the newsletter, Oct 2006

This is what a prenatal course is for

 
Something unknown and not very reassuring. This is how most future mothers live the expected but feared moment of the birth. There are so many questions: "what will happen?", "will I know how to face the pain?", "will I push in the correct way?", "will I know how to recognize the contractions?". The certainties, on the contrary, are very few: the reference points are destined to quickly change, the experience of the former generation is not always able to give answers to the new problems, the new requirements and, furthermore, the chances to compare, to talk and share one's experience are increasingly rare even in the larger cities. Getting to know the birth, its phases and the techniques that help to give birth, and facing one's own fears, talking to other mothers, taking advice from physicians and psychologists, is essential in order to reach the awareness and, therefore, the necessary calm to overcome the fears. The best chance still remains the prenatal classes, whose primary objective has always been to offer future mothers clear and complete information on the birth and the reactions of the body. In the attempt to eliminate the fears and make the women more aware of what is required of them.

 
In Italy the prenatal classes can be organized by the hospitals, by the Local Health Authority by family consultants or by private associations. Generally people go during the last three months of pregnancy, but as they are closed number classes it is a good idea to book well in advance. Going to classes at the hospital where you intend giving birth can be particularly useful because it allows the mother to meet with the medical and paramedical staff that could assist her during the birth. Generally the courses are held once a week, they last from eight to ten meetings and are usually held by a fully trained medical team of a midwife, a gynaecologist, a paediatrician and a psychologist. During the first few weeks the parents receive information on the pregnancy and the birth and some useful indications on managing the baby for the first weeks: nursing, changing, medication of the umbilical cord etc. The final meetings are dedicated to learning techniques of relaxation to be used during labour (autogenous training, yoga, hypnosis) and breathing techniques during labour and when it is necessary to push. In some cases a part of the course is dedicated to keeping in shape with gymnastics in the water, the stretching, light exercises.

 
It is important that the future fathers also attend the classes, especially if he intends to assist the birth.
The meetings can also be very useful for him from a psychological and emotional point of view: they help to understand what is happening to the body and the mind of his companion, to know the development of the events in the labour room, to understand what type of assistance and participation he will be giving. Essential elements needed to take the decision to enter the labour room with awareness and serenity. Obviously, going to prenatal classes is not obligatory. Neither for the mother nor the father. But it is certainly advisable. Not only because it is useful to reach the moment of birth prepared, but because the group work foreseen by a class which is well done allows one to compare emotions with those of other women who are going through the same experience. To discover common fears, to share doubts and uncertainties helps to understand that the anxiety that accompanies the time before the birth is entirely normal and there is no need to dramatize. Wh at today appears to be worrisome will be faced and overcome without problems during the birth. And all fade away, like a distant memory, from the moment you take you baby into your arms.

 

 

Diets during breast feeding

 
How much does one have to eat during nursing? What diet it is necessary to follow? Is it true that drinking beer produces more milk? Common doubts among mothers who, for the first time, face the experience of nursing. The main worry is that an incorrect diet can harm the child. A comprehensible worry but, in most cases, groundless. Breast feeding doesn't require particular precautions except following a healthy and balanced diet. And, naturally, not to be confused by family convictions and popular beliefs.

 
In general, the diet recommendations during nursing are limited to a varied diet with foods rich in proteins such as eggs, meat, fish, milk, cheese that help the growth of the child and strengthen the organism of the mother.
Cheese, milk and yogurt are also the main source of calcium, essential for healthy bones. Bread, pasta and rice must also be part of the diet, rich in complex carbohydrates, that supply a slow release of energy, and guarantee the vitality needed to work and move around. To guarantee the child a higher level of immunity and development of sight, it is essential to take in Vitamin A and C, mainly found in fruit and vegetables. Water or juices, squeezes, herbal teas must be drunk to restore the large amount of liquids that inevitably are lost during nursing. The popular belief whereby "drinking milk produces milk" is not true at all: the mammary glands respond to a request mechanism that only the suction of a child is able to stimulate. It goes without saying that the child does not need to take in nicotine or alcohol with the maternal milk. Limit therefore also the consumption of beer that, according to popular traditions which are absolutely groundless, would have miraculous powers on the production of milk.

 
More realistic is, however, the theory according to which the diet modifies the taste of the milk. Which doesn't mean necessarily preparing a list of foods to exclude and others to endlessly consume. In actual fact most foods have already left their trace in the amniotic liquid and the child has therefore quietly "tasted" them during his time in the uterus. Besides, not all children react to the change of the taste of the milk with a refusal. The suggestion is therefore to eat everything but with moderation to check the possible reactions of the child, excluding only some foods that could cause physical disturbances. Among these we can list preserved meats, mussels and molluscs, possible vehicles of gastro-intestinal infections, sword fish and fresh tuna potentially polluted by mercury and cabbage, broccoli and onions that can cause the production of excessive gas in the bowel of the babies.

