What do milestones really mean?

THE PERILS OF CHECKING MILESTONES
We look for new skills in our babies to see if they are developing well. We check the lists of “milestones” and match our baby’s skills to it. There are some things we need to keep in mind.  Obviously, I believe in the sequence of development. Obviously, I am contributing to the “milestone mania” by printing the lists of milestones on the pages above but I want to caution you to use them carefully.
MILESTONES ARE AVERAGES
A first and important issue is that milestone lists are based on average. This means that half of babies will meet the milestone before and half will meet the milestone a little later. Milestone lists can either be at the time after most children will achieve the skill or most common time. No baby is common so it will be a rare baby who hits all the milestones when they are listed. My favorite developmental screening tool (photo and more on testing later) actually lists the skills on a bar that crosses several age zones and starts when 1% of infants show a skill, has marks for when 25% and 50% demonstrate the skill and finishes when 90% of infants demonstrate the skill. If your child is anywhere on the bar when the skill begins it is within normal limits.

An example of The Denver Developmental Screening Test.

DEVELOPMENT IS NOT SMOOTH
A second factor is that development is not a smooth, even process. It occurs in fits and starts. Some babies will be at the same level for a period of time and then will jump in all areas. Others will make huge steps in one area of development while others rest. Most mothers notice and mention that there is a slowdown in speech when babies start walking. What this means is if you check your baby just before a development spurt he may seem behind but a week or two later just after a spurt, he may seem ahead.

DEVELOPMENT IS NOT EVEN PERFECTLY SEQUENTIAL
You have heard the old expression, “you can’t walk, until you crawl.” Well, technically that is not true. Roughly 12% of typically developing babies never crawl and go on to learn to walk at a typical age. They do tend to find a way to move forward, most by hitching while sitting, but not on their hands and knees. We go back and get these children to crawl after they have walked to get the benefit of crawling for their hands and arms and senses but it shows that crawling is not absolutely essential to motor development. The same applies in all areas of development. Your baby may skip a step or two here and there before achieving a higher skill and may go back later or may never pass some stages.
CULTURAL AND ENVIRONMENTAL ISSUES
Many of the items used to test milestones are based on cultural practices. For example, self feeding is often used as a measure of social development or of fine motor development. In some cultures, babies are not allowed to feed themselves at an early age and would have no experience with this.   Even children from other cultures, who have not been allowed to feed themselves perhaps because it is messy, would not be demonstrating this skill. Children may start to scribble on paper by about 15 months, but an infant who has never seen crayons or watched her mother or siblings color, is just as likely to put the crayon in her mouth as to mark paper without a demonstration. Some degree of experience is assumed in setting milestones as the majority of infants will have had it but not all.

PREMATURE BABIES AND MILESTONES
In order to understand this, we must remember that development starts at conception. A baby born at 40 weeks has been developing for 40 weeks but one born at 25 weeks has only had 25 weeks of development and still needs the extra 15. This means that, if your baby was more than 3 weeks early, you need to count that time for intrauterine development. When checking milestones, you need to use the due date and not the actual birthdate.  Most professionals will do this until your baby is 2 years old. It isn’t that he has suddenly gained that extra couple of weeks at 2. It is just that, by 2, there is so much variation in normal development that we no longer measure in months but in 3 to 6 month increments. I worked with children up to 3 years of age and I kept in mind any prematurity until then, when testing.
INFANT TESTING
Most infant testing is looking at development based on milestones. They tend to look at 5 areas of development, Gross motor, Fine motor (hand skills), Cognitive, Language and Social development.  The results of testing are impacted by all of the above.  More importantly, most infant testing has very poor predictive validity. This means that infant test tell you what your baby is like today. This is useful for doctors and people working with children and you for choosing suitable activities for your child but it is not useful to say anything about your baby’s future develoment. One reason for this is that infant brains are still forming and can change with the proper stimulation. There are several types of testing and most milestone charts fall into the category of screenings. These tests may suggest that there may be a delay but a more complete test would be needed to confirm that. Further testing is much more involved and needs to be done by a specialist. Some delays are due to environmental issues. Babies cannot learn to crawl if they are not on the ground, for example. These can usually be corrected with changes to the environment. Others have their roots in physical causes and may be life-long but all infants can make some progress with early intervention.

