and my legs and ankles are swollen to almost twice their normal size. It is very uncomfortable. What can I do to relieve the discomfort? It is common to have swollen legs and ankles in the latter part of pregnancy. It is often worse when the weather is hot. To relieve the discomfort you should stay off of your feet as much as possible. Lying down with your feet raised above your heart level can help. I know that it is not practical for many to do this for long, so another way to help is to put on support hose when you first get up in the morning if your swelling is down. It is also helpful to wear loose clothes and to get shoes that have a lot of room or have a lot of give. The swelling can continue for a few weeks after the baby is born. Don't be surprised if it does. Dr. Lynn Simpson, obstetrician & gynecologist What is an amniocentesis and when is it necessary? Amniocentesis is a procedure done by an obstetrician where a needle is placed through the mother's abdominal wall and uterus into the sac that contains the baby to obtain amniotic fluid. This is done under ultrasound guidance to find the best pocket of fluid and to avoid injury to the baby. Amniocentesis is needed for genetic testing - its most common use - which is offered to women over 35 or with positive serum screening for Down's syndrome or spina bifida. It is also used to assess fluid in other conditions or to determine if a baby is mature enough to be delivered when the mother or baby are at risk. When done for genetics, it is usually performed at 16 weeks and has a 0.5 percent risk of miscarriage. Most women find it tolerable. After amniocentesis you must rest for 24 hours to let the tiny hole in the membranes heal. Dr. Lynn Simpson, obstetrician & gynecologist What are the risks of an epidural? An epidural is a common anesthetic used in obstetrics. An anesthesiologist places a tiny catheter in the epidural space near the spinal cord. It takes about 20 minutes to perform and about 20 minutes to work. It takes the pain away completely about 90 percent of the time. The risks of an epidural are: Dr. Lynn Simpson, obstetrician & gynecologist Can I get a massage if I’m a few months pregnant? Yes, you can get a massage while you are pregnant. A gentle massage can be very soothing and can help relieve muscle soreness and stiffness. However, there are some special considerations: 1. You should never have a massage lying flat on your back. It is always best to be on your side, sitting up or tilted to the side. 2. You should never have the kind of massage that presses hard on a small point. Both situations can lower your blood pressure and make you feel light-headed or nauseous. Low blood pressure can reduce the amount of blood and oxygen that goes to the baby. Dr. Lynn Simpson, obstetrician If I am taking medication for depression, is it safe to try to conceive a child?You should check with your doctor. Depression is a significant illness and stopping anti-depressants can lead to a significant increase in depressive symptoms. However, there are risks with antidepressants, as with most medications. There are many antidepressant medications and each has advantages and disadvantages. In 2005, it was found that Paxil or paroxetine, an antidepressant, is associated with a slight increased risk of congenital heart defect, some of which may be insignificant. It is now believed that the dose of the drug may affect the risks it entails. Therefore, it is complicated, and both the advantages and the risks of the medication should be discussed at length with your physician, prior to attempting pregnancy, so you can make an informed decision. Dr. Lynn Simpson, obstetrician I’d like to know the sex of my unborn child. But I’ve heard that doctors won’t tell me. Is this true? Usually, a doctor does not know the sex of your baby. Genetic testing and an ultrasound can determine sex. If you get genetic testing request not to know the sex, the sex will not be reported to your doctor. An ultrasound can often make a determination of the baby’s sex at the 16 to 20 week ultrasound, but sex determination isn’t done routinely and most docctors do not report the sex even if they know. However, you should be given the option of knowing, if your doctor knows the sex of your baby. Dr. Lynn Simpson, obstetrician What is a sign that I’m about to give birth? There are various signs that you could be about to give birth. These include: Dr. Lynn Simpson, obstetrician ------- Safety I know that giving a baby a pillow to sleep with is dangerous. But at what age can I safely introduce a pillow into my daughter's bed? A Quebec study of sudden infant deaths from 1991 to 2000, found that almost 20 percent of cases occurred in unsafe sleep environments. The top three unsafe practices identified in the study were: unaccustomed prone sleeping, the presence of pillows on the sleep surface, and sofa-sharing with infants. Although Sudden Infant Death Syndrome (SIDS) still remains largely unexplained, the use of soft bedding such as pillows, bumper pads and quilts does increase the risk. As a result, the Canadian Pediatric Society recommends