How babies learn

Babies are born with a brain which is about one quarter the size of an adult brain. They will make connections and increase their brain size as they learn more about the world around them. Initially the limbic or primitive brain controls their actions. Babies have no experience to bring to the world other than the experiences within the womb and these have little relevance in the wider world.

The most interesting experience that babies have is a sense of the tastes of their mothers diet. While floating in the amniotic fluid, which is changed on a daily basis, they have some diluted taste of mum's diet delivered through this fluid. When the time comes to actually taste these foods, it can be the texture which is foreign rather than the flavour.

The things which soothed baby while in the womb will still soothe baby for the first few weeks in the wider world. These things are;- 

1. Being held, this can be actually holding baby or swaddling them to provide firm boundaries without the need for constant carrying/holding. 
2. Sound, baby has heard digestion, breathing, heartbeat and external noise through the abdominal wall. A world which is suddenly silent can be quite alarming.   
3. Sucking, baby may have been sucking hands, fingers or thumbs before birth and afterwards sucking is associated with feeding, feeling warm, full and comfortable.
4. Movement baby has felt mum rise from sitting to standing, walking, going up and down stairs, so gentle up and down movement is also comforting.
5. Skin to skin being skin to skin with a parent allows the baby to hear heartbeat and breathing of another person, smell a familiar and trusted carer and generally be comforted by not being alone.

Infants live in the moment. If they are cold, uncomfortable, or even just lonely, the only way they can tell us is to cry. To babies in the first two months of life, how they feel at this moment, is how life is always going to be. It takes about three or four months before the child learns that their actions result in their parents reaction. By six months babies can predict how their parents will react in some situations. They are starting to learn about routines then too. By six months babies know what particular event a chain of events should lead to. This can be something as simple as recognising that they are going to be fed, go out with mum for a walk, or put down for a nap. Routines are soothing they help the child to learn his/her place in the world.

Babies learn by repeated demonstration. Once they recognise a routine they also recognise what is expected of them. Changes need to be repeated a number of times to move these from the front of the brain, where this is an experience, to the back of the brain when this is a behaviour which is accepted as normal at the end of a chain of events. The number of times this demonstration has to occur to allow a new behaviour to become an accepted "norm" is individual. For some children it can be very quick, three to seven repetitions, other children take longer.

Babies need parents to be consistent during these repetitions. If you change your own reaction then you naturally, although sometimes inadvertently, alter your child's perception of what is required of them. 

If you would like to learn more about altering your child's behaviour
Contact  us at  info@Dream-Angus.com

Gastric Reflux: Re-visited and Updated

Gastric Reflux is a common problem particularly in pre term babies. It can be defined as a transient, inappropriate relaxation of the lower oesophageal sphincter allowing stomach contents to flow back into the oesophagus.

This can result in regurgitation or vomiting, which may upset the child by causing pain and discomfort or, in milder cases there may be no apparent distress related to these events.'

When there is no distress there is no need for treatment. More moderate to severe reflux should be treated because there is a link to reflux and Asthma in early childhood. 

 In practice, sick children's hospitals, and some special baby care units, use infant Gaviscon as an antacid. This is made from seaweed and forms a "jelly like " layer at the top of the stomach. The result is that this less acid "jelly" is what floats back to the oesophagus and thus pain is reduced.

The only side effect of this, and only in some infants, is constipation. Medical trials using Gaviscon Infant powder have shown that this was effective in reducing vomiting and regurgitation in episodes at 14 days, but did not reduce the level of vomiting. Another double blind trial, found no difference when Gaviscon was used.'

Some Consultant Paediatricians will prescribe medications which will reduce the amount of acid that is released into the stomach. These are only used in the short term and, once the child is established on a semi solid diet these are generally discontinued. Family Doctors are always reluctant to prescribe such medication without the overview of a Consultant.

Although symptoms of reflux can be demonstrated there is only one way to accurately diagnose reflux and that involves a short hospital stay and the passing of an acid monitor to check the level of acid in the oesophagus. This is not always reliable and most Paediatric Consultants will accept the parents description and treat this uncomfortable condition.

Using formulas which thicken on contact with stomach acids , such as Efamil AR and SMA Staydown ( both available on NHS prescription) are only moderately effective in treating reflux in otherwise healthy children.

This is because this issue is often one of mechanics, and nothing is going to make the sphincter muscle mature and perform it's function as it should, other than maturity. Using an antacid or something which will reduce the acid production, is really the only way to reduce discomfort and distress.

The first line of treatment is usually Gaviscon infant powder, and where this is successful, there is no need for further intervention. If this proves ineffective then it is worth exploring other options.

Another study, looking at positioning the infant with the head of the crib raised, found that this is not always justifiable, however, placing infants on their left side, can reduce reflux. Lying on one side is not a stable position for infants and using pillows to maintain this position is not recommended.