 
The differences with a diet which is recommended for any individual are therefore very few. What changes, but not in a substantial way, is the energy intake. Some recent research has in fact shown that breast feeding a baby requires the same energy as facing daily sporting activities. In this phase a correct diet should therefore guarantee a woman that nurses around 500 calories extra a day. Which doesn't mean eating double the amount: compared to the last month of pregnancy, it is enough to make a small addition as the extra energy, needed during nursing, will derive partly from the reserves of fat accumulated during the pregnancy. The conviction that nursing makes you fat is also wrong: it uses the reserves of fat and allows the mother to regain her normal weight in just a few months. In any case immediately after the birth and during nursing, a severe diet is certainly not recommended. Some limitations, with regards above all to sweets, are desirable but in this first phase it is essential to adopt an active style of life, that beginning from the end of the puerperal stage, more or less forty days from the birth, foresees some time to dedicate to some physical activities. Further to helping to burn off the fat, the physical activity contributes in fact to invigorating the muscle tone and improve mood swings. Only at the end of nursing, especially if the increase in weight has been indeed notable, will it be possible, supported by a doctor, to start a real diet. To be followed in any case with patience and constancy: diets that make you lose weight too quickly never give lasting results and the lost weight is easily regained.

How to choose the baby sitter

 
Never at the last moment. This is the first rule when choosing a baby sitter. The search for a reliable and capable girl is never short or simple and ideally should therefore be done in advance. The first problem to face in the selection is naturally: which criterions should I follow? What should I check? What aspect should I give privilege to? A long and difficult job, but not impossible. Simply put aside useless anxieties and groundless jealousies...and, naturally, trust your own instinct.

 
It is impossible, after all, to do otherwise. The person to whom you will leave your child has to arouse your trust, she must be reassuring. It doesn't matter if that same baby sitter is loved or vice-versa not recommended by other mothers, friends and relatives. You have to like her. Otherwise every time you leave the house you will do so accompanied by a feeling of uncertainty that a child, even the smallest, can perceive and take it as a feeling of insecurity and uneasiness. For this reason it is a good idea to spend some time and the necessary commitment when searching for a nanny, bearing in mind all these aspects. Let's start for example with the age. It is certainly advisable to avoid very young people without any experience, but just as advisable not to count on elderly nannies who may no longer have the energy required to look after a child. Always ask in any case for references and check by phoning the families where the girl worked before.

 
It is also important to know how to assess the character of candidates. A baby sitter has to be a "deputy mother" tolerant, comprehensive, affectionate, but also firm enough to give the child some rules and make him abide by them.
Another aspect not to be underestimated is the ability to resolve problems without getting into a panic. When dealing with a small child accidents and emergencies are always on the agenda and it is wise to have a calm and equilibrated person who is capable of facing all events on her own. Be very clear with her that, if this is your need, you want to find a person that can guarantee constant presence and prolonged over time: the most frequent surprise, the experts in the field confirm, is that of the baby sitter disappearing without warning, with the consequence that the child experiences each time a kind of abandonment by a figure which had become for him a reference point. Explain to her your needs too: to be informed about possible delays or any personal initiative regarding administration of medicines or decisions relative to the child, no going out while the child is asleep or visits by strangers to the house. To avoid nevertheless a bad start, do not offer the girl a wage which is lower than the current market rates, immediately clarify times and formalities for the commitment, trying then to respect the schedules and try to be elastic and not impose yourself on her duties: allow her to study when the small child sleeps and allow her space for her own creativeness in the management of the child.

 
If you are thinking about going back to work, it will be a good idea, in any case, to make the "changeover" as less traumatic as possible by sharing a few days together in the house. This, not only helps the child to accept the new presence, but also gives you the possibility to understand if she has established a good relationship with the baby: is he happy in her arms? When you get home from work, do you find him active, happy about the time he has spent? Or is he quiet, silent, lazy? Pay attention to these details but, however, always consider that only signals repeated over time should be taken into consideration.
An initial negative reaction by the child is not sufficient to question his relationship with the nanny . The truth is that it is often difficult to accept the idea that after months of care, affection and attention, it is now a "stranger" who is taking care of your child. It is so difficult that behind the apparent impossibility of being able to find a good nanny, there is often a more secret desire to estrange the moment of separation from the child. And it is not uncommon that the jealousy is understandably accompanies by senses of guilt. Understandable, but groundless. Check everything, check that everything corresponds to the needs of your child, check every minimum detail before deciding. When however a solution seems to be "objectively" acceptable, don't, due to your own uncertainties, allow a baby sitter to get away who you could regret. And if the relationship between her and the child soon becomes idyllic, do not be frightened by your jealousy. Ma ny mothers go to work with some doubt after seeing their own child throwing himself happily into the arms of the baby sitter. Do not worry and try and be happy: you have found the right person and it is normal that your child loves a person that he likes and who looks after him so well. But you are his mother. And, you may be certain, even Mary Poppins can never replace you.


