Goodnight, My Baby

My daughter was a good sleeper from the day she was born. But my son Joe was a whole other story. Maybe your daughter is more like Joe: he never wanted to go to bed—ever. We’d put him in his crib, tiptoe out, and then brace for the scream that would follow. Through my research, interviews, and writings on parenting issues, I’ve since learned that because babies have no idea when they’re supposed to go to sleep, they need us to set the stage and make bedtime predictable and routine. By eight months, your daughter’s biological clock has kicked into gear, so she’s certainly ready to respond to a consistent bedtime ritual that is both predictable and soothing and that will help her fall asleep at the same time every night. A bedtime ritual consists of anything you’d like to do as you routinely put your daughter to bed for the night. A typical ritual might go something like this: You carry your daughter to the bedroom, turn on a night-light, sit to sing a lullaby, kiss a few stuffed animals goodnight, kiss your daughter, and lay her in her bed. Say goodnight and leave the room while she is still awake. After doing this repeatedly, your daughter will know it’s time for bed as soon as you turn on the night-light. Same time, same place, same routine every night. The sameness of the ritual carries comfort, security, and a promise that the separation caused by sleep is predictable and temporary. Whatever rituals you create, make sure they’re ones you can repeat and pass on to your child’s caregivers. If you build a routine that includes a story, a song, and a night-light, your spouse and babysitter will never get your child to sleep if they don’t follow the same steps (in the same order). These are signals that tell your daughter what to do next; without these signals, children lose their sense of security and control. Maybe the reason my daughter was such a good sleeper was because when she came along, I was determined not to repeat the bedtime mistakes I had made with her brother. This bedtime ritual worked like a charm with her. Live and learn.Prevention is the key to good health in this time of late infancy. Planning ahead will help you combat the following two common problems before they even begin. Poison Control: Now that your little girl is finding her way around, you should literally batten down the hatches. The combination of her mobility and her instinct to put everything in her mouth for exploration can be deadly if she consumes a toxic household substance or medication. To make sure your daughter isn’t one of the 1.2 million children younger than six years who ingest potentially poisonous substances each year, the website www.KidsHealth.org recommends these helpful tips: Store all medications, vitamins, cleaning supplies, and alcoholic drinks in high (preferably locked) cabinets. Cosmetics and toiletries should also be kept far from your daughter’s reach. Never tell a child that medicine is “candy.” Take special precautions when you have houseguests. Be sure their medications are far from reach, preferably locked in one of their bags..not in old soda bottles or containers that were once used for food. While cleaning or using household chemicals, never leave the bottles unattended if a small child is present. Similarly, take special care with alcohol during parties—guests may not be conscious of where they’ve left their drinks. Keep rat poison or roach powders off the floors of your home.Tooth Care: By the time your girl is eleven months old, she is likely to have her two bottom and two top teeth as well as her upper and lower side teeth. That’s why it’s time for your baby girl’s first visit to the dentist! The American Dental Association and the American Academy of Pediatric Dentists recommend that children see a dentist by age one, when they generally have about six to eight teeth. Dentists say that dental problems in young children may be difficult for parents to spot, so even though the teeth look fine to you, there may be early signs of trouble that a dentist can detect. Also, a dentist experienced in treating young children can give you extra guidance on how to clean those little teeth and how to prevent future problems. If you decide to take your daughter to a dentist at this youngage, it’s best to find a pediatric dentist with special training in dealing with children, or a family dentist who has a lot of experience with kids. An office that caters to children generally will have interesting toys and books in the waiting room, hygienists who know how to talk to young children, and cheerful props and take-home goodies. This first visit will be for a checkup only. Your daughter will sit on your lap and if she hasn’t developed a severe case of stranger anxiety just yet, she will probably enjoy looking around at the new environment while the dentist examines her teeth. This should be a pleasant visit without discomfort or fear that can help your child avoid an early case of dentist-phobia. Your daughter may look perfectly healthy to you, but she still needs to see her doctor for routine checkups. As your daughter finishes up her first year, the American Academy of Pediatrics recommends a well-baby exam at nine months of age. Just like the previous health checkups, your daughter’s doctor will give your daughter a complete once-over. She will: Record your daughter’s physical growth: her weight, length, and head circumference will be measured. Flash a light in your daughter’s eyes to monitor pupil dilation. She will also move the light from side to side, asking your child to