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					Baby
Advocate
                                                                                    Volume 5
                                                                                                     12 to 18 months




inside                                                                                   See
                                                                                          t Recognizes familiar objects and
        2                                                                                pictures in books and may point to
                                                                                        these and name them
    Ask Baby
    Advocate:                                                                            Say
 Handling middle                                                                          t “No”
  ear infections                                                                          t Knows a few words before pro-
                     12 – 18 month                                                     gressing to using words meaningfully.
                                                                                    Next, names pictures and some colors.
        3
       Eight
                     Milestones                                                     Eventually uses two- and three-word
                                                                                    sentences.
                                                                                    t Experiments with pitch, tone, and
   Suggestions              What can my baby…                                         sound of his own voice
   For Avoiding
Separation Anxiety          Do                                                           Hear and Understand
                            While children develop at different rates, the                t Understands almost everything
                            following activities may be among some that                     you say
        4                 your toddler is beginning to engage in during                 t Follows a simple command by
                      the next six months:                                            18 months is able to follow a few simple
     Building         t Stands alone, initiate steps, walks well, stoops and        rules
   Your Child’s         picks something up, walks backward and forward,             t Knows at least 20 words
                                                                                    t Uses two- to three-word sentences to
                        runs and then climbs
                      t Turns pages in a book
  Independence
                                                                                      talk about and ask for things
                      t Sits down on small stool or chair
 and Socialization
                                                                                    t Points or looks at familiar objects or
                      t Climbs stairs while holding on                                people when asked to
                      t Dances with music                                           t Understands that waving “bye-bye”
                      t Pushes and pulls toys                                         means “goodbye”
        5             t Builds towers of blocks, eventually going from two          t Understands object permanence; can
  An Unruffled          to six cubes high                                             find a hidden object
                      t Washes and dries hands; brushes teeth with help             t Understands cause and effect and can
  Approach to
                      t Kicks a ball                                                  solve problems
                                                                                    t Knows that interesting things may be
Temper Tantrums
                      t Navigates two-to-three-piece puzzles
                      t Scribbles with crayons or pencils; draws lines or circles
                                                                                      inside drawers and boxes
                                                                                    t Understands pretend play, such as
                      t Picks up small items like Cheerios with thumb and
                                                                                      feeding a doll
        6               index finger
                      t Feeds self with fingers
                                                                                    t Knows body parts and can point to

                      t Drinks from cup, uses a spoon and fork
                                                                                      them when asked
                                                                                    t Enjoys imitating what you do around
   Food, Mood
 and Your Toddler     t Takes one afternoon nap                                       the house. Knows appropriate use for
                      t May sleep 10-12 hours at night                                familiar objects, such as sweeping with
                      t First molar may appear                                        a broom or dusting with a rag.
                      t Begins to play make believe                                 t Understands how to ask for help by
                      t Begins to sort by shapes and colors                           pointing
                      Ask Baby                                                                  Did you