Let's train their intelligence

 
Unaware of their own potentialities and their limits, but extraordinarily sensitive to the surrounding world. This is the dimension in which children develop their own intelligence. A dimension made of objective presuppositions but also of sensations and stimulus that every child has to have the possibility to experiment. One thing in fact is certain: intelligence is not in every case an unchangeable inheritance. It is without doubt that the genes transmitted by parents are clearly responsible for the intellectual development of a child. But it is just as undeniable that the cognitive potential of a child only evolve through a mental process that must be "trained" from the first years of life. A process which is largely sustained by environmental and cultural factors. But that assigns the parents with the decisive role of valorizing and stimulating the intellectual abilities of their children.

 
Why doesn't he speak? Why isn't he walking yet? Why isn't he as sharp as his cousin? Behind so many "whys" there are the doubts of so many parents: "Will my child will be an intelligent adult?". The answer is not simple and takes into account numerous factors. Let's start from a presupposition: they are almost never ultra intelligent or stupid children. The cases of geniuses are rare indeed whilst, in most cases, an adult appears to be lacking in intelligence because, simply, as a child he was not offered the opportunity to develop adequate cognitive skills. The role of genetics in the intellectual development of a child is in fact only partial. At birth babies inherit an intellectual potential that can reveal in time to be confirmed, modified, improved or...wasted.
The final level is determined by a series of variables, all equally important and significant: the attention and abstraction skills, the language skills and the attitude to asking questions, imitation and symbolic games and, last but certainly not in importance, the recollection and memory skills. Intelligence is not therefore a concept which can be summarised in the exclusive and limited value of the term but it includes different cognitive aspects that, together, make it possible to assess the degree. Which means that in order for a child to develop a good intellectual level it is essential that all the factors that concur to his cognitive training are adequately sustained and reinforced.

 
It is clear for instance that the more a child has the chance to experiment from the first months of life, sound, visual and hearing sensations, the more he will be able to develop a discrete level of awareness. Equally in a society which is increasingly paying attention to learning and knowledge, the possibility for a child to become intelligent is far superior than that of a contemporary who grows up in a less advanced cultural environment. It is clear nevertheless that what influences the intellectual growth of children is what happens inside the family environment. A family has in fact the opportunity to offer a child the motivations and incomparable educational stimulus. Which does not mean submitting children to weary learning processes. The correct development of the intellectual skills of children is not due to "lessons" of intelligence consisting in notions and didactic activity but, primarily, due to a close "relationship" between parents and chil dren. A relationship that sees the former concentrating on the activity of communication with the latter, in an attempt to make sense of all the actions and all the emotions which children have to deal with and for which they ask the reasons. To establish physical contact with the child, always trying to look him in the eye, recall his attention with gestures and words, to explain to him the actions that you are about to do for instance increase his ability of concentration. Whereas to develop his speech skills it is essential to always speak to the child, to involve him in a conversation, to offer to him alternative words when he cannot remember or cannot use the words in the right context. And, again, it is possible to help him to increase his memory skills giving him emotions and establishing rituals that infuse security and contribute to creating a bond and indissoluble family memories. In short, intelligence is taught to children by striving to constantly be "mediators" between the external world and them, using inventiveness to find new situations, producing experiences learning to see the world from their perspective. Trying to give a child the awareness that growing up means looking around, asking questions, looking for answers, looking for new experiences, sharing doubts and emotions. All things which are good for intelligence.

 

 

Sleep, rules and exceptions

 
A matter of constancy. To sleep well is above all a matter of habit and respect for bed times. It is for adults and even more so for children. For whom sleep must be considered an unquestionable right and need. From three to five years of age children not only need to sleep long at night - from 10 to 11 hours – but also to live the serenity of a family that is based on the respect of sleep and waking times. Nevertheless daily experience tells us how difficult it can be to convince a child to go to bed at a set time. Especially when these daily habits are interrupted by short or longer periods of "freedom".

 
This for instance is the case of the summer holidays.
During the hotter season it is common that the usual times change: the days are longer, everyone goes to bed later in the evening, the sleep rhythms inevitably change and with them the rest times during the day. Which is not negative in itself. The changes during a child's growth are inevitable, legitimate and even necessary. It is common, for instance, that during the summer the he misses his afternoon nap. Now that school starts he can get back into this habit, but only if he really needs it. To force a child to rest after school can jeopardize his sleep at night: there is the risk of him getting to sleep late and then, the following morning, having trouble getting up and having breakfast. It is important, therefore, to bear in mind that in most cases the need for an afternoon nap disappears after three years of age. As they grown and start school children also change their sleep habits. The main point is that in their general change the child must sleep at least the number of hours his organism needs to recharge and rest and, naturally, that the "new" sleeping schedule is respected. The regularity of sleep allows in fact the child to synchronize the sleep rhythms with those of the organism and, consequently, to assure physical and psychological well-being. The research carried out over t he last years reveal that children that sleep less are those that have a life with less "fixed habits", less articulated by certain schedules and appointments.

