newsletter Feb06

the newsletter, Nov 2006

The sweetness of delivering in water

A sweeter labor for the mother, less "traumatic" for the child. These are the main benefits of delivery in water. If until a few years ago it seemed like a quite original alternative and maybe a little hazardous, the possibility of giving birth to a child in a tub is being considered by more and more mothers. An essential assumption to proceed is the child's well-being. Though, before deciding, it is best, in any case to consider some factors. Last but not least, the scarce use of it in public hospitals.

The first aspect to consider is, with no doubt, the week of pregnancy: it is not possible to deliver in water before the 37th week. This is because of the "diving reflex", or rather the reflex of the child's natural immersion, reaches its maximum maturity in the last weeks of intrauterine life. Until then the child could risk inhaling water during the immersion. The choice of delivering in water is also generally ill-judged when a suspected cardio tracing is found, when there are twins or when the child is breech. For everything else it does not present particular risks. On the contrary, the advantages for the mother and the child are many. First of all in a tub full of water the future mother has the opportunity to find a more elevated sense of intimacy and has a suitable environment to relax and to give into the contractions lightly and with more freedom of movements. Also the advantage made from the heat of the water favours relaxation and reduces the production of stress hormones (adrenaline), by at the same time increasing the production of endorphin, hormones that contribute on the contrary to relieve the painful perception of contractions.

Recent researches have also highlighted a reduction of the length of labor, above all for women that are having their first baby and that, thanks to the higher level of relaxation and the semi-erect position, can reach complete dilatation quicker.

This allows, for women at their first delivery, "to save" time in labor of about 70 minutes. In any case the mother can decide to immerse herself in the tub even when the labor has already begun or rather when the dilatation is of 3 or 4 centimetres. Even obstetrician checkups, including the one that is needed to hear the baby's heart beat, can be carried out while in the tub, like the lumbar massage that facilitates contractions. Last but certainly not least important advantage: thanks to the less force of gravity the woman can find the position that she prefers during labor with easier movements. Delivery in water has revealed in the last years to be a valid alternative even for the advantages that it gives the child that is being born. First of all because the child is born in an element, water, that is "familiar" to him, because it is similar to amniotic liquid in which he has been in for nine months. Also, the temperature of the tub water is very simil ar to body temperature, 37° C., and this makes the passage from the uterus to the outside environment less traumatic, while the first sensations because of light, touch and sounds in the tub appear to be sensitively softened. As soon as the head of the child starts popping out, the midwife takes the baby and placed on his mother's belly to establish their first important contact.

The hospitals that offer this service must have one or more tubs, guaranteed from the hygiene point of view and they must be technically adequate to allow birth with no problems. The staff must also be capable of managing the situation and so they must have adequate preparation. It must be said that not all hospital structures are able to offer the possibility of giving birth to a child in water and there are few that do not limit their stay in water only during labor. The mothers that want to live this experience should verify the possibilities of access to this service by the hospitals in their area beforehand and the modalities of assistance that is expected in the delivery room.

The "torture" of a stuffed up nose

If for an adult a stuffed up nose is only an annoyance to solve every once and a while with a handkerchief, for a child of only a few months of life, incapable of blowing his nose, it is a problem that often ends up compromising rest and nutrition. In fact one must keep in mind that small children essentially use their nose to breathe and it is only with time that they learn to also use their mouth to so. That's enough because between disturbed sleep, motiveless crying and difficult feedings their little stuffed up noses become a real torture. A torture that, however, can be easily relieved with a bit of patience and some small solutions.

The first rule to follow, to protect their respiratory system, is with no doubt to keep humid air in the inside of the home, where, the temperature must never exceed 18/20 degrees. The bowls that are put on radiators have the flaw of containing little water: to improve the quality of air it is suggested to use an electric or an ultrasound humidifier or, in alternative, put a wet towel on the radiator. In fact the water remains the best natural mucolytic so much that, to help children with stuffed up noses to breathe better one can momentarily use a "natural" aerosol: all you have to do is close yourself up in the bathroom with your child and turn on all the taps with hot water for a few minutes. It is, obviously a temporary solution that must soon be substituted by daily hygiene with specific products. A free nose, in fact, besides allowing the child to suck with no impediments and rest peacefully, also prevents germs and bacteria to reach the organism provoking inflam mations and infections in his breathing system.

