Breast Feeding FAQs

Like you, all mothers have a lot of concerns about their babies. This is a special chapter to assist you to answer some of your own questions. Some common questions asked by the mothers are:
Q. When should breastfeeding be started?
Ans. Breastfeeding should be started immediately after the baby is born. The naked baby (after baby is mopped gently and made dry) should be held by the mother, close to her breasts for skin to skin contact.It stimulates smooth flow of milk and keeps the baby warm besides helping emotional bonding. After this start breastfeeding.
Q. Why breastfeeding should be started early?
Ans. Because
1 Baby is most active in first 30 to 60 minutes.
2 Sucking reflex is most active at that time.
3 Early start ensures success of exclusive breastfeeding. Colostrum, which is the first yellowish secretion from the breast, is full of substances which protect the baby from getting any infection and acts to prevent infection like a vaccine.
4 It prevents breast swelling and pain, reduces post delivery bleeding.
Q. After Caesarean- section delivery, can I breastfeed my baby successfully?
Ans. Yes. This operation does not affect your ability to successfully breastfeed your baby. You can start breastfeeding after 4 hrs. of operation or when you are out
of the effect of anaestheia. You can tilt your body to one side in the lying-down position and start feeding ,or you can put the baby on your abdomen and then feed the child. All mothers who have caesarean section deliveries are successful in breastfeeding their babies with assistance for the first few days.
Q. Can I feed my baby in lying down position?
Ans. Yes. You can feed your baby in any position comfortable to you and your baby. It may be lying down, sitting or reclining.
Q. I give gripe water and/ or ghutti to my baby- is it desirable or not?
Ans. No. Use of ghutti and gripe water is an unscientific practice.It is better not to use them. These preparations sometimes contain medications which are harmful and may induce sleep which is not natural.
Q. Does my baby needs vitamins?
Ans. Usually not. A baby who is exclusively breastfed for first six months does not need tonics or vitamins.If not exclusively breastfed, then yes.
Q. My milk looks thin and watery . Is it alright?
Ans.Yes. Milk at the start of breastfeed(foremilk)is thin and contains less fat. Hindmilk(near the end of feed) is thicker and full of fats. A baby needs both. Feed the baby in an unrestricted fashion to ensure that baby receives both foremilk and hind milk.
Q. Should I breastfeed from both the breasts each time I feed my baby?
Ans. One breast must be emptied out fully before the second is offered, so that the baby receives both foremilk and hind milk. When the baby releases one, breast other should be offered. If the baby is still
hungry he will feed from the other breast. Alternate breast should be offered at each feed.
Q. My baby is preterm. Can I breastfeed successfully?
Ans Yes. you can breastfeed a preterm baby successfully.
Q. How long can I continue to breastfeed?
Ans. You should breastfeed your baby exclusively for first 6 months and continue breastfeeding well upto 2 years or beyond.
Q. My milk leaks from breast after feeding the baby. What should I do?
Ans. It is a temporary problem and quite normal. If you notice the milk is leaking , press your elbows firmly against the outer margins of your breasts. This will slow down the flow.
Q. I don't have enough milk . What should I do?
Ans. Sign of getting adequate milk supply is the baby passing urine 6 times (or more) in 24 hours and baby gaining weight 500gms per month. The feeling of inadequate milk is usually apparent and not true as it comes from the mother believing that she is not producing enough breastmilk or if the baby asks for feeds more frequently or cries a lot. What you should do is put your child more often at your breast. Increased suckling frequently will increase “prolactin” production and in turn increase your milk supply. Also, avoid tension which inhibits the milk flow.
Q. I have pain in the nipples while feeding the baby.What should I do?
Ans. The cause of pain, probably is that your baby is suckling in an incorrect position. If the baby is suckling only at the nipple, it causes sore nipple, which is painful. The treatment is to feed your baby in the correct position. Once your baby starts suckling in the correct position, pain will immediately disappear. Applying any cream or lotion is not recommended. You can put few drops of your own breastmilk over the damaged area and allow it to dry.
Q. My baby is passing frequent loose stools.Do I need to worry?
Ans. An exclusively breastfed baby sometimes passes frequent loose stools. It is normal.
Q. I am sick, can I still breastfeed my baby?
Ans. Yes. You can continue breastfeeding even if you are sick. Most of the diseases do not affect the baby even typhoid, malaria, tuberculosis, jaundice or leprosy don't call for stopping breastfeeding.
Q. I am taking medicines.Can I continue breastfeeding my baby?
Ans. Yes. Most commonly used drugs don’t cause any harm to babies For further advice consult your doctor.
Q. Should washing the breast before and after each feed be done ?
Ans. No. Daily bathing is all that is required. Avoid applying soap on your nipples. Frequent washing or cleaning of the breast is likely to remove the antibacterial lubricating oil produced by the special glands present in the areola.
Q. Some of my friends give fruit juices and soups during early months of life. My baby is 3 months old.Should I start giving these to my baby?
Ans. No. From birth till 6 months your child should be given only breastmilk. Any other food or drink given may be harmful for your child and also increases his chances of getting diarrhoea. Giving these would deprive your baby of adequate amount of breastmilk.
Q. I want to start bottlefeeding so that baby does not refuse to accept it later. What do you think?
Ans. There is no need to give bottlefeeding and it should be avoided. If necessary, child can take milk from a cup.Even atfer six months if needed your child should be fed with a cup and a spoon.Bottle feeding is not necessary.
Q. What is the harm of using one bottle-feed a day when I am boiling the bottles carefully?
Ans. Starting bottlefeed leads to three major problems

