Friday, 20 September 2013

Child care should not become a curse for young children

As reported in today’s Mumbai Mirror by Jyoti Shelar (21st September 2013, One year old with brain injury responding after 6 months of treatment) shaking young children can spell disaster for young children’s growing brains. A one year old baby has suffered neurological damage and has to undergo surgery due to alleged shaking of the child at her day care. What is even more appalling is that the child was handed over to the parent in an unconscious state and reason given was, ‘we thought the child is feeling very sleepy today’.

The above incidence draws light on the much needed training that care givers should have before they are put in charge of young children. A day care especially should train their staff in maintaining  every day charts of babies sleep and eating patterns. In fact in many countries like Canada, day care centers also have to maintain a record of the ‘potty’ of young babies, citing the color, quantity and consistency.
Care givers at day cares should receive training about the age group that they would be handling. With more and more working parents depending on daycares for babies as young as 3 months, it becomes imperative that parents choose wisely and companies must provide day care for employees in their premises. Here are some things to be alert and aware about the care of young babies.
Shaken Baby Syndrome is the cause of many deaths and harms the young brain- Parenting is not easy. Parents need to be honored for this lifelong commitment they make and at times a parent can lose their cool and end up hitting or shaking their kids. Shaken Baby Syndrome is the cause of many deaths and can also can harm to the brain as shaking may cause your baby’s brain to swell, bleed or bruise. Shaken baby syndrome can be caused in the following ways-
1.     Throwing your baby in the air while playing.
2.     Not strapping your baby in a baby car seat while travelling with baby in car. The quick succession brakes, potholes, bumps can all cause damage.
3.     Taking the young baby on dizzy rides or roller coasters.
4.     Shaking the baby in anger.
5.     In many instances slapping the baby too hard across the face.
Be careful that the daycare/playschool or home nanny is aware of the above and does not practice these incorrect methods.
One of the mistakes the daycare in this case made is in assuming that the child was just sleeping a lot whereas the child was unconscious. Parents and daycares must know how much sleep does a child require and at what age and should maintain a sleep log for each child. So how much sleep do young children require? It differs from child to child but given here are some guidelines –
·         Age 1-4 weeks                                                                                                                             Sleep : 15 to 16 hours a Day
·         Newborns typically sleep in two to four hour blocks both during the night and day. They are yet to establish their internal biological clock
·         Age    : 1-4 months
·         Sleep : 14 – 15 hours a day
·         Usually able to sleep once for six hours in a row.
·         Age : 4 – 12 months
·         Sleep : 14 – 15 hours per day
·         2 – 3 naps. Can sleep through the night by age 6 months  
·         Age : 1 – 3 years
·         Sleep: 12 – 14 hours per day.
·         Toddlers usually lose that second nap. Nap can be 1 – 3.5 hours. Their nap is anywhere from 1 to 3 ½ hours long. 
·         Age : 3 – 6 years
·         Sleep: 10 – 12 hours per day.
·         At three, most children still take naps, by 5 most no longer nap.
Another important danger to young babies is SIDS - Sudden Infant Death Syndrome. The safest position to put young babies to sleep is on their back. Keep the following in mind and ensure at the day care too-
1.     Babies placed on their stomachs to sleep are at greater risk of Sudden Infant Death Syndrome (SIDS). 
2.      Place infants on their backs for sleep.
3.     Provide a firm crib covered by a sheet.
4.     Keep pillows and stuffed toys out of the crib.
5.     Make sure the sleeping area is a comfortable temperature to keep infants from becoming overheated.
6.     That is why we must respect the Indian cradle made of cloth, it not only takes the baby’s body shape, but keeps baby safe from SIDS and gives baby the feeling of being safe and coddled just like in the uterus. So time to bring back the Indian cloth cradle

Yet another danger that parents and daycares need to be aware about and watch for is that touch should not become trouble for young children.
Touch is essential to babies' sensory-motor development, and has a positive impact on their physical growth, emotional well-being, cognitive potential, and health. Up to five years of age, young children's touch sensitivity remains more on the face than on their hands. And so it is important that adults don’t pinch, slap or harm kids on their faces.
Young babies thrive on touch and seek it everywhere and from everyone so it becomes imperative for adults to save them from bad touch from adults. Bad touch in the form of physical abuse and sexual abuse are all to be careful about. Start talking to kids about good and bad touch as early as possible

