WORKSHOP ON Better Parenting skills

Indian Academy Of Pediatrics

Parenting is a Skill One needs to learn it

A NEWBORN BABY THE BUNDLE OF JOY

How does the newborn look? The head - soft areas felt on the head Dark discoloured areas on the babys skin Different birth marks present Look for any congenital anomaly

Routine care of New born

FEEDING OF NEW BORN
The only feed the baby needs is the breast milk How do you ensure exclusive breast feeding?

Feeding of the Newborn

Breastfeeding
Starting Breastfeeds
Initiate breast feeding within 1/2 hr after normal deliveries and 2 hr after a C section Soon after delivery, the new born kept with mother
All mothers, including most malnourished, can breastfeed successfully

Feeding of the Newborn

Breastfeeding
Starting Breastfeeds
Colostrum
It is essential that the baby gets the first breast milk called colostrum which is thicker and more yellow than later milk and comes only in small amounts in the first few days

Colostrum is all the food and fluid needed at this time - no supplements are necessary, not even water

Feeding of the NewbornBreastfeeding

Starting Breastfeeds
Time schedule
As often as the baby desires for as long as the infant wants to suckle Usually a feeding schedule of 3-4 hourly intervals becomes established by the end of first week, with a feeding time of about 10-15 minutes Breasts must be alternated for starting feeds in subsequent feedings

Feeding of New born

Steps For Successful Breastfeeding
Feed within half hour of birth in normal delivery or 2 hours in LSCS cases
Practice roomingin

No prelacteal feeds to be given

Feed on demand, for as long as the baby needs, in the right position and ensure proper attachment of baby to breast Exclusive breastfeeding for 4-6 months

Breastfeeding
Starting Breastfeeds
Technique:
Mother and the baby in comfortable position Mother in the sitting position holds baby in inclined upright position on her lap Mother, ensuring that entire areola, is in the babys mouth

Breastfeeding
Starting Breastfeeds
Breaking the wind: (Burping)
All babies swallow varied amount of air during suckling Baby held upright against mothers chest with babys head resting on her shoulder Babys back gently patted till baby belches out the air

Burp baby after feeding at each breast

Breastfeeding
Starting Breastfeeds
Adequacy of breastfeeding
Mothers should be reassured & encouraged Crying in newborns is not always hunger Sound sleep for 2- 4 hours after the feed Urine every 2- 3 hourly after the 11th day in full term & 15- 20 in pre-term babies Steady weight gain

Feeding of the Newborn

Breastfeeding
Advantages:

Maternal milk is nutritious food for infants which is:

readily available simple to feed hygienic prevents allergic disorders

Feeding of Newborn
Breastfeeding..contd.
Advantages: An exclusively breastfed infant is,
14 times less likely to die from diarrhea 3 to 4 times less likely to die from respiratory disease 2 to 3 times less likely to die from other infections than a non breastfed infant

Improper feeding practices

Common Causes

Discarding or minimal feeding of colostrum Delayed initiation of breastfeeding by nearly 80% of mothers Non-exclusive breastfeeding by 85 - 95% in the first four months of life Unnecessary utilization of commercial infant milk foods and animal milks Early termination of breastfeeding Premature/ delayed or faulty introduction of semi-solids.

Improper Feeding PracticesConsequences

Improper or inept feeding practices, directly or indirectly, contribute substantially to, infectious illnesses malnutrition mortality
What is the mortality due to top feeding?

Breastfeeding
Important Special Situations
Breastfeeding Substitute

Bottle with nipple should Clean cup with or without not be used spoon is preferred

What do I do ?
I am working I am not well Baby is not well I am on medicines My figure ? I have sore nipples I have less milk production ?

Routine care of New born

Skin Care and Baby Bath
First bath preferably given at home, after discharge In hospital, postpone bath till the baby is taking sufficient feeds and temperature is well maintained The Indian method of bathing on extended legs is ideal Baby can also be bathed in a basin of water A mild soap may be used

Routine care of New born Post Natal Care

MASSAGE

What is the role of massage?

