newsletter Feb06

the newsletter, Mar2007

A sweet goodbye to cigarettes

The right circumstance to learn how to care for yourself more. Pregnancy can also be this. Stopping smoking during the nine months means, for instance, taking the opportunity to safeguard your own health whilst assuring the baby healthy development without any risks. Caring for yourself for the love of your child: there are no other reasons to decide to stop smoking during pregnancy. There are no morals, laws or trends that can provide such a valid motivation which is sufficiently strong to encourage your decision to put out your last cigarette.

The harmfulness of smoking during pregnancy has been confirmed over the last few years by a series of international research: there is greater possibility of a spontaneous abortion, a reduction in weight at birth, breathing illnesses. The studies available clearly show that what is harmful is the result of the chemical reactions that develop during the combustion of the cigarette. The smoke contains in fact carbon monoxide, nicotine, cancerogenous ingredients, sulphite and cyanide. Many of these substances cross the placenta barrier and enter the blood stream of the foetus. Carbon monoxide for instance binds to the haemoglobins in the blood preventing them from transporting oxygen to the cells. This would explain why children born to smoking mothers are smaller at birth. The effects of the nicotine have a direct effect on the placenta determining a narrowing of the blood vessels, reducing the amount of oxygen in the blood of the foetus and increasing the baby's heart b eat. Further research shows that smoke also effects the gastrointestinal tract to the extent where babies born to smoking mothers are potentially more subject to the typical pains caused by gassy colics.

Still more alarming are the results of some research that reveal that smoking during pregnancy can increase the risk of malformations in the foetus by about one-third.

That smoking harms the child is therefore unquestionable. One is less aware however of the fact that the risk of damaging the baby is not directly related to the number of cigarettes one smokes a day: there is always the tangible possibility of harming the baby even with just a few cigarettes a day. There is consequently no alternative. To guarantee wellbeing to your child, you will have to stop smoking. Which is understandably not simple. You will have to change your habits. And, above all, test your ability to overcome your own limits and put the wellbeing of the baby, and your own, before your psychological and physical needs.

An exercise, nevertheless, essential for a future mother and something from which, obviously, fathers are not exonerated: if your partner smokes it is more difficult to withstand the temptations and there is a high risk that the future mother will end up feeling lonely in facing the first consequence of a choice, that of having a child, that concerns the couple. To win a challenge such as stopping smoking, on the contrary, collaboration and support is needed from those close to you. In the more difficult case you can, for instance, you could both contact a specialized facility that provides suitable support to face the matter. In most cases, however, it is sufficient to take a positive view of the circumstances: try stopping with your partner. Decide together how, when and ways of doing it. Compare the successes and the defeats, set some targets and give yourselves small prizes when you achieve good results. This applies, naturally, also to non-smoking fath ers: help your companion in her moments of difficulty, help her to care for herself, allow her, above all, to understand that the baby's wellbeing and health depends on her own. Without dramatizing and without blaming. Sharing and collaboration: the tools to be used. Something essential for those who are preparing to become a parent.

Not always objective reasons are sufficient when you make choices. In many cases it is right and necessary to allow yourself to follow your instinct, your impressions, your feelings. Also when it comes to guaranteeing the wellbeing of a child. The presupposition is necessary to understand, for instance, which is the right way to go about calmly and confidently choosing the paediatrician to whom you will entrust your child. The one suggested by mothers, mothers-in-law and friends may well be the "family" paediatrician or the most renowned doctor in the area. But if you feel inside that something doesn't convince you, don't hesitate to consider looking round for an alternative. It would be a mistake to entrust the care of your baby to a physician with whom you realize you don't have a relationship of respect and trust: it is up to him to reassure you when faced with the numerous doubts that bringing up a child involves, and if you are not convinced, all attem pts will be destined to fail.

Remember therefore that the choice is up to you, not your parents or others. But consider also that this may not be so easy and you may encounter some difficulty with the local health authorities that in some areas of the country, do not have a wide choice of the so-called general paediatricians... In some provinces, in fact, the paediatricians who work with the health authorities are few and far between and, due to problems of time or in order to be able to organise you days better, you may have to opt for "whoever is available" in the area you live in. If nevertheless the choice you make, willingly or not, is not satisfactory, it is always possible to consider the possibility, economic conditions permitting, of going to a private paediatrician. In this case, however, you will be called upon to handle carefully the temptation, often dictated by anxiety, of informing both paediatricians when the child is ill. The risk, as there is a professional discretion when facing the same pathology, is that you will be faced with two different therapies, without knowing which one to take. In the case therefore, that you decide to contact a private paediatrician along side the general doctor, remember that the continuity of medical care must be entrusted to only one physician.