   ?
                                                                                                know?
                      Advocate                                                                 Advocate Lutheran General Children’s
Q. “My daughter already has had                                                                Hospital in Park Ridge is the premier
                                                                                               children's hospital serving the north
       several middle ear infections.                                                          and northwest metropolitan area. The
                                                                                               medical staff features over 175 pedi-
       What causes them and how                                                                atric and family practice physicians, as
                                                                                               well as physician specialists and servic-
       can they be treated?”                                                                   es in the following areas:
                                                                                               t Advanced Level III Perinatal Center
A. “Next to the common cold,                                                                   t The Center for Pediatric Therapies
      middle ear infections are one                                                              and Audiology
                                                                        David Walner, M.D.     t Developmental Pediatric Clinics:
      of the most regularly experienced                                                          Attention Deficit Disorder Plus
                                                                                                 Child Development
      of childhood illnesses.”                                                                   Cleft Palate
                                                                                                 Down Syndrome
                                                                                                 Education Consulting and Evaluation
Also known as otitis media, middle ear         amoxicillin. Even if your daughter’s con-         Martha Washington Special Needs
infections are most often seen in children     dition seems to improve, she should use           Neonatal Follow-up
between the ages of three months and           all of her medication. If you stop using          School Age Program
three years old. Ear infections are fre-       an antibiotic too soon, bacteria still pres-      Bronchopulmonary Dysplagia
                                                                                                 Spina Bifida
quently preceded by colds, the flu, sea-       ent in the ear could cause the infection          Williams Syndrome
                                                                                               t Heart Institute for Children
sonal allergies or an upper respiratory        to recur. A stronger antibiotic often takes
infection. Most children will have had at      care of repeat infections.
least one ear infection by the time they                                                       t Level III Neonatal Intensive
                                               If your daughter has had three or more            Care Unit
are three years old.
                                                                                               t Midwest Children's Brain
                                               ear infections in six months or six or more
Often infections occur when bacteria or        ear infections in a year, more aggressive         Tumor Center
                                                                                               t Newly Renovated Adolescent Unit
viruses travel along the Eustachian tube       treatment will likely be needed.
— the channel between the ear and the
throat — to fluid in the middle ear, cre-
                                               The next step may be a myringotomy              t Pediatric Emergency and
                                               and tube placement, an outpatient surgi-          Trauma Services
ating a prime environment for bacteria
                                                                                               t Pediatric Intensive Care Services
                                               cal procedure in which small tubes are
to multiply.
                                                                                               t Pediatric Subspecialty Clinics:
                                               inserted in your child’s eardrum. The
Unlike the common cold, however,               tubes allow fluid to drain from the ear,
                                                                                                 Cardiology
where you will notice a runny nose or          minimizing the chances of further infec-          Cystic Fibrosis
sneezing, ear infections may be more           tion, fluid build-up or hearing loss.             Dermatology
difficult to for you to identify, especially                                                     Endocrinology
                                               The procedure is not complicated and
before your child can tell you exactly                                                           Gastroenterology and Nutrition
                                               your child can go home the same day.
what she is experiencing. Be on the                                                              Hematology and Oncology
                                               If your child has recurrent ear infections,
lookout for these symptoms:                                                                      Infectious Diseases
                                               talk with your pediatrician, seek special-
t Pulling or batting at the ear
                                                                                                 Feeding and Motility Clinic
                                               ized care and put an end to his or her pain.      Nephrology and Hypertension
t More noticeably cranky, especially                                                             Neurology
  when you go to lay her down                                                                    Surgical Services
t Trouble sleeping and feeding
                                               David Walner, M.D.                                Pulmonology
                                                                                                 Rehabilitation
t Fever
                                               Pediatric Otolaryngologist
                                               Advocate Lutheran General Children’s Hospital   t State-of-the-Art Pediatric Inpatient
Until you can see a doctor, give your                                                            Services
child an age- and weight-appropriate
dose of acetaminophen or ibuprofen to
                                                        For information about                   For more…
dull the pain. You can soothe her ear(s)
                                                      Advocate pediatricians, call                 For more information about
with warm compresses.
                                                       1-800-3-ADVOCATE                          Advocate’s children’s hospitals,
If your child’s ear infection appears mild,                (1-800-323-8622).                         call 1-800-3-ADVOCATE
it may be viral and is likely to clear up on                    Or visit
its own without medication. For a more                                                             (1-800-323-8622). Or visit
                                                   www.advocatehealth.com
severe bacterial ear infection, your doc-          and click on “Doctors Directory.”             www.advocatehealth.com/kids.
tor may prescribe antibiotics, such as



