the newsletter, MAY 2007

Three quarters, three ultrasound scans
Since its introduction in the mid seventies, the ultrasound scan has become increasingly important in obstetric circles, and has become an essential diagnostic instrument, that allows physicians to observe the contours of the foetus inside the uterus and the structure of its internal organs. It is a non-invasive examination, safe for both mother and child, and consists in a simple probe which does not use radiation.
They can be performed win two different ways: trans-vaginal, that is with a small probe introduced into the vagina or a trans-abdominal scan, with a probe placed on the abdomen. Although the trans-vaginal method provides better images, especially during the first few weeks, the trans-abdominal scan is the most common method used by Italian public and private structures.
If the pregnancy proceeds normally, three scans are usually performed, one every quarter and each of these examinations provides different information.
The first ultrasound scan is performed as a rule between the 10th and the 12th week of pregnancy, as before the 8th week the embryo is not visible. It is mainly used to check that the embryo is located in the uterus and to avoid the eventuality of an extra-uterine pregnancy. It is also capable of recognizing a possible twin pregnancy, establishing if the twins are homozygote, that is deriving from the same embryo that after being fertilized, divides to produce identical twins, or heterozygote, from the fertilization of different egg cells different spermatozoids. It also records the heart beat of the foetus, it detects possible large malformations, and makes it possible to calculate the date of the birth within a period of around two weeks.
The second scan is performed between the 19th and the 23th week, and is also called the "morphological" exam as it concentrates on observing the measurements and the shape of the foetus. Thanks to the scan in the second quarter, it is possible to appraise the correct growth of the baby through the measurement of some parameters, such as the cranial and abdominal circumferences, and the length of the femur and the humerus. The position of the placenta is also checked, the quantity of amniotic liquid, and (the position of the foetus permitting) the sex of the baby.
The third scan is performed between the 29th and the 33th week. Its main purpose is to appraise the correct development of the foetus based on standard reference values. In the case where the data differs excessively from those established, the physician will programme a second scan in a week's time, and if there is still the suspect of an anomalous development, a second level scan will be necessary which is more in-depth. The quantity of amniotic liquid is checked again, which in turn can indicate possible problems, such as for instance possible forms of pregnancy diabetes in the mother (in the case of too much amniotic liquid), or malformations in the urinary tracts of the baby and maternal hypertension (if the liquid is too little). The position of the foetus is appraised with respect to the birth channel: cephalic (head downwards), podalic (feet or bottom downwards), or transverse (shoulders downwards), so that it is possible to start to program the type of birth.< /DIV>
The three scans can be obtained free of charge, on the condition that a general doctor operating within a public structure prescribes them and they are performed in a public facility or a structure which is approved by the health authority. In any case, what counts is being able to trust an experienced scan doctor: in comparison to the other ultrasound scans that examine only specific parts of the body, the foetal scan has to deal in fact with the entire organism, and the tiny dimensions which are often in movement. Professional skills and experience are essential.

Mother, let dad do it
When a child is born a mother is born too. And also a father. It is a good idea not to forget it when his awkward attempts to be useful make you want to "do it on your own". The worry, though understandable, is often unfounded and something to keep a check on if you want a companion that collaborates in running the family, that helps you to overcome the fatigue and the uncertainties of the first few months, that actively participates in the construction of a happy future in three.
Which doesn't' mean that the father has to turn into a "mammo": an insidious and ugly neologism. "Mammo" implies a substitutive function that risks creating expectations destined to be disappointed and, above all, create a detrimental confusion of roles. Mother and father have different roles, just as they have different times and ways of building a relationship with the newborn baby: to expect a father to have the same emotional involvement as a mother from the first few days is something that will not happen. Even the most attentive, involved fathers, those most prepared for dealing with the baby cannot avoid, during the first months, feeling a bit left out, which is justified and natural: the mother seems to be enough for the baby, and the baby seems to be enough for the mother. On top of this there is the fact that when dealing with a newborn baby, many fathers at their first experience show their natural limits in this role: they hold the baby as if he is going to break as soon as he sneezes; they struggle to find the correct position to hold him without letting his head "rock" from one side to another; they face changing nappies with the anxiety as a teen-ager taking A-levels.