WHEN SHOULD YOU BE WORRIED
According to the Denver Development Screening Test, you should not be worried until you baby has not demonstrated 3 or more of the skill bars that are fully completed below her age range or, for premature babies, adjusted age.  This means that your baby may not show one or two of the skills at age level on a milestones list but that should not cause concern. If your baby is not demonstrating most skills that are 2 months behind his age in any area, you may want to consult your doctor. In any case, never be afraid to bring up your concerns to your pediatrician. You live with the baby. The pediatrician only sees the baby for a few minutes every few months, and usually the baby is distressed simply by being handled by the doctor. They can tell a lot from the weight and height and medical measurements but need your input on daily development issues under normal circumstances. Bringing up your concerns will, at the very least, give you some relief as the pediatrician can reassure you or refer you for help, whichever is needed.

Teeth part 2- Teething

Teething

Sometime between birth and 3, your child will cut about 20 teeth. Exactly when and in which order varies from child to child. On average, the first tooth appears at around 6 months. I have known children who were born with teeth and others who did not get one tooth until they were a year old. Some children get two at a time, first the bottom front then a week later, the upper front and so on (as is the suggested schedule). Others get one tooth then nothing for a month or more and some babies will get one tooth after another for a period of time. Any milestones for teething have to be very general.

Teeth that are present at birth (called “natal teeth”) are generally extra teeth and the doctor may recommend that they be removed.  If not, they should be taken care of and cleaned.

Symptoms

During teething, babies may not feel good. Some may run a fever and some may lose their appetite. Diarrhea is not uncommon during teething. You might see increased drooling, swollen gums and even a rash around the cheek area. Your baby may seem irritable and may be restless. You might even see the baby pulling on an ear.  One problem is that these are all also signs of other illnesses. It is easy to blame everything on teething but it may not be. I was guilty of this. My daughter had cut two teeth when she exhibited a fever and was cranky. I said “teething” but three days later she broke out with a rash so I took her to the doctor. She had Roseola, a childhood illness like measles, which was contagious. She did not get any more teeth for another month.

What to do

It is called “cutting teeth” because the teeth are literally cutting through the gums. This is often not a pleasant experience for baby and therefore not a pleasant experience for anyone who lives with him. There are some things that may help. Chewing on soft things, cold and massaging the gums may help. Cold, clean (but not frozen) teething rings may help. Allowing the baby to suck on a cold wet cloth may help for a while. Massaging the gum with your finger may help but be careful because those teeth are sharp when they start to poke through.  Remember that tooth decay is caused by bacteria so be sure everything that goes in the mouth (and that may be everything that goes into baby’s hand) should be clean.

What not to do

Teething biscuits are NOT recommended because they stick to the teeth and promote tooth decay. Frozen teethers could damage your baby’s gums so cold is good, frozen is not. There are a number of numbing gels and creams that provide some relief but care should be taken when using these and you should consult your pediatrician regarding the latest guidelines on their use.  There are some concerns about one of the main ingredients in these gels (benzocaine) so be careful about using these. 

Note that this post follows the post on care of the teeth. That is because care of the teeth should begin before the teeth start coming in. Below is a rough timeline of teething courtesy of Health Link BC.

Clean Birth Kits for Safe Births

A mother's day gift idea for many mothers at the same time from the Mommyhood Memos. This is directly from Adriel Booker's blog explaining the concept. See her blog for further details.
http://themommyhoodmemos.com/2012/04/bloggers-for-birth-kits-helping-moms-in-developing-nations/
 Clean birth kits can save lives
Did you know that a simple clean birth kit can help save a mom’s life? Did you know that for around $2-3 you can assemble one? Did you know that everything you need to make one can be found easily and quickly at your local hardware store and pharmacy?
Look how simple these clean birth kits are…

And yet, even in their simplicity, they can mark the difference between life and death for a woman unable to get to a regional clinic for birthing her baby.

 

Mom's need love too.

http://bayareabreastfeeding.wordpress.com/2012/04/16/whos-feeding-momma-10-ways-to-support-a-breastfeeding-mom/ I want to share this article which contains specific suggestions of how you can help and support a breastfeeding mother. It is attached to a website and blog dedicted to providing information on breastfeeding. I hope to learn how to share links better and hope this gets you to the article. Thank you Miranda, for passing this on.

Teeth part 1

HEALTHY TEETH START IN INFANCY

 

 

HEALTHY TEETH START IN INFANCY

Healthy teeth are important for your appearance but also for your health. Recent studies have shown that children miss as much school for tooth problems as for Asthma. Anybody who has had a toothache knows that it is not a pleasant experience. And those of you who have never had a cavity are either very lucky or know how to take care of your teeth.  Tooth health has been connected to other health issues as well, including heart trouble. 