Vigorous massage done by malish- wali is harmful

Routine care of New born

Post Natal Care
Role of Massage
One of the ways by which mother bonds emotionally with the child Massage involves touching, movement and usually auditory and visual stimulation as well Advantages
Improves growth and development Improves parent-infant relationships

Routine care of newborn

Benefits of massage:
Calmer and tolerate noise better Settle down and sleep better than babies rocked to sleep Better temperament More easily soothed

Routine care of Newborn

How to Massage a Baby
Preparation Tips
Who should massage:
preferably mother or father of baby

Timing:
when the mother is relaxed unhurried and won't be interrupted

Position/Setting
mother should be comfortable

Routine care of newborn

How to Massage a Baby

Gentle application of oil is all that is necessary

Routine care of Newborn

How to Massage a Baby
Rubbing the baby the right way:
Always make sure your hands are warm Apply oil to decrease friction Stop massage if baby gets rash

THE POSTNATAL PERIOD

Growth
New born: The majority of babies born at full-term
weigh from just over 2.5 to 4.0 kilos Measure 48 - 52 cms in length

During the first month a newborn

gain weight at a rate of 30 g/day grow about 2.5 - 4 cms

Most newborns go through a period of rapid growth when they are,

7 to 10 days old 3 and 6 weeks

THE POSTNATAL PERIOD

Growth
First 3 Months
By the middle of the first month, weight gain is 14 - 28 gm per day An average weight gain is 0.45 - 0.9 kg following the first month Increases in length during this same period may be about 2.5 - 4 cms/month

THE POSTNATAL PERIOD

Growth
4-7 Months
The average rate of weight gain during this period is about 0.4 - 0.5 kg a month By 8 months the baby will probably weigh about 2 times birth weight Length increases by 5 cms during this period

THE POSTNATAL PERIOD

Growth
8-12 Months
Most babies weigh around 6.3 8.1kg by 8 months At 1 year of life, most babies will probably have just about
tripled their birth weight stand about 70 - 80 cms tall

THE POSTNATAL PERIOD

Growth
1-2 Years

Growth rate falls from 300% in 1st year to 20% in 2nd year of life

THE POSTNATAL PERIOD

Growth
1-2 Years
During the 2nd year of life, most babies gain between 1.4 - 2.3kg By their second birthdays, most babies look and grow taller instead of rounder While development going full speed ahead, physical growth slows down during this year

THE POST NATAL PERIOD

Development (Milestones)

THE POSTNATAL PERIOD

Motor Skills Development
Gross motor skills
1 month - lifting of head from a prone position 3 months - hold its chest up and use the arms for support after being in a prone position; head holding achieved 4-6 months - infants can roll over prone to supine 6-8 months - most infants can sit with support

THE POSTNATAL PERIOD

Motor Skills Development
Gross motor skills
7-8 months - crawl and sit without support 8-10 months - pull themselves up to a standing position and can stand with two hand support 10/11 months - walk sideways while holding on to furniture and forwards with two hand support 12-13 months - they can walk few steps with one hand assistance

THE POSTNATAL PERIOD

Motor Skills Development
Gross motor skills
14 months - walk without support 18 months - run 2-3 years - climb up and down the stairs 3 years - ride a tricycle

THE POSTNATAL PERIOD

Motor Skills Development
Fine motor skills
Infants have hardly any control over fine motor skills at birth Such as grasping and reaching become increasingly more refined over the first 2 years of life The maturation of hand-eye coordination over the first 2 years of life is also reflected in the improvement of fine motor skills

Physical Needs
Satisfaction of Hunger Satisfaction of Thirst Comfortable Surroundings
Temperature, humidity

Protection from Harm

Injuries and accidents

Satisfying physical needs are important for development of trust and bonding

Physical Needs
Feed the baby when he is hungry Change his diapers when he has soiled them Maintain comfortable environment and clothe him in a way that will add to his comfort Talk to the baby when he is alert Carry him around whenever possible Put him to sleep when he is tired

SIGNS OF SEVERE ILLNESS

Refusal of feed / inability to feed

Excessive crying Excessive sleeping Breathing difficulty Cyanosis blue discoloration skin/mucosa