                                                                    2
8       Suggestions For Avoiding
                      Have you noticed
                      lately that your
                      child clings more
                      tightly to you in
                      new situations or
                      when he is around
                      strangers? This is a
                      sign of separation
                      anxiety.
                                                                                    Separation
                                                                                     Anxiety
                                                                                           How a parent can help a child who has separa-
                                                                                           tion anxiety:
                                                                                           1. Comfort and reassure your child when he is
                                                                                              afraid.
                                                                                           2. Allow your baby to crawl around your home in
                                                                                              safe areas for short periods to experience
                                                                                              the beginnings of independence.
                                                                                           3. If you need to leave the room for a few
Martin Adeoye, M.D. Part of a baby’s
                                                                                              moments, and your baby can not see you, tell
                    normal develop-
                                                                                              your baby that you will be right back – and
       ment is learning that separation
                                                                                              then be sure to do so. Keep talking to him
       from parents is not permanent.
                                                                                              from the other room so he knows you are
       Young babies do not understand
                                                                                              near.
       time, so they think a parent
       who walks out of the room is                                                        4. Plan your separations when your baby is rest-
       gone forever. They may have not yet developed the concept of object perma-             ed and fed, rather than before a nap or meal.
       nence — that a hidden object (or person) is still there, though it cannot be        5. Introduce new people and places gradually so
       seen. Without these concepts, babies become anxious and fearful when a par-            that he will have time to get to know a new
       ent leaves their sight. However, once your baby understands that although              caregiver or friend.
       you cannot be seen, he or she can still picture you in his or her mind. That        6. Avoid prolonging goodbyes and have the sit-
       way he or she knows you are still there if you are needed.                             ter distract your child with a toy as you
       While separation anxiety usually begins around the age of six months, the              leave.
       anxiety over being separated from a trusted person usually reaches its peak         7. Introduce a transitional object such as a
       between 10 and 18 months. Babies may suddenly be afraid of familiar people             blanket or soft toy to help ease separations.
       like a babysitter or grandparent. Stranger anxiety is also common at this age.      8. During night wakings, pat or soothe your
       Children have different temperaments. Some children are more secure and                child to reassure him, but avoid letting your
       do well when other people are around, while other children are more anx-               child get out of bed. You can reassure from
       ious. If your child has an anxious temperament, you can help ease his anxiety          your room first and go to him if necessary.
       by being calm and in control.
       Separation anxiety typically ends by the time a child is three years old. If it     Martin Adeoye, M.D.
       doesn’t, you need to seek help from your pediatrician, a child psychiatrist or      Child Psychiatrist
                                                                                           Advocate’s Hope Children’s Hospital
       a therapist.



  The “       NO”word
  Your probably will hear your toddler
  say “NO” quite often during this peri-
  od to everything you ask, even if you
                                                    A        bit about biting
                                                     It is very NORMAL for toddlers to bite and also very NORMAL for parents to be
  ask if he wants his favorite treat. It is          upset about it. Toddlers go through a period of grabbing and biting because they
  his way of becoming independent and                don’t always have the language to express themselves. Therefore, they sometimes
  feeling like he is in control, two very            try to communicate their frustration physically by hitting, biting, or grabbing.
  important developmental tasks at this
  time. Choose your battles but remain               How to handle biting:
  in charge because your toddler needs               1. Try to figure out what is going on. Is he angry? Is he kissing too hard?
  you to be in charge. He also needs to                 Does he need something to chew on? Is he imitating another child?
  feel he is able to be independent and              2. Let him know that biting is not O.K. by saying, “no biting!”
  make choices. Give him choices of                  3. Pay attention to the person who has been bitten, making a much bigger
  two things that are O.K. with you. For                fuss over them. Your toddler is beginning to see that others have feelings
  example, ask him if he would like to                  and may try to comfort them by the time he is 18 months old.
  eat peaches or a banana. Routines for
  mealtime, bathtime and bedtime will                4. Move your child away from the situation.
  help, as toddlers love things to be pre-           5. Don’t bite your child back. This encourages biting and is not recommended.
  dictable.                                          6. Be ready to praise and hug even when you have had to set a limit.