In the case nevertheless that it is possible to make a choice, it is important to bear in mind, both in the case of a general doctor or a private physician, that in the relationship with your paediatrician, trust is the conclusive element. As it is always necessary to feel at ease when asking questions, requesting clear explanations, to quickly get an appointment, to be able to phone - without exaggerating, when you notice anything alarming. Aspect that you will notice from the appointment, simply pay attention to a few details: the physician has to know how to put at ease the people who turn to him for help, to be able to express himself using simple language so that he can explain the problems clearly, to have the ability to provide practical recommendations, and make sure that the parents have fully understood. It is also important for experts to inform mothers and fathers of topics they may not be aware of: recent research has shown, for instance, that eight mother s out of ten consider that paediatricians should inform parents on the appropriateness of certain vaccinations. In these cases, it would be a good idea for the physician, besides providing suggestions, to suggest sources of information, books and documents that the parents can consult in order to get more knowledge of a certain problem and increase their level of awareness. Another significant aspect to be assessed when choosing a paediatrician is, naturally, his patience and his ability to listen. It can happen when you talk to a physician, that you get the feeling they are not listening to you, that you doubts and symptoms are not taken fully into consideration. Parents and physicians have to interact, they have to listen to and trust one another, they have to reciprocally make sure they can guarantee solutions and wellbeing to the child. A final tip: asses the paediatrician's attitude towards your child when you make your choice. At times deserving but excessively severe physici ans, in their looks and manners, end up being "refused" by the small patients. And become, in the long run, an uncalled-for unpleasant memory of childhood.

Old games that time has not consumed. Sitting in his mother's lap rocking to and fro, watching his mother's hands move to the music or see her appear and disappear behind a couch: an experience of wonder, joy and serenity for both. Simple childhood games handed down from generation to generation, until today: they don't cost money but, in an unusual way, they present the child with a realistic, and always current, vision of life. It is wrong to consider them old, and underestimate them referring to them as a simple pastime. The play companions of our grandfathers are in actual fact, still today, an expedient which is vital in order to prepare children for the emotions of growing up.

"Cuckoo...where is mummy?" The suspense grows, the child becomes serious and worried, he asks himself where she has gone and if she will ever return. But his mother reappears from behind the chair, to the amazement of the child, who want to play again that unusual game to makes him feel fear and joy in one go. Too amusing for him not to go to see, time after time, how it works. And the game always works and every time it gives the child a little more security and independence. For children, what they don't see doesn't exist and the "cuckoo game" returns a comforting message: even when his mother disappears for a bit, she will always come back. These apparently banal gestures therefore create a process of liberation, an alternation of emotions and feelings that transform the initial dismay, due to the fear of abandonment, into a reassurance of presence and love. And with it starts a journey towards independence that leads to the autonomy required to face the inevitable separations, when for instance you go back to work or when the child starts school.

And it is with this same simplicity that the other childhood games assume a meaningful value in the psycho-physical development of a child. Take for instance the classical "clap hands" or "fly fly butterfly". Starting from the imitative process, the prelude of every growth phase, the child has the opportunity to experiment new abilities and new limits: to learn how to clap his hands the child must know how to coordinate his sight with the movement and to be able to make a sound it is necessary for the movement has a rhythm: the butterfly flies down and the hands follow her miming the chorus, until the movement becomes spontaneous and confident. And again: who doesn't remember "canter canter little pony...", where the mother sits the baby in her lap and mimes a pony trotting and cantering? An important contribution to help the baby's sense of balance mature who, supported by the arms of his mother, slowly learns how not to fall and to accompany the movements with his body. Associating the game with a nursery rhyme can be useful to encourage the child to develop the connections between sound and movement and, above all it will have, forever, the power of a "magic formula", that during particular moments in the life of an adult, will remind him of sweet childhood memories and the reassuring voice of his mother. Be careful however: not everything that is handed down is effective. This is the case of the "aeroplane game" where the child is launched into the air by an adult: the risk is that the child will get frightened to the extent where he will be deeply shocked by the experience and take traces of it through to adult life: it is not rare, according to experts, that the cases of "dizziness" in adults can be associated to this traumatic experience during childhood. There is never need to exaggerate when entertaining a child. The sweetness of childhood is in its simplicity and tenderness. And in its gestures.