COMMON HEALTH CONCERNS

Common concerns of Newborn

VOMITING DIARRHOEA JAUNDICE COLIC CONSTIPATION COLD / SNEEZING

Caring of a Newborn
Common Health Concerns
Vomiting
Bringing out small quantities of milk or curd like milk following a feed is normal Overfeeding, forced feeding and fast feeding in bottle-fed babies may result in vomiting Vomiting in the newborn can be caused by, upper respiratory infections, gastroenteritis Meningitis, urinary infections renal failure Cardiac failure

Caring of a Newborn
Common Health Concerns
Constipation
The diagnosis of constipation depends on
stool consistency stool frequency difficulty in passing stools

A hard stool passed with difficulty every third day should be treated as constipation True constipation in the neonatal period is most likely secondary to Hirschprung disease, intestinal pseudo-obstruction or hypothyroidism

Caring of a Newborn
Common Health Concerns
Diarrhoea
Healthy breastfed babies may pass 10-12 stools each day, usually along with each feed The stools may be liquidy & associated with passage of gas This generally occurs because the baby is getting too much of the fore milk, rich in lactose The problem can be rectified by advising the mother to feed hind milk too

Why is the little one crying?

What makes the baby cry? Main causes of crying What is the best way to comfort my baby?

Colic & Breathholding

What is colic? How can I help my colicky baby? How can I help my colicky baby ? What is breath-holding spell, can there by any effect of such spells? What is to be done during breathholding spell ? Is there any way to prevent breathholding ?

Is the baby yellow ?

How common is jaundice in the newborn & what are the causes of jaundice?

Feeding & Nutrition

Addition of Semi-Solid and Solid Foods
Weaning food
Formulate additional foods from the usual family diet The weaning diet: thickened but mashed form and variety Use of commercial weaning foods should be avoided

Feeding & Nutrition

Weaning food

Addition of Semi-Solid and Solid Foods

Feeding - Broad Age Related Guidelines
i) Around Six Months

Frequency, Amount and Consistency of

One can start with
mashed fruits like banana cereal based porridge , enriched with oil/fat and/or animal milk or

One or two teaspoonfuls to start with, increase the quantity and frequency gradually The baby at the end of this phase should be consuming about 50 to 60 g of food (half a cup) per day

Feeding & Nutrition

Addition of Semi-Solid and Solid Foods Weaning food
ii) Six to Nine Months From 6-9 months of age the baby should be used to feeding from the family pot
mashed rice with dal, khichdi, a little chapati softened in dal, dahi, mashed vegetables, fruits, enriched with some oil/fat and green vegetables

They need four to five weaning meals a day, in addition to regular breastfeeding

Feeding & Nutrition

Weaning food

Addition of Semi-Solid and Solid Foods

iii) Nine to Twelve Months
At 9 months, babies can start chewing on soft food By one year, infants should eat foods cooked for the family A child of one to two years needs about half the food that the mother eats

Feeding & Nutrition

Addition of Semi-Solid and Solid Foods
Feeding During and After Common Illnesses
Feeding should continue during common ailments like diarrhoea, respiratory infections, etc. unless the medical condition of the child contradicts it Restriction or dilution of food should be discouraged Anorexia- give small quantities, more frequently (every 2-3 hours) After illness, provide more than the usual diet to regain the weight lost.

Feeding & Nutrition

Addition of Semi-Solid and Solid Foods
Preparation and Storage of Weaning Foods

Careful hygienic preparation and storage of weaning foods The foods should be preferably fresh, cooked or boiled well If food has been kept for over two hours, reheat it thoroughly until it boils, before consumption

Feeding & Nutrition

Addition of Semi-Solid and Solid Foods
Feeding During and After Common Illnesses
Feeding should continue during common ailments like diarrhoea, respiratory infections, etc. unless the medical condition of the child contradicts it Restriction or dilution of food should be discouraged Anorexia- give small quantities, more frequently (every 2-3 hours) After illness, provide more than the usual diet to regain the weight lost.

Immunization

What is Immunization?
Process of giving vaccines or shots to children or adults so that they develop immunity (resistance) against that particular disease Essential since the babies natural immunity and the antibodies acquired from mothers milk are only temporary

How Does a Vaccine Work?