This rightful premise should not nevertheless represent an alibi to exclude the father from the daily commitments of the new family management. On the contrary. The father must be involved, from day one, day after day, with confidence and, above all, with the disposition to accept "his" way of dealing with the family. Probably it is not the same as yours and, for this reason, you can foresee, especially at the beginning, separate duties, but in any case always conclusive. If until today you had paid particular attention to personally cleaning and tidying the house, now that have a child to attend to, you can, for instance, delegate the management of the daily matters to your partner: it doesn't matter if the glass on the window doesn't shine like when you do it. Allow him to organize the daily chores. Ask him to go shopping, to cook some dishes or to prepare and arrange the accessories that you use for the baby: cleaning baby bottles and teats, putting the baby clothes away or preparing those needed to change him.
The main point is, in any case, that when you ask for his help, you do so clearly and directly. For those who have not lived through maternity and involved in the sudden changes of daily life, it is often difficult to understand the practical needs of a mother. Explain your needs clearly, give instructions directly to the person who will be doing the chore. Try to avoid any misunderstandings and disappointments, which will only increase when the time comes for your partner to deal with the baby on his own. "Don't hold him like that", "watch out!", "leave it to me": you will have to curb your anxieties, your criticisms, your disappointment when he tries to help, when he does his best to "be a good dad" or you will only increase he sense of inadequacy. The result being that his fear to make more mistakes next time will make things worse.
It is a case of understanding that men and women have a different but complementary way of doing things but both are essential for the growth of a child: his mother can look after him in a more gentle way but the strong arms of a father will give him a more "manly" and secure way of experimenting life. A child doesn't need, on the other hand, a father who becomes more gentle or learns how to change him to perfection. It is sufficient if he looks after the general family needs, helping the mother and the baby. Sometimes, perhaps, in a very awkward manner, but the important point being that he does it.

Small swimmers in the pool
Newborn babies love water. The transparency, the warmth, the possibility to move freely remind them of their life in the womb and, at the same time offer the possibility to experiment new feelings: the weight, the noises, the water on the skin. Feelings that a child can experience from the first few months, thanks to "water awareness" courses that are increasingly popular at swimming pools and sporting facilities specifically proposed to new parents.
From a medical point of view there are no side effects to starting from the first few weeks to dip newborns in the pool, but many paediatricians and structures suggest enrolling the child only after he has had his first cycle of vaccinations, when he is three month's old.
All the swimming pools offer a trial lesson because it is important to check the predisposition of the child and the serenity of the parent that accompanies him. Living with anxiety and fears an experience that on paper is intended to give serenity and calm to parents and children has no sense at all.
During the "lesson" the child enters the water together with his mother or father who, following the indications of an instructor, learn how to support him and to actively participate in his playing, whilst the child is left completely free to express himself without ever forcing his approach to the water. The advantages that originate are many: the progressive adaptation of the baby to the water, the experience of playing in a new and stimulating environment, the consolidation of the mother/child bond. And finally, not in importance, the value of imitation: a mother who shows confidence in the water and encourages her child to experiment will help him overcome his fears, enhancing his self-confidence.
It is therefore definitely an interesting and positive experience, but it is necessary to remember that newborns have special needs. For this reason the choice of the swimming pool must be made in consideration of a few but important conditions. An optimal water course should be, for instance, on a weekly basis with 45/50 minute lessons (and however no more than an hour). The groups should not be more than five baby-parent couples per instructor, and the latter should be specialized in working with newborns. It is also important that the sessions foresee a progressive approach to the water; usually at the beginning it is the parent who enters the pool, supporting the child on a special inflatable mat and encouraging him to dip his hands and feet in the water. The immersion of the body will happen in his own time and without forcing him, allowing him to experiment and play, strengthening his confidence and the bond with his parents. The times can vary also i n this case, but a course which lasts around nine-ten months allows the child to complete all the acclimatization, floating and immersion phases.
