Infant and Child Health

My mother had a great deal of trouble with me, but I think she enjoyed it.

Mark Twain

When your child gets sick or hurt, you are usually the first person to provide care. Your calmness, confidence, and competence in caring for your children's health problems will help them enjoy healthy childhoods and learn the importance of self-care for their own use as they mature.

Facts About Infants and Young Children

The following brief notes are of particular concern to parents. This information may help dispel some unnecessary fears and give you some guidance.

Child Car Seats Infant and child car seats save lives. Many states require them for all children under age four and those weighing less than 40 pounds. Children who are not in car seats can be seriously injured or killed during crashes or even abrupt stops at low speeds. For maximum safety, follow the manufacturer's recommendations for car seat use. All children under age 12 should be in the back seat, especially if the car has airbags. Infants under 20 pounds: Use an infant car seat that reclines and faces the rear. Check the manufacturer's instructions. Infants and children over 20 pounds: Use a toddler seat that faces the front and has a shield or harness. Some infant seats can be converted into toddler seats. Children over age four and over 40 pounds: Use a booster seat that raises the child so he or she can see out of the window. Use regular lap and shoulder belts. Adjust the shoulder belt to fit across the shoulder, not the neck. Set a good example for your children by always wearing your own seat belt, and always insist that they buckle up.

Umbilical Cords and Bellybuttons

Clean the bellybutton (navel) three or four times a day with a bit of cotton moistened with a little rubbing alcohol. Pull the cord up gently but firmly to clean the base (try to avoid getting alcohol on the skin around the navel). Swabbing the bellybutton with alcohol will help it to dry and prevent infection.Keep the cord dry and do not give a tub or pan bath until the umbilical cord has fallen off and the navel is healed. Fold diapers below and shirts above the cord
to promote drying.

The umbilical cord will drop off and the navel will heal in one to three weeks. After the cord comes off, there may be a moist or bloody oozing for a few days, less than the size of a quarter, between diaper changes. This does not need special treatment.

Call your doctor if there is redness or swelling around the navel or a large amount of foul-smelling discharge from the navel.

The appearance of the bellybutton is not affected by the way the cord is tied off. A small nodule of tissue sometimes remains after the cord falls off. If it is small, no treatment is usually needed. If it is larger or persists longer than two weeks, call your doctor.

Breast-Feeding

Breast milk is the ideal food for babies younger than four to six months. The American Academy of Pediatrics recommends that babies be breast-fed for the first year of life. Although breast-feeding is best, babies can also get good nutrition from formula.

Breast-feeding has many advantages for both baby and mother. Breast milk contains substances that help your baby resist infections and other diseases. It protects against allergies and asthma and also is easier to digest than formula. Breast-fed babies have fewer colds, ear infections, less diarrhea, and less vomiting.

Some instruction helps ensure that you can breast-feed successfully. Try to take a breast-feeding class. The La Leche League and the Nursing Mother's Council are other good sources of breast-feeding information, advice, and support.

Nursing mothers need 500 calories per day more than they needed before becoming pregnant. Although you don't need to drink milk to make milk, extra calcium and protein are important, and your doctor may prescribe a vitamin supplement. Avoid smoking and drinking alcohol, and limit caffeine to one or two
beverages per day. Do not take any medication while breast-feeding unless it was prescribed by a health professional.

Circumcision

Circumcision is surgery to remove the foreskin of a newborn boy's penis. About 60 percent of boys in the U.S. are circumcised, down from over 80 percent in the late 1970s.

There are both benefits and risks associated with circumcision. Discuss the risks and benefits with your doctor. The decision is entirely up to you.

The major benefit is that circumcision makes it easier to keep the penis clean. Cleanliness reduces the risk of developing urinary tract infections.

The risks of circumcision are slight. Complications of local infection or bleeding occur in about one in every 250 cases. Local anesthetic will reduce the pain of circumcision. Generally, circumcision is not recommended for a sick infant.

After circumcision, apply petroleum jelly liberally to the head of the penis at each diaper change to prevent the scab from sticking to the diaper. Wash the penis by dripping warm water over it (do not use alcohol or baby wipes). Pat dry with a soft towel.

If the circumcision site is red, apply an antibiotic ointment (Bacitracin or Polysporin). Call your doctor if the redness extends down the shaft of the penis.

If you choose not to have your son circumcised, clean the exposed foreskin gently during the first four years. Starting around age four, gently begin to retract the foreskin. Do not forcibly retract the foreskin; it may not be fully retractable until puberty. Teach your son to wash his penis well at every bath and to gently retract the foreskin when possible and clean beneath it.

Toilet Training

Every child has a unique timetable for becoming toilet-trained. Most children are ready to begin toilet training between age 18 and 36 months. Look for these other signs of readiness in your child:

• Understands words referring to bowel movements and urination.
  


• Recognizes the sensation of a full bladder and the urge to have a bowel movement.
  


• Knows what the toilet is for and has watched others use it.
  


• Prefers clean, dry diapers to soiled ones.
  


• Understands that using the potty means having a dry diaper.
  

If you think your child is ready to begin toilet training, the following tips may make it go more smoothly:

• Get the child a potty chair. Make sure the child's feet can rest on the floor or on a footrest. Encourage the child to sit on the chair at least once a day at about the same time each day. Let the child use the chair for looking at books or watching TV.
  


• After the child has had a bowel movement in a diaper, put him or her on the chair, and put the contents of the diaper in the pot.
  


• Once the child is interested, let the child play for short periods without a diaper and have the chair nearby. Encourage the child to use the chair if he or she needs to "go potty."
  


• Reward every success with hugs and words of praise. Relapses are common in the first few weeks, but don't scold or punish when the child forgets. Keep a casual attitude.
  


• Bladder control may take longer than bowel control. If the child is aware of a full bladder, try putting him or her on the potty every 30 to 60 minutes. Praise the child for success and give gentle encouragement when the child wets his or her pants.
  

Sleep Habits

Babies have both deep and light sleep cycles. In each sleep cycle, there are 60 minutes of light sleep, 60 to 90 minutes of deep sleep, and another 30 minutes of light sleep. At the end of this cycle, the baby is semi-alert and can be wakened easily.

Parents can help the baby sleep through the night by helping the baby learn to soothe him- or herself back to sleep during the light sleep cycles.

For infants (birth to 2 months):

• Put the baby in the crib when he or she is drowsy but awake.
  


• Make middle-of-the-night feedings short and boring.
  


• As the baby gets older, delay the middle-of-the-night feeding, and discontinue it sometime after age four months.
  

It appears that it is safer for a baby to sleep on his or her back or side to prevent sudden infant death syndrome (SIDS). Do not force a baby into a sleeping position. Babies are capable of moving themselves.