On exposure to a germ, the body mounts an immune response to clear the germ from the body
The immune response tries to ensures that the germ is not able to cause the disease again

A vaccine is a modified germ

It is capable of inducing immunity without causing the disease

Immunization offers protection from the germ without causing the disease

Timetable for childhood immunization

At birth. BCG Oral Polio Vaccine Zero dose Hepatitis B Vaccine 1st dose 6 WeeksOPV, DPT 1st dose Hepatitis B Vaccine 2nd dose Hib Vaccine 1st dose 10 Weeks.. OPV, DPT 2nd dose Hib Vaccine 2nd dose 14 Weeks..OPV,DPT 3rd dose Hib Vaccine 3rd dose 6 months. Hepatitis B Vaccine 3rd dose
Contd

Timetable for childhood immunization

9 Months.Measles Vaccine Vit.A 15 18 Months. MMR OPV, DPT 1st booster dose Hib Booster dose (Hepatitis A, Chickenpox) 2 yearsTyphoid Vaccine 5 years ........ OPV, DPT- 2nd booster dose, Typhoid (every 3 years) 10 years...dT / Tetanus toxoid booster dose 16 yearsTetanus toxoid booster dose

Emotional Needs
Emotional Security: Parental Love
Recognition and Appreciation

Independence
Discipline

Play Activity

Activities Promoting Social and Emotional Development

0 - 12 months
Turn feeding times into learning and bonding time: Smile and talk to him, hold

him close and cuddle him

Use his name while talking to him

Play music
Read to him several times in a day

Activities Promoting Social and Emotional Development

2- 3 years
Let him see how the words are pronounced
Read to him every day

Play Hide and Seek Games

Let him play games that will allow him to

hone his skills of motor coordination

Go on walks in the neighbourhood

Activities Promoting Social and Emotional Development

2- 3 years
Encourage him to talk about his family Do things together as a family Give him opportunity to exercise his choice Outings for stimulation and learning

Read simple books with repetition

Play Pretend Games with him

Activities Promoting Social and Emotional Development

3 - 4 years
Eat meals together: for the development of conversational, social & cognitive skills Ask his opinion often & respect his answers Let him do simple chores

Encourage the child to try again in case of

unsuccessful attempt

Activities Promoting Social and Emotional Development

3 - 4 years
Provide him opportunities to play with other children

Build up his memory: Through reciting stories and songs, going over the days activities
Let him choose his clothing

Activities Promoting Social and Emotional Development

4 - 5 years
Read to the child every day
Spend time alone with the child each day

Talk to him about his day at Pre- School

Give the child chores to do Play board games that require taking turns. Makes him understand that he has to wait for his turn

Myth and Reality

Quality of Child Care
Myth
The Quality of Child Care Does

Not Have Much

Impact on Childs

Development

Reality Experience gained during the early years have a lasting impact on the way the child thinks, learns & behaves Good Quality Child Care helps a child enter school with confidence Unstimulating, Uncaring and unsafe environs deprive the child of a strong start

Myth and Reality

Quality of Child Care
Myth The earlier a child talks, the more intelligent he is Reality
The ability to understand words is of greater significance than his power of expression The baby who talks before his first birthday may not be superior to a baby who has not begun until he is two years of age

Myth and Reality

Quality of Child Care
Myth If a child is made to stand early he develops bow legs

Reality
Most babies love to stand with support when they are 5- 6 months old Allowing them to do so does not predispose them to develop the deformity If mild degree of deformity does occur it corrects itself

Myth and Reality

Quality of Child Care
Thumb sucking occurs in Thumbearly childhood sucking It leads to forward displacement of upper interferes incisors and backward with normal displacement of lower alignment of incisors Most children stop teeth vigorous thumb- sucking by 4 years of age Myth

Reality

Myth & Reality

Quality of Child Care
Myth
Extra Vitamins Make a Baby Healthier

Reality
Extra vitamins are required only when a child is recovering from an illness After body stores are full, extra vitamins are thrown out in the urine
Excess intake of vitamins can, in fact, lead to untoward effects on the body e.g.; Vitamin A, Vitamin D

Myth & Reality

Quality of Child Care
Reality

Myth

Vaccines are not Safe

Vaccines are cleared for use only after extensive research about safety and efficacy Only safe vaccines are included in the mass immunization programs Like all drugs, vaccines also have side- effects