1. Baby starts refusing the breast due to nipple confusion.
2. It will reduce your own milk supply.
3. The baby becomes more prone to infections because of bottle. Inspite of boiling the bottle the chances of infection are higher in the babies who are bottlefed than who are not given bottles.

Q. In case I need to give artificial milk, how should I give?
Ans. If the baby has to be given artificial milk it should be given with a cup or a spoon and not with a bottle. Any mistake in the process of preparing a bottle-feed can lead to infections.
Q. Does smoking affect my milk and my baby?
Ans. Yes. Smoking can reduce your milk supply. It may also make your child more prone to respiratory infections and asthma.

Q. Some mothers give fruit juices and soups during early months of life. Is it advisable?
No. From birth upto about 6 months a child should be given only breastmilk. Any other thing may be harmful. Giving these would deprive the baby adequate amount of breastmilk and also increases chances of getting diarrhoea.

Q. Most mothers use gripe water and/or Ghutti,-is it desirable?
No. Use of Ghutti and gripe water is an unscientific practice. it is better not to use them. These preparations sometimes contain medications that may induce sleep that is not natural. Also babies should not be given what is not desirable.

Q. Does my baby need vitamins?
Usually not. A baby who is only breastfed for first 6 months does not need tonics or vitamins. Bottle fed babies however may need vitamins. Ask your doctor, he may be the best judge in this case.

Q. My baby is passing frequent loose stools, do I worry?
An exclusively breastfed baby passes frequent, some what loose stools. It is normal. However the baby should be passing urine as frequently should not be given anything other than breastmilk. But if it is bottle fed baby, it is worrying.

Q. My milk leaks from breast after feeding the baby. What should I do?
It is a temporary problem. A little pressure over the breast will stop that. You can put a soft cotton cloth pad inside bra if you are going out doors.

Q. I am taking medicines. Can I continue breastfeeding my baby?
Yes. Most drugs don't cause any harm to babies. Ask your doctor, he may be the best judge in this case.

Q. I am sick. Can I still breastfeed my baby?
Yes. In case you are sick you can continue breastfeeding. Diseases like typhoid, malaria, tuberculosis, jaundice or leprosy don't call for stopping breastfeeding.

Q. My milk looks thin and watery. Is it all right?
Yes. Foremilk (at the start of breastfeed) is thin and contains less fat. Hindmilk (near the end of a feed) is thicker and full of fat. A baby needs both. It has a unique quality of changing with the baby's needs. Feed the baby in an unrestricted fashion to ensure that the baby receives both fore and hindmilk.

Q. I don't have enough milk, What to do?
Most mothers can produce adequate breastmilk for their babies. If you feel that you don't have enough milk, you should check the points listed in the correct positioning of the baby during breastfeeding. See if you are following a demand schedule or not.

The feeling of inadequate milk is usually apparent as it comes from the fact that the baby asks for feed more frequently. “My baby keeps on crying after my feed”, “My baby sleeps well after an artificial feed” and “My friend or mother tells me that I don't have enough milk” are some of the reasons given by the mother. After listening to these problems, a family members, friends or health worker concludes that mother's milk is inadequate for the baby and he needs a supplementary feed.

What you can do is increase suckling frequency of your baby to increase ‘prolactin’ and thus the milk production. Avoid hurry and be confident.