Let's begin with one absolute certainty: child masturbation doesn't have any consequences, it doesn't slow their growth, it doesn't case...blindness. This should be obvious...but often it is not. Old wives tales are sometimes hard to abandon and, more often than one would imagine, the damage is caused by the prejudice of adults, their uneasiness, their handed down taboos. Child masturbation is a common and natural practice that is based on the just as natural desire of children to explore their own body and, with it, the parts that "offer" more pleasure than others. And since, for a small child, one part of the body is the same as any other, he can see no reason why he should not touch himself and enjoy the feeling.

The self-stimulation of genitals represents, up to two years of age, a possibility to console himself which the small one primarily resorts to when he is tired, lonely or bored. A child who masturbates doesn't know embarrassment, he is completely absorbed in his stimulation, unaware of the surrounding environment, unaware of the social rules and of other people's moral. There is nothing worrisome in what he does, or dirty or immoral. Reproach, reprimands or punishment, apart from being unfair and useless, risk being self-defeating and may develop in the long run into taboos or negative reactions towards sexuality. Especially if the disapproval is presented as being "immoral", absolutely incomprehensible to a child: the dirty image of sexuality and pleasure has the immediate consequence of making him think he is doing some "forbidden action", that will inevitably induce the child further towards isolation and self-stimulation.

The serenity of a child, his balanced development in all aspects of life depend largely on the more or less correct attitude that parents are able to assume when faced with different circumstances. Even the most embarrassing. Until the age of three of four a child doesn't have a sense of modesty so it is possible therefore that he can start to masturbate in the presence of other people: distract him nicely, propose a new game to play together, involve him in the conversation. Slowly you can then start to try "to educate" the child not to masturbate in public, but with the same calm and serenity you used to teach him not to eat with his hands or not to put his fingers in his nose. In short, allowing the matter to be exclusively a matter of good manners, in which there is no space for senses of guilt. Try also to find more time for him, play more with him, read him a story: a child who masturbates is nearly always a child who feels lonely and for this reason need lots of cuddles, attention, and affection. If nevertheless the child is frequently attracted to this stimulation during the day, or if the desire for masturbation leads to him spending less time with friends in order to be alone, the uneasiness could have more profound emotional origins. In this case, but only in this case and for a more serene assessment of the situation, you can consult your paediatrician.

Small aggressors, small victims

For a child, starting infant school often represents his first real experience in socialisation. It is in this context that children learn to confront themselves with others, to deal with rules and rights, to share games and duties. It is natural therefore that during these months the child can encounter some negative experiences such as, for instance, having to deal with a companion who is more aggressive or bossy than others. This experience can upset the child, just as it can upset the parents. What can you do? How can you help him defend himself? Is it perhaps necessary to teach him how to "respond" to the aggressions? These are legitimate doubts that however must take into consideration the nature and the character of the child. A child who is upset about the aggression of a companion doesn't need "empathic" interventions by his parents; a timid, submissive child doesn't need to be transformed into a child capable of responding and attacking. He needs reassurance, confirmation of respect and trust from the adults that surround him.

In the case where the child suffers from the bossiness of a school friend, the first thing to do is to listen to the child. If you understand what has happened it will also be easier to find the right way to react. It is certainly wrong to dramatize, but it is not even correct to minimize the situation: if the child does not feel he has comprehension he could decide in the future not to share his sufferings. If the child tells you about a clear episode of bossiness, comfort him and confirm to him his right to be respected and to defend his position, to avoid the risk of excessive submissiveness turning him into a common victim for more exuberant or aggressive children. It is useless and harmful nevertheless to tell him to defend himself with as much aggression as he suffered. Not only because there is the risk of increasing the level of conflict, but because the child could feel inadequate in a role that is not his. With consequent, inevitable, loss of self-confidence. High, low, positive or negative, self-confidence is something that we begin to develop in our childhood and something we continue to feed with our experiences in life. Opinions on his behavior, reflections on his way of managing his friendships and the pride that we show for him and his individuality, represent a conclusive phase for the child in order for him to build up a well-balanced development of its personality. It is important therefore to constantly remind him of our trust in him, to valorise his individual potentiality, to help him discover his capabilities. These are important duties that we are called upon to perform to help the child grow up happily.