Myth & Reality:

Initiation of Immunization
Myth
A baby brought late after one and a half month cannot be started on vaccination

Reality
One and a half month is the age recommended for the first dose of OPV and DPT Modify the schedule for a child who presents later & give all vaccination

Myth & Reality:

Interval between Vaccination Doses
Myth
When the gap between two doses exceeds 4 weeks, the whole course should be repeated

Reality
It is optimal to give doses of vaccinations at appropriate intervals. Delay in vaccine does not affect the effectiveness of the vaccine

Myth & Reality:

Myth Do Not Vaccinate, if a Child has Cold or Diarrhoea

Reality
Presence of minor illnesses like common cold and diarrhea does not increase side-effects nor decreases its effectiveness Severe illnesses do contraindicate the use of vaccines

Myth & Reality:

Medicines for increasing the height
Myth
I heard someone say, There are medicines available for increasing the height of my child

Reality
No medicines, which can increase the height of a child Height depends on many factors:

hereditary genetic configuration absence of chronic illnesses age related optimal growth during childhood

Myth & Reality:

Medicines for increasing the appetite
Myth There are tonics for increasing the appetite of children Reality
Hardly any medicine or tonic is effective in increasing appetite The taste, personal likes and past experience regarding food and frequent feeding can overcome this problem

Health problems of Children

Appetite
It is not true that children generally have less appetite They are able to eat less at a given time as the capacity of the stomach is limited Frequent feeds is an answer Tonics and appetite stimulant do not help and can prove harmful Children with reduced appetite who show faltering of weight needs to be investigated to determine the cause of reduced appetite

Loose Motions
Most diarrheas in children are due to viral infection, where antibiotics do not work It is important to maintain the fluid and electrolyte balance in children with diarrhea with the help of oral rehydration fluids

Loose Motions
Harmful drugs that suppress peristalsis need to be avoided Children should continue to receive their usual diet and nutrition even during diarrhea Consult your doctor if the child is lethargic or excessively irritable or passes less urine

Fever
Fever helps body fight infection It is worthwhile confirming the presence of fever by recording babys temperature before administering drugs Treat fever with paracetamol and tepid sponging It is important to control fever. Is also important to determine the cause of fever and treat it

Vomiting
Several conditions cause vomiting It is vital to maintain intake. This helps prevent dehydration and shock Consult your doctor if vomiting is incessant or if it is associated with fever, lethargy or excessive irritability

Coughs, colds and Asthma

Short lasting coughs and colds do not require extensive medications Asthma can present with cough alone It is better to use inhaled drug rather than oral drugs for prevention of further attacks

Convulsions
Convulsions can be potentially life threatening Take the child to the nearest health facility as it is important to control convulsion. This helps prevent injury to the brain If your child has tendency to develop convulsions, learn to give diazepam through the rectal route Regular follow-up is a must for children with repeated convulsions

Jaundice
Common causes of jaundice include viral hepatitis and certain types of anemia Jaundice due to viral hepatitis is treated with rest and proper diet Unnecessary dietary restriction is undesirable since it is associated with greater weight loss Bleeding, excessive sleep, passage of decreased amount of urine, irritability should prompt you to seek medical help

Measles
Measles can be a dreadful disease in young children Measles is associated with complications like pneumonia, encephalitis and exacerbation of tuberculosis It can be easily prevented by a vaccine that has proved to be effective and safe Measles vaccine is given at the age of 9 months

Chickenpox
It is usually an inconsequential illness in infants and young children. Older children have higher propensity for suffering from complications related to chickenpox Chickenpox can be prevented with the help of a vaccine

Worms
Worm infestations in children are related to unhygienic practices Worm infestations lead to anemia and intestinal obstruction Worm infestation can be easily treated with the help of medicines Prevent worm infestation by promoting hygienic practices

Boils
Boils represent mild infection of the skin Prevent boils by maintenance of hygiene of the skin

Accidents, Poisoning and First Aid

Prevent accidents by providing safe environment Prevent poisoning by keeping hazardous substances and drugs and chemicals out of reach of infants and young children Provide appropriate first aid at home

THANK YOU