follow the light with her eyes. She is looking to see if they wander, cross, or move in different directions—allsigns of strabismus, a common, often correctable childhood eye problem. Examine the ears, checking behind the eardrum for fluid and the middle ear for redness, swelling, or other signs of infection. Look inside the nose, checking nasal membranes for swelling due to a cold or allergy and the mucus for color and consistency (this may indicate infection). Open the mouth wide to check the throat, and tonsils for bumps, sores, swelling, or color changes—all signs of infection. Use a stethoscope to listen to your daughter’s heart for rate and rhythm, and lungs for any respiratory problems. Feel your daughter’s abdomen to rule out abnormal masses or enlarged organs and check for gurgling sounds of the intestinal tract. Check the genitalia for any signs of tenderness or infection. This visit also gives you a good opportunity to discuss any health concerns you may have. If you’re wondering if your daughter’s physical development, large motor skills, language skills, feeding schedule, or sleeping patterns are on track, ask. Your daughter’s doctor sees many infants every day and cannot know what child development issues are most important to each parent. If at all possible, both parents should accompany the baby. This lets both of you get to know the person charged with caring foryour daughter’s health and also offers an extra hand so that at least one of you can listen to the doctor’s advice without being distracted. As you watch your daughter grow, you will routinely deal with normal health concerns such as sniffles, colds, bumps, and bruises. But when your daughter has an ear or urinary tract infection you should visit her doctor for proper treatment, which may or may not include a course of antibiotics. Ear Infections: Popular literature says that ear infections (medical term: otitis media) account for 24.5 million doctor visits each year and are the second most common childhood ailment, following upper respiratory infections. So what causes these common infections? When a baby lies flat, the Eustachian tube—the tube that connects the back of the throat with the middle ear—is more horizontal. This allows fluid and germs to travel more easily from the back of the throat to the middle ear. This tube is shorter in babies and so the fluid more easily finds its way into that middle ear. That’s why if your daughter has a head cold it may lead to an ear infection if fluids back up into the ear, giving the germs that cause ear infections a nice, warm place to grow. Even fluid like formula or breast milk or juice that a baby drinks while lying down can do the same thing. Oddly enough, allergens can also cause ear infections. The allergens in cigarette smoke, for example, trigger secretions to plugthe breathing passages and the Eustachian tube, setting up fluid in the middle ear ripe for possible infection. In fact, even allergens from pet dander can trigger secretions that build up in the middle ear and lead to infection. So, if your daughter is prone to ear infections: 1. Always feed her upright (at no less than 30 degrees) and keep her upright for at least thirty minutes after a feeding. 2. Keep her away from cigarette smoke. 3. Keep pets out of her bedroom (and, certainly, don’t let the baby and your pet sleep together in the same room). Because ear infections are so common in young children, there’s a good chance that your little girl will experience this discomfort. You should suspect an ear infection if your daughter shows these symptoms: Irritability. Your daughter may cry and pull on one ear or the side of her face. Unwillingness to lie down (this increases the pain). Fever ranging from 100 to 104 degrees. Balance problems. If you suspect an ear infection, get your daughter to the doctor for an accurate diagnosis. In some cases the infection is minor and will heal itself. In other cases there can be dangerousconsequences if an ear infection is left untreated. Let the doctor decide. If there is no imminent danger, it’s possible that because of the rampant overuse of antibiotics, the prescribed treatment will be quite different than it was for babies just one generation ago. If my babies had slight fevers, acted irritable, and pulled on their ears, I could call the doctor’s office and get a prescription for an antibiotic over the phone. Today, most physicians are hesitant to prescribe so quickly and prefer a “wait-and-see” approach. In fact, the American Academy of Pediatrics and the American Academy of Family Physicians has issued guidelines with a specific definition of what constitutes an ear infection and how to best treat it. Because it has been found that most children with an acute ear infection will get better without antibiotic treatment, the guidelines call for watchful waiting. They suggest that physicians give children a prescription for antibiotics only if they do not feel better in two days. Doctors aren’t withholding antibiotics in cases where there is clearly an infection and the child is feverish and in pain, or in instances where the baby has a history of ear infections, but if the diagnosis is borderline, your daughter’s physician may ask you to hold off on the antibiotics. Whether you treat an ear infection with antibiotics or not, here are a few tips to help your daughter feel more comfortable: Don’t put over-the-counter eardrops or warm water in your daughter’s ear. Keep your daughter in a sitting position as much as possible. Sitting upright relieves pressure against the eardrum.