Most mothers can increase their own milk supply by allowing the baby to suckle more often. “More suckling makes more milk” is true for all mothers. Sign of getting adequate milk supply is the passing of urine 6 times (or more) in 24 hours. You are the best judge of yourself and your baby.

Q. How can I start breastfeeding immediately- It seems difficult in a hospital?
Talk to the staff of the hospital where you are going to deliver the baby about your determination to breastfeed. Ask for the baby to be near  you as soon as he is delivered and let the baby remain with you as long as you stay there.

Q. If I have a caesarian section delivery can I breastfeed my baby successfully?
Yes. This operation does not affect the ability of the mother to successfully breastfeed her baby. After a few  hours of surgery when you are out of the effects of anesthetic drugs you can manage to keep the baby and start breastfeeding. You can tilt your body to one side in the lying-down position, get in front of the baby with the help of a pillow and start feeding. It is a little difficult in the beginning but most mothers who have C-section deliveries are successful in breastfeeding their babies with assistance for the first few days. You will need practical support from a health worker, relative or a friend.

Q. Can I feed my baby in lying down position?
Yes. You can feed your baby in any position comfortable to you and your baby. It may be lying down, sitting or reclining.

Q. I have pain in the nipples while feeding the baby. What should I do?
One of the most important factors is the baby suckling in an incorrect position. If the baby is suckling only at the nipple, it causes trauma and sore nipples which is painful. The treatment is to feed the baby in the correct position. If breastfeeding, is painful, the baby is in an incorrect position, put your finger in his mouth and break the suction. Then take out the nipple and try again.

Once the baby starts suckling in the correct position, pain will immediately disappear. Feed at frequent intervals. Don't apply any creams or lotions. It is not recommended. You can take a few drops of your own milk and put it over the damaged area. Allow to dry.

Q. What should do if the breasts are full and firm?
You can have this feeling in case there is delay in feeding the baby or missing breastfeeds. It can be relieved by unrestricted feeding to the baby along with hand expression of milk.

Q. How to prevent breast infection or abscess formation?
Unrestricted feeding in the correct position usually prevents this. But in case sore or cracked nipples develop, and are followed by engorgement, it may lead to swelling, pain and redness on the side of the infection. It is to be treated by the doctor with drugs. If an abscess develops it has to be removed surgically. Mother can continue to breastfeed from the same side even after surgery.

Q. How long can I continue to breastfeed?
You can continue to breastfeed, well into the 2nd year of child's life. Breastmilk can take care of the milk requirement of baby even during 2nd year.

Q. I want to start bottlefeeding so that baby does not refuse to accept it later-What do you think?
There is no need to start bottlefeeding for this reason. A child  can take milk from a cup or glass even when he is as small as a newborn. Bottle is never required by the baby.

Q. What is the harm of using one bottle-feed a day When I am boiling the bottles carefully?
Starting bottlefeeds leads to three major problems
1. Baby starts refusing the breast due to nipple confusion.
2. It will reduces your own milk supply.
3. The Baby becomes more prone to infections even though bottles are boiled because your baby misses protection of your milk. Also, since many things are involved in preparing a bottlefeed e.g. spoon, sugar, sugarpot, milk, bottle, caps, nipple and your own hands, a minor mistake at any step could lead to a major infection.
Despite this, if you must start bottlefeeding we shall advise you to boil all the material for 20-25 minutes. Wash your hands with soap before you handle the bottle. Don't put your finger into the milk to check its temperature.

Q. My baby is preterm- Can I breastfeed successfully?
Yes. However babies delivered preterm i.e. before completing their gestation are usually small in size and weight. They may not be able to suck. In such circumstances these babies may have to be kept in special care units. Your own breastmilk can be used to feed such a baby. For this you should learn the method of expression of milk by hands. Expressed breastmilk can be given through a tube or with a cup and a spoon. It is always preferable to avoid bottle. When the baby starts sucking he should be allowed to be breastfed.

Q. If I have twin babies- Can I feed both?
Yes. They can be breastfed simultaneously using one breast for each feed and alternating the breasts for next feeds. Breastmilk production is usually sufficient to meet with the requirements of both the babies. If required fresh milk can be used with cup and spoon.

Q. Should I breastfeed from both breasts each time I feed my baby?
Let your baby decide that. Take your hint from him. He may prefer to have milk from one or both breasts at each feed.

Q. Is there any drug that may increase the milk supply?
Yes. Some drugs have been reported to increase supply, But frequent suckling at the breast and avoiding bottle feeding is more important to ensure adequate supply of milk than medicines to increase your milk supply. The medicines have their inherent side effects as well.