To clean a baby's nose in the best way it is suggested to wash it at least once a day, preferable before a meal so that the child, once it is done, can suck easier. Mothers also have several sterile physiologic solutions that make the mucus more fluid. The operation is simple: lay the baby down on a flat surface. Softly turn his little head on one side and keep it still with your hand. At this point lightly place the dispenser in his right nostril if his head is on the left and in his left nostril if his head is on the right. Push the dispenser until you see the liquid come out of the other nostril. Be careful holding the dispenser with the spout horizontally facing his eye not his forehead: the holes that connect the nostrils are low not high. It is necessary that the nose channel is completely cleaned to the little tube that connects his ear to his nose: in fact it is here that the secretions that are responsible for inflammations are deposited, among which also the most common problem which is with no doubt otitis. Last suggestion: make sure that the child is immobilised while you are doing this: a sudden jerk could make the dispenser move inadvertently and it would ca use some small abrasions to the baby. Now do the other side with confidence blocking his arms and legs with your body: a few minutes and his feeding can continue with no problems.

They hydrate the surface of the eye, they remove substances of waste, they nourish the cornea: tears have necessary functions for the correct development of eyesight and their appearance does not almost ever identify a discomfort for the child's health. It can happen though that lacrimation becomes excessive or that tear stagnation in the child's eyes occurs. The reason is almost always to be found in the obstruction of the little channel that takes tears from the nose to the throat: it is an annoying problem but, most of the time, it is solvable on its own during growth.

Continuous lacrimation, generally from only one eye, lack of crying, tear stagnation, accumulation and secretion of mucus material, reddening and cracking of the bottom eyelid. These are the main symptoms that highlight a possible obstruction of the "lacrimation duct". A discomfort that, according to statistics, counts two children every one hundred. The origin of the affection is almost always congenital, justified by the lack of an opening of a membrane that is on the inside of a little channel that is inside the eye, through which the regular secretions produced by the tear glands can carry out their regular path and flow in the nose cavity and in the throat. If the duct is obstructed tears stop and their path is diverted to the outside of the eye, causing excessive lacrimation or an internal stagnation.

The discomfort generally disappears spontaneously over the months. It is possible though to use some remedies that allow to reduce the discomforts and to accelerate the solution of the problem. In case of excessive lacrimation it is suggested, for example, to massage where the tear sac is found with the point of your finger: the light and repeated compressions done with a sterile gauze with the point placed on the bottom eyelid, on the internal angle of the eye, facilitate the emptying of the sac and favour the opening of the valve. The secretions can be removed by washing his eyes three times a day with compresses of sterile gauze soaked in special physiologic solutions or simply with boiled and then cooled water. It is also important to keep his nose free because the mucus that is in the nostrils tends to climb towards the tear duct, worsening the discomfort. In any case, though, there is no reason to worry. The problem becomes a little more serious only if there are yellow secretions, stinging, itching, or a sensation of "gluey eyes" when they wake up. In these cases it is possible that the obstruction has caused infections, in particular conjunctivitis. I f this happens it is best to speak with your paediatrician that will confirm if that is the discomfort and will give you the prescription for antibacterial eye drops. In all other cases all you have to do is wait. If the child is older than ten months and the obstruction were to continue, it could be necessary, with the suggestion of an eye doctor, a small surgical operation. In most cases it is adjured: 90 % of children solve the problem in any case by their first year of life. With no operations and without too much anxiety from mummy and daddy.