that your baby’s crib be kept free of pillows for the first year of life, as this is the highest risk period for suffocation and SIDS. For more information on infant sleeping and co-sleeping practices in baby’s first year, visit the society’s website at www.cps.ca. Anne Williams, safety expert My public health nurse visited me and my newborn at home, and suggested that having a bumper pad on the crib is actually dangerous to my baby. Is this true? Although there is little statistical evidence to support an all-out ban on crib bumper pads, experts theorize that they, like all soft bedding, can create pockets in which babies can rebreathe carbon dioxide. Rebreathing of carbon dioxide is linked to Sudden Infant Death Syndrome (SIDS). As well, if not properly secured, crib bumpers can pose an entrapment hazard. Between 1996 and 2000, the Consumer Product Safety Commission in the US received eight reports of deaths associated with crib bumper pads. The SIDS Foundation, a leader in SIDS research and prevention, recommends against using them. For more information, visit www.sidscanada.org. Anne Williams, safety expert Is safe to use a 'baby leash' on my daughter? Some parents worry that putting their toddler in a harness or 'leash' is the equivalent of baby jail. But walking harnesses have been in use for decades, and are often the only recourse for parents whose toddlers insist on running off despite repeated warnings and discipline. While many toddlers are content to stay close to Mom or Dad, if you've got one who is prone to disappearing acts, a harness will give you peace of mind in crowded malls, vacation spots and busy streets. It will also help reinforce teaching your child about those environments where it is not safe to wander off. Anne Williams, safety expert ------- Before becoming pregnant, I have been following a low-carbohydrate, high-protein diet. Is this a healthy/safe diet for the baby? It is best to have a balanced diet when pregnant or trying to conceive. Weight gain and nutrition is important for baby’s development. An average weight gain is between 25 to 35 lbs (11 to 16 kg). Higher if you are underweight, lower if overweight prior to pregnancy. Expect two to four lbs in the first 12 weeks, then three to four lbs a month. The following BC government website defines a balanced diet: www.healthservices.gov.bc.ca/cpa/publications/babysbestchance.pdf. It is also important to take .4 mg folic acid daily prior to conception. Other supplements may include iron and calcium. You should always check with your doctor or midwife first. Dr. Lynn Simpson, obstetrician & gynecologist My one-year-old often clamps her mouth shut when I try to feed her a spoonful of anything at mealtimes. I know she’s hungry, but she refuses to be fed by me. How can I get her to eat? Assuming your daughter is healthy and growing well, it sounds as though your toddler wants to feed herself. I suggest serving her meals at the family table (with her in her highchair). You can offer her a well-balanced healthful meal in small portions and let her feed herself. Offer more if she finishes and still seems interested. You can give her a spoon, but don’t expect her to use it to feed herself. Eating at her age is all about exploring the food. This may mean that a lot of it ends up squashed in her fingers and mashed around on her tray. It will help if she has an appetite at mealtime. As they say, “hunger is the best sauce.” Make sure that she isn’t drinking too much milk as that may dampen her appetite. Three servings of dairy per day is plenty. Dr. Cheryl Mutch, pediatrician How do I make sure that I’m giving my baby or child the right amount of medicine for fever? Knowing when to dose, how often and how much can often be confusing for many parents. For example, many parents give their children medication based on their age and don’t consider how much they weigh. This can be tricky, as some two-year-olds weigh as much as a four-year-old. If you dosed your two-year-old according to age, you may not be giving him enough medication. A Canadian study showed that some Canadian families were taking their kids to the ER rooms unnecessarily when really they were underdosing their children with acetaminophen (the active ingredient in Tylenol). This study found that 41 percent of parents gave an underdose and 12 percent gave an overdose of actaminophen to their child with fever. A subsequent survey of new immigrants to Canada, showed that a third of them had difficulty determining the dose, a quarter of them had difficulty determining how often to dose and almost half of them had difficulty determining what side effects to look for. With the right tools, parents can learn to properly administer fever-reducing medication to their kids. The makers of Children’s Tylenol have easy-to-read dosage charts online that can help you determine how much medicine to give your child (www.helpinghand.tylenol.ca/dosage/). They are available in several languages: French, Arabic, Cantonese, Hindi, Punjabi and Tagalog. Dr. Avash Singh, pediatrician |
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