Baby teeth

Tooth care should begin before the first tooth appears. Many people think that “milk teeth” are not important because they will come out eventually. This is not true. “Milk teeth” are important. Baby teeth are used to learn to chew and process food. Much of a child’s growth occurs in the first five years which includes much of the structure of the face and jaw. Missing teeth will impact that growth.  They play a role in learning how to speak both because they are used in speaking and they are important in face development.  Perhaps, most important, baby teeth hold space open for the permanent teeth when they come in. If baby teeth are missing, the mouth may not have room for permanent teeth. 

Another issue is that decay in baby teeth, especially if severe, can cause decay in permanent teeth. First of all, the decay can actually go up to the growing teeth and children with severe bottle mouth have had already decayed teeth grow in. Secondly, It is thought that tooth decay is caused by bacteria, which will be present in the mouth when the permanent teeth grow in, so one must take care of baby teeth.

Cleaning the mouth and teeth

When do you start cleaning your baby’s teeth.  You should start before the first tooth comes in.  Aside from keeping your baby’s mouth clean, starting early makes caring for teeth an easy routine. If you try to start cleaning the mouth of an 18 month old you will find resistance.  From the start clean your baby’s gums twice a day, after the morning feeding and before bedtime at night. Here is how.

1.      Lay baby on your lap with head towards you, face up.

2.      Use a soft wash cloth

3.      Use only water, no toothpaste of any kind

4.      Place wet cloth over your finger and gently rub the inside and outside of the upper and lower gums. Some theories recommend that you start at the outside and rub to the center on one side then go to the outside of the other side and rub towards the center. Do the outside then on the inside of the upper before going to the lower gum.

When the first teeth appear (usually between 5 and 7 months) it may be time to start using a small soft toothbrush specifically made for infants. The toothbrush should be replaced every 2 months (as should yours). The pediatric dental association recommends that NO fluoride be used until a child is over 2 years old. It is not necessary to use toothpaste at all until then (plain water will clean the teeth) but if you want to introduce toothpaste be sure to get one especially made for infants.

Bottle mouth

In addition to cleaning the teeth, there are other preventative measures that you should take. Most people have heard of “bottle mouth”. This is decay in the front teeth due to extended sucking on a bottle containing milk or juice.  This is particularly a danger when babies take a bottle to bed. Breast fed babies do not get bottle mouth from breast feeding because it is a rare mother who will let baby “nibble” on the breast for long enough to cause the problem but it is not impossible. Use the bottle only for feeding and remove it when feeding is over. Do not let the baby keep the bottle in the mouth when sleeping. Remove it from the crib. The worst offender is juice bottles but milk also contains sugars and will decay teeth. It is recommended that only water be given in bottles after the evening feeding.  Some dentists recommend that juice never be given in a bottle. Introduce the cup at about 8 months and there is no need to offer juice until it can be taken by cup.

Other causes of decay

In that vein, avoiding sugary foods as much as possible is helpful. For the teeth, continuous contact with these foods is the problem so definitely avoid letting your little ones walk around the house with snacks all day or chew on sweet biscuits for hours at a time.

Bacteria is the main cause of tooth decay and this bacteria can spread from mouth to mouth. If the whole family has healthy teeth there is less chance that baby will have tooth decay. In any case you should not put toothbrushes, spoons or pacifiers from your mouth to the baby’s. Toys and pacifiers should be kept clean and the latter should be replaced frequently. To avoid problems of misshapen teeth, it is recommended that pacifiers be discontinued by about 15 months of age.

The dentist

The first dentist visit should be early if only to help the child become accustomed to going to the dentist. Some pediatric dentists recommend the first visit take place soon after the first tooth comes in. Others  recommend sometime between the first tooth and the first twenty, which means between 8 months and about 2 years. Around the first birthday is a good target for the first dentist visit. If you have older children, it is easy to bring the baby to a visit for one of the older children. The first visit rarely takes more that about 5 minutes unless you have concerns but it helps baby become comfortable about going and gives the dentist a chance to head off any tooth or mouth problems that may occur.

It is important to take the care of your baby’s mouth and teeth very seriously to lay a foundation for healthy habits and healthy teeth throughout life.