Q. Would washing the breast before and after each feed and application of any cream or ointment help in the prevention or treatment of sore or cracked nipples?
No. Daily bathing is all that is required. Avoid applying soap on your nipples. Frequent washing or cleaning of the breast is likely to remove the antibacterial lubricating oil produced by the special glands present on the areola. The application of creams or ointment available in the market for prevention or treatment of sore or cracked nipples may actually make the problem worse.

Q. Exclusive breastfeeding for first 6 months: What does it mean?
Giving only breastmilk to babies during this period without addition of any other supplementary fluid, food or milk is called exclusive breastfeeding.

Mother's milk is sufficient to meet all the baby's needs for about 6 months. Recent research has shown that exclusively breastfed babies don't require water even during very hot season. If a baby is passing urine 6 times during 24 hours it means he is getting enough food & fluids.

Q. In case I need to give artificial milk:
Breastfeeding takes care of the milk requirement of a baby even upto 2 years. These milks are usually not required. If the baby has to be given these milks they should be given with a cup or spoon and not with a bottle. Your baby does not need bottle at any age.

(courtesy Breast Feeding Promotion Network of India)

Skin Care of Newborn

Childhood Asthma, what you should know about it.

What Is Asthma?

Asthma is a chronic disease of the tubes that carry air to the lungs. These airways become narrow and their linings become swollen, irritated, and inflamed. In patients with asthma, the airways are always irritated and inflamed, even though symptoms are not always present. The degree and severity of airway inflammation varies over time.

Children with asthma can have symptoms start or worsen when they are exposed to many indoor substances such as

• Dust and dust mites

• Cockroaches

• Animals such as cats and dogs

• Molds

• Secondhand cigarette smoke

Children with asthma may also be sensitive to colds and other viral infections, cold air, and particles or chemicals in the air. Ongoing exposures to these substances will not only worsen asthma symptoms, but also continue to aggravate airway inflammation.

Inflammation of the airways causes them to be oversensitive and “twitchy,” often called “hyperreactive.” When the airways are hyperreactive, they can go into spasms, causing blockage and symptoms of wheezing, chest tightness, and shortness of breath.

Who Gets Asthma?

Asthma is a common condition in childhood. In the United States, 10% to 15% of children in grade school have or have had asthma. It can cause a lot of sickness and result in hospital stays and even death. The number of children with asthma is increasing, and the amount of illness due to asthma may also be increasing in some parts of the country. The reasons for these increases are not exactly known; however, outdoor air pollution and increased exposure to allergens are not likely causes.

Recent studies suggest that how often and how early a child is exposed to certain infections and animals can influence the development of asthma. For example, children who come from large families, live with pets, or spend a considerable amount of time in child care in the first year of life are less likely to develop asthma. This early exposure to common allergens may actually protect against the development of asthma.

Studies have also shown that a child’s exposure to infections early in life can determine whether he develops allergies or asthma. Some infections seem to decrease the risk of developing asthma, whereas one infection, respiratory syncytial virus, increases the risk.

How Is Asthma Treated?

Any child who has asthma symptoms more than twice per week should be treated. One of the most important treatments of asthma is to control the underlying inflammation of the airways. This can be done with medications or by avoiding environmental factors that cause or aggravate airway inflammation.

Knowing the causes and triggers for asthma can allow families to reduce or avoid these triggers and reduce ongoing airway inflammation and hyperreactivity. This can reduce the severity and frequency of asthma symptoms and, hopefully, the need for as much asthma medication.

How Is Asthma Diagnosed?

It is often difficult, especially in young children, to be entirely certain that asthma is the diagnosis. After a careful physical examination, your paediatrician will need to ask you specific questions about your child’s health. The information you give your paediatrician will help determine if your child has asthma. Your paediatrician will need information about

• Your child’s symptoms, such as wheezing, coughing, and shortness of breath

• What triggers the symptoms or when the symptoms get worse

• Medications that were tried and if they helped

• Any family history of allergies or asthma

It is very important that your paediatrician test your child’s airway function. One way to do this is with a pulmonary function test using a device called a spirometer. This device measures the amount of air blown out of the lungs over time. Your paediatrician may also want to test your child’s pulmonary function after giving her some asthma medication. This helps confirm that the blockage in the air passages that shows up on pulmonary function tests goes away with treatment.