Friday, 13 September 2013

Effective Parenting for Young Babies

This blog is dedicated to parents of infants especially in the age group of 6 to 9 months who are an active part of my blog.
During this period your baby will be able to –
·         Identify Sounds: will turn and look at you as you approach or talk
·         Produce Sounds: like cooing or babbling.
·         Starts Interacting:  appearance of social smile and like to interact
·         Starts paying attention : to toys and words or songs
·         Rolling Over: from the back to the stomach
·         Grasping and Banging:  loves to grasp objects, hold one in each hand and sometimes even bangs them together.
So here are some terms for parents to remember and use in daily parenting with infants –
·         Reciprocity-  This is the period of the onset of social smiling, which means your baby now consciously smiles to get your attention or to engage you, it is important to remember and practise reciprosity in all your daily interactions with baby. Talk or coo to your baby and then pause and give a chance for your baby to respond. Sometimes it will be with a smile, or cooing and babbling. Reciprocity will be the foundation of social development for your baby.
·         Tummy time –we tend to keep babies on the bed or cot or baby bags, but we must give tummy time to the baby too. So place your baby on its tummy often during play time. Remember sleep on the back and play on the tummy. Putting your baby to sleep on the back is important from the point of view of SIDS- sudden infant death syndrome, in baby cots. That is why I love the Indian cradle made of cloth, it not only takes the baby’s body shape, but keeps baby safe from SIDS and gives baby the feeling of being safe and coddled just like in the uterus. So time to bring back the Indian cloth cradle
·         Floor play- infants and kids today are spending more and more time in baby bags, feeding chairs etc, which needs to change.  Floor play helps infants move and touch freely and also gives them the necessary feeling of free movement which restrained chairs etc are unable to provide . This is beneficial for brain development and overall physical growth and will also improve your baby’s eating and sleeping cycle.
·         Face to face play- it is so tempting to leave babies to play with toys on their own, but at this crucial stage it is important that you engage your baby in face to face play, sing songs, peek a boo etc. This helps your baby bond with you, nurtures a sense of trust and communication in your baby.
·         Receptive and expressive vocabulary- your baby’s language development has two parts, first is receptive language skills which means before learning to talk your baby should be ‘talked to’ so your baby ‘receives’ language much more than your baby is able to express. How much your baby will talk and how early depends on the receptive language that your baby is exposed to. So talk, describe and engage your baby’s vocabulary development.
·         Grasping and releasing – before 6 months your baby’s grasping was almost reflexsive. Now there is focussed grasping of objects, though releasing will still be slightly primitive. So they might ‘dump’ objects instead of releasing them. So play games that help baby grasp and reach for objects. Give different objects and toys for baby to grasp. Remember not to push for handedness, many parents want the baby to use the right hand and so offer toys placed more towards the right side of the baby. Always place toys or hold out toys in the middle and let baby choose the hand to use.
·         Mouth the ‘lab’ of your little scientist – everything that your baby grasps will first land in your little scientists ‘lab’, the mouth! This is because the mouth of young babies has more sensory points then the hands or feet. So actually they feel with their mouths. Try not to stop them, instead choose toys that are safe, non toxic for your baby and help your baby to use the ‘lab’. Remember the brain thrives on sensory stimulation so the ‘lab’ is directly connected to brain growth.
Happy parenting.

Friday, 6 September 2013

The black, white or grey path for autism?

When we hear the term autism many of us think of Raymond the young man with an encyclopedic memory and amazing math skill portrayed by Dustin Hoffman in his Academy award winning performance in the movie Rain Man. But all autistic people are not Raymond as Autism is a spectrum disorder.

Very much in the news these days is the case of an autistic boy and the question of whether he should be in the school or should be placed in a specialized autistic remedial environment. The RTE act stresses on inclusion, but the B.Ed course does not prepare teachers for this inclusive classroom scenario and thus inclusion becomes a mere illusion on paper.

So in this case who is right? If the school removes this child then the path followed is black, if the school keeps this child in the name of inclusion then the path followed is white, because it would have upheld the rights of the autistic child. But do white and black work in autism both for the child and the other children? No it does not.  The path required is grey. In many aspects of autism the children are sound sensitive and would not thrive in a classroom scenario where the noise, clutter and chaos will only add to their issues. So it is not inclusion (white) or seclusion (black) that is the answer, it is a carefully selected path of grey (integration) that has to be arrived at by the parents, therapists, school and teachers.  

It is not easy to deal with autism cases as there is very little expertise on autism available in India. The global research on autism is also fairly new and being a spectrum disorder each child requires a very individualized plan. It is a spectrum which means that its symptoms and characteristics find expression in many different combinations and in any degree of severity .At one end of spectrum we may find a mute child crouched in a corner of his room, spinning a paper over and over again for hours at the other would be a child who screams nonstop and flaps its arms or tends to lash out physically.

Autistic or autism disorder is one of several pervasive developmental disorders (PDDs). These disorders are characterized by severe widespread impairment in social interaction and communication skills and stereotyped patterns of behaviors, interest and activities.

There are a range of treatments of autism. Drugs don't cure autism, but many autistic suffer from multiple problems such as depression or seizures, and the drugs can help with those secondary problems.

·         Allergy induced Autism and Casein/Gluten

·         Auditory Training

·         Music Therapy-  

·         Doman/ Delacato Method  

·         Holding Therapy   

·         Sensory Integration Therapy
The Squeeze Machine  

·         Lovaas Method - 

·         The Son-Rise Program taught at the Option Institute and Fellowship

·         Picture Exchange Communication System (PECS)  

·         Speech-Language Therapy

·         Occupational Therapy  

·         Vitamin/Mineral Therapy

 The grey path would be the ideal path and the grey path would mean that

1.     The school and teachers would have an individualized plan of interacting and supporting the therapies of the child.

2.     The teachers would understand and incorporate the point of view of the mother/parent in regards to interacting and handling the child in various situations. Sometimes mothers/parents have developed a unique way that works best for the child.

3.     Teachers would not only be trained in understanding autism but the individual case of the child with support from its therapists etc

4.     The parents especially the mother would have the emotional support knowing that the child will be not only accepted in the class room but integrated.

5.     It is the mothers that require the most support and counseling. It is an extremely high emotional state for the mother to work on educating an autistic child as the mother has the constant fear of ‘what if I am not there?’ when autistic children are understood by their immediate community of friends, relatives and teachers it becomes easier for the mother and family.

6.     Mothers would also understand not to have too many performance based expectations from their child and would not enter into irrelevant comparisons.

7.     The other children in the classroom would also undergo counseling to help them understand why the child is behaving in that particular manner and how to support the child as friends. This would help them grow up to be citizens of tomorrow who accept differences in the larger society.

8.     The other children would also need therapy in many cases as they too undergo depression, disconnect and worry about the child.

It is truly time to push for a change in the teacher training programs to include education about inclusion but till that happens it is time schools trained teachers as part of their in-service training.

It’s time to have assorted chairs in the classroom and to have the grey view on inclusion, let’s stop the black and white.

Dedicated to all parents of autistic kids, you are doing a great job, it is because of you all (and a special one that I know) that these kids are not the forgotten children.