It is possible to use a breathable fabric rolled against the child's back and supporting the child's legs but, this needs to be done with some care to avoid overheating.

Reflux, like colic, is self limiting. It can be difficult for parents to watch an infant in distress and pain without seeking assistance to make the child more comfortable.Children affected by any degree of reflux often take longer to settle after a feed and can be fussy, because feeding does not comfort them as it would an unaffected child.

Feeding a Toddler

As children move from a purely milk diet, whether this is breast or formula, they are growing very quickly and are usually very active, so they need plenty of energy and nutrients.Between the ages of 2 to 5 years children should be gradually moving to eating with the family, and this means eating the same foods as the family.

Every day toddlers should have the following sorts of foods.

• Milk and dairy foods which will provide protein, vitamins, minerals and calories.
• Meat, fish, eggs, peas,beans, lentils and tofu. Boys need up to 4 portions of oily fish per week, mackerel,sardines, or salmon. Girls should have no more than 2 portions of oily fish per week.
• Bread, pasta, rice, breakfast cereals, potatoes, sweet potatoes,which will provide fibre as well as calories, vitamins and minerals.
• Fruit and vegetables for vitamin C and other protective vitamins.
• A vitamin D supplement for healthy bone and good immune response.

If you are giving your child a vegetarian diet it is important to include milk cheese and eggs. This means the diet will not be too bulky and they will get enough protein, vitamin A calcium and zinc.
Iron is found in many vegetables and pulses such as beans lentils and chickpeas, in dried fruit such as apricots, raisins and sultanas and in some breakfast cereals.
Absorbing iron from vegetable sources is more difficult than absorbing iron from meat so ensure your toddler has some foods containing iron every day. A food or drink which is high in vitamin C given at the same time as vegetables or iron containing foods will help make the absorption of iron easier.

Avoid giving young children tea or coffee especially at meal times as this reduces iron absorption.
Semi skimmed milk can be given from 2 years of age but fully skimmed milk is unsuitable for children under 5 years of age.

Vitamin drops are a useful addition to the diet of under 5's as this ensures, despite any fussy food behaviour, that the child gets enough of the important protective vitamins to encourage bone growth and immune system support.

Small portions on small plates are less daunting. Children can always ask for more but can be discouraged if they are expected to eat large amounts. Plan for three main meals per day and two snacks.

If you want to know more about toddler diet, if you need support with your toddlers eating habits,
Contact us at;-info@dreamangus.com

Infant constipation.

Bowel habit varies between individual infants and frequency is affected by diet, fluid intake, age and behaviour. Less than 3 complete stools per week is considered a potential indicator of constipation in children under one year of age (excluding those exclusively breast fed after 6 weeks of age,)
An exclusively breast fed infant can pass up to 6 stools per day in the first 28 days of life.

The average "normal "stool frequency of formula fed babies is;-
at 1 week old         up to 4 dirty nappies per day.
At 3 months           2-4 dirty nappies per day.
At 6 months           1-2 dirty nappies per day
At 12 months         one dirty nappy every 2-3 days.

Constipation can occur for a variety of reasons.

• Change of formula milk, including change of brand or stage.
• Change to more semi solid diet
• Inadequate fluid intake.
• Illness with a raise in body temperature
• Side effect of some medications (e.g. baby Gaviscon)
• Medical conditions such as Diabetes, Cystic Fibrosis and low thyroid function.
• About 2 percent of children may experience constipation as a result of a congenital abnormality. 

The symptoms of constipation include;-

•  Distress and difficulty in passing stool.
• Reduction in feeding and becoming more "fussy".
• Overflow diarrhoea accompanied by offensive wind being passed.

How can this be resolved?

Circular massaging of the infant's abdomen, or gently stretching and cycling the child's legs when the child is warm and relaxed, can reduce the abdominal tension and allow stool to be passed.

If the infant is straining, put them on their back in a warm room with the nappy off and gently position the baby's knees against their chest will help them pass the stool.

A warm bath may help comfort baby by easing abdominal pain.

In small babies a 30 ml top up with plain boiled water, or boiled cooled water to which a level teaspoon of brown sugar has been added, should be enough to get things moving. This can be repeated. Baby should not be allowed to go longer than three days without a dirty nappy, unless this is normal for that child.

If baby has a swollen abdomen, temperature, blood or mucus in or around the stool, vomits or shows signs of reduced feeding, medical attention should be sought.

If symptoms persist, and baby is older than one month a small dose of oral lactulose may be prescribed to relieve the symptoms and allow stool to be passed. 

Five points to avoiding overheating baby.