                                                                   3
 Healthy Ideas                                                       At this age, find toys and playthings that:
                                                                     t Can be filled up or emptied           t Played with in water, like a
  for Building Your Child’s                                          t Require problem solving skills,         funnel and cups or sponges
                                                                       like shape sorters and puzzles        t Sweep or vacuum
Independence and Socialization                                         with six or fewer pieces              t Withstand rough play, like
                                                                     t Roll, like balls of all sizes and       plastic dishes, bowls and
                     As your child begins to take her first steps,     unbreakable toys with wheels            unbreakable mirrors
                     she may begin to show signs of independ-        t Can be stacked, such as               t Allow pretend play, like dolls,
                     ence and signs of a “social life.” She may        blocks                                  doll bottles and toy phones
                     walk further away from you but return to
                                                                     t Push and pull                         t Can be read, like sturdy, color-
                     look at the expression on your face. She
                     may be thinking, “What does mommy do            t Rock, like a rocking horse              ful board books

                     when I go away? Does she get mad? Is it         t Dig and collect like a shovel
                     okay?” This use of “social referencing”           and bucket                            Melissa Cavanaugh, C.C.L.S.
                                                                     t Play music
                                                                                                             Child Life Specialist
                     allows her to explore and then look back to                                             Advocate Hope Children’s Hospital
Melissa Cavanaugh,
C.C.L.S.
                     use you to interpret a situation. If you are
                     smiling, to her it means “go ahead.” If you
are frowning, to her it is a signal to stop. Soon she learns —                                                                (clip and save)
with your support — that it is okay to explore a little, with
mommy or daddy in close range.                                           Your Next Doctor Visit


                                                                     £
While every child is unique, at around 18 months, separation             What to expect at the 18 month well child visit.
anxiety and fear of strangers may decrease. You may notice other
signs of social consciousness, such as:                                  Your child’s 18 month well child visit is scheduled for:
t Your child may begin to play alongside of others, which is
  called parallel play                                                   Date ________________________ Time _________________
t She may say “no” more frequently to commands
                                                                         with Dr. ____________________________________________
t Temper tantrums may crop up
t She may use a blanket or stuffed animal as a security object           Telephone __________________________________________
How can a parent support a child’s growing independence and              If you have any questions or need to reschedule, call your
socialization? Through lots of love and attention, and also, of          doctor’s office.
course, through opportunities to play.
                                                                         What to bring:
Here are some ideas and playful activities for encouraging               t Your child’s vaccination record
your child’s emotional growth:                                           t A list of the questions you have about your child’s

t Allow your young child to help
                                                                           health and development

  with simple chores around the
  house.                                                                 At this visit, your baby’s physician may:
t Consider providing safe house-                                         t Measure your baby’s length, weight and head
  hold items as playthings, such                                         t Listen to your baby’s heart
                                                                         t Look at your baby’s eyes, ears and mouth
  as pots and pans or a broom.
t Give her large crayons and
                                                                         t Talk to you about injury prevention
                                                                         t Check your child’s development
  paper for scribbling and
  drawing.
t Read to her and talk to her                                            t Test him for lead poisoning or tuberculosis
  — using the correct words for                                          t Ask about his sleeping patterns and feeding habits
  objects.                                                               t Give recommended immunizations
t Limit or omit television watch-                                        t Talk with you about any stress or concerns you have
  ing in favor of active playtime.
t Provide her with space to play
  and explore.                                                           Baby’s height________ Baby’s weight________
t Visit playgrounds and swings.
t Expose her to others for the                                           Don’t forget to talk to the doctor about:
  chance to imitate and pretend.                                         ______________________________________________________
t Play with her in the bathtub and                                       ______________________________________________________
  visit infant and toddler pools,                                        ______________________________________________________
  remembering never to leave her                                         ______________________________________________________
  alone near even shallow water.
t Help her to practice language
  with finger play and simple
  songs.