A good structure also has to have all the right equipment specifically for children: water games and didactic material for correct motor and sensorial stimulation, safety standard mats and mattresses, adequately heated water, equipped changing rooms with all necessary basics. It is also essential that hygiene is guaranteed: newborns have in fact a very thin and delicate skin, particularly exposed therefore to fungus and other skin infections. Once you have found a facility which responds to all these requirements, remember to buy the special water-proof nappies and get ready to spend a special afternoon. Leaving commitments and worries outside the pool.

No appetite without evidence
"One for mummy, one for daddy, one for grandma..." Every trick is acceptable to convince a child to swallow some spoonfuls of food. There are those who tell imaginative stories, those who makes birds and aeroplanes fly, those who promise rewards and those, tired and deadbeat, allow the child to eat in front of his favourite cartoon on TV. At the origin of all this is the firm conviction that the child is not eating enough. Or rather, to be more precise, that "my child doesn't eat anything". Nothing could be further from the truth: in most cases when children refuse food it is due to a common lack of appetite, and, more often, the child simply eats what his organism actually needs and not what his mother and father would expect.
The problem is that parents often have a wrong idea of the nutritional needs of a child. When paediatricians actually check with the mother and father what the child that "doesn't eat anything" has eaten the day before, they often find that between main meals, snacks and extras, the child has greatly exceeded the calorie intake needed to grow. All of this without counting that, after the first year, a certain lack of appetite is physiological, and a simple cold is enough to abate a child's appetite and that the independence he has achieved initiates his "hunger" for discoveries and knowledge and puts his hunger for food in second place. So the children who are considered to be lacking in appetite – but who in actual fact simply know how to regulate their food intake - end up in a war to the bitter end that transforms lunches and suppers into a battleground. The most common effect is that the more passive children end up surrendering to the insistences of their par ents and eating more than they need, risking an excessive increase in weight, whilst the more active children put up an increasingly stronger fight and they often start a preventive refusal battle where they end up eating less than they would if they were left to eat on their own.
There is also then the fact that the incorrect perception of the nutritional needs is aggravated by the anxiety to see the child grow, that gives the food values and excessive expectations, together with a symbolic meaning that many mothers, unconsciously attribute entirely to the feeding and the nourishment of their child. Weaning in fact puts an end to breast feeding and with it the consolatory need of an action of love, essential for both mother and child. A delicate phase that mothers often find more difficult to face than the children. So the variations in appetite, the refusal or pleasure in food are often attributed meanings that go beyond purely nutritional values.
"If he doesn't eat it means he doesn't love me" is the more or less conscious idea that makes it difficult for some mothers to accept the refusal of food, that they have prepared with so much love for their child. Obviously this is not the case. Feeling accepted or rejected according to the satisfaction shown by the child when eating is an error not to commit. The first contact with food represents the beginning of an independent and essential growth phase in which the child "must" have the possibility to develop his own personality and his own preferences regarding the choice of how and what to eat. Very often the refusal of food for a child is the simple expression of his own tastes or his own food pace that does not necessarily coincide with that of his mother. Nothing more. When faced with a clear and constant refusal, simply respond with a smile: "if you don't want it, it doesn't import matter. You can eat later". A few appropriate words that will howe ver teach the child that eating, like loving, is a pleasure not an obligation.

Let's learn how to handle...scoldings
Losing your patience with children is something that happens. In a relationship between parents and children this is something that has to be faced. It is human, common and even understandable: the need to educate children, tiredness, stress accumulated during the day are all conditions which are sufficient to see all good intentions fly our of the window. It is important nevertheless that when the "storm" has passed, the educational value of a scolding is not made fruitless by inadequate attitudes: a child has to understand that rules and limits exist to be respected, but also that a scolding or a punishment is not irreparable. And that after a burst of anger, there is a smile and the desire to still play together.