The cover photo on our facebook page, sort of suitable for pinterest.
https://www.facebook.com/pages/Baby-activities-and-advice/162098350578792

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Are Male Brains Different from Female Brains?

By now, everyone has heard of the Canadian parents have chosen not to reveal the gender of their child, Storm. Of course, there are people who will know, the doctor, the parents and anyone who changes a diaper, but the parents feel that by not revealing the child’s gender, they can raise a gender free child. An obvious first dilemma is what pronouns to use to talk about the child, but more important is the question of whether one can raise a gender free child. Is gender biological or cultural or a mixture?

We know that there are biological differences between males and females. There is a difference in one pair of genes. There are differences in hormone secretions between males and females. Males, on average, tend to be larger than females. The center of balance in females is lower than in males. At puberty, there are a number of changes that differentiate males from females.  Aside from these, there is a question of if there are differences between the male and female brain. The short answer is yes, there are.

It is known that the different sex hormones (estrogen, progestin, testosterone and androgen) affect the development of the brain and differences in brain development have been seen as early as 26 weeks gestation, indicating that these influences are present from very early in fetal development. On average, the male brain is slightly larger than the female brain (as a percentage of overall body size) but some structures are bigger in males and others are bigger in females, which may account for the difference in size.  An example of this is that the limbic cortex (responsible for regulating emotions) is larger in women and the parietal cortex (having to do with space perception) is larger in men.

Another difference is that men have far more (6.5 times) gray matter than women but women have even more white matter (10 times) than men.  Gray matter is neurons, white matter is full of synapses which may mean that women’s brains process faster than men’s.  There is some evidence that neurons are more tightly packed in women’s brains, which would mean that they take up less space.

Since that advent of techniques that can observe the brain at work (such as magnetic resonance imaging and tomography) scientists have discovered that men process language on one side of the brain but women activate parts on both sides of the brain when processing language. The corpus callosum (the part of the brain that connects the two sides) is larger in women too, which might make communication between the two sides faster and easier in women. (It has been suggested that this may be why learning disorders such as dyslexia are more common in males.)

The question then becomes, Are the differences in the brain responsible for the different stereotypes we have for men and for women?  The answer here is not so simple. For one thing, there are certain disabilities that are seen more in one sex over the other. Some of these, such as dyslexia (which is more common in boys) and dementia (more common in women) may be related to physical differences in the brain.

Although the research in not conclusive, there is a suggestion that different parts of the brain develop at different rates in males and females. This would mean that girls would excel at some things and boys at others at certain ages, even though they would equal out in a few more years. The problem with this is that during the learning years, equal performance is expected and at the higher level. In areas where one gender excels, members of the other could get the idea that they are not as good and might give up on those subjects (math for girls and language skills for boys.) If this is true than care needs to be taken to encourage each so that they have confidence by the time their brain is ready for the subject.

There is evidence that people react differently to girls than to boys from the first day. Studies in newborn nurseries have shown that parents use adjectives like dainty, pretty and sweet to describe girls and adjectives like strong, husky and active to describe boys in the first days of their lives, regardless of the birth weight of the child. Girls are dressed in cute little flowery things and boys in football jerseys for the trip home from the hospital. Toy choices are different from the start as can be the color and theme of the nursery. These are influences that have little to do with brain structures. These are the influences that Storm’s parents are trying to minimize. Since they obviously know the gender of the baby, will they be able to control their own well-learned biases regarding gender? What influence it will have on Storm remains to be seen.

Until recently, social roles demanded differences between the genders. Women were often pregnant and providing direct care for young children during their adult life and men were handling the support chores such as finding food and providing safe environments for the offspring. These roles led to different behaviors. Scientists debate whether the biological differences in the brain caused the different roles or whether the different roles caused the biological differences in the brain. Now, with technological advances, women can provide food and safe environments for the offspring. Men can then spend more time in the direct care of their children. Perhaps these role changes will affect brain structures of the future.

Many articles were read to write this article. A partial list follows.

Edmonds, Molly, Do men and women have different brains? Discovery Health, “Male and Female Brain Structure” published online

Kanazawa, S, Male brain vs. female brain !, Psychology Today online, created Mar 2008.

Sabbatini, R, Are there differences between the brains of Males and Females, Mind and Behavior, online 1997

Witt, S, Parental Influence on Children’s Socialization to Gender Roles, online , 1997. This one contains a long bibliography or articles on related subjects.