Some children do not find relief from their symptoms even after using medications. If that is your child, your paediatrician may want to test your child for other conditions that can make asthma worse. These conditions include allergic rhinitis (hayfever), sinusitis (sinus infection), and gastroesophageal reflux disease (the process that causes heartburn).

It is important to remember that asthma is a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma. Also keep in mind that not all children with repeated episodes of wheezing have asthma. Some children are born with small lungs, and their air passages may get blocked by infections. As their lungs grow they no longer wheeze after an infection. This type of wheezing usually occurs in children without a family history of asthma and in children whose mothers smoked during pregnancy.

Non-pharmacological Approaches to Asthma Management

Asthma Triggers

Certain things cause asthma “attacks” or make asthma worse. These are called triggers. Some common asthma triggers are

• Things your child might be allergic to. These are called allergens. (Most children with asthma have allergies, and allergies are a major cause of asthma symptoms.)

- House dust mites

- Animal dander

- Cockroaches

- Mold

- Pollens

• Infections of the airways

- Viral infections of the nose and throat

- Other infections, such as pneumonia or sinus infections

• Irritants in the environment (outside or indoor air you breathe)

- Cigarette and other smoke

- Air pollution

- Cold air, dry air

- Odors, fragrances, volatile organic compounds in sprays, and cleaning products

• Exercise (About 80% of people with asthma develop wheezing, coughing, and a tight feeling in the chest when they exercise.)

• Stress

Be sure to check all of your child’s “environments,” such as school, child care, and relatives’ homes, for exposure to these same things.

Help Your Child Avoid Triggers

While it is impossible to make the place you live in completely allergen- or irritant-free, there are things you can do to reduce your child’s exposure to triggers. The following tips may help.

• Do not smoke or let anyone else smoke in your home or car.

• Reduce exposure to dust mites. The most necessary and effective things to do are to cover your child’s mattress and pillows with special allergy-proof encasings, wash their bedding in hot water every 1 to 2 weeks, remove stuffed toys from the bedroom, and vacuum and dust regularly. Other avoidance measures, which are more difficult or expensive, include reducing the humidity in the house with a dehumidifier or removing carpeting in the bedroom. Bedrooms in basements should not be carpeted.

• If allergic to furry pets, the only truly effective means of reducing exposure to pet allergens is to remove them from the home. If this is not possible, keep them out of your child’s bedroom and consider putting a high-efficiency particulate air (HEPA) filter in their bedroom, removing carpeting, covering mattress and pillows with mite-proof encasings, and washing the animals regularly.

• Reduce cockroach infestation by regularly exterminating, setting roach traps, repairing holes in walls or other entry points, and avoiding leaving exposed food or garbage.

• Mould in homes is often due to excessive moisture indoors, which can result from water damage due to flooding, leaky roofs, leaking pipes, or excessive humidity. Repair any sources of water leakage. Control indoor humidity by using exhaust fans in the bathrooms and kitchen, and adding a dehumidifier in areas with naturally high humidity. Clean existing mould contamination with detergent and water. Sometimes porous materials such as wallboards with mould contamination have to be replaced.

• Pollen exposure can be reduced by using an air conditioner in your child’s bedroom, with the vent closed, and leaving doors and windows closed during high pollen times. (Times vary with allergens, ask your allergist.)

• Reduce indoor irritants by using unscented cleaning products and avoiding mothballs, room deodorizers, or scented candles.

• Check air quality reports in weather forecasts or on the Internet. When the air quality is poor, keep your child indoors and be sure he takes his asthma control medications.

• Decreasing your child’s exposure to triggers will help decrease symptoms as well as the need for asthma medications.

Pharmacologic Management of Asthma

Asthma Medications

The goals of treatment for asthma are to minimize symptoms and allow children to participate in normal physical activities with minimum side effects. It is also important to prevent emergency department visits and hospitalizations due to asthma attacks. Ideally, this means your child should not experience asthma symptoms more than once or twice per week, asthma symptoms should not wake your child at night more than twice per month, and your child should be able to participate in all play, sports, and physical education activities.

Asthma medications come in a variety of forms, including the following:

• Metered-dose inhalers

• Dry powder inhalers

• Liquids that can be used in nebulizers

• Pills

Inhaled forms are preferred because they deliver the medication directly to the air passages with minimal side effects.

Medications Used to Treat Asthma

Asthma is different in every patient, and symptoms can change over time. Your health care provider will determine which asthma medication is best for your child based on the severity and frequency of symptoms and your child’s age. Children with asthma symptoms that occur only once in a while are given medications only for short periods. Children with asthma whose symptoms occur more often need to take controller medications every day.