Overheating can increase the risk of cot death. Babies overheat when there is too much bedding or clothing, or the room is too warm. Remember that a folded blanket is as warm as two blankets.
Lightweight blankets make it easier to control the temperature.
When you check on your baby, if he or she is perspiring, or their tummy feels hot to the touch, remove a blanket. It is absolutely normal that an infant's hands and feet are cool.
Room temperature of 16 to 18degrees C (63-65 degrees F) is a comfortable temperature,
The easy way to get it right is;-

• In summer baby may only need a sheet if it is very warm. (19-22 degrees C)
• Even in winter, most babies who are unwell or feverish need fewer clothes.
• Excess heat is lost through babies head, which is why it should never be covered at bed time, unless the room is very cold.
• Always remove hats and extra clothing as soon as you come indoors, enter a warm car,bus or train, even if it means waking your baby.
• Babies should never sleep with a hot water bottle, electric blanket, next to a radiator or in direct sunshine.

During the day baby should have one more layer of clothing than you have on. 

Children's growth and development.

From birth children are weighed and a note made of their OFC (head circumference) and length. Health professionals chart these measurements on a chart known as a "centiles chart". This allows an accurate following of the child's growth. Some weight loss is expected immediately after delivery but babies generally regain their birth weight by about 2 weeks.

If you look at a centiles chart, there is usually one in your child's personal health record, you will see that the graph has nine curves. Starting at -04th and rising to the 99.6th.
If you lined up 100 children of the same age, in height/length order you would find that, if your child is following the 25th percentile, your child would be number 25 in the row with 75 children taller.

Until a child is 2 years old the weight and length of the child are noted. From the child's second birthday the measurements change to a standing height measurement.

There is no exact measurement at which a child's measurement is abnormal, but, only one child in one thousand will follow the curve at 0.4th.

Weight gain is not the only important measurement, children can gain weight but not be thriving. When a child's weight crosses two percentile lines, for example a child who at birth and the first few months measured along the 50th percentile and then this falls to the 9th percentile, a referral should be made to a Consultant Paediatrician. Further investigation will determine if there is any underlying health problem which requires treatment.

Children do not always follow a centile line exactly an it is not unusual for a child to lose a little weight due to illness but will usually return to the initial centile after two or three weeks. If the charted measurements fall between one percentile curve and another, (e.g.between the 75th and 50th, or, 50th and 25th) that is not a cause for concern.

Children aged 2 weeks to 6 months should be measured and weighed once a month.
Once every two months at age 6-12 months.
Over age 12 months one measurement every three months is enough unless there are concerns about the child's eating or other health issue.

Children born before their due date should be charted on a "preterm" percentile chart, or, if they were born with a particularly low birth weight then the appropriate chart should be used.

When a child is a fussy eater these measurements can be an important indicator of whether this behaviour is affecting their growth and development. Some children have a limited diet but continue to grow and to follow the centile as they always have. Others may have a falling growth pattern. Where growth is failing and weight is rising but not to meet the anticipated pattern, further investigations are necessary.

Simple things like frequent coughs and colds, enlarged tonsils and adenoids, and gastric reflux can have a negative effect on children's growth. It is always important to recognise these and where necessary to treat them.

If you would like a UK percentile chart to plot your child's growth;-
 Contact Dream-Angus at info@dreamangus.com

Learning, genetics, habits and sleep.

Sleep is a complex thing. The sleep patterns we have as adults are composed in part of the sleep patterns of our parents, the sleep patterns we learned and the habits we have adopted.

Children are capable of learning sleep habits from as young as 60 days of life. We encourage them to sleep at regular intervals in infancy and we expect them to extend night sleep and reduce daytime sleep as they grow. Teaching a desirable sleep pattern is fairly easy, however children often pick up sleep associated habits which may be less desirable along the way.

Some professionals talk about "inappropriate sleep associations". What this really means, is that the child has learned that certain things are required to happen before they are comfortable and confident in being able to get themselves to sleep. Sometimes these are things that the child will grow out of. Sometimes one inappropriate association or habit is not eliminated but replaced with another just as inappropriate.

There are "recommended" lengths of sleep for different age groups but, these are not set in tablets of stone, they are guidelines only. Every one of us has a general sleep requirement, but how we have learned to sleep and the effects of previous generations on our genetic make up can, and does have some effect on our sleep pattern and on the sleep patterns of our children.

If your child has shorter sleep than the recommendation for his/her age and stage, look at the amount of sleep the parents need. Does your child generally wake in a positive happy cheerful mood? If so, the chances are that the sleep that they have had has been restful and restorative. A child who sleeps well in generally a child who is happy and copes well with the rest of the day.

Children need routines. These are there to act as touchstones. They help children understand the world and what is expected of them. As they grow these routines change slightly.
Every adult has at least three things which they do every night, regardless of holidays, before they are ready to go to sleep. The last routine of a child's day should consist of three things always completed in the same order, started at the same time of day and finishing in lying down to sleep.

Teaching good sleep habits is every bit as important as teaching good habits in other areas of life.

If you would like some help to teach your child good sleep habits, Contact us at;- info@Dream-Angus.com and we will help you.