This is why it is necessary to teach the child that there are well-mannered ways of expressing the anger and the disappointment that one feels when faced with aggressive or bossy school-friends. We can for instance invite him to answer in an appropriate manner: "Try counting up to 10 and then decide if it is worth reacting aggressively and therefore equally as ill-mannered and disrespectful, as the person who provoked you". Let's not forget, nevertheless, that aggressiveness is a natural reaction, that all children test their own aggressiveness and that only as time goes by do they learn how to manage it. This means that also our child, today a victim, could one day find himself in the role of the aggressor. And, when this happens, the child must not live this experience in anguish being ashamed of his own anger, but he must have the tools to judge it and to learn to manage it. It is useless, for the same reason, to get excessively alarmed when faced with s omeone being bossy with your child: unless the situation "degenerates" it is not necessary to intervene in disputes between children. Children need to be able to find the way out of unpleasant situations on their own and, even when the circumstances oblige is to intervene, don't forget to first of all contact the school staff who have the necessary skills to assess the way to handle the problem in a manner which is positive for the growth and development of the children.

Small steps towards independence

Going to school on his own, spending the afternoon playing outdoors, sleeping over at a friend's house. Right or wrong at his age? It is difficult to respond with certainty, without being conditioned by our anxiety and fears. It is certain that, in order to grow up, a child needs to take a distance, to explore, to gain freedom. Nevertheless there are always risks involved. It is the parents' duty to foresee them and to eliminate them. With the final target being that of giving the child what he needs to be able to distinguish, on his own, the importance of shared limits.

Children grow. Their body and their mind, according to their individual nature and tastes. But with the common desire to gain independence, to be able to "do it on their own", to finally become "a grown up". And becoming "a grown up" also means taking his first steps without counting on the constant support of adults. With progressive stages that mainly depend on the age of the child and his personal sense of responsibility. During the first few years at infant school, for instance it is natural that the child is still in a transitory phase, half way between the desire of independence and the need for reassurance and it is therefore common for him to take a small step forwards, and then immediately look for support. Subsequently the child will begin to gain more independence that, where possible, should be granted: when he is eight or nine years old he can, for instance, start to go out alone, but exclusively perhaps to buy something at the corner shop. The important point is that he doesn't have to cross any roads: he has not yet developed the ability to assess the distances or the speed of a car and his reflexes have not reached the necessary level to be sure that the child is not subject to any danger. It is essential, and possible, to start creating some important foundations which will allow him within the year to try, for instance, going to school alone. When you accompany him, explain to him above all that it is necessary to always cross on the zebra-crossing and that, in any case it is necessary to watch out for the vehicles: the driver may not realise he is about to cross the road and it is therefore best to wait until the cars have stopped before stepping off the pavement. Help the child to get to know the local shop-keeper or policeman that he meets on his way to school and explain to him that in the case of an emergency he can always turn to them for help. Try him out by asking him to show you what road he would take to get home and, at an intersection, let him indicate when it is safe to cross. It is a good idea not to trust this first test completely, even if he did everything right: ask him over a few days to repeat everything in your presence.

It is naturally not easy to accept the desire for independence of a child. It is not easy to respect his need to grow up, to decide, to walk on his own, without giving in to the desire to keep on checking up on him, at least for a little longer. But it is essential. A child who is able to experiment, to gain experience, to discover his own skills and abilities will almost surely be more motivated compared than a child who lives with an adult who has imposed his own exaggerated sense of protection. The greater the motivation and the enthusiasm about "feeling grown up", the greater the results will be. The inverse risk is to induce a mechanism of fear, insecurity and frustration produced by the awareness of not being like the others. "Training" children to face life also means "training them" to do things on their own, a long journey where the duty of the parents is to give up that natural and comprehensible feeling, that pushes them towards maintaining a strong bond and control. This, it goes without saying, does not mean giving the child the possibility to do things without limits. It simply means presenting him with a safe reality within which he can experiment, offering him knowledge from which he can start, introducing him to constructive opportunities from which he can choose and thanks to which he will be able to safely and independently grow up.