Sometimes it is necessary to take several medications at the same time to control and prevent symptoms. Your health care provider may give your child several medications at first, to get the asthma symptoms under control, and then decrease the medications as needed. Your health care provider may also recommend a peak flow meter for your child to use at home to monitor lung function. This can help you make decisions about changing therapy or following the effects of changes made by your health care provider.

Asthma medications are divided into 2 groups: quick-relief medications and controller medications.

Quick-Relief Medications

Quick-relief medications are for short-term use to open up narrowed airways and help relieve the feeling of tightness in the chest, wheezing, and breathlessness. They can also be used to prevent exercise-induced asthma. These medications are taken only on an as-needed basis. The most common quick-relief medication is albuterol.

Controller Medications

Controller medications are used on a daily basis to control asthma and reduce the number of days or nights that your child has symptoms. Controller medications are not used for relief of symptoms. Children with symptoms more than twice per week or who wake up more than twice per month should be on controller medications.

Controller medications include the following:

• Inhaled steroids

• Long-acting bronchodilators

• Combination products that contain inhaled steroids and long-acting bronchodilators

• Leukotriene receptor antagonists (only available in pill form)

• Inhaled nonsteroids (such as cromolyn or nedocromil)

• Methylxanthines (for example, theophylline)

Inhaled corticosteroids are the preferred controller medication for all ages. When used in the recommended doses, they are safe for most children. In your child’s particular case, however, your health care provider may recommend another type of controller medication.

Asthma Management Plan

It is usually helpful to have an asthma management plan written down so you can refer to it from time to time. Such a plan should contain information on daily medications your child takes as well as instructions on what to do for symptoms. A plan should also be provided to your child’s school.

Exercise-Induced Asthma

Exercise can often trigger symptoms in children with asthma. It can almost always be prevented with use of quick-relief medications taken 10 to 15 minutes before exercise. If it occurs frequently, however, it may mean your child’s asthma is not under control. Proper asthma control can make a great difference in the ability for a child to exercise normally. It is important for parents to speak to their child’s physical education teachers and coaches about their child’s asthma management.

Management Aids

Devices to Help Deliver Asthma Medications

Medications for asthma can be given to your child using a variety of devices including the following:

• Nebulizer—This is often used with younger children. This device uses an air compressor and cup to change liquid medication into a mist that can be inhaled through a mouthpiece or mask. Inhaled steroids and quick-relief medications can be given this way.

• Metered-dose inhaler (MDI)—This is the most commonly used device for asthma medications. However, your child will need to learn how to use it properly, which means pressing (or actuating) the device while taking a deep breath at the same time. The technique is reviewed on the following pages. Some MDIs are “breath actuated,” that is, they give out a puff of medication when you start to take a breath. These types of MDIs are much easier to use, but are only available for one type of quick-relief medication. Spacers can be used to help relieve some of the coordination problems in using MDIs and should always be used when using inhaled steroids.

• Dry powder inhaler (DPI)—This device is available for some medications. It is easier to use because you do not need to coordinate breathing with actuation. It also has less taste, and often has a built-in counter to help keep track of doses taken and doses left.

Some asthma medications only come in pill form. However, inhaling the medication using one of the devices listed above is usually better because the medication passes straight into the airways. As a result, side effects are reduced or avoided altogether. Because there are several different inhalers on the market, your health care provider will suggest the one that is best for your child. There are important differences in the way they are used and in the amounts of medications they deliver to the airways. Your child will be taught how to use the inhaler, but her technique should be checked regularly to make sure she is getting the right dose of medication.

Peak Flow Meter

To help control asthma, your child may need to use a peak flow meter. This is a handheld device that measures how fast a person can blow air out of the lungs. Asthma treatment plans using peak flow meters use 3 zones—green, yellow, and red, like traffic lights—to help you determine

if your child’s asthma is getting better or worse. Peak flow rates decrease (the numbers on the scale go down) when your child’s asthma is getting worse or is out of control. Peak flow rates increase (the numbers on the scale go up) when the asthma treatment is working and the airways are opening up.

When to Use the Peak Flow Meter (if your health care provider has recommended one)

Check your child’s asthma using the peak flow meter at the following times:

• Every morning, before he takes any medications.

• If your child’s symptoms worsen or if he has an asthma attack. Check the peak flow rate before and after using medications for the attack. This will help you to see if the medications are working.

• Other times during the day, if your health care provider suggests.