 
Also dinner time and, accordingly, bed time must be scrupulously respected. The exceptions - for a party, the arrival of a family friend, a dinner outside the home obviously occur but they must be exceptions. Sitting down at the table with a tired and fussy child means, for instance, putting up with whims and arguments that end up agitating the child, who will then refuse to go to bed. The child has on the other hand the need to eat early and enjoy your company and your attention, even playing. With some precaution however in the games that you do–better a small puzzle to be done together than a round of "wrestling" on the couch–and beware of the television, whose "exciting" effect is beyond doubt. Once bedtime comes, try to create a calm and pacifying atmosphere. If the child starts to spontaneously feel the need to go to bed, obviously don't hesitate in accompanying him. But don't be deceived by his evening vitality: to avoid going to bed childr en are capable of finding extraordinary resources of energy. But on most occasions convincing them to place their head on the pillow, even with the promise that you will return soon to keep them company, is enough to see them quickly collapse into the world of dreams.

 

 

Liveliness does not mean hyperactive

 
They move around endlessly, they find it hard to concentrate on any one specific activity for long, they shout, they jump and they run sustained by an extraordinary dose of energy. Once they were known as lively children, today they are increasingly referred to as "hyperactive" children. With an enormous risk, that of classifying children with an actual pathology, when there is no such evidence. An uncontrollable dose of energy, difficulty in relationships with contemporaries, bad control over emotions do not make a restless child a hyperactive child. "Hyperactivity" is something quite different. It is an actual illness that sees a combination of continuous nervousness and restlessness combined with other symptoms that distinguish hyperactivity from common forms, even exaggerated, of liveliness.

 
Known with its Anglo-Saxon initials of "ADHD", the "Attention Deficit Hyperactivity Disorder" is a disorder of children's behavior that, according to American surveys strikes 4% of the population from 6 to 12 years, with a predominance of boys rather than girls. The causes are still unknown but there are strong possibilities that it is traceable to genetic factors. In fact children who suffer from this disorder are incapable of controlling impulsiveness and attention, they escape the control of the adults, they associate continuous nervousness with abnormal forms of restlessness and reactions. They are children who, once they start school, end up being labelled as "difficult" children, "earthquakes" that upset the class: they are continually away from their desk, they bother their companions, they don't do their homework, they frequently change desks, class and sometimes school. Their scholastic results, due to their incapability to concentrate, are almost always low as is their relationship with others. All of this is not however enough to diagnosis a condition of ADHD. Children suffering from "hyperactivity" show in fact a series of further common conditions that go well beyond evident restlessness. It is associated in fact to the incapability to pay attention to details, the tendency to make mistakes in every activity, the difficulty to follow rules and instructions, the incapability to organize any work assigned to them. To which one can add often a natural tendency to lose objects and to forget daily activities, further to a clear difficulty to wait for his turn in all circumstances, from games to dialogue, with a propensity, in this latter case, to speak excessively or to intervene and to interrupt conversations.

 
To consider extreme vivacity as conclusive element of hyperactivity is therefore an error not to be made.
A restless child is not necessarily a child suffering from "ADHD" and, in any case, the diagnosis of such an important illness cannot be made from the observations of a parent, of a teacher or of a family paediatrician. To say with certainty that a child is suffering from "hyperactivity" is not simple at all and is exclusively up to the experts who can check with specific examinations the presence of the disorder and establish, where necessary, a suitable therapy. Therapy that only in exceptional cases and those extremely serious contemplate the use of pharmacological treatments, the exponential increase of which, above all on the Anglo-Saxon market, has comprehensibly raised doubts and concern. The initial support, that contemplates the obvious involvement of the parents, has to be of a psychotherapy nature. Particularly the cognitive behaviour therapy, to analyze the problem and the family situation as a whole, and provide further simple but useful instru ctions to parents and teachers to help the child in his development. Practical suggestions to be put into action day after day: to modify the environment in order to reduce where possible the possibilities of distraction, to always give clear and precise instructions and to pretend the child respects them, to encourage the child to organize his own daily routine (meals, homework, washing) with precise times and rules. Rules which must always be accompanied by gratification for correct behavior, respected rules and the successes he achieves. Only the failure of psychotherapy that also involves the family can lead to possible pharmacological solutions. Which must always be formulated and managed by an expert.