Smudgy hands, oily chin and cheeks, bib to wash, food everywhere. Learning how to eat with silverware is not simple for a small child that social conventions, good manners and etiquette are abstract concepts, that are difficult to understand. Especially if the adults' reasons complicate the immediate infantile logic with no apparent reason: once they have learned the distance between their hand and mouth eating with their hands seems easy: why complicate life with strange objects? It's impossible to think they're wrong. But education also goes through processes of adaptation that are exclusively from the need of introducing children to the rules of behaviour of a civil society: there are moments of play with plasticine that must not be eaten but that you can spread to make shapes and there are moments for eating in which it must be put in his mouth without being spread. The path is long and complex, though necessary: once more one must unite a good dose of patience with necessary firmness. Without forgetting the respect of the personal timings of each child.

The milestones of the process that take to the conquest of silverware are many: until 9 months a child can hold his bottle with his hands, put it in his mouth and take it out when he is finished. If he is given a biscuit he sucks it but gets dirty. Around 12 months the child is capable of holding things well and he can take things out of his mouth. At 18 months he uses a spoon turned the right way for solid foods, he wants to eat part of his meal by himself, but he soon gets tired and asks for help. At 21 months he generally eats by himself, but still making a mess. The first real progresses begin only around 2 years of age when the child is capable of eating completely by himself and holding a glass with only one hand without getting dirty...even if he might ask to be fed every once and a while, to check if he can still "count" on mommy's help. The use of forks is learnt only around two years and a half, while around three the child finally begins to sit correctly at the table. In this last phase he can also use a knife (even if in any case it is advisable to not try), though he still doesn't have enough strength to cut meat and hard fruit.

Nevertheless it is clear that learning depends mostly on the psychological and physiologic development of every child. A development that, in any case, must never be forced. If anything one can help the child to accomplish his own personal progresses using some strategies with more tranquillity. For example a small child easily accepts silverware if he has had the opportunity to discover it and "try" it. Keeping the child near the table while you are eating will help him get acquainted with these strange objects, verifying the use and learning that meal time is also a chance to be all together. If he has already eaten there is no use in giving him other food: all you should give him is a fork or a spoon: it will be a new game to discover and the best way to know and accept unknown objects. If possible use silverware made for children: colourful, with drawings, with anatomic curves for a more comfortable use, but above all safe and risk free. Do not make a drama if a fork full of food ends up on the floor for the nth time: the growth path of a child surely doesn't keep small practical discomforts in mind. The more you encourage to eat on his own, the sooner he will learn. If anything you can try to organize better: cover the table with a plastic tablecloth and give the child a large napkin or an old bib. Last suggestion: do not expect a child of one-two years old to acquire good manners on his own. A child's learning is founded also and above all on the imitation of the adults that surround him and on the good example that they give him: don't pick up that piece of cheese with your fingers...it would be difficult to explain that, even for this, there are forks.

Anti-loss strategies

It happens to the most careful mothers and the most attentive fathers. One minute he's there, beside you, just a step behind. And then all of a sudden he's gone, distracted, as only children can be distracted, by something that "irreparably" conquered his attention. It can happen to lose a child, in a department store, among the benches of the market near your house. So it is best, first of all, to prevent, preparing the child to face a situation that, besides putting you into a sense of "panic", it will surely also put him to the test.

So as soon as possible teach him to repeat his name, his surname and, if possible, even his address.

A small stratagem also consists in involving the child in drawing the map of his neighbourhood: this can be a good chance to develop his sense of orientation in a fun way besides, obviously, learning how to come back home in case of an emergency. Generally it is it is tended to underestimate the ability of a child to mentally represent his space. On the contrary, already from the last year of maternal school, children are perfectly able to acquire elements of space reference. So it is a good habit to even teach a small child to always have points of reference that are easy to remember, to make the street where he lives stably represented: a shop, a sign, a particular entrance. Then give him some general indications on how to behave in case he gets lost. Keeping in mind that among the places in which children get easily lost there are grocery stores, shops and malls, establish along with the child that the reference point are the counters: all children can recognize them, they are easily identified and they have people that are able to communicate that the child has been found.

In case of parks the meeting place can be the playground or the games that are closest to where you hang out, or the entrance that you usually use: make sure that the child knows how to get to them, by testing him and also turning his ability of finding them into a game. The case of lost children on the streets is not rare, along roads or in squares full of people especially on weekends: in this case it is best that the child knows that men and women in uniforms can help them. Make him observe, when you are walking together on the street, the presence of police.