Keep in mind, there are differences in peak flow rate measurements at different times of the day. These differences are minimal when asthma is well controlled. Increasing differences may be an early sign of worsening asthma. Also, children of different sizes and ages have different peak flow rate measurements.

Keep a record of your child’s peak flow numbers each day. This will help you and your health care provider see how your child’s asthma is doing. Bring this record with you when you visit the paediatrician.

What are some of the developmental milestones my child should reach by twelve months of age?

From eight to twelve months of age, your baby will become increasingly mobile, a development that will thrill and challenge both of you. Being able to move from place to place will give your child a delicious sense of power and control—her first real taste of physical independence.

Here are some other milestones to look for.

Movement milestones

• Gets to sitting position without assistance
• Crawls forward on belly by pulling with arms and pushing with legs
• Assumes hands-and-knees position
• Creeps on hands and knees supporting trunk on hands and knees
• Gets from sitting to crawling or prone (lying on stomach) position
• Pulls self up to stand
• Walks holding on to furniture
• Stands momentarily without support
• May walk two or three steps without support

Milestones in hand and finger skills

• Uses pincer grasp
• Bangs two cubes together
• Puts objects into container
• Takes objects out of container
• Lets objects go voluntarily
• Pokes with index finger
• Tries to imitate scribbling

Language milestones

• Pays increasing attention to speech
• Responds to simple verbal requests
• Responds to “no”
• Uses simple gestures, such as shaking head for “no”
• Babbles with inflection
• Says “dada” and “mama”
• Uses exclamations, such as “oh-oh!”
• Tries to imitate words

Cognitive milestones

• Explores objects in many different ways (shaking, banging, throwing, dropping)
• Finds hidden objects easily
• Looks at correct picture when the image is named
• Imitates gestures
• Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

Social and emotional milestones

• Shy or anxious with strangers
• Cries when mother or father leaves
• Enjoys imitating people in play
• Shows specific preferences for certain people and toys
• Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
• Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
• May be fearful in some situations
• Prefers mother and/or regular caregiver over all others
• Repeats sounds or gestures for attention
• Finger-feeds himself
• Extends arm or leg to help when being dressed

Developmental health watch

Each baby develops in his own manner, so it’s impossible to tell exactly when your child will perfect a given skill. Although the developmental milestones listed in this book will give you a general idea of the changes you can expect as your child gets older, don’t be alarmed if his development takes a slightly different course. Alert your pediatrician if your baby displays any of the following signs of possible developmental delay in the eight- to twelve-month age range.

• Does not crawl
• Drags one side of body while crawling (for over one month)
• Cannot stand when supported
• Does not search for objects that are hidden while he watches
• Says no single words (“mama” or “dada”)
• Does not learn to use gestures, such as waving or shaking head
• Does not point to objects or pictures
  

(Source:AAP)

What are some of the developmental milestones my child should reach by seven months of age?

From age four to seven months, the most important changes take place within your child. This is the period when he’ll learn to coordinate his emerging perceptive abilities (the use of senses like vision, touch,and hearing) and his increasing motor abilities to develop skills like grasping, rolling over, sitting up, and possibly even crawling.

Here are some other milestones to look for.

Movement milestones

• Rolls both ways (front to back, back to front)
• Sits with, and then without, support of her hands
• Supports her whole weight on her legs
• Reaches with one hand
• Transfers object from hand to hand
• Uses raking grasp (not pincer)

Visual milestones

• Develops full color vision
• Distance vision matures
• Ability to track moving objects improves

Language milestones

• Responds to own name
• Begins to respond to “no”
• Distinguishes emotions by tone of voice
• Responds to sound by making sounds
• Uses voice to express joy and displeasure
• Babbles chains of consonants

Cognitive milestones

• Finds partially hidden object
• Explores with hands and mouth
• Struggles to get objects that are out of reach

Social and emotional milestones

• Enjoys social play
• Interested in mirror images
• Responds to other people’s expressions of emotion and appears joyful often

Developmental health watch

Because each baby develops in his own particular manner, it’s impossible to tell exactly when or how your child will perfect a given skill. The developmental milestones listed in this book will give you a general idea of the changes you can expect, but don’t be alarmed if your own baby’s development takes a slightly different course. Alert your pediatrician, however, if your baby displays any of the following signs of possible developmental delay for this age range.