                                                                     4
                                                       An Unruffled Approach
                                                         to             Temper
Temper tantrums are a way for a young
                                                            Tantrums
                                                   t Knowing your child and thinking ahead         t are severe;
child to let out strong emotions before she          can help.                                     t last a long time;
is able to express herself in a socially accept-   t Keep your child from becoming overtired       t happen very often;
able way. It may feel to you like your child
                                                                                                   t disable your child from speaking;
                                                     or hungry.
                                                   t Stick to routines for meals and sleep
has completely lost control, but these fits of
                     rage — which may                                                              t get worse after three to four years of age;
                                                                                                   t are accompanied by signs of illness or
                                                     times. Avoid long outings and delayed
                     include foot stomping,
                                                     naptimes.
                     screaming, and collaps-
                                                   t Distract your child with a favorite toy.
                                                                                                     if the child is holding her breath to cause
                     ing to the floor — are a
                                                   t Be reasonable about what to expect
                                                                                                     fainting;
                                                                                                   t include your child harming herself or others.
                     normal part of child-
                     hood development.               from your child — remember not to
                                                     expect perfection.                            Tantrums are emotionally draining, so do
                      Interestingly, these
                      tantrums often occur         t Help your child avoid being frustrated —      something nice for yourself and your child
                      only when a toddler is         prepare her for changes or events by          afterward. Be ready to reassure with a hug
Anita Berry,          with a parent. They are        talking about them before they happen.        and relax take a bath or a walk.
                                                   t Let your child know your rules and stick
M.S.N., C.N.P.
                      a way a child communi-
cates feelings that may be held in while she is      to them.                                      Anita Berry, M.S.N., C.N.P.
                                                   t To ease communication frustrations, try
away from mom or dad. You can learn a great                                                        Pediatric Nurse Practitioner, Infant Mental Health
                                                                                                   Specialist; Director, Advocate’s Healthy Steps for
deal about your child by paying attention to         teaching your child some simple baby          Young Children Program
what prompted the tantrum. Does it happen            signs (sign language) for words like “hot,”
at certain times of the day? In special places?      “cold,” “hungry,” “bottle,” “hurt”, etc.
Temper flare-ups often begin around one
year and continue until about age three.
                                                   Responding to a Tantrum                             Attend a Free Class
                                                   1. Stay calm.
Nearly all children have them and, by age                                                              Positive Discipline
four, most children develop the necessary          2. Ignore the tantrum until your child is
communication skills to express their feelings        calmer. Keep doing what you were doing
                                                                                                       for Toddlers
with words. Some tantrums occur out of                prior to it occurring.                           Where do you draw the line? Learn
frustration when children try to let adults        3. Do not hit or spank your child.                  basic goals for discipline and tips on
know their wants and needs but do not have                                                             limit-setting and discipline strategies.
the language skills to communicate them.           4. Do not give in to the tantrum. When par-
                                                                                                       Parents will also learn the develop-
                                                      ents give in, children learn inappropriate
                                                                                                       mental, emotional and behavioral
Be Aware of Prompts                                   behavior to get their way.
                                                                                                       issues associated with toddlers and
As your toddler learns more and becomes            5. Do not bribe your child to stop the              discipline. Taught by a child
more independent, she wants to do more                tantrum — this will teach your child to          development specialist, this free
than she may physically or emotionally be             act inappropriately to get a reward.             workshop helps parents learn:
                                                                                                       t Whether and when using a
able to manage. This can be frustrating to         6. Remove any potentially dangerous
the child and can be expressed in a variety           objects from your child — or her path
of ways. Tantrums tend to occur more                                                                     “time-out” technique might
                                                   7. Resist the temptation to stop the                  be appropriate
often when a child is hungry or tired or
not feeling well. Sometimes there are other           tantrum. Your child will work through            t Alternatives to spanking
                                                                                                       t How to handle temper tantrums,
prompts. Your child might want to “do it              her inner turmoil.
herself.” She may want to get attention;           8. Give yourself and your child a few min-            biting and sibling rivalry
test the rules; be upset that you took some-          utes to take a deep breath and regain
thing away from her; not know how to say              control.                                         This class is offered at various