If anxiety that the child can get lost still is difficult to manage you can try some practical stratagems: before leaving the house to go somewhere where the child could really get lost, for example you could tie a coloured ribbon on his wrist with his name and your mobile phone number on it or, buy "electronic bracelets" that, connected to the mummy's receiver, launch a lighted and noisy alarm: to find the child, all you have to do is follow the sound that the closer you get the faster the sound beeps.

It is important to understand that delegating the control of your child to an electronic device has little to do with the education of a child and much more with the anxiety of an adult. The fear of losing a child is normal, as much as the need of learning to listen to it and stopping it. Of course the risks must be explained, though never magnified: to grow up one needs experience and self-confidence. Instruments that an excessively protective behaviour is seriously questioned. Children do have the need of limits and boundaries. If anything, they need comfort, love and understanding: even if in the case of the feared lost becomes reality. In that inauspicious situation the moment you find him will be determinant: do not get angry, do not slap him, do not yell and leave the scoldings for another moment. The child could get lost again and the last feeling that he should feel is the fear of being found.

A room for two

Mini flats, miniature rooms, spaces that are often too little to easily share. This is the reality for many Italian families that not rarely they are forced to give their children, boys and girls, only one common space. But until when can children share a room? When will they begin not "tolerating each other" anymore? And above all, until when is it right that siblings, especially if of opposite sexes, continue to sleep in the same environment? Much depends on the age of the children. For smaller ones sharing a room with a brother or a sister does not represent a problem, if anything, in many cases, it helps them find comfort and peacefulness. Over the years - when personalities, tastes and needs begin to delineate themselves – the forced nearness risks being suffocating for both.

And to limit a growth reality that is too intimate to share.

The choice of the disposition of rooms mostly depends on the family's possibilities: if you have the luck to have a house that is big enough, the best thing is with no doubt to allow the children to manage their space on their own, an environment to personalize and experience as they want and where they feel like the owners of their own growth. If on the contrary the house does not allow alternative solutions to the forced sharing of rooms the choice doesn't seem to be an option: "same room". Nevertheless, having to share the same environment does not necessarily implicate the consequence of giving up the idea of personal space. Sometimes it is sufficient to divide the room in equal parts to allow each one to personalize their environment the way they want: the use of equipped walls in this sense is very useful. Nevertheless when even this is impossible for reasons of space, there is no use to make a drama of it nor feel guilty: the important thing is that parents know how to make sure that neither of the two children runs the risk of feeling like the "unwanted" guest of a space that really belongs to him. Generally if the age difference between the siblings is only of a few years and if the children still have not reached an adequate psycho-sexual maturation the solution for a pacific cohabitation seems quite simple. Things get complicated when the eldest reaches pre-teen years, even more if we are speaking of siblings of different sexes. In this case keep the oldest one's needs in mind. The need of his own space, the need of being alone, his intimacy, are inevitable needs for the passage from childhood to adulthood. Needs that must be kept in consideration, accepting, if necessary some renunciation.

When the cohabitation between brothers and sisters becomes impossible or, rather, inappropriate, for example it could be necessary to "sacrifice" the dining room, creating space reserved for the younger one of the two: a desk to do his homework, a small bookshelf to put his things that he uses everyday and a living room divan with bedding box, allow most of the time to temporarily solve the problem.

Temporarily. Because soon even the youngest of the children will grow up and he also will need space where he can experience the complete intimacy of his life, like his brother or sister. It is also true that, usually, children's "logistic" problems are solved automatically over the years: one day or another one of the two will begin to live his life outside of the home and one day or another, you will have enough space to use your home in the best way and with no conflicts. The only unjustifiable conflict that could remain is maybe yours. An interior and personal conflict that will occur when you find yourself happily thinking of the day in which your children will "leave" your house free.

This is an understandable, justifiable thought, but above all "healthy": of those who are aware of their children's growth, aware of their needs without forgetting theirs. There is nothing better to peacefully experience that inevitable separation that, one day or another, parents and children will have to face.