• Seems very stiff, with tight muscles
• Seems very floppy, like a rag doll
• Head still flops back when body is pulled up to a sitting position
• Reaches with one hand only
• Refuses to cuddle
• Shows no affection for the person who cares for him
• Doesn’t seem to enjoy being around people
• One or both eyes consistently turn in or out
• Persistent tearing, eye drainage, or sensitivity to light
• Does not respond to sounds around him
• Has difficulty getting objects to his mouth
• Does not turn his head to locate sounds by four months
• Doesn’t roll over in either direction (front to back or back to front) by five months
• Seems inconsolable at night after five months
• Doesn’t smile spontaneously by five months
• Cannot sit with help by six months
• Does not laugh or make squealing sounds by six months
• Does not actively reach for objects by six to seven months
• Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
• Does not bear some weight on legs by seven months
• Does not try to attract attention through actions by seven months
• Does not babble by eight months
• Shows no interest in games of peekaboo by eight months
  

(Source: AAP)

What are some of the developmental milestones my child should reach by three months of age?

By the time your baby is three months of age, she will have made a dramatic transformation from a totally dependent newborn to an active and responsive infant. She’ll lose many of her newborn reflexes while acquiring more voluntary control of her body. You’ll find her spending hours inspecting her hands and watching their movements.

Here are some other milestones to look for.

Movement milestones

• Raises head and chest when lying on stomach
• Supports upper body with arms when lying on stomach
• Stretches legs out and kicks when lying on stomach or back
• Opens and shuts hands
• Pushes down on legs when feet are placed on a firm surface
• Brings hand to mouth
• Takes swipes at dangling objects with hands
• Grasps and shakes hand toys

Visual and hearing milestones

• Watches faces intently
• Follows moving objects
• Recognizes familiar objects and people at a distance
• Starts using hands and eyes in coordination
• Smiles at the sound of your voice
• Begins to babble
• Begins to imitate some sounds
• Turns head toward direction of sound

Social and emotional milestones

• Begins to develop a social smile
• Enjoys playing with other people and may cry when playing stops
• Becomes more communicative and expressive with face and body
• Imitates some movements and facial expressions

Developmental health watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

• Doesn’t seem to respond to loud sounds
• Doesn’t notice her hands by two months
• Doesn’t smile at the sound of your voice by two months
• Doesn’t follow moving objects with her eyes by two to three months
• Doesn’t grasp and hold objects by three months
• Doesn’t smile at people by three months
• Cannot support her head well at three months
• Doesn’t reach for and grasp toys by three to four months
• Doesn’t babble by three to four months
• Doesn’t bring objects to her mouth by four months
• Begins babbling, but doesn’t try to imitate any of your sounds by four months
• Doesn’t push down with her legs when her feet are placed on a firm surface by four months
• Has trouble moving one or both eyes in all directions
• Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
• Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
• Still has the tonic neck reflex at four to five months
  

(Source:AAP)

What are some of the developmental milestones my child should reach by one month of age?

In the very beginning, it may seem that your baby does nothing but eat, sleep, cry, and fill his diapers. By the end of the first month, he’ll be much more alert and responsive. Gradually he’ll begin moving his body more smoothly and with much greater coordination—especially in getting his hand to his mouth. You’ll realize that he listens when you speak, watches you as you hold him, and occasionally moves his own body to respond to you or attract your attention.

Here are some other milestones to look for.

Movement milestones

• Makes jerky, quivering arm thrusts
• Brings hands within range of eyes and mouth
• Moves head from side to side while lying on stomach
• Head flops backward if unsupported
• Keeps hands in tight fists
• Strong reflex movements

Visual and hearing milestones

• Focuses 8 to 12 inches (20.3 to 30.4 cm) away
• Eyes wander and occasionally cross
• Prefers black-and-white or high-contrast patterns
• Prefers the human face to all other patterns
• Hearing is fully mature
• Recognizes some sounds
• May turn toward familiar sounds and voices

Smell and touch milestones

• Prefers sweet smells
• Avoids bitter or acidic smells
• Recognizes the scent of his own mother’s breastmilk
• Prefers soft to coarse sensations
• Dislikes rough or abrupt handling

Developmental health watch

If, during the second, third, or fourth weeks of your baby’s life, she shows any of the following signs of developmental delay, notify your pediatrician.

• Sucks poorly and feeds slowly
• Doesn’t blink when shown a bright light
• Doesn’t focus and follow a nearby object moving side to side
• Rarely moves arms and legs; seems stiff
  
• Seems excessively loose in the limbs, or floppy
• Lower jaw trembles constantly, even when not crying or excited
• Doesn’t respond to loud sounds
  

(Source :AAP)