The no's, the digging in of the heels, the whims, the desperate weeping in public are simply demonstrations of the child's desire to affirm himself as a different person from his parents, to "escape" from a dependence which, however, the child realises he still needs. For this reason the demonstration of "power" by a child is at the same time full of a weakness and a fragility that must be taken into consideration. The resolution in maintaining a position of denial and the severity when scolding or punishing a child must therefore find a correct balance between the need to educate child and the need to handle the effects of the same reproach. Effects that on the other hand can turn out to be educational only if addressed in a correct manner. It is important, for instance, to proportion the entity of the scolding to the personal ability of the mother and father to handles the senses of guilt that inevitably encumber after scolding a child: better a more mode rate scolding than an exasperated reaction where it is easy to repent with the risk of surrendering too soon in front of the suffering of the child. It is equally wrong to sulk, or even worse, scold the child again answering to his anger with just as much anger. If you continue to shout, to aggressively repeat the committed errors, even after having already dosed out the punishment, this will cause the child to rebel as he tries to understand the reason for a grudge extended over time or, even worse, "to intimidate him" and convince him that in order to get respect and consideration it is necessary "to shout" just as much and for just as long.
The objective of every scolding or every punishment has to be, on the contrary, to make the child understand what he has done wrong, what rule he has broken, what the alternatives were at his disposal, what the consequences of his behaviour can be. But also to help him understand that an error is never irremediable and that, above all, the love of a mother and a father remain unchanged whatever happens. This doesn't mean nevertheless having to take the first step towards a reconciliation. Even when the child find it difficult to put aside his own pride. Feeling that children experience even more than adults: they can sulk for hours, they stay in their rooms, they close themselves, they refuse to speak to those who block their attempts to break the rules imposed by adults, and those who have, even unconsciously, "humiliated" them. We have to expect therefore for the anger to pass on its own and, maybe, try to make the child understand that if he wants to he can approach his parents, who are always ready to welcome him with a big hug. It is normally sufficient to appear open and available and to explain to the child that a quarrel is never eternal: as long as the reasons have been understood, it is enough to apologize and to show a desire, naturally, for a reconciliation.
A final tip: avoid laughing at the child for his reaction to a scolding when he acts "childish" or in an exaggerated manner. A child is in any case a child, fragile and defenceless. And, to become a man, he simply needs a mother and a father who are prepared to offer him their understanding, their admiration and, above all, their respect.

The bicycle season begins
The sunny season is here and just right for going for bicycle rides at weekends. To make sure it is a safe enjoyable time it is important to remember the conduct and safety rules and make sure the children have fully understood them.
A bicycle for a 5-6 year-old child is the first real tool-toy, capable of increasing his independence and strengthening his motor-perceptive skills (sense of balance, of speed, of distance, etc.). Bicycles however are also a means of transport, and as such must be considered by both the child and the parents. It is therefore essential, especially if the bicycle ride is not inside a park but along public roads, to teach our child at least the basic road safety rules and make sure he is able to remember and respect them. Explain to him, for instance, that it is always necessary to pedal in the same direction as the traffic, that it is necessary to look to the right and to the left before crossing any roads and that he must never go too fast. It is important to also remind him he must observe the road signals (stopping above all at the STOP signals and red traffic lights) and always use hand signals when turning right and left.
It is also important the use a safety helmet: to encourage a child to wear him it is usually enough to allow him to take part in choosing it, letting him choose the colour, design and model, remembering in any case that lively colours and reflecting strips will also make it more visible in the evening. When buying the helmet make sure it fits well, that it sits still and doesn't move if he shakes his head, that it doesn't compromise his vision and hearing and, above all, that the child is able to easily open and close with one hand the strap under the chin.
And with regards to the choice of the bicycle? Here too there are a few but important rules to consider when making the choice. First of all the bicycle must be the right size for the child: sitting on the saddle the child must be able to easily reach both the handlebars and the pedals and touch the ground with the tips of his toes. Check that the brakes and lights work perfectly and that all the parts are well secured. The purchase of a traditional bicycle is also recommended as they are more stable than mountain and cross bikes. One last tip: once you have bought the bike periodically check that the brakes and the other mechanical parts are in good condition, teaching your child to do the same.
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