what she wants to; not understand what             9. Ask for help when you need it.                   Advocate locations throughout
you want her to do; feel worried or upset                                                              the Chicago area. To find a class near
or stressed in the home.                           Temper tantrums are NORMAL and                      you or to register, call
                                                   happen less often as children get older.            1-800-3-ADVOCATE (1-800-323-8622)
Preventing or Minimizing Tantrums                  Children should play and act normally               or visit our website,
Although tantrums sometimes happen                 between tantrums. But consult your                  www.advocateheallth.com and click
without warning, parents can often tell            physician if you notice if tantrums                 on “Classes and Screenings.”
when a child is becoming upset.
                                                                         5
                                                        Food, Mood and
                                                    Your Toddler
                                                           This is a trying age for
                                                           parents who want to
                                                           get nutritious food into
                                                           their child. This is
                                                           because several devel-
                                                           opmental changes are
                                                           occurring in your tod-
                                                           dler. He is striving for
                                       William Wittert,    independence and con-
Toddlerhood is a great time for        M.D.                trol. Simultaneously,
families to come together and         his growth rate is slowing, causing a
play and to be a little silly.        decrease in his appetite. These changes
Toddlers enjoy pretending to do       can get in the way of your child sitting
everyday tasks as well as unusual     down for a good meal, often when parents
things. Develop routines and          are ready to sit down and enjoy family           Make food easy to eat
traditions; toddlers love struc-      time together!                                   t Cut food into small, safe, bite-sized pieces.
ture and routine.                                                                      t Offer foods that are soft and moist.
                                      To soften or skip battles over
The simple things often are the       food and mealtime, consider the                  t Serve foods near room temperature.
most fun. Talk with your child’s      following tactics:                               t Use ground meat instead of steak or chops.
grandparents about traditions
                                      t Offer regular meals and nutritious             t Use child-sized silverware, including
they had as children. Think                                                              a fork with dull prongs.
                                        snacks, even if your child doesn’t accept
                                                                                       t Seat your child at a comfortable
about what you and your part-
ner liked as a child. Or make up        them.
some new traditions unique to         t Keep in mind that toddlers are often             height in a secure chair.
your family.                            afraid of new things, so be flexible with      t Make meals a social time where all
                                        their food acceptances and rejections.           family members are present enjoying
Start a book or a photo album
about your child. Take pictures       t Be realistic about food amounts –                each others company and catching up
                                        portions should be one-fourth the size           on what’s new, and turn the TV off.
of him and put them into plastic
sandwich bags, stapling the bags        of an adults’. Their tummy is about the
together to create a book. Your         size of their fist.
                                                                                       Prevent choking
                                      t Try not to give juice or liquids containing
                                                                                       t Slowly add more difficult-to-chew foods
child will enjoy hearing stories
about himself and the people he         sugar. If juice is given, try to limit juice
                                                                                         to your child’s menu.
loves while looking at the pic-
                                                                                       t Until your child is four years old, avoid
                                        intake to four to six ounces a day.
tures with you.                       t Dessert should not be used as a reward
                                                                                         foods that are choking hazards or that
Most of all, have fun with each         — try serving it with the rest of the
                                                                                         are hard to chew and swallow. These
other. By this age, siblings really     meal. Just tell your child that we eat
                                                                                         include nuts, raw carrots, gum drops,
need some special time alone            this first, that next and dessert third,
                                                                                         jelly beans and peanut butter (by itself).
                                                                                       t Supervise your child when he is eating.
with their parents. If you have         as opposed to promising that when
more than one child, consider           you finish your dinner you can have a
letting the older sibling stay up       cookie.                                        t Keep your child seated while he eats.
later to play a game, or plan a       t Your job is to offer nutritious meals;
special outing with him. Mom            your child will decide how much to eat.        William Wittert, M.D.
and Dad will need to get away                                                          Pediatrician,
together alone, too. The best                                                          Advocate Lutheran General Children’s Hospital
thing you can do for your child
is stay together, so work on your
relationship. It’s a good time to
ask Grandma and Grandpa to
come spend the night!                     Is It Time for Toilet Training?
                                          A child younger than 12 months has no control over his bladder or bowel
                                          movements. He still he has very little control between 12 and 18 months.
                                          Most children are unable to obtain bowel and bladder control until 24 to 30
                                          months. The average age that these developments occur is around 27 months.




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